bluuebunny/crossref_metadata_2025 huggingface dataset:
The well-to-wheel analysis of hydrogen enriched compressed natural gas for heavy-duty vehicles using life cycle approach to a fuel cycle
Authors: Gupta Pralhad , Zhuge Weilin , Luo Sijie , Ma Fanhua
Published: April 2019

Increasing urban air pollution, greenhouse gases, and declining fossil energy sources are the three major problems of transportation sector which drive the use of alternative vehicular fuels to prevent energy shortage, reduce oil dependency and decrease tailpipe emissions including air pollutants and greenhouse gas emissions. This research work focused on life cycle analysis of HCNG® heavy-duty vehicle in which 20% gaseous hydrogen blended with compressed natural gas has been investigated in terms of net energy ratio, GHG value, and cost-effectiveness over a scale of ‘per MJ energy output’ in two fuel options, i.e. 0%HCNG and 20%HCNG for an entire well-to-wheel cycle. An engineering economic approach has been used to evaluate cost-effectiveness ratio of CNG and 20%HCNG pathways derived from fuel economy improvement. It has been shown that at pump-to-wheel stage, 7% reduction in fuel consumption can be achieved together with 11% reduction in GHGs, 7% reduction in energy consumption at operation and 7% reduction in total costs (RMB/MJ) for 20%HCNG compared with CNG. Rank (1 means ‘best and 10 means ‘worst’) showed that renewable-based hydrogen pathways such as solar, wind and biomass showed dual benefits of lower energy consumption and lower GHG emissions whereas grid electricity-to-hydrogen displayed the worst case in both scenarios. Usually, biomass-based HCNG pathways may have higher net energy ratio, but the sources are cleaner, and renewable in nature. The energy efficiency of fossil-based pathways such as natural gas, coal, etc., is higher than biomass gasification pathway.
Dietary Factors in Prevention of PediatricEscherichia coliInfection: A Model Using Domestic Piglets
Authors: Liu Yanhong , Ji Peng
Published: April 2019

Enterotoxigenic Escherichia coli (ETEC) is the major etiological agent causing acute watery diarrhea that is most frequently seen in young children in lower-income countries. The duration of diarrheal symptom may be shortened by antibiotic treatment, but ETEC is relative refractory to common antibiotics. Burgeoning evidence suggests bioactive components that naturally occur in human milk (e.g., lysozyme and oligosaccharides) and plants (e.g., nondigestible carbohydrates and phytochemicals) contain antimicrobial functions are promising preventive measures to control ETEC infection. Although the exact protective mechanisms may vary for each compound and are still not completely understood, they generally act to (1) competitively inhibit the binding of pathogenic bacteria and toxins to gut epithelium; (2) directly kill pathogens; and (3) stimulate and/or enhance host mucosal and systemic immune defense against pathogenic microorganisms. An appropriate ETEC-challenge animal model is critical to evaluate the effect and unveil the mechanism of bioactive compounds in prevention of enteric infection. Despite wide application in biomedical research, rodents do not usually manifest typical clinical signs of enteric infections. The remarkable differences in digestive physiology, immune response, and gut microbiota between rodents and human beings necessitate the use of alternative animal models. Pigs are closely related to humans in terms of genomes, physiology, anatomy of gastrointestinal tracts, digestive enzymes, components of immune system, and gut microbiota. Like human infants and young children, nursing and nursery piglets are more susceptible to ETEC infection and reproduce the clinical signs as observed in humans. Hence, the ETEC-challenge piglet represents a valuable translational model to study pathogenesis and evaluate dietary factors (e.g., milk bioactive compounds, nondigestible carbohydrates, and phytochemicals) as preventive measures for ETEC infection in pediatrics.
miR-145 improves metabolic inflammatory disease through multiple pathways
Authors: He Min , Wu Nan , Leong Man Cheong , Zhang Weiwei , Ye Zi , Li Rumei , Huang Jinyang , Zhang Zhaoyun , Li Lianxi , Yao Xiao , Zhou Wenbai , Liu Naijia , Yang Zhihong , Dong Xuehong , Li Yintao , Chen Lili , Li Qin , Wang Xuanchun , Wen Jie , Zhao Xiaolong , Lu Bin , Yang Yehong , Wang Qinghua , Hu Renming
Published: April 2019

Chronic inflammation plays a pivotal role in insulin resistance and type 2 diabetes, yet the mechanisms are not completely understood. Here, we demonstrated that serum LPS levels were significantly higher in newly diagnosed diabetic patients than in normal control. miR-145 level in peripheral blood mononuclear cells decreased in type 2 diabetics. LPS repressed the transcription of miR-143/145 cluster and decreased miR-145 levels. Attenuation of miR-145 activity by anti-miR-145 triggered liver inflammation and increased serum chemokines in C57BL/6 J mice. Conversely, lentivirus-mediated miR-145 overexpression inhibited macrophage infiltration, reduced body weight, and improved glucose metabolism in db/db mice. And miR-145 overexpression markedly reduced plaque size in the aorta in ApoE−/− mice. Both OPG and KLF5 were targets of miR-145. miR-145 repressed cell proliferation and induced apoptosis partially by targeting OPG and KLF5. miR-145 also suppressed NF-κB activation by targeting OPG and KLF5. Our findings provide an association of the environment with the progress of metabolic disorders. Increasing miR-145 may be a new potential therapeutic strategy in preventing and treating metabolic diseases such as type 2 diabetes and atherosclerosis.
Parenting Stress, Sleep, and Psychological Adjustment in Parents of Infants and Toddlers With Congenital Heart Disease
Authors: Bishop Meredith N , Gise Jensi E , Donati Matthew R , Shneider Caitlin E , Aylward Brandon S , Cohen Lindsey L
Published: April 2019

Objective

Parents of children with chronic medical needs report increased parenting challenges, poor sleep, and maladjustment. The impact of parenting stress on both sleep and adjustment has yet to be evaluated for parents of infants and young children with congenital heart disease (CHD). We studied the relations among parenting stress, sleep, and adjustment in parents of infants and toddlers with CHD. We expected that sleep quality would mediate the relationship between parenting stress and adjustment.

Methods

Sixty-nine parents of infants and toddlers with CHD were evaluated on self-report measures of illness-related parenting stress (Pediatric Inventory for Parents), sleep (Pittsburgh Sleep Quality Index), and psychological adjustment (Brief Symptom Index-18).

Results

The parents of infants and toddlers with CHD reported elevated levels of parenting stress, sleep problems, and maladjustment. The positive relationship between parenting stress and parent maladjustment was mediated by sleep quality.

Conclusions

Findings suggest that parents of infants and toddlers with CHD report high parenting stress, poor sleep, and maladjustment. Analyses indicate the stress-adjustment relationship is mediated by quality of sleep. Given the multiple demands on parents of infants and children with CHD, it is important to attend to parents’ overall functioning and mental health. Our findings highlight targets for intervention to improve the well-being of parents of young children with CHD.
Organ-preserving approach via radiotherapy for small cell carcinoma of the bladder: an analysis based on the Japanese Radiation Oncology Study Group (JROSG) survey
Authors: Akamatsu Hiroko , Nakamura Katsumasa , Ebara Takeshi , Inaba Koji , Itasaka Satoshi , Jingu Keiichi , Kosaka Yasuhiro , Murai Taro , Nagata Kenji , Soejima Toshinori , Takahashi Shigeo , Toyoda Tatsuya , Toyoshima Shinichiro , Nemoto Kenji , Akimoto Tetsuo
Published: April 2019

Small cell carcinoma of the bladder is extremely rare, accounting for <1% of all malignant tumours in the urinary tract. Thus, no standard therapy modality for this malignancy has been established. This study aimed to retrospectively analyse the clinical outcomes associated with definitive radiotherapy for small cell carcinoma of the bladder. A questionnaire-based survey of patients with pathologically proven small cell carcinoma of the bladder treated with definitive radiation therapy between 1990 and 2010 was conducted by the Japanese Radiation Oncology Study Group. The clinical records of 12 eligible patients were collected from nine institutions. The median age of the patients was 70.5 years (range: 44–87 years), and the median follow-up period was 27.3 months (range: 3.3–117.8 months). The median prescribed dose was 60 Gy (range: 50.0–61.0 Gy), and a median of 2.0 Gy (range: 1.2–2.0 Gy) was administered per fraction. Systemic chemotherapy combined with radiotherapy was performed in eight cases (66.7%). The 3- and 5-year overall survival rates were 50.0% and 33.3%, respectively. And the 3- and 5-year local control rates were 66.7% and 55.6%, respectively. Chemotherapy significantly improved overall survival and relapse-free survival (P = 0.006 and 0.001, respectively). No serious adverse events occurred in the observation period. All patients who achieved local control maintained functional bladders. In conclusion, radiotherapy is a potential local treatment option and has an important role in maintaining quality of life. Systemic chemotherapy combined with local radiotherapy seems to be effective in improving survival.
Reasonable Expectations of Privacy and Disclosure of Health Data
Authors: Taylor Mark J , Wilson James
Published: April 2019

The law of confidence allows for a range of defined circumstances in which confidential patient information (CPI) can be disclosed without breach of confidence—including statutory gateway and overriding public interest. Outside such circumstances, current guidance to health professionals (the ‘standard account’) assumes that CPI can only be lawfully disclosed with patient consent. This article argues that the standard account has not yet caught up with judgments, post the Human Rights Act 1998 coming into force, which have reinterpreted the law of confidence in the light of Article 8 of the European Convention on Human Rights. In particular, the article explains the significance of the concept of a ‘reasonable expectation of privacy’ to an action for breach of confidence and thus to legal liability for disclosure of health data. It argues that conformity with a reasonable expectation of privacy provides an alternative account for the lawful disclosure of CPI, and may provide a more sustainable and authentic approach to meeting obligations under the law of confidence than the standard account. The article concludes with recommendations for an evolution of the standard account in a way that could allow restatement of associated concepts (such as consent) free from particular pressure to bend them out of shape. The evolution proposed continues to bring to the fore the patient perspective and allows protection of their ‘reasonable expectations’ regarding uses of data collected about them rather than those of the profession.
Cosmological magnetic braking and the formation of high-redshift, super-massive black holes
Authors: Pandey Kanhaiya L , Sethi Shiv K , Ratra Bharat
Published: April 2019

We study the effect of magnetic braking due to a primordial magnetic field in the context of the formation of massive (≳104M⊙) direct-collapse black holes (DCBHs) at high redshifts. Under the assumption of axial symmetry, we analytically compute the effect of magnetic braking on the angular momentum of gas collapsing into the potential well of massive dark matter haloes (≃107−9M⊙) which are spun up by gravitational tidal torques. We find that a primordial magnetic field of strength B0 ≃ 0.1 nG (comoving) can remove the initial angular momentum gained by the in-falling gas due to tidal torques, thus significantly lowering the angular momentum barrier to the formation of DCBHs. These magnetic field strengths are consistent with the bounds on primordial fields from astrophysical and cosmological measurements and they are large enough to seed observed galactic magnetic fields.
H α emission in the nebular spectrum of the Type Ia supernova ASASSN-18tb
Authors: Kollmeier Juna A , Chen Ping , Dong Subo , Morrell Nidia , Phillips M M , Kushnir Doron , Prieto J L , Piro Anthony L , Simon Joshua D
Published: April 2019

As part of the 100IAS survey, a program aimed to obtain nebular-phase spectra for a volume-limited and homogeneous sample of Type Ia supernovae (SNe Ia), we observed ASASSN-18tb (SN 2018fhw) at 139 d past maximum light. ASASSN-18tb was a fast-declining, sub-luminous event that fits well within the observed photometric and spectroscopic distributions of the SN Ia population. We detect a prominent H α emission line (LH α = 2.2 ± 0.2 × 1038 ergs s−1) with FWHM ≈ 1100 km s−1 in the nebular-phase spectrum of this SN Ia. High-luminosity H α emission (LH α ≳ 1040 ergs s−1) has previously been discovered in a rare class of SNe Ia-like objects showing circum-stellar medium (CSM) interactions (SNe Ia–CSM). They predominantly belong to overluminous (Mmax < −19 mag in optical) 1991T-like SNe Ia and are exclusively found in star-forming galaxies. By contrast, ASASSN-18tb is a sub-luminous SN Ia (MB,max ∼ −17.7 mag) found in an early-type galaxy dominated by old stellar populations. We discuss possible origins for the observed hydrogen. Of the 75 SNe Ia for which we have so far obtained nebular spectra in 100IAS, no other SN shows a ${\sim } 1000 \, {\rm km\, s^{-1}}$ H α emission line with comparable line luminosity as ASASSN-18tb, emphasizing the rarity of such emission in the nebular phase. Based on preliminary results from our survey, the rate for ASASSN-18tb-like nebular H α emission could be as high as ${\sim } 10{{\ \rm per\ cent}}$ among sub-luminous SNe Ia.
Effect of probiotics on gastrointestinal symptoms and immune parameters in systemic sclerosis: a randomized placebo-controlled trial
Authors: Marighela Thais Fernandes , Arismendi Maria Izabel , Marvulle Valdecir , Brunialti Milena Karina Coló , Salomão Reinaldo , Kayser Cristiane
Published: April 2019

Objectives

Changes in the intestinal microbiota have been associated with the pathogenesis of SSc. Probiotics act by modulating the microbiome and the immune response. This study aimed to evaluate the efficacy of probiotics on gastrointestinal (GI) symptoms and immune responses in SSc patients.

Methods

Patients with SSc with a moderate–severe total score on the University of California Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 (UCLA GIT 2.0) instrument were randomly assigned to receive a daily dose of probiotics (Lactobacillus paracasei, Lactobacillus rhamnosus, Lactobacillus acidophillus and Bifidobacterium lactis, 109 colony-forming units per capsule) or placebo for 8 weeks. The primary endpoint was improvement in the UCLA GIT 2.0 total score after 8 weeks. Secondary outcomes included changes in Th1, Th2, Th17 and regulatory T cell circulating levels and in the HAQ Disability Index (HAQ-DI) score. Parameters were assessed at baseline and after 4 and 8 weeks of treatment.

Results

A total of 73 patients were randomized to receive probiotics (n = 37) or placebo (n = 36). After 8 weeks, there was no difference in the UCLA GIT 2.0 score between the two groups. At week 8, the probiotic group showed a significant decrease in the proportion of Th17 cells compared with placebo (P = 0.003). There was no difference in the proportion of Th1, Th2 and regulatory T cells or in the HAQ-DI score between the groups.

Conclusion

Probiotics did not improve GI symptoms in SSc patients. The reduction in Th17 cell levels suggests an immunomodulatory effect of probiotics on SSc.

Trial registration

ClinicalTrials.gov (http://clinicaltrials.gov), NCT 02302352.
Treatment Discrepancy for Pelvic Fracture Patients With Urethral Injuries: A Survey of Orthopaedic and Urologic Surgeons
Authors: Johnsen Niels V. , Firoozabadi Reza , Voelzke Bryan B.
Published: April 2019

Objectives:

In patients with traumatic pelvic fracture urethral injuries (PFUI), the interaction between urethral management and orthopaedic decision making remains unknown. We aimed to survey orthopaedic and urologic surgeons to assess interdisciplinary interactions in the management of PFUI.

Methods:

An anonymous cross-sectional survey of members of the Orthopaedic Trauma Association (OTA) and the Society of Genitourinary Reconstructive Surgeons (GURS) was conducted between September 2017 and August 2018. Participants were queried regarding the impact of urethral injuries and their management on orthopaedic operative decision making.

Results:

Fifty-three GURS and 64 OTA members responded (17% response rate). For urethral injury management, 73% of OTA respondents preferred that suprapubic tubes (SPTs) were not placed for urethral injury management, whereas 43% of GURS respondents preferred SPTs (P = 0.08). Ninety-two percent of OTA respondents stated that SPTs increase hardware infection risks in patients undergoing pelvic open reduction with internal fixation (ORIF), whereas only 8% of GURS respondents agreed (P < 0.01). Although 66% of GURS respondents reported not considering the operative plans of orthopaedics when determining urethral management, 75% of OTA respondents reported that they were less inclined to proceed with ORIF, and 70% would perform external fixation in the setting of an SPT, despite 78% believing that this resulted in an inferior outcome for the patient.

Conclusions:

There is discordance between urologists and orthopaedists as to the optimal management of PFUI patients, with significant disagreement regarding the infectious risks of SPT in the setting of ORIF. Improved data and interdisciplinary dialogue are required to maximize patient outcomes.

Level of Evidence:

Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
Atypical Fibroxanthoma: The Washington University Experience
Authors: Phelan Patrick S. , Rosman Ilana S. , Council M. Laurin
Published: April 2019

BACKGROUND

Atypical fibroxanthoma (AFX) is a rare dermal neoplasm typically occurring on sun-exposed skin in the elderly. As AFX remains a diagnosis of exclusion, updated characterization and treatment assessments are necessary to support informed diagnosis and management.

OBJECTIVE

Characterization of contemporary AFX and surgical outcomes by Mohs micrographic surgery (MMS) and conventional local excision (LE).

METHODS

Retrospective cohort analysis of all cases of AFX at our institution from January 2000 through July 2016.

RESULTS

Among 75 cases with median age at diagnosis 73 years, most occurred on the head and neck (68) independent of age. Most treated cases (42) underwent MMS alone, with median tissue removal greater for LE (2.6 cm, 4.5 cm2) than MMS (0.6 cm, 1.2 cm2). Over a median 26 months of follow-up, 6 recurrences were observed among 50 cases, with metastases in 2 cases. Intent-to-treat recurrence rates were 3.4% for MMS and 25% for LE. One nonrecurrent and 2 recurrent cases received revised diagnoses after initial treatment, yielding a true recurrence rate of 8.5%.

CONCLUSION

Despite diagnostic confounding by similar pathologies, surgical treatment of AFX remains effective. Tissue-sparing resection by MMS affords the potential for cosmetic and reconstructive advantage, without compromising recurrence compared with conventional excision.
Supplementary Sorafenib Therapies for Hepatocellular Carcinoma—A Systematic Review and Meta-Analysis
Authors: Huang Yuanjian , Cheng Xiang , Sun Ping , Li Tong , Song Zifang , Zheng Qichang
Published: April 2019

Background:

Hepatocellular carcinoma (HCC) is the third deadliest cancer worldwide. Sorafenib is considered a supplementary treatment to surgical or locoregional therapies for improving outcomes. We evaluated the efficacy of sorafenib as a supplementary therapy for HCC.

Methods:

We conducted a meta-analysis including 11 randomized controlled trials. Patients with HCC and studies in which sorafenib was administered alone and compared with placebo or those in which sorafenib was administered in combination with another treatment and compared with that treatment alone were included. The overall effects (OEs) on overall survival and time to progression were pooled as hazard ratios.

Results:

The OEs of sorafenib as a first-line therapy versus placebo for unresectable HCC were 0.62 [95% confidence interval (CI): 0.50-0.77] and 0.58 (95% CI: 0.47-0.70), respectively. The OEs of sorafenib as a second-line therapy versus placebo for progressive HCC were 0.73 (95% CI: 0.47-1.13) and 0.54 (95% CI: 0.30-0.97), respectively. The OEs of sorafenib as an adjuvant therapy versus placebo for early HCC were 1.00 (95% CI: 0.76-1.30) and 0.89 (95% CI: 0.74-1.08), respectively. The OEs of sorafenib combined with transarterial chemoemboliztion (TACE) versus placebo combined with TACE were 0.80 (95% CI: 0.54-1.21) and 0.85 (95% CI: 0.70-1.04), respectively. The OEs of sorafenib as an adjuvant to TACE versus placebo as an adjuvant to TACE for intermediate HCC were 1.06 (95% CI: 0.69-1.64) and 0.65 (95% CI: 0.31-1.36), respectively.

Conclusions:

Sorafenib was effective as a first-line therapy for unresectable HCC, but it was ineffective as a second-line or adjuvant therapy. Sorafenib did not increase the efficacy of TACE.
High-resolution Manometry can Characterize Esophagogastric Junction Morphology and Predict Esophageal Reflux Burden
Authors: Rengarajan Arvind , Gyawali C. Prakash
Published: April 2019

Background:

High-resolution manometry (HRM) allows characterization of esophagogastric junction (EGJ) morphology and identification of hiatus hernia using novel software tools.

Aim:

The main purpose of this study was to determine the impact of HRM-based EGJ and lower esophageal sphincter (LES) metrics in predicting abnormal reflux burden.

Methods:

Total, upright, and supine acid exposure times (AETs) were extracted from ambulatory reflux monitoring performed off therapy in 482 patients (54.2±0.6 y, 63.3% female patients). EGJ morphology was categorized into type 1 (superimposed LES and crural diaphragm), type 2 (<3 cm separation between LES and crural diaphragm), and type 3 (≥3 cm separation). EGJ-contractile integral (EGJ-CI) and distal contractile integral (DCI) were extracted. Conventional EGJ and LES metrics, including basal and end-expiratory LES pressure, and LES length were also analyzed. Univariate and multivariate analyses were performed to determine the value of HRM parameters in predicting abnormal esophageal reflux burden.

Results:

Type 1 EGJ was noted in 298 (61.8%), type 2 in 125 (25.9%), and type 3 in 59 (12.2%); EGJ-CI and mean DCI were lower with abnormal EGJ morphology. Mean AET, and proportions with abnormal AET increased as EGJ morphology became progressively disrupted (P<0.0001 across groups); low EGJ-CI was additive in predicting abnormal AET. All HRM parameters assessed (EGJ morphology, EGJ-CI, and DCI) were independent predictors for abnormal AET (P≤0.02). Conventional LES and EGJ metrics were also associated with abnormal reflux burden, but intra-abdominal LES length, and hiatus hernia size did not independently predict total AET.

Conclusions:

HRM-based EGJ morphology and EGJ barrier assessment independently predict esophageal reflux burden.
Ethical challenges in regionalization of pediatric surgical care
Authors: Carlisle Erica M. , Rowell Erin E.
Published: April 2019

Purpose of review

Rapid advancement in the field of pediatric surgery has resulted in unprecedented opportunities to advance the care of children. However, assuring that the highest quality, most appropriate care is available to all pediatric patients remains challenging. Regionalization of care has been proposed as a means of obtaining this critical goal. In this review, we discuss the ethical challenges associated with regionalization of pediatric surgical care.

Recent findings

Regionalization of pediatric surgical care is associated with improved patient outcomes. Over half of pediatric surgeons favor regionalization of care. Despite these findings, regionalization of care may be associated with inequitable distribution of resources, financial and emotional burdens for patients and families, and surgeon dissatisfaction and technical decline.

Regionalization of pediatric surgical care is fraught with complex ethical issues. Development of a system of pediatric surgery networks may offer a solution to these challenges.
An update on allergic emergencies
Authors: Toy Dana , Braga Matthew S. , Greenhawt Matthew , Shaker Marcus
Published: April 2019

Purpose of review

To provide an updated framework of management for allergic emergencies.

Recent findings

The most frequent causes of anaphylaxis include medications, foods, and stinging insects. Early and appropriate administration of epinephrine is critical to managing anaphylaxis. Although epinephrine is well tolerated and there is no absolute contraindication to using epinephrine in first-aid management of anaphylaxis, many patients at risk for anaphylaxis still fail to carry and use the medication prior to seeking emergency care. Outcomes of allergic emergencies can be improved by educational efforts that focus on adherence to emergency plans, as well as asthma controller treatments in patients with persistent asthma. Though venom immunotherapy is known to decrease the risk for stinging insect anaphylaxis, the role of emerging strategies for food allergen immunotherapy in reducing cases of anaphylaxis requires further study.

Fatalities resulting from anaphylaxis and asthma are rare. Patient education serves an important role in preparing for unexpected emergencies, instituting prompt and appropriate treatment, and incorporating effective strategies into the lives of children and families.
Using Facebook To Recruit Pregnant Women for Research
Authors: Herbell Kayla
Published: April 2019

Background

An estimated 80% of clinical trials fail to meet recruitment and enrollment goals. Recruitment can be even more challenging when vulnerable populations are the focus of the study. This problem may be mitigated with the use of contemporary and innovative methods such as Facebook recruitment.

Objectives

The purpose of this brief is to detail an account of diversifying recruitment strategies with the use of Facebook to recruit pregnant women into research.

Methods

This brief was derived from a parent study that aimed to examine relationships among social determinants of health, psychophysiological stress, and mental health in pregnant women. A Facebook account was created in which the principal investigator (PI) sought permission and posted in private Facebook groups about the research study. All data reported and analyzed in this brief are frequencies of Facebook activity including, likes, shares, comments, referrals (i.e., tags), and participants enrolled.

Results

Target enrollment for the parent study was met, with a total enrollment of 82 participants. The PI gained approval from 100% of the 61 private Facebook groups. Over 75% of the total sample was recruited in 48 days via Facebook. The greatest frequency of likes, shares, comments, and referrals by the recruitment flyer were generated from the sell/trade/jobs page. However, the greatest frequency of participants enrolled viewed the flyer in Facebook groups focused on parent discussion. Facebook groups classified as events, nonparent discussion, and miscellaneous were generally unsuccessful in yielding participants.

Discussion

In order to decrease the time lag between research and practice, and to enroll more participants, innovative strategies are necessary. Although there is evidence that Facebook was useful in recruiting a sample of pregnant women into research, Facebook may also be a useful resource in recruiting other populations into research as well.
Mediterranean Diet, Body Composition, and Activity Associated With Bone Health in Women With Fibromyalgia Syndrome
Authors: Correa-Rodríguez María , El Mansouri-Yachou Jamal , Tapia-Haro Rosa María , Molina Francisco , Rus Alma , Rueda-Medina Blanca , Aguilar-Ferrandiz María Encarnación
Published: April 2019

Background

There is very little scientific literature on the potential relationships between modifiable factors, including body composition, dietary pattern and physical activity (PA), and bone status in patients with fibromyalgia—a musculoskeletal condition characterized by chronic, widespread pain that is often accompanied by a broad spectrum of symptoms.

Objectives

The aim of the study was to investigate the impact of body composition parameters, adherence to the Mediterranean diet (Med Diet), and PA on bone health in a population of premenopausal and postmenopausal women with fibromyalgia syndrome (FMS).

Methods

Ninety-five women diagnosed with FMS were included in this cross-sectional study. Body composition, including fat mass, percentage of fat mass, and lean mass (LM), were calculated using a body composition analyzer. Adherence to the Med Diet was measured through a validated 14-item questionnaire. The International Physical Activity Questionnaire was used to assess PA. Bone mass at the calcaneus was estimated through quantitative ultrasound.

Results

Linear regression analysis revealed that LM had a significant association with broadband ultrasound attenuation (β = 0.211, 95% CI [0.046, 1.259],p= .035) and stiffness index parameters (β = 0.201, 95% CI [0.019, 1.654],p= .045) after adjusting for age and menopausal status. The Med Diet was also significantly associated with broadband ultrasound attenuation (β = 1.693, 95% CI [0.508, 2.879],p= .006).

Discussion

LM and the Med Diet were consistently associated with calcaneal quantitative ultrasound parameters, supporting the hypothesis that LM and adherence to the Med Diet play determinant roles in bone health in FMS women. Training programs to maximize LM and strategies for promoting good adherence to the Med Diet should be considered in order to prevent the development of osteoporosis in FMS women. Because nurses are involved in implementing preventive programs, their roles in promoting this adherence to the Med Diet and maximizing LM in patients with FMS should help reduce the impact of osteoporosis.
The Endocranial Bifrontal Angle: A Longitudinal Evaluation in Two Patients With Metopic Synostosis
Authors: Cabrejo Raysa , Lu Xiaona , Persing John
Published: April 2019

Background:

Metopic craniosynostosis is the early fusion of the skull bones in the frontal region of the metopic suture, which leads to trigonocephaly and neurological sequelae. Severe metopic craniosynostosis is defined by an endocranial bifrontal angle less than 124°, and this serves as a threshold for neurological deficit and significant skull deformity, typically warranting surgical treatment.

Methods:

Two patients presented for evaluation for metopic craniosynostosis. Low-dose computed tomography imaging was performed in both patients due to concern for underlying metopic craniosynostosis.

Results:

In both patients, imaging demonstrated an initial endocranial bifrontal angle greater than 124°. However, in subsequent evaluation, the children developed severe trigonocephaly, and an angle less than 124°.

Conclusion:

The authors present 2 patients with metopic craniosynostosis, which became severe over time. The authors hypothesize that this may be due to an initial smaller head circumference, which later experienced rapid growth, leading to narrower endocranial bifrontal angle. Therefore, younger children with suspected metopic craniosynostosis, with initially smaller head circumference (but not meeting the threshold of 124°) should be followed longitudinally, as the head circumference may demonstrate greater narrowing subsequently into a more severe form of trigonocephaly and possibly surgery.
Correction of Complex Neurofibromatosis Orbital and Globe Malposition Using the Orbital Box Segmentation Osteotomy With Patient-Specific Internal Orbit Reconstruction
Authors: Davidson Edward H. , Khavanin Nima , Grant Michael , Kumar Anand R.
Published: April 2019

Introduction:

Correction of severe orbital and globe malposition from neurofibromatosis remains a significant clinical challenge. Current techniques including zygoma osteotomy, bone grafting, or placement of orbital implants do not adequately address aberrant anatomy, under-correct the deformity, and are prone to relapse. The authors have developed the orbital box segmentation osteotomy to reduce vertical orbital height and translocate the orbit and use patient-specific custom internal orbital titanium implants to close the cranio-orbital communication—reestablishing both the external orbital shape and internal orbital volume.

Methods:

Virtual surgical planning with contralateral mirror imaging was used to design symmetrical repositioning of the external orbit and to determine segmentation required to reduce the vertical excess and inferior rim malposition as well as for manufacturing patient-specific titanium implants. Orbital volume was measured from preoperative, virtual surgical simulation, and postoperative imaging using stereotactic software. Globe position was assessed using pre- and postoperative 3-dimensional photography software (Canfield).

Results:

All patients (n = 3, mean age 12 years) demonstrated improved globe position and orbital contour with resolution of globe pulsatility. Virtual surgical planning predicted postoperative volumes within 0.8 cm3 ± 0.5. Mean volume orbital change was 4.5 cm3, change in conformation and distribution of orbital volume was present in all patients. Vertical globe position improved from 11.5 mm preoperatively to within 1 mm of the unaffected side postoperatively. One patient had surgical site infection, there is no evidence of relapse at mean 24-months follow-up.

Conclusion:

Segmental box osteotomy with internal orbital reconstruction redistributes orbital volume safely and accurately addresses globe malposition from neurofibromatosis.
Sonolucent Cranial Implants: Cadaveric Study and Clinical Findings Supporting Diagnostic and Therapeutic Transcranioplasty Ultrasound
Authors: Belzberg Micah , Shalom Netanel Ben , Yuhanna Edward , Manbachi Amir , Tekes Aylin , Huang Judy , Brem Henry , Gordon Chad R.
Published: April 2019

Background:

Previously, sonographic evaluation of the intracranial contents was limited to intraoperative use following bone flap removal, with placement of the probe directly on the cortical surface or through a transsulcal tubular retractor. Cranioplasty with sonolucent implants may represent a postoperative window into the brain by allowing ultrasound to serve as a novel bedside imaging modality. The potential sonolucency of various commonly used cranial implant types was examined in this study.

Methods:

A 3-phase study was comprised of cadaveric evaluation of transcranioplasty ultrasound (TCU) with cranioplasty implants of varying materials, intraoperative TCU during right-sided cranioplasty with clear implant made of poly-methyl-methacrylate (PMMA), and bedside TCU on postoperative day 5 after cranioplasty.

Results:

The TCU through clear PMMA, polyether-ether-ketone, and opaque PMMA cranial implants revealed implant sonoluceny, in contrast to autologous bone and porous-polyethylene. Intraoperative ultrasound via the clear PMMA implant in a single patient revealed recognizable ventricular anatomy. Furthermore, postoperative bedside ultrasound in the same patient revealed comparable ventricular anatomy and a small epidural fluid collection corresponding to that visualized on an axial computed tomography scan.

Conclusion:

Sonolucent cranial implants, such as those made of clear PMMA, hold great promise for enhanced diagnostic and therapeutic applications previously limited by cranial bone. Furthermore, as functional cranial implants are manufactured with implantable devices housed within clear PMMA, the possibility of utilizing ultrasound for real-time surveillance of intracranial pathology becomes much more feasible.
Imaginology Tridimensional Study of Temporomandibular Joint Osseous Components According to Sagittal Skeletal Relationship, Sex, and Age
Authors: Lobo Fernanda , Tolentino Elen de Souza , Iwaki Lilian Cristina Vessoni , Walewski Leticia Ângelo , Takeshita Wilton Mitsunari , Chicarelli Mariliani
Published: April 2019

Objective:

To assess the temporomandibular joint (TMJ) osseous components morphology and the condyle position in patients with different sagittal skeletal relationships, sex, and age, using cone-beam computed tomography (CBCT).

Methods:

The CBCT images of 180 asymptomatic patients (60 class I, 60 class II, and 60 class III) were assessed retrospectively. Groups were also divided according to age (<40 years, n = 90; ≥40 years, n = 90) and sex (male, n = 90; female, n = 90). Right- and left-sided TMJ spaces, articular eminence inclination (AEI) and height (AEH), thickness of the roof of the glenoid fossa (TRGF) and the anteroposterior position of the condyle in glenoid fossa were evaluated. Differences were tested using the analysis of variance, Tukey and t-tests (P < 0.05).

Results:

For condylar position, no differences were found between sex and age groups, but spatial differences existed among skeletal classes. Significant differences were found between the right and left angular position in patients with malocclusion. Class II individuals presented lower anterior articular spaces. The condyle-glenoid fossa relationship presented a moderate correlation of bilaterality. The AEI and AEH were significant lower in class III individuals and class I patients presented the lowest values for TRGF. The values of AEH, TRGF and of all joint spaces of males were higher. In individuals over the age of 40 years, the AEI and AEH measurements were significant greater.

Conclusion:

Sagittal skeletal relationships have a significant effect on condyle position, AEI, and AEH. The eminence inclination and height and TRGF are influenced by sex and age.
Anatomic Variations of Paranasal Region in Migraine
Authors: Elvan Özlem , Esen Kaan , Çelikcan Havva Didem , Tezer Mesut Sabri , Özgür Anil
Published: April 2019

Purpose:

To assess the incidence of anatomical variations of the paranasal region on computed tomography in migraine patients compared with control subjects.

Methods:

Paranasal computed tomography scans of 2 groups consisting of 50 migraine patients and 50 control subjects were evaluated, retrospectively. The presence of anatomic variations and the unilateral or bilateral presence of these variations were noted. Appropriate statistical tests were performed to compare the migraine and control groups, using a thresholdPvalue of 0.05 for statistical significance.

Results:

The migraine group included 39 female and 11 male patients with mean age of 39.9 (range: 18–65) years. The control subject group included 29 female and 21 male patients with mean age of 41.9 (range: 18–73) years. Anatomic variations noted included nasal septal deviation and spur, paradoxical curvature of middle concha, agger nasi cell, infraorbital ethmoidal (Haller) cells, sphenoethmoidal (Onodi) cells, supraorbital ethmoidal air cells, concha bullosa, uncinate bulla, and pneumatized crista galli. Of these variations, only the presence of Haller cells was statistically significantly higher in the migraine group compared with controls (P = 0.007). The unilateral presence of Onodi (P < 0.001), unilateral presence of supraorbital ethmoidal air cells (P = 0.012), and bilateral presence of concha bullosa (P = 0.016) were statistically significantly higher in the migraine group. There was no statistically significant difference between the unilateral or bilateral presence of Haller cells in migraine patients compared with controls (P > 0.05).

Conclusion:

Radiographic assessment of the paranasal sinuses is useful to elucidate potential points of pathology in migraine patients. The specific contribution of Haller cells to migraine headache symptoms and safe methods for surgical decompression warrant further study.
Application of Cultured Epidermal Homograft (Kaloderm) for Wide Scar Treatment
Authors: Lee Joon Seok , Chu Seung Gyun , Lee Jeong Woo , Choi Kang Young , Yang Jung Dug , Cho Byung Chae , Jeon Saewha , Chung Ho Yun
Published: April 2019

Background:

For the treatment of wide scars, laser resurfacing procedures are generally used. However, sometimes their results are not satisfactory. Many clinical studies have reported that cultured epidermal allogenic sheets promote rapid and good quality wound healing. Therefore, the authors applied a cultured epidermal homograft (CEH) for scar management and investigated its outcomes.

Methods:

Thirty-two patients who received a CEH (Kaloderm) after laser resurfacing (n = 14, under general anesthesia; n = 18, under local anesthesia) between February 2016 and June 2017 were enrolled. Patients treated with dermabrasion using laser resurfacing (n = 60) without CEH in the same period were used as controls. Clinical grading of the scars was performed using a Patient and Observer Scar Assessment Scale (POSAS) at postoperative 12 months.

Results:

The authors conducted a comparative analysis between the control and CEH groups. Evaluation based on Patient and Observer Scar Assessment Scale showed that the mean scores in control/CEH groups for the 7 observer components (vascularity, pigmentation, thickness, relief, pliability, surface area, and overall opinion) were 4.5/3.2, 3.3/2.8, 2.8/2.5, 3.6/3.5, 3.7/2.1, 2.3/1.9, and 3.2/2.7, respectively, with significant differences observed in vascularity, pliability, and surface area (Pvalues = 0.033, 0.021, and 0.048, respectively). Meanwhile, the mean scores in control/CEH groups for 7 patient components (pain, itching sense, color, stiffness, thickness, irregularity, and overall opinion) were 4.1/2.3, 3/3.1, 2.2/2.1, 2.2/1.7, 3.6/3.5, 1.8/1.5, and 2.2/1.9, respectively, with significant differences between groups observed in pain, stiffness, and overall opinion in the pairedttest (Pvalues = 0.041, 0.020, and 0.048, respectively).

Conclusion:

Cultured epidermal homograft provided good quality wound healing and improved scar pliability. Cultured epidermal homograft left less scarring with no pain or other specific complications. Therefore, dermabrasion with CEH is useful for scar management.
Craniofacial Anthropometry: Normative Data for Caucasian Infants
Authors: Dang Rushil R. , Calabrese Carly E. , Burashed Hamad M. , Doyle Michael , Vernacchio Louis , Resnick Cory M.
Published: April 2019

Purpose:

Craniofacial anthropometry is a valuable tool for characterization of facial dysmorphology and evaluation of treatment outcomes. Databases of normal anthropometric ranges are limited for infants. The aim of this study is to establish normative data for craniofacial anthropometric measurements in Caucasian infants.

Methods:

This is a prospective cross-sectional study including Caucasian infants (≤12 months old) that were recruited from a pediatric medicine practice and Boston Children's Hospital. Infants with craniofacial deformities, trauma or operations were excluded. The sample was stratified by age (in months) into 4 groups: 0 to 3, 3.1 to 6, 6.1 to 9, and 9.1 to 12. Three dimensional (3D) photographs were obtained for all subjects. Forty-five standard anthropometric points were plotted, and 37 measurements were made on the 3D photographs. Two evaluators independently performed all measurements. One examiner repeated the measurements on 25% of the subjects. Intraclass correlation coefficients (ICC) were calculated to assess inter-rater and intra-rater agreement.

Results:

Thirty-three subjects were enrolled in the study. The mean age for the entire sample was 6.3 ± 3.0 months, and 17 subjects (52%) were female. The mean ages (months) for each group were: 1.9 ± 0.7 for group 1 (n = 6); 4.4 ± 0.7 for group 2 (n = 8); 7.5 ± 1.1 for group 3 (n = 11); and 9.9 ± 1.0 for group 4 (n = 8). Descriptive statistics are presented for each group. Inter- and intra-rater agreements were acceptable (ICC >0.6) for 21 anthropometric measurements.

Conclusions:

This study generated normative craniofacial anthropometric measurements for Caucasian infants. These data can be used in the interpretation of measurements for research studies evaluating craniofacial anomalies in this population.
Clear Aligner Use Following Surgery-First Mandibular Prognathism Correction
Authors: Kook Min-Suk , Kim Hyun-Min , Oh Hee-Kyun , Lee Kyung-Min
Published: April 2019

This case report introduces a treatment in mandibular prognathism correction by combining the surgery-first (SF) approach and clear aligners. An intraoral scanner (TRIOS 3, 3Shape, Copenhagen, Denmark) and a virtual setup program (OrthoAnalyzer, 3Shape) were used for treatment simulation. All clear aligners were fabricated using a 3-dimensional printer. The total treatment was completed within 3 months after surgery. An immediate improvement of the facial profile was obtained using the SF approach, and rapid and esthetic tooth movement was achieved using clear aligners. This case report demonstrated that the combination of the SF approach and clear aligners could be a patient-oriented surgical-orthodontic treatment method.
Wound ballistics of military rifle bullets: An update on controversial issues and associated misconceptions
Authors: Stefanopoulos Panagiotis K. , Mikros George , Pinialidis Dionisios E. , Oikonomakis Ioannis N. , Tsiatis Nikolaos E. , Janzon Bo
Published: April 2019

The wound ballistics literature contains several misconceptions about the physical effects of penetrating projectiles in tissue and tissue simulants. These can adversely affect the proper management of gunshot injuries, particularly in view of the ongoing threat of terrorist and criminal acts using assault rifles against civilians. The understanding of the wounding effects by military rifle bullets can be founded on the concept of energy transfer to the wound as applied to high-energy missile trauma. A substantial component of high-energy transfer in assault rifle injuries is manifested by the dynamic phenomenon of temporary cavitation, which is extensively reviewed with respect to its impact on the wound production and the associated controversy surrounding its consequences in soft tissue wounds. Part of this controversy emanates from misinterpretation of experimental data regarding the magnitude of the temporary cavity induced by high-velocity projectiles and the different conceptions of the tissue response to cavitation. The interaction between the projectile and tissue can lead to tumbling and possibly to deformation and fragmentation of the bullet, all of which strongly influence the energy transfer characteristics affecting both the temporary cavitation and the size of the permanent wound channel. Awareness of these effects can enhance perception of clinical and radiological findings suggestive of the wounding mechanism by various projectiles.

LEVEL OF EVIDENCE

Review/therapeutic, level V.