bluuebunny/crossref_metadata_2025 huggingface dataset:
Establishing Consensus on the Best Practice Guidelines for Use of Halo Gravity Traction for Pediatric Spinal Deformity
Authors: Roye Benjamin D. , Campbell Megan L. , Matsumoto Hiroko , Pahys Joshua M. , Welborn Michelle Cameron , Sawyer Jeffrey , Fletcher Nicholas D. , McIntosh Amy L. , Sturm Peter F. , Gomez Jaime A. , Roye David P. , Lenke Lawrence G. , Vitale Michael G.
Published: April 2019

Background:

Although halo gravity traction (HGT) has been used to treat children with severe spinal deformity for decades, there is a distinct lack of high-quality evidence to speak to its merits or to dictate ideal manner of implementation. In addition, no guidelines exist to drive research or assist surgeons in their practice. The aim of this study was to establish best practice guidelines (BPG) using formal techniques of consensus building among a group of experienced pediatric spinal deformity surgeons to determine ideal indications and implementation of HGT for pediatric spinal deformity.

Methods:

The Delphi process and nominal group technique were used to formally derive consensus among leaders in pediatric spine surgery. Initial work identified significant areas of variability in practice for which we sought to garner consensus. After review of the literature, 3 iterative surveys were administered from February through April 2018 to nationwide experts in pediatric spinal deformity. Surveys assessed anonymous opinions on ideal practices for indications, preoperative evaluation, protocols, and complications, with agreement of 80% or higher considered consensus. Final determination of consensus items and equipoise were established using the Nominal group technique in a facilitated meeting.

Results:

Of the 42 surgeons invited, responses were received from 32, 40, and 31 surgeons for each survey, respectively. The final meeting included 14 experts with an average 10.5 years in practice and average 88 annual spinal deformity cases. Experts reached consensus on 67 items [indications (17), goals (1), preoperative evaluations (5), protocols (36), complications (8)]; these were consolidated to create final BPG in all categories, including statements to help dictate practice such as using at least 6 to 8 pins under 4 to 8 lbs of torque, with a small, tolerable starting weight and reaching goal weight of 50% TBW in ∼2 weeks. Nine items remained items of equipoise for the purposes of guiding future research.

Conclusions:

We developed consensus-based BPG for the use and implementation of HGT for pediatric spinal deformity. This can serve as a measure to help drive future research as well as give new surgeons a place to begin their practice of HGT.

Level of Evidence:

Level V—expert opinion.
Prevalence of Hip Dysplasia and Associated Conditions in Children Treated for Idiopathic Early-onset Scoliosis—Don’t Just Look at the Spine
Authors: Talmage Matthew S. , Nielson Alexandra N. , Heflin John A. , D’Astous Jacques L. , Fedorak Graham T.
Published: April 2019

Background:

Hip dysplasia, congenital muscular torticollis, plagiocephaly, and metatarsus adductus are known to be associated. The etiology of infantile idiopathic scoliosis and its association with the aforementioned conditions is unknown. This study reviews a series of infantile scoliosis patients to address this gap.

Methods:

The medical records of all patients treated with casting for early-onset scoliosis (EOS) from 2001 to 2016 were retrospectively reviewed. Inclusion criteria were a diagnosis of idiopathic EOS and age below 4 years at the time of the first cast. Demographic information, comorbid conditions, and radiographic measurements including Cobb angle and acetabular index (AI) were collected. The first acceptable anteroposterior pelvis radiograph for each patient was measured. An AI≥30 degrees was defined as hip dysplasia. A measurement between 25 and 30 degrees was defined as a “hip at risk.”

Results:

Between 2001 and 2016, 142 patients were treated with casting. Eighty-one patients met the inclusion criteria. The mean age at the first cast was 19.3 (±7.5) months and the mean Cobb angle was 53.6 (±18.8) degrees. There was no significant correlation between Cobb angle and AI. Nine patients met radiographic criteria for hip dysplasia (11.1%), only 4 of whom had been previously diagnosed. Thirty-six patients (44.4%) met the criteria of having at least 1 hip “at risk” of hip dysplasia. Ten patients (12.3%) had been diagnosed with torticollis and 13 patients (16.0%) with plagiocephaly. Three patients (3.7%) had been diagnosed with metatarsus adductus or clubfoot. In total, 30.9% of patients (25/81) had at least one of the above comorbid conditions.

Conclusions:

In a large group of children treated for idiopathic EOS, we found a high prevalence of commonly associated conditions—hip dysplasia, torticollis, plagiocephaly, metatarsus adductus, and clubfoot. In 6.2% of our sample, a diagnosis of hip dysplasia was not made in a timely manner despite routine radiographic spine follow-up. With increasing subspecialization within pediatric orthopaedics, surgeons need to maintain vigilance in assessing the entire child.

Level of Evidence:

Level IV.
Two Transiliac-Transsacral Screws in a Single Sacral Level: Surgical Technique and Patient Outcomes
Authors: Chang Gerard , Fram Brianna , Sobol Keenan , Krieg James C.
Published: April 2019

Percutaneous fixation of posterior pelvic injuries is increasingly common. Use of transiliac-transsacral (TI-TS) screws can provide improved fixation, relative to standard iliosacral screws. In certain circumstances, utilizing 2 TI-TS screws may confer greater stability and strength, and there may be a need or desire to place them both in a single sacral level safe zone. We describe a technical guide on how to preoperatively assess if the S1 or S2 corridor can safely accommodate 2 TI-TS screws, and how to execute the technique using intraoperative fluoroscopy. We also report our institutional experience of 20 patients who were treated with 2 TI-TS screws for both high-energy and fragility posterior pelvic ring injuries.
Biomechanical Comparison of Pronator Quadratus Repair Techniques in the Modified Henry Approach for Distal Radius Fracture
Authors: Marmen Andreanne , Lepine Josianne , Leblanc Elisabeth , Balg Frederic
Published: April 2019

Background:

Open reduction and volar plate fixation of distal radius fracture frequently involve detaching the pronator quadratus muscle. Repair maybe difficult due to friable muscle fascia or bulky plate. This study evaluates the strength of 3 repair techniques.

Methods and Results:

Repair with separate Simple Sutures, Continuous Suture, or Suture Anchors was tested on 3 groups of 6 cadaver forearms. A distraction load was applied to all repairs on a traction simulator until there was a failure of either the suture, the muscle or the anchor. Simple Suture group could resist 20.7 N, the Continuous Suture group 33.3 N, and the Suture Anchors group 42.5 N. The load to displacement were, respectively, 20.0, 25.9, and 34.6 N. The mode of failure was noted.

Conclusions:

This cadaveric study shows that if deemed necessary for soft tissue coverage or for biological aid in fracture healing, suture anchor is the strongest repair choice for pronator quadratus. This conclusion must be weighed against the fact that no in vivo tensile strength value sustained by the pronator quadratus is known in the literature and that simple suture could be sufficient to hold the repaired muscle while the wrist is immobilized postoperatively.
A Biomechanical Evaluation of Multiple Fixation Methods for the Treatment of Low Transverse Distal Fibula Fractures Seen With Supination Adduction Ankle Injuries Using an Osteoporotic Sawbones Model
Authors: Gao Ian , Ahearn Briggs M. , Fantry Amanda , Tenenbaum Shay , Bariteau Jason
Published: April 2019

This study sought to determine the best biomechanical fixation of low transverse distal fibula fractures as seen in supination-adduction–type ankle fractures. Four different fixation methods—a one-third tubular plate with 1 distal screw, a one-third tubular plate with 2 distal screws, a 2.4-mm mini fragment T-plate, and a fibular-specific locking plate—were compared for fixation of low transverse distal fibula fractures using an osteoporotic Sawbones model. Biomechanical testing was performed to determine stiffness of the constructs as well as load to failure (survival). A one-third tubular plate with either 1 or 2 screws distally as well as a fibula-specific locking plate was biomechanically stiffer than a 2.4-mm mini frag T-plate. Survival rates between groups were not significantly different. These results suggest the use of either a one-third tubular plate or a fibula-specific locking plate for fixation of low transverse distal fibula fractures, especially in osteoporotic bone.
The Association of Premorbid Metformin Exposure With Mortality and Organ Dysfunction in Sepsis: A Systematic Review and Meta-Analysis
Authors: Tan Kaiquan , Simpson Andrew , Huang Stephen , Tang Benjamin , Mclean Anthony , Nalos Marek
Published: April 2019

Objectives:

To examine the association between premorbid metformin exposure and mortality, hyperlactatemia, and organ dysfunction in sepsis.

Data Sources:

PubMed and EMBASE (with Medline via Ovid) databases were searched for all studies of premorbid metformin exposure and sepsis published between January 1974 and August 2018.

Study Selection:

Studies of at least 20 patients with sepsis that reported data on metformin use, mortality, and/or organ dysfunction were independently selected.

Data Extraction:

Two reviewers abstracted data on study design, settings, study quality, participants, metformin exposure, mortality, initial lactate levels, and organ dysfunction. Risk of bias was independently assessed.

Data Synthesis:

Eight observational studies fulfilled our criteria, comprising 4,144 patients with sepsis including 562 diabetics on metformin. Premorbid metformin exposure was associated with reduced mortality in sepsis (odds ratio, 0.57; 95% CI, 0.40–0.80). Between studies heterogeneity was low (i
2 = 43%; τ2 = 0.1; p = 0.09). Premorbid metformin exposure was not significantly associated with initial lactate levels (mean difference, 0.39 [–0.50 to 1.28]; i
2 = 72%; p = 0.39).

Conclusions:

The meta-analysis suggests that premorbid metformin exposure is associated with decreased mortality in sepsis but not with hyperlactatemia. What are the potential mechanisms and whether there is any effect on organ dysfunction remain unclear.
A randomised controlled trial evaluating the effectiveness of Facebook compared to leaflets in raising awareness of melanoma and harmful sun-related behaviour among young adults
Authors: Agha-Mir-Salim Louis , Bhattacharyya Anudeep , Hart Danielle , Lewandowska Marta , Spyropoulou Evangelia , Stinson Luke , Tiefenbach Jakov
Published: April 2019

This study describes a randomised control trial investigating whether printed leaflets or social media are more effective in increasing knowledge of the risks of sun exposure and melanoma in people aged 18–29. The study participants were 18–29-year-old university students or graduates, recruited in London. A baseline level of knowledge was measured using the Skin Cancer and Sun Knowledge questionnaire. Study participants were then randomised into either a leaflet arm or Facebook arm. Identical information was delivered through a SunSafe campaign via either posted leaflets or Facebook during a 10-day exposure window. Following this, participants repeated the Skin Cancer and Sun Knowledge questionnaire. Following the SunSafe intervention, the mean knowledge score improved in both groups to a statistically significant degree (Facebook = 1.82, leaflets = 3.04, P < 0.001). Moreover, the improvement in knowledge score of the leaflet arm was statistically significantly greater than in the Facebook arm (95% confidence interval: 0.35–2.09, P = 0.0059). Participants of lighter skin colour demonstrated greater levels of knowledge about skin cancer and sun exposure at baseline (P = 0.005; P < 0.05). There was no correlation between sex and baseline knowledge (P = 0.7725). There was no significant effect of skin tone or sex on the knowledge change (P = 0.139 and 0.643). The findings suggest that printed information in the form of leaflets is more impactful in increasing knowledge than online platforms such as Facebook among a young adult demographic in the UK. These findings should be considered when designing public health campaigns, acting as a reminder to not neglect traditional media in health promotion.
Fresh or Frozen Embryo Transfer in In Vitro Fertilization: An Update
Authors: PEREIRA NIGEL , PETRINI ALLISON C. , HANCOCK KOLBE L. , ROSENWAKS ZEV
Published: April 2019

The past decade has witnessed a rapid increase in the number of frozen-thawed embryo transfer (FET) cycles. Several factors have contributed to the increase in FET cycles, including improvement in culture media, vitrification, and an increase in preimplantation genetic testing of embryos. However, the accelerated trend in FET cycles also suggests that FET may be preferred over fresh embryo transfer. The current review explores the factors that have influenced this practice shift toward preferential FET and why this shift may be premature.
Corneal Tomography Changes and Refractive Outcomes After Descemet Stripping Without Endothelial Keratoplasty
Authors: Davies Emma , Pineda Roberto
Published: April 2019

Purpose:

To investigate corneal tomography changes and refractive outcomes after Descemetorhexis without endothelial keratoplasty (DWEK).

Methods:

Retrospective chart review of 25 eyes from 16 patients with Fuchs corneal endothelial dystrophy that underwent successful DWEK combined with cataract surgery.

Results:

There was no significant change in anterior corneal curvature on tomography maps. However, all tomography maps demonstrated an increase in central posterior float and all but one demonstrated a decrease in pachymetry after DWEK. Only 7 of 25 eyes had increased irregular astigmatism on tomography after DWEK, of which 57% had preexisting irregular astigmatism before the procedure. The mean difference between the targeted and outcome refraction was +0.65 diopters (D) at the time of corneal clearance, but this improved to +0.38 D 1 month after corneal clearance. Postoperative refraction was within 1 D of target refraction for 92% of cases (23 eyes) but within 0.5 D of target refraction for only 48% of cases (12 eyes). The differences between expected and actual refractive outcomes were correlated with change in posterior corneal curvature and pachymetry.

Conclusions:

DWEK induces an increased central posterior float localized to the site of Descemet membrane stripping, confirming the need for centralized stripping. Irregular astigmatism can occur after DWEK but is typically minimal and occurs more commonly in the setting of preoperative irregular astigmatism. DWEK induces about a 0.5 D hyperopic shift, which should be considered when determining intraocular lens power with simultaneous surgery.
Expressible Meibomian Glands Have Occult Fixed Obstructions: Findings From Meibomian Gland Probing to Restore Intraductal Integrity
Authors: Maskin Steven L. , Alluri Sreevardhan
Published: April 2019

Purpose:

To describe and quantify findings of intraductal obstruction during probing expressible and nonexpressible meibomian glands (MGs) in patients with obstructive meibomian gland dysfunction using a 1-mm intraductal MG probe.

Methods:

A retrospective study of probe findings from 108 consecutive patients. Nonparametric tests using SPSS software 25.0 to explore relationships between expressibility and probe findings.

Results:

Of 11,776 probed glands of 404 lids, 84% showed mechanical resistance (MR) and 16% showed no resistance (NR). Fixed, firm, focal unyielding resistance (FFFUR) occurred in 79.5% of obstructed glands, and nonfixed, nonfocal easily yielding soft resistance (SFT) in 20.4%. FFFUR was characterized by an audible and tactile “firm pop” (FP) or “firm gritty” (FG) sensation. No significant difference in MR and FFFUR for lids between 0% and >90% gland expressibility was observed. FP correlated with increased expressibility (P = 0.011), lid tenderness (P = 0.045), and complete proximal obstruction (P = 0.037), whereas SFT correlated with reduced expressibility (P = 0.016). Upper lids showed greater incidence of MR (P < 0.001), FFFUR (P < 0.001), and FG (P < 0.001), whereas lower lids showed greater expressibility (P < 0.001) and NR (P < 0.001).

Conclusions:

FFFUR was the most common probe finding in a large series of consecutively probed MGs, with an incidence of 67% of glands and 80% of obstructed glands. FFFUR was independent of gland expressibility, demonstrating expressible glands harbor FFFUR deep to at least one acinus. FP was associated with expressible gland occult obstruction and lid tenderness. SFT correlated with reduced expressibility, perhaps related to altered duct/duct contents. Upper lids correlated with increased MR, FFFUR, and FG and lower lids with increased expressibility and NR, possibly reflecting contrasting anatomy and blink-related microtrauma.
Backward walking observational training improves gait ability in patients with chronic stroke: randomised controlled pilot study
Authors: Moon Yiyeop , Bae Youngsook
Published: April 2019

Backward walking has a positive effect on gait ability. Action observational training is an effective treatment method for stroke neurological disorders. This randomised comparator-controlled pilot study aimed to evaluate the feasibility of backward walking observational training on the gait ability of chronic stroke patients. Fourteen chronic stroke participants were randomly allocated to the experimental group (backward walking observation; n = 7) and control group (landscape observation; n = 7). Both groups performed conventional therapy 5 days/week; then the backward walking observation and landscape observation + backward walking training groups performed the observational training 3 days/week for 4 weeks. The primary outcome was measured dynamic gait index, 10-m walking test, and timed up and go test time. Both groups showed significant increases in dynamic gait index, 10-m walking test, and timed up and go test time. The experimental group showed more significant improvements in dynamic gait index (P= 0.04, η2= 0.336), 10-m walking test (P= 0.04, η2= 0.306), and timed up and go test time (P= 0.03, η2= 0.334) than the control group. This pilot study demonstrated that conventional therapy with backward walking observational training improves gait ability. Our findings suggest that observing an action may have a positive effect on chronic stroke patients.

Trial Registration Clinical Trials:KCT0003098.
Recommendations for Fall-Related Injury Prevention
Authors: Soncrant Christina , Neily Julia , Bulat Tatjana , Mills Peter D.
Published: April 2019

Background:

Injurious falls continue to challenge health care. Causes of serious falls from the largest health care system in the United States can direct future prevention efforts.

Purpose:

This article analyzes injurious falls in the Veterans Health Administration and provides generalizable recommended actions to prevent future events.

Methods:

We categorized root cause analysis (RCA) reports and coded injury type, fall type, location, and root causes. We describe interventions during the fall and provide resources for future prevention.

Results:

There were 154 reported fall RCAs during this time. Most (83%, n = 128) resulted in major injury: hip fractures (43%, n = 66), other fractures (25%, n = 38), and head injury (16%, n = 24). Most falls were unwitnessed (75%, n = 116).

Conclusions:

Patients who fell were not wearing hip or head protection. Most falls were unwitnessed, and none were on 1:1 observation. Such interventions may help prevent future injurious falls.
Effectiveness of Retrobulbar Hyaluronidase Injection in an Iatrogenic Blindness Rabbit Model Using Hyaluronic Acid Filler Injection
Authors: Lee Won , Oh Wook , Ko Hyung-Seok , Lee Sang-Young , Kim Ki Wook , Yang Eun-Jung
Published: April 2019

Background:

Blindness caused by soft-tissue filler injection is the most tragic complication, with no standard treatments until recently. Retrobulbar hyaluronidase injection has been proposed as the treatment, but its effectiveness in visual compromise remains to be determined. The authors aimed to determine the effectiveness of retrobulbar hyaluronidase using soft-tissue filler in an iatrogenic blindness animal model.

Methods:

New Zealand White rabbits were used to simulate the hyaluronic acid–associated vascular occlusion model. A volume of 0.7 to 1.6 ml of hyaluronic acid filler was injected into the internal carotid artery to create a retinal artery occlusion. The rabbits were administered retrobulbar hyaluronidase (3000 IU) at different postobstruction time points (5 and 10 minutes). No intervention was given to the control group. Fundus photography was performed before and immediately after the filler injection and immediately after the administration of retrobulbar hyaluronidase. Electroretinography was performed after 60 minutes to confirm the retinal reperfusion and electrophysiologic function.

Results:

All of the experimental eyes recorded total occlusion after hyaluronic acid injection. Three eyes with a completely occluded retinal artery following retrobulbar hyaluronidase treatment showed improved retinal reperfusion by fundus photography and corresponding electroretinography. Despite administration of the retrobulbar hyaluronidase injection, one completely occluded eye showed no improvement in perfusion. All of the control eyes recorded complete occlusion 1 hour after hyaluronic acid filler injection.

Conclusions:

Retrobulbar hyaluronidase may be an effective evidence-based treatment option for humans. Hyaluronidase concentration and injection time are the important factors for faster recovery, but additional studies are still required.
Outcomes of Single versus Double Fascicular Nerve Transfers for Restoration of Elbow Flexion in Patients with Brachial Plexus Injuries: A Systematic Review and Meta-Analysis
Authors: Sneiders Dimitri , Bulstra Liselotte F. , Hundepool Caroline A. , Treling Willemijn J. , Hovius Steven E. R. , Shin Alexander Y.
Published: April 2019

Background:

Elbow flexion after upper brachial plexus injury may be restored by a nerve transfer from the ulnar nerve to the biceps motor branch with an optional nerve transfer from the median nerve to the brachialis motor branch (single and double fascicular nerve transfer). This meta-analysis assesses the effectiveness of both techniques and the added value of additional reinnervation of the brachialis muscle.

Methods:

Comprehensive searches were performed identifying studies concerning restoration of elbow flexion through single and double fascicular nerve transfers. Only C5 to C6 lesion patients were included in quantitative analysis to prevent confounding by indication. Primary outcome was the proportion of patients reaching British Medical Research Council elbow flexion grade 3 or greater. Meta-analysis was performed with random effects models.

Results:

Thirty-five studies were included (n = 688). In quantitative analysis, 29 studies were included (n = 341). After single fascicular nerve transfer, 190 of 207 patients reached Medical Research Council grade 3 or higher (random effects model, 95.6 percent; 95 percent CI, 92.9 to 98.2 percent); and after double fascicular nerve transfer, 128 of 134 patients reached grade 3 or higher (random effects model, 97.5 percent; 95 percent CI, 95.0 to 100 percent; p = 0.301). Significantly more double nerve transfer patients reached grade 4 or greater if preoperative delay was 6 months or less (84 of 101 versus 49 of 51; p = 0.035).

Conclusions:

Additional reinnervation of the brachialis muscle did not result in significantly more patients reaching Medical Research Council grade 3 or higher for elbow flexion. Double fascicular nerve transfer may result in more patients reaching grade 4 or higher in patients with a preoperative delay less than 6 months. The median nerve may be preserved or used for another nerve transfer without substantially impairing elbow flexion restoration.
Physician’s Experience and Disease Activity Affect the Impact of Ultrasound on the Treatment Decision in Rheumatoid Arthritis
Authors: Sifuentes-Cantú Cesar , Contreras-Yáñez Irazú , Gutiérrez Marwin , Torres-Ruiz Jiram , Zamora-Medina Maria del Carmen , Romo-Tena Jorge , Castillo Jose Pablo , Ruiz-Medrano Emmanuel , Martín-Nares Eduardo , Quintanilla-González Lauro , Bermúdez-Bermejo Paola , Pérez-Rodríguez Rogelio , López-Morales Jorge , Whittall-García Laura , García-Galicia Jorge , Valdés-Corona Luis , Pascual-Ramos Virginia
Published: April 2019

Background/Objective

The aim of this cross-sectional study was to explore which factors affect the impact of musculoskeletal ultrasound (MUS) on the treatment proposal among rheumatologists with different degree of experience.

Methods

Sixteen clinical vignettes summarized data from rheumatoid arthritis (RA) outpatients; vignettes included clinical evaluation and a blank section for a first treatment proposal; MUS information was then added, based on German Ultrasound score, followed by a blank section for treatment re-consideration, if applicable. During a 6 months period, each vignette was concomitantly presented to six trainees and six senior rheumatologists (SR); three SR had ≥15 years of experience. Participants were blinded to colleagues’ responses. Appropriated statistics were used.

Results

Vignettes included data from female patients, who had a mean ± SD age of 43.3 ± 9 years, 7.6 ± 3.5 years of disease duration and comorbidities (68.8%). MUS induced treatment modification in 24% of evaluations, with similar percentage among SR and trainees. Within SR, more experienced rheumatologists (≥15 years) never translated MUS findings in a different treatment proposal, compared to 34% of those with lesser experience, p ≤ 0.0001. There were 60 clinical scenarios each, with remission and moderate disease activity, and 36 clinical scenarios each, with low and high disease activity. MUS-induced treatment modifications were more frequent in scenarios with low and moderate disease activity, compared to remission and high disease activity, p = 0.008.

Conclusions

Physician’s experience and disease activity level affect the impact of MUS on the treatment decision in RA outpatients. RA patients with intermediate disease activity may benefit from MUS incorporation to standard assessments.
Selenium and Selenoprotein P Deficiency Correlates With Complications and Adverse Outcome After Major Trauma
Authors: Braunstein Mareen , Kusmenkov Thomas , Zuck Catrin , Angstwurm Matthias , Becker Niels-Peter , Böcker Wolfgang , Schomburg Lutz , Bogner-Flatz Viktoria
Published: April 2019

Background:

A declining selenium (Se) status constitutes a characteristic of critical illness and may affect disease course and survival. The dynamics of trauma-induced changes in biomarkers of Se status are poorly characterized, and an association with multiple organ failure (MOF) and mortality can be hypothesized. It was the aim of this study to investigate Se and selenoprotein P (SELENOP) concentrations in major trauma patients during the early posttraumatic period.

Patients and Methods:

Twenty-four patients after major trauma (ISS ≥16) were included at our level one trauma center. Se supplementation ever during the 90-day observation period was defined as an exclusion criterion. Serum samples were drawn within less than 60 min after trauma, and after 6 h, 12 h, 24 h, 48 h, and 72 h. Serum Se was analyzed by X-ray fluorescence and SELENOP concentrations by ELISA. The data were correlated to clinical parameters, occurrence of MOF defined by MOF and APACHE II score, lung injury defined by Horowitz index and clinical outcome (90-days survival).

Results:

Serum Se and SELENOP concentrations of the trauma patients were significantly below the average of healthy European subjects (mean ±SD; Se, 41.2±8.1 vs. 84.7±23.3 μg/L, P < 0.001; SePP, 1.5±0.3 vs. 4.3±1.0 mg/L, P < 0.001). A strong deficit was present already at the first time point (Se; 33.6±10.5 μg/L, SELENOP: 1.4±0.5 mg/L). The clinical scores collectively showed an inverse relation between health status and Se biomarkers. Patients who did not survive the 90-day observation period exhibited significantly lower initial post-trauma Se status than the surviving patients (mean±SD; Se, 24.7±7.2 vs. 39.2±8.4 μg/L, P<0.05; SePP, 1.1±0.4 vs. 1.6±0.4 mg/L, P<0.05).

Conclusion:

Very low Se and SELENOP concentrations occur fast after major trauma and are associated with poor survival odds. These findings support the notion that early Se substitution may constitute a meaningful adjuvant treatment strategy in trauma patients.
Cholecystokinin Modulates the Mucosal Inflammatory Response and Prevents the Lipopolysaccharide-Induced Intestinal Epithelial Barrier Dysfunction
Authors: Saia Rafael Simone , Ribeiro Aline Barbosa , Giusti Humberto
Published: April 2019

The intestinal mucosa plays a critical role in the organism, acting as an interface between the lamina propria and the harmful antigens in the lumen. Sepsis is associated with primary injury to the intestinal mucosa, which in turn induces bacterial translocation and hyperpermeability. Cholecystokinin (CCK) is a peptide synthesized by several cell types, whose immunomodulatory activity has been reported in experimental models of inflammation. We hypothesized that the CCK treatment could modulate the inflammatory response and protect the integrity of the intestinal barrier in endotoxemic rats. Ten minutes before the endotoxemia induction by lipopolysaccharide (LPS) administration, rats were pretreated with CCK at two doses (0.4 μg/kg or 40 μg/kg). Mucosal permeability, bacterial translocation, cytokines production, histology injury, and expression of tight junction (TJ) proteins were the parameters assessed. In the early phase of endotoxemia, rats exhibited impaired intestinal barrier function, increased mucosal permeability, bacterial translocation, and also hyperactivation of the inflammatory response. On the other hand, the pretreatment with CCK modulated the mucosal production of pro-inflammatory cytokines and increased the expression of seal-forming TJ proteins (occludin, claudin-1 and junctional adhesion molecule (JAM-A)) only in the colon and also, reduced the bacterial counts in the mesenteric lymph nodes. However, CCK has a site-specific mechanism of action in the colon via CCK-1R, which is upregulated by the CCK treatment. In synergy with previous findings from our research group, the present results demonstrated that CCK preserves the integrity of the intestinal mucosa and might be a promising hormonal adjuvant therapy for the treatment of sepsis.
Effect of Vasopressors on the Macro- and Microcirculation During Systemic Inflammation in Humans In Vivo
Authors: van Loon Lex M. , Stolk Roeland F. , van der Hoeven Johannes G. , Veltink Peter H. , Pickkers Peter , Lemson Joris , Kox Matthijs
Published: April 2019

Aim:

Comparing the effects of different vasopressors in septic shock patients is hampered by high heterogeneity and the fact that current guidelines dictate the use of norepinephrine. Herein, we studied the effects of three vasopressor agents, norepinephrine, phenylephrine, and vasopressin, on the macro- and microcirculation during experimental human endotoxemia, a standardized, controlled model of systemic inflammation in humans in vivo.

Methods:

We performed a randomized controlled study in which 40 healthy male volunteers were assigned to a 5-h infusion of either 0.05 μg/kg/min norepinephrine (n = 10), 0.5 μg/kg/min phenylephrine (n = 10), 0.04 IU/min vasopressin (n = 10), or saline (n = 10), starting 1 h before intravenous administration of 2 ng/kg lipopolysaccharide (LPS). The macrocirculation was monitored using arterial catheter-derived parameters with additional blood pressure waveform contour analysis (PCA) until 4.5 h following LPS administration. Sublingual microcirculatory density and flow were assessed using a handheld video microscope until 6 h post-LPS.

Results:

LPS administration affected all macrocirculatory and microcirculatory parameters. The LPS-induced decrease in blood pressure and systemic vascular resistance (SVR) was refractory to low-dose norepinephrine and phenylephrine, and to a lesser extent, to vasopressin. Only vasopressin exerted effects on PCA parameters compared with placebo, by mitigating the LPS-induced decrease in diastolic blood pressure by stabilizing SVR and cardiac output. The endotoxemia-induced decreased indices of microvascular flow and density were not influenced by vasopressor therapy.

Conclusions:

In a highly controlled model of systemic inflammation in humans in vivo, a 5-h infusion of various vasopressors revealed distinctive effects on macrohemodynamic variables without affecting the sublingual microcirculation.
Conversion of Adjustable Gastric Banding to Stapling Bariatric Procedures
Authors: Spaniolas Konstantinos , Yang Jie , Zhu Chencan , Maria Altieri , Bates Andrew T. , Docimo Salvatore , Talamini Mark , Pryor Aurora D.
Published: April 2019

Objective:

The aim of this study was to compare the safety of single- versus two-stage conversion of adjustable gastric band (AGB) to gastric bypass (RYGB) or sleeve gastrectomy (SG).

Summary Background Data:

AGB patients often present for conversion to RYGB or SG. The impact of single- or two-stage approach of such conversion remains unclear.

Methods:

A statewide database was used to identify all patients who underwent AGB removal and concurrent (single-stage) or interval (two-stage) RYGB or SG. Propensity score matching schemes were constructed to account for differences in baseline comorbidities and demographics, allowing for matched pairs available for comparisons.

Results:

A total of 4330 patients underwent AGB conversion. Complications, readmissions, and ED visits were noted in 394 (9.1%), 278 (6.42%), and 589 (13.6%) patients, respectively. Three hundred sixty-seven matched pairs underwent RYGB; single-stage patients experienced shorter length of stay (LOS) (median difference −1 d, P < 0.0001), less complications [risk difference (RD): −8.4%, 95% confidence interval (CI), −13.4% to −3.5%], readmissions (RD: −5.2%, 95% CI, −9.6% to −0.8%), and ED visits (RD: −5.7%, 95% CI, −11.3% to −0.2%). Eight hundred seventy-five matched pairs underwent SG; single-stage patients experienced improved outcomes in all measures examined. For single-stage procedures (809 pairs), RYGB was associated with longer LOS, and more complications (RD: 3.3%, 95% CI, 0.9%–5.8%), with similar readmissions, and ED visits.

Conclusions:

AGB conversion procedures have low morbidity. Single-stage conversion is associated with lower morbidity compared with the two-stage approach. Conversion to SG seems to be safer than RYGB.
Preformed Donor-specific Antibodies Against HLA Class II and Graft Outcomes in Deceased-donor Kidney Transplantation
Authors: Uffing Audrey , Hidalgo Luis G. , McMullan Ciaran , Perry Jacqueline , Milford Edgar L. , Murakami Naoka , Yeung Melissa Y. , Guleria Indira , Wood Isabelle G. , Akalin Enver , Azzi Jamil , Chandraker Anil K. , Riella Leonardo V.
Published: April 2019

Background.

Many kidney transplant centers in the United States report both HLA class I and II antibodies detected by sensitive solid-phase assays (SPAs) to United Network for Organ Sharing as unacceptable antigens, significantly reducing the compatible donor organ pool and prolonging waiting time for highly sensitized patients. However, the clinical relevance of all detected donor-specific antibodies (DSAs) by SPA is not unequivocal, because fluorescence intensity does not always accurately reflect antibody pathogenicity. Our center does not exclude patients from transplantation based on DSA class II.

Methods.

We performed a retrospective analysis in 179 deceased-donor kidney transplant recipients with solely DSA class II before transplant and patients without DSA and compared graft survival, rejection, and clinical outcomes. Patient survival was also compared with matched controls on the waiting list.

Results.

Patients transplanted with DSA class II showed a clear survival benefit compared with matched patients who remained on dialysis or were waitlisted on dialysis/transplanted at 5 years (100%, 34%, and 73%, respectively). After a mean follow-up of 5.5 years, there was no significant difference in death-censored graft survival between transplanted patients without DSA and those with preformed DSA class II (adjusted HR 1.10; 95% confidence interval, 0.41–2.97), although the incidence of rejection was higher in recipients with DSA class II (adjusted HR 5.84; 95% confidence interval, 2.58–13.23; P < 0.001). Serum creatinine levels at 1, 3, and 5 years posttransplant did not differ between groups. No predictors of rejection were found, although patients who received basiliximab induction therapy had higher incidence of rejection (100%) compared with those who received antithymocyte globulin (52%).

Conclusions.

We conclude that for highly sensitized patients, deceased-donor kidney transplantation with DSA class II yields a survival benefit over prolonged waiting time on dialysis. Instead of listing DSA class II as unacceptable antigens, an individual approach with further immunologic risk assessment is recommended.
Cortical visual prosthesis: a detailed large-scale simulation study
Authors: Antolik Jan , Sabatier Quentin , Galle Charlie , Frègnac Yves , Benosman Ryad
Published: April 2019

Recent advances in applying optogenetics in primates initiated the development of light based prosthetic implants for sensory restoration. Thanks to being the most well explored cortical area that is readily accessible at the surface of the brain, vision restoration via direct optogenetic activation of primary visual cortex is one of the most promising early targets for a optogenetics based prosthetic program. However, two fundamental elements of the cortical optogenetic prosthesis remain unclear. First, the exact mechanisms of neural dynamics under direct cortical stimulation, especially in the context of living, active and functionally specific intra-cortical neural circuitry, is poorly understood. Second, we lack protocols for transformation of arbitrary visual stimuli into light activation patterns that would induce perception of the said stimulus by the subject. In this study we address these issues using a large-scale spiking neural network modeling strategy of high biological fidelity. We examine the relationship between specific spatial configuration of light delivered to cortex and the resulting spatio-temporal pattern of activity evoked in the simulated cortical circuitry. Using such virtual experiments, we design a protocol for translation of a specific set of stimuli to activation pattern of a matrix of light emitting elements and provide a detailed assessment of the resulting cortical activations with respect to the natural vision control condition. In this study we restrict our focus to the grating stimulus class, which are an ideal starting point for exploration due to their thoroughly characterized representation in V1 and well-defined information content. However, we also provide an outline of a straight-forward road-map for transforming this grating centric stimulation protocol towards general strategy capable of transforming arbitrary spatio-temporal visual stimulus to a spatio-temporal pattern of light, thus enabling vision restoration via optogenetic V1 activation.
How Cognitive and Affective Empathy Relate to Emotion Regulation: Divergent Patterns from Trait and Task-Based Measures
Authors: Thompson Nicholas M. , Reekum Carien M. van , Chakrabarti Bhismadev
Published: April 2019

Evidence suggests that empathy and emotion regulation may be related, but few studies have directly investigated this relationship. Here we report two experiments which examined: 1) how different components of empathy (cognitive & affective) relate to the habitual use of cognitive reappraisal to regulate emotions (N=220), and 2) how these components of empathy relate to implicit reappraisal in a context-framing task (N=92). In study 1, a positive correlation between cognitive empathy and reappraisal use was observed. Affective empathy showed no relationship with reappraisal use. In study 2, participants completed an implicit reappraisal task in which previously viewed negative images were paired with either a neutralising (intended to reduce negative emotionality) or descriptive (which simply described the image) framing sentence. Participants then reported how unpleasant/pleasant each image made them feel. In contrast to study 1, a positive correlation between affective empathy and the implicit reappraisal task metric (rating of neutralising–descriptive framing conditions) was observed. There was no relationship between cognitive empathy and implicit reappraisal. These findings suggest that both components of empathy are related to reappraisal, but in different ways: Cognitive empathy is related to more deliberate use of reappraisal, while affective empathy is associated with more implicit reappraisal processes.
Computational modelling of hippocampal sensitivity to expectation violation
Authors: Frank Darya , Montemurro Marcelo , Montaldi Daniela
Published: April 2019

Pattern separation and completion are fundamental hippocampal computations supporting memory encoding and retrieval. However, despite extensive exploration of these processes, it remains unclear whether they are modulated by top-down processes. We used a neural network model to examine how unexpected information is represented by the hippocampus. During training the network learned a contingency between a cue and a category, which the target object belongs to. At test, we presented the network with congruous and incongruous cues, as well as perceptually similar foils. We used representational similarity analysis to examine how the top-down expectation modulation interacts with bottom-up perceptual input, in each layer. All subfields showed an interaction between the two, with DG and CA3 being more sensitive to expectation violation than CA1. A further multivariate analysis revealed that representational differences between expected and unexpected inputs were prominent for moderate to high levels of perceptual overlap in DG/CA3. This effect diminished when inputs from DG and CA3 into CA1 were lesioned. Overall, our findings suggest pattern separation in DG and CA3 underlies the effect that violation of expectation exerts on memory.
The Rising Prevalence of Weapons in Unsafe Arming Configurations Discovered in American Airports: the Increasing Practice of Storage and Carry of Firearms with a Round Chambered
Authors: Towers Sherry , Amoundi Bechir , Cordova Richard , Funderburk Karen , Montalvo Cesar , Thakur Mugdha , Velazquez-Molina Josean , Castillo-Chavez Carlos
Published: April 2019

Background

Recent studies have shown that Americans appear to be increasingly owning and carrying firearms for personal protection, and are increasingly storing their firearms loaded. However, the prevalence of firearm carry and/or storage with a round chambered has not hitherto been studied; in this arming configuration the weapon is loaded, with a bullet resting against the firing pin, ready to fire if the trigger is pulled. Ostensibly this decreases reaction time in a threat situation, but carries an increased risk of accidental discharge. It is unknown what fraction of firearm owners typically carry or store their firearms in this configuration, and if there have been significant temporal trends in the practice.

Objective

We examine firearms detected at Transportation Security Administration (TSA) airport security checkpoints between 2012 to 2017, to examine geospatial and temporal trends in the prevalence of unsafe arming configuration in detected firearms.

Results

The fraction of detected firearms found to be loaded has risen significantly since 2012 (Beta Binomial logistic regressionp= 0.011). States with firearm child access prevention laws have significantly fewer firearms found by the TSA to be loaded (p= 0.039).

The fraction of loaded firearms found by the TSA to also have a round chambered has also risen significantly since 2012 (Beta Binomial logistic regressionp< 0.001). By 2017, 36% of firearms found loaded were also found to have a round chambered, representing an apparent concerning trend in unsafe arming configurations during carry and storage.

Conclusions

Americans appear to be increasingly using and storing firearms in unsafe arming configurations. TSA firearm detection data can potentially provide a key source of data when researching trends in firearm injury.
Factors influencing prevention of mother to child HIV transmission service utilization among HIV positive women in Amhara National Regional State, Ethiopia: A thematic content analysis
Authors: Abebe Zebideru Zewdie , Mengistu Mezgebu Yitayal , Gete Yigzaw Kebede , Worku Abebaw Gebeyehu
Published: April 2019

Introduction

Mother to child transmission (MTCT) of HIV is the major source of HIV infection among children under the age of 15 years. Prevention of mother to child transmission (PMTCT) service has been an important strategy in preventing HIV infections in infants. However, improving PMTCT service uptake and continuum of care still remains a significant impediment in the Amhara Region of Ethiopia. The aim of this study was to explore factors that may hinder and promote PMTCT service utilization among HIV positive women.

Methods

Phenomenological study design was used. Three focus group discussions (FGDs) with HIV positive women and five in-depth interviews with health care workers were conducted from the selected health institutions. Data analysis was conducted using thematic content analysis. ATLAS/ti version 7.5.16 software was used to assist in coding and analysis of the qualitative data.

Results

The findings of the study revealed that there are a range of factors that influence HIV positive women on PMTCT service utilization. Stigma, discrimination, limited knowledge on HIV, lack of partner and family support, and not getting friendly service from health facility were factors that might hinder PMTCT service utilization. The experiences of HIV positive mothers revealed that continuous partner support, previous history of getting HIV free child, good health worker support, and advice by mother support group were factors that promote utilization of PMTCT service.

Conclusions

Strengthening community awareness on HIV, engaging male involvement in PMTCT care and getting friendly service were the key determinants for the better PMTCT service utilization.
Cortical Sensitivity to Natural Scene Structure
Authors: Kaiser Daniel , Häberle Greta , Cichy Radoslaw M.
Published: April 2019

Natural scenes are inherently structured, with meaningful objects appearing in predictable locations. Human vision is tuned to this structure: When scene structure is purposefully jumbled, perception is strongly impaired. Here, we tested how such perceptual effects are reflected in neural sensitivity to scene structure. During separate fMRI and EEG experiments, participants passively viewed scenes whose spatial structure (i.e., the position of scene parts) and categorical structure (i.e., the content of scene parts) could be intact or jumbled. Using multivariate decoding, we show that spatial (but not categorical) scene structure profoundly impacts on cortical processing: Scene-selective responses in occipital and parahippocampal cortices (fMRI) and after 255ms (EEG) accurately differentiated between spatially intact and jumbled scenes. Importantly, this differentiation was more pronounced for upright than for inverted scenes, indicating genuine sensitivity to spatial structure rather than sensitivity to low-level attributes. Our findings suggest that visual scene analysis is tightly linked to the spatial structure of our natural environments. This link between cortical processing and scene structure may be crucial for rapidly parsing naturalistic visual inputs.