bluuebunny/crossref_metadata_2025 huggingface dataset:
Grading Modal Judgement
Authors: Charlow Nate
Published: April 2019

This paper proposes a new model of graded modal judgement. It begins by problematizing the phenomenon: given plausible constraints on the logic of epistemic modality, it is impossible to model graded attitudes toward modal claims as judgements of probability targeting epistemically modal propositions. This paper considers two alternative models, on which modal operators are non-proposition-forming: (1) Moss (2015), in which graded attitudes toward modal claims are represented as judgements of probability targeting a ‘proxy’ proposition, belief in which would underwrite belief in the modal claim; (2) a model on which graded attitudes toward modal claims are represented as judgements of credence taking as their objects (non-propositional) modal representations (rather than proxy propositions). The second model, like Moss’s model, is shown to be semantically and mathematically tractable. The second model, however, can be straightforwardly integrated into a plausible model of the role of graded attitudes toward modal claims in cognition and normative epistemology.
The epidemiology and characteristics of acute kidney injury in the Southeast Asia intensive care unit: a prospective multicentre study
Authors: Srisawat Nattachai , Kulvichit Win , Mahamitra Noppathorn , Hurst Cameron , Praditpornsilpa Kearkiat , Lumlertgul Nuttha , Chuasuwan Anan , Trongtrakul Konlawij , Tasnarong Adis , Champunot Ratapum , Bhurayanontachai Rangsun , Kongwibulwut Manasnun , Chatkaew Pornlert , Oranrigsupak Petchdee , Sukmark Theerapon , Panaput Thanachai , Laohacharoenyot Natthapon , Surasit Karjbundid , Keobounma Thathsalang , Khositrangsikun Kamol , Suwattanasilpa Ummarit , Pattharanitima Pattharawin , Santithisadeekorn Poramin , Wanitchanont Anocha , Peerapornrattana Sadudee , Loaveeravat Passisd , Leelahavanichkul Asada , Tiranathanagul Khajohn , Kerr Stephen J , Tungsanga Kriang , Eiam-Ong Somchai , Sitprija Visith , Kellum John A
Published: April 2019

Background

Etiologies for acute kidney injury (AKI) vary by geographic region and socioeconomic status. While considerable information is now available on AKI in the Americas, Europe and China, large comprehensive epidemiologic studies of AKI from Southeast Asia (SEA) are still lacking. The aim of this study was to investigate the rates and characteristics of AKI among intensive care unit (ICU) patients in Thailand.

Methods

We conducted the largest prospective observational study of AKI in SEA. The data were serially collected on the first 28 days of ICU admission by registration in electronic web-based format. AKI status was defined by full Kidney Disease: Improving Global Outcome criteria. We used AKI occurrence as the clinical outcome and explored the impact of modifiable and non-modifiable risk factors on the development and progression of AKI.

Results

We enrolled 5476 patients from 17 ICU centres across Thailand from February 2013 to July 2015. After excluding patients with end-stage renal disease and those with incomplete data, AKI occurred in 2471 of 4668 patients (52.9%). Overall, the maximum AKI stage was Stage 1 in 7.5%, Stage 2 in 16.5% and Stage 3 in 28.9%. In the multivariable adjusted model, we found that older age, female sex, admission to a regional hospital, medical ICU, high body mass index, primary diagnosis of cardiovascular-related disease and infectious disease, higher Acute Physiology and Chronic Health Evaluation II, non-renal Sequential Organ Failure Assessment scores, underlying anemia and use of vasopressors were all independent risk factors for AKI development.

Conclusions

In Thai ICUs, AKI is very common. Identification of risk factors of AKI development will help in the development of a prognostic scoring model for this population and should help in decision making for timely intervention, ultimately leading to better clinical outcomes.
Governmental policies to reduce unhealthy food marketing to children
Authors: Taillie Lindsey Smith , Busey Emily , Stoltze Fernanda Mediano , Dillman Carpentier Francesca Renee
Published: April 2019

Reducing children’s exposure to food marketing is an important obesity prevention strategy. This narrative review describes current statutory regulations that restrict food marketing; reviews available evidence on the effects of these regulations; and compares policy design elements in Chile and the United Kingdom. Currently, 16 countries have statutory regulations on unhealthy food marketing to children. Restrictions on television advertising, primarily during children’s programming, are most common. Schools are also a common setting for restrictions. Regulations on media such as cinema, mobile phone applications, print, packaging, and the internet are uncommon. Eleven evaluations of policies in 4 jurisdictions found small or no policy-related reductions in unhealthy food advertising, in part because marketing shifted to other programs or venues; however, not all policies have been evaluated. Compared with the United Kingdom, Chile restricts marketing on more products, across a wider range of media, using more marketing techniques. Future research should examine which elements of food marketing policy design are most effective at reducing children’s exposure to unhealthy food marketing.
Dietary interventions, intestinal microenvironment, and obesity: a systematic review
Authors: Santos Johnny G , Alves Bruna C , Hammes Thais O , Dall’Alba Valesca
Published: April 2019

Context

Obesity has been linked to the intestinal microenvironment. Diet plays an important role in obesity and has been associated with microbiota.

Objective

This systematic review sought to evaluate the scientific evidence on the effect of dietary modification, including supplementation with prebiotics and probiotics, on microbiota diversity in obesity.

Data sources

A systematic search was performed in the MEDLINE and EMBASE databases. Studies were considered eligible if they were clinical trials evaluating dietary intervention and microbiota, body weight, or clinical parameters in obesity.

Data extraction

Data were extracted by 2 independent reviewers.

Results

From 168 articles identified, 20 were included (n = 931 participants). Increased phyla abundance after food interventions was the main finding in relation to microbiota. Regarding the impact of interventions, increased insulin sensitivity, reduced levels of inflammatory markers, and reduced body mass index were shown in several studies.

Conclusions

Interventions that modulate microbiota, especially prebiotics, show encouraging results in treating obesity, improving insulin levels, inflammatory markers, and body mass index. Because the studies included in this review were heterogeneous, it is difficult to achieve conclusive and definitive results.
Influence of physical activity at a young age and lifetime physical activity on the risks of 3 obesity-related cancers: systematic review and meta-analysis of observational studies
Authors: Hidayat Khemayanto , Zhou Hui-Juan , Shi Bi-Min
Published: April 2019

Context

Excess weight has been linked to increased risks of 13 types of cancers. Physical activity is a non-nutritional modifiable lifestyle factor that is not only crucial for weight control but is also known to regulate hormones and metabolic pathways that may contribute to carcinogenesis. There is solid evidence that being physically active during middle and late adulthood lowers the risks of 3 obesity-related cancers, namely breast cancer, colon cancer, and endometrial cancer. However, the associations between physical activity at a young age (childhood, adolescence, and young adulthood; age 5 to ≤30 yr) and lifetime physical activity and the risks of breast cancer, colon cancer, and endometrial cancer are less defined.

Objective

The present systematic review and meta-analysis of observational studies was performed in accordance with the MOOSE guidelines to determine whether physical activity at a young age and lifetime physical activity may lower the risks of breast cancer, colon cancer, and endometrial cancer.

Data sources

The PubMed and Web of Science databases were searched for relevant observational studies published from inception to July 2018.

Study selection

Observational studies (prospective cohort, case-cohort, nested case-control, historical cohort, and case-control) were considered relevant if they investigated the association between physical activity at a young age or lifetime physical activity and the risks of developing selected cancers.

Data extraction

A random-effects meta-analysis was performed to generate the summary relative risk (RR) with 95%CI for the highest vs the lowest category of physical activity of any type.

Results

Eighty publications were included in the present meta-analysis. Higher physical activity at a young age was associated with lower risks of breast cancer (RR 0.81, 95%CI 0.76, 0.87) and colon cancer (RR 0.67, 95%CI 0.50, 0.88). Similarly, lifetime physical activity was inversely associated with the risks of breast cancer (RR 0.79, 95%CI 0.72, 0.86) and colon cancer (RR 0.75, 95%CI 0.69, 0.82). For breast cancer, menopausal status did not appear to modify the observed inverse association. The benefit with respect to endometrial cancer risk reduction was only observed with higher lifetime physical activity (RR 0.77, 95%CI 0.67, 0.88), not with higher physical activity at a young age (RR 0.89, 95%CI 0.73, 1.07).

Conclusions

Being physically active over a lifetime, starting from early childhood, may lower the risks of developing breast cancer, colon cancer, and endometrial cancer.
The C-type ATP-Binding Cassette Transporter OsABCC7 Is Involved in the Root-to-Shoot Translocation of Arsenic in Rice
Authors: Tang Zhong , Chen Yi , Miller Anthony J , Zhao Fang-Jie
Published: April 2019

Rice is a major dietary source of inorganic arsenic (As), a nonthreshold carcinogen. Reducing As accumulation in rice grain is of critical importance for food safety. In the present study, we investigated the role of a member of the rice C-type ATP-binding cassette (ABC) transporter (OsABCC) family, OsABCC7, in arsenite [As(III)] accumulation in rice. Quantitative real-time RT-PCR showed that OsABCC7 was expressed intensively in the roots and the expression was strongly suppressed by As(III) exposure. Transgenic rice plants expressing OsABCC7 Promoter-GUS (β-glucuronidase) suggest that the gene was predominantly expressed in the xylem parenchyma cells in the stele region of the primary and lateral roots. Transient expression of OsABCC7: GFP fusion protein in Nicotiana benthamiana leaf cells showed that the protein was localized at the plasma membrane. When expressed in Xenopus laevis oocytes, OsABCC7 showed an efflux activity for As(III)-phytochelatin and As(III)-glutathione complexes, but not for As(III). Knockout of OsABCC7 in rice significantly decreased As concentration in the xylem sap and As concentration in the shoots, but had little effect on root As concentration. Taken together, our results indicate that OsABCC7 is involved in the root-to-shoot translocation of As(III).
effectR: An Expandable R Package to Predict Candidate RxLR and CRN Effectors in Oomycetes Using Motif Searches
Authors: Tabima Javier F. , Grünwald Niklaus J.
Published: April 2019

Effectors are small, secreted proteins that facilitate infection of host plants by all major groups of plant pathogens. Effector protein identification in oomycetes relies on identification of open reading frames with certain amino acid motifs among additional minor criteria. To date, identification of effectors relies on custom scripts to identify motifs in candidate open reading frames. Here, we developed the R package effectR, which provides a convenient tool for rapid prediction of effectors in oomycete genomes, or with custom scripts for any genome, in a reproducible way. The effectR package relies on a combination of regular expressions statements and hidden Markov model approaches to predict candidate RxLR and crinkler effectors. Other custom motifs for novel effectors can easily be implemented and added to package updates. The effectR package has been validated with published oomycete genomes. This package provides a convenient tool for wet lab researchers interested in reproducible identification of candidate effectors in oomycete genomes.
Cylindrical Inclusion Protein of Wheat Yellow Mosaic Virus Is Involved in Differential Infection of Wheat Cultivars
Authors: Ohki Takehiro , Sasaya Takahide , Maoka Tetsuo
Published: April 2019

Wheat yellow mosaic virus (WYMV) belongs to the genus Bymovirus in the family Potyviridae and has a bipartite genome (RNA1 and RNA2). WYMV in Japan is classified into three pathotypes (I to III) based on its pathogenicity to wheat cultivars. Among these three, pathotypes I and II are discriminated by their pathogenicity to the wheat cultivar Fukuho; pathotype I infects Fukuho but pathotype II does not. In the present study, the genomic regions that are involved in such pathogenicity were examined using infectious viral cDNA clones of pathotypes I and II. Reassortant experiments between viral RNA1 and RNA2 revealed the presence of a viral factor related to pathogenicity in RNA1. A chimeric pathotype II virus harboring a cylindrical inclusion (CI) cistron from pathotype I facilitated systemic infection of Fukuho, indicating that CI protein is involved in pathogenicity. Furthermore, analysis of chimeric and site-directed mutants revealed that three amino acids at the N-terminal region of CI protein were involved in pathogenicity to Fukuho. On the other hand, at the single-cell level, pathotype II replicated in protoplasts of Fukuho similar to that of pathotype I virus. These data suggest that differential pathogenicity between pathotypes I and II was considered to depend on the ability of cell-to-cell or long-distance viral movement, in which CI protein is involved. To the best of our knowledge, this is the first report to show the involvement of the bymoviral CI protein in pathogenicity.
Incidence of Venous Thromboembolism After Different Modes of Gynecologic Surgery
Authors: Jorgensen Elisa M. , Li Anjie , Modest Anna M. , Leung Katherine , Moore Simas Tiffany A. , Hur Hye-Chun
Published: April 2019

(Abstracted from Obstet Gynecol 2018;132:1275–1284)

An uncommon but potentially fatal complication of surgery is venous thromboembolism (VTE). It is critical when planning surgery that gynecologic surgeons assess the risk of VTE and provide appropriate prophylaxis for high-risk patients.
Rapid Prenatal Diagnosis Using Targeted Exome Sequencing: A Cohort Study to Assess Feasibility and Potential Impact on Prenatal Counseling and Pregnancy Management
Authors: Chandler Natalie , Best Sunayna , Hayward Jane , Faravelli Francesca , Mansour Sahar , Kivuva Emma , Tapon Dagmar , Male Alison , DeVile Catherine , Chitty Lyn S.
Published: April 2019

(Abstracted from Genet Med 2018;20(11):1430–1437)

Unexpected fetal abnormalities occur in 2% to 5% of pregnancies. Although traditional cytogenetic and microarray approaches achieve diagnosis in approximately 40% of cases, lack of diagnosis in others impedes parental counseling, informed decision making, and pregnancy management.
Application of Cell-Free DNA Analysis to Cancer Treatment
Authors: Corcoran Ryan B. , Chabner Bruce A.
Published: April 2019

(Abstracted from N Engl J Med 2018;379(18):1754–1765)

Tumor biopsies represent the standard for cancer diagnosis and the primary method for molecular testing to guide the selection of precision therapies. Liquid biopsies, particularly those involving cell-free DNA (cfDNA) from plasma, are rapidly emerging as an important and minimally invasive adjunct to standard tumor biopsies and, in some cases, even a potential alternative approach.
Omega-3 Fatty Acid Addition During Pregnancy
Authors: Middleton Philippa , Gomersall Judith C. , Gould Jacqueline F. , Shepherd Emily , Olsen Sjurdur F. , Makrides Maria
Published: April 2019

(Abstracted from Cochrane Database Syst Rev 2018;11:CD003402)

Preterm birth is a leading cause of disability or death in the first 5 years of life. Higher intake of foods containing omega-3 long-chain polyunsaturated fatty acids (LCPUFAs), such as fish, during pregnancy has been associated with longer gestations and improved perinatal outcomes.
Clinical Process Modeling: An Approach for Enhancing the Assessment of Physicians’ Clinical Reasoning
Authors: Cook Robert J. , Durning Steven J.
Published: April 2019

To ensure the validity of test interpretation and use, educators must be able to connect the dots between the tasks examinees perform on a test and the decisions educators make based on the results of that test. Toward that end, in this article, the authors introduce an approach called clinical process modeling, which combines clinical reasoning and principled assessment design. The goal of this approach is to better align test item development with the assessment of physicians’ application of knowledge. Clinical process modeling involves creating complex decision trees that can mirror clinical reasoning illness scripts and include the steps and pathways a physician could take to address a specific patient presentation from initial presentation to correct diagnosis and therapy. Once created, these decision trees can be used to inform the assessment development process.

To illustrate this approach, the authors describe how they developed one such clinical process model for a common presentation of low back pain from the field of internal medicine. They explain the steps they took to develop their model and the corresponding test item. They conclude by discussing potential future directions and additional implications for this work, emphasizing how clinical process models can be used to inform other educational processes and clinical practice.
A Lexicon of Concepts of Humanistic Medicine: Exploring Different Meanings of Caring and Compassion at One Organization
Authors: Stergiopoulos Erene , Ellaway Rachel H. , Nahiddi Nima , Martimianakis Maria A.
Published: April 2019

Purpose

There has been scant scholarly attention paid to characterizing how the numerous definitions of terms associated with compassion and humanism have been mobilized or what the organizational implications of pursuing different constructs might be. This study explored the uses and implications of the terminology associated with humanistic medicine in the work of the Associated Medical Services (AMS) Phoenix Project.

Method

This study involved two phases (2014–2015). First, two pilot group workshops with AMS Phoenix Project participants and stakeholders were conducted to explore ways of parsing and interpreting core concepts used in the project. The authors then assembled an archive of texts associated with the project, comprising the project website and blog posts, conference proceedings, and fellowship and grant applications. Informed by critical discourse analysis, the authors identified, described, and analyzed core terms related to the project’s mission and explored the type of health care practices and reforms implied by their use.

Results

Two recurring core terms, care/caring and compassion, and eight clusters of terms related to these core terms were identified in the archive. Caring and compassion as terms were articulated in various psychological, sociological, and political configurations. This polysemy reflected a diverse array of health care reform agendas.

Conclusions

Understanding how different interpretations of caring and compassion cluster around core topics and concerns of humanistic medicine offers scholars an entry point for comparing and appraising the quality and direction of reform agendas, including multilevel strategies that involve systems-level changes.
Rates of and Factors Associated With Patient-reported Illicit Drug Use Screening by Health Care Professionals in the United States From 2013 to 2015
Authors: Scialli Anna C. , Terplan Mishka
Published: April 2019

Objectives:

To examine rates of and factors associated with patient-reported illicit drug use screening by health care professionals.

Methods:

The National Survey on Drug Use and Health (NSDUH), limited to individuals who reported prior year healthcare service utilization, was used to capture the odds of patient-reported illicit drug use screening for survey years 2013 to 2015. Screened patients were contrasted with those not screened by demographic and behavioral characteristics. Adjusted models were produced by year and adjusted odds ratios were compared for changes across years. A separate adjusted model including year as a fixed effect was produced to estimate changes in overall adjusted screening odds.

Results:

The percentage of individuals reporting screening by a health care provider increased from 48.5% in 2013 to 50.9% (2014), and 54.3% (2015) (P < 0.0001). The adjusted model, including year as a fixed effect, indicated that the odds of screening significantly increased from 2013 to 2015. In multivariable regression, individuals reporting screening were more likely to be female, of higher income and educational strata, and received drug or alcohol treatment in the past year and were less likely to be non-Hispanic Asian.

Conclusions:

Only roughly half of individuals seen by a healthcare provider report illicit drug use screening. Racial disparities in screening persist although they are overall decreasing. Coupling screening with treatment initiation, rather than brief intervention, may increase screening rates.
Paraoxonase 1 Was Negatively Associated With Intervertebral Disc Degeneration
Authors: Chen Fan , Liu Hui , Li Zemin , Pei Yuxin , Wang Hua , Zhang Jian , Wang Jianru , Zheng Zhaomin
Published: April 2019

Study Design.

An in vivo and in vitro study of the correlation between Paraoxonase 1 (PON1) and intervertebral disc degeneration (IVDD).

Objective.

The aim of this study is to clarify the expression and role of PON1 on the process of IVDD.

Summary of Background Data.

IVDD is responsible for most of the spinal degenerative diseases. Inflammation and oxidative stress can deteriorate the living environment of nucleus pulposus (NP) cells, leading to IVDD. PON1 is an enzyme reported to have anti-inflammatory and anti-oxidative effects. There is no study about the correlation of PON1 expression with IVDD.

Methods.

Immunohistochemical (IHC), hematoxylin and eosin (H&E) staining, and Western blot examined the expression of PON1 in 88 human disc samples (male: female 43: 45) and rat models (n = 5 each group). The level of PON1 is measured in the tumor necrosis factor (TNF)-α and oxidative stress (H2O2)-induced degenerative NP cell models using Western blot and reverse transcription-polymerase chain reaction (RT-qPCR). The TNF-α, interleukin (IL)-1β, Mito superoxide (SOX), aggrecan, and collagen II are detected in nucleus pulposus (NP) cells transfected with si-RNA of PON1 using Enzyme-Linked Immunosorbent Assay (ELISA), mitoSOX staining Western blot, and RT-qPCR.

Results.

The expression of PON1 is significantly suppressed in human and rat degenerative intervertebral discs. The level of PON1 is significantly decreased in TNF-α and oxidative stress (H2O2)-induced degenerative NP cell models. ELISA results show that the level of TNF-α and IL-1β obviously increased; Mito SOX staining indicates that the Mito SOX fluorescence significantly increased, and the expression of aggrecan and collagen reduced in NP cells transfected with si-RNA of PON1.

Conclusion.

Our study indicates that low PON1 expression is predictive of severe IVDD; PON1 plays an important role of keeping the homeostatic balance of intervertebral discs, and therapeutic approach regarding PON1 may be helpful to alleviate IVDD in the future.

Level of Evidence: N/A
Geography of Lumbar Paravertebral Muscle Fatty Infiltration
Authors: Crawford Rebecca J. , Volken Thomas , Ni Mhuiris Áine , Bow Cora C. , Elliott James M. , Hoggarth Mark A , Samartzis Dino
Published: April 2019

Study Design.

Cross-sectional.

Objective.

We quantified fatty infiltration (FI) geography of the lumbar spine to identify whether demographics, temporal low back pain (LBP), and disability influence FI patterns.

Summary of Background Data.

Lumbar paravertebral muscle FI has been associated with age, sex, LBP, and disability; yet, FI accumulation patterns are inadequately described to optimize interventions.

Methods.

This cross-sectional study employed lumbar axial T1-weighted magnetic resonance imaging in 107 Southern-Chinese adults (54 females, 53 males). Single-slices at the vertebral inferior end-plate per lumbar level were measured for quartiled-FI, and analyzed against demographics, LBP, and disability (Oswestry Disability Index).

Results.

Mean FI% was higher in females, on the right, increased per level caudally, and from medial to lateral in men (P < 0.05). FI linearly increased with age for both sexes (P < 0.01) and was notably higher at L 4&5 than L1, 2&3 for cases aged 40 to 65 years. BMI and FI were unrelated in females and inversely in males (P < 0.001). Females with LBPweek and males with LBPyear had 1.7% (each) less average FI (P < 0.05) than those without pain at that time-point. Men locating their LBP in the back had less FI than those without pain (P < 0.001). Disability was unrelated to FI for both sexes (P > 0.05).

Conclusion.

Lumbar paravertebral muscle FI predominates in the lower lumbar spine, notably for those aged 40 to 65, and depends more on sagittal than transverse distribution. Higher FI in females and differences of mean FI between sexes for BMI, LBP, and disabling Oswestry Disability Index suggest sex-differential accumulation patterns. Our study contradicts pain models rationalizing lumbar muscle FI and may reflect a normative sex-dependent feature of the natural history of lumbar paravertebral muscles.

Level of Evidence: 2
Excision of the Flexor Carpi Radialis Tendon Following Ligament Reconstruction Tendon Interposition for Thumb Carpometacarpal Arthroplasty: A Review of Cases and of the Literature
Authors: Orman Sebastian , Rodner Craig M.
Published: April 2019

Thumb carpometacarpal (CMC) arthroplasty predictably improves pain and function in patients with thumb CMC osteoarthritis. One variation of this technique involves using a split half flexor carpi radialis (FCR) tendon for ligament reconstruction tendon interposition. Postoperative pain in the wrist and distal forearm overlying the remaining FCR tendon is a potential complication that may necessitate follow-up FCR tenotomy. Being aware of this potential complication and modifying surgical technique if a poor quality tendon is discovered at the time of the initial surgery may decrease the incidence of postoperative FCR pain and the need for reoperation. We retrospectively reviewed a consecutive series of 200 thumb CMC arthroplasties involving ligament reconstruction tendon interposition using split half FCR tendon grafts. Of these, we present 4 patients of 200 (2%) who developed FCR area pain in the wrist and distal forearm after undergoing thumb CMC arthroplasty who eventually required FCR tenotomy at a mean of 5 months. In this paper, we provide recommendations that may reduce the incidence of this under-discussed complication for surgeons utilizing split half FCR tendon grafts: (1) when harvesting the graft, split the tendon exactly down the middle while also attempting to preserve the tendon sheath, and (2) opt to harvest the entire tendon if it appears thin or otherwise diseased intraoperatively.
Acrochordon With Histological Features of Lichen Sclerosus
Authors: Arnold Kathryn A. , Sundharkrishnan Lohini , Bolotin Diana , Shea Christopher R.
Published: April 2019

Lichen sclerosus (LS) is a chronic inflammatory dermatosis that classically presents as sclerotic, atrophic plaques in the genital region. We present a case of acrochordon with histological features of LS, clinically mimicking intradermal nevus, in a 53-year-old man with no prior history of LS. Our case highlights an unusual morphologic variant of acrochordon and illustrates the role of chronic pressure and occlusion in the development of secondary features of LS.
Endometriosis of the Eyelid, an Extraordinary Extra-abdominal Location Highlighting the Spectrum of Disease
Authors: Sharghi Kevin G. , Ramey Nicholas A. , Rush Patrick S. , Grider Douglas J.
Published: April 2019

Cutaneous endometriosis is an uncommon dermatologic disorder predominantly seen in young women. Most commonly, it presents within a region of a previous surgical scar, often in relation to a gynecologic procedure on the abdomen or in close proximity to the umbilicus. The typical clinical presentation is that of papules or nodules with monthly cyclical pain and size variation. Histologically, the lesions are composed of endometrial stroma and glands. The pathophysiology is not well understood but is believed to be due to metastasis or seeding of endometrial cells. When this uncommon disorder occurs outside of the most typical clinical setting, it may cause some diagnostic difficulty. In this report, we present the first known case of cutaneous endometriosis on the eyelid.
Hypopigmented Macules as Manifestation of Lichen Planus and Lichen Planopilaris
Authors: Arnold David , Hoffman Melissa B. , Onajin Oluwakemi , Sangüeza Omar P. , McMichael Amy
Published: April 2019

Lichen planus (LP) is an idiopathic inflammatory disease of the skin, hair, nails, and mucous membranes. Classic cutaneous LP is characterized by violaceous flat-topped papules that typically favor the extremities. LP on the scalp, otherwise known as lichen planopilaris, classically presents with scarring alopecia, perifollicular erythema and follicular prominence. Although LP pigmentosus presents primarily as hyperpigmentation, there is only one previous report of hypopigmented LP. In this report, the authors report 2 cases of LP that presented primarily as hypopigmented macules in 2 African American men. The first patient presented with hypopigmented macules on face and scalp as well as trunk and extremities. The second patient presented with hypopigmented macules on scalp with associated alopecia. Histopathological examination from both patients showed features of LP. The authors propose a new variant of LP that presents acutely as hypopigmented lesions.
Syringotropic Mycosis Fungoides: A Variant of Folliculotropic Mycosis Fungoides or a Distinct Entity?
Authors: Echols Kathryn F. , Bressler Lindsey , Armeson Kent , Maize John C.
Published: April 2019

Syringotropic mycosis fungoides (MF) is classified under folliculotropic MF. Although there is significant overlap between the 2, this study demonstrates that folliculotropism is frequently present in syringotropic MF, and when not present, the specimen did not include a follicle to examine. In addition, few of the pathology reports mentioned folliculotropism or syringotropism, although this is an important prognostic feature.
Nurse Preceptor Role in New Graduate Nurses' Transition to Practice
Authors: Powers Kelly , Herron Elizabeth K. , Pagel Julie
Published: April 2019

The transition to practice period is a challenging and demanding time for new graduate nurses. Leaving the structured environment of nursing school and entering professional practice can cause reality and transition shock for the new nurse resulting in unsafe patient care, as well as intention to leave their position or the profession. Successful transition to practice depends on the new nurse building confidence and gaining essential clinical reasoning abilities while orienting to their role. In critical care settings, patient care is more complex and fast-paced, which adds another dimension of overall stress to the new graduate. Structured orientation programs with trained preceptors have been found to be the most successful means of preparing new graduate nurses for clinical practice. Ensuring preceptors are provided with education related to the development of clinical reasoning is essential to successfully assist new nurses in their transition to practice. Safe and effective patient care, especially in the critical care unit, is dependent upon having nurses who are well prepared for their role through being provided guidance and support from trained preceptors.
Corynebacterium kroppenstedtii: a challenging culprit in breast abscesses and granulomatous mastitis
Authors: Saraiya Nidhi , Corpuz Marilou
Published: April 2019

Purpose of review

Corynebacterium kroppenstedtii is a difficult pathogen associated with granulomatous mastitis and recurrent breast abscesses. Despite over a dozen studies, there is no guidance on surgical interventions, steroid use, or dosing or duration of antibiotic treatment.

Recent findings

Initially seen in predominantly Maori and Pacific Islander multiparous, postlactating women, C. kroppenstedtii breast infection has since been reported throughout the world, including in nulliparous women. Additionally, emerging data suggest that hyperprolactinemia is a modifiable risk factor for these infections. This article reviews a patient case and data from 87 other cases to compile current best practices for diagnosis, treatment, and monitoring, and provides areas for future study.

In cases of granulomatous mastitis and breast abscess, especially if recurrent, infection with C. kroppenstedtii should be considered. Microbiologists should be alerted to the specialized growth conditions and tools needed for appropriate culturing, identification, and antibiotic susceptibility testing. Clinicians should utilize a multimodal approach with surgical and antibiotic treatment to maximize clinical cure and reduce recurrence.
A Synthetic Biodegradable Temporising Matrix in Degloving Lower Extremity Trauma Reconstruction: A Case Report
Authors: Damkat-Thomas Lindsay , Greenwood John E. , Wagstaff Marcus J. D.
Published: April 2019

Presented is the case of an obese, 72 year-old diabetic man with a dorsal foot de-gloving injury. Whilst the tendons of extensor hallucis longus, extensor digitorum longus to all digits, and extensor digitorum brevis to hallux and second toe were intact after surgical debridement, none had any covering paratenon. The joint between the medial cuneiform and first metatarsal was open. Reconstructive options were limited by his age and co-morbidities. A novel, completely synthetic dermal matrix (NovoSorb BTM) was applied, after which the patient was discharged home to attend for dressings and review of integration progress as an outpatient. He was allowed to mobilise without limitation. Because of the poor quality of the wound bed (and patient), the material integrated slowly over 9 weeks. Delamination of the matrix, and definitive closure by application of sheet split skin autograft, produced a robust, soft, mobile and excellent aesthetic result, over which he could wear footwear immediately. Clinically, the paratenon-denuded tendons glided under the neo-dermis without tethering to the overlying integrated matrix, allowing a full range of digital movement. This was confirmed on ultrasound examination, which also demonstrated no inflammation or oedema. Already proven in extensive burns, necrotising fasciitis and complex surgical wounds, BTM represents a useful addition to the reconstructive surgeon’s toolbox.
Columella Elongation Surgery Outcome in Complete Bilateral Cleft Lip and Palate
Authors: Broll Daiana , de Souza Telma V. , Nobrega Eudes , Luz Cristiane L. , Repeke Carlos E. , da Silva Luiz C. , Garib Daniela G. , Ozawa Terumi O.
Published: April 2019

Background:

The evaluation of surgical outcomes is needed to achieve excellence in nasal reconstruction of patients with complete bilateral cleft lip and palate (BCLP). The study objective is to evaluate the quality of nasal aesthetics after the columella elongation surgery.

Methods:

The sample of this study consisted of 70 patients with complete BCLP, operated on columella elongation surgery and analyzed at 6 to 12 years. The system for evaluation of nasal appearance after the columella elongation surgery was performed by objective and subjective analyses.

Anthropometric Measurements:

Four anthropometric nose measurements were performed directly on the faces, and the same was performed in control group (60 children without oral clefts), paired by age and sex with the experimental group. The measurements were repeated 3 times (triplicate).

Subjective Analysis:

Scores to evaluate nasal width, nasal tip projection, and length of the columella were applied before and after the columella elongation surgery by 5 raters from the rehabilitation team. Interrater and intrarater agreement was calculated by means of the kappa test.

Results:

Nasal width in BCLP group was higher when compared to the control group (P < 0.05). Nasal tip projection (subnasal–pronasal) and columella length (subnasal–columella) were decreased in BCLP group compared to that of the controls (P < 0.05). Columella width was similar in both study groups (P > 0.05). All scores of nasal aesthetics significantly improved after the columella elongation surgery.

Conclusions:

Nose of the patients with BCLP is wider, is less projected, and has the shorter columella compared to that of the noncleft subjects. After secondary columella elongation surgery in BCLP, nasal width, nasal projection, and columella length significantly improved.
Sigma-lead Male-to-Female Gender Affirmation Surgery: Blending Cosmesis with Functionality
Authors: Kaushik Narendra , Jindal Omi , Bhardwaj Devendra K.
Published: April 2019

Background:

Current male-to-female (MtF) sex-reassignment-surgery techniques have not been fully successful to achieve the ideal objectives. The ordeal of multiple procedures, associated complications, and suboptimal results leads to high rate of dissatisfaction. We have tried to overcome functional inadequacy and address the esthetic issues for outer genitalia and vagina with our innovative “true shape sigma-lead SRS: Kaushik’s technique,” which has now become the technique of choice for MtF genital SRS for our patients.

Methods:

Between April 2007 and April 2017, authors performed 386 sigma-lead SRS in MtF transsexuals. Results were analyzed based on complications, resurgeries, and esthetic/functional outcomes. Corrective SRS using rectosigmoid constituted 145 cases and is not a part of this study.

Results:

Maximum follow-up was 7 years (average 34 months). Seventy-eight (20.2%) patients had complications, majority being minor (97.4%). Forty-four (11.4%) required resurgeries, 10 (2.6%) were corrective for introital stricture and mucosal prolapse, whereas 34 (8.8%) opted for optional minor esthetic enhancement. The overall satisfaction rate for cosmetic and functional outcomes was 4.7 out of 5. In addition to review of the literature, innovations in the technique have been explained.

Conclusions:

Kaushik’s sigma-lead MtF SRS technique is a step short to become the gold standard of genital SRS because it has proven to be safe and reliable. It allows faster healing, minimal dilation, and nearly natural cosmetic results in the form of clitoris/clitoral hood, labia minora, labia majora along with self-lubricating, fully deep, and sensate neovagina with orgasmic capabilities. This is perhaps the largest reported series of rectosigmoid use in transsexuals carried out for primary vaginoplasty.
Quantification of Head Shape and Cranioplasty Outcomes: Six-compartment Volume Method Applied to Sagittal Synostosis
Authors: Liaw William X.Z. , Parr William C.H. , Peltz Tim S. , Varey Alex , Hunt Jeremy , Gianoutsos Mark , Marucci Damian D. , Walsh William
Published: April 2019

Background:

Premature fusion of the sagittal (midline) suture between 2 parietal bones is the most common form of craniosynostosis. Surgical correction is mandated to improve head shape and to decrease the risk of raised intracranial pressure. This study evaluated the utility of 3-dimensional (3D) imaging to quantify the volumetric changes of surgical correction. Currently there is no standardized method used to quantify the outcomes of surgery for craniosynostosis, with the cranial index (width: length ratio) being commonly used.

Methods:

A method for quantification of head shape using 3D imaging is described in which the cranium is divided up into 6 compartments and the volumes of 6 compartments are quantified and analyzed. The method is size invariant, meaning that it can be used to assess the long-term postoperative outcomes of patients through growth. The method is applied to a cohort of sagittal synostosis patients and a normal cohort, and is used to follow up a smaller group of synostotic patients 1, 2, and 3 years postoperatively.

Results:

Statistical analysis of the results shows that the 6-compartment volume quantification method is more accurate in separating normal from synostotic patient head shapes than the cranial index.

Conclusions:

Spring-mediated cranioplasty does not return head shape back to normal, but results in significant improvements in the first year following surgery compared with the preoperative sagittal synostosis head shape. 3D imaging can be a valuable tool in assessing the volumetric changes due to surgery and growth in craniosynstosis patients.
W-plasty in Scar Revision: Geometrical Considerations and Suggestions for Site-specific Design Modifications
Authors: Goutos Ioannis , Yousif Ali H. , Ogawa Rei
Published: April 2019

Background:

A large proportion of scars in clinical practice represent good candidates for surgical revision by virtue of their unfavorable characteristics and relative orientation with respect to skin relaxed tension lines. W-plasty is a very popular excisional revision technique, which involves breaking up the scar margins into small triangular components, which are advanced and interdigitated without any rotation or transposition.

Methods:

We performed an extensive literature search using Pubmed MEDLINE, Web of Science, and Embase using the following keywords [W-plasty] AND [scar] AND [revision]. We retrieved 13 articles pertinent to the indications, geometrical design, and technical evolution of the W-plasty scar revision variants. We formulate indications for the use of isosceles/equilateral as opposed to scalene triangle W-plasty and integrate our experience with regards to the choice of geometrical design for different bodily regions.

Conclusions:

W-plasty represents a popular technique in reconstructive plastic surgery practice. We believe that the exact W-plasty design should be guided by the relaxed skin tension line definition and to this effect propose 2 main variants of geometrical design pertinent to the index anatomical site.
Evaluation of Corneal Morphology in Patients With Hemifacial Spasm
Authors: Ulusoy Döndü Melek , Ulusoy Ersin Kasim , Duru Zeynep , Çiçek Ayşe
Published: April 2019

Purpose:

To determine whether the corneal topographic parameter values, individual corneal layer thicknesses, and its endothelial layer morphology are different in patients with hemifacial spasm (HFS) than in the control contralateral eye.

Methods:

This study was designed as a prospective study. Among patients who applied to our hospital within the past 3-year period, those with HFS in one eye (study eyes) and a completely normal contralateral eye (control eyes) were included in this study. In addition to a complete ophthalmologic examination, all patients were scanned by the Pentacam Scheimpflug camera, and a corneal endothelium cell count was taken using a Topcon Specular Microscope. Also, the thickness of the corneal sublayers was measured on the central cornea with anterior segment module of spectral domain optical coherence tomography. Data entered using SPSS software were then evaluated by paired t test; P<0.05 value was considered statistically significant.

Results:

Twenty-eight patients (16 women and 12 men) were evaluated. Steep K, Kmax, and astigmatism values were significantly higher in the study eyes of patients with HFS than in the control eyes (P<0.05, for all). In addition, the total corneal thickness and corneal stromal thickness measurements in the study eyes were statistically significantly thinner than the control eyes (P=0.04 and P<0.001, respectively). Specular microscopy parameters were not statistically significant between the study eyes and control eyes (P>0.05, for all).

Conclusion:

Corneal stromal thinning suggests that chronic exposure to hypoxia may induce this effect through extracellular matrix remodeling and losses in collagen framework content in patients with HFS.
Description of the Treatment Course by Pregabalin for Anxiety in Patients With a Major Neurocognitive Disorder
Authors: Novais Teddy , Doutone Audrey , Gombault Caroline , Krolak-Salmon Pierre , Lepetit Alexis , Mouchoux Christelle
Published: April 2019

Background

Anxiety symptoms frequently experienced by patients with a major neurocognitive disorder (NCD) are often treated with long-term benzodiazepines despite known adverse effects. Pregabalin has shown efficacy in generalized anxiety disorders but has not been studied in patients with a major NCD. The objective of this study was to describe the use of pregabalin for anxiety in patient with a major NCD and the impact of its use on the pharmacological treatment change.

Methods

A retrospective study was conducted using data of hospitalized patients in a cognitive-behavioral specialized unit between January 2015 and December 2017. Patients with a major NCD treated by pregabalin were included in this study. Data about the use of pregabalin (initiation and effective dosage, titration duration) and the use of other psychotropics were collected from the patients' medical records.

Results

Thirty-three patients were included (mean age, 79.6 ± 11.7 years; 66.7% women). The mean duration of pregabalin titration was 18.6 ± 1.4 days, and the mean effective dosage was 200.0 ± 130.8 mg/d (range, 50–700 mg/d). At admission (before pregabalin use), 78.8% of patients were treated with a systematic prescription of benzodiazepine. At discharge (with pregabalin use), a significant decrease in patients with systematic prescription of benzodiazepine was observed (78.8% vs 33.3%, P = 0.001). During hospitalizations, no pregabalin treatment has been discontinued for lack of efficacy or for tolerance.

Conclusions

Larger controlled studies are needed to confirm the efficacy and the safety of pregabalin to treat anxiety symptoms associated with neurocognitive disorders.
Systematic Review of Gender Bias in the Clinical Trials of New Long-Acting Antipsychotic Drugs
Authors: Santos-Casado María , García-Avello Adela
Published: April 2019

Purpose/Background

This article evaluates gender bias in the published clinical trials of new long-acting antipsychotics.

Methods/Procedures

We conducted a review of controlled clinical trials of the new prolonged-release antipsychotics (aripiprazole, risperidone, or paliperidone) for the treatment of schizophrenia published in MEDLINE over the last 10 years and available in full text in English. The study followed the corresponding international recommendations.

Results

We identified 132 trials, and of these, 40 met the inclusion and exclusion criteria. We found that only 36.41% of the total patients were women. The separate analysis of the main variable between the subpopulations of men and women was carried out in only 6 of the 40 works included. In contrast, in 15 trials, this analysis was performed on secondary variables, generally related to safety. Only 3 of the 40 trials discussed the results separately according to sex.

Conclusions

The clinical trials of long-acting atypical antipsychotic drugs show a far-from-negligible gender bias. Women are underrepresented, and the main and secondary variables are not analyzed separately according to gender. This is despite international recommendations establishing these criteria as part of a package of minimum requirements for meeting scientific validity and making results apt to extrapolate to the general population of patients.