bluuebunny/crossref_metadata_2025 huggingface dataset:
Maxillary mesenchymal chondrosarcoma leading to a diagnosis of Li-Fraumeni syndrome
Authors: Ventura Eduardo , Dionísio Sílvia , Ferreira Ângela , Saleiro Rute , Marques Hugo , Magalhães Manuel , Monteiro Carlos
Published: December 2019

Mesenchymal chondrosarcoma (MCS) is a rare histological variant of chondrosarcoma, with aggressive behaviour. Due to the unique nature of this disease, management strategies are not well established. Li-Fraumeni syndrome (LFS) is a rare cancer predisposition syndrome with a wide tumour spectrum, associated with TP53 germline mutations. We report a case of MCS of the maxilla, treated with surgical excision and adjuvant chemotherapy, in a patient with a past medical history of choroid plexus papilloma and a family history of early age first-degree cervical uterine cancer, that led to the clinical suspicion of a cancer predisposition syndrome and the subsequent diagnosis of LFS. This is the first MCS described in a LFS case. It demonstrates that adjuvant chemotherapy should be considered, in conjunction with surgical excision, in MCS and that cancer predisposition syndromes should be suspected in patients with multiple neoplasms and a strong family history of cancer.
Schistosomiasis, strongyloidiasis and Chagas disease: the leading imported neglected tropical diseases in Italy
Authors: Zammarchi Lorenzo , Gobbi Federico , Angheben Andrea , Spinicci Michele , Buonfrate Dora , Calleri Guido , De Paola Mirella , Bevilacqua Nazario , Carrara Stefania , Attard Luciano , Vanino Elisa , Gulletta Maurizio , Festa Elena , Iacovazzi Tiziana , Grimaldi Anna , Sepe Alessio , Salomone Megna Angelo , Gaiera Giovanni , Castagna Antonella , Parodi Patrizia , Albonico Marco , Bisoffi Zeno , Castelli Francesco , Olliaro Piero , Bartoloni Alessandro
Published: December 2019

Background

In recent years, an increasing number of individuals affected by neglected tropical diseases (NTDs) have been observed in Italy, due to migration, international travels and climate changes. Reliable data on the current NTD epidemiology in Italy and the health system preparedness on this issue are not available.

Methods

We report the results of a survey on selected NTDs (schistosomiasis, strongyloidiasis, echinococcosis, Chagas disease, leishmaniasis, cysticercosis, filariasis and scabies) in nine Italian sentinel centres, in order to investigate their occurrence throughout the country and identify which ones are a priority for public health interventions, development of protocols for case management, and training activities. To explore the preparedness of the centres, we investigate the availability of specific diagnostic tools and drugs, needed for the management of the most common NTDs. We also reviewed and summarized the available national policies, recommendations and guidelines on NTDs in Italy.

Results

Overall, 4123 NTDs cases were diagnosed in nine Italian centres within a 7-year period (2011–2017). Schistosomiasis and strongyloidiasis were the most common NTDs, accounting for about one-third each of all the diagnosed cases, followed by Chagas disease. The number of cases showed a significant trend to increase over time, mainly due to foreign-born subjects. Serology for Schistosoma spp. and Strongyloides stercoralis was available in seven and five centres, respectively. Agar plate stool culture for S. stercoralis was available in three sites. Ivermectin and praziquantel were always available in six centres. Six national policies, recommendations and guidelines documents were available, but for the most part, they are not fully implemented yet.

Conclusions

This survey showed how some NTDs, such as schistosomiasis and strongyloidiasis, are becoming more common in Italy, due to multiple components. A list of seven key actions was proposed, in order to improve diagnosis, management and control of NTDs in Italy.
A Case of Serum Sickness-Like Reaction in an Adult Treated with Omalizumab
Authors: Weiss Samuel L , Smith Derek M
Published: December 2019

Omalizumab has been safely used to treat asthma and urticaria. We report a case of serum sickness-like reaction in a patient treated with omalizumab for chronic idiopathic urticaria/angioedema. An adult female experienced episodic urticaria/angioedema without repeatable trigger, ultimately receiving diagnosis of chronic idiopathic urticaria/angioedema. After initial treatment, attempts with escalating cetirizine and montelukast doses were unsuccessful due to sedation; she began treatment with subcutaneous omalizumab 150 mg monthly. Urticaria frequency partially improved after two injections; therefore, the dose was increased to 300 mg after four treatments. Several days after first 300 mg dose, she reported abdominal cramping, fatigue, fever, lymphadenopathy, and arthralgia. Aside from mild thrombocytosis, inflammatory markers were unremarkable, as were evaluations for infection, autoimmunity, and malignancy. Omalizumab was held with eventual improvement in symptoms, which did not return after discontinuation. Omalizumab is a helpful medication in treating atopic conditions, with at least theoretical risk of immune complex formation and tissue deposition causing serum sickness-like reaction. Although early publications showed very low adverse event rates, there have now been reports of serum sickness-like reactions in children and adults treated for asthma and urticaria. Determining true incidence is difficult, given rarity and non-specific nature. Previous reports described symptoms with initiation of medication, reproducible after reintroduction. While it remains to be determined which factors increase risk for serum sickness-like reaction to omalizumab, our report of an urticaria patient who exhibited symptoms with increasing dose contributes insight into the discussion regarding this adverse effect of an otherwise well-tolerated and important medication.
Cervicogenic dizziness
Authors: Chu Eric Chun Pu , Chin Wui Ling , Bhaumik Amiya
Published: December 2019

Cervical muscles have numerous connections with vestibular, visual and higher centres, and their interactions can produce effective proprioceptive input. Dysfunction of the cervical proprioception because of various neck problems can alter orientation in space and cause a sensation of disequilibrium. Cervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain in patients with cervical pathology. Here, we report a 24-year-old female, who was diagnosed with CGD based on the correlating episodes of neck pain and dizziness. Both symptoms improved with targeted chiropractic adjustment and ultrasound therapy. CGD is a seemingly simple complaint for patients, but tends to be a controversial diagnosis because there are no specific tests to confirm its causality. For CGD to be considered, an appropriate management for the neck pain should not be denied any patient.
Behind the Scenes of South Africa’s Asylum Procedure: A Qualitative Study on Long-term Asylum-Seekers from the Democratic Republic of Congo
Authors: Schockaert Liesbeth , Venables Emilie , Gil-Bazo Maria-Teresa , Barnwell Garret , Gerstenhaber Rodd , Whitehouse Katherine
Published: December 2019

Despite the difficulties experienced by asylum-seekers in South Africa, little research has explored long-term asylum applicants. This exploratory qualitative study describes how protracted asylum procedures and associated conditions are experienced by Congolese asylum-seekers in Tshwane, South Africa. Eighteen asylum-seekers and eight key informants participated in the study. All asylum-seekers had arrived in South Africa between 2003 and 2013, applied for asylum within a year of arrival in Tshwane, and were still in the asylum procedure at the time of the interview, with an average of 9 years since their application. Thematic analysis was used to analyse the data. The findings presented focus on the process of leaving the Democratic Republic of Congo, applying for asylum and aspirations of positive outcomes for one’s life. Subsequently, it describes the reality of prolonged periods of unfulfilled expectations and how protracted asylum procedures contribute to poor mental health. Furthermore, coping mechanisms to mitigate these negative effects are described. The findings suggest that protracted asylum procedures in South Africa cause undue psychological distress. Thus, there is both a need for adapted provision of mental health services to support asylum-seekers on arrival and during the asylum process, and systemic remediation of the implementation of asylum procedures.
A Guide to Representational Similarity Analysis for Social Neuroscience
Authors: Popal Haroon , Wang Yin , Olson Ingrid R
Published: December 2019

Representational similarity analysis (RSA) is a computational technique that uses pairwise comparisons of stimuli to reveal their representation in higher-order space. In the context of neuroimaging, mass-univariate analyses and other multivariate analyses can provide information on what and where information is represented but have limitations in their ability to address how information is represented. Social neuroscience is a field that can particularly benefit from incorporating RSA techniques to explore hypotheses regarding the representation of multidimensional data, how representations can predict behavior, how representations differ between groups and how multimodal data can be compared to inform theories. The goal of this paper is to provide a practical as well as theoretical guide to implementing RSA in social neuroscience studies.
Variability in flooding tolerance, growth and leaf traits in a Populus deltoides intraspecific progeny
Authors: Rodríguez María E , Lauff Diana , Cortizo Silvia , Luquez Virginia M C
Published: December 2019

Climate change will increase the risk of flooding in several areas of the world where Populus deltoides Marshall (eastern cottonwood) is planted, so it would be desirable for this species to select for flooding tolerance. The aims of this work were to explore the variability in growth, leaf traits and flooding tolerance in an F1 full-sib intraspecific progeny of P. deltoides, to analyze the correlations of leaf and growth traits with flooding tolerance and to assess their suitability for use in breeding programs. Two-month-old parental clones and their progeny of 30 full-sib F1 genotypes were grown in pots and subjected to two treatments: (i) plants watered to field capacity (control) and (ii) plants flooded up to 10 cm above soil level for 35 days. Growth (height, diameter and biomass partition) and leaf traits (leaf size and number, specific leaf area, leaf senescence, abscission, stomatal conductance, carbon isotope discrimination, stomatal index) were measured. Flooding tolerance for each genotype was estimated as the ratio of the biomass of stressed plants to the biomass of control plants. Results showed segregation in terms of flooding tolerance in the F1 progeny. A significant genotype effect was found for leaf size and number, carbon isotopic discrimination and stomatal conductance, but it did not correlate with flooding tolerance. Height, diameter and root-to-shoot ratio had a positive phenotypic correlation with flooding tolerance, and there was a positive genetic correlation of height and diameter with biomass on both treatments. The narrow sense heritability values for the traits analyzed ranged from 0 to 0.56. We conclude that growth traits are more adequate than leaf traits for selection to increase flooding tolerance. A vigorous initial growth would increase flooding tolerance in young poplar plants.
Divergences in hydraulic conductance and anatomical traits of stems and leaves in three temperate tree species coping with drought, N addition and their interactions
Authors: Zhang Hongxia , McDowell Nate G , Adams Henry D , Wang Anzhi , Wu Jiabing , Jin Changjie , Tian Jinyuan , Zhu Kai , Li Weibin , Zhang Yushu , Yuan Fenghui , Guan Dexin
Published: December 2019

Drought and nitrogen (N) addition have been shown to affect tree hydraulic traits, but few studies have been made on their interactions across species with different wood types or leaf forms. We examined the responses of hydraulic conductance and xylem anatomical traits of Quercus mongolica (ring porous with simple leaves), Fraxinus mandshurica (ring porous with compound leaves) and Tilia amurensis (diffuse porous with simple leaves) to drought, N addition and their interactions. Drought stress decreased current-year xylem-specific conductivity in stems (Ksx) and leaf hydraulic conductance (Kleaf ), but N addition affected Ksx and Kleaf differently among species and watering regimes. These divergent effects were associated with different responses of anatomical traits and leaf forms. Higher mean vessel diameter in stems and lower vessel density in leaves were observed with N addition. The three-way interactive effects of drought, N addition and tree species were significant for most values of anatomical traits. These results were also reflected in large differences in vessel diameter and density among species with different wood types or leaf forms. The two-way interactive effects of drought and N addition were significant on Kleaf and predawn water potential, but not Ksx, indicating that leaves were more sensitive than stems to a combination of drought stress and N addition. Our results provide mechanistic insight into the variable responses of xylem water transport to the interactions of drought and N availability.
Intragenic recombination influences rotavirus diversity and evolution
Authors: Hoxie Irene , Dennehy John J
Published: December 2019

Because of their replication mode and segmented dsRNA genome, homologous recombination is assumed to be rare in the rotaviruses. We analyzed 23,627 complete rotavirus genome sequences available in the NCBI Virus Variation database, and found 109 instances of homologous recombination, at least eleven of which prevailed across multiple sequenced isolates. In one case, recombination may have generated a novel rotavirus VP1 lineage. We also found strong evidence for intergenotypic recombination in which more than one sequence strongly supported the same event, particularly between different genotypes of segment 9, which encodes the glycoprotein, VP7. The recombined regions of many putative recombinants showed amino acid substitutions differentiating them from their major and minor parents. This finding suggests that these recombination events were not overly deleterious, since presumably these recombinants proliferated long enough to acquire adaptive mutations in their recombined regions. Protein structural predictions indicated that, despite the sometimes substantial amino acid replacements resulting from recombination, the overall protein structures remained relatively unaffected. Notably, recombination junctions appear to occur nonrandomly with hot spots corresponding to secondary RNA structures, a pattern seen consistently across segments. In total, we found strong evidence for recombination in nine of eleven rotavirus A segments. Only segments 7 (NSP3) and 11 (NSP5) did not show strong evidence of recombination. Collectively, the results of our computational analyses suggest that, contrary to the prevailing sentiment, recombination may be a significant driver of rotavirus evolution and may influence circulating strain diversity.
WRKY Transcription Factors Shared by BTH-Induced Resistance and NPR1-Mediated Acquired Resistance Improve Broad-Spectrum Disease Resistance in Wheat
Authors: Li Huanpeng , Wu Jiaojiao , Shang Xiaofeng , Geng Miaomiao , Gao Jing , Zhao Shuqing , Yu Xiumei , Liu Daqun , Kang Zhensheng , Wang Xiaojie , Wang Xiaodong
Published: December 2019

In Arabidopsis, both pathogen invasion and benzothiadiazole (BTH) treatment activate the nonexpresser of pathogenesis-related genes 1 (NPR1)-mediated systemic acquired resistance, which provides broad-spectrum disease resistance to secondary pathogen infection. However, the BTH-induced resistance in Triticeae crops of wheat and barley seems to be accomplished through an NPR1-independent pathway. In the current investigation, we applied transcriptome analysis on barley transgenic lines overexpressing wheat wNPR1 (wNPR1-OE) and knocking down barley HvNPR1 (HvNPR1-Kd) to reveal the role of NPR1 during the BTH-induced resistance. Most of the previously designated barley chemical-induced (BCI) genes were upregulated in an NPR1-independent manner, whereas the expression levels of several pathogenesis-related (PR) genes were elevated upon BTH treatment only in wNPR1-OE. Two barley WRKY transcription factors, HvWRKY6 and HvWRKY70, were predicted and further validated as key regulators shared by the BTH-induced resistance and the NPR1-mediated acquired resistance. Wheat transgenic lines overexpressing HvWRKY6 and HvWRKY70 showed different degrees of enhanced resistance to Puccinia striiformis f. sp. tritici pathotype CYR32 and Blumeria graminis f. sp. tritici pathotype E20. In conclusion, the transcriptional changes of BTH-induced resistance in barley were initially profiled, and the identified key regulators would be valuable resources for the genetic improvement of broad-spectrum disease resistance in wheat.

[Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Storage Root Yield of Sweetpotato as Influenced bySweetpotato leaf curl virusand Its Interaction WithSweetpotato feathery mottle virusandSweetpotato chlorotic stunt virusin Kenya
Authors: Wanjala Bramwel W. , Ateka Elijah M. , Miano Douglas W. , Low Jan W. , Kreuze Jan F.
Published: December 2019

In this study, the effect of a Kenyan strain of Sweetpotato leaf curl virus (SPLCV) and its interactions with Sweetpotato feathery mottle virus (SPFMV) and Sweetpotato chlorotic stunt virus (SPCSV) on root yield was determined. Trials were performed during two seasons using varieties Kakamega and Ejumula and contrasting in their resistance to sweetpotato virus disease in a randomized complete block design with 16 treatments replicated three times. The treatments included plants graft inoculated with SPLCV, SPFMV, and SPCSV alone and in possible dual or triple combinations. Yield and yield-related parameters were evaluated at harvest. The results showed marked differences in the effect of SPLCV infection on the two varieties. Ejumula, which is highly susceptible to SPFMV and SPCSV, suffered no significant yield loss from SPLCV infection, whereas Kakamega, which is moderately resistant to SPFMV and SPCSV, suffered an average of 47% yield loss from SPLCV, despite only mild symptoms occurring in both varieties. These results highlight the variability in yield response to SPLCV between sweetpotato cultivars as well as a lack of correlation of SPLCV-related symptoms with yield reduction. In addition, they underline the lack of correlation between resistance to the RNA viruses SPCSV and SPFMV and the DNA virus SPLCV.

[Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Genome-Wide Mapping of Adult Plant Resistance to Leaf Rust and Stripe Rust in CIMMYT Wheat Line Arableu#1
Authors: Yuan Chan , Singh Ravi P. , Liu Demei , Randhawa Mandeep S. , Huerta-Espino Julio , Lan Caixia
Published: December 2019

Leaf (brown) rust (LR) and stripe (yellow) rust (YR), caused by Puccinia triticina and P. striiformis f. sp. tritici, respectively, significantly reduce wheat production worldwide. Disease-resistant wheat varieties offer farmers one of the most effective ways to manage these diseases. The common wheat (Triticum aestivum L.) Arableu#1, developed by the International Maize and Wheat Improvement Center and released as Deka in Ethiopia, shows susceptibility to both LR and YR at the seedling stage but a high level of adult plant resistance (APR) to the diseases in the field. We used 142 F5 recombinant inbred lines (RILs) derived from Apav#1 × Arableu#1 to identify quantitative trait loci (QTLs) for APR to LR and YR. A total of 4,298 genotyping-by-sequencing markers were used to construct a genetic linkage map. The study identified four LR resistance QTLs and six YR resistance QTLs in the population. Among these, QLr.cim-1BL.1/QYr.cim-1BL.1 was located in the same location as Lr46/Yr29, a known pleiotropic resistance gene. QLr.cim-1BL.2 and QYr.cim-1BL.2 were also located on wheat chromosome 1BL at 37 cM from Lr46/Yr29 and may represent a new segment for pleiotropic resistance to both rusts. QLr.cim-7BL is likely Lr68 given its association with the tightly linked molecular marker cs7BLNLRR. In addition, QLr.cim-3DS, QYr.cim-2AL, QYr.cim-4BL, QYr.cim-5AL, and QYr.cim-7DS are probably new resistance loci based on comparisons with published QTLs for resistance to LR and YR. Our results showed the diversity of minor resistance QTLs in Arableu#1 and their role in conferring near-immune levels of APR to both LR and YR, when combined with the pleiotropic APR gene Lr46/Yr29.
Higd1a improves respiratory function in the models of mitochondrial disorder
Authors: Nagao Takemasa , Shintani Yasunori , Hayashi Takaharu , Kioka Hidetaka , Kato Hisakazu , Nishida Yuya , Yamazaki Satoru , Tsukamoto Osamu , Yashirogi Shohei , Yazawa Issei , Asano Yoshihiro , Shinzawa‐Itoh Kyoko , Imamura Hiromi , Suzuki Takeo , Suzuki Tsutomu , Goto Yu‐ichi , Takashima Seiji
Published: December 2019

The respiratory chain (RC) transports electrons to form a proton motive force that is required for ATP synthesis in the mitochondria. RC disorders cause mitochondrial diseases that have few effective treatments; therefore, novel therapeutic strategies are critically needed. We previously identified Higd1a as a positive regulator of cytochrome c oxidase (CcO) in the RC. Here, we test that Higd1a has a beneficial effect by increasing CcO activity in the models of mitochondrial dysfunction. We first demonstrated the tissue‐protective effects of Higd1a via in situ measurement of mitochondrial ATP concentrations ([ATP]mito) in a zebrafish hypoxia model. Heart‐specific Higd1a overexpression mitigated the decline in [ATP]mito under hypoxia and preserved cardiac function in zebrafish. Based on the in vivo results, we examined the effects of exogenous HIGD1A on three cellular models of mitochondrial disease; notably, HIGD1A improved respiratory function that was coupled with increased ATP synthesis and demonstrated cellular protection in all three models. Finally, enzyme kinetic analysis revealed that Higd1a significantly increased the maximal velocity of the reaction between CcO and cytochrome c without changing the affinity between them, indicating that Higd1a is a positive modulator of CcO. These results corroborate that Higd1a, or its mimic, provides therapeutic options for the treatment of mitochondrial diseases.
Recovery of viable endocrine‐specific cells and transcriptomes from human pancreatic islet‐engrafted mice
Authors: Redick Sambra D. , Leehy Linda , Rittenhouse Ann R. , Blodgett David M. , Derr Alan G. , Kucukural Alper , Garber Manuel G. , Shultz Leonard D. , Greiner Dale L. , Wang Jennifer P. , Harlan David M. , Bortell Rita , Jurczyk Agata
Published: December 2019

Human pancreatic islets engrafted into immunodeficient mice serve as an important model for in vivo human diabetes studies. Following engraftment, islet function can be monitored in vivo by measuring circulating glucose and human insulin; however, it will be important to recover viable cells for more complex graft analyses. Moreover, RNA analyses of dissected grafts have not distinguished which hormone‐specific cell types contribute to gene expression. We developed a method for recovering live cells suitable for fluorescence‐activated cell sorting from human islets engrafted in mice. Although yields of recovered islet cells were relatively low, the ratios of bulk‐sorted β, α, and δ cells and their respective hormone‐specific RNA‐Seq transcriptomes are comparable pretransplant and posttransplant, suggesting that the cellular characteristics of islet grafts posttransplant closely mirror the original donor islets. Single‐cell RNA‐Seq transcriptome analysis confirms the presence of appropriate β, α, and δ cell subsets. In addition, ex vivo perifusion of recovered human islet grafts demonstrated glucose‐stimulated insulin secretion. Viable cells suitable for patch‐clamp analysis were recovered from transplanted human embryonic stem cell‐derived β cells. Together, our functional and hormone‐specific transcriptome analyses document the broad applicability of this system for longitudinal examination of human islet cells undergoing developmental/metabolic/pharmacogenetic manipulation in vivo and may facilitate the discovery of treatments for diabetes.
Longitudinal Investigation of Military-specific Factors Associated With Continued Unhealthy Alcohol Use Among a Large US Military Cohort
Authors: Jacobson Isabel G. , Williams Emily C. , Seelig Amber D. , Littman Alyson J. , Maynard Charles C. , Bricker Jonathan B. , Rull Rudolph P. , Boyko Edward J.
Published: December 2019

Objective:

To examine whether military separation (Veteran), service component (active duty, Reserve/National Guard), and combat deployment are prospectively associated with continuing unhealthy alcohol use among US military service members.

Methods:

Millennium Cohort Study participants were evaluated for continued or chronic unhealthy alcohol use, defined by screening positive at baseline and the next consecutive follow-up survey for heavy episodic, heavy weekly, or problem drinking. Participants meeting criteria for chronic unhealthy alcohol use were followed for up to 12 years to determine continued unhealthy use. Multivariable regression models—adjusted for demographics, military service factors, and behavioral and mental health characteristics—assessed whether separation status, service component, or combat deployment were associated with continuation of 3 unhealthy drinking outcomes: heavy weekly (sample n = 2653), heavy episodic (sample n = 22,933), and problem drinking (sample n = 2671).

Results:

In adjusted models, Veterans (compared with actively serving personnel) and Reserve/Guard (compared with active duty members) had a significantly higher likelihood of continued chronic use for heavy weekly, heavy episodic, and problem drinking (Veteran odds ratio [OR] range 1.17–1.47; Reserve/Guard OR range 1.25–1.29). Deployers without combat experience were less likely than nondeployers to continue heavy weekly drinking (OR 0.75, 95% confidence interval 0.61–0.91).

Conclusions:

The elevated likelihood of continued unhealthy alcohol use among Veterans and Reserve/Guard members suggests that strategies to reduce unhealthy drinking targeted to these populations may be warranted.
Local Application of a Gentamicin-Loaded Hydrogel Early After Injury Is Superior to Perioperative Systemic Prophylaxis in a Rabbit Open Fracture Model
Authors: Vallejo Diaz Alejandro , Deimling Christian , Morgenstern Mario , D'Este Matteo , Puetzler Jan , Zeiter Stephan , Arens Daniel , Metsemakers Willem-Jan , Richards R. Geoff , Eglin David , Moriarty T. Fintan
Published: December 2019

Objectives:

Open fractures are at significant risk of developing a fracture-related infection, despite the routine administration of perioperative antibiotic prophylaxis. Early application of antibiotic prophylaxis is known to reduce infection rates; however, most international guidelines focus on postoperative duration rather than prehospital administration. We compared conventional perioperative prophylaxis against early prehospital prophylaxis either as a systemic single shot of cefuroxime or a locally applied gentamicin-loaded hydrogel in a laboratory animal model.

Methods:

Thirty New Zealand white rabbits underwent a first surgical procedure to create an open wound, bone damage and contamination with Staphylococcus aureus. After a 4-hour observation period mimicking the time-to-treatment, the animals underwent a second procedure to irrigate the wound and apply a fracture fixation device. The 5 groups (n = 6 per group) received (1) no treatment; (2) conventional 24-hour cefuroxime; (3) an early single shot of cefuroxime 15 minutes after trauma; (4) a combined early and standard systemic prophylaxis; and (5) early application of a gentamicin-loaded hydrogel that was removed during irrigation.

Results:

Untreated animals displayed high numbers of bacteria in irrigation fluid and were all highly culture positive at euthanasia. Three of 6 animals were culture positive at euthanasia after conventional prophylaxis. Early systemic prophylaxis reduced bacterial burden in irrigation fluid by up to 100-fold, but 5/6 animals were culture positive at euthanasia. The combined prophylaxis displayed greater efficacy with only 1/6 rabbits culture positive at euthanasia. Local application of the gentamicin-loaded hydrogel reduced bacteria recovered by irrigation to just above our detection limit, and at euthanasia, all animals were culture negative at euthanasia.

Conclusions:

Early systemic antibiotic administration can significantly reduce bacterial burden in the operative field and reduce culture positivity at euthanasia when continued for 24 hours after injury. The early application of a gentamicin-loaded hydrogel that was removed during irrigation displayed superior efficacy to early systemic therapy alone and postoperative conventional gold standard 24-hour systemic therapy alone. These experimental results highlight the importance of early antibiotic administration in fracture care.
The “FCR” Approach to the Knee for the Management of Posterior Tibial Plateau Fractures
Authors: Berwin James T. , Donovan Richard L. , Riddick Andrew , Kelly Michael B.
Published: December 2019

Three-column fixation of tibial plateau fractures is now an established philosophy. A direct posterior approach with the patient prone affords enhanced exposure of the posterior column and ease of access for fixation using a buttress plate and posterior-to-anterior screws. A “direct posterior” approach through a reverse L-shaped incision to back of the knee is popular, yet complications associated with raising a fascial flap can occur. We present a simple method of conceptualizing a direct posterior approach through a single longitudinal incision, by likening it to a commonly performed orthopedic approach, the flexor carpi radialis approach to the wrist.
Developing a province-wide hip surveillance program for children with cerebral palsy: from evidence to consensus to program implementation: a mini-review
Authors: Miller Stacey D. , Mayson Tanja A. , Mulpuri Kishore , O’Donnell Maureen E.
Published: December 2019

Hip displacement is a common orthopedic problem in children with cerebral palsy (CP) that can result in significant morbidity. Hip surveillance has been shown to reduce the incidence of hip dislocations in children with CP and to reduce the need for salvage hip surgeries. Guidelines for hip surveillance have been developed and can be adapted to meet local needs. Implementation of surveillance guidelines for a population of children is complex and highly dependent upon the region, province/state, or country’s system of care for children with CP. Recognizing that implementation of the evidence on hip surveillance was necessary in British Columbia, a Canadian province spanning 1 million square kilometers, a comprehensive, coordinated approach to hip surveillance was developed collaboratively by provincial stakeholders. Surveillance guidelines and a desired implementation plan were established based on the best available research evidence, current international practice, and service delivery in British Columbia. Staged implementation preceded full provincial roll out. Implementation was supported by detailed communication, knowledge translation, and evaluation plans. This province-wide hip surveillance program is the first of its kind in North America.
Apigenin Prevent Abdominal Aortic Aneurysms Formation by Inhibiting the NF-κB Signaling Pathway
Authors: Li Dongyu , Ma Ju , Wang Lei , Xin Shijie
Published: December 2019

Abdominal aortic aneurysms (AAA) is a multifactorial vascular disease with a high rate of mortality and brings heavy burden to both human and society. The pathological process behind AAA is complex. Elastin degradation, chronic inflammation, and vascular smooth muscle cell phenotypic modulation are involved in AAA formation. Apigenin (API) has gained much attention due to its specific properties, such as anti-inflammation, antioxidant, and anti-cancer effects. Previous studies have demonstrated that API exert beneficial effects on prevention of cardiovascular diseases. However, the effects of API on AAA are still unknown. Here, we for the first time evaluated API-related effects on AAA formation using a Cacl2-induced AAA model. Compared with the AAA group, treatment with API reduced the incidence of AAA, attenuated pathological expansion of the aorta, and preserved elastic fiber in a dose-dependent manner. In addition, API attenuated vascular inflammation by inhibiting activation of matrix metalloproteinase and modulated vascular smooth muscle cell contractile phenotypic transition. The preventative effect of API on AAA might be associated with the downregulation of nuclear factor-kappa B (NF-κB) activity via the IKK-dependent signaling pathway. Our findings firstly revealed that API could suppress AAA formation in a dose-dependent manner by inhibiting the NF-κB signaling pathway, and API should be considered as a promising therapeutic drug in prevention of AAA.
A Rare Case of Nipple–Areolar Complex Partial Necrosis following Micropigmentation: What to Learn?
Authors: Starnoni Marta , Pinelli Massimo , Franceschini Gianluca , De Santis Giorgio
Published: December 2019

A 52-year-old woman, without any comorbidity, presented at our institution for reconstruction of nipple–areolar complex (NAC). Nipple reconstruction was obtained through local skin flaps. After 2 months, a tattoo of the NAC was performed. Follow-up was planned at 6 months. Nevertheless, the patient came to our attention 2 days after tattooing for partial necrosis of the epidermal–dermal layer of the tattooed area with partial muscular layer exposition. Empirical antibiotic treatment was immediately started to avoid infection. Daily medications were performed for 3 weeks. Complete healing was obtained within 3 weeks without the necessity of a skin graft. We think that the partial necrosis of the NAC occured because of vascular impairment of the dermal and subdermal vascular plexus during micropigmentation. From this experience, we developed some advice to improve our clinical practice by allowing surgeons, especially if trainees, to avoid complications in performing NAC micropigmentation.
Z-plasty and Postoperative Radiotherapy for Upper-arm Keloids: An Analysis of 38 Patients
Authors: Dohi Teruyuki , Kuribayashi Shigehiko , Tosa Mamiko , Aoki Masayo , Akaishi Satoshi , Ogawa Rei
Published: December 2019

Background:

Therapies for upper arm keloids include surgical excision followed by postoperative radiotherapy, silicone tape stabilization, and steroid plaster. However, a universally accepted therapeutic strategy for upper-arm keloids is lacking.

Methods:

All consecutive patients with single upper-arm keloids who underwent keloid excision followed by tension-reducing suturing, multiple z-plasties, and postoperative radiotherapy in 2013–2016 in the keloid/scar specialist clinic at the Department of Plastic, Reconstructive and Aesthetic Surgery of Nippon Medical School, were included in this case series study. Only keloids that arose from the small injury produced during Bacillus Calmette–Guérin vaccination were selected. The postsurgical radiotherapy regimen was 18 Gy administered in 3 fractions over 3 days. Radiotherapy was followed by tension-reducing wound self-management with silicone tape and, if needed, steroid plaster. The primary study objective was keloid recurrence during the 24-month follow-up period. Recurrence was defined as the growth of stiff red lesions in even small areas of the scar that was refractory to at least 2 months of steroid plaster therapy.

Results:

In total, 38 patients with 38 lesions were enrolled. Two lesions (5.3%) recurred. Both recurrences were successfully treated by concomitant steroid plaster and steroid injection. The recurrence patients were significantly more likely than the nonrecurrence patients to have multiple keloids. The 2 groups did not differ in terms of original keloid size.

Conclusions:

Upper-arm keloids can be successfully treated by customized plans that involve appropriate surgical modalities (including multiple z-plasties), postoperative radiotherapy (18 Gy/3 fractions/3 d), and postoperative wound/scar self-management with silicone tape and steroid plaster.
Reconstruction of the Superficial Palmar Arch Using the Subscapular Arterial System
Authors: Steve Anna K. , Doucet Véronique , Dumestre Danielle , Yau Farrah M. K.
Published: December 2019

Hypothenar hammer syndrome is a rare entity warranting urgent exploration of the ulnar artery if signs of critical digital ischemia are present. To the authors’ knowledge and based on review of the relevant literature, this case report is the first to describe the harvest of the subscapular arterial system for reconstruction of an extensive arterial defect involving the ulnar artery, superficial palmar arch, and associated branches for a case of hypothenar hammer syndrome. The patient presented with an ischemic and exquisitely painful fourth digit. After undergoing the aforementioned reconstruction, all digits were subsequently well perfused with normal capillary refill, color, warmth, and sensation. A strong ulnar pulse was palpated at the volar wrist crease. Patency of the interposition graft was verified by CT angiography (6 weeks postoperatively) and Doppler ultrasound (4 months postoperatively), showing strong radial and ulnar digital pulses of all digits. CT angiography was repeated at 6 months postoperatively and showed graft occlusion. Despite this, no signs of critical ischemia developed, and clinical symptoms were still much improved from initial presentation, with only residual cold intolerance noted 13 months postoperatively. As an arterial graft donor site, the subscapular system is easily accessible, offers generous length, and provides for multiple branches, making it ideal for the reconstruction of large, complex arterial defects in the hand.
Long-term Audiometric Outcomes After Atresiaplasty for Congenital Aural Atresia
Authors: Imbery Terence E. , Gray Lincoln , Champaloux Eve , Kesser Bradley W.
Published: December 2019

Objective:

Describe long-term trends and stability of hearing outcomes for patients undergoing primary congenital aural atresia (CAA) repair.

Study Design:

Retrospective chart review.

Setting:

Single academic, tertiary referral center.

Patients:

Children and adults who underwent primary CAA repair between 1980 and 2017.

Intervention:

CAA repair.

Main Outcome Measures:

Long-term (> 1 yr) postoperative three-tone (500, 1000, 2000 Hz) air conduction pure-tone average (AC PTA) compared with the immediate (within 90 d of surgery) postoperative audiogram.

Results:

The mean preoperative AC PTA was 59.6 dB HL. CAA repair improved hearing an average of 30.5 dB, but hearing declined by 8.2 dB over the long-term follow-up period (mean 4.4 yr; range 1–15.7 yr), leaving a final mean improvement of 22.2 dB (final mean AC PTA 37.3 dB HL). Two-thirds (92 of 138 ears) had an AC PTA ≤ 30 dB HL recorded in the first year after surgery. At the last follow-up test, 64% had “stable” hearing defined as no more than a 10 dB decline in AC PTA compared with the immediate postoperative audiogram; 21% had a 10 to 20 dB decline, 8% a 20 to 30 dB decline, and 7% declined > 30 dB.

Conclusions:

All patients enjoyed improvement in AC PTA after surgery (preoperative minus the best postoperative PTA, mean = 34 dB, range = 3.3–52 dB). Hearing declined by an average 8.2 dB over the long-term leaving a final average AC PTA of 37.4 dB HL. Sixty-four percent of patients exhibited stable (< 10 dB loss) hearing over time; 36% lost 10 dB or more over the long-term follow-up period. Hearing results typically stabilize over time with most of the change occurring in the first 3 years after CAA repair. Bone conduction thresholds remained stable over the study period.
A New, Promising Experimental Ossicular Prosthesis: A Human Temporal Bone Study With Laser Doppler Vibrometry
Authors: Rönnblom Anton , Gladiné Kilian , Niklasson Anders , von Unge Magnus , Dirckx Joris , Tano Krister
Published: December 2019

Objective:

We compared the sound transmission using different types of total ossicular replacement prostheses (TORP); we then studied the performance of a new TORP that we designed inspired by the columella, the single ossicle found in birds.

Methods:

Stapedial vibrations were measured on nine freshly frozen human temporal bones with laser Doppler vibrometry. We then compared the performances of eight common TORP positions or designs as well as the new silver prototype of bird-type prosthesis, designed also according to our digital holography patterns of the human tympanic membrane (TM).

Results:

The TORPs placed in lateral contact with both the TM and the malleus handle outperformed, at most frequencies, those placed only in contact with the TM.

The new bird-type prosthesis performed equally well or better than all other prostheses.

Conclusion:

If the malleus handle can be retained when placing a TORP, the best sound transmission can be achieved by placing the TORP in contact with both the distal part of the malleus handle and the TM. The good performance of our bird-type prosthesis suggests that there is still room for future improvement of prosthesis design to further optimize hearing outcomes after surgery.
Predictive value of the combination of brachial-ankle pulse wave velocity and ankle-brachial index for cardiovascular outcomes in patients with acute myocardial infarction
Authors: Park Hyun-Woong , Kim Hye-Ree , Kang Min Gyu , Kim Kyehwan , Koh Jin-Sin , Park Jeong Rang , Hwang Seok-Jae , Jeong Young-Hoon , Ahn Jong Hwa , Park Yongwhi , Hwang Jin-Yong
Published: December 2019

Background:

Although ankle-brachial index and brachial-ankle pulse wave velocity measurement are well-established modalities for assessing peripheral artery disease and arterial stiffness and predicting cardiovascular events, it is unclear which one is more important or if a combination of the two is more effective for determining prognosis among patients with acute myocardial infarction.

Methods:

Patients with acute myocardial infarction (n = 889) were stratified into four groups according to a brachial-ankle pulse wave velocity (cut-off value: 1684 cm/s) and ankle-brachial index (cut-off value: 0.98): group I (high ankle-brachial index and low brachial-ankle pulse wave velocity, n = 389), group II (high ankle-brachial index and high brachial-ankle pulse wave velocity, n = 281), group III (low ankle-brachial index and low brachial-ankle pulse wave velocity, n = 103), group IV (low ankle-brachial index and high brachial-ankle pulse wave velocity, n = 116). The mean follow-up duration was 348 days.

Results:

Major adverse cardiovascular events or cardiac death occurred in 64 (7.2%) and 26 patients (2.9%), respectively. In multivariable analysis, group III and IV had a significant high hazard ratio for major adverse cardiovascular events (5.93, 5.43) and cardiac death (13.51, 19.06). Additionally, ankle-brachial index had a higher hazard ratio than brachial-ankle pulse wave velocity for major adverse cardiovascular events (3.38 vs. 1.40) and cardiac death (6.21 vs. 2.40). When comparing receiver operating characteristic curves of the combined models of risk factors, brachial-ankle pulse wave velocity, and ankle-brachial index, pulse wave velocity plus ankle-brachial index or pulse wave velocity plus ankle-brachial index plus risk factors were significantly more predictive of major adverse cardiovascular events than risk factors.

Conclusion:

Our findings indicate that ankle-brachial index is a strong independent prognostic factor and adding a brachial-ankle pulse wave velocity measurement to ankle-brachial index increases the prognostic power for cardiac events in patients with acute myocardial infarction, while ankle-brachial index and pulse wave velocity showed additive value to risk factors.
Trait Perfectionism and Psychosocial Outcomes in Adolescents With Inflammatory Bowel Disease
Authors: Piercy Jamie , Stinson Jennifer , Church Peter C. , Walters Thomas D. , Frost Karen , Ahola Kohut Sara
Published: December 2019

Objectives:

The aim of this prospective cross‐sectional study was to examine perfectionism, disease self‐management, and psychosocial outcomes in a sample of adolescents with inflammatory bowel disease (IBD).

Methods:

Adolescent patients with IBD and caregivers were enrolled in the study. Patients completed the Child and Adolescent Perfectionism Scale, the Strengths and Difficulties Questionnaire (SDQ), and the TRANSITION‐Q. Parents completed the Multidimensional Perfectionism Scale and the parent form of the SDQ. Health care providers reported on disease activity using the Pediatric Ulcerative Colitis Activity Index (PUCAI) and the Pediatric Crohn Disease Activity Index (PCDAI).

Results:

Ninety adolescents (mean age 15.17 ± 1.49, range = 12–18) with diagnosed IBD (51 CD, 37 UC, and 2 IBD‐U) and 76 primary caregivers participated in the study. Results indicated high rates of self‐oriented perfectionism in adolescents with IBD (59% of sample reported elevated rates; 33% of sample in the clinical range). After accounting for age, sex, and disease activity, self‐oriented perfectionistic striving was associated with better disease self‐management; nonetheless, adolescent and parent perfectionistic strivings were also related to higher adolescent internalizing symptoms (standardized beta = 0.22 and 0.29, respectively). Additionally, perfectionistic concerns (self‐critical and socially prescribed perfectionism) were associated with higher rates of adolescent‐reported externalizing symptoms (standardized beta 0.30 and 0.24). Further, multilevel mixed modelling found no differences within‐dyad in relation to perfectionism, but documented that adolescents report higher levels of externalizing symptoms compared with parents.

Conclusions:

The present study explores the prevalence and presentation of perfectionism in a sample of adolescents with IBD. Results suggest dimensions of perfectionism are differentially associated with psychosocial and disease management outcomes, suggesting further evidence of the relationship between perfectionism, maladaptive coping, and subsequent influences on health outcomes in the context of pediatric chronic illness.