bluuebunny/crossref_metadata_2025 huggingface dataset:
Children Refusing School for Tangible Rewards Outside of School
Authors: Kearney Christopher A. , Albano Anne Marie
Published: August 2018

Chapter 7 outlines treatment procedures for children who refuse school for tangible rewards outside of school. Such children may be hiding school absences, displaying verbal and physical aggression, running away, spending an excessive amount of time with friends, and/or acting disruptively to stay out of school. Additional behaviors may include a hostile attitude, refusal to talk, drug use, or excessive sleep. The major focus of treatment is relevant family members, most likely parents and the child (more likely adolescent) refusing school. The major goal is to provide family members with a better way of solving problems, reducing conflict, increasing rewards for school attendance, and decreasing rewards for school absence. Ways of improving family communication, solving problems by establishing and sticking to contracts, and dealing with peers are discussed.
Instruments for Assessing Feigned or Exaggerated Psychopathology
Authors: Rubenzer Steve
Published: August 2018

This chapter reviews the most prominent instruments for assessing malingered mental illness and its symptoms. The Structured Interview of Reported Symptoms (SIRS) has been regarded as the gold standard instrument in this area, but a recent revision, the SIRS-2, has come under considerable criticism that extends to its predecessor as well. Although the SIRS-2 may produce fewer false positives than the original SIRS, especially in intellectually disabled examinees and perhaps in examinees with dissociative identity disorder, it is less sensitive than the original SIRS and may misclassify a substantial number of of feigners as genuine. The strengths and weakness of instruments in this domain, such as the M-FAST and SIMMS, are discussed along with the costs of their use (time and money), diagnostic statistics, and recommended cutoff scores.
Special Problems and Populations in Feigned Incompetence
Authors: Rubenzer Steve
Published: August 2018

This chapter addresses assessment of feigning or exaggeration in cases involving claimed amnesia for the crime, in intellectually disabled defendants, and in adolescent examinees. Claimed amnesia for the offense is one of the most common forms of feigning in criminal defendants, and multiple tests, including the crime-specific symptom validity test, as well as self-report measures and traditional validity tests, permit assessment of claimed memory problems. Intellectually disabled defendants, whose reading or verbal ability may compromise self-report measures and even structured interviews, present multiple challenges for validity assessment. Further, many performance validity tests are vulnerable to false positives for such examinees and cannot distinguish low ability from poor effort. This chapter suggests ways in which collateral data, such as prior IQ scores, can help inform the competency judgment. Finally, adolescent defendants present difficulty because much less research has been conducted on response style in non-adults. The available data are reviewed and suggestions are offered.
A Survey of Competency to Stand Trial Examiners
Authors: Rubenzer Steve
Published: August 2018

This chapter reports the results from a nationwide survey of experienced CST examiners regarding their practices, preferences for instruments, and use of collateral data. These examiners also provided estimates of different types of invalid responding (feigned cognitive impairment, amnesia, psychopathology, ignorance of court system, physical infirmity, poor effort) seen in CST defendants. Desirable attributes of CST instruments were assessed, as was the standing of major instruments on each of these attributes. Moderators such as ABPP status, inpatient or outpatient setting, and defense versus prosecution orientation were assessed for their effects on other variables such as instrument choice, use of tests or collateral sources, and estimated rates of invalid responding.
Exploration of Functional Limitation Codes for Outpatient Physical Therapy in the Medicare Population: A Retrospective Cohort Study
Authors: Warren Meghan , Smith Heather L
Published: August 2018

Background

The Centers for Medicare & Medicaid Services (CMS) introduced functional limitation reporting (FLR) to capture patient progress in functional status in outpatient rehabilitation settings. FLR along with the severity modifier (SM) measure the effectiveness of the rehabilitation services at the physical therapist evaluation (initial examination [IE]) after 10 days of therapy and at discharge.

Objective

The objective of this study was to explore the completeness of FLR codes and describe changes in SMs at scheduled checkpoints for patients receiving outpatient physical therapy.

Design

The design was a retrospective cohort descriptive study.

Methods

A 5% random sample of 2014 Part B fee-for-service Medicare claims for outpatient physical therapy was used. FLR codes with SMs were analyzed at required periods. The number of claims with FLR codes and SMs was calculated to describe the completeness for each period. Planned changes in SMs at the physical therapist IE (current status and projected goal status) and differences in SMs from the physical therapist IE (current status) to discharge (discharge status) were calculated.

Results

For 114,588 beneficiaries, 166,572 physical therapist IE and 130,117 discharge claims were analyzed. Completion was greater than 90% for current status and projected goal status FLR codes at the physical therapist IE but was markedly lower for interim and discharge reporting (≤ 50% for all). More than 75% of claims had planned improvements in SMs at the physical therapist IE (projected goal status − current status), with variations by specific FLR codes. For the episodes with FLR codes at the physical therapist IE and discharge, improvements were reported in more than 2 of 3 episodes.

Limitations

Limitations for these analyses include a missing discharge claim on many outpatient physical therapy episodes and potential coding errors with Medicare claims.

Conclusions

Except for the physical therapist IE, FLR codes were not submitted consistent with regulations. Most physical therapy episodes showed improvements in FLR SMs from the physical therapist IE and discharge, although the low completion rate limited interpretation. Changes to the FLR program are warranted to understand whether changes in SMs correspond to changes in a patient's function.
Health Workers' Knowledge and Perceptions on Dementia in Skilled Nursing Homes: A Pilot Implementation of Teepa Snow's Positive Approach to Care Certification Course
Authors: Ehlman Mary C. , Nimkar Swateja , Nolan Beth A. D. , Thomas Pamela , Caballero Carlos E. , Snow Teepa
Published: August 2018

Introduction:

A knowledge gap on caring for people with dementia exists among health workers employed in skilled nursing facilities. This article reports on knowledge gained and perceptions changed among 24 skilled nursing facility health workers who completed Teepa Snow's innovative Positive Approach to Care Certification course as a regional initiative.

Methods:

This pilot study used a quasi-experiment with a one-group pretest-posttest design to assess the dementia knowledge and perceptions of health workers who participated in the course. Paired responses (n = 22) for the 54-item dementia knowledge and training/coaching perceptions survey were compared using the McNemar test, Paired t test, and Wilcoxon signed-rank test to analyze the improvement in knowledge and perceptions of dementia.

Results:

Significant knowledge gain was found among health workers after completing the program (t(21) = −7.46, P < .001). Statistical differences (P < .05) were present in eight knowledge items (ie, working memory, mental health, temporal lobe, “sapphire”, “space and awareness”, personal space, binocular vision, and hippocampus) and four perception areas (ie, approaching, understanding, calming, and instructing) about dementia. Significant changes were also found in four areas of health workers' perceptions about dementia (P < .05).

Discussion:

The certification course can improve knowledge and facilitate perceptual change on dementia. Implementing this program as a novel regional initiative has robust potential in ensuring continuing workforce development in health care settings challenged with ever-changing people living with dementia needs and high staff turnover.
Validation of Multisource Feedback in Assessing Medical Performance: A Systematic Review
Authors: Stevens Sebastian , Read James , Baines Rebecca , Chatterjee Arunangsu , Archer Julian
Published: August 2018

Introduction:

Over the past 10 years, a number of systematic reviews have evaluated the validity of multisource feedback (MSF) to assess and quality-assure medical practice. The purpose of this study is to synthesize the results from existing reviews to provide a holistic overview of the validity evidence.

Methods:

This review identified eight systematic reviews evaluating the validity of MSF published between January 2006 and October 2016. Using a standardized data extraction form, two independent reviewers extracted study characteristics. A framework of validation developed by the American Psychological Association was used to appraise the validity evidence within each systematic review.

Results:

In terms of validity evidence, each of the eight reviews demonstrated evidence across at least one domain of the American Psychological Association's validity framework. Evidence of assessment validity within the domains of “internal structure” and “relationship to other variables” has been well established. However, the domains of content validity (ie, ensuring that MSF tools measure what they are intended to measure); consequential validity (ie, evidence of the intended or unintended consequences MSF assessments may have on participants or wider society), and response process validity (ie, the process of standardization and quality control in the delivery and completion of assessments) remain limited.

Discussion:

Evidence for the validity of MSF has, across a number of domains, been well established. However, the size and quality of the existing evidence remains variable. To determine the extent to which MSF is considered a valid instrument to assess medical performance, future research is required to determine the following: (1) how best to design and deliver MSF assessments that address the identified limitations of existing tools and (2) how to ensure that involvement within MSF supports positive changes in practice. Such research is integral if MSF is to continue to inform medical performance and subsequent improvements in the quality and safety of patient care.
Validation of a Nomogram for Achieving Target Trough Concentration of Vancomycin: Accuracy in Patients With Augmented Renal Function
Authors: Ishii Hidetoshi , Hirai Keita , Sugiyama Kyohei , Nakatani Eiji , Kimura Midori , Itoh Kunihiko
Published: August 2018

Background:

Adjustment of initial vancomycin (VCM) dosage has been recommended on the basis of the renal function nomogram in therapeutic drug monitoring guidelines in Japan. However, this nomogram has not been clinically validated, and few studies have focused on its usefulness in patients with risk of augmented renal function. Therefore, this study aimed to evaluate the validity of the VCM nomogram and the association between patient conditions related to augmented renal function and its accuracy.

Methods:

In this retrospective study, we screened data of 398 patients who received VCM and had estimated glomerular filtration rates ≥30 mL·min−1·1.73 m−2. Patients who met nomogram dosing criteria were categorized into a nomogram group, and the associations of age, renal function, and individual conditions such as febrile neutropenia, solid tumor, blood cancer, and brain injury with subtherapeutic concentrations (<10.0 mcg/mL) of VCM were evaluated.

Results:

In total, 177 patients were categorized into the nomogram group, and 83 (47%), 81 (46%), and 13 patients (7%) had VCM trough concentrations of 10–20, <10, and >20 mcg/mL, respectively. Age <50 years was only significantly associated with subtherapeutic trough concentrations. Specific conditions of patients such as febrile neutropenia, solid tumor, and blood cancer were associated with elevated VCM clearance; however, there was no decline in trough VCM concentrations regardless of the presence of the specific conditions.

Conclusions:

The Japanese VCM dosing nomogram was effective in minimizing the number of instances of supratherapeutic VCM serum concentrations; however, it lacked accuracy in achieving target trough concentrations. The accuracy of the nomogram could be enhanced by categorizing patients according to age. Nevertheless, this study provides novel evidence of the usefulness of this nomogram in avoiding subtherapeutic concentrations of VCM in patients with risk factors for augmented renal clearance.
Addressing the Fentanyl Analogue Epidemic by Multiplex UHPLC-MS/MS Analysis of Whole Blood
Authors: Bergh Marianne Skov-Skov , Bogen Inger Lise , Wilson Steven Ray , Øiestad Åse Marit Leere
Published: August 2018

Background:

Fentanyl and fentanyl analogues (fentanyls) are very potent opioids posing a serious threat to the public health. Thousands of overdose deaths across the world are caused by fentanyls, and the numbers are increasing. Rapid mapping of current trends in opioid abuse is necessary to accelerate preventive measures. To ensure this, there is a need for sensitive targeted multiplex MS/MS methods to pinpoint drugs of abuse. We present a fully validated UHPLC-MS/MS method for the determination of 26 fentanyls, including several structural isomers, and the opioid antagonist naloxone in human whole blood.

Methods:

Blood samples were prepared by liquid–liquid extraction with ethyl acetate and heptane. The fentanyls were separated with UHPLC, using a Kinetex biphenyl column (2.1 × 100 mm, 1.7 µm; Phenomenex, Verløse, Denmark) with an acidic mobile phase. Quantification was performed by MS/MS. The method was validated according to SWGTOX guidelines.

Results:

The developed method could successfully separate all 27 analytes, including 7 isomers, and was validated according to SWGTOX guidelines with very low limits of quantification (4–20 pg/mL). The applicability of the method was demonstrated by determination of fentanyls in postmortem blood samples from 2 cases.

Conclusions:

A selective, highly sensitive, and robust method for determination of a large panel of fentanyls and naloxone in blood was developed and validated. Naloxone was included to monitor use and efficacy of the opioid antidote in cases of fentanyl overdoses. The method demonstrated good ability to separate structural isomers, which is important to differentiate between the numerous available fentanyls with variable potency, toxicity, and legal status. The developed method can be used to identify fentanyls on the drug market to help combat the fentanyl crisis.
The Nutritional and Social Contexts of Celiac Disease in Women: A Qualitative Study
Authors: RODRGUEZ-ALMAGRO Julián , RODRGUEZ-ALMAGRO David , SOLANO-RUIZ MCarmen , SILES-GONZLEZ José , HERNNDEZ-MARTINEZ Antonio
Published: August 2018

Background:

Previous studies have confirmed that women who are diagnosed with celiac disease report a lower quality of life than men who are diagnosed with the same illness.

Purpose:

This article describes the life experiences of women with celiac disease, especially those who adhere to a lifelong gluten-free diet.

Methods:

A phenomenological design based on the Giorgi method was used. Twenty-two women who were diagnosed with celiac disease and were between 16 and 75 years old completed the semistructured interviews.

Results:

The results showed that celiac disease has differing effects on the lives of women sufferers. The general feeling of being a woman with celiac disease was described as an effort toward achieving a normalized life. Four categories emerged from the results: feelings at diagnosis, limitations in daily life, social perceptions of the illness, and personal meanings of celiac disease.

Conclusions/Implications for Practice:

This study shows that celiac disease and its treatment reduce mental and social quality of life in women. Organizations and public institutions should carry out public awareness campaigns targeting celiac disease and promote quality of life in sufferers of celiac disease in general.
Anticoagulation Reversal and Risk of Thromboembolic Events Among Heart Transplant Recipients Bridged with Durable Mechanical Circulatory Support Devices
Authors: Moretz Jeremy , Lindenfeld Joann , Shah Ashish , Wigger Mark , Schlendorf Kelly , Keebler Mary , Danter Matthew , Brown Sacks Suzanne , Ooi Henry , Brinkley Marshall , Hanna Peter , Zalawadiya Sandip
Published: August 2018

Anticoagulation reversal agents (ARAs) can minimize bleeding complications associated with mechanical circulatory support devices (MCSDs) explantation at the time of heart transplantation (HT); data on thromboembolic (TE) risk associated with ARAs are limited in this patient population. In this single-center study, we retrospectively analyzed 118 consecutive adults who were supported with durable MCSDs and underwent HT between May 2013 and October 2016. Patients were categorized based on intraoperative use of ARAs (recombinant factor VIIa [n=23], 4-factor prothrombin complex concentrate [n=48], or factor IX complex [n=2]) at the time of HT; these agents were used at discretion of implanting surgeons for bleeding control. The primary outcome of interest was presence of venous or systemic TE events within 3 months of HT. Multivariable logistic regression analyses were used to assess association between TE events and use of ARAs. A total of 71 (60%) patients received ARAs, and a total of 32 patients (27.1%) had TE events (25 venous [median time to diagnosis: 11.5 days; interquartile range {IQR}: 9–31 days], and 10 systemic [median time to diagnosis: 5.5 days; IQR: 4–8 days]); 26 (81.2%) of those with TE events had ARAs used at the time of HT. Multivariable analysis identified use of ARAs as an independent predictor of TE events (multivariable odds ratio: 3.06; 95% CI: 1.09–8.58; p = 0.034). Unplanned intraoperative use of ARAs to control bleeding was associated with a significantly higher risk of TE events among HT recipients bridged with durable MCSD. Future studies are required to further assess safety of these agents and their impact on patient outcomes.
Differences in risk factor–colorectal adenoma associations according to non-steroidal anti-inflammatory drug use
Authors: Mujtaba Sobia , Bostick Roberd M.
Published: August 2018

Objective

Because multiple observational studies and large, randomized controlled trials indicate that NSAIDs strongly reduce the risk of colorectal neoplasms, we investigated whether NSAID use masks associations of various other risk factors with colorectal neoplasms.

Materials and methods

Using pooled data from three case–control studies of incident, sporadic colorectal adenoma (pooled n=789 cases, 2035 polyp-free controls), using multivariable logistic regression, we investigated various risk factor–colorectal adenoma associations stratified by NSAID use.

Results

Example multivariable-adjusted odds ratios [95% confidence intervals (CI)] for those in the highest relative to the lowest quartiles of exposure, by regular nonaspirin NSAID nonuse/use, respectively, were 1.57 (95% CI: 0.96–2.55) versus 1.14 (95% CI: 0.37, 3.49) for total fat, 1.37 (95% CI: 0.86–2.18) versus 0.70 (95% CI: 0.23–2.25) for saturated fat, 0.93 (95% CI: 0.68–1.28) versus 1.30 (95% CI: 0.61–2.75) for calcium, 0.89 (95% CI: 0.64–1.23) versus 1.38 (95% CI: 0.65–2.94) for total fruits and vegetables, and 0.85 (95% CI: 0.65–1.11) versus 0.94 (95% CI: 0.52–1.71) for physical activity. For current versus never smokers, the odds ratios (95% CIs) among regular non-NSAID users/nonusers were 2.91 (95% CI: 2.22–3.82) versus 1.75 (95% CI: 0.90–3.41), respectively, and for those who were obese versus those who were normal weight, they were 1.67 (95% CI: 1.28–2.17) versus 1.19 (95% CI: 0.69–2.04), respectively.

Conclusion

Our findings suggest that regular nonaspirin NSAID use may mask, beyond simple confounding, associations of major risk factors with colorectal adenoma, and support routinely assessing such associations stratified by regular nonaspirin NSAID use.
Salter-Harris Fractures of the Distal Phalanx: Treatment Algorithm and Surgical Outcomes
Authors: Gibreel Waleed , Charafeddine Ali , Carlsen Brian T. , Moran Steven L. , Bakri Karim
Published: August 2018

Background:

Salter-Harris fractures of the distal phalanx with or without clinical evidence of nail-bed laceration are frequently undertreated.

Methods:

A retrospective review was performed of all patients with distal phalanx Salter-Harris fractures treated between 2004 and 2016.

Results:

Seventy patients were treated for 72 Salter-Harris fractures at a mean ± SD age of 11.3 ± 3.7 years. Median follow-up was 6 weeks (interquartile range, 4 to 12.6 years). The thumb was most commonly involved (n = 21), followed by long (n = 18), ring (n =17), small (n = 9), and index (n = 7) fingers. Sport-related injuries accounted for 39 fractures (54 percent). Forty-two fractures (58 percent) had at least one clinical finding suggestive of nail-bed laceration (subungual hematoma, subluxation of the proximal nail plate, skin laceration proximal to the eponychial fold, bleeding from underneath the nail plate, eponychial fold laceration, and nail plate avulsion). Among 42 fractures with at least one feature of nail-bed laceration, surgical exploration was undertaken in 38 fractures. At exploration, a nail-bed laceration was found in 31 fractures (82 percent) and soft-tissue interposition was found in 18 (47 percent). Fractures with clinical features of nail-bed laceration (n = 42) were treated with open reduction and splinting (n = 25), open reduction and percutaneous pinning (n = 13), or splinting (n = 4). Excellent results were obtained, with few unfavorable outcomes. Infectious complications occurred in six patients.

Conclusion:

The high rate of nail-bed laceration and soft-tissue interposition in Salter-Harris fractures with clinical features of nail-bed laceration mandates surgical exploration.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Donor-Site Morbidity of Vascularized Bone Flaps from the Distal Femur: A Systematic Review
Authors: Giladi Aviram M. , Rinkinen Jacob R. , Higgins James P. , Iorio Matthew L.
Published: August 2018

Background:

Vascularized grafts from the femur, including the medial femoral condyle and medial femoral trochlea, are increasingly being used. It is critical to understand the lower extremity complications from flap harvest.

Methods:

The authors searched available literature reporting on femoral flaps using PubMed, Embase, Cochrane Database, and Web of Science. After article selection, data were collected regarding demographics, procedure details, outcomes, and complications. The authors classified outcomes as good, fair, or poor based on pain, range-of-motion, sensory changes, subjective reporting, patient-reported outcomes, and other donor-site complications, including the need for additional procedures.

Results:

Two hundred twenty articles were identified. Forty-five met criteria for review, with data available for 283 patients. No patients had range-of-motion deficits beyond 1 year. Two percent of patients (six of 283) required additional donor-site procedures, with one report of a femur fracture after medial femoral condyle harvest. Only one study on 45 medial femoral trochlea patients presented patient-reported outcomes regarding the knee. Few objective data were presented. Twenty-eight articles presented adequate complication data for 252 patients to be rated as good, fair, or poor. Overall, 89 percent had good outcomes without donor-site complications. Of the 176 medial femoral condyle patients with outcomes reported, 92 percent had good outcomes; and 71 percent of the 48 medial femoral trochlea patients had good outcomes reported.

Conclusions:

Overall, the reported donor-site morbidity from medial femoral condyle and medial femoral trochlea harvest is low. Chronic knee pain and sensory changes are most frequently reported, especially in medial femoral trochlea patients.
Outcomes of Endoscopic Powered Revision Dacryocystorhinostomy
Authors: Dalgic Abdullah , Ceylan Mehmet Emrah , Çelik Çağri , Aliyeva Aynur , Aksoy Gökçe Yildirim , Edizer Deniz Tuna
Published: August 2018

Objective of this study is to determine the etiology of patients applied with revision endoscopic dacryocystorhinostomy (DCR) and to evaluate the operation results.

The patients were retrospectively evaluated in respect of demographic data, the time from primary to revision surgery, revision etiology, the use of bicanalicular silicone nasolacrimal tube (BNLT), the time to postoperative removal of the silicone tube, and the success of the revision surgery.

The study included 27 patients applied with revision endoscopic DCR between January 2013 and January 2016. The mean age of the patients was 46.7 ± 11.7 years. The mean time from the first operation to revision surgery was 7.2 ± 6.1 months (range, 1–24 months). During the endoscopic DCR, synechia was observed in 2 (7.4%), granulation tissue in 7 (25.9%), inadequate bone window in 5 (18.52%), and membranous scar around the ostium in 22 (81.4%) patients. More than 1 etiologic problem was determined in 8 patients. During the revision procedure, BNLT was applied to 12 (44.4%) patients. At the final follow-up examination, the complaint of epiphora had completely recovered in 18 (66.6%) patients and there were in 9 (33.3%) patients. The mean time to removal of the BNLT was 1.7 ± 0.57 months (range, 1–3 months).

The most common cause of recurrent epiphora in endoscopic DCR was the formation of membranous scar. The use of the mucosal flap technique in primary surgery and the application of BNLT to all patients in revision surgery may increase the functional success rate.
Chitosan as a Bone Scaffold Biomaterial
Authors: Kozusko Steven D. , Riccio Charles , Goulart Micheline , Bumgardner Joel , Jing Xi Lin , Konofaos Petros
Published: August 2018

The current standard of care for bone reconstruction, whether secondary to injury, nonunion, cancer resection, or idiopathic bone loss, is autologous bone grafting. Alternatives to autograft and allograft bone substitutes currently being researched are synthetic and natural graft materials that are able to guide bone regeneration. One promising material currently being researched is chitosan, a highly versatile, naturally occurring polysaccharide, derived from the exoskeleton of arthropods that is comprised of glucosamine andN-acetylglucosamine. Research on chitosan as a bone scaffold has been promising. Chitosan is efficacious in bone regeneration due to its lack of immunogenicity, its biodegradability, and its physiologic features. Chitosan combined with growth factors and/or other scaffold materials has proven to be an effective alternative to autologous bone grafts. Additionally, current studies have shown that it can provide the additional benefit of a local drug delivery system. As research in the area of bone scaffolding continues to grow, further clinical research on chitosan in conjunction with growth factors, proteins, and alloplastic materials will likely be at the forefront.
Quantitative and Neurovascular Anatomy of the Growing Gracilis Muscle in the Human Fetuses
Authors: Beger Burhan , Beger Orhan , Koç Turan , Dinç Uğur , Hamzaoğlu Vural , Kayan Gülden , Uzmansel Deniz , Olgunus Zeliha Kurtoğlu
Published: August 2018

This study is intended to obtain the algebraic growth dynamics of the gracilis in fetuses and determine the variations of neurovascular pedicle(s) of the gracilis, to aid infant surgeries. Forty fetuses (19 males and 21 females) were included in the study. Gestational mean age of the fetuses was 22.40 ± 2.67 (range, 18–28) weeks. Numerical values were obtained using a digital caliper and a digital image analysis software. Linear functions for the surface area, width, anterior, and posterior margin lengths of the gracilis were calculated, respectively, as: y = −289.307 + 20.501 × age (weeks), y = −7.113 + 0.622 × age (weeks), y = −24.421 + 3.434 × age (weeks), and y = −24.397 + 3.314 × age (weeks). In addition, length and width of the gracilis tendon were calculated as y = −6.676 + 0.934 × age (weeks) and y = −0.732 + 0.074 × age (weeks), respectively. Parameters of the gracilis had no statistically significant difference regarding side and sex (P > 0.05). In all the specimens, the gracilis was innervated by the anterior branch of the obturator nerve. Blood supply of the gracilis was identified to be derived from 1 single artery in 38 sides of total 80 (47.5%), from 2 arteries in 36 (45%) and from 3 arteries in 6 (7.5%). In 74 sides (92.5%), the nerve was superficial to the main artery, whereas in 6 sides (7.5%), it was deeper. The data of the present study could be beneficial for surgeons in infant surgeries to treat conditions such as obstetrical brachial plexus paralysis, facial palsy, or anal incontinence. Linear functions can be utilized to better evaluate the growth course of the gracilis in fetuses and to predict the dimensions thereof. Additionally, comprehending the structure and recognizing the variations of the gracilis nerves and arteries can help to protect the neurovascular pedicle(s) of the gracilis during the operations.
A Penetrating Facial Wound With Burn Injury
Authors: Duan Ran , Shi Jun , Tremp Mathias , Oranges Carlo M. , Gao Bowen , Xie Feng , Li Qingfeng
Published: August 2018

A patient presented with a complex penetrating facial wound by high temperature steel. The hot steel penetrated right temple, ethmoid bone, and maxillary sinus, and then exited from his left cheek. He kept his right eye but lost his sight. For functional and esthetic considerations, treatments were provided in a staged procedure. First, the debridement was performed under the endoscope. The dead bone was removed, broken teeth were extracted, and necrotic tissue was cleaned. The exposed wounds were cleaned, and dressing was changed daily until the exudation was widely reduced. Then, a 50-mL expander was placed in the left cheek, and an 80-mL expander was put in the scalp just before the defect in the temple area. Five months later, expander inflation was accomplished. Expanders were taken out and expanded flaps were transposed to cover the defect. At the same time, an anterolateral thigh flap was harvested to repair the inner lining of the cheek and the gingiva. Thereafter, several operations were performed to revise the wound scar and the remaining deformity. Both defects in the temple and left cheek were restored with a satisfactory functional and aesthetic outcome. The temporal area was repaired with haired expanded scalp, whereas the face was repaired with an expanded facial flap with similar texture and color. The oral commissure regained balance and integrity. The defect of the gingiva was repaired. A severe penetrating wound in the cranium and face can be nicely repaired using tissue expander and microvascular reconstruction.
Acceleration of Fracture Healing in Experimental Model: Platelet-Rich Fibrin or Hyaluronic Acid?
Authors: Akyildiz Servet , Soluk-Tekkesin Merva , Keskin-Yalcin Basak , Unsal Gurkan , Ozel Yildiz Sevda , Ozcan Ilknur , Cakarer Sirmahan
Published: August 2018

In this study, we compared the bone-healing effects of the local application of platelet-rich fibrin (PRF) and hyaluronic acid (HA) to bilateral tibial fractures in rats. Twenty-three adult male Sprague-Dawley rats were used. Twenty-two animals were randomly allocated to a control group (n = 6) and 2 study groups: PRF (n = 8) and HA (n = 8). The 23rd rat was used as a donor to obtain PRF. Each group was divided into 2 subgroups for histomorphometric and radiologic assessments at 2 and 6 weeks. Foreign body reaction, necrosis, inflammation, new bone formation, and fibrosis were investigated as bone healing parameters in terms of histopathologic analysis. The difference between the groups for these parameters was evaluated. The radiologic evaluation was performed by comparing the 3-dimensional reconstruction images of the fracture sites between the study and control groups. Histomorphometric evaluation showed that at 2 weeks postoperatively, the control group showed lesser bone formation (26.1 ± 6.6%) when compared to the study (HA: 54.7 ± 9.7%; PRF: 75.3 ± 19.2%) groups and PRF group showed highest total ossification. At 6 weeks postoperatively the PRF group showed lesser total ossification (50.7 ± 28.2%) when compared to control (76.3 ± 21.7%) and HA group. The HA (88.8 ± 13.3%) showed highest total ossification. In the control group, fibrosis was more prominent at week 6, whereas in the HA and PRF groups the amount of ossification increased. In contrast to histopathologic healing, radiologic bone healing did not differ significantly among the study and control groups 2 weeks after surgery, whereas at 6 weeks, the results of radiologic bone formation were in accordance with those of histopathologic bone healing.
Transnasal Endoscopic Removal of a Knife Causing Penetrating Brain Injury in a Child
Authors: Yücel Abitter , Yücel Hilal , Güllüev Mustafa , Alataş Necat
Published: August 2018

Transnasal penetrating brain injuries are rare and a medical emergency, which needs to be treated promptly. A 4-year-old male patient was brought to our emergency room with a knife sticking out of his nose. The patient was immediately taken to the operating room and the knife was removed under general anesthesia. No cerebrospinal fluid leakage or any bleeding was seen and so the operation was terminated. The authors herein report a penetrating brain trauma through to the cella turcica with a knife that improved without any sequelae at a child.
Recipient Age and Mortality After Liver Transplantation: A Population-based Cohort Study
Authors: Gil Eunmi , Kim Jong Man , Jeon Kyeongman , Park Hyejeong , Kang Danbee , Cho Juhee , Suh Gee Young , Park Jinkyeong
Published: August 2018

Background

The feasibility of liver transplantation (LT) in elderly recipients remains a topic of debate.

Methods

This cohort study evaluated the impact of recipient's age on LT outcome between January 2007 and May 2016 covered by the Korean National Health Insurance system (n = 9415). Multilevel regression models were used to determine the impact of recipient's age on in-hospital and long-term mortality after LT.

Results

All patients had a first LT, with 2473 transplanted with liver from deceased donors (DD) and 6942 from living donors. The mean age was 52.2 ± 9.0 years. Most LT were performed on patients in their 50s (n = 4290, 45.6%) and 0.9% (n = 84) of the LT was performed on patients older 70 years. The overall in-hospital mortality was 6.3%, and the 3-year mortality was 11.3%. The in-hospital mortality included, 13.5% associated with DDLT and 3.7% involved living donor LT. When compared with that for patients aged 51 to 55 years, the risk of death among recipients older than 70 years was about fourfold higher after adjusting for baseline liver disease (odds ratio, 4.1; 95% confidence interval, 2.21-7.58), and was nearly threefold higher after adjusting for baseline liver disease and perioperative complications (odds ratio, 2.92; 95% confidence interval, 1.37-6.24). Also, the cost of LT increased significantly with age.

Conclusions

The data show that age remains an important risk factor for LT, suggesting that LT should be considered with caution in elderly recipients.
Indication of spatially random infection of chlamydia-like organisms in Bufo bufo tadpoles from ponds located in the Geneva metropolitan area
Authors: Vajana Elia , Widmer Ivo , Rochat Estelle , Duruz Solange , Selmoni Oliver , Vuilleumier Séverine , Aeby Sébastien , Greub Gilbert , Joost Stéphane
Published: August 2018

Occurrence of bacteria belonging to the order Chlamydiales was investigated for the first time in common toad (Bufo bufo) tadpole populations collected from 41 ponds in the Geneva metropolitan area, Switzerland. A Chlamydiales-specific Real-Time PCR was used to detect and amplify the Chlamydiales 16S rRNA-encoding gene from the tails of 375 tadpoles. We found the studied amphibian populations to be infected by “Chlamydia-like organisms” (CLOs) attributable to the genera Similichlamydia, Neochlamydia, Protochlamydia and Parachlamydia (belonging to the family Parachlamydiaceae), Simkania (family Simkaniaceae) and Estrella (family Criblamydiaceae); additionally, DNA from the genus Thermoanaerobacter (family Thermoanaerobacteriaceae) was detected. A global autocorrelation analysis did not reveal a spatial structure in the observed CLOs infection rates, and association tests involving land cover characteristics did not evidence any clear effect on CLOs infection rates in B. bufo. Despite preliminary, these results suggest a random and ubiquitous distribution of CLOs in the environment, which would support the biogeographical expectation “everything is everywhere” for the concerned microorganisms and their amoeba vectors.
Trisomy 21 activates the kynurenine pathway via increased dosage of interferon receptors
Authors: Powers Rani K. , Sullivan Kelly D. , Culp-Hill Rachel , Ludwig Michael P. , Smith Keith P. , Waugh Katherine A. , Minter Ross , Tuttle Kathryn D. , Lewis Hannah C. , Rachubinski Angela L. , Granrath Ross E. , Wilkerson Rebecca B. , Kahn Darcy E. , Joshi Molishree , D’Alessandro Angelo , Costello James C. , Espinosa Joaquin M.
Published: August 2018

Trisomy 21 (T21) causes Down syndrome (DS), affecting immune and neurological function by unknown mechanisms. We report here the results of a large metabolomics study showing that people with DS produce elevated levels of kynurenine and quinolinic acid, two tryptophan catabolites with potent immunosuppressive and neurotoxic properties, respectively. We found that immune cells of people with DS overexpress IDO1, the rate-limiting enzyme in the kynurenine pathway (KP) and a known interferon (IFN)-stimulated gene. Furthermore, we found a positive correlation between levels of specific inflammatory cytokines and KP dysregulation. Using metabolic flux assays, we found that IFN stimulation causes IDO1 overexpression and kynurenine overproduction in cells with T21, dependent on overexpression of IFN receptors encoded on chromosome 21. Finally, KP dysregulation is conserved in a mouse model of DS carrying triplication of the IFN receptors. Altogether, these results reveal a mechanism by which T21 could drive immunosuppression and neurotoxicity in DS.
Optimization of swelling response of pH sensitive hydrogels using Box-Behnken design
Authors: Shokri Fereshteh , Ebrahimi Pouneh , Honary Soheyla
Published: August 2018

Hydrogels are three-dimensional crosslinked hydrophilic polymer networks capable of swelling or de-swelling reversibly in water and retaining a large volume of liquid in swollen state. Hydrogels can be designed with controllable responses to shrink or expand with changes in external environmental conditions. Among stimulisensitive hydrogels, the pH-sensitive ones are widely-studied and used. Despite these advances, we currently lack a systematic way to optimize the synthesis protocols. Here we propose to use techniques from chemometrics, namely Box–Behnken statistical screening design to optimize the chemical composition of pH-responsive hydrogels for an improved responsiveness as quantified by swelling index. Polymer blends were prepared by mixing different suitable volume of pvp (poly vinyl pyrrolidone) and chitosan aqueous solution in order to obtain a mixture, glutardialdehyde solution was added as crosslinkers to the chitosan/pvp mixture to form semi-IPN(semi-interpenetrating polymeric hydrogel). The pH-dependent swelling properties have been measured and used to obtain a regression model. We characterized the descriptive and predictive abilities of our model. We found a remarkable correlation (correlation coefficient = 0.954) between the observed responses and the responses predicted by the model. Our results demonstrate that Box-Behnken is an appropriate statistical design that can be successfully used in the development of pH-sensitive hydrogels with a predictable swelling ratio. This technology will remarkably reduce the time and cost that is needed for chemical synthesis of hydrogels with a desired pH-sensitivity.
Differential gene expression indicates involvement of F-box proteins and E3 ligases in sexualversusapomictic germline specification inBoechera
Authors: Zuehl Luise , Ibberson David , Schmidt Anja
Published: August 2018

Germline specification is the first step during sexual and apomictic plant reproduction. This takes place in a specialized domain of the reproductive flower tissues, the nucellus of the ovule. In each case, a sporophytic cell is determined to initiate germline development. These cells, the megaspore mother cell (MMC) or apomictic initial cell (AIC) in sexual plants and apomicts, respectively, differ in their developmental fate. While the MMC undergoes meiosis, the AIC aborts or omits meiosis to form the female gametophyte. Although these distinct developmental processes have long been described, little is known about the gene regulatory basis involved.

To elucidate gene regulatory networks underlying sexual and apomictic germline specification, we conducted tissue-specific transcriptional profiling using laser-assisted microdissection and RNA-Seq. We compared the transcriptomes of the nucellar tissues harbouring the MMC or AIC between different accessions ofBoechera. The six accessions we used represented four species and two ploidy levels, allowing us to distinguish between differences in gene expression caused by the genetic background or the reproductive mode.

Comparative data analysis revealed widely overlapping gene expression patterns in apomicticversussexualBoecheraaccessions. Nevertheless, 45 significantly differentially expressed genes were identified, which potentially play a role for determination of sexualversusapomictic reproductive mode. Interestingly, based on annotations, these include F-box proteins and E3 ligases that might relate to genes previously described as regulators important for sexual or apomictic reproduction. Thus, our findings provide new insight into the transcriptional basis of sexual and apomictic germline specification.

One sentence summary

A comprehensive tissue type-specific transcriptional analysis using laser-assisted microdissection combined with RNA-Seq identifies 45 genes consistently differentially expressed during germline specification in different sexualversusapomicticBoecheraaccessions, indicating roles of protein degradation related to cell cycle, transcriptional and post-transcriptional regulatory processes, and stress response for apomixis.
Does the strength of women’s attraction to male vocal masculinity track changes in steroid hormones?
Authors: Jones Benedict C , Hahn Amanda C , Pisanski Katarzyna , Wang Hongyi , Kandrik Michal , Lee Anthony J , Holzleitner Iris J , Feinberg David R , DeBruine Lisa M
Published: August 2018

Recent studies that either used luteinizing hormone tests to confirm the timing of ovulation or measured steroid hormones from saliva have found little evidence that women’s preferences for facial or body masculinity track within-subject changes in women’s fertility or hormonal status. Fewer studies using these methods have examined women’s preferences for vocal masculinity, however, and those that did report mixed results. Consequently, we used a longitudinal design and measured steroid hormones from saliva to test for evidence of hormonal regulation of women’s (N=351) preferences for two aspects of male vocal masculinity (low pitch and low formants). Analyses suggested that preferences for masculine pitch, but not masculine formants, may track within-woman changes in estradiol. Although these results present some evidence for the hypothesis that within-subject hormones regulate women’s attraction to masculine men, we do not discount the possibility that the effect of estradiol on pitch preferences in the current study is a false positive.
Signature patterns for top-down and bottom-up information processing via cross-frequency coupling in macaque auditory cortex
Authors: Márton Christian D. , Fukushima Makoto , Camalier Corrie R. , Schultz Simon R. , Averbeck Bruno B.
Published: August 2018

Predictive coding is a theoretical framework that provides a functional interpretation of top-down and bottom up interactions in sensory processing. The theory has suggested that specific frequency bands relay bottom-up and top-down information (e.g. “γup,βdown”). But it remains unclear whether this notion generalizes to cross-frequency interactions. Furthermore, most of the evidence so far comes from visual pathways. Here we examined cross-frequency coupling across four sectors of the auditory hierarchy in the macaque. We computed two measures of cross-frequency coupling, phase-amplitude coupling (PAC) and amplitude-amplitude coupling (AAC). Our findings revealed distinct patterns for bottom-up and top-down information processing amongcross-frequency interactions. Both top-down and bottom-up made prominent use of low frequencies: low-to-low frequency (θ, α, β) and low frequency-to-high γcouplings were predominanttop-down, while low frequency-to-low γcouplings were predominantbottom-up. These patterns were largely preserved across coupling types (PAC and AAC) and across stimulus types (natural and synthetic auditory stimuli), suggesting they are a general feature of information processing in auditory cortex. Moreover, our findings showed that low-frequency PAC alternated between predominantly top-down or bottom-up over time. Altogether, this suggests sensory information need not be propagated along separate frequencies upwards and downwards. Rather, information can be unmixed by having low frequencies couple to distinct frequency ranges in the target region, and by alternating top-down and bottom-up processing over time.

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Significance

The brain consists of highly interconnected cortical areas, yet the patterns in directional cortical communication are not fully understood, in particular with regards to interactions between different signal components across frequencies. We employed a a unified, computationally advantageous Granger-causal framework to examine bi-directional cross-frequency interactions across four sectors of the auditory cortical hierarchy in macaques. Our findings extend the view of cross-frequency interactions in auditory cortex, suggesting they also play a prominent role in top-down processing. Our findings also suggest information need not be propagated along separate channels up and down the cortical hierarchy, with important implications for theories of information processing in the brain such as predictive coding.