bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of EGFR mutation and ALK rearrangement on the outcomes of non–small cell lung cancer patients with brain metastasis
Authors: Balasubramanian Suresh K , Sharma Mayur , Venur Vyshak A , Schmitt Philipp , Kotecha Rupesh , Chao Samuel T , Suh John H , Angelov Lilyana , Mohammadi Alireza M , Vogelbaum Michael A , Barnett Gene H , Jia Xuefei , Pennell Nathan A , Ahluwalia Manmeet S
Published: October 2019

Background

The impact of activating alterations in non–small cell lung cancer (NSCLC) (epidermal growth factor receptor [EGFR] mutation/anaplastic lymphoma kinase [ALK] translocation) in prognosticating patients with brain metastasis (BM) is not well defined. This study was sought to identify this impact in NSCLC patients with BM accounting for the known validated variables.

Methods

Among 1078 NSCLC-BM patients diagnosed/treated between January 1, 2000 and December 31, 2015, three hundred and forty-eight with known EGFR/ALK status were analyzed. Overall survival (OS) and intracranial progression-free survival (PFS) were measured from the time of BM.

Results

Ninety-one patients had either ALK (n = 23) alterations or EGFR (n = 68) mutation and 257 were wild type (WT; negative actionable mutations/alterations). Median age of EGFR/ALK+ NSCLC BM patients was 60 years (range 29.8–82.6 y) and ~50% (n = 44) had Karnofsky performance status (KPS) score >80. Median number of BM was 2 (1 to ≥99). The median OS for the ALK/EGFR+ NSCLC BM was 19.9 versus 10.1 months for the WT (P = 0.028). The number of BM in the EGFR/ALK+ group did not impact OS (BM = 1 with 21.1 months vs 2–3 with 19.1 months and >3 with 23.7 months, P = 0.74), whereas fewer BM in the WT cohort had significantly better OS (BM = 1 with 13.8 mo, 2–3 with 11.0 mo and >3 with 8.1 mo; P = 0.006) with the adjustment of age, KPS, symptoms from BM and synchronicity.

Conclusions

Number of BM does not impact outcomes in the EGFR/ALK+ NSCLC patients, implying that targeted therapy along with surgery and/or radiation may improve OS irrespective of the number of BM. Number of BM, extracranial metastasis (ECM), and KPS independently affected OS/PFS in WT NSCLC BM, which was consistent with the known literature.
A Compendium of Modern Minimally Invasive Intracerebral Hemorrhage Evacuation Techniques
Authors: Pan Jonathan , Chartrain Alexander G , Scaggiante Jacopo , Spiotta Alejandro M , Tang Zhouping , Wang Wenzhi , Pradilla Gustavo , Murayama Yuichi , Mori Ryosuke , Mocco J , Kellner Christopher P
Published: October 2019

Background

Minimally invasive intracerebral hemorrhage (ICH) evacuation has gained popularity with success in early-phase clinical trials. This procedure, however, is performed in very different ways around the world.

Objective

To provide a technical description of these strategies that facilitates comparison and aids decisions in which surgery to perform, and to inform further improvements in minimally invasive ICH evacuation.

Methods

Major authors of clinical trials evaluating each of the main techniques were contacted and asked to supply a case example and technical description of their respective surgeries.

Results

Five major techniques are presented including stereotactic thrombolysis, craniopuncture, endoscopic, endoscope-assisted, and endoport-mediated. Techniques differ in numerous ways including the size of the cranial access, the size of the access corridor through the brain to the hematoma, and the evacuation strategy. Regarding cranial access, a burr hole is created in stereotactic thrombolysis and craniopuncture, a small craniectomy in endoscopic, and a small craniotomy in the other 2. Access corridors through the parenchyma range from 3 mm in craniopuncture to 13.5 mm in the endoport-mediated evacuation. Regarding evacuation strategies, stereotactic thrombolysis and craniopuncture rely on passive drainage from a catheter placed during surgery that remains in place for multiple days, while the other 3 techniques rely on active evacuation with suction and bipolar cautery.

Conclusion

Future comparative clinical trials may identify the advantageous components of each strategy and contribute to improved outcomes in this patient population.
‘The Harmony of One Choir’? Music and Social Unity in Reformation Heidelberg*
Authors: Laube Matthew
Published: October 2019

From early in the Reformation, Protestant leaders viewed music as a powerful tool not only for educating their followers, but also for forging unity within diverse and dispersed communities. Such a belief found expression in official and unofficial religious contexts, and left its mark on printed devotional material, congregational hymn books, public policies of church authorities, and the musical activities of individual churches. At the same time, the manner in which a person accessed, experienced and produced music in a Reformation urban environment was conditioned as much by social factors such as age, gender, social station and personal contacts, as by confessional affiliation and policy. Using a corpus of previously unexploited sources from the Protestant city of Heidelberg, this article challenges the rhetorical and outdated binary notions of social ‘harmony’ and ‘discord’. It argues that music in a Reformation city — whether congregational song in churches, secular song in taverns, inns and streets, or domestic devotional song — could function as a powerful platform for emphasizing rather than dissolving a range of meaningful social differences, even as it created new kinds of unity across urban society.
From Object to Subject: Intersex Activism and the Rise and Fall of the Gender Binary in Germany
Authors: von Wahl Angelika
Published: October 2019

In several states, the universal gender binary has been challenged by the introduction of an official third sex. This article explains that paradigm shift in Germany by analyzing the successful introduction of a third sex category in 2018. Historical legacies of gender variance in the pre-modern and modern states are compared with the contemporary (re-)introduction of a third sex. I show that intersex activists and their transnational advocacy at the United Nations reframed the discourse from medical correction to legal protection. This study offers critical insights into the changing dynamics and meanings of gender, state power, and social movements.
Safeguarding trustees’ interests
Authors: Hayton David
Published: October 2019

The recent Sofer case shows how trustees can safeguard their interests via exoneration clauses, deeds of indemnity and even estoppel by convention. It also makes clear how beneficiaries faced with an exoneration clause, which they seek to oust due to the dishonesty of the trustee, bear the onus of fully particularising the dishonesty or their claims may be struck out.
The Thenar Crease Skin Graft: A Novel Addition to “Camouflage” Grafts of the Hand
Authors: Kang Yong Chiang , Chin Yuan Hui Andrew
Published: October 2019

Palmar skin defects of the hand are common. When wound conditions are favorable, glabrous skin grafting provides ideal resurfacing—simple, predictable, and excellent esthetic outcome. Glabrous skin grafts are however confined to small sizes from limited donor sites. We present a novel technique of harvesting full-thickness skin grafts from the thenar crease and report the outcome of our cases. We provide further insights to adapt the technique to a variety of clinical scenarios—degloving injuries and shaving injuries of the finger including subcomplete pulp skin loss. Graft size is up to 75 mm by 10 mm, with tension-free donor site closure. We further report the operative experience, functional and esthetic outcome. The technique is fast, versatile, and provides large surface areas of good quality glabrous skin in a single-stage procedure. It will sit well in the armamentarium of the hand surgeon.
Clinical Impact of an Electronic Dashboard and Alert System for Sedation Minimization and Ventilator Liberation: A Before-After Study
Authors: Anderson Brian J. , Do David , Chivers Corey , Choi Katherine , Gitelman Yevgeniy , Mehta Shivan J. , Panchandam Venkat , Gudowski Steve , Pierce Margie , Cereda Maurizio , Christie Jason D. , Schweickert William D. , Gabrielli Andrea , Huffenberger Ann , Draugelis Mike , Fuchs Barry D.
Published: October 2019

Objectives:

Sedation minimization and ventilator liberation protocols improve outcomes but are challenging to implement. We sought to demonstrate proof-of-concept and impact of an electronic application promoting sedation minimization and ventilator liberation.

Design:

Multi-ICU proof-of-concept study and a single ICU before-after study.

Setting:

University hospital ICUs.

Patients:

Adult patients receiving mechanical ventilation.

Interventions:

An automated application consisting of 1) a web-based dashboard with real-time data on spontaneous breathing trial readiness, sedation depth, sedative infusions, and nudges to wean sedation and ventilatory support and 2) text-message alerts once patients met criteria for a spontaneous breathing trial and spontaneous awakening trial. Pre-intervention, sedation minimization, and ventilator liberation were reviewed daily during a multidisciplinary huddle. Post-intervention, the dashboard was used during the multidisciplinary huddle, throughout the day by respiratory therapists, and text alerts were sent to bedside providers.

Measurements and Main Results:

We enrolled 115 subjects in the proof-of-concept study. Spontaneous breathing trial alerts were accurate (98.3%), usually sent while patients were receiving mandatory ventilation (88.5%), and 61.9% of patients received concurrent spontaneous awakening trial alerts. We enrolled 457 subjects in the before-after study, 221 pre-intervention and 236 post-intervention. After implementation, patients were 28% more likely to be extubated (hazard ratio, 1.28; 95% CI, 1.01–1.63; p = 0.042) and 31% more likely to be discharged from the ICU (hazard ratio, 1.31; 95% CI, 1.03–1.67; p = 0.027) at any time point. After implementation, the median duration of mechanical ventilation was 2.20 days (95% CI, 0.09–4.31 d; p = 0.042) shorter and the median ICU length of stay was 2.65 days (95% CI, 0.13–5.16 d; p = 0.040) shorter, compared with the expected durations without the application.

Conclusions:

Implementation of an electronic dashboard and alert system promoting sedation minimization and ventilator liberation was associated with reductions in the duration of mechanical ventilation and ICU length of stay.
Rare Case Report of Pilomatrical Carcinosarcoma in a Pediatric Patient
Authors: Gates Gregory A. , Nguyen Johnny , Binder Scott W.
Published: October 2019

We present a case report of the exceptionally rare pilomatrical carcinosarcoma in an even rarer pediatric age group, a 9-year-old female patient. The tumor showed biphasic pilomatrical carcinoma and malignant sarcomatous transformation. To date, the patient is healing well without signs of recurrence. Although limited clinical follow-up is available due to the recent diagnosis, this case may provide a rare look at the clinical outcome of this very rare tumor.
Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for 5-year hypertension remission in obese patients: a systematic review and meta-analysis
Authors: Climent Elisenda , Goday Albert , Pedro-Botet Juan , Solà Ivan , Oliveras Anna , Ramón José Manuel , Flores-Le Roux Juana Antonia , Checa Miguel Ángel , Benaiges David
Published: October 2019

Controversial results exist on mid-term effects of Roux-en-Y gastric bypass and sleeve gastrectomy on hypertension remission. The aim of the present systematic review was to study 5-year hypertension remission after both procedures. One-year hypertension remission and SBP and DBP pressure change at 1 and 5 years after both surgical techniques were also evaluated. We searched MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials (CENTRAL). Thirty-two articles were included (six randomized controlled trials, 18 cohort and eight case–control studies). The proportion of patients with hypertension remission was greater for those treated with gastric bypass compared with sleeve gastrectomy at 5 years (RR = 1.26, 95% CI = 1.07–1.48) and 1 year (RR = 1.14, 95% CI = 1.06–1.21). Gastric bypass and sleeve gastrectomy did not differ in terms of SBP or DBP change. Patients treated with gastric bypass present a higher hypertension remission rate at 1 and 5 years.
Jet Ventilation Decreases Target Motion and Increases Yield of ENB Especially in Lesions With Negative Bronchus Sign
Authors: Webb Tracey N. , Bonta Dacian V. , Masters Roger , Parks Christopher , Bechara Rabih
Published: October 2019

Background:

Electromagnetic navigational bronchoscopy (ENB) is used to obtain peripheral lung tissue samples for evaluation and staging of central and peripheral lung lesions. Jet ventilation delivers and maintains a sustained airway pressure at high frequency, chest wall and diaphragmatic movement is drastically reduced compared with traditional ventilation. The current study looks to examine the effectiveness of tissue sampling (diagnostic yield) while using jet ventilation on target-lesion movement when compared with traditional ventilation.

Methods:

A total of 36 patients received total intravenous anesthesia with both jet and traditional ventilation during ENB procedure where sensor to lesion displacement was recorded. When planning the ENB procedure, the presence or absence of a viable airway to the lesion was recorded. Sensor to lesion movement was recorded and compared for significance using χ2 and t tests, utilizing stringent P-values.

Results:

Overall patients with an airway to the lesion (n=23) had a higher proportion of successful diagnostic biopsies, 83% compared with those patients that lacked an airway to the lesion (n=13) 70% proportion of successful diagnostic biopsies. When using jet ventilation, the chance of nonzero displacement was 8.3% (0.14 mm), regardless of the presence of an airway. Compared with traditional ventilation, the chance of a nonzero displacement between the sensor and target-lesion was 83% (6.4 mm), independent of airway presence to the lesions.

Conclusion:

In patients without an airway, jet ventilation significantly decreased target displacement when compared with traditional ventilation (2 vs. 17 mm). In patients with direct airway to the lesion, jet ventilation did not significantly decrease target displacement when compared with the traditional approach.
Comparison of two blood pressure oscillometric devices: Datascope Accutorr Plus and Mobil-O-Graph PWA and conversion of blood pressure values from one device to the other
Authors: Sarganas Giselle , Kuhnert Ronny , Gohlisch Christopher , van der Giet Markus , Neuhauser Hannelore
Published: October 2019

Objective

This study aims to compare two oscillometric devices used in national health surveys in Germany, Datascope Accutorr Plus and Mobil-O-Graph PWA and to develop formulas for the conversion of blood pressure (BP) values.

Methods

One hundred and four adults aged 21–86 years had nine alternate same-arm BP measurements according to the International Protocol revision 2010 for the validation of BP measuring devices in adults of the European Society of Hypertension. Measurements 2–8 yielded six pairs of measurements at 30- to 60-second interval with the two devices, totaling 743 pairs used for analysis.

Results

Mean Mobil-O-Graph SBP and DBP were higher than those from Datascope. Mean differences (Mobil-O-Graph minus Datascope) increased within BP ranges (optimal, normal, high normal, hypertensive stage 1, stage 2 and stage 3): SBP 0.5 ± 8.5, 3.1 ± 8.2, 3.7 ± 8.0, 5.3 ± 8.8, 13.8 ± 10.2 and 15.0 ± 25.9, respectively, and DBP 2.6 ± 5.6, 6.0 ± 4.9, 6.6 ± 5.2, 8.4 ± 4.8, 12.3 ± 4.6 and 20.4 ± 4.2, respectively. For Mobil-O-Graph pulse pressure less than 43 mm Hg, the DBP difference was 6.3 ± 5.5, and for Mobil-O-Graph pulse pressure more than 50 mm Hg, the SBP difference was 7.4 ± 9.3. The prevalence of BP at least 140/90 mm Hg was 28.8% with Mobil-O-Graph and 20.5% with Datascope. Bidirectional conversion models of SBP and DBP adjusting for BP, pulse pressure, sex, age and cuff width to arm circumference ratio were developed.

Conclusion

The disagreement in oscillometric devices can reach a magnitude that can be relevant for clinical and epidemiological contexts. The here generated conversion formulas may help to improve comparability.
Gastro‐esophageal Reflux After Laparoscopic Gastrostomy Placement in Children
Authors: Franken Josephine , Stellato Rebecca K. , Tytgat Stefaan H.A.J. , Van der Zee David C. , Mauritz Femke A. , Lindeboom Maud Y.A.
Published: October 2019

Objectives:

Gastrostomy placement is frequently performed in pediatric patients who require long‐term enteral tube feeding. Evidence on the influence of gastrostomy placement on gastro‐oesophageal reflux disease has been inconsistent. The aim of this study was to investigate the influence of gastrostomy on gastro‐oesophageal reflux.

Methods:

A prospective, longitudinal cohort study was performed including 50 patients who underwent laparoscopic gastrostomy between May 2012 and April 2014. Before and 3 months after surgery 24‐hour multichannel intraluminal impedance pH monitoring was performed and caregivers filled out reflux symptom questionnaires.

Results:

Gastro‐oesophageal reflux symptoms were present in a comparable number of patients before (44%) and after gastrostomy placement (40%; P = 0.73). Twenty‐five of the patients (50%) underwent both the preoperative and postoperative tests and were included in impedance‐pH analysis. Acid exposure time (percentage of time with pH below 4) did not change significantly after gastrostomy placement: from 6.2% (3.0–18.1) to 6.1% (2.6–14.9). The number of reflux episodes did not significantly change, for either liquid [mean difference 4.3 (−4.5 to 13.2)] or mixed liquid‐gas reflux [mean difference 2.0 (−9.3 to 13.3)]. Before gastrostomy placement, 18 out of 25 patients had pathological reflux (72%) on pH‐impedance measurement. In 4 patients, pathological reflux dissolved, whereas 4 patients newly developed pathological reflux. A low preoperative weight‐for‐height percentile was associated with increased acid exposure after gastrostomy placement.

Conclusions:

Overall, gastrostomy placement was not associated with an increase in acid exposure on 24‐hour multichannel intraluminal impedance pH monitoring. Similarly, the prevalence of gastro‐oesophageal reflux‐related symptoms did not change after gastrostomy.
Evaluation of Quantitative Imaging Biomarkers for Early‐phase Clinical Trials of Steatohepatitis in Adolescents
Authors: Goyal Nidhi P. , Sawh Mary Catherine , Ugalde‐Nicalo Patricia , Angeles Jorge E. , Proudfoot James A. , Newton Kimberly P. , Middleton Michael S. , Sirlin Claude B. , Schwimmer Jeffrey B.
Published: October 2019

Objectives:

Early‐phase pediatric nonalcoholic fatty liver disease (NAFLD) clinical trials are designed with noninvasive parameters to assess potential efficacy. Increasingly, these parameters include magnetic resonance imaging (MRI)‐derived proton density fat fraction (PDFF) and MR elastography (MRE)‐derived shear stiffness as biomarkers of hepatic steatosis and fibrosis, respectively. Understanding fluctuations in these measures is essential for calculating trial sample sizes, interpreting results, and planning clinical drug trials in children with NAFLD. Lack of such data in children constitutes a critical knowledge gap. Therefore, the primary aim of this study was to assess whole‐liver MRI‐PDFF change in adolescents with nonalcoholic steatohepatitis (NASH) over 12 weeks.

Methods:

Adolescents 12 to 19 years with biopsy‐proven NASH undergoing standard‐of‐care treatment were enrolled. Baseline and week‐12 assessments of anthropometrics, transaminases, MRI‐PDFF, and MRE stiffness were obtained.

Results:

Fifteen adolescents were included (mean age 15.7 [SD 2.9] years). Hepatic MRI‐PDFF was stable over 12 weeks (mean absolute change −0.8%, P = 0.24). Correlation between baseline and week‐12 values of MRI‐PDFF was high (ICC = 0.97, 95% CI 0.90–0.99). MRE stiffness was stable (mean percentage change 2.7%, P = 0.44); correlation between baseline and week‐12 values was moderate (ICC = 0.47; 95% CI 0–0.79). Changes in weight, BMI, and aminotransferases were not statistically significant.

Conclusion:

In adolescents with NASH, fluctuations in hepatic MRI‐PDFF and MRE stiffness over 12 weeks of standard‐of‐care were small. These data on the natural fluctuations in quantitative imaging biomarkers can serve as a reference for interventional trials in pediatric NASH and inform the interpretation and planning of clinical trials.
Applicability of International Classification of Functioning, Disability and Health-based participation measures in stroke survivors in Africa: a systematic review
Authors: Kossi Oyéné , Amanzonwe Elogni Renaud , Thonnard Jean-Louis , Batcho Charles Sèbiyo
Published: October 2019

To appraise available International Classification of Functioning, Disability and Health (ICF)-based tools for the measurement of participation after stroke and to examine their applicability in the African sociocultural context. Pubmed/Medline, Science Direct, Cochrane Library, and Hinari databases were systematically searched. The literature search was limited to studies published in the English or French language from January 2001 up to May 2019. Two reviewers independently screened all identified studies and selected eligible articles. Disagreements about inclusion or exclusion of studies were resolved by consensus. Two reviewers independently extracted the psychometric properties of each instrument using the Consensus-based Standard for the Selection of Health Measurement Instruments checklist and examined the methodological quality of each selected study using the MacDermid checklist. A total of 1030 articles were systematically reviewed for relevance, yielding 22 studies that met inclusion criteria. These studies were related to nine participation tools. The MacDermid scores ranged from 13 to 21 out of 24. The number of investigated psychometric properties and the number of ICF participation domains covered by each tool varied among studies. This systematic review revealed nine ICF-based tools for the measurement of participation after stroke. We examined the content of these tools and provided valuable information that can be used to guide researchers in Africa in their selection of the most appropriate tool for the measurement of participation after stroke.
Assessment of Radiation-Induced Xerostomia
Authors: Jiang Nan , Wei Siqi , Mårtensson Jan , Zhao Yue , Årestedt Kristofer
Published: October 2019

Background

Xerostomia is a common complication in patients with head and neck cancer (HNC) during and after radiotherapy. The lack of a simply-administered and well-validated self-reported instrument has hampered the assessment and management of xerostomia for research and clinical purposes in China.

Objective

This study aimed to evaluate the content validity and psychometric properties of the Xerostomia Questionnaire (XQ) in Chinese patients with HNC undergoing radiotherapy.

Methods

This psychometric evaluation study enrolled 80 patients and was conducted in 2 stages: translation and evaluation of content validity and psychometric evaluation. Cognitive interviews (n = 10) were conducted using the Participant Interview Form. The psychometric evaluation (n = 80) included score distribution, homogeneity (interitem and item-total correlations), factor structure (exploratory factor analysis), internal consistency (Cronbach’s α), criterion-related validity (person correlation), and test-retest reliability (intraclass correlations).

Results

Content validity was supported by cognitive interviews. The factor analysis resulted in a 1-factor solution with strong factor loadings (0.84–0.91) that explained 75.6% of the total variance. The internal consistency was excellent, with a Cronbach’s α of .95. The XQ correlated strongly with other measures of xerostomia (0.70–0.80), which supports criterion-related validity. The test-retest reliability was excellent (intraclass correlation coefficient = 0.92).

Conclusions

The result provides evidence for the validity and reliability of the XQ in a sample of Chinese patients with HNC.

Implications for Practice

The XQ can be used in both clinical practice and research as a valuable tool to screen for problems with xerostomia, monitor the xerostomia level, and evaluate the effects of treatment and interventions among patients with HNC.
Informing New Mothers about Newborn Screening Bloodspot Repositories during Postpartum Hospitalization
Authors: Newcomb Patricia , True Barbara , Wells Jo Nell , Walsh Judith , Pehl Samantha
Published: October 2019

Purpose:

The primary goals of the study were to assess maternal knowledge and attitudes about the newborn screening bloodspot repository program in Texas and to evaluate the effect of a video about the bloodspot repository on the rate of parental permission to store infant bloodspots.

Design:

This descriptive, comparative study used descriptive statistics, nonparametric tests, and multivariable analyses to describe the sample, compare groups, and determine associations between factors that influenced parents' decisions to permit state storage of infant bloodspots.

Results:

There were 465 mothers in the study. Maternal knowledge about basic genetics and risks of genetic testing was poor, but mothers reported strong trust in the state to make good decisions about using genetic material for research. Race, ethnicity, and attitude toward research significantly influenced decisions to opt-in to the bloodspot storage program. Postpartum nurses provided the bulk of information about newborn screening and dried bloodspots, although 2/3 of respondents would have preferred to obtain this information prior to birth.

Clinical Implications:

Although postpartum nurses are the most common source of information about newborn screening, genuine informed consent for bloodspot storage is questionable. Information about newborn screening and bloodspot storage needs to be addressed in community venues prior to birth.
Breastfeeding Support Guided by Swanson's Theory of Caring
Authors: Miller Carrie Westmoreland , Wojnar Danuta
Published: October 2019

Purpose:

Many women struggle with initiation of breastfeeding. The purpose of this study was to explore mothers' perceptions of care and support received from clinicians during breastfeeding initiation and the utility of Swanson's (1991) Theory of Caring to provide person-centered care to breastfeeding mothers and infants.

Study Design and Methods:

Directed content of secondary analysis of data obtained from 11 women via in-person interviews at three time points: before birth, a week after giving birth, and 6 to 8 weeks after giving birth. All women were breastfeeding at the end of the study interview series. Swanson's Theory of Caring provided the theoretical framework for the analysis.

Results:

Two overarching themes The Acts of Caring and The Lapses in Caring summarized women's experiences of care received during the initiation of breastfeeding. Five subthemes supported the Acts of Caring theme, and three subthemes supported the Lapses in Caring theme.

Clinical Implications:

Although all study participants chose to breastfeed after hospital discharge and the majority felt well supported, some received care that was perceived as uncaring, unsupportive, or harmful. Providing breastfeeding support consistent with research evidence and underpinnings of Swanson's Theory of Caring may help women build trusting relationships with clinicians and feel confident in meeting their breastfeeding goals.
Unexpected Infant Death Due to Undiagnosed Biliary Atresia
Authors: Ventura Francesco , Barranco Rosario , Buffelli Francesca , Fulcheri Ezio , Palmieri Antonella
Published: October 2019

Biliary atresia (BA) is a fatal condition resulting in the lack of effective biliary drainage leading invariably to liver failure and cirrhosis within a year, and it is often lethal within a few months in the absence of corrective surgery or liver transplantation. In fact, BA is the most common indication for pediatric liver transplantation.

Herein, we present a rare case of unexpected infant death due to BA diagnosed only postmortem in a context of child neglect and carelessness on the part of the parents. It emerged from the clinical history that after a few months, the parents no longer took their daughter to any medical checkups despite the indications and express recommendations for follow-up. The autopsy revealed agenesis of the gallbladder with BA and complete disruption of the hepatic architecture and parenchyma from biliary cirrhosis. Histological examinations documented severe biliary cirrhosis from hypoplasia of the biliary ducts.

The child neglect in this case proved fatal inasmuch as an early diagnosis by a pediatrician would have likely allowed appropriate surgical treatment, thus avoiding the untimely death of the child. We highlight the importance of educating and informing parents (especially the disadvantaged) in matters of health. At the same time, primary care physicians should closely monitor the conditions and development of infants so as to recognize the early warning signs and symptoms of BA, bearing in mind that a timely diagnosis and proper surgical treatment can save the lives of most of these children.
Median Nerve Entrapment in the Ulna in a Both-Bone Pediatric Forearm Fracture
Authors: Hutchison Richard L. , Wester Christopher J.
Published: October 2019

This case report presents entrapment with subsequent complete disruption of the median nerve in the distal ulna in a both-bone fracture of the forearm in a 9-year-old girl. Closed fractures of the radius and ulna commonly occur in pediatric populations. Postinjury nerve dysfunction is often seen. Severe nerve injury is rare. There are only 3 reports of the median nerve becoming entrapped in an ulnar fracture in a child, with no reports of entrapment in the distal forearm. Features seen on examination and the radiographs supported possible nerve entrapment. Although uncommon, nerve entrapment or transection should be considered in all forearm fractures with sensory or motor nerve dysfunction. If suspicions are high, an early diagnosis of nerve entrapment may be obtained with magnetic resonance imaging evaluation.
Saddle Deformity After Septoplasty and Immediate Correction
Authors: Kim Jooyeon , Kim Chang Hoi , Oh Jung Ho , Choi Gwan , Kwon Jae Hwan
Published: October 2019

Objective:

The aim of this study is to assess the saddle deformity after septoplasty and the usefulness of immediate correction.

Design:

Retrospective study.

Setting:

University medical center.

Patients:

Of 658 patients who underwent endonasal septoplasty from January 2011 to July 2018, 14 underwent immediate cartilage dorsal augmentations following septoplasty for saddle deformity and were enrolled in this study.

Main Outcome Measures:

A total of 14 patients received immediate cartilage augmentation and were followed for >3 months after surgery. External nose status, patterns of septal deformity, and surgical results were investigated with profile view photographs, paranasal sinus computed tomography scans, and nasal endoscopy. Symptom improvement was measured using the Nasal Obstruction Symptom Evaluation scale.

Results:

All patients had middle to high site septal deviation. Anterior deviation and central deviation have statistical significance compared to posterior part deviation (P = 0.025, P = 0.002) and mid part deviation has statistical significance compared to basal part deviation (P = 0.005). Postoperative subjective nasal symptoms of the 14 patients were improved from preoperation (18.54 ± 2.46) to 1 month (7.54 ± 2.16) and 3 months (1.72 ± 1.55) postoperatively.

Conclusions:

Immediate endonasal cartilage augmentation for iatrogenic saddle deformity after septoplasty is easy, safe, and effective. Furthermore, this corrective treatment for post op complication is very important for both of surgeon and patient. Predispositions to postoperative saddle deformity included site and severity of preoperative nasal septal deviation.
Modified Cartilage Sparing Tip Plasty Technique for Extra Projection: Hemitransdomal Suture With Submucosal Dissection: A New Approach to Nasal Tip Dynamics
Authors: Yücel Sercan , Ünverdi Ömer Faruk
Published: October 2019

The nasal tip projection and rotation to be obtained with tip plasty play a key role in achieving successful results. Cartilage sparing techniques provide extra ease to reshape the cartilage in revision rhinoplasty. Freed dome cartilage eliminates the restricting forces of mucosa. The authors recommend to free the dome cartilage from mucosa during the tip plasty which ensures the desired dome shape and extra projection. A total of 218 patients who were operated between the dates of January 2017 and August 2018 were included in this study. About 3 mm parts of the marked domes toward medial and lateral crurae were dissected from the mucosa. New domes were created with bilateral hemitransdomal sutures. The outcome of the operation was asked to the patients verbally and answers were recorded. Of 218 patients who were included in the study, 182 were females and 36 were males. Patients had a mean age of 26.5 years. The length of follow-up was 11.8 months. About 205 patients had primary rhinoplasty while 12 patients had secondary rhinoplasty and 1 patient had revision rhinoplasty. Of the patients, 89.9% (196/218) were very satisfied with the result and 7.4% (16/218) were satisfied, whereas 2.7% (6/218) were dissatisfied. Only 5 patients who were dissatisfied with the result underwent revision rhinoplasty operation. The combination of the modified free dome suture with the mucosal dissection in dome area provides achieving the desired tip projection and symmetry.
Morbidity in Patients With Separation of Cartilaginous Framework: Temporoparietal Fascia Flap and Treatment With Dermal Regeneration Template
Authors: Lesta-Compagnucci Lucas , Arámburo-García Rigoberto , Galaso-Trujillo José Roberto , Apellaniz-Campo Armando G. , Pérez-Caro Emilio
Published: October 2019

Background:

The full creation of an ear requires 2 reconstruction stages. In the second stage of reconstruction, the cartilaginous framework placed at first stage is separated from the head creating an auriculocephalic sulcus. Then a piece of rib cartilage is placed in the sulcus to maintain this separation and is covered with tissue that allows the integration of a full-thickness skin graft.

Methods:

A descriptive study based on the pre and postoperative medical records and photographic archives of patients diagnosed with microtia who underwent separation of the cartilaginous framework from February 2010 to July 2015 in the Plastic and Reconstructive Surgery Department at Hospital General Dr. Manuel Gea González.

Results:

Fifty-four patients met the selection criteria. The temporoparietal fascial flap was performed on 85% (n = 46), and 8 cases with random occipito-temporal fascial flap in association to a dermal regeneration template. The average time at the operating room was 177 minutes in patients with temporoparietal fascial flap versus 84.5 minutes in dermal regeneration template. The complication rate was 25.9% (n = 14), being similar rate with both techniques.

Conclusions:

Coverage with dermal regeneration template and random occipito-temporal fascia flap as an alternative use instead of temporoparietal fascial flaps, offers good postoperative results, lower operating times, and similar rate of complications, with the advantage of producing no visible scars and reserve the temporoparietal fascial flap for possible exposure of the cartilaginous framework.
What Are We Missing From Asymmetric Relationship Between the Retinal Nerve Fiber Layer Thickness Profiles and Sphenoid Sinus Volume?
Authors: Findik Huseyin , Kanat Ayhan , Celiker Fatma Beyazal , Celiker Metin , Beyazal Mehmet , Ozdemir Bulent , Ozdemir Vacide , Batcik Osman Ersegun , Ozdemir Dogukan , Dursun Engin
Published: October 2019

Purpose/Aim of the Study:

Detailed analysis of retinal structure such as the retinal nerve fiber layer can be performed by spectral-domain optical coherence tomography (OCT). There are no published studies concerning a relationship between retinal nerve fiber layer and human sphenoid sinus volumes. We investigated this relationship.

Material and Methods:

Spectral-domain OCT. The peripapillary retinal nerve fiber layer (RNFL) thickness and sphenoid sinus volume estimation of both sides of sex-matched patients were retrospectively analyzed.

Results:

The mean RNFL thicknesses at the left side (91.8 μm) were significantly smaller than the right side (94.5 μm) (P = 0.040). However, the mean left sinus volume (44.5 cm3) is larger than the right side, (34.5 mm3) (P < 0.005). Left and right differences of both parameters are statistically significant (P < 0.05).

Conclusion:

There is a negative correlation between mean RNFL thicknesses and mean sinus volumes. To our knowledge, this article is the first report demonstrating the asymmetry relationship between RNFL and sphenoid sinus volumes.
Release of the Lateral Pharyngeal Mucosa Using a Palatal Elevator
Authors: Hwang Kun , Ma Sung Hwan , Lee Se Il
Published: October 2019

The aim of this paper is to present how to release the nasal mucosa from the hard palate and from the lateral pharyngeal wall using palatal elevator.

After mucoperiosteal flap is raised, the nasal mucosa is detached with an instrument pushed laterally behind the palatine vessels to meet the medial pterygoid plate. The palatal elevator is passed around the spine at the posterior medial border of the bony palate and then moved forward in the cleft to separate the nasal mucosa from bone. The palatal elevator is now introduced behind the greater palatine vessels, maintaining contact with the medial pterygoid plate. The elevator is pushed deeply up toward the base of the skull to elevate the lateral pharyngeal mucosa medially. When this mucosa is freed, the elevator can be moved anteriorly to separate the nasal mucosa from nasal side wall and upper surface of the hard palate. After closure of the buccal layer, 2 posterior flaps are joined to the small anterior flap. Finally, an A suture is made to hold the buccal layers together with the nasal mucosa and lateral pharyngeal mucosa to obliterate dead space.

Herein, the authors present how to completely free the nasal mucosa from the hard palate and from the lateral pharyngeal wall before medial shifting and suturing. In our series of 60 cases of complete or incomplete cleft palate, fistula rate was low (6.7%), which the authors suggest was due to the low tension of the sutured nasal lining with the released lateral pharyngeal wall.
Association Between Neuropsychiatric Symptom Trajectory and Conversion to Alzheimer Disease
Authors: Lo Tsz Wai Bentley , Karameh Wael K. , Barfett Joseph J. , Fornazzari Luis R. , Munoz David G. , Schweizer Tom A. , Fischer Corinne E.
Published: October 2019

Introduction:

Neuropsychiatric symptoms (NPS) are both common in mild cognitive impairment and Alzheimer disease (AD). Studies have shown that some NPS such as apathy and depression are a key indicator for progression to AD.

Methods:

We compared Neuropsychiatric Inventory (NPI) total score and NPI subdomain score between mild cognitive impairment-converters (MCI-C) and mild cognitive impairment-nonconverters (MCI-NC) longitudinally for 6 years using the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. In addition to the NPI, Mini-Mental State Examination (MMSE) scores were also compared to find out if MMSE scores would differ between different NPI groups. Lastly, a linear regression model was done on MMSE and NPI total score to establish a relationship between MMSE and NPI total score.

Results:

The results in this study showed that NPI total scores between MCI-C and MCI-NC differed significantly throughout 6 years. MCI-C subjects had a higher mean NPI total score and lower MMSE score compared with MCI-NC subjects. In addition, MMSE scores were significantly different between the 3 groups of NPI total score. Subjects who have a high NPI score have the lowest mean MMSE score, thus demonstrating that NPI scores do indeed affect MMSE scores. Further analyses using a regression model revealed that a unit change in NPI total score lead to 0.1 to 0.3 decrease in MMSE.

Discussion:

On the basis of the findings, this study showed evidence that increase in NPS burden (reflected by increase in NPI) over time predicts conversion to AD, whereas stability of symptoms (reflected by stable NPI score) favors nonconversion. Further study should investigate the underlying mechanisms that drive both NPS burden and cognitive decline.
Prospecting for life
Authors: Russell Michael J.
Published: October 2019

Books with titles like ‘The Call of the Wild’ seemed to set a path for a life. Thus, I would be an explorer—a plan that did not work out so well, at least at first. On leaving school I got a job as a ‘Works Chemist Improver’, testing Ni catalysts for the hydrogenation of phenol to cyclohexanol. Taking night classes I passed enough exams to study geology at Queen Mary College, London. Armed thus I travelled to the Solomon Islands where geology is a ‘happening’! Next was Canada to visit a mine sunk into a 1.5 billion year old Pb–Zn orebody precipitated from submarine hot springs. At last I reached the Yukon to prospect for silver. Thence to Ireland researching what I also took to be ‘exhalative’ (i.e. hot spring-related) Pb–Zn orebodies. While there in 1979, the discovery of 350°C metal-bearing acidic waters issuing from submarine Black Smoker chimneys in the Pacific sent us searching for fossil examples in the Irish mines. However, the chimneys we found were more like chemical gardens than Black Smokers, a finding that made us think about the emergence of life. After all, what better for life's emergence than to have a membrane comprising Fe minerals dosed with Ni in our chimneys to mediate the ‘hydrogenation’ of CO
2
—life's job anyway. Indeed, such a membrane would keep redox and pH disequilibria at bay, just like biological membranes. At the same time, my field research among Alpine ophiolites—ocean floor mafic rocks obducted to the Alps—indicated that alkaline waters bearing H
2
and CH
4
were a result of serpentinization, a process that must have operated in all ocean floors over all time. Thus it was that we could predict the Lost City hydrothermal field 10 years before its discovery in the North Atlantic in the year 2000. Lost City comprises a number of alkaline springs at up to 90°C that produce carbonate and brucite (Mg[OH]
2
) chimneys. We had surmised that Ni-enriched FeS chimneys would have precipitated at comparable alkaline springs issuing into a metal-rich carbonic ocean on the very early Earth (inducing membrane potentials comparable to those capable of succouring all life, and presumably, sufficient to drive life into being). However, our laboratory precipitates also revealed green rust, thought to be the precursor to the magnetite now comprising the Archaean Banded Iron Formations. We now look upon green rust, also known as fougèrite, as the tangible, base fractal of life.
Intrinsic concentration cycles and high ion fluxes in self-assembled precipitate membranes
Authors: Ding Yang , Cartwright Julyan H. E. , Cardoso Silvana S. S.
Published: October 2019

Concentration cycles are important for bonding of basic molecular building components at the emergence of life. We demonstrate that oscillations occur intrinsically in precipitation reactions when coupled with fluid mechanics in self-assembled precipitate membranes, such as at submarine hydrothermal vents. We show that, moreover, the flow of ions across one pore in such a prebiotic membrane is larger than that across one ion channel in a modern biological cell membrane, suggesting that proto-biological processes could be sustained by osmotic flow in a less efficient prebiotic environment. Oscillations in nanoreactors at hydrothermal vents may be just right for these warm little pores to be the cradle of life.
Description and complete genome sequences of Bradyrhizobium symbiodeficiens sp. nov., a non-symbiotic bacterium associated with legumes native to Canada
Authors: Bromfield Eden S. P. , Cloutier Sylvie , Nguyen Hai D. T.
Published: October 2019

Four bacterial strains isolated from root nodules of soybean plants that had been inoculated with root-zone soil of either Amphicarpaea bracteata (Hog Peanut) or Desmodium canadense (Showy Tick Trefoil) growing in Canada, were previously characterized and placed in a novel lineage within the genus

Bradyrhizobium

. The taxonomic status of the novel strains was verified by genomic and phenotypic analyses. Phylogenetic analyses of individual and concatenated housekeeping gene sequences (atp
D, gln
II, rec
A, gyr
B and rpo
B) placed all novel strains in a highly supported lineage distinct from named

Bradyrhizobium

species. Data for sequence similarities of concatenated housekeeping genes of novel strains relative to type strains of named species were consistent with the phylogenetic data. Average nucleotide identity values of genome sequences (84.5–93.7 %) were below the threshold value of 95–96 % for bacterial species circumscription. Close relatives to the novel strains are

Bradyrhizobium amphicarpaeae

,

Bradyrhizobium ottawaense

and

Bradyrhizobium shewense

. The complete genomes of strains 85S1MBT and 65S1MB consist of single chromosomes of size 7.04 and 7.13 Mbp, respectively. The genomes of both strains have a G+C content of 64.3 mol%. These strains lack a symbiosis island as well as key nodulation, nitrogen-fixation and photosystem genes. Data from various phenotypic tests including growth characteristics and carbon source utilization supported the sequence-based analyses. Based on the data presented here, the four strains represent a novel species for which the name

B

radyrhizobium

symbiodeficiens sp. nov., is proposed, with 85S1MBT (=LMG 29937T=HAMBI 3684T) as the type strain.
Pangenome of Acinetobacter baumannii uncovers two groups of genomes, one of them with genes involved in CRISPR/Cas defence systems associated with the absence of plasmids and exclusive genes for biofilm formation
Authors: Mangas Eugenio L. , Rubio Alejandro , Álvarez-Marín Rocío , Labrador-Herrera Gema , Pachón Jerónimo , Pachón-Ibáñez María Eugenia , Divina Federico , Pérez-Pulido Antonio J.
Published: October 2019

Acinetobacter baumannii

is an opportunistic bacterium that causes hospital-acquired infections with a high mortality and morbidity, since there are strains resistant to virtually any kind of antibiotic. The chase to find novel strategies to fight against this microbe can be favoured by knowledge of the complete catalogue of genes of the species, and their relationship with the specific characteristics of different isolates. In this work, we performed a genomics analysis of almost 2500 strains. Two different groups of genomes were found based on the number of shared genes. One of these groups rarely has plasmids, and bears clustered regularly interspaced short palindromic repeat (CRISPR) sequences, in addition to CRISPR-associated genes (cas genes) or restriction-modification system genes. This fact strongly supports the lack of plasmids. Furthermore, the scarce plasmids in this group also bear CRISPR sequences, and specifically contain genes involved in prokaryotic toxin–antitoxin systems that could either act as the still little known CRISPR type IV system or be the precursors of other novel CRISPR/Cas systems. In addition, a limited set of strains present a new cas9-like gene, which may complement the other cas genes in inhibiting the entrance of new plasmids into the bacteria. Finally, this group has exclusive genes involved in biofilm formation, which would connect CRISPR systems to the biogenesis of these bacterial resistance structures.