bluuebunny/crossref_metadata_2025 huggingface dataset:
Multidisciplinary Management of Collegiate Sports-Related Concussions
Authors: Constantinidou Fofi , Beardslee Jennifer , Dailey Stephen , Knollman-Porter Kelly
Published: January 2019

Purpose Collegiate varsity athletes are at risk for sustaining a sports-related concussion, which can negatively impact performance during academic, social, work, and athletic endeavors. Because of the complex nature of concussions and high rates of underreporting by athletes, concussion education, identification, and postinjury care require a collaborative, multidisciplinary approach. Therefore, the purpose of this paper is to describe the specific responsibilities of the team members along with the established pre- and postconcussion procedures of one of the oldest university-based multidisciplinary concussion management programs that is coordinated by speech-language pathology.

Method The authors provide a theoretical review of current best practices for the multidisciplinary team along with a discussion of baseline and postconcussion neurocognitive assessment and management procedures directly involving speech-language pathology. Included is a case example illustrating the postinjury procedures utilized by the team.

Conclusion Management of the complex sequelae of sports-related concussion for the varsity collegiate athlete necessitates implementation of a multidisciplinary, collaborative approach. Speech-language pathologists' training in the assessment and treatment of brain injury provides the team with an objective perspective in the evaluation and postinjury management of the injured student athlete. While our understanding of concussions has improved greatly over the past two decades, researchers and clinicians on the front lines of care recognize that continued voids exist in our knowledge, with the need to continually explore new methods to identify and manage the complex immediate and potentially long-term ramifications of concussion.
Impact of Sports-Related Subconcussive Injuries in Soccer Players
Authors: Salvatore Anthony , Díaz-Rodríguez Yarimar
Published: January 2019

Sports-related subconcussive impacts to the head are receiving increased interest. Recent evidence indicates that subconcussive impacts will have greater relevance across time because of the number of repetitive impacts. Soccer players are at risk of receiving at least one impact during a soccer game. The authors review the cognitive-communication functioning following subconcussive head injuries in youth and recommendations for baseline assessments and cognitive-communication dysfunctions after subconcussive impacts in youth. The review is followed by a description and discussion of a study that assessed the cognitive-communicative dysfunction in young soccer players prior to and following a series of soccer matches and recommendations for monitoring recovery of cognitive-communication.
Total Knee Arthroplasty Is Safe in Jehovah's Witness Patients—A 12-Year Perspective
Authors: Wolfson Theodore S. , Novikov David , Chen Kevin K. , Kim Kelvin Y. , Anoushiravani Afshin A. , Deshmukh Ajit J. , Lajam Claudette M.
Published: January 2019

Despite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally requires allogeneic blood transfusion. This poses a particular challenge for Jehovah's Witnesses (JW) who believe that the Bible strictly prohibits the use of blood products. The aim of this study was to compare JW and a matched-control cohort of non-JW candidates undergoing TKA to assess the safety using modern blood management protocols. Fifty-five JW patients (63 knees) who underwent TKA at our institution between 2005 and 2017 were matched to 63 non-JW patients (63 knees). Patient demographics, intraoperative details, and postoperative complications including in-hospital complications, revisions, and 90-day readmissions were collected and compared between the groups. Additionally, subgroup analysis was performed comparing JW patients who were administered tranexamic acid (TXA) between the two groups. Baseline demographics did not vary significantly between the study cohorts. The mean follow-up was 3.1 years in both the JW and non-JW cohorts. Postoperative complications, including in-hospital complications (7.9 vs. 4.8%; p = 0.47), revision TKA (1.6 vs. 1.6%; p = 1.00), and 90-day readmission (1.6 vs. 4.8%; p = 0.31) were not significantly different between the JW and non-JW groups. Subgroup analysis demonstrated JW patients who received TXA had a significantly lower decline in postoperative hemoglobin (Hgb) (8.6 vs. 14.0%; p < 0.01). At a follow-up of up to 12 years, JW patients who underwent TKA have outcomes equivalent to non-JW patients without the need for transfusion. Our findings support that surgeons are more likely to optimize JW patients preoperatively with iron and folate supplementation. Despite these variations in preoperative optimization efforts, no significant difference with regard to Hgb or hematocrit levels was demonstrated. Level of evidence is III, retrospective observational study.
Knee Cell-Based Cartilage Restoration
Authors: Hensley Dana , Pickett Adam
Published: January 2019

As our patients become more physically active at all ages, the incidence of injuries to articular cartilage is increasing causing significant pain and disability. The intrinsic healing response of articular cartilage is poor because of its limited vascular supply and capacity for chondrocyte division. Nonsurgical management for the focal cartilage lesion is successful in the majority of patients. Those patients who fail conservative management may be candidates for a cartilage reparative or reconstructive procedure. The type of treatment available depends on a multitude of lesion-specific and patient-specific variables. First-line therapies for isolated cartilage lesions have demonstrated good clinical results in the correct patient, but typically repair cartilage with fibrocartilage, which has inferior stiffness, inferior resilience, and poorer wear characteristics. Advances in cell-based cartilage restoration have provided the surgeon a means to address focal cartilage lesions utilizing mesenchymal stem cells, chondrocytes, and biomimetic scaffolds to restore hyaline cartilage.
Rehabilitation for Femoroacetabular Impingement: Conservative Care and Postoperative Practice
Authors: Westermann Robert , Lynch T. , Rosneck James , Hagen Mia
Published: January 2019

The understanding of femoroacetabular impingement (FAI) has increased over the past 10 years, with advancements in diagnosis and surgical techniques. Controversy remains regarding the ideal regimen of conservative care. Additionally, there is wide variety in postoperative clinical practice after hip arthroscopy. This review is a synthesis of resources on rehabilitation as a stand-alone treatment for FAI as well rehabilitation following surgery. Best evidence regarding conservative care is presented followed by postoperative debates on weight-bearing, range of motion, and physical therapy. In most cases, such as use of bracing and continuous passive motion, there are limited experimental studies to rely on. Higher quality evidence is required to support today's rehabilitation practices which are based mostly on theory and individual experience.
Clinical Assessments of Balance in Adults with Concussion: An Update
Authors: Reed-Jones Rebecca , Szekely Brian , Powell Douglas , Murray Nicholas
Published: January 2019

Postural instability is a cardinal indicator of concussion. Assessments of the postural control system range from clinical to laboratory tests that assess the balance of the individual. In a previous article regarding clinical assessment of balance in adults with concussion, we reviewed the importance of balance as a component in concussion evaluations. The purpose of this review article is to update the information previously published in 2014. Since 2014, research has provided evidence for the incorporation of dynamic methods for evaluating balance postconcussion with particular emphasis on sensory system integration and dual tasking. Therefore, this review will examine the current state of knowledge on how concussion injuries affect postural control, advancements in evaluating balance postconcussion, such as novel eye-tracking techniques, and current recommendations for best practices for balance assessment.
A Unique Factor XIII Mutation in Southeastern Iran with an Unexpectedly High Prevalence: Khash Factor XIII
Authors: Dorgalaleh Akbar , Tabibian Shadi , Shams Mahmood , Majid Golbahar , Naderi Majid , Casini Alessandro , Tavasoli Behnaz , Gheidishiran Maryam , Daneshi Maryam , Safa Majid
Published: January 2019

Congenital factor XIII (FXIII) deficiency is an extremely rare hemorrhagic disorder characterized by a deficiency of FXIII and associated with a high rate of morbidity and mortality. The disorder is more frequent in Iran, especially in Khash, a city in the southeast of the country. As identified in the current report, the prevalence of FXIII deficiency in this city is 1 homozygote per approximately 500 population (which is ∼4,000 times higher than the worldwide prevalence) with 3.5% heterozygotes. The disorder is accompanied by a high rate of mortality in rural areas of Khash, given an averaged observed rate of approximately three deaths per each family with FXIII deficiency, mostly due to late-diagnosis and/or misdiagnosis, and fetal consequences of both umbilical cord and central nervous system bleeding. Almost all patients with FXIII deficiency in the southeast Iran have a unique mutation in F13A gene (Trp187Arg), which leads to a severe FXIII deficiency. This mutation is used for pre-marriage and prenatal diagnosis, as well as for carrier detection and diagnostic confirmation. Fibrogammin P has been used worldwide for about one decade, along with different therapeutic regimens for prophylaxis treatment, major and minor surgeries, and successful delivery. Due to the rapid increase in the number of patients identified to have congenital FXIII deficiency, and the high rate of related morbidity and mortality, a comprehensive regional preventive program is necessary to prevent further expansion of this condition and decrease the burden on the health care system. The area of Khash city provides novel insights into severe FXIII deficiency due to its high prevalence in this region. This report also provides a review of FXIII deficiency, its diagnosis, prevalence, molecular basis, clinical manifestations, management, and treatment, with a particular focus on Iran, representing a hotspot for this disorder.
Immune Modulation in Pediatric Sepsis
Authors: Hall Mark
Published: January 2019

The initial host immune response to sepsis in children is characterized by a proinflammatory surge that can be associated with fever, capillary leak, and organ dysfunction. There is, however, a concurrent anti-inflammatory response that results in hyporesponsiveness of innate and adaptive immune cells. When severe, this response is termed immunoparalysis and is known to be associated with prolonged organ dysfunction, increased risk for nosocomial infection, and death in septic adults and children. Sepsis-induced immune suppression can be defined in the laboratory by reduced whole blood ex vivo-stimulated cytokine production capacities, reduced expression of human leukocyte antigen (HLA)-DR on circulating monocytes, and reduced absolute cell counts. While anti-inflammatory therapies have largely been unsuccessful at improving outcomes from adult and pediatric sepsis, the use of immunostimulatory therapies such as granulocyte macrophage colony-stimulating factor (GM-CSF) in patients with sepsis-induced immunoparalysis shows promise. A greater understanding of the risk factors for immunoparalysis along with the development and execution of immunophenotype-specific clinical trials of strategies to optimize innate and adaptive immune function are needed to further improve outcomes in septic children.
Plasma Protein Oxidation as a Determinant of Impaired Fibrinolysis in Type 2 Diabetes
Authors: Bryk Agata , Konieczynska Malgorzata , Rostoff Pawel , Broniatowska Elzbieta , Hohendorff Jerzy , Malecki Maciej , Undas Anetta
Published: January 2019

Objective We investigated clinical and laboratory determinants of plasma protein oxidation and its associations with clot fibrinolysis in type 2 diabetes patients.

Materials and Methods Our cross-sectional study consisted of 246 type 2 diabetic patients, 143 (58%) with concomitant cardiovascular disease (CVD), including 41 (17%) with previous myocardial infarction (MI). We measured total protein carbonylation (PC), thiobarbituric acid reactive substances (TBARS) and total antioxidant capacity (TAC) along with clot lysis time (CLT) and clot permeation (Ks
), fibrinogen, plasminogen, α-2-antiplasmin, plasminogen activator inhibitor-1 (PAI-1), thrombin activatable fibrinolysis inhibitor (TAFI) and thrombomodulin.

Results Total PC correlated positively, while TAC correlated inversely with glycated haemoglobin and diabetes duration (all p < 0.05). Diabetic patients with CVD had higher total PC, TBARS and lower TAC compared with the remainder (all p < 0.001). Among correlations of total PC with Ks
, PAI-1, thrombomodulin and TAFI, the strongest was with CLT (r = 0.687, all p < 0.01). High total PC, defined as ≥ 3.45 nmol/mg, was predicted by time since diabetes diagnosis ≥ 5 years (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.36–6.63) and previous MI (OR: 11.31, 95% CI: 4.37–29.32). After adjustment for potential confounders, total PC accounted for 34.9% of the total variance in CLT. Total PC at a cut-off of 3.44 nmol/mg showed high discriminatory power for identifying patients with prolonged CLT (area under the curve: 0.845, 95% CI: 0.792–0.898, p < 0.001).

Conclusion Elevated plasma PC, largely driven by a long history of diabetes and concomitant CVD, is an important determinant of hypofibrinolysis in type 2 diabetes.
Blood Collection within the Maxillary Sinus following Orbital Fracture Repair: The Impact of Mesh Implants and Drains
Authors: Cox Jacob T. , Tian Jing , Merbs Shannath , Mahoney Nicholas R.
Published: January 2019

This article aimed to assess the effects of (1) mesh (e.g., uncoated anatomic titanium plates) versus non-mesh (e.g., porous polyethylene-coated titanium sheets) implant materials and (2) drain placement on the accumulation of blood within the maxillary sinus following surgical repair of orbital floor fractures. Ninety-two patients who received orbital floor fracture repair between 2008 and 2014 were selected, with equal case numbers between categories: (1) non-mesh implant, without drain; (2) non-mesh implant, with drain; (3) mesh implant, without drain; and (4) mesh implant, with drain. Lesion-mapping software was used to measure blood and sinus volumes in postoperative computed tomographic images. Average postoperative maxillary sinus filling was 49% ± 29%. Average sinus filling was similar between mesh and non-mesh implant materials; this was true in cases with a drain (45 vs. 40%, respectively) and without (57 vs. 52%, respectively). Orbital drain placement was associated with a significant reduction ( p = 0.048) in maxillary sinus filling of 12%. Mesh and non-mesh implant materials allow for similar drainage of orbital blood into the maxillary sinus postoperatively. In the majority of cases, space is available within the maxillary sinus to allow for drainage of orbital blood. Intraoperative drain placement is associated with reduced blood pooling within the maxillary sinus, suggesting it allows for drainage of orbital blood to the outside world.
The Current Role of Dual Mobility Articulations in Total Hip Arthroplasty
Authors: Parvataneni Hari , Pulido Luis , Prieto Hernan , Silverberg Arnold
Published: January 2019

The concept of dual mobility (DM) bearings in total hip arthroplasty was first introduced by Professors Gilles Bousquet and Andre Rambert in France in 1974 with the goal of enhancing hip stability. Although DM did not receive U.S. Food and Drug Administration approval for commercial use in the United States until 2009, there has been a surge in popularity of DM implants over the past several years, evidenced by the American Joint Replacement Registry data. The enthusiasm for DM stems from a growing body of literature that supports its use across a range of patient populations, most notably revision hip arthroplasty and high-risk primary scenarios. DM has been shown to effectively reduce the risk of dislocation while also exhibiting excellent survivorship. DM does incur some unique risks, namely, intraprosthetic dissociation, but many of the early concerns with DM have not been realized in the literature and do not seem to negatively impact its long-term survivorship. The exact indications for DM have yet to be defined and remain a matter of debate. It should be considered as an alternative for any primary or revision hip arthroplasty at high risk for postoperative instability. In this article, the authors review the current literature regarding the clinical success of DM implants for a variety of indications, all of which predispose to hip instability. The history, basic biomechanics, modern designs, and unique complications are also discussed.
Indwelling Pleural Catheter Placement for Nonmalignant Pleural Effusions
Authors: DeBiasi Erin , Puchalski Jonathan , Bramley Kyle
Published: January 2019

Pleural effusions account for significant symptoms and morbidity. Recent studies demonstrate a high mortality in patients with “benign” pleural effusions, now better characterized as nonmalignant pleural effusions (NMPEs) based on their prognosis. The most common nonmalignant clinical conditions with recurrent pleural effusions are congestive heart failure and hepatic hydrothorax, although many other diseases exist in isolation or as comorbid conditions. When conventional therapy fails, thoracentesis is often performed for relief of dyspnea. Many times, however, the effusions recur despite maximal medical therapy. Placement of tunneled or indwelling pleural catheters provides an effective therapeutic strategy for recurrent NMPEs when other medical therapy fails.
Results of Graft Removal and Negative Pressure Wound Therapy in Management of Graft Infection
Authors: Miyake Keisuke , Kitabayashi Katsukiyo , Sakagoshi Nobuo
Published: January 2019

Graft infections are a challenging complication in lower extremity bypass surgery with poor outcome, even when treated with graft removal (Gr-R) as a gold standard therapy. The efficacy of negative pressure wound therapy (NPWT) for graft infections has been reported recently, but it is still controversial. The purpose of this study was to assess the efficacy of NPWT and Gr-R for treating graft infections. Twelve consecutive patients with graft infections from 2008 to 2014, treated with Gr-R or NPWT, were enrolled. Those procedures were assessed in complete wound healing, reinfection, amputation, and mortality rate. Five grafts were treated with Gr-R, and seven grafts with NPWT. The initial indications for bypass surgery were claudication, in five grafts treated with Gr-R and three grafts treated with NPWT, and critical limb ischemia in four grafts treated with NPWT. The median time until healing in Gr-R and NPWT was 12 and 59 days, with complete healing seen in 100 and 85.7%, respectively. The major amputation rate was 20 and 14.3%, and reinfection rate was 20 and 14.3%, respectively. There was no perioperative mortality. Gr-R did not show devastating outcome when applied for grafts without limb-threatening ischemia. NPWT showed a low level of invasiveness with excellent results, except for anastomosis site infections. To achieve optimal results, a tailored treatment strategy should be considered.
Functional Validation of microRNA-126-3p as a Platelet Reactivity Regulator Using Human Haematopoietic Stem Cells
Authors: Garcia Alix , Dunoyer-Geindre Sylvie , Zapilko Veronika , Nolli Séverine , Reny Jean-Luc , Fontana Pierre
Published: January 2019

Background Platelets are an abundant source of micro-ribonucleic acids (miRNAs) that may play a role in the regulation of platelet function. Some miRNAs, such as miR-126-3p, have been noted as potential biomarkers of platelet reactivity and the recurrence of cardiovascular events. However, the biological relevance of these associations remains uncertain, and the functional validation of candidate miRNAs on human-derived cells is lacking.

Objective This article functionally validates miR-126-3p as a regulator of platelet reactivity in platelet-like structures (PLS) derived from human haematopoietic stem cells.

Materials and Methods CD34+-derived megakaryocytes were transfected with miR-126-3p and differentiated in PLS. PLS reactivity was assessed using perfusion in a fibrinogen-coated flow chamber. miR-126-3p's selected gene targets were validated using quantitative polymerase chain reaction, protein quantification and a reporter gene assay.

Results CD34+-derived megakaryocytes transfected with miR-126-3p generated PLS exhibiting 156% more reactivity than the control. These functional data were in line with those obtained analysing CD62P expression. Moreover, miR-126-3p transfection was associated with the down-regulation of a disintegrin and metalloproteinase-9 (ADAM9) messenger RNA (mRNA), a validated target of miR-126-3p, and of Plexin B2 (PLXNB2) mRNA and protein, an actin dynamics regulator. Silencing PLXNB2 led to similar functional results to miR-126-3p transfection. Finally, using a reporter gene assay, we validated PLXNB2 as a direct target of miR-126-3p.

Conclusion We functionally validated miR-126-3p as a regulator of platelet reactivity in PLS derived from human haematopoietic stem cells. Moreover, PLXNB2 was validated as a new gene target of miR-126-3p in human cells, suggesting that miR-126-3p mediates its effect on platelets, at least in part, through actin dynamics regulation.
New Strategies of Pulmonary Protection of Preterm Infants in the Delivery Room with the Respiratory Function Monitoring
Authors: Zeballos Sarrato Gonzalo , Sánchez Luna Manuel , Zeballos Sarrato Susana , Pérez Pérez Alba , Pescador Chamorro Isabel , Bellón Cano Jose María
Published: January 2019

Objective To investigate if the use of a visible respiratory function monitor (RFM) to use lower tidal volumes (Vts) during positive pressure ventilation (PPV) in the delivery room (DR) reduces the need of surfactant administration and invasive mechanical ventilation during the first 72 hours after birth of preterm infants <32 weeks' gestational age (GA).

Study Design Infants <32 weeks' GA (n = 106) requiring noninvasive PPV were monitored with a RFM at birth and randomized to visible (n = 54) or masked (n = 52) display on RFM. Pulmonary data were recorded during the first 10 minutes after birth. Secondary analysis stratified patients by GA (<28, 28–29+6, or ≥30 weeks).

Results Median expiratory Vts during inflations were greater in the masked group (7 mL/kg) than in the visible group (5.8 mL/kg; p = 0.001) same as peak inflation pressure (PIP) administered (21.5 vs. 19.7 cmH2O; p < 0.001). Consequently, minute volumes were greater in the masked group (256 vs. 214 mL/kg/min; p < 0.001), with no differences in respiratory rate. These differences were higher in those <30 weeks' GA. There was no difference in the need of surfactant administration or intubation during the first 72 hours of age.

Conclusion Using a RFM in the DR prevents the use of large Vt and PIP during respiratory support inflations, mostly in the more immature newborn infants, but with no other short-term benefits.
Antepartum Contraceptive Counseling in Women with Preterm Birth
Authors: Toscano Marika , Li Dongmei , Dye Timothy , Olson-Chen Courtney
Published: January 2019

Objective To compare rates of antepartum contraceptive counseling among women with preterm birth (PTB) and term birth.

Study Design This is a retrospective cohort study of patients with completed delivery records in New York from January 1, 2004, to December 31, 2014. Exposure was determined based on the timing of delivery. Exposed women delivered at <37 weeks, and nonexposed women delivered at ≥37 weeks. Primary outcome was patient response to questions regarding receipt of prenatal contraceptive counseling (PCC) by a health care provider. Secondary outcome was receipt of interpregnancy interval counseling. Chi-square tests and multivariate logistic regression were used for analysis.

Results Of 724,723 delivery records, PTB rate was 7.9%. Women with PTB < 37 weeks were significantly less likely to receive PCC (odds ratio [OR]: 0.9; 95% confidence interval [CI]: 0.89–0.93) or interpregnancy interval counseling (OR: 0.95; 95% CI: 0.94–0.97). The primary outcome remained significant after adjusting for confounders (adjusted OR: 0.91; 95% CI: 0.89–0.93). PTB < 34 weeks was associated with even lower odds of receiving contraceptive counseling (OR: 0.79; 95% CI: 0.76–0.83).

Conclusion Postpartum contraception is an important tool for the prevention of recurrent PTB. Antepartum contraception counseling increases postpartum contraceptive uptake. Women with PTB have less exposure to antepartum contraceptive counseling. Lack of adequate counseling and decreased uptake of postpartum contraception may impact future pregnancy outcomes.
Hospital Charge Variability across New York State: Sociodemographic Factors in Pituitary Surgery
Authors: Kidwai Sarah M. , Yang Anthony , Gray Mingyang L. , McKee Sean , Iloreta Alfred Marc , Shrivastava Raj , Govindaraj Satish
Published: January 2019

Introduction Significant charge disparities exist across New York State (NYS). Race and income are associated with increased charges. To determine risk factor, we correlate hospital charges for pituitary surgery with socioeconomic factors. Additionally, we identify patients at risk for increased hospital charges and provide insight into cost-effective practices.

Methods Retrospective cohort study of the Statewide Planning and Research Cooperative System (SPARCS) database from the NYS Department of Health was conducted. The SPARCS database was reviewed. Patients who underwent transsphenoidal pituitary surgery from 1995 to 2015 were identified. Income and urban status were referenced from U.S. census data. Linear regression was performed to analyze the effect of sociodemographic factors, comorbidities, and complications on hospital charges while controlling for length of stay.

Results A total of 9,373 patients were identified. Black (10.8%, p < 0.001) and Asian (14.5%, p < 0.001) had higher hospital charges. Patients from nonurban cities (13.4%, p < 0.001), Medicaid (13.8%, p < 0.001), and those from the 0 to 25th (9.1%, p < 0.001) and 25 to 50th (11.7%, p < 0.001) income quartile had lower hospital charges. Patients with postoperative cerebrospinal fluid leak (24.0%, p < 0.001), diabetes insipidus (22.1%, p < 0.001), smoking history (11.8%, p < 0.001), hypertension (7.4%, p < 0.001), and hypothyroidism (6.9%, p < 0.001) had higher hospital charges.

Conclusion Patients incurring higher chargers were more likely to have a smoking history, hypertension, hypothyroidism, and comorbidities. The determinants of this analysis may provide insight into barriers to patient access and cost improvement strategies. In addition, this emphasizes the need for future studies to create a risk stratification model, similar to those in other fields.
A Novel Classification and Staging System to Address Prognosis and Treatment Decisions for Patients with Granular Myringitis
Authors: Bansal Mohan
Published: January 2019

Objective Does the severity of disease influence outcomes in patients with granular myringitis (GM)? There is no classification and staging system on the severity of GM although it is not a very rare disorder. The aim of this study was to propose a novel classification and staging system for the patients with GM according to the type, extent, and sequelae of the lesions so that indications of various modalities of treatments for the different classes of the disease and their outcomes could be studied.

Methods Data were retrieved from PubMed, Embase, and Cochrane Library. Relevant articles were also sought by a hand search review of references, books, and journals. The databases were searched using the keywords “granular myringitis,” “granular otitis externa,” “myringitis granulosa,” and “myringitis.” Data from the relevant articles were extracted using a pre-defined data-extraction form.

Results After reviewing the various otoscopic findings, the study proposes a clinical and surgical GAS classification and staging of granular myringitis, which is based on the type of
G
ranulating lesion,
A
rea of involvement, and
S
equelae of the disease. On the basis of GAS classification, patients with GM are grouped into four stages that indicate the overall severity and prognosis of the disease and can be used for selecting various modalities of treatment and their outcomes.

Conclusion The GAS classification is simple, descriptive, and comprehensive and would provide practical basis for the indications of different modalities of management and outcomes research in patients with GM. This would facilitate in knowing the prognostic impact of extent of granulations.

This study has a 1a type level of evidence.
Endoscopic Anatomy of Hypotympanum Surgical Implications
Authors: Boddepalli Rajesh , Boddepalli Sreerama
Published: January 2019

Objective To assess the endomeatal endoscopic morphological anatomy of hypotympanum under local anesthesia and further cadaveric dissection of temporal bone to know complete anatomical details of hypotympanum.

Materials and Methods Two hundred six cases of live operations were studied, these included 160 cases of simple dry perforations for myringoplasty and 46 cases of stapedectomy operations. All operations were performed under local anesthesia using a 0-degree, 4-mm endoscope. The hypotympanum was visualized. Twenty wet temporal bones were dissected endoscopically and complete hypotympanic details were studied.

Results Out of 206 cases, 94 cases (45%) were found to be type A; 51 cases (25%) were type B and 60 cases (30%) were type C hypotympanum. Wet cadaveric bones were dissected to visualize the transmeatal endoscopic jugular foramen in four levels (levels 1, 2, 3, and 4).
Internal Endoconduit Technique during Transcatheter Aortic Valve Implantation
Authors: Sakai Osamu , Oka Katsuhiko , Inoue Tomoya , Yaku Hitoshi
Published: January 2019

The transfemoral approach is the least invasive transcatheter aortic valve implantation (TAVI) approach, but the diameter of the iliofemoral arteries needs to exceed 5 mm. We report a case of limited access transfemoral TAVI by the “internal endoconduit technique,” which is well known as a safe and effective dilatational technique for thoracic endovascular aortic repair. Subsequently, we could deliver the device without iliac artery injury and we performed transfemoral TAVI.
53BP1 Deficiency Promotes Pathological Neovascularization in Proliferative Retinopathy
Authors: Troullinaki Maria , Garcia-Martin Ruben , Sprott David , Klotzsche-von Ameln Anne , Grossklaus Sylvia , Mitroulis Ioannis , Chavakis Triantafyllos , Economopoulou Matina
Published: January 2019

The replication stress inflicted on retinal endothelial cells (ECs) in the context of hypoxia-induced pathological neovascularization during proliferative retinopathy is linked with activation of the deoxyribonucleic acid (DNA) repair response. Here, we studied the effect of deficiency of the DNA damage response adaptor 53BP1, which is an antagonist of homologous recombination (HR), in the context of proliferative retinopathy. In the model of retinopathy of prematurity (ROP), 53BP1-deficient mice displayed increased hypoxia-driven pathological neovascularization and tuft formation, accompanied by increased EC proliferation and reduced EC apoptosis, as compared with 53BP1-sufficient mice. In contrast, physiological retina angiogenesis was not affected by 53BP1 deficiency. Knockdown of 53BP1 in ECs in vitro also resulted in enhanced proliferation and reduced apoptosis of the cells under hypoxic conditions. Additionally, upon 53BP1 knockdown, ECs displayed increased HR rate in hypoxia. Consistently, treatment with an HR inhibitor reversed the hyper-proliferative angiogenic phenotype associated with 53BP1 deficiency in ROP. Thus, by unleashing HR, 53BP1 deletion increases pathological EC proliferation and neovascularization in the context of ROP. Our data shed light to a previously unknown interaction between the DNA repair response and pathological neovascularization in the retina.
A Lung Ultrasound Severity Score Predicts Chronic Lung Disease in Preterm Infants
Authors: Abdelmawla Mohamed , Louis Deepak , Narvey Michael , Elsayed Yasser
Published: January 2019

Objective To test the hypothesis that a lung ultrasound severity score (LUSsc) can predict the development of chronic lung disease (CLD) in preterm neonates.

Study Design Preterm infants <30 weeks' gestational age were enrolled in this study. Lung ultrasound (LUS) was performed between 1 and 9 postnatal weeks. All ultrasound studies were done assessing three lung zones on each lung. Each zone was given a score between 0 and 3. A receiver operating characteristic curve was constructed to assess the ability of LUSsc to predict CLD.

Results We studied 27 infants at a median (interquartile range [IQR]) gestational age and birth weight of 26 weeks (25–29) and 780 g (530–1,045), respectively. Median (IQR) postnatal age at the time of LUS studies was 5 (2–8) weeks. Fourteen infants who developed CLD underwent 34 studies. Thirteen infants without CLD underwent 30 studies. Those who developed CLD had a higher LUSsc than those who did not (median [IQR] of scores: 9 [6–12] vs. 3 [1–4], p < 0.0001). An LUSsc cutoff of 6 has a sensitivity and specificity of 76 and 97% and positive and negative predictive values of 95 and 82%, respectively. Adding gestational age < 27 weeks improved sensitivity and specificity to 86 and 98% and positive and negative predictive values to 97 and 88%.

Conclusion LUSsc between 2 and 8 weeks can predict development of CLD in preterm neonates.
Three-Dimensional Vascular Anatomical Study of the Tensor Fasciae Latae Muscle and Perforators
Authors: Kalandar Abeer , Morris Steven F.
Published: January 2019

Background To harvest any flap on the lateral circumflex femoral artery (LCFA) including tensor fasciae latae (TFL) muscle, a precise description of the vascular anatomy is required. There have been conflicting reports of the vascular supply of TFL and its overlying skin. The objective of this study was to evaluate the anatomy of the TFL muscle according to the location, origin, type, caliber, and length of vessels that supply the muscle.

Methods This study was performed on human cadavers (n = 16 thighs) that were injected with a mixture of lead oxide and gelatin through the femoral artery. Whole body computed tomography scans were performed. Three-dimensional images of the arterial anatomy were created using Materialise Interactive Medical Image Control Software (MIMICS). Anatomical dissection of all cadaver thighs was performed to visualize the arterial blood supply of the muscle and its regional perforators.

Results Sixteen thighs were included in the study. The main arterial supply of the TFL muscle was in all cases, the ascending branch of the LCFA (LCFA-asc) artery. The mean external diameter of the LCFA-asc artery was 2.7 mm ± 0.4 and the mean length was 3.6 cm ± 0.6. The distance from the anterior superior iliac spine to point where the vascular pedicle reaches the muscle ranged from 6.7 to 10.2 cm. The average number of cutaneous perforators was 10.9 ± 4. There were musculocutaneous perforators in all of our dissections (n = 16) and 14 of our specimens had septocutaneous perforators.

Conclusion The main vascular supply to the TFL muscle is the ascending branch of the LCFA, which also gives rise to septocutaneous and musculocutaneous perforators. MIMICS provides excellent three-dimensional anatomical information about the vascular supply of the TFL.
Weight-Based Enoxaparin for Venous Thromboembolism in Obesity Gives Similar Anti-Xa Levels to Patients <100 kg, with No Increase in Major Bleeding
Authors: Stevens Hannah , Tran Huyen , Chunilal Sanjeev , Maclachlan Kylee
Published: January 2019

In trials assessing venous thromboembolism (VTE) treatment, obese patients are under-represented or excluded. The main objective of this article is to examine the safety of weight-based enoxaparin dosing in obesity, as assessed by anti-factor Xa (anti-Xa) activity, bleeding, and recurrence. A 5-year retrospective audit of patients with acute VTE, weighing > 100 kg, prescribed enoxaparin 1 mg/kg twice daily, with an anti-Xa level 2 to 6 hours post-dose. The primary outcome was anti-Xa levels, and the secondary outcomes were bleeding and recurrence. Results were compared with patients weighing < 100 kg (n = 64), and obese patients prescribed doses < 1 mg/kg (n = 28). One-hundred sixty-six patients weighing > 100 kg with VTE were identified, with 64 excluded for not fulfilling criteria. The remaining 102 patients had a median weight of 130 kg (range: 105–222 kg). The median peak anti-Xa level was 0.93 U/mL, with 56% of levels being in the proposed therapeutic range (0.5–1.0 U/mL), 40% > 1.0 U/mL, and 4% < 0.5 U/mL. The median anti-Xa levels and distribution were not significantly different between patients > 100 kg and patients < 100 kg, while obese patients prescribed < 1 mg/kg were more frequently subtherapeutic (21%). Regardless of weight, the majority of patients with moderate renal impairment (eGFR 30–59 mL/min) had an anti-Xa level > 1.0 U/mL (61%). In the obese patients, there was no major bleeding or recurrence within 30 days. In comparison, patients weighing < 100 kg, despite similar peak anti-Xa levels, had higher rates of bleeding and recurrence. This was likely due to their older age and comorbidities, particularly renal impairment and cancer. These data support weight-based dosing of enoxaparin in obesity with no maximum dose, ensuring therapeutic drug levels, with anti-Xa levels suggested in obese patients with clinical risk factors for bleeding.
Was ist Telemedizin? Wie sind die rechtlichen Grundlagen?
Authors: Schöbel Christoph
Published: January 2019

In medizinischen Zeitschriften und in den Medien begegnen uns aktuell immer häufiger Begriffe wie Telemedizin, Telemetrie, Digital-Health, Telemonitoring, eHealth usw. Häufig werden und können diese Begriffe nicht klar voneinander getrennt werden. Hinsichtlich der rechtlichen Rahmenbedingungen bedeutet es jedoch einen Unterschied, ob ein Arzt bestimmte Werte eines Patienten lediglich drahtlos überwacht (Telemonitoring) oder in der Lage ist, über dieselbe drahtlose Verbindung Diagnosen zu stellen und daraufhin Therapien einzuleiten oder anzupassen.
Depression als Stoffwechselstörung
Authors: Karabatsiakis A. , Schönfeldt-Lecuona C.
Published: January 2019

Die Majore Depression (MD) hat sich zu einer Volkskrankheit entwickelt und stellt eine immense soziale sowie volkswirtschaftliche Herausforderung dar. Trotz intensiver Forschung konnten die pathophysiologischen Prozesse der Erkrankung nicht vollständig aufgeklärt werden. Diese sind von besonderer Bedeutung, da entsprechende Therapieansätze für eine effizientere und anhaltende Verbesserung der depressionsassoziierten Symptomatik zwingend erforderlich sind. Bislang galt die MD, wie viele andere psychische Störungen auch, als eine Erkrankungen, die hauptsächlich das zentrale Nervensystem betrifft. In den letzten Jahren konnten jedoch immer mehr Befunde gesammelt werden, die belegen, dass in Zusammenhang mit der MD körperliche Veränderungen auftreten, die den gesamten Organismus in seiner Funktionalität und Integrität beeinträchtigen. Somit scheint ein Paradigmenwechsel hin zu einer gesamtorganischen Betrachtung der MD notwendig, die die zum Einsatz kommenden Behandlungskonzepte mit einschließt. Ein innovativer Ansatz zeigt die Bedeutung des mitochondrialen Energiemetabolismus für das pathophysiologische Verständnis der MD auf. Mitochondrien, intrazelluläre Organellen aller eukaryotischen Zellen, nutzen die in der Nahrung enthaltenen chemischen Verbindungen aus Kohlenwasserstoffen zur biochemischen Bereitstellung von Adenosintriphosphat (ATP). ATP stellt die elementare Energiewährung für enzymatische Aktivität in allen Zellen, Geweben und Organen dar. In den letzten Jahren konnte gezeigt werden, dass klinischrelevante Symptome der MD wie Antriebslosigkeit, Müdigkeit und Konzentrationsschwäche mit Veränderungen der mitochondrialen Energieproduktion und der Anzahl von Mitochondrien pro Zelle (mitochondriales Netzwerk) assoziiert sind.
Imagery Rescripting in der Behandlung von Angststörungen
Authors: Maier A. , Schaitz C. , Kröner J. , Connemann B. , Sosic-Vasic Z.
Published: January 2019

Mentale Bilder, sogenannte Imaginationen, sind durch ähnliche Merkmale und Effekte auf menschliche Reaktionen gekennzeichnet, wie über das sensorische System wahrgenommene, reale Stimuli. Besonders bei Angststörungen spielen die inneren Bilder eine Rolle bei der Aufrechterhaltung der Erkrankung. Daher werden sie in jüngster Zeit vermehrt als Behandlungselement in die kognitive Verhaltenstherapie integriert. Dabei hat sich die Technik des Imagery Rescriptings, bei der aversive Bilder imaginativ verändert werden, bewährt. Durch diese positive Modifikation der Imaginationen können Symptome der sozialen und spezifischen Phobie sowie der posttraumatischen Belastungsstörung reduziert werden. Weniger erforschte, aber dennoch aussichtsreiche Felder zum Einsatz des Imagery Rescriptings sind die Panikstörung/Agoraphobie sowie die generalisierte Angststörung. Eine erste vielversprechende These zur Wirkweise ist die Beeinflussung des Angstgedächtnisses durch Imagery Rescripting.
Sport und Bewegung bei JIA
Authors: Hansmann S. , Girschick H.
Published: January 2019

Der Bewegungsapparat des Menschen bildet eine funktionelle Einheit aus Knochen, Muskeln und Gelenken und ermöglicht durch ein komplexes Zusammenspiel Stabilität und Beweglichkeit. Während des Wachstums findet eine kontinuierliche Anpassung an die neuen Erfordernisse und Kräfte statt. Sportliche Aktivität während des Wachstums hat einen positiven Effekt auf die körperliche Entwicklung, die Muskelkraft und Knochenmineralisation und reduziert das Risiko für chronische Erkrankungen im Kindes- und Erwachsenenalter. Die juvenile idiopathische Arthritis (JIA) ist eine chronische Erkrankung des muskuloskelettalen Systems, die vor dem 16. Lebensjahr auftritt. Betroffene sind initial durch Schmerzen stark in ihrer Bewegungsausübung gehindert und deshalb in ihrer körperlichen, motorischen und psychosozialen Entwicklung eingeschränkt. Sportliche Aktivität beeinflusst die Fitness, Selbstwirksamkeit und Schmerzstärke sowie die Muskelkraft, Knochendichte und Gelenkfunktion günstig und führt nicht zu einer Erkrankungsverschlechterung. Kinder und Jugendliche mit JIA profitieren von körperlicher Aktivität in allen Erkrankungsphasen.
„I feel lonely“
Authors: Schaitz C. , Kröner J. , Maier A. , Sosic-Vasic Z.
Published: January 2019

Selbstverletzendes Verhalten spielt eine wesentliche Rolle innerhalb der Borderline-Persönlichkeitsstörung (BPS). Während bereits Einiges zur Funktion von selbstverletzendem Verhalten bekannt ist, gibt es wenig Studien über die damit assoziierten Gefühle oder mentalen Bilder. In der hier vorgestellten Studie wurden Patientinnen mit BPS hinsichtlich ihrer Gefühle bei der Ausführung selbstschädigender Verhaltensweisen befragt. Die Patientinnen berichteten überwiegend negative Gefühle, auf welche durch Selbstverletzung vornehmlich zum Zwecke der Emotionsregulation oder Selbstbestrafung reagiert wird. Zudem berichtete ein Großteil aller Befragten von sehr lebhaften und sich aufdrängenden mentalen Bildern assoziiert mit willentlichen Selbstschädigungen, welche sich bereits vor der eigentlichen Ausführung der Selbstschädigung ankündigen. Der Erfassung entsprechender mentaler Bilder könnte daher künftig eine stärkere therapeutische Bedeutung zukommen.
Das Sozialistische Patientenkollektiv an der Universität Heidelberg 1970–1971
Authors: Häfner H.
Published: January 2019

Dieser Beitrag ergänzt und erweitert die Rezension, die Christian Pross über den Film „SPK Komplex“ von Gerd Kroske über das Sozialistische Patientenkollektiv (SPK) an der Universität Heidelberg 1970–1971 verfasst hatte. Das SPK wurde von Dr. W. Huber, Assistenzarzt an der psychiatrischen Klinik, als revolutionäre Bewegung gegen die Psychiatrie, gegen die Professoren der Universitätskliniken und gegen das kapitalistische System aufgebaut. Mit immer radikaleren Aktionen kämpften die Mitglieder. Sie besetzten das Büro des Verwaltungsdirektors des Universitätsklinikums und mehrmals das Rektorat. Sie beschafften sich Waffen, Sprengstoff und planten Schießübungen. Sie hatten auch Abhöreinrichtungen am Telefon des Rektors und im Sitzungssaal des Senats montiert. Die Verantwortung für den Selbstmord einer vom SPK enttäuschten Studentin schoben sie ihren Gegnern zu. Ein „Volksgericht“ verurteilte den Landeskultusminister Prof. Hahn, den Rektor Prof. Rendtorff und den „Gegner Nr. 1“ des SPK, H. Häfner, wegen Mordes. Der Schuss, der bei einer nächtlichen Kontrolle die Schulter eines Polizeibeamten durchschlug, hatte die Verhaftung von Dr. Huber und 11 weiteren SPK-Mitgliedern zur Folge.
Prognostische Bedeutung sonographischer Parameter der Pankreatitis der Katze
Authors: Moser Katharina , Mitze Stefanie , Teske Erik , Stockhaus Christian
Published: January 2019

Gegenstand: Die feline Pankreatitis ist eine Erkrankung mit sehr unterschiedlichen klinischen Verlaufsformen. Häufig stellt sich die Frage, inwieweit Parameter der klinischen, labordiagnostischen oder bildgebenden Untersuchungsverfahren zur Früherkennung eines progressiven, mit schlechterer Prognose verbundenen Verlaufs verwendet werden können. Nur wenige Studien untersuchten bei dieser Erkrankung prognostische Faktoren. Bei Vorliegen passender klinischer Symptomen dienen vor allem die feline pankreatische Lipase-Immunreaktivität (fPLI) und die abdominale Ultraschalluntersuchung zur Diagnose-stellung. Verschiedene sonographische Parameter wurden im Zusammenhang mit einer Pankreatitis beschrieben. Ziel der Studie war zu überprüfen, ob einzelne sonographische Kriterien bei Katzen mit Pankreatitis signifikant mit der Prognose korrelieren. Material und Methoden: In dieser retrospektiven Untersuchung (2009–2017) wurden bei 42 Katzen mit mindestens zwei klinischen Symptomen und erhöhtem Serum-fPLI-Wert (> 5,3 µg/l) die folgenden sonographischen Parameter des Pankreas untersucht: Pankreasbreite, -oberfläche, -echogenität, Echogenität des peripankreatischen Fettgewebes und Vorhandensein von Aszites. Tiere, die die ersten 30 Tage überlebten, galten als „Survivor“ (S), Tiere, die innerhalb der ersten 30 Tage starben, als „Nonsurvivor“ (NS). Ergebnisse: Sonographische Veränderungen lagen bei 33/42 (79 %) Katzen vor. Am häufigsten fanden sich hyper-echogenes peripankreatisches Fettgewebe (55 %), hypoechogenes Pankreasgewebe (45 %) und Pankreasverbreiterung (36 %). Bei keinem sonographischen Untersuchungskriterium konnte eine statistisch signifikante Korrelation mit der Zuordnung in die Gruppen S versus NS gefunden werden. Der fPLI-Wert hingegen korrelierte statistisch signifikant mit der Prognose. Schlussfolgerung: Weder vom Vorliegen sonographischer Veränderungen noch von deren Charakter oder Intensität ist ein Rückschluss auf die Prognose möglich. Im Gegensatz dazu stellt, wie in vorherigen Untersuchungen belegt, eine höhere fPLI-Konzentration einen negativen prognostischen Faktor dar.
Checken Sie Ihre Website
Authors: Walters Sabine
Published: January 2019

Die neue Datenschutz-Grundverordnung ist seit gut einem halben Jahr in
Kraft. Leider haben immer noch sehr viele Betreiber einer Website die
erforderlichen Maßnahmen zur DSGVO-Konformität für ihre Website nicht umgesetzt.
Das kann nun sehr teuer werden, denn seit einem Urteil des OLG Hamburg können
zukünftig auch Wettbewerber abmahnen lassen. Sabine Walters,
Datenschutzbeauftragte und Mediendesignerin, hat in einer Checkliste die
wichtigsten Punkte zusammengestellt, die Inhaber einer Website nun beachten
sollten.