bluuebunny/crossref_metadata_2025 huggingface dataset:
Contemporary considerations in concurrent endoscopic sinus surgery and rhinoplasty
Authors: Steele Toby O. , Gill Amarbir , Tollefson Travis T.
Published: June 2018

Purpose of review

Characterize indications, perioperative considerations, clinical outcomes and complications for concurrent endoscopic sinus surgery (ESS) and rhinoplasty.

Recent findings

Chronic rhinosinusitis and septal deviation with or without inferior turbinate hypertrophy independently impair patient-reported quality of life. Guidelines implore surgeons to include endoscopy to accurately evaluate patient symptoms. Complication rates parallel those of either surgery (ESS and rhinoplasty) alone and are not increased when performed concurrently. Operative time is generally longer for joint surgeries. Patient satisfaction rates are high.

Concurrent functional and/or cosmetic rhinoplasty and ESS is a safe endeavor to perform in a single operative setting and most outcomes data suggest excellent patient outcomes. Additional studies that include patient-reported outcome measures are needed.
Advances in Diagnostic and Intraoperative Molecular Imaging of Pancreatic Cancer
Authors: Tummers Willemieke S. , Willmann Juergen K. , Bonsing Bert A. , Vahrmeijer Alexander L. , Gambhir Sanjiv S. , Swijnenburg Rutger-Jan
Published: June 2018

Pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis. To improve outcomes, there is a critical need for improved tools for detection, accurate staging, and resectability assessment. This could improve patient stratification for the most optimal primary treatment modality. Molecular imaging, used in combination with tumor-specific imaging agents, can improve established imaging methods for PDAC. These novel, tumor-specific imaging agents developed to target specific biomarkers have the potential to specifically differentiate between malignant and benign diseases, such as pancreatitis. When these agents are coupled to various types of labels, this type of molecular imaging can provide integrated diagnostic, noninvasive imaging of PDAC as well as image-guided pancreatic surgery. This review provides a detailed overview of the current clinical imaging applications, upcoming molecular imaging strategies for PDAC, and potential targets for imaging, with an emphasis on intraoperative imaging applications.
A Multifaceted Intervention to Reduce Pediatric Acid‐Suppressant Prescriptions for Gastroesophageal Reflux
Authors: Steutel Nina F. , Langendam Miranda W. , Benninga Marc A. , Jansen Minke E.P. , Tabbers Merit M.
Published: June 2018

Objective:

Acid‐suppressant prescriptions for children have increased over past decades, despite guideline recommendations to prescribe prudently. Acid suppressants are often ineffective and may lead to side effects. We aimed to reduce inappropriate acid‐suppressant prescriptions for gastroesophageal reflux in a tertiary care setting through active implementation of national guideline recommendations and to evaluate intervention effect.

Methods:

Implementation consisted of 2 steps. First, all pediatric clinicians in an academic hospital received information on appropriate acid‐suppressant prescribing, a link to an online national guideline application and summary card with important evidence‐based recommendations—Wise Choices. Hereafter, clinicians prescribing acid suppressants were contacted to provide feedback on indications and to assess their knowledge of the guideline and Wise Choices. The pharmacy database supplied prescription data before, during, and after this intervention.

Results:

During the study period prescriptions ranged from 115 to 201/month. Ten months postintervention, a nonsignificant decrease of 4 prescriptions/month was measured (95% confidence interval −49–41). Of the 78 prescribers 76 were successfully contacted: 63% were familiar with the guideline and 45% with Wise Choices. Thirty percent of prescriptions were for gastroesophageal reflux symptoms.

Conclusion:

This multifaceted implementation strategy did not lead to a significant difference in acid‐suppressant prescriptions by tertiary care clinicians of whom the majority was familiar with the gastroesophageal reflux disease guideline. Future studies should clarify, which implementation strategies are most effective in reducing inappropriate prescribing of acid suppressants for children. Uniform registration of prescriptions and indications in a national database will enable monitoring of the intervention effect.
Health Status and Health-related Quality of Life Measurement in Pediatric Cancer Clinical Trials: An Examination of the DFCI 00-01 Acute Lymphoblastic Leukemia Protocol
Authors: Rae Charlene , Furlong William , Feeny David , Couchman Rana , Silverman Lewis , Sallan Stephen , Laverdiere Caroline , Clavell Luis , Michon Bruno , Kelly Kara , Larsen Eric , Pullenayegum Eleanor , Athale Uma , Barr Ronald
Published: June 2018

Health-related quality of life (HRQL) improved progressively during therapy and beyond in children treated for acute lymphoblastic leukemia on the Dana-Farber Cancer Institute (DFCI) 95-01 protocol. This study aimed to validate that trajectory in a successor study (DFCI 00-01) and to compare the HRQL of patients in the 2 studies. Children aged above 5 years were assessed during each phase of treatment (N=4) and 2 years after completion of therapy. Health status and HRQL were measured using Health Utilities Index (HUI) instruments, HUI2 and HUI3. Quality-adjusted life years (QALYs) were calculated and compared with the general population, and patients treated on DFCI 95-01. Over 5 intervals and 758 HUI assessments, mean HRQL increased progressively from remission induction to the time after treatment (P<0.001). During intensification, high-risk patients had lower HRQL than standard-risk patients (P<0.001). During remission induction, patients on DFCI 95-01 had lower HRQL than patients on DFCI 00-01. Patients on DFCI 00-01 had ~0.2 and 0.3 fewer QALYs than controls, measured by HUI2 and HUI3, respectively. QALYs for DFCI 00-01 patients during treatment were similar to those for DFCI 95-01 patients. The trajectory of improvement in HRQL during the treatment of acute lymphoblastic leukemia in children was confirmed.
Aneursymal Bone Cyst: An Uncommon Paraspinal Tumor in Children
Authors: Shah Nilay , Scharschmidt Thomas , Fung Bonita , Conces Miriam , Setty Bhuvana A.
Published: June 2018

Paraspinal tumors with benign histology in the absence of trauma rarely arise in children. Treatment of such benign tumors, in contrast to malignancies, generally consists of surgical resection of the lesion with confirmation of histology via pathologic evaluation. We present a pediatric case of an atraumatic paraspinal mass with a histologic diagnosis of aneurysmal bone cyst, and USP6 gene rearrangement supporting the histologic diagnosis. The patient underwent gross total resection of the paraspinal lesion with no additional intervention. We highlight the differential diagnosis of paraspinal tumors in children and key features that led to the diagnosis in this patient.
PD-L1 Assays 22C3 and SP263 are Not Interchangeable in Non–Small Cell Lung Cancer When Considering Clinically Relevant Cutoffs
Authors: Munari Enrico , Rossi Giulio , Zamboni Giuseppe , Lunardi Gianluigi , Marconi Marcella , Sommaggio Marco , Netto George J. , Hoque Mohammad O. , Brunelli Matteo , Martignoni Guido , Haffner Michael C. , Moretta Francesca , Pegoraro Maria C. , Cavazza Alberto , Samogin Giuseppina , Furlan Vanna , Mariotti Francesca R. , Vacca Paola , Moretta Lorenzo , Bogina Giuseppe
Published: June 2018

Pembrolizumab is the only programmed cell death 1/programmed death-ligand 1 inhibitor for treatment of patients with non–small cell lung cancer, with a companion diagnostic assay, the 22C3 PharmDx. Although in many studies 22C3 and Ventana’s SP263 appear to yield overlapping results, they show discrepancies at clinically relevant cutoffs (1% and 50%). We provide a solid comparison between 22C3 and SP263 assays in a large cohort of non–small cell lung cancer cases taking into account interobserver variability between trained pathologists who are used to either clone in their clinical practice. Serial sections of tissue microarrays, built from 198 cases of resected lung cancer, were stained for 22C3 on the Dako Link-48 platform and for SP263 on the Ventana Benchmark Ultra, following manufacturer’s instructions. A protocol was also developed to run the 22C3 antibody on the Ventana platform. The pathologist used to 22C3 scored consistently higher than the pathologist used to SP263 at both 1% and 50% cutoff for all assays. For 22C3 and SP263 on respective platforms, we found statistically significant differences in terms of proportion of positive cases at both cutoffs; at 50% cutoff, around half of the cases positive with SP263 would have been defined negative with 22C3 by both pathologists. Important differences were also observed, when comparing clone 22C3 and SP263, both run on the Ventana platform. The lowest differences were seen with 22C3 run on both platforms. Assays 22C3 and SP263 show important discrepancies in identifying programmed death-ligand 1–positive cases at clinically relevant cutoffs, with possible underestimation of patients suitable for pembrolizumab therapy.
Neurologic Outcomes After Extracorporeal Membrane Oxygenation: A Systematic Review
Authors: Boyle Katharine , Felling Ryan , Yiu Alvin , Battarjee Wejdan , Schwartz Jamie McElrath , Salorio Cynthia , Bembea Melania M.
Published: June 2018

Objectives:

The goal of this systematic review of the literature was to summarize neurologic outcomes following neonatal and pediatric extracorporeal membrane oxygenation.

Data Sources:

We conducted electronic searches of PubMed, Scopus, Web of Science, CINAHL, Cochrane, and EMBASE.

Study Selection:

Inclusion criteria included publication dates 2000–2016, patient ages 0–18 years, and use of standardized measures to evaluate outcomes after extracorporeal membrane oxygenation.

Data Extraction:

We identified 3,497 unique citations; 60 full-text articles were included in the final review.

Data Synthesis:

Studies evaluated patients with congenital diaphragmatic hernia (7), cardiac disease (8), cardiac arrest (13), and mixed populations (32). Follow-up was conducted at hospital discharge in 10 studies (17%) and at a median of 26 months (interquartile range, 8–61 mo) after extracorporeal membrane oxygenation in 50 studies (83%). We found 55 outcome measures that assessed overall health and function (4), global cognitive ability (7), development (4), motor function (5), adaptive function (2), behavior/mood (6), hearing (2), quality of life (2), school achievement (5), speech and language (6), learning and memory (4), and attention and executive function (8). Overall, 10% to as many as 50% of children scored more than 2 sds below the population mean on cognitive testing. Behavior problems were identified in 16–46% of children tested, and severe motor impairment was reported in 12% of children. Quality of life of former extracorporeal membrane oxygenation patients evaluated at school age or adolescence ranged from similar to healthy peers, to 31–53% having scores more than 1 sd below the population mean.

Conclusions:

This systematic review of the literature suggests that children who have undergone extracorporeal membrane oxygenation suffer from a wide range of disabilities. A meta-analysis was not feasible due to heterogeneity in pathologies, outcome measures, and age at follow-up, underscoring the importance of developing and employing a core set of outcomes measures in future extracorporeal membrane oxygenation studies.
ZC3H7B-BCOR-Rearranged Endometrial Stromal Sarcomas: A Distinct Subset Merits its Own Classification?
Authors: Mansor Sorsiah , Kuick Chik Hong , Lim Sheow Lei , Quek Richard , Wong Adele Pek Choo , Lim-Tan Soo Kim , Lim Timothy Yong Kuei , Chang Kenneth Tou En
Published: June 2018

A 41-yr-old lady with abnormal uterine bleeding underwent total abdominal hysterectomy. Histologic assessment revealed an endometrial stromal sarcoma (ESS) with minimal cytologic atypia and low mitotic count (up to 7/10 high-power fields) with only focal myxoid areas, morphologically corresponding to a low-grade ESS. Immunohistochemical stains showed cyclin D1 and CD10 positivity, and negative staining for CD117 and progesterone receptor. This tumor was clinically aggressive and recurred 6 mo later. The patient died 19 mo following initial diagnosis. Molecular analysis revealed aZC3H7B(exon 10)-BCOR (exon 7)gene fusion. Subsequent BCOR immunohistochemistry was weakly positive. ESS withZC3H7B-BCORgene fusion is classified as a low-grade ESS in some classification schemes, and is also characterized as being typically myxoid. This report supports emerging evidence that ESS withZC3H7B-BCORgene fusion may have an aggressive clinical course in spite of its low-grade histology. This report further expands the morphologic spectrum ofZC3H7B-BCORfusion ESS to include nonmyxoid histology. Finally, this report underlines the value of molecular analysis in the proper classification of this aggressive tumor with deceptive low-grade histology.
Bone Marrow Fat Physiology in Relation to Skeletal Metabolism and Cardiometabolic Disease Risk in Children With Cerebral Palsy
Authors: Whitney Daniel G. , Peterson Mark D. , Devlin Maureen J. , Caird Michelle S. , Hurvitz Edward A. , Modlesky Christopher M.
Published: June 2018

Individuals with cerebral palsy exhibit neuromuscular complications and low physical activity levels. Adults with cerebral palsy exhibit a high prevalence of chronic diseases, which is associated with musculoskeletal deficits. Children with cerebral palsy have poor musculoskeletal accretion accompanied by excess bone marrow fat, which may lead to weaker bones. Mechanistic studies to determine the role of bone marrow fat on skeletal growth and maintenance and how it relates to systemic energy metabolism among individuals with cerebral palsy are lacking. In this review, we highlight the skeletal status in children with cerebral palsy and analyze the existing literature on the interactions among bone marrow fat, skeletal health, and cardiometabolic disease risk in the general population. Clinically vital questions are proposed, including the following: (1) Is the bone marrow fat in children with cerebral palsy metabolically distinct from typically developing children in terms of its lipid and inflammatory composition? (2) Does the bone marrow fat suppress skeletal acquisition? (3) Or, does it accelerate chronic disease development in children with cerebral palsy? (4) If so, what are the mechanisms? In conclusion, although inadequate mechanical loading may initiate poor skeletal development, subsequent expansion of bone marrow fat may further impede skeletal acquisition and increase cardiometabolic disease risk in those with cerebral palsy.
“The Invisible Staff”: A Qualitative Analysis of Environmental Service Workers’ Perceptions of the VA Clostridium difficile Prevention Bundle Using a Human Factors Engineering Approach
Authors: Yanke Eric , Moriarty Helene , Carayon Pascale , Safdar Nasia
Published: June 2018

Objectives

Using a novel human factors engineering approach, the Systems Engineering Initiative for Patient Safety model, we evaluated environmental service workers’ (ESWs) perceptions of barriers and facilitators influencing adherence to the nationally mandated Department of Veterans Affairs Clostridium difficile infection (CDI) prevention bundle.

Methods

A focus group of ESWs was conducted. Qualitative analysis was performed employing a visual matrix display to identify barrier/facilitator themes related to Department of Veterans Affairs CDI bundle adherence using the Systems Engineering Initiative for Patient Safety work system as a framework.

Results

Environmental service workers reported adequate cleaning supplies/equipment and displayed excellent knowledge of CDI hand hygiene requirements. Environmental service workers described current supervisory practices as providing an acceptable amount of time to clean CDI rooms, although other healthcare workers often pressured ESWs to clean rooms more quickly. Environmental service workers reported significant concern for CDI patients’ family members as well as suggesting uncertainty regarding the need for family members to follow infection prevention practices. Small and cluttered patient rooms made cleaning tasks more difficult, and ESW cleaning tasks were often interrupted by other healthcare workers. Environmental service workers did not feel comfortable asking physicians for more time to finish cleaning a room nor did ESWs feel comfortable pointing out lapses in physician hand hygiene.

Conclusions

Multiple work system components serve as barriers to and facilitators of ESW adherence to the nationally mandated Department of Veterans Affairs CDI bundle. Environmental service workers may represent an underappreciated resource for hospital infection prevention, and further efforts should be made to engage ESWs as members of the health care team.
Psychometric Analysis of a Survey on Patient Safety Culture–Based Tool for Emergency Medical Services
Authors: Crowe Remle P. , Cash Rebecca E. , Christgen Alex , Hilmas Tina , Varner Lee , Vogelsmeier Amy , Gilmore William S. , Panchal Ashish R.
Published: June 2018

Objective

Evaluating organizational safety culture is critical for high-stress, high-risk professions such as prehospital emergency medical services (EMS). The aim of the study was to evaluate the psychometric properties of a safety culture instrument for EMS, based on the Agency for Healthcare Research and Quality’s widely used Surveys on Patient Safety Culture (SOPS).

Methods

The final EMS-adapted instrument consisted of 37 items covering 11 safety culture domains including 10 domains from existing SOPS instruments and one new domain for communication while en route to an emergency call. The analysis sample included 23,029 nationally certified EMS providers. Domain structure was evaluated on two separate halves of the data set through confirmatory factor analysis using a polychoric correlation matrix for ordinal data. The reliability and validity of each domain were evaluated using Cronbach α and Pearson correlation coefficients.

Results

The confirmatory factor analysis supported the 11-domain model. All items loaded above the 0.4 threshold (range = 0.508–0.984). Three composite domains exhibited factor variance below the 0.5 threshold: staffing (0.32), communication about incidents (0.26), and handoffs (0.26). Floor and ceiling effects were not detected. Inter-item consistency exceeded 0.6 for all subscales (α = 0.65–0.88). Predictive validity was supported as all domain composites were correlated with the outcome variables of overall safety rating (r = 0.44–0.72) and frequency of event reporting (r = 0.31–0.48).

Conclusions

Overall, the EMS-adapted tool demonstrated adequate psychometric properties consistent with those of existing SOPS instruments. Additional research is needed to evaluate the instrument’s performance at the agency level and its correlation with safety outcomes in the prehospital setting.
Patient Safety Incidents Reported by the General Public in Korea: A Cross-Sectional Study
Authors: Ock Minsu , Jo Min-Woo , Choi Eun Young , Lee Sang-Il
Published: June 2018

Objectives

Previous studies have demonstrated that the general public can report various patient safety incidents (PSIs) that are not identified by other methods. In this study, we investigated the characteristics of PSIs that the general public experience in Korea.

Methods

In face-to-face surveys, participants were asked to report the frequency and type of PSIs, level of patient harm, and whether the PSIs were perceived as a medical error. We conducted logistic regression analysis to identify the sociodemographic factors of participants associated with their PSI experiences. Additionally, we analyzed relationships between the perception of PSIs as a medical error and both the type of PSIs and level of patient harm.

Results

Among the 700 participants surveyed, 24 (3.4%) and 37 (5.3%) individuals reported that they or their family members experienced PSIs, respectively. Participants with at least a college degree were more likely to report PSI experiences than those with a lower educational level (odds ratio, 3.54; 95% confidence interval, 1.86-6.74). Whereas approximately half of participants (48.2%) involved in PSI experiences that caused no harm thought that there were medical errors in their PSIs, all participants (100%) who experienced PSIs with severe harm responded that medical errors occurred in their PSIs.

Conclusions

The general public can report their experiences with PSIs. Periodic surveys that target the general public will provide additional data that reflect the level of patient safety from the viewpoint of the general public.
Survival Associations Using Perfusion and Diffusion Magnetic Resonance Imaging in Patients With Histologic and Genetic Defined Diffuse Glioma World Health Organization Grades II and III
Authors: Latysheva Anna , Eeg Emblem Kyrre , Server Andrés , Brandal Petter , Meling Torstein R. , Pahnke Jens , Hald John K.
Published: June 2018

Objective

According to the new World Health Organization 2016 classification for tumors of the central nervous system, 1p/19q codeletion defines the genetic hallmark that differentiates oligodendrogliomas from diffuse astrocytomas. The aim of our study was to evaluate whether relative cerebral blood volume (rCBV) and apparent diffusion coefficient (ADC) histogram analysis can stratify survival in adult patients with genetic defined diffuse glioma grades II and III.

Methods

Sixty-seven patients with untreated diffuse gliomas World Health Organization grades II and III and known 1p/19q codeletion status were included retrospectively and analyzed using ADC and rCBV maps based on whole-tumor volume histograms. Overall survival and progression-free survival (PFS) were analyzed by using Kaplan-Meier and Cox survival analyses adjusted for known survival predictors.

Results

Significant longer PFS was associated with homogeneous rCBV distribution–higher rCBVpeak (median, 37 vs 26 months; hazard ratio [HR], 3.2; P = 0.02) in patients with astrocytomas, and heterogeneous rCBV distribution–lower rCBVpeak (median, 46 vs 37 months; HR, 5.3; P < 0.001) and higher rCBVmean (median, 44 vs 39 months; HR, 7.9; P = 0.003) in patients with oligodendrogliomas. Apparent diffusion coefficient parameters (ADCpeak, ADCmean) did not stratify PFS and overall survival.

Conclusions

Tumors with heterogeneous perfusion signatures and high average values were associated with longer PFS in patients with oligodendrogliomas. On the contrary, heterogeneous perfusion distribution was associated with poor outcome in patients with diffuse astrocytomas.
Is It Possible to Establish the Extent of Resection of Glioblastoma With 18F-Fluorocholine PET/CT?
Authors: García Vicente Ana María , Perez-Beteta Julian , Calvo García Manuel , Villena Martín Maikal , Soriano Castrejón Angel
Published: June 2018

Defining high-grade glioma resectability is a challenge; and currently, it is based on anatomical imaging. However, complete removal of contrast-enhancing tumor is difficult to define in MRI. We present three cases of patients diagnosed with high-grade glioma. Brain MRI and 18F-fluorocholine PET/CT were performed before and after surgery to establish the extent of resection (EOR) and residual volume. Postoperative brain MRI and PET parameters showed discordant results in all the reported cases. PET was able to assess properly the EOR; however, the rules for the EOR establishment and its prognostic implication should be validated in prospective studies.
Sellar Paraganglioma
Authors: Karlekar Manjiri , Kumar Sanjeet , Jadhav Swati , Lila Anurag , Bandgar Tushar , Shah Nalini
Published: June 2018

Sellar and suprasellar paragangliomas are rare. We report the case of a 19-year-old man with sellar paraganglioma with parasellar and posterior pontine extension, requiring multiple transcranial surgeries and radiotherapy. The lesion was avid on 68Ga DOTANOC PET-CT scan substantiating its neuroendocrine nature.
Bronchial Mucosa–Associated Lymphoid Tissue Lymphoma Staged by 11C-Methionine
Authors: Annunziata Salvatore , Cuccaro Annarosa , Rizzo Alessio , Chiesa Silvia , D'Alò Francesco
Published: June 2018

A 57-year-old man had a diagnosis of a bronchial mucosa–associated lymphoid tissue lymphoma in the left lung and monoclonal gammopathy. The patient underwent whole-body 11C-methionine PET/CT, in order to evaluate the amino acid avidity of the lesion and to stage the bronchial mucosa–associated lymphoid tissue lymphoma. 11C-methionine uptake was detected in the lung lesion and in the mediastinal lymph nodes.
Three-Dimensional Stereophotogrammetric Evaluation of the Efficacy of Autologous Fat Grafting in the Treatment of Parry-Romberg Syndrome
Authors: Pucciarelli Valentina , Baserga Camilla , Codari Marina , Beltramini Giada A. , Sforza Chiarella , Giannì Aldo Bruno
Published: June 2018

Autologous fat grafting is a surgical procedure used to correct volumetric defects, atrophies, and sclerosis. Three-dimensional (3D) facial photography may enable researchers to quantify the success of surgical procedures through volumetric and surface assessments. Using 3D photography, the authors assessed the results of autologous fat grafting performed in a 15-year-old patient affected by Parry-Romberg syndrome, a rare condition resulting in progressive hemifacial atrophy of skin, subcutaneous tissues and, ultimately, bone. Stereophotogrammetric acquisitions were performed before and 4 months after the surgical intervention. The obtained results were objectively assessed in terms of facial symmetry through calculation of root mean square deviation point-to-point distance between the treated and healthy side, and volume modifications between pre- and postsurgical 3D facial scans. Four months after surgery, 73% of injected adipose tissue was resorbed, whereas facial symmetry increased up to 63%. The proposed method is not invasive and provides quantitative information about the surgical and esthetic outcomes. Clinicians could better plan surgery, and the patients could be more motivated and compliant to the treatment.
Hidden Scar Dissection of Benign Parotid Gland Tumors via a V-Shaped Minimal Facelift Incision
Authors: Zheng Zhiwei , Li Jun , Wang Jinbing , Sun Jian
Published: June 2018

Objectives:

The purpose of this article was to propose a V-shaped minimal facelift incision (FLI) and analyze its efficacy for improving the esthetic outcomes of parotid gland tumors.

Methods:

A prospective, nonrandomized study was performed. Forty-six patients with category I benign parotid tumors as to Quer classification (3 cm or less and located superficially and/or peripherally in the gland) were enrolled. The 46 patients who underwent dissection of parotid gland tumors were divided into 2 groups: minimal FLI (group 1) and modified Blair incision (MBI, group 2). The modified minimal FLI was performed via V-shaped preauricular and retroauricular incision with no extension to the hair bearing skin. The operation variables and the cosmetic satisfaction of the patients in each group were compared.

Results:

Twenty-three patients underwent the minimal FLI approach and 23 underwent the conventional modified Blair incision approach. No recurrence developed in any of the patients at the follow-up for an average of 18.9 ± 2.7 months. Among the operation factors, the authors observed no other significant differences in the size of tumor, operative time, or completeness of resection (P > 0.05). Moreover, facial palsy and Frey syndrome also did not differ between the 2 groups (P > 0.05). However, cosmetic satisfaction evaluated with a graded scale showed much better results in the V-shaped minimal FLI approach group (P < 0.001).

Conclusion:

V-shaped minimal FLI with excellent cosmetic outcomes could be used as a safe and preferable approach for parotidectomy, especially for the more conservative extracapsular dissection in small tumors.
Conjunctival Melanoma Metastasis to the Contralateral Orbit
Authors: He Fanglin , Wang Yuxin , Jia Renbin
Published: June 2018

Background:

Malignant melanoma predominantly occurs in whites, and is potentially fatal. Distant metastases often occur in lung, liver, brain, and could occur without prior regional disease. Conjunctival melanoma metastasis to contralateral orbit has never been reported.

Patient Presentation:

A 60-year-old man who underwent a left primary conjunctival neoplasm resection 11 months ago presented for the evaluation of a conjunctival dark-colored mass with a bulging left lower eyelid that directly invaded the orbits bilaterally. A histopathologic examination and immunohistochemistry confirmed metastases from conjunctival melanoma. In addition, the contralateral orbit had metastases without local recurrence after surgery within the authors’ department. The patient was given adjuvant therapy (vincristine + nedaplatin + dacarbazine) for 5 cycles, but he died 8 months after surgery.

Conclusion:

Malignant conjunctival melanoma may metastasize to the contralateral orbit. A histopathologic evaluation should be mandatory in patients with medical histories of malignancy to differentiate new primary tumors, metastases, and benign tumors.
Immediate Implant Placement Into Fresh Extraction Sites Using Single-Drilling Bur and Two Loading Procedures: Follow-Up Results
Authors: Bettach Raphaél , Taschieri Silvio , Mortellaro Carmen , Del Fabbro Massimo
Published: June 2018

Modern clinical protocols in implantology aim at shortening the treatment time and reducing duration and discomfort of the surgical phase, while maintaining optimal treatment outcomes. The purpose of this study was to evaluate clinical outcomes of implants immediately placed in extraction sites, using a single drilling step for implant site preparation. One-hundred thirty-three patients (mean age 55.3 ± 12.7 [SD] years, range 20–83 years) were treated at 2 clinical centers. Two-hundred sixty-one implants were inserted in fresh postextraction sockets. One-hundred sixty-five implants were immediately loaded (IL) and 96 underwent delayed loading (DL). Implant survival, peri-implant bone level change and patients’ satisfaction were assessed after at least 3 years of function. No patient dropout occurred. The mean follow-up was 63.61 ± 11.52 months (range 39.71–85.71 months) from prosthesis delivery. Two IL and 1 DL implant failed in 3 patients. Implant survival was 98.8% and 99% for IL and DL group, respectively. The mean marginal bone loss after 1 year was 0.48 ± 0.40 mm and 0.52 ± 0.34 mm for IL and DL group. No biological nor mechanical complications occurred. All patients demonstrated full satisfaction. The present protocol with single burs for site preparation produced satisfactory clinical outcomes independent of the loading timing. Further long-term comparative studies are needed to confirm the present findings.
Management of Intracranial Condylar Fracture With Intracranial Migration
Authors: Kurimori Kleber Tetsuo , Bastos Endrigo Oliveira , Oliveira Walter Amorim de , Alonso Nivaldo
Published: June 2018

Despite condylar fractures representing one of the most common sites of mandibular fractures, intracranial condylar dislocation is a rare event. In this article, the authors report 2 patients. The first patient is a young female with signs and symptoms as commonly reported in the literature. The second patient reports the consequences of a delayed diagnosis of intracranial condylar fracture dislocation. Both patients underwent surgical treatment. These patients are discussed with a review of the literature, noting biomechanics and mechanism of injury, diagnostic methods, and the treatment for these fractures. Diagnosis also may be challenging at times, though it should always be suspected in patients with bite alterations associated with high energy trauma and the stigmata of direct chin trauma. There is no pathognomonic clinical examination and it is fundamental to use computed tomographic methods for confirmation. Treatment is often open reduction and internal fixation, though it should be tailored for each patient presentation.
Stress Urinary Incontinence Surgery in Washington State Before and After Introduction of the Mesh Midurethral Sling
Authors: Stewart Lauren E. , Eston Michelle A. , Symons Rebecca G. , Fialkow Michael F. , Kirby Anna C.
Published: June 2018

Objectives

Mesh midurethral slings (MUSs) are safe, effective treatments for female stress urinary incontinence (SUI), but many companies have ceased production because of controversies surrounding transvaginal mesh. To determine if introduction of MUS has increased the complication rate associated with SUI surgery, we compared women undergoing SUI surgery in the MUS era to those who had surgery prior its introduction.

Methods

This was a retrospective cohort study of a statewide hospital discharge database. Stress urinary incontinence surgeries from 1987 to 1996 and 2007 to 2013 were identified using International Classification of Diseases, Ninth Revision codes.

Results

A total of 30,723 SUI surgeries were performed during the study periods. After 2006, slings accounted for 91.8% of SUI surgeries. Patients were older (54.5 vs 53.0 years, P < 0.001) and sicker (22.6% vs 9.7% had ≥1 comorbid condition, P < 0.0001). Blood transfusion was more common in the MUS era (1.2% vs 0.4%, P < 0.001) however, other complications were either similar between groups or less common in the MUS era including 30-day readmission (2.5% vs 2.4%, P = 0.543), reoperation for urinary retention (0.1% vs 0.2%, P < 0.0375), and wound infection (0.1% vs 0.5%, P < 0.001), despite more concomitant prolapse surgeries (69.0 vs 26.9%, P < 0.001) and hysterectomies (53.0 vs 35.4%, P < 0.001) in the MUS era. Hospital stays were shorter after 2006 (1.0 vs 3.0 days, P < 0.001), and fewer women required reoperation for SUI within 2 years (0.5% vs 1.8%, P < 0.001).

Conclusions

Following introduction of MUS, women who underwent SUI surgery were slightly older with more medical comorbidities yet did not appear to experience increased surgical complications. Fewer women underwent reoperation for recurrent SUI, and hospital stays were shorter, suggesting an improvement in care. This study supports the continued availability and use of MUSs.
The ADRP domain from a virulent strain of infectious bronchitis virus is not sufficient to confer a pathogenic phenotype to the attenuated Beaudette strain
Authors: Keep Sarah , Bickerton Erica , Armesto Maria , Britton Paul
Published: June 2018

The replicase gene of the coronavirus infectious bronchitis virus (IBV) encodes 15 non-structural proteins (nsps). Nsp 3 is a multi-functional protein containing a conserved ADP-ribose-1″-phosphatase (ADRP) domain. The crystal structures of the domain from two strains of IBV, M41 (virulent) and Beaudette (avirulent), identified a key difference; M41 contains a conserved triple-glycine motif, whilst Beaudette contains a glycine-to-serine mutation that is predicted to abolish ADRP activity. Although ADRP activity has not been formally demonstrated for IBV nsp 3, Beaudette fails to bind ADP-ribose. The role of ADRP in virulence was investigated by generating rIBVs, based on Beaudette, containing either a restored triple-glycine motif or the complete M41 ADRP domain. Replication in vitro was unaffected by the ADRP modifications and the in vivo phenotype of the rIBVs was found to be apathogenic, indicating that restoration of the triple-glycine motif is not sufficient to restore virulence to the apathogenic Beaudette strain.
Co-circulating mumps lineages at multiple geographic scales
Authors: Wohl Shirlee , Metsky Hayden C. , Schaffner Stephen F. , Piantadosi Anne , Burns Meagan , Lewnard Joseph A. , Chak Bridget , Krasilnikova Lydia A. , Siddle Katherine J. , Matranga Christian B. , Bankamp Bettina , Hennigan Scott , Sabina Brandon , Byrne Elizabeth H. , McNall Rebecca J. , Park Daniel J. , Gharib Soheyla , Fitzgerald Susan , Barriera Paul , Fleming Stephen , Lett Susan , Rota Paul A. , Madoff Lawrence C. , MacInnis Bronwyn L. , Yozwiak Nathan L. , Smole Sandra , Grad Yonatan H. , Sabeti Pardis C.
Published: June 2018

Despite widespread vaccination, eleven thousand mumps cases were reported in the United States (US) in 2016–17, including hundreds in Massachusetts, primarily in college settings. We generated 203 whole genome mumps virus (MuV) sequences from Massachusetts and 15 other states to understand the dynamics of mumps spread locally and nationally, as well as to search for variants potentially related to vaccination. We observed multiple MuV lineages circulating within Massachusetts during 2016–17, evidence for multiple introductions of the virus to the state, and extensive geographic movement of MuV within the US on short time scales. We found no evidence that variants arising during this outbreak contributed to vaccine escape. Combining epidemiological and genomic data, we observed multiple co-circulating clades within individual universities as well as spillover into the local community. Detailed data from one well-sampled university allowed us to estimate an effective reproductive number within that university significantly greater than one. We also used publicly available small hydrophobic (SH) gene sequences to estimate migration between world regions and to place this outbreak in a global context, but demonstrate that these short sequences, historically used for MuV genotyping, are inadequate for tracing detailed transmission. Our findings suggest continuous, often undetected, circulation of mumps both locally and nationally, and highlight the value of combining genomic and epidemiological data to track viral disease transmission at high resolution.
A hippocampal model for behavioral time acquisition and fast bidirectional replay of spatio-temporal memory sequences
Authors: Gauy Marcelo Matheus , Lengler Johannes , Einarsson Hafsteinn , Meier Florian , Weissenberger Felix , Yanik Mehmet Fatih , Steger Angelika
Published: June 2018

The hippocampus is known to play a crucial role in the formation of long-term memory. For this, fast replays of previously experienced activities during sleep or after reward experiences are believed to be crucial. But how such replays are generated is still completely unclear. In this paper we propose a possible mechanism for this: we present a model that can store experienced trajectories on a behavioral timescale after a single run, and can subsequently bidirectionally replay such trajectories, thereby omitting any specifics of the previous behavior like speed, etc, but allowing repetitions of events, even with different subsequent events. Our solution builds on well-known concepts, one-shot learning and synfire chains, enhancing them by additional mechanisms using global inhibition and disinhibition. For replays our approach relies on dendritic spikes and cholinergic modulation, as supported by experimental data. We also hypothesize a functional role of disinhibition as a pacemaker during behavioral time.
Modulation of voltage-dependent K+conductances in photoreceptors trades off investment in contrast gain for bandwidth
Authors: Heras Francisco JH , Vähäsöyrinki Mikko , Niven Jeremy E
Published: June 2018

Modulation is essential for adjusting neurons to prevailing conditions and differing demands. Yet understanding how modulators adjust neuronal properties to alter information processing remains unclear, as is the impact of neuromodulation on energy consumption. Here we combine two computational models, one Hodgkin-Huxley type and the other analytic, to investigate the effects of neuromodulation uponDrosophila melanogasterphotoreceptors. Voltage-dependent K+conductances: (i) activate upon depolarisation to reduce membrane resistance and adjust bandwidth to functional requirements; (ii) produce negative feedback to increase bandwidth in an energy efficient way; (iii) produce shunt-peaking thereby increasing the membrane gain bandwidth product; and (iv) inactivate to amplify low frequencies. Through their effects on the voltage-dependent K+conductances, three modulators, serotonin, calmodulin and PIP2, trade-off contrast gain against membrane bandwidth. Serotonin shifts the photoreceptor performance towards higher contrast gains and lower membrane bandwidths, whereas PIP2 and calmodulin shift performance towards lower contrast gains and higher membrane bandwidths. These neuromodulators have little effect upon the overall energy consumed by photoreceptors, instead they redistribute the energy invested in gain versus bandwidth. This demonstrates how modulators can shift neuronal information processing within the limitations of biophysics and energy consumption.
Dynamic Properties of Simulated Brain Network Models and Empirical Resting State Data
Authors: Kashyap Amrit , Keilholz Shella
Published: June 2018

Brain Network Models have become a promising theoretical framework in simulating signals that are representative of whole brain activity such as resting state fMRI. However, it has been difficult to compare the complex brain activity between simulated and empirical data. Previous studies have used simple metrics that surmise coordination between regions such as functional connectivity, and we extend on this by using various different dynamical analysis tools that are currently used to understand resting state fMRI. We show that certain properties correspond to the structural connectivity input that is shared between the models, and certain dynamic properties relate more to the mathematical description of the Brain Network Model. We conclude that the dynamic properties that gauge more temporal structure rather than spatial coordination in the rs-fMRI signal seem to provide the largest contrasts between different BNMs and the unknown empirical dynamical system. Our results will be useful in constraining and developing more realistic simulations of whole brain activity.
Opioids for breathlessness: Psychological and neural factors influencing response variability
Authors: Abdallah Sara J. , Faull Olivia K. , Wanigasekera Vishvarani , Finnegan Sarah L. , Jensen Dennis , Pattinson Kyle
Published: June 2018

Effective management of distressing bodily symptoms (such as pain and breathlessness) is an important clinical goal. However, extensive variability exists in both symptom perception and treatment response. One theory for understanding variability in bodily perception is the ‘Bayesian Brian Hypothesis’, whereby symptoms may result from the combination of sensory inputs and prior expectations. In light of this theory, we explored the relationships between opioid responsiveness, behavioural/physiological symptom modulators and brain activity during anticipation of breathlessness.

Methods

We utilised two existing opioid datasets to investigate the relationship between opioid efficacy and physiological/behavioural qualities, employing hierarchical cluster analyses in: 1) a clinical study in chronic obstructive pulmonary disease, and 2) a functional magnetic resonance brain imaging study of breathlessness in healthy volunteers. We also investigated how opioid efficacy relates to anticipatory brain activity using linear regression in the healthy volunteers.

Results

Consistent across both datasets, diminished opioid efficacy was more closely associated with negative affect than with other physiological and behavioural properties. Furthermore, in healthy individuals, brain activity in the anterior cingulate and ventromedial prefrontal cortices during anticipation of breathlessness were inversely correlated with opioid effectiveness.

Conclusion

Diminished opioid efficacy for relief of breathlessness may be associated with high negative affective qualities, and was correlated with the magnitude of brain activity during anticipation of breathlessness.

Clinical implications

Negative affect and symptom expectations may influence perceptual systems to become less responsive to opioid therapy.
Divergent selection and drift shape the genomes of two avian sister species spanning a saline-freshwater ecotone
Authors: Walsh Jennifer , Clucas Gemma V. , MacManes Matthew D. , Kelley Thomas W. , Kovach Adrienne I.
Published: June 2018

The role of species divergence due to ecologically-based divergent selection – or ecological speciation – in generating and maintaining biodiversity is a central question in evolutionary biology. Comparison of the genomes of phylogenetically related taxa spanning a selective habitat gradient enables discovery of divergent signatures of selection and thereby provides valuable insight into the role of divergent ecological selection in speciation. Tidal marsh ecosystems provide tractable opportunities for studying organisms’ adaptations to selective pressures that underlie ecological divergence. Sharp environmental gradients across the saline-freshwater ecotone within tidal marshes present extreme adaptive challenges to terrestrial vertebrates. Here we sequence 20 whole genomes of two avian sister species endemic to tidal marshes – the Saltmarsh Sparrow (Ammodramus caudacutus) and Nelson’s Sparrow (A. nelsoni) – to evaluate the influence of selective and demographic processes in shaping genome-wide patterns of divergence. Genome-wide divergence between these two recently diverged sister species was notably high (genome-wide FST = 0.32). Against a background of high genome-wide divergence, regions of elevated divergence were widespread throughout the genome, as opposed to focused within islands of differentiation. These patterns may be the result of genetic drift acting during past tidal march colonization events in addition to divergent selection to different environments. We identified several candidate genes that exhibited elevated divergence between Saltmarsh and Nelson’s sparrows, including genes linked to osmotic regulation, circadian rhythm, and plumage melanism – all putative candidates linked to adaptation to tidal marsh environments. These findings provide new insights into the roles of divergent selection and genetic drift in generating and maintaining biodiversity.
Multiplexed imaging of single-synapse activity and astroglial responses in the intact brain
Authors: Reynolds James P. , Zheng Kaiyu , Rusakov Dmitri A.
Published: June 2018

All-optical registration of neuronal and astrocytic activities within the intact mammalian brain has improved significantly with recent advances in optical sensors and biophotonics. However, relating single-synapse release events and local astroglial responses to sensory stimuli in an intact animal has not hitherto been feasible. Here, we present a multiplexed multiphoton excitation imaging approach for assessing the relationship between presynaptic Ca2+ entry at thalamocortical axonal boutons and perisynaptic astrocytic Ca
2+
elevations, induced by whisker stimulation in the barrel cortex of C57BL/6 mice. We find that, unexpectedly, Ca
2+
elevations in the perisynaptic astrocytic regions consistently precede local presynaptic Ca
2+
signals during spontaneous brain activity associated with anaesthesia. The methods described here can be adapted to a variety of optical sensors and are compatible with experimental designs that might necessitate repeated sampling of single synapses over a longitudinal behavioural paradigm.