bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Epithelial Atypia With Recurrence After Surgical Excision in Conjunctival Papilloma
Authors: Yazu Hiroyuki , Dogru Murat , Miyauchi Jun , Tanaka Yoichi , Yamaguchi Takefumi , Den Seika , Satake Yoshiyuki , Tsubota Kazuo , Shimazaki Jun
Published: February 2017

Purpose:

To investigate the association between recurrence of conjunctival papillomas and presence of atypical epithelial changes in patients undergoing surgical excision for conjunctival papilloma.

Methods:

We retrospectively reviewed 1,195 ophthalmic pathology specimens from 2004 to 2014 at Ichikawa General Hospital. Pathologic specimens of 5 patients with a final diagnosis of “conjunctival papilloma” were stained with hematoxylin–eosin, Ki 67, p53, human papillomavirus (HPV) 16 and 18 antibodies.

Results:

Of 1,195 patients, 5 patients (4 men, 1 woman; age range: 27∼57 years, mean age: 38.4 years) had a diagnosis of conjunctival papilloma, which constituted to 0.42% of the pathologic diagnosis made for the ophthalmology specimens. All specimens displayed multiple fronds of thickened conjunctival epithelium that enclosed cores of vascularized connective tissues. Three patients with recurrence after surgical excision demonstrated moderate to severe epithelial atypia, who also showed higher staining with Ki67 and p53 compared with patients with no recurrence. HPV16 and 18 antibodies staining did not appear to relate to recurrences.

Conclusions:

Conjunctival papillomas with higher positive staining for Ki67 and p53 seem to have a higher risk of recurrence even after complete surgical excision and necessitate careful follow-up.
Incidence of Cannula-Associated Deep Vein Thrombosis After Veno-Venous Extracorporeal Membrane Oxygenation
Authors: Menaker Jay , Tabatabai Ali , Rector Raymond , Dolly Katelyn , Kufera Joseph , Lee Eugenia , Kon Zachary , Sanchez Pablo , Pham Si , Herr Daniel L. , Mazzeffi Michael , Rabinowitz Ronald P. , O’Connor James V. , Stein Deborah M. , Scalea Thomas M.
Published: February 2017

Limited literature regarding the incidence of cannula-associated deep vein thrombosis (CaDVT) after veno-venous extracorporeal membrane oxygenation (VV ECMO) exists. The purpose of this study was to identify the incidence of post decannulation CaDVT and identify any associated risk factors. Forty-eight patients were admitted between August 2014 and January 2016 to the Lung Rescue Unit were included in the study. Protocolized anticoagulation levels (partial thromboplastin time [PTT] 45–55 seconds) and routine post decannulation DVT screening were in place during the study period. Forty-one (85.4%) patients had CaDVT. Of those with CaDVT, 31 (76%) patients were treated with full anti-coagulation therapy. Thirty-four (76%) patients with right internal jugular (RIJ) cannulation had CaDVT at cannula site. Twenty-five (61%) patients had CaDVT in the lower extremity (18 associated right femoral vein cannulation and 7 left femoral vein cannulation). Eighteen (44%) patients had both upper and lower extremity CaDVT. Overall, patients with CaDVT tended to be older, have a higher body mass index (BMI), and on ECMO longer (p = NS). Mean PTT during time on ECMO between patients that did and did not have CaDVT did not differ. No clinical evidence of pulmonary embolism (PE) was seen.
Postinterventional critical care management of aneurysmal subarachnoid hemorrhage
Authors: Datar Sudhir , Rabinstein Alejandro A.
Published: February 2017

Purpose of review

Subarachnoid hemorrhage from a ruptured aneurysm (aSAH) is a complex disorder with the potential to have devastating effects on the brain as well as other organ systems. After more than 3 decades of research, the underlying pathophysiologic mechanisms remain incompletely understood and important questions remain regarding the evaluation and management of these patients. The purpose of this review is to analyze the recent literature and improve our understanding of certain key clinical aspects.

Recent findings

Growing body of evidence highlights the usefulness of CT perfusion scans in the diagnosis of vasospasm and delayed cerebral ischemia (DCI). Hypervolemia leads to worse cardiopulmonary outcomes and does not improve DCI. The traditional triple H therapy is falling out of favor with hemodynamic augmentation alone now considered the mainstay of medical management. Randomized controlled trials have shown that simvastatin and intravenous magnesium do not prevent DCI or improve functional outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Emerging data using multimodality monitoring has further advanced our understanding of the pathophysiology of DCI in poor grade aSAH.

The brief review will focus on the postinterventional care of aSAH patients outlining the recent advances over the past few years.
Advancements in the critical care management of status epilepticus
Authors: Bauerschmidt Andrew , Martin Andrew , Claassen Jan
Published: February 2017

Purpose of review

Status epilepticus has a high morbidity and mortality. There are little definitive data to guide management; however, new recent data continue to improve understanding of management options of status epilepticus. This review examines recent advancements regarding the critical care management of status epilepticus.

Recent findings

Recent studies support the initial treatment of status epilepticus with early and aggressive benzodiazepine dosing. There remains a lack of prospective randomized controlled trials comparing different treatment regimens. Recent data support further study of intravenous lacosamide as an urgent-control therapy, and ketamine and clobazam for refractory status epilepticus. Recent data support the use of continuous EEG to help guide treatment for all patients with refractory status epilepticus and to better understand epileptic activity that falls on the ictal–interictal continuum. Recent data also improve our understanding of the relationship between periodic epileptic activity and brain injury.

Many treatments are available for status epilepticus and there are much new data guiding the use of specific agents. However, there continues to be a lack of prospective data supporting specific regimens, particularly in cases of refractory status epilepticus.
Intracranial pressure management in patients with traumatic brain injury: an update
Authors: Stocchetti Nino , Zoerle Tommaso , Carbonara Marco
Published: February 2017

Purpose of review

Intracranial pressure (ICP) monitoring and treatment is central in the management of traumatic brain injury. Despite 4 decades of clinical use, several aspects remain controversial, including the indications for ICP and treatment options.

Recent findings

Two major trials tested surgical decompression and mild hypothermia as treatments for high ICP. Both were rigorous, randomized, multicenter studies, with different designs. Decompression was tested for ICP refractory to conventional treatment, whereas hypothermia was offered as an alternative to conventional medical therapy. Decompression reduced mortality, but at the expense of more disability. The hypothermia trial was stopped because of a worse outcome in the treated arm. Indications for ICP monitoring have been reviewed and new international guidelines issued. New contributions published in 2016 have dealt with computerized analysis for predicting ICP crises; noninvasive or innovative methods for measuring ICP; reassessment of standard therapeutic interventions, such as hypertonic solutions and the level of intensity of ICP therapy.

Aggressive strategies for ICP control, like surgical decompression or hypothermia, carefully tested, have controversial effects on outcome. Several articles have made worthwhile contributions to important clinical issues, but with no real breakthroughs.
Central nervous system infections in immunocompromised patients
Authors: Sonneville Romain , Magalhaes Eric , Meyfroidt Geert
Published: February 2017

Purpose of review

Although rare, central nervous system (CNS) infections are increasingly being recognized in immunocompromised patients. The goal of the present review is to provide a practical diagnostic approach for the intensivist, and to briefly discuss some of the most prevalent conditions.

Recent findings

Immunocompromised patients presenting with new neurological symptoms should always be suspected of a CNS infection. These infections carry a poor prognosis, especially if intracranial hypertension, severely altered mental status or seizures are present. Clinical examination and serum blood tests should be followed by brain imaging, and when no contra-indications are present, a lumbar puncture including cerebrospinal fluid PCR to identify causative organisms. Empirical therapy depends on the type of immunodeficiency. In HIV-infected patients, the most common CNS infection is cerebral toxoplasmosis, whereas in other immunocompromised patients, aspergillosis, cryptococcal meningitis and tuberculous meningitis are more prevalent. Multiple pathogens can be detected in up to 15% of patients. The diagnostic value of fast multiplex PCR has yet to be evaluated in this setting.

CNS infections represent a rare but severe complication in immunocompromised patients. A systematic approach including early diagnosis, appropriate antimicrobial treatment, early ICU admission and aggressive measures to reduce intracranial pressure may improve outcome.
Advanced monitoring in traumatic brain injury: microdialysis
Authors: Carpenter Keri L.H. , Young Adam M.H. , Hutchinson Peter J.
Published: February 2017

Purpose of review

Here, we review the present state-of-the-art of microdialysis for monitoring patients with severe traumatic brain injury, highlighting the newest developments. Microdialysis has evolved in neurocritical care to become an established bedside monitoring modality that can reveal unique information on brain chemistry.

Recent findings

A major advance is recent consensus guidelines for microdialysis use and interpretation. Other advances include insight obtained from microdialysis into the complex, interlinked traumatic brain injury disorders of electrophysiological changes, white matter injury, inflammation and metabolism.

Microdialysis has matured into being a standard clinical monitoring modality that takes its place alongside intracranial pressure and brain tissue oxygen tension measurement in specialist neurocritical care centres, as well as being a research tool able to shed light on brain metabolism, inflammation, therapeutic approaches, blood–brain barrier transit and drug effects on downstream targets. Recent consensus on microdialysis monitoring is paving the way for improved neurocritical care protocols. Furthermore, there is scope for future improvements both in terms of the catheters and microdialysate analyser technology, which may further enhance its applicability.
Bortezomib for Refractory Immune-Mediated Thrombocytopenia Purpura
Authors: Beckman Joan D. , Rollins-Raval Marian A. , Raval Jay S. , Park Yara A. , Mazepa Marshall , Ma Alice
Published: February 2017

The treatment of refractory immune-mediated thrombocytopenia purpura (ITP) can be challenging. This case report describes treatment of refractory ITP with bortezomib, a proteasome inhibitor. This strategy has been successful in relapsing thrombotic thrombocytopenic purpura but is a novel therapeutic approach for ITP. Further research use of proteasome inhibition in refractory ITP may be warranted.
The walking dead: macrophage inflammation and death in atherosclerosis
Authors: Kavurma Mary M. , Rayner Katey J. , Karunakaran Denuja
Published: February 2017

Purpose of review

To highlight recent studies that describe novel inflammatory and signaling mechanisms that regulate macrophage death in atherosclerosis.

Recent findings

Macrophages contribute to all stages of atherosclerosis. The traditional dogma states that in homeostatic conditions, macrophages undergo apoptosis and are efficiently phagocytosed to be cleared by a process called efferocytosis. In advanced atherosclerosis, however, defective efferocytosis results in secondary necrosis of these uncleared apoptotic cells, which ultimately contributes to the formation of the characteristic necrotic core and the vulnerable plaque. Here, we outline the different types of lesional macrophage death: apoptosis, autophagic and the newly defined necroptosis (i.e. a type of programmed necrosis). Recent discoveries demonstrate that macrophage necroptosis directly contributes to necrotic core formation and plaque instability. Further, promoting the resolution of inflammation using preresolving mediators has been shown to enhance efferocytosis and decrease plaque vulnerability. Finally, the canonical ‘don’t eat me’ signal CD47 has recently been described as playing an important role in atherosclerotic lesion progression by impairing efficient efferocytosis. Although we have made significant strides in improving our understanding of cell death and clearance mechanisms in atherosclerosis, there still remains unanswered questions as to how these pathways can be harnessed using therapeutics to promote lesion regression and disease stability.

Improving our understanding of the mechanisms that regulate macrophage death in atherosclerosis, in particular apoptosis, necroptosis and efferocytosis, will provide novel therapeutic opportunities to resolve atherosclerosis and promote plaque stability.
Statin-associated immune-mediated myopathy: biology and clinical implications
Authors: Christopher-Stine Lisa , Basharat Pari
Published: February 2017

Purpose of review

In the last 6 years, our understanding of statin-associated myopathy expanded to include not only a toxic myopathy with limited and reversible side-effects but also an autoimmune variety in which statins likely induce an autoimmune myopathy that is both associated with a specific autoantibody and responsive to immunosuppression and immune modulation. This review widens the reader's understanding of statin myopathy to include an autoimmune process.

Recent findings

Statin-associated immune-mediated myopathy provides an example of an environmental trigger (statins) directly implicated in an autoimmune disease associated with a genetic predisposition as well as potential risk factors including concomitant diseases and specific statins. Given a median exposure to statins of 38 months, providers should be aware that anti-3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR) myopathy may occur even after several years of statin exposure.

It is important for the reader to understand the clinical presentation of statin-associated immune-mediated myopathy and the difference in its clinical presentation to that of statins as direct myotoxins. Prompt recognition of such an entity allows the clinician to immediately stop the offending agent if it has not already been discontinued as well as to recognize that statin rechallenge is not a likely option, and that prompt treatment with immunosuppression and/or immunomodulation is usually of enormous benefit to the patient in restoring muscle strength and physical function.

Video abstract

http://links.lww.com/COL/A15
Utilization of ultrasound for diagnostic evaluation and management of peritonsillar abscesses
Authors: Froehlich Michael H. , Huang Zhen , Reilly Brian K.
Published: February 2017

Purpose of review

We outlined the management of peritonsillar abscess (PTA) through the use of ultrasound, an imaging modality that continues to emerge as a diverse diagnostic and treatment tool. Our review compares the use of ultrasound to alternative diagnostic modalities, particularly computed tomography (CT). Further, the review evaluates how ultrasound can be used to help facilitate guided drainage of PTA and serve as a suitable alternative to more invasive management options.

Recent findings

Studies over the past 5 years have demonstrated that the initial management of PTA with ultrasound is a more cost-efficient and lower-risk option than imaging with CT. Ultrasound possesses great specificity for PTA and may be more diagnostically accurate than previously thought. Ultrasound is particularly well tolerated in children and adults, avoids radiation exposure, as well as minimizes false-positive aspirations. In addition, the ability to utilize ultrasound from different approaches allows for flexibility in the management of PTA.

These findings illustrate that ultrasound is being increasingly considered in the management of stable patients presenting with PTA.
Genetic signature and profiling of head and neck cancer: where do we stand?
Authors: Paczkowska Julia , Szyfter Krzysztof , Giefing Maciej , Wierzbicka Malgorzata
Published: February 2017

Purpose of review

To focus on two novel aspects of head and neck squamous cell carcinoma (HNSCC) genetics of special interest: the epithelial–mesenchymal transition (EMT) process, an initial step in tumor progression that finally leads to metastasis formation, by explaining how genes as well as epigenetic factors control this process, and the new diagnostic options based on the analysis of circulating tumor cells (CTCs) and cell-free DNA (cfDNA) that could revolutionize diagnosis in the coming years.

Recent findings

We present an intriguing recently described group of factors, namely miRNAs, deregulated during EMT. MiRNAs could serve as novel markers of EMT and metastasis formation and are also a potential therapeutic target. Second, we show recent findings on CTC and cfDNA analysis in HNSCC that demonstrate the usefulness of this new diagnostic approach.

We stress the importance of EMT in the context of metastasis formation and the potential of liquid biopsies in clinical practice.
Second‐line Agents in Pediatric Patients With Autoimmune Hepatitis
Authors: Zizzo Andréanne N. , Valentino Pamela L. , Shah Prakesh S. , Kamath Binita M.
Published: February 2017

Background and Aims:

Ten percent to 20% of children with autoimmune hepatitis (AIH) require second‐line therapy to achieve remission. Although current guidelines exist on first‐line management, evidence for second‐line therapy in treatment‐refractory patients is lacking. Our aim was to perform a systematic review and meta‐analysis of the efficacy and safety of second‐line treatments used in this population.

Methods:

Electronic and manual searches were used to identify potential studies for inclusion. Studies were selected based on reported response rates to second‐line therapies in children who failed response to prednisone and azathioprine. Data extraction and risk of bias assessment were performed independently by 2 reviewers. Meta‐analysis using weighted estimate of response rates at 6 months was performed for each treatment option. Heterogeneity was assessed.

Results:

Fifteen studies of 76 pediatric patients with AIH were included in the review. Overall response rates at 6 months were estimated as 36% for mycophenolate mofetil (MMF) (N = 34, 95% confidence interval [CI] (16–57)), and 50% for tacrolimus (N = 4, 95% CI (0–100%)) and 83% for cyclosporine (N = 15, 95% CI (66%–100%)). Adverse effects were most frequent with cyclosporine (64% experiencing at least 1 adverse effect) followed by tacrolimus (54%) and MMF (48%). Pooled estimates of adverse events were 78% for cyclosporine (95% CI (54%–100%)), 42% for tacrolimus (95% CI (0%–85%)) and 45% for MMF (95% CI (25%–68%)). Sensitivity analyses were not performed due to small sample size.

Conclusions:

Cyclosporine had the highest response rate at 6 months in children with standard‐treatment‐refractory AIH; however, it also had the highest rate of adverse events. MMF was the second most efficacious option with a low adverse effect rate.
Increasing Incidence and Altered Presentation in a Population‐based Study of Pediatric Celiac Disease in North America
Authors: Almallouhi Eyad , King Katherine S. , Patel Bhavisha , Wi Chung , Juhn Young J. , Murray Joseph A. , Absah Imad
Published: February 2017

Objectives:

Celiac disease (CD) is a common immune‐mediated disorder that affects up to 1% of the general population. Recent reports suggest that the incidence of CD has reached a plateau in many countries. We aim to study the incidence and altered presentation of childhood CD in a well‐defined population.

Methods:

Using the Rochester Epidemiology Project, we retrospectively reviewed Mayo Clinic and Olmsted Medical Center medical records from January 1994 to December 2014. We identified all CD cases of patients ages 18 years or younger at the time of diagnosis. Incidence rates were calculated by adjusting for age, sex, and calendar year and standardizing to the 2010 US white population.

Results:

We identified 100 patients with CD. Incidence of CD has increased from 8.1 per 100,000 person‐years (2000–2002) to 21.5 per 100,000 person‐years (2011–2014). There was an increase in CD prevalence in children from 2010 (0.10%) to 2014 (0.17%). Thirty‐four patients (34%) presented with classical CD symptoms, 43 (43%) had nonclassical CD, and 23 (23%) were diagnosed by screening asymptomatic high‐risk patients. Thirty‐six patients (36%) had complete villous atrophy, 51 (51%) had partial atrophy, and 11 (11%) had increased intraepithelial lymphocytes. Two patients were diagnosed without biopsy. Most patients (67%) had a normal body mass index, 17% were overweight/obese, and only 9% were underweight.

Conclusions:

Both incidence and prevalence of CD have continued to increase in children during the past 15 years in Olmsted County, Minnesota. Clinical and pathologic presentations of CD are changing over time (more nonclassical and asymptomatic cases are emerging).
Abdominal Arterial Anomalies in Children With Alagille Syndrome
Authors: Kohaut Jules , Pommier Romain , Guerin Florent , Pariente Danièle , Jacquemin Emmanuel , Martelli Hélène , Branchereau Sophie
Published: February 2017

Objectives:

Angiogenic defects secondary to gene mutations of JAG1 and NOTCH2, causing arterial anomalies in Alagille syndrome (AGS), are well described in the literature. The study analyzes the frequency of abdominal arterial anomalies in children with AGS with an emphasis on outcomes following liver transplantation (LT).

Methods:

Between 1988 and 2013, 242 children with AGS were treated at our institution. We performed a retrospective analysis of 55 who underwent LT during the study period. Preoperative abdominal arterial findings, operative reports, arterial reconstruction technique, and early as well as late complications following LT were reviewed specifically focusing on arterial thrombosis.

Results:

Twenty‐five patients had preoperative imaging available for analysis. Twelve of these patients showed celiac trunk stenosis (48.0%), 2, a superior mesenteric artery stenosis (8.0%) and one a stenosis of both renal arteries. Twenty patients (36.3%) underwent standard hepatic reconstruction using the native recipient hepatic artery. Thirty‐five patients (63.7%) underwent aortic conduit reconstruction (ACR) from the infrarenal aorta using donor arterial conduits. Hepatic artery thrombosis occurred in 9 patients (16.3%). This number was higher in the standard arterial anastomosis group 7/20 (35.0%) than in those with ACR 2/35 (5.7%, P = 0.0079).

Conclusions:

In this series, children with AGS pretransplant have a high prevalence of abdominal arterial anomalies. Preoperative abdominal vascular imaging makes it possible to anticipate whether or not a classical arterial revascularization can be performed or whether an ACR is required.
Simple Urine Test to Evaluate Adherence to Oral 5‐ASA in Teenagers With Ulcerative Colitis
Authors: Dijkstra Alie , Touw Daan J. , van Rheenen Patrick F.
Published: February 2017

Objectives:

5‐Aminosalicylic acid (5‐ASA) is an important maintenance drug for patients with ulcerative colitis. A proportion of the ingested dose is excreted in the urine. Measuring 5‐ASA and its metabolites in urine requires mass spectrometry, which is not widely available for this purpose. Urinary 5‐ASA can be measured by colorimetry using the serum salicylic acid assay and is a surrogate marker of recent 5‐ASA ingestion. We evaluated whether measuring 5‐ASA in first morning voids or in random spot urine samples correctly identifies teenagers with poor adherence to oral 5‐ASA.

Methods:

Teenagers who were prescribed a current regimen including >40 mg · kg−1 · day−1 of 5‐ASA were invited to collect their spot urine with various time lapses since their last presumed 5‐ASA ingestion. Classification of adherence was based on a composite method that included a patient‐reported adherence scale and 6‐thioguanine levels in erythrocytes.

Results:

Teenagers who were classified as “good adherers” had 66 of 69 (96%; 95% confidence interval 87%–99%) spot urine samples with detectable 5‐ASA levels. “Poor adherers” had 30 of 45 (67%; 95% confidence interval 52%–79%) spot urine samples with undetectable 5‐ASA levels. The “good adherers” with false‐negative urine tests were on a once daily dosing regimen and had collected a spot urine sample shortly before the next dosage. Their first morning voids had detectable 5‐ASA levels.

Conclusions:

Undetectable 5‐ASA levels in the first morning void confirms short‐term nonadherence to oral 5‐ASA.
Fecal Calprotectin and Eosinophil‐derived Neurotoxin in Healthy Children Between 0 and 12 Years
Authors: Roca María , Rodriguez Varela Ana , Donat Ester , Cano Francisco , Hervas David , Armisen Ana , Vaya Maria J. , Sjölander Anders , Ribes‐Koninckx Carmen
Published: February 2017

Objectives:

In young children, the use of fecal calprotectin (fCP) as a biomarker is limited because reference values have not been widely accepted up to now. Moreover, reference values for fecal eosinophil–derived neurotoxin (fEDN) in children have not been established. The aim of the present study was to investigate fCP and fEDN levels in young healthy children to establish reference values.

Methods:

Stool samples were obtained from healthy children ages 0 to 12 years. fCP and fEDN levels were analyzed using the EliA Calprotectin 2 assay (Phadia AB) and a novel research assay (on the ImmunoCAP platform), respectively.

Results:

In the 174 included children (87 boys), 95th Percentile values ranged from 1519 mg/kg at 0 months to 54.4 mg/kg at 144 months for fCP and from 9.9 mg/kg at 0 months to 0.2 mg/kg at 144 months for fEDN. There was a statistically significant association between age and fCP concentrations (P < 0.001) and age and fEDN concentrations (P < 0.001). We also found a statistically significant association between fEDN and fCP concentrations (rho = 0.52, P < 0.001). According to our results, we provide a nomogram and we suggest 3 different age groups for evaluation of fCP and fEDN concentrations, the 95th percentile being respectively 910.3 and 7.4 mg/kg for 0–12 months, 285.9 and 2.9 mg/kg for >1 to 4 years, and 54.4 and 0.2 mg/kg for >4 to 12 years.

Discussion:

By using an improved analytical method, we have confirmed that young healthy children have higher fCP concentrations than healthy adults. We, for the first time, report reference values for fEDN concentrations in a pediatric population. The proposed nomograms and reference values for fCP and fEDN are aimed at facilitating the applicability of biomarkers for both neutrophil‐ and eosinophil‐mediated intestinal inflammation in children in clinical practice.
Career Development Support in Pediatric Critical Care Medicine: A National Survey of Fellows and Junior Faculty*
Authors: Cifra Christina L. , Balikai Shilpa S. , Murtha Tanya D. , Hsu Benson , Riley Carley L.
Published: February 2017

Objectives:

To determine the perceptions of current pediatric critical care medicine fellows and junior faculty regarding the extent and quality of career development support received during fellowship training.

Design:

Web-based cross-sectional survey open from September to November 2015.

Setting:

Accreditation Council for Graduate Medical Education-accredited pediatric critical care medicine fellowship programs.

Subjects:

Pediatric critical care medicine fellows (second yr or higher) and junior faculty (within 5 yr of completing a pediatric critical care medicine fellowship program).

Interventions:

None.

Measurements and Main Results:

There were 129 respondents to the survey, representing 63% of Accreditation Council for Graduate Medical Education-accredited pediatric critical care medicine fellowship programs. Respondents were evenly divided between fellows and junior faculty. Nearly, half (49%) of respondents reported that their pediatric critical care medicine fellowship program provided a formal career development curriculum. Ideal career tracks chosen included academic clinician educator (64%), physician-scientist (27%), community-based (nonacademic) clinician (11%), and administrator (11%). There was a disparity in focused career development support provided by programs, with a minority providing good support for those pursuing a community-based clinician track (32%) or administrator track (16%). Only 43% of fellows perceived that they have a good chance of obtaining their ideal pediatric critical care medicine position, with the most common perceived barrier being increased competition for limited job opportunities. Most respondents expressed interest in a program specific to pediatric critical care medicine career development that is sponsored by a national professional organization.

Conclusions:

Most pediatric critical care medicine fellows and junior faculty reported good to excellent career development support during fellowship. However, important gaps remain, particularly for those pursuing community-based (nonacademic) and administrative tracks. Fellows were uncertain regarding future pediatric critical care medicine employment and their ability to pursue ideal career tracks. There may be a role for professional organizations to provide additional resources for career development in pediatric critical care medicine.
Micro Free Orbital Fat Grafts to the Tear Trough Deformity during Lower Blepharoplasty
Authors: Miranda Suzette G. , Codner Mark A.
Published: February 2017

Background:

The tear trough deformity is challenging in lower eyelid rejuvenation. Surgical treatment has evolved, with more modern techniques preserving orbital fat and using autologous fat transposition. The senior author (M.A.C.) reviewed his own experience in targeting the tear trough in lower lid blepharoplasty and presents a new technique that incorporates the addition of micro free fat grafts that adds direct volume to the underlying anatomical depression using a transcutaneous skin-muscle approach.

Methods:

Medical records of lower lid blepharoplasty patients performed from February of 2011 to February of 2016 were reviewed. Patients who had tear trough deformities with the addition of micro free fat grafts were included. Standard patient characteristics were collected, complications were identified, and assessment of postoperative results was performed.

Results:

There were 32 patients included in the study, with a median follow-up of 392 days (range, 45 to 1709 days). Scleral show requiring operative correction occurred in one patient (3 percent). Additional complications included chemosis in four patients (13 percent), which resolved in all patients. No patients had infections, ectropion, lid retraction, or palpable or visible grafts.

Conclusion:

The use of micro free orbital fat grafts is an effective and safe technique to treat the tear trough deformity without increased complication rates and good patient and surgeon satisfaction and should be considered a surgical adjunct during an open blepharoplasty technique.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Early Postoperative Results of Percutaneous Needle Fasciotomy in 451 Patients with Dupuytren Disease
Authors: Molenkamp Sanne , Schouten Tanneke A. M. , Broekstra Dieuwke C. , Werker Paul M. N. , Moolenburgh J. Daniel
Published: February 2017

Background:

Percutaneous needle fasciotomy is a minimally invasive treatment modality for Dupuytren disease. In this study, the authors analyzed the efficacy and complication rate of percutaneous needle fasciotomy using a statistical method that takes the multilevel structure of data, regarding multiple measurements from the same patient, into account.

Methods:

The data of 470 treated rays from 451 patients with Dupuytren disease that underwent percutaneous needle fasciotomy were analyzed retrospectively. The authors described the early postoperative results of percutaneous needle fasciotomy and applied linear mixed models to compare mean correction of passive extension deficit between joints and efficacy of primary versus secondary percutaneous needle fasciotomy.

Results:

Mean preoperative passive extension deficits at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 37, 40, and 31 degrees, respectively. Mean preoperative total passive extension deficit was 54 degrees. Results were excellent, with a mean total passive extension deficit correction of 85 percent. Percutaneous needle fasciotomy was most effective for metacarpophalangeal joints and less effective for proximal interphalangeal and distal interphalangeal joints. Secondary percutaneous needle fasciotomy was as effective as primary percutaneous needle fasciotomy. Complications were rare and mostly minor.

Conclusion:

The results of this study confirm that percutaneous needle fasciotomy is an effective and safe treatment modality for patients with mild to moderate disease who prefer a minimally invasive procedure.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
A New Classification of Helix Fabrication Methods with Autogenous Costal Cartilage in Microtia Reconstruction
Authors: Xu Zhicheng , Xu Feng , Zhang Ruhong , Zhang Qun , Li Datao , Li Yiyuan
Published: February 2017

Background:

Recreating the complex architecture of the auricle poses one of the most demanding challenges for the plastic surgeon. The fabrication of the prominent helix is crucial to the final contour of the constructed ear. The success of helix carving depends greatly on the complicated characteristics of the cartilage used, which is commonly the eighth costal cartilage. The authors elaborate on the relevant details for helix sculpting based on different qualities of cartilage.

Methods:

A series of 415 microtia patients underwent autogenous costal cartilage auricular reconstruction between 2012 and 2015. Because the cartilage used for helix reconstruction is always imperfect or insufficient for the fabrication of anatomical structures, they have devised perfect helix duplication by using individualized eighth rib cartilage with different cartilage lengths, widths, and flexibilities. Four possible scenarios in helix fabrication have been elaborated, and the corresponding methods were introduced.

Results:

Selective methods for different scenarios in helix fabrication have been shown to produce favorable results. The results reveal that a harmonious helix was achieved and provide a cohesive framework for the integrity of a reconstructed ear.

Conclusions:

A new classification of helix fabrication methods with autogenous costal cartilage is elaborated, and a favorable framework with harmonious proportions is achieved by precise carving using corresponding measures for different cartilage characteristics. This approach enhances helix aesthetics and helps attain a satisfactory contour of the auricle.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Laparoscopic and Open Surgical Treatment in Gastroduodenal Perforations: Our Experience
Authors: Laforgia Rita , Balducci Giovanni , Carbotta Giuseppe , Prestera Antonio , Sederino Maria Grazia , Casamassima Giulia , Minafra Marina , Sallustio Pierluca , Palasciano Nicola
Published: February 2017

Introduction:

Peptic ulcer perforation (PPU) is a common surgical emergency and the mortality rate ranges 10% to 40%, especially in elderly patients. Laparoscopic repair achieved encouraging results.

Materials and Methods:

We enrolled patients performing surgical repair for PPU from January 2007 to December 2015 in our surgical unit. The aim of this retrospective observational study was to compare the results of PPU laparoscopic repair with open technique. The following characteristics of patients were evaluated: age, sex and American Society of Anesthesiologists classification. The site and the diameter of perforation were recorded: gastric, pyloric, duodenal, and the location on the anterior or posterior wall.

Results:

In total, 59 patients (39 males and 20 females) with a mean age of 58.85 years (±SD) were treated surgically. Laparoscopic repair was accomplished in 21 patients. The mean operative time for laparoscopic repair was 72 minutes (±SD), significantly shorter than open repair time (180 min ±SD). The results demonstrated that laparoscopic repair is associated with a shorter operative time, reduced postoperative pain (4.75 vs. 6.42) and analgesic requirements, a shorter hospital stay (7.5 vs. 13.1), and earlier return to normal daily activities.

Discussion:

Laparoscopic surgery minimizes postoperative wound pain and encourages early mobilization and return to normal daily activities. The benefit of early discharge and return to work may outweigh the consumable cost incurred in the execution of laparoscopic procedures.

Conclusions:

Complications in both procedures are similar but laparoscopic procedure shows economic advantages for reducing postoperative hospital stay, postoperative pain, and for a good integrity of abdominal wall.
Catching ghosts with a coarse net: use and abuse of spatial sampling data in detecting synchronization
Authors: Petrovskaya Natalia , Petrovskii Sergei
Published: February 2017

Synchronization of population dynamics in different habitats is a frequently observed phenomenon. A common mathematical tool to reveal synchronization is the (cross)correlation coefficient between time courses of values of the population size of a given species where the population size is evaluated from spatial sampling data. The corresponding sampling net or grid is often coarse, i.e. it does not resolve all details of the spatial configuration, and the evaluation error—i.e. the difference between the true value of the population size and its estimated value—can be considerable. We show that this estimation error can make the value of the correlation coefficient very inaccurate or even irrelevant. We consider several population models to show that the value of the correlation coefficient calculated on a coarse sampling grid rarely exceeds 0.5, even if the true value is close to 1, so that the synchronization is effectively lost. We also observe ‘ghost synchronization’ when the correlation coefficient calculated on a coarse sampling grid is close to 1 but in reality the dynamics are not correlated. Finally, we suggest a simple test to check the sampling grid coarseness and hence to distinguish between the true and artifactual values of the correlation coefficient.
Pesticides, pollution and the UK's silent spring, 1963–1964: Poison in the Garden of England
Authors: Clark J. F. M.
Published: February 2017

Despite being characterized as ‘one of the worst agricultural accidents in Britain in the 1960s’, the ‘Smarden incident’ has never been subjected to a complete historical analysis. In 1963, a toxic waste spill in Kent coincided with the publication of the British edition of Rachel Carson's
Silent spring
. This essay argues that these events combined to ‘galvanize’ nascent toxic and environmental consciousness. A seemingly parochial toxic waste incident became part of a national phenomenon. The Smarden incident was considered to be indicative of the toxic hazards that were born of technocracy. It highlighted the inadequacies of existent concepts and practices for dealing with such hazards. As such, it was part of the fracturing of the consensus of progress: it made disagreements in expertise publicly visible. By the completion of the episode, 10 different governmental ministries were involved. Douglas Good, a local veterinary surgeon, helped to effect the ‘reception’ of
Silent spring
in the UK by telling the ‘Smarden story’ through local and national media and through the publications of anti-statist organizations.
Flexible motor adjustment of pecking with an artificially extended bill in crows but not in pigeons
Authors: Matsui Hiroshi , Izawa Ei-Ichi
Published: February 2017

The dextrous foraging skills of primates, including humans, are underpinned by flexible vision-guided control of the arms/hands and even tools as body-part extensions. This capacity involves a visuomotor conversion process that transfers the locations of the hands/arms and a target in retinal coordinates into body coordinates to generate a reaching/grasping movement and to correct online. Similar capacities have evolved in birds, such as tool use in corvids and finches, which represents the flexible motor control of extended body parts. However, the flexibility of avian head-reaching and bill-grasping with body-part extensions remains poorly understood. This study comparatively investigated the flexibility of pecking with an artificially extended bill in crows and pigeons. Pecking performance and kinematics were examined when the bill extension was attached, and after its removal. The bill extension deteriorated pecking in pigeons in both performance and kinematics over 10 days. After the bill removal, pigeons started bill-grasping earlier, indicating motor adaptation to the bill extension. Contrastingly, pecking in crows was deteriorated transiently with the bill extension, but was recovered by adjusting pecking at closer distances, suggesting a quick adjustment to the bill extension. These results indicate flexible visuomotor control to extended body parts in crows but not in pigeons.
A novel locus on chromosome 1 underlies the evolution of a melanic plumage polymorphism in a wild songbird
Authors: Bourgeois Yann X. C. , Delahaie Boris , Gautier Mathieu , Lhuillier Emeline , Malé Pierre-Jean G. , Bertrand Joris A. M. , Cornuault Josselin , Wakamatsu Kazumasa , Bouchez Olivier , Mould Claire , Bruxaux Jade , Holota Hélène , Milá Borja , Thébaud Christophe
Published: February 2017

Understanding the mechanisms responsible for phenotypic diversification within and among species ultimately rests with linking naturally occurring mutations to functionally and ecologically significant traits. Colour polymorphisms are of great interest in this context because discrete colour patterns within a population are often controlled by just a few genes in a common environment. We investigated how and why phenotypic diversity arose and persists in theZosterops borbonicuswhite-eye of Reunion (Mascarene archipelago), a colour polymorphic songbird in which all highland populations contain individuals belonging to either a brown or a grey plumage morph. Using extensive phenotypic and genomic data, we demonstrate that this melanin-based colour polymorphism is controlled by a single locus on chromosome 1 with two large-effect alleles, which was not previously described as affecting hair or feather colour. Differences between colour morphs appear to rely upon complexcis-regulatory variation that either prevents the synthesis of pheomelanin in grey feathers, or increases its production in brown ones. We used coalescent analyses to show that, from a ‘brown’ ancestral population, the dominant ‘grey’ allele spread quickly once it arose from a new mutation. Since colour morphs are always found in mixture, this implies that the selected allele does not go to fixation, but instead reaches an intermediate frequency, as would be expected under balancing selection.
Prediction limits of mobile phone activity modelling
Authors: Kondor Dániel , Grauwin Sebastian , Kallus Zsófia , Gódor István , Sobolevsky Stanislav , Ratti Carlo
Published: February 2017

Thanks to their widespread usage, mobile devices have become one of the main sensors of human behaviour and digital traces left behind can be used as a proxy to study urban environments. Exploring the nature of the spatio-temporal patterns of mobile phone activity could thus be a crucial step towards understanding the full spectrum of human activities. Using 10 months of mobile phone records from Greater London resolved in both space and time, we investigate the regularity of human telecommunication activity on urban scales. We evaluate several options for decomposing activity timelines into typical and residual patterns, accounting for the strong periodic and seasonal components. We carry out our analysis on various spatial scales, showing that regularity increases as we look at aggregated activity in larger spatial units with more activity in them. We examine the statistical properties of the residuals and show that it can be explained by noise and specific outliers. Also, we look at sources of deviations from the general trends, which we find to be explainable based on knowledge of the city structure and places of attractions. We show examples how some of the outliers can be related to external factors such as specific social events.
Evaluation of natural sounds in urban greenery: potential impact for urban nature preservation
Authors: Hedblom M. , Knez I. , Ode Sang Å. , Gunnarsson B.
Published: February 2017

Most humans now live in cities and their main experience of nature is through urban greenery. An increasing number of studies show the importance of urban green spaces for well-being, although most of them are based on visual perception. A questionnaire examining people's evaluations of natural sounds was answered by 1326 individuals living near one of six urban green areas of varying naturalness in the city of Gothenburg, Sweden. Women and the elderly reported greater calmness when hearing bird song and rustling leaves (and placed a higher importance on the richness of bird species) than did men, younger and middle-aged individuals. Independent of age and gender, urban woodlands (high naturalness) had higher evaluations than parks (low naturalness). Our results suggest that to increase positive experiences of urban green areas, demographic variables of gender and age should be taken into account, and settings that mimic nature should be prioritized in planning.
In vivostructures of an intact type VI secretion system revealed by electron cryotomography
Authors: Chang Yi-Wei , Rettberg Lee A. , J. Jensen Grant
Published: February 2017

The type VI secretion system (T6SS) is a versatile molecular weapon used by many bacteria against eukaryotic hosts or prokaryotic competitors. It consists of a cytoplasmic bacteriophage tail-like structure anchored in the bacterial cell envelope via a cytoplasmic baseplate and a periplasmic membrane complex. Rapid contraction of the sheath in the bacteriophage tail-like structure propels an inner tube/spike complex through the target cell envelope to deliver effectors. While structures of purified contracted sheath and purified membrane complex have been solved, because sheaths contract upon cell lysis and purification, no structure is available for the extended sheath. Structural information about the baseplate is also lacking. Here we use electron cryotomography to directly visualize intact T6SS structures insideMyxococcus xanthuscells. Using sub-tomogram averaging, we resolve the structure of the extended sheath and membrane-associated components including the baseplate. Moreover, we identify novel extracellular bacteriophage tail fiber-like antennae. These results provide new structural insights into how the extended sheath prevents premature disassembly and how this sophisticated machine may recognize targets.