bluuebunny/crossref_metadata_2025 huggingface dataset:
Antral Wall Approach for Reconstruction of Orbital Floor Fractures Using Anterior Maxillary Sinus Bone Grafts
Authors: Emodi Omri , Nseir Saleh , Shilo Dekel , Srouji Hanna , Rachmiel Adi
Published: March 2018

Isolated orbital wall fractures account for 4% to 16% of all facial fractures. Even a modest change in the position of the bony walls can have a significant impact on orbital volume and globe position. Alloplastic materials or autogenous bone grafts such as the antral maxillary wall can be used to reconstruct small- to medium-size orbital fractures. The main advantage of an antral wall graft is the intraoral approach with minimal morbidity. Nine patients underwent repair of orbital floor fractures using the extraoral and the intraoral antral wall approach. The patients underwent preoperative computed tomography imaging and a minimum of 1 year follow-up. The size of the defects ranged from 0.5 to 1.4 cm. Two patients experienced minor immediate postoperative complications; infraorbital hypoesthesia. On follow-ups, none of our patients suffered from ocular movement restrictions or complications regarding the maxillary antral wall approach. The use of harvested bone grafts from the anterolateral wall of the maxillary sinus is a promising approach for the reconstruction of small- to mid-size orbital floor defects with minimal complications and excellent cosmetic and functional results.
Three-Dimensional Virtual Treatment Planning: Presurgical Evaluation
Authors: Farronato Giampietro , Galbiati Guido , Esposito Luca , Mortellaro Carmen , Zanoni Federica , Maspero Cinzia
Published: March 2018

Objective:

This article describes a virtual protocol designed to optimize surgical orthodontic diagnosis and treatment plan.

Methods:

A total of 15 patients undergoing orthodontic-surgical treatment have been analyzed with a presurgical virtual three-dimensional (3D) treatment planning, which involves 9 steps. All the patients have been treated with the use of occlusal splint guides projected on the basis of the surgical and orthodontic visualized treatment objective .

Results:

In all the analyzed patients, a precise and optimal orthodontic presurgical preparation has been obtained.

Conclusions:

The 3D analysis seems more precise to interpret than two-dimensional; it provides information and images of craniofacial structures free from perspective distortion and it reduces the steps of the presurgical diagnosis. The simplicity of the protocol described in this paper makes possible to apply it in everyday practice.

The study described here allows high-precision planning of orthodontic-surgical therapy and optimization of each treatment phase, with consequent advantages in clinical practice: a more accurate orthognathic surgery with predictable results.
Anatomical Study of the Zygomaticofacial Foramen and Its Related Canal
Authors: Iwanaga Joe , Badaloni Filippo , Watanabe Koichi , Yamaki Koh-ichi , Oskouian Rod J. , Tubbs R. Shane
Published: March 2018

The zygomaticofacial branch (ZFb) of the zygomatic nerve passes through the lateral wall of the orbit anterolaterally and traverses the zygomaticofacial foramen (ZFFOUT). However, in terms of intraorbital course, only a few studies have focused on the orbital opening of the ZFb (ZFFIN) and related canal. Therefore, this study aimed to locate the orbital opening and exit of the ZFb of the zygomatic nerve. Twenty sides from 10 fresh frozen cadaveric Caucasian heads were used in this study. The vertical distance between inferior margin of the orbit and ZFFIN (V-ZFFIN), the horizontal distance between the lateral margin of the orbit and ZFFIN (H-ZFFIN), diameter of the ZFFIN (D-ZFFIN), the vertical distance between the inferior margin of the orbit and ZFFOUT (V-ZFFOUT), the horizontal distance between the lateral margin of the orbit and ZFFOUT (H-ZFFOUT), and the diameter of the ZFFOUT (D-ZFFOUT) were measured, respectively. The ZFFIN were located 5.1 ± 2.0 mm superior to the inferior margin of the orbit and 4.3 ± 1.6 mm medial to the lateral margin of the orbit. The ZFFOUT was located 1.2 ± 2.9 mm inferior to the inferior margin of the orbit and 1.1 ± 3.0 mm lateral to the lateral margin of the orbit. The diameter of the ZFFOUT was significantly larger than that of the ZFFIN. Additional knowledge of the zygomatic nerve and its branches might decrease patient morbidity following invasive procedures around the inferolateral orbit.
Does a Vascularized Fibula Free Bone Grafted Immediately After Hemimandibulectomy in a Child Grow or Relapse During Adolescence?
Authors: Okuyama Kohei , Yamashiro Masashi , Kaida Atsushi , Kawamata Aya , Mizutani Miho , Michi Yasuyuki , Uzawa Narikazu , Yano Tomoyuki , Tohyama Rei , Yamaguchi Satoshi
Published: March 2018

For young growing children before the end of skeletal maturity, the growth activity of the grafted bone after hemimandibulectomy is not well-known. After an adolescence, such a patient may have facial deformity because the anterior growth point of the mandible is in the condylar neck. A 13-year-old boy was performed hemimandibulectomy with immediate mandibular reconstruction by fibula free flap (FFF) because of a huge ameloblastic fibroma. The authors evaluated the length of FFF on the images of computed tomography (CT) at 5 and 60 months after the operation and compared them by calculating growth rates. Five years after surgery, his facial appearance was symmetry and mandibular function was satisfaction. Although the mandibular bone in the contralateral side grew during 5-year follow-up, the vascularized FFF grafted in the child patient did not significantly grow. Moreover, spontaneous regeneration (SR) and the gradual osteosclerosis were confirmed on the left distal edge of the FFF on the CT imaging. The arrival of SR at the left distal edge of the FFF was considered a part of the reason to compensate the unchanging growth rate of the grafted FFF and contribute for the postoperative good functional and esthetic results.
Long-Term Outcomes of Acellular Dermal Allograft as a Tarsal Substitute in the Reconstruction of Extensive Eyelid Defects
Authors: Vahdani Kaveh , Siapno Debrelle Lou , Lee Jung Hye , Woo Kyung In , Kim Yoon-Duck
Published: March 2018

Purpose:

To report the long-term outcomes of using acellular dermal allograft (ADA) as a tarsal substitute for reconstruction of large full-thickness eyelid defects where ipsilateral or contralateral eyelid donor tissue was either not available or tarsoconjunctival transfer was insufficient to cover the full extent of the defect.

Methods:

A retrospective review of a consecutive series of 10 patients between May 2003 and April 2012. Main outcome measures were anatomical and functional outcomes and complications.

Results:

The study cohort included 4 males and 6 females with a mean age of 48.1 years (range 31–64 years). Indications for reconstruction were extensive full-thickness eyelid defects (upper or lower or both) resulting from tumor excision (n = 6), traumatic eyelid defect (n = 2), electrical burn (n = 1), and eyelid necrosis (n = 1). The mean postoperative follow-up was 84.3 months (range 33–164 months). The reconstructive procedure included a variety of techniques using ADA as the posterior lamellar graft. Overall, 7 patients achieved excellent anatomical, cosmetic, and functional results. Reoperation was required in 3 patients (for postoperative upper lid retraction, upper lid entropion, and lower fornix reconstruction) despite acceptable initial results. There were no intraoperative complications, postoperative allergic or immunologic rejection associated with the use of allograft, nor any long-term sequelae.

Conclusion:

The extensive upper and lower eyelid defects with large vertical component can be successfully repaired using ADA as a tarsal substitute. The results of our study with long-term follow-up indicate excellent functional and cosmetic outcomes with minimal morbidity.
Determining the Patient-Specific Optimum Osteotomy Line for Severe Mandibular Retrognathia Patients
Authors: Şensoy Abdullah Tahir , Kaymaz Irfan , Ertaş Ümit , Kiki Ali
Published: March 2018

Purpose:

The purpose of this study is to suggest a patient-specific osteotomy line to optimize the distractor position and thus to minimize the disadvantages of conventional mandibular distraction osteogenesis (MDO) protocols. In addition, this study also aims to compare the conventional MDO protocols with the new MDO protocol proposed in this study in terms of both orthodontic outcomes and mechanical effects of osteotomy level on callus stabilization by means of the finite element method.

Methods:

A preoperative patient-specific 3-dimensional bone model was created and segmented by using computed tomography images of an individual patient. Virtual orthodontic set-up was applied to the segmented model prior to the virtual surgery. In order to compare the proposed osteotomy line with the conventional lines used in clinical applications, virtual surgery simulations were performed and callus tissues were modelled for each scenario. The comparison of the success of each osteotomy line was carried out based on the occlusion of the teeth.

Results:

The osteotomy line determined using the method proposed in this study has resulted in far less malocclusion than the conventional method. Namely, any angular deviation from the optimum osteotomy line determined in this study might result in deep-bite or open-bite. On the other hand, the finite element analysis results have indicated that this deviation also negatively affects the callus stability.

Conclusion:

In order to achieve a better MDO treatment in terms of occlusion of the teeth and the callus stability, the location of the osteotomy line and the distractor position can be computationally determined. The results suggest that MDO protocol developed in this study might be used in clinic to achieve a better outcome from the MDO treatment.
Craniometric Analysis of Frontal Cranial Morphology Following Posterior Vault Distraction
Authors: ter Maaten Netanja S. , Mazzaferro Daniel M. , Wes Ari M. , Naran Sanjay , Bartlett Scott P. , Taylor Jesse A.
Published: March 2018

Background:

Posterior vault distraction osteogenesis (PVDO) is believed to improve frontal contour in infants with syndromic craniosynostosis and turribrachycephaly. This study provides an objective craniometric analysis to determine how PVDO affects anterior cranial morphology.

Methods:

A retrospective chart review of patients who underwent PVDO was performed. Inclusion criteria included pre- and postoperative computed tomography (CT) scans within 3 months before surgery and another 1 to 6 months after device removal. Volumetric and craniometric data were derived using Mimics software and compared using paired t-test and Wilcoxon rank-sum test.

Results:

About 65 patients underwent PVDO, and 13 patients met inclusion criteria. Mean age at intervention was 3.4 ± 4.2 years. Total cranial volume increased 249 ± 159 cm3 in all patients (P = 0.0001) and 380 ± 128 cm3 in patients younger than 1 year of age (n = 6, P =0 .0008). Supraorbital retrusion decreased from 5.44 ± 3.89 to 4.54 ± 3.91 mm postoperatively (P = 0.0004), decreasing significantly in patients without previous frontal surgery and not in those with previous frontal surgery (P = 0.2115; comparison P = 0.0047). Basofrontal angle decreased by 2.92 ± 2.16 degrees (P = 0.0004) with a greater decrease of 3.33±2.68 degrees in those younger than 12 months (P = 0.0289) and 2.58±1.74 degrees in those older (P = 0.0079). No change was found in anterior cranial height and anterofrontal angle (P > 0.05).

Conclusion:

PVDO improves frontal contour by decreasing supraorbital retrusion and reducing frontal bossing in syndromic craniosynostosis patients with turribrachycephaly. When combined with its demonstrated efficacy for cranial expansion, these frontal changes likely reinforce PVDO's ability to influence the timing of, and to a degree, the need for frontal surgery in this group.
The Association Between the Neutrophil-to-Lymphocyte Ratio and Mortality in Patients With Acute Respiratory Distress Syndrome: A Retrospective Cohort Study
Authors: Li Weijing , Ai Xiaolin , Ni Yuenan , Ye Zengpanpan , Liang Zongan
Published: March 2018

Purpose:

Systemic inflammation relates to the initiation and progression of acute respiratory distress syndrome (ARDS). As neutrophil-to-lymphocyte ratio (NLR) has been shown to be a prognostic inflammatory biomarker in various diseases, in this study, we sought to explore whether NLR is a prognostic factor in patients with ARDS.

Methods:

A retrospective study was performed on patients diagnosed as ARDS admitted to the intensive care unit (ICU). We calculated the NLR by dividing the neutrophil count by the lymphocyte count and categorized patients into four groups based on quartile of NLR values. The association of NLR quartiles and 28-day mortality was assessed using multivariable Cox regression. Secondary outcomes included ICU mortality and hospital mortality.

Results:

A total of 224 patients were included in the final analysis. The median (interquartile range) NLRs from first quartile to fourth quartile were as follows: 6.88 (4.61–7.94), 13.06 (11.35–14.89), 20.99 (19.09–23.19), and 39.39 (32.63–50.15), respectively. The 28-day mortalities for the same groups were as follows: 10.7%, 19.6%, 41.4%, and 53.6% (P < 0.001). Cox regression analysis showed NLR was a significant risk factor predicting 28-day mortality (first quartile, reference group; second quartile, adjusted hazard ratio [HR]= 1.674, 95% confidence interval [CI], 0.462–6.063, P = 0.432; third quartile, HR = 5.075, 95% CI, 1.554–16.576, P = 0.007; fourth quartile, HR = 5.815, 95% CI, 1.824–18.533, P = 0.003). Similar trends were observed for ICU mortality and hospital mortality.

Conclusions:

High NLR was associated with the poor outcome in critically ill patients with ARDS. The NLR therefore seems to be a prognostic biomarker of outcomes in critically ill patients with ARDS. Further investigation is required to validate this relationship with data collected prospectively.
Antibiotic-induced Disruption of Intestinal Microbiota Contributes to Failure of Vertical Sleeve Gastrectomy
Authors: Jahansouz Cyrus , Staley Christopher , Kizy Scott , Xu Hongliang , Hertzel Ann V. , Coryell Jessi , Singroy Stephanie , Hamilton Matthew , DuRand Meri , Bernlohr David A. , Sadowsky Michael J. , Khoruts Alexander , Ikramuddin Sayeed
Published: March 2018

Objective:

The aim of this study was to test whether the perioperative composition of intestinal microbiota can contribute to variable outcomes following vertical sleeve gastrectomy (VSG).

Summary of Background Data:

Although bariatric surgery is the most effective treatment for obesity, metabolic outcomes are variable.

Methods:

Diet-induced obese mice were randomized to VSG or sham surgery, with or without exposure to antibiotics that selectively suppress mainly gram-positive (fidaxomicin, streptomycin) or gram-negative (ceftriaxone) bacteria on postoperative days (POD) 1-4. Fecal microbiota was characterized before surgery and on POD 7 and 28. Mice were metabolically characterized on POD 30-32 and euthanized on POD 35.

Results:

VSG resulted in weight loss and shifts in the intestinal microbiota composition relative to sham-operated mice. Antibiotic exposure resulted in sustained reductions in alpha (within-sample) diversity of microbiota and shifts in its composition. All antibiotic treatments proved to be detrimental to metabolic VSG outcomes, regardless of antimicrobial specificity of antibiotics. These effects involved functionally distinct pathways. Specifically, fidaxomicin and streptomycin markedly altered hepatic bile acid signaling and lipid metabolism, while ceftriaxone resulted in greater reduction of key antimicrobial peptides. However, VSG mice exposed to antibiotics, regardless of their specificity, had significantly increased subcutaneous adiposity and impaired glucose homeostasis without changes in food intake relative to control VSG mice.

Conclusion:

Dysbiosis induced by brief perioperative antibiotic exposure attenuates weight loss and metabolic improvement following VSG. Potential mechanisms include disruption of bile acid homeostasis and reduction in the production of gut antimicrobial peptides. Results of this study implicate the intestinal microbiota as an important contributor to metabolic homeostasis and a potentially modifiable target influencing clinical outcomes following VSG.
Mortality of the Severely Obese
Authors: Moussa Osama M. , Erridge Simon , Chidambaram Swathikan , Ziprin Paul , Darzi Ara , Purkayastha Sanjay
Published: March 2018

Objective:

This study aimed to analyze the Clinical Practice Research Datalink to identify the prognostic factors of all-cause mortality in the severely obese.

Background:

Patients who are severely obese [body mass index (BMI) ≥35 kg/m2] are at increased risk of all-cause mortality as a result of metabolic sequelae including hyperlipidemia, hypertension, and diabetes. Bariatric surgery has been shown to reduce the severity of the metabolic complications of obesity.

Method:

A case-controlled analysis was carried out of patients with a BMI of 35 kg/m2 or more from the Clinical Practice Research Datalink, a UK database of primary care clinics. Clinicopathological characteristics at baseline diagnosis were extracted. Cases of all-cause mortality were identified as a clinical endpoint. A Cox proportional hazard model was used to calculate hazard ratios (HRs) for different patient factors. A P value less than 0.050 was defined as significant.

Results:

A total of 187,061 records were identified for analysis. Median follow-up time was 98.0 months (range: 3.0–1095.0). A total of 8655(4.6%) were identified as having died during the study period. The median time from baseline obesity diagnosis until death was 137.0 months (range: 3.0–628.7). Multivariate analysis found bariatric surgery to be associated with reduced risk of all-cause mortality (HR: 0.487; P < 0.001). The following were associated with increased risk of death: male sex (HR: 1.805; P < 0.001), BMI of 60 or greater (HR: 2.541; P < 0.001), hypertension (HR: 2.108; P < 0.001), diabetes (HR: 2.766; P < 0.001), and hyperlipidemia (HR: 1.641; P < 0.001).

Conclusions:

Factors such as high BMI, diabetes, hyperlipidemia, and hypertension at first diagnosis of severe obesity were each independently associated with an increased risk of death. Bariatric surgery was shown to be associated with reduced risk of all-cause mortality. Improving access to bariatric surgery and public health campaigns can improve the prognosis of severely obese patients.
Laparoscopic Total Pancreatectomy for Chronic Pancreatitis
Authors: Gumbs Andrew A. , Daskalaki Despoina , Milone Luca
Published: March 2018

Although minimally invasive pancreatectomy has been performed increasingly for pancreatic malignancies, many authors feel that a history of pancreatitis is a contraindication to either laparoscopic or robotic-assisted pancreatectomy. Shown here is a video (Supplemental Digital Content 1, http://links.lww.com/SLE/A172) of a laparoscopic total pancreatectomy with splenectomy for chronic pancreatitis. This patient was denied auto-islet cell transplantation because of insurance restraints. In total, 4 laparoscopic total pancreatectomies have been attempted and completed. Indications for laparoscopic total pancreatectomy have been 2 for diffuse intraductal papillary mucinous neoplasm, 1 for pancreatic adenocarcinoma, and the above-mentioned patient. No patient suffered a biliary leak, and the average length of stay was 5 days (range, 4 to 8 d). History of pancreatitis is a relative contraindication to minimally invasive pancreatectomy. It should be performed by surgeons with expertise in both open and minimally invasive pancreatic surgery.
The combined utility of extended focused assessment with sonography for trauma and chest x-ray in blunt thoracic trauma
Authors: Schellenberg Morgan , Inaba Kenji , Bardes James M. , Orozco Nicholas , Chen Jessica , Park Caroline , Kang Tarina , Demetriades Demetrios
Published: March 2018

BACKGROUND

Portable chest x-ray (CXR) and extended focused assessment with sonography for trauma (EFAST) screen patients for thoracic injury in the trauma bay. It is unclear if one test alone is sufficient, if both are required, or if the two investigations are complementary. Study objectives were to define the combined diagnostic yield of EFAST and CXR among stable blunt thoracic trauma patients and to determine if a normal EFAST and CXR might obviate the need for computed tomography (CT) scan of the chest.

METHODS

All blunt trauma patients 15 years or older presenting to LAC+USC Medical Center in 2016 were screened. Only patients who underwent CT thorax were included. Patients were excluded if they presented more than 24 hours after injury, were transferred, or if they did not undergo EFAST and CXR. Demographics, physical examination (PEx) of the thorax, injury data, investigations, procedures, and outcomes were collected. The EFAST, CXR, and PEx findings were compared to the gold standard CT thorax to calculate the diagnostic yield of each investigation and combinations thereof in the assessment for clinically significant thoracic injury.

RESULTS

One thousand three hundred eleven patients met inclusion/exclusion criteria. Most common mechanisms of injury were motor vehicle collision (n = 385, 29%) and auto versus pedestrian trauma (n = 379, 29%). Mean Injury Severity Score was 11 (1–75), with mean Abbreviated Injury Scale chest score of 1.6 (1–6). The sensitivities of EFAST, CXR, and PEx, either individually or in combination, were less than 0.73 in the detection of clinically significant thoracic injury. The most common missed clinically significant injuries were sternal fractures, scapular fractures, clavicular fractures, and pneumothoraces. Motorcycle collisions and auto versus pedestrian traumas resulted in the highest rates of missed injury.

CONCLUSION

Even in conjunction with the physical examination, the sensitivity of EFAST+CXR in the detection of clinically significant thoracic injury is low. Therefore, if clinical suspicion for injury exists after blunt thoracic trauma, a normal EFAST+CXR is insufficient to exclude injury and CT scan of the chest should be performed.

LEVEL OF EVIDENCE

Diagnostic tests/criteria, level III.
Shock volume: Patient-specific cumulative hypoperfusion predicts organ dysfunction in a prospective cohort of multiply injured patients
Authors: McKinley Todd O. , McCarroll Tyler , Metzger Cameron , Zarzaur Ben L. , Savage Stephanie A. , Bell Teresa M. , Gaski Greg E.
Published: March 2018

BACKGROUND

Multiply injured patients are at risk of developing hemorrhagic shock and organ dysfunction. We determined how cumulative hypoperfusion predicted organ dysfunction by integrating serial Shock Index measurements.

METHODS

In this study, we calculated shock volume (SHVL) which is a patient-specific index that quantifies cumulative hypoperfusion by integrating abnormally elevated Shock Index (heart rate/systolic blood pressure ≥ 0.9) values acutely after injury. Shock volume was calculated at three hours (3 hr), six hours (6 hr), and twenty-four hours (24 hr) after injury. Organ dysfunction was quantified using Marshall Organ Dysfunction Scores averaged from days 2 through 5 after injury (aMODSD2-D5). Logistic regression was used to determine correspondence of 3hrSHVL, 6hrSHVL, and 24hrSHVL to organ dysfunction. We compared correspondence of SHVL to organ dysfunction with traditional indices of shock including the initial base deficit (BD) and the lowest pH measurement made in the first 24 hr after injury (minimum pH).

RESULTS

SHVL at all three time intervals demonstrated higher correspondence to organ dysfunction (R
2 = 0.48 to 0.52) compared to initial BD (R
2 = 0.32) and minimum pH (R
2 = 0.32). Additionally, we compared predictive capabilities of SHVL, initial BD and minimum pH to identify patients at risk of developing high-magnitude organ dysfunction by constructing receiver operator characteristic curves. SHVL at six hours and 24 hours had higher area under the curve compared to initial BD and minimum pH.

CONCLUSION

SHVL is a non-invasive metric that can predict anticipated organ dysfunction and identify patients at risk for high-magnitude organ dysfunction after injury.

LEVEL OF EVIDENCE

Prognostic study, level III.
The design of an adaptive clinical trial to evaluate the efficacy of platelets stored at low temperature in surgical patients
Authors: Krachey Elizabeth , Viele Kert , Spinella Philip C. , Steiner Marie E. , Zantek Nicole D. , Lewis Roger J.
Published: March 2018

BACKGROUND

Storage of platelets at 4°C compared with 22°C may increase both hemostatic activity and storage duration; however, the maximum duration of cold storage is unknown. We report the design of an innovative, prospective, randomized, Bayesian adaptive, “duration finding” clinical trial to evaluate the efficacy and maximum duration of storage of platelets at 4°C.

METHODS

Patients undergoing cardiac surgery and requiring platelet transfusions will be enrolled. Patients will be randomized to receive platelets stored at 22°C up to 5 days or platelets stored at 4°C up to 5 days, 10 days, or 15 days. Longer durations of cold storage will only be used if shorter durations at 4°C appear noninferior to standard storage, based on a four-level clinical hemostatic efficacy score with a NIM of a half level. A Bayesian linear model is used to estimate the hemostatic efficacy of platelet transfusions based on the actual duration of storage at 4°C.

RESULTS

The type I error rate, if platelets stored at 4°C are inferior, is 0.0247 with an 82% probability of early stopping for futility. With a maximum sample size of 1,500, the adaptive trial design has a power of over 90% to detect noninferiority and a high probability of correctly identifying the maximum duration of storage at 4°C that is noninferior to 22°C.

CONCLUSION

An adaptive, duration-finding trial design will generate Level I evidence and allow the determination of the maximum duration platelet storage at 4°C that is noninferior to standard storage at 22°C, with respect to hemostatic efficacy. The adaptive trial design helps to ensure that longer cold storage durations are only explored once substantial supportive data are available for the shorter duration(s) and that the trial stops early if continuation is likely to be futile.
Does the Use of Clean or Sterile Dressing Technique Affect the Incidence of Wound Infection?
Authors: Kent Dea J. , Scardillo Jody N. , Dale Barbara , Pike Caitlin
Published: March 2018

PURPOSE:

The purpose of this article is to examine the evidence and provide recommendations for the use of clean or sterile dressing technique with dressing application to prevent wound infection.

QUESTION:

In all persons with acute or chronic wounds, does the use of clean or sterile dressing technique affect incidence of wound infection?

SEARCH STRATEGY:

A search of the literature was performed by a trained university librarian, which resulted in 473 articles that examined any age group that dealt with application of a wound dressing using either sterile or nonsterile technique. A systematic approach was used to review titles, abstracts, and text, yielding 4 studies that met inclusion criteria. Strength of the evidence was rated using rating methodology from Essential Evidence Plus: Levels of Evidence and Oxford Center for Evidence-Based Medicine, adapted by Gray and colleagues. Johns Hopkins Nursing Evidence-Based Practice Nursing Research Appraisal Tool was used to rate the quality of the evidence.

FINDINGS:

All 4 studies reported no significant difference in the rate of wound infection when using either clean or sterile technique with dressing application. The strength of the evidence for the identified studies was identified as level 2 (1 level A, 3 level B). The study sizes were variable, and the wounds included do not represent the continuum of wounds clinically encountered across the board.

CONCLUSION/RECOMMENDATION:

Evidence indicates that the use of clean technique for acute wound care is a clinically effective intervention that does not affect the incidence of infection. There is no recommendation that can be made regarding type of dressing technique for a chronic wound due to the lack of evidence in the literature.
Insights into circovirus host range from the genomic fossil record
Authors: Dennis Tristan P.W. , Flynn Peter J. , de Souza William Marciel , Singer Joshua B. , Moreau Corrie S. , Wilson Sam J. , Gifford Robert J.
Published: March 2018

A diverse range of DNA sequences derived from circoviruses (family Circoviridae) have been identified in samples obtained from humans and domestic animals, often in association with pathological conditions. In the majority of cases, however, little is known about the natural biology of the viruses from which these sequences are derived. Endogenous circoviral elements (CVe) are DNA sequences derived from circoviruses that occur in animal genomes and provide a useful source of information about circovirus-host relationships. In this study we screened genome assemblies of 675 animal species and identified numerous circovirus-related sequences, including the first examples of CVe derived from cycloviruses. We confirmed the presence of these CVe in the germline of the elongate twig ant (Pseudomyrmex gracilis), thereby establishing that cycloviruses infect insects. We examined the evolutionary relationships between CVe and contemporary circoviruses, showing that CVe from ants and mites group relatively closely with cycloviruses in phylogenies. Furthermore, the relatively random interspersal of CVe from insect genomes with cyclovirus sequences recovered from vertebrate samples, suggested that contamination might be an important consideration in studies reporting these viruses. Our study demonstrates how endogenous viral sequences can inform metagenomics-based virus discovery. In addition, it raises doubts about the role of cycloviruses as pathogens of humans and other vertebrates.
Na/K pump: Single-channel vs. Two-access-channel
Authors: Liang P. , Mast J. , Chen W.
Published: March 2018

We re-studied the dialyzed Na/K pumps, the experimental foundation for the two-access-channel model. We found that the charge-movement pump currents, the major evidence for the two-access-channel, are only observed in certain situations. Once the stimulation pulse is high enough at low ionic concentration gradient, the backward pump currents disappeared. The two-directional charge movement pump currents become uni-directional pump currents showing that ions have passed through the channel across the cell membrane.

A modified single-channel configuration is introduced to explain the pump currents as two-way charge movement current and the one-way current. The negatively charged amino acids deeply inside the pump channel constitute a spatial array that function as a collimator to align the moving ions in the channel lumen and an energy-well for the moving cations. If the stimulation pulse cannot drive ions to overcome the ionic concentration gradient, the ions will be entrapped into the energy-well as if the pump channel is obstructed showing two separated access-channels. Once the stimulation pulse is high enough to drive ions overcoming the ionic concentration gradient, ions will pass through the channel across the cell membrane so that Na/K pumps exhibit a single channel configuration.
Cellular structure analysis based on magnetic induction finite element method simulations and measurements
Authors: Tang J. , Lu M. , Yin W.
Published: March 2018

Biological samples exhibit frequency dependent spectra caused by the dispersion mechanism which describes a phenomenon of dielectric relaxation due to the interaction between electromagnetic field and biological samples at cellular levels. Changes in cellular structure such as cellular shape, membrane thickness and integrity could affect bio-impedance spectra.

In this paper, the influence of cellular shape, membrane thickness and integrity on dielectric properties of biological cells suspension is simulated using a custom developed FEM solver. In its 2D version, the AC conduction case is simulated. In its 3D version, magnetic induction case is simulated. And a new method for calculating the equivalent complex conductivity of biological cell suspension along the eddy current direction is introduced.

Membrane integrity on beta dispersion was experimentally investigated using AC conduction (contact electrode) method on potato samples.

This suggests that bio-impedance measurements could provide indication of cellular structural changes of biological samples. This could be useful for biomedical, pharmaceutical and food inspection applications.
Direct Evidence of Effect of Glycerol on Hydration and Helix-to-Sheet Transition of Myoglobin
Authors: Hirai M. , Ajito S. , Sugiyama M. , Iwase H. , Takata S.-I. , Shimizu N. , Igarashi N. , Martel A. , Porcar L.
Published: March 2018

By using wide-angle X-ray scattering (WAXS), small-angle neutron scattering, and theoretical scattering function simulation, we have clarified the effect of glycerol on both the thermal structure transition and the hydration-shell of myoglobin. At the glycerol concentration, ≤ ∼40 % v/v, the decreasing tendency in the maximum dimension and the radius of gyration was observed by X-ray scattering. The neutron scattering result using the inverse contrast variation method directly shows the preservation of the hydration-shell density at the concentration ≤ ∼40 % v/v. This phenomenon is reasonably explained by the preferential exclusion of glycerol from the protein surface to preserve the hydration shell, as suggested by the previous studies. While, at the concentration, ≥ 50 % v/v, the opposite tendency was observed. It suggests the preferential solvation (partial preferential penetration or replacement of glycerol into or with hydration-shell water surrounding the protein surface) occurs at the higher concentration. The observed WAXS scattering data covers the distinct hierarchical structural levels of myoglobin structure ranging from the tertiary structure to the secondary one. Therefore, we have clarified the effect of glycerol on the thermal structural stability myoglobin at different hierarchical structural levels separately. Against the temperature rise, the structural transition temperatures for all hierarchical structural levels were elevated. Especially, the tertiary structure of myoglobin was more stabilized compared with the internal-structure and the helix-to-cross transition. It suggests that the protective action of glycerol on protein structures essentially results from the preservation of the preferential hydration-shell of proteins.
Monomeric streptavidin: a versatile regenerative handle for force spectroscopy
Authors: Bauer Magnus S. , Milles Lukas F. , Sedlak Steffen M. , Gaub Hermann E.
Published: March 2018

Most avidin-based handles in force spectroscopy are tetravalent biotin binders. Tetravalency presents two issues: multiple pulling geometries as well as multiple targets bound simultaneously. Additionally, such tetravalent handles require elaborate purification protocols in order to reassemble. A stoichiometric, monomeric variant of streptavidin (mcSA2) had been engineered previously. It is readily expressed and purified, and it binds biotin with a nanomolar KD. For atomic force microscopy-based single-molecule force spectroscopy (AFM-SMFS), we fused the monomeric streptavidin with a small protein domain as an experimental fingerprint and to improve solubility. A ybbR-tag was additionally included for covalent site-specific tethering. Rupture forces of the mcSA2:biotin complex were found to be in a comparable range above 150 pN at force loading rates of 1E4 pN/s as for previously published, tetravalent streptavidin:biotin systems. Additionally, when tethering mcSA2 from its C-terminus, rupture forces were found to be slightly higher than when tethered N-terminally. Due to its monomeric nature, mcSA2 could also be chemically denatured and subsequently refolded - and thus regenerated during an experiment, in case the handle gets misfolded or clogged. We show that mcSA2 features a straightforward expression and purification with flexible tags, high stability, regeneration possibilities and an unambiguous pulling geometry. Combined, these properties establish mcSA2 as a reliable handle for single-molecule force spectroscopy.
Gut microbiota density influences host physiology and is shaped by host and microbial factors
Authors: Contijoch Eduardo J. , Britton Graham J. , Yang Chao , Mogno Ilaria , Li Zhihua , Ng Ruby , Llewellyn Sean R. , Hira Sheela , Johnson Crystal , Rabinowitz Keren M. , Barkan Revital , Dotan Iris , Hirten Robert P. , Fu Shih-Chen , Luo Yuying , Yang Nancy , Luong Tramy , Labrias Philippe R. , Lira Sergio A. , Peter Inga , Grinspan Ari , Clemente Jose C. , Kosoy Roman , Kim-Schulze Seunghee , Qin Xiaochen , Castillo Anabella , Hurley Amanda , Atreja Ashish , Rogers Jason , Fasihuddin Farah , Saliaj Merjona , Nolan Amy , Reyes-Mercedes Pamela , Rodriguez Carina , Aly Sarah , Santa-Cruz Kenneth , Peters Lauren A. , Suárez-Fariñas Mayte , Huang Ruiqi , Hao Ke , Zhu Jun , Zhang Bin , Losic Bojan , Irizar Haritz , Song Won-Min , Di Narzo Antonio , Wang Wenhui , Cohen Benjamin L. , DiMaio Christopher , Greenwald David , Itzkowitz Steven , Lucas Aimee , Marion James , Maser Elana , Ungaro Ryan , Naymagon Steven , Novak Joshua , Shah Brijen , Ullman Thomas , Rubin Peter , George James , Legnani Peter , Telesco Shannon E , Friedman Joshua R. , Brodmerkel Carrie , Plevy Scott , Cho Judy , Colombel Jean-Frederic , Schadt Eric , Argmann Carmen , Dubinsky Marla , Kasarskis Andrew , Sands Bruce , Faith Jeremiah J.
Published: March 2018

To identify factors that regulate gut microbiota density and the impact of varied microbiota density on health, we assayed this fundamental ecosystem property in fecal samples across mammals, human disease, and therapeutic interventions. Physiologic features of the host (carrying capacity) and the fitness of the gut microbiota shape microbiota density. Therapeutic manipulation of microbiota density in mice altered host metabolic and immune homeostasis. In humans, gut microbiota density was reduced in Crohn’s disease, ulcerative colitis, and ileal pouch-anal anastomosis. The gut microbiota in recurrent Clostridium difficile infection had lower density and reduced fitness that were restored by fecal microbiota transplantation. Understanding the interplay between microbiota and disease in terms of microbiota density, host carrying capacity, and microbiota fitness provide new insights into microbiome structure and microbiome targeted therapeutics.
Altered Reward Processing in Abstinent Dependent Cannabis Users: Social Context Matters
Authors: Zimmermann Kaeli , Kendrick Keith M. , Scheele Dirk , Dau Wolfgang , Banger Markus , Maier Wolfgang , Weber Bernd , Ma Yina , Hurlemann René , Becker Benjamin
Published: March 2018

Public perception of cannabis as relatively harmless, alongside claimed medical benefits, have led to moves towards its legalization. Yet, long-term consequences of cannabis dependence, and whether they differ qualitatively from other drugs, are still poorly understood. A key feature of addictive drugs is that chronic use leads to adaptations in reward processing, blunting responsivity to the substance itself and other rewarding stimuli. Against this background, the present study investigated whether cannabis dependence is associated with reductions in hedonic representations by measuring behavioral and neural responses to social reward in 23 abstinent cannabis-dependent men and 24 matched non-using controls. In an interpersonal pleasant touch fMRI paradigm, participants were led to believe they were in physical closeness of or touched (CLOSE, TOUCH) by either a male or female experimenter (MALE, FEMALE), allowing the assessment of touch- and social context-dependent (i.e. female compared to male social interaction) reward dynamics.

Upon female compared to male touch, dependent cannabis users displayed a significantly attenuated increase of reward experience compared to healthy controls. Controls responded to female as compared to male interaction with increased striatal activation whereas cannabis users displayed the opposite activation pattern, with stronger alterations being associated with a higher lifetime exposure to cannabis. Neural processing of pleasant touch in dependent cannabis users remained intact.

These findings demonstrate that cannabis dependence in men is linked to similar lasting neuroadaptations in striatal responsivity to hedonic stimuli as observed for other drugs of abuse. However, reward processing deficits seem to depend on the social context.
The Invisible Maze Task (IMT): Interactive Exploration of Sparse Virtual Environments to Investigate Action-Driven Formation of Spatial Representations
Authors: Gehrke Lukas , Iversen John R. , Makeig Scott , Gramann Klaus
Published: March 2018

The neuroscientific study of human navigation has been con-strained by the prerequisite of traditional brain imaging studies that re-quire participants to remain stationary. Such imaging approaches neglect a central component that characterizes navigation -the multisensory ex-perience of self-movement. Navigation by active movement through space combines multisensory perception with internally generated self-motion cues. We investigated the spatial micro genesis during free ambulatory exploration of interactive sparse virtual environments using motion cap-ture synchronized to high resolution electroencephalographic (EEG) data as well psychometric and self-report measures. In such environments, map-like allocentric representations must be constructed out of transient, egocentric first-person perspective 3-D spatial information. Considering individual differences of spatial learning ability, we studied if changes in exploration behavior coincide with spatial learning of an environment. To this end, we analyzed the quality of sketch maps (a description of spatial learning) that were produced after repeated learning trials for differently complex maze environments. We observed significant changes in active exploration behavior from the first to the last exploration of a maze: a decrease in time spent in the maze predicted an increase in subsequent sketch map quality. Furthermore, individual differences in spatial abilities as well as differences in the level of experienced immersion revealed an impact on the quality of spatial learning. Our results demonstrate the feasibility to observe behavioral changes associated with spatial learning, opening the way to the study of cortical dynamics of navigation.
Tolerogenic transcriptome landscape in CD8+ T lymphocytes after exposure to erythrocyte-targeted antigens
Authors: Grimm Alizée J. , Gobet Cédric , Diaceri Giacomo , Quaglia-Thermes Xavier , Hubbell Jeffrey A.
Published: March 2018

Our group has recently shown induction of antigen-specific T cell tolerance through targeting of the antigen to erythrocytesin situ. The tolerogenic state is characterized by initial proliferation of antigen-specific T cells and subsequent acquisition of signatures associated with both deletional, anergic and regulatory T cell phenotypes. In this study we wished to further understand the molecular mechanisms behind induction of tolerance by erythrocyte-targeted antigens. RNA sequencing was performed to determine how gene expression response is regulated in tolerized ovalbumin-specific CD8+ T cells and which molecular pathways are activated after treatment with this technology. Treatment with erythrocyte-targeted antigens led to the upregulation of genes encoding several TCR co-inhibitory receptors such as CTLA4, PD1, LAG3, TIGIT and CD200R1, and lack of upregulation of cytotoxic and pro-inflammatory signaling molecule genes. Modulation in expression of the master transcription factorsEgr2/NFatc1, Nur77family andE2f1was also observed, all known to be associated with the natural process of establishment of peripheral tolerance. Expression of these genes differed in response to treatment with soluble ovalbumin or SIINFEKL MHCI peptide, suggesting a specific mechanism of T cell modulation and tolerance induction in response to the erythrocyte-associated forms.
NeuroMTL iSEG challenge methods
Authors: Fonov Vladimir S. , Doyle Andrew , Evans Alan C. , Collins D. Louis
Published: March 2018

We propose a tissue classification method for MRI scans of 6-month old infants, and used it to process the iSeg-2017 challenge data. The method relies on a deep-learning 3D U-Net network, trained with MRI scans of 216 infants, aged 6-24 months, from the ACE-IBIS longitudinal database.
Microtubule minus-end aster organization is driven by processive HSET-tubulin clusters
Authors: Norris Stephen R. , Jung Seungyeon , Singh Prashant , Strothman Claire E. , Erwin Amanda L. , Ohi Melanie D. , Zanic Marija , Ohi Ryoma
Published: March 2018

Higher-order structures of the microtubule (MT) cytoskeleton are comprised of two architectures: bundles and asters. Although both architectures are critical for cellular function, the molecular pathways that drive aster formation are poorly understood. Here, we study aster formation by human minus-end directed kinesin-14 (HSET/KIFC1). We show that HSET is incapable of forming asters from pre-formed, non-growing MTs, but rapidly forms MT asters in the presence of soluble tubulin. HSET binds soluble (non-polymer) tubulin via its N-terminal tail domain to form heterogeneous HSET-tubulin “clusters” containing multiple motors. Cluster formation induces motor processivity and rescues the formation of asters from non-growing MTs. We then show that excess soluble tubulin stimulates aster formation in HeLa cells overexpressing HSET during mitosis. We propose a model where HSET can toggle between MT bundle and aster formation in a manner governed by the availability of soluble tubulin.
Spatial and temporal PCP protein dynamics coordinate cell intercalation during neural tube closure
Authors: Butler Mitchell T. , Wallingford John B.
Published: March 2018

Planar cell polarity (PCP) controls the convergent extension cell movements that drive axis elongation in all vertebrates. Though asymmetric localization of core PCP proteins is central to their function, we currently understand little about PCP protein localization as it relates to the subcellular behaviors that drive convergent extension. Here, we have used high magnification time-lapse imaging to simultaneously monitor cell intercalation behaviors and the localization of the PCP proteins Prickle2 and Vangl2. We observed the expected asymmetric enrichment of PCP proteins, but more interestingly, we also observed tight temporal and spatial correlation of PCP protein enrichment with contractile behavior in cell-cell junctions. These patterns of localization were associated with similar pattern of protein turnover at junctions as assessed by FRAP. In fact, dynamic enrichment of PCP proteins was linked more strongly to junction behavior than to spatial orientation. Finally, recruitment of Prickle2 and Vangl2 to cell-cell junctions was temporally and spatially coordinated with planar polarized oscillations of actomyosin enrichment, and all of these dynamic relationships were disrupted when PCP signaling was manipulated. Together, these results provide a dynamic and quantitative view of PCP protein localization during convergent extension and suggest a complex and intimate link between the dynamic localization of core PCP proteins, actomyosin assembly, and polarized junction shrinking during cell intercalation of the closing vertebrate neural tube.