bluuebunny/crossref_metadata_2025 huggingface dataset:
Surface-engineered mesoporous silica particles with luminescent, cytocompatible and targeting properties for cancer cell imaging
Authors: Tagaya Motohiro , Abe Shigeaki , Motozuka Satoshi , Shiba Kota , Takemura Taro , Hayashi Ikuo , Sakaguchi Yoshimitsu
Published: March 2017

Mechanochemically-treated europium(iii)-doped mesoporous silica particles were prepared, and a targeting ligand for cancer cells was immobilized. The surface-engineered particles exhibited the clear imaging along with all the cellular shapes.
The Role of the Veterinary Pathologist in Voice Research
Authors: Durkes Abigail
Published: March 2017

Veterinary pathologists fill many vital roles in a multidisciplinary biomedical research team. They can serve as diagnosticians, basic medical scientists, or liaisons between investigative work and clinical medicine. Advanced education in veterinary pathology can provide expertise in the biology of the whole animal, spontaneous disease manifestations in both human and non-human animals, and experimental disease models. Veterinary pathologists have a unique standpoint in understanding the pathophysiology of disease from a One Health perspective in which human, animal, and environmental health are linked. By collaborating with a veterinary pathologist, voice and voice disorder research can reach new, innovative success and exploration.
Vom Gespräch mit dem Bankräuber lernen
Authors: Rauschek Felix
Published: March 2017

Verhandlungen mit Geiselnehmern, Bankräubern und Drogendealern… das klingt nicht nach meinem Berufsalltag.
Dokumentation: Big Data in der Notaufnahme
Authors: Stöhr Robert
Published: March 2017

Eine moderne Behandlung von Patienten in der Notaufnahme erfordert ein differenziertes Konzept zur Dokumentation. Es gilt einerseits Vorgaben von Fachgesellschaften umzusetzen und andererseits die Erfordernis einer mindestens vierstufigen klinischen Ersteinschätzung (Triage). Eine IT-gestützte Auswertung der Behandlungsprozesse hilft, die Organisation der Notaufnahme zu verbessern.
Senior- und Junior-Experten für den ÖVKT: Wissensbrücken schlagen
Authors: Thalmayr Maria
Published: March 2017

Ein neuer Beirat aus Senior-Experten wird im ÖVKT künftig seinen in vielen Jahren beruflicher Tätigkeit aufgebauten Erfahrungsschatz zur Verfügung stellen. Eine ebenfalls neue Gruppe aus Junior-Experten soll gleichzeitig junge Ideen in die Verbandsarbeit einbringen und durch die bessere Vernetzung gezielt auf das Wissen der Senior-Experten zugreifen können.
DGIV: Neue Wege für Integrierende Versorgungsformen
Authors: Spitzer Stefan G.
Published: March 2017

Unter diesem Titel fand im Dezember 2016 der 13. DGIV-Bundeskongress statt. Die Beiträge machten deutlich, dass Integrierte Versorgung heute schon weit über Paragraf 140a SGB V hinausgeht.
Patient Self-Assessed Passive Range of Motion of the Knee Cannot Replace Health Professional Measurements
Authors: Madsen Frank , Odgaard Anders , Borgbjerg Jens
Published: March 2017

The purpose of this study was to investigate whether patients can accurately self-assess their knee passive range of motion (PROM). A picture-based questionnaire for patient self-assessment of knee PROM was developed and posted to patients. The self-assessed PROM from 58 patients was compared with surgeon-assessed PROM using a short-arm goniometer. Agreement between the measurement methods was calculated with the Bland-Altman method. We calculated the sensitivity and specificity of patient-assessed PROM in dichotomously detecting knee motion impairment in both flexion (≤ 100 degrees) and extension (≥ 10-degree flexion contracture). Surgeon- and patient-assessed knee PROM showed a mean difference (95% limits of agreement) of −2.1 degrees (−42.5 to 38.3 degrees) for flexion and −8.1 degrees (−28.8 to 12.7 degrees) for extension. The sensitivity of patient self-assessed PROM in identifying knee flexion and extension impairments was 86 and 100%, respectively, whereas its specificity was 84 and 43%, respectively. Although wide limits of agreement were observed between surgeon- and patient-assessed knee PROM, the picture-based questionnaire for patient assessment of knee ROM was found to be a valid tool for dichotomously detecting knee motion impairment in flexion (≤ 100 degrees). However, the specificity of the questionnaire for detection of knee extension impairments (≥ 10-degree flexion contracture) was low, which limits is practical utility for this purpose.
The strange star discovered by Planet Hunters
Authors: Schaefer Bradley E.
Published: March 2017

A very ordinary, isolated star varies by 20% in brightness on time scales from a day to a century. No one has yet proposed a convincing explanation.
USDA Forecasts Of Crop Ending Stocks: How Well Have They Performed?
Authors: Xiao Jinzhi , Hart Chad E. , Lence Sergio H.
Published: March 2017

This study analyzes forecasts of U.S. ending stocks for corn, soybeans, and wheat issued by the USDA. The proposed efficiency tests focus on forecast revisions. Forecast errors are decomposed into monthly unforecastable shocks and idiosyncratic residuals. The error covariance matrix allows for heteroscedasticity and auto‐correlations. Results suggest that the USDA forecasts are inefficient, providing strong evidence that the USDA is conservative in forecasting the ending stocks. Unforecastable shocks are heteroscedastic, and idiosyncratic residuals are small. Results are consistent across the three decades analyzed, but soybean forecasts are found to be considerably worse from 2005 to 2015.
Comparison of coronary artery calcification, carotid intima-media thickness and ankle-brachial index for predicting 10-year incident cardiovascular events in the general population
Authors: Geisel Marie Henrike , Bauer Marcus , Hennig Frauke , Hoffmann Barbara , Lehmann Nils , Möhlenkamp Stefan , Kröger Knut , Kara Kaffer , Müller Tobias , Moebus Susanne , Erbel Raimund , Scherag André , Jöckel Karl-Heinz , Mahabadi Amir A. ,   on behalf of the investigative group of the Heinz Nixdorf Recall study
Published: March 2017

Aims

To compare the predictive value of coronary artery calcification (CAC), carotid intima-media thickness (CIMT) and ankle-brachial index (ABI) in a primary prevention cohort depending on risk factor profile to determine which of the three markers improves cardiovascular (CV) risk discrimination best in which risk group.

Methods and Results

We quantified CAC, CIMT, and ABI in 3108 subjects (mean age 59.2 ± 7.7, 47.1% male) without prevalent CV diseases from the population-based Heinz Nixdorf Recall study. Associations with incident major CV events (coronary event, stroke, CV death; n = 223) were assessed during a follow-up period of 10.3 ± 2.8 years with Cox proportional regressions in the total cohort and stratified by Framingham risk score (FRS) groups. Discrimination ability was evaluated with Harrell’s C. All three markers were associated with CV events (hazard ratio [95% confidence interval (CI)]: CAC: 1.31 (1.23–1.39) per 1-unit increase in log(CAC + 1) vs. CIMT: 1.27 (1.13–1.43) per 1 SD vs. ABI: 1.30 (1.14–1.49) per 1 SD, in FRS adjusted models). Considering reclassification, CAC lead to highest reclassification in the total cohort, while also for CIMT and ABI significant improvement in net-reclassification was observed [NRI (95% CI): CAC: 0.55 (0.42–0.69); CIMT: 0.32 (0.19–0.45); ABI: 0.19 (0.10–0.28)].

Conclusion

Coronary artery calcification provides the best discrimination of risk compared with CIMT and ABI, particularly in the intermediate risk group, whereas CIMT may be an alternative measure for reassurance in the low risk group.
Do health information technology self-management interventions improve glycemic control in medically underserved adults with diabetes? A systematic review and meta-analysis
Authors: Heitkemper Elizabeth M , Mamykina Lena , Travers Jasmine , Smaldone Arlene
Published: March 2017

Objective: The purpose of this systematic review and meta-analysis was to examine the effect of health information technology (HIT) diabetes self-management education (DSME) interventions on glycemic control in medically underserved patients.

Materials and Methods: Following an a priori protocol, 5 databases were searched. Studies were appraised for quality using the Cochrane Risk of Bias assessment. Studies reporting either hemoglobin A1c pre- and post-intervention or its change at 6 or 12 months were eligible for inclusion in the meta-analysis using random effects models.

Results: Thirteen studies met the criteria for the systematic review and 10 for the meta-analysis and represent data from 3257 adults with diabetes (mean age 55 years; 66% female; 74% racial/ethnic minorities). Most studies (n = 10) reflected an unclear risk of bias. Interventions varied by HIT type: computer software without Internet (n = 2), cellular/automated telephone (n = 4), Internet-based (n = 4), and telemedicine/telehealth (n = 3). Pooled A1c decreases were found at 6 months (−0.36 (95% CI, −0.53 and −0.19]; I2 = 35.1%, Q = 5.0), with diminishing effect at 12 months (−0.27 [95% CI, −0.49 and −0.04]; I2 = 42.4%, Q = 10.4).

Discussion: Findings suggest that medically underserved patients with diabetes achieve glycemic benefit following HIT DSME interventions, with dissipating but significant effects at 12 months. Telemedicine/telehealth interventions were the most successful HIT type because they incorporated interaction with educators similar to in-person DSME.

Conclusion: These results are similar to in-person DSME in medically underserved patients, showing that well-designed HIT DSME has the potential to increase access and improve outcomes for this vulnerable group.
The Infrazygomatic Segment of the Superficial Temporal Artery: Anatomy and Technique for Harvesting a Better Interposition Graft
Authors: Meybodi Ali Tayebi , Lawton Michael T. , El-Sayed Ivan , Davies Jason , Tabani Halima , Feng Xuequan , Benet Arnau
Published: March 2017

BACKGROUND: The superficial temporal artery (STA) is underutilized as an interposition graft because current techniques expose and harvest STA above the level of the zygoma. This technique yields a diminutive arterial segment in both length and diameter, which limits its use for extracranial−intracranial bypass.

OBJECTIVE: To introduce a safe and efficient technique for harvesting of the infrazygomatic segment of the STA.

METHODS: Scalp layers, STA, and the facial nerve were studied in 18 specimens. The length of the STA segment harvested below the superior border of the zygomatic arch was measured. Safety of this technique was assessed by measuring the distance between the facial nerve and the STA.

RESULTS: The galea and subgaleal fat pad were the only anatomical planes found between the facial nerve and the STA below the zygomatic arch. A dense subcutaneous band of galea contained the STA and allowed proximal dissection of the artery without exposing the facial nerve. The average length of the artery harvested between the zygomatic arch and the parotid gland was 20 mm.

CONCLUSION: Subcutaneous dissection within the galea below the level of the zygomatic arch and preservation of the dense subcutaneous band surrounding the STA avoids transecting the facial nerve branches while providing increased STA exposure. This anatomical knowledge may increase the use of STA as an interposition graft in cerebrovascular bypass procedures and reduce the need to harvest grafts through additional incisions at remote sites.
Performance of the Patient-Reported Outcomes Measurement Information System-29 in scleroderma: a Scleroderma Patient-centered Intervention Network Cohort Study
Authors: Kwakkenbos Linda , Thombs Brett D. , Khanna Dinesh , Carrier Marie-Eve , Baron Murray , Furst Daniel E. , Gottesman Karen , van den Hoogen Frank , Malcarne Vanessa L. , Mayes Maureen D. , Mouthon Luc , Nielson Warren R. , Poiraudeau Serge , Riggs Robert , Sauvé Maureen , Wigley Fredrick , Hudson Marie , Bartlett Susan J. ,   on behalf of the SPIN Investigators
Published: March 2017

Objective. The Patient-Reported Outcomes Measurement Information System (PROMIS)-29 assesses seven health-related quality of life domains plus pain intensity. The objective was to examine PROMIS-29v2 validity and explore clinical associations in patients with SSc.

Methods. English-speaking SSc patients in the Scleroderma Patient-centered Intervention Network Cohort from 26 sites in Canada, the USA and the UK completed the PROMIS-29v2 between July 2014 and November 2015. Enrolling physicians provided medical data. To examine convergent validity, hypotheses on the direction and magnitude of correlations with legacy measures were tested. For clinical associations, t-tests were conducted for dichotomous variables and PROMIS-29v2 domain scores. Effect sizes (ESs) were labelled as small (<0.25), small to moderate (0.25–0.45), moderate (0.46–0.55), moderate to large (0.56–0.75) and large (>0.75).

Results. There were 696 patients (87% female), mean (s.d.) disease duration 11.6 (8.7) years, 57% with limited cutaneous subtype. Validity indices were consistent with seven of nine hypotheses (|r| =0.51–0.87, P < 0.001), with minor divergence for two hypotheses. Gastrointestinal involvement was associated with significantly worse outcomes for all eight PROMIS-29v2 domains (moderate or moderate to large ES in six of eight). Presence of joint contractures was associated with significant decrements in seven domains (small or small to moderate ESs). Skin thickening, diffuse cutaneous subtype and presence of overlap syndromes were significantly associated (small or small to moderate ESs) with five or six domains.

Conclusion. This study further establishes the validity of the PROMIS-29v2 in SSc and underlines the importance of gastrointestinal symptoms and joint contractures in reduced health-related quality of life.
Renal cell carcinoma: molecular characterization and evolving treatment paradigms
Authors: Ball Mark W. , Singer Eric A. , Srinivasan Ramaprasad
Published: March 2017

Purpose of review

The treatment landscape of advanced renal cell carcinoma (RCC) continues to shift as both new targeted therapies and immunotherapies show efficacy in treating the disease. Contemporary insights into the molecular characterization of RCC are likely to fuel the development of additional therapies. This review summarizes recent advancements in the biologic characterization of RCC and discusses newly approved therapies and ongoing studies in the treatment of advanced RCC.

Recent findings

The Cancer Genome Atlas has now completed comprehensive molecular characterization of clear cell, papillary, and chromophobe RCC, providing insights into the biology of these entities. Two new ‘targeted’ therapies, cabozantinib and lenvatinib, as well as a novel immune checkpoint inhibitor, the programed death 1 inhibitor nivolumab, have recently been approved for the treatment of metastatic RCC. Although some of these newer therapies are associated with prolongation of survival, there are few long-term responders and the quest for more durable treatment strategies continues.

The addition of several new agents effective in metastatic RCC has resulted in improvements in overall survival; however, there are few avenues to durable responses or cure. Ongoing studies as well advances in our understanding of the molecular alterations underlying distinct forms of RCC promise further therapeutic advances and have the potential to alter the current treatment paradigm.
New Classification System for Tear Trough Deformity
Authors: Turkmani Mohammed G.
Published: March 2017

BACKGROUND

Tear trough deformities (TTD) refer to a set of conditions leading to different shapes in the junction between the lower eyelid and the cheek. Tear trough deformity is a major aesthetic concern for a lot of individuals seeking periorbital rejuvenation and is one of the most discussed landmarks in facial aesthetic surgery.

OBJECTIVE

To describe a new morphologically related classification system, providing an objective means to evaluating the deformity.

METHODS

The article proposes a new classification system exhibiting 5 different forms of a TTD based on the author's clinical experience and review of medical literature.

CONCLUSION

Five forms of a TTD include a “hill” due to the superficial infraorbital fat pad herniation; a “valley” caused by fat reduction and skin changes; a “hill-valley” resulting from the weakening of the orbital portion of the orbicularis oculi muscle and its retaining ligaments, followed by fat reduction and skin changes; a “hill-valley-hill-valley” formed by a series of changes in portions of the orbicularis oculi muscle and its retaining ligaments; and a “mixed” form depicting a range of any of the 4 deformities. Classification of TTD is of great value to aid the treating physician in choosing the appropriate treating options.
RISK OF SILICONE OIL AS VITREOUS TAMPONADE IN PARS PLANA VITRECTOMY
Authors: Feng XiaoXiao , Li Cheng , Zheng Qishan , Qian XiaoBin g , Shao WanWen , Li YuJie , Li Wei , Yin Lu , Wang Yang , Gao QianYing
Published: March 2017

Purpose:

The authors examined the differences between silicone oil and other vitreous tamponades or placebo in performing pars plana vitrectomy.

Methods:

This review and meta-analysis was conducted in accordance with the PRISMA guidelines. Seven databases and the reference lists of the retrieved randomized controlled trial articles were searched to identify eligible studies. The primary outcomes were the rate of redetachment after endotamponade removal, the rate of reoperation, and poor visual acuity. The secondary outcomes were adverse events and quality of life related to postoperative position.

Results:

Ten articles (12 trials) were included. There were no significant differences between silicone oil and other agents in most of the primary and second outcomes. Only the risk of hypotony was found to be significantly lower when filling with silicone oil, compared with other agents. No trial reported the quality of life related to postoperative position.

Conclusion:

Based on the available studies, the authors conclude that there is no significant difference in the risk of poor outcomes between pars plana vitrectomy with silicone oil and that with other vitreous tamponades with different surgical histories.
RESOLUTION OF FOVEAL CYST AFTER THE RELEASE OF VITREOMACULAR ATTACHMENT IN EYE WITH MACULAR TELANGIECTASIA TYPE 2
Authors: Kimura Machiko , Koizumi Hideki , Maruko Ichiro , Iida Tomohiro
Published: March 2017

Purpose:

To report a case of macular telangiectasia Type 2 that showed a resolution of a foveal cystic change accompanying the release of vitreomacular attachment.

Methods:

Retrospective chart review.

Report of the case:

A 75-year-old man presented with a bilateral decrease in visual acuity and metamorphopsia. At the initial visit, the left eye demonstrated a hyporeflective foveal cyst and a perifoveal vitreous detachment on optical coherence tomography. The characteristic clinical findings were consistent with the diagnosis of macular telangiectasia Type 2. Fifteen months later, the patient returned with a remission of the metamorphopsia in the left eye. The left eye had a vitreous detachment from the macula, and the hyporeflective foveal cyst was completely resolved.

Conclusion:

At least in some cases, vitreous traction or attachment may play a role in the morphologic changes seen in macular telangiectasia Type 2.
Oral Healthcare and Cardiovascular Disease
Authors: Sanchez Paula , Everett Bronwyn , Salamonson Yenna , Ajwani Shilpi , George Ajesh
Published: March 2017

Background:

There is epidemiological evidence showing an association between periodontal disease and cardiovascular disease (CVD). Despite this evidence* no comprehensive review has been undertaken to identify strategies to improve the oral health of people with CVD.

Objectives:

The aim of this review is to identify current evidence relating to the oral healthcare and management of patients with CVD.

Methods:

A scoping review was undertaken focusing on 4 key areas, namely, the impact of periodontal treatment on CVD, current recommendations regarding oral health and CVD, the role of nurses in promoting oral health, and available resources to support them. Databases were searched using a combination of keywords and search terms and 34 articles were selected.

Results:

Systematic reviews suggest that periodontal treatment may improve CVD outcomes by reducing systemic inflammation and improving endothelial function. However, there is insufficient evidence to confirm or refute these findings. International guidelines recognize the link between periodontal disease and CVD and recommend preventative strategies in this area. Non–oral health professionals, including nurses, can promote oral health and have been undertaking this role in areas like aged care and pregnancy. However, this aspect of nursing care has not been explored in the cardiac setting and no relevant training and assessment tools are available.

Conclusions:

Maintaining oral health among cardiovascular patients is important, yet it appears to be neglected during cardiac care. Cardiac nurses are in an excellent position to promote oral health but further research is required to define their role and develop supporting resources.
Family Caregiver Contribution to Self-care of Heart Failure
Authors: Chen Yuxia , Zou Huijing , Zhang Yanting , Fang Wenjie , Fan Xiuzhen
Published: March 2017

Background:

Adherence to self-care behaviors improves outcomes of patients with heart failure (HF). Caregivers play an important role in contributing to self-care.

Objective:

We aimed to explore the relationships among HF knowledge, perceived control, social support, and family caregiver contribution to self-care of HF, based on the Information-Motivation-Behavioral Skills Model.

Methods:

Two hundred forty-seven dyads of eligible patients with HF and family caregivers were recruited from a general hospital in China. Structural equation modeling was used to analyze the data obtained with the Caregiver Contribution to Self-care of Heart Failure Index, the Heart Failure Knowledge Test, the Control Attitudes Scale, and the Social Support Rating Scale.

Results:

In this model, caregiver contribution to self-care maintenance was positively affected by perceived control (β = .148, P = .015) and caregiver confidence in contribution to self-care (β = .293, P < .001). Caregiver contribution to self-care management was positively affected by HF knowledge (β = .270, P < .001), perceived control (β = .140, P = .007), social support (β = .123, P = .019), caregiver confidence in contribution to self-care (β = .328, P < .001), and caregiver contribution to self-care maintenance (β = .148, P = .006). Caregiver confidence in contribution to self-care was positively affected by HF knowledge (β = .334, P < .001).

Conclusions:

Heart failure knowledge, perceived control, and social support facilitated family caregiver contribution to self-care of HF. Targeted interventions that consider these variables may effectively improve family caregiver contributions to self-care.
Metastasis to the Lung From Carcinomas of Nonpulmonary Sites After Prolonged Disease-free Intervals
Authors: Mukhopadhyay Sanjay , Patil Pradnya D. , Roma Andres A.
Published: March 2017

Background:

Most carcinomas of nonpulmonary sites that metastasize to the lung do so within 5 years of diagnosis. Although examples of late metastasis to the lung after prolonged disease-free intervals (>5 y) have been reported sporadically, this phenomenon has not been systematically analyzed. The aim of this study was to describe the clinical and pathologic features of metastases to the lung from carcinomas of nonpulmonary origin after prolonged disease-free intervals.

Methods:

We searched our pathology archives to identify lung biopsies/resections containing metastases from carcinomas of nonpulmonary origin. Medical records were reviewed to determine the interval between resection of the nonpulmonary primary and subsequent detection of lung metastasis. Cases were included if the disease-free interval between initial diagnosis and lung metastasis exceeded 5 years and the site of origin could be verified by pathologic examination.

Results:

Of 195 consecutive lung metastases from carcinomas of nonpulmonary sites, the recurrence-free interval before lung metastasis was >5 years in 20 (10.3%). Primary sites (number of cases, recurrence-free interval) included kidney (5, 6 to 33 y), endometrium (5, 8 to 10 y), colon (3, 6 to 13 y), breast (2, 8 y, 12 y), esophagus (1, 8 y), thyroid (1, 10 y), epiglottis (1, 12 y), prostate (1, 12 y), and ovary (1, 15 y). At diagnosis of lung metastasis, lung nodules/masses were multiple in 12 and solitary in 8.

Conclusions:

Carcinomas of nonpulmonary sites can metastasize to the lung after prolonged disease-free intervals and present as a solitary lung mass. The most common culprits are carcinomas of the kidney and endometrium.
Patterns of testosterone prescription overuse
Authors: Jasuja Guneet K. , Bhasin Shalender , Rose Adam J.
Published: March 2017

Purpose of review

There has been an increase in the prescribing of testosterone therapy in the past decade. There is concern that at least part of this increase is driven by advertising rather than sound medical practice. The purpose of this review is to summarize the recent trends in testosterone prescribing, and to examine whether testosterone is being appropriately prescribed as per guidelines.

Recent findings

Both global and U.S. data reflect an overall increase in the use of testosterone in the last decade, although there are early signs of a decline in testosterone sales since 2014. This increased prescribing has been accompanied with an overall increase in testing for testosterone levels, prescription of testosterone without the appropriate diagnostic evaluation recommended by clinical practice guidelines, and apparent use of this therapy for unproven medical conditions.

Research to date suggests that there is room to improve our prescribing of testosterone. Greater understanding of the potential provider-level and system-level factors that contribute to the current prescribing practices may help accomplish such improvement.
Integrating Quality and Safety Competencies to Improve Outcomes
Authors: Sherwood Gwen , Nickel Barbara
Published: March 2017

Despite intense scrutiny and process improvement initiatives, patient harm continues to occur in health care with alarming frequency. The Quality and Safety Education for Nursing (QSEN) project provides a roadmap to transform nursing by integrating 6 competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. As front-line caregivers, nurses encounter inherent risks in their daily work. Infusion therapy is high risk with multiple potential risks for patient harm. This study examines individual and system application of the QSEN competencies and the Infusion Nurses Society's 2016 Infusion Therapy Standards of Practice in the improvement of patient outcomes.
Aberrant Cytokeratin 20 Reactivity in Epithelioid Malignant Mesothelioma: A Case Report
Authors: Manur Rashmi , Lamzabi Ihab
Published: March 2017

Malignant mesothelioma is an uncommon neoplasm that should be distinguished from the more common pulmonary adenocarcinomas and other metastatic lesions. Although diagnosis is based on morphologic features, immunohistochemical stains such as Calretinin, WT-1, CK-5/6, D2-40, Ber-Ep4, and MOC-31 are routinely used. Other organ-specific immunohistochemical markers are used when metastases from unknown primary lesion is suspected clinically. Here, we report a case of pleural epithelioid malignant mesothelioma expressing CK20. A 68-year-old male presented to the Emergency Department with nonproductive cough and progressive shortness of breath. Chest x-ray showed a large left-sided pleural effusion. Metastasis from a gastrointestinal primary was clinically suspected. Cytopathologic examination of the pleural fluid demonstrated atypical cells singly and in clusters with round nuclei, prominent nucleoli, and dense cytoplasm. The cell block demonstrated single and clusters of atypical cells positive for calretinin, D2-40, WT-1, CK-5/6, and CK7. Ber-EP4, MOC-31, TTF-1, Napsin-A, and CDX-2 were negative. CK20 was diffusely positive. A diagnosis of atypical mesothelial proliferation with aberrant CK20 expression was made. A subsequent pleural biopsy demonstrated sheets of highly atypical cells that were diffusely and strongly positive for the mesothelial markers and CK20. Multiple studies have shown malignant mesotheliomas to lack CK20 reactivity. To our knowledge, this is the first case report of a diffuse and strong CK20-positive mesothelioma. Such aberrant expressions should be kept in mind when cases are histologically atypical or lack reactivity for multiple mesothelial markers, especially when a gastrointestinal primary malignancy is suspected.
Specific Etiologies Associated With the Multiple Organ Dysfunction Syndrome in Children: Part 1
Authors: Upperman Jeffrey S. , Lacroix Jacques , Curley Martha A. Q. , Checchia Paul A. , Lee Daniel W. , Cooke Kenneth R. , Tamburro Robert F.
Published: March 2017

Objective:

To describe a number of the conditions associated with multiple organ dysfunction syndrome presented as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development multiple organ dysfunction syndrome workshop (March 26–27, 2015).

Data Sources:

Literature review, research data, and expert opinion.

Study Selection:

Not applicable.

Data Extraction:

Moderated by an expert from the field, issues relevant to the association of multiple organ dysfunction syndrome with a variety of conditions were presented, discussed, and debated with a focus on identifying knowledge gaps and research priorities.

Data Synthesis:

Summary of presentations and discussion supported and supplemented by the relevant literature.

Conclusions:

There is a wide range of medical conditions associated with multiple organ dysfunction syndrome in children. Traditionally, sepsis and trauma are the two conditions most commonly associated with multiple organ dysfunction syndrome both in children and adults. However, there are a number of other pathophysiologic processes that may result in multiple organ dysfunction syndrome. In this article, we discuss conditions such as cancer, congenital heart disease, and acute respiratory distress syndrome. In addition, the relationship between multiple organ dysfunction syndrome and clinical therapies such as hematopoietic stem cell transplantation and cardiopulmonary bypass is also considered. The purpose of this article is to describe the association of multiple organ dysfunction syndrome with a variety of conditions in an attempt to identify similarities, differences, and opportunities for therapeutic intervention.
Monitoring Severity of Multiple Organ Dysfunction Syndrome: New Technologies
Authors: Typpo Katri V. , Wong Hector R. , Finley Stacey D. , Daniels Rodney C. , Seely Andrew J. E. , Lacroix Jacques
Published: March 2017

Objective:

To describe new technologies (biomarkers and tests) used to assess and monitor the severity and progression of multiple organ dysfunction syndrome in children as discussed as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development MODS Workshop (March 26–27, 2015).

Data Sources:

Literature review, research data, and expert opinion.

Study Selection:

Not applicable.

Data Extraction:

Moderated by an experienced expert from the field, investigators developing and assessing new technologies to improve the care and understanding of critical illness presented their research and the relevant literature.

Data Synthesis:

Summary of presentations and discussion supported and supplemented by relevant literature.

Conclusions:

There are many innovative tools and techniques with the potential application for the assessment and monitoring of severity of multiple organ dysfunction syndrome. If the reliability and added value of these candidate technologies can be established, they hold promise to enhance the understanding, monitoring, and perhaps, treatment of multiple organ dysfunction syndrome in children.
Outcomes in Pelvic Organ Prolapse Surgery in Women Using Chronic Antithrombotic Therapy
Authors: High Rachel , Kavanagh Alex , Khavari Rose , Stewart Julie , Antosh Danielle D.
Published: March 2017

Introduction

Chronic antithrombotic therapy is common among patients requiring surgery for pelvic organ prolapse because of age and comorbidities. The impact of chronic anticoagulation on postoperative complications in pelvic organ prolapse surgery has not been investigated. This study aims to determine if patients on chronic antithrombotic therapy are at increased risk for postoperative complications.

Methods

This retrospective cohort study included women having prolapse surgery from 2012 to 2015, identified by Current Procedural Terminology codes, excluding patients undergoing concomitant major nonurogynecologic procedures. Baseline characteristics were compared and all procedures performed, operative duration, estimated blood loss, and length of hospitalization. Complications (blood transfusion, intensive care unit admission, reoperation, readmission, hematoma, thromboembolic event, and infection) were compared in women on chronic antithrombotic therapy and controls. Logistic regression determined odds ratio (OR) for complications in patients on chronic antithrombotics. Complications were graded by the Clavien-Dindo classification.

Results

A total of 388 charts were reviewed, and 386 patients met inclusion criteria. Twenty-one of the 386 patients were on chronic antithrombotic therapy. Chronic antithrombotic therapy increased overall complications (OR, 6.8; P < 0.0005), blood transfusion (OR, 165; P < 0.001), intensive care unit admission (OR, 19.10; P < 0.004), hospital readmission (OR, 20.7; P < 0.0005), vaginal hematoma (OR, 554.1; P < 0.001), infection (OR, 22.44; P < 0.004), and complications that required specific additional follow-up (OR, 9.42; P < 0.0005). There were no thromboembolic events. Antithrombotic therapy did not significantly increase reoperation rates (OR, 3.8; P = 0.275). Findings were maintained when adjusting for covariates of age and body mass index.

Conclusions

Postoperative surgical complications after prolapse repair procedures are increased in patients who use chronic antithrombotic medication, the majority of cases are successfully managed conservatively.
Change in Health-related Quality of Life After Referral to Memory Assessment Services
Authors: Park Min Hae , Smith Sarah C. , Chrysanthaki Theopisti , Neuburger Jenny , Ritchie Craig W. , Hendriks A.A. Jolijn , Black Nick
Published: March 2017

Despite strong support for the provision of memory assessment services (MASs) in England and other countries, their effectiveness in improving patient outcomes is uncertain. We aimed to describe change in patients’ health-related quality of life (HRQL) 6 months after referral to MASs and to examine associations with patient characteristics and use of postdiagnostic interventions. Data from 883 patients referred to 69 MASs and their informal caregivers (n=569) were collected at referral and 6 months later. Multivariable linear regression was used to examine associations of change in HRQL (DEMQOL, DEMQOL-Proxy) with patient characteristics (age, sex, ethnicity, socioeconomic deprivation, and comorbidity) and use of postdiagnostic interventions (antidementia medications and nonpharmacological therapies). Mean HRQL improved, irrespective of diagnosis: self-reported HRQL increased 3.4 points (95% CI, 2.7-4.1) and proxy-reported HRQL 1.3 points (95% CI, 0.5-2.1). HRQL change was not associated with any of the patient characteristics studied. Patients with dementia (54%) receiving antidementia drugs reported greater improvement in their HRQL but those using nonpharmacological therapies reported less improvement compared with those note receiving therapy. HRQL improved in the first 6 months after referral to MASs. Research is needed to determine longer term sustainability of the benefits and the cost-effectiveness of MASs.
Autoimmune encephalitis with anti-leucine-rich glioma-inactivated 1 or anti-contactin-associated protein-like 2 antibodies (formerly called voltage-gated potassium channel-complex antibodies)
Authors: Bastiaansen Anna E.M. , van Sonderen Agnes , Titulaer Maarten J.
Published: March 2017

Purpose of review

Twenty years since the discovery of voltage-gated potassium channel (VGKC)-related autoimmunity; it is currently known that the antibodies are not directed at the VGKC itself but to two closely associated proteins, anti-leucine-rich glioma-inactivated 1 (LGI1) and contactin-associated protein-like 2 (Caspr2). Antibodies to LGI1 and Caspr2 give well-described clinical phenotypes. Anti-LGI1 encephalitis patients mostly have limbic symptoms, and anti-Caspr2 patients have variable syndromes with both central and peripheral symptoms. A large group of patients with heterogeneous symptoms are VGKC positive but do not have antibodies against LGI1 or Caspr2. The clinical relevance of VGKC positivity in these ‘double-negative’ patients is questionable. This review focusses on these three essentially different subgroups.

Recent findings

The clinical phenotypes of anti-LGI1 encephalitis and anti-Caspr2 encephalitis have been described in more detail including data on treatment and long-term follow-up. A specific human leukocyte antigen (HLA) association was found in nontumor anti-LGI1 encephalitis, but not clearly in those with tumors. There has been increasing interest in the VGKC patients without LGI1/Caspr2 antibodies questioning its relevance in clinical practice.

Anti-LGI1 encephalitis and anti-Caspr2 encephalitis are separate clinical entities. Early recognition and treatment is necessary and rewarding. The term VGKC-complex antibodies, lumping patients with anti-LGI1, anti-Caspr2 antibodies or lacking both, should be considered obsolete.
Myelin oligodendrocyte glycoprotein antibodies: How clinically useful are they?
Authors: Reindl Markus , Jarius Sven , Rostasy Kevin , Berger Thomas
Published: March 2017

Purpose of review

Serum IgG autoantibodies against the myelin oligodendrocyte glycoprotein (MOG) are present in atypical demyelinating disorders such as neuromyelitis optica spectrum disorders (NMOSD) or acute disseminated encephalomyelitis. Whereas the role of aquaporin-4 antibodies as diagnostic markers for NMOSD is meanwhile well established, the role of MOG antibodies is less clear.

Recent findings

Initial studies suggested that MOG antibodies are associated with a more benign disease course than aquaporin-4antibodies. However, recent findings challenged this view. Data from the two largest cohorts of adult MOG antibody-positive patients with the longest clinical follow-up published so far indicate that the majority of patients develop a recurrent disease course with optic neuritis as the most frequent symptom, particularly in women. Frequent attacks are often associated with accumulating damage and functional impairment. The clinical spectrum of acquired demyelinating syndromes associated with MOG antibodies seems to be broader as anticipated in prior studies, with only a third of patients fulfilling the current diagnostic criteria for NMOSD.

MOG antibodies are associated with an increasing spectrum of age and sex-dependent clinical phenotypes, only partly overlapping with NMOSD and multiple sclerosis and with a high risk of a recurrent disease course.
Inter-group cooperation in humans and other animals
Authors: Robinson Elva J. H. , Barker Jessica L.
Published: March 2017

Social interactions are often characterized by cooperation within groups and conflict or competition between groups. In certain circumstances, however, cooperation can arise between social groups. Here, we examine the circumstances under which inter-group cooperation is expected to emerge and present examples with particular focus on groups in two well-studied but dissimilar taxa: humans and ants. Drivers for the evolution of inter-group cooperation include overarching threats from predators, competitors or adverse conditions, and group-level resource asymmetries. Resources can differ between groups in both quantity and type. Where the difference is in type, inequalities can lead to specialization and division of labour between groups, a phenomenon characteristic of human societies, but rarely seen in other animals. The ability to identify members of one's own group is essential for social coherence; we consider the proximate roles of identity effects in shaping inter-group cooperation and allowing membership of multiple groups. Finally, we identify numerous valuable avenues for future research that will improve our understanding of the processes shaping inter-group cooperation.
Elevated nonlinearity as an indicator of shifts in the dynamics of populations under stress
Authors: Dakos Vasilis , Glaser Sarah M. , Hsieh Chih-hao , Sugihara George
Published: March 2017

Populations occasionally experience abrupt changes, such as local extinctions, strong declines in abundance or transitions from stable dynamics to strongly irregular fluctuations. Although most of these changes have important ecological and at times economic implications, they remain notoriously difficult to detect in advance. Here, we study changes in the stability of populations under stress across a variety of transitions. Using a Ricker-type model, we simulate shifts from stable point equilibrium dynamics to cyclic and irregular boom–bust oscillations as well as abrupt shifts between alternative attractors. Our aim is to infer the loss of population stability before such shifts based on changes in nonlinearity of population dynamics. We measure nonlinearity by comparing forecast performance between linear and nonlinear models fitted on reconstructed attractors directly from observed time series. We compare nonlinearity to other suggested leading indicators of instability (variance and autocorrelation). We find that nonlinearity and variance increase in a similar way prior to the shifts. By contrast, autocorrelation is strongly affected by oscillations. Finally, we test these theoretical patterns in datasets of fisheries populations. Our results suggest that elevated nonlinearity could be used as an additional indicator to infer changes in the dynamics of populations under stress.
A unified model of the standard genetic code
Authors: José Marco V. , Zamudio Gabriel S. , Morgado Eberto R.
Published: March 2017

The Rodin–Ohno (RO) and the Delarue models divide the table of the genetic code into two classes of aminoacyl-tRNA synthetases (aaRSs I and II) with recognition from the minor or major groove sides of the tRNA acceptor stem, respectively. These models are asymmetric but they are biologically meaningful. On the other hand, the standard genetic code (SGC) can be derived from the primeval RNY code (R stands for purines, Y for pyrimidines and N any of them). In this work, the RO-model is derived by means of group actions, namely, symmetries represented by automorphisms, assuming that the SGC originated from a primeval RNY code. It turns out that the RO-model is symmetric in a six-dimensional (6D) hypercube. Conversely, using the same automorphisms, we show that the RO-model can lead to the SGC. In addition, the asymmetric Delarue model becomes symmetric by means of quotient group operations. We formulate isometric functions that convert the class aaRS I into the class aaRS II and vice versa. We show that the four polar requirement categories display a symmetrical arrangement in our 6D hypercube. Altogether these results cannot be attained, neither in two nor in three dimensions. We discuss the present unified 6D algebraic model, which is compatible with both the SGC (based upon the primeval RNY code) and the RO-model.
Robust associations between the 20-item prosopagnosia index and the Cambridge Face Memory Test in the general population
Authors: Gray Katie L. H. , Bird Geoffrey , Cook Richard
Published: March 2017

Developmental prosopagnosia (DP) is a neurodevelopmental condition, characterized by lifelong face recognition deficits. Leading research groups diagnose the condition using complementary computer-based tasks and self-report measures. In an attempt to standardize the reporting of self-report evidence, we recently developed the 20-item prosopagnosia index (PI20), a short questionnaire measure of prosopagnosic traits suitable for screening adult samples for DP. Strong correlations between scores on the PI20 and performance on the Cambridge Face Memory Test (CFMT) appeared to confirm that individuals possess sufficient insight into their face recognition ability to complete a self-report measure of prosopagnosic traits. However, the extent to which people have insight into their face recognition abilities remains contentious. A lingering concern is that feedback from formal testing, received prior to administration of the PI20, may have augmented the self-insight of some respondents in the original validation study. To determine whether the significant correlation with the CFMT was an artefact of previously delivered feedback, we sought to replicate the validation study in individuals with no history of formal testing. We report highly significant correlations in two independent samples drawn from the general population, confirming: (i) that a significant relationship exists between PI20 scores and performance on the CFMT, and (ii) that this is not dependent on the inclusion of individuals who have previously received feedback. These findings support the view that people have sufficient insight into their face recognition abilities to complete a self-report measure of prosopagnosic traits.
The wing pattern ofMoerarchisDurrant, 1914 (Lepidoptera: Tineidae) clarifies transitions between predictive models
Authors: Schachat Sandra R.
Published: March 2017

The evolution of wing pattern in Lepidoptera is a popular area of inquiry but few studies have examined microlepidoptera, with fewer still focusing on intraspecific variation. The tineid genusMoerarchisDurrant, 1914 includes two species with high intraspecific variation of wing pattern. A subset of the specimens examined here provide, to my knowledge, the first examples of wing patterns that follow both the ‘alternating wing-margin’ and ‘uniform wing-margin’ models in different regions along the costa. These models can also be evaluated along the dorsum ofMoerarchis, where a similar transition between the two models can be seen. Fusion of veins is shown not to effect wing pattern, in agreement with previous inferences that the plesiomorphic location of wing veins constrains the development of colour pattern. The significant correlation between wing length and number of wing pattern elements inMoerarchis australasiellashows that wing size can act as a major determinant of wing pattern complexity. Lastly, someM. australasiellaspecimens have wing patterns that conform entirely to the ‘uniform wing-margin’ model and contain more than six bands, providing new empirical insight into the century-old question of how wing venation constrains wing patterns with seven or more bands.
Identifying the significance of nonlinear normal modes
Authors: Hill T. L. , Cammarano A. , Neild S. A. , Barton D. A. W.
Published: March 2017

Nonlinear normal modes (NNMs) are widely used as a tool for understanding the forced responses of nonlinear systems. However, the contemporary definition of an NNM also encompasses a large number of dynamic behaviours which are not observed when a system is forced and damped. As such, only a few NNMs are required to understand the forced dynamics. This paper firstly demonstrates the complexity that may arise from the NNMs of a simple nonlinear system—highlighting the need for a method for identifying the significance of NNMs. An analytical investigation is used, alongside energy arguments, to develop an understanding of the mechanisms that relate the NNMs to the forced responses. This provides insight into which NNMs are pertinent to understanding the forced dynamics, and which may be disregarded. The NNMs are compared with simulated forced responses to verify these findings.