bluuebunny/crossref_metadata_2025 huggingface dataset:
Nature and evolution of incommensurate charge order in manganites visualized with cryogenic scanning transmission electron microscopy
Authors: El Baggari Ismail , Savitzky Benjamin H. , Admasu Alemayehu S. , Kim Jaewook , Cheong Sang-Wook , Hovden Robert , Kourkoutis Lena F.
Published: January 2018

Significance

Charge order is a modulation of the electron density and is associated with unconventional phenomena, including colossal magnetoresistance and metal–insulator transitions. Determining how the lattice responds provides insights into the nature and symmetry of the ordered state. Scanning transmission electron microscopy can measure lattice displacements with picometer precision, but its use has been limited to room-temperature phases only. Here, we demonstrate high-resolution imaging at cryogenic temperature and map the nature and evolution of charge order in a manganite. We uncover picometer-scale displacive modulations whose periodicity is strongly locked to the lattice and visualize temperature-dependent phase inhomogeneity in the modulations. These results pave the way to understanding the underlying structure of charge-ordered states and other complex phenomena.
Loss of Capicua alters early T cell development and predisposes mice to T cell lymphoblastic leukemia/lymphoma
Authors: Tan Qiumin , Brunetti Lorenzo , Rousseaux Maxime W. C. , Lu Hsiang-Chih , Wan Ying-Wooi , Revelli Jean-Pierre , Liu Zhandong , Goodell Margaret A. , Zoghbi Huda Y.
Published: January 2018

Capicua (CIC) regulates a transcriptional network downstream of the RAS/MAPK signaling cascade. In
Drosophila
, CIC is important for many developmental processes, including embryonic patterning and specification of wing veins. In humans, CIC has been implicated in neurological diseases, including spinocerebellar ataxia type 1 (SCA1) and a neurodevelopmental syndrome. Additionally, we and others have reported mutations in
CIC
in several cancers. However, whether CIC is a tumor suppressor remains to be formally tested. In this study, we found that deletion of
Cic
in adult mice causes T cell acute lymphoblastic leukemia/lymphoma (T-ALL). Using hematopoietic-specific deletion and bone marrow transplantation studies, we show that loss of
Cic
from hematopoietic cells is sufficient to drive T-ALL.
Cic
-null tumors show up-regulation of the KRAS pathway as well as activation of the NOTCH1 and MYC transcriptional programs. In sum, we demonstrate that loss of CIC causes T-ALL, establishing it as a tumor suppressor for lymphoid malignancies. Moreover, we show that mouse models lacking CIC in the hematopoietic system are robust models for studying the role of RAS signaling as well as NOTCH1 and MYC transcriptional programs in T-ALL.
Path integration in place cells of developing rats
Authors: Bjerknes Tale L. , Dagslott Nenitha C. , Moser Edvard I. , Moser May-Britt
Published: January 2018

Place cells in the hippocampus and grid cells in the medial entorhinal cortex rely on self-motion information and path integration for spatially confined firing. Place cells can be observed in young rats as soon as they leave their nest at around 2.5 wk of postnatal life. In contrast, the regularly spaced firing of grid cells develops only after weaning, during the fourth week. In the present study, we sought to determine whether place cells are able to integrate self-motion information before maturation of the grid-cell system. Place cells were recorded on a 200-cm linear track while preweaning, postweaning, and adult rats ran on successive trials from a start wall to a box at the end of a linear track. The position of the start wall was altered in the middle of the trial sequence. When recordings were made in complete darkness, place cells maintained fields at a fixed distance from the start wall regardless of the age of the animal. When lights were on, place fields were determined primarily by external landmarks, except at the very beginning of the track. This shift was observed in both young and adult animals. The results suggest that preweaning rats are able to calculate distances based on information from self-motion before the grid-cell system has matured to its full extent.
Oxidation of dCTP contributes to antibiotic lethality in stationary-phase mycobacteria
Authors: Fan Xiao-Yong , Tang Bi-Kui , Xu Yuan-Yuan , Han Ang-Xuan , Shi Kun-Xiong , Wu Yong-Kai , Ye Yu , Wei Mei-li , Niu Chen , Wong Ka-Wing , Zhao Guo-Ping , Lyu Liang-Dong
Published: January 2018

Significance

Recent studies revealed that oxidative DNA damage is a common event downstream of the interaction of antibiotics with their molecular targets. For instance, exposure to lethal doses of antibiotics may cause double-strand breaks (DSBs), whereas exposure to sublethal doses of antibiotics may lead to mutagenesis. Therefore, detailed understanding of mechanisms underlying antibiotic-induced DNA damage may broaden our knowledge not only of antibiotic lethality but also the mechanism of stress-induced mutagenesis in bacteria. Here, we show that oxidation of dCTP underlies a mechanism of antibiotic-induced DNA damage and cell death. We demonstrate that antibiotic lethality stemming from 5-OH-dCTP relies on reactive oxygen species production, mispairing induced by DnaE2, and unrepaired DSBs generated by incomplete base excision repair via Nth.
Heat treatments hardening effect on Ni–Al composite electrodeposits
Authors: Offoiach R. , Lekka M. , Johanns K. E. , Fedrizzi L.
Published: January 2018

Pure Ni galvanic coatings show good mechanical properties at room temperature but exhibit a progressive decrease by increasing the temperature due to the recrystallisation. A possible solution to hinder the recrystallisation is the co-electrodeposition of metal particles which could lead to the formation at high temperature of Ni alloy coatings with higher mechanical properties. Ni matrix composite deposits containing either micro (4 μm) or nano (130 nm) particles of Al were produced in a parallel plate geometry. The deposits were characterised regarding their microstructure both prior and after heat treatments for 3 h at 400, 600 and 800°C in order to evaluate the formation of Ni/Al phases. This work focused on the evaluation of the hardness on coatings cross-section by means of Vickers microhardness and Berkovich nano-indentation mapping. The results obtained with the two methods have been compared and correlated to the microstructural modifications in order to understand the hardening mechanisms.
Contextual control of skin immunity and inflammation by Corynebacterium
Authors: Ridaura Vanessa K. , Bouladoux Nicolas , Claesen Jan , Chen Y. Erin , Byrd Allyson L. , Constantinides Michael G. , Merrill Eric D. , Tamoutounour Samira , Fischbach Michael A. , Belkaid Yasmine
Published: January 2018

How defined microbes influence the skin immune system remains poorly understood. Here we demonstrate that Corynebacteria, dominant members of the skin microbiota, promote a dramatic increase in the number and activation of a defined subset of γδ T cells. This effect is long-lasting, occurs independently of other microbes, and is, in part, mediated by interleukin (IL)-23. Under steady-state conditions, the impact of Corynebacterium is discrete and noninflammatory. However, when applied to the skin of a host fed a high-fat diet, Corynebacterium accolens alone promotes inflammation in an IL-23–dependent manner. Such effect is highly conserved among species of Corynebacterium and dependent on the expression of a dominant component of the cell envelope, mycolic acid. Our data uncover a mode of communication between the immune system and a dominant genus of the skin microbiota and reveal that the functional impact of canonical skin microbial determinants is contextually controlled by the inflammatory and metabolic state of the host.
Evidence for Sexual Reproduction: Identification, Frequency, and Spatial Distribution of Venturia effusa (Pecan Scab) Mating Type Idiomorphs
Authors: Young Carolyn A. , Bock Clive H. , Charlton Nikki D. , Mattupalli Chakradhar , Krom Nick , Bowen Joanna K. , Templeton Matthew , Plummer Kim M. , Wood Bruce W.
Published: January 2018

Venturia effusa (syn. Fusicladium effusum), causal agent of pecan scab, is the most prevalent pathogen of pecan (Carya illinoinensis), causing severe yield losses in the southeastern United States. V. effusa is currently known only by its asexual (conidial) stage. However, the degree and distribution of genetic diversity observed within and among populations of V. effusa are typical of a sexually reproducing fungal pathogen, and comparable with other dothideomycetes with a known sexual stage, including the closely related apple scab pathogen, V. inaequalis. Using the mating type (MAT) idiomorphs from V. inaequalis, we identified a single MAT gene, MAT1-1-1, in a draft genome of V. effusa. The MAT1-1-1 locus is flanked by two conserved genes encoding a DNA lyase (APN2) and a hypothetical protein. The MAT locus spanning the flanking genes was amplified and sequenced from a subset of 14 isolates, of which 7 contained MAT1-1-1 and the remaining samples contained MAT1-2-1. A multiplex polymerase chain reaction screen was developed to amplify MAT1-1-1, MAT1-2-1, and a conserved reference gene encoding β-tubulin, and used to screen 784 monoconidial isolates of V. effusa collected from 11 populations of pecan across the southeastern United States. A hierarchical sampling protocol representing region, orchard, and tree allowed for analysis of MAT structure at different spatial scales. Analysis of this collection revealed the frequency of the MAT idiomorphs is in a 1:1 equilibrium of MAT1-1:MAT1-2. The apparent equilibrium of the MAT idiomorphs provides impetus for a renewed effort to search for the sexual stage of V. effusa.

[Formula: see text] Copyright © 2018 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Patient Reported Pain After Successful Nonunion Surgery: Can We Completely Eliminate It?
Authors: Fisher Nina , Driesman Adam S. , Konda Sanjit , Egol Kenneth A.
Published: January 2018

Objectives:

To investigate what factors are associated with continued long-term pain after fracture nonunion surgery.

Design:

Prospective cohort study.

Setting:

Single Academic Institution.

Patients/Participants:

Three hundred forty-one patients surgically treated for fracture nonunion were prospectively followed. Demographics, radiographic evaluations, VAS pain scores, and short musculoskeletal functional assessment (SMFA) scores were collected at routine intervals. Only patients who had a minimum of 1-year follow-up and complete healing were included this analysis. Patients were divided into a high-pain and low-pain cohort for comparison. Inclusion criteria for the high-pain cohort were defined as any patient who reported a pain score greater than one standard deviation above the mean.

Main Outcome Measures:

Long-term VAS pain scores and factors contributing to increased patient-reported long-term VAS pain scores.

Results:

Two hundred seventy patients met criteria and were included in this analysis, with 223 patients (82.6%) in the low-pain cohort and 47 patients (17.4%) in the high-pain cohort. The mean long-term pain score was 7.47 ± 1.2 in the high-pain group and 1.78 ± 1.9 in the low-pain group. Within the high-pain cohort, 55.6% of patients reported a net increase in pain from baseline to long-term follow-up compared with 10.5% in the low-pain cohort (P < 0.0005). High baseline pain score (P = 0.003), increased Charlson comorbidity index (CCI) (P = 0.008), lower income level (P = 0.014), and current smoking status (P = 0.033) were found to be significantly more prevalent in the high-pain cohort.

Conclusions:

Patients with higher baseline pain scores, elevated Charlson comorbidity index, lower income level or history of smoking are at an increased risk of reporting significant and potentially debilitating long-term pain after nonunion surgery. Although patients may expect complete relieve of pain, orthopaedic surgeons must inform patients of the possibility of experiencing pain 1 year or more postoperatively.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Preoperative Planning in the Surgical Correction of Tibial Nonunions and Malunions
Authors: Mast Jeffrey W.
Published: January 2018

Three typical cases demonstrate the achievement of precision in the reconstruction of ununited fractures of the tibia by preliminary planning with the aid of tracings on roentgenograms, templates, and goniometer measurements.
Does Posterior Fixation of Partially Unstable Open-Book Pelvic Ring Injuries Decrease Symphyseal Plate Failure? A Biomechanical Study
Authors: Metz Rachelle M. , Bledsoe J. Gary , Moed Berton R.
Published: January 2018

Objective:

Recent clinical study suggests an advantage to adding an iliosacral screw to the anterior fixation construct for anteroposterior compression type-2 (OTA/AO type 61-B1), partially unstable open-book pelvic ring injuries. Others have described stress examination to determine any required supplemental fixation. However, biomechanical studies investigating iliosacral fixation requirements for this injury are lacking. Our objective was to determine whether adding an iliosacral screw to symphyseal plate fixation decreases displacement in a well-defined open-book pelvic ring injury model.

Methods:

An open-book pelvic ring injury was created in 10 human cadaveric pelves by unilaterally releasing the sacrospinous, sacrotuberous, and anterior sacroiliac ligaments plus transection of the pubic symphysis, approximating the classically described anteroposterior compression type-2 (APC-2) injury. Specimens were divided into 2 groups: (1) symphyseal plating and (2) plating plus an iliosacral screw. Using a standard bilateral stance model loaded at 550 N, displacement measurements were obtained at 210,000 and 500,000 cycles.

Results:

Three specimens failed before 210,000 cycles because of technical errors and were excluded from analysis. For the remaining 7, there was no significant difference in displacement between the 2 groups, and none sustained implant failure. Post hoc analysis showed that a large sample size (45/group) would be required to detect any difference with 80% power, indicating a small effect size with limited clinical application.

Conclusions:

Adding an iliosacral screw to the symphyseal plate fixation does not provide improved biomechanical outcome in classically described APC-2 injuries. Clinically, stress examination may be useful to determine the need for supplemental posterior fixation in APC-2 injuries.
Valgus Slipped Capital Femoral Epiphysis: Pathophysiology of Motion and Results of Intracapsular Realignment
Authors: Kalhor Morteza , Gharanizadeh Kaveh , Rego Paulo , Leunig Michael , Ganz Reinhold
Published: January 2018

Objectives:

The purpose of this study was to report (1) a different but specific pattern of impingement in hips involved with valgus slipped capital femoral epiphysis (valgus SCFE) and (2) the results of surgical treatment using intracapsular realignment techniques.

Design:

Case series.

Setting:

Multiple academic centers.

Patients:

Six patients with 8 involved hips referred for valgus alignment of proximal femoral epiphysis (valgus SCFE).

Intervention:

Intracapsular realignment osteotomy combined with periacetabular osteotomy if needed.

Main outcome Measurement:

The clinical and radiographical results and pathophysiology of motion.

Results:

Eight hips in 6 patients were treated with subcapital (5 hips) or femoral neck (3 hips) osteotomy for realignment. The medially prominent metaphysis created an inclusive impingement at the anterior acetabular wall, whereas the high coxa valga favored impacting impingement at the posterior head-neck junction. The mean preoperative epiphyseal-shaft angle of 110.5 (range 90–125 degrees) was reduced to 62 degrees (range 55–70 degrees) postoperatively. At the last follow-up, all but 1 hip were pain-free and impingement-free, with normal range of motion. One hip was replaced after repeated attempts of correction. The overall hip functional result using modified Merle d'Aubigne scoring system was excellent in 5 hips (18–16 points), good in 2 hips (16–15 points), and poor in 1 hip (6 points).

Conclusions:

Impingement in valgus SCFE deformity is specific and complex. Anatomical realignment can lead to favorable results by the restoration of normal morphology and impingement-free range of motion.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Does Total Hip Arthroplasty Reduce the Risk of Secondary Surgery Following the Treatment of Displaced Acetabular Fractures in the Elderly Compared to Open Reduction Internal Fixation? A Pilot Study
Authors: Weaver Michael J. , Smith Raymond Malcolm , Lhowe David W. , Vrahas Mark S.
Published: January 2018

Objectives:

The goal of open reduction and internal fixation (ORIF) is to anatomically reduce the facture and maintain a congruent hip joint. However, ORIF in the elderly is technically challenging. Therefore, there are advocates for acute total hip arthroplasty (THA) in this patient population. The primary purpose of this study was to evaluate the rate of revision surgery in elderly patients with acetabular fractures treated with ORIF or THA. The secondary purpose was to compare patient's self-reported functional outcomes.

Design:

Retrospective review.

Setting:

Two American College of Surgeons Level 1 trauma centers.

Patients/Participants:

Thirty-three patients were treated with ORIF and 37 were treated with THA. The mean follow-up was 22 months (range 6–89 months). Patients were interviewed, and radiographs were examined.

Intervention:

Treatment of displaced acetabular fractures with either ORIF or THA.

Main Outcome Measurements:

Need for reoperation. Harris Hip Score and SF-36 questionnaire.

Results:

Those treated with ORIF had a higher rate of reoperation (10/33, 30%) compared with those treated with THA (5/37, 14%); however, this was not statistically significant (P = 0.12). Patients reported better bodily pain scores as measured by SF-36 (48 vs. 39, P = 0.04), and a trend toward improved function as measured by patient reported Harris Hip Scores (82 vs. 63, P = 0.06) in those treated with THA compared with ORIF.

Conclusions:

Acute reconstruction of acetabular fractures with THA in the geriatric population seems to compare favorably with ORIF, with a similar rate of complications, but with improved pain scores. In addition, there was a high rate of conversion to THA within 2 years of injury when patients were treated with ORIF. Acute THA as primary treatment in this patient population merits further, more controlled, comparative study.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Use of Spring Plates in Fixation of Comminuted Posterior Wall Acetabular Fractures
Authors: Lee Christopher , Johnson Eric E.
Published: January 2018

Objectives:

Surgical management of comminuted posterior wall acetabular fractures with marginal fragments remains difficult. The purpose of this study was to evaluate the use of spring plates as adjunctive fixation in comminuted posterior wall acetabular fractures.

Methods:

A retrospective review of patients treated for posterior wall acetabular fractures with the use of customized spring plates as adjunctive fixation between 2000 and 2017 was performed. Patients were evaluated radiographically according to the grading criteria of Matta. Complications including subsequent revision surgery and hardware failure were recorded.

Results:

Fifty-two patients underwent surgical fixation of posterior wall acetabular fractures with the use of customized 3.5-mm spring plates combined with posterior buttress compression plating over the spring plates as definitive fixation. Mean follow-up was 13.9 months (range: 3–140 months). Forty-two patients had radiographic grades of excellent, with 6 good, 1 fair, and 3 poor. There were no hardware complications. Five patients underwent revision surgery, including 4 patients (7.7%) who underwent a total hip arthroplasty due to advanced arthritis.

Conclusions:

The use of customized spring plates is a viable method of adjunctive fixation for comminuted posterior wall fractures with marginal fragmentation.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Endosteal Substitution With an Intramedullary Rod in Fractures of the Femur
Authors: Spitler Clay A. , Bergin Patrick F. , Russell George V. , Graves Matthew L.
Published: January 2018

Background:

Morbid obesity and segmental fracture/bone loss are challenging problems in the treatment of fractures and nonunions of the distal femur. The use of an intramedullary rod as an endosteal substitute for a deficient medial cortex along with a lateral locked plate is 1-tool to combat these problems. This article describes the technique used and its results at a single Level 1 trauma center.

Methods:

Retrospective chart and radiographic review of all patients treated for acute fractures and nonunions of the distal femur using endosteal substitution with an intramedullary nail and a lateral locked plate. Fixation construct was determined at the surgeon's discretion and was strongly influenced by bone loss and patient body habitus.

Results:

Seven of 8 acute fractures and 8 of 8 nonunions healed without an unplanned reoperation. There were no cases of secondary displacement after fixation, and only 1 unplanned reoperation in the study group.

Conclusion:

Endosteal substitution with an intramedullary rod and the use of a lateral locked plate provides the stability needed to allow bone healing under prolonged or supraphysiologic loads seen in morbid obesity or segmental bone loss.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Impact of Low Muscularity and Myosteatosis on Long-term Outcome After Curative Colorectal Cancer Surgery: A Propensity Score–Matched Analysis
Authors: Sueda Toshinori , Takahasi Hidekazu , Nishimura Junichi , Hata Taishi , Matsuda Chu , Mizushima Tsunekazu , Doki Yuichiro , Mori Masaki
Published: January 2018

BACKGROUND:

Muscle loss, characterized by reduced muscle mass (myopenia), and infiltration by intermuscular and intramuscular fat (myosteatosis), predicts a poor short-term prognosis in patients with colorectal cancer. However, little is known about the influence of myopenia and myosteatosis on long-term outcomes.

OBJECTIVE:

The present study aimed to evaluate the prognostic influence of both myopenia and myosteatosis on long-term outcomes after curative colorectal cancer surgery.

DESIGN:

This is a retrospective analysis using a propensity score–matched analysis to reduce the possibility of selection bias.

SETTINGS:

The study was conducted at a single institution.

PATIENTS:

We performed a retrospective analysis of 211 consecutive patients with stage I to III colorectal cancer who underwent curative surgery between 2010 and 2011.

INTERVENTION:

CT scans were analyzed to calculate the lumbar skeletal muscle index and mean muscle attenuation using a SYNAPS VINCENT.

MAIN OUTCOME MEASURES:

The primary outcome measure was cancer-specific survival. Secondary end points included overall survival and disease-free survival.

RESULTS:

Of 211 patients, a total of 102 and 106 were matched for myopenia and myosteatosis analyses. The median follow-up was 57.6 months. Versus the nonmyopenia group, the myopenia group manifested a significantly shorter cancer-specific survival, overall survival, and disease-free survival. Significantly shorter cancer-specific survival and overall survival times were also identified for the myosteatosis versus the nonmyosteatosis group. Before matching, multivariate analyses identified both myopenia and myosteatosis as independent prognostic factors for cancer-specific survival (p = 0.04 and p < 0.01), overall survival (p = 0.03 and p < 0.01), and disease-free survival (p < 0.01 and p < 0.01).

LIMITATIONS:

This study is limited by its retrospective, nonrandomized design.

CONCLUSIONS:

Myopenia and myosteatosis adversely affect long-term outcomes after curative colorectal cancer resection. See Video Abstract at http://links.lww.com/DCR/A463.
Symptom Severity and Quality of Life Among Long-term Colorectal Cancer Survivors Compared With Matched Control Subjects: A Population-Based Study
Authors: Hart Tae L. , Charles Susan T. , Gunaratne Mekhala , Baxter Nancy N. , Cotterchio Michelle , Cohen Zane , Gallinger Steven
Published: January 2018

BACKGROUND:

Data are lacking regarding physical functioning, psychological well-being, and quality of life among colorectal cancer survivors >10 years postdiagnosis.

OBJECTIVE:

The purpose of this study was to examine self-reported physical functioning, quality of life, and psychological well-being in long-term colorectal cancer survivors compared with age- and sex-matched unaffected control subjects.

DESIGN:

Participants completed a cross-sectional survey.

SETTINGS:

The colorectal cancer survivors and unaffected control subjects were recruited from the Ontario Familial Colorectal Cancer Registry.

PATIENTS:

A population-based sample of colorectal cancer survivors (N = 296) and their age- and sex-matched unaffected control subjects (N = 255) were included. Survivors were, on average, 15 years postdiagnosis.

MAIN OUTCOME MEASURES:

Quality of life was measured with the Functional Assessment of Cancer Therapy-General scale, bowel dysfunction with the Memorial Sloan–Kettering Cancer Center scale, urinary dysfunction with the International Consultation on Incontinence Questionnaire–Short Form, fatigue with the Functional Assessment of Chronic Illness Therapy–Fatigue scale, and depression with the Center for Epidemiologic Studies–Depression scale.

RESULTS:

In linear mixed-model analyses adjusting for income, education, race, and comorbid medical conditions, survivors reported good emotional, functional, physical, and overall quality of life, comparable to control subjects. Fatigue and urinary functioning did not differ significantly between survivors and control subjects. Survivors reported significantly higher social quality of life and lower depression compared with unaffected control subjects. The only area where survivors reported significantly worse deficits was in bowel dysfunction, but the magnitude of differences was relatively small.

LIMITATIONS:

Generalizability is limited by moderately low participation rates. Findings are likely biased toward healthy participants. No baseline assessment was available to examine change in outcomes over time.

CONCLUSIONS:

Long-term colorectal cancer survivors appear to have comparable quality of life and, in some areas, better well-being than their unaffected peers. Bowel dysfunction may continue to be an ongoing issue even 15 years after colorectal cancer diagnosis. Overall quality of life can be expected to be good in this group of older survivors. See Video Abstract at http://links.lww.com/DCR/A476.
Arc of Riolan-Preserving Splenic Flexure Takedown During Anterior Resection: Potentially Critical to Prevent Acute Anastomotic Ischemia
Authors: Toh James Wei Tatt , Matthews Ronnie , Kim Seon-Hahn
Published: January 2018

INTRODUCTION:

The Arc of Riolan is a strategic vessel that provides collateral mesenteric circulation in 10% of individuals. The importance of identifying and preserving the arc of Riolan in reducing the risk of ischemia to the proximal anastomotic segment after high ligation anterior resection was evaluated.

TECHNIQUE:

The arc of Riolan is a vessel that crosses anterior to the inferior mesenteric vein horizontally below the level of the pancreas. A retrospective review of all recorded videos of laparoscopic and robotic low and ultra-low anterior resections was performed in September to December 2012 and prospective evaluation in April to July 2013. The main outcome measures were arc of Riolan identification and preservation, and this was correlated with postoperative transmural colonic ischemia requiring surgical reintervention. From July 2013 onward, we routinely performed arc of Riolan–sparing anterior resections.

RESULTS:

Arc of Riolan was observed in 17.8% of cases. Between 2006 and 2012, before routinely looking for and preserving the arc of Riolan, our rate of acute colonic transmural ischemia requiring an emergency Hartmann procedure after anterior resection was 0.8% (6/723). Between 2012 and 2016, after we started performing arc of Riolan–sparing splenic flexure takedown, there were no cases of acute colonic transmural ischemia requiring surgical reintervention (0/576) after anterior resection.

CONCLUSIONS:

Recognizing and preserving the arc of Riolan, if visualized, during high inferior mesenteric vein ligation and splenic flexure takedown may be an important step in reducing the risk of acute colonic ischemia postanterior resection. See Video at http://links.lww.com/DCR/A535.
Characteristics of Adrenal Masses in Familial Adenomatous Polyposis
Authors: Shiroky Jonah S. , Lerner-Ellis Jordan P. , Govindarajan Anand , Urbach David R. , Devon Karen M.
Published: January 2018

BACKGROUND:

Adrenal masses are a known extraintestinal manifestation of familial adenomatous polyposis. However, the literature on this association is largely confined to case reports.

OBJECTIVE:

This study aimed to determine the characteristics of adrenal masses in familial adenomatous polyposis and their clinical significance, as well as to estimate their prevalence. Mutational analysis was conducted to determine if any potential genotype-phenotype correlations exist.

DESIGN:

This is a retrospective cohort study.

SETTING:

Analysis included all patients meeting the criteria of classic familial adenomatous polyposis who were registered with the Familial Gastrointestinal Cancer Registry, a national Canadian database.

PATIENTS:

Appropriate imaging or autopsy reports were available in 311 registry patients. Patients with adrenal metastases were excluded.

OUTCOME MEASURES:

Data collection included demographic data, mutation genotype, adrenal mass characteristics, surgical interventions and mortality.

RESULTS:

The prevalence of adrenal masses was 16% (n = 48/311). The median age at diagnosis of adrenal mass was 45 years. The median diameter of adrenal mass at diagnosis was 1.7 cm (interquartile range, 1.4–3.0) with a median maximal diameter of 2.5 cm (interquartile range, 1.7–4.1) with median imaging follow-up of 48 months. The majority of adrenal masses were benign (97%, n = 61/63). Surgery was performed on 7 patients because of concerns for size, malignancy, or hormonal secretion. One adrenal-related death was due to an adrenocortical carcinoma. Mutation analysis did not identify any specific genotype-phenotype correlations.

LIMITATIONS:

There were incomplete or insufficient endocrinology data available in the registry to allow for the analysis of hormone secretion patterns.

CONCLUSIONS:

Adrenal masses are approximately twice as prevalent in the familial adenomatous polyposis population as in previous studies of the general population. Nearly all mutations led to truncation of the APC gene; however, there was no genetic signature to help predict those at increased risk. The majority of adrenal lesions identified were of benign etiology; thus, an intensive management or surveillance strategy with imaging screening is likely unwarranted. See Video Abstract at http://links.lww.com/DCR/A507.
Systematic Review and Meta-analysis of Objective Assessment of Physical Fitness in Patients Undergoing Colorectal Cancer Surgery
Authors: Lee Chun Hin Angus , Kong Joseph C , Ismail Hilmy , Riedel Bernhard , Heriot Alexander
Published: January 2018

BACKGROUND:

Gas exchange-derived variables obtained from cardiopulmonary exercise testing allow objective assessment of functional capacity and hence physiological reserve to withstand the stressors of major surgery. Field walk tests provide an alternate means for objective assessment of functional capacity that may be cheaper and have greater acceptability, in particular, in elderly patients.

OBJECTIVE:

This systematic review evaluated the predictive value of cardiopulmonary exercise testing and field walk tests in surgical outcomes after colorectal surgery.

DATA SOURCE:

A systematic search was undertaken using Medline, PubMed, Embase, CINAHL, and PEDro.

STUDY SELECTION:

Adult patients who had cardiopulmonary exercise testing and/or field walk test before colorectal surgery were included.

MAIN OUTCOME MEASURE:

The primary outcomes measured were hospital length of stay and postoperative morbidity and mortality.

RESULTS:

A total of 7 studies with a cohort of 1418 patients who underwent colorectal surgery were identified for inclusion in a qualitative analysis. Both pooled oxygen consumption at anaerobic threshold (range, 10.1–11.1 mL·kg–1·min–1) and peak oxygen consumption (range, 16.7–18.6 mL·kg–1·min–1) were predictive of complications (OR for anaerobic threshold, 0.76; 95% CI, 0.66–0.85,p<0.0001; OR for peak oxygen consumption, 0.76; 95% CI, 0.67–0.85,p<0.0001). Patients had significant increased risk of developing postoperative complications if their anaerobic threshold was below this cut point (p<0.001). However, it was not predictive of anastomotic leak(p= 0.644). Shorter distance (<250 m) walked in incremental shuttle walk test, lower anaerobic threshold, and lower peak oxygen consumption were associated with prolonged hospital length of stay, which was closely related to the development of complications.

CONCLUSIONS:

Variables derived from cardiopulmonary exercise testing are predictive of postoperative complications and hospital length of stay. Currently, there are insufficient data to support the predictive role of the field walk test in colorectal surgery.
Effects of Lipid- Versus Sodium Hyaluronate-Containing Eye Drops on Optical Quality and Ocular Surface Parameters as a Function of the Meibomian Gland Dropout Rate
Authors: Miháltz Kata , Faschinger Eva Maria , Vécsei-Marlovits Pia Veronika
Published: January 2018

Purpose:

To evaluate the effect of lipid- versus sodium hyaluronate-based eye drops on optical quality and ocular surface parameters.

Methods:

Sixty eyes of 30 patients with mild-to-moderate dry eye disease were included in a prospective randomized study. Each patient received either lipid- or sodium hyaluronate-based eye drops. Ocular symptom scores, breakup time, Schirmer test, fluorescein staining, noncontact meibography, and aberrometry were evaluated before and after 3 months of therapy.

Results:

At the 3-month visit, a statistically significant improvement (P ≤ 0.05) was noted in both groups on the Schirmer test, breakup time, ocular surface staining, and symptom score. In the lipid group, patients with progressive meibomian gland (MG) loss (>50%) showed a significantly greater increase in their corneal higher-order (HO) Strehl ratio (0.25 ± 0.26 vs. −0.01 ± 0.25, P = 0.02) and modulation transfer function (MTF) (0.12 ± 0.17 vs. −0.02 ± 0.06, P = 0.03) than patients with less advanced MG disease. In the lipid group, a significant positive correlation was noted between the MG dropout rate and improvement in Schirmer values [Spearman correlation coefficient (CC): 0.79], corneal HO Strehl (CC: 0.75), and HO modulation transfer function (CC: 0.6), but a significant negative correlation was noted between the MG dropout rate and the HO root mean square (CC: −0.73).

Conclusions:

Lipid-containing artificial tears seem to be superior to sodium hyaluronate-containing drops in terms of improving HO aberrations and optical quality in patients with significant MG dysfunction.
Nomogram to Predict Graft Thickness in Descemet Stripping Automated Endothelial Keratoplasty: An Eye Bank Study
Authors: Bae Steven S. , Menninga Isaac , Hoshino Richard , Humphreys Christine , Chan Clara C.
Published: January 2018

Purpose:

The purpose of this study was to develop a nomogram to predict postcut thickness of corneal grafts prepared at an eye bank for Descemet stripping automated endothelial keratoplasty (DSAEK).

Methods:

Retrospective chart review was performed of DSAEK graft preparations by 3 experienced technicians from April 2012 to May 2017 at the Eye Bank of Canada—Ontario Division. Variables collected included the following: donor demographics, death-to-preservation time, death-to-processing time, precut tissue thickness, postcut tissue thickness, microkeratome head size, endothelial cell count, cut technician, and rate of perforation. Linear regression models were generated for each microkeratome head size (300 and 350 μm).

Results:

A total of 780 grafts were processed during the study period. Twelve preparation attempts resulted in perforation (1.5%) and were excluded. Mean precut tissue thickness was 510 ± 49 μm (range: 363–670 μm). Mean postcut tissue thickness was 114 ± 22 μm (range: 57–193 μm). Seventy-nine percent (608/768) of grafts were ≤130 μm. The linear regression models included precut thickness and donor age, which were able to predict the thickness to within 25 μm 80% of the time.

Conclusions:

We report a nomogram to predict thickness of DSAEK corneal grafts prepared in an eye bank setting, which was accurate to within 25 μm 80% of the time. Other eye banks could consider performing similar analyses.
Metacognitive Interpersonal Therapy for Personality Disorders Featuring Emotional Inhibition
Authors: Gordon-King Keely , Schweitzer Robert D. , Dimaggio Giancarlo
Published: January 2018

Metacognitive interpersonal therapy (MIT) is an integrative psychotherapeutic approach targeting personality disorders (PDs) featuring inhibition and avoidance. The current case series reports the outcome of a time-limited, 12-month MIT intervention for people with PDs featuring emotional inhibition. Seven participants were diagnosed with a PD on the basis of a structured clinical interview. The study followed a multiple baseline design, with baseline measures taken for 3 weeks before intervention. Participants underwent 12 months of weekly MIT sessions, with outcome measures taken every 3 months. Outcome variables were diagnostic recovery, symptom severity, and alexithymia. All participants improved over the course of the 12-month intervention across most measures. For six of the participants, the intervention was a likely driver of change. The current study contributes to a growing evidence base regarding the effectiveness of MIT for the treatment of PDs.
ICD-11 Prevalence Rates of Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in a German Nationwide Sample
Authors: Maercker Andreas , Hecker Tobias , Augsburger Mareike , Kliem Sören
Published: January 2018

Prevalence rates are still lacking for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) diagnoses based on the new ICD-11 criteria. In a nationwide representative German sample (N = 2524; 14–99 years), exposure to traumatic events and symptoms of PTSD or CPTSD were assessed with the International Trauma Questionnaire. A clinical variant of CPTSD with a lower threshold for core PTSD symptoms was also calculated, in addition to conditional prevalence rates dependent on trauma type and differential predictors. One-month prevalence rates were as follows: PTSD, 1.5%; CPTSD, 0.5%; and CPTSD variant, 0.7%. For PTSD, the highest conditional prevalence was associated with kidnapping or rape, and the highest CPTSD rates were associated with sexual childhood abuse or rape. PTSD and CPTSD were best differentiated by sexual violence. Combined PTSD and CPTSD (ICD-11) rates were in the range of previously reported prevalences for unified PTSD (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; ICD-10). Evidence on differential predictors of PTSD and CPTSD is still preliminary.
Building a Culture of Continuous Improvement and Employee Engagement Using a Daily Management System Part 1: Overview
Authors: Maurer Marsha , Canacari Elena , Eng Kimberly , Foley Jane , Phelan Cynthia , Sulmonte Kimberlyann , Wandel Jane
Published: January 2018

A daily management system (DMS) can be used to implement continuous quality improvement and advance employee engagement. It can empower staff to identify problems in the care environment that impact quality or workflow and to address them on a daily basis. Through DMS, improvement becomes the work of everyone, every day. The authors of this 2-part series describe their work to develop a DMS. Part 1 describes the background and organizing framework of the program.
Mycoplasma genitalium Infection in Kenyan and US Women
Authors: Balkus Jennifer E. , Manhart Lisa E. , Jensen Jørgen S. , Anzala Omu , Kimani Joshua , Schwebke Jane , Shafi Juma , Rivers Charles , Kabare Emanuel , McClelland R. Scott
Published: January 2018

Background

Little is known about the natural history of Mycoplasma genitalium (MG) infection in women. We retrospectively tested archived vaginal fluid samples to assess MG prevalence, incidence, persistence, recurrence and antimicrobial resistance markers among women participating in the Preventing Vaginal Infections trial, a randomized trial of monthly presumptive treatment to reduce vaginal infections.

Methods

High-risk, nonpregnant, HIV-negative women aged 18 to 45 years from Kenya and the United States were randomized to receive metronidazole 750 mg + miconazole 200 mg intravaginal suppositories or placebo for 5 consecutive nights each month for 12 months. Clinician-collected swabs containing cervicovaginal fluid were tested for MG using Hologic nucleic acid amplification testing at enrollment and every other month thereafter. Specimens that were MG+ underwent additional testing for macrolide resistance–mediating mutations by DNA sequencing.

Results

Of 234 women enrolled, 221 had available specimens and 25 (11.3%) had MG at enrollment. Among 196 women without MG at enrollment, there were 52 incident MG infections (incidence, 33.4 per 100 person-years). Smoking was independently associated with incident MG infection (adjusted hazard ratio, 3.02; 95% confidence interval, 1.32–6.93), and age less than 25 years trended toward an association (adjusted hazard ratio, 1.70; 95% confidence interval, 0.95–3.06). Median time to clearance of incident MG infections was 1.5 months (interquartile range, 1.4–3.0 months). Of the 120 MG+ specimens, 16 specimens from 15 different women were macrolide resistance–mediating mutation positive (13.3%), with no difference by country.

Conclusions

M. genitalium infection is common among sexually active women in Kenya and the Southern United States. Given associations between MG and adverse reproductive health outcomes, this high burden of MG in reproductive-aged women could contribute to substantial morbidity.
Validity Evidence for a Serious Game to Assess Performance on Critical Pediatric Emergency Medicine Scenarios
Authors: Gerard James M. , Scalzo Anthony J. , Borgman Matthew A. , Watson Christopher M. , Byrnes Chelsie E. , Chang Todd P. , Auerbach Marc , Kessler David O. , Feldman Brian L. , Payne Brian S. , Nibras Sohail , Chokshi Riti K. , Lopreiato Joseph O.
Published: January 2018

Introduction

We developed a first-person serious game, PediatricSim, to teach and assess performances on seven critical pediatric scenarios (anaphylaxis, bronchiolitis, diabetic ketoacidosis, respiratory failure, seizure, septic shock, and supraventricular tachycardia). In the game, players are placed in the role of a code leader and direct patient management by selecting from various assessment and treatment options. The objective of this study was to obtain supportive validity evidence for the PediatricSim game scores.

Methods

Game content was developed by 11 subject matter experts and followed the American Heart Association's 2011 Pediatric Advanced Life Support Provider Manual and other authoritative references. Sixty subjects with three different levels of experience were enrolled to play the game. Before game play, subjects completed a 40-item written pretest of knowledge. Game scores were compared between subject groups using scoring rubrics developed for the scenarios. Validity evidence was established and interpreted according to Messick's framework.

Results

Content validity was supported by a game development process that involved expert experience, focused literature review, and pilot testing. Subjects rated the game favorably for engagement, realism, and educational value. Interrater agreement on game scoring was excellent (intraclass correlation coefficient = 0.91, 95% confidence interval = 0.89–0.9). Game scores were higher for attendings followed by residents then medical students (P
c < 0.01) with large effect sizes (1.6–4.4) for each comparison. There was a very strong, positive correlation between game and written test scores (r = 0.84, P < 0.01).

Conclusions

These findings contribute validity evidence for PediatricSim game scores to assess knowledge of pediatric emergency medicine resuscitation.
Gender, Race and Disease Etiology Predict De Novo Malignancy Risk After Liver Transplantation: Insights for Future Individualized Cancer Screening Guidance
Authors: Bhat Mamatha , Mara Kristin , Dierkhising Ross , Watt Kymberly D.
Published: January 2018

Background

Malignancy after liver transplant (LT) is a leading cause of mortality, but data is limited. The aim of this study was to identify patients at higher risk for de novo malignancies after LT in a large multicenter database.

Methods

The Scientific Registry of Transplant Recipients database comprising all 108 412 LT recipients across the United States between 1987 and March 2015 was analyzed with a median follow-up of 6.95 years. Potential risk factors for malignancies after LT were assessed using Cox regression analysis for the outcome of time to first malignancy.

Results

Mean age 51.9 ± 10.8 years, 64.6% male, 74.5% white, and 15.8% with previous malignancy. Malignancies during follow-up were 4,483 (41.3%) skin, 1519 (14.0%) hematologic, and 4842 (44.7%) solid organ. The 10-year probability of de novo malignancy was 11.5% (11.3-11.8%). On multivariable analysis, age by decade (hazard ratio [HR], 1.52; P < 0.001), male sex (HR, 1.28; P < 0.001), white race (compared with other races: HR, 1.45-2.04; P < 0.001), multiorgan transplant (HR, 1.35; P < 0.001), previous malignancy (HR, 1.34; P < 0.001), and alcoholic liver disease, autoimmune, nonalcoholic steatohepatitis (HR, 1.35; P < 0.001), and primary sclerosing cholangitis pre-LT (compared with hepatitis C virus, P < 0.001) were associated with higher risk of post-LT malignancy, but type of immunosuppression was not (P = NS).

Conclusions

This large data set demonstrates the effects of ethnicity/race and etiologies of liver disease, particularly nonalcoholic steatohepatitis as additional risk factors for cancer after LT. Patients with these high-risk characteristics should be more regularly and diligently screened.