bluuebunny/crossref_metadata_2025 huggingface dataset:
Thalamic and cerebellar hypoperfusion in single photon emission computed tomography may differentiate multiple system atrophy and progressive supranuclear palsy
Authors: Alster Piotr , Nieciecki Michał , Koziorowski Dariusz M. , Cacko Andrzej , Charzyńska Ingeborga , Królicki Leszek , Friedman Andrzej
Published: July 2019

Neuroimaging in the context of examining atypical parkinsonian tauopathies is an evolving matter. Positron emission tomography and single photon emission computed tomography (SPECT) bring tools, which may be reasonable in supplementary examination, however, cannot be interpreted as a criterion standard for correct diagnosis. The aim of this observational study was to assess the differentiating potential of perfusion SPECT in 3 types of atypical parkinsonisms: multiple system atrophy parkinsonian type (MSA-P), corticobasal syndrome (CBS), and progressive supranuclear palsy (PSP). The study was carried out using the comparison of standard deviations of perfusion in patients from these 3 groups. Data obtained from 10 patients with clinical diagnosis MSA-P, 14 patients with CBS and 21 patients with PSP, which were analyzed using Tukey honest significant difference post-hoc test, revealed significant differences of perfusion P < .05 between MSA-P and PSP within the cerebellum and thalamus. No significant differences between CBS and PSP were observed.
Efficacy of mometasone furoate for nasal polyps
Authors: Yu Hai-jiang , Han Lin , Wang Wei-feng , Yang Lin-hong , Nie Yu-fei
Published: July 2019

Background:

This study aims to systematically explore the efficacy and safety of mometasone furoate (MTF) for patients with nasal polyps (NP).

Methods:

We will search MEDLINE, Cochrane Library, PubMed, Springer, Web of Science, Ovid, Wangfang and Chinese Biomedical Literature Database from their inception to April 30, 2019 without language restrictions. All randomized controlled trials (RCTs) of MTF for the treatment of NP will be considered for inclusion. RevMan 5.3 software will be used for data synthesis, subgroup analysis, sensitivity analysis, as well as the meta-analysis.

Results:

Primary outcomes include change in symptom scores (as measured by any symptom scores), and polyp size (as assessed by any Polyp size scores or tools). Secondary outcomes consist of polyp recurrence, change in nasal air flow, quality of life outcomes (as measured by any quality of life scales, such as Short Form Health Survey is a 36-item), and adverse events.

Conclusion:

This study will provide evidence for judging whether MTF is an effective and safe treatment for NP or not.

PROSPERO registration number:

PROSPERO CRD42019134037.
Nonspecific dizziness as an unusual presentation of neurocysticercosis
Authors: Li Huiying , Sun Jing , Nan Guangxian
Published: July 2019

Rationale:

Neurocysticercosis (NCC) can cause lesions across the central nervous system, leading to varying clinical manifestations. While the presentation of nonspecific symptom is rare, they are easy to ignore. The present report documents a case of NCC that manifested as persistent dizziness.

Patient concerns:

A Chinese woman visited the hospital on account of dizziness, the severity of which had increased gradually over the month prior.

Diagnoses:

Head computed tomography and magnetic resonance imaging (MRI) revealed hydrocephalus. Cervical MRI revealed an abnormal object in the spinal canal at the junction of the medulla oblongata and C1, which blocked the circulation cerebrospinal fluid circulation and caused the enlargement of the ventricles.

Intervention:

The patient underwent surgical treatment. The abnormal object was removed, and a diagnosis of NCC was considered by pathological examination.

Outcome:

The patient's dizziness resolved after surgical treatment, and no other symptoms appeared thereafter.

Lesson:

Clinicians should not ignore nonspecific clinical symptoms, as they may indicate hydrocephalus.
A suprasellar bronchogenic cyst
Authors: Bian Bingyang , Yu Miao , Liu Shanshan , Li Shu , Wei Ying , Zhang Bei
Published: July 2019

Rationale:

Bronchogenic cysts are mainly benign, congenital abnormalities, originating from the remnants of the primitive foregut. However, intracranial bronchogenic cysts have been rarely observed. Hence, better understanding of the suprasellar bronchogenic cysts is of great significance to properly perform perioperative management.

Patient's concerns:

A 62-year-old Chinese female was admitted to our hospital due to impairment of memory and asthenia.

Diagnosis:

Magnetic resonance imaging (MRI) confirmed presence of cystic lesion in the suprasellar region. The patient underwent craniotomy with resection of the cystic mass. The histopathological examinations confirmed diagnosis of bronchogenic cyst as well.

Interventions:

The cystic lesion was removed without complications. No drugs during follow-up were recommended.

Outcomes:

After discharge, the patient was advised to undergo MRI for 6 months to 1 year. No evidence of recurrence was found in the first postoperative review.

Lessons:

Bronchogenic cysts should be considered in differential diagnosis of cystic mass detected in the suprasellar region on MRI. Once the disease is considered, surgical resection is recommended to obtain pathological diagnosis, alleviate clinical symptoms, and prevent complications.
Spinal epidural hematoma occurring at a distance from the transforaminal epidural injection site
Authors: Kim Sang-In , Lee Dong-Hyun , Kim Sun-Hee , Cho Yong-Hyun
Published: July 2019

Rationale:

Transforaminal epidural steroid injection (TFESI) is a conservative method to treat back pain due to radiculopathy. However, epidural hematoma can occur after the procedure by various mechanisms, which can cause serious complications.

Patient concerns:

An 82-year-old man with spinal stenosis was treated with TFESI in the right intervertebral foramen at the L2-L3 level. The next morning, he experienced severe back pain and diffuse motor deficit.

Diagnosis:

Emergency magnetic resonance imaging revealed fluid collection in the posterior epidural space at the T11-L1 level with central-canal stenosis.

Interventions:

Emergency hematoma evacuation was performed to remove the epidural hematoma.

Outcomes:

After the surgery, the back pain disappeared.

Lessons:

Epidural hematoma may occur due to causes other than direct needle injury after TFESI. Therefore, careful observation of the patient is necessary after the procedure.
Five-year Impact of a Commercial Accountable Care Organization on Health Care Spending, Utilization, and Quality of Care
Authors: Zhang Hui , Cowling David W. , Graham Joanne M. , Taylor Erik
Published: July 2019

Background:

Accountable Care Organizations (ACOs) have proliferated after the passage of the Affordable Care Act in 2010. Few longitudinal ACO studies with continuous enrollees exist and most are short term.

Objective:

The objective of this study was to evaluate the long-term impact of a commercial ACO on health care spending, utilization, and quality outcomes among continuously enrolled members.

Research Design:

Retrospective cohort study design and propensity-weighted difference-in-differences approach were applied to examine performance changes in 2 ACO cohorts relative to 1 non-ACO cohort during the commercial ACO implementation in 2010–2014.

Subjects:

A total of 40,483 continuously enrolled members of a commercial health maintenance organization from 2008 to 2014.

Measures:

Cost, use, and quality metrics for various type of services in outpatient and inpatient settings.

Results:

The ACO cohorts had (1) increased inpatient and outpatient total spending in the first 2 years of ACO operation, but insignificant differential changes for the latter 3 years; (2) decreased outpatient spending in the latter 2 years through reduced primary care visits and lowered spending on specialists, testing, and imaging; (3) no differential changes in inpatient hospital spending, utilization, and quality measures for most of the 5 years; (4) favorable results for several quality measures in preventive and diabetes care domains in at least one of the 5 years.

Conclusions:

The commercial ACO improved outpatient process quality measures modestly and slowed outpatient spending growth by the fourth year of operation, but had a negligible impact on inpatient hospital cost, use, and quality measures.
Update on treatment options for blast-induced hearing loss
Authors: Mizutari Kunio
Published: July 2019

Purpose of review

The incidence of blast injuries has increased, and the ear is the highest risk organ. Ear injury induced by blast exposure is important in both military and civilian conditions. The permanent hearing loss caused by blast exposure is associated with a decline in the quality of life. In this review, I describe recent therapeutic strategies for each of the ear pathologies caused by blast exposure.

Recent findings

For tympanic membrane perforation after blast exposure, basic fibroblast growth factor (bFGF) has been used as a less invasive treatment to repair the tympanic membrane. The closure rates of tympanic membrane perforations treated with bFGF were reported to be comparable to those following conventional tympanoplasty.

For sensorineural hearing loss after blast exposure, treatment with neurotrophic factors, such as nerve growth factor (NGF) or neurotrophin-3, antioxidants, and Atoh1 induction have recently been applied, and some of them were considered for clinical application.

Recent advances of therapeutics for blast-induced hearing loss, based on their pathologies, have been outlined. There are several promising therapeutic approaches for both middle and inner ear disorders after blast exposure; however, further research is needed to establish new treatments for blast-induced hearing dysfunction.
Spleen and Liver Stiffness to Detect Esophageal Varices in Children with Biliary Atresia
Authors: Sintusek Palittiya , Siriporn Nipaporn , Punpanich Dollapas , Chongsrisawat Voranush , Poovorawan Yong
Published: July 2019

Objectives:

The aim of the study was to determine the accuracy of noninvasive parameters, such as liver (LS) and spleen stiffness (SS) to detect esophageal varices (EV) in children with biliary atresia (BA).

Methods:

Children with BA between 2000 and 2015 were recruited. All underwent esophagogastroduodenoscopy and transient elastography. Demographic data, laboratory investigations, alanine transferase‐to‐platelet ratio index (APRI), and Varices Prediction Rule (VPR) score were collected.

Results:

A total of 51 children (mean age 10.63 years, standard deviation (SD) = 6.08 years; 53% boys) were enrolled. There were differences in onset and outcome of portoenterostomy, spleen palpablility, platelet count, albumin, LS, SS, and VPR between the varice and varice‐free groups (P < 0.05). In the varice group, the median LS was 18.12 (interquartile ratio, IQR 13.15–19.12) and the median SS was 46.85 (IQR 25.95–54.55) kPa. In the varice‐free group, the median LS was 7.85 (IQR 5.88–16.75) and the median SS was 16.54 (IQR 11.75–21.75) kPa. Both LS and SS were higher in the varice than the varice‐free group (P < 0001). The area under the receiver operating characteristic curve of LS, SS, spleen palpability, platelet count, APRI, and VPR were 0.734, 0.870, 0.817, 0.810, 0.751, and 0.794, respectively. Using a cut‐off value of 12.5 kPa for LS, the sensitivity and specificity were 80 and 70%, respectively. Using a cut‐off value of 28.9 kPa for SS, the sensitivity and specificity were 75 and 87%, respectively. Combination of LS and SS to diagnose varices increased the specificity to 93%.

Conclusions:

SS as a single marker had the best diagnostic value to predict esophageal varices in children with BA. The combination of SS and LS furthermore, increased the diagnostic yield.
Toward Optimal Communication About HPV Vaccination for Preteens and Their Parents: Evaluation of an Online Training for Pediatric and Family Medicine Health Care Providers
Authors: Cates Joan R. , Diehl Sandra J. , Fuemmeler Bernard F. , North Stephen W. , Chung Richard J. , Hill Jill Forcina , Coyne-Beasley Tamera
Published: July 2019

Objective:

Health care provider recommendation is a key determinant of human papillomavirus (HPV) vaccination. We developed an online training program for providers that addressed vaccine guidelines, hesitancy to strongly recommend the vaccine, and reluctance to discuss HPV infection as a sexually transmitted infection.

Design:

Single-group evaluation with 3 waves. Providers completed a 29-item electronic survey with closed and open-ended response options after course completion.

Setting:

Pediatric and family medicine practices in North Carolina.

Participants:

Prescribing clinicians (MD, DO, family nurse practitioner, physician assistant) who serve preteens aged 11 to 12 years. In wave 3, we expanded our communities to include nursing and medical staff.

Intervention:

An asynchronous online course to promote preteen HPV vaccination. Topics included HPV epidemiology, vaccine recommendations from the Advisory Committee on Immunization Practices (ACIP), preteen-provider-parent communication, topics about hesitancy to seek vaccination, subjects related to sexual health, and practice-level strategies to increase vaccination rates. The course, approved for 12 CME and CNE credits, was live for 4 weeks and available on-demand for 3 additional months.

Main Outcome Measures:

Provider-reported change in vaccine communication, perceptions of course content in improving practice, and satisfaction with materials.

Results:

A total of 113 providers from 25 practices enrolled in the course and 69 (61%) completed an evaluation. Providers spent an average of 6.3 hours on the course and rated the CDC (Centers for Disease Control and Prevention)-ACIP Web site and multiple resources on hesitancy and communication about sexually transmitted infection vaccines most highly of all materials across the 3 waves. Almost all (96%) agreed the course will improve their practice. About half of all participants said they were either “much more likely” (28%) or “more likely” (19%) to recommend the vaccine after course participation.

Conclusions:

An online format offers a highly adaptable and acceptable educational tool that promotes interpersonal communication and practice-related changes known to improve providers' vaccine uptake by their patients.
Cigarette Use Among American Indians and Alaska Natives in Metropolitan Areas, Rural Areas, and Tribal Lands
Authors: Cunningham James K. , Ritchey Jamie , Solomon Teshia A. , Cordova Felina M.
Published: July 2019

Context:

Cigarette use among the US general population is significantly lower in metropolitan areas than in rural areas.

Objective:

To assess whether cigarette use among American Indians and Alaska Natives (AI/AN) is lower in metropolitan areas than in rural areas and tribal lands (which are predominantly rural).

Design:

Data came from the National Survey on Drug Use and Health (2012-2016). Regressions with adjustments for demographics were performed to assess whether cigarette use differed in association with type of place.

Settings:

The AI/AN in tribal lands (n = 1569), nontribal large metropolitan (1+ million people) areas (n = 582), nontribal small metropolitan (<1 million) areas (n = 1035), and nontribal rural areas (n = 1043).

Main Outcome Measures:

Cigarette abstinence, current smoking, daily use, number of cigarettes used, and days of use—all in the past month. Nicotine dependence was also examined.

Results:

Metropolitan (large or small) areas versus rural areas: no statistically significant differences in cigarette use were found. Metropolitan (large or small) areas versus tribal lands: days of cigarette use and daily use were significantly lower in tribal lands. Tribal lands were also lower than small metropolitan areas regarding number of cigarettes used and nicotine dependence. Rural areas versus tribal lands: cigarette measures were consistently lower in tribal lands. For example, the prevalence of current smokers, daily users and nicotine dependence, respectively, was 37.9%, 25.9%, and 16.3% in rural areas and 27.4%, 13.6%, and 8.9% in tribal lands.

Conclusions:

Differences in cigarette use between AI/AN in nontribal rural and metropolitan areas were not indicated. Instead, the place differences found were lower cigarette use in tribal lands than in nontribal rural areas and, to some extent, metropolitan areas. These findings can help inform policy makers working to develop context-sensitive anticommercial tobacco efforts for AI/AN.
Using Resident and Faculty Focus Groups to Obtain Stakeholder Input during the ACGME Self-study
Authors: Huggins Kathryn M. , Sprewell Angelina R. , Elmore Dominique C. , Shepherd Meagan W. , LeGrow Tracy L. , Frazier Marie D. , Flesher Susan L.
Published: July 2019

Introduction:

The Accreditation Council for Graduate Medical Education describes steps to guide programs regarding self-study. The process relies heavily on obtaining stakeholder input to validate findings. Focus groups have been noted to provide input and data not elicited using other methods. Our objective was to show the value of focus groups in obtaining a clear picture of stakeholder priorities as they relate to program aims, opportunities, threats, areas for improvement, and sustainability of improvements.

Methods:

We conducted a series of focus groups in 2017–2018 at a pediatric residency program with residents and core faculty members. The first session for each group elicited input regarding program aims, opportunities, and threats. The second session focused on evaluating program progress over the past 10 years and identifying strengths and needed areas for improvement. We documented responses obtained during the focus groups and used inductive content analysis methods to identify major themes. We repeated the focus groups every 6 months.

Results:

We identified 8 program aims and pinpointed opportunities and threats. Areas for improvement were selected and then presented back to the stakeholders who confirmed their appropriateness. Repetition of the focus groups every 6 months facilitated ongoing measurement of progress and promoted the development of multiple plan, do, study, act cycles for areas of improvement.

Conclusions:

Focus groups are an effective way to initiate the self-study process, examine the program aims, opportunities, and threats, and formulate a detailed improvement plan. They are also useful as part of continual evaluation during a dynamic change process.
Sensory Recovery of the Breast following Innervated and Noninnervated DIEP Flap Breast Reconstruction
Authors: Beugels Jop , Cornelissen Anouk J. M. , van Kuijk Sander M. J. , Lataster Arno , Heuts Esther M. , Piatkowski Andrzej , Spiegel Aldona J. , van der Hulst René R. W. J. , Tuinder Stefania M. H.
Published: July 2019

Background:

The sensory recovery of the breast remains an undervalued aspect of autologous breast reconstruction. The aim of this study was to evaluate the effect of nerve coaptation on the sensory recovery of the breast following DIEP flap breast reconstruction and to assess the associations of length of follow-up and timing of the reconstruction.

Methods:

A prospective comparative study was conducted of all patients who underwent either innervated or noninnervated DIEP flap breast reconstruction and returned for follow-up between September of 2015 and July of 2017. Nerve coaptation was performed to the anterior cutaneous branch of the third intercostal nerve. Semmes-Weinstein monofilaments were used for sensory testing of the native skin and flap skin.

Results:

A total of 48 innervated DIEP flaps in 36 patients and 61 noninnervated DIEP flaps in 45 patients were tested at different follow-up time points. Nerve coaptation was significantly associated with lower monofilament values in all areas of the reconstructed breast (adjusted difference, −1.2; p < 0.001), which indicated that sensory recovery of the breast was significantly better in innervated compared with noninnervated DIEP flaps. For every month of follow-up, the mean monofilament value decreased by 0.083 in innervated flaps (p < 0.001) and 0.012 in noninnervated flaps (p < 0.001). Nerve coaptation significantly improved sensation in both immediate and delayed reconstructions.

Conclusions:

This study demonstrated that nerve coaptation in DIEP flap breast reconstruction is associated with a significantly better sensory recovery in all areas of the reconstructed breast compared with noninnervated flaps. The length of follow-up was significantly associated with the sensory recovery.
The Use of Emotional Artificial Intelligence in Plastic Surgery
Authors: Levites Heather A. , Thomas Analise B. , Levites Jim B. , Zenn Michael R.
Published: July 2019

Background:

The use of social media to discuss topics related to and within plastic surgery has become widespread in recent years; however, it remains unclear how to use this abundance of largely untapped data to propagate educational research in the field of plastic surgery. In this prospective, observational study, the authors aimed to delineate which plastic surgery–related topics evoked a significant emotional response within the study population and to assess the utility of motivational artificial intelligence within the field of plastic surgery.

Methods:

Over a 4-month period (January to April of 2018), Cognovi Lab’s artificial intelligence technology was used to search and analyze emotional reactions to several commonly hashtagged words. This innovative software uses several key metrics to describe its findings, including awareness, engagement, and motivation.

Results:

Of the search terms examined, “nose job” had the most awareness during the study period, and the topic that most engaged consumers emotionally was “liposuction.” Interestingly, “liposuction” ranked only fifth in terms of awareness. Consumers showed the strongest positive motivation toward the subjects of “plastic surgery” and “cosmetic surgery,” and the lowest motivation toward the topic of “tummy tucks.”

Conclusions:

This analysis by Cognovi Labs is the first quantitative effort to use the plethora of data on social media to interpret patient motivations and subsequent behavior. Moving forward, artificial intelligence technology will make it possible to predict which plastic surgery products, procedures, and practices will be successful. The findings presented in this article describe the unique viewpoint and power that this technology can deliver.
Dynamic FET PET Imaging of a “Butterfly” IDH-Wildtype Anaplastic Astrocytoma
Authors: Galldiks Norbert , Brunn Anna , Fink Gereon R. , Langen Karl-Josef
Published: July 2019

A variety of neoplastic and nonneoplastic conditions involve the corpus callosum, which may result in a “butterfly” appearance on conventional MRI. Typically, that pattern shows a bilateral and heterogeneous contrast enhancement of the lesion, occasionally with central nonenhancing areas indicating intralesional necrosis. In contrast, anaplastic gliomas may show only minimal or even a lack of contrast enhancement on MRI. We here report neuroimaging findings in a 69-year-old man with a “butterfly” pattern on dynamic FET [O-(2-[18F]-fluoroethyl)-l-tyrosine] PET and the diagnosis of an anaplastic astrocytoma (WHO grade III; IDH-1/−2 wildtype, no 1p/19q co-deletion) but without typical MRI contrast enhancement.
Uptake of Pineal Gland Visible on 18F-DOPA PET/CT With Last Generation of SiPM PET/CT
Authors: Decazes Pierre , Hapdey Sébastien , Humbert Olivier , Marie-Cardine Aude , Vera Pierre
Published: July 2019

A 17-year-old girl underwent an 18F-DOPA brain PET/CT on a new high-resolution digital SiPM PET/CT (Vision600 Siemens) to explore a suspicion of recurrence of a pilocytic astrocytoma. This study showed a local recurrence, but a second intense focal uptake was visible above, more intense than striata. On fused MRI, this was the pineal gland considered as physiological. This physiological uptake, due to a pineal DOPA decarboxylase activity, has also been observed with this PET system in other patients with 18F-DOPA to explore movement disorders. New high-resolution PET can show uptake of small structures by being less dependent to partial volume effect.
Direct Rivaroxaban-Induced Factor XA Inhibition Proves to be Cardioprotective in Rats
Authors: Guillou Sophie , Beaumont Justine , Tamareille Sophie , Giraud Sebastien , Mirebeau-Prunier Delphine , Prunier Fabrice , Macchi Laurent
Published: July 2019

Background:

Acute myocardial infarction is a leading cause of death worldwide. Though highly beneficial, reperfusion of myocardium is associated with reperfusion injury. While indirect inhibition of Factor Xa has been shown to attenuate myocardial ischemia-reperfusion (I/R) injury, the underlying mechanism remains unclear. Our study sought to evaluate the effect of rivaroxaban (RIV), a direct inhibitor of Factor Xa, on myocardial I/R injury and determine its cellular targets.

Experimental Approach:

We used a rat model of 40-min coronary ligation followed by reperfusion. RIV (3 mg/kg) was given per os 1 h before reperfusion. Infarct size and myocardial proteic expression of survival pathways were assessed at 120 and 30 min of reperfusion, respectively. Plasmatic levels of P-selectin and von Willebrand factor were measured at 60 min of reperfusion. Cellular RIV effects were assessed using hypoxia-reoxygenation (H/R) models on human umbilical vein endothelial cells and on rat cardiomyoblasts (H9c2 cell line).

Key Results:

RIV decreased infarct size by 21% (42.9% vs. 54.2% in RIV-treated rats and controls respectively, P < 0.05) at blood concentrations similar to human therapeutic (387.7 ± 152.3 ng/mL) levels. RIV had no effect on H/R-induced modulation of endothelial phenotype, nor did it alter myocardial activation of reperfusion injury salvage kinase and survivor activating factor enhancement pathways at 30 min after reperfusion. However, RIV exerted a cytoprotective effect on H9c2 cells submitted to H/R.

Conclusions:

RIV decreased myocardial I/R injury in rats at concentrations similar to human therapeutic ones. This protection was not associated with endothelial phenotype modulation but rather with potential direct cytoprotection on cardiomyocytes.
Utilizing Precision Medicine to Estimate Timing for Surgical Closure of Traumatic Extremity Wounds
Authors: Lisboa Felipe A. , Dente Christopher J. , Schobel Seth A. , Khatri Vivek , Potter Benjamin K. , Kirk Allan D. , Elster Eric A.
Published: July 2019

Background:

Both the frequency and high complication rates associated with extremity wounds in recent military conflicts have highlighted the need for clinical decision support tools (CDST) to decrease time to wound closure and wound failure rates.

Methods:

Machine learning was used to estimate both successful wound closure (based on penultimate debridement biomarker data) and the necessary number of surgical debridements (based on presentation biomarkers) in 73 service members treated according to military guidelines based on clinical data and the local/systemic level of 32 cytokines. Models were trained to estimate successful closure including an additional 8 of 80 civilian patients with similar injury patterns. Previous analysis has demonstrated the potential to reduce the number of operative debridements by 2, with resulting decreases in ICU and hospital LOS, while decreasing the rate of wound failure.

Results:

Analysis showed similar cytokine responses when civilians followed a military-like treatment schedule with surgical debridements every 24 to 72 hours. A model estimating successful closure had AUC of 0.89. Model performance in civilians degraded when these had a debridement interval > 72 hours (73 of the 80 civilians). A separate model estimating the number of debridements required to achieve successful closure had a multiclass AUC of 0.81.

Conclusion:

CDSTs can be developed using biologically compatible civilian and military populations as cytokine response is highly influenced by surgical treatment. Our CDSTs may help identify who may require serial debridements versus early closure, and precisely when traumatic wounds should optimally be closed.
Dissecting Cardiac Surgery
Authors: Dias Roger D. , Zenati Marco A. , Conboy Heather M. , Clarke Lori A. , Osterweil Leon J. , Avrunin George S. , Yule Steven J.
Published: July 2019

Objective:

The aim of this study was to elucidate the cognitive processes involved in surgical procedures from the perspective of different team roles (surgeon, anesthesiologist, and perfusionist) and provide a comprehensive compilation of intraoperative cognitive processes.

Summary Background Data:

Nontechnical skills play a crucial role in surgical team performance and understanding the cognitive processes underlying the intraoperative phase of surgery is essential to improve patient safety in the operating room (OR).

Methods:

A mixed-methods approach encompassing semistructured interviews with 9 subject-matter experts. A cognitive task analysis was built upon a hierarchical segmentation of coronary artery bypass grafting procedures and a cued-recall protocol using video vignettes was used.

Results:

A total of 137 unique surgical cognitive processes were identified, including 33 decision points, 23 critical communications, 43 pitfalls, and 38 strategies. Self-report cognitive workload varied substantially, depending on team role and surgical step. A web-based dashboard was developed, providing an integrated visualization of team cognitive processes in the OR that allows readers to intuitively interact with the study findings.

Conclusions:

This study advances the current body of knowledge by making explicit relevant cognitive processes involved during the intraoperative phase of cardiac surgery from the perspective of multiple OR team members. By displaying the research findings in an interactive dashboard, we provide trainees with new knowledge in an innovative fashion that could be used to enhance learning outcomes. In addition, the approach used in the present study can be used to deeply understand the cognitive factors underlying surgical adverse events and errors in the OR.
Reappraisal of a 2-Cm Cut-off Size for the Management of Cystic Pancreatic Neuroendocrine Neoplasms
Authors: Maggino Laura , Schmidt Andrea , Käding André , Westermark Sofia , Ceppa Eugene P. , Falconi Massimo , Javed Ammar A. , Landoni Luca , Pergolini Ilaria , Perinel Julie , Vollmer Charles M. , Sund Malin , Gaujoux Sebastien
Published: July 2019

Objective:

The aim of this study was to characterize an international cohort of resected cystic pancreatic neuroendocrine neoplasms (cPanNENs) and identify preoperative predictors of aggressive behavior.

Background:

The characteristics of cPanNENs are unknown and their clinical management remains unclear. An observational strategy for asymptomatic cPanNENs ≤2 cm has been proposed by recent guidelines, but evidence is scarce and limited to single-institutional series.

Methods:

Resected cPanNENs (1995–2017) from 16 institutions worldwide were included. Solid lesions (>50% solid component), functional tumors, and MEN-1 patients were excluded. Aggressiveness was defined as lymph node (LN) involvement, G3 grading, distant metastases, and/or recurrence.

Results:

Overall, 263 resected cPanNENs were included, among which 177 (63.5%) were >2 cm preoperatively. A preoperative diagnosis of cPanNEN was established in 162 cases (61.6%) and was more frequent when patients underwent endoscopic ultrasound [EUS, odds ratio (OR) 2.69, 95% confidence interval (CI) 1.52–4.77] and somatostatin-receptor imaging (OR 3.681, 95% CI 1.809–7.490), and for those managed in specialized institutions (OR 3.12, 95% CI 1.57–6.21). Forty-one cPanNENs (15.6%) were considered aggressive. In the whole cohort, LN involvement on imaging, age >65 years, preoperative size >2 cm, and pancreatic duct dilation were independently associated with aggressive behavior. In asymptomatic patients, older age and a preoperative size >2 cm remained independently associated with aggressiveness. Only 1 of 61 asymptomatic cPanNENs ≤2 cm displayed an aggressive behavior.

Conclusions:

The diagnostic accuracy of cPanNENs is increased by the use of EUS and somatostatin-receptor imaging and is higher in specialized institutions. Preoperative size >2 cm is independently associated with aggressive behavior. Consequently, a watch-and-wait policy for sporadic asymptomatic cPanNENs ≤2 cm seems justified and safe for most patients.
Information and Communication Technology Can Increase Patient Participation in Pressure Injury Prevention
Authors: Hultin Lisa , Karlsson Ann-Christin , Öhrvall Margareta , Gunningberg Lena
Published: July 2019

PURPOSE:

The aim of this study was to assess the participatory capabilities of hospitalized older adults in response to the Continuous Bedside Pressure Mapping system placed on the beds to prevent pressure injuries.

DESIGN:

Descriptive study.

SUBJECTS AND SETTING:

A convenience sample of 31 orthopedic patients were recruited from an orthopedic rehabilitation unit at a university hospital in Uppsala, Sweden, that served patients aged 65 years and older.

METHODS:

Semistructured interviews were conducted between November 2016 and February 2017, audio-recorded, and transcribed verbatim. Data were analyzed using qualitative content analysis.

RESULT:

The overall theme from 21 interviews was “A new way of understanding helped patients to recognize vulnerable pressure points and to take action in their own care” from which 2 categories, “awareness” and “action,” emerged. The study showed that verbally adapted information combined with using information and communication technology increased most participants' knowledge and as they became aware of increased pressure, they started to take preventative action by changing position.

CONCLUSIONS:

It is possible for older participants in a rehabilitation unit who had recent orthopedic surgery to understand and use new information and communication technology and should be invited to participate in pressure injury prevention.
Unusual Set of Adverse Effects During Right-Unilateral Ultrabrief Electroconvulsive Therapy Led to the Discovery of a Brain Tumor
Authors: Buday Jozef , Albrecht Jakub , Mareš Tadeáš , Fabián Vratislav , Buday Jozef , Raboch Jiří , Anders Martin
Published: July 2019

We describe a case of a right-handed, 42-year-old, Caucasian female patient who manifested a set of unusual adverse effects during maintenance ultrabrief right-unilateral electroconvulsive therapy (ECT)—generalized myoclonic secondary seizure with lateralization nonresponsive to repeated intravenous diazepam application, deviation of the tongue and the head to the left, ping-pong gaze with nystagmoid jerks, postictal hypoactive confusion state lasting 15 minutes (with a total time to recovery 30 minutes), and likely Todd's paralysis after the procedure (subsided within 24 hours). These adverse effects led to a thorough clinical investigation and eventually the discovery of a brain tumor. In the article, we hypothesize about the possible interaction between the intracranial mass and ECT and provide a literature overview on the topic. Cases like this are likely underreported, and although several studies demonstrate that ECT can be applied safely to patients with an intracranial mass, this report demonstrates that brain tumor can interfere with ECT in an unpredictable way and have severe consequences (eg, unresponsiveness to diazepam when attempting to halt the seizure as our patient). Unusual symptoms after ECT, albeit reversible, such as in this case report, should be followed by a thorough neurological check-up to exclude any underlying organic pathology.
“Plasma Membrane Calcium Atpase downregulation in dopaminergic neurons alters cellular physiology and behavior in Drosophila melanogaster”
Authors: Erhardt Brenda , Leal María Celeste , Marcora María Silvina , Frenkel Lía , Bochicchio Pablo Alejandro , Bodin Diego Hernán , Silva Berenice Anabel , Farías María Isabel , Ferrari Carina Cintia , Ángel Allo Miguel , Höcht Christian , Castaño Eduardo Miguel , Pitossi Fernando Juan
Published: July 2019

Accumulation of calcium is proposed to account for selective dopaminergic neuron (DN) dysfunctionality, a characteristic of Parkinson’s Disease (PD). To test the in vivo impact of calcium increment in DN physiology we downregulated the Plasma Membrane Calcium ATPase (PMCA), a bomb that extrudes cytosolic calcium, in those neurons in Drosophila melanogaster. Using th-GAL4>PMCARNAi, PMCA was selectively reduced, leading to increased cytosolic calcium and mitochondrial oxidative stress with no neurodegeneration. In the eye, PMCARNAi expression provoked a subtle disorganization, suggesting scarce toxicity. Interestingly, we observed several locomotor alterations and a higher level of dopamine in brains. Finally, flies presented a reduction of lifespan and a perimortem non-motor phenotype characterized by abdominal swelling, possibly due to constipation. We conclude that elevated cytosolic calcium in DN could trigger cellular dysfunction generating mitochondrial oxidative stress and motor and non-motor symptoms, typical of PD.
Hypoxia induces transcriptional and translational downregulation of the type I interferon (IFN) pathway in multiple cancer cell types
Authors: Miar Ana , Arnaiz Esther , Bridges Esther , Beedie Shaunna , Cribbs Adam P , Downes Damien J. , Beagrie Robert , Rehwinkel Jan , Harris Adrian L.
Published: July 2019

Hypoxia is a common phenomenon in solid tumours and is considered a hallmark of cancer. Increasing evidence shows that hypoxia promotes local immune suppression. Type I IFN is involved in supporting cytotoxic T lymphocytes by stimulating the maturation of dendritic cells (DCs) and enhancing their capacity to process and present antigens. However, there is little information about the relationship between hypoxia and the type I interferon (IFN) pathway, which comprises the sensing of double-stranded RNA and DNA (dsRNA/dsDNA), followed by IFNα/β secretion and transcription activation of IFN-stimulated genes (ISGs). The aims of this study were to determine both the effect and mechanisms of hypoxia on the I IFN pathway in breast cancer.

There was a downregulation of the type I IFN pathway expression at mRNA and protein level in cancer cell lines under hypoxia in vitro and in vivo in xenografts. This pathway was suppressed at each level of signalling, from the dsRNA sensors (RIG-I, MDA5), the adaptor (MAVS), transcription factors (IRF3, IRF7, STAT1) and several ISGs (RIG-I, IRF7, STAT1, ADAR-p150). There was also lower IFN secretion under hypoxic conditions. HIF1 and HIF2 regulation of gene expression did not explain most of the effects. However, ATAC-Seq data revealed that in hypoxia peaks with STAT1 and IRF3 motifs had decreased accessibility.

Thus hypoxia leads to an overall 50% downregulation of the type I IFN pathway due to repressed transcription and lower chromatin accessibility in a HIF1/2α-independent manner, which could contribute to immunosuppression in hypoxic tumours.
Syntheses and crystal structures of a new family of hybrid perovskites: C5H14N2·ABr3·0.5H2O (A= K, Rb, Cs)
Authors: Ferrandin Sarah , Slawin Alexandra M. Z. , Harrison William T. A.
Published: July 2019

The syntheses and crystal structures of three hybrid perovskites,viz. poly[1-methylpiperizine-1,4-diium [tri-μ-bromido-potassium] hemihydrate], {(C5H14N2)[KBr3]·0.5H2O}n, (I), poly[1-methylpiperizine-1,4-diium [tri-μ-bromido-rubidium] hemihydrate], {(C5H14N2)[RbBr3]·0.5H2O}n, (II), and poly[1-methylpiperizine-1,4-diium [tri-μ-bromido-caesium] hemihydrate], {(C5H14N2)[CsBr3]·0.5H2O}n, (III), are described. These isostructural (space groupAmm2) phases contain a three-dimensional, corner-sharing network of distortedABr6octahedra (A= K, Rb, Cs) with the same topology as the classical perovskite structure. The doubly protonated C5H14N22+cations occupy interstices bounded by eight octahedra and the water molecules lie in square sites bounded by four octahedra. N—H...Br, N—H...(Br,Br), N—H...O and O—H...Br hydrogen bonds consolidate the structures.
N-[(Pyridin-2-yl)methyl]thiophene-2-carboxamide
Authors: Mohanbabu M. , Sathishkumar P. N. , Bhuvanesh N. S. P. , Karvembu R. , Aravindhan S.
Published: July 2019

In the title compound, C11H10N2OS, the dihedral angle between the thiophene and pyridine rings is 77.79 (8)°. In the crystal, inversion dimers linked by pairs of N—H...N hydrogen bonds generate R
2
2(10) loops. The dimers are reinforced by pairs of C—H...N interactions and C—H...O interactions link the dimers into [010] chains.
(S)-1-(Benzylselanyl)-3-phenylpropan-2-amine
Authors: Prabhu Kumar K. M. , Palakshamurthy B. S. , Jasinski J. P. , Butcher R. J. , Raghavendra Kumar P.
Published: July 2019

In the title compound, C16H19NSe, the dihedral angle between the benzene rings is 66.49 (12) and a weak intramolecular N—H...Se hydrogen bond generates an S(6) ring. In the crystal, weak N—H...N hydrogen bonds link the molecules into [100] chains.
(Pyridine-2,6-dicarboxylato-κ3
O,N,O′)(2,2′:6′,2′′- terpyridine-κ3
N,N′,N′′)nickel(II) dimethylformamide monosolvate monohydrate
Authors: Ha Kwang
Published: July 2019

In the title complex, [Ni(C7H3NO4)(C15H11N3)]·C3H7NO·H2O, the NiII ion is six-coordinated within an octahedral geometry defined by three N atoms of the 2,2′:6′,2′′-terpyridine ligand, and two O atoms and the N atom of the pyridine-2,6-dicarboxylate di-anion. In the crystal, the complex molecules are stacked in columns parallel to the a axis being connected by π–π stacking [closest inter-centroid separation between pyridyl rings = 3.669 (3) Å]. The connections between columns and solvent molecules to sustain a three-dimensional architecture are of the type water-O—H...O(carbonyl) and pyridyl-, methyl-C—H...O(carbonyl).
The role of the lead firm in exploratory projects
Authors: Zhu Fangwei , Jiang Mengtong , Yu Miao
Published: July 2019

Purpose

The challenge of unforeseen uncertainties in exploratory projects requires the lead firm in a project alliance to effectively manage exploratory co-innovation. The purpose of this paper is to investigate the types of capabilities a lead firm required in exploratory projects and how these capabilities enable the exploratory innovation of the project alliance.

Design/methodology/approach

A multiple-case study was done to provide empirical evidence for the rationale of the capabilities of the lead firm. The provided analysis used abductive reasoning of two typical exploratory projects in China.

Findings

This paper identifies two types of capabilities: innovation-related capabilities and network-related capabilities. Furthermore, a process model of the capabilities of the lead firm is developed that enables exploratory co-innovation in a project alliance. The capabilities of the lead firm input varied at four different stages.

Practical implications

Innovation-related capabilities and network-related capabilities could form the foundation for the lead firm in an exploratory project alliance. This will enable an exploratory co-innovation and collaboratively overcome the barriers of exploratory projects.

Originality/value

Although exploratory project attracts extensive attention for its unique characteristics and universal value, there is limited amount of research on the context of joint exploratory projects. This study starts from the role of lead firm in an exploratory project alliance, contributes toward the comprehension of the link between the lead firm’s capabilities and the process of exploratory co-innovation. The findings will be of value in supporting the management of exploratory innovation in a project alliance.
The relationship between project governance mechanisms and project success
Authors: Young Raymond , Chen Wenxin , Quazi Ali , Parry Warren , Wong Adrian , Poon Simon K.
Published: July 2019

Purpose

Project governance has been linked to project success because top management support is necessary for projects to succeed. However, top managers are time poor and it is not clear which project governance mechanisms are effective for project success. The purpose of this paper is to address this issue and identify project governance mechanisms that correlate with success.

Design/methodology/approach

This is a quantitative study. A theoretical model of project governance was developed and tested with secondary industry data gathered from 51 global organisations and 66,817 responses.

Findings

The results found five project governance mechanisms (Vision, Change, Sponsor, KPI and Monitor) significantly correlate with project success and are effective at different stages in the project lifecycle.

Originality/value

Earlier research has found a relationship between project governance and project success but it has not been specific enough to guide top managers in practice. This is the first research to take this next step and identify project governance mechanisms that correlate with project success. One finding of this research that has particular value is the identification of when in the project lifecycle a particular governance mechanism is most effective.
Improving the effectiveness of public participation in public infrastructure megaprojects
Authors: Wu Lufeng , Jia Guangshe , Zhang Puwei
Published: July 2019

Purpose

The purpose of this paper is to investigate how to improve the effectiveness of public participation in public infrastructure megaprojects (PIMs). Conflicts among stakeholders and uncertainty disrupt the success of PIMs when public participation is ineffective.

Design/methodology/approach

Secondhand data are collected to study the effectiveness of public participation in the Beijing–Shenyang High-Speed Rail (China) and the California High-Speed Rail (USA). The employed research method is an inductive case study.

Findings

Ineffective public participation can cause schedule and cost overruns and increase uncertainty in PIMs. The ambiguity of meaningful public participation, ineffective participatory approaches and overburden of public participation in environmental impact assessment are the causes of ineffective public participation in PIMs.

Research limitations/implications

Public participation has become an essential part in PIMs management. This study looks at the understanding of the relationship between public participation and the success of PIMs.

Practical implications

Legislative bodies should perfect the laws to guarantee meaningful public participation. Lead agencies should adopt additional effective participatory approaches to solicit public comments and identify critical voices. A dispute solution mechanism is necessary to solve public participation disputes in PIMs in practice.

Originality/value

Stakeholder and uncertainty management are important to the success of PIMs. This study reveals methods to improve the effectiveness of public participation to alleviate the conflicts among stakeholders and reduce uncertainty in PIMs.