bluuebunny/crossref_metadata_2025 huggingface dataset:
Unnecessary Cost of Post-Mohs Permanent Pathology
Authors: MacArthur Kelly M. , Tang Nikki , Hruza George J. , Wang Timothy S. , Egbers Robert G.
Published: May 2017

BACKGROUND

By providing tumor-free margins, Mohs micrographic surgery (MMS) results in high cure rates in the treatment of nonmelanoma skin cancers (NMSCs). However, when closure of the post-MMS defect is coordinated with reconstructive surgery, redundant tissue is sometimes submitted for permanent section evaluation.

OBJECTIVE

The purpose of our study was to investigate the frequency and effect of this practice.

MATERIALS AND METHODS

Patients (12 years and older) with NMSCs cleared by MMS with coordinated closures from 2014 to 2016 were identified. Cost analysis was performed using the 2016 Current Procedural Terminology codes and averaged nation-wide Medicare reimbursement rates.

RESULTS

During the study period, 408 cases were coordinated with reconstructive surgeons post-MMS. Of these, 125 had specimens were submitted for permanent section with none showing residual malignancy. There were no significant differences between the cases sent for permanent section and the remaining coordinated MMS cases, with respect to patient age, to basal cell and squamous cell carcinoma histology, or to defect size (p > .05). The marginal cost of sending specimens for permanent section was $121 per case.

CONCLUSION

Sending post-MMS redundant tissue for permanent sections may be of limited utility and should not be performed routinely. Additional work is warranted to determine when this practice should be used in conjunction with MMS.
Dermatoscopic Patterns of Nonfacial Actinic Keratosis: Characterization of Pigmented and Nonpigmented Lesions
Authors: Reinehr Clarissa P.H. , Garbin Gabriela C. , Bakos Renato M.
Published: May 2017

BACKGROUND

Actinic keratoses (AKs) are dysplastic proliferations of keratinocytes. Studies evaluating nonfacial dermatoscopic pattern of AKs are scarce.

OBJECTIVE

This study aimed to evaluate the dermatoscopic patterns of AKs located in nonfacial sites and to compare their patterns with facial lesions.

MATERIALS AND METHODS

Patients with concomitant facial and nonfacial AKs were recruited to participate and evaluated by clinical and dermatoscopic images of their AKs.

RESULTS

Sixty-eight patients were included in the study. A total of 258 nonfacial AKs and 68 facial AKs were analyzed. The most frequent nonfacial AK dermatoscopic structures were white opaque scales (97.3%) and erythema (57.4%). When analyzed in combination, white scales plus erythema were found in 55.4% of nonfacial AKs. Pigmented structures were observed in 22.5% nonfacial AKs. Homogeneous brown pigmentation was the most prevalent pigmented structure in nonfacial pigmented AK (pAK) (93.1%). There was a positive association between patients having concomitant pigmented facial and nonfacial AKs (p < .001).

CONCLUSION

The combinations of erythema and white opaque scales or yellow opaque scales and homogeneous pigmentation are suggestive, respectively of nonpigmented and pigmented nonfacial AKs. Pigmented AKs occur concomitantly in facial and nonfacial areas.
Use of fertility medications and cancer risk: a review and update
Authors: Kroener Lindsay , Dumesic Daniel , Al-Safi Zain
Published: May 2017

Purpose of review

There is increasing use of fertility medications for ovulation induction and ovarian stimulation for in-vitro fertilization in the treatment of female infertility. In this review, recent literature regarding the association between fertility medication and cancer risk is reviewed.

Recent findings

Several important publications have recently addressed the relationship between use of fertility medications and cancer risk. There are methodological limitations to many of these studies, including unique challenges in studying rare cancers that often develop several years after the time of fertility medication exposure. Although infertility per se is a risk factor for some female cancers, including breast, endometrial and ovarian cancer, most studies do not show a significant risk of these cancers with the use of fertility medications. Some studies, however, have shown a possible increased relative risk of borderline ovarian cancer, although the increased absolute risk is small without a clear causal relationship.

The collective data regarding the risk of developing cancer from use of fertility medications are reassuring, although several methodological issues in these studies limit definitive conclusions.
A systematic review of the exercise effect on bone health: the importance of assessing mechanical loading in perimenopausal and postmenopausal women
Authors: Sañudo Borja , de Hoyo Moisés , del Pozo-Cruz Jesús , Carrasco Luis , del Pozo-Cruz Borja , Tejero Sergio , Firth Elwyn
Published: May 2017

Objective:

The aims of this systematic review were to determine the general effects of exercise on areal bone mineral density (BMD) in perimenopausal and postmenopausal women, and to provide information on the most suitable bone-loading exercise regimens that may improve bone health in this population group.

Methods:

A computerized, systematic literature search was performed in the electronic databases PubMed, Web of Science, CINAHL, SPORTDiscus, and The Cochrane Library, from January 2005 to November 2015, to identify all randomized controlled trials related to exercise in perimenopausal and postmenopausal women. The initial search identified 915 studies, with a final yield of 10 studies. Only randomized controlled trials that examined the effects of exercise programs longer than 24 weeks in women aged 35 to 70 years were included. The 10 studies quantified at least BMD and described training variables adequately (training period, frequency, volume, intensity).

Results:

Ten studies with moderate quality evidence (6.4 ± 1.8 points, range 4-9) were included. Significant changes in lumbar and femoral neck BMD were found mainly with high-impact exercise and whole body vibration interventions.

Conclusions:

While training effects must be interpreted with caution because of the heterogeneity of the protocols and exercises performed, this systematic review confirmed the effectiveness of impact exercises combined with other forms of training (vibration or strength training) to preserve BMD in perimenopausal and postmenopausal women. Despite the results possibly not representing a general dose-response relationship, we highlight the importance of quantifying loading intensity and frequency by means of accelerometry as these parameters are determinants for bone adaptation.
Topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on nonhormonal management of vasomotor symptoms
Authors: Carpenter Janet S. , Laine Tei , Harrison Blake , LePage Meghan , Pierce Taran , Hoteling Nathan , Börner Katy
Published: May 2017

Objective:

We sought to depict the topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on the nonhormonal management of menopause-associated vasomotor symptoms released on September 21, 2015, and its associated press release from September 23, 2015.

Methods:

Three data sources were used: online news articles, National Public Radio, and Twitter. For topical diffusion, we compared keywords and their frequencies among the position statement, press release, and online news articles. We also created a network figure depicting relationships across key content categories or nodes. For geospatial diffusion within the United States, we compared locations of the 109 National Public Radio (NPR) stations covering the statement to 775 NPR stations not covering the statement. For temporal diffusion, we normalized and segmented Twitter data into periods before and after the press release (September 12, 2015 to September 22, 2015 vs September 23, 2015 to October 3, 2015) and conducted a burst analysis to identify changes in tweets from before to after.

Results:

Topical information diffused across sources was similar with the exception of the more scientific terms “vasomotor symptoms” or “vms” versus the more colloquial term “hot flashes.” Online news articles indicated media coverage of the statement was mainly concentrated in the United States. NPR station data showed similar proportions of stations airing the story across the four census regions (Northeast, Midwest, south, west; P = 0.649). Release of the statement coincided with bursts in the menopause conversation on Twitter.

Conclusions:

The findings of this study may be useful for directing the development and dissemination of future North American Menopause Society position statements and/or press releases.
CORRELATION BETWEEN PREOPERATIVE EN FACE OPTICAL COHERENCE TOMOGRAPHY OF PHOTORECEPTOR LAYER AND VISUAL PROGNOSIS AFTER MACULAR HOLE SURGERY
Authors: Kim Kiyoung , Kim Eung Suk , Kim Yonguk , Yu Seung-Young , Kwak Hyung Woo
Published: May 2017

Purpose:

To investigate the correlation between preoperative en face spectral domain optical coherence tomography findings of the photoreceptor layer with restoration of foveal microstructure and visual acuity in repaired macular holes.

Methods:

Medical records of 106 patients with surgically closed macular holes were retrospectively reviewed. Preoperative OCT slabs of the external limiting membrane (ELM) and ellipsoid zone (EZ) were generated using embedded tools. All patients were classified into two groups according to the presence of preoperative retinal pigment epithelium protrusion seen as hyperreflective spots in EZ slab. Visual acuity, homogenous reflectivity, and glial proliferation in the ELM and EZ slabs were followed for 12 months.

Results:

Baseline hyperreflective spots in the EZ slab was observed in 51 (48.1%) eyes. Postoperative homogenous reflectivity and glial proliferation were related to the presence of baseline hyperreflective spots. Vision improvement was significantly greater in the absence of hyperreflective spots group from 9 months after the operation. In logistic regression analysis, the area of hyperreflective spots was significantly associated with foveal homogenous reflectivity at 12 months (P = 0.004).

Conclusion:

Preoperative hyperreflective spots in en face EZ slab might be indicative of functional and anatomical restoration after macular hole surgery.
CHOROIDAL MELANOMA, SECTOR MELANOCYTOSIS, AND RETINAL PIGMENT EPITHELIAL MICRODETACHMENTS IN BIRT–HOGG–DUBÉ SYNDROME
Authors: Marous Charlotte L. , Marous Molly R. , Welch R. Joel , Shields Jerry A. , Shields Carol L.
Published: May 2017

Purpose:

Birt–Hogg–Dubé Syndrome (BHDS) is a rare autosomal dominant condition that can predispose patients to numerous cutaneous fibrofolliculomas and other cutaneous lesions, pulmonary cysts with spontaneous pneumothorax, and multifocal renal tumors and cancer. The genetic mutations responsible for BHDS are related to tumor suppression and the mammalian target of rapamycin (mTOR) pathway. Previous reports of the ocular findings in BHDS include eyelid fibrofolliculomas, “flecked chorioretinopathy,” and one report of choroidal melanoma. We report a patient with BHDS who presented with choroidal melanoma, sector melanocytosis, and retinal pigment epithelial microdetachments.

Methods:

Observational case report.

Results:

A 38-year-old man with BHDS manifesting with facial fibrofolliculomas/tricodiscomas and pulmonary cysts with previous pneumothorax of both lungs was noted to have a large choroidal nevus, managed with observation elsewhere. On referral 1 year later, photopsia and visual field defect were noted, and the patient was discovered to have subtle patchy sector ocular melanocytosis of the iris and choroid with choroidal melanoma and dependent subretinal fluid. The melanoma measured 14 mm in basal dimension and 6.8 mm in thickness. In addition, pinpoint retinal pigment epithelial microdetachments were observed in both eyes at the equator and confirmed on optical coherence tomography. Custom-fit plaque radiotherapy was provided for tumor control.

Conclusion:

The BHDS can be associated with tumors of the skin and kidney. In this case, we noted ocular melanocytosis, malignant choroidal melanoma, and bilateral pinpoint retinal pigment epithelial detachments.
Stabilization of Visual Function After Optic Nerve Sheath Fenestration for Optic Nerve Meningocele
Authors: Mahatma Gina , Sadaka Ama , Berry Shauna , Malik Amina , Lee Andrew G.
Published: May 2017

A 10-year-old boy with bilateral colobomatous cavitary disc anomalies presented with a 3-month history of vision loss in his right eye. MRI of the head and orbit revealed bilateral tubular cystic enlargement of the optic nerve/optic sheath complex with thickening of the optic nerves without inflammation or neoplasm, suggestive of bilateral optic nerve meningocele. An optic nerve sheath fenestration was performed OD, and he experienced an improvement and stabilization of vision in his right eye during a 1-year follow-up period. The authors recommend that surgical decompression, particularly optic nerve sheath fenestration, should be considered in cases with progressive vision loss due to optic nerve meningocele.
Dichotic Listening Deficit Associated With Solvent Exposure
Authors: Landry Simon P. , Fuente Adrian
Published: May 2017

Hypothesis:

A significant left ear deficit can be observed in solvent-exposed individuals using the dichotic digit test.

Background:

Solvents are ubiquitous in global industrial processes. Due to their lipophilic nature, solvents can adversely affect large white matter tracks such as the corpus callosum. Previous investigations reveal that long-term workplace exposure to solvents is also deleterious to various auditory processes. Investigations in exposed populations suggest a decreased performance for dichotic listening.

Methods:

In this present study, we examined the lateralization of a dichotic digit test score for 49 solvent-exposed individuals along with 49 age- and sex-matched controls. We evaluated group differences between test scores and the right ear advantage using a laterality index (LI).

Results:

Individual ear results suggest that long-term workplace solvent exposure is associated with a significantly lower dichotic listening score for the left ear. A binaural compound score analysis using a laterality index supports this left-ear deficit.

Conclusion:

These results provide an insight on the effects of solvent exposure on dichotic listening abilities. Further research should investigate the importance of using dichotic listening tasks to screen for solvent-induced auditory dysfunction in exposed individuals.
Efficacy of Intratympanic Gentamicin in Menière's Disease With and Without Migraine
Authors: Liu Yuan F. , Renk Elizabeth , Rauch Steven D. , Xu Helen X.
Published: May 2017

Objective:

To compare the efficacy of intratympanic gentamicin injection (ITG) on vertigo control, drop attacks, and functional level in Menière's disease patients with and without a history of migraine.

Patients:

Menière's disease patients (patients with migraine and age- and sex-matched control patients without migraine) treated from 2002 to 2012 who failed medical management and received ITG, with a minimum 2-year follow up.

Intervention:

ITG.

Main Outcome Measures:

Vertigo control, drop attack prevalence, and change in functional level.

Results:

Twenty-eight Menière's disease patients were included in this study (14 with migraine and 14 matched patients without migraine). There were three men and 11 women in each groups, with a mean age of 53 ± 8.9 years. Baseline characteristics (Menière's stage, vertigo frequency, drop attack prevalence, and functional level) before ITG were not significantly different between the two groups. Two years after ITG, 71% of Menière's disease with migraine patients and 78% of Menière's disease without migraine patients had class A, B, or C vertigo control (p > 0.999). Change in prevalence of drop attacks (43–7% versus 50–0%, respectively) was also similar (p > 0.999). However, significantly fewer vertigo control class A, B, and C migraine patients achieved functional level 1 or 2 (40%) compared with non-migraine patients (91%) (p = 0.007).

Conclusions:

Although ITG appears equally effective in treating vertigo and drop attacks in Menière's disease with and without migraine, patients with migraine derive significantly less benefit in terms of functional improvement.
Where are we heading with fluid responsiveness research?
Authors: Vistisen Simon T. , Juhl-Olsen Peter
Published: May 2017

Purpose of review

Fluid responsiveness prediction is not always possible with well established dynamic approaches such as passive leg raising or pulse pressure variation in the ICU. The purpose of the present review is to summarize emerging alternative techniques for fluid responsiveness prediction in adult critically ill patients and discuss their methodology and applicability. In addition, the future role of fluid responsiveness prediction in the ICU is discussed.

Recent findings

Several new dynamic techniques have been investigated and they all contribute to the applicability of fluid responsiveness techniques. Although increasing the applicability, most of the emerging techniques still rely on ventilator setting changes in patients that are fully or almost fully adapted to the ventilator or require reliable flow monitoring, which prevents broad applicability. Yet, the mini/micro fluid challenges and the use of extrasystolic preload changes have the potential of being more applicable but all reviewed methods need further validation and methodological refinement.

Emerging techniques are encouraging for broader applicability of fluid responsiveness prediction. Still, the clinical impact of correctly predicting fluid responsiveness remains to be investigated in the critically ill and the research community should have a clear aim of moving toward that type of studies.
Lactate and microcirculation as suitable targets for hemodynamic optimization in resuscitation of circulatory shock
Authors: Kiyatkin Michael E. , Bakker Jan
Published: May 2017

Purpose of review

A discussion of recent research exploring the feasibility of perfusion-guided resuscitation of acute circulatory failure with a focus on lactate and microcirculation.

Recent findings

Upon diagnosis of shock, hyperlactemia is associated with poor outcome and, under appropriate clinical circumstances, may reflect inadequate tissue perfusion. Persistent hyperlactemia despite resuscitation is even more strongly correlated with morbidity and mortality. Importantly, there is minimal coherence between lactate trends and static hemodynamic measures such as blood pressure, especially after the initial, hypovolemic phase of shock. During this early period, lactate guided-resuscitation is effective and possibly superior to hemodynamic-guided resuscitation. Similar to hyperlactemia, impaired microcirculation is ubiquitous in shock and is evident even in the setting of hemodynamic compensation (i.e., occult shock). Moreover, persistent microcirculatory derangement is associated with poor outcome and may reflect ongoing shock and/or long-lasting damage. Although the wait continues for a microcirculation-guided resuscitation trial, there is progress toward this goal.

Although questions remain, a multimodal perfusion-based approach to resuscitation is emerging with lactate and microcirculation as core measures. In this model, hyperlactemia and microcirculatory derangement support the diagnosis of shock, may help guide resuscitation during the initial period, and may reflect resuscitation efficacy and iatrogenic harm (e.g., fluid overload).
Teenage pregnancy prevention: the role of young men
Authors: Vargas Gabriela , Borus Joshua , Charlton Brittany M.
Published: May 2017

Purpose of review

Although teenage pregnancy is declining in many parts of the world, it remains associated with considerable social, health, and economic outcomes. Pregnancy prevention efforts focus primarily on young women, with minimal attention to young men. This review highlights recent literature pertaining to the role of young men in pregnancy prevention.

Recent findings

Young men have varying views on contraception as well as which partner(s) should be responsible for its use. Limited contraception knowledge reduces young men's sexual health communication as well as their contraception use. Healthcare providers play a major role as one of the main sources of sexual health information for young men, but there are gaps in young men's sexual health care so new guidelines have emerged.

Recent literature highlights young men's range of views on contraception as well as their low sexual health knowledge and sexual health communication. To address teenage pregnancy and improve young men's overall wellness, healthcare providers should routinely address sexual health. Healthcare providers may use our newly proposed acronym, HIS BESTT, (Hello. Initiate. Sexual health assessment. Both condoms and female dependent methods. Examine genitals. STI screening. Talking to partner(s). Talking to parent(s) or guardians), to incorporate current clinical recommendations.
Clofarabine Dosing in a Patient With Acute Myeloid Leukemia on Intermittent Hemodialysis: Case Report and Review of the Literature
Authors: Benitez Lydia L. , Gharibian Katherine , Frame David , Mody Rajen , Mora Erika
Published: May 2017

Clofarabine containing chemotherapeutic regimens have demonstrated efficacy in the treatment of relapsed refractory acute myeloid leukemia. Nonetheless, there are limited data on the use of clofarabine in patients with renal failure. The present report describes the use of clofarabine in a patient with renal failure undergoing intermittent dialysis. We describe our rationale for dosing, clofarabine plasma levels obtained, and discuss our findings in the context of other available literature. Consistent with previous findings, intermittent hemodialysis was not found to be a reliable method of removing clofarabine in patients with renal insufficiency.
Successful Reduced Intensity Allogeneic Transplant With Full Donor Chimerism and Good Quality of Life in Adolescent Patient With Wiskott-Aldrich Syndrome
Authors: Ali Salah , Gacsadi Anna , McDougall Elizabeth , Armstrong Christine , Krueger Joerg , Schechter Tal , Ali Muhammad
Published: May 2017

Wiskott-Aldrich syndrome (WAS) is an X-linked disease characterized by microthrombocytopenia, eczema, immune deficiency, and autoimmune phenomena. Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative treatment. Myeloablative conditioning is the most common regimen used for HSCT in patients with WAS to avoid the risk of mixed donor chimerism and autoimmunity post-HSCT. There is limited data on the use of reduced intensity conditioning for HSCT in patients with WAS. Here, we report a case with severe phenotype of WAS transplanted successfully with reduced intensity conditioning, which is an acceptable conditioning regimen and can be considered in patients with WAS with significantly impaired organ functions.
Necrotizing Ulcer After BCG Vaccination in a Girl With Leukocyte-adhesion Deficiency Type 1
Authors: Kurosawa Hidemitsu , Mizukami Tomoyuki , Nunoi Hiroyuki , Kato Masaya , Sato Yuya , Okuya Mayuko , Fukushima Keitaro , Katsuyama Yoshihiko , Arisaka Osamu
Published: May 2017

Leukocyte-adhesion deficiency-1 is a recessively inherited disorder associated with recurrent bacterial infections, severe periodontitis, peripheral leukocytosis, and impaired wound healing. We diagnosed moderate-type leukocyte-adhesion deficiency-1 in a 7-year-old girl who developed a necrotizing ulcer after Bacillus Calmette-Guerin vaccination. The patient showed moderate expression of CD18 in neutrophils with a homozygous splice mutation with c.41_c.58+2dup20 of ITGB2 and experienced recurrent severe infections complicated with systemic lupus erythematosus. She received hematopoietic stem cell transplantation from a matched elder brother with heterozygous mutation of ITGB2, and has since remained free of infection and systemic lupus erythematosus symptoms without immunosuppression therapy.
Veteran-Centered Exemplars in a Prelicensure Nursing Program Curriculum
Authors: Champlin Barbara , Linck Raney , Darst Elaine , Foley Brad , Reuer Berdette , Hammill Colleen
Published: May 2017

Veterans have unique health care needs that must be addressed. Seventy-five percent of veterans are treated outside Veteran Health Administration facilities, so all health care providers should be educated on how to better serve veterans and their families. Nurses are in a prime position to lead the way in these efforts, beginning in prelicensure nursing education. In this article, the authors describe a model and exemplars for integrating veteran-centered care into an existing curriculum, from beginning through advanced levels.
Pain and Analgesia Requirements With Hip Fracture Surgery
Authors: A'Court Jamie , Lees Deborah , Harrison William , Ankers Thomas , Reed Mike R.
Published: May 2017

BACKGROUND:

Hip hemiarthroplasty and dynamic hip screw (DHS) fixation are common procedures performed in trauma units, but there is little information regarding perioperative pain experience with respect to these treatment modalities.

PURPOSE:

To evaluate the relationship between pain, analgesia requirements, and type of procedure for hip fracture surgery.

METHODS:

An analysis was performed on consecutive patients presenting with a hip fracture in 2 hospitals over 2 years. Patients with a diagnosis of dementia were excluded because of the limitations of pain assessment. Postoperative pain scores were taken from standardized patient observation charts. Perioperative opiate consumption was calculated from inpatient drug charts.

RESULTS:

A total of 357 patients were studied; 205 patients (53%) underwent a cemented hemiarthroplasty and 152 (47%) had fixation with a DHS. Patients who underwent a DHS fixation had more pain than those who had a hemiarthroplasty and required almost double the amount of opiates.

CONCLUSION:

The reason for the elevated pain scores and higher morphine requirement in the DHS group (DG) remains unclear. It could be related to highly sensitive periosteum reaction in the DG. It is important to recognize the difference in pain experienced between the groups, and analgesia should be tailored toward the individual based upon clinical assessment and knowledge of the surgery performed. A comprehensive understanding of this principle will allow for improved perioperative surgical care and patient experience.
Bigaussian Wavefront Model for Normal and Keratoconic Eyes
Authors: Rozema Jos J. , Rodríguez Pablo , Navarro Rafael , Koppen Carina
Published: May 2017

Purpose

To report bigaussian multivariate wavefront models capable of stochastically generating an unlimited amount of plausible wavefront data for either normal or keratoconic eyes.

Methods

The models use centroid wavefront data measured previously with an iTrace in 330 healthy right eyes and 122 keratoconic right eyes. These centroids were fitted to an 11th-order Zernike series, followed by principal component analysis to reduce dimensionality and remove correlations. The remaining parameters were then fitted to a sum of two multivariate Gaussian distributions. This fit then forms the core of the stochastic model, which may be used to generate synthetic data. Finally, the agreement between the original and synthetic data was tested using two one-sided t tests.

Results

For normal eyes, the first eigenvectors mostly represent pure Zernike polynomials, with a decreasing degree of purity with increasing order. For keratoconic eyes, eigenvector purity was considerably lower than for normal eyes. Depending on the data set, series of 22 to 29 eigenvectors were found sufficient for accurate wavefront reconstruction (i.e., root-mean-square errors below 0.05 μm). These eigenvectors were then used as a base for the stochastic models. In all models and all Zernike coefficients, the mean of the synthetic data was significantly equal to that of the original data (two one-sided t test, P > .05/75), but the variability of the synthetic data is often significantly lower (F test, P < .05/75).

Conclusions

This synthetic wavefront model may be safely used in calculations as an alternative to actual measurements should such data not be available.
Acute Gastric Volvulus Successfully Treated by Endoscopic Reduction in a 6-Year-Old Girl and a Review of the Japanese Literature
Authors: Haga Mitsuhiro , Sano Nobuyuki , Kamiyama Takamichi , Dairaku Naohiro , Ishii Mari , Nemoto Teruko , Suzuki Hoshiro , Fujie Hiromi , Suzuki Jun
Published: May 2017

A previously healthy 6-year-old girl suddenly developed severe abdominal pain and nausea. She was diagnosed with acute gastric volvulus, and a nasogastric tube was inserted to decompress the stomach. The volvulus did not reduce spontaneously; therefore, we performed endoscopic reduction on day 3 and were able to treat her successfully. We reviewed the Japanese literature on endoscopic reduction for gastric volvulus in children. Fifteen cases have been reported since 1994. There are no reports of perforation during the procedure. Patients whose general condition is stable and who have no severe anatomic anomalies are good candidates for endoscopic reduction.
Assessing Severity in Pediatric Pneumonia
Authors: Berg Are Stuwitz , Inchley Christopher Stephen , Fjaerli Hans Olav , Leegaard Truls Michael , Nakstad Britt
Published: May 2017

Objective

The aim of this study was to determine potential predictors of the need for major medical interventions in the context of assessing severity in pediatric pneumonia.

Methods

This was a prospective, cohort study of previously healthy children and adolescents younger than 18 years presenting to the pediatric emergency room with clinically suspected pneumonia and examining both the full cohort and those with radiologically confirmed pneumonia. The presence of hypoxemia (peripheral oxygen saturation ≤92%), age-specific tachypnea, high temperature (≥38.5°C), chest retraction score, modified Pediatric Early Warning Score, age, C-reactive protein, white blood cell (WBC) count, and chest radiograph findings at first assessment were analyzed by univariate and multivariate analyses to examine their predictive ability for the need for major medical interventions: supplemental oxygen, supplemental fluid, respiratory support, intensive care, or treatment for complications during admission.

Results

Fifty percent of the 394 cases of suspected pneumonia and 60% of the 265 cases of proven pneumonia were in need of 1 or more medical interventions. In multivariate logistic regression, only the presence of hypoxemia (odds ratios, 3.66 and 3.83 in suspected and proven pneumonia, respectively) and chest retraction score (odds ratios, 1.21 and 1.31, respectively for each 1-point increase in the score) significantly predicted the need for major medical interventions in both suspected and proven pneumonia. Specificity of 94% or greater, positive likelihood ratio of 6.4 or greater, and sensitivity of less than 40% were found for both hypoxemia and chest retraction score in predicting major medical interventions. C-reactive protein and white blood cell count were not associated with the need for these interventions, whereas multifocal radiographic changes were.

Conclusions

Hypoxemia and an assessment of chest retractions were the predictors significantly able to rule in more severe pneumonia, but with a limited clinical utility given their poor ability to rule out the need for major medical interventions. Future validation of these findings is needed.
Supporting a Culture of Evidence-Based Policy: Federal Funding for Public Health Law Evaluation Research, 1985-2014
Authors: Ibrahim Jennifer K. , Sorensen Aaron A. , Grunwald Heidi , Burris Scott
Published: May 2017

Objective:

Law powerfully influences health and can be a critical tool for promoting population well-being. Evaluation research is needed to measure the health effects of law and guide policy making and implementation. The purpose of this study was to assess trends in National Institutes of Health (NIH) funding for scientific public health law research (PHLR).

Methods:

Using data from the UberResearch NIH grant repository, we collected and coded all grants with a focus on health law between FY'85 and FY'14 and then analyzed the grants by funding agency and topic areas.

Results:

Between FY'85 and FY'14, NIH funded 510 research grants on health policy making, the health effects of laws or enforcement practices. On average, 4 PHLR grants were funded annually with a median total funding of $545 956 (range: $2535-$44 052 300) and a median annual funding of $205 223 (range: $2535-$7 019 517).

Conclusions:

National Institutes of Health has supported important PHLR but not nearly to the extent necessary to ensure that public health laws affecting the population are evaluated in a rigorous and timely manner. In addition to greater funding evaluation research, NIH can increase its support for creating legal datasets, fund training in PHLR, and work with the National Library of Medicine to create Medical Subject Headings (MeSH) terms related to PHLR.
The Affordable Care Act and Cancer Care Delivery
Authors: Brooks Gabriel A. , Hoverman J. Russell , Colla Carrie H.
Published: May 2017

The Affordable Care Act (ACA) has reformed US health care delivery through insurance coverage expansion, experiments in payment design, and funding for patient-centered clinical and health care delivery research. The impact on cancer care specifically has been far reaching, with new ACA-related programs that encourage coordinated, patient-centered, cost-effective care. Insurance expansions through private exchanges and Medicaid, along with preexisting condition clauses, have helped more than 20 million Americans gain health care coverage. Accountable care organizations, oncology patient-centered medical homes, and the Oncology Care Model—all implemented through the Center for Medicare & Medicaid Innovation—have initiated an accelerating shift toward value-based cancer care. Concurrently, evidence for better cancer outcomes and improved quality of cancer care is starting to accrue in the wake of ACA implementation.
The Impact of the Affordable Care Act on Cancer Survivorship
Authors: Leopold Christine , Park Elyse R. , Nekhlyudov Larissa
Published: May 2017

In 2010, the Patient Protection and Affordable Care Act (ACA) was implemented with the aim of expanding access to quality, affordable care. In this review, we describe the ACA provisions that are most relevant for cancer survivors, provide available published evidence, and offer insights for future research. We found that provisions focusing on access to preventive care, access to quality and coordinated care, and coverage expansion and increased affordability suggest beneficial effects. However, we identified research gaps specifically addressing the intended and unintended consequences of the ACA on cancer survivorship care. Whether or not the ACA continues in its current form, research should address the effects of enhanced preventive services, innovative models of care, and payment structures that promote quality of care, as well as access to affordable, equitable care for a growing population of cancer survivors.
The Affordable Care Act and End-of-Life Care for Patients With Cancer
Authors: Parikh Ravi B. , Wright Alexi A.
Published: May 2017

The Affordable Care Act (ACA) expanded access to high-quality end-of-life care for Americans with serious illness, including cancer. Before the ACA was enacted in 2010, nearly 715,000 patients died in hospitals annually,
1
despite evidence that most Americans prefer to die at home.
2
Moreover, fewer than half of Medicare beneficiaries used hospice before death, despite evidence that hospice services improve cancer patients’ quality of life near death and caregivers’ bereavement outcomes.
3–6
The ACA-stipulated programs and subsequent efforts were designed to address these deficiencies in access to high-quality end-of-life care. However, important gaps in coverage persist. In this article, we highlight the impact of the ACA on end-of-life care for individuals with and without cancer.
Circulating Heparan Sulfate Fragments Attenuate Histone-Induced Lung Injury Independently of Histone Binding
Authors: Zhang Yanlin , Haeger Sarah M. , Yang Yimu , Dailey Kyrie L. , Ford Joshay A. , Schmidt Eric P.
Published: May 2017

Extracellular histones are cationic damage-associated molecular pattern molecules capable of directly inducing cellular injury via charge-mediated interactions with plasma membranes. Accordingly, histones released into the plasma during critical illness are known to contribute to the onset and propagation of lung injury. Vascular injury (with consequent degradation of the endothelial glycocalyx) simultaneously releases anionic heparan sulfate fragments (hexa- to octasaccharides in size) into the plasma. It is unknown whether this endogenous release of heparan sulfate fragments modulates charge-dependent histone cytotoxicity, or if exogenous heparan sulfate fragments could therapeutically attenuate histone-induced lung injury. Using isothermic calorimetry, we found that extracellular histones only bind to heparan sulfate fragments ≥ 10 saccharides in size, suggesting that glycocalyx-derived heparan sulfate hexa/octasaccharides are incapable of intercepting/neutralizing circulating histones. However, we found that even heparan sulfate fragments incapable of histone binding (e.g., tetrasaccharides) attenuated histone-induced lung injury in vivo, suggesting a direct, size-independent protective effect of heparan sulfate. We found that histones had no effect on human neutrophils ex vivo but exerted toll-like receptor-independent cytotoxicity on human pulmonary microvascular endothelial cells in vitro. This cytotoxicity could be prevented by either the addition of negatively charged (i.e., highly sulfated) heparan sulfate tetrasaccharides (incapable of binding histones) or decasaccharides (capable of binding histones). Taken together, our findings suggest that heparan sulfate oligosaccharides may directly exert pulmonary endothelial-protective effects that attenuate histone-mediated lung injury.
Neuroimaging in Parkinson's disease: focus on substantia nigra and nigro-striatal projection
Authors: Frosini Daniela , Cosottini Mirco , Volterrani Duccio , Ceravolo Roberto
Published: May 2017

Purpose of review

The diagnosis of Parkinson disease is based on clinical features; however, unmet need is an imaging signature for Parkinson disease and the early differential diagnosis with atypical parkinsonisms. A summary of the molecular imaging and MRI recent evidences for Parkinson disease diagnosis will be presented in this review.

Recent findings

The nigro-striatal dysfunction explored by dopamine transporter imaging is not a mandatory diagnostic criterion for Parkinson disease, recent evidence supported its utility as in-vivo proof of degenerative parkinsonisms, and there might be compensatory mechanisms leading to an early overestimation. The visualization of abnormalities in substantia nigra by MRI has been recently described as sensitive and specific tool for Parkinson disease diagnosis, even in preclinical conditions, whereas it is not useful for distinguishing between Parkinson disease and atypical parkinsonisms. The relationship between the nigral anatomical changes, evaluated as structural alterations or neuromelanin signal decrease and the dopaminergic nigro-striatal function needs to be further clarified.

With the hopeful advent of potential neuroprotective drugs for PD, it is crucial to have imaging measures that are able to detect at risk subjects. Moreover it is desirable to increase the knowledge about which measure better predicts the probability and the time of clinical conversion to PD.
Fluorescence as a means of colour signal enhancement
Authors: Marshall Justin , Johnsen Sonke
Published: May 2017

Fluorescence is a physico-chemical energy exchange where shorter-wavelength photons are absorbed by a molecule and are re-emitted as longer-wavelength photons. It has been suggested a means of communication in several taxa including flowers, pitcher plants, corals, algae, worms, squid, spiders, stomatopods, fish, reptiles, parrots and humans. The surface or object that the pigment molecule is part of appears to glow due to its setting rather than an actual production of light, and this may enhance both signals and, in some cases, camouflage. This review examines some known uses of fluorescence, mainly in the context of visual communication in animals, the challenge being to distinguish when fluorescence is a functional feature of biological coloration or when it is a by-product of a pigment or other molecule. In general, we conclude that most observations of fluorescence lack enough evidence to suggest they are used in visually driven behaviours.

This article is part of the themed issue ‘Animal coloration: production, perception, function and application’.
Coevolution of coloration and colour vision?
Authors: Lind Olle , Henze Miriam J. , Kelber Almut , Osorio Daniel
Published: May 2017

The evolutionary relationship between signals and animal senses has broad significance, with potential consequences for speciation, and for the efficacy and honesty of biological communication. Here we outline current understanding of the diversity of colour vision in two contrasting groups: the phylogenetically conservative birds, and the more variable butterflies. Evidence for coevolution of colour signals and vision exists in both groups, but is limited to observations of phenotypic differences between visual systems, which might be correlated with coloration. Here, to illustrate how one might interpret the evolutionary significance of such differences, we used colour vision modelling based on an avian eye to evaluate the effects of variation in three key characters: photoreceptor spectral sensitivity, oil droplet pigmentation and the proportions of different photoreceptor types. The models predict that physiologically realistic changes in any one character will have little effect, but complementary shifts in all three can substantially affect discriminability of three types of natural spectra. These observations about the adaptive landscape of colour vision may help to explain the general conservatism of photoreceptor spectral sensitivities in birds. This approach can be extended to other types of eye and spectra to inform future work on coevolution of coloration and colour vision.

This article is part of the themed issue ‘Animal coloration: production, perception, function and application’.
Interspecific visual signalling in animals and plants: a functional classification
Authors: Caro Tim , Allen William L.
Published: May 2017

Organisms frequently gain advantages when they engage in signalling with individuals of other species. Here, we provide a functionally structured framework of the great variety of interspecific visual signals seen in nature, and then describe the different signalling mechanisms that have evolved in response to each of these functional requirements. We propose that interspecific visual signalling can be divided into six major functional categories: anti-predator, food acquisition, anti-parasite, host acquisition, reproductive and agonistic signalling, with each function enabled by several distinct mechanisms. We support our classification by reviewing the ecological and behavioural drivers of interspecific signalling in animals and plants, principally focusing on comparative studies that address large-scale patterns of diversity. Collating diverse examples of interspecific signalling into an organized set of functional and mechanistic categories places anachronistic behavioural and morphological labels in fresh context, clarifies terminology and redirects research effort towards understanding environmental influences driving interspecific signalling in nature.

This article is part of the themed issue ‘Animal coloration: production, perception, function and application’.
Signal function drives phenotypic and genetic diversity: the effects of signalling individual identity, quality or behavioural strategy
Authors: Tibbetts Elizabeth A. , Mullen Sean P. , Dale James
Published: May 2017

Animal coloration is influenced by selection pressures associated with communication. During communication, signallers display traits that inform receivers and modify receiver behaviour in ways that benefit signallers. Here, we discuss how selection on signallers to convey different kinds of information influences animal phenotypes and genotypes. Specifically, we address the phenotypic and genetic consequences of communicating three different kinds of information: individual identity, behavioural strategy and quality. Previous work has shown signals that convey different kinds of information differ in terms of the (i) type of selection acting on signallers (e.g. directional, stabilizing, or negative frequency dependent), and (ii) developmental basis of signals (i.e. heritability, genetic architecture). These differences result in signals that convey different information having consistently different phenotypic properties, including the amount, modality and continuity of intraspecific variation. Understanding how communication influences animal phenotypes may allow researchers to quickly identify putative functions of colour variation prior to experimentation. Signals that convey different information will also have divergent evolutionary consequences. For example, signalling individual identity can increase genetic diversity, signalling quality may decrease diversity, and signalling strategy can constrain adaptation and contribute to speciation. Considering recent advances in genomic resources, our framework highlights new opportunities to resolve the evolutionary consequences of selection on communication across diverse taxa and signal types.

This article is part of the themed issue ‘Animal coloration: production, perception, function and application’.
Human colour in mate choice and competition
Authors: Rowland Hannah M. , Burriss Robert P.
Published: May 2017

The colour of our skin and clothing affects how others perceive us and how we behave. Human skin colour varies conspicuously with genetic ancestry, but even subtle changes in skin colour due to diet, blood oxygenation and hormone levels influence social perceptions. In this review, we describe the theoretical and empirical frameworks in which human colour is researched. We explore how subtle skin colour differences relate to judgements of health and attractiveness. Also, because humans are one of the few organisms able to manipulate their apparent colour, we review how cosmetics and clothing are implicated in courtship and competition, both inside the laboratory and in the real world. Research on human colour is in its infancy compared with human psychophysics and colour research in non-human animals, and hence we present best-practice guidelines for methods and reporting, which we hope will improve the validity and reproducibility of studies on human coloration.

This article is part of the themed issue ‘Animal coloration: production, perception, function and application’.