bluuebunny/crossref_metadata_2025 huggingface dataset:
Disseminated Herpes Simplex Virus in an Immunocompetent Patient Without Presence of Epidermal or Mucosal Lesions
Authors: Marshall Cody , Khatoon Nazia , Lynch Edward
Published: December 2020

Herpes simplex virus (HSV) is a disease usually characterized by lesions within the epidermis or mucosa of children and adults. However, this infection can also cause complications to many systems of the body, including the peripheral and central nervous system, respiratory system, and hepatobiliary system. In this case, we present a 43-year-old man with a history of substance abuse, who presented with fever, cough, and headache, and within days, progressed into fulminant hepatitis and hypoxic failure. Bacterial and fungal cultures were negative, as well as the workup for human immunodeficiency virus. However, the presence of HSV was detected in a bronchial lavage culture after the patients had expired. This result, along with the findings at autopsy, including viral cytopathic effect in the lung and liver, which were confirmed with immunohistochemical stains for HSV, strongly suggest that the cause of death is from disseminated herpes virus infection with hepatitis and viral pneumonitis. This disseminated infection occurred in an immunocompetent host without any evidence of mucocutaneous lesions.
Cardiovascular Effects of Transcranial Direct Current Stimulation and Bimanual Training in Children With Cerebral Palsy
Authors: Keller-Ross Manda L. , Chantigian Daniel P. , Nemanich Samuel , Gillick Bernadette T.
Published: December 2020

Purpose:

To determine the influence of combined transcranial direct current stimulation (tDCS) to the motor cortex (M1) and bimanual training on cardiovascular function in children with cerebral palsy (CP).

Methods:

Mean arterial pressure (MAP), heart rate (HR), and HR variability (HRV) were measured immediately before and after 20 minutes of cathodal tDCS to contralesional M1 and bimanual training on days 1, 6, and 10 of a 10-day trial in 8 participants (5 females, 7-19 years).

Results:

Baseline MAP and HR were similar across days (93 ± 10 mm Hg and 90 ± 10 bpm, P > .05). MAP was similar from baseline to postintervention across all 3 days. Systolic pressure, diastolic pressure, nor HR significantly changed. HRV was not influenced by the 10-day intervention.

Conclusions:

Combined cathodal tDCS to M1 and bimanual training does not influence autonomic and cardiovascular function in children with CP due to perinatal stroke.
Designing Exercise to Improve Bone Health Among Individuals With Cerebral Palsy
Authors: Gannotti Mary E. , Liquori Brianna M. , Thorpe Deborah E. , Fuchs Robyn K.
Published: December 2020

Purpose:

Individuals with cerebral palsy (CP), ambulatory or not, have less bone strength and density than their peers. Aging individuals with CP are at a higher risk for nontraumatic fractures, progressive deformity, pain, and spinal stenosis. Critical periods for skeletal formation are during prepuberty and adolescence. Applying mechanostat theory to exercise design for individuals with CP may be beneficial.

Methods:

Principles of mechanostat theory, particularly the osteogenic index, is applied to guide the design of exercise programs based on varying levels of physical capacity.

Results:

Recommendations are made for optimizing dosing of a variety of interventions for improving bone health among individuals with CP based on mechanostat theory with specific type, number of repetitions, and frequency.

Conclusions:

Researchers and clinicians are called to action to consider the role of exercise throughout the lifespan for all individuals with CP, regardless of level of severity.
Lack of Abdominal Stability and Control as a Possible Contributor to Rectus Femoris Avulsion Fracture in the Adolescent Soccer Player: A Case Report
Authors: Lasky-McFarlin Chelsea , Thomas Mae , Newman Jennifer , Thorpe Deborah
Published: December 2020

Purpose:

To describe evaluation and physical therapy treatment for an athlete who is male and 13 years old with healing bilateral rectus femoris avulsion fractures.

Summary of Key Points:

Fractures of the anterior inferior iliac spine may be linked to poor abdominal stability in soccer athletes who are male and an adolescent. The development and use of an abdominal stability screening tool could be an efficient and effective way to determine fracture risk and guide prevention programs.

Conclusions and Recommendations for Clinical Practice:

Following 8 weeks of conservative physical therapy treatment, the athlete met all goals and returned to pain-free soccer activities without residual impairments. Four months following discharge, he reported full participation in soccer competition without complications. This case illustrates that abdominal weakness is a potential risk factor for anterior inferior iliac spine avulsion fracture. Screening for abdominal weakness and incorporating preventative programs into training regimens is recommended to prevent anterior inferior iliac spine injuries in this population.
Outcomes of Infants With Severe Refractory Food Protein-induced Allergic Proctocolitis Treated With Mesalamine
Authors: Rojas Gallegos Maria Belen , Crissinger Karen D.
Published: December 2020

This retrospective chart review evaluates the outcomes of mesalamine treatment in infants with severe food protein-induced allergic proctocolitis (FPIAP) and persistent clinical symptoms despite the use of elemental formulas. Patients received mesalamine in a 40–60 mg/kg/d dose for an average of 100 days. This group showed significantly higher rates of improvement in the most common symptoms of FPIAP compared with the control group. In addition, the mesalamine group was less likely to need pharmacological treatment for gastroesophageal reflux disease and more likely to successfully transition to whole milk or soy milk after 1 year of age. In conclusion, using mesalamine can be a useful addition to the treatment of severe refractory cases of FPIAP.
Development and Validation of a Syndrome Definition to Identify Suspected Nonfatal Heroin-Involved Overdoses Treated in Emergency Departments
Authors: Scholl Lawrence , Liu Stephen , Vivolo-Kantor Alana , Board Amy , Stein Zachary , Roehler Douglas R. , McGlone Londell , Hoots Brooke E. , Mustaquim Desiree , Smith Herschel
Published: December 2020

Context:

The Centers for Disease Control and Prevention (CDC) works closely with states and local jurisdictions that are leveraging data from syndromic surveillance systems to identify meaningful changes in overdose trends. CDC developed a suspected nonfatal heroin overdose syndrome definition for use with emergency department (ED) data to help monitor trends at the national, state, and local levels.

Objective:

This study assesses the percentage of true-positive unintentional and undetermined intent heroin-involved overdose (UUHOD) captured by this definition.

Design/Setting:

CDC applied the UUHOD definition to ED data available in CDC's National Syndromic Surveillance Program (NSSP). Data were analyzed from 18 states that shared access to their syndromic data in NSSP with the CDC overdose morbidity team. Data were analyzed using queries and manual reviews to identify heroin overdose diagnosis codes and text describing chief complaint reasons for ED visits.

Measures:

The percentage of true-positive UUHOD was calculated as the number of true-positives divided by the number of total visits captured by the syndrome definition.

Results:

In total, 99 617 heroin overdose visits were identified by the syndrome definition. Among 95 323 visits identified as acute heroin-involved overdoses, based on reviews of chief complaint text and diagnosis codes, 967 (1.0%) were classified as possible intentional drug overdoses. Among all 99 617 visits, 94 356 (94.7%) were classified as true-positive UUHOD; 2226 (2.2%) and 3035 (3.0%) were classified as “no” and “maybe” UUHOD, respectively.

Conclusion:

Analysis of the CDC heroin overdose syndrome definition determined that nearly all visits were captured accurately for patients presenting to the ED for a suspected acute UUHOD. This definition will continue to be valuable for ongoing heroin overdose surveillance and epidemiologic analysis of heroin overdose patterns. CDC will evaluate possible definition refinements as new products and terms for heroin overdose emerge.
Negative-Pressure Wound Therapy With Instillation: A Tool in the Multidisciplinary Approach to Limb Function Preservation
Authors: Kim Paul J. , Attinger Christopher E.
Published: December 2020

The multidisciplinary approach to lower extremity function preservation is well established and is globally considered the standard of care. Every member of the team contributes their unique skills and knowledge to patient care. The effective integration of negative-pressure wound therapy with instillation (NPWTi) has fundamentally changed the approach to the infected or contaminated wound. Initially, in conjunction with excisional debridement, NPWTi has demonstrated its utility of expediting wound bed preparation for closure or coverage. With the introduction of a novel foam design, the effectiveness has increased and provided an option in cases where surgical intervention is not available or recommended. The successful implementation and continued monitoring of NPWTi provides an efficient tool to expedite ultimate wound healing and involves all members of the team.
Twins, Telomeres, and Aging—in Space!
Authors: Luxton Jared J. , Bailey Susan M.
Published: December 2020

Background:

The landmark National Aeronautics and Space Administration Twins Study represented an integrated effort to launch human space life science research into the modern age of molecular- and “omics”-based studies. As part of the first One-Year Mission aboard the International Space Station, identical twin astronauts Scott and Mark Kelly were the subjects of this “out of this world” research opportunity. Telomeres, the natural ends of chromosomes that shorten with cell division and a host of lifestyle factors and stresses, are key molecular determinants of aging and aging trajectories.

Methods:

We proposed that telomere length dynamics (changes over time) represent a particularly relevant and integrative biomarker for astronauts, as they reflect the combined experiences and environmental exposures encountered during spaceflight. Telomere length (quantitative polymerase chain reaction and telomere fluorescence in situ hybridization) and telomerase activity (quantitative polymerase chain reaction -telomere repeat amplification protocol) were longitudinally assessed in the space- and earth-bound twins. Chromosome aberrations (directional genomic hybridization), signatures of radiation exposure, were also evaluated.

Results:

The twins had relatively similar telomere lengths before spaceflight, and the earth-bound twins’ telomeres remained relatively stable over the course of the study. Surprisingly, the space twins’ telomeres were longer during spaceflight, and upon return to Earth shortened rapidly, resulting in many more short telomeres after spaceflight than before. Chromosomal signatures of space radiation exposure were also elevated during spaceflight, and increased inversion frequencies persisted after spaceflight, suggestive of ongoing genome instability.

Conclusion:

Although the definitive mechanisms underlying such dramatic spaceflight-associated shifts in telomere length remain unclear, improved maintenance of telomere length has important implications for aging science and improving healthspan for those on Earth, as well.
Inflammasome Activation in Pollution-Induced Skin Conditions
Authors: Ferrara Francesca , Prieux Roxane , Woodby Brittany , Valacchi Giuseppe
Published: December 2020

Exposure to air pollutants has been now associated with detrimental effects on a variety of organs, including the heart, lungs, GI tract, and brain. However, recently it has become clear that pollutant exposure can also promote the development/exacerbation of a variety of skin conditions, including premature aging, psoriasis, acne, and atopic dermatitis. Although the molecular mechanisms by which pollutant exposure results in these cutaneous pathological manifestations, it has been noticed that an inflammatory status is a common denominator of all those skin conditions. For this reason, recently, the activation of a cytosolic multiprotein complex involved in inflammatory responses (the inflammasome) that could promote the maturation of proinflammatory cytokines interleukin-1β and interleukin-18 has been hypothesized to play a key role in pollution-induced skin damage. In this review, we summarize and propose the cutaneous inflammasome as a novel target of pollutant exposure and the eventual usage of inflammasome inhibitor as new technologies to counteract pollution-induced skin damage. Possibly, the ability to inhibit the inflammasome activation could prevent cutaneous inflammaging and ameliorate the health and appearance of the skin.
Targeting Alternative Splicing for Reversal of Cellular Senescence in the Context of Aesthetic Aging
Authors: Bramwell Laura R. , Harries Lorna W.
Published: December 2020

Cellular senescence is a state of stable cell cycle arrest that has increasingly been linked with cellular, tissue, and organismal aging; targeted removal of senescent cells brings healthspan and lifespan benefits in animal models. Newly emerging approaches to specifically ablate or rejuvenate senescent cells are now the subject of intense study to explore their utility to provide novel treatments for the aesthetic signs and diseases of aging in humans. Here, we discuss different strategies that are being trialed in vitro, and more recently in vivo, for the targeted removal or reversal of senescent cells. Finally, we describe the evidence for a newly emerging molecular mechanism that may underpin senescence; dysregulation of alternative splicing. We will explore the potential of restoring splicing regulation as a novel “senotherapeutic” approach and discuss strategies by which this could be integrated into the established portfolio of skin aging therapeutics.
Temporal Variation of the Facial Skin Microbiome: A 2-Year Longitudinal Study in Healthy Adults
Authors: Hillebrand Greg G. , Dimitriu Pedro , Malik Kausar , Park Yulia , Qu Di , Mohn William W. , Kong Rong
Published: December 2020

Background:

The human skin microbiome is highly personalized, depending on, for example, body site, age, gender, and lifestyle factors. The temporal stability of an individual’s skin microbiome—its resiliency and robustness over months and years—is also a personalized feature of the microbiome. The authors measured the temporal stability of the facial skin microbiome in a large cohort of subjects. In addition to measuring microbiome dynamics, they tracked facial skin condition using noninvasive, objective imaging and biophysical measures to identify significant facial features associated with temporal changes in microbiome diversity and composition.

Methods:

The authors used 16S ribosomal RNA amplicon sequencing to track cheek and forehead skin microbiome diversity and composition annually over a 2-year period (2017–2019) in 115 healthy adult men and women. Skin metadata included facial features, such as wrinkles, hyperpigmentation, porphyrins, and skin color tone, as well as biophysical parameters for stratum corneum barrier function, pH, hydration, and elasticity.

Results:

Across the subject population, the facial skin microbiome composition and diversity were relatively stable, showing minor variation over the 2-year period. However, for some subjects, composition, diversity, and relative abundance of specific organisms showed substantial changes from one year to the next, and these changes were associated with changes in stratum corneum barrier function and follicular porphyrins.

Conclusions:

For healthy people, facial skin microbiome diversity and composition are relatively stable from year to year. Tracking the temporal changes in the microbiome along with skin phenotypic changes allows for a deeper understanding of the skin microbiome’s role in health and disease. These results should be helpful in the design of longer-term intervention trials with microbiome-based skin care treatments.
The Effect of Intraoperative Radiotherapy on Healing and Complications After Sacrectomy and Immediate Reconstruction
Authors: Lasso Jose M. , Pinilla Carmen , Vasquez Wenceslao , Asencio JM
Published: December 2020

Introduction

Sacropelvic resection is the treatment of choice for pelvic bone tumors and can be associated with intraoperative electron radiotherapy (IOERT) to optimize local control of the disease. Reconstruction with flaps also is essential to avoid pelvic complications. There is scarcity of publications evaluating outcomes of reconstructive procedures associated with IOERT.

Methods

A prospective study in 53 patients between 2005 and 2018 was performed. Thirty-four patients received IOERT (group I [GI]) and 19 did not (GII). We examined demographic characteristics, tumor pathology, type of resection and volume of surgical specimen, timing of surgery, IOERT doses, postoperative stay, and complications. We used it for reconstruction rectus abdominis, gluteal, omental and gracilis, superior gluteal artery perforator flap, and free flaps.

Results

Colonic adenocarcinoma and chordoma were the most frequent tumors. The median (interquartile range) IOERT dose was 1250 (1000–1250) cGy; operating time was 10.15 (8.6–14.0) hours versus 6.0 (5.0–13.0) hours, hospital stay was 37 (21.2–63.0) days versus 26.0 (12.0–60.0) days, and volume of surgical specimen was 480.5 (88.7–1488.0) mL versus 400 (220.0–6700.0) mL in GI and GII, respectively. Operating time was significantly longer in GI (P < 0.03). There were significant positive correlations between operating time, hospital stay, and volume of surgical specimen. Main complications were exudative wounds (50% vs 31.5%), wound dehiscence (41.1% vs 31.5%), and seroma (29.4% vs 26.3%) in GI and GII, respectively. Complications were similar to previous studies with or without radiotherapy.

Conclusions

Under a reconstructive approach, IOERT did not harm flap survival nor increased pelvic complications when compared with similar cases without IOERT.
Repair of Pediatric Split Earlobe Deformity With Anterior Straight-Line Closure and Posterior Z-Plasty
Authors: Tilt Alexandra , Malphrus Elizabeth , Mantilla-Rivas Esperanza , Manrique Monica , Rogers Gary F. , Oh Albert K.
Published: December 2020

Background

Split earlobe deformity typically results from earring-related trauma or, less commonly, from congenital malformation. Several surgical approaches to repair the earlobe have been described, with the goals of reconstructing normal contour of the earlobe, avoiding notching of the free margin, and minimizing scar visibility.

Methods

The authors reviewed 26 consecutive patients who underwent earlobe reconstruction using the senior author's novel technique, which involves anterior straight-line closure paired with a posterior Z-plasty. Baseline demographic characteristics, etiology of split earlobe, follow-up, outcomes, and rate of complications were analyzed.

Results

The median age at surgical repair was 8.04 (interquartile range, 4.53–12.84) years. Most patients had acquired split earlobe deformity secondary to trauma. Median follow-up was 86.5 (interquartile range, 29–385.5) days. Only 4 patients had less than satisfactory results, 3 having residual contour abnormality and 1 noting earlobe asymmetry. None of these patients desired revision. No keloid formation, dehiscence, or other postoperative complications were reported.

Conclusions

The authors describe a novel and effective surgical technique that successfully reconstructs split earlobe deformity. This technique minimizes visible scarring with an anterior straight-line repair combined with posterior Z-plasty to avoid notching.
Unilateral Vision Loss After Hyaluronic Acid Injection
Authors: Hung Jia-Horung , Wang Chung-Ting , Lee Chaw-Ning , Shieh Shyh-Jou
Published: December 2020

Vascular occlusion causing vision loss is a rare yet one of the most devastating complications of facial esthetic fillers. In this article, we present a case of unilateral blindness and superficial skin necrosis in a 31-year-old woman after the injection of hyaluronic acid for esthetic purposes. The delicate ocular fundal findings of ophthalmic artery occlusion were demonstrated by ophthalmoscopy, optical coherence tomography, and fluorescein angiography. Magnetic resonance imaging also showed subsequent ischemic changes in the optic nerve and posterior scleral wall after ophthalmic artery occlusion. Despite management including intraocular pressure-lowering agents, globe massage, and anticoagulation with acetylsalicylic acid and hyperbaric oxygen therapy, her final vision was not restored. Given the lack of effective treatments, this report depicts the comprehensive ocular fundal findings of an ophthalmic artery occlusion after esthetic hyaluronic acid filler injection, and highlights the importance of a preventive approach to avoid such catastrophic complications.
Rectovaginal Fistula Repair 1 Year Later
Authors: Hauch Adam , McKee Ryan M. , Li Wai-Yee , Crowley Jiwon S. , Ramamoorthy Sonia , Dobke Marek
Published: December 2020

Introduction

Rectovaginal (RV) fistulas are notoriously difficult to treat. Various methods for repair exist, and refinements in techniques can lead to “successful” outcomes. Review of the literature demonstrates that outcomes studies are scarce and mostly limited to comments on closure rate. We have experienced “success” in our own series with 100% closure rate, regardless of fistula etiology and comorbidities (radiation, inflammation, etc). However, long-term outcomes, including various complications and quality of life changes, have previously been underreported.

Methods

Critical analysis of various outcomes after fistula repair in 14 patients was performed. Patients were surveyed and interviewed with regard to problems before and after fistula repair to obtain objective data focusing on their experience and outcomes. Conclusions are based on physician assessment and patient surveys 1 year after fistula repair and at least 6 months after ostomy reversal and are discussed within the context of data from the literature.

Results

Overall satisfaction rate after repairs was high. All patients would undergo attempt at repair again regardless of complications or functional changes (not present before repair). After repair, sexual dyspareunia affected 5 patients (36%); however, most abstained from sexual activity when their RV fistula became apparent. No patient admitted to dyspareunia before the development of their RV fistula. Anal sphincter and defecation function, as well as stool continence, were judged by surgeons and patients uniformly as adequate. However, 3 patients (21%) complained of intermittent problems with urination. A new/different type of pain affected 2 of 4 patients with Crohn disease. One of these patients subsequently developed a new postsphincteric RV fistula. Another patient noted new intermittent vaginal discharge after ostomy reversal, and magnetic resonance imaging suggested a residual fistula, which was not seen on follow-up sigmoidoscopy and “Blue Dye Test.”

Conclusions

We previously reported on algorithms for repair and refinements in techniques for “successful” repair of RV fistulas with zero recurrence rate. Long-term follow-up indicates, however, that although the overall satisfaction rate after surgery is high, true “success,” defined as permanent fistula closure, is not necessarily problem free. Long-term morbidity and the management of other unique sequelae and problems are underreported.
Risk Factors for Lymphedema After Breast Conservation Therapy and Oncoplastic Reduction
Authors: Gowda Arvind U. , Nie James , Mets Elbert , Alperovich Michael , Avraham Tomer
Published: December 2020

Background

Lymphedema is a known complication after the surgical management of breast cancer, yet the incidence is poorly defined after breast conserving therapy and oncoplastic reduction. The primary aim of this study was to define lymphedema incidence in this population. Furthermore, we sought to correlate demographic factors, surgical approach, and complementary treatment modalities with incidence.

Methods

Data were collected retrospectively on patients who underwent breast conserving therapy at our institution from 2012 to 2015 with greater than 1 year of follow-up. Patients were excluded if they underwent breast surgery before treatment, completion mastectomy, delayed breast reconstruction, or delayed breast reduction.

Results

Five hundred and eighty-four patients met study criteria with a 11% lymphedema rate. Patients developing lymphedema had higher preoperative body mass index (P = 0.02), larger breast mass resection volume (P < 0.01), higher rate of axillary dissection (P < 0.01), increased rate of adjuvant whole-breast radiation (P = 0.03), supraclavicular radiation (P < 0.01), axillary radiation (P < 0.01), and neoadjuvant medical therapy (P < 0.01). Multivariate analysis showed breast specimen mass, axillary radiation, and neoadjuvant medical therapy, which were associated with lymphedema (P < 0.05). There was no difference in lymphedema incidence between partial mastectomy and oncoplastic reduction cohorts with independent multivariate analyses for each showing axillary radiation and neoadjuvant medical therapy were significantly associated with lymphedema (P < 0.05), although breast specimen mass was not.

Conclusions

Elevated preoperative body mass index, radiation, axillary dissection, and neoadjuvant medical therapy are associated with an increased risk of lymphedema after breast conserving surgery. Oncoplastic reconstruction is not a risk factor for lymphedema.
Surgical Management of Postmastectomy Lymphedema and Review of the Literature
Authors: Chen Kuo , Sinelnikov Mikhail Y. , Shchedrina Marina A. , Mu Lan , Lu Pengwei
Published: December 2020

Upper limb lymphedema is one of the most common complications after breast cancer surgery and radiotherapy. At present, physical methods and surgical methods can be used for treatment. Surgical operations are mainly based on lymphovenous anastomosis and vascularized lymph node transfer. For these 2 surgical methods, we analyzed and compared the literature review and our own clinical experience. We summarized the differences between the 2 surgical techniques and the selection methods. We hope to help more young plastic surgeons and breast doctors understand how to treat upper limb lymphedema through surgical methods and help patients improve their quality of life.
Factors Impacting Survival in Patients With Major Burn-Induced Acute Kidney Injury Postrenal Replacement Therapy
Authors: Su Chun-Lin , Chang Geng-He , Tsai I-Ju , Hsu Chung-Yi , Wang I-Kuan , Chang Chang-Cheng
Published: December 2020

Background

Major burn-induced acute kidney injury (AKI) causes extremely high mortality, even though renal replacement therapy (RRT) was thought of as the most efficient treatment. There was scanty research for investigating the characteristic of burn-AKI-RRT patients during intensive care. This study aims to investigate the factors impacting the survival outcomes in those burn-AKI-RRT cases.

Methods

Using the Taiwan National Health Insurance Research Database and its affiliated database, the Registry for Catastrophic Illness Patients, we defined a cohort composed of 171 patients encountering major burn-induced AKI and receiving RRT during burn care for a 15-year observation period. Demographic characteristic, comorbidities, total body surface area (TBSA), major procedures, and complications were analyzed to explore the factors affecting the survival outcomes during acute burn care and 1 year after discharge.

Results

Patients who underwent tracheostomy and skin grafting had higher survival rates during acute burn care (tracheostomy: mortality vs survival, 15.7% vs 30.2%; P = 0.0257; skin grafting: mortality vs survival, 57.4% vs 76.2%; P = 0.0134). Multivariate regression analysis showed that tracheostomy group significantly presented with lower mortality risk by 65% (odds ratio [OR], 0.35; P = 0.0372), and subgroup analysis of delaminating follow-up duration showed that patients with tracheostomy had higher overall survival by 22% (90-day postburn mortality: nontracheostomy vs tracheostomy, 58.3% vs 36.3%; adjusted hazards ratio, 0.39; 95% confidence interval, 0.22–0.69; P = 0.0011), especially during postburn first 30 days (adjusted hazards ratio, 0.15; 95% confidence interval, 0.05–0.49; P = 0.0016). Total body surface area did not significantly affect survival; however, mortality risk was significantly higher in those with a larger TBSA (TBSA, ≥80%; OR, 6.48; P = 0.0022; TBSA, 60–79%; OR, 3.12; P = 0.0518; TBSA, 40–59%; OR, 1.88; P = 0.2402; TBSA, 30–39% as reference).

Conclusions

For patients with major burn-induced AKI receiving RRT, tracheostomy and skin grafting may improve survival in the cases living through acute burn stage.
Skeletal Stability and Airway Changes After Maxillary Advancement Using a Rigid External Distraction System in Non-Growing Cleft Patients
Authors: Esmeraldo Gurgel Maia Lúcio Henrique , Wain Thi Lau Geórgia , Mendonça Copello Flávio , Sant‘Anna Eduardo Franzotti , Figueroa Alvaro Alfredo
Published: December 2020

Distraction osteogenesis (DO) is a highly effective technique for correction of severe maxillary hypoplasia, especially in patients with orofacial clefts and craniofacial syndromes. The purpose of this retrospective, longitudinal study was to assess long-term airway alterations after maxillary advancement using a rigid external distraction system (RED) in non growing cleft patients. Fifteen cleft patients (8 males and 7 females) aged from 14 to 25 years were included in this study. All of them were treated with a rigid external distraction system for maxillary advancement after a high Le Fort I osteotomy. To analyse airway changes lateral cephalograms were obteined before distraction (T0), immediately after distraction (T1) and 1 to 3 years and 3 months after distraction (T2). All the measurements were describled by means of median, minimum and maximum. In order to evaluate differences between each time interval, a Wilcoxon test associated to a Delta Cliff test was used to evaluate the effect size (level of significance adopted was 5%). A significant maxillary advancement and increased upper airway antero-posterior dimensions were observed after the distraction osteogeness process, as demonstrated by the difference between T1 and T0. No significant relapse at T2 was found. Lower airway and the airway at tip of uvula region did not display significant alterations. A significant maxillary advancement and increased antero-posterior upper airway dimension was measured immediately after maxillary distraction with rigid external distraction in non growing cleft patients. The findings were stable three years after distraction.
Post-Cranioplasty Complications: Lessons From a Prospective Study Assessing Risk Factors
Authors: Tsianaka Eleni , Drosos Evangelos , Singh Ajit , Tasiou Anastasia , Gatos Charalabos , Fountas Kostas
Published: December 2020

Complication rate related with cranioplasty is described as very high in most of relevant studies. The aim of our study was to try to identify possible factors, that could predict complications following cranioplasty. The authors hypothesized that some physical characteristics on the preoperative brain computed tomography (CT) scan can be predictive for complications.

The authors carried out a prospective observational study. All patients were adults after decompressive craniectomy, planned for cranioplasty and had a brain CT scan the day before cranioplasty. Our data pool included demographics, reason of craniectomy, various radiological parameters, the time of cranioplasty after craniectomy, the type of cranioplasty bone flap, and the complications.

Twenty-five patients were included in the study. The authors identified statistically significant correlation between time of cranioplasty after craniectomy and the complications, as well as between the type of cranioplasty implant and the complications. There was statistically significant correlation between complications and the distance of the free brain surface from the level of the largest skull defect dimension – free brain surface deformity (FBSD). Moreover, the correlation between FBSD and the time of cranioplasty was statistically significant.

It seems that for adult patients with unilateral DC the shorter time interval between craniectomy and cranioplasty lowers the risk for complications. The risk seems to be decreased further, by using autologous bone flap. Low values of the FBSD increase the risk for complications. This risk factor can be avoided, by shortening the time between craniectomy and cranioplasty.
Endothelial Nox2 Limits Systemic Inflammation and Hypotension in Endotoxemia by Controlling Expression of Toll-Like Receptor 4
Authors: Trevelin Silvia Cellone , Sag Can Martin , Zhang Min , Alves-Filho José Carlos , Cunha Thiago Mattar , Santos Célio Xavier dos , Sawyer Greta , Murray Thomas , Brewer Alison , Laurindo Francisco Rafael Martins , Protti Andrea , Lopes Lucia Rossetti , Ivetic Aleksandar , Cunha Fernando Queiroz , Shah Ajay M.
Published: December 2020

Leukocyte Nox2 is recognized to have a fundamental microbicidal function in sepsis but the specific role of Nox2 in endothelial cells (EC) remains poorly elucidated. Here, we tested the hypothesis that endothelial Nox2 participates in the pathogenesis of systemic inflammation and hypotension induced by LPS. LPS was injected intravenously in mice with Tie2-targeted deficiency or transgenic overexpression of Nox2. Mice with Tie2-targeted Nox2 deficiency had increased circulating levels of TNF-α, enhanced numbers of neutrophils trapped in lungs, and aggravated hypotension after LPS injection, as compared to control LPS-injected animals. In contrast, Tie2-driven Nox2 overexpression attenuated inflammation and prevented the hypotension induced by LPS. Because Tie2-Cre targets both EC and myeloid cells we generated bone marrow chimeric mice with Nox2 deletion restricted to leukocytes or ECs. Mice deficient in Nox2 either in leukocytes or ECs had reduced LPS-induced neutrophil trapping in the lungs and lower plasma TNF-α levels as compared to control LPS-injected mice. However, the pronounced hypotensive response to LPS was present only in mice with EC-specific Nox2 deletion. Experiments in vitro with human vein or aortic endothelial cells (HUVEC and HAEC, respectively) treated with LPS revealed that EC Nox2 controls NF-κB activation and the transcription of toll-like receptor 4 (TLR4), which is the recognition receptor for LPS. In conclusion, these results suggest that endothelial Nox2 limits NF-κB activation and TLR4 expression, which in turn attenuates the severity of hypotension and systemic inflammation induced by LPS.
Feasibility of an Interprofessional, Simulation-Based Curriculum to Improve Teamwork Skills, Clinical Skills, and Knowledge of Undergraduate Medical and Nursing Students in Uganda
Authors: Data Santorino , Dubé Mirette M. , Bajunirwe Francis , Kyakwera Catherine , Robinson Traci , Najjuma Josephine N. , Cherop Moses , Abesiga Lenard , Namata Tamara , Brenner Jennifer L. , Singhal Nalini , Twine Margaret , Wishart Ian , MacIntosh Heather , Cheng Adam
Published: December 2020

Introduction

Many deaths in Sub-Saharan Africa are preventable with provision of skilled healthcare. Unfortunately, skills decay after training. We determined the feasibility of implementing an interprofessional (IP) simulation-based educational curriculum in Uganda and evaluated the possible impact of this curriculum on teamwork, clinical skills (CSs), and knowledge among undergraduate medical and nursing students.

Methods

We conducted a prospective cohort study over 10 months. Students were divided into 4 cohorts based on clinical rotations and exposed to rotation-specific simulation scenarios at baseline, 1 month, and 10 months. We measured clinical teamwork scores (CTSs) at baseline and 10 months; CSs at baseline and 10 months, and knowledge scores (KSs) at baseline, 1 month, and 10 months. We used paired t tests to compare mean CTSs and KSs, as well as Wilcoxon rank sum test to compare group CS scores.

Results

One hundred five students (21 teams) participated in standardized simulation scenarios. We successfully implemented the IP, simulation-based curriculum. Teamwork skills improved from baseline to 10 months when participants were exposed to: (a) similar scenario to baseline {baseline mean CTS = 55.9% [standard deviation (SD) = 14.4]; 10-month mean CTS = 88.6%; SD = 8.5, P = 0.001}, and (b) a different scenario to baseline [baseline mean CTS = 55.9% (SD = 14.4); 10-month CTS = 77.8% (SD = 20.1), P = 0.01]. All scenario-specific CS scores showed no improvement at 10 months compared with baseline. Knowledge was retained in all scenarios at 10 months.

Conclusions

An IP, simulation-based undergraduate curriculum is feasible to implement in a low-resource setting and may contribute to gains in knowledge and teamwork skills.
Simulation-Based Mastery Learning to Teach Distal Radius Fracture Reduction
Authors: Toal Georgia G. , Gisondi Michael A. , Miller Nathaniel M. , Sebok-Syer Stefanie S. , Avedian Raffi S. , Dixon William W.
Published: December 2020

Introduction

Distal radius fractures are common orthopedic injuries managed in emergency departments. Simulation-based mastery learning is widely recognized to improve provider competence for bedside procedures but has not been studied to teach fracture management. This study evaluated the effectiveness of a simulation-based mastery learning curriculum to teach distal radius fracture reduction to novice orthopedic surgery and emergency medicine residents.

Methods

We created a novel mastery learning checklist using the Mastery Angoff method of standard setting, paired with a new simulation model designed for this project, to teach orthopedic surgery and emergency medicine interns (N = 22) at the study site. Orthopedic surgery and emergency medicine faculty members participated in checklist development, curriculum design, and implementation. Training included just-in-time asynchronous education with a readiness assessment test, in-classroom expert demonstration, and deliberate practice with feedback. Residents completed a pretest/posttest skills examination and a presurvey/postsurvey assessing procedural confidence.

Results

Standard setting resulted in a 41-item checklist with minimum passing score of 37/41 items. All participants met or surpassed the minimum passing score on postexamination. Postsurvey confidence levels were significantly higher than presurvey in all aspects of the distal radius fracture procedure (P < 0.05).

Conclusions

This study demonstrated that a simulation-based mastery learning curriculum improved skills and confidence performing distal radius fracture reductions for orthopedic surgery and emergency medicine interns. Future planned studies include curriculum testing across additional institutions, examination of clinical impact, and application of mastery learning for other orthopedic procedures.
Bilateral Inguinal Hernia Repair: Robotic TAPP Versus Laparoscopic TEP
Authors: Gundogdu Emre , Guldogan Cem E. , Ozmen Mehmet Mahir
Published: December 2020

Background:

As the advantages of minimally invasive techniques in general surgery have been shown, we prefer laparoscopic total extraperitoneal (LTEP) inguinal hernia repair or robotic transabdominal preperitoneal (RTAPP) inguinal hernia repair in patients diagnosed especially with a bilateral inguinal hernia in our practice. The present study aims to evaluate the early/midterm outcomes and complications in patients who underwent LTEP and RTAPP because of bilateral inguinal hernia.

Materials and Methods:

In total, 189 patients underwent inguinal hernia repair between June 2016 and June 2019 in our department. Data of 49 (2F) patients (33 LTEP/16 RTAPP) who had undergone bilateral inguinal hernia repair were evaluated retrospectively. Univariate analysis was performed to identify the relations between the techniques (LTEP vs. RTAPP), outcomes, and complications.

Results:

Patient demographics and comorbidities were similar in both groups. There was no difference between the groups in terms of American Society of Anesthesiologists (ASA) scores (P=0.09). Operative time was longer in the RTAPP group (P=0.001). Length of hospital stay was similar in both groups (P=0.11). No recurrence was observed in both groups. Mean pain scores were significantly less for the RTAPP group (P=0.05). When general complications were compared, it was found that the RTAPP group had a statistically significant lower complication rate (P=0.02). Mean follow-up was longer in the LTEP group (P=0.04). Total hospital costs for RTAPP and LTEP were 3968$ and 2506$, respectively.

Conclusions:

We conclude that RTAPP seems to have better results in terms of general complications and postoperative pain score when compared with LTAPP. Robotic surgery might be safely recommended for bilateral inguinal hernia repair.
Effectiveness of Electroconvulsive Therapy in Patients With Advanced Parkinson Disease
Authors: Murayama Tomonori , Kobayashi Seiju , Matsuoka Takeshi , Kigawa Yoshiyasu , Ishida Tomotaka , Hyakumachi Kengo , Utsumi Kumiko , Kawanishi Chiaki
Published: December 2020

Objectives

In addition to motor symptoms, patients with Parkinson disease (PD) experience various psychiatric comorbidities, including impulse control disorders (ICDs). Moreover, antiparkinsonian drugs sometimes cause psychiatric symptoms. Antiparkinsonian and antipsychotic drugs are competitive in pharmacodynamics, and psychotropic drugs, including antidepressants, may worsen motor symptoms or induce adverse reactions. Considering this conflicting situation, we examined the effectiveness of electroconvulsive therapy (ECT) on both motor and psychiatric symptoms in PD.

Methods

We retrospectively examined 12 PD patients with advanced motor symptoms and drug-resistant psychiatric symptoms, including ICDs, who had undergone ECT. Both before and after ECT, the severity of PD motor symptoms were evaluated using Hoehn and Yahr staging, while psychiatric symptoms were evaluated using the Neuropsychiatric Inventory. The patients' doses of antiparkinsonian and antipsychotic drugs were also assessed before and after ECT.

Results

Both the mean Hoehn and Yahr and Neuropsychiatric Inventory scores were significantly decreased after ECT. The symptoms of ICDs, which were observed in 5 patients, disappeared following ECT. Improvements in motor symptoms and psychiatric symptoms lasted for more than 1 year in 5 cases and 9 cases, respectively. Furthermore, the daily dose of antiparkinsonian drugs was significantly decreased in 6 cases.

Conclusions

Our results demonstrated that ECT was effective for both severe motor symptoms and psychiatric symptoms in advanced PD patients. ECT might be a solution for the conflicting problem of treating both motor and psychiatric symptoms in PD.
An Open-label Trial of Adjuvant High-frequency Left Prefrontal Repetitive Transcranial Magnetic Stimulation for Treating Suicidal Ideation in Adolescents and Adults With Depression
Authors: Zhang TianHong , Zhu JunJuan , Wang JunJie , Tang YingYing , Xu LiHua , Tang XiaoChen , Hu YeGang , Wei YanYan , Cui HuiRu , Liu XiaoHua , Hui Li , Li ChunBo , Wang JiJun
Published: December 2020

Background

Repetitive transcranial magnetic stimulation (rTMS) offers promise for the treatment of depression, yet its potential impact on suicidal ideation (SI), particularly in adolescents, has not been well studied. This study aimed to investigate the efficacy of add-on rTMS for reducing SI in a large clinical sample experiencing an acute phase of depression.

Methods

This study included 146 patients with a score of ≥14 on the 17-item Hamilton Rating Scale for Depression (HAMD). Among them, 97 had a HAMD-SI (3-item) score of 1 or greater and were pooled into the analysis. Symptoms of depression and SI were measured using the HAMD total score and HAMD-SI score. Comparisons of clinical improvement for both SI and rates of remission were made between adolescent (n = 29) and adult patients (n = 68), as well as between high-frequency (HF) rTMS on the left dorsolateral prefrontal cortex (DLPFC) (80 trains, 30 pulses per train, 12 s intertrain interval, 2400 pulses per session) and low-frequency (LF) rTMS on the right DLPFC protocol (2 trains, 700 pulses per train, 1 s intertrain-interval, 1400 pulses per session), power (intensity) level of 120% of motor threshold (MT), and 5 sessions per week for 2 weeks.

Results

Add-on rTMS treatment showed significant clinical improvement in SI, and was also well tolerated, with no adverse events reported. The SI improvements and remission rates were more significant in adolescents treated with the HF left DLPFC rTMS protocol, compared with adults treated with the LF right DLPFC rTMS protocol (remission rates: adolescent with LF right DLPFC, 50%; adolescent with HF left DLPFC, 94%; adult with LF right DLPFC, 65%; adult with HF left DLPFC, 57%). A positive association between improvement in the HAMD total score and HAMD-SI score was found in adults, but not in adolescents.

Conclusions

Add-on rTMS treatment for SI associated with depression is promising with respect to safety and feasibility. Our preliminary evidence supports an extension of the application of rTMS to adolescent patients with SI during the acute phase of depression, in addition to its use in adult treatment-resistant depression.
Mowing does not redress the negative effect of nutrient addition on alpha and beta diversity in a temperate grassland
Authors: Molina Cecilia D. , Tognetti Pedro M. , Graff Pamela , Chaneton Enrique J.
Published: December 2020

Species loss due to an increasing the number of added nutrients has been explained by both light competition through biomass increase and by niche dimension reduction as a result of species‐specific limiting soil resources trade‐offs. Disturbances, by reducing community biomass, species dominance and increasing light availability, may counteract above‐ground nutrient effects. However, it is unknown if diversity loss at local or spatial scales generated by increasing the number of added nutrients can be redressed with canopy disturbance.

We evaluated if local (alpha) and spatial scale (beta) diversity loss generated by the number of added nutrients can be reverted by disturbances in Flooding Pampa grasslands, Argentina. In a 4‐year replicated field experiment, we added soil resources combining nitrogen, phosphorus and potassium to obtain 0, 1, 2 or 3 nutrients and manipulated the regime of canopy disturbance by seasonal mowing and biomass removal.

We found that the increasing the number of added nutrients strongly reduced local and spatial plant diversity, despite biomass and light changes generated by mowing. In mown plots, nutrient‐driven local diversity loss intensified along time, thus increasing species dominance. While mowing did not affect dominant species loss, increasing the number of added nutrients promoted rare species loss and reduced spatial dissimilarity. Furthermore, mowing increased local and spatial diversity regardless of light or biomass effects, suggesting alternative pathway effects for disturbance.

Synthesis. Our results demonstrate that even when disturbance generated a positive effect on local and spatial diversity, it did not completely counteract the negative effect of number of added nutrients. Thus, the relative importance of above‐ and below‐ground resource competition may change when chronic disturbances alter community dominance. Under low light availability, above‐ground competition may drive species richness loss but when disturbance reduces light limitation, the increasing the number of added nutrients may reduce niche dimensionality and thus species coexistence. In sum, faced with the need to manage eutrophized grasslands, our study showed that disturbance may not completely mitigate the negative effect of multiple nutrient inputs on local and spatial grassland diversity.