bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive Factors of Surgical Outcome in Frontal Lobe Epilepsy Explored with Stereoelectroencephalography
Authors: Bonini Francesca , McGonigal Aileen , Scavarda Didier , Carron Romain , Régis Jean , Dufour Henry , Péragut Jean-Claude , Laguitton Virginie , Villeneuve Nathalie , Chauvel Patrick , Giusiano Bernard , Trébuchon Agnès , Bartolomei Fabrice
Published: May 2017

BACKGROUND

Resective surgery established treatment for pharmacoresistant frontal lobe epilepsy (FLE), but seizure outcome and prognostic indicators are poorly characterized and vary between studies.

OBJECTIVE

To study long-term seizure outcome and identify prognostic factors.

METHODS

We retrospectively analyzed 42 FLE patients having undergone surgical resection, mostly preceded by invasive recordings with stereoelectroencephalography (SEEG). Postsurgical outcome up to 10-yr follow-up and prognostic indicators were analyzed using Kaplan–Meier analysis and multivariate and conditional inference procedures.

RESULTS

At the time of last follow-up, 57.1% of patients were seizure-free. The estimated chance of seizure freedom was 67% (95% confidence interval [CI]: 54-83) at 6 mo, 59% (95% CI: 46-76) at 1 yr, 53% (95% CI: 40-71) at 2 yr, and 46% (95% CI: 32-66) at 5 yr. Most relapses (83%) occurred within the first 12 mo. Multivariate analysis showed that completeness of resection of the epileptogenic zone (EZ) as defined by SEEG was the main predictor of seizure outcome. According to conditional inference trees, in patients with complete resection of the EZ, focal cortical dysplasia as etiology and focal EZ were positive prognostic indicators. No difference in outcome was found in patients with positive vs negative magnetic resonance imaging.

CONCLUSION

Surgical resection in drug-resistant FLE can be a successful therapeutic approach, even in the absence of neuroradiologically visible lesions. SEEG may be highly useful in both nonlesional and lesional FLE cases, because complete resection of the EZ as defined by SEEG is associated with better prognosis.
Perioperative Care for Pediatric Patients With Penetrating Brain Injury: A Review
Authors: Mikhael Marco , Frost Elizabeth , Cristancho Maria
Published: May 2017

Traumatic brain injury (TBI) continues to be the leading cause of death and acquired disability in young children and adolescents, due to blunt or penetrating trauma, the latter being less common but more lethal. Penetrating brain injury (PBI) has not been studied extensively, mainly reported as case reports or case series, due to the assumption that both types of brain injury have common pathophysiology and consequently common management. However, recommendations and guidelines for the management of PBI differ from those of blunt TBI in regards to neuroimaging, intracranial pressure (ICP) monitoring, and surgical management including those pertaining to vascular injury. PBI was one of the exclusion criteria in the second edition of guidelines for the acute medical management of severe TBI in infants, children, and adolescents that was published in 2012 (it is referred to as “pediatric guidelines” in this review). Many reviews of TBI do not differentiate between the mechanisms of injury. We present an overview of PBI, its presenting features, epidemiology, and causes as well as an analysis of case series and the conclusions that may be drawn from those and other studies. More clinical trials specific to penetrating head injuries in children, focusing mainly on pathophysiology and management, are needed. The term PBI is specific to penetrating injury only, whereas TBI, a more inclusive term, describes mainly, but not only, blunt injury.
Trajectory of Short- and Long-Term Recovery of Tibial Shaft Fractures After Intramedullary Nail Fixation
Authors: Ko Sebastian J. , O'Brien Peter J. , Guy Pierre , Broekhuyse Henry M. , Blachut Piotr A. , Lefaivre Kelly A.
Published: May 2017

Objective:

To determine the trajectory of recovery after tibial shaft fracture treated with intramedullary nail over the first 5 years and to evaluate the magnitude of the changes in functional outcome at various time intervals.

Design:

Prospective cohort study.

Setting:

A Level 1 trauma center.

Patients/Participants:

One hundred thirty-two patients with tibial shaft fracture (OTA 42-A, B, C) were enrolled into the Center's prospective orthopaedic trauma database between January 2005 and February 2010. Functional outcome data were collected at baseline, 6 months, 1 year, and 5 years.

Intervention:

Enrolled patients were treated acutely with intramedullary nailing of their tibia.

Main Outcome Measurements:

Evaluation was performed using the Short Form-36 and Short Musculoskeletal Function Assessment (SMFA).

Results:

Mean SF-36 physical component scores improved between 6 and 12 months (P = 0.0008) and between 1 and 5 years (P = 0.0029). Similarly, mean SMFA dysfunction index scores improved between 6 and 12 months (P = 0.0254) and between 1 and 5 years (P = 0.0106). In both scores, the rate or slope of this improvement is flatter between 1 and 5 years than it is between 6 and 12 months. Furthermore, SF-36 and SMFA scores did not reach baseline at 5 years (SF-36 P < 0.0001, SMFA P = 0.0026). A significant proportion of patients were still achieving a minimal clinically important difference in function between 1 and 5 years (SF-36 = 54%, SMFA = 44%).

Conclusions:

The trajectory of functional recovery after tibial shaft fracture is characterized by an initial decline in function, followed by improvement between 6 and 12 months. There is still further improvement beyond 1 year, but this is of flatter trajectory. The 5-year results indicate that function does not improve to baseline by 5 years after injury.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
A 3-Dimensional Analysis of the Fracture Planes in Pediatric Lateral Humeral Condyle Fractures for Image-Based Pin Positioning During Fixation
Authors: Park Do Young , Cho Jae Ho , Lee Doo-Hyung , Choi Wan-Sun , Bang Jun Young , Yin Xiang Yun
Published: May 2017

Objective:

To determine the 3-dimensional morphology of pediatric lateral condylar physeal fractures using 3-dimensional computed tomography (3D-CT) and to identify optimal pin positions for percutaneous pinning.

Design:

Prospective case series of consecutively treated patients.

Setting:

Tertiary university hospital setting.

Patients:

Preoperative 3D-CTs in pediatric surgical candidates diagnosed with lateral condylar physeal fractures.

Intervention:

Closed reduction and percutaneous pinning was performed.

Main Outcome Measures:

Reconstructed images of the distal humerus were aligned accordingly to determine the coronal (α), sagittal (β), and axial tilt (γ) angles of the fracture plane. Both α and β were also measured on plain radiography. Image-based position of the 2 pins was calculated preoperatively using 3D-CT, based on anteroposterior and lateral views. Final angle of pins was measured on postoperative radiographs.

Results:

A total of 29 fractures were assessed. 3D-CT reconstruction images of fractures showed a posterolateral fracture fragment with reference to the long axis of the humerus. The mean α, β, and γ were 62 degrees [95% confidence interval (CI), 59–64], 69 degrees (95% CI, 65–72), and 36 degrees (95% CI, 34–38). Both α and β measured on plain radiography were not significantly different from 3D-CT measurements (P = 0.6712, 0.6218). Average postoperative pin angles were 144 degrees (95% CI, 140–147) and 161 degrees (95% CI, 158–165) for the proximal pin, and 118 degrees (95% CI, 114–122) and 115 degrees (95% CI, 110–120) for the distal pin, on anteroposterior and lateral views, respectively, resulting in similar trajectories to the preoperatively calculated pin positions.

Conclusion:

Our study adds to the current knowledge by providing an image-based angular reference of the fracture configuration in pediatric lateral humeral condyle fractures, which may be used during percutaneous pinning.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Mobius Syndrome: A 35-Year Single Institution Experience
Authors: K. McClure Philip , Kilinc Eray , Oishi Scott , I. Riccio Anthony , A. Karol Lori
Published: May 2017

Background:

Mobius syndrome is a rare syndrome that is known to be associated with a variety of orthopaedic conditions including scoliosis, clubfoot, transverse limb deficiencies, Poland syndrome, and a myriad of hand conditions. To date, no large series exist to characterize the orthopaedic manifestations of Mobius syndrome.

Methods:

Medical records at a single tertiary pediatric institution were reviewed for all patients diagnosed with Mobius syndrome from January 1, 1980 to December 31, 2015. Records and radiographs were reviewed for associated orthopaedic conditions and their management.

Results:

In total, 44 patients with Mobius syndrome were identified. Age at presentation ranged from 6 days to 14 years. When compared with the general population, patients with Mobius syndrome had an increased incidence of clubfoot (41%), Poland syndrome (20%), and scoliosis (14%). Clubfoot treated both before and after the institution of Ponseti casting had a high rate of requiring posteromedial release, with a significant rate of subsequent revision. Hip dysplasia was noted in 1 patient and required surgical correction. Other associated syndromes included arthrogryposis, Pierre Robin syndrome, and chromosome 10 defect.

Conclusions:

Mobius syndrome is accompanied by an increased rate of several orthopaedic problems; most notably clubfoot, scoliosis, and upper extremity differences that often require surgical treatment. The management of clubfoot in the setting of Mobius syndrome often requires surgical intervention due to failure of casting, and seems to have a higher rate of need for revision. Early involvement of orthopaedists in the care of patients with Mobius syndrome is often necessary. Orthopaedist should counsel families that treatment may be more complex than that of idiopathic disease.

Level of Evidence:

Level IV—case series.
Changes in Cervical Alignment after Multilevel Schwab Grade II Thoracolumbar Osteotomies for Adult Spinal Deformity
Authors: Ghobrial George M. , Lebwohl Nathan H. , Green Barth A. , Gjolaj Joseph P.
Published: May 2017

Study Design.

A retrospective cohort.

Objective.

The aim of this study was to describe changes in cervical alignment (CA) and cervical deformity (CD) after multilevel Schwab Grade II Osteotomies for adult spinal deformity (ASD).

Summary of Background Data.

Reciprocal cervical and global changes after ASD surgery have not been previously described in the setting of multilevel osteotomy.

Methods.

Patients with long-segment (> five levels) fusion and osteotomy for ASD were radiographically evaluated. Pre- and postoperative cervical parameters evaluated included cervical lordosis (CL), C2-C7 sagittal vertical axis (C2-C7 SVA), and the T1 slope (T1S) minus the CL (T1S-CL). CD was defined as C2-C7 SVA >4 cm, CL < 0°, or T1S-CL ≥15°.

Results.

Eighty-five patients (mean age 64 ± 11.1) were identified. Preoperative lumbar lordosis (LL) was 28.7° ± 13.8°, thoracic kyphosis (TK) was 28.2° ± 17.0°, C7 plumbline (C7 SVA) was 7.54 ± 6.7 cm, pelvic tilt (PT) was 30.0° ± 8.96°, lumbopelvic mismatch was 32° ± 17.1°, and the T1 pelvic angle (TPA) was 26.8° ± 12.9°. The C7 SVA and TPA corrected to 3.90 cm (P < 0.0001) and 17.5°, respectively (P < 0.0001). CD increased from 41 (48%) to 47 (55%) patients. The mean CL changed from 16.5° to 11.9° (P < 0.013), C2 SVA from 10.1 to 6.37 cm (P < 0.0001), T1S-CL from 10.2° to 14.3° (P = 0.021), and TK from 28° to 39° (P < 0.0001). A correlation was observed between T1S and CL (ρ = 0.435, P < 0.0001) and C2-C7 SVA (ρ = 0.624, P < 0.0001). T1S was the only independent predictor of both the postoperative C2-C7 SVA and CL.

In this study, the presence of any single preoperative CD criterion was noted to be a risk for persistent global deformity on postoperative radiograph [odds ratio (OR) = 2.5] and the development of PJK (OR = 2.1). The T1-CL < 15° may indicate an even greater risk for persistent global deformity (OR = 3.5).

Conclusion.

Thoracolumbar fusion with multilevel Schwab Grade II Osteotomies was associated with a decreased CL and reciprocal increases in TK and T1S-CL.

Level of Evidence: 3
Association of physical activity and sitting time with incident colorectal cancer in postmenopausal women
Authors: Gorczyca Anna M. , Eaton Charles B. , LaMonte Michael J. , Garcia David O. , Johnston Jeanne D. , He Ka , Bidulescu Aurelian , Goodman Deborah , Groessl Erik , Lane Dorothy , Stefanick Marcia L. , Newcomb Polly , Mouton Charles , Chomistek Andrea K.
Published: May 2017

Findings from epidemiological studies have found that physical activity (PA) is associated with a lower risk of colorectal cancer (CRC). Recent studies have found an increased CRC risk with higher sitting time (ST); however, many studies did not include PA as a potential confounder. The objective of this project was to investigate the independent and combined associations of ST and PA with the risk of incident CRC, specifically colon and rectal cancer. Participants in the Women’s Health Initiative Observational Study (n=74 870), 50–79 years of age self-reported ST and PA at baseline, years 3 and 6. Incident CRC was the primary outcome; colon and rectal cancers were the secondary outcomes, which were centrally adjudicated. Over a 13-year follow-up period, 1145 incident cases of CRC were documented. A positive age-adjusted association was found between higher ST (≥10 vs. <5 h/day) and CRC (P for trend=0.04) and colon cancer (P for trend=0.05); however, these associations were attenuated and no longer significant in multivariable-adjusted models. Compared with inactive women (≤1.7 MET-h/week), the multivariable risk of CRC in the high PA (>20 MET-h/week) group was 0.81 (95% confidence interval: 0.66–1.00; P for trend 0.04). Compared with inactive women with high ST (≥10 h/day), there was a trend toward reduced multivariable CRC risks with higher PA irrespective of ST level (interaction=0.64). We observed an inverse association between leisure time PA and the risk of CRC, particularly for rectal cancer. There was no association between ST and CRC in multivariable models.
Congenital Infantile Fibrosarcoma Associated With a Lipofibromatosis-Like Component: One Train May Be Hiding Another
Authors: Swiadkiewicz Romain , Galmiche Louise , Belhous Kahina , Boccara Olivia , Fraitag Sylvie , Pedeutour Florence , Dadone Bérangère , Buis Jacques , Picard Arnaud , Orbach Daniel , Kadlub Natacha
Published: May 2017

Congenital infantile fibrosarcoma (CIFS) is a soft tissue sarcoma of infants mainly involving lower extremities and usually developing during the first year of life. At another end of the spectrum of pediatric fibroblastic lesions, lipofibromatosis is a rare benign infiltrative soft tissue tumor that affects children. The authors report in this study a particular presentation with a CIFS surrounded by lipofibromatosis-like areas. The presence of a surrounding benign tumor confused and delayed CIFS diagnosis.
Counterbalanced Comparison of the BSID-II and Bayley-III at Eighteen to Twenty-two Months Corrected Age
Authors: Sharp Meghan , DeMauro Sara B.
Published: May 2017

Objective:

To evaluate differences in developmental assessments using the current version of the Bayley Scales of Infant Development (Bayley-III) as compared to the older BSID-II. Previous studies suggest that average scores on the Bayley-III may be significantly higher than scores on the previous version, but the magnitude and potential impact of differences between these 2 assessments are uncertain.

Methods:

We enrolled 77 former preterm infants (born <32 wk gestation and ≤2000 g) at 18 to 22 months corrected age in this randomized crossover study. The Bayley-III was administered in follow-up clinic per standard of care. The BSID-II was administered during a separate study visit. The order of testing was randomly assigned. The assessments were performed 4 to 8 weeks apart by masked personnel. The main outcomes were mean difference between BSID-II Mental Development Index (MDI) and Bayley-III Cognitive Composite score, mean difference between BSID-II Psychomotor Development Index (PDI) and Bayley-III Motor Composite score, and difference in the proportion of infants classified as having “developmental delay.”

Results:

Bayley-III scores were significantly higher across the range of scores and in all domains. Mean Cognitive Composite scores were almost 1 SD higher than MDI scores (14.1 ± 12.9 points, p < .001). Mean Motor Composite scores were 9.0 ± 11.9 points higher than PDI scores (p < .001). When severity of delay was classified using standardized cut-points for moderate and severe developmental delay (1 and 2 SDs below reference norm), 40% of children (n = 31/77) were classified as less severely delayed with the Bayley-III Cognitive Composite score than with the BSID-II MDI, whereas only 1 (<2%) was classified as more severely delayed with the Bayley-III (p < .001).

Conclusion:

These findings have critical implications for both the interpretation of clinical research studies and determination of eligibility for services in high-risk children.
Current techniques and outcomes in hysteroscopic sterilization: current evidence, considerations, and complications with hysteroscopic sterilization micro inserts
Authors: Casey James , Cedo-Cintron Laura , Pearce Jessica , Yunker Amanda
Published: May 2017

Purpose of review

To describe the current data regarding effectiveness, complications, postoperative evaluation, and surgical interventions associated with Essure hysteroscopic sterilization.

Recent findings

Hysteroscopic sterilization is a commonly performed procedure that is offered as a well tolerated, effective, outpatient method of permanent sterilization. Over the past several years, concerns have been raised regarding correct placement and postoperative complications. This has led to statements by both the Food and Drug Administration (FDA) in October, 2016 and American Association of Gynecologic Laparoscopists in February, 2017, as a significant portion of women seek removal of these devices. A current black-box warning issued by the FDA in 2016 recommends discussion of ‘the probabilities of rates or events’ of adverse outcomes associated with Essure placement.

Although hysteroscopic sterilization is usually a safe, effective option for permanent contraception, new evidence regarding complications has emphasized the need for proper education and counseling. Appropriate patient selection and knowledge of potential complications is paramount to ensuring patients, and medical providers are well informed and have realistic expectations regarding potential placement and postoperative issues.
Transareolar Video-Assisted Approach to the Atrial Septal Defect and Tricuspid Valve
Authors: Kitamura Tadashi , Torii Shinzo , Horai Tetsuya , Sughimoto Koichi , Kobayashi Kensuke , Irisawa Yusuke , Hayashi Hidenori , Matsushiro Takuya , Miyata Yurie , Tsuchida Yuta , Miyaji Kagami
Published: May 2017

Minimally invasive atrial septal defect closure and tricuspid annuloplasty in female patients are normally performed through a right submammary anterior minithoracotomy approach. However, when the aortic root is located higher, the direction of aortic cannulation becomes not ideal through the submammary incision. In such cases, transareolar approach is useful. Through this approach, aortic cannulation and tricuspid operation can be performed with endoscopic assistance, and ASD closure can be performed under direct vision.
Pulmonary Transplant Salvage Using Ultrasound-Assisted Thrombolysis of Subacute Occlusive Main Pulmonary Artery Embolus
Authors: Spratt John R. , Shrestha Prashant , Loor Gabriel , Patil Jagadish M. , Hertz Marshall I. , Pettersson Gosta B. , Rosenberg Michael S.
Published: May 2017

A 53-year-old woman who underwent bilateral lung transplantation 14 months before presented with 2 to 3 weeks of severe exertional dyspnea. Workup revealed a complete embolic occlusion of her left main pulmonary artery related to a femoral deep venous thrombosis. The occlusion did not respond to systemic anticoagulation, and a trial of catheter-directed thrombolysis was pursued. Flow to the left lower lobe was restored after 2 days of thromobolytic therapy. The patient is alive and well at more than 1 year of follow-up.
Vibroplasty in Severe Congenital or Acquired Meatal Stenosis by Coupling an Active Middle Ear Implant to the Short Process of the Incus
Authors: Thomas Jan Peter , Voelter Christiane , Neumann Katrin , Dazert Stefan
Published: May 2017

Objective:

To evaluate the safety and effectiveness of coupling an active middle ear implant to the short process of the incus in subjects with meatal pathologies.

Study Design:

Retrospective study.

Setting:

Tertiary referral center.

Patients:

Twelve patients suffering from either congenital aural atresia or acquired meatal fibrosis.

Intervention:

Implantation of an active middle ear implant with coupling of the actuator to the short process of the incus.

Main Outcome Measures:

Evaluation of the air conduction and bone conduction hearing thresholds pre- and postoperatively, aided warble-tone hearing thresholds, unaided and aided speech recognition in quiet and noise. Questionnaires on subjective benefit and quality of life.

Results:

Mean unaided postoperative air conduction and bone conduction thresholds did not vary significantly from preoperative values (p = 0.55 and 0.082, respectively). The mean functional gain amounted to 42.1 ± 8.8 dB, the mean aided sound field threshold of the implanted ear was 28.6 ± 8.6 dB. No significant difference in functional gain but a close to significant difference in postoperative aided thresholds (p = 0.053) were found between subjects with congenital atresia and acquired fibrosis. Subjective benefit assessed by the global score of the Abbreviated Profile of Hearing Aid Benefit questionnaire revealed an improvement of 31 to 42%.

Conclusion:

Coupling of the actuator to the short process of the incus is a safe and clinically promising procedure in cases where the standard application to the long process is not feasible. In pure conductive hearing loss the benefit is comparable to long incus process coupling, whereas in mixed hearing loss slightly worse results were observed.
Minimally invasive cardiac output technologies in the ICU: putting it all together
Authors: Clement Ramon P. , Vos Jaap J. , Scheeren Thomas W.L.
Published: May 2017

Purpose of review

Haemodynamic monitoring is a cornerstone in the diagnosis and evaluation of treatment in critically ill patients in circulatory distress. The interest in using minimally invasive cardiac output monitors is growing. The purpose of this review is to discuss the currently available devices to provide an overview of their validation studies in order to answer the question whether these devices are ready for implementation in clinical practice.

Recent findings

Current evidence shows that minimally invasive cardiac output monitoring devices are not yet interchangeable with (trans)pulmonary thermodilution in measuring cardiac output. However, validation studies are generally single centre, are based on small sample sizes in heterogeneous groups, and differ in the statistical methods used.

Minimally and noninvasive monitoring devices may not be sufficiently accurate to replace (trans)pulmonary thermodilution in estimating cardiac output. The current paradigm shift to explore trending ability rather than investigating agreement of absolute values alone is to be applauded. Future research should focus on the effectiveness of these devices in the context of (functional) haemodynamic monitoring before adoption into clinical practice can be recommended.
Avoidant/restrictive food intake disorder: a new eating disorder diagnosis in the diagnostic and statistical manual 5
Authors: Mammel Kathleen A. , Ornstein Rollyn M.
Published: May 2017

Purpose of review

Avoidant/restrictive food intake disorder (ARFID) is a new eating disorder diagnosis in the 5th edition of the diagnostic and statistical manual (DSM-5), published in 2013. The purpose of this review is to describe the creation of ARFID as a diagnostic category, and to explain the DSM-5 diagnostic criteria; to demonstrate what is known thus far about the prevalence of ARFID and characteristics of patients with this disorder; to provide guidance to the pediatrician and other providers on making a diagnosis of ARFID; and to discuss evolving treatment approaches.

Recent findings

Several studies have been published recently on the prevalence and characteristics of patients with ARFID. Research has just begun to focus on new assessment measures, approaches to treatment based on established therapies for other eating/psychiatric disorders, and short-term outcomes. Robust treatment studies are in development.

The addition of ARFID to the DSM-5 has captured a category of patients with clinically significant restrictive eating, but without weight and shape concerns, who were poorly classified in the past. Future research is needed to further elucidate the presentation, characteristics, diagnostic instruments, and effective management.
Translation and Cultural Adaptation of the Scored Patient-Generated Subjective Global Assessment: An Interdisciplinary Nutritional Instrument Appropriate for Dutch Cancer Patients
Authors: Sealy Martine J. , Haß Ulrike , Ottery Faith D. , van der Schans Cees P. , Roodenburg Jan L.N. , Jager-Wittenaar Harriët
Published: May 2017

Background:

Assessment of malnutrition is important in cancer patients. The Scored Patient-Generated Subjective Global Assessment (PG-SGA), an instrument that enables interdisciplinary assessment of malnutrition and its risk factors, was not available in Dutch.

Objective:

Translation and cultural adaption of the original English PG-SGA to the Dutch setting.

Methods:

The PG-SGA was translated and culturally adapted, following the International Society for Pharmacoeconomics and Outcomes Research principles. Perceived content validity, comprehensibility, and difficulty were explored among a multidisciplinary sample of healthcare professionals and their cancer patients. Content validity, comprehensibility, and difficulty were operationalized by calculating item and scale indices. On scale level, indices of 0.80 to 0.90 were considered acceptable, and indices of 0.90 or greater were considered excellent.

Results:

Consensus was reached on 91 and 8 differences in the forward and back translations, respectively. Scale Content Validity Index was 0.89. Scale Comprehensibility Index and Scale Difficulty Index of the patient-generated component of the PG-SGA were 0.99 and 0.96, respectively. Scale Comprehensibility Index and Scale Difficulty Index of the professional component were 0.81 and 0.55, respectively.

Conclusions:

Translation and cultural adaptation of the PG-SGA according to the International Society for Pharmacoeconomics and Outcomes Research principles resulted in a Dutch version that maintained the purpose, meaning, and format and have acceptable content validity. Now a Dutch version of the PG-SGA is available that is considered comprehensible and easy by patients, and comprehensible and relevant by professionals. However, the professional component was considered difficult by the PG-SGA–naive professionals, which indicates a need for training.

Implications for Practice:

A similar systematic approach for future translations of the PG-SGA is recommended, to safeguard cultural equivalence.
Physical Activity Patterns in Infants With and Without Down Syndrome
Authors: Ketcheson Leah , Pitchford E. Andrew , Kwon Hyun-Jin , Ulrich Dale A.
Published: May 2017

Purpose:

Individuals with Down syndrome (DS) are at greater risk for obesity than their peers who are developing typically. One factor contributing to an early onset of obesity is low levels of physical activity (PA). However, there is little known regarding PA patterns during infancy.

Methods:

The purpose of this study was to examine the daily PA patterns in 22 infants developing typically and 11 infants with Down syndrome (aged 1-12 months) using Actigraph GT3X+ (wrist and ankle).

Results:

No significant differences between groups were identified in PA counts at the ankle. Both groups produced significantly more PA at the wrist than at the ankle and PA counts increased across months in age.

Conclusion:

This study represents an important first step in establishing baseline PA patterns during infancy.
Prevalence of Pulmonary Embolism Among Systemic Lupus Erythematosus Discharges
Authors: Annangi Srinadh , Dammalapati Tirumala Rao , Nutalapati Snigdha , Henriques King Marshaleen N.
Published: May 2017

Introduction

Pulmonary embolism (PE) is a life threatening preventable medical condition involving sudden occlusion of arteries within the lungs. Systemic lupus erythematosus (SLE) is an inflammatory disorder and therefore independently poses a risk of PE. We aimed to determine the association of SLE and PE using National Hospital Discharge Survey data, a national representative sample of hospital discharges throughout the United States.

Methods

Retrospective population-based analysis was done using National Hospital Discharge Survey data for the period 2001 to 2010. International Classification of Diseases, Ninth Revision (ICD-9) coding was used to identify SLE (ICD-9 code 710.0) and PE (ICD-9 codes 415.11, 415.12, 415.13, and 415.19) mentioned in any of the discharge diagnosis. Patients 15 years or older were included in the study. Regression analysis was done including hyperlipidemia, heart failure, lower-limb injury or surgery, hypertension, diabetes cerebrovascular disease, and cancer.

Results

Our regression analysis demonstrated a significant association between SLE and PE, which was independent of sex, race, age, and associated comorbidities (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.99–2.16). Of included comorbidities, primary hypercoagulable disorder has the highest odds of association with PE (OR, 15.37; 95% CI, 15.22–15.51) followed by African American race compared with whites (OR, 1.08, 95% 1.08–1.09), and presence of at least 1 of the comorbidities (OR, 1.06; 95% CI, 1.06–1.06). African American SLE cases have the higher prevalence of PE in all age groups, with the exception of persons 35 to 44 years old.

Conclusions

Significant association exists between SLE and PE regardless of sex, race, age, and associated comorbidities. Females had an overall higher prevalence of SLE-related PE (1.67%) compared with males (1.29%). Stratified according to sex, race, and age groups, the association is highest for females, blacks, and age group 35 to 44 years, respectively.
Ultrasound Diagnosis of Clinically Unsuspected Ureteral Stone Presenting as Acute Scrotum
Authors: Wachsberg Ronald H.
Published: May 2017

Ureteral colic is not generally included in the differential diagnoses of acute scrotal pain, although ureteral pathology is a recognized cause of pain referred to the scrotum. We report 3 patients presenting with acute scrotal pain who had normal scrotal color Doppler ultrasound scans; subsequent ultrasound of the ipsilateral kidney revealed hydronephrosis, which ultimately led to the clinically unsuspected diagnosis of ureteral colic. We conclude that ureteral colic should be included in the differential diagnosis of acute scrotal pain, and we further suggest that a survey ultrasound of the kidney on the side of the pain should be performed in patients presenting with acute scrotal pain and a normal color Doppler ultrasound examination of the scrotum.
Coaching the Debriefer
Authors: Cheng Adam , Grant Vincent , Huffman James , Burgess Gavin , Szyld Demian , Robinson Traci , Eppich Walter
Published: May 2017

Summary Statement

Formal faculty development programs for simulation educators are costly and time-consuming. Peer coaching integrated into the teaching flow can enhance an educator's debriefing skills. We provide a practical guide for the who, what, when, where, why, and how of peer coaching for debriefing in simulation-based education. Peer coaching offers advantages such as psychological safety and team building, and it can benefit both the educator who is receiving feedback and the coach who is providing it. A feedback form for effective peer coaching includes the following: (1) psychological safety, (2) framework, (3) method/strategy, (4) content, (5) learner centeredness, (6) co-facilitation, (7) time management, (8) difficult situations, (9) debriefing adjuncts, and (10) individual style and experience. Institutional backing of peer coaching programs can facilitate implementation and sustainability. Program leaders should communicate the need and benefits, establish program goals, and provide assessment tools, training, structure, and evaluation to optimize chances of success.
Reproductive period, endogenous estrogen exposure and dementia incidence among women in Latin America and China; a 10/66 population-based cohort study
Authors: Prince Martin J , Acosta Daisy , Guerra Mariella , Huang Yueqin , Jimenez-Velazquez Ivonne Z , Rodriguez Juan J Llibre , Salas Aquiles , Sosa Ana Luisa , Chua Kia-Chong , Dewey Michael E , Liu Zhaorui , Mayston Rosie , Valhuerdi Adolfo
Published: May 2017

Background

Exposure to endogenous estrogen may protect against dementia, but evidence remains equivocal. Such effects may be assessed more precisely in settings where exogenous estrogen administration is rare. We aimed to determine whether reproductive period (menarche to menopause), and other indicators of endogenous estrogen exposure are inversely associated with dementia incidence

Methods

Population-based cohort studies, of women aged 65 years and over in urban sites in Cuba, Dominican Republic Puerto Rico and Venezuela, and rural and urban sites in Peru, Mexico and China. Sociodemographic and risk factor questionnaires were administered to all participants, including ages at menarche, birth of first child, and menopause, and parity, with ascertainment of incident 10/66 dementia, and mortality, three to five years later.

Results

9,428 women participated in the baseline phase, with response rates of 72–98% by site. The ‘at risk’ cohort comprised 8,466 dementia-free women. Mean age at baseline varied from 72.0 to 75.4 years, lower in rural than urban sites and in China than in Latin America. Mean parity was 4.1, generally higher in rural than urban sites and ranging from 2.4-7.2 by site. 6,854 women with baseline reproductive period data were followed up for 26,463 person years. There were 692 cases of incident dementia, and 895 dementia free deaths. Pooled meta-analysed fixed effects, per year, for reproductive period (Adjusted Sub-Hazard Ratio [ASHR] 1.001, 95% CI 0.988-1.015) did not support any association with dementia incidence, with no evidence also for any interaction between APOE genotype and reproductive period (ASHR 0.993, 95% CI 0.947-1.041, I2=39.3%). Similarly no association was observed between incident dementia and; ages at menarche, birth of first child, and menopause: nulliparity; or index of cumulative endogenous estrogen exposure. Greater parity was positively associated with incident dementia (ASHR 1.030, 95% CI 1.002-1.059, I2=0.0%).

Conclusions

We found no evidence to support the theory that natural variation in cumulative exposure to endogenous oestrogens across the reproductive period influences the incidence of dementia in late life.
Community-led research discovers links between elusive symptoms and clinical tests
Authors: Gabashvili Irene S.
Published: May 2017

Human breath and body odors have been used for diagnosis of serious and life-threatening conditions since the dawn of medical practice. More recently, it has been recognized that malodors without accompanying physical symptoms could be a sign of psychologically but not physically debilitating disorders such as Trimethylaminuria (TMAU). Self-reported intermittent odors without apparent cause, are, however, still treated with suspicion by medical professionals. Most cases of socially-disabling idiopathic malodor remain undiagnosed and there are no guidelines for diagnostic tests nor treatment options that extend beyond TMAU. Internationally-recruited volunteers with undiagnosed body odor and halitosis enrolled to participate in our study, registered asNCT02692495at clinicaltrials.gov. Each volunteer underwent several blood and urine tests conducted by Biolab Medical Unit, a medical referral laboratory in London, specializing in nutritional and environmental medicine. Intestinal permeability measurements were strikingly different for subjects that named the nose/mouth as the malodor source(s) versus other, often unidentified, body regions. Furthermore, metabolite levels in blood and urine allowed matching of participants by dietary sensitivities and the type of odor reported, emphasizing the potential of harnessing patients’ olfactory observations. In discussing the anecdotal “People are Allergic to Me” condition (PATM), we show how it fits into the picture.
Enhancing Ebola Virus Disease Surveillance And Prevention In Counties Without Confirmed Cases In Rural Liberia: Experiences From Sinoe County During The Flare-Up In Monrovia, April To June, 2016
Authors: Weah Vera Darling , Doedeh John S. , Wiah Samson Q. , Nyema Emmanuel , Lombeh Siafa , Naiene Jeremias
Published: May 2017

Introduction

During the flare-ups of Ebola virus disease (EVD) in Liberia, Sinoe County reactivated the multi-sectorial EVD control strategy in order to be ready to respond to the eventual reintroduction of cases.

This paper describes the impacts of the interventions implemented in Sinoe County during the last flare-up in Monrovia, from April 1 to June 9, 2016, using the resources provided during the original outbreak that ended one year back.

Methods

We conducted a descriptive study to describe the key interventions implemented in Sinoe County, the capacity available, the implications for the reactivation of the multi-sectoral EVD control strategy, and the results of the same. We also conducted a cross-sectional study to analyze the impact of the interventions on the surveillance and on infection prevention and control (IPC).

Results

The attrition of the staff trained during the original outbreak was low, and most of the supplies, equipment, and infrastructure from the original outbreak remained available.

With an additional US$1755, improvements were observed in the IPC indicators of triage, which increased from a mean of 60% during the first assessment to 77% (P=0.002). Additionally, personal/staff training improved from 78% to 89% (P=0.04).

The percentage of EVD death alerts per expected deaths investigated increased from 26% to 63% (P<0.0001).

Discussion

The small attrition of the trained staff and the availability of most of the supplies, equipment, and infrastructure made the reactivation of the multi-sectoral EVD control strategy fast and affordable. The improvement of the EVD surveillance was possibly affected by the community engagement activities, awareness and mentoring of the health workers, and improved availability of clinicians in the facilities during the flare-up. The community engagement may contribute to the report of community-based events, specifically community deaths. The mentoring of the staff during the supportive supervisions also contributed to improve the IPC indicators.
Cooperation & Liaison between Universities & Editors (CLUE): Recommendations on Best Practice
Authors:   CLUE Working Group, Wager Elizabeth , Kleinert Sabine , Garfinkel Michele , Bahr Volker , Bazdaric Ksenija , Farthing Michael , Graf Chris , Hammatt Zoë , Horn Lyn , King Susan , Parrish Debra , Pulverer Bernd , Taylor Paul , van Meer Gerrit
Published: May 2017

Journals and research institutions have common interests regarding the trustworthiness of research publications but their specific roles and responsibilities differ. These draft recommendations aim to address issues surrounding cooperation and liaison between journals and institutions about possible and actual problems with reported research. The proposals will be discussed at various meetings including the World Conference on Research Integrity in May 2017. We will also consider comments and suggestions posted on this preprint.

The main recommendations are that:

National registers of individuals or departments responsible for research integrity at institutions should be created.

Institutions should develop mechanisms for assessing the validity of research reports that are independent from processes to determine whether individual researchers have committed misconduct.

Essential research data and peer review records should be retained for at least 10 years.

While journals should normally raise concerns with authors in the first instance, they also need criteria to determine when to contact the institution before, or at the same time as, alerting the authors in cases of suspected data fabrication or falsification to prevent the destruction of evidence.

Anonymous or pseudonymous allegations made to journals or institutions should be judged on their merit and not dismissed automatically.

Institutions should release relevant sections of reports of research trustworthiness or misconduct investigations to all journals that have published research that was the subject of the investigation.
Could the recent zika epidemic have been predicted?
Authors: Muñoz Ángel G. , Thomson Madeleine C. , Stewart-Ibarra Anna M. , Vecchi Gabriel A. , Chourio Xandre , Nájera Patricia , Moran Zelda , Yang Xiaosong
Published: May 2017

Given knowledge at the time, the recent 2015-2016 zika virus (ZIKV) epidemic probably could not have been predicted. Without the prior knowledge of ZIKV being already present in South America, and given the lack of understanding of key epidemiologic processes and long-term records of ZIKV cases in the continent, the best related prediction was for potential risk of anAedes-borne disease epidemic. Here we use a recently published two-vector capacity model to assess the predictability of the conditions conducive to epidemics of diseases like zika, chikungunya or dengue, transmitted by the independent or concurrent presence ofAedes aegyptiandAedes albopictus. We compare the potential risk of transmission forcing the model with the observed climate and with state-of-the-art operational forecasts from the North American Multi Model Ensemble (NMME), finding that the predictive skill of this new seasonal forecast system is highest for multiple countries in Latin America and the Caribbean during the December-February and March-May seasons, and slightly lower –but still of potential use to decision-makers– for the rest of the year. In particular, we find that above-normalsuitable conditionsfor the occurrence of the zika epidemic at the beginning of 2015 could have been successfully predicted for several zika hotspots, and in particular for Northeast Brazil: the heart of the epidemic. Nonetheless, the initiation and spread of an epidemic depends on the effect of multiple factors beyond climate conditions, and thus this type of approach must be considered as a guide and not as a formal predictive tool of vector-borne epidemics.
Morphometrics reveals complex and heritable apple leaf shapes
Authors: Migicovsky Zoë , Li Mao , Chitwood Daniel H. , Myles Sean
Published: May 2017

Apple (Malus spp.) is a widely grown and valuable fruit crop. Leaf shape and size are important for flowering in apple and may also be early indicators for other agriculturally valuable traits. We examined 9,000 leaves from 869 unique apple accessions using linear measurements and comprehensive morphometric techniques. We identified allometric variation in the length-to-width aspect ratio between accessions and species of apple. The allometric variation was due to variation in the width of the leaf blade, not length. Aspect ratio was highly correlated with the primary axis of morphometric variation (PC1) quantified using elliptical Fourier descriptors (EFDs) and persistent homology (PH). While the primary source of variation was aspect ratio, subsequent PCs corresponded to complex shape variation not captured by linear measurements. After linking the morphometric information with over 122,000 genome-wide SNPs, we found high narrow-sense heritability values even at later PCs, indicating that comprehensive morphometrics can capture complex, heritable phenotypes. Thus, techniques such as EFDs and PH are capturing heritable biological variation that would be missed using linear measurements alone, and which could potentially be used to select for a hidden phenotype only detectable using comprehensive morphometrics.
Thoracolumbar intervertebral disc area morphometry in elderly Chinese men and women: radiographic quantifications at baseline and changes at year-4 follow-up
Authors: Wáng Jùn-Qīng , Káplár Zoltán , Deng Min , Griffith James F. , Leung Jason C. S. , Kwok Anthony WL , Kwok Timothy , Leung Ping Chung , Wáng Yì-Xiáng J.
Published: May 2017

The manuscript submitted does not contain information about medical device(s)/drug(s). No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Study Design:

A population-based radiographic study with longitudinal follow-up.

Objective:

To develop a quantitative index for lumbar disc space narrowing (DSN) evaluation in elderly subjects; to determine how DSN in the elderly is influenced by osteoporosis and gender.

Summary of Background Data:

There is paucity of research on quantitative classification of lumbar DSN based on disc areal morphometry.

Methods:

With the database of Osteoporotic Fractures in Men (Hong Kong) and Osteoporotic Fractures in Women (Hong Kong) Studies and those who attended the year-4 follow-up (n = 1519 for men and n = 1546 for women), data of 491 women and 592 men were randomly selected. The anterior, middle, and posterior heights, anteroposterior diameter and area of intervertebral discs (T4T5 to L4L5) were measured on lateral radiographs. Disc Area Index for Lumbar Spine (DAIL, disc area divided by the mean of the sum of square of the adjacent upper and lower vertebrae mid-height anterior-posterior diameter) was developed and compared with semi-quantitative DSN expert grading.

Results:

DAIL correlated with semi-quantitative grading, with sensitivity and specificity varying from 87.3% to 96.8% for grade-1 DSN (<30% reduction in disc height), and 92.9 % to 100% for grade-3 DSN (>60% reduction in disc height). The thoracolumbar disc area loss among men and women during 4-years’ follow-up period varied between 1.32% and 3.56%, and it was greater for women (mean: 2.44%) than for men (mean: 1.90%,p=0.044). Majority of lumbar DSN progressions during 72 to 76 years old were progression from normal disc space to grade-1DSN. Osteoporosis was associated with greater disc area decrease, both for thoracic and lumbar discs.

Conclusion:

Lumbar DSN can be quantified using DAIL. In elderly Chinese, intervertebral disc narrowing over a 4-year period was greater in women than men, and associated with the presence of osteoporosis.