bluuebunny/crossref_metadata_2025 huggingface dataset:
ARD-Serie „Charité“: Alle dabei: Koch, Virchow, Ehrlich, Behring
Authors: Gaede Kirsten
Published: March 2017

„Dr. House“, „Emergency Room“, „Herzflimmern – die Klinik am See“, „In aller Freundschaft“, „Dr. Klein“ – gibt es allmählich nicht genügend Klinikserien? Das Besondere an der neuen Serie „Charitè“: Sie spielt vor historischem Hintergrund und versammelt die klassischen Medizinergrößen.
Quo vadis Kooperation?
Authors: Rybak Christian
Published: March 2017

Sozialversicherungsträger sehen bei Leistungen von Vertragsärzten zunehmend eine Versicherungspflicht. Das gefährdet die Kooperation unter Ärzten.
GKV-Kliniksimulator: Kritik eines Mathematikers
Authors: Englisch Harald
Published: March 2017

Seit September steht der GKV-Kliniksimulator online und bringt viele Klinikmanager noch immer in Rage. Doch es gibt auch Kritiker unter jenen, die weniger betroffen sind – wie Harald Englisch, der die Sache als Medizininformatiker nüchtern-rechnerisch angeht.
Branche in Zahlen
Authors: Mewis Dirk
Published: March 2017

Dieser Artikel ist nur als PDF-Dokument verfügbar.
Generalistik-Diskussion: „Altenpflege ist oft attraktiver als Krankenpflege“
Authors: Gaede Kirsten
Published: March 2017

Das Pflegeberufegesetz wird in dieser Legislaturperiode wohl nicht mehr verabschiedet. Zu zahlreich sind die Kritiker. Sie stammen vor allem aus der Altenpflege. So wird leicht vergessen, dass es dort auch Befürworter gibt – zum Beispiel Alexander Künzel, Chef der Bremer Heimstiftung.
Korallia Afxentiou: Geschlossene Gesellschaft
Authors: Sickinger Nina
Published: March 2017

AUSLÄNDISCHE MITARBEITER BERICHTEN AUS DEUTSCHEN KLINIKEN Korallia Afxentiou (26) ist seit 2007 in Deutschland. Die junge Zypriotin aus dem griechischen Teil der geteilten Insel arbeitet derzeit als Assistenzärztin in der Klinik für Pneumologie an der Lungenklinik Heckeshorn, die seit 2004 Teil der Helios Klinik Emil von Behring in Berlin-Zehlendorf ist.
Tubocutaneous Fistula due to Endometriosis – A Differential Diagnosis in Cutaneous Fistulas with Cyclic Secretion
Authors: Lopes Edinari Nunes de Sousa , Damásio Lia Cruz Vaz da Costa , Passos Laio Santana
Published: March 2017

The development of a tubocutaneous fistula due to endometriosis in a post-cesarean section surgical scar is a rare complication that generates significant morbidity in the affected women. Surgery is the treatment of choice in these cases. Hormonal therapies may lead to an improvement in symptoms, but do not eradicate such lesions. In this report, we present a 34-year-old patient with a cutaneous fistula in the left iliac fossa with cyclic secretion. Anamnesis, a physical examination, and supplementary tests led us to suggest endometriosis as the main diagnosis, which was confirmed after surgical intervention.
Validation of a Prediction Model for Vaginal Birth after Cesarean Delivery Reveals Unexpected Success in a Diverse American Population
Authors: Maykin Melanie , Mularz Amanda , Lee Lydia , Valderramos Stephanie
Published: March 2017

Objective To investigate the validity of a prediction model for success of vaginal birth after cesarean delivery (VBAC) in an ethnically diverse population.

Methods We performed a retrospective cohort study of women admitted at a single academic institution for a trial of labor after cesarean from May 2007 to January 2015. Individual predicted success rates were calculated using the Maternal–Fetal Medicine Units Network prediction model. Participants were stratified into three probability-of-success groups: low (<35%), moderate (35–65%), and high (>65%). The actual versus predicted success rates were compared.

Results In total, 568 women met inclusion criteria. Successful VBAC occurred in 402 (71%), compared with a predicted success rate of 66% (p = 0.016). Actual VBAC success rates were higher than predicted by the model in the low (57 vs. 29%; p < 0.001) and moderate (61 vs. 52%; p = 0.003) groups. In the high probability group, the observed and predicted VBAC rates were the same (79%).

Conclusion When the predicted success rate was above 65%, the model was highly accurate. In contrast, for women with predicted success rates <35%, actual VBAC rates were nearly twofold higher in our population, suggesting that they should not be discouraged by a low prediction score.
Polymer-based transistors bring fully stretchable devices within reach
Authors: Smart Ashley G.
Published: March 2017

Researchers harnessed nanoconfinement effects to achieve elasticity and efficient charge transport in a semiconducting material.
Electron diffraction sees hydrogen atoms
Authors: Miller Johanna L.
Published: March 2017

The detection of the small, light atoms heralds the emergence of the technique as a powerful crystallographic tool.
Climate-data rescue efforts gear up
Authors: Feder Toni
Published: March 2017

Data disappearing is far from the only thing researchers are worried about under the Trump administration, but it’s one they can do something about.
The laws of life
Authors: Cockell Charles S.
Published: March 2017

Notwithstanding the awe-inspiring diversity of living creatures, the forms and processes of life are limited by universal principles that act at large and small scales.
Health service planning and sustainable development: considering what, where and how care is delivered through a pro-environmental lens
Authors: Desmond Sharon
Published: March 2017

The aim of the present paper was to review the opportunities currently available to health service planners to advance sustainable development in their future-facing roles within health service organisation. Critical challenges and enablers to facilitate health services planners in adopting a pro-environmental lens are discussed. What is known about the topic? Despite its harmful effect on the environment, health has been slower than other industries to embrace the sustainable development agenda. The attitudes and knowledge base of health service planners with regard to environmental sustainability has not been widely studied. For health service planners, embracing pro-environmental considerations in sustainable model of care development is a powerful opportunity to review care paradigms and prepare for the implementation of meaningful, improved health and system efficiency. What does this paper add? This paper advances the case for health service planners to embrace a pro-environmental stance and guides health service leaders in the preparation and implementation of sustainable and improved health and system efficiency. What are the implications for practitioners? Health service planers are in an ideal position to champion the sustainable development agenda as they explore what care is delivered, how care is delivered and where care is delivered. External policy, health service leadership and carbon literacy are advanced as critical contextual factors to facilitate the key role that health service planners can play in building sustainable healthcare organisations.
Castration methods in crossbred cattle raised on tropical pasture
Authors: Moreira Aline D. , Siqueira Gustavo R. , Lage Josiane F. , Benatti João Marcos B. , Moretti Matheus H. , Miguel Giulianna Z. , de Oliveira Ivanna M. , de Resende Flávio D.
Published: March 2017

The aim of this study was to evaluate the effects of castration methods (surgical or immunological – GnRH vaccine) on performance and carcass traits of beef cattle raised until slaughter on tropical pasture. On Day 0, 30 crossbred beef bulls (50% Aberdeen Angus × 50% Nellore) with a bodyweight (BW) of 233 ± 38 kg and age of 8 months were randomly divided into three groups: intact males (INT) – Control, surgically castrated (SUC; Day 1), and immunocastrated (IMC; Days 1, 84 and 237). Serum testosterone concentrations, scrotal circumference, average daily gain, and ultrasonic backfat depth were evaluated at 42-day intervals (eight evaluations). All animals were slaughtered for the evaluation of carcass traits on Day 336. The GnRH vaccine was efficient in suppressing serum testosterone concentrations (P = 0.02) and scrotal circumference (P < 0.01). No difference in performance was observed between IMC and SUC animals, in which average daily gain was reduced by 14% (P < 0.01) and final BW by 7% (P < 0.01) compared with the INT group. Regardless of the method used, castration improved carcass traits by reducing carcass drip loss during cooling (P = 0.02), by increasing hindquarter percentage (P < 0.01), and by tending to increase the proportion of noble cuts (P = 0.05) compared with the INT group. However, the surgical method was more efficient than the other treatments by increasing fat deposition in the carcass (P < 0.01). Anti-GnRH immunisation in beef cattle raised on tropical pasture can replace surgical castration, but both methods reduce performance. However, in this production system, castration could be an efficient method to add value to the carcass by increasing the hindquarter proportion and fat deposition.
Changes in abundance and reproductive activity of small arid-zone murid rodents on an active cattle station in central Australia
Authors: Breed W. G. , Leigh C. M. , Breed M. F.
Published: March 2017

Context Boom and bust population cycles are characteristic of many arid-zone rodents, but it is unknown to what extent these dynamics might be influenced by the presence of invasive rodents, such as the house mouse (Mus musculus) in Australia. Aim To determine whether the presence of M. musculus can have negative consequences on the population abundance and reproduction of two old Australian endemic rodents (the spinifex hopping mouse, Notomys alexis, and sandy inland mouse, Pseudomys hermannsburgensis). Methods The study took place on the sand dunes of a cattle station in central Australia. Population abundance was estimated as the number of individuals caught in small mammal traps, and female reproductive condition by external examination and, in a few cases, euthanasia and inspection of the reproductive tract. Key results Two synchronous periods of high abundance of N. alexis and M. musculus occurred several months after significant rainfall events, whereas the abundance of P. hermannsburgensis was consistently low. No reproduction took place in N. alexis or M. musculus when populations had reached high abundance. During low-rainfall periods, M. musculus was not detected on the sand dunes, and the two endemic species were sparsely distributed, with reproduction occasionally being evident. Conclusions During dry periods, M. musculus contracted back to refuges around the homestead and, after significant rainfall, it expanded onto the sand dunes and became abundant at the same time as did N. alexis. In contrast, and unlike in areas where M. musculus was generally rare, P. hermannsburgensis always remained at a low abundance. These patterns suggest that in areas of the natural environment close to human-modified sites, populations of at least one species of an old endemic rodent are supressed by the presence of M. musculus. Reproduction did not occur in the old endemics at times of high M. musculus abundance, but did take place in spring/early summer, even in some dry years. Implications The spread of M. musculus into the Australian arid zone may have had negative impacts on the population dynamics of P. hermannsburgensis. These findings suggest that the presence of human settlements has resulted in refuges for house mice, which periodically spread out into the natural environment during ‘boom’ times and adversely affect the natural population cycle of ecologically similar species such as P. hermannsburgensis.
Monoubiquitylation of histone H2B contributes to the bypass of DNA damage during and after DNA replication
Authors: Hung Shih-Hsun , Wong Ronald P. , Ulrich Helle D. , Kao Cheng-Fu
Published: March 2017

Significance

DNA damage-bypass mechanisms that facilitate the resolution of replication blocks in proliferating cells during and after S phase are important for the defense against damage-induced mutations, genome instability, and cancer. Lesion bypass, mediated either by the ubiquitylation of the replication factor proliferating cell nuclear antigen or by homologous recombination, takes place in the context of chromatin. However, the implications of nucleosome dynamics and chromosome packaging in the efficiency of replication-associated damage processing are still largely unknown. Our physical, genetic, and cytological studies suggest that ubiquitylation of histone H2B facilitates the replicative bypass of fork-stalling DNA lesions by contributing to both DNA damage tolerance and homologous recombination during and after replication, thus revealing a direct link between chromatin architecture and lesion bypass.
Synaptic vesicle glycoprotein 2C (SV2C) modulates dopamine release and is disrupted in Parkinson disease
Authors: Dunn Amy R. , Stout Kristen A. , Ozawa Minagi , Lohr Kelly M. , Hoffman Carlie A. , Bernstein Alison I. , Li Yingjie , Wang Minzheng , Sgobio Carmelo , Sastry Namratha , Cai Huaibin , Caudle W. Michael , Miller Gary W.
Published: March 2017

Significance

Here we describe a role for the synaptic vesicle glycoprotein 2C (SV2C) in dopamine neurotransmission and Parkinson disease (PD). SV2C is expressed on the vesicles of dopamine-producing neurons, and genetic deletion of SV2C causes a reduction in synaptic release of dopamine. The reduced dopamine release is associated with a decrease in motor activity. SV2C is suspected of mediating the neuroprotective effects of nicotine, and we show an ablated neurochemical response to nicotine in SV2C-knockout mice. Last, we demonstrate that SV2C expression is specifically disrupted in mice that express mutated α-synuclein and in humans with PD. Together, these data establish SV2C as an important mediator of dopamine homeostasis and a potential contributor to PD pathogenesis.
The pattern of spatial flood disaster region in DKI Jakarta
Authors: Tambunan M P
Published: March 2017

The study of disaster flood area was conducted in DKI Jakarta Province, Indonesia. The aim of this research is: to study the spatial distribution of potential and actual of flood area The flood was studied from the geographic point of view using spatial approach, while the study of the location, the distribution, the depth and the duration of flooding was conducted using geomorphologic approach and emphasize on the detailed landform unit as analysis unit. In this study the landforms in DKI Jakarta have been a diversity, as well as spatial and temporal pattern of the actual and potential flood area. Landform at DKI Jakarta has been largely used as built up area for settlement and it facilities, thus affecting the distribution pattern of flooding area. The collection of the physical condition of landform in DKI Jakarta data prone were conducted through interpretation of the topographic map / RBI map and geological map. The flood data were obtained by survey and secondary data from Kimpraswil (Public Work) of DKI Jakarta Province for 3 years (1996, 2002, and 2007). Data of rainfall were obtained from BMKG and land use data were obtained from BPN DKI Jakarta. The analysis of the causal factors and distribution of flooding was made spatially and temporally using geographic information system. This study used survey method with a pragmatic approach. In this study landform as result from the analytical survey was settlement land use as result the synthetic survey. The primary data consist of landform, and the flood characteristic obtained by survey. The samples were using purposive sampling. Landform map was composed by relief, structure and material stone, and process data Landform map was overlay with flood map the flood prone area in DKI Jakarta Province in scale 1:50,000 to show. Descriptive analysis was used the spatial distribute of the flood prone area. The result of the study show that actual of flood prone area in the north, west and east of Jakarta lowland both in beach ridge, coastal alluvial plain, and alluvial plain; while the flood potential area on the slope is found flat and steep at alluvial fan, alluvial plain, beach ridge, and coastal alluvial plain in DKI Jakarta. Based on the result can be concluded that actual flood prone is not distributed on potential flood prone
Conformity assessment of the measurement accuracy in testing laboratories using a software application*
Authors: Diniţă A
Published: March 2017

This article presents a method for assessing the accuracy of the measurements obtained at different tests conducted in laboratories by implementing the interlaboratory comparison method (organization, performance and evaluation of measurements of tests on the same or similar items by two or more laboratories under predetermined conditions). The program (independent software application), realised by the author and described in this paper, analyses the measurement accuracy and performance of testing laboratory by comparing the results obtained from different tests, using the modify Youden diagram, helping identify different types of errors that can occur in measurement, according to ISO 13528:2015, Statistical methods for use in proficiency testing by interlaboratory comparison. A case study is presented in the article by determining the chemical composition of identical samples from five different laboratories. The Youden diagram obtained from this study case was used to identify errors in the laboratory testing equipment.
Race, Immigration, Ethnicity, and Religion in America
Authors: Jeung Russell , Calvillo Jonathan
Published: March 2017

In 2010, immigrants represented 13 percent of the United States population, and almost one in four American children lived at home with an immigrant parent. Over half of the population growth in the United States from 2000 to 2010 was due to the increase of Hispanics, and currently, the highest number of immigrants come from Asian nations. This influx of immigrants has not only increased the percentage of people of color in the United States, at 28 percent, but has also dramatically altered the religious landscape of the country. The decline in the number of American Christians signals this shift, as does the growth of the religiously non-affiliated, Hindus, and Muslims. In the past century, sociologists have accounted for religious change by employing theories of secularization, assimilation, and modernization.

For more recent religious change in regard to ethnicity and race, however, four processes are more salient: (1) the religious marketplace, (2) globalization, (3) multicultural discourse production, and (4) racialization. The religious marketplace continues to cater to spiritual consumers who have become increasingly diversified with the influx of new immigrants and the rise of “spiritual but not religious individuals.” The United States has thus remained a religiously vital context, with a strong supply of religious groupings. Globalization has spurred more transnational religious networks, which have increased the flow of religious personnel, ideas, and organizations across borders. New immigrants, furthermore, enter an American host society that is segmented economically. Consequently, ethnic groups do adapt to their neighborhoods, but in different contexts and in dissimilar manners. With the increase in multicultural discourse, ethnic groups may choose to retain their ethnicity and religious heritages for symbolic pride. Finally, race, as a central organizing concept in the United States, is a basis by which religious groups mobilize for spiritual interests. As religious groups become racialized, such as how Islamophobia targets persons with similar physical features, they respond with reactive solidarity.
An Assessment of the Accuracy of Home Blood Pressure Monitors When Used in Device Owners
Authors: Ringrose Jennifer S. , Polley Gina , McLean Donna , Thompson Ann , Morales Fraulein , Padwal Raj
Published: March 2017

OBJECTIVE

To examine the accuracy of home blood pressure (BP) devices, on their owners, compared to auscultatory reference standard BP measurements.

METHODS

Eighty-five consecutive consenting subjects ≥18 years of age, who owned an oscillometric home BP device (wrist or upper-arm device), with BP levels between 80–220/50–120 mm Hg, and with arm circumferences between 25–43 cm were studied. Pregnancy and atrial fibrillation were exclusion criteria. Device measurements from each subject’s home BP device were compared to simultaneous 2-observer auscultation using a mercury sphygmomanometer. Between-group mean comparisons were conducted using paired t-tests. The proportion of patients with device-to-auscultatory differences of ≥5, 10, and 15 mm Hg were tabulated and predictors of systolic and diastolic BP differences were identified using linear regression.

RESULTS

Mean age was 66.4 ± 11.0 years, mean arm circumference was 32.7 ± 3.7 cm, 54% were female and 78% had hypertension. Mean BPs were 125.7 ± 14.0/73.9 ± 10.4 mm Hg for home BP devices vs. 129.0 ± 14.7/72.9 ± 9.3 for auscultation (difference of −3.3 ± 7.3/0.9 ± 6.1; P values <0.0001 for systolic and 0.17 for diastolic). The proportion of devices with systolic or diastolic BP differences from auscultation of ≥5, 10, and 15 mm Hg was 69%, 29%, and 7%, respectively. Increasing arm circumference was a statistically significant predictor of higher systolic (parameter estimate 0.61 per cm increase; P value 0.004) and diastolic (0.38; 0.03) BP.

CONCLUSIONS

Although mean differences from 2-observer auscultation were acceptable, when tested on their owners, most home BP devices were not accurate to within 5 mm Hg. Ensuring acceptable accuracy of the device-owner pairing should be prioritized.
MaBoSS 2.0: an environment for stochastic Boolean modeling
Authors: Stoll Gautier , Caron Barthélémy , Viara Eric , Dugourd Aurélien , Zinovyev Andrei , Naldi Aurélien , Kroemer Guido , Barillot Emmanuel , Calzone Laurence
Published: March 2017

Motivation

Modeling of signaling pathways is an important step towards the understanding and the treatment of diseases such as cancers, HIV or auto-immune diseases. MaBoSS is a software that allows to simulate populations of cells and to model stochastically the intracellular mechanisms that are deregulated in diseases. MaBoSS provides an output of a Boolean model in the form of time-dependent probabilities, for all biological entities (genes, proteins, phenotypes, etc.) of the model.

Results

We present a new version of MaBoSS (2.0), including an updated version of the core software and an environment. With this environment, the needs for modeling signaling pathways are facilitated, including model construction, visualization, simulations of mutations, drug treatments and sensitivity analyses. It offers a framework for automated production of theoretical predictions.

Availability and Implementation

MaBoSS software can be found at https://maboss.curie.fr, including tutorials on existing models and examples of models.

Supplementary information

Supplementary data are available at Bioinformatics online.
Effect of breathing oxygen-enriched air on exercise performance in patients with precapillary pulmonary hypertension: randomized, sham-controlled cross-over trial
Authors: Ulrich Silvia , Hasler Elisabeth D. , Saxer Stéphanie , Furian Michael , Müller-Mottet Séverine , Keusch Stephan , Bloch Konrad E.
Published: March 2017

Aims

The purpose of the current trial was to test the hypothesis that breathing oxygen-enriched air increases exercise performance of patients with pulmonary arterial or chronic thrombo-embolic pulmonary hypertension (PAH/CTEPH) and to investigate involved mechanisms.

Methods and results

Twenty-two patients with PAH/CTEPH, eight women, means ± SD 61 ± 14 years, resting mPAP 35 ± 9mmHg, PaO2 ambient air >7.3 kPa, underwent four bicycle ergospirometries to exhaustion on different days, while breathing oxygen-enriched (FiO2 0.50, hyperoxia) or ambient air (FiO2 0.21, normoxia) using progressively increased or constant load protocols (with 75% maximal work rate under FiO2 0.21), according to a randomized, sham-controlled, single-blind, cross-over design. ECG, pulmonary gas-exchange, arterial blood gases, cerebral and quadriceps muscle tissue oxygenation (CTO and QMTO) by near-infrared spectroscopy were measured. In ramp exercise, maximal work rate increased from 113 ± 38 W with normoxia to 132 ± 48 W with hyperoxia, mean difference 19.7 (95% CI 10.5–28.9) W, P < 0.001. Constant load exercise endurance increased from 571 ± 443 to 1242 ± 514 s, mean difference 671 (95% CI 392–951) s, P < 0.001. At end-exercise with hyperoxia PaO2, CTO, QMTO, and PaCO2 were increased, and ventilatory equivalents for CO2 were reduced while the physiological dead space/tidal volume ratio remained unchanged.

Conclusion

In patients with PAH/CTEPH, breathing oxygen-enriched air provides major increases in exercise performance. This is related to an improved arterial oxygenation that promotes oxygen availability in muscles and brain and to a reduction of the excessive ventilatory response to exercise thereby enhancing ventilatory efficiency. Patients with PAH/CTEPH may therefore benefit from oxygen therapy during daily physical activities and training.

Trial registration

clinicaltrials.gov Identifier: NCT01748474.
The Leadership Case for Investing in Continuing Professional Development
Authors: McMahon Graham T.
Published: March 2017

Continuing medical education (CME) has the power and capacity to address many challenges in the health care environment, from clinician well-being to national imperatives for better health, better care, and lower cost. Health care leaders who recognize the strategic value of education and engage their people in education can expect a meaningful return on their investment—not only in terms of the quality and safety of their clinicians’ work but also in the spirit and cohesiveness of the clinicians who work at their institution. To optimize the benefits of education, clinical leaders need to think of accredited CME as the professional development vehicle that can help them drive change and achieve goals, in consort with quality improvement efforts, patient safety projects, and other systems changes. An empowered CME program, with its multiprofessional scope and educational expertise, can contribute to initiatives focused on both clinical and nonclinical areas, such as quality and safety, professionalism, team communication, and process improvements. In this Invited Commentary, the author describes principles and action steps for aligning leadership and educational strategy and urges institutional leaders to embrace the continuing professional development of their human capital as an organizational responsibility and opportunity and to view engagement in education as an investment in people.
Humerus Lengthening With the PRECICE Internal Lengthening Nail
Authors: Kurtz Anton M. , Rozbruch S. Robert
Published: March 2017

Background:

Deformity and growth arrest of the humerus in children may result as sequelae of proximal humerus fractures and unicameral bone cysts, or as complications of their treatment. As approximately 80% of the growth of the humerus arises from the proximal physis, the resultant upper limb-length discrepancy can be substantial. Benefits to lengthening the shortened arm have been previously demonstrated with the use of external fixation devices. To our knowledge, no reports have been published on the use of intramedullary implants for this purpose.

Methods:

A 15-year-old girl with humeral shortening secondary to proximal humeral growth disturbance following treatment for a unicameral bone cyst was treated with humeral osteoplasty and gradual lengthening with an off-label use of a fully implantable motorized intramedullary lengthening nail. A varus proximal humeral deformity and lateral starting point allowed for avoidance of the rotator cuff insertion.

Results:

Humeral lengthening (5 cm) was achieved at 9 weeks, with bony union at 7 months, and hardware removal at 9½ months. Shoulder and elbow motion was maintained during and after treatment.

Conclusions:

This is the first case report of humeral lengthening using a fully implantable motorized intramedullary lengthening nail. Although some technical limitations remain when compared with other methods, the procedure was well tolerated throughout the course of treatment.

Level of Evidence:

Level IV—case report.
Can a Novel, Low-Cost Simulation Model be Used to Teach Anterior Cruciate Ligament Graft Preparation?
Authors: Brusalis Christopher M. , Lawrence John Todd R. , Ranade Sheena C. , Kerr Joy C. , Pulos Nicholas , Wells Lawrence , Ganley Theodore J.
Published: March 2017

Background:

This study evaluated an anterior cruciate ligament (ACL) graft preparation simulation learning model for use by orthopaedic surgery trainees.

Methods:

A simulation model for ACL graft preparation was constructed using shoelace as graft material and a wooden graft preparation board that matched the dimensions of existing products. A 12-minute instructional video targeted at novice learners was created to accompany the simulation model. A prospective randomized controlled trial was conducted on orthopaedic surgery residents divided into 2 groups with equal distributions of postgraduate year (PGY) status. The intervention group learned ACL graft preparation via the Shoelace ACL Simulation Guide, whereas a control group viewed a standard instructional video. All participants then prepared an 8-strand ACL graft using allograft materials and were evaluated via a checklist of critical steps and a global assessment rating as provided by an expert blinded to group allocation. Participants’ preintervention and postintervention self-assessment scores were also collected.

Results:

Ten orthopaedic surgery residents from a single institution participated in the study, with even distributions across study groups of PGY-1, PGY-3, and PGY-4 residents. Preintervention self-assessments of knowledge and technical ability were similar between participant groups. The mean overall performance score was significantly greater in the shoelace simulation intervention group (22.6±1.5) than in the instructional video only control group (16.0±5.1) (P=0.043). Participants in the intervention group showed greater improvement in self-confidence in their technical ability than those in the control group (P=0.012). Groups demonstrated similar postintervention improvements in self-reported knowledge of ACL graft preparation (P=0.128). All participants who learned via the Shoelace ACL Simulation Guide strongly agreed that they would use the learning tool to prepare for ACL reconstruction surgery.

Conclusions:

A self-directed low-cost simulation model for soft tissue ACL graft preparation utilizing shoelaces resulted in improved performance metrics compared with standard video instruction. The teaching model may be incorporated easily and inexpensively into simulation curricula at other training programs.

Level of Evidence:

Level II—therapeutic study.
Hydroa Vacciniforme–Like T-Cell Lymphoma: A Further Brazilian Case
Authors: Miranda Mario Fernando Ribeiro de , Santos Josie Eiras Bisi dos , Müller Silvia Ferreira Rodrigues , Bittencourt Maraya de Jesus Semblano , Brito Arival Cardoso de , Barros Junior Jorge Nazareno da Silva , Xerfan Ellen Maria Sampaio
Published: March 2017

Hydroa vacciniforme (HV)–like lymphoma is a rare, usually fatal Epstein–Barr virus–driven lymphoproliferative disease affecting children from Asia, Mexico, and South America. Cutaneous manifestations imitate HV, a benign photodermatosis in which systemic symptoms are not observed, and spontaneous regression occurs later in adolescence or young adulthood. We report a case of HV-like lymphoma in a 12-year-old girl, descendent from an ancient Amazon indigenous tribe that, as far as we know, represents the second Brazilian case ever reported in the medical literature.
Intraepithelial Melanoma in the Stomach After Treatment With Immune Checkpoint Blockade Therapy
Authors: Shustef Elina , Torres-Cabala Carlos A. , Curry Jonathan L. , Tetzlaff Michael T. , Nagarajan Priyadharsini , Ivan Doina , Prieto Victor G. , Aung Phyu P.
Published: March 2017

Melanoma is the most common tumor to metastasize to the gastrointestinal tract, commonly affecting the small intestine, colon, and anorectum. Primary mucosal melanoma can arise in any gastrointestinal site, most frequently affecting anorectal mucosa. Melanoma involving the gastric mucosa, specifically, is exceedingly rare and carries a poor prognosis with a median survival of 5 months. The presence of atypical melanocytes exclusively within gastric epithelium has not been previously described. We report a case of a 52-year-old man with widespread BRAFV600E mutant metastatic melanoma who was referred to our institution for immune checkpoint antibody-blockade therapy. The patient had previously been treated with BRAF inhibitors, and despite initial response to therapy, developed resistance leading to disease progression and multiorgan involvement including the liver, spleen, and axial skeleton. Immune checkpoint antibody blockade with ipilimumab and pembrolizumab has been shown to induce significant tumor regression in patients with melanoma by upregulating T-cell activity and removing the natural check on the host immune response. After his first dose of combination therapy, the patient underwent an upper gastrointestinal tract endoscopy for severe nausea and was found to have 2 pigmented lesions within the gastric body, one of which was biopsied. The biopsy showed gastric body-fundic type mucosa with melanophages and scattered atypical intraepithelial melanocytes within the lamina propria, which were strongly positive for S100, HMB45, SOX10, and MITF. A Fontana-Masson silver stain was performed for confirmation. The finding of predominantly atypical intraepithelial melanocytes associated with melanin pigment was interpreted as metastatic melanoma to the stomach with some regression in response to immune checkpoint blockade therapy.
RETINAL VASCULAR ABNORMALITIES IN A LARGE COHORT OF PATIENTS AFFECTED BY NEUROFIBROMATOSIS TYPE 1
Authors: Parrozzani Raffaele , Pilotto Elisabetta , Clementi Maurizio , Frizziero Luisa , Leonardi Francesca , Convento Enrica , Miglionico Giacomo , Pulze Serena , Perrini Pierdavide , Trevisson Eva , Cassina Matteo , Midena Edoardo
Published: March 2017

Purpose:

To evaluate the prevalence, the vascular features, and the clinical diagnostic implication of retinal vascular abnormalities (RVAs) associated with neurofibromatosis Type 1 (NF1) in a large cohort of patients.

Methods:

Two hundred and ninety-four patients affected by NF1 were consecutively enrolled. The presence of RVAs was detected by means of infrared confocal scanning laser ophthalmoscopy images. Three hundred age- and race-matched healthy subjects were enrolled as a healthy control group. Fluorescein angiography, indocyanine green angiography, and optical coherence tomography angiography were also performed in patients with RVAs.

Results:

Retinal vascular abnormalities were detected in 18 patients with NF1 (6.1%) and in none of the healthy subjects. Retinal vascular abnormalities appeared in all cases as well-defined, small, tortuous retinal vessels with a spiral aspect, originating from small tributaries of retinal veins. The presence of RVAs did not correlate with the presence of other specific ocular or systemic NF1 features (P > 0.05). On optical coherence tomography angiography, RVAs appeared as an isolated tortuous vessel of the superficial vascular plexus in all cases, associated with localized anomalous crowded and congested capillary network of the deep vascular plexus in 75% of cases.

Conclusion:

Retinal vascular abnormalities are present in a limited proportion of patients affected by NF1 and can be considered an additional distinctive sign of the disease.
CLINICALLY INVISIBLE RETINOBLASTOMA RECURRENCE IN AN INFANT
Authors: Park Krystal , Sioufi Kareem , Shields Carol L.
Published: March 2017

Purpose:

To report a case of clinically invisible retinoblastoma recurrence detected only on spectral-domain optical coherence tomography.

Methods:

Case report.

Results:

A 3-week-old girl with bilateral familial retinoblastoma underwent six cycles of intravenous chemoreduction. Both eyes showed tumor regression. After 6 cycles of chemoreduction, the tumor in the right eye appeared with clinical regression; however, by spectral-domain optical coherence tomography, there was 40 μm increase in thickness and 290 μm increase in basal diameter. Due to tumor proximity of 1.85 mm to the foveola, the recurrence was treated via intraarterial chemotherapy with two cycles of Melphalan 3 mg. After treatment, spectral-domain optical coherence tomography showed complete regression of the recurrent tumor to a flat scar with intact fovea.

Conclusion:

Precise submillimeter imaging with spectral-domain optical coherence tomography for monitoring retinoblastoma is important and can allow detection of early recurrences that might be clinically invisible otherwise, as well as surveillance of the fovea.
CENTRAL RETINAL VEIN OCCLUSION IN GATA2 DEFICIENCY
Authors: Berry Duncan , Fekrat Sharon
Published: March 2017

Purpose:

To examine the association between GATA2 deficiency–related myelodysplastic syndrome (MDS) and central retinal vein occlusion (CRVO).

Methods:

Clinical ophthalmologic examination and laboratory work-up was performed for a patient with GATA2 deficiency–related MDS who experienced a unilateral CRVO. The literature was reviewed for reports of CRVO in the setting of MDS and allogeneic hematopoietic stem cell transplantation.

Results:

Ophthalmologic examination revealed findings consistent with unilateral CRVO. Typical hypercoagulable work-up did not reveal an identifiable cause. A review of the patient's medical history revealed multiple potential causes of CRVO, including drug-induced and/or related to her history of MDS and hematopoietic stem cell transplantation. The literature was reviewed for reports of CRVO in association with her risk factors.

Conclusion:

On review of the literature, we determined that GATA2 deficiency–related MDS was a possible cause of this patient's CRVO although it is likely that her multiple risk factors worked synergistically to create a prothrombotic state. This case and review of the literature serve as an important reminder of the long and ever-evolving list of risk factors for the development of CRVO.
ACUTE IDIOPATHIC MACULOPATHY: 7-YEAR FOLLOW-UP WITH DEVELOPMENT OF OUTER RETINAL TUBULATIONS
Authors: Heymann Hans B. , Colon Daniel A. , Jampol Lee M.
Published: March 2017

Purpose:

To describe the development of outer retinal tubulations in a patient with acute idiopathic maculopathy.

Methods:

Chart review was performed on a single patient to collect all relevant clinical information and diagnostic imaging.

Results:

A case of outer retinal tubulations in a patient with idiopathic maculopathy is documented.

Conclusion:

Patients with acute idiopathic maculopathy may develop outer retinal tubulations similar to other entities that cause disturbance of retinal pigment epithelium or photoreceptors.
Measuring Maternal Behaviors in the Neonatal Intensive Care Unit
Authors: Lakes Kimberley D. , Guo Yuqing , Taylor Lucas Candice , Cooper Dan
Published: March 2017

One of the most important considerations in designing clinical infant research studies is the selection of reliable and valid measurement procedures. Few measures of caregiver–child interactions have been studied with newborns, particularly premature infants. The main objective of this study was to examine psychometric properties of the National Institute of Child Health and Human Development (NICHD) Mother-Child Interaction Qualitative Ratings in a sample of premature infants and their mothers to evaluate its use in the neonatal intensive care unit. Mother–baby dyads (N = 24) were videotaped in a 10-min interaction in the NICU. Nine raters independently assessed dyadic interactions using the NICHD Mother–Child Interaction Qualitative Ratings in a fully crossed research design. Rater reliability was strong for mother and infant ratings (.76–.94). Scores yielded normal distributions for maternal sensitivity, positive regard, and flatness of affect and skewed distributions for maternal intrusiveness, detachment, negative regard, and all child ratings. Positive maternal behaviors correlated positively with one another and negatively with negative maternal behaviors. Thus, preliminary analyses suggest that scores obtained using the NICHD Mother–Child Interaction Qualitative Ratings with premature babies and their mothers in the neonatal intensive care unit demonstrate adequate interrater reliability, and distributional properties provide preliminary evidence of face validity.
Testicular growth and development in puberty
Authors: Koskenniemi Jaakko J. , Virtanen Helena E. , Toppari Jorma
Published: March 2017

Purpose of review

To describe pubertal testicular growth in humans, changes in testicular cell populations that result in testicular growth, and the role of testosterone and gonadotrophins follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in testicular growth. When human data were not available, studies in nonhuman primates and/or rodents were used as surrogates.

Recent findings

Testicular growth in puberty follows a sigmoidal growth curve, with a large variation in timing of testicular growth and adult testicular volume. Testicular growth early in puberty is due to increase in Sertoli cell number and length of seminiferous tubules, whereas the largest and fastest growth results from the increase in the diameter of the seminiferous tubules first due to spermatogonial proliferation and then due to the expansion of meiotic and haploid germ cells. FSH stimulates Sertoli cell and spermatogonial proliferation, whereas LH/testosterone is mandatory to complete spermatogenesis. However, FSH and LH/testosterone work in synergy and are both needed for normal spermatogenesis.

Testicular growth during puberty is rapid, and mostly due to germ cell expansion and growth in seminiferous tubule diameter triggered by androgens. Pre-treatment with FSH before the induction of puberty may improve the treatment of hypogonadotropic hypogonadism, but remains to be proven.
Reducing Central Line-Associated Bloodstream Infection Rates in the Context of a Caring-Healing Environment
Authors: Hanson Daphne
Published: March 2017

Central line-associated bloodstream infections (CLABSIs) prove to be detrimental to both the patient and the hospital. The present study was a quality improvement training project to affect CLABSI rates in the cardiac intensive care unit in the context of a caring-healing environment, and contributed to a culture of patient safety to empower staff to speak up if they see a breach in protocol at any time. A caring-healing environment encouraged staff to take the extra time and precautions to prevent infections for their patients and created a better quality of care for the patients.
TLE-1-Positive Angiomatoid Fibrous Histiocytoma Mimicking Synovial Sarcoma
Authors: Zaccarini Daniel J. , Naous Rana , Sheth Yesha , El-Zammar Ola , de la Roza Gustavo , Curtiss Christopher M.
Published: March 2017

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor most commonly seen in young adults and children. We report a case with morphology and immunohistochemistry supporting the diagnosis of synovial sarcoma. On core biopsy, the tumor had spindle cell and epithelioid morphology with a myxoid background. Staining for transducin-like enhancer of split 1 and CD99 were positive; however, subsequent fluorescence in situ hybridization for SYT (SS18, nBAF chromatin remodeling complex subunit) break apart returned negative. Further study showed fluorescence in situ hybridization for EWSR1 (EWS RNA binding protein 1) gene rearrangement, supporting the diagnosis of AFH. The resected specimen showed a predominant spindle cell proliferation along with histiocytoid areas supporting a diagnosis of AFH. This case report highlights the fact that synovial sarcoma and AFH can overlap morphologically and immunohistochemically. When approaching a biopsy specimen with spindle cell morphology, and transducin-like enhancer of split 1, CD99, and epithelial membrane antigen positivity it is important to include AFH in the differential diagnosis.
3D Tissue Microarray Controls: A Potential Standardization Solution
Authors: Myers Charles W. , Bhimji-Patel Sonal , Rees Mark , Imam Syed Ashraf , Cohen Cynthia
Published: March 2017

The use of controls is a hallmark for quality control in anatomic pathology. However, standardization of controls between laboratories has been a significant issue. Differential processing techniques between institutions and a multitude of preanalytical difficulties can result in different immunostain intensities. So called histoid controls, xenografts or culture cell lines, have been discussed in the past but with no recent followup. Herein is presented a histoid termed a 3D tissue microarray control (3D TMAC) control to help alleviate the burgeoning need for control standardization. A breast and cervix 3D TMAC control were tested for staining quality for 11 different antibodies commonly tested in either breast or cervical cancer work ups. We additionally looked at a small run of 5 days of CK5 and HER2 for reproducibility of the 3DRSTMA. Staining quality of 9 of the antibodies stained appropriately and 2 stained inappropriately, mammoglobin and GCDFP. Two of the antibodies were not reported to have any staining properties in the 3D TMAC, p16 and mammoglobin. Of these, p16 had appropriate staining and mammoglobin did not. In the 5 runs of CK5 and HER2, there was good reproducibility between stains assessed by both visual and computer-assisted methods, with membrane intensity coefficients of variation of 3.58% and 3.18%, respectively. The 3D TMAC has the potential to markedly improve intralaboratory and interlaboratory standardization practices.
PAX8-positive Biphasic Synovial Sarcoma Expressing Hormonal Receptors
Authors: Lordello Leonardo , Bur Martin E. , Oliva Esther , Lennerz Jochen K.
Published: March 2017

PAX8, estrogen receptor-α (ERα) and progesterone receptor (PR) are markers usually expressed in neoplasms of müllerian origin. We report a subdiaphragmal mass in a 41-year-old woman corresponding to a malignant biphasic tumor with nests of epithelial-like cells forming variably sized cyst-like spaces alternating with spindle cells forming intersecting fascicles. The later were juxtaposed to coalescent densely cellular nodules of spindle cells with appreciable cytologic atypia and mitotic counts up to 30/10 high-power fields. The tumor cells were AE1/AE3, EMA, ERG, ERα, PR, and PAX8 positive whereas spindle cells showed reduced immunopositivity for these markers, especially marked in coalescent nodular areas, with notable exception of PAX8, which was diffuse and strongly positive. The possibility of an endometrioid carcinoma with spindle cells was considered by the referring pathologist, but fluorescent in situ hybridization showed rearrangement of SS18 gene in 48 of 50 tumor nuclei, rendering a diagnosis of biphasic synovial sarcoma, the first reported in the English literature to the best of our knowledge expressing PAX8, ERα, and PR. Further studies evaluating the expression of these markers in synovial sarcoma and other sarcomas are needed, as sometimes the findings may lead to misdiagnosis as other neoplasms including those of the female genital tract. Additional molecular tests may be helpful to determine the molecular mechanism of this aberrant immunoprofile, which could be directly or indirectly related to t(X:18).