bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Myocardial Function and Injury by Echocardiography and Cardiac Biomarkers in African Children With Severe Plasmodium falciparum Malaria*
Authors: Kotlyar Simon , Olupot-Olupot Peter , Nteziyaremye Julius , Akech Samuel O. , Uyoga Sophie , Muhindo Rita , Moore Christopher L. , Maitland Kathryn
Published: December 2017

Objectives:

Perturbed hemodynamic function complicates severe malaria. The Fluid Expansion as Supportive Therapy trial demonstrated that fluid resuscitation, involving children with severe malaria, was associated with increased mortality, primarily due to cardiovascular collapse, suggesting that myocardial dysfunction may have a role. The aim of this study was to characterize cardiac function in children with severe malaria.

Design:

A prospective observational study with clinical, laboratory, and echocardiographic data collected at presentation (T0) and 24 hours (T1) in children with severe malaria. Cardiac index and ejection fraction were calculated at T0 and T1. Cardiac troponin I and brain natriuretic peptide were measured at T0. We compared clinical and echocardiographic variables in children with and without severe malarial anemia (hemoglobin < 5 mg/dL) at T0 and T1.

Setting:

Mbale Regional Referral Hospital.

Patients:

Children 3 months to 12 years old with severe falciparum malaria.

Interventions:

Usual care.

Measurements and Main Results:

We enrolled 104 children, median age 23.3 months, including 61 children with severe malarial anemia. Cardiac troponin I levels were elevated (> 0.1 ng/mL) in n equals to 50, (48%), and median brain natriuretic peptide was within normal range (69.1 pg/mL; interquartile range, 48.4–90.8). At T0, median Cardiac index was significantly higher in the severe malarial anemia versus nonsevere malarial anemia group (6.89 vs 5.28 L/min/m2) (p = 0.001), which normalized in both groups at T1 (5.60 vs 5.13 L/min/m2) (p = 0.452). Cardiac index negatively correlated with hemoglobin, r equals to –0.380 (p < 0.001). Four patients (3.8%) had evidence of depressed cardiac systolic function (ejection fraction < 45%). Overall, six children died, none developed pulmonary edema, biventricular failure, or required diuretic treatment.

Conclusions:

Elevation of cardiac index, due to increased stroke volume, in severe malaria is a physiologic response to circulatory compromise and correlates with anemia. Following whole blood transfusion and antimalarial therapy, cardiac index in severe malarial anemia returns to normal. The majority (> 96%) of children with severe malaria have preserved myocardial systolic function. Although there is evidence for myocardial injury (elevated cardiac troponin I), this does not correlate with cardiac dysfunction.
Enteral Feeding Practices in Infants With Congenital Heart Disease Across European PICUs: A European Society of Pediatric and Neonatal Intensive Care Survey*
Authors: Tume Lyvonne N. , Balmaks Reinis , da Cruz Eduardo , Latten Lynne , Verbruggen Sascha , Valla Frédéric V.
Published: December 2017

Objectives:

To describe enteral feeding practices in pre and postoperative infants with congenital heart disease in European PICUs.

Design:

Cross-sectional electronic survey.

Setting:

European PICUs that admit infants with congenital heart disease pre- and postoperatively.

Participants:

One senior PICU physician or designated person per unit.

Interventions:

None.

Measurements and Main Results:

Fifty-nine PICUs from 18 European countries responded to the survey. PICU physicians were involved in the nutritional care of children with congenital heart disease in most (76%) PICUs, but less than 60% of units had a dedicated dietician. Infants with congenital heart disease were routinely fed preoperatively in only 63% of the PICUs, due to ongoing concerns around prostaglandin E1 infusion, the presence of umbilical venous and/or arterial catheters, and the use of vasoactive drugs. In three quarters of the PICUs (76%), infants were routinely fed during the first 24 hours postoperatively. Units cited, the most common feeding method, both pre and postoperatively, was intermittent bolus feeds via the gastric route. Importantly, 69% of European PICUs still did not have written guidelines for feeding, but this varied for pre and postoperative patients.

Conclusions:

Wide variations in practices exist in the nutritional care between European PICUs, which reflects the absence of local protocols and scientific society-endorsed guidelines. This is likely to contribute to suboptimal energy delivery in this particularly vulnerable group.
Videographic Assessment of Pediatric Tracheal Intubation Technique During Emergency Airway Management
Authors: Shiima Yuko , Hsieh Ting-Chang , Long Andrew , Donoghue Aaron
Published: December 2017

Objectives:

To examine technical aspects of pediatric tracheal intubation using video recording and to determine the association between tracheal intubation technique and procedural outcomes.

Design:

Prospective observational study.

Setting:

Emergency department resuscitation bay in single tertiary pediatric center.

Patients:

Children undergoing emergent tracheal intubation under videorecorded conditions.

Interventions:

None.

Measurements and Main Results:

A published scoring tool for characterizing patient positioning, intubator kinematics, and adjunctive maneuvers during tracheal intubation was applied to videorecorded pediatric resuscitations when tracheal intubation was performed. Procedural outcomes were measured from video review. Seventy-one children underwent 109 tracheal intubation attempts with an overall first attempt success rate of 69% and a median laryngoscopy duration of 34 seconds (interquartile range, 24–47 s). A significant subset of tracheal intubation attempts were made with the patient’s bed at a height below the level of intubator’s umbilicus (61%), the patient in a supine position without head elevation (55%), the intubator bent at the waist to greater than 45° (66%), less than 1 cm of mouth opening by the intubator’s right hand prior to laryngoscopy (46%), and with the intubator’s face less than 12 inches away from the patient’s mouth (65%). Adjunctive maneuvers were used in a minority of attempts (cricoid pressure 48%, external laryngeal manipulation 11%, retraction of the right corner of the patient’s mouth 26%). On multivariate analysis, including controlling for patient age category and intubator background, retraction of the right corner of the patient’s mouth by an assistant showed an independent association with successful tracheal intubation. No other technical aspects were associated with tracheal intubation success.

Conclusions:

Intubators commonly exhibited suboptimal technique during tracheal intubation such as bending deeply at the waist, having their eyes close to the patient’s mouth, failing to widely open the patient’s mouth, and not elevating the occiput in older children. Retraction of the right corner of the patient’s mouth by an assistant during laryngoscopy and intubation was associated with TI success.
Lean Mass and Functional Recovery in Men With Hip Fracture
Authors: Di Monaco Marco , Castiglioni Carlotta , Di Carlo Silvia
Published: December 2017

Objective

The aim of the study was to assess the capability of different definitions of low appendicular lean mass (aLM) to predict the short-term functional recovery in men with hip fracture.

Design

We investigated 80 of 95 men with hip fracture admitted consecutively to a rehabilitation hospital. Body composition was assessed by dual-energy x-ray absorptiometry. Functional recovery after inpatient rehabilitation was evaluated using Barthel Index scores.

Results

The patients with aLM above the cutoff value of 19.75 kg indicated by the Foundation for the National Institutes of Health (FNIH) had significantly higher Barthel Index scores than those with aLM below the cutoff value (P = 0.002). Patients' categorization according to the same threshold (aLM = 19.75 kg) was significantly associated with a Barthel Index score of 85 or higher after adjustment for age, cognitive impairment, hip fracture type, co-morbidities, and medications (odds ratio = 7.17, 95% confidence interval = 1.43–35.94, P = 0.017). Conversely, patients' categorization according to neither Baumgartner's cutoff value (7.26 kg/m2) for aLM/height2 nor Foundation for the National Institutes of Health cutoff value (0.789) for aLM divided by body mass index was significantly associated with the Barthel Index scores.

Conclusions

Categorization according to the Foundation for the National Institutes of Health threshold for aLM, but not to the Foundation for the National Institutes of Health threshold for aLM/body mass index or Baumgartner's threshold for aLM/height2, was associated with the short-term recovery in activities of daily living after a hip fracture in men.
Impact of Racial Discrimination and Hostility on Adrenergic Receptor Responsiveness in African American Adults
Authors: Hill LaBarron K. , Sherwood Andrew , McNeilly Maya , Anderson Norman B. , Blumenthal James A. , Hinderliter Alan L.
Published: December 2017

Objective

Racial discrimination is increasingly recognized as a contributor to increased cardiovascular disease (CVD) risk among African Americans. Previous research has shown significant overlap between racial discrimination and hostility, an established predictor of CVD risk including alterations in adrenergic receptor functioning. The present study examined the associations of racial discrimination and hostility with adrenergic receptor responsiveness.

Methods

In a sample (N= 57) of young to middle-aged African American adults (51% female) with normal and mildly elevated blood pressure, a standardized isoproterenol sensitivity test (CD25) was used to evaluate β-AR responsiveness, whereas the dose of phenylephrine required to increase mean arterial pressure by 25 mm Hg (PD25) was used to assess α1-AR responsiveness. Racial discrimination was measured using the Perceived Racism Scale and hostility was assessed using the Cook-Medley Hostility Scale.

Results

In hierarchical regression models, greater racial discrimination, but not hostility, emerged as a significant predictor of decreased β-adrenergic receptor responsiveness (β = .38,p= .004). However, moderation analysis revealed that the association between racial discrimination and blunted β-adrenergic receptor responsiveness was strongest among those with higher hostility (β = .49, 95% confidence interval = .17–.82,p= .004). In addition, hostility, but not racial discrimination, significantly predicted α1-AR responsiveness.

Conclusions

These findings suggest racial discrimination was associated with blunted β-adrenergic receptor responsiveness, providing further evidence of the potential contribution of racial discrimination to increased CVD risk among African Americans. The adverse effects of discrimination on cardiovascular health may be enhanced in individuals with higher levels of hostility.
Rapid Serological Tests Ineffectively Screen for HIV Exposure in HIV-Positive Infants
Authors: Urick Brittany , Fong Youyi , Okiira Christopher , Nabukeera-Barungi Nicolette , Nansera Denis , Ochola Emmanuel , Nteziyaremye Julius , Bigira Victor , Ssewanyana Isaac , Olupot-Olupot Peter , Peter Trevor , Ghadrshenas Anisa , Vojnov Lara , Kiyaga Charles
Published: December 2017

Background:

Data on the performance and utility of rapid serological tests in infants to determine HIV exposure are unclear and in some instances contradictory. This study sought to understand the performance of rapid serological tests in high HIV burden, high Option B+ coverage settings to be used as an HIV exposure screening tool.

Methods:

A total of 3600 infants up to 24 months of age at 4 regional hospitals in Uganda were systematically enrolled and tested simultaneously using both HIV rapid serological and nucleic acid–based tests.

Results:

Only 58 of the 94 HIV-positive infants who received both rapid serological and nucleic acid–based tests were positive with the rapid serological test (sensitivity: 61.7%; 95% confidence interval: 51.1 to 71.5). Using rapid serological tests to screen infants for exposure to HIV and follow-up nucleic acid-based testing would have missed 38.3% (36 of 94) of HIV-positive infants. Finally, several HIV-positive infants who were negative by rapid serological test presented to well-child entry points and were considered healthy. All 3 HIV-positive infants presenting to outreach and immunization were negative by rapid serological testing and 73% (8 of 11) presenting to outpatient.

Conclusions:

These data suggest that the use of rapid serological tests may have inadequate performance as an indicator of exposure and potential HIV infection among infants presenting at both well-child (immunization and community outreach) and sick-infant (nutrition and inpatient) entry points. To improve the identification of HIV-positive infants, nucleic acid–based testing should instead be considered in infants aged younger than 18 months.
Brief Report: Assessing the Association Between Changing NRTIs When Initiating Second-Line ART and Treatment Outcomes
Authors: Rohr Julia K. , Ive Prudence , Horsburgh Charles Robert , Berhanu Rebecca , Hoffmann Christopher J. , Wood Robin , Boulle Andrew , Giddy Janet , Prozesky Hans , Vinikoor Michael , Mwanza Mwanza wa , Wandeler Gilles , Davies Mary-Ann , Fox Matthew P.
Published: December 2017

Background:

After first-line antiretroviral therapy failure, the importance of change in nucleoside reverse transcriptase inhibitor (NRTI) in second line is uncertain due to the high potency of protease inhibitors used in second line.

Setting:

We used clinical data from 6290 adult patients in South Africa and Zambia from the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Southern Africa cohort.

Methods:

We included patients who initiated on standard first-line antiretroviral therapy and had evidence of first-line failure. We used propensity score-adjusted Cox proportional-hazards models to evaluate the impact of change in NRTI on second-line failure compared with remaining on the same NRTI in second line. In South Africa, where viral load monitoring was available, treatment failure was defined as 2 consecutive viral loads >1000 copies/mL. In Zambia, it was defined as 2 consecutive CD4 counts <100 cells/mm3.

Results:

Among patients in South Africa initiated on zidovudine (AZT), the adjusted hazard ratio for second-line virologic failure was 0.25 (95% confidence interval: 0.11 to 0.57) for those switching to tenofovir (TDF) vs. remaining on AZT. Among patients in South Africa initiated on TDF, switching to AZT in second line was associated with reduced second-line failure (adjusted hazard ratio = 0.35 [95% confidence interval: 0.13 to 0.96]). In Zambia, where viral load monitoring was not available, results were less conclusive.

Conclusions:

Changing NRTI in second line was associated with better clinical outcomes in South Africa. Additional clinical trial research regarding second-line NRTI choices for patients initiated on TDF or with contraindications to specific NRTIs is needed.
Quality and Safety in Health Care, Part XXXIV
Authors: Harolds Jay A.
Published: December 2017

The PINNACLE (Practice INNovation And Clinical Excellence) program was started in 2008 by the American College of Cardiology and its National Cardiovascular Data Registry. This was the first and now the largest countrywide prospective registry to improve care quality for cardiac outpatients. The registry focuses on reporting about the adherence to guidelines in treating individuals with high blood pressure, atrial fibrillation, coronary artery disease, and/or cardiac failure.
Quality and Safety in Health Care, Part XXXIV
Authors: Harolds Jay A.
Published: December 2017

There is an important opportunity for improvement in the care of cardiology outpatients by having greater compliance with published guidelines, and the PINNACLE (Practice Innovation and Clinical Excellence) Registry seeks to do that. One of the major areas studied by this registry is the use of secondary prevention medications for patients with coronary artery disease. Appropriate use of these medications decreases later myocardial infarctions and death from a cardiac cause.
Dilated Internal Thoracic Vertebral Venous Plexus Simulating Bone Metastases on FDG PET/CT
Authors: Hod Nir , Anconina Reut , Levin Daniel , Ezroh Kazap Dina , Lantsberg Sophie
Published: December 2017

A 42-year-old woman with a newly diagnosed malignant thymoma underwent FDG PET/CT, which demonstrated an increased uptake in anterior mediastinal tumor and several pleural masses in the right hemithorax, compatible with “drop metastases.” In addition, contrast-enhanced CT images showed hyperdense abnormality in T2 vertebral body, congruent with intensely increased FDG uptake, raising suspicion of skeletal metastasis. This is a rare but important potential pitfall either in CT and FDG PET/CT—a “false-positive” bony lesion not attributed to skeletal metastasis but to dilated internal thoracic vertebral venous plexus associated with collateral circulation due to superior vena cava syndrome.
Imaging of Acquired Demyelinating Syndrome With 18F-FDG PET/CT
Authors: Malo-Pion Caroline , Lambert Raymond , Décarie Jean-Claude , Turpin Sophie
Published: December 2017

Acquired demyelinating syndromes include acute disseminated encephalomyelitis, transverse myelitis and may progress to multiple sclerosis (MS). Acute disseminated encephalomyelitis is characterized by impairment of level of consciousness and multifocal neurological deficits and transverse myelitis by back pain, weakness and sphincter dysfunction. Only a few cases of acquired demyelinating syndrome have been imaged with 18F-FDG PET/CT. We present two such cases.
A Novel Technique to Measure the Intensity of Abnormality on GI Bleeding Scans
Authors: Farhat Rami , Kim Derek T. , French T. Dustin , Bechhofer Dov , Kranz Anca-Oana , Hoffmann Jason C.
Published: December 2017

Purpose

Develop a technique to quantify intensity of lower gastrointestinal bleeding (LGIB) on 99mTc-labeled red blood cell (RBC) scintigraphy, correlate with angiography, and determine the tool’s predictive value.

Materials and Methods

An IRB-approved, single institution database query of GI bleeding scans performed between January 2013 and December 2015. Reports from all studies and imaging from all positive studies were reviewed. A technique was developed for scan analysis, allowing for calculation of percent increase of activity in the region of interest (ROI, area of bleeding) and ROI in the aorta and liver (controls). Database query determined which patients underwent angiography, and which had positive angiograms. Median ROI percent increase in patients with positive scintigraphy and positive angiography was compared to those with positive scintigraphy and negative angiography.

Results

Of 194 bleeding scans performed during the study period, 71 were positive for active LGIB, 37 had angiography, and 9 had active contrast extravasation. The new tool was used to analyze the 37 cases with positive nuclear scans sent for angiography. Median percent increase in ROI activity was 50% in those with positive scan and positive angiogram and 26.8% in those with positive scan but negative angiogram. Using ROI percent change quartiles, we observed a statistically significant association between percent increase in ROI activity from baseline and the probability of having a positive angiogram (Cochran-Armitage trend test, P = 0.01), such that there are no positive angiogram cases when ROI change was <20% and a majority of the positive angiogram cases (67%) in the highest quartile.

Conclusions

Utilization of processing protocol to determine percent increase in activity from baseline within ROI of active LGIB on scintigraphy has predictive value in determining which patients will not benefit from conventional angiography.
The Effect of Midface Advancement Surgery on Obstructive Sleep Apnoea in Syndromic Craniosynostosis
Authors: Saxby Clair , Stephenson Kate A. , Steele Katherine , Ifeacho Sonna , Wyatt Michelle E. , Samuels Martin
Published: December 2017

Background:

Children with syndromic craniosynostosis frequently suffer from obstructive sleep apnoea (OSA). The aim of the authors’ study was to investigate if midface advancement surgery for patients with SC improved the severity of OSA by examining the results of sleep studies before and after surgery.

Methods:

A retrospective comparison of the pre and postoperative sleep study data of children undergoing midface advancement surgery at Great Ormond Street Hospital between 2007 and 2016.

Results:

A total of 65 children underwent midface advancement surgery between 2007 and 2016 at Great Ormond Street Hospital and had recorded pre- and postoperative sleep studies. Thirteen patients were excluded from the analysis as their sleep study techniques before and after surgery were not comparable (e.g., different conditions with prong/continuous positive airway pressure use). Fifty-six percent of the patients were treated by monobloc surgery and the remainder with bipartition surgery. A greater proportion of patients had a normal OSA grading following midface advancement (42.3% postoperatively vs. 23.1% preoperatively, P = 0.059) although no statistically significant categorical changes in OSA grade were observed. Seventy-one percent of the patients had a decrease in Apnoea-Hypopnoea Index after surgery (21 patients 2011 onward). Similarly, there was no significant change in median oxygen desaturation index or in oxygen saturation nadir following surgery.

Conclusion:

The authors report one of the largest reviews of the effects of midface advancement surgery on sleep study parameters. Most patients showed improvements in Apnoea-Hypopnoea Index and OSA grading, although measures of oxygenation showed no consistent change.
Effect Evaluation of Modified Uvulopalatopharyngoplasty With Low-Temperature Plasma and Selective Nasal Cavity Vasodilatation With Tongue Volume Reduction in Patients With Obstructive Sleep Apnea Hypopnea Syndrome
Authors: Huai De , Ju Lixian , Wang Shoufeng , Wu Hong , Xu Min , Cao Ying
Published: December 2017

Objective:

To compare the clinical effects of modified uvulopalatopharyngoplasty (UPPP) with low-temperature plasma with selective nasal cavity vasodilatation with tongue volume reduction for obstructive sleep apnea/hypopnea syndrome (OSAHS).

Methods:

A retrospective analysis based on 156 patients with serious OSAHS was used for the evaluation. These patients were divided into 2 groups according to surgery methods according to 1:1.s. The patients in observation group accepted modified UPPP with low-temperature plasma and selective nasal cavity vasodilatation with tongue root volume reduction on the basis of fully preparation for surgery, while the patients in the control group accepted normal treatment. The clinic effects, operative complications, postoperative relapse, and other indexes were compared.

Result:

After 6 months of follow-up visit, the general effective rates of the observation group and control groups were 80.77% and 61.54%, the difference was statistically significant (P < 0.05). Besides, the rate complication occurrence in the observation group was also lower than that in the control group.

Conclusion:

The effect of modified UPPP with low-temperature plasma and selective nasal cavity vasodilatation with tongue volume reduction is satisfactory for patients with moderate and severe OSAHS after enough preparation.
Effect of Septoplasty on the Heart Rate Variability in Patients With Nasal Septum Deviation
Authors: Celiker Metin , Cicek Yuksel , Tezi Suat , Ozgur Abdulkadir , Polat Hatice Beyazal , Dursun Engin
Published: December 2017

Background:

Nasal septum deformities (NSD) are one of the most common causes of upper airway obstruction. Heart rate variability (HRV) is a physiologic parameter that is affected by the balance between the sympathetic and parasympathetic tonus.

Objective:

The aim of this study was to evaluate the effects of a septoplasty operation on HRV parameters as assessed by 24 hours ambulatory Holter recordings in patients with NSD.

Methods:

The prospective study involved 54 consecutive patients (16 women and 38 men) who underwent septoplasty due to a marked C- or S-shaped NSD. Twenty-four-hour Holter monitoring was performed to all patients pre- and 2 months postseptoplasty operation. For the HRV analyses, the definitions of evaluated parameters were made according to the Task Force of European Society of Cardiology and the North American Society of Pacing and Electrophysiology on HRV.

Results:

Low-frequency norm () (73 [68–86] versus 78 [70–81], P = 0.039) values were significantly increased after septoplasty whereas changes in other parameters were not statistically significant.

Conclusion:

The authors’ study showed that low-frequency norm values were significantly increased after septoplasty operation in patients with NSD which may be interpreted as a decreased sympathetic tone.
Optimal Conditions for Absorbable Fixation of Hydroxyapatite Ceramic Implants
Authors: Sakamoto Yoshiaki , Kishi Kazuo
Published: December 2017

Synthetic hydroxyapatite (HAP) implants are common in craniofacial surgery; the major problem with HAP implants is fixation instability. An ultrasound-assisted pinned resorbable fixation system has recently been introduced. The authors hypothesized that this resorbable system could be used to fix HAP implants. The authors evaluated the optimal HAP porosity and resorbable pin using the pull-out test and microscopic analysis. Hydroxyapatite blocks were synthesized with 0% (dense type), 35% (fine pore type), and 50% (large pore type) porosity. Bioabsorbable pins of 4 sizes were tested: diameters of 1.6 or 2.1 mm and lengths of 4 or 7 mm. Among the 1.6 mm diameter pins, the 7-mm length pins showed higher pull-out strength (large pore, 6.5 ± 1.2 kgf; fine pore, 4.1 ± 0.7 kgf; dense, 2.4 ± 0.4 kgf) than the 4-mm length pins (large pore, 2.1 ± 1.0 kgf; fine pore, 1.3 ± 0.4 kgf; dense, 1.5 ± 0.9 kgf) with all 3 HAP types (P < 0.01). Among 2.1-mm diameter pins, all were removed from the large and fine pore HAP types without any resistance. Only three of seven 2.1 × 7 mm pins inserted into the dense type HAP showed pull-out strength (3.9 ± 2.1 kgf). Among all conditions, the 7-mm length, 1.6-mm diameter pin in large pore type HAP showed the highest pull-out strength. Microscopically, the large pore type HAP showed the liquefying pin flowing into the large pore adjacent to the pilot hole. By contrast, the fine pore and dense pore types of HAP did not allow flow, and the pins did not change in structure 3-dimensionally. The authors found that pull-out strength depends on HAP porosity, and pin length and diameter.
Computer-Aided Freehand Maxillary Repositioning
Authors: Lin Xiaozhen , Sun Yi , Han Xiaodong , Wang Jing , Zhang Ming , Liang Limin
Published: December 2017

The authors aimed to test the hypothesis that in orthognathic surgery the maxilla could be repositioned using spatial distances from Glabella to 3 maxillary dental landmarks as references. An asymmetric skeletal Class 3 malocclusion patient was involved and bimaxillary orthognathic surgery was planned. Virtual surgery was simulated and spatial distances from Glabella to midpoint of the upper dentition (U0) and bilateral medial-buccal cusp of the first molar (6L and 6R) were measured. These distances were used as the repositioning references and were imported intraoperatively into a digital caliper after the maxilla was mobilized, the repositioning of maxilla was manipulated till all the true spatial distances reached the references. Postoperative computed tomography head model were superimposed onto the planned head model, the maxillary repositioning error was assessed using spatial distances between the pre- and postoperative dental landmarks. The asymmetric skeletal Class 3 malocclusion was corrected through bimaxillary surgery and the errors at U0, 6R and 6L was 1.37, 1.79, and 1.45 mm. The maxilla could be repositioned using spatial distances from Glabella to 3 maxillary dental landmarks as references.
Sensory Innervation of the Upper Eyelid
Authors: Hwang Kun , Wu Xia Jing , Kim Hun , Kim Dae Joong
Published: December 2017

The aim of this study was to elucidate the sensory territory of the trigeminal nerve on the upper eyelid.

Eight hemifaces from Korean cadavers were dissected. The frontal nerve (FN), supraorbital nerve (SON), supratrochlear nerve (STN), infratrochlear nerve (ITN), and lacrimal nerve (LN) were traced.

The terminal branches to the eyelid margin of FN were distributed between 1/6 and 2/5 of the palpebral fissure width lateral to the medial canthus and 1/6 of the eyebrow height from eyelid margin. The SON was distributed between 2/5 and 9/10 of the eye width lateral to the medial canthus, at 1/3 of the eyebrow height. The STN was distributed between −1/4 and −1/5 of the eye width medial to the medial canthus, at 1/5 of the eyebrow height. The ITN was distributed at −1/4 and 1/10 of the eye width medial to the medial canthus, and at 1/5 of the eyebrow height. The LN was distributed between approximately 3/5 and 13/10 of the eye width lateral to the medial canthus, and at 1/4 of the eyebrow height. The main branches of FN and SON ran deep to the orbicularis from the supraorbital notch to the upper border of the tarsal plate. In the pretarsal area, they were between the orbicularis and tarsal plate. The STN and ITN were between the orbicularis and the skin. The LN was observed between the orbicularis and the tarsal plate.

Upper eyelid was mainly supplied by SON and FN. The medial extremity was supplied by STN and ITN, and the lateral extremity by LN.
Microvascular Decompression for Trigeminal Neuralgia Due to Venous Compression Alone
Authors: Zhao Yonghui , Zhang Xiang , Yao Junchao , Li Heyang , Jiang Yong
Published: December 2017

Microvascular decompression (MVD) has been confirmed as an effective treatment of trigeminal neuralgia (TN); however, most previous reports just focused on MVD for TN caused by arterial conflict, there is a paucity of information about its use in venous compression causing TN. In the present study, the authors summarize 5-year experience of MVD for primary TN due to venous compression alone. Thirty-four patients with primary TN caused solely by veins underwent MVD. The presenting symptoms, key operative notes, surgical outcomes together with complications were reviewed. Of all the 34 patients, 19 (55.9%) patients occurred as typical TN. The V2 division was the most commonly affected area. Most of the venous conflicts were grade III (20/34, 58.8%). Deep superior petrosal venous system was the most frequent offending vessel (21/34, 61.8%). The venous conflicts were located at the trigeminal root entry zone in 10 (29.4%) patients, the mid cisternal zone in 18 (52.9%) patients, and the porus of Meckel's cave in 11 (32.4%) patients. At the last follow-up, excellent outcome was obtained in 26 (76.5%) patients, 7 (20.6%) patients got good outcome, fair outcome was achieved in 7 (20.6%) patients, and 1 patient unimproved (2.9%). Cerebrospinal fluid leakage was the most common complication (5.9%). In conclusion, MVD is a safe and effective surgical option for TN due to venous compression alone. It is noteworthy to explore the entire nerve and to protect veins as much as possible.
Endoscopic Repairs of Sinonasal Cerebrospinal Leaks: Outcome and Prognostic Factors
Authors: Song Xiaole , Wang Dehui , Sun Xicai , Liu Quan , Hu Li , Gu Yurong , Zhang Huankang
Published: December 2017

Objective:

The aim of this study was to review the management of sinonasal cerebrospinal fluid (CSF) leaks and outcome of endoscopic repairs and to provide experience regarding leaks at the lateral wall of sphenoid sinus and the posterior wall of frontal sinus.

Methods:

Patients who underwent endoscopic repairs of CSF leaks were reviewed. Characteristics of different etiologies were compared, and prognostic factors were analyzed.

Results:

The study included 144 patients with 150 CSF leaks, in which spontaneous leaks account for 55%. Patients with traumatic leaks were significantly younger than those with spontaneous leaks (P = 0.012), and most traumatic leaks occurred in men (P < 0.001). The computed tomography scan showed an overall accuracy of 86.7%. For 17 leaks at the lateral wall of sphenoid sinus, transnasal (29%), transethmoid (24%), and transpterygoid (47%) approaches were used, with a success rate of 75%. For 11 defects at the posterior wall of the frontal sinus, 2 were managed by draf III surgery, and 3 by trephination-assisted procedure successfully. Success rate for primary repair was 95.6%, reaching 100% after a second repairing. Six leaks failed to be repaired included 4 spontaneous leaks, and 3 occurred at the lateral wall of the sphenoid sinus, 4 occurred in patients with elevated body mass index (BMI), 4 had evidence of raised intracranial pressure (ICP).

Conclusion:

Repair of leaks at lateral sphenoid sinus and posterior frontal sinus could achieve favorable results via selected endoscopic approaches. The failure of repair was associated with inaccessible leak sites, spontaneous leaks, raised ICP, and elevated BMI.
Quality Improvement in Bariatric Surgery
Authors: Fry Brian T. , Scally Christopher P. , Thumma Jyothi R. , Dimick Justin B.
Published: December 2017

Objective:

To determine the temporal relationship between reducing surgical complications and costs, using the study population of bariatric surgery.

Background:

Understanding the relationship between quality and costs has significant implications for the business case of investing in performance improvement. An unprecedented focus on safety in bariatric surgery has led to substantial reductions in complication rates over time, making it an ideal patient population in which to examine this relationship.

Methods:

We performed a retrospective review of Medicare beneficiaries undergoing bariatric surgery in the years 2005 to 2006 and 2013 to 2014 (total N = 37,329 patients, 562 hospitals). Hospitals were ranked into quintiles based on their degree of improvement in risk and reliability-adjusted 30-day rates of serious complications across the time periods. Multivariable regression was used to calculate corresponding changes in average price-standardized payments for each quintile of hospitals.

Results:

We found a strong association between reductions in complications and decreased Medicare payments. The top 20% of hospitals had a decrease in average serious complication rate of 7.3% (10.0%–2.7%; P < 0.001) and an average per-patient savings of $4861 (95% confidence interval $3921–5802). Conversely, the bottom 20% of hospitals had smaller decrease in complication rate of 0.8% (4.4% to 3.6%; P < 0.001) and a smaller average savings of $2814 (95% confidence interval $2139–3490).

Conclusions:

When analyzing Medicare patients undergoing bariatric surgery, hospitals with the largest reductions in serious postoperative complications had the greatest decrease in per-patient payments. This study demonstrates the potential savings associated with quality improvement in high-risk surgical procedures.
Challenges in clarifying goals of care in patients with advanced heart failure
Authors: Strachan Patricia H. , Kryworuchko Jennifer , Li Lin
Published: December 2017

Purpose of review

Patients with advanced heart failure require communication about goals of care, yet many challenges exist, leaving it suboptimal. High mortality rates and advances in the use of life-sustaining technology further complicate communication and underscore the urgency to understand and address these challenges. This review highlights current research with a view to informing future research and practice to improve goals of care communication.

Recent findings

Clinicians view patient and family barriers as more impactful than clinician and system factors in impeding goals of care discussions. Knowledge gaps about life-sustaining technology challenge timely goals of care discussions. Complex, nurse-led interventions that activate patient, clinician and care systems and video-decision aids about life-sustaining technology may reduce barriers and facilitate goals of care communication.

Clinicians require relational skills in facilitating goals of care communication with diverse patients and families with heart failure knowledge gaps, who may be experiencing stress and discord. Future research should explore the dynamics of goals of care communication in real-time from patient, family and clinician perspectives, to inform development of upstream and complex interventions that optimize communication. Further testing of interventions is needed in and across community and hospital settings.
Inhibition of Group Ia Afferents Between Brachioradialis and Flexor Carpi Radialis in Humans: A Study Using an Electromyogram-Averaging Method
Authors: Nito Mitsuhiro , Hashizume Wataru , Suzuki Katsuhiko , Sato Toshiaki , Fujii Hiromi , Miyasaka Takuji , Shindo Masaomi , Naito Akira
Published: December 2017

Purpose:

Our previous studies using a poststimulus time histogram method demonstrated inhibitory spinal reflex arcs (inhibition) between the brachioradialis (BR) and flexor carpi radialis (FCR) in humans. Group I afferents mediated the inhibition through an oligosynaptic path. In this study, effects of the inhibition on excitability of the motoneuron pools were examined, and we tried to clarify which afferents of group Ia or Ib are responsible for the inhibition.

Methods:

We evaluated the effects of low-threshold afferents between BR and FCR on FCR and BR motoneuron pools, respectively, using an electromyogram-averaging method in 14 healthy human subjects. Changes of rectified and averaged electromyogram of BR by electrical conditioning stimulation with the intensity below the motor threshold to the median nerve branch innervating FCR (FCR nerve) and those of FCR by the stimulation to the radial nerve branch innervating BR (BR nerve) were evaluated.

Results:

The stimulation to the FCR and BR nerves produced an early and significant trough of rectified and averaged electromyogram of BR and FCR, respectively, in all the subjects. The amount of inhibition of BR and FCR was 13.2 ± 3.4% (mean ± SD) and 14.2 ± 1.4%, respectively. The trough of BR and FCR diminished by tonic vibration stimuli to a respective FCR and BR. Such a trough was never provoked by cutaneous stimulation.

Conclusions:

The inhibition between BR and FCR depresses excitability of the FCR and BR motoneuron pools, respectively. Group Ia afferents should mediate the inhibition.
Botulinum-neurotoxin-like sequences identified from anEnterococcussp. genome assembly
Authors: Williamson Charles H.D. , Smith Theresa J. , Foley Brian T. , Hill Karen , Keim Paul , Sahl Jason W.
Published: December 2017

Botulinum neurotoxins (BoNTs) are produced by diverse members of theClostridiaand result in a flaccid paralysis known as botulism. Exploring the diversity of BoNTs is important for the development of therapeutics and antitoxins. Here we describe a novel,bont-like gene cluster identified in a draft genome assembly forEnterococcussp. 3G1_DIV0629 by querying publicly available genomic databases. Thebont-like gene is found in a gene cluster similar to knownbontgene clusters. Protease and binding motifs conserved in known BoNT proteins are present in the newly identified BoNT-like protein; however, it is currently unknown if the BoNT-like protein described here is capable of targeting neuronal cells resulting in botulism.
KDM2B is a histone H3K79 demethylase and induces transcriptional repression via SIRT1-mediated chromatin silencing
Authors: Kang Joo-Young , Kim Ji-Young , Kim Kee-Beom , Park Jin Woo , Cho Hana , Hahm Ja Young , Chae Yun-Cheol , Kim Daehwan , Kook Hyun , Rhee Sangmyung , Ha Nam-Chul , Seo Sang Beom
Published: December 2017

The methylation of histone H3 lysine 79 (H3K79) is an active chromatin marker and is prominant in actively transcribed regions of the genome. However, demethylase of H3K79 remains unknown despite intensive research. Here, we show that KDM2B (also known as FBXL10), a member of the Jumonji C family of proteins and known for its histone H3K36 demethylase activity, is a di- and tri-methyl H3K79 demethylase. We demonstrate that KDM2B induces transcriptional repression ofHOXA7andMEIS1via occupancy of promoters and demethylation of H3K79. Furthermore, genome-wide analysis suggests that H3K79 methylation levels increase when KDM2B is depleted, indicating that KDM2B functions as an H3K79 demethylasein vivo. Finally, stable KDM2B-knockdown cell lines exhibit displacement of NAD+-dependent deacetylase SIRT1 from chromatin, with concomitant increases in H3K79 methylation and H4K16 acetylation. Our findings identify KDM2B as an H3K79 demethylase and link its function to transcriptional repression via SIRT1-mediated chromatin silencing.
New genomic data and analyses challenge the traditional vision of animal epithelium evolution
Authors: Belahbib Hassiba , Renard Emmanuelle , Santini Sébastien , Jourda Cyril , Claverie Jean-Michel , Borchiellini Carole , Le Bivic André
Published: December 2017

The emergence of epithelia was the foundation of metazoan expansion. To investigate the early evolution of animal epithelia, we sequenced the genome and transcriptomes of two new sponge species to characterize epithelial markers such as the E-cadherin complex and the polarity complexes for all classes (Calcarea, Demospongiae, Hexactinellida, Homoscleromorpha) of sponges (phylum Porifera) and compare them with their homologs in Placozoa and in Ctenophora. We found that Placozoa and most sponges possess orthologs of all essential genes encoding proteins characteristic of bilaterian epithelial cells, as well as their conserved interaction domains. In stark contrast, we found that ctenophores lack several major polarity complex components such as the Crumbs complex and Scribble. Furthermore, the E-cadherin ctenophore ortholog exhibits a divergent cytoplasmic domain making it unlikely to interact with its canonical cytoplasmic partners. These unexpected findings challenge the current evolutionary paradigm on the emergence of epithelia.

SIGNIFICANT STATEMENT

Epithelial tissues are a hallmark of metazoans deeply linked to the evolution of the complex morphogenesis processes characterizing their development. However, studies on the epithelial features of non-bilaterians are still sparse and it remains unclear whether the last common metazoan ancestor possessed a fully functional epithelial toolkit or if it was acquired later during metazoan evolution. In this work, we demonstrate that if sponges have a well conserved and functionally predicted epithelial toolkit, Ctenophores have either divergent adhesion complexes or lack essential polarity complexes. Altogether, our results raise a doubt on the homology of protein complexes and structures involved in cell polarity and adhesive type junctions between Ctenophora and Bilateria epithelia.
Genomic responses to selection for tame/aggressive behaviors in the silver fox (Vulpes vulpes)
Authors: Wang Xu , Pipes Lenore , Trut Lyudmila N. , Herbeck Yury , Vladimirova Anastasiya V. , Gulevich Rimma G. , Kharlamova Anastasiya V. , Johnson Jennifer L. , Acland Gregory M. , Kukekova Anna V. , Clark Andrew G.
Published: December 2017

Animal domestications have led to a shared spectrum of striking behavioral and morphological changes. To recapitulate this process, silver foxes have been selectively bred for tame and aggressive behaviors for over 50 generations at the Institute for Cytology and Genetics in Novosibirsk, Russia. To understand the genetic basis and molecular mechanisms underlying the phenotypic changes, we profiled gene expression level and coding SNP allele frequencies in two brain tissues from 12 aggressive and 12 tame foxes. Expression analysis revealed 146 genes in prefrontal cortex and 33 genes in basal forebrain that were differentially expressed (5% FDR). These candidates include genes in key pathways known to be critical to neurological processing, including the serotonin and glutamate receptor pathways. In addition, 295 of the 31,000 exonic SNPs show significant allele frequency differences between tame and aggressive population (1% FDR), including genes with a role in neural crest cell fate determination.
A weighted graph of the projections to mouse auditory cortex
Authors: da Costa Nuno Macarico , Martin Kevan A.C. , Sägesser Franziska D.
Published: December 2017

The projections to individual cortical areas from extrinsic sources are a major determinant of the area’s function, but we lack comprehensive quantitative input maps even for primary sensory areas in most model species. To quantify all input sources to the mouse primary auditory cortex (Au1), we made localized injections of modified rabies virus (SADΔG-mCherry) into Au1 of five C57BL/6 mice and identified all the cortical and subcortical areas containing retrogradely labeled cells. Of all neurons projecting to Au1 from extrinsic areas, 27 % were located in the ipsilateral cortex, 14 % in the contralateral cortex, and 58 % in subcortical regions (almost exclusively ipsilateral, predominantly in the medial geniculate nucleus). Although 90 % of the labeled cells in the ipsilateral cortex were located within 1 mm of Au1, most cortical areas projected to Au1, including visual, somatosensory, motor, rhinal, cingulate and piriform cortices. The hierarchical relations of the cortical areas projecting to Au1 were determined based on the proportion of cell bodies in superficial versus deep layers. Feedback projections (from deep layers 5/6) dominated, but temporal association and auditory cortices were on the same hierarchical level, providing input from both superficial and deep layers. Au1 is embedded in a densely connected network that involves a high degree of cross-modal integration.
Inhibitory networks orchestrate the self-organization of computational function in cortical microcircuit motifs through STDP
Authors: Häusler Stefan , Maass Wolfgang
Published: December 2017

Interneurons have diverse morphological and physiological characteristics that potentially contribute to the emergence of powerful computational properties of cortical networks. We investigate the functional role of inhibitory subnetworks in the arguably most common network motif of cortical microcircuits: ensembles of pyramidal cells (PCs) with lateral inhibition, commonly referred to as Winner-Take-All networks. Recent theoretical work has shown that spike-timing-dependent plasticity installs in this network motif an important and ubiquitously useful self-organization process: The emergence of sparse codes and Bayesian inference for repeatedly occurring high-dimensional input patterns. However, this link has so far only been established for strongly simplified models with a symbolic implementation of lateral inhibition, rather than through the interaction of PCs with known types of interneurons. We close this gap in this article, and show that the interaction of PCs with two types of inhibitory networks, that reflect salient properties of somatic-targeting neurons (e.g. basket cells) and dendritic-targeting neurons (e.g. Martinotti cells), provides a good approximation to the theoretically optimal lateral inhibition needed for the self-organization of these network motifs. We provide a step towards unraveling the functional roles of interacting networks of excitatory and inhibitory neurons from the perspective of emergent neural computation.