bluuebunny/crossref_metadata_2025 huggingface dataset:
Bacterial peptidoglycan with amidated meso-diaminopimelic acid evades NOD1 recognition: an insight into NOD1 structure–recognition
Authors: Vijayrajratnam Sukhithasri , Pushkaran Anju Choorakottayil , Balakrishnan Aathira , Vasudevan Anil Kumar , Biswas Raja , Mohan Chethampadi Gopi
Published: October 2016

Nucleotide-binding oligomerization domain-containing protein 1 (NOD1) is an intracellular pattern recognition receptor that recognizes bacterial peptidoglycan (PG) containing meso-diaminopimelic acid (mesoDAP) and activates the innate immune system. Interestingly, a few pathogenic and commensal bacteria modify their PG stem peptide by amidation of mesoDAP (mesoDAPNH2). In the present study, NOD1 stimulation assays were performed using bacterial PG containing mesoDAP (PGDAP) and mesoDAPNH2 (PGDAPNH2) to understand the differences in their biomolecular recognition mechanism. PGDAP was effectively recognized, whereas PGDAPNH2 showed reduced recognition by the NOD1 receptor. Restimulation of the NOD1 receptor, which was initially stimulated with PGDAP using PGDAPNH2, did not show any further NOD1 activation levels than with PGDAP alone. But the NOD1 receptor initially stimulated with PGDAPNH2 responded effectively to restimulation with PGDAP. The biomolecular structure–recognition relationship of the ligand-sensing leucine-rich repeat (LRR) domain of human NOD1 (NOD1–LRR) with PGDAP and PGDAPNH2 was studied by different computational techniques to further understand the molecular basis of our experimental observations. The d-Glu–mesoDAP motif of GMTPDAP, which is the minimum essential motif for NOD1 activation, was found involved in specific interactions at the recognition site, but the interactions of the corresponding d-Glu–mesoDAP motif of PGDAPNH2 occur away from the recognition site of the NOD1 receptor. Hot-spot residues identified for effective PG recognition by NOD1–LRR include W820, G821, D826 and N850, which are evolutionarily conserved across different host species. These integrated results thus successfully provided the atomic level and biochemical insights on how PGs containing mesoDAPNH2 evade NOD1–LRR receptor recognition.
Engineering a trifunctional proline utilization A chimaera by fusing a DNA-binding domain to a bifunctional PutA
Authors: Arentson Benjamin W. , Hayes Erin L. , Zhu Weidong , Singh Harkewal , Tanner John J. , Becker Donald F.
Published: October 2016

Proline utilization A (PutA) is a bifunctional flavoenzyme with proline dehydrogenase (PRODH) and Δ1-pyrroline-5-carboxylate (P5C) dehydrogenase (P5CDH) domains that catalyses the two-step oxidation of proline to glutamate. Trifunctional PutAs also have an N-terminal ribbon–helix–helix (RHH) DNA-binding domain and moonlight as autogenous transcriptional repressors of the put regulon. A unique property of trifunctional PutA is the ability to switch functions from DNA-bound repressor to membrane-associated enzyme in response to cellular nutritional needs and proline availability. In the present study, we attempt to construct a trifunctional PutA by fusing the RHH domain of Escherichia coli PutA (EcRHH) to the bifunctional Rhodobacter capsulatus PutA (RcPutA) in order to explore the modular design of functional switching in trifunctional PutAs. The EcRHH–RcPutA chimaera retains the catalytic properties of RcPutA while acquiring the oligomeric state, quaternary structure and DNA-binding properties of EcPutA. Furthermore, the EcRHH–RcPutA chimaera exhibits proline-induced lipid association, which is a fundamental characteristic of functional switching. Unexpectedly, RcPutA lipid binding is also activated by proline, which shows for the first time that bifunctional PutAs exhibit a limited form of functional switching. Altogether, these results suggest that the C-terminal domain (CTD), which is conserved by trifunctional PutAs and certain bifunctional PutAs, is essential for functional switching in trifunctional PutAs.
Cellular strategies to cope with protein aggregation
Authors: Scior Annika , Juenemann Katrin , Kirstein Janine
Published: October 2016

Nature has evolved several mechanisms to detoxify intracellular protein aggregates that arise upon proteotoxic challenges. These include the controlled deposition of misfolded proteins at distinct cellular sites, the protein disaggregation and refolding by molecular chaperones and/or degradation of misfolded and aggregated protein species by cellular clearance pathways. In this article, we discuss cellular the strategies of prokaroytes and eukaryotes to control protein aggregation.
Protein quality control at the endoplasmic reticulum
Authors: McCaffrey Kathleen , Braakman Ineke
Published: October 2016

The ER (endoplasmic reticulum) is the protein folding ‘factory’ of the secretory pathway. Virtually all proteins destined for the plasma membrane, the extracellular space or other secretory compartments undergo folding and maturation within the ER. The ER hosts a unique PQC (protein quality control) system that allows specialized modifications such as glycosylation and disulfide bond formation essential for the correct folding and function of many secretory proteins. It is also the major checkpoint for misfolded or aggregation-prone proteins that may be toxic to the cell or extracellular environment. A failure of this system, due to aging or other factors, has therefore been implicated in a number of serious human diseases. In this article, we discuss several key features of ER PQC that maintain the health of the cellular secretome.
Cellular proteostasis: degradation of misfolded proteins by lysosomes
Authors: Jackson Matthew P. , Hewitt Eric W.
Published: October 2016

Proteostasis refers to the regulation of the cellular concentration, folding, interactions and localization of each of the proteins that comprise the proteome. One essential element of proteostasis is the disposal of misfolded proteins by the cellular pathways of protein degradation. Lysosomes are an important site for the degradation of misfolded proteins, which are trafficked to this organelle by the pathways of macroautophagy, chaperone-mediated autophagy and endocytosis. Conversely, amyloid diseases represent a failure in proteostasis, in which proteins misfold, forming amyloid deposits that are not degraded effectively by cells. Amyloid may then exacerbate this failure by disrupting autophagy and lysosomal proteolysis. However, targeting the pathways that regulate autophagy and the biogenesis of lysosomes may present approaches that can rescue cells from the deleterious effects of amyloidogenic proteins.
Shape matters: the complex relationship between aggregation and toxicity in protein-misfolding diseases
Authors: Ries Heidrun Maja , Nussbaum-Krammer Carmen
Published: October 2016

A particular subgroup of protein-misfolding diseases, comprising Alzheimer's and Parkinson's disease, involves amyloidogenic proteins that can form alternative pathogenic conformations with a high tendency to self-assemble into oligomeric and fibrillar species. Although misfolded proteins have been clearly linked to disease, the exact nature of the toxic species remains highly controversial. Increasing evidence suggests that there is little correlation between the occurrence of macroscopic protein deposits and toxic phenotypes in affected cells and tissues. In this article, we recap amyloid aggregation pathways, describe prion-like propagation, elaborate on detrimental interactions of protein aggregates with the cellular protein quality control system and discuss why some aggregates are toxic, whereas others seem to be beneficial. On the basis of recent studies on prion strains, we reason that the specific aggregate conformation and the resulting individual interaction with the cellular environment might be the major determinant of toxicity.
Neural tube morphogenesis in synthetic 3D microenvironments
Authors: Ranga Adrian , Girgin Mehmet , Meinhardt Andrea , Eberle Dominic , Caiazzo Massimiliano , Tanaka Elly M. , Lutolf Matthias P.
Published: October 2016

Significance

In vitro organoids have become widely used model systems in basic research and for therapeutic applications due to their ability to recapitulate key elements of in vivo form and function. However, their full potential remains unfulfilled as a result of the poorly defined matrices in which they are grown. Here, we use modular synthetic 3D matrices to show that early neural morphogenesis can be precisely controlled by the extracellular microenvironment. Our approach is broadly applicable to gain a broader understanding of the multifactorial 3D cell–matrix interactions that coordinate multicellular growth and differentiation, and opens up avenues to discover and dissect the unique microenvironments that control morphogenesis in various organoid systems.
Global phosphoproteomic profiling reveals perturbed signaling in a mouse model of dilated cardiomyopathy
Authors: Kuzmanov Uros , Guo Hongbo , Buchsbaum Diana , Cosme Jake , Abbasi Cynthia , Isserlin Ruth , Sharma Parveen , Gramolini Anthony O. , Emili Andrew
Published: October 2016

Significance

The present study demonstrates the utility of global phosphoproteomic profiling of diseased cardiac tissue to identify signaling pathways and other biological processes disrupted in cardiomyopathy. Perturbed Notch-1 signaling was identified by bioinformatics analyses of phosphoprotein patterns present in affected cardiac tissue in a transgenic mouse model system of dilated cardiomyopathy and by complementary molecular biology and microscopy techniques. In addition, dozens of other disturbed signaling pathways offer an opportunity for novel therapeutic and/or diagnostic clinically applicable targets. Although this study was performed in mice, only minor adjustments to the experimental approach would be required for comparative analysis of analogous samples from human cardiac patients, potentially leading to even more clinically relevant data.
Matrix mechanics controls FHL2 movement to the nucleus to activate p21 expression
Authors: Nakazawa Naotaka , Sathe Aneesh R. , Shivashankar G. V. , Sheetz Michael P.
Published: October 2016

Significance

Substrate rigidity has important roles for physiological processes, such as stem cell differentiation and cell growth. Although substrate rigidity clearly modulates gene expression, the mechanism of rigidity control of gene expression remains unknown. Our work reveals that four-and-a-half LIM domains (domain discovered in the proteins, Lin11, Isl-1, and Mec-3) 2 moves from adhesion sites to the nucleus on soft substrates through focal adhesion kinase activity and up-regulates p21 gene expression. Thus, we show a molecular pathway for inhibiting cell growth on soft substrates.
Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children
Authors: Lewinsohn David M. , Leonard Michael K. , LoBue Philip A. , Cohn David L. , Daley Charles L. , Desmond Ed , Keane Joseph , Lewinsohn Deborah A. , Loeffler Ann M. , Mazurek Gerald H. , O’Brien Richard J. , Pai Madhukar , Richeldi Luca , Salfinger Max , Shinnick Thomas M. , Sterling Timothy R. , Warshauer David M. , Woods Gail L.
Published: October 2016

Background.

Individuals infected with Mycobacterium tuberculosis (Mtb) may develop symptoms and signs of disease (tuberculosis disease) or may have no clinical evidence of disease (latent tuberculosis infection [LTBI]). Tuberculosis disease is a leading cause of infectious disease morbidity and mortality worldwide, yet many questions related to its diagnosis remain.

Methods.

A task force supported by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America searched, selected, and synthesized relevant evidence. The evidence was then used as the basis for recommendations about the diagnosis of tuberculosis disease and LTBI in adults and children. The recommendations were formulated, written, and graded using the Grading, Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Results.

Twenty-three evidence-based recommendations about diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis are provided. Six of the recommendations are strong, whereas the remaining 17 are conditional.

Conclusions.

These guidelines are not intended to impose a standard of care. They provide the basis for rational decisions in the diagnosis of tuberculosis in the context of the existing evidence. No guidelines can take into account all of the often compelling unique individual clinical circumstances.
Predictive factors of uterine movement during definitive radiotherapy for cervical cancer
Authors: Maemoto Hitoshi , Toita Takafumi , Ariga Takuro , Heianna Joichi , Yamashiro Tsuneo , Murayama Sadayuki
Published: October 2016

To determine the predictive factors affecting uterine movement during radiotherapy (RT), we quantified interfraction uterine movement using computed tomography (CT) and cone-beam CT (CBCT). A total of 38 patients who underwent definitive RT for cervical cancer were retrospectively analyzed. We compared pre-RT planning CT (n = 38) and intratreatment CBCT (n = 315), measuring cervical and corporal movement in each direction. Correlations between uterine movement and volume changes of the bladder and rectum on all CBCT scans were analyzed using Spearman rank correlation analysis. Relationships between the mean uterine movement and patient factors were analyzed using the Mann–Whitney test. The mean corpus movement was: superior margin (cranio–caudal direction), 7.6 ± 5.9 mm; anterior margin (anteroposterior direction), 8.3 ± 6.3 mm; left margin (lateral direction), 3.3 ± 2.9 mm; and right margin (lateral direction), 3.0 ± 2.3 mm. Generally, the mean values for cervical movement were smaller than those for the corpus. There was a significant, weak correlation between changes in bladder volume and the movement of the superior margin of the corpus (ρ = 0.364, P < 0.001). There was a significant difference in movement of the superior margin of the corpus between the subgroups with and without a history of previous pelvic surgery (P = 0.007). In conclusion, change in bladder volume and a history of previous surgery were significantly related to intrafractional corpus movement; however, our observations suggest that the accurate prediction of uterine movement remains challenging.
Epigenetic regulation and epigenomic landscape in rice
Authors: Deng Xian , Song Xianwei , Wei Liya , Liu Chunyan , Cao Xiaofeng
Published: October 2016

Epigenetic regulation has been implicated in the control of complex agronomic traits in rice (Oryza sativa), a staple food crop and model monocot plant. Recent advances in high-throughput sequencing and the moderately complex genome of rice have made it possible to study epigenetic regulation in rice on a genome-wide scale. This review discusses recent advances in our understanding of epigenetic regulation in rice, with an emphasis on the roles of key epigenetic regulators, the epigenomic landscape, epigenetic variation, transposon repression, and plant development.
Research, rethink and revolutionize rice breeding: an interview with Qifa Zhang
Authors: Ma Zisong
Published: October 2016

More than 100 Nobel laureates recently signed a letter urging Greenpeace to end its opposition to genetically modified organisms (GMOs). With an ever-increasing demand for food, China finds itself confronted with the same question: is it time to rethink and reassess its stance towards GMO? Rice is one of the most important food crops in China and around the world. In recent years, Chinese scientists have made important progress in rice functional genomics research including identifying genes and regulatory mechanisms and platforms and technologies for breeding new varieties. However, in contrast to the progress in scientific research, the commercial, social and policy framework remains largely unresolved. National Science Review (NSR) spoke with Qifa Zhang (Zhang), Professor at Huazhong Agricultural University, Academician of the Chinese Academy of Sciences and Foreign Associate of National Academy of Sciences, USA. In this interview, Prof. Zhang shares with us his views and insights on the frontier research in rice studies and commercialization of transgenic rice in China.
Rapid Occurrence of Chronic Kidney Disease in Patients Experiencing Reversible Acute Kidney Injury after Cardiac Surgery
Authors: Legouis David , Galichon Pierre , Bataille Aurélien , Chevret Sylvie , Provenchère Sophie , Boutten Anne , Buklas Dimitrios , Fellahi Jean-Luc , Hanouz Jean-Luc , Hertig Alexandre
Published: October 2016

Background

There is recent evidence to show that patients suffering from acute kidney injury are at increased risk of developing chronic kidney disease despite the fact that surviving tubular epithelial cells have the capacity to fully regenerate renal tubules and restore renal function within days or weeks. The aim of the study was to investigate the impact of acute kidney injury on de novo chronic kidney disease.

Methods

The authors conducted a retrospective population-based cohort study of patients initially free from chronic kidney disease who were scheduled for elective cardiac surgery with cardiopulmonary bypass and who developed an episode of acute kidney injury from which they recovered. The study was conducted at two French university hospitals between 2005 and 2015. These individuals were matched with patients without acute kidney injury according to a propensity score for developing acute kidney injury.

Results

Among the 4,791 patients meeting the authors’ inclusion criteria, 1,375 (29%) developed acute kidney injury and 685 fully recovered. Propensity score matching was used to balance the distribution of covariates between acute kidney injury and non- acute kidney injury control patients. Matching was possible for 597 cases. During follow-up, 34 (5.7%) had reached a diagnosis of chronic kidney disease as opposed to 17 (2.8%) in the control population (hazard ratio, 2.3; bootstrapping 95% CI, 1.9 to 2.6).

Conclusions

The authors’ data consolidate the recent paradigm shift, reporting acute kidney injury as a strong risk factor for the rapid development of chronic kidney disease.
The ConNECtion Between Abdominal Signs and Necrotizing Enterocolitis in Infants 501 to 1500 g
Authors: Gephart Sheila M. , Fleiner Michelle , Kijewski Amy
Published: October 2016

Background:

Necrotizing enterocolitis (NEC) can become severe quickly, making early recognition a priority and understanding the occurrence of abdominal and clinical signs of impending NEC important.

Purpose:

The purpose of this study was to examine relationships of abdominal signs up to 36 hours before diagnosis of NEC within subgroups treated medically, surgically, or those who died.

Methods:

A 3-site, descriptive correlational case-control design with retrospective data collection was used matching each NEC case to 2 controls (N = 132).

Results:

NEC cases were exposed to less human milk and fed later. Among them, 61% (n = 27) had at least 1 abdominal sign 36 hours before diagnosis, with fewer numbers having 2 (18%; n = 8) or 3 (5%; n = 2). At 36 hours before NEC, abdominal distension, duskiness, higher gastric residual, and greater count of abdominal signs were associated with severe NEC. No medical NEC cases had abdominal signs 36 or 24 hours before diagnosis. Highest severity of NEC was related to more abdominal signs at the times leading up to and at diagnosis of NEC. Gastric residuals were largely unrelated to NEC except for the most severe NEC at 36 hours before diagnosis.

Implications for Practice:

Communicating a count of abdominal signs may support earlier recognition and treatment of NEC.

Implications for Research:

More research is needed to explore timing for clinical worsening of status (eg, surgical and NEC leading to death) and to study effective clinical approaches targeting early recognition to support timely action.
Debilitating Effects of Femoral Nonunion on Health-Related Quality of Life
Authors: Brinker Mark R. , Trivedi Akash , O'Connor Daniel P.
Published: October 2016

Objective:

The purpose of this study was to report the extent of the effects of femoral nonunion on health-related quality of life.

Design:

Retrospective cohort.

Setting:

Tertiary referral center.

Patients/Participants:

One hundred eighty-seven consecutive patients (85 women, age 55.9 ± 16.9 years; 102 men, age 42.8 ± 16.1 years) with 188 nonunions of the femur, excluding those involving the hip or knee articular surfaces.

Intervention:

Average nonunion duration was 28.5 months. 5.7% of the nonunions were infected, and the distal third was the most frequently involved segment.

Main Outcome Measurements:

SF-12 Mental Component Summary (MCS) and Physical Component Summary (PCS) scores, Brief Pain Inventory (BPI), American Academy of Orthopaedic Surgeons Lower Limb Core Scale (LLCS), and Time Trade-Off (TTO) reported at the time of initial clinical evaluation at our center.

Results:

The MCS scores averaged 43 ± 6.5, and the PCS scores averaged 26.3 ± 6.5, indicating the large adverse impact of femoral nonunion on mental and physical health, respectively. The BPI average intensity score averaged 5.1 ± 2.5, indicating moderate to severe pain. The LLCS averaged 53.9 ± 20.0, indicating substantial lower extremity-specific disability. The TTO questionnaire responses indicated that these patients were willing to trade an average of 38.3% of their remaining years of life to regain health.

Conclusions:

The impact of femoral shaft nonunion on physical health was comparable to end-stage hip arthrosis and tibial nonunion and worse than many other medical conditions. Femoral shaft nonunion is a debilitating chronic medical condition with substantial negative effects on health.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Effect of Varying Tension of a Suture Button Construct in Fixation of the Tibiofibular Syndesmosis—Evaluation Using Stress Computed Tomography
Authors: Morellato John , Louati Hakim , Bodrogi Andrew , Stewart Andrew , Papp Steven , Liew Allan , Gofton Wade
Published: October 2016

Background/Purpose:

There have been no studies assessing the optimal biomechanical tension of suture button constructs. The purpose of this study was to assess optimal tensioning of suture button fixation and its ability to maintain reduction under loaded conditions using a stress computed tomography (CT) model.

Methods:

Ten cadaveric lower limbs disarticulated at the knee were used. The limbs were placed in a modified ankle load frame that allowed for the application of sustained torsional axial or combined torsional/axial loads. The syndesmosis and the deep deltoid ligaments complex were sectioned and the limbs were randomized to receive a suture button construct tightened at 4, 8, or 12 kg. The specimens were loaded under the 3 loading scenarios with CT scans performed after each and at the conclusion of testing. Multiple measurements of translation and rotation were compared with baseline CT scan taken before sectioning.

Results:

Significant lateral (maximum 5.26 mm) and posterior translation (maximum 6.42 mm) and external rotation (maximum 11.71 degrees) was noted with the 4 kg repair. Significant translation was also seen with both the 8 and the 12 kg repairs; however, the incidence was less than with the 4 kg repair. Significant overcompression (ML = 1.69 mm, B = 2.69 mm) was noted with the 12 kg repair and also with the 8 kg repair (B = 2.01 mm).

Conclusion:

Suture button constructs must be appropriately tensioned to maintain reduction and re-approximate the degree of physiological motion at the distal tibiofibular joint. These constructs also demonstrate overcompression of the syndesmosis; however, the clinical effect of this remains to be determined.
Reliability and Reproducibility of the OTA/AO Classification for Humeral Shaft Fractures
Authors: Mahabier Kiran C. , Van Lieshout Esther M. M. , Van Der Schaaf Boyd C. , Roukema Gert R. , Punt Bas J. , Verhofstad Michael H. J. , Den Hartog Dennis ,   on behalf of the HUMMER trial investigators
Published: October 2016

Objectives:

This study aimed to determine interobserver reliability and intraobserver reproducibility of the OTA/AO classification for humeral shaft fractures, and to evaluate differences between fracture types, fracture groups, and surgical specializations.

Methods:

Thirty observers (25 orthopaedic trauma surgeons and 5 general orthopaedic surgeons) independently classified 90 humeral shaft fractures according to the OTA/AO classification. Patients of 16 years and older were included. Periprosthetic, recurrent, and pathological fractures were excluded. Radiographs were provided in random order, and observers were blinded to clinical information. To determine intraobserver agreement, radiographs were reviewed again after 2 months in a different random order. Agreement was assessed using kappa statistics.

Results:

Interobserver agreement for the 3 fracture types was moderate (κ = 0.60; 0.59–0.61). It was substantial for type A (κ = 0.77; 0.70–0.84) and moderate for type B (κ = 0.52; 0.46–0.58) and type C fractures (κ = 0.46; 0.42–0.50). Interobserver agreement for the 9 fracture groups was moderate (κ = 0.48; 95% CI, 0.48–0.48). Orthopaedic trauma surgeons had better overall agreement for fracture types, and general orthopaedic surgeons had better overall agreement for fracture groups. Observers classified 64% of fractures identically in both rounds. Intraobserver agreement was substantial for the 3 types (κ = 0.80; 0.77–0.81) and 9 groups (κ = 0.80; 0.77–0.82). Intraobserver agreement showed no differences between surgical disciplines.

Conclusions:

The OTA/AO classification for humeral shaft fractures has a moderate interobserver and substantial intraobserver agreement for fracture types and groups.
Biomechanical Evaluation of the Femoral Neck System in Unstable Pauwels III Femoral Neck Fractures: A Comparison with the Dynamic Hip Screw and Cannulated Screws
Authors: Stoffel Karl , Zderic Ivan , Gras Florian , Sommer Christoph , Eberli Ursula , Mueller David , Oswald Martin , Gueorguiev Boyko
Published: October 2016

Objectives:

To evaluate the biomechanical performance of femoral neck system (FNS) in comparison with established methods for fixation of femoral neck fractures in a cadaveric model.

Methods:

Twenty pairs of fresh-frozen human cadaveric femora were instrumented either with dynamic hip screw and antirotation screw (DHS-screw), DHS-blade, 3 cannulated screws (3CS) or with FNS in a partially paired design. The specimens were randomized to 2 paired treatment groups based on the bone mineral density (BMD), namely DHS-screw/DHS-blade and FNS/3CS. A reduced unstable femoral neck fracture with postero-caudal comminution, OTA/AO 31–B2.3, 70 degrees Pauwels III, was simulated by cutting 30 degrees distal and 15 degrees posterior wedges. Cyclic axial loading was applied in 16 degrees adduction, starting at 500 N and with progressive peak force increase of 0.1 N/cycle until construct failure. Axial stiffness was measured in the third loading cycle. Femoral neck and leg shortening, and varus tilting and implant migration were calculated by means of optical motion tracking.

Results:

Mean axial stiffness was 688.8 ± 132.6 N/mm for DHS-screw, 629.1 ± 94.1 N/mm for DHS-blade, 748.9 ± 211.4 N/mm for FNS, and 584.1 ± 156.6 N/mm for 3CS, with no statistical significances. Cycles until 15-mm leg shortening were comparable for DHS-Screw (20,542 ± 7465), DHS-blade (19,161 ± 3793) and FNS (17,372 ± 2996), however significantly higher than for 3CS (7293 ± 2819), P < 0.001. Similarly, cycles until 15 mm femoral neck shortening were comparable between DHS-screw (20,846 ± 7339), DHS-blade (18,974 ± 4032) and FNS (18,171 ± 2585), and significantly higher than 3CS (8039 ± 2778), P < 0.001.

Conclusions:

From a biomechanical point of view, the femoral neck system is a valid alternative to treat unstable femoral neck fractures, representing the advantages of a minimally invasive implant with comparable stability to the 2 DHS systems and superior to cannulated screws.
Effectiveness of Extracorporeal Life Support for Patients With Cardiogenic Shock Due To Intractable Arrhythmic Storm
Authors: Le Pennec-Prigent Solène , Flecher Erwan , Auffret Vincent , Leurent Guillaume , Daubert Jean-Claude , Leclercq Christophe , Mabo Philippe , Verhoye Jean-Philippe , Martins Raphael P.
Published: October 2016

Objectives:

Extracorporeal life support is used for patients with severe heart failure as a bridge to heart transplantation or recovery. We aimed at analyzing the efficacy and safety of extracorporeal life support to treat refractory arrhythmic storm responsible for cardiogenic shock in patients resistant to antiarrhythmic drugs.

Design:

Retrospective study.

Setting:

University Hospital of Rennes, France.

Patients:

Patients with refractory arrhythmic storm admitted between January 2005 and March 2015.

Interventions:

Patients with intractable refractory arrhythmic storm and cardiogenic shock despite optimal medical therapy were implanted with an extracorporeal life support. Patients’ characteristics and outcomes after extracorporeal life support implantation were analyzed.

Measurements and Main Results:

Twenty-six patients (23 men, 52.4 ± 9.2 yr old) were included, most of them having ischemic cardiomyopathy (65.4%). Stable sinus rhythm restoration was immediate in 61.5% of patients and occurred after a median time of 3 hours after extracorporeal life support implantation for the remaining ones. Thirteen patients (50%) eventually died, none of them due to extracorporeal life support–related complications, but mostly due to the occurrence of multiple organ failure, and occurred after a median time of 4 days. The remaining 13 patients (50%) had extracorporeal life support withdrawn after 6.7 ± 3.6 days and were discharged after 34.7 ± 14.7 days after admission. Patients with repetitive ventricular tachycardia/ventricular fibrillation episodes alternating with periods of sinus rhythm at the time of implantation had a better survival than those in refractory ventricular fibrillation (p = 0.017).

Conclusions:

This is the largest database of patients temporary implanted with extracorporeal life support for refractory arrhythmic storm responsible for cardiogenic shock resistant to antiarrhythmic drugs. It provides efficient hemodynamic support and survival rate after the implantation is 50%.
An update on the status of nerve monitoring for thyroid/parathyroid surgery
Authors: Lin Ho-Sheng , Terris David J.
Published: October 2016

Purpose of review

Recurrent laryngeal nerve (RLN) injury is one of the most common and serious complications associated with thyroid and parathyroid surgery. Although routine visual identification of the RLN is considered the current standard of care, the role of intraoperative neuromonitoring (IONM) of the RLN is more controversial.

Recent findings

Despite initial enthusiasm that IONM might substantially reduce the rate of RLN injury, most studies failed to show a significant difference in the rate of RLN injury when the use of IONM was compared with visualization of the RLN alone. However, a small number of investigators have reported statistically significant differences in the rates of nerve injury when IONM is used to augment visualization alone, particularly in certain high-risk situations. Despite a lack of conclusive data showing benefit, the use of IONM as an adjunct to visual identification of the RLN has gained increasing acceptance among surgeons. IONM remains an excellent tool to help verify the identity of the RLN, confirm its functional integrity, and pinpoint the site of nerve injury in the event of dysfunction.

The utility of IONM in reducing the rate of RLN injury is largely unproven and remains controversial. However, the use of IONM may be helpful in certain high-risk cases. Promising new technology, such as vagal nerve monitoring, may allow more real-time monitoring of the functional integrity of the RLN and allow the surgeon to react in a timely manner to evolving dysfunction in order to abort maneuvers that may risk definitive injury.
Do flame retardant chemicals increase the risk for thyroid dysregulation and cancer?
Authors: Hoffman Kate , Sosa Julie A. , Stapleton Heather M.
Published: October 2016

Purpose of review

Flame retardant chemicals are added to consumer products to reduce fire incidence and severity; approximately 1.5 million tons of these chemicals are used annually. However, their widespread use has led to their ubiquitous presence in the environment and chronic accumulation in human tissues. We summarize current trends in human flame retardant chemical exposure, and review recent data highlighting concerns for thyroid dysregulation and cancer risk in human populations.

Recent findings

Polybrominated diphenyl ethers were once commonly used as flame retardant chemicals, but recently were phased out. Exposure is associated with thyroid dysregulation (mainly T4 reductions) in animals, with new work focusing on specific mechanisms of action. Polybrominated diphenyl ethers also impact human thyroid regulation and are related to clinical thyroid disease, but associations appear both dose and life-stage dependent. Emerging data suggest that common alternate flame retardant chemicals may be more potent thyroid disruptors than their predecessors, which is particularly concerning given increasing levels of exposure.

Potential health impacts of flame retardant chemicals are only beginning to be understood for ‘legacy flame retardant chemicals’ (i.e., polybrominated diphenyl ethers), and are largely unevaluated for newer-use chemicals. Cumulatively, current data suggest impact on thyroid regulation is likely, potentially implicating flame retardant chemicals in thyroid disease and cancers for which thyroid dysregulation impacts risk or prognosis.
Cutaneous Metastasis From Sacral Chordoma
Authors: Gleghorn Kristyna , Goodwin Brandon , Sanchez Ramon
Published: October 2016

Chordoma is a rare primary bone malignancy of notochord origin, representing 1-4% of malignant bone tumors.
1,2
Typically, chordomas follow a slow progressive course with aggressive local extension, multiple recurrences, and metastases.
1
Of particular interest to this case, cutaneous metastasis is exceedingly rare. Diagnosis of this entity can be a challenge due to the rarity of chordoma, as well as the infrequent presentation of distant cutaneous metastasis and non-specific clinical skin findings. We report a case of a 61-year-old male with a history of sacral chordoma treated by wide local excision 8 years prior to presentation developed a nodule on his scalp for 6 weeks. Physical examination revealed a 1 cm rubbery, pink, shiny dome-shaped nodule on his left occipital scalp. Hematoxylin and eosin sections revealed a lobular dermal proliferation of small ovoid cells and larger physaliferous cells with hyperchromatic, displaced nuclei and finely vacuolated “soap-bubble” cytoplasm in a myxoid stroma. Immunohistochemistry of tumor cells showed positivity for both S-100 protein and pancytokeratin (AE1/AE3), while smooth muscle actin (SMA), P63, and CK7 were negative. Additionally, tumor cells stained positive for brachyury. The medical history, clinical presentation, histopathological appearance and immunohistochemical profile are consistent with cutaneous metastasis from sacral chordoma, known as chordoma cutis. This case illustrates the integral role of dermatopathology in the diagnosis of a rare and critical condition.
Cardiac Rehabilitation After Heart Valve Surgery
Authors: Pollmann Agathe Gerwina Elena , Frederiksen Marianne , Prescott Eva
Published: October 2016

PURPOSE:

Evidence of the effect of cardiac rehabilitation (CR) after heart valve surgery is scarce, but nevertheless CR is recommended for this group of patients. Therefore, this study assessed the effect of CR on exercise capacity, cardiovascular risk factors, and long-term mortality and morbidity, as well as predictors for enrolment in or failing to complete CR.

METHODS:

A review of medical records identified 250 patients who underwent heart valve surgery between January 2009 and August 2013. Of these, 211 patients eligible for CR were identified. Effect of CR was assessed by peak oxygen uptake (

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peak) or 6-minute walk test (6MWT). A composite endpoint of all-cause mortality and hospital admission due to myocardial infarction, stroke, heart failure, endocarditis, revascularization, or reoperation was used to assess the hazard ratio between CR attenders and nonattenders. Multivariable logistic regression was used to find predictors for CR attendance and CR completion.

RESULTS:

A total of 146 patients completed CR.

JOURNAL/jcprh/04.03/01273116-201705000-00005/5FSM1/v/2023-09-11T232158Z/r/image-gif

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peak improved by 16% from 21.6 to 24.8 mL/kg/min (P < .0001) and 6MWT distance by 13% from 349 to 393 m (P = .0016). Rate of clinical events was higher among nonattenders with an adjusted hazard ratio of 2.46 (95% CI, 1.26-4.80). Age >75 years was predictive for not attending (adjusted OR, 2.99; 95% CI, .37-6.53), whereas ethnic minorities were less likely to complete CR (adjusted OR, 4.88; 95% CI, 1.58-15.06).

CONCLUSIONS:

CR after heart valve surgery improved exercise capacity and was associated with reduced morbidity. Elderly and ethnic minorities were less likely to attend or complete CR and deserve special attention.
Exercise Training Workloads Upon Exit From Cardiac Rehabilitation in Men and Women
Authors: Keteyian Steven J. , Kerrigan Dennis J. , Ehrman Jonathan K. , Brawner Clinton A.
Published: October 2016

Purpose:

To describe exercise training workloads, estimated as metabolic equivalents of task (METs) both upon exit from cardiac rehabilitation (CR) and as the change in MET level following CR, stratified by age, sex, initial MET level, number of sessions completed, and qualifying event at entry into CR.

Methods:

A retrospective study involving 8319 (31% female) patients who completed ≥9 exercise training sessions in the early outpatient CR program at Henry Ford Hospital. Exercise training MET levels achieved during CR were estimated on the basis of the speed and grade recorded from a treadmill. Exercise training METs at the start of CR were defined as the average of the second and third sessions, whereas MET level upon exit from CR was determined from the average of the last 2 patient encounters.

Results:

The overall mean MET level while training just prior to exit from CR was 3.9 ± 1.4 (4.1 ± 1.4 and 3.3 ± 1.0 in men and women, respectively). The mean change in METs after CR was 1.3 ± 1.1 (+45% ± 37%) and 0.9 ± 0.7 (+40% ± 32%) in men and women, respectively.

Conclusions:

In a large and demographically diverse cohort of patients who participated in CR, increases in mean workload (ie, METs) during exercise training were observed that approximated 45% in men and 40% in women. These data could be considered when establishing benchmarks for program-related performance outcome measures.
Measurement of Functional Capacity Requirements of Farmers
Authors: Jordan Shannon , Karcher Justin , Rogers Rebecca , Kennedy Kathleen , Lawrence Anne , Adams Jenny
Published: October 2016

PURPOSE:

Updated cardiac rehabilitation (CR) and return-to-work guidelines from the American College of Sports Medicine (ACSM) now include specificity of training for industrial athletes (exercise training that involves the muscle groups, movements, and energy systems that these patients use during occupational tasks). However, many CR facilities do not apply this principle, relying instead on the traditional protocol that consists primarily of aerobic exercise. This study was conducted to measure the metabolic cost of typical farming tasks and to compare 2 methods of calculating training intensities.

METHODS:

Metabolic data were collected from 28 participants (23 men and 5 women, aged 18 to 57 years) while they loaded 10 hay bales, dug a fence posthole, filled 8 seed hoppers, and shoveled grain.

RESULTS:

Mean metabolic equivalent levels during these activities were 5.9 to 7.6 and participants reached 60% to 70% of heart rate reserve (HRR). By comparison, their mean resting heart rate + 30 beats per minute (RHR+30, a traditional CR intensity level) represented only 28% of HRR.

CONCLUSIONS:

Participants in the current study performed farming tasks within the ACSM's recommended range of 40% to 80% of HRR, and the results suggest that training at RHR+30 would have been inadequate for helping a farmer return to work after a cardiac event. Using the study tasks as a basis, we described exercises that would be appropriate for the supervised resistance training of farmers in a CR setting.
The protective role of self-efficacy against workplace incivility and burnout in nursing
Authors: Fida Roberta , Laschinger Heather K. Spence , Leiter Michael P.
Published: October 2016

Background:

Incivility has negative consequences in the workplace and remains a prevalent issue in nursing. Research has consistently linked incivility to nurse burnout and, in turn, to poor mental health and turnover intentions. To retain high-quality nurses, it is important to understand what factors might protect nurses from the negative effects of workplace mistreatment.

Purpose:

The aim of the study was to investigate the role of relational occupational coping self-efficacy in protecting nurses from workplace incivility and related burnout and turnover intentions.

Methodology:

A two-wave national sample of 596 Canadian nurses completed mail surveys both at Time 1 and one year later at Time 2. Structural equation modeling was used to test the hypothesized model.

Results:

The model showed a good fit, and most of the hypothesized paths were significant. Overall, the results supported the hypothesized protective effect of relational occupational coping self-efficacy against incivility and later burnout, mental health, and turnover intentions.

Conclusion:

Relational occupational coping self-efficacy is an important protective factor against negative work behavior.

Practice Implications:

Organizations should provide nurses with opportunities to build their coping strategies for managing job demands and difficult interpersonal interactions. Similarly, providing exposure to effective role models and providing meaningful verbal encouragement are other sources of efficacy information for building nurses’ relational coping self-efficacy.
Leadership development programs for health care middle managers: An exploration of the top management team member perspective
Authors: Whaley Alan , Gillis William E.
Published: October 2016

Background:

Hospitals throughout the United States establish leadership and management programs for their middle managers. Despite their pervasiveness and an increased emphasis on physician leadership, there is limited research regarding the development programs designed for clinical and nonclinical health care middle managers.

Purpose:

Using two theoretical lenses, signaling and institutional theory, this exploratory study investigates mid-sized hospital development programs from the perspective of top management team (TMT) members. Our objective is to find out what types of programs hospitals have, how they are developed, and how they are evaluated.

Methodology/Approach:

We conducted semistructured interviews with 13 TMT members in six purposefully selected hospitals and matched these interviews with program curricula. Careful coding of the data allowed us not only to show our data in a meaningful visual representation but also to show the progression of the data from raw form to aggregate themes in the qualitative research process.

Findings:

We identified four types of development programs used in the selected hospitals: (a) ongoing series, (b) curriculum-based, (c) management orientation, and (d) mentoring. Challenges existed in aligning the need for the program with program content. Communication occurred both through direct messaging regarding policies and procedures and through hidden signals. TMT members referenced other programs for guidance but were not always clear about what it is they wanted the programs to accomplish. Finally, there was limited program outcome measurement.

Practice Implications:

Our small sample indicates that specific, structured, and comprehensive programs perform best. The better programs were always trying to improve but that most needed better accountability of tracking outcomes. In setting up a program, a collaborative approach among TMT members to establish what the needs are and how to measure outcomes worked well. Successful programs also tied in their leadership development with overall employee development.
Epidemiology and Outcome of Microbial Keratitis: Private University Versus Urban Public Hospital Care
Authors: Truong David T. , Bui Minh-Thuy , Cavanagh H. Dwight
Published: October 2016

Purpose:

To review the epidemiology, risk factors, microbiologic spectrum, and treatment of microbial keratitis during a 5-year period at an urban public hospital in comparison with an adjacent private university practice.

Methods:

Retrospective chart review in the 5-year interval, 2009 through 2014. Primary outcome measures included patient age at presentation, best-corrected visual acuity (BCVA), risk factors, culture and sensitivities, treatment, and complication occurrence.

Results:

A total of 528 eyes with microbial keratitis were identified, 318 in the public cohort and 210 in the private cohort. Contact lens wear was the most common risk factor in the public cohort, whereas ocular surface disease was the most common risk factor in the private cohort. Gram-positive organisms represented 47.3%, gram-negative organisms 32.1%, fungal organisms 13.6%, and Acanthamoeba 6.4% of corneal isolates. Gentamicin resistance was 4.4% and tobramycin resistance was 2.9%. The inpatient treatment rate of the public cohort was 40% compared with 4% in the private cohort. In the public cohort, average BCVA at resolution was 20/82 (log of minimal angle of resolution [logMAR] 0.61). For the private cohort, average BCVA at resolution was 20/73 [logMAR, 0.56]. The perforation rate was 8% in the public cohort compared with 4% in the private cohort. Six percent of cases underwent urgent penetrating keratoplasty in the public cohort versus 2% in the private cohort.

Conclusions:

Microbial keratitis remains a clinical challenge in the urban public hospital setting. The risk profile of patients presenting in the public hospital setting may be different from patients presenting in a private care setting. Public hospital patients may present later in the course of their infection and thus have a higher rate of complications regardless of effective antimicrobial therapy.