bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding Nurses’ Strategies to Handle (Un)wanted Nurse Calls
Authors: Klemets Joakim , Evjemo Tor Erik
Published: February 2017

Nurse calls in a hospital can constitute either positive or negative (wanted or unwanted) interruptions depending on various factors. This study aims to understand nurses’ strategies in facilitating the reception of wanted nurse calls and the restriction of unwanted nurse calls. Applying a resilience engineering perspective, nurses’ performance variability is investigated as a basis to design appropriate computer support to enhance efficiency and patient safety. A qualitative case study was conducted for a period of 4 years with focus on nurses’ use of a wireless nurse call system at a Norwegian university hospital. The study involved various data collection methods such as observations, interviews, and workshops. The collected data were then transcribed and analyzed using a combined inductive and deductive approach. Results indicate that nurses use four main strategies involving a large degree of collaboration to allow or avoid interruptions in the form of nurse calls depending on situation and circumstances. However, these strategies are not supported by the wireless nurse call system, which requires nurses to use suboptimal workarounds to enable the necessary performance variability. Interruptions have been largely perceived as a threat to patient safety. However, nurses’ handling of calls illustrates that, when aiming to introduce interventions to manage interruptions, a detailed understanding of work as done is important. Nurses continuously make appropriate adjustments to cope with challenges that characterize hospital work to ensure efficient and safe operations. Hence, technology, in terms of a nurse call system, needs to be designed to afford the adjustments made to support a resilient practice and, as such, leverage patient safety.
“Joining the Spots in Adults and Young Tots”: A Clinicopathological Study of Henoch–Schönlein Purpura (IgA Vasculitis)
Authors: Kedia Priyanka P. , Tirumalae Rajalakshmi , Puttegowda Divya , Antony Meryl
Published: February 2017

Introduction:

Henoch–Schönlein Purpura (HSP; IgA vasculitis), the most common vasculitis of childhood, has a wide spectrum of clinical manifestations ranging from palpable purpura with abdominal pain and arthritis to the more morbid renal involvement.

Aims and Objectives:

To study and correlate the clinical presentation, laboratory values, skin and renal histopathology and immunofluoroscence findings in HSP.

Material and Methods:

A total of 44 cases of HSP from March 2011 to February 2014 were studied for the above features along with their clinical outcomes.

Results:

The mean age of the patients at presentation was 28.4 years (range 4.5–69 years) with 26.2% being children younger than 15 years. Purpura at presentation was seen in all with 77.1% cases exhibiting extracutaneous involvement. Skin biopsy revealed leukocytoclastic vasculitis in all cases, dominant IgA deposition in the papillary dermal vessels in 43 cases (97.7%), associated C3 in 10 cases (23.3%), and full-house positivity in 1 case. One case without skin immunofluorescence had renal mesangial IgA deposits. Nine cases (20.9%) with an average age of 39 years had renal symptoms and displayed varied histology from focal mesangioproliferative glomerulonephritis to crescentic. All of them had dominant mesangial IgA deposits, majority falling into International Study of Kidney Disease in Children (ISKDC) class IIIb. Peritubular capillaritis was noted in 3 cases. Two patients (4.5%) progressed to end stage renal disease, one of whom had cellular crescents at presentation.

Conclusions:

HSP was seen both in children and adults. Renal involvement was seen in 20.9% cases, all older than 14 years, and 66.7% with extracutaneous manifestations. The outcome in this series was favorable in 96% cases.
The Histopathology of Urticaria Revisited—Clinical Pathological Study
Authors: Barzilai Aviv , Sagi Lior , Baum Sharon , Trau Henri , Schvimer Michael , Barshack Iris , Solomon Michal
Published: February 2017

Background:

The classic histopathological findings of urticaria include dermal edema and a sparse perivascular infiltrate of neutrophils, eosinophils, macrophages, and lymphocytes. However, this pattern is inconsistently described.

Objective:

To describe the histological and immunofluorescence characteristics of urticaria and to identify distinctive patterns.

Methods:

A retrospective study was performed in which the medical files and biopsy specimens of 58 patients with acute and chronic classical urticaria were reviewed. Pathological parameters were quantified.

Results:

We recognized 2 distinctive patterns of urticaria: lymphocyte and neutrophil predominant; the former was characterized by a perivascular location, whereas the latter was associated with an interstitial location and a denser infiltrate. Mast cells were relatively sparse, better demonstrated with special stains. Tryptase stain demonstrated more mast cells than Giemsa stain. Extravasated erythrocytes were present in 50% of the cases, but vasculitis was not observed.

Conclusions:

Histological findings in classical urticaria show a spectrum of findings from a sparse superficial perivascular to a deep perivascular and interstitial infiltrate. Distinctive groups based on the dominant cell type can be identified, accounting for the similarity to neutrophilic urticarial dermatosis. Lesions may have a purpuric appearance, but leukocytoclastic vasculitis is never present.
Role of Skin Biopsies in the Diagnosis of Hemophagocytic Lymphohistiocytosis
Authors: Santos-Arroyo Aileen , Barrera-Llaurador Julián , Sánchez Julio E. , Martín-García Rafael , Sánchez Jorge L.
Published: February 2017

This is a report of a 15-year-old female who presented with a skin eruption and clinical features consistent with severe sepsis and septic shock. A diagnosis of acquired hemophagocytic lymphohistiocytosis (HLH) was made and confirmed by bone marrow analysis. Skin biopsy showed hemophagocytosis and CD163-positive staining of macrophages. We briefly review the clinical, histologic, and laboratory findings of hemophagocytic lymphohistiocytosis in addition to the potential role of skin biopsies in this condition.
Cardioprotective Effects of Carvedilol in Inhibiting Doxorubicin-induced Cardiotoxicity
Authors: Nabati Maryam , Janbabai Ghasem , Baghyari Saideh , Esmaili Khadige , Yazdani Jamshid
Published: February 2017

Purpose:

Anthracyclines (ANTs) are a class of active antineoplastic agents with topoisomerase-interacting activity that are considered the most active agents for the treatment of breast cancer. We investigated the efficacy of carvedilol in the inhibition of ANT-induced cardiotoxicity.

Methods:

In this randomized, single-blind, placebo-controlled study, 91 women with recently diagnosed breast cancer undergoing ANT therapy were randomly assigned to groups treated with either carvedilol (n = 46) or placebo (n = 45). Echocardiography was performed before and at 6 months after randomization, and absolute changes in the mean left ventricular ejection fraction, left ventricular end diastolic volume, and left ventricular end systolic volume were determined. Furthermore, the percentage change in the left atrial (LA) diameter and other variables of left ventricular (LV) diastolic function, such as transmitral Doppler parameters, including early (E wave) and late (A wave) diastolic velocities, E/A ratio and E wave deceleration time, pulmonary venous Doppler signals, including forward systolic (S wave) and diastolic (D wave) velocities into LA, late diastolic atrial reversal velocity, and early diastolic tissue Doppler mitral annular velocity (e') were measured. In addition, tissue Doppler mitral annular systolic (s') velocity, as a marker of early stage of LV systolic dysfunction, E/e' ratio, as a determinant of LV filling pressure, and troponin I level, as a marker of myocardial necrosis were measured.

Results:

At the end of follow-up period, left ventricular ejection fraction did not change in the carvedilol group. However, this parameter was significantly reduced in the control group (P < 0.001). Echocardiography showed that both left ventricular end systolic volume and LA diameter were significantly increased compared with the baseline measures in the control group. In pulse Doppler studies, pulmonary venous peak atrial reversal flow velocity was significantly increased in the control group. Moreover, a significant decrease in the mitral annuli early diastolic (e') and peak systolic (s') velocities and a significant increase in the E (the peak early diastolic velocity)/e' ratio in the control group were also observed. However, none of these variables were adversely changed at the end of follow-up in the carvedilol group. Furthermore, the TnI level was significantly higher in the control group than in the carvedilol group (P = 0.036) at 30 days after the initiation of chemotherapy.

Conclusions:

Prophylactic use of carvedilol may inhibit the development of anthracycline-induced cardiotoxicity, even at low doses.
Early Treatment With Zofenopril and Ramipril in Combination With Acetyl Salicylic Acid in Patients With Left Ventricular Systolic Dysfunction After Acute Myocardial Infarction: Results of a 5-Year Follow-up of Patients of the SMILE-4 Study
Authors: Borghi Claudio , Omboni Stefano , Novo Salvatore , Vinereanu Dragos , Ambrosio Giuseppe , Ambrosioni Ettore ,   on behalf of the SMILE-4 Working Party
Published: February 2017

The SMILE-4 study showed that in patients with left ventricular dysfunction (LVD) after acute myocardial infarction, early treatment with zofenopril plus acetyl salicylic acid is associated with an improved 1-year survival, free from death or hospitalization for cardiovascular (CV) causes, as compared to ramipril plus acetyl salicylic acid. We now report CV outcomes during a 5-year follow-up of the patients of the SMILE-4 study. Three hundred eighty-six of the 518 patients completing the study (51.2%) could be tracked after the study end and 265 could be included in the analysis. During the 5.5 (±2.1) years of follow-up, the primary endpoint occurred in 27.8% of patients originally randomized and treated with zofenopril and in 43.8% of patients treated with ramipril [odds ratio (OR) and 95% confidence interval, 0.65 (0.43–0.98), P = 0.041]. Such a result was achieved through a significantly larger reduction in CV hospitalization under zofenopril [OR: 0.61 (0.37–0.99), P = 0.047], whereas reduction in mortality rate with zofenopril did not achieve statistical significance versus ramipril [OR: 0.75 (0.36–1.59), P = 0.459]. These results were in line with those achieved during the initial 1-year follow-up. Benefits of early treatment of patients with LVD after acute myocardial infarction with zofenopril are sustained over many years as compared to ramipril.
Free androgen index as a determinant of arterial stiffness in menopause: a mediation analysis
Authors: Lambrinoudaki Irene , Georgiopoulos Georgios A. , Athanasouli Fani , Armeni Elena , Rizos Demetrios , Augoulea Areti , Chatzidou Sofia , Koutli Evangelia , Makris Nikolaos , Kanakakis Ioannis , Stamatelopoulos Kimon
Published: February 2017

Objective:

Associations of endogenous androgens in menopause with blood pressure (BP) and indices of arterial stiffness are reported, but directional relationships are not clear. Structural equation modeling is a contemporary statistical method, which allows assessment of such relationships and improves pathway understanding.

Methods:

We recruited 411 consecutive apparently healthy postmenopausal women who underwent noninvasive vascular evaluation. This included pulse wave analysis (aortic pressures and arterial wave reflections [augmentation index]), measurement of aortic stiffness by pulse wave velocity (PWV), stiffness index (SI), and flow-mediated dilatation. A cumulative marker combining PWV and SI (combined local and aortic arterial stiffness [CAS]) was also assessed. Free androgen index (FAI) was calculated from circulating total testosterone and sex hormone-binding globulin.

Results:

FAI was an independent determinant of systolic BP (SBP) (P = 0.032), SI (P = 0.042), and PWV (P = 0.027). Under structural equation modeling analysis, FAI was a direct predictor for PWV (beta = 0.149, P = 0.014), SI (beta = 0.154, P = 0.022), and CAS (beta = 0.193, P = 0.02), whereas SBP was a parallel mediator of androgen's vascular effects on PWV (beta = 0.280, P < 0.001) and CAS (beta = 0.248, P = 0.004), but not SI (beta = 0.024, P = 0.404). FAI-induced increase in arterial stiffness via flow-mediated dilatation was not established. FAI was not a determinant of augmentation index.

Conclusions:

In healthy postmenopausal women, FAI was directly associated with PWV, SI, and CAS. FAI also directly correlated with SBP, which in turn concurrently increased PWV and CAS. The directional correlations found herein, imply that endogenous androgens may be causally associated with indices of arterial stiffness both directly and indirectly. This hypothesis should be confirmed in further studies with causal design.
Association of follicle-stimulating hormone levels and risk of type 2 diabetes in older postmenopausal women
Authors: Bertone-Johnson Elizabeth R. , Virtanen Jyrki K , Niskanen Leo , Nurmi Tarja , Ronkainen Kimmo , Voutilainen Sari , Mursu Jaakko , Kauhanen Jussi , Tuomainen Tomi-Pekka
Published: February 2017

Objective:

Recent studies of perimenopausal women have observed associations of follicle-stimulating hormone (FSH) levels with markers of insulin resistance, independent of estradiol. Whether FSH is related to type 2 diabetes (T2D) in older women who have completed the menopause transition remains unknown. We assessed the association of FSH levels with diabetes and measures of insulin resistance among 588 postmenopausal Finnish women.

Methods:

Study participants were aged 53 to 73 years and not using hormone therapy at baseline (1998-2001) when FSH was measured. Prevalence of T2D was assessed at baseline, along with fasting insulin and glucose levels. Incident T2D, and insulin and glucose levels were assessed 7 to 9 years later at follow-up examination.

Results:

After adjustment for age, estradiol, body mass index, smoking, lipids levels, and other factors, women with higher FSH (>50 IU/L) had a lower prevalence of T2D (odds ratio 0.49, 95% confidence interval [CI] 0.28-0.86) than women with lower FSH. Each 1 unit increase in FSH level was associated with a significant 1.9% lower risk of T2D (95% CI 0.966-0.997, P = 0.02). Higher FSH was associated with marginally significant lower incidence of T2D at follow-up (hazard ratio 0.53, 95% CI 0.27-1.02). Baseline FSH levels were inversely correlated with fasting insulin and glucose levels at both baseline and follow-up visits (all P < 0.05). After adjustment, FSH was modestly associated with fasting insulin at baseline (P = 0.01) and at follow-up (P = 0.11).

Conclusions:

Higher postmenopausal FSH levels were associated with lower prevalent and incident T2D and fasting insulin levels. These findings warrant replication in larger prospective studies.
Psychometric properties of the medical outcomes study sleep scale in Spanish postmenopausal women
Authors: Zagalaz-Anula Noelia , Hita-Contreras Fidel , Martínez-Amat Antonio , Cruz-Díaz David , Lomas-Vega Rafael
Published: February 2017

Objective:

This study aimed to analyze the reliability and validity of the Spanish version of the Medical Outcomes Study Sleep Scale (MOS-SS), and its ability to discriminate between poor and good sleepers among a Spanish population with vestibular disorders.

Methods:

In all, 121 women (50-76 years old) completed the Spanish version of the MOS-SS. Internal consistency, test-retest reliability, and construct validity (exploratory factor analysis) were analyzed. Concurrent validity was evaluated using the Pittsburgh Sleep Quality Index and the 36-item Short Form Health Survey. To analyze the ability of the MOS-SS scores to discriminate between poor and good sleepers, a receiver-operating characteristic curve analysis was performed.

Results:

The Spanish version of the MOS-SS showed excellent and substantial reliability in Sleep Problems Index I (two sleep disturbance items, one somnolence item, two sleep adequacy items, and awaken short of breath or with headache) and Sleep Problems Index II (four sleep disturbance items, two somnolence items, two sleep adequacy items, and awaken short of breath or with headache), respectively, and good internal consistency with optimal Cronbach's alpha values in all domains and indexes (0.70-0.90). Factor analysis suggested a coherent four-factor structure (explained variance 70%). In concurrent validity analysis, MOS-SS indexes showed significant and strong correlation with the Pittsburgh Sleep Quality Index total score, and moderate with the 36-item Short Form Health Survey component summaries. Several domains and the two indexes were significantly able to discriminate between poor and good sleepers (P < 0.05). Optimal cut-off points were above 20 for “sleep disturbance” domain, with above 22.22 and above 33.33 for Sleep Problems Index I and II.

Conclusions:

The Spanish version of the MOS-SS is a valid and reliable instrument, suitable to assess sleep quality in Spanish postmenopausal women, with satisfactory general psychometric properties. It discriminates well between good and poor sleepers.
An Internet-based cognitive behavioral therapy for treatment-induced menopausal symptoms in breast cancer survivors: results of a pilot study
Authors: Atema Vera , van Leeuwen Marieke , Oldenburg Hester S.A. , van Beurden Marc , Hunter Myra S. , Aaronson Neil K.
Published: February 2017

Objective:

Previous studies demonstrated that a cognitive behavioral therapy (CBT) program delivered in group sessions is effective in alleviating treatment-induced menopausal symptoms in women with breast cancer, but also that in-person CBT is inconvenient for some women and can result in low levels of program compliance. A promising, alternative approach is to use the Internet to make this form of CBT more accessible and feasible for patients. The objective of this study was to evaluate the feasibility and to generate preliminary data on the efficacy of a guided, Internet-based CBT program.

Methods:

Twenty-one participants with treatment-induced menopausal symptoms started the guided Internet-based CBT program. Self-report questionnaires were completed at baseline and at 10 weeks (posttreatment). Counselors’ evaluations were obtained via interviews. Primary outcomes were program usage, compliance rates, and participant and counselor satisfaction. Secondary outcomes were overall levels of endocrine symptoms and hot flush/night sweats problem rating.

Results:

Ninety percent of participants completed the program as planned. Satisfaction rates were high among participants and counselors. Small revisions to the program were advised. There was a significant decrease over time in overall levels of endocrine symptoms and hot flush/night sweats problem rating.

Conclusions:

These findings suggest that an Internet-based CBT program for women with treatment-induced menopausal symptoms is feasible and promising in terms of efficacy. The efficacy of the CBT program is currently being investigated in a larger randomized controlled trial.
Vaginal estrogen: a dual-edged sword in postoperative healing of the vaginal wall
Authors: Ripperda Christopher M. , Maldonado Pedro Antonio , Acevedo Jesus F. , Keller Patrick W. , Akgul Yucel , Shelton John M. , Word Ruth Ann
Published: February 2017

Objective:

Reconstructive surgery for pelvic organ prolapse is plagued with high failure rates possibly due to impaired healing or regeneration of the vaginal wall. Here, we tested the hypothesis that postoperative administration of local estrogen, direct injection of mesenchymal stem cells (MSCs), or both lead to improved wound healing of the injured vagina in a menopausal rat model.

Methods:

Ovariectomized rats underwent surgical injury to the posterior vaginal wall and were randomized to treatment with placebo (n = 41), estrogen cream (n = 47), direct injection of MSCs (n = 39), or both (n = 43).

Results:

MSCs did not survive after injection and had no appreciable effects on healing of the vaginal wall. Acute postoperative administration of vaginal estrogen altered the response of the vaginal wall to injury with decreased stiffness, decreased collagen content, and decreased expression of transcripts for matrix components in the stromal compartment. Conversely, vaginal estrogen resulted in marked proliferation of the epithelial layer and increased expression of genes related to epithelial barrier function and protease inhibition. Transcripts for genes involved in chronic inflammation and adaptive immunity were also down-regulated in the estrogenized epithelium.

Conclusions:

Collectively, these data indicate that, in contrast to the reported positive effects of preoperative estrogen on the uninjured vagina, acute administration of postoperative vaginal estrogen has adverse effects on the early phase of healing of the stromal layer. In contrast, postoperative estrogen plays a positive role in healing of the vaginal epithelium after injury.
Cardiac autonomic function and hot flashes among perimenopausal and postmenopausal women
Authors: Gibson Carolyn J. , Mendes Wendy Berry , Schembri Michael , Grady Deborah , Huang Alison J.
Published: February 2017

Objective:

Abnormalities in autonomic function are posited to play a pathophysiologic role in menopausal hot flashes. We examined relationships between resting cardiac autonomic activity and hot flashes in perimenopausal and postmenopausal women.

Methods:

Autonomic function was assessed at baseline and 12 weeks among perimenopausal and postmenopausal women (n = 121, mean age 53 years) in a randomized trial of slow-paced respiration for hot flashes. Pre-ejection period (PEP), a marker of sympathetic activation, was measured with impedance cardiography. Respiratory sinus arrhythmia (RSA), a marker of parasympathetic activation, was measured with electrocardiography. Participants self-reported hot flash frequency and severity in 7-day symptom diaries. Analysis of covariance models were used to relate autonomic function and hot flash frequency and severity at baseline, and to relate changes in autonomic function to changes in hot flash frequency and severity over 12 weeks, adjusting for age, body mass index, and intervention assignment.

Results:

PEP was not associated with hot flash frequency or severity at baseline or over 12 weeks (P > 0.05 for all). In contrast, there was a trend toward greater frequency of moderate-to-severe hot flashes with higher RSA at baseline (β = 0.43, P = 0.06), and a positive association between change in RSA and change in frequency of moderate-to-severe hot flashes over 12 weeks (β = 0.63, P = 0.04).

Conclusions:

Among perimenopausal and postmenopausal women with hot flashes, variations in hot flash frequency and severity were not explained by variations in resting sympathetic activation. Greater parasympathetic activation was associated with more frequent moderate-to-severe hot flashes, which may reflect increased sensitivity to perceiving hot flashes.
Obesity-related Risk Factors in Implant-based Breast Reconstruction Using AlloDerm
Authors: Yuen James C. , Coleman Cathryn A. , Erickson Stephen W.
Published: February 2017

With a population in which 70% of the patients were overweight or obese, we reviewed retrospectively 135 breasts of 70 consecutive patients who underwent implant-based immediate breast reconstruction using freeze-dried AlloDerm as the acellular dermal matrix. Several obesity-related parameters were evaluated to determine their possible correlation to early postoperative complications. We found that breast width and surface area of AlloDerm usage correlated with the development of infection and mastectomy skin flap necrosis. Increased breast width and size of AlloDerm matrix implanted were correlated with higher rates of both minor and significant skin necrosis and of cellulitis. Body mass index was correlated with the development of cellulitis and minor and major skin necrosis but not with seroma or reconstruction failure. Preexisting breast cup size correlated with the development of seroma but not the other complications. We observed no statistically significant association between reconstruction failure and any of the parameters reviewed, but this is likely due to the small number of failures in our data set (n = 10).
Purpura Fulminans
Authors: Shenoy Rahul , Nanjappa Sowmya , Eaton Kevin , Prieto-Granada Carlos , Messina Jane L. , Greene John N.
Published: February 2017

Purpura fulminans is a rapidly progressing clinical syndrome of hematologic and cutaneous manifestations accompanied by an underlying dysfunction of coagulation resulting in disseminated diathesis. It usually occurs secondary to severe infection, but can also have an idiopathic genesis. A unique subset of inherited coagulation defects leading to fulminant purpura in neonates has also been well documented. We present a case of an adult with sarcomatoid mesothelioma on chemotherapy who presented with rapidly evolving purpuric lesions associated with acral gangrene after a recent dog bite. Once an infectious cause was ruled out, a paraneoplastic presentation of purpura fulminans secondary to the underlying malignancy was postulated. This presentation could be triggered by an altered immune system response to the preexisting neoplasm. We also discuss a comprehensive literature review of the infectious and noninfectious conditions associated with fulminant purpura.
Should Antipsychotic Medications for Schizophrenia Be Given for a Lifetime?
Authors: Glick Ira D. , Davis John M. , Zamora Daisy , Ballon Jacob , Nuthi Meena
Published: February 2017

Background

Schizophrenia remains a major health problem despite antipsychotic medications that, for most patients, can decrease acute symptoms, decrease relapses, and contribute to partial and sometimes strong positive response in patients with chronic symptoms. What has not been clear—because a double-blind, randomized, placebo-controlled trial is not feasible or ethical—is how many years after the initial episode, or onset of antipsychotic treatment, should medication be continued to achieve the best global outcome. We designed a small, clinical study to retrospectively perform a detailed follow-up to examine antipsychotic medication because it relates to both global outcome and life satisfaction.

Methods

This is a naturalistic study of 35 patients with chronic schizophrenia examining antipsychotic medication adherence from 8 to 50 years (average, 21 y) after onset of antipsychotic treatment. The sample was derived from all patients treated for many years in 1 physician's academic clinic. Most were treated by community physicians before referral to the academic clinic. Information was gathered on (1) medication adherence, (2) long-term global outcomes (based on both the patient ratings and a blind clinician's assessment [blind to medication data] on both the Global Outcome Scale and the Global Assessment of Functioning Scale), and (3) a patient-rated Satisfaction With Life Scale. Spearman rank order correlations were used to relate medication adherence to global outcomes and life satisfaction, as were linear regression models adjusted for demographic and clinical characteristics.

Results

A total of 35 patients (mean age, 45 y; mean years of possible medication since onset of treatment, 21 y) were assessed. Medication adherence was a statistically significant predictor of better long-term global outcomes and life satisfaction, both in Spearman rank order correlations and in covariate-adjusted linear regressions (all P values <0.01). Poor medication adherence was associated with poor outcomes, often disastrous, with low life satisfaction. Other variables such as presence of substance use disorders or family support did not explain the difference between those who adhered and those who did not.

Conclusions

In this naturalistic study, patients who adhered to antipsychotic medication had better long-term global outcomes than those who had poor adherence. Study limitations include the potential for residual confounding. This sample provides data consistent with the recommendation, in the absence of clinically important unwanted drug effects like tardive dyskinesia or large weight gain, for continuous, long-term antipsychotic treatment for chronic schizophrenia.
Hepatitis C in a Mobile Low-Threshold Methadone Program
Authors: Silva Mário J. , Pereira Cláudia , Loureiro Rafaela , Balsa Catarina , Lopes Paulo , Água-Doce Ivone , Belo Elsa , Martins Helena C. , Coutinho Rodrigo , Pádua Elizabeth
Published: February 2017

Introduction

Data on the epidemiology of hepatitis C among individuals who use drugs in low-threshold settings are lacking, although crucial to assess the burden of disease and aid in the design of treatment strategies.

Objective

The aim of this study was to characterize the epidemiology and disease related to hepatitis C in a population attending a low-threshold methadone program.

Materials and methods

A cross-sectional study in the population attending the Mobile Low-Threshold Methadone Program in Lisbon, Portugal, was carried out. The survey included assessment of risk factors for infection with hepatitis C virus (HCV) and liver disease, HCV serology and RNA detection, HCV genotyping, and liver disease staging.

Results

A total of 825 participants were enrolled, 81.3% men, mean age 44.5 years. Injecting drug use (IDU) was reported by 58.4% – among these, 28.2% were people who inject drugs. Excessive drinking and HIV coinfection were reported by 33.4 and 15.9%, respectively. Among participants with active infection, 16.9% were followed up in hospital consultation. The overall seroprevalence for HCV was 67.6% (94.2% in IDU, 30.0% in non-IDU, 97.1% in people who inject drugs, and 75.6% in excessive drinkers). Among seropositives for HCV, active infection was present in 68.4%. Among individuals with active infection, the most common genotypes were 1a (45.3%) and 3a (28.7%), whereas 30% had severe liver fibrosis or cirrhosis. Age 45 years or older, HCV genotype 3, and coinfection with HIV were significant predictors of cirrhosis.

Conclusion

This population has a high burden of hepatitis C and several characteristics that favor dissemination of infection. Healthcare strategies are urgently needed to address hepatitis C in this setting.
An effectiveness study of group psychoeducation for hepatitis C patients in community clinics
Authors: North Carol S. , Pollio David E. , Sims Omar T. , Jain Mamta K. , Brown Geri R. , Downs Dana L. , Lisker-Melman Mauricio , Hong Barry A.
Published: February 2017

Objective

A successful psychoeducation program for serious mental illness, PsychoEducation Responsive to Families (PERF), was modified for hepatitis C virus (HCV). An effectiveness study was carried out comparing HCV-PERF with didactic education.

Patients and methods

A sample of 309 adult HCV patients was recruited from three outpatient settings and randomized (60% HCV-PERF, 40% didactic control). Groups met for 90 min bimonthly for 6 months following separate structured protocols. HCV-PERF sessions included a didactic curriculum developed uniquely for groups by member choice, with group problem-solving and support interactions. Patients were assessed at baseline, after the intervention, and 1 year later. Demographic and HCV-related variables and structured diagnostic interview data were obtained.

Results

Both groups improved significantly on major depression and alcohol and drug use, quality of life, risk behaviors, and treatment satisfaction, and worsened on disability and perceived HCV-related problems. Intervention groups did not differ on outcomes.

Conclusion

Even though the active intervention did not achieve a significant improvement relative to the control condition, the observable improvements in both conditions warrant further exploration of the contributions of education and support as potentially important elements of HCV behavioral intervention. Further study is needed to identify elements common to education interventions that may be contributory to the improved outcomes over time.
Endoscopic variceal ligation combined with argon plasma coagulation versus ligation alone for the secondary prophylaxis of variceal bleeding: a systematic review and meta-analysis
Authors: Li Xiaoyan , Jiang Tingting , Gao Jian
Published: February 2017

Endoscopic variceal ligation (EVL) is often recommended as an effective method for the treatment of esophageal varices, despite the important tendency of variceal recurrence. Recent studies indicate that combining EVL with argon plasma coagulation (APC) may be a more effective therapy than ligation alone. To investigate these findings, we carried out a systematic review and meta-analysis to compare the safety and efficacy of EVL combined with APC versus ligation alone for the secondary prophylaxis of esophageal variceal hemorrhage. All studies were searched through PubMed, the Cochrane Library, and Science Direct. The outcome measures were relative risk (RR) or risk difference with 95% confidence intervals (CIs) for dichotomous data and standardized mean difference for continuous data. Heterogeneity was calculated using the χ
2 and the I
2-tests. Two investigators independently identified four randomized-controlled trials included in the research. The variceal recurrence rate was significantly lower in the combined therapy group (RR=0.19, 95% CI: 0.09–0.41, P=0.000). The bleeding recurrence and mortalities in the two groups showed no significant differences (RR=0.29, 95% CI: 0.08–1.04, P=0.058; risk difference=−0.02, 95% CI: –0.08–0.04, P=0.576, respectively). Although the pyrexia incidence rate was significantly higher in the combined group (RR=3.42, 95% CI: 1.56–7.48, P=0.002), there was intertrial heterogeneity (I
2=52.5%, P=0.097). EVL combined with APC is superior to ligation alone for endoscopic variceal recurrence without severe adverse events in secondary prophylaxis against esophageal variceal bleeding. More high-quality studies are needed to strengthen this conclusion.
Effect of isokinetic training on muscle strength and postural balance in children with Down’s syndrome
Authors: Eid Mohamed A. , Aly Sobhy M. , Huneif Mohamed A. , Ismail Dina K.
Published: February 2017

Children with Down’s syndrome (DS) often have greater postural sway and delay in motor development. Muscle weakness and hypotonia, particularly of the lower extremities, are theorized to impair their overall physical health and ability to perform daily activities. Therefore, the aim of this study was to investigate the effects of isokinetic training on muscle strength and postural balance in children with DS. Thirty-one children with DS ranging in age from 9 to 12 years were assigned randomly into two groups. The control group received the conventional physical therapy, whereas the study group received the same therapy as the control group in addition to the isokinetic training 3 days a week for 12 weeks. Measurement of stability indices using the Biodex Stability System as well as peak torque of knee flexors and extensors of both sides using the isokinetic dynamometer was performed before and after 12 weeks of the treatment program. Each group showed significant improvements in postural balance and peak torque of knee flexors and extensors (P<0.05), with significantly greater improvements observed in the study group compared with the control group (P<0.05). These outcomes indicated that participation in the isokinetic training program induced greater improvements in muscle strength and postural balance in children with DS.
Global Adverse Event Reports of Breast Implant–Associated ALCL: An International Review of 40 Government Authority Databases
Authors: Srinivasa Dhivya R. , Miranda Roberto N. , Kaura Arminder , Francis Ashleigh M. , Campanale Antonella , Boldrini Rosaria , Alexander Janette , Deva Anand K. , Gravina Paula R. , Medeiros L. Jeffrey , Nast Karen , Butler Charles E. , Clemens Mark W.
Published: February 2017

Background:

Tracking world cases of breast implant–associated anaplastic large cell lymphoma (ALCL) is currently limited to patient registries at a few academic centers, dependent upon patient referral and case reports in the literature. The purpose of this study was to review and compare federal database adverse event reports of breast implant–associated ALCL encompassing the major breast implant markets worldwide.

Methods:

Federal implantable device regulatory bodies were contacted and database queries were performed for 40 countries. Demographics, device characteristics, pathology, treatment modalities, and outcomes were assessed when available.

Results:

For the countries queried, 363 unique cases were reported for breast implant–associated ALCL. Search terms “anaplastic” and “ALCL” were queried of the U.S. Manufacturer and User Facility Device Experience (MAUDE) database and yielded 258 unique cases as of September 2015, of which only 130 had pathologic markers performed. Implant surface was textured significantly more than smooth (50 percent versus 4.2 percent; p = 0.0001). Treatment, when reported (n = 136), included explantation [n = 125 (91.9 percent)], chemotherapy [n = 42 (30.8 percent)], radiation therapy [n = 25 (18.4 percent)], and/or stem cell transplant [n = 9 (6.6 percent)], and five deaths were reported.

Conclusions:

Federal reporting of breast implant–associated ALCL has limitations in providing clinical history, treatment, and oncologic follow-up. Worldwide and country-specific total and textured implant sales data are needed to determine critical incidence and prevalence analysis. International multi-institutional collaborations and centralized tissue consortiums working in concert with federal authorities are necessary to acquire accurate complete data on breast implant–associated ALCL.
U.S. Epidemiology of Breast Implant–Associated Anaplastic Large Cell Lymphoma
Authors: Doren Erin L. , Miranda Roberto N. , Selber Jesse C. , Garvey Patrick B. , Liu Jun , Medeiros L. Jeffrey , Butler Charles E. , Clemens Mark W.
Published: February 2017

Background:

Breast implant–associated anaplastic large cell lymphoma (ALCL) is a distinctive type of T-cell lymphoma that arises around breast implants. Although rare, all cases with adequate history have involved a textured breast implant. The objective of this study was to determine the U.S. incidence and lifetime prevalence of breast implant–associated ALCL in women with textured breast implants.

Methods:

This is a retrospective review of documented cases of breast implant–associated ALCL in the United States from 1996 to 2015. The incidence and prevalence were determined based on a literature and institutional database review of breast implant–associated ALCL cases and textured breast implant sales figures from implant manufacturers’ annualized data.

Results:

One hundred pathologically confirmed breast implant–associated ALCL cases were identified in the United States. Mean age at diagnosis was 53.2 ± 12.3 years. Mean interval from implant placement to diagnosis was 10.7 ± 4.6 years. Forty-nine patients had breast implants placed for cosmetic reasons, 44 for mastectomy reconstruction, and seven for unknown reasons. Assuming that breast implant–associated ALCL occurs only in textured breast implants, the incidence rate is 2.03 per 1 million person-years (203 per 100 million person-years), which is 67.6 times higher than that of primary ALCL of the breast in the general population (three per 100 million per year; p < 0.001). Lifetime prevalence was 33 per 1 million persons with textured breast implants.

Conclusions:

This study demonstrates a statistically significant association between textured breast implants and breast implant–associated ALCL. Although women with a textured breast implant have a low risk of developing breast implant–associated ALCL, the current U.S. incidence is significantly higher than that of primary ALCL of the breast in the general population.
The Effect of Atomoxetin Use in the Treatment of Attention-Deficit/Hyperactivity Disorder on the Symptoms of Restless Legs Syndrome: A Case Report
Authors: Baykal Saliha , Karakurt Melih Nuri
Published: February 2017

Attention-deficit/hyperactivity disorder (ADHD) is frequently accompanied with sleep disorders such as obstructive sleep apnea, periodic limb movement disorder, restless legs syndrome (RLS), and circadian rhythm disorder. We have limited information about the effects of medical therapies used in the treatment of ADHD on RLS. This article discusses the effects of atomoxetine treatment on both disorders in a patient followed by diagnoses of ADHD and RLS.
The Use of Zonisamide for the Treatment of Psychiatric Disorders: A Systematic Review
Authors: Buoli Massimiliano , Grassi Silvia , Ciappolino Valentina , Serati Marta , Altamura Alfredo C.
Published: February 2017

Objective

Traditional pharmacotherapy has undoubtedly improved the outcome of patients with psychiatric disorders, but partial efficacy or poor tolerability persists in a number of these subjects. Among different compounds, zonisamide has been used to address unmet needs of standard pharmacotherapy. The purpose of the present article is to provide a review about the use of zonisamide for the treatment of psychiatric conditions.

Methods

A research in the main database sources has been conducted to obtain an overview of the use of zonisamide in psychiatric disorders or associated conditions (obesity and smoking cessation).

Results

Most available data indicate the possible effectiveness of zonisamide for the treatment of acute phases of bipolar disorder, binge-eating disorder (BED), alcohol misuse, and obesity. A further assessment of the safety and tolerability of zonisamide is made necessary by the fact that, with the exception of BED, for all other disorders at least some data come from studies with combined pharmacological therapies.

Conclusions

Zonisamide may have some utility, especially as an adjunctive therapy, for the management of acute phases and weight gain in bipolar disorder and for prevention of alcohol misuse. Preliminary evidence indicates zonisamide as a candidate compound for the treatment of BED and obesity. However, open-label design and small sample sizes of most available studies prevent from drawing sound conclusions about the utility of this compound in psychiatry.
Function of the Arabidopsis kinesin-4, FRA1, requires abundant processive motility
Authors: Ganguly Anindya , DeMott Logan , Dixit Ram
Published: February 2017

Processivity is important for kinesins that mediate intracellular transport. Structure-function analyses of N-terminal kinesins have identified several non-motor regions that affect processivityin vitro. However, whether these structural elements affect kinesin processivity and function in vivo is not known. Here, we used an Arabidopsis kinesin-4, called Fragile Fiber1 (FRA1), which is thought to mediate vesicle transport to test whether mutations that alter processivityin vitrobehave similarly in vivo and whether processivity is important for FRA’s function. We generated several FRA1 mutants that differed in their run lengthsin vitroand then transformed them into thefra1-5mutant for complementation and in vivo motility analyses. Our data show that the behavior of processivity mutants in vivo can differ dramatically fromin vitroproperties, underscoring the need to extend structure-function analyses of kinesins in vivo. In addition, we found that high density of processive motility is necessary for FRA1’s physiological function.

This study shows that the motility of kinesin mutants can differ significantly betweenin vitroandin vivoconditions and that abundant processive motility is important for FRA1 kinesin’s function.
The rapid evolution of alternative splicing in plants
Authors: Ling Zhihao , Brockmöller Thomas , Baldwin Ian T. , Xu Shuqing
Published: February 2017

Alternative pre-mRNA splicing (AS) is prevalent among all plants and is involved in many interactions with environmental stresses. However, the evolutionary patterns and underlying mechanisms of AS in plants remain unclear. By analyzing the transcriptomes of six plant species, we revealed that AS diverged rapidly among closely related species, largely due to the gains and losses of AS events among orthologous genes. Furthermore, AS that generates transcripts containing premature termination codons (PTC), although only representing a small fraction of the total AS, are more conserved than those that generate non-PTC containing transcripts, suggesting that AS coupled with nonsense-mediated decay (NMD) might play an important role in regulating mRNA levels post-transcriptionally. With a machine learning approach we analyzed the key determinants of AS to understand the mechanisms underlying its rapid divergence. Among the studied species, the presence/absence of alternative splicing site (SS) within the junction, the distance between the authentic SS and the nearest alternative SS, the size of exon-exon junctions were the major determinants for both alternative 5’ donor site and 3’acceptor site, suggesting a relatively conserved AS mechanism. Comparative analysis further demonstrated that variations of the identified AS determinants, mostly are located in introns, significantly contributed to the AS turnover among closely related species in both Solanaceae and Brassicaceae taxa. These new mechanistic insights into the evolution of AS in plants highlight the importance of post-transcriptional regulation in mediating plant-environment interactions.

One sentence summary

Changes of intron located splicing regulators contributed to the rapid evolution of alternative splicing in plants.
Bursting on a two state stochastic model for gene transcription inDrosophilaembryos
Authors: Yvinec Romain , da Silva Luiz Guilherme S. , Prata Guilherme N. , Reinitz John , Ferreira Ramos Alexandre
Published: February 2017

Recent experimental data on the transcription dynamics ofevegene stripe two formation ofDrosophila melanogasterembryos occurs in bursts of multiple sizes and durations. That has motivated the proposition of a transcription model having multiple ON states for the promoter of theevegene each of them characterized by different synthesis rate. To understand the role of multiple ON states on gene transcription we approach the exact solutions for a two state stochastic model for gene transcription inD. melanogasterembryos and derive its bursting limit. Simulations based on the Gillespie algorithm at the bursting limit show the occurrence of bursts of multiple sizes and durations. Based on our theoretical approach, we interpret the aforementioned experimental data as a demonstration of the intrinsic stochasticity of the transcriptional processes in fruit fly embryos. Then, we conceive the experimental arrangement to determine when gene transcription has multiple ON promoter state in a noisy environment.