bluuebunny/crossref_metadata_2025 huggingface dataset:
Difference Distributions Applicable to Certain Health Physics Measurements
Authors: Justus Alan L.
Published: December 2019

This paper discusses calculational methods for the determination of the difference distributions associated with certain health physics measurements. These measurements include the check-source response counts relative to an initial reference count, the Albatross (i.e., HPI model 2080B) neutron tube counts relative to the gamma tube counts, and those that involve the use of the automatic background subtraction feature of portable health physics instrumentation. Examples are provided that illustrate the methods for a few specific measurements. For the comparison of a daily source count to its previously determined reference value, minimum counts for various scenarios were presented in order to reliably meet required tolerance limits of ±10% and ±20%. In either case, it was found beneficial that the initial reference readings be established using a counting interval of longer length than the daily interval. For the comparison of Albatross neutron counts to the gamma counts, it was seen that the relative error in the difference distribution was still related to that of the parent distribution. It was seen, therefore, that an effective way of reducing the gamma influence on the Albatross was to increase the counting interval used, hence yielding a significantly larger mean count per interval. For the automatic background subtraction feature, it was noted that net count values near 0 counts would almost always have the negative values of the difference distribution truncated to 0 counts by commercially available off-the-shelf instrumentation, whereas significant net count values would be displayed correctly but with a larger associated variance than the gross count itself. This paper therefore also provides a technical basis for the necessary source strength of a check source in order to meet daily limits, the gamma field limitations of the HPI 2080B Albatross, as well as the consequences of automatic background subtraction.
Robotic Dispersal Technique for 35 GBq of 140La in an L-polygon Pattern
Authors: Beckman Blake , Green Anna Rae , Sinclair Laurel , Fairbrother Blaine , Munsie Tim , White Dan
Published: December 2019

In 2018, Defence Research and Development Canada, in partnership with Natural Resources Canada, led a field trial of survey and mapping of a large dispersion of radioactivity using Unmanned Aerial Vehicles (UAVs). The intent was to disperse 140La material in a 3,200 m2 L-polygon with an approximate activity level of 10 MBq m−2 and to measure the radioactive material using sensors carried by UAVs. Due to the potential radiological hazard to personnel, the activity was approved only if Unmanned Ground Vehicles (UGVs) were able to completely handle and disperse the material remotely. One UGV was equipped with a traditional agricultural sprayer to disperse the material, and one UGV was equipped with a force feedback manipulator arm. Due to the freezing temperatures during dispersal, the 35 GBq of 140La was dispersed non-uniformly as one sprayer boom failed to perform as tested. However, rough analysis of the electronic dosimetry on the UGV concluded that 99% of the material was dispersed on the ground. The dosimeter placed closest to the robot manipulator arm, used for dispersal of material, indicated a contact dose of 33.5 mSv. The electronic dosimeter placed where the driver would have sat on the sprayer vehicle if it were not unmanned indicated a dose of 22.3 mSv. Thus, the use of UGVs for material dispersion substantially reduced the external exposure to personnel. The use of UGVs eliminated the potential of internal exposure as well. The Radiation Safety Officer received the highest dose at approximately 3 μSv, with the majority of the exposure coming from the handling of the Type A container.
PROLONGED OZURDEX-MACULAR CONTACT FOLLOWING VITRECTOMY FOR MACULAR HOLE
Authors: Kelkar Aditya S. , Kelkar Jai A. , Agarwal Aanchal A. , Mehta Hetal M. , Kelkar Shreekant B.
Published: December 2019

Purpose:

To evaluate the outcome of prolonged ozurdex-macular contact following vitrectomy for macular hole.

Methods and Patients:

A 63-year-old woman with subtle vitreomacular traction and macula edema in the left eye underwent femto laser-assisted cataract surgery with lens implant and ozurdex injection. Postoperatively, patient developed macular hole for which she underwent vitrectomy.

Results:

The steroid implant that remained in contact with the fovea for 16 weeks disappeared on its own without causing any retinal toxicity, and the best-corrected visual acuity improved to 6/9.

Conclusion:

Vitreomacular traction with edema may worsen after cataract surgery and ozurdex injection. Ophthalmologists should keep in mind this rare possible complication and make patients aware of the same.
Correlation Between Angle Parameters and Central Corneal Thickness in Fuchs Endothelial Corneal Dystrophy
Authors: Watanabe Shinya , Oie Yoshinori , Miki Atsuya , Soma Takeshi , Koh Shizuka , Kawasaki Satoshi , Tsujikawa Motokazu , Jhanji Vishal , Nishida Kohji
Published: December 2019

Purpose:

To evaluate the correlation between anterior chamber parameters and central corneal thickness (CCT) or peripheral corneal thickness (PCT) in patients with Fuchs endothelial corneal dystrophy (FECD) using anterior segment optical coherence tomography.

Methods:

This case–control study included 20 eyes from 20 patients with FECD and 31 eyes from 31 patients with healthy corneas. CCT was measured as an indicator of FECD severity. Anterior chamber angle parameters, including trabecular–iris angle (TIA500) and angle opening distance (AOD500), were measured as an indicator of peripheral anterior chamber morphology. We also analyzed PCT and lens vault (LV). The relationships between CCT or PCT and anterior chamber parameters were also analyzed in patients with FECD.

Results:

Patients with FECD had a larger CCT (593.9 ± 54.6 μm vs. 533.0 ± 25.4 μm, P < 0.001), smaller TIA500 (21.8 ± 9.9 vs. 32.5 ± 11.2 degrees, P = 0.002), smaller AOD500 (0.21 ± 0.11 vs. 0.34 ± 0.18 mm, P = 0.002), and greater LV (0.60 ± 0.27 vs. 0.40 ± 0.29 mm, P = 0.02) than control subjects. In patients with FECD, CCT was negatively correlated with the angle parameters TIA500 (R2 = 0.29, P = 0.009) and AOD500 (R2 = 0.19, P = 0.03). There were no significant correlations between PCT and TIA500 (R2 = 0.008, P = 0.29) or AOD500 (R2 = 0.007, P = 0.29). There were also no significant correlations between CCT and LV (R2 = 0.02, P = 0.55).

Conclusions:

Larger CCT was significantly associated with narrower anterior chamber angle width, but not with LV. We showed that the severity of FECD is associated with angle chamber morphology.
Bristle Worm-Induced Keratouveitis: A Case Report
Authors: Kirk Jonathan , Gunn David , Wong Nathan , Minchin Emily , Darcy Kieren
Published: December 2019

Purpose:

To report keratouveitis arising from corneal penetration by a bristle worm seta (bristle).

Methods:

We report on a 64-year-old woman presenting with uniocular pain, redness, reduced vision, discharge, and pustular rash of the hands after cleaning out her marine aquarium containing bristle worms and rubbing her eye.

Results:

Slit-lamp biomicroscopy showed pseudomembranous conjunctivitis, corneal punctate erosions, stromal infiltrate, and edema, but no visible foreign body. The anterior chamber developed 3+ cells with hypopyon within 24 hours. Laboratory testing of corneal and hand samples was negative. In vivo confocal microscopy revealed a hair-like seta in the anterior corneal stroma, 25 to 105 μm wide, with surrounding inflammatory cells. Anterior chamber washout was performed. Topical prednisolone 0.5% was commenced, and corneal edema gradually resolved over 3 months.

Conclusions:

Bristle worms thrive as detritivores in marine aquarium sediment. Aquarium owners risk touching their setae during tank cleaning. Ophthalmia nodosa describes ocular reaction to caterpillar, vegetable, and spider hairs: features include posterior migration of hairs, granulomatous inflammation, and uncertain prognosis. Eye specialists should be alerted to the possibility of bristle worm-induced ophthalmia nodosa. Confocal microscopy may be useful in identifying microscopic setae.
Trigeminal neuralgia associated with a solitary pontine lesion: clinical and neuroimaging definition of a new syndrome
Authors: Tohyama Sarasa , Hung Peter Shih-Ping , Cheng Joshua C. , Zhang Jia Y. , Halawani Aisha , Mikulis David J. , Oh Jiwon , Hodaie Mojgan
Published: December 2019

Conventional magnetic resonance imaging of patients with trigeminal neuralgia (TN) does not typically reveal associated brain lesions. Here, we identify a unique group of TN patients who present with a single brainstem lesion, who do not fulfill diagnostic criteria for multiple sclerosis (MS). We aim to define this new clinical syndrome, which we term TN associated with solitary pontine lesion (SPL-TN), using a clinical and neuroimaging approach. We identified 24 cases of SPL-TN, 18 of which had clinical follow-up for assessment of treatment response. Lesion mapping was performed to determine the exact location of the lesions and site of maximum overlap across patients. Diffusion tensor imaging was used to assess the white-matter microstructural properties of the lesions. Diffusivity metrics were extracted from the (1) SPL-TN lesions, (2) contralateral, unaffected side, (3) MS brainstem plaques from 17 patients with TN secondary to MS, (4) and healthy controls. We found that 17/18 patients were nonresponders to surgical treatment. The lesions were uniformly located along the affected trigeminal pontine pathway, where the site of maximum overlap across patients was in the area of the trigeminal nucleus. The lesions demonstrated abnormal white-matter microstructure, characterized by lower fractional anisotropy, and higher mean, radial, and axial diffusivities compared with the unaffected side. The brainstem trigeminal fiber microstructure within a lesion highlighted the difference between SPL-TN lesions and MS plaques. In conclusion, SPL-TN patients have identical clinical features to TN but have a single pontine lesion not in keeping with MS and are refractory to surgical management.
Reduction of Speckle Noise and Image Enhancement in Ultrasound Image Using Filtering Technique and Edge Detection
Authors: Mustafa Zeinab A. , Abrahim Banazier A. , Omara Akram , Mohammed Arwa A. , Hassan Islam A. , Mustafa Etimad A.
Published: December 2019

Ultrasound (US) imaging application in medicine and other fields is enormous. It has several advantages over other medical imaging modalities. The use of US in diagnosis is well established because of its noninvasive nature, portable, accurate, low-cost imaging modality, capable of forming real-time imaging and continuing improvement in image quality. Medical images and satellite images are usually degraded by noise during image acquisition and transmission process. It is estimated that 1 out of every form medical diagnostic image studies in the world involves ultrasonic techniques. The objectives of this article are to give an overview of the types of speckle reduction techniques in US imaging, present a new technique of speckle reduction, and carry out a comparative evaluation of despeckle filtering based on image quality metrics. A new speckle suppression method and coherence enhancement of medical US image are proposed: 9 despeckled filtering techniques and 5 edge detection operators, with the result evaluated by image quality metrics. The best edge detection hybrid with best filter, quality evaluation metrics has been found that the proposed method performance better than all other methods, while the structural details and result preserving of small and important image feature that contain diagnostic information in a better way than other despeckling filter.
Sensor-Integrated Laryngoscope
Authors: McWilliam Paula , Halamek Louis P. , King Brian , Martineau Narra , Fuerch Janene , Yamada Nicole K. , Kent Nancy , Kennedy Paige , LaCourse John
Published: December 2019

The physics and motions of neonatal intubation have never been described by quantitative measurement of the variables (such as force and torque) associated with it. To address this issue, a sensor-integrated laryngoscope was developed to record the force and torque exerted on airway tissues during intubation. This article presents the functionality of the sensor-integrated laryngoscope and the methods used to interpret the force and torque data during the procedure. The long-term objectives of this project are to identify a “safe range” of metrics of force and torque applied to the airway during intubation and incorporate those findings into the device.
The 3-Dimensional Printing Program at the Biomedical Engineering Department at Niagara Health
Authors: Akinlalu Tofunmi , Galaszewicz Milena , Gigliotti Frank , Reece Connor , Teeluckdharry Kritananda , Yu Bonnie , Gill Amir
Published: December 2019

The Biomedical Engineering Department at Niagara Health has recently launched a 3-dimensional printing program to better support the maintenance and repair of medical devices. Originally, the program was conceived to extend the life of equipment that is no longer supported by the manufacturers. The program is gradually expanding to cover clinical and digital imaging applications mostly geared toward the education of residents and patients. Recently, with impetus from the Information and Communication Department, a partnership has been set up with Brock University, Niagara College, and the Buffalo Niagara Medical Campus. This is gradually evolving to become a regional endeavor.
Acute Effects of Concussion in Youth With Pre-existing Migraines
Authors: Terry Douglas P. , Reddi Preethi J. , Cook Nathan E. , Seifert Tad , Maxwell Bruce A. , Zafonte Ross , Berkner Paul D. , Iverson Grant L.
Published: December 2019

Objective:

To examine associations between pre-existing migraines and postconcussion symptoms and cognitive performance acutely (within 72 hours) after a suspected concussion.

Design:

Nested case–control study.

Setting:

High schools in Maine, USA.

Participants:

From a sample of 39 161 adolescent athletes who underwent baseline preseason testing, 633 were assessed within 3 days of a suspected concussion. Of these, 59 reported a history of treatment for migraines at baseline (9.3%). These athletes were individually matched to 2 athletes who had a suspected concussion but denied preinjury migraines (total N = 177; age: M = 15.8, SD = 1.3).

Assessment of Risk Factors:

Self-reported history of treatment for migraines by a physician.

Main Outcome Measures:

Post-Concussion Symptom Scale total score, ImPACT composite scores, and individual symptom endorsement.

Results:

Individuals with a pre-existing migraine disorder endorsed greater symptom severity (M = 8.4, SD = 9.9) compared with controls (M = 4.5, SD = 6.5; Cohen's d = 0.47) at preinjury baseline and acutely after suspected injury (migraine: M = 26.0, SD = 25.5; controls: M = 16.7, SD = 15.4; d = 0.44). Acutely after a suspected concussion, greater proportions of athletes with migraine disorders reported mental fogginess (49.2% vs 33.9%) and memory problems (39.0% vs 24.6%; P < 0.05). Baseline ImPACT composite scores were similar between migraine and control groups (d = 0.04-0.13). Adolescents with pre-existing migraine disorders performed worse after a suspected concussion compared with the control participants on verbal memory (F = 4.32, P = 0.041) and visual memory (F = 3.95, P = 0.049).

Conclusions:

Individuals with pre-existing migraine disorders may be at higher risk for worse outcomes, including greater overall burden of symptoms and worse cognitive functioning in the memory domain, in the first 72 hours after concussion.
Knee Biomechanical Deficits During a Single-Leg Landing Task Are Addressed With Neuromuscular Training in Anterior Cruciate Ligament–Reconstructed Athletes
Authors: Nagelli Christopher V. , Di Stasi Stephanie , Wordeman Samuel C. , Chen Albert , Tatarski Rachel , Hoffman Joshua , Hewett Timothy E.
Published: December 2019

Objective:

Faulty neuromuscular and biomechanical deficits of the knee are nearly ubiquitous in athletes after anterior cruciate ligament (ACL) reconstruction (ACLR). Knee biomechanical deficits are directly associated with an increased risk of second ACL injury, which typically occurs during a sports-related movement on a single limb. To date, the biomechanical effects of a neuromuscular training (NMT) program on knee biomechanics during a single-leg landing task have not been investigated.

Design:

Prospective Cohort Study.

Setting:

Controlled laboratory setting.

Participants:

Eighteen ACLR and 10 control athletes.

Interventions:

Neuromuscular training.

Main Outcome Measures:

Knee kinematics and kinetics.

Results:

There were no significant interactions of session and limb (P > 0.05) for the athletes with ACLR after training. However, there were several significant main effects of session (P < 0.05) for knee kinematics and kinetics during the single-leg landing task. After training, the athletes with ACLR landed with greater knee flexion angles, decreased knee abduction angles, increased knee flexion range of motion, and decreased knee excursion. Also, the ACLR athletes landed with lower knee flexion moments, greater knee adduction moments, and lower peak vertical ground reaction force. Post-training comparison of the ACLR and control cohorts found no significant interactions of group and limb (P > 0.05) and only a significant main effect of group (P < 0.05) for frontal plane knee angle at initial contact. The athletes with ACLR landed with greater knee adduction angles than the control group.

Conclusions:

Deficits in knee biomechanics that are associated with an increased risk of ACL injury are attenuated after completion of this NMT program.
Part II: Comparison of Crossfit-Related Injury Presenting to Sports Medicine Clinic by Sex and Age
Authors: Sugimoto Dai , Zwicker Rebecca L. , Quinn Bridget J. , Myer Gregory D. , Stracciolini Andrea
Published: December 2019

Objective:

To examine CrossFit-related injuries based on sex and age.

Design:

Retrospective case series.

Setting:

A tertiary-level pediatric sports medicine clinic.

Participants:

CrossFit athletes.

Main Outcome Measures:

CrossFit-related injuries by sex (males vs females) and age groups (≤19 years vs >19 years) using a χ2analysis withP= 0.05, odds ratio (OR), and 95% confidence interval (95% CI).

Results:

Among injured CrossFit athletes, female athletes sustained lower extremity injuries more frequently than male athletes (P= 0.011; OR, 2.65; 95% CI, 1.25-5.65). In observed CrossFit injuries, shoulder injuries were more frequently observed in male athletes compared with female athletes (P= 0.049; OR, 2.79; 95% CI, 0.98-7.95). Additionally, a greater proportion of CrossFit athletes aged 19 years and younger suffered trunk/spine injuries than those older than 19 years (P= 0.027; OR, 2.61; 95% CI, 1.10-6.21) in injured CrossFit athletes.

Conclusions:

The current results indicated sex- and age-specific susceptibility to CrossFit-related injuries based on body parts and diagnoses. The presented information may be useful to develop a safer exercise program, especially for pediatric and adolescent CrossFit participants.
Performance of 4 Molecular Assays for Detection of Chlamydia and Gonorrhea in a Sample of Human Immunodeficiency Virus-Positive Men Who Have Sex With Men
Authors: Footman Alison , Dionne-Odom Jodie , Aaron Kristal J. , Raper James L. , Van Der Pol Barbara
Published: December 2019

Background

Nucleic acid amplification testing (NAAT) is the preferred method to detect Chlamydia trachomatis and Neisseria gonorrhoeae, but information regarding performance of currently available assays is needed. This study evaluated the performance of the Aptima Combo 2, GeneXpert, cobas4800, and ProbeTec QX (CTQ/GCQ) to detect chlamydia and gonorrhea in pharyngeal, rectal, and urine specimen.

Methods

Adult male patients seen at an urban human immunodeficiency virus clinic in Birmingham, Alabama who reported sex with men (men who have sex with men) and no antibiotic use in the past 30 days were enrolled between November 2014 and December 2016. Following a baseline survey, rectal and initial void urine specimens were self-collected. A composite infection standard was used, where 1 assay was compared with 3 others to determine sensitivity and specificity estimates for rectal and urine samples. Two pharyngeal samples were clinician-collected for chlamydia and gonorrhea testing and both had to be positive to be considered a true positive.

Results

Among the 181 men enrolled into the study, 15.5% and 7.2% had at least 1 positive chlamydia and gonorrhea result at any site, respectively. Among all 4 assays, chlamydia sensitivity rates ranged from 82% to 96% among rectal samples. Rectal gonorrhea sensitivity estimates ranged from 67% to 99%. The GCQ assay was less sensitive in detecting rectal gonorrhea compared with the other assays (P = 0.02).

Conclusions

More than 80% of chlamydia and gonorrhea infections would have been missed with urine-only screening, highlighting the importance in using NAATs to detect chlamydia and gonorrhea infections among men who have sex with men.
Detection-Based Monetary Incentives to Improve Syphilis Screening Uptake: Results of a Pilot Intervention in a High Transmission Setting in Southern China
Authors: Smith M. Kumi , Shen Hongcheng , Huang Shujie , Zheng Heping , Yang Bin , Wiesen Christopher , Wang Cheng
Published: December 2019

Background

Underscreening of syphilis in clinical settings is a pervasive problem in resource-constrained settings where heavy patient loads and competing health priorities inhibit health providers' ability to meet screening coverage targets. A “detection-based” pay-for-performance (P4P) strategy can incentivize more targeted testing by rewarding providers with a monetary bonus for every confirmed case.

Methods

Five clinics in a high transmission setting of China participated in the 6-month pilot intervention. Seropositive proportions during the P4P intervention were compared with those during the preintervention phase using multilevel logistic regression models adjusted for age and sex of clinic attendees.

Results

There were 8423 patients that sought care at 1 of the 6 clinics over the course of the study. Adjusted odds of a positive syphilis screen were greater during the intervention period compared to the preintervention interval (odds ratio, 1.33; 95% confidence interval, 1.14–1.56). Variability in clinic-level effects was substantial given the small number of sites of this pilot study.

Conclusions

Results of this detection-based P4P pilot study demonstrate the feasibility and preliminary effectiveness of this approach for improving syphilis case detection in resource-constrained clinical settings. A fully powered randomized trial is needed to inform the full utility of this approach for improving sexually transmitted disease detection globally.
Beyond Point-of-Care Ultrasound
Authors: Scheier Eric , Balla Uri
Published: December 2019

Cancer is diagnosed in 1 in 7000 children annually. Here, we report 6 cases of a mass identified by the author, a novice sonographer in a pediatric emergency medicine fellowship, using point-of-care ultrasound, from January of 2017 to May of 2018. Identification of these cases early in presentation allowed for earlier involvement of the relevant specialist and shorter time to diagnosis and treatment, and might be expected to increase parent satisfaction as well.
Proximal Interphalangeal Joint Adipofascial Flap Resurfacing Improves the Active Motion of the Proximal Interphalangeal Joint after Contracture Release
Authors: Lee Che-Hsiung , Loh Charles Yuen Yung , Chen Yueh-Hsia , Lin Yu-Te
Published: December 2019

Background:

Posttraumatic proximal interphalangeal (PIP) joint contractures of the digits are common and are associated with impaired hand function. However, relapse is common after surgical release of PIP joint contractures. This article presents a novel treatment strategy with a PIP joint adipofascial flap to resurface the joint after release, and compares patients with similar joint contracture release who did and did not undergo resurfacing with a PIP joint adipofascial flap.

Methods:

From January of 2010 to January of 2018, 10 patients received single-digit PIP joint flexion contracture release and PIP joint adipofascial flap resurfacing; 20 patients received a stepwise release as a control group. Thirty joints were compared, and the degree of extension lag improvement over time was measured during an average follow-up period of 292.4 days.

Results:

Greater extension lag improvement was observed in the PIP joint adipofascial flap group compared with the control group (37.0 ± 19.2 degrees versus 21.0 ± 19.5 degrees; p =0.055). The ratio of improvement was also significantly higher in the flap group (0.79 ± 0.26 versus 0.49 ± 0.46; p =0.049). Flap resurfacing appeared to have a beneficial effect on improvements in extension lag (p =0.042), whereas a higher number of secondary operations, associated fractures, and maximum visual analogue scale score 1 week postoperatively were negatively associated with extension lag in univariate analysis (p < 0.05). Generalized estimating modeling showed that flap resurfacing had a significantly positive effect on extensor lag improvement with time (β = 2.235; p =0.04).

Conclusions:

PIP joint adipofascial flap resurfacing following PIP joint contracture release may improve and maintain extensor lag. Recovery of joint motion may also be quicker compared with conventional release alone.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Cost-Effectiveness of Long-Term, Targeted OnabotulinumtoxinA versus Peripheral Trigger Site Deactivation Surgery for the Treatment of Refractory Migraine Headaches
Authors: Schoenbrunner Anna R. , Khansa Ibrahim , Janis Jeffrey E.
Published: December 2019

Background:

Chronic migraines affect approximately 2 percent of the U.S. population and cost an estimated $17 billion per year. OnabotulinumtoxinA (botulinum toxin type A) is a U.S. Food and Drug Administration–approved prophylactic medication for chronic migraine headaches and is best injected in a targeted fashion into specific trigger sites. The purpose of this study was to determine the cost-effectiveness of long-term, targeted botulinum toxin type A versus peripheral trigger site deactivation surgery for the treatment of migraine headaches.

Methods:

A Markov model was constructed to examine long-term, targeted botulinum toxin type A versus peripheral trigger site deactivation surgery. Costs, utilities, and other model inputs were identified from the literature. One-way and probabilistic sensitivity analyses were performed. An incremental cost-effectiveness ratio under $50,000 per quality-adjusted life-year was considered cost-effective.

Results:

The mean cost of peripheral trigger site deactivation surgery was $10,303, with an effectiveness of 7.06; whereas the mean cost of long-term, targeted botulinum toxin type A was $36,071, with an effectiveness of 6.34. Trigger-site deactivation surgery is more effective and less costly over the time horizon of the model. One-way sensitivity analysis revealed that surgery is the most cost-effective treatment in patients requiring treatment for greater than 6.75 years.

Conclusions:

Based on this model, peripheral trigger site deactivation surgery is the more cost-effective option for treating refractory migraine headaches requiring treatment beyond 6.75 years. The model reveals that peripheral trigger-site deactivation surgery is more effective and less costly than long-term, targeted botulinum toxin type A over the course of a patient’s lifetime.
A Review of 30 Years of Alveolar Bone Grafting in the Mixed Dentition Using a Standardized Protocol in Western Australia
Authors: Keribin Pierre , Nicholls Wendy , Walters Mark , Tan Albert , McAlpine Melanie , Gillett David
Published: December 2019

Background:

Outcomes for a continuously applied alveolar bone grafting protocol, established in 1982, are reported and compared to previously published outcomes from the authors’ unit and elsewhere.

Methods:

A descriptive, retrospective cohort study of alveolar bone grafting outcomes at a tertiary referral cleft center was performed. Records of all alveolar bone grafts between 2002 and 2014 were reviewed (224 grafts). Three-year postoperative periapical radiographs were evaluated using the Bergland, Kindelan, and standardized way to assess graft scores by an external rater. Incomplete records, a syndromic diagnosis, or primary surgery performed elsewhere resulted in 123 grafts being excluded, leaving 101 grafts for assessment. The distribution of scores was compared to the authors’ previous studies and international reports. The authors also tested for any impact on the outcome based on cleft type, laterality, timing for incisor or canine eruption, and surgeon experience.

Results:

A total of 95.6 percent of applicable grafts (66 of 69) were considered “successful” by Bergland scores and 96 percent by Kindelan scores. Eighty-nine percent of grafts were “very good” based on standardized way to assess graft score. No significant differences were detected in outcomes based on timing, cleft type, or laterality. Surgeon experience had a significant impact (p < 0.05) on outcome for Bergland and Kindelan scores. Distribution of Bergland scores did not differ from the authors’ earlier studies demonstrating consistent outcomes for over 30 years.

Conclusions:

The Western Australian alveolar bone grafting protocol has consistently achieved a very high success rate (96 percent) for over 30 years despite multiple staff changes. These results compared well with best-reported outcomes from worldwide cleft centers. Surgeon training and experience were significant in achieving these outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Neural Correlates of Stress and Abdominal Obesity in Patients With Coronary Artery Disease
Authors: Moazzami Kasra , Wittbrodt Matthew T. , Lima Bruno B. , Levantsevych Oleksiy , Kaseer Belal , Martini Afif , Haffar Ammer , Nye Jonathon A. , Quyyumi Arshed A. , Shah Amit , Vaccarino Viola , Bremner J. Douglas
Published: December 2019

Objective

This study aimed to investigate the relationship between waist circumference as a measure of abdominal obesity and brain responses to stress among patients with coronary artery disease (CAD).

Methods

Patients with CAD (N = 151) underwent acute mental stress tasks in conjunction with high-resolution positron emission tomography and radiolabeled water imaging of the brain. Brain responses to mental stress were correlated with waist circumference.

Results

Waist circumference was positively correlated with increased activation in the right and left frontal lobes (β values ranging from 2.81 to 3.75 in the paracentral, medial, and superior gyri), left temporal lobe, left hippocampal, left amygdala, left uncus, and left anterior and posterior cingulate gyri (β values ranging from 2.93 to 3.55). Waist circumference was also negatively associated with the left and right parietal lobes, right superior temporal gyrus, and right insula and precuneus (β values ranging from 2.82 to 5.20).

Conclusion

Increased brain activation in the brain regions involved in the stress response and autonomic regulation of the cardiovascular system during psychological stress may underlie stress-induced overeating and abdominal obesity in patients with CAD.
Choice of Single-Staged Reconstruction of Nasal Defect
Authors: Ni Jian , Yan Xin , Wang Shuqin , Tan Qian
Published: December 2019

Introduction:

The nasal defect is still a challenge for plastic surgeon now. Many surgical options are reported in previous literatures. There are few studies reported about the 1-staged repair of large nasal defect. In this article, the authors describe the experience about the nasal reconstruction in the last 8 years.

Patients and Methods:

Fifty-two patients diagnosed with nasal defect were retrospectively examined between 2011 and 2018. All of them performed under local anesthesia and received 1-staged surgical method.

Results:

In the authors’ patients, the mean size of the defect was 2.16 cm. Nine patients were treated by nasolabial flap, and 30 patients were treated by local flap. The modified auricular composite tissue flap was used in 5 patients. There were no major postoperative complications. All patients were satisfied with aesthetically nasal contours as well as inconspicuous scars when follow-up.

Conclusion:

Single-staged reconstruction is still considered the first choice for nasal defect. The design of flap depends on the surrounding condition and the size of defect. Locoregional flaps are still considered as an ideal choice for nasal reconstruction in most patients. O–Z flap and modified auricular free flap could be an option for large-sized defect of nasal alar and nasal tip.
Hypertension and Diabetes Are Associated With Clinical Characteristics in Patients Undergoing Microvascular Decompression for Hemifacial Spasm
Authors: Min Lingzhao , Zhang Wenbo , Tao Bangbao , Sun Qiuyang , Li Shiting , Wang Xiaoqiang
Published: December 2019

Objectives:

The aim of the present study is to investigate effect of hypertension and diabetes on neuroelectrophysiology, outcomes and complications in patients with hemifacial spasm (HFS) treated by microvascular decompression (MVD).

Methods:

From June 2014 to December 2016, 476 consecutive HFS patients who had undergone MVD were divided into 2 groups according to the presence or absence of comorbidities: diabetic group (n = 26) versus non-diabetic group (n = 450), and hypertensive group (n = 141) versus normotensive group (n = 335). Relevant patient data, including preoperative and postoperative neuroelectrophysiology, operative findings, outcome of MVD and complications, were collected and analyzed retrospectively over the 2-year follow-up period. The impact of hypertension and diabetes on the clinical features of HFS patients was investigated by using logistic regression models.

Results:

Brainstem auditory evoked potential (BAEP), postoperative prognosis and abnormal muscle response (AMR) were not different between any of the 2 groups. Preoperative positive AMR occurred more frequently in the nondiabetic group than diabetic group [OR = 0.202, P = 0.004], whereas hypertension was not independently predictive for neuroelectrophysiology in patients with HFS. Adjusted multivariate analysis indicated that hypertension was the only clinical factor associated with MVD-related complications [OR = 0.482, P = 0.007] and hearing impairment [OR = 0.28, P = 0.004] after various potential confounders were taken into account, whereas diabetes was not predictive for postoperative complications.

Conclusions:

Diabetes is associated with low positive rate of preoperative AMR, thus weakening the predictive role of AMR for successful MVD. Hypertension may be an independent risk factor for hearing impairment after MVD.
Deep Convolutional Neural Networks for Automatic Detection of Orbital Blowout Fractures
Authors: Li Lunhao , Song Xuefei , Guo Yucheng , Liu Yuchen , Sun Rou , Zou Hao , Zhou Huifang , Fan Xianqun
Published: December 2019

Orbital blow out fracture is a common disease in emergency department and a delay or failure in diagnosis can lead to permanent visual changes. This study aims to evaluate the ability of an automatic orbital blowout fractures detection system based on computed tomography (CT) data.

Orbital CT scans of adult orbital blowout fractures patients and normal cases were obtained from Shanghai Ninth People's Hospital between January and March 2017. The region of fractures was annotated using 3D Slicer. The Inception V3 convolutional neural networks were constructed utilizing the Python programming language with PyTorch as the framework to extract high dimension features from each slice in a CT scan. These extracted features are processed through a XGBoost model to make the final differentiation of fracture cases and nonfracture ones. Accuracy, receiver operating characteristics, and area under the curve were evaluated.

This study used 94 CT scans diagnosed with orbital blowout fractures and 94 healthy control cases. The automatic detection system showed accuracy of 92% in single-image classification and 87% in patient level detection. The area under the receiver operating characteristic curve was 0.9574.

Using a deep learning-based automatic detection system of orbital blowout fracture can accurately detect and classify orbital blowout fractures from CT scans. The convolutional neural networks model combined with an accurate annotation system could achieve good performance in a small dataset. Further studies with large and multicenter data are required to refine this technology for possible clinical applications.
No association between CYP2C19 genetic polymorphism with treatment remission to antidepressant venlafaxine in Han Chinese population
Authors: Zhang Naixing , Ji Lei , Chen Zhixuan , An Lin , Ren Decheng , Bi Yan , Guo Zhenming , Yuan Ruixue , Yuan Fan , Dong Zaiquan , Yin Li , Sun Xueli , Yang Fengping , Li Xingwang , Yu Tao , He Lin , Shi Lei , He Guang
Published: December 2019

Objective:

Major depressive disorder (MDD) is a global mental health problem. As a serotonin-noradrenaline reuptake inhibitor (SNRI), the antidepressant venlafaxine is used to alleviate MDD clinically. Recent research has shown that Cytochrome P450 (CYP) enzymes affect venlafaxine efficacy by mediating its metabolism. The present study investigates genetic polymorphisms of cytochrome P450 family 2 subfamily C member 19 (CYP2C19) are associated with remission after venlafaxine treatment for MDD.

Methods:

A total of 175 Han Chinese patients with depression were recruited to accept a 6-week treatment with venlafaxine. Three single-nucleotide polymorphisms of CYP2C19 were selected from dbSNP and previous literature to compare the allele and genotype frequencies between patients in remission and nonremission. Seventeen items Hamilton Depression Scale (17-HAMD) was used to access the outcomes of patients’ depressive symptoms through the study. Our results denied the role of CYP2C19 polymorphisms for remission after venlafaxine treatment in MDD patients.

Result & Conclusion:

CYP2C19 genetic polymorphism may not have association with SNRI venlafaxine treatment remission in the Han Chinese population.
The neurocognitive basis of knowledge about object identity and events: dissociations reflect opposing effects of semantic coherence and control
Authors: Jefferies Elizabeth , Thompson Hannah , Cornelissen Piers , Smallwood Jonathan
Published: December 2019

Semantic memory encompasses knowledge of specific objects and their diverse associations, but the mechanisms that allow us to retrieve aspects of knowledge required for a given task are poorly understood. The dual hub theory suggests that separate semantic stores represent knowledge of (i) taxonomic categories (in the anterior temporal lobes, ATL) and (ii) thematic associations (in angular gyrus, AG or posterior middle temporal gyrus, pMTG). Alternatively, the controlled semantic cognition (CSC) framework suggests that semantic processing emerges from the flexible interaction of heteromodal semantic representations in ATL with a semantic control network, which includes pMTG as well as prefrontal regions. According to this view, ATL supports patterns of coherent auto-associative retrieval, while semantic control sites respond when ongoing conceptual activation needs to be altered to suit the task or context. These theories make different predictions about the nature of functional dissociations within the semantic network. We review evidence for these claims across multiple methods. First, we show ATL is sensitive to the strength of thematic associations as well as taxonomic relations. Next, we document functional dissociations between AG and pMTG: rather than these regions acting as comparable thematic hubs, AG is allied to the default mode network and supports more ‘automatic’ retrieval, while pMTG responds when control demands are high. However, the semantic control network, including pMTG, also shows a greater response to events/actions and verbs, supporting the claims of
both
theories. We propose that tasks tapping event semantics often require greater shaping of conceptual retrieval than comparison tasks, because these elements of our knowledge are inherently flexible, with relevant features depending on the context. In this way, the CSC account might be able to account for findings that suggest both a process and a content distinction within the semantic network.

This article is part of the theme issue ‘Towards mechanistic models of meaning composition’.
Phase synchronization varies systematically with linguistic structure composition
Authors: Brennan Jonathan R. , Martin Andrea E.
Published: December 2019

Computation in neuronal assemblies is putatively reflected in the excitatory and inhibitory cycles of activation distributed throughout the brain. In speech and language processing, coordination of these cycles resulting in phase synchronization has been argued to reflect the integration of information on different timescales (e.g. segmenting acoustics signals to phonemic and syllabic representations; (Giraud and Poeppel 2012Nat. Neurosci.15, 511 (doi:10.1038/nn.3063)). A natural extension of this claim is that phase synchronization functions similarly to support the inference of more abstract higher-level linguistic structures (Martin 2016Front. Psychol.7, 120; Martin and Doumas 2017PLoS Biol.15, e2000663 (doi:10.1371/journal.pbio.2000663); Martin and Doumas. 2019Curr. Opin. Behav. Sci.29, 77–83 (doi:10.1016/j.cobeha.2019.04.008)). Haleet al. (Haleet al. 2018 Finding syntax in human encephalography with beam search.arXiv1806.04127 (http://arxiv.org/abs/1806.04127)) showed that syntactically driven parsing decisions predict electroencephalography (EEG) responses in the time domain; here we ask whether phase synchronization in the form of either inter-trial phrase coherence or cross-frequency coupling (CFC) between high-frequency (i.e. gamma) bursts and lower-frequency carrier signals (i.e. delta, theta), changes as the linguistic structures of compositional meaning (viz., bracket completions, as denoted by the onset of words that complete phrases) accrue. We use a naturalistic story-listening EEG dataset from Haleet al. to assess the relationship between linguistic structure and phase alignment. We observe increased phase synchronization as a function of phrase counts in the delta, theta, and gamma bands, especially for function words. A more complex pattern emerged for CFC as phrase count changed, possibly related to the lack of a one-to-one mapping between ‘size’ of linguistic structure and frequency band—an assumption that is tacit in recent frameworks. These results emphasize the important role that phase synchronization, desynchronization, and thus, inhibition, play in the construction of compositional meaning by distributed neural networks in the brain.

This article is part of the theme issue ‘Towards mechanistic models of meaning composition’.
The geometry of predication: a configurational derivation of the defining property of clause structure
Authors: Moro Andrea
Published: December 2019

Predication is the fundamental grammatical relation defining clausal structures in all (and only) human languages. This notion is by definition compositional, since it consists of a link between a subject and a predicate. The central question addressed here is whether this traditional notion, which has never been dismissed ever since the canonical models of Ancient Greek linguistics, can be derived at a formal level from more abstract compositional algorithms. Capitalizing on predication in copular sentences, which allow factoring out non-essential aspects of this phenomenon, such as the morphological asymmetry between verbs and nouns, I propose a configurational approach to predication. This new approach is based on the notion of symmetry as derived by purely compositional mechanisms. Finally, I address some theoretical and empirical consequences of this generalization including those pertaining to neurolinguistics.

This article is part of the theme issue ‘Towards mechanistic models of meaning composition’.
Quasi-compositional mapping from form to meaning: a neural network-based approach to capturing neural responses during human language comprehension
Authors: Rabovsky Milena , McClelland James L.
Published: December 2019

We argue that natural language can be usefully described as quasi-compositional and we suggest that deep learning-based neural language models bear long-term promise to capture how language conveys meaning. We also note that a successful account of human language processing should explain both the outcome of the comprehension process and the continuous internal processes underlying this performance. These points motivate our discussion of a neural network model of sentence comprehension, the Sentence Gestalt model, which we have used to account for the N400 component of the event-related brain potential (ERP), which tracks meaning processing as it happens in real time. The model, which shares features with recent deep learning-based language models, simulates N400 amplitude as the automatic update of a probabilistic representation of the situation or event described by the sentence, corresponding to a temporal difference learning signal at the level of meaning. We suggest that this process happens relatively automatically, and that sometimes a more-controlled attention-dependent process is necessary for successful comprehension, which may be reflected in the subsequent P600 ERP component. We relate this account to current deep learning models as well as classic linguistic theory, and use it to illustrate a domain general perspective on some specific linguistic operations postulated based on compositional analyses of natural language.

This article is part of the theme issue ‘Towards mechanistic models of meaning composition’.
Extraction of near-complete genomes from metagenomic samples: a new service in PATRIC
Authors: Parrello Bruce , Butler Rory , Chlenski Philippe , Pusch Gordon D , Overbeek Ross
Published: December 2019

Background

Large volumes of metagenomic samples are being processed and submitted to PATRIC for analysis as reads or assembled contigs. Effective analysis of these samples requires solutions to a number of problems, including the binning of assembled, mixed, metagenomically-derived contigs into taxonomic units.

Description

The PATRIC metagenome binning service utilizes the PATRIC database to furnish a large, diverse set of reference genomes. Reference genomes are assigned based on the presence of single-copy universal marker proteins in the sample, and contigs are assigned to the bin corresponding to the most similar reference genome. Each set of binned contigs represents a draft genome that will be annotated by RASTtk in PATRIC. A structured-language binning report is provided containing quality measurements and taxonomic information about the contig bins.

Conclusion

We provide a new service for rapid and interpretable metagenomic contig binning and annotation in PATRIC.