bluuebunny/crossref_metadata_2025 huggingface dataset:
Thucydides on the Political Passions
Authors: Wohl Victoria
Published: March 2017

This chapter discusses the political passions in Thucydides’ History. Focusing on the seminal antithesis between emotion and (political) reason, it argues that this antithesis is itself inherently political: the nature and role of the passions in politics are themselves political questions; their answers, the stakes of political conflict. The chapter examines this contention within Thucydides’ analysis of Athenian democratic politics, particularly Pericles’ affective governance of an angry demos; and within Athenian imperial politics, in which disastrous expansion is fueled by the irrational passions of the demos, Athens, and mankind as a whole. In both domains, Thucydides uses emotion (performatively as well as analytically) to construct a particular vision of political rationality and to secure the authority of his own rational and dispassionate historiography.
Striving for Authenticity in Learning and Teaching Black South African Choral Music
Authors: Stone Mollie Spector
Published: March 2017

Black South African choral music has a rich and complex history rooted in the cultures and communities that first gave voice to it, in modern times contributing to the anti-apartheid struggle and the fight against AIDS. In striving to perform this world music authentically, Western choirs can introduce a sense of solidarity with and understanding of South African people, whose music is often oversimplified and westernized in published arrangements and transcriptions. This chapter provides an overview of techniques and resources directors can use in teaching this repertoire to choirs. Focus on authenticity; the importance of fully understanding the text; dancing; learning the music orally; teaching the cultural, social, political, and religious contexts of each piece; and maintaining high performance expectations. Developing an understanding of this genre encourages interest in the cultures that created it, opening the minds of all who encounter this powerful music.
The Art of Successful Programming
Authors: Bjella Richard
Published: March 2017

It seems that many concert programs are presented without enough concern for the overall flow, purpose, and direction of the choral performance itself. Often, many wonderful selections are included, but rarely do they truly work together in tandem or with enough significant diversity and color changes to warrant the audiences complete attention. Several unique models for programming at all levels are discussed. Questions are raised concerning choral programming tendencies (from Psalm choral settings to mixed meter music to Carmina Burana) and how the building of varied repertoires and unorthodox pairings can assist true success. In this age of diminishing crowds, fiscal resources, and rehearsal time, our ability to creatively weave the material to capture our singers and our audiences at the same time is extremely critical. Finally, we touch upon engaging the audience from the moment the ensemble takes the stage until the final ovation.
Choral Pedagogy Responds to the Media
Authors: Ward-Steinman Patricia Madura
Published: March 2017

Pop choral music has changed during the 21st century due to the enormous popularity of contemporary a cappella and commercial network TV shows such as Glee, The Voice, The Choir, The Sing-Off, American Idol, and the Clash of the Choirs. Choir students watch these shows and are influenced by them in terms of vocal tone, repertoire, showmanship, and competitive spirit. What is the proper pedagogical response? Should the media shape/influence choral pedagogy, or should traditional pedagogy develop the pop-influenced singer? This chapter addresses these questions and includes viewpoints of choral teachers throughout the age and experience spectra—from first-year teachers who are very familiar with these shows to competition-winning show choir directors and leaders in the field of choral music who have witnessed the effects of these programs on choral interest, enrollment, attitudes, and achievement in school choral programs.
“A Different Kind of Goose Bump”
Authors: Beale Charles
Published: March 2017

This chapter examines the musical practices and procedures of choruses such as the famous Gay Men’s Chorus within the LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer) communities of the United States and Europe, and more specifically the discourse in and around them. It focuses on choral pedagogy as it is found in such ensembles and communities, drawing on the literature and first-hand accounts from singers, conductors and audience members, and examines what they uniquely value in their singing. Specific questions include: what is a good sound for an early MTF (male to female) transgender singer? Is it good to have female tenors in your ensemble, and if so, how many? How does the meaning of a song change for singers and audience when sung by a group of 250 gay men? How does that inflect the way in which that song should be taught to the singers? In short, is there a queer choral pedagogy?
Building Sound and Skills in the Men’s Chorus at Colleges and Universities in the United States
Authors: Rardin Paul
Published: March 2017

Conductors of collegiate men’s choruses face unique challenges in building excellent choirs. They are likely to lead ensembles with disproportionately wide gaps between their most- and least-experienced singers, with a plurality or even majority of non-music majors—and may need to teach voice as much as they conduct. This chapter offers rehearsal techniques for these conductors which involve learning and utilizing vocal pedagogy, imparting basic phonation, and utilizing vocal tone exercises to build foundation and sound in a choir or glee club. They must then create a sense of community within their musically and vocally diverse choir; instill habits that lead to effective “core singing,” combining alignment, breathing technique, and resonance; and help male singers navigate shifts between their vocal registers.
Choral Pedagogy and the Construction of Identity
Authors: Garnett Liz
Published: March 2017

This chapter examines how theories of identity construction can usefully inform choral praxis. It starts with an outline of key concepts in theories of identity and how they can help us understand the processes by which choirs inculcate their members into their particular choral culture. It then examines three areas particularly salient for the choral leader. The first is the phenomenon of “non-singers”: how they emerge as a by-product of western cultural discourses, and what can be done to rehabilitate them. The second is the interpenetration of social and musical identity categories: how elements we may think of as “purely” musical are constructed in terms of wider social categories, including the habitus of the cultural environment, and the implications for how we frame the choral techniques we use. The third is the relationship between individual and group: how an ensemble establishes a corporate, supra-personal identity, and ways to facilitate this.
Happiness and Resilience Following Physical Disability
Authors: Dunn Dana S. , Uswatte Gitendra , Elliott Timothy R.
Published: March 2017

Restricted mobility, activity, or physical loss can have psychological consequences, so that some individuals report a variety of depressive symptoms and problem behaviors following disability onset. Yet many people with disabilities adjust to their circumstances reasonably well. The focus of this chapter is on those who exhibit positive reactions to living with disability. Our discussion is grounded in the theoretical and empirical perspectives of positive psychology; the constructive, person–situation focus of rehabilitation psychology; and the approaches emerging from the synergy of both research areas. Positive psychology emphasizes three foci: subjective states, individual processes, and the creation and maintenance of positive social institutions that facilitate participation in personal and social activities. We consider the first two foci by examining happiness, and then resiliency and positive growth. We then consider the implications of our review for future research and therapy.
What Is Expected of Higher Education Graduates in the Twenty-first Century?
Authors: Humburg Martin , Van der Velden Rolf
Published: March 2017

In this chapter, we reflect on the skills higher education graduates are expected to have in today’s economy and the role of higher education in equipping graduates with these skills. First, we identify six trends which form the basis of the changing role of graduates in economic life. These trends are the knowledge society, increasing uncertainty, the ICT revolution, high performance workplaces, globalization, and the change of the economic structure. By changing the nature and range of tasks graduates are expected to fulfil in today’s economy, we argue that these trends generate new and intensify traditional skill demands, which we summarize as professional expertise, flexibility, innovation and knowledge management, mobilization of human resources, international orientation, and entrepreneurship. Second, we draw out some key issues concerning the role of higher education institutions in equipping graduates with these skills.
Skills and Training for the Older Population
Authors: Loretto Wendy , Phillipson Chris , Vickerstaff Sarah
Published: March 2017

Despite rises in employment rates across many countries, older workers (those aged 50+) are less likely than younger employees to receive workplace training and skills development. Using the UK as its starting focus, this chapter analyses the theoretical and empirical reasons for these gaps. The analysis covers in-work training and development, as well as considering the position of those older people who are unemployed but looking for work. The discussion also embraces the roles of training and education for older workers who may want to delay retirement or retire flexibly, and examines the relationships between training, development and active ageing. Concluding discussions highlight national and international policy initiatives to encourage investment in educating and training for this new work generation.
Measuring Job Content
Authors: Handel Michael J.
Published: March 2017

Labour market research often relies on assumptions regarding job skill requirements but most information on job content is relatively thin or too general for easy interpretation, requiring new approaches to concepts and measurement. This chapter provides a detailed map of the domains that need to be measured and an approach to measuring them called explicit scaling, involving behaviourally concrete survey questions and response options with relatively fixed meanings across respondents. The measures capture both the diverse kinds of skills used at work and the complexity gradients that are the focus of recent concerns but which have largely eluded objective measurement. This chapter describes the measures first used in the survey of Skills, Technology, and Management Practices (STAMP) and presents empirical evidence on their validity and reliability, including comparisons with other established measures of job skill content.
Skill Development in Middle-level Occupations
Authors: Lerman Robert I.
Published: March 2017

Concerns about the polarization of the labor market are widespread. However, countries vary widely in strategies for strengthening jobs at intermediate levels of skill. This paper examines the role of apprenticeship in training and upgrading for middle-level occupations. The first section defines and describes middle-skills occupations, largely in terms of education and experience. The next step is to examine skill requirements and alternative approaches to preparing and upgrading the skills of individuals for these occupations. Programs of academic education and apprenticeship programs emphasizing work-based learning have often competed for the same space but with significant complementarities. Third, we consider the evidence on the costs and effectiveness of apprenticeship training in several countries from the employer, worker, and government perspectives. The final section highlights the advantages of apprenticeship training for intermediate level skills, jobs, and careers.
Technology and the Law of International Trade Regulation
Authors: Cottier Thomas
Published: March 2017

With regards to global trade, where new technologies impact both on what is traded and how, this chapter sketches the current regulatory landscape and projects the implications of emerging technologies for future regulatory approaches. While the regulation of technology mainly rests with domestic law, it is international trade law that addresses problems of regulatory diversity, overcomes unnecessary barriers to international trade and investment, and articulates common standards. Apart from general principles of non-discrimination and transparency, technology is particularly addressed by rules of intellectual property protection and by technical regulations and standards for industrial and nutritional products. For international trade law to respond to the challenges of legitimacy and democratic accountability, there need to be new approaches to regulatory cooperation and coherence, operating within a proper framework of multi-level governance that harnesses the process of globalization which is much driven by technological advances.
Human Dignity and the Ethics and Regulation of Technology
Authors: Düwell Marcus
Published: March 2017

This chapter investigates how human dignity might be understood as a normative concept for the regulation of technologies. First, various distinctions that are relevant for the way human dignity can be understood are discussed. It is argued that it is particularly important that we should see human dignity as a concept that ascribes a specific status that forms the basis of the human rights regimes. Second, the author’s own approach, inspired by Kant and Gewirth, is presented, it being proposed that we should see the concrete content of human dignity as the protection of the authority of human beings to govern their own lives. Third, various consequences for the evaluation of technologies are discussed. In a context of major global and ecological challenges, together with the replacement of human action by automation, the role of human dignity becomes one of guiding the development of a technology-responsive human rights regime.
The Moral Equality of Combatants
Authors: Barry Christian , Christie Lars
Published: March 2017

The doctrine of the moral equality of combatants holds that combatants on either side of a war have equal moral status even if one side is fighting a just war while the other is not. This chapter examines arguments that have been offered for and against this doctrine, including the collectivist position famously articulated by Walzer and McMahan’s influential individualist critique. We also explore collectivist positions that have rejected the moral equality doctrine and arguments that some individualists have offered in its favor. We defend a noncategorical version of the moral equality doctrine, according to which combatants on either side of a just war sometimes (but not always) have equal moral status. On our view nonculpable combatants are not liable to attack even when they fight for an unjust cause.
Long-term Risk of Endometrial Cancer Following Postmenopausal Bleeding and Reassuring Endometrial Biopsy
Authors: Visser Nicole C. M. , Sparidaens Ellen Marie , van den Brink Jan-Willem , Breijer Maria C. , Boss Erik A. , Veersema Sebastiaan , Siebers Albert G. , Bulten Johan , Pijnenborg Johanna M. A. , Bekkers Ruud L. M.
Published: March 2017

(Abstracted from Acta Obstet Gynecol Scand 2016;95(12):1418–1424)

Women with postmenopausal bleeding who present with an endometrial thickness 4 mm or less are at a very low risk of endometrial cancer, and therefore refraining from endometrial sampling in these women is considered justified. If the endometrial thickness is more than 4 mm, endometrial sampling is indicated to exclude endometrial cancer.
Addressing the Role of Obesity in Endometrial Cancer Risk, Prevention, and Treatment
Authors: Onstad Michaela A. , Schmandt Rosemarie E. , Lu Karen H.
Published: March 2017

(Abstracted from J Clin Oncol 2016;34:4225–4230)

The worldwide obesity epidemic has had a major impact on the health and well-being of both men and women. Obesity is well established as a major causal factor for the development of cardiovascular disease, diabetes, a number of cancers, and several other diseases.
Altered Functional Connectivity in Sickle Cell Disease Exists at Rest and During Acute Pain Challenge
Authors: Zempsky William T. , Stevens Michael C. , Santanelli James P. , Gaynor Alexandra M. , Khadka Sabin
Published: March 2017

Objectives:

Sickle cell disease (SCD) is a chronic pain disorder in which abnormally shaped red blood cells obstruct microcirculation causing ischemia and pain. The lack of SCD responsiveness to analgesics has led many to propose that nociceptive neural systems engaged when detecting pain become sensitized, resulting in an enhancement of pain response.

Methods:

Individuals with SCD and non-SCD controls were exposed to a painful stimuli of varying intensity using a pressure algometer and underwent several neuroimaging tasks.

Results:

This study identified and characterized the neural correlates of possible central sensitization in SCD. We found functional connectivity abnormalities in individuals with SCD in the brain’s somatosensory network, salience network, and default mode network during both an unstructured resting state and paradigm involving acute pain challenge.

Discussion:

There was evidence for both increased and decreased connectivity which is consistent with findings in other chronic pain disorders. Preliminary evidence was found that subcortical brain regions might contribute to neurodevelopmental abnormalities in chronic pain. The results support a model in which SCD pain sensitization involves abnormally low functional integration of brain regions that make use of nociceptive information to plan movements, and hyperconnectivity of various frontal and parietal lobe regions that direct attention to or represent higher-order abstractions within circuits involved with either nocioceptive processing or detection of abnormally salient environmental stimuli.
M1 and M2 macrophages’ clinicopathological significance in cutaneous melanoma
Authors: Falleni Monica , Savi Federica , Tosi Delfina , Agape Elena , Cerri Amilcare , Moneghini Laura , Bulfamante Gaetano P.
Published: March 2017

Skin malignant melanoma (MM) is an aggressive cancer with an increasing incidence with limited therapies in advanced stages. Tumor-associated macrophages (TAMs) are the major immune constituent of the MM microenvironment and contribute toward its prognosis. TAMs’ characterization and localization in human cancer is important to understand cancer progression and to identify molecular personalized therapies. M2 TAMs in stage I–II MMs are associated with worse prognostic parameters. A comprehensive M1-macrophage and M2-macrophage intratumoral localization and quantification in all stages of skin MMs is documented here with its clinical significance. To highlight immune pathways and possible early indicators of MM progression, we evaluated the number of M1 and M2 TAMs and intratumoral distribution in a large series of skin MMs. CD68 double immunostaining with MRP8–14 or inducible nitric oxide synthase (M1 macrophages) and with CD163 or CD204 (M2 macrophages) was performed in 94 stage I–IV skin MMs with a long duration of follow-up. The accumulation and distribution of M1 and M2 TAMs in intratumoral nests, stroma, and at the invasive front was correlated with clinicopathological variables. Since the early stage of MMs, M1 intratumoral macrophages were fewer than the M2 population; their recruitment was rapidly and progressively overwhelmed by an increase in M2 TAMs during MM progression. Independent of their intratumoral distribution, the accumulation of both M1 and M2 TAMs is associated with poor prognostic indicators and patients’ survival. M1-recruited macrophages shift to the M2 phenotype early in MM development, possibly induced by high inducible nitric oxide synthase intratumoral increase peculiarly occurring since the initial MM stages. M2-recruited TAMs overwhelm M1 accumulation in all stages of MM progression, thus favoring neoplastic growth and dissemination. Independent of their intratumoral distribution, the prevalent accumulation of M2 TAMs in MM is statistically confirmed to be a poor indicator of patients’ outcome and a potential target of immune therapies.
Follicular Porokeratosis, a Porokeratosis Variant
Authors: Tallon Ben , Emanuel Patrick
Published: March 2017

Porokeratosis derives from a process of abnormal keratinization, resulting in clinical and histologic variants. Follicular involvement is infrequently described, with previous suggestions that it may represent a distinct condition. We describe a case of typical disseminated superficial actinic porokeratosis with additional clinically prominent folliculocentric keratosis. Histologically, this represented follicular cornoid lamellae. These findings support follicular porokeratosis as an anatomic site variant of porokeratosis, as opposed to a distinct condition. We also want to raise awareness of this variant which clinically should be considered when presented with a discrete papular keratotic eruption.
Histological Subtype Remains a Significant Prognostic Factor for Survival Outcomes in Patients With Appendiceal Mucinous Neoplasm With Peritoneal Dissemination
Authors: Huang Yeqian , Alzahrani Nayef A. , Chua Terence C. , Morris David L.
Published: March 2017

BACKGROUND:

It has been increasingly recognized that appendiceal mucinous neoplasm with peritoneal dissemination is not a homogenous disease.

OBJECTIVE:

This study aimed to examine the impact of different histological subtypes on survival of a large cohort of patients with appendiceal mucinous neoplasms uniformly treated by cytoreductive surgery and intraperitoneal chemotherapy.

DESIGN:

This was a retrospective study of prospectively collected data of patients with peritoneal dissemination of appendiceal neoplasm who underwent cytoreductive surgery and intraperitoneal chemotherapy.

SETTING:

The study was conducted by 1 surgical team at St. George Hospital.

PATIENTS:

A total of 444 patients formed the cohort of this study.

MAIN OUTCOME MEASURES:

Histological diagnoses were categorized based on Carr criteria to include acellular mucin, disseminated peritoneal adenomucinosis, peritoneal mucinous neoplasms without signet ring cells, and peritoneal mucinous carcinomatosis with signet cells.

RESULTS:

Patients with low-grade appendiceal mucinous neoplasms with neoplastic epithelium absent tended to have lower CEA, CA19-9, and CA125 levels preoperatively (p = 0.109, 0.008, and 0.034). Factor analysis showed that histological diagnosis was an independent prognostic factor for survival outcomes (HR = 3.13 (95% CI, 2.34–4.39); p < 0.001), adjusted for peritoneal cancer index >20, completeness of cytoreductive score ≥2, use of early postoperative intraperitoneal chemotherapy, transfusion units, CEA >7.0 mg/L, CA19-9 >24.0 U/mL, and CA125 >24 U/mL.

LIMITATIONS:

This study was limited by its retrospective nature, lack of uniform classifications of appendiceal mucinous neoplasms in early years, and the heterogeneity of this study cohort given the long study period.

CONCLUSIONS:

Histological subtype remains a significant prognostic factor for survival outcomes in patients with appendiceal mucinous neoplasms. It should be taken into account when selecting patients for cytoreductive surgery, tailoring appropriate adjuvant therapies and follow-up surveillance plan.
BMI as a Predictor for Perioperative Outcome of Laparoscopic Colorectal Surgery: a Pooled Analysis of Comparative Studies
Authors: He Yazhou , Wang Jiarong , Bian He , Deng Xiangbing , Wang Ziqiang
Published: March 2017

BACKGROUND:

There has been a long-lasting controversy about whether higher BMI is associated with worse perioperative outcomes of laparoscopic colorectal surgery. Recently, a number of newly published investigations have made it possible to draw a quantitative conclusion.

OBJECTIVE:

We conducted this comprehensive meta-analysis to clarify the exact effect that BMI imposes on perioperative outcome of laparoscopic colorectal surgery.

DATA SOURCES:

We systematically searched MEDLINE, Embase, and Cochrane Library databases to identify all relevant studies.

STUDY SELECTION:

Comparative studies in English that investigated perioperative outcome of laparoscopic colorectal surgery for patients with different BMIs were included. Quality of studies was evaluated by using the Newcastle-Ottawa Scale.

INTERVENTION:

The risk factor of interest was BMI.

MAIN OUTCOME MEASURES:

Effective sizes were pooled under a random-effects model to evaluate preoperative, intraoperative, and postoperative outcomes.

RESULTS:

A total of 43 studies were included. We found that higher BMI was associated with significantly longer operative time (p < 0.001), greater blood loss (p = 0.01), and higher incidence of conversion to open surgery (p < 0.001). Moreover, BMI was a risk factor for overall complication rates (p < 0.001), especially for ileus (p = 0.02) and events of the urinary system (p = 0.03). Significant association was identified between higher BMI and risk of surgical site infection (p < 0.001) and anastomotic leakage (p = 0.02). Higher BMI might also led to a reduced number of harvest lymph nodes for patients with colorectal cancer (p = 0.02). The heterogeneity test identified no significant cross-study heterogeneity, and the results of cumulative meta-analysis, sensitivity analysis, and the publication bias test verified the reliability of our study.

LIMITATIONS:

Most studies included were retrospectively designed.

CONCLUSIONS:

Body mass index is a practical and valuable measurement for the prediction of the perioperative outcome of laparoscopic colorectal surgery. Higher BMI is associated with worse perioperative outcome. More accurate conclusions, with more precise cutoff values, can be achieved by future well-designed prospective investigations.
Gracilis Muscle Interposition for Rectourethral Fistula After Laparoscopic Prostatectomy: A Prospective Evaluation and Long-term Follow-up
Authors: Muñoz-Duyos Arantxa , Navarro-Luna Albert , Pardo-Aranda Fernando , Caballero Josep M. , Borrat Pere , Maristany Carles , Pando José A. , Veloso Enrique
Published: March 2017

BACKGROUND:

Postoperative rectourethral fistula after radical prostatectomy is an infrequent but very serious problem.

OBJECTIVE:

We aimed to describe our experience with transperineal repair and unilateral gracilis muscle interposition in patients with rectourethral fistula after radical prostatectomy in nonradiated prostate cancer.

DESIGN:

This was a cohort study.

SETTINGS:

All of the procedures were performed at the same hospital by the same multidisciplinary team made up of a senior colorectal surgeon and a senior urologist.

PATIENTS:

Patients with postoperative rectourethral fistula after laparoscopic prostatectomy were included.

INTERVENTION:

Transperineal fistula repair and gracilis muscle interposition were included.

MAIN OUTCOME MEASURES:

Fistula healing rate was measured.

RESULTS:

Nine patients with postoperative rectourethral fistula were treated between November 2009 and February 2016. Four of them had received other previous treatments without success, and 5 had previously been treated with this technique. Seven patients had a fecal diverting stoma. After a median follow-up of 54 months (range, 2–72), all of the fistulas had successfully healed, and, to date, the patients remain asymptomatic without urinary diversion. Fecal diversion was closed in all but 1 patient. No intraoperative or infectious complications were detected. With the results of our series, we present specific technical details of our technique and hope to provide additional evidence of the low morbidity profile and excellent healing rate of this treatment. Moreover, we note that, although small, this series corresponds with a homogeneous group of patients with rectourethral fistula after radical prostatectomy in nonradiated prostate cancer.

LIMITATIONS:

This is a small but very homogeneous group of patients.

CONCLUSIONS:

Simple repair with perineal gracilis muscle interposition is a safe and effective technique for the treatment of postoperative rectourethral fistulas after nonradiated prostate cancer surgery.
Interpretative Guidelines and Possible Indications for Indocyanine Green Fluorescence Imaging in Robot-Assisted Sphincter-Saving Operations
Authors: Kim Jin Cheon , Lee Jong Lyul , Park Seong Ho
Published: March 2017

BACKGROUND:

Since the introduction of indocyanine green angiography more than 25 years ago, few studies have presented interpretative guidelines for indocyanine green fluorescent imaging.

OBJECTIVE:

We aimed to provide interpretative guidelines for indocyanine green fluorescent imaging through quantitative analysis and to suggest possible indications for indocyanine green fluorescent imaging during robot-assisted sphincter-saving operations.

DESIGN:

This is a retrospective observational study.

SETTINGS:

This study was conducted at a single center.

PATIENTS:

A cohort of 657 patients with rectal cancer who consecutively underwent curative robot-assisted sphincter-saving operations was enrolled between 2010 and 2016, including 310 patients with indocyanine green imaging (indocyanine green fluorescent imaging+ group) and 347 patients without indocyanine green imaging (indocyanine green fluorescent imaging− group).

MAIN OUTCOME MEASURES:

We tried to quantitatively define the indocyanine green fluorescent imaging findings based on perfusion (mesocolic and colic) time and perfusion intensity (5 grades) to provide probable indications.

RESULTS:

The anastomotic leakage rate was significantly lower in the indocyanine green fluorescent imaging+ group than in the indocyanine green fluorescent imaging− group (0.6% vs 5.2%) (OR, 0.123; 95% CI, 0.028–0.544; p = 0.006). Anastomotic stricture was closely correlated with anastomotic leakage (p = 0.002) and a short descending mesocolon (p = 0.003). Delayed perfusion (>60 s) and low perfusion intensity (1–2) were more frequently detected in patients with anastomotic stricture and marginal artery defects than in those without these factors (p ≤ 0.001). In addition, perfusion times greater than the mean were more frequently observed in patients aged >58 years, whereas low perfusion intensity was seen more in patients with short descending mesocolon and high ASA classes (≥3).

LIMITATIONS:

The 300 patients in the indocyanine green fluorescent imaging− group underwent operations 3 years before indocyanine green fluorescent imaging.

CONCLUSIONS:

Quantitative analysis of indocyanine green fluorescent imaging may help prevent anastomotic complications during robot-assisted sphincter-saving operations, and may be of particular value in high-class ASA patients, older patients, and patients with a short descending mesocolon.
POOLED ESTIMATES OF INCIDENCE OF ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION OF ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR AGENTS WITH AND WITHOUT TOPICAL ANTIBIOTIC PROPHYLAXIS
Authors: Reibaldi Michele , Pulvirenti Alfredo , Avitabile Teresio , Bonfiglio Vincenza , Russo Andrea , Mariotti Cesare , Bucolo Claudio , Mastropasqua Rodolfo , Parisi Guglielmo , Longo Antonio
Published: March 2017

Purpose:

To assess the effect of topical antibiotic prophylaxis on postoperative endophthalmitis after intravitreal injection of anti–vascular endothelial growth factor agents.

Methods:

A systematic literature search was performed from inception to March 2016 using PubMed, Medline, Web of Science, Embase, and the Cochrane Library, to identify articles that reported cases of endophthalmitis after intravitreal injection of anti–vascular endothelial growth factor agents. We used a pooled analysis to estimate the incidence of cases of endophthalmitis who developed after injections performed with and without topical antibiotic prophylaxis. We used regression analysis to explore the effects of study characteristics on heterogeneity.

Results:

From our search of electronic databases, we identified and screened 4,561 unique records. We judged 60 articles to have reported findings for cohorts of patients who met our inclusion criteria, (12 arms of randomized clinical trials, 11 prospective cohort studies, and 37 retrospective cohort studies), which included 244 cases of endophthalmitis and 639,391 intravitreal injections of anti–vascular endothelial growth factor agents. The final pooled estimate endophthalmitis proportions were 9/10,000 (95% confidence interval, 7/10,000–12/10,000) in the antibiotic-treated group and 3/10,000 (95% confidence interval, 2/10,000–5/10,000) in the untreated group. The estimated incidence of endophthalmitis with topical antibiotic prophylaxis was approximated three times the incidence without prophylaxis. Random effects regression showed that none of the study characteristics significantly affected the effect size in either group.

Conclusion:

Topical antibiotic after intravitreal injection of anti–vascular endothelial growth factor agents is associated with a higher risk of endophthalmitis.
CYSTOID MACULAR EDEMA SECONDARY TO RITUXIMAB
Authors: Gilca Marina , Merrill Pauline T.
Published: March 2017

Background/Purpose:

To describe a case of bilateral macular edema appearing after treatment with rituximab.

Methods:

This is a case report describing macular edema after rituximab infusions. The information was collected retrospectively through chart review.

Results:

A 53-year-old patient known for IgG4-related disease of the face and sinuses presented with bilateral decreased visual acuity from cystoid macular edema shortly after undergoing two rituximab infusions. Laboratory workup did not reveal any underlying systemic etiology. Treatment with topical and oral corticosteroids as well as with anti–vascular endothelial growth factor injections led to mild improvement. Treatment with intraocular triamcinolone resulted in complete resolution of the edema, although accompanied by an increase in intraocular pressure.

Conclusion

Rituximab has been previously associated with macular edema. Macular edema causing visual loss shortly after receiving rituximab may respond to discontinuation of the rituximab and local steroid injection.
When Interactions Between Young Children and Dogs Become Dangerous
Authors: Warner Holly , Schilling Samantha
Published: March 2017

Dog bites are an important public health problem and often require significant medical and surgical care, especially among younger children. Although decades of research and clinical experience have revealed specific risk factors and potential avenues for the prevention of dog bite injuries to children, the problem remains widespread and serious. Prevention efforts underway largely target older children with limited focus on how to protect the infants and toddlers who experience the most serious morbidity and mortality from dog bite injuries. Recent research on the relationship between parent supervision and dog bites highlights an opportunity to educate parents on the risk of dog bites and appropriate dog–child interaction. The overall goal of such efforts is to reduce the frequency of dog bites, thus protecting children and avoiding hospital and surgical treatment.
Traumatic brain injury in the Netherlands, trends in emergency department visits, hospitalization and mortality between 1998 and 2012
Authors: Van den Brand Crispijn L. , Karger Lennard B. , Nijman Susanne T.M. , Hunink Myriam G.M. , Patka Peter , Jellema Korné
Published: March 2017

Background

Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. The effects of epidemiological changes such as ageing of the population and increased traffic safety on the incidence of TBI are unknown.

Objective

The objective of this study was to evaluate trends in TBI-related emergency department (ED) visits, hospitalization and mortality in the Netherlands between 1998 and 2012.

Design

This was a retrospective observational, longitudinal study.

Main outcome measures

The main outcome measures were TBI-related ED visits, hospitalization and mortality.

Results

Between 1998 and 2012, there were 500 000 TBI-related ED visits in the Netherlands. In the same period, there were 222 000 TBI-related admissions and 17 000 TBI-related deaths. During this period, there was a 75% increase in ED visits for TBI and a 95% increase for TBI-related hospitalization; overall mortality because of TBI did not change significantly. Despite the overall increase in TBI-related ED visits, this increase was not evenly distributed among age groups or trauma mechanisms. In patients younger than 65 years, a declining trend in ED visits for TBI caused by road traffic accidents was observed. Among patients 65 years or older, ED visits for TBI caused by a fall increased markedly. TBI-related mortality shifted from mainly young (67%) and middle-aged individuals (<65 years) to mainly elderly (63%) individuals (≥65 years) between 1998 and 2012. The conclusions of this study did not change when adjusting for changes in age, sex and overall population growth.

Conclusion

The incidence of TBI-related ED visits and hospitalization increased markedly between 1998 and 2012 in the Netherlands. TBI-related mortality occurred at an older age. These observations are probably the result of a change in aetiology of TBI, specifically a decrease in traffic accidents and an increase in falls in the ageing population. This hypothesis is supported by our data. However, ageing of the population is not the only cause of the changes observed; the observed changes remained significant when correcting for age and sex. The higher incidence of TBI with a relatively stable mortality rate highlights the importance of clinical decision rules to identify patients with a high risk of poor outcome after TBI.
Big and disparate data: considerations for pediatric consortia
Authors: Stingone Jeanette A. , Mervish Nancy , Kovatch Patricia , McGuinness Deborah L. , Gennings Chris , Teitelbaum Susan L.
Published: March 2017

Purpose of review

Increasingly, there is a need for examining exposure disease associations in large, diverse datasets to understand the complex determinants of pediatric disease and disability. Recognizing that children's health research consortia will be important sources of big data, it is crucial for the pediatric research community to be knowledgeable about the challenges and opportunities that they will face. The present review will provide examples of existing children's health consortia, highlight recent pooled analyses conducted by children's health research consortia, address common challenges of pooled analyses, and provide recommendations to advance collective research efforts in pediatric research.

Recent findings

Formal consortia and other collective-science initiatives are increasingly being created to share individual data from a set of relevant epidemiological studies to address a common research topic under the concept that the joint effort of many individual groups can accomplish far more than working alone. There are practical challenges to the participation of investigators within consortia that need to be addressed in order for them to work.

Researchers who access consortia with data centers will be able to go far beyond their initial hypotheses and potentially accomplish research that was previously thought infeasible or too costly.
Surgical Management of Crohn Disease in Children
Authors: Amil‐Dias Jorge , Kolacek Sanja , Turner Dan , Pærregaard Anders , Rintala Risto , Afzal Nadeem A. , Karolewska‐Bochenek Katarzyna , Bronsky Jiri , Chong Sonny , Fell John , Hojsak Iva , Hugot Jean‐Pierre , Koletzko Sibylle , Kumar Devinder , Lazowska‐Przeorek Izabella , Lillehei Craig , Lionetti Paolo , Martin‐de‐Carpi Javier , Pakarinen Mikko , Ruemmele Frank M. , Shaoul Ron , Spray Christine , Staiano Annamaria , Sugarman Ian , Wilson David C. , Winter Harland , Kolho Kaija‐Leena ,   IBD Working Group of ESPGHAN (IBD Porto Group)
Published: March 2017

The incidence of Crohn disease (CD) has been increasing and surgery needs to be contemplated in a substantial number of cases. The relevant advent of biological treatment has changed but not eliminated the need for surgery in many patients. Despite previous publications on the indications for surgery in CD, there was a need for a comprehensive review of existing evidence on the role of elective surgery and options in pediatric patients affected with CD. We present an expert opinion and critical review of the literature to provide evidence‐based guidance to manage these patients. Indications, surgical options, risk factors, and medications in pre‐ and perioperative period are reviewed in the light of available evidence. Risks and benefits of surgical options are addressed. An algorithm is proposed for the management of postsurgery monitoring, timing for follow‐up endoscopy, and treatment options.
Guidelines for the Prophylaxis of Pneumocystis jirovecii Pneumonia (PJP) in Children With Solid Tumors
Authors: Proudfoot Rebecca , Phillips Bob , Wilne Sophie
Published: March 2017

Although it is well-established that children undergoing allogeneic stem cell transplants and treatment for leukemia should be offered prophylaxis against Pneumocystis jirovecii pneumonia, the risk for children with solid malignancies is less certain. This guideline has been developed with the aim of standardizing practice and optimizing the benefit versus risk of prophylactic medication in this group of patients. P. jirovecii pneumonia has a high mortality rate even with prompt antimicrobial treatment. Since prophylaxis with co-trimoxazole is safe, effective, and inexpensive, we suggest that all children with malignancies undergoing immunosuppressive therapy are offered prophylaxis unless there are clear contraindications.
Hemolytic Anemia due to Right Ventricular to Pulmonary Artery Conduit Stenosis
Authors: Rao Sudha , Creaden Julie A. , Gong Shunyou , Rigsby Cynthia , Costello John M.
Published: March 2017

Hemolytic anemia is a well-recognized complication in patients with left-sided mechanical heart valves. It is rare to see hemolysis with a bioprosthetic valve in the right ventricular outflow tract. We report a 4-year-old-girl with history of truncus arteriosus status-post repair who developed hemolytic anemia as a result of a calcified and obstructed bioprosthetic right ventricular to pulmonary artery–valved conduit. The hemolysis was alleviated by replacing the obstructed conduit with a larger valved conduit.
Toxic Epidermal Necrolysis-like Reaction After Hematopoietic Stem Cell Transplantation in Children
Authors: Faraci Maura , Giardino Stefano , Lanino Edoardo , Morreale Giuseppe , Ghibaudo Emilia , Francesia Berta Monica , Risso Marco , Castagnola Elio , Ripaldi Mimmo , Moscatelli Andrea , Ghigliotti Giovanni
Published: March 2017

This study report clinical course, etiology, management, and long-term outcome of children who developed toxic epidermal necrolysis-like reaction (TEN-LR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We retrospectively collected children with TEN-LR occurring after allo-HSCT performed in 2 pediatric bone marrow units between 2005 and 2014. We identified 6 cases of TEN-LR of 322 patients (1.8%). Possible triggers of TEN included antibiotics, antiepileptics, antimycotics, and Mycoplasma infection. In 3 patients TEN-LR occurred concurrently with severe multiorgan acute graft versus host disease. The management of TEN included administration of high doses of intravenous immunoglobulins and steroids (n=6), anti-tumor necrosis factor (n=3), and plasmapheresis (n=3) and whenever possible, discontinuation of the potentially causative drugs. Four patients (66%) reached a complete clinical response of TEN-LR after a median of 11.2 days. Two children (34%) are presently alive, 1 with long-term ocular sequelae. TEN-LR is a potentially lethal complication that may occur after HSCT also in pediatric patients. In our experience, TEN-LR and acute graft versus host disease probably coexisted and an overlap between the 2 forms is suggested. The multidisciplinary approaches involving specialized nurses, hematologists, dermatologists, burn surgeons, and infectious disease specialists is crucial to treat these patients.
Biliary Adenofibroma of Liver
Authors: Arnason Thomas , Borger Darrell R. , Corless Christopher , Hagen Catherine , Iafrate A. John , Makhlouf Hala , Misdraji Joseph , Sapp Heidi , Tsui Wilson M. , Wanless Ian R. , Zuluaga Toro Tania , Lauwers Gregory Y.
Published: March 2017

Biliary adenofibroma is a rare primary hepatic neoplasm, recognized in the World Health Organization classification, although only 14 cases have been reported to date. This series includes extended follow-up from 2 of the early case reports and 4 novel cases. Clinical history and histology were reviewed in all 6 cases. Tumor DNA was analyzed for point mutations by multiplex polymerase chain reaction and copy number alterations by array comparative genomic hybridization. The patients included 4 females and 2 males presenting between 46 and 83 years of age, with tumors ranging from 7 to 16 cm in diameter. The tumors had similar morphology, with tubules and cysts lined mainly by bland to mildly atypical cuboidal epithelium embedded in fibrous stroma. Multiplex polymerase chain reaction did not identify mutations in 4 tumors tested. Three tumors tested by array comparative genomic hybridization showed chromosomal copy number alterations, including 1 with amplifications of CCND1 and ERBB2. Three patients underwent resection with no recurrence at 21, 20, and 3 years of follow-up. One patient is alive after 14 months with no resection. Two patients with margin-positive resections had local recurrence at 1 and 6 years after surgery. No patient had distant metastasis. The distinct morphology and multiple clonal cytogenetic alterations in biliary adenofibromas indicate that the lesions are neoplastic. Amplifications of CCND1 and ERBB2 are not typical of benign neoplasms, and suggest that these tumors may have the ability to behave aggressively. However, the clinical outcomes in these patients suggest the neoplasms are only slowly progressive.
Thoracic Manifestations of Klippel-Trenaunay Syndrome
Authors: Hammer Mark M. , Miller Wallace T.
Published: March 2017

Klippel-Trenaunay syndrome (KTS) is a congenital disorder characterized by venous malformations and a predisposition to pulmonary embolism. We reviewed the imaging findings of 7 adult patients with KTS who underwent thoracic CT. While the superficial manifestations of KTS predominantly affect the extremities, patients frequently develop abnormalities of the pulmonary arterial system, particularly chronic thromboembolic pulmonary hypertension. Additionally, some patients are seen to develop pulmonary arteriolar aneurysms; the physiologic significance of this finding is unknown at this time. Radiologists should be aware of these potential findings and have a high index of suspicion for chronic PE in patients with KTS.