bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermally stable electrostrains of morphotropic 0.875NaNbO3-0.1BaTiO3-0.025CaZrO3 lead-free piezoelectric ceramics
Authors: Qi He , Zuo Ruzhong , Fu Jian , Dou Mengxian
Published: March 2017

The 0.875NaNbO3-0.1BaTiO3-0.025CaZrO3 relaxor ferroelectric ceramics were reported to exhibit thermally stable electrostrains (∼0.15% @ 6 kV/mm) from room temperature (RT) to ∼175 °C and comparable strain hysteresis (<13%) to that of typical lead-based piezoelectric ceramics. Dominant strain contribution mechanisms with increasing temperature were analyzed by means of temperature-dependent permittivity, polarization, and strain measurements and synchrotron x-ray diffraction. The rhombohedral (R) and tetragonal (T) morphotropic phase boundary provided a solid structural base for temperature-stable piezoelectric strains from RT to ∼140 °C. The growth of polar nanoregions (pseudocubic) into microdomains (R) and subsequent field-induced R-T phase transition, as well as large electrostrictive effects, sequentially contributed to high electrostrain levels in the proximity of the Curie temperature (from 140 to 175 °C). In addition, the observed low strain hysteresis was attributed to the small strain fraction from domain switching. These experimental results demonstrated that NaNbO3-based relaxor ferroelectrics might be potential lead-free materials for actuator applications.
Influence of environmental factors on the corrosion-fatigue response of a nickel-based superalloy
Authors: Cockings Hollie L. , Perkins Karen M. , Dowd Michael
Published: March 2017

Nickel disc corrosion is an important area within the gas turbine engine, with the potential to affect the lives of critical rotating parts. To understand the influence of corrosion on such components, it is essential to generate material data in a representative environment; hot corrosion in conjunction with cyclic loading. A comprehensive assessment of the behaviour of alloys U720Li and RR1000 in a laboratory-simulated environment has been undertaken to explore and replicate corrosion-fatigue features that have been identified in service. Key parameters such as salt loading (flux) and variations in mechanical stress cycle have been examined and have shown to modify the corrosion morphology and resulting fatigue life of the material.

This paper is part of a thematic issue on the 9th International Charles Parsons Turbine and Generator Conference. All papers have been revised and extended before publication in Materials Science and Technology.
Synthesis of nanoparticles composed of silver and copper for metal–metal bonding
Authors: Maeda Takafumi , Matsubara Norihisa , Kobayashi Yoshio , Yasuda Yusuke , Morita Toshiaki
Published: March 2017

A metal–metal bonding technique is described that uses nanoparticles composed of silver and copper. Colloid solutions of nanoparticles with an Ag content of 0–100 mol% were prepared by simultaneous reduction of Ag+ and Cu2+ using hydrazine with polyvinylpyrrolidone and citric acid as stabilisers. The nanoparticles ranged in size from 34 to 149 nm depending on the Ag content. Copper discs were strongly bonded at 400°C for 5 min under 1.2 MPa pressure in hydrogen gas; the maximum shear strength was as high as 23.9 MPa. The dependence of shear strength on the Ag content was explained by a mismatch between the d-spacings of Cu metal and Ag metal.
DLTree: efficient and accurate phylogeny reconstruction using the dynamical language method
Authors: Wu Qi , Yu Zu-Guo , Yang Jianyi
Published: March 2017

A number of alignment-free methods have been proposed for phylogeny reconstruction over the past two decades. But there are some long-standing challenges in these methods, including requirement of huge computer memory and CPU time, and existence of duplicate computations. In this article, we address these challenges with the idea of compressed vector, fingerprint and scalable memory management. With these ideas we developed the DLTree algorithm for efficient implementation of the dynamical language model and whole genome-based phylogenetic analysis. The DLTree algorithm was compared with other alignment-free tools, demonstrating that it is more efficient and accurate for phylogeny reconstruction.

Availability and Implementation

The DLTree algorithm is freely available at http://dltree.xtu.edu.cn

Supplementary information

Supplementary data are available at Bioinformatics online.
Induction of Xa10-like Genes in Rice Cultivar Nipponbare Confers Disease Resistance to Rice Bacterial Blight
Authors: Wang Jun , Tian Dongsheng , Gu Keyu , Yang Xiaobei , Wang Lanlan , Zeng Xuan , Yin Zhongchao
Published: March 2017

Bacterial blight of rice, caused by Xanthomonas oryzae pv. oryzae, is one of the most destructive bacterial diseases throughout the major rice-growing regions in the world. The rice disease resistance (R) gene Xa10 confers race-specific disease resistance to X. oryzae pv. oryzae strains that deliver the corresponding transcription activator-like (TAL) effector AvrXa10. Upon bacterial infection, AvrXa10 binds specifically to the effector binding element in the promoter of the R gene and activates its expression. Xa10 encodes an executor R protein that triggers hypersensitive response and activates disease resistance. ‘Nipponbare’ rice carries two Xa10-like genes in its genome, of which one is the susceptible allele of the Xa23 gene, a Xa10-like TAL effector-dependent executor R gene isolated recently from ‘CBB23’ rice. However, the function of the two Xa10-like genes in disease resistance to X. oryzae pv. oryzae strains has not been investigated. Here, we designated the two Xa10-like genes as Xa10-Ni and Xa23-Ni and characterized their function for disease resistance to rice bacterial blight. Both Xa10-Ni and Xa23-Ni provided disease resistance to X. oryzae pv. oryzae strains that deliver the matching artificially designed TAL effectors (dTALE). Transgenic rice plants containing Xa10-Ni and Xa23-Ni under the Xa10 promoter provided specific disease resistance to X. oryzae pv. oryzae strains that deliver AvrXa10. Xa10-Ni and Xa23-Ni knock-out mutants abolished dTALE-dependent disease resistance to X. oryzae pv. oryzae. Heterologous expression of Xa10-Ni and Xa23-Ni in Nicotiana benthamiana triggered cell death. The 19-amino-acid residues at the N-terminal regions of XA10 or XA10-Ni are dispensable for their function in inducing cell death in N. benthamiana and the C-terminal regions of XA10, XA10-Ni, and XA23-Ni are interchangeable among each other without affecting their function. Like XA10, both XA10-Ni and XA23-Ni locate to the endoplasmic reticulum (ER) membrane, show self-interaction, and induce ER Ca2+ depletion in leaf cells of N. benthamiana. The results indicate that Xa10-Ni and Xa23-Ni in Nipponbare encode functional executor R proteins, which induce cell death in both monocotyledonous and dicotyledonous plants and have the potential of being engineered to provide broad-spectrum disease resistance to plant-pathogenic Xanthomonas spp.
Impact of elimination diets on nutrition and growth in children with multiple food allergies
Authors: Venter Carina , Mazzocchi Alessandra , Maslin Kate , Agostoni Carlo
Published: March 2017

Purpose of review

Growth and nutritional intake of children with cows’ milk allergy and other food allergens has been thoroughly investigated in recent years across many different countries and age groups. An impaired growth in atopic children should not be attributed only to a high number of allergens and foods to be avoided, but to a general condition of ‘sub-inflammation’, which unfavorably affects the absorption and utilization of fuel and substrates. Atopic study participants may represent a good target for personalized nutrition and in this review we sought to outline many of the issues that should be taken into account when dietitians advise patients regarding food avoidance and expected effects on growth.

Recent findings

The dietary management of food allergy requires appropriate dietary choices to maintain adequate growth, starting with special formulas in infancy. An emerging area of research is the fussy eating related to the exclusion of cow's milk and other foods during infancy and the long-term effects on eating habits and food preferences.

Study participants with either mono or polyallergic diseases should ideally undergo the definition of their allergic and metabolic characteristics, to precisely adjust dietary interventions on an individual basis to support the genetic potential of growth and prevent unfavorable outcomes.
IgG4-related disease
Authors: Bozzalla Cassione Emanuele , Stone John H.
Published: March 2017

Purpose of review

Remarkable insights have been gleaned recently with regard to the pathophysiology of IgG4-related disease (IgG4-RD). These findings have direct implications for the development of targeted strategies for the treatment of this condition.

Recent findings

Oligoclonal expansions of cells of both the B and T lymphocyte lineages are present in the blood of patients with IgG4-RD. Oligoclonal expansions of plasmablasts are a good biomarker for disease activity. An oligoclonally expanded population of CD4+ cytotoxic T lymphocytes is found not only in the peripheral blood but also at tissue sites of active disease. This cell elaborates cytokines that may drive the fibrosis characteristic of IgG4-RD. T follicular helper cells (Tfhc), particularly the Tfhc2 subset, appear to play a major role in driving the class switch to IgG4 that typifies this disease. The relationship between malignancy and IgG4-RD remains an area of interest.

Advances in understanding the pathophysiology of IgG4-RD have proceeded swiftly, leading to the identification of a number of potential targeted treatment strategies. The completion of classification criteria for IgG4-RD, an effort supported jointly by the American College of Rheumatology and the European League Against Rheumatism, will further facilitate studies on this disease.
Obesity Is Associated With High Perioperative Complications Among Surgically Treated Intertrochanteric Fracture of the Femur
Authors: Kempegowda Harish , Richard Raveesh , Borade Amrut , Tawari Akhil , Graham Jove , Suk Michael , Howenstein Abby , Kubiak Erik N. , Sotomayor Vanessa R. , Koval Kenneth , Liporace Frank A. , Tejwani Nirmal , Horwitz Daniel S.
Published: March 2017

Objectives:

To document the complications among obese patients who underwent surgical fixation for intertrochanteric femur (IT) fractures and to compare with nonobese patients.

Design:

Retrospective cohort study.

Setting:

Four level I trauma centers.

Patients:

1078 IT fracture patients.

Interventions:

None.

Main Outcome Measures:

Patient and fracture characteristics, surgical duration, surgical delay intraoperative and postoperative complications, inpatient mortality, and length of stay.

Method:

A retrospective review at 4 academic level I trauma centers was conducted to identify skeletally mature patients who underwent surgical fixation of intertrochanteric fractures between June 2008 and December 2014. Descriptive data, injury characteristics, OTA fracture classification, and associated medical comorbidities were documented. The outcomes measured included in-hospital complications, length of stay, rate of blood transfusion, change in hemoglobin levels, operative time, and wound infection.

Results:

Of 1078 unique patients who were treated for an IT fracture, 257 patients had a Body mass index (BMI) of 30 or greater. Patients with a high BMI (≥30) had a significantly lower mean age (73 vs. 77 years, P < 0.0001), higher percentage of high-energy injuries (18% vs. 9%, P = 0.0004), greater mean duration of surgery (96 vs. 86 minutes, P = 0.02), and higher mean length of stay (6.5 vs. 5.9 days, P = 0.004). The high-BMI group (n = 257) had significantly higher percentages of patients with complications overall (43% vs. 28%, P < 0.0001), respiratory complications (11% vs. 3%, P < 0.0001), electrolyte abnormalities (4% vs. 2%, P = 0.01), and sepsis (4% vs. 1%, P = 0.002). Patients with BMI ≥ 40 had a much higher rate of respiratory complications (18%) and wound complications (5%) than obese (BMI: 30–39.9) and nonobese patients (BMI < 30).

Conclusion:

Intertrochanteric hip fracture patients with a BMI of >30 kg/m2 are much more likely to sustain systemic complications including respiratory complications, electrolyte abnormalities, and sepsis. In addition, morbidly obese patients are more likely to sustain respiratory complications and wound infections than obese (BMI: 30–39.9 kg/m2) and nonobese patients (BMI: < 30 kg/m2). The findings from this study can help direct surgeons in the counseling to obese patients and their family, and perhaps increase hospital reimbursement for this group of patients.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Defining the Role of the Lower Limbs in Compensating for Sagittal Malalignment
Authors: Lafage Renaud , Liabaud Barthelemy , Diebo Bassel G. , Oren Jonathan H. , Vira Shaleen , Pesenti Sébastien , Protopsaltis Themistocles S. , Errico Thomas J. , Schwab Frank J. , Lafage Virginie
Published: March 2017

Study Design.

Retrospective review.

Objective.

To investigate the role of lower limbs compensation with progressive sagittal malalignment.

Summary of Background Data.

Although lower limb compensatory mechanisms are established response to progressive sagittal malalignment, their specific role and potential impact on surgical planning has not been evaluated.

Methods.

Single center retrospective review of full body x-rays was performed in patients of age >20 years. Parameters were measured with dedicated software. Population was stratified by 50 mm intervals of sagittal vertical axis (SVA) and one-way ANOVA was performed to compare P.shift (P.shift = anteroposterior translation of the pelvis vs. the feet) across SVA groups. Anteroposterior offset of each vertebra in relation to a vertical line extended from the distal tibial metaphysis (TM) was investigated. Linear regression was performed to predict pelvic tilt (PT) using Knee angle (KA) and P.shift, whereas controlling for pelvic incidence minus lumbar lordosis mismatch (PI-LL) and SVA.

Results.

A total of 2124 patient visits were included (PI = 55.1 ± 14.1°, PT=21.0 ± 11°, PI-LL=6.3 ± 17.3°, SVA = 29 ± 51 mm). With progressively increased SVA, P.shift decreased from 30 to −100 mm (all P < 0.005). Analysis of vertebral offset from the distal tibial metaphysis revealed that T9 was aligned with the TM line across all SVA groups. Prediction of PT based on PI-LL and SVA yielded R2=0.76 (P < 0.001). Subsequent addition of KA and P.shift as independent parameters using hierarchical multiple regression led to significant improvement in R2, demonstrating the independent role of lower limbs parameters in PT prediction. KA and P.shift had a positive standardized coefficient (all P < 0.05).

Conclusion.

Lower limb compensatory mechanisms increase with progressive sagittal malalignment. Anteroposterior translation of pelvis allows the T9 vertebra to remain in line with the ankle (“conus of economy”). Lower limb compensatory mechanisms are positive predictors of PT and thus do not require additional consideration in surgical realignment planning.

Level of Evidence: 3
Effects of IV Acetaminophen on Core Body Temperature and Hemodynamic Responses in Febrile Critically Ill Adults: A Randomized Controlled Trial
Authors: Schell-Chaple Hildy M. , Liu Kathleen D. , Matthay Michael A. , Sessler Daniel I. , Puntillo Kathleen A.
Published: March 2017

Objective:

To determine the effects of IV acetaminophen on core body temperature, blood pressure, and heart rate in febrile critically ill patients.

Design:

Randomized, double-blind, placebo-controlled clinical trial.

Setting:

Three adult ICUs at a large, urban, academic medical center.

Patients:

Forty critically ill adults with fever (core temperature, ≥ 38.3°C).

Intervention:

An infusion of acetaminophen 1 g or saline placebo over 15 minutes.

Measurement and Main Results:

Core temperature and vital signs were measured at baseline and at 5–15-minute intervals for 4 hours after infusion of study drug. The primary outcome was time-weighted average core temperature adjusted for baseline temperature. Secondary outcomes included adjusted time-weighted average heart rate, blood pressure, and respiratory rate, along with changes-over-time for each. Baseline patient characteristics were similar in those given acetaminophen and placebo. Patients given acetaminophen had an adjusted time-weighted average temperature that was 0.47°C less than those given placebo (95% CI, –0.76 to –0.18; p = 0.002). The acetaminophen group had significantly lower adjusted time-weighted average systolic blood pressure (–17 mm Hg; 95% CI, –25 to –8; p < 0.001), mean arterial pressure (–7 mm Hg; 95% CI, –12 to –1; p = 0.02), and heart rate (–6 beats/min; 95% CI, –10 to –1; p = 0.03). Changes-over-time temperature, blood pressure, and heart rate outcomes were also significantly lower at 2 hours, but not at 4 hours.

Conclusions:

Among febrile critically ill adults, treatment with acetaminophen decreased temperature, blood pressure, and heart rate. IV acetaminophen thus produces modest fever reduction in critical care patients, along with clinically important reductions in blood pressure.
Changing face of metastatic prostate cancer: the law of diminishing returns holds true
Authors: Vaishampayan Ulka N.
Published: March 2017

Purpose of review

Prostate cancer presents with a multitude of faces. It ranges from localized cancers staying quiescent for many years during active surveillance to the raging diffuse liver metastases causing terminal disease. The incidence of metastatic disease is increasing. This review will highlight some of the recent developments as well as ongoing challenges of managing advanced prostate cancer.

Recent findings

Significant strides are being made in managing metastatic prostate cancer. With the evolution of multiple new therapies, now the optimal use of these therapies and their proper sequencing is being addressed. Research is ongoing for mapping out pathways of resistance to therapies and for discovering new targets. Genomic alterations and abnormalities in circulating tumor DNA are being detected and will hopefully lead us more toward biomarker based therapies. The next era in oncology belongs to immune therapy. However, in prostate cancer the immune checkpoint inhibitors have shown modest responses and a phase III trial of radiation therapy ± ipilimumab revealed no benefit. Efforts are ongoing with combination trials of enzalutamide and atezolizumab or pembrolizumab. PARP inhibitors are gradually being established for therapeutic purposes, with olaparib achieving breakthrough status for prostate cancer patients with BRCA1 and 2 and ATM mutations.

The future will bring an era of personalized medicine in advanced prostate cancer as well as optimization and more strategic sequencing of existing therapies.
Clinical Features and Treatment of Dermatofibrosarcoma Protuberans Affecting the Vulva: A Literature Review
Authors: Nguyen Austin H. , Detty Shannon Q. , Gonzaga Maria I. , Huerter Christopher
Published: March 2017

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) is a low-to-intermediate grade cutaneous neoplasm with a low propensity for metastasis and a high rate of local recurrence. It typically presents as a dermal plaque or nodule on the trunk, limbs, or head and neck region. Vulvar DFSP has also been described, although it is less common.

OBJECTIVE

To review the available literature and discuss the clinical course of DFSP affecting the vulva.

MATERIALS AND METHODS

We reviewed the existing English-language literature on DFSP of the vulva with respect to clinical presentation, diagnosis, treatment, and outcome.

RESULTS

Thirty three case reports and series were included (n = 54 patients). Vulvar DFSP most commonly presents as a slowly enlarging tender or asymptomatic mass on the labia majora, with histological findings of classic DFSP. Most patients were treated with wide local excision. Three patients were treated with Mohs micrographic surgery, which may decrease local recurrence and seems well suited for use in vulvar DFSP.

CONCLUSION

This literature review comprehensively reviews and describes the clinical presentation of vulvar DFSP and the treatment options for this rare vulvar neoplasm.
Right Axillary Artery Cannulation for Endovascular Repair of an Acute type a Aortic Dissection
Authors: Muetterties Corbin E. , Conklin Jeremy H. , Moser G. William , Wheatley Grayson H.
Published: March 2017

We present the case of a 48-year-old woman with an acute type A aortic dissection that was treated with thoracic endovascular aortic repair at our institution. The patient was found to have a focal type A dissection with pericardial effusion but no tamponade physiology and no involvement of the aortic valve or root. We elected to treat the patient's type A aortic dissection with an endovascular stent because of the patient's favorable anatomy and no evidence of neurologic deficits or signs of distal malperfusion. The patient was successfully treated with an abdominal aortic cuff deployed through the axillary artery. An axillary approach was necessary because of the short length of the delivery sheath preventing a transfemoral delivery. At 2-year follow-up, the patient remains free of complications with computed tomography scan revealing complete false lumen thrombosis and a stable endovascular repair. This report demonstrates a case of acute type A aortic dissection successfully treated using thoracic endovascular aortic repair and illustrates the utility of axillary cannulation for precise deployment of stent grafts in the ascending aorta.
A Numerical Simulation Comparing a Cavopulmonary Assist Device and VA ECMO for Failing Fontan Support
Authors: Hsu Po-Lin , Wang Dongfang , Ballard-Croft Cherry , Xiao Dawei , Zwischenberger Joseph B.
Published: March 2017

A cavopulmonary assist device (CPAD) has been developed for failing Fontan support. This CPAD pumps blood from superior/inferior vena cavae (SVC/IVC) to pulmonary artery. In this study, we compared failing Fontan support with CPAD versus veno-arterial extracorporeal membrane oxygenation (VA ECMO) in silico. A numerical lumped-parameter circulatory system model was used to simulate Fontan circulation. Failing Fontan was simulated by increased pulmonary resistance. Central venous pressure (CVP), mean pulmonary arterial pressure (mPAP), left atrial pressure (LAP), and univentricular outflow (CO) were simulated and compared with published clinical data. The CPAD and VA ECMO were simulated using 1–5 L/min pump flows. In agreement with published clinical data, the simulated failing Fontan condition had increased CVP (19 mmHg) and mPAP (18 mmHg) with decreased LAP (7 mmHg) and cardiac output (3 L/min) compared with functional Fontan condition. The CPAD achieved total Fontan assistance with pump flows higher than original CO. Veno-arterial extracorporeal membrane oxygenation provided partial Fontan assistance with low pump flows. Blood went through pulmonary circulation with CPAD whereas VA ECMO bypassed pulmonary circulation and diminished univentricular blood flow (0.8 L/min). This in silico study demonstrated that CPAD preserved heart/lung function whereas VA ECMO had very low univentricular flow, potentially leading to thrombosis or univentricular atrophy.
Warfarin and Aspirin Versus Warfarin Alone for Prevention of Embolic Events in Patients with a HeartMate II Left Ventricular Assist Device
Authors: Van Tuyl Joseph S. , Hollis Ian B. , Alburikan Khalid A. , Tran Richard H. , Murray Brian P. , Rodgers Jo E. , Katz Jason N. , Sheridan Brett C.
Published: March 2017

Acquired von Willebrand disease increases bleeding risk in patients implanted with a continuous-flow left ventricular assist device. Lower aspirin (ASA) doses decrease the risk of bleeding without an increased risk of embolic events. No published studies in the United States have compared the incidence of bleeding and thrombotic events between antithrombotic regimens with and without ASA. A single-center, retrospective analysis was conducted of adult patients implanted with a HeartMate II (HM II). Patients received warfarin and ASA 81 mg daily or warfarin alone. The primary end-point was a composite of death, bleeding events, and thrombotic events from the date of HM II implantation to first event or 18 months. Secondary end-points included the individual components of the primary end-point and the proportion of patients alive with HM II or transplanted. The Wilcoxon rank sum test and Fisher’s exact test were used for statistical analysis. Of the 76 patients meeting inclusion criteria, 44 received warfarin and ASA and 32 received warfarin alone. Baseline characteristics were similar between groups. Warfarin alone was not associated with an increased risk of the primary composite outcome (53 vs. 59%, respectively, p = 0.64). No significant difference was observed in any bleeding event (34 vs. 43%, respectively, p = 0.48) nor any thrombotic event (9 vs. 11%, respectively, p = 1.00) with warfarin alone compared with warfarin and ASA. Elimination of antiplatelet therapy from the HM II antithrombotic regimen was associated with no significant difference in the composite outcome of bleeding events, thrombotic events, or death, nor the individual components of each end-point.
Infections in Patients with a Total Artificial Heart Are Common but Rarely Fatal
Authors: Hidalgo Luis F. , Shah Keyur B. , Cooke Richard H. , Tang Daniel G. , Kasirajan Vigneshwar , Cooper Howard A. , Aronow Wilbert S.
Published: March 2017

Patients who received a total artificial heart (TAH) at Virginia Commonwealth University (VCU) between January 1, 2010 and December 31, 2011 were identified from the VCU Mechanical Circulatory Support Clinical Database. Retrospective data extraction from the medical records was performed from the time of TAH implantation until heart transplantation or death. Infections were classified as confirmed or suspected. Twenty-seven men and five women, mean age 49.5 years (range 24–68 years) received a TAH. The mean duration of TAH support was 225 days (range 1–1,334 days). Of the 32 patients, 4 (12.5%) died and 28 (87.5 %) underwent heart transplantation. Causes of death were pneumonia (n = 1), TAH malfunction (n = 1), refractory cardiogenic shock (n = 1), and respiratory failure (n = 1). Seventy documented and 13 suspected infections developed in 25 patients (78%). The most common sources of infection were urinary tract (n = 26), respiratory tract (n = 18), and bloodstream (n = 11). There were five pump infections and two driveline infections. The number of infections per patient ranged from 0 to 10. Sixteen different pathogens were identified; the most common were: Klebsiella pneumoniae (n = 15), coagulase-negative Staphylococci (n = 10), Enterococcus species (n = 9), and Enterobacter species (n = 8). Mortality directly attributable to infection was infrequent.
Voice outcomes post total laryngectomy
Authors: Hurren Anne , Miller Nick
Published: March 2017

Purpose of review

A consensus and body of robust evidence has developed regarding optimal laryngeal voice outcome measures. This contrasts with a lack of clarity for equivalent assessments in alaryngeal voice. Addressing this situation would enable clinicians to select the best tools currently available to facilitate research, audit and clinical practice. This is important because of the limited knowledge regarding the optimal surgical or reconstruction techniques and rehabilitation regimes for the laryngectomy population.

Recent findings

There is currently no evidence to support the use of acoustic instrumental measures in terms of validity. Preliminary data support the validity of a new tracheoesophageal voice auditory–perceptual tool the SToPS, for professional and naive raters. Few specific self-rating tools exist with the Self Evaluation of Communication Experiences after Laryngectomy having the most evidence regarding validity, reliability and clinical utility. Laryngeal self-report questionnaires have been utilized, but concerns have been expressed regarding content validity. Patient self-report outcomes do not concur with professional or naive judgements, which reflect findings in the laryngeal voice literature.

Further research is needed to establish the optimal tools for research and clinical practice. Investigations should also incorporate assessments of real-life communication in daily living rather than solely focussing on recordings in laboratory conditions.
Rash diagnostics: an update on the diagnosis of allergic rashes
Authors: Happel Corinne Savides
Published: March 2017

Purpose of review

The purpose of this review is to summarize recent research regarding the diagnosis of allergic rashes and to suggest future directions for the promotion of accurate diagnosis and endotype specification.

Recent findings

Multiple cohort studies demonstrate that with appropriate clinical evaluation, drug allergy labels can be removed in up to 90% of cases. Genetic tests can predict severe adverse cutaneous drug reactions in some cases and in vitro tests are being sought to identify causative drugs in others. Biomarkers to define endotypes of atopic dermatitis are needed to predict which patients will benefit from evolving targeted therapies. Hyperspectral imaging is a rapidly evolving technology in medical diagnostics; additional research is needed to demonstrate whether this promising technology can be used to distinguish allergic rashes and/or endotypes in atopic dermatitis.

Diagnostic tools for the assessment of allergic rashes are primitive in that they frequently rely on challenges to ascertain whether suspected allergens were causative. Validated in vitro tests with high sensitivity and specificity for drug allergies would benefit the field, particularly in delayed type reactions, as would identification of any hyperspectral signatures that could identify endotypes in atopic dermatitis.
Oxidative Stress in Tunisian Patients With Acute Lymphoblastic Leukemia and Its Involvement in Leukemic Relapse
Authors: Ben Mahmoud Lobna , Mdhaffar Moez , Ghozzi Hanene , Ammar Mariam , Hakim Ahmed , Atheymen Rim , Sahnoun Zouheir , Elloumi Moez , Zeghal Khaled
Published: March 2017

The aim of the present study was to evaluate in patients with acute lymphoblastic leukemia (ALL), the oxidative status and antioxidant defense and its involvement in the relapse of ALL. The plasmatic levels of malondialdehyde, advanced oxidation of protein products and reduced glutathione (GSH), and the plasmatic activities of catalase, superoxide dismutase (SOD), and glutathione peroxidase were determined in 34 patients who were newly diagnosed with ALL and compared with 92 healthy individuals. The plasmatic concentrations of malondialdehyde and advanced oxidation of protein products were higher in ALL patients than in controls and increased during chemotherapy. A decrease in glutathione peroxidase activity and an increase in catalase and SOD activities and GSH plasma levels were observed in ALL patients, as compared with sex-matched controls. Moreover, SOD activity and GSH levels were significantly correlated with the relapse of ALL patients. These data suggest the involvement of oxidative stress in acute lymphoid leukemias and leukemic relapse.
Carvacrol and thymol: strong antimicrobial agents against resistant isolates
Authors: Memar Mohammad Y. , Raei Parisa , Alizadeh Naser , Akbari Aghdam Masoud , Kafil Hossein Samadi
Published: March 2017

Antibiotics have been effective in treatment of infectious diseases, but resistance to these drugs has led to the severe consequences. In recent years, medicinal herbs have been used for the prevention and protection against infectious diseases. Thymol and carvacrol are active ingredients of family Lamiaceae; these components have antibacterial and antifungal effects. In this review, we survey antimicrobial properties of carvacrol and thymol. Available data from different studies (microbiological, retrieve from PubMed, and Scopus databases) about antimicrobial affects carvacrol and thymol was evaluated. Carvacrol and thymol can inhibit the growth of both gram-positive and gram-negative bacteria. These compounds have antifungal and antibiofilm effects. Thymol and carvacrol can also be applied as an alternative antimicrobial agent against antibiotic-resistant pathogenic bacteria. Thus, thymol and carvacrol are recommended for potential medical use; however, more research is required on toxicity and side-effects of the compounds.
Psychopathological Assessment of Risk of Restraint in Acute Psychiatric Patients
Authors: Dazzi Federico , Tarsitani Lorenzo , Di Nunzio Michele , Trincia Valeria , Scifoni Gabriella , Ducci Giuseppe
Published: March 2017

The study aims to identify independent predictors of physical restraint in acute psychiatric patients and to determine the predictive power of a risk assessment model centered on psychopathological dimensions. We included 1552 patients admitted to a psychiatric intensive care unit over a 5-year period. Patients were rated on the Brief Psychiatric Rating Scale (BPRS-E) at admission. Principal axis factoring (PAF) with varimax rotation was performed on BPRS-E items to identify psychopathological factors. Multiple logistic regression analysis was performed. PAF pointed six factors: positive symptoms, negative symptoms, resistance, activation, negative affect, and disorganization. Male sex, younger age, proposal for compulsory admission, severity of symptoms, resistance, activation, and disorganization were identified as independent predictors. Negative symptoms and negative affect were instead protective factors. The BPRS-E factors, when added to other sociodemographic and clinical variables, significantly increased the predictive power of the model. Our findings suggest that a systematic evaluation of the psychopathological dimensions can be usefully included in the early risk assessment of restraint.
Position Between Trunk and Pelvis During Gait Depending on the Gross Motor Function Classification System
Authors: Sanz-Mengibar Jose Manuel , Altschuck Natalie , Sanchez-de-Muniain Paloma , Bauer Christian , Santonja-Medina Fernando
Published: March 2017

Purpose:

To understand whether there is a trunk postural control threshold in the sagittal plane for the transition between the Gross Motor Function Classification System (GMFCS) levels measured with 3-dimensional gait analysis.

Method:

Kinematics from 97 children with spastic bilateral cerebral palsy from spine angles according to Plug-In Gait model (Vicon) were plotted relative to their GMFCS level.

Results:

Only average and minimum values of the lumbar spine segment correlated with GMFCS levels. Maximal values at loading response correlated independently with age at all functional levels. Average and minimum values were significant when analyzing age in combination with GMFCS level.

Conclusion:

There are specific postural control patterns in the average and minimum values for the position between trunk and pelvis in the sagittal plane during gait, for the transition among GMFCS I-III levels. Higher classifications of gross motor skills correlate with more extended spine angles.
Vascular Smooth Muscle Cell Maturation Stage and Ki-67 Index are Diagnostic Biomarkers for Pathologic Grade of Ovarian Teratoma
Authors: Hongo-Kohama Masako , Kurata Atsushi , Hashimoto Hirotsugu , Fujita Koji , Horiuchi Hajime , Nagao Toshitaka , Kuroda Masahiko
Published: March 2017

Although immature teratoma of the ovary is a rare disease, its pathologic grading, especially between low-grade (grade 1) and high-grade (grade 2 or 3) immature teratomas, is important for optimal therapy and prognosis. This grading, however, is currently solely dependent on quantitation of neuroepithelial components as judged by subjective assessments. As we have recently successfully studied the maturation of vascular smooth muscle cells (SMCs) in other organs using an h-caldesmon to α-smooth muscle actin (α-SMA) ratio, we decided to use this ratio to investigate a potential link between teratoma grade and SMC maturation, in combination with Ki-67 index. Sixteen immature teratomas along with 5 mature teratomas of the ovary were studied and stained with antibodies to CD31, α-SMA, h-caldesmon, and Ki-67. The number of vascular SMCs calculated using the α-SMA/CD31 ratio did not differ between teratoma grades (except between grade 0 and 3), whereas the number of mature vascular SMCs calculated using the h-caldesmon/CD31 ratio and maturation state calculated using the h-caldesmon/α-SMA ratio reduced significantly as teratoma grade progressed from 0 to 3. Furthermore, these parameters were significantly lower in high-grade than in low-grade immature teratomas (P<0.05). Ki-67 labeling index, regardless of germ cell layer, also significantly increased with teratoma grade (P<0.05). These results suggest that not only the number of neuroepithelial elements but also vascular immaturity and proliferating cell counts are biomarkers for ovarian teratoma grading. Thus, assessment of the maturity of vascular SMCs may serve as a valuable diagnostic tool for assessing teratoma maturity.
Microcystic, Elongated, and Fragmented Pattern Invasion in Ovarian Endometrioid Carcinoma: Immunohistochemical Profile and Prognostic Implications
Authors: Goldberg Allison , Hand Lauren , DeCotiis Dan , Rosenblum Norman , Chan Joanna
Published: March 2017

Microcystic, elongated, and fragmented (MELF) pattern invasion is a poor prognostic indicator in uterine endometrioid carcinoma, but its existence, biology, and prognostic value have not been described in ovarian endometrioid carcinoma. We evaluated cases of ovarian endometrioid carcinoma without synchronous uterine endometrioid carcinoma for MELF and other histologic features. To evaluate tumor biology, we assessed an immunohistochemical profile, including MLH1, PMS2, MSH2, MSH6, β-catenin, e-cadherin, CK19, and cyclin D1. A retrospective chart review evaluated clinical and demographic features and survival. The Fisher exact test analyzed data. The Kaplan-Meier method assessed overall survival. Forty-two patients met inclusion criteria. MELF was found in 45%. Two MELF cases showed MSH2/MSH6 deficiency and 2 conventional cases showed PMS2 deficiency. Clear cell features were seen exclusively in MELF cases (P-value=0.044). No difference was identified in overall survival, cancer recurrence, serous features, concurrent endometriosis, lymphovascular space invasion, lymph node metastasis, bilaterality of disease, extranodal metastasis, or remainder of immunohistochemical profile. MELF occurs at similar rates in ovarian endometrioid carcinoma and uterine endometrioid carcinoma and can be helpful in defining ovarian endometrioid carcinoma as it proves definitive invasion. Recurrence and overall survival in ovarian endometrioid carcinoma are not affected by MELF. Clear cell features are identified exclusively in MELF cases. Different mismatch repair proteins are lost in MELF compared with conventional ovarian endometrioid carcinomas. Given its association with clear cell features and mismatch repair protein loss, presence of MELF may be useful in clinical decisions regarding surgical staging and Lynch syndrome screening.
Antimicrobial-resistant Gram-negative infections in neonates: burden of disease and challenges in treatment
Authors: Folgori Laura , Bielicki Julia , Heath Paul T. , Sharland Mike
Published: March 2017

Purpose of review

This review summarizes the main challenges of antimicrobial resistance (AMR) in the neonatal population with a special focus on multidrug-resistant (MDR) Gram-negative pathogens.

Recent findings

MDR-Gram-negative bacteria are a great concern in the neonatal population, with a worldwide rise in the reported incidence and with very limited therapeutic options. Extended-spectrum β-lactamase and carbapenem-resistant Enterobacteriaceae (CRE) have been reported as responsible for neonatal ICU outbreaks. Hospital data from low/middle-income countries show high proportions of isolates from neonates resistant to the WHO first-line and second-line recommended treatments. The spread of CRE has resulted in old antibiotics, such as colistin and fosfomycin, to be considered as alternative treatment options, despite the paucity of available data on safety and appropriate dosage.

Improved global neonatal AMR surveillance programmes including both epidemiology and clinical outcomes are critical for defining the burden and designing interventions. The optimal empiric treatment for neonatal sepsis in settings of high rates of AMR is currently unknown. Both strategic trials of older antibiotics and regulatory trials of new antibiotics are required to improve clinical outcomes in MDR-Gram-negative neonatal sepsis.
Dynamic Measurement of Arterial Liver Perfusion With an Interventional C-Arm System
Authors: Datta Sanjit , Müller Kerstin , Moore Terilyn , Molvin Lior , Gehrisch Sonja , Rosenberg Jarrett , Saenz Yamil , Manhart Michael , Deuerling-Zheng Yu , Kothary Nishita , Fahrig Rebecca
Published: March 2017

Purpose

Objective intraprocedural measurement of hepatic blood flow could provide a quantitative treatment end point for locoregional liver procedures. This study aims to validate the accuracy and reproducibility of cone-beam computed tomography perfusion (CBCTp) measurements of arterial liver perfusion (ALP) against clinically available computed tomography perfusion (CTp) measurements in a swine embolization model.

Methods

Triplicate CBCTp measurements using a selective arterial contrast injection were performed before and after complete embolization of the left lobe of the liver in 5 swine. Two CBCTp protocols were evaluated that differed in sweep duration (3.3 vs 4.5 seconds) and the number of acquired projection images (166 vs 248). The mean ALP was measured within identical volumes of interest selected in the embolized and nonembolized regions of the perfusion map generated from each scan. Postembolization CBCTp values were also compared with CTp measurements.

Results

The 2 CBCTp protocols demonstrated high concordance correlation (0.90, P < 0.001). Both CBCTp protocols showed higher reproducibility than CTp in the nontarget lobe, with an intraclass correlation of 0.90 or greater for CBCTp and 0.83 for CTp (P < 0.001 for all correlations). The ALP in the embolized lobe was nearly zero and hence excluded for reproducibility. High concordance correlation was observed between the CTp and each CBCTp protocol, with the shorter CBCTp protocol reaching a concordance correlation of 0.75 and the longer achieving 0.87 (P < 0.001 for both correlations).

Conclusions

Dynamic blood flow measurement using an angiographic C-arm system is feasible and produces quantitative results comparable to CTp.
Breaking Down the Objective Structured Clinical Examination
Authors: Seto Teresa L. , Tabangin Meredith E. , Taylor Kathryn K. , Josyula Srirama , Vasquez Juan Carlos , Kamath-Rayne Beena D.
Published: March 2017

Introduction

Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation curriculum designed for low-resource settings. At the completion of the workshop, learners complete the following four assessments: a multiple-choice question (MCQ) test, bag-mask ventilation (BMV) checklist, and two objective structured clinical examinations (OSCEs). Objective structured clinical examinations are clinical performance assessments that evaluate learners' skills in simulated scenarios. The aims of this study were (1) to evaluate the validity and reliability of the OSCEs used in the HBB curriculum, (2) to conduct an itemized analysis of the OSCEs to identify specific deficits in knowledge and performance, and to identify areas of improvement for future versions of HBB.

Methods

Seventy physicians and nurses completed an HBB workshop conducted in Spanish at a Honduran community hospital. Validity and reliability were examined using an item analysis of item difficulty, discrimination, correlation, and internal consistency/reliability.

Results

Posttest scores were higher for all assessments. Most items on the OSCEs were of low difficulty and low discrimination. Item agreement was lowest for multistep items.

Conclusions

As summative and formative assessments of performance in simulated neonatal resuscitation, the HBB OSCEs are effective because most learners were able to perform the skills correctly after an HBB workshop. On the basis of our results, we recommend changes to future editions of HBB, including the following: simplification of multistep items to single tasks, use of a global rating scale, provision of additional scenarios, and specific instructions to raters on how to grade OSCEs and promote self-reflection to enhance debriefings/feedback. Further validation and study of the OSCEs in the second edition of HBB would enhance their quality and translation into clinical performance.
Simulation Faculty Development
Authors: Peterson Dawn Taylor , Watts Penni I. , Epps Chad A. , White Marjorie Lee
Published: March 2017

Summary Statement

Simulation faculty development has become a high priority for the past couple of years because simulation programs have rapidly expanded in health systems and universities worldwide. A formalized, structured model for developing quality facilitators of simulation is helpful to support and sustain this continued growth in the field of simulation. In this article, we present a tiered faculty development plan that has been implemented at a university in the United States and includes the essentials of faculty development. We discuss the rationale and benefits of a tiered faculty development program as well as describe our certification plan. The article concludes with lessons learned throughout the process of implementation.
Risk for Clostridium difficile Infection After Allogeneic Hematopoietic Cell Transplant Remains Elevated in the Postengraftment Period
Authors: Dubberke Erik R. , Reske Kimberly A. , Olsen Margaret A. , Bommarito Kerry M. , Seiler Sondra , Silveira Fernanda P. , Chiller Tom M. , DiPersio John , Fraser Victoria J.
Published: March 2017

Background

Clostridium difficile infection (CDI) is a frequent cause of diarrhea among allogeneic hematopoietic cell transplant (HCT) recipients. It is unknown whether risk factors for CDI vary by time posttransplant.

Methods

We performed a 3-year prospective cohort study of CDI in allogeneic HCT recipients. Participants were enrolled during their transplant hospitalizations. Clinical assessments were performed weekly during hospitalizations and for 12 weeks posttransplant, and monthly for 30 months thereafter. Data were collected through patient interviews and chart review, and included CDI diagnosis, demographics, transplant characteristics, medications, infections, and outcomes. CDI cases were included if they occurred within 1 year of HCT and were stratified by time from transplant. Multivariable logistic regression was used to determine risk factors for CDI.

Results

One hundred eighty-seven allogeneic HCT recipients were enrolled, including 63 (34%) patients who developed CDI. 38 (60%) CDI cases occurred during the preengraftment period (days 0-30 post-HCT) and 25 (40%) postengraftment (day >30). Lack of any preexisting comorbid disease was significantly associated with lower risk of CDI preengraftment (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.1-0.9). Relapsed underlying disease (OR, 6.7; 95% CI, 1.3-33.1), receipt of any high-risk antimicrobials (OR, 11.8; 95% CI, 2.9-47.8), and graft-versus-host disease (OR, 7.8; 95% CI, 2.0-30.2) were significant independent risk factors for CDI postengraftment.

Conclusions

A large portion of CDI cases occurred during the postengraftment period in allogeneic HCT recipients, suggesting that surveillance for CDI should continue beyond the transplant hospitalization and preengraftment period. Patients with continued high underlying severity of illness were at increased risk of CDI postengraftment.