bluuebunny/crossref_metadata_2025 huggingface dataset:
Dengue Vaccine Booster in Healthy Adolescents and Adults in Latin America
Authors: Coronel Diana , García-Rivera Enid J. , Rivera Maribel , Arredondo-García José Luis , Dietze Reynaldo , Perroud Ana Paula , Cortés Margarita , Bonaparte Matthew , Zhao Jessie , Tila Mihaela , Jackson Nick , Zambrano Betzana , Noriega Fernando
Published: February 2019

Background:

The tetravalent dengue vaccine (CYD-TDV, Dengvaxia, Sanofi Pasteur) demonstrated efficacy in 2 previous phase III trials conducted in endemic countries. Neutralizing antibodies (NAbs) elicited by 3 doses of this vaccine have been associated with efficacy. Long-term follow-up data has shown that NAb immune responses tend to wane over time, after the third dose. This study compared the immune response elicited by a booster (4th) dose of CYD-TDV with the immune responses from the same participants obtained post-dose 3 of the primary series administered 4–5 years earlier.

Methods:

This multicenter, observer-blind, randomized, placebo-controlled, phase II noninferiority trial was conducted in healthy adolescents and adults in dengue endemic countries of Latin America (Colombia, Honduras, Brazil, Mexico and Puerto Rico). All participants had been immunized with 3 doses of CYD-TDV in phase II studies conducted 4–5 years earlier. NAb levels against each dengue virus serotype 28 days postbooster or placebo injection were reported.

Results:

A total of 187 participants received CYD-TDV and 64 received placebo. Prospectively defined noninferiority criteria for dengue NAbs after the booster dose compared with postdose 3 were met for all 4 serotypes. Prospectively defined superiority criteria were met for 3 of the 4 serotypes.

Conclusions:

Antidengue NAb levels can be boosted to levels at least as high as, or higher than those observed after completion of the primary 3-dose series, with an additional dose of CYD-TDV 4–5 years after the standard 3-dose vaccination schedule.
Highly Sensitive Molecular Assay for Group A Streptococci Over-identifies Carriers and May Impact Outpatient Antimicrobial Stewardship
Authors: Tanz Robert R. , Ranniger Elizabeth J. , Rippe Jason L. , Dietz Renée L. , Oktem Caroline L. , Lowmiller Christine L. , Shulman Stanford T.
Published: February 2019

Background:

Timely, accurate diagnosis of group A streptococci (GAS) pharyngitis prevents acute rheumatic fever and limits antibiotic overuse. The illumigene group A Streptococcus assay (Meridian Bioscience, Cincinnati, OH) is a molecular test for GAS pharyngitis with high sensitivity and specificity. We sought to determine whether the illumigene test is more likely than throat culture to be positive in patients without pharyngeal symptoms and explore the limits of detection of the test.

Methods:

Patients 3–17 years of age were eligible if they had no history of pharyngitis or use of antibiotics within the previous 2 weeks; there were no upper respiratory infection symptoms, sore throat or fever and no signs of infection. Culture and illumigene were performed on duplicate throat swabs. Excess lysate from a subset of illumigene tests was evaluated by real-time polymerase chain reaction. Institutional Review Board approval was obtained.

Results:

We enrolled 385 patients from February 2016 to October 2017; mean age was 10 yr; 51% were male. Most visits were for health supervision (69%). Significantly more illumigene tests (78/385, 20.3%) than throat cultures (48/385, 12.5%) were positive (χ2; P =0.0035). Illumigene was “indeterminate” for 3 patients, leaving 382 pairs of swabs for analysis. Results were discordant for 32 of 382 pairs (8.4%); 31 of 32 (97%) were illumigene-positive/culture-negative (McNemar test; P < 0.000001). Real-time polymerase chain reaction was negative in 4 of 13 (31%) tested illumigene-positive lysates; the paired culture had been negative in all four. The limit of detection for the illumigene test was 55 colony forming units/mL.

Conclusions:

The illumigene test is significantly more likely than throat culture to yield positive results in patients without GAS pharyngitis. Failure to appropriately select patients for testing may negatively impact antimicrobial stewardship efforts without benefit to patients.
Complicated Head and Neck Infections Following Influenza Virus Infection in Children
Authors: Foster Catherine E. , Kaplan Sheldon L.
Published: February 2019

Seasonal influenza infection is associated with secondary bacterial complications involving the upper and lower respiratory tract. However, the association of influenza infection with secondary severe or complicated head and neck infections is not appreciated. We report 6 cases of head and neck infections following influenza infection in pediatric patients.
The Feasibility Study of a Revised Standard Care Procedure on the Capacity of Nasogastric Tube Placement Verification Among Critical Care Nurses
Authors: Yang Feng-Huang , Lin Feng-Yu , Hwu Yueh-Juen
Published: February 2019

Background

Evidence-based studies propose that the aspirate pH test may be easily and reliably conducted to verify the proper placement of nasogastric tubes (NGTs). Nurses rarely implement this procedure because of the lack of related knowledge.

Purpose

The purpose of this study was to explore the feasibility of implementing a revised standard care procedure to enhance nurses' ability to verify placement of the NGT.

Methods

his study used a quasi-experimental, longitudinal research design. Nurses from two intensive care units were randomly assigned to the experimental group (n = 35) and the control group (n = 31). A revised standard-of-care procedure to confirm the proper placement of an NGT was incorporated into a slideshow presentation, a printed leaflet, and an audit checklist. The experimental group received continuous education and individual teaching on the revised standard-of-care procedure, whereas the control group did not receive additional education and continued to provide conventional care. The study gathered data using scales designed to address knowledge of and attitudes toward verification of NGT placement and the checklist for auditing the NGT care procedure. Scales were implemented before and after the practice program was conducted, in Months 1, 2, and 3, to evaluate the feasibility of the developed improvement measures.

Results

This study found significant improvements in the experimental group in terms of knowledge regarding NGT placement verification and the NGT care auditing procedure. The positive improvement of the intervention on the NGT care auditing procedure remained for at least 3 months after the end of the intervention.

Conclusions

The findings suggest that using an aspirate pH test is a feasible approach to verify NGT placement in critical care units, a crucial aspect of care necessary to promote patient safety and quality of care.
The Impact of Communication Surrounding Intrauterine Congenital Anomaly Diagnoses
Authors: Berry Shandeigh N. , Colorafi Karen
Published: February 2019

Congenital anomalies are the leading cause of infant death in the United States, accounting for 20% of the annual infant mortality. Advancements in ultrasound diagnostic technology allow practitioners to diagnose fetal anomalies as early as 11 weeks' gestational age, 75% of which are detected in low-risk pregnancies. Communicating a fetal anomaly diagnosis to parents and initiating perinatal end-of-life discussions are difficult for healthcare providers and parents alike. Furthermore, poorly communicated diagnoses have had long-term negative impacts on perinatal grief intensity, which can manifest into lifelong symptoms of adverse psychosocial outcomes such as anxiety, depression, substance abuse, and suicidal ideation. The purpose of this integrative review is to examine the impact of communication in discussing an intrauterine diagnosis of a fetal congenital anomaly on perinatal grief. An integrative review was conducted following the distinct 5-stage process of problem identification, searching the literature, evaluating data, analyzing, and presenting findings. A systematic literature review using the PICO model (Population, Intervention, Comparison, Outcome) and structured after the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). This framework was completed between November 2017 and May 2018 using PubMed, CINAHL, and PsycINFO databases. Of the 931 article results, 15 satisfied search criteria. Emerging themes included parental need for appropriate time to assimilate and understand the diagnosis, freedom to explore options and alternatives, and the need for clinicians with expert communication skills. The initial conversation communicating the diagnosis of a congenital anomaly impacts expectant parents for the remainder of their lives. Healthcare professionals are in a unique position to either positively or negatively impact the intensity of perinatal grieving reactions. The application of empathetic, sensitive communication may offer solace and promote healing surrounding perinatal end-of-life discussions.
The Functionality of the Bio-Mechanical Prosthetic Finger When Compared With Results on Standardized and Functional Assessments: A Single-Case Study
Authors: Denham Susan P. , Hawkins Taylor , Johnson Kelsey , Rhoads Jenna , Sims Sara
Published: February 2019

Introduction

The purpose of this study was to examine the functionality of the bio-mechanical prosthetic finger (BPF). The researchers administered various assessments to examine how the BPF performed in comparison with the affected hand without the BPF, as well as the unaffected hand.

Materials and Methods

A single subject participant with amputations at the proximal phalanx of the third and fourth digits was recruited for this study. The subject was assessed without a prosthetic device and while wearing a BPF on each digit. The researchers also assessed the uninvolved hand for comparison. The following standardized assessments were administered: Minnesota Manual Dexterity Test, Jamar Hand Function Test, and Box and Blocks Test. Two qualitative questionnaires and The Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire were also administered to examine the participant's abilities and satisfaction with and without the prosthetic device.

Results

The results were analyzed to assess the difference in performance with and without the prosthetic device as compared with the unaffected side. The results indicated that the participant performed at a higher level on all assessments while using the BPF. In addition, the participant reported a higher level of comfort and satisfaction while using the prosthesis.

Conclusions

The results of the study showed that the BPF is a viable option for digit amputations to restore function in daily tasks.
American Medical Society for Sports Medicine Position Statement on Concussion in Sport
Authors: Harmon Kimberly G. , Clugston James R. , Dec Katherine , Hainline Brian , Herring Stanley A. , Kane Shawn , Kontos Anthony P. , Leddy John J. , McCrea Michael A. , Poddar Sourav K. , Putukian Margot , Wilson Julie C. , Roberts William O.
Published: February 2019

Sport-related concussion (SRC) is a common injury in recreational and organized sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment, and management of SRC. In addition to a growing need for knowledgeable health care professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. The American Medical Society for Sports Medicine formed a writing group to review the existing literature on SRC, update its previous position statement,1and address current evidence and knowledge gaps regarding SRC. The absence of definitive outcomes-based data is challenging and requires relying on the best available evidence integrated with clinical experience and patient values. This statement reviews the definition, pathophysiology, and epidemiology of SRC, the diagnosis and management of both acute and persistent concussion symptoms, the short- and long-term risks of SRC and repetitive head impact exposure, SRC prevention strategies, and potential future directions for SRC research. The American Medical Society for Sports Medicine is committed to best clinical practices, evidence-based research, and educational initiatives that positively impact the health and safety of athletes.
Gene editing: The power and risks of creation
Authors: Seibert Diane
Published: February 2019

This article explores the origin of the first cellular structures, briefly examines the process of evolution, explores some of the earlier challenges in human gene editing, explains how bacterial immune systems have provided the secret to a very powerful gene editing tool, and finally explores some of the very troubling ethical issues emerging with gene editing.
Young Age Predicts Acute Pancreatitis Severity in Children
Authors: Galai Tut , Cohen Shlomi , Yerushalmy‐Feler Anat , Weintraub Yael , Moran‐Lev Hadar , Amir Achiya Z.
Published: February 2019

Objectives:

The course and evolution of pediatric acute pancreatitis (AP) is poorly understood. Prognostication models in children perform poorly and lack consensus. We aimed to identify predictors of AP severity, and the risk for AP recurrence.

Methods:

We retrospectively studied all patients hospitalized with AP at a single tertiary center, between January 1995 and June 2016. Patient demographics and admission laboratory data were assessed for severity and recurrence prediction.

Results:

A total of 68 patients accounting for a total of 117 (15 moderate‐severe) AP episodes were reviewed. Patients with moderate‐severe disease were significantly younger (median [interquartile range (IQR)] of 8.3 [4.0–14.4] vs 13.8 [8.1–16.0] years, P = 0.02). Young age at presentation was associated with odds ratio of 3.8 (confidence interval [CI] 1.2–12.1) for children younger than 12 years and 5.8 (CI 1.6–21.4) for children younger than 6 years for developing moderate‐severe disease.

Further subanalysis of the 59 patients with first‐time AP episodes, demonstrated younger age (median [IQR] of 5.3 [2.9–10.4] vs 12.0 [6.3–15.8] years, P = 0.03) and elevated white blood cell count (median [IQR] of 22.8 [11.8–31.3] vs 11.0 [8.1–14.6] 109/L, P < 0.01) of patients with moderate‐severe disease, conferring a risk for moderate‐severe disease with odds ratio of 7.5 (CI 1.5–38.2) for children younger than 6 years and 5.3 (CI 1.1–25.4) for patients with white blood cell count >15 × 109/L, respectively. Fourteen (23.7%) of 59 patients with first‐time episodes had recurrent AP. Analysis of the data at the primary episode failed to identify predictors to indicate future recurrence.

Conclusions:

In our cohort, only young age (<12 years) predicted AP severity. No parameters were identified to predict future development of AP recurrence.
Analysis of Influencing Factors of Poststroke Depression
Authors: Xue Zhiqiang , Wang Yanjun , Wang Lijuan , Shen Li , Zhang Anning , Pan Pan , Wang Hongjie , Dou Jing , Guo Xin , Lv Yaogai , Jin Lina , Yao Yan
Published: February 2019

Poststroke depression (PSD) is a common complication of stroke. We sought to investigate the influencing factors of PSD and explored the association between body mass index (BMI) and PSD. A total of 397 stroke patients in a hospital in Qiqihar City, China, were included in this study in 2016. The order of independent variable importance was the score of the National Institute of Health Stroke Scale, frequency of stroke, age, BMI, and sleep duration. Sleep duration of 7 hours or more (compared with <7 hours) was negatively associated with the Self-Rating Depression Scale (SDS) score in all quantiles. BMI of 28.0 kg/m2 or more (compared with 24.0–28.0 kg/m2) was negatively associated with SDS score, and the coefficients manifested a continuous increasing trend from P
30 to P
84.1 in patients aged 65 years or more. In addition, the relationship between BMI and SDS score demonstrated a “U”-shaped curve in patients aged less than 65 years. The National Institute of Health Stroke Scale score, the frequency of stroke, sleep duration, and BMI were the influencing factors of PSD. BMI played different roles in the two age groups.
Factors Associated With Length of Stay in Emergency Departments for Pediatric Patients With Psychiatric Problems
Authors: Smith Joseph L. , De Nadai Alessandro S. , Petrila John , Storch Eric A.
Published: February 2019

Objectives

Length of stay (LOS) and boarding for pediatric psychiatric patients presenting in the emergency department (ED) have been understudied, despite evidence that children with psychiatric disorders experience longer LOS relative to those without. This investigation examined correlates of LOS and boarding among youth with psychiatric disorders presenting to the ED in a large, statewide database.

Methods

Using the 2010 to 2013 Florida ED discharge database, generalized linear mixed models were used to examine for associations between LOS and patient and hospital characteristics among pediatric patients (<18 years) who presented with a primary psychiatric diagnosis (N = 44,328).

Results

Patients had an overall mean ± SD ED LOS of 5.96 ± 8.64 hours. Depending on the definition used (ie, 12 or 6 hours), between 23% and 58% of transferred patients were boarded. Patient characteristics associated with a longer LOS included female sex, being 15 to 17 years old, Hispanic ethnicity, having Medicaid or VA/TriCare insurance, having impulse control problems, having mood or psychotic disorders, and exhibiting self-harm behaviors. Patient transfer, large hospital size, and rural designation were associated with longer LOS. Teaching hospital status and profit status were not significantly associated with LOS.

Conclusions

These data suggest that LOS for pediatric psychiatry patients in the ED varies significantly by psychiatric presentation, patient disposition, and hospital factors. Such findings have implications for quality of care, patient safety, and health outcomes.
Management of Pain After Pediatric Trauma
Authors: Day Lindsay Marie , Huang Rong , Okada Pamela Joy
Published: February 2019

Objectives

The primary objective of this study was to evaluate the management of pain after traumatic injury in the pediatric emergency department (ED) as measured by time to analgesic administration and pain resolution, stratified by triage acuity level.

Methods

This is a retrospective descriptive study evaluating the management of children who presented with pain after injury to an urban level 1 trauma center. Consecutive enrollment of 1000 patients identified by ICD-9 codes that included all injuries or external causes for injury (700–999 and all E codes) and who had pain identified by triage pain assessment was performed. For analysis, patients were grouped according to triage level.

Results

Fifty-one percent (511/1000) of patients achieved pain resolution, and an additional 20% (200/1000) of patients had documented improvement in pain score during their ED visit. Triage acuity level 1 group received medications the fastest with a median time of 12 minutes (interquartile range, 10–53 minutes); 65.3% of patients (653/1000) received a pain medication during their ED visit; 54.3% of these patients received oral medications only. Average time to intravenous line placement was 2 hours 35 minutes (SD, 2 hours 55 minutes). Only 1.9% of patients received any medications prior to arrival.

Conclusions

Higher-acuity patients received initial pain medications and had initial pain score decrease before lower-acuity patients. Given the retrospective nature of the study, we were unable to clearly identify barriers that contributed to delay in or lack of pain treatment in our patient population.
Success Rates for Reduction of Pediatric Distal Radius and Ulna Fractures by Emergency Physicians
Authors: Putnam Kristy , Kaye Bryan , Timmons Zebulon , Wade Shrader M. , Bulloch Blake
Published: February 2019

Background

Emergency physicians are trained in urgent fracture reduction. Many hospitals lack readily available in-house orthopedic coverage.

Objectives

The aim of this study was to determine success rates for reduction of pediatric distal radius or ulna fractures by emergency department (ED) physicians.

Methods

We conducted a retrospective study of children younger than 18 years presenting to a large, urban, freestanding children's hospital from January 1, 2009, to December 31, 2010, with forearm fracture. Exclusions included open fracture, those requiring immediate surgical intervention, or additional fractures. The primary end point was the proportion of successful closed forearm fracture reductions in the ED, as defined by orthopedic follow-up.

Results

All reductions were performed by a board-certified/eligible pediatric emergency medicine (PEM) physician or PEM fellow. Two hundred ninety-five fractures were reduced in the ED during the study period. Mean age was 8.27 years (median, 8 years; range, 1–16 years), and males comprised 69.2% (n = 204). A total of 222 fractures (76%) were of the distal forearm, and 70 involved the midshaft (24%). Orthopedic follow-up was completed in 77.3%. A total of 33 patients (11%) required remanipulation; 24 in the distal forearm fracture group (22 closed reductions, 2 open reductions with internal fixation) versus 9 in the midshaft group (7 closed reductions, 2 open reductions with internal fixation) (P = 0.948).

Conclusions

The literature reveals 7% to 39% of children with fracture reductions performed in the ED by orthopedic surgeons/residents require remanipulation. Our rate of 11% is consistent within that range. With training, PEM physicians have similar success rates as orthopedists in forearm fracture reductions.
Burns Due to Application of Raw Garlic to the Feet as a Home Remedy for Fever
Authors: Strickler Leslie , Harjo Tracy
Published: February 2019

We present an illustrative case of unintentional burns to the feet of a 15-month-old child following the application of raw garlic as a home remedy for fever. We provide an overview of the historical medicinal uses of garlic as well as its unintended adverse effects. This case underscores the importance of clinicians' ability to recognize unusual presentations of injury due to culturally based practices that require care in emergency settings. This is particularly important in patient populations for whom abusive etiology would be considered.
A Multi-institutional Case Series With Review of Point-of-Care Ultrasound to Diagnose Malrotation and Midgut Volvulus in the Pediatric Emergency Department
Authors: Garcia Angélica Marie , Asad Imran , Tessaro Mark O. , Sivitz Adam , Osborn Katharine , Shaahinfar Ashkon , Leung Stephanie K. , Rowe Erin , Riera Antonio
Published: February 2019

Point-of-care ultrasound can be used to screen for malrotation with and without volvulus in the newborn with bilious vomiting, as well as children with unexplained intermittent abdominal pain. We discuss cases where infants and children presenting to pediatric emergency departments with bilious vomiting and/or intermittent abdominal pain were initially screened for small bowel pathology with point-of-care ultrasound. Bedside findings suggestive of midgut volvulus were confirmed with radiology-performed ultrasound or upper gastrointestinal fluoroscopy. In all cases, operative findings were consistent with malrotation of the small bowel with or without evidence of midgut volvulus.
The Effect of Computed Tomography–Guided Botulinum Toxin Injection on Cervical Dystonia, Confirmed by a 9-Month Follow-Up Using Positron Emission Tomography/Computed Tomography
Authors: Lee Seung Ah , Choi Ja-Young , Oh Byung-Mo
Published: February 2019

Although accurate targeting of the causative muscles is of paramount importance in the treatment of focal dystonia, this is often challenging because of distortion of the affected anatomical structures and difficulty in proper positioning of injections. We report a case of idiopathic cervical dystonia that was treated by computed tomography–guided injection of botulinum toxin into multiple deep muscles. Based on clinical presentation of combined torticollis and retrocollis, and needle electromyography results, botulinum toxin was injected under electromyography guidance. This treatment resulted in no improvement. Subsequently, target muscles were identified using 18F-fludeoxyglucose fusion positron emission tomography/computed tomography. botulinum toxin was injected into the hypermetabolic muscles guided by computed tomography. This injection successfully relieved the symptoms, and nine months of follow-up using positron emission tomography/computed tomography confirmed that hypermetabolic muscles had been normalized. This case indicated that computed tomography guidance may facilitate accurate targeting of botulinum toxin injection. To the authors' knowledge, this is the first case reporting a positive effect of botulinum toxin on cervical dystonia symptoms that lasted 9 mos, confirmed by follow-up positron emission tomography/computed tomography.
Computer-Aided Design and Computer-Aided Manufacturing Cutting Guides in Eminoplasty for the Treatment of Temporomandibular Joint Dislocation
Authors: Xu Chunwei , Liu Hanghang , Du Wen , Wang Yiyao , Hu Jian , Luo En
Published: February 2019

Objective:

Temporomandibular joint (TMJ) dislocation means the condyle moves out of the normal position. There are several treatments for TMJ dislocation, including conservative treatment, injection treatment, minimally invasive treatment, and open surgical treatment. In this study, we tried to review the literature related to the augmentation of the articular eminence and proposed a modified eminoplasty technique of TMJ dislocation by computer-aided design and computer-aided manufacturing (CAD/CAM) cutting guides.

Methods:

The literature on eminoplasty for TMJ was reviewed with 3 charts. Besides, 2 (67 and 69 years old) patients with chronic recurrent dislocation were treated by the CAD/CAM-guided surgical technique in our study, and postoperative measures were recorded to verify the safety and effectiveness regarding this technique.

Results:

A total of 28 studies (including 268 patients) of the augmentation of the articular eminence have been reported since 1967, including the 2 present patients. According to the analysis of the recurrence and complications in the review, we found the modified technique had an obvious advantage. The technique with cutting guides was also found having higher accuracy.

Conclusion:

The modified technique was a reliable method when treating the TMJ dislocation, and the combination of CAD/CAM cutting guides was useful for more accuracy, even reduced the operation difficulty.
Tissue Necrosis in Epstein–Barr Virus-Negative Orbital Diffuse Large B-Cell Lymphoma
Authors: Sarbajna Tushar , Takahashi Yasuhiro , Valencia Ma. Regina Paula , Nishimura Kunihiro , Kakizaki Hirohiko
Published: February 2019

An 82-year-old man presented with a history of diplopia for 5 months and painful swelling of the left eyelids for 3 months. Imaging studies revealed a lesion involving the left extraocular muscles, orbital fat, and optic nerve. Laboratory investigations were negative for Epstein–Barr virus antiviral capsid antigens-immunoglobulin M. Initial biopsy of the lesion was performed and histopathologic examination revealed only necrosis with positivity of cluster of differentiation 20. This prompted a second biopsy of the involved left extraocular muscles and the orbital fat. The results of histopathological and immunohistochemical tests corresponded to Epstein–Barr virus-negative diffuse large B-cell lymphoma, germinal center B-cell type.
The Impact of Early Clinical and Subclinical T Cell–mediated Rejection After Kidney Transplantation
Authors: Hoffman William , Mehta Rajil , Jorgensen Dana R. , Sood Puneet , Randhawa Parmjeet , Wu Christine M. , Puttarajappa Chetan , Shah Nirav A. , Tevar Amit D. , Hariharan Sundaram
Published: February 2019

Background.

We investigated the effect of clinical and subclinical T cell–mediated rejection (C-TCMR and SC-TCMR) on allograft histology, function, and progression.

Methods.

Adult kidney recipients with 2 protocol biopsies were divided into No-TCMR on biopsies (n = 104), SC-TCMR (n = 56), and C-TCMR (n = 32) in at least 1 biopsy. Chronicity (ci + ct + cg + cv) scores, renal function, and the burden of renal disease measured by area under the curve (serum creatinine, mg mo/dL) were compared.

Results.

Baseline characteristics were similar except for mean donor age and Kidney Donor Profile index scores. Patients with C-TCMR had higher mean serum creatinine, lower mean estimated glomerular filtration rate, and higher area under the curve with 95% confidence interval (75.2 [67.7-82.7]) as opposed to patients with SC-TCMR and No-TCMR (58.3 [53.6-62.9], 65.1 [58.8-71.5]), P = 0.0004. Chronicity scores were higher at 3 months in C-TCMR (2.30 ± 1.58) compared with SC-TCMR (2.02 ± 1.42) and No-TCMR (1.31 ± 1.18), P = 0.0001 and also at 12 months. At last follow-up, 18.8% patients with C-TCMR had ≥50% decline in estimated glomerular filtration rate from 3 months compared with 7% and 1% among No-TCMR and SC-TCMR groups (P = 0.038). Multivariate analyses revealed higher odds of Δ-creatinine ≥ 0.5 mg/dL from 3 months to last follow-up for C-TCMR (3.39 [95% confidence interval, 1.25-9.20]) versus No-TCMR (P = 0.016).

Conclusions.

Kidney transplant recipients with C-/SC-TCMR have heightened early allograft chronicity and worse renal function compared with those with No-TCMR. Progressive renal dysfunction was noted among patients with C-TCMR as opposed to SC-TCMR and No-TCMR.
Cannabis Dependence or Abuse in Kidney Transplantation: Implications for Posttransplant Outcomes
Authors: Alhamad Tarek , Koraishy Farrukh M. , Lam Ngan N. , Katari Sreelatha , Naik Abhijit S. , Schnitzler Mark A. , Xiao Huiling , Axelrod David A. , Dharnidharka Vikas R. , Randall Henry , Ouseph Rosemary , Segev Dorry L. , Brennan Daniel C. , Devraj Radhika , Kasiske Bertram L. , Lentine Krista L.
Published: February 2019

Background.

Cannabis is categorized as an illicit drug in most US states, but legalization for medical indications is increasing. Policies and guidance on cannabis use in transplant patients remain controversial.

Methods.

We examined a database linking national kidney transplant records (n = 52 689) with Medicare claims to identify diagnoses of cannabis dependence or abuse (CDOA) and associations [adjusted hazard ratio (aHR) with 95% upper and lower confidence limits (CLs)] with graft, patient, and other clinical outcomes.

Results.

CDOA was diagnosed in only 0.5% (n = 254) and 0.3% (n = 163) of kidney transplant recipients in the years before and after transplant, respectively. Patients with pretransplant CDOA were more likely to be 19 to 30 years of age and of black race, and less likely to be obese, college-educated, and employed. After multivariate and propensity adjustment, CDOA in the year before transplant was not associated with death or graft failure in the year after transplant, but was associated with posttransplant psychosocial problems such as alcohol abuse, other drug abuse, noncompliance, schizophrenia, and depression. Furthermore, CDOA in the first year posttransplant was associated with an approximately 2-fold increased risk of death-censored graft failure (aHR, 2.29; 95% CL, 1.59–3.32), all-cause graft loss (aHR, 2.09; 95% CL, 1.50–2.91), and death (aHR, 1.79; 95% CL, 1.06–3.04) in the subsequent 2 years. Posttransplant CDOA was also associated with cardiovascular, pulmonary, and psychosocial problems, and with events such as accidents and fractures.

Conclusions.

Although associations likely, in part, reflect associated conditions or behaviors, clinical diagnosis of CDOA in the year after transplant appears to have prognostic implications for allograft and patient outcomes. Recipients with posttransplant CDOA warrant focused monitoring and support.
Effect of Donepezil on Cognitive Deficits Associated With Electroconvulsive Therapy: A Randomized Triple-blind Clinical Trial
Authors: Shams-Alizadeh Narges , Maroufi Azad , Sofla Akbar Qanbarzadeh Chelan , Ghaderi Ebrahim , Hassanzadeh Kambiz
Published: February 2019

Objectives

Despite the effectiveness of electroconvulsive therapy (ECT) in a wide range of psychiatric disorders, the role of memory-enhancing agents in post-ECT cognitive disturbances has remained controversial. In this study, we aimed to assess the effect of donepezil on improving the cognitive performance of patients undergoing ECT.

Methods

In a psychiatry hospital, patients who were admitted for ECT underwent a triple-blind randomized controlled trial. After randomizing the participants into 2 groups, 1 group received ECT with placebo, whereas the other group received ECT plus 5 mg/d donepezil during the ECT period. The patients in both groups were cognitively assessed using the Mini Mental Status Evaluation and Wechsler Memory Scale, 24 hours before ECT and 48 hours after the end of the ECT sessions.

Results

The results of Mini Mental Status Evaluation scores did not show any significant difference in memory performance between the 2 groups before and after ECT (F = 0.108, P = 0.743). Moreover, the intervention and placebo groups did not have any significant difference in the scores of the 7 subscales of the Wechsler Memory Scale after ECT (P = 0.07). In addition, the patients on donepezil group tolerated the drug well and did not differ significantly compared with the control group in this regard.

Conclusions

Despite a few evidence confirming the effect of acetylcholinesterase inhibitors in improving cognitive defects related to ECT, this study did not find such an effect in patients under ECT. Further studies are required to reach a clear conclusion.
Postinjection Delirium/Sedation Syndrome After 31st Long-Acting Olanzapine Depot Injection
Authors: Venkatesan Velprashanth , Khanra Sourav , Mandal Kamalika , Deepak MB
Published: February 2019

Objective

Long-acting depot preparations of antipsychotics are the mainstay of treatment for patients with schizophrenia who show nonadherence to their medications. Olanzapine pamoate is one of the recently approved long-acting depot psychotropic preparations that have shown its efficacy both in clinical trials and in clinical uses against the illness. However, emerging literature indicates toward a cluster of adverse effects known as postinjection delirium/sedation syndrome (PDSS).

Methods

We here present a case of PDSS in a woman with paranoid schizophrenia. After maintaining well for almost 1½ years, she developed PDSS at her 31st scheduled long-acting olanzapine injection.

Results

Several features of PDSS including its mechanism and course have been discussed.

Conclusions

More research is necessary to understand the syndrome and the association between PDSS and long-acting olanzapine injection. Clinicians should keep in mind that PDSS may worsen compliance in an index patient and affect the course of the illness.
Peristomal Moisture-Associated Skin Damage and Independence in Pouching System Changes in Persons With New Fecal Ostomies
Authors: Nagano Midori , Ogata Yasuko , Ikeda Masaomi , Tsukada Kunio , Tokunaga Keiko , Iida Satoru
Published: February 2019

PURPOSE:

The purpose of this study was to evaluate factors related to peristomal moisture-associated skin damage (MASD) in patients who underwent ostomy surgery because of colorectal cancer, and their independence in pouching system changes. Findings were used to determine pre- and postsurgical care for these patients.

DESIGN:

Retrospective review of medical records.

SUBJECTS AND SETTING:

The study setting was an 800-bed hospital in metropolitan Tokyo, Japan. The sample comprised 89 patients (median age: 65 years; male vs female: 58 vs 31) who visited a stoma clinic within 8 weeks of ostomy surgery. Fifty-two subjects had ileostomies and 37 had colostomies; data were collected between January 2008 and July 2014.

METHODS:

Data were collected from outpatient and inpatient records. Potential relationships between MASD and independence in pouching system changes were evaluated via univariate tests to identify possible associations, followed by logistic regression analysis.

RESULTS:

Patients living with an ileostomy were more likely to experience peristomal MASD than were patients living with a colostomy (odds ratio [OR] = 3.782; 95% confidence interval [CI]: 1.34-10.64; P = .012). Analysis also found that patients with postsurgical chemotherapy were more than 2.5 times more likely to experience peristomal MASD than patients who did not require postoperative chemotherapy (OR = 2.702; 95% CI: 1.02-7.18; P = .046). We also found that patients 65 years or older were significantly more likely to have difficulty in changing their pouching system than were younger patients (OR = 7.193; 95% CI: 2.21-23.41; P = .001), as were those with diabetes mellitus (OR = 11.842; 95% CI: 2.56-54.77; P = .002).

CONCLUSIONS:

Patients undergoing ileostomy and those receiving postoperative chemotherapy are more likely to experience peristomal MASD. Older patients (>65 years) and those with diabetes mellitus are less likely to achieve independence. These findings influenced our management of persons undergoing ostomy surgery for management of colorectal cancer in our clinic. We recommend additional research using a larger and more diverse sample to confirm our findings.
The monoplastidic bottleneck in algae and plant evolution
Authors: de Vries Jan , Gould Sven B.
Published: February 2019

Plant and algae plastids evolved from the endosymbiotic integration of a cyanobacterium by a heterotrophic eukaryote. A consequence of their ancestry is that new plastids can only emerge through fission and vital to organelle and host co-evolution was the early synchronization of bacterial division with the host’s eukaryotic cell cycle. Most of the sampled algae, including multicellular macroalgae, house a single plastid per cell — or nucleus in case of coenocytic cells — and basal branching relatives of polyplastidic lineages are all monoplastidic. The latter is also true regarding embryophytes, as some non-vascular plants are monoplastidic at least at some stage of their life cycle. Here we synthesize recent advances regarding plastid division and associated proteins, including those of the peptidoglycan wall biosynthesis, across the diversity of phototrophic eukaryotes. Through the comparison of the phenotype of 131 species harbouring plastids of primary or secondary origin, we uncover that one prerequisite for an algae or plant to house multiple plastids per nucleus appears the loss of the genes MinD and MinE from the plastid genome. Housing a single plastid whose division is coupled to host cytokinesis appears a prerequisite of plastid emergence; escaping that monoplastidic bottleneck succeeded rarely and appears tied to evolving a complex morphology. Considering how little we know about the mechanisms that guarantee proper organelle (and genome) inheritance raises the peculiar possibility that a quality control checkpoint of plastid transmission remains to be explored and which is tied to understanding the monoplastidic bottleneck.
Prodomain-Growth Factor Swapping in the Structure of pro-TGF-β1
Authors: Zhao Bo , Xu Shutong , Dong Xianchi , Lu Chafen , Springer Timothy A.
Published: February 2019

Transforming growth factor (TGF)-β is synthesized as a proprotein that dimerizes in the endoplasmic reticulum. After processing in the Golgi to cleave the N-terminal prodomain from the C-terminal growth factor (GF) domain in each monomer, pro-TGF-β is secreted and stored in latent complexes. It is unclear which prodomain and GF monomer are linked prior to proprotein convertase (PC) cleavage, and how much conformational change occurs following cleavage. We have determined a structure of pro-TGF-β1 with the PC cleavage site mutated, to mimic the structure of the TGF-β1 proprotein. Our structure demonstrates that the prodomain arm domain in one monomer is linked to the GF that interacts with the arm domain in the other monomer in the dimeric structure, i.e., the prodomain arm domain and GF domain in each monomer are swapped. Swapping has important implications for the mechanism of biosynthesis in the TGF-β family and is relevant to the mechanism for preferential formation of heterodimers over homodimers for some members of the TGF-β family. Our structure also provides comparisons between independent TGF-β1 crystal structures and between human and porcine pro-TGF-β1.
The Effect of Visual Capture Towards Subjective Embodiment Within the Full Body Illusion
Authors: Carey Mark , Crucianelli Laura , Preston Catherine , Fotopoulou Aikaterini
Published: February 2019

Typically, multisensory illusion paradigms emphasise the importance of synchronous visuotactile integration to induce subjective embodiment towards another body. However, the extent to which embodiment is due to the ‘visual capture’ of congruent visuoproprioceptive information alone remains unclear. Thus, across two experiments (total N = 80), we investigated how mere visual observation of a mannequin body, viewed from a first-person perspective, influenced subjective embodiment independently from concomitant visuotactile integration. Moreover, we investigated whether slow, affective touch on participants’ own, unseen body (without concomitant touch on the seen mannequin) disrupted visual capture effects to a greater degree than fast, non-affective touch. In total, 40% of participants experienced subjective embodiment towards the mannequin body following mere visual observation, and this effect was significantly higher than conditions which included touch to participants own, unseen body. The velocity of the touch that participants received (affective/non-affective) did not differ in modulating visual capture effects. Furthermore, the effects of visual capture and perceived pleasantness of touch was not modulated by subthreshold eating disorder psychopathology. Overall, this study suggests that congruent visuoproprioceptive cues can be sufficient to induce subjective embodiment of a whole body, in the absence of visuotactile integration and beyond mere confabulatory responses.
Propidium iodide staining underestimates viability of adherent bacterial cells
Authors: Rosenberg Merilin , Azevedo Nuno F. , Ivask Angela
Published: February 2019

Combining membrane impermeable DNA-binding stain propidium iodide (PI) with membrane-permeable DNA-binding counterstains is a widely used approach for bacterial viability staining. In this paper we show that PI staining of adherent cells in biofilms may significantly underestimate bacterial viability due to the presence of extracellular nucleic acids. We demonstrate that gram-positive Staphylococcus epidermidis and gram-negative Escherichia coli 24-hour initial biofilms on glass consist of 76 and 96% PI-positive red cells in situ, respectively, even though 68% the cells of either species in these aggregates are metabolically active. Furthermore, 82% of E. coli and 89% S. epidermidis are cultivable after harvesting. Confocal laser scanning microscopy (CLSM) revealed that this false dead layer of red cells is due to a subpopulation of double-stained cells that have green interiors under red coating layer which hints at extracellular DNA (eDNA) being stained outside intact membranes. Therefore, viability staining results of adherent cells should always be validated by an alternative method for estimating viability, preferably by cultivation.
Ozymandias: A biodiversity knowledge graph
Authors: Page Roderic D. M.
Published: February 2019

Enormous quantities of biodiversity data are being made available online, but much of this data remains isolated in their own silos. One approach to breaking these silos is to map local, often database-specific identifiers to shared global identifiers. This mapping can then be used to construct a knowledge graph, where entities such as taxa, publications, people, places, specimens, sequences, and institutions are all part of a single, shared knowledge space. Motivated by the 2018 GBIF Ebbe Nielsen Challenge I explore the feasibility of constructing a “biodiversity knowledge graph” for the Australian fauna. These steps involved in constructing the graph are described, and examples its application are discussed. A web interface to the knowledge graph (called “Ozymandias”) is available at https://ozymandias-demo.herokuapp.com.
Genome of the parasitoid waspDiachasma alloeum, an emerging model for ecological speciation and transitions to asexual reproduction
Authors: Tvedte Eric S. , Walden Kimberly K.O. , McElroy Kyle E. , Werren John H. , Forbes Andrew A. , Hood Glen R. , Logsdon John M. , Feder Jeffrey L. , Robertson Hugh M.
Published: February 2019

Parasitoid wasps are among the most speciose animals, yet have relatively few available genomic resources. We report a draft genome assembly of the waspDiachasma alloeum(Hymenoptera: Braconidae), a host-specific parasitoid of the apple maggot flyRhagoletis pomonella(Diptera: Tephritidae) and a developing model for understanding how ecological speciation can “cascade” across trophic levels. Identification of gene content confirmed the overall quality of the draft genome, and we manually annotated ∼400 genes as part of this study, including those involved in oxidative phosphorylation, chemosensation, and reproduction. Through comparisons to model hymenopterans such as the European honeybeeApis melliferaand parasitoid waspNasonia vitripennis, as well as a more closely related braconid parasitoidMicroplitis demolitor, we identified a proliferation of transposable elements in the genome, an expansion of chemosensory genes inD. alloeumand other parasitoid wasps, and the maintenance of several key genes with known roles in sexual reproduction and sex determination. TheD. alloeumgenome will provide a valuable resource for comparative genomics studies in Hymenoptera as well as specific investigations into the genomic changes associated with ecological speciation and transitions to asexuality.
Cell cycle dynamics of human pluripotent stem cells primed for differentiation
Authors: Shcherbina Anna , Li Jingling , Narayanan Cyndhavi , Greenleaf William , Kundaje Anshul , Chetty Sundari
Published: February 2019

Understanding the molecular properties of the cell cycle of human pluripotent stem cells (hPSCs) is critical for effectively promoting differentiation. Here, we use the Fluorescence Ubiquitin Cell Cycle Indicator (FUCCI) system adapted into hPSCs and perform RNA-sequencing on cell cycle sorted hPSCs primed and unprimed for differentiation. Gene expression patterns of signaling factors and developmental regulators change in a cell cycle-specific manner in cells primed for differentiation without altering genes associated with pluripotency. Furthermore, we identify an important role for PI3K signaling in regulating the early transitory states of hPSCs towards differentiation.