bluuebunny/crossref_metadata_2025 huggingface dataset:
Additional femoral nerve block analgesia does not reduce the chronic pain after total knee arthroplasty
Authors: Yao Yuan-yuan , Zhou Qing-he , Yu Li-na , Yan Min
Published: March 2019

Femoral nerve block analgesia was deemed to the gold standard for acute pain management after total knee arthroplasty (TKA). But effect on chronic pain management is not investigated fully. We conducted a retrospective study to explore the effect of single-injection femoral nerve block on postsurgical chronic pain.

All medical records of patients undertaking TKA between January, 2013 and June, 2014 were reviewed via the Docare anesthesia database. Patients who administrated with the self-controlled intravenous analgesia were assigned to group P. Patients who received a single-injection femoral never block combined with patient self-controlled intravenous analgesia were assigned to group N + P. The visual analog scale (VAS) score before surgery, the first postoperative day (POD 1), POD 2, 3 months, 6 months, and 12 months after surgery were extracted from medical records. Pain score was compared over these 2 groups to investigate treatment outcomes.

In all, 470 patients met the selection criteria for group P and 266 patients met the selection criteria for group N + P. Compared with group P, the VAS score decreased significantly in group N + P at POD 1 (P < .001), and the same was observed at POD 2 (P < .001); the moderate to severe pain incidence rate decreased significantly in group N + P at POD 1 (P < .01) and POD 2 (motion, P < .001). The rescued anesthesia rate reduced significantly in group N + P in POD 1 (P = .001), whereas no difference was found in POD 2 (P = .864). No difference was found at 3, 6, and 12 months after surgery (all P > .05).

The single-injection femoral nerve block could relieve the acute postsurgical pain in a short period of time. But no evidence was found that it could reduce the chronic pain between 3 and 12 months after TKA.
Herb induced liver injury after using herbal medicine
Authors: Lin Nai-Hui , Yang Hsiu-Wu , Su Yu-Jang , Chang Chen-Wang
Published: March 2019

In Taiwan, traditional herbal medication was included in Taiwan's National Health Insurance (NHI) system since 1996 and in 9 out of 10 hospitals have developed their own departments of traditional medicine. This study aims to address the herb-induced liver injury (HILI) after using herbal medicine on the relationship between age, gender, epidemiology, laboratory data, pathogenesis, mobility, and mortality.

We searched the PubMed database with “hepatitis after herbal medicine” and “in human” till 2018 April and returned 163 articles in a systemic review manner. Two cases reports describing in-vitro liver injury were excluded. Reviews and articles without the detailed report, laboratory data and history were excluded from this study. In the end, there were 53 articles enrolled in this study. These enrolled literatures are from France (n = 13), Germany (n = 12), Switzerland (n = 5) United States of America (n = 4), Korea (n = 4), Hong Kong (n = 4), Greece (n = 3), China (n = 2), Canada (n = 1), Italy (n = 1), Thailand (n = 1), Finland (n = 1), Taiwan (n = 1), and Japan (n = 1). The data were analyzed with a commercial statistical software Stata/SE 12.0 program Stata Corporation, College Station, TX, USA. Statistical χ2 tests were performed and the significance was set at a P value of less than .05 (2-tailed).

The ages are ranged from 15 to 78 years with the mean ± SD (standard deviation) of 48.3 ± 16.2 years old. The majority of cases are female (n = 37). In elderly, man is more commonly seen than female in HILI (37.5% vs 10.5%, P = .02). Female is vulnerable to cholestatic type of HILI than male (21.1% vs 0.0%, P = .04). Of all the cases in HILI, using pure substance are more commonly seen than mixed substance (P = .02). In gender, male patients have higher alanine aminotransferase (GPT) (IU/L) level in HILI than female ones (1560 ± 819 vs 1047 ± 706, P = .03).

In HILI, the female is more commonly seen than male, but less than male in the elderly. The pure substance more often happens to HILI than mixture substance. Female is predominant in the cholestatic type of HILI. The major prevalence of HILI is in Europe rather than Asia. HILI cases in Europe is 2.75-fold than in Asia. This could be due to fewer reports of the herb induced liver injury in Asia compared to Europe. Prevention of HILI is the best policy, because it needs to take 78 ± 59 days to recover.
Clostridium difficile-associated diarrhea following the therapy with antibiotic and proton pump inhibitors in a 77-year-old man with several comorbidities
Authors: Lv Xiaoqun , Zhang Jun , Jiang Miao , Liu Yujuan , Ren Weifang , Fang Zhonghong
Published: March 2019

Rationale:

Clostridium difficile-associated diarrhea (CDAD) remains a persistent challenge, with substantially increased incidence and severity. The rising burden of CDAD requires urgent identification of preventable risk factors.

Patients concerns:

A 77-year-old man with the symptoms of abdominal pain and watery diarrhea was readmitted to the hospital, who received cephalosporins and proton pump inhibitors (PPIs) during the initial hospitalization for 12 days until discharge. Antibiotic-associated diarrhea was seriously suspected. And the stool sample was immediately sent for inspection for C difficile. He had a history of chronic bronchitis, coronary heart disease, and osteonecrosis.

Diagnosis:

CDAD, renal insufficiency

Interventions:

Oral vancomycin was administered for 14 days.

Outcomes:

On the third day after readmission, the stool sample turned out to be positive for both C difficile toxin and its antigen. After 10-day treatment with vancomycin, diarrhea symptoms disappeared and his stools became normal.

Lessons:

In elderly patients with multiple comorbidities, PPIs must be administered cautiously to minimize the risk for adverse effects including CDAD. It is important to identify the preventable risk factors of CDAD for clinicians and pharmacists. Oral vancomycin therapy seems to be effective in CDAD.
A CARE-compliant article: optical coherence tomography for epithelial basement membrane dystrophy
Authors: Kuo Yi-Chun , Lee Yuan-Chieh
Published: March 2019

Rationale:

The etiology of anterior corneal opacities and the effect of debridement cannot be determined by biomicroscopy. Optical coherence tomography (OCT) helps identify the character and depth of these lesions.

Patient concerns:

A 45-year-old female complained of progressive blurred vision for a long time. Slit lamp biomicroscopy showed irregular, faint scar-like opacity of anterior cornea in her both eyes. Pentacam Scheimpflug camera tomography showed irregular astigmatism of anterior corneal surface. Anterior segment spectral-domain OCT revealed thickened, hyper-reflective linings, and scattered lesions, mainly in the epithelial layer.

Diagnoses:

Epithelial basement membrane dystrophy (EBMD).

Intervention:

Epithelial debridement and bandage lenses.

Outcomes:

The cornea became clear and the vision improved soon after debridement. The pathology showed thickened aberrant basement membrane extending into mid-epithelial layer, with microcyst-like lesions also noted.

Lessons:

OCT defines the depth of lesions and helps diagnosis and management of EBMD.
Changes in the neutrophil-to-lymphocyte ratio predict the prognosis of patients with advanced hepatocellular carcinoma treated with sorafenib
Authors: Hong Young Mi , Yoon Ki Tae , Hwang Tae Ho , Heo Jeong , Woo Hyun Young , Cho Mong
Published: March 2019

Background and aim

Although sorafenib is the first systemic therapy to show survival benefit for advanced hepatocellular carcinoma (HCC), its survival benefit is variable for HCC. Systemic inflammation may be associated with survival in HCC. We investigated the use of systemic inflammation markers, including neutrophil-to-lymphocyte ratio (NLR), in the prognosis of sorafenib-treated HCC patients.

Patients and methods

We retrospectively analyzed data of 82 patients with advanced HCC who received sorafenib as the first-line treatment. Data on pretreatment and post-treatment (2–3 months after initiating sorafenib therapy, first tumor response evaluation day) clinical, laboratory, and tumor characteristics were collected. Survival-related prognostic factors were analyzed.

Results

Patients were mostly in the intermediate (12.2%) or advanced (87.8%) Barcelona Clinic Liver Cancer stages. Fifty-six (68.3%) patients had vascular invasion and 34 (41.5%) patients had extrahepatic disease. The median progression-free survival (PFS) and overall survival (OS) were 4.7 months [95% confidence interval (CI): 2.8–6.5 months] and 4.7 months (95% CI: 2.8–6.5 months). In multivariate analysis for OS, diarrhea (hazard ratio: 0.588; 95% CI: 0.348–0.993) and NLR decline (decreased compared with pretreatment) (hazard ratio: 0.479; 95% CI: 0.300–0.765) were independent factors of good OS. In the NLR decline group, the median PFS and OS were 7.1 and 7.3 months, respectively. In the NLR nondecline group, the median PFS and OS were 3.0 and 3.2 months, respectively. The difference in OS between the two groups was significant (P = 0.004).

Conclusion

A change in NLR after sorafenib therapy was associated with a better prognosis in patients with advanced HCC.
Can Obesity and Health Coexist?
Authors: Metcalf Kevin Blake
Published: March 2019

Obesity in individuals who appear to be metabolically healthy is a transient state during which clinically silent diseases such as hypertension and diabetes may be progressing. Psychological problems may also be developing, and social stigma may be present. Therefore, obesity should be treated as soon as it is identified.
Wheelchair-Assisted Ligature Strangulation
Authors: Janík Martin , Krajčovič Jozef , Novomeský František , Straka Ľubomír , Hejna Petr
Published: March 2019

Multiple sclerosis, currently incurable and potentially profoundly disabling demyelinating central nervous system disease, is associated with higher occurrence of suicide as affected individuals are prone to major depression and psychosis. Despite progressively incapacitating neurologic impairment, well-staffed institutions, and limited repertoire of methods of suicide, which prevents patients from purposefully ending their lives, suicide-determined patients typically commit suicide resulting from a medication overdose, sharp force traumata, self-neglect, or deliberate starvation. Here we describe a successful suicide committed by a 39-year-old wheelchair-bound, institutionalized, quadriparetic male patient with a diagnosis of multiple sclerosis with secondary progressive clinical course who utilized his motorized wheelchair to terminate his life. He tied a rope between his neck and wall bars and then propelled the wheelchair forwardly. The acceleration of the wheelchair resulted in ligature self-strangulation. This case report, with a review of the literature, is noteworthy for the rareness of the wheelchair-related fatality combined with an unusual, if not entirely unseen, suicidal mechanism in severely disabled adult.
Sez6 levels are elevated in cerebrospinal fluid of patients with inflammatory pain–associated conditions
Authors: Roitman Maria , Edgington-Mitchell Laura E. , Mangum Jon , Ziogas James , Adamides Alexios A. , Myles Paul , Choo-Bunnett Hearan , Bunnett Nigel W. , Gunnersen Jenny M.
Published: March 2019

Introduction:

Seizure-related protein 6 (Sez6) contributes to chronic pain development as sez6 knockout mice show attenuated pain behaviours after peripheral nerve injury, compared with control mice. The type I transmembrane isoform of Sez6 is cleaved by the β-amyloid precursor protein cleavage enzyme 1 (BACE1), resulting in Sez6 extracellular domain shedding from the neuron surface.

Objectives:

To determine whether this BACE1-shed form of Sez6 can be detected in the cerebrospinal fluid (CSF) and whether Sez6 levels in the CSF are altered in neuropathic pain or chronic inflammatory pain (IP).

Methods:

We analysed the CSF samples collected during surgery from patients with chronic neuropathic pain (n = 8) or IP (n = 33), comparing them to the CSF samples from patients with suspected subarachnoid haemorrhage that was subsequently excluded (nonsurgical group, n = 5). Western blots were used to determine the relative Sez6 levels in the CSF from the different patient and nonsurgical comparison groups.

Results:

The results show that BACE1-shed Sez6 can be readily detected in the CSF by Western blot and that the levels of Sez6 are significantly higher in the IP group than in the nonsurgical comparison group.

Conclusion:

The association between elevated Sez6 levels in the CSF and IP is further evidence for persistent alterations in central nervous system activity in chronic IP conditions.
Safety Profiles of Fat Processing Techniques in Autologous Fat Transfer for Breast Reconstruction
Authors: Ruan Qing Zhao , Rinkinen Jacob R. , Doval Andres F. , Scott Benjamin B. , Tobias Adam M. , Lin Samuel J. , Lee Bernard T.
Published: March 2019

Background:

Autologous fat transfer is common in breast reconstruction because of its versatility for use in contour deformities. The authors examined three different fat grafting processing techniques for complications and safety profile using their institutional database.

Methods:

Retrospective review was performed of patients from a single institution who had undergone autologous fat transfer following breast reconstruction from 2012 to 2016. Individuals were separated into three cohorts according to fat harvest technique: (1) centrifugation, (2) Telfa gauze, or (3) Revolve. Complications between the groups were assessed.

Results:

A total of 267 cases of autologous fat transfer were identified (centrifugation, n = 168; Telfa, n = 44; and Revolve, n = 55). Grafting by means of centrifugation was associated with the greatest incidence of oil cysts (12.5 percent; p = 0.034), postoperative adverse events observed in the clinic (13.7 percent; p = 0.002), and total complications (25.6 percent; p = 0.001). The use of Telfa resulted in the lowest rates of oil cyst formation (0 percent; p = 0.002) and total complications (2.3 percent; p = 0.001). Grafting by means of centrifugation was also associated with the highest frequency of repeated injections among the three techniques after initial grafting (19.6 percent; p = 0.029). In contrast, Revolve demonstrated a repeated injection rate of just 5.45 percent, significantly lower when independently compared with centrifugation (p = 0.011). Multivariate analysis demonstrated that higher total graft volume (p = 0.002) and the use of centrifugation (p = 0.002) were significant risk factors for adverse events seen in the clinic postoperatively.

Conclusions:

Significant differences in postoperative outcomes exist between varying fat transfer techniques. Autologous fat transfer by means of centrifugation harbored the highest rates of complication, whereas Telfa and Revolve exhibited similar safety profiles.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Perioperative Treatment with a Prolyl Hydroxylase Inhibitor Reduces Necrosis in a Rat Ischemic Skin Flap Model
Authors: Sergesketter Amanda R. , Cason Roger W. , Ibrahim Mohamed M. , Lane Whitney O. , Lubkin David T. , Hollenbeck Scott T. , Brown David A.
Published: March 2019

Background:

The hypoxia-inducible factor (HIF) pathway, regulated by prolyl hydroxylase, is central to tissue adaptation to ischemia. The authors tested whether the prolyl hydroxylase inhibitor dimethyloxalylglycine reduces skin flap necrosis.

Methods:

Dorsal skin flaps were raised on hairless rats, with dimethyloxalylglycine delivered intraperitoneally and/or topically for 7 days before and after surgery. After 14 treatment days, percentage of flap necrosis was compared grossly and tissue perfusion compared with an in vivo imaging system. Angiogenesis was compared using immunohistochemical CD31 staining and enzyme-linked immunosorbent assay for tissue vascular endothelial growth factor. Expression levels of HIF-1α and terminal deoxynucleotidyl transferase-mediated dUDP end-labeling were compared using immunohistochemical staining. Complete blood counts and gross necropsy specimens were obtained to assess systemic toxicity.

Results:

Dimethyloxalylglycine administration significantly improved postoperative flap viability, with combined topical and intraperitoneal dimethyloxalylglycine administration leading to reduced necrosis on postsurgical day 7 at 6 mg/kg/day, 12 mg/kg/day, 24 mg/kg/day, and 48 mg/kg/day versus controls (all p < 0.05). Compared with controls (unperfused, 39.9 ± 3.8 percent), dimethyloxalylglycine treatment led to a dose-dependent decrease in unperfused tissue at 6 mg/kg/day (11.4 ± 1.7 percent), 12 mg/kg/day (9.4 ± 4.2 percent), 24 mg/kg/day (4.7 ± 2.6 percent), and 48 mg/kg/day (1.4 ± 0.9 percent) (all p < 0.001). Topical dimethyloxalylglycine application alone administered at 48 mg/kg/day was sufficient to improve flap viability (p = 0.005). Dimethyloxalylglycine-treated flaps exhibited higher CD31 staining (p = 0.004), tissue vascular endothelial growth factor (p = 0.007), HIF-1α staining (p < 0.001), and reduced terminal deoxynucleotidyl transferase-mediated dUDP end-labeling staining (p = 0.045). There were no differences in hematocrit or macroscopic organ changes on gross necropsy.

Conclusion:

Topical and systemic targeting of the HIF-1 pathway may be a promising therapeutic approach to improve flap resistance to ischemia.
Nanofat Needling: A Novel Method for Uniform Delivery of Adipose-Derived Stromal Vascular Fraction into the Skin
Authors: Verpaele Alexis , Tonnard Patrick , Jeganathan Charan , Ramaut Lisa
Published: March 2019

A novel method for delivering nanofat into the skin is presented. The principle is based on documented experience with introduction of agents into the skin by means of microneedling.
Autologous Ear Reconstruction for Microtia Does Not Result in Loss of Cutaneous Sensitivity
Authors: Denadai Rafael , Raposo-Amaral Cassio Eduardo , Zanco Guilherme Luis , Raposo- Amaral Cesar Augusto
Published: March 2019

Background:

Cutaneous sensitivity of microtia reconstruction has been sparsely documented. The purpose of this study was to evaluate whether there is a loss of cutaneous sensitivity following two-stage autologous ear reconstruction for unilateral microtia.

Methods:

A prospective study was performed including unilateral microtia patients who underwent two-stage autologous ear reconstruction performed by a single plastic surgeon between 2011 and 2016. Standardized sensory testing (i.e., temperature discrimination and Semmes-Weinstein monofilaments) was executed at 11 predefined anatomical points of the affected and unaffected ears preoperatively and at 6 and 12 months postoperatively.

Results:

Thirty-eight patients were included. Affected and unaffected sides presented similar (all p > 0.05) preoperative cutaneous sensitivity. Most (72.7 percent) of the tested points showed (all p < 0.05) preservation or recovery of cutaneous sensitivity at 12 months postoperatively. When comparing the reconstructed ears with the unaffected ears, there was no significant difference (all p > 0.05) in most (72.7 percent) of the tested points, except (all p < 0.05) at those points involving the postauricular sulcus.

Conclusion:

There is a temporary cutaneous sensitivity loss after a two-stage autologous microtia reconstruction, which returned to similar preoperative sensitivity at 12-month follow-up, except in the postauricular sulcus.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Abdominal Etching: Surgical Technique and Outcomes
Authors: Husain Tarik M. , Salgado Christopher J. , Mundra Leela S. , Perez Chelsey , AlQattan Husain T. , Bustillo Erik , Perez Ramiro , Garri Jose I.
Published: March 2019

Background:

The ideal body is characterized by a muscular physique and defined anterior abdominal wall. Despite diet and exercise, many are unable to achieve this desired result. Liposuction with abdominal etching is used to achieve high-definition abdominal aesthetics. The etching technique is performed with liposuction in a superficial plane, to create indentures consistent with “six-pack abs,” or definition of vertical abdominal lines.

Methods:

The authors’ abdominal etching preoperative markings, surgical technique, and postoperative care are discussed. The surgeons’ experience with abdominal etching in 50 consecutive patients is reviewed, including rate of complications and patient satisfaction.

Results:

The average patient age was 36.4 years. We had an almost equal number of men (n = 26) and women (n = 24), with an average body mass index of 26.7 kg/m2. The average blood loss was 275 ml, the average tumescence was 6 liters, and the average lipoaspirate was 5 liters. There were no major complications such as fat embolus, deep venous thrombosis, or intraabdominal injury. The most common minor postoperative complications were contour irregularities (12 percent), seromas (10 percent), and hyperpigmentation (2 percent). The majority of patients were satisfied (98 percent). The average length of postoperative follow-up was 27 months.

Conclusions:

Abdominal etching is a safe and effective method of creating a defined anterior abdominal wall for patients who desire the muscular definition of vertical abdominal lines. Almost all of our patients reviewed were satisfied with this procedure, maintained long-term results, and had an acceptable rate of complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Psychological and Psychosomatic Symptoms of Second Victims of Adverse Events: a Systematic Review and Meta-Analysis
Authors: Busch Isolde M. , Moretti Francesca , Purgato Marianna , Barbui Corrado , Wu Albert W. , Rimondini Michela
Published: March 2019

Objectives

Despite growing interest in the second-victim phenomenon and greater awareness of its consequences, there has not been a meta-analysis quantifying the negative impact of adverse events on providers involved in adverse events. This study systematically reviewed the types and prevalence of psychological and psychosomatic symptoms among second victims.

Methods

We conducted a systematic review of nine electronic databases up to February 2017, without restrictions to publication date or language, examining also additional sources (e.g., gray literature, volumes of journals). Two reviewers performed the search, selection process, quality assessment, data extraction, and synthesis. We resolved disagreements by consensus and/or involving a third reviewer. Quantitative studies on the prevalence of psychological and psychosomatic symptoms of second victims were eligible for inclusion. We used random effects modeling to calculate the overall prevalence rates and the I
2 statistic.

Results

Of 7210 records retrieved, 98 potentially relevant studies were identified. Full-text evaluation led to a final selection of 18 studies, based on the reports of 11,649 healthcare providers involved in adverse events. The most prevalent symptoms were troubling memories (81%, 95% confidence interval [CI] = 46–95), anxiety/concern (76%, 95% CI = 33–95), anger toward themselves (75%, 95% CI = 59–86), regret/remorse (72%, 95% CI = 62–81), distress (70%, 95% CI = 60–79), fear of future errors (56%, 95% CI = 34–75), embarrassment (52%, 95% CI = 31–72), guilt (51%, 95% CI = 41–62), and sleeping difficulties (35%, 95% CI = 22–51).

Conclusions

Second victims report a high prevalence and wide range of psychological symptoms. More than two-thirds of providers reported troubling memories, anxiety, anger, remorse, and distress. Preventive and therapeutic programs should aim to decrease second victims’ emotional distress.
Validation of an Instrument to Measure the Results of Quality Assurance in the Operating Room
Authors: Gomes José Augusto Pereira , Martins Maria Manuela , Tronchin Daisy , Fernandes Carla Sílvia
Published: March 2019

Background and Objectives:

This study aims to validate an instrument designed to measure care quality in the operating room.

Methods:

We conducted a transversal exploratory descriptive study with the objective of analyzing the psychometric properties of the scale. The 13 items included in the scale result from 2 previously conducted studies, a literature review study and a Delphi study. The instrument was administered to health professionals with at least 2 years of experience in the operating room in 71 Portuguese hospitals.

Results:

The sample consisted of 1019 professionals who worked in an operating room; among them were nurses and doctors. The results show that the scale is a reliable and valid instrument composed of 3 dimensions: assessment of the quality of care; evaluation of processes; and control systems.

Conclusion:

The final version of the scale meets the validity requirements, revealing high potential to be used in research and clinical practice. The use of this scale will allow evaluation and comparison of the results among the different operating rooms.
Implementing Daily Leadership Safety Huddles in a Public Hospital: Bridging the Gap
Authors: Castaldi Maria , Kaban Jody M. , Petersen Martina , George Geena , O'Neill Andrea , Mullaney Kathi , Pennacchio Suzanne , Morley John
Published: March 2019

Background:

A Leadership Safety Huddle was instituted in efforts to improve communication and make safety culture a priority at our institution. The Huddle is a transparent, regularly recurring forum of clinical and administrative hospital leaders, in which safety issues and concerns are identified, shared, and swiftly addressed.

Methods:

Metrics regarding huddle effectiveness in 3 areas are studied: information technology (IT) services ticket resolution time, bladder catheterization, and one-to-one inpatient monitoring.

Results:

Analysis revealed effectiveness of the huddle on quality of inpatient care and cost savings. Survey revealed 75% or higher favorable responses to huddle improving communication, transparency, time to resolution of issues, ability to voice concerns, and patient safety. As a result of huddle implementation, metrics showed 46% reduction in IT ticket turnaround time (P = .0001), 28% reduction in non–intensive care unit bladder catheter days (P = .011), and 10% decrease in continuous observations (P = .008), allowing a 24% reduction in cost (P = .001) with quarterly savings of $139 107.00.

Conclusion:

These metrics demonstrate how huddles are instrumental in infusing and sustaining a culture of patient safety in hospitals.
Different Methods of Fabricating Cartilaginous Ear Framework in Children With Microtia According to the Length of the Eighth Costal Cartilage Intraoperatively
Authors: Yan Hongshan , Zhang Guohui , Liu Wenming , Wang Ningning , Liu Zhenzhong
Published: March 2019

Background:

There is controversy over the optimal timing of microtia reconstruction. The eighth costal cartilage, which is used to shape the helix framework, can be one of the key factors determining surgical timing of microtia reconstruction. Nevertheless, it is difficult to predict the length of the eighth costal cartilage preoperatively. The aim of the present study was to discuss different methods of fabricating cartilaginous ear framework in children with microtia according to different lengths of the eighth costal cartilage.

Methods:

Based on the actual length of the eighth costal cartilage in microtia children, there are 2 methods to fabricate auricular framework. In method I, the eighth costal cartilage was divided into 2 parts. Part A was used to fashion the helix, while part B was used to protrude the antihelix, superior, and inferior crus. The seventh rib was used to form the main body and the sixth rib was used to form the base of the framework. In method II, the seventh costal cartilage was used to fashion the helix and extrude the antihelix, superior, and inferior crus as method I did. The sixth rib was used to form the main body and the eighth rib was used to form the base of the framework.

Results:

A total of 68 microtia children underwent auricular reconstruction adopting the modified techniques between 2015 and 2016. The great majority of patients (66 patients) were satisfied with the reconstructed ears. Two patients were relatively satisfied with the reconstructed ears. Three cases have been selected to illustrate the favorable result achieved. They revealed that the helix, antihelix, superior crus, and inferior crus all appeared distinct and presented a favorable result of the contour of the reconstructed auricle.

Conclusions:

Based on different lengths of eighth costal cartilage in children, different methods of fabricating ear framework make full use of the autogenous costal cartilage and elevate anatomical details, demonstrating that personalized treatment is necessary.
The Regenerated Tissue at the Donor Site After Costal Cartilage Harvest for Auricular Reconstruction
Authors: Yang Jinxiu , Lin Lin , Zhang Ye , Wang Yongzhen , Cui Lei , He Leren
Published: March 2019

Objective:

To observe and summarize the nature of the regenerative tissue at the donor site after harvesting costal cartilage for auricular reconstruction and to explore the contribution of the perichondrium to the regeneration of costal cartilage in the clinic.

Methods:

From January 2016 to June 2017, 23 patients with microtia who were performed chest computed tomography (CT) after costal cartilage harvest for ear reconstruction were reviewed. And they had the surgery for at least 6 months. Of 23 patients, 17 patients were males and 6 were females; these patients were aged 7 to 43 years (mean age, 15.2 years). The authors divided the patients into 2 groups according to whether the perichondrium was retained or not. Group 1 was patients with intact perichondrium, total 20. Group 2 was patients with damaged perichondrium, total 3. Every patients’ regenerative tissue CT value at the donor-site region of costal cartilage was measured and recorded. In addition, 2 regenerated tissue samples for examined histologic evaluation by hematoxylin and eosin stain were collected.

Results:

Of 23 patients, regenerated tissue with high CT value (above 100 Hounsfield unit [Hu]) was observed in 19 (82.61%) patients from group 1. And the direction of the regenerated tissue is roughly similar to that of the resected cartilage in the early surgery. Of 4 patients (1 from group and 3 from group 2), nothing on the donor site was found. From histologic evaluation, fibrocalcific tissue was seen, and cartilage cells were not seen in 2 patients with high CT value.

Conclusion:

Clinical observation presented that regenerative tissue at the donor site after harvesting costal cartilage, leaving the subjacent perichondrium completely intact, was mostly fibrocalcific tissue rather than cartilage tissue. The authors suspect that the perichondrium itself may not have regenerative power, but as an envelope for regeneration, perichondrium has a role.
Incidence of Familial Craniosynostosis Among Patients With Nonsyndromic Craniosynostosis
Authors: Kalantar-Hormozi Hadis , Abbaszadeh-Kasbi Ali , Sharifi Guive , Davai Nazanin Rita , Kalantar-Hormozi Abdoljalil
Published: March 2019

Background:

Craniosynostosis has an incidence of 1 in 2000 to 2500 live births, and is categorized into syndromic and nonsyndromic types. Nonsyndromic ones can be familial in which more than one of the family members are involved.

Methods:

This is a prospective study which is carried out from April 2015 to January 2018 in 2 academic hospitals. Those patients who had nonsyndromic craniosynostosis and completed medical follow-up were included in the study as well as their 1st degree relatives. Age of patients, gender, existing consanguineous marriage, type of deliveries, type of pregnancy (assisted reproductive technologies [ART] versus sexual intercourse), severity and type of craniosynostosis were gathered.

Results:

Ninety-four (46.0%), 58 (28.4%), 28 (13.7%), 16 (7.8%), and 8 (3.9%) of patients had trigonocephaly, scaphocephaly, anterior plagiocephaly, complex, and brachycephaly, respectively. A total number of 204 patients were included in the study. Of all 204 families which were included, 30 (14.7%) families had positive familial history. Familial patients were determined in 10, 15, 8, 1, and 5 patients with scaphocephaly, trigonocephaly, anterior plagiocephaly, rachycephaly, and mixed type. Male to female ratio was 2:1, 1.9:1, 1.3:1, 1:1, and 1:1 for scaphocephaly, trigonocephaly, anterior plagiocephaly, brachycephaly, and mixed craniosynostosis. Twelve (5.9%) women had applied ART.

Conclusion:

Present study reveals that metopic suture is the most frequent craniosynostosis within nonsyndromic types. All the types of nonsyndromic craniosynostosis had male prevalence but for complex one which was equal in both gender. Nonsyndromic craniosynostosis in about 14.7% of patients was familial.
Macular Ganglion Cell and Inner Plexiform Layer Thickness Is More Strongly Associated With Visual Function in Multiple Sclerosis Than Bruch Membrane Opening–Minimum Rim Width or Peripapillary Retinal Nerve Fiber Layer Thicknesses
Authors: Nguyen James , Rothman Alissa , Gonzalez Natalia , Avornu Ama , Ogbuokiri Esther , Balcer Laura J. , Galetta Steven L. , Frohman Elliot M. , Frohman Teresa , Crainiceanu Ciprian , Calabresi Peter A. , Saidha Shiv
Published: March 2019

Background:

Optical coherence tomography (OCT) measurements of ganglion cell + inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses are associated with visual function (VF) and disability in multiple sclerosis (MS). However, the value of measuring Bruch membrane opening–minimum rim width (BMO-MRW) thickness in MS remains unclear.

Methods:

Sixty-eight patients with MS and 22 healthy controls (HCs) underwent spectral domain OCT, 100%-contrast visual acuity (VA), 2.5%- and 1.25%-contrast letter acuity (LA), and Expanded Disability Status Scale (EDSS) testing. Mixed-effects linear regression models, accounting for within-subject, intereye correlations, were used to assess relationships.

Results:

The MS cohort exhibited significantly lower BMO-MRW (P= 0.01), pRNFL at 3.7-, 4.1-, and 4.7-mm diameters surrounding the optic disc (P< 0.001 for all), and GCIPL (P< 0.001) thicknesses than HCs. BMO-MRW thickness was associated with 100%-VA (P< 0.001, R2= 0.08), 2.5%-LA (P< 0.001; R2= 0.13), and 1.25%-LA (P= 0.002; R2= 0.11). All measured pRNFL thicknesses were associated with high- and low-contrast VF (all:P< 0.001). GCIPL thickness was more strongly associated with 100%-VA (P< 0.001; R2= 0.23), 2.5%-LA (P< 0.001; R2= 0.27), and 1.25%-LA (P< 0.001; R2= 0.21) than the other OCT measures assessed. All OCT measures were significantly, but weakly, associated with EDSS scores.

Conclusions:

BMO-MRW and pRNFL thicknesses are reduced and associated with VF and disability in MS, but GCIPL thickness is a stronger marker of visual impairment. Our findings corroborate the utility of OCT in providing valuable information regarding the MS disease process.
rPinecone: Define sub-lineages of a clonal expansion via a phylogenetic tree
Authors: Wailan Alexander M. , Coll Francesc , Heinz Eva , Tonkin-Hill Gerry , Corander Jukka , Feasey Nicholas A. , Thomson Nicholas R.
Published: March 2019

The ability to distinguish different circulating pathogen clones from each other is a fundamental requirement to understand the epidemiology of infectious diseases. Phylogenetic analysis of genomic data can provide a powerful platform to identify lineages within bacterial populations, and thus inform outbreak investigation and transmission dynamics. However, resolving differences between pathogens associated with low-variant (LV) populations carrying low median pairwise single nucleotide variant (SNV) distances remains a major challenge. Here we present rPinecone, an R package designed to define sub-lineages within closely related LV populations. rPinecone uses a root-to-tip directional approach to define sub-lineages within a phylogenetic tree according to SNV distance from the ancestral node. The utility of this software was demonstrated using both simulated outbreaks and real genomic data of two LV populations: a hospital outbreak of methicillin-resistant

Staphylococcus aureus

and endemic

Salmonella

Typhi from rural Cambodia. rPinecone identified the transmission branches of the hospital outbreak and geographically confined lineages in Cambodia. Sub-lineages identified by rPinecone in both analyses were phylogenetically robust. It is anticipated that rPinecone can be used to discriminate between lineages of bacteria from LV populations where other methods fail, enabling a deeper understanding of infectious disease epidemiology for public health purposes.
Surveillance-embedded genomic outbreak resolution of methicillin-susceptibleStaphylococcus aureusin a neonatal intensive care unit
Authors: Cremers AJH , Coolen JPM , Bleeker-Rovers CP , van der Geest-Blankert ADJ , Haverkate D , Hendriks H , Henriet SSV , Huynen MA , Kolwijck E , Liem D , Melchers WJG , Rossen JW , Zoll J , van Heijst A , Hopman J , Wertheim HFL
Published: March 2019

Background

We observed an increase in methicillin-susceptibleStaphylococcus aureus(MSSA) infections among neonates at a Dutch third level neonatal intensive care unit. Weekly surveillance data of MSSA carriage among neonates and cross-sectional screenings of health care workers (HCWs) were available for outbreak tracing. While traditional typing of MSSA isolates by staphylococcal protein A gene (spatyping) and Multiple-Locus Variable number tandem repeat Analysis (MLVA) suggested that nosocomial transmission had contributed to the infections, here they lacked the resolution to draw solid conclusions.

Methods

MSSA isolates from neonatal infections, carriage surveillance, and HCWs were subjected to whole-genome sequencing and compared by a series of automated tools includingde novoassembly, identification and localization of high-quality single nucleotide polymorphisms, and in-depth analysis of subsets of isolates. Outbreaks were defined as isolates that were more closely related than was to be expected from the genetic diversity in background surveillance.

Results

Genomic analysis identified isolates that had been unjustly assigned to clusters based on MLVA typing, whilespatyping was concordant but of insufficient resolution. Detailing particular subsets of isolates further improved resolution and although it provided evidence that HCWs were involved in multiple outbreaks, it alleviated heavy concerns about one particular HCW. Genomic clustering of isolates based on deviations from background surveillance matched epidemiological patient linkage. Compared to MLVA typing, the genomic analysis demonstrated more, shorter, and re-assorted nosocomial transmission chains during this outbreak.

Conclusions

In this study the improved resolution and accuracy of genomic outbreak analyses compared tospatyping and MLVA substantially altered the view on outbreaks, along with apposite outbreak measures. Inclusion of the circulating background population has the potential to overcome current issues in genomic outbreak inference.
Model-based tumor subclonal reconstruction
Authors: Caravagna Giulio , Heide Timon , Williams Marc , Zapata Luis , Nichol Daniel , Chkhaidze Ketevan , Cross William , Cresswell George D. , Werner Benjamin , Acar Ahmet , Barnes Chris P. , Sanguinetti Guido , Graham Trevor A. , Sottoriva Andrea
Published: March 2019

The vast majority of cancer next-generation sequencing data consist of bulk samples composed of mixtures of cancer and normal cells. To study tumor evolution, subclonal reconstruction approaches based on machine learning are used to separate subpopulation of cancer cells and reconstruct their ancestral relationships. However, current approaches are entirely data-driven and agnostic to evolutionary theory. We demonstrate that systematic errors occur in subclonal reconstruction if tumor evolution is not accounted for, and that those errors increase when multiple samples are taken from the same tumor. To address this issue, we present a novel approach for model-based subclonal reconstruction that combines data-driven machine learning with evolutionary theory. Using public, synthetic and newly generated data, we show the method is more robust and accurate than current techniques in both single-sample and multi-region sequencing data. With careful data curation and interpretation, we show how the method allows minimizing the confounding factors that affect non-evolutionary methods, leading to a more accurate recovery of the evolutionary history of human tumors.
Estimating spatially and temporally complex range dynamics when detection is imperfect
Authors: Rushing Clark S. , Royle J. Andrew , Ziolkowski David J. , Pardieck Keith L.
Published: March 2019

Species distributions are determined by the interaction of multiple biotic and abiotic factors, which produces complex spatial and temporal patterns of occurrence. As habitats and climate change due to anthropogenic activities, there is a need to develop species distribution models that can quantify these complex range dynamics. In this paper, we develop a dynamic occupancy model that uses a spatial generalized additive model to estimate non-linear spatial variation in occupancy not accounted for by environmental covariates. The model is flexible and can accommodate data from a range of sampling designs that provide information about both occupancy and detection probability. Output from the model can be used to create distribution maps and to estimate indices of temporal range dynamics. We demonstrate the utility of this approach by modeling long-term range dynamics of 10 eastern North American birds using data from the North American Breeding Bird Survey. We anticipate this framework will be particularly useful for modeling species’ distributions over large spatial scales and for quantifying range dynamics over long temporal scales.
Easily adaptable head-free training system of macaques for tasks requiring precise measurements of eye position
Authors: Kawaguchi Katsuhisa , Pourriahi Paria , Seillier Lenka , Clery Stephane , Nienborg Hendrikje
Published: March 2019

We describe a modified system for training macaque monkeys without invasive head immobilization on visuomotor tasks requiring the control of eye-movements. The system combines a conventional primate chair, a chair-mounted infrared camera for measuring eye-movements and a custom-made concave reward-delivery spout firmly attached to the chair. The animal was seated head-free inside the chair but the concavity of the spout stabilized its head during task performance. Training on visual fixation and discrimination tasks was successfully performed with this system. Eye-measurements, such as fixation-precision, pupil size as well as micro-saccades were comparable to those obtained using conventional invasive head-fixation methods. The system is inexpensive (∼$40 USD material cost), easy to fabricate in a workshop (technical drawings are included), and readily adjustable between animals without the need to immobilize or sedate them for these adjustments.

Highlights

We developed an approach to train macaque monkeys head-free on visuomotor tasks requiring measurements of eye position

The setup is inexpensive, easy to build, and readily adjusted to the animal without the need for sedation

The system was tested for training on a visual fixation and a visual discrimination task

Eye measurements (fixation precision, pupil size, microsaccades) were comparable to those from head-fixed animals
Metabolic cost calculations of gait using musculoskeletal energy models, a comparison study
Authors: Koelewijn Anne D. , Heinrich Dieter , van den Bogert Antonie J.
Published: March 2019

This paper compares predictions of metabolic energy expenditure in gait using seven metabolic energy expenditure models to assess their correlation with experimental data. Ground reaction forces, marker data, and pulmonary gas exchange data were recorded for six walking trials at combinations of two speeds, 0.8 m/s and 1.3 m/s, and three inclines, −8% (downhill), level, and 8% (uphill). The metabolic cost, calculated with the metabolic energy models was compared to the metabolic cost from the pulmonary gas exchange rates. A repeated measures correlation showed that all models correlated well with experimental data, with correlations of at least 0.9. The model by Bhargava et al. [7] and the model by Lichtwark and Wilson [21] had the highest correlation, 0.96. The model by Margaria [23] predicted the increase in metabolic cost following a change in dynamics best in absolute terms.
Correlating Synaptic Ultrastructure and Function at the Nanoscale
Authors: Maus Lydia , Altas Bekir , Rhee JeongSeop , Brose Nils , Imig Cordelia , Cooper Benjamin H.
Published: March 2019

Despite similarities in the composition of the molecular release machinery, synapses can exhibit strikingly different functional transmitter release properties and short- and long-term plasticity characteristics. To address the question whether ultrastructural differences could contribute to this functional synaptic heterogeneity, we employed a combination of hippocampal organotypic slice cultures, high-pressure freezing, freeze substitution, and 3D-electron tomography to resolve the spatial organization of vesicle pools at individual active zones (AZ) in two functionally distinct synapses, namely Schaffer collateral (SC) and mossy fiber (MF) synapses. We found that mature MF and SC synapses harbor equal numbers of docked vesicles at their AZs, MF synapses at rest exhibit a second pool of possibly ‘tethered’ vesicles in the AZ vicinity, and MF synapses contain at least three morphological types of docked vesicles, indicating that differences in the ultrastructural organization of MF and SC synapses may contribute to their respective functional properties and corresponding plasticity characteristics.
A test of the evolution of increased competitive ability in two invaded regions
Authors: Rotter Michael C. , Vallejo-Marin Mario , Holeski Liza M.
Published: March 2019

Finding patterns that predict and explain the success of non-native species has been an important focus in invasion ecology. The evolution of increased competitive ability (EICA) hypothesis has been a frequently used framework to understand invasion success. Evolution of increased competitive ability predicts that 1. Non-native populations will escape from coevolved specialist herbivores and this release from specialist herbivores should result in relaxed selection pressure on specialist-related defense traits, 2. There will be a trade-off between allocation of resources for resistance against specialist herbivores and allocation to traits related to competitive ability and 3. This shift will allow more allocation to competitive ability traits.

We tested the predictions of EICA in the model plant Mimulus guttatus, a native of western North America (WNA). We compared how well the predictions of EICA fit patterns in two non-native regions, the United Kingdom (UK) and eastern North America (ENA). Coupled with extensive herbivore surveys we quantified genetic variation for herbivore resistance traits and fitness/ competitive ability traits to test adherence to the predictions of EICA in a common greenhouse environment.

Herbivore communities differed significantly between WNA, UK, and ENA populations with evidence of specialist herbivore escape in the UK, but not necessarily the ENA plants. Compared to native plants, resistance traits were lower in non-native UK plants with the exception of trichome density, while the non-native ENA plants had equivalent or higher levels of herbivore resistance traits. The UK plants had increased competitive traits than native plants while the ENA plants had equivalent competitive traits to native plants. The UK plants, but not the ENA plants, showed some signs of tradeoffs between resistance traits and fitness/ competitive ability.

Synthesis. Plants from the UK conformed to predictions of EICA more closely than those from ENA. The UK invasion is an older, more successful invasion, suggesting that support for EICA may be highest in more successful invasions. The lack of comprehensive conformity of either non-native region to the predictions of EICA also leaves room for other hypotheses that may add to our mechanistic understanding of the success of non-native plant invasions.