bluuebunny/crossref_metadata_2025 huggingface dataset:
The Managment of cervical spine abnormalities in children with spondyloepiphyseal dysplasia congenita
Authors: Al Kaissi Ali , Ryabykh Sergey , Pavlova Olga M. , Ochirova Polina , Kenis Vladimir , Chehida Farid Ben , Ganger Rudolf , Grill Franz , Kircher Susanne Gerit
Published: January 2019

Spondyloepiphyseal dysplasia congenita (SEDC) is an autosomal dominant disorder, characterized by disproportionate dwarfism with short spine, short neck associated with variable degrees of coxa vara. Cervical cord compression is the most hazardous skeletal deformity in patients with SEDC which requires special attention and management.

Ten patients with the clinical and the radiographic phenotypes of spondyloepiphyseal dysplasia congenita have been recognized and the genotype was compatible with single base substitutions, deletions or duplication of part of the COL2A1 gene (6 patients out of ten have been sequenced). Cervical spine radiographs showed apparent atlantoaxial instability in correlation with odontoid hypoplasia or os-odontoideum.

Instability of 8 mm or more and or the presence of symptoms of myelopathy were the main indications for surgery. Posterior cervical fusion from the occiput or C1–3, decompression of C1–2 and application of autorib transfer followed by halo vest immobilization have been applied accordingly.

Orthopedic management of children with spondyloepiphyseal dysplasia congenita (SEDC) should begin with the cervical spine to avoid serious neurological deficits and or mortality.
Effect of parecoxib in the treatment of postoperative cognitive dysfunction
Authors: Huang Song , Hu Haijun , Cai Yue-Hong , Hua Fuzhou
Published: January 2019

Background:

Parecoxib is a selective cyclooxygenase (COX)-2 inhibitor widely used as an analgesia technique in perioperative period for its potent anti-inflammatory and analgesic effects. However, litter is known about its effect on postoperative cognitive dysfunction (POCD). The purpose of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the effect of parecoxib in the treatment of postoperative cognitive dysfunction.

Methods:

We searched PubMed, Cochrane Library and Embase databases for relevant studies up to October 2017. We selected fixed-effect model for analysis of data heterogeneity. Statistical analyses were performed by using Review Manager Version 5.3 for Windows.

Results:

Four RCTs with 904 patients that underwent surgical operations were included. The meta-analysis demonstrated parecoxib could significantly decrease the incidence of POCD on postoperative day 1, day 3, day 5, and day 7 when compared with control treatment; IL-6 and S100β concentrations were lower up to postoperative day 2. The consumption of morphine, fentanyl and tramadol in parecoxib groups were lower than control groups.

Conclusion:

Our meta-analysis suggested that the administration of Parecoxib was effective in treating early POCD within 7 days and reducing IL-6 and S100β concentrations within 2 days after operations. Nevertheless, our current study with some limitations such as the small sample size only provided limited quality of evidence, confirmation from further meta-analysis with large-scale, well-designed RCTs is required.
Pain-induced peripheral artery tonometry scores in the control arm are impaired in patients with apical ballooning syndrome
Authors: Sun Tao , Widmer R. Jay , Matsuzawa Yasushi , Lennon Ryan J. , Park Kyoung H. , Lerman Lilach O. , Lerman Amir
Published: January 2019

Mental and physical stress is thought to play an important causative factor in apical ballooning syndrome (ABS) likely secondary to the vasomotor dysfunction. However, there are currently few data related to the impact of physical stress in this unique cardiomyopathy.

A total 18 patients, including 8 females with history of ABS and 10 post-menopausal controls, underwent physical and mental tests. Assessments included the pain-induced peripheral artery tonometry scores (PIPATs) and mental stress peripheral artery tonometry scores (PATs).

Compared with control group, PIPATs were significantly attenuated in patients with ABS in both baseline and post-mental stress (0.94 ± 0.08 vs1.30 ± 0.54, P <.05 and 0.87 ± 0.19 vs1.24 ± 0.21 P = .01, respectively); mental stress PATs were significantly lower in patients with ABS, both in Stroop test (0.79 ± 0.30 vs 1.24 ± 0.43, P = .01) and arithmetic test (0.91 ± 0.27 vs 1.36 ± 0.57, P = .01). PIPATs correlated significantly with mental stress PATs, both in arithmetic and Stroop test (P <.05).

The PIPATs were attenuated in female with history of ABS and the vascular response to pain may provide a different pathogenesis mechanism on detecting patients with ABS.
Prognosis of osteosarcomas in the mandible: 15-year experience of 55 patients
Authors: Seng Dongjie , Wu Junfu , Fang Qigen , Liu Fei
Published: January 2019

Our goal was to evaluate the prognosis of osteosarcomas (OS) in the mandible for finding out the best treatment.

Patients diagnosed with OS in the mandible from January 2000 to December 2015 were retrospectively enrolled. Demographic, tumor-specific, treatment, and survival data were collected and analyzed.

A total of 55 patients (35 male and 20 female) were included, all patients had first manifestation of swelling. Cachexia occurred in 15 (27.3%) patients. Chondroblastic type was the most common histology subtype followed by osteoblastic type. High grade tumors were found in 30 (63.6%) patients. 33 (60%) patients received an operation of hemimandibulectomy, and free fibula reconstruction was performed in 20 (36.4%) patients. The 5-year recurrence-free survival (RFS) and disease-specific survival (DSS) rates were 73.6% and 66.9%, respectively. Univariate prognostic analysis reported risk factors of tumor grade, reconstruction type (free fibula flap vs non-free flap), and operation extent were significant for the recurrence, and reconstruction type and operation extent were significant for the disease-specific death, but in multivariate analysis, only the factor of operation extent was significantly associated with both the recurrence and death.

A wide excision extent such as hemimandibulectomy is suggested for OS in the mandible for achieving good prognosis.
A CARE-compliant article: a case report of primary adenocarcinoma of the anal glands
Authors: Ji Yong , Zhou Youxin
Published: January 2019

Rationale:

Adenocarcinoma of the anal canal is an uncommon malignancy. Primary adenocarcinoma, in particular, is extremely rare.

Patient concerns:

A 61-year-old man was referred to our institution with complaints of repeated hematochezia.

Diagnosis:

Digital rectal examination revealed a hard palpable ulcer in the anal canal, measuring 2 cm × 2 cm in size, at the 5 o’clock direction (in the lithotomy position). The pelvic enhanced magnetic resonance imaging revealed anal verge occupying mass. A diagnosis of carcinoma of the anal canal was considered. Colonoscopic examination revealed a poorly differentiated adenocarcinoma of the anal canal.

Interventions:

The patient underwent abdominoperineal resection (APR) of the rectum, and was administered 6 courses of adjuvant chemotherapy with mFOLFOX.

Outcomes:

The patient was followed up for more than 1 year after operation, and no local recurrence or distant metastasis occurred.

Lessons:

The diagnosis and treatment of this disease is still a huge challenge because its incidence is very low. A study of more cases is required for uniformity in diagnosis and for the development of treatment protocols.
Successful treatment of a lung adenocarcinoma patient with a novel EGFR exon 20-ins mutation with afatinib
Authors: Cai Yangyang , Wang Xu , Guo Ye , Sun Chao , Xu Yinghui , Qiu Shi , Ma Kewei
Published: January 2019

Rationale:

Comprehensive genomic profiling for non-small cell lung cancer (NSCLC) is likely to identify more patients with rare genetic alterations, including uncommon epidermal growth factor receptor (EGFR) gene mutation.

Patient concerns:

A 63-year-old Chinese woman who had never smoked visited our lung cancer clinic due to a chronic cough.

Diagnosis:

The patient was diagnosed with lung adenocarcinoma by transbronchial lung biopsy. An EGFR mutation (exon 20 insertion H773_V774insH, D770_N771insG, V769_D770insASV, D770_N771insSVD) was detected in the biopsy specimen by quantitative real-time PCR.

Interventions:

The patient was treated with osimertinib first, and the progression-free survival (PFS) was 4.4 months. After the disease progressed, the second genetic test of pleural effusion suggesting the EGFR exon 20-ins mutation site changed to A767delinsASVD only. Then the patient was treated with afatinib with informed consent.

Outcomes:

The treatment of afatinib in this patient was successful, PFS was 7.4 months.

Lessons:

To our knowledge, EGFR exon 20-ins mutation A767delinsASVD has never been reported, and the successful treatment of afatinib may provide a new therapeutic option for this type of exon 20 insertion mutations.
Association between chronic bacterial airway infection and prognosis of bronchiolitis obliterans syndrome after hematopoietic cell transplantation
Authors: Yomota Makiko , Yanagawa Noriyo , Sakai Fumikazu , Yamada Yuta , Sekiya Noritaka , Ohashi Kazuteru , Okamura Tatsuru
Published: January 2019

Bronchiolitis obliterans syndrome (BOS) is a rare pulmonary complication of hematopoietic stem cell transplantation (HSCT) with high mortality. Chronic bacterial airway infection (CAI) causes exacerbation and progression of several airway diseases, and bacterial airway colonization was shown to be associated with BOS after lung transplantation.

We assessed the association between CAI and clinical course in patients with BOS after HSCT. This retrospective study included 910 patients undergoing allogeneic HSCT between 2005 and 2013 at our institution. BOS diagnosis was reevaluated according to the 2014 US National Institutes of Health criteria. Sputum and bronchial lavage culture results, pulmonary function, and survival were compared between patients with and without CAI.

Median follow-up was 974.5 (261.5–2748.5) days. BOS was diagnosed in 27 (3.0%) patients, including 18 males. Median age at BOS diagnosis was 45 (40.5–58) years. Nine patients had ≥2 positive sputum cultures for bacteria or one positive bronchial lavage culture for nontuberculous mycobacteria (CAI+), whereas 9 patients had negative sputum/bronchial lavage culture or only one positive sputum culture (CAI−). Median change in forced expiratory volume in 1 s within 6 months after BOS diagnosis and overall survival were significantly worse in CAI+ patients than in CAI− patients (−250 vs +260 mL, P = .002, and 1340 days vs not reached, P = .04, respectively). No other factors including patient demographics or transplant protocol affected prognosis. There were no differences in clinical characteristics of patients with and without CAI, except for the time from transplantation to BOS diagnosis (214 vs 768 days for CAI+ and CAI−, respectively; P = .02).

CAI was associated with worse outcomes in patients with BOS after HSCT. Further prospective studies should assess the association between the airway microbiome and changes in pulmonary function after HSCT to improve prognosis.
A simplified scoring system for the prediction of pancreatoduodenectomy's complications
Authors: Chen Long , Su Dai-Wen , Zhang Fan , Shen Jun-Yi , Zhang Yan-Hong , Wang Yun-Bing
Published: January 2019

To assess the efficiency of several previous scoring systems in the prediction of postoperative complications of pancreatoduodenectomy (PCPD) and to explore a new simplified scoring system for PCPD prediction.

All 183 consecutive patients scheduled for PD from 2010 to 2017 in the Second Affiliated Hospital of Chongqing Medical University were collected retrospectively. The area under the curve (AUC) for the prediction of PCPD was calculated for POSSUM, E-PASS, APACHE-II, and APACHE-III, which were used to test the efficiency of PCPD prediction. The independent risk factors included in the new scoring system were determined by univariate analysis and a logistic regression model. Next, the prediction efficiency was validated.

The results of the univariate analysis showed that such variables as male sex, weight, WBC, serum sodium, arterial pH, postoperative 24 hours urine output, and operation time were influence factors for postoperative complications (P <.05). Arterial pH, serum sodium, postoperative 24 hours urine output, and WBC were independent risk factors of postoperative complications based on the logistic regression analysis (P <.05). The AUC of the novel scoring system for PCPD prediction was 85.4%.

The proposed scoring system might be a more effective tool for predicting PCPD compared with previous multipurpose scoring systems.
Trigger finger secondary to a neglected flexor tendon rupture
Authors: Lee Malrey , Jung Young-Ran , Lee Young-Keun
Published: January 2019

Secondary trigger finger caused by trauma to the hand, especially associated with partial flexor tendon rupture, is not a common condition. Thus, the clinical manifestations of these patients are not well-known. The aim of this study is to present secondary trigger finger caused by a neglected partial flexor tendon rupture including discussion of the mechanism and treatment.

We retrospectively reviewed the records of 6 patients with trigger finger caused by a neglected partial flexor tendon rupture who had been treated with exploration, debridement, and repairing of the ruptured tendon from August 2010 to May 2015. The average patient age was 41 years (range, 23–59). The time from injury to treatment averaged 4.7 months. The average follow-up period was 9 months (range, 4–18). Functional outcome was evaluated from a comparison between the Quick-disabilities of the arm, shoulder, and hand (DASH) score and the visual analogue scale (VAS) for pain, which were measured at the time of preoperation and final follow up.

Four patients showed partial rupture of the flexor digitorum profundus (FDP) tendon and 3 showed partial rupture of the flexor digitorun superficialis (FDS) tendon. Both the FDP and FDS tendons were partially ruptured in 2 patients, and the remaining patient had a partial rupture of the flexor pollicis longus tendon. All patients regained full range of motion, and there has been no recurrence of triggering. The average VAS score decreased from 3.6 (range, 3–5) preoperatively to 0.3 (range, 0–1) at the final follow up. The average Quick-DASH score decreased from 33.6 preoperatively to 5.3 at the final follow up.

When we encounter patients with puncture or laceration wounds in flexor zone 2, even when the injury appears to be simple, partial flexor tendon laceration must be taken into consideration and early exploration is recommended.
A CARE-compliant article: Lymphangiomatous polyps of the palatine tonsils in a miner
Authors: Gan Weigang , Xiang Yu , He Xinrong , Feng Yiyuan , Yang Hongbin , Liu Hai , Liu Shixi , Meng Juan
Published: January 2019

Rationale:

Lymphangiomatous polyps of the palatine tonsils are benign tumors that are rare in both adults and children. Most patients suffering from this disease present with nonspecific symptoms similar to those of chronic tonsillitis.

Patient concern:

We report a case of a 21-year-old male miner who presented with a chronic history of a foreign body sensation in the oropharynx and an intermittently sore throat.

Diagnosis:

The patient was preoperatively diagnosed with the palatine tonsils neoplasm.

Interventions:

The neoplasm with palatine tonsils was completely resected under general anesthesia. The tissue was sent for histological examination, and the diagnosis was lymphangiomatous polyps of the palatine tonsils.

Outcome:

The surgical outcome was good, and no surgical site infection was recorded. After 12 months of follow-up, the miner was asymptomatic with no recurrence.

Lessons:

Tonsillectomy is a curative method to address lymphangiomatous polyps (LAPs) of the tonsils which resulted in no recurrence during the clinical follow-up period. The etiology of this rare disorder and potential pathogenesis should be studied in the future, which would help prevent its occurrence.
Herbal medicine for the management of postoperative pain
Authors: Park Kyung Moo , Kim Ji Hwan
Published: January 2019

Background:

Postoperative pain is caused by surgical trauma and poses a significant challenge for health care providers. Opioid analgesics are commonly used to control postoperative pain. However, these drugs are associated with a number of negative side effects. This review will assess the clinical evidence for and against the use of herbal medicine formulas as a treatment for postoperative pain, especially after musculoskeletal surgery.

Methods:

Twelve databases will be searched from inception to March 2019. We will include randomized controlled trials (RCTs) assessing herbal medicine decoctions used to treat any type of postoperative pain. All RCTs of decoctions or modified decoctions will be included. The methodologic qualities of the RCTs will be assessed using the Cochrane Collaboration tool for assessing risk of bias, while confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation method.

Conclusion:

This systematic review will be published in a peer-reviewed journal and disseminated electronically and in print. The review will be updated to inform and guide health care practices.

Registration number: CRD42018094897
Chronic eosinophilic pneumonia after trastuzumab and radiation therapy for breast cancer
Authors: Jin Fan , Wang Shao-ting
Published: January 2019

Rationale:

Chronic eosinophilic pneumonia (CEP) is rare and an idiopathic disorder. The disease has been associated with drugs, infection, or irradiation, and its relationship with asthma remains unclear.

Patient concerns:

We reported a case of a 49-year-old female patient after trastuzumab and radiation therapy for breast cancer. Two months after radiation treatment, the patient complained of productive cough, progressive breathlessness, occasional wheezing, and left pectoralgia.

Diagnoses:

Computed tomography (CT) scan revealed infiltrates in lungs. Without evidence of infection, marked increased eosinophils in a transbronchial biopsy performed from the left upper lobe confirmed the diagnosis of CEP after trastuzumab and radiation therapy.

Interventions:

The patient was started with oral prednisone at 0.5 mg/kg/day.

Outcomes:

A CT scan of the chest obtained 2 weeks after steroid treatment showed diminishment of the lesions, and at the 6-month follow-up, the patient had no complaints of discomfort with no relapse of pulmonary lesions.

Lessons:

Physicians should consider CEP as a diagnosis in patients who have had previous exposure to trastuzumab and radiation therapy, especially with a history of asthma. Timely diagnosis and treatment may benefit these patients.
Clinical and genetic analysis of 7 Chinese patients with β-ureidopropionase deficiency
Authors: Fang Yulian , Cai Chunquan , Wang Chao , Sun Bei , Zhang Xinjie , Fan Wenxuan , Hu Wenchao , Meng Yingtao , Lin Shuxiang , Zhang Chunhua , Zhang Yuqin , Shu Jianbo
Published: January 2019

β-Ureidopropionase (βUP) deficiency is an autosomal recessive disease caused by abnormal changes in the pyrimidine-degradation pathway. This study aimed to investigate the mutation of β-ureidopropionase gene (UPB1) gene and clinical features of 7 Chinese patients with βUP deficiency.

We reported 7 Chinese patients with βUP deficiency who were admitted at Tianjin Children's Hospital. Urine metabolomics was detected by gas chromatography–mass spectrometry (GC–MS). Then genetic testing of UPB1 was conducted by polymerase chain reaction (PCR) method.

The patients presented with developmental delay, seizures, autism, abnormal magnetic resonance imaging, and significantly elevated levels of N-carbamyl-β-alanine and N-carbamyl-β-aminoisobutyric acid in urine. Subsequent analysis of UPB1 mutation revealed 2 novel missense mutations (c.851G>T and c.853G>A), 3 previously reported mutations including 2 missense mutations (c.977G>A and c.91G>A) and 1 splice site mutation (c.917-1 G>A).

The results suggested that the UPB1 mutation may contribute to βUP deficiency. The c.977G>A is the most common mutation in Chinese population.
Herbal medicine for benign prostatic hyperplasia
Authors: Kim Ji Hwan , Park Kyung Moo , Lee Ju Ah
Published: January 2019

Background:

Herbal medicine has been used to manage benign prostatic hyperplasia (BPH) and the associated lower urinary tract symptoms, but its effects are not yet fully understood. The purpose of this review is to assess the efficacy and safety of herbal medicine as a treatment for BPH.

Methods and analysis:

Thirteen databases will be searched for relevant studies from inception to the present date. We will include randomized controlled trials assessing herbal medicine for the treatment of BPH. The methodological qualities, including the risk of bias, will be evaluated using the Cochrane risk of bias assessment tool, while confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Ethics and dissemination:

Ethical approval is not required, as this study is based on the review of published research. This review will be published in a peer-reviewed journal and disseminated both electronically and in print.
Early versus late clinical outcomes following same day discharge after elective percutaneous coronary intervention
Authors: Lu Hongtao , Guan Wenjun , Zhou Yanhua , Bao Hong
Published: January 2019

Background:

Nowadays 57% of the cardiologists based in the United Kingdom and 32% of the cardiologists based in Canada utilize same day discharge (SDD) following elective percutaneous coronary intervention (PCI) as a routine practice. In this analysis, we aimed to systematically assess early versus late clinical outcomes following SDD after elective PCI.

Methods:

The Medical Literature Analysis and Retrieval System Online, the Cochrane Central, the Resources from the United States National Library of Medicine (www.ClinicalTrials.gov: http://www.clinicaltrials.gov) and EMBASE were carefully searched for relevant English publications which reported early versus late clinical outcomes in patients who were discharged on the same day following revascularization by PCI. Relevant clinical outcomes which were reported in the original studies were considered as the endpoints in this analysis. Odd ratios (OR) and 95% confidence intervals (CI) were used to represent the data, and RevMan 5.3 was used as the statistical software.

Results:

A total number of 21, 687 participants (enrollment time period from the year 1998 to the year 2015) were assigned to this analysis. When early versus late clinical outcomes were compared in patients who were discharged on the same day following elective PCI, major adverse cardiac events (OR: 0.75, 95% CI: 0.31–1.79; P = .51), mortality (OR: 0.26, 95% CI: 0.06–1.06; P = .06), stroke (OR: 1.46, 95% CI: 0.72–2.94; P = .29), arrhythmia (OR: 1.30, 95% CI: 0.64–2.63; P = .47), hematoma (OR: 1.00, 95% CI: 0.60–1.66; P = 1.00) and major bleeding from access site (OR: 1.68, 95% CI: 0.22–12.85; P = .62) were not significantly different. Post-procedural myocardial infarction (OR: 2.01, 95% CI: 0.71–5.70; P = .19) and minor bleeding from access site (OR: 6.61, 95% CI: 0.86–50.66; P = .07) were also similarly manifested. However, re-hospitalization was significantly higher in those patients with late clinical outcomes (OR: 0.18, 95% CI: 0.07–0.44; P = .0002).

Conclusions:

In those patients who were discharged from the hospital on the same day following elective PCI, no significant difference was observed in the assessed early versus late clinical outcomes. However, late clinical outcomes resulted in a significantly higher rate of re-hospitalization. Larger studies should confirm this hypothesis.
Comparison of EMLA and Diclofenac on Reduction of Pain and Phlebitis Caused by Peripheral IV Catheter
Authors: Babaieasl Faezeh , Yarandi Hossein N. , Saeidzadeh Seyedehtanaz , Kheradmand Motahareh
Published: January 2019

Peripheral venous catheters (PVC) are often used to provide hydration, medications, and blood products when the length of therapy is expected to be less than 1 week. Pain and phlebitis are frequent complications of PVC. Diclofenac and EMLA have been used to minimize these adverse effects; however, conflicting results have been reported regarding which has better outcomes. This double-blind, randomized controlled trial was conducted to compare the efficacy of EMLA and Diclofenac (TDP) in attenuating PVC pain and phlebitis. The inpatient setting was chosen because of the higher frequency of PVC insertions, allowing for a sufficient sample size. One hundred fifty-four subjects were randomly assigned to three groups: EMLA patch (n = 61), a TDP patch (n = 50), or a patch with lubricant gel (n = 46) as a placebo. The pain was measured by Visual Analogue Scale (VAS). Phlebitis was examined based on Boxter criteria in intervals of 6, 12, 18, 24, and 48 hours after PVC insertion. The mean score of VAS was 41.86 ± 22.49 for the control, 39.40 ± 21.60 for TDP, and 38.77 ± 23.28 for the EMLA group, with no significant differences in pain severity between the three groups. The rate of phlebitis in the group with EMLA was significantly higher than the other two groups at 6, 12, and 18 hours (p = 0.02, p = 0.003 and p = 0.04, respectively). In all interval times, the rate of phlebitis in the TDP group was significantly lower than the other groups. Compared with men, women experienced higher rate of phlebitis and intensity of PVC pain. EMLA and TDP had similar analgesic effects, but phlebitis was less frequently observed with TDP, suggesting TDP as a potential medication for reducing pain and phlebitis before PVC insertion.
Promoting Skin Care for Older Adults
Authors: Brennan-Cook Jill , Turner Rachel L.
Published: January 2019

Chronic conditions and age-related changes place older adults at increased risk for skin breakdown and damage to skin integrity, leading to poor outcomes that may impact quality of life. Although we cannot stop skin from aging, home care clinicians are in the best position to mitigate further skin problems and influence healthier outcomes for patients with skin issues. Home healthcare clinicians can improve skin health and well-being for older adults by incorporating simple but thorough systematic skin assessments at every visit. This includes identifying the patient's personal skin care practices and preferences. Home healthcare clinicians can intervene and address excessive moisture or extreme dryness of skin, use available resources for best practices in wound care, and educate about sun protection.
Effectiveness of the Teach-Back Method for Improving Caregivers’ Confidence in Caring for Hospice Patients and Decreasing Hospitalizations
Authors: Ryan-Madonna Meghan , Levin Rona F. , Lauder Bonnie
Published: January 2019

Health care professionals use teach-back to foster adherence to treatment recommendations and to improve safety and quality of care. This improvement project, conducted in one division of a home care agency, used a pretest-posttest design with an interprofessional group of hospice home care clinicians to incorporate teach-back into home visits to evaluate if the use of teach-back enhanced caregiver and patient-provider communication, improved caregivers' confidence in caring for hospice home care patients, and decreased hospitalizations. After the intervention, the teach-back group had zero hospitalizations compared with 2 for the non–teach-back group (0% and 1.97%, respectively), and patient-caregiver “confidence” increased from 58% to 81%, pre to post intervention. In conclusion, teach-back is a cost-effective teaching methodology that can be implemented by any discipline to improve patient-provider communication and patient outcomes.
Laterally Based Orbicularis Oculi Myocutaneous Flap: Revisiting for the Secondary Ectropion Correction
Authors: Park Seong H. , Elfeki Bassem , Eun Seokchan
Published: January 2019

Background:

The management of lower eyelid ectropion is considered a challenge. Lower eyelid ectropion is conventionally reconstructed with a full-thickness skin graft or a local flap. However, complications as scar contracture and the recurrence of ectropion frequently occur. This article describes an effective surgical technique for ectropion correction using an upper eyelid as the laterally based orbicularis oculi myocutaneous flap.

Methods:

The flap was used in 7 patients who were subjected to lower eyelid reconstruction. A strip of unipedicled orbicularis oculi myocutaneous flap from the lateral canthus was elevated and transposed to the lower eyelid to suspend the lower eyelid and repair the skin defect.

Results:

Satisfactory eyelid function and cosmetic appearance were obtained and no recurrence was found in 2-years follow-up. The method proved that the donor scar was well hidden in the supratarsal crease. Mild flap color change occurred in the early stages but disappeared gradually within 2 months after.

Conclusions:

The use of this flap not only gives similar tissue reconstruction, additional support, well-hidden scar, and no loss of function, but also fast flap rising with the reliable donor. With a thorough knowledge of anatomy, the authors believe that their technique described below will expand anatomical understanding and powerful reasons for using laterally based orbicularis oculi myocutaneous flap for not only reconstructive but also aesthetic surgeons.
Low Titers of Antidonor ABO Antibodies After ABO-Incompatible Living Donor Liver Transplantation: A Long-Term Follow-Up Study
Authors: Ueda Daisuke , Yoshizawa Atsushi , Kaneshiro Masakatsu , Hirata Yoshihiro , Yagi Shintaro , Hata Koichiro , Okajima Hideaki , Egawa Hiroto , Uemoto Shinji
Published: January 2019

Background

The ABO blood-type barrier in kidney and liver transplantation has been overcome by aggressive treatments such as B cell depletion using rituximab. However, the long-term effects of ABO-incompatible liver transplantation (ABO-I LTx) on immunological status have not previously been studied. Here, we assessed whether long-term immune hyporesponsiveness against ABO blood-group antigens was retained.

Methods

We recruited 81 patients, 75 patients who had survived ABO-I LTx without retransplantation and 6 patients who had survived after retransplantation using blood type-compatible grafts. The time between ABO-I LTx and outpatient visits for blood sampling for this study ranged from 1.1 to 16.8 years. We also evaluated patients' backgrounds and postoperative therapies.

Results

Overall, antidonor ABO antibody titers in the 75 patients without retransplantation decreased during long-term follow-up. In the subset of 40 patients with blood type O, anti-nondonor ABO antibody titers did not decrease and were significantly higher than antidonor ABO antibody titers. In addition, long-term antidonor ABO antibody titers were significantly lower in pediatric patients than in adult patients. In the 6 patients who were retransplanted with blood type–compatible grafts, antidonor ABO antibody immunoglobulin G titers remained low, but IgM titers increased slightly long after removal of the ABO-incompatible graft.

Conclusions

These findings suggest that donor-specific hyporesponsiveness remains after ABO-I LTx, particularly in pediatric patients. Long-term persistence of blood antigens may contribute to this donor-specific hyporesponsiveness.
Prevalence of Moisture-Associated Skin Damage in an Acute Care Setting
Authors: Werth Sherry Lynn , Justice Rachel
Published: January 2019

Moisture-associated skin damage (MASD) is characterized by inflammation of the skin with or without erosion of the skin caused by prolonged exposure to various sources of moisture including urine or stool, perspiration, wound exudate, or mucus. The purpose of this quality improvement project was to determine the prevalence of MASD at a teaching hospital in the Midwestern United States. Data were collected quarterly over a period of 12 months concurrently with the quarterly Pressure Ulcer Prevalence Survey (PUPS). The PUPS team comprises 40 RNs; 20 of whom are Skin Care Champions with training in skin care and pressure injury prevention. Patients' skin was assessed from head to toe; in addition to assessing for pressure injuries, a data collection form developed by WOC nurse was also filled out by the PUPS team nurses for patients identified as having MASD. We assessed anatomic location of MASD and treatment in use at the time of assessment. The prevalence of MASD was 4.34% (62 out of 1427 patients), and the prevalence of incontinence-associated dermatitis was 1.54% (22 out of 1427 patients).
A computational study on the three-dimensional printability of precipitate-strengthened nickel-based superalloys
Authors: Basoalto H. C. , Panwisawas C. , Sovani Y. , Anderson M. J. , Turner R. P. , Saunders B. , Brooks J. W.
Published: January 2019

This paper presents a computational framework to study the differences in process-induced microvoid and precipitate distributions during selective laser melting (SLM) of two nickel-based superalloys representative of low (IN718) and high (CM247LC) volume fraction precipitate-strengthened alloys. Simulations indicate that CM247LC has a higher propensity to form process-induced microvoids than IN718. Particle sintering is predicted to be strongly influenced by the powder size distribution. For deposition thickness of approximately 40 μm, thermal gradients during cooling are predicted to be larger for CM247LC than IN718 and consequently expect the development of larger residual stresses for a high volume fractionγ′ alloy. A coupled mean field/finite-element approach has been used to predict the precipitate distributions across a simple rectangular build and during a subsequent hot isostatic pressing (HIP) cycle. Unimodal and multi-modal particle distributions are predicted for IN718 and CM247LC at the end of the SLM, respectively. A higher volume fraction ofγ′ is predicted for CM247LC at the end of the SLM process. During HIP, simulations indicate a dramatic increase in theγ′ volume fraction in CM247LC, which can result in a reduction in stress relaxation and lead to a ductility drop.
LIDAR explains diversity of plants, fungi, lichens and bryophytes across multiple habitats and large geographic extent
Authors: Moeslund Jesper Erenskjold , Zlinszky András , Ejrnæs Rasmus , Brunbjerg Ane Kirstine , Bøcher Peder Klith , Svenning Jens-Christian , Normand Signe
Published: January 2019

Effective planning and nature management require spatially accurate and comprehensive measures of the factors important for biodiversity. Light detection and ranging (LIDAR also known as light radar) can provide exactly this, and is hereby a promising technology to support future nature management and related applications. However, until now studies evaluating the potential of LIDAR for this field have been highly limited in scope. Here, we assess the potential of LIDAR to estimate the local diversity of four species groups in multiple habitat types, from open grasslands and meadows over shrubland to forests and across a large area (approximately 43.000 km2), providing a crucial step towards enabling the application of LIDAR in practice, planning and policy-making. We assessed the relationships between the species richness of macrofungi, lichens, bryophytes and plants, respectively, and 25 LIDAR-based measures related to potential abiotic and biotic diversity drivers. We used negative binomial Generalized Linear Modelling to construct 19 different relevant models for each species group, and leave-one-region-out cross validation to select the best models. These best models explained 49, 31, 32 and 28 % of the variation in species richness (R2) for macrofungi, lichens, bryophytes and plants respectively. Three LIDAR measures were important and positively related to the richness in three of the four species groups: variation in local heat load, terrain slope and shrub layer height. Four other LIDAR measures were ranked among the three most important for at least one of the species groups: point amplitude entropy, shrub layer density (1.5 – 5 m), medium-tree layer density (10 – 15 m) and variation in biomass. Generally, LIDAR measures exhibited strong associations to the biotic environment, and to some abiotic factors, but was not suitable for representing spatiotemporal continuity. In conclusion, we showed how well LIDAR alone can predict the local biodiversity across habitats. We also showed that several LIDAR measures are highly correlated to important biodiversity drivers, which are notoriously hard to measure in the field. This opens up hitherto unseen possibilities for using LIDAR for cost-effective monitoring and management of local biodiversity across species groups and habitat types even over large areas.
The axonal actin-spectrin lattice acts as a tension buffering shock absorber
Authors: Dubey Sushil , Bhembre Nishita , Bodas Shivani , Ghose Aurnab , Callan-Jones Andrew , Pullarkat Pramod A
Published: January 2019

Axons are thin tubular extensions generated by neuronal cells to transmit signals across long distances. In the peripheral and the central nervous systems, axons experience large deformations during normal activity or as a result of injury. Yet, axon biomechanics, and its relation to the internal structure that allows axons to withstand such deformations, is poorly understood. Up to now, it has been generally assumed that microtubules and their associated proteins are the major load-bearing elements in axons. We revise this view point by combining mechanical measurements using a custom developed force apparatus with biochemical or genetic modifications to the axonal cytoskeleton, revealing an unexpected role played by the actin-spectrin skeleton. For this, we first demonstrate that axons exhibit a reversible strain-softening response, where its steady state elastic modulus decreases with increasing strain. We then explore the contributions from the various cytoskeletal components of the axon, and show that the recently discovered membrane-associated skeleton consisting of periodically spaced actin filaments interconnected by spectrin tetramers play a prominent mechanical role. Finally, using a theoretical model we argue that the actin-spectrin skeleton act as an axonal tension buffer by reversibly unfolding repeat domains of the spectrin tetramers to buffer excess mechanical stress.
Recording of “sonic attacks” on U.S. diplomats in Cuba spectrally matches the echoing call of a Caribbean cricket
Authors: Stubbs Alexander L. , Montealegre-Z Fernando
Published: January 2019

Beginning in late 2016, diplomats posted to the United States embassy in Cuba began to experience unexplained health problems—including ear pain, tinnitus, vertigo, and cognitive difficulties1–4—which reportedly began after they heard1,2strange noises in their homes or hotel rooms. In response, the U.S. government dramatically reduced1–3the number of diplomats posted at the U.S. embassy in Havana. U.S. officials initially believed1,2,5a sonic attack might be responsible for their ailments. The sound linked to these attacks, which has been described as a “high-pitched beam of sound”, was recorded by U.S. personnel in Cuba and released by the Associated Press (AP). Because these recordings are the only available non-medical evidence of the sonic attacks, much attention has focused on identifying health problems6–11and the origin12–17of the acoustic signal. As shown here, the calling song of the Indies short-tailed cricket (Anurogryllus celerinictus)matches, in nuanced detail, the AP recording in duration, pulse repetition rate, power spectrum, pulse rate stability, and oscillations per pulse. The AP recording also exhibits frequency decay in individual pulses, a distinct acoustic signature of cricket sound production. While the temporal pulse structure in the recording is unlike any natural insect source, when the cricket call is played on a loudspeaker and recorded indoors, the interaction of reflected sound pulses yields a sound virtually indistinguishable from the AP sample. This provides strong evidence that an echoing cricket call, rather than a sonic attack or other technological device, is responsible for the sound in the released recording. Although the causes of the health problems reported by embassy personnel are beyond the scope of this paper, our findings highlight the need for more rigorous research into the source of these ailments, including the potential psychogenic effects, as well as possible physiological explanations unrelated to sonic attacks.
β1 integrin is a sensor of blood flow direction
Authors: Xanthis Ioannis , Souilhol Celine , Serbanovic-Canic Jovana , Roddie Hannah , Kalli Antreas C. , Fragiadaki Maria , Wong Raymond , Shah Dhruv R. , Askari Janet A. , Canham Lindsay , Akhtar Nasreen , Feng Shuang , Ridger Victoria , Waltho Jonathan , Pinteaux Emmanuel , Humphries Martin J. , Bryan Matthew T. , Evans Paul C.
Published: January 2019

The ability of endothelial cells (EC) to sense blood flow direction is a critical determinant of vascular health and disease. Unidirectional flow induces EC alignment and vascular homeostasis, whereas bidirectional flow has pathophysiological effects. EC express several mechanoreceptors that can respond to fluid flow (shear stress) but the mechanism for sensing the direction of shearing force is poorly understood. We observed usingin vitroflow systems and magnetic tweezers that β1 integrin is a key sensor of force direction because it is activated by unidirectional but not bidirectional shearing forces. Consistently, β1 integrin was essential for Ca2+signalling and cell alignment in response to unidirectional but not bidirectional shear stress. β1 integrin activation by unidirectional force was amplified in EC that were pre-sheared in the same direction, indicating that alignment and β1 integrin activity has a feedforward interaction which is a hallmark of system stability.En facestaining and EC-specific genetic deletion studies of the murine aorta revealed that β1 integrin is activated and is essential for EC alignment at sites of unidirectional flow but is not activated at sites of bidirectional flow. In summary, β1 integrin sensing of unidirectional force is a key mechanism for decoding blood flow mechanics to promote vascular homeostasis.

SUMMARY STATEMENT

We demonstrate using flow systems, magnetic tweezers and knockout mice that β1 integrin is a sensor of shear stress direction in endothelial cells. β1 integrin is activated by unidirectional hemodynamic shear force leading to calcium signalling and cell alignment, but it is not activated by bidirectional force.
Dissecting the heterogeneity of DENV vaccine-elicited cellular immunity using single-cell RNA sequencing and cellular metabolic profiling
Authors: Waickman Adam T. , Victor Kaitlin , Li Tao , Hatch Kristin , Rutvisuttinnunt Wiriya , Medin Carey , Gabriel Benjamin , Jarman Richard G. , Friberg Heather , Currier Jeffrey R.
Published: January 2019

Generating effective and durable T cell immunity is a critical prerequisite for vaccination against dengue virus (DENV) and other viral diseases. Understanding the precise molecular mechanisms of vaccine-elicited T cell immunity remains a critical knowledge gap in vaccinology. In this study, we utilized single-cell RNA sequencing (scRNAseq) and TCR clonotype analysis to demonstrate that a unique transcriptional signature is present in acutely-activated and clonally-expanded T cells that become committed to the memory repertoire. This effector-associated transcriptional signature is dominated by a unique metabolic transcriptional program. Based on this transcriptional signature, we were able to define a set of functional markers that identify the most potent and durable vaccine-reactive memory precursor CD8+T cells. The transferrin receptor (CD71) other important transporters of amino acids, and direct measurements of glucose and fatty acid uptake, were further validated as early markers of durable T cell memory using conventional flow cytometry. These data suggest that generating durable T cell immunity is a process that is determined by metabolic programming and metabolite availability during the acute phase of the immune response. This study illustrates the power of scRNAseq as an analytical tool to assess the molecular mechanisms of host control and vaccine modality in determining the magnitude, diversity, and persistence of vaccine-elicited cell-mediated immunity.
Identification of Factors Complicating Bioluminescence Imaging
Authors: Yeh Hsien-Wei , Wu Tianchen , Chen Minghai , Ai Hui-wang
Published: January 2019

In vivo bioluminescence imaging (BLI) has become a standard, non-invasive imaging modality for following gene expression or the fate of proteins and cells in living animals. Currently, bioluminescent reporters used in laboratories are mostly derivatives of two major luciferase families: ATP-dependent insect luciferases and ATP-independent marine luciferases. Inconsistent results have been reported for experiments using different bio-luminescent reporters and users are often confused when trying to choose an optimal bioluminescent reporter for a given research purpose. Herein, we re-examined inconsistency in several experimental settings and identified factors, such as ATP dependency, serum stability, and molecular size, which significantly affected BLI results. We expect this study will make the research community aware of these factors and facilitate more accurate interpretation of BLI data by considering the nature of each bioluminescent reporter.
Distinguishing Closely Related Pancreatic Cancer Subtypes In Vivo by 13C Glucose MRI without Hyperpolarization
Authors: Kishimoto Shun , Brender Jeffrey R. , Matsumoto Shingo , Seki Tomohiro , Oshima Nobu , Merkle Hellmut , Reed Galen , Chen Albert P. , Ardenkjaer-Larsen Jan Henrik , Munasinghe Jeeva , Saito Keita , Yamamoto Kazu , Choyke Peter L. , Mitchell James , Krishna Murali C.
Published: January 2019

Metabolic differences between patients and within the tumor itself can be an important determinant in cancer treatment outcome. However, methods for determining these differences non-invasively in vivo have been lacking. Using pancreatic ductal adenocarcinoma as a model, we demonstrate that tumor xenografts with a similar genetic background can be distinguished by their differing rates of metabolism, as detected by imaging of uniformly 13C labeled glucose tracers using a newly developed technique using tensor decomposition for noise suppression to bring the signal to a detectable level without hyperpolarization of the tracer. Using this method, cancer subtypes that appeared to exhibit similar metabolic profiles by other techniques that measured steady state metabolism can be distinguished.