bluuebunny/crossref_metadata_2025 huggingface dataset:
A futuristic vision of pocket ultrasound machines: watch this space
Authors: Woo Joyce Su Ling , Magotti Robert , Benzie Ronald
Published: December 2015

Introduction: Australian medical ultrasound started in 1959 with the establishment of the Ultrasonics Institute. Since then the technology has advanced tremendously. We are now not only able to obtain clearer images on high specification ultrasound machines but also on pocket‐sized ultrasound machines that are compact, lightweight and affordable.

Method: The following descriptive review will examine the indication for use of pocket ultrasound machines in different clinical settings as well as provide evidence of its image clarity and accuracy. Potentially eligible studies were sought primarily through searches of the electronic databases PubMed, Medline (1996–Present), Embase (1996–Present) and Cochrane Library.

Conclusion: Pocket ultrasound machines, with appropriate ultrasound knowledge and training, can be incorporated successfully in patient management. The addition of point‐of‐care ultrasound has been shown to improve management recommendations and outcomes.
Clinical case presentation: life threatening Group A sepsis secondary to HyCoSy
Authors: Rodgers Rachael , Ludlow Joanne , Gee Alison , Ramsay Philippa , Benness Christopher
Published: December 2015

Hysterosalpingo contrast sonography (HyCoSy) is a commonly performed procedure in the investigation of infertility. Infection is an uncommon complication of this procedure. Should it occur, it is generally mild and amenable to outpatient treatment with oral antibiotics. We present a case of an immunosuppressed woman who underwent HyCoSy for investigation of secondary infertility and developed life‐threatening sepsis with Group A streptococcus.
Ultrasound guided therapeutic injections of the cervical spine and brachial plexus
Authors: Cormick Wes
Published: December 2015

Introduction: Recent applications in ultrasound imaging include ultrasound assessment and ultrasound guided therapeutic injections of the spine and brachial plexus.

Discussion: Ultrasound is an ideal modality for these regions as it allows accurate safe and quick injection of single or multiple sites. It has the added advantages of lack of ionising radiation, and can be done without requiring large expensive radiology equipment.

Conclusion: Brachial plexus pathology may be present in patients presenting for shoulder symptoms where very little is found at imaging the shoulder. It is important to understand the anatomy and normal variants that may exist to be able to recognise when pathology is present. When pathology is demonstrated it is easy to do a trial of therapy with ultrasound guided injection of steroid around the nerve lesion. This review will outline the normal anatomy and variants and common pathology, which can be amenable to ultrasound guided injection of steroid.
Imaging of slings and meshes
Authors: Shek Ka Lai , Dietz Hans Peter
Published: December 2015

The popularity of imaging in pelvic floor medicine continues to increase. Among the various modalities, ultrasound is superior as it is cheap, safe, easily accesible and simple, resulting in high patient compliance. It is the only technique that allows imaging of modern wide‐weave polypropylene sling or mesh implants, and imaging of such implants is commonly required due to the popularity of surgical techniques that involve the placement of slings and meshes. This review article will discuss the role of translabial ultrasound in the evaluation of synthetic implants used in the treatment of urinary incontinence and pelvic organ prolapse.
Increased endometrial vascularity and intraoperative haemorrhage among women undergoing surgical evacuation for retained product of conception
Authors: Ebrahimi Maryam , Trivedi Amarendra
Published: December 2015

The aim of this study was to ascertain the incidence of “increased endometrial vascularity” recorded in the ultrasound scan reports, in the context of RPOC and correlate this finding with the incidence of life threatening intra‐operative bleeding.

Ultrasound scan reports sometimes mention the presence of increased endometrial / sub‐endometrial vascularity in the context of retained products of conception or secondary post partum haemorrhage. This raises the possibility of serious intra‐operative haemorrhage in the minds of the junior doctors because of the possibility of arterio‐venous malformation. This retrospective case series was designed to find the incidences of increased endometrial vascularity and severe intra‐operative haemorrhage in the patients with RPOC in the south eastern part of Melbourne population. The study found that the incidence of increased endometrial vascularity was 7.57% and none of these patients suffered severe intra‐operative haemorrhage. A literature survey revealed that there were few studies on this topic.
Congenital Epulis: a clinical case presentation
Authors: Sweeney Kristie , Spurway Jacqueline , Mein Brendan , Magotti Robert , Benzie Ron , Challis Daniel , Henry Guy
Published: December 2015

Congenital Epulis (CE) is a rare, benign tumour of the mucosa of the mouth in a neonate. It presents as an intraoral tumour and is rarely diagnosed prenatally. Complications include neonatal airway compromise, difficulty feeding and aesthetic considerations. Ultrasound is useful in aiding decisions regarding site, age, method of delivery and preparing parents and staff for the appearances of the tumour at birth. We present a case where CE was identified at 35 weeks gestational age during a routine third trimester prenatal ultrasound.

The patient was scanned at a rural centre, referred to a tertiary institution for follow up and delivered at a specialist perinatal surgical centre, in preparation for neonatal surgery. The outcome was excellent and this case is a good example of multi‐centre cooperation.
Echocardiographic assessment of left ventricular outflow tract diameter in preterm infants
Authors: Beker Friederike , Davis Peter G , Sehgal Arvind , Rogerson Sheryle
Published: December 2015

Introduction: Left ventricular output (LVO) measurement is an important part of the echocardiographic assessment of cardiac function in preterm infants. The accurate measurement of left ventricular outflow tract diameter (LVOD) is key to the calculation of LVO. Given the lack of an appropriate gold standard, we used right ventricular output (RVO) as the comparator and sought to identify the most accurate method of determining LVO in preterm infants.

Methods: We studied stable preterm infants without significant cardiac shunts. LVOD was measured at the aortic valve, the aortic sinus and at the sinotubular junction. LVOs were calculated and the precision and accuracy of each was determined relative to the RVO using the Bland‐Altman method. Results: 52 infants were included in this analysis. The mean difference between RVO and LVO was largest when LVOD was measured at the aortic valve and aortic sinus, +106 and −115 ml/kg/min, respectively, and smallest when measured at the sinotubular junction, 9 ml/kg/min. Limits of agreement between RVO and LVO were narrowest when LVOD was measured at the STJ. Conclusion: LVOD measurement at the sinotubular junction provides more precise and accurate measurement of LVO, in comparison to RVO, than measurement at the aortic valve or the aortic sinus.
Sonographic diagnosis of Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome: a report of two cases
Authors: Mishra Neetika , Ng Stanley
Published: December 2015

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare urogenital anomaly. Patients typically present at puberty, shortly after menarche with increasing pelvic pain, dysmenorrhea and pelvic mass. There may be a known history of unilateral renal agenesis. Diagnosis can usually be established by ultrasound or magnetic resonance imaging. Resection of the vaginal septum is the treatment of choice. Early diagnosis and treatment can relieve symptoms, prevent complications and preserve fertility. We present two cases of OHVIRA syndrome diagnosed by ultrasound to promote recognition of this rare but important condition.
Lung ultrasound in heart failure: Lessons from re‐analysis of Lung Ultrasound 2011 database
Authors: Baker Kylie , Mitchell Geoffrey , Thompson Angus G , Stieler Geoffrey , Rippey James
Published: December 2015

Introduction: In the setting of patients presenting with shortness of breath to an Emergency Department a simple lung ultrasound protocol aimed at detecting pulmonary oedema has been shown to have diagnostic accuracy of 85%. This article reviews data from the original study, in an attempt to determine whether adjusting the protocol and/or interpretive criteria would improve results.

Method: A large lung ultrasound project provided the dataset. Inter‐rater and intertest discrepancies were reviewed. Then original stored images and comments were retrospectively analysed using alternate interpretive criteria. Specific variations included changing the number of B‐lines required to define ‘wet lung’ and assessing other pleural line abnormalities. Where they had been acquired cardiac loops were reviewed in addition to the lung images.

Results: The 204 original studies available were reviewed. Some disagreement could be attributed to inexperience and unclear definitions. Adjusting the number of B‐lines did not improve diagnostic accuracy. All positive scans, with numerous B‐lines were reviewed using more advanced diagnostic criteria (pleural line abnormalities) and the number of false positives was decreased. In cases where cardiac views were available, their inclusion was beneficial.

Conclusion: A simple lung ultrasound protocol to assess for ‘wet lung’ in patients presenting to Emergency Departments provides diagnostic accuracy of around 85% in the hands of relative novices. More advanced interpretation of the same_ultrasound images, and the addition of cardiac views, is likely to further improve diagnostic accuracy.
Use of bedside ultrasound to diagnose dislodged gastric band
Authors: Bass Dirk , Telfah Malek , Bowra Justin
Published: December 2015

Introduction: Obesity levels mean an increased presentation of patients with Laparoscopic adjustable gastric banding (LAGB).

Method: Literature search revealed a paucity of information on ultrasonography to diagnose a slipped LAGB.

Conclusion: 2D Ultrasonography with a standard low frequency curvilinear probe proved to be a simple, effective method of diagnosing slipped Laparoscopic adjustable gastric banding (LAGB). We suggest the inclusion of routine abdominal ultrasound (after drinking water to improve sensitivity of the test) as part of the routine workup of suspected LAGB slippage.
Can we measure the spiral and uterine artery blood flow by real‐time sonography and Doppler indices to predict spontaneous miscarriage in a normal‐risk population?
Authors: Özkan Mehmet Burak , Ozyazici Elif , Emiroglu Baris , Özkara Enis
Published: December 2015

Introduction: The predictive value of spiral artery flow Doppler measurements of a subsequent early miscarriage in first trimester pregnancy is explored here.

Objective: The aim of this study is to determine uterine and spiral artery blood flow changes in first trimester subsequent miscarriages and correlate within the mechanisms of the Doppler indicies.

Study design: The uterine artery and spiral artery pulsatility and resistance indexes, systolic and diastolic ratios, acceleration times, and blood flow of both the right and left uterine arteries were obtained by trans vaginal color Doppler ultrasonography in consecutive viable pregnancies between 5 and 12 gestational week. Women were subsequently classified as having continuing pregnancies or pregnancy loss before 20 weeks gestation. To predict subsequent pregnancy loss, Doppler findings were adjusted for maternal age, history of previous abortion, presence of subchorionic hematoma, embryonic bradycardia, and gestational age by means of multivariate logistic regression analysis. The cut‐off values are used for the ROC curve.

Results: Twenty‐five pregnancies (11.7%) were spontaneously aborted before 20 weeks of gestational age. In 29 (13.6%) cases there were previously abortion history, 30 (14%) had bradycardia, and 37 (17.3%) had subchoronic hematoma. Regarding the parameters of uterine and spiral artery pulsatility and resistive index, acceleration time, systolic/diastolic ratios and blood flows, only uterine artery S/D low values were significantly associated with pregnancy loss in the multivariate logistic regression analysis (P = 0.0001,95% CI: 4.968–55.675).

Conclusion: The uterine artery systolic/diastolic ratios have a predictive value for early pregnancy loss and seem to be useful as a marker. On the other hand, spiral artery changes could be so local that they cannot be determined by the parameters of spectral Doppler techniques. This suggests that uterine vascular bed alterations should be measured to understand the prognosis of early pregnancy loss during the first trimester.
Persistent median artery thrombosis: A rare cause of carpal tunnel syndrome
Authors: Srivastava Ankur , Sharma Praneal , Pillay Sugnedran
Published: December 2015

Background: Carpal tunnel syndrome (CTS) is a sporadic event with compression of the median nerve (MN). Persistent median artery (PMA) thrombosis is an exceptionally rare cause of CTS.

Case report: 38‐year‐old male presented with acute on subacute right wrist pain with positive Tinel's sign. An ultrasound and computed angiography study confirmed a PMA with thrombosis. The patient was treated with intravenous heparin then discharged home on enoxaparin and warfarin crossover. Discussion: PMA can lead to CTS by compression from the adjacent median nerve. Thrombosis of the PMA can also lead to CTS. Surgical intervention is needed in cases of severe CTS. Carpal tunnel release is usually successful. Excision of the PMA can risk vascular compromise of the digits. Ultrasound is excellent for detecting rare causes of CTS.

Conclusion: Ultrasound examination for CTS should include search for PMA and associated anatomical variations.
A comparison of ultrasonic measurement techniques for the maternal cervix in the second trimester
Authors: O'Hara Sandra , Zelesco Marilyn , Sun Zhonghua
Published: December 2015

Introduction: The appropriate ultrasound technique to assess the maternal cervical length in women at low risk of preterm birth is yet to be established. This study aimed to determine the accuracy of different ultrasound approaches for measuring the maternal cervix in patients between 17 and 22 weeks gestation.

Methods: The prospective study recruited 50 patients who were at a low risk of preterm birth. All measurements were acquired by one operator who was blind to the measurements being acquired in all approaches. The cervical length was registered using the transabdominal approach with a full and empty bladder, the transperineal approach and the transvaginal. The transvaginal approach was used as the reference measurement.

Results: The transabdominal full bladder, post void, transperineal and transvaginal measurements were obtainable in 50, 49, 45 and 50 participants respectively. The transabdominal post void measurements showed a bias of −0.06 mm from perfect agreement with transvaginal. The transperineal measurements showed a bias of −0.16 mm. The transabdominal full bladder measurements were positively biased by 14.05 mm (p < 0.05). All transabdominal post void cervical lengths of 30 mm or greater registered a transvaginal cervical length greater than 25 mm in this study.

Conclusion: The cervix should not be assessed in the transabdominal approach with a full maternal bladder due to overestimation of cervical length. Transvaginal cervical length can be reproduced accurately by post void transabdominal cervical length in most cases. Transperineal cervical length should be considered if transvaginal cervical length is contraindicated.
Renal transplant ultrasound: The nephrologist's perspective
Authors: Leong Khai Gene , Coombs Peter , Kanellis John
Published: December 2015

One of the principal roles of a nephrologist is to closely monitor renal transplant allograft function and promptly evaluate any dysfunction. Renal transplant sonography has a major role in this assessment process given its ability to easily define renal transplant anatomy and surrounding structures. Abnormalities can be extrarenal or involve vascular, parenchymal and urological components of the graft and these can acutely or chronically influence graft function and survival. Procedural guidance as is required during allograft biopsy, as well as routine surveillance and screening for post transplant complications such as malignancy are also important applications of ultrasound in the management of renal transplant recipients. This article outlines key ultrasound findings and applications in renal transplantation from the clinician's perspective.
Sensitivity, specificity and diagnostic accuracy of novices integrating lung ultrasound into the care of breathless older patients
Authors: Baker Kylie , Soong Luke , Harding Timothy , Wain Amy , Cheah Jon , Mitchell Geoffrey , Brierley Stephen
Published: December 2015

Background: Lung ultrasound is frequently used to identify pulmonary oedema, using the ‘B line’ artefact. A small study in 2011 suggested that novice sonologists had a potential diagnostic accuracy of 85%, when performing the test without reference to other patient information.

Aim: We aimed to test the overall diagnostic accuracy of novice clinician sonologists incorporating the 2011 protocol into routine assessment of the patient.

Method: A prospective convenience sample of breathless older patients presenting to ED received an 8‐view lung scan early in management. Initial ED diagnoses, utilising all information including ultrasound result, were compared against the opinion of a medical expert auditing the patient records after discharge from hospital.

Results: The cohort of five novices scanned 63 cases, from which eleven were excluded.

Novices using ultrasound differentiated between pulmonary oedema and other causes of breathlessness with a sensitivity of 71% (95%CI 44 to 87), Specificity of 91% (76 to 98), a diagnostic accuracy of 85% (72 to 92), a positive LR of 8.2 (2.7 to 25) and a negative LR of 0.32 (0.15 to 0.68).

Discussion: The diagnostic accuracy of emergency department clinicians incorporating novice lung ultrasound into the investigation of breathlessness is consistent with the diagnostic accuracy of scanning performed in parallel to patient care, and is likely to be an improvement on current estimates of conventional ED diagnostic strategies. Clinicians should not be afraid that their learning curve would disadvantage the patient.
Catastrophic consequences of a caesarean scar pregnancy missed on ultrasound
Authors: Collins Kelly , Kothari Alka
Published: December 2015

Ectopic pregnancy that implants within the scar tissue of a previous caesarean scar is a situation that is seldom encountered and is almost invariably incompatible with a successful pregnancy. Caesarean scar ectopic pregnancies are fraught with life threatening complications such as scar rupture, significant haemorrhage, disseminated intravascular coagulation and the need for emergency life saving hysterectomy. The clinical diagnosis can be elusive, particularly in the early stages; therefore clinicians should be familiar with the condition's sonographic hallmarks. Early diagnosis and management is the key to preventing these complications. We describe a case of caesarean scar pregnancy which was initially misdiagnosed as “a spontaneous miscarriage in progress”, resulting in uncontrollable bleeding, necessitating an emergency abdominal hysterectomy. We also endeavour to review the literature with regards to the use of ultrasound in its management, treatment and follow up.
Assessing Conceptual Knowledge Using Three Concept Map Scoring Methods
Authors: Watson Mary Katherine , Pelkey Joshua , Noyes Caroline R. , Rodgers Michael O.
Published: December 2015

Background

Conceptual understanding is a prerequisite for engineering competence. Concept maps may be effective tools for assessing conceptual knowledge, yet further work is needed to examine scoring methods.

Purpose

Our purpose was to evaluate the efficacy of three concept map scoring methods. Traditional scoring requires judges to count concept map components. Holistic scoring requires judges to analytically evaluate concept maps using a rubric. Categorical scoring requires judges to categorize concepts according to relevant categories before quantification of overall complexity.

Design/Method

In this study, concept maps were collected from 72 undergraduates before and after a capstone design course. Judges analyzed the concept maps using three methods. Using statistical analyses, we examined the comparability, interrater reliability, and convergent/divergent validity of scoring methods.

Results

While traditional scoring allowed judges to score concept maps relatively quickly, holistic scoring allowed judges to better capture changes in knowledge structure, because ranking of data was required without assuming hierarchical concept arrangement. Only categorical scoring provided insight into content and structure of student knowledge. For all methods, interrater reliability was acceptable, and convergent/divergent validity was established.

Conclusions

Due to its applicability to concept maps of varying structures, holistic scoring is best if more than one judge is available; traditional scoring is appropriate if there are time constraints or if multiple methods are used. Categorical scoring has potential as a supplemental or stand‐alone method, depending on the needs of the instructor or researcher.
Mood and Creativity over Time in a Bipolar Participant
Authors: Glicksohn Joseph , Boikova Ola
Published: December 2015

When depression alternates with mania, as in a bipolar affective disorder, creativity might be enhanced. To investigate this, we employed a single‐subject design, looking at both affective space and the spectral covariation of mood and creativity in a participant presenting with bipolar affective disorder. The study was conducted over a period of 54 days, and employed a standard measure of mood (the Brief Mood Introspection Scale) and a standard task of creativity (Alternative Uses Task). Both positive affect and negative affect appear to be somewhat undifferentiated for this participant, and her mood space does not conform to that described by the accepted major dimensions of Arousal and Pleasure. Conceivably, this is because of her rapid mood fluctuations. A 2.7‐day periodicity was found for Tired, Peppy, Nervous, and Calm, on the one hand, and ideational fluency, ideational flexibility, and originality, on the other. In addition, a 9‐day periodicity was common to Happy, Sad, and Gloomy—all three affects clustering in the same affective space—together with both ideational flexibility and originality. This finding brings into question the relationship between creativity and both positive and negative mood.
Vortex‐ and CO2‐gas‐assisted liquid–liquid microextraction with salt addition for the high‐performance liquid chromatographic determination of furanic compounds in concentrated juices and dried fruits
Authors: Abu‐Bakar Nur‐Bahiyah , Makahleh Ahmad , Saad Bahruddin
Published: December 2015

A novel microextraction method based on vortex‐ and CO2‐assisted liquid–liquid microextraction with salt addition for the isolation of furanic compounds (5‐hydroxymethyl‐2‐furaldehyde, 5‐methyl‐2‐furaldehyde, 2‐furaldehyde, 3‐furaldehyde, 2‐furoic and 3‐furoic acids) was developed. Purging the sample with CO2 was applied after vortexing to enhance the phase separation and mass transfer of the analytes. The optimum extraction conditions were: extraction solvent (volume), propyl acetate (125 μL); sample pH, 2.4; vortexing time, 45 s; salt concentration, 25% w/v and purging time, 5 min. The analytes were separated using an ODS Hypersil C18 column (250×4.6 mm i.d, 5 μm) under gradient flow. The proposed method showed good linearities (r2 >0.999), low detection limits (0.08–1.9 μg/L) and good recoveries (80.7–122%). The validated method was successfully applied for the determination of the furanic compounds in concentrated juice (mango, date, orange, pomegranate, roselle, mangosteen and soursop) and dried fruit (prune, date and apricot paste) samples.
Automated 3D bone ablation with 1,070 nm ytterbium‐doped fiber laser enabled by inline coherent imaging
Authors: Yin Chenman , Ruzzante Sacha W. , Fraser James M.
Published: December 2015

Background and Objective

Laser osteotomy bears well‐identified advantages over conventional techniques. However, lack of depth control and collateral thermal damage are barriers to wide clinical implementation. Flexible fiber delivery and economical benefits of ytterbium‐doped fiber lasers make them desirable for laser osteotomy. In this work, we demonstrate automated bone ablation with a 1,070 nm industrial‐scale fiber laser to create 3D target structures with minimal thermal side‐effects.

Materials and Methods

Fresh and dry ex vivo cortical bone samples are ablated using 50–100 µs laser pulses of 15–30 mJ. In situ inline coherent imaging monitors ablation dynamics with micron precision and on microsecond timescales. Ablation depth is extracted by on‐the‐fly processing of ICI data, enabling feedback control of depth (via laser pulse number). Final ablated morphology, measured by an ex situ stylus profiler, is compared to the target shape. Histological examination is performed to quantify the thermal side‐effects of laser ablation.

Results

Percussion drilled hole depth is highly variable for fixed laser parameters (880 ± 151 µm on fresh bone and 1038 ± 148 µm on dry bone) due to nondeterministic ablation. ICI‐enabled depth control is implemented to achieve precise ablation of complex 3D features. The RMS deviation between target and ablated morphology is 12.6 µm. The heat‐affected zone is found to be 5–10 µm on fresh and dry bone.

Conclusions

An ytterbium‐doped fiber laser is utilized for cortical bone ablation with limited thermal side‐effects. In situ real‐time ICI measurement enables characterization of bone ablation dynamics. Furthermore, ICI closed‐loop feedback realizes depth‐controlled ablation on heterogeneous bone. This proof‐of‐principle study shows great promise for ICI‐guided laser osteotomy. Lasers Surg. Med. 48:288–298, 2016. © 2015 Wiley Periodicals, Inc.
Assessment of circular wound healing in rats after exposure to 808‐nm laser pulses during specific healing phases
Authors: Tabakoglu Hasim O. , Sani Musbahu M. , Uba Abdullahi I. , Abdullahi Umar A.
Published: December 2015

Background and Objectives

Low‐level laser therapy (LLLT), is an important application modality for the advancement of wound healing processes. In this study, histological and morphometric analyses have been made to understand and compare effects of high‐power 808‐nm pulses on circular skin wounds among groups irradiated immediately after wounding and groups irradiated at specific stages of the healing period.

Study Design

Experimental groups were as follows: Laser Therapy (LT) was received as three sessions of laser irradiation (6.38 J/cm2, 1.276 W/cm2, 808 nm) immediately after wounding (Inflammatory group, n = 12), 24 hours post‐wounding (Proliferative group, n = 12), and 72 hours post‐wounding (Remodeling group, n = 12); the Control group (n = 12) received no irradiation. Histological analyses were performed on the 3rd, 7th, and 14th days post‐wounding.

Results

Mean wound diameters were 5 mm for all groups. On Day 7, wound diameters were measured as 2.99 ± 0.17, 2.95 ± 0.3, 2.52 ± 0.11, and 2.41 ± 0.34 mm for the Control, Inflammatory, Proliferative, and Remodeling groups, respectively. At 2 weeks post‐wounding, dermal tissue in the Inflammatory and Proliferative groups closed superficially, while 1.30 ± 0.1 mm and 1.30 ± 0.06 mm openings remained in the Control and Remodeling groups, respectively. Mean wound healing rates (WHR) for all treatment groups were found to differ significantly from the control group (P < 0.05). Upon comparing the Proliferative group with the other treatment groups, a significant difference was found. However, no significant difference was found between the Inflammatory and Remodeling groups, with the former having a slightly higher mean value.

Conclusion

Histological and morphometric results showed that high‐power, low‐energy application has the best effect when first applied 24 hours post‐wounding (late inflammatory, early proliferative stage) as demonstrated by increases in granulation tissue, fibroblasts and collagen deposition, which lead to faster rates of wound contraction and thus accelerated healing. Lasers Surg. Med. 48:409–415, 2016. © 2015 Wiley Periodicals, Inc.
Utilizing confocal laser endomicroscopy for evaluating the adequacy of laparoscopic liver ablation
Authors: Schneider Crispin , Johnson Sean P. , Walker‐Samuel Simon , Gurusamy Kurinchi , Clarkson Matthew J. , Thompson Stephen , Song Yi , Totz Johannes , Cook Richard J. , Desjardins Adrien E. , Hawkes David J. , Davidson Brian R.
Published: December 2015

Background

Laparoscopic liver ablation therapy can be used for the treatment of primary and secondary liver malignancy. The increased incidence of cancer recurrence associated with this approach, has been attributed to the inability of monitoring the extent of ablated liver tissue.

Methods

The feasibility of assessing liver ablation with probe‐based confocal laser endomicroscopy (CLE) was studied in a porcine model of laparoscopic microwave liver ablation. Following the intravenous injection of the fluorophores fluorescein and indocyanine green, CLE images were recorded at 488 nm and 660 nm wavelength and compared to liver histology. Statistical analysis was performed to assess if fluorescence intensity change can predict the presence of ablated liver tissue.

Results

CLE imaging of fluorescein at 488 nm provided good visualization of the hepatic microvasculature; whereas, CLE imaging of indocyanine green at 660 nm enabled detailed visualization of hepatic sinusoid architecture and interlobular septations. Fluorescence intensity as measured in relative fluorescence units was found to be 75–100% lower in ablated compared to healthy liver regions. General linear mixed modeling and ROC analysis found the decrease in fluorescence to be statistically significant.

Conclusion

Laparoscopic, dual wavelength CLE imaging using two different fluorophores enables clinically useful visualization of multiple liver tissue compartments, in greater detail than is possible at a single wavelength. CLE imaging may provide valuable intraoperative information on the extent of laparoscopic liver ablation. Lasers Surg. Med. 48:299–310, 2016. © 2015 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
Preliminary study of optical coherence tomography imaging to identify microscopic extrathyroidal extension in patients with papillary thyroid carcinoma
Authors: Lee Hyoung Shin , Shin Sung Won , Bae Jung Kweon , Jung Woong Gyu , Kim Sung Won , Oak Chulho , Chun Bong Kwon , Ahn Yeh‐Chan , Lee Byung‐Joo , Lee Kang Dae
Published: December 2015

Background and Objectives

We evaluated the feasibility of using optical coherence tomography (OCT), to identify microscopic extrathyroidal extension (mETE) in ex vivo thyroidectomy specimens of patients who underwent thyroidectomy for the treatment of papillary thyroid carcinoma (PTC).

Methods

A total of 170 ex vivo OCT images of the tumor, were acquired just after completion of thyroidectomy in 17 patients. The OCT images of each patient were separately evaluated by two blinded investigators, and the outcomes were compared with the histopathology reports.

Results

The sensitivity and specificity of mETE identification from the OCT images were 81.4% and 86.0%, respectively, for the first investigator, and 82.9% and 87.0%, respectively, for the second investigator. Substantial agreement between the investigators was verified by Cohen's κ (Cohen's κ = 0.772).

Conclusion

In this preliminary study of a limited series of ex vivo thyroidectomy specimens, we verified the feasibility of OCT as a method of identifying mETE in patients with PTC. Lasers Surg. Med. 48:371–376, 2016. © 2015 Wiley Periodicals, Inc.
Withania somnifera: From prevention to treatment of cancer
Authors: Palliyaguru Dushani L. , Singh Shivendra V. , Kensler Thomas W.
Published: December 2015

The identification of bioactive molecules that have potential to interrupt carcinogenesis continues to garner research interest. In particular, molecules that have dietary origin are most attractive because of their safety, cost‐effectiveness and feasibility of oral administration. Nutraceuticals have played an important role in the overall well‐being of humans for many years, with or without rigorous evidence backing their health claims. Traditional medicine systems around the world have utilized plants that have medicinal properties for millennia, providing an opportunity for modern day researchers to assess their efficacies against ailments such as cancer. Withania somnifera (WS) is a plant that has been used in Ayurveda (an ancient form of medicine in Asia) and in the recent past, has been demonstrated to have anti‐tumorigenic properties in experimental models. While scientific research performed on WS has exploded in the past decade, much regarding the mode of action and molecular targets involved remains unknown. In this review, we discuss the traditional uses of the plant, the experimental evidence supporting its chemopreventive potential as well as roadblocks that need to be overcome in order for WS to be evaluated as a chemopreventive agent in humans.
Dietary procyanidins selectively modulate intestinal farnesoid X receptor‐regulated gene expression to alter enterohepatic bile acid recirculation: elucidation of a novel mechanism to reduce triglyceridemia
Authors: Heidker Rebecca M. , Caiozzi Gianella C. , Ricketts Marie‐Louise
Published: December 2015

Scope

Understanding the molecular basis by which dietary procyanidins modulate triglyceride and cholesterol homeostasis has important implications for the use of natural products in the treatment and prevention of cardiovascular disease.

Methods

To determine whether modulation of bile acid (BA) homeostasis contributes to the hypotriglyceridemic action of grape seed procyanidin extract (GSPE) we examined the effect on genes regulating BA absorption, transport and synthesis in vitro, in Caco‐2 cells, and in vivo, in wild type (C57BL/6) and farnesoid x receptor knockout (Fxr−/−) mice.

Results

We provide novel evidence demonstrating that GSPE is a naturally occurring gene‐selective bile acid receptor modulator (BARM). Mechanistically, GSPE down‐regulates genes involved in intestinal BA absorption and transport in an Fxr‐dependent manner, resulting in decreased enterohepatic BA recirculation. This correlates with increased fecal BA output, decreased serum triglyceride and cholesterol levels, increased hepatic cholesterol 7α‐hydroxylase (Cyp7a1), and decreased intestinal fibroblast growth factor 15 (Fgf15) expression. GSPE also increased hepatic HmgCoA reductase (Hmgcr) and synthase (Hmgcs1) expression, while concomitantly decreasing sterol regulatory element‐binding protein 1c (Srebp1c).

Conclusion

GSPE selectively regulates intestinal Fxr‐target gene expression in vivo, and modulation of BA absorption and transport is a critical regulatory point for the consequential hypotriglyceridemic effects of GSPE.
Late midlife C‐reactive protein and interleukin‐6 in middle aged danish men in relation to body size history within and across generations
Authors: Pedersen Jolene Masters , Budtz‐Jørgensen Esben , Mortensen Erik Lykke , Bruunsgaard Helle , Osler Merete , Sørensen Thorkild I.A. , Rod Naja Hulvej , Lund Rikke
Published: December 2015

Objective

The aim was to estimate the effects of ponderal index at birth and body mass index (BMI) in early adulthood on C‐reactive protein (CRP) and interleukin‐6 (IL‐6) and to quantify the effects through subsequent measures of body size. In a subanalysis, the contributions of maternal BMI to the inflammatory status of offspring were investigated.

Methods

The study was based on 2,986 Danish males from the Copenhagen Aging and Midlife Biobank. Path analysis was employed to estimate direct and indirect effects.

Results

A 10% higher maternal BMI was associated with 7% higher CRP and 3% higher IL‐6 among offspring. A 10% higher ponderal index at birth was associated with 4% lower CRP in late midlife; this effect was only partially mediated by later growth. A 10% higher BMI in early adulthood was associated with 8% higher CRP and 4% higher IL‐6 in late midlife. The findings suggest that weight gain in adulthood is associated with low‐grade inflammation in late midlife.

Conclusions

Ponderal index at birth is associated with CRP in later life independently of adult BMI. The findings additionally suggest that preventing weight gain in early adulthood would be beneficial for inflammatory status in later life.
Behaviors and motivations for weight loss in children and adolescents
Authors: Brown Callie Lambert , Skelton Joseph A. , Perrin Eliana M. , Skinner Asheley Cockrell
Published: December 2015

Objectives

To examine the association between weight loss behaviors and motivations for weight loss in children and adolescents and the association of weight status with these behaviors and motivations in a nationally representative sample.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) was examined, focusing on children in the United States aged 8‐15 years, in repeated cross‐sections from 2005 to 2011.

Results

Half of participants (N = 6,117) reported attempting to lose weight, and children with obesity attempted to lose weight more frequently (76%) than children who were a healthy weight (15%). Children reported attempting to lose weight by both healthy and unhealthy means: “exercising” (92%), “eating less sweets or fatty foods” (84%), “skipping meals” (35%), and “starving” (18%). The motivation to be better at sports was more likely to be associated with attempting weight loss through healthy behaviors, whereas children motivated by teasing were more likely to engage in unhealthy behaviors. Motivations for losing weight differed by weight status.

Conclusions

Many children and adolescents attempt to lose weight, using either or both healthy and unhealthy behaviors, and behaviors differed based on motivations for weight loss. Future research should examine how physicians, parents, and teachers can inspire healthy behavior changes.
The Social and Productive Impacts of Zambia's Child Grant
Authors: Handa Sudhanshu , Seidenfeld David , Davis Benjamin , Tembo Gelson ,   Zambia Cash Transfer Evaluation Team
Published: December 2015

Accumulated evidence from dozens of cash transfer (CT) programs across the world suggests that there are few interventions that can match the range of impacts and cost‐effectiveness of a small, predictable monetary transfer to poor families in developing countries. However, individual published impact assessments typically focus on only one program and one outcome. This article presents two‐year impacts of the Zambian Government's Child Grant, an unconditional CT to families with children under age 5, across a wide range of domains including consumption, productive activity, and women and children's outcomes, making this one of the first studies to assess both protective and productive impacts of a national unconditional CT program. We show strong impacts on consumption, food security, savings, and productive activity. However, impacts in areas such as child nutritional status and schooling depend on initial conditions of the household, suggesting that cash alone is not enough to solve all constraints faced by these poor, rural households. Nevertheless, the apparent transformative effects of this program suggest that unconditional transfers in very poor settings can contribute to both protection and development outcomes.
Streptomyces sanglieri which colonised and enhanced the growth of Elaeis guineensis Jacq. seedlings was antagonistic to Ganoderma boninense in in vitro studies
Authors: Nur Azura A B , Yusoff M , Tan G Y A , Jegadeesh R , Appleton D R , Vikineswary S
Published: December 2015

Actinomycete strain AUM 00500 was 99.5 % similar to Streptomyces sanglieri NBRC 100784T and was evaluated for antagonistic activity towards Ganoderma boninense, the causative fungus of basal stem rot of oil palm. The strain showed strong antifungal activity towards G. boninense in in vitro and SEM analysis showed various modes of inhibition of the fungus. Ethyl acetate extracts of single culture and inhibition zone of cross-plug culture by HPLC indicated that strain AUM 00500 produced two different antibiotics of the glutarimide group namely cycloheximide and actiphenol. In greenhouse trials, oil palm seed treated with spores of S. sanglieri strain AUM 00500 at 109 cfu/ml showed significant (P < 0.05) increase in oil palm seedlings growth when compared to the control. Streptomyces sanglieri strain AUM 00500 successfully colonised the epidermal surface of the roots of treated oil palm seedlings and it was recovered from root fragments plated on starch casein agar.
Super Mario brothers and sisters: Associations between coplaying video games and sibling conflict and affection
Authors: Coyne Sarah M. , Jensen Alexander C. , Smith Nathan J. , Erickson Daniel H.
Published: December 2015

Video games can be played in many different contexts. This study examined associations between coplaying video games between siblings and levels of affection and conflict in the relationship. Participants were 508 adolescents (M age = 16.31 years of age, SD = 1.08) who completed questionnaires on video game use and sibling relationships. Participants were recruited from a large Northwestern city and a moderate city in the Mountain West of the United States. Video games played between siblings were coded by an independent sample to assess levels of physical aggression and prosocial behavior in each game. Playing video games with a sibling was associated with higher levels of sibling affection for both boys and girls, but higher levels of conflict for boys only. Playing a violent video game with a brother was associated with lower levels of conflict in the sibling relationship, whereas playing a prosocial video game was not related to any sibling outcome. The value of video games in sibling relationships will be discussed, with a focus on the type of game and the sex of the adolescent.
Patient Abuse in the Health Care Setting: The Nurse as Patient Advocate
Authors: Albina Julie K.
Published: December 2015

Incidents of verbal and physical patient abuse in health care settings continue to occur, with some making headline news. Nurses have a professional and ethical responsibility to advocate for their patients when incidents of abuse occur. Tolerating or ignoring inappropriate behaviors occurs for multiple reasons, including ignorance, fear of retaliation, the need for peer acceptance, and concerns for personal advancement. Nurses need to reflect on their biases before they can truly respect patients’ autonomy. Through the examination of reported cases of patient abuse, the need for a change in hospital culture becomes evident. The primary steps in eliminating patient abuse are opening communication, providing education, establishing competency, eliminating tolerance of unacceptable behavior, and creating a code of mutual respect. A change in culture to one of mutual respect and dignity for staff members and patients will lead to the best outcomes for all involved.
Reducing OR Traffic Using Education, Policy Development, and Communication Technology
Authors: Esser Jennifer , Shrinski Keonemana , Cady Rhonda , Belew John
Published: December 2015

A bundled approach to surgical site infection (SSI) prevention strategies includes reducing OR traffic. A nurse‐led quality improvement (QI) team sought to reduce OR traffic through education and a process change that included wireless communication technology and policy development. The team measured OR traffic by counting the frequency of door openings per hour in seven surgical suites during 305 surgical procedures conducted during similar 22‐week periods before and after the QI project intervention. Door openings decreased significantly (P < 0.05) from an average of 37.8 per hour to 32.8 per hour after the QI project intervention. This suggests that our multifaceted approach reduces OR traffic. The next steps of this project include analyzing automatically captured video to understand OR traffic patterns and expanding education to departments and external personnel frequently present in our surgical suites. Future research evaluating the effectiveness of this OR traffic initiative on SSI incidence is recommended.
Back to Basics: Surgical Skin Antisepsis
Authors: Spruce Lisa
Published: December 2015

The fundamental basis for preventing surgical site infections is the antiseptic preparation of the skin at the surgical site. All perioperative nurses must learn this skill. The goal of surgical skin antisepsis, frequently referred to as prepping the skin, is to remove soil and transient (ie, temporary) microorganisms living on the skin that could pose a risk for surgical site infections. This Back to Basics article examines the origin of surgical skin antisepsis and the steps perioperative nurses should take to provide the patient with an aseptic surgical site before any surgical or other invasive procedure.
Student Nurses in the OR: Improving Recruitment and Retention
Authors: Helzer Doroh Holly M. , Monahan Janean Carter
Published: December 2015

Changes in nursing education have made it difficult for students to find or participate in perioperative clinical experiences, which makes it difficult for employers to find experienced perioperative nurses. We developed a perioperative preceptorship for senior‐level nursing students, to provide them with the opportunity to learn RN circulator skills based on AORN's Guidelines for Perioperative Practice. Senior nursing students had the opportunity to demonstrate critical thinking skills within the context of patient‐centered care while integrating knowledge and skills learned in the classroom. The students applied the knowledge and skills learned in the classroom in the OR setting during a required minimum 210‐hour clinical commitment. We believe the course has been successful in providing the foundation needed to become a competent perioperative nurse, because, to date, all students who were hired are still employed in the OR.
Preparing the Next Generation of Perioperative Nurses
Authors: Chappy Sharon , Madigan Patricia D. , Doyle Deborah S. , Conradt Laurie A. , Tapio Nathan C.
Published: December 2015

Perioperative nursing faces a workforce crisis. There are too few perioperative nurses entering the workforce to replace those who will reach retirement age. Further, the costs of orienting perioperative nurses is high, and turnover rates in the first year after graduation are significant. To address these issues, nursing leaders at Theda Clark Medical Center, Neenah, Wisconsin, and the University of Wisconsin Oshkosh College of Nursing partnered with local medical centers to form a precepted clinical immersion program intended to orient senior baccalaureate nursing students to the perioperative setting. The students were hired after graduation, and the cost savings for orienting each new employee was estimated at $16,000 to $25,000 per student. Other benefits include identifying students who are and are not a good fit for perioperative nursing. The collaboration of health care and academic leaders is one solution for addressing the perioperative nursing workforce crisis.