bluuebunny/crossref_metadata_2025 huggingface dataset:
Curdione Ameliorated Doxorubicin-Induced Cardiotoxicity Through Suppressing Oxidative Stress and Activating Nrf2/HO-1 Pathway
Authors: Wu Zimei , Zai Wenjing , Chen Wei , Han Yuxuan , Jin Xin , Liu Hongrui
Published: July 2019

Doxorubicin (DOX) is a representative antibiotic of terpenoids and clinically used in the treatment of various malignant tumors. However, its application is limited by the cardiotoxocity. Curdione, an extract from Rhizoma Curcumae, has many promising pharmacological effects including protecting acute liver injury and cerebral ischemia. It is still unknown whether curdione has a protective function for DOX-induced cardiotoxicity. In our study, we investigated the protective effects of curdione against DOX-induced cardiotoxicity. Our results showed that curdione attenuated DOX-induced growth inhibition and release of lactic dehydrogenase in a concentration-dependent manner. And curdione ameliorated the histopathological damage, reduced the elevation of serum creatine kinase-MB isoenzyme (CK-MB) and lactic dehydrogenase by DOX. Furthermore, curdione inhibited DOX-induced cell apoptosis and modulated the expression of Bcl-2 and Bax proteins, as well as abrogated DOX-induced reactive oxygen species accumulation and prevented mitochondria dysfunction. Further study indicated that curdione decreased DOX-induced phosphorylation of extracellular signal-regulated kinase1/2 (Erk1/2) and c-Jun-N-terminal kinase and activated nuclear factor-erythroid 2–related factor 2/heme oxygenase 1 (Nrf2/HO-1) signal pathway. Our results suggested that curdione maybe is a new and feasible strategy to prevent DOX-induced cardiotoxicity through monitoring multiple targets.
NLRP3 Inflammasome in Cardioprotective Signaling
Authors: Zuurbier Coert J.
Published: July 2019

The NLRP3 inflammasome may contribute to infarct development during acute cardiac ischemia-reperfusion (IR). Because infarct size strongly correlates with the degree of heart failure in the long term, therapies that reduce reperfusion injury are still needed as first primary care against heart failure development. Inhibition of the NLRP3 inflammasome is currently viewed as such a potential therapy. However, previous research studies directed at inhibition of various inflammatory pathways in acute cardiac IR injury were often disappointing. This is because inflammation is a double-edged sword, detrimental when hyperactive, but beneficial at lower activity, with activity critically dependent on time of reperfusion and cellular location. Moreover, several inflammatory mediators can also mediate cardioprotective signaling. It is reasonable that this also applies to the NLRP3 inflammasome, although current literature has mainly focused on its detrimental effects in the context of acute cardiac IR. Therefore, in this review, we focus on beneficial, cardioprotective properties of the NLRP3 inflammasome and its components NLRP3, ASC, and caspase-1. The results show that (1) NLRP3 deficiency prevents cardioprotection in isolated heart by ischemic preconditioning and in vivo heart by TLR2 activation, associated with impaired STAT3 or Akt signaling, respectively; (2) ASC deficiency also prevents in vivo TLR2-mediated protection; and (3) caspase-1 inhibition results in decreased infarction but impaired protection through the Akt pathway during mild ischemic insults. In conclusion, the NLRP3 inflammasome is not only detrimental, it can also be involved in cardioprotective signaling, thus fueling the future challenge to acquire a full understanding of NLRP3 inflammasome role in cardiac IR before embarking on clinical trials using NLRP3 inhibitors.
Alirocumab in Acute Myocardial Infarction: Results From the Virginia Commonwealth University Alirocumab Response Trial (VCU-AlirocRT)
Authors: Trankle Cory R. , Wohlford George , Buckley Leo F. , Kadariya Dinesh , Ravindra Krishna , Markley Roshanak , Park Tae Shik , Potere Nicola , Van Tassell Benjamin W. , Abbate Antonio
Published: July 2019

Alirocumab improves outcomes in patients with a history of recent acute coronary syndrome, but treatment acutely at the time of myocardial infarction is untested. We present the results of a randomized, placebo-controlled, double-blinded pilot study of alirocumab treatment at the time of non-ST elevation MI (NSTEMI). Twenty patients with type 1 NSTEMI and low-density lipoprotein cholesterol (LDL-C) >70 mg/dL despite high intensity statin therapy were randomized 1:1 to one dose of alirocumab 150 mg subcutaneously or placebo within 24 hours of presentation. LDL-C and inflammatory biomarkers—including C-reactive protein—were obtained at baseline, 72 hours, and 14 days. Median (interquartile range) and number (%) were: age 59 (49, 65) years, 7 (35%) men, 16 (80%) black; baseline characteristics were similar between groups. Alirocumab significantly reduced LDL-C from baseline to 14 days by 64 mg/dL (−96, −47) compared with placebo [+1 mg/dL (−25, +16)] (primary endpoint). There were no significant between-group differences in C-reactive protein changes at any time point (all P > 0.2) or serious adverse events attributable to the study treatment. In conclusion, alirocumab administration at the time of NSTEMI significantly reduced LDL-C levels at 14 days, was safe, and had neutral effects on inflammatory biomarkers. Further studies are warranted to explore the effects on clinical outcomes.
Carthamin Yellow Protects the Heart Against Ischemia/Reperfusion Injury With Reduced Reactive Oxygen Species Release and Inflammatory Response
Authors: Lu Qi Yu , Ma Jian Qiang , Duan Yu Yin , Sun Yi , Yu Songhua , Li Bin , Zhang Gui Min
Published: July 2019

Carthamin yellow (CY) is a flavonoid compound isolated from safflower, which is widely used clinically in China. It has various pharmacological effects including promoting blood circulation to remove blood stasis and alleviating pain. Ischemic heart disease is one of the main culprits of illness and death. Here, in this study, ex vivo and in vivo models were used to investigate whether CY reduces ischemia/reperfusion injury. In vitro experiments further verify and explain the potential mechanisms of CY cardioprotective function. Isolated hearts from male rats with or without CY pretreatment before ischemia which underwent 30-minute ischemia followed by 60-minute reperfusion showed that CY pretreatment significantly reduced the infarct size and lactate dehydrogenase release. The in vivo experiments also indicated CY preadministration (i.v.) reduced infarct size and improved the heart function, which was impaired by myocardial ischemia/reperfusion injury. The in vitro model on myocardial cell also showed that CY reduced ischemia/reperfusion injury by reducing the lactate dehydrogenase and reactive oxygen species (ROS) releasing. Eliminating ROS with N-acetylcysteine or preinject CY into rat jugular vein reduces the expression of IL-6, TNF-a, and, especially, IL-1b in an in vivo I/R model. Also, CY pretreatment strongly reduces ischemia/reperfusion-induced NLRP3 up-expression and caspase-1 activation. Our results indicated CY reduced ischemia–reperfusion injury when administered before reperfusion. The reduction in injury is accompanied by a reduced ROS release and decreased inflammatory response.
Practical Recommendations for the Diagnosis and Medical Management of Stable Angina: An Expert Panel Consensus
Authors: Farmakis Dimitrios , Andrikopoulos George , Giamouzis Gregory , Giannakoulas George , Poulimenos Leonidas , Skalidis Emmanouil , Vlachopoulos Charalambos , Parissis John
Published: July 2019

Stable angina affects a significant number of coronary artery disease patients, impairing their quality of life and worsening their prognosis. It manifests even despite a history of revascularization and is often poorly controlled with drug therapy. Comorbid conditions are frequently encountered in coronary artery disease patients, affecting their prognosis and rendering the diagnosis and management of angina more challenging. In this article, derived by an expert panel meeting, we attempt a practical approach to stable angina, focusing on symptomatic patients subjected to previous coronary revascularization or not suitable for revascularization and providing handy diagnostic and therapeutic algorithms and comorbidity-adjusted therapeutic approaches in accordance with existing evidence, current recommendations, and locally available therapeutic options.
Association of MMP-1 (rs1799750)-1607 2G/2G and MMP-3 (rs3025058)-1612 6A/6A Genotypes With Coronary Artery Disease Risk Among Iranian Turks
Authors: Ghaffarzadeh Ayda , Bagheri Morteza , Khadem-Vatani Kamal , Abdi Rad Isa
Published: July 2019

The study was conducted to evaluate the association between MMP-1 (rs1799750)−1607 1G/2G and MMP-3 (rs3025058)−1612 5A/6A polymorphisms/haplotypes and coronary artery disease (CAD) risk among Iranian Turks. Totally, 102 patients with CAD and 102 healthy subjects joined the study. Genomic DNA isolation was carried out using “salting out” method from 3 to 4 mL of whole blood samples. The MMP-1 (−1607 2G/1G) and MMP-3 (−1612 5A/6A) promoter gene polymorphisms were detected via polymerase chain reaction restriction fragment length polymorphism. Our results indicated that the frequencies of the MMP-1 (−1607) 2G alleles and 2G/2G genotypes and the MMP-3 (−1612) 6A alleles and 6A/6A genotypes were higher in CAD patients older than 50 years than in healthy controls (P < 0.05). We failed to show statistically significant differences between the CAD patients younger than 50 years and controls concerning MMP-1 −1607 ins/delG (1G > 2 G, rs1799750) and MMP-3 −1612 ins/delA (5A/6A, rs3025058) polymorphisms (P > 0.05). The frequencies of MMP-3/MMP-1 haplotypes were not statistically different among tested groups (P > 0.05). This examination, as the first study of its own kind in Iranian Turks, reported association between MMP-1 (rs1799750) −1607 2G/2G and MMP-3 (rs3025058) −1612 6A/6A genotypes and CAD risk in patients older than 50 years.
Natural Breast Symmetry in Preoperative Breast Cancer Patients
Authors: Cheong Audrey L. , Liu Jun , Reece Gregory P. , Nicklaus Krista M. , Catherine Bordes Mary , Hanson Summer E. , Markey Mia K. , Merchant Fatima A.
Published: July 2019

Background:

Plastic surgeons aim to achieve breast symmetry during cosmetic and reconstructive breast surgery. They rely on measures of breast size, position, and projection to determine and achieve breast symmetry, but normative data on symmetry in preoperative breast reconstruction patients are scarce.

Methods:

A statistical evaluation was performed to examine the relationship of breast symmetry to demographic and clinical factors such as age, body mass index (BMI), race, and cancer status in a sample population of 87 patients who were scheduled to undergo mastectomy and breast reconstruction. The sternal notch to nipple (SN-N) distance and breast volume were measured on three-dimensional images, and distance and volume ratios across the left and right breasts were compared to determine symmetry. Ptosis grades were recorded and grade agreement (match) across the left and right breasts was assessed to determine shape symmetry.

Results:

A substantial portion of women (41.4%) showed SN-N distance differences >5 mm and 50.6% exhibited a volume difference >50 mL between their right and left breasts. Multiple linear regression modeling did not show any association between age, BMI, and cancer status and the SN-N and volume ratios. Race showed an association with volume symmetry but not with SN-N symmetry. A higher BMI increased the likelihood of ptosis disagreement. Additionally, tumor size did not impact overall breast symmetry.

Conclusion:

This study provides normative data on the extent of breast asymmetry in preoperative patients that can guide physicians in setting realistic goals for reconstruction procedures and manage patients’ expectations related to outcomes.
Establishment of a Standardized Technique for Concha-type Microtia―How to Incorporate the Cartilage Frame into the Remnant Ear
Authors: Yotsuyanagi Takatoshi , Yamashita Ken , Yamauchi Makoto , Nakagawa Tsugufumi , Sugai Asuka , Kato Shinji , Gonda Ayako , Suzuki Akiyo , Onuma Masahiro
Published: July 2019

Background:

We have already reported surgical procedures for lobule-type microtia that provide an excellent contour and shape of the ear with minimum sacrifice of the donor. We have succeeded in establishing a standard surgical technique for almost all types of concha-type microtia that effectively uses the remnant ear and can use a unified costal cartilage frame.

Methods and Results:

The concept of our technique is that remnant cartilage should be used maximally but that the deformed area should be completely replaced by the costal cartilage frame. The differences between the cartilage frame for lobule-type microtia and that for concha-type microtia are that the lower half beneath the antihelical area and the concha cymba in the base frame are omitted in concha-type microtia. The area from the tragus to the incisura of the tragus in the antihelical-tragal frame is also omitted. The area of the helical crus in the helical frame and the lower half in the antihelix are not immobilized in the base frame and are free edges. On the other hand, the remnant cartilage outside the concha is removed, but the antitragus is preserved. When the cartilage frame and the remnant are incorporated, all of the components of the ear can be provided.

Conclusion:

The ears created by our technique have a natural appearance and clear contour.
Do different uses of performance measurement systems in hospitals yield different outcomes?
Authors: van Elten Hilco J. , van der Kolk Berend , Sülz Sandra
Published: July 2019

Background

Inspired by the new public management movement, many public sector organizations have implemented business-like performance measurement systems (PMSs) in an effort to improve organizational efficiency and effectiveness. However, a large stream of the accounting literature has remained critical of the use of performance measures in the public sector because of the inherent difficulty in measuring output and the potential adverse effects of performance measurement. Although we acknowledge that PMSs may indeed sometimes yield adverse effects, we highlight in this study that the effects of PMSs depend on the way in which they are used.

Purpose

The aim of this study was to investigate various uses of PMSs among hospital managers and their effects on hospital outcomes, including process quality, degree of patient-oriented care, operational performance, and work culture.

Methodology

We use a survey sent to 432 Dutch hospital managers (19.2% response rate, 83 usable responses). For our main variables, we rely on previously validated constructs where possible, and we conduct ordinary least squares regressions to explore the relation between PMS use and hospital outcomes.

Results

We find that the way in which PMSs are used is associated with hospital outcomes. An exploratory use of PMS has a positive association with patient-oriented care and collective work culture. Furthermore, the operational use of PMSs is positively related to operational performance but negatively related to patient-oriented care. There is no single best PMS use that positively affects all performance dimensions.

Practice Implications

The way in which managers use PMSs is related to hospital outcomes. Therefore, hospital managers should critically reflect on how they use PMSs and whether their type of use is in line with the desired hospital outcomes.
High Frequency Electrotherapy for the Treatment of Meibomian Gland Dysfunction
Authors: Ferrari Giulio , Colucci Annalisa , Barbariga Marco , Ruggeri Alfredo , Rama Paolo
Published: July 2019

Purpose:

To test the safety and efficacy of high frequency electrotherapy (ET) on the clinical signs and symptoms of patients affected by dry eye and meibomian gland dysfunction (MGD).

Methods:

Twenty-five patients affected by MGD were enrolled. Quantum Molecular Resonance ET was administered by means of the Rexon-Eye device 4 times, once per week for 4 weeks. Patients were reexamined 1 month after the last treatment. The primary endpoint was reduction in corneal fluorescein staining. Additional endpoints were tear break-up time, Ocular Surface Disease Index score, meibomian gland secretion score, and the number of expressible meibomian glands. Safety endpoints were Logarithm of the Minimum Angle of Resolution (LogMar) best spectacle-corrected visual acuity and intraocular pressure.

Results:

Corneal fluorescein staining improved by 62.5% (P < 0.0001), tear breakup time increased by 30.9% (P < 0.0001), and the Ocular Surface Disease Index score improved by 37% (P < 0.001). The meibum quality and the number of expressible meibomian glands also increased (35.7% and 12%, P < 0.001 and P < 0.0001, respectively). Schirmer test scores increased after treatment by 16.5% (P = 0.01). No adverse events were observed.

Conclusions:

Quantum Molecular Resonance ET appears to be safe and significantly reduces symptoms and signs associated with MGD. It may have a relevant role in the treatment of evaporative dry eye disease.
Clinical Outcome of Autologous Cultivated Oral Mucosal Epithelial Transplantation in Ocular Surface Reconstruction
Authors: Gopakumar Vidya , Agarwal Shweta , Srinivasan Bhaskar , Krishnakumar Subramanian , Krishnan Uma Maheswari , Iyer Geetha
Published: July 2019

Purpose:

To evaluate the outcomes of autologous cultivated oral mucosal epithelial transplantation (COMET) in ocular surface reconstructive procedures.

Methods:

Twenty-five eyes of 24 patients who underwent COMET for ocular surface reconstruction were studied retrospectively from April 2011 to March 2014. Oral mucosal biopsy of 2 mm2 was harvested from all patients and cultured on amniotic membrane for 14 days. COMET was performed as a means to achieve corneal epithelization (group 1) and for fornix reconstruction (group 2). The extent of epithelization achieved (group 1) and the depth of the fornix reconstructed (group 2) were the primary outcome measures.

Results:

Six eyes of 5 patients [2 chemical injury (CI), 3 Stevens–Johnson Syndrome (SJS)] underwent COMET for nonhealing of an epithelial defect within a month after insult or had a nonhealing defect since insult despite maximal medical/surgical therapy. Group 2 included 19 eyes of 19 patients (10 CI, 8 SJS, 1 ocular cicatricial pemphigoid) which underwent COMET for fornix reconstruction. Postsurgery, the cornea was fully epithelized in 66.67% of the eyes (n = 4) and partially epithelized in 33.33% of the eyes (n = 2). The overall improvement in surface epithelization was statistically significant (P = 0.046). Reconstruction of an anatomically deep fornix was achieved in 57% of the eyes (4 CI, 6 SJS and 1 ocular cicatricial pemphigoid). The fornix was partially formed in 26% of the eyes (4 CI and 1 SJS). The overall improvement in fornix reconstruction was considered statistically significant (P = 0.024). The follow-up ranged from 1 to 5 to 27 months with a mean follow-up of 18 months SD ±8.9.

Conclusions:

COMET, by providing an alternate source of epithelium, aids in faster epithelization and thus can be considered as an option in management of severe grade CI or SJS in the acute stage as well as in fornix reconstructive procedures in chronic stage of ocular surface disorders.
Essential key messages about diagnosis, imaging, and self-care for people with low back pain: a modified Delphi study of consumer and expert opinions
Authors: French Simon D. , Nielsen Mandy , Hall Leanne , Nicolson Philippa J.A. , van Tulder Maurits , Bennell Kim L. , Hinman Rana S. , Maher Chris G. , Jull Gwendolen , Hodges Paul W.
Published: July 2019

People with back pain regularly search for information online; however, the quality of this online information is often poor. We established a list of the most important messages about diagnosis, imaging, and self-care for people with low back pain, based on consensus opinion and prioritised in order of importance. A list of key messages was derived from clinical practice guidelines for back pain. During 2 survey rounds, a Delphi panel of consumers with back pain and experts rated the importance of each item and suggested additional statements. Messages were retained that were rated as important by more than 70% of the panel. Retained messages were reviewed by consumer focus groups. A priority pairwise ranking activity determined the rank order of the important messages. A final online survey determined the robustness and currency of the final list of statements. The Delphi process and consumer focus groups resulted in 30 unique messages. Experts considered that the most important messages for patients are (1) remain active and (2) reassurance that back pain is a normal experience and not necessarily related to serious harm. This differed from the preferences of people with back pain who prioritised messages related to (1) identification of more serious pathology and (2) principles of management. This list of important key messages about diagnosis, imaging, and general self-care for people with back pain can be used to inform the development of education resources, including new web sites, as well as to direct clinicians in the information they provide to patients.
Cell-specific role of histone deacetylase 6 in chemotherapy-induced mechanical allodynia and loss of intraepidermal nerve fibers
Authors: Ma Jiacheng , Trinh Ronnie T. , Mahant Iteeben D. , Peng Bo , Matthias Patrick , Heijnen Cobi J. , Kavelaars Annemieke
Published: July 2019

Chemotherapy-induced peripheral neuropathy (CIPN) is a serious adverse side effect of cancer treatment with no Food and Drug Administration-approved medication for its prevention or management. Using RNA sequencing analysis of dorsal root ganglia (DRG), we identify critical contributions of histone deacetylase 6 (HDAC6) and mitochondrial damage to the establishment of CIPN in a mouse model of cisplatin-induced neuropathy. We show that pharmacological inhibition of HDAC6 using ACY-1215 or global deletion of HDAC6 is sufficient to prevent cisplatin-induced mechanical allodynia, loss of intraepidermal nerve fibers (IENFs), and mitochondrial bioenergetic deficits in DRG neurons and peripheral nerves in male and female mice. The bioenergetic deficits in the neuronal cell bodies in the DRG are characterized by reduced oxidative phosphorylation, whereas the mitochondrial deficits in the nerves are due to a reduction in axonal mitochondrial content. Notably, deleting HDAC6 in sensory neurons protects against the cisplatin-induced loss of IENFs and the reduction in mitochondrial bioenergetics and content in the peripheral nerve. By contrast, deletion of HDAC6 in sensory neurons only partially and transiently prevents cisplatin-induced mechanical allodynia and does not protect against impairment of mitochondrial function in DRG neurons. We further reveal a critical role of T cells in the protective effects of HDAC6 inhibition on these signs of CIPN. In summary, we show that cisplatin-induced mechanical allodynia is associated with mitochondrial damage in DRG neurons, whereas the loss of IENFs is related to bioenergetic deficits in peripheral nerves. Moreover, our findings identify cell-specific contributions of HDAC6 to mechanical allodynia and loss of IENFs that characterize cisplatin-induced peripheral neuropathy.
A Multicenter Study on the Early Assessment of Functional Capacity of Patients With Brain Tumor After Surgery
Authors: Ślusarz Robert , Biercewicz Monika , Rosińczuk Joanna , Lorencowicz Regina
Published: July 2019

BACKGROUND: Brain tumors pose a great therapeutic problem as they cause the impairment of basic vital functions and disability of various levels. The goal of this research was to describe and compare the functional capacity of patients in an early period after surgical treatment of brain tumor. METHODS: This multicenter study includes 165 patients who underwent surgical treatment of brain tumor, hospitalized on neurosurgical wards in Poland. The research was based on the assessment of patients’ functional capacity measured with the Functional Capacity Scale (FCS). The patients were examined twice: first, on the day of admission and, second, on the day of discharge. Patient FCS scores were compared with the scores obtained using the Karnofsky Performance Scale and Glasgow Outcome Scale. RESULTS: The mean FCS score was 43.72 points on the day of admission and 43.07 points on the day of discharge from hospital (P > .05). The FCS was correlated with age (r = 0.373, P < .001) and consciousness level (r = −0.418, P < .001). A high correlation (P < .001) was found between the scales used for the assessment of functional capacity (r = 0.68–0.84). CONCLUSIONS: Most patients showed independence in terms of functional capacity on the day of discharge. Significant factors influencing patient functional capacity are age and level of consciousness. The use of the FCS allows for an accurate assessment of the functional condition of a patient and correlates with the Karnofsky Performance Scale and Glasgow Outcome Scale.
Speech Perception Outcomes in Transcutaneous Versus Percutaneous Bone Conduction Stimulation in Individuals With Single-sided Deafness
Authors: Snapp Hillary A. , Morgenstein Kari E. , Kuzbyt Brianna
Published: July 2019

Objective(s):

To investigate the differences in percutaneous versus passive transcutaneous bone-conduction stimulation in individuals with single-sided deafness.

Study Design:

Prospective, single-subject.

Setting:

Tertiary academic referral center.

Patients:

Adult bone-anchored implant listeners with single-sided deafness using a percutaneous implant system.

Interventions:

Experienced percutaneous bone anchored implant recipients were tested in the percutaneous and transcutaneous conditions using a BAHA 5 (Cochlear Corp., Cochlear Bone-Anchored Solutions, Mölnlycke, Sweden) sound processor on the patient's own abutment and on a softband.

Main Outcome Measures:

Phoneme recognition was assessed using Consonant-Nucleus-Consonant (CNC) words for soft (47 dB SPL) and average (62 dB SPL) speech inputs. Speech perception in noise performance was also assessed for soft (47 dB SPL) and average (62 dB SPL) speech inputs using sentences presented in multi-talker babble. Aided free-field thresholds were obtained in both conditions using warble tone stimuli.

Results:

Compared with percutaneous bone-conduction stimulation, transcutaneous stimulation demonstrated reduced effective gain for high frequency stimulation. Transcutaneous stimulation required higher signal to noise ratios to achieve comparable performance to the percutaneous condition. Phoneme recognition was poorer in transcutaneous versus percutaneous stimulation with the most significant impact observed for soft speech inputs.

Conclusion:

A significant performance gap in speech recognition is observed between percutaneous and transcutaneous bone-conduction stimulation in individuals with single-sided deafness at the same signal to noise ratios. Compared with percutaneous bone-conduction stimulation, transcutaneous stimulation demonstrated reduced effective gain, decreased phoneme recognition, word recognition, and performance in noise, with the most significant impact observed for soft speech inputs.
Historic review of long-term outcomes research
Authors: Rylander Christian
Published: July 2019

Purpose of review

This review summarizes the results from long-term intensive care outcome research over the past 50 years. Key findings from early studies are reflected in citations of contemporary research.

Recent findings

The postintensive care syndrome (PICS) is a multifaceted entity of residual disability and complications burdening survivors of critical illness. Some interventions applied early in the history of outcomes research have now been confirmed as effective in counteracting specific PICS components.

Interest in patient-centred outcomes has been present since the beginning of modern intensive care. Findings from early long-term studies remain valid even in the face of contemporary large registries that facilitate follow-up of larger cohorts. A further understanding of the mechanisms leading to experienced physical and psychological impairment of PICS will be essential to the design of future intervention trials.
Vascular malformations syndromes: an update
Authors: Martinez-Lopez Antonio , Salvador-Rodriguez Luis , Montero-Vilchez Trinidad , Molina-Leyva Alejandro , Tercedor-Sanchez Jesus , Arias-Santiago Salvador
Published: July 2019

Purpose of review

To provide an update of vascular malformation syndromes by reviewing the most recent articles on the topic and following the new International Society for the Study of Vascular Anomalies (ISSVA) 2018 classification.

Recent findings

This review discusses the main features and diagnostic approaches of the vascular malformation syndromes, the new genetic findings and the new therapeutic strategies developed in recent months.

Some vascular malformations can be associated with other anomalies, such as tissue overgrowth. PIK3CA-related overgrowth spectrum (PROS) is a group of rare genetic disorders with asymmetric overgrowth caused by somatic mosaic mutations in PI3K-AKT-mTOR pathway that encompass a heterogeneous group of rare disorder that are associated with the appearance of overgrowth. CLOVES syndrome and Klippel–Trénaunay syndrome are PROS disease. Proteus syndrome is an overgrowth syndrome caused by a somatic activating mutation in AKT1. CLOVES, Klippel–Trénaunay and Proteus syndromes are associated with high risk of thrombosis and pulmonary embolism. Hereditary hemorrhagic telangiectasia is an autosomic dominant disorder characterized by the presence of arteriovenous malformations. New therapeutic strategies with bevacizumab and thalidomide have been employed with promising results.
Osteogenesis imperfecta: advancements in genetics and treatment
Authors: Rossi Vittoria , Lee Brendan , Marom Ronit
Published: July 2019

Purpose of review

The purpose of this review is to outline the current understanding of the molecular mechanisms and natural history of osteogenesis imperfecta, and to describe the development of new treatments for this disorder.

Recent findings

The introduction of next-generation sequencing technology has led to better understanding of the genetic cause of osteogenesis imperfecta and enabled cost-effective and timely diagnosis via expanded gene panels and exome or genome sequencing. Clinically, despite genetic heterogeneity, different forms of osteogenesis imperfecta share similar features that include connective tissue and systemic manifestations in addition to bone fragility. Thus, the goals of treatment in osteogenesis imperfecta extend beyond decreasing the risk of fracture, to include the maximization of growth and mobility, and the management of extraskeletal complications. The standard of care in pediatric patients is bisphosphonates therapy. Ongoing preclinical studies in osteogenesis imperfecta mouse models and clinical studies in individuals with osteogenesis imperfecta have been instrumental in the development of new and targeted therapeutic approaches, such as sclerostin inhibition and transforming growth factor-β inhibition.

Osteogenesis imperfecta is a skeletal dysplasia characterized by bone fragility and extraskeletal manifestations. Better understanding of the mechanisms of osteogenesis imperfecta will enable the development of much needed targeted therapies to improve the outcome in affected individuals.
Measuring Communication Similarity Between Hospice Nurses and Cancer Caregivers Using Latent Semantic Analysis
Authors: Kane Lauren , Clayton Margaret F. , Baucom Brian R. , Ellington Lee , Reblin Maija
Published: July 2019

Background

Optimal end-of-life care requires effective communication between hospice nurses, caregivers, and patients, yet defining and evaluating effective communication are challenging. Latent semantic analysis (LSA) measures the degree of communication similarity (talking about the same topic) without relying on specific word choices or matching of communication behaviors (question-answer), thus more comprehensively evaluating communication interactions.

Objective

Guided by the Communication Accommodation Theory, we evaluated communication similarity, indicating theoretical convergence, between hospice nurses and caregivers of cancer patients, identifying nurse attributes and communication skills that were associated with greater communication similarity.

Methods

A descriptive secondary analysis of self-reported nurse data and 31 audio-recorded cancer patient home hospice nursing visits across 2 states and 7 hospices.

Results

The average LSA score was 0.83 (possible range, 0–1). A nurse preference for greater patient-oriented visits, use of more Nurse Partnering statements, and less Conversation Dominance (ratio of total nurse to total caregiver talk) were associated with higher LSA scores.

Conclusions

Effective communication is essential to optimal end-of-life care. Latent semantic analysis is a feasible and promising approach for assessing communication similarity during home hospice care.

Implications for Practice

Hospice nurses are at the forefront of family caregiver communication, playing a vital role in empowering caregivers to assume required patient care tasks. Communication strategies such as the use of partnering statements that increase LSA scores can be taught to hospice nurses and other members of the hospice interdisciplinary team as a way to enrich communication skills and improve communication confidence and can be translated into other oncology nursing contexts.
The Mediating Role of Implicit and Explicit Emotion Regulation in the Relationship Between Academic Emotions and Approaches to Learning
Authors: Rentzios Christos , Kamtsios Spiridon , Karagiannopoulou Evangelia
Published: July 2019

The present study belongs to a new strand of research in learning in higher education focusing on emotions and emotion regulation, including defense mechanisms. The purpose of the study was to investigate the mediating role of implicit and explicit emotion regulation in the relationship between academic emotions and approaches to learning. Participants were composed of 226 undergraduates (40 males and 186 females studying in a social science department). They completed the following questionnaires: Emotion Regulation Questionnaire, Student Experience of Emotions Inventory, Defense Style Questionnaire, and Approaches to Learning and Studying Inventory. Both the moderating (interaction) and the mediational (indirect) effects were examined using the PROCESS program. Results failed to indicate the moderating role of emotion regulation in the association between academic emotions and approaches to learning. Instead, results revealed the dominant mediating role of emotion regulation and particularly the role of immature defense style in the relationship between negative emotions and approaches to learning. Moreover, reappraisal and suppression seemed to act as mediators in the relationship between positive and negative emotions with deep and surface approaches, respectively. The results of the study are discussed in the context of the recent literature. Implications for higher-education institutions regarding the role of unconscious cognitive processes are also discussed.
Resolution of Symptoms and Resumption of Sex After Diagnosis of Nongonococcal Urethritis Among Men Who Have Sex With Men
Authors: Chambers Laura C. , Hughes James P. , Glick Sara N. , Morgan Jennifer L. , Lowens M. Sylvan , Robinson Tashina S. , Romano Sarah S. , Leipertz Gina L. , Jensen Jørgen S. , Khosropour Christine M. , Fredricks David N. , Golden Matthew R. , Manhart Lisa E.
Published: July 2019

Background

Standard counseling at nongonococcal urethritis (NGU) diagnosis includes advice to abstain from sex for at least 7 days and until symptoms resolve.

Methods

From December 2014 to July 2018, we enrolled men who have sex with men and received azithromycin (1 g) for NGU at the Public Health–Seattle and King County STD Clinic. Over 12 weeks of follow-up, participants reported daily urethral symptoms and sexual activity on web-based diaries. Nongonococcal urethritis was defined as urethral symptoms or visible urethral discharge plus 5 or greater polymorphonuclear leukocytes per high-power field. Time of symptom resolution was defined as the first of 5 consecutive asymptomatic days.

Results

Of 100 participants with NGU and no Chlamydia trachomatis (CT)/Mycoplasma genitalium (MG) coinfection, 36 (36%), 22 (22%), and 42 (42%) had CT-NGU, MG-NGU, and non-CT/non-MG NGU, respectively. Among men with MG-NGU, 94% had a macrolide resistance mutation. For all etiologies, median time to symptom resolution after azithromycin was 7 days (95% confidence interval [CI], 5–9); 37% had symptoms lasting longer than 7 days. For men with CT-NGU, MG-NGU, and non-CT/non-MG NGU, median time to symptom resolution was 4 days (95% CI, 2–6; 16% >7 days), undefined days (95% CI, 7 to undefined; 60% >7 days), and 7 days (95% CI, 5–11; 46% >7 days), respectively. Median time to first sexual activity (any type) was 12 days (95% CI, 11–17); it was 16 days (95% CI, 12–18) to first urethral sexual exposure. Twenty-seven percent did not avoid urethral exposure for the recommended period.

Conclusions

Counseling at NGU diagnosis should educate patients that symptoms may persist more than 7 days, particularly for non-CT NGU, and emphasize the rationale for the 7-day abstinence period.
Autologous Breast Reconstruction after Failed Implant-Based Reconstruction: Evaluation of Surgical and Patient-Reported Outcomes and Quality of Life
Authors: Coriddi Michelle , Shenaq Deana , Kenworthy Elizabeth , Mbabuike Jacques , Nelson Jonas , Pusic Andrea , Mehrara Babak , Disa Joseph J.
Published: July 2019

Background:

There is a subset of patients who initially undergo implant-based breast reconstruction but later change to autologous reconstruction after failure of the implant reconstruction. The purpose of this study was to examine outcomes and quality of life in this group of patients.

Methods:

After institutional review board approval, a retrospective chart review of a prospectively maintained database was performed and BREAST-Q surveys were evaluated.

Results:

One hundred thirty-seven patients underwent autologous breast reconstruction following failed implant-based reconstruction with 192 total flaps. Failure of implant reconstruction was defined as follows: capsular contracture causing pain and/or cosmetic deformity [n = 106 (77 percent)], dissatisfaction with the aesthetic result [n = 15 (11 percent)], impending exposure of the implant/infection [n = 8 (6 percent)], and unknown [n = 8 (6 percent)]. Complications requiring operative intervention included partial flap loss [n = 5 (3 percent)], hematoma [n = 5 (3 percent)], vascular compromise requiring intervention for salvage [n = 2 (1 percent)], and total flap loss [n = 1 (1 percent)]. Thirty-four patients (23 percent) had BREAST-Q surveys. There was a statistically significant increase in overall outcomes (p < 0.001), satisfaction with appearance of breasts (p < 0.001), psychosocial well-being (p < 0.001), and physical well-being of the chest (p = 0.003). A statistically significant decrease in physical well-being of the abdomen was observed (p = 0.001).

Conclusions:

Autologous breast reconstruction after failed implant-based reconstruction has an acceptable complication rate and is associated with significantly improved patient satisfaction and quality of life.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
A Weighted Genetic Risk Score Predicts Surgical Recurrence Independent of High-Risk Clinical Features in Dupuytren’s Disease
Authors: Riesmeijer Sophie A. , Manley Oliver W. G. , Ng Michael , Nolte Ilja M. , Broekstra Dieuwke C. , Werker Paul M. N. , Furniss Dominic
Published: July 2019

Background:

Dupuytren’s disease is a very common, highly heritable palmar fibromatosis. In a recent genome-wide association study, 26 single-nucleotide polymorphisms were found to be associated with development of Dupuytren’s disease. The authors generated a weighted genetic risk score based on the genotype at these single-nucleotide polymorphisms. In two independent cohorts, they tested the association among high weighted genetic risk score, clinical features that predict a high risk of recurrence, and recurrence after surgery.

Methods:

Clinical data were obtained from patient questionnaires and clinical records, with missing data accounted for by imputation. Genotyping was performed as part of the recent genome-wide association study. Logistic regression was performed to study the association among weighted genetic risk score, high-risk clinical features, and recurrence, with a weighted genetic risk score analyzed as a continuous variable, and also grouped into four categories.

Results:

Using univariable logistic regression, a high weighted genetic risk score was associated with the presence of all high-risk clinical features: early age of onset, bilateral disease, ectopic disease, and a positive family history (p ≤ 0.004). After multivariable logistic regression accounting for these factors, an increased weighted genetic risk score was still associated with the need for repeated Dupuytren’s disease surgery (p = 0.004).

Conclusions:

The authors’ results suggest that a weighted genetic risk score is useful in predicting the risk of disease recurrence, and may be used by surgeons to personalize prognostication. In the future, a weighted genetic risk score may be useful for determining the most appropriate initial surgical procedure in patients with Dupuytren’s disease.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Reuse of the Masseteric Nerve for Dynamic Reanimation in Facial Palsy Patients with Previously Failed One-Stage Dynamic Smile Reanimation
Authors: Mohanty Ahneesh J. , Hembd Austin , Thrikutam Nikhitha , Rozen Shai M.
Published: July 2019

Failed primary dynamic smile reanimation procedures present significant challenges for the patient and surgeon alike. This is particularly true in older patients with a history of previous neck dissection and radiation therapy who underwent previous reconstruction with a free functional muscle transfer innervated with an ipsilateral masseter nerve. The objective of this study was to demonstrate feasibility, describe surgical technique, and assess results of reusing the masseter nerve to reinnervate a new free functional muscle transfer. Patients presenting between 2007 and 2017 to a single center after previously failed dynamic smile reanimation using the masseteric nerve who underwent a salvage dynamic procedure involving reuse of the masseteric nerve were analyzed for demographics, history of radiation therapy or chemotherapy, surgical techniques, and objective measurements using the MEEI Facegram software. The average age was 50 years, the average duration of palsy was 6.2 years, and the average preoperative House-Brackmann score was 6. Causes of palsy included Bell palsy in one, parotid malignancies in two, and a seventh cranial nerve schwannoma in one patient, with two patients requiring radiation therapy preoperatively. Three patients failed to achieve any motion after the first reanimation, and the fourth patient initially achieved excursion; however, because of cancer recurrence and resection of free functional muscle transfer, motion was subsequently lost. Average smile excursion after salvage was 11.32 mm and philtral deviation correction was 1.3 mm. Reusing the masseter nerve for dynamic smile restoration with free functional muscle transfer in previously failed reanimation patients is feasible and may provide successful reanimation. Careful patient evaluation and clear understanding of previous procedures are essential for success.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
A Preliminary Study of the Effects of Venous Drainage Position on Arterial Blood Supply and Venous Return within the Conjoined Flap
Authors: Xi Shanshan , Cheng Sheng , Lou Junsheng , Qiu Lingfeng , Yang Qingwen , Yu Wanping , Mei Jin , Tang Maolin
Published: July 2019

Background:

Conjoined flap viability is associated with arterial blood supply and venous return. This study aimed to assess the effects of venous drainage position on arterial blood supply and venous return within the conjoined flap.

Methods:

Fifty-four rats were divided randomly into three groups (n = 18 per group). In experimental group 2, only the right intercostal posterior artery and the left iliolumbar vein were maintained; meanwhile, only the right intercostal posterior artery and the left intercostal posterior vein were preserved in experimental group 1. The control group had only the right intercostal posterior artery and vein preserved. The distances between angiosomes were measured. At 7 days after surgery, flap survival was evaluated, lead oxide–gelatin flap angiography was performed, and average microvessel density was assessed by hematoxylin and eosin staining, and lactate levels were assessed.

Results:

The distance between angiosomes I and II was the shortest, whereas angiosomes I and III were most distant (p < 0.05). At 7 days after surgery, survival rates in experimental group 2 and experimental group 1 were both 100 percent, whereas 86.5 ± 1.6 percent of controls survived. Furthermore, angiogenesis was more obvious in experimental group 2 than in experimental group 1 and controls. Moreover, lactate levels were lower in experimental group 2 (7.47 ± 0.17 mM) and experimental group 1 (8.03 ± 0.31 mM) compared with control values (9.98 ± 0.37 mM; p < 0.05).

Conclusion:

Changes in position of venous drainage might cause continuous arterial high-pressure perfusion and venous superdrainage, which improves flap survival.
Multiplane Forehead Shortening: Sparing the Frontalis Muscle and Supraorbital Nerve
Authors: Ahn Yong Su , Park Yun Yong , Chang Jung Woo
Published: July 2019

Background:

An appropriate forehead-to-face ratio is an important factor contributing to a balanced and attractive face. Conventional methods have been used to correct long forehead, but these methods have drawbacks. The primary objective of this study was to introduce a modified technique with better results.

Methods:

Between March of 2015 and March of 2017, 525 patients with long forehead underwent multiplane forehead shortening with sparing of the frontalis muscle and supraorbital nerve. The operation began with a design indicating the area of skin excision. The sensory nerves were preserved during the skin excision, and the frontalis muscle was not cut. Subgaleal dissection was performed through a small window on the galea. The postoperative assessments included the change in forehead length, sensory changes on the scalp, the presence of a scar, alopecia, and synchronous movement of the flap.

Results:

A mean forehead shortening of 2.0 cm (range, 1.1 to 2.8 cm) was observed. Sensory deficits were observed only in the anteromedian scalp, which the supratrochlear nerve innervates. However, sensation recovered to the normal level within 6 months. Scars were barely visible or not visible at all in 85.5 percent of the patients. Postoperative alopecia occurred in only two cases. The synchronous movement of the forehead and scalp was natural in all cases.

Conclusion:

This modified technique of multiplane forehead shortening with sparing the frontalis muscle and supraorbital nerve provided both cosmetic and functional benefits.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.