bluuebunny/crossref_metadata_2025 huggingface dataset:
Final report for CCQM-K107: total elements and selenomethionine in human serum
Authors: Infante Heidi Goenaga
Published: March 2016

Routine tests that measure the concentration of electrolytes in serum are needed for diagnosis and management of renal, endocrine, acid-base, water balance and other conditions such as screening D- and A-vitamin disorders, kidney insufficiency, bone diseases and leukaemia. The diagnostic concentration ranges for many such markers are narrow, requiring reference methods with small uncertainty. Serum concentration of total selenium (Se) is important in health studies but there is increasing interest in the speciation of selenium compounds in clinical samples such as serum and individual Se- Species are bio-indicators of Se status.

The last CCQM IAWG key comparison for elements in the clinical area (CCQM-K14: Ca in human serum) was organized in 2003 and the previous key comparison (CCQM-K60) for Se and Se species used a wheat flour sample. Therefore, the CCQM IAWG agreed that CCQM-K107 and a parallel pilot study CCQM-P146 should be carried out. The candidate human serum sample used for both CCQM-K107 and P146 is of high complexity and contains approximately 1000-fold lower concentrations of selenium methionine (SeMet) than those encountered in the CCQM-K60 wheat flour. This significantly broadens the scope and degree of difficulty of earlier measurements in this field.

A total of eleven institutes participated in CCQM-K107 (11 participants for total elements and 7 for SeMet). The performance of the majority of the K107 participants for all the measurands was very good, illustrating their ability to obtain accurate results for analytes such as electrolytes at mg kg-1 level, essential elements at µg kg-1 level and selenium species at µg kg-1 level in a complex biological fluid. The range of agreement between participants was within the interval of ± 0.1% for Ca and up to ± 1.8% for Fe.

CMC claims based on total elements in this study may include other elements with similar core competencies (e.g. Se, Cu, Zn) in a wide range of biological materials (including liquids and solids) at a similar level of performance using the same measurement technique applied in CCQM-K107 provided that there are no additional factors (e.g. blank or dissolution issues). CMC claims based on SeMet measurements in this study may be applied to other biological matrices (e.g., tissues) provided that the concentration range is similar and due diligence is taken to ensure an appropriate extraction process is achieved and species specific spikes are available for quantitation by isotope dilution. Indeed, having accepted such conditions, application to quantitation of other organometallic species and other elements in similar matrices should be possible with the same level of performance.

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Retracted: One-pot synthesis of a gold nanoparticle–Vmh2 hydrophobin nanobiocomplex for glucose monitoring
Authors: Politi Jane , De Stefano Luca , Rea Ilaria , Gravagnuolo Alfredo Maria , Giardina Paola , Methivier Christophe , Casale Sandra , Spadavecchia Jolanda
Published: March 2016

HydrophobinVmh2 is a small amphiphilic protein, which self-assembles on different surfaces and naturally interacts with glucose. Here, we report on the synthesis of a nanobiocomplex made of polyethylene glycol, Vmh2 and gold nanoparticles by a one-step process and on its ability to recognise glucose in an aqueous solution at 0.3–0.6–1.2 mg ml−1 concentrations. Even though the Vmh2 proteins are intrinsically bonded to the gold core, effective glucose interaction monitoring was demonstrated by using dynamic light scattering, ultraviolet–visible, polarization-modulated infrared reflection–absorption  and x-ray photoelectron spectroscopies. Experimental results highlighted an affinity constant of 7.3 ± 0.3 mg ml−1 between the nanobiosystem and the sugar, and a detection sensitivity of 0.13 ± 0.06 a.u./mg ml−1.
Clinical features of gout
Authors: Dalbeth Nicola
Published: March 2016

About 60% of the variance in serum urate levels can be explained by inherited genetic factors, but the extent of the contribution of genetic factors to gout in the presence of hyperuricaemia is not known. Genome-wide association studies in Europeans have identified 28 loci controlling serum urate levels, although the molecular basis of the majority of these genetic associations is currently unknown. The SLC2A9 and ABCG2 renal and gut uric acid transporters have very strong effects on urate levels and the risk of gout. Other uric acid transporters (e.g. SLC22A11/OAT478, SLC22A12/URAT1) and a glycolysis gene (GCKR) are associated with urate levels. Environmental exposures such as sugar-sweetened beverages and alcohol interact with urate-associated genetic variants in an unpredictable fashion. Very little is known about the genetic control of gout in the presence of hyperuricaemia, formation of monosodium urate crystals, and the immune response.
Laboratory testing in gout diagnosis and management
Authors: Dalbeth Nicola
Published: March 2016

Gout typically presents as recurrent flares of acute self-limiting arthritis. The acute gout flare is characterized by severe joint inflammation. In the presence of prolonged untreated hyperuricaemia, some people with gout may develop gouty tophi, which cause retracted joint movement, ulceration, and joint damage. The differential diagnosis for gout includes septic arthritis (which may co-exist with gout), joint injury, calcium pyrophosphate deposition, basic calcium phosphate arthritis or tendinitis, reactive arthritis, and psoriatic arthritis.
Urate-lowering therapy agents
Authors: Dalbeth Nicola
Published: March 2016

Xanthine oxidase (allopurinol or febuxostat) is considered first-line urate-lowering therapy. Combination therapy with uricosuric agents may be required. The choice of urate-lowering therapy is dictated by co-morbidities, particularly renal and hepatic impairment. Appropriate monitoring for drug adverse effects as well as serum urate to ensure targets are achieved is required.
Gout research tools
Authors: Dalbeth Nicola
Published: March 2016

Although most tools used in gout research are generic, there are some important gout-specific instruments. New gout classification criteria were published in 2015. Outcome measure domains have been identified for both acute and chronic gout studies. A preliminary flare definition has been reported. Gout-specific, patient-reported outcome measure instruments allow assessment of gout disease activity and impact of tophi. Imaging scoring systems allow quantification of joint damage, inflammation, and urate burden in gout.
The future of gout management
Authors: Dalbeth Nicola
Published: March 2016

At present, despite the increasing prevalence of the disease, gout is poorly treated. Alternative models of care within primary care offer new opportunities for effective gout management. In addition to more effective use of approved agents, future gout management will be improved with increasing availability of new urate-lowering drugs. The role of urate-lowering therapy for asymptomatic hyperuricaemia, particularly in the context of co-morbid conditions such as chronic kidney disease, hypertension, and coronary artery disease is currently unknown; large clinical trials are needed to address this key question. Wider and earlier adoption of urate-lowering therapy in those with established gout is likely to reduce the long-term impact of this common condition.
An urgent and frequent symptom
Authors: Stern William M. , Panicker Jalesh N.
Published: March 2016

Lower urinary tract symptoms such as urgency, daytime frequency, nocturia, and incontinence commonly occur in patients with neurological disorders. These problems may significantly impact quality of life for patients, who may be embarrassed to report them unless specifically questioned. Through a case report, this case outlines the essentials of history-tak ing and key investigations required to establish the cause of urinary difficulties, along with the differential diagnosis. We discuss various pharmacological treatments for bladder dysfunction, outlining their indications, mechanisms of action, and side effects. Non-pharmacological treatments are also discussed, such as different strategies for catheterization and electrical nerve stimulation. The case includes expert comments highlighting common pitfalls and tips for clinicians seeing neurological patients who report urinary symptoms.
Not moving a muscle
Authors: Rayan Dipa Raja , Turner Chris
Published: March 2016

This case uses a case to illustrate the common presentations of myotonic dystrophy type 1 and the large variability of phenotypes within a family. It discusses the key differentials to consider when patients present with myotonia, as well as the primary investigations to perform when confirming the diagnosis. It discusses the most important aspects in the multidisciplinary management of the condition, including the key aspects of managing respiratory and cardiac manifestations. It also outlines some of the landmark trials affecting the management of the disease, including the efficacy of mexiletine in treating myotonia and the importance of pacing in this cohort. Thereby it gives an overview of the key aspects of diagnosis and management of myotonic dystrophy for the clinician.
Picking out an inherited disease
Authors: Rubio-Agusti Ignacio , Lachmann Robin
Published: March 2016

Inherited metabolic disorders can present at any age and can affect single or multiple organ systems. Because of its complex structure and metabolism, nervous system involvement is prominent in a wide range of these diseases. It is important to make the diagnosis as disease-modifying therapy is now available for a number of these conditions and, even when specific treatment is not available, genetic counselling can be important for other members of the family. Metabolic disorders should be suspected in all patients with neurological or psychiatric symptoms, particularly those with a complex phenotype involving several neurological systems. Special attention must be given during history-tak ing and examination to identify specific systemic features that may help in narrowing an otherwise vast differential diagnosis. As an example, we discuss a man with Niemann-Pick disease type C, a progressive neurovisceral lysosomal storage disorder. We discuss the presentation, diagnosis, and management.
An unusual case of basilar stroke
Authors: Kennedy Fiona , Brown Martin M.
Published: March 2016

The basilar artery and two vertebral arteries comprise the vertebrobasilar system and supply the posterior part of the circle of Willis and the posterior cerebral arteries. Vertebrobasilar disease accounts for approximately 20 per cent of ischaemic stroke. Occlusion of the basilar artery is an uncommon cause of stroke, but carries a poor prognosis with mortality rates up to 90 per cent. Patients who do survive rarely regain functional independence and are at risk of recurrent strokes. Patients with basilar artery occlusion can present with reduced level of consciousness, the locked-in state, hemi- or tetraplegia, cortical blindness, and cranial nerve palsies causing horizontal gaze palsy, facial palsy, and oropharyngeal palsy. Interventional techniques, including intravenous and intra-arterial thrombolysis, mechanical clot retrieval, and stent insertion, are available for basilar artery thrombosis. However, none of these approaches have been evaluated in terms of randomized controlled trials.
Parkinsonism with little response to levodopa
Authors: Doherty Karen M. , Houlden Henry
Published: March 2016

Multiple system atrophy (MSA) is an α-synucleinopathy clinically characterized by autonomic disturbance, parkinsonism, and cerebellar ataxia occurring in any combination. Other clinical features include pyramidal signs, dystonia, and REM sleep behaviour disorder (RBD) and early bladder involvement. Mean age at onset is mid to late fifties, earlier than the other atypical parkinsonian disorders (progressive supranuclear palsy and corticobasal syndrome) and rarely over 70 years. MSA can be subdivided into a predominantly parkinsonian type (MSA-P) and a predominantly cerebellar type (MSA-C) depending on the principal clinical features. MSA-P is the more common subtype found in Europe and is associated with a more rapid progression to loss of function; MSA-C is generally less common, but is the more common variant in Japan. Almost all patients, often later in the disease, will have symptoms of autonomic disturbance such as urinary dysfunction and orthostatic hypotension. Disease duration is typically 7–8 years.
Non-convulsive status epilepticus
Authors: Novy Jan , Chinthapalli Krishna , Mula Marco
Published: March 2016

Non-convulsive status epilepticus can be a challenging diagnosis as it often relies on EEG confirmation. Prognosis is largely dependent on the underlying cause and investigations should be continued until aetiology is identified. Some forms, such as absence status epilepticus, are widely considered as harmless. The aggressiveness of acute treatment should be tailored to the type of status epilepticus, the underlying cause, and the overall condition of the patient. Treatment should be conducted alongside investigations. First-line treatment comprises benzodiazepines such as lorazepam or midazolam followed by antiepileptic drugs such as phenytoin, sodium valproate, and levetiracetam. In refractory cases, treatment with anaesthetic agents may be necessary and should be balanced with the risk of complications.
A life-threatening drug reaction
Authors: Chinthapalli Suchitra , O’Toole Edel
Published: March 2016

This case describes a case of toxic epidermal necrolysis (TEN) occurring secondary to anti-epileptic drug (AED) use for seizures. It outlines the clinical features that patients with TEN present with as well as the diagnosis and management of this serious condition. It discusses up to date research on risk factors for developing serious cutaneous reactions secondary to AED use, including dosing of drug use, different types of AEDs, and genetic factors such as HLA alleles. It outlines other serious and common cutaneous reactions secondary to AEDs, including Stevens-Johnson syndrome (SJS) and exanthems, with advice regarding management. Photographs are provided to aid clinical recognition.
On the emitting region of X-ray fluorescent lines around Compton-thick AGN
Authors: Liu Jiren
Published: March 2016

X-ray fluorescent lines are unique features of the reflection spectrum of the torus when irradiated by the central active galactic nuclei (AGN). Their intrinsic line width can be used to probe the line-emitting region. Previous studies have focused on the Fe K α line at 6.4 keV, which is the most prominent fluorescent line. These studies, however, are limited by the spectral resolution of currently available instruments, the best of which is ∼1860 km s−1 afforded by the Chandra High-Energy Grating (HEG). The HEG spectral resolution is improved by a factor of 4 at 1.74 keV, where the Si K α line is located. We measured the full width at half-maximum of the Si K α line for Circinus, Mrk 3, and NGC 1068, which are 570 ± 240, 730 ± 320, and 320 ± 280 km s−1, respectively. They are 3–5 times smaller than those measured with the Fe K α line previously. It shows that the intrinsic widths of the Fe K α line are most likely to be overestimated. The measured widths of the Si K α line put the line-emitting region outside the dust sublimation radius in these galaxies. It indicates that for Compton-thick AGN, the X-ray fluorescence material are likely to be the same as the dusty torus emitting in the infrared band.
Ultradiffuse galaxies: the high-spin tail of the abundant dwarf galaxy population
Authors: Amorisco N. C. , Loeb A.
Published: March 2016

Recent observations have revealed the existence of an abundant population of faint, low surface brightness (SB) galaxies, which appear to be numerous and ubiquitous in nearby galaxy clusters, including the Virgo, Coma and Fornax clusters. With median stellar masses of dwarf galaxies, these ultradiffuse galaxies (UDGs) have unexpectedly large sizes, corresponding to a mean SB of 24 ≲ 〈μe〉r mag−1 arcsec2 ≲ 27 within the effective radius. We show that the UDG population represents the tail of galaxies formed in dwarf-sized haloes with higher-than-average angular momentum. By adopting the standard model of disc formation – in which the size of galaxies is set by the spin of the halo – we recover both the abundance of UDGs as a function of the host cluster mass and the distribution of sizes within the UDG population. According to this model, UDGs are not failed L* galaxies, but genuine dwarfs, and their low SB is not uniquely connected to the harsh cluster environment. We therefore expect a correspondingly abundant population of UDGs in the field, with possibly different morphologies and colours.
Impact of Prior Tissue Expander/Implant on Postmastectomy Free Flap Breast Reconstruction
Authors: Roostaeian Jason , Yoon Alfred P. , Ordon Shannon , Gold Chris , Crisera Christopher , Festekjian Jaco , Da Lio Andrew , Lipa Joan E.
Published: March 2016

Background:

Implant-based breast reconstructions can result in unsatisfactory results requiring surgical revision or salvage reconstructive surgery with autologous tissue. This study compares the outcomes and complications of salvage (tertiary) flap reconstruction after failed prosthesis placement to those of primary/secondary flap reconstruction.

Methods:

All patients undergoing free flap breast reconstruction after failed prosthesis between July 1, 2005, and June 30, 2014, were identified. A matched number of patients who underwent a de novo free flap breast reconstruction were selected randomly for review. The indication for prosthesis removal, demographic and operative data, flap type and inset, and complication rates were evaluated.

Results:

Eighty-nine women with a history of failed implant-based reconstruction required free flap reconstruction for salvage in 121 breasts. Capsular contracture was the most common indication for prosthesis removal (62.0 percent). Recipient vessel scarring was 5.23 times more likely to occur in the prior prosthesis group (p < 0.001). Alternate flap types other than deep inferior epigastric perforator and transverse rectus abdominis myocutaneous flaps were more frequently used in this cohort. Major complications requiring operative management were more common in the experimental group (17.4 percent versus 8.1 percent; p = 0.035). No difference was noted in flap loss rates, operative take back, or operative time.

Conclusions:

Salvage breast reconstruction with autologous tissue after failed prosthesis can be safely performed, with success rates similar to those of primary free flap breast reconstruction. However, these procedures may have increased complexity because of recipient vessel scarring, higher rates of prior radiation therapy, and major complications, which may warrant appropriate preoperative planning and patient counseling.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Breast Implant Informed Consent Should Include the Risk of Anaplastic Large Cell Lymphoma
Authors: Clemens Mark W. , Miranda Roberto N. , Butler Charles E.
Published: March 2016

Breast implant–associated anaplastic large cell lymphoma (ALCL) is a rare T-cell lymphoma arising around breast implants. Public awareness has increased following a safety communication warning of the association of breast implant–associated ALCL by the U.S. Food and Drug Administration in 2011. Difficulty with determining an accurate assessment of risk, including diagnosis, or standardized treatment regimen has led surgeons to commonly omit preoperative discussion of this rare and frequently misunderstood cancer. Risk disclosure is a form of respect for patient autonomy, and informed consent has positive practical and moral consequences for the practice of plastic surgery. A model of breast implant–associated ALCL informed consent implementation and health care provider education are reviewed with 1-year process follow-up at a tertiary cancer center. Breast implant–associated ALCL should be included during preoperative counseling on the risks of breast implantation when obtaining informed consent. Pertinent aspects of decision-making include disease awareness, presenting symptoms, and resources for concerned patients. Education of health care professionals and provision of patient-focused materials ensures effectiveness of the informed consent process.
Traumatic Finger Amputation Treatment Preference among Hand Surgeons in the United States and Japan
Authors: Shauver Melissa J. , Nishizuka Takanobu , Hirata Hitoshi , Chung Kevin C.
Published: March 2016

Background:

Large geographic differences in procedure utilization draw into question its appropriate use. In Japan, replantation is frequent for even very distal finger amputations. In the United States, revision amputation is far more common. There has been no detailed investigation into the drivers of these differences.

Methods:

The authors created a survey to assess experience with replantation, estimates of physical and functional outcomes, attitudes toward amputees, and preferences in several injury scenarios. The survey was distributed to members of the Finger Replantation and Amputation Multicenter Study and to hand surgeons making podium presentations at the Thirty-Second Annual Meeting of the Central Japanese Society for Surgery of the Hand.

Results:

One hundred percent of both groups responded. There were no significant differences in surgeon experience. Japanese surgeons were significantly more likely to recommend replantation in all scenarios, despite 62 percent ranking function 6 months after replantation as “poor.” Japanese surgeons also rated the appearance of a hand with an amputated finger significantly poorer. Finally, Japanese surgeons were significantly more likely to report stigmatization against finger amputees.

Conclusions:

There is no study with a high level of evidence comparing outcomes following replantation and revision amputation. The lack of evidence results in surgeons basing recommendations on personal preference. In this case, Japanese surgeons preferred replantation despite agreeing that functional outcomes were suboptimal. This may be because of Japanese cultural beliefs. Comparative effectiveness research, such as that planned by the Finger Replantation and Amputation Multicenter Study, can provide evidence toward the appropriate use of replantation.
Induced Pluripotent Stem Cell–conditioned Medium Suppressed Melanoma Tumorigenicity Through the Enhancement of Natural-Killer Cellular Immunity
Authors: Hsieh Chang-Ting , Luo Yung-Hung , Chien Chian-Shiu , Wu Chieh-Hung , Tseng Pei-Chun , Chiou Shih-Hwa , Lee Yu-Chin , Whang-Peng Jacqueline , Chen Yuh-Min
Published: March 2016

Induced pluripotent stem cells (iPSCs) can secrete cytokines that are involved in T-cell development and affect cytotoxic activity. To assess the effect of iPSC-conditioned medium on tumorigenicity, we retrieved splenocytes from B6 mice and cocultured them with or without irradiated B16 melanoma cells, mouse interleukin-2 (mIL-2), or iPSC-conditioned medium. Splenocyte cytotoxicity assays against B16 melanoma cells [as cytotoxic T lymphocyte (CTL) activity] and P815 cells [as natural killer (NK) activity] were performed. IL-10 and interferon-γ concentrations were measured. An in vivo subcutaneous B16 melanoma growth model was performed in B6 mice and treated with iPSC-conditioned medium. The lymphocyte subpopulation depletion test was performed to determine effectors against B16 melanoma cells. We found that unstimulated splenocytes had little cytotoxic activity. Without tumor cells, mIL-2 could augment iPSC-conditioned medium-treated CTL and NK activities (P<0.01). With irradiated tumor cells, mIL-2 treatment of splenocytes could not enhance CTL or NK activity, but iPSC-conditioned medium could enhance CTL and NK activity (P<0.001). Irradiated tumor cells induced mice splenocytes to secrete more IL-10, similar to mIL-2 treatment, but not iPSC-conditioned medium treatment. mIL-2 had better efficacy than conditioned medium in inducing splenocyte interferon-γ production. The CTL and NK cell depletion test showed that the immunostimulating effect of iPSC-conditioned medium on splenocytes was through the enhancement of NK cellular activity (P<0.05). The subcutaneous melanoma growth model showed that B16-bearing mice treated with an iPSC-conditioned medium intraperitoneal injection had a decreased tumor growth rate (P<0.01). Our study suggests that iPSC-conditioned medium had a protective effect against tumor-induced immunosuppression through the enhancement of host NK cellular activity.
Adjuvant Pelvic Radiation Therapy±Vaginal Brachytherapy in Patients With High-risk Stage I or Stage II Uterine Papillary Serous, Clear Cell, and High-grade Endometrioid Carcinoma
Authors: Nagar Himanshu , Yan Weisi , Parashar Bhupesh , Nori Dattatreyudu , Chao K.S.C. , Christos Paul , Gupta Divya , Holcomb Kevin , Caputo Thomas , Wernicke A. Gabriella
Published: March 2016

Purpose:

Radiation therapy (RT) for stages I-II uterine papillary serous carcinoma (UPSC), clear cell (CC), and high-grade endometrioid (HGE) carcinoma present a treatment challenge. Regimens include external beam radiotherapy (EBRT) with or without brachytherapy. We examine the use of these radiation modalities in these endometrial cancers (EC) with respect to cause-specific survival (CSS).

Methods:

The Surveillance, Epidemiology, and End Results (SEER) database was queried for patients with AJCC stages I-II UPSC, CC, or HGE cancer treated with hysterectomy and RT between 1998 and 2008. Patients who did not receive adjuvant RT or received brachytherapy alone were excluded. CSS was evaluated by the Kaplan-Meier survival analysis and the log-rank test was used to compare CSS. Multivariate analysis was performed using the Cox proportional hazards regression model. Adjusted hazard ratios (HR) were calculated for risk of EC death.

Results:

There were 1653 patients included in this analysis. The overall 100-month CSS for the entire cohort was 81.0%. The 100-month CSS was 85.3% for EBRT alone and 86.5% for EBRT+brachytherapy (P=0.72). Stage IC/IIA/IIB patients had a greater risk of EC death compared with stage IA/IB patients (adjusted HR=2.39; P<0.0001). Patients with UPSC and CC had a slightly higher risk of EC death compared with HGE (adjusted HR=1.01 [P=0.97] and 1.42 [P=0.02], respectively). On subset analysis, there was no difference in CSS with the addition of brachytherapy for UPSC (P=0.37), CC (P=0.27), or HGE cancer patients (P=0.42). Patients treated with brachytherapy in addition to EBRT did not demonstrate a reduced adjusted risk of EC death compared with EBRT alone (P=0.38).

Conclusions:

The addition of brachytherapy to adjuvant EBRT in stages I-II UPSC, CC, and HGE cancer did not demonstrate superior CSS. Thus, patients may not benefit from the addition of brachytherapy to EBRT.
Oncologic and Functional Hazards of Obesity Among Patients With Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiation Therapy
Authors: Park In J. , You Y. Nancy , Skibber John M. , Rodriguez-Bigas Miguel A. , Das Prajnan , Eng Cathy , Kopetz Scott , Wolff Robert A. , Crane Christopher H. , Krishnan Sunil , Minsky Bruce , Hu Chung-Yuan , Nguyen Sa , Chang George J.
Published: March 2016

Objective:

Obesity is a major health concern and risk factor for colorectal cancer that may also impact cancer treatment and outcomes. Rectal cancer response to chemoradiotherapy (CXRT) is associated with long-term survival and sphincter preservation. The purpose of this study was to evaluate the impact of obesity on treatment outcomes after neoadjuvant CXRT for rectal cancer.

Methods:

A retrospective cohort study of patients diagnosed (1993 to 2010) with cT3-4 or cN+ (by endorectal ultrasound, computed tomography, or magnetic resonance imaging) rectal carcinoma and treated with CXRT and total mesorectal excision was performed. Patients were classified as obese (body mass index ≥30 kg/m2) or nonobese (body mass index <30 kg/m2), and by response to CXRT: complete (pCR) or incomplete (pIR). Associations between obesity, tumor response, and sphincter preservation were evaluated using multivariate logistic regression analysis and survival outcomes by Cox regression.

Results:

A total of 753 patients met criteria and 28.7% (n=216) patients were obese. Obese and nonobese groups did not differ in age, sex, tumor location, grade, or number of examined lymph nodes. However, obesity was associated with a lower rate of pCR (ORmulti=0.60; 95% confidence interval, 0.38-0.94; P=0.04) and among mid to low rectal cancer patients, a lower rate of sphincter preservation (ORmulti=0.67; 95% confidence interval, 0.45-0.99). Among both obese and nonobese patients, CR was associated with more favorable recurrence-free survival than pIR.

Conclusions:

Considering the increasing obesity prevalence and its association with CXRT response, oncologic outcomes, and sphincter preservation, further study is needed regarding the impact of obesity on neoadjuvant treatment response. Moreover, obesity should be targeted as a modifiable risk factor for adverse outcomes following multimodality treatment for rectal cancer.
Use of Metabolic Parameters as Prognostic Factors During Concomitant Chemoradiotherapy for Locally Advanced Cervical Cancer
Authors: Krhili Samar , Muratet Jean-Pierre , Roche Sophie , Pointreau Yoann , Yossi Sena , Septans Anne-Lise , Denis Fabrice
Published: March 2016

Objectives:

To investigate the use of metabolic parameters as early prognostic factors during concomitant chemoradiotherapy for locally advanced cervix carcinoma (LACC).

Materials and Methods:

Between February 2008 and January 2012, 34 consecutive patients treated for LACC (International Federation of Gynecology and Obstetrics Staging System stage IB2-IVA) were included in a retrospective study. Treatment was standard of care: total dose of 45 Gy in 1.8 Gy per fraction with concurrent cisplatin followed by brachytherapy. 18F-FDG PET-CT modalities were performed before treatment and per-treatment (at 40 Gy). The analyzed parameters were: maximum standardized uptake value (SUVmax), SUVmax variations of the primary tumor between the 2 investigations (DSUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Survival was assessed according to early metabolic changes during chemoradiotherapy.

Results:

Median follow-up was 16 months (range, 5.3 to 32.4 mo). Median SUVmax before treatment was 13.15 (5.9 to 31) and was 5.05 (0 to 12) per-treatment. Median DSUVmax was 63.97% (0% to 100%). Median MTV before treatment was 44.16 mL (3.392 to 252.768 mL) and was 5.44 mL (0 to 69.88 mL) per-treatment. Median TLG before treatment was 249.82 mL (13.40 to 1931.10 mL) and was 20.14 mL (0 to 349.99 mL) per-treatment. At 40 Gy, SUVmax≥6, DSUVmax≤40%, MTV≥5.6 mL, and TLG≥21.6 mL were significantly associated with overall survival and progression-free survival reduction. MTV predicted progression with a sensitivity of 80% and a specificity of 87.5% and TLG with a sensitivity of 80% and a specificity of 83.3%.

Conclusions:

PET-CT imaging could be useful as an early prognostic factor during treatment for LACC. MTV and TLG seem to provide better prognostic information than SUVmax and DSUVmax.
Preenlistment and Early Service Risk Factors for Traumatic Brain Injury in the Army and Marine Corps: FY 2002-2010
Authors: Elmasry Hoda , Boivin Michael R. , Feng Xiaoshu , Packnett Elizabeth R. , Cowan David N.
Published: March 2016

Objective:

To determine the preenlistment and early service risk factors for traumatic brain injury (TBI)-related disability in Army and Marine Corps service members.

Design:

Matched case-control design.

Main Outcome:

TBI disability discharges.

Subjects:

Army and Marine Corps service members with an enlistment record and disability discharge for TBI were included as cases. Controls were selected from the enlisted population with no disability evaluation record and were matched on fiscal year of enlistment, sex, and service at a ratio of 5:1.

Results:

Older age at enlistment resulted in a significantly increased risk for TBI disability in the crude and adjusted models (adjusted odds ratio [aOR] = 1.49; 95% confidence interval [CI], 1.16-1.91). An enlistment military occupational specialty (MOS) with a combat arms designation resulted in an almost 3-fold increased odds of TBI disability compared with other MOS categories (aOR = 2.75; 95% CI, 2.46-3.09). This remained a significant risk factor for TBI disability in the multivariate model (aOR = 2.74; 95% CI, 2.45-3.08).

Conclusion:

Results from this study help inform the existing body of military TBI research by highlighting the preenlistment demographic and early service risk factors for TBI disability. Further research into the role of age on TBI disability in the military is merited.
Research on rehabilitation interventions for adults living with HIV: a scoping review
Authors: Stevens Marianne E. , Nixon Stephanie A.
Published: March 2016

The aim of this paper is to use a scoping review to investigate the extent, range, and nature of research on rehabilitation interventions for adults living with HIV. Electronic databases (MEDLINE, EMBASE, CINAHL, AMED, and PsychINFO) and reference lists of the included articles were searched. Authors were emailed when possible for unavailable articles. A total of 897 titles and abstracts were retrieved. Thirty-three articles were included. There were 27 different rehabilitation interventions delivered by 18 professions. The studies were completed in four different countries. Most studies were published in 2008. A randomized-controlled trial was the most used method. The nature of the studies was analyzed according to the three-core concepts of the International Classification of Functioning, Disability and Health: 28 studies addressed impairments; six studies addressed activity limitations; and 14 studies addressed participation restrictions. This scoping study advances the knowledge of research on rehabilitation interventions for adults living with HIV. More research on rehabilitation interventions is needed in sub-Saharan Africa and other low-income and middle-income countries to ensure that these individuals are receiving the best possible care. There is a need for the HIV field to recognize the important contribution of rehabilitation toward the HIV care continuum.
A Nursing Semester in a Developing Country
Authors: Steen Sue , Zdechlik Lynn
Published: March 2016

Nurses need to gain knowledge and experience that will assist them to practice in a global environment. This article shares the unique experiences of a university in providing a semester of nursing study in a developing country. What makes this experience unique is that theory and clinical courses were taught similarly on both the US and Ugandan campuses. Benefits and challenges of the semester are discussed, as well as details of planning, implementation, and posttrip conclusions.
An Integrative Review of Cybercivility in Health Professions Education
Authors: De Gagne Jennie C. , Choi Min , Ledbetter Leila , Kang Hee Sun , Clark Cynthia M.
Published: March 2016

Although incivility in higher education has been widely described, little evidence exists regarding incivility among health professions students in online environments. This study aims to integrate literature on cybercivility in health professions education. The extent to which health professions students and faculty experience cyberincivility, the direct and indirect effects and actions taken after cyberincivility, and themes that guide facilitation of cybercivility are discussed. Efforts to prevent cyberincivility can be achieved through focused education on cybercivility, development of clear policies related to its consequences, and formulation of guidelines for both student and faculty behavior online.
Detecting Gene Rearrangements in Patient Populations Through a 2-Step Diagnostic Test Comprised of Rapid IHC Enrichment Followed by Sensitive Next-Generation Sequencing
Authors: Murphy Danielle A. , Ely Heather A. , Shoemaker Robert , Boomer Aaron , Culver Brady P. , Hoskins Ian , Haimes Josh D. , Walters Ryan D. , Fernandez Diane , Stahl Joshua A. , Lee Jeeyun , Kim Kyoung-Mee , Lamoureux Jennifer , Christiansen Jason
Published: March 2016

Targeted therapy combined with companion diagnostics has led to the advancement of next-generation sequencing (NGS) for detection of molecular alterations. However, using a diagnostic test to identify patient populations with low prevalence molecular alterations, such as gene rearrangements, poses efficiency, and cost challenges. To address this, we have developed a 2-step diagnostic test to identify NTRK1, NTRK2, NTRK3, ROS1, and ALK rearrangements in formalin-fixed paraffin-embedded clinical specimens. This test is comprised of immunohistochemistry screening using a pan-receptor tyrosine kinase cocktail of antibodies to identify samples expressing TrkA (encoded by NTRK1), TrkB (encoded by NTRK2), TrkC (encoded by NTRK3), ROS1, and ALK followed by an RNA-based anchored multiplex polymerase chain reaction NGS assay. We demonstrate that the NGS assay is accurate and reproducible in identification of gene rearrangements. Furthermore, implementation of an RNA quality control metric to assess the presence of amplifiable nucleic acid input material enables a measure of confidence when an NGS result is negative for gene rearrangements. Finally, we demonstrate that performing a pan-receptor tyrosine kinase immunohistochemistry staining enriches detection of the patient population for gene rearrangements from 4% to 9% and has a 100% negative predictive value. Together, this 2-step assay is an efficient method for detection of gene rearrangements in both clinical testing and studies of archival formalin-fixed paraffin-embedded specimens.
Secondary Neck Lift and the Importance of Midline Platysmaplasty: Review of 101 Cases
Authors: Narasimhan Kailash , Ramanadham Smita , O’Reilly Eamon , Rohrich Rod J.
Published: March 2016

Background:

The authors believe that open access to the submental region, platysmaplasty, and wide skin undermining provide the most long-lasting results in neck rejuvenation, and sought to evaluate this hypothesis by reviewing their neck-lift patients.

Methods:

The authors performed a retrospective chart review of their experience with neck-lift procedures and patients who underwent a secondary procedure. Patient age, sex, initial technique, visible neck deformities, and reasons for revision were assessed. Photographs were used to assess the features of persistent or recurrent neck-lift deformity and techniques to correct them.

Results:

Of 1089 neck lifts reviewed, 101 patients underwent secondary or revision procedures (approximately 10 percent of total). The average patient age was 57.4 years, 95 percent were women, and secondary procedures were performed 10.3 years after the first procedure. Seventy percent of the revisions were of the authors’ own primary neck lifts, and all of these after 10 years. The most common aesthetic deformities—recurrent platysmal bands (87 percent), persistent/recurrent jowling (48 percent), fat malposition/irregularities (10 percent), and vertical band deformity (8 percent)—were most often corrected with open platysmaplasty and medial or lateral plication and skin redraping. All patients had their submental region opened in the secondary procedure. All secondary operations were performed at least 10 years after primary surgery.

Conclusions:

The authors believe their technique of open submental neck access and platysmal approximation in patients with medial bands provides long-lasting results. The authors use precise preoperative evaluation, recontouring of neck fat irregularities, opening of the submental region with platysmaplasty, drains, and strict hemostasis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Principles for Management of Orbital Fractures in the Pediatric Population: A Cohort Study of 150 Patients
Authors: Coon Devin , Kosztowski Martin , Mahoney Nicholas R. , Mundinger Gerhard S. , Grant Michael P. , Redett Richard J.
Published: March 2016

Background:

Pediatric orbital fractures represent a challenging and sometimes controversial clinical problem. Patients may present with clear indications for surgery, but most require balancing benefits against intraoperative and late complications. The authors assessed these fractures at a state-designated ophthalmology referral center to develop criteria for surgery.

Methods:

Institutional review board approval was obtained to retrospectively analyze pediatric trauma registry patients with orbital fracture diagnoses at the Wilmer Eye Institute over 10 years. Patients were excluded if they did not undergo a full ophthalmologic examination, never followed up after their injury, or had significant facial fractures outside of the orbit.

Results:

One hundred fifty patients met selection criteria; 116 patients (77 percent) completed all follow-up (average, 309 days). Two patients had 20/40 vision or worse at the end of follow-up. One hundred ten patients (71 percent) underwent surgery; 96 underwent acute repair (<3 weeks) and 11 underwent delayed repair (median, 49 days). Three patients required reoperation, two for plate infection and one for hyperglobus, with an overall complication rate of 4.7 percent.

Conclusions:

The authors analyzed the largest series of operative pediatric orbital fractures to propose criteria for surgical intervention. There are four potential indications: (1) rectus muscle entrapment; (2) early enophthalmos; (3) central-gaze diplopia or extraocular movement restriction after the resolution of swelling; and (4) loss of orbital support likely to produce secondary changes in globe position and/or binocular stereo vision. In our series, application of these principles offered excellent long-term aesthetic and ophthalmic outcomes with an acceptably low complication profile.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Arterialization of the Venous System for Treatment of Chronic Ischemia in the Hand
Authors: Zeng Wenjing , Hammert Warren C.
Published: March 2016

Symptomatic chronic ischemia of the upper extremity is a difficult condition to treat. At a critical level of ischemia, patients suffer from intractable pain and nonhealing ulcerations and potentially necrosis. When no distal vessels are available for vascular reconstruction, arterialization of the venous system is a salvage procedure that may be considered. This article describes a surgical technique for venous arterialization to improve the vascular supply to the ischemic hand, which can result in decreased pain, wound healing, improved patient function, and limb salvage.
Adipose Tissue and Extracellular Matrix Development by Injectable Decellularized Adipose Matrix Loaded with Basic Fibroblast Growth Factor
Authors: Zhang Shipin , Lu Qiqi , Cao Tong , Toh Wei Seong
Published: March 2016

Background:

There is a significant need for soft-tissue replacements in the field of reconstructive surgery. Decellularized adipose tissues were heparin crosslinked and loaded with basic fibroblast growth factor (bFGF). This injectable system was evaluated for its adipogenic and angiogenic capabilities for in vivo adipose tissue regeneration.

Methods:

Decellularized adipose tissues were harvested from the inguinal fat pads of C57BL/6J mice, minced, and heparinized before being loaded with bFGF. Decellularized adipose tissues without bFGF served as a control. In vivo adipose neotissue formation, neovascularization, and volume stability were evaluated over a period of 12 weeks. After 6 or 12 weeks, mice were killed and the newly formed adipose tissues, together with the contralateral endogenous adipose tissues, were harvested for gross, volumetric, histologic, and immunohistochemical analysis.

Results:

Decellularized adipose tissues that were heparinized and loaded with bFGF induced significant de novo adipose neotissue formation, with progressive tissue growth and neovascularization from 6 to 12 weeks. The adipose neotissues exhibited mature adipose morphology and extracellular matrix that closely resembled that of the endogenous adipose tissue. In contrast, decellularized adipose tissues without bFGF induced limited adipose neotissue formation and were completely resorbed by the end of 12 weeks.

Conclusion:

This study demonstrates the high efficiency of heparinized decellularized adipose tissue matrix loaded with bFGF in promoting adipose neotissue formation and neovascularization with long-term volume stability.
The Role of Military Plastic Surgeons in the Management of Modern Combat Trauma: An Analysis of 645 Cases
Authors: Maitland Laura , Lawton Graham , Baden James , Cubison Tania , Rickard Rory , Kay Alan , Hettiaratchy Shehan
Published: March 2016

Background:

Plastic surgery has historically been linked to war. Between 2008 and the end of combat operations in Afghanistan in 2014, British military plastic surgeons formed part of the multinational military surgical team at the Role 3 Medical Treatment Facility, Camp Bastion, Helmand Province. The present study aimed to analyze the activity of these surgeons objectively and to determine the utility of their deployment.

Methods:

Data were gathered prospectively from four periods (2009 to 2012). This coincided with different surgeons, types of combat activity, wounding patterns, and mission emphases for the hospital. Various metrics were employed.

Results:

Plastic surgeons were involved in 40 percent of surgical cases (645 of 1654). This was consistent, despite changes in the predominant wounding mechanism and casualty population. One-third of cases involved the plastic surgeon as the lead or sole surgeon and two-thirds involved working with surgeons from other disciplines. Caseload by anatomical region was as follows: hand and upper limb, 64 percent; head and neck, 46 percent; lower limb, 40 percent; and trunk, 25 percent. A median of 1.75 body areas were operated on per patient. Involvement did not differ between patients wearing combat body armor when injured and those who were not.

Conclusions:

Plastic surgeons played a significant role in the management of modern military trauma. This reflects the types of injuries sustained and the expertise of military plastic surgeons complementing the skill set of the other surgical team members. The level of activity was independent of wounding patterns, suggesting that the specialty may be useful, irrespective of the nature of the conflict.