bluuebunny/crossref_metadata_2025 huggingface dataset:
Gene-to-Gene Network Analysis of the Mediation of Plant Innate Immunity by the Eliciting Plant Response-Like 1 (Epl1) Elicitor of Trichoderma formosa
Authors: Cheng Chi-Hua , Shen Bing-Nan , Shang Qian-Wen , Liu Li-Yu Daisy , Peng Kou-Cheng , Chen Yan-Huey , Chen Fang-Fang , Hu Sin-Fen , Wang Yu-Tai , Wang Hao-Ching , Wu Hsin-Yi , Lo Chaur-Tsuen , Lin Shih-Shun
Published: February 2018

A new clade, Trichoderma formosa, secretes eliciting plant response-like 1 (Epl1), a small peptide elicitor that stimulates plant immunity. Nicotiana benthamiana pretreated with Epl1 for 3 days developed immunity against Tomato mosaic virus (ToMV) infection. The transcriptome profiles of T. formosa and N. benthamiana were obtained by deep sequencing; the transcript of Epl1 is 736 nt in length and encodes a 12-kDa peptide. Identifying critical genes in Epl1-mediated immunity was challenging due to high similarity between the transcriptome expression profiles of Epl1-treated and ToMV-infected N. benthamiana samples. Therefore, an efficient bioinformatics data mining approach was used for high-throughput transcriptomic assays in this study. We integrated gene-to-gene network analysis into the ContigViews transcriptome database, and genes related to jasmonic acid and ethylene signaling, salicylic acid signaling, leucine-rich repeats, transcription factors, and histone variants were hubs in the gene-to-gene networks. In this study, the Epl1 of T. formosa triggers plant immunity against various pathogen infections. Moreover, we demonstrated that high-throughput data mining and gene-to-gene network analysis can be used to identify critical candidate genes for further studies on the mechanisms of plant immunity.
Phylogenetic Diversity and Host Specialization of Corynespora cassiicola Responsible for Emerging Target Spot Disease of Cotton and Other Crops in the Southeastern United States
Authors: Sumabat Leilani G. , Kemerait Robert C. , Brewer Marin Talbot
Published: February 2018

Corynespora cassiicola is a ubiquitous fungus causing emerging plant diseases worldwide, including target spot of cotton, soybean, and tomato, which have rapidly increased in incidence and severity throughout the southeastern United States. The objectives of this study were to understand the causes for the emerging target spot epidemics in the United States by comparing phylogenetic relationships of isolates from cotton, tomato, soybean, and other crop plants and ornamental hosts, and through the determination of the host range of isolates from emerging populations. Fifty-three isolates were sampled from plants in the southeastern United States and 1,380 nucleotides from four nuclear loci were sequenced. Additionally, sequences of the same loci from 23 isolates representing each of the distinct lineages of C. cassiicola described from previous studies were included. Isolates clustered based on host of origin, regardless of the geographic location of sampling. There was no genetic diversity detected among isolates from cotton, which were genetically distinct from isolates from other host species. Furthermore, pathogenicity and virulence assays of 40 isolates from various hosts onto cotton, soybean, tomato, and cucumber showed that isolates from cotton were more aggressive to cotton than those from other hosts. Soybean and tomato were most susceptible to isolates that originated from the same host, providing evidence of host specialization. These results suggest that emerging target spot epidemics in the United States are caused by either the introduction of host-specific isolates or the evolution of more aggressive strains on each host.
Identifying Pain and Effects on Quality of Life from Chronic Wounds Secondary to Lower-Extremity Vascular Disease: An Integrative Review
Authors: Newbern Stacy
Published: February 2018

GENERAL PURPOSE:

To provide information to enable better assessment and management of patients with lower extremity vascular disease (LEVD) chronic wound pain.

TARGET AUDIENCE:

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES:

After completing this continuing education activity, you will be able to:

A lack of wound pain validation and provider understanding about the effect of pain on quality of life are the biggest barriers to pain management for patients with chronic wound pain. There is also a need for a holistic, validated pain assessment tool for these patients. This is an integrative review of the literature intended to identify gaps in pain identification and (re)assessment for patients with chronic wounds related to lower-extremity vascular disease.
Characterizing Treatment Utilization Patterns for Trigeminal Neuralgia in the United States
Authors: Zakrzewska Joanna M. , Wu Ning , Lee John Y.K. , Werneburg Brian , Hoffman Deborah , Liu Ying
Published: February 2018

Background and Aim:

Trigeminal neuralgia (TN) is a rare orofacial disorder characterized by severe unilateral paroxysmal pain in the region of the fifth cranial nerve. Clinical guidelines recommend carbamazepine (only US Food and Drug Administration–approved drug for TN) and oxcarbazepine as first-line therapies. We utilized the US Truven Health MarketScan database to examine treatment patterns among patients with TN.

Methods:

Included patients were aged 18 years and above, newly diagnosed with TN (≥2 TN diagnoses ≥14 days apart; no diagnosis in the previous year), continuously enrolled 1 year before index, with ≥3 years’ follow-up postindex. We assessed utilization of selected pharmacotherapies (carbamazepine, oxcarbazepine, pregabalin, gabapentin, baclofen, duloxetine, topiramate), surgery (posterior fossa, radiosurgery), and injections (peripheral anesthetic injections, Gasserian ganglion procedures) for TN.

Results:

In total, 3685 patients were included (2425 commercial, 1260 Medicare; 71.8% female; age, mean [SD], 59 [15] y). Overall, 72.5% of patients received at least 1 studied medication, most commonly carbamazepine (51.7%) or gabapentin (48.6%). In total, 65% of pharmacologically treated patients had ≥2 treatment episodes; 41.6% had ≥3 (defined by a change in pharmacotherapy [monotherapy/combination] regimen). Overall, 12.3% had surgery and 7.3% injections; 42.9% received opioids for TN.

Conclusions:

In the 3 years after diagnosis, patients with TN in the United States receive a variety of pharmacological treatments, including opioids, despite carbamazepine being the only approved medication. A notable proportion utilize surgeries/injections. A high proportion of pharmacologically treated patients receive multiple treatment episodes, suggesting frequent therapy switching, perhaps because of suboptimal efficacy/tolerability. Our data suggest a high burden of illness associated with TN.
Full-endoscopic Uniportal Odontoidectomy and Decompression of the Anterior Cervicomedullary Junction Using the Retropharyngeal Approach
Authors: Ruetten Sebastian , Hahn Patrick , Oezdemir Semih , Baraliakos Xenophon , Merk Harry , Godolias Georgios , Komp Martin
Published: February 2018

Study Design.

A study of a series of consecutive full-endoscopic uniportal decompressions of the anterior craniocervical junction with retropharyngeal approach.

Objective.

The aim of this study was to evaluate the direct anterior decompression of the craniocervical junction in patients with bulbomedullary compression using a full-endoscopic uniportal technique via an anterolateral retropharyngeal approach.

Summary of Background Data.

Acute or progressive myelopathy may necessitate direct anterior decompression of the craniocervical junction and odontoidectomy. Different techniques with individual advantages and disadvantages can be used. In addition to the gold standard – the transoral approach – there is increasing experience with the endoscopic transnasal technique. Other alternative procedures are also being developed.

Methods.

Between 2013 and 2016, eight patients with basilar impression, retrodental pannus, or retrodental infection were operated in the full-endoscopic uniportal technique with a retropharyngeal approach. Anterior decompression of the bulbomedullary junction with odontoidectomy was performed. All patients additionally underwent posterior stabilization. Imaging and clinical data were collected in follow-up examinations for 1 year.

Results.

The bulbomedullary junction was adequately decompressed. No problems due to swelling of pharyngeal soft tissue occurred. One patient required revision due to secondary bleeding. No other complications were observed. All patients had a good clinical outcome with stable regression of the myelopathy symptoms and/or healing of the infection. The imaging follow-up showed sufficient decompression of bone and soft tissue in all cases. No evidence was found of increasing instability or failure of posterior fusion.

Conclusion.

In the operated patients, the full-endoscopic uniportal surgical technique with anterior retropharyngeal approach was found to be a sufficient and minimally invasive method with the known advantages of an endoscopic procedure under continuous irrigation. It should not be viewed only as competition for other surgical techniques – due to its individual technical parameters, it can also be considered to be an alternative or complementary procedure.

Level of Evidence: 4
The History of Total Knee Arthroplasty
Authors: Papas Paraskevi Vivian , Cushner Fred D. , Scuderi Giles R.
Published: February 2018

Total knee arthroplasty has evolved immensely over the last 4 decades, giving patients a greater quality of life and restoring function of their knee joint. Along with changes in implant designs and the development of instrumentation, changes to preoperative and postoperative protocols have improved surgical outcomes. Modern arthroplasty has evolved into a procedure that can offer long-lasting results and functional improvement, with 3.48 million total knee procedures estimated to be performed annually by 2030.
The Randomized Educational Acute Respiratory Distress Syndrome Diagnosis Study: A Trial to Improve the Radiographic Diagnosis of Acute Respiratory Distress Syndrome*
Authors: Goddard Shannon L. , Rubenfeld Gordon D. , Manoharan Venika , Dev Shelly P. , Laffey John , Bellani Giacomo , Pham Tai , Fan Eddy
Published: February 2018

Objectives:

Radiographic criteria for acute respiratory distress syndrome have been criticized for poor reliability. Our objective was to test an educational intervention to improve the radiographic identification of acute respiratory distress syndrome by participants in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure study.

Design:

Randomized controlled trial.

Settings:

Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure study centers.

Subjects:

Study coordinators in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure study.

Interventions:

Participants were randomized to either an online training module followed by a test module (intervention) or test module followed by training module (control).

Measurements and Main Results:

The primary outcome was the number of radiographs correctly identified as meeting criteria for acute respiratory distress syndrome on an online test module (out of 11). Prespecified secondary analyses included a comparison of agreement between the groups and subgroup analyses by profession, age, years of experience, and stated familiarity with diagnostic criteria for acute respiratory distress syndrome. Four-hundred sixty-three study participants consented to participate. There was no effect of the intervention on correct answers by participants (proportion correct 58% [intervention] vs 56% [control]; p = 0.15), or in any subgroup analyses. Overall agreement between raters was 0.296 for the intervention and 0.272 for the control (p < 0.001).

Conclusions:

Participant recognition of radiographic criteria for acute respiratory distress syndrome was low, with poor agreement. This was not impacted by an educational intervention designed to improve accuracy of identification of radiographic criteria for acute respiratory distress syndrome.
Racial Differences in Sepsis Mortality at U.S. Academic Medical Center–Affiliated Hospitals*
Authors: Chaudhary Ninad S. , Donnelly John P. , Wang Henry E.
Published: February 2018

Objectives:

To determine the racial disparities in severe sepsis hospitalizations and outcomes in U.S. academic medical center–affiliated hospitals.

Design:

Retrospective analysis of sepsis hospitalizations.

Settings:

U.S. academic medical center–affiliated hospitals participating in Vizient Consortium from 2012 to 2014.

Patients:

Sepsis hospitalizations using International Classification of Diseases, Ninth revision, discharge diagnoses codes defined by the Angus method.

Interventions:

None.

Measurements and Main Results:

We compared rates of sepsis hospitalization, ICU admission, organ dysfunction, and hospital mortality between blacks and whites. We repeated the analyses stratified by community-acquired, healthcare-associated, and hospital-acquired sepsis subtypes. Of 10,244,780 hospitalizations in our cohort, 1,114,386 (10.9%) had sepsis. Sepsis subtypes included community-acquired sepsis (61.8%), healthcare-associated sepsis (23.8%), and hospital-acquired sepsis (14.4%). Although the proportion of discharges with sepsis was lower for blacks than whites (106.72 vs 109.43 per 1,000 hospitalizations; p < 0.001), the proportion of black sepsis hospitalizations was higher for individuals greater than 30 years old. Blacks exhibited lower adjusted sepsis hospital mortality than whites (odds ratio, 0.85; 95% CI, 0.84–0.86). The adjusted odds of hospital mortality following community-acquired, healthcare-associated, and hospital-acquired sepsis were lower for blacks than whites.

Conclusions:

In this current series of hospital discharges at U.S. academic medical center–affiliated hospitals, blacks exhibited lower adjusted rates of sepsis hospitalizations and mortality than whites.
25-Hydroxyvitamin D serum levels and melanoma risk: a case–control study and evidence synthesis of clinical epidemiological studies
Authors: Cattaruzza Maria Sofia , Pisani Daniela , Fidanza Laura , Gandini Sara , Marmo Giovanna , Narcisi Alessandra , Bartolazzi Armando , Carlesimo Marta
Published: February 2018

There is accumulating evidence that the vitamin D pathway may play a role in melanoma. The aim of this study was to investigate the association between 25-hydroxyvitamin D [25(OH)D] serum levels and the risk of cutaneous melanoma. A case–control study with 137 incident cases of melanoma (serum samples collected at the time of diagnosis) and 99 healthy controls (serum samples collected between October and April) was carried out and evaluated in the framework of an evidence synthesis of clinical epidemiological studies on the topic to facilitate comparisons and summarize the scientific evidence produced so far. There was a statistically significant difference in the median levels of serum vitamin D between melanoma patients and healthy controls (18.0 vs. 27.8 ng/ml, P<0.001). Among melanoma patients, 66.2%, compared with 15.2% of healthy controls, had vitamin D deficiency (≤20 ng/ml), whereas vitamin D sufficiency (≥30 ng/ml) was observed in only 7.4% of melanoma patients and in 37.4% of the healthy controls (P<0.001). A multivariate model including age, sex, and BMI showed a statistically significant inverse association between melanoma and vitamin D sufficiency versus deficiency (odds ratio=0.04; 95% confidence interval: 0.02–0.10, P<0.001). Also, vitamin D insufficiency versus deficiency was significantly inversely associated with melanoma (odds ratio=0.13; 95% confidence interval: 0.06–0.27, P<0.001). These results suggest that both deficient and insufficient serum levels of vitamin D are associated with melanoma and that a trend seems to be present with a reduced risk of melanoma when vitamin D approaches normal values.
Standardizing a federally qualified health center’s preventive care processes: Use of failure modes and effects analysis
Authors: Carman Angela L. , Vanderpool Robin C. , Stradtman Lindsay R. , Moore Stephanie C.
Published: February 2018

A multisite federally qualified health center used a Failure Modes and Effects Analysis to identify and correct potential challenges to the implementation of the proactive office encounter model. This model is designed to proactively identify and close preventive care gaps through electronic medical record use, new workflows, and staff training.
MiSight Assessment Study Spain: Adverse Events, Tear Film Osmolarity, and Discontinuations
Authors: Ruiz-Pomeda Alicia , Pérez-Sánchez Belén , Prieto-Garrido Francisco L. , Gutiérrez-Ortega Ramón , Villa-Collar César
Published: February 2018

Objectives:

To assess the relative clinical success of MiSight contact lenses (CLs) (study group) and distance single-vision (SV) spectacles (control group) in children in terms of adverse events (AEs), discontinuations, and tear film osmolarity over a 2-year period.

Methods:

Seventy-four subjects aged 8 to 12 with myopia of −0.75 to −4.00 D and astigmatism less than 1.00 D were randomly assigned to MiSight CLs or SV groups. Subjects were monitored at 6-month intervals over the course of 24 months and advised to report to the clinic immediately should AEs occur. Adverse events were categorized as serious, significant, and nonsignificant. Discontinuation was defined as cessation of participation in the study.

Results:

Forty-four children were corrected with MiSight CLs and 33 with SV spectacles. No serious or significant AEs were found in any of the participants in either group. Two nonsignificant AEs were found in MiSight group, corresponding to a foreign body on the cornea in two children. There were five discontinuations in MiSight group, one because of change of residence and four because of unwillingness to use the CL. There were no discontinuations in SV group. Neither group showed any significant changes in osmolarity data over the 24 months of follow-up (P≥0.05).

Conclusions:

No clinically serious events were observed in either group. Our results show that correct use of MiSight CLs is a safe option for myopia correction. The success of this treatment requires a combination of proper lens fitting, good adherence to routine follow-ups, and timely treatment of complications.
Blood Culture and Pleural Fluid Culture Yields in Pediatric Empyema Patients
Authors: Stankey Christina T. , Spaulding Alicen B. , Doucette Angela , Hamre Karen E. S. , Wheeler William , Pomputius William F. , Kurachek Stephen
Published: February 2018

Empyema is a complication of community-acquired pneumonia. We conducted a retrospective analysis of empyema patients discharged from 1996 to 2016, examining culture results according to timing of antibiotic administration. Blood culture decreased from 45% to 4% after antibiotics, and pleural fluid culture yield decreased from 67% to 30%. More than half of methicillin-resistant Staphylococcus aureus cases occurred from 2011 to 2016.
Successful Combination Therapy of Liposomal Amphotericin B and Caspofungin for Disseminated Fusariosis in a Pediatric Patient With Acute Lymphoblastic Leukemia
Authors: Uemura Suguru , Tamura Akihiro , Yamamoto Nobuyuki , Saito Atsuro , Nakamura Sayaka , Fujiwara Takahiro , Tahara Teppei , Kozaki Aiko , Kishimoto Kenji , Ishida Toshiaki , Hasegawa Daiichiro , Muraosa Yasunori , Kamei Katsuhiko , Kosaka Yoshiyuki
Published: February 2018

Disseminated fusariosis is a fatal infection in immunocompromised hosts. However, the optimal antifungal treatment for disseminated fusariosis has not yet been established. We report a case of disseminated fusariosis after chemotherapy for acute lymphoblastic leukemia, presenting with multiple skin, lung and kidney lesions and cerebrospinal fluid invasion. The combination therapy of liposomal amphotericin B and caspofungin resolved disseminated fusariosis successfully.
Improved Neurodevelopment After Initiation of Antiretroviral Therapy in Human Immunodeficiency Virus–infected Children
Authors: Gómez Laurén A. , Crowell Claudia S. , Njuguna Irene , Cranmer Lisa M. , Wamalwa Dalton , Chebet Daisy , Otieno Vincent , Maleche-Obimbo Elizabeth , Gladstone Melissa , John-Stewart Grace , Benki-Nugent Sarah
Published: February 2018

Background:

Late human immunodeficiency virus (HIV) diagnosis after severe co-morbidity remains common in resource-limited settings. Neurodevelopmental recovery during antiretroviral therapy (ART) for late-diagnosed children is understudied. We determined 6-month neurodevelopmental trajectories in HIV-infected children initiating ART during hospitalization.

Methods:

HIV-infected children initiated ART after HIV diagnosis during hospitalization in Kenya. The Malawi Developmental Assessment Tool was administered after clinical stabilization within 1 month and at 6 months post-ART initiation. Baseline versus 6-month Z scores for each developmental domain were compared; cofactors for change in Z scores were evaluated using linear regression.

Results:

Among 74 children, median age was 1.7 years (interquartile range, 0.8–2.4) and median Z scores for gross motor, fine motor, social and language domains were −1.34, −1.04, −0.53 and −0.95, respectively. At baseline, children with higher plasma viremia had lower social Z scores (P = 0.008). Better nourished (weight-for-age Z score [WAZ] ≥−2) children had higher Z scores in all developmental domains (all P values ≤0.05). After 6 months on ART (n = 58), gross and fine motor Z scores improved significantly (mean change 0.39; P = 0.007 and 0.43; P = 0.001, respectively), but social and language did not. Children with better immune and growth response to ART had higher gains in gross motor (0.05 per unit-gain CD4%; P = 0.04; 0.34 per unit-gain WAZ; P = 0.006 and 0.44 per unit-gain height-for-age Z score; P = 0.005), social (0.37 per unit-gain WAZ; P = 0.002) and language (0.25 per unit-gain height-for-age Z score; P = 0.01).

Conclusions:

Children had significant neurodevelopmental gains during 6 months of ART, and children with better growth and immune recovery had greater improvement. Prompt commencement of ART may improve neurodevelopment in addition to immunity and growth.
The Association Between Depressive Symptoms and N-Terminal Pro–B-Type Natriuretic Peptide With Functional Status in Patients With Heart Failure
Authors: Saleh Zyad T. , Wu Jia-Rong , Salami Ibrahim , Yousef Khalil , Lennie Terry A.
Published: February 2018

Background:

N-terminal pro–B-type natriuretic peptide (NT-proBNP) and depressive symptoms are each associated with functional status in patients with heart failure (HF), but their association together with functional status has not been examined.

Objective:

The aim of this study was to determine whether functional status scores differ as a function of depressive symptoms and NT-proBNP levels considered together.

Methods:

We studied 284 patients with HF who were divided into 4 groups based on the median split of NT-proBNP levels and cut point for depressive symptoms (Beck Depression Inventory ≥ 14): (1) low NT-proBNP of 562.5 pg/mL or less without depressive symptoms, (2) low NT-proBNP of 562.5 pg/mL or less with depressive symptoms, (3) high NT-proBNP of greater than 562.5 pg/mL without depressive symptoms, and (4) high NT-proBNP of greater than 562.5 pg/mL with depressive symptoms. The Duke Activity Status Index was used to assess functional status.

Results:

Nonlinear regression demonstrated that patients without depressive symptoms were more than twice as likely to have higher (better) functional status scores than patients with depressive symptoms regardless of NT-proBNP levels after controlling for age, gender, prescribed antidepressants, and body mass index. Functional status levels of patients with low NT-proBNP did not differ from those with high NT-proBNP in the presence of depressive symptoms.

Conclusion:

When examined together, depressive symptoms rather than NT-proBNP levels predicted functional status.

Clinical Implications:

Adequate treatment of depressive symptoms may lead to better functional status regardless of HF severity.
Risk factors for low bone mineral density in pediatric inflammatory bowel disease: the positive role of physical activity
Authors: Nobile Stefano , Grand Richard J. , Pappa Helen M.
Published: February 2018

Objective

In pediatric inflammatory bowel disease (IBD), the prevalence of low bone mineral density (BMD) and bone fractures and the relationship between these are still debated. Our aim was to report data from a cohort of pediatric patients with IBD.

Patients and methods

Cross-sectional assessment of growth and BMD [(dual-energy x-ray absorptiometry (DXA)] and retrospective chart review were performed to report the lifetime prevalence of bone fractures and clinical associations with patients’ data.

Results

We examined 216 patients with IBD, 8–25 years old (median: 14 years). Low BMD was found in 12.5% (spine) and 27% (total body). Multiple regression analysis showed that BMD was predicted by Z-scores for height and weight at DXA. History of menstrual irregularities and nasogastric tube feedings was associated with lower BMD, whereas physical activity and higher Z-score for height at DXA were associated with higher BMD.

The prevalence of lifetime fractures was 11.8%. Patients with a history of fractures had lower Z-scores for spine BMD (−1.20 vs. −0.69, P=0.020) and total-body BMD (−1.30 vs. −0.75, P=0.014) compared with those without a history of fractures. Patients with spine BMD Z-score of up to −2 SD score had significantly increased prevalence of fractures compared with those with Z-score more than −2 SD score (28 vs. 10%, P=0.015).

Conclusion

This study provides further insight into risk factors for low BMD in pediatric IBD. Novel findings were the association between low BMD and fractures, and the positive relationship between BMD and physical activity.
Assessment of prognostic performance of Albumin–Bilirubin, Child–Pugh, and Model for End-stage Liver Disease scores in patients with liver cirrhosis complicated with acute upper gastrointestinal bleeding
Authors: Xavier Sofia A. , Vilas-Boas Ricardo , Boal Carvalho Pedro , Magalhães Joana T. , Marinho Carla M. , Cotter José B.
Published: February 2018

Objective

The Albumin–Bilirubin (ALBI) score was developed recently to assess the severity of liver dysfunction. We aimed to assess its prognostic performance in patients with liver cirrhosis complicated with upper gastrointestinal bleeding (UGIB) while comparing it with Child–Pugh (CP) and Model for End-stage Liver Disease (MELD) scores.

Patients and methods

This was a retrospective unicentric study, including consecutive adult patients with cirrhosis admitted for UGIB between January 2011 and November 2015. Clinical, analytical, and endoscopic variables were assessed and ALBI, CP, and MELD scores at admission were calculated.

Results

This study included 111 patients. During the first 30 days of follow-up, 12 (10.8%) patients died, and during the first year of follow-up, another 10 patients died (first-year mortality of 19.8%).

On comparing the three scores, for in-stay and 30-day mortality, only the ALBI score showed statistically significant results, with an area under the curve (AUC) of 0.80 (P<0.01) for both outcomes. For first-year mortality, AUC for ALBI, CP, and MELD scores were 0.71 (P<0.01), 0.64 (P<0.05), and 0.66 (P=0.02), respectively, whereas for global mortality, AUC were 0.75 (P<0.01), 0.72 (P<0.01), and 0.72 (P<0.01), respectively. On comparing the AUC of the three scores, no significant differences were found in first-year mortality and global mortality.

Conclusion

In our series, the ALBI score accurately predicted both in-stay and 30-day mortality, whereas CP and MELD scores could not predict these outcomes. All scores showed a fair prognostic prediction performance for first-year and global mortality. These results suggest that the ALBI score is particularly useful in the assessment of short-term outcomes, with a better performance than the most commonly used scores.
Teaching Patient-Centered Care Through the Veterans History Project
Authors: Vessey Judith A. , Wendt Judith , Glynn Donna M. , McVey Cecilia
Published: February 2018

Determining the best ways to teach military culture and the veteran experience to nursing students and new nurses is an essential component in developing a culturally sensitive nursing workforce. The purpose of this article is to describe a theory-driven, experiential learning approach to integrating the Veterans History Project into the curricula for a postbaccalaureate nurse residency program. Participants acknowledged that this educational project better prepared them to care for the veteran population.
Visualization of Myocardial Infarction in Postmortem Multiphase Computed Tomography Angiography
Authors: Sabatasso Sara , Vanhaebost Jessica , Doenz Francesco , Palmiere Cristian , Michaud Katarzyna , Dedouit Fabrice , Grabherr Silke
Published: February 2018

Recent studies have indicated that multiphase postmortem computed tomography angiography (MPMCTA) allows detection of a pathological enhancement of the myocardium in regions that correlate with the localization of the infarction at histology. The aim of this study was to verify this hypothesis by examining MPMCTA images in cases of myocardial infarction. Therefore, we investigated 10 autopsy cases where death was attributed to myocardial infarction or which showed cardiovascular pathology. As a control group, we selected 10 cases of non-natural (namely, not cardiac) death. The MPMCTA was performed in both groups to ascertain whether a pathological enhancement could be observed. We detected a myocardial enhancement in all cardiac death cases, in the same region that showed infarction at histology. No enhancement was observed in control cases. These results have important implications in the routine management of sudden cardiac death cases. In fact, MPMCTA can not only orient about the cause of death before autopsy, but can especially help to identify affected regions for guiding and improving the sampling for microscopic examination.
Fatal Road Traffic Vehicle Collisions With Pedestrian Victims
Authors: Chatzaraki Vasiliki , Thali Michael J. , Ampanozi Garyfalia , Schweitzer Wolf
Published: February 2018

Fatal car-to-pedestrian collisions regularly appear in the forensic pathologist's routine, particularly in places of extended urbanization. Postmortem computed tomography has gained an exceptional role to supplement autopsy worldwide, giving information that is supplementary or complimentary to conventional autopsy. In this retrospective study, a total number of 320 findings in a series of 21 pedestrians fatally hit by cars and trucks of both postmortem computed tomography and autopsy were correlated. According to our results, it is best to combine both methods to give well-founded answers to questions pertaining to both collision reconstruction and cause of death.
Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) Syndrome and Carcinoid Tumors With/Without NECH
Authors: Mengoli Maria Cecilia , Rossi Giulio , Cavazza Alberto , Franco Renato , Marino Federica Zito , Migaldi Mario , Gnetti Letizia , Silini Enrico Maria , Ampollini Luca , Tiseo Marcello , Lococo Filippo , Fournel Ludovic , Spagnolo Paolo , Cottin Vincent , Colby Thomas V.
Published: February 2018

The diagnostic criteria of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) are not well defined, and DIPNECH can be mistaken for carcinoids associated with neuroendocrine cell hyperplasia (NECH). In this study, we compared clinical, radiologic, histologic, immunohistochemical, and molecular features of DIPNECH and isolated carcinoids with/without NECH. The study population included 151 cases (77 female patients and 74 male patients), 19 with DIPNECH and 132 with carcinoids with/without NECH. None of the cases displayed molecular alterations or anaplastic lymphoma kinase expression. Compared with individuals with carcinoids with/without NECH, patients with DIPNECH were more likely to be female individuals (P<0.0001), nonsmokers (P=0.021), and symptomatic, and to have an obstructive/mixed respiratory defect, peripheral location of the lesions, and air trapping (P<0.0001) on chest computed tomography, and constrictive bronchiolitis on histology (P<0.0001). Among immunohistochemical markers, DIPNECH was associated with higher expression of thyroid transcription factor-1, CD10, and gastrin-releasing peptide/bombesin-like peptide (P<0.0001). Yet, when a purely histopathologic definition of DIPNECH was applied, 40% of isolated carcinoids also met the diagnostic criteria for DIPNECH, even in the absence of symptoms and/or radiologic abnormalities. Therefore, as DIPNECH represents a distinct clinical syndrome, we suggest the term DIPNECH be limited to cases presenting with respiratory symptoms, functional and/or radiologic abnormalities, and constrictive bronchiolitis on histology.
Fallopian Tube Mucosal Involvement in Cervical Gastric-type Adenocarcinomas
Authors: Rajendran Simon , Hussein Yaser , Park Kay J. , McCluggage W. Glenn
Published: February 2018

Cervical gastric-type adenocarcinomas are aggressive non–human papillomavirus-related carcinomas with a propensity for extracervical spread, including unusual sites such as the omentum, peritoneum, and ovary. We report 7 cases of cervical gastric-type adenocarcinoma with fallopian tube involvement predominantly in the form of mucosal colonization without underlying invasion. As far as we are aware, this has not been previously described and this report adds to the literature regarding metastatic neoplasms, which may exhibit tubal mucosal involvement and mimic an in situ lesion at this site. In all cases, there was associated ovarian involvement and in 6 of 7 cases, there was endometrial colonization. We speculate that the fallopian tube (and ovarian) involvement is secondary to transuterine spread. Given the occasional occurrence of multifocal gastric-type glandular lesions (benign or malignant) involving different sites in the female genital tract, we discuss the distinction between synchronous independent and metastatic lesions.
Hemangioma of the Hard Palate in an Elderly Patient as a Life-Threatening Surgical Emergency
Authors: Uluyol Sinan
Published: February 2018

Hemangiomas of the head and neck are common benign tumors usually in childhood. They are rarely seen in hard palate. The authors present a geriatric patient with abundant hemorrhage due to a capillary hemangioma of the hard palate. Management and treatment approaches of this rare, urgent, and life-threatening situation is discussed.
Endoscopic Modified Medial Maxillectomy for Fungal Ball of the Hypoplastic Maxillary Sinus With Bony Hypertrophy
Authors: Nomura Kazuhiro , Ikushima Hiroyuki , Ozawa Daiki , Shimizu Yuichi , Arakawa Kazuya , Suzuki Jun , Hidaka Hiroshi , Katori Yukio , Ohyama Kenji
Published: February 2018

Sinus fungal ball is defined as noninvasive chronic rhino-sinusitis with a clump of mold in the paranasal sinuses, typically affecting the maxillary sinus. Fairly good outcomes of endoscopic surgery have been reported where the ball is removed through the antrostomy. However, the affected sinus tends to have a smaller cavity and thicker bony walls. As such, it is often challenging to maintain a window size that is sufficient to control possible recurrence. The endoscopic modified medial maxillectomy procedure was applied to a 61-year old and a 70-year old female patient with maxillary sinus fungal ball. Using this method, we created a much larger inferior meatal antrostomy without difficulty. The window provided us with an endoscopic view of the whole sinus and complete eradication of the lesion. Endoscopic modified medial maxillectomy is useful as a surgical procedure for maxillary sinus fungal ball and should be considered for better outcomes.
Maxillo-Mandibular Reconstruction in Pediatric Patients: How To Do It?
Authors: Valentini Valentino , Califano Luigi , Cassoni Andrea , Marco Della Monaca , Raponi Ingrid , Priore Paolo , Fadda Maria Teresa , Dell’Aversana Orabona Giovanni , Terenzi Valentina
Published: February 2018

Maxillo-mandibular reconstruction in pediatric patients involves particular functional and cosmetic implications. Attention is required for the craniofacial growth over time, involvement of the permanent dentition, facial symmetry, and donor site morbidity. Our aim is to identify the best reconstructive options for maxilla-mandibular defects in children (<18 years) based on our experience with 25 pediatric patients. We believe that reconstruction has to be performed at the same time as resection in pediatric patients. Local flaps should be reserved for cases of maxillary defects because of malignant neoplasms, which ultimately have poor prognosis. In cases of large mandibular defects, radiotherapy is eventually required. When the condition of the soft tissues is poor (because of previous surgery, etc), free flaps potentially represent the best options. Nevertheless, in patients younger than 5 years old (with no damaged tissues), reconstruction with rib grafts should be performed, and the use of titanium plates should be reserved for very select cases (such as temporary reconstruction in toddlers).
Osteoarthritis pain. Recent advances and controversies
Authors: Schaible Hans-Georg
Published: February 2018

Purpose of review

Osteoarthritis is one of the most frequent causes of chronic pain. Because there is no causal treatment of osteoarthritis, sufficient pain control is of uppermost importance but often not met. The review reports recent advances and controversies in our understanding of osteoarthritis pain and its treatment.

Recent findings

Osteoarthritis pain is determined by processes at different levels. An important local factor of pain generation in the joint is inflammation such as synovitis, and neuropathic components of osteoarthritis pain are being discussed. Neuroplastic changes in the nociceptive system such as peripheral and central sensitization facilitate pain processing. Osteoarthritis pain may also be aggravated by general factors such as metabolic changes and diabetes mellitus, genetic and psychological factors. The review will also address mediators involved in osteoarthritis pain and treatment options.

Recent research is increasing our understanding of osteoarthritis pain by elucidating local factors in the joint which cause pain, by showing neuroplastic changes in the nociceptive system and by addressing the significance of general factors in pain such as metabolic changes. The weight of such factors may determine the pain pattern in individual patients.
Keep Your Eyes Wide Open: On Visual- and Vision-Related Measurements to Better Understand Multiple Sclerosis Pathophysiology
Authors: Backner Yael , Levin Netta
Published: February 2018

Background:

Multiple sclerosis (MS), a demyelinating disease of the central nervous system, is multifaceted. It manifests as acute episodes as well as an accumulative chronic disability; myelin involvement as well as axonal damage; local as well as global effects; and disease load elements as well as compensatory mechanisms. The visual system, with its clear structural organization and relatively direct reflection of damage, may serve as an appropriate model to study MS.

Methods:

In recent years, we have witnessed a blossoming in the field of visual measures in MS. Because it is impossible to cover all different aspects of these measures, we chose to focus on several hot topics in MS literature and shed light on them through studies conducted in the visual system.

Results:

We argue that numerous methods can be used to study axonal and demyelinating aspects of the disease. Although optical coherence tomography and static visual functions better reflect the axonal aspects of the disease, conduction velocity as measured by visual-evoked potential latencies and dynamic visual function mirrors myelin levels. We also posit that the classic disease load parameters cannot be the only means by which we assess a patient's condition. Novel imaging methods such as diffusion tensor imaging and functional magnetic resonance imaging can be used to assess the global effects of local damage on neighboring white matter and compensatory abilities of the brain.

Conclusions:

There have been great advances in therapeutic research in MS. However, the stratification of patients according to their prognosis and predictive outcomes in response to treatment is still in its infancy. The many facets of MS make it difficult to piece all the data together into one cohesive conclusion for the individual patient. The visual system, with our ability to assess both structure and function, offers a promising opportunity to study both pathophysiologic mechanisms and novel therapies.
Disinhibited Blink Reflex Recovery Is Related to Lateral Trunk Flexion in Parkinson Disease
Authors: Sugiyama Takashi , Mochizuki Hitoshi , Hara Yoshine , Miyamoto Miyuki , Nakazato Yuki , Taniguchi Akitoshi , Ishii Nobuyuki , Shiomi Kazutaka , Nakazato Masamitsu
Published: February 2018

Purpose:

Lateral trunk flexion is often observed in patients with Parkinson disease (PD) and causes poor quality of life. Asymmetrical function of the basal ganglia is believed to be the main cause of lateral trunk flexion, and dysfunction of the basal ganglia facilitates the blink reflex by disinhibiting the spinal trigeminal nucleus. Our aim was to investigate whether a disinhibited blink reflex recovery curve (BRrc) was associated with lateral trunk flexion in PD patients.

Methods:

We enrolled 21 PD patients, including 11 with marked lateral trunk flexion (F-PD) and 10 with normal posture (N-PD), and 10 normal controls. Blink reflex recovery curves at interstimulus intervals of 200, 300, and 500 ms were compared between F-PD, N-PD, and normal controls.

Results:

The BRrc in F-PD patients was more disinhibited than in N-PD patients and controls, and this disinhibition was asymmetrical.

Conclusions:

The asymmetrically disinhibited BRrc in F-PD patients was associated with lateral trunk flexion. This is the first neurophysiological study of patients with PD with abnormal posture. Examination of the BRrc may permit early detection of asymmetrical basal ganglia dysfunction that can eventually cause lateral trunk flexion.
High-magnitude innovators as keystone individuals in the evolution of culture
Authors: Arbilly Michal
Published: February 2018

Borrowing from the concept of keystone species in ecological food webs, a recent focus in the field of animal behaviour has been keystone individuals: individuals whose impact on population dynamics is disproportionally larger than their frequency in the population. In populations evolving culture, such may be the role of high-magnitude innovators: individuals whose innovations are a major departure from the population's existing behavioural repertoire. Their effect on cultural evolution is twofold: they produce innovations that constitute a ‘cultural leap' and, once copied, their innovations may induce further innovations by conspecifics (socially induced innovations) as they explore the new behaviour themselves. I use computer simulations to study the coevolution of independent innovations, socially induced innovations and innovation magnitude, and show that while socially induced innovation is assumed here to be less costly than independent innovation, it does not readily evolve. When it evolves, it may in some conditions select against independent innovation and lower its frequency, despite it requiring independent innovation in order to operate; at the same time, however, it leads to much faster cultural evolution. These results confirm the role of high-magnitude innovators as keystones, and suggest a novel explanation for the low frequency of independent innovation.

This article is part of the theme issue ‘Bridging cultural gaps: interdisciplinary studies in human cultural evolution'.
Assessing the relative impact of historical divergence and inter-group transmission on cultural patterns: a method from evolutionary ecology
Authors: von Cramon-Taubadel Noreen , Lycett Stephen J.
Published: February 2018

In the study of cultural evolution, observed among-group affinity patterns reflect the effects of processes such as mutation (e.g. innovation and copying error), between-group interaction (culture flow), drift and selection. As in biology, cultural affinity patterns are often spatially correlated, making it difficult to distinguish between the opposing geographically mediated forces of divergence and interaction, which cause groups to become more distinct or similar over time, respectively. Analogous difficulties are faced by evolutionary biologists examining the relationship between biological affinity and geography, particularly at lower taxonomic levels where the potential for gene flow between lineages is greatest. Tree models are generally used to assess the fit between affinity patterns and models of historical divergence. However, factors driving lineage divergence are often spatially mediated, resulting in tree models that are themselves geographically structured. Here, we showcase a simple method drawn from evolutionary ecology for assessing the relative impact of both geographically mediated processes simultaneously. We illustrate the method using global human craniometric diversity and material culture from the northern coast of New Guinea as example case studies. This method can be employed to quantify the relative importance of history (divergence) and geographically mediated between-group interaction (culture flow) in explaining observed cultural affinity patterns.

This article is part of the theme issue ‘Bridging cultural gaps: interdisciplinary studies in human cultural evolution’.