bluuebunny/crossref_metadata_2025 huggingface dataset:
Prostanoid Release from Ex Vivo Perfused Canine Arteries and Veins: Effects of Prolonged Perfusion, Intermittent Perfusion, as well as Exposure to Exogenous Arachidonic Acid, Thrombin and Bradykinin
Authors: Brunkwall Jan S , Stanley James C , Kresowik Timothy F , Graham Linda M , Burkel William E , Bergqvist David
Published: June 2018

Regulation of prostanoid release from ex vivo perfused vessel segments is not fully understood. A series of perfusion experiments were performed with canine arteries and veins to define certain regulatory phenomena. Arteries were perfused with pulsatile flow of 90 ml/min at a pressure of 100 mmHg, and veins with nonpulsatile flow of 90 ml/min at a pressure of 7 mmHg. Segments were perfused with Hanks' balanced salt solution for five 15-min periods with the perfusate exchanged after each study period. With onset of perfusion, there was an initial burst of prostacyclin release to 127 ± 40 pg/mm2, declining to 32 ± 10 pg/mm2 after 60 minutes (p <0.005). If perfusion continued for 5.5 hours, there was a stable release period between 1 and 3 hours, followed by a very slow decline. At that time addition of arachidonic acid (AA) increased prostacyclin release six-fold (p <0.01). Vessels perfused for 1 hour and then rested for another hour, responded to reperfusion at the second onset of flow with a two-fold increase in prostacyclin release (p <0.01). Vessels perfused with thrombin, bradykinin or A A (either added to each perfusate or only to the last perfusate) exhibited greater prostacyclin release than did control segments. Release of thromboxane steadily declined with time in all parts of the study, and only increased with the addition of A A to the perfusate. These data indicate that vessel segments subjected to ex vivo perfusion do not maximally utilize enzyme systems responsible for prostanoid production, and after 1 hour perfusion have not depleted their phospholipids, and maintain functioning levels of phospholipase and cyclooxygenase activity. This perfusion model allows for the study of prostacyclin and thromboxane release from arteries and veins and their response to various drugs and other stimuli.
Quality of Life in Children with Epilepsy in Private and Public Tertiary Care Centers in India
Authors: Karnavat Purva , Hegde Anaita , Kulkarni Shilpa
Published: June 2018

Background Pediatric epilepsy is associated with various comorbidities. It is known that children with epilepsy have a compromised health-related quality of life (QOL) and may be affected across physical, psychological, social, and educational domains.

Aims and Objectives (1) To study QOL in children with epilepsy from private and public outpatient departments, (2) study various risk factors affecting QOL, and (3) compare risk factors between groups.

Methods Sample consisted of 400 and 201 children aged 5 to 18 years from private and public settings with epilepsy taking antiepileptic drugs (AEDs) for at least 6 months. Structured case record form was used to collect data on sociodemographic, clinical, and treatment parameters. QOL was measured by the Pediatric Quality of Life Inventory (PedsQL) questionnaire (in the local language). Adverse effects were monitored by Pediatric Epilepsy Side Effects Questionnaire (PESQ). Univariate regression analysis was performed on the data (p < 0.005).

Results Overall PedsQL score was 67.21 ± 29.391 and 78.66 ± 9.161 in private and public settings, respectively (p = 0.000). QOL was affected significantly by age of the child, educational and economic background of the caregivers, age at the onset of epilepsy, seizure frequency, duration of treatment, number of drugs, presence of comorbidities, intelligence quotient (IQ) levels of children, and PESQ score in both the groups. Total PESQ score was 18.63 ± 17.02 and 7.69 ± 10.646 in private and public settings, respectively (p = 0.000).

Conclusions Children with epilepsy have a compromised QOL. Risk factors relating to QOL are numerous. Educational and economic status of caregivers plays a significant role in awareness of the problem.
Deletion of Extra Domain A of Fibronectin Reduces Acute Myocardial Ischaemia/Reperfusion Injury in Hyperlipidaemic Mice by Limiting Thrombo-Inflammation
Authors: Chorawala Mehul , Prakash Prem , Doddapattar Prakash , Jain Manish , Dhanesha Nirav , Chauhan Anil
Published: June 2018

Background Fibronectin splicing variant containing extra domain A (Fn-EDA), which is an endogenous ligand for Toll-like receptor 4 (TLR4), is present in negligible amounts in the plasma of healthy humans, but markedly elevated in patients with co-morbid conditions including diabetes and hyperlipidaemia, which are risk factors for myocardial infarction (MI). Very little is known about the role of Fn-EDA in the pathophysiology of acute MI under these co-morbid conditions.

Materials and Methods We determined the role of Fn-EDA in myocardial ischaemia/reperfusion (I/R) injury in the hyperlipidaemic apolipoprotein E-deficient (ApoE−/−) mice. Infarct size, plasma cardiac troponin I (cTnI) levels, intravascular thrombosis (CD41-positive), neutrophil infiltration (Ly6 B.2-positive), neutrophil extracellular traps (citrullinated H3-positive) and myocyte apoptosis (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling-positive) were assessed in myocardial I/R injury model (1-hour ischaemia/23 hours of reperfusion).

Results Irrespective of gender, Fn-EDA−/−ApoE−/− mice exhibited smaller infarct size and decreased cTnI levels concomitant with reduced post-ischaemic intra-vascular thrombi, neutrophils influx, neutrophil extracellular traps and myocyte apoptosis (p < 0.05 vs. ApoE−/− mice). Genetic deletion of TLR4 attenuated myocardial I/R injury in ApoE−/− mice (p < 0.05 vs. ApoE−/− mice), but did not further reduce in Fn-EDA−/− ApoE−/− mice suggesting that Fn-EDA requires TLR4 to mediate myocardial I/R injury. Bone marrow transplantation experiments revealed that Fn-EDA exacerbates myocardial I/R injury through TLR4 expressed on the haematopoietic cells. Infusion of a specific inhibitor of Fn-EDA, 15 minutes post-reperfusion, into ApoE−/− mice attenuated myocardial I/R injury.

Conclusion Fn-EDA exacerbates TLR4-dependent myocardial I/R injury by promoting post-ischaemic thrombo-inflammatory response. Targeting Fn-EDA may reduce cardiac damage following coronary artery re-canalization after acute MI.
Mitochondrial Neurogastrointestinal Encephalomyopathy Disease in Three Siblings from Pakistan with a Novel Mutation
Authors: Durrani Sana , Chen Bee , Yakob Yusnita , Hian Lua , Afroze Bushra
Published: June 2018

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare multisystem autosomal recessive disorder. The disease is clinically heterogeneous with gastrointestinal symptoms of intestinal dysmotility and cachexia as well as neurological symptoms of ophthalmoplegia, neuropathy, sensorineural hearing impairment, and diffuse leukoencephalopathy being most prominent. MNGIE is caused by mutations in TYMP, a gene that encodes thymidine phosphorylase (TP)—a cytosolic enzyme. Mutations in TYMP lead to very low TP catalytic activity, resulting in dramatically increased thymidine and deoxyuridine in plasma. We describe the clinical, biochemical, and neuroimaging findings of three boys with MNGIE from a Pakistani family with a novel homozygous mutation, c.798_801dupCGCG p. (Ala268Argfs*?), in exon 7 of TYMP.
Analysis of cysteine protease inhibitor gene (BmCPI) promoter activity in silkworms using bac-to-bac baculovirus systems
Authors: Tian Sha , Zhang Ziyu , Zhang Renze , Liu Qing , Xu Shuping , Gong Jing , Hou Yong
Published: June 2018

A cysteine protease inhibitor of Bombyx mori (BmCPI) plays an important role in pupation, molting, and dissociation of tissues. The present study identified and analyzed the BmCPI promoter region to better understand its functional regulatory mechanisms. Eight promoter fragments of different lengths were analyzed using an improved Bac-to-Bac expression system. Luciferase activities were investigated both in BmE cells and larval organisms after infection with the Bac-to-Bac system, and similar changes in activity were observed in both models. Strong activity was detected in the longest promoter (2005 bp, −1969 to +36), and activity changed significantly with truncation of promoter length. An electrophoretic mobility shift assay showed that the promoter region from −32 to +6 bp played a critical role in activating the downstream gene promoter element, where some potential elements were also predicted by informatics tools. The findings offer a basic reference for the mechanism of transcriptional regulation of BmCPI.
Calciphylaxis in a patient without renal failure
Authors: Hesse Amber , Herber Andrew , Breunig Mike
Published: June 2018

Calciphylaxis is a rare disease that typically presents in patients with end-stage renal disease on dialysis or those who have received a renal transplant. Nonuremic calciphylaxis leads to ischemia and subsequent necrosis of subcutaneous tissue. Diseases associated with nonuremic calciphylaxis include primary hyperparathyroidism, connective tissue disease, malignancy, and alcoholic liver disease. Due to its high mortality, early identification and an aggressive multidisciplinary treatment approach is necessary to improve patient outcomes.
Using drug monitoring programs to optimize pain management for elective surgery patients
Authors: Lowry Robert
Published: June 2018

This article describes an innovative workflow that incorporates the prescription drug monitoring program (PDMP) into a suggested workflow for managing pain in elective surgery patients. Using the PDMP and working with the patient's pain management provider, clinicians can make sure that patients on chronic opioid therapy are identified before admission so that their care can be individualized, a plan developed to manage postoperative pain, and the patient can be transitioned seamlessly back to outpatient pain management.
Understanding posterior reversible encephalopathy syndrome
Authors: Fittro Kenneth , Dizon Roderick
Published: June 2018

Posterior reversible encephalopathy syndrome is a characteristic clinical-radiographic syndrome with diverse and multifactorial causes. Symptoms include headache, altered mental status, seizures, nausea and vomiting, and vision abnormalities. The syndrome is treated by lowering BP, administering anticonvulsant medications, correcting metabolic abnormalities, and removing offending agents. Secondary complications include ischemia, hemorrhage, and cerebral infarction.
Combined angiotensin receptor and neprilysin inhibition therapy for heart failure
Authors: Lu Becky N. , Davis Lindsay E.
Published: June 2018

The FDA has approved sacubitril/valsartan, an angiotensin-receptor-neprilysin inhibitor, for the treatment of chronic symptomatic heart failure (stage C) in patients with a left ventricular ejection fraction of 35% or less. This article discusses results from a major clinical trial, PARADIGM-HF, and the role of this new drug in heart failure treatment.
Effectiveness of NPs and PAs in managing diabetes and cardiovascular disease
Authors: Faza Nadeen N. , Akeroyd Julia M. , Ramsey David J. , Shah Tina , Nasir Khurram , Deswal Anita , Ballantyne Christie M. , Petersen Laura A. , Virani Salim S.
Published: June 2018

Background:

The effectiveness of cardiovascular disease (CVD) and diabetes care delivered by NPs and physician assistants (PAs), and resource use by these providers has not been studied.

Methods:

We performed regression analyses of patients with diabetes or CVD with a primary care visit in 130 Veterans Affairs (VA) facilities to assess the association between provider type and effectiveness or resource use.

Results:

The diabetes cohort consisted of 156,034 patients assigned to NPs and 54,590 assigned to PAs. Glycemic and BP control, statin use, number of primary or specialty care visits, lipid panels, and A1C results were comparable between groups. The CVD cohort consisted of 185,694 patients assigned to NPs and 66,217 assigned to PAs. BP control; use of beta-blockers, statins, or antiplatelets; primary or specialty care visits; lipid panels; and number of stress tests ordered were comparable between groups.

Conclusion:

Effectiveness of care and resource use among patients in both groups were comparable.
The Impact of Legalization of Medical and Recreational Marijuana
Authors: Mechcatie Elizabeth
Published: June 2018

Study looks at Colorado youth.
Reducing Fall Risk in Older Adults
Authors: Haddad Yara K. , Bergen Gwen , Luo Feijun
Published: June 2018

Evidence supports addressing medication management.
Ethics Champion Programs
Authors: Trotochaud Karen , Fitzgerald Heather , Knackstedt Angela D.
Published: June 2018

A promising practice to promote moral agency in health care settings.
Presenting Symptoms Independently Predict Mortality in Septic Shock: Importance of a Previously Unmeasured Confounder*
Authors: Filbin Michael R. , Lynch James , Gillingham Trent D. , Thorsen Jill E. , Pasakarnis Corey L. , Nepal Saurav , Matsushima Minoru , Rhee Chanu , Heldt Thomas , Reisner Andrew T.
Published: June 2018

Objectives:

Presenting symptoms in patients with sepsis may influence rapidity of diagnosis, time-to-antibiotics, and outcome. We tested the hypothesis that vague presenting symptoms are associated with delayed antibiotics and increased mortality. We further characterized individual presenting symptoms and their association with mortality.

Design:

Retrospective cohort study.

Setting:

Emergency department of large, urban, academic U.S. hospital.

Patients:

All adult patients with septic shock treated in the emergency department between April 2014 and March 2016.

Interventions:

None.

Measurements and Main Results:

Of 654 septic shock cases, 245 (37%) presented with vague symptoms. Time-to-antibiotics from first hypotension or elevated lactate was significantly longer for those with vague symptoms versus those with explicit symptoms of infection (1.6 vs 0.8 hr; p < 0.01), and in-hospital mortality was also substantially higher (34% vs 16%; p < 0.01). Patients with vague symptoms were older and sicker as evidenced by triage hypotension, Sequential Organ Failure Assessment score, initial serum lactate, and need for intubation. In multivariate analysis, vague symptoms were independently associated with mortality (adjusted odds ratio, 2.12; 95% CI, 1.32–3.40; p < 0.01), whereas time-to-antibiotics was not associated with mortality (adjusted odds ratio, 1.01; 95% CI, 0.94–1.08; p = 0.78). Of individual symptoms, only the absence of fever, chills, or rigors (odds ratio, 2.70; 95% CI, 1.63–4.47; p < 0.01) and presence of shortness of breath (odds ratio, 1.97; 95% CI, 1.23–3.15; p < 0.01) were independently associated with mortality.

Conclusions:

More than one third of patients with septic shock presented to the emergency department with vague symptoms that were not specific to infection. These patients had delayed antibiotic administration and higher risk of mortality even after controlling for demographics, illness acuity, and time-to-antibiotics in multivariate analysis. These findings suggest that the nature of presenting symptoms is an important component of sepsis clinical phenotyping and may be an important confounder in sepsis epidemiologic studies.
Acute Respiratory Failure in Pediatric Hematopoietic Cell Transplantation: A Multicenter Study*
Authors: Rowan Courtney M. , McArthur Jennifer , Hsing Deyin D. , Gertz Shira J. , Smith Lincoln S. , Loomis Ashley , Fitzgerald Julie C. , Nitu Mara E. , Moser Elizabeth A. S. , Duncan Christine N. , Mahadeo Kris M. , Moffet Jerelyn , Hall Mark W. , Pinos Emily L. , Tamburro Robert F. , Cheifetz Ira M.
Published: June 2018

Objectives:

Acute respiratory failure is common in pediatric hematopoietic cell transplant recipients and has a high mortality. However, respiratory prognostic markers have not been adequately evaluated for this population. Our objectives are to assess respiratory support strategies and indices of oxygenation and ventilation in pediatric allogeneic hematopoietic cell transplant patients receiving invasive mechanical ventilation and investigate how these strategies are associated with mortality.

Design:

Retrospective, multicenter investigation.

Setting:

Twelve U.S. pediatric centers.

Patients:

Pediatric allogeneic hematopoietic cell transplant recipients with respiratory failure.

Interventions:

None.

Measurements and Main Results:

Two-hundred twenty-two subjects were identified. PICU mortality was 60.4%. Nonsurvivors had higher peak oxygenation index (38.3 [21.3–57.6] vs 15.0 [7.0–30.7]; p < 0.0001) and oxygen saturation index (24.7 [13.8–38.7] vs 10.3 [4.6–21.6]; p < 0.0001), greater days with Fio
2 greater than or equal to 0.6 (2.4 [1.0–8.5] vs 0.8 [0.3–1.6]; p < 0.0001), and more days with oxygenation index greater than 18 (1.4 [0–6.0] vs 0 [0–0.3]; p < 0.0001) and oxygen saturation index greater than 11 (2.0 [0.5–8.8] vs 0 [0–1.0]; p < 0.0001). Nonsurvivors had higher maximum peak inspiratory pressures (36.0 cm H2O [32.0–41.0 cm H2O] vs 30.0 cm H2O [27.0–35.0 cm H2O]; p < 0.0001) and more days with peak inspiratory pressure greater than 31 cm H2O (1.0 d [0–4.0 d] vs 0 d [0–1.0 d]; p < 0.0001). Tidal volume per kilogram was not different between survivors and nonsurvivors.

Conclusions:

In this cohort of pediatric hematopoietic cell transplant recipients with respiratory failure in the PICU, impaired oxygenation and use of elevated ventilator pressures were common and associated with increased mortality.
Combination of cytokine-directed and anti-programmed cell death protein 1 therapy – a new attractive option in melanoma treatment?
Authors: Urbonas Vincas , Smailyte Giedre
Published: June 2018

The use of monoclonal antibodies against programmed cell death protein 1 (anti-PD-1) has markedly transformed the management of melanoma. However, only a minority of patients treated with anti-PD-1 therapy show a response to therapy and some of them develop immune-related adverse events that can be managed with steroids or anticytokine therapy. A recent study published in Nature Communications has reported that treatment with anti-PD-1 in a tumor necrosis factor-deficient environment may lead to higher response rates to immunotherapy by reducing tumor-infiltrating lymphocytes death, accumulating dendritic cells within cancer, and downregulating T-cell immunoglobulin and mucin-domain-containing-3 expression. This research provides the first proof-of-concept of combining immunotherapy and anti-tumour necrosis factor-α in the melanoma treatment.
Pharmacokinetics and Pharmacodynamics of Once-Daily Tacrolimus Compared With Twice-Daily Tacrolimus in the Early Stage After Living Donor Liver Transplantation
Authors: Iwasaki Mami , Yano Ikuko , Fukatsu Sachio , Hashi Sachiyo , Yamamoto Yuki , Sugimoto Mitsuhiro , Fukudo Masahide , Masuda Satohiro , Nakagawa Shunsaku , Yonezawa Atsushi , Kaido Toshimi , Uemoto Shinji , Matsubara Kazuo
Published: June 2018

Background:

This study investigates the pharmacokinetics and pharmacodynamics of tacrolimus using the once-daily (OD) formulation in the early stage after living donor liver transplantation (LDLT) in comparison with those using the twice-daily (TD) formulation.

Methods:

Nine patients undergoing primary LDLT and treated with the OD tacrolimus formulation were included. The trough blood concentration (C0) of tacrolimus was monitored every day for 3 weeks after LDLT. A time course study of the blood tacrolimus concentrations and calcineurin (CN) phosphatase activity in peripheral blood mononuclear cells was performed 3 weeks after LDLT. Pharmacokinetic and pharmacodynamic parameters were compared with previously reported data using the TD formulation.

Results:

The interindividual variability in the daily dose of tacrolimus was significantly larger in the OD formulation than in the TD formulation (P < 0.001). In the time course study, the tacrolimus blood concentrations at 4, 8, and 12 hours after administration and the area under the concentration–time curve from 0 to 24 hours (AUC0–24) in the OD group were significantly higher than in the TD group, although the C0 was equivalent. In addition, the C0 was not significantly correlated with the AUC0–24 in the OD formulation. The apparent clearance and the pharmacodynamic parameters examined were not significantly different between the OD and TD groups.

Conclusions:

The C0 monitoring of the OD formulation may not be optimal in patients at the early stage after LDLT because the C0 was not correlated with the AUC0–24. If clinicians target the same C0 using the OD and TD formulations, the exposure of tacrolimus can be higher in the OD formulation, and excessive immunosuppression should be noted. Particular attention should be paid to the patients in the early stage after LDLT in the use of the OD oral formulation of tacrolimus.
Descemet Stripping Automated Endothelial Keratoplasty With a Retention Suture: Description of a Technique for Patients at High Risk of Graft Detachment
Authors: Newman Lara R. , Rosenwasser George O. D.
Published: June 2018

Purpose:

To evaluate the utility, safety, and efficacy of a parallel or cloverleaf retention suture in Descemet stripping automated endothelial keratoplasty that does not penetrate donor tissue and can be removed at the slit lamp for patients at high risk of graft detachment.

Methods:

Data were prospectively collected over 9 years from patients who received a retention suture. Indications for use of a retention suture included difficulty with postoperative positioning, abnormal intraocular anatomy including glaucoma tube shunts, trabeculectomies, anterior chamber intraocular lens implants, previous vitrectomy, aniridia, and aphakia, or history of previous graft detachment.

Results:

Of 128 surgeries, 12 (9.4%) required additional intervention for graft reattachment (rebubble). Overall, 120 grafts (93.8%) remained clear and attached either after surgery with a retention suture or after rebubble procedures. Mean endothelial cell density at 1 year was 1840 cells/mm2, and mean endothelial cell density loss was 37.3%.

Conclusions:

A cloverleaf or parallel retention suture in conjunction with Descemet stripping automated endothelial keratoplasty seems to reduce the risk of detachment in high-risk patients, while maintaining adequate cell density and graft clarity at 1 year.
Medical Management of Glaucoma in Exfoliation Syndrome
Authors: Michalik Aleksandra Z. , Kaufman Paul L.
Published: June 2018

The treatment of glaucoma in exfoliation syndrome is similar to primary open-angle glaucoma. Frequently, exfoliation glaucoma (XFG) patients require early polytherapy with topical medications. Little emphasis has been placed on tailoring treatment specifically to XFG. New outflow enhancing agents with novel mechanisms of action, such as Rho Kinase inhibition, NO signaling (both recently FDA-approved drugs) and adenosine α1-receptor stimulation, act directly on the trabecular meshwork. These agents may prove to be effective in lowering intraocular pressure and perhaps altering the pathogenesis of XFG aid in the long-term management of this disease.
Utah Project on Exfoliation Syndrome (UPEXS): Insight Into Systemic Diseases Associated With Exfoliation Syndrome
Authors: Wirostko Barbara , Allingham Rand , Wong Jathine , Curtin Karen
Published: June 2018

The Utah Project on Exfoliation Syndrome (UPEXS) study was created to investigate the association between exfoliation syndrome (XFS) and systemic disorders or pathologies. The study utilizes the resources of the Utah Population Database, which is linked to the Utah genealogy, a compilation of large pedigrees extending back 3 to ≥11 generations, representing most families in the state. These family members medical and health records are linked to vital records and can be used effectively to identify familial clustering of disorders, like XFS, with comorbid diseases or health-related data. There is growing evidence that XFS patients have an increased risk for systemic disorders that may reflect the systemic tissue involvement of this disease. Epidemiologic studies of individuals with XFS have reported an increased risk of various pathologies that have abnormalities in extracellular matrix metabolism and repair. For this reason, the UPEXS has focused on disorders that involve the extracellular matrix in general and elastin specifically, such as pelvic organ prolapse, atrial fibrillation, inguinal hernias, and chronic obstructive pulmonary disease. In this paper we present our results from the analysis of pelvic organ prolapse, as well as, preliminary data for atrial fibrillation.
Reversible Cystoid Macular Edema Following Uneventful Microinvasive Kahook Dual Blade Goniotomy in a Pseudophakic Patient: A Case Report
Authors: Arnljots Thorsteinn S. , Economou Mario A.
Published: June 2018

Purpose:

The purpose of this study is to present a case of cystoid macular edema (CME) as a potential complication following uncomplicated stand-alone Kahook Dual Blade (KDB) goniotomy in a patient with pseudoexfoliative glaucoma.

Methods:

A 71-year-old woman who developed CME following KDB goniotomy subsequently treated with topical nonsteroidal anti-inflammatory (NSAID) therapy.

Results:

The CME successfully regressed following a standard course of topical NSAID therapy.

Conclusions:

This case report describes the first case of CME following uneventful stand-alone KDB goniotomy and highlights the importance of postoperative topical NSAID therapy with regard to both prophylaxis and treatment.
Longitudinal Changes in Bleb Height, Vascularity, and Conjunctival Microcysts After Trabeculectomy
Authors: Kumaran Arjunan , Husain Rahat , Htoon Hla M. , Aung Tin
Published: June 2018

Objective:

The objective of this article was to study longitudinal changes in bleb morphology (presence of microcysts and bleb height and vascularity) in subjects enrolled in the Singapore 5-Fluorouracil (5-FU) trabeculectomy study.

Study Design:

Retrospective subgroup analysis of a randomized controlled trial.

Materials and Methods:

Following trabeculectomy with either 5-FU or placebo, subjects were reviewed at day 1, weeks 1, 2, and 3, and months 3, 6, 9, 12, 16, 20, 24, 28, 32, and 36 and intraocular pressure (IOP), presence of microcysts and bleb height and vascularity graded and recorded. Statistical analyses were used to investigate baseline factors (demographics, eye drops use, IOP, treatment type, and comorbidities) that might account for long-term bleb changes and assess the influence of bleb morphology on mean, maximum, minimum, and variation in IOP following trabeculectomy.

Results:

One hundred fifty-nine (61.2%) subjects completed follow-up and 71 subjects (44.7%) received 5-FU. Proportion of subjects with microcysts increased posttrabeculectomy till weeks 3 and 6 in 5-FU and placebo-treated eyes, respectively, before decreasing. Presence of microcysts at day 1 and week 2 was associated with lower mean (P=0.027 to 0.033), maximum (P=0.040), and minimum IOP (P=0.010). Mean bleb height decreased over 36 months and at months 20 and 36 was associated with maximum (P=0.031) and minimum IOP (P=0.032), respectively. Mean bleb vascularity decreased till month 9 and remained fairly constant after.

Conclusions:

Microcysts seen early posttrabeculectomy is associated with lower IOP. Blebs reduce in height as they remodel and the relationship between bleb vascularity and IOP is complex.
Histopathologic Examination of Trabecular Meshwork Changes After Trabecular Bypass Stent Implantation
Authors: Capitena Young Cara E. , Ammar David A. , Seibold Leonard K. , Pantcheva Mina B. , SooHoo Jeffrey R. , Kahook Malik Y.
Published: June 2018

Purpose:

The purpose of this article was to evaluate how human trabecular meshwork (TM) is influenced by the chronic presence of trabecular bypass implants.

Methods:

Human TM samples were obtained intraoperatively from 3 patients who had previously undergone implantation of a trabecular micro-bypass stent. Trabecular strips were obtained with a goniotomy blade from areas directly adjacent to the stent after stent removal. Tissue samples were preserved, processed, cut, and stained according to standardized laboratory protocol. Harvested samples were compared with human cadaveric TM from an eye without ocular disease as well as TM obtained from a glaucomatous eye without prior stent placement.

Results:

In all samples, a significant increase in the amount of fibrous material compared with cellular material was noted when compared with controls. In a single strip, a basement membrane-like structure was noted, which correlated with a semiopaque membrane noted intraoperatively overlying the stent and adjacent TM. Further, TM cells were absent from areas adjacent to the stent implantation site with related collapse of collagen beams.

Conclusions:

These findings indicate that inflammatory and fibrotic changes are present surrounding the device with clear differences noted when compared with both healthy and glaucomatous controls. These changes suggest a possible etiology for device failure over time. Further studies are necessary to tease out differences in TM tissue reaction to various implant materials as well as to make comparisons to procedures that excise TM.
Epidemiology of Nephrostomy Tube–Related Urinary Tract Infections Among US Veterans
Authors: Maramara Bennadette , Lobo Zeena , Psevdos George
Published: June 2018

Objective

The aim of this study was to review the incidence of asymptomatic bacteriuria (AB) and pyelonephritis after placement of percutaneous nephrostomy tube (NT) in our patients.

Methods

We retrospectively reviewed patients who underwent NT placement from January 1, 2005, to December 31, 2015, at Northport Veterans Affairs Medical Center. We identified patients with NT-associated AB and NT-related pyelonephritis within 60 days following NT placement. We analyzed demographic data, medical history, and microbiological data.

Results

Seventy-one patients underwent NT placement. Indications for NT placement included intrinsic obstruction (34%) and extrinsic obstruction (66%). Prostate and urinary bladder cancers were the most common causes of extrinsic obstruction. Twenty percent (14/71) had pyelonephritis, and 24% (17/71) had AB. All patients were men, and median age was 73 years. In the pyelonephritis group, Pseudomonas aeruginosa (36%) and Enterococcus faecalis (35%) were most commonly isolated. Three cases of extended-spectrum β-lactamase–producing Enterobacteriaceae and 2 multiple drug–resistant gram-negative organisms were identified. In the AB group, P. aeruginosa (23%), Enterococcus species (23%), and coagulase-negative staphylococci (23%) were most common. Only 1 case of extended-spectrum β-lactamase organism was identified. Comparing the 2 groups, there was no difference in age (P = 0358), diabetes mellitus (P = 0.441), chronic kidney disease (P = 0.6705), and prior urinary tract infection (P = 1.000). Presence of ureteral stent was seen more in AB (P = 0.057).

Conclusions

Nephrostomy tube placement was associated with pyelonephritis and AB in 44% of cases overall. Pseudomonas and Enterococcus species were the most common pathogens. Isolation of resistant organisms was mostly observed in the pyelonephritis group.
Outpatient High-dose Methotrexate for Osteosarcoma: It’s Safe and Feasible, If You Want It
Authors: Hendershot Eleanor , Volpe Jocelyn , Taylor Tracey , Nicksy Darcy , Mills Denise , Ramachandran Nivetha , Shaikh Furqan , Riss Vera , Grant Ronald , Gupta Abha A.
Published: June 2018

Background:

High-dose methotrexate (HD MTX) is usually administered as an inpatient to those with osteosarcoma. We prospectively tested the safety and feasibility of administering HD MTX in the ambulatory setting.

Materials and Methods:

In this single arm prospective observational study, eligible patients had previously completed 2 courses of HD MTX as an inpatient. On study, patients received MTX in hospital, discharged home and returned for daily assessment. Criteria to determine safety and feasibility included: (1) parent compliance with home instructions, (2) pump functioning/failure, and/or (3) admission for toxicity/noncompliance. Outpatient therapy was deemed feasible if <25% courses resulted in study event. Patient satisfaction was assessed.

Results:

Six patients (median age, 13.5 y) with extremity osteosarcoma completed 35 courses of MTX. There were no study events—no hospitalizations or pump failures and all parents were compliant. The Data and Safety Committee concluded that with zero events in 35 courses, it was unlikely for outpatient MTX to be infeasible; study was thus terminated early. Participants reported value to stay out of hospital, permitted life to feel “more normal”; however, burden of daily commute to hospital was cited.

Conclusions:

The delivery of HD MTX is safe and feasible in patients with osteosarcoma.
Incidence and Clinical Features of Panic Related Posttraumatic Stress
Authors: Shasha Tomer , Dolgin Michael J. , Tzur Bitan Dana , Somer Eli
Published: June 2018

The current study assessed the incidence and associated features of posttraumatic stress after the experience of panic. One hundred seventy-eight participants meeting diagnostic criteria for panic attacks (PAs) were assessed using standardized measures of posttraumatic symptoms and posttraumatic stress disorder (PTSD) in specific reference to their experience of panic. Sixty-three (35.4%) participants scored above the cutoff for PTSD in reference to the worst PA they had experienced. Adjusted means for the four PTSD symptom clusters indicate that panic-related posttraumatic symptoms are, on average, experienced “moderately” to “quite a bit.” Panic-related posttraumatic symptoms and PTSD were best predicted by specific features of the panic experience itself, including subjective levels of distress, fear of losing control, chest pain, agoraphobia, and number of PAs experienced. These findings are discussed in terms of the diagnostic, prognostic, and treatment implications for a subset of individuals presenting with panic who may also have panic-related PTSD.
Before, During, and After Self Injury
Authors: Stacy Stephanie E. , Bandel Shelby L. , Lear Mary K. , Pepper Carolyn M.
Published: June 2018

Little is currently known about the repetitive behaviors that take place before, during, and after nonsuicidal self-injury (NSSI). These practice patterns surrounding repetitive self-injury may be part of a habituation process in NSSI. Congruent with the opponent process theory (OPT), the mechanisms through which NSSI is reinforced may include preparation, engagement, and follow-up practice patterns to achieve the desired effect. This may result in increased habituation leading to a change in method and resulting NSSI severity. College students with a history of NSSI (N= 80) completed questionnaires, including an instrument to assess practice patterns around NSSI. High levels of NSSI practice patterns were positively related to various NSSI characteristics and clinical correlates, suggesting higher levels of NSSI severity. Further, NSSI versatility partially explained the relationship between NSSI practice patterns and habituation. Consistent with OPT, practice patterns associated with repetitive NSSI may lead an individual to change methods, fostering habituation to self-injury.
Treatment Within an Adult Mental Health Day Program
Authors: Taube-Schiff Marlene , Mehak Adrienne , Ferreira Natalie , Kalim Anastasia , Ungar Thomas , Mills Jennifer S.
Published: June 2018

Day hospital programs provide stabilization, medication optimization, and therapeutic intervention for individuals experiencing acute psychiatric illnesses. The current study investigated treatment impact within an adult day hospital setting in a large Canadian general acute care hospital. A total of 196 patients were sampled in a naturalistic design. Participants filled out measures at admission and discharge, including the Patient Health Questionnaire–9, the Generalized Anxiety Disorder–7, the World Health Organization Disability Assessment Schedule 2.0, the Behavior and Symptom Identification Scale–24, the Quality of Life Enjoyment and Satisfaction Questionnaire–Short Form, and the Emotion Regulation Questionnaire (ERQ). Paired sample t-tests revealed significant improvements from admission to discharge on all but one measure, the ERQ Suppression scale. Overall, patients improved during treatment in terms of psychopathology and disability, and perceived quality of life. When the emotion regulation strategy of reappraisal was increasingly used over the duration of the treatment, improvements were observed in symptomatology, quality of life, and enhanced functionality. This article highlights the impact of therapeutic interventions received within a Canadian day hospital program.
Cannabis Use, Psychotic Like Experiences and Aberrant Salience in a Sample of Belgian Students
Authors: Bernardini Francesco , Gobbicchi Chiara , Attademo Luigi , Puchalski Severin , Trezzi Riccardo , Moretti Patrizia , Tortorella Alfonso , Loas Gwenolé
Published: June 2018

The main goal of our study was to investigate the association between psychotic-like experiences, aberrant salience, and cannabis use in a nonclinical sample of Belgian students. The participants were asked to complete a self-report questionnaire on cannabis use. The Community Assessment of Psychic Experiences and the Aberrant Salience Inventory were used to assess psychotic-like experiences and aberrant salience. The final sample was of 257 students. Cannabis users showed significantly higher Aberrant Salience Inventory score and, concerning the Community Assessment of Psychic Experiences, higher total, positive, and negative dimension scores. Years of cannabis use and frequency of use showed a positive correlation with Aberrant Salience Inventory score. Our results support the evidence that cannabis use is associated with an increased rate of psychotic experiences in individuals without a clinical form of psychosis. Future studies are required to better investigate the meaning of the association between cannabis use, psychotic-like experiences, and aberrant salience.
Correlates of Rectal Douching Practices Among Men Who Have Sex With Men in Kenya
Authors: Saleska Jessica Londeree , Turner Abigail Norris , Syvertsen Jennifer , Nakhumwa Jesse , Soo Leonard , Ohaga Spala , Agot Kawango
Published: June 2018

Background

Among men who have sex with men (MSM), rectal douching (RD) has been associated with increased prevalence of human immunodeficiency virus and other sexually transmitted infections. Substances commonly used for RD, especially water-based solutions, could disrupt the rectal epithelium and increase susceptibility to infection. The few existing reports on RD among MSM are primarily in middle- and high-income settings, and to date, no study has focused on RD among MSM in Africa.

Methods

We conducted a secondary data analysis of programmatic data from key population service centers in western Kenya. Data were extracted from records of clients who identified as MSM and accessed services between January 1, 2014, and September 1, 2016. We compared demographic and behavioral characteristics of men who did and did not practice RD. Logistic regression assessed associations with RD.

Results

Of the 202 MSM in this analysis, 63% engaged in RD. All who engaged in RD used water-based substances. Those who engaged in receptive anal intercourse in the last 3 months were more likely to report RD (odds ratio, 3.19; 95% confidence interval, 1.67–6.07). Among MSM who engaged in sex work, those who practiced RD reported more regular clients per week (2.8 clients vs. 1.3 clients, P = 0.01). Rectal douching practices did not vary by other sexual risk practices.

Conclusions

Rectal douching is common in this population of Kenyan MSM, especially among those who have recently engaged in receptive anal intercourse, suggesting that a rectal douche that delivers microbicides could be a potential intervention to reduce human immunodeficiency virus/sexually transmitted infection within this population.
Factors Associated With Mortality in Children Who Successfully Wean From Extracorporeal Membrane Oxygenation*
Authors: Howard Taylor S. , Kalish Brian T. , Rajagopal Satish K. , Williams Kathryn , Zalieckas Jill , Thiagarajan Ravi R. , Alexander Peta M. A.
Published: June 2018

Objectives:

Extracorporeal membrane oxygenation is an established therapy for cardiac and respiratory failure unresponsive to usual care. Extracorporeal membrane oxygenation mortality remains high, with ongoing risk of death even after successful decannulation. We describe occurrence and factors associated with mortality in children weaned from extracorporeal membrane oxygenation.

Design:

Retrospective cohort study.

Setting:

Two hundred five extracorporeal membrane oxygenation centers reporting to the Extracorporeal Life Support Organization.

Subjects:

Eleven thousand ninety-six patients, less than 18 years, supported with extracorporeal membrane oxygenation during 2007–2013, who achieved organ recovery before decannulation.

Interventions:

None.

Measurements and Main Results:

Primary outcome was hospital mortality less than or equal to 30 days post extracorporeal membrane oxygenation decannulation. Among 11,096 patients, indication for extracorporeal membrane oxygenation cannulation was respiratory (6,206; 56%), cardiac (3,663; 33%), or cardiac arrest (extracorporeal cardiopulmonary resuscitation, 1,227; 11%); the majority were supported with venoarterial extracorporeal membrane oxygenation at some stage in their course (8,576 patients; 77%). Mortality was 13%. Factors associated with mortality included younger age (all < 1 yr categories compared with older, p < 0.05), lower weight among neonates (≤ 3 vs > 3 kg; p < 0.001), mode of extracorporeal membrane oxygenation support (venoarterial extracorporeal membrane oxygenation compared with venovenous extracorporeal membrane oxygenation, p < 0.001), longer admission to extracorporeal membrane oxygenation cannulation time (≥ 28 vs < 28 hr; p < 0.001), cardiac and extracorporeal cardiopulmonary resuscitation compared with respiratory extracorporeal membrane oxygenation (both p < 0.001), extracorporeal membrane oxygenation duration greater than or equal to 135 hours (p < 0.001), preextracorporeal membrane oxygenation hypoxemia (Po
2 ≤ 43 vs > 43 mm Hg; p < 0.001), preextracorporeal membrane oxygenation acidemia (p < 0.001), and extracorporeal membrane oxygenation complications, particularly cerebral or renal (both p < 0.001).

Conclusions:

Despite extracorporeal membrane oxygenation decannulation for organ recovery, 13% of patients die in hospital. Mortality is associated with patient factors, preextracorporeal membrane oxygenation illness severity, and extracorporeal membrane oxygenation management. Evidence-based strategies to optimize readiness for extracorporeal membrane oxygenation decannulation and postextracorporeal membrane oxygenation decannulation care are needed.
Chikungunya in Children
Authors: Ward Caleb E. , Chapman Jennifer I.
Published: June 2018

Chikungunya (CHIKV) is an emerging arboviral infection with recent spikes in transmission in the Americas. Chikungunya is most commonly transmitted by mosquitos, specifically Aedes aegypti and Aedes albopictus. These mosquitoes are found throughout many parts of the United States. The classic tetrad of symptoms for CHIKV is fever, symmetric polyarthralgia, maculopapular rash, and nonpurulent conjunctivitis. Although the majority (3 of 4) of infected people will be symptomatic, the viral illness generally runs a benign course. Nevertheless, when compared with infected adults, children more commonly have neurological and dermatological symptoms and are less likely to have arthralgia. The key differential diagnosis to consider is dengue, which has greater immediate morbidity and which can cause coinfection. Local health departments facilitate diagnostic testing, using either RNA polymerase chain reaction or antibody screening based on the timing of presentation. Management is supportive. The purpose of this review article is to provide readers basic knowledge regarding the microbiology, epidemiology, risk factors for transmission, and typical clinical presentation of CHIKV. A practical approach to diagnosis and management of infected children is provided.
Bridging the Gap: A 20-Year Experience with Vein Grafts for Free Flap Reconstruction. The Odds for Success
Authors: Inbal Amir , Silva Amanda K. , Humphries Laura S. , Teven Chad M. , Gottlieb Lawrence J.
Published: June 2018

Background:

Successful free tissue transfer requires tension-free microvascular anastomosis. Vein grafts are used when this cannot be obtained, which increases microsurgical complexity and the chance of vessel thrombosis. Previous studies on vein grafts are limited to low numbers and selected techniques, making it difficult to draw conclusions.

Methods:

A retrospective chart review was performed for all patients who underwent vein grafts in free flap reconstruction from 1995 to 2015. Information on patient and flap characteristics, returns to the operating room, and flap loss was analyzed.

Results:

Seventy-two free flap reconstructions requiring 122 vein grafts were performed in the genitourinary/perineal (49 percent) and head and neck (38 percent) regions. The majority were performed in the initial operation (82 percent) and, of those, the majority were planned (71 percent). The most common vein graft types used were transposition arteriovenous loops (57 percent) and interpositions (26 percent). Of the initial cases, 22 percent returned to the operating room, resulting in a 7 percent total flap loss rate and a 7 percent partial flap loss rate. On univariate analysis, graft timing/planning, gap type, vein graft type, and reconstruction location were significantly associated with take-backs and flap loss. However, gap type and location seem to be strongly associated with graft timing/planning and vein graft type. Graft type and planning/timing do not have as strong a relationship and seem to independently relate to flap loss.

Conclusions:

Vein grafts are more successful when planned and when performing transpositions and arteriovenous loops over interpositions. These graft types should be considered over interpositions when possible.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Validity of 7-Joint Versus Simplified 12-Joint Ultrasonography Scoring Systems in Assessment of Rheumatoid Arthritis Activity
Authors: El-Gohary Rasmia M. , Ahmed Mahmoud Ayman Abdel-Monem , Khalil Adham , El-Gendy Hala , Gado Kamel Heshmat
Published: June 2018

Introduction

Musculoskeletal ultrasonography (US) is an objective tool for the evaluation of disease activity in rheumatoid arthritis (RA) patients. There is no consensus on the exact number of joints that should be examined. Examination of reduced joint count is more practical than the comprehensive one.

Objectives

This is a cross-sectional study investigated the validity of a 7-joint US score (US7) in assessment of joint inflammation in RA patients compared with a simplified 12-joint US score (US12) and correlated both to composite disease activity indices.

Methods

The activity status of 50 RA patients was assessed clinically and ultrasonographically. The disease activity was calculated using 3 composite indices. Ultrasonography was performed by 1 blinded rheumatologist, using power Doppler (PD) and gray-scale (GS) US examination. The US7 and simplified US12 were performed as originally described. However, the GS synovitis and PD synovitis of US12 were computed in 2 separate scores instead of 1. Two sum US7 scores were added, sum (GS) US7 and sum (PD) US7 after summating synovitis and tenosynovitis scores. Ultrasonography interobserver/intraobserver reliability was evaluated on 40 stored images.

Results

Correlation coefficient between the different ultrasonographic scores showed no difference. The GS scores showed no correlation with disease activity parameters; however, the PD scores did. The sum (PD) US7 was the only score that showed significant correlation with the 3 different composite disease indices.

Conclusions

All studied US scores proved valid in assessment of disease activity status in RA. This is in favor of using the less-time-consuming US7 scores. The strongest correlation found with sum (PD) US7 confirmed the importance of incorporating the tendon in the disease activity assessment.