bluuebunny/crossref_metadata_2025 huggingface dataset:
Unified Staging System for Lewy Body Disorders: Clinicopathologic Correlations and Comparison to Braak Staging
Authors: Adler Charles H , Beach Thomas G , Zhang Nan , Shill Holly A , Driver-Dunckley Erika , Caviness John N , Mehta Shyamal H , Sabbagh Marwan N , Serrano Geidy E , Sue Lucia I , Belden Christine M , Powell Jessica , Jacobson Sandra A , Zamrini Edward , Shprecher David , Davis Kathryn J , Dugger Brittany N , Hentz Joseph G
Published: September 2019

This study was designed to correlate clinical findings with the extent of pathologic a-synuclein (aSyn) in the brain using the Unified Staging System for Lewy Body disorders (USSLB). Data from 280 cases from the Arizona Study of Aging and Neurodegenerative Disorders are presented. Each case had a complete USSLB staging and at least 1 full research clinical assessment, including subspecialty neurologist-administered movement and cognitive evaluation. Of the 280, 25.7% were cognitively normal, 8.6% had mild cognitive impairment, and 65.7% had dementia. All cases could be categorized into 1 of 5 USSLB stages (8.6% stage I—olfactory bulb only; 15.4% IIa—brainstem predominant; 13.6% IIb—limbic predominant; 31.8% III—brainstem and limbic; and 30.7% IV—neocortical) yet using the Braak staging system 70 cases (25.3%) could not be classified. Those with USSLB stages III and IV died at a younger age. Multiple measures of motor parkinsonism, cognitive impairment, hyposmia, and probable RBD were significantly correlated with increasing USSLB stage. We conclude that the USSLB is the most comprehensive staging system for all Lewy body disorders and allows for categorization and ranking of all brains with significant correlations to many motor and nonmotor clinical signs and symptoms.
Fragmented fields: Professionalisms and work settings in Italian management consultancy
Authors: Maestripieri Lara
Published: September 2019

Management consultancy has long been a contested terrain in the sociology of the professions. Although the professionalism of management consultants has always been emphasized by practitioners themselves, the lack of a strong community of peers has been an impediment to their professionalization. In this article, I argue that professionalism is not the outcome of a process of regulation and institutionalization but that it has to be conceived a discourse comprising norms, worldviews, and values that define what is appropriate for an individual to be considered a competent and recognized member of this community. Given the diversity characterizing the field, there are multiple discourses surrounding professionalism of management consultants, and these discourses are shaped by work settings. Work settings are a combination of the type of organization professional partnership or professional service firm and the employment status (employee or self-employed). Drawing on the empirical evidence from various work settings (professional service firms, professional partnership, and self-employment), I investigate four clusters of practitioners identified in 55 biographical and semi-structured interviews conducted with management consultants in Italy. Four types of professionalism emerge from the clusters. Organizing professionalism is the sole professionalism that appears in all work settings. Other discourses (corporate, commercialized, and hybrid professionalism) are context-dependent and more likely to be found in specific work settings.
Massive necrotizing fasciitis: a life threatening entity
Authors: Vilallonga Ramon , Mazarro Alejandro , Rodríguez-Luna María Rita , Caubet Enric , Fort José Manuel , Armengol Manuel , Guirao Xavier
Published: September 2019

Necrotizing fasciitis (NF) is a complicated soft tissue infection frequently associated with severe sepsis if an early medical and surgical treatment is not performed. We report two postoperative cases of severe NF after oophorectomy and colorectal resection. Because of the similarity with more benign skin infections at the early steps, clinical suspicion is crucial. Surgical exploration and resection will provide both the diagnosis confirming necrotizing infection of the fascia with vessels and treatment. Also, empirical broad-spectrum antibiotics must be initiated as soon as possible. Regardless of the presence of risk factors, NF is a condition with a high mortality rate and only an expeditious and undelayed treatment may improve the patient’s outcome. Surgical focus control requires wide and repeated resections, and planned reconstructive plastic surgery might be necessary.
The SkyMapper DR1.1 search for extremely metal-poor stars
Authors: Da Costa G S , Bessell M S , Mackey A D , Nordlander T , Asplund M , Casey A R , Frebel A , Lind K , Marino A F , Murphy S J , Norris J E , Schmidt B P , Yong D
Published: September 2019

We present and discuss the results of a search for extremely metal-poor stars based on photometry from data release DR1.1 of the SkyMapper imaging survey of the southern sky. In particular, we outline our photometric selection procedures and describe the low-resolution (R ≈ 3000) spectroscopic follow-up observations that are used to provide estimates of effective temperature, surface gravity, and metallicity ([Fe/H]) for the candidates. The selection process is very efficient: of the 2618 candidates with low-resolution spectra that have photometric metallicity estimates less than or equal to −2.0, 41 per cent have [Fe/H] ≤ −2.75 and only approximately seven per cent have [Fe/H] > −2.0 dex. The most metal-poor candidate in the sample has [Fe/H] < −4.75 and is notably carbon rich. Except at the lowest metallicities ([Fe/H] < −4), the stars observed spectroscopically are dominated by a ‘carbon-normal’ population with [C/Fe]1D, LTE ≤ +1 dex. Consideration of the A(C)1D, LTE versus [Fe/H]1D, LTE diagram suggests that the current selection process is strongly biased against stars with A(C)1D, LTE > 7.3 (predominantly CEMP-s) while any bias against stars with A(C)1D, LTE < 7.3 and [C/Fe]1D,LTE > +1 (predominantly CEMP-no) is not readily quantifiable given the uncertainty in the SkyMapper v-band DR1.1 photometry. We find that the metallicity distribution function of the observed sample has a power-law slope of Δ(Log N)/Δ[Fe/H] = 1.5 ± 0.1 dex per dex for −4.0 ≤ [Fe/H] ≤ −2.75, but appears to drop abruptly at [Fe/H] ≈ −4.2, in line with previous studies.
Ash2l interacts with Oct4-stemness circuitry to promote super-enhancer-driven pluripotency network
Authors: Tsai Ping-Hsing , Chien Yueh , Wang Mong-Lien , Hsu Chih-Hung , Laurent Benoit , Chou Shih-Jie , Chang Wei-Chao , Chien Chian-Shiu , Li Hsin-Yang , Lee Hsin-Chen , Huo Teh-Ia , Hung Jui-Hung , Chen Chung-Hsuan , Chiou Shih-Hwa
Published: September 2019

Pluripotency and cell fates can be modulated through the regulation of super-enhancers; however, the underlying mechanisms are unclear. Here, we showed a novel mechanism in which Ash2l directly binds to super-enhancers of several stemness genes to regulate pluripotency and self-renewal in pluripotent stem cells. Ash2l recruits Oct4/Sox2/Nanog (OSN) to form Ash2l/OSN complex at the super-enhancers of Jarid2, Nanog, Sox2 and Oct4, and further drives enhancer activation, upregulation of stemness genes, and maintains the pluripotent circuitry. Ash2l knockdown abrogates the OSN recruitment to all super-enhancers and further hinders the enhancer activation. In addition, CRISPRi/dCas9-mediated blocking of Ash2l-binding motifs at these super-enhancers also prevents OSN recruitment and enhancer activation, validating that Ash2l directly binds to super-enhancers and initiates the pluripotency network. Transfection of Ash2l with W118A mutation to disrupt Ash2l–Oct4 interaction fails to rescue Ash2l-driven enhancer activation and pluripotent gene upregulation in Ash2l-depleted pluripotent stem cells. Together, our data demonstrated Ash2l formed an enhancer-bound Ash2l/OSN complex that can drive enhancer activation, govern pluripotency network and stemness circuitry.
Potential Unintended Effects of Standardized Pain Questionnaires: A Qualitative Study
Authors: De Silva Theresa , Hodges Paul W , Costa Nathalia , Setchell Jenny
Published: September 2019

Objective

Low back pain is a common musculoskeletal condition with substantial individual and societal costs. Standardized self-report questionnaires are commonly used in clinical practice to identify prognostic risk factors and tailor interventions for low back pain. However, most of these low back pain questionnaires have been developed in Western cultures and may not be clinically applicable to other cultures. These cultural aspects have not been explored. This study aimed to investigate the cultural assumptions underlying back pain questionnaires and the potential implications of using standardized questionnaires with non-Western populations.

Design

An interpretive qualitative design was employed.

Subjects

Participants (N = 16) self-identified as coming from culturally and linguistically diverse backgrounds.

Methods

Data collection and analysis were guided by thematic analysis. Four focus groups of three to five participants were conducted during which participants discussed two questionnaires commonly used in low back pain settings: the Fear-Avoidance Beliefs Questionnaire and Örebro Musculoskeletal Pain Questionnaire.

Results

Analysis identified four themes: questionnaires affect the patient–clinician encounter; results are not only about back pain; questionnaires affect people’s understanding of their back pain; and results potentially affect people’s lives beyond their back condition.

Conclusions

Findings suggest that questionnaires could potentially negatively affect the patient–clinician rapport and lead to inaccurate and unanticipated results when used with culturally and linguistically diverse populations. Findings are also likely to be applicable to people with low back pain more broadly, regardless of culture. Implications include a need for cultural sensitivity when using questionnaires, greater consideration of when to use these measures, and adaptations to the use/design of standardized questionnaires.
The Prospects for Durable Solutions for Syrian Refugees in the Kurdistan Region of Iraq: A Case Study of Erbil Governorate Camps
Authors: Yassen Abdullah Omar
Published: September 2019

Today, forced displacement from Syria has resulted in one of the largest refugee populations worldwide, creating yet another ‘protracted displacement’ in the Middle East. To explore this situation, an analysis of the perceptions held by all stakeholders of potential durable solutions is urgently required. This research examines three durable solutions: voluntary repatriation, local integration, and resettlement in a third country. It also examines the State practice of the Kurdistan Region of Iraq in terms of its response to the protection of Syrian refugees and their entitlement to education, health care, employment, and residency. In so doing, it identifies the challenges and issues facing Syrians in the region. The focus is on local-level perceptions of practitioners, policy-makers, and Syrian refugees in the Kurdistan Region of Iraq. The methodology for this study includes desk research, focus groups, and interviews with refugees in four camps in Erbil governorate, namely, Basirma, Darashakran, Kawergosk, and Qushtapa between August 2017 and December 2017. The findings show that the preferred durable solution for the overall majority of the Syrian refugees in this research was resettlement to third countries. Both local integration and voluntary repatriation were viewed as largely unworkable.
Mean diffusivity associated with trait emotional intelligence
Authors: Takeuchi Hikaru , Taki Yasuyuki , Nouchi Rui , Yokoyama Ryoichi , Kotozaki Yuka , Nakagawa Seishu , Sekiguchi Atsushi , Iizuka Kunio , Yamamoto Yuki , Hanawa Sugiko , Araki Tsuyoshi , Miyauchi Carlos Makoto , Sakaki Kohei , Sassa Yuko , Nozawa Takayuki , Ikeda Shigeyuki , Yokota Susumu , Daniele Magistro , Kawashima Ryuta
Published: September 2019

Previous neuroimaging studies have suggested that the neural bases of trait emotional intelligence (TEI) lie in the social cognition network (SCN) and the somatic marker circuitry (SMC). The current study was the first to investigate the associations of total TEI factors and subfactors with mean diffusivity (MD) of these networks as well as regional MD of the dopaminergic system (MDDS). We found that TEI intrapersonal factor score and total TEI score were negatively correlated with regional MDDS in the vicinity of the right putamen and right pallidum and that TEI intrapersonal factor score was negatively correlated with MD values of the fusiform gyrus. Total TEI score and TEI factor scores were positively correlated with MD values of various areas within or adjacent to SCN components, SMC structures and the lateral prefrontal cortex (LPFC). Our MD findings demonstrated the importance of the dopaminergic system to TEI and implicate the SCN, SMC and LPFC in TEI. Future studies are required to investigate the implications of positive and negative associations with MD values.
Quantitative Real-Time PCR Analysis of Individual Flue-Cured Tobacco Seeds and Seedlings Reveals Seed Transmission of Tobacco Mosaic Virus
Authors: Ellis Madeleine D. , Hoak Jessica M. , Ellis Bradley W. , Brown Jessica A. , Sit Tim L. , Wilkinson Carol A. , Reed T. David , Welbaum Gregory E.
Published: September 2019

Tobacco mosaic virus (TMV) is an extensively studied RNA virus known to infect tobacco (Nicotiana tabacum) and other solanaceous crops. TMV has been classified as a seedborne virus in tobacco, with infection of developing seedlings thought to occur from contact with the TMV-infected seed coat. The mechanism of TMV transmission through seed was studied in seed of the K 326 cultivar of flue-cured tobacco. Cross pollinations were performed to determine the effect of parental tissue on TMV infection in seed. Dissection of individual tobacco seeds into seed coat, endosperm, and embryo was performed to determine TMV location within a seed, while germination tests and separation of the developing seedling into seed coat, roots, and cotyledons were conducted to estimate the percent transmission of TMV. A reverse-transcriptase quantitative PCR (RT-qPCR) assay was developed and used to determine TMV concentrations in individual seed harvested from pods that formed on plants from TMV-infected and noninfected crosses. The results showed maternal transmission of TMV to tobacco seed and seedlings that developed from infected seed, not paternal transmission. RT-qPCR and endpoint PCR assays were also conducted on the separated seed coat, endosperm, and embryo of individual seed and separated cotyledons, roots, and seed coats of individual seedlings that developed from infected tobacco seed to identify the location of the virus in the seed and the subsequent path the virus takes to infect the developing seedling. RT-qPCR and endpoint PCR assay results showed evidence of TMV infection in the endosperm and embryo, as well as in the developing seedling roots and cotyledons within 10 days of initiating seed germination. To our knowledge, this is the first report of TMV being detected in embryos of tobacco seed, demonstrating that TMV is seedborne and seed-transmitted in flue-cured tobacco.
Influence of Nutrition and Nonnutrition Factors on Pressure Injury Outcomes Among At-Risk Asian Nursing Home Residents
Authors: Yap Tracey L. , Kennerly Susan , Horn Susan D. , Barrett Ryan , Dixon Jequie , Bergstrom Nancy
Published: September 2019

OBJECTIVE

Given evidence that malnutrition and immobility increase the risk of pressure injuries (PIs) in nursing home (NH) residents and that body mass index guidelines related to undernutrition may differ between Asian and non-Asian populations, the purpose of this study was to describe differences in overall nutrition, dietary intake, and nonnutrition risk factors for PIs between Asian and non-Asian NH residents.

DESIGN AND SETTING

Secondary data analysis of a 3-week PI prevention randomized controlled trial in seven Canadian NHs.

PATIENTS

Asian (n = 97) and non-Asian (n = 408) residents at moderate or high mobility-related risk of PI.

MAIN OUTCOME MEASURE

Incident PI by racial subgroups.

MAIN RESULTS

Asian residents (PI = 6) consumed significantly smaller meals and marginally different patterns of daily dietary consumption of protein types, liquid supplements, and snacks; took more frequent tub baths; and had marginally lower body mass index than non-Asian residents (PI = 4).

CONCLUSIONS

Findings are consistent with earlier research suggesting that nutrition consumption and care patterns may predispose Asian NH residents to develop more PIs than their non-Asian counterparts. Future research should focus on the threshold for and types of nutrition support sufficient to improve nutrition status and reduce PI risk.
From the ICU to the operating room: how to manage the patient?
Authors: Tankel James , Zimmerman Frederic , De Jong Audrey , Martin-Loeches Ignacio , Einav Sharon
Published: September 2019

Purpose of review

To outline key points for perioperative ICU optimization of nutrition, airway management, blood product preparation and transfusion, antibiotic prophylaxis and transport.

Recent findings

Optimization entails glycemic control for all, with specific attention to type-1 diabetic patients. Transport-related adverse events may be averted with surgery in the ICU. If moving the patient is unavoidable, transport guidelines should be followed and hemodynamic optimization, airway control, and stabilization of mechanical ventilation ensured before transport. Preinduction preparation includes assessment of the airway and the provision of high-flow oxygen to prolong apneic oxygenation. Postintubation, a protective positive ventilation strategy should be employed. Ideal transfusion thresholds are 7 g/dl for hemodynamically stable adult patients, 8 g/dl in orthopedic or cardiac surgery patients as well as those with underlying cardiovascular disease. Higher transfusions thresholds may be required in specific disease states. Antimicrobial prophylaxis within 120 min of incision prevents most surgical site infections. Antibiotic therapy depends on the antibiotics being received in the ICU, the time elapsed since ICU admission, local epidemiology and the type of surgery. Tailored antimicrobial regimens may be continued periprocedurally. If more than 70% of the nutritional requirement cannot be met enterally, parenteral nutrition should be initiated within 5–7 days of surgery or earlier if the patient is malnourished.

ICU patients who require surgery may benefit from appropriate perioperative management.
Safety in office-based anesthesia: an updated review of the literature from 2016 to 2019
Authors: de Lima Andres , Osman Brian M. , Shapiro Fred E.
Published: September 2019

Purpose of review

Office-based anesthesia (OBA) is rapidly growing across the world. Availability of less invasive interventions has facilitated the opportunity of offering new procedures in office-based settings to patient populations that would not have been considered in the past. This article provides a practical approach to discuss and analyze newest literature supporting different practices in the field of OBA. In addition, an update of the most recent guidelines and practice management directives is included.

Recent findings

Selected procedures may be performed in the office-based scenario with exceedingly low complication rates, when the right patient population is selected, and adequate safety protocols are followed. Current regulations are focused on reducing surgical risk through the implementation of patient safety protocols and practice standardization. Strategies include cognitive aids for emergencies, safety checklists, facility accreditation standards among other.

New evidence exists supporting procedures in the office-based scenario in areas such as plastic and cosmetic surgery, dental and oral surgery, ophthalmology, endovascular procedures and otolaryngology. Different systematic approaches have been developed (guidelines and position statements) to promote standardization of safe practices through emergency protocols, safety checklists, medication management and surgical risk reduction. New regulations and accreditation measures have been developed to homogenize practice and promote high safety standards.
Relationship Between Etonogestrel Concentrations and Bleeding Patterns in Contraceptive Implant Users
Authors: Lazorwitz Aaron , Aquilante Christina L. , Dindinger Eva , Harrison Margaret , Sheeder Jeanelle , Teal Stephanie
Published: September 2019

OBJECTIVE:

To estimate whether serum etonogestrel concentrations influence bleeding patterns and related side effects in contraceptive implant users.

METHODS:

We conducted a prospective cross-sectional study with healthy, reproductive-aged women using etonogestrel implants for 12–36 months. Participants completed a brief questionnaire to assess their current bleeding pattern and any experience of abnormal bleeding with the implant. We then measured serum etonogestrel concentrations. We also reviewed the charts of participants to determine whether a prescription for oral contraceptive pills was ever given for treatment of implant-related bothersome bleeding. We performed multivariable logistic regression to test for associations between serum etonogestrel concentrations and both bleeding patterns and related side effects.

RESULTS:

We enrolled 350 women, and 59.4% reported having experienced abnormal bleeding with the contraceptive implant. Only 14.9% of participants reported amenorrhea and 37.7% reported monthly periods. Among participants with reviewable medical records (n=253), roughly 20% had received a prescription for oral contraceptive pills during implant use. Increasing serum etonogestrel concentrations were significantly associated with increasing odds of reporting abnormal bleeding (adjusted odds ratio [aOR] 1.005, P=.015) and increasing odds of having received an oral contraceptive pill prescription (aOR 1.008, P=.002). For every 100 pg/mL increase in serum etonogestrel concentration, contraceptive implant users in this study had 1.6 times the odds of reporting abnormal bleeding and 2.3 times the odds of having received a prescription as treatment for bothersome bleeding.

CONCLUSION:

We found both objective and subjective evidence that higher levels of progestin from the contraceptive implant were associated with bleeding side effects experienced by women in this study. Pharmacologic variation may influence the side effects women experience with a variety of hormonal contraceptive methods, in turn affecting patient satisfaction and discontinuation rates.
Labor Curve Analysis of Medically Indicated Early Preterm Induction of Labor
Authors: Becker David A. , Szychowski Jeff M. , Kuper Spencer G. , Jauk Victoria C. , Wang Michelle J. , Harper Lorie M.
Published: September 2019

OBJECTIVE:

To analyze the labor curves of nulliparous and multiparous women between 23.0 and 34.0 weeks of gestation who underwent induction of labor and achieved vaginal delivery.

METHODS:

This is a retrospective cohort study of all live singletons delivered vaginally after medically indicated induction of labor between 23.0 and 34.0 weeks of gestation from 2011 through 2014 at our institution. We excluded those with one or no cervical examinations available during labor. Prior cesarean delivery, 5-minute Apgar score less than 5, and arterial cord pH less than 7.0 were exclusions. The course of cervical dilation was modeled using repeated measures analysis, and smoothed curves for nulliparous and parous women were generated separately. Estimates of the median (5th–95th percentile) traverse times between two dilations were computed using interval censored regression. Traverse times (ie, the elapsed time between two given dilation measures) were compared between nulliparous and parous women.

RESULTS:

Sixty-seven nulliparous and 69 multiparous women were included. Each group exhibited similar rates of change from 1 to 3 cm of dilation (median 3.6 hours nulliparous and 3.4 hours multiparous, P=.90). Nulliparous women progressed from 3 to 6 cm more slowly than multiparous women (median 10 hours vs 4.4 hours, P<.001). After 6 cm, both groups rapidly progressed to 10 cm (median 0.3 hours vs 0.3 hours, P=.64). Although the 95th percentile traverse time from 6 to 10 cm was about 2 hours in each group, progression from 1 to 6 cm at the 95th percentile was much longer (64.0 vs 42.2 hours).

CONCLUSION:

Early preterm labor induction takes less time in multiparous women owing to more rapid progression from 3 to 6 cm. At the 95th percentile, both nulliparous and multiparous women delivered vaginally, even with latent labor lasting well longer than 24 hours.
Antibiotic Use Without Indication During Delivery Hospitalizations in the United States
Authors: Andrikopoulou Maria , Huang Yongmei , Duffy Cassandra R. , Stern-Ascher Conrad N. , Wright Jason D. , Goffman Dena , D'Alton Mary E. , Friedman Alexander M.
Published: September 2019

OBJECTIVE:

To analyze trends in unindicated antibiotic use during vaginal delivery hospitalization.

METHODS:

This study used an administrative database to analyze antibiotic use during delivery hospitalizations from January 2006 to March 2015. Women were classified by mode of delivery and whether they had an evidence-based indication for antibiotics. Indications for antibiotics included preterm prelabor rupture of membranes (PROM), cesarean delivery, group B streptococcus (GBS) colonization, chorioamnionitis, endometritis, urinary tract infections, and other infections. The Cochran-Armitage test was used to assess trends of antibiotic administration. Unadjusted and adjusted analyses for antibiotic receipt including demographic, hospital, and obstetric and medical factors were performed with unadjusted and adjusted risk ratios (RRs) with 95% CIs as measures of association.

RESULTS:

A total of 5,536,756 delivery hospitalizations, including 2,872,286 vaginal deliveries without an indication for antibiotics, were analyzed. The most common indication for antibiotics was cesarean delivery (33.6% of the entire cohort), followed by GBS colonization (15.8%), chorioamnionitis (1.7%), preterm PROM (1.6%), endometritis (1.2%), urinary tract infections (0.6%), and other infections (total less than 0.5%). The proportion of women receiving unindicated antibiotics decreased 44.4%, from 38.1% in 2006 to 21.2% in 2015. Adjusted risk for receipt of unindicated antibiotics was lower in 2015 vs 2006 (adjusted RR 0.56, 95% CI 0.55–0.57).

CONCLUSION:

Use of antibiotics during vaginal delivery hospitalizations without an indication for antibiotic use declined significantly based on an analysis of a large administrative data set.
Aspiration Pneumonitis Causing Respiratory Collapse in a Pregnant Patient Not in Labor
Authors: Westerfield Katie L. , Bhavsar Amit K. , Green Samantha
Published: September 2019

BACKGROUND:

Aspiration is a known risk of obstetric anesthesia; however; it has not been previously described outside of active labor or the setting of anesthesia.

CASE:

We present the case of a 31-year-old patient with a twin gestation at 33 weeks of gestation, not in labor, with clinically silent aspiration leading to aspiration pneumonitis and respiratory collapse requiring endotracheal intubation and transport to a pulmonary critical care service. After 4 days, she was extubated and eventually underwent a cesarean delivery at 37 weeks of gestation with no long-term pulmonary sequelae.

CONCLUSION:

Clinicians should consider aspiration pneumonitis in the gravid patient who develops acute shortness of breath, even in the absence of active labor or receipt of anesthesia.
Congenital pseudarthrosis of the tibia: the outcome of a pathology-oriented classification system and treatment protocol
Authors: El-Rosasy Mahmoud Abdel-Monem
Published: September 2019

Congenital pseudarthrosis of the tibia is defined as a non-union of a tibial fracture that develops in a dysplastic bone segment of the tibial diaphysis. Pathologically, a fibrous hamartoma surrounds the bone at the congenital pseudarthrosis of the tibia site. The cases of 25 children, who have congenital pseudarthrosis of the tibia, were included in this study. Their ages ranged from 15 months to 15 years at the time of treatment. Neurofibromatosis-1 was present in 24 children. They were managed according to our classification system and treatment protocol. The treatment for mobile pseudarthrosis (types 1 and 2) included complete excision of the pathological periosteum, insertion of autogenous iliac crest bone graft, and combined fixation using intramedullary rod and Ilizarov external fixator. For type 3 pseudarthrosis (stiff pseudarthrosis), a pre-constructed Ilizarov fixator was applied for simultaneous distraction of the pseudarthrosis and deformity correction without open surgery. Evaluation of results was mainly radiological and included achievement of union, leg length equalization, deformity correction and prevention of refracture. Consolidation of the pseudarthrosis and osteotomies was achieved in all cases (100%). Refracture occurred in one case (4%) at the site of previous pseudarthrosis. Residual limb length discrepancy more than 2.5 cm occurred in two cases (8%). Valgus deformity of the ankle was present in 12 cases (48%) and was treated by supramalleolar osteotomy. Follow-up ranged from 24 to 48 months (average 36.9 months) after fixator removal. The results of our treatment protocol, based on our classification system, have been consistently good and predictable in all cases of congenital pseudarthrosis of the tibia. Mobility of the pseudarthrosis is an important factor in choosing the type of interference.
Differential MRI findings of transient synovitis of the hip in children when septic arthritis is suspected according to symptom duration
Authors: Kang Michael Seungcheol , Jeon Ji Young , Park Soo-Sung
Published: September 2019

We investigated the differential MRI findings in children with transient synovitis of the hip in whom septic arthritis was suspected. Under the hypothesis that disease progression can alter representative MRI findings, we stratified these findings in accordance with symptom duration as this can correlate with disease progression. We analyzed 65 children who underwent MRI for acute hip pain and who were suspected of having a septic condition (i.e. presented with fever or increased inflammatory markers) when the imaging was performed. Symptom duration was defined as the interval from the first presentation of hip pain to the MRI scan. We divided the patients into two subgroups according to symptom duration: patients with short symptom duration (≤2 days, short-term subgroup, n = 30) and those with long symptom duration (≥3 days, long-term subgroup, n = 35). Twenty-eight (43.1%) of the study subjects were diagnosed with septic arthritis. Whereas only a high-grade joint effusion was a significant MRI finding differentiating septic arthritis from transient synovitis in the whole cohort, the presence of contralateral joint effusion in the short-term subgroup (P= 0.024) and the absence of a change/enhancement of the signal intensity of soft tissue in the long-term subgroup (P< 0.001) were significant predictors of transient synovitis. The significances of differential MRI findings for septic arthritis and transient synovitis seem to change according to symptom duration. We suggest that symptom duration, which may correlate with disease progression, should also be considered when interpreting MRIs of children under suspicion of septic arthritis.
Pediatric acute leg compartment syndrome after peroneus longus rupture: a case series
Authors: Hull Brandon R. , Wingfield Jessica J. , Stall Alec , Birch Craig M. , Ho Christine A.
Published: September 2019

We present the case of three pediatric patients who presented with non-fracture acute lateral compartment syndrome after ‘minor trauma’. All patients were male and sustained the inciting event during football. Two of the patients were able to resume play after their injury. All patients sustained intramuscular proximal avulsion ruptures of the peroneus longus muscle. At final follow-up, all but one patient had documented full neurologic recovery. A seemingly innocuous event may cause acute compartment syndrome in the adolescent male. Compartment syndrome in the absence of fracture should be promptly recognized to prevent delay in surgical treatment.
Clinical Outcomes of Surgically Unresectable Endometrial Cancers
Authors: Conway Jessica L. , Lukovic Jelena , Ferguson Sarah E. , Zhang Jiahui , Xu Wei , Dhani Neesha , Croke Jennifer , Fyles Anthony , Milosevic Michael , Rink Alexandra , Rouzbahman Marjan , Han Kathy
Published: September 2019

Objective:

The objective of this study was to determine the outcomes of patients with unresectable endometrial cancer managed with definitive or neoadjuvant radiation (RT) and/or chemotherapy.

Materials and Methods:

Patients with unresectable stages II to IVA endometrial cancer who were treated with curative intent between January 2000 and March 2018 were identified. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method and compared using the log-rank test. Multivariate logistic regression analysis was performed to identify factors associated with receipt of surgery. Multivariate Cox regression analysis was performed to identify factors associated with OS and DFS.

Results:

Of the 59 patients identified, the median age was 63 years (range: 37 to 88 y) and histology was endometrioid in 59%. Median follow-up was 2.2 years (range: 0.3 to 9.8 y). Seventeen patients (29%) received neoadjuvant chemotherapy, 28 (47%) neoadjuvant radiation, and 14 (24%) definitive RT; 39 (66%) underwent surgery. Patients who received surgery had higher 3-year OS and DFS than those who did not (84% vs. 41%; P<0.001 and 56% vs. 11%; P<0.001, respectively). Factors associated with higher odds of surgical resection included younger age, endometrioid histology, and earlier stage. Younger age, endometrioid histology, and surgical resection were significantly associated with higher OS. Surgical resection was also associated with higher DFS.

Conclusions:

Surgical resection following RT and/or chemotherapy for locally advanced, unresectable endometrial cancer is associated with higher DFS and OS and more likely to be achieved in endometrioid subtypes.
Myxoid Onychomatricoma—A New Case
Authors: Pessoa e Costa Tomás , João Ana Luísa , Pinheiro Rita , Carvalho Rodrigo , Matos Pires Eugénia , Lencastre André
Published: September 2019

Onychomatricoma is a slow-growing, benign neoplasm of the nail matrix with several histological variants. With only 2 cases previously reported, the term “myxoid onychomatricoma” has been used by some authors to describe a rare variant, known to have a fibromixoid component. We present a case of a 51-year-old Caucasian woman with a 1-year history of thickening and discoloration of the right thumbnail, who was initially misdiagnosed as onychomycosis. After performing a magnetic resonance imaging that showed a tumor with several filamentous projections, an onychomatricoma was suspected and a total distal plaque avulsion was performed. Histology revealed a biphasic tumor with an epithelial component and a prominent myxoid stroma. Immunohistochemical staining was then used, confirming the diagnosis. Considering these findings, we believe that our case meets the diagnostic description of “myxoid onychomatricoma” and is, therefore, a new case of this rare histological variant.
The effects of Engelhardtia chrysolepis Hance on long-term memory and potential dopamine involvement in mice
Authors: Jeon So-Yeon , Kim Na-Hyun , Kim Yu-Jeong , Lee Kyung-A , Goto Yukiori , Lee Young-A
Published: September 2019

Engelhardtia chrysolepis Hance (ECH) is a perennial plant used in traditional medicine. A major active ingredient of ECH is astilbin (ASB), which has recently been shown to have neuroprotective effects as well as to affect catecholamine neurotransmissions in brain areas such as the prefrontal cortex. In this study, we investigated the effects of ECH and ASB on long-term memory in mice using a battery of behavioral tests. Acute ECH treatments dose-dependently facilitated nonspatial, but not spatial, memory. ECH treatments also upregulated expression of tyrosine hydroxylase, the enzyme mediating catecholamine synthesis, in neuroblastoma cell culture. Acute ASB treatments similarly improved nonspatial memory, whereas chronic ASB treatments improved both nonspatial and spatial memory. In accordance with such behavioral effects, the increased ratio of tissue concentrations of dopamine metabolites over dopamine in striatal regions was observed in mice with chronic ASB treatments. These results suggest that ECH and its active ingredient ASB may facilitate long-term memory by modulating catecholamine transmission.
Piperlongumine produces antidepressant-like effects in rats exposed to chronic unpredictable stress
Authors: Zhang Lei , Liu Chen , Yuan Mei , Huang Chunlan , Chen Lin , Su Ting , Liao Zigen , Gan Lu
Published: September 2019

Piperlongumine, an alkaloid compound extracted from Peper longum L, has been reported to produce neuroprotective effects in the brain and exert various pharmacological activities such as antitumor, antiangiogenic, anti-inflammatory and analgesic properties. The aim of this study was to investigate the antidepressant-like effects and the possible mechanism of action of piperlongumine in a chronic unpredictable stress (CUS) model. We found that, with venlafaxine as a positive control, orally administered piperlongumine (12.5 and 25 mg/kg) for 7 days, not a single dose, significantly reduced immobility time in the forced swimming test, but did not alter locomotor activity in the open field test, indicating that piperlongumine has antidepressant-like effects without nonspecific motor changes. Then, using the CUS model of depression, piperlongumine was administrated orally for 4 weeks, followed by sucrose preference and forced swimming tests to evaluate the depressive-like behaviors. We found that piperlongumine reversed both the decreased sucrose preference and increased immobility time in rats exposed to CUS. In addition, piperlongumine also reversed the increase in proinflammatory cytokine levels in the hippocampus of rats in the CUS model. Altogether, the present study demonstrated that piperlongumine exhibits the antidepressant-like effects in rats, which may be mediated by the inhibition of the neuronal inflammation in the hippocampus.
Management of Menopause and the Role For Hormone Therapy
Authors: PINKERTON JOANN V. , CONNER EDWARD A. , KAUNITZ ANDREW M.
Published: September 2019

Hormone therapy remains the most effective treatment for menopausal symptoms but decisions are complex, requiring an assessment of benefits and risks and determination of best treatment type, dose, and duration. Benefits exceed risks for most women with bothersome menopausal symptoms or high risk for fracture if initiated under age 60 years or within 10 years since menopause. Long-term mortality and safety data from the Women’s Health Initiative is reassuring, with no increase in deaths from cardiovascular disease or cancer compared with placebo after 18 years of follow-up and a trend towards less mortality in those who initiate hormone therapy ages 50 to 59 years.
Thermal Neutron Characterization and Dose Modeling of a 239PuBe Alpha-Neutron Source
Authors: Willey Adam H. , DeVol Timothy A. , Martinez Nicole E.
Published: September 2019

Determination of neutron dose can be challenging and requires knowledge of neutron flux as a function of energy. The goal of this project was to characterize the thermal neutron flux of a 37 GBq 239PuBe alpha-neutron source and model the associated neutron dose using version MCNPX of the Monte-Carlo N-Particle transport codes. The 239PuBe source was placed in a neutron howitzer, and foil activation (dysprosium foils with and without cadmium covers) was used at various distances to determine thermal neutron flux, which was then used to verify the MCNPX model representing the system. The model was then adapted for dosimetric modeling to enable future neutron dose-response studies.
Measuring Self-Reported Physical Function in Individuals With TBI: Development of the TBI-QOL Mobility and Upper Extremity Item Banks and Short Forms
Authors: Capó-Lugo Carmen E. , Kisala Pamela A. , Boulton Aaron J. , Choi Seung W. , Heinemann Allen W. , Tulsky David S.
Published: September 2019

Objectives:

To describe the development and field testing of the patient-reported outcome measures of Mobility and Upper Extremity function from the Traumatic Brain Injury Quality of Life (TBI-QOL) measurement system, and to evaluate the use of computer adaptive testing.

Setting:

Five rehabilitation facilities funded as part of the TBI Model Systems network.

Participants:

Individuals with complicated mild, moderate, or severe traumatic brain injury (n = 590).

Interventions:

Not available.

Outcome Measures:

TBI-QOL Mobility and Upper Extremity item banks.

Results:

Item response theory and factor analyses supported the unidimensionality of the Mobility and Upper Extremity banks. Descriptive statistics showed a ceiling effect for both measures. Simulated computer adaptive tests (CATs) showed that measurement precision was maintained across administration formats for both measures. The Upper Extremity CAT showed a loss of precision for individuals without impairment and that a higher number of items were required to achieve sufficiently precise measurement, compared to the Mobility CAT.

Conclusions:

The TBI-QOL Upper Extremity and Mobility item banks achieved good breadth of coverage, particularly among those individuals who have experienced some degree of functional limitation. The use of CAT administration minimizes respondent burden, while allowing for the comprehensive assessment of adults with TBI. The combined use of the TBI-QOL with performance-based measures could guide the development of targeted rehabilitation treatments.
Capillary Hemangioma Presenting as a Scleral Vascular Lesion in a Child
Authors: Bradfield Yasmin , Burkat Cat N. , Albert Daniel M. , Potter Heather A.D.
Published: September 2019

A 7-year-old healthy girl presented for an evaluation of a left vascular scleral mass. The lesion appeared spontaneously with no history of trauma, coagulopathy, or topical medication use. It was nontender, enlarging, and did not extend intraocularly. Her OS vision was 20/20, and the remainder of her eye examination was normal. Evaluation of the ocular mass included B-scan ultrasound, ultrasound biomicroscopy, anterior segment optical coherence tomography (OCT), and orbital MRI. The anterior segment OCT demonstrated vessels within the mass with no defined capsule. The orbital MRI confirmed a lesion isolated to the scleral layers of the globe, with low blood flow. The patient had a partial response to oral propranolol. Because the lesion vessels began to extend into her corneal endothelium, there was a concern for malignancy. A biopsy confirmed a benign intrascleral capillary hemangioma. Discontinuation of the propranolol demonstrated stability of the lesion 6 months later.
Novel Use of Porcine Urinary Bladder Matrix in the Exenterated Socket
Authors: Wilson Caroline W. , Fisher Mark T. , Pagedar Nitin A. , Kass Gretchen , Terry William W. , Shriver Erin M.
Published: September 2019

The aim of exenteration reconstruction is to stabilize the postsurgical wound bed to promote expeditious healing particularly in patients who are undergoing adjuvant radiation and/or chemotherapy. Porcine urinary bladder matrix has previously been used successfully as a wound-healing scaffold in treatment of burns and in acute, chronic, and surgical wounds, but the use of these products has not previously been reported in the exenterated orbit. The authors present a case of the novel use of porcine urinary bladder matrix in a pediatric patient who underwent exenteration for recurrent embryonal rhabdomyosarcoma, subsequent split-thickness skin grafting, and adjuvant radiation.
Identifying Targets to Improve Coding of Child Physical Abuse at a Pediatric Trauma Center
Authors: Durand Maria Bautista , McLaughlin Cory M. , Imagawa Karen Kay , Upperman Jeffrey S. , Jensen Aaron R.
Published: September 2019

Child physical abuse is a leading cause of morbidity and mortality in young children. Identification of abused children is challenging, and can affect risk-adjusted benchmarking of trauma center performance. The purpose of this project was to understand diagnosis coding capture rates for child abuse and develop a standardized approach to clinician documentation to improve trauma registry capture. A retrospective cohort was obtained including all admitted trauma patients with injuries from known or suspected abusive mechanism in 2017. Patients who received forensic workup for child physical abuse were classified as “no abuse,” “suspected abuse,” and “confirmed abuse” using narratives from social work notes. Our trauma registry was used to abstract International Classification of Diseases, Tenth Revision (ICD-10) diagnostic and external cause codes for each patient. Abuse classifications defined by chart review were then compared with coding in the registry using crosstabs. A total of 115 patients were identified as having a forensic workup for child physical abuse. Patients who underwent forensic workup were classified as: 40% no abuse, 37% suspected abuse, and 23% confirmed abuse at the time of discharge. Three patients (6%) with a negative forensic workup were overcoded as suspected abuse in our trauma registry. Among patients with clinically confirmed abuse, our trauma registry identified only 63% by diagnostic codes and only 33% by external cause codes. Child physical abuse is frequently undercoded, and clear clinical documentation of the level of suspicion of abuse at discharge is needed to accurately identify abused patients.
Insight Into Illness and Defense Styles in Schizophrenia
Authors: Ogawa Yasuhiro , Fukuhara Keita , Tanaka Hiroyuki , Nagata Yuma , Ishimaru Daiki , Nishikawa Takashi
Published: September 2019

Although the psychological denial model argues that poor insight is a result of defense mechanisms, the direct relationship between the two remains unclear. This study aimed to examine the relationship between insight into illness and defense mechanisms while considering cognitive dysfunction in schizophrenia. A total of 38 patients with schizophrenia were evaluated for level of insight (Schedule for the Assessment of Insight), defense mechanisms (Defense Style Questionnaire), neurocognitive function (Brief Assessment of Cognition in Schizophrenia), and psychotic symptoms (Brief Psychiatric Rating Scale). Regarding level of insight, partial correlation analysis controlling neurocognitive and psychotic variables showed that “recognition of illness” was positively correlated with immature defense styles and negatively correlated with mature defense styles. Stepwise regression analyses revealed that “recognition of illness” was significantly predicted by immature defense styles. Our findings suggest that patients who tend to use immature defense styles are more likely to accept their own mental illness.