bluuebunny/crossref_metadata_2025 huggingface dataset:
MULTIMODAL IMAGING OF AN INTRARETINAL TUBERCULAR GRANULOMATOUS NEURORETINITIS
Authors: Lyons Lance J. , Singh Malkit K. , Carvounis Petros E. , El-Annan Jaafar
Published: February 2020

Purpose:

To report a rare case of an intraretinal tuberculoma and associated neuroretinitis.

Methods:

The patient was evaluated with various imaging modalities including fundus photography, fluorescein angiography, magnetic resonance imaging, and optical coherence tomography; her extensive laboratory workup returned positive for tuberculosis.

Results:

After initially presenting with no light perception, 13 weeks of antitubercular therapy allowed for visual acuity recovery to 20/30.

Conclusion:

We demonstrate the spectral domain optical coherence tomography characteristics of an intraretinal tuberculoma.
Targeting interleukin-20 alleviates paclitaxel-induced peripheral neuropathy
Authors: Chen Li-Hsien , Yeh Yu-Min , Chen Yi-Fan , Hsu Yu-Hsiang , Wang Hsiao-Hsuan , Lin Peng-Chan , Chang Lian-Yun , Lin Chou-Ching K. , Chang Ming-Shi , Shen Meng-Ru
Published: February 2020

The role of immune mediators, including proinflammatory cytokines in chemotherapy-induced peripheral neuropathy (CIPN), remains unclear. Here, we studied the contribution of interleukin-20 (IL-20) to the development of paclitaxel-induced peripheral neuropathy. Increased serum levels of IL-20 in cancer patients with chemotherapy were accompanied by increased CIPN risk. In mouse models, proinflammatory IL-20 levels in serum and dorsal root ganglia fluctuated with paclitaxel treatment. Blocking IL-20 with the neutralizing antibody or genetic deletion of its receptors prevented CIPN, alleviated peripheral nerve damage, and dampened inflammatory responses, including macrophage infiltration and cytokine release. Mechanistically, paclitaxel upregulated IL-20 through dysregulated Ca2+ homeostasis, which augmented chemotherapy-induced neurotoxicity. Importantly, IL-20 suppression did not alter paclitaxel efficacy on cancer treatment both in vitro and in vivo. Together, targeting IL-20 ameliorates paclitaxel-induced peripheral neuropathy by suppressing neuroinflammation and restoring Ca2+ homeostasis. Therefore, the anti-IL-20 monoclonal antibody is a promising therapeutic for the prevention and treatment of paclitaxel-induced neuropathy.
Healthcare Personnel's Knowledge and Management of Frequently Encountered Forensic Cases in Emergency Departments in Turkey
Authors: Topçu Emine Tuğba , Erek Kazan Ebru , Büken Erhan
Published: February 2020

Background

Emergency department (ED) personnel frequently encounter incidents related to crime, violence, and suspicious injuries. The aim of this descriptive study was to determine the knowledge levels of ED healthcare personnel in their handling of frequently encountered forensic cases.

Methods

A cross-sectional descriptive study composed of ED healthcare personnel at all state, education and research, and university hospitals with EDs, located in Ankara, Turkey, was completed. Participants at the 15 hospitals in question were interviewed via a questionnaire developed by the researchers.

Results

Three hundred fifty healthcare personnel who worked agreed to participate in the study. The results show that ED healthcare personnel have less knowledge than expected of the right way to handle frequently encountered forensic cases. Very few of the healthcare professionals who participated in the study had received any training or education in the field of forensic nursing. Among participants, postgraduates, health professionals educated in forensic nursing, and healthcare staff who used additional resources to understand forensic cases, and those who had evaluated cases that presented to the ED as forensic cases, had significantly higher levels of knowledge.

Implications

This study supports the need for professional development in forensic nursing, such as in-service training, and curriculum development for a certificate in forensic nursing to enhance the practical training of healthcare professionals who work in EDs.
The International Classification of Diseases, 11th Revision: A Step-Back for Women With Vulvodynia?
Authors: Radici Gianluigi , Preti Mario , Vieira-Baptista Pedro , Stockdale Colleen K. , Bornstein Jacob
Published: February 2020

Objective

The aim of the study was to compare the International Classification of Diseases, 11th revision, (ICD-11) with current terminology of vulvodynia, approved by a broad-based consensus of the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for the Study of Women Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS).

Methods

The diagnostic criteria and descriptions of vulvodynia as well as the definition and classification of chronic pain in ICD-11 were reviewed and compared with the Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia, endorsed in 2015 by the ISSVD, ISSWSH, and IPPS.

Results

Diagnostic criteria and descriptors of vulvodynia in the ICD-11 are outdated. Moreover, vulvodynia is not identified among chronic pain diagnoses, despite fulfilling the diagnostic criteria of chronic primary pain. Specifically, vulvodynia is a vulvar pain of at least 3-month duration, which is associated with significant emotional distress and functional disability, and is not better accounted for by another specific condition.

Conclusions

The ICD-11 is not aligned with current vulvodynia diagnostic criteria and terminology, approved by the ISSVD, ISSWSH, and IPPS. Collaboration among the International Association for the Study of Pain Task Force on Classification of Chronic Pain, ICD team, ISSVD, ISSWSH, and IPPS is needed to harmonize terminologies, codes, and clinical approach regarding vulvar pain and vulvodynia classification.
Can Osteopenia Induce Residual Dizziness After Treatment of Benign Paroxysmal Positional Vertigo?
Authors: Suh Kang Duk , Oh Seung Ri , Chae Hyunkyu , Lee Sei Young , Chang Munyoung , Mun Seog-Kyun
Published: February 2020

Objective:

This study aimed to determine whether there is an association between osteopenia and residual dizziness after successful treatment of benign paroxysmal positional vertigo (BPPV).

Methods:

In all, 62 patients with canalolithiasis-type BPPV were included in the study. Patients were divided into two groups according to the presence of residual dizziness after resolution of BPPV. Univariate and multivariate analyses were performed to determine the factors associated with residual dizziness. Patients were analyzed based on age, sex, affected semicircular canal, affected side, BPPV duration, and presence of hypertension, diabetes mellitus, hyperlipidemia, and osteopenia.

Results:

In univariate analysis, BPPV duration and osteopenia showed a relatively significant association (p < 0.20) with the development of residual dizziness. On subsequent multivariate analysis using these factors, osteopenia remained a statistically significant factor in association with residual dizziness (p = 0.012, odds ratio, 9.916).

Conclusion:

Osteopenia is associated with the development of residual dizziness. BPPV patients with osteopenia more frequently suffer from residual dizziness after successful treatment of BPPV than those without osteopenia.
Establishing Genotype–phenotype Correlation in USH2A-related Disorders to Personalize Audiological Surveillance and Rehabilitation
Authors: Molina-Ramírez Leslie P. , Lenassi Eva , Ellingford Jamie M. , Sergouniotis Panagiotis I. , Ramsden Simon C. , Bruce Iain A. , Black Graeme C. M.
Published: February 2020

Objective:

USH2A-related disorders are characterised by genetic and phenotypic heterogeneity, and are associated with a spectrum of sensory deficits, ranging from deaf blindness to blindness with normal hearing. It has been previously proposed that the presence of specific USH2A alleles can be predictive of unaffected hearing. This study reports the clinical and genetic findings in a group of patients with USH2A-related disease and evaluates the validity of the allelic hierarchy model.

Patients and Intervention:

USH2A variants from 27 adults with syndromic and nonsyndromic USH2A-related disease were analyzed according to a previously reported model of allelic hierarchy. The analysis was replicated on genotype–phenotype correlation information from 197 individuals previously reported in 2 external datasets.

Main Outcome Measure:

Genotype–phenotype correlations in USH2A-related disease.

Results:

A valid allelic hierarchy model was observed in 93% of individuals with nonsyndromic USH2A-retinopathy (n = 14/15) and in 100% of patients with classic Usher syndrome type IIa (n = 8/8). Furthermore, when two large external cohorts of cases were combined, the allelic hierarchy model was valid across 85.7% (n = 78/91) of individuals with nonsyndromic USH2A-retinopathy and 95% (n = 123/129) of individuals with classic Usher syndrome type II (p = 0.012, χ
2 test). Notably, analysis of all three patient datasets revealed that USH2A protein truncating variants were reported most frequently in individuals with hearing loss.

Conclusion:

Genetic testing results in individuals suspected to have an USH2A-related disorder have the potential to facilitate personalized audiological surveillance and rehabilitation pathways.
Evaluating the Decision for Cochlear Implantation in Individuals With Single-Sided Deafness (SSD); Implementing the SSD Consensus Protocol Into Clinical Routine
Authors: Kurz Anja , Rak Kristen , Hagen Rudolf , Ehrmann-Müller Désirée
Published: February 2020

Objective:

To implement a unified testing framework into clinical routine that can be used by adults with single-sided deafness (SSD) to assess alternative treatment options before cochlear implantation.

Study Design:

Retrospective data analysis.

Setting:

Tertiary referral center with a large CI program.

Subjects and Methods:

Thirty four participants underwent the new implemented testing procedure, including a test trial with contralateral routing of the signal (CROS) hearing aids and bone conduction devices (BCD) on a headband, before deciding whether to proceed with cochlear implantation. A test battery was used to assess speech in noise, binaural effects (head shadow, squelch, summation, spatial release from masking), sound localization, and quality of life. For participants that chose a CI, the same test battery was repeated during the 6 and 12 months follow-up appointments.

Results:

Of the 34 participants involved in the study, 11 were implanted with a CI and finished their 12 month evaluation. Sixteen participants decided to stop after the CROS/BCD trial. In the CI-recipient group, a significant head shadow effect of 5.1 to 7.1 dB was achieved with the CI. Recipients in this group received only a limited benefit with either CROS or BCD before implantation. In the non-CI-recipient group, a significant difference between the CROS and BCD, in favor for the CROS device, was found calculating the head shadow and squelch effect. Localization abilities with the CI improved significantly in the CI-recipient group, even between the 6- and 12-month follow-up appointments. In the non-CI-recipient group, localization was significantly better with the BCD during the trial period. Higher scores were obtained from the speech and spatial categories of the Speech, Spatial, and Qualities of Hearing (SSQ) questionnaire with the CI. No subjective difference could be determined in the non-CI-recipient group.

Conclusion:

Implementing the unified testing framework into a clinical routine was challenging but provided helpful insight into the best treatment option for each individual.
Mobile stroke units: taking stroke care to the patient
Authors: Bhalla Tarun , Rahmani Redi , Le Roux Peter
Published: February 2020

Purpose of review

Since the development of intravenous tissue plasminogen activator (tPA) for acute ischemic stroke (AIS), functional outcome has improved when treatment occurs within 4.5 h of stroke onset and treatment benefits are greater with earlier treatment. Endovascular revascularization also is better the sooner it is delivered.

Recent findings

The Get with the Guidelines Stroke registry found that less than one-third of treatment-eligible AIS patients receive intravenous tPA within 60 min of hospital arrival. Initiatives have tried to improve public education and awareness of stroke symptoms to decrease time to presentation. The mobile stroke unit (MSU) facilitates earlier computed tomography scans, delivery of tPA, proper triage and on-scene goal-directed care. MSUs reduce time from stroke alarm to treatment by 25–40 min and increase the rate of intravenous tPA use without an increase in hemorrhage risk. In addition, three-month favorable outcome is increased.

MSUs likely will evolve further and be used for other acute neurologic disorders, help triage patients for endovascular therapy, and be incorporated into systems of care in remote areas. Further studies are awaited to fully understand the overall medical and health-economic benefit of MSUs.
Early mobilization in neurocritical care patients
Authors: Kumar Monisha A. , Romero Francisco G. , Dharaneeswaran Kiruba
Published: February 2020

Purpose of review

To examine the potential benefits of early mobilization in neurocritically ill patients and to summarize the recent evidence for and against early mobilization.

Recent findings

Early ICU mobilization in medically critically ill patients may decrease ICU and hospital length of stay, increase discharge-to-home, and reduce medical costs. Whether these benefits apply to neurologically critically ill patients remains unclear, as neuro ICU patients are often excluded from trials of early mobility. Neurocritically ill patients may present with hemodynamic instability, acute hemiplegia, altered consciousness and visual field deficits which complicate mobilization, or have cerebral ischemia, which may be exacerbated when upright or active. Results of early mobilization in neurocritical care are mixed. For example, a randomized trial in acute ischemic stroke demonstrated that very early mobilization was associated with worse outcomes. However, many smaller intervention trials in neurocritical care demonstrate safety and feasibility with early mobilization, including those in patients with invasive devices, for example, external ventricular drains.

Given successes in other critically ill populations, early mobility of neurocritically ill patients may be warranted. However, caution should be exercised given the results in acute stroke trials. In addition, before routine use, the character, quality, dose, duration, and timing of early mobilization therapies requires further definition.
Bioactive peptides derived from human milk proteins: an update
Authors: Wada Yasuaki , Lönnerdal Bo
Published: February 2020

Purpose of review

Human milk contains a variety of bioactive proteins, and some of the bioactivities are exerted only after proteins are digested in the gastrointestinal tract. This review aims to overview recent studies on bioactive peptides in human milk and gastric digesta of breast-fed infants.

Recent findings

Milk protein-derived peptides are endogenously present in human milk, and some of them have been reported to be bioactive peptides, such as a homologue of caseinophosphopeptide, an antimicrobial peptide, and an immunomodulatory peptide. A larger number of peptides are identified in gastric aspirates from breast-fed infants, and bioactive peptides such as angiotensin I-converting enzyme-inhibitory peptides, an antioxidative peptide, opioid agonist peptides are only found in the digesta of human milk but not in human milk per se. Casein is the greatest source of released bioactive peptides.

Technological advances have considerably increased our capability to identify and characterize peptides derived from human milk proteins. However, their physiological significance and the roles of these bioactive peptides in growth and development of breast-fed infants have not yet been sufficiently elucidated, and further in-vivo experiments and clinical trials are warranted.
Pediatric screening tools for malnutrition: an update
Authors: Hulst Jessie M. , Huysentruyt Koen , Joosten Koen F.
Published: February 2020

Purpose of review

There is ongoing interest in nutritional screening tools in pediatrics to facilitate the identification of children at risk for malnutrition who need further assessment and possible nutritional intervention. The choice for a specific tool depends on various factors. This review aims to provide an overview of recent progress in pediatric nutritional screening methods.

Recent findings

We present recent studies about newly developed or adjusted tools, the applicability of nutritional screening tools in specific populations, and how to implement screening in the overall process of improving nutritional care in the pediatric hospital setting.

Three new screening tools have been developed for use on admission to hospital: two for the mixed pediatric hospitalized population and one for infants. A simple weekly rescreening tool to identify hospital-acquired nutritional deterioration was developed for use in children with prolonged hospital stay. Different from most previous studies that only assessed the relationship between the nutritional risk score and anthropometric parameters of malnutrition, new studies in children with cancer, burns, and biliary atresia show significant associations between high nutritional risk and short-term outcome measures such as increased complication rate and weight loss. For implementation of a nutritional care process incorporating nutritional screening in daily practice, simplicity seems to be of great importance.
Advances in molecular diagnostic tests for pneumonia
Authors: Cilloniz Catia , Liapikou Adamanthia , Torres Antoni
Published: February 2020

Purpose of review

Pneumonia is the main global cause of sepsis, and has been associated with high morbidity and high short and long-term mortality rates. As it may be caused by a wide spectrum of microorganisms, microbial diagnosis is challenging and the choice of adequate therapy remains an important problem. This review focuses on recently published studies of microbiological diagnostic tests and clinical assessments for pneumonia, including community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia.

Recent findings

Over the past decade, the microbiological diagnosis of pneumonia has improved significantly – thanks to the development and implementation of molecular diagnostic tests for identifying the most frequent pathogens causing pneumonia and for determining their patterns of resistance. Molecular methods for the diagnosis of pneumonia focus on multiple target detection systems and pathogen detection arrays, and, more recently, have been used in combination with mass spectrometry.

The implementation of rapid diagnostic techniques in routine clinical practice able to identify and determine the resistance patterns of the causative microbes may transform the management of pneumonia, improving the selection and administration of antimicrobial therapies especially in critically ill patients. The validation of new diagnostic technology platforms is crucial in order to assess their usefulness and to guide antimicrobial treatment in this population.
Successful Stem Cell Apheresis Using Spectra Optia in a 6 kg Child With Atypical Teratoid/Rhabdoid Tumor
Authors: Brust Patrick , Schubert Claudia , Blohm Martin , Winkler Beate
Published: February 2020

Peripheral blood stem cell apheresis has become a routine procedure for the collection of peripheral blood stem cells to enable high-dose chemotherapy followed by autologous stem cell transplantation in high-risk pediatric malignancies. However, the procedure remains challenging in very low-weight infants due to high extracorporeal blood volume and citrate toxicity. Our case report demonstrates in detail a successful and complication-free large-volume leukapheresis in a very small infant weighing 6 kg using a Spectra Optia apheresis system after placing a femoral double-lumen Shaldon catheter. Anticoagulation was achieved by citrate dextrose solution without the use of heparin. The total amount of blood being processed during the procedure equaled almost 4 times the total blood volume of the patient. The final apheresis product contained 14.0×106 CD34+ cells/kg body weight. The infant was diagnosed with an atypical teratoid/rhabdoid tumor of the thalamus and third ventricle at the age of 3 months and had a history of epileptic seizures.
DAISY
Authors: Sweeney Cynthia Divens
Published: February 2020

The International Council of Nurses and the World Health Organization have designated 2020 as the International Year of the Nurse and Midwife. 2020 Is also being celebrated as the 200th anniversary of Florence Nightingale's birth. The DAISY Award, as a global recognition of compassionate, extraordinary nursing care, aligns with both celebrations. DAISY stories from around the world demonstrate that nursing care delivered with compassionate skill is truly global and knows no boundaries!
Educational Program for Physiologic Monitor Use and Alarm Systems Safety
Authors: Phillips JoAnne , Sowan Azizeh , Ruppel Halley , Magness Rochelle
Published: February 2020

Clinical alarm systems safety is a national healthcare concern in the United States. Physiologic monitors are the medical devices associated with the highest number of false and clinically insignificant alarms, producing alarm fatigue and a challenge to meet the national clinical alarm systems safety goal. Modern physiologic monitors are high-tech complex devices with multimeasurement modalities and high sensitivity for alarms. This complexity hinders safe operation of the monitors by nurses and appropriate management of associated alarms. Nurses need to integrate cognitive knowledge, psychomotor skills, and critical thinking to safely operate the monitors and support clinical decisions. Limited resources are available to support clinical education for nurses on physiologic monitor use and alarm management. This toolkit presents an educational framework for physiologic monitor use and alarm safety guided by adult learning principles. The components of the program are (1) knowledge, skills, and attitude of physiologic monitor use; (2) scenario-based learning model to support the knowledge, skills, and attitude necessary for safe monitor use; and (3) a framework for evaluating the educational program. Education should be ongoing and customized per facility to ensure safe use of complex technology and to decrease alarm fatigue, the leading cause of alarm-related sentinel events.
New treatment options for multiresistant gram negatives
Authors: Paterson David L. , Isler Burcu , Stewart Adam
Published: February 2020

Purpose of review

Multidrug-resistant (MDR) Gram-negative bacteria infections are listed among the top public health threats of the current era. As a result, there has been an increase in efforts to develop new therapeutic agents against MDR Gram-negatives. The purpose of this review is to summarize the clinical and preclinical findings associated with recently approved drugs and the drugs in clinical development against ESBL and carbapenemase-producing Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii infections.

Recent findings

There are a number of ESBL active agents in late stage clinical development that can help spare carbapenems. Likewise, recently approved β-lactam/β-lactamase inhibitor combinations allow a change in the treatment of KPC and OXA-48 producers and carbapenem-resistant P. aeruginosa from colistin to new, safer agents. Treatment of Meta-beta-lactamase (MBL) producers remains an unmet need – apart from cefiderocol, most agents with MBL activity are still in clinical development. Among the few agents with carbapenem-resistant A. baumannii activity, durlobactam/sulbactam in phase III clinical trials provides hope.

Armamentarium against MDR Gram-negatives has expanded with the dominance of agents active against ESBL and KPC producers. There is a need to prioritize MBL producers and carbapenem-resistant A. baumannii, as well as the need for clinical trials to test the new agents against serious infections.
Role of new antibiotics in the treatment of acute bacterial skin and skin-structure infections
Authors: Bassetti Matteo , Magnasco Laura , Del Puente Filippo , Giacobbe Daniele Roberto
Published: February 2020

Purpose of review

To summarize the available efficacy and safety data of novel agents for treating acute bacterial skin and skin-structure infections (ABSSSI), focusing on those active against methicillin-resistant Staphylococcus aureus (MRSA).

Recent findings

There are now several agents active against MRSA that are approved for the treatment of ABSSSI, including tedizolid, ceftaroline, dalbavancin, telavancin, oritavancin, delafloxacin, and omadacycline. In addition, iclaprim has completed phase-3 randomized clinical trials (RCTs).

Considering the similar efficacy that arose from direct comparisons in phase-3 RCTs, in order to adopt the best approach for treating ABSSSI on patient-tailored basis, the different safety profiles and formulations of the different available agents should be balanced by taking into account the specific features of each treated patient in terms of baseline comorbidities, related risk of toxicity, need for hospitalization, possibility of early discharge, and expected adherence to outpatient oral therapy.
In-House Hybrid Technique for Customization of Guides and Miniplates in Orthognathic Surgery
Authors: Claus Jonathas Daniel Paggi , Almeida Matheus Spinella , Hernandez-Alfaro Federico
Published: February 2020

The use of customized plates in Orthognathic surgery offers precision in the repositioning of the jaws, according to the virtual planning performed, with the great advantage of avoiding the need for intermediate occlusal splints. However, the conventional customization process takes time to manufacture, present high cost and still involve legal issues with insurance companies. Moreover, a technical disadvantage is that the systems available for customized plates require large incisions, with large detachment of soft tissues for insertion of the guides and plates. The objective of this paper is to present the in-house hybrid technique for customization of guides and miniplates in orthognathic surgery using minimally invasive approaches.
Sinus Floor Augmentation Using Recombinant Human Bone Morphogenetic Protein-2 With Hydroxyapatite: Volume Assessment
Authors: Nam Jung Woo , Chee Young Deok , Park Young Bum
Published: February 2020

Introduction:

The aim of this study was to assess the efficacy of using bone morphogenetic protein-2 with hydroxyapatite granules (BMP-2/hydroxyapatite) during augmentation of maxillary sinus floor, with respect to changes in volume, relative to conventional bone graft materials.

Method and materials:

Twenty of 25 patients in the BMP-2/hydroxyapatite group, and 16 of 33 patients in the conventional materials group met the criteria for inclusion in this study. Computed tomography scans were performed preoperatively, immediately postoperatively, and at follow-up, approximately 6 months postoperatively. Changes in volume and height of both grafted materials were measured using 3-dimensional reconstruction software; these changes were compared between groups.

Results:

The mean (standard deviation) volumetric changes were 0.25 (0.11) cc and −0.07 (0.35) cc, and the mean rates of volumetric changes were 26.44% (7.78%) and −2.92% (30.92%) in BMP-2/hydroxyapatite and conventional materials groups, respectively. The mean height changes were 0.34 (0.73) mm and −0.63 (1.07) mm, and the mean rates of height changes were 3.67% (7.57%) and −5.95% (9.98%) in BMP-2/hydroxyapatite and conventional materials groups, respectively.

Conclusion:

Compared with the conventional materials group, the BMP-2/hydroxyapatite group showed better maxillary sinus floor augmentation results in terms of volumetric changes and grafted material densities, and can provide predictably reliable outcomes.
The Upper Lip Squamous Cell Carcinoma the Role of Wedge Excision
Authors: Obradovic Bojan
Published: February 2020

Lip cancer is the most common malignant lesion of the oral cavity. Most of the tumors have been presented in the lower lip as a SCC, whereas the upper lip SCC is rare. Surgical excision with negative margins is the mainstay of treatment for lip SCC. The author presents a patient with the upper lip SCC treated by wedge surgical excision. Primary reconstruction of the large upper lip defects can be successfully used in appropriately selected patients.
The Management of Facial Fractures: The Legacy of William Milton Adams
Authors: Wallace Robert Doyle , Puente-Espel Jordi , Konofaos Petros
Published: February 2020

Dr Adams was one of the most prominent members of the American Association of Plastic Surgeons and served as secretary and president (1954) of the American Society of Plastic Surgery. Although Dr Adams died unexpectedly at 51 years of age (1957), he described many new techniques and published several outstanding and innovating papers. He was the first to report, in 1942, the use of subcutaneous wires for internal fixation of fractures of the upper jaw. The purpose of this historical paper is to point out the contribution of Dr Adams in the evolution of management of facial fractures.
The Efficacy of Absolute Ethanol and Polidocanol in the Treatment of Venous Malformations
Authors: Sun Li-Ming , Ni Xiao-Dong , Yuan Si-Ming
Published: February 2020

Introduction:

Using meta-analysis to evaluate the efficacy of absolute ethanol and polidocanol in the treatment of venous malformations.

Materials and Methods:

A systematic search of the English literature was conducted in April 2019 including PubMed, Embase and Web of Science. Article selection was based on preset criteria. The included literature was scored on the MINORS scale, and the meta-analysis and the forest plot were made using the R 3.5.1 software for efficiency.

Results:

Ten articles were included in the meta-analysis. Absolute ethanol response rate ranged between 79% and 92% with a pooled rate of 85%, and polidocanol response rate ranged between 63% and 94% with a pooled rate of 77%.

Discussion:

Although sclerotherapy is effective in most studies, a large number of randomized controlled trials are still needed to confirm the best treatment options at different sites.
Patients With Nasal Fracture
Authors: Sindi Abdullah , Abaalkhail Yousef , Malas Moayyad , Alghamdi Abdullah , Joharji Mahmoud
Published: February 2020

Nasal fractures are the most common type of facial bone fracture. Studies conducted globally have shown that nasal fractures represent a significant liability on the health care system due to the frequency of its occurrence among most populations. This study aimed to describe the frequency, etiology, and demographics of nasal fractures in patients presenting to King Fahad General Hospital, Jeddah, Saudi Arabia.

This study was a cross-sectional questionnaire-based study and included all patients with a nasal fracture who were referred from the emergency department to the ENT unit of King Fahad General Hospital over a four-month period (December 2018 to March 2019).

A total of 130 patients with nasal fracture were included in the present study; most of the included patients were males (83.1%). The mean age of the patients was 28.5 years. The most frequent cause of nasal fracture was physical assault (54.6%), followed by road traffic accidents (20%). Most patients had epistaxis and presented with either active epistaxis at the time of assessment or epistaxis that spontaneously resolved after injury. Patients who had lacerations on the nose were more likely to have a displaced nasal bone (P 
= 0.016). Isolated nasal bone fractures were more commonly noted in victims of physical assault, whereas combined facial bone fractures were commonly noted in patients involved in road traffic accidents (P < 0.001).

Most of the injuries occurred in the city, particularly among foreigners and young adults. Physical assault was reported to be the leading cause of nasal fractures.
Assessment of Health Related Quality of Life and Digestive Symptoms in Long-term, Disease Free Survivors After Esophagectomy
Authors: Boshier Piers R. , Klevebro Fredrik , Savva Katerina V. , Waller Anabelle , Hage Lory , Hanna George B. , Low Donald E.
Published: February 2020

Objective:

The aim of this study was to investigate long-term HRQOL and symptom evolution in disease free patients up to 20 years after esophagectomy.

Background:

Esophagectomy has been associated with decreased HRQOL and persistent gastrointestinal symptoms.

Methods:

The study cohort was identified from 2 high volume centers for the management of esophageal cancer. Patients completed HRQOL and symptom questionnaires, including: Digestive Symptom Questionnaire, EORTC QLQ-C30, EORTC QLQ-OG25 Euro QoL 5D, and SF36. Patients were assessed in 3 cohorts: <1 year; 1–5 years, and; >5 years after surgery.

Results:

In total 171 of 222 patients who underwent esophagectomy between 1991 and 2017 who met inclusion criteria and were contactable, responded to the questionnaires, corresponding to a response rate of 77%. Median age was 66.2 years, and median time from operation to survey was 5.6 years (range 0.3–23.1). Early satiety was the most commonly reported symptom in all patients irrespective of timeframe (87.4%; range 82%–92%). Dysphagia was seen to decrease over time (58% at <2 years; 28% at 2–5 years; 20% at >5 years; P = 0.013). Weight loss scores demonstrated nonstatistical improvement over time. All other symptom scores including heartburn, regurgitation, respiratory symptoms, and pain scores remained constant over time. Average HRQOL did not improve from levels 1 year after surgery compared to patients up to 23 years after esophagectomy.

Conclusion:

With the exception of dysphagia, which improved over time, esophagectomy was associated with decreased HRQOL and lasting gastrointestinal symptoms up to 20 years after surgery. Pertinently however long-term survivors after oesophagectomy demonstrated comparable to improved HRQOL compared to the general population. The impact of esophagectomy on gastrointestinal symptoms and long-term HRQOL should be considered when counseling and caring for patients undergoing esophagectomy.
What Constitutes a Clear Margin in Patients With Locally Recurrent Rectal Cancer Undergoing Pelvic Exenteration?
Authors: Koh Cherry E. , Brown Kilian G. M. , Steffens Daniel , Young Jane , Salkeld Glenn , Solomon Michael J.
Published: February 2020

Objectives:

To determine what constitutes a clear resection margin (R0) in patients with LRRC.

Summary of Background Data:

R0 is the most important predictor of survival in patients with LRRC. However, it is not clear what constitutes an R0. A 1–2 mm margin is often used to define R0 but this is based on primary rectal cancer studies. The same definition of R0 is likely inappropriate considering the anatomy and etiology of local recurrences.

Methods:

A prospective maintained database was reviewed. A R2 margin was defined as macroscopic residual disease. R1 was defined as a microscopically involved margin (0 mm margin) and R0 as at least a 0.1 mm margin. Associations between R status and local recurrence was explored using X
2 test. Associations between margins and overall survival and local recurrence free survival were explored using Kaplan-Meier analysis.

Results:

There were 210 patients eligible for inclusion for analysis. Of these, 165 (78.6%), 35 (16.7%), and 10 (4.8%) patients had R0, R1, and R2 margins, respectively. Overall survival was significantly different between patients with R0 versus R1 margins but wider resection margins do not confer a survival benefit [57 months (95% confidence interval 38.5–75.5) vs 33 months (95% confidence interval 20.3–45.7), P = 0.03]. Local recurrence free survival was significantly different between patients with R0 versus R1 margins (2- and 5-year local recurrence free survivals of 53.5% and 20.4% vs 25.9% and 14.8%, respectively, P = 0.001 for both). Margins >0.5 mm were not predictive of local recurrence free survival.

Conclusions:

A microscopically clear resection margin is most important in predicting overall survival. Margins up to 0.5 mm offers a local recurrence benefit but does not confer survival benefit.
Two novel resource-based metrics to quantify pediatric trauma severity based on probability of requiring critical care and anesthesia services
Authors: Snyder Christopher W. , Ciesla David J. , Tepas Joseph J. , Chandler Nicole M. , Danielson Paul D. , Gonzalez Raquel , Partain Kristin , Poulos Nicholas , Pracht Etienne E.
Published: February 2020

BACKGROUND

Mortality-based metrics like the International Classification of Diseases (ICD) Injury Severity Score (ICISS) may underestimate burden of pediatric traumatic disease due to lower mortality rates in children. The purpose of this study was to develop and validate two resource-based severity of injury (SOI) measures, then compare these measures and the ICISS across a broad age spectrum of injured patients.

METHODS

The ICISS and two novel SOI measures, termed ICD Critical Care Severity Score (ICASS) and ICD General Anesthesia Severity Score (IGASS), were derived from Florida state administrative 2012 to 2016 data and validated with 2017 data. The ICASS and IGASS predicted the need for critical care services and anesthesia services, respectively. Logistic regression was used to validate each SOI measure. Distributions of ICISS, ICASS, and IGASS were compared across pediatric (0–15 years), adult (16–64 years), and elderly (65–84 years) age groups.

RESULTS

The derivation and validation cohorts consisted of 668,346 and 24,070 emergency admissions, respectively. On logistic regression, ICISS, ICASS, and IGASS were strongly predictive of observed mortality, critical care utilization, and anesthesia utilization, respectively (p < 0.001). The mean ICISS was 10.6 for pediatric and 19.0 for adult patients (ratio, 0.56), indicating that the predicted mortality risk in pediatric patients was slightly over half that of adults. In contrast, the mean ICASS for pediatric and adult patients was 50.2 and 53.2, respectively (ratio, 0.94); indicating predicted critical care utilization in pediatric patients was nearly the same as that of adults. The IGASS comparisons followed comparable patterns.

CONCLUSION

When a mortality-based SOI measure is used, the severity of pediatric injury appears much lower than that of adults, but when resource-based measures are used, pediatric and adult burden of injury appear very similar. The ICASS and IGASS are novel and valid resource-based SOI measures that are easily calculated with administrative data. They may complement mortality-based measures in pediatric trauma.

LEVEL OF EVIDENCE

Level III, prognostic and epidemiological study.
Humanization of Immunodeficient Animals for the Modeling of Transplantation, Graft Versus Host Disease, and Regenerative Medicine
Authors: Adigbli George , Ménoret Séverine , Cross Amy R. , Hester Joanna , Issa Fadi , Anegon Ignacio
Published: February 2020

The humanization of animals is a powerful tool for the exploration of human disease pathogenesis in biomedical research, as well as for the development of therapeutic interventions with enhanced translational potential. Humanized models enable us to overcome biologic differences that exist between humans and other species, while giving us a platform to study human processes in vivo. To become humanized, an immune-deficient recipient is engrafted with cells, tissues, or organoids. The mouse is the most well studied of these hosts, with a variety of immunodeficient strains available for various specific uses. More recently, efforts have turned to the humanization of other animal species such as the rat, which offers some technical and immunologic advantages over mice. These advances, together with ongoing developments in the incorporation of human transgenes and additional mutations in humanized mouse models, have expanded our opportunities to replicate aspects of human allotransplantation and to assist in the development of immunotherapies. In this review, the immune and tissue humanization of various species is presented with an emphasis on their potential for use as models for allotransplantation, graft versus host disease, and regenerative medicine.
Early Posttransplant Mobilization of Monocytic Myeloid-derived Suppressor Cell Correlates With Increase in Soluble Immunosuppressive Factors and Predicts Cancer in Kidney Recipients
Authors: Utrero-Rico Alberto , Laguna-Goya Rocio , Cano-Romero Francisco , Chivite-Lacaba Marta , Gonzalez-Cuadrado Cecilia , Rodríguez-Sánchez Elena , Ruiz-Hurtado Gema , Serrano Antonio , Fernández-Ruiz Mario , Justo Iago , González Esther , Andrés Amado , Paz-Artal Estela
Published: February 2020

Background.

Myeloid-derived suppressor cells (MDSCs) increase in patients with cancer and are associated with poor prognosis; however, their role in transplantation is not yet understood. Here we aimed to study the MDSC effects on the evolution of kidney transplant recipients (KTRs).

Methods.

A cohort of 229 KTRs was prospectively analyzed. Two myeloid cells subsets. CD11b+CD33+CD14+CD15-HLA-DR–/low (monocytic MDSC [M-MDSC]) and CD11b+CD33+CD14+CD15–HLA-DR+ (monocytes), were defined by flow cytometry. The suppressive capacity of myeloid cells was tested in cocultures with autologous lymphocytes. Suppressive soluble factors, cytokines, anti-HLA antibodies, and total antioxidant capacity were quantified in plasma.

Results.

Pretransplant, M-MDSC, and monocytes were similar in KTRs and healthy volunteers. M-MDSCs increased immediately posttransplantation and suppressed CD4 and CD8 T cells proliferation. M-MDSCs remained high for 1 y posttransplantation. Higher M-MDSC counts at day 14 posttransplant were observed in patients who subsequently developed cancer, and KTRs with higher M-MDSC at day 14 had significantly lower malignancy-free survival. Day 14 M-MDSC >179.2 per microliter conferred 6.98 times (95% confidence interval, 1.28-37.69) more risk to develop cancer, independently from age, gender, and immunosuppression. Early posttransplant M-MDSCs were lower in patients with enhanced alloimmune response as represented by anti-HLA sensitization. M-MDSC counts correlated with higher circulatory suppressive factors arginase-1 and interleukin-10, and lower total antioxidant capacity.

Conclusions.

Early posttransplant mobilization of M-MDSCs predicts cancer and adds risk as an independent factor. M-MDSC may favor an immunosuppressive environment that promotes tumoral development.
Bedside Technologies to Enhance the Early Detection of Pressure Injuries
Authors: Scafide Katherine N. , Narayan Mary Curry , Arundel Linda
Published: February 2020

BACKGROUND:

Hospital-acquired pressure injuries strain organizational resources and negatively impact the quality of life of affected patients. However, early detection of pressure injuries is limited due to challenges with visual assessment, particularly in individuals with dark skin.

PURPOSE:

The purpose of this systematic review was to determine whether sufficient research evidence exists to support the use of bedside technologies for early detection of pressure injures, which is inclusive of pressure-related blanchable erythema (PrBE), pressure-related nonblanchable erythema (PrNBE), and deep tissue pressure injury (DTPI).

SEARCH QUESTION:

What available bedside technologies enhance the early detection of pressure injuries?

METHODS:

A systematic search of Medline, CINAHL, Web of Science, and Cochrane databases was executed. Quantitative studies were included that examined whether accessible technologies could indicate the presence of PrBE, PrNBE, and DTPI. The quality of the research was evaluated using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale.

FINDINGS:

We identified 18 eligible studies that represented a variety of technologies, including ultrasound (n = 5), thermography (n = 7), subepidermal moisture (SEM) measurement (n = 5), reflectance spectrometry (n = 2), and laser Doppler (n = 1). The methodological rigor in study quality was variable. Subepidermal moisture measurement provided the most consistent findings in the early detection of pressure injury.

CONCLUSIONS:

Objective methods that provide accurate and timely assessment of DTPIs augment early implementation of optimal prevention and treatment measures. Evidence identified in this systematic review supports the use of SEM measurement devices as effective tools for early pressure injury detection. However, more research in the field of technology-enhanced, pressure injury detection is needed to support the use of existing and emerging devices.
Do we need sex-oriented clinical practice guidelines for the treatment of schizophrenia?
Authors: Fernando Piyumi , Sommer Iris E.C. , Hasan Alkomiet
Published: February 2020

Purpose of review

Clinical practice guidelines (CPGs) do not usually offer a sex-specific approach for the management of schizophrenia. With this narrative review, we aim to give an integrated and synthesized overview of the current state of knowledge regarding sex-specific aspects in schizophrenia and how this topic may be adapted in the development of CPGs.

Recent findings

Recent studies further suggest sex-specific differences in epidemiologic features, the course of illness, underlying pathomechanisms, response likelihood to antipsychotic medication and differences in tolerability. Beyond this, selective estrogen receptor modulators like raloxifene have shown beneficial effects on symptom severity and cognition in women with schizophrenia.

Sex-specific aspects can already be integrated in clinical guideline recommendations, especially with regard to efficacy and tolerability of antipsychotic treatment. Moreover, these aspects may be used for an individual risk-stratification. Recent studies provide evidence supporting the hypothesis of sex-specific modulation in schizophrenia and build the groundwork for sex-specific novel treatment options. However, there remains a clear need for additional studies focusing on women with schizophrenia to substantiate current findings.
An interdisciplinary and catchment approach to enhancing urban flood resilience: a Melbourne case
Authors: Rogers B. C. , Bertram N. , Gersonius B. , Gunn A. , Löwe R. , Murphy C. , Pasman R. , Radhakrishnan M. , Urich C. , Wong T. H. F. , Arnbjerg-Nielsen K.
Published: February 2020

This paper presents a novel interdisciplinary and catchment-based approach for exploring urban flood resilience. Our research identified and developed a diverse set of adaptation measures for Elwood, a suburb in Melbourne, Australia, that is vulnerable to pluvial and coastal flooding. We drew on methods from social science, urban design and environmental engineering to gain integrated insights into the opportunities for Elwood to increase its flood resilience and urban liveability. Results showed that an appropriate balance of social, infrastructural and urban design responses would be required to retreat from, accommodate and protect against flood risk. These would also deliver broader benefits such as securing water supplies through harvested stormwater and mitigating extreme heat through greener landscapes. Our interdisciplinary approach demonstrated the value of (i) engaging with the community to understand their concerns, aspirations and adaptation ideas, (ii) exploring design measures that densify and use urban forms in ways that implement adaptation measures while responding to local context, (iii) adopting modelling techniques to test the performance, robustness and economic viability of possible adaptation solutions, and (iv) innovating governance arrangements and principles needed to improve flood resilience in the Elster Creek catchment. Our research also provided valuable insight on how to operationalize interdisciplinary work in practice, highlighting the importance of sharing an impact agenda, taking a place-based approach, developing a common conceptual framework, and fostering a constructive team culture.

This article is part of the theme issue ‘Urban flood resilience’.