bluuebunny/crossref_metadata_2025 huggingface dataset:
Autotrophic and heterotrophic indicators of ecological impairment in Toronto Harbour and coastal Lake Ontario
Authors: Munawar M. , Fitzpatrick M. , Niblock H. , Lorimer J.
Published: August 2018

The Toronto and Region Area of Concern (also known as Toronto Harbour) includes 42 km of Lake Ontario coastline and 6 watersheds. Over 4 million people reside within its boundaries which includes the City of Toronto (Ontario, Canada). We sampled eleven sites along the Lake Ontario coastline approximately monthly with 6 cruises from May to early November. Our analyses included standard water quality indicators (total phosphorus, nitrate + nitrite, chlorophyll a) in addition to a robust suite of autotrophic and heterotrophic indicators of ecosystem health, specifically: primary productivity and bacterial growth assays, phytoplankton biomass assessments, and microbial loop assessments. The sites were compared using mean values from May – November. Results from the offshore waters of Lake Ontario, the Bay of Quinte and Hamilton Harbour have also been presented for comparative purposes. The highest mean values observed in Toronto Harbour for total phosphorus (26.5 µg l−1) and chlorophyll a (6.2 µg l−1) which were both in the inner harbour suggested mesotrophic conditions, although the majority of observations suggested oligotrophy. With respect to autotrophic indicators, primary productivity at the mouth of the Humber River as well as the inner harbour (averaging 15 – 20 mg C m−3 h−1) suggested mesotrophy whereas the remaining sites were more oligotrophic. Phytoplankton biomass (≈400 – 1000 mg m−3) suggested oligotrophy. There was a surprising amount of heterotrophic microbial activity at the Humber Bay and inner harbour sites which were influenced by the Humber and Don Rivers. This included elevated rates of bacterial production (≈2 – 3 mg C m−3 h−1) and a high biomass of heterotrophic nanoflagellates (≈1300 – 2600 mg m−3) which was not likely sustained by the autotrophic production. Our findings suggest that a significant amount of organic matter is being deposited by these two rivers and shunted to the microbial food web. Such findings are not obvious from standard indicators (e.g. total phosphorus, chlorophyll a). More work is needed to quantify the sources of organic carbon and assess its utility as ecological indicators.
Transcription factor Etv6 regulates functional differentiation of cross-presenting classical dendritic cells
Authors: Lau Colleen M. , Tiniakou Ioanna , Perez Oriana A. , Kirkling Margaret E. , Yap George S. , Hock Hanno , Reizis Boris
Published: August 2018

An IRF8-dependent subset of conventional dendritic cells (cDCs), termed cDC1, effectively cross-primes CD8+ T cells and facilitates tumor-specific T cell responses. Etv6 is an ETS family transcription factor that controls hematopoietic stem and progenitor cell (HSPC) function and thrombopoiesis. We report that like HSPCs, cDCs express Etv6, but not its antagonist, ETS1, whereas interferon-producing plasmacytoid dendritic cells (pDCs) express both factors. Deletion of Etv6 in the bone marrow impaired the generation of cDC1-like cells in vitro and abolished the expression of signature marker CD8α on cDC1 in vivo. Moreover, Etv6-deficient primary cDC1 showed a partial reduction of cDC-specific and cDC1-specific gene expression and chromatin signatures and an aberrant up-regulation of pDC-specific signatures. Accordingly, DC-specific Etv6 deletion impaired CD8+ T cell cross-priming and the generation of tumor antigen–specific CD8+ T cells. Thus, Etv6 optimizes the resolution of cDC1 and pDC expression programs and the functional fitness of cDC1, thereby facilitating T cell cross-priming and tumor-specific responses.
iTOP: inferring the topology of omics data
Authors: Aben Nanne , Westerhuis Johan A , Song Yipeng , Kiers Henk A L , Michaut Magali , Smilde Age K , Wessels Lodewyk F A
Published: August 2018

Motivation

In biology, we are often faced with multiple datasets recorded on the same set of objects, such as multi-omics and phenotypic data of the same tumors. These datasets are typically not independent from each other. For example, methylation may influence gene expression, which may, in turn, influence drug response. Such relationships can strongly affect analyses performed on the data, as we have previously shown for the identification of biomarkers of drug response. Therefore, it is important to be able to chart the relationships between datasets.

Results

We present iTOP, a methodology to infer a topology of relationships between datasets. We base this methodology on the RV coefficient, a measure of matrix correlation, which can be used to determine how much information is shared between two datasets. We extended the RV coefficient for partial matrix correlations, which allows the use of graph reconstruction algorithms, such as the PC algorithm, to infer the topologies. In addition, since multi-omics data often contain binary data (e.g. mutations), we also extended the RV coefficient for binary data. Applying iTOP to pharmacogenomics data, we found that gene expression acts as a mediator between most other datasets and drug response: only proteomics clearly shares information with drug response that is not present in gene expression. Based on this result, we used TANDEM, a method for drug response prediction, to identify which variables predictive of drug response were distinct to either gene expression or proteomics.

Availability and implementation

An implementation of our methodology is available in the R package iTOP on CRAN. Additionally, an R Markdown document with code to reproduce all figures is provided as Supplementary Material.

Supplementary information

Supplementary data are available at Bioinformatics online.
Uraemia-induced immune senescence and clinical outcomes in chronic kidney disease patients
Authors: Crépin Thomas , Legendre Mathieu , Carron Clémence , Vachey Clément , Courivaud Cécile , Rebibou Jean-Michel , Ferrand Christophe , Laheurte Caroline , Vauchy Charline , Gaiffe Emilie , Saas Philippe , Ducloux Didier , Bamoulid Jamal
Published: August 2018

Background

Patients with chronic kidney disease (CKD) are more prone to develop premature age-related diseases. Data on immune senescence are scarce in CKD populations, except in end-stage renal disease and dialysis. We designed a longitudinal prospective study to evaluate immune senescence at different CKD stages and its influence on CKD patient outcomes.

Methods

Clinical and biological data collections were performed on 222 patients at different CKD stages [1–2 (n = 85), 4 (n = 53) and 5 (n = 84)]. Immune senescence biomarkers were measured by cytometry on T cells (CD28, CD57, CD45RA, CD31, γH2A.X) or by quantitative polymerase chain reaction [relative telomere length (RTL)] on peripheral blood mononuclear cells and analysed according to CKD stages and outcomes.

Results

CKD was associated with an increase in immune senescence and inflammation biomarkers, as follows: low thymic output (197 ± 25 versus 88 ± 13 versus 73 ± 21 CD4+CD45RA+CD31+ T cells/mm3), an increased proportion of terminally differentiated T cells (CD8+CD28−CD57+) (24 ± 18 versus 32 ± 17 versus 35 ± 19%) restricted to cytomegalovirus-positive patients, telomere shortening (1.11 ± 0.36 versus 0.78 ± 0.24 versus 0.97 ± 0.21 telomere:single copy ratio) and an increase in C-reactive protein levels [median 2.9 (range 1.8–4.9) versus 5.1 (27–9.6) versus 6.2 (3.4–10.5) mg/L]. In multivariate analysis, shorter RTL was associated with death {hazard ratio [HR] 4.12 [95% confidence interval (CI) 1.44–11.75]}. Low thymic output was associated with infections [HR 1.79 (95% CI (1.34–9.58)] and terminally differentiated CD8+ T-cell expansion with a risk of cardiovascular events [CEs; HR 4.86 (95% CI 1.72–13.72)].

Conclusion

CKD was associated with premature immune ageing. Each of these alterations increased the risk of specific age-related diseases, such as RTL and death, thymic function and infections and terminally differentiated CD8+ T-cell expansion and CEs.
Double Blinded Randomized Trial of Subcutaneous Trigeminal Nerve Stimulation as Adjuvant Treatment for Major Unipolar Depressive Disorder
Authors: Gorgulho Alessandra A , Fernandes Fernando , Damiani Lucas P , Barbosa Daniel A N , Cury Abrão , Lasagno Camila M , Bueno Priscila R T , Santos Bruno F O , Santos Renato H N , Berwanger Otávio , Cavalcanti Alexandre B , Teixeira Manoel J , Moreno Ricardo A , De Salles Antonio A F
Published: August 2018

BACKGROUND

More than 30% of major depressive disorder patients fail to respond to adequate trials of medications and psychotherapy. While modern neuromodulation approaches (ie, vagal nerve stimulation, deep brain stimulation) are yet to prove their efficacy for such cases in large randomized controlled trials, trigeminal nerve stimulation (TNS) has emerged as an alternative with promising effects on mood disorders.

OBJECTIVE

To assess efficacy, safety, tolerability, and placebo effect duration of continuous subcutaneous TNS (sTNS) in treatment-resistant depression (TRD).

METHODS

The TREND study is a single-center, double-blind, randomized, controlled, phase II clinical trial. Twenty unipolar TRD patients will receive V1 sTNS as adjuvant to medical therapy and randomized to active vs sham stimulation throughout a 24-wk period. An additional 24-wk open-label phase will follow. Data concerning efficacy, placebo response, relapse, and side effects related to surgery or electrical stimulation will be recorded. We will use the HDRS-17, BDI-SR, IDS_SR30, and UKU scales.

EXPECTED OUTCOMES

The main outcome measure is improvement in depression scores using HAM-17 under continuous sTNS as adjuvant to antidepressants. Active stimulation is expected to significantly impact response and remission rates. Minor side effects are expected due to the surgical procedure and electrical stimulation. The open-label phase should further confirm efficacy and tolerability.

DISCUSSION

This study protocol is designed to define efficacy of a novel adjuvant therapy for TRD. We must strive to develop safe, reproducible, predictable, and well-tolerated neuromodulation approaches for TRD patients impaired to manage their lives and contribute with society.
Far Lateral Craniotomy for Posterior Inferior Cerebellar Artery–Posterior Inferior Cerebellar Artery Bypass and Trapping of Posterior Inferior Cerebellar Artery Aneurysm: 3-Dimensional Operative Video
Authors: Gandhi Sirin , Mascitelli Justin , Hardesty Douglas , Lawton Michael T
Published: August 2018

Posterior inferior cerebellar artery (PICA) aneurysms account for 3% to 4% of all intracranial aneurysms with an unusually high predilection towards a nonsaccular morphology making microsurgical clipping or endovascular reconstruction of the parent artery difficult. The management of these complicated aneurysms may require revascularization procedures for flow preservation with aneurysm trapping. Recently, there is an increasing inclination towards intracranial–intracranial (IC-IC) bypasses over traditional extracranial donors.

 This video demonstrates a side-to-side PICA–PICA in situ bypass with trapping of an unruptured incidental right p1-PICA aneurysm. Radiological lesion progression and presence of dysplastic morphological characteristics prompted surgical management. The aneurysm was not amenable to clip reconstruction due to the dysplastic PICA segment and lack of a discernable neck. Institutional Review Board approval and patient consent were sought. With patient in three-quarter-prone position, a right far lateral craniotomy was performed. A left-to-right p3-p3 PICA bypass was completed. The aneurysm was clipped along with proximal PICA at its takeoff from vertebral artery. Indocyanine green videoangiography revealed complete occlusion of aneurysm and proximal PICA and a patent anastomosis with distal right PICA flow. Postoperatively, patient recovered with no new neurological deficits.

 Dolichoectatic posterior circulation aneurysms are not readily amenable to clip reconstruction. PICA–PICA in situ bypass is an elegant alternative to existing extracranial–intracranial revascularization constructs (occipital artery to PICA).
1
There is lower neurological morbidity associated with IC-IC bypass vs PICA reimplantation due to the deep surgical corridor and its proximity to lower cranial nerves. Additionally, in this patient endovascular occlusion posed a higher risk of thrombotic complications and postprocedural cerebellar edema with brainstem compression.
2
Recanalization of Acute Common Carotid Artery Occlusion: 2-Dimensional Operative Video
Authors: Sorenson Thomas J , Cloft Harry , Rabinstein Alejandro , Lanzino Giuseppe
Published: August 2018

While revascularization of the acutely or chronically occluded internal carotid artery has become commonplace with modern endovascular techniques, revascularization of an acutely occluded common carotid artery (CCA) is a controversial procedure with unique challenges. These challenges can be related to the lack of observable markers for identifying vessels during navigation or for identifying the exact location and extent of occlusion within the CCA, in addition to wide-ranging treatment risks. In this video, we illustrate the controversial revascularization of a 68-yr-old woman with an acute CCA occlusion who presented with fluctuating neurological symptoms. We believed treatment to be indicated by the lack of adequate collaterals on the intracranial CTA, and fluctuating symptoms in the absence of an intracranial major vessel occlusion, suggesting that the CCA occlusion was exerting important hemodynamic effects and at risk of causing a major stroke without revascularization, despite a low initial NIH stroke score. Though acute recanalization of patients with low NIH stroke score with stent-angioplasty is a controversial procedure, we believed it to be necessary in the case of our patient and believe it will likely be the focus of the next wave of large clinical trials dedicated to acute stroke.
THE GERMAN DOSE RATE MONITORING NETWORK AND IMPLEMENTED DATA HARMONIZATION TECHNIQUES
Authors: Stöhlker U , Bleher M , Doll H , Dombrowski H , Harms W , Hellmann I , Luff R , Prommer B , Seifert S , Weiler F
Published: August 2018

Environmental radiation monitoring networks have been established in Europe and world-wide for the purpose of protecting population and environment against ionizing radiation. Some of these networks had been established during the cold war period and were improved after the Chernobyl accident in 1986. Today, the German Federal Office for Radiation Protection (BfS) operates an early warning network with roughly 1800 ambient dose equivalent rate (ADER) stations equally distributed over the German territory. The hardware and software of all network components are developed in-house allowing the continuous optimization of all relevant components. A probe characterization and quality assurance and control program are in place. Operational and technical aspects of the network and data harmonization techniques are described. The latter allows for calculating of the terrestrial and net ADER combined with uncertainties mainly from site specific effects. Harmonized data are finally used as input to the German emergency management system and the European radiological data exchange platform.
Neural symptoms in a gene knockout mouse model of Sjögren‐Larsson syndrome are associated with a decrease in 2‐hydroxygalactosylceramide
Authors: Kanetake Tsukasa , Sassa Takayuki , Nojiri Koki , Sawai Megumi , Hattori Satoko , Miyakawa Tsuyoshi , Kitamura Takuya , Kihara Akio
Published: August 2018

Insulation by myelin lipids is essential to fast action potential conductivity: changes in their quality or amount can cause several neurologic disorders. Sjögren‐Larsson syndrome (SLS) is one such disorder, which is caused by mutations in the fatty aldehyde dehydrogenase ALDH3A2. To date, the molecular mechanism underlying SLS pathology has remained unknown. In this study, we found that Aldh3a2 is expressed in oligodendrocytes and neurons in the mouse brain, and neurons of Aldh3a2 knockout (KO) mice exhibited impaired metabolism of the long‐chain base, a component of sphingolipids. Aldh3a2 KO mice showed several abnormalities corresponding to SLS symptoms in behavioral tests, including increased paw slips on a balance beam and light‐induced anxiety. In their brain tissue, 2‐hydroxygalactosylceramide, an important lipid for myelin function and maintenance, was reduced by the inactivation of fatty acid 2‐hydroxylase. Our findings provide important new insights into the molecular mechanisms responsible for neural pathogenesis caused by lipid metabolism abnormalities.—Kanetake, T., Sassa, T., Nojiri, K., Sawai, M., Hattori, S., Miyakawa, T., Kitamura, T., Kihara, A. Neural symptoms in a gene knockout mouse model of Sjögren‐Larsson syndrome are associated with a decrease in 2‐hydroxygalactosylceramide. FASEB J. 33, 928–941 (2019). www.fasebj.org
Pro‐ and antiangiogenic therapies: current status and clinical implications
Authors: Rust Ruslan , Gantner Christina , Schwab Martin E.
Published: August 2018

Blood vessels nurture every part of the human body. Consequently, abnormalities in the vasculature are closely associated with a variety of diseases, including cerebral stroke, heart disease, retinopathy, and cancer. Pro‐ or antiangiogenic therapies can influence these diseases by regulating the growth of new blood vessels from a pre‐existing vascular network or dampening excessive blood growth. However, clinical translation of these approaches is slow and challenging. In this review, we discuss recent preclinical approaches to regulate angiogenesis and their potential and risks in a clinical setting.—Rust, R., Gantner, C., Schwab, M. E. Pro‐ and antiangiogenic therapies: current status and clinical implications. FASEB J. 33, 34–48 (2019). www.fasebj.org
The State of the Science on Clinical Evaluation in Nursing Education
Authors: Lewallen Lynne P. , Van Horn Elizabeth R.
Published: August 2018

AIM

The purpose was to synthesize the published evidence to present the state of the science in clinical evaluation research in nursing education.

BACKGROUND

Clinical evaluation is key to ensuring nursing students’ clinical competence, application of knowledge, and critical thinking, all of which are important to patient safety and quality nursing care.

METHOD

Cooper’s research synthesis method was used.

RESULTS

A comprehensive literature search resulted in 250 documents, of which 88 met study criteria. Topics were exhaustive but not mutually exclusive and included competence, instrumentation, congruence, teaching methods, objective structured clinical evaluation, faculty/preceptor issues with clinical evaluation, essential clinical behaviors, topic-based evaluation, decision-making about clinical grade, and clinical reasoning.

CONCLUSION

Nursing education science is in its infancy in many areas. Two areas most in need of future research are the need to accurately define and efficiently measure competence in the clinical area and the need for reliable and valid instrumentation.
Preparing the Nurse of the Future: Emergent Themes in Online RN-BSN Education
Authors: Perfetto Linda M.
Published: August 2018

AIM

Registered nurse to baccalaureate in nursing (RN-BSN) programs hold the second lowest average graduation rate of US nursing programs. Online education is often cited as a good fit for the working nurse for its convenience, accessibility, and flexibility. With a focus on supporting persistence in RN-BSN programs, this research sought to answer the question, What are the best practices for distance/online/hybrid RN to BSN program curriculum and instruction?

BACKGROUND

Distance/online/hybrid approaches are a component of most RN-BSN programs and may hold promise for working nurses balancing multiple responsibilities while in school.

METHOD

The Garrard Matrix Method was aligned with the work of Whittemore and Knafl to synthesize research that addressed the question.

RESULTS

Four themes emerged through this synthesis.

CONCLUSION

The findings serve as the beginning of a comprehensive guide on the subject.
Effectiveness of Fertility Awareness–Based Methods for Pregnancy Prevention
Authors: Peragallo Urrutia Rachel , Polis Chelsea B. , Jensen Elizabeth T. , Greene Margaret E. , Kennedy Emily , Stanford Joseph B.
Published: August 2018

OBJECTIVE:

To summarize best available prospective data on typical and perfect use effectiveness of fertility awareness–based methods for avoiding pregnancy.

DATA SOURCES:

We conducted a systematic review of studies published in English, Spanish, French, or German by June 2017 in MEDLINE, EMBASE, CINAHL, Web of Science, and ClinicalTrials.gov.

METHODS OF STUDY SELECTION:

We reviewed 8,755 unique citations and included 53 studies that contained 50 or greater women using a specific fertility awareness–based method to avoid pregnancy, calculated life table pregnancy probabilities or Pearl rates, and prospectively measured pregnancy intentions and outcomes. We systematically evaluated study quality.

TABULATION, INTEGRATION, AND RESULTS:

Of 53 included studies, we ranked 0 high quality, 21 moderate quality, and 32 low quality for our question of interest. Among moderate-quality studies, first-year typical use pregnancy rates or probabilities per 100 woman-years varied widely: 11.2–14.1 for the Standard Days Method, 13.7 for the TwoDay Method, 10.5–33.6 for the Billings Ovulation Method, 4–18.5 for the Marquette Mucus-only Method, 9.0–9.8 for basal body temperature methods, 13.2 for single-check symptothermal methods, 11.2–33.0 for Thyma double-check symptothermal methods, 1.8 for Sensiplan, 25.6 for Persona, 2–6.8 for the Marquette Monitor-only Method, and 6–7 for the Marquette Monitor and Mucus Method. First-year perfect use pregnancy rates or probabilities among moderate-quality studies were 4.8 for the Standard Days Method, 3.5 for the TwoDay Method, 1.1–3.4 for the Billings Ovulation Method, 2.7 for the Marquette Mucus Method, 0.4 for Sensiplan, 12.1 for Persona, and 0 for the Marquette Monitor.

CONCLUSION:

Studies on the effectiveness of each fertility awareness–based method are few and of low to moderate quality. Pregnancy rates or probabilities varied widely across different fertility awareness–based methods (and in some cases, within method types), even after excluding low-quality studies. Variability across populations studied precludes comparisons across methods.
Rectal Chlamydia trachomatis and Neisseria gonorrhoeae Infections Among Women Reporting Anal Intercourse
Authors: Llata Eloisa , Braxton Jim , Asbel Lenore , Chow Joan , Jenkins Lindsay , Murphy Ryan , Pathela Preeti , Schumacher Christina , Torrone Elizabeth
Published: August 2018

OBJECTIVE:

To examine the prevalence and treatment of rectal Chlamydia trachomatis and Neisseria gonorrhoeae infections among women reporting receptive anal intercourse in a network of sexually transmitted disease or sexual health clinics and estimate the proportion of missed infections if women were tested at the genital site only.

METHODS:

We conducted a cross-sectional analysis of C trachomatis and N gonorrhoeae test results from female patients reporting receptive anal intercourse in the preceding 3 months during visits to 24 sexually transmitted disease clinics from 2015 to 2016. Primary outcomes of interest were 1) anatomic site-specific C trachomatis and N gonorrhoeae testing and positivity among women attending selected U.S. sexually transmitted disease clinics who reported receptive anal intercourse and 2) the proportion of rectal infections that would have remained undetected if only genital sites were tested.

RESULTS:

Overall, 7.4% (3,743/50,785) of women reported receptive anal intercourse during the 2 years. Of the 2,818 women tested at both the genital and rectal sites for C trachomatis, 292 women were positive (61 genital only, 60 rectal only, and 171 at both sites). Of the 2,829 women tested at both the genital and rectal sites for N gonorrhoeae, 128 women were positive (31 genital only, 23 rectal only, and 74 at both sites). Among women tested at both anatomic sites, the proportion of missed C trachomatis infections would have been 20.5% and for N gonorrhoeae infections, 18.0%.

CONCLUSION:

Genital testing alone misses approximately one fifth of C trachomatis and N gonorrhoeae infections in women reporting receptive anal intercourse in our study population. Missed rectal infections may result in ongoing transmission to other sexual partners and reinfection.
Arthroscopic decompression of the flexor hallucis longus tendon in posttraumatic tendinopathy
Authors: Diab Hossam S.
Published: August 2018

Background:

Tenosynovitis of the flexor hallucis longus (FHL) tendon is more frequent than previously reported, and the condition is often overlooked or misdiagnosed. Overuse in ballet dancers or competitive runners was believed to be the main triggering factor. Recent advances in diagnostic modalities have shown a wide occurrence in nonathletes. The purpose of this study was to evaluate arthroscopic decompression of the FHL tendon in posttraumatic tenosynovitis.

Methods:

Nine consecutive patients with posttraumatic flexor hallucis longus stenosing tenosynovitis were treated and enrolled in this prospective study. All patients dated their complaint to previous ankle fracture or major sprain. The standard procedure included posterior ankle arthroscopy, thorough debridement of posterior adhesions, and adequate decompression of the tendon at the fibroosseous tunnel. Patients were evaluated for functional outcome through both Foot and Ankle Outcome Score (FAOS) and Ankle-Hindfoot Scale.

Results:

The mean FAOS score at 1-year follow-up improved from a preoperative mean of 72.56 (SD 4.43) to a postoperative mean of 87.33 (SD 4.03), which is considered to be extremely statistically significant with a P value less than 0.0001. The mean Ankle-Hindfoot Scale improved from a preoperative mean of 71.78 (SD 3.77) to a postoperative mean of 85.33 (SD 5.94). All patients reported being fully satisfied with an overall satisfaction score of 9.42.

Conclusions:

Flexor hallucis longus stenosing tenosynovitis is more frequent than previously thought and should be considered in patients with posterior ankle pain especially if a history of ankle trauma exists.
Early Revision Surgery for Tibial Plateau Fractures
Authors: Kloen Peter , van Wulfften Palthe Olivier D. R. , Nützinger Jorn , Donders Johanna C. E.
Published: August 2018

Objective:

To describe patients' outcomes after revision of tibial plateau fracture fixation within 12 months of the initial surgical procedure. To assess differences in objective outcome scores [International Knee Documentation Committee (IKDC), short form-36, arthrosis score, physical examination] depending on whether patients were treated for malreduction, malunion, or nonunion.

Design:

Retrospective case series.

Patients:

Twenty-seven patients who underwent revision within 1 year of primary surgery and with a minimum follow-up of 1 year.

Main Outcome Measurement:

IKDC Subjective Knee Form, alignment, osteoarthritis, timed up and go test, range of motion, and physical and mental health (using the short form-36 survey).

Results:

At the most recent follow-up, the mean IKDC subjective knee score of all patients within the study group was 62 (SD 17). In the malreduction group, the mean was 71 (SD 17), in the malunion group the mean was 56 (SD 17), and in the nonunion group, the mean was also 56 (SD 12; χ2 0.94; P = 0.624). Comparing the malreduction group with the malunion and nonunion groups combined, there was a significantly higher IKDC score (P = 0.019) in the malreduction group.

Conclusion:

A suboptimal outcome after open reduction and internal fixation of a tibial plateau fracture is common. If the underlying cause of the fracture is malreduction, malunion, or a nonunion, salvage of the joint without a knee replacement is worthwhile. When using a strategy incorporating revision plate fixation, osteotomy (intra- and/or extraarticular), debridement, and bone grafting when needed, patients should experience favorable long-term outcomes, including less residual pain and functional limitations.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
A Novel Inexpensive Technique to Seal Negative Pressure Wound Therapy on External Fixation Devices
Authors: Caputo Glenda G. , Marchetti Alberto , Governa Maurizio , Dalla Pozza Edoardo
Published: August 2018

Negative pressure wound therapy, a tool widely applied to treat lower limb traumas, is useful in reconstructive procedures. However, obtaining an airtight vacuum seal when using a negative pressure dressing around an external fixation device can be complicated and time-consuming. The plastic drape seldom adheres to screws, pins, or wires and, as such, the vacuum seal is jeopardized. In surgical departments, colostomy paste is widely used, readily available, and applied where pins and wires make contact with the plastic drape. It is a fast, practical, and inexpensive method of preventing air leakage. In conclusion, to obtain an airtight seal between the skin and an external fixation device, colostomy paste may be used to ensure an optimal tight seal, even for complex and extended wounds, for 3–5 days without complications or the requirement for additional dressing changes. Furthermore, it is inexpensive, readily available, simple to use, and quick to apply.
Granulomatous Rosacea Versus Lupus Miliaris Disseminatus Faciei—2 Faces of Facial Granulomatous Disorder: A Clinicohistological and Molecular Study
Authors: Chougule Abhijit , Chatterjee Debajyoti , Yadav Rakesh , Sethi Sunil , De Dipankar , Saikia Uma Nahar
Published: August 2018

Granulomatous rosacea (GR) and lupus miliaris disseminatus faciei (LMDF) are 2 forms of facial granulomatous diseases. Although they show some morphological overlap, they have distinct clinical presentation. This study was performed to demonstrate the clinical and histological features of GR and LMDF and to establish their relationship to tuberculous etiology by molecular technique. All the cases of GR (n = 20) and LMDF (n = 10) diagnosed on skin biopsy over the past 6 years were reviewed along with their clinical detail. Polymerase chain reaction (PCR) was performed using primers specific for Mycobacterium tuberculosis. The mean age of patients with GR was 45 years 10 months (range 18–75 years) as compared to 33 years 5 months (range 18–57 years) in patients with LMDF. The GR cases comprised 13 men and 7 women patients, whereas all 10 LMDF cases were seen in men. GR cases had papular lesion over an erythematous base on face, whereas LMDF cases had papular/nodular/nodulocystic lesions on the face and neck. Histologically, GR cases showed small granulomas without necrosis in a background of variable lymphoid infiltrate and dilated capillaries, whereas LMDF showed large granulomas with caseous necrosis and minimal inflammation. Five cases (25%) of GR showed degenerating Demodex folliculorum mites. No case of GR or LMDF showed positivity for mycobacterial polymerase chain reaction. Despite some similarities, GR and LMDF show distinct clinical and histological features. Thus, LMDF is a distinct clinicopathological entity separate from the GR, with different etiopathogenesis. However, none of the conditions are related to a tuberculous etiology.
Long-term Functional Outcome After Right-Sided Complete Mesocolic Excision Compared With Conventional Colon Cancer Surgery: A Population-Based Questionnaire Study
Authors: Bertelsen Claus Anders , Larsen Helene M. , Neuenschwander Anders U. , Laurberg Søren , Kristensen Bent , Emmertsen Katrine J.
Published: August 2018

BACKGROUND:

Complete mesocolic excision improves the long-term outcome of colon cancer but might carry a risk of bowel dysfunction.

OBJECTIVE:

This study aimed to investigate whether right-sided complete mesocolic excision is associated with an increased risk of long-term bowel dysfunction and reduced quality of life compared with conventional colon cancer resections.

DESIGN:

Data were extracted from a population-based study comparing complete mesocolic excision and conventional colon cancer resections and from a national questionnaire survey regarding functional outcome.

SETTINGS:

Elective right-sided colon resections for stage I to III colon adenocarcinoma were performed at 4 university colorectal centers between June 2008 and December 2014.

PATIENTS:

Seven hundred sixty-two patients were eligible to receive the questionnaire in November 2015.

MAIN OUTCOME MEASURES:

The primary outcomes measured were the risk of diarrhea (Bristol stool scale score of 6–7), 4 or more bowel movements daily, and the impact of bowel function on quality of life. Secondary outcomes were other bowel symptoms, chronic pain, and quality of life measured by the European Organisation for Research and Treatment of Cancer QLQ-C30.

RESULTS:

One hundred forty-one (63.8%) and 324 (59.9%) patients undergoing complete mesocolic excision and conventional resections responded after a median of 3.99 (interquartile range, 2.11–5.32) and 4.11 (interquartile range, 3.01–5.53) years (p= 0.04). Complete mesocolic excision was not associated with increased risk of diarrhea (adjusted OR, 1.07; 95% CI, 0.57–1.95;p= 0.84), 4 or more bowel movements daily (adjusted OR, 1.16; 95% CI, 0.57–2.24;p= 0.68), or lower quality of life (adjusted OR, 0.84; 95% CI, 0.49–1.40;p= 0.50). Complete mesocolic excision was associated nonsignificantly with nocturnal bowel movements, but not associated with chronic pain or other secondary outcomes.

LIMITATIONS:

This study was limited by the retrospective design with unknown baseline symptoms. Responding patients were younger but without obvious selection bias. The outcome “diarrhea” seemed somehow sensitive to information bias.

CONCLUSION:

Right-sided complete mesocolic excision seems associated with neither bowel dysfunction nor impaired quality of life when compared with conventional surgery. SeeVideo Abstractat http://links.lww.com/DCR/A665.
Should a History of Extraperitoneal Disease Be a Contraindication to Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Cancer Peritoneal Metastases?
Authors: Baratti Dario , Kusamura Shigeki , Iusco Domenico , Cotsoglou Christian , Guaglio Marcello , Battaglia Luigi , Virzì Salvatore , Mazzaferro Vincenzo , Deraco Marcello
Published: August 2018

BACKGROUND:

Survival improvements have been reported in selected patients affected by colorectal peritoneal metastases who were undergoing cytoreductive surgery with intraperitoneal hyperthermic chemotherapy. Treatment of peritoneal metastases associated with extraperitoneal disease is still controversial.

OBJECTIVE:

We assessed the prognostic impact of a history of extraperitoneal disease that was curatively treated either at the same time as or before the onset of peritoneal metastases.

DESIGN:

We reviewed 2 prospective databases. Peritoneal involvement was scored by Peritoneal Cancer Index.

SETTINGS:

Our study was conducted in 2 high-volume peritoneal malignancy management institutions.

PATIENTS:

A total of 148 patients with peritoneal metastases were included. In 27 patients, extraperitoneal disease involving the liver (n = 23), lung (n = 1), both lung and liver (n = 2), or inguinal lymph nodes and liver (n = 1) was curatively treated either simultaneously with peritoneal metastases (n = 22) or before their onset (n = 5).

INTERVENTIONS:

All of the macroscopic tumors were removed by means of peritonectomy procedures and visceral resections. Microscopic residual disease was treated by mitomycin C/cisplatin-based hyperthermic intraperitoneal chemotherapy.

MAIN OUTCOME MEASURES:

Overall survival was the primary outcome measure.

RESULTS:

After a median follow-up of 34.6 months (95% CI, 22.6–65.7 mo), 5-year survival of patients treated for both peritoneal and extraperitoneal disease versus peritoneal metastases alone was 16.5% versus 52.0% (p = 0.019). After multivariate analysis, reduced survival correlated with extraperitoneal disease (p = 0.001), Peritoneal Cancer Index >19 (p = 0.004), and peritoneal residual disease >2.5 mm (p = 0.018). Three prognostic groups were defined, and median survival was not reached for group 1 (Peritoneal Cancer Index ≤19 and no extraperitoneal disease), reached in 27.0 months for group 2 (Peritoneal Cancer Index ≤9 and extraperitoneal disease), and reached in 11.6 months for group 3 (Peritoneal Cancer Index >19 and no extraperitoneal disease or Peritoneal Cancer Index >9 and extraperitoneal disease).

LIMITATIONS:

The main study limitation is its observational nature.

CONCLUSIONS:

A history of extraperitoneal disease is associated with poorer prognosis. However, survival benefit may be obtained in selected patients with limited peritoneal involvement. See Video Abstract at http://links.lww.com/DCR/A655.
Management of Large Cecal Polyps: When Can the Ileocecal Valve Be Spared?
Authors: Kulaylat Audrey S. , Boltz Melissa M. , Moyer Matthew , Mathew Abraham , McKenna Kevin , Messaris Evangelos
Published: August 2018

BACKGROUND:

Endoscopic mucosal resection comprises the first-line treatment for large cecal polyps. With up to 14% of unresectable colonic polyps harboring malignancy, the management of endoscopically unresectable cecal polyps remains an oncologic right hemicolectomy, which can be associated with substantial postoperative morbidity.

OBJECTIVE:

This study compares the outcomes of patients with cecal polyps who underwent either endoscopic mucosal resection, a cecectomy, or a right hemicolectomy.

DATA SOURCES:

Patients undergoing either endoscopic mucosal resection, partial cecectomy, or right hemicolectomy from 2008 to 2017 at a single tertiary care institution were selected.

STUDY SELECTION:

This was a retrospective cohort study.

MAIN OUTCOME MEASURES:

The primary outcomes measured were the rate of malignancy, complication rate, estimated blood loss, and hospital length of stay between surgical cohorts.

RESULTS:

One hundred twenty-nine patients with cecal polyps were identified, of which 52 were referred for surgery. Nineteen underwent partial cecectomy and 33 (27.3%) underwent right hemicolectomy. Two patients undergoing cecectomy required conversion to hemicolectomy because the resected specimen did not contain the polyp. The 2 surgical cohorts did not differ significantly regarding age, sex, or ASA classification. Procedural complication rates were higher among those undergoing hemicolectomy compared with those undergoing cecectomy (37.1% versus 5.9%, p = 0.02). Estimated blood loss (50 vs 10 mL, p = 0.02), operative duration (98 vs 76 minutes, p = 0.009), and length of stay (4 vs 2 days, p < 0.001) were higher in patients undergoing hemicolectomy than in those undergoing cecectomy. No invasive malignancies were identified on final pathology within the cecectomy cohort.

LIMITATIONS:

Single-institution data and retrospective design were limitations of this study.

CONCLUSIONS:

In tertiary centers, the majority of large cecal polyps are benign and can be addressed by using endoscopic mucosal resection. When involvement of the appendiceal orifice or ileocecal valve precludes endoscopic treatment, surgical resection is the standard of care. In the subset of cases not involving the ileocecal valve and without preoperative evidence of malignancy, partial cecectomy spares the ileocecal valve and can offer reduced postoperative morbidity compared with a formal right hemicolectomy. See Video Abstract at http://links.lww.com/DCR/A674.
Validation of the 10-item Cervantes Scale in middle-aged Portuguese women: paper-and-pencil and online format assessment of menopause-related symptoms
Authors: Pimenta Filipa , Albergaria Rita , Marôco João , Leal Isabel , Chedraui Peter , Pérez-López Faustino R.
Published: August 2018

Objective:

The aim of the study was to validate the Portuguese language version of the 10-item Cervantes Scale (CS-10), a self-reporting instrument that assesses menopausal symptoms, and to compare the results (both symptom severity and multigroup invariance) of middle-aged women who completed the questionnaire in paper-and-pencil format (PPF) or in the online format (OF).

Methods:

A total of 292 women, aged 45 to 65 years, completed the questionnaires (PPF = 66; OF = 226). Construct (factorial and convergent) and external validity, as well as reliability and psychometric sensitivity were studied. Multigroup confirmatory factor analysis was performed to compare PPF with OF, regarding the measure's invariance.

Results:

The CS-10 showed good psychometric properties (ie, factor and external validity), as well as good sensitivity and reliability. The association with the Utian Quality of Life Scale (UQoLS) was significant and positive, though weak. The measured structure was invariant when comparing both subsamples (PPF and OF), evidencing an equivalent structure in both. No differences in reported symptoms were observed between the two subgroups.

Conclusions:

The Portuguese language version of the CS-10 rendered data with good psychometric properties in a sample of middle-aged Portuguese women. Therefore, it can be used in both clinical and community settings. The weak association between both instruments (UQoLS and CS-10) might be due to the different conceptualization of the quality of life construct: the CS-10 focuses on symptom severity, whereas the UQoLS assesses domains such as work-related or health-related behaviors.
HOW TO MEASURE THE LARGEST BASAL DIMENSION OF CHOROIDAL MELANOMA
Authors: França Maira , Ayres Bernadete , Parrish Elizabeth , Demirci Hakan
Published: August 2018

Purpose:

To identify the most accurate ultrasonographic technique to measure the largest basal dimension (LBD) of choroidal melanoma.

Methods:

B-scan ultrasound images were retrospectively reviewed in 99 eyes of 99 choroidal melanoma patients. The LBD was measured using one, two, and three straight lines along the inner and outer sclera. Theoretical arc length, calculated using trigonometry formulas based on the spherical model with the axial length as the sphere diameter, was used for comparisons with the actual measurements using straight lines.

Results:

For straight-line measurements in the inner sclera, the lowest error was found when using two straight-line measurements (P = 0.118). Differences in measurement using one-segment or three-segment measurements as compared with the theoretical arc length were found to be statistically significant (P < 0.001 in both cases). For tumors with LBD smaller than 12 mm, the absolute error, compared with the theoretical arc length, was smaller than 1 mm. In the outer sclera, the smallest errors were also found for measurements using two straight-line segments; however, it was statistically different than the theoretical inner arc length (P < 0.001).

Conclusion:

When using ultrasound to estimate LBD of ocular tumors, 2 straight-line measurements should be used when LBD is larger than 12 mm. For tumors with LBD smaller than 12 mm, measurements using 1 straight-line segment can provide accurate estimates.
Preoperative Brimonidine Tartrate 0.2% Does not Prevent an Intraocular Pressure Rise During Prostatectomy in Steep Trendelenburg Position
Authors: Mathew David J. , Greene Rana A. , Mahsood Yousaf J. , Hallaji Numan , Vargas Ana M.B. , Jin Ya-Ping , Finelli Antonio , Parotto Matteo , Belkin Avner , Trope Graham E. , Buys Yvonne M.
Published: August 2018

Purpose:

This study evaluated the effect of preoperative brimonidine tartrate 0.2% on intraocular pressure (IOP) during robotic-assisted laparoscopic radical prostatectomy in steep Trendelenburg position (sTBURG).

Materials and Methods:

In this prospective randomized controlled masked interventional trial, eligible patients scheduled for robotic-assisted laparoscopic radical prostatectomy in sTBURG at the Toronto General Hospital had one eye randomized to placebo (artificial tears) or drug (brimonidine tartrate 0.2%) preoperatively. Visual acuity (VA), tonometry, disc photography, visual field (VF), and retinal nerve fiber layer (RNFL) assessments were performed preoperatively and postoperatively. A standardized anesthetic protocol was followed intraoperatively. IOP was measured using Tono-Pen AVIA (Reichert Inc., New York, NY) as follows: preanesthesia supine, anesthetized supine, hourly in sTBURG and awake supine. The primary outcome was IOP in sTBURG in the drug group compared with the placebo group. Secondary outcomes were changes in VA, VF, RNFL thickness, mean arterial pressure, and ocular perfusion pressure. This study was approved by University Health Network Research Ethics Board.

Results:

In total, 26 eligible patients, mean age 61.9±5.1 years, were randomized to brimonidine (11 patients) and placebo (15 patients). Baseline IOP was not significantly different between the drug and placebo groups (P=0.42). Significant and sustained IOP elevation of >1.5X baseline in the sTBURG was noted in both groups. The mean IOP 1 hour after sTBURG was 29.4±6.9 and 27.2±3.4 mm Hg in the drug and placebo groups, respectively (P=0.35). No significant changes were noted in VA, VF, or RNFL.

Conclusions:

Significant and sustained IOP increases occur during sTBURG. Preoperative brimonidine does not prevent IOP spikes in sTBURG.
Morphine effects within the rodent anterior cingulate cortex and rostral ventromedial medulla reveal separable modulation of affective and sensory qualities of acute or chronic pain
Authors: Gomtsian Lusine , Bannister Kirsty , Eyde Nathan , Robles Dagoberto , Dickenson Anthony H. , Porreca Frank , Navratilova Edita
Published: August 2018

Modulation of pain may result from engagement of opioid receptors in multiple brain regions. Whether sensory and affective qualities of pain are differentially affected by brain opioid receptor circuits remains unclear. We previously reported that opioid actions within the rostral anterior cingulate cortex (ACC) produce selective modulation of affective qualities of neuropathic pain in rodents, but whether such effects may occur in other areas of the ACC is not known. Here, morphine was microinjected into 3 regions of the ACC or into the rostral ventromedial medulla (RVM), and pain behaviors in naive, sham, or spinal nerve ligated (SNL) rats were evaluated. In naive animals, the tail-flick response was inhibited by RVM, but not ACC, morphine. Anterior cingulate cortex morphine did not affect tactile allodynia (the von Frey test) or mechanical (Randall–Selitto) or thermal (Hargreaves) hyperalgesia in spinal nerve ligated rats. In contrary, RVM morphine reduced tactile allodynia and produced both antihyperalgesic and analgesic effects against mechanical and thermal stimuli as well as conditioned place preference selectively in nerve-injured rats. Within the RVM, opioids inhibit nociceptive transmission reflected in both withdrawal thresholds and affective pain behaviors. Activation of mu opioid receptors within specific rostral ACC circuits, however, selectively modulates affective dimensions of ongoing pain without altering withdrawal behaviors. These data suggest that RVM and ACC opioid circuits differentially modulate sensory and affective qualities of pain, allowing for optimal behaviors that promote escape and survival. Targeting specific ACC opioid circuits may allow for treatment of chronic pain while preserving the physiological function of acute pain.