bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive modeling in urgent care: a comparative study of machine learning approaches
Authors: Tang Fengyi , Xiao Cao , Wang Fei , Zhou Jiayu
Published: June 2018

Objective

The growing availability of rich clinical data such as patients’ electronic health records provide great opportunities to address a broad range of real-world questions in medicine. At the same time, artificial intelligence and machine learning (ML)-based approaches have shown great premise on extracting insights from those data and helping with various clinical problems. The goal of this study is to conduct a systematic comparative study of different ML algorithms for several predictive modeling problems in urgent care.

Design

We assess the performance of 4 benchmark prediction tasks (eg mortality and prediction, differential diagnostics, and disease marker discovery) using medical histories, physiological time-series, and demographics data from the Medical Information Mart for Intensive Care (MIMIC-III) database.

Measurements

For each given task, performance was estimated using standard measures including the area under the receiver operating characteristic (AUC) curve, F-1 score, sensitivity, and specificity. Microaveraged AUC was used for multiclass classification models.

Results and Discussion

Our results suggest that recurrent neural networks show the most promise in mortality prediction where temporal patterns in physiologic features alone can capture in-hospital mortality risk (AUC > 0.90). Temporal models did not provide additional benefit compared to deep models in differential diagnostics. When comparing the training–testing behaviors of readmission and mortality models, we illustrate that readmission risk may be independent of patient stability at discharge. We also introduce a multiclass prediction scheme for length of stay which preserves sensitivity and AUC with outliers of increasing duration despite decrease in sample size.
Origin of the low-temperature plasma in the Galactic center X-ray emission
Authors: Yamauchi Shigeo , Shimizu Miku , Nobukawa Masayoshi , Nobukawa Kumiko K , Uchiyama Hideki , Koyama Katsuji
Published: June 2018

The Galactic Center X-ray emission (GCXE) is composed of high-temperature (∼7 keV) and low-temperature (∼1 keV) plasmas (HTP and LTP, respectively). The global structure of the HTP is roughly uniform over the Galactic Center (GC) region, and the origin of the HTP has been extensively studied. On the other hand, the LTP is more clumpy, and its origin has not been studied in detail. In the S xv Heα line map, a pair of horn-like soft diffuse sources are seen at symmetric positions with respect to Sagittarius A⋆. The X-ray spectra of the pair are well represented by an absorbed thin thermal plasma model of temperature and NH of 0.6–0.7 keV and 4 × 1022 cm−2, respectively. The NH values indicate that the pair are located near the GC. Then the dynamical time scales of the pair are ∼105 yr. The Si and S abundances and the surface brightnesses in the S xv Heα line band are 0.7–1.2 and 0.6–1.3 solar, and (2.0–2.4) × 10−15 erg s−1 cm−2 arcmin−2, respectively. The temperature, abundances, and surface brightness are similar to those of the LTP in the GCXE, while the abundances are far larger than those of known point sources, typically coronal active stars and RS CVn-type active binaries. Based on these results, the possible origin of the LTP is discussed.
Physical activity accrued as part of public transport use in England
Authors: Patterson R , Webb E , Millett C , Laverty A A
Published: May 2018

Background

Walking and cycling for transport (active travel) is an important source of physical activity with established health benefits. However, levels of physical activity accrued during public transport journeys in England are unknown.

Methods

Using the English National Travel Survey 2010–14 we quantified active travel as part of public transport journeys. Linear regression models compared levels of physical activity across public transport modes, and logistic regression models compared the odds of undertaking 30 min a day of physical activity.

Results

Public transport users accumulated 20.5 min (95% confidence interval=19.8, 21.2) a day of physical activity as part of public transport journeys. Train users accumulated 28.1 min (26.3, 30.0) with bus users 16.0 min (15.3, 16.8). Overall, 34% (32%, 36%) of public transport users achieved 30 min a day of physical activity in the course of their journeys; 21% (19%, 24%) of bus users and 52% (47%, 56%) of train users.

Conclusion

Public transport use is an effective way to incorporate physical activity into daily life. One in three public transport users meet physical activity guidelines suggesting that shifts from sedentary travel modes to public transport could dramatically raise the proportion of populations achieving recommended levels of physical activity.
The role of SGLT2 inhibitors in managing type 2 diabetes
Authors: Tat Velen , Forest Christopher P.
Published: May 2018

The sodium glucose cotransporter 2 (SGLT2) inhibitors canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin represent a novel class of medications to manage type 2 diabetes through urinary excretion of glucose. These drugs block glucose reabsorption by the kidneys to increase glucosuria. These drugs provide hemoglobin A1C reduction, promote weight loss, and remain hypoglycemic-neutral when not used in combination with insulin or secretagogues. Canagliflozin and empagliflozin have shown cardiovascular benefit. The potential to reduce the risk of cardiovascular death in patients with type 2 diabetes, along with the benefit of weight reduction, makes these new agents useful tools for the primary care provider.
A Nurse-Led Mobility Program on an Acute Rehabilitation Unit
Authors: Anton Paula , Richard Christy
Published: May 2018

Rehabilitation assists patients with return to baseline activities of daily living after catastrophic events or long hospitalizations. In an effort to increase mobility episodes in the rehabilitation patient, a nurse-led mobility program was suggested. This allows the rehabilitation nurse to participate in the improvement of mobility for rehabilitation patients by mobilizing the patients safely during hours in which physical therapy is not available. The purpose of this project was twofold: (1) Can additional mobility episodes improve outcomes in the rehabilitation patient? (2) How can safe patient handling principles be applied to the rehabilitation patient?
Instituting a Standardized Mobility Aid in the Cardiovascular Intensive Care Unit
Authors: Freeman Regi , Koerner Erika
Published: May 2018

The complexity of ambulation increases when patients are challenged with acute illness in the cardiovascular intensive care unit (CVICU). The difficulties in this setting entailed limited ancillary assistance, proper equipment, and complex medical devices. It was imperative that mobility was made a priority in the CVICU despite multiple barriers. To improve mobility functionality, mobility aids were obtained. To evaluate the effectiveness of the mobility aids, data were collected, including staff surveys, time studies, and chart audits. The outcomes from implementing the mobility aids revealed a reduction in the number of staff required to ambulate medically complex patients from an average of 2.3 to 1.9 staff members and in medically noncomplex patients remained unchanged from 1.4 to 1.6 staff members. Preparation time for ambulation was reduced from 12.8 to 8.3 minutes on average for medically noncomplex patients and from 14 to 9.7 minutes for the medically complex patients. Ambulation sessions for medically noncomplex patients increased on average from 1.5 to 2.8 sessions per day and for medically complex patients decreased from 1.2 to 0.5 sessions per day. Overall, clinically significant improvements were noted with both preparation time for ambulation and the number of mobility sessions that support the use of a standardized mobility aid.
Sex still matters: has the prevalence of male-only studies of drug effects on rodent behaviour changed during the past decade?
Authors: Hughes Robert N.
Published: May 2018

During the past 10 years, for a number of biomedical disciplines, including behavioural pharmacology, there have been appeals to include both sexes in animal studies of processes that are not sex specific. In 2007, a survey of experimental studies of drug or other chemical effects on rodent behaviour, published in five prominent journals over 20 months (February 2005 to September 2006, inclusive), revealed that 85% of these conducted with rats and 78% of these conducted with mice involved males only. This was in spite of the evidence of sex differences in responsiveness to an increasing number of compounds. To see if the situation has improved, the survey was repeated with the same journals for a comparable period namely, February 2016 to September 2017 (inclusive). Even though there have been repeated appeals for biomedical research that is not sex specific to involve both sexes, it was apparent that little has changed since 2005–2006, as 82% of rat and 75% of mouse studies were again conducted with males only. However, there was an increase in studies with mice, which may be owing to a greater interest in genetic factors. The male-only situation could be rectified by appropriate funding agencies and journals that publish behavioural pharmacological research insisting that both sexes must be included in research that is not sex specific along with valid scientific justification for single-sex studies, as now typifies some other disciplines.
TOPICAL DORZOLAMIDE–TIMOLOL WITH INTRAVITREOUS ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR FOR RETINAL VEIN OCCLUSION: A PILOT STUDY
Authors: Obeid Anthony , Hsu Jason , Ehmann David , Gao Xinxiao , Sridhar Jayanth , Chiang Allen , Park Carl H. , Ho Allen C.
Published: June 2018

Purpose:

To evaluate topical dorzolamide hydrochloride–timolol maleate as an adjunct therapy to intravitreous anti–vascular endothelial growth factor injections in eyes with retinal vein occlusion resistant to treatment.

Methods:

Retinal vein occlusion patients with a history of persistent macular edema, despite fixed-interval intravitreous anti–vascular endothelial growth factor injections, were enrolled between April 4, 2016, and June 4, 2017. On enrollment, patients were instructed to administer one drop of topical dorzolamide–timolol twice daily for the duration of the study. They were maintained on the same anti–vascular endothelial growth factor drug and same interval between injections as preenrollment for the subsequent two visits. Primary outcome measures were change in central foveal thickness, central subfield thickness, and thickest macular cut at the final study visit.

Results:

Eight patients (8 eyes) were eligible for enrollment and completed the study. There was a significant decrease in central foveal thickness (P = 0.02), central subfield thickness (P = 0.03), and thickest macular cut (P = 0.01) between the enrollment visit and the final visit. There was a decrease in mean (±SD) logarithm of the minimal angle of resolution from 0.52 (±0.35) (20/66, Snellen equivalent) at the enrollment visit to 0.41 (±0.35) (20/51, Snellen equivalent) at the final visit (P = 0.08).

Conclusion:

Topical dorzolamide–timolol may have a beneficial anatomical and functional effect in eyes with macular edema secondary to retinal vein occlusion resistant to treatment.
Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies
Authors: Stockings Emily , Campbell Gabrielle , Hall Wayne D. , Nielsen Suzanne , Zagic Dino , Rahman Rakin , Murnion Bridin , Farrell Michael , Weier Megan , Degenhardt Louisa
Published: May 2018

This review examines evidence for the effectiveness of cannabinoids in chronic noncancer pain (CNCP) and addresses gaps in the literature by: considering differences in outcomes based on cannabinoid type and specific CNCP condition; including all study designs; and following IMMPACT guidelines. MEDLINE, Embase, PsycINFO, CENTRAL, and clinicaltrials.gov were searched in July 2017. Analyses were conducted using Revman 5.3 and Stata 15.0. A total of 91 publications containing 104 studies were eligible (n = 9958 participants), including 47 randomised controlled trials (RCTs) and 57 observational studies. Forty-eight studies examined neuropathic pain, 7 studies examined fibromyalgia, 1 rheumatoid arthritis, and 48 other CNCP (13 multiple sclerosis–related pain, 6 visceral pain, and 29 samples with mixed or undefined CNCP). Across RCTs, pooled event rates (PERs) for 30% reduction in pain were 29.0% (cannabinoids) vs 25.9% (placebo); significant effect for cannabinoids was found; number needed to treat to benefit was 24 (95% confidence interval [CI] 15-61); for 50% reduction in pain, PERs were 18.2% vs 14.4%; no significant difference was observed. Pooled change in pain intensity (standardised mean difference: −0.14, 95% CI −0.20 to −0.08) was equivalent to a 3 mm reduction on a 100 mm visual analogue scale greater than placebo groups. In RCTs, PERs for all-cause adverse events were 81.2% vs 66.2%; number needed to treat to harm: 6 (95% CI 5-8). There were no significant impacts on physical or emotional functioning, and low-quality evidence of improved sleep and patient global impression of change. Evidence for effectiveness of cannabinoids in CNCP is limited. Effects suggest that number needed to treat to benefit is high, and number needed to treat to harm is low, with limited impact on other domains. It seems unlikely that cannabinoids are highly effective medicines for CNCP.
Inhibition of the Ubc9 E2 SUMO-conjugating enzyme–CRMP2 interaction decreases NaV1.7 currents and reverses experimental neuropathic pain
Authors: François-Moutal Liberty , Dustrude Erik T. , Wang Yue , Brustovetsky Tatiana , Dorame Angie , Ju Weina , Moutal Aubin , Perez-Miller Samantha , Brustovetsky Nickolay , Gokhale Vijay , Khanna May , Khanna Rajesh
Published: May 2018

We previously reported that destruction of the small ubiquitin-like modifier (SUMO) modification site in the axonal collapsin response mediator protein 2 (CRMP2) was sufficient to selectively decrease trafficking of the voltage-gated sodium channel NaV1.7 and reverse neuropathic pain. Here, we further interrogate the biophysical nature of the interaction between CRMP2 and the SUMOylation machinery, and test the hypothesis that a rationally designed CRMP2 SUMOylation motif (CSM) peptide can interrupt E2 SUMO-conjugating enzyme Ubc9-dependent modification of CRMP2 leading to a similar suppression of NaV1.7 currents. Microscale thermophoresis and amplified luminescent proximity homogeneous alpha assay revealed a low micromolar binding affinity between CRMP2 and Ubc9. A heptamer peptide harboring CRMP2's SUMO motif, also bound with similar affinity to Ubc9, disrupted the CRMP2–Ubc9 interaction in a concentration-dependent manner. Importantly, incubation of a tat-conjugated cell-penetrating peptide (t-CSM) decreased sodium currents, predominantly NaV1.7, in a model neuronal cell line. Dialysis of t-CSM peptide reduced CRMP2 SUMOylation and blocked surface trafficking of NaV1.7 in rat sensory neurons. Fluorescence dye-based imaging in rat sensory neurons demonstrated inhibition of sodium influx in the presence of t-CSM peptide; by contrast, calcium influx was unaffected. Finally, t-CSM effectively reversed persistent mechanical and thermal hypersensitivity induced by a spinal nerve injury, a model of neuropathic pain. Structural modeling has now identified a pocket-harboring CRMP2's SUMOylation motif that, when targeted through computational screening of ligands/molecules, is expected to identify small molecules that will biochemically and functionally target CRMP2's SUMOylation to reduce NaV1.7 currents and reverse neuropathic pain.
A Multipronged Initiative to Improve Productivity and Patient Access in a Federally Qualified Health Center Network
Authors: Cruz Heriberto “Eddie” , Gawrys Janie , Thompson Donna , Mejia Jairo , Rosul Linda , Lazar Danielle
Published: May 2018

In 2012, Access Community Health Network, a Federally Qualified Health Center (FQHC) network with 36 health centers serving the greater Chicago area, embarked on a 3-year initiative to improve patient access. “Dramatic Performance Improvement” (DPITM) included the adoption of modified open access scheduling and practice changes designed to improve capacity and the ability to balance supply and demand. This article describes DPITM implementation, strategies, and associated outcomes, including a 20% decrease in no-show rate, a 33% drop in time to the third next available appointment (TNAA), a 37% decrease in cycle time, and a 13% increase in patient satisfaction.
“Practice What You Teach” Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe): Program Evaluation
Authors: Hasson Ronnie , Stark Aliza H. , Constantini Naama , Polak Rani , Verbov Gina , Edelstein Naomi , Lachmi Michel , Cohen Rivka , Maoz Shuli , Daoud Nihaya , Soltz-Aharony Hannah , Stein-Zamir Chen
Published: May 2018

Healthy lifestyle programs are essential for meeting the challenge of noncommunicable diseases. The Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe) program engaged nurses from family health clinics in Jerusalem District and included physical activity, healthy nutrition, and motivational skills. Questionnaires were completed at baseline, postintervention, and at 18 months. Results showed a marked effect on health practices. The proportion of nurses consuming a balanced diet and the use of food labels significantly increased and were maintained over time. Short-term improvements in physical activity were also observed. Nurses who practiced a healthy lifestyle were significantly more likely to provide guidance and counseling to families on healthy behaviors.
Is Alcohol Use Associated With Increased Risk of Developing Adverse Health Outcomes Among Adults Living With Human Immunodeficiency Virus
Authors: Ge Song , Sanchez Michael , Nolan Marie , Liu Tingting , Savage Christine L.
Published: June 2018

Background:

Alcohol use is associated with many HIV-related behaviors that are associated with increased risk of reinfection, transmission, and poorer health outcomes in people living with HIV (PLHIV). The population of middle-aged and older PLHIV is growing because of increased life longevity and aging trend.

Methods:

A systematic review across three databases was conducted to evaluate existing studies that examined the association between alcohol use and medication adherence, high-risk sex behaviors, HIV progression, depression, resource utilization, and survival among studies of PLHIV with an average age of 40 years and above.

Results:

Among the 47 included studies, most found a positive association between alcohol use and depression, risky sex behaviors, medication nonadherence, and healthcare resource utilization among PLHIV. The association between alcohol use and response to treatment was variable. The association between alcohol use and survival warrants further study because of lack of existing studies.

Conclusions:

The results of this review support that alcohol use negatively impacts middle-aged and older PLHIV in many aspects; however, there is lack of studies exclusively targeting older PLHIV, and more relevant studies in the future are needed.
The Effect of Work Addiction on Korean Nurses’ Professional Quality of Life
Authors: Kwak Yeunhee , Kim Ji-Su , Han Yonghee , Seo Yeji
Published: June 2018

This study sought to delineate the relations between work addiction and professional quality of life among nurses in university hospitals. The differences between compassion satisfaction, burnout, and secondary traumatic stress by work addiction tendency were investigated among 278 Korean nurses. Results revealed that 46.5% of participating nurses had mild or high work addiction, and nurses with high work addiction tended to have higher burnout and secondary traumatic stress. Factors influencing burnout were work addiction and daily work hours. Only work addiction influenced secondary traumatic stress. Therefore, concern, understanding, and prevention of nurses’ work addiction are needed, as work addiction could affect nurses’ professional quality of life.
Acute Variceal Bleeding Causes Significant Morbidity
Authors: Carneiro de Moura Marta , Chen Shiyi , Kamath Binita M. , Ng Vicky L. , Ling Simon C.
Published: May 2018

Background and Aims:

The need for primary prophylaxis of variceal bleeding in children is unclear due to insufficient evidence of the efficacy of prophylactic therapy and the mortality and morbidity associated with the first bleeding event. Previous studies have provided estimates of mortality. We aimed to investigate the morbidity associated with acute variceal bleeding (AVB) in children and to identify contributing factors.

Methods:

We retrospectively reviewed children with chronic liver disease or portal vein thrombosis admitted with acute upper gastrointestinal bleeding between 2000 and 2015.

Results:

Seventy AVB episodes in 57 children (median age 6 years, 52% girls) were included, 58% with cirrhosis and 30% portal vein thrombosis. Approximately 67% were the patient's first bleed. Post‐AVB morbidity was present in 57% of all episodes and in 64% of first bleeds and included: ascites (34%), infection (30%), respiratory complications (24%), intensive care unit admission (20%), rebleed (11%), encephalopathy (7%), acute kidney injury (6%), and failure to control bleed (4%). Two patients died (4% of first bleeds, 8% of cirrhotics’ first bleeds) within 6 weeks of bleeding. Median length of stay was 7 days. Overall morbidity was associated with total bilirubin (P = 0.001). Ascites after AVB was associated with pediatric end‐stage liver disease (P = 0.0007), total bilirubin (P = 0.001), and cirrhosis (P = 0.006). Median length of stay was longer in patients with morbidities (18 vs 4 days, P < 0.0001).

Conclusion:

Children with AVB suffer significant morbidity but have a low risk of death. Morbidity should therefore be considered in future studies measuring the risks and benefits of primary prophylaxis of first AVB in children.
Evolving Trends of Gastrostomy Insertion Within a Pediatric Population
Authors: Glasson Emma J. , Wong Kingsley , Leonard Helen , Forbes David , Ravikumara Madhur , Mews Catherine , Jacoby Peter , Bourke Jenny , Trollor Julian , Srasuebkul Preeyaporn , Wilson Andrew , Nagarajan Lakshmi , Downs Jenny
Published: May 2018

Objective:

Gastrostomy insertion in pediatrics is usually used in children with complex needs and severe disability. The accessibility and acceptance of the procedure is increasing but population‐based occurrence data are lacking and there is limited understanding of its use in clinical subgroups.

Methods:

This birth cohort study investigated the trends in first gastrostomy insertion among a pediatric population born between 1983 and 2009 in Western Australia using linked administrative and health data collected over a 32‐year period (1983–2014). Indications were identified using diagnosis codes from linked hospitalization data and grouped according to a refined classification system. Age and birth cohort patterns of first gastrostomy use, over calendar year and age respectively, were described.

Results:

Of the 690,688 children born between 1983 and 2009, 466 underwent a gastrostomy insertion. Overall, the prevalence was approximately 7 cases per 10,000 births. New gastrostomy insertions were increasingly performed in children during the preschool years over calendar years and in successive birth cohorts. Children with a neurological disorder constituted the largest group receiving gastrostomy (n = 372; 79.8) including 325 (87.4%) with comorbid intellectual disability.

Conclusions:

New gastrostomy insertion among children who require long‐term enteral feeding support increased over the study period. The procedure is most often performed in the context of severe neurological disability, including intellectual disability, and offers families potential for long‐term home‐based management of feeding difficulties.
Acquired Cystic Disease-associated Renal Cell Carcinoma (ACD-RCC)
Authors: Przybycin Christopher G. , Harper Holly L. , Reynolds Jordan P. , Magi-Galluzzi Cristina , Nguyen Jane K. , Wu Angela , Sangoi Ankur R. , Liu Peter S. , Umar Saleem , Mehra Rohit , Zhang Xiaochun , Cox Roni M. , McKenney Jesse K.
Published: May 2018

The incidence of renal cell carcinoma (RCC) is known to be higher in patients with end-stage renal disease, including those with acquired cystic kidney disease due to dialysis. Acquired cystic disease (ACD)-associated RCC was recently incorporated into the 2016 WHO Classification of Tumors of the Urinary System and Male Genital Tract as a distinct entity and is reportedly the most common RCC arising in end-stage renal disease. In this study, we sought to further describe clinicopathologic findings in a large series of ACD-RCC, emphasizing histologic features, immunophenotype, clinical outcome, and patterns of disease spread. We collected 40 previously unpublished cases of ACD-RCC with mean clinical follow-up of 27 months (median, 19 mo; range, 1 to 126 mo). Mean tumor size was 2.7 cm (median, 2.4 cm), and 32 tumors (80%) were confined to the kidney (pT stage less than pT3a). International Society of Urological Pathology grade was 3 in 37 cases (92.5%), grade 2 in 1 case (2.5%), and grade 4 in 2 cases (5%). Architectural variability among ACD-RCC was common, as 39 cases (98%) showed varying combinations of tubular, cystic, solid, and/or papillary growth. ACD-RCC frequently occurred in association with other renal tumor subtypes within the same kidney, including papillary RCC (14 patients), papillary adenomas (7 cases), clear cell papillary RCC (5 cases), clear cell RCC (1 case), and RCC, unclassified type (1 case). A previously undescribed pattern of perinephric and renal sinus adipose tissue involvement by dilated epithelial cysts with minimal or absent intervening capsule or renal parenchyma was identified in 20 cases (50%); these cysts were part of the tumor itself in 5 cases (25%) and were part of the non-neoplastic acquired cystic change in the background kidney in the remaining 15 cases (75%). Of the 24 cases (60%) with tissue available for immunohistochemical stains, 19 (79%) were positive for PAX8, 20 (83%) showed negative to patchy expression of cytokeratin 7, and 24 (100%) were both positive for AMACR and negative for CD117. Fumarate hydratase expression was retained in all tumors, including those with nuclear features resembling fumarate hydratase-deficient RCCs. Of the 36 patients (90%) with available follow-up information, 4 (11%) experienced adverse events: 2 patients developed a local recurrence, 1 patient experienced multiple visceral metastases and subsequently died of disease, and 1 patient developed metastases to regional lymph nodes only. One local recurrence and the lymph node only metastasis both had an unusual, exclusively cystic pattern of growth. In summary, we present the largest clinicopathologic series of ACD-RCC to date and describe previously unreported cystic patterns of local soft tissue involvement and recurrence/metastases.
Exploring the Association of Hypertension With Risk for Depression: Evidence for Tamed Neurobehavioral Arousal Versus Central Emotional Dysregulation
Authors: Herrmann-Lingen Christoph , al'Absi Mustafa
Published: May 2018

Depression is an established predictor of adverse cardiovascular disease outcomes. Less is known about cardiovascular risk factors as predictors of depression. In this issue of Psychosomatic Medicine (2018;80:508–514), Patel et al. report data indicating that pre-existing hypertension may be inversely associated with the atypical but not typical form of depression. We highlight here the strengths and limitations of the article and discuss the findings in light of research linking blood pressure and emotion regulation. In general, evidence suggests that higher blood pressure is associated with reduced expression of negative emotions and pain. Two prominent models of interaction have been proposed and supported by epidemiological and experimental research: one assumes that elevations in blood pressure lead to reduced arousal and pain sensitivity through baroreceptor activation and possibly additional afferent mechanisms. Operant conditioning may then result in (chronic) hypertension. The other one posits that impaired emotion processing as indicated by dampened emotion recognition may lead to disinhibition of hypothalamic centers and thereby result in sustained increases in blood pressure. These models are described in context of the current literature and open research questions are formulated.
Magnetic Resonance Imaging–Based Grading of Cartilaginous Bone Tumors
Authors: Fritz Benjamin , Müller Daniel A. , Sutter Reto , Wurnig Moritz C. , Wagner Matthias W. , Pfirrmann Christian W.A. , Fischer Michael A.
Published: May 2018

Objectives

The aim of this study was to assess the interreader agreement and diagnostic accuracy of morphologic magnetic resonance imaging (MRI) analysis and quantitative MRI-based texture analysis (TA) for grading of cartilaginous bone tumors.

Materials and Methods

This retrospective study was approved by our local ethics committee. Magnetic resonance imaging scans of 116 cartilaginous bone neoplasms were included (53 chondromas, 26 low-grade chondrosarcomas, 37 high-grade chondrosarcomas). Two musculoskeletal radiologists blinded to patient data separately analyzed 14 morphologic MRI features consisting of tumor and peritumoral characteristics. In addition, 2 different musculoskeletal radiologists separately performed TA including 19 quantitative TA parameters in a similar fashion. Interreader reliability, univariate, multivariate, and receiver operating characteristics analyses were performed for MRI and TA parameters separately and for combined models to determine independent predictors and diagnostic accuracy for grading of cartilaginous neoplasms. P values of 0.05 and less were considered statistically significant.

Results

Between both readers, MRI and TA features showed a mean kappa value of 0.49 (range, 0.08–0.82) and a mean intraclass correlation coefficient of 0.79 (range, 0.43–0.99), respectively. Independent morphological MRI predictors for grading of cartilaginous neoplasms were bone marrow edema, soft tissue mass, maximum tumor extent, and active periostitis, whereas TA predictors consisted of short-run high gray-level emphasis, skewness, and gray-level and run-length nonuniformity. Diagnostic accuracies for differentiation of benign from malignant as well as for benign from low-grade cartilaginous lesions were 87.0% and 77.4% using MRI predictors exclusively, 89.8% and 89.5% using TA predictors exclusively, and 92.9% and 91.2% using a combined model of MRI and TA predictors, respectively. For differentiation of low-grade from high-grade chondrosarcoma, no statistically significant independent TA predictors existed, whereas a model containing MRI predictors exclusively had a diagnostic accuracy of 84.8%.

Conclusions

Texture analysis improves diagnostic accuracy for differentiation of benign and malignant as well as for benign and low-grade cartilaginous lesions when compared with morphologic MRI analysis.
Quality of Life of Caregivers of Individuals With Parkinson’s Disease
Authors: Lee JuHee , Kim Sung Hae , Kim Yonji , Kim Yie Lin , Sohn Youngho
Published: June 2018

Purpose

This study aimed to construct a structural equation model to predict the quality of life of caregivers of individuals with Parkinson’s disease.

Design

A cross-sectional survey using a structured questionnaire in South Korea.

Methods

A total of 208 subjects participated in this study from August 31 to November 26, 2015. The questionnaire included caregiving appraisal, social support, educational program needs, and the Parkinson’s Disease Questionnaire-Carer.

Findings

Participants were either spouses (46.2%) or adult children (45.2%) of individuals with Parkinson’s disease. The mean score obtained on the caregiver’s quality of life was 40.94 ± 25.30. Social support, caregiving appraisal, and educational program needs were the predictors, explaining 67.0% of the variance in caregivers’ quality of life.

Conclusions

Predicting the quality of life is useful for the development of support resources for caregivers of individuals with Parkinson’s disease. Further studies exploring the multidimensional aspects of caregivers’ quality of life are needed.

Clinical Relevance

Rehabilitation nurses should identify caregivers at high risk in order to improve their quality of life. Nurses should assess education program needs and caregiving appraisal of caregivers of individuals with Parkinson’s disease and develop a customized intervention program.
Effects of Craniofacial Morphology on Nasal Respiratory Function and Upper Airway Morphology
Authors: Gong Xu , Li Weiran , Gao Xuemei
Published: May 2018

Background:

Craniofacial skeletal patterns change after orthognathic surgery. The present study aimed to investigate the effects of different craniofacial patterns on nasal respiratory function and the upper airway.

Methods:

Forty-seven healthy subjects were selected and divided into 3 groups according to their mandibular position. Sixteen were in the skeletal Class I group, 15 were in the skeletal Class II group, and 16 were in the skeletal Class III group. Cone beam computed tomography was performed, and nasal airflow and nasal resistance were measured. Differences in nasal respiratory functions and upper airway were compared among the groups. A correlation analysis was conducted for nasal respiratory function, upper airway, and skeletal patterns.

Results:

There were significant differences among the 3 groups regarding dominant-side nasal inspiratory capacity (P = 0.001), bilateral nasal inspiratory capacity (P = 0.005), nasal partitioning ratio-inspiration (P = 0.007), and velopharyngeal minimum cross-sectional area (P = 0.029). The values were significantly higher for the skeletal Class III group than the skeletal Class I and II groups. A correlation analysis showed that the nasal partitioning ratio and nasal airway resistance were mostly negatively correlated with SNA, but the upper airway volume and cross-sectional area were positively correlated with SNB and negatively correlated with ANB. The dominant-side nasal expiratory capacity was mainly negatively correlated with the mean velopharyngeal cross-sectional area (r = −0.324, P = 0.026), mean glossopharyngeal cross-sectional area (Glosso-A mean) (r = −0.293, P = 0.046), and mean total airway cross-sectional area (Total-A mean) (r = −0.307, P = 0.036).

Conclusion:

Craniofacial skeletal morphology may affect nasal respiratory function and the upper airway.
Post-Neurosurgical Temporal Deformities: Various Techniques for Correction and Associated Complications
Authors: Santiago Gabriel F. , Terner Jordan , Wolff Amir , Teixeira Jeffrey , Brem Henry , Huang Judy , Gordon Chad R.
Published: May 2018

Introduction:

An irregular craniofacial contour along the temporal fossa, known commonly as "temporal hollowing deformity," (THD) can arise from multiple etiologies. In fact, up to half of all patients who undergo neurosurgical pterional dissections develop some form of temporal contour deformities. Unfortunately, temporal hollowing correction remains surgically challenging with many techniques resulting in high rates of failure and/or morbidity.

Methods:

Herein, we describe anatomy contributing to postsurgical temporal deformity as well as time-tested prevention and surgical correction techniques. In addition, a review of 25 articles summarizing various techniques and complication profiles associated with temporal hollowing correction are presented.

Results:

Complications included infection, implant malposition, revision surgery, pain, and implant removal because of implant-related complications Augmentation with either autologous fat or dermal filler is associated with the highest number of reported complications, including catastrophic events such as stroke, pulmonary embolism, and death. No such complications were reported with use of alloplastic material, use of autologous bone, or free tissue transfer. Furthermore, careful attention to adequate temporalis muscle resuspension and position remain paramount for stable restoration of craniofacial symmetry.

Conclusions:

Catastrophic complications were associated with injection augmentation of both fat and dermal filler in the temporal region. In contrast, use of alloplastic materials was not found to be associated with any catastrophic complications. As such, for the most severe cases of THD, we prefer to employ alloplastic reconstruction.
Lower extremity cooling reduces ischemia-reperfusion injury following Zone 3 REBOA in a porcine hemorrhage model
Authors: Simon Meryl A. , Tibbits Emily M. , Hoareau Guillaume L. , Davidson Anders J. , DeSoucy Erik S. , Faulconer E. Robert , Grayson J. Kevin , Neff Lucas P. , Johnson M. Austin , Williams Timothy K.
Published: May 2018

BACKGROUND

New strategies to mitigate ischemia during REBOA and to prolong its maximal duration are needed. We hypothesized that simple external cooling of the hind limbs would decrease ischemia-reperfusion injury following prolonged Zone 3 REBOA.

METHODS

Twelve swine were anesthetized, instrumented, splenectomized, and then underwent 15% total blood volume hemorrhage. Animals were randomized to hypothermia or control followed by 4 hours of Zone 3 REBOA, resuscitation with shed blood, and 3 hours of critical care. Physiologic parameters were continuously recorded, and laboratory specimens were obtained at regular intervals. Baseline and end-of-study muscle biopsies were obtained for histologic analysis.

RESULTS

There were no significant differences between groups at baseline or after hemorrhage. Maximum creatine kinase was significantly lower in the hypothermia group compared with the normothermia group (median [interquartile range] = 3,445 U/mL [3,380–4,402 U/mL] vs. 22,544 U/mL [17,030–24,981 U/mL]; p < 0.01). Maximum serum myoglobin was also significantly lower in the hypothermia group (1,792 ng/mL [1,250–3,668 ng/mL] vs. 21,186 ng/mL [14,181–24,779 ng/mL]; p < 0.01). Fascial compartment pressures were significantly lower during critical care in the hypothermia group (p = 0.03). No histologic differences were observed in hind limb skeletal muscle.

CONCLUSIONS

External cooling during prolonged Zone 3 REBOA decreased ischemic muscle injury and resulted in lower compartment pressures following reperfusion. Hypothermia may be a viable option to extend the tolerable duration of Zone 3 occlusion, beyond what is currently achievable. Future survival studies are required to assess functional outcomes.
A US military Role 2 forward surgical team database study of combat mortality in Afghanistan
Authors: Kotwal Russ S. , Staudt Amanda M. , Mazuchowski Edward L. , Gurney Jennifer M. , Shackelford Stacy A. , Butler Frank K. , Stockinger Zsolt T. , Holcomb John B. , Nessen Shawn C. , Mann-Salinas Elizabeth A.
Published: May 2018

BACKGROUND

Timely and optimal care can reduce mortality among critically injured combat casualties. US military Role 2 surgical teams were deployed to forward positions in Afghanistan on behalf of the battlefield trauma system. They received prehospital casualties, provided early damage control resuscitation and surgery, and rapidly transferred casualties to Role 3 hospitals for definitive care. A database was developed to capture Role 2 data.

METHODS

A retrospective review and descriptive analysis were conducted of battle-injured casualties transported to US Role 2 surgical facilities in Afghanistan from February 2008 to September 2014. Casualties were analyzed by mortality status and location of death (pretransport, intratransport, or posttransport), military affiliation, transport time, injury type and mechanism, combat mortality index–prehospital (CMI-PH), and documented prehospital treatment.

RESULTS

Of 9,557 casualties (median age, 25.0 years; male, 97.4%), most (95.1%) survived to transfer from Role 2 facility care. Military affiliation included US coalition forces (37.4%), Afghanistan National Security Forces (23.8%), civilian/other forces (21.3%), Afghanistan National Police (13.5%), and non-US coalition forces (4.0%). Mortality differed by military affiliation (p < 0.001). Among fatalities, most were Afghanistan National Security Forces (30.5%) civilian/other forces (26.0%), or US coalition forces (25.2%). Of those categorized by CMI-PH, 40.0% of critical, 11.2% of severe, 0.8% of moderate, and less than 0.1% of mild casualties died. Most fatalities with CMI-PH were categorized as critical (66.3%) or severe (25.9%), whereas most who lived were mild (56.9%) or moderate (25.4%). Of all fatalities, 14.0% died prehospital (pretransport, 5.8%; intratransport, 8.2%), and 86.0% died at a Role 2 facility (posttransport). Of fatalities with documented transport times (median, 53.0 minutes), most (61.7%) were evacuated within 60 minutes.

CONCLUSIONS

Role 2 surgical team care has been an important early component of the battlefield trauma system in Afghanistan. Combat casualty care must be documented, collected, and analyzed for outcomes and trends to improve performance.

LEVEL OF EVIDENCE

Therapeutic/Care Management, level IV.
Hereditary ataxias and paraparesias: clinical and genetic update
Authors: Parodi Livia , Coarelli Giulia , Stevanin Giovanni , Brice Alexis , Durr Alexandra
Published: May 2018

Purpose of review

This review aims at updating the clinical and genetic aspects of hereditary spastic paraplegias (HSPs) and hereditary cerebellar ataxias (HCAs), focusing on the concept of spastic-ataxia phenotypic spectrum and on newly identified clinical overlaps with other neurological and nonneurological diseases.

Recent findings

Next-generation sequencing (NGS) has allowed the discovery of new genes involved in HSPs and HCAs. They include new HCAs genes such as GRM1 (SCA44), FAT2 (SCA45), PLD3 (SCA46), SCYL1 (SCAR21), UBA5 (SCAR24) and XRCC1 (SCAR26) as well as CAPN1 (SPG76) and CPT1C (SPG73) in HSPs. Furthermore, NGS allowed enriching known genes phenotype, reinforcing the overlap between HSPs and HCAs defining the spastic ataxia spectrum. Clear examples are the expanded phenotypes associated with mutations in SPG7, PNPLA6, GBA2, KIF1C, CYP7B1, FA2H, ATP13A2 and many others. Moreover, other genes not previously linked to HCAs and HSPs have been implicated in spastic or ataxic phenotypes.

The increase of HSPs and HCAs-related phenotypes and the continuous discovery of genes complicate clinical diagnostic in practice but, at the same time, it helps highlighting common pathological pathways, therefore opening new ways to the development of common therapeutic approaches.
Low incidence of plastic ingestion among three fish species significant for human consumption on the island of Newfoundland, Canada
Authors: Liboiron Max , Melvin Jessica , Richárd Natalie , Saturno Jacquelyn , Ammendolia Justine , Liboiron France , Charron Louis , Mather Charles
Published: May 2018

This study reports the first baselines of plastic ingestion for three fish species that are common food fish in Newfoundland, Canada. Species collections occurred between 2015-2016 for Atlantic cod (Gadus morhua), Atlantic salmon (Salmo salar), and capelin (Mallotus villosus). The frequency of occurrence (%FO) of plastic ingestion for both spawning Atlantic salmon (n=69) and capelin (n=350) was 0%. Of the 1,010 Atlantic cod collected over two years, 17 individuals had ingested plastics, a %FO of 1.68%. This is the only multi-year investigation of plastic ingestion in Atlantic cod for the Northwest Atlantic, and the first for capelin and salmon in the region. Considering the ecological, economic, and cultural importance of these fish species, this study is the beginning of a longitudinal study of plastic ingestion to detect future changes in contamination levels.

Highlights

Ingestion rate (%FO) of plastics in Atlantic cod is 1.68%

Ingestion rate (%FO) of plastics in Atlantic salmon and capelin is 0%

First study of plastic ingestion rates in Atlantic salmon and capelin

Multi-year baseline of plastic ingestion in Atlantic cod in the Northwest Atlantic

Plastic ingestion rates for three food fish species in Newfoundland, Canada, are low

Terms

Frequency of occurrence (%FO): the number of individuals in a population or group that have ingested plastics (not indicative of the number of particles ingested per individual)
Loss of the Wnt/β-catenin pathway in microglia of the developing brain drives pro-inflammatory activation leading to white matter injury
Authors: Van Steenwinckel Juliette , Schang Anne-Laure , Krishnan Michelle L , Degos Vincent , Delahaye-Duriez Andrée , Bokobza Cindy , Verdonk Franck , Montané Amélie , Sigaut Stéphanie , Hennebert Olivier , Lebon Sophie , Schwendimann Leslie , Le Charpentier Tifenn , Hassan-Abdi Rahma , Ball Gareth , Aljabar Paul , Saxena Alka , Holloway Rebecca K , Birchmeier Walter , Miron Veronique , Rowitch David , Chretien Fabrice , Leconte Claire , Besson Valérie C , Petretto Enrico G , Edwards A David , Hagberg Henrik , Soussi-Yanicostas Nadia , Fleiss Bobbi , Gressens Pierre
Published: May 2018

Microglia of the developing brain have unique functional properties but how their activation states is regulated is poorly understood. Inflammatory activation of microglia in the still-developing brain of preterm born infants is associated with permanent neurological sequelae in 9 million infants every year. Investigating the regulators of microglial activation in the developing brain with multiple models of neuroinflammation-mediated injury and primary human microglia we found that a reduction in Wnt/β-catenin signalling is necessary and sufficient to drive an oligodendrocyte-injurious microglial phenotype. We validated in a cohort of preterm born infants that genomic variation in the WNT pathway is associated with the levels of connectivity found in their brains. Using a Wnt agonist delivered by a BBB penetrant microglia-specific targeting nanocarrier we prevented in our animal model the pro-inflammatory microglial activation, white matter injury and behavioural deficits. Collectively, these data validate that the Wnt pathway regulates microglial activation, is critical in the evolution of an important form of human brain injury and is a viable therapeutic target.
Spatial RNA sequencing identifies robust markers of vulnerable and resistant human midbrain dopamine neurons and their expression in Parkinson’s Disease
Authors: Aguila Julio , Cheng Shangli , Kee Nigel , Cao Ming , Wang Menghan , Deng Qiaolin , Hedlund Eva
Published: May 2018

Defining transcriptional profiles of substantia nigra pars compacta (SNc) and ventral tegmental area (VTA) dopamine neurons is critical to understanding their differential vulnerability in Parkinson’s Disease (PD). Here, we determine transcriptomes of human SNc and VTA dopamine neurons using LCM-seq on a large sample cohort. We apply a bootstrapping strategy as sample input to DESeq2 and identify 33 stably differentially expressed genes (DEGs) between these two subpopulations. We also compute a minimal sample size for identification of stable DEGs, which highlights why previous reported profiles from small sample sizes display extensive variability. Network analysis reveal gene interactions unique to each subpopulation and highlight differences in regulation of mitochondrial stability, apoptosis, neuronal survival, cytoskeleton regulation, extracellular matrix modulation and well as synapse integrity, which could explain the relative resilience of VTA dopamine neurons. Analysis of PD tissues showed that while identified stable DEGs can distinguish the subpopulations also in disease, the SNc markers SLIT1 and ATP2A3 were downregulated and thus appears to be biomarkers of disease. In summary, our study identifies human SNc and VTA marker profiles, which will be instrumental for studies aiming to modulate dopamine neuron resilience and to validate cell identity of stem cell-derived dopamine neurons.