bluuebunny/crossref_metadata_2025 huggingface dataset:
A note on band-limited minorants of an Euclidean ball
Authors: Gonçalves Felipe
Published: December 2017

We study the Beurling-Selberg problem of finding band-limited

L
1

L^1

-functions that lie below the indicator function of an Euclidean ball. We compute the critical radius of the support of the Fourier transform for which such construction can have a positive integral.
Microsclerotial Enumeration, Size, and Survival of Calonectria pseudonaviculata
Authors: Yang Xiao , Hong Chuanxue
Published: December 2017

Boxwood blight caused by Calonectria pseudonaviculata (Cps) is an emerging disease in the United States. Understanding the biology and survival of microsclerotia, the resting propagules of Cps, is important to managing the disease and restoring Cps-infested sites. In this study, an image-analyzing software (OpenCFU) was adapted to enumerate microsclerotia produced in culture plates. Microsclerotial counts increased with time up to 42 days while their size continued to grow for 70 days. Additionally, younger microsclerotia were less sensitive to extreme temperatures of –10 and 40°C than older ones. For instance, 21-day-old microsclerotia survived at almost twice the rate of 70-day-old ones after a 24-h exposure to –10°C. Likewise, the 21-day-old microsclerotia survived at much greater rates than 70-day-old ones (50 to 70% versus <10%) after a 24-h exposure to 40°C. The practical implications of these results are discussed.
Economics of gynecologic morcellation
Authors: Bortoletto Pietro , Friedman Jaclyn , Milad Magdy P.
Published: December 2017

Purpose of review

As the Food and Drug Administration raised concern over the power morcellator in 2014, the field has seen significant change, with patients and physicians questioning which procedure is safest and most cost-effective. The economic impact of these decisions is poorly understood.

Recent findings

Multiple new technologies have been developed to allow surgeons to continue to afford patients the many benefits of minimally invasive surgery while minimizing the risks of power morcellation. At the same time, researchers have focused on the true benefits of the power morcellator from a safety and cost perspective, and consistently found that with careful patient selection, by preventing laparotomies, it can be a cost-effective tool.

Changes since 2014 have resulted in new techniques and technologies to allow these minimally invasive procedures to continue to be offered in a safe manner. With this rapid change, physicians are altering their practice and patients are attempting to educate themselves to decide what is best for them. This evolution has allowed us to refocus on the cost implications of new developments, allowing stakeholders the opportunity to maximize patient safety and surgical outcomes while minimizing cost.
Quantification of Collagen Organization after Nerve Repair
Authors: Israel Jacqueline S. , Esquibel Corinne R. , Dingle Aaron M. , Liu Yuming , Keikhosravi Adib , Pisaniello Jane A. , Hesse Madison A. , Brodnick Sarah K. , Novello Joseph , Krugner-Higby Lisa , Williams Justin C. , Eliceiri Kevin W. , Poore Samuel O.
Published: December 2017

Background:

Clinical outcomes after nerve injury and repair remain suboptimal. Patients may be plagued by poor functional recovery and painful neuroma at the repair site, characterized by disorganized collagen and sprouting axons. Collagen deposition during wound healing can be intrinsically imaged using second harmonic generation (SHG) microscopy. The purpose of this study was to develop a protocol for SHG imaging of nerves and to assess whether collagen alignment can be quantified after nerve repair.

Methods:

Sciatic nerve transection and epineural repair was performed in male rats. The contralateral nerves were used as intra-animal controls. Ten-millimeter nerve segments were harvested and fixed onto slides. SHG images were collected using a 20× objective on a multiphoton microscope. Collagen fiber alignment was calculated using CurveAlign software. Alignment was calculated on a scale from 0 to 1, where 1 represents perfect alignment. Statistical analysis was performed using a linear mixed-effects model.

Results:

Eight male rats underwent right sciatic nerve repair using 9-0 Nylon suture. There were gross variations in collagen fiber organization in the repaired nerves compared with the controls. Quantitatively, collagen fibers were more aligned in the control nerves (mean alignment 0.754, SE 0.055) than in the repairs (mean alignment 0.413, SE 0.047; P < 0.001).

Conclusions:

SHG microscopy can be used to quantitate collagen after nerve repair via fiber alignment. Given that the development of neuroma likely reflects aberrant wound healing, ex vivo and/or in vivo SHG imaging may be useful for further investigation of the variables predisposing to neuroma.
FOVEAL AVASCULAR ZONE AREA ANALYSIS USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BEFORE AND AFTER IDIOPATHIC EPIRETINAL MEMBRANE SURGERY
Authors: Kitagawa Yorihisa , Shimada Hiroyuki , Shinojima Ari , Nakashizuka Hiroyuki
Published: December 2017

Purpose:

To determine the size of the foveal avascular zone (FAZ) by optical coherence tomography angiography before and after idiopathic epiretinal membrane surgery.

Methods:

Thirteen consecutive patients (13 eyes) with unilateral epiretinal membrane were studied retrospectively. Optical coherence tomography angiography was used to measure the FAZ area within 3 mm2 × 3 mm2 scans of the superficial (superficial FAZ) and deep plexus layers (deep FAZ) before and 6 months after vitrectomy. The unaffected fellow eyes were used as controls.

Results:

The mean superficial and deep FAZ areas at 6 months after vitrectomy (0.080 ± 0.038 and 0.113 ± 0.045 mm2, respectively) were significantly (P < 0.0001, P = 0.0035) larger than the corresponding mean preoperative FAZ areas (0.056 ± 0.030 and 0.082 ± 0.035 mm2). However, the areas of FAZ expansion were small (0.024 ± 0.013 and 0.031 ± 0.031 mm2). The mean postoperative superficial and deep FAZ areas were significantly (P < 0.0001, P < 0.0001) smaller than those of fellow eyes (0.295 ± 0.108 and 0.410 ± 0.142 mm2). Multiple regression analysis showed that preoperative FAZ area had the highest correlation with postoperative FAZ area (P < 0.05).

Conclusion:

This study showed horizontal contraction of the FAZ area in eyes with epiretinal membrane. Because preoperative FAZ area correlates with postoperative FAZ area, FAZ area may be a useful parameter for determining timing of surgery for epiretinal membrane.
Minimally Invasive Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy
Authors: Musharbash Farah N. , Schill Matthew R. , Henn Matthew C. , Damiano Ralph J.
Published: December 2017

Surgical septal myectomy is the treatment of choice for patients with symptomatic hypertrophic obstructive cardiomyopathy refractory to medications. This report describes our minimally invasive approach for performing a septal myectomy via a ministernotomy that has been used at our institution for more than a decade. In particular, patient preparation, surgical technique, and clinical considerations are highlighted. Performed properly, this minimally invasive technique is a feasible and effective approach in our experience.
Three-Dimensional Printing of Life-Like Models for Simulation and Training of Minimally Invasive Cardiac Surgery
Authors: Yamada Toshiyuki , Osaka Motohiko , Uchimuro Tomoya , Yoon Ryogen , Morikawa Toshiaki , Sugimoto Maki , Suda Hisao , Shimizu Hideyuki
Published: December 2017

Objective

As the use of minimally invasive surgery in cardiothoracic surgery increases, so does the need for simulation and training. We developed a heart model for simulation and training of minimally invasive cardiac surgery, particularly minimally invasive mitral valve repair using our new three-dimensional printing system.

Methods

Digital imaging and communication in medicine data from patient computed tomography, three-dimensional computer-aided design, and three-dimensional printing helped create replicas of the heart and thoracic cavity. A polyvinyl alcohol model material with a texture and physical properties similar to those of heart tissue was initially used in mitral valve replicas to simulate surgical procedures. To develop this material, we mechanically investigated the composition of each part of the porcine heart.

Results

We investigated the elastic modulus and breaking strength of the porcine heart. Based on investigation results, the cardiac model was set at rupture strength 20 MPa, elastic modulus 0.17 MPa, and moisture content 85%. This provided a biotexture and feeling exactly like a patient heart. Computed tomography scans confirmed that the model shape was nearly the same as that of a human heart. We simulated minimally invasive mitral valve repair, including ring annuloplasty, chordal reconstruction, resection and suture, and edge-to-edge repair. Full surgery simulations using this model used minimally invasive cardiac surgery tools including a robot.

Conclusions

This life-like model can be used as a standard simulator to train younger, less experienced surgeons to practice minimally invasive cardiac surgery procedures and may help develop new operative tools.
The Need for Consistent Predictors of Success for Surgical Ablation of Atrial Fibrillation
Authors: Ad Niv , Holmes Sari Diana , Patel Jay , Je Hyung Gon , Shuman Deborah J.
Published: December 2017

Objective

As with any medical therapy, identification of consistent and reliable outcome predictors is essential to understanding the efficacy of surgical ablation for atrial fibrillation. We originally intended to conduct a meta-analysis on atrial fibrillation surgical ablation to identify clinical factors that are most often associated with success. However, these studies are greatly heterogeneous. We conducted a systematic review to identify trends in outcome predictors and to provide recommendations for more uniform data analysis and reporting.

Methods

Relevant studies published between January 2005 and September 2013 were identified. To minimize heterogeneity, data were extracted only from multivariate analyses of outcome predictors. The initial approach for meta-analytic analyses was abandoned for a systematic review approach.

Results

From 604 initial citations, 19 studies with 5200 patients were included in the review. Systematic review of multivariable atrial fibrillation recurrence rates after surgical ablation revealed that studies were statistically heterogeneous, but atrial fibrillation recurrence after surgical ablation in mid-term follow-up was most often predicted by left atrium size, duration of atrial fibrillation, fine-wave atrial fibrillation, age of patient, and atrial fibrillation type.

Conclusions

The innate heterogeneity of published data precludes a meta-analysis for predictors of surgical ablation success. Of the few published studies that allow comparison, the most consistent predictors of failure were enlarged left atrium and long atrial fibrillation duration. These results underscore the need for consistent and reliable outcome predictors. We strongly recommend the development of a standardized system of measurement for consistent clinical parameters that can be used in outcome analyses for surgical ablation of atrial fibrillation.
Lithium + Colchicine
Authors: Mooney John J. , Brady Roscoe O.
Published: December 2017

Purpose

Rosenblat and McIntyre (Acta Psychiatr Scand. 2015;132: 180–191) propose that immune disorders are important mediators between bipolar disorders and medical comorbidities. Rosenblat et al (Bipolar Disord. 2016;18:89–101) present a meta-analysis showing that adjunctive anti-inflammatory agents could evoke moderate antidepressant responses in bipolar disorders. We propose using the anti-inflammatory drug colchicine to improve the long-term safety and efficacy of lithium treatment for bipolar disorders.

Methods

This report is based on searches of the PubMed and Web of Science databases.

Results

Bipolar disorders are associated with significant medical comorbidities such as hypertension, overweight/obesity, diabetes mellitus, metabolic syndrome, and arteriosclerosis, accompanied by enhanced release of pro-inflammatory markers during changes in mood state. During lithium therapy, granulocyte-colony stimulating factor, CD34+ hematopoietic stem/progenitor cells, and neutrophil elastase enter the circulation with activated neutrophils to promote the extravascular migration of activated neutrophils and enhance tissue inflammation. Concurrent treatment with lithium and low-dose colchicine could facilitate the responsiveness of bipolar patients to lithium by reducing leukocyte tissue emigration, the release of neutrophil elastase, and the release of leukocyte pro-inflammatory cytokines such as IL-1β that are regulated by the NLRP3 inflammasome assembly complex.

Conclusions

Concurrent therapy with lithium and low-dose colchicine could reduce complications involving leukocyte-mediated inflammatory states in bipolar patients and promote patient acceptance and responsiveness to lithium therapy.
Attitude of Nursing Students Toward Scientific Research: A Cross-Sectional Study in Turkey
Authors: ÜNVER Seher , SEMERCI Remziye , ÖZKAN Zeynep Kizilcik , AVCIBAŞI İlker
Published: December 2017

Background:

Nursing, a social applied science, is a dynamic profession. Professional nurses must be curious, investigative, and open to learning as well as practice critical and analytic thinking to sustain their professionalism.

Purpose:

The aim of this study was to determine the attitudes of nursing students toward scientific research.

Methods:

A descriptive and cross-sectional study design was used. This study was conducted at a nursing department of a university in Turkey. A sample of 375 nursing students participated. Data were collected using the “Personal Information Form” and “Attitude Scale towards Scientific Studies.” Standard descriptive statistical methods, correlation, Mann–Whitney U, Kruskal–Wallis, and post hoc Bonferroni were used in data analysis.

Results:

Nearly all (90.1%) of the participants were female, and 33.9% were sophomore (second-year) students. Junior (third-year) students held the most positive attitudes toward research, as compared with the participants in other academic years. Participants who had participated in scientific activities held more positive attitudes toward research than those who had not. Participants who had prior experience doing scientific research showed more positive attitudes toward research and researchers than those without this experience. Being older, having scientific research experience, following the continuous broadcasts related to nursing, and participating in scientific activities all significantly influenced attitude toward research (p < .05).

Conclusions/Implications for Practice:

Although nursing students who participated in this study exhibited generally positive attitudes toward scientific research, they had relatively little experience participating in scientific activities. Therefore, to foster a positive scientific research culture among undergraduate students, grants should be provided that encourage wider participation in scientific activities and offer opportunities for undergraduate students to do scientific research.
Significant Effect of Acupressure in Elevating Blood Stem Cell Factor During Chemotherapy in Patients With Gynecologic Cancer
Authors: SHIH Ya-Wen , YANG Shun-Fa , CHIEN Ming-Hsien , CHANG Ching-Wen , CHANG Vincent H. S. , TSAI Hsiu-Ting
Published: December 2017

Background:

Chemotherapy is used mainly to treat and control the progression of gynecological cancer. Bone marrow suppression, one of the adverse side effects of chemotherapy, may decrease immune function, increasing the risk of serious, fatal infections.

Purpose:

The aims of this study were to evaluate the effectiveness of noninvasive acupressure in preventing and diminishing chemotherapy-induced myelosuppression in patients with gynecologic cancer and to determine whether this effect is associated with the regulation of the expressions of granulocyte-macrophage colony-stimulating factor and stem cell factor (SCF).

Methods:

In total, 28 women with gynecological cancer were randomly assigned either to the experimental group (n= 10) or to the control group (n= 18). The experimental group received acupressure of 5-minute duration to the Hegu (LI4), Quchi (LI11), Xuehai (SP10), Sanyinjiao (SP6), Taixi (K3), Zusanli (ST36), Taichong (LR3), and Baihui (GV20) points, respectively, three times per day for 6 weeks. The control group did not receive the acupressure intervention. The blood count, including white blood cells, platelets, and hemoglobin, and serum levels for SCF and granulocyte-macrophage colony-stimulating factor were assessed before (pretest) and 6 weeks after (posttest) the participants’ first course of chemotherapy.

Results:

At posttest, blood hemoglobin had significantly decreased from (mean ±SD) 11.6 ± 2.2 to 10.8 ±1.6 mg/dl (p= .03) in the control group. However, no significant pretest–posttest difference in hemoglobin concentration (11.4 ± 1.0 vs. 10.9 ± 1.1 mg/dl) was detected in the experimental group. Levels of SCF increased significantly between pretest and posttest in both the control group (from 1196.10 ± 293.17 to 1325.05 ± 253.77 ng/ml;p= .01) and the acupressure group (from 1046.78 ± 469.52 to 1387.06 ± 310.00 ng/ml;p= .007). In addition, a borderline difference (p= .05) in mean pretest–posttest SCF increase was found between the acupressure group (340.28 ± 255.46 ng/ml) and the control group (128.94 ± 250.64 ng/ml). Finally, a significant time-dependent interactive effect was found between acupressure and the increased blood level of SCF at posttest (β = 211.34,p= .02).

Conclusions/Implications for Practice:

The findings support that acupressure on specific acupoints increases blood SCF levels significantly, which may help protect chemotherapy patients from experiencing reduced hemoglobin levels and may relieve chemotherapy-induced myelosuppression in patients with gynecologic cancer. This noninvasive approach is suggested for practical implementation in patients undergoing a course of chemotherapy.
Knowledge of the Warning Signs of Foot Ulcer Deterioration Among Patients With Diabetes
Authors: CHIN Yen-Fan , YEH Jiun-Ting , YU Hsing-Yi , WENG Li-Chueh
Published: December 2017

Background:

Seeking treatment in a timely manner may prevent lower limb amputation subsequent to diabetic foot ulcers. Knowledge regarding the warning signs is one importantfactor that is related to the timely treatment seeking of patients with diabetic foot ulcers. However, there is no previousresearch on which aspects of such knowledge that patients with diabetes are lacking.

Purpose:

The aims of this study were to test the psychometric properties of a questionnaire that was designed to assess the knowledge of the warning signs of diabetic foot ulcer deterioration and to determine the knowledge of these warning signs among patients with a history of diabetic foot ulcers.

Methods:

A cross-sectional study design was used. Patients with a history of diabetic foot ulcers were recruited using convenience sampling (N = 385). Data were analyzed using Spearman’s rank correlation and the Mann–Whitney U test.

Results:

The questionnaire showed good known-group validity, satisfied internal consistency (Kuder-Richardson Formula 20 = .82), and exhibited acceptable 2-week test–retest reliability (Spearman’s rho coefficient = .75). More than 30% of the participants were unaware of the warning signs of peripheral vascular insufficiency and severe infection. Of the participants, 75.8% felt that the time to seek medical treatment of diabetic foot ulcers was when they experienced wound deterioration. Those who held this opinion had significantly less knowledge regarding the warning signs of diabetic foot ulcer deterioration than did those who had not. Other factors that were significantly associated with less knowledge included being older, having less education, not having an existing foot ulcer, having no foot ulcer treatment history, and never having received education regarding foot ulcers.

Conclusions/Implications for Practice:

The questionnaire showed adequate validity and reliability and thus may be used by healthcare practitioners and researchers to assess the knowledge of at-risk patients regarding the warning signs of diabetic foot ulcer deterioration. Patient education regarding the importance of timely treatment seeking and warning signs should be promoted.
Celiac disease is uncommon in irritable bowel syndrome in the USA
Authors: Almazar Ann E. , Talley Nicholas J. , Larson Joseph J. , Atkinson Elizabeth J. , Murray Joseph A. , Saito Yuri A.
Published: December 2017

Background and aims

Routine serologic testing for celiac disease (CD) may be useful in irritable bowel syndrome (IBS) patients, but this is controversial. We aimed to compare the prevalence of unrecognized CD in a large cohort of patients with and without IBS.

Participants and methods

This is a family case–control IBS study conducted at a single US academic medical center. Stored serum and DNA were available. Tissue transglutaminase (TTg) immunoglobulin A was performed, followed by indirect immunofluorescence testing for endomysial antibodies with positive or weakly positive TTg results. Individuals were considered to have CD if both results were positive.χ2and Fisher’s exact tests were used to compare prevalence between the two groups.

Results

Serum samples were studied from 533 cases and 531 controls. In all, 80% of participants were female, with a median age of 50 years; 65% of cases and 0% controls met the Rome criteria for IBS. Previous serological testing for CD had occurred in 142 (27%) cases and 13 (2%) controls, but none had CD on subsequent testing. Six (1.1%) cases versus five (0.9%) controls had positive or weakly positive TTg test. Six cases (1.1%) versus three (0.6%) controls were confirmed to have CD by endomysial antibody (P=0.51).

Conclusion

No difference in the prevalence of CD between patients with IBS and patients without IBS at a tertiary medical center was observed. Our findings do not support routine celiac serologic or genetic testing in patients with IBS in all US populations.
Evidence-Based Management of Drains Following Pancreatic Resection
Authors: Villafane-Ferriol Nicole , Shah Rohan M. , Mohammed Somala , Van Buren George , Barakat Omar , Massarweh Nader N. , Tran Cao Hop S. , Silberfein Eric J. , Hsu Cary , Fisher William E.
Published: December 2017

Many pancreatic surgeons continue to use intraperitoneal drains, but others have limited or avoided their use, believing this improves outcomes. We conducted a systematic review and meta-analysis of the literature assessing outcomes in pancreatectomy without drains, selective drainage, and early drain removal. We searched PubMed, Embase, and the Cochrane Library databases and conducted a systematic review of randomized and nonrandomized studies comparing routine intra-abdominal drainage versus no drainage, selective drain use, and early versus late drain removal after pancreatectomy, with major complications as the primary outcome. A meta-analysis of the literature assessing routine use of drains was conducted using the random-effects model. A total of 461 articles met search criteria from PubMed (168 articles), Embase (263 articles), and the Cochrane Library (30 articles). After case reports and articles without primary data on complications were excluded, 14 studies were identified for systematic review. Definitive evidence-based recommendations cannot be made regarding the management of drains following pancreatectomy because of limitations in the available literature. Based on available evidence, the most conservative approach, pending further data, is routine placement of a drain and early removal unless the patient's clinical course or drain fluid amylase concentration suggests a developing fistula.
Fetal Anemia Causing Hydrops Fetalis From an Alpha-Globin Variant: Homozygous Hemoglobin Constant Spring
Authors: Komvilaisak Patcharee , Komvilaisak Ratana , Jetsrisuparb Arunee , Wiangnon Surapon , Jirapradittha Junya , Kiatchoosakun Pakaphan , Fucharoen Goonapa
Published: December 2017

Background:

Fetal anemia is often assumed to be due to red cell alloimmunization and Parvovirus infection, and can lead to hydrops fetalis and death in utero. Other causes, such as mutations of hemoglobin alpha, are less commonly considered.

Methods:

We report 7 cases with fetal anemia causing hydrops fetalis. Serial Doppler ultrasound for measurement peak systolic velocity (PSV) of middle cerebral artery (MCA) was used for evaluation of fetal anemia. Fetal anemia is suggested if the MCA/PSV ratio is >1.5 multiple of median. Cordocentesis was performed subsequently to find the cause of fetal anemia and check fetal hemoglobin for consideration of intrauterine infusion. Investigations for fetal anemia include complete blood count, blood morphology, and blood group of mother and fetus, reticulocyte counts, red cell indices, screening for thalassemia, hemoglobin typing, acid elution test, parvovirus B 19 serology, and TORCH titer (toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, human immunodeficiency virus, and syphilis). Intrauterine infusion, using irradiated prestorage filtered red cell with hematocrit level of 80%, is indicated if fetal hemoglobin is <10 g/dL.

Result:

Seven cases with fetal anemia were prenatally diagnosed from gestational ages 20 to 34 weeks. Initial hematocrit in these cases varied from 9% to 17.2%. In each case, causes of anemia were determined using the investigations listed above. All cases underwent uneventfully up to 3 intrauterine transfusions. DNA study for thalassemia demonstrated homozygous Constant Spring (CS) in 5 cases, homozygous CS with heterozygous E in 1 case, and compound heterozygous CS and Pakse in 1 case. The perinatal outcomes were normal term in 5 cases, preterm in 2 cases. Low birth weight was determined in 2 cases. The screening for thalassemia major, including the osmotic fragility and dichlorophenol indophenol precipitation test (DCIP), is not helpful for detecting hemoglobin variants such as Constant Spring or Pakse.

This study emphasizes homozygous Constant Spring and compound heterozygous CS and Pakse as a cause of hydrops fetalis. Proper management for the fetus after diagnosis can lead to a good fetal outcome. Prevention control programs should include screening of parents for the heterozygous state.
Delayed Methotrexate Clearance Despite Carboxypeptidase-G2 (Glucarpidase) Administration in 2 Patients With Toxic Methotrexate Levels
Authors: Wyatt Kirk D. , Cooper Jeffrey , Scott Katherine , Broomall Eileen , Altaf Sadaf , Hogan Marie C. , Rodriguez Vilmarie , Khan Shakila
Published: December 2017

High-dose methotrexate has been a treatment for osteosarcoma; however, its nephrotoxic effects are considerable. Carboxypeptidase-G2 (glucarpidase) was approved by the US Food and Drug Administration in 2012 for treatment of toxic methotrexate levels. We report our experience using glucarpidase under compassionate use before Food and Drug Administration approval in 2 patients who had delayed methotrexate clearance and prolonged kidney injury despite glucarpidase administration. Our results show that patients with methotrexate toxicity may require repeated doses of glucarpidase in addition to supportive measures, such as dialysis.
Classroom Participation
Authors: Tedesco-Schneck Mary
Published: December 2017

Nursing faculty need to provide students with problem-solving skills during their formative academic years, and feminist pedagogy supported by classroom participation may foster these skills. Through the lens of feminist pedagogy, factors that influence classroom participation of nursing students were identified using the College and University Classroom Environment Inventory. Nursing students reported higher levels of attendance and punctuality compared with preparation and contribution to class discussion and favored personalization and equity over innovation and individualization in the classroom.
Prevention of HIV-1 Transmission Through Breastfeeding: Efficacy and Safety of Maternal Antiretroviral Therapy Versus Infant Nevirapine Prophylaxis for Duration of Breastfeeding in HIV-1-Infected Women With High CD4 Cell Count (IMPAACT PROMISE): A Randomized, Open-Label, Clinical Trial
Authors: Flynn Patricia M. , Taha Taha E. , Cababasay Mae , Fowler Mary Glenn , Mofenson Lynne M. , Owor Maxensia , Fiscus Susan , Stranix-Chibanda Lynda , Coutsoudis Anna , Gnanashanmugam Devasena , Chakhtoura Nahida , McCarthy Katie , Mukuzunga Cornelius , Makanani Bonus , Moodley Dhayendre , Nematadzira Teacler , Kusakara Bangini , Patil Sandesh , Vhembo Tichaona , Bobat Raziya , Mmbaga Blandina T. , Masenya Maysseb , Nyati Mandisa , Theron Gerhard , Mulenga Helen , Butler Kevin , Shapiro David E. ,   the PROMISE Study Team
Published: December 2017

Background:

No randomized trial has directly compared the efficacy of prolonged infant antiretroviral prophylaxis versus maternal antiretroviral therapy (mART) for prevention of mother-to-child transmission throughout the breastfeeding period.

Setting:

Fourteen sites in Sub-Saharan Africa and India.

Methods:

A randomized, open-label strategy trial was conducted in HIV-1–infected women with CD4 counts ≥350 cells/mm3 (or ≥country-specific ART threshold if higher) and their breastfeeding HIV-1–uninfected newborns. Randomization at 6–14 days postpartum was to mART or infant nevirapine (iNVP) prophylaxis continued until 18 months after delivery or breastfeeding cessation, infant HIV-1 infection, or toxicity, whichever occurred first. The primary efficacy outcome was confirmed infant HIV-1 infection. Efficacy analyses included all randomized mother–infant pairs except those with infant HIV-1 infection at entry.

Results:

Between June 2011 and October 2014, 2431 mother–infant pairs were enrolled; 97% of women were World Health Organization Clinical Stage I, median screening CD4 count 686 cells/mm3. Median infant gestational age/birth weight was 39 weeks/2.9 kilograms. Seven of 1219 (0.57%) and 7 of 1211 (0.58%) analyzed infants in the mART and iNVP arms, respectively, were HIV-infected (hazard ratio 1.0, 96% repeated confidence interval 0.3–3.1); infant HIV-free survival was high (97.1%, mART and 97.7%, iNVP, at 24 months). There were no significant differences between arms in median time to breastfeeding cessation (16 months) or incidence of severe, life-threatening, or fatal adverse events for mothers or infants (14 and 42 per 100 person-years, respectively).

Conclusions:

Both mART and iNVP prophylaxis strategies were safe and associated with very low breastfeeding HIV-1 transmission and high infant HIV-1–free survival at 24 months.
Elevated Interleukin 1β and Interleukin 6 Levels in the Serum of Children With Hyperuricemia
Authors: Di Yazhen , Wang Jiapei , Chen Yuanling , Sun Nan , Wu Ling , Dai Xiahua , Shen Mengjiao , Ying Qianqian , Fu Shiwei
Published: December 2017

Purposes

The aim of this study was to investigate the serum levels and clinical significance of interleukin 1β (IL-1β) and IL-6 in children with hyperuricemia (HUA).

Methods

We included 71 children with HUA and 71 children with no HUA as control subjects. Children with HUA were divided into groups I and II according to whether they had a history of acute gout-like attacks (including sudden monoarthritis of rapid onset with intense pain and swelling). Group I was examined twice (A, in the acute phase; B, in the remission phase). Serum IL-1β and IL-6 levels were measured by enzyme-linked immunosorbent assay.

Results

Serum IL-1β and IL-6 levels were increased in children with HUA and were overall statistically different from the control group (P < 0.05, respectively). Serum IL-1β and IL-6 were significantly higher in group IA in comparison with group IB, group II, and control subjects (P < 0.05, respectively), as well as in groups IB and II compared with control subjects (P < 0.05, respectively). In group IB, the serum IL-1β and IL-6 concentrations were higher than those in group II, but there were no statistical differences (P > 0.05). In addition, in children with HUA, serum IL-1β and IL-6 levels were positively associated with white blood cell count, neutrophil count, monocyte count, uric acid levels, erythrocyte sedimentation rate, C-reactive protein, blood urea nitrogen, and serum creatinine levels (all P < 0.05), but were not associated with triglycerides, total cholesterol, low-density lipoprotein cholesterol, or high-density lipoprotein cholesterol levels (all P > 0.05).

Conclusion

IL-1β and IL-6 levels are increased in children with hyperuricemia, even if they have not had acute gout. Further studies are necessary to fully characterize the significance of IL-1β and IL-6 found in HUA children, and whether they could be correlated with long-term prognosis.
Racial Variation in Total Knee Replacement in a Diverse Nationwide Clinical Trial
Authors: MacFarlane Lindsey A. , Kim Eunjung , Cook Nancy R. , Lee I-Min , Iversen Maura D. , Katz Jeffrey N. , Costenbader Karen H.
Published: December 2017

Objective

Racial variation in total knee replacement (TKR) utilization in the United States has been reported in administrative database studies. We investigated racial variation in TKR procedures in a diverse cohort with severe knee pain followed in an ongoing clinical trial.

Methods

VITAL (VITamin D and OmegA-3 TriaL) is a nationwide, randomized controlled trial of 25,874 adults, 20% of whom are black. We identified a subgroup highly likely to have knee osteoarthritis based on severity of knee pain, physician-diagnosed knee osteoarthritis, and inability to walk 2 to 3 blocks without pain. Participants completed a modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and self-reported incident TKR annually in follow-up. Using Cox regression, we analyzed the association of black versus white race with TKR, adjusting for demographic and socioeconomic characteristics, comorbidities, and WOMAC pain and function.

Results

Among 1070 participants who met the inclusion criteria, black participants reported worse baseline WOMAC pain (45 vs. 32,P< 0.001) and worse function (45 vs. 32,P< 0.001). During a median of 3.6 years (interquartile range, 3.2, 3.8 years) of follow-up, TKRs were reported by 180 participants. Black participants were less likely to undergo TKR (11% vs. 19%). After adjustment, the hazard ratio for TKR for black versus white participants was 0.51 (95% confidence interval, 0.32–0.81). Lower use of TKR among black participants was observed across all levels of income and education.

Conclusions

Despite worse baseline knee pain and function, black participants had much lower adjusted risk of having TKR than white participants, demonstrating persistent racial disparity in TKR utilization.
Utility of Electronic Medical Records in Community Rheumatology Practice for Assessing Quality of Care Indicators for Gout
Authors: Estrada Augusto , Tsao Nicole W. , Howren Alyssa , Esdaile John M. , Shojania Kamran , De Vera Mary A.
Published: December 2017

Objectives

With comprehensive capture of information on patient encounters, electronic medical records (EMRs) may have utility for assessing adherence to quality indicators (QIs) in gout. Our objectives were to translate 10 previously established gout QIs into relevant EMR data and evaluate and describe the feasibility of using EMRs to assess gout QIs.

Methods

Using EMRs from 3 community rheumatology practices in Vancouver, British Columbia, Canada, we identified gout patients seen between January 1, 2012, and December 31, 2013. We translated each gout QI into potential EMR variables that would allow identification of patients the QI pertains to and whether the QI could be assessed. We extracted deidentified EMR data on gout diagnosis, medications, laboratory tests, radiological tests, and clinical notes and calculated the percent availability of data for each QI.

Results

We included 125 patients with gout, with mean age of 64 ± 17 years and with males comprising 78%. Overall, there were sufficient EMR data to allow translation of 7 QIs and assessment of 6 QIs including therapy-related gout QIs (69%–83% data availability) and one counseling-related QI (8% data availability). The highest percent data availability was observed in the single QI translated into EMR data and assessed based on diagnostic codes and prescription medications and not laboratory tests.

Conclusions

Electronic medical records are promising tools for assessing QIs for gout. It was feasible to translate seven gout QIs into relevant EMR variables and there was sufficient EMR data to feasibly assess six of these QIs –Our findings lend evidence to support the utility of EMRs for ut QI assessment, with implications for helping improve management of this disease.
Vaccination Recommendations for Adults With Autoimmune Inflammatory Rheumatic Diseases in Latin America
Authors: Brenol Claiton Viegas , Azevedo Valderilio Feijo , Bonvehi Pablo Eduardo , Coral-Alvarado Paola Ximena , Granados Julio , Muñoz-Louis Roberto , Pineda Carlos , Vizzotti Carla
Published: December 2017

Background/Objective

Patients with autoimmune inflammatory rheumatic diseases (AIRDs) are at increased risk of contracting severe infections and suffering complications, particularly when they are receiving immunomodulating therapy. Vaccination is an important means to prevent many potential infections and thereby reduce the morbidity and mortality associated with AIRD. The purpose of this consensus document is to provide health care professionals with recommendations for the vaccination of AIRD patients who reside in Latin America. The recommendations were developed by an expert committee from the region based on a review of the literature and their clinical experience.

Methods

The Americas Health Foundation (AHF) used PubMed and EMBASE to identify clinicians and scientists with an academic or hospital affiliation and who had published in the field of adult vaccination and rheumatic diseases since 2010. As a result of this effort, AHF convened an 8-member panel of clinical and scientific experts from Latin America. Both the AHF and panel members conducted a careful literature review to identify relevant publications in the areas of adult vaccination and rheumatology, and the sum of the articles identified was provided to the entire panel. Prior to the conference, panelists were each asked to prepare a written response to a salient issue on the subject, identified by AHF.

Results and Conclusions

During the conference, each response was edited by the entire group, through numerous drafts and rounds of discussion until a complete consensus on vaccination recommendations for adult patients with AIRDs was obtained, including 7 key recommendations.
Cost of Major Complications After Liver Resection in the United States
Authors: Idrees Jay J. , Johnston Fabian M. , Canner Joseph K. , Dillhoff Mary , Schmidt Carl , Haut Elliott R. , Pawlik Timothy M.
Published: December 2017

Objective:

The aim of the study was to estimate the cost of major complications after liver resection and determine whether high-volume (HV) centers are cost-effective.

Methods:

From 2002 to 2011, 96,107 cases of liver resection performed in the United States were identified using Nationwide Inpatient Sample. Hospitals were categorized as HV (150+ cases/yr), medium-volume (51–149 cases/yr), and low-volume (LV) (1–50 cases/yr) centers. Multivariable regression analysis identified predictors of cost. Propensity score matching comparing cases with versus without complications and costs of specific complications were estimated. Cost-effectiveness of HV centers was determined by calculating the incremental cost-effectiveness ratio.

Results:

After propensity score matching, the occurrence of a major complication added $33,855 extra cost, increased mean length of stay by 8.7 [95% confidence interval (CI), 8.4–9] days and increased risk of death by 9.3% (all P < 0.001). The cost of most common complications was wound infection (3.8%, $21,995), renal failure (2.8%, $19,201), respiratory failure (2.7%, $25,169), and hemorrhage (3.3%, $9,180), whereas sepsis (0.8%, $33,009), gastrointestinal bleeding (0.5%, $32,835), fistula (0.2%, $27,079), and foreign body removal (0.1%, $29,404) were most costly, but less frequent. Compared with LV centers, liver resection at HV centers was associated with $5109 (95% CI, 4409–5809, P < 0.001) more cost per case, yet on average 0.54 years (95% CI, 0.23–0.86) longer survival for an incremental cost-effectiveness ratio of $9392.

Conclusions:

HV centers were cost-effective at performing liver resection compared with LV centers. After liver resection, complications such as surgical site infection, respiratory failure, and renal failure contributed the most to annual cost burden.
Development of a Formula to Correct Particle-Enhanced Turbidimetric Inhibition Immunoassay Values so That it More Precisely Reflects High-Performance Liquid Chromatography Values for Mycophenolic Acid
Authors: Nakano Keiichi , Iwami Daiki , Yamada Takehiro , Morita Ken , Yasuda Keiko , Shibuya Hitoshi , Kahata Kaoru , Shinohara Nobuo , Shimizu Chikara
Published: December 2017

Background

Mycophenolic acid (MPA) concentration measured by homogeneous particle-enhanced turbidimetric inhibition immunoassay (PETINA) may be overestimated due to its cross-reactivity with pharmacologically inactive MPA glucuronide (MPAG), as well as other minor metabolites, accumulated with renal function impairment or co-administered cyclosporine A. In contrast, high-performance liquid chromatography (HPLC) is precise because it can exclude the cross-reactivity. In this study, we assumed HPLC values for MPA (HPLC-MPA) as a reference and aimed to develop a formula correcting PETINA values for MPA (PETINA-MPA) to more precisely reflect HPLC-MPA.

Methods

MPA trough concentrations were measured both by HPLC-UV and PETINA in 39 samples issued from 39 solid-organ transplant recipients. MPAG concentrations were also measured using HPLC UV assay. We determined the impacts of renal function and coadministered calcineurin inhibitor on concentrations of MPA and MPAG measured by HPLC. Then, we evaluated the difference between PETINA-MPA and HPLC-MPA. Finally, we develop a formula to reflect HPLC-MPA by using multilinear regression analysis.

Results

MPAG concentration was negatively correlated with estimated glomerular filtration rate (eGFR) (R
2 = 0.376, P < 0.001), although MPA was not correlated with eGFR. There were no significant differences in MPA or MPAG concentrations per dose between the patients who were co-administered tacrolimus versus cyclosporine A. Finally, we developed the formulas to reflect HPLC-MPA:

Formula 1: Estimated MPA concentration = 0.048 + 0.798 × PETINA‐MPA

Formula 2: Estimated MPA concentration = − 0.059 + 0.800 × PETINA‐MPA + 0.002 × eGFR

However, there was no significant improvement in the coefficient of determination with addition of eGFR in the formula, suggesting that HPLC-MPA can be well predicted by only 1 variable, PETINA-MPA.

Conclusions

This study developed a formula so that PETINA-MPA can be corrected to more precisely reflect HPLC-MPA.
Metabolic retroconversion of trimethylamine N-oxide and the gut microbiota
Authors: Hoyles Lesley , Jiménez-Pranteda Maria L. , Chilloux Julien , Brial Francois , Myridakis Antonis , Aranias Thomas , Magnan Christophe , Gibson Glenn R. , Sanderson Jeremy D. , Nicholson Jeremy K. , Gauguier Dominique , McCartney Anne L. , Dumas Marc-Emmanuel
Published: December 2017

BACKGROUND

The dietary methylamines choline, carnitine and phosphatidylcholine are used by the gut microbiota to produce a range of metabolites, including trimethylamine (TMA). However, little is known about the use of trimethylamine N-oxide (TMAO) by this consortium of microbes.

RESULTS

A feeding study using deuterated TMAO in C57BL6/J mice demonstrated microbial conversion of TMAO to TMA, with uptake of TMA into the bloodstream and its conversion to TMAO. Microbial activity necessary to convert TMAO to TMA was suppressed in antibiotic-treated mice, with deuterated TMAO being taken up directly into the bloodstream. In batch-culture fermentation systems inoculated with human faeces, growth of Enterobacteriaceae was stimulated in the presence of TMAO. Human-derived faecal and caecal bacteria (n = 66 isolates) were screened on solid and liquid media for their ability to use TMAO, with metabolites in spent media analysed by 1H-NMR. As with the in vitro fermentation experiments, TMAO stimulated the growth of Enterobacteriaceae; these bacteria produced most TMA from TMAO. Caecal/small intestinal isolates of Escherichia coli produced more TMA from TMAO than their faecal counterparts. Lactic acid bacteria produced increased amounts of lactate when grown in the presence of TMAO, but did not produce large amounts of TMA. Clostridia (sensu stricto), bifidobacteria and coriobacteria were significantly correlated with TMA production in the mixed fermentation system but did not produce notable quantities of TMA from TMAO in pure culture.

CONCLUSIONS

Reduction of TMAO by the gut microbiota (predominantly Enterobacteriaceae) to TMA followed by host uptake of TMA into the bloodstream from the intestine and its conversion back to TMAO by host hepatic enzymes is an example of metabolic retroconversion. TMAO influences microbial metabolism depending on isolation source and taxon of gut bacterium.

Correlation of metabolomic and abundance data from mixed microbiota fermentation systems did not give a true picture of which members of the gut microbiota were responsible for converting TMAO to TMA; only by supplementing the study with pure culture work and additional metabolomics was it possible to increase our understanding of TMAO bioconversions by the human gut microbiota.
Sensory and decisional components of endogenous attention are dissociable
Authors: Banerjee Sanjna , Grover Shrey , Ganesh Suhas , Sridharan Devarajan
Published: December 2017

Endogenous attention acts by enhancing sensory processing (perceptual sensitivity) and prioritizing gating of attended information for decisions (choice bias). It is unknown if the sensitivity and bias components of attention are under the control of common or distinct mechanisms. We tested human observers on a multialternative visuospatial attention task with probabilistic cues, whose predictive validity varied across locations. Analysis of behavior with a multidimensional signal detection model revealed striking dissociations between sensitivity and bias changes induced by cueing. While bias varied in a graded manner, reflecting cue validities, across locations, sensitivity varied in an ‘all-or-none’ fashion, being highest at the cued location. Cue-induced modulations of sensitivity and bias were uncorrelated within and across observers. Moreover, bias changes, rather than sensitivity changes, covaried robustly with key metrics of reaction times and optimal decision-making. Our results demonstrate that endogenous attention engages not a unitary process, but dissociable sensory and decisional processes.