bluuebunny/crossref_metadata_2025 huggingface dataset:
Suprascapular and Interscalene Nerve Block for Shoulder Surgery
Authors: Hussain Nasir , Goldar Ghazaleh , Ragina Neli , Banfield Laura , Laffey John G. , Abdallah Faraj W.
Published: September 2017

Background

Interscalene block provides optimal shoulder surgery analgesia, but concerns over its associated risks have prompted the search for alternatives. Suprascapular block was recently proposed as an interscalene block alternative, but evidence of its comparative analgesic effect is conflicting. This meta-analysis compares the analgesic effect and safety of suprascapular block versus interscalene block for shoulder surgery.

Methods

Databases were searched for randomized trials comparing interscalene block with suprascapular block for shoulder surgery. Postoperative 24-h cumulative oral morphine consumption and the difference in the area under curve for pooled rest pain scores were designated as primary outcomes. Analgesic and safety outcomes, particularly block-related and respiratory complications, were evaluated as secondary outcomes. Results were pooled using random-effects modeling.

Results

Data from 16 studies (1,152 patients) were analyzed. Interscalene block and suprascapular block were not different in 24-h morphine consumption. The difference in area under the curve of pain scores for the 24-h interval favored interscalene block by 1.1 cm/h, but this difference was not clinically important. Compared with suprascapular block, interscalene block reduced postoperative pain but not opioid consumption during recovery room stay by a weighted mean difference (95% CI) of 1.5 cm (0.6 to 2.5 cm; P < 0.0001). Pain scores were not different at any other time. In contrast, suprascapular block reduced the odds of block-related and respiratory complications.

Conclusions

This review suggests that there are no clinically meaningful analgesic differences between suprascapular block and interscalene block except for interscalene block providing better pain control during recovery room stay; however, suprascapular block has fewer side effects. These findings suggest that suprascapular block may be considered an effective and safe interscalene block alternative for shoulder surgery.
Comparison of the Spectral-Temporally Modulated Ripple Test With the Arizona Biomedical Institute Sentence Test in Cochlear Implant Users
Authors: Lawler Marshall , Yu Jeffrey , Aronoff Justin M.
Published: September 2017

Objectives:

Although speech perception is the gold standard for measuring cochlear implant (CI) users’ performance, speech perception tests often require extensive adaptation to obtain accurate results, particularly after large changes in maps. Spectral ripple tests, which measure spectral resolution, are an alternate measure that has been shown to correlate with speech perception. A modified spectral ripple test, the spectral-temporally modulated ripple test (SMRT) has recently been developed, and the objective of this study was to compare speech perception and performance on the SMRT for a heterogeneous population of unilateral CI users, bilateral CI users, and bimodal users.

Design:

Twenty-five CI users (eight using unilateral CIs, nine using bilateral CIs, and eight using a CI and a hearing aid) were tested on the Arizona Biomedical Institute Sentence Test (AzBio) with a +8 dB signal to noise ratio, and on the SMRT. All participants were tested with their clinical programs.

Results:

There was a significant correlation between SMRT and AzBio performance. After a practice block, an improvement of one ripple per octave for SMRT corresponded to an improvement of 12.1% for AzBio. Additionally, there was no significant difference in slope or intercept between any of the CI populations.

Conclusion:

The results indicate that performance on the SMRT correlates with speech recognition in noise when measured across unilateral, bilateral, and bimodal CI populations. These results suggest that SMRT scores are strongly associated with speech recognition in noise ability in experienced CI users. Further studies should focus on increasing both the size and diversity of the tested participants, and on determining whether the SMRT technique can be used for early predictions of long-term speech scores, or for evaluating differences among different stimulation strategies or parameter settings.
Midterm follow-up results for 10 patients with giant cell tumor of the distal tibia treated by extended curettage, adjuvant liquid nitrogen, and autogenous bone graft.
Authors: Rahman Mohamed Abdel , Mashhour Mohamed Ahmed , El Masry Ayman Mohammad , Azmy Sherif Ishak
Published: September 2017

Background:

The distal tibia is an unusual location for giant cell tumor. Less than 4% occurring in bone involve the foot and ankle region; the exact prevalence in the distal tibia is not known. Treatment remains unclear because of the rarity of the lesion in this location, the anatomy of the ankle, and difficulties associated with reconstruction.

Methods:

We retrospectively reviewed 10 patients who underwent extended curettage for giant cell tumor of the distal tibia, using adjuvant cryotherapy and biological reconstruction with autograft. The age of the patients ranged between 23-50 yr. Nine patients had newly diagnosed giant cell tumor while one patient presented with a recurrent lesion after simple curettage and synthetic bone grafting at another hospital. One patient presented with a nondisplaced pathological fracture of the distal tibia. He was treated initially with a short leg cast until the fracture healed, then surgical intervention was done. No intraarticular extension was present preoperatively in any patient.

Results:

The average follow-up from primary surgical intervention was 57 mo. At the end of the study, the mean musculoskeletal tumor score (MSTS) was 90. Local recurrence occurred in two patients. The average duration until union of the graft was 6.2 mo (range, 4-10 mo).

Conclusions:

Giant cell tumor of the distal tibia is a rare benign but aggressive tumor. Extended curettage and liquid nitrogen as adjuvant, followed by biologic reconstruction using autogenous bone graft is a solid line of treatment for lesions without intraarticular extension that provides good results.
Does musculoskeletal health literacy differ between urban and rural orthopaedic patients?
Authors: Johnson Christopher K. , Alley Maxwell C. , Talwar Ankoor , Tirrell Julie , Leinhart August , Pauze Denis R. , Pauze Daniel K. , Rosenbaum Andrew J.
Published: September 2017

Background:

Many patients lack the necessary skills needed to make informed decisions regarding their health. This critical skill set, broadly defined as health literacy, is influenced by various demographic factors including age, gender, ethnicity, education, and socioeconomic status. Patients seeking care for musculoskeletal ailments are afflicted by low health literacy, with several studies identifying higher rates of inadequate musculoskeletal health literacy than general health literacy. This study aimed to evaluate and compare the prevalence of limited musculoskeletal health literacy in patients seeking orthopaedic care in both urban and rural environments, looking at the geographical distribution in a single state.

Methods:

Validated health literacy assessment instruments and demographic surveys were administered to patients seeking musculoskeletal care in two emergency departments (one rural, one urban). Patients were eligible to participate if they had a single musculoskeletal complaint, were at least 18 yr old, and spoke English.

Results:

There were 55 participants in the rural emergency department (ED), and 65 in the urban ED. Adequate general health literacy was found in 62% of rural and 52% of urban patients, while 44% of rural and 43% of urban patients had adequate musculoskeletal health literacy. There was no significant difference in the prevalence of adequate health literacy between the two populations, but both cohorts had significantly worse rates of musculoskeletal health literacy as compared to general health literacy (P<0.05).

Conclusions:

This study confirms that there is a greater prevalence of limited musculoskeletal health literacy as compared to general health literacy, and that this transcends geographic boundaries.
Closed reduction of shoulder dislocations in the emergency department: does an emergency medicine residency affect the orthopaedic resident experience?
Authors: Mondestin Max , Barfield William R. , Griffith Adam , Smalley Jeremy , Woolf Shane K.
Published: September 2017

Background:

The shoulder is a mobile joint at risk for dislocation that can lead to presentation to an emergency department (ED). Our objective was to study the impact of establishing an emergency medicine (EM) residency program on the orthopaedic resident experience in management of simple shoulder dislocations (SSD).

Methods:

A retrospective review of patients presenting to the ED with a diagnosis of an isolated SSD was conducted based on ICD-9/CPT code. The time intervals studied were: 2006-07 (Group 1, pre-EM residency) and 2012-13 (Group 2, post-EM residency). Forty-three patients met inclusion criteria in group 1; 38 patients met the inclusion criteria in group 2. Outcomes studied were reduction attempts and success rates by EM and orthopaedic residents.

Results:

In Group 1, orthopaedic residents attempted reductions in 37% (16 of 43) of the patients and were 100% successful in the ED. There was a mean of 2.67 reduction attempts per orthopaedic junior resident per year. In group 2, orthopaedics attempted reductions in 29% of the patients (11 of 38). Orthopaedic residents were successful in nine of 11 of ED reductions. There was a mean of 1.57 attempts at shoulder reductions per orthopaedic resident per year. The average number of shoulder reduction attempts per orthopaedic resident was not significantly different between the groups (P=0.566).

Conclusions:

No significant change in the number of reductions managed by either department was shown, but the discrepancy should be discussed. Orthopaedic residency directors should audit their trainees experience with SSDs and consider collaborating with the EM program to optimize training opportunities.
What Is Caring in Nursing?
Authors: Newbanks R. Shirlene , Rieg Linda S. , Schaefer Beverly
Published: September 2017

Historically, some propose that organized nursing was founded on biblical principles and the caring behaviors and characteristics of Christ, and that caring originates with God. More recently, perceptions of caring have shifted to a humanistic, postmodern worldview, where the source of caring is within the person. This integrative literature review synthesized caring literature from humanistic, postmodern, and biblical, theological worldviews. Findings reveal that 95% of research and 85% of nonresearch publications were written from the humanistic perspective. The results lay a foundation for an alternative middle range theory on caring from a biblical worldview for nurses holding Christian beliefs.
Age at natural menopause and its associated factors in Canada: cross-sectional analyses from the Canadian Longitudinal Study on Aging
Authors: Costanian Christy , McCague Hugh , Tamim Hala
Published: September 2017

Background:

Early onset of menopause is associated with long-term disease and higher mortality risks. Research suggests that age at natural menopause (ANM) varies across populations. Little is known about factors that affect ANM in Canadian women.

Objective:

This study aims to estimate the median ANM and examine factors associated with earlier ANM among Canadian women.

Methods:

Baseline data from the Tracking cohort of the Canadian Longitudinal Study on Aging was used for this analysis. The relation of sociodemographic, lifestyle, and health-related factors with ANM was examined among 7,719 women aged 40 and above. Nonparametric Kaplan-Meier cumulative survivorship estimates were used to assess the timing of natural menopause. Univariate and multivariate Cox proportional hazard regression models were used to characterize ANM and its association with relevant covariates.

Results:

Overall, median ANM was 51 years. Having no partner, low household income and education levels, current and former smoking, and cardiovascular disease were all associated with an earlier ANM, whereas current employment, alcohol consumption, and obesity were associated with later ANM.

Conclusions:

These findings provide a national estimate of ANM in Canada and show the importance of lifestyle factors and health conditions in determining menopausal age. These factors might help in risk assessment, prevention and early management of chronic disease risk during the menopausal transition.
OPACIFICATION OF SCLERAL-SUTURED AKREOS AO60 INTRAOCULAR LENS AFTER VITRECTOMY WITH GAS TAMPONADE: CASE SERIES
Authors: Kalevar Ananda , Dollin Michael , Gupta R. Rishi
Published: September 2017

Background/Purpose:

We report the first two cases of postoperative opacification of scleral-sutured Akreos AO60 intraocular lens after vitrectomy with the gas tamponade.

Methods:

Two patients with ectopia lentis underwent pars plana vitrectomy, pars plana lensectomy, and scleral fixation of an Akreos AO60 intraocular lens with Gore-Tex suture. Retinal breaks were noted during vitrectomy and consequently intravitreal gas tamponade was used after endolaser retinopexy. Postoperatively, both patients developed intraocular lens opacification but maintained excellent visual acuity; however, one patient developed bothersome though tolerable photophobia.

Conclusion:

Although still an excellent option for the management of surgical aphakia in the absence of capsular support, caution should be taken when using a hydrophilic secondary intraocular lens, such as Akreos AO60, during vitreoretinal surgery if gas is required.
Scleral Lenses in the Management of Corneal Irregularity and Ocular Surface Disease
Authors: Shorter Ellen , Harthan Jennifer , Nau Cherie B. , Nau Amy , Barr Joseph T. , Hodge David O. , Schornack Muriel M.
Published: September 2017

Purpose:

To describe current practice patterns regarding the use of scleral lens therapy in the management of corneal irregularity and ocular surface disease among eye care providers who fit scleral lenses.

Methods:

The Scleral Lenses in Current Ophthalmic Practice: an Evaluation (SCOPE) study group conducted an electronic survey of eye care providers from January 15 to March 31, 2015. Respondents ranked management options for corneal irregularity in the order in which they would generally consider their use. Respondents also ranked options for the management of ocular surface disease in the order in which they would use each of the treatments. Results for each option were analyzed as percentage first-place ranking; percentage first-, second-, or third-place ranking; and mean rank score.

Results:

Survey responses were obtained from 723 providers who had fit 5 or more scleral lenses. Of these respondents, 629 ranked options for management of corneal irregularity and 612 ranked options for management of ocular surface disease. Corneal rigid gas-permeable lenses were the first option for management of corneal irregularity for 44% of respondents, and scleral lenses were the first option for 34% of respondents. Lubricant drops were the first therapeutic recommendation for ocular surface disease for 84% of respondents, and scleral lenses were ranked first by 6% of respondents.

Conclusion:

Scleral lenses rank second only to corneal rigid gas-permeable lenses for management of corneal irregularity. Scleral lenses are generally considered after other medical intervention and before surgery for the management of ocular surface disease.
The Relationship Between and Factors Influencing Staff Nurses' Perceptions of Nurse Manager Caring and Exposure to Workplace Bullying in Multiple Healthcare Settings
Authors: Olender Lynda
Published: September 2017

OBJECTIVE

The aim of this study was to examine the relationship between, and factors influencing, staff nurse perceptions of nurse manager caring (NMC) and the perceived exposure to workplace bullying (WPB) in multiple healthcare settings.

BACKGROUND

Workplace bullying is commonplace, increasing, and detrimental to the health and availability of our nursing workforce. Positive relationships between a nurse manager (NM) and staff increase staff satisfaction and reduce turnover. Still unknown, however, is whether a caring relationship between manager and staff can reduce staff nurse perception of exposure to WPB.

METHODS

On the basis of Watson's theory that caring is reciprocal in nature, a descriptive correlational design was used to assess 156 staff nurses' self-report of NMC and their exposure to negative acts using the Caring Factor Survey–Caring of the Manager and the Negative Acts Questionnaire-Revised instruments.

RESULTS

There is a significant inverse relationship between NMC and exposure to WPB in the nursing workplace. Gender, work environment, and a high workload influenced these findings.

CONCLUSIONS

This study highlights the importance of caring leadership to reduce exposure to negative behaviors. The data lend support to the idea of educating NMs regarding the application of caring behaviors to support staff at the point of care.
Diagnostic Utility of PD-L1 Expression in Lung Adenocarcinoma: Immunohistochemistry and RNA In Situ Hybridization
Authors: Gafeer Mohamad Mazen , Hosny Mohammed Kareem , Ormenisan-Gherasim Claudia , Choudhary Fahad , Siddiqui Momin T. , Cohen Cynthia
Published: September 2017

Background:

Programmed death receptor and programmed death ligand (PD-L1) are immunoregulatory proteins. Nonsmall cell lung cancer bypasses the immune system through the induction of protumorigenic immunosuppressive changes. The better understanding of immunology and antitumor immune responses has brought the promising development of novel immunotherapy agents like programmed death receptor checkpoint inhibitors. The aim of this study was to investigate the expression of PD-L1 in lung adenocarcinoma (ADC), comparing 2 different technologies: immunohistochemistry (IHC) by 2 methods versus RNA in situ hybridization (RISH).

Methodology:

In total, 20 cases of ADC of the lung and 4 samples of metastatic colon ADC were selected. Evaluation of PD-L1 expression was performed by IHC and RISH. RISH was performed using RNAscope. Both methods were scored in tumor cells and quantified using combined intensity and proportion scores.

Results:

Eight of 20 (40%) lung ADC and 2 of 4 (50%) colon ADC were positive for PD-L1 with Cell Signaling IHC, and 65% lung ADC were positive by Dako IHC (13/20). All 4 cases of colon ADC were negative. When evaluated by RISH, 12 lung ADC (60%) and 1 colon ADC (25%) were PD-L1 positive.

Conclusions:

RNAscope probes provide sensitive and specific detection of PD-L1 in lung ADC. Both IHC methods (Cell Signaling and Dako) show PD-L1 expression, with the Dako method more sensitive (40% vs. 65%). This study illustrates the utility of RISH and Cell Signaling IHC as complementary diagnostic tests, and Food and Drug Administration approved Dako IHC as a companion diagnostic test.
The Louisiana Mental and Behavioral Health Capacity Project Trauma-Informed Integrated Care Model and Improved Posttraumatic Stress Outcomes
Authors: Osofsky Howard J. , Osofsky Joy D. , Hansel Tonya Cross , Flynn Trevor
Published: September 2017

Objective:

The Mental and Behavioral Health Capacity Project in Louisiana has been addressing health disparities by increasing accessibility and availability through integrating services into primary care clinics. Integrated health is becoming the standard of care, providing an opportunity to address the trauma-specific needs of communities, and allowing for informed and less stigmatized services. The purpose of this study is to test the efficacy of the Mental and Behavioral Health Capacity Project in Louisiana model in the primary care settings to reduce posttraumatic stress symptoms and physical health complaints.

Design:

A pre-experimental time series design was used on the basis of participants self-reporting at least 1 trauma at intake and follow-up collected at 1-, 3-, and 6-month intervals. The hypotheses were that posttraumatic stress and physical health complaints would significantly decrease over the course of treatment.

Setting:

This study was part of a larger study to evaluate the effectiveness of the Mental and Behavioral Health Capacity Project in Louisiana–integrated health efforts. Sample parameters included (1) intake date from January 2013 through December 2015; (2) at least 18 years of age; and (3) presented at 1 of 5 primary health care clinics in Southeast Louisiana.

Participants:

A total of 235 patients were selected; the mean age was 44.7 years (SD = 13.6) and the majority were white (68%) and female (76%).

Intervention:

Brief behavioral-based trauma treatment was delivered using both on-site and telemedicine therapies provided by a psychologist, psychiatrist, or through a combined treatment model.

Main Outcome Measure:

The main outcome measures were the Posttraumatic Stress Civilian Checklist (PCL-C) and the Patient Health Questionnaire (PHQ-15).

Results:

The hypothesis was supported. Statistically significant decreases in posttraumatic stress symptoms and physical health complaints were shown over the course of treatment, with 63% of the group demonstrating clinically significant change.

Conclusions:

This study supports brief trauma treatment in primary care clinics as an effective method of reducing trauma and physical health symptoms in postdisaster environments.
Successes and Lessons Learned From Implementing Community Health Worker Programs in Community-Based and Clinical Settings: Insights From the Gulf Coast
Authors: Sherman Mya , Covert Hannah , Fox Laila , Lichtveld Maureen
Published: September 2017

Context:

Community health workers (CHWs) are an increasingly viable component of the American health system. While organizations may be interested in incorporating CHWs into the health care workforce, there are challenges to doing so.

Objective:

This study characterizes the successes and lessons learned from implementing new CHW programs in clinical and community-based settings in 4 US Gulf states.

Design:

Semistructured interviews were conducted with CHWs and their supervisors.

Setting:

Interviews were conducted with participants in 16 community-based organizations and federally qualified health centers located in coastal counties and parishes of Louisiana, Florida, Alabama, and Mississippi.

Participants:

Study participants consisted of 22 CHWs and 17 CHW supervisors.

Results:

Although most challenges and strategies were reported by participants working in both clinical and community-based settings, some were workplace-specific. Participants from predominantly clinical settings described the importance of strengthening organizational cohesion and coordination, whereas participants from community-based participants discussed the need for specialized training for CHWs. In both work environments, participants indicated that CHW functioning was constrained by limited organizational resources, difficulty accessing the client population, and limited knowledge regarding the CHW's scope of practice. Strategies to improve CHW functioning in both settings included investing in local partnerships, streamlining resources, prioritizing strong communication and outreach, and establishing explicit operating procedures. The majority of participants noted that challenges lessened over time.

Conclusions:

Evaluating successes and lessons learned in CHW work is critical to maximize CHWs' abilities to address clients' health needs and promote health in underserved communities. This study provides important insights into how to successfully integrate CHWs into the public health workforce.
A Framework for Integrating Environmental and Occupational Health and Primary Care in a Postdisaster Context
Authors: Kirkland Katherine , Sherman Mya , Covert Hannah , Barlet Grace , Lichtveld Maureen
Published: September 2017

Context:

Integration of environmental and occupational health (EOH) into primary care settings is a critical step to addressing the EOH concerns of a community, particularly in a postdisaster context. Several barriers to EOH integration exist at the physician, patient, and health care system levels.

Program:

This article presents a framework for improving the health system's capacity to address EOH after the Deepwater Horizon oil spill and illustrates its application in the Environmental and Occupational Health Education and Referral (EOHER) program. This program worked with 11 Federally Qualified Health Center systems in the Gulf Coast region to try to address the EOH concerns of community members and to assist primary care providers to better understand the impact of EOH factors on their patients' health.

Implementation:

The framework uses a 3-pronged approach to (1) foster coordination between primary care and EOH facilities through a referral network and peer consultations, (2) increase physician capacity in EOH issues through continuing education and training, and (3) conduct outreach to community members about EOH issues.

Evaluation:

The EOHER program highlighted the importance of building strong partnerships with community members and other relevant organizations, as well as high organizational capacity and effective leadership to enable EOH integration into primary care settings. Physicians in the EOHER program were constrained in their ability to engage with EOH issues due to competing patient needs and time constraints, indicating the need to improve physicians' ability to assess which patients are at high risk for EOH exposures and to efficiently take environmental and occupational histories.

Discussion:

This article highlights the importance of addressing EOH barriers at multiple levels and provides a model that can be applied to promote community health, particularly in the context of future natural or technological disasters.
Evaluation of Syndromic Surveillance Systems in 6 US State and Local Health Departments
Authors: Thomas Mathew J. , Yoon Paula W. , Collins James M. , Davidson Arthur J. , Mac Kenzie William R.
Published: September 2017

Objective:

Evaluating public health surveillance systems is critical to ensuring that conditions of public health importance are appropriately monitored. Our objectives were to qualitatively evaluate 6 state and local health departments that were early adopters of syndromic surveillance in order to (1) understand the characteristics and current uses, (2) identify the most and least useful syndromes to monitor, (3) gauge the utility for early warning and outbreak detection, and (4) assess how syndromic surveillance impacted their daily decision making.

Design:

We adapted evaluation guidelines from the Centers for Disease Control and Prevention and gathered input from the Centers for Disease Control and Prevention subject matter experts in public health surveillance to develop a questionnaire.

Participants:

We interviewed staff members from a convenience sample of 6 local and state health departments with syndromic surveillance programs that had been in operation for more than 10 years.

Results:

Three of the 6 interviewees provided an example of using syndromic surveillance to identify an outbreak (ie, cluster of foodborne illness in 1 jurisdiction) or detect a surge in cases for seasonal conditions (eg, influenza in 2 jurisdictions) prior to traditional, disease-specific systems. Although all interviewees noted that syndromic surveillance has not been routinely useful or efficient for early outbreak detection or case finding in their jurisdictions, all agreed that the information can be used to improve their understanding of dynamic disease control environments and conditions (eg, situational awareness) in their communities.

Conclusion:

In the jurisdictions studied, syndromic surveillance may be useful for monitoring the spread and intensity of large outbreaks of disease, especially influenza; enhancing public health awareness of mass gatherings and natural disasters; and assessing new, otherwise unmonitored conditions when real-time alternatives are unavailable. Future studies should explore opportunities to strengthen syndromic surveillance by including broader access to and enhanced analysis of text-related data from electronic health records. Health departments may accelerate the development and use of syndromic surveillance systems, including the improvement of the predictive value and strengthening the early outbreak detection capability of these systems. These efforts support getting the right information to the right people at the right time, which is the overarching goal of CDC's Surveillance Strategy.
The Functional Angiosome: Clinical Implications of the Anatomical Concept
Authors: Taylor G. Ian , Corlett Russell J. , Ashton Mark W.
Published: September 2017

Background:

The angiosome is a three-dimensional block of tissue supplied by a source vessel with its boundary outlined either by an anastomotic perimeter of reduced-caliber choke vessels or by true anastomoses with no reduction of vessel caliber. This article focuses on the role of these anastomotic vessels in defining flap survival or the necrotic pattern seen in fulminating meningococcal septicemia.

Methods:

Experiments in pigs, dogs, guinea pigs, and rabbits over the past 46 years were reviewed, focusing on the necrosis line of flaps, the effects of various toxins in vivo, and correlating these results in the clinical setting.

Results:

Experimentally, choke anastomoses are functional and control flow between perforator angiosomes. They (1) permit capture of an adjacent angiosome when the flap is raised on a cutaneous perforator in 100 percent of cases, with the necrosis line occurring usually in the next interperforator connection; (2) confine flow to the territory of the involved artery when a toxin is introduced by spasm around its perimeter; and (3) lose this property of spasm when choke vessels are converted to true anastomoses following surgical delay, or where true anastomoses occur naturally, thereby allowing unimpeded blood flow and capture of additional angiosome territories. Clinical experience supports these observations.

Conclusions:

The functional angiosome is the volume of tissue that clinically can be isolated on a source vessel. The area extends beyond its anatomical territory to capture an adjacent territory if connections are by choke anastomoses, or more if they are by true anastomoses.
Facial Assessment and Injection Guide for Botulinum Toxin and Injectable Hyaluronic Acid Fillers: Focus on the Midface
Authors: de Maio Maurício , DeBoulle Koen , Braz André , Rohrich Rod J.
Published: September 2017

This second article of a three-part series addresses techniques and recommendations for aesthetic treatment of the midface. Injectable fillers are important for rejuvenation of the midface by replacing lost volume and providing structural support; neuromodulators play a smaller role in this facial region. Fillers are used for volumization and contouring of the midface regions, including the upper cheek and lid-cheek junction and the submalar and preauricular areas. Also, treatment of the frontonasal angle, the dorsum, the nasolabial angle, and the columella may be used to shape and contour the nose. Neuromodulators may be used to treat bunny lines and for elevation of the nasal tip. The midface is considered an advanced area for treatment, and injectors are advised to obtain specific training, particularly when injecting fillers near the nose, because of the risk of serious complications, including blindness and necrosis. Injections made in the midcheek must be performed with caution to avoid the infraorbital artery.
Management of a Brain Abscess Presumably Caused by Radiation Osteomyelitis of the Mandible
Authors: Noguchi Tadahide , Okada Naruo , Tsuchiya Yoshiyuki , Sarukawa Shunji , Fujita Akifumi , Nishino Hiroshi , Jinbu Yoshinori , Mori Yoshiyuki
Published: September 2017

In this clinical report, we present the management of a brain abscess that was presumed to be caused by radiation osteomyelitis of the mandible. The patient underwent chemoradiotherapy for oropharyngeal carcinoma on the left side at the Department of Otolaryngology of our hospital in 2000. Local recurrence or metastasis did not occur post-treatment. In January 2009, the patient was diagnosed with radiation osteomyelitis of the mandible on the left side, complicated by a pathologic fracture. In July 2011, numbness occurred in the left upper extremity and the patient was transferred to the emergency center of our hospital. A computed tomography scan showed a tumor lesion in the brain that was diagnosed as a brain abscess by magnetic resonance imaging. Neurosurgeons performed burr hole drainage of the abscess, followed by administration of antibiotics. Although impaired fine movements of the left hand remain, progress has been relatively favorable with no recurrence of osteomyelitis or brain abscess post-surgery.
Fracture Healing and the Underexposed Role of Extracellular Vesicle-Based Cross Talk
Authors: Qiao Zhi , Greven Johannes , Horst Klemens , Pfeifer Roman , Kobbe Philipp , Pape Hans-Christoph , Hildebrand Frank
Published: September 2017

The process of fracture healing is complex and requires an interaction of multiple organ systems. Cell–cell communication is known to be very important during this process. Extracellular vesicles (EVs) are small membranous vesicles generated from a variety of cells. Proteins, RNAs, small molecules, and mitochondria DNA were found to be transported among cells through EVs. EV-based cross talk represents a substantial cell–cell communication pattern that can both interact with cells through molecular surfaces and transfer molecules to cells. These interactions can assist in the synchronization of cellular functions among cells of the same kind, and coordinate the functions of different types of cells. After activation, platelets, neutrophils, macrophages, osteoblasts, osteoclasts, and mesenchymal stem cell (‘) all secrete EVs, promoting the fracture healing process. Moreover, some studies have found evidence that EVs may be used for diagnosis and treatment of delayed fracture healing, and may be significantly involved in the pathophysiology of fracture healing disturbances. In this review, we summarize recent findings on EVs released by fracture healing-related cells, and EV-mediated communications during fracture healing. We also highlight the potential applications of EVs in fracture healing. Lastly, the prospect of EVs for research and clinical use is discussed.
HDAC3 Mediates Cardioprotection of Remifentanil Postconditioning by Targeting GSK-3β in H9c2 Cardiomyocytes in Hypoxia/Reoxygenation Injury
Authors: Chen Manli , Liu Qin , Chen Lijian , Zhang Lei , Cheng Xinqi , Gu Erwei
Published: September 2017

Background:

Remifentanil postconditioning (RPC) confers robust cardioprotection against ischemia/reperfusion (I/R) injury. We recently determined that HDAC3 was involved in RPC-induced cardioprotection. However, the role of HDAC3 and its possible mechanisms in RPC-induced cardioprotection are unknown, which we aimed to evaluate in an in vitro hypoxia/reoxygenation (HR) model.

Methods:

Myocardium I/R injury was established after HR with H9c2 cardiomyoblasts. Cell viability and apoptosis were evaluated usingCCK-8 and flow cytometry of HR-injured cardiomyoblasts treated with or without RPC. Furthermore, effects of RPC on HDAC3 protein and mRNA expression were evaluated with Western blot and quantitative real-time PCR analyses, whereas GSK-3β expression was measured with Western blot.

Results:

RPC increased cell viability and reduced cell apoptosis (P < 0.05) in H9c2 cardiomyoblasts subjected to HR injury. In addition, RPC promoted the phosphorylation of GSK-3β at Ser9 site (P < 0.05) and suppressed the protein and mRNA expression of HDAC3 (P < 0.05). Lentiviral-transduced overexpression of HDAC3 had no significant effects on HR injury while attenuating the cardioprotective effects of RPC on cell viability and apoptosis (P < 0.05), GSK-3β phosphorylation (P < 0.05) in H9c2 cardiomyoblasts.

Conclusions:

RPC attenuates apoptosis in H9c2 cardiomyoblasts after HR injury by downregulating HDAC3-mediated phosphorylation of GSK-3β. Our findings suggest that HDAC3, and its cross talk function with GSK-3β, may be a promising target for myocardium I/R injury.
Development of a high-throughput bead based assay system to measure HIV-1 specific immune signatures in clinical samples
Authors: Liechti Thomas , Kadelka Claus , Ebner Hanna , Friedrich Nikolas , Kouyos Roger D. , Günthard Huldrych F. , Trkola Alexandra
Published: September 2017

The monitoring and assessment of a broadly neutralizing antibody (bnAb) based HIV-1 vaccine require detailed measurements of HIV-1 binding antibody responses to support the detection of correlates of protection. Here we describe the development of a flexible, high-throughput microsphere based multiplex assay system that allows monitoring complex binding antibody signatures. Studying a panel of 13 HIV-1 antigens in a parallel assessment of different IgG subclasses (IgG1, IgG2 and IgG3) we demonstrate the potential of our strategy. The technical advances we describe include means to improve antigen reactivity using directed neutravidin-biotin immobilization of antigens and biotin saturation to reduce background. A particular emphasis of our study was to provide tools for the assessment of reproducibility and stability of the assay system and strategies to control for variations allowing the application in high-throughput assays, where reliability of single measurements needs to be guaranteed.
Odonata diversity of the eastern region of Bangladesh with four new addition to the Bangladeshi dragonfly fauna
Authors: Khan Md Kawsar
Published: September 2017

A study was conducted in the eastern region to contribute to the Odonata fauna of Bangladesh. A total of 76 species belonging to 9 families have been recorded during the study period of April 2014 to July 2016. Three Zygopteran species e.g,Ceriagrion rubiae,Calicnemia imitans,Prodasineura autumnalisand one Anisopteran species e.g,Megalogomphus smithiihave been newly discovered from Bangladesh.Megalogomphusgenus have been first time recorded from Bangladesh.
Investigations of the phase relations amonge1,e2 andC{\bar {\bf 1}} structures of Na-rich plagioclase feldspars: a single-crystal X-ray diffraction study
Authors: Jin Shiyun , Xu Huifang
Published: September 2017

The subsolidus phase relations of plagioclase feldspar solid solution have been puzzling mineralogists and petrologists for decades, mainly due to the complicated structures of intermediate plagioclase at low temperature. The crystal structures of 12 Na-rich plagioclase samples are investigated by single-crystal X-ray diffraction analyses. The samples studied cover a compositional range from An21to An49(An is anorthite, CaAl2Si2O8), as well as a wide variety of origins, from extremely slow-cooled gabbroic rocks to pegmatite and metamorphic rocks. The structures fall into three different types:C{\bar 1},e2 ande1, with an obviously increasing trend in the ordering states of the structures. The phase transitions from C{\bar 1} toe2 ande2 toe1 are both continuous in nature, as no abrupt structure change is required for the transformation. However, the structural difference betweenC\bar 1 ande1 is large enough to create a miscibility gap causing the Bøggild intergrowth. As the plagioclase structure becomes more and more ordered, Al–Si reorganization in the framework would occur before the ordering of Ca and Na inMsites. Dramatic variations of Na occupancy would only appear ine1 structure with density modulation. This result confirms that Al–Si ordering is the major driving force of the formation ofe-plagioclase structure. The composition of the lower end of the Bøggild intergrowth is precisely constrained to An44–An45, based on the structural differences between two samples from the same pegmatite crystal. The modulation periods and directions ofe-plagioclase are dependent on the conditions at whiche-ordering starts to happen, other than the composition of the plagioclase. However, the three components (δh, δkand δl) of theqvector show strong linear correlations among one another, indicating some crystallographic constraint on the modulation direction which might be independent from the composition. The detailed subsolidus phase relations amonge1,e2 and C{\bar 1} are illustrated with a local phase diagram, and schematic free energy curves at different temperatures are provided.
Unexpected beauty and diversity in the structures of three homologous 4,5-dialkoxy-1-ethynyl-2-nitrobenzenes: the subtle interplay between intermolecular C—H...O hydrogen bonds and alkyl chain length
Authors: Oburn Shalisa M. , Bosch Eric
Published: September 2017

The synthesis, 1H and 13C NMR spectra, and X-ray structures are described for three dialkoxy ethynylnitrobenzenes that differ only in the length of the alkoxy chain, namely 1-ethynyl-2-nitro-4,5-dipropoxybenzene, C14H17NO4, 1,2-dibutoxy-4-ethynyl-5-nitrobenzene, C16H21NO4, and 1-ethynyl-2-nitro-4,5-dipentoxybenzene, C18H25NO4. Despite the subtle changes in molecular structure, the crystal structures of the three compounds display great diversity. Thus, 1-ethynyl-2-nitro-4,5-dipropoxybenzene crystallizes in the trigonal crystal system in the space group R{\overline 3}, with Z = 18, 1,2-dibutoxy-4-ethynyl-5-nitrobenzene crystallizes in the monoclinic crystal system in the space group P21/c, with Z = 4, and 1-ethynyl-2-nitro-4,5-dipentoxybenzene crystallizes in the triclinic crystal system in the space group P{\overline 1}, with Z = 2. The crystal structure of 1-ethynyl-2-nitro-4,5-dipropoxybenzene is dominated by planar hexamers formed by a bifurcated alkoxy sp-C—H...O,O′ interaction, while the structure of the dibutoxy analogue is dominated by planar ribbons of molecules linked by a similar bifurcated alkoxy sp-C—H...O,O′ interaction. In contrast, the dipentoxy analogue forms ribbons of molecules alternately connected by a self-complementary sp-C—H...O2N interaction and a self-complementary sp
2-C—H...O2N interaction. Disordered solvent was included in the crystals of 1-ethynyl-2-nitro-4,5-dipropoxybenzene and its contribution was removed during refinement.
(E)-7-[(4-Nitrophenyl)diazenyl]-3a-(p-tolyl)-2,3,3a,4-tetrahydro-1H-benzo[d]pyrrolo[1,2-a]imidazol-1-one 0.58-dimethyl sulfoxide 0.42-acetonitrile solvate: crystal structure, Hirshfeld analysis and DFT estimation of the energy of intermolecular interactions
Authors: Grinev Vyacheslav S. , Babkina Natalya V. , Yegorova Alevtina Yu.
Published: September 2017

In the crystal structure of the title compound, C23H19N5O3·0.58C2H6OS·0.42C2H3N, prepared by the azo coupling of the 4-nitrophenyldiazonium salt with 3a-(p-tolyl)-2,3,3a,4-tetrahydro-1H-benzo[d]pyrrolo[1,2-a]imidazol-1-one, the azo molecules are linked by N—H...O hydrogen bonds into chains along thea-axis direction, and by the π–π interaction into [101] chains. The dimethyl sulfoxide and acetonitrile solvent molecules occupy the same positions, with populations of 0.585 (3) and 0.415 (3), respectively. These molecules take part in C—H...O(N) and C—H...π contacts. The energy of the π–π interactions was estimated using DFT calculations. The Hirshfeld molecular surface analysis revealed the positions of the most important intermolecular contacts, such as hydrogen bonds and π–π interactions.
Crystal structure and identification of resonance forms of diethyl 2-(3-oxoiso-1,3-dihydrobenzofuran-1-ylidene)malonate
Authors: Tyumentsev Mikhail S. , Foreman Mark R. StJ. , Steenari Britt-Marie , Slawin Alexandra M. Z.
Published: September 2017

The reaction of diethyl malonate with phthaloyl chloride in acetonitrile in the presence of triethylamine and magnesium chloride results in the formation of the title compound, diethyl 2-(3-oxo-1,3-dihydro-2-benzofuran-1-ylidene)propanedioate, C15H14O6. One of the ester groups of the diethyl malonate fragment is almost coplanar with the isobenzofuran unit, while the plane of the other group is perpendicular to it [dihedral angles = 5.45 (3) and 83.30 (3)°, respectively]. The C—C and C—O distances both in the heterocyclic furan ring and the diethyl malonate fragment are indicative of the dipolar delocalization occurring within the isobenzofuran unit. This delocalization is likely to be responsible for the unusual intermolecular O...O contact [2.756 (2) Å], established between the O atom of the furan ring and the carbonyl O atom of the diethyl malonate fragment. In the crystal, weak C—H...O interactions are observed, which link the molecules into [100] chains.
Bis(flavonolato-κ2O,O′)dioxidoosmium(VI) dichloromethane disolvate
Authors: Lynch Will , Padgett Clifford
Published: September 2017

In the crystal structure of the title solvatedtrans-dioxidoosmium(VI) flavonolate (flav) complex, [Os(C15H9O3)2O2]·2CH2Cl2or [Os(flav)2O2]·2CH2Cl2, the two dichloromethane solvent molecules have nonclassical hydrogen-bonding contacts at or greater than 3.18 Å. The pseudo-octahedrally coordinated central metal cation is observed with all donor atoms being oxygen. The Os=O bond lengths are 1.721 (5) and 1.728 (5) Å, with a 170.4 (2)° bond angle. The O—Os bond lengths arising from the flanvonolate ligand are observed to all be slightly over 2.0 Å. The chelate bond angles arising from the flavonolate O atoms with the osmium cation are constrained by the ligand at 80.72 (18) and 80.92 (17)°.
Household income inequality in Ghana: a decomposition analysis
Authors: Novignon Jacob
Published: September 2017

Purpose

The purpose of this paper is to decompose income inequality across various household income components and to estimate the marginal effects of changes in each of the income components on overall income inequality in Ghana.

Design/methodology/approach

Data were collected from the fifth and sixth rounds of the Ghana Living Standards Surveys. Gini coefficient was estimated and decomposed across structured income components. The marginal effects were obtained by computing the partial derivatives of the Gini coefficient with respect to a percentage change in a particular income source.

Findings

The results suggest that, in general, income inequality has increased marginally over the years (Gini coefficient of 0.66 in 2013 and 0.62 in 2006). Inequality was, however, higher in urban areas than in rural areas in 2013 with the reverse observed in 2006. The income component decomposition analysis suggests that wage employment income dominated household income in both rural and urban areas, even though the magnitude was higher in urban areas. Farm income was only dominant in rural communities in 2006. Self-employment and remittance income had consistent inequality reducing effects on total household income distribution.

Originality/value

The study goes beyond inequality studies in Ghana to estimate the marginal effect of income components on inequality. Such decomposition will allow for effective policy targeting in a resource-constrained developing country like Ghana.