bluuebunny/crossref_metadata_2025 huggingface dataset:
Division of labor
Authors: Puranam Phanish
Published: July 2018

Division of labor involves task division and task allocation. An extremely important consequence of task division and allocation is the creation of interdependence between agents. In fact, division of labor can be seen as a process that converts interdependence between tasks into interdependence between agents. While there are many ways in which the task structure can be chunked and divided among agents, two important heuristic approaches involve division of labor by activity vs. object. I show that a choice between these two forms of division of labor only arises when the task structure is non-decomposable, but the product itself is decomposable. When the choice arises, a key criterion for selection between activity vs. object-based division of labor is the gain from specialization relative to the gain from customization.
Hierarchies of Authority
Authors: Puranam Phanish
Published: July 2018

Authority hierarchies are ubiquitous, yet we know little about how they arise. I outline a process model of hierarchical growth through sequential delegation. I also consider the consequences of the growth of layers in an authority hierarchy. Control and information losses in multi-layered authority hierarchies may act as a limit on organizational size. However, they may also serve as a valuable source of exploration by the organization as a whole, aiding effective organizational adaptation. I also discuss re-organizations and how they re-shape existing hierarchies. I conclude with some thoughts on the unpopularity of authority hierarchies despite their obvious success as a form of organizing.
“La Idea Mueve” (The Idea Moves Us)
Authors: González Gabriela
Published: July 2018

The concluding chapter explains how race had served defenders of slavery by providing them with an excuse to hold men and women in bondage. For their inhumane treatment of Africans during the Age of Enlightenment to be justified, their humanity needed to be ideologically stripped away—scientific racism served that purpose. Racist theories also kept other groups in subaltern positions. Mexicans with mestizo, mulatto, and Indian genealogies experienced racialization in the United States. Simply put, Americans, proud of their liberal political heritage and their democratic institutions, needed to see oppressed groups as somehow sub-human in order to reconcile their political beliefs with the nation’s less than egalitarian realities. It is for this reason that the politics of redemption practiced by Mexican immigrant and Mexican American activists merits attention.
Interplay between SUMOylation and NEDDylation regulates RPL11 localization and function
Authors: El Motiam Ahmed , Vidal Santiago , De La Cruz-Herrera Carlos F. , Da Silva-Álvarez Sabela , Baz-Martínez Maite , Seoane Rocío , Vidal Anxo , Rodríguez Manuel S. , Xirodimas Dimitris P. , Carvalho Ana Sofia , Beck Hans Christian , Matthiesen Rune , Collado Manuel , Rivas Carmen
Published: July 2018

The ribosomal protein L11 (RPL11) integrates different types of stress into a p53‐mediated response. Here, we analyzed the impact of the ubiquitin‐like protein SUMO on the RPL11‐mouse double‐minute 2 homolog‐p53 signaling. We show that small ubiquitin‐related modifier (SUMO)1 and SUMO2 covalently modify RPL11. We find that SUMO negatively modulates the conjugation of the ubiquitin‐like protein neural precursor cell‐expressed developmentally downregulated 8 (NEDD8) to RPL11 and promotes the translocation of the RP outside of the nucleoli. Moreover, the SUMO‐conjugating enzyme, Ubc9, is required for RPL11‐mediated activation of p53. SUMOylation of RPL11 is triggered by ribosomal stress, as well as by alternate reading frame protein upregulation. Collectively, our data identify SUMO protein conjugation to RPL11 as a new regulator of the p53‐mediated cellular response to different types of stress and reveal a previously unknown SUMO‐NEDD8 interplay.—El Motiam, A., Vidal, S., de la Cruz‐Herrera, C. F., Da Silva‐Álvarez, S., Baz‐Martínez, M., Seoane, R., Vidal, A., Rodríguez, M. S., Xirodimas, D. P., Carvalho, A. S., Beck, H. C., Matthiesen, R., Collado, M., Rivas, C. Interplay between SUMOylation and NEDDylation regulates RPL11 localization and function. FASEB J. 33, 643–651 (2019). www.fasebj.org
Clinical Evaluation of Portable Wound Volumetric Measurement Devices
Authors: Chiang Nathaniel , Rodda Odette A , Kang Anna , Sleigh Jamie , Vasudevan Thodur
Published: July 2018

OBJECTIVE:

Wound dimensional assessments are important in determining the progress of a wound and the effect of interventions on wound healing. The FastSCAN (FS; Polhemus Inc, Colchester, Vermont) and Silhouette Mobile (SM; ARANZ Medical, Christchurch, New Zealand) are portable devices that quantify surface area, depth, and volume of wounds. This study evaluated their reliability in producing accurate wound measurements.

DESIGN AND SETTING:

This study was conducted at the Waikato Hospital, Hamilton, New Zealand.

PATIENTS AND INTERVENTION:

Eleven vascular patients with a combined total of 16 wounds underwent simultaneous wound measurements using three-dimensional computed tomography (CT) reconstruction, FS, and SM.

MAIN OUTCOME MEASURE:

The validity of FS and SM was tested against CT. Additionally, the interoperator reliability and intraoperator reliability of FS and SM were determined.

MAIN RESULTS:

The intraoperator reliability and interoperator reliability for volume recordings of the SM were 0.97 and 0.97, respectively, and for the FS were 0.96 and 0.97, respectively. The FS and SM measurements were not significantly different from CT. The SM consistently produced smaller wound volume and depth measurements compared with CT. In contrast, overestimation was observed for FS when compared with CT. However, the volume measurements in one wound were anomalous, being 10 times larger than CT measurements. Excluding this wound, there were strong correlations in wound volumes for SM and CT (r = 0.81; P ≤ .0001), for FS and CT (r = 0.99; P ≤ .001), and for SM and FS (r = 0.99; P ≤ .0001).

CONCLUSIONS:

Measurements from FS and SM were comparable to CT. Therefore, SM and FS devices both offer the benefit of being noncontact portable devices that produce reproducible and reliable readings.
Conjunctival provocation tests: prediction of seasonal allergy
Authors: Schröder Julian , Mösges Ralph
Published: July 2018

Purpose of review

The conjunctival provocation test (CPT) is often used to clearly identify the specific allergen causing the symptoms of allergic rhinoconjunctivitis but also to assess the clinical efficacy of an allergen immunotherapy (AIT). As there is no consensus about its predictive value, the aim of this publication is to evaluate under which conditions the CPT can predict the symptom severity during the allergy season after previous AIT.

Recent findings

Three out of four randomized controlled trials (RCTs) showed a correlation between CPT reactivity and symptoms occurring under natural allergen exposure after previous AIT. Furthermore, one RCT found that performing the CPT 4 weeks after initiating AIT can identify early responders who also show a benefit during the season. Another RCT suggested that conducting the CPT prior to starting AIT can be used to identify patients who may benefit more from treatment than others.

The assessment of the reviewed literature led us to the conclusion that the CPT has a predictive value and can consequently be used to assess the efficacy of an administered AIT if performed according to a standardized challenge protocol with high-quality allergen extracts.
Topical antihistamines, mast cell stabilizers, and dual-action agents in ocular allergy: current trends
Authors: Ben-Eli Hadas , Solomon Abraham
Published: July 2018

Purpose of review

To address the current trends of therapeutic mechanisms for treatment of allergic conjunctivitis (AC), based on topical antihistamines and mast cell stabilizers (MCS).

Recent findings

The antihistamine drug alcaftadine has H4 receptor inverse agonism, anti-inflammatory and MCS activities. The antihistamines levocabastine and azelastine are more effective than placebo in treatment of AC symptoms in randomized controlled trials (RCTs). The topical dual-action antihistamines/MCS olopatadine, azelastine, ketotifen, and epinastine are commonly used in Europe and in the United States for mild subtypes of AC. For the main symptoms of AC, ocular itch and conjunctival hyperemia, epinastine 0.05% was superior to placebo, but equal or more effective than olopatadine 0.1%, while the later was more effective than ketotifen. High concentration olopatadine 0.77% had longer duration of action, better efficacy on ocular itch, and a similar safety profile to low-concentration olopatadine 0.2%. The new formulas of topical dual-action agents present longer duration of action, leading to a decreased frequency of use.

The topical dual-action agents are the most effective agents treating signs and symptoms of mild forms of AC. There is superiority to the high-concentration olopatadine drug over other agents on ocular itch, with prolonged effect when used once-daily.
Cosmetics and ocular allergy
Authors: Norris Matthew R. , Bielory Leonard
Published: July 2018

Purpose of review

The purpose of this review was to explore recent developments in the study of ocular cosmetics, as they pertain to adverse reactions that can be attributed to them.

Recent findings

Immunologically mediated adverse reactions to cosmetics are most commonly the result of sensitization to preservatives, fragrances and dyes used in these products. Metals such as nickel, cobalt, chromium and lead are used in products such as eye shadows and eye liners as well as toy makeup sets in amounts greater than the recommended amount of 1 ppm. Cosmetics make up the majority of fragrance-induced contact dermatitis. Recently, a free smartphone app was developed by American Contact Dermatitis Society that holds promise in better enabling patients to utilize their patch test data while shopping for cosmetics.

Both immediate and delayed hypersensitivity reactions linked to cosmetics are often the result of sensitization to preservatives, fragrances and additives in the products themselves. Despite significant advances in our understanding of these reactions, further research will be necessary to elucidate the mechanisms behind these reactions and bring this knowledge to the bedside as to improve patient care with potential cosmetic-based related allergic disorders.
Examining Demographics, Prior Academic Performance, and United States Medical Licensing Examination Scores
Authors: Rubright Jonathan D. , Jodoin Michael , Barone Michael A.
Published: July 2018

Purpose

To examine whether demographic differences exist in United States Medical Licensing Examination (USMLE) scores and the extent to which any differences are explained by students’ prior academic achievement.

Method

The authors completed hierarchical linear modeling of data for U.S. and Canadian allopathic and osteopathic medical graduates testing on USMLE Step 1 during or after 2010, and completing USMLE Step 3 by 2015. Main outcome measures were computer-based USMLE examinations: Step 1, Step 2 Clinical Knowledge, and Step 3. Test-taker characteristics included sex, self-identified race, U.S. citizenship status, English as a second language, and age at first Step 1 attempt. Covariates included composite Medical College Admission Test (MCAT) scores, undergraduate grade point average (GPA), and previous USMLE scores.

Results

A total of 45,154 examinees from 172 medical schools met the inclusion criteria. The sample was 67% white and 48% female; 3.7% non-U.S. citizens; and 7.4% with English as a second language. Hierarchical linear models examined demographic variables with and without covariates including MCAT scores and GPA. All Step examinations showed significant differences by gender after adding covariates, varying by Step. Racial differences were observed for each Step, attenuated by the addition of covariates.

Conclusions

Demographic differences in USMLE performance were tempered by previous examination performance and undergraduate performance. Additional research is required to identify factors that contribute to demographic differences, can aid educators’ identification of students who would benefit from assistance preparing for USMLE, and can assist residency program directors in assessing performance measures while meeting diversity goals.
It’s Time for Medical Schools to Introduce Climate Change Into Their Curricula
Authors: Wellbery Caroline , Sheffield Perry , Timmireddy Kavya , Sarfaty Mona , Teherani Arianne , Fallar Robert
Published: July 2018

Climate change presents unprecedented health risks and demands universal attention to address them. Multiple intergovernmental organizations, health associations, and health professions schools have recognized the specific importance of preparing physicians to address the health impacts of climate change. However, medical school curricula have not kept pace with this urgent need for targeted training.

The authors describe the rationale for inclusion of climate change in medical education and some potential pathways for incorporating this broad topic into physician training and continuing medical education. Reasons include the magnitude and reach of this transboundary issue, the shared responsibility of the U.S. health care sector as a major contributor to greenhouse gas emissions, and the disproportionate effects of climate change on vulnerable populations. The integration of climate-change-related topics with training of essential physician skills in a rapidly changing environment is feasible because many health topic areas already exist in medical school curricula in which climate change education can be incorporated. To fully integrate the health topics, underlying concepts, and the needed clinical and system-wide translations, content could be included across the scope of training and into continuing medical education and faculty development. The authors provide examples of such an approach to curricular inclusion.
Interprofessional Practice and Education in Clinical Learning Environments: Frontlines Perspective
Authors: Uhlig Paul N. , Doll Joy , Brandon Kristy , Goodman Christopher , Medado-Ramirez Josephine , Barnes Michael A. , Dolansky Mary A. , Ratcliffe Temple A. , Kornsawad Kanapa , Raboin W. Ellen , Hitzeman Maggie , Brown Jeffrey , Hall Les
Published: July 2018

This Invited Commentary is written by coauthors working to implement and study new models of interprofessional practice and education in clinical learning environments. There are many definitions and models of collaborative care, but the essential element is a spirit of collaboration and shared learning among health professionals, patients, and family members. This work is challenging, yet the benefits are striking. Patients and family members feel seen, heard, and understood. Health care professionals are able to contribute and feel appreciated in satisfying ways. Learners feel included. Care interactions are richer and less hierarchical, and human dimensions are more central. A crucial insight is that collaborative care requires psychological safety, so that people feel safe to speak up, ask questions, and make suggestions. The most important transformation is actively engaging patients and families as true partners in care creation. A leveling occurs between patients, family members, and health professionals, resulting from closer connections, deeper understandings, and greater mutual appreciation. Leadership happens at all levels in collaborative care, requiring team-level capabilities that can be learned and modeled, including patience, curiosity, and sharing power. These abilities grow as teams work and learn together, and can be intentionally advanced by reconfiguring organizational structures and care routines to support collective team reflection. Collaborative care requires awareness and deliberate practice both individually and as a team together. Respectful work is required, and setbacks should be considered normal at first. Once people have experienced the benefits of collaborative care, most “never want to go back.”
Effects of the OPRM1 A118G Polymorphism (rs1799971) on Opioid Analgesia in Cancer Pain
Authors: Yu Zhicao , Wen Lei , Shen Xingyong , Zhang Hongmei
Published: July 2018

Objectives:

Although previous studies have demonstrated that the OPRM1 A118G polymorphism may influence the analgesia response to cancer pain, the results are inconsistent. In this article we aimed to fully examine the association between OPRM1 A118G (rs1799971) polymorphism and opioid analgesia by analyzing published information. This will provide information for better cancer pain management.

Materials and Methods:

A systematic search of the literature dating to August 31, 2017 was conducted using PubMed, EMBase, Sinomed, and the Cochrane Library databases. The standardized mean difference (SMD) of required amounts of opioids between AA homozygotes and the G-allele was calculated. Subgroup analyses for race and opioid use was performed. In addition, drug sensitivity analysis, heterogeneity description, and publication bias assessment were performed.

Results:

Of the 467 screened studies, 12 including 2118 participants were eligible to be included in our analysis. The meta-analysis results indicated that G-allele carriers (AG+GG) of the OPRM1 A118G polymorphism required higher opioid doses for pain management than those with the AA homozygotes (SMD=−0.3; 95% confidence interval [CI], −0.45 to −0.15; P<0.001). In subgroup analysis, we did not find statistically significant correlation between OPRM1 A118G polymorphism and opioid pain relief among Caucasian patients (SMD=−0.15; 95% CI, −0.29 to −0.00; P=0.04), as well as among morphine users (SMD =−0.20; 95% CI, −0.40 to 0.00, P=0.05), except for Asian patients (SMD=−0.42; 95% CI, −0.62 to −0.23; P<0.001).

Discussion:

Our meta-analysis indicates that G allele (AG+GG) carriers of OPRM1 A118G polymorphism required more opioid analgesia in cancer pain management. The OPRM1 A118G polymorphism may help predict individuals’ response to analgesia and achieve satisfactory cancer pain control.
Nurses Providing End-of-Life Care for Infants and Their Families in the NICU
Authors: Gibson Kim , Hofmeyer Anne , Warland Jane
Published: July 2018

Background:

Nurses working in the neonatal intensive care unit (NICU) who care for dying infants and their families say they do not necessarily have the expertise or the specific training to provide quality end-of-life-care (EOLC).

Purpose:

The purpose of this review was to critically appraise the existing qualitative literature regarding nurses' experiences when caring for infants during end of life in the NICU and to identify barriers and enablers to provide quality EOLC.

Search Strategy:

A literature search was conducted using CINAHL and OVID databases. Studies that explored nurses' experiences when caring for infants who were dying or when lifesaving care was withdrawn were retrieved and 15 studies were thematically analyzed.

Results:

Five major themes emerged: advocating for the dying infant, building close relationships with the family, providing an appropriate care environment, nurses' emotional responses to dying or death, and professional inadequacy in EOLC.

Implications for Practice:

Nurses face multiple challenges when providing EOLC including moral dilemmas and feelings of professional inadequacy. Avoidance was a common strategy used by nurses to cope with the stress associated with EOLC. Managers can foster quality EOLC by implementing education sessions about infant mortality, EOLC, advocacy, team communication, and self-care practices.

Implications for Research:

Research could evaluate the effectiveness of EOLC education sessions to build nurses' competence and confidence in advocacy and EOLC clinical skills.
Congenital Syphilis
Authors: Rowe Christine R. , Newberry Desi M. , Jnah Amy J.
Published: July 2018

Background:

Syphilis is caused by the spirochete bacterium Treponema pallidum. Syphilis left untreated, or inadequately treated during pregnancy, can result in congenital syphilis (CS). Congenital syphilis can lead to severe sequelae or fetal, neonatal, or infant death.

Purpose:

To discuss the epidemiological trends, pathophysiology, diagnosis, and management of CS; the implications of CS upon the infant; as well as the importance of the nurse's role in the prompt identification of CS and the timely interventions needed to minimize sequelae.

Methods:

A literature search was completed using ProQuest, CINAHL, Google Scholar, and PubMed. Articles published within the past 10 years were included.

Findings:

Epidemiological trends of CS in the United States indicate that maternal syphilis infection and CS are on the rise. Risk factors include ethnicity, socioeconomic status, access to prenatal care, and sexual behaviors, as well as compliance with prenatal syphilis screening by prenatal providers. Risks of CS to the developing fetus begin at approximately 14 weeks. Timely treatment is necessary to minimize or eliminate mortality and morbidity.

Implications for Practice:

Evidence-based, interprofessional strategies, which promote a collaborative perinatal/neonatal preventative approach to care of the pregnant female, are indicated to reverse the increasing incidence of CS within the United States. Strategies prioritizing early identification and treatment of at-risk neonates are necessary to reduce/eliminate the devastating long-term consequences of CS upon this vulnerable population.

Implications for Research:

The paucity of research, which focuses on CS, is most likely due to ethical concerns related to infants as research participants and provides an opportunity for future research. Future research could focus on factors that focus on maternal–fetal/maternal–child transmission of CS.
Systemic High-Mobility Group Box-1: A Novel Predictive Biomarker for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage*
Authors: Chaudhry Shafqat R. , Güresir Agi , Stoffel-Wagner Birgit , Fimmers Rolf , Kinfe Thomas M. , Dietrich Dirk , Lamprecht Alf , Vatter Hartmut , Güresir Erdem , Muhammad Sajjad
Published: July 2018

Objectives:

To investigate the release of proinflammatory damage-associated molecular pattern molecule “high-mobility group box-1” in the serum of patients after aneurysmal subarachnoid hemorrhage and its association with cerebral vasospasm.

Design:

Retrospective observational study.

Setting:

University hospital.

Patients:

Aneurysmal subarachnoid hemorrhage patients admitted within 24 hours of ictus.

Interventions:

Standard subarachnoid hemorrhage treatment after clipping or coiling of aneurysm.

Measurements and Main Results:

We enrolled 53 aneurysmal subarachnoid hemorrhage patients from which peripheral venous blood was withdrawn on days 1, 3, 5, 7, 9, 11, and 13 and once from the controls to obtain the serum. Serum high-mobility group box-1 concentration was quantified by enzyme-linked immunosorbent assay. Serum interleukin-6 and peripheral blood leukocytes were also determined over the first 2 weeks after subarachnoid hemorrhage. Patients’ data were recorded prospectively. Serum high-mobility group box-1 was significantly elevated in subarachnoid hemorrhage patients from day 1 to day 13 when compared with nonsubarachnoid hemorrhage patients (p < 0.05). Patients with cerebral vasospasm showed significantly higher high-mobility group box-1 starting from day 1 to day 13 when compared with patients without cerebral vasospasm. Cumulative levels of high-mobility group box-1 showed significant correlation with peripheral blood leukocytes and interleukin-6 levels (p < 0.05). Receiver operating characteristic curve analysis showed that serum high-mobility group box-1 level at admission may be a predictive biomarker for cerebral vasospasm with a sensitivity of 59% and a specificity of 82% at a cutoff value of 5.6 ng/mL.

Conclusions:

Serum high-mobility group box-1 is differentially elevated after subarachnoid hemorrhage. Serum high-mobility group box-1 levels were elevated early after subarachnoid hemorrhage (day 1) and remained significantly high until day 13 in patients who developed cerebral vasospasm. Our data suggest that serum high-mobility group box-1 may be a predictive biomarker for the detection of CVS.
Handovers Among Staff Intensivists: A Study of Information Loss and Clinical Accuracy to Anticipate Events*
Authors: Dutra Mariana , Monteiro Mariana V. , Ribeiro Karina B. , Schettino Guilherme P. , Kajdacsy-Balla Amaral Andre Carlos
Published: July 2018

Objectives:

Handovers are associated with medical errors, and our primary objective is to identify missed diagnosis and goals immediately after a shift handover. Our secondary objective is to assess clinicians’ diagnostic accuracy in anticipating clinical events during the night shift.

Design:

Single-center prospective observational cohort study.

Setting:

Thirty-bed tertiary ICU in Sao Paulo, Brazil.

Patients:

Three-hundred fifty-two patient encounters over 44 day-to-night handovers.

Interventions:

None.

Measurements and Main Results:

We used a multimethods approach to measure transmission of information among staff physicians on diagnoses and goals for the night shift. We surveyed clinicians immediately after a handover and identified clinical events through chart abstractions and interviews with clinicians the next morning. Nighttime clinicians correctly identified 454 of 857 diagnoses (53%; 95% CI 50–56) and 123 of 304 goals (40%; 95% CI, 35–46). Daytime clinicians were more sensitive (65% vs 46%; p < 0.01) but less specific (82% vs 91%; p < 0.01) than nighttime clinicians in anticipating clinical events at night, resulting in similar accuracy (area under the receiver operating characteristic curve, 0.74 [95% CI, 0.68–0.79] vs 0.68 [95% CI 0.63–0.74]; p = 0.09). The positive predictive value of both daytime and nighttime clinicians was low (13% vs 17%; p = 0.2). Gaps in diagnosis and anticipation of events were more pronounced in neurologic diagnoses.

Conclusions:

Among staff intensivists, diagnoses and goals of treatment are either not conveyed or retained 50–60% of the cases immediately after a handover. Clinicians have limited ability to anticipate events, and the expectation that anticipatory guidance can inform handovers needs to be balanced against information overload. Handovers among staff intensivists showed more gaps in the identification of diagnostic uncertainty and for neurologic diagnoses, which could benefit from communication strategies such as cognitive checklists, prioritizing discussion of neurologic patients, and brief combined clinical examination at handover.
Do Patterns of Reconstruction Choices After Mohs Surgery Vary by Specialty? A Pilot Study of Mohs Surgeons and Facial Plastic Surgeons
Authors: Kurta Anastasia O. , Sarhaddi Deniz , Sheikh Umar A. , Bernstein Michael , Walen Scott , Armbrecht Eric S. , Maher Ian A.
Published: July 2018

BACKGROUND

Differences in approach to repair a specified defect after Mohs micrographic surgery (MMS) between specialties have not been previously examined.

OBJECTIVE

To assess the difference in frequency of which reconstruction repairs are selected after MMS, among Mohs surgeons and facial plastic surgeons (FPS), and evaluate whether the level of satisfaction with the final repair outcome differed between specialties.

MATERIALS AND METHODS

The study was approved by the Saint Louis University Institutional Review Board. A link to the survey was distributed to members of American College of Mohs Surgery (ACMS) and American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), between January and May 2016.

RESULTS

The reconstructive procedure selected most often (“top choice”) was not significantly different between Mohs surgeons and FPS for the majority of the images. There was no material difference in how dermatologists and FPS rate the aesthetic outcome of the 3 presented closure types, with the exception of one closure type—nose with graft.

CONCLUSION

Mohs surgeons were found to more likely cluster around a single preference for their reconstruction technique compared with FPS, in which a higher percentage of surgeons also selected other options.
Reconstruction of Preauricular Wounds Using a Flipped Island Pedicle Flap
Authors: DeWitt Corey , Holmes Todd
Published: July 2018

BACKGROUND

Island pedicle flaps (IPFs) are a frequently used reconstructive option in dermatologic surgery. With variations in its execution, the flap can be used for an assortment of facial defects.

OBJECTIVE

To describe the execution of a flipped IPF for the reconstruction of medium to large preauricular wounds after Mohs micrographic surgery.

MATERIALS AND METHODS

An analysis of the flipped IPF reconstruction of 12 preauricular defects is presented. Patient demographics, surgical defects, aesthetic outcomes, and complications are described.

RESULTS

Twelve patients with 12 preauricular tumors (9 basal cell carcinomas, 2 squamous cell carcinomas, and 1 malignant melanoma) were treated using Mohs micrographic surgery. A flipped IPF reconstruction was successfully used with good cosmetic outcomes and no complications in all 12 patients.

CONCLUSION

In this series, the authors demonstrate the effective use of flipped IPFs for the reconstruction of medium to large preauricular defects with good aesthetic outcomes and no complications.
Surgical Site Infections After Dermatologic Surgery in Immunocompromised Patients: A Single-Center Experience
Authors: Balakirski Galina , Kotliar Konstantin , Pauly Karolin J. , Krings Laura K. , Rübben Albert , Baron Jens M. , Schmitt Laurenz
Published: July 2018

BACKGROUND

Immunosuppression is often considered as an indication for antibiotic prophylaxis to prevent surgical site infections (SSI) while performing skin surgery. However, the data on the risk of developing SSI after dermatologic surgery in immunosuppressed patients are limited.

PATIENTS AND METHODS

All patients of the Department of Dermatology and Allergology at the University Hospital of RWTH Aachen in Aachen, Germany, who underwent hospitalization for a dermatologic surgery between June 2016 and January 2017 (6 months), were followed up after surgery until completion of the wound healing process. The follow-up addressed the occurrence of SSI and the need for systemic antibiotics after the operative procedure. Immunocompromised patients were compared with immunocompetent patients. The investigation was conducted as a retrospective analysis of patient records.

RESULTS

The authors performed 284 dermatologic surgeries in 177 patients. Nineteen percent (54/284) of the skin surgery was performed on immunocompromised patients. The most common indications for surgical treatment were nonmelanoma skin cancer and malignant melanomas. Surgical site infections occurred in 6.7% (19/284) of the cases. In 95% (18/19), systemic antibiotic treatment was needed. Twenty-one percent of all SSI (4/19) were seen in immunosuppressed patients.

CONCLUSION

According to the authors' data, immunosuppression does not represent a significant risk factor for SSI after dermatologic surgery. However, larger prospective studies are needed to make specific recommendations on the use of antibiotic prophylaxis while performing skin surgery in these patients.
NOVEL OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BIOMARKER IN BRANCH RETINAL VEIN OCCLUSION MACULAR EDEMA
Authors: Yeung Ling , Wu Wei-Chi , Chuang Lan-Hsin , Wang Nan-Kai , Lai Chi-Chun
Published: July 2018

Purpose:

To evaluate the association between deep–superficial flow ratio (DSFR) and the treatment response of macular edema in branch retinal vein occlusion.

Methods:

Thirty eyes from 30 patients with branch retinal vein occlusion who had received optical coherence tomography angiography examination were included. Seventeen normal fellow eyes acted as the control group. Patients were classified into the “good response group” and the “refractory group” by absence or presence of macular edema after 6 months of treatment. The DSFRs were calculated by dividing deep capillary plexus vessel density by superficial capillary plexus vessel density on optical coherence tomography angiography.

Results:

The DSFR was 1.00 (SD ± 0.05) over parafoveal area in the control group. Among branch retinal vein occlusion eyes, parafoveal DSFR remained stable in the good response group (P = 0.822) and significantly decreased in the refractory group (P = 0.002). The DSFRs in the most severe nonperfusion area were significantly lower in the refractory group than in the good response group (0.85 ± 0.13 vs. 1.01 ± 0.15, P = 0.004). The DSFR in the most severe nonperfusion area was associates with treatment response in multivariate logistic regression (P = 0.015).

Conclusion:

Deep–superficial flow ratio can represent the relative damage of deep capillary plexus to superficial capillary plexus. Decreased DSFR was found in branch retinal vein occlusion eyes with refractory macular edema.
PATTERNS OF CHORIOCAPILLARIS FLOW SIGNAL VOIDS IN CENTRAL SEROUS CHORIORETINOPATHY
Authors: Matet Alexandre , Daruich Alejandra , Hardy Samuel , Behar-Cohen Francine
Published: July 2018

Purpose:

To investigate choriocapillaris flow signal void distribution on optical coherence tomography (OCT) angiography in central serous chorioretinopathy (CSCR) and its correlation to choroidal vessel morphology.

Methods:

Fifty-three CSCR eyes (48 patients) and 34 healthy control eyes were included, retrospectively. Exclusion criteria were refractive error >2D, previous laser or photodynamic therapy, low-quality OCT angiography, or excessive shadowing artifacts. Choriocapillaris OCT angiography scans were processed by local-threshold binarization to identify signal voids, and extract their cumulative area. The locations of the two largest voids in each eye were reported on the corresponding enhanced depth imaging OCT raster scan. Choriocapillaris thickness and diameter of underlying outer choroidal vessels were measured at the level of flow voids and of adjacent outer choroidal vessels, not colocalizing with voids.

Results:

There were 22 acute, 16 recurrent, and 15 chronic CSCR eyes. Total flow void area was larger in CSCR than control eyes. In univariate analysis, the total flow void area on OCT angiography increased with age (P = 0.0002), duration since CSCR diagnosis (P = 0.004), extension of autofluorescence alterations (P = 0.016), and CSCR severity (P < 0.0001). In multivariate analysis, age (P = 0.014) and CSCR type (P = 0.046) influenced independently the total flow void area. On enhanced depth imaging OCT, outer choroidal vessel diameter was higher (P < 0.0001), and choriocapillaris was thinner (P < 0.0001) at flow voids compared with adjacent sites, independently from eccentricity from the fovea.

Conclusion:

Choriocapillaris flow voids colocalize with choriocapillaris thinning and deep choroidal vessel dilation in CSCR eyes. Age and CSCR severity influence choriocapillaris flow, a key contributor to CSCR pathophysiology and clinical expression.
Comparison Between Q-Adjusted LASIK and Small-Incision Lenticule Extraction for Correction of Myopia and Myopic Astigmatism
Authors: El-Mayah Esraa , Anis Mohamed , Salem Mohsen , Pinero David , Hosny Mohamed
Published: July 2018

Purpose:

To compare Q-adjusted femtosecond-assisted laser in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE) in terms of safety, efficacy, and predictability, as well as in terms of changes in dry eye parameters, corneal biomechanics, higher-order aberrations (HOAs), and corneal asphericity.

Methods:

A total of 60 eyes were enrolled in this prospective comparative study: 30 underwent SMILE and 30 underwent FS-LASIK. Changes in manifest refraction, uncorrected distance visual acuity and corrected distance visual acuity, corneal topography, corneal hysteresis (CH), and corneal resistance factor (CRF) (Ocular Response Analyzer, ORA), and dry eye parameters were evaluated during a 3-month follow-up.

Results:

Mean manifest refraction spherical equivalent (MRSE) was −4.17 (±1.86) preoperatively in FS-SMILE group and −3.97 (±2.02) in FS-LASIK group (P=0.69). Mean postoperative MRSE in FS-SMILE group was −0.25±0.38 diopter (D) and −0.183±0.33 D in FS-SMILE group (P=0.50). A total of 93% of treated eyes in both groups had a MRSE within ±0.5 D. The mean percentage change of CH was 14.23±17.59 and 18.89±7.2 mm Hg (P=0.1871) in FS-SMILE and FS-LASIK groups, respectively. The mean percentage change of CRF was 27.43±16.8 and 21.32±17.1 mm Hg (P=0.1682) in FS-SMILE and FS-LASIK groups, respectively. A statistically significant difference between techniques were found in the values of Schirmer test (P=0.0002) and tear breakup time (P=0.0035). Regarding corneal HOAs, no statistically significant differences between groups were found in the change in the root mean square of HOAs (P=0.2), coma aberration (P=0.0589), and spherical aberration (P=0.0543).

Conclusion:

SMILE is as safe and predictable as FS-LASIK. According to the ORA system, SMILE is not better than FS-LASIK in terms of biomechanical changes. However, SMILE causes less effect on dry eye parameters during the first 3 postoperative months.
The Role of Oxygen Therapy in Normoxemic Acute Coronary Syndrome
Authors: Hu Xinyu , Cheng Shijiao , Yin Yuehui , Ning Lin , Xiang Liquan , Zhou Yinpin
Published: July 2018

Background:

Supplemental oxygen has been commonly used in the cases of acute coronary syndrome (ACS); however, recent evidence suggests that high-concentration oxygen supplementation and hyperbaric oxygen in ACS patients are associated with adverse cardiovascular effects.

Objective:

The purpose of this article is to systematically review the role of supplemental oxygen therapy in normoxemic patients with ACS.

Methods:

A search for randomized controlled trials before November 2017 in biomedical databases was performed, and a total of 6 eligible studies with 7508 participants were identified. Four studies reported all-cause mortality after randomization, whereas 3 studies measured myocardial infarct size using cardiac enzyme levels and magnetic resonance imaging. The effect size of our primary end point was the odds ratio for all-cause mortality. The mean difference was calculated as a secondary outcome for myocardial infarct size.

Results:

Compared with ambient air or titrated oxygen, high-concentration oxygen therapy did not significantly decrease all-cause mortality (odds ratio, 1.01; 95% confidence interval [CI], 0.81–1.25; P = .95) within 1 year nor infarct size detected by peak cardiac troponin (mean difference, −0.53 ng/mL; 95% CI, −1.20 to 0.14; P = .12) and magnetic resonance imaging (mean difference, 1.45 g; 95% CI, −1.82 to 4.73; P = .39). These outcomes were listed through a fixed-effects model because of low statistical heterogeneity across the studies.

Conclusions:

Oxygen therapy did not significantly reduce clinical all-cause mortality and myocardial infarct size in ACS patients with normoxemia. Further large-scale randomized clinical trials are warranted to evaluate the cardiovascular effects in this field.
Validation of a Spanish Version of the Information Needs in Cardiac Rehabilitation Scale to Assess Information Needs and Preferences in Cardiac Rehabilitation
Authors: Ghisi Gabriela Lima de Melo , Anchique Claudia Victoria , Fernandez Rosalía , Quesada-Chaves Daniel , Gordillo M. Ximena , Acosta Sheiles , Fernandez Julia , Arrieta-Loaiciga Blanca , Heredia Marco , Oh Paul
Published: July 2018

Background:

The identification of information needs is considered the first step to increase knowledge that ultimately could improve health outcomes in cardiac rehabilitation (CR).

Objective:

The aim of this study was to psychometrically validate the Spanish Information Needs in Cardiac Rehabilitation (INCR).

Methods:

The Spanish INCR was psychometrically tested in 184 patients undergoing CR. The internal consistency was assessed using Cronbach α, factor structure was assessed using exploratory factor analysis, and criterion validity regarding educational level, occupation, and duration in CR was assessed.

Results:

Cronbach α was .97. Factor analysis revealed 10 factors, all internally consistent. Criterion validity was supported by significant differences in total INCR scores by educational level (P < .01), occupation (P < .01), and duration in CR (P < .05). Emergency/safety was the greatest information need perceived by patients.

Conclusions:

The Spanish INCR was demonstrated to have good reliability and validity. This tool can be applicable in clinical and research settings, assessing patients' information needs during CR and as part of education programming.
Metabolism of innate immune cells: impact on atherosclerosis
Authors: Riksen Niels P. , Stienstra Rinke
Published: July 2018

Purpose of review

It is increasingly recognized that profound metabolic changes occur in activated myeloid cells, which shape their inflammatory phenotype and cellular functions. The purpose of this review is to summarize the accumulating evidence that major metabolic adaptations occur in monocytes and macrophages in the context of atherosclerosis ultimately modulating atherosclerotic plaque formation.

Recent findings

Plaque macrophages show a profound metabolic reprogramming which is driven by atherogenic factors in the plaque microenvironment, such as damage associated molecular patterns, modified lipoproteins, and hypoxia. In addition, systemic atherogenic factors modulate metabolism of circulating monocytes and their bone marrow progenitors. Activation of glycolysis, the pentose phosphate pathway, and fatty acid synthesis, a reduction of fatty acid oxidation accompanied by complex changes in the lysosomal handling of lipids all appear to facilitate atherogenesis. These processes also drive the development of trained immunity, a phenomenon describing the persistent pro-inflammatory phenotype that develops after brief stimulation of monocytes with pro-atherogenic stimuli.

A pro-atherosclerotic environment reprograms the metabolism of myeloid cells in the various developmental phases of atherosclerosis. Knowledge of these metabolic programs facilitates the development of novel drugs to prevent atherosclerotic cardiovascular disease.
Functional considerations in oral cavity reconstruction
Authors: Pipkorn Patrik , Rosenquist Kelsey , Zenga Joseph
Published: July 2018

Purpose of review

The treatment of oral cavity cancer may impair speech and swallowing function. Optimizing posttreatment function may lead to significant improvement of quality of life.

Recent findings

Although oncologic control remains the main goal of treatment for oral cavity cancer, posttreatment function for surviving patients has over the last decades been recognized as an important secondary outcome. Reconstruction of oral cavity defects range from primary closure to advanced microvascular reconstruction, including multiple tissue types. Free flap reconstruction has greatly enhanced the ability to tailor transferred tissue to specific defects. In this review, we describe recent findings in reconstruction of tongue defects, including data from perforator flaps. We also summarize recent evidence regarding reinnervated flaps.

When vascularized tissue is needed, it remains unclear how the reconstructive choice impacts postoperative outcome, although in many situations it appears to be dominated by the donor site morbidity rather than the reconstructive technique. Despite numerous case series, the functional impact of motor and sensory reinnervation in vascularized tissue remains unknown. Although perforator flaps have emerged as a promising flap option, with favorable donor site morbidity, their ultimate impact on functional outcomes remains unclear, whereas the success rate appears to be lower than traditional flaps.
Optimizing regulatory T cells for therapeutic application in human organ transplantation
Authors: Vaikunthanathan Trishan , Safinia Niloufar , Lombardi Giovanna
Published: July 2018

Purpose of review

Initial clinical trials of adoptive regulatory T-cell (Treg) therapy in solid organ transplantation have proven to be both feasible and well tolerated. With Phase 2 trials underway, efforts have been focused on the optimization of the Treg product.

Recent findings

With science and our knowledge on the biology of these cells constantly advancing, we have been able to refine our search for a Treg population that would be ideally suited for therapeutic application. This idealized population must be readily isolated, allow for in-vitro expansion, demonstrate potent and specific suppressor function, maintain lineage stability and demonstrate a relevant homing profile. With the advent of innovative cell analysis/isolation techniques and genetic modifications, we are able to choose and design Tregs to fulfil these criteria.

By utilizing advances in science and technology, we can optimize Treg therapy in human organ transplantation maximizing their prospects in the arena of transplantation tolerance.
Preparation of Powdered Infant Formula
Authors: Losio Marina Nadia , Pavoni Enrico , Finazzi Guido , Agostoni Carlo , Daminelli Paolo , Dalzini Elena , Varisco Giorgio , Cinotti Stefano
Published: July 2018

The recent outbreak of Salmonella Agona linked to the consumption of infant formula (powdered formula) has rekindled the attention about the correct procedures for preparation and use of these products. International guidelines have already been published so far, particularly in association with Cronobacter sakazakii in early 2000s. FAO/WHO suggested to reconstitute formula with water at no less than 70°C. We therefore contaminated powdered formula with low levels of Salmonella spp and C sakazakii to evaluate the pathogens inactivation during the formula preparation using water at 70°C. In these conditions we observed a survival of both pathogens, indicating that the suggested recommendations may be not enough to guarantee the safety of this product. Higher temperatures are needed to reduce the biological risk, even if it may be not easily realized in actual domestic conditions. Moreover, the impact on the nutritional value of reconstituted formulas should be evaluated.
Trajectories of Fasting Blood Glucose in Autologous Hematopoietic Cell Transplantation
Authors: Hammer Marilyn J. , Paul Steven M. , Steinberg Amir , Eckardt Patricia , Barton-Burke Margaret , Miaskowski Christine
Published: July 2018

Background

Patients who receive autologous hematopoietic cell transplantation (HCT) for the treatment of hematologic malignancies are at risk of serious adverse outcomes including infections and death. Hyperglycemia following the HCT is associated with increased risk of these adverse outcomes. However, limited information is available on demographic and clinical characteristics that contribute to changes in blood glucose levels following HCT.

Objective

The objective of this study was to determine the trajectories of fasting blood glucose (FBG) levels as well as the demographic and clinical characteristics that predicted interindividual differences in these FBG trajectories.

Methods

A sample of adult patients with hematologic malignancies who were scheduled to receive autologous HCT (n = 53) was enrolled in the study. Patients with preexisting diabetes were excluded. Demographic and clinical characteristics were abstracted from electronic medical records. Morning fasting laboratory tests (ie, FBG and absolute neutrophil counts) were obtained. Data were analyzed using hierarchical linear modeling from the day of HCT (day 0) through 14 days post-HCT.

Results

Among 8 characteristics evaluated, pre-HCT FBG was associated with variability in both the initial levels and the trajectories of FBG. Body mass index was only associated with initial levels of FBG.

Conclusions

The large amount of interindividual variability in the trajectories of FBG levels following autologous HCT suggests that glucose control in these patients warrants ongoing assessments and preemptive tailoring.

Implications for Practice

Fasting blood glucose monitoring is warranted. Additional research with larger samples is warranted to identify additional modifiable and nonmodifiable characteristics associated with interindividual variability in FBG levels.