bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation and experiment on the catalytic degradation of high-concentration SF6 on TiO2 surface under UV light
Authors: Zhang Ying , Li Yalong , Cui Zhaolun , Chen Dachang , Zhang Xiaoxing
Published: May 2018

The high-temperature effect gas SF6 is used in the power industry, and its emissions are increasing daily. Therefore, the degradation of SF6 is particularly important. In this work, SF6 with a high concentration of 2% was degraded using the catalytic principle of TiO2 under UV light at normal temperature and pressure. Experimental results proved that this method can effectively degrade SF6. Moreover, the addition of TiO2 can effectively increase the degradation rate of SF6. The degradation of eight pieces of TiO2 with a unit area of 3 cm2 was 8.98% after 3 h of catalysis. FTIR spectral analysis showed that the main degradation products were SO2F2, SiF4, SF4, and SO2. Adding H2O can further increase the degradation rate, which can reach 27.22% in 3 h. The main degradation products were SO2F2, SiF4, SF4, SiH4, HF, and SO2. Finally, simulations verified the catalytic decomposition of SF6 on the surface of TiO2.
Remodelling of mitochondria during spermiogenesis of Chinese soft-shelled turtle (Pelodiscus sinensis)
Authors: Haseeb Abdul , Chen Hong , Huang Yufei , Yang Ping , Sun Xuejing , Iqbal Adeela , Ahmed Nisar , Wang Taozhi , Samad Gandahi Noor , Bai Xuebing , Chen Qiusheng
Published: May 2018

Mitochondria are vital cellular organelles that have the ability to change their shape under different conditions, such as in response to stress, disease, changes in metabolic rate, energy requirements and apoptosis. In the present study, we observed remodelling of mitochondria during spermiogenesis and its relationship with mitochondria-associated granules (MAG). At the beginning of spermiogenesis, mitochondria are characterised by their round shape. As spermiogenesis progresses, the round-shaped mitochondria change into elongated and then swollen mitochondria, subsequently forming a crescent-like shape and finally developing into onion-like shaped mitochondria. We also noted changes in mitochondrial size, location and patterns of cristae at different stages of spermiogenesis. Significant differences (P < 0.0001) were found in the size of the different-shaped mitochondria. In early spermatids transitioning to the granular nucleus stage, the size of the mitochondria decreased, but increased subsequently during spermiogenesis. Changes in size and morphological variations were achieved through marked mitochondrial fusion. We also observed a non-membranous structure (MAG) closely associated with mitochondria that may stimulate or control fusion during mitochondrial remodelling. The end product of this sophisticated remodelling process in turtle spermatozoa is an onion-like mitochondrion. The acquisition of this kind of mitochondrial configuration is one strategy for long-term sperm storage in turtles.
Molecular status of Human Immunodeficiency Virus, Hepatitis B virus, and Hepatitis C virus among injecting drug male commercial sex workers in Surakarta, Indonesia
Authors: Prasetyo Afiono Agung , Marwoto  , Adnan Zainal Arifin , Hartono
Published: May 2018

Male commercial sex workers are one of the high-risk community for blood-borne viruses. However, there are no data concerning the molecular status of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV) circulated among male commercial sex workers with injecting drug habits in Surakarta, Indonesia. Blood samples obtained from injecting drug male commercial sex workers in Surakarta were examined for HIV antibodies, HBsAg, and HCV antibodies, respectively, by immunological assays. Blood samples were also subjected to viral nucleic acid extraction and molecular detection of HIV, HBV, and HCV by nested (RT) PCRs. The PCR products were purified from agarose gels, and the nucleotide sequences were retrieved and molecular analyzed. HIV, HBV, and HCV were detected in 29.4% (10/34), 17.6% (6/34), and 52.9% (18/34), respectively. HIV CRF01_AE and B were found to be circulating in the community. HBV genotype B3 was predominated, followed by C1. HCV genotype 1a was predominated, followed by 1c, 3a, 1b, and 4a. HIV, HBV, and HCV were found circulating in the male commercial sex workers with injecting drug habits in Surakarta, Indonesia.
Human T-lymphotropic Virus-1/2 detected in drug abused men who have sex with men infected with HIV in Surakarta, Indonesia
Authors: Prasetyo Afiono Agung , Sari Yulia
Published: May 2018

Human T-lymphotropic virus types 1 and 2 (HTLV-1/2) share similar routes of transmission with human immunodeficiency virus (HIV), and the HTLV-1/2 co-infection may affect the clinical course of HIV infection. The HIV/HTLV-1/2 co-infection risk higher if the patient performing the high-risk activities. This study evaluated the presentation of HTLV-1 and 2 in HIV-infected men who have sex with men with drug abused history in Surakarta Indonesia. Blood samples collected from HIV-infected men who have sex with men with drug abused history in Surakarta were tested using HTLV-1/2 enzyme-linked immunosorbent assays and confirmed by RT-PCR nested addressed the part of HTLV-1 LTR and HTLV-2 LTR region, respectively. The specificity of the molecular assays was confirmed by sequencing the amplicons. The anti HTLV-1/2 positive rate was 17.4% (8/46). All positive serological samples were confirmed by nested RT-PCR. Of these, three was HTLV-1 positive and five was HTLV-2 positive. Molecular analysis of positive PCR products revealed that all HTLV-1 isolates had a close relationship with HTLV-1 isolated in Japan while all HTLV-2 isolates with that of isolated in the USA. HTLV-1 and HTLV-2 were detected in drug abused men who have sex with men infected with HIV in Surakarta.
Structure of a free convective flow over a horizontal heated surface under conditions of conjugate heat transfer
Authors: Khrapunov E F , Potechin I V , Chumakov Y S
Published: May 2018

The paper presents the results of an experimental and numerical study of the structure of a plume formed over a heated disk under conditions of conjugate heat transfer in a wide range of Grashof number. The data on the temperature field in the plume is compared with the visualization patterns. Numerical simulation was performed using the Ansys Fluent code, where the problem of the flow of a compressible gas in conditions of conjugate heat transfer in an unsteady formulation was solved under the assumption of laminar flow regime. As a result of a comparison of the results of physical and numerical experiments, there is a conclusion about a good qualitative concurrence of the flow structure. The heat transfer characteristics were studied experimentally and numerically: the local heat transfer coefficient, the heat flow from the heated disk, and the local and average Nusselt numbers. It is shown that the establishment of a periodic flow regime leads to a violation of the monotonicity of the distribution of the local heat transfer coefficient. In general, the data is in satisfactory agreement with the results of known works.
Structure and Function of Systemic Arteries: Reflections on the Arterial Pulse
Authors: O’Rourke Michael F , Adji Audrey , Safar Michel E
Published: May 2018

“Structure and Function of Arteries”—is a topic of great importance to those who deal with arterial hypertension, since it links the source of flow, the left ventricle of the heart (whose output is pulsatile) to the peripheral tissues (whose flow is near continuous). The arterial tree acts passively as a conduit and cushion, and the interaction of heart, arterial tree, and organs is conventionally gauged on the basis of blood pressure measured by cuff in a conveniently located place (the brachial artery). For any precision and perspective to be gained, measurements of brachial systolic and diastolic pressure need be supplemented by other information. When such information is gained, one can understand how beautifully the arterial tree is tuned to the beat of the heart in animals of different size and shape and in humans at age 30 through the first third of a 3 billion beat lifetime. After age 30, the beats themselves progressively destroy the human arteries and their tuning to the heart, with emergence of clinical syndromes. In this review, the subject is tackled quantitatively on the basis of published numerical, physical, physiological, and pathophysiological basis, with principal focus on the beat of the heart, the pulse of the arteries, and their interaction.
bcSeq: an R package for fast sequence mapping in high-throughput shRNA and CRISPR screens
Authors: Lin Jiaxing , Gresham Jeremy , Wang Tongrong , Kim So Young , Alvarez James , Damrauer Jeffrey S , Floyd Scott , Granek Joshua , Allen Andrew , Chan Cliburn , Xie Jichun , Owzar Kouros
Published: May 2018

CRISPR-Cas9 and shRNA high-throughput sequencing screens have abundant applications for basic and translational research. Methods and tools for the analysis of these screens must properly account for sequencing error, resolve ambiguous mappings among similar sequences in the barcode library in a statistically principled manner, and be computationally efficient. Herein we present bcSeq, an open source R package that implements a fast and parallelized algorithm for mapping high-throughput sequencing reads to a barcode library while tolerating sequencing error. The algorithm uses a Trie data structure for speed and resolves ambiguous mappings by using a statistical sequencing error model based on Phred scores for each read.

Availability and implementation

The package source code and an accompanying tutorial are available at http://bioconductor.org/packages/bcSeq/.

Supplementary information

Supplementary data are available at Bioinformatics online.
Development and implementation of a mobile device-based pediatric electronic decision support tool as part of a national practice standardization project
Authors: McCulloh Russell J , Fouquet Sarah D , Herigon Joshua , Biondi Eric A , Kennedy Brandan , Kerns Ellen , DePorre Adrienne , Markham Jessica L , Chan Y Raymond , Nelson Krista , Newland Jason G
Published: May 2018

Objective

Implementing evidence-based practices requires a multi-faceted approach. Electronic clinical decision support (ECDS) tools may encourage evidence-based practice adoption. However, data regarding the role of mobile ECDS tools in pediatrics is scant. Our objective is to describe the development, distribution, and usage patterns of a smartphone-based ECDS tool within a national practice standardization project.

Materials and Methods

We developed a smartphone-based ECDS tool for use in the American Academy of Pediatrics, Value in Inpatient Pediatrics Network project entitled “Reducing Excessive Variation in the Infant Sepsis Evaluation (REVISE).” The mobile application (app), PedsGuide, was developed using evidence-based recommendations created by an interdisciplinary panel. App workflow and content were aligned with clinical benchmarks; app interface was adjusted after usability heuristic review. Usage patterns were measured using Google Analytics.

Results

Overall, 3805 users across the United States downloaded PedsGuide from December 1, 2016, to July 31, 2017, leading to 14 256 use sessions (average 3.75 sessions per user). Users engaged in 60 442 screen views, including 37 424 (61.8%) screen views that displayed content related to the REVISE clinical practice benchmarks, including hospital admission appropriateness (26.8%), length of hospitalization (14.6%), and diagnostic testing recommendations (17.0%). Median user touch depth was 5 [IQR 5].

Discussion

We observed rapid dissemination and in-depth engagement with PedsGuide, demonstrating feasibility for using smartphone-based ECDS tools within national practice improvement projects.

Conclusions

ECDS tools may prove valuable in future national practice standardization initiatives. Work should next focus on developing robust analytics to determine ECDS tools’ impact on medical decision making, clinical practice, and health outcomes.
An investigation of sepsis surveillance and emergency treatment on patient mortality outcomes: An observational cohort study
Authors: Amland Robert C , Sutariya Bharat B
Published: May 2018

Objective

To determine the prevalence of initiating the sepsis 3-h bundle of care and estimate effects of bundle completion on risk-adjusted mortality among emergency department (ED) patients screened-in by electronic surveillance.

Materials and Methods

This was a multiple center observational cohort study conducted in 2016. The study population was comprised of patients screened-in by St. John Sepsis Surveillance Agent within 4 h of ED arrival, had a sepsis bundle initiated, and admitted to hospital. We built multivariable logistic regression models to estimate impact of a 3-h bundle completed within 3 h of arrival on mortality outcomes.

Results

Approximately 3% ED patients were screened-in by electronic surveillance within 4 h of arrival and admitted to hospital. Nearly 7 in 10 (69%) patients had a bundle initiated, with most bundles completed within 3 h of arrival. The fully-adjusted risk model achieved good discrimination on mortality outcomes [area under the receiver operating characteristic 0.82, 95% confidence interval (CI) 0.79–0.85] and estimated 34% reduced mortality risk among patients with a bundle completed within 3 h of arrival compared to non-completers.

Discussion

The sepsis bundle is an effective intervention for many vulnerable patients, and likely to be completed within 3 h after arrival when electronic surveillance with reliable alert notifications are integrated into clinical workflow. Beginning at triage, the platform and sepsis program enables identification and management of patients with greater precision, and increases the odds of good outcomes.

Conclusion

Sepsis surveillance and clinical decision support accelerate accurate recognition and stratification of patients, and facilitate timely delivery of health care.
Surgical Outcomes Following Repeat Transsphenoidal Surgery for Nonfunctional Pituitary Adenomas: A Retrospective Comparative Study
Authors: Bakhsheshian Joshua , Wheeler Sarah , Strickland Ben A , Pham Martin H , Rennert Robert C , Carmichael John , Weiss Martin , Zada Gabriel
Published: May 2018

BACKGROUND

Endonasal transsphenoidal surgery (ETSS) remains the preferred treatment for recurrent or residual nonfunctional pituitary adenomas (NFPAs). However, surgical complications and outcomes with repeat ETSS are unclear.

OBJECTIVE

To compare outcomes from primary and repeat ETSS in patients with NFPAs.

METHODS

Retrospective review of ETSS for NFPAs at USC University Hospital and LAC + USC Medical Center between 2000 and 2015. Patients with ≥3-mo follow-up data were included. Patients were categorized as primary or repeat ETSS. Patient and tumor characteristics were compared preoperatively, and postoperative outcomes were analyzed.

RESULTS

Two hundred sixty-eight patients (89%) met the inclusion criteria (primary ETSS = 211 and repeat ETSS = 57) with a mean follow-up time of 38 mo (range 3-235 mo). Both groups had similar demographics, endocrine function, and tumor characteristics. Surgical complication rates were similar and no mortalities were observed. Repeat ETSS patients had a higher rate of new postoperative panhypopituitarism (primary ETSS: 0.5% vs repeat ETSS: 7.1%, P = .011), lower rates of gross total resection (GTR; primary ETSS: 59.2% vs repeat ETSS: 26.3%, P = .001), and greater rates of postoperative radiosurgery (36.8% vs 24.2%, P = .009). At 2-yr follow-up, progression-free survival on MRI was similar in both groups (primary ETSS: 97.9% vs repeat ETSS: 95.4%, log-rank test P = .807).

CONCLUSION

At experienced tertiary pituitary centers, repeat ETSS for NFPAs was associated with a similar incidence of surgical complications as primary ETSS. However, repeat ETSS carried a higher rate for worsening endocrine dysfunction and a lower rate of GTR.
MIRIS observation of near-infrared diffuse Galactic light
Authors: Onishi Yosuke , Sano Kei , Matsuura Shuji , Jeong Woong-Seob , Pyo Jeonghyun , Kim Il-Jong , Seo Hyun Jong , Han Wonyong , Lee DaeHee , Moon Bongkon , Park Wonkee , Park Younsik , Kim MinGyu , Matsumoto Toshio , Matsuhara Hideo , Nakagawa Takao , Tsumura Kohji , Shirahata Mai , Arai Toshiaki , Ienaka Nobuyuki
Published: May 2018

We report near-infrared (IR) observations of high Galactic latitude clouds to investigate diffuse Galactic light (DGL), which is starlight scattered by interstellar dust grains. The observations were performed at 1.1 and 1.6 μm with a wide-field camera instrument, the Multi-purpose Infra-Red Imaging System (MIRIS) onboard the Korean satellite STSAT-3. The DGL brightness is measured by correlating the near-IR images with a far-IR 100 μm map of interstellar dust thermal emission. The wide-field observation of DGL provides the most accurate DGL measurement achieved to-date. We also find a linear correlation between optical and near-IR DGL in the MBM32 field. To study interstellar dust properties in MBM32, we adopt recent dust models with and without μm-sized very large grains and predict the DGL spectra, taking into account the reddening effect of the interstellar radiation field. The result shows that the observed color of the near-IR DGL is closer to the model spectra without very large grains. This may imply that dust growth in the observed MBM32 field is not active owing to the low density of its interstellar medium.
First Report of Carboxylic Acid Amide Fungicide Resistance in Plasmopara viticola (Grapevine Downy Mildew) in North America
Authors: Feng Xuewen , Baudoin Anton
Published: May 2018

This report documents the first known occurrence in North America of resistance in grape downy mildew (Plasmopara viticola) to the carboxylic acid amide (CAA) fungicides mandipropamid and dimethomorph. These fungicides (FRAC group 40) have been an important component of downy mildew management programs for the past decade. Resistant isolates were obtained at three locations in Virginia and one in North Carolina, at considerable distances from each other. Resistance was documented by bioassay and the presence of the G1105S mutation, which has been associated with CAA resistance of P. viticola in other areas. Further survey is needed to determine the geographic extent of this resistance.
Intraneural Ultrasound-guided Sciatic Nerve Block
Authors: Cappelleri Gianluca , Ambrosoli Andrea Luigi , Gemma Marco , Cedrati Valeria Libera Eva , Bizzarri Federico , Danelli Giorgio Francesco
Published: May 2018

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Both extra- and intraneural sciatic injection resulted in significant axonal nerve damage. This study aimed to establish the minimum effective volume of intraneural ropivacaine 1% for complete sensory-motor sciatic nerve block in 90% of patients, and related electrophysiologic variations.

Methods

Forty-seven consecutive American Society of Anesthesiologists physical status I-II patients received an ultrasound-guided popliteal intraneural nerve block following the up-and-down biased coin design. The starting volume was 15 ml. Baseline, 5-week, and 6-month electrophysiologic tests were performed. Amplitude, latency, and velocity were evaluated. A follow-up telephone call at 6 months was also performed.

Results

The minimum effective volume of ropivacaine 1% in 90% of patients for complete sensory-motor sciatic nerve block resulted in 6.6 ml (95% CI, 6.4 to 6.7) with an onset time of 19 ± 12 min. Success rate was 98%. Baseline amplitude of action potential (mV) at ankle, fibula, malleolus, and popliteus were 8.4 ± 2.3, 7.1 ± 2.0, 15.4 ± 6.5, and 11.7 ± 5.1 respectively. They were significantly reduced at the fifth week (4.3 ± 2.1, 3.5 ± 1.8, 6.9 ± 3.7, and 5.2 ± 3.0) and at the sixth month (5.9 ± 2.3, 5.1 ± 2.1, 10.3 ± 4.0, and 7.5 ± 2.7) (P < 0.001 in all cases). Latency and velocity did not change from the baseline. No patient reported neurologic symptoms at 6-month follow-up.

Conclusions

The intraneural ultrasound-guided popliteal local anesthetic injection significantly reduces the local anesthetic dose to achieve an effective sensory-motor block, decreasing the risk of systemic toxicity. Persistent electrophysiologic changes suggest possible axonal damage that will require further investigation.
External Validation of the Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) in the Scoli-RISK-1 Patient Database
Authors: Miller Emily K. , Lenke Lawrence G. , Neuman Brian J. , Sciubba Daniel M. , Kebaish Khaled M. , Smith Justin S. , Qiu Yong , Dahl Benny T. , Pellisé Ferran , Matsuyama Yukihiro , Carreon Leah Y. , Fehlings Michael G. , Cheung Kenneth M. , Lewis Stephen , Dekutoski Mark B. , Schwab Frank J. , Boachie-Adjei Oheneba , Mehdian Hossein , Bess Shay , Shaffrey Christopher I. , Ames Christopher P.
Published: May 2018

Study Design.

Analysis of a prospective multicenter database.

Objective.

To assess the ability of the recently created Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) to predict odds of major complications and length of hospital stay for patients who had more severe preoperative deformity and underwent more invasive ASD surgery compared with patients in the database used to create the index.

Summary of Background Data.

Accurate preoperative estimates of risk are necessary given the high complication rates currently associated with ASD surgery.

Methods.

Patients were enrolled by participating institutions in Europe, Asia, and North America from 2009 to 2011. ASD-FI scores were used to classify 267 patients as not frail (NF) (<0.3), frail (0.3–0. 5), or severely frail (SF) (>0.5). Multivariable logistic regression, adjusted for preoperative and surgical covariates such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and incidence of major complications, overall incidence of complications, and length of hospital stay.

Results.

The mean ASD-FI score was 0.3 (range, 0–0.7). We categorized 105 patients as NF, 103 as frail, and 59 as SF. The adjusted odds of developing a major complication were higher for SF patients (odds ratio = 4.4; 95% CI 2.0, 9.9) compared with NF patients. After adjusting for covariates, length of hospital stay for SF patients increased by 19% (95% CI 1.4%, 39%) compared with NF patients. The odds of developing a major complication or having increased length of stay were similar between frail and NF patients.

Conclusion.

Greater patient frailty, as measured by the ASD-FI, is associated with a longer hospital stay and greater risk of major complications among patients who have severe preoperative deformity and undergo invasive surgical procedures.

Level of Evidence: 2
Incidence and Risk Factors for Instrumentation-related Complications After Scoliosis Surgery in Pediatric Patients With NF-1
Authors: Yao Ziming , Li Hao , Zhang Xuejun , Li Chengxin , Qi Xinyu
Published: May 2018

Study Design.

Retrospective cohort study.

Objective.

To assess the incidence and risk factors of instrumentation-related complication (IRC) in pediatric patients surgically treated for neurofibromatosis type 1 (NF-1) dystrophic scoliosis.

Summary of Background Data.

Surgical management including growing rods technique and early definitive fusion has been recommended to avoid progression of NF-1 scoliosis. However, no study has yet investigated the incidence and risk factors of IRC in these surgical interventions.

Methods.

Data of 59 pediatric NF-1 patients who had been surgically treated for dystrophic scoliosis were retrospectively reviewed. All of their clinical and radiographic data were collected. We evaluated potential risk factors, including age, sex, curve type, preoperative Cobb angle, kyphosis angle and spinal length, and surgical procedure. The univariate analysis and multivariate logistic regression analysis were performed to identify the risk factors associated with IRC.

Results.

Seventeen (28.8%) patients suffered 19 IRCs, including seven cases of curve progression, three cases of screw dislodgement, three cases of adding-on phenomenon, two cases of rod breakage, two cases of proximal junctional kyphosis, one case of cap loosing, and one case of pedicle cutting. The univariate logistic regression analysis revealed age<9, kyphosis≥50°, and growing-rod techniques the significant risk factors (P < 0.05). Binomial logistic regression analysis demonstrated two independent risk factors of IRC, including kyphosis≥50° (OR: 8.23; P = 0.025) and application of growing-rod technique (OR: 8.75; P = 0.032).

Conclusion.

17/59 (28.8%) patients suffered IRCs and age less than 9 years, kyphosis more than 50° and application of growing-rod are three risk factors for IRC after surgical treatment of NF-1 dystrophic scoliosis. Identification of these risk factors aids in stratifying preoperative risk to reduce IRC incidence. In addition, the results could be used in counseling patients and their families during the consent process.

Level of Evidence: 3
Management of Airway Obstruction in Infants With Pierre Robin Sequence
Authors: Runyan Christopher M. , Uribe-Rivera Armando , Tork Shahryar , Shikary Tasneem A. , Ehsan Zarmina , Weaver K. Nicole , Hossain Md Monir , Gordon Christopher B. , Pan Brian S.
Published: May 2018

Background:

Pierre Robin sequence (PRS)-related airway obstruction is often treated surgically; however, objective measures predicting the need for surgery are poorly defined.

Methods:

A retrospective chart review was performed on 171 neonates with PRS. Infants were grouped based upon intervention modality: nonsurgical (conservative) or surgical [mandibular distraction osteogenesis (MDO) or tracheostomy]. Demographic data, physical examination findings, and study results were compared between groups to determine risk factors for surgical intervention, and to predict long-term success or failure of those interventions.

Results:

The most significant, objective risk factor among those receiving surgery was a poor preintervention sleep study [obstructive index (OI): 42.4 versus 12.9 for the conservative treatment group; P < 0.001]. Only 11% of those treated conservatively had an OI >20, whereas 67.5% of those treated surgically met this severity measure. Of those receiving surgery, tracheostomy was associated with neurologic impairment (P = 0.030) and low birth weight (P = 0.046) compared with the MDO group. Together with syndromic status, these risk factors were useful for predicting failure of MDO to avoid subsequent tracheostomy (test sensitivity and specificity were 64.2% and 100.0%, respectively). No long-term differences in speech or micrognathia were detected between the 3 groups; however, those treated conservatively or with MDO had improved long-term feeding and airway obstruction outcomes compared with the tracheostomy group.

Conclusions:

Surgical intervention for PRS-related tongue-based airway obstruction should be strongly considered with an OI >20. Tracheostomy should be reserved for complex patients with concomitant syndromic diagnosis, neurologic impairment, and low birth weight.
Menopausal Hormone Therapy in Gynecologic Cancer Survivors: A Review of the Evidence and Practice Recommendations
Authors: KAPOOR EKTA , BENRUBI DANIEL , FAUBION STEPHANIE S.
Published: May 2018

Gynecologic cancers are common in the United States and represent a significant health burden. Treatment of these cancers often causes premature cessation of ovarian function, with resultant symptoms that are often more severe than those associated with natural menopause. Hormone therapy is the most effective treatment for menopausal symptoms, but the decision-making process about its use can be complex for survivors of gynecologic cancer. In this review, we provide evidence-based recommendations about the use of hormone therapy after gynecologic cancer.
Achieving Guideline-Driven High-Intensity Statin Dose in Cardiac Rehabilitation Patients With Coronary Artery Disease
Authors: Lin Jonathan , Banathy Alexandra , Winters Carla , Andersen Lars , Hudson Cindy , Testa Heidi , Reardon Joy , Alagona Peter
Published: May 2018

Purpose:

The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommends high-intensity statin therapy in patients aged ≤75 y with clinical coronary artery disease (CAD). The effectiveness of cardiac rehabilitation (CR) in lipid management and guideline adherence is unknown. The purpose of this study is to determine whether CR participation affects guideline-driven achievement for statin use.

Methods:

This multicenter retrospective study evaluated statin utilization in patients pre- and post-CR between January 1, 2014, and August 31, 2015. Records for patients with known CAD who completed 18 or more CR sessions were reviewed for statin-drug use and dose before and after CR and documented statin intolerance.

Results:

Of the total 468 patients, 76% were male with mean age ± SD = 66.0 ± 10.8 y and range of 32 to 89 y. Patients aged ≤75 y (n = 375) showed a modest but statistically significant increase (P = .0006) in high-intensity statin use post-CR (56.3%-61.1%). Males demonstrated a significant increase in high-intensity statin use (P = .0005). Of the 146 patients aged ≤75 y not on high-intensity statins post-CR, only 21 had history of statin intolerance. Of the subjects aged >75 y (n = 93), 91% were already on high- or moderate-intensity statins with no significant change during CR.

Conclusions:

Patients aged ≤75 y following CR completion increased high-intensity statin use but only by 4.8% and 33% of subjects were inadequately treated. The updated 2013 treatment recommendations simplified statin use, yet substantial data continue to reveal that guideline achievement even post-CR remains limited.
The More, the Better? The Usefulness of Brimonidine as the Fourth Antiglaucoma Eye Drop
Authors: Bro Tomas , Lindén Christina
Published: May 2018

Purpose:

The purpose of this article was to study the intraocular pressure (IOP)-lowering effect of adding brimonidine as the fourth antiglaucoma medication to a preexisting therapy of 3 topical drugs.

Methods:

This was a retrospective, register-based, cohort study of medical records and computerized medical information comprising 1 county in Sweden. The main outcome measure was change in IOP after brimonidine addition. Short-term and long-term effects were evaluated.

Results:

Of 4910 patients on antiglaucoma medication, 69 (1.4%) initiated a treatment with brimonidine as the fourth drug during 2014. Fifty-three patients were eligible for analysis. Forty-six patients tolerated the treatment. Among them, short-term IOP decreased by 17% (confidence interval, 10%-25%; P<0.001) after a mean of 46 days (SD, 50 d). Twenty-eight patients, that is, 53% of the eligible, remained on unchanged therapy after a mean follow-up time of 368 days (SD, 61 d). The long-term mean IOP decrease in this group was 20% (confidence interval, 11%-29%; P<0.0001). An IOP reduction of at least 20% was reached by 28 and 14 patients, in the short-term and long-term follow-ups, respectively.

Conclusions:

Brimonidine has the potential to reduce the IOP significantly even when used as the fourth drug. In the short-term, half of the patients reached the target IOP reduction (≥20%). After 1 year, a quarter of the eligible patients had had a sustained, uneventful effect. Thus, brimonidine as the fourth adjunctive antiglaucoma drop seems a valuable option for a minority of patients.
Clinical indications associated with opioid initiation for pain management in Ontario, Canada: a population-based cohort study
Authors: Pasricha Sachin V. , Tadrous Mina , Khuu Wayne , Juurlink David N. , Mamdani Muhammad M. , Paterson J. Michael , Gomes Tara
Published: May 2018

Concerns over prescription opioids contributing to high levels of opioid use disorder and overdose have led policymakers and clinicians to seek means to reduce inappropriate and high-dose initial prescriptions. To inform such efforts, we sought to describe the clinical indications associated with opioid initiation and the characteristics of the initial prescriptions and patients through a retrospective population-based cohort study. Our cohort included Ontarians initiating prescription opioids for pain management between April 1, 2015, and March 31, 2016. We identified the apparent clinical indication for opioid initiation by linking prescription drug claims to procedural and diagnostic information on health service records on the day of, and 5 days preceding prescription. Outcomes included initial opioid type, prescription duration, and daily dose (in milligram morphine equivalents), stratified either by indication or indication cluster. Among 653,993 individuals, we successfully classified 575,512 (88.0%) people initiating opioids into 23 clinical indications in 6 clusters: dental (23.2%); postsurgical (17.4%); musculoskeletal (12.0%); trauma (11.2%); cancer/palliative care (6.5%); and other less frequent indications (17.7%). Individuals with postsurgical pain received the highest daily doses (40.5% with greater than 50 milligram morphine equivalent), and those with musculoskeletal pain received more initial prescriptions with a duration exceeding 7 days (34.2%). Opioids are initiated for a wide range of indications with varying doses and durations; yet, those who initiated opioids for postsurgical and musculoskeletal pain received the greatest doses and durations of therapy, respectively. These findings may help tailor and prioritize efforts to promote more appropriate opioid prescribing.
What Is the Optimal Blood Pressure on Veno-Arterial Extracorporeal Membrane Oxygenation? Impact of Mean Arterial Pressure on Survival
Authors: Tanaka Daizo , Shimada Shogo , Mullin Megan , Kreitler Kristin , Cavarocchi Nicholas , Hirose Hitoshi
Published: May 2018

Blood pressure management is crucial for patients on veno-arterial extracorporeal membrane oxygenation (VA ECMO). Lower pressure can lead to end-organ malperfusion, whereas higher pressure may compete with ECMO flow and cardiac output. The impact of mean arterial pressure (MAP) on outcomes of patients on VA ECMO was evaluated. Patients who were supported on VA ECMO from September 2010 to March 2016 were retrospectively analyzed for average MAP throughout their course on ECMO, excluding the first and last day. Survival and complications observed during ECMO were investigated by classifying patients into groups based on their average MAP. A total of 116 patients were identified. Average MAP was significantly higher in patients who survived to discharge (82 ± 5.6 vs. 78 ± 5.5 mm Hg, p = 0.0003). There was a positive association between MAP and survival. Survival was best with MAP higher than 90 mm Hg (71%) and worst with MAP less than 70 mm Hg, where no patient survived. MAP was an independent predictor of survival to discharge by multivariate analysis (odds ratio 1.17, p = 0.013). Vasopressors were used more frequently in patients with lower pressure (coefficient −3.14, p = 0.005) without affecting survival (odds ratio 0.95, p = 0.95). Although the MAP did not affect the probability of strokes or bleeding complications, patients with a higher MAP had a lower incidence of kidney injury (p = 0.007). In conclusion, survival of patients on VA ECMO was significantly greater with a higher MAP, without being affected by prolonged vasopressor use.
Short article: Influence of regulatory NLRC5 variants on colorectal cancer survival and 5-fluorouracil-based chemotherapy
Authors: Catalano Calogerina , da Silva Filho Miguel I. , Jiraskova Katerina , Vymetalkova Veronika , Levy Miroslav , Liska Vaclav , Vycital Ondrej , Naccarati Alessio , Vodickova Ludmila , Hemminki Kari , Vodicka Pavel , Weber Alexander N.R. , Försti Asta
Published: May 2018

Background

NLRC5 is an interferon γ-inducible protein, which plays a role in immune surveillance with a potential influence on cancer survival.

Objective

We aimed to evaluate the effect of potential regulatory variants in NLRC5 on overall survival and survival after 5-fluorouracil (5-FU)-based therapy of colorectal cancer (CRC) patients.

Patients and methods

We carried out a case-only study in a Czech population of 589 cases; 232 received 5-FU-based therapy. Eleven variants within NLRC5 were selected using in-silico tools. Associations between polymorphisms and survival were assessed by Cox regression analysis adjusting for age at diagnosis, sex, and TNM stage. Survival curves were derived using the Kaplan–Meier method.

Results

Two variants showed a significant association with survival. All patients and metastasis-free patients at the time of diagnosis (pM0) who were homozygous carriers of the minor allele of rs27194 had a decreased overall survival (OSall and OSpM0) and event-free survival (EFSpM0) under a recessive model (OSall
P=0.003, OSpM0
P=0.005, EFSpM0
P=0.01, respectively). OS was also decreased for all patients and for pM0 patients who carried at least one minor allele of rs289747 (OSall
P=0.03 and OSpM0
P=0.003, respectively). Among CRC patients, who underwent a 5-FU-based adjuvant regimen, rs12445252 was associated with OSall, OSpM0 and EFSpM0, according to the dosage of the minor allele T (OSall
P=0.0004, OSpM0
P=0.0001, EFSpM0
P=0.008, respectively).

Conclusion

Our results showed that polymorphisms in NLRC5 may be used as prognostic markers of survival of CRC patients, as well as for survival in response to 5-FU treatment.
Differences in Experiences With Care Between Homeless and Nonhomeless Patients in Veterans Affairs Facilities With Tailored and Nontailored Primary Care Teams
Authors: Jones Audrey L. , Hausmann Leslie R.M. , Kertesz Stefan , Suo Ying , Cashy John P. , Mor Maria K. , Schaefer James H. , Gundlapalli Adi V. , Gordon Adam J.
Published: May 2018

Background:

Homeless patients describe poor experiences with primary care. In 2012, the Veterans Health Administration (VHA) implemented homeless-tailored primary care teams (Homeless Patient Aligned Care Team, HPACTs) that could improve the primary care experience for homeless patients.

Objective:

To assess differences in primary care experiences between homeless and nonhomeless Veterans receiving care in VHA facilities that had HPACTs available (HPACT facilities) and in VHA facilities lacking HPACTs (non-HPACT facilities).

Research Design:

We used multivariable multinomial regressions to estimate homeless versus nonhomeless patient differences in primary care experiences (categorized as negative/moderate/positive) reported on a national VHA survey. We compared the homeless versus nonhomeless risk differences (RDs) in reporting negative or positive experiences in 25 HPACT facilities versus 485 non-HPACT facilities.

Subjects:

Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941).

Measures:

Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support.

Results:

In non-HPACT facilities, homeless patients reported more negative and fewer positive experiences than nonhomeless patients. However, these patterns of homeless versus nonhomeless differences were reversed in HPACT facilities for the domains of communication (positive experience RDs in non-HPACT versus HPACT facilities=−2.0 and 2.0, respectively); comprehensiveness (negative RDs=2.1 and −2.3), shared decision-making (negative RDs=1.2 and −1.8), and self-management support (negative RDs=0.1 and −4.5; positive RDs=0.5 and 8.0).

Conclusions:

VHA facilities with HPACT programs appear to offer a better primary care experience for homeless versus nonhomeless Veterans, reversing the pattern of relatively poor primary care experiences often associated with homelessness.
Glucose Requirements of the Developing Human Brain
Authors: Goyal Manu S. , Raichle Marcus E.
Published: May 2018

Adequate nutrition is critical for human brain development, which depends particularly upon glucose. The adult human brain accounts for 20% to 25% of total body resting glucose consumption, and studies indicate that the developing brain requires an even greater percentage of glucose. Here we critically review the currently available data on glucose requirements for early childhood brain development. Implications of these findings are then discussed in the context of childhood malnutrition and future areas of investigation.
Correlation of Level of Trauma Activation With Emergency Department Intervention
Authors: Cooper Michael C. , Srivastava Geetanjali
Published: May 2018

Background

In-hospital trauma team activation criteria are formulated to identify severely injured patients requiring specialized multidisciplinary care. Efficacy of trauma activation (TA) criteria is commonly measured by emergency department (ED) disposition, injury severity score, and mortality. Necessity of critical ED interventions is another measure that has been proposed to evaluate the appropriateness of TA criteria.

Methods

Two-year retrospective cohort study of 1715 patients from our trauma registry at a Level 1 pediatric trauma center. We abstracted data on acute interventions, level and criterion of TA, ED disposition, and mortality. We report odds ratio (OR) with 95% confidence intervals (CIs), positive predictive value, and frequency of acute interventions.

Results

Trauma activation was initiated for 947 (55%) of the 1715 patients. There were 426 ED interventions performed on 235 patients (14%); 67.8% were in level 1 activations; 17.6% in level 2, and 14.6% in level 3. Highest-level activations were highly associated with need for ED interventions (OR, 16.1; 95% CI, 11.5–22.4). The ORs for requiring an ED intervention were low for lower level activations (OR, 0.4; 95% CI, 0.3–0.5), trauma service consults (OR, 0.3; 95% CI, 0.2–0.4), and certain mechanism-based criteria. The ORs for ED intervention for isolated motor vehicle collision (0.2; 95% CI, 0.1–0.7), isolated all-terrain vehicle rollover (0.4; 95% CI, 0.1–1.7), and suspected spinal cord injury (0.5; 95% CI, 0.1–3.7) were significantly lower than 1.

Conclusions

Highest-level activation criteria correlate with high utilization of ED resources and interventions. Lower level activation criteria and trauma service consult criteria are not highly correlated with need for ED interventions. Downgrading isolated motor vehicle collision and all-terrain vehicle rollovers and suspected spinal cord injury to lower level activations could decrease the overtriage rate, and adding age-specific bradycardia as a physiologic criterion could improve our undertriage rate.
Radiology Callbacks to a Pediatric Emergency Department and Their Clinical Impact
Authors: Arora Rajan , Kannikeswaran Nirupama
Published: May 2018

Background

Clinical impact of radiology callbacks (missed initial radiologic diagnosis) remains largely unknown in the pediatric emergency department (PED).

Objective

The aim of this study was to describe the incidence, nature of radiology callbacks, and the impact on clinical care during the return visit (RV).

Methods

We performed a retrospective chart review of quality assurance database of RVs for radiology callbacks to our PED over a 1-year period.

Results

Return visit rate to our PED was 3% (2765/92,000) of which 1.9% (55/2765) was for radiology callbacks. Radiology misses involved mostly x-ray interpretations (92.7%), occurred after-hours (83.6%), with fractures being the most common missed finding. Majority of patients (94.5%) required 1 or more interventions during the RV; 34.5% of radiology callbacks had a major impact on clinical management; 27.2% of radiology callbacks were false-positive.

Conclusions

Although RVs secondary to radiology callback remain low, one third of them resulted in major changes in diagnosis, treatment, or disposition and impacted patient outcome.
Fast Abdominal Contrast-Enhanced Imaging With High Parallel-Imaging Factors Using a 60-Channel Receiver Coil Setup
Authors: Weiss Jakob , Martirosian Petros , Wolf Steffen , Horger Wilhelm , Taron Jana , Nikolaou Konstantin , Notohamiprodjo Mike , Othman Ahmed E.
Published: May 2018

Purpose

The aim of this study was to assess a novel 60-channel receiver body coil (B60) setup for accelerated contrast-enhanced abdominal magnetic resonance imaging (MR) imaging with respect to signal-to-noise ratio (SNR) and image quality using high parallel-imaging technique (PAT) factors in comparison to a standard 30-channel coil setup.

Methods

All imaging data were acquired on a 3 T MR scanner using a novel B60 receiver coil setup in comparison to a standard 30-channel setup serving as reference standard. Phantom measurements were performed to systematically evaluate SNR and geometry factor performance in an ex vivo setting. To assess the in vivo application, additional measurements in 5 healthy volunteers and 17 patients were performed using a 3-dimensional T1w gradient-echo sequences with different acceleration factors. At first, the volunteers were examined. In a second step, standard contrast-enhanced abdominal images were acquired in the 17 patients, who were randomly assigned into 2 groups (group A: 60-channel, n = 8; group B: 30-channel, n = 9). Image quality, noise, lesion conspicuity, and artifacts were assessed by 2 radiologists independently on a 5-point Likert scale (5 = excellent).

Results

The phantom study revealed substantial advantages (SNR and geometry factor) of the B60 coil for measurements in the head-to-feet phase encoding direction, whereas only minor differences were found in other directions. Comparison of image quality in volunteers revealed significantly higher ratings of the B60 setup for all acquisitions (P ≤ 0.032), except for PAT = none. In patients, similar results were observed with comparable image quality at lower PAT factors and significantly superior image quality of the B60 setup for higher PAT factors (2 × 2 and 3 × 2; P = 0.008).

Conclusions

The 60-channel coil setup facilitates improved SNR and image quality at high PAT factors with diagnostic image quality, which allows for accelerated contrast-enhanced MR imaging of the abdomen.