bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of an Educational Video
Authors: Koss Tiffany S. , Macci Bires Angela , Cline Thomas W. , Mason Donna L.
Published: February 2018

According to the American Cancer Society, more than 1.6 million new cases of cancer were diagnosed in 2015. Anxiety levels in individuals diagnosed with cancer are high, with the highest levels occurring at the time of diagnosis. A cancer diagnosis and the associated chemotherapy are life-altering events for patients and their families. In addition to managing the devastating news about the disease, patients are tasked with learning to manage the impact of chemotherapy and its impact on their bodies and sense of well-being. These authors report the development of an education video aimed at addressing typical questions and concerns about treatment regimens. Results of their studies to determine the effectiveness of their video indicate significant value for the patient, especially anxiety reduction and enhanced ability to absorb new information and instructions from their caregiving team.
Effects of Nurse-Led Intervention on Patients' Anxiety and Sleep Before Coronary Artery Bypass Grafting
Authors: Mousavi Malek Nesa , Zakerimoghadam Masoumeh , Esmaeili Maryam , Kazemnejad Anoushiravan
Published: February 2018

The aim of this study to examine the effects of supportive-educational nurse-led intervention on the patients' anxiety and sleep before the coronary artery bypass grafting.

The current clinical trial recruited 160 patients (N = 160) waiting for the coronary artery bypass grafting by random block sampling and divided them into two 80-people experimental and control groups. Spielberger's State Anxiety Inventory was completed on the first day. The Groningen's Sleep Quality Index was also completed by the patients on the day of surgery. Data were analyzed in SPSS software version 16, using descriptive and inferential statistics tests.

The mean anxiety score in the experimental group decreased to 48.39, whereas in the control group, the mean anxiety score saw a rise after the intervention (61.09). The comparison of the mean quality of sleep the night before the surgery for both groups showed that sleep in the control group compared with sleep in the experimental group had a lower quality, and statistically, it was significant (P < .001).

Results showed that nonpharmacological and supportive interventions can reduce patients' anxiety and sleep disturbance before the coronary artery bypass grafting. According to the results, nonpharmacological therapies should be placed at the top of nurses' tasks.
Targeted Temperature Management for Improved Outcomes
Authors: Carwell Micaela
Published: February 2018

Therapeutic hypothermia, also referred to as targeted temperature management, has been a component of the postcardiac arrest treatment guidelines since 2010. Although almost a decade has passed since its inclusion in the postarrest guidelines, many unanswered questions remain regarding selection of the appropriate patient population, optimal target temperature, ideal window of time in which to initiate therapy after arrest, most efficient, safe, and accurate equipment choice for inducing and maintaining hypothermia, most effective duration of treatment, and rate of cooling or rewarming. On a national and international level, critical care nurses are in a unique position to participate in research that will define targeted temperature management protocols and practices. Nurses are also ideal for standardizing the targeted temperature management policy and protocol locally and nationally based on current available evidence. This review aims to serve 2 purposes: first, to provide a broad update on the current clarifications and limitations per research findings on target temperature management therapy; second, to explain how critical care nurses can use this updated information to improve outcomes for their patients with cardiac arrest.
Pathophysiological mechanisms of neuropathic pain: comparison of sensory phenotypes in patients and human surrogate pain models
Authors: Vollert Jan , Magerl Walter , Baron Ralf , Binder Andreas , Enax-Krumova Elena K. , Geisslinger Gerd , Gierthmühlen Janne , Henrich Florian , Hüllemann Philipp , Klein Thomas , Lötsch Jörn , Maier Christoph , Oertel Bruno , Schuh-Hofer Sigrid , Tölle Thomas R. , Treede Rolf-Detlef
Published: February 2018

As an indirect approach to relate previously identified sensory phenotypes of patients suffering from peripheral neuropathic pain to underlying mechanisms, we used a published sorting algorithm to estimate the prevalence of denervation, peripheral and central sensitization in 657 healthy subjects undergoing experimental models of nerve block (NB) (compression block and topical lidocaine), primary hyperalgesia (PH) (sunburn and topical capsaicin), or secondary hyperalgesia (intradermal capsaicin and electrical high-frequency stimulation), and in 902 patients suffering from neuropathic pain. Some of the data have been previously published. Randomized split-half analysis verified a good concordance with a priori mechanistic sensory profile assignment in the training (79%, Cohen κ = 0.54, n = 265) and the test set (81%, Cohen κ = 0.56, n = 279). Nerve blocks were characterized by pronounced thermal and mechanical sensory loss, but also mild pinprick hyperalgesia and paradoxical heat sensations. Primary hyperalgesia was characterized by pronounced gain for heat, pressure and pinprick pain, and mild thermal sensory loss. Secondary hyperalgesia was characterized by pronounced pinprick hyperalgesia and mild thermal sensory loss. Topical lidocaine plus topical capsaicin induced a combined phenotype of NB plus PH. Topical menthol was the only model with significant cold hyperalgesia. Sorting of the 902 patients into these mechanistic phenotypes led to a similar distribution as the original heuristic clustering (65% identity, Cohen κ = 0.44), but the denervation phenotype was more frequent than in heuristic clustering. These data suggest that sorting according to human surrogate models may be useful for mechanism-based stratification of neuropathic pain patients for future clinical trials, as encouraged by the European Medicines Agency.
Positioning a Novel Transcutaneous Bone Conduction Hearing Implant: a Systematic Anatomical and Radiological Study to Standardize the Retrosigmoid Approach, Correlating Navigation-guided, and Landmark-based Surgery
Authors: Arnold Heinz , Schulze Maximilian , Wolpert Stephan , Hirt Bernhard , Tropitzsch Anke , Zimmermann Rainer , Radeloff Andreas , Löwenheim Hubert , Reimann Katrin
Published: February 2018

Hypothesis:

Anatomical and radiological evaluation improves safety and accuracy of the retrosigmoid approach for positioning a transcutaneous bone conduction implant and provides anatomical reference data for standardized, landmark-based implantation at this alternative site.

Background:

The primary implantation site for the floating mass transducer of a novel bone conduction hearing implant is the mastoid. However, anatomical limitations or previous mastoid surgery may prevent mastoid implantation. Therefore, the retrosigmoid approach has been introduced as an alternative.

Methods:

Mastoid and retrosigmoid implantation sites were radiologically identified and evaluated in preoperative computed tomography scans of anatomical head specimens. Navigation-guided implantation was then performed in the retrosigmoid site (n = 20). The optimal retrosigmoid position was determined in relation to both the asterion and the mastoid notch as surgical landmarks in an anatomical coordinate system.

Results:

Preoperative radiological analysis revealed spatial limitations in the mastoid in 45% of the specimens. Navigation-guided retrosigmoid implantation was possible without affecting the sigmoid sinus in all the specimens. The optimal implantation site was located 1.9 ± 0.1 cm posterior/1.7 ± 0.1 cm inferior to the asterion and 3.3 ± 0.2 cm posterior/2.1 ± 0.1 cm superior to the mastoid notch.

Retrosigmoid skull thickness was 6.6 ± 0.4 mm, measured anatomically, 7.0 ± 0.4 mm, measured radiologically and 6.7 ± 0.5 mm, measured with the navigation software.

Conclusion:

The navigation-guided retrosigmoid approach seemed to be a reliable procedure in all the specimens. Measurements of bone thickness revealed the need for spacers in 95% of the specimens. Reference coordinates of the optimal implantation site are provided and can confirm image-guided surgery or facilitate orientation if a navigation system is not available.
Antimicrobial Efficacy of a New Chlorhexidine-based Device Against Staphylococcus aureus Colonization of Venous Catheters
Authors: Kowalewska Paulina M. , Petrik Shawn M. , Di Fiore Attilio E. , Fox-Robichaud Alison E.
Published: February 2018

Vascular catheters are a major cause of nosocomial bloodstream infections. ChloraLock (ATTWILL Medical Solutions, Inc, West Jordan, UT, and ICU Medical, Inc, San Clemente, CA) is a novel antimicrobial device containing chlorhexidine digluconate (CHG) that is fitted onto a syringe and infuses CHG into the catheter lumen during locking. The objective of this study was to evaluate the antimicrobial efficacy of ChloraLock with in vitro tests and its ability to reduce Staphylococcus aureus contamination of catheters in the external jugular veins of Yorkshire swine. ChloraLock significantly reduced the bacterial load in the in vitro tests by up to 6 log10 colony-forming units (CFU) and by 3 to 4 log10 CFU/lumen in vivo in a swine model with 0.9% NaCl catheter locks.
The Mediating Role of Exercise on Relationships Between Fatigue, Sleep Quality, and Quality of Life for Adolescents With Cancer
Authors: Wu Wei-Wen , Jou Shiann-Tarng , Liang Shu-Yuan , Tsai Shao-Yu
Published: February 2018

Background

Fatigue and poor sleep are two of the most common and most distressing symptoms for adolescents with cancer. These 2 symptoms concurrently heighten distress, further decreasing quality of life (QoL).

Objectives

The aims of this study were to describe the degree of exercise involvement, fatigue, sleep quality, and QoL among adolescents with cancer and to determine whether exercise mediates the relationships between (a) fatigue and QoL and (b) sleep quality and QoL.

Methods

A cross-sectional study of 100 participants was conducted. Multiple regression was performed to examine the mediation relationship.

Results

Participants in the off-treatment group had a significantly higher degree of exercise involvement, as well as less fatigue, greater sleep quality, and less QoL distress. Exercise partially mediated the adverse effect of fatigue on QoL for adolescents undergoing cancer treatment, accounting for 49.80% of the total variation; exercise partially mediated the adverse effect of poor sleep on QoL for adolescents both in treatment and in survivorship, accounting for 42.06% and 28.71% of the total variations, respectively.

Conclusion

Exercise partially mediated the relationship between fatigue and QoL for adolescents in cancer treatment and partially mediated the relationship between sleep quality and QoL both for those in cancer treatment and for those in survivorship.

Implications for Practice

Developing tailored exercise programs based on both treatment status and the degree of fatigue and sleep quality is important. In-service education that enhances nurses’ awareness of the importance of exercise in improving adolescents’ QoL is recommended.
Valproate-induced Hyperammonemic Encephalopathy Presenting as Catatonia
Authors: Pérez-Esparza Rodrigo , Oñate-Cadena Nelcy , Ramírez-Bermúdez Jesús , Espínola-Nadurille Mariana
Published: February 2018

Hyperammonemic encephalopathy secondary to the use of valproate is rare without evidence of hepatotoxicity, and it usually presents with confusion, agitation, irritability, cognitive disturbances, lethargy, coma, and death. We present the case of a 21-year-old woman presenting with catatonia as a manifestation of hyperammonemic encephalopathy that resolved with the normalization of ammonia and suspension of valproate.
Diagnostic Evaluation in Primary CNS Lymphoma
Authors: Lukas Rimas V. , Riedell Peter , Horowitz Peleg M. , Pytel Peter , Kamson David O.
Published: February 2018

The diagnosis of primary central nervous system lymphoma (PCNSL) may be fraught with difficulty. After initial imaging reveals enhancing intracranial mass lesions steroids are often initiated. This leads to a decreased diagnostic yield of tumor biopsies which may be associated with delay in treatment initiation. We review a case of PCNSL treated with a very brief steroid course. Initial nondiagnostic biopsy histopathology is juxtaposed against subsequent diagnostic pathology. Imaging before and after steroids is presented, as is imaging after tumor regrowth in a noncontiguous location. Elements in the clinical history and radiographic presentation which should raise suspicion for PCNSL are reviewed. Increased understanding of the potential pitfalls surrounding PCNSL diagnosis may limit their future occurrence.
Magnesium Sulfate Treatment Correlates With Improved Neurological Function in Posterior Reversible Encephalopathy Syndrome (PRES)
Authors: Pandita Aakriti , Lehmann David F.
Published: February 2018

Posterior reversible encephalopathy syndrome (PRES) is a potentially reversible failure of cerebral autoregulation managed by correction of hypertension or underlying medical condition. Nonresponding cases progress to irreversible brain damage. There is some evidence of association of hypomagnesemia with PRES. We describe a case of nonresolving PRES where use of magnesium sulfate led to improvement in neurological function and eventual recovery. Our case highlights the need for a randomized controlled trial to test the efficacy of magnesium in PRES.
Use of Complementary Health Approaches for Acute Complaints Presenting to the Emergency Department
Authors: Kalaichandran Amitha , Barrowman Nick , Chan Jason , Toupin-April Karine , Vohra Sunita , Zemek Roger
Published: February 2018

Objective

This study aimed to determine the prevalence of complementary health approaches (CHAs) specifically for acute complaints in patients assessed in a pediatric emergency department (ED) and factors associated with use.

Methods

A cross-sectional survey was offered to patients between the age of 28 days and 18 years assessed at a tertiary pediatric ED between December 2014 and July 2015. Univariate and multivariate logistic regressions were used to identify variables associated with CHA use.

Results

Of 475 potential participants, 412 (86.7%) participated, of which 369 (89.5%) completed the survey. Overall, 28.7% (95% confidence interval [CI], 24.3–33.5) reported using any CHA for their child to treat the presenting complaint in the prior 72 hours to the ED visit. Gastrointestinal complaints had the highest use of CHA (46.3% of presentations endorsed use). The most common complementary health products used were vitamins and minerals (40.9%; 95% CI, 31.2–51.4); the most common complementary health practice used was massage (37.2%; 95% CI, 24.4–52.1). Multivariate analysis showed lower odds of using CHA for rash/skin complaint (odds ratio, 0.23; 95% CI, 0.09–0.59; P < 0.01) or musculoskeletal/extremity complaints (odds ratio, 0.23; 95% CI, 0.07–0.75; P = 0.01) compared with use for fever. No statistically significant association was found between CHAs use and child's sex, child's age, private insurance, or caregiver education.

Conclusions

Caregivers commonly use CHA for acute pediatric complaints requiring an ED visit, with greatest use for gastrointestinal complaints. Clinicians should consider the use and safety of CHA when evaluating children presenting to the ED with acute conditions.
Oculocardiac Reflex in a Pediatric Trauma Patient
Authors: DesPain Angelica W. , Chapman Jennifer , Shaukat Haroon
Published: February 2018

We describe the case of a 6-year-old boy who presented to a tertiary care emergency department after a motor vehicle accident with facial trauma and bradycardia. The patient was found to have an orbital floor fracture and inferior rectus muscle entrapment with resulting bradycardia secondary to the oculocardiac reflex. The oculocardiac reflex is an uncommon cause of bradycardia in the setting of trauma but should be considered because it can necessitate surgical intervention.
Point-of-Care Ultrasound to Identify Congenital Heart Disease in the Pediatric Emergency Department
Authors: Rosenfield Daniel , Fischer Jason W. , Kwan Charisse W.
Published: February 2018

The first presentation of congenital heart disease can be a diagnostic challenge in the emergency department. We report on 2 cases where point-of-care ultrasound identified gross cardiac abnormalities in 2 children and expedited disposition and downstream care.
The Impact of a Displayed Checklist on Simulated Pediatric Trauma Resuscitations
Authors: Hulfish Erin , Diaz Maria Carmen G. , Feick Megan , Messina Catherine , Stryjewski Glenn
Published: February 2018

Background

Advanced Trauma Life Support resuscitation follows a strict protocolized approach to the initial trauma evaluation. Despite this structure, elements of the primary and secondary assessments can still be omitted. The aim of this study is to determine if a cognitive aid checklist reduces omissions and speeds the time to assessment completion. We additionally investigated if a displayed checklist improved performance further.

Methods

A series of 131 simulated trauma resuscitations were performed. Teams were randomized to 1 of 3 arms (no checklist, handheld checklist, or displayed). The scenarios were recorded and analyzed to determine time to completion and absolute completion of tasks of the primary and secondary survey. The workload of individual team members was assessed via NASA-TLX.

Results

There was no difference in time to completion of surveys among the 3 arms. In the primary survey, there was a nonsignificant increase in the number of completed tasks with the use of the displayed checklist. In the secondary survey, there was a significant improvement in task completion with the displayed checklists with improved evaluation of the pelvis (P = 0.011), lower extremities (P = 0.048), and covering the patient (P = 0.046). There was a significant improvement in performance in those reported among nurse documenters with use of the displayed checklist.

Conclusions

Despite a structured approach to trauma resuscitations, omissions still occur. The use of a displayed checklist improves performance and reduces omissions without delaying assessment. Better compliance with Advanced Trauma Life Support protocols may improve patient outcomes.
Child Car Safety
Authors: Krepis Panagiotis , Papasotiriou Maria , Tsolia Maria N. , Soldatou Alexandra
Published: February 2018

Objectives

This study aimed to assess parental behavior in terms of child restraint systems (CRS) use under emergency conditions while driving to the hospital's outpatient settings as well as their routine child car safety (CCS) practices.

Methods

A cross-sectional survey of parents/caregivers transporting children 13 years or younger was conducted at the Emergency Treatment Center of a pediatric tertiary care center in Athens, Greece. Participants completed a questionnaire inquiring about the possession of CRS, and type and use of appropriate CRS while driving to the Emergency Treatment Center and under routine conditions. In addition, presence and type of parental education with regard to CCS and the use of seat belts among drivers were assessed.

Results

Of 444 participants, 51.4% children were carried restrained, although 48.6% were fastened in an improper seat for their age, in contrast with 23.7% who travel unrestrained on a daily basis. Forward-facing restraint seats were most popular, with 53.9% total use even in children younger than 2 years or older than 4 years, whereas booster seats (9.4%) and rear-facing restraint seats (18.2%) were inappropriately disfavored. Children younger than 4 years, male drivers, and drivers who had received information on CCS had higher odds of using CRS. The proportion of those had never been provided any CCS education was 38.5%.

Conclusions

Child restraint systems use was inappropriately low under routine conditions and declined even further under emergency circumstances. Most children younger than 2 years and older than 4 years traveled inappropriately restrained in a forward-facing restraint seat. Parents should be more intensively educated on child car safety seat and the proper CRS use.
Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation in a 5-Year-Old Pediatric Patient
Authors: Klučka Jozef , Juřenčák Tomáš , Štourač Petr , Vít Pavel , Foralová Vladimíra , Synková Iva
Published: February 2018

Out-of-hospital cardiac arrest in pediatric population is rare and predominantly has respiratory aetiology. Authors present the relatively unique case of out-of hospital cardiac arrest in 5-years old pediatric patient due to ventricular fibrillation (VF) as the initial rhythm during the advanced life support. The patient was resuscitated by his parents and the initial rhythm was VF. After defibrillation the patient was admitted to the pediatric intensive care were another two episodes of VF was detected and treated. After standard postresuscitation care, patient was weaned from sedation and extubated with good neurologic outcome. Genetic screening of the 7 genes associated with cardiac channelopathies (KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, RYR2, CASQ2) found mutation in gene KCHN2 and gene SCN5A, that were according to actual data considered benign. This case highlights the need for automated external defibrillator implementation in basic life support also in pediatric population and possible role of genetic predisposition in emergence of fibrillation.
Spontaneous Spinal Epidural Hematoma in an Infant
Authors: Kim Michael , Hoffman Jessa , Amin Anubhav , Purohit Manish , Mohan Avinash
Published: February 2018

A spontaneous spinal epidural hematoma is a collection of blood in the spinal epidural space that occurs in the absence of trauma. They most commonly present in the fourth to fifth decade in life with acute onset neck or back pain with delayed neurologic deficit. However, this presentation is often complicated in children because of the limitations in the pediatric neurologic exam. Magnetic resonance imaging is the imaging modality of choice for diagnosis. Here is a rare case of an infant spontaneous spinal epidural hematoma whose diagnosis was delayed because of a recent history of fever and viral pharyngitis before his development of neurologic deficits. Spontaneous spinal epidural hematomas are a rare phenomenon, which often present with nonspecific symptoms in the pediatric population. This diagnosis should be considered to initiate treatment in a timely manner. The treatment typically is emergent surgical decompression to minimize the risk of permanent neurologic deficit.
Intra-Aortic Balloon Pump Simulating Thoracic Aortic Dissection
Authors: Siegel Yoel , Munera Felipe , Durso Anthony M. , Roth Patrick
Published: February 2018

We present a 70-year-old woman who had an intra-aortic balloon pump (IABP) in its deflated state in the aorta during a computed tomography angiogram scan. The scan was performed to assess for aortic dissection. The deflated IABP created a curvilinear filling defect in the aortic lumen that suggested an intimal flap. Herein, we described the finding and suggest key features that can help distinguish between this intra-aortic device and a true dissection. This distinction between the device and aortic dissection is not only important because of the potential pitfall of a false positive diagnosis but also because an IABP itself can lead to an aortic dissection and therefore its computed tomography features should be recognized in both its inflated and deflated state.
Evaluation of the Olfactory Function With the “Sniffin’ Sticks” Test After Endoscopic Transsphenoidal Pituitary Surgery
Authors: Cingoz Ilker Deniz , Kizmazoglu Ceren , Guvenc Gonul , Sayin Murat , Imre Abdulkadir , Yuceer Nurullah
Published: February 2018

The aim of this study was to evaluate the olfactory function of patients who had undergone endoscopic transsphenoidal pituitary surgery. In this prospective study, the “Sniffin’ Sticks” test was performed between June 2016 and April 2017 at Izmir Katip Celebi University Ataturk Training and Research Hospital. Thirty patients who were scheduled to undergo endoscopic transsphenoidal pituitary surgery were evaluated preoperatively and 8 weeks postoperatively using the Sniffin’ Sticks test battery for olfactory function, odor threshold, smell discrimination, and odor identification. The patients were evaluated preoperatively by an otolaryngologist. The patients’ demographic data and olfactory functions were analyzed with a t test and Wilcoxon-labeled sequential test. The study group comprised 14 women (46.7%) and 16 men (53.3%) patients. The mean age of the patients was 37.50 ± 9.43 years (range: 16–53 years). We found a significant difference in the preoperative and postoperative values of the odor recognition test (P = 0.017); however, there was no significant difference between the preoperative and postoperative odor threshold values (P = 0.172) and odor discrimination values (P = 0.624). The threshold discrimination identification test scores were not significant (P = 0.110). The olfactory function of patients who were normosmic preoperatively was not affected postoperatively. This study shows that the endoscopic transsphenoidal technique for pituitary surgery without nasal flap has no negative effect on the olfactory function.
Ablation of Buccal Cancer and Functionality Buccal Reconstruction Using an Individuation Anterolateral Thigh Flap
Authors: Zhou Ting , Zhang Lei , Sun Guowen , Hu Qingang
Published: February 2018

The complex area for reconstruction of the head and the neck is the buccal because of difficult anatomy of this region. This article aimed to describe our individualized design for the reconstruction of the buccal using an different categories anterolateral thigh (ALT) flap. Ninety-four patients were involved in this study. Among 94cases, the number of using the musculocutaneous ALT flap was 57, using the fasciocutaneous ALT flap was 25, and using the thin ALT flap was 12. Postoperative vessel thrombosis occurred in 8 flaps, and required operative exploration in the perioperative period, 6 flaps were complete survival after the salvages, 2 flap was failure. The ALT flap represents a very good choice for the reconstruction of the complex defects at the cheek level. The flap can replace large volumes of tissues and the skin island is large and can be used both for the tegument reconstruction and for the oral mucosa reconstruction.
Unilateral Orticochea Pharyngoplasty for Unilateral Velopharyngeal Dysfunction: Long-Term Outcomes Data
Authors: Klement Kristen A. , Black Jonathan S. , Vanlue Michael J. , Denny Arlen D.
Published: February 2018

A unilateral deficit in velopharyngeal closure during speech production is an unusual presentation of velopharyngeal dysfunction (VPD) and few solutions have been described for this problem. This report details the long-term outcomes using this technique. We performed a retrospective chart review of all the patients who underwent a unilateral Orticochea pharyngoplasty for VPD. The authors identified 10 patients treated with 11 unilateral pharyngoplasty at a single tertiary care institutional setting. The mean age at repair was 8.6 years. The mean length of follow-up was 7.6 years. All the patients demonstrated improvement in velopharyngeal closure and speech resonance with 4 showing complete resolution of VPD. There were no revisions required or complications. One patient, after 10.7 years, required a unilateral procedure on the contralateral side which resulted in complete resolution of VPD postoperatively.
A Rare Cause of Recurrent Cerebral Ischemia and Syncope: Eagle Syndrome
Authors: Bal Kemal Koray , Ismi Onur , Esen Kaan , Yilmaz Ibrahim Arda , Vayisoglu Yusuf
Published: February 2018

Eagle syndrome is defined as symptomatic elongation of the styloid process or calcification of the stylohyoid and stilomandibular ligament. The syndrome was described by WW Eagle in 1937. The styloid process is located between the internal and external carotid arteries and laterally in the tonsillar fossa. Patients with cerebrovascular ischemia causing syncope or hemiparesia due to Eagle syndrome are rarely published in the literature. The authors presented a patient with recurrent cerebrovascular attacks due to long styloid process.
Nasolabial Morphology Following Nasoalveolar Molding in Infants With Unilateral Cleft Lip and Palate
Authors: Nur Yilmaz Rahime Burcu , Germeç Çakan Derya
Published: February 2018

Aim:

The aim of the present study is to evaluate the effects of nasoalveolar molding (NAM) therapy on nasolabial morphology three dimensionally, and compare the nasolabial linear and surface distance measurements in infants with unilateral cleft lip and palate.

Methods:

Facial plaster casts of 42 infants with unilateral cleft lip and palate taken at the onset (pre-NAM) and finishing stage (post-NAM) of NAM were scanned with 3dMDface stereophotogrammetry system (3dMD, Atlanta, GA). Nineteen nasolabial linear and surface distance measurements were performed on three-dimensional images. In addition to standard descriptive statistical calculations (means and SDs), pre- and post-NAM measurements were evaluated by paired t test.

Results:

All measurements except lip gap, nostril floor width, and nostril diameter increased between pre-NAM and post-NAM. Nostril and lip height increased significantly on the cleft side (P < 0.05). No differences were present between linear and surface distance measurements except for nasal width measurement.

Conclusions:

Nasal and lip symmetry improved with NAM. The use of surface distance measurements may be advised particularly for continuous and curved anatomic structures in which circumference differences are expected.
Reliability and Validity of the Turkish Version of the Gastrointestinal Symptom Rating Scale
Authors: Turan Nuray , Aştı Türkinaz Atabek , Kaya Nurten
Published: February 2018

The purpose of this methodological study is to investigate the validity and reliability of the Turkish version of the Gastrointestinal Symptom Rating Scale (GSRS). The scale was adapted to the Turkish language via backward translation. Content validity was examined by referring to experts. Reliability was examined via test-retest reliability and internal consistency, and validity was examined with divergent and convergent validity. The Epworth Sleepiness Scale (ESS) and the Marlowe-Crowne Social Desirability Scale (MCSDS) were used for divergent validity. As for convergent validity, the Constipation Severity Instrument (CSI) and the Patient Assessment of Constipation Quality of Life Scale (PAC-QOLQ) were utilized. The relationship between the GSRS and the health-related quality of life (36-item short-form health survey [SF-36]) was also analyzed. The study population consisted of patients in orthopedic clinic who volunteered to participate. Test-retest reliability was examined with the participation of 30 patients; internal consistency and validity were examined with 150 patients. Test-retest reliability correlation coefficients of the GSRS varied from 0.39 to 0.87 for all items. For internal consistency, the GSRS's item total correlation was found to be 0.17–0.67, and Cronbach α was 0.82 for all items. There was a positive linear significant correlation between the GSRS, CSI, and PAC-QOLQ. There was no significant correlation between the GSRS, MCSDS, and ESS. Higher GSRS scores inversely correlated with general quality of life (SF-36). The Turkish version of the GSRS has been found to be a reliable and valid instrument for assessing patients' gastrointestinal symptoms. Therefore, this instrument can be confidently used with Turkish individuals.
Achievements and Challenges in Facial Transplantation
Authors: Rifkin William J. , David Joshua A. , Plana Natalie M. , Kantar Rami S. , Diaz-Siso J. Rodrigo , Gelb Bruce E. , Ceradini Daniel J. , Rodriguez Eduardo D.
Published: February 2018

The first facial transplantation in 2005 ushered in a new era in reconstructive surgery, offering new possibilities for the repair of severe disfigurements previously limited by conventional techniques. Advances in allograft design, computerized preoperative planning, surgical technique, and postoperative revisions have helped push the boundaries in this new frontier of vascularized composite allotransplantation. Over the past 12 years, 40 of these procedures have been performed across the world, offering the field the opportunity to reflect on current outcomes. Successes achieved in the brief history of facial transplantation have resulted in a new set of obstacles the field must now overcome. In this review, we aim to highlight the achievements, major challenges, and future directions of this rapidly evolving field.
Nephrogenic Adenoma in the Setting of Refractory Labial Agglutination in an Elderly Woman
Authors: Bretschneider Carol Emi , Share Sarah M. , Paraiso Marie Fidela R.
Published: February 2018

Background

Severe labial agglutination can be refractory to outpatient management and can lead to voiding dysfunction in postmenopausal women. Labial agglutination is often a sequela of long-standing inflammatory processes, which include untreated lichen planus, lichen sclerosus, and atrophic vaginitis.

Case

An 82-year-old parous woman presented with severe labial agglutination and complete obstruction of her vaginal introitus, causing obstructive voiding symptoms. She underwent a surgical procedure to release the fused labia. Pathologic evaluation of a vulvar biopsy revealed nephrogenic adenoma, which is an uncommon benign lesion usually presenting in the urinary tract.

Conclusions

Refractory, severe labial agglutination in postmenopausal women can lead to significant voiding dysfunction, and the underlying chronic inflammation may result in pathologic changes such as nephrogenic adenoma. Pathologic tissue diagnosis is important to plan appropriate surveillance for patients with this chronic condition.
Impact of Trainee Involvement on Complication Rates Following Pelvic Reconstructive Surgery
Authors: Sheyn David , Bretschneider C. Emi , Canfield Dana , Duarte Mary , Mangel Jeffrey M. , Mahajan Sangeeta T.
Published: February 2018

Objective

Trainee involvement in surgical procedures has been associated with longer surgical times and increased rates of certain complications. There has been limited study of the impact trainee involvement has on outcomes in urogynecologic surgery. We sought to determine the impact of resident and fellow involvement in pelvic reconstructive surgeries on 30-day complication rates.

Methods

Using the American College of Surgeons National Surgical Quality Improvement Program database, patients who underwent pelvic floor surgery were identified between 2010 and 2015. Patients were stratified into 3 groups: no trainee, resident, or fellow involvement. The primary outcome was the composite complication rate. Three-group comparison was performed using Kruskal-Wallis analysis. If statistically significant, then pairwise analysis was performed between the reference group (attending alone) and experimental groups (resident or fellow). Additional pairwise analysis was performed between the fellow and resident groups. Logistic regression was used to identify factors associated with an increased risk of complications.

Results

Seven thousand seven hundred fifty-two surgical cases met all criteria for inclusion; 2440 (31.4%) included residents, and 646 (8.3%) included fellows. The median operating times were significantly higher in the resident and fellow groups compared with the attending-alone group (109 minutes [interquartile range, 55–164 minutes) compared with 110 minutes [interquartile range, 61–174 minutes] compared with 72 minutes [interquartile range, 38–113 minutes], P < 0.001). After multivariable logistic regression, trainee participation did not result in an increase in complication rate. Preoperative transfusion (adjusted odds ratio [aOR], 7.82; 95% confidence interval [CI], 2.03–30.09), coagulopathy (aOR, 3.18; 95% CI, 1.74–5.82), nonwhite race (aOR, 1.57; 95% CI, 1.31–1.89), insulin-dependent diabetes (aOR, 1.68; 95% CI, 1.03–2.72), American Society of Anesthesiologists class greater than 2 (aOR, 1.46; 95% CI, 1.21–1.77), length of stay (aOR, 1.04, 95%CI:1.02–1.06), operating time (aOR, 1.01; 95% CI, 1.00–1.03), and undergoing a sling procedure (aOR, 1.18; 95% CI, 1.01–1.41) were associated with higher complication rates.

Conclusions

Resident and fellow involvement during pelvic reconstructive surgery is associated with longer operating times but does not increase the risk of complications within 30 days of the procedure.
Narrow anthropogenic corridors direct the movement of a generalist boreal butterfly
Authors: Riva Federico , Acorn John H. , Nielsen Scott E.
Published: February 2018

Ecological and anthropogenic corridors are becoming more common worldwide, but little is known about how corridor size (width) affects species' movements, and thus their effects. Here we investigated whether 4- and 8-m wide anthropogenic corridors (seismic lines) cleared for petroleum (oil sands) exploration in boreal forests in Alberta, Canada, act on altering the behaviour of a habitat generalist butterfly, the Arctic fritillary (
Boloria chariclea
). Specifically, we captured 539 Arctic fritillaries and released them in seismic line corridor or control sites with no structural directionality (i.e. forests and clearings), and recorded both their initial direction (along the seismic line or not) and persistence in directional movements. Arctic fritillaries moved inside these lines twice as often as they left them, and maintained their initial direction more often, regardless of line size and independently of forest structure or sex of individuals. Thus, anthropogenic corridors as narrow as 4 m can affect insect movements. Given the vast area of boreal forests disturbed from seismic assessments, investigating if the effects of these dense, localized lines affect population dynamics and species interactions would provide important insights to managing this ecosystem and identifying restoration actions.
An update on smart biocatalysts for industrial and biomedical applications
Authors: Shakya Akhilesh Kumar , Nandakumar Kutty Selva
Published: February 2018

Recently, smart biocatalysts, where enzymes are conjugated to stimuli-responsive (smart) polymers, have gained significant attention. Based on the presence or absence of external stimuli, the polymer attached to the enzyme changes its conformation to protect the enzyme from the external environment and regulate the enzyme activity, thus acting as a molecular switch. Owing to this behaviour, smart biocatalysts can be separated easily from a reaction mixture and re-used several times. Several such smart polymer-based biocatalysts have been developed for industrial and biomedical applications. In addition, they have been used in biosensors, biometrics and nano-electronic devices. This review article covers recent advances in developing different kinds of stimuli-responsive enzyme bioconjugates, including conjugation strategies, and their applications.
Natural variation in female reproductive hormones does not affect contrast sensitivity
Authors: Webb Abigail L. M. , Hibbard Paul B. , O'Gorman Rick
Published: February 2018

Evidence suggests that females experience adaptive shifts in facial preferences across the menstrual cycle. However, recent discussions and meta-analyses suggest that these findings are equivocal. A previously unexplored question is the extent to which shifts in female preferences are modulated by hormone-dependent changes occurring in low-level vision, such as visual sensitivity. This mechanistic approach has been a novel method for investigating the extent to which complex perceptual phenomena are driven by low-level versus higher-level perceptual processes. We investigated whether the contrast sensitivity function—an early dimension of vision—is also influenced by variation in female reproductive hormones. Visual contrast thresholds were measured for 1, 4 and 16 cycles/degree gratings during the ovulatory, luteal and menstrual phases of the menstrual cycle in naturally cycling women, and women using oral contraceptives. Male participants were tested at similar time intervals. Results showed that visual contrast sensitivity does not differ according to sex, or use of oral contraception, nor does it vary relative to hormonal shifts across the menstrual cycle. These findings suggest that shifts in female preferences are not driven by changes in visual sensitivity, and are therefore likely attributable to changes in higher-level perception or cognition.
On gamesmen and fair men: explaining fairness in non-cooperative bargaining games
Authors: Suleiman Ramzi
Published: February 2018

Experiments on bargaining games have repeatedly shown that subjects fail to use backward induction, and that they only rarely make demands in accordance with the subgame perfect equilibrium. In a recent paper, we proposed an alternative model, termed ‘economic harmony’ in which we modified the individual's utility by defining it as a function of the ratio between the actual and aspired pay-offs. We also abandoned the notion of equilibrium, in favour of a new notion of ‘harmony’, defined as the intersection of strategies, at which all players are equally satisfied. We showed that the proposed model yields excellent predictions of offers in the ultimatum game, and requests in the sequential common pool resource dilemma game. Strikingly, the predicted demand in the ultimatum game is equal to the famous Golden Ratio (approx. 0.62 of the entire pie). The same prediction was recently derived independently by Schuster (Schuster 2017.Sci. Rep.7, 5642). In this paper, we extend the solution to bargaining games with alternating offers. We show that the derived solution predicts the opening demands reported in several experiments, on games with equal and unequal discount factors and game horizons. Our solution also predicts several unexplained findings, including the puzzling ‘disadvantageous counter-offers’, and the insensitivity of opening demands to variations in the players' discount factors, and game horizon. Strikingly, we find that the predicted opening demand in the alternating offers game is also equal to the Golden Ratio.
Aspirin locally disrupts the liquid-ordered phase
Authors: Alsop Richard J. , Himbert Sebastian , Dhaliwal Alexander , Schmalzl Karin , Rheinstädter Maikel C.
Published: February 2018

Local structure and dynamics of lipid membranes play an important role in membrane function. The diffusion of small molecules, the curvature of lipids around a protein and the existence of cholesterol-rich lipid domains (rafts) are examples for the membrane to serve as a functional interface. The collective fluctuations of lipid tails, in particular, are relevant for diffusion of membrane constituents and small molecules in and across membranes, and for structure and formation of membrane domains. We studied the effect of aspirin (acetylsalicylic acid, ASA) on local structure and dynamics of membranes composed of dimyristoylphosphocholine (DMPC) and cholesterol. Aspirin is a common analgesic, but is also used in the treatment of cholesterol. Using coherent inelastic neutron scattering experiments and molecular dynamics (MD) simulations, we present evidence that ASA binds to liquid-ordered, raft-like domains and disturbs domain organization and dampens collective fluctuations. By hydrogen-bonding to lipid molecules, ASA forms ‘superfluid’ complexes with lipid molecules that can organize laterally in superlattices and suppress cholesterol’s ordering effect.
Photothermal fabrication of microscale patterned DNA hydrogels
Authors: Shimomura Suguru , Nishimura Takahiro , Ogura Yusuke , Tanida Jun
Published: February 2018

This paper introduces a method for fabricating microscale DNA hydrogels using irradiation with patterned light. Optical fabrication allows for the flexible and tunable formation of DNA hydrogels without changing the environmental conditions. Our scheme is based on local heat generation via the photothermal effect, which is induced by light irradiation on a quenching species. We demonstrate experimentally that, depending on the power and irradiation time, light irradiation enables the creation of local microscale DNA hydrogels, while the shapes of the DNA hydrogels are controlled by the irradiation patterns.
Effects of complexity and seasonality on backward bifurcation in vector–host models
Authors: Bilal Shakir , Michael Edwin
Published: February 2018

We study implications of complexity and seasonality in vector–host epidemiological models exhibiting backward bifurcation. Vector–host diseases represent complex infection systems that can vary in the transmission processes and population stages involved in disease progression. Seasonal fluctuations in external forcing factors can also interact in a complex way with internal host factors to govern the transmission dynamics. In backward bifurcation, the insufficiency ofR0 < 1 for predicting the stability of the disease-free equilibrium (DFE) state arises due to existence of bistability (coexisting DFE and endemic equilibria) for a range ofR0values below one. Here we report that this region of bistability decreases with increasing complexity of vector-borne disease transmission as well as with increasing seasonality strength. The decreases in the bistability region are accompanied by a reduced force of infection acting on primary hosts. As a consequence, we show counterintuitively that a more complex vector-borne disease may be easier to control in settings of high seasonality.
Quasi-two-layer morphodynamic model for bedload-dominated problems: bed slope-induced morphological diffusion
Authors: Maldonado Sergio , Borthwick Alistair G. L.
Published: February 2018

We derive a two-layer depth-averaged model of sediment transport and morphological evolution for application to bedload-dominated problems. The near-bed transport region is represented by the lower (bedload) layer which has an arbitrarily constant, vanishing thickness (of approx. 10 times the sediment particle diameter), and whose average sediment concentration is free to vary. Sediment is allowed to enter the upper layer, and hence the total load may also be simulated, provided that concentrations of suspended sediment remain low. The model conforms with established theories of bedload, and is validated satisfactorily against empirical expressions for sediment transport rates and the morphodynamic experiment of a migrating mining pit by Lee
et al.
(1993
J. Hydraul. Eng.
119
, 64–80 (
doi:10.1061/(ASCE)0733-9429(1993)119:1(64)
)). Investigation into the effect of a local bed gradient on bedload leads to derivation of an analytical, physically meaningful expression for morphological diffusion induced by a non-zero local bed slope. Incorporation of the proposed morphological diffusion into a conventional morphodynamic model (defined as a coupling between the shallow water equations, Exner equation and an empirical formula for bedload) improves model predictions when applied to the evolution of a mining pit, without the need either to resort to special numerical treatment of the equations or to use additional tuning parameters.