bluuebunny/crossref_metadata_2025 huggingface dataset:
Inferring transcriptional logic from multiple dynamic experiments
Authors: Minas Giorgos , Jenkins Dafyd J , Rand David A , Finkenstädt Bärbel
Published: June 2017

Motivation

The availability of more data of dynamic gene expression under multiple experimental conditions provides new information that makes the key goal of identifying not only the transcriptional regulators of a gene but also the underlying logical structure attainable.

Results

We propose a novel method for inferring transcriptional regulation using a simple, yet biologically interpretable, model to find the logic by which a set of candidate genes and their associated transcription factors (TFs) regulate the transcriptional process of a gene of interest. Our dynamic model links the mRNA transcription rate of the target gene to the activation states of the TFs assuming that these interactions are consistent across multiple experiments and over time. A trans-dimensional Markov Chain Monte Carlo (MCMC) algorithm is used to efficiently sample the regulatory logic under different combinations of parents and rank the estimated models by their posterior probabilities. We demonstrate and compare our methodology with other methods using simulation examples and apply it to a study of transcriptional regulation of selected target genes of Arabidopsis Thaliana from microarray time series data obtained under multiple biotic stresses. We show that our method is able to detect complex regulatory interactions that are consistent under multiple experimental conditions.

Availability and implementation

Programs are written in MATLAB and Statistics Toolbox Release 2016b, The MathWorks, Inc., Natick, Massachusetts, United States and are available on GitHub https://github.com/giorgosminas/TRS and at http://www2.warwick.ac.uk/fac/sci/systemsbiology/research/software.

Supplementary information

Supplementary data are available at Bioinformatics online.
Primary Prevention in the 21st Century
Authors: Bloom Martin
Published: June 2017

The 19th century saw the beginnings of prevention, focused primarily on specific issues, like Dr. John Snow’s (b. 1813–d. 1858) intuitive epidemiology that led to the prevention of a mysterious disease (cholera) by removing the water pump handle (of a contaminated public water source); or Pasteur’s (b. 1822–d. 1895) solid research leading to the pasteurization of milk (thus preventing illness from contaminated milk, among his many achievements). The 20th century expanded this vision through the work of large numbers of workers all over the world, and eventually came to include the prevention of predictable untoward events, the protection of existing states of health and healthy functioning, and the promotion of desired events for populations of individuals or groups relative to given physical environments and sociocultural settings. As illustrated here, many professional and nonprofessional people involved in topics on health and well-being in the 21st century are beginning to see these issues in more complex terms: to see more systemic interrelationships among helping modalities—prevention, protection, promotion, treatment, rehabilitation, and palliative care—and more cooperative ventures among social agencies, governments, universities and citizens’ groups. Tadmor (2014) in the chapter “Cancer: Multiple Services for Children Dying of Cancer and for Their Families” (in Gullotta and Bloom 2014, cited under Theories Used in Primary Prevention), Ciporah S. Tadmor illustrates why it is no longer possible to provide palliative care solely to a dying teenager without considering related health issues that might arise within his or her family, which may also need help in reconstituting (rehabilitating) the family without its lost member, all of which involve protecting existing healthy functioning of members, promotion of desired goals (to help move the family members forward in their lives), and prevention of any predictable issues that might interfere with their functioning.
Buddhism and Sexuality
Authors: Langenberg Amy
Published: June 2017

Because of its high regard for celibate monasticism and incisive critique of desire as a root cause of suffering, Buddhism is widely assumed to be a sex-negative religion. In fact, as a growing body of scholarship has demonstrated, the sexual landscape of Buddhist traditions across time and place is varied, complex, and at times transgressive. The beginnings of Buddhism and sexuality as a research subfield can arguably be traced to the 1998 publication of Bernard Faure’s The Red Thread, a work that attempts to identity major themes and lines of tension in Buddhists’ imaginative encounters with, efforts to discipline, and philosophical understandings of human sexuality. Faure’s monograph was, however, preceded by L. P. N. Perera study of sexuality in ancient Buddhist India (Sexuality in Ancient India); see Perera 1993, cited under Seminal Monographs), Miranda Shaw’s monograph on women and Tantra (Passionate Enlightenment); see Shaw 1994, cited under Sexuality in Indo-Tibetan Tantra), and Liz Wilson’s book on disgust and the female body in early Buddhism (Charming Cadavers); see Wilson 1996, cited under Seminal Monographs). Since Faure, specialists in various Asian traditions have focused on sexuality with ever increasing levels of historical detail and theoretical sophistication. Examples include Sarah Jacoby’s work, Love and Liberation (Jacoby 2014, cited under Seminal Monographs), Richard Jaffe’s monograph, Neither Monk nor Layman (Jaffe 2001, cited under Non-celibate Monasticisms), John Power’s 2009 book A Bull of a Man (Powers 2009, cited under Seminal Monographs), and José Ignacio Cabezón’s Sexuality and Classical South Asian Buddhism (Cabezón 2017, cited under Seminal Monographs). In the meantime, scholars of tantra, yoga, and consort traditions such as Holly Gayley, David Gray, Janet Gyatso, and Christian Wedemeyer have moved past the orientalist judgements of early Indology and the phenomenology of Mircea Eliade in their treatments of Tantric sexuality; advances in Vinaya studies by Shayne Clarke, Alice Collett, Anālayo, and others have deepened understanding of early monastic negotiations with Indian sexual concepts and social mores; and queer and LGBT studies by Richard Corless and Hsiao-lan Hu have generated new research angles. The subfield of Buddhist ethics has also produced a small literature on Buddhist sexual ethics to complement its already substantial work on related topics like human rights and abortion. Additionally, specialists in Buddhist modernisms such as Ann Gleig and Stephanie Kaza have enriched the literature on Buddhism and sexuality by addressing issues such as sexual expression, sexual identity, and sexual abuse in contemporary Buddhist communities in the West.
Uruguay
Authors: Borucki Alex , Duffau Nicolás
Published: June 2017

Uruguayans living in the country and abroad have written most of the books listed here. Thus, most of these works are written in Spanish. Current Uruguayan historiography concentrates on four periods: (i) Independence with a focus on José Artigas and the regional anti-colonial fight that involved the former Viceroyalty of the Río de la Plata, (ii) the early-20th-century “Batllista” movement that shaped modern Uruguay with its radical reforms, (iii) the crisis (1960s) and dictatorship (1973–1985), including the post-1985 legacies, and (iv) the progressive Frente Amplio’s government (2005–2020), which has drawn regional and international attention to the study of the country’s past. The history of Uruguay before 1904 may be divided into three broad subperiods: the colonial era (1580–1810), revolution and independence (1810–1860), and modernization (1860–1904). While this chronology does not correspond strictly to how Uruguayan historians divide pre-1904 Uruguayan history, the post-1904 periodization presented here matches the perspectives of Uruguayan scholarship. The division in 1904 marks the end of the 19th-century civil wars and the beginning of modern Uruguay under the political, economic, social, and cultural reforms encouraged by the presidencies of José Batlle y Ordóñez. The 1904 landmark is also a proper but approximate transition to chart the usage of terms referring to the people of this country: Orientales and Uruguayans. The term Banda Oriental, or Eastern Bank, referred to the territory east of the Uruguay River, currently Uruguay. The predominant term for people born in the territory of modern-day Uruguay was Orientales, given that this land was called Banda Oriental, Provincia Oriental, and, after independence, Estado Oriental del Uruguay and its current name República Oriental del Uruguay. The descendants of the Spaniards, the criollos of Montevideo and its countryside, called themselves Orientales in the late colonial period and during the nineteenth century. The Constitutional Assembly named the new country Estado Oriental del Uruguay in May 1829, drawing on the prevalent term Oriental. Usage in the early twentieth century, when massive European immigration changed the demographics of Uruguay, increasingly made the terms “Uruguay” and “Uruguayan” prevalent, but without eliminating the expression Orientales that still is employed by Uruguayans.
Long Distance Dependencies
Authors: Larson Brooke
Published: June 2017

Words bear relations and interact with other words in every sentence. These interactions can take the form of overt morphological reflexes as well as intuitions of semantic composition and constituency. But relations that hold between linearly adjacent words come, in a sense, pre-equipped with a quasi-mechanical explanation for any interactions that may arise between them: they interact in virtue of their obvious proximity. For example, in the phrase an apple, an takes the particular form that it does (as opposed to the consonant-less a) in virtue of being immediately followed by a word that begins with a vowel. Had a different word intervened between those two, the form of the determiner would hinge upon that new word: (a red apple). Some relations do not require that linear adjacency and can hold from a distance. When one speaks of Long Distance Dependencies, it is not obvious that there is a particular length of dependency beyond which a dependency must be deemed “long.” In this work I will use Long Distance Dependency to mean any dependency that need not hold between strictly linearly adjacent words or morphemes. As such, this will include obvious instances like wh-question (which apple did you buy?) formation as well as more bounded dependencies like those of anaphora (Jane saw herself). This admittedly broad definition serves to rule-in discussion of dependencies for which distance is immediately relevant if however delimited (say clause-bound anaphora). It will also however unfortunately rule in other such non-adjacent dependencies that are not immediately relevant and thus won’t be discussed (for example, thematic role assignment to indirect objects or semantic selection restrictions between verbs and nouns). In any case, long distance dependencies are of interest precisely because they do not come so pre-equipped with a quasi-mechanical explanation. Rather, something additional must be said to explain the a priori unexpected “action at a distance.” How can things apparently far apart come to interact as if they were adjacent? The answer to this question has repercussions for the study of language as a reflection of the human mind in general as well as the study of language for its own sake.
Public Participation GIS, Participatory GIS, and Participatory Mapping
Authors: Norris Timothy B.
Published: June 2017

Participatory mapping (PM) and public/participation GIS (P/PGIS) are umbrella terms under which a variety of mapping research and practice takes place. Local people who reside “in the map” are included in the collection, analysis, sharing, and visualization of geospatial data with the goal to make GIS and cartographic practice more inclusive and democratic. To make a map, the map-maker must elicit knowledge from local people to capture the human geography of the area. Until relatively recently this cartographic process was practiced either by, or for, those in positions of power. The subsequent use of the maps most often reinforced power relations between rulers and the populations “in the map.” In post–Second World War development circles, and as a part of inclusive social science initiatives such as participatory rural appraisal (PRA) and participatory action research (PAR), PM emerged as a response to criticisms of such cartographic practices. During the same period, native peoples in Canada used land use and occupancy mapping to defend their ancestral territorial rights. Two fundamental assumptions emerged from these parallel processes that remain relevant to all participatory map-making. First, information gathered by local populations in a participatory/inclusive research design is more useful than information compiled by outside cartographers. Second, PM can empower local communities. With the advent of relatively inexpensive and readily available GIS technology in the 1990s, P/PGIS emerged as a close cousin to PM. While the power of these tools for planning and development is undeniable, researchers and practitioners recognized that P/PGIS might cause negative social effects such as marginalization of underprivileged populations and that P/PGIS lacks methods to represent qualitative aspects of culture. Indeed, debates around empowerment, inclusion, access, application, and representation of culture comprise the core of PM and P/PGIS research. Notwithstanding, there is no one definition of PM or P/PGIS and several other synonymous terms exist including participatory 3D modeling (P3DM), public participation GIS (PPGIS), community-integrated GIS (CiGIS), community GIS (CGIS), bottom-up GIS (BuGIS), and volunteered graphic information (VGI). While there are subtle differences between these terms, with VGI as a recognized outlier, definitions overlap substantially. This bibliography traces the emergence of PM and P/PGIS from the original participatory development and occupancy mapping work, follows it through the critical cartography debates in the 1980s and 1990s, covers their crystallization as fields at the turn of the 20th century, and closes with their continuing development as active research programs.
The Emerging British Verticillium longisporum Population Consists of Aggressive Brassica Pathogens
Authors: Depotter Jasper R. L. , Rodriguez-Moreno Luis , Thomma Bart P. H. J. , Wood Thomas A.
Published: June 2017

Verticillium longisporum is an economically important fungal pathogen of brassicaceous crops that originated from at least three hybridization events between different Verticillium spp., leading to the hybrid lineages A1/D1, A1/D2, and A1/D3. Isolates of lineage A1/D1 generally cause stem striping on oilseed rape (Brassica napus), which has recently been reported for the first time to occur in the United Kingdom. Intriguingly, the emerging U.K. population is distinct from the north-central European stem striping population. Little is known about the pathogenicity of the newly emerged U.K. population; hence, pathogenicity tests were executed to compare British isolates to previously characterized reference strains. In addition to the model plant Arabidopsis thaliana, the pathogenicity of four British isolates was assessed on four cultivars of three Brassica crop species: oilseed rape (Quartz and Incentive), cauliflower (Clapton), and Chinese cabbage (Hilton). To this end, vascular discoloration of the roots, plant biomass accumulations, and fungal stem colonization upon isolate infection were evaluated. The British isolates appeared to be remarkably aggressive, because plant biomass was significantly affected and severe vascular discoloration was observed. The British isolates were successful stem colonizers and the extent of fungal colonization negatively correlated with plant biomass of cauliflower and Quartz oilseed rape. However, in Quartz, the fungal colonization of A1/D1 isolates was significantly lower than that of the virulent reference isolate from lineage A1/D3, PD589. Moreover, despite levels of stem colonization similar to those of A1/D1 strains, PD589 did not cause significant disease on Incentive. Thus, A1/D1 isolates, including British isolates, are aggressive oilseed rape pathogens despite limited colonization levels in comparison with a virulent A1/D3 isolate.
Intramedullary Implant Choice and Cost in the Treatment of Pediatric Diaphyseal Forearm Fractures
Authors: Heare Austin , Goral Dawn , Belton Matthew , Beebe Corey , Trizno Anastasiya , Stoneback Jason
Published: June 2017

Objectives:

To compare outcomes and costs between titanium elastic nails (TENs), stainless steel elastic nails (SENs), and Kirschner wires (K-wires) in the treatment of pediatric diaphyseal forearm fractures with intramedullary fixation.

Design:

Retrospective cohort study.

Setting:

Level 1 Pediatric Trauma Center.

Patients/Participants:

A total of 100 patients (65 male and 35 female) younger than 18 years with diaphyseal forearm fractures treated with intramedullary fixation were included in the study.

Intervention:

Patients received single or both bone intramedullary fixation with either TENs, SENs, or K-wires.

Main Outcome Measurements:

Time to radiographic union, complication rate, surgical time, and average cost per implant.

Results:

One hundred patients were included in the study. Thirty-one patients were treated with TENs, 30 with SENs, and 39 with K-wires. No significant difference in time to radiographic union, complication rate, or surgical time was found between the 3 types of fixation. Average time to union was 9.4 ± 5.4 weeks, and complication rate was 12.9% for TENs, 10.0% for SENs, and 12.8% for K-wires. There was a significant difference in cost per implant, with an average cost of $639, $172, and $24 for TENs, SENs, and K-wires, respectively (P < 0.001).

Conclusions:

This study demonstrates no difference between TENs, SENs, and K-wires in the treatment of pediatric diaphyseal forearm fractures with regards to outcome, time to union, surgical time, or complication rates. Given the significant cost difference between these implants, we recommend that surgeons consider modifying their implant selection to help mitigate cost.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Intramedullary Fixation With Minimally Invasive Clamp-Assisted Reduction for the Treatment of Ipsilateral Femoral Neck and Subtrochanteric Fractures: A Technical Trick
Authors: Sun Qi , Ge Wei , Li RenLong , Li ShaoHua , Cai Ming
Published: June 2017

The purpose of this study is to describe a surgical technique for intramedullary fixation and minimally invasive clamp-assisted reduction with selective cerclage wiring for the management of combined ipsilateral femoral neck and subtrochanteric fractures and to present the clinical outcomes in 17 patients after treatment using this technique.
Surgical Fixation of Periprosthetic Humerus Fractures Using an Extension Plate: Surgical Technique and Report of 5 Cases
Authors: Schoch Bradley , Mehta Samir , Namdari Surena
Published: June 2017

Periprosthetic fractures after shoulder arthroplasty occur in up to 2% of patients. In patients with stable components who fail or cannot undergo nonoperative management, stable fixation is required. We present a new technique to obtain proximal fixation around the humeral component using a 4.5-mm large fragment plate and a 3.5-mm attachment plate.
Histopathologic review of negative sentinel lymph node biopsies in thin melanomas: an argument for the routine use of immunohistochemistry
Authors: Stowman Anne M. , Hickman Alexandra W. , Gru Alejandro A. , Slingluff Craig L.
Published: June 2017

Sentinel lymph node biopsy (SLNB) is performed for some thin melanomas in the presence of concerning histopathological features. There are no defined standards for how sentinel nodes should be processed to detect microscopic metastases. We compared our method of serially sectioning nodes at 2–3 mm intervals and performing one hematoxylin and eosin (H&E) slide versus multiple H&E levels and utilizing immunohistochemistry (IHC). This was a retrospective review of a prospectively collected database identified patients with thin melanomas treated with wide local excision and SLNB between 1995 and 2010. Two patients had positive nodes. Out of 95 patients with negative SLNBs, 48 (49 nodes) patients were evaluable. Additional sections of each SLNB tissue block were stained with H&E (×2), Melan-A (×2) and HMB45 (×2), and reviewed by two pathologists. Additional histopathological sections showed that 1/49 (2.0%) nodes originally called negative had evidence of metastasis, which was evident both on additional H&E levels and by IHC; 3/49 (6.1%) nodes had benign nodal rests. All other nodes (45/49, 91.8%) were negative by H&E and IHC for metastatic disease. This study supports previous work suggesting the value of IHC in detecting micrometastases in melanoma sentinel nodes. Especially for thin melanomas where metastases are uncommon, but where detection of the metastasis upstages considerably from stage IA to IIIA, evaluation of nodes may be enhanced by combining breadloafing at 2–3 mm intervals with multiple H&E sections and IHC analysis.
Quantifying Decreased Radiation Exposure From Modern CT Scan Technology and Surveillance Programs of Germ Cell Tumors
Authors: Howard Stephanie A. , Rosenthal Michael H. , Qin Lei , Matalon Shanna A. , Bernard Brandon D. , Beard Clair J. , Sweeney Christopher J.
Published: June 2017

Introduction:

Upgrading computerized tomography (CT) scanners to iterative reconstruction techniques (IRT) decreases radiation dose. This reduction, combined with changes in surveillance protocols in clinical stage I testicular cancer (CS1TC) measurably decrease the lifetime attributable risk (LAR) of dying of radiation-associated cancer.

Materials and Methods:

This IRB-approved study enrolled 24 CS1TC patients who had CT scans on the same Toshiba Aquilion 64 CT before and after IRT software installation. Dose-length product and CT dose index volume were recorded. A physicist calculated effective doses. Radiation doses were compared using the Wilcoxon signed rank test. Median effective dose per scan was multiplied by scan number based on 16 versus 7 scans in 5-year AS protocols to calculate estimated cumulative dose (ECD). LAR of dying of radiation-associated solid tumor was estimated using ECD for a single exposure at age 35 with the excess absolute risk transport model from the BEIR VII analysis of long-term atomic bomb survivors.

Results:

Median preupgrade and postupgrade effective doses were 12.5 and 7.7 mSv, respectively (P<0.0001). A linear regression model with a constrained zero intercept fit to the data found that IRT dose was estimated as 61% of filtered back projection dose (95% confidence interval, 0.56-0.66). The IRT upgrade reduced the LAR of the 16-scan protocol 35%. Combination of IRT upgrade and 7-scan protocol reduced surveillance LAR 72%.

Conclusions:

Modern CT technology combined with reduced scanning strategies can markedly decrease lifetime radiation exposure, further lowering the already small potential mortality of imaging-associated cancers.
High-Velocity Paint Gun Injuries
Authors: Wohltmann Wendi E. , Wisell Joshua A. , Lafrades Celina M. C. , Cramer Daniel M. , Ragsdale Bruce D.
Published: June 2017

Cutaneous injuries due to industrial high-pressure paint guns are well-documented in the literature; however, the histologic characteristics are uncommonly described, and facial involvement has not been previously reported. Histopathologic features of paint gun injuries vary depending on the time since injection and type of material. Early lesions display an acute neutrophilic infiltrate, edema, and thrombosis, with varying degrees of skin, fat, and muscle necrosis. More developed lesions (120–192 hours after injury) have prominent histiocytes and fibrosis around necrotic foci, possibly with the pitfall of muscle regenerative giant cells that could be mistaken for sarcoma. Continuing inflammation, swelling, and resultant vascular compression could explain ongoing necrosis months after the accident. The histopathologic differential diagnosis in the absence of clinical history includes paint in an abrasion, foreign body reaction to tattoo, giant cell tumor of tendon sheath, and various neoplasms. If available, radiologic studies can substitute for clinical photographs to indicate the extent of injury. The radiologic differential, uninformed by history, may include calcific periarthritis, gouty tophus, and tumoral calcinosis. Seven cases of injury due to high-velocity paint guns are presented with 4 additional cases mimicking paint gun injury and with review of the literature.
Mohs Mapping Fidelity: Optimizing Orientation, Accuracy, and Tissue Identification in Mohs Surgery
Authors: Li Janet Y. , Silapunt Sirunya , Migden Michael R. , McGinness Jamie L. , Nguyen Tri H.
Published: June 2017

BACKGROUND

Mohs micrographic surgery (MMS) is a highly effective process that requires consistent accuracy in resection, mapping, and histologic interpretation. Although the general sequence in MMS is similar, there are numerous variations among Mohs surgeons as to how this process is performed.

OBJECTIVE

This article aims to review the process of MMS, with the intent to identify and mitigate the potential errors at each step. Existing variations will be discussed and protocols offered to minimize error and optimize accuracy.

METHODS

A Pubmed search was performed for publications on methods of tissue mapping, orienting, and processing in MMS.

RESULTS

Our literature review highlights various techniques for tissue orientation, transfer, flattening, inking, mapping, and processing of later stages and multiple specimens. We discuss our system, which reduces error during tissue transfer, tissue identification in vivo and ex vivo, and tissue flattening. Furthermore, we discuss adaptations to increase the accuracy during reexcisions of subsequent Mohs layers.

CONCLUSION

Variations in MMS reflects the diverse training and creativity among Mohs surgeons. Unless potential errors are addressed, however, false negatives will occur and undermine the superior cure rate of MMS.
Hot flush frequency and severity at baseline as predictors of time to transient and stable treatment success: pooled analysis of two CE/BZA studies
Authors: Pinkerton JoAnn V. , Bushmakin Andrew G. , Bobula Joel , Lavenberg Joanne , Komm Barry S. , Abraham Lucy
Published: June 2017

Objective:

To evaluate the impact of baseline hot flush frequency and severity on time to symptom improvement during treatment with conjugated estrogens/bazedoxifene (CE/BZA).

Methods:

Data were pooled through week 12 from two randomized placebo-controlled trials (SMART-1 and SMART-2) of nonhysterectomized postmenopausal women with hot flushes treated with CE 0.45 mg/BZA 20 mg or CE 0.625 mg/BZA 20 mg. Time to transient and stable improvement (≥ 50% reduction in hot flush frequency/severity) was estimated using nonparametric models.

Results:

Transient improvement in hot flush frequency occurred earlier in women treated with CE 0.45 mg/BZA 20 mg with less frequent versus more frequent baseline hot flushes per day: median time to transient improvement was 2, 7, and 11 days for women with < 3, 3 to < 8, and ≥ 8 hot flushes per day at baseline, respectively (P = 0.0009). Transient improvement in severity occurred earlier for women with less severe versus more severe baseline hot flushes: median time to transient improvement was 2, 6, and 16 days for women with mild, moderate, and severe hot flushes at baseline, respectively (P < 0.0001). Stable improvement typically occurred 2 to 3 days after the transient event and was less influenced by baseline status. A similar pattern was observed with CE 0.625 mg/BZA 20 mg treatment, though improvement occurred a few days earlier than with CE 0.45 mg/BZA 20 mg.

Conclusion:

Women with more frequent/severe hot flushes take longer to achieve transient improvements with CE/BZA and should be encouraged to continue treatment, as it may take longer than a few weeks to achieve significant improvement.
Ochrobactrum anthropi Fulminant Early-onset Neonatal Sepsis: A Case Report and Review of Literature
Authors: Khasawneh Wasim , Yusef Dawood
Published: June 2017

Ochrobactrum anthropi is Gram-negative bacteria that cause infection in humans, particularly immunocompromised patients and those with indwelling central venous catheters. O. anthropi is unlikely to cause fulminant sepsis in infected patients. A few cases of late-onset neonatal sepsis have been reported in preterm infants with congenital anomalies. We hereby present the first published case of fulminant early-onset neonatal sepsis in a premature newborn.
Laryngeal mask airway as a rescue device for failed endotracheal intubation during scene-to-hospital air transport of combat casualties
Authors: Shavit Itai , Aviram Eliad , Hoffmann Yoav , Biton Oded , Glassberg Elon
Published: June 2017

Background

Advanced airway management of combat casualties during scene-to-hospital air transport is challenging. Because of the short transport time, flight physicians of the Israeli military airborne combat evacuation unit are approved for the use of a laryngeal mask airway (LMA) in the event of failed endotracheal intubation (ETI). The aim of this study was to assess the effectiveness of LMA use during scene-to-hospital transport of combat casualties in Israel.

Patients and methods

A retrospective cohort analysis of all combat casualties treated with ETI during scene-to-hospital transport over a 3-year period was carried out. Successful LMA insertion was defined as satisfactory placement of the device on the basis of adequate chest expansion with bag-mask ventilation.

Results

The median flight time from scene to hospital was 13 min [interquartile range (IQR): 9–15 min]. Sixty-five casualties underwent ETI attempts, 47 successful and 18 failed. All 18 casualties who had failed ETI underwent LMA insertion as a rescue treatment. Six casualties suffered from traumatic brain injury, six had firearm injuries, two had blast injuries, and two had inhalational injuries. LMA insertion was successful in 16/18 (88.9%) casualties, 14 survived to hospital discharge, whereas two were declared dead upon hospital arrival. Two cases of LMA insertion were unsuccessful, but patients survived to hospital discharge. Among the 16 successful cases, the median oxygen saturation on scene-pickup before LMA insertion and on hospital-handover with LMA in place were 90% (IQR: 84–96%) and 98% (IQR: 96–99%), respectively (P<0.0001, the 95% confidence interval for difference between medians was 4–11).

Conclusion

The findings of this study suggest that in the event of failed ETI, combat casualties can be treated effectively with LMA during a short scene-to-hospital transport time.
Techniques for endoscopic retrograde cholangiopancreatography in altered gastrointestinal anatomy
Authors: Moreels Tom G.
Published: June 2017

Purpose of review

This review highlights the current status of endoscopic retrograde cholangiopancreatography (ERCP) techniques in patients with altered anatomy. Endoscopic treatment of biliopancreatic disorders is particularly challenging in patients with altered anatomy.

Recent findings

There are two main approaches to perform ERCP in patients with altered anatomy: the transluminal access and the transmural access. The transluminal access uses device-assisted enteroscopy (DAE) to reach and cannulate the biliopancreatic system. The transmural access is created using therapeutic endoscopic ultrasound (EUS) or surgery to reach the biliopancreatic system. Both techniques are under continuous development and optimization.

Based on the currently available data in the literature, the transluminal access is the preferred first-line approach because of an acceptable success rate and an excellent safety profile, whereas the transmural approach may be more efficacious but with a higher complication rate, even in experienced hands. Due to the complexity of both techniques and the relative low number of procedures, patients with altered anatomy are best referred to high-volume centres where both techniques are available for optimal treatment.
Sepsis in Obstetrics
Authors: Parfitt Sheryl E. , Bogat Mary L. , Hering Sandra L. , Roth Cheryl
Published: June 2017

In spite of many medical breakthroughs, sepsis continues to be challenging to identify, treat, and successfully resolve, including among the obstetric population. Sepsis is the result of an overactive, complex inflammatory response that is not completely understood. Currently there are no nationally agreed-upon criteria for systemic inflammatory response syndrome or sepsis in pregnant or peripartum women, as the physiologic changes of pregnancy have not been taken into consideration.

This article is the first in a series of three that discuss the importance of sepsis and septic shock in pregnancy. The focus of this article is to understand the proposed pathophysiology of sepsis and new definitions associated with sepsis and septic shock. Knowledge of these conditions can assist in better identification of sepsis in the obstetric population.
Idiopathic Megacolon
Authors: Hlavaty Leigh , Sung LokMan
Published: June 2017

Abnormal dilation of the colon and rectum can develop from a range of disease processes. When encountered at autopsy, its contribution to death requires assessment and a thorough investigation of its origins. Elimination of known causes elicits a diagnosis of idiopathic megacolon. This entity is uncommonly encountered and presents with similar gross anatomic findings as Hirschsprung disease. Although death is infrequent, it most commonly results from disruption of the bowel wall and subsequent peritonitis. The authors report 2 rare deaths from idiopathic megacolon with retained integrity of the bowel wall. The first was a 9-year-old girl who was administered a laxative and subsequently died the following day. She expressed difficulty passing stool since birth with a marked decline at the age of 7 years. The second case was a 16-year-old adolescent girl with recent diarrhea who collapsed after showering. She, too, had a long history of chronic constipation. Years before death, her rectum and sigmoid colon were found to be dilated on x-ray for an unrelated event, but follow-up was never pursued. Cases such as these require a thorough review of the medical history and exclusion of established conditions, such as infectious, inflammatory, metabolic, and neurogenic origins.
Lichenoid Dermatitis of the Vulva: Diagnosis and Differential Diagnosis for the Gynecologic Pathologist
Authors: Lewin Marc R. , Hick Ryan W. , Selim Maria A.
Published: June 2017

Inflammatory processes affecting the vulva may present a unique challenge due to location specific changes. Different factors are behind the intricacy in the presentation of vulvar dermatoses. First, the vulva is lined by different epithelia (hair-bearing keratinized epithelium, modified mucosa, and mucosa). Furthermore, among other factors, this organ is exposed to friction, occlusion, and trauma. Lastly, as there is a tendency to look for health care advice at an advanced stage of the disease, the lesion may be modified by secondary changes due to self-treatment. This article describes the clinical presentation and pathologic features of vulvar dermatoses with a lichenoid pattern and highlights practical points for their diagnoses.
Use of Lower-Limb Robotics to Enhance Practice and Participation in Individuals With Neurological Conditions
Authors: Jayaraman Arun , Burt Sheila , Rymer William Zev
Published: June 2017

Purpose:

To review lower-limb technology currently available for people with neurological disorders, such as spinal cord injury, stroke, or other conditions. We focus on 3 emerging technologies: treadmill-based training devices, exoskeletons, and other wearable robots.

Summary of Key Points:

Efficacy for these devices remains unclear, although preliminary data indicate that specific patient populations may benefit from robotic training used with more traditional physical therapy. Potential benefits include improved lower-limb function and a more typical gait trajectory.

Statement of Conclusions:

Use of these devices is limited by insufficient data, cost, and in some cases size of the machine. However, robotic technology is likely to become more prevalent as these machines are enhanced and able to produce targeted physical rehabilitation.

Recommendations for Clinical Practice:

Therapists should be aware of these technologies as they continue to advance but understand the limitations and challenges posed with therapeutic/mobility robots.
Psychometric Properties of a Standardized Observation Protocol to Quantify Pediatric Physical Therapy Actions
Authors: Sonderer Patrizia , Akhbari Ziegler Schirin , Gressbach Oertle Barbara , Meichtry André , Hadders-Algra Mijna
Published: June 2017

Purpose:

Pediatric physical therapy (PPT) is characterized by heterogeneity. This blurs the evaluation of effective components of PPT. The Groningen Observation Protocol (GOP) was developed to quantify contents of PPT. This study assesses the reliability and completeness of the GOP.

Methods:

Sixty infant PPT sessions were video-taped. Two random samples of 10 videos were used to determine interrater and intrarater reliability using interclass correlation coefficients (ICCs) with 95% confidence intervals. Completeness of GOP 2.0 was based on 60 videos.

Results:

Interrater reliability of quantifying PPT actions was excellent (ICC, 0.75-1.0) in 71% and sufficient to good (ICC, 0.4-0.74) in 24% of PPT actions. Intrarater reliability was excellent in 94% and sufficient to good in 6% of PPT actions. Completeness was good for greater than 90% of PPT actions.

Conclusions:

GOP 2.0 has good reliability and completeness. After appropriate training, it is a useful tool to quantify PPT for children with developmental disorders.
Developing Overhand Throwing Skills for a Child With Autism With a Collaborative Approach in School-Based Therapy
Authors: Colebourn Jennifer A. , Golub-Victor Ann C. , Paez Arsenio
Published: June 2017

Purpose:

This case report presents an interdisciplinary approach in school-based therapy, combining physical therapy and applied behavior analysis to improve the motor skills and the participation in recreational activities of a child with autism spectrum disorder.

Methods:

A 9-year-old child with autism spectrum disorder participated in a 20-week gross motor intervention designed to improve the child's overhand throwing ability, which included weekly physical therapy instruction and daily throwing trials using applied behavior analysis approaches.

Results:

The child demonstrated gains in throwing accuracy, significant gains on measures of the Bruininks-Oseretsky Test of Motor Proficiency-2, the Test of Gross Motor Development-2, and the School Function Assessment.

Conclusion:

This unique approach in school-based therapy demonstrates effective strategies for a multidisciplinary intervention to improve motor learning skills and participation in recreational activities in the school setting.
Effectiveness of Functional Power Training on Walking Ability in Young Children With Cerebral Palsy: Study Protocol of a Double-Baseline Trial
Authors: van Vulpen Liesbeth F. , de Groot Sonja , Rameckers Eugene A. A. , Becher Jules G. , Dallmeijer Annet J.
Published: June 2017

Purpose:

To evaluate the effect of functional high-velocity resistance (power) training to improve walking ability of young children with cerebral palsy.

Methods:

Twenty-two children with bi- or unilateral spastic cerebral palsy, Gross Motor Function Classification System levels I and II, aged 4 to 10 years will be recruited. A double-baseline design will be used to compare a 14-week functional power training (3 times a week) program with a 14-week usual care period and a 14-week follow-up period. The power exercises will be loaded and performed at 50% to 70% of the maximum unloaded speed. Load will be increased when exercises are performed faster than 70% of the unloaded speed. Primary outcomes will be sprinting capacity (15-m Muscle Power Sprint Test) and goal attainment scaling score of walking-related treatment goals. Secondary outcomes will be walking speed (1-min walk test), endurance (10-m shuttle run test), gross motor function, lower-limb strength, and parent-reported mobility.
Therapy Use for Children With Developmental Conditions: Analysis of Colorado Medicaid Data
Authors: McManus Beth M. , Rapport Mary Jane , Richardson Zachary , Lindrooth Richard
Published: June 2017

Study Purpose:

To examine therapy use and spending for Medicaid-enrolled infants and toddlers with developmental conditions.

Methods:

Sample infants and toddlers had a diagnosis (eg, cerebral palsy) or developmental delay (DD). Colorado Children's Medicaid administrative outpatient therapy claims (2006-2008) were used to estimate differences, by condition type and number of comorbid chronic conditions (CCCs), of any physical therapy (PT)/occupational therapy (OT) and Medicaid PT/OT spending.

Results:

The sample included 20 959 children. Children with at least 2 CCCs had higher odds of PT/OT than children with no CCC. Children with DD had 12-fold higher odds of having any PT/OT compared with children with diagnosis. Children with a DD and 2 CCCs had the highest PT/OT spending.

Conclusions:

Medicaid PT/OT use and spending are higher for children with more CCCs and those with DD because children with DD receive more specialized PT/OT.
Avulsion of the Anterior Inferior Iliac Spine Rehabilitation in a Rural Private Practice
Authors: Burn Damon
Published: June 2017

An unusual case is presented of an 11-year-old girl presenting for treatment to a semirural private physical therapy practice, not specializing in pediatric care, following an avulsion fracture of the anterior inferior iliac spine. The patient presented initially non–weight-bearing, with little hip movement due to pain. Following treatment, the patient returned to preinjury status including return to full participation in netball. A review of the literature regarding healing and rehabilitation is described. Concepts of neuromuscular retraining were integrated in the rehabilitation program. Recent evidence demonstrates deficiencies in hip and knee control for girls between 11 and 15 years of age. Evidence suggests that these deficiencies may be a precursor to injury and poor outcomes in lower extremity injuries in this patient group.
Cross-cultural Translation and Adaptation of the Lifestyle Assessment Questionnaire (LAQ-CP) Into Dutch: A Brief Report
Authors: Beckers Laura , Speth Lucianne , Rameckers Eugène , Janssen-Potten Yvonne
Published: June 2017

Purpose:

To produce a Dutch translation of the Lifestyle Assessment Questionnaire for children with cerebral palsy (LAQ-CP), adapted for cross-cultural differences.

Methods:

The translation process consisted of 6 stages, following a guideline for cross-cultural adaptations including duplicate forward- and back-translations, expert group review, pilot-testing, and a process audit.

Results:

Several adaptations to the questionnaire were required due to cross-cultural differences. As a result of the pilot-test, the layout was adapted to the desires of the users. The process auditor stated that the process had been comprehensive and valued the quality of the work.

Conclusion:

The project resulted in a Dutch translation of the LAQ-CP, adapted for cross-cultural differences. Validation of the translated questionnaire is required before use in clinical practice and research is recommended (Dutch abstract, Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A164).
Polysaccharides from Bupleurum Induce Immune Reversal in Late Sepsis
Authors: Wang Yue-Xin , Liu Qing-yang , Zhang Mei , Yang Zhao , Pei Xin , Wu Xu , Chen Xin , Hong Jun , Xu Kai-zhi
Published: June 2017

Background:

Bupleurum chinense, a well-known Traditional Chinese Medicine, has been used for thousands of years in China. In this study, we would suggest that Bupleurum polysaccharides (BPS) could improve the prognosis of sepsis through its impact on redistribution of BMCs, which triggers immune reversal in late sepsis.

Methods:

BALB/c mice were divided into five groups: sham burn group, burn plus P aeruginosa group, burn plus P aeruginosa with BPS (40 mg/kg, 100 mg/kg, and 250 mg/kg) treatment group, and they were sacrificed at post-burn day (PBD) 0, 3, 5, and 7. BMCs, liver cells, and dendritic cells (DCs) were harvested. Flow cytometry was used to determine the change of phenotypes of DCs and isolate these cells. Cytometric beads array was utilized to analyze the level of inflammatory factors. Cell therapy of BMCs, liver cells, and DCs was administrated to explore the protective role of regional organ immunity.

Results:

BPS could decrease the lethality of burn sepsis in a dose-dependent fashion and increase both the percentage of CD11c-CD45RBhigh DCs in bone marrow (BM) and liver and the number of BMCs and liver cells significantly. Cell therapy of BMCs, liver cells, and CD11c-CD45RBhigh DCs at PBD7 could protect septic mice from sepsis.

Conclusion:

BPS has shown its potential in promoting the prognosis of post-burn sepsis through its effect on immune redistribution of BMCs, especially via differentiation of CD11c-CD45RBhigh DC cells in BM and nonimmune organs to induce immune reversal in late sepsis.
Age and Dyssynergia Subtypes Associated With Normal Sphincter Pressures in Women With Fecal Incontinence
Authors: James-Stevenson Toyia , Xu Huiping , Heit Michael , Shin Andrea
Published: June 2017

Objectives

Fecal incontinence (FI) is frequently associated with low sphincter pressures, sensory abnormalities, and advanced age. Twenty-three percent of patients with FI and 22% of healthy patients demonstrate dyssynergic defecation (DD) on high-resolution anorectal manometry. Overflow incontinence occurs in some DD patients with normal resting and squeeze anal sphincter pressures. Our aim was to identify factors associated with normal sphincter pressures in women with FI.

Methods

We reviewed medical records of 134 women with FI. Patients with normal resting and squeeze anal pressures were compared with those with abnormal pressures using Wilcoxon rank sum test and Fisher exact. Multivariable logistic regression was performed to identify factors associated with normal resting and squeeze anal pressures.

Results

Among 134 women, abnormal resting and/or squeeze pressures were identified in 113 and normal pressures were identified in 21. Women with normal sphincter pressures were younger (mean age 52.7 ± 10.8 years vs 59.0 ± 14.0 years, P = 0.036), more often had abnormal defecation indices (100% vs 83.2%, P = 0.043) and higher rectal defecation pressures (30.8 ± 18.8 mm Hg vs 50.8 ± 22.6 mm Hg, P < 0.001). There was an overall association between DD subtype and normal and abnormal sphincter pressure groups (P = 0.021). Dyssynergia subtypes I or III (odds ratio, 7.2; 95% confidence interval, 1.8–28.8) and age younger than 67 years (odds ratio, 8.5; 95% confidence interval, 1.5–48.6) were associated with greater odds of having normal sphincter pressures.

Conclusions

Female FI patients with normal anal sphincter pressures are younger, have higher rectal defecation pressures, and more often have type I or type III DD.