bluuebunny/crossref_metadata_2025 huggingface dataset:
Cranial neuralgias and persistent idiopathic facial pain
Authors: Gozalov Aydin , Ashina Messoud , Zakrzewska Joanna M.
Published: April 2020

Orofacial pain is a complex problem and affects up to 7% of the population. Although trigeminal neuralgia has been considered the prime neuralgic condition in the facial region, other forms of neuropathic pain are now being more frequently recognized and require recognition and a different management approach. Many patients with chronic orofacial pain report numerous comorbidities, such as psychiatric or personality disorders, which significantly affect management. Various pain conditions present in the facial region. Some of them rarely present extra-orally (unless as radiating pain) such as atypical odontalgia or persistent dento-alveolar pain disorder and burning mouth syndrome, whereas others will present in both areas such as classical trigeminal neuralgia, post-traumatic trigeminal neuropathy, trigeminal neuropathy attributed to multiple sclerosis, and persistent idiopathic facial pain. Myofascial pain syndrome related to the muscles of mastication is very common and may also be associated with temporomandibular joint problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are similar in quality and characteristics with specific treatment modalities, but differ in pain location. Trigeminal neuropathic pain is caused most frequently by trauma. If no other diagnostic criteria are fulfilled, a diagnosis of persistent idiopathic facial pain is made. It is crucial for these patients to be managed by multidisciplinary teams.
Some rare headache disorders, including Alice in Wonderland syndrome, blip syndrome, cardiac cephalalgia, epicrania fugax, exploding head syndrome, Harlequin syndrome, lacrimal neuralgia, neck–tongue syndrome, and red ear syndrome
Authors: Evans Randolph W.
Published: April 2020

A fascinating array of rare headache disorders—Alice in Wonderland syndrome, blip syndrome, cardiac cephalalgia, epicrania fugax, exploding head syndrome, harlequin syndrome, lacrimal headache, ictal epileptic headache, neck–tongue syndrome, and red ear syndrome—are reviewed in this chapter. Appropriate diagnosis and treatment as appropriate can be most reassuring to the patient. There are additional rare headache disorders just waiting to be described by astute clinicians.
Headache associated with head trauma
Authors: Lucas Sylvia
Published: April 2020

Traumatic brain injury (TBI) is an extremely important, common global health issue with approximately 2.5 million TBIs occurring yearly in the civilian population alone. The symptom manifestations of TBI are called ‘concussion’ symptoms and headache is the most common. Post-traumatic headache (PTH) is a secondary headache occurring in temporal association with the TBI and thought to be caused by the injury. Many studies have found PTH to be frequent and persistent, with a higher prevalence of PTH after mild than moderate to severe TBI. In both severity injuries, the most frequent phenotype of PTH is migraine or probable migraine. PTH risk factor after injury is a prior history of primary headache disorder. The relationship between TBI and PTH is unknown and currently the subject of intense research. As yet, treatment of PTH is empiric with standard of care to ‘phenotype’ the headache according to primary headache clinical characteristics and use the type as a guideline for management.
Cervicogenic headache
Authors: Bogduk Nikolai
Published: April 2020

Idiopathic intracranial hypertension (IIH) is a disorder of raised intracranial pressure, almost always associated with papilloedema, in the absence of underlying central nervous system pathology. It is a rare disease, with an annual incidence of around 1 in 100,000 persons, with an age of onset between 11 and 58 years. It is predominantly seen in obese women of childbearing age (incidence 10–20 per 100,000), but can affect any age, ethnicity, or sex. The two morbidities associated with IIH are vision loss and headache, with headache ultimately affecting > 90% of patients. The exact mechanisms underlying IIH related headache pain are still unknown, but it is often debilitating and significantly impacts on quality of life. The goal of treatment is to reduce intracranial pressure to minimize vision loss and headaches. Effective medical and surgical interventions are available for treatment of headache in IIH and are tailored to each individual patient. Overall, the prognosis for treatment of headache in IIH is good.
Headache associated with high cerebrospinal fluid pressure
Authors: Adesina Ore-ofe O. , Reddi Sudama , Friedman Deborah I. , Digre Kathleen
Published: April 2020

Idiopathic intracranial hypertension (IIH) is a disorder of raised intracranial pressure, almost always associated with papilloedema, in the absence of underlying central nervous system pathology. It is a rare disease, with an annual incidence of around 1/100,000 persons with an onset between 11 and 58 years. It is predominantly seen in obese women of childbearing age (incidence 10–20/100,000), but can affect any age, race, or sex. The two morbidities associated with IIH are vision loss and headache, with headache ultimately affecting over 90% of patients. The exact mechanisms underlying IIH related headache pain are still unknown, but it is often debilitating and significantly impacts quality of life. The goal of treatment is to reduce intracranial pressure to minimize vision loss and headaches. Effective medical and surgical interventions are available for treatment of headache in IIH and are tailored to each individual patient. Overall, the prognosis for treatment of headache in IIH is good.
Headache and fibromyalgia
Authors: de Tommaso Marina , Sciruicchio Vittorio
Published: April 2020

Fibromyalgia (FM) is a chronic pain syndrome that is associated with a high level of disability and medical costs. FM is commonly comorbid with migraine and tension-type headache, and is also associated with sleep disturbances, anxiety, and pericranial muscle tenderness Fibromyalgia may be caused by central sensitization, which is also believed to be an important mechanism in the development of chronic headache. Fibromyalgia remains underdiagnosed in the paediatric population, while the early recognition of this syndrome would improve the efficacy of therapy. There are presently no evidence-based guidelines for the pharmacological and non-pharmacological treatment of headache patients with comorbid FM. Amitriptyline has been reported to be efficacious in in migraine, tension-type headache, and fibromyalgia independently, but evidence regarding comorbid headache and fibromyalgia is lacking. Non-pharmacological approaches that have shown promise in patients with chronic migraine and fibromyalgia include transcranial electric and mechanical stimulation.
Low-energy core-collapse supernovae in the frame of the jittering jets explosion mechanism
Authors: Gofman Roni Anna , Soker Noam
Published: April 2020

We relate the pre-explosion binding energy of the ejecta of core-collapse supernovae (CCSNe) of stars with masses in the lower range of CCSNe and the location of the convection zones in the pre-collapse core of these stars, to explosion properties in the frame of the jittering jets explosion mechanism. Our main conclusion is that in the frame of the jittering jets explosion mechanism the remnant of a pulsar in these low-energy CCSNe has some significance, in that the launching of jets by the newly born neutron star (NS) spins-up the NS and create a pulsar. We crudely estimated the period of the pulsars to be tens of milliseconds in these cases. The convective zones seed perturbations that lead to accretion of stochastic angular momentum that in turn is assumed to launch jittering jets in this explosion mechanism. We calculate the binding energy and the location of the convective zones with the stellar evolution code mesa. For the lowest stellar masses, we study, MZAMS ≃ 8.5–11 M⊙, the binding energy above the convective zones is low, and so is the expected explosion energy in the jittering jets explosion mechanism that works in a negative feedback cycle. The expected mass of the NS remnant is MNS ≈ 1.25–1.6 M⊙, even for these low-energy CCSNe.
The eye of Gaia on globular clusters structure: tidal tails
Authors: Sollima A
Published: April 2020

I analyse the projected density distribution of member stars over a wide area surrounding 18 Galactic globular clusters using the photometric and astrometric information provided by the second data release of the Gaia mission. A 5D mixture modelling technique has been employed to optimally isolate the signal of the cluster stellar population from the contamination of the Galactic field, taking advantage of its different distribution in the space formed by colours, magnitudes, parallaxes, and proper motions. In 7 clusters I detect collimated overdensities at a >3σ level above the background density extending well beyond the cluster tidal radius, consistent with the distortion expected as a result of the tidal interaction with the Milky Way potential. In five of these clusters (NGC 288, NGC 2298, NGC 5139, NGC 6341, and NGC 7099) spectacular tidal tails extend up to the border of the analysed field of view at 5 deg from the centre. At large distances from the cluster centre, the orientation of the detected overdensities appears to be systematically aligned with the cluster orbital path, in agreement with the predictions of N-body simulations. The fraction of stars contained in the tidal tails of these clusters is also used to determine the first observational estimate of their present-day destruction rates.
Magnetic field configurations in neutron stars from MHD simulations
Authors: Sur Ankan , Haskell Brynmor , Kuhn Emily
Published: April 2020

We have studied numerically the evolution of magnetic fields in barotropic neutron stars, by performing non-linear magnetohydrodynamical simulations with the code pluto. For both initially predominantly poloidal and toroidal fields, with varying strengths, we find that the field settles down to a mixed poloidal–toroidal configuration, where the toroidal component contributes between ${\rm 10}$ and $20 {{\ \rm per\ cent}}$ of the total magnetic energy. This is, however, not a strict equilibrium, as the instability leads to the development of turbulence, which, in turn, gives rise to an inverse helicity cascade, which determines the final ‘twisted torus’ setup. The final field configuration is thus dictated by the non-linear saturation of the instability, and is not stationary. The average energy of the poloidal and toroidal components, however, is approximately stable in our simulations, and a complex multipolar structure emerges at the surface, while the magnetic field is dipolar at the exterior boundary, outside the star.
Intermittent hydrodynamic jets in collapsars do not produce GRBs
Authors: Gottlieb Ore , Levinson Amir , Nakar Ehud
Published: April 2020

Strong variability is a common characteristic of the prompt emission of gamma-ray bursts (GRB). This observed variability is widely attributed to an intermittency of the central engine, through formation of strong internal shocks in the GRB-emitting jet expelled by the engine. In this paper, we study numerically the propagation of hydrodynamic jets, injected periodically by a variable engine, through the envelope of a collapsed star. By post-processing the output of 3D numerical simulations, we compute the net radiative efficiency of the outflow. We find that all intermittent jets are subject to heavy baryon contamination that inhibits the emission at and above the photosphere well below detection limits. This is in contrast to continuous jets that, as shown recently, produce a highly variable gamma-ray photospheric emission with high efficiency, owing to the interaction of the jet with the stellar envelope. Our results challenge the variable engine model for hydrodynamic jets, and may impose constraints on the duty cycle of GRB engines. If such systems exist in nature, they are not expected to produce bright gamma-ray emission, but should appear as X-ray, optical, and radio transients that resemble a delayed GRB afterglow signal.
Improved gastrointestinal health for irritable bowel syndrome with metagenome-guided interventions
Authors: Meydan Cem , Afshinnekoo Ebrahim , Rickard Nate , Daniels Guy , Kunces Laura , Hardy Theresa , Lili Loukia , Pesce Sarah , Jacobson Paul , Mason Christopher E , Dudley Joel , Zhang Bodi
Published: April 2020

Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal disorder worldwide, and the most common reason for referral to gastroenterology clinics. However, the pathophysiology is still not fully understood and consequently current management guidelines are very symptom-specific, leading to mixed results. Here we present a study of 88 individuals with IBS who had baseline sequencing of their gut microbiome (stool samples), received targeted interventions that included dietary, supplement, prebiotic/probiotic, and lifestyle recommendations for a 30-day period, and a follow-up sequencing of their gut microbiome. The study's objectives were to demonstrate unique metagenomic signatures across the IBS phenotypes and to validate whether metagenomic-guided interventions could lead to improvement of symptom scores in individuals with IBS. Enrolled subjects also completed a baseline and post-intervention questionnaire that assessed their symptom scores. The average symptom score of an individual with IBS at baseline was 160 and at the endpoint of the study the average symptom score of the cohort was 100.9. The mixed IBS subtype showed the most significant reduction in symptom scores across the different subtypes (average decrease by 102 points, P = 0.005). The metagenomics analysis reveals shifts in the microbiome post-intervention that have been cross-validated with the literature as being associated with improvement of IBS symptoms. Given the complex nature of IBS, further studies with larger sample sizes, more targeted analyses, and a broader population cohort are needed to explore these results further.
Interventions for Breast Cancer–Related Lymphedema: Clinical Practice Guideline From the Academy of Oncologic Physical Therapy of APTA
Authors: Davies Claire , Levenhagen Kimberly , Ryans Kathryn , Perdomo Marisa , Gilchrist Laura
Published: April 2020

A work group from the American Physical Therapy Association (APTA) Academy of Oncologic Physical Therapy developed a clinical practice guideline to aid clinicians in identifying interventions for people with breast cancer–related lymphedema, targeting volume reduction, beginning at breast cancer diagnosis and continuing through cancer treatments and survivorship. Following a systematic review of published studies and a structured appraisal process, recommendations were developed to guide physical therapists and other health care clinicians in their intervention selection. Overall, clinical practice recommendations were formulated based on the evidence for each intervention and were assigned a grade based on the strength of the evidence. The evidence for each specific intervention was synthesized and appraised by lymphedema stage, when the information was available. In an effort to make recommendations clinically applicable, they were presented by modality throughout the care trajectory. Methodology and research populations varied significantly across studies, and it will be important for future research to use standardized definitions for participant characteristics, diagnostic criteria, and interventions.
Association between shift work and biological factors including FGF-23, klotho, and serum 25-(OH) vitamin D3 among Korean firefighters: a cross-sectional study
Authors: Min Jeehee , Jang Tae-Won , Ahn Yeon Soon , Sim Chang Sun , Jeong Kyoung Sook
Published: April 2020

Study Objectives

Shift work is known to be detrimental to an individual’s health as it disrupts the circadian rhythm and is a risk factor for cancer. It has been reported that elevated fibroblast growth factor (FGF)-23, increased serum soluble α-klotho, and decreased vitamin D3 are associated with cancer progression. We studied the relationship between shift work and the levels of FGF-23, α-klotho, and vitamin D3 amongst firefighters, as they work in long shifts outside the traditional daytime schedule.

Methods

The study consisted of 450 participants who were firefighters. We measured FGF-23, α-klotho, and vitamin D3 levels in their blood and a set of questionnaires were given to the participants to evaluate their health habits. After determining and adjusting for potential confounding factors, we compared the levels of FGF-23, α-klotho, and serum vitamin D3 by job and shift types.

Results

FGF-23 and α-klotho levels were significantly higher in shift workers than traditional day workers, and in 3-day cycle shift workers than workers with another shift schedule. When the levels of these substances were compared based on different types of jobs, firefighters had a lower level of vitamin D3. We conclude that shift work is positively correlated with the levels of FGF-23 and α-klotho.

Conclusions

Levels of FGF-23 and α-klotho were linked to shift work and job types. Although vitamin levels did not differ by shift types, vitamin D3 levels were lower in firefighters. These findings suggest that high levels of FGF-23 and α-klotho are potential risk factors for cancer among firefighters.
Effects of replacing canola meal with camelina expeller on intake, total tract digestibility, and feeding behavior of beef heifers fed high-concentrate diets
Authors: Salas Hèctor , Castillejos Lorena , Faturi Cristian , Ferret Alfred
Published: April 2020

To assess the effect of inclusion of camelina expeller in beef cattle diets, 24 Simmental heifers were used. Two experiments were carried out. In the first, two free-choice tests, one without and another with molasses, were conducted to know the preference of animals for a total mixed ration (TMR) made with a 90 to 10 concentrate to barley straw ratio, where canola meal (CM) or camelina expeller (CE) was used in the concentrate as a protein source. Heifers were allotted in four pens with two independent feedbunks, one for each diet. In the second, a replicated 4 × 4 Latin square design was used to assess the effects of the replacement of CM with CE on intake, digestibility, and sorting and animal behavior. The experiment was performed in four 28-d periods during which groups of three animals were allotted in each pen of 12.5 m2. Diets were formulated with a 90 to 10 concentrate to barley straw ratio and fed as TMR, and they were designed to contain 1) CM as main protein source and 0% of CE (0CE), 2) 3% of CE replacing CM (3CE), 3) 6% of CE replacing CM (6CE), and 4) 9% of CE replacing CM (9CE). In the free-choice test without molasses, heifers showed a greater preference for CM than for CE (38.6 vs. 8.7 kg/d; P < 0.001). When molasses were added to the diet, the preference for CM was maintained (39.1 vs. 9.8 kg/d; P < 0.001). Dry matter (DM), organic matter (OM), crude protein (CP), and neutral detergent fiber (NDF) intake was unaffected by the level of replacement of CM by CE (P > 0.10), and there was no effect of this replacement on DM, OM, CP, and NDF apparent digestibility (P > 0.10). Intake of long particle size increased lineally as CE proportion increased (P = 0.015). In addition, extension of sorting behavior for long particle size tended to increase lineally (P = 0.07), and sorting against this particle size was detected in 0CE and 3CE, but not in 6CE and 9CE (P < 0.05). However, the results recorded for long particle size intake and for sorting behavior against these particles did not translate into more time spent ruminating in heifers fed diets with higher proportion of CE. In conclusion, when canola meal was replaced with camelina expeller at more than 14% of inclusion, heifers preferred the canola meal diet. However, replacing canola meal with camelina expeller up to 9% of inclusion in diets for beef cattle did not affect intake and digestibility but promoted a greater intake of long particle size of barley straw.
Ability of a Risk Prediction Tool to Stratify Quality and Cost for Older Patients With Tibial Shaft and Plateau Fractures
Authors: Konda Sanjit R. , Dedhia Nicket , Ganta Abhishek , Egol Kenneth A.
Published: April 2020

Objectives:

To determine whether a validated trauma triage tool can identify the middle-aged and geriatric trauma patients with tibial shaft and plateau fractures who are at the risk for costly admissions and poorer hospital quality measures.

Design:

Prospective cohort study.

Setting:

Level-1 trauma center.

Patients/Participants:

Sixty-four patients older than 55 years hospitalized with isolated tibial shaft or plateau fractures.

Intervention:

Patients with either isolated tibial plateau fractures or tibial shaft fractures over a 3-year period were prospectively enrolled in an orthopedic trauma registry. Demographic information, injury severity, and comorbidities were assessed and incorporated into the Score for Trauma Triage in Geriatric and Middle Aged (STTGMA) score, a validated trauma triage score that calculates inpatient mortality risk upon admission. Patients were then grouped into tertiles based on their STTGMA score.

Main Outcome Measures:

Length of stay, complications, discharge location, and direct variable costs.

Results:

Sixty-four patients met inclusion criteria. Thirty-three patients (51.6%) presented with tibial plateau fractures and 31 (48.4%) with tibial shaft fractures. The mean age was 66.7 ± 10.2 years. Mean length of stay was significantly different between risk groups with a mean of 6.8 ± 4 days (P < 0.001). Although 19 (90.5%) of the minimal risk patients were discharged home, only 7 (33.3%) and 5 (22.7%) of moderate- and high-risk patients were discharged home, respectively (P < 0.001). Higher-risk patients experienced a significantly greater number of complications during hospitalization but had no differences in the need for intensive care unit–level care (P = 0.027 and P = 0.344, respectively). The total cost difference between the lowest- and highest-risk group was nearly 50% ($14,070 ± 8056 vs. $25,147 ± 14,471; mean difference, $11,077; P = 0.022).

Conclusion:

Application of the STTGMA triage tool allows for the prediction of key hospital quality measures and cost of hospitalization that can improve clinical decision-making.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Two Doses of Tranexamic Acid Reduce Blood Loss in Primary Posterior Lumbar Fusion Surgery
Authors: Zhu Xianren , Shi Qian , Li Dongya , Wu Jibin , Guo Kaijin , Zheng Xin , Li Hongwei
Published: April 2020

Purpose:

Tranexamic acid (TXA) has been widely used in hip and knee arthroplasty to reduce perioperative blood loss and blood transfusion, but the dosage and efficacy of TXA in posterior lumbar spinal surgery are not fully clear. The aim of this study was to investigate the efficacy and safety of TXA and to determine whether 2 doses of TXA could reduce the blood loss in primary single-segment or double-segment posterior lumbar fusion surgery.

Materials and Methods:

A total of 150 patients with lumbar degenerative disease undergoing posterior lumbar interbody fusion surgery between October 2017 and February 2019 were randomized to 3 groups. Group A was treated with 0.9% normal saline solution without TXA, group B was treated with a 15 mg/kg loading dose intravenous infusion 30 minutes before surgery, and group C was treated with a 15 mg/kg loading dose intravenous infusion 30 minutes before surgery; then, the same dose was administered again 3 hours later. The assessed outcomes were the operation time, the total blood loss, the hidden blood loss, postoperative drainage, blood transfusions, incidence of venous thromboembolism, and incision infection.

Results:

The total blood loss, the hidden blood loss, and postoperative drainage were the lowest in group C. The amount of intraoperative blood loss was similar among the 3 groups. The hemoglobin and hematocrit values of the third postoperative day were the highest in group C. No significant differences in the incidence of complications and adverse events from TXA use were observed among the 3 groups. The use of TXA, the operation time, and the number of fusion segments were identified as risk factors related to total blood loss.

Conclusion:

Two doses of TXA significantly reduced the total blood loss, the hidden blood loss and postoperative drainage, and decreased hemoglobin and hematocrit drop in patients undergoing posterior lumbar fusion without increasing the risk of complications.
Effects of a Simulation With Team-Based Learning on Knowledge, Team Performance, and Teamwork for Nursing Students
Authors: Roh Young Sook , Kim Sang Suk , Park Sunah , Ahn Jung-Won
Published: April 2020

Simulation and team-based learning are reported as useful strategies in nursing education. However, empirical evidence on the effects of participating in an integrated course of team-based learning and simulation is limited. The aim of this study was to identify the effects of a nursing simulation program with team-based learning on knowledge, team performance, and teamwork among Korean nursing students. A one-group pretest-posttest design was used. Fourth-year students (N = 229) participated in a 32-hour nursing simulation program with team-based learning. Each of the three sessions of the program involved a 3-hour task training with video-assisted learning and skills performance assessment, 1-hour team-based learning, and 4-hour simulation session with a high-fidelity simulator. In addition to the knowledge test and performance assessment, participants completed a self-administered questionnaire on teamwork. Participants achieved higher scores in the Group Readiness Assurance Test than they did in the Individual Readiness Assurance Test. The posttest scores on team performance and teamwork were significantly higher than their pretest scores. The simulation with team-based learning induced favorable effects on participants' knowledge, performance, and teamwork. A curricular integration of simulation program with team-based learning is consistent with achieving outcomes-based learning in nursing education.
BCMA-targeting Bispecific Antibody That Simultaneously Stimulates NKG2D-enhanced Efficacy Against Multiple Myeloma
Authors: Wang Yang , Li Hui , Xu Wei , Pan Mingzhu , Qiao Chun , Cai Jialing , Xu Jingjing , Wang Min , Zhang Juan
Published: April 2020

B-cell maturation antigen (BCMA) is a highly plasma cell-selective protein expressed on malignant plasma cells of patients with multiple myeloma (MM), and it is a defined therapeutic target. Major histocompatibility complex class I-related chain A (MICA) is frequently expressed in lymphoproliferative malignancies including MM. MICA activates natural killer (NK) cells and costimulates T cells by interaction with its immunoreceptor NK cell receptor G2D (NKG2D). Nonetheless, during full-blown MM, tumor cells promote efficient MICA shedding, which evokes NKG2D internalization and immune suppression. To enhance the directional killing efficacy of immune cells against myeloma cells, we constructed a novel bispecific antibody 2A9-MICA and explored its potential antimyeloma activity against MM. 2A9-MICA consists of human MICA extracellular region and a single–chain antibody fragment (scFv) that targets BCMA generated by phage display technology. In vitro, 2A9-MICA activated NK cell-mediated cytotoxicity and induced NK cells to kill BCMA–positive human myeloma cells. Moreover, in BCMA-positive, MM-bearing nude mice, 2A9-MICA specifically targeted tumor tissue, where it effectively recruited immune cells and inhibited tumor tissue growth showed superior antitumor activity. Taken together, bispecific antibody 2A9-MICA provides a new approach for MM-targeting immunotherapy and has attractive potential for clinical applications.
Labiaplasty with Stable Labia Minora Retraction—Butterfly-like Approach
Authors: Filho Osvaldo Pereira , Ely Jorge Bins , Lee Kuang Hee , Paulo Elizabeth Machado
Published: April 2020

Labiaplasty, referring to a surgical labia minora reduction, is the most commonly requested genital rejuvenation by women. The purpose of this article is to show an innovative maneuver in the technique for this increasingly demanded procedure. In this strategy, labia minora are attached temporarily to the internal thigh with stitches resembling an open butterfly wing. This maneuver stabilizes the redundant labia minora soft tissue, easing the evaluation of asymmetry and aiding precision in the treatment. The study investigated 12 patients, 10 presenting bilateral hypertrophic labia minora and 2 patients with only unilateral abnormal anatomy, n = 22. The mean age was 25 years. The postoperative follow-up was uneventful. All patients presented labia minora with anatomic configuration. In 1 patient, we registered immediate bleeding that needed revision. The butterfly-like maneuver with the labia minora temporarily attached to the inner thigh can ease labiaplasty with central and inferior wedge resection. It helps diagnose asymmetry and adds precision to resect the correct amount of the hypertrophic tissue.
A Prospective Study on Safety, Complications and Satisfaction Analysis for Tear Trough Rejuvenation Using Hyaluronic Acid Dermal Fillers
Authors: Diwan Zoya , Trikha Sanjay , Etemad-Shahidi Sepideh , Alli Zunaid , Rennie Christopher , Penny Amanda
Published: April 2020

Background:

Tear trough (TT) treatment with hyaluronic acid soft tissue fillers is an increasingly popular aesthetic procedure. The traditional needle technique is cited many times in the literature with no studies looking at the results, complications and satisfaction rate with the use of the cannula device instead. The aims of this study are to describe the experience of 4 aesthetic doctors in the treatment of TT deformity and assess complications and side effects, overall satisfaction and improvement.

Methods:

Twenty-four patients were included (48 TTs) that fulfilled the inclusion and exclusion criteria and they were assessed over a 4-week period, looking at the complications, side effects, satisfaction rate, and others with the cannula technique for the medial TT.

Results:

Twenty-two women and 2 men each had the medial TT filler supra-periosteally using a cannula device. They were all reviewed at the 2-week stage +/− the 4-week stage. 100% of patients noted an overall improvement to the TTs and 75% were satisfied with their results with the other 25% requiring further filler to be satisfied. There were no major complications and only a small number of minor side effects like mild bruising and swelling that lasted up to 4 weeks.

Conclusions:

TT treatment, if performed using a cannula with a maximum of 1ml used in one sitting between both eyes, according to this study, is a safe treatment with a very low pain rating and with no major complications and high patient satisfaction.
Short-term Treatment Outcomes of Facial Rejuvenation Using the Mint Lift Fine
Authors: Moon Hyoung-Jin , Chang Dooyeol , Lee Won
Published: April 2020

Background:

Threadlifts are classified as absorbable or nonabsorbable, natural or synthetic, and multifilament or monofilament ones, each of which has its own merits and demerits. We placed a novel absorbable polydioxanone monofilament threadlift (Mint Lift Fine; HansBiomed Co. Ltd., Seoul, Korea) in the subcutaneous fat compartment for facial rejuvenation in patients with nasolabial folds, nasojugal groove, marionette lines, or sagging jowl. Here, we describe its short-term treatment outcomes in a retrospective consecutive series of 21 patients.

Methods:

A total of 21 patients (n = 21) were evaluated; their treatment outcomes were described based on a comparison between preoperative and postoperative findings and Global Aesthetic Improvement Scale (GAIS) scores were assessed at 6 months. This is accompanied by analysis of the incidence of postoperative complications.

Results:

The patients had a mean GAIS score of 3.62 ± 0.84 points, which corresponds to “Much improved” or “Very much improved.” Moreover, there were no significant differences in the GAIS scores between the target sites (midface and lower face: 3.78 ± 1.13; lower face: 3.43 ± 0.50; and midface: 3.60 ± 0.49; P > 0.05). Furthermore, there were a total of 4 cases (19.0%) of postoperative complications, all of which were spontaneously resolved within a maximum period of 4 months.

Conclusions:

We describe short-term treatment outcomes of facial rejuvenation using the Mint Lift Fine in patients with nasolabial folds, nasojugal groove, marionette lines, or sagging jowl. But further large-scale, prospective, multicenter studies with long periods of follow-up are, therefore, warranted to establish our results.
Venous Thromboembolism after the Repair of Abdominal Incisional Hernia with a Pedicled Anterolateral Thigh Flap
Authors: Iwata Tomohiro , Matsumine Hajime , Shimizu Mari , Inui Masashi , Takeuchi Masaki
Published: April 2020

Summary: Incisional hernia often complicates kidney transplant. However, there are few reports showing pitfalls after the repair of incisional hernia following living-donor kidney transplant. A 55-year-old man underwent living-donor kidney transplant from his wife at the Department of Urology at the authors’ hospital. He noticed abdominal distension 6 months postoperatively and was diagnosed with incisional hernia by computed tomography (CT) imaging. Clinical examination revealed the extensive distension of the right abdomen; noncontrast abdominal CT showed transverse colon, descending colon, and mesenteric prolapse through a hernial orifice measuring 11 × 14 cm, located slightly cranial to the anterior superior iliac spine. Repair was performed under general anesthesia the following day; the right thigh was the donor site. A pedicled anterolateral thigh flap from the donor site was used for abdominal wall reconstruction. He developed fever, and pain and swelling were noted in the right leg on postoperative day 14. Contrast-enhanced thoracic CT confirmed a diagnosis of pulmonary embolism (PE) and deep vein thrombosis. He was quickly started on an oral factor Xa inhibitor (edoxaban) and continuous intravenous heparin; contrast-enhanced thoracic CT on postoperative day 23 showed that PE had disappeared. At 6 months postoperatively, there was no recurrence of the venous thromboembolism or incisional hernia. The authors reported a case of incisional hernia repair after living-donor kidney transplant with a pedicled anterolateral thigh flap, complicated by deep vein thrombosis and PE. Adequate preoperative evaluation was required to determine optimal surgical techniques and preventive measures in cases with myriad thrombogenic risk factors.
Utilization of a Simple Surgical Guide for Multidirectional Cranial Distraction Osteogenesis in Craniosynostosis
Authors: Matsui Chihiro , Tokuyama Eijiro , Senoo Takaya , Yamada Kiyoshi , Kameda Masahiro , Takeuchi Tetsuo , Kimata Yoshihiro
Published: April 2020

Background:

Multidirectional cranial distraction osteogenesis (MCDO) can achieve a desired shape for deformities of the cranium. In the past, visual estimation was used to reflect on the actual skull, but it was time-consuming and inaccurate. Here we demonstrate an effective osteotomy navigation method using surgical guides made from a dental impression silicone.

Methods:

Seven patients who underwent MCDO between August 2013 and September 2016 were included in the study. Five cases involved utilization of the surgical guide for osteotomy. Three-dimensional (3D) printed cranium models were made using 3D computed tomography (3DCT) imaging data and dental impression silicone sheets were molded using the printed cranium models. These surgical guides were sterilized and used for intraoperative osteotomy design. Vertical distance between nasion/porion and osteotomy lines were calculated using 3D printed cranial models and postoperative 3DCT images to assess reproducibility.

Results:

The average surgical time/design time was 535/37.0 minutes for the nonsurgical guide group and 486.8/11.8 minutes for the surgical guide group (SG).Treatment using the surgical guide was significantly shorter in terms of operative time and time required for design. For the vertical distance comparison, the average distance was 5.7mm (SD = 0.3) in the non-SG and 2.5mm (SD = 0.44) in the SG, and SG was more accurate.

Conclusions:

Shorter operative times and higher reproducibility rates could be achieved by using the proposed surgical guide, which is accurate, low-cost, and easily accessible.
Use of radiographic features in COVID-19 diagnosis: Challenges and perspectives
Authors: Chen Sin-Guang , Chen Ju-Yu , Yang Yi-Ping , Chien Chian-Shiu , Wang Mong-Lien , Lin Liang-Ting
Published: April 2020

The rapid surge and wide spread of the coronavirus disease-2019 (COVID-19) overshadows the entire medical industries worldwide. The stringent medical resources hinder the diagnostic capacity globally, while 84 000 of new cases confirmed within a single day of April 14, 2020. Real-time reverse-transcription polymerase chain reaction (RT-PCR) with is the current first-line diagnosis, but the false-negative rate remains concerned. Radiographic technologies and tools, including computed tomography (CT) and chest X-ray, were applied for initial screening and follow-up, from which the tools provide detail diagnosis with specific pathologic features for staging and treatment arrangement. Although the radiographic imaging is found less sensitive, numerous CT-positive patients were not screened out by RT-PCR initially and later confirmed as COVID-19 positive. Besides, the shortage of sampling kits and the longer turn-over time of PCR examinations in some areas were noticed due to logistic issues and healthcare burden. In this review, we will discuss the challenges and the future perspectives of using radiographic modalities for COVID-19 diagnosis in view of securing human lives amid the crisis.
The clinicopathological characteristics and prognosis of patients with node-positive gastric cancer after curative surgery
Authors: Lum Chih Yean , Huang Kuo-Hung , Chen Ming-Huang , Fang Wen-Liang , Chao Yee , Lo Su-Shun , Li Anna Fen-Yau , Wu Chew-Wun , Shyr Yi-Ming
Published: April 2020

Background:

Lymph node (LN) metastasis is one of the independent prognostic factors of gastric cancer (GC). The difference in survival rates and initial recurrence patterns in patients with node-positive GC with retrieved LN numbers greater than or less than 16 is worthy of further study.

Methods:

A total of 1314 patients with node-positive GC were enrolled. The clinicopathological characteristics, retrieved LN numbers, adjuvant chemotherapy, initial recurrence patterns, and survival differences between serosa-negative and serosa-positive GC were investigated.

Results:

For serosa-negative GC, patients with retrieved LN numbers ≥16 were associated with fewer tumor recurrences, locoregional recurrences, distant metastases, and better 5-year overall survival (OS) rates and disease-free survival (DFS) rates. For serosa-positive GC, patients with retrieved LN numbers ≥16 were associated with similar locoregional and distant metastasis and similar 5-year OS and DFS rates compared with those with retrieved LN numbers <16. Retrieved LN numbers fewer than 16 can cause stage migration compared with retrieved LN numbers ≥16. Multivariate analysis showed that both the retrieved LN numbers (≥ or <16) and adjuvant chemotherapy were independent prognostic factors affecting OS in serosa-negative GC, while adjuvant chemotherapy but not the retrieved LN numbers was an independent prognostic factor of OS in serosa-positive GC.

Conclusion:

For serosa-negative GC, retrieved LN numbers fewer than 16 can cause stage migration, a higher tumor recurrence rate and worse OS and DFS rates compared with patients with retrieved LN numbers ≥16. Due to a high tumor recurrence rate in serosa-positive GC, adjuvant chemotherapy rather than retrieved LN numbers played an important role in improving patient prognosis.
Quality and Safety in Health Care, Part LXIX
Authors: Harolds Jay A.
Published: April 2020

The chief medical officer (CMO) is a key member of the administration of most large health care systems. The CMO helps with communication between the medical staff and the nonphysician administrators. The CMO typically plays an important role in utilization review, ensuring compliance with laws and regulations, peer review, credentialing, and privileging. One of the most important roles of the CMO has been to improve quality and safety while keeping costs under control, although now many institutions also have quality and safety officers. In addition, the CMO plays a major role in advising the administration regarding clinical equipment purchases, including those for emerging technologies, and in long-range clinical planning.
Mating changes the genital microbiome in both sexes of the common bedbug
Cimex lectularius
across populations
Authors: Bellinvia Sara , Johnston Paul R. , Mbedi Susan , Otti Oliver
Published: April 2020

Many bacteria live on host surfaces, in cells and in specific organ systems. In comparison with gut microbiomes, the bacterial communities of reproductive organs (genital microbiomes) have received little attention. During mating, male and female genitalia interact and copulatory wounds occur, providing an entrance for sexually transmitted microbes. Besides being potentially harmful to the host, invading microbes might interact with resident genital microbes and affect immunity. Apart from the investigation of sexually transmitted symbionts, few studies have addressed how mating changes genital microbiomes. We dissected reproductive organs from virgin and mated common bedbugs,
Cimex lectularius
L., and sequenced their microbiomes to investigate composition and mating-induced changes. We show that mating changes the genital microbiomes, suggesting bacteria are sexually transmitted. Also, genital microbiomes varied between populations and the sexes. This provides evidence for local and sex-specific adaptation of bacteria and hosts, suggesting bacteria might play an important role in shaping the evolution of reproductive traits. Coadaptation of genital microbiomes and reproductive traits might further lead to reproductive isolation between populations, giving reproductive ecology an important role in speciation. Future studies should investigate the transmission dynamics between the sexes and populations to uncover potential reproductive barriers.
Small burrowing amphipods cause major damage in a large kelp
Authors: Gutow Lars , Poore Alistair G. B. , Díaz Poblete Manuel A. , Villalobos Vieia , Thiel Martin
Published: April 2020

Large herbivores such as sea urchins and fish consume a high proportion of benthic primary production and frequently control the biomass of marine macrophytes. By contrast, small mesograzers, including gastropods and peracarid crustaceans, are abundant on seaweeds but have low per capita feeding rates and their impacts on marine macrophytes are difficult to predict. To quantify how mesograzers can affect macrophytes, we examined feeding damage by the herbivorous amphipodsSunamphitoe lessoniophilaandBircennasp., which construct burrows in the stipes of subtidal individuals of the kelpLessonia berteroanain northern-central Chile, southeast Pacific. Infested stipes showed a characteristic sequence of progressive tissue degeneration. The composition of the amphipod assemblages inside the burrows varied between the different stages of infestation of the burrows. Aggregations of grazers within burrows and microhabitat preference of the amphipods result in localized feeding, leading to stipe breakage and loss of substantial algal biomass. The estimated loss of biomass of single stipes varied between 1 and 77%. For the local kelp population, the amphipods caused an estimated loss of biomass of 24–44%. Consequently, small herbivores can cause considerable damage to large kelp species if their feeding activity is concentrated on structurally valuable algal tissue.
Deciphering an extreme morphology: bone microarchitecture of the hero shrew backbone (Soricidae:
Scutisorex
)
Authors: Smith Stephanie M. , Angielczyk Kenneth D.
Published: April 2020

Biological structures with extreme morphologies are puzzling because they often lack obvious functions and stymie comparisons to homologous or analogous features with more typical shapes. An example of such an extreme morphotype is the uniquely modified vertebral column of the hero shrew
Scutisorex
, which features numerous accessory intervertebral articulations and massively expanded transverse processes. The function of these vertebral structures is unknown, and it is difficult to meaningfully compare them to vertebrae from animals with known behavioural patterns and spinal adaptations. Here, we use trabecular bone architecture of vertebral centra and quantitative external vertebral morphology to elucidate the forces that may act on the spine of
Scutisorex
and that of another large shrew with unmodified vertebrae (
Crocidura goliath
). X-ray micro-computed tomography (µCT) scans of thoracolumbar columns show that
Scutisorex thori
is structurally intermediate between
C. goliath
and
S. somereni
internally and externally, and both
Scutisorex
species exhibit trabecular bone characteristics indicative of higher
in vivo
axial compressive loads than
C. goliath.
Under compressive load,
Scutisorex
vertebral morphology is adapted to largely restrict bending to the sagittal plane (flexion). Although these findings do not solve the mystery of how
Scutisorex
uses its byzantine spine
in vivo
, our work suggests potentially fruitful new avenues of investigation for learning more about the function of this perplexing structure.
The lag-time constraint for behavioural plasticity
Authors: Gomes Ana Cristina R. , Cardoso Gonçalo C.
Published: April 2020

Environmental instability (i.e. environments changing often) can select fixed phenotypes because of the lag time of plastically adapting to environmental changes, known as the lag-time constraint. Because behaviour can change rapidly (e.g. switching between foraging strategies), the lag-time constraint is not considered important for behavioural plasticity. Instead, it is often argued that responsive behaviour (i.e. behaviour that changes according to the environment) evolves to cope with unstable environments. But proficiently performing certain behaviours may require time for learning, for practising or, in social animals, for the group to adjust to one's behaviour. Conversely, not using certain behaviours for a period of time can reduce their level of performance. Here, using individual-based evolutionary simulations, we show that environmental instability selects for fixed behaviour when the ratio between the rates of increase and reduction in behavioural performance is below a certain threshold; only above this threshold does responsive behaviour evolve in unstable environments. Thus, the lag-time constraint can apply to behaviours that attain high performance either slowly or rapidly, depending on the relative rate with which their performance decreases when not used. We discuss these results in the context of the evolution of reduced behavioural plasticity, as seen in fixed personality differences.