bluuebunny/crossref_metadata_2025 huggingface dataset:
Mid-term and Long-term Functional and Radiographic Results of 13 Surgically Treated Adolescent Capitellum Fractures
Authors: Onay Tolga , Gümüştaş Seyit A. , Baykan Said E. , Akgülle Ahmet H. , Erol Bülent , Irgit Kaan S.
Published: June 2018

Background:

Capitellum fractures are rare in adolescents, and information in literature is still limited. The purpose of this study was to report the mid-term and long-term functional and radiographic results of 13 surgically treated adolescent capitellum fractures in a level I trauma center.

Methods:

This retrospective study included patients aged 10 to 16 years, who underwent surgery for a capitellum fracture and were followed up for at least 12 months. Fractures were classified according to the McKee modification of the Bryan and Morrey classification, and elbow arthritis was classified using the Broberg and Morrey system. Functional outcomes were assessed with the Mayo Elbow Performance Index (MEPI) and the Turkish-language version of the shortened version of the Disabilities of Arm, Shoulder, and Hand (QuickDASH) scale.

Results:

The mean time to surgical intervention was 4.5 days (range, 1 to 18 d). The mean flexion-extension range of motion arc was measured as 115 (range, 45 to 150) degrees. The mean restriction for extension and flexion compared with the uninjured side was measured as 10.7 (range, 0 to 45) and 11.5 (range, 0 to 45) degrees, respectively. The mean MEPI was 87.7 points (range, 50 to 100 points) with 9 patients as excellent, 1 good, 1 fair, and 2 poor results. The mean QuickDASH score was 11 (range, 0 to 57). The mean MEPI score was 95.6 and 75 and the mean QuickDASH score was 2.62 and 25.0 for early surgery group (≤3 d) and late surgery group (>3 d), respectively (P=0.073, 0.024). Elbow joint contracture developed in 4 patients. Implant removal and open release of joint contracture was applied to 2 patients. Elbow arthritis of grade 3 was observed in 2 patients and grade 2 in 1 patient.

Conclusions:

Capitellum fractures may be easily missed on conventional radiographs, if not suspected. Delayed diagnosis may lead to a worsening of the functional outcomes. Computerized tomography is helpful in the determination of these fractures. Early diagnosis and a well-performed surgery is essential for successful outcome.

Level of Evidence:

Level IV—case series.
Comparing the Efficacy of Methods for Immobilizing the Cervical Spine
Authors: Rahmatalla Salam , DeShaw Jonathan , Stilley Joshua , Denning Gerene , Jennissen Charles
Published: June 2018

Study Design.

This was a prospective simulator study with 16 healthy male subjects.

Objective.

The aim of this study was to compare the relative efficacy of immobilization systems in limiting involuntary movements of the cervical spine using a dynamic simulation model.

Summary of Background Data.

Relatively few studies have tested the efficacy of immobilization methods for limiting involuntary cervical movement, and only one of these studies used a dynamic simulation system to do so.

Methods.

Immobilization configurations tested were cot alone, cot with cervical collar, long spine board (LSB) with cervical collar and head blocks, and vacuum mattress (VM) with cervical collar. A motion platform reproduced shocks and vibrations from ambulance and helicopter field rides, as well as more severe shocks and vibrations that might be encountered on rougher terrain and in inclement weather (designated as an “augmented” ride). Motion capture technology quantitated involuntary cervical rotation, flexion/extension, and lateral bend. The mean and 95% confidence interval of the mean were calculated for the root mean square of angular changes from the starting position and for the maximum range of motion.

Results.

All configurations tested decreased cervical rotation and flexion/extension relative to the cot alone. However, the LSB and VM were significantly more effective in decreasing cervical rotation than the cervical collar, and the LSB decreased rotation more than the VM in augmented rides. The LSB and VM, but not the cervical collar, significantly limited cervical lateral bend relative to the cot alone.

Conclusion.

Under the study conditions, the LSB and the VM were more effective in limiting cervical movement than the cervical collar. Under some conditions, the LSB decreased repetitive and acute movements more than the VM. Further studies using simulation and other approaches will be essential for determining the safest, most effective configuration should providers choose to immobilize patients with suspected spinal injuries.

Level of Evidence: 3
Surgical Treatment of Cervical Spondylotic Myelopathy in the Elderly
Authors: Isogai Norihiro , Nagoshi Narihito , Iwanami Akio , Kono Hitoshi , Kobayashi Yoshiomi , Tsuji Takashi , Fujita Nobuyuki , Yagi Mitsuru , Watanabe Kota , Kitamura Kazuya , Shiono Yuta , Nakamura Masaya , Matsumoto Morio , Ishii Ken , Yamane Junichi
Published: June 2018

Study Design.

Retrospective multicenter study.

Objective.

We aimed to assess the outcomes following posterior cervical decompression for cervical spondylotic myelopathy (CSM) in a large sample of patients older than 80 years.

Summary of Background Data.

Although age is a predictor of surgical outcomes for CSM, most previous studies have only investigated the effect of age for patients aged 65 to 75 years, and surgical outcomes remain unclear for older patients.

Methods.

Patients older than 50 years who underwent posterior cervical decompression for CSM were enrolled from 17 institutions. The patients were grouped into a young–old group (<80 yrs old) and an old–old group (≥80 yrs). Clinical information, comorbidities, perioperative complications, Japanese Orthopaedic Association (JOA) scores, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), visual analog scale (VAS) scores, and radiographic parameters were compared between the two groups. All patients were followed for at least 1 year after surgery.

Results.

The young–old and old–old groups included 491 and 77 patients, respectively. The JOA score and quality of life measured by JOACMEQ improved significantly after surgery in both groups. Compared with the young–old group, the old–old group had lower preoperative JOA scores (9.6 vs. 11.0), lower final JOA scores (12.6 vs. 14.0), and lower recovery rates (42% vs. 50%). However, there were no significant differences in perioperative complications or in the VAS scores at the final assessments. The old–old group had a higher mean preoperative sagittal Cobb angle at C2–C5, though this was not statistically significant postoperatively.

Conclusion.

Posterior decompression surgery is safe and beneficial for patients older than 80 years with CSM, despite having a more limited neurological recovery compared with younger patients.

Level of Evidence: 3
Inferring Pathogen Type Interactions Using Cross-sectional Prevalence Data: Opportunities and Pitfalls for Predicting Type Replacement
Authors: Man Irene , Wallinga Jacco , Bogaards Johannes A.
Published: June 2018

Background:

Many multivalent vaccines target only a subset of all pathogenic types. If vaccine and nonvaccine types compete, vaccination may lead to type replacement. The plausibility of type replacement has been assessed using the odds ratio (OR) of co-infections in cross-sectional prevalence data, with OR > 1 being interpreted as low risk of type replacement. The usefulness of the OR as a predictor for type replacement is debated, as it lacks a theoretical justification, and there is no framework explaining under which assumptions the OR predicts type replacement.

Methods:

We investigate the values that the OR can take based on deterministic S usceptible- I infected- S usceptible and S usceptible- Infected- Recovered- S usceptible multitype transmission models. We consider different mechanisms of type interactions and explore parameter values ranging from synergistic to competitive interactions.

Results:

We find that OR > 1 might mask competition because of confounding due to unobserved common risk factors and cross-immunity, as indicated by earlier studies. We prove mathematically that unobserved common risk factors lead to an elevation of the OR, and present an intuitive explanation why cross-immunity increases the OR. We find that OR < 1 is predictive for type replacement in the absence of immunity. With immunity, OR < 1 remains predictive under biologically reasonable assumptions of unidirectional interactions during infection, and an absence of immunity-induced synergism.

Conclusions:

Using the OR in cross-sectional data to predict type replacement is justified, but is only unambiguous under strict assumptions. An accurate prediction of type replacement requires pathogen-specific knowledge on common risk factors and cross-immunity.
Prevalence and Distribution of Potential Vascularized Composite Allotransplant Donors, Implications for Optimizing the Donor-recipient Match
Authors: Mendenhall Shaun D. , Ginnetti Michael T. , Sawyer Justin D. , Verhulst Steven J. , West Bradford L. , Levin L. Scott , Neumeister Michael W.
Published: June 2018

Background:

Vascularized composite allotransplantation (VCA) is an emerging and growing field. Little is known about the prevalence and distribution of the adult potential donor population in the United States now that it falls under the oversight of the United Network for Organ Sharing (UNOS).

Methods:

We assessed the UNOS database from 2008 to 2015 to estimate the prevalence and distribution of adult potential vascularized composite allograft donors. Donor inclusion and exclusion criteria were developed in a way to minimize risk to recipients and were applied to the dataset. Donors were categorized by factors that influence vascularized composite allograft matching including ABO blood type, cytomegalovirus status, and ethnicity (correlate for skin color) and sorted by UNOS region.

Results:

Just under half of all brain dead donors met the inclusion/exclusion criteria. Blood type O, cytomegalovirus+, White donors represented the most frequent donor profile while blood type AB, cytomegalovirus-, Asian donors were the least common. UNOS region 3 had the most and region 1 had the least potential VCA donors per year. Nearly all potential VCA donors were solid organ donors with the liver being the most commonly donated solid organ in this population.

Conclusions:

A large portion of the solid organ donor pool would qualify as adult vascularized composite allograft donors in the current UNOS system. These data will assist transplant teams in determining the prevalence and distribution of vascularized composite allograft donors for their individual patients awaiting composite allografts based on relevant matching characteristics in addition to standard transplant criteria.
Prediction Accuracy of the Dynamic Structure-Function Model for Glaucoma Progression Using Contrast Sensitivity Perimetry and Confocal Scanning Laser Ophthalmoscopy
Authors: Ramezani Koosha , Marín-Franch Iván , Hu Rongrong , Swanson William H. , Racette Lyne
Published: June 2018

Purpose:

The purpose of this study was to determine whether combining a structural measure with contrast sensitivity perimetry (CSP), which has lower test-retest variability than static automated perimetry (SAP), reduces prediction error with 2 models of glaucoma progression.

Methods:

In this retrospective analysis, eyes with 5 visits with rim area (RA), SAP, and CSP measures were selected from 2 datasets. Twenty-six eyes with open-angle glaucoma were included in the analyses. For CSP and SAP, mean sensitivity (MS) was obtained by converting the sensitivity values at each location from decibel (SAP) or log units (CSP) to linear units, and then averaging all values. MS and RA values were expressed as percent of mean normal based on independent normative data. Data from the first 3 and 4 visits were used to calculate errors in prediction for the fourth and fifth visits, respectively. Prediction errors were obtained for simple linear regression and the dynamic structure-function (DSF) model.

Results:

With linear regression, the median prediction errors ranged from 6% to 17% when SAP MS and RA were used and from 9% to 17% when CSP MS and RA were used. With the DSF model, the median prediction errors ranged from 6% to 11% when SAP MS and RA were used and from 7% to 16% when CSP MS and RA were used.

Conclusions:

The DSF model had consistently lower prediction errors than simple linear regression. The lower test-retest variability of CSP in glaucomatous defects did not, however, result in lower prediction error.
Minimally Invasive Cardiac Surgery
Authors: Van Praet Karel M. , Stamm Christof , Sündermann Simon H. , Meyer Alexander , Unbehaun Axel , Montagner Matteo , Nazari Shafti Timo Z. , Starck Christoph , Jacobs Stephan , Kempfert Jörg
Published: June 2018

A 58-year-old white male with a history of stroke and deep vein thrombosis presented with an interatrial intraseptal mass. Cardiac-computed tomography demonstrated a thin-walled, well-demarcated cyst in the inferior border of the fossa ovalis protruding into both atria. Removal of the interatrial intraseptal cyst was performed using a minimally invasive three-dimensional endoscopic periareolar approach.
Implementation of the PROMIS-29 in Routine Care for People With Diabetes
Authors: Scholle Sarah Hudson , Morton Suzanne , Homco Juell , Rodriguez Kristin , Anderson Daren , Hahn Elizabeth , Kendrick David , Bardach David , Hart Elizabeth
Published: June 2018

Using patient-reported outcome measures (PROMs) in care planning has the potential to improve care, but information about routine implementation in settings serving disadvantaged groups is needed. Two primary care clinics serving populations predominantly eligible for Medicaid and diverse in race/ethnicity implemented the PROMIS-29 as part of clinical care planning. Of the target population with diabetes, 26% (n = 490) completed the PROMs; the proportion that set a goal based on the PROMs differed by site. This report describes factors influencing the PROMs process and the results of interviews with patients and members of the care team about PROMs' implementation and impact.
A Method of Facilitating Mobility in Children Undergoing Halo Skeletal Traction
Authors: Mullan Betsy , Turner-Bare Karen R. , Pedicone Dave , Shannon Christina , Kane Meghan , Hancock Sarah , Rahman Tariq , Ditro Colleen , Mackenzie William , Gabos Peter , Shah Suken A.
Published: June 2018

The earliest documented use of skeletal traction devices was detailed by Hippocrates. From the Middle Ages through to the evolution of modern medicine, patients undergoing skeletal traction were confined to bed. Early to mid-1900s studies document the use of a halo to apply skeletal traction to manage spinal deformities. Adapted wheelchairs for halo traction were developed in the mid-1900s. Our halo traction program team modified wheelchairs and walkers to provide out-of-bed mobility. Optimization of patient independence during mobility in halo traction and the staff’s ability to manage increasing amounts of halo traction weight were considered during program development.
Prospective Evaluation of the ESPGHAN Guidelines for Diagnosis of Celiac Disease in New Zealand Children
Authors: Bishop Jonathan , Reed Peter , Austin Paul , Hurst Miriam , Ameratunga Rohan , Craigie Alyson , McFarlane Jeannette , Chin Simon E. , Mouat Stephen M. , Evans Helen M.
Published: June 2018

Objective:

The 2012 European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guideline for diagnosis of celiac disease (CD) questioned the requirement for intestinal biopsy to confirm the diagnosis. The guideline recommends that in symptomatic patients with consistent human leukocyte antigen (HLA) subtypes, the diagnostic accuracy of strongly positive serology is sufficient to confirm the diagnosis. We prospectively assessed these guidelines in a “real‐life” clinical setting.

Methods:

One hundred and four children referred for evaluation of possible CD were prospectively recruited. Following informed consent, blood was drawn for serological testing and HLA analysis at upper gastrointestinal endoscopy. Histological findings according to Marsh criteria were correlated with blood results and the accuracy of the guideline analyzed.

The study also examined the role of deamidated gliadin peptide (DGP) in the diagnosis of CD.

Results:

For symptomatic patients with consistent HLA subtypes, strongly positive serology (as described in the ESPGHAN guidelines) accurately predicted biopsy‐proven CD in >95% of cases. DGP was positive in fewer patients than anti‐TG2 or EMA. Incorporation of DGP as a second confirmatory serological test in place of EMA was associated with maintained predictive value of guideline, but fewer patients fulfilling criteria for biopsy‐free diagnosis.

Conclusions:

The ESPGHAN guideline performs well in our population. Adoption of the guideline would reduce the number of patients requiring endoscopy without compromise in diagnostic accuracy. The involvement of pediatric gastroenterological expertise, however, remains key to diagnosis of CD.
Onabotulinum Toxin A Injections Into the Salivary Glands for Spinal Muscle Atrophy Type I
Authors: Shoval Hannah Aura , Antelis Esther , Hillman Andrew , Wei Xiaofang , Tan Patricia , Alejandro Ruth , Kim Heakyung
Published: June 2018

Objective

The aim of the study was to investigate the safety and efficacy of onabotulinum toxin A injection to the salivary glands under ultrasound guidance for the treatment of sialorrhea in patients with spinal muscular atrophy type I.

Design

Prospective case series with four patients with spinal muscular atrophy type I who received onabotulinum toxin A injection to parotid and submandibular glands for sialorrhea as part of clinical care. All four patients received validated surveys for measuring drooling, including objective measures of number of bib changes, and number of mouth wipes before injection and 4–6 wks after injection. Research was limited to survey completion. Scales included the Drooling Severity and Frequency Scale and the Drooling Impact Scale as well as a new scale used in our clinic, the Posterior Drooling Scales looking at coughing/choking and number of aspiration pneumonias.

Results

There were no adverse events. All four patients showed clinically significant improvements. The improvement in drooling using the Drooling Impact Scale was statistically significant (paired t test, t = 3.243, P = 0.048). All patients improved with number of mouth wipes.

Conclusion

Ultrasound-guided onabotulinum toxin A injections to the salivary glands may be a safe and effective method of decreasing drooling in patients with spinal muscular atrophy type I.
Cost-Effectiveness of Cervical Cancer Screening in Women Living With HIV in South Africa: A Mathematical Modeling Study
Authors: Campos Nicole G. , Lince-Deroche Naomi , Chibwesha Carla J. , Firnhaber Cynthia , Smith Jennifer S. , Michelow Pam , Meyer-Rath Gesine , Jamieson Lise , Jordaan Suzette , Sharma Monisha , Regan Catherine , Sy Stephen , Liu Gui , Tsu Vivien , Jeronimo Jose , Kim Jane J.
Published: June 2018

Background:

Women with HIV face an increased risk of human papillomavirus (HPV) acquisition and persistence, cervical intraepithelial neoplasia, and invasive cervical cancer. Our objective was to determine the cost-effectiveness of different cervical cancer screening strategies among women with HIV in South Africa.

Methods:

We modified a mathematical model of HPV infection and cervical disease to reflect coinfection with HIV. The model was calibrated to epidemiologic data from HIV-infected women in South Africa. Clinical and economic data were drawn from in-country data sources. The model was used to project reductions in the lifetime risk of cervical cancer and incremental cost-effectiveness ratios (ICERs) of Pap and HPV DNA screening and management algorithms beginning at HIV diagnosis, at 1-, 2-, or 3-year intervals. Strategies with an ICER below South Africa's 2016 per capita gross domestic product (US$5270) were considered “cost-effective.”

Results:

HPV testing followed by treatment (test-and-treat) at 2-year intervals was the most effective strategy that was also cost-effective, reducing lifetime cancer risk by 56.6% with an ICER of US$3010 per year of life saved. Other cost-effective strategies included Pap (referral threshold: HSIL+) at 1-, 2-, and 3-year intervals, and HPV test-and-treat at 3-year intervals. Pap (ASCUS+), HPV testing with 16/18 genotyping, and HPV testing with Pap or visual triage of HPV-positive women were less effective and more costly than alternatives.

Conclusions:

Considering per capita gross domestic product as the benchmark for cost-effectiveness, HPV test-and-treat is optimal in South Africa. At lower cost-effectiveness benchmarks, Pap (HSIL+) would be optimal.
Rates of Neuropsychological Dysfunction in Fibromyalgia and Rheumatoid Arthritis
Authors: Medina Luis D. , Hirshberg Linda , Taylor Michael J. , Gilbert Paul E. , Heaton Robert K.
Published: June 2018

Background/Objective

Fibromyalgia (FM) is a chronic pain syndrome of unknown etiology that can include subjective cognitive symptoms and variable evidence of cognitive dysfunction. Rates of occurrence and severity of cognitive impairment remain unclear. Additionally, comparison of this group with other pain conditions has been limited. The current cross-sectional study sought to identify rates of clinically significant cognitive impairment in FM and rheumatoid arthritis (RA) using an automated clinical rating approach.

Methods

A total of 61 females (32 with FM, 29 with RA) completed a comprehensive neuropsychological (NP) battery and an assessment of personality and psychological distress. All study measures were completed in one visit and all participants were recruited over the span of 3 years. Demographically corrected NP scores were used to compare participants with normative expectations and a summary score was calculated to compare groups on NP impairment.

Results

Compared to normative expectations using a 1 standard deviation cutoff, moderately increased rates of cognitive deficits were observed in both groups (FM = 23.3%, RA = 34.5%), with most test scores in affected individuals falling in the mild to moderate ranges of impairment. Compared to RA, FM participants endorsed higher and significant levels of psychological symptoms overall. These were not associated with cognitive performance in either patient group.

Conclusions

Increased rates of cognitive dysfunction as well as psychological distress exist in both FM and RA compared to a normative sample. However, psychological distress was unrelated to cognition in both groups. These findings have implications regarding the clinical presentation of individuals with FM and RA.
Failure of Classical β-Blocker Carvedilol to Deactivate Brown Adipose Tissue in a Patient With Pheochromocytoma
Authors: Tsechelidis Ioannis , El Darazi Eva , Muteganya Raoul , Weyts Kathleen , Goldman Serge
Published: June 2018

A 37-year-old woman with pheochromocytoma underwent presurgical FDG PET/CT. Despite her usual antiadrenergic medication consisting in 25 mg of carvedilol, PET/CT demonstrated intense and widespread FDG uptake in brown adipose tissue (BAT). No BAT FDG uptake was detectable on a repeated examination after specific preparation consisting in 40 mg propranolol and 5 mg diazepam. We therefore recommend this propranolol-diazepam preparation in patients with pheochromocytoma referred for PET/CT. Carvedilol—classically prescribed to alleviate effects of adrenergic overstimulation—seems ineffective on BAT. This observation questions the benefit of carvedilol to reduce β3-adrenoreceptor–mediated effects, not only in BAT, but also in other tissues.
Willingness to Pay for Home-Based Rehabilitation Service Among Older Adults
Authors: Li Xuemei , Wan Xia , Pang Yajuan , Zhou Lanshu
Published: June 2018

Purpose

This study aims to investigate the willingness to pay (WTP) for a home-based rehabilitation service and explore the influencing factors of WTP among older adults in Shanghai, China.

Design

A cross-sectional design was used.

Methods

A questionnaire survey based on the contingent valuation method was conducted by face-to-face survey over 3 months.

Findings

Only 242 (44%) participants were willing to pay for a home-based rehabilitation service. The median amount they were willing to pay was RMB 8 (US$1.15) per visit. Older adults who had higher monthly income, had at least one partner who worked, and had medical insurance were willing to pay more for the service.

Conclusions

Older adults showed low WTP for a home-based rehabilitation service. Economic status and health condition are the significant influencing factors of WTP.

Clinical Relevance

Studies on recipients’ precise needs and ability to pay are required before home-based services are implemented.
Evaluation of Fronto-Orbital Advancement Using Titanium-Based Internal Fixation for Corrective Pediatric Craniofacial Surgery
Authors: Kreppel Matthias , Kauke Martin , Grandoch Andrea , Safi Ali-Farid , Nickenig Hans-Joachim , Zöller Joachim
Published: June 2018

Background:

For successful reshaping of the cranial vault in terms of corrective fronto-orbital advancement (FOA) efficient and reliable internal fixation systems for stabilization of bone fragments are indispensable. The rate of complications and feasibility of corrective FOA with the usage of titanium-based rigid fixation systems is rarely analyzed and discussed.

Methods:

The authors retrospectively reviewed the medical records of 42 patients who received corrective FOA with the implementation of titanium internal rigid fixation and consecutive secondary surgery for removal. The reliability of the fixation system was judged by the outcome of the FOA as evaluated by the Whitaker score, esthetic outcome as well as by the complication rate of the secondary intervention, necessary for removal of the fixation system.

Results:

All patients were categorized as Whitaker I (no further treatment desirable). Esthetic outcome was excellent in all patients as judged by surgeon and parents. Mean age at the time of FOA was 9.3 months. Time to removal, duration of the second hospital stay for removal of the fixation system, and duration of surgical drains were on average 5 months, 2 days, and 1.7 days, respectively. Mean duration of the secondary surgery was 63 min. No complications occurred.

Conclusion:

Our investigation supports the usage of titanium internal rigid fixation systems in pediatric craniofacial surgery, thereby providing a reliable alternative to avoid the well-documented problems of bio-absorbable plate fixation systems.
Deliberate Practice: Preliminary Results of a Useful Strategy for Correcting Articulation in Children With Cleft Palate
Authors: Pamplona María del Carmen , Ysunza Pablo Antonio
Published: June 2018

Children with cleft palate frequently show speech and language disorders. In the related scientific literature, several reports have described the use of different strategies for treating speech disorders in children with cleft palate. However, only a few studies have addressed the use of these strategies within a meaningful linguistic context.

Deliberate practice is a procedure or strategy, which proposes that the key for achieving high levels of expert performance is dedicating long time for practice. Deliberate practice has been studied mainly in the areas of sports and intellectual games. The purpose of this article is to study whether the use of a strategy originally designed for achieving expert performance in sports and intellectual games, can be useful for the speech intervention of children with cleft palate.

For this project, 32 children with cleft palate were studied. The children were randomly assigned to 2 independent groups. Both groups received speech therapy based on the principles of the Whole Language Model. In addition, deliberate practice was used in the children included in the active group.

After a speech intervention, although both groups of children demonstrated significant improvement in articulation placement, the active group demonstrated a significantly higher improvement as compared with the control group.

In conclusion, these preliminary results seem to suggest that the use of deliberate practice can be effective for enhancing articulation in children with cleft palate.
Surgical Alternative for Repair of Bilateral Macrostomia
Authors: Wong Romo Gabriela , Carrillo Terán Erick , Sánchez Pérez Yadheli Xeomara
Published: June 2018

The transverse or lateral cleft is the second most common type of craniofacial cleft. The authors report a case of bilateral macrostomia in a male newborn and the authors present a refined method of Kaplan technique for correcting macrostomia. The authors’ method is characterized by the creation of a single Z-plasty with the transposed central limb placed in the nasogenian crease.
Part III: Minimum Quality Threshold in Preclinical Sepsis Studies (MQTiPSS) for Fluid Resuscitation and Antimicrobial Therapy Endpoints
Authors: Hellman Judith , Bahrami Soheyl , Boros Mihaly , Chaudry Irshad H. , Fritsch Gerhard , Gozdzik Waldemar , Inoue Shigeaki , Radermacher Peter , Singer Mervyn , Osuchowski Marcin F. , Huber-Lang Markus
Published: June 2018

As outlined in the “International Guidelines for Management of Sepsis and Septic Shock: 2016,” initial fluid resuscitation and administration of antibiotics are key steps in the early management of sepsis and septic shock. However, such clear guidelines do not exist for preclinical sepsis models. To address these shortcomings, the Wiggers-Bernard conference on preclinical sepsis models was held in Vienna in May 2017. The participants reviewed 260 of the most highly cited papers between 2003 and 2012 that used sepsis models. The review demonstrated that over 70% of experiments either did not use or failed to report resuscitation and/or antibiotic treatment. This information served as the basis to create a series of recommendations and considerations for preclinical sepsis models; this Part III report details the recommendations for fluid resuscitation and antibiotic treatment that should be addressed in sepsis models. Similar to human sepsis, fluid resuscitation is recommended in the experimental setting unless part of the study. Iso-osmolar crystalloid solutions are preferred. The administration route and its timing should be adjusted to the specific requirements of the model with preference given to dynamic rather than static hemodynamic monitoring. Predefined endpoints for fluid resuscitation and avoidance of fluid overload should be considered. Preclinical sepsis studies display serious inconsistencies in the use of antimicrobial protocols. To remedy this, antimicrobials are recommended for preclinical studies, with choice and dose adjusted to the specific sepsis model and pathogen (s). Ideally, the administration of antimicrobials should closely mimic clinical practice, taking into account the drug's pharmacokinetic profile, alterations in absorption, distribution and clearance, and host factors such as age, weight, and comorbidities. These recommendations and considerations are proposed as “best practices” for animal models of sepsis that should be implemented.
Prospective Creation and Validation of the PREVENTT (Prediction and Enaction of Prevention Treatments Trigger) Scale for Surgical Site Infections (SSIs) in Patients With Diverticulitis
Authors: Bordeianou Liliana , Cauley Christy E. , Patel Ruchin , Bleday Ronald , Mahmood Sadiqa , Kennedy Kevin , Ahmed Khawaja F. , Yokoe Deborah , Hooper David , Rubin Marc
Published: June 2018

Objective:

Create and validate diverticulitis surgical site infection prediction scale.

Background:

Surgical site infections cause significant morbidity after colorectal surgery. An infection prediction scale could target infection prevention bundles to high-risk patients.

Methods:

Prospectively collected National Surgical Quality Improvement Program and electronic medical record data obtained on diverticulitis colectomy patients across a Healthcare Network-wide Colorectal Surgery Collaborative (5 hospitals). Patients with and without surgical site infections were compared. Predictive variables were identified using logistic regression model; model estimates obtained through 1000 bootstrap replications for scale validation.

Results:

A total of 1737 colectomies were performed (2010–2016): mean age 59.9 years (SD 12.7), 56.4% female; 93.4% Caucasian; smokers 16.3%, diabetics 7.7%, steroid use 6.0%. Two hundred thirty-one (13.3%) were presented to operating room emergently and 138 (7.9%) with abscess at time of disease admission. Two hundred ninety-six patients underwent Hartman procedures, and 113 (6.5%) received diverted primary anastomosis. Average length of stay was 6.9 days (standard deviation 7.01), 30-day mortality was 1.5%, anastomotic leak rate was 3.1%. Twenty-one percent of patients (n = 366) developed a surgical site infection. Several predictors for infection were identified: obesity (body mass index >30), advanced age (>70 years), diabetes mellitus, preoperative abscess, open surgery, emergent operations, and prolonged operations (>3 h). Creation of protected anastomosis in emergent settings was associated with increased infection rates. Presence of more than 5 risk factors was associated with infection rates of 45.8% (c = 0.69).

Conclusions:

Patients with diverticulitis have high surgical site infection rates due to nonmodifiable risk factors. Our Prediction and Enaction of Prevention Treatments Trigger scale can risk stratify patients for targeting surgical site infection prevention bundles and outcomes risk adjustments.
Design, Conduct, and Analysis of Surgical Randomized Controlled Trials
Authors: Yu Jiajie , Chen Wenwen , Chen Shidong , Jia Pengli , Su Guanyue , Li Youping , Sun Xin
Published: June 2018

Background:

Randomized controlled trial (RCT) testing surgical intervention faced challenges due to complexities of surgery and made it more difficult for surgeons and methodologists than pharmaceutical providers to build a well-design, conduct RCT.

Objective:

We conducted a cross-sectional survey to address the methodological challenges of RCTs on surgical intervention and offer potential solutions.

Methods:

We searched PubMed in order to summarize 2-arm parallel randomized trials for surgical interventions published in 2013. The information regarding general characteristics, general methodological and special surgical characteristics related to surgical trials comparing alternative procedures was gathered.

Results:

Some 200 surgical trials were identified. The extent to which these trials in design, conduct and analysis differed substantially across items. The general information about sample size calculation (77.0%), lost to follow-up (71.5%), trial registration (55.5%), protocols of trials (56.0%), implementation of randomization (59.5%), concealment of randomization (56.0%); reporting of primary outcome as P value (67.0%). Surgery special information revealed that only 21.0% of trials considered surgeons’ preference, approximately 12% to 50% of them controlled the quality of surgical interventions and none evaluated the effect of the learning curve.

Conclusion:

There is much room for improvement concerning the reported designs, conduct, and analysis of surgical RCTs. Considering the difficulty of surgical RCTs, some other approaches, such as surgeons’ eligibility, performance of pilot studies, or implementation of pragmatic RCTs/expertise-based trials, should be feasibly implemented to overcome the presented challenges.
A Multicenter Matched Comparison of Transanal and Robotic Total Mesorectal Excision for Mid and Low-rectal Adenocarcinoma
Authors: Lee Lawrence , de Lacy Borja , Gomez Ruiz Marcos , Liberman Alexander Sender , Albert Matthew R. , Monson John R. T. , Lacy Antonio , Kim Seon Hahn , Atallah Sam B.
Published: June 2018

Objective:

To compare the quality of surgical resection of transanal total mesorectal excision (TA-TME) and robotic total mesorectal excision (R-TME).

Background:

Both TA-TME and R-TME have been advocated to improve the quality of surgery for rectal cancer below 10 cm from the anal verge, but there are little data comparing TA-TME and R-TME.

Methods:

Data of patients undergoing TA-TME or R-TME for rectal cancer below 10 cm from the anal verge and a sphincter-saving procedure from 5 high-volume rectal cancer referral centers between 2011 and 2017 were obtained. Coarsened exact matching was used to create balanced cohorts of TA-TME and R-TME. The main outcome was the incidence of poor-quality surgical resection, defined as a composite measure including incomplete quality of TME, or positive circumferential resection margin (CRM) or distal resection margin (DRM).

Results:

Out of a total of 730 patients (277 TA-TME, 453 R-TME), matched groups of 226 TA-TME and 370 R-TME patients were created. These groups were well-balanced. The mean tumor height from the anal verge was 5.6 cm (SD 2.5), and 70% received preoperative radiotherapy. The incidence of poor-quality resection was similar in both groups (TA-TME 6.9% vs R-TME 6.8%; P = 0.954). There were no differences in TME specimen quality (complete or near-complete TA-TME 99.1% vs R-TME 99.2%; P = 0.923) and CRM (5.6% vs 6.0%; P = 0.839). DRM involvement may be higher after TA-TME (1.8% vs 0.3%; P = 0.051).

Conclusions:

High-quality TME for patients with rectal adenocarcinoma of the mid and low rectum can be equally achieved by transanal or robotic approaches in skilled hands, but attention should be paid to the distal margin.
Evidence-based Reviews in Surgery
Authors: Kao Lillian S. , Ball Chad G. , Chaudhury Prosanto K.
Published: June 2018

Question:

What are the clinical outcomes of early versus delayed laparoscopic cholecystectomy (LC) in acute cholecystitis with more than 72 hours of symptoms?

Design:

A randomized controlled trial.

Setting:

Single center at the University Hospital of Lausanne, Switzerland.

Patients:

Eighty-six patients were enrolled in the study that had symptoms of acute cholecystitis lasting more than 72 hours before admission.

Intervention:

Patients were randomly assigned to early LC or delayed LC.

Main Outcome:

Primary outcome was overall morbidity following initial diagnosis. Secondary outcomes included total length of stay, duration of antibiotic used, cost, and surgical outcome.

Results:

Overall morbidity was lower in early laparoscopic cholecystectomy (ELC) [6 (14%) vs 17 (39%) patients, P = 0.015]. Median total length of stay (4 vs 7 days, P < 0.001) and duration of antibiotic therapy (2 vs 10 days, P < 0.001) were shorter in the ELC group. Total hospital costs were lower in ELC (9349€ vs 12,361€, P = 0.018). Operative time and postoperative complications were similar (91 vs 88 minutes; P = 0.910) and (15% vs 17%; P = 1.000), respectively.

Conclusions:

ELC for acute cholecystitis even beyond 72 hours of symptoms is safe and associated with less overall morbidity, shorter total hospital stay, and duration of antibiotic therapy, as well as reduced cost compared with delayed cholecystectomy.
High Compliance to an Enhanced Recovery Pathway for Patients ≥65 Years Undergoing Major Small and Large Intestinal Surgery Is Associated With Improved Postoperative Outcomes
Authors: Owodunni Oluwafemi P. , Hampton Jessica , Bettick Dianne , Sateri Sara , Magnuson Thomas , Wick Elizabeth , Psoter Kevin J. , Gearhart Susan L.
Published: June 2018

Objective:

This study was performed to evaluate compliance to an Enhanced Recovery Pathway (ERP) among patients ≥65 years and determine the effect of compliance on postoperative outcomes.

Summary Background Data:

ERPs improve postoperative outcomes in patients undergoing major surgery. Given the inherent decline of the older surgical patient, the benefit of an ERP in this population has been questioned.

Methods:

Patients undergoing major small and large intestinal surgery prior to and following ERP implementation at the Johns Hopkins Medical Institutions were entered into the ACS-NSQIP database. Outcomes included ERP compliance rates, complications, length of stay (LOS), and 30-day readmission rates were determined for older patients.

Results:

Nine hundred seventy-four patients (693 < 65 yrs and 281 ≥ 65 yrs) were included. Of those ≥ 65 years, 142 (51%) were entered prior to and 139 (49%) were entered following ERP implementation. More ERP than pre-ERP patients underwent laparoscopic procedures (45.3% vs. 32.4%, P = 0.02), had disseminated malignancies (9.4% vs. 2.8%, P = 0.03), and smoked (14.4% vs. 4.9%, P = 0.01). Overall compliance was 74.5%, and 47% of older ERP patients achieved high compliance (≥75% compliance with ERP variables). High compliance was associated with a 30% decrease LOS (IRR: 0.7 P = 0.001) and 60% decrease in major (CD ≥ II) complications (OR: 0.4 P = 0.05).

Conclusion:

LOS and complication rates following implementation of an ERP were significantly improved in highly compliant elderly patients. Interventions to further improve outcomes should target decreasing variability by increasing individual compliance with an effective clinical pathway.
HaploBlocker: Creation of subgroup specific haplotype blocks and libraries
Authors: Pook Torsten , Schlather Martin , de los Campos Gustavo , Mayer Manfred , Schoen Chris Carolin , Simianer Henner
Published: June 2018

The concept of haplotype blocks has been shown to be useful in genetics. Fields of application range from the detection of regions under positive selection to statistical methods that make use of dimension reduction. We propose a novel approach (“HaploBlocker”) for defining and inferring haplotype blocks that focuses on linkage instead of the commonly used population-wide measures of linkage disequilibrium. We define a haplotype block as a sequence of genetic markers that has a predefined minimum frequency in the population and only haplotypes with a similar sequence of markers are considered to carry that block, effectively screening a dataset for group-wise identity-by-descent. From these haplotype blocks we construct a haplotype library that represents a large proportion of genetic variability with a limited number of blocks. Our method is implemented in the associated R-package HaploBlocker and provides flexibility to not only optimize the structure of the obtained haplotype library for subsequent analyses, but is also able to handle datasets of different marker density and genetic diversity. By using haplotype blocks instead of SNPs, local epistatic interactions can be naturally modelled and the reduced number of parameters enables a wide variety of new methods for further genomic analyses such as genomic prediction and the detection of selection signatures. We illustrate our methodology with a dataset comprising 501 doubled haploid lines in a European maize landrace genotyped at 501’124 SNPs. With the suggested approach, we identified 2’991 haplotype blocks with an average length of 2’685 SNPs that together represent 94% of the dataset.
Recapture rates and habitat associations of White-faced Darter Leucorhinnia dubia on Fenn’s and Whixall Moss, Shropshire, UK
Authors: Davies Rachel , Hardenberg Achaz von , Geary Matthew
Published: June 2018

Land-use change and habitat loss are important drivers of biodiversity decline at both global and local scales. To protect species from the impacts of land-use change it is important to understand the population dynamics and habitat associations across these scales. Here we present an investigation into the survival and habitat preferences of White-faced Darter (Leucorrhinia dubia) at the local scale at Fenn’s and Whixall Moss, Shropshire, UK. We used capture-mark-recapture methods to investigate survival and used sightings of individual dragonflies along with habitat data to investigate habitat preference. We found that survival between capture-visits was very low and that White-faced Darter show a clear preference for the open moss habitat on this site. In both cases, we found that the detectability either through sightings or recaptures was potentially very low and suggest that this should be taken into account in future analyses. We suggest that this could be achieved by encouraging recorders to submit complete lists and to repeat visits to sites.
Childhood Cerebellar Tumors Mirror Conserved Fetal Transcriptional Programs
Authors: Vladoiu Maria C , El-Hamamy Ibrahim , Donovan Laura K , Farooq Hamza , Holgado Borja L , Ramaswamy Vijay , Mack Stephen C , Lee John JY , Kumar Sachin , Przelicki David , Michealraj Antony , Juraschka Kyle , Skowron Patryk , Luu Betty , Suzuki Hiromichi , Morrissy A Sorana , Cavalli Florence MG , Garzia Livia , Daniels Craig , Wu Xiaochong , Qazi Maleeha A , Singh Sheila K , Chan Jennifer A , Marra Marco A , Malkin David , Dirks Peter , Pugh Trevor , Notta Faiyaz , Kleinman Claudia L , Joyner Alexandra , Jabado Nada , Stein Lincoln , Taylor Michael D.
Published: June 2018

The study of the origin and development of cerebellar tumours has been hampered by the complexity and heterogeneity of cerebellar cells that change over the course of development. We used single-cell transcriptomics to study >60,000 cells from the developing murine cerebellum, and show that different molecular subgroups of childhood cerebellar tumors mirror the transcription of cells from distinct, temporally restricted cerebellar lineages. Sonic Hedgehog medulloblastoma transcriptionally mirrors the granule cell hierarchy as expected, whereas Group 3 medulloblastoma resemble Nestin+ve stem cells, Group 4 medulloblastomas resemble unipolar brush cells, and PFA/PFB ependymoma and cerebellar pilocytic astrocytoma resemble the prenatal gliogenic progenitor cells. Furthermore, single-cell transcriptomics of human childhood cerebellar tumors demonstrates that many bulk tumors contain a mixed population of cells with divergent differentiation. Our data highlight cerebellar tumors as a disorder of early brain development, and provide a proximate explanation for the peak incidence of cerebellar tumors in early childhood.
Neuropathological correlates and genetic architecture of microglial activation in elderly human brain
Authors: Felsky Daniel , Roostaei Tina , Nho Kwangsik , Risacher Shannon L. , Bradshaw Elizabeth M. , Petyuk Vlad , Schneider Julie A , Saykin Andrew , Bennett David A. , De Jager Philip L.
Published: June 2018

Microglia, the resident immune cells of the brain, have important roles in brain health. However, little is known about the regulation and consequences of microglial activation in the aging human brain. We assessed the effect of microglial activation in the aging human brain by calculating the proportion of activated microglia (PAM), based on morphologically defined stages of activation in four regions sampled postmortem from up to 225 elderly individuals. We found that cortical and not subcortical PAM measures were strongly associated with β-amyloid, tau-related neuropathology, and rates of cognitive decline. Effect sizes for PAM measures are substantial, comparable to that of APOE ɛ4, the strongest genetic risk factor for Alzheimer’s disease. Mediation modeling suggests that PAM accelerates accumulation of tau pathology leading to cognitive decline, supporting an upstream role for microglial activation in Alzheimer’s disease. Genome-wide analyses identified a common variant (rs2997325) influencing cortical PAM that also affected in vivo microglial activation measured by positron emission tomography using [11C]-PBR28 in an independent cohort. Finally, we identify overlaps of PAM’s genetic architecture with those of Alzheimer’s disease, educational attainment, and several other traits.