bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECT ON MICROBIAL PRODUCTS ON CAESIUM ELUTION BEHAVIOUR FROM CLAY MINERALS
Authors: Kimura T , Fukutani S , Yamaji K , Ikegami M , Yoneda M
Published: April 2019

Some microorganisms in the environment make siderophores, which are low molecular chelators, to take up minerals from soil. Eleven bacteria were separated from the root of white clover by chlome azrol S (CAS) assay. Each bacterium was incubated in casamino acid (CAA) culture, and siderophores in CAA culture were purified. These extractions were applied to biotite or vermiculite spiked with Cs. From each clay mineral, 57.1–72.8% (5100 ppm), 55.6–63.8% (920 ppm) and 48.6–54.3% (2300 ppm), 31.6–34.4% (520 ppm) was eluted, respectively. To understand elution behaviour, Cs desorption ratio of each clay was measured every 30 min. The results indicate Cs elution was occurred quickly.
DETERMINATION OF GUT BACTERIAL METABOLITES IN RADIATION EXPOSED MICE
Authors: Sakamoto Yamato , Tsujiguchi Takakiyo , Ito Koichi , Yamanouchi Kanako
Published: April 2019

Gut microflora (GM) impacts human health in various ways, both beneficial and detrimental. Recently, it has attracted attention for its application in treatment, as protective agents, and as biomarkers in radiation exposure. In this study, we focused on organic acids that have not yet been reported to be related to radiation exposure; we measured the pH and organic acid content in the faeces of 0, 2, 4 and 8 Gy-irradiated mice. A common trend of fluctuation of some organic acids was observed in each group, suggesting a correlation between radiation exposure and organic acid fluctuation. Lactate fluctuation was similar between 0 and 2 Gy-, and 4 and 8 Gy-irradiated mice. Based on this finding, we suggest that lactate may also be an organic acid that is greatly affected by irradiation.
Whole-Genome Analyses Resolve the Phylogeny of Flightless Birds (Palaeognathae) in the Presence of an Empirical Anomaly Zone
Authors: Cloutier Alison , Sackton Timothy B , Grayson Phil , Clamp Michele , Baker Allan J , Edwards Scott V
Published: April 2019

Palaeognathae represent one of the two basal lineages in modern birds, and comprise the volant (flighted) tinamous and the flightless ratites. Resolving palaeognath phylogenetic relationships has historically proved difficult, and short internal branches separating major palaeognath lineages in previous molecular phylogenies suggest that extensive incomplete lineage sorting (ILS) might have accompanied a rapid ancient divergence. Here, we investigate palaeognath relationships using genome-wide data sets of three types of noncoding nuclear markers, together totaling 20,850 loci and over 41 million base pairs of aligned sequence data. We recover a fully resolved topology placing rheas as the sister to kiwi and emu + cassowary that is congruent across marker types for two species tree methods (MP-EST and ASTRAL-II). This topology is corroborated by patterns of insertions for 4274 CR1 retroelements identified from multispecies whole-genome screening, and is robustly supported by phylogenomic subsampling analyses, with MP-EST demonstrating particularly consistent performance across subsampling replicates as compared to ASTRAL. In contrast, analyses of concatenated data supermatrices recover rheas as the sister to all other nonostrich palaeognaths, an alternative that lacks retroelement support and shows inconsistent behavior under subsampling approaches. While statistically supporting the species tree topology, conflicting patterns of retroelement insertions also occur and imply high amounts of ILS across short successive internal branches, consistent with observed patterns of gene tree heterogeneity. Coalescent simulations and topology tests indicate that the majority of observed topological incongruence among gene trees is consistent with coalescent variation rather than arising from gene tree estimation error alone, and estimated branch lengths for short successive internodes in the inferred species tree fall within the theoretical range encompassing the anomaly zone. Distributions of empirical gene trees confirm that the most common gene tree topology for each marker type differs from the species tree, signifying the existence of an empirical anomaly zone in palaeognaths.
The Origins and Diversification of the Exceptionally Rich Gemsnakes (Colubroidea: Lamprophiidae: Pseudoxyrhophiinae) in Madagascar
Authors: Burbrink Frank T , Ruane Sara , Kuhn Arianna , Rabibisoa Nirhy , Randriamahatantsoa Bernard , Raselimanana Achille P , Andrianarimalala Mamy S M , Cadle John E , Lemmon Alan R , Lemmon Emily Moriarty , Nussbaum Ronald A , Jones Leonard N , Pearson Richard , Raxworthy Christopher J
Published: April 2019

Processes leading to spectacular diversity of both form and species on islands have been well-documented under island biogeography theory, where distance from source and island size are key factors determining immigration and extinction resistance. But far less understood are the processes governing in situ diversification on the world’s mega islands, where large and isolated land masses produced morphologically distinct radiations from related taxa on continental regions. Madagascar has long been recognized as a natural laboratory due to its isolation, lack of influence from adjacent continents, and diversification of spectacular vertebrate radiations. However, only a handful of studies have examined rate shifts of in situ diversification for this island. Here, we examine rates of diversification in the Malagasy snakes of the family Pseudoxyrhophiinae (gemsnakes) to understand if rates of speciation were initially high, enhanced by diversification into distinct biomes, and associated with key dentition traits. Using a genomic sequence-capture data set for 366 samples, we determine that all previously described and newly discovered species are delimitable and therefore useful candidates for understanding diversification trajectories through time. Our analysis detected no shifts in diversification rate between clades or changes in biome or dentition type. Remarkably, we demonstrate that rates of diversification of the gemsnake radiation, which originated in Madagascar during the early Miocene, remained steady throughout the Neogene. However, we do detect a significant slowdown in diversification during the Pleistocene. We also comment on the apparent paradox where most living species originated in the Pleistocene, despite diversification rates being substantially higher during the earlier 15 myr.
Molecular and Biochemical Characterization of Carbendazim-Resistant Botryodiplodia theobromae Field Isolates
Authors: Yang Ye , Di Zeng Geng , Zhang Yu , Xue Ru , Hu Ya Juan
Published: April 2019

Stem-end rot caused by Botryodiplodia theobromae is a destructive disease of mango. B. theobromae field isolates resistant to carbendazim (MBC) were collected in Hainan Province, China. In this study, the characteristics of these field isolates with resistance to MBC were investigated. The resistance of B. theobromae isolates to MBC was stably inherited. Both the MBC-resistant and MBC-sensitive isolates had similar mycelial growth rates, pathogenicity, sensitivity to high glucose, glycerol content, and peroxidase activity. Compared with MBC-sensitive isolates, MBC-resistant isolates were more sensitive to low temperature and had a significant decrease in sensitivity to high NaCl and a significant increase in catalase (CAT) and glutathione S-transferase (GST) activities. After MBC treatment, the cell membrane permeability of the sensitive isolates was markedly increased compared with that of the resistant isolates. Analysis of the β-tubulin gene sequence revealed point mutations resulting in substitutions at codon 198 from glutamic acid (GAG) to alanine (GCG) in moderately resistant isolates, and at codon 200 from phenylalanine (TTC) to tyrosine (TAC) in highly resistant isolates. These β-tubulin gene mutations were consistently associated with MBC resistance. Overall, we infer that the altered cell membrane permeability and the increase in CAT and GST activities of the resistant isolates are linked to MBC resistance.
Rapid Early Tumor Progression is Prognostic in Glioblastoma Patients
Authors: Palmer Joshua D. , Bhamidipati Deepak , Shukla Gaurav , Sharma Dinesh , Glass Jon , Kim Lyndon , Evans James J. , Judy Kevin , Farrell Christopher , Andrews David W. , Wang Zi-Wuan , Peiper Stephen C. , Werner-Wasik Maria , Shi Wenyin
Published: April 2019

Objectives:

Determine the prognostic significance of rapid early tumor progression before radiation and chemotherapy for glioblastoma patients.

Methods:

A retrospective review of glioblastoma patients was performed. Rapid early progression (REP) was defined as new enhancing tumor or >25% increase in enhancement before radiotherapy. The pre/postoperative magnetic resonance imaging was compared with the preradiation magnetic resonance imaging to determine REP. A blinded review of imaging was performed. Kaplan-Meier curves were generated to compare progression-free and overall survival (OS). Univariate analysis was performed using the log-rank test for categorical variables and Cox proportional hazards for continuous variables. Multivariable logistic regression was performed to assess factors related to early progression and Cox proportional hazards model was used for multivariate analysis of OS.

Results:

Eighty-seven patients met entry criteria. A total of 52% of patients developed REP. The OS in the REP group was 11.5 months (95% confidence interval [CI]: 7.4-17.6) and 20.1 months (95% CI: 17.8-26.1) without REP (P=0.013). On multivariate analysis including significant prognostic factors, presence of REP was found to increase the risk of death (hazard ratio: 2.104, 95% CI: 1.235-3.583, P=0.006). A total of 74% of patients recurred in the site of REP.

Conclusions:

REP was common and independently predicted for a worse OS. Integrating REP with MGMT promotor methylation improved prognostic assessment. The site of REP was a common site of tumor progression. Our findings are hypothesis generating and may indicate a particular subset of glioblastoma patients who are resistant to current standard of care therapy. Further study to determine other molecular features of this group are underway.
Combined environmental and social exposures during pregnancy and associations with neonatal size and body composition
Authors: Martenies Sheena E. , Allshouse William B. , Starling Anne P. , Ringham Brandy M. , Glueck Deborah H. , Adgate John L. , Dabelea Dana , Magzamen Sheryl
Published: April 2019

Background:

Prenatal environmental and social exposures have been associated with decreased birth weight. However, the effects of combined exposures (CEs) in these domains are not fully understood. Here we assessed multi-domain exposures for participants in the Healthy Start study (Denver, CO) and tested associations with neonatal size and body composition.

Methods:

In separate linear regression models, we tested associations between neonatal outcomes and three indices for exposures. Two indices were developed to describe exposures to environmental hazards (ENV) and social determinants of health (SOC). A third index CEs in both domains (CE = ENV/10 × SOC/10). Index scores were assigned to mothers based on address at enrollment. Birth weight and length were measured at delivery, and weight-for-length z-scores were calculated using a reference distribution. Percent fat mass was obtained by air displacement plethysmography.

Results:

Complete data were available for 897 (64%) participants. Median (range) ENV, SOC, and CE values were 31.9 (7.1–63.2), 36.0 (2.8–75.0), and 10.9 (0.4–45.7), respectively. After adjusting for potential confounders, 10-point increases in SOC and CE were associated with 27.7 g (95% confidence interval [CI] = 12.4, 42.9 g) and 56.3 g (19.4 – 93.2 g) decreases in birth weight, respectively. SOC and CE were also associated with decreases in percent fat mass.

Conclusions:

CEs during pregnancy were associated with lower birth weight and percent fat mass. Evidence of a potential synergistic effect between ENV and SOC suggests a need to more fully consider neighborhood exposures when assessing neonatal outcomes.
Reducing Delirium and Improving Patient Satisfaction With a Perioperative Mindfulness Intervention
Authors: Lisann-Goldman Lauren R. , Pagnini Francesco , Deiner Stacie G. , Langer Ellen J.
Published: April 2019

Postoperative delirium (incidence estimated up to 82%) can be ameliorated with nonpharmacologic methods. Mindfulness has not yet been incorporated into these methods, although mindfulness has been demonstrated to help patients adapt to illness and hospitalization. To reduce postoperative delirium incidence and increase patient satisfaction, this study employs a program of thought exercises based on Langerian mindfulness. Preoperatively, cardiac surgical patients listened to a mindfulness or informational audio; mindfulness subjects were also guided by the principal investigator through mindfulness exercises. Postoperatively, mindfulness subjects were visited twice daily for mindfulness exercises. For all patients, delirium screening was performed twice daily. Before discharge, affective status and satisfaction with hospital stay were assessed. No patients who completed the study screened positive for delirium. Trends include (1) lower (improved) median anxiety and depression scores postoperatively when considering both study groups together; (2) both groups rated the hospital more favorably on global satisfaction measures; (3) both groups shared generally positive comments regarding the audio files (qualitative data). Audio files and mindfulness exercises are associated with patient satisfaction among cardiothoracic surgery patients. The absence of delirium precludes determination of the effectiveness of the intervention in reducing delirium incidence.
Dietary Supplement Use in Gastrointestinal Symptom Management and Effect on Hopelessness Levels in Patients With Irritable Bowel Syndrome
Authors: Erdogan Zeynep , Kurçer Mehmet Ali
Published: April 2019

This study was conducted to determine the dietary supplement (DS) use in gastrointestinal symptom management, and its effect on hopelessness levels in patients with irritable bowel syndrome (IBS). The universe of this cross-sectional study consisted of 132 patients presenting at the polyclinic, while the sample consisted of 127 patients who meet the inclusion criteria to study. Data were collected using a patient identification form including sociodemographic characteristics and DS use, the Gastrointestinal Symptom Rating Scale, and the Beck Hopelessness Scale. The frequency of DS use in the last year among patients with IBS was 73.2%. Younger, women, those with graduate education, and those with better economic status were found to prefer more DS (P < .0001). Nausea and decreased passage of stools were predictors of DS use with a rate of 40.9% (R
2 = 0.409, P < .0001). The patients were found to use mint oil (35.6%), mint juice (24.6%), lemon (20.5%) for nausea, and apricots (48.2%) and dietary fibers (16.9%) for decreased passage of stools. Patients who did not use DSs were found to be more hopeless (P < .03). It was found that 73.2% of patients with IBS used DSs. Patients who did not use DSs were found to be more hopeless. DSs with proven effectiveness can be integrated into medical treatments.
Development of Validated Checklists to Evaluate Clinical Specialists in Pediatric ECMO Emergencies Using Delphi Method
Authors: Abulebda Kamal , Hocutt Gail R.N.C. , Gray Brian W. , Ahmed Rami A. , Slaven James E. , Malin Stefan , Wetzel Elizabeth A. , Medsker Brock H. , Byrne Bobbi J.
Published: April 2019

Extracorporeal membrane oxygenation (ECMO) is a low-volume, high-risk modality of care. Clinical specialists (CS) who manage ECMO circuit emergencies vary in background and approach to circuit emergencies based on institutional training standards, leading to variation that may impact the quality of care. Validated checklists to assess CS performance are crucial to eliminate disparities and improve efficiency. This study focused on the development and validation of checklists to evaluate the clinical performance of ECMO CS in three ECMO circuit emergencies. A research team with diverse clinical background from our institution developed the first iteration of three ECMO emergency checklists: (1) venous air, (2) arterial air, and (3) oxygenator failure. A modified Delphi technique with a panel of 11 national content experts in ECMO was used to develop content validity evidence. Rating scales from 1 to 7 were used to evaluate each checklist item. The response rate for three rounds of Delphi was 100%. Items with mean score >4 were kept, and new item recommendations were added based on comments from the panel. The venous air, arterial air, and oxygenator failure checklists were revised from 10, 13, and 9 items to 12, 12, and 10 items, respectively. A Cronbach’s α of 0.74 during the second round of responses indicated an acceptable degree of agreement. This study demonstrated content validation of three ECMO emergency checklists to assess performance of ECMO CS using a consensus-based Delphi technique. Future validity evidence should be acquired by implementing these checklists in the simulation environments.
Fibrinogen Albumin Ratio and Ischemic Stroke During Venoarterial Extracorporeal Membrane Oxygenation
Authors: Acharya Prakash , Jakobleff William A. , Forest Stephen J. , Chinnadurai Thiru , Mellas Nicolas , Patel Snehal R. , Kizer Jorge R. , Billett Henny H. , Goldstein Daniel J. , Jorde Ulrich P. , Saeed Omar
Published: April 2019

Fibrinogen is a clotting factor and a major determinant of platelet aggregation. Albumin, on the other hand, inhibits platelet function and thrombus formation. Taken together, an elevated fibrinogen albumin ratio (FAR) has been described as a marker of disease severity during prothrombotic conditions. We evaluated the association of FAR and ischemic stroke during venoarterial extracorporeal membrane oxygenation (VA ECMO) support. A single center, retrospective study was performed including all adult patients placed on VA ECMO. FAR was calculated from fibrinogen and albumin measurements in the first 24 hours of VA-ECMO initiation. Patients were categorized into high (≥125) and low (<125) FAR groups and the risk of eventual ischemic stroke was determined. There were 201 patients who underwent VA ECMO placement and 157 had a FAR. They were 56 ± 14 years old and 66 (42%) had a high FAR. Patients with a high FAR had lower survival free from an ischemic stroke during VA ECMO (log rank p < 0.001; adjusted hazard ratio 5.51; 95% CI: 1.8–16.5). In tertile analysis, the level of FAR was associated with an incrementally higher likelihood of eventual ischemic stroke (log rank p = 0.004). Those with a high FAR had greater mean platelet volume (10.8[10.4–12] vs. 10.5[10.2–11.9]fl, p = 0.004). An elevated FAR during the first 24 hours of VA ECMO placement is associated with a greater risk of a subsequent ischemic stroke. Our findings suggest that assessment of FAR soon after VA ECMO placement may assist with early stratification of patients at risk for an ischemic stroke.
Assessing Computational Model Credibility Using a Risk-Based Framework: Application to Hemolysis in Centrifugal Blood Pumps
Authors: Morrison Tina M. , Hariharan Prasanna , Funkhouser Chloe M. , Afshari Payman , Goodin Mark , Horner Marc
Published: April 2019

Medical device manufacturers using computational modeling to support their device designs have traditionally been guided by internally developed modeling best practices. A lack of consensus on the evidentiary bar for model validation has hindered broader acceptance, particularly in regulatory areas. This has motivated the US Food and Drug Administration and the American Society of Mechanical Engineers (ASME), in partnership with medical device companies and software providers, to develop a structured approach for establishing the credibility of computational models for a specific use. Charged with this mission, the ASME V&V 40 Subcommittee on Verification and Validation (V&V) in Computational Modeling of Medical Devices developed a risk-informed credibility assessment framework; the main tenet of the framework is that the credibility requirements of a computational model should be commensurate with the risk associated with model use. This article provides an overview of the ASME V&V 40 standard and an example of the framework applied to a generic centrifugal blood pump, emphasizing how experimental evidence from in vitro testing can support computational modeling for device evaluation. Two different contexts of use for the same model are presented, which illustrate how model risk impacts the requirements on the V&V activities and outcomes.
Nonhuman leukocyte antigen antibodies that have impact in the heart transplant patient
Authors: Reddy Yogesh N.V. , Pereira Naveen L.
Published: April 2019

Purpose of review

Despite human leukocyte antigen (HLA) matching and monitoring for donor-specific HLA antibodies, antibody-mediated rejection and chronic rejection in the form of allograft vasculopathy and chronic graft dysfunction continue to occur. There has been increasing interest in non-HLA antibodies as mediators of these changes.

Recent findings

In this review, we discuss the recent literature describing the importance of non-HLA antibodies in organ transplantation and summarize the literature evaluating such antibodies in heart transplantation.

Monitoring of non-HLA antibodies requires additional measurement standardization and correlation of specific antibodies with outcomes. However, there is promise that identification with newer immunoproteomic techniques and therapy toward such antibodies may improve long-term graft outcomes and decrease acute rejection and allograft vasculopathy.
Stability studies in oncology
Authors: Vigneron Jean , D’Huart Elise , Demoré Béatrice
Published: April 2019

Introduction:

Hospital pharmacists, physicians, and nurses need stability information on the drugs used in their daily practice. The objectives of this work were to evaluate if the information given by pharmaceutical companies about the stability of reconstituted and diluted solutions in the field of oncology were sufficient in the daily practice of hospitals.

Methods:

The first step was to establish a list of the main needs about stability data on the basis of the daily practice of hospital pharmacists. The second step was to search through information given by pharmaceutical companies and then to compare to hospital pharmacists’ needs. The third step was to find information in the cases, in which pharmaceutical companies’ information was not sufficient.

Results:

The situation is different depending on the product. For originators, stability data given by pharmaceutical companies are often very limited, the goal being to obtain the marketing authorization. For generics or biosimilars, extended stability studies are carried out to conquer the market and are part of the marketing strategy.

A list of studies to fill the gap of companies’ information was presented. Examples including bortezomib, rituximab, azacitidine, nivolumab, and some mixtures were presented. The importance of stability studies conducted in hospitals is emphasized.

Conclusion:

Pharmaceutical companies perform stability studies for their products and for their own interest. In many cases, the results of these studies are insufficient and do not meet the need for information that hospital pharmacists are looking for. Conducting stability studies by hospital pharmacy teams should be encouraged.
Early Ultrasound Follow-Up of Extension-Type Supracondylar Fractures Treated by the Collar-and-Cuff (Blount) Technique
Authors: Choufani Camille , Blondiaux Eléonore , Pietton Raphaël , Bachy Manon , Leroy Antonin , Vialle Raphaël
Published: April 2019

Background

Extension-type supracondylar fractures can be treated with external immobilization, with the elbow flexed 100°. However, this technique requires early evaluation by true lateral x-ray of the elbow to detect secondary fracture displacement.

Questions/Purpose

The purpose of this work is to evaluate whether ultrasound imaging is suitable for demonstrating initial reduction of supracondylar fractures and early secondary displacement of the fracture.

Methods

Fourteen patients aged 3 to 7 years (mean, 4.8 years) were treated by closed reduction under general anesthesia and immobilization with a collar and cuff. All patients had early postoperative x-rays and ultrasonography on day 1, as well as day 8 x-rays and ultrasonography. Ultrasonograms were performed by an experienced senior radiologist.

Results

In all cases, a complete reduction was confirmed at initial follow-up on both sonogram and intraoperative fluoroscopy. In 13 of 14 cases, no secondary displacement of the fracture was noted at day 8 on either ultrasonography or x-ray images. In 1 case, a secondary displacement was noted at day 8 on ultrasonography and confirmed by the lateral x-ray.

Conclusions

Our study found a complete agreement assessing the quality of intraoperative reduction of supracondylar fractures by radiographs and ultrasonography. These results confirm that ultrasound imaging is suitable for demonstrating secondary displacements of supracondylar fractures in children. We postulate that in Gartland types II and III fractures treated by Blount procedure, a negative ultrasound result at day 8 follow-up may reduce the need for further radiographs. However, in any doubtful situation, the need for conventional radiographs remains.

Level of Evidence

Diagnostic study, level II.
A Novel Pharyngeal Clearance Maneuver for Initial Tracheostomy Tube Cuff Deflation in High Cervical Tetraplegia
Authors: Ehsanian Reza , Klein Christina , Mohole Jyodi , Colaci Joshua , Pence Benjamin T. , Crew James , McKenna Stephen
Published: April 2019

Mechanical insufflation-exsufflation, or “cough assist,” is a commonly used method of clearing tracheal and pulmonary secretions in patients with respiratory insufficiency secondary to spinal cord injury. This report presents a novel technique termed the pharyngeal clearance maneuver, which uses a modified application of the mechanical insufflation-exsufflation device to mobilize “secretion burden” at the portion of the trachea above the tracheostomy cuff during cuff deflation. Utilization of this strategy may reduce the risk of aspiration, infection, and respiratory compromise for patients with high cervical spinal cord injury in the acute rehabilitation setting. It is of particular benefit for those whose cuffs are being deflated for the first time and who may have large secretion volumes above the cuff. It can be further used as needed before speaking trials and swallow therapies. We anticipate that the pharyngeal clearance maneuver may be used in other populations with impaired cough and need for invasive ventilator support because of ventilator pump failure (eg, spinal muscular atrophy, congenital myopathies, obesity hypoventilation, amyotrophic lateral sclerosis, muscular dystrophy, and acute inflammatory demyelinating polyneuropathy).
Sustained Effect of a Community-based Behavioral and Nutrition Intervention on HIV-related Outcomes Among Women Living With HIV in Rural India: A Quasi-experimental Trial
Authors: Nyamathi Adeline M. , Shin Sanghyuk S. , Sinha Sanjeev , Carpenter Catherine L. , Garfin Dana Rose , Ramakrishnan Padma , Yadav Kartik , Ekstrand Maria L.
Published: April 2019

Background:

Women living with HIV (WLH) in rural communities face challenges to obtaining treatment and accurate disease-related information. Nutritional deficits exacerbate disease progression.

Setting:

WLH were recruited from primary health centers in rural India.

Method:

A quasi-experimental trial of a comprehensive Accredited Social Health Activist (Asha)-supported intervention compared 4 distinct Asha-based programs [(1) standard education (SE) alone; (2) nutrition education (+NE); (3) nutrition supplements (+NS); or (4) nutrition education and nutrition supplements (+NENS)] on key disease and nutrition-related outcomes [CD4 count, body mass index (BMI), serum albumin, and hemoglobin]. Assessments occurred at baseline, and months 6 (immediately after intervention), 12, and 18. Multilevel modeling examined effects of program (group) over time.

Findings:

Among 600 WLH enrolled (n = 150 per arm), mean age, CD4 count, and BMI (kg/m2) were 34.31, 447.42, and 20.09, respectively, at baseline. At 18-month follow-up, program 4 (+NENS) experienced greatest improvements in CD4 counts compared with program 1 (+SE) [adjusted difference = 223.81, 95% confidence interval (CI): 170.29 to 277.32]. For BMI, programs 3 (+NS; adjusted difference = 2.33, 95% CI: 1.39 to 3.26) and 4 (+NENS; adjusted difference = 2.14, 95% CI: 1.17 to 3.12) exhibited greater gains compared with program 1 (+SE). Programs 3 and 4 were not significantly different from each other (adjusted difference = −0.18, 95% CI: −1.12 to 0.76). Hemoglobin and serum albumin also improved over time; program 4 (+NENS) exhibited the greatest gains.

Conclusions:

A low-cost Asha-supported behavioral and nutritional intervention improved outcomes for WLH. Gains were sustained at 18-month follow-up. Similar approaches may help improve HIV and other infectious disease-related outcomes in vulnerable populations.
Advances in molecular diagnostic testing for central nervous system infections
Authors: Houlihan Catherine F. , Bharucha Tehmina , Breuer Judith
Published: April 2019

Purpose of review

Central nervous system (CNS) infections present an ongoing diagnostic challenge for clinicians, with an aetiological agent remaining unidentified in the majority of cases even in high-income settings. This review summarizes developments in a range of diagnostic methods published in the past 18 months.

Recent findings

Several commercial assays exist for the detection of viral, bacterial and fungal pathogens using single multiplex PCR. Multicentre validation of the Biofire FilmArray panel illustrated high sensitivity for bacterial and fungal pathogens, but poor results for Cryptococcus species detection. The development of microarray cards for bacterial CNS pathogens shows promise but requires further validation. Few developments have been made in proteomics and transcriptomics, contrasted with significant increase in the use of metagenomic (or unbiased) sequencing. Novel viruses causing CNS infection have been described using this technique but contamination, cost, expertise and turnaround time requirements remain restrictive. Finally, the development of Gene Xpert and Ultra has revolutionized tuberculosis meningitis diagnostics with newly released recommendations for their use from the WHO.

Progress has been made in the clinical validation and international recommendation of PCR-based tests for CNS infections. Sequencing techniques present the most dynamic field, although significant ongoing challenges persist.
Accessory Palmaris Longus
Authors: Yuan Jing , Dhanaraj Ian Dominic , Ng Hannah Jia Hui , Rajaratnam Vaikunthan
Published: April 2019

Current medical literature has described many variations of the palmaris longus. One variation that is rarely seen is that of the accessory palmaris longus, which is better known in literature as the “palmaris profundus.” This brief review will describe the anatomy and the developmental origins of the palmaris longus, as well as the clinical relevance of an accessory palmaris longus. We will also present a case on the accessory palmaris longus and discuss whether the accessory palmaris longus, if encountered during a routine carpal tunnel surgery, should be resected intraoperatively.
Merkel Cell Carcinoma of the Digit
Authors: Persitz Jonathan , Atzmon Ran , Keren Timoret , Avisar Erez
Published: April 2019

Merkel cell carcinoma (MCC) is a biologically aggressive neuroendocrine tumor of the skin. There are roughly 1500 new cases of MCC diagnosed every year in the United States, with an increased incidence over the past 15 years reaching up to 8%. Epidemiological studies show that the highest MCC incidence is seen in men older than 65 years, with a ratio of 0.23 per 10,000 among whites. Merkel cell carcinoma of the skin most commonly presents as a single, rapidly growing, flesh-colored, painless mass. Because MCC is uncommon, histopathological examination is usually delayed. Because of the high mortality rate associated with this aggressive tumor, a multidisciplinary panel is recommended to ensure high-quality coordinated care. The choice of treatment option depends on disease characteristics, staging at presentation, regional lymph node involvement, comorbidities, and performance status of the patient. We report a case of MCC to alert medical professionals of this potentially fatal tumor, as early diagnosis and treatment may improve morbidity and mortality rates.
Hematoma Risks of Nonsteroidal Anti-inflammatory Drugs Used in Plastic Surgery Procedures
Authors: Walker Nicholas J. , Jones Veronica M. , Kratky Lauren , Chen Haiying , Runyan Christopher M.
Published: April 2019

Background

The opioid crisis in America has sparked a shift toward a multimodality perioperative pain regimen. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the perioperative period decreases opioid consumption and increases efficacy. However, many plastic surgeons avoid their use because of antiplatelet effects. The purpose of this article is to systematically review the plastic surgery literature to assess the risk of intraoperative or postoperative bleeding and hematoma formation.

Methods

A systematic review of articles published in PubMed was performed in September 2018 to investigate the incidence of increased bleeding and hematoma formation with use of NSAIDs in the perioperative period in plastic surgery. All articles were reviewed for primary outcome measures, and a selective literature review was performed to examine perioperative NSAID use in other surgical subspecialties. Random-effect meta-analysis was performed.

Results

Our search yielded 806 total articles, with 15 meeting inclusion criteria, and this included 3064 patients (1679 with perioperative NSAIDs, 1385 with no NSAIDs). There was no significant difference in overall incidence of bleeding/hematoma in the treatment group versus control (no NSAIDs). The overall pooled odds ratio (OR) and corresponding 95% confidence interval were 1.20 and 0.73 to 1.97 (P = 0.48). When separated by drug administered across all plastic surgery procedures, there were no statistically significant differences in incidences of hematoma or increased bleeding with use of ketorolac (OR, 1.48 [0.86–2.56]; P = 0.57), ibuprofen (OR, 0.55 [0.14–2.14]; P = 0.87), or celecoxib (OR, 0.22 [0.02–2.52]; P = 0.39). When examining NSAID use in breast surgery, there was no statistically significant difference in incidence of hematoma or increased bleeding when combining all 3 drug types (OR, 1.39 [0.82–2.37]; P = 0.60). Some individual studies demonstrated trends toward increased bleeding/hematoma in reduction mammoplasties.

Conclusions

Nonsteroidal anti-inflammatory drugs significantly improve pain control and decrease opioid use when used in plastic surgery. The majority of evidence in plastic surgery does not support an increased incidence of bleeding/hematoma with the use of perioperative NSAIDs.
County-level Variation in Use of Surgery and Cancer-specific Survival for Stage I-II Pancreatic Adenocarcinoma
Authors: Swords Douglas S. , Mulvihill Sean J. , Brooke Benjamin S. , Stoddard Gregory J. , Firpo Matthew A. , Scaife Courtney L.
Published: April 2019

Objective:

The aim of the study was to describe county-level variation in use of surgery for stage I-II pancreatic ductal adenocarcinoma (PDAC) and the association between county surgery rates and cancer-specific survival (CSS).

Background:

The degree of small geographic area variation in use of surgery for stage I-II PDAC and the association between area surgery rates and CSS remain incompletely defined.

Methods:

This is a retrospective cohort study of patients aged 18 to 80 years in the 2007 to 2015 Surveillance, Epidemiology, and End Results database with stage I-II PDAC without contraindications to surgery or refusal. Multilevel models were used to characterize county-level variation in use of surgery and CSS. County-specific risk- and reliability-adjusted surgery rates and CSS rates were calculated.

Results:

Of 18,100 patients living in 581 counties, 10,944 (60.5%) underwent surgery. Adjusted county-specific surgery rates varied 1.5-fold from 49.9% to 74.6%. Median CSS increased in a graded fashion from 13 months [interquartile range (IQR) 13–14] in counties with surgery rates of 49.9% to 56.9% to 18 months (IQR 17–19) in counties with surgery rates of 68.0% to 74.6%. Results were similar in multivariable analyses. Adjusted county 18-month CSS rates varied 1.6-fold from 32.7% to 53.7%. Adjusted county surgery and 18-month CSS rates were correlated (r = 0.54; P < 0.001) and county surgery rates explained approximately half of county-level variation in CSS. Only 18 (3.1%) counties had adjusted surgery rates of 68.0% to 74.6%, which was associated with the longest CSS.

Conclusions:

County-specific rates of surgery varied substantially, and patients living in areas with higher surgery rates lived longer. These data suggest that increasing use of surgery in stage I-II PDAC could lead to improvements in survival.
Association ‘Between Gabapentinoids on the Day of Colorectal Surgery and Adverse Postoperative Respiratory Outcomes
Authors: Ohnuma Tetsu , Krishnamoorthy Vijay , Ellis Alan R. , Yan Rosalie , Ray Neil D. , Hsia Hung-Lun , Pyati Srinivas , Stefan Mihaela , Bryan William E. , Pepin Marc J. , Lindenauer Peter K. , Bartz Raquel R. , Raghunathan Karthik
Published: April 2019

Objective:

The aim of this study was to determine the association between gabapentinoids on the day of surgery and adverse postoperative outcomes in patients undergoing colorectal surgery in the United States.

Background:

Gabapentinoids, gabapentin and pregabalin, are recommended in multimodal analgesia protocols for acute postoperative pain management after colorectal surgery. However, current literature focuses on the efficacy in reducing opioid consumption, but provides limited information about adverse risks.

Methods:

This was a retrospective study including 175,787 patients undergoing elective colorectal surgery using the Premier database between 2009 and 2014. Multilevel regression models measured associations of receipt of gabapentinoids with naloxone use after surgery, non-invasive ventilation (NIV), invasive ventilation (IMV), hospital length of stay (LOS), and parental morphine equivalents (PMEs) on the day of surgery and on the day before discharge.

Results:

Overall, 4677 (2.7%) patients received gabapentinoids on the day of surgery, with use doubling (1.7% in 2009 to 4.3% in 2014). Compared with patients who were unexposed to ganapentinoids, gabapentinoid exposure was associated with lower PMEs on the day of surgery [−2.7 mg; 95% confidence interval (CI), −5.2 to −0.0 mg], and with higher odds of NIV [odds ratio (OR) 1.22, 95% CI, 1.00–1.49] and receipt of naloxone (OR 1.58, 95% CI, 1.11–2.26). There was no difference between the groups with respect to IMV or PMEs on the day before discharge.

Conclusions:

Although use of gabapentinoids on the day of surgery was associated with slightly lower PMEs on the day of surgery, it was associated with higher odds of NIV and naloxone use after surgery.
Continuation Electroconvulsive Therapy for Patients With Clozapine-Resistant Schizophrenia
Authors: Braga Raphael J. , John Majnu , Schooler Nina R. , Bailine Samuel H. , Malur Chitra , Mendelowitz Alan , Petrides Georgios
Published: April 2019

Objectives

The risk of relapse after a successful acute course of treatment is a clinical challenge in electroconvulsive therapy (ECT) practice, particularly in patients with a history of marked resistance to previous treatments. Research suggests that a gradual decrease of ECT or its long-term continuation might be the best strategy. Notwithstanding, current studies do not address the role of continuation ECT in the truly refractory cases, that is, the clozapine-resistant patients. Our group published a randomized controlled trial of ECT augmentation of clozapine in clozapine-resistant patients with schizophrenia, where the augmentation was vastly superior in efficacy for the acute treatment. The aim of the current study is to evaluate the efficacy of continuation ECT for patients who showed response to the combination of acute ECT and clozapine for treatment-resistant schizophrenia.

Methods

Continuation ECT was offered to all patients who completed the acute study and who met response criterion. We followed a tapered schedule of 4 weekly ECT sessions, followed by 4 ECT sessions every 2 weeks and 2 monthly ECT sessions for a total of 10 sessions.

Results

Patients sustained the gains achieved with the acute course of ECT, and no individual patient presented with clinically relevant worsening of symptoms. Moreover, the long-term use of ECT was not associated with added adverse effects.

Conclusions

This is an open pilot study with a small sample size, and results should be interpreted accordingly, but this report offers a relevant starting point for much needed future studies.
Body composition and markers of cardiometabolic health in transgender youth compared to cisgender youth: a cross-sectional study
Authors: Nokoff Natalie J , Scarbro Sharon L , Moreau Kerrie L , Zeitler Philip , Nadeau Kristen J , Juarez-Colunga Elizabeth , Kelsey Megan M
Published: April 2019

Context

Up to 1.8% of adolescents identify as transgender and many more seek care, yet the impact of gender affirming hormone therapy (GAHT) on cardiometabolic health is unknown.

Objective

To determine insulin sensitivity and body composition among transgender females (TF) and males (TM) on estradiol or testosterone, compared to cisgender females (CF) and males (CM).

Design

Pilot, cross-sectional study conducted from 2016-2018.

Setting. Academic regional transgender referral center.

Participants

Transgender adolescents on either testosterone or estradiol for at least 3 months were recruited. Nineteen TM were matched to 19 CM and 42 CF on pubertal stage and body mass index (BMI). Eleven TF were matched to 23 CF and 13 TF to 24 CM on age and BMI.

Main Outcome Measure(s)

1/[fasting insulin] and body composition (dual-energy absorptiometry, DXA).

Results

Total body fat was lower in TM than CF (29±7 vs. 33±7%, p=0.002) and higher than CM (28±7 vs. 24±9%, p=0.047). TM had higher lean mass than CF (68±7 vs. 64±7%, p=0.002) and lower than CM (69± vs. 73±8%, p=0.029). Insulin sensitivity was not different between the groups.

TF had lower body fat than CF (31±7 vs. 35±8%, p=0.033) and higher than CM (28±6 vs. 20±10, p=0.001). TF had higher lean mass than CF (66±6 vs. 62±7%, p=0.032) and lower than CM (69±5 vs. 77±9%, p=0.001). TF were more insulin resistant than CM (0.078±0.025 vs. 0.142±0.064, p=0.011).

Conclusions

Transgender adolescents on GAHT have significant differences in body composition compared to cisgender controls, with a body composition intermediate between BMI-matched cisgender males and females. These changes in body composition may have consequences for the cardiometabolic health of transgender adolescents.

Precis

Transgender youth on gender affirming hormone therapy have differences in their percent fat and lean mass compared to cisgender (non-transgender) youth.
Re-configuration of Chromatin Structure During the Mitosis-G1 Phase Transition
Authors: Zhang Haoyue , Emerson Daniel J. , Gilgenast Thomas G. , Titus Katelyn R. , Lan Yemin , Huang Peng , Zhang Di , Wang Hongxin , Keller Cheryl A. , Giardine Belinda , Hardison Ross C. , Phillips-Cremins Jennifer E , Blobel Gerd A.
Published: April 2019

Higher-order chromatin organization such as A/B compartments, TADs and chromatin loops are temporarily disrupted during mitosis. These structures are thought to organize aspects of gene regulation, and thus it is important to understand how they are re-established after mitosis. We examined the dynamics of chromosome reorganization by Hi-C at defined time points following exit from mitosis in highly purified, synchronous cell populations. We observed that A/B compartments are rapidly established and progressively gain in strength following mitotic exit. Contact domain formation occurs from the “bottom-up” with smaller sub-TADs forming initially, followed by convergence into multi-domain TAD structures. CTCF is strongly retained at a significant fraction of sites on mitotic chromosomes and immediately resumes full binding at ana/telophase, the earliest tested time point. In contrast, cohesin is completely evicted from mitotic chromosomes and resumes focal binding with delayed kinetics. The formation of CTCF/cohesin co-anchored structural loops follows the kinetics of cohesin positioning. Stripe-shaped contacts anchored by CTCF grow in length, consistent with a loop extrusion process after mitosis. Interactions between cis-regulatory elements can form rapidly, preceding CTCF/cohesin anchored structural loops. Strikingly, we identified a group of rapidly emerging transient contacts between cis-regulatory elements in ana/telophase, that are dissolved upon G1 entry, co-incident with the establishment of inner boundaries or nearby interfering loops. Our findings indicate that distinct but mutually influential forces drive post-mitotic chromatin re-configuration to shape compartments, contact domains, cis-element contacts, and CTCF/cohesin dependent loops.
Pan-genome analysis reveals the molecular basis of niche adaptation ofStaphylococcus epidermidisstrains
Authors: Su Fei , Tian Rui , Yang Yi , Zou Lihui , Xu Xiaomao , Chen Dongke , Zhang Junhua , Chen Xue , Xiao Fei , Zhao Gang , Li Yanming , Xu Hongtao
Published: April 2019

Staphylococcus epidermidisis the most commonly isolated species from human skin and the second leading cause of bloodstream infections. Here, we performed a large-scale comparative study without any pre-assigned reference to identify genomic determinants associated with their diversity and adaptation as a “double-side spy”, a skin dominant colonization, and a successful pathogen. The pan-genome ofS. epidermidisis open with 435 core proteins and a pan-genome size of 8034 proteins. Genome-wide phylogenetic tree shows that whole genome sequence is a powerful tool to analyze the complex evolutionary process ofS. epidermidisand investigate the source of infection. Comparative genome analyses demonstrate the high diversity of antimicrobial resistances, especially mobile genetic elements. The complicated relationships of host-bacterium and bacterium-bacterium helpS. epidermidisto play a vital role in balancing the epithelial microflora. The highly variable and dynamic nature of theS. epidermidisgenome may be the result of its success in adapting to broad habitats, which is necessary to deal with complex environments. This study gives the general landscape ofS. epidermidispan-genome and provides valuable insights into mechanisms for genome evolution and lifestyle adaptation of this ecologically flexible species.