bluuebunny/crossref_metadata_2025 huggingface dataset:
The spare part maintenance of cake breaker conveyor with reliability centered spares method
Authors: Sembiring N , Batubara YP
Published: July 2019

The company that this research conducted is a manufacturing industry that produces CPO. Many machines in the production section need maintenance activities so that existing machines can work without inhibiting the production process. At seed processing station, there is CBC machine that experienced frequent occurrence damage. The machine applies corrective maintenance regardless of reliability machine production components, consequently, often occur sudden machine damage. Calculation of time interval-based maintenance policy scheduled discard task and needs a replacement component (spare part) that should be available are concerned with an optimal using method of Reliability-centered Spares (RCS). Based on the results of the calculations are based on a policy scheduled discard task then obtained a policy to perform maintenance on a screw conveyor components is 91 days, hangers and bearings are 40 days, jig-drilled couplings is 21 days. The result of the method of RCS acquired number of screw conveyor parts needs with this type of repair of repairable spare is 3 units for one year, while jig-drilled couplings with this type of repair repairable, need spare part 27 units for a year, as well as the hangers and bearing with this type of repair of repairable spare part, needs 21 units for one year.
Expandable human cardiovascular progenitors from stem cells for regenerating mouse heart after myocardial infarction
Authors: Schwach Verena , Gomes Fernandes Maria , Maas Saskia , Gerhardt Sophie , Tsonaka Roula , van der Weerd Louise , Passier Robert , Mummery Christine L , Birket Matthew J , Salvatori Daniela C F
Published: July 2019

Aims

Cardiovascular diseases caused by loss of functional cardiomyocytes (CMs) are a major cause of mortality and morbidity worldwide due in part to the low regenerative capacity of the adult human heart. Human pluripotent stem cell (hPSC)-derived cardiovascular progenitor cells (CPCs) are a potential cell source for cardiac repair. The aim of this study was to examine the impact of extensive remuscularization and coincident revascularization on cardiac remodelling and function in a mouse model of myocardial infarction (MI) by transplanting doxycycline (DOX)-inducible (Tet-On-MYC) hPSC-derived CPCs in vivo and inducing proliferation and cardiovascular differentiation in a drug-regulated manner.

Methods and results

CPCs were injected firstly at a non-cardiac site in Matrigel suspension under the skin of immunocompromised mice to assess their commitment to the cardiovascular lineage and ability to self-renew or differentiate in vivo when instructed by systemically delivered factors including DOX and basic fibroblast growth factor (bFGF). CPCs in Matrigel were then injected intra-myocardially in mice subjected to MI to assess whether expandable CPCs could mediate cardiac repair. Transplanted CPCs expanded robustly both subcutis and in the myocardium using the same DOX/growth factor inducing regime. Upon withdrawal of these cell-renewal factors, CPCs differentiated with high efficiency at both sites into the major cardiac lineages including CMs, endothelial cells, and smooth muscle cells. After MI, engraftment of CPCs in the heart significantly reduced fibrosis in the infarcted area and prevented left ventricular remodelling, although cardiac function determined by magnetic resonance imaging was unaltered.

Conclusion

Replacement of large areas of muscle may be required to regenerate the heart of patients following MI. Our human/mouse model demonstrated that proliferating hPSC-CPCs could reduce infarct size and fibrosis resulting in formation of large grafts. Importantly, the results suggested that expanding transplanted cells in situ at the progenitor stage maybe be an effective alternative causing less tissue damage than injection of very large numbers of CMs.
Tree Strata Structure in an Ecotone among the Amazon Forest Types: A Comparative Study
Authors: Canetti Aline , Braz Evaldo Muñoz , de Mattos Patrícia Póvoa , Figueiredo Filho Afonso , Basso Renato Olivir
Published: July 2019

This work aimed to describe the structural dynamics of the Transitional Amazonian Forest and to evaluate whether the most abundant tree species present a structural pattern. As it is an ecotone composed of two forest types, a high composition complexity is expected. Forest analysis occurred with six 100 percent inventories data considering all trees with diameter at breast height ≥15.7 in., totalizing over 13 000 ac. The study areas were compared in terms of tree density, number of species, and importance value of the most abundant species. The Morisita index and the cluster analysis tested the forests similarity. We also evaluated the importance value of species in the upper and middle strata. Differences between study areas were detected regarding tree density and number of species. However, the forests presented more than 75 percent similarity and were grouped in three structural clusters. Some species showed alternations of dominance in the middle and upper strata. Although the forest is an ecotone, the trees had a structural pattern, where the same species dominate large areas, allowing us to apply the results on a huge scale.
Acute kidney injury after thoracic surgery: a proposal for a multicentre evaluation (MERITS)
Authors: Naruka Vinci , Mckie Mikel A , Khushiwal Rasoel , Clayton James , Aresu Giuseppe , Peryt Adam , Villar Sofía S , MacKay Jon , Coonar Aman S
Published: July 2019

OBJECTIVES

Because the mortality rate is very low in thoracic surgery, its use as a quality discriminator is limited. Acute kidney injury (AKI) is a candidate measure because it is associated with increased rates of morbidity and mortality and is partly preventable. The incidence of AKI after thoracic surgery is not well documented. We conducted an audit to determine the incidence and outcomes of AKI. This audit became a pilot project, and the results indicate the feasibility of a larger study.

METHODS

Retrospective data on renal function post-thoracic surgery were collected at a tertiary cardiothoracic unit over 12 months. Renal impairment was classified according to the Kidney Disease Improving Global Outcomes criteria.

RESULTS

Of 568 patients (mean = 59  ±  SD 18; 38% women), AKI was diagnosed in 86 (15.1%) within 72 h post-thoracic surgery based on the Kidney Disease Improving Global Outcomes staging system (stage 1, n = 55; stage 2, n = 25; stage 3, n = 6). Significant differences were found in postoperative length of stay (3 vs 5 days; P < 0.001) of patients with and without AKI. There was a significant difference between the age groups of patients with and without AKI (P < 0.05) in the open surgical group but not in the group having video-assisted thoracoscopic surgery (VATS). There was no significant difference in the mortality rates between patients with and without AKI.

CONCLUSIONS

The incidence of AKI after thoracic surgery was 15.1%. AKI was associated with longer hospital stays and was more likely in ≥60-year-old patients after open surgery than after VATS. Reducing AKI could improve patient outcomes. We propose that AKI may be a useful quality measure in thoracic surgery. We are developing a multicentre audit based on this approach.
Conjugation of Different Immunogenic Enterococcal Vaccine Target Antigens Leads to Extended Strain Coverage
Authors: Romero-Saavedra F , Laverde D , Kalfopoulou E , Martini C , Torelli R , Martinez-Matamoros D , Sanguinetti M , Huebner J
Published: July 2019

Enterococci have emerged as important nosocomial pathogens due to their resistance to the most commonly used antibiotics. Alternative treatments or prevention options are aimed at polysaccharides and surface-related proteins that play important roles in pathogenesis. Previously, we have shown that 2 Enterococcus faecium proteins, the secreted antigen A and the peptidyl-prolyl cis-trans isomerase, as well as the Enterococcus faecalis polysaccharide diheteroglycan, are able to induce opsonic and cross-protective antibodies. Here, we evaluate the use of glycoconjugates consisting of these proteins and an enterococcal polysaccharide to develop a vaccine with broader strain coverage. Diheteroglycan was conjugated to these 2 enterococcal proteins. Rabbit sera raised against these glycoconjugates showed Immunoglobulin G titers against the corresponding conjugate, as well as against the respective protein and carbohydrate antigens. Effective opsonophagocytic killing for the 2 sera was observed against different E. faecalis and E. faecium strains. Enzyme-linked immunosorbent assays against whole bacterial cells showed immune recognition of 22 enterococcal strains by the sera. Moreover, the sera conferred protection against E. faecalis and E. faecium strains in a mouse infection model. Our results suggest that these glycoconjugates are promising candidates for vaccine formulations with a broader coverage against these nosocomial pathogens and that the evaluated proteins are potential carrier proteins.
Revision of fin whale Balaenoptera physalus (Linnaeus, 1758) subspecies using genetics
Authors: Archer Frederick I , Brownell Robert L , Hancock-Hanser Brittany L , Morin Phillip A , Robertson Kelly M , Sherman Kathryn K , Calambokidis John , Urbán R Jorge , Rosel Patricia E , Mizroch Sally A , Panigada Simone , Taylor Barbara L
Published: July 2019

Three subspecies of fin whales (Balaenoptera physalus) are currently recognized, including the northern fin whale (B. p. physalus), the southern fin whale (B. p. quoyi), and the pygmy fin whale (B. p. patachonica). The Northern Hemisphere subspecies encompasses fin whales in both the North Atlantic and North Pacific oceans. A recent analysis of 154 mitogenome sequences of fin whales from these two ocean basins and the Southern Hemisphere suggested that the North Pacific and North Atlantic populations should be treated as different subspecies. Using these mitogenome sequences, in this study, we conduct analyses on a larger mtDNA control region data set, and on 23 single-nucleotide polymorphisms (SNPs) from 144 of the 154 samples in the mitogenome data set. Our results reveal that North Pacific and North Atlantic fin whales can be correctly assigned to their ocean basin with 99% accuracy. Results of the SNP analysis indicate a correct classification rate of 95%, very low rates of gene flow among ocean basins, and that distinct mitogenome matrilines in the North Pacific are interbreeding. These results indicate that North Pacific fin whales should be recognized as a separate subspecies, with the name B. p. velifera Cope in Scammon 1869 as the oldest available name.
Nutrition & Exercise Interventions in Pediatric Patients with Brain Tumors: A Narrative Review
Authors: Runco Daniel V , Yoon Lisa , Grooss Samantha A , Wong Christopher K
Published: July 2019

Brain tumors have been the most common pediatric solid tumor and leading cause of morbidity and mortality. Improved survival emphasizes the importance of adverse treatment effects especially related to nutrition and exercise. Although studies have examined nutrition and exercise outcomes, few randomized trials exist. This narrative review included a systematic literature search with analysis of controlled or single group studies examining clinical and quality-of-life impact of nutrition or exercise interventions. Seven articles were included. Three nutrition studies demonstrated improvement with proactive feeding tubes, nutritional supplementation, and nutritional status. Two exercise studies showed improvement in measures of fitness and neuroanatomy with exercise in pediatric brain tumor survivors; two cohort studies demonstrated a link between quality of life and physical activity. Preliminary studies show nutrition and exercise may improve physical well-being and quality of life, suggesting future controlled studies are warranted to inform clinical care of children with brain tumors.
Supervisory Leadership at the Frontlines: Street-Level Discretion, Supervisor Influence, and Street-Level Bureaucrats’ Attitude Towards Clients
Authors: Keulemans Shelena , Groeneveld Sandra
Published: July 2019

Steering street-level bureaucrats is utterly complex due to their discretion and professional status which grant them relative autonomy from supervisory directives. Drawing from transformational leadership theory, this article explores the opportunities these work conditions provide for supervisory leadership at the frontlines. Looking at street-level bureaucrats’ attitude towards clients, we analyze how the frontline supervisor affects this core perception that protrudes the human judgments street-level bureaucrats are required to pass in their use of their discretion. Using a survey dataset of 971 street-level bureaucrats and their 203 frontline supervisors, this study shows that frontline supervisors function as an attitudinal role model to street-level bureaucrats. Moreover, their supportive leadership behaviors are crucial to them upholding a positive attitude towards clients. Supportive leadership does not unequivocally strengthen the supervisor’s position as an attitudinal referent, though. These findings challenge pessimistic assessments of the potential for supervisory leadership at the frontlines. Theoretical and practical implications are discussed.
Leishmania spp. and leishmaniasis on the Caribbean islands
Authors: Yao Chaoqun
Published: July 2019

The kinetoplastid protozoan Leishmania spp. cause leishmaniasis, which clinically exhibit mainly as a cutaneous, mucocutanous or visceral form depending upon the parasite species in humans. The disease is widespread geographically, leading to 20 000 annual deaths. Here, leishmaniases in both humans and animals, reservoirs and sand fly vectors on the Caribbean islands are reviewed. Autochthonous human infections by Leishmania spp. were found in the Dominican Republic, Guadeloupe and Martinique as well as Trinidad and Tobago; canine infections were found in St. Kitts and Grenada; and equine infections were found in Puerto Rico. Imported human cases have been reported in Cuba. The parasites included Leishmania amazonensis, Le. martiniquensis and Le. waltoni. Possible sand fly vectors included Lutzomyia christophei, Lu. atroclavatus, Lu. cayennensis and Lu. flaviscutellata as well as Phlebotomus guadeloupensis. Reservoirs included rats, rice rats and mouse opossum. An updated study is warranted for the control and elimination of leishmaniasis in the region because some of the data are four decades old.
Psychometric Properties of Cognitive-Motor Dual-Task Studies With the Aim of Developing a Test Protocol for Persons With Vestibular Disorders: A Systematic Review
Authors: Danneels Maya , Van Hecke Ruth , Keppler Hannah , Degeest Sofie , Cambier Dirk , van de Berg Raymond , Van Rompaey Vincent , Maes Leen
Published: July 2019

Objectives:

Patients suffering from vestibular disorders (VD) often present with impairments in cognitive domains such as visuospatial ability, memory, executive function, attention, and processing speed. These symptoms can be attributed to extensive vestibular projections throughout the cerebral cortex and subcortex on the one hand, and to increased cognitive-motor interference (CMI) on the other hand. CMI can be assessed by performing cognitive-motor dual-tasks (DTs). The existing literature on this topic is scarce and varies greatly when it comes to test protocol, type and degree of vestibular impairment, and outcome. To develop a reliable and sensitive test protocol for VD patients, an overview of the existing reliability and validity studies on DT paradigms will be given in a variety of populations, such as dementia, multiple sclerosis, Parkinson’s disease, stroke, and elderly.

Design:

The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An extensive literature search on psychometric properties of cognitive-motor DTs was run on MEDLINE, Embase, and Cochrane Databases. The studies were assessed for eligibility by two independent researchers, and their methodological quality was subsequently evaluated using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN).

Results and Conclusions:

Thirty-three studies were included in the current review. Based on the reliability and validity calculations, including a static as well as dynamic motor task seems valuable in a DT protocol for VD patients. To evoke CMI maximally in this population, both motor tasks should be performed while challenging the vestibular cognitive domains. Out of the large amount of cognitive tasks employed in DT studies, a clear selection for each of these domains, except for visuospatial abilities, could be made based on this review. The use of the suggested DTs will give a more accurate and daily life representation of cognitive and motor deficiencies and their interaction in the VD population.
Psychobiological Responses Reveal Audiovisual Noise Differentially Challenges Speech Recognition
Authors: Bidelman Gavin M. , Brown Bonnie , Mankel Kelsey , Nelms Price Caitlin
Published: July 2019

Objectives:

In noisy environments, listeners benefit from both hearing and seeing a talker, demonstrating audiovisual (AV) cues enhance speech-in-noise (SIN) recognition. Here, we examined the relative contribution of auditory and visual cues to SIN perception and the strategies used by listeners to decipher speech in noise interference(s).

Design:

Normal-hearing listeners (n = 22) performed an open-set speech recognition task while viewing audiovisual TIMIT sentences presented under different combinations of signal degradation including visual (AVn), audio (AnV), or multimodal (AnVn) noise. Acoustic and visual noises were matched in physical signal-to-noise ratio. Eyetracking monitored participants’ gaze to different parts of a talker’s face during SIN perception.

Results:

As expected, behavioral performance for clean sentence recognition was better for A-only and AV compared to V-only speech. Similarly, with noise in the auditory channel (AnV and AnVn speech), performance was aided by the addition of visual cues of the talker regardless of whether the visual channel contained noise, confirming a multimodal benefit to SIN recognition. The addition of visual noise (AVn) obscuring the talker’s face had little effect on speech recognition by itself. Listeners’ eye gaze fixations were biased toward the eyes (decreased at the mouth) whenever the auditory channel was compromised. Fixating on the eyes was negatively associated with SIN recognition performance. Eye gazes on the mouth versus eyes of the face also depended on the gender of the talker.

Conclusions:

Collectively, results suggest listeners (1) depend heavily on the auditory over visual channel when seeing and hearing speech and (2) alter their visual strategy from viewing the mouth to viewing the eyes of a talker with signal degradations, which negatively affects speech perception.
Osthole inhibits the progression of human gallbladder cancer cells through JAK/STAT3 signal pathway both in vitro and in vivo
Authors: Le Zou Tian , Wang Hong Fei , Ren Tai , Shao Zi Yu , Yuan Rui Yan , Gao Yuan , Zhang Yi Jian , Wang Xu An , Liu Ying Bin
Published: July 2019

Osthole is an antitumor compound, which effect on Gallbladder cancer (GBC) has been not elucidated. This study focused on its anti-GBC effect and mechanism both in vitro and in vivo. The antiproliferation effect on cell lines NOZ and SGC-996 were measured by cell counting kit-8 (CCK-8) and colony formation assay. The effects on cell apoptosis and cell cycle were investigated by flow cytometry assay. The migration effect was checked by transwell assay and the expressions of proteins were examined by Western Blots. Also, we did an in-vivo experiment by intraperitoneal injection of osthole in nude mice. The results showed that cell proliferation and viability were inhibited in a dose- and time-dependent manner. The similar phenomenon was also found in vivo. Flow cytometric assay confirmed that osthole inhibited cells proliferation via inducing apoptosis and G2/M arrest. Transwell assay indicated that osthole inhibited the migration in a dose-dependent manner. Expression of key proteins related with apoptosis and cell cycle were testified after osthole treatment. Also, we found the key proteins involved in the JAK/STAT3 signal way decreased after osthole treatment. This study suggested that osthole can inhibit the progression of human GBC cell lines, thus maybe a potential drug for GBC treatment.
Surgical Management of an Ileal J-Pouch-Anal Anastomosis Volvulus
Authors: Geers Joachim , Bislenghi Gabriele , D’Hoore André , Wolthuis Albert M.
Published: July 2019

BACKGROUND:

A restorative proctocolectomy with an IPAA is the surgical treatment of choice for medically refractory ulcerative colitis. Until now, a pouch volvulus has been considered a rare complication, only described in case reports and small case series. The aim of this technical note was to develop a standardized approach to allow a minimally invasive treatment.

TECHNIQUE:

First, an endoscopic decompression of the pouch is attempted. Subsequently, an exploratory laparoscopy is performed. If the endoscopic decompression was successful, a complete laparoscopic reduction is feasible. Once the integrity of the pouch is confirmed, a bilateral pouchopexy is performed, using multifilament interrupted sutures. Finally, the pouch patency is tested by pouchoscopy.

RESULTS:

Between December 2010 and December 2018, 151 minimally invasive restorative proctocolectomies with an IPAA were performed. Eighty-nine IPAAs were constructed with the mesentery positioned anteriorly, 35 posteriorly, and 27 on the right side. Three patients were diagnosed with an IPAA volvulus. All 3 of the patients were in the anterior group (3.4%) compared with 0 patients in the nonanterior group. One patient (33%) was treated laparoscopically, after a successful endoscopic reduction. In the other 2 cases, conversion to a laparotomy was needed because an endoscopic decompression could not be achieved.

CONCLUSION:

An endoscopic decompression was required to allow a laparoscopic treatment, and a bilateral pouchopexy was needed to avoid recurrence. This standardized approach might be a good treatment option, and we are awaiting additional follow-up to determine its long-term durability. In addition to the already described risk factors (minimally invasive technique, female sex, and low BMI), an anterior positioning of the pouch mesentery might be a potential risk factor as well for pouch volvulus. However, these observations should be carefully interpreted, considering the small number of cases.
Identification of Collagenolytic Bacteria in Human Samples: Screening Methods and Clinical Implications for Resolving and Preventing Anastomotic Leaks and Wound Complications
Authors: Guyton Kristina L. , Levine Zoe C. , Lowry Ann C. , Lambert Laura , Gribovskaja-Rupp Irena , Hyman Neil , Zaborina Olga , Alverdy John
Published: July 2019

BACKGROUND:

Bacteria that produce collagen-digesting enzymes (collagenolytic bacteria) have been shown to play a critical and previously unappreciated role in anastomotic leak pathogenesis by breaking down host tissue extracellular matrix proteins. Detection of these bacteria is labor intensive, and no screening method currently exists.

OBJECTIVES:

We evaluated a rapid screening method developed to detect the presence of these collagenolytic bacteria in clinical samples, such as drain fluid, anastomotic tissue, or feces.

DESIGN:

We compared a new method of detecting collagenolytic bacterial species with a previously used technique using samples from a murine experimental model and then demonstrated the utility of this screening method in samples from patients with anastomotic complications.

SETTINGS:

All of the laboratory work and previous murine experiments were performed in Dr Alverdy’s laboratory at the University of Chicago under institutional review board–approved protocols.

PATIENTS:

Samples from patients with challenging wound complications were provided by participating clinicians with verbal patient consent. Given the small number of patients, this was determined to be institutional review board exempt.

MAIN OUTCOME MEASURES:

Whether this analysis can influence patient management and outcomes will require additional study.

RESULTS:

This screening method detects numerous strains of bacteria with collagenolytic properties, including the collagenolytic species that have been implicated previously in anastomotic leak. Once collagenolytic strains are identified, they can be speciated and tested for antibiotic resistance using standard laboratory techniques.

LIMITATIONS:

This study is limited by the small number of patient samples tested.

CONCLUSIONS:

We demonstrated the potential applicability of this assay to evaluate rare and complex anastomotic complications that often require analysis beyond standard culture and sensitivity assays. Future applications of this method may allow the development of strategies to prevent anastomotic leak related to collagenolytic bacteria. See Video Abstract at http://links.lww.com/DCR/A962.
Emergency Surgery for Obstructive Colon Cancer in Elderly Patients: Results of a Multicentric Cohort of the French National Surgical Association
Authors: Manceau Gilles , Mege Diane , Bridoux Valérie , Lakkis Zaher , Venara Aurélien , Voron Thibault , Sielezneff Igor , Karoui Mehdi
Published: July 2019

BACKGROUND:

Although elderly patients constitute most of the patients undergoing surgery for obstructed colon cancer, available data in the literature are very limited.

OBJECTIVE:

The purpose of this study was to assess the management and outcomes of elderly patients treated for obstructed colon cancer.

DESIGN:

This was a multicenter, retrospective cohort study.

SETTINGS:

Between 2000 and 2015, 2325 patients managed for an obstructed colon cancer in member centers of the French National Surgical Association were identified. Data were collected by each center on a voluntary basis after institutional approval. Bowel obstruction was defined clinically and confirmed by imaging.

PATIENTS:

Three age groups were defined, including patients <75 years, 75 to 84 years, and ≥85 years.

MAIN OUTCOME MEASURES:

Postoperative and oncologic results in elderly patients with an obstructed colon cancer were measured. Relative survival was calculated as the ratio of the overall survival with the survival that would have been expected based on the corresponding general population.

INTERVENTIONS:

A total of 302 patients (13%) underwent colonic stent insertion, and 1992 (87%) underwent surgery as emergency procedure.

RESULTS:

A total of 2294 patients were analyzed (<75 y, n = 1200 (52%); 75–84 y, n = 650 (28%); and ≥85 y, n = 444 (20%)). Elderly patients were more likely to be women (p < 0.0001), to have proximal colon cancer (p < 0.0001), and to have a higher incidence of comorbidities (p < 0.0001). The use of colonic stent or the type of surgery was identical regardless of age. In patients with resected colon cancer, elderly patients had less stage IV disease (p < 0.0001). The absence of tumor resection (p < 0.0001) and definitive stoma rate increased with age (p < 0.0001). Postoperative mortality and morbidity were significantly higher in elderly patients (p < 0.0001), but surgical morbidity was similar across age groups (p = 0.60). Postoperative morbidity was correlated to the 6-month mortality rate in elderly (p < 0.0001). Overall and disease-free survivals were significantly lower in more elderly patients (p < 0.0001) but relative survival was not (p = 0.09).

LIMITATIONS:

It is quite difficult to know how to interpret these data as a whole, given the inherent bias in the study population, lack of ability to stratify by performance status, and long study period duration.

CONCLUSIONS:

Elderly patients have high morbidity with lower survival in the highest age ranges of elderly subgroups. These data should be considered when deciding on an operative approach. See Video Abstract at http://links.lww.com/DCR/A964.
Functional and Aesthetic Reconstruction for Microtia Using the Combination of Superficial Circumflex Iliac Artery Perforator Superthin Flap Transfer and Skin Grafting
Authors: Karakawa Ryo , Iida Takuya , Yoshimatsu Hidehiko , Kanayama Koji , Yamasoba Tatsuya
Published: July 2019

Microtia with congenital aural atresia is challenging to achieve aesthetically and functionally good results. We herein present a case where a vascularized superthin superficial circumflex iliac artery perforator (SCIP) flap was used for reconstruction of the external auditory canal (EAC) and a full-thickness skin graft was used for reconstruction of the postauricular region for a 10-year-old male who suffered from microtia with congenital aural atresia. After costal cartilage grafting (the first operation), EAC reconstruction and auricle elevation (the second surgery) was performed. After the atticoantrostomy, a superthin SCIP flap was rolled up in a sac and was inset to the newly created EAC. The postauricular skin defect was covered with full-thickness skin graft. The SCIP flap survived completely and good patency of the reconstructed EAC was accomplished, which results in an improvement of previous hearing loss. The skin graft survived completely, which eventually demonstrated aesthetically satisfactory results.
The Buccal Fat Pad: A Case Report and Retrospective Case Series
Authors: Weniger Frederick G. , Weidman Allan A.
Published: July 2019

Buccal fat contributes significantly to the contour of the face, but the contribution of buccal fat is often neglected on examination and in surgery. A case of isolated buccal fat removal is examined. Previous literature relevant to this case is discussed and the author’s experience from 10 subsequent lower facial rejuvenation surgeries combined with buccal fat reductions is presented with suggestions.
Streamlining Regulatory Activities Within Radiation Therapy Departments Using QATrack+
Authors: Angers Crystal , Bottema Ryan , Buckley Lesley , Studinski Ryan , Petzold Don , Abbassian Farhoud , Taylor Randy
Published: July 2019

Radiation therapy departments are faced with the challenge of tracking numerous quality control tests as well as monitoring service events affecting radiation therapy treatment units. Service events, in particular, pose a challenge since the clinic must be able to provide evidence to the regulatory body that both the service work and any required follow-up tests were recorded and authorized by the appropriate staff. This article presents an integrated approach to tracking quality control tests and service event logs using QATrack+. The newly developed version of this quality assurance software integrates quality control tracking with the service event log, allowing a direct link between a service event and any initiating routine tests or follow-up tests that are performed. This improves the ability of a licensee to ensure compliance with regulations and permits a simple platform from which to access all machine equipment tests and service events. Furthermore, this improves the ability of a department to assess the service record of equipment and to identify trends in failure modes.
BUCKLE-ASSOCIATED EPITHELIAL CYST MASQUERADING AS INTRAOCULAR INFLAMMATION
Authors: Crowell Eric , Stroh Inna , Wenick Adam , Burkholder Bryn
Published: July 2019

Background/Purpose:

To describe a case of a rare, late scleral buckle-related complication, which was masquerading as ocular inflammation.

Methods:

Case report.

Results:

A 63-year-old woman with ocular history significant for cataract extraction with intraocular lens placement and retinal detachment repaired through pars plana vitrectomy and scleral buckle presents with anterior chamber inflammation and debris in the left eye. Uveitis workup was negative for any associated systemic disease. Anterior chamber washout and biopsy were nondiagnostic. At postoperative Month 1, she had recurrent anterior chamber debris and new debris noted in the vitreous cavity. A pars plana vitrectomy was performed, and during intraoperative scleral depression, copious strands of whitish material were expressed into the vitreous cavity. The scleral buckle was removed with additional whitish material noted within the encapsulated area. Papanicolaou stain of the material demonstrated a mixture of epithelial cells, histiocytes, lymphocytes, plasma cells, and neutrophils consistent with an epithelial cyst.

Conclusion:

Epithelial inclusion cysts are a rare complication of scleral buckle placement. These cysts are lined by a nonkeratinized, stratified squamous epithelium with or without goblet cells and most commonly occur after ocular trauma, inflammation, or surgical procedures. To the best of our knowledge, this is the first reported case of erosion of an epithelial inclusion cyst into the vitreous cavity.
ACUTE MACULAR EDEMA WITH SEROUS RETINAL DETACHMENT AFTER CATARACT SURGERY IN A VITRECTOMIZED EYE: A CASE REPORT
Authors: Bryan Eric A. , Cruz-Iñigo Yousef J. , Brems Robert N. , Bryan J. Shepard
Published: July 2019

Purpose:

To present the first case of acute macular edema with serous retinal detachment after cataract surgery in a vitrectomized eye.

Methods:

A 63-year-old female patient, with history of pars plana vitrectomy and epiretinal membrane removal, underwent uneventful phacoemulsification surgery with injection of standard intracameral dose of cefuroxime (1 mg/0.1 mL of solution) at the end of the procedure.

Results:

First day after cataract surgery, visual acuity did not correlate with anterior segment findings, and funduscopic eye examination revealed acute macular edema with serous retinal detachment, which was confirmed by spectral domain optical coherence tomography. Fluorescein angiography showed no retinal or choroidal hyperpermeability. At 2-week follow-up visit, visual acuity had significantly improved, and there was complete resolution of macular edema and subretinal fluid.

Conclusion:

The current case suggests that acute macular edema with serous retinal detachment after cataract surgery with standard cefuroxime prophylaxis can occur even in vitrectomized eyes. A high level of suspicious is needed when visual acuity does not correlate with anterior segment findings immediately after cataract surgery. Similar to reports from nonvitrectomized eyes, visual prognosis was favorable.
Effect of Life Review on Quality of Life in Terminal Patients: A Systematic Review and Meta-Analysis
Authors: HUANG Mei-Hua , WANG Ruey-Hsia , WANG Hsiu-Hung
Published: July 2019

Background

Enhancing quality of life takes precedence in the terminal stage of a disease, when a cure is considered impossible and all alternative methods to prevent disease progression have been exhausted. Life review, involving appreciating accomplishments and resolving conflicts, is widely considered to be an effective approach to bringing peace to terminal patients.

Purpose

This study was conducted to assess the effects of life review on quality of life in terminal patients.

Methods

The Cochrane Library, PubMed, MEDLINE, CINAHL, CEPS, and ProQuest databases were searched for original studies published between 2007 and July 2018. Studies that used experimental designs to assess the effects of life review on quality of life in terminal patients, involved patients aged >18 years, and were published in English or Chinese were considered eligible for inclusion. Studies that measured quality of life in individuals other than patients as well as unpublished papers or data were excluded. The search terms used included “life review,” “end of life,” “terminal or terminally ill,” “advanced cancer,” “palliative,” “hospice,” and “quality of life.” The quality of each included study was assessed using the Downs and Black checklist.

Results

Six studies with 296 patients were included in the review. The participants in the included studies were from multiple countries. Life review was found to affect quality of life significantly (95% CI [0.147, 0.668], Z = 3.062, p < .05). The selected studies exhibited moderate heterogeneity (I
2 = 42.407, p > .1).

Conclusions

Life review was found to affect quality of life significantly in the participants in the included studies. The feasibility and safety of applying life review interventions should be considered for terminal patients, and implementers of these interventions should be trained and qualified. Only a few studies in the literature have evaluated the effects of life review therapy in terminal patients. Further studies that use stricter selection criteria are necessary to evaluate the efficacy of the life review intervention before its adoption in clinical practice.
Trauma Team Activation: Accuracy of Triage When Minutes Count
Authors: Schwing Lisa , Faulkner Tyneida Diane , Bucaro Pamela , Herzing Karen , Meagher David P. , Pence Jeffrey
Published: July 2019

Accuracy and timeliness of trauma activations are vital to patient safety. The American College of Surgeons mandates the trauma surgeon's presence within 15 min of the patient's arrival to the emergency department (ED) 80% of the time. In 2015, at this Level II Pediatric Trauma Center, average mean activation times were approximately 16 min and activation accuracy (over- and undertriage) affected 27% of the trauma patient activations. This evidence-based quality improvement project set out to determine the most efficient method of Emergency Medical Services (EMS) intake. Communication Center (Com. Center) recordings were carefully reviewed to identify time when EMS notifies the Com. Center and actual time of trauma activation page. A timeline was formulated with assessment of time to activation and patient triage accuracy. An educational curriculum was developed as an intervention for the Com. Center staff. Education included a decision tree for trauma activations and the development of templates for our electronic health record and prompts to improve accurate activations. After additional focus groups analyzed present ED performance and the industry standard, a policy requiring only paramedic-trained staff was put in place. After implementation of the aforementioned intervention, the Com. Center performance revealed reduction in incorrect activations from 27.3% to 10.7% from 2015 to 2016. Mean activation time in January 2015 was 48.5 min before the intervention and 4.71 min postintervention in December 2016; this is a staggering reduction in activation times of 90%!
Factors associated with functional recovery in Japanese patients with convalescent stroke stratified by age: a multicenter observational study
Authors: Kimura Yosuke , Ohji Shunsuke , Ishiyama Daisuke , Nishio Naohito , Otobe Yuhei , Suzuki Mizue , Ogawa Hideyuki , Ichikawa Takeo , Taguchi Ryota , Shino Shuhei , Tanaka Shu , Yamada Minoru
Published: July 2019

Factors associated with functional recovery after stroke may differ by age demographics because the aging process leads to various regressive changes. The aim of this study was to identify factors related to functional recovery in Japanese patients with convalescent stroke stratified by age. A multicenter retrospective observational study was conducted in 243 patients from six convalescent inpatient rehabilitation wards. Participants were categorized into three groups: 40–64, 65–74, and ≥75 years. Demographic data, laboratory data, physical function, and cognitive function were collected upon admission, and outcome measures were represented using the relative gain of the Functional Independence Measure (FIM effectiveness) during hospitalization. Stepwise multivariate logistic analysis was performed to identify the significant factors for functional recovery in each group. In the 40–64 years group, stroke type [odds ratio (OR), 10.38; 95% confidence interval (CI), 2.22–48.59], spatial neglect (OR, 7.61; 95% CI, 2.07–28.00), and memory disorder (OR, 4.68; 95% CI, 1.08–20.30) were shown to be significant factors. In the 65–74 years group, only memory disorder (OR, 3.42; 95% CI, 1.19–9.81) was significant. In the ≥75 years group, low albumin level (OR, 3.35; 95% CI, 1.05–10.67), severe motor impairment (OR, 5.11; 95% CI, 1.14–22.97), and memory disorder (OR, 4.34; 95% CI, 1.43–13.23) were significantly related to poor functional recovery. In conclusions, the findings showed that there were different trends among the factors related to poststroke functional recovery among the three age groups.
Functional improvement after severe brain injury with disorder of consciousness paralleling treatment for comorbid obstructive sleep apnoea: a case report
Authors: Silva Marc A. , Schwartz Daniel J. , Nakase-Richardson Risa
Published: July 2019

Survivors of brain injury who have disorders of consciousness often have chronic functional deficits and disability. Obstructive sleep apnoea, a sleep-related breathing disorder, is a medical comorbid condition common among persons with brain injury and is injurious to health. Research on obstructive sleep apnoea treatment among brain-injured patients–particularly persons with disorders of consciousness–is sparse. This case study describes a patient with severe brain injury admitted for neurorehabilitation in a minimally conscious state. Obstructive sleep apnoea was identified and treated. Treatment compliance was variable, and functional motor and cognitive improvement were observed during periods of better compliance. Study design does not permit casual attribution for functional improvement, but identification and treatment of obstructive sleep apnoea are suggested as a possible way to promote recovery after brain injury.
A Cluster of Failures of Midline Catheters in a Hospital in the Home Program: A Retrospective Analysis
Authors: Dickson Hugh G. , Flynn Olivia , West Dana , Alexandrou Evan , Mifflin Nicholas , Malone Matthew
Published: July 2019

A cluster of 11 midline catheter failures occurred during a 2-week period in a Hospital in the Home program in an urban tertiary hospital in Australia. These failures prompted a 4-month retrospective audit of patients receiving outpatient antimicrobial therapy between December 1, 2016 and March 1, 2017. Primary outcomes were dwell time and catheter failure. Peripherally inserted central catheters had significantly fewer failures and significantly longer dwell times compared with midline catheters. Women experienced higher rates of midline catheter failure than men. The proportion of patients with midline catheters receiving continuous infusions who experienced a failure was markedly higher than those receiving bolus doses. Suggestions for further related research are discussed.
Application of a 5 Marker Panel to the Routine Diagnosis of Peripheral T-Cell Lymphoma With T-Follicular Helper Phenotype
Authors: Basha Basma M. , Bryant Sandra C. , Rech Karen L. , Feldman Andrew L. , Vrana Julie A. , Shi Min , Reed Katelyn A. , King Rebecca L.
Published: July 2019

The 2017 World Health Organization update introduced a new category of nodal peripheral T-cell lymphoma with T-follicular helper phenotype (PTCL-TFH) defined by expression of at least 2 or 3 TFH markers. Our study assesses the utility of an immunohistochemical panel of 5 TFH markers (CD10, BCL6, PD-1, CXCL13, and ICOS) for identification of TFH phenotype in angioimmunoblastic T-cell lymphoma (AITL) and PTCL not otherwise specified (NOS). Immunohistochemical for the 5 markers was performed on 22 cases of AITL and 29 cases of PTCL-NOS. Cases were reviewed for morphologic features characteristic of AITL. All AITL cases showed expression of ≥2 TFH markers. This panel resulted in reclassification of 41% PTCL-NOS cases to PTCL-TFH. Positive percent agreement for the TFH phenotype is 97% for PD1, 94% for ICOS, 44% for CD10 and CXCL13, and 29% for BCL6. Negative percent agreement for TFH phenotype is 100% for CD10, BCL6, and CXCL13, 82% for ICOS and 71% for PD1. AITL cases were more likely than PTCL-TFH cases to contain expanded CD21-positive follicular dendritic cell meshworks, clear cell cytology and polymorphous inflammatory background; however, there was a significant (P<0.005) Kruskal-Wallis trend in all morphologic variables between the 3 groups suggesting a continuum from PTCL-NOS to PTCL-TFH to AITL. The median number of morphologic features of AITL also correlated significantly with number of TFH markers positive (Spearman coefficient ρ=0.759). In summary, the stain panel chosen will have an impact on cases classified as PTCL-TFH. This entity may exist along a spectrum between PTCL-NOS and AITL.
The Morphologic Features of Primary Epstein-Barr Virus Infection in the Gastrointestinal Tract
Authors: Tian Sufang , Westbrook Lindsey M. , Xiao Shu-Yuan , Zhang Yanlin , Huang Yan , Wang Hanlin L.
Published: July 2019

Epstein-Barr virus (EBV) is a herpes virus that has been shown to contribute to the development of multiple tumor types. There are isolated reports on EBV infection in the gastrointestinal tract, but, notably, there are none with detailed descriptions of the morphologic features. It is believed to be difficult to generalize the histologic features, as EBV does not cause viral inclusions in infected cells. This study was aimed at describing the pathologic changes of nonlymphomatous gastrointestinal EBV lymphoproliferative diseases in both immunocompetent and immunocompromised settings; the former was focused on chronic active EBV infection, and the latter was about the infection in posttransplantation patients. A retrospective search identified a total of 26 cases of EBV lymphoproliferative disease in the gastrointestinal tract—8 in immunocompetent patients and 18 in immunocompromised patients. We found that there was no difference in pathologic findings in immunocompetent and immunocompromised patients, which ranged from essentially subtle to severe mucosal architectural distortion with prominent lymphoid aggregates. Most cases showed either focal or diffuse lymphocytic infiltration comprised of small to intermediate-sized lymphocytes with a round shape and increased cytoplasm when compared with mature small lymphocytes. Focal lymphoepithelial lesions and karyorrhexis can be seen. Although gastrointestinal primary EBV lymphoproliferative diseases are not common, the mortality is high. Awareness of the potential histologic features combined with suspicion of EBV infection from clinical presentation, radiographic findings, and/or EBV serologies can aid in the diagnosis of primary EBV infection in the gastrointestinal tract.