bluuebunny/crossref_metadata_2025 huggingface dataset:
Conceptualizations of writing in early years curricula and standards documents: international perspectives
Authors: Stagg Peterson Shelley , Parr Judy , Lindgren Eva , Kaufman Douglas
Published: October 2018

In this article, researchers in the field of early writing identify underlying beliefs and values about writing and learning to write for the beginning years of formal schooling in four jurisdictions: the American state of Connecticut, New Zealand, the Canadian province of Ontario, and Sweden, as reflected in the respective curricula and standards documents that guide instruction. Using Ivanič’s Discourses of Writing and Learning to Write to guide our text analysis, we found that curriculum developers have primarily been influenced by views of writing as a set of skills, processes, and genres. We found few references to the sociopolitical discourse which indicates a view among curriculum developers that sociopolitical literacy is not suitable for this age group. We argue, with support in previous research, that young children's writing does not have to be politically neutral and that it can be developed under age‐appropriate circumstances. Implications for policy and curriculum development include a need for greater consideration of the complexities of writing shown in research conducted across five decades. We propose a change to the model for early years, recognising that young children's socio‐political understandings lie within their home and school lives, rather than the broader community.
Aretaic pedagogy: how we can transform the aesthetics of good teaching
Authors: Hadjipanteli Angela
Published: October 2018

The article aims to introduce the epistemology of aretaic pedagogy as a refreshing paradigm of good teaching, situating at its centrality, instead of a knowledge‐based perspective, a virtue‐based approach to education. Its origins are in Aristotelian virtue ethics, which premise the acquisition of intellectual and ethical virtues as the highest good of the good life. Aretaic pedagogy is therefore constructed on the basis of the theory of virtue development and deliberates teaching as an ethical, virtue‐driven practice. Its epistemological framework depends largely on three components: the notion of teaching as a practice, the embodiment of internal goods in teaching/learning and the harnessing of students’ private knowledge. Dialogue, beauty and play are proposed as the main internal goods within the students’ learning, which can act as key sources of their practice of virtues. As concerns a teacher's pedagogical presence, it is argued from a dual professional prospect: the technological and the ethical. Therefore, a teacher is called to exercise a nexus of epistemic, technical, poetic and ethical virtues.
Climate, air quality, and health benefits of a carbon fee-and-rebate bill in Massachusetts, USA
Authors: Buonocore Jonathan J , Levy Jonathan I , Guinto Renzo R , Bernstein Aaron S
Published: October 2018

State and regional climate policies in the United States are becoming more prevalent. Quantifying these policies’ health co-benefits provides a local and near-term rationale for actions that also mitigate global climate change and its accompanying harms. Here, we assess the health benefits of a carbon fee-and-rebate policy directed at fuel use in transport, residential and commercial buildings and industry in Massachusetts. We find that the air pollution reductions from this policy would save 340 lives (95% CI: 82–590), 64% of which would occur in Massachusetts, and reduce carbon emissions by 33 million metric tons, with 2017 as an implementation year, through 2040. When monetized, the benefits to health may be larger than the benefits from climate mitigation, but are sensitive to valuation methods, discount rates, and the leakage rate of natural gas, among other factors. These benefits derive largely from lower transportation emissions, including volatile organic compounds from gasoline combustion. Reductions in oil and coal use have relatively large benefits, despite their limited use in Massachusetts. This study finds substantial health benefits of a proposed statewide carbon policy in Massachusetts that carries near-term and direct benefit to residents of the commonwealth and demonstrates the importance of co-benefits modeling.
MetWork: a web server for natural products anticipation
Authors: Beauxis Yann , Genta-Jouve Grégory
Published: October 2018

Motivation

The annotation of natural products and more generally small molecules is one of the major drawbacks in untargeted mass spectrometry analysis. Molecular networking has emerged as a structured way to organize and mine data from untargeted tandem mass spectrometry (MS/MS) experiments. Despite the great potential of this tool, the annotation is usually performed manually by the expert as only few spectral libraries are available.

Results

Herein we propose a web server of in silico metabolization of metabolites that represents a full implementation of the metabolome consistency concept. The workflow is based on MS/MS data, organized in molecular network using the Global Natural Products Social Molecular Networking (GNPS) platform, a collaborative library of reactions and a MS/MS spectra prediction module. Having one node identified in the molecular network, the server generates putative structures and predict the associated MS/MS spectra when the exact mass is detected in the network. A similarity comparison between the MS/MS spectra is then performed in order to annotate the node.

Availability and implementation

The web server is available at: https://metwork.pharmacie.parisdescartes.fr.
XY oocytes of sex-reversed females with a Sry mutation deviate from the normal developmental process beyond the mitotic stage†
Authors: Sakashita Akihiko , Wakai Takuya , Kawabata Yukiko , Nishimura Chiaki , Sotomaru Yusuke , Alavattam Kris G , Namekawa Satoshi H , Kono Tomohiro
Published: October 2018

The fertility of sex-reversed XY female mice is severely impaired by a massive loss of oocytes and failure of meiotic progression. This phenomenon remains an outstanding mystery. We sought to determine the molecular etiology of XY oocyte dysfunction by generating sex-reversed females that bear genetic ablation of Sry, a vital sex determination gene, on an inbred C57BL/6 background. These mutant mice, termed XYsry− mutants, showed severe attrition of germ cells during fetal development, resulting in the depletion of ovarian germ cells prior to sexual maturation. Comprehensive transcriptome analyses of primordial germ cells (PGCs) and postnatal oocytes demonstrated that XYsry− females had deviated significantly from normal developmental processes during the stages of mitotic proliferation. The impaired proliferation of XYsry− PGCs was associated with aberrant β-catenin signaling and the excessive expression of transposable elements. Upon entry to the meiotic stage, XYsry− oocytes demonstrated extensive defects, including the impairment of crossover formation, the failure of primordial follicle maintenance, and no capacity for embryo development. Together, these results suggest potential molecular causes for germ cell disruption in sex-reversed female mice, thereby providing insights into disorders of sex differentiation in humans, such as “Swyer syndrome,” in which patients with an XY karyotype present as typical females and are infertile.
Yap is required for scar formation but not myocyte proliferation during heart regeneration in zebrafish
Authors: Flinn Michael A , Jeffery Brooke E , O’Meara Caitlin C , Link Brian A
Published: October 2018

Aims

The Hippo signalling pathway regulates multiple cellular processes during organ development and maintenance by modulating activity of the transcriptional cofactor Yap. Core components of this pathway are required for neonatal mouse heart regeneration, however, investigations to date have typically focused on expression and activity in cardiomyocytes. Due to the regenerative capacity of zebrafish and the fact that global loss of Yap is not fully embryonic lethal in zebrafish, we leveraged a yap null mutant to investigate the impact of constitutive Yap deletion during zebrafish heart regeneration.

Methods and results

Following cryoinjury in adult hearts, myocyte proliferation was not decreased in yap mutants, contrary to expectations based on mouse data. Experiments in larval zebrafish (Danio rerio) revealed that deletion of either Yap or Taz had a modest effect on heart growth, reducing gross organ size, while their combined deletion was synergistic; thus, Yap and Taz share some overlapping roles in zebrafish heart development. Surprisingly, adult yap mutants exhibited decreased collagen composition at 7 days post-injury, suggesting a critical role for Yap in scar formation during heart regeneration. siRNA-mediated Yap knockdown in primary rat (Rattus norvegicus) cardiac cells revealed a fibroblast-specific role for Yap in controlling the expression of cytoskeletal and myofibroblast activation genes, as well as pro-inflammatory cyto/chemokines. Corroborating these RNAseq data, we observed increased macrophage infiltration in the scars of yap mutants at 7 days post-injury.

Conclusion

These results suggest that Yap deletion has minimal effect on myocyte proliferation in adults, but significantly influences scar formation and immune cell infiltration during zebrafish heart regeneration. Collectively, these data suggest an unexpected role for Yap in matrix formation and macrophage recruitment during heart regeneration.
Meaningful Change Estimates for the Late-Life Function and Disability Instrument in Older Adults
Authors: Beauchamp Marla K , Ward Rachel E , Jette Alan M , Bean Jonathan F
Published: October 2018

Background

The Late-Life Function and Disability Instrument (LLFDI) is a well-validated and frequently used patient-reported outcome for older adults. The aim of this study was to estimate the minimal clinically important difference (MCID) of the LLFDI-Function Component (LLFDI-FC) and its subscales among community-dwelling older adults with mobility limitations.

Methods

We performed a secondary analysis of the Boston Rehabilitative Impairment Study of the Elderly, a longitudinal cohort study of older adults with mobility limitations residing in the community. The MCID for each LLFDI-FC scale over 1 year of follow-up was estimated using both anchor- and distribution-based methods, including mean change scores on a patient-reported global rating of change in function scale, the standard error of measurement (SEM), and the minimal detectable change with 90% confidence (MDC90).

Results

Data from 320 older adults were used in the analysis (mean age 76 years, 69% female, mean of four chronic conditions). Meaningful change estimates for “small change” based on the global rating of change and SEM were 2, 3, 4, and 4 points for the LLFDI-FC overall function scale and basic lower-extremity, advanced lower-extremity, and upper-extremity subscales, respectively. Estimates for “substantial change” based on the global rating of change and minimal detectable change with 90% confidence were 5, 6, 9, and 10 points for the overall function scale and basic lower-extremity, advanced lower-extremity, and upper-extremity subscales, respectively.

Conclusion

This study provides the first MCID estimates for the LLFDI-FC, a widely used patient-reported measure of function. These values can be used to interpret the outcomes of longitudinal investigations of functional status in similar populations of community-dwelling older adults.
Cost-Effectiveness of Chimeric Antigen Receptor T-Cell Therapy in Pediatric Relapsed/Refractory B-Cell Acute Lymphoblastic Leukemia
Authors: Sarkar Reith R , Gloude Nicholas J , Schiff Deborah , Murphy James D
Published: October 2018

Background

Chimeric antigen receptor T-cell (CAR-T) therapy is a promising new class of cancer therapy but has a high up-front cost. We evaluated the cost-effectiveness of CAR-T therapy among pediatric patients with relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL).

Methods

We built a microsimulation model for pediatric patients with relapsed/refractory B-ALL receiving either CAR-T therapy or standard of care. Outcomes included costs, quality of life (health utility), complications, and survival. We measured cost-effectiveness with the incremental cost-effectiveness ratio (ICER), with ICERs under $100 000 per quality-adjusted life-year (QALY) considered cost effective. One-way and probabilistic sensitivity analyses were used to test model uncertainty.

Results

Compared to standard of care, CAR-T therapy increased overall cost by $528 200 and improved effectiveness by 8.18 QALYs, resulting in an ICER of $64 600/QALY. The model was sensitive to assumptions about long-term CAR-T survival, the complete remission rate of CAR-T patients, and the health utility of long-term survivors. The base model assumed a 76.0% one-year survival with CAR-T, although if this decreased to 57.8%, then CAR-T was no longer cost effective. If the complete remission rate of CAR-T recipients decreased from 81% to 56.2%, or if the health utility of disease-free survivors decreased from 0.94 to 0.66, then CAR-T was no longer cost effective. Probabilistic sensitivity analysis found that CAR-T was cost effective in 94.8% of iterations at a willingness to pay of $100 000/QALY.

Conclusion

CAR-T therapy may represent a cost-effective option for pediatric relapsed/refractory B-ALL, although longer follow-up of CAR-T survivors is required to confirm validity of these findings.
Systemic Antimicrobial Prophylaxis and Antimicrobial-Coated External Ventricular Drain Catheters for Preventing Ventriculostomy-Related Infections: A Meta-Analysis of 5242 Cases
Authors: Sheppard John P , Ong Vera , Lagman Carlito , Udawatta Methma , Duong Courtney , Nguyen Thien , Prashant Giyarpuram N , Plurad David S , Kim Dennis Y , Yang Isaac
Published: October 2018

BACKGROUND

External ventricular drain (EVD) placement is essential for the management of many neurocritical care patients. However, ventriculostomy-related infection (VRI) is a serious complication, and there remains no well-established protocol guiding use of perioperative or extended antibiotic prophylaxis to minimize risk of VRI.

OBJECTIVE

To analyze published evidence on the efficacy of extended prophylactic antimicrobial therapy and antibiotic-coated external ventricular drains (ac-EVDs) in reducing VRI incidence.

METHODS

We searched PubMed for studies related to VRIs and antimicrobial prophylaxis. Eligible articles reported VRI incidence in control and treatment cohorts evaluating prophylaxis with either extended systemic antibiotics (> 24 hr) or ac-EVD. Risk ratios and VRI incidence were aggregated by prophylactic strategy, and pooled estimates were determined via random or mixed effects models. Study heterogeneity was quantified usingI2and Cochran's Q statistics. Rigorous assessment of study bias was performed, and PRISMA guidelines were followed throughout.

RESULTS

Across 604 articles, 19 studies (3%) met eligibility criteria, reporting 5242 ventriculostomy outcomes. Extended IV and ac-EVD prophylaxis were associated with risk ratios of 0.36 [0.14, 0.93] and 0.39 [0.21, 0.73], respectively. Mixed effects analysis yielded expected VRI incidence of 13% to 38% with no prophylaxis, 7% to 18% with perioperative IV prophylaxis, 3% to 9% with either extended IV or ac-EVD prophylaxis as monotherapies, and as low as 0.8% to 2% with extended IV and ac-EVD dual prophylaxis.

CONCLUSION

Management with both extended systemic antibiotics and ac-EVDs could lower VRI risk in ventriculostomy patients, but the impact on associated morbidity and mortality, healthcare costs, and length of stay remain unclear.
Socioeconomic status and change in sports activity among middle-aged and older men and women: evidence from the German Ageing Survey
Authors: Lehne Gesa , Bolte Gabriele
Published: October 2018

Background

Sports activity (SA) behavior is unequally distributed across socioeconomic status (SES) groups. However, little is known about the impact of SES on change in SA over time.

Methods

Based on data from the German Ageing Survey, we examined the role of objective (education, occupational prestige, household equivalent income, composite SES-index) and subjective (self-rated standard of living) SES indicators on negative and positive changes in SA during a follow-up of 6 years among adults aged 40+ years using logistic regression analysis.

Results

Among active individuals at baseline, 32.1% of males and 24.8% of females experienced a negative change in SA. Among inactive individuals, 25.8 and 29.9% experienced a positive change. In the multivariate analysis, males and females with low SES were about twice as likely to experience a negative change and half as likely to experience a positive change. These patterns were observed regardless which SES indicator was examined.

Conclusions

This study provides comprehensive evidence for socioeconomic inequalities in negative and positive changes in SA behavior among middle-aged and older adults in Germany. To reduce socioeconomic inequalities, future SA interventions should address the mechanisms leading to differential probabilities of change in SA behavior by SES.
IMPROVEMENT OF DOSE ESTIMATION PROCESS USING ARTIFICIAL NEURAL NETWORKS
Authors: Amit Gal , Datz Hanan
Published: October 2018

We present here for the first time a fast and reliable automatic algorithm based on artificial neural networks for the anomaly detection of a thermoluminescence dosemeter (TLD) glow curves (GCs), and compare its performance with formerly developed support vector machine method. The GC shape of TLD depends on numerous physical parameters, which may significantly affect it. When integrated into a dosimetry laboratory, this automatic algorithm can classify ‘anomalous’ (having any kind of anomaly) GCs for manual review, and ‘regular’ (acceptable) GCs for automatic analysis. The new algorithm performance is then compared with two kinds of formerly developed support vector machine classifiers—regular and weighted ones—using three different metrics. Results show an impressive accuracy rate of 97% for TLD GCs that are correctly classified to either of the classes.
Patient perceptions and willingness to stop smoking prior to foot and ankle surgery
Authors: Baker Adam , Dean Erin Prewitt , Ishikawa Susan N. , Murphy G. Andrew , Grear Benjamin J. , Richardson David R.
Published: October 2018

Background:

Much attention has been focused on the effects of cigarette smoking on surgical outcomes and bone healing. There has been a recent push to educate patients on the negative effects of smoking on orthopaedic injuries and surgery and to provide support to patients during the smoking cessation process. The goal of this study was to determine whether patients are aware of the orthopaedic effects of smoking and to determine their level of interest in a supervised smoking cessation program.

Methods:

A five-question survey was given to patients who were admitted smokers, along with a short explanation of the deleterious effects of smoking on bones, soft tissue, and wound healing. In addition to questions on how long and how much patients smoked, the survey included questions assessing the patient’s knowledge of the deleterious effects of smoking and their willingness to stop smoking.

Results:

Two hundred thirty-seven patients completed the survey. Of these patients, 104 (44%) indicated that they were unaware of the effects that smoking had on bone and wound healing. Eighty-two percent (195/237) indicated that with this knowledge they would be interested in a smoking cessation program, with 188 (96%) indicating they would stop smoking if their surgery were delayed until they did. Eighteen percent (42/237) were not interested in a smoking cessation program.

Conclusions:

This study indicates that a short discussion of smoking cessation after injury or before elective foot and ankle surgery and referral to a smoking cessation program could positively affect outcomes in smokers undergoing foot and ankle procedures.
Impact of ICARE Training Speed and Motor Assistance on Cardiovascular Response
Authors: Burnfield Judith M. , Pfeifer Chase M. , Kwapiszeski Sarah J. , Irons Sonya L. , Buster Thad W. , Cesar Guilherme M.
Published: October 2018

Purpose:

A motor-assisted elliptical, ICARE, is used to address walking and fitness goals; yet, only limited data guide understanding of the impact of ICARE training parameters (e.g., speed and motor assistance) on cardiovascular response. A repeated-measures design investigated the influence of 5 predetermined ICARE speeds (25, 35, 45, 55, and 65 revolutions per minute) and 2 motor-assistance levels (with and without assistance) on heart rate (HR), Borg ratings of perceived exertion (RPE), and blood pressure (BP).

Methods:

Ten healthy participants' HR, RPE, and BP were recorded during steady state Active Assist (ICARE's motor assisting leg movement) and Active Assist Plus exercise (without motor's assistance) at 5 speeds.

Results:

Significant main effects on HR were documented for ICARE speed (F[4,36] = 77.313, P < .001) and motor assistance (F[1,36] = 224.813, P < .001), and an interaction (F[4,36] = 4.410, P = .005). Significant main effects on RPE were documented for speed (F[4,36] = 47.106, P < .001) and motor assistance (F[1,36] = 24.929, P < .001). Significant main effects on systolic BP were documented for speed (F[4,36] = 78.849, P < .001) and motor assistance (F[1,36] = 6.911, P = .027), and an interaction (F[4,36] = 5.695, P = .001). Only the main effect of motor assistance on diastolic BP was significant (F[1,36] = 7.917, P = .020).

Conclusions:

Increases in ICARE speed and decreases in motor assistance contributed to clinically relevant increases in HR, RPE, and systolic BP in a cohort of young, nondisabled adults.
MiR-486-5p Downregulation Marks an Early Event in Colorectal Carcinogenesis
Authors: Kelley Katherine A. , Wieghard Nicole , Chin Yuki , Potter Amiee , Mori Motomi , Wong Melissa H. , Chin Koei , Tsikitis V. Liana
Published: October 2018

BACKGROUND:

MicroRNAs are dysregulated in colorectal cancer and subsets correlated with advanced tumor stage and metastasis. Data are lacking on microRNA dysregulation from early to late-stage disease.

OBJECTIVE:

The purpose of this study was to identify a microRNA signature associated with the primary tumor and metastatic site in stage IV disease and to examine whether the signature is evident in earlier stages.

DESIGN:

A microRNA profile was generated and then explored in normal colon tissue (n = 5), early stage (stage I and II; n = 10), and late-stage (stage III and IV; n = 14) colorectal primary tumors via polymerase chain reaction to delineate molecular events that may promote colorectal carcinogenesis.

SETTING:

Genome-wide microRNA expression profiling was performed.

PATIENTS:

A total of 14 patient-matched stage IV primary colorectal cancer tumors and corresponding liver metastases were included.

MAIN OUTCOME MEASURES:

MicroRNA array technology was used to identify microRNA expression–predictive metastatic potential in the primary tumor.

RESULTS:

A distinct 9-member signature group of microRNAs was concurrent in stage IV primary colorectal cancer and their corresponding liver metastases, when compared with surrounding unaffected colon and liver tissue (microRNA-18b, microRNA-93, microRNA-182, microRNA-183, microRNA21, microRNA-486-5p, microRNA-500a, microRNA-552, and microRNA-941). Of the microRNA panel, only microRNA486-5p was differentially expressed in early stage colorectal cancer samples compared with normal tissue (p = 0.001) and additionally differentially expressed between late-stage colorectal cancer samples and normal tissue (p < 0.01).

LIMITATIONS:

Our microRNA profile was generated in a small subset of patients and will require validation in more samples.

CONCLUSIONS:

We identified a distinct microRNA signature in primary colon and matched metastatic disease. On additional investigation, 1 microRNA was differentially expressed in both early and late-stage cancer patient samples, and it may herald an early event in colorectal carcinogenesis. This study warrants additional investigation with a larger patient cohort to better understand the effect of microRNAs in carcinogenesis. See Video Abstract at http://links.lww.com/DCR/A723.
Different Risk Factors for Early and Late Colorectal Anastomotic Leakage in a Nationwide Audit
Authors: Sparreboom Cloë L. , van Groningen Julia T. , Lingsma Hester F. , Wouters Michel W.J.M. , Menon Anand G. , Kleinrensink Gert-Jan , Jeekel Johannes , Lange Johan F.
Published: October 2018

BACKGROUND:

Anastomotic leakage remains a major complication after surgery for colorectal carcinoma, but its origin is still unknown. Our hypothesis was that early anastomotic leakage is mostly related to technical failure of the anastomosis, and that late anastomotic leakage is mostly related to healing deficiencies.

OBJECTIVE:

The aim of this study was to assess differences in risk factors for early and late anastomotic leakage.

DESIGN:

This was a retrospective cohort study.

Settings:

The Dutch ColoRectal Audit is a nationwide project that collects information on all Dutch patients undergoing surgery for colorectal cancer.

PATIENTS:

All patients undergoing surgical resection for colorectal cancer in the Netherlands between 2011 and 2015 were included.

MAIN OUTCOME MEASURES:

Late anastomotic leakage was defined as anastomotic leakage leading to reintervention later than 6 days postoperatively.

RESULTS:

In total, 36,929 patients were included; early anastomotic leakage occurred in 863 (2.3%) patients, and late anastomotic leakage occurred in 674 (1.8%) patients. From a multivariable multinomial logistic regression model, independent predictors of early anastomotic leakage relative to no anastomotic leakage and late anastomotic leakage relative to no anastomotic leakage included male sex (OR, 1.8; p < 0.001 and OR, 1.2; p = 0.013) and rectal cancer (OR, 2.1; p < 0.001 and OR, 1.6; p = 0.046). Additional independent predictors of early anastomotic leakage relative to no anastomotic leakage included BMI (OR, 1.1; p = 0.001), laparoscopy (OR, 1.2; p = 0.019), emergency surgery (OR, 1.8; p < 0.001), and no diverting ileostomy (OR, 0.3; p < 0.001). Independent predictors of late anastomotic leakage relative to no anastomotic leakage were Charlson Comorbidity Index of ≥II (OR, 1.3; p = 0.003), ASA score III to V (OR, 1.2; p = 0.030), preoperative tumor complications (OR, 1.1; p = 0.048), extensive additional resection because of tumor growth (OR, 1.7; p = 0.003), and preoperative radiation (OR, 2.0; p = 0.010).

LIMITATIONS:

This was an observational cohort study.

CONCLUSIONS:

Most risk factors for early anastomotic leakage were surgery-related factors, representing surgical difficulty, which might lead to technical failure of the anastomosis. Most risk factors for late anastomotic leakage were patient-related factors, representing the frailty of patients and tissues, which might imply healing deficiencies. See Video Abstract at http://links.lww.com/DCR/A730.
Pregnancy outcome in mothers over the age of 35
Authors: Heazell Alexander E.P. , Newman Lydia , Lean Samantha C. , Jones Rebecca L.
Published: October 2018

Purpose of review

The proportion of pregnancies occurring in women of at least 35 years of age has increased from 6.2% in 1980 to 22.3% of births in 2016. This review summarizes recent epidemiological and basic scientific studies investigating the association between older maternal age and adverse pregnancy outcome(s), and clinical studies which investigate the effects of intervention to reduce adverse events.

Recent findings

Women of at least 35 years of age have increased risk of maternal and foetal complications in pregnancy including: stillbirth, a small for gestational age baby, preterm birth, preeclampsia and maternal death. These risks increase with increasing age. The reasons for this increased risk are incompletely understood, but likely involve ageing of the maternal cardiovascular and endocrine systems which impacts upon placental function. Intervention, by induction of labour (IOL) at 39-week gestation does not increase operative deliveries or short-term adverse maternal and neonatal outcomes and would reduce perinatal mortality.

The additional risks of pregnancy should be discussed with women of at least 35 years of age; additional foetal surveillance may be required in the antenatal period. The benefits and risks of IOL at 39-week gestation should be discussed with women at least 35 years of age.
Rationalizing the Vascular Anatomy for Oblique Osteotomy of the Metatarsal Head during Toe/Joint Transfers of the Metatarsophalangeal Joint
Authors: Lin Yu-Te , Chen Shih-Heng , Loh Charles Yuen Yung , Hsu Chung-Cheng , Lin Cheng-Hung
Published: October 2018

Background:

The metatarsophalangeal joint (MTPJ) of the lessor toe has been used to reconstruct the metacarpophalangeal joint. When an oblique osteotomy of the metatarsal head is performed, the orientation of the vascular pedicle is crucial to preserve the blood supply to the MTPJ. This study was conducted to identify the path of the nutrient artery to the MTPJ.

Methods:

We reviewed our operative records in consecutive series of 45 patients during toe or joint harvest. Retrograde dissection of the vascular pedicle was performed starting from the distal communicating artery at the first webspace toward the first dorsal metatarsal and first plantar metatarsal arteries. All the vessels related to the MTPJ were explored and ligated if the MTPJ was not included in the flap.

Results:

The condylar branches to the proximal phalanx and the metaphyseal branches to the second metatarsus were barely identifiable during the dissections. The articular branch running perpendicularly from the plantar artery toward the plantar surface of MTPJ was verified in all cases. The articular branches originated either from the first plantar metatarsal artery (92.1%) or from the tibial plantar digital artery (7.9%). The external diameter of the articular branches was around 0.5–1 mm. When the articular branch was included and preserved, the metatarsal heads oozed immediately after the flap was reperfused.

Conclusions:

The study demonstrated the constant and sizable articular branch of the MTPJ that originates from the plantar artery system. The consistency of the vascular anatomy enables oblique osteotomies of the metatarsal head to be performed without fear of injury to the pedicle.
What Influences a Plastic Surgery Resident to Pursue an Academic Career?
Authors: Mandel Benjamin A. , Weber Sharon M. , Gutowski Karol A. , Salyapongse A. Neil , Bentz Michael L.
Published: October 2018

Background:

A previous study demonstrated that independent model plastic surgery residents are less likely to pursue a career in academic surgery than those graduating from other surgical fellowships. This study was designed to evaluate whether a significant curriculum change emphasizing academic plastic surgery skills would be significant in influencing a plastic surgery resident’s decision to pursue a career in academic plastic surgery.

Methods:

A survey was sent to 30 consecutive graduates of a university plastic surgery residency program. This program had transitioned from a clinically focused independent residency-training model to an integrated model with a new and structured academic emphasis. Respondents who graduated after this transition (“ACADEMIC” n = 19) were compared with those who graduated before (“CLINICAL” n = 9). Results were analyzed using Fisher’s exact test and Wilcoxon rank sum test.

Results:

There were a total of 28 respondents (response rate = 93%). A higher percentage of the ACADEMIC group, in contrast to the CLINICAL group reported that they spent time during residency performing clinical research (84% versus 33%, P = 0.013), and that they are currently conducting clinical research in their practices (79% versus 0%, P < 0.001). These graduates were also more likely to have engaged their mentor both regarding professional issues (61% versus 0%, P = 0.016), and as a role model when choosing a career plan (72% versus 17%, P = 0.050). Finally, a higher percentage of the ACADEMIC exposed group entered an academic practice after training (44% versus 0%, P = 0.026).

Conclusion:

In a single plastic surgery residency program, the transition to strong academic mentorship with a structured academic educational program focus correlated with an increase in academic careers among program graduates. A proactive academically oriented educational and mentoring environment may help attract residents to careers in academic surgery.
Successful Use of Negative-pressure Wound Therapy and Dermal Substitute in the Treatment of Gluteal Ecthyma Gangrenosum in a 2-year-old Girl
Authors: Persano Giorgio , Pinzauti Enrico , Pancani Simone , Incerti Filippo
Published: October 2018

Ecthyma Gangrenosum is a manifestation of Pseudomonas Aeruginosa infection, usually occurring in immunocompromised patients, which can be associated with Pseudomonas Aeruginosa bacteremia with potentially lethal outcome. The clinical appearance is of an inflammatory cutaneous lesion with a central necrotic spot; the lesion then rapidly progresses to a gangrenous ulcer with a gray-black eschar extending in the deep soft tissues. Treatment of Ecthyma Gangrenosum includes both aggressive systemic antibiotic therapy and surgical procedures. A 2-year-old girl affected by B-cell precursor acute lymphoblastic leukemia was admitted to our hospital for suspected sepsis; the diagnosis was later confirmed by blood cultures positive for Pseudomonas Aeruginosa. In the days following the diagnosis, the patient developed a necrotic lesion of the right gluteal area consistent with Ecthyma Gangrenosum. Aggressive surgical debridement was then performed, followed by negative-pressure wound therapy and reconstruction with dermal substitute and autologous skin graft, which were successful. Ecthyma Gangrenosum is a potentially lethal condition affecting especially immunocompromised patients; aggressive medical treatment with combination antibiotic therapy is warranted and multiple surgical procedures, including extensive surgical debridement and diverting colostomy, are needed. Various reconstructive techniques have been reported in the literature, although no gold-standard can be established to date. Since Ecthyma Gangrenosum lesions are characterized by the presence of both high inflammatory activity due Pseudomonas infection and extensive tissue loss, the association of negative-pressure therapy and dermal substitutes implant seem to have a rationale in the surgical treatment of Ecthyma Gangrenosum and should therefore be considered.
An update on membranes and cartridges for extracorporeal blood purification in sepsis and septic shock
Authors: Honoré Patrick M. , De Bels David , Spapen Herbert D.
Published: October 2018

Purpose of review

This review aims to summarize the most recent advances on different membranes and cartridges used for extracorporeal blood purification in critically ill patients with sepsis or septic shock.

Recent findings

Despite positive signals from experimental, cases and small clinical studies, blood purification showed no distinct morbidity and mortality benefit in large clinical trials.

None of the discussed specific membranes or cartridges can currently be recommended as sole adjunctive treatment in sepsis and septic shock. Any available technique should be timely initiated and adapted to the patient's status. Sickest patients seem to benefit more from blood purification. Patient selection is thus of crucial importance and may be optimized by focusing on disease severity and degree of organ failure. Measurement of endotoxin activity and plasma procalcitonin levels can support the selection process but ideal cutoff values need to be defined. Well-designed prospective randomized clinical trials assessing or comparing the various available membranes and cartridges are eagerly awaited.
Oxygen therapy in acute resuscitation
Authors: Frei Daniel R. , Young Paul J.
Published: October 2018

Purpose of review

Avoidance and treatment of hypoxaemia is a cornerstone of acute resuscitation and yet the optimal approach to oxygen therapy in the acute care setting is uncertain. The aim of this review is to appraise recent evidence relating to the provision of supplemental oxygen to adult patients with acute illnesses with a focus on the resuscitation phase.

Recent findings

Recent findings generally support the notion that exposure to hyperoxaemia is associated with adverse outcomes in acutely ill adults with a range of diseases and raise the possibility that liberal provision of oxygen may cause harm. Several ongoing multicentre randomized trials aim to assess the effects of different oxygen therapy regimens on patient outcomes to provide a foundation for evidence-based recommendations regarding the use of supplemental oxygen in Intensive Care Unit patients.

At present, evidence is lacking to support routine liberal oxygen administration in acutely ill patients and, in most circumstances, a reasonable approach is to titrate supplemental oxygen to achieve an arterial oxygen saturation measured by pulse oximetry (SpO2) of 92–96% with the aim of avoiding both hypoxaemia and hyperoxaemia.
Corticosteroids administration to improve outcome in high-risk surgical patients
Authors: Asehnoune Karim , Vourc’h Mickael , Roquilly Antoine
Published: October 2018

Purpose of review

Postoperative complications are major healthcare problems and are associated with a reduced short-term and long-term survival. Major surgery is associated with a predictable and usually transient systemic inflammatory response (SIRS), depending on the magnitude of the surgical trauma. An excessive SIRS syndrome participates to the development of postoperative organ dysfunction, infection and mortality. Corticosteroids may decrease the postsurgical SIRS. This review aims to discuss recent findings on the use of corticosteroids in major surgery.

Recent findings

In acute medicine, several lines of evidence have shown that moderate doses of corticosteroids decrease the excessive inflammatory response, without inducing immunosuppression. Evidences from several meta-analyses suggest that intraoperative administration of corticosteroids during major surgery decreases postoperative infectious complications, without significant risk of anastomotic leakage, or bleeding complications.

At present, no large randomized controlled trial has been performed in patients undergoing major noncardiac surgery. However, despite the widespread use of corticosteroids to improve analgesia and reduce postoperative nausea or vomiting, concerns continue to be raised about their safety. At present, the safety profile for using short course of moderate dose of corticosteroids is good, but glycaemic control and natremia should be carefully monitored during the postoperative period.
Enhanced triage for patients with suspected cardiac chest pain: the History and Electrocardiogram-only Manchester Acute Coronary Syndromes decision aid
Authors: Alghamdi Abdulrhman , Howard Laura , Reynard Charles , Moss Philip , Jarman Heather , Mackway-Jones Kevin , Carley Simon , Body Richard
Published: October 2018

Objectives

Several decision aids can ‘rule in’ and ‘rule out’ acute coronary syndromes (ACS) in the Emergency Department (ED) but all require measurement of blood biomarkers. A decision aid that does not require biomarker measurement could enhance risk stratification at triage and could be used in the prehospital environment. We aimed to derive and validate the History and ECG-only Manchester ACS (HE-MACS) decision aid using only the history, physical examination and ECG.

Methods

We undertook secondary analyses in three prospective diagnostic accuracy studies that included patients presenting to the ED with suspected cardiac chest pain. Clinicians recorded clinical features at the time of arrival using a bespoke form. Patients underwent serial troponin sampling and 30-day follow-up for the primary outcome of ACS. The model was derived by logistic regression in one cohort and validated in two similar prospective studies.

Results

The HE-MACS model was derived in 796 patients and validated in cohorts of 474 and 659 patients. HE-MACS incorporated age, sex, systolic blood pressure plus five historical variables to stratify patients into four risk groups. On validation, 5.5 and 12.1% (pooled total 9.4%) patients were identified as ‘very low risk’ (potential immediate rule out) with a pooled sensitivity of 99.5% (95% confidence interval: 97.1–100.0%).

Conclusion

Using only the patient’s history and ECG, HE-MACS could ‘rule out’ ACS in 9.4% of patients while effectively risk stratifying remaining patients. This is a very promising tool for triage in both the prehospital environment and ED. Its impact should be prospectively evaluated in those settings.
Cervical osteophytosis and spine posture: contribution to swallow disorders and symptoms
Authors: Abdel-Aziz Mosaad , Azab Noha , El-Badrawy Amr
Published: October 2018

Purpose of review

The article reviews the effects of cervical osteophytosis and spine posture on swallowing, and how they can cause dysphagia.

Recent findings

Cerivical osteophytosis which is a bony overgrowth of the cervical spines, it affects the swallowing through different mechanisms, including direct mechanical compression of the pharynx and esophagus, disturbances of normal epiglottic tilt over the inlet of the larynx by the osteophytes at C3–C4 level, inflammatory reactions in the tissues around the esophagus and cricopharyngeal spasm. Also, cervical spine posture in normal individuals could affect the swallowing mechanism by disturbance of the sphincteric action of the larynx and upper esophageal sphincter.

Cervical osteophytosis and abnormal cervical curvature may be overlooked by the Otolaryngologists as causes of swallowing disorders. The diagnosis is usually confirmed by radiologic study for the cervical spine. Cervical abnormality should be kept in mind while we are investigating patients with swallowing problem, and postural modification may help in treatment of such cases.
Distinct Patterns of Fiber Type Adaptation in Rat Hindlimb Muscles 4 Weeks After Hemorrhagic Stroke
Authors: Snow LeAnn M. , Low Walter C. , Thompson LaDora V.
Published: October 2018

Objective

The aim of this study was to evaluate adaptations in soleus and tibialis anterior muscles in a rat model 4 wks after hemorrhagic stroke.

Design

Young adult Sprague Dawley rats were randomly assigned to two groups: stroke and control, with eight soleus and eight tibialis anterior muscles per group. Hemorrhagic stroke was induced in the right caudoputamen of the stroke rats. Control rats had no intervention. Neurologic status was evaluated in both groups before stroke and 4 wks after stroke. Muscles were harvested after poststroke neurologic testing. Muscle fiber types and cross-sectional areas were determined in soleus and tibialis anterior using immunohistochemical labeling for myosin heavy chain.

Results

No generalized fiber atrophy was found in any of the muscles. Fiber types shifted from faster to slower in the tibialis anterior of the stroke group, but no fiber type shifts occurred in the soleus muscles of stroke animals.

Conclusions

Because slower myosin heavy chain fiber types are associated with weaker contractile force and slower contractile speed, this faster to slower fiber type shift in tibialis anterior muscles may contribute to weaker and slower muscle contraction in this muscle after stroke. This finding may indicate potential therapeutic benefit from treatments known to influence fiber type plasticity.
Reporting Adverse Events in Plastic Surgery: A Systematic Review of Randomized Controlled Trials
Authors: Morzycki Alexander D. , Hudson Alexandra S. , Samargandi Osama A. , Bezuhly Michael , Williams Jason G.
Published: October 2018

Background:

Accurate knowledge of adverse events is critical for evaluation of the safety of interventions. Historically, adverse events in surgical trials have been poorly reported. The objective of this study was to systematically evaluate the reporting of adverse events in randomized controlled trials in the plastic surgery literature.

Methods:

Two independent reviewers conducted a systematic search using MEDLINE, Embase, and Scopus of the top seven plastic surgery journals with the highest impact factors. Randomized controlled trials describing a potentially invasive treatment, published between January of 2012 and December of 2016, were included.

Results:

One hundred forty-five randomized controlled trials involving 10,266 patients were included, of which 30 percent were registered. Anticipated adverse events were clearly defined in 15 percent of trials, and in 70 percent it was not clear who would be documenting adverse events. Furthermore, 72 percent of randomized controlled trials reported the occurrence of adverse events, of which 61 percent failed to report events occurring in the intrainterventional period. Binary logistic regression revealed that funded randomized controlled trials were 4.04 times more likely to report adverse events compared with nonfunded randomized controlled trials (95 percent CI, 1.41 to 10.83; p = 0.009).

Conclusions:

The authors’ findings suggest the need for reporting standards for adverse events in the plastic surgery literature, as such reporting remains heterogeneous and is lacking rigor. Improved quality and transparency are needed to strengthen evidence-based practice and permit a balanced intervention assessment. This study provides a set of recommendations aimed at improving adverse event reporting.
Assessing Quality of Life and Patient-Reported Satisfaction with Masculinizing Top Surgery: A Mixed-Methods Descriptive Survey Study
Authors: Poudrier Grace , Nolan Ian T. , Cook Tiffany E. , Saia Whitney , Motosko Catherine C. , Stranix John T. , Thomson Jennifer E. , Gothard M. David , Hazen Alexes
Published: October 2018

Background:

Masculinizing top surgery (bilateral mastectomy with chest wall reconstruction) is an important gender-affirming procedure sought by many transmasculine and nonbinary individuals. Current literature is focused primarily on details of surgical technique and complication rates, with limited data available on how top surgery affects subjective quality-of-life measures.

Methods:

An anonymous online survey was distributed to 81 of the senior author’s former top-surgery patients. The survey response rate was 72 percent (58 respondents). Responses were analyzed to investigate quality of life, sexual confidence, mental health, satisfaction with top surgery, and patient attitudes toward top surgery’s role in gender affirmation.

Results:

Following top surgery, measures of quality of life and sexual confidence improved significantly (p < 0.001). In addition, 86 percent reported improvement in gender dysphoria–related mental health conditions. All but one respondent reported that top surgery had an overall positive impact on their life.

Conclusions:

Top surgery had major positive effects on all mental health and quality-of-life metrics. The authors’ findings contribute to a much-needed body of evidence that top surgery markedly improves the daily lives and functioning of transgender and nonbinary individuals who choose to undergo it.