bluuebunny/crossref_metadata_2025 huggingface dataset:
A Military Case Review Method to Determine and Record the Mechanism of Injury (BioTab) from In-Theater Attacks
Authors: Danelson Kerry A , Frounfelker Patricia , Pizzolato-Heine Karen , Valentine Raymond , Watkins Laura C , Tegtmeyer Michael , Bolte John H , Hardy Warren N , Loftis Kathryn L
Published: March 2019

A recent study of all mounted vehicle underbody blast attacks found that 21% of Abbreviated Injury Scale Severity 2+ injuries in the Joint Trauma Analysis and Prevention of Injury in Combat network were injuries to the leg and ankle. To develop effective countermeasure systems for these attacks, the epidemiology and mechanisms of injury from this loading environment need to be quantified. The goal of this study was to develop a military correlate of an existing civilian case review framework, the Crash Injury Research and Engineering Network (CIREN), to consider the differences in military event types and the amount of available vehicle/attack information. Additional data fields were added to the CIREN process to cover military-specific data and “certainty” definitions in the proposed injury hypothesis were modified. To date, six group reviews have been conducted analyzing 253 injuries to the foot/ankle, tibia, femur, pelvis, and lumbar spine from 52 occupants. The familiar format and unclassified nature of the presentations allowed for the involvement of biomechanics experts from multiple disciplines.
Sources of Stress and Psychological Health Outcomes Among U.S. Air Force Total Force Distributed Common Ground System Operators
Authors: Chappelle Wayne L , Prince Lillian R , Goodman Tanya M
Published: March 2019

U.S. Air Force Distributed Common Ground Station (DCGS) intelligence (Intel) operators sustain 24/7 battlefield situational awareness and facilitate precision-strike operations. DCGS operations are global, synergistic, Total Force (TF) endeavors by active duty, Air National Guard (ANG) and Reserve units, providing combatant commanders with critical real-time intelligence and shaping operational and tactical decisions. Continual surveillance of this community’s psychological health is important to its military leaders. This study re-examines the most frequently reported occupational stressors, as well as the prevalence of occupational burnout (i.e., high-emotional exhaustion and cynicism, and low professional efficacy), and psychological distress within this population. Active duty (n = 1717), ANG (n = 139), and Reserve (n = 173) Intel operators participated in a comprehensive, online, occupational health assessment. Results reveal that occupational stressors contributing to elevated rates of distress, regardless of TF status (i.e., low manning, long work hours, excessive workload, and organizational communication concerns) are consistent with previous research. The prevalence of high-emotional exhaustion (AD: 29%/ANG: 25%/RES: 14%) and psychological distress (AD: 19%/ANG: 17%/RES: 5%) are above estimates for other military communities. These findings combined with demographic and occupational risk factors lay the foundation for improving psychological health within this Total Force community.
Serum Biomarkers for Racial Disparities in Breast Cancer Progression
Authors: Srivastava Meera , Eidelman Ofer , Craig James , Starr Joshua , Kvecher Leonid , Liu Jianfang , Hueman Matthew , Pollard Harvey B , Hu Hai , Shriver Craig D
Published: March 2019

African American (AA) women are often diagnosed with more aggressive breast cancers and have worse survival outcomes than their Caucasian American (CA) counterparts. However, a comprehensive understanding of this disparity remains unclear. In this study, we attempted to identify the race-specific non-invasive protein biomarkers that may particularly benefit interventions aimed at reducing the risk of recurrence and metastasis in breast cancers (BrCa). Our technical strategy has been to discover candidate protein biomarkers in patient sera using a high throughput antibody microarray platform. A total of 240 subjects were selected, composed of controls and all immunohistochemistry-based subtypes of breast cancer cases, subdivided by pre- and post-menopausal status and by race. A global Wilcoxon analysis comparing no-cancer controls and cancer patients identified Pyk2, SAPK/JNK, and phosphatase and tensin homolog as present in higher concentrations in cancer patient serum. A paired t-test revealed that c-kit and Rb are significantly over-represented in AA cancer serum when compared to CA cancer serum. Interestingly, VEGFR2, a protein linked to BrCa metastasis and poor prognosis, was significantly over-represented in AA cancer serum compared to AA controls; however, this was not found in CA cancer serum compared to CA controls, suggesting a possible explanation for the higher incidence of aggressive BrCa in AA versus CA patients. Through examining race-specific differences in the protein landscape of BrCa patient serum, the identified proteins could lay the groundwork for the development of an all-inclusive “liquid mammogram test.”
Tumorigenesis as the Paradigm of Quasi-neutral Molecular Evolution
Authors: Chen Bingjie , Shi Zongkun , Chen Qingjian , Shen Xu , Shibata Darryl , Wen Haijun , Wu Chung-I
Published: March 2019

In the absence of both positive and negative selections, coding sequences evolve at a neutral rate (R = 1). Such a high genomic rate is generally not achievable due to the prevalence of negative selection against codon substitutions. Remarkably, somatic evolution exhibits the seemingly neutral rate R ∼ 1 across normal and cancerous tissues. Nevertheless, R ∼ 1 may also mean that positive and negative selections are both strong, but equal in intensity. We refer to this regime as quasi-neutral. Indeed, individual genes in cancer cells often evolve at a much higher, or lower, rate than R ∼ 1. Here, we show that 1) quasi-neutrality is much more likely when populations are small (N < 50); 2) stem-cell populations in single normal tissue niches, from which tumors likely emerge, have a small N (usually <50) but selection at this stage is measurable and strong; 3) when N dips below 50, selection efficacy decreases precipitously; and 4) notably, N is smaller in the stem-cell niche of the small intestine than in the colon. Hence, the ∼70-fold higher rate of phenotypic evolution (observed as cancer risk) in the latter can be explained by the greater efficacy of selection, which then leads to the fixation of more advantageous and fewer deleterious mutations in colon cancers. In conclusion, quasi-neutral evolution sheds a new light on a general evolutionary principle that helps to explain aspects of cancer evolution.
An integrative method to predict signalling perturbations for cellular transitions
Authors: Zaffaroni Gaia , Okawa Satoshi , Morales-Ruiz Manuel , del Sol Antonio
Published: March 2019

Induction of specific cellular transitions is of clinical importance, as it allows to revert disease cellular phenotype, or induce cellular reprogramming and differentiation for regenerative medicine. Signalling is a convenient way to accomplish such transitions without transfer of genetic material. Here we present the first general computational method that systematically predicts signalling molecules, whose perturbations induce desired cellular transitions. This probabilistic method integrates gene regulatory networks (GRNs) with manually-curated signalling pathways obtained from MetaCore from Clarivate Analytics, to model how signalling cues are received and processed in the GRN. The method was applied to 219 cellular transition examples, including cell type transitions, and overall correctly predicted experimentally validated signalling molecules, consistently outperforming other well-established approaches, such as differential gene expression and pathway enrichment analyses. Further, we validated our method predictions in the case of rat cirrhotic liver, and identified the activation of angiopoietins receptor Tie2 as a potential target for reverting the disease phenotype. Experimental results indicated that this perturbation induced desired changes in the gene expression of key TFs involved in fibrosis and angiogenesis. Importantly, this method only requires gene expression data of the initial and desired cell states, and therefore is suited for the discovery of signalling interventions for disease treatments and cellular therapies.
Association between timing of dialysis initiation and clinical outcomes in the paediatric population: an ESPN/ERA-EDTA registry study
Authors: Preka Evgenia , Bonthuis Marjolein , Harambat Jerome , Jager Kitty J , Groothoff Jaap W , Baiko Sergey , Bayazit Aysun K , Boehm Michael , Cvetkovic Mirjana , Edvardsson Vidar O , Fomina Svitlana , Heaf James G , Holtta Tuula , Kis Eva , Kolvek Gabriel , Koster-Kamphuis Linda , Molchanova Elena A , Muňoz Marina , Neto Gisela , Novljan Gregor , Printza Nikoleta , Sahpazova Emilija , Sartz Lisa , Sinha Manish D , Vidal Enrico , Vondrak Karel , Vrillon Isabelle , Weber Lutz T , Weitz Marcus , Zagozdzon Ilona , Stefanidis Constantinos J , Bakkaloglu Sevcan A
Published: March 2019

Background

There is no consensus regarding the timing of dialysis therapy initiation for end-stage kidney disease (ESKD) in children. As studies investigating the association between timing of dialysis initiation and clinical outcomes are lacking, we aimed to study this relationship in a cohort of European children who started maintenance dialysis treatment.

Methods

We used data on 2963 children from 21 different countries included in the European Society of Pediatric Nephrology/European Renal Association–European Dialysis and Transplant Association Registry who started renal replacement therapy before 18 years of age between 2000 and 2014. We compared two groups according to the estimated glomerular filtration rate (eGFR) at start: eGFR ≥8 mL/min/1.73 m2 (early starters) and eGFR <8 mL/min/1.73 m2 (late starters). The primary outcomes were patient survival and access to transplantation. Secondary outcomes were growth and cardiovascular risk factors. Sensitivity analyses were performed to account for selection- and lead time-bias.

Results

The median eGFR at the start of dialysis was 6.1 for late versus 10.5 mL/min/1.73 m2 for early starters. Early starters were older [median: 11.0, interquartile range (IQR): 5.7–14.5 versus 9.4, IQR: 2.6–14.1 years]. There were no differences observed between the two groups in mortality and access to transplantation at 1, 2 and 5 years of follow-up. One-year evolution of height standard deviation scores was similar among the groups, whereas hypertension was more prevalent among late initiators. Sensitivity analyses resulted in similar findings.

Conclusions

We found no evidence for a clinically relevant benefit of early start of dialysis in children with ESKD. Presence of cardiovascular risk factors, such as high blood pressure, should be taken into account when deciding to initiate or postpone dialysis in children with ESKD, as this affects the survival.
A Multicenter, Prospective, Randomized, Placebo-Controlled, Double-Blind Study of a Novel Pain Management Device, AT-02, in Patients with Fibromyalgia
Authors: Oka Hiroshi , Miki Kenji , Kishita Iwao , Kong David F , Uchida Takahiro
Published: March 2019

Objectives

Existing treatments for fibromyalgia have limited efficacy, and only a minority of individuals clinically respond to any single intervention. This study was a prospective, multicenter, randomized, double-blind, controlled clinical trial to evaluate the feasibility of alternating magnetic field therapy in fibromyalgia patients by comparing the Angel Touch device (AT-02) with a sham control (S-01).

Methods

Two sites enrolled 44 subjects with diagnosed fibromyalgia. After informed consent, subjects taking prohibited concomitant drugs underwent a washout period of two or more weeks. All subjects then began a one-week run-in period. Numerical rating scale (NRS) pain scores were collected without device intervention for one day, followed by S-01 application to four or more painful sites for 10 minutes at each site, twice daily for six days. Subjects were then randomized to AT-02 or S-01, applied to four or more painful sites for 10 minutes at each site, twice daily for eight weeks. NRS scores were obtained twice daily during the entire treatment period.

Results

The primary end point (change in NRS ± SD at week 8 vs baseline) was –0.94 ± 1.33 in the AT-02 group and –0.22 ± 1.38 in the S-01 group. A trend toward a between-group difference in eight-week NRS scores favored the AT-02 group (–0.73, 95% confidence interval = –1.56 to 0.11, P = 0.086). An adjusted repeated measure analysis detected a significant difference in NRS scores (P = 0.039).

Conclusions

The reduction in NRS scores for AT-02 relative to sham was comparable to reductions observed in meta-analyses of fibromyalgia drug therapy. The unadjusted results and the persistence of the pain score reductions remain encouraging.
What if Acupuncture Were Covered by Insurance for Pain Management? A Cross-Sectional Study of Cancer Patients at One Academic Center and 11 Community Hospitals
Authors: Liou Kevin T , Hung Tony K W , Meghani Salimah H , Epstein Andrew S , Li Q Susan , Romero Sally A D , Cohen Roger B , Mao Jun J
Published: March 2019

Objective

In response to the national opioid crisis, governmental and medical organizations have called for broader insurance coverage of acupuncture to improve access to nonpharmacologic pain therapies, especially in cancer populations, where undertreatment of pain is prevalent. We evaluated whether cancer patients would be willing to use insurance-covered acupuncture for pain.

Design and Setting

We conducted a cross-sectional survey of cancer patients with pain at one academic center and 11 community hospitals.

Methods

We used logistic regression models to examine factors associated with willingness to use insurance-covered acupuncture for pain.

Results

Among 634 cancer patients, 304 (47.9%) reported willingness to use insurance-covered acupuncture for pain. In univariate analyses, patients were more likely to report willingness if they had severe pain (odds ratio [OR] = 1.59, 95% confidence interval [CI] = 1.03–2.45) but were less likely if they were nonwhite (OR = 0.59, 95% CI = 0.39–0.90) or had only received high school education or less (OR = 0.46, 95% CI = 0.32–0.65). After adjusting for attitudes and beliefs in multivariable analyses, willingness was no longer significantly associated with education (adjusted OR [aOR] = 0.78, 95% CI = 0.50–1.21) and was more negatively associated with nonwhite race (aOR = 0.49, 95% CI = 0.29–0.84).

Conclusions

Approximately one in two cancer patients was willing to use insurance-covered acupuncture for pain. Willingness was influenced by patients’ attitudes and beliefs, which are potentially modifiable through counseling and education. Further research on racial disparities is needed to close the gap in utilization as acupuncture is integrated into insurance plans in response to the opioid crisis.
Pregnancy outcomes in mixed connective tissue disease: a multicentre study
Authors: Radin Massimo , Schreiber Karen , Cuadrado Maria José , Cecchi Irene , Andreoli Laura , Franceschini Franco , Caleiro Teresa , Andrade Danieli , Gibbone Elena , Khamashta Munther , Buyon Jill , Izmirly Peter , Aguirre Maria Angeles , Benedetto Chiara , Roccatello Dario , Marozio Luca , Sciascia Savino
Published: March 2019

Objectives

In this study we aimed to investigate foetal and maternal pregnancy outcomes from a large multicentre cohort of women diagnosed with MCTD and anti-U1RNP antibodies.

Methods

This multicentre retrospective cohort study describes the outcomes of 203 pregnancies in 94 consecutive women ever pregnant who fulfilled the established criteria for MCTD with confirmed U1RNP positivity.

Results

The foetal outcomes in 203 pregnancies were as follows: 146 (71.9%) live births, 38 (18.7%) miscarriages (first trimester pregnancy loss of <12 weeks gestation), 18 (8.9%) stillbirths (pregnancy loss after 20 weeks gestation) and 11 (5.4%) cases with intrauterine growth restriction. Maternal pregnancy outcomes were as follows: 8 (3.9%) developed pre-eclampsia, 2 (0.9%) developed eclampsia, 31 (15.3%) developed gestational hypertension and 3 (1.5%) developed gestational diabetes. Women with MCTD and aPL and pulmonary or muscular involvement had worse foetal outcomes compared with those without. Moreover, we report a case of complete congenital heart block (0.45%) and a case of cutaneous neonatal lupus, both born to a mother with positive isolated anti-U1RNP and negative anti-Ro/SSA antibodies.

Conclusion

In our multicentre cohort, women with MCTD had a live birth rate of 72%. While the true frequency of heart block associated with anti-U1RNP remains to be determined, this study might raise the consideration of echocardiographic surveillance in this setting. Pregnancy counselling should be considered in women with MCTD.
Genome Sequence Resource for Stemphylium vesicarium, Causing Brown Spot Disease of Pear
Authors: Gazzetti Katia , Diaconu Elena L. , Nanni Irene M. , Ciriani Alessandro , Collina Marina
Published: March 2019

Stemphylium vesicarium is the causal agent of several plant diseases as well brown spot of pear (BSP), which is one of the most economically important fungal diseases in European pear-production areas. In addition to the relevance of the economic impact, conidia spread widely from plant material infected by the pathogen can trigger respiratory allergy. Here, we report the first genome of a S. vesicarium strain, 173-1a13FI1M3, isolated from pear and sensitive to the mostly used fungicide classes currently authorized in Europe against BSP. The availability of this draft genome could represent a first important step in understanding the physiology and the infection mechanism of the pathogen. Furthermore, this contribution could be fundamental in order to design more effective and sustainable strategies to control the disease.
Green Fluorescent Protein Transformation Sheds More Light on a Widespread Mycoparasitic Interaction
Authors: Németh Márk Z. , Pintye Alexandra , Horváth Áron N. , Vági Pál , Kovács Gábor M. , Gorfer Markus , Kiss Levente
Published: March 2019

Powdery mildews, ubiquitous obligate biotrophic plant pathogens, are often attacked in the field by mycoparasitic fungi belonging to the genus Ampelomyces. Some Ampelomyces strains are commercialized biocontrol agents of crop pathogenic powdery mildews. Using Agrobacterium tumefaciens-mediated transformation (ATMT), we produced stable Ampelomyces transformants that constitutively expressed green fluorescent protein (GFP) to (i) improve the visualization of the mildew–Ampelomyces interaction and (ii) decipher the environmental fate of Ampelomyces fungi before and after acting as a mycoparasite. Detection of Ampelomyces structures, and especially hyphae, was greatly enhanced when diverse powdery mildew, leaf, and soil samples containing GFP transformants were examined with fluorescence microscopy compared with brightfield and differential interference contrast optics. We showed for the first time, to our knowledge, that Ampelomyces strains can persist up to 21 days on mildew-free host plant surfaces, where they can attack powdery mildew structures as soon as these appear after this period. As saprobes in decomposing, powdery mildew-infected leaves on the ground and also in autoclaved soil, Ampelomyces strains developed new hyphae but did not sporulate. These results indicate that Ampelomyces strains occupy a niche in the phyllosphere where they act primarily as mycoparasites of powdery mildews. Our work has established a framework for a molecular genetic toolbox for the genus Ampelomyces using ATMT.
Medical Burden of Disease Among Individuals in Recovery From Alcohol and Other Drug Problems in the United States: Findings From the National Recovery Survey
Authors: Eddie David , Greene M. Claire , White William L. , Kelly John F.
Published: March 2019

Objectives:

The medical sequalae of alcohol and other drug (AOD) problems exact a prodigious personal and societal cost, but little is known about the specific prevalence of such medical problems, and their relationship to quality of life and indices of well-being among those recovering from problematic AOD use. To better characterize the lifetime physical disease burden, this study investigated the prevalence of medical conditions commonly caused or exacerbated by excessive and chronic AOD exposure in a nationally representative sample of US adults in AOD problem recovery. Comparisons were made to the general US population. Demographic and clinical correlates of disease prevalence were also investigated along with the relationship between distinct medical conditions and indices of quality of life/well-being.

Methods:

Cross-sectional nationally representative survey of the US adult population who report resolving an AOD problem (n = 2002). Weighted lifetime prevalence of common medical conditions were estimated and compared to the US population. Demographic and clinical correlates of medical conditions, and also overall disease burden, were estimated using logistic regression.

Results:

Relative to the general population, prevalence of hepatitis C, chronic obstructive pulmonary disease, heart disease, and diabetes were elevated. Likelihood of having a lifetime diagnosis of a specific disease was related to primary substance used and sex. Quality of life was lower among those with physical disease histories relative to those without.

Conclusions:

Findings highlight the increased medical burden associated with AOD problems, and speak to the need for earlier and more sustained intervention for AOD problems, greater integration of addiction treatment and primary health care, and longitudinal research to explore the complex, dynamic relationships between AOD use and physical disease.
Provision of and Barriers to Integrating Reproductive and Sexual Health Services for Reproductive-age Women in Opioid Treatment Programs
Authors: Klaman Stacey L. , Lorvick Jennifer , Jones Hendrée E.
Published: March 2019

Objectives:

To identify the level of provision of reproductive and sexual health (RSH) services to reproductive-age women enrolled in opioid treatment programs (OTPs) in 2017, and to understand provider-perceived barriers to integration of services.

Methods:

A web-based survey was sent to medical or program directors at all OTPs (n = 48) in North Carolina (NC). Data were collected regarding program characteristics, demographic information about female patient populations, provision of RSH services, and provider-perceived barriers to service integration into OTPs. Survey results were aggregated for descriptive analysis.

Results:

The survey response rate was 79%, representing 38 out of the 48 OTPs. Among OTPs, 95% serve pregnant and parenting women, 21% have female-specific programs, and together they serve a total of about 5000 women annually. Medical and program directors reported that approximately 53% of women have 1 or more children, and 6.5% are, at present, pregnant. Nearly 90% of programs provide pregnancy testing, but only about 50% provide contraception. Although more than half offer hepatitis C virus (HCV) testing, less than half offer human immunodeficiency virus (HIV) testing and sexually transmitted infection (STI) testing. Half of the programs provide education about STI prevention and safer sex practices. Most medical and program directors (84%) perceive female patients could benefit from RSH education and more than two-thirds (68%) perceive female patients need increased access to RSH services. Provider-perceived barriers to service integration include lack of facility equipment and supplies, trained staff, and childcare.

Conclusions:

NC OTPs are a logical setting for integrating RSH services to meet the needs of reproductive-age women in treatment for OUD.
Further Utilization of Emergency Department and Inpatient Psychiatric Services Among Young Adults Admitted at the Emergency Department With Clinical Alcohol Intoxication
Authors: Adam Angéline , Faouzi Mohamed , McNeely Jennifer , Yersin Bertrand , Daeppen Jean-Bernard , Bertholet Nicolas
Published: March 2019

Objectives:

To assess in a cohort of young adults admitted with alcohol intoxication (AI) to the Emergency Department (ED): how many patients are readmitted to the ED or to a Psychiatric Department (PD) inpatient unit; and which characteristics are associated with further ED and PD inpatient admissions.

Methods:

In 630 patients aged 18 to 30 years admitted for AI in 2006 to 2007 to the ED of a Swiss tertiary hospital, further ED and PD inpatient admissions through 2013 were assessed. Patient characteristics at the index (initial) ED visit were assessed using administrative and medical records.

Measurements:

Proportion of subjects with at least 1 further ED admission, 1 further ED admission with AI, and any PD admission over the study period.

Associations between patients’ characteristics at index visit and readmissions were assessed using backward selection multivariate regression analyses.

Results:

Mean age was 24, 66% were male, 60% had any ED/PD admissions during the study period, 17.9% a PD admission, and 13.8% were re-admitted to ED with AI. Disruptive behavior at the index visit was associated with further ED (odds ratio [OR] 1.69 [1.13; 2.54]) and PD admissions (OR 2.41 [1.44; 4.05]). Psychiatric diagnosis was associated with any further ED admission (OR 2.07 [1.41; 3.05]), with further ED admission with AI (OR 4.56 [2.36; 8.81]) and with PD admission (OR 3.92 [2.40; 6.41]). Female sex predicted any further ED admission (OR 1.65 [1.14; 2.39]).

Conclusions:

Young adults presenting with alcohol intoxication have high rates of subsequent inpatient emergency and psychiatric admissions. Being female, presenting with disruptive behavior, and having a psychiatric diagnosis at the ED visit were predictors of further admissions.
Effect of Intraoperative Goal-directed Balanced Crystalloid versus Colloid Administration on Major Postoperative Morbidity
Authors: Kabon Barbara , Sessler Daniel I. , Kurz Andrea ,   on behalf of the Crystalloid–Colloid Study Team
Published: March 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Crystalloid solutions leave the circulation quickly, whereas colloids remain for hours, thus promoting hemodynamic stability. However, colloids are expensive and promote renal toxicity in critical care patients. This study tested the hypothesis that goal-directed colloid administration during elective abdominal surgery decreases 30-day major complications more than goal-directed crystalloid administration.

Methods

In this parallel-arm double-blinded multicenter randomized trial, adults having moderate- to high-risk open and laparoscopically assisted abdominal surgery with general anesthesia were randomly assigned to Doppler-guided intraoperative volume replacement with 6% hydroxyethyl starch 130/0.4 (n = 523) or lactated Ringer’s solution (n = 534). The primary outcome was a composite of serious postoperative cardiac, pulmonary, infectious, gastrointestinal, renal, and coagulation complications that were assessed with a generalized estimating equation multivariate model. The primary safety outcome was a change in serum creatinine concentration up to 6 months postoperatively, compared to baseline concentrations.

Results

A total of 1,057 patients were included in the analysis. Patients assigned to crystalloid received a median [quartile 1, quartile 3] amount of 3.2 l [2.3, 4.4] of crystalloid, and patients assigned to colloid received 1.0 l [0.5, 1.5] of colloid and 1.8 l [1.2, 2.4] of crystalloid. The estimated intention-to-treat common effect relative risk for the primary composite was 0.90 for colloids versus crystalloids (95% CI: 0.65 to 1.23, P = 0.51), and 18% (91 of 523) of colloid patients and 20% (103 of 534) of crystalloid patients incurred at least one component of the primary outcome composite. There was no evidence of renal toxicity at any time.

Conclusions

Doppler-guided intraoperative hydroxyethyl starch administration did not significantly reduce a composite of serious complications. However, there was also no indication of renal or other toxicity.
Evaluating Teamwork in the Neonatal Intensive Care Unit
Authors: Masten Marjorie , Sommerfeldt Susan , Gordan Suzanne , Greubel Elizabeth , Canning Caroline , Lioy Janet , Chuo John
Published: March 2019

Background:

A unified vision of team mission, psychologically safe practice environment, effective communication, and respect among team members are key characteristics of an effective interdisciplinary neonatal intensive care unit (NICU) team.

Purpose:

A quality improvement team in a quaternary NICU surveyed parents, physicians, and nurses on perceptions of teamwork to identify opportunities for improvement.

Design/Methods:

Parents and healthcare staff (n = 113) completed an anonymous survey from May to July of 2014 to assess team roles and membership, team qualities, shared mission, psychological safety, hierarchy, communications, and conflict awareness. An expert panel assigned questions into one or more characteristics of team intelligence.

Results:

Physicians, nurses, and parents perceive their roles and the composition of the healthcare team differently. Most providers reported a shared mission and having a cooperative spirit as their teams' best attributes. While most nurses chose safety as most important, the majority of doctors chose treatment plan. Parents consider tenderness toward their infant, providing medical care and answers to their questions important. All expressed varying concerns about psychological safety, conflict resolution, and miscommunications.

Implications for Practice:

This survey identifies strengths and gaps of teamwork in our NICU and provides insight on necessary changes that need to be made to improve collaboration among the interdisciplinary care team including parents.

Implications for Research:

This quality improvement report identifies aspects of team care delivery in NICUs that require further study. The concept of team intelligence and its impact on team effectiveness invites in-depth exploration.
Evaluation of BMI as a Risk Factor for Complications following Gender-affirming Penile Inversion Vaginoplasty
Authors: Ives Graham C. , Fein Lydia A. , Finch Lindsey , Sluiter Emily C. , Lane Megan , Kuzon William M. , Salgado Christopher J.
Published: March 2019

Background:

Gender affirmation surgery (GAS) has a positive impact on the health of transgender patients; however, some centers employ body mass index (BMI) as a strict selection criterion for surgical candidacy. Several single-center studies have found no clear correlation between BMI and complication rates. We conducted a retrospective multicenter study at 2 university-based centers to test the null hypothesis: obesity is not a significant determinant of the risk of acute surgical complications in patients undergoing penile inversion vaginoplasty (PIV).

Methods:

This is a retrospective chart review of all adult patients at the University of Michigan and the University of Miami undergoing gender-affirming PIV with minimum follow-up time of 3 months between 1999 and 2017. A logistic regression model of analysis is used to examine the predictive factors for surgical complications and delayed revision urethroplasty in our patient sample.

Results:

One hundred and one patients met inclusion criteria for this study. The mean BMI at the time of procedure was 26.9kg/m2 (range 17.8–48.2). Seventeen patients (16.8%) had major complications and 36 patients (35.6%) had minor complications. On logistic regression analysis, none of the recorded covariates were significant predictors of delayed revision urethroplasty or major, minor, or any complications.

Conclusions:

We found that obese patients can safely undergo GAS and that BMI alone should not preclude appropriately selected patients from undergoing GAS. We acknowledge that selection based on overall health and other medical comorbidities is certainly warranted for gender-affirming PIV and all other surgical procedures.
American Society of Plastic Surgeons Member Post-Operative Opioid Prescribing Patterns
Authors: Torabi Radbeh , Bourn Lynn , Mundinger Gerhard S. , Saeg Fouad , Patterson Charles , Gimenez Alejandro , Wisecarver Ian , St. Hilaire Hugo , Stalder Mark , Tessler Oren
Published: March 2019

Introduction:

Despite the widespread use of opioids in pain management, there are currently no evidence-based guidelines for the treatment of postoperative pain with opioids. Although other surgical specialties have begun researching their pain prescribing patterns, there has yet to be an investigation to unravel opioid prescribing patterns among plastic surgeons.

Methods:

Survey Monkey was used to sample the American Society of Plastic Surgeons (ASPS) members regarding their opioid prescribing practice patterns. The survey was sent randomly to 50% of ASPS members. Respondents were randomized to 1 of 3 different common elective procedures in plastic surgery: breast augmentation, breast reduction, and abdominoplasty.

Results:

Of the 5,770 overall active ASPS members, 298 responses (12% response rate) were received with the following procedure randomization results: 106 for breast augmentation, 99 for breast reduction, and 95 for abdominoplasty. Overall, 80% (N = 240) of respondents used nonnarcotic adjuncts to manage postoperative pain, with 75.4% (N = 181) using nonnarcotics adjuncts >75% of the time. The most commonly prescribed narcotics were Hydrocodone with Acetaminophen (Lortab, Norco) and Oxycodone with Acetaminophen (Percocet, Oxycocet) at 42.5% (N = 116) and 38.1% (N = 104), respectively. The most common dosage was 5 mg (80.4%; N = 176), with 48.9% (N = 107) mostly dispensing 20–30 tablets, and the majority did not give refills (94.5%; N = 207).

Conclusions:

Overall, plastic surgeons seem to be in compliance with proposed American College of Surgeon’s opioid prescription guidelines. However, there remains a lack of evidence regarding appropriate opioid prescribing patterns for plastic surgeons.
Keystone Flap: Overcoming Paradigms
Authors: Gómez Oswaldo J. , Barón Oscar I. , Peñarredonda Martha L.
Published: March 2019

Background:

The physiology and geometry of the keystone flap (KF) are the main factors that support its development. This study reports our experience using the KF and proposes the concept of pedicular area.

Methods:

A prospective cohort study was conducted from October 2014 to December 2016, in which 112 KF procedures were performed with an average follow-up time of 10 months. The conclusions drawn from clinical observations were compared with the findings of a literature review.

Results:

One hundred twelve flaps were performed in 89 patients (45 men and 44 women) with an average age of 64 years (range, 3–89 years). The flap survival rate was 100%. The term pedicular area (PA) was coined to describe a flap segment that remains attached to its bed without vascular detriment and whose location can be randomly selected. In this study, the PA could be reduced up to a 10%, which means that over 90% of each flap was dissected without any harm.

Conclusions:

The KF is a safe, cost-effective technique with better results when compared with other reconstructive procedures. Although research is still needed to better understand the physiological adaptations of KF, the clinical evidence supports its use in many reconstructive scenarios.
Z-plasty and Postoperative Radiotherapy for Anterior Chest Wall Keloids: An Analysis of 141 Patients
Authors: Arima Juri , Dohi Teruyuki , Kuribayashi Shigehiko , Akaishi Satoshi , Ogawa Rei
Published: March 2019

Background:

The therapies for anterior chest wall keloids include surgical excision, postoperative radiotherapy, silicone taping stabilization, and steroid plaster. However, to date, there is no universally accepted combination treatment strategy for anterior chest wall keloids.

Methods:

All consecutive patients with single or multiple anterior chest wall keloids who underwent keloid excision, tension-reducing suturing, z-plasty, and postoperative radiotherapy in 2013–2016 in Nippon Medical School were included in this case series study. Only keloids that arose from small injuries such as folliculitis or acne were selected. The surgery was followed by tension-reducing self-management of the wounds with silicone tape and steroid plaster. The postsurgical radiotherapy modality was 18 Gy administered in 3 fractions over 3 days. The primary study outcome was keloid recurrence during the 24-month follow-up period. Recurrence was defined as the development of stiff and red lesions in even a small part of the scar that did not respond to 6 months of steroid plaster therapy.

Results:

In total, 141 patients with 141 lesions were enrolled. Of the 141 lesions, 15 (10.6%) recurred. All recurrences were successfully treated by steroid plaster and steroid injection. The recurrence patients did not differ from the nonrecurrence patients in terms of the size of the original keloid or gender distribution.

Conclusions:

Anterior chest wall keloids can be successfully treated by customized plans that involve appropriate surgical modalities (including z-plasty) followed by postoperative radiotherapy (18 Gy in 3 fractions over 3 days) and scar self-management with silicone tape and steroid plaster.
NCRP Report 181, Evaluation of the Relative Effectiveness of Low-energy Photons and Electrons in Inducing Cancer in Humans: A Critique and Alternative Analysis
Authors: Kocher David C. , Hoffman F. Owen
Published: March 2019

A recent report from the National Council on Radiation Protection and Measurements presents an evaluation of the effectiveness of low-energy photons and electrons, relative to higher-energy photons, in inducing cancer in humans. The objective of that evaluation was to develop subjective probability distributions of an uncertain quantity, denoted by ρ, to represent ranges of credible values of the effectiveness of five groups of low-energy radiations (L): photons at about 1.5 keV; 15 to 30 keV photons; 40 to 60 keV photons; >60 to 150 keV photons; and electrons from beta decay of tritium (3H). Probability distributions of ρ
L for all low-energy groups were derived based on an evaluation of uncertainties in data on biological effectiveness from five areas of research and use of an elicitation process and decomposition method to combine probability distributions to represent those uncertainties. In this paper, we argue that uncertainties in ρ
Ls for all low-energy groups are too small compared with uncertainties in biological effectiveness from the different areas of research, especially that upper confidence limits of all ρ
Ls are too low. These deflations of uncertainty in all ρ
Ls apparently are due, at least in part, to an invalid assumption in the decomposition method that probability distributions of biological effectiveness from the different areas of research are representations of random uncertainty that arises from repeated measurements of the same quantity under the same conditions using well-calibrated instruments. However, those distributions essentially are representations of systematic uncertainty in different estimates of biological effectiveness from each area of research, which means that a deflation of uncertainty in ρ
Ls is not a credible result. We then use the same probability distributions of biological effectiveness from the different areas of research in an alternative analysis to derive wider probability distributions of ρ
L that we believe provide a better representation of the state of knowledge of the effectiveness of low-energy photons and electrons in inducing cancer in humans. Our analysis is based on the notion that each probability distribution of biological effectiveness from an area of research represents a distinctly different model of a ρ
L and use of the concept of model averaging to combine those distributions.
Invasive Fungal Sinusitis: Risk Factors for Visual Acuity Outcomes and Mortality
Authors: Hirabayashi Kristin E. , Idowu Oluwatobi O. , Kalin-Hajdu Evan , Oldenburg Catherine E. , Brodie Frank L. , Kersten Robert C. , Vagefi M. Reza
Published: March 2019

Endoscopic sinus debridement portends better visual acuity outcomes in patients with invasive fungal sinusitis, whereas exenteration yields no difference in survival benefit.

Purpose:

Invasive fungal sinusitis is a rare but potentially lethal disease that primarily affects immunocompromised patients. The purpose of this study was to review an academic medical center’s experience in the presentation, diagnosis, and treatment of invasive fungal sinusitis.

Methods:

A retrospective chart review was performed at a single institution over a 17-year period. Medical records, radiographic imaging, and operative reports were analyzed. Bivariate and multivariable analyses were performed to determine factors that affected visual acuity outcomes and mortality.

Results:

Fifty-five patients with histopathologically confirmed invasive fungal sinusitis were included. The average duration of follow up was 1.8 ± 2.6 years (range: 1 week to 10 years). The most common causes of immunosuppression were hematologic malignancy (45%), diabetes (31%), and organ transplantation (9%). At presentation, 35% of individuals were neutropenic (absolute neutrophil count < 500/μl). All patients received systemic antifungal treatment. A surgical intervention was performed on 50 patients (91%), and all but one had functional endoscopic sinus surgery. Nine (16%) patients underwent orbital exenteration. Multivariable analysis of visual acuity outcomes demonstrated that individuals infected with Zygomycota had 6–7 lines worse vision than those infected with Ascomycota (mean difference in logMAR 0.66, 95% confidence interval 0.27 to 1.06, p = 0.001). Patients who had functional endoscopic sinus surgery had 7–8 lines better visual acuity than those without functional endoscopic sinus surgery (mean difference in logMAR −0.76, 95% confidence interval −1.13 to −0.38, p < 0.001). The overall death rate due to infection was 24%. Bivariate models demonstrated no difference in mortality in patients receiving exenteration versus those who did not (p = 0.14). Multivariable analysis of mortality demonstrated that neutropenia increased mortality (adjusted odds ratio 10.05, 95% confidence interval 1.49 to 67.67, p = 0.02). Having a greater number of surgeries was associated with an increased rate of survival (adjusted odds ratio 0.39, 95% confidence interval 0.15 to 0.96, p = 0.04).

Conclusions:

Invasive fungal sinusitis is an aggressive disease with significant mortality. Patients with neutropenia had a lower rate of survival, and infection with Zygomycota was associated with worse visual acuity outcomes. Those having functional endoscopic sinus surgery had better final visual acuity, and an increased number of surgeries was associated with a decreased chance of death. Exenteration yielded no observed survival benefit.
A Study of Congenital Protein C Deficiency With Infancy Onset of CADASIL in a Chinese Baby
Authors: Yuan Xiuli , Li Changgang , Chen Xiaowen , Liu Liwei , Liu Guosheng , Wen Feiqiu
Published: March 2019

Objective:

The main objectives of this article were to study a severe congenital protein C deficiency (PCD) in a patient with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and analyze the cause of this case.

Materials and Methods:

We had recorded clinical manifestations of the patient, laboratory tests, imaging studies, and gene sequencing of the PROC gene and NOTCH3 gene to study the disease in this family. We checked the change of NOTCH3 protein by immunohistochemistry.

Results:

Laboratory studies of the patient had revealed that his PC activity was 3%. Magnetic resonance imaging results showed hyperintense lesions in the cerebral white matter of the patient. PROC gene and NOTCH3 gene sequencing was performed among the family members. The patient was confirmed as homozygous for the (A-G)-12 at the transcription initiation site in the promoter region of the PROC gene and heterozygous mutation of the NOTCH3 gene. Immunohistochemical results showed that NOTCH3 protein was positive in the skin vascular smooth muscle of the patient.

Conclusions:

We studied a rare case of an infat boy diagnosed with both congenital PCD and CADASIL; congenital PCD was attributable to a compound that was homozygous for (A-G)-12 at the transcription initiation site in the promoter region of the PROC gene, and CADASIL was caused by missense mutation in exon 24 of NOTCH3. He was a sporadic patient with congenital PCD and CADASIL; it maybe that the deficiency of protein C led to early onset of CADASIL. The gene sequencing of PROC gene and NOTCH3 gene may have important value for fertility guidance and prenatal diagnosis.
Effects of Adaptive Bungee Trampolining for Children With Cerebral Palsy: A Single-Subject Study
Authors: Germain Ashleigh M. , Blackmore A. Marie , Gibson Noula , Newell Becky , Williams Sîan A.
Published: March 2019

Purpose:

To assess effects of adaptive bungee trampoline training for children with cerebral palsy.

Methods:

This was a single-subject intervention study, A-B-A, with 4 children aged 6 to 11 years. Measurements included muscle strength, balance, functional muscle strength, functional mobility, selected Gross Motor Function Measure items, heart rate, enjoyment, and for adverse effects—range of motion and spasticity. Goals were measured using the Canadian Occupational Performance Measure.

Results:

Lower limb muscle strength improved in 3 children, and balance and functional strength in 2 children. The child who was not walking increased sitting and supported standing times. All participants had clinically significant increases on the Canadian Occupational Performance Measure. Adherence and enjoyment were high, with no adverse effects.

Conclusion:

Adaptive bungee trampoline training can improve strength, balance, and functional mobility in children with cerebral palsy.
Does Weight Status Impact Metabolic Health in Adolescents When Controlling for Physical Fitness?
Authors: Stolzman Stacy C. , Skelton Joseph , Harkins April , Hoeger Bement Marie
Published: March 2019

Purpose:

To determines whether adolescents who are fit with overweight/obesity are similar in their metabolic profile to adolescents who are fit and normal weight.

Methods:

Adolescents participated in 3 sessions: (1) resting vitals and anthropometrics; (2) maximal aerobic treadmill test (

JOURNAL/ppyty/04.03/00001577-201904000-00003/3MMU1/v/2023-08-23T235932Z/r/image-gif

) to determine physical fitness; and (3) dual-energy x-ray absorptiometry and fasting laboratory draw for analysis of insulin, glucose, high-density lipoprotein, triglycerides, and C-reactive protein.

Results:

Of the 30 fit adolescents who are normal weight and 16 adolescents who are fit and overweight/obese (OW/OB), metabolic syndrome was apparent in 1 adolescent who are normal weight and 4 adolescents who are OW/OB. Metabolic syndrome severity was positively associated with body mass index, waist circumference, total body fat, insulin resistance, and C-reactive protein but inversely associated with peak relative, but not lean

JOURNAL/ppyty/04.03/00001577-201904000-00003/3MMU1/v/2023-08-23T235932Z/r/image-gif

.

Conclusions:

Despite good physical fitness, adolescents who are OW/OB demonstrated greater metabolic syndrome than adolescents who are normal weight. Future intervention research is necessary to explore the relation between physical fitness and metabolic syndrome.