bluuebunny/crossref_metadata_2025 huggingface dataset:
23. The ‘War on Terror’ and the War in Afghanistan
Authors: Young John W. , Kent John
Published: September 2017

This chapter focuses on the United States’s ‘war on terror’ and its involvement in the war in Afghanistan. In the later years of the twentieth century, Middle Eastern groups launched terrorist acts against Western targets. The advent of suicide bombers and groups like al-Qaeda changed the relationships between means and ends in the use of terror. The end of the Cold War severely undermined the effectiveness of the US Central Intelligence Agency (CIA) in gathering intelligence on terrorists. The chapter first provides an overview of terrorism prior to 9/11 before discussing George W. Bush’s ‘war on terror’, the defeat of the Taliban in Afghanistan during the period 2001–2003 and its revival, and the problem of Pakistan. It concludes with an assessment of Barack Obama’s strategy for Afghanistan.
24. The Iraq War and the Middle East
Authors: Young John W. , Kent John
Published: September 2017

This chapter focuses on the Iraq war of 2003–2011 and the troubles in the Middle East. George W. Bush’s advisers, led by Dick Cheney and Don Rumsfeld, had been considering an attack on Iraq well before 9/11. At the same time, many experts within the government pointed to the lack of any evidence for Iraqi-sponsored terrorism directed against the United States. The threats to US national security were outlined to Bush in a briefing just prior to his inauguration; these threats came primarily from al-Qaeda’s terrorism and the proliferation of nuclear arms and other weapons of mass destruction (WMDs). The chapter first considers the US decision to invade Iraq before discussing the war, taking into account the US’s Operation Iraqi Freedom and the war’s costs to the US and to Iraq. It also examines the Israeli–Palestinian conflict and concludes with an assessment of the ‘Arab Spring’.
The Politics of the Earth
Authors: Dryzek John S.
Published: September 2017

The Politics of the Earth provides an introduction to thinking about the environment, through investigation of related political discourses. The text analyses the various approaches which have dominated environmental issues over the last three decades and which are likely to be influential in the future, including survivalism, environmental problem solving, sustainability, and green radicalism. This new edition includes more on global environmental politics, as well as updated and expanded examples including more material on China. The text looks at the most modern discourses, including discussions surrounding climate change, and reworks the material on justice and green radicalism to include more on climate justice and new developments such as transition towns and radical summits.
2. Looming Tragedy: Limits, Boundaries, Survival
Authors: Dryzek John S.
Published: September 2017

This chapter focuses on the environmental discourse of limits and survival and how it set the apocalyptic horizon of environmentalism. Population biologists and ecologists use the concept of ‘carrying capacity’ — the maximum population of a species that an ecosystem can support in perpetuity. When the population of a species grows to the point where carrying capacity is exceeded, the ecosystem is degraded and the population crashes, recovering only if and when natural processes restore the ecosystem to its previous capacity. One complicating factor when it comes to applying population biology to human societies is the possibility of economic growth. The chapter first considers the origins of survivalism before discussing the political philosophy of survival, discourse analysis of limits and survival, and limits and survival in practice. It also examines the challenges confronting the limits discourse, including the lack of international action on climate change.
3. Growth Unlimited: The Promethean Response
Authors: Dryzek John S.
Published: September 2017

This chapter focuses on the Promethean response to unlimited growth. Discourses do not need conscious articulation. They can be so ingrained and taken-for-granted that it would never occur to anyone to mention them. Such was the case for the environmental discourse which can be styled Promethean. In Greek mythology Prometheus stole fire from Zeus, thus significantly increasing the human capacity to manipulate the world. Prometheans have unlimited confidence in the ability of humans and their technologies to overcome any problem — including environmental problems. The term ‘cornucopian’ is sometimes associated with this denial of environmental limits. After providing a background on the central argument of the Promethean discourse with respect to growth, the chapter considers various criticisms levelled against it. It also explores Promethean environmentalism and the impact of Promethean discourse.
9. Changing People: Green Consciousness
Authors: Dryzek John S.
Published: September 2017

This chapter examines a category of green radicalism that focuses on green consciousness. The stress on green consciousness means that the way people experience and regard the world in which they live, and each other, is the key to green change. Once consciousness has changed in an appropriate direction, then policies, social structures, institutions, and economic systems are expected to fall into place. This prioritization of consciousness is widespread in the green movement, among deep ecologists, bioregionalists, ecofeminists, ecotheologists, and lifestyle greens, among others. The chapter begins with a discussion of deep ecology, ecofeminism, bioregionalism, ecological citizenship, lifestyle greens, and ecotheology. It then considers romanticism, the discourse analysis of green consciousness, and the impact of green consciousness change. Finally, it highlights the challenges confronting green consciousness.
10. New Society: Green Politics
Authors: Dryzek John S.
Published: September 2017

This chapter considers a category of green radicalism that focuses on green politics. Green radicalism is about political change targeted at social structures and institutions as well as consciousness change. This more overtly political emphasis is advanced by a number of movements and schools of thought whose degree of radicalism varies from eco-anarchists to ‘realo’ greens. The chapter begins with a discussion of different types of green politics, including green parties, social ecology, transition towns and new materialism, red and green, environmental justice, and environmentalism of the global poor. It also considers the antiglobalization movement, global justice, the Occupy Movement, and radical summits, as well as the discourse analysis of green politics. Finally, it looks at green politics in practice and emphasizes the uncertainty about the best way to practice green politics in the face of a seemingly recalcitrant and secure liberal capitalist political economy.
11. Ecological Democracy
Authors: Dryzek John S.
Published: September 2017

This chapter summarizes the volume's main ideas, a common thread of which is a renewed democratic politics, an ecological democracy. Each of the discourses analyzed in the text offers a reasonably comprehensive account of and orientation to environmental affairs at all levels, from the global to the local, and across different issue areas such as pollution, resource depletion, biodiversity, and climate change. Of the discourses surveyed, only Promethean discourse and ecological modernization provide any coherent analysis of what to do with the liberal capitalist economic order. The chapter considers how democratic pragmatism, sustainable development, ecological modernization, and green radicalism seem to provide more possibilities for learning. It also discusses several specific claims that can be made on behalf of deliberative democracy in an environmental context and concludes by arguing that ecological democracy should transcend the boundary between human social systems and natural systems.
Barriers to the success of an electronic pharmacovigilance reporting system in Kenya: an evaluation three years post implementation
Authors: Agoro Oscar O , Kibira Sarah W , Freeman Jenny V , Fraser Hamish S F
Published: September 2017

Objective

Electronic pharmacovigilance reporting systems are being implemented in many developing countries in an effort to improve reporting rates. This study sought to establish the factors that acted as barriers to the success of an electronic pharmacovigilance reporting system in Kenya 3 years after its implementation.

Materials and Methods

Factors that could act as barriers to using electronic reporting systems were identified in a review of literature and then used to develop a survey questionnaire that was administered to pharmacists working in government hospitals in 6 counties in Kenya.

Results

The survey was completed by 103 out of the 115 targeted pharmacists (89.5%) and included free-text comments. The key factors identified as barriers were: unavailable, unreliable, or expensive Internet access; challenges associated with a hybrid system of paper and electronic reporting tools; and system usability issues. Coordination challenges at the national pharmacovigilance center and changes in the structure of health management in the country also had an impact on the success of the electronic reporting system.

Discussion

Different personal, organizational, infrastructural, and reporting system factors affect the success of electronic reporting systems in different ways, depending on the context. Context-specific formative evaluations are useful in establishing the performance of electronic reporting systems to identify problems and ensure that they achieve the desired objectives.

Conclusion

While several factors hindered the optimal use of the electronic pharmacovigilance reporting system in Kenya, all were considered modifiable. Effort should be directed toward tackling the identified issues in order to facilitate use and improve pharmacovigilance reporting rates.
Long-term Safety of Pregnancy Following Breast Cancer According to Estrogen Receptor Status
Authors: Lambertini Matteo , Kroman Niels , Ameye Lieveke , Cordoba Octavi , Pinto Alvaro , Benedetti Giovanni , Jensen Maj-Britt , Gelber Shari , Del Grande Maria , Ignatiadis Michail , de Azambuja Evandro , Paesmans Marianne , Peccatori Fedro A , Azim Hatem A
Published: September 2017

Safety of pregnancy in women with history of estrogen receptor (ER)–positive breast cancer remains controversial. In this multicenter case–control study, 333 patients with pregnancy after breast cancer were matched (1:3) to 874 nonpregnant patients of similar characteristics, adjusting for guaranteed time bias. Survival estimates were calculated using the Kaplan-Meier analysis; groups were compared with the log-rank test. All reported P values were two-sided. At a median follow-up of 7.2 years after pregnancy, no difference in disease-free survival was observed between pregnant and nonpregnant patients with ER-positive (hazard ratio [HR] = 0.94, 95% confidence interval [CI] = 0.70 to 1.26, P = .68) or ER-negative (HR = 0.75, 95% CI = 0.53 to 1.06, P = .10) disease. No overall survival (OS) difference was observed in ER-positive patients (HR = 0.84, 95% CI = 0.60 to 1.18, P = .32); ER-negative patients in the pregnant cohort had better OS (HR = 0.57, 95% CI = 0.36 to 0.90, P = .01). Abortion, time to pregnancy, breastfeeding, and type of adjuvant therapy had no impact on patients’ outcomes. This study provides reassuring evidence on the long-term safety of pregnancy in breast cancer survivors, including those with ER-positive disease.
Seizure Outcome After Surgical Resection of Insular Glioma
Authors: Wang Doris D , Deng Hansen , Hervey-Jumper Shawn L , Molinaro Annette A , Chang Edward F , Berger Mitchel S
Published: September 2017

BACKGROUND

A majority of patients with insular tumors present with seizures. Although a number of studies have shown that greater extent of resection improves overall patient survival, few studies have documented postoperative seizure control after insular tumor resection.

OBJECTIVE

To (1) characterize seizure control rates in patients undergoing insular tumor resection, (2) identify predictors of seizure control, and (3) evaluate the association between seizure recurrence and tumor progression.

METHODS

The study population included adults who had undergone resection of insular gliomas between 1997 and 2015 at our institution. Preoperative seizure characteristics, tumor characteristics, surgical factors, and postoperative seizure outcomes were reviewed.

RESULTS

One-hundred nine patients with sufficient clinical data were included in the study. At 1 yr after surgery, 74 patients (68%) were seizure free. At final follow-up, 42 patients (39%) were seizure free. Median time to seizure recurrence was 46 mo (95% confidence interval 31-65 mo). Multivariate Cox regression analysis revealed that greater extent of resection (hazard ratio = 0.2899 [0.1129, 0.7973], P = .0127) was a significant predictor of seizure freedom. Of patients who had seizure recurrence and tumor progression, seizure usually recurred within 3 mo prior to tumor progression. Repeat resection offered additional seizure control, as 8 of the 22 patients with recurrent seizures became seizure free after reoperation.

CONCLUSION

Maximizing the extent of resection in insular gliomas portends greater seizure freedom after surgery. Seizure recurrence is associated with tumor progression, and repeat operation can provide additional seizure control.
Sedation and Mobilization During Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Failure: An International Survey
Authors: Marhong Jonathan D. , DeBacker Julian , Viau-Lapointe Julien , Munshi Laveena , Del Sorbo Lorenzo , Burry Lisa , Fan Eddy , Mehta Sangeeta
Published: September 2017

Objectives:

To characterize sedation, analgesia, delirium, and mobilization practices in patients supported with venovenous extracorporeal membrane oxygenation for severe acute respiratory failure.

Design:

Cross-sectional electronic survey administered January 2016 to March 2016.

Setting:

Three-hundred ninety-four extracorporeal membrane oxygenation centers registered with the Extracorporeal Life Support Organization.

Subjects:

Extracorporeal membrane oxygenation medical directors and program coordinators.

Interventions:

None.

Measurements and Main Results:

We analyzed responses from 209 respondents (53%), mostly from academic centers (63%); 41% respondents provide venovenous extracorporeal membrane oxygenation to adults exclusively. Following venovenous extracorporeal membrane oxygenation initiation, 97% respondents administer sedative/analgesic infusions, and the sedation target was “sedated” or “very sedated” for 59%, “calm and cooperative” for 25%, and “unarousable” for 16%. Use of daily sedation interruption and a sedation/analgesia protocol was reported by 51% and 39%, respectively. Midazolam (48%) and propofol (19%) were reported as the most frequently used sedatives; fentanyl (44%) and morphine (20%) the most frequent opioids. Use of a delirium scale was reported by 55% respondents. Physical therapy was reported by 84% respondents, with 41% initiating it within 72 hours after cannulation. Mobilization goals varied from range of motion exercises (81%) to ambulation (22%). The most frequently perceived barriers to mobilization were hemodynamic instability, hypoxemia, and dependency on venovenous extracorporeal membrane oxygenation support.

Conclusions:

The majority of respondents reported targeting moderate to deep sedation following cannulation, with the use of sedative and opioid infusions. There is considerable variability surrounding early physical therapy and mobilization goals for patients with acute respiratory failure supported by venovenous extracorporeal membrane oxygenation.
Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass
Authors: Kim-Campbell Nahmah , Gretchen Catherine , Callaway Clifton , Felmet Kathryn , Kochanek Patrick M. , Maul Timothy , Wearden Peter , Sharma Mahesh , Viegas Melita , Munoz Ricardo , Gladwin Mark T. , Bayir Hülya
Published: September 2017

Objectives:

To determine the relationship between the production of cell-free plasma hemoglobin and acute kidney injury in infants and children undergoing cardiopulmonary bypass for cardiac surgery.

Design:

Prospective observational study.

Setting:

Twelve-bed cardiac ICU in a university-affiliated children’s hospital.

Patients:

Children were prospectively enrolled during their preoperative outpatient appointment with the following criteria: greater than 1 month to less than 18 years old, procedures requiring cardiopulmonary bypass, no preexisting renal dysfunction.

Interventions:

None.

Measurements and Main Results:

Plasma and urine were collected at baseline (in a subset), the beginning and end of cardiopulmonary bypass, and 2 hours and 24 hours after cardiopulmonary bypass in 60 subjects. Levels of plasma hemoglobin increased during cardiopulmonary bypass and were associated (p < 0.01) with cardiopulmonary bypass duration (R
2 = 0.22), depletion of haptoglobin at end and 24 hours after cardiopulmonary bypass (R
2 = 0.12 and 0.15, respectively), lactate dehydrogenase levels at end cardiopulmonary bypass (R
2 = 0.27), and change in creatinine (R
2 = 0.12). Forty-three percent of patients developed acute kidney injury. There was an association between plasma hemoglobin level and change in creatinine that varied by age (overall [R
2 = 0.12; p < 0.01]; in age > 2 yr [R
2 = 0.22; p < 0.01]; and in < 2 yr [R
2 = 0.03; p = 0.42]). Change in plasma hemoglobin and male gender were found to be risk factors for acute kidney injury (odds ratio, 1.02 and 3.78, respectively; p < 0.05).

Conclusions:

Generation of plasma hemoglobin during cardiopulmonary bypass and male gender are associated with subsequent renal dysfunction in low-risk pediatric patients, especially in those older than 2 years. Further studies are needed to determine whether specific subgroups of pediatric patients undergoing cardiopulmonary bypass would benefit from potential treatments for hemolysis and plasma hemoglobin–associated renal dysfunction.
Extending indication of cyclin-dependent kinase 4/6 inhibitors in the adjuvant and neoadjuvant setting
Authors: Criscitiello Carmen , Viale Giulia , Curigliano Giuseppe
Published: September 2017

Purpose of review

A burst of recent activity has surrounded the study of cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors for the treatment of metastatic breast cancer. The success of these drugs in the metastatic setting has pushed the evaluation of these agents in early-stage disease. The use of CDK 4/6 inhibitors as neoadjuvant and adjuvant therapy is a hot topic and several studies are underway.

Recent findings

Ongoing studies are exploring the addition of CDK 4/6 inhibitors to endocrine therapy in early breast cancer.

Identification of the optimal treatment combinations is the goal of current research. Finding biomarkers for patients’ selection will be the goal of future research.
A case of pure red cell aplasia during nivolumab therapy for cardiac metastatic melanoma
Authors: Yuki Akihiko , Takenouchi Tatsuya , Takatsuka Sumiko , Ishiguro Takuro
Published: September 2017

Nivolumab is an antibody against programmed cell death 1 and functions as an immune checkpoint inhibitor for various malignancies, including unresectable melanomas. Nivolumab causes several immune-related adverse events, which typically include skin rash, pneumonitis, thyroid dysfunction, hepatitis, and colitis; in rare cases, anemia may be present. There are several reports of autoimmune hemolytic anemia that has developed in response to nivolumab; however, there are few reports of pure red cell aplasia (PRCA). We describe a patient who developed PRCA during nivolumab administration. A 70-year-old Japanese woman received nivolumab for cardiac metastasis from malignant melanoma from an unknown site. Twenty-one months after nivolumab administration (31 courses), treatment was discontinued because she developed severe anemia. Blood test results indicated normocytic, normochromic anemia, and reticulocytopenia, but all other components were normal. Bone marrow aspiration showed increased megakaryocytes and decreased erythroblasts; these findings were consistent with PRCA. Anemia improved without recurrence after treatment with corticosteroids and blood transfusions. The steroid dosage was reduced gradually, and to date, the patient has not experienced recurrence of anemia. The tumor decreased in size and the patient has shown a continued response to treatment with decrease in disease for 3 years. Although it is unclear how nivolumab causes PRCA, hematological toxicities have been reported in patients treated with immunotherapy drugs. PRCA might be an unrecognized immune-mediated adverse event that did not manifest during the clinical trial phase.
Assessing the Accuracy of Eyelid Measurements Utilizing the Volk Eye Check System and Clinical Measurements
Authors: Sinha Kunal R. , Yeganeh Amir , Goldberg Robert A. , Rootman Daniel B.
Published: September 2017

Purpose:

The purpose of this study was to validate the accuracy of marginal reflex distance 1 (MRD1) measurements obtained by the Volk Eye Check system, a modified smartphone that measures MRD1 automatically, relative to clinical and digital measurements.

Methods:

In this prospective observational study of adults with normal eyelids and ptosis, MRD1 was measured clinically, digitally, and automatically with the Volk device. Eyes were divided into successful versus unsuccessful Volk trial groups; successful eyes were then subdivided into control and ptosis subgroups. The primary outcome measures were mean MRD1 obtained by the 3 modalities. Secondary outcome measures included the success rate of the device and the prevalence of ptosis within the successful and unsuccessful groups.

Results:

In the overall sample of 88 eyes, clinical and digital MRD1 were not significantly different. Among eyes with successful Volk trials, significant differences in MRD1 measured by the 3 modalities were as follows: in the successful group, Volk MRD1 (3.05 mm) was significantly (p < 0.01) higher than digital MRD1 (2.68 mm); in the ptosis subgroup, Volk MRD1 (2.47 mm) was significantly higher than clinical (2.05 mm; p < 0.05) and digital MRD1 (1.91 mm; p < 0.01). Eyes in the successful group (66% of attempted collections) demonstrated significantly higher MRD1 (mean difference, 1.21 mm; p < 0.01) and were significantly less likely to demonstrate ptosis (2.7×; p < 0.05) than those in the unsuccessful group.

Conclusions:

The Volk device measures MRD1 well in normal patients but overestimates MRD1 in patients with ptosis. It may be most appropriate in assessing patients with normal or elevated eyelid position. Clinical and digital MRD1 measurements were not different than each other.
Common Versus Unique Findings on Processing-Based Task Performance in Korean Speaking Children With Cochlear Implants
Authors: Yim Dongsun
Published: September 2017

Hypothesis:

To better understand individual variability by examining overall neurocognitive underlying features in children with cochlear implants (CIs), and to investigate whether previous findings hold constant in Asian-language users.

Background:

Studies have tried to explain the individual variability in children with CIs. However, performance on experience-dependent tasks does not seem to be sensitive enough to explain the underlying reason why children have language difficulties even after the surgical procedure. Thus, this current research has focused on underlying neurocognitive functions to better explain the reason for the wide variability in this population.

Methods:

Using a separate univariate analysis paradigm, performance on processing-based tasks was compared between children with CIs and children with normal hearing. A total of 34 children ranging from 10 to 12 years old participated in the study. There were two different categories of processing-based tasks tapping processing capacity and processing speed. This study used nonword repetition (NWR), competing language processing task (CLPT), and counting span (CS) for examining processing capacity, while rapid naming (RAN) in color, shape, and color shape were used to investigate processing speed.

Results:

Children with NH outperformed children with CIs on all processing-capacity tasks, except CS. Children with CIs performed similarly to children with NH on processing speed tasks.

Conclusions:

We found children with CIs still experienced difficulties with processing capacity. Due to cross-linguistic features, we also discovered some interesting findings that differed from previous studies. Lastly, we found processing speed was fairly intact in children with CIs, which is a new finding.
Pediatric Tandem Therapeutic Apheresis: A Multidisciplinary Approach
Authors: Sirignano Rachel M. , Meyer Erin K. , Fasano Ross , Paden Matthew L.
Published: September 2017

The epidemiology, safety, and efficacy of pediatric multiple tandem extracorporeal therapies are not well understood. We conducted a retrospective chart review of therapeutic apheresis (TA) from January 1, 2012 to October 31, 2015. We collected procedural/clinical demographics, American Society for Apheresis (ASFA) indication, complications, and mortality. One hundred eighty tandem TA procedures were performed in 53 patients. Median age was 9 years (range: 2 months to 21 years) with a median weight of 28 kg (range: 6–170.3 kg) with nine patients weighing < 10 kg. Forty-five percent of patients were in tandem with continuous veno-venous hemofiltration (CVVH), 21% cardiopulmonary bypass (CPB), 4% extracorporeal membrane oxygenation (ECMO), and 11% had multiple extracorporeal therapies (CVVH and ECMO). Common indications were solid organ transplant (50% cardiac, 13% renal) and sepsis-induced thrombocytopenia-associated multiple organ failure (26%). Equipment (4%) and patient (4%) complications occurred, with rare failure (1%) and no procedure-related mortality. Tandem procedures are used in critically ill pediatric patients with higher morbidity and mortality (21%) than typical TA patients. The high percentage of patients outside of category I or II (83%) underscores the emerging nature of tandem extracorporeal therapies and need for further investigation.
Long-Term Durability Test for the Left Ventricular Assist System EVAHEART under the Physiologic Pulsatile Load
Authors: Kitano Tomoya , Iwasaki Kiyotaka
Published: September 2017

The EVAHEART Left Ventricular Assist System (LVAS) was designed for the long-term support of a patient with severe heart failure. It has an original water lubrication system for seal and bearing and wear on these parts was considered one of its critical failure modes. A durability test focusing on wear was designed herein. We developed a mock loop, which generates a physiologic pulsatile flow and is sufficiently durable for a long-term test. The pulsatile load and the low fluid viscosity enable the creation of a severe condition for the mechanical seal. A total of 18 EVAHEART blood pumps completed 2 years of operation under the pulsatile condition without any failure. It indicated the EVAHEART blood pump had a greater than 90% reliability with a 88% confidence level. The test was continued with six blood pumps and achieved an average of 8.6 years, which was longer than the longest clinical use in Japan. The test result showed that no catastrophic, critical, marginal, or minor failures of the blood pump or their symptoms were observed. The seal performance was maintained after the test. Moreover, the surface roughness did not change, which showed any burn or abnormal wear occurred. The original water lubrication system equipped in EVAHEART LVAS prevent severe wear on the seal and the bearing, and it can be used in the bridge to transplant and destination therapy.
Del Nido Cardioplegia for Myocardial Protection in Adult Cardiac Surgery: A Systematic Review and Meta-Analysis
Authors: Li Yongnan , Lin Hao , Zhao Yinglu , Li Zhenzhen , Liu Debin , Wu Xiangyang , Ji Bingyang , Gao Bingren
Published: September 2017

Cardioplegia is an important strategy for myocardial protection during cardiac surgery. This meta-analysis was to compare the effects of del Nido and conventional cardioplegia in adult patients. Systematic searches were performed to identify studies using PubMed, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform. A total of nine studies were included. Cardiopulmonary bypass and cross-clamp time were significantly shorter in the del Nido than conventional cardioplegia (mean difference [MD]: −7.52, 95% confidence interval [95% CI]: −14.76 to −0.29, p = 0.04; MD: −5.74, 95% CI: −10.14 to −1.34, p = 0.01). During the operation, cardioplegia volume and blood glucose level were lower in the del Nido group (MD: −522.53, 95% CI: −926.68 to −118.37, p = 0.01; standardized mean difference [SMD]: −1.11, 95% CI: −1.74 to −0.48, p = 0.0006). Ventilation time and length of intensive care unit were decreased significantly with del Nido cardioplegia (MD: −1.05, 95% CI: −1.79 to −0.31, p = 0.006; MD: −0.65, 95% CI: −0.92 to −0.38, p < 0.00001). There were no differences in myocardial enzyme, postoperative inotropic support, atrial fibrillation, hospital, and mortality between the two groups. In adult cardiac surgery, myocardial protection used with the del Nido or conventional cardioplegia solution yield similar short-term clinical outcomes.
Decellularized Rat Lung Scaffolds Using Sodium Lauryl Ether Sulfate for Tissue Engineering
Authors: Ma Jinhui , Ju Zhihai , Yu Jie , Qiao Yeru , Hou Chenwei , Wang Chen , Hei Feilong
Published: September 2017

Perfusion decellularization with detergents is effective to maintain the architecture and proteins of extracellular matrix (ECM) for use in the field of lung tissue engineering (LTE). However, it is unclear which detergent is ideal to produce an acellular lung scaffold. In this study, we obtained two decellularized rat lung scaffolds using a novel detergent sodium lauryl ether sulfate (SLES) and a conventional detergent sodium dodecyl sulfate (SDS). Both decellularized lung scaffolds were assessed by histology, immunohistochemistry, scanning electron microscopy, DNA quantification, sulfated glycosaminoglycans (GAGs) quantification and western blot. Subsequently, the scaffolds were implanted subcutaneously in rats for 6 weeks and were evaluated via hematoxylin and eosin staining and Masson staining. Results indicated that SLES was effective to remove cells; moreover, lungs decellularized with SLES showed better preservation of sulfated GAGs, lung architecture, and ECM proteins than SDS. After 6 weeks, SLES scaffolds demonstrated a significantly greater potential for cell infiltration and blood vessel formation compared with SDS scaffolds. Taken together, we conclude that SLES is a promising detergent to produce an acellular scaffold using LTE for eventual transplantation.
The genetics of congenital heart disease… understanding and improving long-term outcomes in congenital heart disease: a review for the general cardiologist and primary care physician
Authors: Simmons M. Abigail , Brueckner Martina
Published: September 2017

Purpose of review

This review has two purposes: to provide an updated review of the genetic causes of congenital heart disease (CHD) and the clinical implications of these genetic mutations, and to provide a clinical algorithm for clinicians considering a genetics evaluation of a CHD patient.

Recent findings

A large portion of congenital heart disease is thought to have a significant genetic contribution, and at this time a genetic cause can be identified in approximately 35% of patients. Through the advances made possible by next generation sequencing, many of the comorbidities that are frequently seen in patients with genetic congenital heart disease patients can be attributed to the genetic mutation that caused the congenital heart disease. These comorbidities are both cardiac and noncardiac and include: neurodevelopmental disability, pulmonary disease, heart failure, renal dysfunction, arrhythmia and an increased risk of malignancy. Identification of the genetic cause of congenital heart disease helps reduce patient morbidity and mortality by improving preventive and early intervention therapies to address these comorbidities.

Through an understanding of the clinical implications of the genetic underpinning of congenital heart disease, clinicians can provide care tailored to an individual patient and continue to improve the outcomes of congenital heart disease patients.
Coagulopathy in Children With Liver Disease
Authors: Kawada Patricia S. , Bruce Aisha , Massicotte Patti , Bauman Mary , Yap Jason
Published: September 2017

It was thought that a high international normalized ratio predicted bleeding in patients with chronic liver disease (CLD) and patients were “autoanticoagulated.” Contrary to this belief, while patients with CLD experienced bleeding, they also developed thromboses. In the last decade, the prevailing literature challenged the idea that an elevated international normalized ratio increased bleeding risk. The global assays of coagulation such as thromboelastography (TEG)/rotational thromboelastometry and thrombin generation assays provide additional insight into coagulation processes. It has become apparent that a parallel reduction of procoagulant and anticoagulant factors leave patients in a new “balanced” state, albeit a fragile one, where the balance can be easily disrupted. The inherent differences in coagulation between children and adults such as differences in levels of procoagulant and anticoagulant factors, underlying liver disease, and the paucity of studies in children make extrapolation of these findings to the pediatric population problematic. Ultimately, this is an area that requires further investigation to avoid inappropriate use of blood products and medication.
Intervertebral Disc Degeneration in a Percutaneous Mouse Tail Injury Model
Authors: Tian Zuozhen , Ma Xiaoyuan , Yasen Miersalijiang , Mauck Robert L. , Qin Ling , Shofer Frances S. , Smith Lachlan J. , Pacifici Maurizio , Enomoto-Iwamoto Motomi , Zhang Yejia
Published: September 2017

Objectives

Intervertebral disc (IVD) degenerates progressively with age and after injuries. In this study, we aimed to characterize early molecular events underlying disc degeneration using a mouse tail IVD injury model.

Design

We have established a transcutaneous minimally invasive approach to induce mouse tail IVD injury under fluoroscopic guidance. Morphological and molecular changes in the injured IVDs are compared with the baseline features of adjacent intact levels.

Results

After needle puncture, tail IVDs exhibited time-dependent histological changes. The aggrecan neoepitope VDIPEN was evident from 2 days to 4 wks after injury. A disintegrin and metalloproteinase domain-containing protein 8 (adam8) is a surface protease known to cleave fibronectin in the IVD. Gene expression of adam8 was elevated at all time points after injury, whereas the increase of C-X-C motif chemokine ligand (cxcl)-1 gene expression was statistically significant at 2 days and 2 wks after injury. Type 1 collagen gene expression decreased initially at day 2 but increased at 2 wks after injury, whereas no significant change in type 2 collagen gene expression was observed. The extracellular matrix gene expression pattern is consistent with fibrocartilage formation after injury.

Conclusions

Mouse tail IVDs degenerate after needle puncture, as demonstrated by histological changes and aggrecan degradation. The minimally invasive tail IVD injury model should prove useful to investigators studying mechanisms of IVD degeneration and repair.
Past, Present, and Future of Psychosomatic Movements in an Ever-Changing World: Presidential Address
Authors: Herrmann-Lingen Christoph
Published: September 2017

Objective

The American Psychosomatic Society was founded in 1942 and is celebrating its 75th anniversary in 2017. In recognizing the society's anniversary, this article provides a historical perspective on its history, the field of psychosomatic medicine in general, and anticipated future directions.

Methods

Essay and narrative review of the literature on the historic development of psychosomatic concepts and their impact on medicine over time.

Results

Mind-body associations have been described in the medical literature for more than 3500 years. Early concepts of mind-body dualism and attempts to overcome them are found in classical Greek medicine. Psychosomatic thinking can be observed ever since, but only in the 20th century, a “psychosomatic movement” emerged in Europe and North America, aiming at humanizing medicine by introducing a holistic understanding of man into what was considered a widely reductionistic practice of medicine. This movement led to the inauguration of the American Psychosomatic Society during World War II and of national and international societies of psychosomatic medicine and its subspecializations thereafter.

Conclusions

Psychosomatic medicine has its roots in the beginnings of medicine. During the past 75 years, it has made substantial contributions to the science and practice of medicine. The field has also changed in response to developments in medicine, technology, and society and is facing new challenges and opportunities that may require further adaptation of its concepts and practice.
Pancreatoblastoma With Metastatic Retroperitoneal Lymph Node and PET/CT
Authors: Corrias Giuseppe , Ragucci Monica , Basturk Olca , Saba Luca , Mannelli Lorenzo
Published: September 2017

A previously healthy 4-year-old girl presented with petechial rash and low platelet count. There were no other symptoms. On abdominal ultrasound, a 4.7-cm heterogeneous mass was demonstrated anterior to the left kidney. An abdominal MRI subsequently performed demonstrated a heterogeneously enhancing mass at the same location extending to the pancreas and spleen. A surgical biopsy of the mass was obtained. Pathology reported a malignant epithelioid neoplasm consistent with pancreatoblastoma. The mass demonstrated intense FDG uptake on PET and an FDG avid retrocaval lymph node.
Diagnosis and Management of Cerebrospinal Fluid Leak in a Panfacial Fracture
Authors: Mulinari-Santos Gabriel , Bonardi João Paulo , Pires Willian Ricardo , Jacob Ricardo Garcia Mureb , Batista Fábio Roberto de Souza , Faverani Leonardo Perez , Souza Francisley Ávila , Garcia Júnior Idelmo Rangel
Published: September 2017

Cerebrospinal fluid fistula caused by head trauma is a potentially dangerous problem and precise localization and radical treatment are necessary. We present a case of a patient with Panfacial fracture caused by a motorcycle accident, resulting in a cerebrospinal fluid leakage. The correct diagnosis was realized by computed tomography and auxiliary tests. The successful treatment can be confirmed with the support of radionuclide cisternography examination.
Simple Septocutaneous Free Flap Design for One-Stage Reconstruction of Pharyngocutaneous and Orocutaneous Fistulae
Authors: Woo Soo Hyun , Bae Tae Hui , Kim Woo Seob , Kim Han Koo
Published: September 2017

Reconstruction of pharyngocutaneous fistula (PCF) or orocutaneous fistula is always a challenging task. It has many causes and is especially related to radiation therapy after resection of head and neck cancers. There are many reports of surgical procedures for fistula repair. For example, 2-stage methods, methods of combining multiple flaps, and methods of using chimeric flaps have been reported. However, there is no established simple method as a treatment of choice. The authors describe 5 patients of head and neck fistulas and recommend a useful 1-stage reconstruction method using a double skin paddle free flap.

The authors modified the free flaps simply with a double skin paddle sharing 1 pedicle. The skin paddle of the flap was split into 2 parts, one skin island for inner mucosal coverage, and the other for outer skin resurfacing. The bridge between the 2 skin paddles was deepithelialized and then folded. To prevent leakage, a water-tight closure was ensured.

The double skin paddle free flap method was used in 5 patients. Two patients had orocutaneous fistula, and the other 3 patients had PCF due to irradiation. Flap losses did not occur, but wound dehiscence was noted in the 3 PCF patients. Repeat wound revision procedures were performed in these patients, and the end result was good.

Conventional methods are complex and require multiple flaps or repeat surgery. However, the double skin paddle free flap method allows for simple and effective 1-stage reconstruction using 1 flap, 1 pedicle, and 1 microanastomosis even for patients who received preoperative radiotherapy.
Effects of Different Tissue Adhesives in Treating Calvarial Bone Defects
Authors: Türer Akif , Önger Mehmet Emin
Published: September 2017

The purpose of this study is to investigate the potential of the 2 different tissue adhesive materials as a barrier for guided bone regeneration and to compare them with resorbable collogen membrane on autogenous grafted critical-sized cortical bone defects. Twenty-four rats were divided into 3 groups: Group M, Group G, and Group B. A 5-mm diameter critical-size defect was created in the calvarium of each animal. All defects were filled by autogenous graft harvested from tibia. In group M, resorbable collogen membrane was applied to defect area. In groups G and B, defects were closed by Glubran2 and Bioglue. All animals were euthanized at 28 days postoperative. Stereologic analyses were performed. New bone area and connective tissue volumes were measured. Mean new bone volumes were 0.97 ± 0.28, 0.59 ± 0.2, and 0.8 ± 0.32 mm3 in groups M, G, and B, respectively. The differences between groups were not statistically significant (P 
> 0.05). In group M, mean connective tissue volumes were 4.25 ± 0.7 mm3, in groups G and B, 2.9 ± 1.82 and 4.54 ± 0.64 mm3. Connective tissue volume differences were not statistically significant between groups. Glubran2 and Bioglue may play a role as a barrier for guided bone regeneration in treatment of critical size defects.
Mandibular Condylar Fractures in Children: Morphofunctional Results After Treatment With External Fixation
Authors: Cascone Piero , Marra Marcozzi Marco , Ramieri Valerio , Bosco Giulio , Vellone Valentino , Spallaccia Fabrizio
Published: September 2017

Best treatment for paediatric patients with mandibular condylar fractures is still debated, and many approaches have been proposed. Closed treatment is the most used, but there is evidence showing long-term problems in patients with dislocated fractures. On the other hand, there are concerns on surgical treatment with open reduction internal fixation, particularly on the implanted hardware during growth. The aim of this study is to evaluate the long-term outcomes of paediatric patients treated surgically with external fixation. A total of 21 paediatric patients were treated. Diagnostic procedures included clinical and radiographic examinations. Of those 21 patients, 16 presented monocondylar fractures, 5 bicondylar fractures. They were treated surgically with open reduction and external fixation. Patients showed good recovery in maximal mouth opening, maximal lateral excursion and in vertical height of ramus, and all returned to preinjury occlusion. No patient presented permanent facial nerve palsy, and none referred pain or stiffness in the operated area. Minimal scars were visible. Just 1 patient referred clicking in the operated temporo-mandibular joint. Surgical approach using external fixation could be considered an option for treatment of mandibular condylar fractures in paediatric patient. Vertical height recovery, early mobilization, and good occlusion can be achieved, minimizing the risk of facial asymmetry.
For the patient—Evolution in the management of vascular trauma
Authors: Feliciano David V.
Published: September 2017

There has been an evolution in the diagnosis and management of vascular trauma over the past 100 years. The primary stimulus to these changes has been the increased volume of patients with cervical, truncal, and peripheral vascular injuries during military conflicts and in civilian life. Patients with “hard” signs of a vascular injury are taken to surgery emergently with a few exceptions to be described. In contrast, patients with “soft” signs of a vascular injury undergo a careful physical examination including measurement of vascular index to determine if radiologic imaging is necessary. Computed tomography arteriography has become the most commonly used method of imaging, whereas duplex ultrasonography is used in some centers. Nonoperative management is now common for nonocclusive injuries diagnosed on computed tomography arteriography. Proximal tourniquets are commonly used to control exsanguinating hemorrhage from injuries to extremities, whereas balloons can be used to control hemorrhage from difficult to expose areas at operation. Temporary intraluminal shunts are now used in 3% to 9% of arterial injuries. Operative techniques of repair have been refined and contribute to the excellent results noted in modern trauma centers.
Lytic lesions: looking lethal but leaving room for a simple cure? A case of Veillonella spinal osteomyelitis
Authors: Baker Sarah , Allyn Rebecca
Published: September 2017

Introduction. Diagnosing clinically significant infection caused by Veillonella species can be a challenge. Veillonella species are usually found in polymicrobial processes and are often regarded as a contaminant. Additionally, they are slow to grow in culture and this can lead to a delay in diagnosis or a missed diagnosis. Veillonella species rarely cause serious infections, but have been found to cause bacteraemia and osteomyelitis.

Case presentation. A 67-year-old man with a history of treated prostate cancer presented with 2 weeks of progressive lower back pain and weakness. He had no signs or symptoms of active infection. He was found to have multiple lytic lesions in his lumbar spine that were initially suspected to be secondary to metastatic cancer. However, tissue and blood cultures were ultimately consistent with infection by Veillonella species.

Conclusion. This case report highlights the fact that uncommon illnesses can often present like common disease processes. Because of the radiological appearance of the patient’s lesions and his lack of infectious symptoms, a diagnosis of metastatic cancer was initially thought to be likely. Relying on the pathology and culture data, and waiting on the initiation of antimicrobials until the diagnosis was accurately established, were important factors in diagnosing and treating this infection. Veillonella species can be true pathogens when found in isolation and associated with bacteraemia. Additionally, they can cause an indolent infection that can lead to osteomyelitis. Failure to accurately diagnose this infection in a timely manner would have led to ongoing debility and diagnostic uncertainty for this patient.