bluuebunny/crossref_metadata_2025 huggingface dataset:
Religious Insanity
Authors: Geppert Cynthia M.A.
Published: August 2019

Among the more common admission diagnoses of patients admitted to 19th century American asylums that have now disappeared completely from the psychiatric nosology is “religious insanity.” This article presents a review of the historical and sociological research, which suggests the theory that religious belief and practice was a common cause of insanity, hence the diagnosis of “religious insanity.” The way in which the diagnosis developed at the intersection of Protestant revival movements and the growth of modern asylum psychiatry in the United States, and thereby served several important functions in psychiatry and society, is discussed. The article concludes with reflections on how the rise and fall of the theory of religion as a primary cause or contributor to insanity in the 19th century mirrors the often conflicted relationship between religion and psychiatry in modern history and the difficulty in drawing scientifically reliable and morally justifiable lines between spiritual experience and mental illness in any cultural period.
Melancholia
Authors: Martino Diego J. , Szmulewicz Alejandro G. , Valerio Marina P. , Parker Gordon
Published: August 2019

We sought to identify clinical features that best discriminate melancholia from nonmelancholic depressive conditions. An extensive review of studies using latent factor models that identified a melancholic depression dimension/factor was undertaken. Clinical variables extracted from these studies were analyzed in terms of their contribution to a diagnosis of melancholia and their consistency across studies. Psychomotor retardation and mood nonreactivity were the most relevant clinical features for the identification of melancholic depressions. Other clinical features commonly described as weighted to melancholia, such as anhedonia, psychomotor agitation, late insomnia, or appetite/weight loss, seemed less useful in distinguishing these subtypes of depression. Study results are considered in relation to the potential limitations of current operational definitions of melancholia, and how symptom sets could be modified.
Traumatic Hystero-Neurasthenia in Professor Charcot's Leçons du Mardi
Authors: Yrondi Antoine , Taib Simon , Dupuch Laetitia , Schmitt Laurent , Very Etienne , Birmes Philippe
Published: August 2019

At the end of the 19th century, several authors became interested in the physical and psychological symptoms resulting from traumatic life events. Oppenheim presented 42 detailed clinical observations. He suggested the term “traumatic neurosis.” Charcot, who was interested in male hysteria, published over 20 cases of traumatic hysteria between 1878 and 1893. The symptoms were considered to have a dynamic or functional origin. The role of horror and terror during the trauma was emphasized. However, Charcot opposed the idea of traumatic neuroses as specific syndromes as he considered them to be only an etiological form of hystero-neurasthenia. InThe Tuesday Lessons(Les Leçons du Mardi), he presents several observations. They are surprising when compared with the current criteria for posttraumatic stress disorder (PTSD). Although he had rejected this new entity, a hundred years before the appearance of theDiagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, Charcot described most of the symptoms mentioned for a diagnosis of PTSD such as intrusion (reliving the trauma, nightmares, and severe emotional distress), avoidance, negative changes in thinking and mood (negative thoughts, lack of interest, etc.), arousal, and reactivity (trouble sleeping, trouble concentrating, being easily startled or frightened, irritability, etc.).
Macrocystic (Mammary Analogue) Secretory Carcinoma
Authors: Hernandez-Prera Juan C. , Holmes Brittany J. , Valentino Alessandro , Harshan Manju , Bacchi Carlos E. , Petersson Fredrik , Liu Kenian K. , Najfeld Vesna , Wenig Bruce M.
Published: August 2019

Mammary analogue secretory carcinoma (MASC) is a relatively recently described salivary gland adenocarcinoma characterized by ETV6-NTRK3 gene fusion and in most cases indolent clinical behavior. The majority of tumors show an admixture of microcystic, solid, and tubular growth patterns but only a few cases with dominant macrocystic growth have been reported. We report 15 cases of macrocystic MASC. There were 11 men and 4 women (17 to 88 y age range, average 47 y). The patients presented with a painless cystic mass, the majority in the region of the parotid gland (n=13), as well as in submandibular gland (n=1) and the neck (n=1). All tumors were circumscribed measuring 1.0 to 4.0 cm in greatest diameter (mean: 1.75 cm). Twelve tumors were unilocular, while 3 were multilocular. The cystic spaces were predominantly lined by a single epithelial cell layer with focal areas in which the epithelium was multilayered with papillary and hobnail features. In 3 of the cases there were more solid foci of intracystic tumor characterized by papillary and/or microcystic growth. The neoplastic cells were round to oval with hyperchromatic to vesicular nuclei with centrally located nucleoli and eosinophilic or vacuolated cytoplasm. Tumor cells showed strong positivity for S100 protein and mammaglobin, while DOG1 was uniformly negative. A minority of cases showed focal p63 reactivity predominantly limited to the periphery of the cystic lining. ETV6 gene rearrangement was identified in 9 cases. Macrocystic MASC can simulate benign and malignant salivary gland lesions and needs to be included in the differential diagnosis of cystic lesions in the head and neck. To the best of our knowledge, our report represents the first series of macrocystic MASCs wholly focusing on this unusual variant.
Methods Used to Maximize Follow-Up: Lessons Learned From the Therapeutic Hypothermia After Pediatric Cardiac Arrest Trials*
Authors: Gildea Marianne R. , Moler Frank W. , Page Kent , Meert Kathleen , Holubkov Richard , Dean J. Michael , Christensen James R. , Slomine Beth S.
Published: August 2019

Objectives:

To describe telephone interview completion rates among 12-month cardiac arrest survivors enrolled in the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital and Out-of-Hospital trials, identify key characteristics of the completed follow-up interviews at both 3- and 12-month postcardiac arrest, and describe strategies implemented to promote follow-up.

Setting:

Centralized telephone follow-up interviews.

Design:

Retrospective report of data collected for Therapeutic Hypothermia after Pediatric Cardiac Arrest trials, and summary of strategies used to maximize follow-up completion.

Patients:

Twelve-month survivors (n = 251) from 39 Therapeutic Hypothermia after Pediatric Cardiac Arrest PICU sites in the United States, Canada, and United Kingdom.

Interventions:

Not applicable.

Measurements and Main Results:

The 3- and 12-month telephone interviews included completion of the Vineland Adaptive Behavior Scales, Second Edition. Vineland Adaptive Behavior Scales, Second Edition data were available on 96% of 3-month survivors (242/251) and 95% of 12-month survivors (239/251) with no differences in demographics between those with and without completed Vineland Adaptive Behavior Scales, Second Edition. At 12 months, a substantial minority of interviews were completed with caregivers other than parents (10%), after calls attempts were made on 6 or more days (18%), and during evenings/weekends (17%). Strategies included emphasizing the relationship between study teams and participants, ongoing communication between study team members across sites, promoting site engagement during the study’s final year, and withholding payment for work associated with the primary outcome until work had been completed.

Conclusions:

It is feasible to use telephone follow-up interviews to successfully collect detailed neurobehavioral outcome about children following pediatric cardiac arrest. Future studies should consider availability of the telephone interviewer to conduct calls at times convenient for families, using a range of respondents, ongoing engagement with site teams, and site payment related to primary outcome completion.
Neural Tract Injuries Revealed by Diffusion Tensor Tractography in a Patient With Severe Heat Stroke
Authors: Chang Min Cheol , Lee Jun , Kwak Soyoung
Published: August 2019

Neurologic sequelae of heat stroke are prevalent among patients with severe heat stroke who require admission to an intensive care unit. Radiologic diagnosis of the condition is challenging because not every patient with clinical deficits shows abnormalities in computed tomography or magnetic resonance imaging. In this case review, we report a patient who had been diagnosed with a severe heat stroke and showed gait disturbance, language disorder, and cognitive impairment although conventional magnetic resonance imaging did not reveal significant findings that correlated with his symptoms. Diffusion tensor tractography has been reported to be a useful tool for evaluating the neural status of white matter tracts across a wide range of conditions. The corticospinal tract, the corticoreticular pathway, the cingulum, the fornix, the medial lemniscus, and the arcuate fasciculus of the patient were reconstructed using diffusion tensor tractography. A narrowing, discontinuation, and decreased fractional anisotropy and fiber volume of the examined neural tracts were observed, which correlated well with his symptoms. These results suggest that diffusion tensor tractography might be a useful tool for the detection of neurologic deficits even when conventional brain magnetic resonance imaging reveals no significant abnormality and in establishing appropriate rehabilitation strategies for patients with neurologic symptoms after a heat stroke.
Strength and Range of Motion in the Contralateral Side to Pain and Pain-Free Regions in Unilateral Chronic Nonspecific Neck Pain Patients
Authors: Kahlaee Amir Hossein , Ghamkhar Leila , Nourbakhsh Mohammad Reza , Arab Amir Massoud
Published: August 2019

Objective

The aim of the study was to determine whether strength and range of motion deficits are present in patients with unilateral chronic neck pain at contralateral side to pain and at other regions.

Design

Forty-nine patients with unilateral chronic neck pain and 98 asymptomatic subjects participated in this case-control study. Range of motion and muscle strength of the cervical, shoulder, trunk, and hip regions were assessed bilaterally using inclinometer and dynamometer, respectively.

Results

Chronic neck pain patients demonstrated reduced cervical, shoulder, and trunk range of motion in their ipsilateral side to pain comparing the asymptomatic participants (P < 0.05). The ipsilateral side to pain cervical and shoulder range of motion were also significantly lower than the contralateral side to pain (P < 0.05). Significant differences were also observable in the contralateral side to pain comparing the asymptomatic group (P < 0.05). Cervical, shoulder, and scapulothoracic muscles were found weaker both in the ipsilateral side to pain and contralateral side to pain comparing the asymptomatic group (P < 0.05). Ipsilateral side to pain and contralateral side to pain in hip flexors were also found to be significantly weaker than the asymptomatic group (P < 0.01).

Conclusions

The results revealed range of motion and strength deficits in the pain-free regions of the body in unilateral chronic neck pain patients. Findings support the regional interdependence theory and emphasize the need for managing seemingly intact neighboring and more remote regions in unilateral chronic neck pain patients.
Preliminary Study of the Effect of Training With a Gaming Balance Board on Balance Control in Children With Cerebral Palsy
Authors: Hsieh Hsieh-Chun
Published: August 2019

Objective

A new protocol based on the use of a gaming balance board for children with cerebral palsy was tested.

Design

A total of 56 children with cerebral palsy were enrolled and randomly divided into two groups: experimental and control. The children in experimental group underwent 12 wks of rehabilitation using their foot to play personal computer games with the proposed balance board, whereas those in the control group played personal computer games with a computer mouse in the standing position. Balance control was assessed before and after the intervention using the Zebris FDM System for measuring the center of pressure. The Pediatric Balance Scale and 2-min walk test were used for evaluating functional balance.

Results

In the analysis of covariance, the proposed new balance board used for the personal computer games decreased the postural sway (sway path,F= 6.95,P= 0.011; sway area,F= 11.79,P= 0.001) and improved the performance of the functional balance tests.

Conclusions

This study demonstrated the possibility that this new gaming balance board can be used for balance control in children with cerebral palsy.
The Certainty Behind Reporting a Significance Result
Authors: Kumbhare Dinesh , Alavinia Seyed Mohammad
Published: August 2019

ThePvalue is the most common method used in medical literature for the result of a statistical test. It is the probability of the data with a true null hypothesis and is calculated using a formal statistical test after the appropriate model has been determined to analyze study data. ThePvalue is dependent on the effect size, sample size, and a measure of variability within the outcomes. For many years, thePvalue has been set at 0.05, which is an arbitrary cutoff. It is important to understand that setting the cutoff at 0.05 may be correct for some study designs but not in others. Therefore, we recommend that in addition to thePvalue, another metric should be reported that specifies the magnitude of the effect such as effect size, confidence interval of the effect size, or fragility index.
Rehabilitation After Complete Hemisensory Loss
Authors: Kaner Mahmut T. , Hon Emily , He Tammy , Patira Riddhi , Altschuler Eric L.
Published: August 2019

The role and function that proprioception plays in movement and motor learning have been debated since the 19th century but can be difficult to isolate and study. Lesions at various points along the proprioceptive pathway result in afferent paresis that can be significantly disabling. Compensatory mechanisms can help with successful rehabilitation and provide an opportunity to study the role of these mechanisms in sensory feedback. Here, we present two cases of adult patients with complete hemisensory loss after a stroke: one patient with a cortical stroke and the other one with a thalamic stroke. First, we see that that motor learning can occur without proprioception, with the help of visual feedback. Second, proprioception plays an important role in movement: in the upper limb, it can facilitate individual finger movements, and in the lower limb, it maintains sufficient knee flexion to prevent the knee from going into recurvatum (backward bending) during ambulation.
Ultrasound Imaging and Rehabilitation of Muscle Disorders
Authors: Chang Ke-Vin , Wu Wei-Ting , Özçakar Levent
Published: August 2019

Ultrasound imaging has several advantages that include the absence of radiation, portability, excellent resolution of neuromuscular structures, and the ability to perform dynamic examinations. Traumatic muscle injury can be comprehensively evaluated using static, dynamic, and Doppler ultrasound imaging. In the present review, we briefly discuss mechanisms of traumatic muscle injury, present ultrasound images of normal muscles, focus on ultrasound assessment of injured muscles, and concisely discuss treatment and rehabilitation options for muscle injuries.
Disaster Rehabilitation Response Plan
Authors: Amatya Bhasker , Lee Su Yi , Galea Mary P. , Khan Fary
Published: August 2019

There is a strong consensus among humanitarian response authorities for a need for global action by professional organizations to work toward developing a structured approach to provide a coordinated international response during sudden-onset disasters. The aim of this report was to develop a Disaster Rehabilitation Response Plan to enable International Society of Physical and Rehabilitation Medicine to provide leadership and governance role in liaison/coordination with the WHO emergency medical team initiative and other relevant stakeholders to provide rehabilitation input during sudden-onset disasters. The proposed plan uses a “three-tier approach”: tier 1, immediate disaster response at a national/international level; tier 2, organization and deployment of rehabilitation personnel; and tier 3, rehabilitation management of disaster survivors and community reintegration. The International Society of Physical and Rehabilitation Medicine (and its subcommittee, the Disaster Rehabilitation Committee), categorized in the tier 2, could provide central leadership role working for the rehabilitation subcluster within the WHO emergency medical team initiative (tier 1) and support in coordination, preparation, and management of rehabilitation teams and/or members for deployment to sudden-onset disasters. The Disaster Rehabilitation Committee could also contribute to advocacy, training, and accreditation processes for rehabilitation professionals. The challenge ahead is commitment of countries worldwide to develop comprehensive rehabilitation-inclusive approach to ensure effective delivery of services to communities at risk.
Visualizing the Pharmacologic Preconditioning Effect of Botulinum Toxin Type A by Infrared Thermography in a Rat Pedicled Perforator Island Flap Model
Authors: Chen Miao , Li Xiucun , Jiang Zhenmin , Gong Xu
Published: August 2019

Background:

Surgical delay can improve flap viability, leading to vasodilation, neovascularization, and vessel reorganization. Experiments suggest a similar positive effect of botulinum toxin type A on pedicled flap viability. However, whether it may convert choke anastomoses into true anastomoses and how to identify the optimal timing for flap transfer remain unclear.

Methods:

One hundred fifty-four Sprague-Dawley rats were divided into a control group, three saline injection groups, and three botulinum toxin type A injection groups defined by time of injection (2, 3, and 4 weeks before flap harvest). A pedicled 11 × 3-cm flap was marked on the unilateral dorsum of each rat. Before flap harvest, the flap donors were assessed by infrared thermal imaging, postmortem arteriography, immunohistochemical staining of CD31, and enzyme-linked immunosorbent assay. Flap survival area percentage was measured on postoperative day 7.

Results:

In the control and saline groups, infrared thermography showed three independent white hotspots interspaced by red zones over flaps, whereas it presented a continuous white band in the botulinum toxin type A groups. There was a significant increase in flap survival area, flap surface temperatures, numbers of identifiable vessels in the choke zones, microvascular density, and vascular endothelial growth factor concentration in the botulinum toxin type A groups.

Conclusions:

Botulinum toxin type A can convert choke anastomoses into true anastomoses, and its preconditioning effect cannot increase over time; it is appropriate to choose the timing point when the infrared thermal images show a continuous white band existing over flaps for flap transfer.
Arthroscopic Suture Repair With Additional Pronator Quadratus Advancement for the Treatment of Acute Triangular Fibrocartilage Complex Tear With Distal Radioulnar Joint Instability
Authors: Lee Sang Ki , Chun Young Sub , Bae Jin Hyun , Yu Young Tak , Choy Won Sik
Published: August 2019

Treatment of acute triangular fibrocartilage complex (TFCC) tear using arthroscopic suture repair has been used as a general treatment method, but it is difficult to obtain perfect results in all cases. We evaluated clinical and radiologic outcomes of the acute TFCC tear with distal radioulnar joint instability using the arthroscopic suture repair with pronator quadratus (PQ) advancement. Altogether, 80 patients (48 male, 32 female; mean ± SD age, 37.3 ± 11.5 years; mean ± SD follow-up, 23.7 ± 11.4 months) were enrolled in the study. Follow-up was at least 12 months (range, 12–38 months). Patients were divided into group 1 with arthroscopic suture repair alone (34 patients; 17 male, 17 female; mean ± SD age, 35.2 ± 10.8 years; mean ± SD follow-up, 28.1 ± 15.1 months) and group 2 with additional PQ advancement (46 patients; 29 male, 17 female; mean ± SD age, 38.9 ± 11.9 years; mean ± SD follow-up, 18.4 ± 6.2 months), and clinical and radiological assessment was performed. We also compared the ulnar translation of the injured wrist with that of the uninjured wrist using the Push Pull gauge.

There was no difference in the range of motion and the grip strength between the 2 groups. However, the disabilities of the arm, shoulder, and hand score (P = 0.042) at 6-month follow-up and disabilities of the arm, shoulder, and hand score (P = 0.015) and patient-rated wrist evaluation score (P = 0.012) at 12-month follow-up were improved in group 2, and patients' satisfaction (P = 0.032) was also higher in group 2. The ulnar translation rate was also improved in group 2 at 6-month follow-up (P = 0.015) and 12-month follow-up (P = 0.045).

Arthroscopic suture repair with PQ advancement provided more clinical improvement and proper stability; therefore, it will be an acceptable effective treatment option for acute TFCC tear with distal radioulnar joint instability.
Comparative Antimicrobial Activity of Commercial Wound Care Solutions on Bacterial and Fungal Biofilms
Authors: Harriott Melphine M. , Bhindi Nayan , Kassis Salam , Summitt Blair , Perdikis Galen , Wormer Blair A. , Rankin Timothy M. , Kaoutzanis Christodoulos , Samaha Mario , Stratton Charles , Schmitz Jonathan E.
Published: August 2019

Background

Biofilms represent a complex milieu of matrix-enclosed microorganisms, which can significantly contribute to the pathology of chronic wounds. In this study, we compare the activity of 3 commercial antimicrobial wound care solutions, Vashe (HOCl based), PhaseOne (HOCl based), and Sulfamylon (mafenide acetate), for their in vitro activity against bacterial and fungal biofilms.

Methods

Reference and clinical isolates of 6 Gram-negative bacterial species (36 total strains), 3 Gram-positive bacteria (21 strains), and 3 Candida species (9 strains) were used to create biofilms. Various working concentrations of the 3 antiseptic agents were incubated with the biofilms in microwell plates; they were monitored from 1 minute to 24 hours to compare bacterial and fungal viability through colony forming unit analysis.

Results

Vashe and PhaseOne displayed excellent bactericidal and fungicidal activity, whereas Sulfamylon demonstrated minimal activity against the biofilms tested. With the exception of Candida albicans, all biofilms were eliminated at either 1 or 10 minutes using Vashe and PhaseOne solutions. In most cases, mafenide was unable to eliminate both bacterial and fungal biofilms, even with 24 hours of treatment.

Conclusions

Biofilms represent a major clinical challenge, with no clear consensus for treatment of chronic wounds or prosthetic devices. Our results suggest that hypochlorous acid–based wound solutions such as Vashe and PhaseOne are more efficacious than mafenide in eliminating bacterial and fungal biofilms. Further studies are necessary to investigate and compare the in vivo efficacy of these products in clinical care.
Anterior Neck Resurfacing Using a Single Free Flap
Authors: Angrigiani Claudio , Neligan Peter , Thrikutam Nikhitha
Published: August 2019

Background

Burn sequelae involving the anterior neck and thorax produce a difficult challenge for reconstruction because contracture of anterior thoracic burns in addition to functional movement of the chest wall can result in downward displacement of the neck unit. The purpose of this study was to understand the influence of burn sequelae of the anterior thorax on anterior neck flap descent, function, and aesthetics.

Methods

Ten patients with burn sequelae of only the anterior neck (group 1) and 10 additional patients with burn sequelae of the anterior neck and thorax (group 2) were retrospectively identified. All 20 patients were treated with scar release and a single extended circumflex scapular free flap for neck resurfacing. Patients were followed for an average of 10 years, at which time flap descent from the sternal notch, deficit of neck extension, and subjective reports of discomfort were measured.

Results

Patients in group 1 experienced a median flap descent of 0 [interquartile range (IQR), 1.62 cm] and a median deficit of 0° (IQR, 5°) during neck extension. Patients in group 2 experienced a median flap descent of 8 cm (IQR, 1.75 cm) and a median deficit of 12.5° (IQR, 10°) during neck extension. Retrospective analysis of the 10 patients with burn sequelae of the anterior neck and thorax (group 2) demonstrated a significantly greater degree of flap descent and deficit of neck extension compared with the 10 patients with burn sequelae of only the anterior neck (group 1). Patients in group 1 also subjectively reported less discomfort at follow-up compared with patients in group 2.

Conclusions

We conclude that patients with burn sequelae involving the anterior neck and thorax have a significantly greater degree of flap descent and neck extension compared with patients with burn sequelae involving only the anterior neck. Flaps of a larger surface area or use of multiple flaps for neck resurfacing may be considered to avoid significant flap descent associated with burn sequelae involving both the anterior neck and thorax.
Triangular Fossa Graft for Philtral Reconstruction After Facial Burns
Authors: Roh Danny Sam , Bojovic Branko , Woolard Alexander C. , Donelan Matthias B.
Published: August 2019

Background

Upper lip burns and skin grafts used for the resulting deformities all contract, leading to distortion of regional tissues and producing a flattened upper lip devoid of normal anatomic landmarks. Absence of the philtral contour draws attention to the upper lip and can accentuate other reconstructive inadequacies. Philtral restoration requires a 3-dimensional reconstruction capable of resisting contractile forces to restore and maintain normal relationships between the upper and lower lips.

Methods

This was a 34-year retrospective review of a single surgeon's experience using a composite triangular fossa graft from the ear for philtral reconstruction. Ten patients were identified and analyzed using records of follow-up examinations, long-term clinical evaluations, and photographic documentation.

Results

Five males and 5 females were identified with 2- to 34-year follow-up. Age at operation ranged from 14 to 52 years. Percent total body surface area ranged from less than 1% to greater than 90%. Previous upper lip grafts prior to the auricular graft included 5 full-thickness skin grafts and 5 split-thickness skin grafts. No significant complications were noted. All patients were satisfied with the end aesthetic result and donor site morbidity.

Conclusions

A triangular fossa composite graft restores and preserves the philtral dimple and corrects the obvious visible deformity of a featureless upper lip. Addition of tissue loosens the lip transversely, and the cartilage component provides a consistent and predictable upper lip position. This results in improved projection, a concave shape to the upper lip, and a better relationship with the lower lip. Restoration of this anatomic landmark creates a more normal-appearing upper lip and helps to minimize the negative impact of other abnormalities in this vitally important area. The overall improvement in total facial appearance can be profound.
Establishing Orbital Floor Symmetry to Support Mirror Imaging in Computer-Aided Reconstruction of the Orbital Floor
Authors: Jozaghi Yelda , Chan Harley H.L. , Davies Joel C. , Irish Jonathan C.
Published: August 2019

Background:

Surgical precision in the reconstruction of the orbital floor is crucial to functional visual and aesthetic outcomes. Increasingly, computer-aided design is being utilized to aid in precise preoperative planning by using the mirror images of the unaffected side. The authors aim to use 3-dimensional (3D) quantitative analysis to establish whether the native orbital floor topography is sufficiently symmetric to support this practice.

Methods:

Ten high resolution head and neck computed tomography scans of patients without periorbital pathology were obtained. These were imported into a 3D medical image processing software and segmented to isolate bilateral orbital floors. Each native orbital floor was compared to the mirror image of the contralateral side by conformance map computation. Data collection included measures of 25% and 75% quartile, median, mean, standard deviation, and root-mean-square (RMS).

Results:

The topographic analysis demonstrated a high degree of topographic conformance with a mean RMS of 0.58 ± 0.37 mm. Further volumetric analysis comparing the total orbital volume between each side also demonstrates a high degree of volumetric symmetry with a mean difference of 0.55 mL (P = 0.30).

Conclusion:

Comparison of the native orbital floor and the mirror image of the contralateral side by conformance map computation and volumetric analysis demonstrated a high degree of morphologic similarity. The native orbital floor topography provides optimal symmetry to support mirror imaging techniques used in orbital floor reconstruction.
Assessing the Role of Virtual Surgical Planning in Mandibular Reconstruction With Free Fibula Osteocutaneous Graft
Authors: Saini Varun , Gaba Sunil , Sharma Shagun , Kalra Praveen , Sharma Ramesh K.
Published: August 2019

Background:

The role of virtual surgical planning and three-dimensional printing in improving the accuracy, precision, functional and aesthetic outcomes have been demonstrated in the literature; however, there is a dearth of studies evaluating these parameters.

Objective:

This study was carried out at a tertiary care center in North India to assess the accuracy of virtual surgical planning in mandibular reconstruction.

Method:

All the included patients were preoperatively assessed with a contrast enhanced computed tomography (CECT) of head and neck. Based on the dimensions a patient-specific fibula cutting guide was fabricated by three-dimensional printing. All patients were evaluated with a postoperative CECT at 6 months of follow-up. The precision outcomes were measured by comparing surgical results with the images of the preoperative virtual planning based on several measurements on the reconstructed mandible such as anteroposterior measurement, transverse measurement, height of the mandible, angle of the mandible, and lateral tilt.

The secondary outcomes analyzed were the mean total operative time, mean ischemia time, and morbidity parameters.

Result:

Twelve consecutive patients (6 male, 6 female) with mean age of 33.1 ± 11 years who underwent free fibula graft mandibular reconstruction were included in the study. The mean difference in the anteroposterior, transverse, and height dimensions were 0.87 ± 0.43 mm (P = 0.24), 2.43 ± 3.72 mm (P = 0.64), and 1.08 ± 0.67 (P = 0.88), respectively. The difference in the angles of the reconstructed mandible was 2.37 ± 3.92 degrees (P = 0.51) and of lateral tilt was 1.57 ± 1.5 degrees (P = 0.54). The mean total operative time was 639 ± 27.2 minutes and mean ischemia time was 88.4 ± 8.6 minutes.

Conclusion:

All the patients had satisfactory aesthetic results and good oral function at 6 months postoperative period.
Sometimes the Power of Science is Driven by the Ratio of Love
Authors: Geurtsen Madelon , Otte Rob , Corel Linda , Mathijssen Irene , Joosten Koen
Published: August 2019

An infant with Crouzon syndrome was in need of cranial surgery. The optimum surgical correction was not possible, because at that time she was supported with continuous positive airway pressure attached to her occiput. However, the parents wanted the best craniofacial option and her father designed a respiratory support device with attachment to the forehead. Therefore, the most optimum cranial surgery could continue.
Role of Tumor Necrosis Factor-α in vascular hyporeactivity following endotoxic shock and its mechanism
Authors: Zhao HongLiang , Kuang Lei , He JiaoJiang , Zhang ZiSen , Zheng DanYang , Duan ChenYang , Zhu Yu , Wu Yue , Zhang Jie , Peng XiaoYong , Li BingHu , Yang GuangMing , Li Tao , Liu LiangMing
Published: August 2019

BACKGROUND

Vascular hyporeactivity plays an important role in organ dysfunction induced by endotoxic shock. Given that cytokine, such as TNF-α, plays an important role in endotoxic shock, the aim of the present study is to investigate the role of Tumor Necrosis Factor (TNF)-α in vascular hyporeactivity following endotoxic shock and the mechanisms.

METHODS

Lipopolysaccharide (LPS) (1 mg/kg) injection was used for replicating the endotoxic shock model in the rabbit. The changes in the level of TNF-α in plasma in the rabbits model and the contractile response of superior mesenteric arteries (SMA) to norepinephrine (NE) and Ca2+ were observed. The mechanisms in TNF-α–induced vascular hyporeactivity were further explored.

RESULTS

The levels of TNF-α in plasma were gradually increased after 1 hour of LPS administration and reached the peak at 6 hours. The contractile responses of SMA to NE were decreased at 1 hour of LPS and lowest at 6 hour. TNF-α (200 ng/mL) incubation decreased contractile response of SMA to NE significantly. Further studies found that calcium desensitization participated in the occurrence of TNF-α–induced vascular hyporeactivity, the changes were consistent with the changes of vascular reactivity, calcium sensitivities were decreased significantly at 1 hour, 2 hours, 4 hours, and 6 hours after LPS injection. TNF-α (200 ng/mL) incubation could significantly reduce the contractile response of SMA to Ca2+. The activity of Rho-kinase and the changes of myosin light chain 20 (MLC20) phosphorylation level were significantly decreased at 6 hours following LPS administration, and TNF-α (200 ng/mL) incubation led to a decrease of Rho-kinase and MLC20 phosphorylation. Arginine vasopressin significantly antagonized TNF-α (200 ng/mL)-induced the decrease of the vascular reactivity and calcium sensitivity.

CONCLUSION

TNF-α is involved in vascular hyporeactivity after endotoxic shock. Calcium desensitization plays an important role in TNF-α–induced vascular hyporeactivity after endotoxic shock. Rho-kinase/MLC20 phosphorylation pathway takes part in the regulation of calcium desensitization and vascular hyporeactivity induced by TNF-α. Arginine vasopressin is beneficial to endotoxic shock in TNF-α-induced vascular hyporeactivity.
Vancomycin dosing in critically ill trauma patients: The VANCTIC Study
Authors: Villanueva Ruben D. , Talledo Oscar , Neely Stephen , White Bryan , Celii Amanda , Cross Alisa , Kennedy Ryan
Published: August 2019

BACKGROUND

Current guidelines from the Infectious Diseases Society of America and the American Society of Health-System Pharmacists recommend vancomycin troughs of 15 mg/L to 20 mg/L for serious methicillin-resistant Staphylococcus aureus infections. The pharmacokinetics of vancomycin are altered in critically ill patients, leading to inadequate serum levels. Rates of initial therapeutic vancomycin troughs have ranged from 17.6% to 33% using intermittent infusions (i.e., 15–20 mg/L) and approximately 60% using continuous infusions (i.e., 15–25 mg/L) in critically ill trauma patients (1–4). We hypothesized that our dosing protocol would achieve higher rates of initial therapeutic troughs compared with previously published reports due to more aggressive loading doses than those seen in previously published reports.

METHODS

This was a retrospective study of all critically ill trauma patients admitted to a Level I trauma intensive care unit over a 39-month period who had a suspected serious infection, who were treated with empiric vancomycin per the “pharmacy to dose” protocol, and who had an appropriately drawn steady state trough level. The primary outcome was the rate of initial therapeutic troughs, which was defined as 14.5 mg/L to 20.5 mg/L.

RESULTS

One hundred ninety-seven patients were screened. Seventy patients met inclusion criteria. The study cohort had a median age of 47.5 years and a median Injury Severity Score of 28. Augmented renal clearances were observed, with a median creatinine clearance of 159.1 mL/min and a median Augmented Renal Clearance in Trauma Intensive Care (ARCTIC) score of 7. The median vancomycin loading dose was 24.6 mg/kg with an initial maintenance dose of 17.71 mg/kg. An every eight hour dosing interval was initiated on 47.14% of the patients, and 45.71% of the patients were initially started on an every 12 hour dosing interval. Only 15.71% of the study patients achieved an initial therapeutic trough; 42.86% were less than 10 mg/L, and 8.57% were greater than 20.5 mg/L. Acute kidney injury occurred in 10% based on the Infectious Diseases Society of America/American Society of Health-System Pharmacists vancomycin guidelines and in 11.4% based on the Acute Kidney Injury Network criteria.

CONCLUSION

Our incidence of initial therapeutic troughs was slightly below previously reported studies. Based on our results, which are consistent with previous literature, it would appear that our guideline-adherent protocol of intermittent vancomycin is insufficient to achieve troughs of 15 mg/L to 20 mg/L.

LEVEL OF EVIDENCE

Therapeutic, level III.
PATHway to success: Implementation of a multiprofessional acute trauma health care team decreased length of stay and cost in patients with neurological injury requiring tracheostomy
Authors: Perry Alvin , Mallah Mike M. , Cunningham Kyle W. , Christmas A. Britton , Marrero Jennifer J. , Gombar Meridith A. , Davis Michael L. , Miles William S. , Jacobs David G. , Fischer Peter E. , Sing Ronald F. , Thomas Bradley W.
Published: August 2019

BACKGROUND

The aim of this study was to determine whether the implementation of a dedicated multiprofessional acute trauma health care (mPATH) team would decrease length of stay without adversely impacting outcomes of patients with severe traumatic brain and spinal cord injuries. The mPATH team was comprised of a physical, occupational, speech, and respiratory therapist, nurse navigator, social worker, advanced care provider, and physician who performed rounds on the subset of trauma patients with these injuries from the intensive care unit to discharge.

METHODS

Following the formation and implementation of the mPATH team at our Level I trauma center, a retrospective cohort study was performed comparing patients in the year immediately prior to the introduction of the mPATH team (n = 60) to those in the first full year following implementation (n = 70). Demographics were collected for both groups. Inclusion criteria were Glasgow Coma Scale score less than 8 on postinjury Day 2, all paraplegic and quadriplegic patients, and patients older than 55 years with central cord syndrome who underwent tracheostomy. The primary endpoint was length of stay; secondary endpoints were time to tracheostomy, days to evaluation by occupational, physical, and speech therapy, 30-day readmission, and 30-day mortality.

RESULTS

The median time to evaluation by occupational, physical, and speech therapy was universally decreased. Injury Severity Score was 27 in both cohorts. Time to tracheostomy and length of stay were both decreased. Thirty-day readmission and mortality rates remained unchanged. A cost savings of US $11,238 per index hospitalization was observed.

CONCLUSION

In the year following the initiation of the mPATH team, we observed earlier time to occupational, physical, and speech therapist evaluation, decreased length of stay, and cost savings in severe traumatic brain and spinal cord injury patients requiring tracheostomy compared with our historical control. These benefits were observed without adversely impacting 30-day readmission or mortality.

LEVEL OF EVIDENCE

Therapeutic/care management, Level III.
Blame it on the injury: Trauma is a risk factor for pancreatic fistula following distal pancreatectomy compared with elective resection
Authors: Rozich Noah S. , Morris Katherine T. , Garwe Tabitha , Sarwar Zoona , Landmann Alessandra , Siems Chesney B. , Jones Alexandra , Butler Casey S. , McGaha Paul K. , Axtman Benjamin C. , Edil Barish H. , Lees Jason S.
Published: August 2019

BACKGROUND

Postoperative pancreatic fistula (POPF) remains a significant source of morbidity following distal pancreatectomy (DP). There is a lack of information regarding the impact of trauma on POPF rates when compared with elective resection. We hypothesize that trauma will be a significant risk factor for the development of POPF following DP.

METHODS

A retrospective, single-institution review of all patients undergoing DP from 1999 to 2017 was performed. Outcomes were compared between patients undergoing DP for traumatic injury to those undergoing elective resection. Univariate and multivariable analyses were performed using SAS (version 9.4).

RESULTS

Of the 372 patients who underwent DP during the study period, 298 met inclusion criteria: 38 DPs for trauma (TDP), 260 elective DPs (EDP). Clinically significant grade B or C POPFs occurred in 17 (44.7%) of 38 TDPs compared with 41 (15.8%) of 260 EDPs (p < 0.0001). On multivariable analysis, traumatic injury was found to be independently predictive of developing a grade B or C POPF (odds ratio, 4.3; 95% confidence interval, 2.10–8.89). Age, sex, and wound infection were highly correlated with traumatic etiology and therefore were not retained in the multivariable model. When analyzing risk factors for each group (trauma vs. elective) separately, we found that TDP patients who developed POPFs had less sutured closure of their duct, higher infectious complications, and longer hospital stays, while EDP patients that suffered POPFs were more likely to be male, younger in age, and at a greater risk for infectious complications. Lastly, in a subgroup analysis involving only patients with drains left postoperatively, trauma was an independent predictor of any grade of fistula (A, B, or C) compared with elective DP (odds ratio, 8.6; 95% confidence interval, 3.09–24.15), suggesting that traumatic injury is risk factor for pancreatic stump closure disruption following DP.

CONCLUSION

To our knowledge, this study represents the largest cohort of patients comparing pancreatic leak rates in traumatic versus elective DP, and demonstrates that traumatic injury is an independent risk factor for developing an ISGPF grade B or C pancreatic fistula following DP.

LEVEL OF EVIDENCE

Prognostic study, Therapeutic, level III.
Diagnosis of Rapidly Progressive Dementia in a Referral Center in Argentina
Authors: Acosta Julián N. , Ricciardi Mario E. , Alessandro Lucas , Carnevale Martin , Farez Mauricio F. , Nagel Vanesa , Allegri Ricardo F. , Varela Francisco
Published: August 2019

Introduction:

Rapidly progressive dementia (RPD) is a broadly defined clinical syndrome. Our aim was to describe clinical and ancillary study findings in patients with RPD and evaluate their diagnostic performance for the identification of nonchronic neurodegenerative rapidly progressive dementia (ncnRPD).

Methods:

We reviewed clinical records and ancillary methods of patients evaluated for RPD at our institution in Buenos Aires, Argentina from 2011 to 2017. We compared findings between chronic neurodegenerative RPD and ncnRPD and evaluated the diagnostic metrics using receiver operating characteristic curves.

Results:

We included 104 patients with RPD, 29 of whom were chronic neurodegenerative RPD and 75 of whom were ncnRPD. The 6-month time to dementia cutpoint had a sensitivity of 89% and specificity of 100% for ncnRPD, with an area under the receiver operating characteristic curve of 0.965 (95% confidence interval=0.935-0.99; P<0.001). A decision tree that included time to dementia, brain magnetic resonance imaging, and cerebrospinal fluid analysis identified ncnRPD patients with a sensitivity of 100%, specificity of 79%, positive predictive value of 93%, and negative predictive value of 100% overall.

Discussion:

RPD is a clinical syndrome that comprises different diagnoses, many of them for treatable diseases. Using the time to dementia, brain magnetic resonance imaging, and cerebrospinal fluid analysis when triaging these patients could help identify those diseases that need to be studied more aggressively.
Lipid-derived electrophiles induce covalent modification and aggregation of Cu,Zn-superoxide dismutase in a hydrophobicity-dependent manner
Authors: Dantas Lucas S. , Viviani Lucas G. , Inague Alex , Piccirillo Erika , de Rezende Leandro , Ronsein Graziella E. , Augusto Ohara , de Medeiros Marisa H. G. , Amaral Antonia T.-do , Miyamoto Sayuri
Published: August 2019

Lipid peroxidation generates a huge number of reactive electrophilic aldehyde products. These reactive aldehydes can modify macromolecules such as proteins, resulting in loss of function and/or aggregation. The accumulation of Cu,Zn-superoxide dismutase (SOD1) aggregates is associated with familial cases of amyotrophic lateral sclerosis (ALS). Recent studies have shown that lipid and its oxidized derivatives may play a role in this process. Here we aimed to compare and characterize the ability of lipid-derived electrophiles with different hydrophobicities to induce SOD1 modification and aggregationin vitro. SOD1 was incubated with 4-hydroxy-2-hexenal (HHE), 4-hydroxy- 2-nonenal (HNE), 2-hexen-1-al (HEX), 2,4-nonadienal (NON), 2,4-decadienal (DEC) or secosterol aldehydes (Seco-A or Seco-B) at 37°C for 24 h. Size exclusion chromatography analysis showed that hydrophobic aldehydes smarkedly enhances apo- SOD1 aggregation. More importantly, aggregation level was positively correlated to calculated aldehyde hydrophobicities (LogP). Protein sequencing by LC-MS/MS showed that aldehydes covalently modifies SOD1 at aggregation prone regions. For instance, specific lysine residues located mainly nearby the dimer interface (K3, K9) and at the electrostatic loop (K122, K128, K136) were ubiquitously modified by all aldehydes. The α,β-unsaturated aldehydes also promoted modifications on histidine and cysteine residues, with H120 and C6 being the most commonly modified residues. Overall, our data suggest that electrophile’s hydrophobicity is a critical factor that strongly influences protein aggregation propensity.

Graphical abstract

Highlights

- Aldehyde hydrophobicity is positively correlated to SOD1 aggregation;

- Lys residues located nearby the SOD1 dimer interface and electrostatic loop are ubiquitously modified by all aldehydes;

- Hydrophobic aldehydes increase the lipophilic potential surface of the region where they bind;