bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the Motor Performance and Vestibular Function in Infants with a Congenital Cytomegalovirus Infection or a Connexin 26 Mutation: A Preliminary Study
Authors: Maes Leen , De Kegel Alexandra , Van Waelvelde Hilde , De Leenheer Els , Van Hoecke Helen , Goderis Julie , Dhooge Ingeborg
Published: August 2016

Objectives:

Hearing-impaired children are at risk for vestibular damage and delayed motor development. Two major causes of congenital hearing loss are cytomegalovirus (CMV) infection and connexin (Cx) 26 mutations. Comparison of the motor performance and vestibular function between these specific groups is still underexplored. The objective of this study was to investigate the impact of congenital (c)CMV and Cx26 on the motor performance and vestibular function in 6 months old infants.

Design:

Forty children (mean age 6.7 months; range 4.8 to 8.9 months) participated in this cross-sectional design and were recruited from the Flemish CMV registry. They were divided into five age-matched groups: normal-hearing control, asymptomatic cCMV, normal-hearing symptomatic cCMV, hearing-impaired symptomatic cCMV, and hearing-impaired Cx26. Children were examined with the Peabody Developmental Motor Scales-2 and cervical vestibular-evoked myogenic potential (cVEMP) test.

Results:

Symptomatic hearing-impaired cCMV children demonstrated a significantly lower gross motor performance compared with the control group (p = 0.005), the asymptomatic cCMV group (p = 0.034), and the Cx26 group (0.016). In this symptomatic hearing-impaired cCMV group, 4 out of 8 children had absent cVEMP responses that were related to the weakest gross motor performance. The Cx26 children showed no significant delay in motor development compared with the control children and none of these children had absent cVEMP responses.

Conclusions:

The weakest gross motor performance was found in symptomatic hearing-impaired cCMV-infected children with absent cVEMP responses. These results suggest that abnormal saccular responses are a major factor for this delayed motor development, although more work is needed including comprehensive vestibular function testing to verify this.
Distally based peroneus brevis flap: a reliable and versatile flap to cover the lateral foot and ankle
Authors: Masadeh Suhail , Bibbo Christopher
Published: August 2016

Defects of the lower extremity are multifactorial, frequent, and complex. The distally based peroneus brevis muscle flap “PB” provides a good option for coverage of wounds of the lower leg and hindfoot. This technique largely replaces free flap surgery because it offers the benefit of microsurgical dissection and harvest of vascularized tissue without the addition of anastomosis. Additionally the procedure allows preservation of function, causes minimal donor site morbidity, and has a shorter operative time. This paper provides the historical background, anatomy, and technique illustration through a case study for this procedure.
Risk of Subluxation or Dislocation After Operative Treatment of Terrible Triad Injuries
Authors: Zhang Dafang , Tarabochia Matthew , Janssen Stein , Ring David , Chen Neal
Published: August 2016

Objective:

The management of terrible triad injuries has evolved over the last 2 decades to include routine radial head fixation or replacement, reattachment of the lateral collateral ligament, with or without coronoid fixation. Our objective was to determine the likelihood of and factors associated with subluxation or dislocation after operative treatment of terrible triad injuries among a large group of surgeons using current techniques.

Design:

Retrospective cohort study.

Setting:

Two level I trauma centers.

Patients/Participants:

A total of 107 patients with operatively treated terrible triad injuries from January 2000 to June 2015.

Intervention:

Review of patient- and surgery-related factors during the first postoperative month.

Main Outcome Measurement:

Radiographic subluxation of the ulnohumeral joint.

Results:

One hundred of the 107 patients (93%) treated with open fixation of terrible triad injuries had no radiographic subluxation or redislocation. Two patients (2%) had slight transient radiographic subluxation (“drop sign”) that corrected with active exercises within weeks of surgery. Five patients (5%) had persistent radiographic subluxation, 3 treated with a second surgery (3%). When treated within 2 weeks of injury, recurrent subluxation or dislocation after operative fixation of terrible triad injuries was rare (1%), provided that the radial head was replaced and the lateral collateral ligament reattached.

Conclusions:

Radiographic subluxation is very uncommon with current operative management of terrible triad injuries of the elbow within 2 weeks. Patients treated more than 2 weeks after injury might benefit from ancillary fixation to limit subluxation (ie, cross pinning, external fixation, or internal joint stabilizer).

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Gartland Type 3 Supracondylar Humeral Fractures in Children: Which Open Reduction Approach Should Be Used After Failed Closed Reduction?
Authors: Kızılay Yusuf Onur , Aktekin Cem Nuri , Özsoy Mehmet Hakan , Akşahin Ertuğrul , Sakaoğulları Abdurrahman , Pepe Murad , Kocadal Onur
Published: August 2016

Objectives:

For displaced supracondylar humeral fractures in children, in the event of closed reduction failure, anatomic reduction is achieved via open reduction techniques; however, there are no confirmative reports among the published open reduction approaches that deliver the best functional and cosmetic results. Here, we compared long-term functional and cosmetic results of different surgical approaches.

Design:

Retrospective cohort study.

Setting:

Ankara Education and Research Hospital/Turkey. Secondary care hospital and trauma center.

Patients/participants:

We evaluated 70 surgically treated Gartland type 3 supracondylar humeral fractures. Patients, with detailed history record, were divided into 5 groups with respect to surgery methods.

Intervention:

All patients were treated surgically using closed reduction and percutaneous pinning or 4 different open reduction approaches and percutaneous pinning.

Main Outcome Measures:

Flynn cosmetic and functional score results were compared between surgical groups.

Results:

Posterior open reduction and triceps transection groups showed worst results, whereas medial and lateral open reduction groups showed good to excellent results similar to closed reduction group.

Conclusion:

Medial and lateral approaches demonstrated better functional results than posterior and triceps transection approaches. Posterior approaches lead to restrictions in extension and poor functional results. In the posterior approach, transecting triceps from olecranon does not benefit from fracture reduction but results in loss of triceps strength and should be avoided. In failed closed reduction, medial and lateral open reduction approaches lead to similar cosmetic outcomes and functional results that are only slightly worse compared with those in closed reduction.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Clinical and Radiological Study Focused on Relief of Low Back Pain After Decompression Surgery in Selected Patients With Lumbar Spinal Stenosis Associated With Grade I Degenerative Spondylolisthesis
Authors: Ikuta Ko , Masuda Keigo , Tominaga Fuyuki , Sakuragi Takahide , Kai Kazuhiro , Kitamura Takahiro , Senba Hideyuki , Shidahara Satoshi
Published: August 2016

Study Design.

A retrospective study.

Objective.

The aim of the present study was to identify the clinical and radiological features of low back pain (LBP) that was relieved after decompression alone of lumbar spinal stenosis (LSS) associated with grade I lumbar degenerative spondylolisthesis (LDS).

Summary of Background Data.

Although decompression and fusion are generally the recommended surgical treatments of LDS, several authors have reported that some patients with LDS could obtain good clinical results including relief from LBP by decompression alone. The pathogenesis of relief from LBP after decompression is, however, not known.

Methods.

Forty patients with LSS associated with grade I LDS, who underwent a minimally invasive surgical-decompression were enrolled in the present study. All patients complained preoperatively of predominantly leg-related symptoms and LBP (≥ 4 points on Numeric Rating Scale). Clinical and radiological assessments were performed 1 year after surgery (a relief of LBP: Numeric Rating Scale reduction ≥3 points and valuation ≤3 points) and at the last follow-up. We conducted a comparative study between patient groups with and without the relief from LBP (groups R and N, respectively).

Results.

Twenty-nine patients were distributed to group R and the remaining 11 patients to group N. Preoperatively, there was a significant difference between the two groups for age and radiographic flexibility for lumbar extension. Postoperatively, there was a positive correlation between improvement in both LBP and leg symptoms. The clinical outcomes of group R were significantly better than those of group N throughout follow-up period (mean 37 mo). In group R, sagittal lumbopelvic radiographic parameters improved significantly after surgery.

Conclusion.

Although the causes of LBP are varied in each patients, our results show that concomitant LSS itself might cause LBP in some patients with grade I LDS, because it involves impingement of the neural tissue and discordant sagittal lumbopelvic alignment.

Level of Evidence: 3
Direct Repair of Lumbar Pars Interarticularis Defects by Utilizing Intraoperative O-Arm-Based Navigation and Microendoscopic Techniques
Authors: Jia Min , Wang Jian , Zhang Zhengfeng , Zheng Wenjie , Zhou Yue
Published: August 2016

Study Design.

A retrospective analysis of the clinical outcomes of eight patients with the lumbar pars interarticulars defects treated by direct repair with the aid of intraoperative O-arm based navigation and microendoscopic techniques.

Objective.

The aim of this study was to investigate the efficacy and safety of direct screw repair by using minimally invasive surgery for the lumbar pars interarticulars defects in a pilot study.

Summary of Background Data.

Direct repair of pars interarticulars defects has been used to treat young adult patients. Reports concerning direct repair by minimally invasive techniques for pars interarticulars defects are quite rare.

Methods.

Review of medical records identified eight consecutive patients treated with intraoperative O-arm based navigation and microendoscopic techniques. Debridement and autograft of pars interarticularis defects was performed under microendoscopic procedure. Then, percutaneous bilateral intralaminar screws were inserted by utilizing intraoperative navigation. The clinical and radiological data were collected and analyzed retrospectively.

Results.

Eight patients had a mean age of 28.4 years, and five were 30 years or younger at the time of treatment. Symptoms included axial back pain in 100% of patients without concomitant radiculopathy. Autograft was used in all cases. The average follow-up duration was 27.4 months with a range of 20 to 33 months. Symptoms resolved completely or partially in all patients. Low back pain visual analog scores decrease from preoperative 6.8 to postoperative 1.4 of eight cases. Of 16 pars defects, healing was observed in 13 (81.3%) at last radiological follow-up. One patient with bilateral fusion failure refused revision surgery because of mild complaint. No complications such as dural tear, nerve root injury, and infection occurred.

Conclusion.

Minimally invasive direct repair of the pars interarticularis defects with intralaminar screws by using microendoscopic system and navigation procedure can provide safe and effective treatment of spondylolysis with satisfactory clinical and radiological outcomes, which need some special tools with steep learning curve.

Level of Evidence: 4
Transpars Microscopic Approach for the Treatment of Purely Foraminal Herniated Lumbar Disc
Authors: De Bonis Pasquale , Mongardi Lorenzo , Pompucci Angelo , Ricciardi Luca , Cavallo Michele Alessandro , Farneti Marco , Lapparelli Marcello , Capone Gennaro , Altruda Carmela , Schivalocchi Roberta , Campioni Paolo , Ghisellini Giulia , Trapella Giorgio
Published: August 2016

Study Design.

This is a prospective two-center study.

Objective.

The aim of this study was to assess the safety and efficacy of treating patients with lumbar foraminal disc herniations via a microscopic transpars approach, with a clinical and radiological follow-up evaluation.

Summary of Background Data.

Purely foraminal lumbar disc herniations comprise about 5% of all lumbar herniated intervertebral discs. Operative management can be technically difficult, and the optimum surgical treatment remains controversial.

Methods.

From January 2012 to January 2015, 47 patients were prospectively recruited. Patients were followed-up as outpatients at 1 week after discharge, then at 1, 6, and 12 months.

A clinical multiparametric evaluation of patients including numeric rating scale (NRS), drugs intake, Macnab criteria, and working days lost was used.

Postoperative dynamic x-rays (flexion, extension) were performed in all cases 12 months after surgery.

Results.

No surgery-related complications occurred.

Among the 35 patients who were not retired at the time of the study, 29 patients returned to work and to normal daily activities within 60 days after surgery.

Pain evaluation at discharge showed a significant improvement of NRS score, from 8.93 to 1.45 at 12 months. Root palsy significantly improved in all cases already at 1-month follow-up. Drugs intake analysis showed that at 6-month follow-up, no patients used steroids, or opioids, 17 patients used non-steroidal anti-inflammatory drugs when needed, and 29 patients (61.7%) used no drugs for pain relief. No significant variations occurred at 12-month-follow-up.

At 12-month follow-up, excellent or good outcome (following Macnab criteria) was achieved in 36 (76.6%) and 8 (17%) patients, respectively.

There were no cases of spinal instability at 12-month radiological evaluation.

No recurrence occurred at follow-up.

Conclusion.

Transpars microscopic approach is effective and safe for the treatment of FLDH, but larger studies are needed.

Level of Evidence: 3
Pediatric Sepsis Biomarker Risk Model-II: Redefining the Pediatric Sepsis Biomarker Risk Model With Septic Shock Phenotype
Authors: Wong Hector R. , Cvijanovich Natalie Z. , Anas Nick , Allen Geoffrey L. , Thomas Neal J. , Bigham Michael T. , Weiss Scott L. , Fitzgerald Julie , Checchia Paul A. , Meyer Keith , Quasney Michael , Hall Mark , Gedeit Rainer , Freishtat Robert J. , Nowak Jeffrey , Raj Shekhar S. , Gertz Shira , Howard Kelli , Harmon Kelli , Lahni Patrick , Frank Erin , Hart Kimberly W. , Nguyen Trung C. , Lindsell Christopher J.
Published: August 2016

Objective:

The Pediatric Sepsis Biomarker Risk Model (PERSEVERE), a pediatric sepsis risk model, uses biomarkers to estimate baseline mortality risk for pediatric septic shock. It is unknown how PERSEVERE performs within distinct septic shock phenotypes. We tested PERSEVERE in children with septic shock and thrombocytopenia-associated multiple organ failure (TAMOF), and in those without new onset thrombocytopenia but with multiple organ failure (MOF).

Design:

PERSEVERE-based mortality risk was generated for each study subject (n = 660). A priori, we determined that if PERSEVERE did not perform well in both the TAMOF and the MOF cohorts, we would revise PERSEVERE to incorporate admission platelet counts.

Setting:

Multiple PICUs in the United States.

Interventions:

Standard care.

Measurements and Main Results:

PERSEVERE performed well in the TAMOF cohort (areas under the receiver operating characteristic curves [AUC], 0.84 [95% CI, 0.77–0.90]), but less well in the MOF cohort (AUC, 0.71 [0.61–0.80]). PERSEVERE was revised using 424 subjects previously reported in the derivation phase. PERSEVERE-II had an AUC of 0.89 (0.85–0.93) and performed equally well across TAMOF and MOF cohorts. PERSEVERE-II performed well when tested in 236 newly enrolled subjects. Sample size calculations for a clinical trial testing the efficacy of plasma exchange for children with septic shock and TAMOF indicated PERSEVERE-II–based stratification could substantially reduce the number of patients necessary, when compared with no stratification.

Conclusions:

Testing PERSEVERE in the context of septic shock phenotypes prompted a revision incorporating platelet count. PERSEVERE-II performs well upon testing, independent of TAMOF or MOF status. PERSEVERE-II could potentially serve as a prognostic enrichment tool.
Lactated Ringer Is Associated With Reduced Mortality and Less Acute Kidney Injury in Critically Ill Patients: A Retrospective Cohort Analysis*
Authors: Zampieri Fernando G. , Ranzani Otavio T. , Azevedo Luciano Cesar Pontes , Martins Izanio D. S. , Kellum John A. , Libório Alexandre B.
Published: August 2016

Objectives:

To assess the impact of the percentage of fluid infused as Lactated Ringer (%LR) during the first 2 days of ICU admission in hospital mortality and occurrence of acute kidney injury.

Design:

Retrospective cohort.

Setting:

Analysis of a large public database (Multiparameter Intelligent Monitoring in Intensive Care-II).

Patients:

Adult patients with at least 2 days of ICU stay, admission creatinine lower than 5 mg/dL, and that received at least 500 mL of fluid in the first 48 hours.

Interventions:

None.

Measurement and Main Results:

10,249 patients were included in mortality analysis and 8,085 were included in the acute kidney injury analysis. For acute kidney injury analysis, we excluded patients achieving acute kidney injury criteria in the first 2 days of ICU stay. Acute kidney injury was defined as stage 2/3 Kidney Disease: Improving Global Outcomes creatinine criteria and was assessed from days 3–7. The effects of %LR in both outcomes were assessed through logistic regression controlling for confounders. Principal component analysis was applied to assess the effect of volume of each fluid type on mortality. Higher %LR was associated with lower mortality and less acute kidney injury. %LR effect increased with total volume of fluid infused. For patients in the fourth quartile of fluid volume (> 7 L), the odds ratio for mortality for %LR equal to 75% versus %LR equal to 25% was 0.50 (95% CI, 0.32–0.79; p < 0.001). Principal component analysis suggested that volume of Lactated Ringer and 0.9% saline infused had opposite effects in outcome, favoring Lactated Ringer.

Conclusions:

Higher %LR was associated with reduced hospital mortality and with less acute kidney injury from days 3–7 after ICU admission. The association between %LR and mortality was influenced by the total volume of fluids infused.
Atrial Fibrillation Following Out-of-Hospital Cardiac Arrest and Targeted Temperature Management—Are We Giving It the Attention it Deserves?*
Authors: Thomsen Jakob Hartvig , Hassager Christian , Erlinge David , Nielsen Niklas , Horn Janneke , Hovdenes Jan , Bro-Jeppesen John , Wanscher Michael , Pehrson Steen , Køber Lars , Kjaergaard Jesper
Published: August 2016

Objectives:

Atrial fibrillation has been associated with increased mortality in the general population and mixed populations of critical ill. Atrial fibrillation can also affect patients during post–cardiac arrest care. We sought to assess the prognostic implications of atrial fibrillation following out-of-hospital cardiac arrest, including relation to the level of targeted temperature management.

Design:

A post hoc analysis of a prospective randomized trial.

Setting:

Thirty-six ICUs.

Patients:

We included 897 (96%) of the 939 comatose out-of-hospital cardiac arrest survivors from the targeted temperature management trial (year, 2010–2013) with data on heart rhythm on day 2.

Interventions:

Targeted temperature management at 33°C or 36°C.

Measurements and Main Results:

Endpoints included cumulative proportion of atrial fibrillation following out-of-hospital cardiac arrest and 180-day all-cause mortality and specific death causes stratified by atrial fibrillation. Atrial fibrillation on day 2 was used as primary endpoint analyses to exclude effects of short-term atrial fibrillation related to resuscitation and initial management. The cumulative proportions of atrial fibrillation were 15% and 11% on days 1 and 2, respectively. Forty-three percent of patients with initial atrial fibrillation the first day were reported with sinus rhythm on day 2. No difference was found between the groups treated with targeted temperature management at 33°C and 36°C. Patients affected by atrial fibrillation had significantly higher 180-day mortality (atrial fibrillation: 66% vs no-atrial fibrillation: 43%; p
logrank < 0.0001 and unadjusted hazard ratio, 1.75 [1.35–2.30]; p < 0.0001). The association between atrial fibrillation and higher mortality remained significant (adjusted hazard ratio, 1.34 [1.01–1.79]; p < 0.05) adjusted for potential confounders. Atrial fibrillation was independently associated with increased risk of cardiovascular death and multiple-organ failure (adjusted hazard ratio, 2.07 [1.39–3.09]; p < 0.001), whereas no association with higher risk of death from cerebral causes was found.

Conclusions:

Atrial fibrillation was independently associated with higher mortality, primarily driven by cardiovascular causes and multiple-organ failure, and may thus identify a vulnerable subpopulation. Whether treatment to prevent atrial fibrillation is associated with an improved prognosis remains to be established.
Seasonal Variation in Diverticulitis
Authors: Adler Joel T. , Chang David C. , Chan Andrew T. , Faiz Omar , Maguire Lillias H.
Published: August 2016

BACKGROUND:

Diverticulitis is a common and morbid disease with incompletely understood risk factors and pathophysiology. Geographic and, recently, seasonal trends in diverticulitis have been described in the United States.

OBJECTIVE:

The purpose of this study was to investigate and compare seasonal trends in urgent hospital admission for diverticulitis in geographically distinct populations in the northern and southern hemispheres.

DESIGN:

Inpatient, urgent admissions for diverticulitis were identified within the Dr Foster Intelligence Global Comparators Dataset, a global benchmarking collaborative.

SETTINGS:

Admissions to participating hospitals in the United Kingdom, Australia, and the United States were identified between 2008 and 2013.

PATIENTS:

A total of 18,672 urgent admissions for diverticulitis were identified among 5.5-million admissions.

MAIN OUTCOME MEASURES:

Four separate hypothesis testing methods were used to identify seasonal trends in diverticulitis admissions among international patient populations.

RESULTS:

Seasonal trends were present in all 3 countries. A summer peak was observed in both hemispheres using multiple statistical testing methods. Logistic regression analyses identified summer months as significantly associated with diverticulitis admission in all 3 countries.

LIMITATIONS:

This study is limited by restriction to inpatient admissions, reliance on administrative data, and participation of select hospitals within the database.

CONCLUSIONS:

These data suggest a shared seasonal risk factor among geographically distinct populations for diverticulitis.
Bilobalide alleviates depression-like behavior and cognitive deficit induced by chronic unpredictable mild stress in mice
Authors: Wu Ruiyong , Shui Li , Wang Siyang , Song Zhenzhen , Tai Fadao
Published: August 2016

Bilobalide (BB), a unique constituent of Ginkgo biloba, has powerful neuroprotection and stress-alleviating properties. However, whether BB exerts a positive effect on depression and cognitive deficit induced by chronic stress is not known. The present study was designed to investigate the influence of BB on depression and cognitive impairments induced by chronic unpredictable mild stress (CUMS) in mice. During daily exposure to stressors for 5 consecutive weeks, mice were administered BB at the doses of 0, 3, or 6 mg/kg/day intraperitoneally. We replicated the finding that CUMS induced depression-like behavior and cognitive deficits as the CUMS+vehicle (VEH) group showed a significant increase in immobility in the tail suspension test, a decrease in the discrimination index of the novel object recognition task, and increased latency to platform and decreased number of platform crossings in the Morris water maze compared with the control+VEH group. Chronic administration of BB effectively reversed these alterations. In addition, the CUMS+VEH group showed significantly higher levels of baseline serum corticosterone than those of the control+VEH group and BB dose-dependently inhibited this effect. Our results suggest that BB may be useful for inhibition of depression-like behavior and cognitive deficits, and this protective effect was possibly exerted partly through an action on the hypothalamic–pituitary–adrenal axis.
Antioxidant Treatment Improves Cardiac Dysfunction in a Murine Model of Premature Aging
Authors: Hemmeryckx Bianca , Hohensinner Philipp , Swinnen Melissa , Heggermont Ward , Wojta Johann , Lijnen Henri Roger
Published: August 2016

Bmal1-(brain and muscle ARNT-like protein-1) deficient (Bmal1−/−) mice prematurely age because of an increased reactive oxygen species (ROS) production. These mice also show a decline in cardiac function with age. We investigated whether an antioxidant treatment can ameliorate the declining cardiac function in prematurely aged Bmal1−/− mice. Male Bmal1−/− and wild-type (Bmal1+/+) mice were exposed for 15 weeks to a high fat and high cholesterol diet with or without the antioxidant 4-hydroxy-2,2,6,6-tetramethylpiperidin-1-oxyl (TEMPOL; 5 mmol/L; in drinking water during the last 10 weeks). Echocardiographic analysis revealed that TEMPOL treatment of Bmal1−/− mice normalized cardiac function, as evidenced by a decrease in left ventricular diastolic and systolic internal diameters, and by an increase in fractional shortening and ejection fraction. The antioxidant did not affect cardiac function in Bmal1+/+ mice. Although TEMPOL did not influence cardiac ROS levels in Bmal1−/− mice, it significantly protected Bmal1−/− cardiac telomeres from oxidation, as evidenced by a reduction in the telomere damage score (0.11 ± 0.012% vs. 0.16 ± 0.015%; P = 0.028). Thus, antioxidant treatment normalized cardiac function of Bmal1−/− mice, probably in part by scavenging ROS.
Evaluation of the New Siemens Tacrolimus Assay on the Dimension EXL Integrated Chemistry System Analyzer: Comparison With an Ultra-Performance Liquid Chromatography–Tandem Mass Spectrometry Method
Authors: Bargnoux Anne-Sophie , Sutra Thibault , Badiou Stéphanie , Kuster Nils , Dupuy Anne-Marie , Mourad Georges , Pageaux Georges-Philippe , Le Quintrec Moglie , Cristol Jean-Paul
Published: August 2016

Background:

Many patients are maintained at the lower end of the tacrolimus (TAC) reference range (3–7 ng/mL), requiring the use of analytical methods displaying a very low limit of quantification for their follow-up. Therefore, the new Dimension TAC, based on affinity chrome-mediated immunoassay technology, was evaluated on the Dimension EXL Integrated Chemistry System (Siemens Healthcare Diagnostics Inc). The aims of this study were (1) to evaluate the analytical performances with special emphasis on sensibility at low levels of TAC, (2) to compare the results with an ultra-performance liquid chromatography–tandem mass spectrometry (UPLC/MS/MS) method.

Methods:

Analytical performance (imprecision, linearity, limit of detection, and limit of quantification) was evaluated. Comparison to UPLC/MS/MS was performed on 106 whole blood samples from 88 transplant recipients using regression analysis and Bland–Altman plot analysis.

Results:

Repeatability and within-laboratory coefficients of variation were <6% at mean TAC control levels of 3.7, 11.7, and 19.2 ng/mL. Linearity was confirmed between 1.0 and 22 ng/mL. Passing–Bablok regression analysis of Siemens TAC assay in comparison with UPLC/MS/MS values displayed a slope of 1.09 and an intercept of −0.42. Using Bland–Altman analysis, the mean bias was 0.27 ng/mL with 1.96 SD limits of −2.14 and 2.67 ng/mL.

Conclusions:

The new Dimension TAC immunoassay on the EXL analyzer demonstrated reliable and reproducible performances allowing routine monitoring in transplant patients, even at TAC concentrations at the lower end of the therapeutic range.
Understanding women's experience of memory over the menopausal transition: subjective and objective memory in pre-, peri-, and postmenopausal women
Authors: Unkenstein Anne E. , Bryant Christina A. , Judd Fiona K. , Ong Ben , Kinsella Glynda J.
Published: August 2016

Objective:

Many women complain of forgetfulness during the menopausal transition. This study aimed to examine women's subjective perception of memory and their objective memory performance across the menopausal transition.

Methods:

One hundred thirty women, aged 40 to 60 years were recruited from outpatient Menopause and Gynaecological clinics at the Royal Women's Hospital, Melbourne. Women were divided into menopausal stage groups according to the Stages of Reproductive Aging Workshop criteria based on menstrual patterns. All women completed self-report measures of depressive, anxiety, vasomotor, and sleep symptoms; attitude to menopause; and various aspects of memory, including memory contentment, frequency of forgetting, sense of control over memory, and use of memory strategies. Women also completed a comprehensive neuropsychological evaluation assessing memory and executive function.

Results:

Comprehensive neuropsychological assessment showed no difference between premenopausal (n = 36), perimenopausal (n = 54), and postmenopausal (n = 40) groups in performance on memory and executive tasks. Perimenopausal women, however, reported significantly more frequent forgetting (η2 = 0.09, P < 0.01) and less contentment with their memory (η2 = 0.08, P < 0.01) than pre- and postmenopausal women.

Conclusions:

Although no impairment was observed in neuropsychological performance, when compared with pre- and postmenopausal women, perimenopausal women were more likely to be dissatisfied with their memory. During the menopausal transition women with a more negative attitude to menopause and more intense depressive, anxiety, vasomotor, and sleep symptoms are more vulnerable to feeling less content with their memory.
PEMBROLIZUMAB ADMINISTRATION ASSOCIATED WITH POSTERIOR UVEITIS
Authors: Aaberg Michael T. , Aaberg Thomas M.
Published: August 2016

Purpose:

To describe the development of uveitis and retinal vasculitis in association with pembrolizumab treatment for metastatic uveal melanoma.

Methods:

A case report and a brief review of the literature are presented. Information collected and reported include the patient's clinical course, physical examination findings, fluorescein angiogram images, retinal photographs, and her response to treatment.

Results:

A 54-year-old woman was diagnosed with a large choroidal malignant melanoma and had the affected eye enucleated. Pathology confirmed a mixed cell choroidal melanoma, and gene expression profiling was Class 2. Seventeen months after enucleation, the patient was diagnosed with metastatic uveal melanoma to the liver. Disease progression was observed during ipilimumab treatment. Pembrolizumab treatment was initiated, and after four infusions, she presented to clinic complaining of floaters and blurred vision. Examination revealed a nongranulomatous panuveitis characterized by perivascular retinal pigment epithelium pigmentary changes, retinal venous sheathing, 1+ anterior chamber and vitreous cellular reaction, 2+ vitreous haze, and optic disk edema. A dexamethasone sustained-release implant was administered and the uveitis regressed. A relapse in symptoms occurred but quickly subsided with a repeat injection.

Conclusion:

Pembrolizumab may induce a uveitic reaction. There is mounting evidence that patients using prembrolizumab should be educated and monitored for signs of uveitis.
25G PARS PLANA VITRECTOMY AND IRIDO-ZONULO-HYALOIDO-VITRECTOMY IN THE MANAGEMENT OF MALIGNANT GLAUCOMA IN PHAKIC EYES FOLLOWING TRABECULECTOMY
Authors: Rani Padmaja K. , Gulati Isha , Rao Harsha Laxmana , Senthil Sirisha
Published: August 2016

Purpose:

To describe a new surgical technique in the management of malignant glaucoma in phakic eyes.

Methods:

We performed 25-gauge pars plana vitrectomy with anterior irido-zonulo-hyaloido-vitrectomy in 2 young phakic patients with malignant glaucoma after trabeculectomy. This technique allowed posteroanterior aqueous communication, relieved aqueous misdirection, helped restoring anterior chamber depth, normalized the intraocular pressure and most importantly helped to preserve the crystalline lens.

Results:

At 8 months follow-up, both patients have stable visual acuity, normal intraocular pressure, well-functioning blebs, and clear crystalline lens.

Conclusion:

One can consider 25-gauge pars plana vitrectomy with anterior irido-zonulo-hyaloido-vitrectomy as a safe and effective treatment option for the management of malignant glaucoma in phakic eyes.
Postoperative Changes in Strabismus, Ductions, Exophthalmometry, and Eyelid Retraction After Orbital Decompression for Thyroid Orbitopathy
Authors: Rootman Daniel B. , Golan Shani , Pavlovich Peter , Rootman Jack
Published: August 2016

Introduction:

Surgical rehabilitation of thyroid orbitopathy involves reducing proptosis, treating strabismus, lengthening the eyelids, and managing aesthetic changes. Not all are necessary in each patient; however, they often are. The current investigation intends to describe postdecompression changes that may influence the staging of these procedures.

Methods:

In this retrospective cohort study, records of 169 patients who underwent orbital decompression between 1983 and 2001 were reviewed. A single orbital specialist confirmed all measurements. Time to follow up was defined as the most recent follow up after decompression and prior to any secondary procedures. No strabismus or eyelid surgery was performed at the time of decompression. Strabismus was measured with alternating prism cover test. Ductions were estimated utilizing Hirschberg’s method. Exophthalmometry was measured with Hertel. Eyelid positions were defined relative to the pupillary light reflex. Strabismus data were analyzed within eye pairs. Ductions, exophthalmometry and eyelid position were analyzed for each eye. T-test for paired data was utilized to compare means pre- and postoperatively.

Results:

The study population was on average 45 years old and 73.4% women. Average length of follow up was 1.2 years. Esotropia was significantly increased after decompression by an average of 8.1 prism diopters (p < 0.01). Exotropia and vertical deviations were not significantly altered. Ductions decreased by >5 degrees in at least one meridian for 68.1% of the population. Upper eyelid retraction remained unchanged; however, lower eyelid retraction improved by 50% from 1.4 mm to 0.7 mm (p < 0.01). Exophthalmometry improved from 23.5 mm to 19.7 mm (p < 0.01), and this result was correlated with the number of walls removed (Pearson r = −0.302, p < 0.01).

Conclusions:

On average, esotropia and ductions tend to worsen with decompression surgery. This result supports the clinical dictum to avoid strabismus surgery until after decompression. The improvement in lower eyelid retraction suggests that at least lower eyelid-lengthening surgery should be reserved for after decompression, as there may be significant spontaneous improvement, while the same may not be true for upper eyelid retraction, which does not tend to change with decompression.
Streptococcus agalactiae Toxic Shock Syndrome: New Agent, New Challenges
Authors: Meireles Mariana , Ricardo Miguel , Ribeiro Sofia , Correia João Araújo
Published: August 2016

Toxic shock syndrome is a rare life-threatening disease. The raising of new etiologic agent identification and antimicrobial therapy resistance poses new questions. We report a rare case of Streptococcus agalactiae toxic shock–like syndrome and a literature review focusing on the presentation, current therapeutic challenges, and future approaches.
Early Cerebritis Resulting in a First-Time Seizure in an Otherwise Healthy Young Man
Authors: Jenks Jeffrey D. , Benson Constance A.
Published: August 2016

We report the case of an otherwise healthy 28-year-old man who presented with a first-time seizure. Computed tomography and magnetic resonance imaging revealed a circumscribed left frontal lobe heterogeneous mass most consistent with a neoplasm. He underwent left supraorbital craniotomy with mass resection of the lesion, with histopathology of the brain tissue revealing heightened cellularity with perivascular neutrophilic predominance and neutrophils percolating through the brain parenchyma and surrounding cortical neurons, most consistent with a diagnosis of early cerebritis. He completed 6 weeks of empiric antimicrobial therapy with resolution of his seizures. Early cerebritis, which was elegantly demonstrated on histopathology in this case, is an uncommon diagnosis as patients typically present later with progressive disease and signs and symptoms reflective of an underlying brain abscess.
The mitogen and stress-activated protein kinase 1 regulates the rapid epigenetic tagging of dorsal horn neurons and nocifensive behaviour
Authors: Tochiki Keri K. , Maiarú Maria , Norris Caspar , Hunt Stephen P. , Géranton Sandrine M.
Published: August 2016

Phosphorylation of histone H3 at serine 10 (p-H3S10) is a marker of active gene transcription. Using cognitive models of neural plasticity, p-H3S10 was shown to be downstream of extracellular signal-regulated kinase (ERK) signalling in the hippocampus. In this study, we show that nociceptive signalling after peripheral formalin injection increased p-H3S10 expression in the ipsilateral dorsal horn. This increase was maximal 30 minutes after formalin injection and occurred mainly within p-ERK-positive neurons. Spinal p-H3S10-enhanced expression was also observed in neurokinin 1 receptor (NK1R), c-Fos, and Zif268 positive neurons and was inhibited by ablation of serotonergic descending controls. The mitogen and stress-activated protein kinase 1 (MSK1) is downstream of ERK and can induce p-H3S10. We found that, after formalin injection, most phospho-MSK1 (p-MSK1)-positive cells (87% ± 3%) expressed p-ERK and the majority of p-H3S10-positive cells (85% ± 5%) expressed p-MSK1. Inhibition of ERK activity with the MEK inhibitor SL327 reduced formalin-induced p-ERK, p-MSK1, and p-H3S10, demonstrating that spinal p-MSK1 and p-H3S10 were at least partly downstream of ERK signalling. Crucially, pharmacological blockade of spinal MSK1 activity with the novel MSK1 inhibitor SB727651A inhibited formalin-induced spinal p-H3S10 and nocifensive behaviour. These findings are the first to establish the involvement of p-H3S10 and its main kinase, MSK1, in ERK regulation of nociception. Given the general importance of ERK signalling in pain processing, our results suggest that p-H3S10 could play a role in the response to injury.
Activation of cannabinoid CB1 receptor contributes to suppression of spinal nociceptive transmission and inhibition of mechanical hypersensitivity by Aβ-fiber stimulation
Authors: Yang Fei , Xu Qian , Shu Bin , Tiwari Vinod , He Shao-Qiu , Vera-Portocarrero Louis P. , Dong Xinzhong , Linderoth Bengt , Raja Srinivasa N. , Wang Yun , Guan Yun
Published: August 2016

Activation of Aβ-fibers is an intrinsic feature of spinal cord stimulation (SCS) pain therapy. Cannabinoid receptor type 1 (CB1) is important to neuronal plasticity and pain modulation, but its role in SCS-induced pain inhibition remains unclear. In this study, we showed that CB1 receptors are expressed in both excitatory and inhibitory interneurons in substantia gelatinosa (SG). Patch-clamp recording of the evoked excitatory postsynaptic currents (eEPSCs) in mice after spinal nerve ligation (SNL) showed that electrical stimulation of Aβ-fibers (Aβ-ES) using clinical SCS-like parameters (50 Hz, 0.2 millisecond, 10 μA) induced prolonged depression of eEPSCs to C-fiber inputs in SG neurons. Pretreatment with CB1 receptor antagonist AM251 (2 μM) reduced the inhibition of C-eEPSCs by Aβ-ES in both excitatory and inhibitory SG neurons. We further determined the net effect of Aβ-ES on spinal nociceptive transmission in vivo by recording spinal local field potential in SNL rats. Epidural SCS (50 Hz, Aβ-plateau, 5 minutes) attenuated C-fiber-evoked local field potential. This effect of SCS was partially reduced by spinal topical application of AM251 (25 μg, 50 μL), but not CB2 receptor antagonist AM630 (100 μg). Finally, intrathecal pretreatment with AM251 (50 μg, 15 μL) in SNL rats blocked the inhibition of behavioral mechanical hypersensitivity by SCS (50 Hz, 0.2 millisecond; 80% of motor threshold, 60 minutes). Our findings suggest that activation of spinal CB1 receptors may contribute to synaptic depression to high-threshold afferent inputs in SG neurons after Aβ-ES and may be involved in SCS-induced inhibition of spinal nociceptive transmission after nerve injury.
Effect of Simulation on the Confidence of University Nursing Students in Applying Cardiopulmonary Assessment Skills: A Randomized Controlled Trial
Authors: Tawalbeh Loai I.
Published: August 2016

Background:

Simulation is an effective teaching strategy. However, no study in Jordan has examined the effect of simulation on the confidence of university nursing students in applying heart and lung physical examination skills.

Purpose:

The current study aimed to test the effect of simulation on the confidence of university nursing students in applying heart and lung physical examination skills.

Method:

A randomized controlled trial design was applied. The researcher introduced the simulation scenario regarding cardiopulmonary examination skills. This scenario included a 1-hour PowerPoint presentation and video for the experimental group (n= 35) and a PowerPoint presentation and a video showing a traditional demonstration in the laboratory for the control group (n = 34). Confidence in applying cardiopulmonary physical examination skills was measured for both groups at baseline and at 1 day and 3 months posttest.

Results:

A paired t test showed that confidence was significantly higher in the posttest than in the pretest for both groups. An independent t test showed a statistically significant difference (t(67) = −42.95, p < .001) between the two groups in terms of the difference between the first posttest and second posttest scores (t(67) = −43.36, p < .001) for confidence in applying physical examination skills.

Conclusions:

Both simulation and traditional training in the laboratory significantly improved the confidence of participants in applying cardiopulmonary assessment skills. However, the simulation training had a more significant effect than usual training in enhancing the confidence of nursing students in applying physical examination skills.
Correlates of Perceived Social Support in Chinese Adult Child Caregivers of Parent Stroke Survivors
Authors: Pan Yuqin , Jones Patricia S.
Published: August 2016

Background:

Prevalence of stroke and traditional filial responsibility involve adult children in caregiving to their parent stroke survivors in China. Support resources are insufficient because of the shrinking size of family and the underdeveloped support system.

Purpose:

The aim of this study was to identify the correlates of perceived social support among adult child caregivers of parent stroke survivors in China.

Methods:

A cross-sectional correlational design was used in this study. A nonproportional quota sample of 126 adult child caregivers was recruited from Zhejiang Province, China. Data were collected at either the hospital stroke units or the respondents’ homes using structured questionnaires of caregiving dyadic demographics and caregiving characteristics, 14-item Activities of Daily Living, 15-item Mutuality Scale, and 12-item Multidimensional Scale of Perceived Social Support. SPSS 17.0 was used for analysis.

Results:

Caregivers’ mutuality, education, full employment or being retired, monthly income, having a co-carer, and having a father as the care receiver were significantly positively associated with caregivers’ perceived social support. However, mutuality was not significantly associated with caregivers’ perceived social support after the other factors were adjusted.

Conclusions/Implications for Practice:

Adult child caregivers with higher levels of mutuality, education, or monthly income; who are fully employed or are retired; who have a co-carer; or who are caring for a father perceived more social support. Nursing strategies and social policies need to be directed to enhance caregiver mutuality and support caregiving efforts.
Career Obstacles Faced by Female Nurse Academicians in Turkey
Authors: Alaçam Burcu , Altuntaş Serap
Published: August 2016

Background:

Most academicians in the nursing field are women, and they face many difficulties throughout the course of their careers for various reasons.

Purpose:

This study aims to determine the career difficulties faced by female academicians in the nursing field.

Methods:

This study is descriptive, sectional, and comparative. The study was conducted in cooperation with female academicians in the nursing field (n = 132) from 11 different nursing schools in Turkey’s Eastern Anatolia Region providing undergraduate education in nursing. Data were collected using the Female Academicians’ Career Obstacles Scale. Ethics committee and required official permissions were obtained from the relevant institutions. Data analysis was conducted in an electronic environment using SPSS for Windows 22.0 package software for statistics.

Results:

In terms of research outcomes, it was determined that the most significant obstacles reported by female academicians were “organizational culture and politics” (M = 43.92 ± 12.64) and “playing multiple roles” (M = 31.35 ± 10.15); the most insignificant obstacles were reported to be “organizational conditions” (M = 21.43 ± 7.06) and “stereotypical prejudices” (M = 20.44 ± 6.31). Other obstacles mentioned by the academicians were working as a research assistant with a bachelor’s degree, being married with children, studying with young and inexperienced academicians, and serving as department head.

Conclusions/Implications for Practice:

Organizational culture and politics in particular should be reviewed at educational institutions from the perspective of career obstacles, and these principles should be rearranged so that they constitute a supportive work environment.