bluuebunny/crossref_metadata_2025 huggingface dataset:
Green Discoloration of Human Postmortem Brains
Authors: Ahrendsen Jared T. , Varma Hemant
Published: December 2020

A variety of gross discolorations of human postmortem brains is occasionally encountered and can have diagnostic implications. We describe 3 cases of green discoloration of the human brain observed on postmortem examination. Two patients who succumbed shortly after administration of methylene blue (MB) showed diffuse green discoloration that was detectable as early as 24 hours and was seen for at least 48 hours after MB administration. Green discoloration was largely in cortical and deep gray matter structures with relative sparing of the white matter. In contrast, a patient with severe hyperbilirubinemia who died after intracerebral hemorrhage showed localized bright green bile stained brain parenchyma in the areas surrounding the hemorrhage. We highlight the distinct patterns of discoloration in different causes of green brain discoloration, including MB, bile staining, and hydrogen sulfide poisoning. Recognition of these patterns by practicing pathologists can be used to differentiate between these etiologies and allow correct interpretation in both the medical and forensic autopsy settings.
A Novel Means-End Problem-Solving Assessment Tool for Early Intervention: Evaluation of Validity, Reliability, and Sensitivity
Authors: Cunha Andrea Baraldi , Babik Iryna , Koziol Natalie A. , Hsu Lin-Ya , Nord Jayden , Harbourne Regina T. , Westcott-McCoy Sarah , Dusing Stacey C. , Bovaird James A. , Lobo Michele A.
Published: December 2020

Purpose:

To evaluate validity, reliability, and sensitivity of the novel Means-End Problem-Solving Assessment Tool (MEPSAT).

Methods:

Children with typical development and those with motor delay were assessed throughout the first 2 years of life using the MEPSAT. MEPSAT scores were validated against the cognitive and motor subscales of the Bayley Scales of Development. Intra- and interrater reliability, developmental trends, and differences among groups were evaluated.

Results:

Changes in MEPSAT scores positively related to changes in Bayley scores across time for both groups of children. Strong intra- and interrater reliability was observed for MEPSAT scoring across all children. The MEPSAT was sensitive to identify change across time and differences in problem-solving among children with varying levels of motor delay.

Conclusions:

The MEPSAT is supported by validity and reliability evidence and is a simple tool for screening early problem-solving delays and evaluating change across time in children with a range of developmental abilities. What this adds to the evidence: The novel MEPSAT is supported by validity and reliability evidence. It is sensitive to detect problem-solving differences among young children with varying motor ability and to capture changes in problem-solving across time. It requires minimal equipment and time to administer and score and, thus, is a promising tool for clinicians to screen for early problem-solving delays or to track intervention progress in young children with or at risk for problem-solving delays.
Improvements in Muscle Strength Are Associated With Improvements in Walking Capacity in Young Children With Cerebral Palsy: A Secondary Analysis
Authors: van Vulpen Liesbeth F. , de Groot Sonja , Rameckers Eugene A. A. , Becher Jules G. , Dallmeijer Annet J.
Published: December 2020

Purpose:

To evaluate whether changes in lower-limb muscle strength explain changes in walking capacity during 14-week periods of usual care, power training and follow-up for children with spastic cerebral palsy.

Methods:

Secondary analysis of a previously conducted double-baseline controlled trial of 22 children with spastic cerebral palsy. Generalized estimating equations were used to evaluate the relationships between within-subject changes in isometric muscle strength and walking capacity over 3 periods.

Results:

Changes in hip abductor strength were associated with changes in the Muscle Power Sprint Test, changes in gastrocnemius and hip abductor strength were associated with changes in the Shuttle Run Test, and changes in gastrocnemius strength were associated with changes in the 1-minute walk test. All associations supported better walking capacity with increased strength.

Conclusion:

Walking capacity, especially sprint capacity, can be improved by increasing strength by functional power training in this population.
Collecting Infant Environmental and Experiential Data Using Smartphone Surveys
Authors: Rosales Marcelo R. , Rohloff Peter , Vanderbilt Douglas L. , Tripathi Tanya , Valentini Nadia Cristina , Dusing Stacey , Smith Beth A.
Published: December 2020

We propose that the collection of infant experiential and environmental data using smartphone surveys has the potential to fill a gap in foundational and clinical knowledge. To achieve this, these data need to be collected in a systematic way that is translatable globally. We can then begin to understand differences in child development and physical therapy from a variety of cultures and traditions. An infant's development is shaped by experiences in everyday life, and everyday experiences vary around the world. Hence, it is important to quantify these experiences to better understand variability in developmental trajectories. Recent increase in smartphone access has made the capability of collecting infant experiential data more feasible around the world. We provide examples and suggestions for ways in which experiential and environmental data can be collected for future practice.
Embracing Our Role in the Prevention of Chronic Pain
Authors: Swiggum Mary , Jacobson Erin , Wrisley Diane
Published: December 2020

This perspective article advocates for pediatric physical therapists to increase their role and visibility in the primary and secondary prevention of chronic pain during 2 critical developmental periods: infancy and early adolescence. The opioid epidemic and the disabling aspects of chronic pain are adversely affecting children and their families. Health care disciplines are adopting measures that address risk factors for the development of chronic pain in children, including strategies to minimize acute procedural pain and parental education to reinforce healthy pain-coping behaviors. Pediatric physical therapists are uniquely positioned to develop and adopt strategies to aid in this effort. They routinely screen and evaluate children for developmental delays and work with children who are at increased risk for developing chronic pain as a sequela of their health condition or as a consequence of painful medical procedures.
Using a 3D-Printed Prosthetic to Improve Participation in a Young Gymnast
Authors: Anderson Brittany , Schanandore James V.
Published: December 2020

Background and Purpose:

The purpose of this case report was to investigate the application of a 3-dimensional (3D)-printed prosthetic hand to improve a child's participation, confidence, and satisfaction in gymnastic classes, specifically, horizontal bar-related skills.

Summary of Key Points:

A 9-year-old child was unable to participate in horizontal bar-related gymnastic skills due to a congenital hand deficiency. A prosthetic hand was designed, 3D printed, modified repeatedly, and incorporated into a program, which resulted in improvements in the child's ability to participate in gymnastics.

Conclusions:

Using a 3D-printed upper limb prosthetic hand improved the child's participation, confidence, and satisfaction in her gymnastic classes permitting use of horizontal bar. To progress to higher-intensity activities, further safety measures and testing of the prosthetic hand are needed.

What This Case Adds to Evidence-Based Practice:

A 3D-printed prosthetic hand was manufactured and customized allowing closely monitored, gradually increased, participation in horizontal bar gymnastics.
Virtual Reality Facilitates Engagement in Physical Therapy in the Pediatric CVICU
Authors: Hemphill Sydney , Nguyen Alan , Kwong Joann , Rodriguez Samuel T. , Wang Ellen , Caruso Thomas J.
Published: December 2020

Purpose:

The purpose of this report is to demonstrate the successful application of virtual reality to improve physical therapy in the pediatric cardiovascular intensive care unit. Early mobilization and cognitive stimulation improve morbidity of critically ill children. However, maintaining child engagement with these therapies can be challenging, especially during extended intensive care stays.

Summary of Key Points:

While virtual reality has been successfully used as an analgesic and anxiolytic in the cardiovascular intensive care unit, this report demonstrates its novel use as a tool to augment physical therapy for a child who had been debilitated after heart transplantation. Virtual reality encouraged the child to engage in physical therapy sessions, participate for greater durations, and directly address barriers to discharge.

Conclusions and Recommendations for Clinical Practice:

While further studies are needed to define best practice, this report demonstrates that virtual reality can be safely used for carefully selected and monitored children in critical care.
Outcomes of an 8-Week Treadmill Training Program for a Toddler With Williams Syndrome: A Case Report
Authors: Conklin Ashley , Simonds Adrienne H.
Published: December 2020

Purpose:

This case report highlights the functional and quality-of-life outcomes of an 8-week treadmill training program for an 18-month old child with Williams syndrome who is not walking.

Summary of Key Points:

The child had clinical improvements in gross motor function and quality of life as determined by the Gross Motor Function Measure and Pediatric Quality of Life Inventory after 8 weeks of treadmill training as an outpatient.

Statement of Conclusion and Recommendations for Clinical Practice:

Treadmill training is clinically feasible and effective for this child with Williams syndrome. Further research is necessary for generalizability. Treadmill training should be considered when developing a plan of care for children with Williams syndrome who are not walking or children with similar deficits.
Management of Acute and Traumatic Wounds With Negative-Pressure Wound Therapy With Instillation and Dwell Time
Authors: Diehm Yannick F. , Fischer Sebastian , Wirth Garrett A. , Haug Valentin , Orgill Dennis P. , Momeni Arash , Horch Raymund E. , Lehner Burkhard , Kneser Ulrich , Hirche Christoph
Published: December 2020

Background:

A promising and useful development of negative-pressure wound therapy (NPWT) is the addition of instillation and dwell time of topical wound solutions (NPWTi-d). Uses of NPWTi-d include acute and traumatic wounds, whereby wound closure may be facilitated via wound cleansing and promotion of granulation tissue formation. This systematic review summarizes publications on NPWTi-d in the treatment of acute and traumatic wounds.

Methods:

A systematic review was performed analyzing articles from major clinical databases. Only clinical studies ≥10 patients reporting on the application of NPWTi-d in acute and traumatic wounds were included.

Results:

One hundred ninety-two articles were retrieved, of which 10 articles met inclusion criteria. Of those, 2 were lesser-quality randomized controlled trials, comparative studies or prospective cohorts, 2 were retrospective studies, and 6 retrospective cohort studies. In total, included publications reported 109 patients with acute and traumatic wounds treated with NPWTi-d. Data from these studies indicated the potential for reduction in bacterial bioburden through wound cleansing and promotion of granulation tissue formation, thereby facilitating wound closure, reduced length of therapy and hospital time. However, for most publications, different wound causes and subsequently no isolated results for acute and traumatic wounds were reported.

Conclusion:

NPWTi-d has promise to be effective in facilitating wound closure and reducing the time for wound closure. The present systematic review demonstrates a relatively low level of evidence available to objectively support this effect. To underline these positive results, large prospective, randomized controlled trials are necessary to manifest the role of NPWTi-d in the daily clinical routine for this wound category.
Challenges and Management in Wound Care
Authors: Teot Luc , Ohura Norihiko
Published: December 2020

Wounds have been one of the most prominent pathologies since the beginning of humanity. For the last 5 decades, a drastic improvement of healing has been observed, thanks to new medical devices based on fluid aspiration capacities and the development of negative pressure wound therapy. Negative-pressure wound therapy was initially designed for a double action, fluid aspiration and mechanical stimulation of wound edges by a foam. Successive technical evolutions of negative pressure wound therapy were declined since 1997 when Argenta and Morykwas first presented their solution. The adjunct of instillation in 2009 was considered as the first interactive dressing, allowing topical wound solutions to sequentially reach the wound, in alternance with negative pressure. Other devices based on the same principle were designed to prevent postoperative infections when placed over a suture after surgery. This long evolution could enhance the armamentarium of possible solutions, considerably reducing the wound healing time.
Helicobacter pylori and Upper Endoscopy in Systemic Sclerosis
Authors: Zullo Angelo , Bruzzese Vincenzo , Pellegrino Greta , Scolieri Palma , Stefanantoni Katia , Angelelli Carlotta , Riccieri Valeria
Published: December 2020

Background/Aims

A role for Helicobacter pylori in triggering systemic sclerosis (SSc) has been proposed, but data are conflicting. In previous studies, infection has been generally searched for by using serology. We designed this study to assess H. pylori prevalence in SSc patients with histology of gastric mucosa, considered the criterion standard for infection diagnosis.

Methods

This cross-sectional study enrolled 30 SSc patients who complained of upper gastrointestinal symptoms. All underwent upper endoscopy with gastric biopsies. Endoscopic alterations were recorded, and gastric mucosa biopsies were used for both histological examination and searching for H. pylori. The role for proton-pump inhibitor (PPI) therapy was considered. Fisher exact test was used for statistical analysis.

Results

Data of 28 SSc patients were available, 14 with ongoing PPI therapy. Helicobacter pylori infection at histology was detected in 14.3% patients, and it equally occurred in patients with or without PPI therapy. Erosive esophagitis/Barrett esophagus was detected in 26.6% of cases. Among patients with PPI therapy, 30% received half dose only. The prevalence of intestinal metaplasia was low (14.3%). Endoscopic esophageal alterations were significantly more frequent in those patients showing anti-Scl70 antibody positivity.

Conclusions

This study showed that prevalence of H. pylori is very low in SSc patients, so that it seems not having a role in triggering SSc. Management of gastroesophageal diseases in SSc patients needs to be improved, and looking to the autoimmune profile may be of help. Thus, collaboration between rheumatologist and gastroenterologist is highly recommended.
Empiric Switching of Gadolinium-Based Contrast Agents in Patients With History of Previous Immediate Hypersensitivity Reaction to GBCA
Authors: Walker Daniel , McGrath Trevor A. , Glikstein Rafael , Chakraborty Santanu , Blanchette Charles , Schieda Nicola
Published: December 2020

Background

Breakthrough hypersensitivity reactions (HRs) to gadolinium-based contrast agent (GBCA) occur in 40% of patients despite corticosteroid premedication. Other strategies to reduce HRs are not well studied.

Objective

The aim of this study was to prospectively evaluate HR rate to GBCA among patients with history of HR to GBCA, empirically given an alternative GBCA prior to repeat administration.

Materials and Methods

From September 2019 to September 2020, patients with prior HR to GBCA received 13-hour oral corticosteroid and diphenhydramine premedication prescription with switching of GBCA to gadoterate (previously unavailable at our institution before September 2019). Power analysis (α error, 0.05; β error, 0.80) determined 21 patients were required. Patients were evaluated under a quality assurance waiver from the institutional review board. A radiologist documented the nature of initial HR and inciting GBCA, premedication received, incidence, and severity of breakthrough HR.

Results

After exclusions, we evaluated 26 patients with mild (92.3% [24/26]) or moderate (7.7% [2/26]) HR to gadobutrol (53.8% [14/26]), gadoxetate (3.8% [1/26]), and gadopentetate (3.8% [1/26]). In 38.5% (10/26), inciting GBCA was unknown but was likely gadobutrol or gadopentetate based on availability. There were 22 females. The mean patient age was 52.1 ± 15.8 years.

From 27 gadoterate administrations, 59.3% (16/27) patients received corticosteroid and diphenhydramine premedication, 11.1% (3/27) received only diphenhydramine, and 29.6% (8/27) with no premedication.

Hypersensitivity reaction rate after empiric switching to gadoterate was 3.7% (1 mild reaction; 95% confidence interval [CI], 0.09%–18.9%) overall with no difference in patients with (6.3% [1/16]; 95% CI, 0.15%–28.7%) or without (0%; [0/11] upper bound 95% CI, 25.0%) corticosteroid premedication.

Conclusions

In this prospective single-arm study, empirically switching GBCA to gadoterate in patients with prior HR to GBCA substantially reduced the expected rate of subsequent HRs in patients with and without the use of corticosteroid premedication.

Implications for Patient Care

Empirically switching GBCAs, with or without the use of corticosteroid premedication, can substantially reduce the rate of hypersensitivity breakthrough reactions.
Postoperative Health-related Quality of Life in Reduction Mammaplasty
Authors: Lin Yan , Yang Yan , Zhang Xiaoyu , Li Wandi , Li Haoran , Mu Dali
Published: December 2020

Background

Breast hypertrophy is a chronic health problem. Until now, reduction mammaplasty is still a critical treatment for this disease. Given the publications, which reviewed the relationship between operation and quality of life, based on nonrandomized controlled studies and how low their quality are. Thus, we aimed to assess the effectiveness of reduction mammaplasty in improving health-related quality of life based on high-quality randomized-controlled trials.

Method

A systematic search of the following databases: PubMed (MEDLINE), the Cochrane Library, the Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, ClinicalTrials.gov, BIOSIS previews, and GreyNet. All the English publications have been searched without any restrictions of time, countries, or article type. Studies examining the effects of breast reduction versus control group on postoperative quality of life were included. Data on studies, patient characteristics, outcome measures were extracted. Statistical analysis was performed using Review Manager 5.3.

Results

In all, 7 randomized-controlled trials involving 285 participants were included, in which 4 studies were pooled in the meta-analysis. Because of the effect of reduction mammaplasty, statistically significant improvements were found on pain (standardised mean difference [SMD], −1.29; 95% confidence interval [CI], −1.63 to −0.96; P < 0.00001), physical function (SMD, 0.97; 95% CI, 0.69–1.25; P < 0.00001) and psychological function (SMD, −0.79; 95% CI, −1.07 to −0.52; P < 0.00001).

Conclusions

Our findings based on the randomized-controlled trials suggest that the quality of life of women undergoing breast reduction surgery is significantly improved. Reduction mammaplasty is an effective treatment for symptomatic breast hypertrophy.
Personal Approach to Optimizing Inframammary Fold Incision for Asian Augmentation Mammoplasty
Authors: Lai Ya-Wei , Huang Shu-Hung , Lee Youngdae , Chen Fang-Ming , Lai Chung-Sheng
Published: December 2020

Background

The rates of aesthetic breast augmentation have risen substantially in Asia. Outcomes of various breast augmentation approaches in Asia have not been comprehensively studied. In the past, the inframammary approach to breast augmentation was not popular because of conspicuous scarring. In this article, the authors review academic articles related to the use of an inframammary incision for breast augmentation in Asian women and present our recommendations for the available techniques.

Methods

A literature search was performed for articles published after 2015 on Asian women with augmentation mammoplasty describing techniques, incision sites, outcomes, and complications. The search was performed using the MEDLINE, Embase, and Cochrane databases. We also included our own technique to demonstrate the outcome of augmentation mammoplasty through inframammary incision.

Results

Eight articles satisfied our inclusion criteria. Evidence indicates that with proper preoperative design and surgical techniques, scarring resulting from the inframammary approach is not inferior to that resulting from the transaxillary approach in Asian patients. Long-term satisfaction with the inframammary approach to breast augmentation is high in Asian patients.

Eight articles reported the outcomes of 1168 women receiving breast augmentation. Inframammary incisions were used in 45.29% of patients (529 patients). After the 2015 publication of Zelken's review paper on Asian breast augmentation, the rate of inframammary incisions increased from 3.1% to 45.29%.

Conclusions

With precise design of the new inframammary fold, accurate wound suture fixation, and postoperative scar care, the inframammary approach to breast augmentation offers optimal operative visualization, reduced pain, fewer complications, and desirable esthetic outcomes even in Asian patients. This study demonstrates that the percentage of inframammary fold approach of Asian esthetic mammoplasty grows rapidly after 2015.
Achieving an Optimal Outcome in Immediate Breast Reconstruction
Authors: Song Ping , Pu Lee L. Q.
Published: December 2020

Performing immediate breast reconstruction requires careful consideration of preoperative, intraoperative, and postoperative factors. One of the fundamental necessities is a well-coordinated multidisciplinary team to achieve successful reconstruction. Clear and effective communication between the oncological surgeon and plastic surgeon is imperative. The treatment plan must take into account any potential neoadjuvant and adjuvant therapies. Surgical planning and incisional approach must be carefully considered to optimize a safe oncologic surgery and ensure a viable reconstructive outcome. Furthermore, there are fundamentals to immediate breast reconstruction that must be met to obtain an aesthetically pleasing and structurally durable breast reconstruction. The goal of this article was to highlight important considerations in surgical planning and execution of immediate breast reconstruction so that an optimal outcome can be accomplished after either autologous or implant-based breast reconstruction.
Contemporary Breast Augmentation Practice in the United States
Authors: Xue Yunfeng , Pu Lee L.Q.
Published: December 2020

Breast augmentation is one of the most commonly performed cosmetic surgical procedures in the United States. Modern breast augmentation has evolved with the development of various implant options, as well as surgical techniques. To achieve ideal result, it is important for the surgeon to develop a systematic approach to evaluate each patient. The 5 key steps in determining the best surgical plan include: (1) assess the need for concurrent mastopexy, (2) implant selection, (3) pocket plane, (4) inframammary fold position, (5) choice of incision. The purpose of this review is to discuss the principles behind each of these key concepts and how to utilize them in achieving the optimal outcome in breast augmentation.
The Superficial Inferior Epigastric Artery Based Abdominal Flap for Reconstruction of Extensive Defects of the Hand and Forearm
Authors: Chaware Suresh Mahadev , Dhopte Amol Anand
Published: December 2020

Introduction

The reconstruction of the hand and forearm targets the restoration of their function and aesthetic appearance. Inferiorly based abdominal flaps are reliable and versatile flaps that can cover large defects of the forearm and hand. Here we present a modified abdominal flap design based exclusively on the superficial inferior epigastric artery (SIEA) to reconstruct the hand and forearm's extensive defects. The donor site is closed primarily.

Methods

This is a retrospective study of the patients who underwent reconstruction of hand and forearm defects with SIEA flap from 2006 to 2018. The flap was designed on the ipsilateral hemiabdomen with a narrow pedicle based on the SIEA. We describe the anatomical basis and the outcomes of SIEA flap for reconstruction of the hand and forearm's extensive defects.

Results

Forty-eight soft tissue defects of the hand and forearm were reconstructed with the SIEA-based abdominal flap. Twenty-nine (60.41%) dorsal defects, 4 (8.33%) volar defects, 4 (8.33%) circumferential defects, 6 (12.5%) hand amputation stump, and 5 (10.41%) finger and thumb defects were covered using the SIEA flap. Forty-seven (97.91%) flaps had complete survival, whereas 1 (2.08%) flap had distal necrosis at the time of division. One (2.08%) flap had marginal necrosis, and 1 (2.08%) flap had distal necrosis after the division. The donor site was closed primarily in all patients. One (2.08%) patient had wound dehiscence at the abdominal donor site. All flaps gave excellent coverage with a satisfactory contour.

Conclusion

Abdominal flap based on SIEA is a safe, reliable, and versatile flap for the reconstruction of extensive soft-tissue defects of the hand and forearm. An ability to provide a large amount of skin and soft tissue and the abdominal donor site's primary closure make it a favorable option for upper limb reconstruction in regions with limited resources and technical expertise.
Palatal Re-Repair With Z-Plasty in Treatment of Velopharyngeal Insufficiency of Syndromic and Nonsyndromic Patients With Cleft Palate
Authors: Ahti Veera , Alaluusua Suvi , Vuola Pia , Rautio Jorma , Leikola Junnu , Saarikko Anne
Published: December 2020

Background:

Velopharyngeal insufficiency (VPI) often results from palatal shortening or insufficient levator function after cleft palate repair.

Aims:

To assess the efficacy of palatal re-repair with Z-plasty in treatment of VPI for patients with isolated cleft palate (ICP).

Methods:

This retrospective analysis comprised 130 consecutive patients who had ICP with VPI that required Z-plasty as secondary surgery between 2008 and 2017. Pre- and post-operative evaluation of velopharyngeal function was done perceptually and instrumentally by Nasometer.

Results:

Median patient age at Z-plasty was 6.8 years (range 3.0–20.1). Of the 130 patients, preoperatively VPI was severe in 73 (56%), mild-to-moderate in 55 (42%), and borderline in 2 (2%). Postoperatively, 105 (81%) of patients achieved adequate (normal or borderline) velopharyngeal competence and 16 (12%) required second operation for residual VPI. The success rate was 84% in nonsyndromic patients, 79% in nonsyndromic Pierre Robin sequence patients, and 58% in syndromic patients. In syndromic children, the speech outcome was significantly worse than in nonsyndromic children (P = 0.014). Complications included wound healing problems in 3 patients (2%), mild infection in 1 patient (1%), postoperative bleeding in 1 (1%), and postoperative fistula in 2 (2%).

Conclusion:

Palatal re-repair with Z-plasty is a safe operation for VPI correction in patients with ICP with a success rate of 81%. In syndromic patients, the procedure did not seem to work as well as in nonsyndromic patients.
Examination of the Safe Zone in Mandibular Ramus Osteotomies
Authors: Sevmez Fatma , Orhan Mustafa , Bahşi Ilhan , Yalçin Eda Didem
Published: December 2020

In the surgical procedures such as osteotomy to be applied to ramus of the mandible, care should be taken not to damage the inferior alveolar nerve (IAN). The safe zone, which is the area above and behind the mandibular foramen (MF), is the ramus of mandible area, where these surgeries can be performed without damaging the inferior alveolar neurovascular bundle. It was aimed to determine the safe zone in the ramus of mandible in the cone-beam computed tomography (CBCT) images of individuals. The CBCT images of 300 Turkish individuals between the ages of 18 to 65 were bilaterally and retrospectively evaluated. Three parameters on the sagittal and two parameters on the axial plane were measured. Additionally, two ratios were calculated which determined the superior and posterior part of the safe zone through the measured parameters. In this study, the safe zone was determined as the area where 55% of the upper part and 49% of the posterior part of the mandibular ramus. Determining the safe zone in surgical procedures to be applied to the ramus of mandible will help protect the neurovascular structures passing through the MF, reduce complications and increase the success rate of the surgical procedure. However, it is seen that there are few studies on this subject in the literature and there are some differences between these studies. The authors think that preoperative CBCT screening will be safer for each patient in the mandibular ramus osteotomies and more studies should be done on different populations to determine standard values.
Bone Marrow-Derived Mononuclear Cell Transplantation Can Reduce Systemic Inflammation and Endothelial Glycocalyx Damage in Sepsis
Authors: Matsubara Tsunehiro , Umemura Yutaka , Ogura Hiroshi , Matsuura Hiroshi , Ebihara Takeshi , Matsumoto Hisatake , Yamakawa Kazuma , Shimizu Kentarou , Okada Hideshi , Shimazu Takeshi
Published: December 2020

Bone marrow-derived mononuclear cells (BMMNCs) secrete anti-inflammatory mediators that protect against acute inflammation. Current evidence suggests that BMMNC transplantation can reduce acute tissue injury caused by systemic inflammation and lung dysfunction. This study evaluated the role of BMMNCs in reducing systemic inflammatory responses to vascular endothelial injury in sepsis. Bone marrow cells were harvested from the tibias and femurs of 12-week-old male Wistar rats; BMMNCs were separated by density centrifugation. Additional rats underwent cecal ligation and puncture (CLP) or similar sham surgery. BMMNCs were injected intravenously 30 min after CLP. The Sham and CLP Control groups were administered PBS. The 7-day survival rate improved markedly in the CLP-BMMNC group compared with that in the Control group. BMMNCs markedly suppressed the serum levels of pro-inflammatory mediators such as tumor necrosis factor-alpha, interleukin-6, and histone H3 at 3, 6, and 12 h after CLP. In the CLP-BMMNC group, the serum levels of syndecan-1, the main component of the vascular endothelial glycocalyx layer, were notably lower than those in the Control group 6 h after CLP. Histological analysis revealed improvement of morphological damages in the CLP-BMMNC group. Ultrastructural analysis revealed that the glycocalyx structure was maintained and the continuity of the vascular endothelial glycocalyx layer was preserved in the BMMNC group, compared with the case for the Control group at 6 and 12 h. Therefore, BMMNC transplantation may provide reduced systemic inflammation and endothelial glycocalyx damage, dramatically improving the survival of rats. These findings provide insights into formulating potential therapeutic strategies against sepsis.
The Nomenclature of Electroconvulsive Therapy
Authors: Sidhom Emad , Omar Mostafa Hussein
Published: December 2020

Electroconvulsive therapy (ECT) is an established but stigmatized psychiatric treatment. The term ECT reflects the treatment's modality and action. Several authors proposed different names for ECT to deal with stigma; however, available literature that promoted different names did not address the risk/benefit ratio or offer evidence-based approach to the efficacy of this approach. We aim to examine proposed names for their specificity, accuracy, understandability, and popularity. In addition, we aim to find evidence-based methods to combat the ECT-related stigma. We reviewed the literature relating to the proposed names using snowballing technique for literature search. Known ECT alternative names were used for search, and whenever another name appears, it was added to our search list. We conducted Medline, PsycINFO, Google Scholar, and PubMed search to check for popularity and cross examine whether proposed terms refer back to ECT. We searched for ECT and stigma, to find evidence for methods to tackle ECT-related stigma. Once, the search stopped yielding newer ideas, we stopped the search at a point of saturation, where no more ideas where generated. Our name search yielded 14 terms. Nine names avoided “electricity” and “convulsion,” because of perceived associated stigma. Presence of different terminology can affect the clarity of patient-doctor communication, with no evidence of added benefit. Alternative names may affect doctor-doctor communication about this treatment. We concluded that it is safer to retain the term ECT for the sake of consistency and clarity of communication. Education and experience are evidence-based effective methods of tackling ECT-related stigma.
Survival Rate Following Involuntary Electroconvulsive Therapy: A Population-Based Study
Authors: Salagre Estela , Rohde Christopher , Ishtiak-Ahmed Kazi , Gasse Christiane , Østergaard Søren D.
Published: December 2020

Objective

Involuntary electroconvulsive therapy (ECT) can be a lifesaving intervention for patients suffering from potentially lethal conditions who are unable to give informed consent. However, its use is not widespread, probably partly because of the scarce data on hard outcomes following involuntary ECT. In Denmark, involuntary ECT is only used when patients are at imminent/potential risk of dying if not receiving ECT. Here, we aimed to estimate the 1-year survival rate after the administration of involuntary ECT as a proxy for the effectiveness of this treatment.

Methods

We conducted a register-based cohort study involving (i) all patients receiving involuntary ECT in Denmark between 2008 and 2019, (ii) age- and sex-matched patients receiving voluntary ECT, and (iii) age- and sex-matched individuals from the general population. One-year survival rates were compared via mortality rate ratios.

Results

We identified 618 patients receiving involuntary ECT, 547 patients receiving voluntary ECT, and 3080 population-based controls. The survival rate in the year after involuntary ECT was 90%. For patients receiving involuntary ECT, the 1-year mortality rate ratios were 3.1 (95% confidence interval, 1.9–5.2) and 5.8 (95% confidence interval, 4.0–8.2) compared with those receiving voluntarily ECT and to the population-based controls, respectively. Risk factors for early death among patients receiving involuntary ECT were male sex, being 70 years or older and having organic mental disorder as the treatment indication.

Conclusions

Treatment with involuntary ECT is associated with a high survival rate, suggesting that the intervention is effective. However, patients receiving involuntary ECT constitute a high-risk population that should be monitored closely after this treatment.
Regionalization in elderly care: what makes up a healthcare region?
Authors: Schuurmans Jitse Jonne , van Pijkeren Nienke , Bal Roland , Wallenburg Iris
Published: December 2020

Purpose

The purpose of this paper is to explore the formation and composition of “regions” as places of care, both empirically and conceptually.

Design/methodology/approach

This paper draws on action-oriented research involving experiments aimed at designing, implementing and evaluating promising solutions to the entwined problems of a burgeoning elderly population and an increasing shortage of medical staff. It draws on ethnographic research conducted in 14 administrative areas in the Netherlands, a total of 273 in-depth interviews and over 1,000 h of observations.

Findings

This research challenges the understanding of a healthcare region as a clearly bounded topological area. It shows that organizations and professionals collaborate in a variety of different networks, some conterminous with the administrative region established by policymakers and others not. These networks are by nature unstable and dynamic. Attempts to form new regional collaborations with neighbouring organizations are complicated by existing healthcare governance and accountability structures that position organizations as competitors.

Practical implications

Policymakers should take the pre-established partnerships of healthcare organizations into account before delineating the area in which regionalization is meant to take place. A better alignment of governance and accountability structures is also needed for regionalization to occur in healthcare.

Originality/value

This paper combines insights from valuation studies with sociogeographical literature and provides a framework for understanding the assembling and disassembling of “regions”.
The factors affecting student satisfaction with online education during the COVID-19 pandemic: an empirical study of an emerging Muslim country
Authors: Basuony Mohamed A.K. , EmadEldeen Rehab , Farghaly Marwa , El-Bassiouny Noha , Mohamed Ehab K.A.
Published: December 2020

Purpose

This study aims to investigate factors affecting students’ satisfaction with online learning during the COVID-19 pandemic.

Design/methodology/approach

This study uses quantitative data. A survey of 280 respondents, representing undergraduate students in business schools in Cairo, Egypt is conducted. The survey includes both public and private universities. The participants are questioned about their opinions and attitudes toward satisfaction with online learning amidst the COVID-19 pandemic.

Findings

The findings of this study reveal that Egyptian university students prefer to use synchronous teaching methods using different platforms. Attending virtual sessions and real-time conference call classes are the most preferred mode of delivery as perceived by the respondents. Also, the results of this study found that the internet, platform, class time, loss of interest, motivation and self-motivation and use of online exams as an assessment can be considered as the factors that significantly affect students’ satisfaction with online learning in Egypt.

Originality/value

To the best of the knowledge, this study is among the first group of studies in Muslim emerging countries that explore the factors affecting students’ satisfaction with online learning during the COVID-19 pandemic.
Strong survival selection on seasonal migration versus residence induced by extreme climatic events
Authors: Acker Paul , Daunt Francis , Wanless Sarah , Burthe Sarah J. , Newell Mark A. , Harris Michael P. , Grist Hannah , Sturgeon Jenny , Swann Robert L. , Gunn Carrie , Payo‐Payo Ana , Reid Jane M.
Published: December 2020

Elucidating the full eco‐evolutionary consequences of climate change requires quantifying the impact of extreme climatic events (ECEs) on selective landscapes of key phenotypic traits that mediate responses to changing environments. Episodes of strong ECE‐induced selection could directly alter population composition, and potentially drive micro‐evolution. However, to date, few studies have quantified ECE‐induced selection on key traits, meaning that immediate and longer‐term eco‐evolutionary implications cannot yet be considered.

One widely expressed trait that allows individuals to respond to changing seasonal environments, and directly shapes spatio‐seasonal population dynamics, is seasonal migration versus residence. Many populations show considerable among‐individual phenotypic variation, resulting in ‘partial migration’. However, variation in the magnitude of direct survival selection on migration versus residence has not been rigorously quantified, and empirical evidence of whether seasonal ECEs induce, intensify, weaken or reverse such selection is lacking.

We designed full annual cycle multi‐state capture–recapture models that allow estimation of seasonal survival probabilities of migrants and residents from spatio‐temporally heterogeneous individual resightings. We fitted these models to 9 years of geographically extensive year‐round resighting data from partially migratory European shags Phalacrocorax aristotelis. We thereby quantified seasonal and annual survival selection on migration versus residence across benign and historically extreme non‐breeding season (winter) conditions, and tested whether selection differed between females and males.

We show that two of four observed ECEs, defined as severe winter storms causing overall low survival, were associated with very strong seasonal survival selection against residence. These episodes dwarfed the weak selection or neutrality evident otherwise, and hence caused selection through overall annual survival. The ECE that caused highest overall mortality and strongest selection also caused sex‐biased mortality, but there was little overall evidence of sex‐biased selection on migration versus residence.

Our results imply that seasonal ECEs and associated mortality can substantially shape the landscape of survival selection on migration versus residence. Such ECE‐induced phenotypic selection will directly alter migrant and resident frequencies, and thereby alter immediate spatio‐seasonal population dynamics. Given underlying additive genetic variation, such ECEs could potentially cause micro‐evolutionary changes in seasonal migration, and thereby cause complex eco‐evolutionary population responses to changing seasonal environments.
Effects of social structure and management on risk of disease establishment in wild pigs
Authors: Yang Anni , Schlichting Peter , Wight Bethany , Anderson Wesley M. , Chinn Sarah M. , Wilber Mark Q. , Miller Ryan S. , Beasley James C. , Boughton Raoul K. , VerCauteren Kurt C. , Wittemyer George , Pepin Kim M.
Published: December 2020

Contact heterogeneity among hosts determines invasion and spreading dynamics of infectious disease, thus its characterization is essential for identifying effective disease control strategies. Yet, little is known about the factors shaping contact networks in many wildlife species and how wildlife management actions might affect contact networks.

Wild pigs in North America are an invasive, socially structured species that pose a health concern for domestic swine given their ability to transmit numerous devastating diseases such as African swine fever (ASF). Using proximity loggers and GPS data from 48 wild pigs in Florida and South Carolina, USA, we employed a probabilistic framework to estimate weighted contact networks. We determined the effects of sex, social group and spatial distribution (monthly home‐range overlap and distance) on wild pig contact. We also estimated the impacts of management‐induced perturbations on contact and inferred their effects on ASF establishment in wild pigs with simulation.

Social group membership was the primary factor influencing contacts. Between‐group contacts depended primarily on space use characteristics, with fewer contacts among groups separated by >2 km and no contacts among groups >4 km apart within a month.

Modelling ASF dynamics on the contact network demonstrated that indirect contacts resulting from baiting (a typical method of attracting wild pigs or game species to a site to enhance recreational hunting) increased the risk of disease establishment by ~33% relative to direct contact. Low‐intensity population reduction (<5.9% of the population) had no detectable impact on contact structure but reduced predicted ASF establishment risk relative to no population reduction.

We demonstrate an approach for understanding the relative role of spatial, social and individual‐level characteristics in shaping contact networks and predicting their effects on disease establishment risk, thus providing insight for optimizing disease control in spatially and socially structured wildlife species.
Shifts in plant composition mediate grazing effects on carbon cycling in grasslands
Authors: Liang Maowei , Smith Nicholas G. , Chen Jiquan , Wu Yantao , Guo Zhiwei , Gornish Elise S. , Liang Cunzhu
Published: December 2020

Carbon cycling in grasslands can be impacted by livestock grazing, partially as an indirect result of herbivory‐induced compositional shifts in the plant community. However, the underlying mechanisms of how these shifts impact carbon cycling are not well‐documented.

We conducted a long‐term grazing experiment with four sheep stocking rates in the semi‐arid grasslands of Inner Mongolia, China, to examine grazing effects on the ratio of C3 to C4 species (C3:C4), shoot biomass, root biomass, root:shoot, soil respiration, soil C, soil N and soil C:N between 2014 and 2018. We explored the responses of these carbon metrics to C3:C4 under different grazing treatments and the mechanisms driving grazing‐induced carbon loss using structural equation models.

Livestock grazing directly shifted plant community composition (i.e. increasing C3:C4) and reduced vegetation carbon (i.e. shoot biomass), whereas grazing effects on below‐ground carbon were mediated by the interactions of the soil profile (i.e. depth dependence) and year‐to‐year variation (e.g. rainfall regulation). Grazing‐induced increases in C3:C4 suppressed soil carbon loss by inhibiting the rate of soil respiration. Furthermore, grazing intensity indirectly altered these relationships. Specifically, C3:C4 was positively related to shoot biomass and negatively associated with root:shoot, soil C and soil N, whereas these relationships were only significant in no‐grazed plots. Meanwhile, soil respiration was negatively associated with C3:C4, soil C, soil N and soil C:N, but a positive relationship with shoot biomass; these relationships were significant only in grazed plots.

Synthesis and applications. Our study highlights the importance of the functional linkages between community characteristics and ecosystem processes, that is, shifts in plant community composition play a key role in regulating grassland carbon cycling. These findings provide a useful field‐observed resource for model development and could improve the guidelines for livestock management and policies regarding climate mitigation.