bluuebunny/crossref_metadata_2025 huggingface dataset:
Are cosmological gas accretion streams multiphase and turbulent?
Authors: Cornuault Nicolas , Lehnert Matthew D. , Boulanger François , Guillard Pierre
Published: November 2017

Simulations of cosmological filamentary accretion reveal flows (“streams”) of warm gas, T ~ 104 K, which bring gas into galaxies efficiently. We present a phenomenological scenario in which gas in such flows, if it is shocked as it enters the halo as we assume and depending on the post-shock temperature, stream radius, its relative overdensity, and other factors, becomes biphasic and turbulent. We consider a collimated stream of warm gas that flows into a halo from an overdense filament of the cosmic web. The post-shock streaming gas expands because it has a higher pressure than the ambient halo gas and fragments as it cools. The fragmented stream forms a two phase medium: a warm cloudy phase embedded in hot post-shock gas. We argue that the hot phase sustains the accretion shock. During fragmentation, a fraction of the initial kinetic energy of the infalling gas is converted into turbulence among and within the warm clouds. The thermodynamic evolution of the post-shock gas is largely determined by the relative timescales of several processes. These competing timescales characterize the cooling, expansion of the post-shock gas, amount of turbulence in the clouds, and dynamical time of the halo. We expect the gas to become multiphase when the gas cooling and dynamical times are of the same order of magnitude. In this framework, we show that this mainly occurs in the mass range, Mhalo ~ 1011 to 1013 M⊙, where the bulk of stars have formed in galaxies. Because of the expansion of the stream and turbulence, gas accreting along cosmic web filaments may eventually lose coherence and mix with the ambient halo gas. Through both the phase separation and “disruption” of the stream, the accretion efficiency onto a galaxy in a halo dynamical time is lowered. Decollimating flows make the direct interaction between galaxy feedback and accretion streams more likely, thereby further reducing the overall accretion efficiency. As we discuss in this work, moderating the gas accretion efficiency through these mechanisms may help to alleviate a number of significant challenges in theoretical galaxy formation.
Timing and Management of Inguinal Hernia in the Premature Baby
Authors: Casaccia Germana , Arnoldi Rossella , Pini Prato Alessio
Published: November 2017

Inguinal hernias in children occur with a prevalence ranging from 3 to 5%. The likelihood of a symptomatic patent processus vaginalis is significantly higher in preterms, as reported by most series. As a consequence, inguinal hernia represents the most common condition requiring surgical repair in the neonate and preterm baby. Surgery aims at avoiding and preventing intestinal and gonadal lesions related to incarceration. Nonetheless, hernia repair is technically demanding, with a relatively high risk of complications including recurrence and testicular atrophy. This paper will address some of most debated aspect of inguinal hernia management in preterms babies. The authors will discuss anesthesiological implications, available surgical techniques, optimal timing for surgery, and reasons for possible contralateral groin exploration. The authors will also discuss literature evidences and will propose their own behavior to provide an algorithm for the correct management of neonates and ex-preterms with inguinal hernia.
Interview – Im Gespräch mit Andreas Storm
Authors: Rychlik Reinhard
Published: November 2017

Andreas Storm ist Vorstandsvorsitzender der drittgrößten Krankenkasse in Deutschland, der DAK-Gesundheit, welche rund sechs Millionen
Menschen versichert. Der frühere saarländische Gesundheitsminister und Diplom-Volkswirt ist seit mehr als zwanzig Jahren im deutschen
Gesundheitswesen tätig und bestens in der Politik vernetzt. Im Interview wagt er im Gespräch mit uns einen Blick in die Zukunft des
Gesundheitswesens.
Behandlung und Pflege von Schlaganfallpatienten – Zur Spastik nach Schlaganfall und den damit assoziierten
volkswirtschaftlichen Kosten
Authors: Thiem Helena , Bretzke Pascal , Rebscher Herbert
Published: November 2017

In Deutschland liegt die Prävalenz für den Schlaganfall bei etwa 1000000 Patienten. Jährlich kommt es dabei zu etwa 240 000
Hirninfarkten, zusätzlich zu etwa 55 000 Hirnblutungen 1. Zwischen 20 und 40 % der Patienten haben ein Jahr nach dem Schlaganfall eine
Spastik entwickelt 2. Dies bringt sowohl für die betroffenen Patienten als auch für das Deutsche Gesundheitssystem weitgehende
Belastungen mit sich.
Peritoneale Metastasen
Authors: Piso Pompiliu
Published: November 2017

Die Diagnose peritonealer Metastasen ist nach wie vor ein negativer prognostischer Faktor für die meisten betroffenen Patienten. Der
zunehmende Einsatz aggressiver lokoregionaler Therapien darf nicht darüber hinwegtäuschen, dass nur einem geringen Anteil der Patienten
wirklich prognostisch geholfen werden kann. Dennoch handelt es sich bundesweit um Tausende von Patienten, die in den Genuss eines kurativen
Ansatzes kommen könnten. Eine Rolle spielen grundsätzlich die zugrunde liegende Tumorentität, das Ausmaß der isolierten peritonealen
Metastasen und die Radikalität der Chirurgie, die alle sichtbaren Läsionen entfernen muss. Die zytoreduktive Chirurgie, kombiniert mit der
hyperthermen intraperitonealen Chemotherapie, kann bei einem Drittel der Patienten mit einem kolorektalen Karzinom und isolierten
peritonealen Metastasen durchgeführt werden. Die Behandlung ist komplex und setzt eine intensive interdisziplinäre Absprache voraus, mit
aktiver Einbeziehung des Patienten.
Neue Entwicklungen in der Strahlentherapie
Authors: Seidensaal Katharina , Harrabi Semi Ben , Debus Jürgen
Published: November 2017

Kaum eine andere Disziplin wird durch physikalische Erkenntnisse und technologischen Fortschritt beeinflusst wie die Radiotherapie. Die
Einführung der Intensitätsmodulierten Radiotherapie (IMRT) ermöglichte eine höhere Präzision und bessere Risikoorganschonung. Der Einsatz
von Protonen mit ihren speziellen Eigenschaften bietet insbesondere große Vorteile in der Therapie von pädiatrischen und jungen Patienten
und ermöglicht die Therapie von Tumoren mit heikler anatomischer Lagebeziehung z. B. an der Schädelbasis. Zu den modernsten Errungenschaften
gehört die Kohlenstoffionentherapie, sie steht gerade mal an 11 Standorten weltweit zur Verfügung. Durch die besonderen biophysikalischen
Eigenschaften ist diese besonders für die Behandlung von strahlenresistenten Tumoren wie Chordomen, Chondrosarkomen und adenoidzystischen
Karzinomen, in Angrenzung an strahlensensible Risikoorgane geeignet. Die Dosisverteilung der Partikeltherapie ist auch den modernsten
Methoden der Photonentherapie weit überlegen. In besonderer Weise wird die Radiotherapie durch die Fortschritte in der Bildgebung, speziell
MRT und PET, beeinflusst. Die Möglichkeiten der „image guidance“, der bildgebenden Betrachtung unter der laufenden Therapie zur
Positionierungsgenauigkeit, gipfeln in der adaptiven Radiotherapie, der Anpassung an Veränderungen des Tumors in Größe und Lage sowie an
Lageveränderungen von Risikoorganen. Für die weitere Erforschung dieser Möglichkeiten werden aktuell 2 Hybridgeräte aus MRT und
Linearbeschleuniger in Heidelberg und Tübingen installiert. Mit Spannung gestaltet sich die Suche nach patientenspezifischen Biomarkern für
Therapieansprechen sowie strahlensensibilisierenden Substanzen zur „Targeted Therapy“. Die große Herausforderung der modernen
Strahlentherapie wird die Individualisierung der Therapie bezüglich der Dosis, Zielvolumendefinition und Therapiedauer darstellen.
Point defect induced giant enhancement of flux pinning in Co-doped FeSe0.5Te0.5 superconducting single crystals
Authors: Sang Lina , Maheswari Pankaj , Yu Zhenwei , Yun Frank F. , Zhang Yibing , Dou Shixue , Cai Chuanbing , Awana V. P. S. , Wang Xiaolin
Published: November 2017

Point defect pinning centers are the key factors responsible for the flux pinning and critical current density in type II superconductors. The introduction of the point defects and increasing their density without any changes to the superconducting transition temperature Tc, irreversibility field Hirr, and upper critical field Hc2, would be ideal to gain insight into the intrinsic point-defect-induced pinning mechanism. In this work, we present our investigations on the critical current density Jc, Hc2, Hirr, the activation energy U0, and the flux pinning mechanism in Fe1-xCoxSe0.5Te0.5 (x = 0, 0.03 and 0.05) single crystals. Remarkably, we observe that the Jc and U0 are significantly enhanced by up to 12 times and 4 times for the 3at.% Co-doped sample, whereas, there is little change in Tc, Hirr, and Hc2. Furthermore, charge-carrier mean free path fluctuation, δl pinning, is responsible for the pinning mechanism in Fe1-xCoxSe0.5Te0.5.
Proposal and verification numerical simulation for a microwave forward scattering technique at upper hybrid resonance for the measurement of electron gyroscale density fluctuations in the electron cyclotron frequency range in magnetized plasmas
Authors: Kawamori E. , Igami H.
Published: November 2017

A diagnostic technique for detecting the wave numbers of electron density fluctuations at electron gyro-scales in an electron cyclotron frequency range is proposed, and the validity of the idea is checked by means of a particle-in-cell (PIC) numerical simulation. The technique is a modified version of the scattering technique invented by Novik et al. [Plasma Phys. Controlled Fusion 36, 357–381 (1994)] and Gusakov et al., [Plasma Phys. Controlled Fusion 41, 899–912 (1999)]. The novel method adopts forward scattering of injected extraordinary probe waves at the upper hybrid resonance layer instead of the backward-scattering adopted by the original method, enabling the measurement of the wave-numbers of the fine scale density fluctuations in the electron–cyclotron frequency band by means of phase measurement of the scattered waves. The verification numerical simulation with the PIC method shows that the technique has a potential to be applicable to the detection of electron gyro-scale fluctuations in laboratory plasmas if the upper-hybrid resonance layer is accessible to the probe wave. The technique is a suitable means to detect electron Bernstein waves excited via linear mode conversion from electromagnetic waves in torus plasma experiments. Through the numerical simulations, some problems that remain to be resolved are revealed, which include the influence of nonlinear processes such as the parametric decay instability of the probe wave in the scattering process, and so on.
The influence of mesoscopic confinement on the dynamics of imidazolium-based room temperature ionic liquids in polyether sulfone membranes
Authors: Thomaz Joseph E. , Bailey Heather E. , Fayer Michael D.
Published: November 2017

The structural dynamics of a series of 1-alkyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide (CnmimNTf2, n = 2, 4, 6, 10: ethyl—Emim; butyl—Bmim; hexyl—Hmim; decyl—Dmim) room temperature ionic liquids confined in the pores of polyether sulfone (PES 200) membranes with an average pore size of ∼350 nm and in the bulk liquids were studied. Time correlated single photon counting measurements of the fluorescence of the fluorophore coumarin 153 (C153) were used to observe the time-dependent Stokes shift (solvation dynamics). The solvation dynamics of C153 in the ionic liquids are multiexponential decays. The multiexponential functional form of the decays was confirmed as the slowest decay component of each bulk liquid matches the slowest component of the liquid dynamics measured by optical heterodyne-detected optical Kerr effect (OHD-OKE) experiments, which is single exponential. The fact that the slowest component of the Stokes shift matches the OHD-OKE data in all four liquids identifies this component of the solvation dynamics as arising from the complete structural randomization of the liquids. Although the pores in the PES membranes are large, confinement on the mesoscopic length scale results in substantial slowing of the dynamics, a factor of ∼4, for EmimNTf2, with the effect decreasing as the chain length increases. By DmimNTf2, the dynamics are virtually indistinguishable from those in the bulk liquid. The rotation relaxation of C153 in the four bulk liquids was also measured and showed strong coupling between the C153 probe and its environment.
Graphene-based sensor rapidly detects HIV drug in nanoscale concentrations
Authors: Liebendorfer Adam
Published: November 2017

A new nanosensor based on graphene field-effect transistors boasts the ability to detect a target HIV drug comparable to liquid chromatography-mass spectrometry in a fraction of the time and cost.
Aerosols droplets controlled by catching the right waves
Authors: Wolverton Mark
Published: November 2017

Better control of aerosolized droplets demonstrated with a new method using capillary confinement.
Measuring shot noise provides a new technique to calibrate spintronic devices
Authors: Woo Marcus
Published: November 2017

Room-temperature measurements of the white shot noise of a spin torque oscillator at microwave frequencies offer a way to accurately characterize spintronic devices.
Adoption of agricultural innovations in Azerbaijan: no prospects for modernization
Authors: Sadigov Turkhan
Published: November 2017

Adoption of best agri-practices and innovations are vital for commercialization and modernization of agriculture. Favourable geographic position and climatic resources of Azerbaijan make agriculture one of the most promising launchpads for the rapid development of non-oil industry in the country. However, despite efforts of international donors, the rate of innovation adoption among local farmers is still low. The article analyzes major factors shaping Azerbaijani farmers’ adoption of best agri-methods. It reveals that technological parameters of innovation, while important, are mediated by both personal and structural factors. Therefore, selective improvement of one factor might not yield sustainable results. While both the government and the majority of farmers take conservative position toward innovations, agriculture, despite its potential, has low probability of becoming a strong pillar of Azerbaijani non-oil economy. Specific configuration of incentive structure and social classes means that agriculture in Azerbaijan is unlikely to experience capitalist modernization in the foreseeable future.
Igβ ubiquitination activates PI3K signals required for endosomal sorting
Authors: Veselits Margaret , Tanaka Azusa , Chen Yaoqing , Hamel Keith , Mandal Malay , Kandasamy Matheswaran , Manicassamy Balaji , O’Neill Shannon K. , Wilson Patrick , Sciammas Roger , Clark Marcus R.
Published: November 2017

A wealth of in vitro data has demonstrated a central role for receptor ubiquitination in endocytic sorting. However, how receptor ubiquitination functions in vivo is poorly understood. Herein, we report that ablation of B cell antigen receptor ubiquitination in vivo uncouples the receptor from CD19 phosphorylation and phosphatidylinositol 3-kinase (PI3K) signals. These signals are necessary and sufficient for accumulating phosphatidylinositol (3,4,5)-trisphosphate (PIP3) on B cell receptor–containing early endosomes and proper sorting into the MHC class II antigen-presenting compartment (MIIC). Surprisingly, MIIC targeting is dispensable for T cell–dependent immunity. Rather, it is critical for activating endosomal toll-like receptors and antiviral humoral immunity. These findings demonstrate a novel mechanism of receptor endosomal signaling required for specific peripheral immune responses.
Host resistance to endotoxic shock requires the neuroendocrine regulation of group 1 innate lymphoid cells
Authors: Quatrini Linda , Wieduwild Elisabeth , Guia Sophie , Bernat Claire , Glaichenhaus Nicolas , Vivier Eric , Ugolini Sophie
Published: November 2017

Upon infection, the immune system produces inflammatory mediators important for pathogen clearance. However, inflammation can also have deleterious effect on the host and is tightly regulated. Immune system–derived cytokines stimulate the hypothalamic–pituitary–adrenal (HPA) axis, triggering endogenous glucocorticoid production. Through interaction with ubiquitously expressed glucocorticoid receptors (GRs), this steroid hormone has pleiotropic effects on many cell types. Using a genetic mouse model in which the gene encoding the GR is selectively deleted in NKp46+ innate lymphoid cells (ILCs), we demonstrated a major role for the HPA pathway in host resistance to endotoxin-induced septic shock. GR expression in group 1 ILCs is required to limit their IFN-γ production, thereby allowing the development of IL-10–dependent tolerance to endotoxin. These findings suggest that neuroendocrine axes are crucial for tolerization of the innate immune system to microbial endotoxin exposure through direct corticosterone-mediated effects on NKp46-expressing innate cells, revealing a novel strategy of host protection from immunopathology.
Chromatin histone modifications and rigidity affect nuclear morphology independent of lamins
Authors: Stephens Andrew D. , Liu Patrick Z. , Banigan Edward J. , Almassalha Luay M. , Backman Vadim , Adam Stephen A. , Goldman Robert D. , Marko John F.
Published: November 2017

Chromatin decompaction via increasing euchromatin or decreasing heterochromatin results in a softer nucleus and abnormal nuclear blebbing, independent of lamin perturbations. Conversely, increasing heterochromatin stiffens the nucleus and rescues nuclear morphology in lamin-perturbed cells that present abnormal nuclear morphology.
Theorizing a model information pathway to mitigate the menstrual taboo
Authors: Yagnik Arpan
Published: November 2017

The impact of menstruation on the society is directly seen in the educational opportunities, quality of life and professional endeavors of females. However, lack of menstrual hygiene management has indirect implication on the balance and development of the society and nation. This study is set in the Indian context. The researcher identifies actors with a potential of mitigating menstrual taboo and then theorizes an optimal information pathway to mitigate menstrual taboo. Diffusion of innovation, framing and agenda setting theories contribute as frameworks in the creation of an optimal pathway to dissolve the menstrual taboo. The actors identified in this model are scholars, health activists, students, NGOs, media, government, corporations and villages or communities. The determinants for the direction and the order of the pathway to diffuse knowledge and confidence among these actors are the ultimate goal and sustainability of the model, strengths and weaknesses of actors, and actors’ extent of influence. Considering the absence of an existing alternate, this model pathway provides a solid framework purely from a theoretical perspective. Theoretically, this model pathway is possible, practical and optimal.
High-Voltage Electrical Stimulation Versus Ultrasound in the Treatment of Pressure Ulcers
Authors: Bora Karsli Pinar , Gurcay Eda , Karaahmet Ozgur Zeliha , Cakci Aytul
Published: November 2017

OBJECTIVE:

The aim of this study was to assess and compare the efficacy of high-voltage electrical stimulation (HVES) with ultrasound (US) in treating Stage II through Stage IV pressure ulcers (PrUs)* of hospitalized patients.

DESIGN:

This study was designed as a prospective, controlled trial in which patients were randomly assigned to 2 groups.

PARTICIPANTS AND SETTINGS:

A total of 27 patients (22 male, 5 female) hospitalized for neurologic rehabilitation in the Clinic of Physical Medicine and Rehabilitation with Stage II through Stage IV PrUs were included in this study. The patients were randomly assigned to either HVES or US treatment group, and all patients underwent standard wound care. Over 4 to 12 weeks, HVES was applied for 60 minutes 3 times per week, and US was applied 3 times per week.

MAIN OUTCOME MEASURES:

Properties of the PrUs were noted during pre- and posttreatment.

RESULTS:

The PrUs of patients in the HVES and US groups healed at a mean rate of 43% and 63%, respectively. There was no statistically significant intergroup difference in healing found after treatment. Regression analysis was performed for the factors that could influence the wound surface areas, and significant effects were detected among the level of ambulation, pretreatment stage, and smoking.

CONCLUSIONS:

Both HVES and US are promising methods for wound healing, and both electrotherapy modalities have been demonstrated to support the healing of PrUs.
Managing hypertriglyceridemia
Authors: Copple Tina , Ciffone Nicole A.
Published: November 2017

Cardiovascular (CV) risk remains in some patients who are treated with statins. Evidence supports a role for triglycerides (TGs) in CV disease. TG-lowering agent outcomes studies have been inconsistent, but eicosapentaenoic acid significantly reduced coronary events in hypercholesterolemic patients who were treated with statins. Ongoing outcomes studies will clarify the role of TG-lowering treatments in CV risk reduction.
Drug updates and approvals
Authors: Mospan Geoffrey , Mospan Cortney , Vance Shayna , Bradshaw Alyssa , Meosky Kalyn , Bowles Kirklin
Published: November 2017

In 2017, the FDA approved several new drugs for use in primary care. This article highlights the following new drugs: brodalumab (Siliq), dapagliflozin and saxagliptin (Qtern), dupilumab (Dupixent), oxymetazoline (Rhofade), safinamide (Xadago), and sarilumab (Kevzara).
Risk Factors for Emergency Department Visits After Hysterectomy for Benign Disease
Authors: Mahnert Nichole , Kamdar Neil , Lim Courtney S. , Skinner Bethany , Hassett Afton , Kocher Keith E. , Morgan Daniel M. , As-Sanie Sawsan
Published: November 2017

(Abstracted from Obstet Gynecol 2017;130:296–304)

The need for emergency department (ED) visits following hysterectomy for benign indications may reflect quality of care and affect costs of health care. These visits are potentially modifiable and a target for development of interventions to improve care coordination, enhance patient satisfaction, and reduce health care costs.
Clinical Utility of Noninvasive Prenatal Testing in Pregnancies With Ultrasound Anomalies
Authors: Beulen L. , Faas B. H. W. , Feenstra I. , Van Vugt J. M. G. , Bekker M. N.
Published: November 2017

(Abstracted from Ultrasound Obstet Gynecol 2017;49:721–728)

Following an ultrasound examination indicating an elevated risk of a fetal chromosomal abnormality, pregnant women are offered prenatal genetic testing to more accurately identify the anomalies' etiology and fetal prognosis. Follow-up genetic testing usually includes G-band karyotyping and/or chromosomal microarray analysis (CMA).
24/7 Presence of Medical Staff in the Labor Ward; No Day-Night Differences in Perinatal and Maternal Outcomes
Authors: Tavares Sara , Cavaco-Gomes João , Moucho Marina , Severo Milton , Mateus Mário , Ramalho Carla , Visser Gerard H. A. , Montenegro Nuno
Published: November 2017

(Abstracted from Am J Perinatol 2017;34:529–534)

An unavoidable part of every health care professional's life is nighttime shifts that may have negative effects on both the providers themselves and the patients they care for. Absence of experienced staff during the night and exhaustion after long working days could lead to errors and subsequently adverse neonatal and maternal outcomes.
Gender Disparities in Medical Student Research Awards: A 13-Year Study From the Yale School of Medicine
Authors: King Joseph T. , Angoff Nancy R. , Forrest John N. , Justice Amy C.
Published: November 2017

Purpose

The Liaison Committee on Medical Education mandates instruction in research conduct, and many U.S. medical schools require students to complete a research project. All Yale School of Medicine (YSM) graduating students submit a research thesis, and ~5% are awarded highest honors. Gender disparities exist in areas related to physician research productivity, including academic rank, research funding, and publications. The authors asked whether gender disparities exist for medical student research.

Method

The authors conducted a retrospective review of 1,120 theses submitted by graduating medical students from 2003 to 2015 at YSM and collected data on gender, mentoring, research type, sponsoring department, and other characteristics. Multivariate logistic regression modeling examined gender differences in medical student research awards.

Results

Women authored 50.9% of theses, but earned only 30.9% of highest honors awards (OR 0.41; 95% CI: 0.23, 0.74). Among factors associated with increased receipt of highest honors that differed by gender, men were more likely than women to work with a mentor with a history of three or more thesis honorees, take a fifth year of study, secure competitive research funding, undertake an MD–master of health science degree, and conduct laboratory research (all P < .001). After adjustment for these factors, and for underrepresented in medicine status and sponsoring department, women remained less likely to receive highest honors (OR 0.51; 95% CI: 0.27, 0.98).

Conclusions

Women YSM students were less likely to receive highest honors for medical research. Gender disparities in postgraduate biomedical research success may start during undergraduate medical education.
Integrating Social Determinants of Health Into Graduate Medical Education: A Call for Action
Authors: Siegel Jennifer , Coleman David L. , James Thea
Published: November 2017

Social determinants of health (SDH) are the major drivers of health and disparate health outcomes across communities and populations. Given this, the authors assert that competency in recognizing and mitigating SDH should become a vital component of graduate medical education in all specialties. Although the most effective approaches to educating trainees about SDH are uncertain, in this Invited Commentary, the authors offer several key principles for implementing curricula focusing on SDH. These include universalization of the material, integration into clinical education, identification of space for trainee introspection, clarification of specific competencies in identification and mitigation of SDH, and creation of robust faculty development programming. The authors highlight several examples of curricular approaches to SDH, touching on orientation, experiential learning, community-based and service–learning opportunities, interprofessional activities, and the hidden curriculum. The authors argue that all clinical trainees must learn to recognize and mitigate SDH and that doing so will allow them to achieve meaning and mastery in medicine and to better meet society’s pressing health needs.
Value and Health Care Policy Ramifications of Opioid Use and Abuse: Can We Do Better and Now Finally Abandon Opioids?
Authors: Antony Ajay , Margaret Hsu Yu-ning , Przkora Rene
Published: November 2017

Opioids are some of the most potent analgesics available and their use has been promoted over the last several decades to improve suffering from pain. Unfortunately, with the increased use and access to opioid therapy, significant side effects have surfaced and the death toll caused by opioid overdose has surpassed any other medication, including illegal drugs such as heroin. This observation and the fact that opioid therapy has not met the expectations placed onto it, health care providers and policy makers are seeking alternatives with the intent to avoid opioids. Several nonopioid analgesic strategies have since been studied with variable success, demonstrating that opioid therapy will still play a role in the near future. As health care providers are becoming more aware of the side effects and problems with patient selection, we can assume that a selective approach to opioid therapy will decrease mortality related to this medication class and improve outcomes through the use of better education, compliance monitoring, abuse-deterrent formulations, and a proactive approach to anticipated side effects.
Liposomal Bupivacaine: Market Penetration Versus Scientific Evidence: Only the Facts
Authors: Sah Alexander P. , Warren Lisa
Published: November 2017

Hip and knee replacement continue to be two of the most reliable surgical procedures in relieving pain. The number of joint replacements performed in the United States are expected to continue to increase exponentially. Shorter hospital stays and rapid recovery protocols require optimal pain management to allow early or outpatient discharges. Traditional pain protocols based on opioids are associated with adverse events and complications. Growing literature has shown that the use of opioids even in association with elective joint replacement can lead to abuse and chronic use. Periarticular injections have offered the potential for improved pain relief while avoiding systemic side effects. Liposomal bupivacaine has gained rapid interest and broad use, despite conflicting results in the literature. The balance of market penetration and scientific evidence before widespread use requires careful analysis of the available literature. This review summarizes the current studies of liposomal bupivacaine used in total joint replacement.
Recurrent Corneal Erosions Secondary to Use of Sleep Mask
Authors: McGlumphy Elyse J. , Margo Jordan A. , Jeng Bennie H.
Published: November 2017

A 31-year-old woman with a history of unusual appearing recurrent linear corneal epithelial defects and subepithelial scaring in both eyes underwent 2 years of evaluation and treatment. It was eventually discovered that the patient was using a sleep mask with excessive fabric pilling, which was found to be the source of her chronic epitheliopathy. After discontinuation of the sleep mask, the patient experienced complete resolution of symptoms. When evaluating recurrent corneal epithelial defects, external sources of repeated trauma, including sleepwear, should be investigated.
Sealing of Corneal Lacerations Using Photoactivated Rose Bengal Dye and Amniotic Membrane
Authors: Soeken Timothy A. , Zhu Hong , DeMartelaere Sheri , Davies Brett W. , Kim Mirang , Wang Heuy-Ching , Aden James , Grimm Rose , Alt Clemens , Kochevar Irene E. , Johnson Anthony J.
Published: November 2017

Purpose:

Watertight closure of perforating corneoscleral lacerations is necessary to prevent epithelial ingrowth, infection, and potential loss of the eye. Complex lacerations can be difficult to treat, and repair with sutures alone is often inadequate. In this study, we evaluated a potentially sutureless technology for sealing complex corneal and scleral lacerations that bonds the amniotic membrane (AM) to the wound using only green light and rose bengal dye.

Methods:

The AM was impregnated with rose bengal and then sealed over lacerations using green light to bond the AM to the deepithelialized corneal surface. This process was compared with suture repair of 3 laceration configurations in New Zealand White rabbits in 3 arms of the study. A fourth study arm assessed the side effect profile including viability of cells in the iris, damage to the blood–retinal barrier, retinal photoreceptors, retinal pigment epithelium, and choriocapillaris in Dutch Belted rabbits.

Results:

Analyses of the first 3 arms revealed a clinically insignificant increase in polymorphonuclear inflammation. In the fourth arm, iris cells appeared unaffected and no evidence of breakdown of the blood–retinal barrier was detected. The retina from green light laser-treated eyes showed normal retinal pigment epithelium, intact outer segments, and normal outer nuclear layer thickness.

Conclusions:

The results of these studies established that a light-activated method to cross-link AM to the cornea can be used for sealing complex penetrating wounds in the cornea and sclera with minimal inflammation or secondary effects.
T-SPOT.TB Performance in Routine Pediatric Practice in a Low TB Burden Setting
Authors: Mandalakas Anna M. , Highsmith Heather Y. , Harris Nadine M. , Pawlicka Anna , Kirchner H. Lester
Published: November 2017

Background:

The T-SPOT.TB, an interferon-gamma release assay, is an indirect test of Mycobacterium tuberculosis infection. Due to sparse and conflicting evidence, the use of interferon-gamma release assay is limited in young and HIV-infected children. We determined the prevalence of invalid, borderline, positive and negative results and associations with key demographic variables during routine pediatric use in a low tuberculosis burden setting.

Methods:

For pediatric samples received at Oxford Diagnostic Laboratories between 2010 and 2015, the associations between initial test outcome and demographics were estimated by bivariate analysis and logistic regression.

Results:

A total of 44,289 samples (median age 12.5 years; interquartile range 7.7–15.5), including 5057 samples (11.6%) from children under 5 years old, were received from 46 U.S. states, Washington, DC and Puerto Rico. A total of 592 samples (1.3%) could not be tested. T-SPOT.TB positivity was strongly correlated (r = 0.60; P < 0.0001) with state TB incidence. Compared with negative results, positive results were more likely in samples from older children (P < 0.0001), public health clinics (P < 0.0001) and rural locations (P = 0.005). Although infrequent (0.6%), invalid results were more common in samples collected at HIV clinics (odds ratio = 2.5, 95% confidence interval: 1.3–4.9) and from younger children (P = 0.03). These invalid results were more likely due to a robust nil (negative) control response rather than a weak mitogen (positive) control response.

Conclusions:

The T-SPOT.TB test correlated strongly with well-recognized risk factors for tuberculosis infection and provided evaluable results in 98% of children. To optimize the impact of testing on clinical decision making and patient outcomes, local epidemiology and individual patient risk should be considered when incorporating IGRAs into pediatric guidelines.
Immunity After Childhood Vaccinations in Perinatally HIV-exposed Children With and Without HIV Infection in Latin America
Authors: Succi Regina C. M. , Krauss Margot R. , Harris D. Robert , Machado Daisy M. , de Moraes-Pinto Maria I. , Mussi-Pinhata Marisa M. , Pavia Ruz Noris , Pierre Russell B. , Kolevic Roca Lenka A. , Joao Esaú , Foradori Irene , Scotta Marcelo C. , Hazra Rohan , Siberry George K. ,   for the NISDI Pediatric Study Group 2012
Published: November 2017

Background:

Perinatally HIV-infected (PHIV) children are at risk for under-vaccination and poor vaccine response at 4 years of age. Childhood vaccine coverage and immune response were compared between PHIV and HIV-exposed uninfected (HEU) children in Latin America and the Caribbean.

Methods:

PHIV and HEU children were enrolled prospectively at 15 sites from 2002 to 2009. Full vaccination by age 4 years was defined as: 3 hepatitis B virus vaccine doses; 4 tetanus toxoid–containing vaccine doses; 3 doses of Haemophilus influenzae type b vaccine by age 12 months or ≥1 dose given after age 12 months; one measles-containing vaccine dose; one rubella-containing vaccine dose. Immunity was defined by serum antibody titer. Fisher exact test (for categorical measures) and t test (for continuous measures) were used for comparisons.

Results:

Among 519 children seen at age 4 years, 191 had serum specimens available (137 PHIV, 54 HEU). Among those with specimens available, 29.3% initiated combination antiretroviral therapy (cART) <12 months of age, 30.9% initiated at ≥12 months of age, and 39.8% had not received cART by the time they were seen at 4 years of age. At 4 years of age, 59.9% were on PI-containing cART (cART/PI), and 20.4% were on no ART. PHIV children were less likely than HEU children to be fully vaccinated for tetanus (55.5% vs. 77.8%, P = 0.005) and measles and rubella (both 70.1% vs. 94.4%, P < 0.001). Among those fully vaccinated, immunity was significantly lower among PHIV than HEU for all vaccines examined: 20.9% versus 37.8% for hepatitis B virus (P = 0.04), 72.0% versus 90.5% for tetanus (P = 0.02), 51.4% versus 68.8% for H. influenzae type b (P = 0.05), 80.2% versus 100% for measles (P < 0.001) and 72.9% versus 98.0% for rubella (P < 0.001) vaccine, respectively.

Conclusions:

Compared with HEU, PHIV children were significantly less likely to be immune to vaccine-preventable diseases when fully vaccinated. Strategies to increase immunity against vaccine-preventable diseases among PHIV require further study.
Baccalaureate Nursing Students’ Perceptions Regarding Autopsy Experiences
Authors: Cannon Emily J. , Bauer Renee N.
Published: November 2017

Purpose

Since 2012, a medical–surgical nursing course at a midsized state university has provided the opportunity for students to view autopsies with a board-certified forensic pathologist. The autopsies are performed at a midsized hospital relatively close to the campus. The purpose of this study was to discover nursing students’ perceptions that emerged during the autopsy experience.

Methods

A convenience sample of 23 baccalaureate nursing students took part in the autopsy experience over a 4-month period. Archival data from an online, anonymous questionnaire, completed after the experience, were reviewed and subjected to qualitative analysis. This study was approved by the university’s institutional review board.

Results

Rich data emerged regarding the students’ experiences, including emotional, psychological, and knowledge-based perceptions.

Conclusion

Autopsies are important learning tools for nursing students, especially those who go into advanced practice nursing and forensic nursing. Anatomy, physiology, and pathophysiology are essential for students to understand as they learn about medical–surgical nursing concepts. Unique emotional characteristics of the students and cause of death of the deceased influenced how some students viewed the autopsy experience. Students reported that processing and debriefing activities were important after viewing autopsies and should be encouraged.
Evolving paradigms for new agent development in pediatric oncology
Authors: Flynn Andrea , Fox Elizabeth
Published: November 2017

Purpose of review

To discuss considerations of new paradigms for clinical drug development in pediatric oncology that incorporate our expanding knowledge and complexity of molecular alterations associated with cancer; advances in cancer immunology and cellular therapy; the increasing number of new anticancer drugs, therapeutic approaches, and potential combinations; and recent initiatives by regulatory agencies to improve access to safe and effective therapies.

Recent findings

Cancer in children and adolescents is a rare event with significant long-term impact on individuals and society. Using multimodality therapy, stratified by patient and disease characteristics, the cure rate for childhood cancer exceeds 80%. Cancer genomics has transformed anticancer drug development. Understanding the genetic basis of pediatric cancers and the use of genomics for risk stratification has changed the focus of drug development from cytotoxic drugs to targeted therapeutic approaches. Advances in cancer immunology, immune checkpoint blockade, and cellular therapy offer novel approaches to harness T cells to treat cancer. To improve the outcome for children and adolescents with cancer and accelerate drug development, understanding drug and target interactions in preclinical models of pediatric cancer should be coupled with efficient clinical trial designs that incorporate biomarker selection, assessment of toxicity and drug exposure, and improved measures of response.

Clinical trials for children and adolescents with cancer evaluate cytotoxic drugs, molecularly target drugs, immunotherapy as well as combination therapies. The framework for oncology clinical trials will continually adapt to improve efficiency of trials and evaluate new therapeutic approaches.
Magnet® Enculturation
Authors: Lal M. Maureen
Published: November 2017

In this column, the senior manager for the Magnet Appraiser Program® relates the importance of the components of the journey to Magnet with developing and sustaining a culture of excellence through the appraisal period and beyond. Sustainment of excellence includes regular critical assessments and support in nursing practice, governance models, and resources throughout organizational settings where nursing is practiced.
Management of Menopausal Symptoms in Women With Gynecologic Cancers
Authors: del Carmen Marcela G. , Rice Laurel W.
Published: November 2017

(Abstracted from Gynecol Oncol 2017;146:427–435)

Treatment of gynecologic cancers usually involves surgery, systemic chemotherapy, and/or radiation therapy, which often result in loss of ovarian function. Many of these women will be cured or become long-term cancer survivors and will become postmenopausal.
Effectiveness of Vaccination During Pregnancy to Prevent Infant Pertussis
Authors: Baxter Roger , Bartlett Joan , Fireman Bruce , Lewis Edwin , Klein Nicola P.
Published: November 2017

(Abstracted from Pediatrics 2017;139(5):e20164091)

Pertussis is a virulent and life-threatening respiratory infection, particularly in infants, caused by the bacteria Bordetella pertussis. Tetanus toxoid, reduced diphtheria toxoid, acellular pertussis (TDaP) vaccination during pregnancy is recommended to protect newborns against pertussis.
Unusual Suicide by a Speargun Shot Through the Mouth
Authors: Nouma Youssef , Krimi Sami , Regaieg Karama
Published: November 2017

We report an unusual case of suicide committed with a speargun shot through the mouth, causing a penetrating brain injury. The special features of the present case are not only related to the method chosen for the purpose but also to the difficulties encountered in confirming the diagnosis. Although this type of suicide has been previously reported, this case is particularly interesting in terms of the shooting mechanism and manner of death. Because of the length of the weapon, which was apparently used and found at the scene, a suicidal manner of death first seemed unlikely and the possibility of a simulated suicide was raised. It seemed impossible for the decedent to have shot himself without a mechanism to launch the shaft through the mouth. However, a complete forensic approach eventually allowed for a plausible mechanism of self-infliction, confirming the suicide diagnosis.
A Rare Case of Hemopericardium From a Ruptured Dissecting Pulmonary Artery Aneurysm
Authors: Tse Rexson , Garland Jack , Triggs Yvonne , Stables Simon
Published: November 2017

Nontraumatic hemopericardium is a potentially fatal pathology that is most commonly caused by myocardial wall rupture, ruptured aortic dissection, aortic aneurysm rupture, or a neoplastic process. A rare potential cause of hemopericardium is pulmonary artery dissection, with less than 100 reported cases in the literature. Pulmonary artery dissection is associated with pulmonary artery aneurysm, pulmonary artery hypertension, and congenital heart disease. We report a fatal case of nontraumatic hemopericardium caused by a ruptured dissecting pulmonary artery aneurysm in a 16-year-old girl with patent ductus arteriosus. The unenhanced postmortem computed tomography performed before autopsy was able to identify a large hemopericardium with a pulmonary artery aneurysm and lifting of mural calcification suggestive of a dissecting aneurysm. This enabled the pathologist to locate the exact rupture site that caused the hemopericardium.
B Lymphoblastic Leukemia/Lymphoma With Burkitt-like Morphology and IGH/MYC Rearrangement
Authors: Li Yiting , Gupta Gunjan , Molofsky Ari , Xie Yi , Shihabi Nader , McCormick Jane , Jaffe Elaine S.
Published: November 2017

Isolated MYC rearrangement without other recurrent genetic abnormalities is rare in B lymphoblastic leukemia/lymphoma (B-ALL/LBL), with most cases reported in pediatric patients. We report 3 adult cases with lymphoblasts showing a precursor B cell immunophenotype, and isolated MYC/IGH translocation. All 3 cases occurred in male patients with initial presentation of diffuse lymphadenopathy. Cases 1 and 2 had B-ALL with significantly increased lymphoblasts in peripheral blood and bone marrow. Case 3, a patient with human immunodeficiency virus infection, had the diagnosis of B-LBL made on a retroperitoneal lymph node biopsy and had no peripheral blood or bone marrow involvement. The leukemic and lymphoma cells in all 3 cases demonstrated Burkitt lymphoma-like morphology with deeply basophilic cytoplasm and numerous cytoplasmic vacuoles. However, all 3 had immature immunophenotypes including expression of terminal deoxynucleotidyl transferase (TdT), absence of BCL6, and dim-to-negative CD45. CD20 was largely negative in 2 of 3 cases. All 3 had confirmed MYC/IGH translocation, but lacked rearrangements of BCL2 or BCL6. EBV was negative by Epstein-Barr virus encoded small RNA in situ hybridization. Treatment protocols varied, including both high-risk ALL-type (protocol 8707) and high-grade lymphoma regimens (hyper-CVAD [cyclophosphamide, vincristine, adriamycin, and dexamethasone]), but no patient achieved continuous complete remission. These cases seem to represent a distinct biological phenomenon, in which a MYC translocation may be acquired at an immature stage of differentiation, thus manifesting features of both B-ALL/LBL and Burkitt lymphoma.
PD-L1 and PD-L2 Are Differentially Expressed by Macrophages or Tumor Cells in Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type
Authors: Menguy Sarah , Prochazkova-Carlotti Martina , Beylot-Barry Marie , Saltel Fréderic , Vergier Béatrice , Merlio Jean-Philippe , Pham-Ledard Anne
Published: November 2017

As checkpoint molecules’ inhibition may represent a therapeutic option in relapsing cases, we assessed programmed death ligands’ (PD-L1/PD-L2) expression in a series of 29 primary cutaneous diffuse large B-cell lymphoma, leg-type (PCDLBCL-LT) cases. Double immunostaining for either PD-L1 or PD-L2 was associated either with PAX5 staining to evaluate tumor cells or with CD68 or CD163 staining for macrophages. The microenvironment of PCDLBCL-LT was characterized by immunostainings for CD3 (tumor-infiltrating lymphocytes), FOXP3 (regulatory T cells), programmed cell death-1, and CD33 (myeloid-derived suppressor cells). The 9p24.1 locus encoding for PD-L1/PD-L2 was evaluated by fluorescence in situ hybridization. A PD-L1 expression was observed in all cases. However, double staining with PD-L1/PAX5 identified only 1 case harboring PD-L1 expression by tumor cells. All cases displayed PD-L1 expression by numerous immune cells, characterized as CD68+ CD163+ M2 macrophages. A normal fluorescence in situ hybridization pattern was observed in 21 of 26 cases. Three cases (11.5%) harbored a low polysomy status including the case with PD-L1 expression by tumor cells. Interestingly, 2 cases (7.7%) exhibited a PD-L1/PD-L2 locus break-apart pattern, and PD-L2 expression by tumor cells was observed. PD-L2 expression by tumor cells was not observed in the 24 cases without 9p24.1 rearrangement. Treating patients with relapsing PCDLBCL-LT by using immune checkpoint inhibitors may have an indirect effect through immune cells, except in rare cases with 9p24.1 rearrangement leading to PD-L2 expression by tumor cells. Reprogramming tumor-associated macrophages with anticancer therapies is appealing in such lymphoma subtypes wherein M2 macrophages represent the majority of immune cells.