bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence, Risk Factors, and Impact of Clostridium difficile Colitis After Spine Surgery
Authors: Bovonratwet Patawut , Bohl Daniel D. , Russo Glenn S. , Ondeck Nathaniel T. , Singh Kern , Grauer Jonathan N.
Published: September 2017

Study Design.

A retrospective study of prospectively collected data.

Objective.

The aim of this study was to utilize a large national database with post-hospitalization follow-up data [National Surgical Quality Improvement Program (NSQIP)] to determine the incidence, risk factors, timing, and clinical impact of Clostridium difficile colitis in spine surgery patients.

Summary of Background Data.

Recent literature has suggested an increased incidence of C. difficile infections. However, there has been a lack of large cohort studies defining the incidence and impact of C. difficile colitis in patients undergoing spine surgery.

Methods.

Patients who underwent spine surgical procedures in the 2015 NSQIP database were identified. The primary outcome was a diagnosis of C. difficile colitis within the 30-day postoperative period. Independent risk factors for development of C. difficile colitis were identified using multivariate regression. Postoperative length of stay and rate of 30-day readmission were compared between patients who did and did not develop C. difficile colitis.

Results.

A total of 23,981 patients who underwent spine surgical procedures were identified. The incidence of C. difficile colitis was approximately 0.11% [95% confidence interval (95% CI), 0.07–0.16]. Of the cases that developed C. difficile colitis, 70% were diagnosed postdischarge and 88% had not had a pre-existing infection diagnosed. Independent risk factors for the development of C. difficile colitis were combined anterior/posterior lumbar fusion procedures [odds ratio (OR) = 12.29, 95% CI = 2.22–68.13, P = 0.010], greater age (most notably ≥76 years old, OR = 10.31, 95% CI = 3.06–34.76, P < 0.001), hypoalbuminemia (OR = 6.40, 95% CI = 2.49–16.43, P < 0.001), and anemia (OR = 2.39, 95% CI = 1.13–5.05, P = 0.023). The development of C. difficile colitis was associated with greater length of stay (2.2 vs. 12.5 days; P < 0.001) and increased 30-day readmission (OR = 8.21, 95% CI = 3.14–21.45, P < 0.001).

Conclusion.

C. difficile was diagnosed in 0.11% of patients undergoing spine surgery. The majority of these cases occurred after discharge and in patients not having prior infection diagnoses. High-risk patients should be monitored and targeted with preventative interventions accordingly.

Level of Evidence: 3
Quality of Electronic Nursing Records
Authors: Nomura Aline Tsuma Gaedke , Pruinelli Lisiane , da Silva Marcos Barragan , Lucena Amália de Fátima , Almeida Miriam de Abreu
Published: September 2017

Hospital accreditation is a strategy for the pursuit of quality of care and safety for patients and professionals. Targeted educational interventions could help support this process. This study aimed to evaluate the quality of electronic nursing records during the hospital accreditation process. A retrospective study comparing 112 nursing records during the hospital accreditation process was conducted. Educational interventions were implemented, and records were evaluated preintervention and postintervention. Mann-Whitney and χ
2 tests were used for data analysis. Results showed that there was a significant improvement in the nursing documentation quality postintervention. When comparing records preintervention and postintervention, results showed a statistically significant difference (P < .001) between the two periods. The comparison between items showed that most scores were significant. Findings indicated that educational interventions performed by nurses led to a positive change that improved nursing documentation and, consequently, better care practices.
Cardiovascular origins of preeclampsia
Authors: Kalafat Erkan , Thilaganathan Basky
Published: September 2017

Purpose of review

To review the current data on maternal cardiovascular adaptation in normal pregnancy and preeclampsia.

Recent findings

Defective placentation causes early-onset preeclampsia, a disease entity that is considered more or less distinct from late-onset preeclampsia. The latter has been attributed as ‘maternal’ preeclampsia. There are inconsistencies with the placental origins hypothesis, especially when considering the lack of a causative association with abnormal placental histology or impaired fetal growth. An alternative explanation is that placental dysfunction is secondary to maternal cardiovascular maladaptation in pregnancy. The concept that placental dysfunction is secondary to a maternal disorder is not new when one considers the clinical similarities between preeclampsia and gestational diabetes – both pregnancy-specific conditions that are cured by birth. It is accepted that gestational diabetes develops when the maternal pancreas is unable to manage the increasing glucose load of pregnancy. It is now apparent that pregnancy presents a substantial cardiovascular load on the maternal heart, and that cardiovascular dysfunction precedes the disorder, predominates in the clinical syndrome and persists for several decades postpartum. It is time to consider the evidence that failure of the maternal cardiovascular system to adapt to pregnancy may well be the primary mechanism leading to secondary placental dysfunction in preeclampsia.

Many of the existing paradoxes of preeclampsia challenge the placental origin hypothesis and are explained if one considered preeclampsia to be a cardiovascular syndrome.
Ovarian Cancer Prevention in High-risk Women
Authors: TEMKIN SARAH M. , BERGSTROM JENNIFER , SAMIMI GOLI , MINASIAN LORI
Published: September 2017

Ovarian carcinoma is the most lethal malignancy of the female genital tract. Population-based trials in the general population have not demonstrated that screening improves early detection or survival. Therefore, application of prevention strategies is vital to improving outcomes from this disease. Surgical prevention reduces risk and prophylactic risk-reducing salpingo-oophorectomy is the most effective means to prevent ovarian carcinoma in the high-risk patient although the risks do not outweigh the benefits in average risk patients. Other surgical and medical options have unknown or limited efficacy in the high-risk patient. In this review, we define the patient at high risk for ovarian cancer, discuss how to identify these women and weigh their available ovarian cancer prevention strategies.
Management of Reverse Pellucid Type Topography
Authors: Çakir Hanefi , Utine Canan Asli
Published: September 2017

Purpose:

Evaluation of the etiopathogenesis and management of topographic reverse pellucid pattern after rigid intraocular lens (IOL) implantation with wide limbal clear corneal incision (CCI).

Methods:

Fifteen eyes with a history of gradual decrease in vision after IOL surgery with at least 6.5-mm CCI were diagnosed with wound dehiscence and were managed with tight resuturation, delayed, and selective suture removal. The improvement in uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively) and refractive errors were analyzed, at least 6 months postoperatively.

Results:

Postoperatively, UDVA improved in 13/15 eyes (86.7%), whereas CDVA also improved for at least 2 Snellen lines in 11/15 eyes (73.3%) (P<0.01 for both). In all patients, against-the-rule astigmatism changed to with-the-rule astigmatism pattern and the amount of cylinder decreased as the sutures are removed progressively. Vector analysis of astigmatism showed an arithmetic mean of corrected amount of cylinder of 4.17±2.10 D using manifest refraction data and 4.90±2.83 D using keratometric data at the last follow-up.

Conclusion:

Low visual acuity together with high astigmatism after rigid IOL surgery should prompt the surgeon for considering wound dehiscence that could be managed by careful and deliberate wound revision.
Meta-Analysis of Postoperative Outcome Parameters Comparing Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty
Authors: Pavlovic Ivana , Shajari Mehdi , Herrmann Eva , Schmack Ingo , Lencova Anna , Kohnen Thomas
Published: September 2017

Purpose:

This meta-analysis compares Descemet membrane endothelial keratoplasty (DMEK) with Descemet stripping automated endothelial keratoplasty (DSAEK) to evaluate their strength and weakness profiles.

Design:

Meta-analysis.

Methods:

We performed a meta-analysis and searched the peer-reviewed literature in PubMed, Cochrane Library, Web of Science, and Embase following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prospective and retrospective trials performing and comparing DMEK and DSAEK were included. Effects were calculated as odds ratios or standardized mean differences.

Results:

A total of 11 studies with a total of 723 eyes (350 DMEK and 373 DSAEK) were included. No significant difference was found regarding the total detachment rate, graft failure, and rejection. One of 340 eyes undergoing DMEK showed total detachment and 5 of 363 eyes undergoing DSAEK showed total detachment (P = 0.28). Six of 280 eyes undergoing DMEK showed graft failure; 1 of 313 eyes undergoing DSAEK developed this complication (P = 0.18). No rejection was observed in 158 eyes undergoing DMEK; 4 cases of rejection occurred in 196 eyes undergoing DSAEK (P = 0.37). No significant difference was found regarding endothelial cell loss (P = 0.48). There was a significantly higher partial detachment rate with DMEK: 88 of 340 eyes undergoing DMEK showed partial detachment; 16 of 363 eyes undergoing DSAEK showed this complication (P < 0.00001). DMEK was superior in best-corrected visual acuity after 6 months (P < 0.001), subjective evaluation of visual acuity (P = 0.001), patient satisfaction (P < 0.001), and was the method preferred by patients (P = 0.001).

Conclusions:

DMEK and DSAEK have a similar complication profile. However, the superiority in the visual outcome and patient satisfaction makes DMEK the preferred option for most patients.
Should the Risk of Invasive Cancer in Pregnancy and the Safety of Loop Electrosurgical Excision Procedure During the First 15 Weeks Change Our Practice?
Authors: Siegler Efraim , Lavie Ofer , Amit Amnon , Vaknin Zvi , Auslander Ron , Blumenfeld Zeev
Published: September 2017

Objective

The aim of this article was to describe the outcome of women diagnosed with cervical intraepithelial neoplasia (CIN) grades 2 or 3 in pregnancy either observed or treated by loop electrosurgical excision procedure (LEEP) in the first 15 weeks of gestation.

Methods

Loop electrosurgical excision procedure during the first 15 gestational weeks compared with observation of CIN2/3. This is a retrospective analysis of a nonrandomized study at tertiary, academic, and referring centers in Israel. Ninety-three pregnant women diagnosed with CIN2/3 between 2006 and 2016 were included in this study. Fifty patients with CIN2/3 on cervical biopsy were conservatively followed-up, and 43 patients have undergone LEEP during the first 15 gestational weeks. Main outcome measures were ultimate diagnosis of invasive cancer or CIN, pregnancy outcome, and complications.

Results

In 5.4% of CIN2/3 during pregnancy, the final diagnosis was invasive cancer. The postpartum results of 50 women who were conservatively observed were as follows: 3 (6.0%) had cervical cancer and undergone radical hysterectomy, 33 (66.6%) had CIN2/3, and 14 (28%) had CIN1 or normal histology. The diagnoses of the 43 patients who have undergone LEEP were invasive cancer in 2 patients (4.6%) but did not undergo hysterectomy, CIN2/3 or adenocarcinoma in situ (AIS) in 38 patients (88.4%), and 3 women (7%) had CIN1 or normal histology. None of them suffered severe bleeding. Thirty-seven women continued their pregnancy, 34 (91.9%) had term deliveries, 2 (5.4%) gave birth at 34 and 36 weeks, and 1 patient had missed abortion (2.7%).

Conclusions

The LEEP procedure during the first 15 weeks of pregnancy is safe. A total of 5.4% of the women with CIN2/3 during pregnancy were diagnosed with invasive cancer. It is time to reconsider the recommendations about CIN2/3 in early gestation.
Outcomes of Early Versus Delayed Colonoscopy in Lower Gastrointestinal Bleeding Using a Hospital Administrative Database
Authors: Nigam Neha , Patel Parita , Sengupta Neil
Published: September 2017

Background:

Limited data exist on whether early colonoscopy for lower gastrointestinal bleeding (LGIB) alters 30-day mortality, performance of endoscopic intervention, or need for blood transfusion. Our primary objective was to determine whether early colonoscopy in LGIB is associated with decreased 30-day mortality using a large hospital administrative database.

Methods:

Patients hospitalized between January 2008 and September 2015 were identified using a validated, machine learning algorithm for identifying patients with LGIB. “Early” colonoscopy occurred by day 2 of admission and “late” colonoscopy between days 3 and 5. A propensity score for early colonoscopy was constructed using plausible confounders. Univariable and multivariable logistic regression were used to determine factors associated with 30-day mortality, endoscopic intervention, and transfusion need. The propensity score was included as a confounding factor for mortality analysis in the multivariable model.

Results:

In total, 1204 patients underwent colonoscopy for LGIB. Of these, 295 patients (25%) underwent early colonoscopy, and these patients had a lower Charlson Comorbidity Index (P=0.001) and shorter length of stay (3 vs. 5 d, P=0.0001). Early colonoscopy was not associated with decreased 30-day mortality [odds ratio (OR), 0.73; confidence interval (CI), 0.27-1.69], but was associated with increased endoscopic intervention (OR, 2.62; CI, 1.37-4.95) and decreased need for transfusion (OR, 0.65; CI, 0.49-0.87). On multivariable analysis adjusting for timing of colonoscopy, age, and propensity score for early colonoscopy, early colonoscopy was not associated with a decrease in 30-day mortality (OR, 1.37; CI, 0.50-3.79).

Conclusions:

Early colonoscopy does not affect 30-day mortality but may allow for earlier endoscopic intervention and decreased transfusion need.
Therapeutic Outcome of Achalasia Based on High-Resolution Manometry: A Korean Multicenter Study
Authors: Lee Hyuk , Chung Hyunsoo , Lee Tae Hee , Hong Kyoung Sup , Youn Young Hoon , Park Jung Ho , Park Hyung Seok , Park Hyojin ,   Korean Achalasia Study Team (KAST)
Published: September 2017

Background:

Because achalasia subtype is associated with therapeutic response, it is possible that regional differences in subtype distribution could lead to differences in therapeutic outcomes.

Study Question:

We aimed to evaluate and compare high-resolution manometry (HRM) profiles among the different subtypes of achalasia and to elucidate predictive factors associated with treatment outcomes.

Study Design:

Patients who were diagnosed with achalasia using HRM at 4 Korean university hospitals were retrospectively identified and analyzed. Sixty-four patients with untreated achalasia were divided into 3 subtypes using the Chicago classification system.

Measures and Outcomes:

Clinical characteristics, manometric features, and treatment outcomes were compared.

Results:

Among 64 patients diagnosed with achalasia, 31 patients were classified as type I, 27 as type II, and 6 as type III. Regarding HRM parameters, there were statistically significant differences in basal lower esophageal sphincter pressure, 4-second-integrated relaxation pressure, residual upper esophageal sphincter pressure, body amplitude, and maximal intrabolus pressure between subtypes. Regarding therapeutic outcome, type II patients (overall success rate of 80.0%) were more likely to respond than type I (55.2%) or type III (33.2%) patients. Multivariate analysis demonstrated that achalasia subtype (type I vs. III, P = 0.072; type II vs. III, P = 0.005), therapeutic modality (dilation vs. pharmacologic, P = 0.013; laparoscopic Heller's myotomy vs. pharmacologic, P = 0.006), and HRM-measured esophageal length (<27.5 vs. ≥27.5 cm, P = 0.014) are independent predictive factors for therapeutic failure.

Conclusions:

Patients with type II achalasia had better treatment outcomes than patients with other achalasia subtypes. Achalasia subtype, therapeutic modality, and esophageal length are independent predictive factors of therapeutic outcome.
Typologies for Restructuring Relationships in Cancer Survivorship
Authors: Henshall Catherine L. , Greenfield Sheila M. , Gale Nicola K.
Published: September 2017

Background

Cancer survivors with good social support are generally more motivated to undertake self-management behaviors and make lifestyle changes. However, the impact of changes in social support over time, from prediagnosis through treatment and into survivorship, on the health and recovery of cancer survivors with a range of cancer diagnoses has not been explored.

Objective

The aim of this study was to examine how temporal changes in social support offered to cancer survivors by family and friends influence their engagement with self-management practices and adaptation to lifestyle changes.

Methods

The interview study took place in a teaching hospital in the West Midlands, United Kingdom. Forty participants were purposively sampled. A narrative approach to data collection was chosen, and data were thematically analyzed.

Results

Six typologies of restructuring relationships postcancer were identified. A greater understanding of the changes to social relationships that a cancer diagnosis can incur and the impact of this on people's outlook and ability to self-manage was developed.

Conclusion

The restructuring of social relationships by cancer survivors over time can impact their outlook and ability to self-manage in survivorship, shaping their engagement with health promoting activities and reconciling cancer within the wider context of their lives.

Implications for Practice

Appropriate clinical nursing processes and tailored interventions are required to support cancer survivors and promote engagement with self-management practices. Nurses are a vital component of the social support that enables patients to make the best health and lifestyle choices available to them.
Psychotropic Medication Prescribing in Iraq/Afghanistan Veterans and Vietnam Era Veterans With Posttraumatic Stress Disorder
Authors: Vojvoda Dolores , Stefanovics Elina A. , Rosenheck Robert A.
Published: September 2017

A new generation of veterans from Iraq/Afghanistan wars is seeking psychotropic pharmacotherapy for posttraumatic stress disorder (PTSD) from the Veterans Health Administration, but little is known about differences in prescribing practices between this group and Vietnam era veterans with the same diagnosis. The Veterans Health Administration administrative data for fiscal year 2012 were used to compare prescribing for 155,631 Iraq/Afghanistan veterans and for 327,634 Vietnam era veterans diagnosed with PTSD. The proportion of veterans who were prescribed psychotropic medications (altogether and within five of seven medication classes) were not substantially different between veteran groups. Iraq/Afghanistan veterans were more frequently prescribed prazosin (p < 0.0001, relative risk = 1.51). However, the number of prescriptions for anxiolytics/sedatives/hypnotics as well as prazosin and opiates filled by this younger group was lower by a small magnitude (Cohen's d < 0.2). Iraq/Afghanistan veterans have good access to psychopharmacological treatment for PTSD but fill somewhat fewer prescriptions than Vietnam era veterans.
Maternal–Child Feeding Practices and Associations With Maternal and Child Characteristics
Authors: Gonçalves Sónia , Lima Virgínia , Machado Bárbara C. , Machado Paulo
Published: September 2017

We evaluated associations between maternal child-feeding practices and maternal (age, body mass index [BMI], education, disordered eating) and child (age, BMI, emotional and behavioral) characteristics in 412 mothers and their children using the Parental Feeding Practices, the Child Behavior Checklist, and the Eating Disorders Examination Questionnaires. Maternal BMI was positively correlated with covert control feeding practices. Younger maternal age and lower maternal educational level were associated with increased maternal pressure to eat and overt control in their child-feeding practices. Maternal disordered eating behaviors were associated with increased restriction and covert control in their child-feeding practices. Maternal monitoring during child feeding was associated with lower levels of the child’s problems with internalization and externalization. Finally, maternal feeding practices that involved covert control were related to higher eating restriction by the mother on herself and more maternal concern about her child’s weight. Our findings suggest that maternal feeding practices such as overt and covert control are related to both maternal and child factors. Clinicians must become aware that these maternal feeding practices can model children’s eating behavior and disrupt children’s self-regulation of food intake; however, maternal monitoring during child feeding seems to be related to children’s well-being.
Feeding Guidelines for Infants and Young Toddlers
Authors: Pérez-Escamilla Rafael , Segura-Pérez Sofia , Lott Megan
Published: September 2017

Responsive parenting is a caregiving style expected to foster the development of self-regulation and promote optimal cognitive, social, and emotional development from the beginning of life. Critical dimensions of responsive parenting include feeding, sleeping, soothing, and play/physical activity; all are highly interconnected with each other. Responsive parenting interventions have been shown to have a beneficial impact on child feeding behaviors and weight outcomes. An expert panel convened by Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, developed evidence-based guidelines for feeding infants and toddlers during the first 2 years of life. These responsive feeding guidelines were developed after an evidence-based consensus methodology. The guidelines address the periods of gestation, birth to 6 months, more than 6 months to 1 year, and more than 1 to 2 years. Fundamental principles of the guidelines include hunger and satiety cues, developmental milestones that indicate readiness for introduction of solids, and responsive approaches to repeatedly expose the young child to a variety of healthy foods and age-appropriate textures in the context of a stable and predictable nurturing environment.
Development of a risk stratification and prevention index for stratified care in chronic low back pain. Focus: yellow flags (MiSpEx network)
Authors: Wippert Pia-Maria , Puschmann Anne-Katrin , Drießlein David , Arampatzis Adamantios , Banzer Winfried , Beck Heidrun , Schiltenwolf Marcus , Schmidt Hendrik , Schneider Christian , Mayer Frank
Published: September 2017

Introduction:

Chronic low back pain (LBP) is a major cause of disability; early diagnosis and stratification of care remain challenges.

Objectives:

This article describes the development of a screening tool for the 1-year prognosis of patients with high chronic LBP risk (risk stratification index) and for treatment allocation according to treatment-modifiable yellow flag indicators (risk prevention indices, RPI-S).

Methods:

Screening tools were derived from a multicentre longitudinal study (n = 1071, age >18, intermittent LBP). The greatest prognostic predictors of 4 flag domains (“pain,” “distress,” “social-environment,” “medical care-environment”) were determined using least absolute shrinkage and selection operator regression analysis. Internal validity and prognosis error were evaluated after 1-year follow-up. Receiver operating characteristic curves for discrimination (area under the curve) and cutoff values were determined.

Results:

The risk stratification index identified persons with increased risk of chronic LBP and accurately estimated expected pain intensity and disability on the Pain Grade Questionnaire (0–100 points) up to 1 year later with an average prognosis error of 15 points. In addition, 3-risk classes were discerned with an accuracy of area under the curve = 0.74 (95% confidence interval 0.63–0.85). The RPI-S also distinguished persons with potentially modifiable prognostic indicators from 4 flag domains and stratified allocation to biopsychosocial treatments accordingly.

Conclusion:

The screening tools, developed in compliance with the PROGRESS and TRIPOD statements, revealed good validation and prognostic strength. These tools improve on existing screening tools because of their utility for secondary preventions, incorporation of exercise effect modifiers, exact pain estimations, and personalized allocation to multimodal treatments.
CNS Drug Development: Lessons Learned Part 3: Psychiatric and Central Nervous System Drugs Developed Over the Last Decade—Implications for the Field
Authors: PRESKORN SHELDON H.
Published: September 2017

This column reviews the divergence between the approach to drug development in infectious disease, oncology, and immunology versus psychiatry. Between 2009 and 2016, 254 new drugs were approved. Of those, only 9 were for a psychiatric indication; another 5 were labeled to treat central nervous system disorders that are not considered psychiatric per se but are frequently found in individuals with psychiatric illnesses (eg, substantial weight gain). There were 2 additional new products for psychiatric indications that involved either a combination product (Contrave) or a prodrug for the production of aripiprazole (Aristada). The column discusses the reasons behind these different rates of development of psychiatric and/or central nervous system drugs compared with drugs in the areas of infectious disease, oncology, and immunology, and it predicts that this situation will change over the next century as we develop an improved understanding of the neurobiology underlying specific psychiatric illnesses.
A Randomized Controlled Trial Examining the Effects of Reflexology on Children With Functional Constipation
Authors: Canbulat Sahiner Nejla , Demirgoz Bal Meltem
Published: September 2017

Functional constipation is a common problem in Turkey that affects up to 10% of children. Reflexologists claim that reflexology can be beneficial in the treatment of constipation. The aim of this randomized controlled study was to determine the effectiveness of reflexology in treating functional constipation in children. Thirty-seven children who were referred to a pediatrician with functional constipation as defined by the Rome III criteria were recruited to the study. After the physician's diagnosis, two groups (intervention/control) were created. The intervention and control groups comprised 17 and 20 children, respectively. Each child in the intervention group was given a foot massage for 10 minutes five times a week, and toilet/diet/motivation training was given to their parents. The test period lasted for 4 weeks. Toilet/diet/motivation training was undertaken for 30 minutes once per week (for a total of 4 weeks) in an interactive manner. The parents of children in the control group received equivalent toilet/diet/motivation training only. No significant differences in terms of feces frequency and feces consistency were noted between the intervention and control groups (p> .05). This study sample showed that only toilet/diet/motivation training had potential benefit for treating functional constipation in children. Further larger randomized trials are required to establish whether there are benefits to foot message in the treatment of functional constipation in children.
Management of Colorectal Cancer Patients Undergoing a Colonic Stenting
Authors: Utomo Bejo , Alvarez Carmen , Baldonedo Ricardo F.
Published: September 2017

Colonic stent procedure is one of the best therapeutic medical interventions for managing a colorectal cancer patient with large bowel obstruction. This is a retrospective study that evaluated data from the past 10 years; it examined the epidemiological and clinical data of patients with colorectal cancer undergoing a colonic stent procedure. In addition, this study prospectively evaluated the nurse's roles during a colonic stent procedure, and at the same time, it explored the patient's satisfaction with the procedure at the Hospital Universitario Central de Asturias (Spain). The results revealed that for the last 10 years, a total of 102 patients underwent a colonic stent procedure. Male patients outnumbered female patients by 2:1. The palliative group consisted of patients with multiple cancer metastases, elderly patients, and patients with other comorbidities, whereas the preoperative group comprised those patients with fewer comorbidities and no multiple cancer metastases. Survival time in the palliative group was 3 months without any aggressive treatment, whereas patients with a favorable condition and fit for surgery after a colonic stent procedure had a survival time of 28 months. In the prospective study, nurses implemented care in terms of a multidisciplinary team approach of safety culture that included patient safety, equipment safety, and environment and procedure safety. Therefore, the level of patient satisfaction was high. In conclusion, management of a colorectal cancer patient undergoing colonic stenting performed at the Hospital Universitario Central de Asturias has high technical and clinical success, and it is a quality procedure that includes a multidisciplinary team approach.
Real-World Retention Rates After Intravesical OnabotulinumtoxinA for Idiopathic Overactive Bladder
Authors: Liberman Daniel , Milhouse Olufenwa , Johnson-Mitchell Marta , Siegel Steven W.
Published: September 2017

Introduction

The risk of incomplete bladder evacuation requiring catheterization after intravesical onabotulinumtoxinA (BoNT-A) is well established. However, the rates reported in the literature are highly variable and low overall in clinical trials. We attempt to evaluate the rate of symptomatic acute urinary retention requiring catheterization after initial BoNT-A in a private practice setting of patients with idiopathic overactive bladder.

Methods

We performed a retrospective study from 2010 to 2014 for patients with idiopathic overactive bladder undergoing their first BoNT-A. Demographic information recorded included age, sex, presence of diabetes, baseline postvoid residual (PVR), presence of urodynamic detrusor overactivity, bladder capacity, peak flow rate (Q
max), BoNT-A unit dose, and carrier volume. Urinary retention was defined as those patients who were symptomatic and required catheterization for a PVR of 200 mL or greater.

Results

Of 103 patients who received BoNT-A, 21 (20.3%) developed symptomatic retention requiring catheterization. There was no difference in baseline characteristics, preoperative PVR, and units injected (all P > 0.05). The retention group had a higher rate of bacteriuria and symptomatic urinary tract infection (all P < 0.05). Despite developing symptomatic retention requiring performance of catheterization, 47% of these patients continued with a subsequent injection of BoNT-A.

Conclusions

The need for catheterization after initial delivery of intravescial BoNT-A is an adverse event that seems to be higher in our clinical practice than seen in clinical trials. This information will be critical in order to properly counsel our future patients about the risks and benefits of this therapy.
Kinetics of water vapor adsorption by vacuum-dried jujube powder
Authors: Lee Jun Ho , Zuo Li
Published: September 2017

Water vapor adsorption kinetics of vacuum-dried jujube powder were investigated in temperature and relative humidity ranges of 10 to 40℃ and 32 to 75%, respectively. Water vapor was initially adsorbed rapidly and then reached equilibrium condition slowly. Reaction rate constant for water vapor adsorption of vacuum-dried jujube powder increased with an increase in temperature. The temperature dependency of water activity followed the Clausius-Clapeyron equation. The net isosteric heat of sorption increased with an increase in water activity. Good straight lines were obtained with plotting of 1/(m-m0) vs. 1/t. It was found that water vapor adsorption kinetics of vacuum-dried jujube powder was accurately described by a simple empirical model, and temperature dependency of the reaction rate constant followed the Arrhenius-type equation. The activation energy ranged from 50.90 to 56.00 kJ/mol depending on relative humidity. Arrhenius kinetic parameters (Ea and k0) for water vapor adsorption by vacuum-dried jujube powder showed an effect between the parameters with the isokinetic temperature of 302.51 K. The information on water vapor adsorption kinetics of vacuum-dried jujube powder can be used to establish the optimum condition for storage and processing of jujube.
Antioxidative capacity of hydrolyzed rapeseed cake extract and oxidative stability of fish oil-in-water emulsion added with the extract
Authors: Lee A-Young , Lee Jeung-Hee
Published: September 2017

Rapeseed cake was extracted with 80% ethanol and then fractionated with H2O (fraction I) as well as with 30% (II), 50% (III), 70% (IV), and 100% ethanol (V). Total phenolic content (TPC), 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity, ferric-reducing antioxidant potential, and Trolox equivalent antioxidant capacity were in the order of fractions II > III > I > IV > V. The three fractions with high antioxidant activities and TPC (I, II, and III) were pooled and hydrolyzed by NaOH solution, resulting in 18.97 mg sinapic acid/g hydrolyzed extract and 21- and 2.2-fold increases in TPC and DPPH radical scavenging activity, respectively. Hydrolyzed rapeseed cake extracts (200, 500, and 1,000 ppm) and catechin (200 ppm) as a comparison were added to 10% fish oil-in-water emulsion, and their effects on oxidative stability were investigated by measuring hydroperoxide values (PV) during refrigerated storage. PVs were significantly lower in the emulsions with added hydrolyzed extract as compared to the control (p<0.05) and significantly decreased with increasing extract concentration (p<0.05) over a period of 29 days. The emulsion added with hydrolyzed extract showed higher PV than that added catechin at the same concentration (200 ppm) during 13-22 days (p<0.05), but after then, the PV was not significantly different (p>0.05). This study indicates that hydrolyzed rapeseed cake extract rich in sinapic acid may inhibit oxidation in a fish oil-in-water emulsion in a concentration-dependent manner.
Isolation of antioxidant peptide from sandfish (Arctoscopus japonicus) roe hydrolysate
Authors: Jang Hye Lim , Shin Seung Ryeul , Yoon Kyung Young
Published: September 2017

In this study, a peptide exhibiting antioxidant activity was isolated from sandfish (Arctoscopus japonicus) roe hydrolysate (SRH) in order to evaluate their practical uses as materials for manufacturing functional foods. The A. japonicus roe protein was hydrolyzed using Collupulin MG, and isolation of antioxidant peptide was performed using ultrafiltration (UF), prep-HPLC, and RP-HPLC. The SRH with a molecular weight below 3 kDa constituted about 38% of the whole hydrolysate, and the fraction with a molecular weight below 3 kDa showed significantly greater antioxidant activity compared to the original SRH and other fractions. The isolation fold of the antioxidant peptide isolated from SRH throughout the four-step procedure was 7.11-fold, and protein yield was 14.8%. The DPPH radical scavenging activity of isolated antioxidant peptide was above 90% at a concentration of 1.0 mg/mL, which was similar to that of the Trolox at a concentration of 0.1 mg/mL. These results suggested that the antioxidant peptide derived from A. japonicus roe could be a useful additive for producing functional foods and protein supplements. However, it is necessary to perform further study the structural characteristics of this antioxidant peptide isolated from A. japonicus roe.
Enzyme hydrolysate of silk protein suppresses tert-butyl hydroperoxide-induced hepatotoxicity by enhancing antioxidant activity in rats
Authors: Suh Hyung Joo , Kang Bobin , Kim Chae-Young , Choi Hyeon-Son
Published: September 2017

The purpose of current study is to investigate the beneficial effect of enzyme (Alcalase) hydrolysates of silk protein in rat. Alcalase-treated silk protein hydrolysate (ATSH) itself did not show any cytotoxicity on the hepatic tissues and blood biochemistry, similar to the normal condition. ATSH played a protective role in tert-butyl hydroperoxide (t-BHP)-induced hepatotoxicity and liver damage. The values of AST (aspartate aminotransferase) and ALT (alanine aminotransferase), which are the indicators of the liver function, were effectively alleviated with the ATSH treatment in a dose dependent manner. The level of Lactate dehydrogenase (LDH) and Malondialdehyde (MDA), which were increased with t-BHP treatment, were significantly reduced by ATSH. High dose of ATSH (2 g/kg) reduced the t-BHP-induced LDH release by 48%. Antioxidant and antioxidant enzymes in liver cells were significantly increased by ATSH treatment in their level and activities. ATSH (2 g/kg) increased glutathione (GSH), an intracelluar antioxidant, by 2.5-fold compared with the t-BHP treated group. The activities of glutathione-s-transferase (GST), superoxide dismutase (SOD), and catalase were also elevated by 38%, 60%, and 45%, respectively, with ATSH (2 g/kg) treatment. The antioxidative effect of ATSH was recapitulated to the protection from t-BHP induced liver damages in hematoxylin and eosin (H&E) staining. Thus, ATSH might be used as a hepatoprotective agent.
Otolith microchemistry identifies diadromous populations of Patagonian river fishes
Authors: Alò Dominique , Correa Cristián , Samaniego Horacio , Krabbenhoft Corey A. , Turner Thomas F.
Published: September 2017

Compliance with Ethical Standards

Otolith analysis was funded by a RAC grant from the University of New Mexico, USA. The Government of Chile supported the drafting of this document with a CONICYT Doctoral Fellowship to D. Alò in 2015 and to C. Correa through grants CONICYT-PAI N°82130009, and FONDECYT-Iniciación en la Investigación N°11150990.

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. Specimens were collected under permits No. 3587, 29 December 2006, and No. 2886, 4 November 2008 (amendment No. 602, 12 February 2009) granted by the Chilean Subsecretary of Fishing to C. Correa. The McGill University Animal Care Committee (UACC), Animal Use Protocol No. 5291, approved use and handling of animals.

Coastal habitats in Chile are hypothesized to support a number of diadromous fishes. The objective of this study was to document migratory life histories of native galaxiids and introduced salmonids from a wide latitudinal range in Chilean Patagonia (39-48°S). Otolith microchemistry data were analysed using a recursive partitioning approach to test for diadromy. Based on annular analysis of Sr:Ca ratios, a diadromous life history was detected for populations of nativeAplochiton taeniatus, A. marinus, andGalaxias maculatus. Lifetime residency in freshwater was suggested for populations ofA. zebraandG. platei. Among introduced salmonids, populations ofOncorhynchus tshawytschaandO. kisutchexhibited anadromous migratory patterns, whereas the population ofO. mykissscreened appeared restricted to freshwater.Salmo truttaexhibited variable habitat use consistent with establishment of an ocean-type life history in some populations. The capacity and geographic scope of hydropower development is increasing and may disrupt migratory routes of diadromous fishes. Identification of diadromous species is a critical first step for preventing their loss due to hydropower development.
Seasonal influenza circulation patterns and projections for Sep 2017 to Sep 2018
Authors: Bedford Trevor , Neher Richard A.
Published: September 2017

This report details current seasonal influenza circulation patterns as of Sep 2017 and makes projections up to Sep 2018 to coincide with selection of the 2018 Southern Hemisphere vaccine strain. This is not meant as a comprehensive report, but is instead intended as particular observations that we’ve made that may be of relevance. Please also note that observed patterns reflect the GISAID database and may not be entirely representative of underlying dynamics. All analyses are based on the nextflu pipeline [1] with continual updates posted tonextflu.org.

A/H3N2

H3N2 continues to diversify with many coexisting clades, all of which carry several amino acid mutations at previously characterized epitope sites. The majority of viruses fall into the 3c2.a clade which has been dominating globally for>3 years, but 3c3.a viruses continue to persist. The common ancestor of circulating H3N2 viruses is now more than 5 years old, which is rare for H3N2. Despite extensive genetic diversity, serological assays suggest limited, but non-zero, antigenic evolution. We expect multiple competing clades within 3c2.a to persist into the future with no clear immediate winner.

A/H1N1pdm

A clade comprising mutations S74R and I295V has recently risen to>60% global frequency. Although it shows no antigenic distinction by ferret HI data, the rapidity of its rise suggests a selective origin.

B/Vic

A clade with a two amino acid deletion 162-/163-has altered serological properties and is increasing in frequency, albeit slowly. Two other clades (carrying mutations K209N and V87A/I175V) have increased in frequency moderately.

B/Yam

A clade comprising M251V within clade 3 viruses continues to dominate. The is little genetic differentiation within this clade and no evidence of antigenic evolution.
Overlooked biodiversity loss in Amazonian smallholder agriculture
Authors: Socolar Jacob B. , Valderrama Sandoval Elvis H. , Wilcove David S.
Published: September 2017

Diversified smallholder agriculture is the main human land-use affecting the western Amazon, home to the world’s richest terrestrial biota, but the scant available data to date have suggested that the biodiversity impacts of this land-use are small. Here, we present comprehensive surveys of birds and trees in primary forest and smallholder agricultural mosaics in northern Peru. These surveys reveal substantial biodiversity losses that have been overlooked by other studies. Avian biodiversity losses arise primarily from biotic homogenization across infrequently surveyed forest habitats (a loss of beta-diversity). Furthermore, tree species richness declines much more steeply than bird richness. Statistical modeling of local habitat features that allow forest-associated species to persist in the smallholder mosaic strongly suggests that our results represent a best-case scenario for Amazonian agricultural biodiversity. We conclude that previous assessments of the biodiversity value of Amazonian smallholder agriculture have been overly optimistic because they are restricted to upland habitat, thereby missing losses in beta diversity; do not evaluate trees; and/or rely on generalizations from less speciose areas of the Neotropics, where habitat specialization amongst species is less prevalent. Smallholder agriculture will likely expand in western Amazonia due to infrastructure development, and it must be seen as a serious threat to the region’s biodiversity.
Fitness effects and transmission of phoretic nematodes of the burying beetle,Nicrophorus vespilloides
Authors: Wang Yin , Rozen Daniel E.
Published: September 2017

Nicrophorus vespilloidesis a cosmopolitan social beetle that rears its offspring on decomposing carrion. Wild beetles are frequently associated with two types of macrobial symbionts, mites and nematodes.

Although these organisms are believed to be phoretic commensals that harmlessly use beetles as a means of transfer between carcasses, the role of these symbionts onN. vespilloidesfitness is poorly understood. Here we show that nematodes have significant negative effects on beetle fitness across a range of worm densities and also quantify the density-dependent transmission of worms between mating individuals and from parents to offspring.

Using field-caught beetles, we provide the first report of a new nematode symbiont inN. vespilloides, most closely related toRhabditoides regina, and show that worm densities are highly variable across individuals isolated from nature but do not differ between males and females. Next, by inoculating mating females with increasing densities of nematodes, we show that worm infections significantly reduce brood size, larval survival and larval mass, and also eliminate the trade-off between brood size and larval mass. Finally, we show that nematodes are efficiently transmitted between mating individuals and from mothers to larvae, directly and indirectly via the carcass, and that worms persist through pupation.

These results show that the phoretic nematodeR. reginacan be highly parasitic to burying beetles but can nevertheless persist because of efficient mechanisms of intersexual and intergenerational transmission.

Phoretic species are exceptionally common and may cause significant harm to their hosts, even though they rely on these larger species for transmission to new resources. However, this harm may be inevitable and unavoidable if transmission of phoretic symbionts requires nematode proliferation. It will be important to determine the generality of our result for other phoretic associates of animals.
Systemic Markers of Adaptive and Innate Immunity Are Associated with COPD Severity and Spirometric Disease Progression
Authors: Halper-Stromberg Eitan , Yun Jeong H. , Parker Margaret M. , Tal Singer Ruth , Gaggar Amit , Silverman Edwin K. , Leach Sonia , Bowler Russell P. , Castaldi Peter J.
Published: September 2017

The progression of chronic obstructive pulmonary disease (COPD) is associated with marked alterations in circulating immune cell populations, but no studies have characterized alterations in these cell types across the full spectrum of lung function impairment in current and former smokers. In 6,299 subjects from the COPDGene and ECLIPSE studies, we related Coulter blood counts and proportions to cross-sectional FEV1adjusting for current smoking status. We also related cell count measures to three-year change in FEV1in ECLIPSE subjects. In a subset of subjects with blood gene expression data, we used cell type deconvolution methods to infer the proportions of immune cell subpopulations, and we related these to COPD clinical status. We observed that FEV1levels are positively correlated with lymphocytes and negatively correlated with myeloid populations such as neutrophils and monocytes. In multivariate models, absolute cell counts and proportions were associated with cross-sectional FEV1, and lymphocytes, monocytes, and eosinophil counts were predictive of three-year change in lung function. Using cell type deconvolution to study immune cell subpopulations, we observed that subjects with COPD had a lower proportion of CD4+ resting memory cells and naive B cells compared to non-COPD smokers. Alterations in circulating immune cells in COPD support a mixed pattern of lymphocyte suppression and an enhanced myeloid cell immune response. Cell counts and proportions contribute independent information to models predicting lung function suggesting a critical role for immune response in long-term COPD outcomes. Cell type deconvolution is a promising method for immunophenotyping in large cohorts.