bluuebunny/crossref_metadata_2025 huggingface dataset:
The Intergenerational Impact of Management Relations on Nurse Career Satisfaction and Patient Care
Authors: Price Sheri L. , Paynter Martha , Hall Linda McGillis , Reichert Carol
Published: November 2018

Objective

This article provides insights into the role of management relations on nurses’ career satisfaction across different career stages.

Background

Managers and positive relations with staff are critical to improving job satisfaction, career development, and retention for new graduates to mid- to late-career nurses.

Methods

Using a descriptive qualitative approach, we conducted a thematic analysis of 18 focus groups held in 8 Canadian provinces with 185 student, early-career, and mid- to late-career nurse participants.

Results

Student participants expressed the need for a supportive environment to enable successful transition to practice. Early-career nurses expected effective leadership at the unit level, effective communication, and positive working relationships to enable best care outcomes. Mid- to late-career nurses were most dissatisfied with management interactions and relationships.

Conclusions

Management relations are important across all career stages, affecting patient care and job satisfaction. Findings provide insight into how nurse-manager relations can be enhanced from new graduate support to guidance in career development and ongoing recognition and respect for nurses throughout their careers.
Surgical Complications Associated With Cervical Spine Surgery
Authors: Hemmer Christopher
Published: November 2018

Cervical spine complaints are routinely evaluated in the office and urgent care facilities. Many of these complaints will resolve with conservative modalities. However, when operative intervention is necessary for nontraumatic pathology, recognition of pre-, intra-, and postoperative complications is imperative. This article reviews basic anatomy and surgical anatomy of the cervical spine. The common surgical approaches to the cervical spine as well complications that can occur from an anterior and posterior perspective are discussed. Cervical spine surgery when used in the appropriate clinical scenarios can be very successful. It is important to remember that risk reduction begins prior to the surgery with appropriate planning, identification of any anatomical anomalies, and adequate preparation.
Measuring Daily Disposable Contact Lenses against Nonwearer Benchmarks
Authors: Lazon de la Jara Percy , Diec Jennie , Naduvilath Thomas , Papas Eric B.
Published: November 2018

SIGNIFICANCE

Since becoming a popular form of refractive error correction, contact lenses have aspired to replicate the nonwearer experience. This study assessed how well currently available daily disposable soft lenses have achieved that goal, using a graphical representation to show individual lens behavior relative to benchmarks.

PURPOSE

The purpose of this study was to assess comfort, vision, and adverse events during daily disposable contact lens wear, relative to emmetropes and spectacle wearers.

METHOD

Three-month clinical studies, where participants either wore one of five daily disposable contact lenses (n = 201), were full-time spectacle wearers with no history of contact lens wear (n = 34), or emmetropic non–contact lens wearers (n = 40). Vision quality and comfort were assessed at the beginning and end of the day (1 to 10). Corneal infiltrative events were recorded. Between-group comparisons were made using a linear mixed model and literature estimates of clinical significance.

RESULTS

Initial comfort among emmetropes (mean ± 95% confidence interval, 8.0 ± 0.5) was not significantly different from any of the lens types (range, 7.2 ± 0.4 to 8.0 ± 0.4, all P > .06) or spectacle wearers (7.3 ± 0.5, P = .45). Comfort deteriorated during the day in all groups (P < .05). End-of-day comfort for emmetropes (7.3 ± 0.6) was significantly better, only than lenses B (5.7 ± 0.6, P < .001) and D (6.2 ± 0.5, P = .01). Vision quality for emmetropes (8.6 ± 0.5) was better than spectacle wearers (7.8 ± 0.5, P = .04) and lenses A (7.6 ± 0.4, P = .003) and B (7.5 ± 0.4, P < .001). Corneal infiltrative events occurred in 0% of emmetropes and 2.9% of spectacle wearers and ranged from 2.4 to 7.5% in lens wearers.

CONCLUSIONS

Under the conditions of this study, comfort and vision with some contemporary daily disposable contact lenses were indistinguishable from nonwearing emmetropes. Although the contact lens–wearing groups had rates of corneal infiltrative events that were not statistically different from the nonwearers, the study had insufficient power to permit robust conclusions in this respect.
Ranibizumab versus Dexamethasone Implant in Macular Edema Secondary to Branch Retinal Vein Occlusion: Two-year Outcomes
Authors: Ozkaya Abdullah , Tarakcioglu Hatice Nur , Tanir Ipek
Published: November 2018

SIGNIFICANCE

We compared the 24-month outcomes of ranibizumab and dexamethasone implants in treatment-naive branch retinal vein occlusion patients. Ranibizumab was effective in improving visual outcomes, whereas the dexamethasone implant was not.

PURPOSE

The aim of this study was to compare the 2-year real-world outcomes of intravitreal ranibizumab with dexamethasone implants in patients with macular edema secondary to branch retinal vein occlusion.

METHODS

The treatment-naive branch retinal vein occlusion patients with macular edema who were treated with intravitreal ranibizumab or dexamethasone implant were included retrospectively. Primary outcome measures were the change in best-corrected visual acuity and central retinal thickness.

RESULTS

Eighty-seven eyes of 87 patients were included. Mean ± SD best-corrected visual acuity in the intravitreal ranibizumab group at baseline and 24 months was 0.64 ± 0.48 and 0.49 ± 0.44 logMAR (P < .05). Mean ± SD best-corrected visual acuity in the intravitreal dexamethasone implant group at baseline and 24 months was 0.98 ± 0.56 and 0.92 ± 0.61 logMAR (P > .05). Mean ± SD central retinal thickness in the intravitreal ranibizumab group at baseline and 24 months was 530 ± 150 and 337 ± 103 μm (P < .05). Mean ± SD central retinal thickness in the intravitreal dexamethasone implant group at baseline and 24 months was 591 ± 113 and 335 ± 99 μm (P < .05). Mean ± SD number of injections at 24 months was 5.6 ± 1.8 in the intravitreal ranibizumab group and 2.7 ± 1.1 in the dexamethasone implant group (P < .0001). Progression in lens opacity was detected in 5.7% of the phakic patients in the intravitreal ranibizumab group and 46.1% of them in the dexamethasone implant group (P < .0001). None of the patients in the intravitreal ranibizumab group and 9 (22.0%) of 41 patients in the dexamethasone implant group showed an increase of more than 10 mmHg in intraocular pressure.

CONCLUSIONS

Ranibizumab was effective in the treatment of macular edema secondary to branch retinal vein occlusion in both visual and anatomical outcomes; however, dexamethasone implant was effective only in anatomical outcomes.
Scotoma Simulation in Healthy Subjects
Authors: Klee Sascha , Link Dietmar , Sinzinger Stefan , Haueisen Jens
Published: November 2018

SIGNIFICANCE

This article shows a successful concept for simulating central scotoma, which is associated with age-related macular degeneration (AMD), in healthy subjects by an induced dark spot at the retina using occlusive contact lenses. The new concept includes a control mechanism to adjust the scotoma size through controlling pupil size without medication. Therefore, a miniaturized full-field adaptation device was used.

PURPOSE

The aim of this study was to design a novel concept to simulate AMD scotoma in healthy subjects using occlusive contact lenses.

METHODS

To define an optimal set of lens parameters, we constructed an optical model and considered both the anatomical pupil diameter and the opaque central zone diameter of the contact lens. To adjust the scotoma size, we built a miniaturized full-field adaptation device. We demonstrate the validity of this novel concept by functional measurements of visual fields using automated threshold perimetry. Finally, we conducted a perception study including two tasks, consisting of pictograms and letters. The stimuli were presented at different eccentricities and magnifications.

RESULTS

The visual fields of all 10 volunteers exhibited absolute scotomas. The loss of contrast sensitivity ranged within 27 and 36 dB (P< .05), and the scotoma localizations were nearly centered to the macula (mean variation, 2.0 ± 4.8° horizontally; 3.5 ± 4.7° vertically). The eccentric perception of letters showed the largest numbers of correctly identified stimuli. The perception of pictograms showed significantly reduced numbers (P< .0001) and revealed a dependency on magnification. The results suggest that best perception is possible for magnified stimuli near the scotoma.

Conclusions

We demonstrated that the creation of an absolute simulated AMD scotoma is possible using occlusive contact lenses combined with a miniaturized full-field adaptation device.
Ophthalmic Conditions Associated with Inpatient Falls among Veterans
Authors: Campagna Giovanni , Chamberlain Paul , Orengo-Nania Silvia , Biggerstaff Kristin , Khandelwal Sumitra
Published: November 2018

SIGNIFICANCE

Efforts to describe the relationship between pathological visual impairment and fall risk are typically confined to community dwellers. Among admitted patients, however, the associations are less understood. Fall risk assessment tools are used in some clinical settings, but most do not capture the suspected importance of ophthalmic pathologies in predicting the likelihood of an inpatient fall.

PURPOSE

The purpose of this study was to determine the association between ophthalmic conditions and inpatient falls at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), where vision and ophthalmic conditions are not considered when assessing fall risk.

METHODS

This is a population-based, retrospective case-control study of 805 patients admitted to the MEDVAMC in January 2014 who had also visited the MEDVAMC Eye Clinic within 1 year of admission. The patients' eye examinations, ophthalmic diagnoses, and other indicators of constitutive health were compared between 60 patients who experienced an inpatient fall (“cases”) and 749 patients who did not (“controls”). Significant differences between the cases and the controls were determined using logistic regression models.

RESULTS

Baseline demographics were similar among the two groups. Ophthalmic conditions associated with an increased incidence of inpatient falls included age-related macular degeneration (odds ratio, 3.9; 95% confidence interval, 1.5 to 9.9; P = .008) and a presenting visual acuity of worse than 20/40 in the better-seeing eye (odds ratio, 2.0; 95% confidence interval, 1.0 to 4.1; P = .04). Those without falls demonstrated a better mean presenting visual acuity in the better-seeing eye compared with those who fell (logMAR, 0.12 ± 0.23 vs. 0.28 ± 0.49, P < .001).

CONCLUSIONS

In this population, age-related macular degeneration and poor presenting visual acuity in the better-seeing eye are associated with increased incidence of inpatient falls. An assessment of visual function and ophthalmic diagnoses may be warranted upon admission to the hospital for increased prevention of inpatient falls.
Molecular Profiling of Pheochromocytoma and Abdominal Paraganglioma Stratified by the PASS Algorithm Reveals Chromogranin B as Associated With Histologic Prediction of Malignant Behavior
Authors: Stenman Adam , Svahn Fredrika , Hojjat-Farsangi Mohammad , Zedenius Jan , Söderkvist Peter , Gimm Oliver , Larsson Catharina , Juhlin C. Christofer
Published: November 2018

Pheochromocytomas (PCCs) and abdominal paragangliomas (PGLs), collectively abbreviated PPGL, are believed to exhibit malignant potential—but only subsets of cases will display full-blown malignant properties. The Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) algorithm is a proposed histologic system to detect potential for aggressive behavior, but little is known regarding the coupling to underlying molecular genetics. In this study, a total of 92 PPGLs, previously characterized for susceptibility gene status and mRNA expressional profiles, were histologically assessed using the PASS criteria. A total of 32/92 PPGLs (35%) exhibited a PASS score ≥4, including all 8 cases with malignant behavior (7 with known metastases and 1 with extensively infiltrative local recurrence). Statistical analyzes between expressional data and clinical parameters as well as individual PASS criteria yielded significant associations to Chromogranin B (CHGB), BRCA2, HIST1H3B, BUB1B, and RET to name a few, and CHGB had the strongest correlation to both PASS and metastasis/local recurrence of all analyzed genes. Evident CHGB downregulation was observed in PPGLs with high PASS and overtly malignant behavior, and was also associated with shorter disease-related survival. This finding was validated using quantitative real-time polymerase chain reaction, in which CHGB expression correlated with both PASS and metastasis/local recurrence with consistent findings obtained in the TCGA cohort. Moreover, immunohistochemical analyses of subsets of tumors showed a correlation between high PASS scores and negative or weak CHGB protein expression. Patients with PPGLs obtaining high PASS scores postoperatively, also exhibited low preoperative plasma levels of CHGB. These data collectively point out CHGB as a possible preoperative and postoperative marker for PPGLs with potential for aggressive behavior.
Noninvasive Ventilation During Pediatric and Neonatal Critical Care Transport: A Systematic Review*
Authors: Cheema Baljit , Welzel Tyson , Rossouw Beyra
Published: November 2018

Objectives:

Noninvasive ventilation is increasingly used in neonatal and pediatric patients, but the intensive care transport setting is lagging in terms of availability of noninvasive ventilation for children. The objective of this systematic review of the literature was to answer the question: In children 0 days to 18 years old, who are hospitalized with acute respiratory distress and require critical care transport, is noninvasive ventilation effective and safe during transport?

Data Sources:

MEDLINE via PubMed, EMBASE (via Scopus), Cochrane Central Register of Controlled Trials, African Index Medicus, Web of Science Citation Index, and the World Health Organization Trials Registry.

Study Selection:

Two reviewers independently reviewed all identified studies for eligibility and quality.

Data Extraction:

Data were extracted independently by two reviewers using piloted data extraction forms.

Data Synthesis:

Data were not synthesized due to nature of studies included.

Results:

A total of 1,287 records were identified; no randomized or quasi-randomized controlled trials were found. Eight observational studies, enrolling 858 patients were included, of these 60.4% were neonatal ICU and 39.6% were nonneonatal ICU patient transports. The mode of noninvasive ventilation during transport was continuous positive airway pressure in seven studies (708 patients) and high-flow nasal cannula in one study (150 patients). During transport on noninvasive ventilation, three of 858 patients (0.4%) required either intubation or escalation of noninvasive ventilation. In the 24 hours following transfer, 63 of 650 children (10%) transferred on noninvasive ventilation were intubated. The odds of intubation within 24 hours were significantly higher for continuous positive airway pressure transfer 60 of 500 (12%) compared with high-flow nasal cannula three of 150 (2%): odds ratio (95% CI) 6.68 (2.40–18.63), p value equals to 0.00003. Minor adverse events occurred in 1–4% of noninvasive ventilation transports.

Conclusions:

This review found observational study evidence of a rate of intubation or escalation of 0.4% during noninvasive ventilation transport of children 0–18 years old, with an in-transport adverse event rate of 1–4%. Further studies are required. If randomized trials are not possible, it is suggested that well-conducted observational studies are reported in a more standardized manner.
The Need and Desire for Mental Health and Substance Use–Related Services Among Clients of Publicly Funded Sexually Transmitted Infection Clinics in Vancouver, Canada
Authors: Salway Travis , Ferlatte Olivier , Shoveller Jean , Purdie Aaron , Grennan Troy , Tan Darrell H. S. , Consolacion Theodora , Rich Ashleigh J. , Dove Naomi , Samji Hasina , Scott Kai , Blackwell Everett , Mirau Dean , Holgerson Natalie , Wong Jason , Gilbert Mark
Published: November 2018

Context:

Sexually transmitted infections (STI) and mental health and substance use (MHSU) disorders all occur at elevated rates in sexual and gender minorities. These overlapping epidemics, or syndemics, are exacerbated by challenges these same populations face in accessing sexual/gender minority-affirming services. Many publicly funded STI clinics are a low barrier and provide sexual minority-competent care. These sites therefore may be uniquely situated to address clients' MHSU-related needs.

Objective:

We characterize the need and desire for MHSU services among STI clinic clients.

Design, Setting, Participants:

We conducted a waiting room survey at 6 STI clinics in Metro Vancouver, Canada.

Main Outcome Measures:

We calculated the proportion of clients with self-reported unmet MHSU needs in the previous 12 months and, among these clients, barriers to accessing MHSU services and desire for MHSU services within the STI clinic. We also examined social disparities in barriers to accessing MHSU services.

Results:

Among 1115 respondents—65% of whom were sexual minorities—39% reported a recent need for MHSU-related care, most frequently in relation to anxiety (29%), depression (26%), substance use (10%), or suicide ideation (7%). Seventy-two percent of this group had not yet talked to a provider about their concern. Common barriers included shame (26%) and inability to afford the service (24%). Eighty-three percent of clients with unmet MHSU needs indicated that they were comfortable discussing MHSU concerns with an STI clinic provider, and 94% expressed desire to receive MHSU assessments, referrals, or counseling in the STI clinic. Sexual and gender minorities and those attending a suburban clinic were more likely to report barriers to accessing MHSU services.

Conclusions:

More than a quarter of STI clinic clients report unmet MHSU health care needs; moreover, these clients report high levels of comfort with and desire to discuss MHSU concerns with STI clinic providers. Sexually transmitted infections clinics are thus opportune sites for syndemic service integration.
Anonymity Decreases the Punitive Nature of a Departmental Morbidity and Mortality Conference
Authors: Jansson Paul S. , Schuur Jeremiah D. , Baker Olesya , Hagan Sean C. , Nadel Eric S. , Aaronson Emily L.
Published: November 2018

Objectives

We sought to analyze the effect of an anonymous morbidity and mortality (M&M) conference on participants' attitudes toward the educational and punitive nature of the conference. We theorized that an anonymous conference might be more educational, less punitive, and would shift analysis of cases toward systems-based analysis and away from individual cognitive errors.

Methods

We implemented an anonymous M&M conference at an academic emergency medicine program. Using a pre-post design, we assessed attitudes toward the educational and punitive nature of the conference as well as the perceived focus on systems versus individual errors analyzed during the conference. Means and standard deviations were compared using a paired t test.

Results

Fifteen conferences were held during the study period and 53 cases were presented. Sixty percent of eligible participants (n = 38) completed both the pretest and posttest assessments. There was no difference in the perceived educational value of the conference (4.42 versus 4.37, P = 0.661), but the conference was perceived to be less punitive (2.08 versus 1.76, P = 0.017). There was no difference between the perceived focus of the conference on systems (2.76 versus 2.76, P = 1.00) versus individual (4.21 versus 4.16, P = 0.644) errors. Most participants (59.5%) preferred that the conference remain anonymous.

Conclusions

We assessed the effect of anonymity in our departmental M&M conference for a 7-month period and found no difference in the perceived effect of M&M on the educational nature of the conference but found a small improvement in the punitive nature of the conference.
T1- and T2*-Mapping for Assessment of Tendon Tissue Biophysical Properties
Authors: Bachmann Elias , Rosskopf Andrea B. , Götschi Tobias , Klarhöfer Markus , Deligianni Xeni , Hilbe Monika , Pfirrmann Christian W.A. , Snedeker Jess Gerrit , Fischer Michael A.
Published: November 2018

Objectives

The aim of this study was to quantitatively assess changes in collagen structure using MR T1- and T2*-mapping in a novel controlled ex vivo tendon model setup.

Materials and Methods

Twenty-four cadaveric bovine flexor tendons underwent MRI at 3 T before and after chemical modifications, representing mechanical degeneration and augmentation. Collagen degradation (COL), augmenting collagen fiber cross-linking (CXL), and a control (phosphate-buffered saline [PBS]) were examined in experimental groups, using histopathology as standard of reference. Variable echo-time and variable-flip angle gradient-echo sequences were used for T2*- and T1-mapping, respectively. Standard T1- and T2-weighted spin-echo sequences were acquired for visual assessment of tendon texture. Tendons were assessed subsequently for their biomechanical properties and compared with quantitative MRI analysis.

Results

T1- and T2*-mapping was feasible and repeatable for untreated (mean, 545 milliseconds, 2.0 milliseconds) and treated tendons. Mean T1 and T2* values of COL, CXL, and PBS tendons were 1459, 934, and 1017 milliseconds, and 5.5, 3.6, and 2.5 milliseconds, respectively. T2* values were significantly different between enzymatically degraded tendons, cross-linked tendons, and controls, and were significantly correlated with mechanical tendon properties (r = −0.74, P < 0.01). T1 values and visual assessment could not differentiate CXL from PBS tendons. Photo-spectroscopy showed increased autofluorescence of cross-linked tendons, whereas histopathology verified degenerative lesions of enzymatically degraded tendons.

Conclusions

T2*-mapping has the potential to detect and quantify subtle changes in tendon collagen structure not visible on conventional clinical MRI. Tendon T2* values might serve as a biomarker for biochemical alterations associated with tendon pathology.
Modification of the Lazy-T Procedure for Correction of Punctal Ectropion
Authors: Ishikawa Eri , Takahashi Yasuhiro , Kakizaki Hirohiko
Published: November 2018

The Lazy-T procedure is used to correct moderate-to-severe punctal ectropion in the lower eyelid. It includes full-thickness wedge resection of the medial lower eyelid and horizontal tarso-conjunctival diamond excision inferior to the lower punctum. However, the skin wound vertical to the relaxed skin tension lines is often conspicuous and horizontal excision of a part of the tarsus may impair function of the meibomian gland. In this study, the authors developed a modified Lazy-T procedure, which includes subciliary incision, pentagonal tarso-conjunctival resection, and medial spindle excision for submerging the vertical wound after suturing the pentagonal tarso-conjunctival resection under the skin flap and minimizing damage to the tarsus. The modified Lazy-T procedure was applied in 4 eyelids of 3 patients and achieved good anatomical results with cosmetically acceptable postoperative appearances and no remarkable complication.
Assessing the Compliance of Randomized Controlled Trials Published in Craniofacial Surgery Journals With the CONSORT Statement
Authors: Borrelli Mimi R. , Farwana Reem , Andrew Tom W. , Chicco Maria , Abukhder Munir , Mobarak Dima , Thavayogan Rachel , Agha Riaz , Pidgeon Thomas E.
Published: November 2018

Background:

Randomized controlled trials (RCTs) are gold standard assessments for healthcare interventions. The Consolidated Standards of Reporting Trials (CONSORT) statement was published to maximize RCT reporting transparency. The authors conducted a systematic review to assess current compliance of RCTs published within craniofacial surgery with the CONSORT statement.

Methods:

The Thomson Reuters Impact Factor Report 2016 was consulted to identify craniofacial surgery journals. PubMed was used to search for recent RCTs published within the 5 journals identified. Two independent researchers assessed each study for inclusion and performed data extraction. The primary outcome was compliance of each RCT with the CONSORT statement. Secondary outcomes were the pathology and interventions examined, impact factor, multi-versus-single center, number of authors, and publication date.

Results:

Eighty-six studies met the inclusion criteria, across which a median of 56% (range 33%–94%) applicable CONSORT items were reported. The 5 least reported items were: trial design (3a); registration number and name of trial registry (23); who generated random allocation sequences, enrolled participants, and assigned participants to interventions (10); sample size determination (7a); mentioning “randomized trial” in the title (1a).

Conclusion:

The compliance of craniofacial surgery RCTs with the CONSORT statement requires improvement. Areas in need are identified, and methods to improve reporting transparency, are discussed.
Effects of Ultraviolet Irradiation on Cellular Senescence in Keratinocytes Versus Fibroblasts
Authors: Moon Kyung-Chul , Yang Jong-Phil , Lee Jae-Sun , Jeong Seong-Ho , Dhong Eun-Sang , Han Seung-Kyu
Published: November 2018

Aging is a biologic process characterized by time-dependent functional declines that are influenced by oxidative stress-induced inflammatory reactions. In particular, ultraviolet (UV) irradiation plays a key role in cellular senescence in photo-aged skin. However, the cellular senescence of epidermal keratinocytes and dermal fibroblasts by UV irradiation may differ depending on the exposure time and dosage of UV irradiation. Therefore, the purpose of the study was to evaluate and compare the effects of UV irradiation on cellular senescence in human epidermal keratinocytes (HaCaT) and human dermal fibroblasts (HDFs). After cell viability test, 200 mJ/cm2 UV irradiation was used in this study. To evaluate the reactive oxygen species and reactive nitrogen species production, the levels of glutathione (GSH) and nitrite (NO2) were measured. We also performed reverse transcription-polymerase chain reaction, Western blot analysis, and senescence-associated beta-galactosidase assay. An overall decrease in GSH and an increase in NO2 were observed in the HaCaT and HDF cells. However, the time-line and dose-dependent effects varied. Higher expressions of tumor necrosis factor-α, inducible nitric oxide synthase, and interleukin-1β than that of the control group were observed in both cells. The HDF cells showed high levels of matrix metallopeptidase 9 and neutral endopeptidase protein but low levels of SIRT1 and procollagen I. The expression of nuclear factor kappa-light-chain-enhancer of activated B cell (NF-κB) was increased in the HaCaT cells, but not in the HDF cells. The NF-κB peaked at 1 hour after UV irradiation in the HaCaT cells. The “turning-on” signal was faster in the irradiated HaCaT cells.
Development of Multidirectional Cranial Distraction Osteogenesis for the Treatment of Craniosynostosis
Authors: Sunaga Ataru , Sugawara Yasushi , Kamochi Hideaki , Gomi Akira , Uda Hirokazu , Sarukawa Shunji , Yoshimura Kotaro
Published: November 2018

Background:

Previously, the authors developed a new method of distraction osteogenesis for the treatment of craniosynostosis, multidirectional cranial distraction osteogenesis (MCDO). The purpose of this study is to review the authors’ experience of MCDO for remodeling of the anterior cranium in the patients of craniosynostosis.

Methods:

Forty-five patients with craniosynostosis underwent MCDO for anterior cranial remodeling from 2003 to 2017. The ages of the patients ranged from 8 to 72 months (mean: 23.9 months, median: 13 months). The involved sutures included the bicoronal suture in 14 patients, unicoronal suture in 4 patients, sagittal suture in 14 patients, metopic suture in 2 patient, and multiple sutures in 10 patients.

Results:

An improvement of in cranial shape was achieved in 40 patients. In 1 patient, intraoperative massive bleeding forced us finishing the procedure before completing the planned osteotomy. Transient cerebrospinal fluid leakage occurred in 3 patients during the activation phase but recovered with conservative therapy. The mean blood transfusion was 25.5 mL/kg. The phase of activation ranged from 7 to 17 days (mean, 10.6 days) and the consolidation period ranged from 16 to 67 days (mean, 32.4 days). Loosening of traction pins occurred in 7 patients, resulting in undercorrection in 2 patients, and loosening of anchor pins occurred in 19 patients, resulting in acceleration of removal of the devices in 7 patients.

Conclusions:

Multidirectional cranial distraction osteogenesis was effective and has several advantages over the conventional procedures. Therefore, the authors conclude that MCDO will be a useful alternative for all phenotypes of craniosynostosis.
Preliminary Analysis on Characteristics of Rib Cartilage Calcification in Patients With Congenital Microtia
Authors: Guo Fengfeng , Yu Xiaobo , Chen Weiwei , Yang Qinghua , Pan Bo , Lin Lin , Jiang Haiyue
Published: November 2018

Autogenous rib cartilage graft procedure for microtia reconstruction has been adopted as the most standardized current method. But calcification would make it difficult for cartilage harvesting and ear framework sculpting. The objective of this study was to explore the rate, degree, and pattern of rib cartilage calcification in microtia and to guide rib cartilage harvesting and the optimal timing of auricular reconstruction. A retrospective study was performed with the imaging data from 320 consecutive patients who received a preoperative 3-dimensional chest computed tomography (CT). Overall, calcification rate of cartilages in female patients was higher than male's (P < 0.05). In 6 to 15 years group, calcification rates of male and female had a similar rate, while female's were higher than male's in other 3 groups. Furthermore, the moderate-to-severe calcification rate was higher in female than in male patients (P < 0.001). Therefore, girls who are over 15 years should be paid more attention regarding the possibility of moderate-to-severe calcification; these patients should take CT examinations if necessary. Calcification rate of the youngest group (6–15 years) was the lowest of all groups, while other 3 groups showed no statistical significance (P > 0.05). So merely the age increasing is not the contradiction for cartilage harvesting, as long as the authors effectively evaluate the condition of rib cartilage before operation. Rib cartilages serve as the key material in auricular framework sculpting and determine the feasibility and outcomes of the surgery. So CT examinations for preoperative evaluation of rib cartilage could be a useful method for planning microtia reconstruction.
Surgical Treatment of Growing Skull Fracture: Technical Aspects of Cranial Bone Reconstruction
Authors: Tamada Ikkei , Ihara Satoshi , Hasegawa Yuki , Aoki Marie
Published: November 2018

Background:

Growing skull fracture (GSF) is a rare, posttraumatic complication observed mainly in young infants. In GSF, the skull fracture associated with an underlying dural tear gradually expands due to herniation of the intracranial tissue into the fracture site. Many reports have discussed GSF from various points of view. However, only a few studies have focused on the details of cranial reconstruction. The present study aims to redress this omission by shedding some light on bone work in GSF surgery.

Methods:

Patients registered in the institutional database who underwent surgical repair of GSF were retrospectively reviewed.

Results:

Four patients underwent surgical repair for GSF. The site of injury was parietal in 3 patients and occipital in 1 patient . Age at the time of injury ranged from 3 months to 1 year 5 months (mean: 7 months). The duration from injury to surgery ranged from 5 to 7 months (mean: 5 months). In all patients, dural reconstruction was performed with autologous periosteum and cranial reconstruction was performed with an autologous calvarial bone graft. Regardless of the age distribution, split bone grafting was possible for all patients.

Conclusion:

To diagnose GSF promptly and thereby reduce the risk of neurologic sequelae, careful observation of the course, and education of the patients’ parents are desirable. Although most children with GSF are under 3 years old, the age before the formation of the diploic layer, split bone grafts should be considered for the treatment of GSF to reduce the risk of residual cranial bone defects.
Dacryocystitis and Rhinosinusitis Secondary to Sarcoidosis
Authors: Ishikawa Eri , Takahashi Yasuhiro , Nishimura Kunihiro , Ito Makoto , Kakizaki Hirohiko
Published: November 2018

Sarcoidosis rarely develops in the lacrimal sac. Lacrimal sac sarcoidosis may be associated with sarcoidosis-related rhinosinusitis. The anatomical and histological relationship between the lacrimal drainage system and nasal mucosa has been indicated as a predisposing factor for this concomitance. However, the characteristics of this condition are not fully understood. Herein, the authors report a case where dacryocystitis and rhinosinusitis developed secondary to sarcoidosis. Pathological examination of the lacrimal sac wall revealed noncaseating epithelioid granulomas in the subepithelial layer, which contains the lacrimal-drainage-associated lymphoid tissue. The lacrimal-drainage-associated lymphoid tissue comprises the main immune mechanism of the lacrimal system and forms a functional unit with the lacrimal gland, conjunctiva, and nasal mucosa to maintain ocular surface integrity through lymphocyte recirculation. Because sarcoidosis is an autoimmune disorder, this lymphocyte recirculation may be associated with the concurrent nasal lesions in the authors’ case.
Body Mass Index and Parotidectomy Outcomes
Authors: Ziegler Andrea , Teng Stephanie , Thorpe Eric
Published: November 2018

Multiple specialties have demonstrated increased risk of certain postoperative complications in patients with an increased body mass index (BMI). The goal of this study was to understand the outcomes of patients undergoing parotidectomy with an increased BMI and to identify any other patient risk factors for postoperative complications. This study was a retrospective chart review of 432 patients. Patient variables collected included BMI, age, gender, history of diabetes mellitus, type of parotidectomy, and pathology. Outcomes reviewed included facial nerve weakness, hematoma or seroma formation, and wound infection. The results showed that BMI had no statistically significant effect on complications. However, patients undergoing a total parotidectomy, malignant pathology, and patients with a history of diabetes mellitus had significantly more postoperative facial weakness. In conclusion, BMI does not influence postoperative complications in patients undergoing parotidectomy. Patients with diabetes, those undergoing total parotidectomies, and patients with malignant pathology have significantly more facial weakness and should be counseled accordingly.
Primary Reconstruction After Maxillectomy Defects Using Ultra Flex Mesh Plate and Rectus Abdominis Myocutaneous Free Flap Including Aponeurosis of External Abdominal Oblique Muscle
Authors: Ogino Akihiro , Onishi Kiyoshi , Nakamichi Miho
Published: November 2018

Background:

In primary reconstruction after maxillectomy for cancer, simple and less invasive surgical techniques considering functionality and aesthetics are necessary. The authors performed reconstruction for tissue defects after maxillectomy using an Ultra flex mesh plate and a free rectus abdominis myocutaneous flap including the aponeurosis of the external abdominal oblique muscle.

Method:

A 72-year-old male with a maxillary squamous cell carcinoma underwent subtotal maxillectomy. For maxillary defects, including those in the orbital floor and hard palate, the authors performed rigid reconstruction using an Ultra flex mesh plate produced after simulation surgery using a 3-dimensional solid model, and palatal and soft tissue reconstruction using a free rectus abdominis myocutaneous flap including the aponeurosis of the external abdominal oblique muscle. After screw fixation of the mesh plate at the surrounding normal bone, the skinpaddle of the rectus abdominis flap was transferred to the oral defect. The surface of the mesh plate was completely covered with the aponeurosis of the external abdominal oblique muscle, and the remaining rectus abdominis flap was inserted into the maxillary sinus.

Results:

At present, 1 year after the operation, there is no recurrence, complications, such as infection, or titanium mesh breakage/exposure, and his facial shape is favorably maintained.

Conclusion:

Reconstruction using this method is simple and less invasive. Postoperative infection and plate exposure were prevented by the complete coverage of the mesh plate with the aponeurosis of the external abdominal oblique muscle and flap. Mesh plates, when properly used, are useful reconstruction materials, but are susceptible to infection compared with autologous tissue, requiring long-term follow-up.
Evaluation of Temporomandibular Joint Movement After Mandibular Reconstruction
Authors: Shiozaki Masataka , Terao Yasunobu , Taniguchi Koichiro
Published: November 2018

Mandibular head dislocation and problems with mouth opening may develop after mandibular reconstruction. The authors investigated dislocation of the mandibular head and amount of protrusive sliding (excursion) and their effect on mouth opening. The authors divided 55 mandibular reconstruction patients into 3 groups on the basis of the extent of masticatory muscle and mandibular resection and investigated mandibular head dislocation. On the other hand, the authors focused on mandibular head protrusive excursion as a function of a reconstructed mandible. Protrusive excursion was measured by plain radiography in 29 patients. The extent of mouth opening was measured between the central incisors. Fluoroscopy was performed in 9 patients and the motions of the mandible were analyzed with video-analysis software. Mandibular head dislocation was observed in 15 patients (27.2%) who underwent resection of the mandibular ramus and coronoid process. The extent of mouth opening did not vary significantly among the 3 groups but was lower than that in healthy persons. Mandibular excursion was restricted in patients with conserved temporalis and lateral pterygoid muscles. Protrusive excursion was correlated with the extent of mouth opening. Structural problems involving dislocation of the mandibular head are caused by severing the coronoid process and protrusive excursion disorders are important factors causing mouth opening problems. Physiological sliding and other motions were observed in reconstructed models. The authors believe that when the ramus is resected, there is a greater chance of articular head dislocation. These findings suggest that dislocation of the mandibular head and protrusive excursion disorders arise from imbalances of the remaining masticatory muscles.
Assessment of Simultaneous Surgery for Odontogenic Sinusitis: Endoscopic Sinus Surgery With Endoscopic Apicoectomy
Authors: Akiyama Kosuke , Nakai Yasuhiro , Samukawa Yasushi , Miyake Minoru , Hoshikawa Hiroshi
Published: November 2018

Odontogenic sinusitis (OS) is a disease commonly encountered by otolaryngologists and oral surgeons. There is currently no standard consensus for the management of the causative teeth of OS, and the therapeutic outcomes of endodontic surgery remain unclear. The authors herein report the outcomes of simultaneous surgery for OS, endoscopic sinus surgery (ESS) with endoscopic apicoectomy. Twenty-one OS patients who underwent ESS were included in the intent-to-treat population. Eleven patients who simultaneously underwent endoscopic apicoectomy were included as the study group, and another 10 patients who were subjected to the extraction of the causative teeth preceding or during surgery were included as the control group. The postoperative tooth course after surgery in the study group was assessed as the primary outcome by periodic radiographs. The postoperative sinus course was compared between the 2 groups as the secondary outcome. Seventeen teeth were subjected to endoscopic apicoectomy concurrently with ESS, and the treatment success rate for periapical lesions was 94.1% (16 out of 17 teeth), which was consistent with previously reported outcomes for endodontic microsurgery. Ten of 11 patients (90.9%) had good postoperative sinus courses, and the mean wound-healing period of the sinus mucosa was 6.9 ± 3.5 weeks. These results were not significantly different from those obtained for the control group (90% and 6.1 ± 3.2 weeks). This surgical procedure may contribute to the preservation of causative teeth without having an impact on the successful treatment of sinusitis. A comprehensive surgical approach by otolaryngologists and oral surgeons is desirable for the treatment of OS.
Guidelines for a system-wide multidisciplinary approach to institutional resuscitative endovascular balloon occlusion of the aorta implementation
Authors: Zakaluzny Scott A. , Beldowicz Brian C. , Salcedo Edgardo S. , DuBose Joseph J. , Moore Laura J. , Brenner Megan
Published: November 2018

Resuscitative endovascular occlusion of the aorta (REBOA) is a rapidly evolving technology which requires careful system-wide multidisciplinary implementation for optimal success. These guidelines developed by experienced REBOA practitioners provide a framework for a key practitioner to use in the development of a REBOA program in their institution. They detail the importance of involving doctors, nurses, and staff across departments and disciplines in the application of this technique.
Emergency general surgery in geriatric patients: How should we evaluate hospital experience?
Authors: Mehta Ambar , Varma Sanskriti , Efron David T. , Joseph Bellal A. , Lunardi Nicole , Haut Elliott R. , Cooper Zara , Sakran Joseph V.
Published: November 2018

INTRODUCTION

As the aging American population poses unique challenges to acute care services, we determined if either hospital proportion or annual volume of geriatric patients undergoing emergency general surgery (EGS) procedures is associated with outcomes.

METHODS

Using criteria from the American Association of the Surgery of Trauma, we identified five EGS procedures in the 2012–2015 Nationwide Inpatient Sample common in geriatric patients (65+ years). We defined hospital proportion as the fraction of geriatric EGS patients divided by all EGS patients, where volume was the raw number of geriatric EGS patients. We then divided hospitals into quartiles both by proportion and then by volume of geriatric patients. Multivariable logistic regressions compared four outcomes between these quartiles: mortality, complications, failure to rescue (FTR; death after a complication), and extended length of stay (LOS; procedure-specific top decile of patients).

RESULTS

We identified 25,084 complex EGS procedures in geriatric patients at 3,528 hospitals (mortality, 10.6%; complications, 30.5%; FTR, 27.7%; extended LOS, 9.1%). The median hospital proportion of geriatric patients among EGS procedures was 42.8% (interquartile range, 33.3–52.2%), whereas the median hospital geriatric EGS volume after nationwide weighting was 40 per year (interquartile range, 20–70/year). After adjustment, the lowest hospital proportion quartile relative to the highest was associated with adverse outcomes: mortality (odds ratio, 1.21 [95% confidence interval, 1.03–1.44]), complications (1.16 [1.05–1.29]), FTR (1.32 [1.08–1.63]), and extended LOS (1.30 [1.12–1.50]). The lowest volume quartile relative to the highest was not associated with adverse outcomes. As the hospital proportion of geriatric patients increased by 10%, the odds of all adverse outcomes decreased: mortality by 7%, complications by 4%, FTR by 9%, and extended LOS by 8%.

CONCLUSION

When accounting for both, hospital proportion of geriatric EGS patients but not hospital volume is associated with postoperative outcomes, having important implications for quality improvement initiatives, benchmarking endeavors, and health services research.

LEVEL OF EVIDENCE

Care management, level IV; prognostic, level III.
mTOR Inhibitor Everolimus in Regulatory T Cell Expansion for Clinical Application in Transplantation
Authors: Gedaly Roberto , De Stefano Felice , Turcios Lilia , Hill Marita , Hidalgo Giovanna , Mitov Mihail I. , Alstott Michael C. , Butterfield D. Allan , Mitchell Hunter C. , Hart Jeremy , Al-Attar Ahmad , Jennings Chester D. , Marti Francesc
Published: November 2018

Background.

Experimental and preclinical evidence suggest that adoptive transfer of regulatory T (Treg) cells could be an appropriate therapeutic strategy to induce tolerance and improve graft survival in transplanted patients. The University of Kentucky Transplant Service Line is developing a novel phase I/II clinical trial with ex vivo expanded autologous Treg cells as an adoptive cellular therapy in renal transplant recipients who are using everolimus (EVR)-based immunosuppressive regimen.

Methods.

The aim of this study was to determine the mechanisms of action and efficacy of EVR for the development of functionally competent Treg cell-based adoptive immunotherapy in transplantation to integrate a common EVR-based regimen in vivo (in the patient) and ex vivo (in the expansion of autologous Treg cells). CD25+Treg cells were selected from leukapheresis product with a GMP-compliant cell separation system and placed in 5-day (short) or 21-day (long) culture with EVR or rapamycin (RAPA). Multi-parametric flow cytometry analyses were used to monitor the expansion rates, phenotype, autophagic flux, and suppressor function of the cells. phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin signaling pathway profiles of treated cells were analyzed by Western blot and cell bioenergetic parameters by extracellular flux analysis.

Results.

EVR-treated cells showed temporary slower growth, lower metabolic rates, and reduced phosphorylation of protein kinase B compared with RAPA-treated cells. In spite of these differences, the expansion rates, phenotype, and suppressor function of long-term Treg cells in culture with EVR were similar to those with RAPA.

Conclusions.

Our results support the feasibility of EVR to expand functionally competent Treg cells for their clinical use.