bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmental Conditions Associated with Stripe Rust in Kansas Winter Wheat
Authors: Grabow B. S. , Shah D. A. , DeWolf E. D.
Published: August 2016

Stripe rust has reemerged as a problematic disease in Kansas wheat. However, there are no stripe rust forecasting models specific to Kansas wheat production. Our objective was to identify environmental variables associated with stripe rust epidemics in Kansas winter wheat as an initial step in the longer-term goal of developing predictive models for stripe rust to be used within the state. Mean yield loss due to stripe rust on susceptible varieties was estimated from 1999 to 2012 for each of the nine Kansas crop reporting districts (CRD). A CRD was classified as having experienced a stripe rust epidemic when yield loss due to the disease equaled or exceeded 1%, and a nonepidemic otherwise. Epidemics were further classified as having been moderate or severe if yield loss was 1 to 14% or greater than 14%, respectively. The binary epidemic categorizations were linked to a matrix of 847 variables representing monthly meteorological and soil moisture conditions. Classification trees were used to select variables associated with stripe rust epidemic occurrence and severity (conditional on an epidemic having occurred). Selected variables were evaluated as predictors of stripe rust epidemics within a general estimation equations framework. The occurrence of epidemics within CRD was linked to soil moisture during the fall and winter months. In the spring, severe epidemics were linked to optimal (7 to 12°C) temperatures. Simple environmentally based stripe rust models at the CRD level may be combined with field-level disease observations and an understanding of varietal reaction to stripe rust as part of an operational disease forecasting system in Kansas.
On Seed Transmissibility of Soybean vein necrosis-associated virus in Symptomless Soybean Seedlings
Authors: Hajimorad M. R.
Published: August 2016

A letter regarding a recent PLoS One paper, in which Groves et al (2016) claims that Soybean vein necrosis-associated virus (SVNaV) was seed transmissible in symptomless seedlings derived from a seed lot of a field-grown soybean variety with symptoms indicative of virus infection.

Accepted for publication 28 July 2016.
Genome-Wide Association Study in Wheat Identifies Resistance to the Cereal Cyst Nematode Heterodera filipjevi
Authors: Pariyar Shree R. , Dababat Abdelfattah A. , Sannemann Wiebke , Erginbas-Orakci Gul , Elashry Abdelnaser , Siddique Shahid , Morgounov Alexei , Leon Jens , Grundler Florian M. W.
Published: August 2016

The cyst nematode Heterodera filipjevi is a plant parasite causing substantial yield loss in wheat. Resistant cultivars are the preferred method of controlling cyst nematodes. Association mapping is a powerful approach to detect associations between phenotypic variation and genetic polymorphisms; in this way favorable traits such as resistance to pathogens can be located. Therefore, a genome-wide association study of 161 winter wheat accessions was performed with a 90K iSelect single nucleotide polymorphism (SNP) chip. Population structure analysis grouped into two major subgroups and first principal component accounted 6.16% for phenotypic diversity. The genome-wide linkage disequilibrium across wheat was 3 cM. Eleven quantitative trait loci (QTLs) on chromosomes 1AL, 2AS, 2BL, 3AL, 3BL, 4AS, 4AL, 5BL, and 7BL were identified using a mixed linear model false discovery rate of P < 0.01 that explained 43% of total genetic variation. This is the first report of QTLs conferring resistance to H. filipjevi in wheat. Eight QTLs on chromosomes 1AL, 2AS, 2BL, 3AL, 4AL, and 5BL were linked to putative genes known to be involved in plant−pathogen interactions. Two other QTLs on 3BL and one QTL on 7BL linked to putative genes known to be involved in abiotic stress.
Enhanced Thalamic Spillover Inhibition during Non–rapid-eye-movement Sleep Triggers an Electrocortical Signature of Anesthetic Hypnosis
Authors: Mesbah-Oskui Lia , Horner Richard L.
Published: August 2016

Background

Alterations in thalamic γ-aminobutyric acid–mediated signaling are thought to underlie the increased frontal α-β frequency electrocortical activity that signals anesthetic-induced loss of consciousness with γ-aminobutyric acid receptor type A (GABAAR)–targeting general anesthetics. The general anesthetic etomidate elicits phasic extrasynaptic GABAAR activation (“spillover” inhibition) at thalamocortical neurons in vitro. We hypothesize that this action of etomidate at the thalamus is sufficient to trigger an increase in frontal α-β frequency electrocortical activity and that this effect of etomidate is fully recapitulated by enhanced thalamic spillover inhibition in vivo.

Methods

We recorded electrocortical activity and sleep–wake behavior in freely behaving wild-type (n = 33) and extrasynaptic δ-subunit–containing GABAAR knockout mice (n = 9) during bilateral microperfusion of the thalamus with etomidate and/or other pharmacologic agents that influence GABAAR or T-type Ca2+ channel activity.

Results

Microperfusion of etomidate into the thalamus elicited an increase in α-β frequency electrocortical activity that occurred only during non–rapid-eye-movement (REM) sleep (11.0 ± 11.8% and 16.0 ± 14.2% greater 8 to 12- and 12 to 30-Hz power, respectively; mean ± SD; both P < 0.031) and was not affected by blockade of thalamic T-type Ca2+ channels. Etomidate at the thalamus also increased spindle-like oscillations during non-REM sleep (4.5 ± 2.4 spindle per minute with etomidate vs. 3.2 ± 1.7 at baseline; P = 0.002). These effects of etomidate were fully recapitulated by enhanced thalamic extrasynaptic GABAAR-mediated spillover inhibition.

Conclusions

These findings identify how a prototypic GABAAR-targeting general anesthetic agent can elicit the characteristic brain wave pattern associated with anesthetic hypnosis when acting at the thalamus by promoting spillover inhibition and the necessity of a preexisting non-REM mode of activity in the thalamus to generate this effect.
Sites Related to Crawford Williamson Long in Georgia
Authors: Roddy Katie J. , Starnes Vicki , Desai Sukumar P.
Published: August 2016

Background

Crawford Williamson Long (1815 to 1878) was the first to use ether as an inhaled anesthetic for surgical operations. By not publishing his discovery for 7 yr, his pioneering work was largely overshadowed by that of Horace Wells (1815 to 1848), Charles Thomas Jackson (1805 to 1880), and William Thomas Green Morton (1819 to 1868). As a result, sites commemorating Long’s discovery are not offered the same recognition as those affiliated with Wells or Morton.

Methods

We highlight sites in Athens, Danielsville, and Jefferson, Georgia, that honor the first man to regularly use ether as an anesthetic agent. Extensive site visits, examination of museum artifacts, and genealogical research were used to obtain information being presented.

Results

Historic Oconee Hill Cemetery in Athens is where Long and members of his family are buried. Established in 1856, it is closely linked to the history of Athens and the University of Georgia (Athens, Georgia). The main site we describe is the Crawford W. Long Museum, located in Jefferson, Georgia, which opened to the public in 1957. It has undergone extensive renovations and holds an expansive collection of Long’s family heirlooms and personal artifacts. In addition, it displays an impressive art collection, depicting Long, surgical procedures, members of Long’s family, and homes associated with him. Visitors to the museum may also enjoy a walking audio tour that highlights the life of Long and his contribution to medicine.

Conclusions

We provide information on sites and artifacts that honor Georgia’s most celebrated physician. Much of this has not been published before, and it is our hope that Crawford Williamson Long’s legacy receives the attention it richly deserves.
C-arm Positioning Is a Significant Source of Radiation in Spine Surgery
Authors: Reiser Elizabeth W. , Desai Rupen , Byrd Sarah A. , Farber Harrison , Chi Deborah , Idler Cary S. , Isaacs Robert E.
Published: August 2016

Study Design.

Prospective chart review.

Objective.

It is well-known that radiation exposure during minimally invasive spine procedures can be substantial. Less interest has focused on setup radiation exposure before incision, including preoperative images used for surgical approach. The present study seeks to better quantify the significance of setup radiation in the total radiation exposure of minimally invasive spine surgery.

Summary of Background Data.

Radiographic localization is necessary in minimally invasive spine procedures to visualize anatomy, but increased radiation exposure is associated with health risks. Preoperative imaging for anatomical localization has not been previously analyzed as an appreciable source of radiation.

Methods.

From an institutional review board–approved database of more than 1100 procedures, the minimally invasive spine cases with recorded set-up radiation were extracted. The total radiation, set-up radiation, and procedure type data were evaluated. Statistics were generated using a chi-squared analysis.

Results.

Set-up and total radiation data were collected for 270 spine surgeries performed by four surgeons at two locations. There were 30 thoracic and 240 thoracolumbar/lumbar cases; 78 anterior and 192 posterior cases. Average total radiation (set-up and intraoperative) was 8.04 rad, and average setup radiation was 1.90 rad (28%, std 2.97 rad) across all cases. On average for the thoracolumbar/lumbar cases, set-up radiation accounted for almost 25% of total radiation with 1.76 rad from setup out of 8.16 rad total. Thoracic-only cases often necessitated even more images for localization, generating an average set-up/total percentage of 52%. Across all procedures, set-up radiation significantly increased the total radiation exposure because it accounted for more than 25% of the total procedure.

Conclusion.

Radiation exposure during preoperative localization can be substantial. Operating room personnel should recognize the high percentage of radiation that occurs during set-up, and merit should be given to techniques and technologies that can limit unnecessary radiation exposure during this portion of the procedure.

Level of Evidence: 2
Stagnant Physical Therapy Referral Rates Alongside Rising Opioid Prescription Rates in Patients With Low Back Pain in the United States 1997–2010
Authors: Zheng Patricia , Kao Ming-Chih , Karayannis Nicholas V. , Smuck Matthew
Published: August 2016

Study Design.

A cross-sectional observational study utilizing the National Ambulatory and National Hospital Ambulatory Medical Care Surveys between 1997 and 2010.

Objective.

The aim of this study was to characterize national physical therapy (PT) referral trends during primary care provider (PCP) visits in the United States.

Summary of Background Data.

Despite guidelines recommending PT for the initial management of low back pain (LBP), national PT referral rates remain low.

Methods.

Race, ethnicity, age, payer type, and PT referral rates were collected for patients aged 16 to 90 years who were visiting their PCPs. Associations among demographic variables and PT referral were determined using logistic regression.

Results.

Between 1997 and 2010, we estimated 170 million visits for LBP leading to 17.1 million PT referrals. Average proportion of PCP visits associated with PT referrals remained stable at about 10.1% [odds ratio (OR) 1.00, 95% confidence interval (95% CI) 0.96–1.04)], despite our prior finding of increasing number of visits associated with opioid prescriptions in the same timeframe.

Lower PT referral rates were observed among visits by patients who were insured by Medicaid (OR 0.48, 95% CI 0.33–0.69) and Medicare (OR 0.50, 95% CI 0.35–0.72). Furthermore, visits not associated with PT referrals were more likely to be associated with opioid prescriptions (OR 1.69, 95% CI 1.22–2.35).

Conclusion.

Although therapies delivered by PTs are promoted as a first-line treatment for LBP, PT referral rates remain low. There also exist disparately lower referral rates in populations with more restrictive health plans and simultaneous opioid prescription. Our findings provide a broad overview to PT prescription trend and isolate concerning associations requiring further explorations.

Level of Evidence: 3
Surgical and Functional Outcomes After Multilevel Cervical Fusion for Degenerative Disc Disease Compared With Fusion for Radiculopathy
Authors: Faour Mhamad , Anderson Joshua T. , Haas Arnold R. , Percy Rick , Woods Stephen T. , Ahn Uri M. , Ahn Nicholas U.
Published: August 2016

Study Design.

Retrospective cohort comparative study.

Objective.

To evaluate presurgical and surgical factors that affect return to work (RTW) status after multilevel cervical fusion, and to compare outcomes after multilevel cervical fusion for degenerative disc disease (DDD) versus radiculopathy.

Summary of Background Data.

Cervical fusion provides more than 90% of symptomatic relief for radiculopathy and myelopathy. However, cervical fusion for DDD without radiculopathy is considered controversial. In addition, multilevel fusion is associated with poorer surgical outcomes with increased levels fused.

Methods.

Data of cervical comorbidities was collected from Ohio Bureau of Workers’ Compensation for subjects with work-related injuries. The study population included subjects who underwent multilevel cervical fusion. Patients with radiculopathy or DDD were identified. Multivariate logistic regression was performed to identify factors that affect RTW status. Surgical and functional outcomes were compared between groups.

Results.

Stable RTW status within 3 years after multilevel cervical fusion was negatively affected by: fusion for DDD, age > 55 years, preoperative opioid use, initial psychological evaluation before surgery, injury-to-surgery > 2 years and instrumentation.

DDD group had lower rate of achieving stable RTW status (P= 0.0001) and RTW within 1 year of surgery (P= 0.0003) compared with radiculopathy group. DDD patients were less likely to have a stable RTW status [odds ratio, OR = 0.63 (0.50–0.79)] or RTW within 1 year after surgery [OR = 0.65 (0.52–0.82)].

DDD group had higher rate of opioid use (P= 0.001), and higher rate of disability after surgery (P= 0.002).

Conclusion.

Multiple detriments affect stable RTW status after multilevel cervical fusion including DDD. DDD without radiculopathy was associated with lower RTW rates, less likelihood to return to work, higher disability, and higher opioid use after surgery. Multilevel cervical fusion for DDD may be counterproductive. Future studies should investigate further treatment options of DDD, and optimize patient selection criteria for surgical intervention.

Level of Evidence: 3
Do Patients With Chronic Low Back Pain Benefit From Early Intervention Regarding Absence From Work?
Authors: Norbye Anja Davis , Omdal Aina Vedvik , Nygaard Marit Eikrem , Romild Ulla , Eldøen Guttorm , Midgard Rune
Published: August 2016

Study Design.

A randomized, controlled, single-center pilot study.

Objective.

The aim of this study was to investigate the feasibility of running a trial to explore if early intervention in individuals with chronic low back pain (CLBP) would lead to an early return to work (RTW) and reduce sick leave during 12 months of follow-up compared with patients on a 3-month waiting list.

Summary of Background Data.

Back pain is the reason for numerous absent days from work. In Norway, the government initiated a priority program, Earlier Return to Work (ERTW), to reduce work absences through early intervention. However, no proper evaluation has been performed on populations with CLBP. There is no consensus on how RTW should be measured. Only a few studies have examined how waiting time affects RTW.

Methods.

Fifty-eight patients were included in the study. The group with early intervention was examined within 2 weeks, and the group on the waiting list was examined after 12 weeks. The intervention was identical in both groups and consisted of an outpatient, intensive back school. The data were obtained by questionnaire after 3, 6, and 12 months. The primary outcome was absence from work.

Results.

The sample size in a full-scale study must comprise at least 382 patients on the basis of the assumptions in the pilot. In the pilot study, early intervention directly compared with an ordinary waiting list did not significantly affect the number of sick leave days after 12 months of follow-up.

Conclusion.

A prerequisite for launching a full-scale clinical trial is a redesign of the intervention, an improvement of procedures concerning inclusion and randomization, and finally a more precise definition of RTW.

Level of Evidence: 3
Mini-Open Achilles Tendon Rupture Repair
Authors: Hsu Andrew R. , Anderson Robert B.
Published: August 2016

Acute midsubstance Achilles tendon ruptures are an increasingly common athletic injury that can result in significant pain, functional limitation, and decreased quality of life. In recent years, mini-open Achilles tendon repair techniques have been developed to optimize the functional benefits of surgery while reducing the incidence of postoperative complications associated with traditional open repair. The percutaneous Achilles repair system is a modern mini-open technique that has been shown to help improve time to return to baseline activities and lower the rate of postoperative wound complications compared with traditional open repair.

Level of Evidence: Diagnostic Level V, Expert Opinion. See Instructions for Authors for a complete description of levels of evidence.
Anterior Plating With Retention of Nail for Ankle Nonunion After Tibiotalocalcaneal Arthrodesis
Authors: Matson Andrew P. , Hamid Kamran S. , Dekker Travis J. , DeOrio James K.
Published: August 2016

Tibiotalocalcaneal arthrodesis (TTCA) by retrograde intramedullary nailing (RIMN) may result in isolated nonunion of the ankle joint. In these cases, revision TTCA with RIMN may be technically difficult and carry some morbidity. However, if the subtalar joint has achieved union a full revision of RIMN may be unnecessary. This report describes a technique of anterior plating with retention of nail as a salvage option for patients with this problem. In addition, outcomes are reported for 6 patients who underwent anterior plating with retention of nail for isolated ankle nonunion after attempted TTCA by RIMN. All 6 patients achieved tibiotalar fusion at an average of 9.3 weeks (range, 5.4 to 16.1 wk) postoperatively and average pain scores significantly improved (7.8 to 5.3, P=0.019) postoperatively. One major complication and 1 minor complication occurred. Anterior plating with retention of nail appears to be a viable option for salvage ankle arthrodesis after failed TTCA by RIMN; however, detailed preoperative counseling regarding the potential risks of surgery should be performed.

Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Endobutton Fixation Technique for Multifragmented Coronoid Fractures
Authors: Altan Egemen , Ozel Omer , Ozbaydar Mehmet U. , Bekmezci Taner
Published: August 2016

Coronoid fractures commonly occur in a part of unstable elbow fractures. Stable coronoid fracture fixation is important for early elbow motion. It may be difficult to fix multifragmented coronoid process fractures with loose capsular attachment. Thus, we demonstrated the endobutton suspensory technique to fix the anterior coronoidal fragments due to its suspensory effect providing capsular attachment. This technique allows stable fixation to the small multifragmented coronoid fractures with early range of motion.
On the International Agency for Research on Cancer classification of glyphosate as a probable human carcinogen
Authors: Tarone Robert E.
Published: August 2016

The recent classification by International Agency for Research on Cancer (IARC) of the herbicide glyphosate as a probable human carcinogen has generated considerable discussion. The classification is at variance with evaluations of the carcinogenic potential of glyphosate by several national and international regulatory bodies. The basis for the IARC classification is examined under the assumptions that the IARC criteria are reasonable and that the body of scientific studies determined by IARC staff to be relevant to the evaluation of glyphosate by the Monograph Working Group is sufficiently complete. It is shown that the classification of glyphosate as a probable human carcinogen was the result of a flawed and incomplete summary of the experimental evidence evaluated by the Working Group. Rational and effective cancer prevention activities depend on scientifically sound and unbiased assessments of the carcinogenic potential of suspected agents. Implications of the erroneous classification of glyphosate with respect to the IARC Monograph Working Group deliberative process are discussed.
A Computerized Cognitive Assessment Method in a Nurse-Led Clinic
Authors: Lai Claudia K.Y. , Kwan Rick Y.C. , Cheung Daphne S.K. , Wu Yee Ming , Yap Louise S.Y.
Published: August 2016

This article reports our experience in developing a computerized cognitive assessment method in a nurse-led clinic. The assessment and report-writing time and the accuracy of using a computer as an assessment medium were compared with assessments that use the traditional pencil-and-paper method. The attitudes of professionals and service users toward the computerized approach were also collected. The results found that the computerized approach not only helped to reduce the time spent making assessments and writing reports but also improved the accuracy of the assessment when compared with the pencil-and-paper method. Most of the professionals and service users who were interviewed responded positively toward computerized assessments. The experience gained in this study will also help us to standardize our assessment procedures, promote communication among members of the clinical team, and facilitate data management and clinical research.
Human Immunoglobulin Versus Plasmapheresis in Guillain–Barre Syndrome and Myasthenia Gravis: A Meta-Analysis
Authors: Ortiz-Salas Paola , Velez-Van-Meerbeke Alberto , Galvis-Gomez Camilo Alberto , Rodriguez Q Jesús H.
Published: August 2016

Objectives:

To evaluate the efficacy and safety over a short time period of human intravenous immunoglobulin versus plasma exchange (PE) in the management of some autoimmune neurologic diseases. In addition, length of hospital stay and duration of ventilator support were compared.

Methods:

Randomized controlled trials and analytical observational studies of more than 10 cases were reviewed. Cochrane Neuromuscular Disease Group trials, MEDLINE, EMBASE, HINARI, and Ovid, were searched as data source. Reference lists were examined for further relevant articles. A random-effect model was used to derive a pooled risk ratio.

Results:

A total of 552 articles were found and 24 met the criteria for a studied population of 4657 cases: 14 articles were about Guillain–Barré syndrome and 10 of myasthenia gravis. No evidence was found to suggest that PE or intravenous immunoglobulin differed in terms of efficacy or safety to treat any of the 2 diseases. Hospital stay length and ventilatory support time are different in each illness; however, we found no statistical difference in either of the 2 treatments.

Conclusions:

There is no evidence for superiority in the efficacy or safety of immunoglobulin or plasmapheresis in the management of Guillain–Barré syndrome and myasthenia gravis. However, caution should be exercised in the interpretation of these results given the limitations in the quality of the evidence and the heterogeneity of the studies.
Small Fiber Neuropathy Following Vaccination
Authors: Kafaie Jafar , Kim Minsoo , Krause Erik
Published: August 2016

Objective:

To identify clinical and quantitative relationship between vaccinations and small fiber neuropathy (SFN). SFN refers to damaged unmyelinated or thinly myelinated sensory and/or autonomic fibers. Diagnosis is primarily based on clinical presentation. Intraepidermal nerve fiber density can provide diagnostic confirmation with a sensitivity of 88% and a specificity of 91%. However, the possible association between vaccination and small fiber polyneuropathy is not well defined.

Methods:

Case study.

Results:

Fourteen-year-old white adolescent girl presented with intractable generalized pain for 1.5 years. Burning dysesthetic pain began in the lower back and progressed to all extremities 9 days following human papillomavirus vaccination. The pain persisted despite various pain medications. Examination was significant for allodynia of right scapula (T4–T6) and decreased pinprick sensation in feet. MRI Brain with and without contrast, MR Face, Orbit with and without contrast, and MR Cervical, Lumbar spines with and without contrast were all normal. Nerve Conduction Studies/Electromyogram studies were unremarkable, and skin biopsy of the right thigh and foot showed low intraepidermal nerve fiber density with normal sweat gland nerve fiber density.

Conclusions:

This case report describes an acute onset of non–length-dependent SFN potentially related to human papillomavirus vaccine administration. Literature review includes several similar case studies, and various pathological processes have been proposed for vaccine-associated polyneuropathies. Some theories describe immune-mediated hypersensitivity to the solvents/adjuvants and/or invasion of nervous system through a prolonged, less virulent infection. However, the lack requires that evidence must be carefully reviewed.
Evaluation of the potential antidepressant effects of soybean isoflavones
Authors: Messina Mark , Gleason Carey
Published: August 2016

Objective:

The aim of the study was to determine whether isoflavones affect depressive symptoms in women.

Methods:

Literature searches were conducted to identify clinical and epidemiologic studies that evaluated the impact of soy intake and isoflavone exposure on depressive symptoms. References from identified studies were also evaluated to identify eligible studies.

Results:

Only limited epidemiologic research has evaluated the impact of soy or isoflavone intake on depression although several studies from China and Japan did find soy product intake was inversely related to risk of depression. Often times, soy was, however, evaluated only as a component of a summative dietary pattern (eg, a “Japanese” or “Healthy” diet). Of the 20 intervention studies identified, roughly half found statistically significant reductions in depressive symptoms in response to isoflavones although several had design weakness. Of those studies reporting a lack of antidepressant effects of isoflavones, design limitations likely contributed to the lack of efficacy. In all but two trials, assessment of depression was, however, a secondary outcome. It is notable that both trials in which depression was a primary outcome found isoflavones significantly improved symptoms.

Conclusions:

Although the data are inconsistent and limited, the clinical and epidemiologic evidence suggests that isoflavones may offer a safe, well-tolerated option for management of depression. Furthermore, the intervention doses used in the clinical studies fall well within the dietary range. The extant literature reveals key design features for future studies, which based upon the results of this review, are clearly warranted.
Sexual and reproductive healthcare utilization among women aged 40 to 49 in rural China
Authors: Sun Xiaoming , Sun Yu , Zong Zhanhong , Shu Xingyu , Mao Jingshu , Hearst Norman
Published: August 2016

Objective:

China's national family planning system is mainly directed toward women of early reproductive ages. Most studies of service provision focused on younger women, who almost all receive regular examinations. Little is known about service-seeking behavior among women of late reproductive ages.

Methods:

This cross-sectional household survey interviewed 1,811 rural women aged 40 to 49 in seven provinces. We examined sexual and reproductive health, utilization of sexual and reproductive health services, and predictors of receiving a free gynecological examination in the past 2 years.

Results:

Educational levels were not high, and most women were rural farmers or housewives. More than one-fourth had migrated for work to big cities when they were younger. The mean frequency of sex in the last month was 3.6 times. Approximately 22.7% of women had not received a gynecological examination and 31.2% had not received any health education during the past 2 years. The first choice for where to seek services was township medical facilities (58.4%). On multivariate regression, age, education, migrant working experience, awareness of the need for intrauterine device removal after menopause, health education received, and attitude toward health examinations were significantly associated with receiving a gynecological examination in the past 2 years.

Conclusions:

Women of late reproductive age in rural China are not receiving as regular care as younger women. This study identifies sociodemographic and health service correlates for service-seeking behavior, many of which are modifiable. Health services should pay greater attention to this group, including community-based efforts to encourage routine examinations and appropriate use of health services.
EFFECT OF PLASMAPHERESIS AND PASSAGE OF ANTI-RETINAL ANTIBODIES THROUGH THE PLACENTA IN A CASE OF NON-PARANEOPLASTIC AUTOIMMUNE RETINOPATHY
Authors: Sierpina David I. , Skale David M. , Fan Joseph T.
Published: August 2016

Purpose:

To present a case of nonparaneoplastic autoimmune retinopathy in association with myasthenia gravis in a young woman, and to report the effect of plasmapheresis as well as passage of antiretinal antibodies through the placenta.

Methods:

Case report.

Results:

A 31-year-old woman presented with a history of myasthenia gravis and rapidly progressive vision loss at the age of 23. Funduscopic appearance and fluorescein angiographic findings on presentation were consistent with an autoimmune retinopathy. Paraneoplastic etiology was ruled out, and antiretinal antibody testing revealed positivity for autoantibodies against GAPDH, aldolase, enolase, arrestin, as well as unnamed 48-kDa and 60-kDa proteins. ARA Western Blot and immunohistochemistry profiles were unchanged by either plasmapheresis therapy or passage of serum through the maternal placenta. However, the patient's 6-month and 8-year-old daughters appeared unaffected.

Conclusion:

This is the first report of nonparaneoplastic autoimmune retinopathy associated with myasthenia gravis, although a strong history of autoimmune disorders is a known risk factor. Our patient's antiretinal antibody panel was unaffected immediately after plasmapheresis treatment. Antibodies to GAPDH and unnamed 38-kDa and 86-kDa proteins were able to pass through the placenta into the fetal circulation, although their effect on the growing fetus is not clear.
CHEMOTHERAPEUTIC NADIR-ASSOCIATED RETINOPATHY
Authors: Rivera-De La Parra David , Graue-Hernandez Enrique O.
Published: August 2016

Purpose:

To describe subinternal limiting membrane hemorrhage as a retinal complication of chemotherapy nadir in a patient with leukemia.

Methods:

Case report.

Results:

A 23-year-old man presented with bilateral subinternal limiting membrane hemorrhages in both eyes as a manifestation of thrombocytopenia secondary to chemotherapy treatment for acute myeloid leukemia.

Conclusion:

Chemotherapeutic nadir-associated retinopathy may present with sub-internal limiting membrane hemorrhages most probably secondary to thrombocytopenia.
Comparison of Surgical Outcome After Ahmed Valve Implantation for Patients With and Without Fluocinolone Intravitreal Implant (Retisert)
Authors: Hennein Lauren , Hou Jing , Stewart Jay M. , Lowry Eugene A. , Jiang Zhengxuan , Enanoria Wayne T.A. , Han Ying
Published: August 2016

Purpose:

To determine whether long-term, slow-release exposure to corticosteroids with Retisert promotes better surgical outcomes after Ahmed valve implantation.

Patients:

This comparative retrospective cohort study included 17 study eyes (10 patients) with uncontrolled uveitis requiring Retisert and Ahmed implantation, and 55 control eyes (51 patients) with other types of medically uncontrolled glaucoma that only received Ahmed.

Materials and Methods:

Main outcome measures were intraocular pressure (IOP), glaucoma eye drops per day, best-corrected visual acuity, early complications, and late complications at 1, 3, 6, and 12 months. Linear mixed effects models were used to model IOP, glaucoma drops per day, and visual acuity at 1 year after surgery.

Results:

At 1 year, the study eyes had a mean IOP of 12.24, which was lower than that for control eyes at 15.17 (P=0.04). At 1 year, the average number of glaucoma eye drops used per day for study eyes was 1.4, which was lower than that for control eyes at 2.3 (P=0.03). At 1 year, there were no statistically significant differences in change in visual acuity, early complications, and late complications between study and control eyes.

Conclusions:

Patients who received a Retisert implantation had lower IOP and used fewer glaucoma eye drops compared with control eyes at 1-year post-Ahmed valve surgery. This study suggests that long-term, slow-release corticosteroid medication from Retisert (fluocinolone acetonide) may improve the surgical outcome for patients with an Ahmed valve implantation and/or Retisert helps control uveitis in patients with uveitic glaucoma receiving Ahmed valves.
Ahmed Versus Baerveldt Glaucoma Drainage Implantation in Patients With Markedly Elevated Intraocular Pressure (≥30 mm Hg)
Authors: Resende Arthur F. , Moster Marlene R. , Patel Neal S. , Lee Daniel , Dhami Hermandeep , Pro Michael J. , Waisbourd Michael
Published: August 2016

Purpose:

Glaucoma patients with markedly elevated intraocular pressure (IOP) are at risk for developing severe hypotony-related complications. The goal of this study was to compare the surgical outcomes of the Ahmed Glaucoma Valve (AGV) and the Baerveldt Glaucoma Implant (BGI) in this patient population.

Methods:

Patients with preoperative IOP≥30 mm Hg were included. Outcome measures were: (1) surgical failure (IOP>21 mm Hg or <30% reduction from baseline or IOP≤5 mm Hg on 2 consecutive follow-up visits after 3 mo, or additional glaucoma surgery, or loss of light perception) and (2) surgical complications.

Results:

A total of 75 patients were included: 37 in the AGV group and 38 in the BGI group. The mean±SD follow-up was 2.3±1.6 years for the AGV group and 2.4±1.7 years for the BGI group (P=0.643). Mean preoperative IOP was 38.7±6.5 mm Hg for the AGV group and 40.8±7.6 mm Hg for the BGI group. At the last follow-up, 10 (27.0%) patients failed in the AGV group compared with 6 (15.8%) patients in the BGI group (P=0.379). The BGI group had higher rate of flat or shallow anterior chamber (n=4, 10%) compared with the AGV group (n=0, 0%) (P=0.043).

Conclusions:

Failure rates of AGV and BGI in patients with IOP≥30 mm Hg were comparable. There were more early hypotony-related complications in the BGI group; however, none were vision threatening. Both glaucoma drainage implants were effective in treating patients with uncontrolled glaucoma in an emergency setting.
Trabeculotomy in the Treatment of Pediatric Uveitic Glaucoma
Authors: Wang Qianqian , Wang Jing , Fortin Eric , Hamel Patrick
Published: August 2016

Purpose:

To evaluate the efficacy and safety of trabeculotomy in the treatment of pediatric uveitic glaucoma (UG).

Materials and Methods:

We retrospectively reviewed all cases that underwent trabeculotomy for pediatric UG at our center between 2008 and 2014. Up to 2 trabeculotomies per eye were performed in patients with medically controlled uveitis. Surgical success was defined as final intraocular pressure <22 mm Hg and ≥6 mm Hg after 1 or 2 trabeculotomies, with or without medications. Kaplan-Meier survival analyses were done.

Results:

A total of 33 trabeculotomies were performed in 28 eyes of 22 patients. Diagnoses included UG associated with juvenile idiopathic arthritis (68.2%), idiopathic uveitis (22.7%), and pars planitis (9.1%). The average age at surgery was 9.8±3.7 (5 to 17) years. With a mean follow-up of 33.6±18.3 (10 to 78) months, the overall surgical success was 81.8%. The cumulative survival probability after up to 2 trabeculotomies was 0.86 (95% confidence interval, 0.71-0.93) at 12 months and 0.77 (95% confidence interval, 0.60-0.87) at 24 months. Four (11.5%) eyes required a second trabeculotomy to achieve surgical success and 4 (7.7%) required filtrating procedures. Intraocular pressure improved from 31.4±7.6 (18 to 50) mm Hg preoperatively to 15.0±3.6 (8 to 23) mm Hg at final visits, whereas the number of glaucoma medications decreased from 4.2±1.1 (1 to 5) to 0.4±1.0 (0 to 4). Visual acuity and intraocular inflammation remained stable (P>0.05) and there were no major complications.

Conclusions:

Trabeculotomy is a safe and effective surgery for pediatric UG.
Changes in the Choroidal Thickness and Axial Length Upon Mannitol Infusion in Patients With Asymmetric Intraocular Pressure
Authors: Çalişkan Sinan , Uğurbaş Silay C. , Alpay Atilla , Uğurbaş Suat H.
Published: August 2016

Background/Aims:

To evaluate the changes in the choroidal thickness (CT) and axial length (AL) upon systemic mannitol infusion in glaucoma patients with asymmetric intraocular pressure (IOP).

Materials and Methods:

Forty glaucoma patients with asymmetric IOP, with the IOP of 1 eye ≥40 mm Hg and the fellow eye <25 mm Hg, were administered 150 mL of a 20% mannitol infusion to reduce the IOP. The CT and AL were measured before and an hour after the infusion. The relationship between the IOP reduction and the changes in the CT and AL were investigated.

Results:

The mean decrease in the IOP was −14.23 mm Hg (32.15%) and −4.13 mm Hg (21.40%) in the eyes with higher IOP and their fellow eyes, respectively. The mean changes in the subfoveal CT were 19.28 µm (9.20%; P<0.001) and 2.60 µm (1.93%; P=0.452) in the eyes with higher IOP and their fellow eyes, respectively. The mean changes in the AL were −0.10 µm (0.42%; P<0.001) and −0.33 mm (0.14%; P=0.008) in the eyes with higher IOP and their fellow eyes, respectively. Stepwise analysis revealed that the percent IOP change is the most influential factor on the percent change of the subfoveal CT (P<0.0001; R
2=0.3).

Conclusions:

These results suggest that large IOP changes upon mannitol infusion cause the shortening of the AL in both the eyes and the thickening of the choroid only in the eyes with a higher IOP.
Role of lipoproteins and proprotein convertase subtilisin/kexin type 9 in endotoxin clearance in sepsis
Authors: Walley Keith R.
Published: August 2016

Purpose of review

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition is a recent high-impact cardiovascular intervention aimed at reducing low-density lipoprotein (LDL) cholesterol levels. Notably, pathogen lipids are also carried in lipoprotein particles and are cleared by hepatocyte LDL receptors. Therefore, the role of PCSK9 in sepsis is reviewed.

Recent findings

Endogenous PCSK9 decreases clearance of LDL cholesterol by decreasing the number of LDL receptors on hepatocytes. Similarly, PCSK9 decreases clearance of pathogen lipids, such as endotoxin, carried in LDL. Pathogen lipids, such as lipopolysaccharide (LPS) from gram-negative organisms or lipoteichoic acid from gram-positive organisms, are carried in high-density lipoprotein, LDL, and very low-density lipoprotein particles. Transfer proteins that handle pathogen lipids (e.g., LPS binding protein) are homologous to transfer proteins that handle cholesterol (e.g., phospholipid transfer protein, cholesterol ester transfer protein). Reduction in PCSK9 function results in increased LPS clearance, a decreased inflammatory response, and improved clinical outcomes in mice. PCSK9 inhibition improves survival in septic mice. Similarly, humans who carry loss-of-function variants of the PCSK9 gene have increased survival in sepsis.

PCSK9 inhibition may be a useful strategy to increase pathogen lipid clearance in the treatment of patients with sepsis.
Results of the FIT-based National Colorectal Cancer Screening Program in Slovenia
Authors: Tepeš Bojan , Bracko Matej , Novak Mlakar Dominika , Stefanovic Milan , Stabuc Borut , Frkovic Grazio Snjezana , Maucec Zakotnik Jozica
Published: August 2016

Background:

Colorectal cancer (CRC) is one of the most common malignancies in the western world.

Objective:

We aimed to assess the first round of fecal immunochemical test (FIT)-based National CRC screening program (NCSP).

Methods:

In the NCSP conducted in Slovenia, a FIT and colonoscopy for those tested positive was used. The NCSP central unit sent 536,709 invitations to Slovenian residents age 50 to 69 years old between 2009 and 2011. The adherence rate was 56.9% (303,343 participants). FIT was positive in 6.2% (15,310) of the participants (men, 7.8%; women, 5.0%; P<0.01). A total of 13,919 unsedated colonoscopies were performed with the cecal intubation rate of 97.8%.

Results:

The overall adenoma detection rate was 51.3% [95% confidence interval (CI), 50.5%-52.1%] of which 61.0% (95% CI, 59.9%-62.1%) was in men, and 39.1% (95% CI, 37.8%-40.3%) in women (P<0.01). The mean number of adenoma per positive colonoscopy was 1.94 (95% CI, 1.90-1.97). Adenoma, advanced adenoma, or cancer were found in 7732 (55.5%) colonoscopies. A total of 862 (6.2%) CRC cases were found. Only 161 (18.7%) carcinomas were situated in the right colon. A total of 597 (70.2%) patients with cancer were in the early clinical stages (N, negative; 194 22.8%) of all cancers were cured with only endoscopic resection.

Conclusions:

In the NCSP, CRC was found in 6.2% of those participants attending colonoscopy, with 81.3% of carcinomas found in the left colon. A localized clinical stage was found in 70.2% participants. In 22.8% of CRC patients, cancer was cured with endoscopic resection only.
Clinical Features of Chronic Hepatitis B in Treatment-naive Asian Patients With Positive HBeAg and Coexisting Precore and/or Basal Core Promoter Mutations
Authors: Pan Calvin Q. , Dai Erhei , Bhamidimarri Kalyan R. , Zeng Zheng , Yin Paley
Published: August 2016

Background:

Precore or/and basal core promoter (PC/BCP) mutations are frequently detected in hepatitis B e antigen (HBeAg)-negative patients, but little is known about their clinical significance in HBeAg-positive patients.

Aim:

To characterize and report the clinical features of treatment-naive chronic hepatitis B patients who are HBeAg positive and harbor PC and/or BCP mutations.

Patients and Methods:

Consecutive treatment-naive patients with chronic hepatitis B between 2004 and 2014 were enrolled. Clinical characteristics were compared based on the stratification of HBeAg status and the presence of PC/BCP mutations. In addition, subset analysis in HBeAg-positive cohort was performed to compare clinical features of patients with and without PC/BCP mutations

Results:

Of the 267 patients enrolled from 3 centers, 177 were HBeAg positive and 90 HBeAg negative. When compared with HBeAg-negative patients, HBeAg-positive patients were significantly younger in mean age (37.93 vs. 44.40; P<0.001), had higher levels of median ALT (51 vs. 30.5 U/mL; P<0.001), higher levels of mean HBV DNA (7.50±1.48 vs. 5.10±1.44 log10 copies/mL; P<0.001), and lower frequency of detectable PC/BCP mutations (60.45% vs. 93.33%; P<0.001), but had significantly higher frequency of BCP when mutations were detected (37.85% vs. 22.22%; P=0.013). Among HBeAg-positive patients, when compared with patients with wild type, those with PC/BCP mutations were significantly older (30.63 vs. 42.71; P<0.001), had higher median ALT levels (29.5 vs. 73 U/mL; P<0.001), but there was no significant association with mean HBV DNA levels (7.96 vs. 7.20 log10 copies/mL; P=0.865) or HBV genotype (P=1.000). In the multivariate analysis, only age and ALT were independently associated with PC/BCP mutations in HBeAg-positive patients, but there was no association with HBV genotype or DNA.

Conclusions:

PC/BCP mutants were frequent (up to 60%) in treatment-naive HBeAg-positive patients and were associated with distinct clinical characteristics when compared with patients with wild type or HBeAg negative. Future large studies are needed to substantiate the long-term clinical outcomes when PC/BCP mutations are detected in HBeAg-positive patients as it may impact the natural history or treatment response in such patients.
Succinate Dehydrogenase B (SDHB) Immunohistochemistry for the Evaluation of Muscle Biopsies
Authors: Punsoni Michael , Mangray Shamlal , Lombardo Kara A. , Heath Nancy , Stopa Edward G. , Yakirevich Evgeny
Published: August 2016

Succinate dehydrogenase (SDH) is a key mitochondrial enzyme complex composed of 4 subunits. SDH histochemistry is routinely utilized in the assessment of muscle biopsies to reveal underlying pathology such as subsarcolemmal mitochondrial aggregates. In this study, we evaluated the utility of succinate dehydrogenase B (SDHB) immunohistochemistry (IHC) in 27 muscle biopsies, including 13 mitochondrial myopathies (MMs), 9 inflammatory myopathies, and 5 controls. SDHB IHC was performed on formalin-fixed, paraffin-embedded tissue sections with a mouse monoclonal antibody (Abcam 21A11AE7) in parallel with histochemical SDH stains on a fresh-frozen tissue. In all muscle biopsies, SDHB IHC exhibited granular immunoreactivity and highlighted the dark type 1 and lighter type 2 staining pattern observed by histochemistry. In all cases of MM, SDHB IHC showed subsarcolemmal granular aggregates involving the entire periphery of the fibers that were more distinct than those seen by SDH histochemistry. In 3 extraocular muscle biopsies, SDHB immunoreactive speckles of various sizes were distributed throughout the entire sarcoplasm that were more prominent than those seen on SDH histochemistry. Subsarcolemmal and cytoplasmic granular aggregates seen on SDHB IHC correlated with mitochondrial pathology on electron microscopy. In cases of inflammatory myopathy, there was diffuse sarcoplasmic SDHB immunoreactivity in degenerating fibers, but no evidence of subsarcolemmal aggregates. This study demonstrates that SDHB IHC is highly sensitive and specific in the identification of MM. The automation, reproducibility, and cost efficiency of SDHB IHC offer advantages over the labor-intensive histochemical method requiring frozen sections. As this technique is performed on formalin-fixed, paraffin-embedded tissues, it can be easily applied for retrospective studies.
Building a Multidisciplinary Hospital-Based Wound Care Center: Nuts and Bolts
Authors: Kim Paul J. , Attinger Christopher E. , Steinberg John S. , Evans Karen K. , Akbari Cameron , Mitnick Carol Deane Benedict , Johnson-Arbor Kelly K. , Singh Brinder
Published: August 2016

Background:

A hospital-based wound care center provides an important platform for the multidisciplinary approach to wound care. The colocation of specialists is an ideal working environment for the efficient delivery of quality care of the complex wound through daily communication and shared resources.

Methods:

We describe the critical components necessary in building a hospital-based wound care center. Furthermore, the experience at the authors’ institution in developing the multidisciplinary approach is discussed.

Results:

Readily available ancillary services, specially trained personnel, continuum of care from the outpatient clinic to admission to surgery, and inpatient and outpatient post operative care all contribute to a process that is especially amenable to the care of the complex wound.

Conclusions:

The final goal is to return the patient to the best quality of life achievable given his or her wound or disability. The aim of this study is to present the authors’ experiences and provide insight for others who may want to build this model within their institutions.