bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of the heat treatment on the microstructure and mechanical properties of medium-Mn-steels
Authors: Schneider Reinhold , Steineder Katharina , Krizan Daniel , Sommitsch Christof
Published: December 2018

The heat-treatment (HT) schedule and selected annealing parameters have a substantial effect on the microstructure and mechanical properties of medium-Mn-steels. The structure morphology depends on the fact, whether the austenite-reverted transformation takes place from deformed (one-step HT) or non-deformed (two-step HT) microstructures. Depending on the intercritical annealing temperature, the stability of the retained austenite can be altered to a large extent. As a result, the mechanical properties can be adjusted from high strength with excellent ductility to very high strength with reasonable ductility. The present contribution, therefore, elucidates the dependence of the microstructural characteristics and material behaviour on the HT parameters for medium-Mn alloy compositions with different Mn-contents.

This paper is part of a Thematic Issue on Medium Manganese Steels.
Icon and taboo: single-payer politics in Canada and the US
Authors: Tuohy Carolyn Hughes
Published: December 2018

In 1965 and 1966, the United States and Canada adopted single-payer models of government insurance for physician and hospital services – universal in Canada, but restricted to certain population groups in the US. At the time, the American and Canadian political economies of health care and landscapes of public opinion were remarkably similar, and the different policy designs must be understood as products of the distinctive macro-level politics of the day. Subsequently, however, the different scopes of single-payer coverage would drive the two systems in different directions. In Canada, the single-payer system became entrenched in popular support and in the nexus of interest it created between the medical profession and the state. In the US, Medicare became similarly entrenched in popular support, but did so as part of the larger multi-payer private insurance system. In the process universal single-payer coverage became politically iconic in Canada and taboo in the US.
Self-reported Instances of Major Discrimination, Race/Ethnicity, and Inflammation Among Older Adults: Evidence From the Health and Retirement Study
Authors: Cobb Ryon J , Parker Lauren J , Thorpe Roland J
Published: December 2018

Background

This study examines the relationship between self-reported instances of major discrimination and inflammation among older adults, and explores whether this relationship varies in accordance with race/ethnicity. We hypothesized that self-reported instances of major discrimination would be associated with higher levels of high-risk inflammation and that this relationship would be stronger for racial/ethnic minorities than whites.

Methods

Data from the 2006/2008 Health and Retirement Study, an ongoing biennial nationally representative sample of older adults in the United States, were used to collect measures of self-reported instances of major discrimination and high-risk C-reactive protein (CRP), which was assayed from blood samples. Modified Poisson regression with robust standard errors was applied to estimate the prevalence ratios of self-reported instances of major discrimination, as it relates to high-risk CRP (CRP ≥ 22 kg/m2), and test whether this relationship varies by race/ethnicity.

Results

Respondents who experienced any instances of major discrimination had a higher likelihood of high-risk CRP (prevalence ratio [PR]: 1.14, 95% confidence interval [CI] = 1.07–1.22) than those who did not report experiencing any instances of major discrimination. This association was independent of differences in newly diagnosed health conditions and socioeconomic status. The relationship between any self-reported instance of major discrimination and high-risk CRP was weaker for blacks than whites (PR: 0.81, 95% CI = 0.69–0.95).

Conclusions

Our study confirms that self-reported instances of major lifetime discrimination is a psychosocial factor that is adversely associated with high-risk CRP among older adults; this association is especially pronounced among older whites. Future studies among this population are required to examine whether the relationship between self-reported instances of major discrimination and high-risk CRP changes over time.
Neuromuscular Mechanosensitivity in Subjects with Chronic Ankle Sprain: A Cross-Sectional Study
Authors: Lorenzo-Sánchez-Aguilera Cristina , Rodríguez-Sanz David , Gallego-Izquierdo Tomás , Lázaro-Navas Irene , Plaza-Rodríguez Josue , Navarro-Santana Marcos , Pecos-Martín Daniel
Published: December 2018

Background

Ankle sprain is one of the most common musculoskeletal injuries in sports, at work, and at home. Subjects who suffer from this injury may develop ankle instability. Functional instability has been associated with a high rate of resprain and impaired neuromuscular control in patients with ankle instability.

Objective

Measurement of neural and muscular mechanosensitivity after ankle sprain injury and establishment of the relationship between these variables.

Methods

A cross-sectional case-control study was performed with a sample of 58 students from Alcalá de Henares University (21 males and 37 females, mean age ± SD = 21 ± 3.7 years). Subjects were divided into two groups: a case group (N = 29, subjects with unstable ankle) and a control group (N = 29, healthy subjects). The pressure pain threshold (PPT) of the tibialis anterior, peroneus longus, and peroneus brevis muscles and mechanosensitivity of the common peroneus and tibial nerves were evaluated in all subjects through a manual mechanical algometer.

Results

Neuromuscular PPTs showed significant differences (P < 0.05) between both groups, such that, compared with the control group, the case group exhibited significantly lower PPT levels. In the case group, a strong positive correlation was observed between neural and muscular homolateral mechanosensitivity in both lower limbs.

Conclusions

Participants with chronic ankle instability showed higher neuromuscular mechanosensitivity in muscles and nerves surrounding the ankle joint than healthy subjects. These findings indicate that low PPT values may be associated with symptoms that characterize this disease.
Using Simulation to Improve Care of the Critically Ill Mental Health Patient at the End of Life
Authors: Mariolis Tara , McKew Carol
Published: December 2018

This article summarizes a pilot simulation using standardized patients that was designed to develop skills necessary to care for the critically ill mental health patient nearing the end of life. Although the simulation was found to be a valuable teaching strategy, additional research, with a rigorous design, is recommended to further develop this teaching method. The authors suggest adopting a theoretical framework for debriefing that would elicit emotions, address the emotional needs of students, and assist them to develop coping strategies and skills necessary to care for patients at the end of life.
SmartTots Outcomes Workshop 2017: Notes From a Round Table Discussion About Outcome Measures
Authors: Jackson William M. , McCullough Aston K. , Rauh Virginia , Salorio Cynthia
Published: December 2018

An important element of designing research studies is the selection of appropriate outcome measures to ensure that the question posed is properly answered given the evidence. The selection of outcome measures is especially important when tackling complex, interdisciplinary problems, where appropriate outcome measures may not be as simple as a blood test or a laboratory value. One such area of study is the research into neurodevelopmental outcomes after early exposure to anesthetic agents. Concern has arisen recently that certain anesthetic agents may be toxic to the developing brain; a public-private partnership, SmartTots, was formed in conjunction with the Food and Drug Administration and various stakeholders to develop safe anesthetic regimens for neonates and infants who require surgery. However, as research has progressed, questions have arisen regarding the best outcome measures to use in order to detect a true effect, as well as the optimal window in which to measure. These issues were discussed in a round table meeting during the SmartTots meeting in September 2017, and a summary of the discussion is presented here.
Detecting Early Markers of Ventilator-Associated Pneumonia by Analysis of Exhaled Gas
Authors: Kunze-Szikszay Nils , Walliser Karoline , Luther Jakob , Cambiaghi Barbara , Reupke Verena , Dullin Christian , Vautz Wolfgang , Bremmer Felix , Telgheder Ursula , Zscheppank Cornelia , Quintel Michael , Perl Thorsten
Published: December 2018

Objectives:

The detection of microbial volatile organic compounds or host response markers in the exhaled gas could give an earlier diagnosis of ventilator-associated pneumonia. Gas chromatography-ion mobility spectrometry enables noninvasive, rapid, and sensitive analysis of exhaled gas. Using a rabbit model of ventilator-associated pneumonia we determined if gas chromatography-ion mobility spectrometry is able to detect 1) ventilator-associated pneumonia specific changes and 2) bacterial species-specific changes in the exhaled gas.

Design:

Experimental in vivo study.

Setting:

University research laboratory.

Subjects:

Female New Zealand White rabbits.

Interventions:

Animals were anesthetized and mechanically ventilated. To induce changes in the composition of exhaled gas we induced ventilator-associated pneumonia via endobronchial instillation of either Escherichia coli group (n = 11) or Pseudomonas aeruginosa group (n = 11) after 2 hours of mechanical ventilation. In a control group (n = 11) we instilled sterile lysogeny broth endobronchially.

Measurements and Main Results:

Gas chromatography-ion mobility spectrometry gas analysis, CT scans of the lungs, and blood samples were obtained at four measurement points during the 10 hours of mechanical ventilation. The volatile organic compound patterns in the exhaled gas were compared and correlated with ventilator-associated pneumonia severity. Sixty-seven peak areas showed changes in signal intensity in the serial gas analyses. The signal intensity changes in 10 peak regions differed between the groups. Five peak areas (P_648_36, indole, P_714_278, P_700_549, and P_727_557) showed statistically significant changes of signal intensity.

Conclusions:

This is the first in vivo study that shows the potential of gas chromatography-ion mobility spectrometry for early detection of ventilator-associated pneumonia specific volatile organic compounds and species differentiation by noninvasive analyses of exhaled gas.
Semilunar Flap for Minimizing the Scar Length in Nipple Reconstruction
Authors: Lee Jang Won , Hwang Euna
Published: December 2018

Nipple reconstruction is an essential procedure to change an amorphous breast mound to a distinct breast. Various skin flaps have been proposed for nipple reconstruction. In the C-V flap technique, which is one of the most commonly used flaps for nipple reconstruction, the scar that is developed after closure of the donor site of the V-flap frequently extends beyond a new areola area. To reduce the length of the donor site scar, various modifications of the C-V flap have been proposed. We adopted the semilunar flap instead of the V flap of C-V flap by changing the angle of V flap for nipple reconstruction. The semilunar flap design allowed generation of a donor flap with sufficient width and length of the skin flap for a nipple barrel without increasing the length of the donor site scar. In most cases, the semilunar flaps showed stable outcomes and resulted in angled donor-site scars that were usually located within the boundary of a new areola. We think the semilunar flap represents a good alternative method in nipple reconstruction by changing the angle of the donor-site scar and leaving the scar length within the new areolar area.
Lower Extremity Muscle Strength and Force Variability in Persons With Parkinson Disease
Authors: Skinner Jared W. , Christou Evangelos A. , Hass Chris J.
Published: December 2018

Background and Purpose:

Adequate lower limb strength and motor control are essential for mobility and quality of life. People with Parkinson disease (PD) experience a significant and progressive decline in motor capabilities as part of this neurodegenerative disease. The primary objective of this study was to examine the effect of PD on (1) muscular strength and (2) force steadiness in muscles that are primarily responsible for locomotion and stability.

Methods:

Thirteen persons with PD and 13 healthy age-matched controls participated. Participants performed maximal and submaximal (5%, 10%, and 20% maximum voluntary contractions) isometric force tasks with the limb stabilized in a customized device. Strength of the hip extensors and flexors, hip abductors and adductors, and ankle plantar flexors and dorsiflexors was quantified based on data obtained from force transducers, with the relevant joint stabilized in standardized positions.

Results:

Individuals with PD were weaker and exhibited higher amounts of force variability than controls across the lower extremity. Reduced strength was greatest in the hip flexors (2.0 N/kg vs 2.6 N/kg) and ankle plantar flexors (1.74 N/kg vs 2.64 N/kg) and dorsiflexors (1.9 N/kg vs 2.3 N/kg). Force steadiness was impaired in the hip flexors, ankle plantar flexors, and dorsiflexors.

Discussion and Conclusions:

Reduced maximal force production was concomitant with impaired force control within the muscles that are critical for effective ambulation (hip flexion, ankle dorsiflexion, and ankle plantar flexion). These features should be evaluated when considering contributors to reduced mobility and quality of life.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A241).
Procalcitonin and Other Common Biomarkers Do Not Reliably Identify Patients at Risk for Bacterial Infection After Congenital Heart Surgery
Authors: D’Souza Shane , Guhadasan Rathi , Jennings Rebecca , Siner Sarah , Paulus Stéphane , Thorburn Kent , Chesters Christine , Downey Colin , Baines Paul , Lane Steven , Carrol Enitan
Published: December 2018

Objectives:

Following surgery, it is difficult to distinguish a postoperative inflammatory reaction from infection. This study examined the predictive value of the biomarkers; procalcitonin, C-reactive protein, lactate, neutrophils, lymphocytes, platelets, and the biphasic activated partial thromboplastin time waveform in diagnosing bacterial infection following cardiac surgery.

Design:

Prospective, observational study.

Setting:

A regional, PICU in the United Kingdom.

Patients:

Three-hundred sixty-eight children under the age of 16 admitted to the PICU for elective cardiac surgery were enrolled in the study.

Interventions:

All biomarker measurements were determined daily until postoperative day 7. Children were assessed for postoperative infection until day 28 and divided into four groups: bacterial infection, culture-negative sepsis, viral infection, and no infection. We used the Kruskal-Wallis test, chi-square test, analysis of variance, and area under the curve in our analysis.

Measurements and Main Results:

In total, 71 of 368 children (19%) developed bacterial infection postoperatively, the majority being surgical site infections. In those with bacterial infection, procalcitonin was elevated on postoperative days 1–3 and the last measurement prior to event compared with those without bacterial infection. The most significant difference was the last measurement prior to event; 0.72 ng/mL in the bacterial infection group versus 0.13 ng/mL in the no infection group (for all groups; p < 0.001). Longitudinal profiles of all biomarkers were indistinct in the bacterial infection and nonbacterial infection groups except in those with culture-negative infections who had distinct procalcitonin kinetics on postoperative days 1–4. Children with culture-negative sepsis required longer ventilatory support and PICU stay and were more likely to develop complications than the other groups.

Conclusions:

None of the biomarkers studied within 3 days of infection distinguished between infection and postoperative inflammatory reaction. However, procalcitonin kinetics peaked on postoperative day 2 and fell more sharply than C-reactive protein kinetics, which peaked at postoperative day 3. The monitoring of procalcitonin kinetics following cardiac surgery may help guide rational antimicrobial use.
Nonsurgical Rhinoplasty: Nasal Grid Analysis and Nasal Injecting Protocol
Authors: Bertossi Dario , Lanaro Luca , Dorelan Simone , Johanssen Kristen , Nocini Pierfrancesco
Published: December 2018

Background:

Nonsurgical rhinoplasty using injectable fillers improved skin quality and texture, cost-effectiveness, and quick recovery. The aim of this study was to provide a valid and customized protocol for injecting the nose with the aid of a nasal grid.

Methods:

From January of 2015 to October of 2018, 150 consecutive patients entered the trial. The mean patient age was 36 years (range, 16 to 60 years). The patients were divided into two arms: primary nasal defects (no previous surgery, n = 109) and secondary nasal defects (previous surgery, n = 41). The primary defect group included 43 male patients and 66 female patients, and the secondary nasal defect group included 14 male patients and 27 female patients. Within each arm, patients were stratified into three age group tiers: younger than 30 years, 30 to 45 years, and older than 45 years.

Results:

The grid became the reference for quantity and sequence of injection records. The overall complication rate was 1.82 percent, and a visual analogue scale ranging from 1 to 10 was implemented (with 10 being the most accurate correction). Of the patients evaluated, 98.350 percent scored 8 to 10, 0.825 percent scored 6 to 8, and 0.825 percent scored below 6.

Conclusions:

Fillers can be either alternatives or complementary to plastic surgery. Nonsurgical rhinoplasty, with its avoidance of general anesthesia, splints, swelling, and bruising, represents a distinct advantage, allowing the patient to return to work as quickly as the same or the next day.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Wider Suturectomy Before Posterior Distraction for Craniosynostosis
Authors: Kyutoku Shigeo , Iwanaga Masahiro , Okamoto Toyoko , Harada Atsuko , Ueda Koichi
Published: December 2018

The aim of the surgery for craniosynostosis is to release increased intracranial pressure and to normalize cranial shape. The procedure has developed so far in Japan, from a simple strip craniectomy before 1960s through a total calvarial remodeling after 1970s and later methods of 1990s, such as distraction and its modifications applying to the posterior cranium. Since a distracter needs certain hardness and thickness of the bone, the surgery has to be stood by until 5 to 6 months of age. Modified Jimenez procedure, as a latest option, were applied for very early years of 10 patients with several types of craniosynostosis, in our team in the past 3 years. The experience was small with short follow-up; the results are all good in those volume change and shape. The procedure proved to be another alternative especially prior to posterior distraction of syndromic patients in terms of positive and expedited control in an earlier surgical management.
Cone Beam Computed Tomographic Evaluation of Intracranial Physiologic Calcifications
Authors: Bayrak Seval , Göller Bulut Duygu , Kurşun Çakmak Emine Şebnem , Orhan Kaan
Published: December 2018

Objective:

The aim of the present study was to evaluate the incidence of physiologic intracranial calcifications detected in cone beam computed tomography (CBCT) images of a Turkish subpopulation.

Methods:

The CBCT image of the full head of 573 patients taken between 2015 and 2018 was evaluated retrospectively. The prevalence of habenular calcification, petroclinoid ligament, coroid plexus, interclinoid ligament (ICL), and carotico-clinoid ligament (CCL) calcifications was investigated. The age and gender of the patients were recorded.

Results:

Intracranial calcification was found in 190 (33.1%) of 573 cases. The frequency of physiological calcifications is respectively; 19.2% were found as habenular, 4.88% as ICL, 3.83% as CCL, 2.7% as petroclinoid ligament, and 2.4% as choroid plexus. 38.2% of the women and 29.3% of the men had intracranial calcification. In 4 patients, both ICL and CCL ossification were detected. No statistically significant relationship was found between age, gender, and calcifications.

Conclusion:

Cone beam computed tomography is a widely used imaging technique for dental diagnosis and treatment. Intracranial physiological calcifications may be a common incidental finding of CBCT scans.
Supplemental Internal Wire Suspension in Orthognathic Surgery Fixation
Authors: Harikrishnan Pandurangan , Madivanan Ilangovan
Published: December 2018

Internal wire suspensions were previously used in the management of maxillary trauma and orthognathic surgery, but currently the gold standard is rigid internal fixation with bone plates and screws. The authors report a case of bimaxillary osteotomy in a skeletal class III patient where a supplemental circum-zygomatic-mandibular suspension was done to stabilize the maxilla because of the instability after rigid internal fixation due to poor bone thickness.
The Fate of the Mandibular Reconstruction Plate
Authors: Abdulrazaq Saif Saadedeen , Riyadh Safaa
Published: December 2018

To preserve the continuity of the mandible after resection or traumatic bone loss, the defect is usually reconstructed with a bone graft fixed by a reconstruction plate. The fate of these plates is the objective of this study. Twenty-three patients (4 females and 19 males) required a reconstructive procedure to restore the discontinuity defect in the mandible by a mandibular reconstruction plate. Postoperative follow-up was performed to assess the outcomes of these plates. The mean age of the patients was 28.22 years. The most common cause of the discontinuity defect was bullet injury. The mean follow-up period was 3.65 years. The most common postoperative complication was the surgical site infection. The reconstruction plate of the mandible is associated with long-term success and body acceptance in the hands of an experienced surgeon.
Immunoglobulin G4-Related Periorbital Soft-Tissue Destruction
Authors: Ana-Magadia Marian Grace , Takahashi Yasuhiro , Valencia Ma Regina Paula , Ishikawa Eri , Nishimura Kunihiro , Kakizaki Hirohiko
Published: December 2018

A study on immunoglobulin G4-related ophthalmic disease (IgG4-ROD) with destructive changes in periorbital soft tissues was presented. The patient was an 89-year-old-man who developed a left-sided orbital lesion involving the globe, lacrimal gland, and extraocular muscles. A diagnosis of definite IgG4-ROD was made based on clinical and histopathologic findings. The patient was started on oral prednisolone, which afforded good response initially. However, when tapering was initiated, full-thickness destruction developed on the lateral half of the lower eyelid margin. Steroid dose was increased, and the patient underwent a series of surgeries (suspension of the lower eyelid and lateral tarsorrhaphy, subtotal exenteration, and debridement and endonasal sinus surgery) in an attempt to manage the progression and recurrence of the condition. Medical management consisting of antibiotics and anti-fungal was administered to control the disease process. With close follow-up, repeated ancillary testing, and continuous management, the periocular and systemic findings were stable for 3 months after the last surgery.
Assessment of Therapeutic Effect of Intra-Articular Nanofat Injection for Temporomandibular Disorders
Authors: Mahmmood Venus H. , Shihab Saif Mohamed
Published: December 2018

Introduction:

Temporomandibular disorders (TMD) refer to a group of heterogeneous, pain and dysfunction conditions involving the masticatory system, which influences life quality of the sufferers. Nanofat graft injection in temporomandibular joint (TMJ) is a simple and less invasive surgical procedure for treatment of TMJ problems.

The aim of this study was to evaluate influence and effectiveness of nanofat injection in TMJ for treatment of TMD.

Patients and Methods:

This study was performed in Al-Shaheed Ghazi Al-Hariri Hospital, Department of Oral and Maxillofacial Surgery, Baghdad Medical City from October 2016 and December 2017.

A total of 11 patients (3 males) and (8 females) with range of age 18 to 34 years old.

Every patient was assessed for the following parameters preoperatively: Pain level, maximum mouth opening (MMO), joint clicking, and deviation.

Results:

The present study revealed marked female predilection with female ratio about 72.7% (8 patients) and male ratio 27.3% (3 patients), range between 18 and 34 years old. Three patients were presented with single joint (15.8%) and 16 patients were presented with both joints (84.2%).

In general, all patients tolerated treatment procedures without any serious complications during the procedure or after the procedure.

The results of parameters were pain, clicking, and deviation (P < 0.001 HS) and MMO (P < 0.032–0.041 S).

Conclusion:

Nanofat injection in TMJ showed therapeutic benefits, simplicity, safety, lack of significant side effects, and complication.
Alveolar Ridge Expansion: Comparison of Osseodensification and Conventional Osteotome Techniques
Authors: Tian Jimmy H. , Neiva Rodrigo , Coelho Paulo G. , Witek Lukasz , Tovar Nick M. , Lo Ivan C. , Gil Luiz F. , Torroni Andrea
Published: December 2018

Objective:

The aim of this in vivo study is to compare the osseointegration of endosteal implants placed in atrophic mandibular alveolar ridges with alveolar ridge expansion surgical protocol via an experimental osseodensification drilling versus conventional osteotome technique.

Methods:

Twelve endosteal implants, 4 mm × 13 mm, were placed in porcine models in horizontally atrophic mandibular ridges subsequent to prior extraction of premolars. Implants were placed with osseodensification drilling technique as the experimental group (n = 6) and osteotome site preparation as the control group (n = 6). After 4 weeks of healing, samples were retrieved and stained with Stevenel's Blue and Van Gieson's Picro Fuschin for histologic evaluation. Quantitative analysis via bone-to-implant contact (BIC%) and bone area fraction occupancy (BAFO%) were obtained as mean values with corresponding 95% confidence interval. A significant omnibus test, post-hoc comparison of the 2 drilling techniques’ mean values was accomplished using a pooled estimate of the standard error with P-value set at 0.05.

Results:

The mean BIC% value was approximately 62.5% in the osseodensification group, and 31.4% in the regular instrumentation group. Statistical analysis showed a significant effect of the drilling technique (P = 0.018). There was no statistical difference in BAFO as a function of drilling technique (P = 0.198).

Conclusion:

The combined osseodensification drilling-alveolar ridge expansion technique showed increased evidence of osseointegration and implant primary stability from a histologic and biomechanical standpoint, respectively. Future studies will focus on expanding the sample size as well as the timeline of the study to allow investigation of long-term prognosis of this novel technique.
New Technique for Closure of Alveolar Cleft With Umbilical Cord Stem Cells
Authors: Garcia Botero Alejandra , Prada Madrid Rolando , Ávila-Portillo Luz Mabel , Rojas Holguin Nancy , Gómez-Ortega Viviana , Menze Erica
Published: December 2018

This article presents the case of a newly born female patient with a cleft of the primary palate (alveolar cleft), with an in utero diagnosis of the described cleft, from whom umbilical cord stem cells are obtained and cryopreserved. The patient is managed with nasoalveolar molding, and at 5 months of age, she is taken to surgery for cheiloplasty and gingivoperiostioplasty with umbilical cord stem cells. A radiographic and CT follow-up is carried out on the described cleft.
Intraparotid Facial Nerve Schwannoma in a Nine-Year-Old Patient: Diagnosis, Classification, and Surgical Approach Stages
Authors: Gumussoy Murat , Ekmekci Sumeyye
Published: December 2018

Intraparotid facial nerve schwannoma (IFNS) is rarely observed in children compared with adults. Only a few cases have been reported in the literature. After radiological imaging and fine needle aspiration biopsy, an IFNS diagnosis may be skipped and confused with pleomorphic adenoma, which has a high prevalence among patients who have a mass in the parotid gland. The probability of IFNS can be recognized by a close relation between the mass and the facial nerve during the application of parotidectomy and by the frozen biopsy of the mass. The surgeon evaluates the mass and faces with surgical mass excison and facial nerve reconstruction according to the relation between the mass and the facial nerve because there is no diagnostic method for the presurgery diagnosis of IFNS. Therefore, the surgeon should be prepared for the possibility of functional lossin the facial nerve during parotidectomy. This article presents the case of a 9-year-old patient with an IFNS diagnosis who had a surgical operation in our clinic, and the algorithm designed according to the literature for the diagnosis and surgical classification of IFNS, as well as the approaches to facial nerve reconstruction.
Study on the Therapeutic Effects of Trigeminal Neuralgia With Microvascular Decompression and Stereotactic Gamma Knife Surgery in the Elderly
Authors: Yu Rui , Wang Chengwei , Qu Chuncheng , Jiang Jun , Meng Qinghu , Wang Ji , Wei Shengcheng
Published: December 2018

Objective:

The aim of the study was to evaluate the efficacy of microvascular decompression (MVD) and stereotactic gamma knife surgery (GKS) in the treatment of trigeminal neuralgia (TN) in the elderly.

Patients and Methods:

Retrospective analysis of 137 elderly cases with TN underwent MVD, partial sensory rhizotomy (PR) treatment from August 2007 to March 2017 and 56 cases underwent GKS treatment from May 2014 to February 2017 was made, compared the efficacy of MVD and GKS in different age groups.

Results:

In 125 patients of MVD alone, the responsible vessels included 60 cases of superior cerebellar artery, 55 cases of anterior inferior cerebellar artery, 4 cases of venous vascular compression, 13 cases of mixed arteriovenous compression and 3 cases of vertebral artery, and 2 cases of no responsible vessel. Operation methods: MVD 125 cases, MVD + PR 10 cases, PR 1 cases, simple exploration in 1 case. Results of MVD surgery: Among 125 patients of MVD alone, 95 cases were cured, 15 cases improved, and 15 cases were ineffective. Among 10 cases of MVD + PR, cured in 9 cases and improved in 1 case. PR and simple exploration in 2 cases got pain disappeared. Postoperative complications of MVD: No deaths, CSF leakage in 2 cases, intracranial infection in 3 cases, ipsilateral hearing loss in 1 case, and ipsilateral facial paralysis in 1 case, delayed intracranial hematoma in 2 cases. After GKS treatment, the shortest onset time was from 9 days up to 6 months, an average of 2.2 months. Among 56 patients, 30 cases were cured, accounting for 53.6%, 20 cases improved, accounting for 35.7%, 6 cases were ineffective, accounting for 10.7%. Postoperative complications were facial numbness and dysesthesia, 7 cases, the incidence was 12.5%. In the group of 60 to 70 years old and the group of 70 to 80 years old, the treatment effect of MVD was better than that of GKS (χ2 test, P < 0.05); there was no significant difference between MVD and GKS in >80 years old group (χ2 test, P > 0.05). There was no significant difference in the therapeutic effect of TN underwent GKS among all age groups (χ2 test, P > 0.05).

Conclusion:

Microvascular decompression should be performed more prudently in elderly patients (>80 years old), and the indications for PR should be relatively relaxed. MVD + PR could improve the curative effect in patients with trigeminal neuralgia >80 years. Gamma knife treatment of trigeminal neuralgia had high safety, less complications, and positive curative effect, especially suitable for patients >80 years.
Microsurgical Replantation of Completely Avulsed Nasal Segment
Authors: Akyurek Mustafa , Perry Dylan
Published: December 2018

Complete avulsion of the nose is a devastating injury that may result in permanent disfigurement. Microvascular reattachment is technically difficult due to small size of the injured vessels, associated avulsion or crush injury, and relative inability to achieve venous anastomosis. This report describes a successful case of microsurgical replantation of the distal third of the nose in a 47-year-old patient after a dog bite injury with the use of a superficial temporal vein graft for arterial repair and leeching for venous outflow. The recovery was uneventful with total survival of the replant noted except for marginal skin necrosis, which healed by secondary intention. There was no need for any transfusion. The authors found that use of the superficial temporal vein for arterial revascularization was efficient and convenient as it was in the same surgical field, offering a favorable donor site scar in the preauricular sulcus. Microsurgical replantation should be attempted whenever feasible in cases of complete nose amputation.
Clinical Research on Prevention and Treatment of Respiratory Tract Complications With Acupoint Application After Operation Under General Anesthesia
Authors: Lu Xiang-Hong , Zhang Xin-Mei , Liu Si-Lan , Jiang Fang-Qin , Ding Ren-Xian , Bin Xi , Jie Yang , Gou Xiao-Jun
Published: December 2018

There are various respiratory tract complications in patients undergoing general anesthesia, with postoperative sore throat (POST) being the most commonly seen. Although measures have been taken to prevent and treat POST in clinical practice, the control of POST is still not satisfactory. In this study, 880 ASA patients with grade I to II general anesthesia were randomly assigned into control group and experimental group. After patients entered into the operating room, the plasters were applied to the designated points (Tianzhu, Lianquan, Dazhui, etc), and the clinical efficacy of acupoint application in prevention and treatment of respiratory tract complications after general anesthesia was observed. The results showed that patients starting using acupoint application before operation could significantly reduce the incidence of postoperative respiratory tract complications, and the effects lasted for up to 24 hours. In this study, acupoint application was used, providing a simple, safe, efficient, and durable approach to prevent and treat respiratory tract complications after operation under general anesthesia.
Multiple Variations at the Base of an Adult Skull: Implications in Radiology and Skull Base Surgery
Authors: Nayak Satheesha B.
Published: December 2018

Knowledge of variations at the base of the skull may be important for academic, anthropological, forensic, and clinical purposes, especially in computed tomography and magnetic resonance imaging and while performing safe radical surgery. This report presents multiple variations at the base of an adult Indian skull. The variations noted include the presence of foramen of Civinini bilaterally, absence of carotid canal on the left side, reduced size of foramen lacerum on the left side, presence of petro-occipital foramen bilaterally, asymmetry between the jugular fossae, and asymmetrical occipital condyles. The rare, multiple variations reported here might be useful for neurosurgeons, orthopedic surgeons, and radiologists.
Connecting the legs with a spring improves human running economy
Authors: Simpson Cole S. , Welker Cara G. , Uhlrich Scott D. , Sketch Sean M. , Jackson Rachel W. , Delp Scott L. , Collins Steve H. , Selinger Jessica C. , Hawkes Elliot W.
Published: December 2018

Spring-like tissues attached to the swinging legs of animals are thought to improve running economy by simply reducing the effort of leg swing. Here we show that a spring, or ‘exotendon,’ connecting the legs of a human runner improves economy instead through a more complex mechanism that produces savings during both swing and stance. The spring increases the energy optimal stride frequency; when runners adopt this new gait pattern, savings occur in both phases of gait. Remarkably, the simple device improves running economy by 6.4 ± 2.8%, comparable to savings achieved by motorized assistive robotics that directly target the costlier stance phase of gait. Our results highlight the importance of considering both the dynamics of the body and the adaptive strategies of the user when designing systems that couple human and machine.
IgG is differentially and selectively transferred across the placenta in HIV-infected women
Authors: Martinez David R. , Fong Youyi , Li Shuk Hang , Yang Fang , Jennewein Madeleine , Weiner Joshua A. , Harrell Erin A. , Mangold Jesse F. , Goswami Ria , Seage George , Alter Galit , Ackerman Margaret E. , Peng Xinxia , Fouda Genevieve G. , Permar Sallie R.
Published: December 2018

SUMMARY

The transplacental transfer of maternal IgG to the developing fetus is critical for infant protection against infectious pathogens in the first year of life. However, factors that modulate the transplacental transfer efficiency of maternal IgG that could be harnessed for maternal vaccine design remain largely undefined. HIV-infected women have impaired placental IgG transfer, yet the mechanism underlying this impaired transfer is unknown, presenting an opportunity to explore factors that contribute to the efficiency of placental IgG transfer. We measured the transplacental transfer efficiency of maternal HIV and other pathogen-specific IgG in historical U.S. (n=120) and Malawian (n=47) cohorts of HIV-infected mothers and their HIV- exposed uninfected and HIV-infected infants. We then examined the role of maternal HIV disease progression, infant factors, placental Fc receptor expression, and IgG Fc region subclass and glycan signatures and their association with transplacental transfer efficiency of maternal antigen-specific IgG. We established 3 distinct phenotypes of placental IgG transfer efficiency in HIV-infected women, including: 1) efficient transfer of the majority of antigen-specific IgG populations; 2) generally poor IgG transfer phenotype that was strongly associated with maternal CD4+ T cell counts, hypergammaglobulinemia, and frequently yielded non-protective levels of vaccine-specific IgG; and 3) variable transfer of IgG across distinct antigen specificities. Interestingly, maternal IgG characteristics, such as binding to placentally expressed Fc receptors FcγRIIa and FcγRIIIa, IgG subclass frequency, and Fc region glycan profiles were associated with placental IgG transfer efficiency. These maternal IgG transplacental transfer determinants were distinct among different antigen-specific IgG populations. Our findings suggest that in HIV-infected women, both maternal disease progression and Fc region characteristics modulate the selective placental transfer of distinct IgG subpopulations, with implications for both the health of HIV-exposed uninfected infants and maternal vaccine design.

Highlights

Low peripheral blood CD4 + T cell count and hypergammaglobulinemia are associated with inefficient transplacental IgG transfer in HIV-infected women

Antigen-specific IgG binding strength to placentally-expressed Fc receptors, but not placental Fc receptor expression levels, mediates selective placental IgG transfer

Antigen-specific IgG Fc region glycan profiles also contribute to the selective placental IgG transfer of maternal IgG populations in HIV-infected women
Sparking “The BBC Four Pandemic”: Leveraging citizen science and mobile phones to model the spread of disease
Authors: Kissler Stephen M. , Klepac Petra , Tang Maria , Conlan Andrew J.K. , Gog Julia R.
Published: December 2018

The nexus of mobile technology, mass media, and public engagement is opening new opportunities for research into the human behaviours relevant to the spread of disease. On 22 March 2018, the British Broadcasting Corporation (BBC) released the documentary “Contagion! The BBC Four Pandemic” to describe the science behind pandemic preparedness in the UK. The authors of this article were responsible for producing a mathematical simulation for that documentary of how a highly contagious respiratory pathogen might spread across the UK. According to the documentary narrative, the ‘outbreak’ begins in the town of Haslemere, England. To ground the simulation in true human interaction patterns, a three-day citizen science experiment was conducted during which the pairwise distances between 469 volunteers in Haslemere were tracked continuously using a mobile phone app. Here, we offer a scientific companion to the documentary in which we describe the methods behind our simulation and release the pairwise interpersonal distance dataset. We discuss salient features of the dataset, including daily patterns in the clustering and volatility of interpersonal interactions. Our epidemiological analysis of the simulated Haslemere outbreak serves as a springboard to discuss scientific opportunities opened by the Haslemere dataset and others like it. We believe that the Haslemere dataset will productively challenge current strategies for incorporating population structure into disease transmission models, and hope that it will inspire the collection and analysis of other similar datasets in the future.
The impact of isoniazid preventive therapy on tuberculosis among household contacts of isoniazid-resistant patients
Authors: Huang Chuan-Chin , Becerra Mercedes C. , Calderon Roger , Contreras Carmen , Galea Jerome , Grandjean Louis , Lecca Leonid , Yataco Rosa , Zhang Zibiao , Murray Megan
Published: December 2018

Background

The World Health Organization recommends the use of isoniazid (INH) alone or combination INH and rifapentine therapy to treat latent tuberculosis infection (LTBI) in groups at high risk of tuberculosis (TB) progression. The recent rise of INH– and multi–drug resistant (MDR) TB has complicated the choice of LTBI treatment regimen. We examine the risk of TB disease among household contacts (HHCs) who received INH after being exposed to patients with drug–sensitive, INH–resistant, or MDR tuberculosis.

Methods

In this prospective cohort study conducted Between September 2009 and August 2012 in Lima, Peru, we identified 4,500 index TB patients and measured incident TB disease in their 14,044 HHCs over a one–year follow–up period. HHCs under 19 years of age were offered INH preventive therapy (IPT). We used a Cox frailty proportional hazards model to evaluate whether the effect of IPT on incident TB disease varied by the resistance profile of the index case. We repeated the analyses in a second independent dataset.

Findings

Among 4,216 HHCs under 19 years of age, 2,106 (50%) initiated IPT at enrolment. The protective effect of INH was more extreme in HHCs exposed to drug–sensitive (Hazard Ratio [95% confidence interval]=0·2[0·20–0·50]) and to MDR–TB (0·26[0·08–0·77]) compared to those exposed to mono–INH–resistant (0·80[0·23 to 2·79]). Among those who received at least three months of INH, effectiveness increased across all three groups (INH–sensitive:0·20 [0·10 to 040]; MDR:0·16 [0 02–127]; mono–INH–resistant:0·72 [0·16–3·16]). In the second independent study, TB occurred in none of the 76 HHCs who received IPT compared to 3% (8/273) of those who did not.

Interpretation

We found that IPT use is associated with reduced incidence of TB disease among contacts of MDR–TB patients. This finding suggests that INH may have role in the management of MDR–LTBI.

Funding

National Institutes of Health and the National Institute of Allergy and Infectious Diseases CETR (U19AI109755) and TBRU (U19AI111224)
Loss of Adenomatous polyposis coli function renders intestinal epithelial cells resistant to the cytokine IL-22
Authors: Chen Yu , Newton Ian P. , Vandereyken Maud , Moraga Ignacio , Näthke Inke , Swamy Mahima
Published: December 2018

Interleukin-22 (IL-22) is critical in maintaining homeostasis in the intestine by regulating the balance between pathogenic and commensal bacteria. IL-22 also promotes wound healing and tissue regeneration, which can support the growth of colorectal tumours. Mutations in the tumour suppressor Adenomatous Polyposis Coli gene (Apc) cause intestinal tumorigenesis and are a major driver of familial colorectal cancers. To understand the role of IL-22 in APC-mediated tumorigenesis, we analysed IL-22 signalling in wild-type (WT) and APC-mutant cells in murine small intestinal epithelial organoids and in mice. In WT epithelia, antimicrobial defence, mucus production, and cellular stress response pathways were most strongly upregulated by IL-22. Surprisingly, we found that although IL-22 activated STAT3 in APC-mutant cells, STAT3 target genes were not effectively induced. Our analyses revealed that ApcMin/Min cells were resistant to IL-22 due to reduced expression of the IL-22 receptor, and increased expression of inhibitors of STAT3, including histone deacetylases. We further show that IL-22 induced expression of nitric oxide synthase in WT epithelial cells and corresponding DNA damage. These findings suggest that IL-22 does not promotes tumour formation by driving the proliferation of transformed intestinal epithelial cells. Rather, IL-22 increases genetic instability thereby accelerating transition from heterozygosity (ApcMin/+) to homozygosity (ApcMin/Min) to drive tumour progression.
Genetic Effects of Welding Fumes on the progression of Neurodegenerative Diseases
Authors: Rana Humayan Kabir , Akhtar Mst. Rashida , Ahmed Md Bashir , Lio’ Pietro , Quinn Julian , Huq Fazlul , Moni Mohammad Ali
Published: December 2018

Background

Welding exposes different types of fumes, gases and radiant energy that can be potentially dangerous for unsafe welder’s health. Welding fumes (WFs) are a significant problem among all those exposed. WFs are a complex mixture of metallic oxides, silicates and fluorides that may result in different health effects. If a welder inhales such fumes in large quantities over a long period of time, there is a risk of various neurodegenerative diseases (NDGDs) development.

Methods

We developed quantitative frameworks to identify the genetic relationship of WFs and NDGDs. We analyzed Gene Expression microarray data from WFs exposed tissues and NDGDs including Parkinson’s disease (PD), Alzheimer’s disease (AD), Lou Gehrig’s disease (LGD), Epilepsy disease (ED), Multiple Sclerosis disease (MSD) datasets. We constructed disease-gene relationship networks and identified dysregulated pathways, ontological path- ways and protein-protein interaction sub-network using multilayer network topology and neighborhood-based benchmarking.

Results

We observed that WFs shares 18, 16, 13, 19 and 19 differentially expressed genes with PD, AD, LGD, ED and MSD respectively. Gene expression dysregulation along with relationship networks, pathways and ontologic analysis showed that WFs are responsible for the progression of PD, AD, LGD, ED and MSD neurodegenerative diseases.

Conclusion

Our developed network-based approach to analysis and investigate the genetic effects of welding fumes on PD, AD, LGD, ED and MSD neurodegenerative diseases could be helpful to understand the causal influences of WF exposure for the progression of the NDGDs.