bluuebunny/crossref_metadata_2025 huggingface dataset:
Juveniles
Authors: Bell Carl C.
Published: September 2017

The incarceration of juveniles occurs in both juvenile systems and adult correctional systems, depending on jurisdiction, age, and criminal charges. Holding adolescents responsible for behavior that sometimes leads to juvenile crimes ensures that offenders will be held accountable, but also provides justice to victims. However, children are still developing, and their brains develop from bottom up and inside out causing their flight, fight, or freeze (limbic) systems to be fully engaged before their judgment and wisdom (frontal lobe) systems are in place to mediate their behavior. Children are not little adults. More simply put - children are essentially all gasoline and no brakes or steering wheel, and they need mature adults to provide braking and steering until they can develop their own internal control systems. Accordingly, the mechanisms of accountability for juveniles should not mimic adult punishments. Suicide risk, developmental disabilities such as fetal alcohol spectrum disorder, and trauma histories are each of particular importance in this age group. Considering the complexity of the mental, emotional, and behavioral disorders of youth in corrections, there are several best-practice approaches to screening, assessment, and treatment. This chapter reviews the history of juvenile incarceration, and best or evidence-based practices in the management and treatment of incarcerated juvenile offenders.
A Battle for Control
Authors: Koenig K. Alexa
Published: September 2017

This chapter offers insights gleaned from 78 interviews with former Guantánamo detainees to illustrate the ways in which the learning theory of torture is helpful for better integrating victims’ experiences into legal definitions. Shaped around former detainees’ reports about their worst detention-related experiences, this chapter illustrates how a lack of control, and a sense of both hopelessness and helplessness, exacerbated their overall distress. From a normative perspective, this chapter suggests that the Convention Against Torture’s current definition of torture fails to adequately reflect the experiences of victims, and that incorporating a learning theory of torture into legal analyses holds tremendous promise for better aligning legal prohibitions with antitorture policies and empirical realities.
Domestic Violence and Torture
Authors: Şalcıoğlu Ebru , Başoğlu Metin
Published: September 2017

Although gender-based violations, including rape and domestic violence, are already recognized as torture in international law, their commonalities with torture have not been adequately investigated. This chapter is intended as a “case study” to demonstrate the conceptual, contextual, and definitional commonalities between torture and domestic violence from a psychological perspective. A direct comparison of 228 domestic violence survivors with 109 tortured women showed that domestic violence was not distinguishable from torture in the nature and severity of trauma, its mental effects, and the psychological processes that lead to posttraumatic stress disorder (PTSD) and depression. Loss of control over life through deprivation of liberty contributed to PTSD and depression independently of acts of violence. These findings suggest that both torture and domestic violence share the same contextual characteristic: helplessness under the control of others. As such, they support recognition of domestic violence as torture by international law.
From Complicity to Impunity
Authors: Rubenstein Leonard S.
Published: September 2017

As the “enhanced interrogation” program of the US Central Intelligence Agency (CIA) at secret detention facilities developed, health professionals came to play a gradually increasing role in accommodating, facilitating, and finally, rationalizing torture. Ultimately, they contributed substantially to a redefinition that, although contrary to the United Nations Convention Against Torture, was adopted by the US Department of Justice and focused on whether interrogation methods were “safe,” by which was meant not resulting in death or permanent physical injury. This role evolved in stages: CIA health professionals accommodated the use of torture by their role in keeping it “safe”; participated directly in the infliction of torture; imposed purported “limitations” on enhanced methods consistent with the “safety” definition; and by 2005, provided the foundation for US Department of Justice legal opinions purporting to justify the use of methods of torture. In doing so, they rationalized their complicity in and culpability for torture.
The 2016 revision of the WHO classification of tumours of the central nervous system
Authors: Kleihues Paul , Rushing Elisabeth , Ohgaki Hiroko
Published: September 2017

The revised fourth edition of the WHO classification of Tumours of the Central Nervous System, published in 2016, comprises several newly recognized tumour entities, and a significant restructuring of the classification, mainly based on genetic profiling. Glioblastomas are now classified into two major types. Isocitrate dehydrogenase (IDH)-wildtype glioblastoma (primary glioblastoma IDH-wildtype) develops rapidly de novo without a recognizable precursor lesion. IDH-mutant glioblastoma (secondary glioblastoma IDH-mutant) develops more slowly through malignant progression from diffuse or anaplastic astrocytoma. Medulloblastomas are now defined by combining histological patterns (classic, desmoplastic/nodular, extensive nodularity, anaplastic) and genetic hallmarks (WNT-activated; SHH-activated, TP53-mutant; SHH-activated, TP53-wildtype; non-WNT/non-SHH). Other newly recognized tumour entities include diffuse midline glioma, H3 K27M-mutant; ependymoma, RELA fusion-positive; and embryonal tumour with multilayered rosettes. The new classification is a significant step forward and will facilitate the development of novel targeted therapies of brain tumours.
Astrocytic tumours: pilocytic astrocytoma, pleomorphic xanthoastrocytoma, and subependymal giant cell astrocytoma
Authors: O’Neill Brian P , Allen Jeffrey , Berger Mitchell S. , Kortmann Rolf-Dieter
Published: September 2017

Pilocytic astrocytoma (PA) (World Health Organization (WHO) grade I). A relatively circumscribed, slow-growing, often cystic astrocytoma occurring in children and young adults, histologically characterized by a biphasic pattern with varying proportions of compacted bipolar cells associated with Rosenthal fibres and loose-textured multipolar cells associated with microcysts and eosinophilic granular bodies. Most PAs are localized, macrocystic, and only marginally infiltrative. However some PAs, such as those arising in the optic pathways, are rarely cystic and may have an extensive infiltrative pattern but within a neuroanatomic pathway. Pleomorphic xanthoastrocytoma (PXA) (WHO grade II). An astrocytic neoplasm with a relatively favourable prognosis, typically encountered in children and young adults, with superficial location in the cerebral hemispheres and involvement of the meninges; characteristic histological features include pleomorphic and lipidized cells expressing glial fibrillary acidic protein and often surrounded by a reticulin network as well as eosinophilic granular bodies. Subependymal giant cell astrocytoma (SEGA) (WHO grade I). A benign, slow-growing tumour typically arising in the wall of the lateral ventricles and composed of large ganglioid astrocytes. It is the most common CNS neoplasm in patients with tuberous sclerosis.
Astrocytic tumours: diffuse astrocytoma, anaplastic astrocytoma, glioblastoma, and gliomatosis cerebri
Authors: Weller Michael , Brada Michael , Wong Tai-Tong , Vogelbaum Michael A.
Published: September 2017

Astrocytic gliomas are primary brain tumours thought to originate from neural stem or progenitor cells. They are assigned grades II, III, or IV by the World Health Organization according to degree of malignancy as defined by histology. The following molecular markers are increasingly used for diagnostic subclassification or clinical decision-making: 1p/19q co-deletion status, O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status, and isocitrate dehydrogenase 1 and 2 mutation status. Extent of resection is a favourable prognostic factor, but surgery is never curative. Radiotherapy prolongs progression-free survival across all astrocytic glioma entities. Alkylating agent chemotherapy is an active treatment in particular for patients with MGMT promoter-methylated tumours. Anti-angiogenic therapies have failed to improve survival, and the current focus of major clinical trials is on novel targeted agents or on immunotherapy.
Ependymal tumours
Authors: Gilbert Mark R. , Rudà Roberta
Published: September 2017

Ependymomas are uncommon central nervous system cancers that can arise in the supratentorial, infratentorial, or spinal cord region. Recently, there have been several seminal findings regarding the molecular profiles of ependymomas that have led to marked changes in the classification of this disease. In addition to the World Health Organization grading system that designates ependymomas based on histological appearance into grade I, II, or III, a new molecular classification with distinct entities within the three anatomical regions provides additional subtyping that has prognostic significance and may ultimately provide therapeutic targets. Ependymomas are typically treated with maximum safe tumour resection. Grade III tumours always require radiation treatment even with extensive resection. Radiation is also often administered to patients with grade II ependymomas. Grade I tumours typically receive radiation if there is extensive residual disease, but complete resection may be curative. Local radiation is optimal unless there is imaging or cytological evidence of dissemination in the cerebrospinal fluid. Chemotherapy is less well established although recent molecular findings may lead to subtype specific treatments.
Other neuroepithelial tumours: astroblastoma, angiocentric glioma, and chordoid glioma
Authors: van den Bent Martin J. , Dhermain Frederic , Stummer Walter
Published: September 2017

This chapter contains a description of three rare entities: astroblastoma, angiocentric glioma, and chordoid glioma. Because these tumours are so rare, the evidence on how to best treat them is anecdotal and essentially consists of case series, but it is the best guidance available and the presentation of larger series with new cases remain unlikely. If one is confronted with such a case, a meticulous review of the clinical, radiological, and pathological characteristics of the case is indicated, to minimize the risk of an erroneous diagnosis. If the case does not fit in with the descriptions of previous cases, alternative diagnoses should be considered.
Familial tumour syndromes: tuberous sclerosis complex
Authors: Weiner Howard , Crino Peter B.
Published: September 2017

Tuberous sclerosis complex (TSC) is a multisystem, genetic disorder that results from mutations in TSC1 or TSC2 genes. Neurological and neuropsychiatric disabilities include epilepsy, intellectual disability, autism, attention deficit disorder, and generalized anxiety. Cortical dysplasias (also known as tubers) are developmental abnormalities of the cerebral cortex that are believed to be responsible for seizures, cognitive disability, and autism. Subependymal giant cell astrocytomas (SEGAs) are intraventricular tumours that can cause hydrocephalus, increased intracranial pressure, and death. TSC results from hyperactivation of the mammalian target of rapamycin (mTOR) pathway in neurons in the brain. This chapter reviews the clinical presentations of TSC as well as diagnostic approaches for epilepsy and SEGAs. It discusses the genetics and cellular pathogenesis of TSC as well as reviewing the link to mTOR signalling. This chapter also presents evidence for different treatment modalities for seizures and SEGAs. It is written for qualified specialist physicians and caregivers.
Neoplastic meningitis: metastases to the leptomeninges and cerebrospinal fluid
Authors: Chamberlain Marc C. , Combs Stephanie E. , Shibui Soichiro
Published: September 2017

Carcinomatous meningitis or meningeal carcinomatosis is a term that defines leptomeningeal metastases arising as a result of metastases from systemic solid cancers. Similarly, lymphomatous and leukaemic meningitis result from cerebrospinal fluid dissemination of lymphoma or leukaemia. All three entities are commonly referred to as neoplastic meningitis or leptomeningeal metastases due to involvement of both the cerebrospinal fluid compartment as well as the leptomeninges comprised of the pia and arachnoid. Treatment options are limited for these neurological complications and outcomes are generally poor. New therapeutic strategies are desperately needed as more cancer patients survive longer and are at increased risk for neoplastic meningitis.
The Office Assessment of Depression and Cognitive Impairment
Authors: Steinberg Martin , Rosenberg Paul B.
Published: September 2017

Changes in mood and/or cognition are common complaints in the elderly population. This chapter uses case studies to illustrate insights to make clinical assessment more efficient. These include assessing for cognitive impairment when depression is present and vice versa, being mindful of assuming that patients reporting cognitive difficulties are “worried well,” avoiding overreaction to very mild symptoms, assessing the four key cortical cognitive domains (amnesia, aphasia, apraxia, agnosia), assessing for subcortical dysfunction, assessing Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), and understanding that depression in the elderly often presents with atypical symptoms. Brief cognitive instruments which can improve assessment include the Mini Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA), Patient Health Questionnaire (PHQ), Clock Drawing Test (CDT), and the Mini Cog. Brief depression instruments include the Geriatric Depression Scale (GDSS), and Cornell Scale for Depression in Dementia (CSDD).
Capacity and Decision-Making
Authors: Kimchi Eitan
Published: September 2017

Cognitive loss brings up crucial questions of autonomy and capacity to make one’s decisions. Capacity refers to an assessment of whether a person can make a particular medical, legal, or financial decision, and is commonly assessed in medical settings. Competency, on the other hand, is a global assessment of decision-making abilities and is a legal, not medical, assessment. Most persons with mild cognitive impairment (MCI) retain capacity to make decisions. As their cognitive deficits progress, this capacity may be lost, impacting their global competency. This chapter reviews the process of assessing capacity in older persons in outpatient settings. It incorporates information from chapters 1-3 regarding the routine office evaluation of cognitive impairment and adds assessments targeting capacity.
Future Directions
Authors: Rosenberg Paul B.
Published: September 2017

Predicting the future of medical and psychological treatments is uncertain work at best, and the discussion below will likely cover some “promising” avenues of research that will go nowhere. But clinicians are eager to know what is coming in the near future in terms of diagnosis and treatment and we will present our best estimate of these innovations below. The reader should note in advance that our approach to cognitive impairment is in rapid flux but to depression already pretty solidly established.
The use of silver-coated orthopaedic implants: are all silvers the same?
Authors: Morris Guy V. , Kozdryk Jakub , Gregory Jonathan , Jeys Lee
Published: September 2017

The use of silver in the treatment and prevention of infection is widespread in the medical community today. Advances in technology have enabled its use to be incorporated into orthopaedic practice with increasing success. This review aims to examine the different types of silver use in orthopaedics along with a review of the literature to assess the clinical efficacy of this emerging treatment.
Current megaprostheses options
Authors: Pala Elisa , Angelini Andrea , Trovarelli Giulia , Berizzi Antonio , Ruggieri Pietro
Published: September 2017

The introduction of a multidisciplinary approach with chemotherapy and radiotherapy, and the advances and improvements in surgical and diagnostic techniques now allow limb salvage surgery in most patients with bone sarcomas instead of amputation. Megaprostheses have been used more frequently in the last 3 decades and are now the most common method of reconstruction after segmental resection of the long bones in extremities. Several types of megaprosthetic implants are currently available for limb salvage surgery. The aim of this study was to report the advantages and disadvantages of the most frequently used current megaprosthesis systems to date.
Epidemiology of fragility fractures and fall prevention in the elderly: a systematic review of the literature
Authors: Tsuda Takayuki
Published: September 2017

Fragility fractures in the elderly is an ongoing concern for orthopaedic surgeons. A 50-year-old woman has a 40% chance of having a vertebral compression fracture in her lifetime. The incidence of vertebral fractures, reported to be more than 10 times higher than that of femoral fractures, is estimated as 1–1.5 million per year in Japan. Vertebral fractures often occur without a fall, whereas the majority of nonvertebral fractures are the consequence of falls; the site of the nonvertebral fracture appears to be dictated by the type of fall. Distal radial fractures commonly occur as a consequence of hand protection during the fall. In older patients, falling load tends to directly affect shoulder and hip joints and lead to proximal humeral and femoral fractures. The incidence of vertebral fractures is increased in women over 50 yr of age, following the same trend as osteoporosis prevalence. Conversely, the mean age for proximal femoral fractures is around 80 yr, and more than 75% of femoral fractures occur in individuals over the age of 75. The prognostic risk of aging is 11-fold greater than that of reduced bone mineral density, and age is another risk factor for femoral fractures. Prophylactic therapy for osteoporosis and femoral fractures was shown to more effective in women in their 70s than in those over the age of 80. Although several approaches, including exercise therapy, vitamin D administration, and environmental adjustment at home, have been reported to be effective in fall prevention, effective fracture prevention approaches in frail elderly individuals have not yet been well established.
Seasonal Variation in Slipped Capital Femoral Epiphysis: New Findings Using a National Children’s Hospital Database
Authors: Loder Randall T. , Schneble Chris A.
Published: September 2017

Background:

Slipped capital femoral epiphysis (SCFE) demonstrates seasonal variation in certain latitudes but not others. Is such variation influenced by temperature differences, sunlight exposure and subsequent vitamin D production, or other climate variables? It was the purpose of this study to further investigate the seasonal variation in month of presentation for SCFE.

Methods:

Data for this study originated from the Pediatric Hospital Information System for all children with a diagnosis of SCFE from January 1, 2004 through December 31, 2014. From this database the patient’s sex, ethnicity, hospital location, and month of presentation was determined. Only those patients treated primarily for SCFE were included. Geographic and climate data [latitude, average annual temperature, precipitation, climate type (Köppen-Geiger and Liss), horticultural plant zone hardiness, and sunlight exposure] for each of the 49 Pediatric Hospital Information System hospitals was determined. Seasonal variation was analyzed using cosinor analysis. A P<0.05 was considered statistically significant.

Results:

There were 10,350 cases of SCFE with an overall peak presentation in mid August. For those living at a latitude of >35-degree N there was single peak, a less prominent double peak for those 31- to 35-degree N, and no variation for those <31-degree N. As the average annual temperature increased there was less seasonal variability. Humid, temperate and cold winter climates demonstrated seasonal variation, whereas other climate types did not. Those living in areas having <2500 hours of sunlight per year demonstrated seasonal variation. Further, areas having a photovoltaic solar production potential <5.0 kWh/m2/d also demonstrated seasonal variation.

Conclusions:

We discovered new seasonal variation findings regarding SCFE. These are a double peak pattern for those between 31- and 35-degree N latitude; less variability as the average annual temperature increases; and sunlight exposure correlates with seasonal variability. Potential explanations are a rachitic state due to seasonal variation in vitamin D production, and seasonal variation in physeal growth and strength. These new findings will require further investigation.

Level of Evidence:

Level III.
Efficacy and Tolerability of IncobotulinumtoxinA for Treating Glabellar Frown Lines in Korean Adults: A Postmarketing Observational Study
Authors: Park Je-Young , Sung Nak-Kwan , Pitt Jonathan M.
Published: September 2017

BACKGROUND

IncobotulinumtoxinA is safe and effective in Caucasian adults. Its effects have been less documented in Asian adults.

OBJECTIVE

To describe the efficacy and tolerability of incobotulinumtoxinA for treating glabellar frown lines (GFLs) in South Korean adults.

METHODS

South Korean adults aged 18 to 65 years with moderate-to-severe GFLs received a single dose of 10 to 28 U incobotulinumtoxinA during routine clinical practice. After 30 ± 14 days, investigators assessed the efficacy using the Global Aesthetic Improvement Scale and rated tolerability using a 4-point scale.

RESULTS

Six hundred seventy-three subjects were enrolled, of which 528 completed the study according to protocol. Glabellar frown lines improved in 98.7% (521/528) of subjects, with 30.8% of cases rated as “very much improved” and 47.4% as “much improved.” The extent of improvement was unaffected by sex, age, and weight but was greater when the time between GFL identification and treatment was <6 months (p < .001) and when concomitant aesthetic nondrug treatments were used (p < .001). For 94% of subjects, tolerability was good or very good. All reported adverse events were transient and mild or moderate in severity.

CONCLUSION

IncobotulinumtoxinA was well tolerated and effective for treating moderate-to-severe GFLs in Korean adults irrespective of age, sex, or weight.
Effect of the Salary Model on Sustainability of a Professional Practice Environment
Authors: Hickey Rosa G. , Buchko Barbara L. , Coe Paula F. , Woods Anne B.
Published: September 2017

OBJECTIVE

This replication study examined differences in RN perception of the professional practice environment (PPE) between salary- and hourly-wage compensation models over time.

BACKGROUND

A previous study demonstrated that nurses in a salary-wage model had a significantly higher perception of the PPE compared with their peers receiving hourly wages.

METHODS

A descriptive, comparative design was used to examine the Revised Professional Practice Environment (RPPE) scale of nurses in the same units surveyed in the previous study 2 years later.

RESULTS

Mean scores on the RPPE continued to be significantly lower for hourly-wage RNs compared with the RNs in the salary-wage model.

CONCLUSIONS

Nurses in an hourly-wage unit have significantly lower perceptions of the clinical practice environment than their peers in a salary-wage unit, indicating that professional practice perceptions in a salary-wage unit were sustained for a 2-year period and may provide a more effective PPE.
Four States, Four Projects, One Mission: Collectively Enhancing Mental and Behavioral Health Capacity Throughout the Gulf Coast
Authors: Langhinrichsen-Rohling Jennifer , Osofsky Howard , Osofsky Joy , Rohrer Glenn , Rehner Timothy
Published: September 2017

Context:

The 2010 Deepwater Horizon oil spill triggered numerous concerns regarding the health and well-being of citizens within the already vulnerable Gulf Coast region. Four Mental and Behavioral Health Capacity Projects (MBHCPs) united to form the Quad-State MBHCP component of the Gulf Region Health Outreach Program (GRHOP). Their shared mission was to increase mental and behavioral health (MBH) capacity within coastal counties of Louisiana, Mississippi, Alabama, and the Florida Panhandle.

Objective:

To describe strategies used to collectively enhance the impact of the 4 state-specific MBHCPs and to share lessons learned from a multistate collaborative flexibly designed to meet a shared mission.

Materials and Procedures:

Archival materials were assessed. They included attendance sheets/notes from regularly scheduled group meetings, GRHOP quarterly and annual reports, and state-specific MBHCP logic models. Nationally available data on MBH services provided in project-relevant primary care sites were also examined.

Results:

Three strategies were found to be effective facilitators of collective success: (i) reciprocal participation in the backbone organization (GRHOP); (ii) creation and comparison of state-specific MBHCP logic models and activities; and (iii) cross-fertilization among the MBHCP state-specific logic models, a unified Quad-State, and the GRHOP-wide logic model to generate additional synergistic endeavors and measureable outcomes. Examples of region-wide MBHCP success, such as uptake in integrated health services in health care clinics across the jurisdiction of investment, are presented.

Conclusions:

Isolated approaches to complex issues are, at times, ineffective. The Collective Impact (CI) model, with an emphasis on coordination among existing organizations, stakeholders, and the public, can serve as a guidepost to facilitate sustainable change even when used in a modified form. Strategies discussed herein for maximizing the 5 prescribed CI conditions provide an important roadmap for how to interface among multidisciplinary projects seeking to address the same, large-scale public health problem.
Weight-Based Dosing for Once-Daily Enoxaparin Cannot Provide Adequate Anticoagulation for Venous Thromboembolism Prophylaxis
Authors: Pannucci Christopher J. , Hunt Madison M. , Fleming Kory I. , Prazak Ann Marie
Published: September 2017

Background:

Surgeons commonly provide enoxaparin prophylaxis to high-risk patients to decrease venous thromboembolism risk. The authors’ prior work demonstrated that most patients receive inadequate venous thromboembolism prophylaxis, based on anti–factor Xa level, when enoxaparin 40 mg/day is provided and that peak anti–factor Xa level correlates with weight. This study models a weight-based strategy for daily enoxaparin prophylaxis and its impact on anti–factor Xa levels.

Methods:

The authors enrolled plastic surgery patients who received enoxaparin 40 mg/day and had anti–factor Xa levels drawn. The enoxaparin dose of 40 mg was converted to a milligram-per-kilogram dose for each patient. Stratified analysis examined the milligram-per-kilogram dose that produced low, in-range, and high anti–factor Xa levels to identify the appropriate milligram-per-kilogram dose to optimize venous thromboembolism prevention and bleeding events.

Results:

Among 94 patients, weight-based dosing ranged from 0.28 to 0.94 mg/kg once daily. For peak and trough anti–factor Xa levels, there was nearly complete overlap for milligram-per-kilogram dosing that produced low versus in-range anti–factor Xa levels. For peak anti–factor Xa, there was nearly complete overlap for milligram-per-kilogram dosing that produced in-range versus high anti–factor Xa levels. Mean milligram-per-kilogram dose was not significantly different between patients who did or did not have postoperative venous thromboembolism (0.41 mg/kg versus 0.52 mg/kg; p = 0.085) or clinically relevant bleeding (0.48 mg/kg versus 0.51 mg/kg; p = 0.73).

Conclusions:

Alterations in enoxaparin dose magnitude based on patient weight cannot allow a high proportion of patients to achieve appropriate anti–factor Xa levels when once-daily enoxaparin prophylaxis is provided. Future research should examine the impact of increased enoxaparin dose frequency on anti–factor Xa levels, venous thromboembolism events, and bleeding.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Transparency in Functional Rhinoplasty: Benefits of Routine Prospective Outcome Measurements in a Tertiary Referral Center
Authors: Datema Frank R. , van Zijl Floris V. W. J. , van der Poel Egge F. , Baatenburg de Jong Robert J. , Lohuis Peter J. F. M.
Published: September 2017

Background:

Patients, governments, health care providers, and insurance companies are increasingly interested in medical performance. Transparent outcome reporting requires a thorough methodologic design, dedicated prospective data collection process, and preferably no interference with the efficacy of daily practice. The primary aim of this article is to describe how these bottlenecks are tackled with an automated prospective rhinoplasty outcome routine. The secondary aim is to motivate others by describing practical benefits encountered during implementation.

Methods:

Since April 2014, 269 consecutive patients referred for functional-aesthetic (revision) rhinoplasty were included. The Nasal Obstruction Symptom Evaluation scale, the Utrecht Questionnaire, and visual analogue scales were offered to all patients before primary consultation and follow-up to translate the subjective burden of nasal problems and change herein following surgery, into data. These data were exported for real-time automated outcome analysis supported by graphic output through a customized Web-based dashboard.

Results:

One hundred seventy-one patients proved eligible for rhinoplasty, of which 121 had sufficient follow-up. The dashboard provides an overview of demographic characteristics of different populations, reasons why rhinoplasties were not performed, and real-time short- and long-term change in functional and aesthetic outcome in both primary and revision cases. Practical benefits of the instruments used are presented and discussed.

Conclusions:

Routine prospective outcome monitoring provides an evidence-based response to the increasing demand for transparency in health care. The dashboard proved valuable during patient counseling, patient selection, and management of expectations and has the potential to compare rhinoplasty results between surgeons and institutions, provided that the populations share similar characteristics.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Three-Dimensional Printing: A Novel Approach to the Creation of Obturator Prostheses Following Palatal Resection for Malignant Palate Tumors
Authors: Bartellas Michael , Tibbo Jamie , Angel Doug , Rideout Arthur , Gillis Joshua
Published: September 2017

Background:

A subgroup of patients who have an oronasal fistula live in areas that have limited access to oral prosthetics. For these individuals, a temporary prosthesis, such as a palatal obturator, may be necessary in order to speak, eat, and breath properly. The creation of an obturator, which requires a highly trained prosthodontist, can take time and can be expensive. Through the current proof-of-concept study, there is an attempt to create a patient-specific palatal obturator through use of free and publicly available software, and a low-cost desktop 3-dimensional printer. The ascribed study may provide a means to increase global access to oral prosthetics if suitable biomaterials are developed.

Methods:

Computerized tomography data were acquired from a patient who had an oronasal fistula. Through use of free software, these data were converted into a 3-dimensional image. The image was manipulated in order to isolate the patient's maxilla and was subsequently printed. The palatal obturator models were designed, and reformed, in correspondence with the maxilla model design. A final suitable obturator was determined and printed with 2 differing materials in order to better simulate a patient obturator.

Results:

Creating a suitable palatal obturator for the specified patient model was possible with a low-cost printer and free software.

Conclusions:

With further development in biomaterials, it may be possible to design and create an oral prosthesis through use of low-cost 3-dimensional printing technology and freeware. This can empower individuals to attain good healthcare, even if they live in rural, developing, or underserviced areas.
Reconstruction of an Alar Defect With a Fusiform Nasolabial Turnover Flap With a Proximal, Superiorly Tapered Apex
Authors: El Habr Constantin , Vinelli Gian , Tinklepaugh Adam , Ciocon David
Published: September 2017

The nasolabial turnover flap was first described by Spear et al in 1987 for the coverage of full thickness defects of the lateral ala. It offered a single-stage repair that recreated the internal nasal lining, the external nasal valve, and the rounded contour of the ala without requiring a cartilage graft. A frequently encountered problem with the execution of Spear's original design is elevation of the ipsilateral commissure of the adjacent lip due to its broad proximal pedicle. Here, the authors describe a fusiform-type design with a proximal, superiorly tapered apex that relies on anteriorly coursing perforators from the underlying angular artery. The authors also review the inherent advantages and disadvantages of the flap itself and the unique situation where there is a skin cancer adjacent to the donor site.
A Study on the Effects of the Use of Propofol in Experimental Model Inferior Epigastric Island Flap on Ischemia-Reperfusion Injury
Authors: Eroglu Tuncay , Bozkurt Mehmet , Kapi Emin , Selcuk Caferi Tayyar , Kuvat Samet Vasfi , Tufek Adnan , Isik Fatma Birgul , Bozarslan Beri Hocaoglu , Firat Ugur , Satici Omer
Published: September 2017

Problems concerning vascular blood flow are the most frequently encountered ones after flap applications. The flap tissue starts to develop ischemia in patients with a vascular blood flow insufficiency. And reperfusion starts in those patients in whom the ischemia is temporary, triggering an ischemia-reperfusion injury depending on the duration of the ischemia. The aim of this study was to evaluate the effect of propofol, which is an anesthetic agent known to have an antioxidant effect and a free radical scavenging feature on the ischemia-reperfusion injury created on an experimental epigastric island flap.

Thirty Sprague–Dawley rats were used in the study. The rats were divided into 3 groups of 10 rats each. Inferior epigastric artery-based abdominal flaps were prepared in all the groups. In group 1 (sham), the flap was elevated but no ischemia was applied. In groups 2 (control) and 3 (propofol), the flap was exposed to ischemia for 2 hours after it was elevated. All the rats were sacrificed and biochemical and histopathological assessments were made on the tissue samples taken on the 14th day. As a result of a comparison between the groups, the flap viability rates and the superoxide dismutase, total antioxidant capacity, and catalase values were found to be significantly higher (P < 0.001) in the propofol group while the malondialdehyde and total oxidative stress values were lower (P < 0.001). Based on the data obtained from the present study, the use of propofol was observed to have a protective effect against ischemia-reperfusion injuries in flap surgeries.
Efficiency and Duration of Orthodontic/Orthognathic Surgery Treatment
Authors: Dehghani Mahboobe , Fazeli Faryal , Sattarzadeh Ali Payam
Published: September 2017

Introduction:

To investigate the combined orthodontic-orthognathic treatment times at an academic hospital in the UK and to consider the level of occlusal change in delivering this treatment by the way of comparing peer assessment rating (PAR) scores pre- and post-treatment.

Methods:

It was a retrospective longitudinal study of orthognathic patients between 2010 and 2013 who had completed orthognathic treatment. Analysis of records of 50 patients was carried out. Age, gender malocclusion, and skeletal pattern, extraction/nonextraction of teeth, duration of active orthodontic treatment, number of appointments, transfer of patients between orthodontists mid-treatment, and PAR scores pre and post-treatment were recorded for each patient.

Results:

The skeletal pattern was III in 70% of and II in 28% of patients. Mean duration of active orthodontic treatment was 27.9 months. Age, gender, malocclusion, and skeletal pattern did not seem to affect treatment times. Extraction of teeth and transfer of operators increased treatment times. The mean PAR reduction was 89% with the PAR efficiency factor (reduction in PAR scores divided by duration of treatment in months) of 1.61. Younger patients, those with class III malocclusions and patients starting with higher PAR scores, achieved greater PAR reductions. Gender, number of appointments, extractions, transfer of operators, and total duration of treatment were not shown to affect the PAR % reduction.

Conclusions:

Combined orthodontic-orthognathic treatment has been effective in treating patients with severe skeletal discrepancies. Transfer of operators and extractions protracted treatment times. Younger patients and those with class III malocclusions achieved higher PAR % reduction.
Establishing a Rodent Model of Ventricular Fibrillation Cardiac Arrest With Graded Histologic and Neurologic Damage With Different Cardiac Arrest Durations
Authors: Ettl Florian , Magnet Ingrid A.M. , Weihs Wolfgang , Warenits Alexandra-Maria , Grassmann Daniel , Wagner Michael , Teubenbacher Ursula , Högler Sandra , Sterz Fritz , Janata Andreas
Published: September 2017

Purpose:

The aim of the study was to establish a ventricular fibrillation (VF) cardiac arrest (CA) resuscitation model with consistent neurologic and neuropathologic damage as potential therapeutic target.

Methods:

Prospectively randomized groups of experiments in two phases. In phase 1 four groups of male Sprague–Dawley rats (n = 5) were resuscitated after 6 min VFCA with 2 and 6 min basic life support durations (BLS) with and without adrenaline. In phase 2 the most promising group regarding return of spontaneous circulation (ROSC) and survival was compared with a group of 8 min CA. Resuscitability, neurologic deficit scores (NDS), and overall performance category (OPC) were assessed daily; histolopathology of the hippocampal CA1 region [hematoxylin and eosin- (viable neurons), Fluoro-Jade- (dying neurons), and Iba-1 immunostaining (microglial activation–semiquantitative)] on day 14.

Results:

Two minutes BLS and with adrenaline as most promising group of phase 1 compared with an 8 min group in phase 2 exhibited ROSC in 8 (80%) vs. 9 (82%) animals and survivors till day 14 in 7 (88%) (all OPC 1, NDS 0 ± 0) vs. 6 (67%) (5 OPC 1, 1 OPC 2, NDS 0.83 ± 2.4) animals. OPC and NDS were only significantly different at day 1 (OPC: P = 0.035; NDS: P = 0.003). Histopathologic results between groups were not significantly different; however, a smaller variance of extent of lesions was found in the 8 min group. Both CA durations caused graded neurologic, overall, such as histopathologic damage.

Conclusions:

This dynamic global ischemia model offers the possibility to evaluate further cognitive and novel neuroprotective therapy testing after CA.
Host's Endogenous Caveolin-1 Expression is Downregulated in the Lung During Sepsis to Promote Cytoprotection
Authors: Kataki Agapi , Karagiannidis Ioannis , Memos Nikolaos , Koniaris Efthymios , Antonakis Pantelis , Papalois Apostolos , Zografos George C. , Konstadoulakis Manoussos M.
Published: September 2017

The present study focuses on the profile of “endogeneous” caveolin-1 protein in septic lung (CLP model).

Caveolin-1, CD25, pP38, pAkt, and 14-3-3b protein expression profiles were studied using flow cytometry and immunohistochemistry 6, 12, 24, 36, and 48 h after sepsis induction. Cell viability was determined by 7-AAD staining and fibrosis by Masson trichrome stain. The effect of protein C zymogen concentrate (PC) on caveolin-1 expression was also investigated given that PC, once dissociated from caveolin-1, elicits a PAR-1-mediated protective signaling by forming a complex with endothelial protein C receptor (EPCR).

CLP treatment increased lung inflammation and cell apoptosis. Fibrosis was apparent in vessels and alveoli. Caveolin-1+ cells presented reduced protein expression, especially 12 h post-CLP (P = 0.002). Immunohistochemistry revealed caveolin-1 positive expression mainly in regions with strong inflammatory reaction. Early induction of pP38+ cell population (P = 0.014) and gradual increase of CD25+ cells were also observed. Alternations in 14-3-3b expression related to apoptosis were apparent and accompanied by increased AKT phosphorylation activity late during sepsis progression.

After PC administration, cell apoptosis was reduced (P = 0.004) and both the percentile and expression intensity of caveolin-1 positive cells were compromised (P = 0.009 and P = 0.027, respectively). 14-3-3b, CD25, and pP38 protein expression were decreased (P = 0.014, P = 0.004, and P = 0.007, respectively), whereas pAkt expression was induced (P = 0.032).

The observed decline of endogenous caveolin-1 protein expression during sepsis implies its involvement in host's cytoprotective reaction either directly, by controlling caveolae population to decrease bacterial burden, or indirectly via regulating 14-3-3b-dependent apoptosis and EPCR-PAR-1-dependent protective signaling.
Massive expression of germ cell specific genes is a hallmark of cancer and a potential target for novel treatment development
Authors: Bruggeman Jan Willem , Koster Jan , Repping Sjoerd , Hamer Geert
Published: September 2017

Cancer cells have been found to frequently express genes that are normally restricted to the testis, often referred to as cancer/testis (CT) antigens or genes1, 2. Because germ cell specific antigens are not recognized as “self” by the innate immune system3, CT-genes have previously been suggested as ideal candidate targets for cancer therapy4. The use of CT- genes in cancer therapy has thus far been unsuccessful, most likely because their identification has relied on gene expression in whole testis, including the testicular somatic cells, precluding the detection of true germ cell specific genes. By comparing the transcriptomes of micro-dissected germ cell subtypes, representing the main developmental stages of human spermatogenesis5, with the publicly accessible transcriptomes of 2.617 samples from 49 different healthy somatic tissues6and 9.232 samples from 33 tumor types7, we here discover hundreds of true germ cell specific cancer expressed genes. Strikingly, we found these germ cell cancer genes (GC-genes) to be widely expressed in all analyzed tumors. Many GC-genes appeared to be involved in processes that are likely to actively promote tumor viability, proliferation and metastasis. Targeting these true GC-genes thus has the potential to inhibit tumor growth with infertility being the only possible side effect. Moreover, we identified a subset of GC-genes that are not expressed in spermatogonial stem cells. Targeting of this GC-gene subset is predicted to only lead to temporary infertility, as untargeted spermatogonial stem cells can recover spermatogenesis after treatment. Our GC- gene dataset enables improved understanding of tumor biology and provides multiple novel targets for cancer treatment.
Interconnections accelerate collapse in a socio-ecological metapopulation
Authors: Dockstader Zachary , Bauch Chris T. , Anand Madhur
Published: September 2017

Resource over-exploitation can have profound effects on both ecosystems and the human populations residing in them. Models of population growth based on a depletable resources have been studied previously, but relatively few consider metapopulation effects. Here we analyze a socio-ecological metapopulation model where resources grow logistically on each patch. Each population harvests resources on its own patch to support population growth, but can also harvest resources from other patches when their own patch resources become scarce. We find that allowing populations to harvest from other patches significantly accelerates collapse and also increases the parameter regime for which collapse occurs, compared to a model where populations are not able to harvest resources from other patches. As the number of patches in the metapopulation increases, collapse is more sudden, more severe, and occurs sooner. These effects also persist under scenarios of asymmetry and inequality between patches. We conclude that metapopulation effects in socio-ecological systems can be both helpful and harmful and therefore require urgent study.
Coupling of autonomic and central events during sleep benefits declarative memory consolidation
Authors: Naji Mohsen , Krishnan Giri P. , McDevitt Elizabeth A , Bazhenov Maxim , Mednick Sara C.
Published: September 2017

While anatomical pathways between forebrain cognitive and brainstem autonomic nervous centers are well defined, autonomic–central interactions during sleep and their contribution to waking performance are not understood. Here, we analyzed simultaneous central activity via electroencephalography (EEG) and autonomic heart beat-to-beat intervals (RR intervals) from electrocardiography (ECG) during wake and daytime sleep. We identified bursts of ECG activity that lasted 4-5 seconds and predominated in non-rapid-eye-movement sleep (NREM). Using event-based analysis of NREM sleep, we found an increase in delta (0.5-4Hz) and sigma (12-15Hz) power and an elevated density of slow oscillations (0.5-1Hz) about 5 secs prior to peak of the heart rate burst, as well as a surge in vagal activity, assessed by high-frequency (HF) component of RR intervals. Using regression framework, we show that these Autonomic/Central Events (ACE) positively predicted post-nap improvement in a declarative memory task after controlling for the effects of spindles and slow oscillations from sleep periods without ACE. No such relation was found between memory performance and a control nap. Additionally, NREM ACE negatively correlated with REM sleep and learning in a non-declarative memory task. These results provide the first evidence that coordinated autonomic and central events play a significant role in declarative memory consolidation.
Accessibility of the Shine–Dalgarno sequence dictates N-terminal codon bias inE. coli
Authors: Bhattacharyya Sanchari , Jacobs William M. , Adkar Bharat V. , Yan Jin , Zhang Wenli , Shakhnovich Eugene I.
Published: September 2017

Despite considerable efforts, no physical mechanism has been shown to explain N-terminal codon bias in prokaryotic genomes. Using a systematic study of synonymous substitutions in two endogenousE. coligenes, we show that interactions between the coding region and the upstream Shine–Dalgarno (SD) sequence modulate the efficiency of translation initiation, affecting both intracellular mRNA and protein levels due to the inherent coupling of transcription and translation inE. coli. We further demonstrate that far-downstream mutations can also modulate mRNA levels by occluding the SD sequence through the formation of non-equilibrium secondary structures. By contrast, a non-endogenous RNA polymerase that decouples transcription and translation largely alleviates the effects of synonymous substitutions on mRNA levels. Finally, a complementary statistical analysis of theE. coligenome specifically implicates avoidance of intra-molecular base-pairing with the SD sequence. Our results provide general physical insights into the coding-level features that optimize protein expression in prokaryotes.