bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraoperative Optical Coherence Tomography-Assisted Descemet Stripping Automated Endothelial Keratoplasty for Anterior Chamber Fibrous Ingrowth
Authors: Shazly Tarek A. , To Lillian K. , Conner Ian P. , Espandar Ladan
Published: April 2017

Purpose:

Here, we present the first reported case of intraoperative optical coherence tomography (OCT)-assisted Descemet membrane stripping automated endothelial keratoplasty (DSAEK) in a patient with anterior segment fibrous ingrowth.

Methods:

A 61-year-old woman with corneal edema and chronic angle-closure glaucoma secondary to fibrous ingrowth after 2 glaucoma shunt device implantations underwent dissection and removal of anterior chamber fibrous ingrowth and DSAEK. The surgical techniques using intraoperative OCT and outcome are described.

Results:

Intraoperative OCT provided a clear dissection plane of the fibrous membranes in the anterior chamber and view of their relation to the iris and corneal endothelium, despite an opacified cornea. The placement of the donor lenticule and absence of interface fluid were also verified intraoperatively. The postoperative course was uncomplicated with satisfactory outcome.

Conclusions:

We conclude that intraoperative OCT is a useful tool during DSAEK surgery, particularly in complicated cases such as anterior segment fibrous ingrowth and significant corneal edema.
Implications for Ophthalmic Formulations: Ocular Buffers Show Varied Cytotoxic Impact on Human Corneal–Limbal and Human Conjunctival Epithelial Cells
Authors: Schuerer Nadine , Stein Elisabeth , Inic-Kanada Aleksandra , Pucher Marion , Hohenadl Christine , Bintner Nora , Ghasemian Ehsan , Montanaro Jacqueline , Barisani-Asenbauer Talin
Published: April 2017

Purpose:

To investigate toxicity associated with buffers commonly used in topical ocular drug formulations using a human corneal–limbal epithelial (HCLE) and a human conjunctival epithelial (HCjE) cell model.

Methods:

HCLE and HCjE cells were incubated for 10, 30, or 60 minutes with 4 different buffers based on borate, citrate, phosphate, and Tris-HCl at 10, 50, and 100 mM concentrations. To detect possible delayed effects on cell viability, after 60 minutes of buffer incubation, cells were further incubated for 24 hours with a cell medium. Cell viability was determined using a colorimetric XTT–based assay. The morphology of cells was also investigated.

Results:

HCjE cells showed more sensitivity to buffer incubation than HCLE cells. The 100 mM phosphate buffer displayed significant delayed effects on cell viability of HCLE 16.8 ± 4.8% and HCjE 39.2 ± 6.1% cells after 60 minutes of exposure (P < 0.05). HCjE cell viability was reduced after 60 minutes incubations with 50 and 100 mM citrate buffer to 42.8 ± 6.5% and 39.3 ± 7.9%, respectively, and even lower percentages at the delayed time point (both P < 0.05). HCLE cell morphology was distinctly altered by 100 mM phosphate and Tris buffers after 30 minutes, whereas HCjE cells already showed marked changes after 10 minutes of exposure to 100 mM citrate and phosphate buffers.

Conclusions:

We observed a time-dependent decrease of viability in both HCLE and HCjE cells exposed to higher buffer concentrations. Therefore, we propose further in vivo studies to translate these finding to humans to discern the real effects of the buffer concentration in eye drops on the ocular surface.
Characterization of Corneal Involvement in Eyes With Mucous Membrane Pemphigoid by In Vivo Confocal Microscopy
Authors: Tepelus Tudor C. , Huang Jianyan , Sadda SriniVas R. , Lee Olivia L.
Published: April 2017

Purpose:

To describe the morphological features of the corneal epithelial layers, subbasal nerve plexus, stroma, and endothelium in patients with mucous membrane pemphigoid (MMP) as shown by in vivo confocal microscopy (IVCM).

Methods:

Central corneal images were captured from 10 healthy age-matched control eyes and 30 eyes with clinically diagnosed MMP by in vivo laser scanning confocal microscopy (HRT III RCM). Morphological changes of the corneal epithelial layers, stroma, and endothelium, characteristics of corneal nerves, and presence of inflammatory dendritic cells (DCs) were evaluated.

Results:

Images obtained by IVCM from 40 eyes were analyzed. The eyes with MMP were divided into 2 groups based on clinical staging: 16 eyes with end-stage MMP and 14 eyes with non–end-stage MMP. Compared with controls, IVCM in eyes with end-stage MMP displayed severe conjunctivalization and neovascularization of the cornea, with otherwise limited identifiable cellular or structural elements. Those with non–end-stage MMP showed metaplasia of the corneal epithelial layers, presence of hyperreflective cells similar to conjunctival cells, intraepithelial defects, fibrosis of anterior stroma, and hyperreflective endothelial deposits. Images of the subbasal nerve plexus demonstrate significant reduction in density (1251.3 ± 806.9 μm/frame vs. 2688.8 ± 607.33 μm/frame, P < 0.001), increased tortuosity (2.76 ± 0.6 vs. 2.3 ± 0.42, not significant), decreased reflectivity (2.73 ± 0.4 vs. 3.46 ± 0.52, P < 0.01), and increased density of DCs (115 ± 88 cells/mm2 vs. 43.9 ± 28.14 cells/mm2, P < 0.05) in MMP-affected eyes compared with controls.

Conclusions:

IVCM reveals profound and variable microstructural changes in the corneas of patients with MMP compared with normal controls. Our study demonstrated decreased corneal nerve density and elevated DC density in eyes with non–end-stage MMP compared with normal controls. Frequent scarring, conjunctivalization, and neovascularization observed in eyes with end-stage MMP preclude recognition by IVCM of the morphologic architecture of the corneal layers. Our findings suggest implications for using IVCM to evaluate and monitor patients with MMP.
Long-term Visual and Ocular Sequelae in Patients With Congenital Cytomegalovirus Infection
Authors: Jin Haoxing Douglas , Demmler-Harrison Gail J. , Coats David K. , Paysse Evelyn A. , Bhatt Amit , Edmond Jane C. , Yen Kimberly G. , Steinkuller Paul , Miller Jerry
Published: April 2017

Background:

Cytomegalovirus (CMV) is the most common congenital viral infection in the United States. Visual and ocular sequelae in adolescents and adults who are congenitally infected with CMV have not been well studied. Better understanding of the long-term visual and ocular sequelae can help with early detection, intervention and appropriate educational accommodations.

Methods:

This study evaluated 237 patients (77 symptomatic, 109 asymptomatic and 51 control) who underwent a series of age-appropriate ophthalmologic, audiologic and neurodevelopmental examinations from 1982 to 2013. The frequency and etiology of visual impairment and other nonophthalmologic findings were recorded for each patient. Ophthalmologic findings were tabulated, and risk factors for abnormalities were analyzed.

Results:

Fourteen of the 77 (18.2%) symptomatic and none of the asymptomatic and control subjects had severe visual impairments (P ≤ 0.006). Moderate visual impairment did not differ between symptomatic and asymptomatic subjects. Three asymptomatic subjects had retinal scars. The most common visual or ocular sequelae in the symptomatic group were strabismus (23.4%), chorioretinal scars (19.5%), cortical visual impairment (14.3%), nystagmus (14.3%) and optic nerve atrophy (11.7%). Three symptomatic patients had delayed visual deterioration because of later occurring retinal disorders: peripheral retinal scar, rhegmatogenous retinal detachment and Coats’ disease.

Conclusion:

Symptomatic CMV patients experienced more ophthalmologic sequelae and significantly worse visual outcomes than asymptomatic CMV and control patients. Later occurring retinal disorders were found in symptomatic patients, and there is no clear evidence that CMV can reactivate in the retinas of children who were congenitally infected. Major risk factors for severe visual impairment included symptomatic status, optic nerve atrophy, chorioretinitis, cortical visual impairment and sensorineural hearing loss.
Staphylococcus aureus Central Nervous System Infections in Children
Authors: Vallejo Jesus G. , Cain Alexandra N. , Mason Edward O. , Kaplan Sheldon L. , Hultén Kristina G.
Published: April 2017

Background:

Central nervous system (CNS) infections caused by Staphylococcus aureus are uncommon in pediatric patients. We review the epidemiology, clinical features and treatment in 68 patients with a S. aureus CNS infection evaluated at Texas Children’s Hospital.

Methods:

Cases of CNS infection in children with positive cerebrospinal fluid cultures or spinal epidural abscess (SEA) for S. aureus at Texas Children’s Hospital from 2001 to 2013 were reviewed.

Results:

Seventy cases of S. aureus CNS infection occurred in 68 patients. Forty-nine cases (70%) were secondary to a CNS device, 5 (7.1%) were postoperative meningitis, 9 (12.8%) were hematogenous meningitis and 7 (10%) were SEAs. Forty-seven (67.2%) were caused by methicillin-sensitive S. aureus (MSSA) and 23 (32.8%) by methicillin-resistant S. aureus (MRSA). Community-acquired infections were more often caused by MRSA that was clone USA300/pvl
+. Most patients were treated with nafcillin (MSSA) or vancomycin (MRSA) with or without rifampin. Among patients with MRSA infection, 50% had a serum vancomycin trough obtained with the median level being 10.6 μg/mL (range: 5.4–15.7 μg/mL). Only 1 death was associated with S. aureus infection.

Conclusions:

The epidemiology of invasive of S. aureus infections continues to evolve with MSSA accounting for most of the infections in this series. The majority of cases were associated with neurosurgical procedures; however, hematogenous S. aureus meningitis and SEA occurred as community-acquired infections in patients without predisposing factors. Patients with MRSA CNS infections had a favorable response to vancomycin, but the beneficial effect of combination therapy or targeting vancomycin trough concentrations of 15–20 μg/mL remains unclear.
Effect of Disease Definition on Perceived Burden of Acute Respiratory Infections in Children
Authors: Zoch Beate , Günther Annette , Karch André , Mikolajczyk Rafael
Published: April 2017

Background:

Acute respiratory infections (ARIs) are among the most frequent childhood diseases in Western countries. Assessment of ARI episodes for research purposes is usually based on parent-administered retrospective questionnaires or prospective symptom diaries. The aim of our analysis was to compare the effect of ARI definitions on the corresponding disease burden in a prospective cohort study using symptom diaries.

Methods:

A literature search was performed to identify definitions of ARI used in research studies. The definitions were applied to a symptom diary dataset from a cohort study of 1–3-year-old children conducted in the winter season 2013/2014. We compared the total number of ARI episodes, the total number of days with ARI and the median and mean duration of ARI episodes resulting from the use of the different definitions.

Results:

Six ARI definitions were identified in the literature. Depending on ARI definition, the total number of ARI episodes and the total number of days with ARI in our dataset varied by a factor of 1.69 and 1.53, respectively, between the lowest and the highest. The median duration of the episodes ranged from 7 to 10 days.

Discussion:

Different definitions led to considerable differences in the number and duration of ARI episodes, making direct comparisons of studies with different methods questionable. We propose the use of a standardized ARI definition in upcoming cohort studies working with diary data. This process could be conducted using a Delphi survey with experts in this study field.
No small matter: pediatric resuscitation
Authors: McCormick Taylor , McVaney Kevin , Pepe Paul E.
Published: April 2017

Purpose of review

To present advancements in pediatric cardiac arrest research, highlighting articles most relevant to clinical practice published since the latest international guidelines for cardiopulmonary resuscitation (CPR).

Recent findings

Clinical trials examining targeted temperature management in children support avoidance of hyperthermia for both pediatric in-hospital cardiac arrest (PIHCA) and out-of-hospital cardiac arrest (POHCA), but no statistically significant outcome differences were confirmed comparing 33 and 36 °C in the limited populations studied. Retrospective analyses of population-based POHCA registries revealed several associations: both bystander CPR and public-access defibrillation were associated with improved POHCA outcomes; conflicting results overshadow the benefits of conventional versus compression-only CPR; extracorporeal CPR was associated with improved PIHCA outcomes regardless of cause; intubation in PIHCA was associated with decreased survival, whereas there were no significant differences in outcomes between advanced airway management and bag-valve-mask ventilation in POHCA; and early epinephrine delivery in nonshockable rhythms during PIHCA was associated with improved outcomes. Length, age, and weight-based dosing systems can reduce time to medication delivery, quantitative errors, and anxiety among care providers.

Mounting evidence continues to align management priorities for resuscitation of children and adults.
The past, present, and future of ventilation during cardiopulmonary resuscitation
Authors: Chang Mary P. , Idris Ahamed H.
Published: April 2017

Purpose of review

To evaluate the past and present literature on ventilation during out of hospital cardiac arrest, highlighting research that has informed current guidelines.

Recent findings

Previous studies have studied what are optimal compression-to-ventilation ratios, ventilation rates, and methods of ventilation. Continuous chest compression cardiopulmonary resuscitation (CPR) has not shown to provide a significant survival benefit over the traditional 30 : 2 CPR. The optimal ventilation rate is recommended at 8 to 10 breaths per minute. Methods such as capnography and thoracic impedance are being used to evaluate ventilation in research studies.

Future out of hospital cardiac arrest studies are still exploring how to optimize the delivery of ventilation during the initial stages of resuscitation. More prospective studies focusing on ventilation are needed to inform guidelines.
Can Vertical Integration Reduce Hospital Readmissions? A Difference-in-Differences Approach
Authors: Lopes Sílvia , Fernandes Óscar B. , Marques Ana Patrícia , Moita Bruno , Sarmento João , Santana Rui
Published: April 2017

Background:

Vertical integration is expected to improve communication and coordination between inpatient care and care after discharge. Despite being used across health systems worldwide, evidence about its impact on readmissions is sparse and contradictory.

Objective:

To assess the impact of vertical integration on hospital readmissions.

Research Design, Subjects, and Measures:

Using difference-in-differences we compared readmissions before and after vertical integration in 6 Portuguese hospitals for years 2004–2013. A control group with 6 similar hospitals not integrated was utilized. Considered outcome was 30-day unplanned readmission. We used logistic regression at the admission level and accounted for patients’ risk factors using claims data. Analyses for each hospital and selected conditions were also run.

Results:

Our results suggest that readmissions decreased overall after vertical integration [odds ratio (OR)=0.900; 95% confidence interval (CI), 0.812–0.997]. Hospital analysis indicated that there was no impact for 2 hospitals (OR=0.960; 95% CI, 0.848–1.087 and OR=0.944; 95% CI, 0.857–1.038), and a positive effect in 4 hospitals (greatest effect: OR=0.811; 95% CI, 0.736–0.894). A positive evolution was observed for a limited number of conditions, with better results for diabetes with complications (OR=0.689; 95% CI, 0.525–0.904), but no impact regarding congestive heart failure (OR=1.067; 95% CI, 0.827–1.377).

Conclusions:

Merging acute and primary care providers was associated with reduced readmissions, even though improvements were not found for all institutions or condition-specific groups. There are still challenges to be addressed regarding the success of vertical integration in reducing 30-day hospital readmissions.
New insights into redox homeostasis as a therapeutic target in B-cell malignancies
Authors: Graczyk-Jarzynka Agnieszka , Zagozdzon Radoslaw , Muchowicz Angelika , Siernicka Marta , Juszczynski Przemyslaw , Firczuk Malgorzata
Published: April 2017

Purpose of review

The goal of this review is to summarize recent advances in our understanding of the regulation of redox homeostasis and the subtype-specific role of antioxidant enzymes in B-cell-derived malignancies. Furthermore, it presents selected prooxidative therapeutic strategies against B-cell neoplasms.

Recent findings

Recent reports have shown that the disturbed redox homeostasis in B-cell malignancies is regulated by cancer-specific signaling pathways and therefore varies between the individual subtypes. For instance, in a subtype of diffuse large B-cell lymphoma with increased oxidative phosphorylation, elevated reactive oxygen species are accompanied by higher levels of thioredoxin and glutathione and inhibition of either of these systems is selectively toxic to this subtype. In addition, growing number of small molecule inhibitors targeting antioxidant enzymes, such as auranofin, SK053, adenanthin, or decreasing glutathione level, such as imexon, buthionine sulfoximine, and L-cysteinase, trigger specific cytotoxic effects against B-cell malignancies. Lastly, attention is drawn to recent reports of effective treatment modalities involving prooxidative agents and interfering with redox homeostasis provided by stromal cells.

Recent findings reveal important differences in redox homeostasis within the distinct subsets of B-cell-derived malignancies that can be therapeutically exploited to improve existing treatment and to overcome drug resistance.
National Study of Off‐label Proton Pump Inhibitor Use Among New Zealand Infants in the First Year of Life (2005–2012)
Authors: Blank Mei‐Ling , Parkin Lianne
Published: April 2017

Objectives:

Off‐label prescribing of proton pump inhibitors (PPIs) to infants to treat symptoms attributed to gastroesophageal reflux disease (GERD) is widely reported, despite evidence that PPIs are no more effective than placebo in relieving those symptoms. To initiate discussion about appropriate prescribing of these drugs for infants, we describe the characteristics of PPI use among infants in New Zealand.

Methods:

In this population‐based study we used routinely collected dispensing data to identify all children born between 2005 and 2012 who were dispensed a government‐subsidized PPI (omeprazole, lansoprazole, pantoprazole) before their first birthday. Unique patient identifiers were used to link administrative datasets containing patient‐level demographic, dispensing, and health information.

Results:

In total, 22,643 children were dispensed a study PPI before their first birthday. The prevalence of infant PPI use as a proportion of all live births increased from 2.4% for children born in 2005 to 5.2% for children born in 2012. Overall, 71.6% of infants were dispensed a PPI by 3 months of age, and 8.7% received a PPI within the first month of life. Before PPI initiation, only 7.0% of infants had a hospital‐based diagnosis of GERD (with or without esophagitis), and 4.7% of infants had a hospital‐based diagnosis of one or more known or suspected GERD risk factors.

Conclusions:

Off‐label prescribing of PPIs to New Zealand infants was relatively common and increased over the study period. The appropriateness of PPI treatment should be questioned, as the majority of infants who received these drugs were not diagnosed with severe GERD.
Commercial Probiotic Products
Authors: Kolaček Sanja , Hojsak Iva , Berni Canani Roberto , Guarino Alfredo , Indrio Flavia , Orel Rok , Pot Bruno , Shamir Raanan , Szajewska Hania , Vandenplas Yvan , van Goudoever Johannes , Weizman Zvi ,   ESPGHAN Working Group for Probiotics and Prebiotics
Published: April 2017

Probiotics have been proposed for a number of indications ranging from the hypothetical long‐term immunomodulatory effects to proven benefits in the management of different clinical conditions.

An increasing number of commercial products containing probiotics are available. In those products, irrespective if it is food, food supplement, medical food, or drug, the probiotic microorganisms have to be present in a sufficient number by the end of the shelf‐life, to pass through the gastrointestinal tract resisting acid and bile, to colonize the gut, and to retain functional properties required to obtain the suggested beneficial effect. Finally, it should be contamination‐free.

Studies organized worldwide and summarized in this article have shown that inconsistencies and deviations from the information provided on the product label are surprisingly common. Frequently strains are misidentified and misclassified, products are occasionally contaminated, sometimes with even facultative or obligatory pathogens, strains are not viable, the labeled number of colonies cannot be verified, or the functional properties are diminished to the extent that preclude the proposed health benefit. As the probiotic preparations are commonly used for a wide range of conditions, the aim of the Working Group was to summarize results of the studies looking into the quality of the probiotic products and to raise the awareness of the important issue of their quality control.

Based on the results obtained, we strongly suggest a more stringent quality control process. This process should ensure that the probiotic content as mentioned on the label meets the actual content throughout the shelf life of the product, while no contamination is present.
Pediatric Lawnmower Injuries
Authors: Lee Tina S. , Luhmann Jan D. , Luhmann Scott J. , Quayle Kimberly S.
Published: April 2017

Objective

The aim of this study was to evaluate demographics, characteristics, and mechanisms of injuries caused by lawnmowers in children.

Methods

Chart review from 1990 to 2010 at a level I pediatric trauma center identified patients younger than 18 years with lawnmower injuries. Demographics and characteristics of the injuries were analyzed by descriptive statistical analysis.

Results

The study identified 88 subjects, with 80% males and 42% of the subjects younger than 5 years. When the lawnmower type was specified, riding lawnmowers caused the majority of injuries (72%). The most common mechanism of injury was related to slipping under lawnmower/being run over (51%). The most common injuries were lacerations (36%), fractures (27%), and amputations (22%); lower extremities were injured more frequently than other body areas (62%). The majority of patients (76%) required hospitalization with a mean length of stay (LOS) of 9.7 days and a mean number of procedures of 4. Complications included 6 infections, 1 tissue necrosis, and 1 death from hemorrhagic shock. Riding-lawnmower injuries were associated with younger children (P < 0.0001). Riding lawnmowers and younger age were associated with longer hospital LOS (P = 0.01, 0.006) and increased number of procedures (P = 0.03, 0.003, respectively).

Conclusions

Lawnmower injuries are still prevalent in children despite national safety recommendations. Injuries seen with riding lawnmowers were associated with younger age, higher number of procedures, longer LOS, and more severe injuries.
A Comparison of Pediatric Weight Estimation Methods for Emergency Resuscitation
Authors: Samerchua Artid , Suraseranivongse Suwannee , Komoltri Chulaluk
Published: April 2017

Objectives

Obtaining accurate pediatric weight is necessary during emergency resuscitation. Although several weight estimation methods exist, the most precise method has not been conclusively determined. This study aimed to evaluate the validity, reliability, and practicality of these tools.

Methods

A prospective observational study was conducted in healthy Thai children aged 6 months to 12 years. Correlations between estimated and actual weights were tested. Validity was assessed by mean bias (estimated weight minus actual weight) and accuracy (10% error). Practicality was evaluated by time usage and data derived from user questionnaires.

Results

Four hundred thirty participants with mean age of 6.7 years and mean weight of 26 kg were enrolled. A strong correlation between estimated weight and actual weight in all methods was demonstrated. Parental estimation was the most accurate tool in all age groups, with the lowest overall mean error (ME) of −0.83 kg and the highest accuracy of 88.7%. The Broselow tape was the second most accurate tool in ages younger than 1 year and 1-to-5–year age groups (ME = 0.23 and 0.50 kg; accuracy = 55.3% and 54.1%, respectively). The Mercy method was the second most accurate tool in the 6-to-10–year and 11-to-12–year age groups (ME = −2.47 and −2.77; accuracy = 54.6% and 67.9%, respectively). The Broselow tape had the highest score for practicality of use.

Conclusions

Parental estimation was the most accurate method in every age group. The next best alternative is the Broselow tape in children aged 5 years or younger and the Mercy method in children aged older than 5 years.
Integrating PMTCT Into Maternal, Newborn, and Child Health and Related Services: Experiences From the Global Plan Priority Countries
Authors: Kiragu Karusa , Collins Lynn , Von Zinkernagel Deborah , Mushavi Angela
Published: April 2017

The urgency to scale-up sustainable programs for the prevention of mother-to-child transmission of HIV (PMTCT) prompted priority countries of the Global Plan Toward the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan) to expand the delivery of PMTCT services through greater integration with sexual and reproductive health and child health services. Countries approached integration—what, where, and how services are provided—in diverse ways, with predominantly favorable results. Approaches to integrated services have increased access to a broader range of PMTCT interventions, and they also have proved to be largely acceptable to clients and providers. The integration of PMTCT interventions with maternal, newborn, and child health settings was supported by strategies to reconfigure service delivery to provide additional services, including shifting tasks to nurses (such as initiating antiretroviral therapy and providing long-term follow-up). This was complemented by supporting community outreach and integrating HIV and sexual and reproductive health services bidirectionally, including by providing family planning through antiretroviral therapy clinics and HIV testing in family planning clinics. A systematic and rigorous study of country experiences integrating HIV and maternal, newborn, and child health services, including maternal and pediatric TB services, cost analysis, could provide valuable lessons and demonstrate how such integration can improve systems for health care delivery.
Translating Technical Support Into Country Action: The Role of the Interagency Task Team on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers, and Children in the Global Plan Era
Authors: Luo Chewe , Hirnschall Gottfried , Rodrigues Jessica , Romano Sostena , Essajee Shaffiq , Rogers Braeden , McCarthy Elizabeth , Mwango Albert , Sangrujee Nalinee , Adler Michelle R. , Houston James C. , Langa Judite O. , Urso Marilena , Bolu Omotayo , Tene Gilbert , Elat Nfetam Jean B. , Kembou Etienne , Phelps Benjamin R.
Published: April 2017

While the Interagency Task Team on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers, and Children (IATT) partnership existed before the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), its reconfiguration was critical to coordinating provision of technical assistance that positively influenced country decision-making and program performance. This article describes how the Global Plan anchored the work of the IATT and, in turn, how the IATT's technical assistance helped to accelerate achievement of the Global Plan targets and milestones. The technical assistance that will be discussed addressed a broad range of priority actions and milestones described in the Global Plan: (1) planning for and implementing Option B+; (2) strengthening monitoring and evaluation systems; (3) translating evidence into action and advocacy; and (4) promoting community engagement. This article also reviews the ongoing challenges and opportunities of providing technical assistance in a rapidly evolving environment that calls for ever more flexible and contextualized responses. The effectiveness of technical assistance facilitated by the IATT was defined by its timeliness, evidence base, and unique global perspective that built on the competencies of its partners and promoted synergies across program areas. Reaching the final goal of eliminating vertical transmission of HIV infection and achieving an AIDS-free generation in countries with the highest HIV burden requires that the IATT partnership and technical assistance remain responsive to country-specific needs while aligning with the current programmatic reality and new global goals such as the Sustainable Development Goals and 90-90-90 targets.
Overcoming Health System Challenges for Women and Children Living With HIV Through the Global Plan
Authors: Modi Surbhi , Callahan Tegan , Rodrigues Jessica , Kajoka Mwikemo D. , Dale Helen M. , Langa Judite O. , Urso Marilena , Nchephe Matsepeli I. , Bongdene Helene , Romano Sostena , Broyles Laura N.
Published: April 2017

To meet the ambitious targets set by the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), the initial 22 priority countries quickly developed innovative approaches for overcoming long-standing health systems challenges and providing HIV testing and treatment to pregnant and breastfeeding women and their infants. The Global Plan spurred programs for prevention of mother-to-child HIV transmission to integrate HIV-related care and treatment into broader maternal, newborn, and child health services; expand the effectiveness of the health workforce through task sharing; extend health services into communities; strengthen supply chain and commodity management systems; reduce diagnostic and laboratory hurdles; and strengthen strategic supervision and mentorship. The article reviews the ongoing challenges for prevention of mother-to-child HIV transmission programs as they continue to strive for elimination of vertical transmission of HIV infection in the post-Global Plan era. Although progress has been rapid, health systems still face important challenges, particularly follow-up and diagnosis of HIV-exposed infants, continuity of care, and the promotion of services that are respectful and client centered.
Comprehensive Dynamic Contrast-Enhanced 3D Magnetic Resonance Imaging of the Breast With Fat/Water Separation and High Spatiotemporal Resolution Using Radial Sampling, Compressed Sensing, and Parallel Imaging
Authors: Benkert Thomas , Block Kai Tobias , Heller Samantha , Moccaldi Melanie , Sodickson Daniel K. , Kim Sungheon Gene , Moy Linda
Published: April 2017

Objectives

The aim of this study was to assess the applicability of Dixon radial volumetric encoding (Dixon-RAVE) for comprehensive dynamic contrast-enhanced 3D magnetic resonance imaging (MRI) of the breast using a combination of radial sampling, model-based fat/water separation, compressed sensing, and parallel imaging.

Materials and Methods

In this Health Insurance Portability and Accountability Act–compliant prospective study, 24 consecutive patients underwent bilateral breast MRI, including both conventional fat-suppressed and non–fat-suppressed precontrast T1-weighted volumetric interpolated breath-hold examination (VIBE). Afterward, 1 continuous Dixon-RAVE scan was performed with the proposed approach while the contrast agent was injected. This scan was immediately followed by the acquisition of 4 conventional fat-saturated VIBE scans. From the comprehensive Dixon-RAVE data set, different image contrasts were reconstructed that are comparable to the separate conventional VIBE scans.

Two radiologists independently rated image quality, conspicuity of fibroglandular tissue from fat (FG), and degree of fat suppression (FS) on a 5-point Likert-type scale for the following 3 comparisons: precontrast fat-suppressed (pre-FS), precontrast non–fat-suppressed (pre-NFS), and dynamic fat-suppressed (dyn-FS) images.

Results

When scores were averaged over readers, Dixon-RAVE achieved significantly higher (P < 0.001) degree of fat suppression compared with VIBE, for both pre-FS (4.25 vs 3.67) and dyn-FS (4.10 vs 3.46) images. Although Dixon-RAVE had lower image quality score compared with VIBE for the pre-FS (3.56 vs 3.67, P = 0.490), the pre-NFS (3.54 vs 3.88, P = 0.009), and the dyn-FS images (3.06 vs 3.67, P < 0.001), acceptable or better diagnostic quality was achieved (score ≥ 3). The FG score for Dixon-RAVE in comparison to VIBE was significantly higher for the pre-FS image (4.23 vs 3.85, P = 0.044), lower for the pre-NFS image (3.98 vs 4.25, P = 0.054), and higher for the dynamic fat-suppressed image (3.90 vs 3.85, P = 0.845).

Conclusions

Dixon-RAVE can serve as a one-stop-shop approach for comprehensive T1-weighted breast MRI with diagnostic image quality, high spatiotemporal resolution, reduced overall scan time, and improved fat suppression compared with conventional imaging.
Thoracoscopic Esophagectomy in the Prone Position Versus the Lateral Position (Hand-assisted Thoracoscopic Surgery): A Retrospective Cohort Study of 127 Consecutive Esophageal Cancer Patients
Authors: Fukuda Naoya , Shichinohe Toshiaki , Ebihara Yuma , Nakanishi Yoshitsugu , Asano Toshimichi , Noji Takehiro , Kurashima Yo , Nakamura Toru , Murakami Soichi , Tsuchikawa Takahiro , Okamura Keisuke , Hirano Satoshi
Published: April 2017

Purpose:

To assess the validity of esophagectomy with the patient in the prone position (PP), the short-term surgical results of PP and hand-assisted thoracoscopic surgery (HATS) were compared.

Methods:

This study enrolled 127 patients who underwent esophagectomy with HATS (n=91) or PP (n=36) between October 1999 and September 2014. The patients’ background characteristics, operative findings, and postoperative complications were examined.

Results:

The patients’ background characteristics were not significantly different. During surgery, total and thoracic blood loss were significantly lower in PP than in HATS (P<0.0001, <0.0001). Other operative findings were not significantly different between the 2 groups. Postoperatively, recurrent nerve palsy was significantly less frequent in PP than in HATS (P=0.049). In the comparison between the recurrent nerve palsy-positive and palsy-negative groups, sex (male) and preoperative respiratory comorbidity (negative) were significantly correlated with recurrent nerve palsy.

Conclusions:

In thoracoscopic esophagectomy, the PP was associated with lower surgical stress than HATS, with equal operative performance oncologically. The PP could prevent recurrent nerve palsy because of the magnified view effect.
Vertical Head Thrusting in Acquired Supranuclear Vertical Ophthalmoplegia
Authors: Lee Yeon-Hee , Jeong Seong-Hae , Kim Hyo-Jung , Hwang Jeong-Min , Lee Woohyuk , Kim Ji-Soo
Published: April 2017

Patients with congenital ocular motor apraxia (OMA) typically show head thrusts while attempting to shift gaze. In congenital OMA, this compensatory head motion mostly occurs in the horizontal plane. Two patients with acquired palsy of voluntary vertical gaze and continuous upward gaze deviation, one from aortic surgery and the other from multiple infarctions involving the mesodiencephalic junction, showed intermittent downward head thrusting to redirect the eyes straight ahead or downward. The head thrusting behavior improved markedly after surgical correction of the upward gaze deviation in one patient. Vertical head thrusting may be a characteristic sign of acquired vertical gaze palsy when combined with vertical gaze deviation.
A review of Phase I trials of Ebola virus vaccines: what can we learn from the race to develop novel vaccines?
Authors: Lambe Teresa , Bowyer Georgina , Ewer Katie J
Published: April 2017

Sporadic outbreaks of Ebola virus infection have been documented since the mid-Seventies and viral exposure can lead to lethal haemorrhagic fever with case fatalities as high as 90%. There is now a comprehensive body of data from both ongoing and completed clinical trials assessing various vaccine strategies, which were rapidly advanced through clinical trials in response to the 2013–2016 Ebola virus disease (EVD) public health emergency. Careful consideration of immunogenicity post vaccination is essential but has been somewhat stifled because of the wide array of immunological assays and outputs that have been used in the numerous clinical trials. We discuss here the different aspects of the immune assays currently used in the Phase I clinical trials for Ebola virus vaccines, and draw comparisons across the immune outputs where possible; various trials have examined both cellular and humoral immunity in European and African cohorts. Assessment of the safety data, the immunological outputs and the ease of field deployment for the various vaccine modalities will help both the scientific community and policy-makers prioritize and potentially license vaccine candidates. If this can be achieved, the next outbreak of Ebola virus, or other emerging pathogen, can be more readily contained and will not have such widespread and devastating consequences.

This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’.
Contact tracing performance during the Ebola virus disease outbreak in Kenema district, Sierra Leone
Authors: Senga Mikiko , Koi Alpha , Moses Lina , Wauquier Nadia , Barboza Philippe , Fernandez-Garcia Maria Dolores , Engedashet Etsub , Kuti-George Fredson , Mitiku Aychiluhim Damtew , Vandi Mohamed , Kargbo David , Formenty Pierre , Hugonnet Stephane , Bertherat Eric , Lane Christopher
Published: April 2017

Contact tracing in an Ebola virus disease (EVD) outbreak is the process of identifying individuals who may have been exposed to infected persons with the virus, followed by monitoring for 21 days (the maximum incubation period) from the date of the most recent exposure. The goal is to achieve early detection and isolation of any new cases in order to prevent further transmission. We performed a retrospective data analysis of 261 probable and confirmed EVD cases in the national EVD database and 2525 contacts in the Contact Line Lists in Kenema district, Sierra Leone between 27 April and 4 September 2014 to assess the performance of contact tracing during the initial stage of the outbreak. The completion rate of the 21-day monitoring period was 89% among the 2525 contacts. However, only 44% of the EVD cases had contacts registered in the Contact Line List and 6% of probable or confirmed cases had previously been identified as contacts. Touching the body fluids of the case and having direct physical contact with the body of the case conferred a 9- and 20-fold increased risk of EVD status, respectively. Our findings indicate that incompleteness of contact tracing led to considerable unmonitored transmission in the early months of the epidemic. To improve the performance of early outbreak contact tracing in resource poor settings, our results suggest the need for prioritized contact tracing after careful risk assessment and better alignment of Contact Line Listing with case ascertainment and investigation.

This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’.
The impact of control strategies and behavioural changes on the elimination of Ebola from Lofa County, Liberia
Authors: Funk Sebastian , Ciglenecki Iza , Tiffany Amanda , Gignoux Etienne , Camacho Anton , Eggo Rosalind M. , Kucharski Adam J. , Edmunds W. John , Bolongei Josephus , Azuma Phillip , Clement Peter , Alpha Tamba S. , Sterk Esther , Telfer Barbara , Engel Gregory , Parker Lucy Anne , Suzuki Motoi , Heijenberg Nico , Reeder Bruce
Published: April 2017

The Ebola epidemic in West Africa was stopped by an enormous concerted effort of local communities and national and international organizations. It is not clear, however, how much the public health response and behavioural changes in affected communities, respectively, contributed to ending the outbreak. Here, we analyse the epidemic in Lofa County, Liberia, lasting from March to November 2014, by reporting a comprehensive time line of events and estimating the time-varying transmission intensity using a mathematical model of Ebola transmission. Model fits to the epidemic show an alternation of peaks and troughs in transmission, consistent with highly heterogeneous spread. This is combined with an overall decline in the reproduction number of Ebola transmission from early August, coinciding with an expansion of the local Ebola treatment centre. We estimate that healthcare seeking approximately doubled over the course of the outbreak, and that isolation of those seeking healthcare reduced their reproduction number by 62% (mean estimate, 95% credible interval (CI) 59–66). Both expansion of bed availability and improved healthcare seeking contributed to ending the epidemic, highlighting the importance of community engagement alongside clinical intervention.

This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’.
An unusual cutaneous infection caused by Mycobacterium marinum
Authors: Veronese Federica , Zavattaro Elisa , Farinelli Pamela , Colombo Enrico , Savoia Paola
Published: April 2017

Introduction.
Mycobacterium marinum is a non-tubercular mycobacterium residing in fresh or salt water (in tropical or temperate areas); it is a fish and human pathogen, and in immunocompromised patients can cause severe cutaneous and subcutaneous infections.

Case presentation. A 46-year-old white man who underwent immunosuppressive therapy was admitted to our department in May 2016 for skin lesions previously diagnosed as ‘unusual erysipelas’. We rejected the hypothesis of erysipelas, due to the clinical features, and our diagnostic hypotheses were oriented towards sporotrichosis, atypical mycobacteriosis, cutaneous tuberculosis and cutaneous sarcoidosis. Histological examination performed after a skin biopsy was compatible with a diagnosis of sporotrichosis. However, PCR performed on fresh tissue demonstrated the presence of M. marinum.

Conclusion. The case reported is interesting for the unusual clinical localization and modality of infection. The patient became infected by contact with contaminated remains or in the sea, in a geographical area not endemic for M. marinum. The previous state of immunosuppression favoured infection; however, the presence of M. marinum in this area suggests a possible tropicalization of the water of the Mediterranean Sea. To our knowledge, this case is the only one reported in the literature with this modality of infection and in that geographical area.
Multichannel Sleep Spindle Detection using Sparse Low-Rank Optimization
Authors: Parekh Ankit , Selesnick Ivan W. , Osorio Ricardo S. , Varga Andrew W. , Rapoport David M. , Ayappa Indu
Published: April 2017

Background

We propose a multichannel spindle detection method that detects global and local spindle activity across all channels of scalp EEG in a single run

New Method

Using a non-linear signal model, which assumes the multichannel EEG to be a sum of a transient component and an oscillatory component, we propose a multichannel transient separation algorithm. Consecutive overlapping blocks of the multichannel oscillatory component are assumed to be low-rank whereas the transient component is assumed to be piecewise constant with a zero baseline. The estimated multichannel oscillatory component is used in conjunction with a bandpass filter and the Teager operator for detecting sleep spindles

Results and comparison with other methods

Several examples are shown to illustrate the utility of the proposed method in detecting global and local spindle activity. The proposed method is applied to two publicly available databases and compared with 7 existing single-channel automated detectors. F1scores for the proposed spindle detection method averaged 0.66 (0.02) and 0.62 (0.06) for the two databases, respectively. For an overnight 6 channel EEG signal, the proposed algorithm takes about 4 minutes to detect sleep spindles simultaneously across all channels with a single setting of corresponding algorithmic parameters

Conclusions

The proposed method aims to mimic and utilize, for better spindle detection, a particular human expert behavior where the decision to mark a spindle event may be subconsciously influenced by the presence of a spindle in EEG channels other than the central channel visible on a digital screen
Antibiotic resistance detection is essential for gonorrhoea point-of-care testing: A mathematical modelling study
Authors: Fingerhuth Stephanie M. , Low Nicola , Bonhoeffer Sebastian , Althaus Christian L.
Published: April 2017

Antibiotic resistance is threatening to make gonorrhoea untreatable. Point-of-care (POC) tests that detect resistance promise individually tailored treatment, but might lead to more treatment and higher levels of resistance. We investigate the impact of POC tests on antibiotic-resistant gonorrhoea. We used data about the prevalence and incidence of gonorrhoea in men who have sex with men (MSM) and heterosexual men and women (HMW) to calibrate a mathematical gonorrhoea transmission model. With this model, we simulated four clinical pathways for the diagnosis and treatment of gonorrhoea: POC test with (POC + R) and without (POC − R) resistance detection, culture, and nucleic acid amplification tests (NAATs). We calculated the proportion of resistant infections, cases averted after 5 years, and compared how fast resistant infections spread in the populations. The proportion of resistant infections after 30 years is lowest for POC + R (median MSM: 0.18%, HMW: 0.12%), and increases for culture (MSM: 1.19%, HWM: 0.13%), NAAT (MSM: 100%, HMW: 99.27%), and POC − R (MSM: 100%, HMW: 99.73%). NAAT leads to 36 366 (median MSM) and 1 228 (median HMW) observed cases after 5 years. When compared with NAAT, POC + R results in most cases averted after 5 years (median MSM: 3 353, HMW: 118 per 100 000 persons). POC tests that detect resistance with intermediate sensitivity slow down resistance spread more than NAAT. POC tests with very high sensitivity for the detection of resistance are needed to slow down resistance spread more than using culture. POC with high sensitivity to detect antibiotic resistance can keep gonorrhoea treatable longer than culture or NAAT. POC tests without reliable resistance detection should not be introduced because they can accelerate the spread of antibiotic-resistant gonorrhoea.