bluuebunny/crossref_metadata_2025 huggingface dataset:
Analytical treatment interruption in chronic HIV-1 infection: time and magnitude of viral rebound in adults with 10 years of undetectable viral load and low HIV-DNA (APACHE study)
Authors: Castagna Antonella , Muccini Camilla , Galli Laura , Bigoloni Alba , Poli Andrea , Spagnuolo Vincenzo , Nozza Silvia , Racca Sara , Galli Andrea , Cinque Paola , Carini Elisabetta , Lazzarin Adriano
Published: March 2019

Objectives

Despite the fact that there are individuals who have chronic HIV infection, few studies have investigated ART interruption in this setting. The aim of this study was to evaluate the ability to spontaneously control viral replication during analytical treatment interruption (ATI) in adults with chronic HIV-1 infection, on ART, with suppressed viraemia for >10 years and with a low reservoir.

Patients and methods

This was a prospective, open-label, single-arm, non-randomized, proof-of-concept study (NCT03198325) of subjects with chronic HIV-1 infection, HIV-RNA <50 copies/mL for ≥10 years, without residual viraemia for ≥5 years, CD4+ >500 cells/mm3, HIV-DNA <100 copies/106 PBMCs and without comorbidities or AIDS-defining diseases. Enrolled patients were strictly monitored. The ART regimen in use at ATI was resumed in the case of confirmed viral rebound (CVR, two consecutive HIV-RNA >50 copies/mL). Results are reported as median (IQR).

Results

Nine patients underwent ATI. All participants experienced CVR [4.84 (IQR: 3.47–6.47) HIV-RNA log10 copies/mL] after ATI at a median time of 21 days (range 14–56) and restarted ART. After ART resumption, all the subjects achieved HIV-RNA <50 copies/mL in a median of 88 days (range 15–197). No serious adverse event occurred; one subject experienced acute retroviral syndrome. No significant correlation between baseline factors and time to viral rebound was observed, while the magnitude of viral rebound was significantly associated with pre-ART HIV-1 RNA (Spearman r = 0.786, P = 0.036), nadir CD4+ (Spearman r = −0.800, P = 0.010), baseline CD4+ (Spearman r = −0.667, P = 0.049) and years with undetectable viral load (Spearman r = −0.717, P = 0.030).

Conclusions

Despite a long period of HIV viral load suppression and a low viral reservoir, early and consistent viral rebound was observed during ATI in all subjects.
Researching Human Rights Professionals: Tracing the Networks of Human Rights Practice
Authors: Bruch Elizabeth M
Published: March 2019

Human rights professionals are significant actors in international institutions, humanitarian interventions, and other dimensions of global governance. Despite their significance, they remain part of an under-researched global elite of international expert practitioners. This article explores the challenges of conducting transnational research involving human rights professionals in exploring the networks of institutions, actors and relationships in human rights fieldwork. It raises practical and methodological issues related to research relationships, access to participants and information, and the larger contexts of geopolitical and structural power. Using insights from human rights professionals themselves, it illuminates questions of expertise, identity and location, as well as the mediating roles of texts and technology in the research and in the network of practice.
Characterization of Corn Root Factors to Improve Artificial Diet for Western Corn Rootworm (Coleoptera: Chrysomelidae) Larvae
Authors: Huynh Man P , Bernklau Elisa J , Coudron Thomas A , Shelby Kent S , Bjostad Louis B , Hibbard Bruce E
Published: March 2019

The western corn rootworm, Diabrotica virgifera virgifera LeConte (Coleoptera: Chrysomelidae), is an important economic pest of maize (Zea mays L.) in North America and Europe. Previous efforts to formulate an artificial diet for western corn rootworm larvae highlighted an important role of corn root powder, which had a significant positive impact on several larval developmental traits. Unfortunately, this ingredient is not available for purchase. Toward the goal of developing an artificial diet for western corn rootworm larvae with all ingredients readily accessible, we conducted research to isolate essential growth factors for larval development from corn root powder to improve the performance of diet without corn root powder. For all experiments, multiple life history parameters (survival, weight, and molting) were recorded from 15-d diet bioassays. Corn roots may contain factors that assist in larval growth, but some of these factors were not fully extracted by methanol and remained in the extracted root. Methanolic extracts significantly increased molting to second instar, but did not significantly increase survival, dry weight, or molting to third instar, suggesting the primary corn root substituents affecting these factors cannot be extracted or other extraction methods may be required to extract the essential factors from corn roots. We showed that whole corn root powder was best when used in combination with all the other nutrient sources in the published western corn rootworm formulation. Corn root powder made from proprietary seed and Viking seed has similar value.
Measuring mobility, disease connectivity and individual risk: a review of using mobile phone data and mHealth for travel medicine
Authors: Lai Shengjie , Farnham Andrea , Ruktanonchai Nick W , Tatem Andrew J
Published: March 2019

Rationale for review

The increasing mobility of populations allows pathogens to move rapidly and far, making endemic or epidemic regions more connected to the rest of the world than at any time in history. However, the ability to measure and monitor human mobility, health risk and their changing patterns across spatial and temporal scales using traditional data sources has been limited. To facilitate a better understanding of the use of emerging mobile phone technology and data in travel medicine, we reviewed relevant work aiming at measuring human mobility, disease connectivity and health risk in travellers using mobile geopositioning data.

Key findings

Despite some inherent biases of mobile phone data, analysing anonymized positions from mobile users could precisely quantify the dynamical processes associated with contemporary human movements and connectivity of infectious diseases at multiple temporal and spatial scales. Moreover, recent progress in mobile health (mHealth) technology and applications, integrating with mobile positioning data, shows great potential for innovation in travel medicine to monitor and assess real-time health risk for individuals during travel.

Conclusions

Mobile phones and mHealth have become a novel and tremendously powerful source of information on measuring human movements and origin–destination-specific risks of infectious and non-infectious health issues. The high penetration rate of mobile phones across the globe provides an unprecedented opportunity to quantify human mobility and accurately estimate the health risks in travellers. Continued efforts are needed to establish the most promising uses of these data and technologies for travel health.
Estimates for the impact of ultraviolet background fluctuations on galaxy clustering measurements
Authors: Upton Sanderbeck Phoebe , Iršič Vid , McQuinn Matthew , Meiksin Avery
Published: March 2019

Spatial fluctuations in ultraviolet backgrounds can subtly modulate the distribution of extragalactic sources, a potential signal and systematic for large-scale structure surveys. While this modulation has been shown to be significant for 3D Ly α forest surveys, its relevance for other large-scale structure probes has been hardly explored, despite being the only astrophysical process that likely can affect clustering measurements on the scales of ≳Mpc. We estimate that the background fluctuations, modulating the amount of H i, have a fractional effect of (0.03–0.3) × (k/[10−2 Mpc−1])−1 on the power spectrum of 21 cm intensity maps at z = 1–3. We find a smaller effect for H α and Ly α intensity mapping surveys of (0.001–0.1) × (k/[10−2 Mpc−1])−1 and even smaller effect for more traditional surveys that correlate the positions of individual H α or Ly α emitters. We also estimate the effect of backgrounds on low-redshift galaxy surveys in general based on a simple model in which background fluctuations modulate the rate halo gas cools, modulating star formation: We estimate a maximum fractional effect on the power of ∼0.01 (k/[10−2 Mpc−1])−1 at z = 1. We compare sizes of these imprints to cosmological parameter benchmarks for the next generation of redshift surveys: We find that ionizing backgrounds could result in a bias on the squeezed triangle non-Gaussianity parameter fNL that can be larger than unity for power spectrum measurements with a SPHEREx-like galaxy survey, and typical values of intensity bias. Marginalizing over a shape of the form k−1PL, where PL is the linear matter power spectrum, removes much of this bias at the cost of ${\approx } 40{{\ \rm per\ cent}}$ larger statistical errors.
ETHOS – an effective theory of structure formation: formation of the first haloes and their stars
Authors: Lovell Mark R , Zavala Jesús , Vogelsberger Mark
Published: March 2019

A cut-off in the linear matter power spectrum at dwarf galaxy scales has been shown to affect the abundance, formation mechanism and age of dwarf haloes, and their galaxies at high and low redshifts. We use hydrodynamical simulations of galaxy formation within the ETHOS framework in a benchmark model that has such a cut-off and that has been shown to be an alternative to the cold dark matter (CDM) model that alleviates its dwarf-scale challenges. We show how galaxies in this model form differently to CDM, on a halo-by-halo basis, at redshifts z ≥ 6. We show that when CDM haloes with masses around the ETHOS half-mode mass scale are resimulated with the ETHOS matter power spectrum, they form with 50 per cent less mass than their CDM counterparts due to their later formation times, yet they retain more of their gas reservoir due to the different behaviour of gas and dark matter during the monolithic collapse of the first haloes in models with a galactic-scale cut-off. As a result, galaxies in ETHOS haloes near the cut-off scale grow rapidly between z = 10 and 6 and by z = 6 end up having very similar stellar masses, higher gas fractions and higher star formation rates relative to their CDM counterparts. We highlight these differences by making predictions for how the number of galaxies with old stellar populations is suppressed in ETHOS for both z = 6 galaxies and for gas-poor Local Group fossil galaxies. Interestingly, we find an age gradient in ETHOS between galaxies that form in high- and low-density environments.
Synthesizing the Strength of the Evidence of Complementary and Integrative Health Therapies for Pain
Authors: Giannitrapani Karleen F , Holliday Jesse R , Miake-Lye Isomi M , Hempel Susanne , Taylor Stephanie L
Published: March 2019

Objective

Pain and opioid use are highly prevalent, leading for calls to include nonpharmacological options in pain management, including complementary and integrative health (CIH) therapies. More than 2,000 randomized controlled trials (RCTs) and many systematic reviews have been conducted on CIH therapies, making it difficult to easily understand what type of CIH therapy might be effective for what type of pain. Here we synthesize the strength of the evidence for four types of CIH therapies on pain: acupuncture, therapeutic massage, mindfulness techniques, and tai chi.

Design

We conducted searches of English-language systematic reviews and RCTs in 11 electronic databases and previously published reviews for each type of CIH. To synthesize that large body of literature, we then created an “evidence map,” or a visual display, of the literature size and broad estimates of effectiveness for pain.

Results

Many systematic reviews met our inclusion criteria: acupuncture (86), massage (38), mindfulness techniques (11), and tai chi (21). The evidence for acupuncture was strongest, and largest for headache and chronic pain. Mindfulness, massage, and tai chi have statistically significant positive effects on some types of pain. However, firm conclusions cannot be drawn for many types of pain due to methodological limitations or lack of RCTs.

Conclusions

There is sufficient strength of evidence for acupuncture for various types of pain. Individual studies indicate that tai chi, mindfulness, and massage may be promising for multiple types of chronic pain. Additional sufficiently powered RCTs are warranted to indicate tai chi, mindfulness, and massage for other types of pain.
Prevalence and lameness-associated risk factors in Alberta feedlot cattle
Authors: Davis-Unger Jessica , Schwartzkopf-Genswein Karen S G , Pajor Ed A , Hendrick Steve , Marti Sonia , Dorin Craig , Orsel Karin
Published: March 2019

Lameness in cattle is a health and welfare concern; however, limited information is available on risk factors and the relationship between lameness and common diseases like bovine respiratory disease (BRD). Therefore, the objectives of this study were to: 1) identify prevalence of lameness in feedlot cattle and related risk factors of cattle diagnosed as lame; and 2) determine associations between BRD occurrence and lameness. Feedlot cattle health records were available from 28 feedlots for 10 yr. The data set consisted of 663,838 cattle records, with 13.9% (92,156) diagnosed with a disease, including 32.3%, 46.0%, and 22.0% with lameness, BRD, and other diagnoses, respectively. Lameness was classified into four categories: foot rot (FR), joint infections (JI), lame with no visible swelling (LNVS), and injuries (INJ), with a prevalence of 74.5%, 16.1%, 6.1%, and 3.1%, respectively. Lameness was compared across cattle types (arrival date and weight) as well as age classification (calf vs. yearling), gender (steer vs. heifer), and season of placement in the feedlot (spring, summer, fall, and winter). Within the disease-diagnosed population, lameness represented 28.5% of treated fall-placed calves, 38.5% of winter-placed calves, and 40.8% of treated yearlings. Foot rot was the most common diagnosis with 74.5% of all lameness diagnoses, with winter- and fall-placed calves more likely to be diagnosed with FR compared to yearlings (OR: 1.19, 95% CI: 1.10–1.30 and OR: 1.46, 95% CI: 1.38–1.55, respectively). Joint infections were the second most common diagnosis (16.1%). Compared to yearlings, fall-placed calves had a higher odds (OR: 3.64, 95% CI: 3.12–4.24) for JI. Injuries and LNVS were the least common but again fall-placed calves had higher odds of this diagnosis compared to yearlings (OR: 2.26, 95% CI: 1.70–2.99 and OR: 9.10, 95% CI: 6.26–13.2, respectively). Gender was significantly different for JI as steers were less likely affected compared to heifers (OR: 0.687, 95% CI: 0.545–0.867), and more likely affected by LNVS (OR: 2.46, 95% CI: 1.57–3.84). Of all lameness-associated deaths, JI accounted for almost 50%. Finally, cattle diagnosed with BRD were subsequently more likely to be diagnosed with INJ, JI, or LNVS (P < 0.001 for all comparisons). In conclusion, animal type and gender were associated with type of lameness diagnoses, allowing feedlots to allocate resources to groups at highest risk and focus on early intervention strategies.
A Percutaneous Threaded Wire as a Clamp Technique for Avoiding Wedge Deformity While Nailing Intertrochanteric Femur Fractures
Authors: Maupin Jeremiah J. , Steinmetz Raymond G. , Hickerson Lindsay E.
Published: March 2019

Hip fractures are common injuries managed by the orthopaedic surgeon, and within the umbrella of hip fractures, intertrochanteric femur fractures constitute a significant portion of these injuries. Recent trends have shown an increased usage of cephalomedullary nails for these injuries. A known potential complication of this technique is the generation of a wedge deformity creating a varus alignment, especially when the cranial portion of the intertrochanteric fracture exits at or near the starting point of the nail. Although the biomechanics of this phenomenon are well described, few reports have shown techniques to help avoid this phenomenon. Here, we present a novel technique we have found useful to help prevent the wedge deformity incorporating commonly available instruments.
Uncemented Reverse Total Shoulder Arthroplasty as Initial Treatment for Comminuted Proximal Humerus Fractures
Authors: Wright Jon O. , Ho Anthony , Kalma Jeremy , Koueiter Denise , Esterle Jason , Marcantonio David , Wiater J. Michael , Wiater Brett
Published: March 2019

Objectives:

To determine whether uncemented implants would provide similar outcomes while avoiding the complications associated with cement in the treatment of elderly patients with proximal humerus fractures (PHFs) with primary reverse total shoulder arthroplasty (RTSA).

Design:

Case series.

Setting:

A single Level I trauma center.

Patients/Participants:

A prospectively obtained cohort of 30 patients who underwent uncemented RTSA as initial treatment for a comminuted PHF: 4 male, 26 female; average age 71 ± 11 years.

Intervention:

Uncemented RTSA.

Main Outcome Measures:

(1) Radiographic analysis, (2) postoperative clinical range of motion, and (3) functional outcome scores: the American Shoulder and Elbow Surgeons Shoulder score and the Simple Shoulder Test score.

Results:

Radiographic analysis showed 97% achieved stable humeral stem fixation and 70% had healing of the tuberosities in anatomical position. Average range of motion was 130 ± 31 degrees of forward flexion, 32 ± 18 degrees of external rotation, and internal rotation to the midlumbar spine. Average American Shoulder and Elbow Surgeons Shoulder score was 82.0 ± 13.5 (with an average pain rating of 0.8 ± 1.3), and average Simple Shoulder Test score was 69.4% ± 19.1%.

Conclusions:

Our data show that treatment of comminuted PHFs in elderly patients with uncemented RTSA can consistently produce good clinical outcomes with a low rate of complications and suggest that cement may not be necessary for RTSA in the trauma setting.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Screening in adrenal tumors
Authors: Corssmit Eleonora P.M. , Dekkers Olaf M.
Published: March 2019

Purpose of review

Adrenal tumors are mostly encountered as incidentalomas in patients undergoing imaging not performed for suspected adrenal disease; although the majority are benign and nonfunctioning, malignant tumors and functioning tumors need to be excluded. The purpose of this review is to highlight recent advances in the evaluation of adrenal tumors.

Recent findings

As a consequence of increased use of technologically improved imaging techniques, the detection of adrenal incidentalomas has continued to increase. The vast majority of adrenal tumors are adrenocortical adenomas. To discriminate malignant from benign tumors and to identify clinically relevant functioning tumors, necessitating therapeutic intervention, adrenal tumors are best evaluated with unenhanced computed tomography (CT) attenuation and 1 mg dexamethasone overnight suppression test. An unenhanced CT attenuation value of 10 Hounsfield units or less excludes adrenocortical carcinoma and pheochromocytoma. Testing for hyperaldosteronism should be performed in hypertensive and/or hypokalemic patients, sex hormones, and steroid precursors in patients with clinical features suggestive of adrenocortical carcinoma. In patients with active extraadrenal malignancy and a single adrenal lesion without suspicion for metastasis elsewhere, CT-guided biopsy can be considered to rule out metastatic disease.

All patients with an adrenal tumor and without a prior history of cancer should be initially evaluated by unenhanced CT attenuation and 1 mg overnight dexamethasone suppression test, and additional hormone testing when indicated.
Challenges of denosumab in giant cell tumor of bone, and other giant cell-rich tumors of bone
Authors: Lipplaa Astrid , Dijkstra Sander , Gelderblom Hans
Published: March 2019

Purpose of review

Giant cell tumor of bone (GCTB) is an uncommon benign primary bone tumor, consisting of receptor activator of nuclear factor kappa-B (RANK) expressing reactive osteoclast-like giant cells and neoplastic spindle-shaped cells. Denosumab was approved by FDA in 2013 and by EMA in 2014 to treat adults and skeletally mature adolescents with unresectable GCTB or when resection is likely to result in severe morbidity. However, there is much discussion regarding the optimal applied treatment strategy.

Recent findings

Neoadjuvant treatment of GCTB with denosumab can effectively downstage tumors to facilitate less morbid surgery or completely avoid the need for resection, but there is concern about local recurrence postsurgery. Definitive treatment of unresectable GTCB improves symptoms and halts tumor progression. The optimal treatment duration is unclear and long-term treatment is associated with adverse events like osteonecrosis of the jaw (ONJ) and atypical femoral fractures. Denosumab maintenance dose interval is currently being investigated.

For the related but heterogenous group of giant cell rich tumors of bone, like aneurysmal bone cysts (ABC) and central giant cell granuloma (CGCG), denosumab is a new treatment modality under investigation. Given the effectiveness in GCTB, this could be a promising treatment option for selected patients with advanced disease.
Confronting Incivility in the Online Classroom
Authors: Swartzwelder Kay , Clements Paul , Holt Karyn , Childs Gary
Published: March 2019

Confronting incivility in the online classroom can significantly benefit from spiritual approaches that address behaviors on a continuum of mild to aggressive. This may include the need to intervene when covert or overt threats occur. Electronic communications can lead to misperceptions and misunderstandings between students and faculty. Lack of understanding of diverse cultures, life experiences, and professional and spiritual histories can lead to behaviors that are perceived as intentionally hostile when, in fact, they are not. It is important in the online classroom to differentiate between the two and establish expected virtual classroom behaviors.
210Po in Pacific Salmon from the West Coast of Canada and its Contribution to Dose by Ingestion
Authors: Chen J. , Cooke M.W. , Mercier J.F. , Trudel M. , Kellogg J. , Cullen J.T.
Published: March 2019

In response to public concern in Canada regarding health impacts attributable to the Fukushima Daiichi nuclear accident, oceanic seawater samples from the north Pacific and Arctic oceans, coastal seawater samples from 16 locations along the British Columbia coastline, and seafood samples (salmon, steelhead trout, and shellfish) from British Columbia coastal waters were collected and analyzed. This paper reports radiological analysis results of Pacific salmon samples (Oncorhynchus species) obtained from summer 2013 to fall 2016. While radioactive cesium from the Fukushima disaster was not detectable in most salmon samples, naturally occurring 210Po was measured in almost all individual samples in varying activity concentrations, from below the detection limit of 0.2 Bq kg−1 fresh weight up to 4.7 Bq kg−1 fresh weight. The average 210Po concentration among 297 salmon samples was 0.73 Bq kg−1 fresh weight. The average ingested radiation dose per kilogram of salmon from 210Po is estimated to be 0.88 μSv, and the average dose from 137Cs is estimated to be 0.0026 μSv. The annual dose from ingested salmon would be only a fraction of the worldwide average annual effective dose from exposure to natural background radiation (2,400 μSv y−1) (UNSCEAR 2000). The measurement results showed clearly that radiation doses to people consuming fish (such as salmon) from the Canadian west coast pose no health concern.
Optimization of Spectral String Data Analysis Using a Binomial Discriminator for Weak-source Detection Decisions
Authors: Meengs M. , Brogan J. , Brandl A.
Published: March 2019

Operational health physics applications, such as radiological and nuclear monitoring and detection for homeland security or radiation protection purposes, generate time sequences of independent individual measurement data. Statistical algorithms have been developed that use the analysis of patterns in the data strings to enhance the test statistic for the decision on the absence or presence of a radiation source. These hypothesis test procedures have been applied to spectral data and have been optimized for the highest rate of correct identification of a weak 137Cs source at constant false positive detection rates. Optimization of correct detection decisions was investigated for various string data sequence lengths and for the regions of interest in the gamma spectrum. The highest correct source identification is achieved for string data analyses of the spectral contributions that maximize a ∆μ/σ criterion, including energy regions around and containing the photopeak, but potentially also regions in the gamma spectrum other than those photopeak energies.
OUTCOMES OF RHEGMATOGENOUS RETINAL DETACHMENT REPAIR AFTER FAILED PNEUMATIC RETINOPEXY
Authors: Vidne-Hay Orit , Abumanhal Muhammad , Elkader Amir Abd , Fogel Miri , Moisseiev Joseph , Moisseiev Elad
Published: March 2019

Purpose:

To evaluate the visual and anatomical outcomes of reoperations following failure of pneumatic retinopexy (PR) for rhegmatogenous retinal detachment repair and compare the different surgical techniques used in these cases.

Methods:

The study included 114 eyes of 114 patients who underwent PR for rhegmatogenous retinal detachment and required subsequent surgery for its repair. These included repeated PR, scleral buckling, vitrectomy with gas or silicone oil, and vitrectomy with scleral buckling. The groups were compared for rates of retinal reattachment, visual improvement, and the occurrence of recurrent rhegmatogenous retinal detachment and any other postoperative complications.

Results:

In 91 (79.8%) eyes, the retina was reattached with one additional procedure. The success rate was significantly lower in eyes treated by repeated PR than by other surgical techniques (33 vs. 76–90%; P < 0.001). Visual acuity after PR failure was not significantly different than that at presentation and had improved significantly after surgery for retinal reattachment (P < 0.001).

Conclusion:

Pneumatic retinopexy failure was not associated with visual acuity loss, and the outcomes in 79.2% of cases that required only one additional surgery are comparable with those achieved with primary surgery. Poor outcomes were associated with eyes that required more than one additional surgery and that suffered complications.
Descemet Membrane Endothelial Keratoplasty Using Tissues From Donors With a History of Radial Keratotomy
Authors: Boulter Tyler , Rayl Sarah , McEntire M. Wade , Mifflin Mark
Published: March 2019

Purpose:

We report 2 successful cases of Descemet Membrane Endothelial Keratoplasty using transplanted tissues from donors with a history of radial keratotomy (RK).

Methods:

Four corneas were obtained from 2 donors with a history of RK. After one successful laboratory practice preparation of Descemet Membrane Endothelial Keratoplasty (DMEK) for each patient, 2 additional donor tissues were prepared for DMEK using the established eye bank protocols.

Results:

Recipient 1 was a 69-year-old female patient who underwent DMEK 6 hours after eye bank preparation of the graft. The postoperative course was uneventful with a clear, attached graft noted at all postoperative visits. The endothelial cell count of the recipient at 7 months was 1953 cells/mm2, and the best-corrected distance visual acuity at 1 year was 20/25 + 2. Recipient 2 was a 79-year-old male patient whose DMEK surgery was performed 18 hours after eye bank preparation of the graft. The postoperative course was notable for a re-bubble with air at postoperative day 4 for a peripheral 30% detachment of the donor tissue. No adverse events were noted, with a clear, attached graft at all postoperative visits. A recipient cell count at 6 months showed 2024 cells/mm2, and the best-corrected distance visual acuity at 1 year was 20/20.

Conclusions:

Two patients received successful DMEK grafts using tissues from donors with a history of RK. Careful eye bank screening and processing of RK donor tissues has thus far yielded similar outcomes in our recipient patients to what would be expected using tissues from donors without a history of RK.
The Comparative Effect of Cosmetic and Mechanical Prosthesis on Quality of Life and Performance in People With Medium-Length Below-Elbow Amputation
Authors: Moradi-Hades Atiye , Farmani Farzad , Mardani Mohammad Ali , Bahramizadeh Mahmood , Heidarimoghadam Rashid
Published: March 2019

Introduction

Upper-limb prostheses are divided into three groups: cosmetic (passive), mechanical, and powered. Each of these groups has specific characteristics and would be prescribed for special purposes. Some studies have separately examined function and quality of mechanical and cosmetic prostheses. Using the Trinity Amputation and Prosthesis Experience Scales (TAPES), the present research was aimed to compare and evaluate the quality of life and function of individuals with medium-length below-elbow amputation using mechanical and cosmetic prostheses.

Materials and Methods

Fifty-two individuals with medium-length below-elbow amputation voluntarily participated in this study. The TAPES questionnaire was used in this study.

Results

Regarding the general adjustment subscale, social adjustment subscale, functional activity subscale, social activity, appearance, satisfaction of weight, and functional satisfaction, significant differences were seen between two groups (P < 0.05). No significant difference was experienced between the groups in adjustment with restrictions subscale, sociopsychological adjustment, professional activity subscale, activity scale, and prosthesis satisfaction.

Conclusions

It was found out that each of these two types of prosthesis is suitable for special activities and tasks, and each has a specific function that potentially could improve an individual's quality of life. Because both cosmetic and mechanical prostheses have their own strengths and weaknesses, they can both together be used by one individual with amputation, complement each other, and fulfill the needs of the person with amputation.
In Vitro Durability and Stability Testing of a Novel Polymeric Transcatheter Aortic Valve
Authors: Rotman Oren M. , Kovarovic Brandon , Bianchi Matteo , Slepian Marvin J. , Bluestein Danny
Published: March 2019

Transcatheter aortic valve replacement (TAVR) has emerged as an effective therapy for the unmet clinical need of inoperable patients with severe aortic stenosis (AS). Current clinically used tissue TAVR valves suffer from limited durability that hampers TAVR’s rapid expansion to younger, lower risk patients. Polymeric TAVR valves optimized for hemodynamic performance, hemocompatibility, extended durability, and resistance to calcific degeneration offer a viable solution to this challenge. We present extensive in vitro durability and stability testing of a novel polymeric TAVR valve (PolyNova valve) using 1) accelerated wear testing (AWT, ISO 5840); 2) calcification susceptibility (in the AWT)—compared with clinically used tissue valves; and 3) extended crimping stability (valves crimped to 16 Fr for 8 days). Hydrodynamic testing was performed every 50M cycles. The valves were also evaluated visually for structural integrity and by scanning electron microscopy for evaluation of surface damage in the micro-scale. Calcium and phosphorus deposition was evaluated using micro-computed tomography (μCT) and inductive coupled plasma spectroscopy. The valves passed 400M cycles in the AWT without failure. The effective orifice area kept stable at 1.8 cm2 with a desired gradual decrease in transvalvular pressure gradient and regurgitation (10.4 mm Hg and 6.9%, respectively). Calcium and phosphorus deposition was significantly lower in the polymeric valve: down by a factor of 85 and 16, respectively—as compared to a tissue valve. Following the extended crimping testing, no tears nor surface damage were evident. The results of this study demonstrate the potential of a polymeric TAVR valve to be a viable alternative to tissue-based TAVR valves.
Temperament and Depression After a First Acute Coronary Syndrome
Authors: Ossola Paolo , Generali Irene , Schito Graziana , De Panfilis Chiara , Tonna Matteo , Gerra Maria Lidia , Marchesi Carlo
Published: March 2019

Few studies assess the role of personality styles in predicting the onset of depression among cardiac patients. This study evaluates whether temperament and character can represent a risk factor for the development of incident first-ever depressive episodes in patients at their first acute coronary syndrome (ACS). Two hundred sixty-seven (72.1%) subjects (male) completed the Temperament and Character Inventory (TCI) a few days after the cardiac event. At baseline and after 1, 2, 4, 6, 9, 12, and 24 months of follow-up, the participants completed the Primary Care Evaluation of Mental Disorder (PRIME-MD) and the Hospital Anxiety and Depression Scale to establish the presence of a depressive episode and its severity. During the follow-up, 61 (22.8%) participants developed a depressive episode. Temperamental risk factors for incident depression were scored high on novelty seeking and harm avoidance at the TCI. Given the detrimental effect of depression on cardiac prognosis, clinicians should take temperament variables into account when determining the treatment plans of their patients with ACS.
Facilitators and Barriers to Minority Blood Donations
Authors: Spratling Regena , Lawrence Raymona H.
Published: March 2019

Background

Minority blood donations have historically been low in the United States; however, increasing the proportion of minority blood donations is essential to reducing blood transfusion complications—particularly in African Americans with sickle cell disease and thalassemia.

Objectives

The research question was as follows: What are the facilitators and barriers to blood donation in minority populations?

Methods

Beginning August 2017, we conducted a literature search using the following electronic databases: CINAHL Plus with Full Text, Academic Search Complete, MEDLINE, PsycINFO, Sociological Collection, Cochrane Library, ProQuest Dissertation and Theses, and PubMed, which continued through December 2017. Based on primarily descriptive data in the articles (n= 15), the systematic review proceeded as a meta-synthesis. An inductive approach was used to analyze commonalities, differences, patterns, and themes in the study findings; interpret the findings; and synthesize the findings to generate new knowledge about the phenomena of study.

Results

The themes included (a) knowing a blood recipient; (b) identifying with culture, race/ethnicity, and religious affiliation; and (c) medical mistrust and misunderstanding. All were prominent in the descriptions of minorities on blood donation and exist as facilitators and barriers.

Discussion

The reviewed studies demonstrated that facilitators and barriers to minority blood donations are complex and exist concurrently. Community education and communication about blood donation have a positive effect on fellow community members, including friends and family, in racial and ethnic minorities that are underrepresented among blood donors. Findings further suggest the need to rebuild trust among minority communities.
Latin America trauma systems—Mexico and Brazil
Authors: Padilla Rojas Luis Gerardo , López Cervantes Roberto Enrique , Pérez Atanasio José Manuel , Sánchez Mónica Martínez , Gómez Acevedo José Máximo , Kojima Kodi Edson
Published: March 2019

In this brief review, the authors describe the main characteristics of trauma systems in Latin America's 2 most populous countries, Mexico and Brazil. Trauma is a common health problem and the major cause of death in the young populations in both countries. Mexico and Brazil have well-organized systems based on system designation and prehospital triage. The highest level trauma hospitals are only available in the biggest cities, with residents of the smaller cities having less access to quality care. Both countries can provide adequate musculoskeletal trauma and polytrauma care, but the systems are not universally equal and, therefore, not ideal. The lack of consistency and standardization of the systems across each country must be addressed to improve patient outcomes across each country.
BCOR Overexpression in Renal Malignant Solitary Fibrous Tumors
Authors: Argani Pedram , Kao Yu-Chien , Zhang Lei , Sung Yun-Shao , Alaggio Rita , Swanson David , Matoso Andres , Dickson Brendan C. , Antonescu Cristina R.
Published: March 2019

BCOR immunoreactivity is a sensitive and highly specific marker for clear cell sarcoma of the kidney (CCSK). However, a subset of adult renal sarcomas which overexpress BCOR are negative for BCOR genetic alterations, including BCOR gene fusions or BCOR-internal tandem duplication, and thus remain unclassified. We report 5 such undifferentiated renal/perirenal sarcomas which raised the differential diagnosis of CCSK due to their morphologic appearance and strong BCOR immunoreactivity, but which on RNA sequencing proved to be malignant solitary fibrous tumors (SFTs). The neoplasms occurred in patients at an age range of 30 to 62 years. Three patients were females and 2 male. Four were primary renal neoplasms while one was perirenal. All 5 neoplasms were cellular, nonpleomorphic, undifferentiated sarcomas with branching capillary vasculature composed of primitive round to ovoid neoplastic cells with scant cytoplasm and nuclei having fine, evenly dispersed chromatin. None of the cases demonstrated the typical hyperchromatic fusiform nuclei, prominent collagen deposition, or hemangiopericytomatous vasculature of SFT. All 5 cases were strongly immunoreactive for BCOR. Three cases were CD34 negative, where the other 2 were only focally CD34 positive. STAT6 was subsequently found to be positive by immunohistochemistry in all 5 cases. In summary, we report a previously unrecognized mimic of CCSK: malignant SFTs with an undifferentiated/small round cell phenotype along with branching capillary vasculature, strong immunoreactivity for BCOR, and minimal or no immunoreactivity for CD34. As CCSK is treated with a specific chemotherapy regimen, this distinction has therapeutic implications.
The Invisible Product: Preferences for Sustained-Release, Long-Acting Pre-exposure Prophylaxis to HIV Among South African Youth
Authors: Montgomery Elizabeth T. , Atujuna Millicent , Krogstad Emily , Hartmann Miriam , Ndwayana Sheily , O'Rourke Shannon , Bekker Linda-Gail , van der Straten Ariane , Minnis Alexandra M.
Published: March 2019

Background:

Long-acting injectable and implantable approaches aim to overcome some of the documented challenges with uptake and adherence to current HIV prevention methods. Youth are a key end-user population for these methods. We used qualitative methods to examine product attributes and preferences for current and future long-acting HIV prevention approaches.

Methods:

Ninety-five South African youth aged 18–24 years, of whom 62 were female and 33 male, completed 50 interviews and 6 focus groups. We purposively selected for previous product experience, including oral pre-exposure prophylaxis, injectable pre-exposure prophylaxis, or the vaginal ring, to ensure participants' opinions were rooted in actual experience.

Results:

Irrespective of previous method-use experience, gender, or sexual orientation, the majority expressed a preference for prevention methods formulated as injectables or implants. Several mentioned that their top priority in any product was efficacy, and for some, this overrode other concerns; for example, even if they feared pain, an implant or an injectable would be used if fully protective. Although efficacy was a top priority, there was also a clear desire across all subgroups for a product that would not interfere with sex, would stay in the system to provide protection, and that caused minimal burden, or was not apparent to others, and these characteristics were most salient for long-acting methods.

Conclusions:

Narrative explanations for preferences converged thematically around different dimensions of “invisibility” including invisibility to oneself, one's partner and household members, and community members. End-user preferences can be used to inform product development of long-acting HIV prevention approaches formulated as injections or implants to optimize adherence and impact.
Transcranial Blade Injuries and Principles of Their Safe Extraction
Authors: Azzi Alain J. , Saluja Rajeet , Mankowski Peter , Wakil Susan , Arthurs Bryan , Lessard Lucie
Published: March 2019

Retained cranial blade injuries are uncommon events lacking standardized recommendations for appropriate surgical extraction. The authors present a case of a 30-year-old male who sustained a penetrating blade injury of the left orbit with intracranial extension through the skull base into the temporal lobe. The patient walked to the emergency room and remained alert. Clinically, the patient had only a small laceration of the left upper eyelid with no gross visual impairment.

The radiological investigation confirmed the presence of a knife blade in the orbit. Intraoperative management included an intracranial approach and an extracranial craniofacial dissection for blade visualization and soft tissue protection, globe protection and to avoid any major bleeding. A thorough review of the penetrating cranial injuries literature is presented and a trauma management algorithm is offered for the care of similar injuries.
The Effect of Dexamethasone on Pain Severity After Zygomatic Complex Fractures
Authors: Kormi Eeva , Thorén Hanna , Snäll Johanna , Törnwall Jyrki
Published: March 2019

The authors sought to assess the effect of systemic perioperative dexamethasone (DXM) on pain severity after zygomatic complex (ZC) fracture surgery. To achieve this, the authors conducted a prospective randomized observer-blinded trial on 63 patients with isolated ZC fracture requiring surgical intervention. Patients randomly received either perioperative systemic DXM (10 or 30 mg), or served as controls receiving no DXM, and postoperative pain severity was assessed. Pain was measured with a 10 cm visual analogue scale (VAS) each time that analgesics (1 g paracetamol 4 times daily or oxycodone upon request) were administered, and analyzed as the area under the VAS curve for the immediate postoperative 24 hours. This further divided experienced pain into 2 categories (mild, or moderate to severe) using VAS = 4 as the cutoff. For statistics the authors used χ
2 test, Mann–Whitney U test, and logistic regression analysis, setting significance at P < 0.05. Zygomatic complex fracture patients receiving perioperative systemic DXM experienced milder pain compared with controls (P = 0.04). Subgroups receiving DXM (10 or 30 mg) reported no statistical difference regarding pain (P = 0.43). Overall, patients receiving DXM experienced less pain, thus DXM may be recommended as pre-emptive analgesic. Nonetheless, considering the possible adverse effects, a 10 mg single dose may be sufficient.
Comprehensive Analyses of Intraoral Benign and Malignant Nerve Sheath Tumors: The Rare Disease Entities Revisited
Authors: Song Yue , Hu Jiaan , Wu Yaping , Wang Dongmiao , Wang Yanling , Zhang Ping , Jiang Hongbing , Yang Jianrong , Cheng Jie
Published: March 2019

Introduction:

Intraoral benign and malignant nerve sheath tumors (BNST and MNST) are rare tumors with non-specific clinical presentations and represent diagnostic and therapeutic challenges. Current knowledge regarding their demographic, clinicopathological features and treatments remains fragmented.

Materials and Methods:

The original data about patients diagnosed as intraoral BNST and MNST were retrieved from our disease registry (2005–2017). Comprehensive reviews of English and Chinese literature were performed to collect and analyze the epidemiological, clinicopathological data and treatment outcomes about those published cases.

Results:

Thirty-four intraoral BNSTs were found at our institution in the past 13 years. Literature reviews identified 354 intraoral BNSTs in 223 articles and 60 intraoral MNSTs in 50 articles. Most intraoral BNSTs and MNSTs were presented in the second to fifth decade of life. Males outnumbered females in MNSTs, while BNSTs displayed a slight female preponderance. The common sites for intraoral BNSTs were parapharyngeal space followed by tongue, whereas mandible was the most common site for MNSTs. Most intraoral BNSTs were presented as slow-growing, painless mass or swelling, while MNSTs usually appeared as painful and invasive mass with discomfort. Surgical excision was preferred for intraoral BNSTs with excellent prognosis. Complete resection was indicated for intraoral MNST with dismal prognosis as evidenced by much recurrence, metastasis, and death.

Conclusion:

Intraoral BNST and MNST are rare diseases which should not be ignored when intraoral painless or painful mass/swelling is found. Surgical excision is indicated for intraoral BNST with favorable outcomes. However, further investigations are warranted to optimize the treatment for intraoral MNST to improve its prognosis.
Treatment of Synchronous Traumatic Perforations of the Trachea and the Esophagus With Two Inferiorly Based Strap Muscle Interposition Flaps: An Innovative Approach
Authors: Rammos Charalambos K. , Anderson Richard C. , Taege Sara M. , King Victor A. , Yoo Aran
Published: March 2019

Traumatic perforations of the esophagus and trachea are devastating injuries that necessitate prompt treatment. Large defects benefit from coverage with well vascularized tissue. Injuries at the level of the thoracic inlet are more challenging, as the options for local tissue coverage are limited.

This report describes the case of a 24-year-old male who suffered gunshot wounds to his neck resulting in right posterolateral tracheal perforation as well as esophageal perforation at the level of the thoracic inlet. Bronchoscopy and esophagogastroduodenoscopy showed injury of the trachea at 19 cm from the incisors and 2 large defects of the anterior and posterior esophagus at 26 cm. The esophageal defects were temporized with a stent at a first stage. Plastic surgery team was then consulted for flap coverage of the defects.

The thoracic team exposed the tracheal and esophageal perforations with a j-type incision of the neck, extending to the sternal notch, and the esophageal stent was removed. The 2 muscles, sternohyoid (SH) and sternothyroid (ST), were dissected free and were inferiorly rotated after they were disinserted superiorly. The SH was placed between the trachea and the esophagus, and the ST between the esophagus and the spine.

Postoperative, the patient was receiving nutrition via a gastrostomy tube. An esophagogram was performed on postoperative day (POD) # 7, which showed no esophageal leak. Postoperative diet was started and the patient was discharged on POD# 10 in a good condition. Twelve months postoperative, his wounds were found to be intact, and had no trouble either with breathing or swallowing.

Level of Evidence:

V