bluuebunny/crossref_metadata_2025 huggingface dataset:
Régénération osseuse guidée dans le secteur antérieur
Authors: BOUSSETTA Kilani , JAOUA Sarra
Published: March 2018

La régénération osseuse guidée est aujourd’hui
une solution fiable pour la reconstitution
des défauts osseux antérieurs. Les biomatériaux
actuels, en particules, mélangés avec de l’os
autogène, protégés par une membrane
en collagène soutenue par des « tenting screws »
nous permettent de traiter des défauts osseux
importants, évitant ainsi l’utilisation des
blocs osseux dont le prélèvement est très
invasif, l’adaptation aux contours du défaut
osseux difficile et la résorption par manque
de vascularisation importante.
Physique des plasmas - 9e Festival de Théorie à Aix-en-Provence
Authors: Sarazin Yanick
Published: March 2018

La neuvième édition du « Festival de Théorie » de physique des plasmas s’est tenue du 26 juin au 20 juillet 2017. Tous les deux ans depuis 2001, l’Institut de recherche sur la fusion par confinement magnétique (IRFM) du CEA/Cadarache [1] organise cette manifestation scientifique internationale à Aix-en-Provence – un clin d’oeil aux nombreux festivals qui rythment la saison estivale dans la région – avec le concours d’Aix-Marseille Université.
Evaluation of the Neurobehavioral Properties of Naringin in Swiss Mice
Authors: Ben-Azu Benneth , Nwoke Ekene , Umukoro Solomon , Aderibigbe Adegbuyi , Ajayi Abayomi , Iwalewa Ezekiel
Published: March 2018

Objectives This study was carried out to investigate the neurobehavioral properties of naringin, a flavonoid compound formed from naringenin on behavioral models in mice.

Method The neurobehavioral property of naringin (2.5, 5 and 10 mg/kg) administered intraperitoneally (i.p.) was assessed on novelty-induced rearing, locomotor behavior using open field test; anxiolytic effect was evaluated using hole-board, light and dark box, and elevated-plus maze paradigms. The anti-depressant-like property was also assessed using forced swim test (FST), tail suspension test (TST) and social interaction test (SIT). The cognitive enhancing effect of naringin was evaluated using Y-maze test.

Results Intraperitoneal administration of naringin (2.5 and 5 mg/kg) demonstrated significant (p<0.05) increase in rearing behavior but not the spontaneous motor activity in comparison to control. In the anti-depressant test, naringin (2.5, 5 and 10 mg/kg, i.p.) significantly decreased the duration of immobility in the FST and TST, and increased the % social interaction preference in the SIT relative to controls, suggesting anti-depressant-like and increased social behaviors. Moreover, naringin also exhibited anxiolytic and memory enhancing properties in mice.

Conclusion These findings suggest that naringin possesses anti-depressant- and anxiolytic-like activities as well as memory enhancing effect in mice.
Professionelle Kodierung in Orthopädie und Unfallchirurgie
– Schnell verdientes Geld im Krankenhaus?
Authors: Burger Frank , Koob Sebastian , Walgenbach Maren , Parbs Sonja , Neugebauer Edmund A. M.
Published: March 2018

Das DRG-System (Diagnoses Related Groups) dient der Berechnung von
Fallpauschalen, mit denen den Kliniken die stationären Behandlungen vergütet
werden. Der erweiterte Arbeitsaufwand für die fachgerechte Durchführung
erfordert zusätzliches Personal (Gesundheitsökonomen, Dokumentare). Bei der
Codierung von Behandlungsprozeduren konnten Diskrepanzen zwischen den
Eintragungen der behandelnden Ärzte und denen der Medizinökonomen festgestellt
werden, die zu beträchtlichen Unterschieden hinsichtlich der Erlöse führten. Die
vorliegende Untersuchung diente der Analyse dieser Diskrepanzen bezogen auf die
im DRG-System vorgegebenen Fallbeschreibungen.

Material und Methoden An einer Klinik für Orthopädie und Unfallchirurgie
führten die behandelnden Ärzte und ein Gesundheitsökonom unabhängig voreinander
Codierungen der Diagnosen und Behandlungsprozeduren nacheinander eingewiesener
Patienten unter Einbeziehung der Berechnung von Erlösen durch. Die
Dokumentationen wurden tabellarisch zusammengestellt, um Vergleiche und
Berechnungen vornehmen zu können.

Resultate Es wurden 295 Eintragungen gegenübergestellt. In 24,75 % der
Fälle stimmten die Codierungen von Ärzten und Gesundheitsökonom überein. In den
übrigen Fällen differierten die Eintragungen. Der durchschnittliche Unterschied
bei den Erlösen betrug 3.552,29 (± 2947) Euro pro Abrechnungsfall. In 6 Fällen
bewertete der Gesundheitsökonom den Erlös um mehr als 10 000,-€ höher als die
Ärzte.

Diskussion Die teilweise sehr diffizile DRG-Codierung wird von
behandelnden Ärzten nur teilweise beherrscht. Es entstehen bedeutende
Diskrepanzen bei den Fallbeurteilungen zu den Medizinökonomen, was auf ein
ungenügendes Wissen über das DRG-System, eine fehlende Routine und begrenzte
Zeitressourcen zurückzuführen ist. Die Notwendigkeit einer Kosteneffektivität
bewirkt eine mehr ökonomisch ausgerichtete Patientenversorgung, wodurch das
individuelle Arzt-Patientenverhältnis eingeschränkt werden muss.
Begleiterkrankungen können zum Nachteil der Patienten unterschätzt werden. Es
sollte angestrebt werden, dass behandelnde Ärzte und Gesundheitsökonomen durch
regelmäßigen Informationsaustausch einen Modus finden, um bei der DRG-Zuordnung
einen weitgehenden Konsens zu erzielen, der ärztliche und ökonomische Aspekte
berücksichtigt.
Lobectomy on ECMO as a Life-Saving Procedure following Necrotizing Pneumonia in a Toddler: A Case Study
Authors: Ben-Nun Alon , Pessach Itai , Rubinshtein Marina , Paret Gideon , Ashkenazi Shira
Published: March 2018

Necrotizing pneumonia is a severe form of pneumonia that is mainly treated with conservative treatment, including antibiotics. We report a unique case of necrotizing pneumonia due to group A streptococcus infection in an 18-month-old boy who required extracorporeal membrane oxygenation (ECMO) support. Following surgical lobectomy, the child was weaned off ECMO and recovered uneventfully.
Challenges in Diagnosing Rare Genetic Causes of Common In Utero Presentations: Report of Two Patients with Mucolipidosis Type II (I-Cell Disease)
Authors: Costain Gregory , Saleh Maha , Yaniv-Salem Shimrit , Ryan Greg , Morgen Eric , Goh Elaine , Nishimura Gen , Chitayat David , Inbar-Feigenberg Michal
Published: March 2018

Traditional approaches to prenatal genetic diagnosis for common presentations such as short femurs or intrauterine growth restriction are imperfect, and whole-exome sequencing is an emerging option. Mucolipidosis type II (I-cell disease) is an ultra-rare autosomal recessive lysosomal storage disorder with the potential for prenatal-onset skeletal and placental manifestations. We describe the prenatal signs in two recent unrelated patients with confirmed diagnoses soon after birth. In both cases, parents were consanguineous but there was no known family history of mucolipidosis type II. False reassurance was provided after negative testing for another disease with overlapping prenatal manifestations already present in one of the families, emphasizing that offspring of consanguineous parents can be at risk for more than one recessive condition. Our experience illustrates the potential advantages in expanding prenatal applications of WES for the identification of rare single gene disorders in offspring of consanguineous unions.
Severe complication during remission of Crohn’s disease: hemophagocytic lymphohistiocytosis due to acute cytomegalovirus infection
Authors: Miechowiecki Jan , Stainer Waltraud , Wallner Gertraud , Tuppy Herwig , Aichinger Walter , Prammer Wolfgang , Kirchgatterer Andreas
Published: March 2018

Introduction Immunosuppressive therapy is today’s standard treatment of patients with moderate to severe inflammatory bowel disease (IBD). The risk for opportunistic infections is increased due to this therapy and is a concern in the management of patient with IBD undergoing such a treatment.

Case report In this paper, we describe a case of an acute cytomegalovirus (CMV) infection in a 35-year-old male patient with Crohn’s disease being in remission while receiving azathioprine therapy. His clinical presentation was high-grade fever, night sweats, skin rash, and abdominal pain.

Laboratory findings showed pancytopenia, elevated liver enzymes, and high ferritin levels. Sonographic examination revealed splenomegaly and serological analysis proved an acute CMV infection. The severity of the acute illness and these results in the setting of immunosuppressive treatment with azathioprine were highly suspicious of hemophagocytic lymphohistiocytosis (HLH).

Further investigations including bone marrow biopsy, analysis of natural killer cell function, and measurement of T-cell activity confirmed the suspected diagnosis. Treatment consisted of antiviral and symptomatic therapy.

Discussion and conclusion HLH is a rare and severe condition triggered by uncontrolled stimulation of histiocytes and lymphocytes, resulting in abnormal cytokine production. The causes can be primary (genetic) or secondary due to acquired immunodeficiency or viral infections such as CMV. Several symptoms of this condition are unspecific, but the summary of clinical symptoms and signs are diagnostic. Treatment consists of specific intervention if possible and application of immunosuppressive drugs such as corticosteroids.
Stellenwert des Débridements bei der Behandlung fokaler (Grad II – III) Knorpelschäden des Kniegelenks. Systematische Literaturübersicht und Empfehlungen der AG Geweberegeneration (DGOU)
Authors: Gelse Kolja , Angele Peter , Behrens Peter , Brucker Peter , Fay Jakob , Günther Daniel , Kreuz Peter , Lützner Jörg , Madry Henning , Müller Peter , Niemeyer Philipp , Pagenstert Geert , Tischer Thomas , Walther Markus , Zinser Wolfgang , Spahn Gunter
Published: March 2018

Hintergrund Bei fokalen teilschichtigen Knorpelläsionen (Grad II – III) besteht im klinischen Alltag oft noch Unsicherheit hinsichtlich des zu empfehlenden therapeutischen Vorgehens. Während bei großflächigen, arthrotischen Knorpelveränderungen das Débridement gemäß der gängigen Lehrmeinung weitgehend abzulehnen ist, so steht eine Empfehlung bei fokalen teilschichtigen Knorpelschäden noch aus.

Material und Methoden In dieser Arbeit wurden die wissenschaftlichen Hintergründe der Knorpelglättung und der Gelenkspülung aufgearbeitet und eine systematische Literaturanalyse bez. des klinischen Effekts des Knorpeldébridements bei fokalen Defekten durchgeführt. Zudem erfolgte auch eine aktuelle Beurteilung dieser Thematik durch die Mitglieder der AG Klinische Geweberegeneration der DGOU auf der Basis eines Konsensusprozesses.

Ergebnisse In therapeutischer Hinsicht sind asymptomatische Läsionen mit stabiler Reststruktur und symptomatische Defekte mit instabilen Fragmenten voneinander zu unterscheiden. Grundsätzlich ist der Nutzen einer Gelenk-Lavage und Knorpelglättung fokalen teilschichtigen Knorpelschäden (Grad II – III) nicht belegt. Das mechanische und thermische Resezieren von Knorpelgewebe führt sogar zu einer Nekrosezone der angrenzenden Knorpelschicht und damit zu einer zusätzlichen Gewebeschädigung. Daher sollte eine großflächige „Glättung“ klinisch asymptomatischer, aufgefaserter oder unregelmäßiger Knorpeldefektareale mit ansonsten stabiler Reststruktur nicht durchgeführt werden. Hingegen kann bei klinischen Symptomen das Resezieren von instabilen und delaminierten Knorpelfragmenten sinnvoll sein, um schädliche Scherspannungen im noch vorhandenen Gewebe zu verringern und damit eine Progredienz des Schadens oder die Bildung von freien Gelenkkörpern zu reduzieren.

Schlussfolgerung Die Entscheidungskriterien für ein Débridement von teilschichtigen, fokalen Knorpelläsionen sind multifaktoriell und berücksichtigen die klinische Symptomatik, die Größe und den Grad des Defektes, die Stabilität der Reststruktur, die Defektlokalisation sowie patientenindividuelle Parameter. Während das Débridement bei asymptomatischen fokalen Läsionen weitgehend abzulehnen ist, kann es bei symptomatischen, instabilen Defektsituationen gerechtfertigt sein.
Lipid diffusion in the distal and proximal leaflets of supported lipid bilayer membranes studied by single particle tracking
Authors: Schoch Rafael L. , Barel Itay , Brown Frank L. H. , Haran Gilad
Published: March 2018

Supported lipid bilayers (SLBs) have been studied extensively as simple but powerful models for cellular membranes. Yet, potential differences in the dynamics of the two leaflets of a SLB remain poorly understood. Here, using single particle tracking, we obtain a detailed picture of bilayer dynamics. We observe two clearly separate diffusing populations, fast and slow, that we associate with motion in the distal and proximal leaflets of the SLB, respectively, based on fluorescence quenching experiments. We estimate diffusion coefficients using standard techniques as well as a new method based on the blur of images due to motion. Fitting the observed diffusion coefficients to a two-leaflet membrane hydrodynamic model allows for the simultaneous determination of the intermonolayer friction coefficient and the substrate-membrane friction coefficient, without any prior assumptions on the strengths of the relevant interactions. Remarkably, our calculations suggest that the viscosity of the interfacial water confined between the membrane and the substrate is elevated by ∼104 as compared to bulk water. Using hidden Markov model analysis, we then obtain insight into the transbilayer movement of lipids. We find that lipid flip-flop dynamics are very fast, with half times in the range of seconds. Importantly, we find little evidence for membrane defect mediated lipid flip-flop for SLBs at temperatures well above the solid-to-liquid transition, though defects seem to be involved when the SLBs are cooled down. Our work thus shows that the combination of single particle tracking and advanced hydrodynamic modeling provides a powerful means to obtain insight into membrane dynamics.
Band-offset-induced lateral shift of valley electrons in ferromagnetic MoS2/WS2 planar heterojunctions
Authors: Ghadiri Hassan , Saffarzadeh Alireza
Published: March 2018

Low-energy coherent transport and a Goos-Hänchen (GH) lateral shift of valley electrons in planar heterojunctions composed of normal MoS2 and ferromagnetic WS2 monolayers are theoretically investigated. Two types of heterojunctions in the forms of WS2/MoS2/WS2 (type-A) and MoS2/WS2/MoS2 (type-B) with incident electrons in the MoS2 region are considered in which the lateral shift of electrons is induced by band alignments of the two constituent semiconductors. It is shown that the type-A heterojunction can act as an electron waveguide due to electron confinement between the two WS2/MoS2 interfaces which cause the incident electrons with an appropriate incidence angle to propagate along the interfaces. In this case, the spin- and valley-dependent GH shifts of totally reflected electrons from the interface lead to separated electrons with distinct spin-valley indexes after traveling a sufficiently long distance. In the type-B heterojunction, however, transmission resonances occur for incident electron beams passing through the structure, and large spin- and valley-dependent lateral shift values in propagating states can be achieved. Consequently, the transmitted electrons are spatially well-separated into electrons with distinct spin-valley indexes. Our findings reveal that the planar heterojunctions of transition metal dichalcogenides can be utilized as spin-valley beam filters and/or splitters without external gating.
An alternative explanation of negative capacitance
Authors: Patrick Chris
Published: March 2018

Researchers describe negative capacitance in resistor-ferroelectric and ferroelectric-dielectric networks without invoking the Landau-model based explanation.
One domain fits all: Using disordered regions to sequester misfolded proteins
Authors: Boczek Edgar E. , Alberti Simon
Published: March 2018

Small heat shock proteins (sHsps) are adenosine triphosphate–independent chaperones that protect cells from misfolded proteins. In this issue, Grousl et al. (2018. J. Cell Biol. https://doi.org/10.1083/jcb.201708116) show that the yeast sHsp Hsp42 uses a prion-like intrinsically disordered domain to bind and sequester misfolded proteins in protein deposition sites.
Angle between terminator and meridian: flat geometry versus formulae of solar azimuth and an easy approach to the daylight map
Authors: de Eulate Martín Perea-Alvarez , Gloria Del Río-Cidoncha , Francisco Montes-Tubío
Published: March 2018

The calculation of the angle between the day-night line on the Earth’s surface, a terminator, and the meridian at a given point, at dawn or at sunset, can easily be performed either by means of flat geometry or, for those familiarized with astronomy, through formulae for the Sun’s azimuth and elevation, both derived from spherical trigonometry. The two procedures are compared. An auxiliary angle obtained in the process of derivation via planar geometry becomes useful to represent the daylight map on a terrestrial planisphere.
Nimbus: a design-driven analyses suite for amplicon-based NGS data
Authors: Brouwer R W W , van den Hout M C G N , Kockx C E M , Brosens E , Eussen B , de Klein A , Sleutels F , van IJcken W F J
Published: March 2018

Motivation

PCR-based DNA enrichment followed by massively parallel sequencing is a straightforward and cost effective method to sequence genes up to high depth. The full potential of amplicon-based sequencing assays is currently not achieved as analysis methods do not take into account the source amplicons of the detected variants. Tracking the source amplicons has the potential to identify systematic biases, enhance variant calling and improve the designs of future assays.

Results

We present Nimbus, a software suite for the analysis of amplicon-based sequencing data. Nimbus includes tools for data pre-processing, alignment, single nucleotide polymorphism (SNP), insertion and deletion calling, quality control and visualization. Nimbus can detect SNPs in its alignment seeds and reduces alignment issues by the usage of decoy amplicons. Tracking the amplicons throughout analysis allows easy and fast design optimization by amplicon performance comparison. It enables detection of probable false positive variants present in a single amplicon from real variants present in multiple amplicons and provides multiple sample visualization. Nimbus was tested using HaloPlex Exome datasets and outperforms other callers for low-frequency variants. The variants called by Nimbus were highly concordant between twin samples and SNP-arrays. The Nimbus suite provides an end-to-end solution for variant calling, design optimization and visualization of amplicon-derived next-generation sequencing datasets.

Availability and implementation

https://github.com/erasmus-center-for-biomics/Nimbus.

Supplementary information

Supplementary data are available at Bioinformatics online.
Evaluating a mobile application for improving clinical laboratory test ordering and diagnosis
Authors: Meyer Ashley N D , Thompson Pamela J , Khanna Arushi , Desai Samir , Mathews Benji K , Yousef Elham , Kusnoor Anita V , Singh Hardeep
Published: March 2018

Objective

Mobile applications for improving diagnostic decision making often lack clinical evaluation. We evaluated if a mobile application improves generalist physicians’ appropriate laboratory test ordering and diagnosis decisions and assessed if physicians perceive it as useful for learning.

Methods

In an experimental, vignette study, physicians diagnosed 8 patient vignettes with normal prothrombin times (PT) and abnormal partial thromboplastin times (PTT). Physicians made test ordering and diagnosis decisions for 4 vignettes using each resource: a mobile app, PTT Advisor, developed by the Centers for Disease Control and Prevention (CDC)’s Clinical Laboratory Integration into Healthcare Collaborative (CLIHC); and usual clinical decision support. Then, physicians answered questions regarding their perceptions of the app’s usefulness for diagnostic decision making and learning using a modified Kirkpatrick Training Evaluation Framework.

Results

Data from 368 vignettes solved by 46 physicians at 7 US health care institutions show advantages for using PTT Advisor over usual clinical decision support on test ordering and diagnostic decision accuracy (82.6 vs 70.2% correct; P < .001), confidence in decisions (7.5 vs 6.3 out of 10; P < .001), and vignette completion time (3:02 vs 3:53 min.; P = .06). Physicians reported positive perceptions of the app’s potential for improved clinical decision making, and recommended it be used to address broader diagnostic challenges.

Conclusions

A mobile app, PTT Advisor, may contribute to better test ordering and diagnosis, serve as a learning tool for diagnostic evaluation of certain clinical disorders, and improve patient outcomes. Similar methods could be useful for evaluating apps aimed at improving testing and diagnosis for other conditions.
Venomous Snakebite in Thailand II: Clinical Experience
Authors: Pochanugool Charn , Wilde Henry , Bhanganada Kasien , Chanhome Lawan , Cox Merel J. , Chaiyabutr Narongsak , Sitprija Visith
Published: March 2018

We reviewed a total of 2,525 snakebite patients in Bangkok. Of these, 1,415 were bitten by venomous snakes, 91 by neurotoxic snakes of genus Naja or Bungarus and 1,324 by snakes of family Viperidae or Crotalidae. Seventy-one percent of bites were on the lower extremity. There were two fatal cobra bites; both patients were dead on arrival at the hospital. Bites from vipers caused morbidity but no deaths. Species-specific antivenins are effective in reversing respiratory failure from cobra bites and coagulopathies from bites by Viperidae and Crotalidae snakes. However, early respiratory and wound care will save lives even in the absence of specific cobra and krait antivenin. Care of a snakebite victim should consist of immobilization and bandaging of the bitten limb with elastic bandages during transport to the hospital, early surgical debridement of necrotic tissue, appropriate infusion of antivenin, aggressive respiratory support, management of shock and infection, and peritoneal dialysis or hemodialysis. Incision of bite wounds, suctioning, application of ice, and tourniquets are of no proven value and may be dangerous. All snakebite victims in southeast Asia should survive if they receive early competent care.
Inhalation of Volatile Substances: An Emerging Threat to Readiness?
Authors: Wilkerson James Andrew , Burton Mark Preston
Published: March 2018

Volatile substance abuse is the deliberate inhalation of volatile substances to achieve intoxication. We discuss the history and pathophysiological effects of commonly abused volatile substances. We explore three deaths and one serious accident in active duty military settings. The causes for abuse in the military environment are numerous and include remote duty, peer influence, low cost, rapid onset, limitation of ethanol use, difficult detection/screening for use, and lack of knowledge among users and authorities. The lethality of these substances and their casual use can constitute a threat to military readiness. Our experience suggests an increase in the use of these substances in the military paralleling their increasing use in the general population. Education and awareness training could limit fatalities and decrease the threat in military and civilian populations.
Noninfectious causes of fever in adults
Authors: Steele Gregory M. , Franco-Paredes Carlos , Chastain Daniel B.
Published: March 2018

Fever is a common clinical sign encountered in hospitalized patients and often represents the cardinal sign of infectious processes. However, a number of noninfectious etiologies causing fever should be considered prior to initiating broad-spectrum antibiotic therapy. Reducing unnecessary antibiotic use is crucial in an era of increasing resistance.
The effect of BMI and surgical approach on acetabular component malpositioning in a cohort of military patients with hip arthroplasty
Authors: Formby Peter M. , Nappo Kyle E. , Purcell Richard L. , Pickett Adam , Newman Michael T. , Mack Andrew W.
Published: March 2018

Background:

Previous studies have looked at body mass index (BMI) and its effects on acetabular cup malpositioning with differing results. In the present study, we sought to add to the literature by examining for a correlation between obesity and cup malposition in a military population.

Methods:

We reviewed the radiographs and clinical notes of 200 patients undergoing primary total hip arthroplasty (THA) from November 2011 to April 2014. Acetabular component position was determined on standing postoperative anteroposterior pelvic radiographs. We then determined correlations between cup anteversion and inclination with BMI and surgical approach. Further, we determined differences in the rate of acetabular component malpositioning outside of an “ideal” position between nonobese (BMI <30) and obese (BMI >30) patient groups.

Results:

We found no correlation between cup anteversion or inclination and BMI when examined independently (r=0.02, P=0.79 and r=0.08, P=0.29, respectively). However, there was a difference in the proportion of cups outside of the “ideal” position between nonobese and obese groups (53% vs. 69%; P=0.029). Without regard for BMI, the lateral approach had lower anteversion (15.4 vs. 26.6, P<0.001) and higher cup inclination angles (48.4 vs. 45.3, P=0.002) compared to the posterior approach.

Conclusions:

Although obesity may not correlate in a linear relationship with anteversion or inclination, it is a risk factor for acetabular component malposition outside of an “ideal” zone. This study shows that increased BMI may be a risk factor for cup malpositioning in a younger, military THA population.
Reliability of a Condensed Computer-Based Patient Outcomes Scoring Tool in Orthopaedic Trauma Patients
Authors: Crist Brett D. , Pashuck Troy D.
Published: March 2018

Objectives:

To determine the reliability of a condensed computer-based patient-centered outcome score system versus multiple standard uncondensed validated outcome scores used in orthopaedic trauma.

Design:

Prospective.

Setting:

Level I Trauma Center.

Patients/Participants:

One hundred patients older than 18 years with various orthopaedic injuries were evaluated at a Level I Trauma Clinic.

Intervention:

Study participants were randomly assigned to complete the paper-based and computer-based versions of the EQ-5D and musculoskeletal functional assessment at different times during the same visit.

Main Outcome Measurements:

Score variability between the computer-based and paper-based versions.

Results:

The average score difference between the computer-based and paper-based musculoskeletal functional assessment was 0.50, with an SD of 6.03 and a 95% confidence interval of −0.71 to 1.71. For the EQ-5D, the average score difference was 0.12 with an SD of 0.20 and a 95% confidence interval of −0.05 to 0.05.

Conclusions:

Because patient-centered outcomes drive the direction of orthopaedic care, it is critical to collect patient data efficiently while minimizing responder burden. This condensed web-based adaptive outcome tool reliably produced similar scores when compared with individual paper scores, and it decreased responder burden and error.
Molding Spica Casts to Maintain Alignment of Femur Fractures
Authors: Nielsen Ena , Skaggs David L. , Ryan Deirdre , Andras Lindsay M.
Published: March 2018

Background:

Femur fractures in young children are frequently treated with spica casting. Texts recommend molding spica casts into valgus and recurvatum to counter deforming muscular forces, but how much overcorrection to aim for has not been evaluated. Our goal was to determine how much valgus and recurvatum is optimal at the time of casting to end up with anatomic alignment.

Methods:

Patients 1 to 6 years old with femur fractures treated with spica casts between January 1, 2008 and January 31, 2014 who were followed until radiographic union were included in the study. Patients with underlying medical comorbidities affecting bone quality, refractures, or preexisting femur deformities or that did not have intraoperative imaging were excluded.

Results:

A total of 52 patients met the inclusion criteria. Average intraoperative angulation was 2.6 degrees of valgus (range: 9 degrees varus to 13 degrees valgus, SD: 4.5) and 1.1 degrees of recurvatum (range: 10 degrees recurvatum to 17 degrees procurvatum, SD: 4.8). At the initial postoperative visit, the average angulation was 2.7 degrees of varus (range: 21 degrees varus to 11degrees valgus, SD: 6.4) and 7.2 degrees of procurvatum (range: 6 degrees recurvatum to 25 degrees procurvatum, SD: 6.6). At the time of radiographic union/wedging average angulation was 2.0 degrees of varus (range: 15 degrees varus to 10 degrees valgus, SD: 5.8) and 8.5 degrees of procurvatum (range: 5 degrees recurvatum to 29 degrees procurvatum, SD: 7.5). Between the intraoperative period to time of union or wedging, fracture alignment gained an average of 4.6 degrees of varus (range: 17 degrees varus to 13 degrees valgus, SD: 6.6) and 9.8 degrees of procurvatum (range: 8 degrees recurvatum to 30 degrees procurvatum, SD: 9.1). Seven patients underwent cast wedging due to loss of reduction before radiographic union, 2 patients underwent reoperation due to excessive angulation in the early postoperative period, and 5 patients developed malunions.

Conclusion:

Femur fractures treated with spica casts gain 5 degrees of varus and 10 degrees of procurvatum between cast application and fracture union.

Level of Evidence:

Level IV.
Literature Review of Spinal Cord Glioblastoma
Authors: Timmons Joshua J. , Zhang Kisa , Fong Johnson , Lok Edwin , Swanson Kenneth D. , Gautam Shiva , Wong Eric T.
Published: March 2018

Objectives:

This systematic review aims to investigate spinal cord glioblastoma (scGBM) and correlations between patient traits and survival outcome, as well as differences in cohorts administered temozolomide or total resections, through an analysis of published cases reported up to October 2016.

Methods:

We obtained patient data by querying PubMed and Google Scholar with predetermined search terms and inclusion criteria that enabled the identification of relevant case reports. Survival was compared using Kaplan-Meier curves and log-rank analyses.

Results:

Of 153 patients with scGBM identified through a literature search, 135 met the predetermined search and inclusion criteria. Median overall survival (OS) for the resulting cohort was 12 (95% CI, 10-14) months. The female sex was found to significantly predict worse outcomes, and a sizable number of patients with long-term disease were found to have afflictions of the thoracic spinal cord. Neither the pediatric, temozolomide nor total resection subgroups had significantly improved survival characteristics, by log-rank analysis, relative to counterparts.

Conclusions:

These data elucidate the characteristics of patients with scGBM. For more sophisticated and in-depth analyses in the future, it is imperative that time-of-treatment information is recorded in future case reports. In addition, all case reports should be made available to prevent publication bias.
Are You There? The Growing Need to Get the Right Diagnosis in Disorder of Consciousness
Authors: Torrisi Michele , Piccolo Adriana , De Luca Rosaria , Berenati Matteo , Olivo Antonella , Maresca Giuseppa , Naro Antonino , Calabrò Rocco Salvatore
Published: March 2018

Disorder of consciousness (DOC) can be either an acute and reversible condition or a chronic condition, including vegetative state or minimally conscious state. Herein, we describe a patient who has unexpectedly recovered consciousness after being in a misdiagnosed vegetative state for a long period. A 63-year-old woman was admitted to our rehabilitation center in vegetative state (Coma Recovery Scale-Revised score, 6) and treated with a standard rehabilitation program, including physical therapy and multisensory stimulation, besides psychoactive drugs. After 26 months of such training, she progressively presented with unexpected signs of awareness. Thus, she was submitted to an intensive cognitive rehabilitation with a significant improvement of her performance (Coma Recovery Scale-Revised score, 19). With this report, we want to underline that the early use of paraclinical methods, including neuroimaging and neurophysiological paradigms, is mandatory in DOC to reach a more accurate diagnosis and perform the most appropriate neurorehabilitation. Moreover, diagnosis of functional locked-in syndrome should be considered because some patients with DOC may have covert awareness with the impossibility to display consistent and reproducible behaviors due to a “motor-cognitive dissociation.”
Recovery in the Severely Impaired Arm Post-Stroke After Mirror Therapy
Authors: Chan Wing Chiu , Au-Yeung Stephanie S.Y.
Published: March 2018

Objective

This study aimed to examine the effectiveness of mirror therapy on recovery in the severely impaired arm after stroke.

Design

Using single-blind randomized controlled design, patients with severely impaired arm within 1-month post-stroke were assigned to receive mirror therapy (n = 20) or control therapy (n = 21), 30 mins twice daily for 4 wks in addition to conventional rehabilitation. During mirror therapy and control therapy, subjects practiced similar structured exercises in both arms, except that mirror reflection of the unaffected arm was the visual feedback for mirror therapy, but mirror was absent for control therapy so that subjects could watch both arms in exercise. Fugl-Meyer Assessment and Wolf Motor Function Test were the outcome measurements.

Results

After the intervention, both mirror therapy and control therapy groups had significant arm recovery similarly in Fugl-Meyer Assessment (P = 0.867), Wolf Motor Function Test-Time (P = 0.947) and Wolf Motor Function Test-Functional Ability Scale (P = 0.676).

Conclusion

Mirror therapy or control therapy, which involved exercises concurrently for the paretic and unaffected arms during subacute stroke, promoted similar motor recovery in the severely impaired arm.
Neutralization Sensitivity of a Novel HIV-1 CRF01_AE Panel of Infectious Molecular Clones
Authors: Chenine Agnes-Laurence , Merbah Melanie , Wieczorek Lindsay , Molnar Sebastian , Mann Brendan , Lee Jenica , O'Sullivan Anne-Marie , Bose Meera , Sanders-Buell Eric , Kijak Gustavo H. , Herrera Carolina , McLinden Robert , O'Connell Robert J. , Michael Nelson L. , Robb Merlin L. , Kim Jerome H. , Polonis Victoria R. , Tovanabutra Sodsai
Published: March 2018

Background:

HIV-1 CRF01_AE is dominant in Thailand where RV144 vaccine trial was conducted. To study immune correlates of protection in ongoing trials, CRF01_AE-derived reagents are essential. Here, we present a panel of 14 HIV-1 infectious molecular clones (IMCs) identified from different stages of infection and characterization of their neutralization sensitivity using 2 standard assays.

Methods:

One full-length IMC was constructed using a transmitted-founder virus to express Renilla luciferase (LucR) reporter gene and full-length envelopes (envs) of exogenous HIV-1. A panel of IMCs was generated, expressing envs of viruses from acute (Fiebig stages I/II and I-IV) and chronic (>Fiebig VI) infection. Neutralization assays were performed using TZM-bl or A3R5 cell lines, and sera or monoclonal antibodies (mAbs). Wilcoxon matched-paired test was used to assess neutralization differences between assays and reagents; correlation coefficients were evaluated by linear regression.

Results:

Neutralization potency observed was significantly higher in the A3R5 assay when testing mAbs and serum pools (P < 0.0001); the stage of infection from which env was derived did not associate with IMC neutralization sensitivity. Neutralization values from A3R5 and TZM-bl assays were strongly correlated when mAbs were tested (R2 = 0.7, P < 0.0001), but a weaker association was seen with serum pools (R2 = 0.17, P = 0.03).

Conclusions:

This novel panel of CRF01_AE reporter IMC is useful for assessing vaccine-induced neutralizing antibodies in multiple assays, including those using primary cell targets. The significant differences in TZM-bl and A3R5 neutralization sensitivity, as well as the poor association when using polyclonal sera indicates the need for caution in choosing one specific platform.
Conservative Treatment for Delayed Infection After Cranioplasty With Titanium Alloy
Authors: Hu Yuanwei , Li Xiang , Zhao Ruirui , Zhang Kang
Published: March 2018

Cranioplasty (CP) is considered a low-risk operation in the field of neurosurgery following decompression craniectomy. Nevertheless, CP is still burdened by surgical complications, among which early or late infections are the most common outcome-threatening ones. Most of infection cases occur within a week after CP. Except that, implant-associated scalp infection is the most common complication, and leads to implant removal in many patients with refractory and recurrent infection. The authors reported a patient presenting with epidural infection about 3 months after titanium implant and cured by anti-infective treatment for 2 weeks.
Use of Irradiated Homologous Costal Cartilage in Rhinoplasty: Complications in Relation to Graft Location
Authors: Suh Man Koon , Lee Seung Jong , Kim Yeon-Jun
Published: March 2018

Background:

Nasal septal cartilage and conchal cartilages are preferred sources of grafts in augmentation rhinoplasty. Rib cartilage can also be used, but it may evoke a patient's concerns about a scar and an extensive surgery. In such cases, irradiated homologous costal cartilage (IHCC) can be a useful alternative. However, controversy still exists in many literatures regarding complications with use of IHCC. Therefore, the authors reviewed our experiences with IHCC in rhinoplasty and analyzed the complications in relation to graft location.

Methods:

A retrospective chart review was made of all patients who underwent rhinoplasty with IHCC between 2007 and 2015. A total of 323 patients were included. The authors considered the cases that required revision surgery for external aesthetic changes as complications. The authors defined major complications, including resorption, infection, fracture, or warping.

Results:

The total complication rate was 8%. Two fractures (0.6%), 4 fragmentation (1.2%), 4 resorptions (1.2%), 4 infections (1.2%), and 2 warpings (0.6%) were noted. Most of these complications occurred for the septal extension graft. Other complications, including 1 nasal obstruction, 2 visible contours, 3 caudal septal deviations, and 4 cases of unfavorable results (patient unsatisfactions), were noted.

Conclusions:

Based on the outcomes of this study, the authors concluded that IHCC is a useful and reliable source of cartilage graft and can serve as an alternative graft material for rhinoplasty. However, care must be taken in use of IHCC graft in areas under tension such as septal extension graft, though its complication rate is low.
Upper First Premolar Positioning Evaluation for the Stability of the Dental Occlusion: Anatomical Considerations
Authors: Sambataro Sergio , Cervino Gabriele , Fiorillo Luca , Cicciù Marco
Published: March 2018

The present study aimed to find the proper distorotation of the upper first premolar to achieve the therapeutic ideal advocated for the stability of the human occlusion. Normal teeth were analyzed and occlusal photocopies of upper arch were made to perform the 2 measurements. The first parameter was the angle formed by the perpendicular to the wire through the buccal cusp and a line connecting the buccal and the lingual cusps of the upper first premolar. The second one was the angle from the buccal line and the sagittal plane of the model. The amount of distorotation was calculated and a method to bond the bracket was suggested.
Orbital Subcutaneous Emphysema in a Child
Authors: Aubin-Lemay Camille , Acar Philippe , Alnaif Nayif , Alamri Abdulrahman , Azzi Alain Joe , Cugno Sabrina
Published: March 2018

The authors present a rare case of nontraumatic medial orbital wall fracture in an 11-year-old girl. Fractures of the orbital wall secondary to nose blowing have not been previously described in the pediatric population. The patient reported a history of chronic forceful nose blowing, followed by periorbital swelling after an episode of vigorous nose blowing. Erroneous diagnoses of sinusitis and periorbital cellulitis lead to unnecessary antibiotic treatment. The authors hypothesize that repeated and aggressive nose blowing is analogous to stress fractures, leading to weakening and eventual fracture of the medial orbital wall.
Antiviral Therapy Reduces Hepatocellular Carcinoma Recurrence in Patients With Low HBV-DNA Levels
Authors: Huang Gang , Li Peng-peng , Lau Wan Yee , Pan Ze-ya , Zhao Ling-hao , Wang Zhen-guang , Wang Meng-chao , Zhou Wei-ping
Published: March 2018

Background:

Despite antiviral treatment has been shown to reduce hepatocellular carcinoma (HCC) recurrence after curative treatment for hepatitis B virus (HBV)-related HCC in patients with high preoperative HBV-DNA levels, it is still unclear whether antiviral therapy is useful in reducing recurrence in patients with low preoperative HBV-DNA levels.

Methods:

In this randomized controlled trial, 200 patients who underwent curative resection for HCC with low baseline HBV-DNA levels were randomly assigned to receive preemptive antiviral therapy or not. The primary endpoints were recurrence-free survival. This study was censored on March 31, 2015 when all surviving patients had a minimum follow-up of 60 months. The analysis was done on an intention-to-treat basis.

Results:

The baseline clinical, laboratory, and tumor characteristics of the 2 groups were comparable. The 1-, 3-, and 5-year recurrence-free survival rates for the antiviral group and the control group were 85.9%, 55.2%, and 52.0% and 80.6%, 40.9%, and 32.3%, respectively. The corresponding overall survival rates for the 2 groups were 94.0%, 75.7%, and 64.1% and 90.0%, 62.4%, and 43.7%, respectively. The recurrence-free survival and overall survival for the antiviral group were significantly better than the control group (P = 0.016, P = 0.004, respectively). After adjusting for confounding prognostic factors in a Cox model, the relative risks of recurrence and death for antiviral treatment were 0.601 [95% confidence interval (CI), 0.409–0.884; P = 0.010] and 0.509 (95% CI, 0.333–0.778; P = 0.002), respectively. Antiviral therapy was an independent protective factor of late tumor recurrence (hazard ratio [HR] = 0.316, 95% CI 0.157–0.637; P = 0.001) but not of early tumor recurrence (HR = 0.782, 95% CI, 0.493–1.240; P = 0.296).

Conclusions:

In patients with low preoperative HBV-DNA levels, antiviral therapy significantly reduced HCC recurrence after R0 hepatic resection.
Prevention of firearm injuries with gun safety devices and safe storage: An Eastern Association for the Surgery of Trauma Systematic Review
Authors: Violano Pina , Bonne Stephanie , Duncan Thomas , Pappas Peter , Christmas A. Britton , Dennis Andrew , Goldberg Stephanie , Greene Wendy , Hirsh Michael , Shillinglaw William , Robinson Bryce , Crandall Marie
Published: March 2018

BACKGROUND

Over 50,000 homicides and suicides occur each year. An estimated half of all US households are believed to have a firearm present, making them one of the most ubiquitous consumer products. Our goal was to determine if the manner of storage of a firearm in a home could potentially make a difference in the outcomes of intentional and unintentional injuries involving a firearm; specifically addressing the use of gun safes and devices that block/disable firearm function (trigger locks, cable locks, etc.).

METHODS

A comprehensive review of the literature was performed. We used Grading of Recommendations Assessment, Development, and Evaluation methodology to assess the breadth and quality of the data specific to our Population, Intervention, Comparator, Outcomes (PICO) questions.

RESULTS

A total of 176 studies were initially identified, then, 120 more added after a subsequent literature review, with 97 removed as duplicates. One hundred ninety-one case reports, case series, and reviews were removed because they did not focus on prevention or did not address our comparators of interest. This left a total of two studies which merited inclusion for PICO 1, should gun locks be used to prevent firearm injuries and six studies which merited inclusion for PICO 2, should safe storage for guns be used to prevent firearm injuries.

CONCLUSION

PICO 1: We conditionally recommend that gun locks be used to prevent unintentional firearm injury. PICO 2: Because of the large effect size and the reasonable quality of available evidence with safe storage of firearms, we recommend safe storage prevent firearm-related injuries.

LEVEL OF EVIDENCE

Systematic review, level III.
The Alvarado score should be used to reduce emergency department length of stay and radiation exposure in select patients with abdominal pain
Authors: Coleman Jamie J. , Carr Bryan W. , Rogers Tyrone , Field Matthew S. , Zarzaur Ben L. , Savage Stephanie A. , Hammer Peter M. , Brewer Brian L. , Feliciano David V. , Rozycki Grace S.
Published: March 2018

BACKGROUND

Abdominal pain is the common reason patients seek treatment in emergency departments (ED), and computed tomography (CT) is frequently used for diagnosis; however, length of stay (LOS) in the ED and risks of radiation remain a concern. The hypothesis of this study was the Alvarado score (AS) could be used to reduce CT scans and decrease ED LOS for patients with suspected acute appendicitis (AA).

METHODS

A retrospective review of patients who underwent CT to rule out AA from January 1, 2015, to December 31, 2015, was performed. Patient demographics, medical history, ED documentation, operative interventions, complications, and LOS were all collected. Alvarado score was calculated from the medical record. Time to CT completion was calculated from times the patient was seen by ED staff, CT order, and CT report.

RESULTS

Four hundred ninety-two patients (68.1% female; median age, 33 years) met the inclusion criteria. Most CT scans (70%) did not have findings consistent with AA. Median AS for AA on CT scan was 7, compared with 3 for negative CT (p < 0.001). One hundred percent of female patients with AS of 10 and males with AS of 9 or greater had AA confirmed by surgical pathology. Conversely, 5% or less of female patients with AS of 2 or less and 0% of male patients with AS of 1 or less were diagnosed with AA. One hundred six (21.5%) patients had an AS within these ranges and collectively spent 10,239 minutes in the ED from the time of the CT order until the radiologist's report.

CONCLUSION

Males with an AS of 9 or greater and females with AS of 10 should be considered for treatment of AA without imaging. Males with AS of 1 or less and females with AS of 2 or less can be safely discharged with follow-up. Using AS, a significant proportion of patients can avoid the radiation risk, the increased cost, and increased ED LOS associated with CT.

LEVEL OF EVIDENCE

Diagnostic IV, therapeutic IV.