bluuebunny/crossref_metadata_2025 huggingface dataset:
Transforaminal epidural steroid injections in cervical spinal disease with moderate to severe disability
Authors: Hong Jae-Young , Park Jin-Sung , Suh Seung-Woo , Yang Jae-Hyuk , Park Si-Young , Kim Bo Taek
Published: February 2020

Despite many clinical trials on cervical epidural steroid injections, the indications for and long-standing outcomes of this treatment remain controversial. We evaluated the outcomes and indications for transforaminal cervical epidural steroid injection (TCESI) in patients with moderate to severe disability.

We prospectively gathered data from patients with 1 or 2-level cervical degenerative disease (herniated disc, foraminal stenosis) with moderate to severe disability (3.5 < initial visual analog scale < 6.5, 15 < Neck Disability Index < 35) and greater than 12 weeks of pain, despite conservative treatment. Patients with persistent disability and those who desired surgical intervention underwent decompression surgery. The clinical and demographic characteristics were compared between groups.

Of the 309 patients who underwent TCESI, 221 (72%) did not receive surgical treatment during the 1-year follow-up period. The remaining 88 patients (28%) underwent surgery at a mean of 4.1 months after initial TCESI. Patients who underwent injection alone showed a significant decrease in disability and pain that persisted until the 1-year follow-up visit (P < .05). In patients who underwent surgery, the mean disability and pain scores after injection did not decrease for several months, although the scores significantly decreased up to 1 year after surgery (P < .05).

The TCESI significantly decreased pain and disability in the moderate to severe disability group up to 1 year after injection. We recommend cervical TCESI as an initial treatment with moderate to severe disability patients.
The Prevalence and Incidence of Attention-deficit/Hyperactivity Disorder in the Veterans Health Administration From 2009 to 2016
Authors: Hale Andrew C. , Bohnert Kipling M. , Spencer Robert J. , Ganoczy Dara , Pfeiffer Paul N.
Published: February 2020

Background:

The prevalence and incidence of attention-deficit/hyperactivity disorder (ADHD) have increased substantially among children and adolescents over the past decade; however, little is known regarding trends in adult populations.

Objective:

The objective of this study was to explore trends in the prevalence, incidence, and correlates of adult ADHD in a national sample of veterans receiving care at Veteran Affairs (VA) hospitals and clinics.

Research Design:

A retrospective design was used to examine ADHD diagnosed in all VA primary care (PC) and mental health clinics (MHCs) from fiscal years (FYs) 2009 to 2016. Age-adjusted prevalence and incidence were calculated using direct standardization, and Poisson regressions modeled differences in trends between demographic groups.

Subjects:

All veterans with VA PC or MHC visits during the observation period.

Measures:

ADHD incidence and prevalence, psychiatric comorbidity, neuropsychological evaluation.

Results:

An annual average of 5.09 million (range: 4.63–5.42 million) VA patients attended a PC or MHC appointment between FY09 and FY16. During this period, age-adjusted annual prevalence increased 258% from 0.23% to 0.84% and incidence increased 240% from 0.14% to 0.48%. Black veterans and older veterans had the lowest prevalence and incidence across all years. Increases in prevalence and incidence occurred across all demographic subgroups. The proportion of patients who had a neuropsychological evaluation within 6 months before or after a new ADHD diagnosis decreased from 12.6% to 10.8% [χ2
(1)=16.59, P<0.001].

Conclusion:

Overall increases and demographic differences in adult veterans diagnosed with ADHD suggest a growing need to establish the reliability of diagnostic practices to ensure appropriate and equitable care.
Financial Performance of Medicare Advantage Contracts in 2014 and Plan Renewal, Consolidation, and Termination Rates in the Subsequent Year
Authors: Langellier Brent A. , Park Sungchul
Published: February 2020

Background:

Starting in 2014, the Affordable Care Act mandated that Medicare Advantage (MA) contracts spend at least 85% of total revenue on claims and quality improvement [ie, the medical loss ratio (MLR)] and submit revenue and cost data annually in MLR reports. These reports can improve transparency of the financial performance of MA contracts. However, little is known about revenues and costs of insurers that participate in MA and its impacts on status changes in the following year.

Objective:

To characterize revenues and costs of MA contracts in 2014, with a focus on MLRs and gross margins, and to assess heterogeneity in subsequent-year plan renewal and termination rates by gross margins.

Research Design:

Cross-sectional data from MLR reports submitted in 2014 by MA contracts and from 2015 Part C & D Plan Crosswalk Files regarding plan renewal, termination, and other status changes from 2014 to 2015.

Subjects:

Three hundred eighty-nine MA contracts.

Measures:

Primary outcomes are MLRs and gross margins.

Results:

MLRs averaged 93% in 2014; 11% of contracts reported MLRs of at least 100%. Fifty-six percent reported negative margins, or costs that exceeded revenues. Seventeen percent of plans in contracts in the lowest quartile of gross margins were terminated in 2015, compared to under 5% of plans in the highest-margin contracts.

Conclusions:

In 2014, MA contracts reported MLRs greater than the mandatory minimum of 85%. Gross margins likely contribute to trends in plan and insurer availability. MLR reports from subsequent years can help explain fluctuations in insurers’ participation in MA.
Three years’ clinical practice of Radium-223 therapy in patients with symptomatic bone metastases from metastatic castrate-resistant prostate cancer: a single-centre experience
Authors: Gazzilli Maria , Durmo Rexhep , Cossalter Erika , Cerudelli Elisabetta , Panarotto Maria Beatrice , Albano Domenico , Bertagna Francesco , Giubbini Raffaele
Published: February 2020

Background

Radium-223 was a treatment approved for patients with metastatic castrate-resistant prostate cancer, symptomatic bone metastases and no-visceral metastases, in progression after at least two prior lines of systemic therapy, or ineligible for any available systemic treatment. The aim of this study was to provide further characterization and sub-selection of patients who would benefit most with Radium-223 treatment.

Methods

We retrospectively analysed 38 patients treated with Radium-223 between 2015 and 2018. All patients underwent a baseline visit and a bone scintigraphy. Bone scan, ALP and PSA levels were repeated after third and after the end of therapy. All patients were re-evaluated after 2 months from the end of therapy. Survival curves were plotted according to the Kaplan–Meier method and differences between groups were analysed by using a two-tailed log-rank test.

Results

The response to the treatment in term of change in pain was reduction in 16 patients; no change in 14 and increased in eight. We arbitrarily established a cut-off 10 bone lesions to evaluate the response: patients with less than 10 metastasis had significant differences in PFS (P < 0.001) compared to patients with more than 10, no statistical significance was found considering the OS (P = 0.23) between the two groups. The same results were founded in patients with baseline ALP <220 U/L with a PFS (P < 0.001) and OS (P = 0.027).

Conclusion

The most important finding was the correlation between the number of bone metastasis and ALP with outcome survival and efficacy of Radium-223 treatment.
Children With Gastroesophageal Reflux Disease Consume More Calories and Fat Compared to Controls of Same Weight and Age
Authors: Borodina Galina , Morozov Sergey
Published: February 2020

Objective:

The aim of the study was to compare the rates of nutrients consumption in children and adolescents with gastroesophageal reflux disease (GERD) compared to the control group without the disease.

Methods:

Based on symptom evaluation and esophageal pH‐impedance recordings patients were allocated on to GERD and control groups. All patients underwent esophagogastroscopy. Levels of nutrients consumption were assessed with the use of food frequency questionnaire in the regard to the presence of the disease, esophagitis, and z score body mass index (BMI).

Results:

Data of 219 children and adolescents were available for the final analysis. Risks to have GERD were higher in groups with obesity (risk ratio 1.2 [95% confidence interval 0.8–1.7]) and excessive weight (1.1 [0.9–1.4]). Energy values of the rations and amount of fat consumption were higher in the GERD group compared to the control when rations were compared according to z score BMI. In contrast to nonerosive form of GERD, patients with erosive esophagitis consumed more protein (percentage deviation from the recommended daily allowance Me [25%;75%]): 14.3 (11.07; 19.1) % versus 8.5 (6.71; 14.1) %, total fat 36.8 (12.5; 75.5) % versus 16.9 (10.1; 17.9) %, and less polyunsaturated fats −54.3 (−73.4; −47.7) % versus −45.6 (−56.2; −33.1) %, P < 0.05.

Conclusions:

The rations of children with GERD are characterized by higher calorie values and larger amounts of fat intake compared to the control group in the regard to z score BMI. Low dietary fiber consumption is additional factor associated with GERD in children with excessive weight and obesity. Compared to nonerosive GERD, higher intake of energy, protein, and total fat and lower of polyunsaturated fats revealed in patients with GERD with erosive esophagitis.
Septic Arthritis Caused by Mycobacterium Kansasii in a Bone Marrow Transplant Recipient
Authors: Sugiyama Minako , Terashita Yukayo , Hara Kazuya , Cho Yuko , Asano Tsuyoshi , Iguchi Akihiro
Published: February 2020

We report an 18-year-old female individual with septic arthritis due to Mycobacterium kansasii. Three years and 6 months before arthritis, the patient underwent bone marrow transplantation and developed severe chronic graft-versus-host disease. The arthritis was refractory to medication, and she underwent joint lavage of the right foot, hip joint, and elbow joint. After surgery, her joint symptoms were relieved, and chronic graft-versus-host disease remitted more easily. It is important that we maintain a high index of suspicion for mycobacterial arthritis and diagnose it early when immunosuppressed patients experience chronic pain and joint swelling.
Therapy Response in a Pediatric Patient With Extracutaneous Juvenile Xanthogranuloma Monitored by FDG PET/CT
Authors: Wen Zhe , Zhuang Hongming
Published: February 2020

Juvenile xanthogranuloma, a rare type of non-Langerhans cell histiocytosis, generally manifests as widespread skin lesions, which is often self-limited. However, when other organs are involved, its outcome can be unfavorable, and there is no clearly defined consensus regarding what is the best imaging modality in monitoring the therapy. We report here findings of a series of FDG PET/CT scans during the course of clofarabine therapy in a 12-year-old girl with extracutaneous juvenile xanthogranuloma.
Posttherapeutic Critical Organ Dosimetry of Extensive 177Lu-PSMA Inhibitor Therapy With Metastatic Castration-Resistant Prostate Cancer
Authors: Özkan Ahu , Uçar Burcu , Seymen Hülya , Yildiz Yarar Yasemin , Falay Fikri Okan , Demirkol Mehmet Onur
Published: February 2020

Purpose

177Lu-PSMA inhibitor peptide receptor radioligand therapy (RLT) is playing an increasing role in metastatic castration-resistant prostate cancer. We aimed to estimate the absorbed radiation doses for critical organs (eg, kidneys, parotid glands, submandibular glands, and lacrimal glands) of patients treated with 4 to 6 cycles by 177Lu-PSMA inhibitor RLT, retrospectively, and to evaluate the findings extensively in order to determine the critical organ radiation-absorbed limitations and the number of prospective RLT.

Materials and Methods

A total of 51 cycles 177Lu-PSMA inhibitor RLT in 10 patients was analyzed. Therapies have been applied in 4 to 6 cycles with 8 to 10 weeks' intervals. Dosimetric estimates of kidneys, parotid glands, submandibular glands, and lacrimal glands have been calculated based on MIRD scheme pamphlet no. 16. Regions of interest were drawn with GE Xeleris Functional Imaging Workstation. OLINDA/EXM 1.1 simulation software was used to calculate radiation-absorbed doses.

Results

Mean radiation-absorbed doses were 0.70 ± 0.24 Gy/GBq for kidneys, 1.34 ± 0.78 Gy/GBq for parotid glands, 0.94 ± 0.45 Gy/GBq for submandibular glands, and 2.28 ± 1.29 Gy/GBq for lacrimal glands.

Conclusions

Due to the critical target organ risks and the optimal therapy doses, patient-specific dosimetry is a deterministic factor in radionuclide therapy. Even when the absorbed kidney doses were above the ICRP critical dose limits in patients who had 4 to 6 cycles of therapy, mortality due to nephrotoxicity has not been observed. Mild increased tolerated radiation dose is acceptable for the patient groups with very low survival rate.
Unsuspected Accessory Ossicle in Possible Sinus Tarsi Syndrome
Authors: Achong Dwight M.
Published: February 2020

Three-phase bone scan was performed for evaluation of possible sinus tarsi syndrome in a 52-year-old man with chronic left ankle pain. MRI was initially read as unremarkable, and there was little symptomatic improvement after intra-articular anesthetic injection. The primary finding that appreciated only delayed bone SPECT/CT images was focal increased uptake associated with a well-corticated 8-mm bony fragment adjacent to the left calcaneus, thought to represent an accessory ossicle within the left sinus tarsi. The increased uptake suggested fracture or severe degenerative change of the ossicle, likely contributing to the patient's chronic pain.
18F-FDOPA PET/CT Findings in a Patient With Primary Cerebral Amyloidoma
Authors: Rozenblum Laura , Bertaux Marc , Bielle Franck , Ollivier Morgan , Choquet Sylvain , Garcilazo Ytel , Mokhtari Karima , Kas Aurélie
Published: February 2020

Amino acid PET, including 18F-FDOPA, is recommended for initial characterization, delineation of tumor extent, and follow-up of gliomas because of its high diagnostic performances. 18F-FDOPA accumulates inside tumor cells via the l-type amino acid transporter 1 (LAT1) whose expression is increased in gliomas. We report here a case of a histopathologically proven brain amyloidoma that was first addressed for a suspected glioma. Congo red staining showed scattered extracellular deposits of amyloid and immunohistochemistry-highlighted LAT1 expression, explaining the high 18F-FDOPA uptake found in this lesion. This case indicates that differential diagnosis of the 18F-FDOPA uptake in brain lesions should include amyloidoma.
Incorporating Cleft Lip Simulation Into a “Bootcamp-Style” Curriculum
Authors: Saldanha Francesca Y.L. , Loan Gregory J. , Calabrese Carly E. , Sideridis Georgios D. , Weinstock Peter H. , Rogers-Vizena Carolyn R.
Published: February 2020

Introduction

The traditions of surgical education have changed little over the years. However, the increasing focus on patient safety and duty hour restrictions mandates that residents start developing complex skill sets earlier to ensure they graduate with procedural competency. Surgical training is poised to exploit high-fidelity simulation technology to mitigate these pressures.

Methods

By revisiting principles of adult learning theory, the authors created a “bootcamp-style” cleft lip curriculum that sought to (1) maximize educational impact and (2) pilot a high-fidelity procedural trainer permitting resident operative autonomy as part of that curriculum. Trainees participated in small group educational sessions comprised of a standard cleft didactic lecture, augmented by instructional video. Participants immediately processed knowledge from the lecture/video by “operating” on the simulator, allowing opportunities for questions and self-reflection, completing the learning cycle. A self-assessment survey was taken before and after each component of the session, including a self-confidence survey to conclude the session. Anthropometric measures of lip/nasal symmetry were assessed.

Results

Sixteen trainees participated in the program. Little increase in self-assessed knowledge/skill was seen after the lecture, but significant increases in most aspects of cleft lip repair were seen after simulation. The greatest increase in self-assessment was seen for the program as a whole, with significant differences across all aspects of the self-assessment. Higher levels of training were associated with both higher self-assessment scores and better lip symmetry. Regardless of level of training, all participants strongly agreed that simulation helped them actively engage in learning and should be a required aspect of training, whereas 94% (n = 15) thought simulation was much more effective than standard preparation alone.

Conclusions

This pilot curriculum illustrates a mechanism to incorporate lessons from adult learning theory into plastic surgery training using a high-fidelity simulator for deliberate practice of cleft lip repair. Further evaluation is warranted to determine whether this didactic model can accelerate the acquisition of the complex skill set required for cleft lip repair and other surgical procedures.
Use of Sentinel Lymph Node Incision for Second Stage Implant-Based Breast Reconstruction After Radiation
Authors: Lobb David C. , Deal Alexandra L. , Campbell Christopher A.
Published: February 2020

Background

Staged expander to implant breast reconstruction is associated with a high complication rate when the patient has had postmastectomy radiation. With an increasing number of American women undergoing implant-based breast reconstruction after postmastectomy radiation, surgeons may find themselves operating in a radiated field with synthetic devices. We report the performance characteristics of a novel surgical modification to the second stage expander to implant exchange after adjuvant radiation using a transaxillary approach through a prior sentinel lymph node incision, a site remote from the breast implant pocket.

Methods

We performed a retrospective review of a prospectively maintained database to evaluate the surgical outcomes of serial patients undergoing second staged expander to implant exchange through the sentinel lymph node incision 6 months or more after completing whole breast radiation. A case matched cohort to age, body mass index, and comorbid status was used to compare outcomes between patients in the group of interest versus a traditional skin sparing incision on the anterior breast mound through the radiated skin envelope. All patients included demonstrated grade 1 or 2 skin changes on the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Schema for the skin organ system.

Results

Nineteen breasts were reconstructed for 18 women after immediate tissue expander placement and adjuvant whole breast radiation were included in our group of interest. Forty-one case-matched second controls were identified for the comparison group. There were no intraoperative complications. Two postoperative complications were reported for the sentinel lymph node approach group (10.5%) with an average of 9 months of follow-up: 1 operative exploration for hematoma and 1 minor wound requiring recloser in the office. The case matched cohort demonstrated significantly more minor postoperative complications (P = 0.037) with a total complications rate of 41.4%. There were 31.7% of the patients that experienced a minor complication alone, whereas 9.7% of the case-matched cohort experienced a major complication.

Conclusions

These data support the use of the existing axillary sentinel lymph node access incision for second stage placement of a gel implant after immediate expander and adjuvant radiation therapy. The sentinel lymph node incision approach facilitates layered closure over the breast pocket at a site remote from irradiated tissue, reducing the incidence of postoperative minor complications. Forthcoming long-term data will determine if differences in reported capsular contracture rates can be achieved with a remote transaxillary approach to second stage implant reconstruction after radiation.
Autologous Fat Grafting Does Not Increase Risk of Oncologic Recurrence in the Reconstructed Breast
Authors: Vyas Krishna S. , DeCoster Ryan C. , Burns Jack C. , Rodgers Louis T. , Shrout Max A. , Mercer James P. , Coquillard Cristin , Dugan Adam J. , Baratta Michael D. , Rinker Brian D. , Vasconez Henry C.
Published: February 2020

Introduction

Autologous fat grafting (AFG) is a popular and effective method of breast reconstruction after mastectomy; however, the oncological safety of AFG remains in question. The aim of this study was to determine whether AFG increases the risk of cancer recurrence in the reconstructed breast.

Methods

A matched, case-control study was conducted from 2000 to 2017 at the senior author's institution. Inclusion was limited to female patients who underwent mastectomy and breast reconstruction with or without AFG. Data were further subdivided at the breast level. χ2 analyses were used to test the association between AFG status and oncologic recurrence. A Cox proportional-hazards model was constructed to assess for possible differences in time to oncologic recurrence. The probability of recurrence was determined by Kaplan-Meier analyses and confirmed with log-rank testing.

Results

Overall, 428 breasts met study criteria. Of those, 116 breasts (27.1%) received AFG, whereas 312 (72.9%) did not. No differences in the rates of oncologic recurrence were found between the groups (8.2% vs 9.0%, P < 1.000). Unadjusted (hazard ratio = 1.03, confidence interval = 0.41–2.60, P < 0.957) and adjusted hazard models showed no statistically significant increase in time to oncologic recurrence when comparing AFG to non-AFG. In addition, no statistical differences in disease-free survival were found (P = 0.96 by log rank test).

Conclusion

Autologous fat grafting for breast reconstruction is oncologically safe and does not increase the likelihood of oncologic recurrence. Larger studies (eg, meta analyses) with longer follow-up are needed to further elucidate the long-term safety of AFG as a reconstructive adjunct.
Health-Related Quality of Life in Craniofacial Conditions
Authors: Morgan Austin , Ataseven Burçin , Din Hena , Blum Jessica , Paap Michael , Meier Annie , Carrizosa Claudia , Malcarne Vanessa , Gosman Amanda
Published: February 2020

Introduction

Craniofacial conditions (CFCs) profoundly influence health-related quality of life (HRQoL). In children with CFCs, patient-reported outcome measures have become an integral adjunct to more objective surgical outcome measures. Patient-reported outcome measures are designed to assess HRQoL domains. Few studies have evaluated parent and child agreement about HRQoL in the context of CFCs. The aims of this study were to explore the impact of CFCs on HRQoL domains in children and their parents and to determine whether patient and parent perspectives converge.

Methods

The Craniofacial Conditions Quality of Life Scale (CFC-QoL) is a newly developed 5-domain survey available in child self-report and parent report and in English- and Spanish-language versions. The 5 domains are the following: social impact, psychological function, physical function, family impact, and appearance impact. Children with CFCs (ages 7–21 years) and parents of children with CFCs were recruited via the craniofacial care team clinic at a major metropolitan children's hospital. All children and parents completed the CFC-QoL Scale in their preferred language of English or Spanish. Scale internal consistencies were calculated for child patients and parents, for English and Spanish versions. Scores on the 5 domains were compared for children and parents across English versus Spanish versions.

Results

For children with CFCs (N = 75), the sex was distributed almost equally. Patients were mostly Hispanic (69.3%), and their ages ranged from 7 to 21 years old (M = 13.2, SD = 3.62). The mean values for patient and parent scores were low, suggesting good HRQoL across all 5 domains. Pearson correlation coefficients were computed to explore the interrelationships between patient and parent report for each of the 5 CFC-QoL subscales. For the total sample, patient and parent scores were significantly and moderately positively correlated for all subscales. When analyzed separately based on sex, ethnicity, and diagnostic group, the correlation patterns were not identical to those found for the total sample. When analyzed separately for diagnostic group, there was less consistency in patterns, with patient-parent dyads showing different levels of agreement based on child's diagnostic grouping.

Conclusions

Although there is substantial agreement between parents and patients when considered on a group level, there is moderate agreement between patients and parents when considered at the dyadic level, underscoring the importance of measuring and considering both perspectives.
Improving the Versatility of the Latissimus Dorsi Myocutaneous Flap Using the Perforator Propeller Flap Concept
Authors: Liu Yuanbo , Zang Mengqing , Wu Lehao , Zhu Shan , Chen Bo , Li Shanshan , Han Tinglu , Qu Huayi
Published: February 2020

Background

The latissimus dorsi myocutaneous flap is widely used in reconstructive surgery; however, primary donor-site closure remains challenging when a wide flap is harvested.

Methods

A large latissimus dorsi myocutaneous flap was elevated and transferred to repair defects. Perforators adjacent to the donor site of the myocutaneous flap were explored using an ultrasound Doppler probe or a technique of extensive exploration along the margins of the donor site wound. A single or multiple perforator propeller flaps based on these perforators were used to close the donor site defect.

Results

From June 2012 to April 2018, this method was used to restore posttraumatic and oncologic defects of the chest wall in 14 cases, upper extremity in 6 cases, and lower extremity in 1 case. The size and width of the latissimus dorsi myocutaneous flaps ranged from 16 × 11 cm to 33 × 17 cm (mean area, 335.6 cm2) and 9 cm to 20 cm (mean width, 14 cm), respectively. The donor site defect was closed primarily by using a single flap in 11 cases, dual flap in 9, and triple flap in one. Donor site breakdown was not observed in any of the cases.

Conclusions

The perforator propeller flap could be used to reconstruct a latissimus dorsi myocutaneous flap donor site defect, ensuring not only the harvesting of a wide flap but also achieving primary donor site closure, thus greatly improving the versatility and capability of the latissimus dorsi myocutaneous flap in the reconstruction of large-sized defects.
Comparison of Rhinoplasty Patients Informed With Standard Verbal Information in Preoperative Period and Rhinoplasty Patients Informed and Treated With Visual Information Through Catalog in Terms of the Development of Agitation, Edema and Ecchymose in the Postoperative Period
Authors: Keleş Havva Pinar , Besir Ahmet , Livaoğlu Murat
Published: February 2020

Aim:

In this study, we aimed to compare the effects of standard verbal information in the preoperative period and the information by visual expression and physical applications in the development of agitation, edema and ecchymosis in the postoperative period.

Materials and Methods:

The study was carried out in 60 ASA I-II patients who were going to undergo open rhinoplasty by plastic surgery. In the Preoperative Anesthetic Assessment the patients were divided into two groups as the patients given standard verbal information (Group S; n = 30) and those informed with a catalog which contains visuals (Group V; n = 30) In the preoperative period, anxiety levels of the patients were evaluated. Standard anesthesia induction was performed in both groups after standard monitoring. Patients were monitored in the post-anesthesia care unit and ward. Patient's extubation quality, presence of postoperative agitation and periorbital edema and ecchymosis at the 6th, 12th, 18th, and 24th hours were evaluated.

Results:

No significant difference was found between the groups in terms of intraoperative and postoperative MAP, HR, extubation quality, presence of recovery agitation, postoperative pain, development edema and ecchymosis (P > 0.05). Significant positive correlation was found between post-extubation MAP and edema scores at the 16th and 24th hours postoperatively and between the post-anesthesia care unit entry MAP and ecchymosis at the 24th postoperative hours independently of the groups (r = 0.27; P = 0.038, r = 0.302; P = 0.019, r = 0.345; P = 0.007, respectively).

Result:

In our study, it was concluded that detailed visual information and physical application in the preoperative period among rhinoplasty patients had no effect on the incidence of postoperative agitation, development of edema and ecchymosis.
Huge Anterior Skull Base Defect Reconstruction on Communicating Between Cranium and Nasal Cavity: Combination Flap of Galeal Flap and Reverse Temporalis Flap
Authors: Shin Dongwoo , Yang Chae Eun , Kim Yong Ook , Hong Jong Won , Lee Won Jai , Lew Dae Hyun , Chang Jong Hee , Kim Chang Hoon
Published: February 2020

Introduction:

Traditionally, galeal flap or cranialization was often used to reconstruct the skull base defect caused by trauma or tumor removal. However, in the case of huge skull base defect, galeal flap is not enough to block the communication between nasal cavity and intracranial space. In this study, authors suggest combination flap of galea and reverse temporalis muscle as a method for reconstruction of huge skull base defect.

Materials and Methods:

From 2016 to 2019, retrospective review was conducted, assessing 7 patients with bone defect which is not just opening of frontal sinus but extends to frontal sinus and cribriform plate. Reconstructions were done by combination of galeal flap and reverse temporalis muscle flap transposition.

Results:

Defects were caused by nasal cavity tumor with intracranial extension or brain tumor with nasal cavity extension. There was no major complication in every case. During the follow up period, no patient had signs of complication such as ascending infection, herniation and CSF rhinorrhea. Postoperative radiologic images of all patients that were taken at least 6 months after the surgery showed that flaps maintained the lining and the volume well.

Discussion:

Conventional reconstruction of skull base defect with galeal flap is not effective enough to cover the large sized defect. In conclusion, galeal flap in combination with reverse temporalis muscle flap can effectively block the communication of nasal cavity and intracranium.
Use of Intravenous Immunoglobulins in Patients with Suspected Toxin-Mediated Shock Requiring Extracorporeal Membrane Oxygenation
Authors: Peetermans Marijke , Wan Ruth Y.Y. , Camporota Luigi , Barrett Nicholas A. , Retter Andrew
Published: February 2020

Background:

Toxin-producing, gram-positive bacteria can lead to severe and refractory septic shock with high attributable mortality. Adjunctive therapies such as intravenous immunoglobulins (IVIG) have been proposed for these patients. However, at presentation the presence of a toxin-producing organism is most often unknown. As IVIG is a potentially valuable but also limited resource, we investigated the use of IVIG in our critically ill patients requiring extracorporeal membrane oxygenation (ECMO).

Materials and methods:

Retrospective cohort study (April 2016 to March 2018) of adult patients with clinically suspected toxin-mediated shock requiring ECMO and who received IVIG in our regional severe respiratory failure (SRF)/ECMO center.

Results:

In 44% (15/34) of the patients, group A Streptococcus or Panton-Valentine Leukocidin producing S aureus was isolated. IVIG use in these patients was safe. The mortality was 30%, lower than the predicted mortality of >90% based on the SOFA scores.

Conclusion:

IVIG administration can be considered in a selected group of patients presenting with acute and very severe septic shock.
The Value of Serum Uncoupling Protein-2 Level for the Patients With Sepsis
Authors: Huang Wei , Wang Xiaoting , Zhang Hongmin , Wang Cui , Liu Dawei
Published: February 2020

Background:

To investigate the potential utility of serum uncoupling protein-2 (UCP2) level as a biomarker in septic patients.

Methods:

Critically ill patients with diagnoses of sepsis—sepsis non-shock group (n = 20) and septic shock group (n = 53), and a control group (n = 15) were enrolled within 24 h of entry into the ICU. Serum levels of UCP2 were measured by enzyme-linked immunosorbent assay (ELISA) at ICU admission for all the groups and at ICU discharge for septic shock group. Clinical parameters and laboratorial tests (APACHE II, SOFA, lactate, etc.) were also collected.

Results:

Serum UCP2 concentrations on ICU admission were significantly increased in septic shock group and sepsis non-shock group, compared with control subjects (263.21 ± 29.99 vs. 115.96 ± 32.99 vs. 60.56 ± 10.05 pg/mL, P < 0.001). Concentrations of UCP2 performed better than other parameters (APACHE II score, SOFA score, procalcitonin, and WBC) in predicting the incidence of sepsis or septic shock on the day of ICU admission, as reflected by AUC. On the day of ICU admission, the AUC for UCP2 level associated with 28-day mortality was 0.704, higher than the AUC for SOFA and APACHE II scores. Patients with higher admission levels of UCP2 (>246.52 pg/mL) had significantly increased 28-day mortality compared with those with lower UCP2 levels (<246.52 pg/mL).

Conclusion:

Serum UCP2 levels at admission were markedly increased in patients with sepsis, which is useful for early diagnose and prognostic prediction. UCP2 is a potential biomarker for sepsis, or even a subtype of sepsis.
Comparison of Short-Term Outcomes Between Hand-assisted Laparoscopic Distal Gastrectomy and Laparoscopy-assisted Distal Gastrectomy in Gastric Cancer
Authors: Hagiwara Ken , Matsuda Minoru , Hayashi Shigeoki , Takayama Tadatoshi , Ikarashi Masahito , Matsuno Yoritaka
Published: February 2020

Hand-assisted laparoscopic surgery is considered to provide the benefits of laparoscopic surgery in various diseases. However, limited information is available regarding the feasibility of hand-assisted laparoscopic distal gastrectomy (HALDG)—a subset of hand-assisted laparoscopic surgery—as a gastric cancer treatment. This study aimed to evaluate the usefulness of HALDG compared with laparoscopy-assisted distal gastrectomy (LADG). Consecutive patients who underwent HALDG (n=58) or LADG (n=90) for stage I gastric cancer between 2005 and 2016 were eligible. Operative time was significantly shorter and blood loss was significantly higher in HALDG than in LADG (P<0.001, both). Postoperative aminotransferase levels were significantly lower in HALDG than in LADG (P<0.001). There was no significant difference in perioperative complications, a number of analgesics, postoperative C-reactive protein levels, and 3-year relapse-free and overall survival rates between the groups. This study suggests that HALDG is a safe and feasible approach and could become an effective option for stage I gastric cancer treatment.
Conversion of Mild Cognitive Impairment to Alzheimer Disease in Monolingual and Bilingual Patients
Authors: Berkes Matthias , Bialystok Ellen , Craik Fergus I.M. , Troyer Angela , Freedman Morris
Published: February 2020

Purpose:

Conversion rates from mild cognitive impairment (MCI) to Alzheimer disease (AD) were examined considering bilingualism as a measure of cognitive reserve.

Methods:

Older adult bilingual (n=75) and monolingual (n=83) patients attending a memory clinic who were diagnosed with MCI were evaluated for conversion to AD. Age of MCI and AD diagnoses and time to convert were recorded and compared across language groups.

Patients:

Patients were consecutive patients diagnosed with MCI at a hospital memory clinic.

Results:

Bilingual patients were diagnosed with MCI at a later age than monolingual patients (77.8 and 75.5 y, respectively), a difference that was significant in some analyses. However, bilingual patients converted faster from MCI to AD than monolingual patients (1.8 and 2.8 y, respectively) resulting in no language group difference in age of AD diagnosis. This relationship held after accounting for education, cognitive level, immigration status, and sex.

Discussion:

The findings suggest that greater cognitive reserve as measured by language status leads to faster conversion between MCI and AD, all else being equal.
Quantitative MRI markers in Parkinson's disease and parkinsonian syndromes
Authors: Arribarat Germain , Péran Patrice
Published: February 2020

Purpose of review

In Parkinson's disease and parkinsonian disorders, the differential diagnosis is still challenging. We aim to review current developments in MRI quantitative markers and their potential in a clinical and neuroscientific setting.

Recent findings

There have been efforts to improve MRI acquisition methods and to explore new promising biomarkers. In parallel, technological advances in data analysis (i.e. deep learning) open new ways to use these biomarkers. The MRI markers may differ according to the brain structure investigated. Even if the newly adopted acquisition protocols served mainly the development of brainstem-related biomarkers (neuromelanin MRI, nigrosome sensitive MRI), more established markers (e.g. morphometric values) in basal ganglia, cortex and cerebellum demonstrate their relevance especially to differential diagnosis in parkinsonian syndromes.

We provide an overview on recent advances in MRI quantitative markers of Parkinson's disease that we divide for didactic purposes in three anatomical levels – cortical/cerebellum structures, basal ganglia and brainstem. We show the complementarity of new biomarkers sensitive to brain tissue properties to established morphometrics.
Anomalies in language as a biomarker for schizophrenia
Authors: de Boer Janna N. , Brederoo Sanne G. , Voppel Alban E. , Sommer Iris E.C.
Published: February 2020

Purpose of review

After more than a century of neuroscience research, reproducible, clinically relevant biomarkers for schizophrenia have not yet been established. This article reviews current advances in evaluating the use of language as a diagnostic or prognostic tool in schizophrenia.

Recent findings

The development of computational linguistic tools to quantify language disturbances is rapidly gaining ground in the field of schizophrenia research. Current applications are the use of semantic space models and acoustic analyses focused on phonetic markers. These features are used in machine learning models to distinguish patients with schizophrenia from healthy controls or to predict conversion to psychosis in high-risk groups, reaching accuracy scores (generally ranging from 80 to 90%) that exceed clinical raters. Other potential applications for a language biomarker in schizophrenia are monitoring of side effects, differential diagnostics and relapse prevention.

Language disturbances are a key feature of schizophrenia. Although in its early stages, the emerging field of research focused on computational linguistics suggests an important role for language analyses in the diagnosis and prognosis of schizophrenia. Spoken language as a biomarker for schizophrenia has important advantages because it can be objectively and reproducibly quantified. Furthermore, language analyses are low-cost, time efficient and noninvasive in nature.
A developmentally descriptive method for quantifying shape in gastropod shells
Authors: Larsson J. , Westram A. M. , Bengmark S. , Lundh T. , Butlin R. K.
Published: February 2020

The growth of snail shells can be described by simple mathematical rules. Variation in a few parameters can explain much of the diversity of shell shapes seen in nature. However, empirical studies of gastropod shell shape variation typically use geometric morphometric approaches, which do not capture this growth pattern. We have developed a way to infer a set of developmentally descriptive shape parameters based on three-dimensional logarithmic helicospiral growth and using landmarks from two-dimensional shell images as input. We demonstrate the utility of this approach, and compare it to the geometric morphometric approach, using a large set of
Littorina saxatilis
shells in which locally adapted populations differ in shape. Our method can be modified easily to make it applicable to a wide range of shell forms, which would allow for investigations of the similarities and differences between and within many different species of gastropods.
Revisiting the hypothesis of an energetic barrier to genome complexity between eukaryotes and prokaryotes
Authors: Chiyomaru Katsumi , Takemoto Kazuhiro
Published: February 2020

The absence of genome complexity in prokaryotes, being the evolutionary precursors to eukaryotic cells comprising all complex life (the prokaryote–eukaryote divide), is a long-standing question in evolutionary biology. A previous study hypothesized that the divide exists because prokaryotic genome size is constrained by bioenergetics (prokaryotic power per gene or genome being significantly lower than eukaryotic ones). However, this hypothesis was evaluated using a relatively small dataset due to lack of data availability at the time, and is therefore controversial. Accordingly, we constructed a larger dataset of genomes, metabolic rates, cell sizes and ploidy levels to investigate whether an energetic barrier to genome complexity exists between eukaryotes and prokaryotes while statistically controlling for the confounding effects of cell size and phylogenetic signals. Notably, we showed that the differences in bioenergetics between prokaryotes and eukaryotes were less significant than those previously reported. More importantly, we found a limited contribution of power per genome and power per gene to the prokaryote–eukaryote dichotomy. Our findings indicate that the prokaryote–eukaryote divide is hard to explain from the energetic perspective. However, our findings may not entirely discount the traditional hypothesis; in contrast, they indicate the need for more careful examination.
Disentangling non-specific and specific transgenerational immune priming components in host–parasite interactions
Authors: Ben-Ami Frida , Orlic Christian , Regoes Roland R.
Published: February 2020

Exposure to a pathogen primes many organisms to respond faster or more efficiently to subsequent exposures. Such priming can be non-specific or specific, and has been found to extend across generations. Disentangling and quantifying specific and non-specific effects is essential for understanding the genetic epidemiology of a system. By combining a large infection experiment and mathematical modelling, we disentangle different transgenerational effects in the crustacean model
Daphnia magna
exposed to different strains of the bacterial parasite
Pasteuria ramosa
. In the experiment, we exposed hosts to a high dose of one of three parasite strains, and subsequently challenged their offspring with multiple doses of the same (homologous) or a different (heterologous) strain. We find that exposure of
Daphnia
to
Pasteuria
decreases the susceptibility of their offspring by approximately 50%. This transgenerational protection is not larger for homologous than for heterologous parasite challenges. Methodologically, our work represents an important contribution not only to the analysis of immune priming in ecological systems but also to the experimental assessment of vaccines. We present, for the first time, an inference framework to investigate specific and non-specific effects of immune priming on the susceptibility distribution of hosts—effects that are central to understanding immunity and the effect of vaccines.
Social learning of acoustic anti-predator cues occurs between wild bird species
Authors: Keen Sara C. , Cole Ella F. , Sheehan Michael J. , Sheldon Ben C.
Published: February 2020

In many species, individuals gather information about their environment both through direct experience and through information obtained from others. Social learning, or the acquisition of information from others, can occur both within and between species and may facilitate the rapid spread of antipredator behaviour. Within birds, acoustic signals are frequently used to alert others to the presence of predators, and individuals can quickly learn to associate novel acoustic cues with predation risk. However, few studies have addressed whether such learning occurs only though direct experience or whether it has a social component, nor whether such learning can occur between species. We investigate these questions in two sympatric species of Parids: blue tits (
Cyanistes caeruleus
) and great tits (
Parus major
). Using playbacks of unfamiliar bird vocalizations paired with a predator model in a controlled aviary setting, we find that blue tits can learn to associate a novel sound with predation risk via direct experience, and that antipredator response to the sound can be socially transmitted to heterospecific observers, despite lack of first-hand experience. Our results suggest that social learning of acoustic cues can occur between species. Such interspecific social information transmission may help to mediate the formation of mixed-species aggregations.
Host–microbiome coevolution can promote cooperation in a rock–paper–scissors dynamics
Authors: Lewin-Epstein Ohad , Hadany Lilach
Published: February 2020

Cooperation is a fundamental behaviour observed in all forms of life. The evolution of cooperation has been widely studied, but almost all theories focused on the cooperating individual and its genes. We suggest a different approach, taking into account the microbes carried by the interacting individuals. Accumulating evidence reveals that microbes can affect their host's well-being and behaviour, yet hosts can evolve mechanisms to resist the manipulations of their microbes. We thus propose that coevolution of microbes with their hosts may favour microbes that induce their host to cooperate. Using computational modelling, we show that microbe-induced cooperation can evolve and be maintained in a wide range of conditions, including when facing hosts' resistance to the microbial effect. We find that host–microbe coevolution leads the population to a rock–paper–scissors dynamics that enables maintenance of cooperation in a polymorphic state. Our results suggest a mechanism for the evolution and maintenance of cooperation that may be relevant to a wide variety of organisms, including cases that are difficult to explain by current theories. This study provides a new perspective on the coevolution of hosts and their microbiome, emphasizing the potential role of microbes in shaping their host's behaviour.