bluuebunny/crossref_metadata_2025 huggingface dataset:
SEVA 3.0: an update of the Standard European Vector Architecture for enabling portability of genetic constructs among diverse bacterial hosts
Authors: Martínez-García Esteban , Goñi-Moreno Angel , Bartley Bryan , McLaughlin James , Sánchez-Sampedro Lucas , Pascual del Pozo Héctor , Prieto Hernández Clara , Marletta Ada Serena , De Lucrezia Davide , Sánchez-Fernández Guzmán , Fraile Sofía , de Lorenzo Víctor
Published: October 2019

The Standard European Vector Architecture 3.0 database (SEVA-DB 3.0, http://seva.cnb.csic.es) is the update of the platform launched in 2013 both as a web-based resource and as a material repository of formatted genetic tools (mostly plasmids) for analysis, construction and deployment of complex bacterial phenotypes. The period between the first version of SEVA-DB and the present time has witnessed several technical, computational and conceptual advances in genetic/genomic engineering of prokaryotes that have enabled upgrading of the utilities of the updated database. Novelties include not only a more user-friendly web interface and many more plasmid vectors, but also new links of the plasmids to advanced bioinformatic tools. These provide an intuitive visualization of the constructs at stake and a range of virtual manipulations of DNA segments that were not possible before. Finally, the list of canonical SEVA plasmids is available in machine-readable SBOL (Synthetic Biology Open Language) format. This ensures interoperability with other platforms and affords simulations of their behaviour under different in vivo conditions. We argue that the SEVA-DB will remain a useful resource for extending Synthetic Biology approaches towards non-standard bacterial species as well as genetically programming new prokaryotic chassis for a suite of fundamental and biotechnological endeavours.
The neXtProt knowledgebase in 2020: data, tools and usability improvements
Authors: Zahn-Zabal Monique , Michel Pierre-André , Gateau Alain , Nikitin Frédéric , Schaeffer Mathieu , Audot Estelle , Gaudet Pascale , Duek Paula D , Teixeira Daniel , Rech de Laval Valentine , Samarasinghe Kasun , Bairoch Amos , Lane Lydie
Published: October 2019

The neXtProt knowledgebase (https://www.nextprot.org) is an integrative resource providing both data on human protein and the tools to explore these. In order to provide comprehensive and up-to-date data, we evaluate and add new data sets. We describe the incorporation of three new data sets that provide expression, function, protein-protein binary interaction, post-translational modifications (PTM) and variant information. New SPARQL query examples illustrating uses of the new data were added. neXtProt has continued to develop tools for proteomics. We have improved the peptide uniqueness checker and have implemented a new protein digestion tool. Together, these tools make it possible to determine which proteases can be used to identify trypsin-resistant proteins by mass spectrometry. In terms of usability, we have finished revamping our web interface and completely rewritten our API. Our SPARQL endpoint now supports federated queries. All the neXtProt data are available via our user interface, API, SPARQL endpoint and FTP site, including the new PEFF 1.0 format files. Finally, the data on our FTP site is now CC BY 4.0 to promote its reuse.
Generation of diffuse intrinsic pontine glioma mouse models by brainstem targeted in utero electroporation
Authors: Patel Smruti K , Hartley Rachel M , Wei Xin , Furnish Robin , Escobar-Riquelme Fernanda , Bear Heather , Choi Kwangmin , Fuller Christine , Phoenix Timothy N
Published: October 2019

Background

Diffuse intrinsic pontine gliomas (DIPGs) are highly lethal childhood brain tumors. Their unique genetic makeup, pathological heterogeneity, and brainstem location all present challenges to treatment. Developing mouse models that accurately reflect each of these distinct features will be critical to advance our understanding of DIPG development, progression, and therapeutic resistance. The aim of this study was to generate new mouse models of DIPG, and characterize the role of specific oncogenic combinations in DIPG pathogenesis.

Methods

We used in utero electroporation (IUE) to transfect neural stem cells in the developing brainstem with PiggyBac DNA transposon plasmids. Combinations of PDGFB, PdgfraD842V, or PdgfraWT, combined with dominant negative Trp53 (DNp53) and H3.3K27M expression induced fully penetrant brainstem gliomas.

Results

IUE enabled the targeted transfection of brainstem neural stem cells. PDGFB + DNp53 + H3.3K27M induced the rapid development of grade-IV gliomas. PdgfraD842V + DNp53 + H3.3K27M produced slower forming grade-III gliomas. PdgfraWT + DNp53 + H3.3K27M produced high and low-grade gliomas with extended latencies. PDGFB, PdgfraD842V, and PdgfraWT DIPG models display unique histopathological and molecular features found in human DIPGs.

Conclusion

Brainstem targeted in utero electroporation provides a rapid and flexible system to generate diverse DIPG mouse models. Using IUE to investigate mutation and pathohistological heterogeneity of DIPG will provide a valuable tool for future genetic and preclinical studies.
Back Pain in a 23-Year-Old Male With X-Linked Chronic Granulomatous Disease
Authors: Sabo Michelle C , Blain Michela , McCulloch Denise , Glasgow Heather L , Sengupta Dhruba J , Le Thang , Cookson Brad T , Pottinger Paul S , Liles W Conrad , Graham Susan M
Published: October 2019

Patients with chronic granulomatous disease are at increased risk for invasive aspergillosis. Cryptic Aspergillus species are being increasingly recognized as distinct causes of infection in this population. In this study, we describe the first case of Aspergillus udagawae vertebral osteomyelitis in a patient with X-linked chronic granulomatous disease.
5G and intelligence medicine—how the next generation of wireless technology will reconstruct healthcare?
Authors: Li Dong
Published: October 2019

Despite intensive efforts, there are still enormous challenges in provision of healthcare services to the increasing aging population. Recent observations have raised concerns regarding the soaring costs of healthcare, the imbalance of medical resources, inefficient healthcare system administration, and inconvenient medical experiences. However, cutting-edge technologies are being developed to meet these challenges, including, but not limited to, Internet of Things (IoT), big data, artificial intelligence, and 5G wireless transmission technology to improve the patient experience and healthcare service quality, while cutting the total cost attributable to healthcare. This is not an unrealistic fantasy, as these emerging technologies are beginning to impact and reconstruct healthcare in subtle ways. Although the technologies mentioned above are integrated, in this review we take a brief look at cases focusing on the application of 5G wireless transmission technology in healthcare. We also highlight the potential pitfalls to availability of 5G technologies.
Do Decision Aids Benefit Patients with Chronic Musculoskeletal Pain? A Systematic Review
Authors: Bowen Emily , Nayfe Rabih , Milburn Nathaniel , Mayo Helen , Reid M C , Fraenkel Liana , Weiner Debra , Halm Ethan A , Makris Una E
Published: October 2019

Objective

To review the effect of patient decision aids for adults making treatment decisions regarding the management of chronic musculoskeletal pain.

Methods

We performed a systematic review of randomized controlled trials of adults using patient decision aids to make treatment decisions for chronic musculoskeletal pain in the outpatient setting.

Results

Of 477 records screened, 17 met the inclusion criteria. Chronic musculoskeletal pain conditions included osteoarthritis of the hip, knee, or trapeziometacarpal joint and back pain. Thirteen studies evaluated the use of a decision aid for deciding between surgical and nonsurgical management. The remaining four studies evaluated decision aids for nonsurgical treatment options. Outcomes included decision quality, pain, function, and surgery utilization. The effects of decision aids on decision-making outcomes were mixed. Comparing decision aids with usual care, all five studies that examined knowledge scores found improvement in patient knowledge. None of the four studies that evaluated satisfaction with the decision-making process found a difference with use of a decision aid. There was limited and inconsistent data on other decision-related outcomes. Of the eight studies that evaluated surgery utilization, seven found no difference in surgery rates with use of a decision aid. Five studies made comparisons between different types of decision aids, and there was no clearly superior format.

Conclusions

Decision aids may improve patients’ knowledge about treatment options for chronic musculoskeletal pain but largely did not impact other outcomes. Future efforts should focus on improving the effectiveness of decision aids and incorporating nonpharmacologic and nonsurgical management options.
Changes in tobacco use patterns and motivation to quit related to the new smoke-free legislation in the Czech Republic
Authors: Kulhánek Adam , Lukavská Kateřina , Švancarová Iveta , Fidesová Hana , Gabrhelík Roman
Published: October 2019

Background

Smoke-free policy belongs to key public health instruments to promote health in populations. In 2017, new comprehensive smoke-free law prohibiting smoking in indoor public places was implemented. We aimed to measure changes in tobacco smoking patterns and changes in motivation to quit in adult smokers prior to and after the new smoke-free legislation came into force.

Methods

We conducted a prospective cohort study prior to and post the implementation of Act No. 65/2017 Coll. Self-reported questionnaires were administered to 131 adult smokers by trained nurses in general practitioner offices in Prague. We analysed changes in cigarette consumption per day; ratio of cigarettes smoked in pub, street, work and home; and motivation to quit using regression modelling.

Results

We found a statistically significant decrease in the daily consumption of cigarettes (an average of 1.7 cigarettes per day, P < 0.001, d = 0.34). Smoking in indoor public spaces decreased to almost zero, while tobacco consumption in outdoor public spaces (such as streets and squares) increased by nearly 20%. We observed statistically significant increase of motivation to quit smoking (P = 0.021, d = 0.21).

Conclusion

The study brings valuable indication of the desired public health impact related to key legislative change in the Czech Republic.
Epidemiological and clinical characteristics of patients with malaria admitted to a hospital in Mérida, Venezuela
Authors: Gabaldón-Figueira Juan C , Salmen Siham , Silva Nubia , Mancilla Betania , Vielma Silvana
Published: October 2019

Background

Malaria is expanding rapidly across Venezuela, spreading outwards from traditional high transmission regions in the southeast of the country, but the lack of official data make it impossible to understand the reasons for this expansion and to estimate its real magnitude. This study aims to evaluate the epidemiological characteristics driving the re-emergence of malaria in Mérida, a state in the west of Venezuela, where no cases have been reported since 2003, and also to study the clinical presentation of the disease in patients presenting with malaria.

Methods

Thirty-three patients who presented with anemia and fever and with a microscopic diagnosis of malaria were examined and interviewed. Data were collected in standardized forms and analyzed. One-way analysis of variance was used to study differences among patients infected with different parasites.

Results

Twenty-two patients were from the Zulia state and eleven were from the Mérida state, mainly from the lowlands south of Lake Maracaibo. Six of these patients traveled to the Bolívar state between 2017 and 2019. Thirteen patients presented with the WHO criteria for severe malaria.

Conclusions:

Domestic migration to the southeast of Venezuela may have played an important role in the expansion of malaria in previously existing endemic areas of transmission and also in the increase in the number of cases of severe malaria.
Introgression obscures lineage boundaries and phylogeographic history in the western banded gecko, Coleonyx variegatus (Squamata: Eublepharidae)
Authors: Leavitt Dean H , Hollingsworth Bradford D , Fisher Robert N , Reeder Tod W
Published: October 2019

The geomorphological formation of the Baja California peninsula and the Gulf of California is a principal driver of diversification for the reptiles of North America’s warm deserts. The western banded gecko, Coleonyx variegatus, is distributed throughout the Mojave, Sonoran and Peninsular deserts. In this study we use multilocus sequence data to address deep phylogeographic structure within C. variegatus. Analyses of mtDNA data recover six divergent clades throughout the range of C. variegatus. Topology of the mtDNA gene tree suggests separate origins of peninsular populations with an older lineage in the south and a younger one in the north. In contrast, analyses of multilocus nuclear data provide support for four lineages, corresponding to the subspecies C. v. abbotti, C. v. peninsularis, C. v. sonoriensis and C. v. variegatus. Phylogenetic analyses of the nuclear data recover C. v. abbotti and C. v. peninsularis as a clade, indicating a single origin of the peninsular populations. Discordance between the nuclear and mtDNA data is largely the result of repeated episodes of mtDNA introgression that have obscured both lineage boundaries and biogeographic history. Dating analyses of the combined nuclear and mtDNA data suggest that the peninsular clade diverged from the continental group in the Late Miocene.
Pulmonary rehabilitation: promising nonpharmacological approach for treating asthma?
Authors: Zampogna Elisabetta , Spanevello Antonio , Visca Dina
Published: October 2019

Purpose of review

Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation with a history of respiratory symptoms that vary over time and in intensity, together with variable expiratory airflow limitation. The goal of asthma treatment is to reach symptoms control, reduction in future risk and improvement in quality of life (QoL). Guideline-based pharmacologic therapies and the effect of inhaled steroids and bronchodilators have been widely studied over the past decades. We provide an overview of the available evidence on pulmonary rehabilitation as a nonpharmacologic therapy in asthmatic patients.

Recent findings

Recently, some studies have highlighted the promising role of nonpharmacologic therapies in asthma, such as pulmonary rehabilitation demonstrating that a pulmonary rehabilitation programme consisting of exercise training, breathing retraining, educational and psychological support, improve exercise capacity, asthma control and QoL and reduce dyspnea, anxiety, depression and bronchial inflammation at any step of the disease.

Pulmonary rehabilitation shows positive results on exercise tolerance, respiratory symptoms and QoL in asthmatic patients at any steps of the diseases. However, additional information is required to better characterize rehabilitation programmes in order to improve clinical care in asthma.
Does Intramedullary Nail Fixation of the Tibia Pose the Same Risk of Pulmonary Complications as Intramedullary Nail Fixation of the Femur? A Propensity Score–Matched Analysis
Authors: Wheatley Benjamin M. , O'Hara Nathan N. , Coale Max , O'Toole Robert V.
Published: October 2019

Objectives:

To compare duration of mechanical ventilation and pulmonary outcomes in patients treated with intramedullary nail (IMN) fixation of the tibia versus the femur.

Design:

Retrospective cohort study.

Setting:

Level I trauma center.

Patients:

One thousand thirty patients were categorized based on treatment: those treated with IMN of the tibia (n = 515) and those treated with IMN of the femur (n = 515).

Intervention:

IMN fixation of tibial and femoral fractures.

Outcome Measurements:

The primary outcome was duration of mechanical ventilation. Secondary outcomes included length of intensive care unit (ICU) stay and risk of tracheostomy, pulmonary embolism (PE), acute respiratory distress syndrome (ARDS), and mortality.

Results:

In an unadjusted analysis, femoral fractures were associated with increase in ventilator days (mean difference, 1.4; P < 0.001), ICU days (mean difference, 1.8; P < 0.001), and odds of tracheostomy (odds ratio, 1.7; P < 0.01). No difference was shown in likelihood of PE, ARDS, or mortality (P > 0.2). Propensity score–matched estimates showed no differences in any measured outcomes (P > 0.40). In patients with Injury Severity Scores >17, we found no difference in length of ventilator or ICU days or likelihood of tracheostomy, PE, ARDS, or mortality in the unadjusted (P > 0.2) or propensity score–matched estimates (P > 0.3).

Conclusions:

These findings suggest that IMN fixation of the tibia is associated with duration of mechanical ventilation and risk of poor pulmonary outcomes similar to those of femoral nailing, after adjustment for baseline characteristics.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Comparison of Automated Sepsis Identification Methods and Electronic Health Record–based Sepsis Phenotyping: Improving Case Identification Accuracy by Accounting for Confounding Comorbid Conditions
Authors: Henry Katharine E. , Hager David N. , Osborn Tiffany M. , Wu Albert W. , Saria Suchi
Published: October 2019

Objective:

To develop and evaluate a novel strategy that automates the retrospective identification of sepsis using electronic health record data.

Design:

Retrospective cohort study of emergency department and in-hospital patient encounters from 2014 to 2018.

Setting:

One community and two academic hospitals in Maryland.

Patients:

All patients 18 years old or older presenting to the emergency department or admitted to any acute inpatient medical or surgical unit including patients discharged from the emergency department.

Interventions:

None.

Measurements and Main Results:

From the electronic health record, 233,252 emergency department and inpatient encounters were identified. Patient data were used to develop and validate electronic health record–based sepsis phenotyping, an adaptation of “the Centers for Disease Control Adult Sepsis Event toolkit” that accounts for comorbid conditions when identifying sepsis patients. The performance of this novel system was then compared with 1) physician case review and 2) three other commonly used strategies using metrics of sensitivity and precision relative to sepsis billing codes, termed “billing code sensitivity” and “billing code predictive value.” Physician review of electronic health record–based sepsis phenotyping identified cases confirmed 79% as having sepsis; 88% were confirmed or had a billing code for sepsis; and 99% were confirmed, had a billing code, or received at least 4 days of antibiotics. At comparable billing code sensitivity (0.91; 95% CI, 0.88–0.93), electronic health record–based sepsis phenotyping had a higher billing code predictive value (0.32; 95% CI, 0.30–0.34) than either the Centers for Medicare and Medicaid Services Sepsis Core Measure (SEP-1) definition or the Sepsis-3 consensus definition (0.12; 95% CI, 0.11–0.13; and 0.07; 95% CI, 0.07–0.08, respectively). When compared with electronic health record–based sepsis phenotyping, Adult Sepsis Event had a lower billing code sensitivity (0.75; 95% CI, 0.72–0.78) and similar billing code predictive value (0.29; 95% CI, 0.26–0.31). Electronic health record–based sepsis phenotyping identified patients with higher in-hospital mortality and nearly one-half as many false-positive cases when compared with SEP-1 and Sepsis-3.

Conclusions:

By accounting for comorbid conditions, electronic health record–based sepsis phenotyping exhibited better performance when compared with other automated definitions of sepsis.
Incidence and Outcomes of Acute Laryngeal Injury After Prolonged Mechanical Ventilation*
Authors: Shinn Justin R. , Kimura Kyle S. , Campbell Benjamin R. , Sun Lowery Anne , Wootten Christopher T. , Garrett C. Gaelyn , Francis David O. , Hillel Alexander T. , Du Liping , Casey Jonathan D. , Ely E. Wesley , Gelbard Alexander
Published: October 2019

Objectives:

Upper airway injury is a recognized complication of prolonged endotracheal intubation, yet little attention has been paid to the consequences of laryngeal injury and functional impact. The purpose of our study was to prospectively define the incidence of acute laryngeal injury and investigate the impact of injury on breathing and voice outcomes.

Design:

Prospective cohort study.

Setting:

Tertiary referral critical care center.

Patients:

Consecutive adult patients intubated greater than 12 hours in the medical ICU from August 2017 to May 2018 who underwent laryngoscopy within 36 hours of extubation.

Interventions:

Laryngoscopy following endotracheal intubation.

Measurements and Main Results:

One hundred consecutive patients (62% male; median age, 58.5 yr) underwent endoscopic examination after extubation. Acute laryngeal injury (i.e., mucosal ulceration or granulation tissue in the larynx) was present in 57 patients (57%). Patients with laryngeal injury had significantly worse patient-reported breathing (Clinical Chronic Obstructive Pulmonary Disease Questionnaire: median, 1.05; interquartile range, 0.48–2.10) and vocal symptoms (Voice Handicap Index-10: median, 2; interquartile range, 0–6) compared with patients without injury (Clinical Chronic Obstructive Pulmonary Disease Questionnaire: median, 0.20; interquartile range, 0–0.80; p < 0.001; and Voice Handicap Index-10: median, 0; interquartile range, 0–1; p = 0.005). Multivariable logistic regression independently associated diabetes, body habitus, and endotracheal tube size greater than 7.0 with the development of laryngeal injury.

Conclusions:

Acute laryngeal injury occurs in more than half of patients who receive mechanical ventilation and is associated with significantly worse breathing and voicing 10 weeks after extubation. An endotracheal tube greater than size 7.0, diabetes, and larger body habitus may predispose to injury. Our results suggest that acute laryngeal injury impacts functional recovery from critical illness.
Leadership Gender Disparity Within Research-Intensive Medical Schools: A Transcontinental Thematic Analysis
Authors: Abdellatif Waleed , Ding Jeffrey , Jalal Sabeena , Chopra Sanjiv , Butler Javed , Ali Ismail Tawakol , Shah Samad , Khosa Faisal
Published: October 2019

Background:

The underrepresentation of women in senior leadership positions of academic medicine continues to prevail despite the ongoing efforts to advance gender parity. Our aim was to compare the extent of gender imbalance in the leadership of the top 100 medical schools and to critically analyze the contributing factors through a comprehensive theoretical framework.

Methods:

We adopted the theoretical framework of the Systems and Career Influences Model. The leadership was classified into four tiers of leadership hierarchy. Variables of interest included gender,h-index, number of documents published, total number of citations, and number of years in active research. A total of 2448 (77.59%) men and 707 (22.41%) women met the inclusion criteria.

Results:

Male majority was found in all regions with a significant difference in all levels of leadership (chi square = 91.66;Pvalue = .001). Women had a lower meanh-index across all positions in all regions, and when we adjusted for number of years invested, M Index for women was still significantly lower than men (T test = 6.52;Pvalue = .02).

Discussion:

Organizational and individual influences are transcontinental within the top 100 medical school leadership hierarchy. Those factors were critically assessed through in-depth analysis of the Systems and Career Influences Model. Evidence-driven actionable recommendations to remedy those influences were outlined.
Neurotized Diagonal Profunda Artery Perforator Flaps for Breast Reconstruction
Authors: Dayan Joseph H. , Allen Robert J.
Published: October 2019

Although the deep inferior epigastric artery perforator flap remains the gold standard for autologous breast reconstruction, many patients are not candidates for this surgery. A variety of thigh-based flaps have been used including the diagonal upper gracilis (DUG) flap, vertical upper gracilis flap, profunda artery perforator (PAP) flap, and lateral thigh perforator flap. However, each of these techniques has a unique set of benefits and drawbacks in terms of wound healing, donor site morbidity, and potential for lymphedema. We describe the first report of a sensate diagonal PAP flap for breast reconstruction: combining the benefits of the DUG (wider skin paddle and reliable wound healing) with the benefits of the PAP (muscle-sparing technique and greater distance from the lymphatic collectors). This was the authors' sentinel case in a woman with paraplegia and chronic leg swelling. Preoperative imaging, markings, and technical details are presented along with postoperative results. In the appropriately selected patient, this flap offers several advantages: a 2-team approach to reconstruction, ample tissue for breast reconstruction, potential neurotization for breast sensibility, wound closure in resting skin tension lines, and avoidance of the lymphatic drainage to the lower extremity. The diagonal PAP flap provides a muscle-sparing alternative to the DUG flap while minimizing the risk of lymphedema. Future studies are needed to assess the donor site morbidity of this flap; however, this case proves the safety and reliability of the diagonal PAP flap in our breast reconstruction population.
Urgent Management of Secondary Glaucoma in Uveitis Using the Xen-45 Gel Stent
Authors: Qureshi Amreen , Jones Nicholas P. , Au Leon
Published: October 2019

Precis:

The Xen-45 implant is an effective and safe treatment option for patients with medically uncontrolled glaucoma in the setting of uveitis, including those where urgent surgical intervention is required.

Purpose:

The purpose of this study was to report the efficacy and safety of the Xen-45 gel stent in eyes with glaucoma secondary to uveitis.

Methods:

Retrospective observational case series of 37 eyes, with medically uncontrolled glaucoma in uveitis using Xen-45 implantation. All patients had at least 12 months follow-up. Primary outcome measures included visual acuity, intraocular pressure (IOP), degree of inflammation and ocular hypotensive medications. In addition, the time taken from the decision to surgery was recorded. Data were collected preoperatively and 1 day, 1 week, 1, 3, 6, and 12 months postoperatively. Postoperative complications included hypotony and decompressive retinopathy. The requirement for further glaucoma surgery, including bleb needling, and failure were documented.

Results:

The mean follow-up time was 16.7 months (range: 12 to 32 mo). Preoperatively all patients were on >3 ocular hypotensive medications and 75.7% were on oral acetazolamide. Systemic immunosuppression was used in 62.2% and all were on topical steroids. Mean preoperative IOP was 36.1 mm Hg (±SD 9.6) on an average 3.69 (±SD 0.47) drops. The median time from decision to operate to surgery was 5.5 days (range: 1 to 120 d). Mean postoperative IOP was 12.6 mm Hg (±SD 4.1) with an average 0.62 (±SD 1.1) drops at 1 year representing a 65% drop in IOP and 83% reduction in IOP-lowering medication. Bleb needling with 5-fluorouracil was performed on 5 eyes (13.5%). Symptomatic hypotony occurred in 7 eyes requiring further interventions. No decompressive retinopathy was found at last follow-up. Five eyes (13.5%) failed, needing drainage tube surgery or trabeculectomy.

Conclusions:

The Xen‐45 implant is an effective treatment for hypertensive crises in glaucoma in uveitis, offering dramatic IOP lowering without significant uveitis flare-up. In this group of patients with uveitis, needling rates are lower than reported in primary open-angle glaucoma. However, complications including hypotony can still occur.
Living With Diabetes: Perceived Barriers of Adolescents
Authors: GÜRKAN Kübra Pinar , BAHAR Zuhal
Published: October 2019

Background

Type 1 diabetes mellitus is the most common endocrine disease during infancy and adolescence. Diabetes causes serious coping problems during adolescence because of the need for continuous observation and because of diabetes-related complications. Thus, adolescents must adapt to and effectively manage their diabetes.

Purpose

This study was designed to determine the perceived barriers to home care in adolescents with Type 1 diabetes using the Health Promotion Model.

Methods

Eighteen adolescents were selected from the qualified patients who applied to a diabetes polyclinic at a training and research hospital in western Turkey. Interview questions were created based on the Health Promotion Model. A phenomenological analysis of the data was conducted using the content analysis method.

Results

The barriers that participants identified as negatively impacting their ability to manage their disease effectively were categorized into the three themes of “negative feelings about having diabetes,” “personal barriers,” and “environmental barriers.” The barriers identified included school, friends, family, fear of complications, lack of information, and personal characteristics, among others.

Conclusions/Implications for Practice

This qualitative study enables us to understand what patients feel because the participants explained their difficulties in managing their disease and in maintaining metabolic control. The findings provide an understanding of the subjective experiences of adolescent patients with diabetes. The findings of this study are intended to be helpful in restructuring training in clinics, raising diabetes awareness among teachers and students, socializing diabetic adolescents, and providing family-centered education.
The measurement of blood pressure by the linear method compared to the deflation methods differently modifies the pulse oximeter alarm frequency
Authors: Kitamoto Norihisa , Hitosugi Takashi , Kawakubo Yoshifumi , Hayashi Keisuke , Yokoyama Takeshi
Published: October 2019

Background

Noninvasive blood-pressure measurement device and pulse oximeter are important for patient monitoring. When these are placed on the same side, cuff inflation sometimes causes measurement failure by pulse oximeter.

Objective

The present study aimed to compare the pulse oximeter alarm frequency and pulse-wave disappearance duration between noninvasive blood-pressure measurement using the deflation method and that using the linear inflation method.

Methods

The study included 10 healthy subjects. The cuff for automatic sphygmomanometer was wrapped on one side of the upper arm and for pulse oximeter was attached to the thumb of the same side of upper limbs.

Results

The alarm frequency was 0 and 26% using the linear inflation and the deflation methods, respectively. Additionally, the pulse-wave disappearance duration was significantly longer using the deflation method than that using the linear inflation method (10.0 ± 1.5 vs 1.7 ± 0.8 s). With the linear inflation method, this duration was or less 3 s. In the deflation method, an excess pressure of 40 mmHg was used, which caused the alarm to turn on. Additionally, the heart rate was found to influence the alarm occurrence during measurement using the deflation method.

Conclusion

Heart rate may influence alarm occurrence during blood-pressure measurement using the step deflation method. Using the linear inflation method, the risks of alarm occurrence and measurement failure are low, even when the pulse oximeter and blood-pressure measurement cuffs are installed on the same side, suggesting that this method is suitable for clinical use.
The role of circadian rhythm in male reproduction
Authors: Peterlin Ana , Kunej Tanja , Peterlin Borut
Published: October 2019

Purpose of review

To integrate evidence on the role of circadian rhythm in male reproduction. Several studies report on various aspects of the association between the circadian system and male reproductive function in animals and humans both in physiological condition as well as in the case of subfertility.

Recent findings

Epidemiological data demonstrate diurnal and seasonal changes as well as the effect of sleep/wake cycles on the quality of semen. Rare and common genetic variation in circadian clock genes in humans and animal models support the role of circadian rhythms in male fertility in humans.

Current data support the modest effect of the circadian clock on male reproductive potential; however, the evidence available is still fragmented and inconclusive. Additional well designed and sufficiently powered studies are needed to delineate the role of the circadian clock both in cause and potential interventional and preventive approaches in male subfertility.
Biomechanics of two-thumb versus two-finger chest compression for cardiopulmonary resuscitation in an infant manikin model
Authors: Tsou Jui-Yi , Kao Chia-Lung , Chang Chih-Jan , Tu Yi-Fang , Su Fong-Chin , Chi Chih-Hsien
Published: October 2019

Objective

The loading force applied in infant external chest compression (ECC) has not been determined. The objective of this crossover study was to quantify the actual force involved in two-thumb (TT)-encircling hands and two-finger (TF) methods during infant cardiopulmonary resuscitation.

Methods

A total of 42 emergency medical professionals performed lone rescuer infant external chest compression (ECC) with TF and TT methods. The order of two methods was arranged randomly, with an interval of 30 min in between. The force was collected by MatScan as primary outcomes. The secondary outcomes, quality of chest compressions, and fatigue level were also recorded by SkillReporter and perceived exertion scale.

Results

Using the TT method, the rescuers performed cardiopulmonary resuscitation (CPR) with higher ECC quality, but more incomplete recoil than they did using the TF method. The mean compression forces delivered in the first and second minutes were 3.53 ± 1.27 kg and 3.22 ± 1.11 kg (P = 0.012) for TF and 4.11 ± 1.80 kg and 4.04 ± 1.83 kg (P = 0.568) for TT, respectively. Pairwise comparison indicates that the compression force delivered through the TF method during the first and second minute of ECC were inferior to that delivered through the TT method. The TF method involved greater perceived exertion than the TT method (5.27 ± 4.69 vs. 4.02 ± 2.31; P = 0.007). The median perceived exertions for the TF and TT methods were 5 and 4, respectively.

Conclusion

For infant CPR, the TT method involved greater loading force, lower fatigue, and higher overall ECC quality than the TF method. The optimal compression force is about 3.8–4.3 kg.
An Extraordinary Complication in a Child With Combined Familial Mediterranean Fever and Inflammatory Bowel Disease
Authors: Aydoğdu İbrahim , Mirapoglu Semih Lutfi , Goknar Nilufer , Coban Ganime , Kilincaslan Huseyin
Published: October 2019

Familial Mediterranean fever (FMF) is a recurrent disease with autosomal recessive trait and fever that is generally self-limiting. Clinical manifestations are pain in the abdomen, chest, and joints as a result of inflammation in the serous surfaces. No case of multiple intestinal perforations has been reported in children with FMF, whereas cases with a single intestinal perforation have been encountered, although very rarely. In addition, co-occurrence of FMF and inflammatory bowel disease is a situation that is very rarely reported in the literature. Here, we report a case of a 5-year-old girl who was being followed up with the diagnosis of FMF and who also had inflammatory bowel disease, which was complicated with multiple ileal perforations. Our aim is to point out a rarely encountered co-occurrence and also the importance of evaluation of additional diseases with FMF that are unresponsive to treatment so as to prevent complications.
Reducing Provider Workload While Preserving Patient Safety: A Randomized Control Trial Using 2-Way Texting for Postoperative Follow-up in Zimbabwe's Voluntary Medical Male Circumcision Program
Authors: Feldacker Caryl , Murenje Vernon , Holeman Isaac , Xaba Sinokuthemba , Makunike-Chikwinya Batsirai , Korir Michael , Gundidza Patricia T. , Holec Marrianne , Barnhart Scott , Tshimanga Mufuta
Published: October 2019

Background:

Voluntary medical male circumcisions (MCs) are safe: the majority of men heal without complication. However, guidelines require multiple follow-up visits. In Zimbabwe, where there is high mobile phone ownership, severe health care worker shortages, and rapid MC scale up intersect, we tested a 2-way texting (2wT) intervention to reduce provider workload while safeguarding patient safety.

Setting:

Two high-volume facilities providing MC near Harare, Zimbabwe.

Methods:

A prospective, unblinded, noninferiority, randomized control trial of 722 adult MC clients with cell phones randomized 1:1. 2wT clients (n = 362) responded to a daily text with in-person follow-up only if desired or an adverse event (AE) was suspected. The control group (n = 359) received routine in-person visits. All men were asked to return on postoperative day 14 for review. AEs at ≤day 14 visit and the number of in-person visits were compared between the groups.

Results:

Cumulative AEs were identified in 0.84% [95% confidence interval (CI): 0.28 to 2.43] among routine care men as compared with 1.88% (95% CI: 0.86 to 4.03) of 2wT participants. Noninferiority cannot be ruled out (95% CI: −∞ to +2.72); however, AE rates did not differ between the groups (P = 0.32). 2wT men attended an average of 0.30 visits as compared with 1.69 visits among routine care men, a significant reduction (P < 0.001).

Conclusions:

Although noninferiority cannot be demonstrated, increased AEs in the 2wT arm likely reflect improved AE ascertainment. 2wT serves as a proxy for active surveillance, improving the quality of MC patient care. 2wT also reduced provider workload. 2wT provides an option for men to heal safely at home, returning to care when desired or if complications arise. 2wT should be further tested to enable widespread scale-up.
Should Urine-LAM Tests Be Used in TB Symptomatic HIV-Positive Patients When No CD4 Count Is Available? A Prospective Observational Cohort Study From Malawi
Authors: Huerga Helena , Rucker Sekai Chenai Mathabire , Bastard Mathieu , Dimba Andrew , Kamba Cosmas , Amoros Isabel , Szumilin Elisabeth
Published: October 2019

Background:

Current eligibility criteria for urine lateral-flow lipoarabinomannan assay (LF-LAM) in ambulatory, HIV-positive patients rely on the CD4 count. We investigated the diagnostic yield of LF-LAM and the 6-month mortality in ambulatory, TB symptomatic, HIV-positive patients regardless of their CD4 count.

Methods:

We conducted a prospective, observational study that included all ambulatory, ≥15-year-old, TB symptomatic (cough, weight loss, fever, or night sweats) HIV-positive patients presenting at 4 health facilities in Malawi. Patients received a clinical examination and were requested urine LF-LAM, sputum microscopy, and Xpert MTB/RIF. TB was defined as bacteriologically confirmed if Xpert was positive.

Results:

Of 485 patients included, 171 (35.3%) had a CD4 <200 and 32 (7.2%) were seriously ill. Median CD4 count was 341 cells/µL (interquartile range: 129–256). LAM was positive in 24.9% patients with CD4 < 200 (50% LAM grades 2–4) and 12.5% with CD4 ≥ 200 (12.8% LAM grades 2–4). Xpert was positive in 14.1% (44/312). Among Xpert-positive patients, LAM positivity was 56.7% (CD4 < 200) and 42.9% (CD4 ≥ 200), P = 0.393. Of the patients without an Xpert result, 13.4% (23/172) were LAM positive (ie, potentially missed patients). Overall, mortality was 9.2% (44/478). More pronounced LAM-positive patients had higher mortality than LAM-negative (grades 2–4: 36.0%; grade 1: 9.1%; negative: 7.4%; P < 0.001). LAM-positive patients with CD4 <200 cells/µL had higher risk of mortality than LAM negatives (adjusted hazard ratio: 3.2, 95% confidence interval: 1.4 to 7.2, P = 0.006), particularly those with LAM grades 2–4 (adjusted hazard ratio: 4.9, 95% confidence interval: 1.8 to 13.3, P = 0.002).

Conclusions:

Urine-LAM testing can be useful for TB diagnosis in HIV-positive TB-symptomatic patients with no CD4 cell count. LAM grade can identify patients at higher risk of death in this situation.
The Ideal Male Nipple-Areola Complex
Authors: Maas Marissa , Howell Anna C. , Gould Daniel J. , Ray Edward C.
Published: October 2019

Introduction

Top surgery (mastectomy and masculinization of the chest) is a key gender affirming operation for many female-to-male transgender patients. Positioning of the nipple-areola complex (NAC) is a crucial part of this procedure. To date, there are no standards as to where to place the new NAC based on the patient's anatomy, to achieve the most aesthetically pleasing result.

Objective

The objectives of this study were to review the literature and analyze the anatomical averages for NAC shape, width, and height as well as vertical and horizontal placement and to compile the recommendations and proposed equations of NAC placement based on chest wall measurements, chest wall landmarks, and body habitus.

Methods

A systematic review of the literature was conducted in the spring of 2018. Eleven articles met the inclusion criteria, with objective measurements of, and guidelines for, positioning the male NAC in men that had not been preselected for being aesthetically perfect.

Results

The average diameter for a round NAC was 25.9 mm (SD, 2.5 mm), and the width and height of the oval-shaped NAC were found to be 25.3 mm (SD, 2.6 mm) and 20.1 mm (SD, 0.75 mm), respectively. The average sternal notch to nipple distance was found to be 19.3 cm (SD, 1.7 cm). The average internipple distance was 22.3 cm (SD, 1.6 cm).

Conclusions

The data are inconclusive about the effects of anatomical measurements on NAC vertical and horizontal position, but areola diameter is reasonably consistent. There are a wide variety of guidelines and algorithms offered for determining these measurements.
Single-Stage Direct-to-Implant Breast Reconstruction
Authors: Manrique Oscar J. , Kapoor Trishul , Banuelos Joseph , Jacobson Steven R. , Martinez-Jorge Jorys , Nguyen Minh-Doan T. , Tran Nho V. , Harless Christin A. , Degnim Amy C. , Jakub James W.
Published: October 2019

Background

Single-stage direct-to-implant (DTI) breast reconstruction can offer several potential benefits. Subpectoral DTI reconstruction can present with animation deformity and pectoralis muscle spasm. To potentially avoid these complications, surgeons have attempted prepectoral placement for DTI; however, the benefits of this approach are mostly unknown. We evaluated the outcomes of DTI between prepectoral and subpectoral placement.

Methods

This was a retrospective review of patients who underwent immediate DTI breast reconstruction (prepectoral vs subpectoral) between 2011 and 2018. Demographics, clinical characteristics, complications, and patient-reported outcomes (BREAST-Q) were compared.

Results

Thirty-three patients (55 breasts) underwent prepectoral DTI, and 42 patients (69 breasts) underwent subpectoral DTI. Demographics were similar among groups. The number of breasts with preoperative ptosis lower than grade 2 was not significantly different between groups (29.1% vs 26.1%; P = 0.699). Median follow-up was 20.3 and 21 months in the prepectoral and subpectoral groups, respectively. Average mastectomy weight was 300 g (180–425 g) and 355 g (203–500 g). Average implant size was 410 cc (330–465 cc) and 425 cc (315–534 cc) in the prepectoral and subpectoral groups, respectively. Alloderm was used in all reconstructions. Total numbers of complications were 4 (7.2%) and 8 (11.6%) in the prepectoral and subpectoral groups, respectively (P = 0.227). BREAST-Q demonstrated mean patient satisfaction was high and similar among groups (75 and 73.9, P = 0.211).

Conclusions

Based on these results, we believe prepectoral DTI is safe, reliable, and a promising reconstructive option for selected patients, with equivalent results to other reconstructive options. Our present treatment recommendations are for patients who wish to maintain the same breast size and have minimal or no breast ptosis.
Does Meningioma Volume Correlate With Clinical Disease Manifestation Irrespective of Histopathologic Tumor Grade?
Authors: Kauke Martin , Safi Ali-Farid , Stavrinou Pantelis , Krischek Boris , Goldbrunner Roland , Timmer Marco
Published: October 2019

Objectives:

The aim of the study was to investigate the association between meningioma volume and the occurrence of clinic-radiologic signs of tumor aggressiveness. For volumetric approximation, the authors evaluated the method of semiautomatic image segmentation at hand of high-resolution MRI-image sequences.

Methods:

ITK-SNAP was utilized for semiautomatic image segmentation of 58 gadolinium-contrast enhanced T1-weighted thin-slice MRI datasets for volumetric analysis. Furthermore, multimodal imaging datasets (including T2, FLAIR, T1) were evaluated for radiological biomarkers of aggressiveness and growth potential. Thereby generated data was checked for association with retrospectively collected data points.

Results:

Location (P = 0.001), clinical disease manifestation (P = 0.033), peritumoral edema (P = 0.038), tumor intrinsic cystic degeneration (P = 0.007), three-dimensional complexity (P = 0.022), and the presence of meningioma mass effect (P = 0.001) were statistically associated with higher tumor volumes. There was no association between higher tumor volumes and histopathological tumor grade.

Conclusion:

The size of a meningioma does not seem to reliably predict tumor grade. Growth potential seems to be influenced by tumor location. Higher tumor volumes were significantly associated with the occurrence of clinical symptoms.