bluuebunny/crossref_metadata_2025 huggingface dataset:
Proptosis Reduction Using Sirolimus in a Child With an Orbital Vascular Malformation and Blue Rubber Bleb Nevus Syndrome
Authors: Gildener-Leapman Juliana R. , Rosenberg Jamie B. , Barmettler Anne
Published: April 2016

A 15-month-old boy with left congenital proptosis presented to the emergency department with melena. Upper GI endoscopy and magnetic resonance angiography revealed vascular lesions, consistent with gastrointestinal tract manifestations of blue rubber bleb nevus syndrome. MRI revealed vascular malformations in both orbits, with mass effect on the left side. The patient was started on a trial of the antiangiogenic agent sirolimus (also known as rapamycin), and after 6 months of treatment showed clinical improvement in proptosis supported by radiologic evidence of regression in the larger, left orbital mass, with stability of the smaller, right orbital mass. There are 11 published cases of orbital blue rubber bleb nevus syndrome in the English literature. To our knowledge, this is the first reported case of successful, long-term treatment with sirolimus causing a reduction in the size of an orbital vascular malformation.
Assessment of physical function and participation in chronic pain clinical trials: IMMPACT/OMERACT recommendations
Authors: Taylor Ann M. , Phillips Kristine , Patel Kushang V. , Turk Dennis C. , Dworkin Robert H. , Beaton Dorcas , Clauw Daniel J. , Gignac Monique A.M. , Markman John D. , Williams David A. , Bujanover Shay , Burke Laurie B. , Carr Daniel B. , Choy Ernest H. , Conaghan Philip G. , Cowan Penney , Farrar John T. , Freeman Roy , Gewandter Jennifer , Gilron Ian , Goli Veeraindar , Gover Tony D. , Haddox J. David , Kerns Robert D. , Kopecky Ernest A. , Lee David A. , Malamut Richard , Mease Philip , Rappaport Bob A. , Simon Lee S. , Singh Jasvinder A. , Smith Shannon M. , Strand Vibeke , Tugwell Peter , Vanhove Gertrude F. , Veasley Christin , Walco Gary A. , Wasan Ajay D. , Witter James
Published: April 2016

Although pain reduction is commonly the primary outcome in chronic pain clinical trials, physical functioning is also important. A challenge in designing chronic pain trials to determine efficacy and effectiveness of therapies is obtaining appropriate information about the impact of an intervention on physical function. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) and Outcome Measures in Rheumatology (OMERACT) convened a meeting to consider assessment of physical functioning and participation in research on chronic pain. The primary purpose of this article is to synthesize evidence on the scope of physical functioning to inform work on refining physical function outcome measurement. We address issues in assessing this broad construct and provide examples of frequently used measures of relevant concepts. Investigators can assess physical functioning using patient-reported outcome (PRO), performance-based, and objective measures of activity. This article aims to provide support for the use of these measures, covering broad aspects of functioning, including work participation, social participation, and caregiver burden, which researchers should consider when designing chronic pain clinical trials. Investigators should consider the inclusion of both PROs and performance-based measures as they provide different but also important complementary information. The development and use of reliable and valid PROs and performance-based measures of physical functioning may expedite development of treatments, and standardization of these measures has the potential to facilitate comparison across studies. We provide recommendations regarding important domains to stimulate research to develop tools that are more robust, address consistency and standardization, and engage patients early in tool development.
Predicting pain outcomes after traumatic musculoskeletal injury
Authors: Rosenbloom Brittany N. , Katz Joel , Chin Kelly Y.W. , Haslam Lynn , Canzian Sonya , Kreder Hans J. , McCartney Colin J.L.
Published: April 2016

Traumatic musculoskeletal injury results in a high incidence of chronic pain; however, there is little evidence about the nature, quality, and severity of the pain. This study uses a prospective, observational, longitudinal design to (1) examine neuropathic pain symptoms, pain severity, pain interference, and pain management at hospital admission and 4 months after traumatic musculoskeletal injury (n = 205), and (2) to identify predictors of group membership for patients with differing moderate-to-severe putative neuropathic pain trajectories. Data were collected on mechanism of injury, injury severity, pain (intensity, interference, neuropathic quality), anxiety (anxiety sensitivity, general anxiety, pain catastrophizing, pain anxiety), depression, and posttraumatic stress while patients were in-hospital and 4 months after injury. A third of patients had chronic moderate-to-severe neuropathic pain 4 months after injury. Specifically, 11% of patients developed moderate-to-severe pain by 4 months and 21% had symptoms immediately after injury that persisted over time. Significant predictors of the development and maintenance of moderate-to-severe neuropathic pain included high levels of general anxiety while in-hospital immediately after injury (P < 0.001) and symptoms of posttraumatic stress 4 months after injury (P < 0.001). Few patients had adequate pharmacological, physical, or psychological pain management in-hospital and at 4 months. Future research is needed among trauma patients to better understand the development of chronic pain and to determine the best treatment approaches.
Gi-protein–coupled 5-HT1B/D receptor agonist sumatriptan induces type I hyperalgesic priming
Authors: Araldi Dioneia , Ferrari Luiz F. , Levine Jon D.
Published: April 2016

We have recently described a novel form of hyperalgesic priming (type II) induced by agonists at two clinically important Gi-protein–coupled receptors (Gi-GPCRs), mu-opioid and A1-adenosine. Like mu-opioids, the antimigraine triptans, which act at 5-HT1B/DGi-GPCRs, have been implicated in pain chronification. We determined whether sumatriptan, a prototypical 5-HT1B/Dagonist, produces type II priming. Characteristic of hyperalgesic priming, intradermal injection of sumatriptan (10 ng) induced a change in nociceptor function such that a subsequent injection of prostaglandin-E2(PGE2) induces prolonged mechanical hyperalgesia. However, onset to priming was delayed 3 days, characteristic of type I priming. Also characteristic of type I priming, a protein kinase Cε, but not a protein kinase A inhibitor attenuated the prolongation phase of PGE2hyperalgesia. The prolongation of PGE2hyperalgesia was also permanently reversed by intradermal injection of cordycepin, a protein translation inhibitor. Also, hyperalgesic priming did not occur in animals pretreated with pertussis toxin or isolectin B4–positive nociceptor toxin, IB4–saporin. Finally, as observed for other agonists that induce type I priming, sumatriptan did not induce priming in female rats. The prolongation of PGE2hyperalgesia induced by sumatriptan was partially prevented by coinjection of antagonists for the 5-HT1Band 5-HT1D, but not 5-HT7, serotonin receptors and completely prevented by coadministration of a combination of the 5-HT1Band 5-HT1Dantagonists. Moreover, the injection of selective agonists, for 5-HT1Band 5-HT1Dreceptors, also induced hyperalgesic priming. Our results suggest that sumatriptan, which signals through Gi-GPCRs, induces type I hyperalgesic priming, unlike agonists at other Gi-GPCRs, which induce type II priming.
Inpatient Unit Heart Failure Discharge Volume Predicts All-cause 30-Day Hospital Readmission
Authors: Dordunoo Dzifa , Thomas Sue A. , Friedmann Erika , Russell Stuart D. , Newhouse Robin P. , Akintade Bim
Published: April 2016

Background:

All-cause 30-day hospital readmission is a heart failure (HF) quality of care metric. Readmission costs the healthcare system $30.7 million annually. Specific structure, process, or patient factors that predispose patients to readmission are unclear.

Objective:

The aim of this study is to determine whether the addition of unit-level structural factors (attending medical service, patient-to-nurse ratio, and unit HF volume) predicts readmission beyond patient factors.

Methods:

A retrospective chart review of 425 patients who resided in Maryland and were discharged home in 2011 with the primary diagnosis of HF from a large, urban academic center was conducted.

Results:

The patients were predominately (66.6%) black/African American, with mean (SD) age of 62.2 (14.8) years. Men represented 48.2% of the sample; 32% had nonischemic HF, 31.3% had preserved ejection fractions, 25.4% had implantable cardioverter defibrillators, and 15.3% had permanent pacemakers. Average length of stay was 6.0 days. All-cause 30-day hospital readmission rate was 20.2%. Inpatient unit HF discharge volume significantly predicted readmission after controlling for patient factors.

Conclusions:

The study found that discharge from inpatient units with higher HF discharge volume was associated with increased risk of readmission. The findings suggest that in caring for patients with severe HF, inpatient unit HF discharge volume may negatively impact care processes, increasing the odds of hospital readmission. It is unclear what specific care processes are responsible. The discharge period is a vulnerable point in care transition that warrants further investigation.
New Dual Lumen Self-Expanding Catheter Design Requiring Less Suction
Authors: Abdel-Sayed Saad , von Segesser Ludwig-Karl
Published: April 2016

Contribution of venovenous extracorporeal membrane oxygenation (v-v ECMO) to gas transfer is flow dependent. Catheter design is a key factor for optimal pressure/flow rate relationship. This study was designed for the assessment of a new self-expanding dual lumen catheter design versus the current standard. Outlet pressure/flow rate and inlet pressure/flow rate for a new Smart catheter with self-expanding dual lumen design constricted to 27 F with 5 mm long constrictor corresponding to the percutaneous path versus Avalon 27 F catheter (control) were compared on a flow bench with a Biomedicus centrifugal pump. Flow, pump inlet pressure and outlet pressure were determined at 500, 1,000, 1,500, 2,000, and 2,500 revolutions per minute (RPM). At 500 RPM and with a 5 mm long constrictor (1,000; 1,500; 2,000; and 2,500 RPM), catheter outlet pressure values were −0.13 ± 0.07 mm Hg (−2.55 ± 0.06; −7.38 ± 0.14; −15.03 ± 0.44; −26.46 ± 0.39) for self-expanding versus −2.93 ± 0.23* (−10.60 ± 0.14; −22.74 ± 0.34; −38.43 ± 0.41; –58.25 ± 0.40)*: p < 0.0001* for control. The flow values were 0.61 ± 0.01 L/min (1.64 ± 0.03, 2.78 ± 0.02; 4.07 ± 0.04; 5.37 ± 0.02) for self-expanding versus 1.13 ± 0.06*; (2.19 ± 0.04; 3.30 ± 0.03; 4.30 ± 0.03; 5.30 ± 0.03)*: p < 0.0001* for control. The corresponding catheter inlet flow rates of the self-expanding catheter were slightly more than that of the control. For the given setup, our evaluation demonstrated that the new dual lumen self-expanding catheter requires lower catheter outlet pressures for higher flows as compared to the current standard.
HPLC and GC–MS Analysis of Tunisian Peganum harmala Seeds Oil and Evaluation of Some Biological Activities
Authors: Khadhr Maroua , Bousta Dalila , Hanane El Hajaji , El Mansouri Latifa , Boukhira Smahane , Lachkar Mohammed , Jamoussi Bassem , Boukhchina Sadok
Published: April 2016

In this work, we characterized by high-performance liquid chromatography, the γ-tocopherol (573.66 μg/g), and by gas chromatography–mass spectrometry, the linoleic acid (62.05%) as major components from Peganum harmala L. seeds oil and evaluated their potential in vivo acute antiinflammatory, analgesic activities, and in vitro antioxidative capacity. The 2,2-Diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assay showed an important antioxidant activity (62.50% with an IC50 of 4.8 mg/mL). In addition, the antiinflammatory effect of the formulation cream at 20% caused a reduction in inflammation at 5 hours after carrageenan application compared with diclofenac at 1% (60.4%; 45.65%; respectively). A slight potential peripheral analgesia was noted in plantar test in treated rats with cream (20 s). Therefore, our findings demonstrate that formulation cream of P. harmala seeds oil has an interesting antiinflammatory activity with a slight peripheral analgesic effect due mainly to its richness on linoleic acid, γ-tocopherol, and polyphenols and to its important antioxidant capacity.
Unmet Nursing Care Linked to Rehospitalizations Among Older Black AMI Patients
Authors: Brooks-Carthon J. Margo , Lasater Karen B. , Rearden Jessica , Holland Sara , Sloane Douglas M.
Published: April 2016

Background:

Recent studies suggest that nurses may be unable to complete all aspects of necessary care due to a lack of time. Research is needed to determine whether unmet nursing care contributes to disparities in readmissions for vulnerable populations.

Objectives:

To examine differences in the relationship between nursing care left undone and acute myocardial infarction readmissions among older black patients compared with older white patients.

Research Design:

Cross-sectional analysis of multiple datasets, including: 2006 to 2007 administrative discharge data, a survey of registered nurses, and the American Hospital Association Annual Survey. Risk-adjusted logistic regression models were used to estimate the association between care left undone and 30-day readmission. Interactions were used to examine the moderating effect of care left undone on readmission by race.

Results:

The sample included 69,065 patients in 253 hospitals in California, New Jersey, and Pennsylvania. Older black patients were 18% more likely to experience a readmission after adjusting for patient and hospital characteristics and more likely to be in hospitals where nursing care was often left undone. Black patients were more likely to be readmitted when nurses were unable to talk/comfort patients [odds ratio (OR), 1.09; 95% confidence interval (CI), 1.01–1.19], complete documentation (OR, 1.16; 95% CI, 1.01–1.32), or administer medications in a timely manner (OR, 1.26; 95% CI, 1.09–1.46).

Conclusions:

Unmet nursing care is associated with readmissions for older black patients following acute myocardial infarction. Investment in nursing resources to improve the delivery of nursing care may decrease disparities in readmission.
A systematic review of current studies in patients with familial hypercholesterolemia by use of national familial hypercholesterolemia registries
Authors: Mundal Liv , Retterstøl Kjetil
Published: April 2016

Purpose of review

More than 25 million are expected to have familial hypercholesterolemia worldwide. The risk of cardiovascular disease (CVD) in familial hypercholesterolemia is not clear and register studies represent a valuable tool to get such data, which will be discussed in the present paper.

Recent finding

A systematic review of current familial hypercholesterolemia studies, by use of National familial hypercholesterolemia registries was performed from 1980 to 2016. This review shows that familial hypercholesterolemia patients have a high prevalence of CVD also in the time period after statins became available. The patient group does not reach recommended target values for lipids, and have a significantly higher CVD mortality as compared with the general population according to age and sex.

The review underscores the importance of establishing National familial hypercholesterolemia registries with complete datasets on familial hypercholesterolemia patients to improve early diagnostics, therapeutics and long-term follow-up to prevent the premature CVD events and deaths in this patient group.
Should apolipoprotein B replace LDL cholesterol as therapeutic targets are lowered?
Authors: Meeusen Jeffrey W. , Donato Leslie J. , Jaffe Allan S.
Published: April 2016

Purpose of review

The success of LDL cholesterol (LDL-C) as a predictor of atherosclerotic cardiovascular disease and a therapeutic target is indisputable. Apolipoprotein B (apoB) is a more contemporary and physiologically relevant measure of atherogenic lipoproteins. This report summarizes recent comparisons of apoB and LDL-C as biomarkers of cardiovascular risk.

Recent findings

Multiple recent reports have found that LDL-C methods perform poorly at low concentrations (<70 mg/dl). Several meta-analyses from randomized controlled trials and large prospective observational studies have found that apoB and LDL-C provide equivalent information on risk of cardiovascular disease. More innovative analyses have asserted that apoB is a superior indicator of actual risk when apoB and LDL-C disagree.

ApoB is more analytically robust and standardized biomarker than LDL-C. Large population studies have found that apoB is at worst clinically equivalent to LDL-C and likely superior when disagreement exists. Realistically, many obstacles prevent the wide spread adoption of apoB and for now providers and their patients must weigh the costs and benefits of apoB.
Which PCDAI Version Best Reflects Intestinal Inflammation in Pediatric Crohn Disease?
Authors: Turner Dan , Levine Arie , Walters Thomas D. , Focht Gili , Otley Anthony , López Victor Navas , Koletzko Sibylle , Baldassano Robert , Mack David , Hyams Jeffrey , Griffiths Anne M.
Published: April 2016

Introduction:

There is increasing interest in measuring mucosal inflammation in Crohn disease (CD), but there are minimal data correlating the Pediatric Crohn's Disease Activity Index (PCDAI) versions (PCDAI, weighted Pediatric Crohn's Disease Activity Index [wPCDAI], abbreviated Pediatric Crohn's Disease Activity Index [abbrPCDAI], and the short Pediatric Crohn's Disease Activity Index [shPCDAI]) with mucosal inflammation.

Methods:

We aimed to compare the 4 PCDAI versions head to head with endoscopic degree of inflammation as measured by the Simple Endoscopic Score for Crohn's Disease (SES‐CD), fecal calprotectin, erythrocyte sedimentation rate (ESR), and C‐reactive protein (CRP) and to explore cut‐off values that are associated with mucosal healing. We used the prospectively collected data from the ImageKids study on 100 children with CD undergoing colonoscopy and from the Growth Relapse and Outcomes with Therapy study (n = 222), in which 145 children had calprotectin data at week 12 after diagnosis.

Results:

All 4 PCDAI versions had fair correlation with the SES‐CD (r = 0.42–0.45, all P < 0.001) and CRP (r = 0.32–0.45, all P < 0.01); the wPCDAI and PCDAI were superior to the shorter versions when comparing the blood tests. All versions had poor correlation with calprotectin, and only the wPCDAI reached significance (r = 0.26, P = 0.002 vs r = 0.15, P = 0.07 for PCDAI; r = 0.08, P = 0.37 for shPCDAI; r = 0.06, P = 0.5 for abbrPCDAI). The best cut‐off to identify endoscopic mucosal healing was <12.5 points for the wPCDAI (sensitivity 58% and specificity 84%) and <10 for PCDAI (sensitivity 63% and specificity 77%).

Conclusions:

The more feasible wPCDAI and the PCDAI had comparable correlation with measures of endoscopic inflammation. These were slightly superior to the other 2 shorter versions, but still none of the PCDAI versions can give a valid assessment of mucosal healing.
When Partial Hospitalization Fails
Authors: Beard Courtney , Hearon Bridget A. , Lee Josephine , Kopeski Lynne M. , Busch Alisa B. , Björgvinsson Thröstur
Published: April 2016

Partial hospitalization is an understudied bridge between outpatient and inpatient care. One of its primary functions is to prevent the need for inpatient hospitalization. We examined potential demographic and clinical risk factors for inpatient hospitalization for current partial hospital patients. We conducted separate multiple logistic regression analyses for patients referred from inpatient care and the community. For individuals referred from inpatient care, suicidal ideation and greater psychotic symptoms upon admission to the partial program were associated with acute inpatient re-hospitalization. For individuals referred from the community, suicidal ideation and worse relationship functioning upon partial hospital admission were significant risk factors for inpatient hospitalization. Number of previous inpatient hospitalizations and greater substance abuse were not associated with inpatient hospitalization in either sample. Implications at the provider and program level are discussed.
Value of Routine Eye Examinations in Asymptomatic Patients
Authors: Irving Elizabeth L. , Harris Joel D. , Machan Carolyn M. , Robinson Barbara E. , Hrynchak Patricia K. , Leat Susan J. , Lillakas Linda
Published: April 2016

Purpose

To determine if routine eye examinations in asymptomatic patients result in spectacle prescription change, new critical diagnosis, or new management of existing conditions. We also investigate whether age and time between assessments (assessment interval) impact detection rates.

Methods

The Waterloo Eye Study (WatES) database was created from a retrospective file review of 6397 patients seen at the University of Waterloo Optometry Clinic. Significant changes since the previous assessment (significant change) were defined as a change in spectacle prescription, presence of a new critical diagnosis, or a new management. Significant change, assessment interval, and age were extracted from the database for all asymptomatic patients presenting for a routine eye examination. The frequency of patients with significant change and the median assessment interval were determined for different age groups.

Results

Of 2656 asymptomatic patients, 1078 (41%) patients had spectacle prescription changes, 434 (16%) patients had new critical diagnoses, 809 (31%) patients had new managements, and 1535 (58%) patients had at least one of these (significant change). Median assessment intervals were 2.9 and 2.8 years for age groups 40 to <65 years and 20 to <40 years, respectively, approximately 1.5 years for patients 7 to <20, and between 1 and 1.5 years for patients <7 or >64. Controlling for assessment interval and sex, increasing age was associated with having a significant change (OR = 1.03, 95% CI 1.029–1.037). Similarly, controlling for age and sex, increased assessment interval was associated with having a significant change (OR = 1.06, 95% CI 1.02–1.11).

Conclusions

In asymptomatic patients, comprehensive routine optometric eye examinations detect a significant number of new eye conditions and/or result in management changes. The number detected increases with age and assessment interval.
Neuroimaging Rates for Closed Head Trauma in a Community Hospital
Authors: Rothman Steven M. , Alander Sarah W.
Published: April 2016

Objectives

We aimed to characterize the utility of neuroimaging for head trauma in a suburban community hospital and determine whether imaging practices conform to most recent pediatric guidelines.

Methods

The electronic medical record was surveyed for computed tomographic and magnetic resonance imaging head scans on patients aged 1 to 18 years who were evaluated for trauma. The query included the following: date, sex, type of scan (computed tomography or magnetic resonance imaging), age, patient location, reason for scan, Glasgow Coma Scale (GCS) score (if entered), result, and text from physician's notes.

Results

A total of 2679 patients were identified. Within this cohort was a maximum of 29 surgical patients, of whom 8 required a surgical procedure but not neurosurgery among the 592 patients who had a GCS score of 14–15 entered, 2 were confirmed/possible neurosurgical patients, giving a neurosurgical rate of 0.34%. When the GCS 3–13 patient group was analyzed, the relative risk of requiring neurosurgery climbed to 52. Using an established algorithm for pediatric head trauma imaging would have reduced the number of scanned patients to 533. The individual cost of identifying the 29 surgical patients in our population exceeded $31,000.

Conclusions

Our rate of serious lesions in GCS 14–15 patients was identical to a larger prospective study in urban teaching hospitals. Using their previously described algorithm might have reduced the number of patients scanned by more than 70% and saved close to $750,000 for the study period.
An Unexpected Fish Bite
Authors: Berkowitz Tal , Goldsmith Michael Paul
Published: April 2016

We report a case of a 22-month-old boy who suffered a piranha bite, amputating his fourth distal phalanx. His finger was irrigated and closed with a flap under sedation, but we could find little evidence during a brief literature search of what prophylactic antibiotics, if any, to provide. Because reports of infections from piranha bites are lacking, we examined studies evaluating oral flora from fish, as well as flora cultured from aquariums. In conclusion, if infection is present or prophylaxis is strongly desired, a broad spectrum oral antibiotic that covers Gram-positive and Gram-negative bacteria including Pseudomonas and Aeromonas species, such as ciprofloxacin, would be recommended; however, there is little evidence to suggest that prophylactic antibiotics provide benefit over appropriate wound management.
Relationship Between Central Hypotonia and Motor Development in Infants Attending a High-Risk Neonatal Neurology Clinic
Authors: Segal Idan , Peylan Tali , Sucre Jennifer , Levi Loren , Bassan Haim
Published: April 2016

Purpose:

To study the relationship between central hypotonia and motor development, and to determine the relative contribution of nuchal, truncal, and appendicular hypotonia domains to motor development.

Methods:

Appendicular, nuchal, and truncal tones of high-risk infants were assessed, as was their psychomotor developmental index (PDI). Infants with peripheral hypotonia were excluded.

Results:

We included 164 infants (mean age 9.6 ± 4 months), 36 with normal tone in all 3 domains and 128 with central hypotonia. Twenty-six of the latter had hypotonia in 1 domain and 102 had multiple combinations of 3 domains. Hypotonia domains were distributed as follows: truncal (n = 115), appendicular (n = 93), and nuchal (n = 70). Each domain was significantly associated with PDI scores (P < .001) but not with a later diagnosis of cerebral palsy. On linear regression, nuchal hypotonia had the strongest contribution to PDI scores (β = −0.6 [nuchal], −0.45 [appendicular], and −0.4 [truncal], P < .001).

Conclusions:

Central hypotonia, especially nuchal tone, is associated with lowered motor development scores.
Association of Polymorphisms in the Regulatory Region of the Cyclophilin a Gene (PPIA) with Gene Expression and HIV/AIDS Disease Progression
Authors: Madlala Paradise , Singh Ravesh , An Ping , Werner Lise , Mlisana Koleka , Abdool Karim Salim S. , Winkler Cheryl A. , Ndung'u Thumbi
Published: April 2016

Background:

Human cyclophilin A (CypA) encoded by peptidyl prolyl isomerase A gene (PPIA), enhances HIV-1 replication by aiding capsid uncoating. The association of genetic variation in the PPIA regulatory region with susceptibility to HIV-1 infection, disease progression, and gene expression among black South Africans at risk for infection or infected with HIV-1 is unknown.

Methods:

We genotyped 539 participants from 2 longitudinal study cohorts of black South Africans at high risk for infection or infected with HIV-1 for PPIA regulatory single nucleotide polymorphisms by polymerase chain reaction–restriction fragment length polymorphism.

Results:

Minor allele (G) of SNP rs6850 (rs6850 G) significantly associated with higher viral loads (mean 4.85 versus 4.46 log copies/mL, P = 0.0006) and lower CD4+ T-cell counts (mean 506 versus 557 cells/μL, P = 0.0256) during the acute phase of infection in the Centre for the AIDS Programme of Research in South Africa (CAPRISA) 002 cohort. Consistently, rs6850 G significantly associated with higher viral loads (mean 4.49 versus 4.01 log copies/mL, P < 0.0001) and lower CD4+ T-cell counts (mean 442 versus 494 cells/μL, P = 0.0002) during the early chronic phase of infection in the CAPRISA 002 cohort; rs6850 G further associated significantly with rapid CD4+ T-cell decline in the CAPRISA 002 cohort (P = 0.0481) and Sinikithemba chronic infection cohort (P = 0.0156). Interestingly, rs6850 G significantly associated with elevated CypA mRNA levels in HIV-1–positive individuals (P = 0.0061).

Conclusions:

These data suggest that rs6850 G enhances HIV-1 replication through upregulation of CypA expression following HIV-1 infection. The data support ongoing efforts to develop anti–HIV-1 drugs that block interaction of HIV-1 and cellular proteins.
Thoracic Incidental Findings in Preoperative Computed Tomography Evaluation for Transcatheter Aortic Valve Implantation (TAVI)
Authors: Hussien Amira F. , Jeudy Jean , Kligerman Seth J. , White Charles S.
Published: April 2016

Background:

Many older patients with aortic stenosis are excluded from surgical intervention due to multiple comorbidities. For these patients, transcatheter aortic valve implantation (TAVI) is a viable treatment alternative. Cardiothoracic computed tomography (CT) provides detailed anatomic assessment of the aortic root structures for patient selection, preprocedural planning, and intraoperative decision-making; however, nonaortic incidental findings are frequently detected. The prevalence and clinical significance of these findings have not been well described.

Materials and Methods:

This retrospective study examined incidental findings in 209 consecutive patients (96 women and 113 men; mean age, 70 y) with aortic stenosis undergoing preoperative cardiothoracic CT evaluation for TAVI during a 3-year period. Incidental findings were recorded, and medical records were reviewed for follow-up diagnostic examinations.

Results:

Incidental findings, both significant and nonsignificant, were observed in 85.6% of patients (179/209). Noncalcified pulmonary nodules were the most common incidental finding occurring in 59/209 (28.2%) patients, followed by pleural effusion and emphysema both of which occurred in 34/209 (16.3%) patients, respectively.

Conclusions:

Cardiothoracic CT obtained for evaluation before TAVI has a high frequency of incidental findings.
An Algorithm for the Management of Concomitant Maxillofacial, Laryngeal, and Cervical Spine Trauma
Authors: Tan Joshua Yuan Wang , Khoo Wan Xin , Hing Eileen Chor Hoong , Yap Yan Lin , Lee Hanjing , Nallathamby Vigneswaran , Thong Mark Kim Thye , Ong Wei Chen , Lim Jane , Lim Thiam Chye
Published: April 2016

Concomitant maxillofacial, laryngeal and cervical spine injuries may occur after high-energy accidents. Although this presentation is uncommon, the multiple injuries may compromise airway, breathing, circulation, and neurologic function. We identified 8 adult trauma patients admitted to the National University Hospital with the concomitant injuries. We reviewed the patient data and existing literature to identify the important factors that must be considered for management. Seven resulted from high velocity accidents, whereas 1 was assaulted. An algorithm that prioritizes in-tandem diagnosis and acute management of the adult trauma patient with maxillofacial, laryngeal, and cervical spine trauma was developed. The first priority is to assess airway, breathing, and circulation with cervical spine immobilization. Early diagnosis of patients with severe laryngeal injury, confirmation by video endoscopy, and establishing a surgical airway prevents airway obstruction or even a laryngotracheal dissociation. Urgent computed tomography scans of the head and neck are essential for definitive diagnosis and surgical planning for the 3 injuries. Prudent sequencing of surgery is important to avoid complications and to achieve better functional outcomes.
When the Mannequin Dies, Creation and Exploration of a Theoretical Framework Using a Mixed Methods Approach
Authors: Tripathy Shreepada , Miller Karen H. , Berkenbosch John W. , McKinley Tara F. , Boland Kimberly A. , Brown Seth A. , Calhoun Aaron W.
Published: April 2016

Introduction

Controversy exists in the simulation community as to the emotional and educational ramifications of mannequin death due to learner action or inaction. No theoretical framework to guide future investigations of learner actions currently exists. The purpose of our study was to generate a model of the learner experience of mannequin death using a mixed methods approach.

Methods

The study consisted of an initial focus group phase composed of 11 learners who had previously experienced mannequin death due to action or inaction on the part of learners as defined by Leighton (Clin Simul Nurs. 2009;5(2):e59–e62). Transcripts were analyzed using grounded theory to generate a list of relevant themes that were further organized into a theoretical framework. With the use of this framework, a survey was generated and distributed to additional learners who had experienced mannequin death due to action or inaction. Results were analyzed using a mixed methods approach.

Results

Forty-one clinicians completed the survey. A correlation was found between the emotional experience of mannequin death and degree of presession anxiety (P < 0.001). Debriefing was found to significantly reduce negative emotion and enhance satisfaction. Sixty-nine percent of respondents indicated that mannequin death enhanced learning. These results were used to modify our framework.

Conclusions

Using the previous approach, we created a model of the effect of mannequin death on the educational and psychological state of learners. We offer the final model as a guide to future research regarding the learner experience of mannequin death.
Simulation for Milestone Assessment
Authors: Frey-Vogel Ariel S. , Scott-Vernaglia Shannon E. , Carter Lindsay P. , Huang Grace C.
Published: April 2016

Introduction

Determining clinical competency on the milestones requires direct observation of residents, which is difficult for faculty members who are also providing patient care. Simulation can potentially represent an effective standardized tool for high-stakes assessment. Using a longitudinal simulation curriculum with formative and summative components, we conducted a pilot investigation to examine whether (1) performance on the formative cases predicted performance on the summative cases and (2) performance on the summative cases correlated with the clinical competency committee’s (CCC) milestone placement.

Methods

We developed 6 formative and 6 matched summative cases for pediatric interns that covered core pediatric topics. The interns progressed through the formative cases in pairs during the course of the academic year and then through the summative cases back to back individually at the end of the year. The interns were evaluated using a competency-based simulation evaluation. We determined the relationship between the formative and summative scores and between the summative scores and those from the CCC.

Results

The relationship between formative and summative scores was not statistically significant. There was a statistically significant relationship between summative and CCC scores.

Conclusions

Significant methodological limitations preclude definite conclusions about the predictive power of simulation cases for Pediatric Milestones-based assessment. However, our work is an example of how simulation is a potentially useful tool for assessing residents’ skill development on the Pediatric Milestones. More rigorous research is needed to determine the extent to which simulation can be used for high-stakes, milestones-based assessment.
A Minimally Invasive Strategy for Mirizzi Syndrome Type II: Combined Endoscopic With Laparoscopic Approach
Authors: Yuan Haicheng , Yuan Tian , Sun Xiangyu , Zheng Mingwei
Published: April 2016

Background:

Mirizzi syndrome (MS) is a rare complication of the gallstone disease. Despite the fact that successful laparoscopic treatments have been reported for MS type I, open surgery remains the gold standard approach for MS type II because of the technical difficulties involved.

Objective:

The aim of this study is to determine the best technique for patients with MS type II by comparing the duration of surgery, loss of blood, rates of complication, duration of hospitalization, and outcomes of long-term follow-up.

Materials and Methods:

From January 2009 to September 2014, combined endoscopic retrograde cholangiopancreatography with laparoscopic surgery for MS type II was implemented. Patients’ demographics and treatment outcomes were collected prospectively and during the follow-up.

Results:

Forty-nine patients with MS type II were managed with this strategy. Laparoscopic subtotal cholecystectomy was successfully performed in all the patients without conversion or morbidity. When compared with a historical cohort of 57 patients who underwent a surgery for MS, this group of patients had significantly shorter duration of hospitalization (7.21±1.61 vs. 15.31±3.82 d, P<0.01). It also showed less blood loss (162.81±40.83 vs. 207.55±37.01 mL, P=0.425) and less postoperative complications (10.20% vs. 14.04%, P=0.594), although the duration of surgery (165.73±54.33 vs. 156.04±48.61 min, P=0.334) was longer, but these were not statistically significant. However, no significant difference in the rate of recurrence (4.55% vs. 9.52%, P=0.522) of choledocholithiasis was found.

Conclusions:

The MS type II can be effectively managed with a laparoscopic surgery combined with preoperative endoscopic retrograde cholangiopancreatography, which is feasible and minimally invasive.
Robotic Sigmoid Vaginoplasty in an Adolescent Girl With Mayer-Rokitansky-Kuster-Hauser Syndrome
Authors: Boztosun Abdullah , Olgan Safak
Published: April 2016

Background

Sigmoid vaginoplasty has carved a niche for itself in reconstructive genitoplasty. We describe the successful use of a robotically assisted sigmoid vaginoplasty in an adolescent girl with Mayer-Rokitansky-Kuster-Hauser syndrome.

Case

An 18-year-old girl was referred to our hospital with the complaint of primary amenorrhea. She was thoroughly evaluated and magnetic resonance imaging was done, which revealed absence of a vagina and uterus but bilateral normal ovaries. Because cytogenetic analysis was “normal 46,XX” karyotype, Mayer-Rokitansky-Kuster-Hauser syndrome was diagnosed. She was successfully managed by the use of robot-isolated sigmoid colon segment for vaginal replacement and robot-sewn colon-colon anastomosis. A follow-up was done at the 3rd and 6th months, which revealed a large capacious vagina even without self-dilatation.

Conclusions

The robotic approach is feasible and can produce satisfying postoperative outcomes and might be a minimally invasive technique in future vaginoplasty surgery.
Effective Treatment of Paroxysmal Nonkinesigenic Dyskinesia With Oxcarbazepine
Authors: Kumar Aditya , Szekely Anna , Jabbari Bahman
Published: April 2016

Paroxysmal nonkinesigenic dyskinesia (PNKD) is a rare chronic disorder characterized by intermittent, non–movement-related involuntary movements. The response to currently available therapies is inconsistent and temporary. We describe here a patient with infantile-onset PNKD who failed a number of pharmaceutical agents used alone or in combination. Treatment with oxcarbazepine resulted in a substantial reduction in the frequency and severity of episodes. The patient has been followed for 4 years now, and the outcome of treatment is consistently favorable. Oxcarbazepine has been effective in managing the kinesigenic form of this disorder; however, its use has never been reported in PNKD to our knowledge. Oxcarbazepine is safer and better tolerated than most of the drugs currently used for treating PNKD, but blinded clinical trials are needed to verify its efficacy in the management of this debilitating, often difficult-to-treat disease.
Ocular Myasthenia Gravis: Toward a Risk of Generalization Score and Sample Size Calculation for a Randomized Controlled Trial of Disease Modification
Authors: Wong Sui H. , Petrie Aviva , Plant Gordon T.
Published: April 2016

Background:

There is currently no prognostic test to determine the risk of developing generalized myasthenia gravis (GMG) risk in patients who first present with ocular disease. Most studies that report risk factors are flawed by the inclusion of patients on immunosuppression, which is likely to reduce the risk.

Objective:

To create a prognostic score to predict the risk of GMG.

Methods:

Multicenter retrospective cohort of patients with ocular myasthenia gravis for minimum 3 months, untreated with immunosuppression for minimum 2 years or until GMG onset.

Results:

One hundred one (57 female) patients were included, with median follow-up of 8.4 years (2–42) from disease onset. Thirty-one developed GMG at median of 1.31 years (3.5 months–20.2 years); 19 occurred within 2 years. Univariable logistic regression analysis produced 3 significant predictors (P < 0.10), adjusted odds ratios in a multivariable logistic model (χ2
P = 0.01) with multiple imputations for missing data: seropositivity, 5.64 (95% CI, 1.45–21.97); presence of 1 or more comorbidities including autoimmune disorders, 6.49 (95% CI, 0.78–53.90); thymic hyperplasia, 5.41 (95% CI, 0.39–75.43). Prognostic score was derived from the coefficients of the logistic model: sum of the points (1 point for the presence of each of the above predictive factors), classified “low risk” if ≤1 and “high risk” if ≥2. Predicted probabilities were 0.07 (SD, 0.03) for low risk and 0.39 (SD, 0.09) for high risk. Negative predictive value was 91% (95% CI, 79–98), positive predictive value was 38% (95% CI, 23–54), sensitivity was 79% (95% CI, 54–94), specificity was 63% (95% CI, 50–74), area under receiver operating characteristic curve was 0.74 (95% CI, 0.64–0.85).

Conclusions:

In this preliminary study, we have shown by proof of principle that it is possible to stratify risk of GMG: an approach that may allow us to better counsel patients at diagnosis, complement decision-making, and move us toward addressing the question of modifying GMG risk in high-risk patients. Furthermore, the effect of comorbidities is novel and demands further elucidation.
Optic Neuropathy and Stroke Secondary to Invasive Aspergillus in an Immunocompetent Patient
Authors: Hersh Carrie M. , John Seby , Subei Adnan , Willis Mary A. , Kosmorsky Gregory S. , Prayson Richard A. , Bhimraj Adarsh
Published: April 2016

Angioinvasive aspergillosis is an aggressive fungal infection that is potentially life threatening without prompt treatment. Optic nerve involvement of Aspergillus can mimic optic neuritis commonly seen in demyelinating and other inflammatory conditions. Treatment of Aspergillus infection with steroids may worsen the clinical course. We describe a unique case of disseminated central nervous system aspergillosis, initially presenting as an optic neuropathy, with subsequent stroke in multiple vascular territories.
An Investigation of Patient Preferences for Music Played Before Electroconvulsive Therapy
Authors: Graff Veena , Wingfield Peter , Adams David , Rabinowitz Terry
Published: April 2016

Objective

Patients often feel anxious before electroconvulsive therapy (ECT), which can lead to avoidance of treatments. Music is a noninvasive safe option to reduce anxiety in the preoperative setting. Therefore, we examined patients' preferences of listening to music while receiving ECT by providing music—by way of headphones or speakers—to participants before treatment.

Methods

Patients receiving ECT were recruited for this study. Patients served as their own controls in 3 separate music intervention sessions: 1) randomization to music via headphones or speakers, 2) no music, 3) the remaining music intervention. Patients completed a questionnaire related to satisfaction and preferences of music being played before ECT. Patients received a final questionnaire at the end of the study asking which intervention they preferred.

Results

Thirty patients completed the study. Ninety percent enjoyed listening to music through speakers. Eighty percent liked listening to music through headphones. Seventeen percent preferred not having any music. The difference in preference between speakers and headphones was not significant (P = 0.563; McNemar-Bowker test). There was no association between preference at the end of the study and the initial assignment of speakers or headphones (P = 0.542 and P = 0.752, respectively; Pearson χ2 tests). No adverse events were reported.

Conclusions

Music is a low-cost intervention with virtually no side effects that could be offered as an adjunctive therapy for patients receiving ECT. A significant proportion of patients liked hearing music before treatment.
Did viruses evolve as a distinct supergroup from common ancestors of cells?
Authors: Harish Ajith , Abroi Aare , Gough Julian , Kurland Charles
Published: April 2016

The evolutionary origins of viruses according to marker gene phylogenies, as well as their relationships to the ancestors of host cells remains unclear. In a recent article Nasir and Caetano-Anollés reported that their genome-scale phylogenetic analyses identify an ancient origin of the “viral supergroup” (Nasir et al (2015) A phylogenomic data-driven exploration of viral origins and evolution.Science Advances, 1(8):e1500527). It suggests that viruses and host cells evolved independently from a universal common ancestor. Examination of their data and phylogenetic methods indicates that systematic errors likely affected the results. Reanalysis of the data with additional tests shows that small-genome attraction artifacts distort their phylogenomic analyses. These new results indicate that their suggestion of a distinct ancestry of the viral supergroup is not well supported by the evidence.
Give and you shall receive: investing in the careers of women professionals
Authors: Walsh Kate , Fleming Susan S. , Enz Cathy A.
Published: April 2016

Purpose

– The purpose of this paper is to explore what organizations can do to facilitate the retention and advancement of women professionals into top leadership positions. A social exchange framework is applied to examine ways organizations can signal support for and investment in the careers of women professionals, and ultimately the long-term work relationship.

Design/methodology/approach

– This paper employed a qualitative methodology; specifically, semi-structured interviews with 20 women executives, in primarily the US hospitality industry, were conducted. The interviews were recorded, transcribed, and content analyzed.

Findings

– Organizations are likely to strengthen the retention of their female professionals if they signal support through purposeful, long-term career development that provides a sightline to the top, and ultimately creates more female role models in senior-level positions. Organizations can also signal support through offering autonomy over how work is completed, and designing infrastructures of support to sustain professionals during mid-career stages. Findings are used to present a work-exchange model of career development.

Research limitations/implications

– This research is an exploratory study that is limited in its scope and generalizability.

Practical implications

– The proposed work-exchange model can be used to comprehensively structures initiatives that would signal organizational support to – and long-term investment in – female professionals and enable them to develop their career paths within their organizations.

Originality/value

– Through offering a work-exchange model of career development, this paper identifies components of organizational support from a careers perspective, and highlights the factors that could potentially contribute to long-term growth and retention of women professionals.