bluuebunny/crossref_metadata_2025 huggingface dataset:
COT-18 TWO CASES OF GLIOBLASTOMA WITH ASYMPTOMATIC PULMONARY ARTERY EMBOLISM AND DEEP VEIN THROMBOSIS FROM ADMISSION TO HOSPITAL
Authors: Kobayashi Yusuke , Kon Takashi , Shimizu Katsuyoshi , Tanioka Daisuke , Satou Yosuke , Mizutani Tohru
Published: December 2019

Patients with malignant tumors are susceptible to concurrent venous thromboembolism. We report two cases of glioblastomas that showed asymptomatic pulmonary embolism and deep vein thrombosis on admission. The first case was a 77-year-old male. He was referred to our clinic for a tumor found in the left temporal lobe on computed tomography scan performed when he suffered pneumonia. On admission,he had a Karnofsky performance status (KPS) score of 50 and an elevated D-dimer level (16.46 μg/ml). Pulmonary embolism and deep vein thrombosis were noted on detailed examination. Direct oral anticoagulant (DOAC) therapy resulted in the disappearance of pulmonary embolism. On biopsy,the tumor was diagnosed as glioblastoma. The patient underwent radiation therapy in combination with chemotherapy. The second case was a 71-year-old female. She developed a disorder of consciousness and was admitted to a clinic. Brain magnetic resonance imaging (MRI) revealed a high T2 signal area in the left temporal lobe. The patient was initially diagnosed with encephalitis. Though the consciousness disorder improved quickly,she was referred to our clinic after a hyperintense area was observed on MRI. On admission,she had a KPS score of 100,and an elevated D-dimer level (7.59μg/ml),revealing pulmonary embolism and deep vein thrombosis. She was started on a DOAC and underwent surgical removal of the tumor via craniotomy. She was diagnosed with glioblastoma and underwent radiation therapy in combination with chemotherapy. Approximately 20% of the patients with glioblastomas suffer concurrent symptomatic venous thromboembolism. The incidence of venous thromboembolism is further elevated in patients with a poor KPS score or elderly people. Many patients with glioblastomas suffer asymptomatic venous thromboembolism. In this report,asymptomatic venous thromboembolism was noted in patients with a good KPS score. In glioblastoma patients,it is necessary to test for venous thromboembolism by measuring D-dimer levels before surgery.
SCATTER RADIATION IN THE FLUOROSCOPY-GUIDED INTERVENTIONAL ROOM
Authors: Bohari Asmah , Hashim Suhairul , Mohd Mustafa Siti Norsyafiqah
Published: December 2019

Radiation scattered throughout the room during fluoroscopy-guided interventional (FGI) procedures was quantified at different locations using nanoDot optically stimulated luminescence dosemeters. All the tube angulation imaging shows that the radiation spectrum resembled a single peak distribution. The left anterior oblique 90° shows the highest single peak distribution (28.65 mSv/h). The single peak distribution for standard anteroposterior, left anterior oblique 45° and right anterior oblique 45° imaging was 13.32, 22.99 and 17.40 mSv/h, respectively. All tube angulation shows that the position of the interventional radiologist experienced a higher radiation level compared to other staffs. The doses of radiation varied widely around the perimeter of the patient’s table and changed in accordance to imaging angles during procedures. Knowledge pertaining to radiation exposure levels is integral in order to avoid adverse risks, particularly among staff.
Reduction of Sudden Death Syndrome Foliar Symptoms and Fusarium virguliforme DNA in Roots Inoculated With Rhizophagus intraradices
Authors: Pawlowski Michelle L. , Hartman Glen L.
Published: December 2019

There is increasing interest in incorporating arbuscular mycorrhizal fungi (AMF) into agricultural production because of the benefits they provide, including protection against pathogens and pests. Sudden death syndrome (SDS) of soybean is a devastating disease caused by the soilborne pathogen Fusarium virguliforme. Multiple management methods are needed to control SDS. The relationship between F. virguliforme and AMF is not well documented. The goal of this study was to determine whether soybean plants co-inoculated with F. virguliforme and the AMF species Rhizophagus intraradices showed reduced SDS foliar symptom severity and reduced relative F. virguliforme DNA quantities in soybean roots. Six soybean genotypes were inoculated with F. virguliforme alone or with R. intraradices in a greenhouse experiment. Averaged over the six soybean genotypes, area under the disease progress curve values and relative F. virguliforme DNA quantities were 45 and 28% lower (P < 0.05), respectively, in roots co-inoculated with R. intraradices compared with roots of control plants inoculated with F. virguliforme only. Weight of roots co-inoculated with R. intraradices were 58% higher (P < 0.05) compared with roots of plants not inoculated with R. intraradices. Nutrient analysis showed higher boron, phosphorus, potassium, sodium, and sulfur concentrations in root tissues of plants co-inoculated with R. intraradices compared with plants inoculated with F. virguliforme (P < 0.05). Overall, this study showed that R. intraradices reduced SDS severity and relative F. virguliforme DNA quantities while simultaneously increasing growth and nutrient uptake of plants. Further testing of AMF inoculants in the field will indicate whether incorporating them into soybean SDS management practices will reduce the impact of SDS on soybean production.
Therapeutic Advantages of Frequent Physical Therapy Sessions for Patients With Lumbar Spinal Stenosis
Authors: Minetama Masakazu , Kawakami Mamoru , Teraguchi Masatoshi , Kagotani Ryohei , Mera Yoshimasa , Sumiya Tadashi , Nakagawa Masafumi , Yamamoto Yoshio , Matsuo Sachika , Sakon Nana , Nakatani Tomohiro , Kitano Tomoko , Nakagawa Yukihiro
Published: December 2019

Study Design.

A retrospective study of a randomized clinical trial and a prospective study of patients with lumbar spinal stenosis (LSS).

Objective.

The aim of this study was to identify the effects of the number of physical therapy (PT) sessions on clinical outcomes of patients with LSS.

Summary of Background Data.

Supervised PT for patients with LSS has been reported to lead to better short-term outcomes in terms of disability and leg pain than unsupervised exercise. However, no studies have investigated the relationship between the number of PT sessions and the therapeutic effects in patients with LSS.

Methods.

All patients received exercise therapy for 6 weeks. Included were 43 patients receiving supervised PT twice a week (P2 group), 38 patients receiving supervised PT once a week (P1 group), and 43 patients receiving a home exercise program alone (HE group). Clinical outcomes were measured using the Zurich Claudication Questionnaire (ZCQ), a numerical rating scale (NRS) of back pain and leg pain, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) at baseline and at 6 weeks.

Results.

At 6 weeks, the P2 group showed significant improvements in ZCQ physical function, back and leg pain on the NRS compared with the P1 group (P < 0.05). Compared with the HE group, the P2 group showed significant improvements in ZCQ symptom severity and physical function, back and leg pain on the NRS, and JOABPEQ gait disturbance (P < 0.05). There were no significant differences in mean changes after 6 weeks between the P1 and HE groups.

Conclusion.

Six weeks of supervised PT twice a week resulted in significant short-term improvements in symptom severity, physical function, back and leg pain, and gait disturbance compared with once a week and/or home exercise alone. Patients with LSS should be treated with intensive and supervised exercise programs to obtain maximum benefit of exercise therapy.

Level of Evidence: 3
Disparities in Outcomes by Insurance Payer Groups for Patients Undergoing Anterior Cervical Discectomy and Fusion
Authors: Rasouli Jonathan J. , Neifert Sean N. , Gal Jonathan S. , Snyder Daniel J. , Deutsch Brian C. , Steinberger Jeremy , Caridi John M.
Published: December 2019

Study Design.

Retrospective, observational study of clinical outcomes at a single institution.

Objective.

To compare postoperative complication and readmission rates of payer groups in a cohort of patients undergoing anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.

Studies examining associations between primary payer and outcomes in spine surgery have been equivocal.

Methods.

Patients at Mount Sinai having undergone ACDF from 2008 to 2016 were queried and assigned to one of five insurance categories: uninsured, managed care, commercial indemnity insurance, Medicare, and Medicaid, with patients in the commercial indemnity group serving as the reference cohort. Multivariable logistic regression equations for various outcomes with the exposure of payer were created, controlling for age, sex, American Society of Anesthesiology Physical Status Classification (ASA Class), the Elixhauser Comorbidity Index, and number of segments fused. A Bonferroni correction was utilized, such that alpha = 0.0125.

Results.

Two thousand three hundred eighty seven patients underwent ACDF during the time period. Both Medicare (P < 0.0001) and Medicaid (P < 0.0001) patients had higher comorbidity burdens than commercial patients when examining ASA Class. Managed care (2.86 vs. 2.72, P = 0.0009) and Medicare patients (2.99 vs. 2.72, P < 0.0001) had more segments fused on average than commercial patients. Medicaid patients had higher rates of prolonged extubation (odds ratio [OR]: 4.99; 95% confidence interval [CI]: 1.13–22.0; P = 0.007), and Medicare patients had higher rates of prolonged length of stay (LOS) (OR: 2.44, 95% CI: 1.13–5.27%, P = 0.004) than the commercial patients. Medicaid patients had higher rates of 30- (OR: 4.12; 95% CI: 1.43–11.93; P = 0.0009) and 90-day (OR: 3.28; 95% CI: 1.34–8.03; P = 0.0009) Emergency Department (ED) visits than the commercial patients, and managed care patients had higher rates of 30-day readmission (OR: 3.41; 95% CI: 1.00–11.57; P = 0.0123).

Conclusion.

Medicare and Medicaid patients had higher rates of prolonged LOS and postoperative ED visits, respectively, compared with commercial patients.

Level of Evidence: 3
What Is the Reliability of a New Classification for Bone Defects in Revision TKA Based on Preoperative Radiographs?
Authors: Belt Maartje , Smulders Katrijn , van Houten Albert , Wymenga Ate , Heesterbeek Petra , van Hellemondt Gijs
Published: December 2019

Background

Accurate quantification of bone loss facilitates preoperative planning and standardization for research purposes in patients who undergo revision TKA. The most commonly used classification to rate bone defects in this setting, the Anderson Orthopaedic Research Institute classification, does not quantify diaphyseal bone loss and reliability has not been well studied.

Questions/purposes

We developed a new classification scheme to rate bone defects in patients undergoing revision TKA and tested (1) the intraobserver and interobserver reliability of this classification for revision TKA based on preoperative radiographs, and (2) whether additional CT images might improve interobserver reliability.

Methods

This was a preregistered observational study. Interobserver reliability was analyzed using preoperative radiographs of 61 patients who underwent (repeat) revision TKA, and their bone defects were rated by five experienced orthopaedic surgeons. For intraobserver reliability, ratings were repeated at least 2 weeks after the first rating (Timepoints 1 and 2). Directly after the radiographic assessments of Timepoint 2, the observers were provided with CT images of each patient and asked to rate the bone defects for a third time (Timepoint 3), to assess the additional value of CT. Intraobserver and interobserver reliability were tested using Gwet’s agreement coefficient 2, which is a measure of agreement between observers in categorical data. Substantial agreement was defined as coefficients between 0.61 to 0.8 and almost perfect agreement as > 0.8.

Results

The intraobserver reliability varied between 0.55 (95% CI 0.40 to 0.71) and 0.87 (95% CI 0.78 to 0.96) in the epiphysis, between 0.69 (95% CI 0.58 to 0.80) and 0.98 (95% CI 0.95 to 1) in the metaphysis, and between 0.95 (95% CI 0.90 to 0.99) and 0.99 (95% CI 0.98 to 1) in the diaphysis. The interobserver reliability varied between 0.48 (95% CI 0.39 to 0.57) and 0.49 (95% CI 0.42 to 0.56) in the epiphysis and between 0.81 (95% CI 0.75 to 0.87) and 0.88 (95% CI 0.83 to 0.93) in the metaphysis, and was 0.96 (95% CI 0.93 to 0.99) in the diaphysis at Timepoint 1. The interobserver reliability at Timepoint 2 was similar to that of Timepoint 1. The addition of CT images did not improve reliability (Timepoint 3).

Conclusions

The bone defect classification was less reliable in the epiphyseal area compared with the metaphysis and diaphysis. This finding may be explained by prosthetic components obscuring this region or the more severe bone defects in this region. The addition of CT scans did not improve reliability. Further testing of reliability with observers from other institutions is necessary, as well as validity testing, by testing the classification in relation to intraoperative findings.

Level of Evidence

Level III, diagnostic study.
Suggested Training and Experience Qualifications for Health and Safety Officers During a Radiological Incident
Authors: Karam P. Andrew
Published: December 2019

During the response to any large-scale emergency, it is not unusual for emergency response organizations to assign Health and Safety Officer (HSO) duties to a qualified person who is responsible for seeing to the health and safety of personnel from their organization during all phases of the emergency response. This would likely occur during response to radiological and/or nuclear emergencies. Most emergency responders, however, have little formal training (and even less experience) in radiation safety. Thus, during a radiological or nuclear emergency, these HSOs are likely to lack the training and experience to prioritize radiological hazards compared to other risks present at the scene. A properly structured training program that includes both classroom and practical training will help to address this lack and will help those who complete it to see to the safety of their charges, even during a complex radiological or nuclear incident.
BLOOD PRESSURE VARIABILITY IN PATIENTS WITH BRANCH RETINAL VEIN OCCLUSION
Authors: Gulmez Mehmet , Tekce Abdulhakim
Published: December 2019

Purpose:

To evaluate short-term blood pressure variability over 24 hours in patients with branch retinal vein occlusion (BRVO) versus controls.

Methods:

A sample of 80 patients with BRVO (i.e., Group 1) and 75 controls (i.e., Group 2) was formed for a prospective, cross-sectional, comparative, case–control study. In a 24-hour period, each participant's blood pressure was measured by ambulatory monitoring every 15 minutes during the day and every 30 minutes at night. Mean values of systolic blood pressure (SBP), diastolic blood pressure (DBP), arterial blood pressure (ABP), and a variability index recorded during the day, at night, and throughout the 24-hour period were subjected to statistical analyses.

Results:

Mean daytime, night-time, and 24-hour SBP, DBP, and ABP values did not significantly differ between the groups. However, mean variability index values of daytime, night-time, and 24-hour SBP, DBP, and ABP significantly increased in patients with BRVO versus controls. Multivariate logistic regression analyses revealed that 24-hour blood pressure variability in each of SBP, DBP, and ABP was an independent determinant of BRVO.

Conclusion:

Because the daytime, night-time, and 24-hour blood pressure variability in SBP, DBP, and ABP was significantly greater among patients with BRVO than among controls, blood pressure variability could factor into the pathogenesis of BRVO.
Is It Possible to Predict Progression of Childhood Myopia Using Short-Term Axial Change After Orthokeratology?
Authors: Zhao Yingying , Hu Peike , Chen Duya , Ni Hailong
Published: December 2019

Objectives:

To investigate changes in axial length in children undergoing orthokeratology (OK) and evaluate short-term axial change in predicting post-OK myopia progression.

Methods:

In this retrospective study, the subjects included 70 myopic children aged 8 to 15 years wearing OK contact lenses for more than 3 years. Axial length changes at 0.5, 1, 2, and 3 years relative to the baseline were measured. Patients were evaluated for age, spherical equivalent refraction (SER), pupil size, and half-year axial change using repeated analysis of variance and multivariate linear regression analysis to predict half to 3 year-axial elongation (AE, seventh–36th month post-OK).

Results:

The axial length grew significantly during the 3 years; the mean annual axial growth was 0.20±0.12 mm. The half-year axial change was 0.04±0.12 mm. The univariate linear analyses showed that half to 3-year AE was correlated with baseline age (r=−0.393, P<0.001) and half-year axial change (r=0.379, P=0.001), but not pupil diameter (P=0.692) or SER (P=0.673). In a multiple linear regression model, the half to 3-year AE was related with the baseline age (standardized β=−0.312, P=0.007) and half-year axial change (standardized β=0.293, P=0.01). The model was fair (adjusted R
2=0.21) and statistically significant (F=10.24, P<0.001).

Conclusions:

It is practical to predict long-term AE with half-year axial change for children with OK correction. Therefore, this may aid in fast and timely measures in children who are predicted to have rapid myopia progression.
Topical Tacrolimus in Thygeson Superficial Punctate Keratitis
Authors: Shoughy Samir S. , Tabbara Khalid F.
Published: December 2019

Purpose:

To evaluate the efficacy of topical tacrolimus 0.02% eye drops in the treatment of patients with Thygeson superficial punctate keratitis.

Methods:

Ten consecutive patients with Thygeson superficial punctate keratitis were included retrospectively. Seven patients were unresponsive to topical steroids and/or lubricants. Diagnosis was made based on the history and clinical findings. All patients were treated with topical tacrolimus 0.02% solution twice daily. Outcome measures included improvement in symptoms of tearing and photophobia, whereas improvement in signs included decrease in the number of the lesions, resolution of the lesions, flattening of the lesions, and decrease in stain of the lesions.

Results:

There were 3 male and 7 female patients with an age range of 3 to 51 years (mean 17 years). All patients had bilateral ocular involvement. Duration of treatment ranged from 1 to 42 weeks (mean 10 weeks). All patients had subjective improvement in symptoms of tearing and photophobia and resolution of the superficial punctate keratitis. The response to treatment was noted 72 hours after initiation of therapy in all patients. Topical tacrolimus was well tolerated in all patients.

Conclusions:

Topical tacrolimus 0.02% is safe and effective in reducing ocular surface inflammation in patients with Thygeson superficial punctate keratitis who are not responsive to conventional therapy. Tacrolimus is helpful as a steroid-sparing agent to avoid vision-threatening complications.
Effects of Different Doses of Systemic Isotretinoin on Eyes: A Histopathological and Immunohistochemical Study in Rats
Authors: Karadag Remzi , Karadag Ayse Serap , Ozlu Emin , Oguztuzun Serpil , Simsek Gulcin Guler , Esmer Oktay , Onder Sevda , Bilgili Serap Gunes
Published: December 2019

Purpose:

To evaluate ocular side effects associated with systemic isotretinoin histopathologically.

Methods:

In this multicenter study, a total of 15 male and 15 female rats were randomly divided into 3 equal groups according to the oral dose of isotretinoin they were administered: 0 mg/kg/d (group A), 7.5 mg/kg/d (group B), and 15 mg/kg/d (group C). Biopsy specimens were taken from the globe conjunctiva, cornea, and eyelid conjunctiva. Expression levels of human beta-defensin-1, human beta-defensin-2, toll-like receptor (TLR)-2, and TLR-4 were evaluated by immunohistochemical methods.

Results:

The number of goblet cells in eyelid conjunctiva was significantly lower in group B than that in group A and group C (P = 0.002). The sizes of meibomian gland acini were significantly smaller in group B and group C than those in group A (P < 0.001). Fibrosis of eyelid conjunctiva was significantly higher in group C and group B than that in group A (P = 0.002). The levels of staining of TLR-4 in the cornea with group B were significantly lower compared with group C (P = 0.035).

Conclusions:

Our study suggests that isotretinoin in the early period affects eyelid conjunctiva and meibomian glands without affecting the globe conjunctiva and cornea. Occurrence of the initial symptoms of isotretinoin on the eyelids, especially on the meibomian glands, suggests that the symptoms of patients occur because of evaporative dry eye.
A Review of Using Common Spatial Pattern in Discrimination of Multiclass Motor Imagery–Based Brain-Computer Interface
Authors: Elmahdi Rania Elsadig , Ahmed Nosaiba Yusuf , Amin Magdy Baker M. , Hamza Alnazier O.
Published: December 2019

Brain-computer interface (BCI) is now being one of the interesting and attractive topics for researchers in recent years. Common spatial pattern is the most common approach applied in motor imagery (MI)-based BCI because of its effectiveness in differentiating between 2 different MI classes. The main objective of this article is to review using common spatial pattern combining with different methods such as Hilbert transform, error correction output coding, wavelet transform, joint approximate diagonalization, and others to extract features that can be used to differentiate between multiclass MI-based BCI. Data set 2a from BCI competition IV is used as an example for all authors. In addition, results of using various classifiers are demonstrated.
Relationship Between Bereavement Reaction With Posttraumatic Stress Disorder and Depression in Organ Donor Families in Iran
Authors: Tirgari Batool , Samareh Hamideh , Forouzi Mansooreh Azzizadeh
Published: December 2019

BACKGROUND: This study aimed to determine the relationship among bereavement, depression, and posttraumatic stress disorder (PTSD) in organ donor families in Iran. METHODS: This is a correlational study of 96 family members of brain-dead patients whose organs were donated. Using census sampling method, we approached the families through the Kerman University's Organ Donation Center. Data were collected using the Core Bereavement Items, Beck Depression Inventory, and Impact of Event Scale-Revised. RESULTS: The mean (SD) total score of bereavement, depression, and PTSD were 38.44 (9.25), 18.01 (12.92), and 41.90 (12.69), respectively. Among bereavement subscales, the highest mean (SD) score belonged to the “Images and Thoughts” (15.96 [4.16]) and the lowest belonged to “Grief” (10.57 [3.16]). Among different aspects of PTSD, the Intrusion subscale had the highest mean (SD) score (19.25 [6.22]), and the Hyperarousal subscale had the lowest (11.23 [5.34]). The Pearson correlation coefficient showed that bereavement was positively correlated with both depression (r = 0.72, P < .001) and PTSD (r = 0.59, P < .001). CONCLUSION: Donor families experienced bereavement, PTSD, and depression after organ donation. Healthcare professionals should approach and assess these families for potential emotional-psychological consequences, provide emotional and practical support to alleviate their depression and PTSD, and assist them through the bereavement process.
Proceedings From the Ice Hockey Summit III: Action on Concussion
Authors: Smith Aynsley M. , Alford Patrick A. , Aubry Mark , Benson Brian , Black Amanda , Brooks Alison , Burke Charles , D'Arcy Ryan , Dodick David , Eaves Michael , Eickhoff Chad , Erredge Kristen , Farrell Kyle , Finnoff Jonathan , Fraser Douglas D. , Giza Christopher , Greenwald Richard M. , Hoshizaki Blaine , Huston John , Jorgensen Janelle , Joyner Michael , Krause David , LaVoi Nicole , Leaf Matthew , Leddy John , Margarucci Kevin , Margulies Susan , Mihalik Jason , Munce Thayne , Oeur Anna , Prideaux Cara , Roberts William O. , Shen Francis , Soma David , Tabrum Mark , Stuart Michael B. , Wethe Jennifer , Whitehead James , Wiese-Bjornstal Diane , Stuart Michael J.
Published: December 2019

Objectives:

The Ice Hockey Summit III provided updated scientific evidence on concussions in hockey to inform these 5 objectives: (1) describe sport related concussion (SRC) epidemiology; (2) classify prevention strategies; (3) define objective, diagnostic tests; (4) identify treatment; and (5) integrate science and clinical care into prioritized action plans and policy.

Methods:

Our action plan evolved from 40 scientific presentations. The 155 attendees (physicians, athletic trainers, physical therapists, nurses, neuropsychologists, scientists, engineers, coaches, and officials) voted to prioritize these action items in the final Summit session.

Results:

To (1) establish a national and international hockey database for SRCs at all levels; (2) eliminate body checking in Bantam youth hockey games; (3) expand a behavior modification program (Fair Play) to all youth hockey levels; (4) enforce game ejection penalties for fighting in Junior A and professional hockey leagues; (5) establish objective tests to diagnose concussion at point of care; and (6) mandate baseline testing to improve concussion diagnosis for all age groups.

Conclusions:

Expedient implementation of the Summit III prioritized action items is necessary to reduce the risk, severity, and consequences of concussion in the sport of ice hockey.
An Uneven Playing Field: Athlete Injury, Illness, Load, and Daily Training Environment in the Year Before the FINA (Aquatics) World Championships, 2017
Authors: Mountjoy Margo , Junge Astrid , Slysz Josh , Miller Jim
Published: December 2019

Objective:

To assess athlete's training environment and health problems before the FINA World Championships (WC) (2017) and to analyze the differences between the 6 disciplines, gender, and countries with different medal rankings during the championships.

Design:

Retrospective anonymous questionnaire.

Setting:

FINA WC 2017.

Participants:

Registered aquatic athletes (swimmers, divers, high divers, water polo players, artistic swimmers, open water swimmers).

Main Outcome Measures:

The outcome measures included the following: training and competition load, availability of support staff, performance of injury prevention exercises, and prevalence of health problems. The independent variables included gender, aquatic discipline, and country group based on medal ranking.

Results:

In the 12 months preceding the Championships, 67% of the athletes reported physical complaints and 41% trained or competed with a diagnosed injury. Only half of the athletes reported that injury prevention exercises were always (29.9%) or often (23.4%) a regular part of their daily training. In the daily training environment, support staff (excluding coach) was not available or available only if the athlete pays in 28.4% (specialized trainer) to 58.9% (sport scientist) of cases. About one-quarter of the athletes rated the support offered by their National Team program as poor or very poor. There were discrepancies in training loads and support staff among the 6 aquatic disciplines. Availability of support staff, athlete's satisfaction with their training environment/support, and regular use of injury prevention exercises were higher in countries that ranked higher in the medal list.

Conclusions:

Injury prevention strategies should be promoted in aquatic sports, with prospective surveillance for the early identification of physical complaints. The facilitation of access to sport-specific experts could improve athlete's health and performance, especially in countries with low medal ranking.
A New In-Skates Balance Error Scoring System for Ice Hockey Players
Authors: Robert Antony , Moroz Mickey , Correa Jose A. , Var Danny , Delaney J. Scott
Published: December 2019

Objective:

Evaluate a new in-skates balance error scoring system (SBESS) for ice hockey players wearing their equipment.

Design:

Prospective, randomized, single blinded study.

Setting:

Sport Medicine Clinic.

Participants:

Eighty university hockey players.

Intervention:

A control group performed the SBESS assessment at rest on 2 separate occasions and an experimental group performed the assessment at rest and after exertion. The SBESS consists of maintaining different stances on ice skates for 20 seconds each, while wearing full equipment (no stick, gloves and helmet) and standing on a hard rubber surface. Three independent reviewers scored the video recorded assessments.

Main Outcomes Measures:

Primary outcome was the number of balance errors and the secondary outcome was the number of falls.

Results:

The control group's median SBESS scores were 2 and 3 on the first and second attempts at rest, respectively. The experimental group's median SBESS scores were 2 at rest and 2 after exertion. There was no fatigue effect and no athletes fell while performing the test. Of the 4 stances tested, the tandem stance had the highest variability in error scores between athletes and when repeated by the same athlete. The intraclass correlation coefficient (ICC) for interrater reliability was above 0.82, and the intrarater reliability ICC was above 0.86 for all SBESS scores. There was no concordance between the SBESS and the modified BESS.

Conclusions:

The SBESS, omitting the tandem stance, is a safe and reproducible sideline balance assessment of ice hockey players wearing full equipment.
Paroxysmal Nocturnal Hemoglobinuria: Case Report of a Rare Cause of Thrombosis in the Pediatric Age
Authors: Rosa Joana , Arruda Augusta , Rodrigues Ana L. , Soares Marina R.
Published: December 2019

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired life-threatening disorder that is extremely rare in the pediatric age. Patients with PNH may present a wide range of clinical manifestations. In most cases, the severity is associated with the size of the PNH clones; yet, some patients can be asymptomatic with a large clone. Thrombosis occurs less frequently as a presenting symptom, but it is considered the leading cause of mortality. In this article, we describe a case of PNH in a pediatric patient, complicated with venous thrombosis and with portal hypertension, associated with gastroesophageal varices at the time of diagnosis.
Single Intraosseous Injection of Simvastatin Promotes Endothelial Progenitor Cell Mobilization, Neovascularization, and Wound Healing in Diabetic Rats
Authors: Liu Can , Zhu Junxiong , Hai Bao , Zhang Wen , Wang Hong , Leng Huijie , Xu Yingsheng , Song Chunli
Published: December 2019

Background:

This study explored the effect of a single local intraosseous application of a small dose of simvastatin on the wound healing process in type 1 diabetic rats and related mechanisms.

Methods:

The authors chose the streptozotocin-induced type 1 diabetic rat to establish a full-thickness dermal wound using a 12-mm-diameter sterile disposable punch. The rats (n = 32) were divided randomly into four groups: (1) normal control rats, (2) type 1 diabetic rats with intraosseous injection of hydrogel vehicle, (3) type 1 diabetic rats with intraosseous injection of simvastatin (0.5 mg), and (4) type 1 diabetic rats with intragastric administration of simvastatin (20 mg/kg per day). Wound closure was followed by digital planimetry. Mobilization of endothelial progenitor cells into the circulatory system was studied using fluorescence-activated cell sorting. Neovascularization was analyzed with immunofluorescence histochemical staining. The relative levels of adiponectin and stromal cell-derived factor 1 (SDF-1) in serum, bone, and wound tissues were examined by enzyme-linked immunosorbent assay and Western blot.

Results:

Diabetic rats exhibited impaired wound healing. Intraosseous administration of simvastatin accelerated wound healing beginning at day 4, and angiogenesis was more obvious than in the control group. Enzyme-linked immunosorbent assay revealed that adiponectin concentrations in the diabetic rats with intraosseous injection of hydrogel vehicle plus simvastatin 0.5-mg group were significantly higher compared with the diabetic rats with intraosseous injection of hydrogel vehicle group beginning at day 4. Intraosseous administration of simvastatin decreased the expression of adiponectin and SDF-1 in bone tissue but enhanced the expression of adiponectin in wounded skin.

Conclusions:

A single local intraosseous application of simvastatin promotes wound healing in type 1 diabetic rat. The underlying mechanisms may be attributed to the regulation of the adiponectin/SDF-1 pathway, which plays a pivotal role in endothelial progenitor cell mobilization and angiogenesis.
Social Isolation, Loneliness, and All-Cause Mortality in Patients With Cardiovascular Disease: A 10-Year Follow-up Study
Authors: Yu Bin , Steptoe Andrew , Chen Li-Jung , Chen Yi-Huei , Lin Ching-Heng , Ku Po-Wen
Published: December 2019

Objective

Social isolation and loneliness have been associated with increased incidence of cardiovascular disease (CVD), but few studies have evaluated the impact of social isolation and loneliness on mortality in people with existing CVD, and these are limited to Western populations. We examined whether social isolation and loneliness are associated with increased risk of mortality in individuals with established CVD in Taiwan.

Methods

The cohort was composed of 1267 patients with confirmed CVD 65 years or older followed up for up to 10 years. Cox proportional hazard regression models were used to examine the association between social isolation and loneliness at baseline and mortality at follow-up by adjusting for demographic variables, health-related behaviors, and health status.

Results

There were 593 deaths during the follow-up period. Social isolation was associated with increased risk of mortality after accounting for established risk factors (hazard ratio [HR] = 1.16; 95% confidence interval [CI] = 1.06–1.26), whereas loneliness was not associated with increased risk of mortality (HR = 0.95; 95% CI = 0.82–1.09). When both social isolation and loneliness were included in the model, social isolation maintained an association with mortality (HR = 1.16; 95% CI =1.07–1.27).

Conclusions

Social isolation is associated with an increased risk of mortality in patients with CVD, and the effects are independent of loneliness. These findings expand our knowledge about the impact of social isolation on the outcomes of CVD in non-Western countries. Efforts to reduce isolation may have substantial benefits in terms of mortality in patients with CVD.
Pediatric Ventriculoperitoneal Shunt Infection: The Role of Shunt Tract Debridement in Mycobacterium abscessus Eradication
Authors: Abu-Ghname Amjed , Davis Matthew J. , Davies Lesley W. , Whitehead William E. , Buchanan Edward P.
Published: December 2019

Ventricular shunt infections caused by nontuberculous mycobacteria are uncommon, and those caused by Mycobacterium abscessus are particularly rare. This mycobacterium is intrinsically resistant to first-line anti-tuberculous drugs and is considered the most pathogenic of the atypical, rapidly growing mycobacteria. Given the paucity of reported M. abscessus ventricular shunt infections, the appropriate surgical treatment for these cases, especially in the pediatric setting, has yet to be described. The authors present a 4-year-old male with history of intraventricular hemorrhage resulting in hydrocephalus who presented with an M. abscessus ventricular shunt infection that disseminated to the skin and soft tissue of the entire shunt tract. Despite aggressive antimicrobial therapy, several shunt exchanges, and numerous incisions and debridements of separate infected tract areas, the patient's clinical course was prolonged by multiple relapses and re-admissions. Only after opening and debriding the entire length of the infected tract, which measured 100 cm2 and extended from the scalp to the groin, and months of intrathecal antibiotics did CSF and tissue culture results become negative, and the entire tract was able to be closed. This article describes the management of the second-encountered pediatric M. abscessus shunt infection along with the management of the 4 previously reported cases. In addition, it highlights the vital role of early, aggressive surgical debridement to achieve infection eradication.
The Role of Overriding Preseptal Orbicularis Oculi Muscle in Development of Involutional Lower Eyelid Entropion: Microscopic Viewpoints
Authors: Valencia Regina Paula , Kitaguchi Yoshiyuki , Nakano Takashi , Naito Munekazu , Ikeda Hiroshi , Kakizaki Hirohiko , Takahashi Yasuhiro
Published: December 2019

The aim of this study was to demonstrate the extent of preseptal orbicularis oculi muscle (OOM) override onto the pretarsal OOM in the lower eyelids. In this experimental microscopic study, 22 exenterated specimens from 22 Japanese cadavers were prepared as full-thickness sagittal sections. All exenterated specimens were devoid of lower eyelid entropion. The tarsal dimension and distance from the lower tarsal edge to the tip of overriding OOM were microscopically measured. The rotation axis of the tarsus was presumed to pass through the tarsal centroid and the distance from an estimated tarsal centroid to the lower tarsal edge was calculated. Consequently, 2 eyelids did not exhibit any overriding of the OOM. In the remaining 20 eyelids with OOM override, the average distance of the overriding OOM was found at a level covering 48.0% of the whole tarsal height. In 15 out of the 20 eyelids, the tip of the overriding OOM was located lower than the centroid. These microscopic findings suggest that overriding of the preseptal OOM does not always produce an inward rotational force on the tarsus.
Bite Force Simulator: A Novel Technique to Simulate Craniofacial Strain In Vitro
Authors: Ip Kenneth K.C. , You Peng , Moore Corey C. , Ferreira Louis M.
Published: December 2019

Existing in vitro simulators rely on external manipulation of the skull to replicate masticatory forces; however, external manipulations do not accurately represent internal loads as in physiological muscle forces.

The purpose of the project is to develop an in vitro simulator that internally replicates the forces of mastication. The simulator has 3-dimensional-printed piston mounts that are reverse-engineered using a computed tomography scan of the specimen. The mounts are attached to the skull at muscle attachment sites using adhesive. The pneumatic pistons are sutured to muscle tendons; when the pistons are activated, they pull on the tendons which proportionally replicate muscle loads. The force output of the pistons can be individually modified by a custom software. Strain gauges are attached to craniofacial bones to measure deformation under replicated muscle loads. A 6 degrees-of freedom force sensor is placed intraorally to measure the generated bite force.

The methodology was validated on 6 fresh-frozen cadaveric heads. Change in strain measurements was observed with change in simulated muscle loads. The simulator can validate computer simulation models and provide an experimental platform for craniofacial and dental implants. It sets the framework for a new, more physiologically consistent way of studying craniofacial stresses.
Calvarial Reconstruction With Autologous Sagittal Split Rib Bone Graft and Latissimus Dorsi Rib Myoosseocutaneous Free Flap
Authors: Hong Seung Heon , Lim So Young
Published: December 2019

Objective:

Cranioplasty is essential because cranial defects cause cosmetic and functional problems, and neurologic sequalae in patients. However, reconstruction options are limited in patients with unfavorable conditions. This study aimed to review our experience with skull defect reconstruction using autogenous bone with sagittal split rib bone grafts or latissimus dorsi rib myoosseocutaneous free flaps.

Methods:

Patients who underwent autogenous bone graft for cranial defect coverage from December 2011 to November 2015 at our institution were reviewed. Rib bone graft or latissimus dorsi rib myoosseocutaneous free flaps were done to cover the defect. The patient follow-up period ranged from 3 months to 7 years.

Results:

There were 6 patients, with 9 surgeries. Two cases of latissimus dorsi rib myoosseocutaneous free flap procedures were performed in 2 patients and 7 sagittal split rib bone grafts were performed in 6 patients. There were no postoperative infections in any patients, despite 4 patients had previous surgical site infection histories. Two patients with neurologic sequalae showed improvement after the surgeries.

Conclusion:

Sagittal split rib bone graft and latissimus dorsi rib myoosseocutaneous free flap procedures could be fine options for calvarial reconstruction of defects under the unfavorable conditions of bilateral cranial defects or previous infection history.
Course of the Maxillary Vein and its Positional Relationship With the Mandibular Ramus Require Attention During Mandibuloplasty
Authors: Odaka Kento , Matsunaga Satoru
Published: December 2019

Purpose:

The maxillary vein is associated with major hemorrhage, an intraoperative risk factor during mandibuloplasty. Our objectives in this study were to identify the anatomical course of the maxillary vein relative to the mandible, and to ascertain the relationship of its course with that of the maxillary artery.

Methods:

Thirteen sides of 13 cadavers in the possession of the Department of Anatomy of Tokyo Dental College were used. The maxillofacial region was first dissected, after which the upper part of the mandibular ramus was removed and the maxillary artery, maxillary vein, and pterygoid venous plexus were identified. The length of the maxillary vein and its height from the mandibular plane were then measured, and its anatomical course was recorded.

Results:

The maxillary vein ran downward along the inner aspect of the temporal muscle, then from the base of the coronoid process it ran horizontally near the bone surface of the inner aspect of the mandibular ramus. After joining the inferior alveolar vein, it joined the superficial temporal vein to form the retromandibular vein. The mean length of the maxillary vein was 22.2 ± 3.2 mm. At the posterior margin of the mandibular ramus, its mean height above the mandibular plane was 34.2 ± 5.4 mm. From the posterior margin of the mandibular ramus to the lowest point of the mandibular notch, the maxillary vein was located within the areolar connective tissue directly above the periosteum adjoining the inner aspect of the mandibular ramus.

Conclusions:

In the wide area from the center of the maxillary notch to the posterior margin of the mandibular ramus, the maxillary vein runs extremely close to the periosteum on the inner aspect of the mandibular ramus, suggesting that it may pose a risk of hemorrhage in various oral surgical procedures.
Changes of Occlusal Plane in Growing Patients With Increased Vertical Dimension During Class II Correction by Using Cervical Headgear
Authors: Sambataro Sergio , Lorusso Paola , Caprioglio Alberto , Franchi Lorenzo , Cicciù Marco , Fastuca Rosamaria
Published: December 2019

This retrospective research aimed to highlight the changes of occlusal plane in Class II hyperdivergent subjects that received cervical headgear treatment and compared them to untreated controls in order to evaluate the occlusal changes that might be connected to a potential mandibular rotation.

The sample of this investigation was represented by 20 hyperdivergent Class II subjects (10 males, 10 females; mean age 8.54) corrected by using cervical headgear (treated group) and 21 Class II patients (11 males, 10 females; mean age 8.41) hyperdivergent who had no therapy (control group). Lateral head films were studied for all the patients before treatment (T1) and after therapy (T2) for both groups; cephalometric analysis was used in order to seek the modifications between time points and between groups.

Means and standard deviation have been computed for both groups. In order to confront the modification between the time points within the same group the Wilcoxon test was applied. The Mann–Whitney U test was applied to confront the dissimilarities between groups at T2.

As a result of the Class II correction by using the cervical headgear treatment the occlusal plane was lowered and flattened compared to T1 and to the control group; the upper molars showed extrusion to the palatal plane, there was a significant forward rotation of mandible and the vertical dimension was not significantly modified. Downward and backward displacement of the upper jaw occurred.
Gene drive and resilience through renewal with next generationCleave and Rescueselfish genetic elements
Authors: Oberhofer Georg , Ivy Tobin , Hay Bruce A
Published: December 2019

Gene drive-based strategies for modifying populations face the problem that genes encoding cargo and the drive mechanism are subject to separation, mutational inactivation, and loss of efficacy. Resilience, an ability to respond to these eventualities in ways that restore population modification with functional genes is needed for long-term success. Here we show that resilience can be achieved through cycles of population modification with “Cleave and Rescue”(ClvR) selfish genetic elements.ClvRcomprises a DNA sequence-modifying enzyme such as Cas9/gRNAs that disrupts endogenous versions of an essential gene, and a recoded version of the essential gene resistant to cleavage.ClvRspreads by creating conditions in which those lackingClvRdie because they lack functional versions of the essential gene. Cycles of modification can in principal be carried out if twoClvRelements targeting different essential genes are located at the same genomic position, and one of them,ClvRn+1, carries aRescuetransgene from an earlier element,ClvRn.ClvRn+1should spread within a population ofClvRn, while also bringing about a decrease in its frequency. To test this hypothesis we first show that multipleClvRs, each targeting a different essential gene, function when located at a common chromosomal position inDrosophila. We then show that when several of these also carry theRescuefrom a differentClvR, they spread to transgene fixation in populations fixed for the latter, and at its expense. Therefore, genetic modifications of populations can be overwritten with new content, providing an ongoing point of control.

Significance

Gene drive can spread beneficial traits through populations, but will never be a one-shot project in which one genetic element provides all desired modifications, for an indefinitely long time. Here we show that gene drive mediated population modification inDrosophilacan be overwritten with new content while eliminating old, usingCleave and Rescue(ClvR) selfish genetic elements. The ability to carry out cycles of modification that create and then leave behind a minimal genetic footprint while entering and exiting a population provides important points of control. It makes possible the replacement of broken elements, upgrades with new elements that better carry out their tasks and/or provide new functions, all while promoting the removal of modifications no longer needed.