bluuebunny/crossref_metadata_2025 huggingface dataset:
Über die Aetiologiesymptome
Authors: Schmidt Pierre
Published: July 2017

Eine Diskussion von Pierre Schmidt mit Kollegen, in welcher er die herausragende Bedeutung der Aetiologiesymptome betont, mit Hinweisen auf die Wirkungsebene von Arzneien.
Kurativer Effekt von Bryonia alba bei chronischer Diarrhoe mit Fruktoseintoleranz
Authors: Zwemke Hans
Published: July 2017

Dargestellt wird die erfolgreiche Behandlung einer chronischen, schulmedizinisch und pseudo-diagnostisch als „Fruktoseintoleranz“ klassifizierten Durchfallerkrankung mittels wiederholter Gaben von Bryonia alba. Diskutiert werden verschiedene repertoriale Ansätze wie die Folgerepertorien nach Kent, die General Analysis und der Synoptic Key nach Boger sowie die Polaritätsanalyse nach Bönninghausen. Es erfolgt dann ein Materia-medica-Abgleich mit der Reinen Arzneimittellehre von Hahnemann, die den wichtigen Hinweis enthält, Bryonia wegen seiner Wechselwirkungen innerhalb von 24 Stunden nochmals zu wiederholen.
Zur Bewertung spontaner Atemänderungen bei der Respirations-Olfaktometrie
Authors: Gudziol Hilmar , Thielscher Doreen , Lehnich Holger , Guntinas-Lichius Orlando , Bitter Thomas
Published: July 2017

Einleitung Durch Gerüche evozierte Atemänderungen werden zum objektivierenden Nachweis der Intaktheit des Riechsystems im Sinne einer
Respirations-Olfaktometrie genutzt. Spontane Atemänderungen lassen sich in der Regel nicht von evozierten unterscheiden. Es müssen deshalb
wiederholt Reize mit reinen Riechstoffen randomisiert mit Leerreizen in die Ruheatmung appliziert werden, um mehrheitliche Atemänderungen
bei olfaktorischer Reizung darzustellen.

Methodik Bei 26 erwachsenen Normosmikern wurden mit Hilfe eines Fluss-Olfaktometers 15 überschwellige H2S- und 15
Neutralluft-Reize (Dauer: 2 s) randomisiert mit einem Interstimulusintervall von mindestens 1 Minute inspirationssynchron appliziert. Vor
der Reizung durfte die Ruheatmung nicht sehr streuen (Variationskoeffizient der Dauer der Inspiration und der Exspiration ≤0,1). Eine
respiratorische Reaktion im Reizatemzug lag vor, wenn die Dauer der Inspiration (DIN) bzw. der Exspiration (DEX) des Reizatemzuges jenseits
der doppelten Standardabweichung dieser Atemparameter vom Mittelwert der fünf vorausgehenden Ruheatemzüge lag. Die Anzahl der Reaktionen
wurde auf die Anzahl der Reize und der off-line als regelmäßig ermittelten Ruheatemkomplexe normiert und Reaktionsindizes gebildet.

Ergebnisse H2S-Reize evozierten deutlich mehr Atemänderungen als Neutralluftreize. DIN und DEX verringerten sich bei
olfaktorischer Reizung häufiger als bei einer Applikation von Neutralluft. Verlängerungen von DIN und DEX waren zwischen den beiden
Reizqualitäten nicht different.

Schlussfolgerungen Nur die randomisierte nasale Reizung mit einem Riechstoff und einem Leerreiz machen die Respirations-Olfaktometrie
aussagefähig.
Errata: Qualitätsprüfungen in Krankenhäusern durch den MDK Hessen: Erfahrungen und Ausblick - ein Praxisbericht
Authors: Ritter Sebastian , Lehr Frauke , Gaertner Thomas , van Essen Jörg
Published: July 2017

Erratum

Qualitätsprüfungen in Krankenhäusern durch den MDK Hessen: Erfahrungen und Ausblick – ein Praxisbericht.

Tabelle 2 wurde korrigiert und ausgetauscht.
Proposition of stair climb of a drop using chemical wettability gradient
Authors: Seerha Prabh P. S. , Kumar Parmod , Das Arup K. , Mitra Sushanta K.
Published: July 2017

We propose a passive technique for a drop to climb along the staircase textured surface using chemical wettability gradients. The stair structure, droplet configuration, and contact angle gradient are modeled using Lagrangian smoothed particle hydrodynamics. The stair climb efficiency of the droplet is found to be a function of wettability gradient strength. Using analytical balance of actuation and resistive forces across droplets, physical reasons behind stair climbing are established and influencing parameters are identified. Evolution of the droplet shape along with the advancing and the receding contact angles is presented from where instantaneous actuation and hysteresis forces are calculated. Using history of Lagrangian particles, circulation at the foot of stairs and progressing development of the advancing drop front are monitored. Higher efficiency in stair climbing in the case of a bigger sized drop than smaller one is obtained from simulation results and realized from force balance. Difficulty in climbing steeper stairs is also demonstrated to delineate the effect of gravitational pull against the actuation force due to the wettability gradient.
Simulation of the spreading of a gas-propelled micro-droplet upon impact on a dry surface using a lattice-Boltzmann approach
Authors: Ebrahim Mahsa , Ortega Alfonso , Delbosc Nicolas , Wilson Mark C. T. , Summers Jonathan L.
Published: July 2017

Spray cooling is one of the most promising methods of cooling high heat flux electronics. Depending on the type of the nozzle, spray cooling can be categorized as single-phase or two-phase. In the latter, which is known to be more effective, a secondary gas is used to further pressurize the liquid and form smaller droplets at higher velocities. The gas is also assumed to assist the spreading phase by imposing normal and tangential forces on the droplet free surface which adds to the complicated hydrodynamics of the droplet impact. Moreover, the order of magnitude of droplet size in spray cooling is 10−6 m, thereby introducing a low Weber and Reynolds numbers’ impact regime which heretofore has not been well understood. A 3D lattice Boltzmann method was implemented to simulate the impact of a single micro-droplet on a dry surface both in ambient air and under a stagnation gas flow. Two cases were closely compared and correlations were proposed for the instantaneous spreading diameter. Contrary to recent findings at higher impact Weber and Reynolds numbers, it was found that a stagnation flow only significantly affects the spreading phase for Ca* ≥ 0.35 but has little influence on the receding physics.
A general intermolecular force field based on tight-binding quantum chemical calculations
Authors: Grimme Stefan , Bannwarth Christoph , Caldeweyher Eike , Pisarek Jana , Hansen Andreas
Published: July 2017

A black-box type procedure is presented for the generation of a molecule-specific, intermolecular potential energy function. The method uses quantum chemical (QC) information from our recently published extended tight-binding semi-empirical scheme (GFN-xTB) and can treat non-covalently bound complexes and aggregates with almost arbitrary chemical structure. The necessary QC information consists of the equilibrium structure, Mulliken atomic charges, charge centers of localized molecular orbitals, and also of frontier orbitals and orbital energies. The molecular pair potential includes model density dependent Pauli repulsion, penetration, as well as point charge electrostatics, the newly developed D4 dispersion energy model, Drude oscillators for polarization, and a charge-transfer term. Only one element-specific and about 20 global empirical parameters are needed to cover systems with nuclear charges up to radon (Z = 86). The method is tested for standard small molecule interaction energy benchmark sets where it provides accurate intermolecular energies and equilibrium distances. Examples for structures with a few hundred atoms including charged systems demonstrate the versatility of the approach. The method is implemented in a stand-alone computer code which enables rigid-body, global minimum energy searches for molecular aggregation or alignment.
Lévy noise-induced phenomena in CO oxidation on Ir(111) surfaces
Authors: Feng Jing , Xu Wei , Xu Yong , Wang Xiaolong , Kurths Jürgen
Published: July 2017

The influences of external Lévy noise in CO oxidation on the Ir(111) surfaces are numerically examined. Depending on the control parameters, such as the temperature T  and the CO fraction Y  in the total reactant input gas flux, the reaction exhibits one or two stable stationary states in the absence of noise. Lévy noise is introduced in the reaction by randomly varying the quality of the influx mixture. We then observe a large variety of different types of behaviors depending on the initial CO fraction Y, in particular, the phenomenon of noise-induced shifts of the steady state in the monostable regime is regarded. We also show how the stationary probability density changes in terms of stochastic bifurcation when Lévy noise is applied in the bistable regime. The results provide a strong evidence for noise-induced transitions. We concentrate on the effects of the stability index α, the skewness parameter β,  and the noise intensity D  that emphasize the differences with Gaussian fluctuations.
Theory to guide future research on promising hybrid materials
Authors: Larter Raima
Published: July 2017

New hybrid materials show promise for use in space travel, electronics, separations and a host of other fields.
Influenza infection triggers disease in a genetic model of experimental autoimmune encephalomyelitis
Authors: Blackmore Stephen , Hernandez Jessica , Juda Michal , Ryder Emily , Freund Gregory G. , Johnson Rodney W. , Steelman Andrew J.
Published: July 2017

Significance

Peripheral infections exacerbate symptoms of many neurological diseases, including the most common autoimmune demyelinating disease of the central nervous system (CNS), multiple sclerosis (MS). We demonstrate that influenza viral infection of autoimmune-prone mice triggers clinical and histological disease. We further show that influenza infection alters the transcriptome of the central nervous system and facilitates immune cell trafficking to the brain. Finally, we identified a specific chemokine that is upregulated in the CNS during infection that is also increased in the cerebrospinal fluid of MS patients during relapse. These observations improve our understanding of how peripheral infection may act to exacerbate neurological diseases such as multiple sclerosis.
Multiplexed RNAi therapy against brain tumor-initiating cells via lipopolymeric nanoparticle infusion delays glioblastoma progression
Authors: Yu Dou , Khan Omar F. , Suvà Mario L. , Dong Biqin , Panek Wojciech K. , Xiao Ting , Wu Meijing , Han Yu , Ahmed Atique U. , Balyasnikova Irina V. , Zhang Hao F. , Sun Cheng , Langer Robert , Anderson Daniel G. , Lesniak Maciej S.
Published: July 2017

Significance

Glioblastoma is a deadly brain tumor with no cure. Brain tumor-initiating cells (BTICs) have been recognized as the key driver behind the unstoppable malignant growth, therapy resistance, and recurrence. BTICs are exceptionally difficult to target because of heterogeneous genetic and epigenetic aberrations that are challenging to reverse therapeutically using conventional pharmaceuticals or biologics. Here we report a lipopolymeric nanoparticle (LPNP) formulation that demonstrates a surprisingly high affinity for BTICs and the capacity to encapsulate multiple siRNAs for potent and targeted anti-BTIC therapy. We show that direct infusion of LPNP siRNAs to brain tumors effectively impedes tumor growth in mouse and provides encouraging survival benefits. This multiplexed nanomedicine platform carries strong potential for personalized anti-BTIC therapies.
Synaptic properties of the lemniscal and paralemniscal pathways to the mouse somatosensory thalamus
Authors: Mo Christina , Petrof Iraklis , Viaene Angela N. , Sherman S. Murray
Published: July 2017

Significance

Functional mapping of the routes of information processing is essential to understand how the brain operates. The main carriers of information are excitatory (glutamatergic) neurons, which form synapses that can either reliably deliver information or modify it. Using the somatosensory system in the mouse, we show that the two parallel glutamatergic routes from periphery to cortex should not be considered equal in carrying somatosensory information. Instead, one route has synapses solely suited for fast information transfer—the Lemniscal pathway—and the other suited for mainly modifying such information—the Paralemniscal pathway. This is an example of synaptic and anatomical analyses that inform circuit function and build on a framework for feedforward and feedback processing.
Bioinspired supramolecular fibers drawn from a multiphase self-assembled hydrogel
Authors: Wu Yuchao , Shah Darshil U. , Liu Chenyan , Yu Ziyi , Liu Ji , Ren Xiaohe , Rowland Matthew J. , Abell Chris , Ramage Michael H. , Scherman Oren A.
Published: July 2017

Significance

Fiber materials have great impact on our daily lives, with their use ranging from textiles to functional reinforcements in composites. Although the manufacturing process of manmade fibers is potentially limited by extensive energy consumption, spiders can readily spin silk fibers at room temperature. Here, we report a class of material that is based on a self-assembled hydrogel constructed with dynamic host–guest cross-links between functional polymers. Supramolecular fibers can be drawn from this hydrogel at room temperature. The supramolecular fiber exhibits better tensile and damping properties than conventional regenerated fibers, such as viscose, artificial silks, and hair. Our approach offers a sustainable alternative to current fiber manufacturing strategies.
Intestinal virome changes precede autoimmunity in type I diabetes-susceptible children
Authors: Zhao Guoyan , Vatanen Tommi , Droit Lindsay , Park Arnold , Kostic Aleksandar D. , Poon Tiffany W. , Vlamakis Hera , Siljander Heli , Härkönen Taina , Hämäläinen Anu-Maaria , Peet Aleksandr , Tillmann Vallo , Ilonen Jorma , Wang David , Knip Mikael , Xavier Ramnik J. , Virgin Herbert W.
Published: July 2017

Significance

Type 1 diabetes (T1D) is a major autoimmune disease with increasing incidence in recent years. In this study, we found that the intestinal viromes of cases were less diverse than those of controls. We identified eukaryotic viruses and bacteriophage contigs that are associated with the presence or absence of autoimmunity. These viruses provide targets for future mechanistic studies to differentiate causal and incidental associations between the virome and protection against the development of T1D.
From fatalism to mass action to incorporation to neoliberal individualism: worker safety on South African mines, c.1955–2016
Authors: Stewart Paul , Nite Dhiraj Kumar
Published: July 2017

The article resurfaces ‘tacit knowledge’ to periodise developments in worker safety in South African mines. ‘Tacit knowledge’ evolved over time, is orally transmitted, learned on the job, and is central to worker safety; it lay behind acts of resistance and demands for a safer mining workplace which underpinned unionisation, and which won worker safety representation under apartheid. Under democracy, a modern consultative tripartite legislative safety regime was instituted. With worker representation institutionalised, health and safety legislation enacted and tripartite institutions established, procedural compliance eclipsed workers’ ‘tacit knowledge’. The right to refuse to do dangerous work, state-initiated safety work stoppages and the impact on safety of inter-union rivalry are currently in the spotlight and are noted below. With the state firmly in neoliberal mode post-Fordism, this article concludes by noting the emergence of the individualisation of safety – ironically motivated by a behaviourist construal of ‘tacit beliefs’ underpinning a major industry safety initiative.
Gyrokinetic projection of the divertor heat-flux width from present tokamaks to ITER
Authors: Chang C.S. , Ku S. , Loarte A. , Parail V. , Köchl F. , Romanelli M. , Maingi R. , Ahn J.-W. , Gray T. , Hughes J. , LaBombard B. , Leonard T. , Makowski M. , Terry J.
Published: July 2017

The XGC1 edge gyrokinetic code is used to study the width of the heat-flux to divertor plates in attached plasma condition. The flux-driven simulation is performed until an approximate power balance is achieved between the heat-flux across the steep pedestal pressure gradient and the heat-flux on the divertor plates. The simulation results compare well against the empirical scaling λ
q

∝

1/

B

P

γ

obtained from present tokamak devices, where λ
q is the divertor heat-flux width mapped to the outboard midplane, γ  =  1.19 as found by Eich et al (2013 Nucl. Fusion
53 093031), and B
P is the magnitude of the poloidal magnetic field at the outboard midplane separatrix surface. This empirical scaling predicts λ
q  ≲  1 mm when extrapolated to ITER, which would require operation with very high separatrix densities (n
sep/n
Greenwald  >  0.6) (Kukushkin et al 2013 J. Nucl. Mater. 438 S203) in the Q  =  10 scenario to achieve semi-detached plasma operation and high radiative fractions for acceptable divertor power fluxes. Using the same simulation code and technique, however, the projected λ
q for ITER’s model plasma is 5.9 mm, which could be suggesting that operation in the ITER Q  =  10 scenario with acceptable divertor power loads may be obtained over a wider range of plasma separatrix densities and radiative fractions. The physics reason behind this difference is, according to the XGC1 results, that while the ion magnetic drift contribution to the divertor heat-flux width is wider in the present tokamaks, the turbulent electron contribution is wider in ITER. Study will continue to verify further this important projection. A high current C-Mod discharge is found to be in a mixed regime: While the heat-flux width by the ion neoclassical magnetic drift is still wider than the turbulent electron heat-flux width, the heat-flux magnitude is dominated by the narrower electron heat-flux.
Tadalafil Improves L-NG-Nitroarginine Methyl Ester-Induced Preeclampsia With Fetal Growth Restriction-Like Symptoms in Pregnant Mice
Authors: Yoshikawa Kento , Umekawa Takashi , Maki Shintaro , Kubo Michiko , Nii Masafumi , Tanaka Kayo , Tanaka Hiroaki , Osato Kazuhiro , Kamimoto Yuki , Kondo Eiji , Ikemura Kenji , Okuda Masahiro , Katayama Kan , Miyoshi Takekazu , Hosoda Hiroshi , Ma Ning , Yoshida Toshimichi , Ikeda Tomoaki
Published: July 2017

BACKGROUND

We investigated the efficacy and mechanisms of tadalafil, a selective phosphodiesterase 5 inhibitor, in treating preeclampsia (PE) with fetal growth restriction (FGR) using L-NG-nitroarginine methyl ester (L-NAME)-induced PE with FGR in pregnant mice as our experimental model.

METHODS

C57BL/6 mice were divided into 2 groups 11 days postcoitum (d.p.c.). A control group of dams (C dam) received 0.5% carboxymethylcellulose (CMC). A L-NAME-treated group received 1 mg/ml L-NAME dissolved in CMC. The L-NAME-treated dams were divided into 2 subgroups 13 d.p.c. One subgroup continued to receive L-NAME (L dams). The other subgroup received L-NAME with 0.08 mg/ml tadalafil suspended in CMC (TL dams). Maternal systolic blood pressure (SBP) and proteinuria were assessed 16 d.p.c. Fetal weight was recorded, and placentas and maternal kidneys were collected 17 d.p.c.

RESULTS

Maternal SBP, proteinuria, and fetal weight were improved for TL dams compared to L dams. The placental concentration of placental growth factor (PlGF) was higher for TL dams than for the C and L dams. The placental maternal blood sinuses of L dams were narrower than those of C dams, but those of TL dams improved to a similar width as C dams. Glomerular oxidative stress was ameliorated in TL dams compared to L dams.

CONCLUSIONS

Tadalafil dilates the placental maternal blood sinuses, which leads to increase PlGF production, and contributes to facilitate fetal growth and improve maternal SBP. Moreover, tadalafil ameliorates glomerular damage by reducing oxidative stress. These results suggest that tadalafil is a candidate for treatment of PE with FGR.
Out of air
Authors: Mendenhall Ann M. , Forest Christopher P.
Published: July 2017

As more people travel to high altitudes for recreation or work, more travelers with underlying medical conditions will need advice before traveling or treatment for altitude illness. This article focuses on the two main issues for travelers: whether travel to a high altitude will have a negative effect on their underlying medical condition and whether the medical condition increases the patient's risk of developing altitude illness. Although patients with severe pulmonary or cardiac conditions are most at risk in the hypoxic environment, other conditions such as diabetes and pregnancy warrant attention as well.
Pregnancy-Related Mortality in the United States, 2011–2013
Authors: Creanga Andreea A. , Syverson Carla , Seed Kristi , Callaghan William M.
Published: July 2017

OBJECTIVE:

To update national population-level pregnancy-related mortality estimates and examine characteristics and causes of pregnancy-related deaths in the United States during 2011–2013.

METHODS:

We conducted an observational study using population-based data from the Pregnancy Mortality Surveillance System to calculate pregnancy-related mortality ratios by year, age group, and race–ethnicity groups. We explored 10 cause-of-death categories by pregnancy outcome during 2011–2013 and compared their distribution with those in our earlier reports since 1987.

RESULTS:

The 2011–2013 pregnancy-related mortality ratio was 17.0 deaths per 100,000 live births. Pregnancy-related mortality ratios increased with maternal age, and racial–ethnic disparities persisted with non-Hispanic black women having a 3.4 times higher mortality ratio than non-Hispanic white women. Among causes of pregnancy-related deaths, the following groups contributed more than 10%: cardiovascular conditions ranked first (15.5%) followed by other medical conditions often reflecting pre-existing illnesses (14.5%), infection (12.7%), hemorrhage (11.4%), and cardiomyopathy (11.0%). Relative to the most recent report of Pregnancy Mortality Surveillance System data for 2006–2010, the distribution of cause-of-death categories did not change considerably. However, compared with serial reports before 2006–2010, the contribution of hemorrhage, hypertensive disorders of pregnancy, and anesthesia complications declined, whereas that of cardiovascular and other medical conditions increased (population-level percentage comparison).

CONCLUSION:

The pregnancy-related mortality ratio and the distribution of the main causes of pregnancy-related mortality have been relatively stable in recent years.
Chlorhexidine-Alcohol Compared With Povidone-Iodine for Preoperative Topical Antisepsis for Abdominal Hysterectomy
Authors: Uppal Shitanshu , Bazzi Ali , Reynolds R. Kevin , Harris John , Pearlman Mark D. , Campbell Darrell A. , Morgan Daniel M.
Published: July 2017

OBJECTIVE:

To compare preoperative chlorhexidine-alcohol topical antiseptic agent with povidone-iodine in patients undergoing abdominal hysterectomy for benign indications.

METHODS:

A retrospective cohort study of patients undergoing abdominal hysterectomy from July 2012 to February 2015 in the Michigan Surgical Quality Collaborative was performed. The primary exposure was the use of chlorhexidine-alcohol or povidone-iodine. The primary outcome was surgical site infection within 30 days. Multivariable logistic regression and propensity score matching analysis were done to estimate the independent association of skin antiseptic choice on the rate of surgical site infection.

RESULTS:

Of the total 4,259 abdominal hysterectomies included, chlorhexidine-alcohol was used in 70.5% (n=3,005) and povidone-iodine in 29.5% (n=1,254) of surgeries. The overall unadjusted rate of any surgical site infection was 2.9% (95% CI 2.5–3.5; n=124). The unadjusted rate of surgical site infection 2.6% (95% CI 2.1–3.3; n=79) for chlorhexidine-alcohol and 3.6% (95% CI 2.7–4.8; n=45; P=.09) for the povidone-iodine group. Using multivariate logistic regression and adjusting for differences between populations in patient demographic factors (age and body mass index), medical comorbidities (American Society of Anesthesiologists class and diabetes status), perioperative variables (estimated blood loss, surgical time, intraoperative adhesions, and antibiotic categories), and hospital characteristics (bed size and teaching status), we estimate that patients receiving chlorhexidine-alcohol had 44% lower odds of developing a surgical site infection (adjusted odds ratio 0.56, 95% CI 0.37–0.85, P=.01). Propensity score matching (one to one) yielded 808 patients in the chlorhexidine-alcohol group and 845 patients in the povidone-iodine group. In the matched groups, the rate of surgical site infection was 1.5% (95% CI 0.8–2.6; n=12) for the chlorhexidine-alcohol group and 4.7% (95% CI 3.5–6.4; n=40) for the povidone-iodine group (P<.001).

CONCLUSION:

In abdominal hysterectomy performed for benign indications, chlorhexidine-alcohol-based skin antisepsis is associated with overall lower odds of surgical site infection compared with povidone-iodine.
When Guild Interests and Professional Obligations Collide
Authors: Minkoff Howard , Ecker Jeffrey
Published: July 2017

Physicians who work in medical organizations are called on to fulfill two roles: guild members who work to advance physician interests (eg, lobbying for tort reform) and professional society members who work to advance patient interests (eg, developing clinical guidelines). Most often, physicians' self-interest and their interest in patient well-being align. When they do not, members of a guild or profession may justify the prioritization of self-interest with a form of motivated reasoning (a process wherein physicians weigh data differently depending on whether it supports their a priori beliefs). This allows physicians to frame self-interest as being in the best interests of their patients (eg, tort reform makes malpractice insurance affordable and allows physicians to continue to serve their patients). When interests conflict, physicians must be cognizant of the forces at play, that is, self-interest or in-group interest on the one hand and obligations to patients on the other. This entails recognition and negation of motivated reasoning. Often the most difficult calculus is evaluating proposed actions that would disadvantage physicians but advantage patients. In such cases, the health care provider must be aware not only of the temptation to oppose the action for financial reasons, but also the equally natural temptation to frame the proposal as a threat to patient well-being. Ultimately recognizing that a central tenet of professionalism is the primacy of patient welfare should help physicians both to maintain their fidelity to patient good and to uphold their reputation for altruism.
What Is New in Obstetric Imaging?
Authors: Dashe Jodi S.
Published: July 2017

This month we focus on current research in obstetric imaging. Dr. Dashe discusses five recent publications, which are concluded with a “bottom line” that is a take-home message. A complete reference for each can be found in Box 1 on this page along with direct links to abstracts.
Intraoperative Video Production With a Head-Mounted Consumer Video Camera
Authors: Avery Matthew C.
Published: July 2017

The use of high-definition video in surgical education is becoming increasingly popular. Because of the availability of relatively inexpensive, consumer-grade video cameras, surgeons with minimal video production experience can produce high-quality surgical videos. A number of video capture methods are available, with varying degrees of production quality, economic constraint, and level of attention required from the operating surgeon. The accompanying video provides an overview of the advantages and disadvantages of several options and describes a technique for capturing intraoperative video with the use of a head-mounted, consumer video camera.
Percutaneous Repair of a Schatzker III Tibial Plateau Fracture Assisted by Arthroscopy
Authors: Egol Kenneth A. , Cantlon Matthew , Fisher Nina , Broder Kari , Reisgo Aldo
Published: July 2017

Purpose:

Tibial plateau fractures are articular fractures that sometimes prove difficult to effectively manage and treat. Although fluoroscopy is frequently used to assess the articular reduction in the surgical repair of tibial plateau fractures, this video demonstrates the additional benefit of arthroscopy in assisting with the articular reconstruction of a Schatzker III tibial plateau fracture.

Methods:

The goal of operative treatment of tibial plateau is reconstruction of the articular surface followed by reestablishment of tibial alignment. Arthroscopy has been advocated as a possible supplement to the operative treatment of tibial plateau fractures. Arthroscopy-assisted fracture reduction has been shown to provide a significantly improved visualization of fracture fragment displacement when compared with traditional fluoroscopy use in select cases.

Results:

This video demonstrates the use of arthroscopy to visualize the articular surface and aid in reduction during fixation of a tibial plateau fracture. Initially, arthroscopic visualization confirms depression of lateral tibial plateau and the elevation of the fractured segment. After fixation with 2 partially threaded cancellous screws, arthroscopy confirms articular reduction and normal relation of lateral meniscus to the articular surface.

Conclusions:

Arthroscopic visualization is a reliable technique for assessing articular reduction during surgical repair of a tibial plateau fracture. In addition, this technique enables the surgeon to assess for soft tissue injuries that could potentially go undiagnosed.
Posterolateral Bone Grafting for Distal Tibia Nonunion
Authors: Konda Sanjit , Saleh Hesham , Fisher Nina , Egol Kenneth A.
Published: July 2017

Introduction:

This video demonstrates the technique of posterolateral bone grafting with iliac crest bone graft for a distal tibial nonunion.

Methods:

The patient is a 42-year-old man who is 6 months status post an open distal tibia–fibula fracture treated surgically, and presents complaints of persistent right ankle pain. The fracture site was tender to palpation, and 3 consecutive plain radiographs spaced 6 weeks apart demonstrated no evidence of callus formation.

Results:

This patient was indicated for posterolateral bone grafting of his tibia and fibula nonunion with autogenous iliac crest bone graft. The plan was to create a synostosis between the fibula and tibia. Atrophic and oligotrophic nonunions have poor biology at the fracture site to promote bone growth and would therefore benefit from autogenous iliac bone graft, as this technique is osteoinductive, osteoconductive, and osteogenic stem cells. Indications for posterolateral bone grafting of the tibia include atrophic or oligotrophic nonunions, an ipsilateral same level tibia and fibula nonunion, or a tibial nonunion with a large anteromedial soft-tissue injury.

Conclusion:

The technique of posterolateral bone grafting with iliac crest bone graft for distal third tibia and fibula atrophic nonunion provides a reliable method for achieving union. If patients with injuries at high risk of nonunion are followed closely and intervention is performed in a timely manner, additional fixation or revision of fixation is not necessary if the addition of appropriate osteoinductive, osteoconductive, and osteogenic material to the nonunion is performed.
Navigating the cervical cancer screening guidelines for women aged older than 65 years
Authors: Miller Taniqua A. , Flowers Lisa
Published: July 2017

One of the most notable changes stemming from consensus guidance in 2012 is cessation of cervical cancer screening in low-risk women aged older than 65 years. Despite evidence provided for this recommendation, implementation in clinical practice can be challenging, with resistance from patients and providers. This NAMS Practice Pearl reviews data supporting this recommendation and provides clinicians with confidence as we counsel our patients.
Factors associated with different symptom domains among postmenopausal Saudi women in Riyadh, Saudi Arabia
Authors: AlQuaiz AlJohara M. , Kazi Ambreen , Habib Fawzia , AlBugami Muneerah , AlDughaither Aida
Published: July 2017

Objective:

To determine factors associated with different symptom domains among postmenopausal Saudi women in Riyadh, Saudi Arabia.

Methods:

In a cross-sectional study, interviews were conducted with 542 postmenopausal Saudi women, comprising sociodemographic history, social support, and the Menopause-specific Quality of Life questionnaire.

Results:

The mean age of participants was 58 (±7.0) years, and the mean age at menopause was 49 (±4.7) years. We found that 41% (n = 224), 14.4% (n = 78), 57% (n = 307), and 12.7% (n = 69) of women reported severe/moderate impact of vasomotor, psychosocial, physical, and sexual symptoms, respectively. Multivariate logistic regression revealed that lacking emotional support was associated with severe/moderate vasomotor (adjusted odds ratio [aOR] 1.5, 95% confidence interval [CI] 1.1, 2.3), psychosocial (aOR 2.0, 95% CI 1.2, 3.4), and physical (aOR 1.7, 95% CI 1.2, 2.6) symptoms. Lack of tangible social support was associated with severe/moderate sexual symptoms (aOR 1.9, 95% CI 1.0, 3.4). In addition, women who worked (aOR 1.8, 95% CI 1.1, 3.2), were obese (aOR 2.0, 95% CI 1.0, 4.1), lived in rented accommodations (aOR 3.9, 95% CI 1.2, 13.1), or had a retired spouse (aOR 1.6, 95% CI 1.0, 2.4) had higher odds for moderate/severe menopausal symptoms.

Conclusions:

Establishing educational and counseling programs for postmenopausal women, their spouses, and other family members could improve social support and hence quality of life of postmenopausal women. Effective preventive strategies to deal with modifiable risk factors, such as obesity and work stress, should also be implemented.
Patient characteristics, menopause symptoms, and care provided at an interdisciplinary menopause clinic: retrospective chart review
Authors: Sydora Beate C. , Yuksel Nese , Veltri Nicole L. , Marillier Justin , Sydora Christoph P. , Yaskina Maryna , Battochio Lori , Shandro Tami M.L. , Ross Sue
Published: July 2017

Objective:

The goal of this study was to describe the characteristics, menopause symptoms, and treatment progressions in women cared for at an interdisciplinary menopause clinic.

Methods:

We conducted a retrospective review of patient charts from women attending a multidisciplinary menopause clinic. Data collected from the charts included patient demographics, menopause symptoms, other concurrent medical conditions, and treatment recommendations. Data were entered into Research Electronic Data Capture database and analyzed descriptively. Generic symptom severity questionnaires were used to compare severity scores from initial to follow-up visits.

Results:

Among the 198 women (mean age 52.1 y [±SD 6.3], 63.6% postmenopausal), the most common moderate/severe menopause symptoms were as follows: difficulty staying asleep or waking frequently (76.3%), tiredness (73.7%), and lack of interest in sex (60.1%). Women tended to have complex chronic medical conditions, with 54.5% suffering from four or more concurrent medical conditions. The majority of women (70.2%) were recommended various forms of hormone therapy. Women with a follow-up visit at 3 to 4 months reported a reduction in symptom severity.

Conclusions:

Our study addresses a gap in published information on patient characteristics and treatment in menopause-specific interdisciplinary clinics. The chart review highlights the variety of symptom experience and complexity of care faced in a menopause clinic. Rigorous prospective studies including standardized data collection and follow-up are needed to help guide clinicians in managing complex menopause patients.
Autonomic responses to tonic pain are more closely related to stimulus intensity than to pain intensity
Authors: Nickel Moritz M. , May Elisabeth S. , Tiemann Laura , Postorino Martina , Ta Dinh Son , Ploner Markus
Published: July 2017

Pain serves the protection of the body by translating noxious stimulus information into a subjective percept and protective responses. Such protective responses rely on autonomic responses that allocate energy resources to protective functions. However, the precise relationship between objective stimulus intensity, subjective pain intensity, autonomic responses, and brain activity is not fully clear yet. Here, we addressed this question by continuously recording pain ratings, skin conductance, heart rate, and electroencephalography during tonic noxious heat stimulation of the hand in 39 healthy human subjects. The results confirmed that pain intensity dissociates from stimulus intensity during 10 minutes of noxious stimulation. Furthermore, skin conductance measures were significantly related to stimulus intensity but not to pain intensity. Correspondingly, skin conductance measures were significantly related to alpha and beta oscillations in contralateral sensorimotor cortex, which have been shown to encode stimulus intensity rather than pain intensity. No significant relationships were found between heart rate and stimulus intensity or pain intensity. The findings were consistent for stimulation of the left and the right hands. These results suggest that sympathetic autonomic responses to noxious stimuli in part directly result from nociceptive rather than from perceptual processes. Beyond, these observations support concepts of pain and emotions in which sensory, motor, and autonomic components are partially independent processes that together shape emotional and painful experiences.
Impact of EBUS-TBNA on PET-CT Imaging of Mediastinal Nodes
Authors: Sivapalan Pradeesh , Naur Therese Maria Henriette , Colella Sara , Richter Larsen Klaus , Konge Lars , Frost Clementsen Paul
Published: July 2017

Background:

Positron emission tomography-computed tomography (PET-CT) with fluorine-18-fluorodeoxyglucose has a high sensitivity in detecting malignancy in patients suspected of lung cancer but a low specificity as inflammatory reactions can also result in metabolic activity. Furthermore, it is assumed that invasive pulmonary procedures with biopsies from benign lesions can induce metabolic activity resulting in false-positive results. However, this hypothesis lacks solid evidence. We aimed to evaluate how often endobronchial ultrasound (EBUS) with biopsies from benign lesions are followed by false-positive results.

Methods:

Patients with suspected or proven lung cancer admitted for invasive pulmonary procedures in a 6-year period were retrospectively reviewed. Patients who had at least 1 nonmalignant mediastinal lymph node (MLN) biopsied 1 to 13 days before PET-CT were included. The number of false-positive and true-negative results shortly after EBUS biopsy of nonmalignant MLN was reviewed.

Results:

Of 1025 patients, 216 patients were referred for PET-CT 1 to 13 days after biopsy. Of these, 107 patients had at least 1 MLN biopsied. From a total of 198 biopsied MLNs, we found 62% without metabolic activity (benign) and 38% with metabolic activity. In 5% the metabolic activity could be explained by an infection or inflammatory disorder, in 15% no cytologic follow-up was available, in 1% malignancy was confirmed at follow-up, and in 3% the patients were not possible to follow-up. In the remaining 14%, no other reasonable explanation for the metabolic activity was found other than the biopsy.

Conclusions:

EBUS with biopsy do not necessarily result in PET activity. Therefore, PET-positive results should always be taken seriously, even when PET is performed shortly after biopsies.
Congenital Amegakaryocytic Thrombocytopenia: A Case Series Indicating 2 Founder Variants in the Mississippi Band of Choctaw Indians
Authors: Newman Laura A. , Luter Meghan A. , Davis Dereck B. , Abdul-Rahman Omar A. , Johnson Juantina M. , Megason Gail C.
Published: July 2017

Congenital amegakaryocytic thrombocytopenia is a rare disorder causing thrombocytopenia that progresses to pancytopenia and bone marrow failure if untreated. It is caused by variants in the MPL gene which encodes the thrombopoeitin receptor. In this report, we review 5 cases of congenital amegakaryocytic thrombocytopenia, all of whom belong to the Mississippi Band of Choctaw Indians. There are 2 common variants in these cases: R90X and R537W. One variant was previously reported only once and had unclear significance at that time. With these variants identified, we hope to improve screening that results in earlier diagnosis in the Choctaw population in the future.
Pretreatment Neutrophil-to-Lymphocyte Ratio and Lymphocyte Recovery: Independent Prognostic Factors for Survival in Pediatric Sarcomas
Authors: Vasquez Liliana , León Esmeralda , Beltran Brady , Maza Ivan , Oscanoa Monica , Geronimo Jenny
Published: July 2017

Background:

Pretreatment neutrophil-to-lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) recovery have been shown to be associated with prognosis in several types of cancer in adults. However, evidence in pediatric cancer is scarce. The aim of our study was to evaluate whether pretreatment NLR and lymphocyte recovery are prognostic factors in pediatric sarcomas.

Materials and Methods:

Study participants were identified from a retrospective cohort of 100 children with osteosarcoma (n=55), rhabdomyosarcoma (n=22), and Ewing sarcoma (n=23). Data for the hematological variables were obtained from medical records and analyzed with other known prognostic factors in univariate and multivariate analyses.

Results:

In multivariate analysis, NLR>2 was an independent prognostic factor for OS in patients with osteosarcoma (hazard ratio [HR], 2.27, 95% confidence interval [CI], 1.07-5.30; P=0.046) along with metastatic disease and poor histologic response; as well as in patients with rhabdomyosarcoma (HR, 4.76, 95% CI, 1.01-22.24; P=0.0237) along with metastatic disease and risk group. ALC recovery correlated for inferior OS in osteosarcoma (HR, 3.34, 95% CI, 1.37-8.12; P=0.008) and rhabdomyosarcoma (HR, 3.89; 95% CI, 1.01-14.89; P=0.0338).

Conclusions:

Our study confirms that NLR and ALC recovery are independent prognostic factors for pediatric sarcomas, implying an important role of immune system in survival. Clinical utility of these prognostic biomarkers should be validated in larger pediatric studies.
Utility of Lumbar Puncture in Children Presenting With Status Epilepticus
Authors: Michelson Kenneth A. , Lyons Todd W. , Johnson Kara B. , Nigrovic Lise E. , Harper Marvin B. , Kimia Amir A.
Published: July 2017

Objectives

Because meningitis may trigger seizures, we sought to determine its frequency in children with first-time status epilepticus (SE).

Methods

We performed a retrospective cross-sectional study of children aged 1 month to 21 years who presented to a single pediatric emergency department between 1995 and 2012 with SE and who had a lumbar puncture (LP) performed as part of the diagnostic evaluation. We defined bacterial meningitis as a cerebrospinal fluid (CSF) culture positive for a bacterial pathogen or CSF pleocytosis (CSF white blood cells ≥10 cells/mm3) with a blood culture positive for a bacterial pathogen. We defined viral meningitis or encephalitis using a positive enterovirus or herpes simplex virus polymerase chain reaction test.

Results

Among 126 children with SE who had an LP performed, 8 (6%) had CSF pleocytosis. Of these, 5 had received antibiotics before performance of a diagnostic LP. One child in the cohort was proven to have bacterial meningitis (0.8%; 95% confidence interval [CI], 0%–6%). Two other children had enteroviral meningitis (2/13 tested, 15%; 95% CI, 3%–51%), and 1 had a herpes simplex virus infection (1/47, 2%; 95% CI, 0%–15%).

Conclusions

Bacterial meningitis is an uncommon cause of SE.
Adenomyoma With Pseudoinvasive Growth Pattern and Serosal Penetration Mimicking Endometrial Carcinoma
Authors: Raj Thomas , DeWitt Robert , Smith Nathaniel E.
Published: July 2017

We present a novel case of a 48-yr-old female with a uterine adenomyoma with an unusual pseudoinvasive growth pattern displaying full-thickness penetration beyond the serosal surface in association with a dehisced Caesarian scar. Before hysterectomy, magnetic resonance imaging findings showed an infiltrative lesion suggestive of endometrial carcinoma. An endometrial biopsy was benign but definitive operative management was pursued given the concerning imaging. Gross examination of the uterus demonstrated a 7.2 cm, relatively well-circumscribed polypoid neoplasm with pushing borders extending through the full thickness of the myometrium. A serosal defect with protruding red tissue was noted where the neoplasm penetrated the exterior surface of the uterus. Histologic examination demonstrated benign endometrial glands, associated endometrial stroma, thick-walled vessels, and a prominent smooth muscle component consistent with an adenomyoma. To our knowledge, this unique presentation of a pseudoinvasive adenomyoma extending beyond the serosa is extremely rare and is the first time reported in the literature.
Computerized Virtual Reality Simulation in Preclinical Dentistry: Can a Computerized Simulator Replace the Conventional Phantom Heads and Human Instruction?
Authors: Plessas Anastasios
Published: July 2017

Summary Statement

In preclinical dental education, the acquisition of clinical, technical skills, and the transfer of these skills to the clinic are paramount. Phantom heads provide an efficient way to teach preclinical students dental procedures safely while increasing their dexterity skills considerably. Modern computerized phantom head training units incorporate features of virtual reality technology and the ability to offer concurrent augmented feedback. The aims of this review were to examine and evaluate the dental literature for evidence supporting their use and to discuss the role of augmented feedback versus the facilitator's instruction. Adjunctive training in these units seems to enhance student's learning and skill acquisition and reduce the required faculty supervision time. However, the virtual augmented feedback cannot be used as the sole method of feedback, and the facilitator's input is still critical. Well-powered longitudinal randomized trials exploring the impact of these units on student's clinical performance and issues of cost-effectiveness are warranted.
Assessment of Conflicts of Interest in Robotic Surgical Studies
Authors: Patel Sunil V. , Yu David , Elsolh Basheer , Goldacre Ben M. , Nash Garrett M.
Published: July 2017

Background:

Accurate conflict of interest (COI) statements are important, as a known COI may invalidate study results due to the potential risk of bias.

Objective:

To determine the accuracy of self-declared COI statements in robotic studies and identify risk factors for undeclared payments.

Methods:

Robotic surgery studies were identified through EMBASE and MEDLINE and included if published in 2015 and had at least one American author. Undeclared COI were determined by comparing the author's declared COI with industry reported payments found in the “Open Payments” database for 2013 and 2014. Undeclared payments and discrepancies in the COI statement were determined. Risk factors were assessed for an association with undeclared payments at the author and study level.

Results:

A total of 458 studies (2253 authors) were included. Approximately, 240 (52%) studies had 1 or more author receive undeclared payments and included 183 where “no COI” was explicitly declared, and 57 with no declaration statement present. Moreover, 21% of studies and 18% of authors with a COI declared it so in a COI statement. Studies that had undeclared payments from Intuitive were more likely to recommend robotic surgery compared with those that declared funding (odds ratio 4.29, 95% confidence interval 2.55–7.21).

Conclusions:

We found that it was common for payments from Intuitive to be undeclared in robotic surgery articles. Mechanisms for accountability in COI reporting need to be put into place by journals to achieve appropriate transparency to those reading the journal article.