bluuebunny/crossref_metadata_2025 huggingface dataset:
Descemet Membrane Thickening as a Sign for the Diagnosis of Corneal Graft Rejection: An Ex Vivo Study
Authors: VanDenBerg Ryan , Diakonis Vasilios F. , Bozung Alison , Gameiro Gustavo Rosa , Fischer Oliver , El Dakkak Ahmed , Ulloa-Padilla Jan Paul , Anagnostopoulos Apostolos , Dubovy Sander , Abou Shousha Mohamed
Published: September 2017

Purpose:

To disclose, using an ex vivo study, the histopathological mechanism behind in vivo thickening of the endothelium/Descemet membrane complex (En/DM) observed in rejected corneal grafts (RCGs).

Methods:

Descemet membrane (DM), endothelium, and retrocorneal membranes make up the total En/DM thickness. These layers are not differentiable by high-definition optical coherence tomography; therefore, the source of thickening is unclear from an in vivo perspective. A retrospective ex vivo study (from September 2015 to December 2015) was conducted to measure the thicknesses of DM, endothelium, and retrocorneal membrane in 54 corneal specimens (31 RCGs and 23 controls) using light microscopy. Controls were globes with posterior melanoma without corneal involvement.

Results:

There were 54 corneas examined ex vivo with mean age 58.1 ± 12.2 in controls and 51.7 ± 27.9 years in RCGs. The ex vivo study uncovered the histopathological mechanism of En/DM thickening to be secondary to significant thickening (P < 0.001) of DM (6.5 ± 2.4 μm) in RCGs compared with controls (3.9 ± 1.5 μm).

Conclusions:

Our ex vivo study shows that DM is responsible for thickening of the En/DM in RCGs observed in vivo by high-definition optical coherence tomography and not the endothelium or retrocorneal membrane.
Metabolic regulation of macrophages in tumor microenvironment
Authors: Kim Jaehong , Bae Jong-Sup
Published: September 2017

Purpose of review

Insight into the metabolic changes in cancer has become so important that cancer is regarded as a disease entity full of metabolic implications. We summarize the recent findings pertaining to cancer cell-derived metabolic changes that regulate the function of macrophages to favor cancer cell survival, and the reported approaches to reverse these changes.

Recent findings

Since the observation and dramatic revitalization of the Warburg effect, metabolic changes were thought to be confined in cancer cells. However, the Warburg effect has recently been proven to exist in various types of immune cells in tumor tissue. A growing number of publications now indicate that cancer cells interact with other cells in the tumor microenvironment, not only through traditional inflammatory mediators, but also through oncometabolites, and that metabolic changes in immune cells by oncometabolites are the key factors favoring the survival of cancer cells and pro-tumoral function of immune cells. Notably, these metabolic changes do not occur uniformly in tumor progression.

Understanding of the complex metabolic interactions in the tumor microenvironment can not only set a new paradigm for tumor progression, but also provide new breakthroughs to control cancer by modulation of function in tumor-associated macrophages.
New insights into the role of glycosylation in lipoprotein metabolism
Authors: van den Boogert Marjolein A.W. , Rader Daniel J. , Holleboom Adriaan G.
Published: September 2017

Purpose of review

Human genetics has provided new insights into the role of protein glycosylation in regulating lipoprotein metabolism. Here we review these new developments and discuss the biological insights they provide.

Recent findings

Case descriptions of patients with congenital defects in N-glycosylation (CDG-I) frequently describe a distinct hypocholesterolemia in these rare multisystem clinical syndromes. Two novel CDGs with disturbed Golgi homeostasis and trafficking defects result in mixed glycosylation disorders, hepatic steatosis and hypercholesterolemia. In addition, the presence of particular N-glycans is essential for physiological membrane expression of scavenger receptor B1 and for adequate lipolytic activity of endothelial lipase. GalNAc-T2, a specific O-glycosyl transferase, was found to be a direct modulator of HDL metabolism across mammals, validating its relationship with HDL-c found in genome-wide association studies. Furthermore, genetic variation in ASGR1, the major subunit of the asialoglycoprotein receptor (ASGPR), was found to be associated with a reduction in LDL-c and risk of coronary artery disease.

Protein glycosylation plays an important regulatory role in lipoprotein metabolism. Greater insight into how protein glycosylation regulates lipoprotein metabolism could provide novel approaches for the treatment of dyslipidemia.
Maximum Step Length Test Performance in People With Parkinson Disease: A Cross-sectional Study
Authors: Duncan Ryan P. , McNeely Marie E. , Earhart Gammon M.
Published: September 2017

Background and Purpose:

The Maximum Step Length Test (MSLT), a measure of one's capacity to produce a large step, has been studied in older adults, but not in people with Parkinson disease (PD). We characterized performance and construct validity of the MSLT in PD.

Methods:

Forty participants (mean age: 65.12 ± 8.20 years; 45% female) with idiopathic PD completed the MSLT while “OFF” and “ON” anti-PD medication. Construct validity was investigated by examining relationships between MSLT and measures of motor performance. The following measures were collected: Mini-Balance Evaluation Systems Test (Mini-BESTest), Activities-specific Balance Confidence (ABC) scale, gait velocity, 6-minute walk test (6MWT), Movement Disorder Society-Unified Parkinson Disease Rating Scale subsection III (MDS-UPDRS III), and Timed Up and Go (TUG) test. A repeated-measures analysis of variance tested for main effects of medication and stepping direction and the interaction between the 2. Pearson or Spearman correlations were used to assess the relationships between MSLT and motor performance measures (α = 0.05).

Results:

Regardless of medication status, participants stepped further in the forward direction compared with the backward and lateral directions (P < 0.001). Participants increased MSLT performance when ON-medication compared with OFF-medication (P = 0.004). Regardless of medication status, MSLT was moderately to strongly related to Mini-BESTest, TUG, and 6MWT.

Discussion and Conclusions:

People with PD stepped furthest in the forward direction when performing the MSLT. Increased MSLT performance was observed in the ON-medication state compared with OFF-medication; however, the small increase may not be clinically meaningful. Given the relationships between the MSLT and the Mini-BESTest, 6MWT, and TUG, MSLT performance appears to be associated with balance and gait hypokinesia in people with PD.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A186).
Lateral Perturbation-Induced Stepping: Strategies and Predictors in Persons Poststroke
Authors: Gray Vicki L. , Yang Chieh-ling , McCombe Waller Sandy , Rogers Mark W.
Published: September 2017

Background and Purpose:

Falls commonly occur as weight is transferred laterally, and impaired reactive stepping responses are associated with falls after stroke. The purpose of this study was to examine differences in and the determinants of mediolateral (M-L) protective stepping strategies when pulled off balance toward the paretic and nonparetic sides.

Methods:

Eighteen individuals more than 6 months poststroke were pulled in the M-L direction by a lateral waist-pull perturbation system. Step type (crossover, medial, and lateral) and count were recorded, along with first-step initiation time, length, and clearance. Sensorimotor variables including hip adductor/abductor and ankle plantar flexor/dorsiflexor peak isokinetic torques, paretic foot plantar cutaneous sensation, and motor recovery were used to predict step type by discriminant function analyses (DFAs).

Results:

Regardless of pull direction, nearly 70% of trials required 2 or more recovery steps, with more frequent nonparetic leg first steps, 63.5%. The step type was significantly different for pull direction (P = 0.005), with a greater percentage of lateral steps when pulled toward the nonparetic side (45.1%) compared with the paretic side (17.5%). The M-L step length of the lateral step was increased (P < 0.001), with a reduced step clearance (P = 0.05), when pulled toward the paretic side compared with a pull toward the nonparetic side. DFAs revealed that nonparetic and paretic-side pulls could respectively classify step type 64% and 60% of the time, with foot cutaneous sensation discriminating for pull direction.

Discussion and Conclusions:

Balance recovery initiated with the nonparetic leg occurred more frequently in response to M-L perturbations, and paretic foot cutaneous sensation was an important predictor of the stepping response regardless of the pull direction.

Video Abstract available for more insights from the authors (see Video, Supplementary Digital Content 1, http://links.lww.com/JNPT/A190).
Body Mass Index and Saltwater Drowning
Authors: Byard Roger W.
Published: September 2017

Comparison of body mass index (BMI) was undertaken between 30 cases of salt water drowning and 30 age- and sex-matched controls randomly selected from the autopsy files of Forensic Science SA, Adelaide, Australia, during the period 2000 to 2017. The age range of drowning cases and controls was 18 to 80 (average, 49) years, with a male to female ratio of 19:11. The BMIs of the drowning cases ranged from 15.5 to 37.5 (average, 25.4; median, 23). The control cases had higher BMIs ranging from 22.9 to 44.3 (average, 29.2; median, 25). The number of obese (BMI, ≥30) decedents in the drowning group was 5 (17%) and in the controls was 9 (30%). Individuals who drown in the sea may regularly swim, and thus be fitter and therefore slimmer than more sedentary controls. However, it is also possible that greater amounts of adipose tissue may be protective against drowning, as increased fat stores could improve buoyancy. Thinner individuals with denser body mass may have to struggle more to avoid submersion. It could be that a low BMI is an underappreciated finding that may increase the risk of lethal immersion along with alcohol intoxication and poor swimming skills.
The 1-Year Follow-Up Clinic for Neonates and Children After Respiratory Extracorporeal Membrane Oxygenation Support: A 10-Year Single Institution Experience*
Authors: Kakat Suzan , O’Callaghan Maura , Smith Liz , Hreiche Raymond , Ridout Deborah A. , Wray Jo , Thiruchelvam Timothy , Brown Katherine L. , Hoskote Aparna U.
Published: September 2017

Objectives:

To establish the effectiveness of a “1-year extracorporeal membrane oxygenation follow-up clinic” and to characterize any neurodevelopmental concerns identified.

Design:

Single-center retrospective cohort of respiratory extracorporeal membrane oxygenation survivors over 10 years.

Setting:

Nationally commissioned center for neonatal and pediatric (> 28 d of life) respiratory extracorporeal membrane oxygenation.

Patients:

Children attending the follow-up clinic 1 year after receiving respiratory extracorporeal membrane oxygenation between 2003 and 2013.

Interventions:

Standardized follow-up 1 year after extracorporeal membrane oxygenation.

Measurements and Main Results:

In 10 years, 290 children received extracorporeal membrane oxygenation, 194 (67%) survived; all were offered 1-year follow-up, and 98 (51%) attended the clinic. Among these, 51 of 98 (52%) had meconium aspiration syndrome, and 74 of 98 (75%) were on veno-arterial extracorporeal membrane oxygenation with a median (interquartile range) duration of 6 days (4–8 d). Neurodevelopmental problems were identified in 30 of 98 (30%). The specific abnormalities noted included neurologic (seizures, motor, or vision abnormalities) (n = 8), hearing with/without language delay (n = 8), and behavioral problems (as reported by parents) (n = 6), with eight of 30 (27%) having difficulties spanning these domains. An acute neurologic event on extracorporeal membrane oxygenation was found to be the only risk factor for neurodevelopmental concerns (p = 0.006 with odds ratio 5.4 [95% CI, 1.63–17.92]). Despite having neither a cardiac arrest nor an acute neurologic event documented, 18 of 74 (24.3%), 95% CI (15.1–35.7), had neurodevelopmental concerns at 1-year follow-up. Among the nonattenders, 30 (15%) had local follow-up, and 66 (34%) were lost to follow-up.

Conclusions:

All extracorporeal membrane oxygenation survivors need follow-up either at the extracorporeal membrane oxygenation center or in their community, as evidenced by the 1-year follow-up data. Our 1-year extracorporeal membrane oxygenation follow-up clinic provides an opportunity to engage with families, identify neurodevelopmental concerns, and signpost to appropriate services. Of concern, one third of survivors are lost to follow-up, some with an acute neurologic event on extracorporeal membrane oxygenation, a significant risk factor. A consensus-based standardized national follow-up program is vital.
Vectra 3D Imaging for Quantitative Volumetric Analysis of the Upper Limb: A Feasibility Study for Tracking Outcomes of Lymphedema Treatment
Authors: Landau Mark J. , Kim Jennifer S. , Gould Daniel J. , Patel Ketan M.
Published: September 2017

Background:

Secondary lymphedema of the upper limb is a common sequela following lymphadenectomy during oncologic surgery. The gold standard for evaluating treatment outcomes in upper limb lymphedema is limb volume measurement. However, current techniques lack sensitivity to localized changes. In this study, the Vectra 3D imaging system was used to accurately and precisely obtain volume measurements of the upper limb in patients with lymphedema.

Methods:

A feasibility study was performed in 11 patients with lymphedema and 22 upper extremities; 24 arms were evaluated in total. Three-dimensional images were taken of the upper extremities, and Vectra 3D software was used to calculate the volume of the hand, forearm, and upper arm. These measurements were compared to traditional circumference (tape) and water displacement measurements.

Results:

The 24 arm volumes ranged from 1517 to 4050 cc. The Vectra 3D provided precise and accurate volume measurements (average SD ± 1.0 percent of total volume). Measurements of the forearm and upper arm correlated with circumference measurements (R
2 = 0.991) and were in good agreement, with the mean difference between measurement techniques being 2.8 ± 2.0 percent. Three-dimensional measurements of hand, forearm, and upper arm correlated with water measurements (R
2 = 0.990) and had a mean difference between measurement techniques of 2.6 ± 2.1 percent.

Conclusions:

The Vectra 3D system provides precise and accurate data comparable to those of the most commonly used technique to estimate limb volume (tape measurement) and gold-standard water volume measurement. Three-dimensional imaging also offers several advantages, including time efficiency and obtaining localized measurements with high spatial resolution.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, II.
Septum-Based Nasal Tip Plasty: A Comparative Study between Septal Extension Graft and Double-Layered Conchal Cartilage Extension Graft
Authors: Suh Young Chul , Jeong Woo Shik , Choi Jong Woo
Published: September 2017

Background:

The septal extension graft is currently the most commonly used primary and secondary rhinoplasty technique in Asia because it provides maximal tip projection and rotational controllability. The authors compared the tip projection amount and rotational controllability of the tip support between the septal extension graft based on the L-strut septum and double-layer conchal cartilage graft based on the full septum at the nasal tip.

Methods:

Twenty-seven consecutive patients who underwent nasal tip plasty with the septal extension graft or double-layer conchal cartilage graft for purely aesthetic reasons between March of 2014 and July of 2016 were included. The nasal tip projection and columellar labial angle preoperatively (time 0), immediately postoperatively (time 1, an average of 2 weeks after the operation), and postoperatively (time 2, an average of 7 months after the operation) were analyzed with clinical photography.

Results:

Fourteen patients (group A) underwent septal extension graft surgery and 13 (group B) underwent double-layer conchal cartilage graft surgery. Changes of 61 and 74 percent in tip projection ratio were immediately achieved and were maintained after surgery for groups A and B, respectively (time 2 versus time 0 dividing time 1 versus time 0; p = 0.722 for groups A and B). Therefore, the relapse ratio of this technique was 39 and 26 percent for groups A and B, respectively.

Conclusions:

This comparative study between the septal extension graft and double-layer conchal cartilage graft showed that both nasal tip plasties are similar in terms of stability. Considering the fact that the double-layer conchal cartilage graft could preserve septal support, this technique could become an effective and safe alternative option for rhinoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Metacarpal-Like Hand: Classification and Treatment Guidelines for Microsurgical Reconstruction with Toe Transplantation
Authors: Wei Fu-Chan , AL Deek Nidal F. , Lin Yu-Te , Hsu Chung-Chen , Lin Cheng-Hung
Published: September 2017

The metacarpal-like hand is a severe hand injury, never addressed before. It describes a hand that has lost a significant degree of prehension through a wide array of amputations, involving all digits proximal to the functional length except in one finger or in two digits, including the thumb. The thumb condition can be used to differentiate between two types. In type I, the thumb is intact or amputated at or distal to the interphalangeal joint (functional length); therefore, the reconstruction is focused mainly on fingers. In type II, the thumb is amputated proximal to the interphalangeal joint; therefore, the reconstruction is focused on both the thumb and fingers. Thumb amputation level, integrity of the first basal joint, and functionality of the thenar muscles can be used to subdivide type II. Functional reconstruction should consider the patient’s desire and vocational needs. The finger left with adequate functional length is assessed for its location, level of amputation, and joint motion, especially the proximal interphalangeal joint. The goal is to use the reliable techniques of toe-to-hand surgery to reconstruct more opposable units, at least two fingers, whether adjacent to each other or not, and the thumb, when needed, to achieve a functionally and aesthetically better hand instead of a functionally adequate hand, with a more acceptable to ideally natural hand cascade. Strategic, individualized toe transfer(s) is the key element in fulfilling the goals of this operation whether single or multiple toes are transplanted.
Nocardia infections in solid organ and hematopoietic stem cell transplant recipients
Authors: Coussement Julien , Lebeaux David , Rouzaud Claire , Lortholary Olivier
Published: September 2017

Purpose of review

Nocardia spp. is a gram-positive bacteria that may cause infections in humans. Nocardiosis has been described since the early years of transplantation. This review aims to provide an overview of present knowledge regarding posttransplant nocardiosis, with a focus on recent findings.

Recent findings

Nocardiosis is not rare among transplant recipients, especially after thoracic transplantation and/or in case of intense immunosuppressive regimen or use of tacrolimus. Low-dose cotrimoxazole is not effective to prevent nocardiosis. Although lung is the most common site of infection, more than 40% of organ transplant patients have a disseminated infection. As central nervous system involvement is frequent (about 1/3 of the patients) and possibly asymptomatic, brain imaging is mandatory. Diagnosis relies on direct examination and culture; molecular species identification is useful to guide treatment. Although cotrimoxazole is the drug for which we have the strongest clinical experience, other antibiotics such as linezolid, parenteral cephalosporins, carbapenems, and amikacin can be used to treat nocardiosis. Although treatment duration has historically been set to at least 6 months, shorter durations (<120 days) seem associated with a good outcome in selected patients.

Physicians in charge of transplant patients should be aware of nocardiosis. Diagnosis and management of transplant recipients with nocardiosis require a multidisciplinary approach.
Spinal Metastasis Characterized on FDG PET/CT in Head and Neck Squamous Cell Carcinoma
Authors: Khan Shahroz , Son Hannah
Published: September 2017

Spinal metastases are rare in head and neck cancer. We present a rare case of vocal cord squamous cell cancer that metastasized to the spinal cord and cauda equina. A 63-year-old man presented with acute back pain and bilateral leg weakness 5 months after having a surgical treatment for moderately differentiated vocal cord squamous cell cancer (T2 N0 M0). Restaging 18F-FDG PET examination demonstrated a soft tissue mass with intense hypermetabolism in the distal spinal cord and a hypermetabolic leptomeningeal metastatic deposit at the L3 level. The findings were confirmed on MRI prior to treatment.
Differentiation of Malignant Thrombus From Bland Thrombus of the Portal Vein in Patient With Hepatocellular Carcinoma on 18F-FDG PET CT
Authors: Agarwal Krishan Kant , Shah Dipalkumar , Shah Neha , Mayank Manas
Published: September 2017

Hepatocellular carcinoma carries a high risk of invasion of the portal vein. Neoplastic and bland portal vein thrombi discrimination is of great clinical significance for determining the therapeutic approach, predicting survival, and assessing candidates for liver transplantation. 18F-FDG PET/CT may be helpful in discriminating between malignant and portal vein thrombi. We present the case of a 61-year old man who presented with hepatocellular carcinoma with portal vein involvement. 18F-FDG PET/CT has a role in differentiating malignant from benign portal vein thrombosis.
Cleft Lip and Palate: An Experience of a Developing Center in Egypt
Authors: Abulezz Tarek A.
Published: September 2017

Background:

Cleft lip and palate is the most common congenital anomaly in the head and neck region. These clefts are not just a distortion of the normal appearance, but they may impose a major influence on the whole patient's life, both functionally and psychologically. Clefts affect feeding, teething, hearing, speech, and social communication. The incidence of cleft lip and palate is variable in different countries and different communities. The surgical correction of cleft lip and palate went through many evolutions, but still there is no single universal protocol of repair; however, many European countries have adopted national protocols and have established cleft centers for the management and follow up of affected population.

Patient and Methods:

In this study, the problem of cleft lip and palate in the area of upper Egypt was presented through the records of patients admitted to the Department of Plastic Surgery at the Sohag University Hospital in a 15-year period (2001–2015).

Results:

A total number of 1318 patients, who were admitted and had been operated upon in our department, were included in this study. The majority of patients presented to the department with a primary disease, yet 14.7% (194 patients) of them were first presented for a secondary interference after being operated upon elsewhere. A total number of 1923 surgical procedures were performed.
Fibular Graft-Effective Panorama for Prosthetic Rehabilitation of Resected Mandible
Authors: Kharade Pankaj , Islam Saidul , Verma Mahesh , Sharma Swati , Bodh Ranjeet
Published: September 2017

Surgical management of extensive tumors in the mandibular region leads to massive disfigurement of the face. Also the prosthetic outcome of such patients rehabilitated with free soft tissue flaps is very poor. Reconstruction of extensive defects to overcome the disfigurement is a challenging procedure and can be achieved with free fibula flap. Free fibula graft provides sufficient length of bone for the reconstruction of the postsurgical defects. Excellent vascularity of fibula flap allows for easy uptake of the graft and osseointegration of the dental implants. The addition of a skin island allows for absolute tension-free intraoral closure that enhances tongue mobility. Fibula graft allows proper tissue support after mandibular reconstruction. After rehabilitation with free fibula graft we can plan for prosthodontic rehabilitation with implant retained prosthesis leading to improved masticatory function. It also helps to improve speech outcome as a stable prosthesis can be delivered with the help of implants retained in the fibula graft. It is essential to assess the outcome of surgical reconstruction with fibula graft followed by prosthetic rehabilitation with implant retained prosthesis for their recognition as a treatment of preference. This article details the clinical report along with various clinical parameters for implant retained prosthetic rehabilitation of the patient who had undergone mandibular resection and reconstruction with free fibula graft.
A Craniometric Analysis of Cranial Base and Cranial Vault Differences in Patients With Metopic Craniosynostosis
Authors: Naran Sanjay , Mazzaferro Daniel , Wes Ari , Vossough Arastoo , Bartlett Scott P. , Taylor Jesse A.
Published: September 2017

Purpose:

The effect of synostosis is not confined to the immediate vicinity of the suture. The authors hypothesized metopic craniosynostosis results in migration of lateral structures from midline, and differences in segmental volume of the cranial fossa.

Methods:

A retrospective case-controlled cohort analysis of patients with nonsyndromic metopic craniosynostosis was performed. Craniometric angles, distances to landmarks from midline, cephalic index, and segmented volume ratios were calculated. A comparison group consisted of patients without cranial pathology or with mild positional plagiocephaly.

Results:

Twenty patients with metopic craniosynostosis and 19 controls were identified. The bifrontal angle was significantly more acute in metopic patients. Distance from midline to the medial carotid, the foramen ovale, and the hypoglossal canal were all significantly longer in metopic patients. Ratio of anterior third to total cranial vault volume was significantly smaller in metopic patients; however, ratio of middle third to total cranial vault volume was significantly larger. As the bifrontal angle decreased by 1°, the volume of the anterior third of the cranial vault was observed to decrease by 0.17% (P < 0.001).

Conclusions:

Patients with metopic craniosynostosis show a distinct and significant transverse lateralization of structures of the anterior skull base relative to midline, significant restriction of the anterior third of the cranial vault, and compensatory expansion of the middle third. There is a linear relationship between the bifrontal angle and the subsequent change in anterior third cranial vault volume.

Level of Evidence:

IV; Therapeutic
Maxillary Corticotomies With Bone-to-Bone Retraction and Mandibular Segmental Osteotomy for Correcting an Anterior Double Protrusion
Authors: Kim Kyung A. , Lee Baek-Soo , Akbulut Ayse Selenge , Kim Seong-Hun , Nelson Gerald
Published: September 2017

Backgrounds:

This article presents maxillary corticotomies with bone-to-bone retraction and anterior segmental osteotomy (ASO) as an alternative to 2-jaw orthognathics in the bimaxilary protrusion patient with partially anchylosed maxillary anterior tooth.

Methods:

The 18-year-old male, complaining of anterior protrusion, with a trauma history to the maxillary central incisor, and requesting rapid treatment, was treated with maxillary corticotomies in 2 stages and ASO in the mandible. The mandibular ASO and palatal corticotomy were done under local anesthesia and 2 weeks later, labial corticotomy followed. The anterior segment was retracted bodily using buccal C-tubes and a combination of the C-lingual retractor and palatal C-plate.

Results:

Due to a concern about ankylosis of the maxillary right central incisor, retraction of the anterior bone/tooth segment was chosen over any attempt to move teeth through the bone. After bone-to-bone retraction, the remaining extraction space was closed by protraction of posteriors. The total treatment period was 18 months. There was good retraction of the anterior segment and retrusion of the lips.

Conclusions:

A combination of maxillary corticotomies with skeletal anchorage for bone-to-bone retraction and a mandibular ASO under local anesthesia might be an alternative treatment option for excellent profile change in a short treatment period.
Patient-Centered Outcome Spectrum
Authors: Ingraham Angela M. , Agarwal Suresh K. , Jung Hee Soo , Liepert Amy E. , O’Rourke Ann P. , Scarborough John E.
Published: September 2017

Objective:

Our objective was to develop an alternate construct for reporting anticipated outcomes after emergency general surgery (EGS) that presents risk in terms of a composite measure.

Background:

Currently available prediction tools generate risk outputs for discrete as opposed to composite measures of postoperative outcomes. A construct to synthesize multiple discrete estimates into a global understanding of a patient's likely postoperative health status is lacking and could augment shared decision-making conversations.

Methods:

Using the 2012 to 2014 American College of Surgeons National Surgical Quality Improvement Program Participant Use File, we developed the Patient-Centered Outcomes Spectrum (PCOS) for patients ≥65 years old who underwent an EGS operation. The PCOS defines 3 exclusive types of global outcomes (good, intermediate, and bad outcomes) and allows patients to be prospectively stratified by both their EGS diagnosis and preoperative surgical risk profile.

Results:

Of the patients in our study population, 13,330 (46.4%) experienced a 30-day postoperative course considered a good outcome. Conversely, 3791 (13.2%) of study patients experienced a bad outcome. The remainder of patients (11,617; 40.4%) were classified as experiencing an intermediate outcome. The incidence of good, intermediate, and bad outcomes was 69.7%, 28.2%, and 2.1% for low-risk patients, and 22.0%, 48.9%, and 29.1% for high-risk patients. Diagnosis-specific PCOS constructs are also provided.

Conclusions:

Consistent with the goals of shared decision-making, the PCOS provides an evidence-based construct based upon a composite outcome measure for patients and providers as they weigh the risks of undergoing EGS.
Postoperative Pain After Laparoscopic Repair of Primary Umbilical Hernia: Titanium Tacks Versus Absorbable Tacks: A Prospective Comparative Cohort Analysis of 80 Patients With a Long-term Follow-up
Authors: Stirler Vincent M.A. , Nallayici Erol G. , de Haas Robbert J. , Raymakers Johan T.F.J. , Rakic Srdjan
Published: September 2017

We investigated if a novel fixation device with absorbable tacks (Securestrap) causes less early and chronic postoperative pain after laparoscopic repair with a double-crown mesh fixation of ventral abdominal wall hernia when compared with the standard fixation device with nonabsorbable titanium tacks (Protack). The primary outcome measure was early postoperative pain at 2, 6, and 12 weeks postoperatively. The secondary outcome measure was chronic postoperative pain measured ≥18 months after surgery. Pain levels were assessed using a visual analog scale ranging from 0 (no pain) to 100 mm (excruciating pain). Early postoperative pain was significantly lower in group 2 (absorbable tacks) at 6 (2 vs. 5; P=0.008) and 12 weeks (1 vs. 2; P=0.008) but not at follow-up (6 vs. 11; P=0.21). Given the very low visual analog scale scores in both groups, the clinical significance of these finding remains open to discussion.
The role of vitamin D in cancer cachexia
Authors: Penna Fabio , Camperi Andrea , Muscaritoli Maurizio , Filigheddu Nicoletta , Costelli Paola
Published: September 2017

Purpose of review

The possibility to use vitamin D supplementation to improve muscle wasting, with particular focus on cancer cachexia, is discussed.

Recent findings

Vitamin D exerts biological actions on myogenic precursor proliferation and differentiation, impinging on muscle regeneration. However, the effects of VitD supplementation in diseases associated with muscle atrophy, such as cancer cachexia, are poorly investigated. Data obtained in experimental models of cancer cachexia show that the administration of vitamin D to tumor-bearing animals is not able to prevent or delay both muscle wasting and adipose tissue depletion, despite increased expression of muscle vitamin D receptor. Not just vitamin D supplementation impairs muscle damage-induced regeneration, suggesting that upregulation of vitamin D receptor signaling could contribute to muscle wasting.

Vitamin D supplementation is likely beneficial to reduce or delay aging-related sarcopenia and osteoporosis, although the available data still put in evidence significant discrepancies. By contrast, VitD supplementation to tumor-bearing animals or to rats with arthritis was shown to be totally ineffective. In this regard, the adoption of VitD treatment in patients with cancer cachexia or other chronic diseases should be carefully evaluated, in particular whenever a regenerative process might be involved.
Health professionals’ quality of life in relation to end of life care
Authors: Linzitto Juan P. , Grance Gladys
Published: September 2017

Purpose of review

Palliative care professionals are frequently exposed to stressful and demanding situations in the assistance of patients and their families, therefore research related to their quality of life is a relevant topic to provide evidence on interventions oriented to professional self-care.

Recent findings

Research about professionals’ quality of life is having a profuse development with core concepts being under review.

Currently, burnout syndrome and compassion fatigue are considered relevant determinants of professionals’ quality of life. Self-awareness-based interventions could bring positive influence on the context of a multidimensional approach to professionals’ self-care. Self-care topics should be considered to be included in professional training programmes.
Estimated Blood Loss During Vaginal Hysterectomy and Adnexal Surgery Described With an Intraoperative Pictographic Tool
Authors: Nelson Nancy C. , Ostby Stuart A. , Weaver Amy L. , McGree Michaela E. , Gebhart John B. , Bakkum-Gamez Jamie N.
Published: September 2017

Objective

We describe a novel way to calculate estimated blood loss (EBL) using an intraoperative pictographic tool in gynecologic surgery.

Methods

A pictographic tool to estimate sponge saturation was developed to calculate EBL during surgery. A prospective cohort of women 18 years or older undergoing benign vaginal hysterectomy with planned adnexal surgery at Mayo Clinic were consented for use of the pictographic tool. Demographic, preoperative, intraoperative, and postoperative data were abstracted. Estimated blood loss was compared among surgeons, anesthesia providers, and the pictographic tool and then correlated with change in hemoglobin.

Results

Eighty-one patients met inclusion with mean age of 45.3 ± 8.7 years. Successful vaginal hysterectomy was achieved in all patients with successful completion of planned adnexectomy in 69 (85.2%). Mean EBL among surgeons, anesthesia providers, and pictographic estimates, respectively, was as follows: 199.4 ± 81.9 mL, 195.5 ± 152.2 mL, and 288.5 ± 186.6 mL, with concordance correlation coefficients for surgeons and anesthesia providers versus pictographic tool of 0.40 (95% confidence interval, 0.29–0.51) and 0.68 (95% confidence interval, 0.57–0.79), respectively. The mean postoperative change in hemoglobin was −1.8 g/dL; there were no postoperative transfusions. Change in hemoglobin was more correlated with blood loss estimates from surgeons (r = −0.31, P = 0.008) and anesthesia providers (r = −0.37, P = 0.003) than the pictographic tool (r = −0.19, P = 0.11).

Conclusions

Use of a pictographic tool to objectively estimate blood loss demonstrated significant overestimations compared with both anesthesia providers’ and surgeons’ estimates because the pictographic tool was less correlated with postoperative change in hemoglobin than anesthesia provider and surgeon estimates.
Expanding heterochromatin reveals discrete subtelomeric domains delimited by chromatin landscape transitions
Authors: Hocher Antoine , Ruault Myriam , Kaferle Petra , Descrimes Marc , Garnier Mickael , Morillon Antonin , Taddei Angela
Published: September 2017

The eukaryotic genome is divided into chromosomal domains of heterochromatin and euchromatin. Transcriptionally silent heterochromatin is found at subtelomeric regions, leading to the telomeric position effect (TPE) in yeast, fly and man. Heterochromatin generally initiates and spreads from defined loci, and diverse mechanisms prevent the ectopic spread of heterochromatin into euchromatin. Here, we overexpressed the silencing factor Sir3 at various levels in yeast, and found that Sir3 spreading into Extended Silent Domains (ESD) eventually reached saturation at subtelomeres. We observed that Sir3 spreading into ESDs covered zone associated with specific histone marks in wild-type cells and stopped at zones of histone mark transitions including H3K79 tri-methylation levels. The conserved enzyme Dot1 deposits H3K79 methylation, and we found that it is essential for viability upon overexpression of Sir3, but not of a spreading-defective mutant Sir3A2Q. These data suggest that H3K79 methylation actively blocks Sir3 spreading. Lastly, our meta-analysis uncovers previously uncharacterized discrete subtelomeric domains associated with specific chromatin features offering a new viewpoint on how to separate subtelomeres from the core chromosome.
Four fundamental processes of community assembly
Authors: Ladau Joshua , Schwager Steven J.
Published: September 2017

A central aim of ecology is understanding the mechanisms of community assembly. To address this problem, community assembly is often modeled as a sampling process, in which species are selected from a pool of available species, possibly with effects of interspecific interactions, habitat filtering, and other ecological mechanisms. However, the fundamental stochastic sampling process by which species are selected from the pool remains unexplored. Here we demonstrate the distinctness of four canonical sampling processes, the Bernoulli, Plackett-Luce, multinomial, and fractional multinomial processes. Each process can be affected by ecological mechanisms or it can occur in their absence. Although all four of the processes area prioriplausible and the first two are widely used in ecological models, we show that the multinomial and fractional multinomial processes broadly underlie community assembly.
Controller for microfluidic large-scale integration
Authors: White Jonathan A , Streets Aaron M
Published: September 2017

Microfluidic devices with integrated valves provide precise, programmable fluid handling platforms for high-throughput biological or chemical assays. However, setting up the infrastructure to control such platforms often requires specific engineering expertise or expensive commercial solutions. To address these obstacles, we present a Kit for Arduino-based Transistor Array Actuation (KATARA), an open-source and low-cost Arduino-based controller that can drive 70 solenoid valves to pneumatically actuate integrated microfluidic valves. We include a python package with a GUI to control the KATARA from a personal computer. No programming experience is required.
Minor allele frequency thresholds dramatically affect population structure inference with genomic datasets
Authors: Linck Ethan , Battey C.J.
Published: September 2017

One common method of minimizing errors in large DNA sequence datasets is to drop variable sites with a minor allele frequency below some specified threshold. Though widespread, this procedure has the potential to alter downstream population genetic inferences and has received relatively little rigorous analysis. Here we use simulations and an empirical SNP dataset to demonstrate the impacts of minor allele frequency (MAF) thresholds on inference of population structure. We find that model-based inference of population structure is confounded when singletons are included in the alignment, and that both model-based and multivariate analyses infer less distinct clusters when more stringent MAF cutoffs are applied. We propose that this behavior is caused by the combination of a drop in the total size of the data matrix and by correlations between allele frequencies and mutational age. We recommend a set of best practices for applying MAF filters in studies seeking to describe population structure with genomic data.
Age-related differences in prestimulus subsequent memory effects assessed with event-related potentials
Authors: Koen Joshua D. , Horne Erin D. , Hauck Nedra , Rugg Michael D.
Published: September 2017

Prestimulus subsequent memory effects (preSMEs) – differences in neural activity elicited by a task cue at encoding that are predictive of later memory performance – are thought to reflect differential engagement of preparatory processes that benefit episodic memory encoding. We investigated age differences in preSMEs indexed by differences in ERP amplitude just prior to the onset of a study item. Young and older adults incidentally encoded words for a subsequent memory test. Each study word was preceded by a task cue that signaled the judgment to perform on the word. Words were presented for either a short (300 ms) or a long (1000 ms) duration with the aim of placing differential benefits on engaging preparatory processes initiated by the task cue. ERPs associated with subsequent successful and unsuccessful recollection, operationalized here by source memory accuracy, were estimated time-locked to the onset of the task cue. In a late time-window (1000-2000 ms following onset of the cue), young adults demonstrated frontally distributed preSMEs for both the short and the long study durations, albeit with opposite polarities in the two conditions. This finding suggests that preSMEs in young adults are sensitive to perceived task demands. Although older adults showed no evidence of preSMEs in the same late time window, significant preSMEs were observed in an earlier time window (500-1000 ms) that were invariant with study duration. These results are broadly consistent with the proposal that older adults differ from their younger counterparts in how they engage preparatory processes during memory encoding.
Allosteric effector ppGpp potentiates the inhibition of transcript initiation by DksA
Authors: Molodtsov Vadim , Sineva Elena , Zhang Lu , Huang Xuhui , Cashel Michael , Ades Sarah E. , Murakami Katsuhiko S.
Published: September 2017

DksA and ppGpp are the central players in theEscherichia colistringent response and mediate a complete reprogramming of the transcriptome from one optimized for rapid growth to one adapted for survival during nutrient limitation. A major component of the response is a reduction in ribosome synthesis, which is accomplished by the synergistic action of DksA and ppGpp bound to RNA polymerase (RNAP) inhibiting transcription of rRNAs. Here, we report the X-ray crystal structures ofE. coliRNAP holoenzyme in complex with DksA alone and with ppGpp. The structures show that DksA accesses the template strand at the active site and the downstream DNA binding site of RNAP simultaneously and reveal that binding of the allosteric effector ppGpp reshapes the RNAP–DksA complex. The structural data support a model for transcriptional inhibition in which ppGpp potentiates the destabilization of open complexes on rRNA promoters by DksA. We also determined the structure of RNAP–TraR complex, which reveals the mechanism of ppGpp-independent transcription inhibition by TraR. This work establishes new ground for understanding the pleiotropic effects of DksA and ppGpp on transcriptional regulation in proteobacteria.

Highlights

DksA has two modes of binding to RNA polymerase

DksA is capable of inhibiting the catalysis and influences the DNA binding of RNAP

ppGpp acts as an allosteric effector of DksA function

ppGpp stabilizes DksA in a more functionally important binding mode
Cell size and growth rate are modulated by TORC2-dependent signals
Authors: Lucena Rafael , Alcaide-Gavilán Maria , Schubert Katherine , He Maybo , Domnauer Matthew , Marquer Catherine , Kellogg Douglas R.
Published: September 2017

The size of all cells, from bacteria to vertebrates, is proportional to the growth rate set by nutrient availability, but the underlying mechanisms are unknown. Here, we show that nutrients modulate TORC2 signaling, and that cell size is proportional to TORC2 signaling in budding yeast. The TORC2 network controls production of ceramide lipids, which play roles in signaling. We discovered that ceramide-dependent signals control both growth rate and cell size. Thus, cells that can not make ceramides fail to modulate their growth rate or size in response to changes in nutrients. PP2A associated with the Rts1 regulatory subunit (PP2ARts1) is embedded in a feedback loop that controls TORC2 signaling and plays an important role in mechanisms that modulate TORC2 signaling in response to nutrients. Together, the data suggest a model in which growth rate and cell size are mechanistically linked by ceramide-dependent signals arising from the TORC2 network.