bluuebunny/crossref_metadata_2025 huggingface dataset:
Where and When to Cut? Fluorescein Guidance for Brain Stem and Spinal Cord Tumor Surgery—Technical Note
Authors: Suero Molina Eric , Stummer Walter
Published: December 2017

BACKGROUND

Spinal cord and brain stem lesions require a judicious approach with an optimized trajectory due to a clustering of functions on their surfaces. Intraoperative mapping helps locate function. To confidently locate such lesions, neuronavigation alone lacks the desired accuracy and is of limited use in the spinal cord.

OBJECTIVE

To evaluate the clinical value of fluoresceins for initial delineation of such critically located lesions.

METHODS

We evaluated fluorescein guidance in the surgical resection of lesions with blood-brain barrier disruption demonstrating contrast enhancement in magnet resonance imaging in the spinal cord and in the brain stem in 3 different patients. Two patients harbored a diffuse cervical and thoracic spinal cord lesion, respectively. Another patient suffered metastatic lesions in the brain stem and at the floor of the fourth ventricle. Low-dose fluorescein (4 mg/kg body weight) was applied after anesthesia induction and visualized using the Zeiss Pentero 900 Yellow560 filter (Carl Zeiss, Oberkochen, Germany).

RESULTS

Fluorescein was helpful for locating lesions and for defining the best possible trajectory. During resection, however, we found unspecific propagation of fluorescein within the brain stem up to 6 mm within 3 h after application. As these lesions were otherwise distinguishable from surrounding tissue, monitoring resection was not an issue.

CONCLUSION

Fluorescein guidance is a feasible tool for defining surgical entry zones when aiming for surgical removal of spinal cord and brain stem lesions. Unselective fluorescein extravasation cautions against using such methodology for monitoring completeness of resection. Providing the right timing, a window of pseudoselectivity could increase fluoresceins’ clinical value in these cases.
Diverse Chromosomal Locations of Quantitative Trait Loci for Tolerance to Maize chlorotic mottle virus in Five Maize Populations
Authors: Jones Mark W. , Penning Bryan W. , Jamann Tiffany M. , Glaubitz Jeff C. , Romay Cinta , Buckler Edward S. , Redinbaugh Margaret G.
Published: December 2017

The recent rapid emergence of maize lethal necrosis (MLN), caused by coinfection of maize with Maize chlorotic mottle virus (MCMV) and a second virus usually from the family Potyviridae, is causing extensive losses for farmers in East Africa, Southeast Asia, and South America. Although the genetic basis of resistance to potyviruses is well understood in maize, little was known about resistance to MCMV. The responses of five maize inbred lines (KS23-5, KS23-6, N211, DR, and Oh1VI) to inoculation with MCMV, Sugarcane mosaic virus, and MLN were characterized. All five lines developed fewer symptoms than susceptible controls after inoculation with MCMV; however, the virus was detected in systemic leaf tissue from each of the lines similarly to susceptible controls, indicating that the lines were tolerant of MCMV rather than resistant to it. Except for KS23-5, the inbred lines also developed fewer symptoms after inoculation with MLN than susceptible controls. To identify genetic loci associated with MCMV tolerance, large F2 or recombinant inbred populations were evaluated for their phenotypic responses to MCMV, and the most resistant and susceptible plants were genotyped by sequencing. One to four quantitative trait loci (QTL) were identified in each tolerant population using recombination frequency and positional mapping strategies. In contrast to previous studies of virus resistance in maize, the chromosomal positions and genetic character of the QTL were unique to each population. The results suggest that different, genotype-specific mechanisms are associated with MCMV tolerance in maize. These results will allow for the development of markers for marker-assisted selection of MCMV- and MLN-tolerant maize hybrids for disease control.
Effect of Blast Injury on Auditory Localization in Military Service Members
Authors: Kubli Lina R. , Brungart Douglas , Northern Jerry
Published: December 2017

Objectives:

Among the many advantages of binaural hearing are the abilities to localize sounds in space and to attend to one sound in the presence of many sounds. Binaural hearing provides benefits for all listeners, but it may be especially critical for military personnel who must maintain situational awareness in complex tactical environments with multiple speech and noise sources. There is concern that Military Service Members who have been exposed to one or more high-intensity blasts during their tour of duty may have difficulty with binaural and spatial ability due to degradation in auditory and cognitive processes. The primary objective of this study was to assess the ability of blast-exposed Military Service Members to localize speech sounds in quiet and in multisource environments with one or two competing talkers.

Design:

Participants were presented with one, two, or three topic-related (e.g., sports, food, travel) sentences under headphones and required to attend to, and then locate the source of, the sentence pertaining to a prespecified target topic within a virtual space. The listener’s head position was monitored by a head-mounted tracking device that continuously updated the apparent spatial location of the target and competing speech sounds as the subject turned within the virtual space. Measurements of auditory localization ability included mean absolute error in locating the source of the target sentence, the time it took to locate the target sentence within 30 degrees, target/competitor confusion errors, response time, and cumulative head motion. Twenty-one blast-exposed Active-Duty or Veteran Military Service Members (blast-exposed group) and 33 non-blast-exposed Service Members and beneficiaries (control group) were evaluated.

Results:

In general, the blast-exposed group performed as well as the control group if the task involved localizing the source of a single speech target. However, if the task involved two or three simultaneous talkers, localization ability was compromised for some participants in the blast-exposed group. Blast-exposed participants were less accurate in their localization responses and required more exploratory head movements to find the location of the target talker.

Conclusions:

Results suggest that blast-exposed participants have more difficulty than non-blast-exposed participants in localizing sounds in complex acoustic environments. This apparent deficit in spatial hearing ability highlights the need to develop new diagnostic tests using complex listening tasks that involve multiple sound sources that require speech segregation and comprehension.
Effects of Amplification on Neural Phase Locking, Amplitude, and Latency to a Speech Syllable
Authors: Jenkins Kimberly A. , Fodor Calli , Presacco Alessandro , Anderson Samira
Published: December 2017

Objective:

Older adults often have trouble adjusting to hearing aids when they start wearing them for the first time. Probe microphone measurements verify appropriate levels of amplification up to the tympanic membrane. Little is known, however, about the effects of amplification on auditory-evoked responses to speech stimuli during initial hearing aid use. The present study assesses the effects of amplification on neural encoding of a speech signal in older adults using hearing aids for the first time. It was hypothesized that amplification results in improved stimulus encoding (higher amplitudes, improved phase locking, and earlier latencies), with greater effects for the regions of the signal that are less audible.

Design:

Thirty-seven adults, aged 60 to 85 years with mild to severe sensorineural hearing loss and no prior hearing aid use, were bilaterally fit with Widex Dream 440 receiver-in-the-ear hearing aids. Probe microphone measures were used to adjust the gain of the hearing aids and verify the fitting. Unaided and aided frequency-following responses and cortical auditory-evoked potentials to the stimulus /ga/ were recorded in sound field over the course of 2 days for three conditions: 65 dB SPL and 80 dB SPL in quiet, and 80 dB SPL in six-talker babble (+10 signal to noise ratio).

Results:

Responses from midbrain were analyzed in the time regions corresponding to the consonant transition (18 to 68 ms) and the steady state vowel (68 to 170 ms). Generally, amplification increased phase locking and amplitude and decreased latency for the region and presentation conditions that had lower stimulus amplitudes—the transition region and 65 dB SPL level. Responses from cortex showed decreased latency for P1, but an unexpected decrease in N1 amplitude. Previous studies have demonstrated an exaggerated cortical representation of speech in older adults compared to younger adults, possibly because of an increase in neural resources necessary to encode the signal. Therefore, a decrease in N1 amplitude with amplification and with increased presentation level may suggest that amplification decreases the neural resources necessary for cortical encoding.

Conclusion:

Increased phase locking and amplitude and decreased latency in midbrain suggest that amplification may improve neural representation of the speech signal in new hearing aid users. The improvement with amplification was also found in cortex, and, in particular, decreased P1 latencies and lower N1 amplitudes may indicate greater neural efficiency. Further investigations will evaluate changes in subcortical and cortical responses during the first 6 months of hearing aid use.
Bending the Arc of the Trilobed Flap Through External Interlobe Angle Inequality
Authors: Wang Chang Ye , Armbrecht Eric S. , Burkemper Nicole M. , Glaser Dee Anna , Maher Ian A.
Published: December 2017

BACKGROUND

The trilobed flap is a useful repair option for distal nasal defects. In certain cases, however, the placement of its quaternary defect may risk compression of the internal nasal valve or induction of ectropion. In this study, we propose a modified design of the trilobed flap, which uses unequal external interlobe angles.

OBJECTIVE

To present the design principles and results of our modified trilobed flap for the reconstruction of difficult distal nasal Mohs defects.

MATERIALS AND METHODS

Mohs defects of 26 patients were reconstructed (21 with long-term follow-up) using our modified trilobed flap over 1 year. Two independent masked raters graded postoperative photographs for alar symmetry and overall cosmesis.

RESULTS

Median alar symmetry scores were excellent and overall cosmesis grades were between excellent and very good.

CONCLUSION

The modified trilobed flap with unequal external angles offers an excellent option for reconstruction of Mohs defect of the distal nose that may not be well-suited for other repairs. Over 1 year, 21 modified trilobed repairs were performed with overall excellent outcomes.
A systematic review of intravaginal testosterone for the treatment of vulvovaginal atrophy
Authors: Bell Robin J. , Rizvi Farwa , Islam Rakabul M. , Davis Susan R.
Published: December 2017

Objectives:

Intravaginal testosterone has emerged as a potential treatment for vulvovaginal atrophy (VVA) in women, in general, and women taking an aromatase inhibitor (AI). A systematic review of the literature was undertaken to determine whether available clinical trial data support efficacy and safety of intravaginal testosterone for the treatment of VVA.

Methods:

Scopus, MEDLINE, EMBASE, and the Cochrane Library databases were systematically searched on July 26, 2017, for human studies published in English of clinical trials of intravaginal testosterone.

Results:

Six separate clinical trials were identified that ranged in size from 10 to 80 participants, with either single dose, or durations of 4 to 12 weeks. Only one study incorporated a double-blind design. Three studies were of women taking an AI.

Taken together, the studies suggest that intravaginal testosterone may lower vaginal pH, increase the proportion of vaginal lactobacilli, and possibly improve the vaginal maturation index. The lack of a placebo treatment in four studies, and failure to adjust for baseline differences, resulted in uncertainty of the effect on sexual function. Safety remains uncertain because of the small number of women exposed, short study durations, and inconsistent and incomplete outcome reporting for sex steroid levels.

Conclusion:

Adequately powered double-blind, placebo-controlled clinical trials of intravaginal testosterone therapy are needed to establish both efficacy and safety.
Descriptive Analysis of the Arterial Supply to the Auricle in Patients with Unilateral Microtia
Authors: Márquez-Gutiérrez Erik Agustín , Gutiérrez-Gómez del Hierro Claudia , Rodríguez-Quintero Jorge Humberto , Pereyra-Arzate Jorge Enrique , Rivera-Martínez Rodolfo
Published: December 2017

Background:

Microtia is a congenital auricular deformity that occurs in 1:5,000–10,000 births. It can cause severe impairment to the patient’s self-esteem and problems regarding social integration. Multiple measures have been described in attempt to better operative outcomes of these patients. We used computed tomography (CT) angiography to analyze the vascular pattern of the auricular region before surgery.

Methods:

Fourteen patients with unilateral microtia were included. All underwent CT angiogram plus tridimensional reconstruction. Both healthy and microtic auricles were analyzed descriptively in terms of main arterial supply, pattern, diameter of subbranches, and angulation. The sample was divided in 2 age groups for better understanding of the data.

Results:

Blood supply to the auricle was found to depend on 2 main vessels: temporal superficial artery (TSA) and its subbranches (superior, middle, and lower branch) and posterior auricular (PA) artery. In the microtic group, TSA was the dominant artery in 13 of 14 cases (92%). Superior, middle, and inferior branches were present in 4, 3, and 0 cases, respectively. Three of the microtic auricles presented supply from PA artery, from which in 1 case, it represented the only supply to the region.

Conclusions:

There is wide variability in the blood supply of both healthy and microtic auricles; however, we were able to identify some tendencies in our sample. Further research is needed to prove the benefit of a preoperative imaging study in these patients. Still, in our experience, we found it useful as a complement for surgical planning.
Active Voluntary Contraction of the Ruptured Muscle Tendon during the Wide-awake Tendon Reconstruction
Authors: Zukawa Mineyuki , Osada Ryusuke , Makino Hiroto , Kimura Tomoatsu
Published: December 2017

Purpose:

The purpose of this study was to measure the active voluntary contraction distances of ruptured musculotendinous units during wide-awake tendon reconstruction surgery and to investigate the relationships between active contraction distance and the passive distraction distance and the time elapsed before reconstruction.

Methods:

The passive distraction distance and active contraction distance of 36 tendons of 22 patients who underwent forearm tendon transfer or tendon graft during wide-awake surgery were measured.

Results:

The passive distraction distance was significantly related to the active contraction distance of the ruptured musculotendinous unit (r = 0.60, P < 0.05). The passive distraction distance accounted for approximately half of the total excursion of the musculotendinous unit. There was no significant correlation between each distance and the time elapsed before reconstruction.

Conclusions:

The passive distraction distance was significantly related to the active contraction distance of the ruptured musculotendinous unit in vivo during wide-awake surgery. Active musculotendinous unit contraction distance may be a useful index to evaluate ruptured musculotendinous unit degeneration and donor muscle function in standard tendon reconstruction. This study suggested that the advantages of the wide-awake approach were not just as a clinical tool but also as an in vivo research tool.
Internal Mammary Vessels’ Impact on Abdominal Skin Perfusion in Free Abdominal Flap Breast Reconstruction
Authors: Nergård Solveig , Mercer James B. , de Weerd Louis
Published: December 2017

Background:

Wound healing problems at the donor site in free abdominal flap breast reconstruction cause significant morbidity to patients. No studies have investigated what impact the use of the internal mammary artery in free abdominal flap breast reconstruction has on abdominal skin perfusion. We hypothesized that harvesting the internal mammary vessels (IMV) has a negative effect on abdominal skin perfusion.

Methods:

The abdomen and anterior thoracic wall of 17 patients scheduled for secondary free abdominal flap breast reconstruction using IMV was pre-, intra-, and postoperatively examined with dynamic infrared thermography. Qualitative and quantitative analyses of the rate and pattern of recovery in Huger’s vascular zones were made with each patient being its own control. Zone III on the side where IMV were used was numbered zone IV. The contralateral zone III was used as reference.

Results:

Postoperative abdominal skin perfusion in zone IV was always significantly reduced compared with zone III (1-tailed t test, P < 0.05). The difference between zones II and III was statistically significant for day 1 and 3, but not for day 6 (2-tailed t test, P < 0.05). Skin perfusion in zones II and IV increased during consecutive postoperative days with an increase of hot spots in these areas.

Conclusions:

Using the IMV in free abdominal flap breast reconstruction had a significant effect on abdominal skin perfusion and may contribute to abdominal wound healing problems. The reperfusion of the abdominal skin was a dynamic process showing an increase in perfusion in the affected areas during the postoperative days.
COLORADO AGE-RELATED MACULAR DEGENERATION REGISTRY
Authors: Lynch Anne M. , Patnaik Jennifer L. , Cathcart Jennifer N. , Mathias Marc T. , Siringo Frank S. , Lacey Echalier E. , Wagner Brandie D. , Oliver Scott C.N. , Pecen Paula E. , Olson Jeffrey L. , Fine Stuart L. , Palestine Alan G. , Mandava Naresh
Published: December 2017

Purpose:

To study new and existing risk factors related to age-related macular degeneration (AMD) phenotypes in a Colorado cohort.

Methods:

Age-related macular degeneration was categorized into early, intermediate, or advanced forms. Controls (n = 180) were patients with cataract and no AMD. Demographic and clinical data were gathered by patient interview and verified by chart review. Image data were reviewed by vitreoretinal specialists. Statistical analysis included univariable and multivariate logistic regression analysis (P < 0.05).

Results:

Among the 456 patients with AMD, 157 (34.4%), 80 (17.6%), and 219 (48.0%) had the early/intermediate, geographic atrophy, and neovascular forms of the disease, respectively. Adjusted for age, African-American race was associated with a reduced risk of early/intermediate (adjusted odds ratio [AOR] = 0.08, confidence interval [CI] = 0.01–0.67) and neovascular AMD (AOR = 0.15, CI = 0.03–0.72). A family history of AMD was a risk factor for early/intermediate (AOR = 4.08, CI = 2.30–7.25), geographic atrophy (AOR = 8.62, CI = 3.77–19.7), and neovascular AMD (AOR = 3.76, CI = 2.16–6.56). A history of asthma was related to the early/intermediate form of AMD (AOR = 2.34, CI = 1.22–4.46).

Conclusion:

Studying AMD in specific populations may reveal novel risk factors such as our finding of a relationship between asthma history and AMD.
INVISIBLE, HONEYCOMB-LIKE, CAVITARY RETINAL ASTROCYTIC HAMARTOMA
Authors: Mellen Phoebe L. , Sioufi Kareem , Shields Jerry A. , Shields Carol L.
Published: December 2017

Purpose:

To report a patient with clinically invisible retinal astrocytic hamartomas (RAHs) detected on optical coherence tomography (OCT) and studied with OCT angiography (OCTA).

Method:

Case report.

Results:

An 11-year-old healthy girl was evaluated for reduced visual acuity in the right eye. On examination, best-corrected visual acuity was 20/50 in the right eye and 20/20 in the left eye. Fundus examination revealed blunted foveal reflex in the right eye and normal findings in the left eye. Optical coherence tomography disclosed an abruptly elevated, honeycomb-like macular mass with thin filamentous walls in the right eye, limited to the nerve fiber layer and measuring 756 μm in thickness. The numerous intralesional cavities (optically empty spaces) displayed no calcification. These findings were consistent with Type IV RAH. Optical coherence tomography of the left eye revealed intact foveola and focal nerve fiber layer thickening inferiorly without cavity, measuring 136 μm in thickness, consistent with Type I RAH. En face OCTA detected microvascular flow within the walls of the cavitary RAH in the right eye. Bilateral RAH in a child with no systemic evidence of tuberous sclerosis syndrome was established.

Conclusion:

Multimodal imaging is important in revealing causes of visual loss and in the detection of subclinical fundus tumors. In this case, clinically invisible RAHs were detected only by OCT and surrounding vascular flow by OCTA.
Integrated Spanish Language Training: Learners' Expanded Spanish Vocabulary and Positive Perceptions After 4 Semesters
Authors: Villarreal Evelyn , Pechak Celia
Published: December 2017

Introduction.

Spanish-speaking individuals with limited English proficiency face health disparities. In response, The University of Texas at El Paso (UTEP) Doctor of Physical Therapy (DPT) Program has integrated Spanish training across their curriculum to better serve this population. The purpose of this study was to evaluate the effects of this training.

Methods.

Participants were first-year students from the UTEP DPT Program. Students enrolled in a required 8-week, 1-credit beginner or advanced Spanish medical terminology course in their first semester. In addition, they practiced Spanish during laboratory and service-learning experiences. The students completed pretests in the first semester and posttests in their fifth semester: self-ratings of their ability to speak, understand, read, and write Spanish; a written Spanish vocabulary test; and a questionnaire about their beliefs and attitudes about Spanish language training. A repeated-measures two-way analysis of variance was used to analyze self-ratings and vocabulary test scores. Descriptive statistics and paired t tests were used to analyze the data from the pre- and post-questionnaires.

Results.

There were significant improvements in self-ratings of speaking, understanding, reading, and writing Spanish (P < .001). There was significant improvement in vocabulary test scores (P < .001); no significant difference was seen between beginning and advanced students (P = .097). Results from the questionnaires suggest that students recognize personal and professional benefits from learning Spanish.

Discussion and Conclusion.

This study supports that the UTEP DPT Program's Spanish language training model improved self-ratings of Spanish proficiency and increased Spanish vocabulary. In addition, students had an overall positive attitude about learning Spanish. Future research is indicated to determine whether self-ratings of proficiency are correlated with observed Spanish proficiency in a clinical setting.
Defining Underrepresented Minorities and Promoting Holistic Review Admission Strategies in Physical Therapist Education
Authors: Wise Denise , Dominguez Jesus , Kapasi Zoher , Williams-York Bernadette , Moerchen Victoria , Brooks Salome , Ross Libby J.
Published: December 2017

Background and Purpose.

Given the changing demographics of the United States, it is important for Doctor of Physical Therapy (DPT) education programs to address how best to recruit and retain students who will be able to provide culturally competent and sensitive care. Compared with the general population, the racial and ethnic diversity of professional membership in the American Physical Therapy Association and applications to and acceptance in professional physical therapist education programs has remained relatively static and does not mirror the diversity of the population at large.

Position and Rationale.

To best determine effective recruitment and retention strategies to address this shortfall in PT education, it is necessary to have (1) a unifying definition of underrepresented minorities (URMs) in physical therapy education and (2) an understanding of what is currently being done to promote a diverse student body. The American Council of Academic Physical Therapy empaneled its Diversity Task Force in January 2013 to address these two issues. This position paper reports on the efforts of the Diversity Task Force in developing a working definition of URMs in physical therapy education that reaches beyond traditional racial and ethnic descriptors, along with supporting information from a survey of entry-level DPT program directors on barriers to increasing diversity within the professional PT student population and strategies currently in place to overcome them.

Discussion and Conclusion.

Based on a uniform definition of URMs and the current status of recruitment/retention policies and practices designed to foster a diverse student population, we conclude that ongoing work is needed to increase diversity within DPT education and that utilization of a holistic application review process for admissions is one method to increase diversity.
Student Perception of Preparedness for Clinical Management of Adults With Lifelong Disability Using a Standardized Patient Assessment
Authors: Dannemiller Lisa , Basha Elshimaa , Kriekels Wendy , Nordon-Craft Amy
Published: December 2017

Background and Purpose.

A need exists to increase entry-level Doctor of Physical Therapy student exposure to adults with lifelong disability using novel educational methods. The purpose of this project was to determine whether student perception of preparedness with the knowledge, skills, and attitudes required for the management of lifelong disability was enhanced by the use of a standardized patient (SP) assessment experience with actors trained as adults with cerebral palsy (CP).

Method/Model Description and Evaluation.

An SP case about a young adult with CP was developed, and an assessment was implemented by a team of faculty members in a neuromuscular management track. Entry-level physical therapy students in their fifth of 7 semesters completed a survey about their perception of preparedness in the 3 learning domains at 3 time points, before (time 1) and after (time 2) the SP assessment and after a 10-week clinical education experience (time 3).

Outcomes.

Fifty-one students completed a series of 3 surveys. There was no change in student perception of preparation with the knowledge required for physical therapist management of an adult with CP at the 3 time points. Student perception of preparation with skills was increased significantly at time 2 and was maintained at time 3. Student perception of preparation with attitudes was also significantly increased at time 2, but returned to original levels at time 3.

Discussion and Conclusion.

Use of an SP experience was an educational assessment method that resulted in enhanced student perception of preparedness with the skills and attitudes necessary to work with adults with CP. Physical therapy programs may consider this method to address the need for creative educational strategies to address physical therapist management of lifelong disability.
Comparison of Surgical Strategies between Proximal Nerve Graft and/or Nerve Transfer and Distal Nerve Transfer Based on Functional Restoration of Elbow Flexion: A Retrospective Review of 147 Patients
Authors: Hu Ching-Hsuan , Chang Tommy Nai-Jen , Lu Johnny Chuieng-Yi , Laurence Vincent G. , Chuang David Chwei-Chin
Published: December 2017

Background:

Surgical strategy to treat incomplete brachial plexus injury with palsies of the shoulder and elbow by using proximal nerve graft/transfer or distal nerve transfer is still debated. The aim of this study was to compare both strategies with respect to the recovery of elbow flexion.

Methods:

One hundred forty-seven patients were enrolled: 76 patients underwent reconstruction using proximal nerve graft/transfer, and 71 patients underwent reconstruction using distal nerve transfer. All patients were evaluated preoperatively and postoperatively to assess the recovery rate and muscle strength of elbow flexion. Shoulder abduction and hand grip power were also recorded to assess any concomitant postoperative changes between the two methods.

Results:

The best recovery rate for functional elbow flexion (p = 0.006) and the fastest recovery to M3 strength (p < 0.001) were found in the double fascicular transfer group. However, recovery of shoulder abduction with proximal nerve graft/transfer was significantly better than with distal nerve transfer (80.3 percent versus 66.2 percent in shoulder abduction ≥60 degrees; and 56.6 percent versus 38.0 percent in shoulder abduction ≥90 degrees). A significant decrease in grip strength between the operative and nonoperative hands was also found in patients undergoing distal nerve transfer (p = 0.001).

Conclusions:

Proximal nerve graft/transfer offers more accurate diagnosis and proper treatment to restore shoulder and elbow function simultaneously. Distal nerve transfer can offer more efficient elbow flexion. Combined, both strategies in primary nerve reconstruction are especially recommended when there is no healthy or not enough donor nerve available.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Evidence-Based Medicine: Current Practices in Rhinoplasty
Authors: Tanna Neil , Nguyen Khang T. , Ghavami Ashkan , Calvert Jay W. , Guyuron Bahman , Rohrich Rod J. , Gruber Ronald P.
Published: December 2017

Learning Objectives:

After studying this article, the participant should be able to: 1. Perform aesthetic and functional nasal analysis to guide septorhinoplasty. 2. Recognize common complications associated with rhinoplasty. 3. Select appropriate septorhinoplasty techniques to refine nasal aesthetics and treat nasal airway obstruction. 4. Identify factors leading to poor patient satisfaction following rhinoplasty.

Septorhinoplasty is among the most technically challenging procedures in the realm of plastic and reconstructive surgery. Moreover, it is a constantly evolving topic with extensive background literature. Surgeons must be comfortable with the traditional knowledge base and the current practices in the field. This article reviews the latest thinking on patient selection, functional indications, aesthetic analysis, and operative techniques in septorhinoplasty, with an emphasis on key cartilage grafting and tip suture techniques.
Involvement in Root Cause Analysis and Patient Safety Culture Among Hospital Care Providers
Authors: Boussat Bastien , Seigneurin Arnaud , Giai Joris , Kamalanavin Kevin , Labarère José , François Patrice
Published: December 2017

Background

The experience feedback committee (EFC) is a tool designed to involve medical teams in patient safety management, through root cause analysis within the team.

Objective

The aim of the study was to determine whether patient safety culture, as measured by the Hospital Survey on Patient Safety Culture (HSOPS), differed regarding care provider involvement in EFC activities.

Methods

Using the original data from a cross-sectional survey of 5064 employees at a single university hospital in France, we analyzed the differences in HSOPS dimension scores according involvement in EFC activities.

Results

Of 5064 eligible employees, 3888 (76.8%) participated in the study. Among the respondents, 440 (11.3%) participated in EFC activities. Experience feedback committee participants had a more developed patient safety culture, with 9 of the 12 HSOPS dimension scores significantly higher than EFC nonparticipants (overall effect size = 0.31, 95% confidence interval = 0.21 to 0.41, P < 0.001). A multivariate analysis of variance indicated that all 12 dimension scores, taken together, were significantly different between EFC participants and nonparticipants (P < 0.0001), independently of sex, hospital department, and healthcare profession category. The largest differences in scores related to the “feedback and communication about error,” “organizational learning,” and “Nonpunitive response to error” dimensions. The analysis of the subgroup of professionals who worked in a department with a productive EFC, defined as an EFC implementing at least five actions per year, showed a higher patient safety culture level for seven of the 12 HSOPS dimensions (overall effect size = 0.19, 95% confidence interval = 0.10 to 0.27, P < 0.001).

Discussion and Conclusions

Participation in EFC activities was associated with higher patient safety culture scores. The findings suggest that root cause analysis in the team’s routine may improve patient safety culture.
Retention in HIV Care During Pregnancy and the Postpartum Period in the Option B+ Era: Systematic Review and Meta-Analysis of Studies in Africa
Authors: Knettel Brandon A. , Cichowitz Cody , Ngocho James Samwel , Knippler Elizabeth T. , Chumba Lilian N. , Mmbaga Blandina T. , Watt Melissa H.
Published: December 2017

Background:

Under Option B+ guidelines for prevention of mother-to-child transmission of HIV, pregnant and breastfeeding women initiate antiretroviral therapy for lifelong use. The objectives of this study were: (1) to synthesize data on retention in care over time in option B+ programs in Africa, and (2) to identify factors associated with retention in care.

Methods:

PubMed, EMBASE, and African Index Medicus were systematically searched from January 2012 to June 2017. Pooled estimates of the proportion of women retained were generated and factors associated with retention were analyzed thematically.

Results:

Thirty-five articles were included in the final review; 22 reported retention rates (n = 60,890) and 25 reported factors associated with retention. Pooled estimates of retention were 72.9% (95% confidence interval: 66.4% to 78.9%) at 6 months for studies reporting <12 months of follow-up and 76.4% (95% confidence interval: 69.0% to 83.1%) at 12 months for studies reporting ≥12 months of follow-up. Data on undocumented clinic transfers were largely absent. Risk factors for poor retention included younger age, initiating antiretroviral therapy on the same day as diagnosis, initiating during pregnancy versus breastfeeding, and initiating late in the pregnancy. Retention was compromised by stigma, fear of disclosure, and lack of social support.

Conclusions:

Retention rates in prevention of mother-to-child transmission under option B+ were below those of the general adult population, necessitating interventions targeting the complex circumstances of women initiating care under option B+. Improved and standardized procedures to track and report retention are needed to accurately represent care engagement and capture undocumented transfers within the health system.
HBV or HCV Coinfection in HIV-1-Infected Pregnant Women in France: Prevalence and Pregnancy Outcomes
Authors: Benhammou Valérie , Tubiana Roland , Matheron Sophie , Sellier Pierre , Mandelbrot Laurent , Chenadec Jérôme Le , Marel Emmanuelle , Khoshnood Babak , Warszawski Josiane ,   for the ANRS CO1/CO11-EPF French Perinatal Cohort study group
Published: December 2017

Background:

Chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection is frequent in HIV-infected persons but their impact on pregnant HIV-infected women is understudied. We explored whether these coinfections are associated with adverse pregnancy outcomes and lower response to antiretroviral therapy (ART).

Methods:

Pregnancies in HIV-1–infected women included in the ANRS French Perinatal Cohort between 2005 and 2013 were analyzed if HBV and HCV infection statuses were available.

Results:

Among 4236 women, the prevalence of HBV (HBs Ag+) and HCV (RNA+) were 6.2% (95% confidence interval: 5.4 to 6.8) and 1.7% (1.3 to 2.1), respectively. HCV coinfection was strongly associated with a history of drug use; HBV coinfection was 6 times more frequent in women born in Sub-Saharan Africa than in European France. Baseline HIV viral load, CD4 count, and HIV care during pregnancy were similar in coinfected and monoinfected HIV mothers, except that 90% of HBV/HIV women were receiving tenofovir and/or lamivudine or emtricitabine. HCV coinfection was significantly associated with cholestasis [adjusted odds ratio: 4.1 (1.5–10.8), P = 0.005], preterm delivery [3.0 (1.6–5.7), P < 0.001], lower CD4 [2.6 (1.0–6.4), P < 0.001], and detectable viral load [2.3 (1.0–5.5), P = 0.06] at the end of pregnancy. HBV coinfection was not associated with any of these outcomes.

Conclusions:

In HIV-infected women, chronic HBV infection, mostly treated using targeted ART, had no major impact on the course of pregnancy. By contrast, chronic HCV infection was associated with a higher risk of obstetrical complications and a poorer immune–virological response to ART. It is yet unknown whether cure of HCV infection before conception can limit these adverse outcomes.
Low-Dose Noncontrast Examination of the Paranasal Sinuses Using Volumetric Computed Tomography
Authors: Pirimoglu Berhan , Sade Recep , Sakat Muhammed Sedat , Ogul Hayri , Levent Akin , Kantarci Mecit
Published: December 2017

Objectives

The objective of this study was to evaluate image quality of low dose in noncontrast paranasal sinus computed tomography (CT) using single volumetric 320-row multidetector CT technique.

Methods

The low-dose protocol including tube voltage of 135 kV and tube current of 5 mAs was chosen based on results of the present phantom study. Forty-six patients were assigned to control group with factory standard settings (120 kVp, 75 mAs), and 46 patients were assigned to study group and underwent noncontrast CT of paranasal sinus with low-dose protocol using single volumetric 320-row multidetector CT device. Objective and subjective image qualities were performed.

Results

Effective radiation dose calculated for control group scans was 0.45 (SD, 0.39) mSv. It was 0.038 (SD, 0.004) mSv for study group scans. The effective radiation dose of study group was statistically significant lower than control group (P < 0.001).

Conclusions

Noncontrast paranasal sinus CT imaging can be performed at very low radiation exposure maintaining high image quality with 135 kVp and 5 mAs.
Preliminary Results of High-Precision Computed Diffusion Weighted Imaging for the Diagnosis of Hepatocellular Carcinoma at 3 Tesla
Authors: Akagi Motonori , Nakamura Yuko , Higaki Toru , Matsubara Yoshiko , Terada Hiroaki , Honda Yukiko , Tatsugami Fuminari , Baba Yasutaka , Iida Makoto , Awai Kazuo
Published: December 2017

Objective

To compare the utility of high-precision computed diffusion-weighted imaging (hc-DWI) and conventional computed DWI (cc-DWI) for the diagnosis of hepatocellular carcinoma (HCC) at 3 T.

Methods

We subjected 75 HCC patients to DWI (b-value 150 and 600 s/mm2). To generate hc-DWI we applied non-rigid image registration to avoid the mis-registration of images obtained with different b-values. We defined c-DWI with a b-value of 1500 s/mm2 using DWI with b-value 150 and 600 s/mm2 as cc-DWI, and c-DWI with b-value 1500 s/mm2 using registered DWI with b-value 150 and 600 s/mm2 as hc-DWI. A radiologist recorded the contrast ratio (CR) between HCC and the surrounding hepatic parenchyma.

Results

The CR for HCC was significantly higher on hc- than cc-DWIs (median 2.0 vs. 1.8, P < 0.01).

Conclusion

The CR of HCC can be improved with image registration, indicating that hc-DWI is more useful than cc-DWI for the diagnosis of HCC.
Divergent Effects of Hypertonic Fluid Resuscitation on Renal Pathophysiological and Structural Parameters in Rat Model of Lower Body Ischemia/Reperfusion-Induced Sterile Inflammation
Authors: Ergin Bulent , Zuurbier Coert J. , Kapucu Aysegul , Ince Can
Published: December 2017

The pathogenesis of acute kidney injury (AKI) is characterized by the deterioration of tissue perfusion and oxygenation and enhanced inflammation. The purpose of this study was to investigate whether or not the hemodynamic and inflammatory effects of hypertonic saline (HS) protect the kidney by promoting renal microcirculatory oxygenation and possible deleterious effects of HS due to its high sodium content on renal functional and structural injury following ischemia/reperfusion. Mechanically ventilated and anesthetized rats were randomly divided into four groups (n = 6 per group): a sham-operated control group; a group subjected to renal ischemia for 45 min by supra-aortic occlusion followed by 2 h of reperfusion (I/R); and I/R group treated with a continuous i.v. infusion (5 mL/kg/h) of either % 0.9 NaCl (IR+NS) or %10 NaCl (I/R+HS) after releasing the clamp. Systemic and renal hemodynamic, renal cortical (CμPO2), and medullar microcirculatory pO2 (MμPO2) are measured by the oxygen-dependent quenching of the phosphorescence lifetime technique. Renal functional, inflammatory, and tissues damage parameters were also assessed. HS, but not NS, treatment restored I/R-induced reduced mean arterial pressure, CμPO2, renal oxygen deliver (DO2ren), and consumption (VO2ren). HS caused a decrease in tubular sodium reabsorption (TNa+) that correlated with an elevation of fractional sodium excretion (EFNa+) and urine output. HS had an anti-inflammatory effect by reducing the levels TNF-α, IL-6, and hyaluronic acid in the renal tissue samples as compared with the I/R and I/R+NS groups (P < 0.05). HS treatment was also associated with mild acidosis and an increased renal tubular damage. Despite HS resuscitation improving the systemic hemodynamics, microcirculatory oxygenation, and renal oxygen consumption as well as inflammation, it should be limited or strictly controlled for long-term use because of provoking widespread renal structural damage.
Prehospital spine immobilization/spinal motion restriction in penetrating trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma (EAST)
Authors: Velopulos Catherine G. , Shihab Hasan M. , Lottenberg Lawrence , Feinman Marcie , Raja Ali , Salomone Jeffrey , Haut Elliott R.
Published: December 2017

BACKGROUND

Spine immobilization in trauma has remained an integral part of most emergency medical services protocols despite a lack of evidence for efficacy and concern for associated complications, especially in penetrating trauma patients. We reviewed the published evidence on the topic of prehospital spine immobilization or spinal motion restriction in adult patients with penetrating trauma to structure a practice management guideline.

METHODS

We conducted a Cochrane style systematic review and meta-analysis and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology to construct recommendations. Qualitative and quantitative analyses were used to evaluate the literature on the critical outcomes of mortality, neurologic deficit, and potentially reversible neurologic deficit.

RESULTS

A total of 24 studies met inclusion criteria, with qualitative review conducted for all studies. We used five studies for the quantitative review (meta-analysis). No study showed benefit to spine immobilization with regard to mortality and neurologic injury, even for patients with direct neck injury. Increased mortality was associated with spine immobilization, with risk ratio [RR], 2.4 (confidence interval [CI], 1.07–5.41). The rate of neurologic injury or potentially reversible injury was very low, ranging from 0.002 to 0.076 and 0.00034 to 0.055, with no statistically significant difference for neurologic deficit or potentially reversible deficit, RR, 4.16 (CI, 0.56–30.89), and RR, 1.19 (CI, 0.83–1.70), although the point estimates favored no immobilization.

CONCLUSION

Spine immobilization in penetrating trauma is associated with increased mortality and has not been shown to have a beneficial effect on mitigating neurologic deficits, even potentially reversible neurologic deficits. We recommend that spine immobilization not be used routinely for adult patients with penetrating trauma.

Level of Evidence

Systematic review with meta-analysis study, level III.
Interaction of quercetin with transcriptional regulator LasR of Pseudomonas aeruginosa: Mechanistic insights of the inhibition of virulence through quorum sensing
Authors: Grabski Hovakim , Hunanyan Lernik , Tiratsuyan Susanna , Vardapetyan Hrachik
Published: December 2017

Background

Pseudomonas aeruginosais one of the most dangerous superbugs in the list of bacteria for which new antibiotics are urgently needed, which was published by World Health Organization.P. aeruginosais an antibiotic-resistant opportunistic human pathogen. It affects patients with AIDS, cystic fibrosis, cancer, burn victims and people with prosthetics and implants.P. aeruginosaalso forms biofilms. Biofilms increase resistance to antibiotics and host immune responses. Because of biofilms, current therapies are not effective. It is important to find new antibacterial treatment strategies againstP. aeruginosa. Biofilm formation is regulated through a system called quorum sensing. Thus disrupting this system is considered a promising strategy to combat bacterial pathogenicity. It is known that quercetin inhibitsPseudomonas aeruginosabiofilm formation, but the mechanism of action is unknown. In the present study, we tried to analyse the mode of interactions of LasR with quercetin.

Results

We used a combination of molecular docking, molecular dynamics (MD) simulations and machine learning techniques for the study of the interaction of the LasR protein ofP. aeruginosawith quercetin. We assessed the conformational changes of the interaction and analysed the molecular details of the binding of quercetin with LasR. We show that quercetin has two binding modes. One binding mode is the interaction with ligand binding domain, this interaction is not competitive and it has also been shown experimentally. The second binding mode is the interaction with the bridge, it involves conservative amino acid interactions from LBD, SLR, and DBD and it is also not competitive. Experimental studies show hydroxyl group of ring A is necessary for inhibitory activity, in our model the hydroxyl group interacts with Leu177 during the second binding mode. This could explain the molecular mechanism of how quercetin inhibits LasR protein.

Conclusions

This study may offer insights on how quercetin inhibits quorum sensing circuitry by interacting with transcriptional regulator LasR. The capability of having two binding modes may explain why quercetin is effective at inhibiting biofilm formation and virulence gene expression.

List of abbreviations

PDB

Protein data bank

MD

Molecular Dynamics

PCA

Principal Component Analysis

PC

Principal Component

SLR

Short Linker Region

BLAST

Basic local alignment search tool

DBI

David-Bouldin Index

psF

pseudo-F statistic