bluuebunny/crossref_metadata_2025 huggingface dataset:
Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy
Authors: Trabuco Emanuel C. , Linder Brian J. , Klingele Christopher J. , Blandon Roberta E. , Occhino John A. , Weaver Amy L. , McGree Michaela E. , Gebhart John B.
Published: December 2017

OBJECTIVE:

To evaluate 1- and 2-year urinary continence rates after Burch retropubic urethropexy compared with a retropubic midurethral sling for women with urinary incontinence undergoing sacrocolpopexy.

METHODS:

We conducted a planned secondary analysis of a multicenter, randomized, single-blind trial comparing Burch with a sling that enrolled participants from June 2009 to August 2013. Objective outcome measures of continence were assessed at 1- and 2-year follow-up through office visits and validated questionnaires. Overall continence was defined as a negative stress test, no retreatment for stress incontinence, and no self-reported urinary incontinence (International Consultation on Incontinence Questionnaire, Short Form, score, 0). Stress-specific continence was defined as fulfillment of the first two criteria and no self-reported stress-related incontinence. Primary outcomes were assessed with intention-to-treat and within-protocol analyses. Comparisons between groups were evaluated using χ2 or Fisher exact test.

RESULTS:

The two groups were similar in all measured baseline features. Outcome assessments at 2 years were available for 48 of 57 patients (84%) in the sling group and 45 of 56 patients (80%) in the Burch group. With intention-to-treat analysis, the sling group had significantly higher rates of overall continence than the Burch group (49% [28/57] vs 29% [16/56]; 95% CI for absolute risk difference 3.0–38.1; P=.03) at 1- but not 2-year follow-up (47% [27/57] vs 32% [18/56]; 95% CI for absolute risk difference −2.6 to 33.1; P=.10). The sling group had significantly higher rates of stress-specific continence than the Burch group at 1-year (70% [40/57] vs 46% [26/56]; 95% CI for absolute risk difference 6.1–41.4; P=.01) and 2-year (70% [40/57] vs 45% [25/56]; 95% CI for absolute risk difference 7.9–43.2; P=.006) follow-up. No difference was detected in prolapse recurrence, voiding dysfunction, antimuscarinic medication use, urgency incontinence, or patient satisfaction.

CONCLUSION:

Among women with baseline urinary incontinence undergoing sacrocolpopexy, the retropubic midurethral sling resulted in higher stress-specific continence rates than Burch retropubic urethropexy at 1- and 2-year follow-up.
Challenges and Opportunities in Identifying, Reviewing, and Preventing Maternal Deaths
Authors: St. Pierre Amy , Zaharatos Julie , Goodman David , Callaghan William M.
Published: December 2017

Despite many efforts at the state, city, and national levels over the past 70 years, a nationwide consensus on how best to identify, review, and prevent maternal deaths remains challenging. We present a brief history of maternal death surveillance in the United States and compare the three systems of national surveillance that exist today: the National Vital Statistics System, the Pregnancy Mortality Surveillance System, and maternal mortality review committees. We discuss strategies to address the perennial challenges of shared terminology and accurate, comparable data among maternal mortality review committees. Finally, we propose that with the opportunity presented by a systematized shared data system that can accurately account for all maternal deaths, state and local-level maternal mortality review committees could become the gold standard for understanding the true burden of maternal mortality at the national level.
Long-term Trends in Singleton Preterm Birth in South Australia From 1986 to 2014
Authors: Verburg Petra E. , Dekker Gus A. , Venugopal Kamalesh , Scheil Wendy , Erwich Jan Jaap H. M. , Mol Ben W. , Roberts Claire T.
Published: December 2017

OBJECTIVE:

To describe long-term trends in the prevalence of preterm birth and rates of preterm birth in singleton pregnancies complicated by hypertensive disorders of pregnancy, small for gestational age (SGA), and preterm prelabor rupture of membranes (PROM) in South Australia.

METHODS:

We conducted a retrospective population study including all singleton live births in the state of South Australia from 1986 to 2014. Long-term trends for preterm birth, hypertensive disorders of pregnancy, SGA, preterm PROM as well as stillbirth were assessed using joinpoint regression analyses. Trends in maternal age, body mass index (BMI), ethnic diversity, parity, and smoking over time were also assessed.

RESULTS:

From 1986 to 2014, with a total of 539,234 singleton births, the overall preterm birth rates increased from 5.1% to 7.1% (P<.001) and for iatrogenic preterm birth increased from 1.6% to 3.2% (P<.001). The incidence of hypertensive disorders of pregnancy decreased from 8.7% to 7.2%. Among pregnancies complicated by hypertensive disorders of pregnancy, the proportion of preterm birth increased (10.4–17.5%, P<.001). The incidence of SGA decreased from 11.1% to 8.0%. Among pregnancies complicated by SGA, the proportion of preterm birth increased (2.9–5.4%, P<.001). The incidence of preterm PROM increased from 1.4% to 2.2%. Among pregnancies complicated by preterm PROM, the proportion of preterm birth remained stable. Preterm stillbirth rates declined (4.23–2.32%, P<.001). Maternal age, BMI, and ethnic diversity have all increased since 1986, whereas maternal smoking has decreased.

CONCLUSION:

In South Australia, the preterm birth rate among singletons increased from 1986 to 2014 by 40%, with iatrogenic preterm birth being responsible for 80% of this increase. Incidence of hypertensive disorders of pregnancy and SGA declined. Among pregnancies complicated by hypertensive disorders of pregnancy and SGA, the proportions of preterm birth increased, indicating earlier interventions in these women. The diagnosis of preterm PROM increased from 1% to 2%, and greater than 80% of preterm PROM was associated with preterm birth after 1990. Increasing iatrogenic delivery may be attributable, in part, to changing maternal phenotype and to altered clinicians' behavior. However, improvements in fetal surveillance, particularly ultrasonography, and advanced neonatal care may underpin perinatal clinical decision-making and the likelihood of iatrogenic birth.
Patient Experience: The New Heart of Healthcare Leadership
Authors: Wolf Jason A.
Published: December 2017

In a healthcare world in which consumerism is no longer a question and value has claimed its place at center stage, leaders are called to think differently about how they operate and manage their organizations. Priorities are curving in new directions with shifts in policy, direction of dollars, and evolution of practice. At the center of this transition is an opportunity for healthcare leaders to recognize that patient experience is the new heart of healthcare leadership.

To address quality, safety, service, cost, and population health outcomes, leaders must rethink how they understand and engage in experience efforts overall. An intentional and clear strategic line of sight and purpose are required, including how patient experience is defined, the core concepts it comprises and is influenced by, and the outcomes it ultimately helps achieve. The challenge for leaders is to reconceive how this maximum potential can be achieved as compared with how experience has been traditionally managed through tactical efforts.

Quick lists of effective tactics are relatively easy to come by, and leaders are already aware of many, if not most, of them. So why do so many organizations applying these tactics today struggle to maintain the results they seek? The reason is that tactics are only as useful as the framework in which they are applied and as robust as the foundation on which they are implemented. The intent of this article is to stir a dialogue on how to reframe the issue of patient experience.

In reframing a collective view about what patient experience is, the way leaders choose to address it must change. This adjustment requires balancing the work of defining patient experience with the strategic intent behind what organizations ultimately aim to achieve. In changing the conversation on patient experience, we move it from an idea that lurks at the edges of healthcare, or that stands as just one of many strategic pillars, to the central call to action for healthcare leaders.
Patient Experience: A Critical Indicator of Healthcare Performance
Authors: Guler Pamela H.
Published: December 2017

Patient experience has become a critical differentiator for healthcare organizations, and it will only grow in importance as transparency and consumerism dominate the healthcare landscape. Creating and sustaining a consistently exceptional experience that promotes patient engagement and the best outcomes is far more than just “satisfying” patients, going well beyond amenities that may be provided.

Perception of care experience is often shaped by methods we use to address the biopsychosocial needs of patients. Building relationships and communicating well with our patients and families are primary approaches. In a complex healthcare situation, patients may not fully understand or remember the highly clinical nature of treatment. However, they always remember how we made them feel, how we communicated with them as a team, and what interactions they experienced while in our care.

Patients who are fully informed and feel connected to their caregivers are often less anxious than those who are disengaged. Informed and engaged patients are enabled to participate in their healthcare. Organizations that focus on developing an accountable culture—one that inspires caregivers to communicate in a way that connects to patients’ mind, body, and spirit while leveraging standard, evidence-based patient experience practices—find that patients’ perception of care, or “the patient experience,” is vastly improved.

Adventist Health System has embarked on a journey to patient experience excellence with a commitment to whole-person care and standard patient experience practice across the system. Recognized with several national awards, we continue to strengthen our approach toward bringing all of our campuses and patient settings to sustained high-level performance. We have found that a combination of strong, accountable leadership; a focus on employee culture; engagement of physicians; standardized patient experience practices and education; and meaningful use of patient feedback are top contributors to excellence in patient experience.
Finding Like-Minded Partners to Span the Continuum of Care
Authors: Lawrence Bruce
Published: December 2017

This is an era of profound industry transformation, characterized by such forces as acceleration away from inpatient-centered care and toward alternative payment models, rising rates of chronic disease, and an aging population. Add to this mix physician and nurse shortages and a newfound understanding that today’s patients are informed consumers, and the reality becomes clear: Healthcare providers must be adaptable, agile, and innovative to survive. Sometimes, the best way forward in transformative times is collaboration with other like-minded organizations.

For INTEGRIS, an integrated, not-for-profit health system based in Oklahoma City, Oklahoma, partnering has always been a part of the corporate culture and a vital strategy in fulfilling its mission to improve the health of the people and communities it serves. In earlier days, collaborations often took the form of partnerships with community organizations to go beyond the hospital’s walls and reach deeply into the community to address the underlying health needs of its population.

However, the concept of partnerships has expanded to meet today’s strategic business needs. INTEGRIS, for example, evaluates most partnerships in terms of population health management and the system’s continuum of care. Care settings are viewed as being of three distinct types: community-based, acute, and post-acute. When it comes to health—and, increasingly, wellness—the goal of the system is to connect patients to whatever service they need, at whatever stage of life, whether that service is fully or partly owned by INTEGRIS or provided through partner affiliations.

This network of partnerships involves the patient, the community, physicians, other clinicians and providers, insurers, regional collaborators, and others. INTEGRIS’s partnership strategies have evolved over the years, and its partnerships have produced synergy and alignment to decrease costs, increase revenue, and better serve customers with the right care, in the right setting, at the right time.
Pursuit of Value Drives Strategy to Improve Operations and Outcomes
Authors: Borgstrom Marna P. , Deshpande Ohm M. , Balcezak Thomas J.
Published: December 2017

The future of American healthcare remains cloudy, with the shifting contours of regulatory and fiscal reform still being shaped. Providers are beset by many challenges that vary but often include state and federal healthcare funding decisions that are antithetical to the interests of patients and aging populations. Regional public health crises and rapidly evolving relationships with third-party payers complicate matters even further.

Yale New Haven Health System decided to pursue value as its overriding strategy for navigating the uncertainty in healthcare that is likely to persist for years to come. Many, if not most, of the challenges we face at Yale New Haven Health are shared by health systems across the country; the operational concepts that drive our strategy likely will be familiar. The differentiator is the execution: At Yale New Haven Health, infusing our organization with a culture of high reliability, as well as adopting the practice of clinical redesign, has yielded concrete enhancements in patient care, operational resilience, and financial sustainability. Clinical redesign saved Yale New Haven Health nearly $25 million in direct costs in one year alone.
IMAGING OF VITELLIFORM MACULAR LESIONS USING POLARIZATION-SENSITIVE OPTICAL COHERENCE TOMOGRAPHY
Authors: Deák Gábor G. , Schmidt Wolfgang M. , Bittner Reginald E. , Mylonas Georgios , Roberts Philipp K. , Zotter Stefan , Baumann Bernhard , Pircher Michael , Hitzenberger Christoph K. , Schmidt-Erfurth Ursula M. , Ritter Markus
Published: December 2017

Purpose:

To examine the involvement of the retinal pigment epithelium (RPE) in the presence of vitelliform macular lesions (VML) in Best vitelliform macular dystrophy (BVMD), autosomal recessive bestrophinopathy, and adult-onset vitelliform macular degeneration using polarization-sensitive optical coherence tomography (PS-OCT).

Methods:

A total of 35 eyes of 18 patients were imaged using a PS-OCT system and blue light fundus autofluorescence imaging. Pathogenic mutations in the BEST1 gene, 3 of which were new, were detected in all patients with BVMD and autosomal recessive bestrophinopathy.

Results:

Polarization-sensitive optical coherence tomography showed a characteristic pattern in all three diseases with nondepolarizing material in the subretinal space consistent with the yellowish VML seen on funduscopy with a visible RPE line below it. A focal RPE thickening was seen in 26 eyes under or at the edge of the VML. Retinal pigment epithelium thickness outside the VML was normal or mildly thinned in patients with BVMD and adult-onset vitelliform macular degeneration but was diffusely thinned or atrophic in patients with autosomal recessive bestrophinopathy. Patients with autosomal recessive bestrophinopathy showed sub-RPE fibrosis alongside the subretinal VML. Polarization-sensitive optical coherence tomography was more reliable in assessing the localization and the integrity of the RPE than spectral domain OCT alone. On spectral domain OCT, identification of the RPE was not possible in 19.4% of eyes. Polarization-sensitive optical coherence tomography allowed for definite identification of the location of VML in respect to the RPE in all eyes, since it provides a tissue-specific contrast.

Conclusion:

Polarization-sensitive optical coherence tomography confirms in vivo the subretinal location of VML and is useful in the assessment of RPE integrity.
Topical Tacrolimus as Adjuvant Therapy to Corticosteroids in Acute Endothelial Graft Rejection After Penetrating Keratoplasty: A Randomized Controlled Trial
Authors: Hashemian Mohammad Nasser , Latifi Golshan , Ghaffari Reza , Ghassemi Hamed , Zarei-Ghanavati Mehran , Mohammadi Seyed-Farzad , Yasseri Mehdi , Fallah Tafti Mohammad Reza , Tafti Zahra Fallah
Published: December 2017

Purpose:

To evaluate the efficacy of topical tacrolimus 0.05% as adjuvant therapy to corticosteroids in the treatment of acute endothelial rejection of a penetrating keratoplasty (PKP) graft.

Methods:

Patients with the clinical diagnosis of acute endothelial rejection of a PKP graft were randomized into 2 groups—group 1: receiving topical tacrolimus 0.05% as adjuvant therapy to corticosteroid treatment and group 2: receiving only corticosteroid treatment. Main outcome measures were rejection reversal, time to rejection reversal, and recurrence of rejection.

Results:

Thirty-one eyes of 31 patients (17 and 14 eyes in group 1 and 2, respectively) were included in the study. The rejection episode completely resolved in 88.2% of patients in group 1 and 85.7% of patients in group 2 [hazard ratio = 0.60, 95% confidence interval (CI) = 0.28–1.29,P= 0.191]. After adjusting for preoperative factors using the inverse-probability weighting method, the time to resolution of rejection was significantly shorter in group 1 than group 2 (average treatment effect = 16, 95% CI, 3.7–28.7,P= 0.013). The recurrence rate of rejection was significantly higher in group 2 (39.7, 95% CI, 12.8–92.6 per 1000 months of follow-up) than in group 1 (3.6, 95% CI, 0.05–19.9 likewise); risk ratio: 11.1, 95% CI, 1.3–95.0,P= 0.028.

Conclusions:

Topical tacrolimus 0.05% as an adjunct to steroids can hasten the resolution of endothelial rejection of a PKP graft and potentially decreases the recurrence of rejection. However, it may not improve rejection reversal success.
Keratoconus and Personality—A Review
Authors: Mannis Mark J. , Ling Jennifer J. , Kyrillos Ralph , Barnett Melissa
Published: December 2017

Purpose:

To assess the existing literature on the subject of keratoconus and personality and to propose a theory that might account for the perceived personality changes associated with this condition.

Methods:

A literature search was conducted in the PubMed database using the term “keratoconus” in combination with keywords such as personality, psychiatry, psychology, anxiety, depression, or psychosis. A total of 15 articles pertaining to personality and psychiatric disorders in keratoconus were retained and reviewed.

Results:

Although patients with keratoconus tend to score differently on personality scales compared with normal controls, the literature fails to substantiate the existence of a unique “keratoconic personality.” Instead, patients with keratoconus prove to have more dysfunctional coping mechanisms that specifically alter their interaction with health care providers and may account for the persistent clinical impression of less respectful, conforming, and cooperative patients.

Conclusions:

We hypothesize that the stage of life at which keratoconus commonly presents plays a crucial role in personality and coping mechanism development that significantly affects behavioral patterns and the relationship with caregivers.
Minimally Invasive Surgical Pulmonary Embolectomy
Authors: Pasrija Chetan , Shah Aakash , Sultanik Elliot , Rouse Michael , Ghoreishi Mehrdad , Bittle Gregory J. , Boulos Francesca , Griffith Bartley P. , Kon Zachary N.
Published: December 2017

Objective

Surgical pulmonary embolectomy has gained increasing popularity over the past decade with multiple series reporting excellent outcomes in the treatment of submassive pulmonary embolism. However, a significant barrier to the broader adoption of surgical pulmonary embolectomy remains the large incision and long recovery after a full sternotomy. We report the safety and efficacy of using a minimally invasive approach to surgical pulmonary embolectomy.

Methods

All consecutive patients undergoing surgical pulmonary embolectomy for a submassive pulmonary embolism (2015–2017) were reviewed. Patients were stratified as conventional or minimally invasive. The minimally invasive approach included a 5- to 7-cm skin incision with upper hemisternotomy to the third intercostal space. The primary outcomes were in-hospital and 90-day survival.

Results

Thirty patients (conventional = 20, minimally invasive = 10) were identified. Operative time was similar between the two groups, but cardiopulmonary bypass time was significantly longer in the minimally invasive group (58 vs 94 minutes, P = 0.04). While ventilator time and intensive care unit length of stay were similar between groups, hospital length of stay was 4.5 days shorter in the minimally invasive group, and there was a trend toward less blood product use. In-hospital and 90-day survival was 100%. Within the minimally invasive cohort, median right ventricular dysfunction at discharge was none-mild and no patient experienced postoperative renal failure, deep sternal wound infection, sepsis, or stroke.

Conclusions

Minimally invasive surgical pulmonary embolectomy appears to be a feasible approach in the treatment of patients with a submassive pulmonary embolism. A larger, prospective analysis comparing this modality with conventional surgical pulmonary embolectomy may be warranted.
Mood-Stabilizing Anticonvulsants, Spina Bifida, and Folate Supplementation
Authors: Patel Neil , Viguera Adele C. , Baldessarini Ross J.
Published: December 2017

Purpose/Background

High risks of neural tube defects and other teratogenic effects are associated with exposure in early pregnancy to some anticonvulsants, including in women with bipolar disorder.

Methods/Procedures

Based on a semistructured review of recent literature, we summarized findings pertaining to this topic.

Findings/Results

Valproate and carbamazepine are commonly used empirically (off-label) for putative long-term mood-stabilizing effects. Both anticonvulsants have high risks of teratogenic effects during pregnancy. Risks of neural tube defects (especially spina bifida) and other major malformations are especially great with valproate and can arise even before pregnancy is diagnosed. Standard supplementation of folic acid during pregnancy can reduce risk of spontaneous spina bifida, but not that associated with valproate or carbamazepine. In contrast, lamotrigine has regulatory approval for long-term use in bipolar disorder and appears not to have teratogenic effects in humans.

Implications/Conclusions

Lack of protective effects against anticonvulsant-associated neural tube defects by folic acid supplements in anticipation of and during pregnancy is not widely recognized. This limitation and high risks of neural tube and other major teratogenic effects, especially of valproate, indicate the need for great caution in the use of valproate and carbamazepine to treat bipolar disorder in women of child-bearing age.
Relationship Between Maternal Characteristics and Postpartum Hemorrhage: A Meta-Analysis Study
Authors: DURMAZ Aysegul , KOMURCU Nuran
Published: December 2017

Background:

Postpartum hemorrhage (PPH) is a leading cause of maternal death in low-income countries and the primary cause of approximately one of every four maternal deaths worldwide.

Purpose:

The aim of this study was to determine the antenatal risk factors of PPH and its effects.

Methods:

The literature from nine databases was reviewed, and studies published between 2000 and 2012 were analyzed using terms such as “postpartum hemorrhage,” “prevention of postpartum hemorrhage,” and “management of postpartum hemorrhage.” The full text of 1,061 articles was reviewed, and 29 studies were selected according to the inclusion criteria. Studies that determined bias using the funnel plot test were excluded, and 20 studies were included in the meta-analysis. The data were analyzed using Microsoft Office Excel 2010 and comprehensive meta-analysis.

Results:

The meta-analysis included five studies and 1,286,752 women for maternal age, six studies and 607,822 women for body mass index, and six studies and 1,118,490 women for parity. The results of the analysis showed that body mass index ≥ 25.00 kg/m2 (OR = 1.43, 95% CI [1.40, 1.47]), primiparity of mothers (OR = 1.37, 95% CI [1.35, 1.40]), and hypertensive disorder in mothers (OR = 1.52, 95% CI [1.43, 1.61]) are risk factors for the development of PPH. No rela-tionship was found between maternal age ≥ 35 years and PPH (OR = 1.02, 95% CI [0.99, 1.04]).

Conclusions:

Midwives, obstetric nurses, and obstetricians should carefully evaluate mothers for the risk factors of PPH during the antepartum, intrapartum, and postpartum periods. Moreover, at-risk pregnant women should give birth in a unit with emergency initiative options. Future studies should examine relevant personal characteristics of mothers, as familiarity with the risk factors facilitates the management and treatment of PPH. Finally, meta-analyses should review more studies to detect risk factors more comprehensively.
Correlations Among Self-Rated Health, Chronic Disease, and Healthcare Utilization in Widowed Older Adults in Taiwan
Authors: HO Shu-Hsi
Published: December 2017

Background:

Taiwan has a rapidly aging population. It is well known that older adults usually have worse health than younger adults, with widowed older adults at a particularly high risk of poor health. Widowed older adults experience the effects of bereavement, which affects their health. Therefore, health topics related to widowed older adults deserve special attention.

Purpose:

The aim of this study was to discuss self-rated health for chronic diseases and healthcare utilization among widowed older adults.

Methods:

A cross-section of data was used to analyze self-rated health-related issues. Data were adopted from the National Health Interview Survey in Taiwan, with the data on adults aged 65 years and over extracted and included in the assessment. Multinomial logistic regression models were used to investigate the relationships between healthcare utilization and self-rated health and chronic disease variables.

Results:

The main empirical results show worse self-rated health status among widowed older adults in comparison with their nonwidowed peers and worse health status for widowers than widows. Next, age was negatively correlated with health rating, whereas a positive correlation with health was found for education. In addition, chronic diseases, particularly stroke, were found to be a significant predictive factor related to poor health status. Similar results were observed for healthcare utilization, apart from traditional Chinese medicine. Older adults who habitually purchased and used traditional Chinese medicine were shown to enjoy relatively better health statuses.

Conclusions/Implications for Practice:

These findings identified that chronic diseases and healthcare utilization correlated strongly with self-rated health for widowed older adults. Therefore, self-rated health may be used as a screening tool by the National Health Insurance System in Taiwan, and the results may be referenced by public health officials who are responsible for developing welfare strategies to promote healthy aging among the widowed in Taiwan.
Factors Influencing Postpartum Fatigue in Vaginal-Birth Women: Testing a Path Model
Authors: HSIEH Ching-Hsing , CHEN Chien-Lan , HAN Tan-Ju , LIN Pei-Ju , CHIU Hui-Chun
Published: December 2017

Background:

Postpartum fatigue is a very common complaint among postpartum women. Although current evidence indicates that several factors (e.g., parity, epidural analgesia, perineal trauma, perineal pain, and longer second stage of labor) are associated with postpartum, not enough is known about the relationships among these physical factors simultaneously and how they contribute to the development of postpartum fatigue. Increased awareness of the complex relationships among these factors will help nurses assess, prevent, and alleviate postpartum fatigue.

Purpose:

The aims of this study were to test a model of factors that influence postpartum fatigue and to estimate the direct and indirect effects of these factors on postpartum fatigue in vaginal-birth women.

Methods:

The hypothesized model of the factors that influence postpartum fatigue after vaginal birth was developed based on previous studies. This study used a cross-sectional correlational design and convenience sampling. The Visual Analog Scale for Pain was used to measure postpartum perineal pain, and the Postpartum Fatigue Scale was used to assess postpartum fatigue via a structured, self-report questionnaire. Data analysis included descriptive statistics, Pearson’s correlation coefficients, and path analysis.

Results:

This study evaluated 326 healthy postpartum women within the first day after vaginal birth. Participants ranged from 20 to 43 years old, and 50.9% were primiparous. The model of the factors influencing postpartum fatigue after vaginal birth showed a good fit with the empirical data. Parity and the use of epidural analgesia predicted the duration of the second stage of labor, and the degree of perineal trauma predicted perineal pain. Participants who had experienced longer durations of the second stage of labor and more perineal pain reported higher levels of early postpartum fatigue.

Conclusions/Implications for Practice:

It is suggested that maternal nurses should better understand postpartum fatigue, take precautions to decrease perineal pain, and pay more attention to the longer duration of the second stage of labor to minimize postpartum fatigue, increase patient comfort, and improve the quality of perinatal care.
Toxicity of Vincristine Combined With Posaconazole in Children With Acute Lymphoblastic Leukemia
Authors: Pekpak Esra , İleri Talia , İnce Elif , Ertem Mehmet , Uysal Zümrüt
Published: December 2017

Background:

Vincristine (VCR) is one of the main drugs of acute lymphoblastic leukemia (ALL) treatment. Azole antifungal medications are used for treatment or prophylaxis of invasive fungal infections in acute leukemia. Coadministration of these drugs increases the risk of VCR toxicity.

Observations:

We presented a girl with ALL using posaconazole prophylaxis. She developed VCR toxicity that included tubulopathy, high blood pressure, neuropathic pain, difficulty walking, diffuse muscular weakness, constipation, abdominal pain.

Conclusions:

There are limited data in children with ALL for posaconazole prophylaxis. We recommend that VCR side effects should be evaluated by careful monitoring of the patients who are on this combination therapy.
Medical Versus Surgical Approach to Initial Treatment in Septic Arthritis
Authors: Flores-Robles Bryan Josué , Jiménez Palop Mercedes , Sanabria Sanchinel Abel Alejandro , Andrus Robert Francis , Royuela Vicente Ana , Sanz Pérez Marta Isabel , Espinosa Malpartida María , Ramos Giráldez Consuelo , Merino Argumanez Carolina , Villa Alcázar Luis Fernando , Andréu Sánchez José Luis , Godoy Tundidor Hildegarda , Campos Esteban José , Sanz Sanz Jesús , Barbadillo Mateos Carmen , Isasi Zaragoza Carlos , Mulero Mendoza Juan
Published: December 2017

Objective

The aim of this study was to compare the functional results of 2 different procedure types, medical or surgical used in treating native joint septic arthritis.

Methods

In this cohort study, we reviewed the clinical registries of patients admitted to a single third-level hospital with the diagnosis of septic arthritis during the period of January 1, 2008, to January 31, 2016.

Results

A total of 63 cases of septic arthritis were identified in which the initial approach for 49 patients was medical (arthrocentesis), whereas the initial approach for 14 patients was surgical (arthroscopy or arthrotomy). Of the 49 patients who received initial medical treatment (IMT), 15 patients (30%) later required surgical treatment because of poor progress. The median age of the patients was 60 (SD, 18) years. The group who received IMT were older than those who received initial surgical treatment (median, 64 years [interquartile range {IQR}, 54–76 years], vs. 48 years [IQR, 30–60 years]). There was a larger percentage of male patients in the surgical group (78% vs. 42% [p = 0.018]). Thirty percent of the medical group had been receiving corticosteroid treatment (p = 0.018). Results of complete recovery of joint functionality showed no significant differences after 1 year (68% with MT vs. 67% with ST, p = 0.91). Both groups had similar symptom duration until diagnosis, duration of antibiotic therapy (median, 30 days [IQR, 28–49 days], vs. 29.5 days [IQR, 27–49] days), and mortality rate (3 in the medical group).

Conclusions

The results of the study show that initial surgical treatment in patients with native joint septic arthritis is not superior to IMT. However, half of the patients with shoulder and hip infections treated with IMT eventually required surgical intervention, suggesting that perhaps this should be the preferred initial approach in these cases.
Relaxivity of Ferumoxytol at 1.5 T and 3.0 T
Authors: Knobloch Gesine , Colgan Timothy , Wiens Curtis N. , Wang Xiaoke , Schubert Tilman , Hernando Diego , Sharma Samir D. , Reeder Scott B.
Published: December 2017

Objectives

The aim of this study was to determine the relaxation properties of ferumoxytol, an off-label alternative to gadolinium-based contrast agents, under physiological conditions at 1.5 T and 3.0 T.

Materials and Methods

Ferumoxytol was diluted in gradually increasing concentrations (0.26–4.2 mM) in saline, human plasma, and human whole blood. Magnetic resonance relaxometry was performed at 37°C at 1.5 T and 3.0 T. Longitudinal and transverse relaxation rate constants (R1, R2, R2*) were measured as a function of ferumoxytol concentration, and relaxivities (r1, r2, r2*) were calculated.

Results

A linear dependence of R1, R2, and R2* on ferumoxytol concentration was found in saline and plasma with lower R1 values at 3.0 T and similar R2 and R2* values at 1.5 T and 3.0 T (1.5 T: r1saline= 19.9 ± 2.3 s−1mM−1; r1plasma= 19.0 ± 1.7 s−1mM−1; r2saline= 60.8 ± 3.8 s−1mM−1; r2plasma= 64.9 ± 1.8 s−1mM−1; r2*saline= 60.4 ± 4.7 s−1mM−1; r2*plasma= 64.4 ± 2.5 s−1mM−1; 3.0 T: r1saline= 10.0 ± 0.3 s−1mM−1; r1plasma= 9.5 ± 0.2 s−1mM−1; r2saline= 62.3 ± 3.7 s−1mM−1; r2plasma= 65.2 ± 1.8 s−1mM−1; r2*saline= 57.0 ± 4.7 s−1mM−1; r2*plasma= 55.7 ± 4.4 s−1mM−1). The dependence of relaxation rates on concentration in blood was nonlinear. Formulas from second-order polynomial fittings of the relaxation rates were calculated to characterize the relationship between R1bloodand R2bloodwith ferumoxytol.

Conclusions

Ferumoxytol demonstrates strong longitudinal and transverse relaxivities. Awareness of the nonlinear relaxation behavior of ferumoxytol in blood is important for ferumoxytol-enhanced magnetic resonance imaging applications and for protocol optimization.
Computed Tomography Features associated With the Eighth Edition TNM Stage Classification for Thymic Epithelial Tumors
Authors: Padda Sukhmani K. , Terrone Donato , Tian Lu , Khuong Amanda , Neal Joel W. , Riess Jonathan W. , Berry Mark F. , Hoang Chuong D. , Burt Bryan M. , Leung Ann N. , Schwartz Erich J. , Shrager Joseph B. , Wakelee Heather A.
Published: December 2017

Purpose:

The eighth edition of the TNM classification of malignant tumors for the first time includes an official staging system for thymic epithelial tumors (TETs) recognized by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). Staging is critical for the management of TETs, and determining stage accurately from imaging has the potential to improve clinical outcomes. We examine preoperative computed tomography (CT) characteristics of TETs associated with AJCC/UICC pathologic TNM stage.

Materials and Methods:

In this retrospective study, patients were included if they met all the following criteria: (1) diagnosis of TET, (2) had primary curative intent surgery performed at Stanford University, and (3) had available preoperative CT imaging for review. Tumor pathology was staged according to the eighth edition TNM classification. Fifteen CT scan features were examined from each patient case according to the International Thymic Malignancy Interest Group standard report terms in a blinded manner. A Lasso-regularized multivariate model was used to produce a weighted scoring system predictive of pathologic TNM stage.

Results:

Examining the 54 patients included, the following CT characteristics were associated with higher pathologic TNM stage when using the following scoring system: elevated hemidiaphragm (score of 6), vascular endoluminal invasion (score of 6), pleural nodule (score of 2), lobulated contour (score of 2), and heterogeneous internal density (score of 1). Area under the receiver operating characteristic curve was 0.76.

Conclusions:

TETs with clearly invasive or metastatic features seen on CT are associated with having higher AJCC/UICC pathologic TNM stage, as expected. However, features of lobulated contour and heterogeneous internal density are also associated with higher stage disease. These findings need to be validated in an independent cohort.
Muramyl Dipeptide Enhances Thermal Injury-Induced Autophagy and Inflammatory Cytokine Response of Lungs via Activation of NOD2/Rick Signaling Pathway in Rats
Authors: Wu Xiao-Jing , Liang Hui , Zhang Ying , Yang Xu-Ming , Wang Hong-Yu , Li Hui , Li Xin-Yi , Chen Kai , Wang Yan-Lin , Li Jian-Guo , Zhang Zong-Ze , Song Xue-Min
Published: December 2017

Objective:

Nucleotide-binding oligomerization domain 2 (NOD2) is the innate receptor of muramyl dipeptide (MDP). Our previous study revealed that MDP could enhance thermal injury-induced inflammatory cytokine production and organ function injury in rats. The present study was to determine the effect of MDP on autophagy and NOD2/receptor-interacting serine/threonine protein kinases (RICK) signaling pathway of lung injury after thermal injury.

Methods:

Forty male Sprague–Dawlay rats were randomly divided into four groups: normal control (NC) group, MDP group, Scald group, and MDP + Scald group. Scald group only suffered 20% total body surface area third-degree (TBSA) thermal injury. MDP group was only administered 5.0 mg/kg MDP through the left femoral vein; 5.0 mg/kg MDP was administered through the left femoral vein at 24 h after thermal injury in the MDP + Scald group.

Results:

TBSA thermal injury (20%) not only significantly increased the plasma inflammatory cytokines production, but also elevated the expression of LC3-I/II, the accumulation of autophagosome in the lung tissue. Compared with the Scald group, MDP + Scald double hit led to more serious inflammatory responses and higher expression of NOD2 mRNA, RICK, NF-κB p65, LC3-I/II, and the accumulation of more autophagosome in the lung tissue.

Conclusions:

MDP enhances thermal injury-induced autophagy and proinflammatory cytokine response of lung injury, which could be achieved via activating the NOD2/RICK signaling pathway in rats.
Freezer on, lights off! Environmental effects on activity rhythms of fish in the Arctic
Authors: Hawley Kate L. , Rosten Carolyn M. , Haugen Thrond O. , Christensen Guttorm , Lucas Martyn C.
Published: December 2017

Polar regions are characterized by acute seasonal changes in the environment, with organisms inhabiting these regions lacking diel photoperiodic information for parts of the year. We present, to our knowledge, the first high-resolution analysis of diel and seasonal activity of free-living fishes in polar waters (74°N), subject to extreme variation in photoperiod, temperature and food availability. Using biotelemetry, we tracked two sympatric ecomorphs of lake-dwelling Arctic charr (
Salvelinus alpinus n
= 23) over an annual cycle. Charr activity rhythms reflected the above-surface photoperiod (including under ice), with diel rhythms of activity observed. During the dark winter solstice period, charr activity became arrhythmic and much reduced, even though estimated light levels were within those at which charr can feed. When twilight resumed, charr activity ensued as diel vertical migration, which continued throughout spring and with increasing day length, despite stable water temperatures. Diel activity rhythms ceased during the polar day, with a sharp increase in arrhythmic fish activity occurring at ice-break. Despite contrasting resource use, circannual rhythms were mirrored in the two ecomorphs, although individual variability in activity rhythms was evident. Our data support conclusions of functionally adaptive periods of arrhythmicity in polar animals, suggesting maintenance of a circannual oscillator for scheduling seasonal behavioural and developmental processes.
Treating hummingbirds as feathered bees: a case of ethological cross-pollination
Authors: Pritchard D. J. , Tello Ramos M. C. , Muth F. , Healy S. D.
Published: December 2017

Hummingbirds feed from hundreds of flowers every day. The properties of these flowers provide these birds with a wealth of information about colour, space and time to guide how they forage. To understand how hummingbirds might use this information, researchers have adapted established laboratory paradigms for use in the field. In recent years, however, experimental inspiration has come less from other birds, and more from looking at other nectar-feeders, particularly honeybees and bumblebees, which have been models for foraging behaviour and cognition for over a century. In a world in which the cognitive abilities of bees regularly make the news, research on the influence of ecology and sensory systems on bee behaviour is leading to novel insights in hummingbird cognition. As methods designed to study insects in the laboratory are being applied to hummingbirds in the field, converging methods can help us identify and understand convergence in cognition, behaviour and ecology.
Water vascular system architecture in an Ordovician ophiuroid
Authors: Clark Elizabeth G. , Bhullar Bhart-Anjan S. , Darroch Simon A. F. , Briggs Derek E. G.
Published: December 2017

Understanding the water vascular system (WVS) in early fossil echinoderms is critical to elucidating the evolution of this system in extant forms. Here we present the first report of the internal morphology of the water vascular system of a stem ophiuroid. The radial canals are internal to the arm, but protected dorsally by a plate separate to the ambulacrals. The canals zig-zag with no evidence of constrictions, corresponding to sphincters, which control pairs of tube feet in extant ophiuroids. The morphology suggests that the unpaired tube feet must have operated individually, and relied on the elasticity of the radial canals, lateral valves and tube foot musculature alone for extension and retraction. This arrangement differs radically from that in extant ophiuroids, revealing a previously unknown Palaeozoic configuration.
The tactile perception of transient changes in friction
Authors: Gueorguiev David , Vezzoli Eric , Mouraux André , Lemaire-Semail Betty , Thonnard Jean-Louis
Published: December 2017

When we touch an object or explore a texture, frictional strains are induced by the tactile interactions with the surface of the object. Little is known about how these interactions are perceived, although it becomes crucial for the nascent industry of interactive displays with haptic feedback (e.g. smartphones and tablets) where tactile feedback based on friction modulation is particularly relevant. To investigate the human perception of frictional strains, we mounted a high-fidelity friction modulating ultrasonic device on a robotic platform performing controlled rubbing of the fingertip and asked participants to detect induced decreases of friction during a forced-choice task. The ability to perceive the changes in friction was found to follow Weber's Law of just noticeable differences, as it consistently depended on the ratio between the reduction in tangential force and the pre-stimulation tangential force. The Weber fraction was 0.11 in all conditions demonstrating a very high sensitivity to transient changes in friction. Humid fingers experienced less friction reduction than drier ones for the same intensity of ultrasonic vibration but the Weber fraction for detecting changes in friction was not influenced by the humidity of the skin.
Navigating features: a topologically informed chart of electromyographic features space
Authors: Phinyomark Angkoon , Khushaba Rami N. , Ibáñez-Marcelo Esther , Patania Alice , Scheme Erik , Petri Giovanni
Published: December 2017

The success of biological signal pattern recognition depends crucially on the selection of relevant features. Across signal and imaging modalities, a large number of features have been proposed, leading to feature redundancy and the need for optimal feature set identification. A further complication is that, due to the inherent biological variability, even the same classification problem on different datasets can display variations in the respective optimal sets, casting doubts on the generalizability of relevant features. Here, we approach this problem by leveraging topological tools to create charts of features spaces. These charts highlight feature sub-groups that encode similar information (and their respective similarities) allowing for a principled and interpretable choice of features for classification and analysis. Using multiple electromyographic (EMG) datasets as a case study, we use this feature chart to identify functional groups among 58 state-of-the-art EMG features, and to show that they generalize across three different forearm EMG datasets obtained from able-bodied subjects during hand and finger contractions. We find that these groups describe meaningful non-redundant information, succinctly recapitulating information about different regions of feature space. We then recommend representative features from each group based on maximum class separability, robustness and minimum complexity.
A eukaryotic nicotinate-inducible gene cluster: convergent evolution in fungi and bacteria
Authors: Ámon Judit , Fernández-Martín Rafael , Bokor Eszter , Cultrone Antonietta , Kelly Joan M. , Flipphi Michel , Scazzocchio Claudio , Hamari Zsuzsanna
Published: December 2017

Nicotinate degradation has hitherto been elucidated only in bacteria. In the ascomyceteAspergillus nidulans, six loci,hxnS/AN9178 encoding the molybdenum cofactor-containing nicotinate hydroxylase, AN11197 encoding a Cys2/His2 zinc finger regulator HxnR, together with AN11196/hxnZ, AN11188/hxnY, AN11189/hxnPand AN9177/hxnT, are clustered and stringently co-induced by a nicotinate derivative and subject to nitrogen metabolite repression mediated by the GATA factor AreA. These genes are strictly co-regulated by HxnR. Within thehxnRgene, constitutive mutations map in two discrete regions.Aspergillus nidulansis capable of using nicotinate and its oxidation products 6-hydroxynicotinic acid and 2,5-dihydroxypyridine as sole nitrogen sources in an HxnR-dependent way. HxnS is highly similar to HxA, the canonical xanthine dehydrogenase (XDH), and has originated by gene duplication, preceding the origin of the Pezizomycotina. This cluster is conserved with some variations throughout the Aspergillaceae. Our results imply that a fungal pathway has arisen independently from bacterial ones. Significantly, the neo-functionalization of XDH into nicotinate hydroxylase has occurred independently from analogous events in bacteria. This work describes for the first time a gene cluster involved in nicotinate catabolism in a eukaryote and has relevance for the formation and evolution of co-regulated primary metabolic gene clusters and the microbial degradation ofN-heterocyclic compounds.