bluuebunny/crossref_metadata_2025 huggingface dataset:
Brief Electrical Stimulation Promotes Nerve Regeneration Following Experimental In-Continuity Nerve Injury
Authors: Shapira Yuval , Sammons Vanessa , Forden Joanne , Guo Gui Fang , Kipp Alexander , Girgulis Jill , Mishra Tanmay , de Villers Alant Jacob Daniel , Midha Rajiv
Published: June 2018

BACKGROUND

Brief electrical stimulation (ES) therapy to the nerve may improve outcome in lacerated, repaired nerves. However, most human nerve injuries leave the nerve in continuity with variable and often poor functional recovery from incomplete axon regeneration and reinnervation.

OBJECTIVE

To evaluate the effect of brief ES in an experimental model for neuroma-in-continuity (NIC) injuries in rodents.

METHODS

Lewis rats were randomly assigned to 1 of 4 groups: NIC injury immediately followed by brief (1 h) ES; NIC injury without ES; sham-operated controls; sciatic nerve transection without repair. Outcome measures included serial behavioral evaluation and electrophysiology together with terminal retrograde spinal cord motor neuron labeling and histomorphological analysis for axonal regeneration.

RESULTS

Applying brief ES immediately after in-continuity nerve injury resulted in earlier recovery and significantly improved locomotion function at 4 and 6 wk. At 8 wk, brief ES resulted in higher compound action potential amplitude. By 12 wk there was no significant difference between the 2 groups in behavior or electrophysiology. Histomorphological analysis demonstrated a significantly higher percentage of neural tissue in the brief ES group. Spinal cord motor neuron pool cell counts revealed a preference for regeneration into a motor over a sensory nerve, for the group receiving ES.

CONCLUSION

The application of brief ES for in-continuity nerve injury promotes faster recovery, although in a rat model where regeneration distances are short the control group ultimately recovers to a similar degree. Brief EF requires further evaluation as a promising therapy for in-continuity nerve injuries in humans.
Quality of Life Improvement Following Deep Brain Stimulation for Parkinson Disease: Development of a Prognostic Model
Authors: Frizon Leonardo A , Hogue Olivia , Achey Rebecca , Floden Darlene P , Nagel Sean , Machado Andre G , Lobel Darlene A
Published: June 2018

BACKGROUND

There is a growing attention to determine the factors that predict quality of life (QoL) improvement after deep brain stimulation (DBS) for Parkinson's disease. Prior literature has largely focused on examining predictors one at a time, sometimes controlling for covariates.

OBJECTIVE

To develop a model that could be used as a nomogram to predict improvement in QoL following DBS surgery in patients with Parkinson's disease.

METHODS

All patients with complete pre- and postoperative movement disorder and neuropsychological testing who underwent DBS at a single institution between 2007-2012 were analyzed. The Parkinson's Disease Questionnaire-39 (PDQ-39) was used to measure QoL. Potential predictive factors, including patient demographics, clinical presentation characteristics, radiographic imaging, and motor and psychological testing were analyzed for impact on QoL.

RESULTS

Sixty-seven patients were identified, 36 (53.73%) of whom had meaningfully improved QoL following surgery. Five baseline variables showed significant relationships with the outcome: years since symptom onset, percent change in on/off motor evaluation, levodopa equivalent daily dose, bilateral vs unilateral DBS implantation, and PDQ-39 score. The final model includes PDQ-39, percent change in UPRS-III, and years since symptom onset and is able to predict improvement in QoL with 81% accuracy.

CONCLUSION

Our model accurately predicted whether QoL would improve in patients undergoing subthalamic nucleus DBS 81% of the time. Our data may serve as the foundation to further refine a clinically relevant prognostic tool that would assist the decision-making process for clinicians and DBS multidisciplinary teams assessing patient candidacy for surgery.
Novel Dual Lumen Catheter and Filtration Device for Removal of Subarachnoid hemorrhage: First Case Report
Authors: Blackburn Spiros L , Swisher Christa B , Grande Andrew W , Rubi Alba , Verbick Laura Zitella , McCabe Aaron , Lad Shivanand P
Published: June 2018

BACKGROUND AND IMPORTANCE

The amount of subarachnoid blood and the presence of toxic blood breakdown products in the cerebrospinal fluid (CSF) have long been associated with poor outcomes in aneurysmal subarachnoid hemorrhage. The Neurapheresis™ system (Minnetronix Inc, St. Paul, Minnesota) has been developed to filter CSF and remove blood products, and is being investigated for safety and feasibility in the ExtracorPoreal FILtration of subarachnoid hemorrhage via SpinaL CAtheteR (PILLAR) study. We report the first case using this novel device.

CLINICAL PRESENTATION

A 65-yr-old female presented with a ruptured left posterior communicating artery aneurysm. Following placement of a ventriculostomy and coil embolization of her aneurysm, the patient underwent placement of a lumbar dual lumen catheter for CSF filtration as part of the PILLAR study. In this case, a total of 9 h of filtration during 31 h of catheter indwelling resulted in 309.47 mL of processed CSF without complication. Computed tomography images demonstrated an interval reduction of subarachnoid hemorrhage immediately after filtration. The patient was discharged home on postbleed day 11 and at 30 d showed good recovery.

CONCLUSION

Safety of the Neurapheresis procedure was confirmed in this first case, and we will continue to evaluate safety of the Neurapheresis system through the PILLAR trial.
Approach to the Hip for SCFE: The North American Perspective
Authors: Sucato Daniel J.
Published: June 2018

The treatment of slipped capital femoral epiphysis (SCFE) in North America has seen a change over the past 15 to 20 years due to a better understanding of the blood flow supplying the femoral head, the ability to monitor the pressure/flow in real time and greater access to the deformity with the development of surgical approaches providing that access. These advances have mainly affected the treatment of the unstable SCFE to mitigate the risk of avascular necrosis but have also been utilized for the stable SCFE when severe deformity remains. This paper will provide a summary of some of the current techniques utilized in North America in the treatment of SCFE and will focus on the studies reported on this condition from this continent. In addition, I wanted this report to reflect the opinions and practices of North American surgeons and so I polled an audience that was representative of the current North American pediatric orthopaedist.
Considering Spine Surgery
Authors: Moulton Haley , Tosteson Tor D. , Zhao Wenyan , Pearson Loretta , Mycek Kristina , Scherer Emily , Weinstein James N. , Pearson Adam , Abdu William , Schwarz Susan , Kelly Michael , McGuire Kevin , Milam Alden , Lurie Jonathan D.
Published: June 2018

Study Design.

Prospective evaluation of an informational web-based calculator for communicating estimates of personalized treatment outcomes.

Objective.

To evaluate the usability, effectiveness in communicating benefits and risks, and impact on decision quality of a calculator tool for patients with intervertebral disc herniations, spinal stenosis, and degenerative spondylolisthesis who are deciding between surgical and nonsurgical treatments.

Summary of Background Data.

The decision to have back surgery is preference-sensitive and warrants shared decision making. However, more patient-specific, individualized tools for presenting clinical evidence on treatment outcomes are needed.

Methods.

Using Spine Patient Outcomes Research Trial data, prediction models were designed and integrated into a web-based calculator tool: http://spinesurgerycalc.dartmouth.edu/calc/. Consumer Reports subscribers with back-related pain were invited to use the calculator via email, and patient participants were recruited to use the calculator in a prospective manner following an initial appointment at participating spine centers. Participants completed questionnaires before and after using the calculator. We randomly assigned previously validated questions that tested knowledge about the treatment options to be asked either before or after viewing the calculator.

Results.

A total of 1256 consumer reports subscribers and 68 patient participants completed the calculator and questionnaires. Knowledge scores were higher in the postcalculator group compared to the precalculator group, indicating that calculator usage successfully informed users. Decisional conflict was lower when measured following calculator use, suggesting the calculator was beneficial in the decision-making process. Participants generally found the tool helpful and easy to use.

Conclusion.

Although the calculator is not a comprehensive decision aid, it does focus on communicating individualized risks and benefits for treatment options. Moreover, it appears to be helpful in achieving the goals of more traditional shared decision-making tools. It not only improved knowledge scores but also improved other aspects of decision quality.

Level of Evidence: 2
Negative beliefs about back pain are associated with persistent, high levels of low back disability in community-based women
Authors: Alyousef Bothaina , Cicuttini Flavia M. , Davis Susan R. , Bell Robin , Botlero Roslin , Urquhart Donna M.
Published: June 2018

Objectives:

Although pessimistic beliefs about back pain are associated with low back pain and disability, our understanding of their role in the natural history of the condition is limited. This study examined the association between beliefs about back pain and the development and progression of low back pain and disability over a 2-year period in community-dwelling women.

Methods:

A total of 506 women were recruited at baseline to participate in a 2-year cohort study. Beliefs about back pain were measured at baseline using the Back Beliefs Questionnaire, and low back pain and disability were assessed at baseline and 2 years using the Chronic Pain Grade Questionnaire (CPG). Participants were categorized into the following groups based on their CPG scores: no, developing, resolving, and persistent high-intensity pain and disability.

Results:

Of the 442 (87.4%) women who participated in the 2-year follow up study, 108 (24.4%) and 69 (15.6%) reported high levels of low back pain and disability, respectively. Negative beliefs about low back pain were associated with persistent, high levels of low back disability (M(SE) = 26.1(1.4) vs 31.3(0.31), P = 0.002), but not persistent, high-intensity pain (M(SE) = 28.9(1.02) vs 31.2(0.33), P = 0.2), after adjusting for confounders. Women with persistent high-intensity pain and disability had more negative responses to belief statements about the future consequences of the condition compared with those with no, resolving, or developing pain and disability (P < 0.001-0.03).

Conclusions:

This study found that pessimistic beliefs about back pain were associated with persistent high levels of low back disability, suggesting that strategies aimed at improving negative beliefs may reduce the chronicity associated with this condition.
Chronic Intraocular Inflammation as a Risk Factor for XEN Gel Stent Occlusion: A Case of Microscopic Examination of a Fibrin-obstructed XEN Stent
Authors: Gillmann Kevin , Mansouri Kaweh , Bravetti Giorgio E. , Mermoud André
Published: June 2018

Introduction:

In recent years microinvasive glaucoma surgery has risen in popularity. Among microinvasive glaucoma surgery options is the XEN gel stent (Allergan Plc, Dublin, Ireland), a 45 μm wide ab-interno microstent. It has proven effective in lowering intraocular pressure (IOP) with low complication rates. However, XEN gel stents can become obstructed and cause postoperative rise in IOP. The causes and predicting factors for such obstructions still requires further research.

Case Report:

We describe the case of a 69-year-old male patient, with traumatic glaucoma and chronic intraocular inflammation showed by laser flare photometry, following childhood trauma and anterior segment surgery. Uncontrollable IOP despite maximal antiglaucomatous therapy was managed with XEN-augmented Baerveldt surgery. Despite good initial filtration and IOP control, the XEN stent became obstructed and was surgically replaced. After a month, the new stent became obstructed and was replaced by a thicker-lumened Baerveldt tube. This restored good filtration, and adequate IOP was maintained postoperatively. Microscopic examination of the obstructed XEN stent showed a dense fibrin plug.

Discussion and Conclusions:

This case report shows that fibrin formation could be an important factor in XEN gel stent obstruction, even in initially successfully filtering stents. The association of fibrinogenesis and intraocular inflammation could add a note of caution to the use of XEN gel stents in complicated cataract surgery, or advocate for aggressive anti-inflammatory treatments postoperatively. This could lead to a refinement in success predictors and better patient selection for XEN surgery. Finally, this could open the way to new management options for persistent obstructions, including pharmaceutical fibrinolysis.
The Narrow-Lumen Jones Tube: A Novel Approach to Dry Eye Following Conjunctivodacryocystorhinostomy
Authors: Henriksen Brad , Perry C. Blake , Ng John D.
Published: June 2018

Conjunctivodacryocystorhinostomy with placement of a Jones tube (JT) is the gold standard for upper lacrimal system dysfunction. However, traditional JT have been associated with various complications. In their practice, the authors have encountered challenges with postoperative dry eye in a select group of patients, with recurrence of epiphora following tube occlusion, suggesting a need for decreasing the rate of tear drainage while maintaining a patent JT. To address this issue, the senior author (J.D.N.) introduced a modified JT with a narrow lumen (reduced-flow JT) for patients who experience significant dry eye symptoms after placement of a JT. The authors describe 3 patients who experienced improvement in dry eye symptoms after the placement of reduced-flow JT.
Trends in Avoidable Hospitalizations for Diabetes: Experience of a Large Clinically Integrated Health Care System
Authors: Yaqoob Maidah , Wang Jihan , Sweeney Ann T. , Wells Cynthia , Rego Virginia , Jaber Bertrand L.
Published: June 2018

Prevention quality indicators (PQIs) are used in hospital discharge data sets to identify quality of care for ambulatory care–sensitive conditions, such as diabetes. We examined the impact of clinical integration efforts on diabetes-related PQIs in a large community-based health care organization. Inpatient and observation hospitalizations from nine acute care hospitals were trended over 5 years (2012–2016). Using established technical specifications, annual hospitalizations rates were calculated for four diabetes-related PQIs: uncontrolled diabetes, short-term complications, long-term complications, and lower extremity amputations. The mean (±standard error of the mean) annual hospitalization rate for uncontrolled diabetes and short-term complications gradually increased from 1.3 ± 1.1 and 3.2 ± 2.5 per 1,000 discharges to 2.4 ± 1.7 (p < .001) and 7.1 ± 3.2 (p < .001) per 1,000 discharges, respectively. Conversely, the annual hospitalization rate for long-term complications and lower extremity amputations gradually decreased from 12.6 ± 1.1 and 88.6 ± 1.0 per 1,000 discharges to 6.5 ± 1.0 (p = .004) and 82.2 ± 1.0 per 1,000 discharges (p < .001). Trends generally persisted across payers, age, sex, and race. There was an inverse correlation between county income-per-capita and hospitalization rate for short-term complications (p = .04), long-term complications (p = .03), and lower extremity amputations (p < .001). Study limitations included use of administrative data, evolving coding practices, and ecological fallacy. Ambulatory-based efforts to optimize diabetes care can prevent long-term complications and reduce avoidable hospitalizations.
Terrorist attacks in Paris: managing mass casualties in a remote trauma center
Authors: Femy Florent , Follin Arnaud , Juvin Philippe , Feral-Pierssens Anne-Laure
Published: June 2018

Objective

On 13 November 2015, Paris was the target of multiple terrorist attacks responsible for a massive influx of casualties in emergency departments (EDs). Because of the activation of a local crisis plan and the arrival of extra staff, our capacities increased markedly. Our aim was to analyze whether our center, in this challenging context, efficiently managed this massive influx of patients.

Patients and methods

We carried out a monocentric retrospective study. All patients received in the first 24 h were included (isolated psychological trauma with no physical injury excluded). Our main endpoint was to assess patient diversion through early secondary transfers ( ≤ 24 h) because of an overrun of our capacities.

Results

A total of 53 victims were sent to our center in a 4 h timeframe; 12 patients were excluded (no physical injury). We analyzed 41 victims. Their median injury severity score was 4 (1;9). Three (7%) patients were transferred after ED management to a nearby hospital within the first 24 h for minor orthopedic surgery. There was a significant increase in medical/surgical staff (eight ED physicians instead of two; six intensivists vs. two; three orthopedic surgeons vs. one). Among the victims, 71% had firearms wounds and 30% had open fractures. Twenty surgeries were performed in the first 24 h. There were no in-hospital deaths.

Conclusion

Faced with an unusual event and thanks to the increase in staff, our operating capacities increased. Our center took charge of almost all victims. Patient diversion concerned only three patients transferred to a nearby hospital for minor orthopedic surgery.
Self-organizing Development Teams for Innovative Nursing Care
Authors: Bondas Terese
Published: June 2018

The purpose of this study was to describe the participation of nurses and nurse leaders in self-organizing teams formed to develop innovative nursing care. The theoretical perspective combines Bondas' caritative theory on nursing leadership with Waterman's and Dolan's work on ad hoc organizations. Seven self-organizing teams participated in a 2-year action research project. Data were collected through fieldwork, formal and informal individual and group interviews, and diaries. Analytical abstraction methodology described by Miles et al was used. The metaphor “overcoming the jet lag of bureaucracy” is based on 5 themes: struggling to design the new team; investing time and self; needing research and leadership support; evolving collegial collaboration, professional growth, and pride; and growing professional security and the will to continue education as a result of learning.
Strategies and Barriers to Engaging Dual-Eligible Patients in a Hospital Patient and Family Advisory Program
Authors: Grant Susan M. , Jones Pamela , Pilon Bonnie
Published: June 2018

As national efforts intensify to improve health outcomes and reduce health care costs, hospitals search for effective ways to partner with patients and families to achieve these goals. Many are implementing patient and family advisory programs (PFAPs) where patients, families, administrators, and clinicians work together to improve the patient experience. However, hospitals struggle with engaging the underserved—specifically, dual-eligible patients enrolled in both Medicare and Medicaid—in PFAPs. This quality improvement project used telephone interviews with 12 dual-eligible beneficiaries and 4 of their providers to identify successful approaches to engage these patients in the hospital PFAP. While none of the participants had direct experience with a PFAP, many of the strategies and barriers identified from their individual care experiences will be used to inform the hospital's plan to engage this patient population in future patient and family engagement efforts.
Evolution in Prostate Cancer Staging: Pathology Updates From AJCC 8th Edition and Opportunities That Remain
Authors: Fine Samson W.
Published: June 2018

The Tumor-Nodes-Metastasis system at the core of prognostic staging has been recently updated in the American Joint Committee on Cancer (AJCC) 8th edition, published in 2016. For prostate cancer, significant changes in staging of organ-confined disease, inclusion of a new grade grouping, and provision of levels of evidence for these modifications are part of what differentiates the 8th edition AJCC from prior iterations. Herein, the rationale underlying these changes is detailed. In addition, data elements not well represented in the present system are highlighted as opportunities for fresh study that may impact future AJCC classifications.
Kidney Biopsy Adequacy
Authors: Ferrer German , Andeen Nicole K. , Lockridge Joseph , Norman Douglas , Foster Bryan R. , Houghton Donald C. , Troxell Megan L.
Published: June 2018

There are differences in renal biopsy yield related to on-site evaluation, tissue division, and operator, among others. To understand these variations, we collected adequacy-associated data (%cortex, glomeruli, arteries, length) from consecutive native and allograft kidney biopsies over a 22-month period. In total, 1332 biopsies (native: 873, allograft: 459) were included, 617 obtained by nephrologists, 663 by radiologists, and 559 with access to on-site division. Proceduralists with access to on-site evaluation had significantly lower inadequacy rates and better division of tissue for light microscopy (LM), immunofluorescence, and electron microscopy than those without access to on-site evaluation. Radiologists in our region were significantly less likely to have access to on-site evaluation than nephrologists. On multivariate analysis for native kidney biopsies, the effect of having a radiologist perform the biopsy and having access to on-site division were both significant predictors of obtaining greater calculated amount of cortex for LM. Despite the trend for radiologists to obtain more tissue in general, biopsies from nephrologists contained a greater percentage of cortex and were more likely to be considered adequate for LM (native kidney inadequacy rate for LM: 1.11% vs. 5.41%, P=0.0086). Biopsies in which inadequate or marginal cortical tissue was submitted for LM had only minor decreases in the amount of cortex submitted for immunofluorescence and electron microscopy, revealing an opportunity for improved specimen triaging when limited tissue is obtained. In conclusion, both on-site evaluation/division and proceduralist significantly affect quantitative kidney biopsy metrics, which in turn affects the pathologist’s ability to render an accurate diagnosis with appropriate prognostic information for the patient and treating nephrologist.
Evaluation of Ventricle Size Measurements in Infants by Pediatric Emergency Medicine Physicians
Authors: Halm Brunhild M. , Leone Tina A. , Chaudoin Lindsey T. , McKinley Kenneth W. , Ruzal-Shapiro Carrie , Franke Adrian A. , Tsze Daniel S.
Published: June 2018

Objectives

The identification of hydrocephalus in infants by pediatric emergency medicine (PEM) physicians using cranial point-of-care ultrasound (POCUS) has not been evaluated. We aimed to conduct a pilot/proof-of-concept study to evaluate whether PEM physicians can identify hydrocephalus (anterior horn width >5 mm) in 15 infants (mean 69 ± 42 days old) from the neonatal intensive care unit using POCUS. Our exploratory aims were to determine the test characteristics of cranial POCUS performed by PEM physicians for diagnosing hydrocephalus and the interrater reliability between measurements made by the PEM physicians and the radiologist.

Methods

Depending on the availability, 1 or 2 PEM physicians performed a cranial POCUS through the open anterior fontanel for each infant after a 30-minute didactic lecture to determine the size of the left and right ventricles by measuring the anterior horn width at the foramen of Monroe in coronal view. Within 1 week, an ultrasound (US) technologist performed a cranial US and a radiologist determined the ventricle sizes from the US images; these measurements were the criterion standard.

Results

A radiologist determined 12 of the 30 ventricles as hydrocephalic. The sensitivity and specificity of the PEM physicians performed cranial POCUS was 66.7% (95% confidence interval [CI], 34.9%–90.1%) and 94.4% (95% CI, 72.7%–99.9%), whereas the positive and negative predictive values were 88.9% (95% CI, 53.3%–98.2%) and 81.0% (95% CI, 65.5%–90.5%), respectively. The interrater reliability between the PEM physician's and radiologist’s measurements was r = 0.91. The entire POCUS examinations performed by the PEM physicians took an average of 1.5 minutes. The time between the cranial POCUS and the radiology US was, on average, 4 days.

Conclusions

While the PEM physicians in our study were able to determine the absence of hydrocephalus in infants with high specificity using cranial POCUS, there was insufficient evidence to support the use of this modality for identifying hydrocephalus. Future studies with more participants are warranted to accurately determine test characteristics.
Procurement of Extended Vascularized Skin Flaps from the Donor Enables Hand Transplantation in Severe Upper Extremity Burns: An Anatomical Study
Authors: Dalla Pozza Edoardo , Bassiri Gharb Bahar , Papay Francis A. , Drake Richard L. , Steckler Andrew , Rampazzo Antonio
Published: June 2018

Background:

Hand transplantation in patients with severe upper extremity burns can be associated with an increased risk of exposure of vessels, tendons, and nerves because of extensive skin and soft-tissue deficit. This study evaluated how to reliably transfer additional extended skin flaps with a standard hand allograft.

Methods:

Twenty-five upper extremities were used. Sixteen were injected with latex to map the perforating branches of the brachial, superior ulnar collateral, radial, ulnar, and posterior interosseous arteries. Nine hand allografts were procured, injected with blue ink through the brachial artery to assess the perfusion of the skin flaps, and then mock transplanted.

Results:

Sizable perforators from the brachial, superior ulnar collateral, radial, ulnar, and posterior interosseous arteries were used to augment the vascularization of the skin flaps. The average stained area of the medial arm flap was between 85.7 and 93.9 percent. The stained area of the volar forearm flap was the smallest when based on perforators within 6 cm from the wrist crease (51.22 percent). The dorsal forearm flap showed the least amount of staining (34.7 to 46.1 percent). The average time to repair tendons, nerves, and vessels was longer when a single volar forearm-arm flap was harvested (171.6 minutes). Harvest of the allograft associated with a distally based forearm flap and islanded arm flap was the fastest (181.6 ± 17.55 minutes).

Conclusion:

Extended skin flaps, based on perforators of the main axial vessels, can be reliably transplanted with a standard hand allograft based on the brachial or axillary vascular pedicle.
68Ga DOTA-Exendin PET/CT for Detection of Insulinoma in a Patient With Persistent Hyperinsulinemic Hypoglycemia
Authors: Parihar Ashwin Singh , Vadi Shelvin Kumar , Kumar Rajender , Mittal Bhagwant Rai , Singh Harmandeep , Bal Amanjit , Walia Rama , Shukla Jaya , Sinha Saroj Kumar
Published: June 2018

Insulinomas are the most common functioning pancreatic neuroendocrine tumors and the leading cause of persistent hypoglycemia with hyperinsulinemia in adults. Glucagon-like-peptide-1 (GLP) receptor analogs are the latest agents being used in the detection of insulinomas, with initial reports suggesting high sensitivity due to universal GLP1 receptor expression on these tumors. PET/CT imaging in this patient using 68Ga DOTA-Exendin, a GLP receptor analog, proved useful for accurate localization of the culprit lesion, aiding in the definitive management of the patient.
Dog Attack Causing Lip Wound
Authors: Maia Gabriela Vasconcelos , de Albuquerque Amanda Lobão , Ximenes Talyne Albuquerque , Magalhães Tibério Gomes , de Souza Carvalho Abrahão Cavalcante Gomes
Published: June 2018

Animal bites are relatively common occurrences reaching about 4.5 millions of people every year. The main aggressor is the domesticated dog, responsible for around 90% of the patients, with children being the most affected, with 70% of the registered patients, while with adults that number is a lot lower (15%). Bites around the head and neck require special attention. Due to the presence of noble structures and the rich local vascularization, any wounds have been immediately addressed to stop bleeding and further complications. The present study shows a woman patient, victim of a dog bite in her face, where the dog is her own, a domesticated Weimaraner. The patient was attended to in the Unidade de Pronto Atendimento, the procedure was to first apply anesthesia, then clean up the wound, debris of borders, and the plane suturation. Two months after the surgery, the patient showed satisfactory healing, with no complaints about pain or esthetics. As final considerations, it has to be remembered that facial trauma has to be assessed and taken care of immediately, in a way that closing the wound in the first hours after the trauma increase the chances of obtaining a better esthetic as physiologic result for the patient, also preventing infections from the wound and external environment. Also, in the case of animal bites, it is important that the professional possess the knowledge to deal with each individual situation, employing the correct prophylactic vaccine and perform the correct notification.
Evaluating the National Surgical Quality Improvement Program-Pediatric Surgical Risk Calculator for Pediatric Craniosynostosis Surgery
Authors: Gadgil Nisha , Pan I-Wen , Babalola Solomon , Lam Sandi
Published: June 2018

Background:

The American College of Surgeons’ National Surgical Quality Improvement Program-Pediatric (NSQIP-P) risk calculator was developed based on national data. There have been no studies assessing the risk calculator's performance in pediatric neurosurgery. The authors aimed to evaluate the predictions from the risk calculator compared to our single institution experience in craniosynostosis surgery.

Methods:

Outcomes from craniosynostosis surgeries performed between 2012 and 2016 at our academic pediatric hospital were evaluated using the NSQIP-P risk calculator. Descriptive statistics were performed comparing predicted 30-day postoperative events and clinically observed outcomes. The performance of the calculator was evaluated using the Brier score and receiver operating characteristic curve (ROC).

Results:

A total of 202 craniosynostosis surgeries were included. Median age was 0.74 years (range 0.15–6.32); 66% were males. Blood transfusion occurred in 162/202 patients (80%). The following clinical characteristics were statistically correlated with surgical complications: American Society of Anesthesiologists physical status classification >1 (P < 0.001), central nervous system abnormality (P < 0.001), syndromic craniosynostosis (P = 0.001), and redo operations (P = 0.002). Postoperative events occurred in <3%, including hardware breakage, tracheal-cartilaginous sleeve associated with critical airway, and surgical site infection. The calculator performed well in predicting any complication (Brier = 0.067, ROC = 73.9%), and for pneumonia (Brier = 0.0049, ROC 99%). The calculator predicted a low rate of cardiac complications, venous thromboembolism, renal failure, reintubation, and death; the observed rate of these complications was 0.

Conclusions:

The risk calculator demonstrated reasonable ability to predict the low number of perioperative complications in patients undergoing craniosynostosis surgery with a composite complications outcome. Efforts to improve the calculator may include further stratification based on procedure-specific risk factors.
The Second Society for Simulation in Healthcare Research Summit
Authors: Scerbo Mark W. , Calhoun Aaron W. , Paige John T. , Sanko Jill , Sokolowski John
Published: June 2018

Summary Statement

In this article, we report on the Second Society for Simulation in Healthcare Research Summit held in 2017. This meeting succeeded the First Research Summit from 2011 with the goal of advancing the scope of healthcare simulation research. During the one and a half day summit, some of the world's leading experts in simulation, healthcare, and simulation in healthcare convened to discuss ideas about what research goals would be most beneficial to the healthcare simulation community, and what could be done to achieve them. We describe the rationale for the meeting, the organization, the program, and the articles that emerged from the Summit, which are found in this supplemental issue of Simulation in Healthcare.
Novel Approaches to Block Complement
Authors: Böhmig Georg A. , Wahrmann Markus , Eskandary Farsad , Rostaing Lionel
Published: June 2018

The complement system may contribute in many ways to transplant injury, being a promising target for specific therapeutic interventions. There is evidence that the monoclonal anti-C5 antibody eculizumab is effective in the prevention and treatment of early antibody-mediated rejection, but terminal complement blockade might be of limited efficiency in chronic rejection. Given the diversity of immunological events triggered by activation steps upstream to C5, in particular, opsonin and anaphylatoxin formation through C3 cleavage, one may argue that, in the specific context of antibody-mediated rejection, inhibition of antibody-triggered classical pathway (CP) activation might be beneficial. Strategies to interfere with key CP component C1 are currently under clinical evaluation and include the therapeutic use of purified C1-inhibitor, which, besides targeting the integrity and function of the C1 complex, also affects components of the LP, the contact system, the coagulation cascade or surface molecules mediating leukocyte-endothelial interactions. In addition, a monoclonal anti-C1s antibody (BIVV009) has now entered clinical evaluation and was shown to effectively block antibody-triggered CP activation in rejecting kidney allografts. Moreover, modified apheresis techniques for preferential removal of macromolecules, including C1q, may allow for efficient complement depletion, in addition to antibody removal. The availability of effective strategies to interfere with the CP, as well as innovative approaches targeting other pathways, some of them already being tested in clinical trials, will help us figure out how complement contributes to acute and chronic graft injury, and hopefully provide us with new ways to more efficiently counteract rejection.
Long-term Sustained Cognitive Benefits of Vagus Nerve Stimulation in Refractory Depression
Authors: Desbeaumes Jodoin Véronique , Richer François , Miron Jean-Philippe , Fournier-Gosselin Marie-Pierre , Lespérance Paul
Published: June 2018

Background

Treatment-resistant depression (TRD) is a serious chronic condition disabling patients functionally and cognitively. Chronic vagus nerve stimulation (VNS) is recognized for the management of TRD, but few studies have examined its long-term effects on cognitive dysfunction in unipolar and bipolar resistant depression.

Objective

The purpose of this study was to assess the course of cognitive functions and clinical symptoms in a cohort of patients treated with VNS for TRD.

Methods

In 14 TRD patients with VNS, standardized clinical and neuropsychological measures covering memory, attention/executive functions, and psychomotor speed were analyzed prestimulation and up to 2 years poststimulation.

Results

Vagus nerve stimulation patients significantly improved on cognitive and clinical measures. Learning and memory improved rapidly after 1 month of stimulation, and other cognitive functions improved gradually over time. Cognitive improvements were sustained up to 2 years of treatment. At 1 month, improvement in Montgomery-Åsberg Depression Rating Scale scores was not correlated with changes in any of the cognitive scores, whereas at 12 months, the change in Montgomery-Åsberg Depression Rating Scale score was significantly correlated with several measures (Stroop interference, verbal fluency, and Rey-Osterrieth Complex Figure delayed recall).

Conclusions

In recent years, a growing interest in cognitive dysfunction in depression has emerged. Our results suggest that chronic VNS produces sustained clinical and cognitive improvements in TRD patients, with some mental functions improving as soon as 1 month after the initiation of the VNS therapy. Vagus nerve stimulation seems a very promising adjunctive therapy for TRD patients with cognitive impairment.
Factors Associated with Scientific Misconduct and Questionable Research Practices in Health Professions Education
Authors: Maggio Lauren A. , Dong Ting , Driessen Erik W. , Artino Anthony R.
Published: June 2018

Introduction

Engaging in scientific misconduct and questionable research practices (QRPs) is a noted problem across fields, including health professions education (HPE). To mitigate these practices, other disciplines have enacted strategies based on researcher characteristics and practice factors. Thus, to inform HPE, this article seeks to determine which researcher characteristics and practice factors, if any, might explain the frequency of irresponsible research practices.

Method

In 2017, a cross-sectional survey of HPE researchers was conducted. The survey included 66 items derived from two published QRP surveys and a publication pressure scale adapted from the literature. The study outcome was the self-reported misconduct frequency score, which is a weighted mean score for each respondent on all misconduct and QRP items. Statistical analysis included descriptive statistics, correlation analysis, and multiple linear regression analysis.

Results and Discussion

In total, 590 researchers took the survey. Results from the regression analysis indicated that researcher age had a negative association with the misconduct frequency score (b = −.01, t = −2.91, p<.05) suggesting that older researchers tended to have lower misconduct frequency scores. Publication pressure (b = .20, t = 7.82, p<.001) and number of publications (b = .001, t = 3.27, p<.01) had positive associations with the misconduct frequency score. The greater the publication pressure or the more publications a researcher reported, the higher the misconduct frequency score. Overall, the explanatory variables accounted for 21% of the variance in the misconduct frequency score, and publication pressure was the strongest predictor. These findings provide an evidence base from which HPE might tailor strategies to address scientific misconduct and QRPs.
High-resolution sweep metagenomics using fast probabilistic inference
Authors: Mäklin Tommi , Kallonen Teemu , David Sophia , Boinett Christine J. , Pascoe Ben , Méric Guillaume , Aanensen David M. , Feil Edward J. , Baker Stephen , Parkhill Julian , Sheppard Samuel K. , Corander Jukka , Honkela Antti
Published: June 2018

Determining the composition of bacterial communities beyond the level of a genus or species is challenging because of the considerable overlap between genomes representing close relatives. Here, we present the mSWEEP method for identifying and estimating the relative abundances of bacterial lineages from plate sweeps of enrichment cultures. mSWEEP leverages biologically grouped sequence assembly databases, applying probabilistic modelling, and provides controls for false positive results. Using sequencing data from major pathogens, we demonstrate significant improvements in lineage quantification and detection accuracy. Our method facilitates investigating cultures comprising mixtures of bacteria, and opens up a new field of plate sweep metagenomics.
Optogenetic silencing of immature and mature neurons in dentate gyrus to assess their roles in memory discriminations
Authors: van Dijk Milenna T. , Yu Zejia Angel , Lim Younghun , Hen René , Fenton André A.
Published: June 2018

Discriminating similar memories and events depends on the dentate gyrus region of the hippocampus. This region is also distinctive because neurogenesis continues in adulthood. Whether both mature and immature granule cells play a role in memory discrimination, and whether the roles are distinct is actively investigated. Here we demonstrate that manipulating either mature or immature granule cells can impair discrimination of similar active place avoidance memories, but the manipulations have different effects. We also observe that prior experience modulates which memories are compromised by inactivation of immature neurons. These data demonstrate the importance of the dentate gyrus network of cells for memory discrimination.
A non-canonical metal center drives activity of the Sediminispirochaeta smaragdinae metallo-β- lactamase SPS-1
Authors: Cheng Zishuo , VanPelt Jamie , Bergstrom Alexander , Bethel Christopher , Katko Andrew , Miller Callie , Mason Kelly , Cumming Erin , Zhang Huan , Kimble Robert , Fullington Sarah , Bretz Stacey Lowery , Nix Jay C. , Bonomo Robert A. , Tierney David L. , Page Richard C. , Crowder Michael W
Published: June 2018

In an effort to evaluate whether a recently reported putative metallo-β-lactamase (MβL) contains a novel MβL active site, SPS-1 from Sediminispirochaeta smaragdinae was over-expressed, purified, and characterized using spectroscopic and crystallographic studies. Metal analyses demonstrate that recombinant SPS-1 binds nearly 2 equivalents of Zn (II), and steady-state kinetic studies show that the enzyme hydrolyzes carbapenems and certain cephalosporins but not β-lactam substrates with bulky substituents in the 6-7 position. Spectroscopic studies on Co (II)-substituted SPS-1 suggest a novel metal center in SPS-1, with reduced spin coupling between the metal ions and a novel Zn1 metal binding site. This site was confirmed with a crystal structure of the enzyme. The structure shows a Zn2 site that is similar that that in NDM-1 and other subclass B1 MβLs; however, the Zn1 metal ion is coordinated by 2 histidine residues and a water molecule, which is held in position by a hydrogen bond network. The Zn1 metal is displaced nearly 1 Å from the position reported in other MβLs. The structure also shows extended helices above the active site, which create a binding pocket that precludes the binding of substrates with large, bulky substituents in the 6/7 position of β-lactam antibiotics. This study reveals a novel metal binding site in MβLs, and suggests that the targeting of metal binding sites in MβLs with inhibitors is now more challenging with the identification of this new MβL.
Anti-V2 Antibody Deficiency in Individuals Infected With HIV-1
Authors: Liu Lily , Li Liuzhe , Nanfack Aubin , Mayr Luzia M. , Soni Sonal , Kohutnicki Adam , Agyingi Lucy , Wang Xiao-Hong , Tuen Michael , Shao Yongzhao , Totrov Maxim , Zolla-Pazner Susan , Kong Xian-Peng , Duerr Ralf , Gorny Miroslaw K.
Published: June 2018

The positive correlation of high levels of plasma anti-V2 antibodies (Abs) with protective immunity in the Phase III anti-HIV RV144 vaccine trial generated interest in the induction of these Abs for HIV vaccine development. We analyzed plasma samples from 79 chronically infected Cameroonian individuals for Ab reactivity against three V1V2 fusion proteins and five cyclic V2 peptides and found that HIV-1 infection induces different levels of anti-V2 Abs. While the majority of plasma samples reacted strongly with one or more V2 antigens, 10% (8) of the samples were nonreactive. Deficiency of anti-V2 Abs was consistently found in longitudinal plasma samples tested over 8 to 54 months of HIV infection. There was a strong correlation between binding activities of plasma anti-V2 Abs and anti-gp120 and anti-gp41 Abs, suggesting that deficiency of V2 Abs could be related, in part, to a limited ability to elicit strong Ab responses. Analysis of gp120 sequences revealed that the V2 region of viruses from donors with V2-deficient versus V2-reactive Abs displayed a tendency toward longer length, more glycans, and lower isoelectric point and charge. No differences between these two patient groups were noted in the same parameters measured in the V1 region. These data suggest that immunogens containing a shorter V2 region with fewer glycosylation sites and higher electrostatic charges would be beneficial for induction of anti-V2 Abs, but the ability to mount a strong general Ab response to HIV-1 appears to be a dominant factor.

IMPORTANCE

The results of the RV144 vaccine clinical trial showed a correlation between plasma Abs against a V1V2 fusion protein and a decreased risk of acquiring HIV-1 infection. This turned the focus of some HIV vaccine design to the induction of elevated levels of anti-V2 Abs to increase vaccine efficacy. In plasma samples from Cameroonian individuals infected with HIV-1, we observed broad variations in levels of anti-V2 Abs, and 8 of the 79 plasma samples tested displayed substantial deficiency of V2 Abs. Sequence analysis of the V2 region from plasma viruses and multivariate analyses of V2 characteristics showed a significant difference in several features between V2-deficient and V2-reactive plasma Abs. These results suggest that HIV vaccine immunogens containing a V2 region with shorter length, fewer glycosylation sites, and higher electrostatic charges may be beneficial for induction of a higher level of anti-V2 Abs and thus contribute to HIV vaccine efficacy.
The identification of critical lethal action in antimicrobial mechanism of glycerol monomyristate against foodborne pathogens
Authors: Zhang Song , Xiong Jian , Lou Wenyong , Ning Zhengxiang , Zhang Denghui , Yang Jiguo
Published: June 2018

Glycerol monomyristate (GMM) is a promising antimicrobial substance due to its broad antibacterial spectrum: however, the critical lethal action in its antimicrobial mechanism for foodborne pathogens remains unclear. In the present study, the inhibitory activities of GMM onEscherichia coli(E. coli),Staphylococcus aureus(S. aureus) andCandida albicans(C. albicans) were compared, and its membrane and intracellular action mechanism was investigated. The results showed that the susceptibility ofE. colito GMM was the highest, followed byS. aureus, andC. albicansbeing the poorest. Using flow cytometry, the GMM dose causing above 50% permeability ratio onE. coliwas lower than that onS. aureus. The images from scanning electron microscope revealed no doses difference existed between the two strains when the obvious cell damage occurred. Furthermore, cell cycle and multiple fluorescent staining assays showed only the cell division ofE. coliandS. aureus, excluding that ofC. albicans, was obviously affected at 1/4 MIC and 1/2 MIC, indicating that the DNA interfere and subsequent cell division inhibition was likely to be the critical lethal action with doses near MIC, which can also explain the poor sensitivity ofC. albicans.

Importance

Foodbornepathogens, as a common source of biological pollution in the food industry, can cause millions of food poisoning incidents each year, which poses great risks to consumers’ health and safety. The use of monoglyceride as an edible surfactant to inhibit the growth of food-borne microorganisms has been a long time, but the relevant antibacterial mechanism is too broad to accurately grasp its key lethal effect and its action doses, which not only affects the antibacterial efficiency, but also may result in the abnormalities of food flavor when adding at overdoses. The significance of the study is to identify the key lethal effect and its action doses, which will greatly enhance the understanding of the response mechanism of different types of foodborne pathogens to monoglycerides, and provide a more reasonable reference for differential control and treatment of different gastrointestinal infections when combined with antibiotics in clinical.