bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurosurgical treatment for addiction: lessons from an untold story in China and a path forward
Authors: Ma Shuo , Zhang Chencheng , Yuan Ti-fei , Steele Douglas , Voon Valerie , Sun Bomin
Published: December 2019

Addiction is a major public-health crisis associated with significant disability and mortality. Although various pharmacological and behavioral treatments are currently available, the clinical efficacy of these treatments is limited. Given this situation, there is a growing interest in finding an effective neurosurgical treatment for addiction. First, we discuss the use of ablative surgery in treating addiction. We focus on the rise and fall of nucleus accumbens ablation for addiction in China. Subsequently, we review recent studies that have explored the efficacy and safety of deep-brain-stimulation treatment for addiction. We conclude that neurosurgical procedures, particularly deep-brain stimulation, have a potentially valuable role in the management of otherwise intractable addictive disorders. Larger well-controlled clinical trials, however, are needed to assess clinical efficacy and safety. We end by discussing several key issues involved in this clinical field and identifying some areas of progress.
Interplay Between Patient Colonization and Environmental Contamination With Vancomycin-Resistant Enterococci and Their Association With Patient Health Outcomes in Postacute Care
Authors: Cassone Marco , Zhu Ziwei , Mantey Julia , Gibson Kristen E , Perri Mary B , Zervos Marcus J , Snitkin Evan S , Foxman Betsy , Mody Lona
Published: December 2019

Background

The clinical utility of patient and environmental surveillance screening for vancomycin-resistant enterococci (VRE) in the postacute care setting has not been definitively clarified. We assessed the longitudinal relationship between patient colonization and room contamination, and we established their association with unfavorable health outcomes.

Methods

Four hundred sixty-three postacute care patients were followed longitudinally from enrollment to discharge for up to 6 months. Multiple body and environmental sites were sampled at regular intervals to establish correlation between environmental contamination and patient colonization and with longer than expected stay, unplanned hospitalization, and infections adjusting for sex, age, race, Charlson’s comorbidity index, and physical self-maintenance score.

Results

New VRE acquisition was more likely in patients residing in contaminated rooms (multivariable odds ratio [OR] = 3.75; 95% confidence interval [CI], 1.98–7.11) and vice versa (OR = 3.99; 95% CI, 2.16–7.51). New acquisition and new contamination were associated with increased length of stay (OR = 4.36, 95% CI = 1.86–10.2 and OR = 4.61, 95% CI = 1.92–11.0, respectively) and hospitalization (OR = 2.42, 95% CI = 1.39–4.22 and OR = 2.80, 95% CI = 1.52–5.12). New-onset infections were more common with higher VRE burdens (15% in the absence of VRE, 20% when after VRE isolation only on the patient or only in the room, and 29% after VRE isolation in both the patient and the room).

Conclusions

Room contamination with VRE is a risk factor for patient colonization, and both are associated with future adverse health outcomes in our postacute care patients. Further research is warranted to establish whether VRE screening may contribute to better understanding of risk assessment and adverse outcome prevention in postacute care.
Far-Lateral Approach for Medullary Cavernous Malformation: 2-Dimensional Operative Video
Authors: Hendricks Benjamin K , Spetzler Robert F
Published: December 2019

Medullary cavernous malformations are the rarest subtype of brainstem cavernous malformation and are associated with a high degree of morbidity. Selection of surgical candidates is critical, and cases are most favorable when the cavernous malformation abuts the surface of the brainstem. This limits the amount of native tissue transgressed during the resection. This patient had a large cavernous malformation within the caudal medulla eccentric. A right-sided paramedian far-lateral approach was used to access the brainstem. The cavernous malformation was readily apparent along the medullary surface and was dissected away in its entirety. Postoperative imaging confirmed complete resection. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Bonhoeffer and the Church Struggle
Authors: Hockenos Matthew D.
Published: December 2019

Dietrich Bonhoeffer’s unflinching opposition to the Nazi-backed German Christians and the Nazi state in the German Church Struggle (1933–45) led his more conservative colleagues in the Confessing Church to ostracize him and label him a radical. Along with Martin Niemöller he was one of the founders of the Pastors’ Emergency League in September 1933 and a devoted advocate of the 1934 Barmen Declaration and the Dahlem Resolution. As a pastor of a German parish in London and director of a Confessing Church seminary in Finkenwalde he continued his struggle against the heresies of the German Christians and their efforts to establish racial criteria for membership in the church, the so-called Aryan paragraph. As the Confessing Church’s primary contact with the ecumenical movement he kept Protestant leaders abroad informed about the Church Struggle. Bonhoeffer was one of the very few churchmen to speak out against Nazi persecution of Jews.
Music Education in the Generalist Classroom
Authors: Jeanneret Neryl , DeGraffenreid George M.
Published: December 2019

This article examines music in the generalist classroom, both its advantages and its challenges. The term “generalist” in this context refers to those teachers who have responsibility for all content areas of the primary/elementary curriculum. The article also addresses how best practices in music education can be embodied in generalist teachers' classrooms, and suggests that for effective music education in the generalist classroom, musical knowledge is not enough, and neither is confidence. Knowledge and confidence must be part of an integrated whole with a best practice pedagogy that is learner-centered and mindful of the multiple ways children learn and what each child brings to the classroom. There is also a need for generalist teachers to contextualize the knowledge of their students' development with regard to music learning, as they do with mathematics, language, or social studies.
Psychological and Physiological Aspects of Learning to Perform
Authors: Papageorgi Ioulia , Kopiez Reinhard
Published: December 2019

This article discusses psychological and physiological demands of learning to play a musical instrument and proposes ways of addressing them. It begins by discussing performance anxiety—one of the most common psychological problems experienced by musicians—and then considers physiological problems relating to sensorimotor and musculoskeletal functions. Next, the article looks at how musicians can address common psychological and physiological problems. Implications for teachers are also discussed, particularly concerning the assessment of students' susceptibility to performance anxiety and physical problems, as well as the development of critical skills in evaluating performance.
Theoretical and Empirical Foundations for Early Relationship Assessment in Evaluating Infant and Toddler Mental Health
Authors: Clark Roseanne , Tluczek Audrey , Moore Elizabeth C. , Evenson Amber L.
Published: December 2019

This chapter reviews the theoretical foundations and empirical support for employing a relational perspective when assessing the mental health of an infant or toddler. A review of specific measures widely used in assessing the quality of affect and behavior in parent–child interactions, relationship quality, and parenting capacities (see Clark, Tluczek, Moore, & Evenson, 2019, Chapter 3) illustrates the importance of utilizing a parent–child relationship paradigm in the assessment of the mental health and social and emotional functioning of infants and young children. Although the term parent is used throughout the chapter, another significant caregiver who holds a parenting or primary caregiving role may be substituted as needed, such as a grandparent or foster parent.
Exceptional Musical Abilities: Musical Prodigies
Authors: McPherson Gary E. , Lehmann Andreas C.
Published: December 2019

This article begins with discussions of theories of exceptional achievement developed by Renzulli, Mönks, and Gagné. Next, it considers the prevalence of exceptional achievement in the population; neuropsychological aspects of exceptional achievement; and the stages of talent development. The article then presents a case study of a young pianist, and concludes with suggestions for parents and teachers for identifying and supporting prodigies.
The Role of Higher Education in Fostering Musically Engaged Adults
Authors: Bowles Chelcy L. , Jensen Janet L.
Published: December 2019

This article examines the responsibilities and roles of higher education in fostering musically engaged adults by exploring three primary contexts: (a) the adult population within the university; (b) the adult population in the community in which the university resides; and (c) the interactive university-community adult population. Adults whose lives are enriched through musical engagement are more likely to have the passion and the power to advocate for, and facilitate musical engagement for others.
Commentary: Musical Creativity as Practice
Authors: Burnard Pamela
Published: December 2019

This article presents an overview of Section 4 of the Oxford Handbook of Music Education, Volume 2. It reviews notions of musical creativity and proposes a practice-based perspective for understanding the variegated types of musical creativity. It presents three vignettes showing how creativity in music is rendered differently in different contexts. It argues that in the field of music education, there is a need to promote practices that directly develop creativity. In doing so, individualistic approaches wedded to socio-historical foundations and traditional beliefs (which tend to be independent and autonomous from other fields of music) must be played down. Educators need to promote the power of relationships over individual minds, multiple worlds over singular realities, collaborative interdependence over individual heroism, and dialogue over alienation.
Music Education: An Unanswered Question
Authors: Gruhn Wilfried
Published: December 2019

Music education today is rife with proposals that appeal in different ways to different people. Finding objective criteria to establish new paradigms and evaluate its efficiency is difficult because music educators often work from personal experiences, subjective beliefs, or traditional ideologies. This article calls for a local and cultural consensus about the essence of the music that is being taught; the steps and stages of music learning which are individually performed; and the final goals and functions within a particular educational culture.
Improving Primary Teaching: Minding the Gap
Authors: Hennessy Sarah
Published: December 2019

This article assesses the discrepancies between policy and practice in primary music education, from the perspective of a music teacher educator. It argues that there is a need for generalists who can engage in the music learning of their classes, understand how to combine musical experiences and learning with other subjects, and lead and facilitate music making with imagination and enthusiasm; as well as an adequate number of specialists to provide support to generalists and develop high quality music learning opportunities for all children.
Time-Series Single-Cell RNA-Seq Data Reveal Auxin Fluctuation during Endocycle
Authors: Torii Kotaro , Kubota Akane , Araki Takashi , Endo Motomu
Published: December 2019

Appropriate cell cycle regulation is crucial for achieving coordinated development and cell differentiation in multicellular organisms. In Arabidopsis, endoreduplication is often observed in terminally differentiated cells and several reports have shown its molecular mechanisms. Auxin is a key factor for the mode transition from mitotic cell cycle to endocycle; however, it remains unclear if and how auxin maintains the endocycle mode. In this study, we reanalyzed root single-cell transcriptome data and reconstructed cell cycle trajectories of the mitotic cell cycle and endocycle. With progression of the endocycle, genes involved in auxin synthesis, influx and efflux were induced at the specific cell phase, suggesting that auxin concentration fluctuated dynamically. Such induction of auxin-related genes was not observed in the mitotic cell cycle, suggesting that the auxin fluctuation plays some roles in maintaining the endocycle stage. In addition, the expression level of CYCB1;1, which is required for cell division in the M phase, coincided with the expected amount of auxin and cell division. Our analysis also provided a set of genes expressed in specific phases of the cell cycle. Taking these findings together, reconstruction of single-cell transcriptome data enables us to identify properties of the cell cycle more accurately.
Interdependent Phenotypic and Biogeographic Evolution Driven by Biotic Interactions
Authors: Quintero Ignacio , Landis Michael J
Published: December 2019

Biotic interactions are hypothesized to be one of the main processes shaping trait and biogeographic evolution during lineage diversification. Theoretical and empirical evidence suggests that species with similar ecological requirements either spatially exclude each other, by preventing the colonization of competitors or by driving coexisting populations to extinction, or show niche divergence when in sympatry. However, the extent and generality of the effect of interspecific competition in trait and biogeographic evolution has been limited by a dearth of appropriate process-generating models to directly test the effect of biotic interactions. Here, we formulate a phylogenetic parametric model that allows interdependence between trait and biogeographic evolution, thus enabling a direct test of central hypotheses on how biotic interactions shape these evolutionary processes. We adopt a Bayesian data augmentation approach to estimate the joint posterior distribution of trait histories, range histories, and coevolutionary process parameters under this analytically intractable model. Through simulations, we show that our model is capable of distinguishing alternative scenarios of biotic interactions. We apply our model to the radiation of Darwin’s finches—a classic example of adaptive divergence—and find limited support for in situ trait divergence in beak size, but stronger evidence for convergence in traits such as beak shape and tarsus length and for competitive exclusion throughout their evolutionary history. These findings are more consistent with presympatric, rather than postsympatric, niche divergence. Our modeling framework opens new possibilities for testing more complex hypotheses about the processes underlying lineage diversification. More generally, it provides a robust probabilistic methodology to model correlated evolution of continuous and discrete characters. [Bayesian; biotic interactions; competition; data augmentation; historical biogeography; trait evolution.]
Traits controlling shade tolerance in tropical montane trees
Authors: Ntawuhiganayo Elisée Bahati , Uwizeye Félicien K , Zibera Etienne , Dusenge Mirindi E , Ziegler Camille , Ntirugulirwa Bonaventure , Nsabimana Donat , Wallin Göran , Uddling Johan
Published: December 2019

Tropical canopies are complex, with multiple canopy layers and pronounced gap dynamics contributing to their high species diversity and productivity. An important reason for this complexity is the large variation in shade tolerance among different tree species. At present, we lack a clear understanding of which plant traits control this variation, e.g., regarding the relative contributions of whole-plant versus leaf traits or structural versus physiological traits. We investigated a broad range of traits in six tropical montane rainforest tree species with different degrees of shade tolerance, grown under three different radiation regimes (under the open sky or beneath sparse or dense canopies). The two distinct shade-tolerant species had higher fractional biomass in leaves and branches while shade-intolerant species invested more into stems, and these differences were greater under low radiation. Leaf respiration and photosynthetic light compensation point did not vary with species shade tolerance, regardless of radiation regime. Leaf temperatures in open plots were markedly higher in shade-tolerant species due to their low transpiration rates and large leaf sizes. Our results suggest that interspecific variation in shade tolerance of tropical montane trees is controlled by species differences in whole-plant biomass allocation strategy rather than by difference in physiological leaf traits determining leaf carbon balance at low radiation.
Genetic diversity in natural range remnants of the critically endangered hirola antelope
Authors: Jowers Michael Joseph , Queirós João , Resende Pinto Rui , Ali Abdullahi H , Mutinda Mathew , Angelone Samer , Alves Paulo Célio , Godinho Raquel
Published: December 2019

The hirola antelope (Beatragus hunteri) is considered to be the most endangered antelope in the world. In the ex situ translocated population at Tsavo East National Park, calf mortality and the critically low population numbers might suggest low genetic diversity and inbreeding depression. Consequently, a genetic study of the wild population is pivotal to gain an understanding of diversity and differentiation within its range before designing future translocation plans to increase the genetic diversity of the ex situ population. For that purpose, we assessed 55 individuals collected across five localities in eastern Kenya, covering its entire natural range. We used the complete mitochondrial DNA control region and microsatellite genotyping to estimate genetic diversity and differentiation across its range. Nuclear genetic diversity was moderate in comparison to other endangered African antelopes, with no signals of inbreeding. However, the mitochondrial data showed low nucleotide diversity, few haplotypes and low haplotypic differentiation. Overall, the inferred low degree of genetic differentiation and population structure suggests a single population of hirola across the natural range. An overall stable population size was inferred over the recent history of the species, although signals of a recent genetic bottleneck were found. Our results show hope for ongoing conservation management programmes and that there is a future for the hirola in Kenya.
Imaging of Tumors of the Tibia
Authors: Tjong Willy , Schiffman Scott
Published: December 2019

Although the tibia can serve as the location for relatively common benign and malignant bone tumors, there are several more uncommon entities that occur almost exclusively in the tibia. For example, rare lesions such as adamantinoma, osteofibrous dysplasia, and chondromyxoid fibroma are seen predominantly in the tibia with infrequent involvement of other bones in the appendicular skeleton. This article reviews the imaging features of common and uncommon tibial tumors and provides a framework for formulating a differential diagnosis based on imaging and patient characteristics.
Extracellular Glutamate Concentration Increases Linearly in Proportion to Decreases in Residual Cerebral Blood Flow After the Loss of Membrane Potential in a Rat Model of Ischemia
Authors: Kawase Hirokazu , Takeda Yoshimasa , Mizoue Ryoichi , Sato Sachiko , Fushimi Miki , Murai Satoshi , Morimatsu Hiroshi
Published: December 2019

Background:

Brain ischemia due to disruption of cerebral blood flow (CBF) results in increases in extracellular glutamate concentration and neuronal cell damage. However, the impact of CBF on glutamate dynamics after the loss of the membrane potential remains unknown.

Materials and Methods:

To determine this impact, we measured extracellular potential, CBF, and extracellular glutamate concentration in the parietal cortex in male Sprague-Dawley rats (n=21). CBF was reduced by bilateral occlusion of the common carotid arteries and exsanguination until loss of extracellular membrane potential was observed (low-flow group), or until CBF was further reduced by 5% to 10% of preischemia levels (severe-low-flow group). CBF was promptly restored 10 minutes after the loss of membrane potential. Histologic outcomes were evaluated 5 days later.

Results:

Extracellular glutamate concentration in the low-flow group was significantly lower than that in the severe-low-flow group. Moreover, increases in extracellular glutamate concentration exhibited a linear relationship with decreases in CBF after the loss of membrane potential in the severe-low-flow group, and the percentage of damaged neurons exhibited a dose-response relationship with the extracellular glutamate concentration. The extracellular glutamate concentration required to cause 50% neuronal damage was estimated to be 387 μmol/L, at 8.7% of preischemia CBF. Regression analyses revealed that extracellular glutamate concentration increased by 21 μmol/L with each 1% decrease in residual CBF and that the percentage of damaged neurons increased by 2.6%.

Conclusion:

Our results indicate that residual CBF is an important factor that determines the extracellular glutamate concentration after the loss of membrane potential, and residual CBF would be one of the important determinants of neuronal cell prognosis.
Uterine fibroids in menopause and perimenopause
Authors: Ulin Mara , Ali Mohamed , Chaudhry Zunir Tayyeb , Al-Hendy Ayman , Yang Qiwei
Published: December 2019

Uterine fibroids (UFs) are benign tumors that arise from a single genetically altered mesenchymal stem cell under the influence of gonadal hormones. UFs are the most common benign gynecologic tumors in premenopausal women worldwide. It is estimated that nearly 70% to 80% of women will develop UFs at some point during their lifetime. UFs often present with abnormal uterine bleeding (AUB), pelvic fullness, and may have deleterious effects on fertility. The natural regression of UFs begins in menopause. This is, however, a generality as this pathology may still be present in this age group. Many clinicians are concerned about hormone therapy (HT) because of UFs regrowth; nevertheless, research of this subject remains inconclusive. If UFs are present in perimenopause or menopause, they typically manifest as AUB, which represents up to 70% of all gynecological consultations in perimenopausal and postmenopausal women. As AUB is a broad symptom and may not be specific to UFs, a thorough evaluation is required for correct diagnosis and proper treatment accordingly. Understanding the unique characteristics of the available treatment modalities is crucial in deciding the appropriate treatment approach. Decision on treatment modality should be made based on selection of the least morbidity and lowest risk for each patient. Multiple modalities are available; however, surgery remains the method of choice, with the best cure rates. Various attempts to create an inexpensive, safe, and effective drug for the treatments of UFs are still in the early stages of the clinical trials with some showing great promise. Treatment options include tibolone, aromatase inhibitors, selective estrogen receptor modulators, uterine artery embolization, and selective progesterone receptor modulators.

Video Summary:
http://links.lww.com/MENO/A493.
Traumatic Brain Injury and Opioid Overdose Among Post-9/11 Veterans With Long-Term Opioid Treatment of Chronic Pain
Authors: Fonda Jennifer R. , Gradus Jaimie L. , Brogly Susan B. , McGlinchey Regina E. , Milberg William P. , Fredman Lisa
Published: December 2019

Objective:

To evaluate the association between traumatic brain injury (TBI) and nonfatal opioid overdose, and the role of psychiatric conditions as mediators of this association.

Setting:

Post-9/11 veterans receiving care at national Department of Veterans Affairs (VA) facilities from 2007 to 2012.

Participants:

In total, 49 014 veterans aged 18 to 40 years receiving long-term opioid treatment of chronic noncancer pain.

Design:

Longitudinal cohort study using VA registry data.

Main Measures:

TBI was defined as a confirmed diagnosis (28%) according to VA comprehensive TBI evaluation; no TBI was defined as a negative primary VA TBI screen (ie, no head injury). Nonfatal opioid overdose was defined using ICD-9 (International Classification of Diseases, Ninth Revision) codes. We performed demographic-adjusted Cox proportional hazards regression. We quantified the impact of co-occurring and individual psychiatric conditions (mood, anxiety, substance use, and posttraumatic stress disorder) on this association using mediation analyses.

Results:

Veterans with TBI had more than a 3-fold increased risk of opioid overdose compared with those without (adjusted hazards ratio [aHR] = 3.22; 95% confidence interval [CI], 2.13-4.89). This association was attenuated in mediation analyses of any co-occurring psychiatric condition (aHR = 1.77; 95% CI, 1.25-2.52) and individual conditions (aHR range, 1.52-2.95).

Conclusion:

TBI status, especially in the context of comorbid conditions, should be considered in clinical decisions regarding long-term use of opioids in patients with chronic pain.
The Influence of Evidence-Based Design on Staff Perceptions of a Supportive Environment for Person-Centered Care in Forensic Psychiatry
Authors: Degl' Innocenti Alessio , Wijk Helle , Kullgren Anette , Alexiou Eirini
Published: December 2019

This prospective longitudinal study aimed to examine the relocation of three forensic psychiatric hospitals in Sweden into new facilities. The research focused on the effects of the physical and psychosocial environment and other staff-related parameters on the delivery of person-centered care after relocation. In forensic psychiatry, most relocations to new environments are to support a person-centered approach and to promote patients' rehabilitation and reintegration into society. Hopefully, this is undertaken in accordance with an evidence-based design strategy allowing improvement in staff satisfaction and working conditions as well as their capacity to provide individualized care. All staff members working on the wards of the facilities in question were invited to participate in the study. Data were collected prospectively between 2010 and 2014, before and after relocation of the forensic psychiatric clinics to new buildings. Structured validated questionnaires were employed. Staff members' job satisfaction and perceptions of a person-centered physical and psychosocial environment increased after relocation and provide evidence that staff perceptions of ward atmosphere in forensic psychiatric clinics are susceptible to factors in the physical and psychosocial environment. The importance of always taking the environmental factors into consideration, to achieve greater staff well-being and capacity to accomplish goals in forensic psychiatry, is emphasized.
99mTc-D(RGD): molecular imaging probe for diagnosis of αvβ3-positive tumors
Authors: Ramezanizadeh Mohammadali , Masterifarahani Arezou , Sadeghzadeh Nourollah , Abediankenari Saied , Mardanshahi Alireza , Maleki Fariba
Published: December 2019

Objective

Arginine–glycine–aspartic acid (RGD) peptide with its specific binding affinity to integrin αvβ3, is widely investigated for the development of molecular imaging probes for diagnosis of αvβ3-positive tumors. The aim of this work was to evaluate the ability of 99mTc- HYNIC-D(RGD), a novel retro-inverso peptidomimetic derivative for U87MG tumor (αvβ3-positive) imaging.

Methods

HYNIC-D(RGD) labeled with 99mTc using tricine/EDDA as an exchange coligands. Single-photon emission computed tomography imaging and biodistribution study were performed in nude mice bearing U87MG xenograft tumor.

Results

The labeling yield was >95%. The radiopeptide showed high uptake value in the U87MG tumor relative to muscle after 2 hours (1.43 ± 0.05 vs. 0.22 ± 0.11 %ID/g). The tumor/muscle ratio was 6.5. Blocking experiment showed specific binding towards tumor. Single-photon emission computed tomography imaging study revealed that radiopeptide had prominent uptake in U87MG tumor.

Conclusion

The novel 99mTc HYNIC- D(RGD) was demonstrated to be a useful radiotracer for the assessment of αvβ3-positive tumor in animal model. Therefore, further clinical and preclinical studies are required.
Frontal sinus fractures and cerebrospinal fluid leaks: a change in surgical paradigm
Authors: Banks Catherine , Grayson Jessica , Cho Do Yeon , Woodworth Bradford A.
Published: December 2019

Purpose of review

Traditionally, frontal sinus trauma has been treated using open incisions to access the anterior and/or posterior table. Mounting evidence indicates frontal sinus trauma can be managed using an endoscopic endonasal approach (EEA) with less morbidity. Such an approach permits preservation of a functional sinus and less reliance on computed tomography for postoperative follow up. The goal of this article is to highlight a shift in paradigm away from open approaches using external incisions towards an EEA to repair cerebrospinal fluid (CSF) leaks and fractures of the frontal sinus.

Recent findings

In a prospective case series of 46 patients undergoing EEA to frontal sinus fractures, 41 patients had active CSF leaks arising from the posterior table of the frontal sinus. A successful endoscopic repair was achieved in 97.6% with only one patient requiring revision Draf IIB surgery. Anterior table fractures were also successfully reduced with excellent cosmesis.

Endoscopic repair of frontal sinus fractures and CSF leaks is effective and well tolerated. In select patients, it is the preferred treatment as it maintains normal sinus structure and function, minimizing both early and late complications.
Direct Health Care Costs, Health Services Utilization, and Outcomes of Biliary Atresia
Authors: Siddiq Shabnaz , Jimenez‐Rivera Carolina , Kuenzig M. Ellen , Lima Isac , Geraghty Michael T. , Ng Vicky L. , Tam Karen , Benchimol Eric I.
Published: December 2019

Objectives:

Biliary atresia (BA) is the most common reason for liver transplant in childhood, and outcomes worsen with older age at hepatoportoenterostomy (HPE). We determined direct health care costs in children with BA, compared to controls in a population‐based cohort of children in Ontario, Canada.

Methods:

We used health administrative data to identify all children diagnosed with BA between 2002 and 2016 (n = 121) and matched controls (n = 602). We determined annual direct healthcare costs, and rates of health services utilization, liver transplantation, death, portal hypertension, cirrhosis, esophageal varices, and major upper gastrointestinal bleeding requiring hospitalization. Multivariable regression models determined the association between age at HPE, risk of liver transplant, and direct costs.

Results:

Incidence of BA was 6.07 (4.99–7.15) per 100,000 live births. The annual median (interquartile range) direct health care costs were higher in BA cases ($4210; interquartile range $1091–$16,765) compared to controls ($283; $112–$634). Compared to age at HPE <45 days, there was no significant association between direct costs and HPE ≥90 days (rate ratio 1.24, 95% confidence interval [CI] 0.78–1.97) or 45 to 90 days (rate ratio 1.05, 95% CI 0.73–1.50). Age at HPE ≥90 days was significantly associated with risk of undergoing liver transplant compared to age <45 days (hazard ratio 5.27, 95% CI 2.45–11.34). Direct costs were higher in patients with BA who underwent liver transplantation compared to those who did not ($39,476±$84,367 vs $22,579 ± $67,913).

Conclusions:

Direct ealth care costs were high in patients with BA, especially in those who underwent liver transplantation. Age at HPE was associated with risk of liver transplantation, but not direct health care costs, utilization, or other risk outcomes.
Positive Psychological Change Following a Cancer Diagnosis in Old Age
Authors: Hoogland Aasha I. , Jim Heather S. L. , Schoenberg Nancy E. , Watkins John F. , Rowles Graham D.
Published: December 2019

Background

Despite the stress inherent in a cancer diagnosis, many cancer survivors report benefits, including perceptions of personal growth and well-being. Among adults 60 years or older, for whom cancer diagnoses are most prevalent, there is a notable lack of research on positive psychological change.

Objective

This mixed-methods study was designed to advance current understanding of positive psychology (ie, posttraumatic growth, well-being) in older adults with cancer.

Methods

Fifty-six older adult cancer survivors were recruited through a statewide cancer registry and the community. Participants completed questionnaires on posttraumatic growth, well-being, coping, and quality of life, as well as a series of open-ended questions via mail.

Results

Participants reported high posttraumatic growth and well-being and primarily adaptive and emotion-focused coping strategies. They also reported better mental quality of life (P = .0001) but not physical quality of life (P = .31) compared with age-adjusted population norms. Older age was associated with less posttraumatic growth (r = −0.32, P = .02) but not well-being (P = .34). Qualitative responses emphasized appreciation and acceptance and a reliance on faith and social support and provided context for quantitative results.

Conclusions

This mixed-methods study suggests that older adults report positive psychological change and adaptive coping with cancer, demonstrating their high level of emotional resilience.

Implications for Practice

Mental health screenings should be provided as appropriate, but oncology nurses should also consider the potential for positive psychological change postdiagnosis. The provision of care and social support may need to be modified to accommodate older cancer survivors’ needs.
Childhood Trauma and Childhood Mental Disorder in Military and Employed Civilian Men
Authors: Syed Sheriff Rebecca , Van Hooff Miranda , Malhi Gin , Grace Blair , McFarlane Alexander
Published: December 2019

We aimed to retrospectively investigate childhood trauma and childhood mental disorder in military and employed civilian men aged 18 to 54 years. Data, derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study and the 2007 Australian Bureau of Statistics National Survey of Mental Health and Wellbeing Study, were analyzed and compared using direct age standardization and logistic regression. A greater proportion of ADF reported childhood trauma, multiple trauma types, trauma onset below 12 years of age, and interpersonal trauma than civilian employed men. A greater proportion of ADF reported childhood noninterpersonal trauma, such as accidents, than civilian employed men, with a marked difference in those aged 45 to 54 years. In both populations, childhood disorder was associated with childhood trauma; however, childhood depression was not associated with childhood noninterpersonal trauma in either population. A deeper understanding of the longer-term risk and resilience conferred by different childhood trauma profiles is needed.
Zolpidem-Associated Consequences
Authors: Westermeyer Joseph , Carr Tegan M.
Published: December 2019

A post-2000 literature search reviewed prevalence of health consequences associated with zolpidem, plus two salient case reports. Common zolpidem-related harms encompassed accidents, falls, overdoses, delirium, and infections. Risks to others included assaults, vehicular accidents, various crimes, and civil actions that occurred during zolpidem-induced delirium, withdrawal, and other impediments. Remarkably, much harm occurred while patients were taking therapeutic doses of licitly prescribed zolpidem (10–30 mg). Zolpidem-associated health, behavioral, and social problems comprise an international pandemic of preventable heath misfortunes.
Increased Psychiatric Risk in Children After Pediatric Intensive Care Unit Admission
Authors: Rady Hanaa I. , Ismail Omnia Raafat , Abdelkader Mohammed Safwat , Abdelgalil Abobakr Abosree
Published: December 2019

We aimed to assess psychiatric risk in children after admission to pediatric intensive care units (PICUs) and its association with greater psychiatric morbidity. We examined 130 children aged 6 to 13 years in a cross-sectional study divided into two groups: 65 children discharged from PICU and another 65 from general wards. The PICU group scored worse on all measured scales of psychiatric morbidities. The child-specific assessment methods included the posttraumatic stress disorder (PTSD) scale as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and Impact of Event Scale Revised for PTSD; Revised Children's Manifest Anxiety Scale for anxiety; and Birleson Depression Scale for depression. The PICU group had significantly higher frequencies of PTSD compared with the general ward group (84.6% vs. 6.2%, respectively; p < 0.001). Hence, PICU survivors have higher risk of psychiatric morbidities such as PTSD, anxiety, and depression compared with general ward patients.
Case Report: Bilateral Horizontal Gaze Palsy (1 + 1 Syndrome): A Supranuclear Gaze Palsy
Authors: Borgman Christopher J.
Published: December 2019

SIGNIFICANCE

A rare case of bilateral horizontal gaze palsy with intact vertical gaze eye movements and largely intact vestibulo-ocular reflex is presented owing to demyelinating lesions of the patient's bilateral paramedian pontine reticular formations and left infranuclear abducens nerve from the patient's recently diagnosed multiple sclerosis.

PURPOSE

The purpose of this study was to report on a rare case of bilateral horizontal gaze palsy from a supranuclear lesion in a patient with a recent diagnosis of multiple sclerosis.

CASE REPORT

A 43-year-old African American woman presented urgently for evaluation of her inability to move her eyes into either horizontal gaze. Vertical conjugate movements remained intact, as did three of four extraocular muscles with horizontal vestibulo-ocular reflex testing, suggesting a supranuclear palsy. Magnetic resonance imaging revealed two demyelinating lesions in her inferior pons, which spared her nuclear and internuclear horizontal gaze pathways, as well as three of four extraocular muscles of her infranuclear horizontal gaze pathway as evidenced by her largely intact vestibulo-ocular reflex. This suggested bilateral paramedian pontine reticular formation lesions (supranuclear) and a mild left abducens nerve palsy (infranuclear).

CONCLUSIONS

Close evaluation of extraocular motilities and a solid understanding of the supranuclear, nuclear, internuclear, and infranuclear components of the horizontal gaze pathway can help identify challenging gaze palsies when encountered in a clinical setting. Appropriate neuroimaging can then be performed with an emphasis on the suspected location of the lesion(s) based on the patient's clinical findings.
Two drugs regimens for HIV
Authors: Waters Laura , Church Hannah
Published: December 2019

Purpose of review

As the evidence for two-drug regimens (2DR) for HIV treatment accumulates and 2DR start to enter consensus guidelines, this review covers the history, rationale and current evidence for 2DR in first-line and switch settings.

Recent findings

Until recently, most evidence for 2DR was for boosted protease inhibitor-based therapies but now we have large, randomized trials to support the use of dolutegravir (DTG)-based 2DR, both for initial therapy and suppressed switch, with high efficacy and no emergent resistance at failure.

2DR will increasingly form part of the choice we are able to offer people with HIV but we must consider some of the limitations to ensure these regimens are used in the most clinically appropriate manner.
Gastric 99mTc-Methylene Diphosphonate Accumulation in a Patient With Primary Upper Gastrointestinal Tract Melanoma
Authors: Zhou Yi , Fan Qiu-ping , Tian Rong , Su Ming-gang
Published: December 2019

Unexpected extraosseous uptake is common on 99mTc–methylene diphosphonate bone scintigraphy, but accumulation by primary upper gastrointestinal tract malignant melanoma is rarely reported. The present case is a 58-year-old woman with a 10-day history of diffuse bone pain and weakness. Her bone scintigraphy showed unexpected diffuse gastric tracer uptake. Subsequent gastroscopy revealed a number of hyperpigmented lesions in the stomach and duodenal bulb. Malignant melanoma was confirmed by histopathology and immunohistochemistry. Because extensive physical examination failed to identify any other site of ocular and cutaneous melanoma, a diagnosis of primary upper gastrointestinal tract malignant melanoma was established.
Dissection in the Pyramidal Space for Effective Relief of Tension in Cleft Palate Repair
Authors: Jung Soyeon , Lo Lun-Jou
Published: December 2019

Objective

Although several methods of note have been reported for the repair of cleft palate, wound separation and oronasal fistula can still occur. This study reports a useful technique of dissection in the pyramidal space for adequate release of tension and the prevention of palatal fistula.

Methods

A total of 404 consecutive patients with cleft palate with or without cleft lip who had received standard surgical repair were evaluated. The mucoperiosteal flaps were raised from the hard palate. Dissection was performed in the pyramidal space to expose the greater palatine foramen, neurovascular pedicle, pyramidal process of the palatine bone, opening to the space of Ernst, and hamulus with tensor veli palatini aponeurosis. The restricting ligamentous fibers lateral and posterior to the pedicle were released. The hamulus process was divided at its root and pushed medially for further relief and medial mobilization of the flap. Closure of the flaps was achieved with minimal tension in the midline. The patients received regular postoperative follow-ups.

Results

Only 1 case was found to have postoperative palatal fistula, resulting in a fistula rate of 0.25% during the 11-year study period.

Conclusion

Adequate dissection in the pyramidal space helped to close the palatal flaps with minimal tension and prevent the formation of palatal fistula.
The Effects of Combining Progressive Tension Sutures, Closed Drain, and Fibrin Sealant in Abdominoplasty Wound After Deep Inferior Epigastric Perforator Flap Harvesting
Authors: Fang Chien-Liang , Changchien Chih-Hsuan , Chen Ming-Shan , Hsu Chin-Hao , Chen Wei-Chen , Yang Hsin-Yi , Lin Yi-Ling
Published: December 2019

Background

This study is a retrospective review to compare combining progressive tension sutures, closed drain, and fibrin sealant effects on seroma formation, postoperative drainage volume, and hospital stay for abdominoplasty after deep inferior epigastric artery perforator (DIEP) flap. We ever published a 0% seroma rate in abdominoplasty after DIEP flap using progressive tension sutures and closed drain. Massive abdominal wound drainage caused delayed drain removal and increased hospital stay and medical costs.

Methods

We retrospectively evaluated 54 abdominoplasty patients between December 2013 and September 2017; 43 patients used fibrin glue and 11 used progressive tension sutures and closed drain.

Results

Abdominal drainage for the first 3 postoperative days was 84.65 ± 52.95 mL in the fibrin group, with total drainage of 127.70 ± 125.50 mL and 214.45 ± 104.35 mL in the no fibrin group, with total drainage of 350.45 ± 213.58 mL. Drains were removed on postoperative day 6.21 ± 1.44 in the fibrin group and day 9.64 ± 1.96 in the no fibrin group. The association of the first 3 days and total drainage volumes with the drain removal day significantly differed in the fibrin and no fibrin groups. Hospital stay was 9.88 ± 3.55 and 12.45 ± 5.22 days in the fibrin and no fibrin group, respectively, with borderline significant differences.

Conclusions

Donor site abdominoplasty after DIEP flap combining progressive tension sutures, closed drainage, and fibrin glue can prevent seroma occurrence, reduce postoperative abdominal drainage and need for blood transfusion, and achieve early removal of the abdominal drain, shorter hospital stay, and lower medical cost.
Fat Grafting in Patients With Extensive Unilateral Facial Deficiency
Authors: Lo Lun-Jou , Yamaguchi Kazuaki , Niu Lien-Shin , Liao Chun-Hao , Lin Hsiu-Hsia
Published: December 2019

Purpose

Autologous fat injection is a widely used, simple, and less invasive technique to correct volume deficiency. This study developed a treatment method by using a 3-dimensional (3D) simulation to plan and implement fat injection in patients with an extensive facial deficiency and then validated the accuracy of the method and treatment outcomes.

Methods

Seven patients with a large unilateral facial deficiency receiving autologous fat grafts between 2015 and 2017 were recruited. One patient received repeated treatment. Furthermore, 3D surgical simulation was used to measure the difference between the mirrored image and lesion side. An extra 20% to 30% of fat graft was added. A color map was provided, and contour lines 2 mm deep marked the location of the fat injection. Outcome assessments were then performed, and a 3D symmetry index was defined using the contour lines on the facial surface.

Results

No significant difference was noted between the predicted volume and postoperative fat graft retention (35.7 ± 7.4 and 31.6 ± 9.7 mL, respectively; P = 0.176). A comparison of preoperative (79.5% ± 4.3%) and postoperative (89.0% ± 3.3%) 3D symmetry indexes indicated significantly improved facial symmetry (P = 0.018). Patient-reported outcomes of satisfaction on FACE-Q questionnaires yielded an average score of 62.73, higher than the control score (59.83).

Conclusions

By using the proposed method, we could predict the required fat graft volume; moreover, the contoured map aided accurate surgical implementation. Thus, this method is useful for planning and guiding fat grafting treatment in patients with major unilateral facial deficiency.
Severe Ocular Complications After Blepharoptosis Correction in the Oculopharyngeal Muscular Dystrophy Patient
Authors: Lin Tzu-Yu , Chen Austin D. , Chang Cheng-Hsien , Liang Wen-Chen , Minami Narihiro , Nishino Ichizo , Lai Chung-Sheng
Published: December 2019

Background

Blepharoptosis correction in oculopharyngeal muscular dystrophy (OPMD) patients may result in severe ocular complications owing to lagophthalmos and ophthalmoplegia. Managing the acute episode to prevent further aggravation of the keratopathy or blindness is of paramount importance.

Methods

A review of the literature for severe chemosis, keratopathy, and corneal ulceration in the patient population was performed using the PubMed database, with key words including ptosis surgery, ptosis correction, ptosis repair, and oculopharyngeal muscular dystrophy. A retrospective review of all patients with blepharoptosis from a single surgeon from September 2009 and May 2017 was performed, selecting those with OPMD who underwent blepharoptosis correction.

Results

Our literature review revealed a total of 15 articles after excluding repeated articles and selecting those meeting our inclusion criteria. A total of 232 OPMD patients underwent blepharoptosis correction. Severe ocular complications were noted in 7 patients, with treatment unspecified. For 9 years, 2 OPMD patients at our institute underwent blepharoptosis correction, with one developing severe acute keratitis, chemosis, and corneal ulceration due to lagophthalmos and ophthalmoplegia. Use of the temporary drawstring tarsorrhaphy and topical eye drop treatment for 2 weeks led to resolution of corneal ulcerations without necessitating further intervention.

Conclusions

Severe ocular complications may occur after blepharoptosis correction in OPMD patients, potentially owing to lagophthalmos and ophthalmoplegia. Temporary drawstring tarsorrhaphy is an effective option to treat these adverse outcomes.