bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender Differences Among Patients Hospitalized With Cirrhosis in the United States
Authors: Rubin Jessica B. , Sundaram Vinay , Lai Jennifer C.
Published: February 2019

Background and Aims:

Gender disparities exist in outcomes among patients with cirrhosis. We sought to evaluate the role of gender on hospital course and in-hospital outcomes in patients with cirrhosis to help better understand these disparities.

Study:

We analyzed data from the National Inpatient Sample (NIS), years 2009 to 2013, to identify patients with any diagnosis of cirrhosis. We calculated demographic and clinical characteristics by gender, as well as cirrhosis complications. Our primary outcome was inpatient mortality. We used logistic regression to associate baseline characteristics and cirrhosis complications with inpatient mortality.

Results:

Our cohort included 553,017 patients with cirrhosis admitted from 2009 to 2013. Women made up 39% of the cohort; median age was 57 with 66% non-Hispanic white. Women were more likely than men to have noncirrhosis comorbidities, including diabetes and hypertension but were less likely to have most cirrhosis complications, including ascites and variceal bleeding. Women were more likely than men to have acute bacterial infections (34.9% vs. 28.2%; P<0.001), and were less likely than men to die in the hospital on univariable (odds ratio, 0.88; 95% confidence interval, 0.86-0.90; P<0.001) and multivariable (odds ratio, 0.86; 95% confidence interval, 0.83-0.88; P<0.001) analysis.

Conclusions:

In patients hospitalized with cirrhosis, women have lower rates of hepatic decompensating events and higher rates of nonhepatic comorbidities and infections, resulting in lower in-hospital mortality. Understanding differences in indications for and disposition following hospitalization may help with the development of gender-specific cirrhosis management programs to improve long-term outcomes in women and men living with cirrhosis.
Liver stiffness measurement by acoustic radiation forced impulse and transient elastography in patients with intrahepatic cholestasis
Authors: Zayed Naglaa , Darweesh Samar K. , Mousa Shereef , Atef Mira , Ramzy Eman , Yosry Ayman
Published: February 2019

Background

Transient elastography (TE) and acoustic radiation force impulse (ARFI) imaging enable a noninvasive assessment of liver stiffness measurement (LSM) and liver fibrosis/cirrhosis staging. However, their use in cholestatic diseases is still scarce.

Aim

The aim of this study was to evaluate the performance of TE and ARFI for the initial assessment of hepatic fibrosis in intrahepatic cholestatic (IHC) diseases and assess LSM changes after 3 months of specific therapy.

Patients and methods

This prospective study was carried out on 50 IHC patients. Assessment at baseline and after 3 months of LSM by TE and ARFI was performed.

Results

Overall, 60% of the patients were women (36.5±9.2 years). IHC etiologies were 23 (46%) autoimmune hepatitis, eight (16%) primary sclerosing cholangitis, eight (16%) drug induced, and five (10%) primary biliary cirrhosis. TE could diagnose ≥F2, ≥F3, and F4 stages at cutoffs of at least 6.7, 9.4, and 14.0 kPa, sensitivity/specificity were 100/50% for ≥F2, 88.2/83% for ≥F3, and 90/100% for F4. Moreover, the sensitivity and specificity of ARFI were 93/50% for ≥F2 (cutoff: 1.53 m/s); 71/67% for ≥F3 (cutoff 1.77 m/s); and 90/100% for F4 (cutoff: 2.43 m/s).

Follow-up showed a significant decrease in TE and ARFI values by 27 and 22.3% (P<0.001 and <0.001, respectively) and, accordingly, fibrosis stages decreased significantly by both TE and ARFI (P=0.002 and <0.001, respectively).

Conclusion

TE and ARFI represent noninvasive methods with adequate diagnostic performance for the assessment of fibrosis, and monitoring disease progression and treatment response in intrahepatic cholestasis.
Early recurrence detected in hepatocellular carcinoma patients after transcatheter arterial chemoembolization treatment with plasma cell-free DNA
Authors: Li Zhen , Xiao Du , Li Xin , Zhan Pengchao , Wang Jiaxiang , Zhang Henghui
Published: February 2019

Objective

Hepatocellular carcinoma (HCC) is one of the most lethal malignancies worldwide with poor prognosis due to the high incidence of recurrence. For patients with advanced HCC, transcatheter arterial chemoembolization (TACE) is the preferred treatment option owing to the minimal invasive clinical treatment with optimum therapeutic outcomes. But, there is a paucity of studies on early detection of residual cancer and relapse that result in the bottleneck of long-term effects after TACE therapy.

Patients and methods

Using next-generation sequencing platform targeting a panel of 622 cancer-associated genes, we prospectively evaluated the predictive significance of plasma cell-free DNA (cfDNA) to detect minimal residual disease in plasma cfDNA in comparison with DNA obtained from tumor tissue and blood cells of three eligible cases with HCC following TACE therapy.

Results

The results indicated that the mutational spectrum from plasma cfDNA was consistent with tumor-derived DNA and potentially suggested disease progression. Next, we determined if the dynamic variation of plasma cfDNA could indicate treatment response, the findings suggested that the mutation burden of plasma cfDNA could reveal relapse before alterations in conventional computed tomography imaging and serum α-fetoprotein values.

Conclusion

The mutation burden in plasma cfDNA may serve as a novel prognostic biomarker by providing early evidence of residual disease and identifying high risk of recurrence in patients with HCC following TACE therapy.
Attributes of analgesics for emergency pain relief: results of the Consensus on Management of Pain Caused by Trauma Delphi initiative
Authors: Porter Keith , Morlion Bart , Rolfe Mark , Dodt Christoph
Published: February 2019

Objectives

Management of pain is suboptimal in many prehospital and emergency department settings, and European guidelines are lacking. We carried out the Consensus On Management of PAin Caused by Trauma (COMPACT) Delphi initiative to gain insights into the factors physicians consider important when selecting analgesics for trauma pain.

Patients and methods

A pan-European panel of experts in emergency medicine or pain (N = 31) was recruited to participate in the COMPACT Delphi initiative. In round 1, panelists supplied free-text responses to an open question about the attributes of analgesics for emergency pain relief favored by physicians. Common themes were consolidated into factors. In round 2, factors rated important by more than 75% of the panel were taken forward into round 3. In round 3, the point at which the consensus was achieved was defined a priori as at least 75% of panelists agreeing or strongly agreeing that a factor was important.

Results

Twenty-nine experts participated, representing 12 European countries and with a mean (SD) of 20 (8.6) years of clinical experience. Most worked in an emergency department (79.3%). The consensus was achieved for 10 factors that were important to consider when selecting analgesics for trauma pain relief. The highest level of consensus was achieved for ‘efficacy’ (100%), followed by ‘safety and tolerability’ (96.6%), and ‘ease of use’ (93.1%).

Conclusion

These findings may facilitate the development of evidence-based guidelines supporting the provision of pain management in prehospital, emergency department, and critical care settings.
Racial Differences in Insurance Stability After Health Insurance Reform
Authors: Freund Karen M. , LeClair Amy , Terrin Norma , Hanchate Amresh D. , Price Lori Lyn , Moreno-Koehler Alejandro , Suzukida Jill , Kher Sucharita , Byhoff Elena , Kressin Nancy R.
Published: February 2019

Background:

One of the potential benefits of insurance reform is greater stability of insurance and reduced coverage disparities by race and ethnicity.

Objectives:

We examined the temporal trends in insurance coverage by racial/ethnic group before and after Massachusetts Insurance Reform by abstracting records across 2 urban safety net hospital systems.

Research Design:

We examined adjusted odds of being uninsured and incident rate ratios of gaining and losing insurance over time by race and ethnicity. We used billing records to capture the payer for each episode of care.

Subjects:

We included data from January 2005 through December 2013 on patients with hypertension between the ages of 21 and 64 years. We compared 4 racial and ethnic groups: non-Hispanic white, non-Hispanic Black, non-Hispanic Asian, and Hispanic.

Measures:

We examined individual patients’ insurance coverage status in 6-month intervals. We compared odds of being uninsured in the transition and postinsurance reform period to the prereform period, adjusting for age, sex, comorbidities practice location and education, and income by Census tract.

Results:

Among 48,291 patients with hypertension, reduction in rates of uninsurance with insurance reform was greater for Hispanic (29.7%), non-Hispanic Black (24.8%), and non-Hispanic Asian (26.8%) than non-Hispanic white (14.9%) patients. The odds of becoming uninsured were reduced in all racial and ethnic groups (odds ratio, 0.27–0.41).

Conclusions:

Massachusetts Insurance Reform resulted in stable insurance coverage and a reduction in disparities in insurance instability by race and ethnicity.
MYH9 Disorders (May-Hegglin Anomaly) the Role of the Blood Smear
Authors: Barros Pinto Marco P. , Marques Guilhermina
Published: February 2019

MYH9 disorders are associated with sensorineural hearing loss, glomerular nephropathy, and presenile cataract. With this case report, we show the important role of the blood smear in its identification.
A System-Wide Approach to Prevention of In-Hospital Newborn Falls
Authors: Carr Hester , Crotto Joshua , Demirel Shaban , Fisher Stephanie , Logue Leona , Marcott Meghan , Miller Lacey Rose , Mochnal Mary , Scheans Patricia
Published: February 2019

Background:

The Centers for Disease Control and Prevention lists accidents (unintentional injuries) as the fifth leading cause of infant mortality. Data analysis from a multihospital system of inpatient family birth centers revealed fluctuations in newborn birth admission falls rates at times above the benchmark reported in the literature.

Purpose:

We describe a multipronged approach to address an identified safety concern. The aim of the project was to decrease the rate of newborn falls during birth hospitalization. Despite applying multiple interventions described in the literature, newborn falls were not eliminated.

Study Design and Methods:

In this quality improvement project, a nursing leadership team was convened to review the literature, identify current and ideal states, obtain stakeholder input, identify contributing factors, and agree on standardized interventions to prevent newborn falls. The project received exempt status from the institutional review board.

Results:

Since we started the project in 2016, there was a downward trend in newborn birth admission falls in 2017; however, based on our variable data over the last 5 years and small numbers of falls, it is difficult to conclude that any one strategy or combination of strategies has been successful. Because falls from bed with the new mother were the most common types of newborn falls, interventions were focused; however, our falls rate for newborns never fell below comparable rates in the literature.

Clinical Implications:

More data are needed on effective interventions that can reduce the rate of newborn falls, especially those from bed while with the new mother. A comprehensive approach based on analysis of events and review of existing evidence are necessary first steps.
Cardiac Arrest Outcomes in Children With Preexisting Neurobehavioral Impairment*
Authors: Christensen James R. , Slomine Beth S. , Silverstein Faye S. , Page Kent , Holubkov Richard , Dean J. Michael , Moler Frank W.
Published: February 2019

Objectives:

To describe survival and 3-month and 12-month neurobehavioral outcomes in children with preexisting neurobehavioral impairment enrolled in one of two parallel randomized clinical trials of targeted temperature management.

Design:

Secondary analysis of Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital and Out-of-Hospital trials data.

Setting:

Forty-one PICUs in the United States, Canada, and United Kingdom.

Patients:

Eighty-four participants (59 in-hospital cardiac arrest and 25 out-of-hospital cardiac arrest), 49 males, 35 females, mean age 4.6 years (sd, 5.36 yr), with precardiac arrest neurobehavioral impairment (Vineland Adaptive Behavior Scales, Second Edition composite score < 70). All required chest compressions for greater than or equal to 2 minutes, were comatose and required mechanical ventilation after return of circulation.

Interventions:

Neurobehavioral function was assessed using the Vineland Adaptive Behavior Scales, Second Edition at baseline (reflecting precardiac arrest status), and at 3 and 12 months postcardiac arrest, followed by on-site cognitive evaluation. Vineland Adaptive Behavior Scales, Second Edition norms are 100 (mean) ± 15 (sd); higher scores indicate better function. Analyses evaluated survival, changes in Vineland Adaptive Behavior Scales, Second Edition, and cognitive functioning.

Measurements and Main Results:

Twenty-eight of 84 (33%) survived to 12 months (in-hospital cardiac arrest, 19/59 (32%); out-of-hospital cardiac arrest, 9/25 [36%]). In-hospital cardiac arrest (but not out-of-hospital cardiac arrest) survival rate was significantly lower compared with the Therapeutic Hypothermia after Pediatric Cardiac Arrest group without precardiac arrest neurobehavioral impairment. Twenty-five survived with decrease in Vineland Adaptive Behavior Scales, Second Edition less than or equal to 15 (in-hospital cardiac arrest, 18/59 (31%); out-of-hospital cardiac arrest, 7/25 [28%]). At 3-months postcardiac arrest, mean Vineland Adaptive Behavior Scales, Second Edition scores declined significantly (–5; sd, 14; p < 0.05). At 12 months, Vineland Adaptive Behavior Scales, Second Edition declined after out-of-hospital cardiac arrest (–10; sd, 12; p < 0.05), but not in-hospital cardiac arrest (0; sd, 15); 43% (12/28) had unchanged or improved scores.

Conclusions:

This study demonstrates the feasibility, utility, and challenge of including this population in clinical neuroprotection trials. In children with preexisting neurobehavioral impairment, one-third survived to 12 months and their neurobehavioral outcomes varied broadly.
Sensory pain characteristics of vulvodynia and their association with nociceptive and neuropathic pain: an online survey pilot study
Authors: Schlaeger Judith M. , Patil Crystal L. , Steffen Alana D. , Pauls Heather A. , Roach Keesha L. , Thornton Patrick D. , Hartmann Dee , Kobak William H. , Yao Yingwei , Suarez Marie L. , Hughes Tonda L. , Wilkie Diana J.
Published: February 2019

Objectives:

To evaluate self-reported sensory pain scores of women with generalized vulvodynia (GV) and provoked vestibulodynia (PVD), characterize pain phenotypes, and assess feasibility of using the Internet for recruitment and data collection among women with vulvodynia.

Methods:

Descriptive online survey. Data collected using an online survey accessed via a link on the National Vulvodynia Association web site. Convenience sample, 60 women aged 18 to 45 years (mean = 32.7 ± 5.5); 50 white, 2 black/African American, 4 Hispanic/Latino, and 4 Native American/Alaskan Native, diagnosed with vulvodynia, not in menopause. Pain assessment and medication modules from PAINReportlt.

Results:

Women with GV (n = 35) compared to PVD (n = 25). Estimated mean pain sites (2.5 ± 1.4 vs 2.2 ± 1.0, P = 0.31), mean current pain (8.7 ± 1.4 vs 5.5 ± 4.0, P = 0.0008), worst pain (8.1 ± 1.8 vs 6.1 ± 3.6, P = 0.02), and least pain in the past 24 hours (4.4 ± 1.8 vs 2.0 ± 2.0, P < 0.0001). Average pain intensity (7.1 ± 1.2 vs 4.6 ± 2.9, P = 0.0003) on a scale of 0 to 10, mean number of neuropathic words (8.3 ± 3.6 vs 7.7 ± 5.0), and mean number of nociceptive words (6.9 ± 4 vs 7.5 ± 4.4). Nineteen (54%) women with GV compared to 9 (38%) with PVD were not satisfied with pain levels.

Conclusion:

Women with GV reported severe pain, whereas those with PVD reported moderate to severe pain. Pain quality descriptors may aid a clinician's decisions about whether to prescribe adjuvant drugs vs opioids to women with vulvodynia.
Trigeminal Neuropathy After Mandibular Fractures: Epidemiology and Neurophysiologic Diagnosis
Authors: Joachim Michael , Tabib Rami , Laviv Amir , Pikovsky Anna , Zadik Yehuda , Zeltser Rephael
Published: February 2019

Objectives:

To study the trigeminal nerve neuropathy prevalence after mandibular fractures and follow nerve recovery and to examine associations with clinical features.

Subjects:

The files of 304 patients treated for 424 mandibular fractures in Hadassah Medical Center between 2001 and 2008 were analyzed. Twenty-five patients with paresthesia were examined by electro-diagnostic conduction test (quantitative sensory testing).

Results:

The most common fracture sites were the symphysis (28.5%) and condyle (21.4%). A strong correlation between fracture severity and treatment modality was found. Nerve damage occurred in 13.4% of nondisplaced fractures and in 65.3% of >5 mm displaced fractures. Patients who were treated by open reduction internal fixation demonstrated the biggest difference in quantitative sensory testing values between the affected and nonaffected sides. C nerve fibers were the most damaged and least regenerated. There was correlation between damage perception and objective test results.

Conclusions:

There is a correlation between fracture type and displacement severity on neurologic deficit and prognosis. The objective neurosensory damage was manifested by higher nerve excitation threshold on the injured side. Patients should be informed on the prognosis of neurologic deficit according to fracture type.
Transversal Maxillary Distraction in Patients with Cleft Lip and Palate
Authors: Martinez Plaza Adoración , Bullejos Martínez Elena , Cariati Paolo , Fernández-Valdés Gámez Ricardo , España López Antonio , Fernández Valadés Ricardo
Published: February 2019

Objective:

The aim of this study is to describe the importance of osteodistraction with transpalatal distractors for treating transversal maxillary hypoplasia in patients with cleft and lip palate.

Methods:

The participants were 17 patients (9 females and 8 males) with cleft lip and palate. Among these, 10 presented unilateral cleft lip and palate, 4 bilateral cleft lip and palate, and 3 cleft palate only.

Results:

All patients experienced a satisfactory palatal expansion and crossbite correction. The mean lengthening was 12.7 mm. The average increase of intercanine distance, intermolar distance, maxillary transverse dimension (MTD), facial transverse dimension (FTD) was 12.16, 8.45, 1.77, and 1.67 mm, respectively. The clinical follow-up was 29.7 months (range: 6–61 months).

Conclusion:

Palatal distraction is a safe and successful alternative for treating maxillary transversal alterations in patients with cleft lip and palate. This technique facilitates the establishment of an adequate transverse dimension of maxillary, and consequently a proper dental occlusion.
Langerhans Cell Histiocytosis in the Pediatric Population: Treatment of Isolated Craniofacial Lesions
Authors: Gargano Francesco , Welch Jennifer J. , Klinge Petra M. , Sullivan Stephen R. , Taylor Helena O.
Published: February 2019

Langerhans cell histiocytosis (LCH) commonly affects the craniofacial skeleton and prognosis depends on location, extension, and recurrence of the disease. The aim of our study is to better define the treatment of single craniofacial lesions, as to date different treatment modalities have been suggested and recurrence rates for both unifocal and multifocal bony lesion range between 10% and 70%. Between 2000 and 2014, we retrospectively reviewed clinical findings, anatomic location, extent of the disease, therapy, and outcomes in 24 pediatric patients with histologically confirmed LCH. Seventeen patients (67%) had craniofacial involvement, of which 13 had single system involvement and 4 had multisystem involvement. Eight patients (33%) had no craniofacial involvement. Eleven patients affected by unifocal cranial lesions were treated with resection and reconstruction. One patient with a unifocal mastoid lesion was treated with chemotherapy alone (vinblastine and prednisone). Four patients with mandible lesions were treated with curettage alone.

There were no recurrences in patients treated with excision alone. One patient (25%) treated with curettage recurred. Two patients with diffuse disease manifested organ dysfunction and diabetes insipidus. Chemotherapy was tolerated in 12 patients treated.

Our findings suggest that resection of isolated LCH lesions of the cranium is safe and chemotherapy is effective and well tolerated for nonsurgical cases.
Prevalence of Bifid Zygomaticus Major Muscle
Authors: Phan Kevin , Onggo James
Published: February 2019

Facial expression muscles have significant morphological variability, including its size, shape, attachment patterns, and prevalence. The zygomaticus major (ZMj) represents one such important structure involved in facial expressions. The bifid ZMj muscle is a known anatomical variation that clinically presents as a dimple in the cheek; however, its prevalence and variation with ethnicity and geography remains poorly understood. The authors performed the first meta-analysis examine and established the prevalence of bifid ZMj variant across different population groups. From 7 studies identified via electronic databases, the prevalence of bifid ZMj variant was most prominent in the American subgroup 34% (95% CI 22.3%–48%), followed by the Asian subgroup at 27.4% (95% CI 14.3%–46.1%) and European subgroup at 12.3% (95% CI 6.5%–22.1%). Subgroup difference was found to be statistically significant (P = 0.027). The overall prevalence of the bifid ZMj is 22.7% (95% CI 14.3%–34.2%). This contributes to the understanding of various facial muscle morphologies and attachment patterns, which have significant implications in surgical planning and procedures for facial reanimation and recreation of natural patient appearances.
What Is a Safe Distance for Preservation of the Inferior Alveolar Nerve in Lower Gingival Squamous Cell Carcinoma? A Radiographic and Histopathological Study
Authors: Tabrizi Reza , Farahani Zeinab , Barouj Mehrdad Dehghanpour , Kheirkhahi Mahtab , Jafari Mehrshad , Sadeghi Hassan Mirmohammad
Published: February 2019

Purpose:

Involvement of the inferior alveolar nerve (IAN) is important in the prognosis and treatment of gingival squamous cell carcinoma (SCC).

Methods:

In this cross sectional study, patients with gingival SCC (T4a), undergoing hemimandibulectomy or subtotal hemimandibulectomy, were examined. The distance between the lesion and inferior alveolar canal (IAC) was measured, using axial computed tomography scans before resection. Following that, histopathological evaluation of IAN was conducted. The receiver operating characteristic curve was plotted to determine the association of IAN involvement in histopathological evaluation with various distances between the lesion and IAC.

Results:

A total of 29 patients were examined in this study. The mean distance between the lesion and IAC was 9.40 ± 2.21 mm. Nerve involvement was documented in 9 (45%) out of 20 males, while 11 (55%) men showed no involvement. Thirteen (44.82%) patients showed IAN involvement. The receiver operating characteristic curve demonstrated a cut-off point of 9.75 mm for the lesion-IAN distance. The possibility of IAN involvement was 23.33 times higher in patients who reported paresthesia, compared with patients without nerve involvement (odds ratio, 23.33; 95% CL; P = 0.001)

Conclusion:

It seems that in a CT scan view, a 9.75-mm safe margin is associated with high accuracy for preserving IAN in patients with gingival SCC. Also, neurosensory disturbance can be considered a strong predictor of IAN involvement.
Tracheoesophageal Puncture Site Closure With Butterfly Cartilage Graft
Authors: Yenigun Alper , Ozturan Orhan , Kulaksiz Yasin , Aksoy Fadlullah , Tugrul Selahattin
Published: February 2019

A tracheoesophageal voice prosthesis is very effective for improving speech after total laryngectomy. Although it is generally a safe method, it may be necessary to close the tracheoesophageal fistula due to complications such as prosthesis-related cellulitis, granulation tissue formation, tracheoesophageal fistula necrosis, or salivary leakage around the prosthesis. Surgical and non-surgical methods for closure have been described. In this article, a method for closing the tracheoesophageal fistula with a butterfly cartilage graft is described. The butterfly cartilage technique is safe and efficient in terms of anatomical closure of the fistula. This study shows that the method can be easily applied, with low morbidity, using an auto-graft material with local anesthesia in an outpatient setting.
Clinical Application of Temporary External Fixator for Immediate Mandibular Reconstruction
Authors: Yin Xue-lai , Tan Yi-ran , Liu Ying , Sun Wen-wen , Zhang Xin-yu , Hu Yong-jie , Sun Jian , Zhang Chen-ping , Zhong Lai-ping
Published: February 2019

Immediate mandibular reconstruction is always necessary for the patients receiving segmental mandibulectomy to recover the facial contour and function of occlusion. When 3D modeling is unavailable, temporary external fixator is necessary to maintain the occlusion relationship and facial contour. In this study, we introduce the clinical application of temporary external fixator for immediate mandibular reconstruction in patients receiving segmental mandibulectomy, which consists of 2 anchor claws, 2 all-round retentive arms, and 1 central locking structure. From August 2016 to September 2017, temporary external fixator was applied in 13 patients. Clinical data of gender, age, surgical procedure, duration of operation, and clinical outcomes were recorded and analyzed. Among the 13 patients, there were 4 men and nine women whose ages ranged from 21 to 64 (mean 47.7) years old. There were 9 benign and 4 malignant lesions. All lesions expended at the buccal side of mandible. 12 fibular flaps and 1 vascularized iliac bone graft were used. The mandibular defect ranged from 6 to 14 (mean 10) cm. The operation duration of surgery ranged from 5 to 10 (mean 7) hours. All flaps survived with primary healing. The occlusion and facial contour were good, without significant changes of the length of mandibular body and width of mandible before and after surgery. No functional sequelae were noted at the donor sites. From these results, the temporary external fixator is easy to operate; the surgical procedure is simple and time-saving for surgeon when 3D modeling is unavailable. The indication for temporary external fixator usage is the mandibular lesion growing outward to cheek soft tissue.
Likelihood of Diagnosing Neuroblastoma in Isolated Horner Syndrome
Authors: Ben Shabat Avi , Ash Shifra , Luckman Judith , Toledano Helen , Goldenberg-Cohen Nitza
Published: February 2019

Background:

The need for an extensive evaluation for neuroblastoma in children with Horner syndrome is controversial.

Methods:

A retrospective study design was used. The cohort included 47 children with anisocoria who were diagnosed with Horner syndrome and 135 children with neuroblastoma evaluated at a pediatric medical center between 2007 and 2015. To detect neuroblastoma, patients with Horner syndrome underwent brain and cervical MRI, abdominal ultrasound, and/or measurement of urinary vanillylmandelic acid (VMA). The neuroblastoma group was evaluated for signs/symptoms of Horner syndrome at the time of diagnosis.

Results:

Seven patients with Horner syndrome were lost to follow-up, and the findings of the remaining 40 were categorized according to the age of the patient. Horner syndrome most frequently was idiopathic (58%), and in only 1 patient did the discovery of neuroblastoma precede the appearance of Horner syndrome. In the 21 patients aged 1–18 years, Horner syndrome was acquired in 15 patients and congenital in 6. The most common etiology was trauma (62%). Imaging was performed in 14 patients and VMA testing in 13. Neuroblastoma was diagnosed in 5 patients; in none was it related to Horner syndrome. In the 135 patients with neuroblastoma, most of the tumors were diagnosed at Stage 4 (60%) or Stage 3 (30%) with 53% originating in the abdomen. In one patient (0.74%) with signs/symptoms of Horner syndrome at diagnosis of neuroblastoma, the tumor had been identified prenatally and the diagnosis confirmed by imaging postnatally.

Conclusions:

The absence of occult neuroblastoma in children with Horner syndrome and of signs/symptoms of Horner syndrome in the children diagnosed with neuroblastoma suggests that Horner syndrome might not be as frequent a cause of neuroblastoma as previously thought. We recommend that full investigation for neuroblastoma be reserved for suspicious cases associated with additional systemic signs or symptoms.
Genomic epidemiology of severe community-onset Acinetobacter baumannii infection
Authors: Meumann Ella M. , Anstey Nicholas M. , Currie Bart J. , Piera Kim A. , Kenyon Johanna J. , Hall Ruth M. , Davis Joshua S. , Sarovich Derek S.
Published: February 2019

Acinetobacter baumannii

causes severe, fulminant, community-acquired pneumonia (CAP) in tropical and subtropical regions. We compared the population structure, virulence and antimicrobial resistance determinants of northern Australian community-onset

A. baumannii

strains with local and global strains. We performed whole-genome sequencing on 55 clinical and five throat colonization

A. baumannii

isolates collected in northern Australia between 1994 and 2016. Clinical isolates included CAP (n=41), healthcare-associated pneumonia (n=7) and nosocomial bloodstream (n=7) isolates. We also included 93 publicly available international

A. baumannii

genome sequences in the analyses. Patients with

A. baumannii

CAP were almost all critically unwell; 82 % required intensive care unit admission and 18 % died during their inpatient stay. Whole-genome phylogenetic analysis demonstrated that community-onset strains were not phylogenetically distinct from nosocomial strains. Some non-multidrug-resistant local strains were closely related to multidrug-resistant strains from geographically distant locations. Pasteur sequence type (ST)10 was the dominant ST and accounted for 31/60 (52 %) northern Australian strains; the remainder belonged to a diverse range of STs. The most recent common ancestor for ST10 was estimated to have occurred in 1738 (95 % highest posterior density, 1626–1826), with evidence of multiple introduction events between Australia and Southeast Asia between then and the present day. Virulence genes associated with biofilm formation and the type 6 secretion system (T6SS) were absent in many strains, and were not associated with in-hospital mortality. All strains were susceptible to gentamicin and meropenem; none carried an AbaR resistance island. Our results suggest that international dissemination of

A. baumannii

is occurring in the community on a contemporary timescale. Genes associated with biofilm formation and the T6SS may not be required for survival in community niches. The relative contributions of host and bacterial factors to the clinical severity of community-onset

A. baumannii

infection require further investigation.
Can one trust kinetic and thermodynamic observables from biased metadynamics simulations: detailed quantitative benchmarks on millimolar drug fragment dissociation
Authors: Pramanik Debabrata , Smith Zachary , Kells Adam , Tiwary Pratyush
Published: February 2019

Obtaining atomistic resolution of ligand dissociation from a protein is a much sought after experimental and computational challenge. Structural details of the dissociation process are in general hard to capture in experiments, while the relevant timescales are far beyond molecular dynamics (MD) simulations even with the most powerful super-computers. As such many different specialized enhanced sampling methods have been proposed that make it possible to efficiently calculate the dissociation mechanisms in protein-ligand systems. However, accurate benchmarks against long unbiased MD simulations are either not reported yet or simply not feasible due to the extremely long timescales. In this manuscript, we consider one such recent method “infrequent metadynamics”, and benchmark in detail the various thermodynamics and kinetic information obtained from this method against extensive unbiased MD simulations for the dissociation dynamics of two different millimolar fragments from the protein FKBP in explicit water with residence times in nanoseconds to microseconds regime. We find that the metadynamics approach gives the same binding free energy profile, dissociation pathway and ligand residence time as the unbiased MD, albeit using only 6 to 50 times lower computational resources. Furthermore, we demonstrate how the metadynamics approach can self-consistently be used to ascertain whether the reweighted kinetic constants are reliable or not. We thus conclude that the answer to the question posed in the title of this manuscript is: statistically speaking, yes.
A Novel Integrative Multiomics Method Reveals a Hypoxia-Related Subgroup of Breast Cancer with Significantly Decreased Survival
Authors: Pouryahya Maryam , Oh Jung Hun , Javanmard Pedram , Mathews James C. , Belkhatir Zehor , Deasy Joseph O. , Tannenbaum Allen R.
Published: February 2019

The remarkable growth of multi-platform genomic profiles has led to the multiomics data integration challenge. The effective integration of such data provides a comprehensive view of the molecular complexity of cancer tumors and can significantly improve clinical out-come predictions. In this study, we present a novel network-based integration method of multiomics data as well as a clustering technique involving the Wasserstein (Earth Mover’s) distance from the theory of optimal mass transport. We applied our proposed method of integrative Wasserstein-based clustering (iWCluster) to invasive breast carcinoma from The Cancer Genome Atlas (TCGA) project. The subtypes were characterized by the concordant effect of mRNA expression, DNA copy number alteration, and DNA methylation as well as the interaction network connectivity of the gene products. iW-Cluster is substantially more effective in distinguishing clusters with different survival rates as compared to isolated one-dimensional conventional omics analysis. Applying iWCluster to breast cancer TCGA data successfully recovered the known PAM50 molecular subtypes. In addition, iWCluster preserves the gene-specific data, which enables us to interpret the results and perform further analysis of significant genes for a specific cluster. The gene ontology enrichment analysis of significant genes in our substantially low survival sub-group leads to the well-known phenomenon of tumor hypoxia and the transcription factor ETS1 whose expression is induced by hypoxia. Increased expression of ETS1 is associated with an increased risk of recurrence and worse prognosis in breast cancer. Consequently, we believe iWCluster has the potential to discover novel subtypes by accentuating the genes that have concordant multiomics measurements in their interaction network, which are challenging to find without the network inference or with single omics analysis.
Genetic and epigenetic architectures of neurological protein biomarkers in the Lothian Birth Cohort 1936
Authors: Hillary Robert F. , McCartney Daniel L. , Harris Sarah E. , Stevenson Anna J. , Seeboth Anne , Zhang Qian , Liewald David C. , Evans Kathryn L. , Ritchie Craig W. , Tucker-Drob Elliot M. , Wray Naomi R. , McRae Allan F. , Visscher Peter M. , Deary Ian J. , Marioni Riccardo E.
Published: February 2019

Although plasma proteins may serve as important markers of disease risk in neurological conditions, the molecular mechanisms responsible for inter-individual variation in plasma protein levels are poorly understood. In this study, we conducted genome- and epigenome-wide association studies on the levels of 92 neurological proteins to identify genetic and epigenetic loci associated with their plasma concentrations (n = 750). We identified 62 independent genome-wide significant loci for 37 proteins (P < 5.4 × 10−10) and 68 epigenome-wide significant sites associated with the levels of 7 proteins (P < 3.9 × 10−10). Using this information, we identified biological pathways in which putative neurological biomarkers are implicated as well as molecular mechanisms through which genetic variation may perturb plasma protein levels. Additionally, we found evidence that poliovirus receptor is causally associated with Alzheimer’s disease. In conclusion, we identified many novel genetic and epigenetic factors that are associated with neurological protein levels which may inform disease biology and establish causal relationships between biomarkers and neurological diseases.
Synaptotagmin-11 mediates a vesicle trafficking pathway that is essential for development and synaptic plasticity
Authors: Shimojo Masafumi , Madara Joseph , Pankow Sandra , Liu Xinran , Yates John , Südhof Thomas C. , Maximov Anton
Published: February 2019

Synaptotagmin-11 (Syt11) is a Synaptotagmin isoform that lacks an apparent ability to bind calcium, phospholipids, or SNARE proteins. While human genetic studies have linked mutations in the Syt11 gene to schizophrenia and Parkinson's disease, the localization or physiological role of Syt11 remain unclear. We found that in neurons, Syt11 resides on abundant vesicles that differ from synaptic vesicles and resemble trafficking endosomes. These vesicles recycle via the plasma membrane in an activity-dependent manner, but their exocytosis is slow and desynchronized. Constitutive knockout mice lacking Syt11 died shortly after birth, suggesting Syt11-mediated membrane transport is required for survival. In contrast, selective ablation of Syt11 in excitatory forebrain neurons using a conditional knockout did not affect life span but impaired synaptic plasticity and memory. Syt11-deficient neurons displayed normal secretion of fast neurotransmitters and peptides but exhibited a reduction of long-term synaptic potentiation. Hence, Syt11 is an essential component of a neuronal vesicular trafficking pathway that differs from the well-characterized synaptic vesicle trafficking pathway but is also essential for life.
Rapid embryonic cell cycles defer the establishment of heterochromatin by Eggless/SetDB1 in Drosophila
Authors: Seller Charles A. , Cho Chun-Yi , O'Farrell Patrick H.
Published: February 2019

Acquisition of chromatin modifications during embryogenesis distinguishes different regions of an initially naïve genome. In many organisms, repetitive DNA is packaged into constitutive heterochromatin that is marked by di/trimethylation of histone H3K9 and the associated protein HP1a. These modifications enforce the unique epigenetic properties of heterochromatin. However, in the early Drosophila melanogaster embryo, the heterochromatin lacks these modifications, which appear only later, when rapid embryonic cell cycles slow down at the midblastula transition (MBT). Here we focus on the initial steps restoring heterochromatic modifications in the embryo. We describe the JabbaTrap, a technique for inactivating maternally provided proteins in embryos. Using the JabbaTrap, we reveal a major requirement for the methyltransferase Eggless/SetDB1 in the establishment of heterochromatin. In contrast, other methyltransferases contribute minimally. Live imaging reveals that endogenous Eggless gradually accumulates on chromatin in interphase but then dissociates in mitosis, and its accumulation must restart in the next cell cycle. Cell cycle slowing as the embryo approaches the MBT permits increasing accumulation and action of Eggless at its targets. Experimental manipulation of interphase duration shows that cell cycle speed regulates Eggless. We propose that developmental slowing of the cell cycle times embryonic heterochromatin formation.
Antagonistic framing of sustainability by energy suppliers
Authors: Weder Franzisca , Koinig Isabell , Voci Denise
Published: February 2019

Purpose

The purpose of this paper is to determine inasmuch energy suppliers dedicate communicative resources toward sustainable development and corporate social responsibility (CSR), also paying attention to how they frame it, and if they manage to achieve consistency in their communication or fall victim to contradictions.

Design/methodology/approach

By use of a qualitative content analysis, online communication tools (information on corporate websites) as well as content for download were examined in detail. The present study sample comprised of 12 case studies from selected countries (Austria, Russia, Germany, the USA, France and Korea).

Findings

Overall, findings indicate that CSR has already been implemented in most energy and energy-related industries; however, it is put forward with varying degrees of attention and intensity, depending on which topics energy companies choose to address communicatively (results were classified according to a frame positioning scheme by Weder, 2012, 2018). Results underscore the fact that, at times, companies are struggling to link their CSR projects back to their core businesses. Yet, a clear trend to politicization can be described as a strong correlation of communication strategies of energy suppliers and political programs of the respective country becomes obvious.

Research limitations/implications

Limited research as to how CSR topics are framed in different branches has been conducted to date; likewise, the energy sector, whose motives has been often subject to public questioning, has received little attention in CSR communication research to date. Hence, ambiguities were presumed to exist.

Originality/value

The present study examines the relevance and framing of CSR in a highly competitive, centralized industry that is challenged by a global process of transition to renewable energy. The results show that the analyzed energy suppliers offer only a limited variety of issue-specific frames; instead CSR as well as sustainability are (ab)used as master frames or “buzz words” in a fairly shallow economic or socio-political argumentation.
Resource budget for workface planning in industrial-construction
Authors: Siu Ming Fung Francis
Published: February 2019

Purpose

The purpose of this paper is to develop a novel analytical approach for workface planning practice in industrial-construction sector such that the construction work package (CWP) resource budget can be sufficiently planned for delivering possible field installation work package (FIWP) schedules with work uncertainty.

Design/methodology/approach

The relationship between CWP resource budget and FIWP schedules is first elucidated based on workface planning practice. The literature of work packaging, workface planning and project scheduling is reviewed. A novel analytical approach is then developed to quantify CWP resource budget based on a probability theory, in consideration of the probability of occurrence of feasible FIWP schedules formulated based on a resource scheduling approach. The results of case studies given by the new approach are cross validated by using simulation and optimization techniques.

Findings

The new analytical approach can assist workface planning by quantifying the expected CWP resource budget to deliver the FIWP work scope with certain activities that are planned at project level and with uncertain activities that are found at workface level.

Practical implications

The new analytical approach helps project and workface planners to reliably deploy CWP resource budget for delivering FIWP schedules instead of guessing the budget based on experience. An industrial-construction project for upgrading oil-sands refinery facility is used to show the practical implications.

Originality/value

This research develops a new analytical approach for workface planning practice to determine sufficient CWP resource budget for delivering feasible FIWP schedules with work uncertainty.
Perceived corporate social responsibility performance in professional football and its impact on fan-based patronage intentions
Authors: Liu Dongfeng , Wilson Rob , Plumley Daniel , Chen Xiaofeng
Published: February 2019

Purpose

The purpose of this paper is to analyze fans’ perceptions of the corporate social responsibility (CSR) activities of a professional football club, specifically whether or not perceived CSR performances are then likely to influence patronage intentions of the fans in relation to the football club.

Design/methodology/approach

The paper uses the example of a professional football club in China as a case study for data analysis. Based on a sample of 451 home team fans, analysis was conducted through calculation of descriptive statistics, and exploratory factor analysis. Regression analysis was conducted to determine the impact of perceived CSR performance on fans’ patronage intentions.

Findings

The results revealed that factor 3 (“CSR to customer and employee”) and factor 4 (“Community development and youth education”) were significantly predictive of all the three patronage intention variables, i.e. repeat purchase, word-of-mouth and merchandise consumption. In addition, factor 2 (“charity”) would also affect merchandise consumption intention, but have no effect on any other dimensions.

Originality/value

A scale measuring perceived CSR performance in professional football clubs by the fans in the Chinese context has been developed. In addition, the authors have identified that the two main CSR factors that would influence fans’ patronage intentions are: “CSR to the customer and employee” and “community development and youth education.” Thus, if football clubs are to use CSR strategically to leverage spend, then it is these two areas that they should focus on, explicitly in relation to CSR activities. This paper adds value to an area that is currently under-researched in respect of CSR activities in Chinese professional football.