bluuebunny/crossref_metadata_2025 huggingface dataset:
How redistributive policies reduce market inequality: education premiums in 22 OECD countries
Authors: Weisstanner David , Armingeon Klaus
Published: March 2018

What explains the large cross-country variation in the wage premium for higher education? Economic analyses of wage differentials by education point to technological change and globalization, but we know little about the impact of different types of public policies. We argue that public education spending and tax-transfer policies contain the spread of ‘education premiums’ through material incentives (decommodification) and attitudinal responses, i.e. changing attitudes towards education premiums and the motivation to request a maximum return on individual investment in education. The empirical analysis relies on a new dataset of education premiums constructed from Luxembourg Income Study surveys, covering 22 OECD countries between 1989 and 2014. We provide evidence that taxation levels and public education spending particularly affect education premium levels and changes within countries. For the literature on income inequality, these findings imply the need to pay attention more systematically to redistributive policies shaping the ‘market’ distribution of incomes.
Hepcidin and Anemia in Surgical Critical Care: A Prospective Cohort Study*
Authors: Cherry-Bukowiec Jill R. , Engoren Milo , Wiktor Arek , Raghavendran Krishnan , Napolitano Lena M.
Published: March 2018

Objective:

Because anemia of inflammation is common in ICU patients and hepcidin is the key regulator of iron homeostasis, we examined time-dependent changes in hepcidin, erythropoietin, iron, and inflammatory markers in surgical ICU patients with anemia.

Design:

Prospective single-center clinical noninterventional study.

Setting:

Surgical ICUs; U.S. university hospital.

Patients:

One hundred surgical adult ICU patients.

Measurements and Main Results:

Time-dependent changes in serum hepcidin, hematologic, and erythropoietic studies were performed on ICU admission and at serial time-points through day 28, and correlated with hematologic and iron parameters and inflammatory response. Median serum hepcidin levels were significantly increased at ICU admission and decreased over time (144–36 ng/mL; p < 0.0001). Despite increased reticulocyte counts (1.3–2.9%), mean serum erythropoietin levels remained low (29–44 mU/mL) and hemoglobin did not significantly change. Hepcidin was positively correlated with RBC transfusion, C-reactive protein, interleukin-6, ferritin, and negatively correlated with iron, total iron binding capacity, transferrin, and reticulocyte response. Hepcidin did not correlate with tumor necrosis factor-α serum concentrations. Regression analyses confirmed that ferritin, C-reactive protein, and reticulocyte number were predictive of same-day hepcidin; hepcidin and C-reactive protein were predictive of same-day reticulocyte count.

Conclusions:

Hepcidin serum concentrations are markedly increased on ICU admission, and decrease significantly over the course of the ICU stay (28 d). Decreased hepcidin concentrations are associated with increased reticulocyte response and decreased inflammatory response reflected by decreased interleukin-6 and C-reactive protein concentrations, but not with anemia resolution.
Impact of Trabectedin Interruption and Subsequent Rechallenge on Progression in Patients With Advanced Soft Tissue Sarcoma
Authors: Kotecki Nuria , Le Cesne Axel , Tresch-Bruneel Emmanuelle , Ray-Coquard Isabelle , Chevreau Christine , Bertucci François , Bogart Emilie , Mir Olivier , Pautier Patricia , Decoupigny Emilie , Clisant Stéphanie , Blay Jean-Yves , Penel Nicolas
Published: March 2018

Objective:

To assess the impact of trabectedin rechallenge.

Patients and Methods:

In the T-DIS trial (NCT0130309), after the 6 initial cycles of trabectedin, patients who were free from progressive disease (PD) were randomly assigned either to continuous treatment with trabectedin (C arm) or therapy interruption (I arm). Patients randomized in the interruption arm were allowed to restart trabectedin in case of PD. Herein we report an update of the impact of trabectedin discontinuation after subsequent rechallenge.

Results:

From February 2011 to March 2013, 27 and 26 nonprogressive patients were randomized to C and I arm, respectively. Twenty-two of 26 patients in I arm and 25 of 27 patients in C arm received 7 cycles and more. After randomization, the median number of cycles was similar in both arms (C arm: 5 cycles [range, 1 to 34]; I arm: 6 cycles [range, 1 to 48], P=0.96). After a median follow-up from randomization of 35.3 months, continuous treatment with trabectedin was associated with a significant improvement in progression-free survival compared with the rechallenge arm (5.3 vs. 3.5 mo, P=0.019). The observed difference in median overall survival from the seventh cycle did not meet the level of significance (26.0 vs. 14.9 mo, P=0.14). The safety profile was similar in both arms. Mean time spent without symptoms and toxicity (Q-TWIST) was higher in the C arm, but the difference did not reach the level of significance.

Conclusions:

We have demonstrated that trabectedin retains its activity when patients are rechallenged on progression after a treatment break.
Does temperature-confounding control influence the modifying effect of air temperature in ozone–mortality associations?
Authors: Chen Kai , Wolf Kathrin , Hampel Regina , Stafoggia Massimo , Breitner Susanne , Cyrys Josef , Samoli Evangelia , Andersen Zorana Jovanovic , Bero-Bedada Getahun , Bellander Tom , Hennig Frauke , Jacquemin Bénédicte , Pekkanen Juha , Peters Annette , Schneider Alexandra
Published: March 2018

Background:

Recent epidemiological studies investigating the modifying effect of air temperature in ozone–mortality associations lack consensus as how to adjust for nonlinear and lagged temperature effect in addition to including an interaction term.

Methods:

We evaluated the influence of temperature confounding control on temperature-stratified ozone–mortality risks in a time series setting in eight European cities and 86 US cities, respectively. To investigate potential residual confounding, we additionally incorporated next day’s ozone in models with differing temperature control.

Results:

Using only a categorical variable for temperature or only controlling nonlinear effect of low temperatures yielded highly significant ozone effects at high temperatures but also significant residual confounding in both regions. Adjustment for nonlinear effect of temperature, especially high temperatures, substantially reduced ozone effects at high temperatures and residual confounding.

Conclusions:

Inadequate control for confounding by air temperature leads to residual confounding and an overestimation of the temperature-modifying effect in studies of ozone-related mortality.
Perspectives on counseling patients about menopausal hormone therapy: strategies in a complex data environment
Authors: Parish Sharon J. , Nappi Rossella E. , Kingsberg Sheryl
Published: March 2018

Objective:

This narrative review strives to give healthcare providers (HCPs) who care for menopausal women better tools and skills to initiate discussions with women about menopause and hormone therapy (HT), communicate complex concepts and data, and promote shared decision-making.

Methods:

We review relevant studies on HT, barriers to treatment of menopausal symptoms, and effective communication strategies. We also provide recommendations for communicating with patients about HT based on the medical literature and our own professional experience.

Results:

Both patient and HCP-related barriers can prevent women from accessing treatment for bothersome symptoms of menopause. Many women and HCPs have a poor understanding of the complex, nuanced data regarding HT. The benefits and risks vary with patient age and time since menopause, duration of use, inclusion of a progestin, and patient medical history. Women may also have fears about potential side effects of HT and feel unable to make informed choices. Strategies for effective patient communication and shared decision-making include use of open-ended questions to elicit patient's concerns and preferences, reflecting back to the patient what the HCP heard, presenting evidence about benefits and risks in language the patient can understand, keeping risks in perspective (eg, provide absolute, and also relative risks) without minimizing them, and making conscious efforts to minimize potential bias.

Conclusions:

Necessary components for achieving high-quality, shared decisions about HT involve a combination of medical evidence, communication skills, and recognition of patient goals and concerns. Use of such strategies can enhance women's satisfaction with care.
The National Surgical Quality Improvement Program 30-Day Challenge: Microsurgical Breast Reconstruction Outcomes Reporting Reliability
Authors: Chen Austin D. , Kamali Parisa , Chattha Anmol S. , Bucknor Alexandra , Cohen Justin B. , Bletsis Patrick P. , Flecha-Hirsch Renata , Tobias Adam M. , Lee Bernard T. , Lin Samuel J.
Published: March 2018

Background:

The aim was to assess reliability of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 30-day perioperative outcomes and complications for immediate, free-tissue transfer breast reconstruction by direct comparisons with our 30-day and overall institutional data, and assessing those that occur after 30 days.

Methods:

Data were retrieved for consecutive immediate, free-tissue transfer breast reconstruction patients from a single-institution database (2010–2015) and the ACS-NSQIP (2011–2014). Multiple logistic regressions were performed to compare adjusted outcomes between the 2 datasets.

Results:

For institutional versus ACS-NSQIP outcomes, there were no significant differences in surgical-site infection (SSI; 30-day, 3.6% versus 4.1%, P = 0.818; overall, 5.3% versus 4.1%, P = 0.198), wound disruption (WD; 30-day, 1.3% versus 1.5%, P = 0.526; overall, 2.3% versus 1.5%, P = 0.560), or unplanned readmission (URA; 30-day, 2.3% versus 3.3%, P = 0.714; overall, 4.6% versus 3.3%, P = 0.061). However, the ACS-NSQIP reported a significantly higher unplanned reoperation (URO) rate (30-day, 3.6% versus 9.5%, P < 0.001; overall, 5.3% versus 9.5%, P = 0.025). Institutional complications consisted of 5.3% SSI, 2.3% WD, 5.3% URO, and 4.6% URA, of which 25.0% SSI, 28.6% WD, 12.5% URO, and 7.1% URA occurred at 30–60 days, and 6.3% SSI, 14.3% WD, 18.8% URO, and 42.9% URA occurred after 60 days.

Conclusion:

For immediate, free-tissue breast reconstruction, the ACS-NSQIP may be reliable for monitoring and comparing SSI, WD, URO, and URA rates. However, clinicians may find it useful to understand limitations of the ACS-NSQIP for complications and risk factors, as it may underreport complications occurring beyond 30 days.
EML1–ABL1 Is Activated by Coiled‐Coil‐Mediated Oligomerization and Induces T‐Cell Acute Lymphoblastic Leukemia or Myeloproliferative Disease in a Mouse Bone Marrow Transplant Model
Authors: Vanden Bempt Marlies , Mentens Nicole , Vandenberghe Peter , Cools Jan , De Keersmaecker Kim
Published: March 2018

Supplemental Digital Content is available in the text
Neuropsychological Performance and Subjective Symptom Reporting in Military Service Members With a History of Multiple Concussions: Comparison With a Single Concussion, Posttraumatic Stress Disorder, and Orthopedic Trauma
Authors: Cooper Douglas B. , Curtiss Glenn , Armistead-Jehle Patrick , Belanger Heather G. , Tate David F. , Reid Matthew , Bowles Amy O. , Velez Carmen S. , Kennedy Jan E. , Vanderploeg Rodney D.
Published: March 2018

Objective:

To examine differences in objective neurocognitive performance and subjective cognitive symptoms in individuals with a history of a single concussion, multiple concussions, orthopedic injuries, and posttraumatic stress disorder (PTSD).

Method:

Participants included 116 military service members who sustained a mild traumatic brain injury (mTBI) during combat deployment. Subjects were subdivided into groups based on concussion frequency: a single concussion (n = 42), 2 concussions (n = 21), and 3 or more concussions (n = 53). Eighty-one subjects sustained an orthopedic injury (n = 60) during deployment or were diagnosed with PTSD (n = 21), but had no history of mTBI. Subjects completed a battery of neuropsychological tests and self-report measures of postconcussive symptoms, PTSD symptoms, and psychopathology.

Results:

No differences were found among the concussion groups on a composite neuropsychological measure. The PTSD group had the highest number of symptom complaints, with the 2-concussion and 3-plus-concussion groups being most similar to the PTSD group. The concussion groups showed a nonsignificant pattern of increasing distress with increasing number of concussions.

Conclusions:

The current findings are consistent with meta-analytic results showing no differential effect on neuropsychological functioning due to multiple concussions. Results also support the burden of adversity hypothesis suggesting increasing symptom levels with increasing psychological or physically traumatic exposures.
PHOTODYNAMIC THERAPY FOR SYMPTOMATIC SUBFOVEAL RETINAL PIGMENT EPITHELIAL DETACHMENT IN CENTRAL SEROUS CHORIORETINOPATHY
Authors: Hwang Sungsoon , Kang Se Woong , Kim Sang Jin , Jang Jun Won , Kim Kyung Tae
Published: March 2018

Purpose:

To report the clinical outcomes of reduced-fluence photodynamic therapy (PDT) for symptomatic subfoveal retinal pigment epithelial detachment (RPED) in central serous chorioretinopathy and identify prognostic factors affecting treatment outcome.

Methods:

This retrospective interventional study included 35 eyes of 35 patients with serous subfoveal RPED with choroidal hyperpermeability. Cases with evidence of age-related macular degeneration were excluded from the study. Reduced-fluence PDT was applied to each patient. Best-corrected visual acuity, anatomical resolution of RPED, subjective symptom improvement, and complications were analyzed.

Results:

One month after reduced-fluence PDT, 28 eyes (80.0%) manifested complete resolution of subfoveal RPED. Among the patients whose eyes manifested complete resolution, 19 (67.9%) reported subjective vision improvement. This subjective improvement was significantly associated with the presence of dysmorphopsia at baseline. Logarithm of the minimal angle of resolution visual acuity improved from 0.15 (Snellen equivalent of 20/28) to 0.09 (20/25) between baseline and 3 months after PDT (P = 0.008). Older age and increased RPED height were independent risk factors of poor resolution of RPED after PDT. The mean follow-up period after treatment was 10.4 ± 13.6 months; recurrence of RPED did not occur in any case.

Conclusion:

Subfoveal RPED in central serous chorioretinopathy responded well to reduced-fluence PDT, especially in younger patients with less RPED. Dysmorphopsia, rather than decreased visual acuity, is a main symptomatic presentation in subfoveal RPED.
Implanted In-Body Tissue-Engineered Heart Valve Can Adapt the Histological Structure to the Environment
Authors: Takewa Yoshiaki , Sumikura Hirohito , Kishimoto Satoru , Naito Noritsugu , Iizuka Kei , Akiyama Daichi , Iwai Ryosuke , Tatsumi Eisuke , Nakayama Yasuhide
Published: March 2018

Tissue-engineered heart valves (TEHVs) are expected to be viable grafts. However, it is unknown whether they transit their histological structure after implantation. We developed a novel autologous TEHV (named stent biovalve) for transcatheter implantation, using in-body tissue engineering based on a tissue encapsulation phenomenon. In this study, a time-course histological transition of implanted biovalves was investigated in goats. Three types of stent biovalves were prepared by 2 month embedding of plastic molds mounted with metallic stents, in the subcutaneous spaces. After extracting the molds with tissue and removing the molds only, stent biovalves were constituted entirely from the connective tissues. Stent biovalves were implanted in the aortic or pulmonary valve position of other goats with transcatheter technique. In each animal, the stent biovalve was explanted at 1 month step (from 1 to 6 months) or as long as possible. Total 12 goats (five for aortic and seven for pulmonary) were successfully implanted. The maximum duration became 19 months as a result. Even then the leaflets of the biovalves kept their shape and elasticity, and neither calcification nor thrombi were observed in any cases and duration. Histology showed the recipients’ cells covering the laminar surface of the leaflets like the endothelium even after 1 month. The cells have also migrated in the leaflets gradually and finally constructed characteristic 3 layered tissues like native leaflets. Implanted stent biovalves can adapt their histological structure to the environment. They have a potential as viable grafts keeping better function and biocompatibility.
Clinical Utility of Imaging Left Ventricular Assist Devices with 320 Row Multidetector Computed Tomography
Authors: Chrysant George S. , Phancao Anita A. , Horstmanshof Douglas A. , Jones Susie , Long James W.
Published: March 2018

Evaluation of left ventricular devices is becoming increasingly important as the implantation of these devices increases. Cardiac computed tomography angiography (CCTA) has many potential advantages compared with plain radiographs and echocardiography to troubleshoot these devices and potentially help guide therapy. Heart failure (HF) remains a deadly, progressive disease with substantive and increasing morbidity, mortality, cost, and prevalence. Use of left ventricular assist devices (LVAD) as treatment for refractory HF has been steadily rising during the last decade. Seventy-four LVAD recipients who met an indication for CCTA were referred for scanning at our center for a total of 94 studies. All recipients had received a Heart Mate II (Thoratec, Pleasanton, CA) LVAD at a previous time. All patients underwent gated CCTA on a 320 row multidetector scanner (Aquilion ONE, Toshiba Medical Systems, Irvine, California, USA). Images were then reconstructed and analysis was performed using multiple oblique views. All 94 studies had technically good images. In survival analysis, 43 of the 74 LVAD patients had normal CCTA findings while 31 had abnormal CCTA results. The 6, 12, and 18 months survival was 93%, 79%, and 77% in those with normal results and 71%, 61%, and 61%, respectively, in the abnormal CCTA findings. Overall survival was statistically significant in when comparing the two groups (p = 0.003). Cardiac computed tomography angiography may be used as an aid for risk stratification and a potential indicator of short- and long-term prognosis in LVAD patients.
Cannula-Related Infection in Patients Supported by Peripheral ECMO: Clinical and Microbiological Characteristics
Authors: Allou Nicolas , Lo Pinto Hugo , Persichini Romain , Bouchet Bruno , Braunberger Eric , Lugagne Nathalie , Belmonte Olivier , Martinet Olivier , Delmas Benjamin , Dangers Laurence , Allyn Jérôme
Published: March 2018

Little is known about cannula-related infection (CRI) in patients supported by extracorporeal membrane oxygenation (ECMO). The aim of this study was to assess the incidence, the risk factors, prognosis, and microbiological characteristics of CRI in patients supported by ECMO. This retrospective cohort study was conducted in one intensive care unit (ICU). Among 220 consecutive patients with peripheral ECMO, 39 (17.7%) developed CRI. The incidence of CRI was 17.2 per 1,000 ECMO days. The main isolated microorganisms were Enterobacteriaceae (38%), Staphylococcus spp. (28.2%; 8.5% were methicillin-sensitive Staphylococcus aureus and 19.7% were coagulase-negative staphylococci), and Pseudomonas aeruginosa (18.3%). Bacteremia was present in 23 cases (59.7%). In multivariate analysis, the risk factors for CRI were longer ECMO duration (p = 0.006) and higher Simplified Acute Physiology Score 2 (p = 0.004). Forty-one percentage of patients with CRI needed surgical management of the infected site. Cannula-related infection was not associated with higher in-hospital mortality (p = 0.73), but it was associated with a longer stay in ICU (p < 0.0001) and a longer stay in hospital (p = 0.002). In conclusion, CRI is frequent in patients with ECMO and associated with a longer stay in hospital. Risk factors for CRI were longer ECMO duration and higher Simplified Acute Physiology Score 2. Concomitant bacteremia was frequent (59.7%) and CRI should be strongly investigated in cases of positive blood culture.
Hospital Utilization in Patients With Gastric Cancer and Factors Affecting In-Hospital Mortality, Length of Stay, and Costs
Authors: Sarvepalli Shashank , Garg Sushil K. , Sarvepalli Siri S. , Anugwom Chimaobi , Wadhwa Vaibhav , Thota Prashanthi N. , Sanaka Madhusudhan R.
Published: March 2018

Introduction:

Although gastric cancer (GC) rates have been declining in the United States, it continues to be a major cause of morbidity. This study examined trends in hospital admissions, in-hospital mortality, length of stay (LOS), and inpatient costs related to GC. In addition, various factors associated with in-hospital mortality, LOS, and inpatient costs were examined.

Methods:

National inpatient sample—the largest publicly available all-payer inpatient care database—was interrogated to obtain information about various demographic and hospital-related factors (including those mentioned above) in patients who were primarily admitted for GC between the years 1998 to 2013. These trends were analyzed. Multivariate analysis was also performed to identify risk factors associated with LOS, costs, and mortality.

Results:

A total of 679,330 hospital discharges with the principal diagnosis of GC were obtained. Hospital stays increased by approximately 340 stays per year (±110; P=0.00079). However, inpatient mortality rate and LOS declined by 0.36% per year (±0.024%; P<0.0001), and 0.11 days per year (±0.01; P<0.0001), respectively. The inpatient charges have increased at the rate of $3241 per year (±133.3; P<0.0001). Differences in mortality rate, LOS, and inpatient costs were affected by multiple factors.

Conclusions:

Despite the overall decline in GC incidence, the incidence of hospitalizations per 100,000 US population related to GC did not change significantly. Although LOS and mortality declined, inpatient charges increased over the study period.
Effects of “Essential AD2” Supplement on Blood Acetaldehyde Levels in Individuals Who Have Aldehyde Dehydrogenase (ALDH2) Deficiency
Authors: Fujioka Ken , Gordon Spencer
Published: March 2018

Background:

It is estimated that 1 billion people in the world have a point mutation in the gene encoding the aldehyde dehydrogenase 2 (ALDH2) enzyme, the primary enzyme responsible for the metabolism of acetaldehyde. The presence of this mutation is called ALDH2 deficiency. Because of limited ability to metabolize acetaldehyde, individuals with ALDH2 deficiency experience elevated levels of blood acetaldehyde after exposure to various common sources such as recreational alcohol. Because of higher levels of acetaldehyde, individuals with ALDH2 deficiency are at higher risk for numerous diseases, including liver cirrhosis, esophageal and gastric cancer, osteoporosis, and Alzheimer disease.

Study Question:

The present trial was designed to study the effectiveness, safety, and tolerability of a nutritional supplement (Essential AD2).

Measures and Outcomes:

The primary outcome was change in acetaldehyde levels in the blood after exposure to alcohol in individuals with ALDH2 deficiency before and after the use of study nutritional supplement.

Study Design:

This was a 28-day open-label trial, comparing initial acetaldehyde levels after alcohol ingestion to levels after 28 days of a nutritional supplement (Essential AD2). The study consisted of 12 subjects genotyped to be heterozygous for the ALDH2 gene mutation.

Results and Conclusions:

ALDH2 deficient subjects showed a significant decrease in average blood acetaldehyde level 20 minutes after alcohol consumption (from 0.91 mg/dL to 0.71 mg/dL, P value = 0.02) after receiving 28 days of the nutritional supplement. Acetaldehyde levels taken at 10 minutes and 40 minutes also showed a decrease, although they were not statistically significant. In addition, safety tests looking at liver function tests showed a decrease in aspartate transaminase and alanine transaminase liver proteins from 27.3 to 15.2 and 20.9 to 13.2, respectively, over the 28 days. The treatment was well tolerated and no significant side effects were noted.
Detection of surgical margins in oral cavity cancer: the role of dynamic optical contrast imaging
Authors: Pellionisz Peter A. , Badran Karam W. , Grundfest Warren S. , St. John Maie A.
Published: March 2018

Purpose of review

The quantity of tissue removed during an oncologic surgical procedure is not standardized and there are numerous reports of local recurrence despite histologically adequate resection margins. The oral cavity is one of the sites in the head and neck with high chances of recurrence following negative margins. To address this need, this article reviews the recent applications of Dynamic Optical Contrast Imaging (DOCI) towards both oral screening and the intraoperative evaluation of tumor margins in head and neck surgery.

Recent findings

Human ex-vivo and in-vivo trials suggest DOCI is well tolerated, low-cost, and sensitive for differentiating cancerous from normal tissues throughout the head and neck, in addition to the oral cavity. Ex-vivo imaging of OSCC specimens generated histologically verified image contrast. Furthermore, in-vivo intraoperative results demonstrate significant potential for image-guided detection and resection of oral cavity squamous cell carcinoma (OSCC).

DOCI augments tissue contrast and may enable surgeons to clinically screen patients for oral cancer, make histologic evaluations in vivo with fewer unnecessary biopsies, delineate clinical margins for tumor resection, provide guidance in the choice of biopsy sites, and preserve healthy tissue to increase the postoperative functionality and quality of life of the patient.
Potential Prediction of Acute Biliary Pancreatitis Outcome on Admission
Authors: Papapanagiotou Angeliki , Sgourakis George , Peristeraki Stella , Raptis Dimitris , Karkoulias Kyriakos , Tezas Stergios , Patel Panna , Papavassiliou Athanasios G.
Published: March 2018

Objectives

This pilot study aimed to determine the feasibility of serum values of osteonectin, adiponectin, transforming growth factor beta 1, and neurotensin being used in clinical practice to predict the severity of acute pancreatitis.

Methods

Blood samples were collected from 45 consecutive newly diagnosed acute pancreatitis patients and 30 matched healthy controls. The 2 groups were matched according to age, sex, weight, height, diabetes, smoking, and alcohol consumption. The aforementioned markers were measured using enzyme-linked immunosorbent assay kits.

Results

Characteristics of acute pancreatitis patients and healthy controls were comparable. Osteonectin values differed significantly (P < 0.0001). Median/lower quartile/upper quartile of osteonectin levels for acute pancreatitis patients and healthy controls were 263.5/110.3/490.36 and 63.2/46.1/87.2 ng/mL, respectively. Two patients died, 1 patient underwent necrosectomy, and 4 patients had a prolonged intensive care unit/hospital stay. Acute Physiology and Chronic Health Evaluation II and Systemic Inflammatory Response Syndrome scores neither predicted serum values of any of the measured substances nor the clinical outcome (need for intervention, prolonged intensive care unit/hospital stay and mortality). Osteonectin was the only independent predictor for clinical outcome (P = 0.007).

Conclusions

Serum osteonectin strongly discriminates healthy individuals from acute pancreatitis patients. Serum osteonectin shows promise in the prediction of the clinical outcome.
Age and Disease Duration Impact Outcomes of Total Pancreatectomy and Islet Autotransplant for PRSS1 Hereditary Pancreatitis
Authors: Bellin Melena D. , Prokhoda Polina , Hodges James S. , Schwarzenberg Sarah J. , Freeman Martin L. , Dunn Ty B. , Wilhelm Joshua J. , Pruett Timothy L. , Kirchner Varvara A. , Beilman Gregory J. , Chinnakotla Srinath
Published: March 2018

Objectives

We investigated the impact of patient age and disease duration on islet isolation results, diabetes outcomes, and pain outcomes after total pancreatectomy with islet autotransplant (TPIAT) performed in 64 patients with hereditary pancreatitis due to PRSS1 gene mutation.

Methods

We evaluated the association of patient age and disease duration on islet isolation results and opioid use at 1 year using logistic regression and on graft function using 1-way analysis of variance.

Results

Islet mass was negatively associated with increasing age and longer disease duration, with a 13% reduction (95% confidence interval [CI], 3%–22%) and 22% (95% CI, 14%–29%) reduction in islet equivalents per kilogram body weight (IEQ/kg) for each 5 years of age and disease duration, respectively. Full graft function was associated with younger age and shorter duration of disease (P < 0.01). Persistent opioid use (15% of patients at 1 year) increased with age (P = 0.05) and disease duration (P = 0.04).

Conclusions

The TPIAT outcomes were adversely impacted by older age and prolonged disease. In particular, islet mass is lower and risk of diabetes high in older patients with prolonged disease. This should be considered when counseling this subgroup of TPIAT recipients on expected outcomes.
Risk Factors for the Need of Surgical Necrosectomy After Percutaneous Catheter Drainage in the Management of Infection Secondary to Necrotizing Pancreatitis
Authors: Ji Liang , Wang Gang , Li Le , Li Yi-Long , Hu Ji-Sheng , Zhang Guang-Quan , Chen Hong-Ze , Chen Hua , Kong Rui , Bai Xue-Wei , Sun Bei
Published: March 2018

Objectives

This study aimed to assess the need of surgical necrosectomy after percutaneous catheter drainage (PCD) for infected necrotizing pancreatitis.

Methods

The clinical data of documented/suspected patients who were treated with a step-up approach were extracted and analyzed.

Results

Of the 329 patients enrolled, the initial PCD was performed at 12 (interquartile range, 9–15) days since onset and 35.3% were cured by PCD alone. In the pre-PCD model, mean computed tomographic (CT) density of necrotic fluid collection (NFC; P < 0.001), and multiple-organ failure (MOF; P < 0.001) within 24 hours before the initial PCD were independent risk factors, and a combination of the previously mentioned 2 factors produced an area under the curve of 0.775. In the post-PCD model, mean CT density of NFC (P = 0.041), MOF (P = 0.002), and serum procalcitonin level (P = 0.035) 3 days after the initial PCD were independent risk factors, and a combination of these previously mentioned factors produced an area under the curve of 0.642.

Conclusions

Both mean CT density of NFC and MOF are independent pre- and post-PCD risk factors for the need of necrosectomy after PCD. Post-PCD serum procalcitonin level might be a respondent factor that is correlated with the necessity of necrosectomy.
Pediatric Eosinophilic Esophagitis Is Associated With Increased Lamina Propria Immunoglobulin G4‐Positive Plasma Cells
Authors: Mohammad Nissreen , Avinashi Vishal , Chan Edmond , Vallance Bruce A. , Portales‐Casamar Elodie , Bush Jonathan W.
Published: March 2018

Objective:

Eosinophilic esophagitis (EoE) is considered a TH2‐mediated food allergy disease that leads to submucosal esophageal fibrosis and strictures. Recent studies focused on adults with EoE identified a strong association with elevated esophageal IgG4 immunostaining. Our study aimed to determine the association of IgG4 with EoE in pediatric patients.

Methods:

Using our local EoE research registry, we identified 41 adequate biopsies from EoE patients. We used 10 age‐ and sex‐matched patients with no diagnostic abnormalities at endoscopy or on biopsy. Using a monoclonal antibody to Immunoglobulin G4 (IgG4), we determined the maximum density of IgG4‐positive plasma cells (IgG4‐PC) per high‐power field (hpf). Using a semi‐quantitative assessment, we also graded the noncellular staining of the lamina propria and epithelium.

Results:

Our EoE cohort consisted predominantly of boys with an average age of 5.9 years and 63% had a documented IgE‐based food allergy. Median peak eosinophilia was 40 eosinophils/hpf and the median IgG4‐PC density was 39/hpf in the active esophagitis patients, compared with a median of 0 IgG4‐PC/hpf in the non‐EoE patients (P = 0.0001). EoE patients with a food allergy showed a significantly higher IgG4‐PC density (44.5/hpf) than those without a food allergy (8/hpf; P = 0.0385). There was no significant association between IgG4‐PC density and peak eosinophilia (r2 = 0.0011).

Conclusions:

We demonstrate that active esophagitis in pediatric EoE patients is associated with elevated levels of IgG4‐positive plasma cells, which was more significant in EoE patients with a documented food allergy. Our study also adds to the growing literature that EoE may involve more than just an exaggerated TH2 immune response.
Long‐term Treatment With Proton Pump Inhibitors Is Effective in Children With Eosinophilic Esophagitis
Authors: Gutiérrez‐Junquera Carolina , Fernández‐Fernández Sonia , Cilleruelo M. Luz , Rayo Ana , Echeverría Luis , Borrell Belén , Román Enriqueta
Published: March 2018

Objectives:

Proton pump inhibitor (PPI)‐responsive eosinophilic esophagitis (EoE) is frequently observed in children, but data on long‐term treatment are scarce. The objective of this study is to evaluate the long‐term efficacy and safety of PPIs in children with EoE.

Methods:

This prospective study enrolled children with EoE and histological remission to an 8‐week esomeprazole trial (1 mg/kg/dose, twice daily). Esomeprazole was maintained at 1 mg/kg/day for 1 year. Symptom recurrence and adverse events were monitored and a follow‐up endoscopy was performed at 12 months. Complete histological remission was defined as ⩽5 eosinophils/high‐power field (eos/hpf), and partial histological remission as >5 and <15 eos/hpf. Patients had no concomitant dietary restrictions or topical steroid.

Results:

Fifty‐seven children were included. Histological remission on maintenance PPI therapy was present in 40 children (70.1%; 95% CI 56.5–81.5). Long‐term remission rate was higher in children with initial complete histological remission than in those with partial remission (81% vs 50%, P = 0.014). Forty‐nine children (86%) remained asymptomatic. Pretreatment clinical and histological findings and median PPI dose/kg/day were similar between relapsers and nonrelapsers. Eleven out of 12 children (91.6%) receiving esomeprazole 0.5 mg · kg−1 · day−1 for 12 additional months remained in remission. Mild and transient side effects without requiring PPI avoidance were observed in 5 children.

Conclusions:

Up to 70% of children with PPI‐responsive EoE remain in histological and clinical remission on a low‐dose maintenance treatment at 1‐year follow‐up, with adequate safety profile. Complete histological remission to an 8‐week PPI trial was associated with higher probability of histological remission on maintenance therapy.
Prevalence of Mycoplasma genitalium and Azithromycin-resistant Infections Among Remnant Clinical Specimens, Los Angeles
Authors: Allan-Blitz Lao-Tzu , Mokany Elisa , Campeau Shelley , Wee Rachel , Shannon Chelsea , Klausner Jeffrey D.
Published: March 2018

Background

Mycoplasma genitalium is an important cause of bacterial sexually transmitted diseases. Diagnosis and susceptibility testing of M. genitalium are limited by the fastidious nature of the organism. Therefore, the prevalence of infection and azithromycin resistance are poorly studied.

Methods

We conducted an exploratory study on remnant clinical specimens. We collected remnant DNA from consecutive urine samples and clinical swabs (cervical/vaginal, rectal, and pharyngeal) previously tested for Neisseria gonorrhoeae and Chlamydia trachomatis using the Cobas 4800 CT/NG assay (Roche Molecular Systems, Pleasanton, CA) between March-April 2017 from across the University of California, Los Angeles Health System. We then retrospectively tested all specimens with the ResistancePlus MG (550) kit, a molecular assay for the detection of M. genitalium and genetic mutations associated with azithromycin resistance.

Results

Among 500 specimens, the prevalence of M. genitalium was 1.1% (95% confidence interval [CI], 0.04%–3.0%) in urine samples (n = 362), 17.4% (95% CI, 5.7%–39.6%) in rectal swabs (n = 23), and 1.9% (95% CI, 0.3%–7.3%) in cervical/vaginal swabs (n = 106). The prevalence of N. gonorrhoeae was 0.6% in urine samples and 4.3% in rectal swabs, whereas the prevalence of C. trachomatis was 2.2% in urine samples, 4.3% in rectal swabs and 3.8% in cervical/vaginal swabs. Of the 10 M. genitalium positive specimens, 8 (80.0%) had a mutation associated with azithromycin resistance.

Conclusions

The prevalence of M. genitalium infection in our population varied by anatomic site of infection. Most M. genitalium infections had at least 1 mutation associated with azithromycin resistance.
Situating pain in a more helpful place
Authors: Osborn Mike
Published: March 2018

Milton Cohen et al. proposed a revision of the IASP definition of pain of 1979. This commentary summarizes, why this redefinition is necessary, appropriate, and timely.
Penile Metastases From Renal Cell Carcinoma
Authors: Gitto Salvatore , Vaiani Marta , Cascella Tommaso , Lanocita Rodolfo
Published: March 2018

The prostate and bladder are the most common primary cancer sites for penile metastases. Here, we describe an unusual case of metastases from renal cell carcinoma to the penis discovered 1 month after nephrectomy in a 60-year-old man. The diagnosis was achieved using B-mode and contrast-enhanced ultrasound.
Consensus and clustering in opinion formation on networks
Authors: Bujalski Julia , Dwyer Grace , Kapitula Todd , Le Quang-Nhat , Malvai Harjasleen , Rosenthal-Kay Jordan , Ruiter Joshua
Published: March 2018

Ideas that challenge the status quo either evaporate or dominate. The study of opinion dynamics in the socio-physics literature treats space as uniform and considers individuals in an isolated community, using ordinary differential equation (ODE) models. We extend these ODE models to include multiple communities and their interactions. These extended ODE models can be thought of as being ODEs on directed graphs. We study in detail these models to determine conditions under which there will be consensus and pluralism within the system. Most of the consensus/pluralism analysis is done for the case of one and two cities. However, we numerically show for the case of a symmetric cycle graph that an elementary bifurcation analysis provides insight into the phenomena of clustering. Moreover, for the case of a cycle graph with a hub, we discuss how having a sufficient proportion of zealots in the hub leads to the entire network sharing the opinion of the zealots.

This article is part of the theme issue ‘Stability of nonlinear waves and patterns and related topics’.
On the vortices for the nonlinear Schrödinger equation in higher dimensions
Authors: Feng Wen , Stanislavova Milena
Published: March 2018

We consider the nonlinear Schrödinger equation in
n
space dimensions

and study the existence and stability of standing wave solutions of the form

and

For
n
=2
k
, (
r

j

,
θ

j

) are polar coordinates in

,
j
=1,2,…,
k
; for
n
=2
k
+1, (
r

j

,
θ

j

) are polar coordinates in

, (
r

k

,
θ

k

,
z
) are cylindrical coordinates in

,
j
=1,2,…,
k
−1. We show the existence of functions
ϕ

w

, which are constructed variationally as minimizers of appropriate constrained functionals. These waves are shown to be spectrally stable (with respect to perturbations of the same type), if 1<
p
<1+4/
n
.

This article is part of the theme issue ‘Stability of nonlinear waves and patterns and related topics’.
The phase structure of grain boundaries
Authors: Ercolani Nicholas M. , Kamburov Nikola , Lega Joceline
Published: March 2018

This article discusses numerical and analytical results on grain boundaries, which are line defects that separate roll patterns oriented in different directions. The work is set in the context of a canonical pattern-forming system, the Swift–Hohenberg (SH) equation, and of its phase diffusion equation, the regularized Cross–Newell equation. It is well known that, as the angle made by the rolls on each side of a grain boundary is decreased, dislocations appear at the core of the defect. Our goal is to shed some light on this transition, which provides an example of defect formation in a system that is variational. Numerical results of the SH equation that aim to analyse the phase structure of far-from-threshold grain boundaries are presented. These observations are then connected to properties of the associated phase diffusion equation. Outcomes of this work regarding the role played by phase derivatives in the creation of defects in pattern-forming systems, about the role of harmonic analysis in understanding the phase structure in such systems, and future research directions are also discussed.

This article is part of the theme issue ‘Stability of nonlinear waves and patterns and related topics’.
Transcriptional differences between the two host strains ofSpodoptera frugiperda(Lepidoptera: Noctuidae)
Authors: Orsucci Marion , Moné Yves , Audiot Philippe , Gimenez Sylvie , Nhim Sandra , Naït-Saïdi Rima , Frayssinet Marie , Dumont Guillaume , Boudon Jean-Paul , Vabre Marin , Rialle Stéphanie , Koual Rachid , Kergoat Gael J. , Nagoshi Rodney N. , Meagher Robert L. , d’Alençon Emmanuelle , Nègre Nicolas
Published: March 2018

Abstract

Spodoptera frugiperda, the fall armyworm (FAW), is an important agricultural pest in the Americas and an emerging pest in sub-Saharan Africa, India, East-Asia and Australia, causing damage to major crops such as corn, sorghum and soybean. While FAW larvae are considered polyphagous, differences in diet preference have been described between two genetic variants: the corn strain (sf-C) and the rice strain (sf-R). These two strains are sometimes considered as distinct species, raising the hypothesis that ost plant specialization might have driven their divergence. To test this hypothesis, we irst performed controlled reciprocal transplant (RT) experiments to address the impact of plant diet on several traits linked to the fitness of the sf-C and sf-R strains. The phenotypical data suggest that sf-C is specialized to corn. We then used RNA-Se to identify constitutive transcriptional differences between strains, regardless of diet, in laboratory as well as in natural populations. We found that variations in mitochon rial transcription levels are among the most substantial and consistent differences between the two strains. Since mitochondrial genotypes also vary between the strains, we believe the mitochondria may have a significant role in driving strain divergence.
Conjugation factors controlling F-plasmid antibiotic resistance transmission
Authors: Alalam Hanna , Graf Fabrice E. , Palm Martin , Abadikhah Marie , Zackrisson Martin , Mattsson Matilda , Hadjineophytou Chris , Persson Linnéa , Stenberg Simon , Ghiaci Payam , Sunnerhagen Per , Warringer Jonas , Farewell Anne
Published: March 2018

The rapid horizontal transmission of many antibiotic resistance genes between bacterial host cells on conjugative plasmids is a major cause of the accelerating antibiotic resistance crisis. Preventing understanding and targeting conjugation, there currently are no experimental platforms for fast and cost-efficient screening of genetic effects on antibiotic resistance transmission by conjugation. We introduce a novel experimental framework to screen for conjugation based horizontal transmission of antibiotic resistance between >60.000 pairs of cell populations in parallel. Plasmid-carrying donor strains are constructed in high throughput. We then mix the resistance plasmid carrying donors with recipients in a design where only transconjugants can reproduce, measure growth in dense intervals and extract transmission times as the growth lag. As proof-of-principle, we exhaustively explored chromosomal genes controlling F plasmid donation withinE. colipopulations, by screening the Keio deletion collection at high replication. We recover all six known chromosomal gene mutants affecting conjugation and identify >50 novel factors, all of which diminish antibiotic resistance transmission. We verify 10 of the novel genes’ effects in a liquid mating assay. The new framework holds great potential for exhaustive disclosing of candidate targets for helper drugs that delay resistance development in patients and societies and improves the longevity of current and future antibiotics.
Pointing Errors in Non-Metric Virtual Environments
Authors: Muryy Alexander , Glennerster Andrew
Published: March 2018

There have been suggestions that human navigation may depend on representations that have no metric, Euclidean interpretation but that hypothesis remains contentious. An alternative is that observers build a consistent 3D representation of space. Using immersive virtual reality, we measured the ability of observers to point to targets in mazes that had zero, one or three ‘wormholes’ – regions where the maze changed in configuration (invisibly). In one model, we allowed the configuration of the maze to vary to best explain the pointing data; in a second model we also allowed the local reference frame to be rotated through 90, 180 or 270 degrees. The latter model outperformed the former in the wormhole conditions, inconsistent with a Euclidean cognitive map.
A widespread thermodynamic effect, but maintenance of biological rates through space across life’s major domains
Authors: Sørensen Jesper G. , White Craig R. , Duffy Grant A. , Chown Steven L.
Published: March 2018

For over a century, temperature compensation (maintenance of biological rates with changing temperatures) has remained controversial. An alternative idea, that fitness is greater at higher temperatures (the thermodynamic effect), has gained increasing traction, and is being used to understand large-scale biodiversity responses to environmental change. Yet evidence in favour of each of these contrasting hypotheses continues to emerge. In consequence, the fundamental nature of organismal thermal responses and its implications remain unresolved. Here we investigate these ideas explicitly using a global dataset of 619 observations of four categories of organismal performance, spanning 14 phyla and 403 species. In agreement with both hypotheses, we show a positive relationship between the temperature of maximal performance rate (Topt) and environmental temperature (Tenv) for all traits. Next we demonstrate that relationships between Tenvand the temperature of maximal performance rate (Umax) are rarely significant and positive, as expected if a thermodynamic effect predominates. By contrast, a positive relationship between Toptand Umaxis always present, but markedly weaker than theoretically predicted. These outcomes demonstrate that while some form of thermodynamic effect exists, ample scope is present for biochemical and physiological adaptation to thermal environments in the form of temperature compensation.