bluuebunny/crossref_metadata_2025 huggingface dataset:
Moderate and Severe Acute Respiratory Distress Syndrome: Hemodynamic and Cardiac Effects of an Open Lung Strategy With Recruitment Maneuver Analyzed Using Echocardiography*
Authors: Mercado Pablo , Maizel Julien , Kontar Loay , Nalos Marek , Huang Stephen , Orde Sam , McLean Anthony , Slama Michel
Published: July 2018

Objectives:

Open lung ventilation with a recruitment maneuver could be beneficial for acute respiratory distress syndrome patients. However, the increased airway pressures resulting from the recruitment maneuver may induce cardiac dysfunction, limiting the benefit of this maneuver. We analyzed the effect of a recruitment maneuver and decremental positive end-expiratory pressure titration on cardiac function.

Settings:

Medical ICU Amiens, France.

Patients:

Twenty patients with moderate to severe acute respiratory distress syndrome

Interventions:

Patients underwent a stepwise recruitment maneuver with respiratory evaluation and echocardiography assessment of cardiac function including longitudinal strain at baseline, peak positive end-expiratory pressure of recruitment maneuver (positive end-expiratory pressure 40 cm H2O), and at “optimal” positive end-expiratory pressure. The patients were divided into two groups based on change on the Pao
2/Fio
2 ratio (nonresponders < 50%; responders ≥ 50%).

Measurements and Main Results:

At peak positive end-expiratory pressure during the recruitment maneuver, the arterial pressure, cardiac output, left ventricular size decreased and right ventricular size increased. The left ventricular ejection fraction decreased from 60% ± 13% to 48% ± 18% (p = 0.05). Both left and right ventricular global longitudinal strain were impaired (–15.8% ± 4.5% to –11% ± 4.7% and –19% ± 5% to –14% ± 6% [p = 0.05] respectively). Fifty percent of patients were nonresponders and demonstrated a lower hemodynamic tolerance to the recruitment maneuver than responders. Optimal positive end-expiratory pressure was 14 ± 5 cm H2O (vs 11 ± 4 cm H2O at baseline), and Pao
2/Fio
2 ratio increased from 111 ± 25 to 197 ± 89 mm Hg (p < 0.0001). All hemodynamic variables returned to their baseline value after the recruitment maneuver despite a higher positive end-expiratory pressure.

Conclusions:

An open lung strategy with a stepwise recruitment maneuver permitted a higher positive end-expiratory pressure and improved oxygenation without any cardiac impairment. The recruitment maneuver was associated with mild and transient, cardiac dysfunction, with nonresponders demonstrating poorer tolerance.
New Morbidity and Discharge Disposition of Pediatric Acute Respiratory Distress Syndrome Survivors*
Authors: Keim Garrett , Watson R. Scott , Thomas Neal J. , Yehya Nadir
Published: July 2018

Objectives:

Much of the research related to pediatric acute respiratory distress syndrome has focused on inhospital mortality and interventions affecting this outcome. Limited data exist on survivors’ morbidity, hospital disposition, and 1-year survival. The aim of this study was to determine new morbidity rate, discharge disposition, and 1-year mortality for survivors of pediatric acute respiratory distress syndrome.

Design:

Secondary analysis of prospective cohort study.

Setting:

Quaternary children’s hospital.

Patients:

Three-hundred sixteen mechanically ventilated children with pediatric acute respiratory distress syndrome (Berlin and Pediatric Acute Lung Injury Consensus Conference criteria) between July 2011 and December 2014.

Interventions:

None.

Measurements and Main Results:

We performed secondary analysis of a prospectively recruited cohort of 316 mechanically ventilated children with pediatric acute respiratory distress syndrome between July 2011, and December 2014. Preillness and hospital discharge Functional Status Scale score were determined via chart review, and factors associated with new morbidity, defined as an increase of Functional Status Scale score of 3 or more, were analyzed. Demographic variables, pediatric acute respiratory distress syndrome characteristics, and ventilator management were tested for association with development of new morbidity, discharge disposition, and 1-year mortality. Inhospital mortality of pediatric acute respiratory distress syndrome was 13.3% (42/316). Of 274 survivors to hospital discharge, new morbidity was seen in 63 patients (23%). Discharge to rehabilitation rate was 24.5% (67/274) and associated with development of new morbidity. One- and 3-year mortality of survivors was 5.5% (15 deaths) and 8% (22 deaths) and was associated with baseline Functional Status Scale, immunocompromised status, Pediatric Risk of Mortality III, and organ failures at pediatric acute respiratory distress syndrome onset, but not with pediatric acute respiratory distress syndrome severity.

Conclusions:

New morbidity was common after pediatric acute respiratory distress syndrome and appears to be intermediate phenotype between survival without morbidity and death, making it a useful metric in future interventional and outcome studies in pediatric acute respiratory distress syndrome.
Enhancing the prognostic role of melanoma sentinel lymph nodes through microscopic tumour burden characterization: clinical usefulness in patients who do not undergo complete lymph node dissection
Authors: Borgognoni Lorenzo , Bellucci Francesco , Urso Carmelo , Manneschi Gianfranco , Gerlini Gianni , Brandani Paola , Chiarugi Cristina , Gelli Riccardo , Giannotti Vanni , Sestini Serena
Published: July 2018

This study aimed to investigate the sentinel lymph node (SLN) tumour burden to predict the non-SLN positivity rate and the survival of melanoma patients to evaluate whether SLN microstaging could predict the prognosis, similar to what is currently performed by examining the lymph nodes excised by complete lymph node dissection. Of 1130 consecutive melanoma patients who underwent SLN biopsy, 226 were tumour-positive and 204 were included in this study. SLN metastases were classified on the basis of dimensional (Rotterdam) and topographic (Dewar) criteria either separately or combined. SLN metastases more than 1 mm in diameter had the highest non-SLN positivity rate (31%) compared with metastases 0.1–1 mm (10%) and less than 0.1 mm (4%). The non-SLN positivity rate was 45% for extensive metastases, 5% for subcapsular metastases and 23–29% for parenchymal, combined and multifocal classes, therefore suggesting a simplification of the parenchymal SLN metastases into only two classes: extensive and ‘not extensive’. The dimension of the metastasis was correlated with a different non-SLN positivity rate only when the metastasis was in the parenchyma (20–36%) and not when it was in the subcapsular location (4–7%). Interestingly, the 5-year melanoma-specific survival (MSS) was 89% for patients with subcapsular less than 0.1 mm metastases and 45% for patients with nonsubcapsular more than 1 mm metastases (P=0.017). In the parenchyma, larger metastases (>1 mm) were related to a lower 5-year MSS (46%) than smaller (<1 mm) metastases (MSS 77%). SLN tumour burden characterization can be simplified and it can provide prognostic information on non-SLN positivity and survival, which is especially useful in patients who do not undergo complete lymph node dissection.
27-GAUGE SUTURELESS INTRASCLERAL FIXATION OF INTRAOCULAR LENSES WITH HAPTIC FLANGING
Authors: Stem Maxwell S. , Wa Christianne A. , Todorich Bozho , Woodward Maria A. , Walsh Mark K. , Wolfe Jeremy D.
Published: July 2018

Purpose:

To determine whether haptic flanging during 27-gauge sutureless intrascleral fixation of intraocular lenses (IOLs) increases IOL stability and to report the short-term clinical outcomes of sutureless intrascleral surgery using 27-gauge trocar cannulas with haptic flanging.

Methods:

Retrospective surgical case series using live and cadaveric human eyes.

Results:

In the cadaveric experiment using five eyes, flanged haptics required more force to dislocate the IOL compared with unflanged haptics (14 ± 4 vs. 3 ± 1 g, P = 0.03). The clinical series included 52 eyes from 52 patients. The average age at the time of surgery was 73 ± 14 years, with a mean follow-up of 27 ± 19 weeks. The most common indication for surgery was IOL dislocation/subluxation (n = 43, 83%). Mean visual acuity improved from 20/140 preoperatively to 20/50 at postoperative Month 1 (P < 0.001). The most common postoperative issue was intraocular pressure elevation (n = 12, 23%). Two patients (4%) needed a reoperation for IOL dislocation.

Conclusion:

Haptic flanging during 27-gauge sutureless intrascleral surgery creates a more stable scleral-fixated IOL compared with the traditional unflanged technique based on a cadaveric human eye study. In addition, this variation of sutureless intrascleral surgery seems safe and effective for patients who require secondary IOLs.
Acute Lower Leg Heating Increases Exercise Capacity in Patients With Peripheral Artery Disease
Authors: Pellinger Thomas K. , Neighbors Catherine B. , Simmons Grant H.
Published: July 2018

Background/Objective:

In this pilot study, we tested the hypothesis that acute lower leg heating (LLH) increases postheating popliteal artery blood flow and 6-minute walk distance in patients with peripheral artery disease (PAD).

Methods:

Six patients (5 male, 1 female) with PAD (69 ± 6.9 years; claudication: ankle-brachial index < 0.90) participated in 3 randomized treatment sessions (2–7 days apart): control or bilateral LLH conducted via water bath immersion (42°C; ~40-cm depth) for either 15 or 45 minutes. Popliteal artery blood flow (Doppler ultrasound) and arterial pressure were measured before and after LLH. Six-minute walk distance was measured on the control day and each experimental day 35 minutes post-LLH.

Results:

Popliteal artery blood flow increased after heating in a duration-dependent manner (P < .05, postheating vs control for both heating conditions and between them). Six-minute walk distance increased by 10% and 12% after 15- and 45-minute heating treatments, respectively (P < .05 vs control session).

Conclusions:

Lower leg heating, for as short as 15 minutes, increases postheating leg perfusion and exercise capacity in patients with PAD.
Sex differences in metabolism and cardiometabolic disorders
Authors: Chella Krishnan Karthickeyan , Mehrabian Margarete , Lusis Aldons J.
Published: July 2018

Purpose of review

Sex differences are pervasive in metabolic and cardiovascular traits, yet they have often been ignored in human and animal model research. Sex differences can arise from reversible hormonal effects, from irreversible organizational (developmental) processes, and from gene expression differences from the X and Y chromosomes. We briefly review our current understanding of the impact of these factors in metabolic traits and disorders, with an emphasis on the recent literature.

Recent findings

Novel sex differences continue to be identified for metabolic and cardiovascular traits. For example, it is now clear that gut microbiota tend to differ between men and women, with potentially large implications for disease susceptibility. Also, tissue-specific gene regulation differs between men and women, contributing to differential metabolism. These new insights will open up personalized therapeutic avenues for cardiometabolic diseases.

Sex differences in body fat distribution, glucose homeostasis, insulin signaling, ectopic fat accumulation, and lipid metabolism during normal growth and in response to hormonal or nutritional imbalance are mediated partly through sex hormones and the sex chromosome complement. Most of these differences are mediated in a tissue-specific manner. Important future goals are to better understand the interactions between genetic variation and sex differences, and to bring an understanding of sex differences into clinical practice.
The many faces of CD8+ T cells in atherosclerosis
Authors: van Duijn Janine , Kuiper Johan , Slütter Bram
Published: July 2018

Purpose of review

Atherosclerosis and the clinical consequence of cardiovascular disease remain the leading cause of death worldwide. Both an increase in cholesterol levels, as well as immune responses drive the pathogenesis of this disease. Although much is known about the role of many immune cell subsets in atherogenesis, research into the role of CD8+ T cells is limited.

Recent findings

Both atheroprotective and atherogenic functions of CD8+ T cells have been reported. On the one hand, the inflammatory cytokines produced by CD8+ T cells exacerbate inflammatory responses, and the cytotoxic activity of these cells toward lesion-stabilizing cells such as endothelial cells drives the progression and instability of atherosclerotic lesions. On the other hand, cytotoxic activity toward antigen presenting cells and the presence of regulatory CD8+ T-cell subsets dampen immunity and can limit atherosclerosis.

Here we review the different roles of CD8+ T cells in atherosclerosis and discuss possible treatment strategies targeting these cells to reduce atherosclerotic lesion burden.
Pearls for the middle fossa approach in acoustic neuroma surgery
Authors: Peng Kevin A. , Lekovic Gregory P. , Wilkinson Eric P.
Published: July 2018

Purpose of review

To discuss the use of the middle fossa craniotomy for resection of vestibular schwannomas; to present pearls of and modifications to the approach.

Recent findings

The middle fossa craniotomy allows for hearing preservation in the resection of intracanalicular vestibular schwannomas. Over recent years, the approach has been modified to address larger tumors with a limited cerebellopontine angle component. Positive identification of the superior semicircular canal allows for rapid exposure of the internal auditory canal (IAC). Removal of cerebrospinal fluid from the posterior fossa during exposure of the IAC allows for removal of the middle fossa retractor; reinforced silicone sheeting is used to protect the middle fossa dura during further drilling. The use of the endoscope has allowed for more complete dissection at the fundus of the IAC, including tumors lateral to the transverse crest.

Technical modifications to the middle fossa craniotomy have allowed for a shorter duration of temporal lobe retraction intraoperatively and more complete resection of tumors with fundal involvement.
Pancreatic Fat Content Detected by Computed Tomography and Its Significant Relationship With Intraductal Papillary Mucinous Neoplasm
Authors: Kashiwagi Kazuhiro , Seino Takashi , Fukuhara Seiichirou , Minami Kazuhiro , Horibe Masayasu , Iwasaki Eisuke , Takaishi Hiromasa , Itoh Kazunari , Sugino Yoshinori , Inoue Nagamu , Iwao Yasushi , Kanai Takanori
Published: July 2018

Objectives

Intraductal papillary mucinous neoplasms (IPMNs) are premalignant lesions of pancreatic ductal adenocarcinomas (PDACs). Fat accumulation in the pancreas is increasingly recognized as a cause of PDAC. We aimed to identify factors that are relevant between IPMN and metabolic-related factors, including pancreatic fat.

Methods

The database for 781 subjects who underwent a health checkup and upper abdominal magnetic resonance imaging was searched and computed tomography attenuation indexes (pancreatic and spleen attenuation, pancreas-to-spleen attenuation ratio) were decided by measuring the regions of interest in the pancreas and spleen on nonenhanced images, using Hounsfield units. Eighty-five subjects from each of the IPMN and noncyst groups were matched for age, sex, and glycemic status and statistically compared in clinical characteristics.

Results

There was no difference in metabolic-related factors except for apolipoprotein A1 and high-density lipoprotein cholesterol between the 2 groups in univariate analysis. Multivariate logistic regression analysis showed that both indexes were significantly associated with IPMN (odds ratio, 0.905 [95% confidence intervals, 0.851–0.963; P = 0.002]; odds ratio, 0.006 [95% confidence intervals, 0.000–0.152; P = 0.002]).

Conclusions

Pancreatic fat content measured by computed tomography was significantly associated with IPMN. These results suggest that IPMN may develop secondary to pancreatic steatosis that could be an overlapping risk factor for PDAC and IPMN.
Cholecystectomy During Index Admission for Acute Biliary Pancreatitis Lowers 30-Day Readmission Rates
Authors: Krishna Somashekar G. , Kruger Andrew J. , Patel Nishi , Hinton Alice , Yadav Dhiraj , Conwell Darwin L.
Published: July 2018

Objectives

Few studies have evaluated national readmission rates after acute pancreatitis (AP) in the United States. We sought to evaluate modifiable factors impacting 30-day readmissions after AP hospitalizations.

Methods

We used the Nationwide Readmission Database (2013) involving all adults with a primary discharge diagnosis of AP. Multivariable logistic regression models assessed independent predictors for specific outcomes.

Results

Among 180,480 patients with AP index admissions, 41,094 (23%) had biliary AP, of which 10.5% were readmitted within 30 days. The 30-day readmission rate for patients who underwent same-admission cholecystectomy (CCY) was 6.5%, compared with 15.1% in those who did not (P < 0.001). Failure of index admission CCY increased the risk of readmissions (odds ratio [OR], 2.27; 95% confidence interval [CI], 2.04–2.56). Same-admission CCY occurred in 55% (n = 19,274) of patients without severe AP. Severe AP (OR, 0.73; 95% CI, 0.65–0.81), sepsis (OR, 0.63; 95% CI, 0.52–0.75), 3 or more comorbidities (OR, 0.74; 95% CI, 0.68–0.79), and admissions to small (OR, 0.76; 95% CI, 0.64–0.91) or rural (OR, 0.78; 95% CI, 0.65–0.95) hospitals were less likely to undergo same-admission CCY.

Conclusions

Same-admission CCY should be considered in patients with biliary AP when feasible. This national appraisal recognizes modifiable risk factors to reduce readmission in biliary AP and reinforces adherence to major society guidelines.
Morning Fatigue Severity Profiles in Oncology Outpatients Receiving Chemotherapy
Authors: Wright Fay , Dunn Laura B. , Paul Steven M. , Conley Yvette P. , Levine Jon D. , Hammer Marilyn J. , Cooper Bruce A. , Miaskowski Christine , Kober Kord M.
Published: July 2018

Background

Morning fatigue is a distinct symptom experienced during chemotherapy that demonstrates significant interindividual variability.

Objectives

The aims of this study were to identify subgroups with distinct morning fatigue profiles and evaluate how these subgroups differed by demographic, clinical, and symptom characteristics.

Methods

Outpatients (N = 1332) with breast, gastrointestinal, gynecological, or lung cancer completed questionnaires 6 times over 2 cycles of chemotherapy. Morning fatigue was assessed with the Lee Fatigue Scale. Latent profile analysis was used to identify distinct morning fatigue profiles.

Results

Four morning fatigue profiles (ie, very low, low, high, and very high) were identified. In the high and very high classes, all 6 morning fatigue scores were higher than the clinical cutoff score. Compared with those in the very low and low classes, patients in the very high class were younger and not married/partnered; lived alone; had higher incomes, higher comorbidity, and higher body mass index; and did not exercise regularly. Across the 4 classes, functional status and attentional function scores decreased and anxiety, depression, sleep disturbance, morning fatigue, and evening fatigue scores increased across the 2 cycles.

Conclusion

Results provide insights into modifiable risk factors for morning fatigue. These risk factors can be used to develop more targeted interventions.

Implications for Practice

Patients in the high and very high morning fatigue classes experienced high symptom and comorbidity burdens and significant decrements in functional status. Using this information, clinicians can identify patients who are at an increased risk for higher levels of morning fatigue and prescribe interventions to improve this devastating symptom.
Empty Delta Sign on Unenhanced Postmortem Computed Tomography Scan in Cerebral Venous Thrombosis
Authors: Garland Jack , Kesha Kilak , Vertes Dianne , Modahl Lucy , Milne David , Ruder Thomas , Stables Simon , Tse Rexson
Published: July 2018

Cerebral venous thrombosis is a rare condition which constitutes 0.5% to 2% of all types of stroke and carries a mortality of up to 20% to 50%. It leads to cerebral edema, infarction, hemorrhage and venous hypertension. Clinically the diagnosis is confirmed using enhanced computed tomography (CT) angiography which demonstrates an empty delta sign in cerebral veins, particularly in the superior sagittal sinus. However, postmortem CT (PMCT) findings on cerebral venous thrombosis have not been documented in the literature. We present a case report of a 69-year-old man who on unenhanced PMCT scan showed an empty delta sign in the cerebral veins. The empty delta sign was able to be demonstrated in unenhanced PMCT which can be explained by hyper attenuation of the dural veins at postmortem forming an internal contrast highlighting the thrombus.
Effects of long-term opioid analgesics on cognitive performance and plasma cytokine concentrations in patients with chronic low back pain: a cross-sectional pilot study
Authors: Richards Georgia C. , Lluka Lesley J. , Smith Maree T. , Haslam Catherine , Moore Brendan , O'Callaghan James , Strong Jenny
Published: July 2018

Introduction:

Cognitive performance and inflammation are altered in people with chronic low back pain (CLBP). Yet, the magnitude of these changes has been unclear because of the potential influence of opioid analgesics.

Objectives:

This cross-sectional pilot study aimed to explore whether patients with CLBP receiving long-term opioid analgesics differed from patients not taking opioids on measures of cognitive performance and plasma cytokine concentrations.

Methods:

Patients with CLBP who were either taking (N = 18) or not taking (N = 22) opioids daily for 3 or more months were recruited from a tertiary care private hospital and compared with healthy adults (N = 20). All groups were administered validated questionnaires to assess depression, anxiety, and stress; a cognitive test of memory, attention, and executive function; and a peripheral blood draw to measure proinflammatory (IL-1β, IL-2, IL-8, IL-12p70, TNF-α, and IFN-γ), anti-inflammatory (IL-4, IL-10, and IL-13), and pleiotropic (IL-6) cytokine concentrations. Patients also completed pain-specific questionnaires.

Results:

Patients receiving opioid analgesics performed significantly (P < 0.05) worse in attention and had significantly (P < 0.05) lower pain self-efficacy beliefs than those patients not taking opioids. Patient groups did not differ in mean pain severity or pain interference scores, tests of memory and executive function, and mean plasma cytokine concentrations, despite long-term opioid analgesics.

Conclusion:

Patients receiving long-term opioid analgesics for CLBP have minor differences when compared with patients not taking opioids. This has important clinical implications when considering long-term treatment for patients with CLBP.
Adverse Effects of the Medicare PSI-90 Hospital Penalty System on Revenue-Neutral Hospital-Acquired Conditions
Authors: Padula William V. , Black Joyce M. , Davidson Patricia M. , Kang So Yeon , Pronovost Peter J.
Published: July 2018

Objective

Health systems are grappling with improving the quality and safety of health care. By setting clear expectations, there is an opportunity to configure care models to decrease the risk of adverse events and promote the quality of care. The US Centers for Medicare and Medicaid Services have used Patient Safety Indicator 90 (PSI90), a composite rate of hospital-acquired conditions (HACs), to adjust payments and score hospitals on quality since 2015. However, PSI90 may be associated with adverse prioritization for preventing some conditions over others.

Our objective was to evaluate the time-dependent rates of HACs between 2013 and 2016 to assess the association of funding models on adverse events, particularly pressure injury.

Methods

We analyzed a retrospective observational cohort of patients hospitalized in US Academic Medical Centers observed by the Vizient CDB/RM pre-post PSI90 implementation. Changes in HAC component rates of PSI90 between 2013 and 2016 were measured longitudinally using mixed-effects negative binomial regression modeling.

Results

Regardless of whether the composite measure of patient outcomes was PSI90 or all HACs, in general, there was significant decrease after PSI90 was implemented, reflecting an association between PSI90 and CMS reimbursement policy. However, pressure injury rates increased by 29.4% (SE = 0.08; P < 0.05) during this time frame, the only HAC observed to increase related to PSI90.

Conclusions

Patient safety in hospitals will only thoroughly improve when hospitals are fully incentivized to practice prevention of all HACs rather than work around the harms that result from failed prevention efforts.
The Application of Three-Dimensional Simulation Program and Three-Dimensional Printing in Secondary Rhinoplasty
Authors: Khan Galina , Choi Yean Su , Park Eun Soo , Choi Yim Don
Published: July 2018

Background:

In recent years, efficacy of 3-dimensional (3D) simulation, in preoperative planning of aesthetic and reconstructive surgeries and prediction of the postoperative result, has been reported in many clinical studies. Especially in rhinoplasty, it can be used not only for prediction the outcome but also for fabricating implants that will strictly match with the anatomical needs of patient.

Clinical Report:

A 30-year-old male after traffic accident visited emergency room complaining on painful swelling and contour deformity of nose. Under the diagnosis of nasal bone fracture and deviated nose, he had been admitted to our hospital. Considering his medical history of rhinoplasty, which was performed in the local aesthetic clinic 6 years ago, the authors decided to perform the operation with 3D simulation program and 3D printed implant. There were no specific complications, such as hematoma, infection, or necrosis. Patient was discharged on fourth postoperation day.

Discussion:

There is no doubt that creating an ideal dorsal aesthetic line is critically important in rhinoplasty. Therefore creating individual implants for certain patient's anatomical nasal structure is highly significant in the rhinoplasty. Although usefulness of primary rhinoplasty using patient-specific 3D implant is introduced in previous study, the authors successfully applied the patient-specific 3D implant to patient who has fracture of nasal bone and primary rhinoplasty history. It means that the patient-specific implants are stable and can be used not only in primary rhinoplasty patients but also for the patients who had primary rhinoplasty previously.
Reduction of Supraorbital Fractures via a Short Sub-Brow Incision
Authors: Hwang Kun , Joong Kim Dae
Published: July 2018

The authors report a short-incision supraorbital approach through an upper eyebrow skin incision that was used to treat supraorbital rim fractures in 2 patients.

With the patient in the supine position, short incision lines were designed. Their length was usually less than 1 cm (1 or 2 mm medial to the frontal nerve and lateral to the supraorbital nerve), and they were designed at the inferior margin of the eyebrow to avoid injuring the frontal, supraorbital, or supratrochlear nerve. The skin was incised and blunt dissection was performed to reach the supraorbital rim. The periosteum was incised and a cleft palate periosteal elevator was introduced below the fracture segments. Gentle forward and upward traction was applied through the elevator and a click could be heard when the segment was reduced into its anatomical position. An intraoperative skull lateral X-ray was taken and the reduction was confirmed. The skin was repaired layer by layer.

In supraorbital rim fractures, this short-incision supraorbital approach through an upper eyebrow skin incision could be applied without injuring the supraorbital nerve, instead of the bicoronal approach.
An Algorithmic Approach to the Management of Ballistic Facial Trauma in the Civilian Population
Authors: Chattha Anmol , Lee Johnson C. , Johnson Philip K. , Patel Ashit
Published: July 2018

Annual incidence of non-fatal ballistic civilian has been increasing for the last decade. The aim of the present study was to clarify the optimal reconstructive management of civilian ballistic facial injuries. A systematic review of PubMed was performed. Articles were evaluated for defect type and site, reconstructive modality, complications, and outcomes. A total of 30 articles were included. Most common region of injury was mandibular with a 46.6% incidence rate. All-cause complication rate after reconstruction was 31.0%. About 13.3% of patients developed a postoperative infection. Gunshot wounds had overall lower complication rates as compared with shotgun wounds at 9.0% and 17.0%. By region, complications for gunshot wounds were 35% and 34% for mandible and maxilla, respectively. Immediate surgical intervention with conservative serial debridement is recommended. However, for patients with pre-existing psychiatric disorders, secondary revisions should be delayed until proper psychiatric stabilization. When there is extensive loss of soft tissue in the midface, aesthetic outcomes are achieved with a latissimus dorsi or anterolateral thigh free flap. Radial forearm flap is favored for thin lining defects. Open reduction is suggested for bony-tissue stabilization. The fibula flap is recommended for bony defects >5 cm in both midface and mandible. For bony defects, <5 cm bone grafting was preferred. Delaying bone grafting does not worsen patient outcomes. Surgical treatment of ballistic facial trauma requires thorough preparation and precise planning. An algorithm that summarizes the approach to the main decision points of surgical management and reconstruction after ballistic facial trauma has been presented in this study.
Cleft Alveolus Reconstruction Using a Three-Dimensional Printed Bioresorbable Scaffold With Human Bone Marrow Cells
Authors: Ahn Geunseon , Lee Jeong-Seok , Yun Won-Soo , Shim Jin-Hyung , Lee Ui-Lyong
Published: July 2018

Bone tissue engineering technology based on scaffold has been applied for cleft lip and palate treatment. However, clinical applications of patient-specific three-dimensional (3D) scaffolds have rarely been performed. In this study, a clinical case using patient-specific 3D-printed bioresorbable scaffold with bone marrow stromal cells collected from iliac crest in the operating room has been introduced. At 6-month after transplantation, the bone volume of the newly regenerated bone was approximately 45% of the total defect volume. Bone mineral density of the newly regenerated bone was about 75% compared to the surrounding bone. The Hounsfield unit value was higher than that of cancellous maxillary alveolar bone and lower than that of the cortical maxillary alveolar bone. Bone-marrow-derived mesenchymal stem cells-seeded 3D-printed patient-specific polycaprolactone scaffolds offer a promising alternative for alveolar cleft reconstruction and other bony defects.
Anthropometric Analysis of the Dental Arches of Five-Year-Old Children With Cleft Lip and Palate
Authors: Rando Gabriela Mendonça , Ambrosio Eloá Cristina Passucci , Jorge Paula Karine , Prado Danielle Zola Almeida , Falzoni Maiara Miyuki Matsui , Carrara Cleide Felício Carvalho , Soares Simone , Machado Maria Aparecida Andrade Moreira , Oliveira Thais Marchini
Published: July 2018

This study aimed to analyze the dimensional alterations of the dental arches of 5-year-old children with cleft lip and palate and to compare these dimensions with children without oral clefts. One hundred twenty children were divided into the following groups: unilateral cleft lip (UCL), unilateral cleft lip and palate (UCLP), cleft palate (CP), and control (C). A specific software was used to digitize the dental casts and perform the anthropometric analyses through the measurement of transversal linear intercanine and intermolar distances on the maxilla and mandible. The intergroup comparisons of the maxillary dimensions exhibited that the intercanine distances of groups C and UCL were statistically greater than that of groups UCLP and CP. The intermolar distance was significantly smaller in group UCLP than in the other groups. No statistically significant difference occurred in the mandibular intercanine and intermolar distance among groups. The analysis of the superposition of the maxillary over the mandibular transversal distances showed statistically significant differences among groups. This study showed that at 5-year old, the children with cleft involving the palate had more maxillary dimensional alterations than those without cleft palate.
Design and implementation of the Western Pennsylvania regional Stop the Bleed initiative
Authors: Neal Matthew D. , Reynolds Benjamin R. , Bertoty David , Murray Keith J. , Peitzman Andrew B. , Forsythe Raquel M.
Published: July 2018

BACKGROUND

Hemorrhage is the leading cause of preventable death in trauma, and nearly 40% of prehospital deaths can be attributed to blood loss. The Stop the Bleed program provides a structured curriculum for teaching hemorrhage control and the use of bleeding control kits. To overcome implementation barriers and to achieve the goal of making education on bleeding control as common as cardiopulmonary resuscitation, widespread implementation with outreach to the public and law enforcement is necessary.

METHODS

We provide a description and analysis of the implementation of a regional Stop the Bleed program, which includes a step-by-step guide to the design of this program provided as a template to guide attempts at large-scale Stop the Bleed program development.

RESULTS

Combining the efforts of regional trauma and nontrauma centers as a hub-and-spoke design, a region covering four states, 72 counties, and 30,000 square miles was targeted. A total of 27,291 individuals were trained in a 21-month period including 3,172 trainers, 19,310 lay public, and 4,809 law enforcement officers. A total of 436 bleeding control kits were distributed to 102 public schools, and tourniquets were provided to 4,809 law enforcement officers. Program development and community outreach resulted in official recognition of the program by the Pennsylvania State Senate.

CONCLUSIONS

With the use of a multicenter outreach program design with emphasis on law enforcement and public education while developing a train-the-trainer program, widespread and rapid dissemination of Stop the Bleed teaching is feasible. The general steps described in this manuscript may serve as a template for new or developing programs in other areas to increase the national exposure to Stop the Bleed.

LEVEL OF EVIDENCE

Economic/Decision study, level IV.
Fluoxetine-Induced Skin Picking and Compulsive Behaviors in a Preschool Girl
Authors: Çoşkun Fatma , Bilgiç Ayhan
Published: July 2018

Skin-picking disorder is regarded as a type of obsessive-compulsive and related disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Selective serotonin reuptake inhibitors (SSRIs) are reported to be effective in the treatment of skin-picking disorder. However, these agents can cause opposite effects in some cases. There is a report on SSRI-induced skin-picking disorder in adults. However, to our knowledge, there are no data regarding SSRI-induced skin picking in children. We present the case of a preschool girl with separation anxiety disorder who displayed skin-picking and compulsive-asking behaviors after fluoxetine therapy.
The Gram-negative phytopathogen Xanthomonas campestris pv. campestris employs a 5'UTR as a feedback controller to regulate methionine biosynthesis
Authors: Zhang Jian-Ling , Wang Dan , Liang Yu-Wei , Zhong Wan-Ying , Ming Zhen-Hua , Tang Dong-Jie , Tang Ji-Liang
Published: July 2018

The synthesis of methionine is critical for most bacteria. It is known that cellular methionine has a feedback effect on the expression of met genes involved in de novo methionine biosynthesis. Previous studies revealed that Gram-negative bacteria control met gene expression at the transcriptional level by regulator proteins, while most Gram-positive bacteria regulate met genes at post-transcriptional level by RNA regulators (riboregulators) located in the 5′UTR of met genes. However, despite its importance, the methionine biosynthesis pathway in the Gram-negative Xanthomonas genus that includes many important plant pathogens is completely uncharacterized. Here, we address this issue using the crucifer black rot pathogen Xanthomonas campestris pv. campestris (Xcc), a model bacterium in microbe–plant interaction studies. The work identified an operon (met) involved in de novo methionine biosynthesis in Xcc. Disruption of the operon resulted in defective growth in methionine-limited media and in planta. Western blot analysis revealed that the expression of the operon is dependent on methionine levels. Further molecular analyses demonstrated that the 5′UTR, but not the promoter of the operon, is involved in feedback regulation on operon expression in response to methionine availability, providing an example of a Gram-negative bacterium utilizing a 5′UTR region to control the expression of the genes involved in methionine biosynthesis.
Searching for sympatric speciation in the genomic era
Authors: Richards Emilie J , Servedio Maria R. , Martin Christopher H
Published: July 2018

Sympatric speciation illustrates how natural and sexual selection may create new species in isolation without geographic barriers. However, recent genomic reanalyses of classic examples of sympatric speciation have revealed complex histories of secondary gene flow. Thus, there is a need to revisit how to connect the diverse theoretical models of sympatric speciation and their predictions to empirical case studies in the face of widespread gene flow. We summarize theoretical differences between sympatric speciation and speciation-with-gene-flow models and propose genomic analyses for distinguishing which models apply to case studies based on the timing and function of adaptive introgression. Investigating whether secondary gene flow contributed to reproductive isolation is necessary to test whether predictions of theory are ultimately borne out in nature.
Identification of novel mutational signatures in Asian oral squamous cell carcinomas associated with bacterial infections
Authors: Boot Arnoud , Ng Alvin W.T. , Chong Fui Teen , Ho Szu-Chi , Yu Willie , Tan Daniel S.W. , Iyer N. Gopalakrishna , Rozen Steven G.
Published: July 2018

Mutational signatures can reveal the history of mutagenic processes that cells were exposed to prior to and during tumourigenesis. We expect that as-yet-undiscovered mutational processes will shed further light on mutagenesis leading to carcinogenesis. With this in mind, we analyzed the mutational spectra of 36 Asian oral squamous cell carcinomas. The mutational spectra of two samples from patients who presented with oral bacterial infections, showed novel mutational signatures. One of these novel signatures, SBS_AnT, is characterized by a preponderance of thymine mutations, strong transcriptional strand bias, and striking enrichment for adenines in the 4 base pairs 5’ of mutation sites. Examination of publicly available sequencing data revealed SBS_AnT in 25 tumours from several mucosal tissue types, all of which harbour human symbionts or are adjacent to tissues that harbour symbionts. Data in a preprint released while this manuscript was in revision strongly suggest that the bacterial compound colibactin causes SBS_AnT.
The impact of 10-valent Pneumococcal Conjugate Vaccine on the incidence of radiologically-confirmed pneumonia and clinically-defined pneumonia in Kenyan children
Authors: Silaba Micah , Ooko Michael , Bottomley Christian , Sande Joyce , Benamore Rachel , Park Kate , Ignas James , Maitland Kathryn , Mturi Neema , Makumi Anne , Otiende Mark , Kagwanja Stanley , Safari Sylvester , Ochola Victor , Bwanaali Tahreni , Bauni Evasius , Gleeson Fergus , Knoll Maria Deloria , Adetifa Ifedayo , Marsh Kevin , Williams Thomas N , Kamau Tatu , Sharif Shahnaaz , Levine Orin S , Hammitt Laura L , Scott J Anthony G
Published: July 2018

Background

Pneumococcal conjugate vaccines (PCV) are highly protective against invasive pneumococcal disease caused by vaccine serotypes but the burden of pneumococcal disease in developing countries is dominated by pneumonia, most of which is non-bacteraemic. We examined the impact of PCV on pneumonia incidence.

Methods

We linked prospective hospital surveillance for clinically-defined WHO severe or very-severe pneumonia at Kilifi County Hospital from 2002-2015 to population surveillance at Kilifi Health and Demographic Surveillance System, comprising 45,000 children aged <5 years. Chest radiographs were read according to a WHO standard. A 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PCV10) was introduced in Kenya in January 2011. In Kilifi, there was a catch-up campaign for children aged <5 years. We estimated the impact of PCV10 on pneumonia incidence through interrupted time series analysis accounting for seasonal and temporal trends.

Findings

The incidence of admission with clinically-defined pneumonia in 2002/3 was 21·7/1000/year in children aged 2-59 months. This declined progressively over 13 years. By the end of March 2011, 61·1% of children aged 2-11 months received ≥2 doses and 62·3% of children aged 12-59 months received ≥1 dose of PCV10. Adjusted incidence rate ratios for admissions with radiologically-confirmed pneumonia, clinically-defined pneumonia, and diarrhoea (control condition), associated with PCV10 introduction, were 0·52 (95% CI 0·32-0·86), 0·73 (95% CI 0·54-0·97) and 0·63, (95% CI 0·31-1·26), respectively. The annual incidence of clinically-defined pneumonia in December 2010 was 12·2/1000; this was reduced by 3·3/1000 with PCV10 introduction.

Interpretation

Over 13 years, hospitalisations for clinically-defined pneumonia declined progressively at Kilifi County Hospital but fell abruptly by 27% in association with PCV10 introduction. The incidence of radiologically-confirmed pneumonia fell by 48%. The burden of childhood pneumonia in Kilifi, Kenya, has been reduced substantially by PCV10.

Funding

Gavi, Wellcome Trust
A randomised controlled trial of an Intervention to Improve Compliance with the ARRIVE guidelines (IICARus)
Authors: Hair Kaitlyn , Macleod Malcolm , Sena Emily ,   Study steering committee, Howells David , Bath Philip ,   Study management committee, Irvine Cadi , MacCallum Catriona , Morrison Gavin , Clark Alejandra , Alvino Gina , Dohm Michelle ,   Programming and data management, Liao Jing , Sena Chris ,   Redactions, Moreland Rosie ,   Design of outcome assessment platform, Cramond Fala , Irvine Cadi , Liao Jing , Currie Gillian L. , Bahor Zsanett , Grill Paula , Bannach-Brown Alexandra ,   Outcome assessment, Hair Kaitlyn , Marcu Daniel-Cosmin , Antar Sarah , Irvine Cadi , Blazek Katrina , Konold Timm , Dingwall Monica , Hohendorf Victoria , Hosh Mona , Grill Paula , Gerlei Klara Zsofia , Wever Kimberley Elaine , Sena Emily , Jones Victor , Quinn Terence J , Karp Natasha A , Freymann Jennifer , Shek Anthony , Gregorc Teja , Rinaldi Arianna , Jheeta Privjyot , Nazzal Ahmed , Henshall David Ewart , Storey Joanne , Baginskaite Julija , de Oliveira Cilene Lino , Laban Kamil , Charbonney Emmanuel , Lynn Savannah A. , Cascella Marco , Wheater Emily , Baker Daniel , Currie Gillian L. , Cheyne Ryan , Christopher Edward , Roncon Paolo , De-Souza Evandro Araújo , Warda Mahmoud , Corke Sarah , Ammar Zeinab , O’Connor Leigh , Devonshire Ian M. ,   Reconciliation, Hair Kaitlyn , Marcu Daniel-Cosmin , Antar Sarah , Konold Timm , Dingwall Monica , Sena Emily , Grill Paula , McCann Sarah K. ,   Data analysis, Liao Jing , Gray Laura J , Ayder Ezgi Tanriver ,   Writing committee
Published: July 2018

The ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines are widely endorsed but compliance is limited. We sought to determine whether journal-requested completion of an ARRIVE checklist improves full compliance with the guidelines. In a randomised controlled trial, manuscripts reporting in vivo animal research submitted to PLOS ONE (March-June 2015) were allocated to either requested completion of an ARRIVE checklist or current standard practice. We measured the change in proportion of manuscripts meeting all ARRIVE guideline checklist items between groups. We randomised 1,689 manuscripts, 1,269 were sent for peer review and 762 accepted for publication. The request to complete an ARRIVE checklist had no effect on full compliance with the ARRIVE guidelines. Details of animal husbandry (ARRIVE sub-item 9a) was the only item to show improved reporting, from 52.1% to 74.1% (X2=34.0, df=1, p=2.1×10−7). These results suggest that other approaches are required to secure greater implementation of the ARRIVE guidelines.
Multi-omic and multi-view clustering algorithms: review and cancer benchmark
Authors: Rappoport Nimrod , Shamir Ron
Published: July 2018

High throughput experimental methods developed in recent years have been used to collect large biomedical omics datasets. Clustering of such datasets has proven invaluable for biological and medical research, and helped reveal structure in data from several domains. Such analysis is often based on investigation of a single omic. The decreasing cost and development of additional high throughput methods now enable measurement of multi-omic data. Clustering multi-omic data has the potential to reveal further systems-level insights, but raises computational and biological challenges. Here we review algorithms for multi-omics clustering, and discuss key issues in applying these algorithms. Our review covers methods developed specifically for multi-omic data as well as generic multi-view methods developed in the machine learning community for joint clustering of multiple data types.

In addition, using cancer data from TCGA, we perform an extensive benchmark spanning ten different cancer types, providing the first systematic benchmark comparison of leading multi-omics and multiview clustering algorithms. The results highlight several key questions regarding the use of single-vs. multi-omics, the choice of clustering strategy, the power of generic multi-view methods and the use of approximated p-values for gauging solution quality. Due to the rapidly increasing use of multi-omics data, these issues may be important for future progress in the field.