bluuebunny/crossref_metadata_2025 huggingface dataset:
Essential role of CCL21 in establishment of central self-tolerance in T cells
Authors: Kozai Mina , Kubo Yuki , Katakai Tomoya , Kondo Hiroyuki , Kiyonari Hiroshi , Schaeuble Karin , Luther Sanjiv A. , Ishimaru Naozumi , Ohigashi Izumi , Takahama Yousuke
Published: June 2017

The chemokine receptor CCR7 directs T cell relocation into and within lymphoid organs, including the migration of developing thymocytes into the thymic medulla. However, how three functional CCR7 ligands in mouse, CCL19, CCL21Ser, and CCL21Leu, divide their roles in immune organs is unclear. By producing mice specifically deficient in CCL21Ser, we show that CCL21Ser is essential for the accumulation of positively selected thymocytes in the thymic medulla. CCL21Ser-deficient mice were impaired in the medullary deletion of self-reactive thymocytes and developed autoimmune dacryoadenitis. T cell accumulation in the lymph nodes was also defective. These results indicate a nonredundant role of CCL21Ser in the establishment of self-tolerance in T cells in the thymic medulla, and reveal a functional inequality among CCR7 ligands in vivo.
Elevated cAMP improves signal-to-noise ratio in amphibian rod photoreceptors
Authors: Astakhova Luba A. , Nikolaeva Darya A. , Fedotkina Tamara V. , Govardovskii Victor I. , Firsov Michael L.
Published: June 2017

The absolute sensitivity of vertebrate retinas is set by a background noise, called dark noise, which originates from several different cell types and is generated by different molecular mechanisms. The major share of dark noise is produced by photoreceptors and consists of two components, discrete and continuous. Discrete noise is generated by spontaneous thermal activations of visual pigment. These events are undistinguishable from real single-photon responses (SPRs) and might be considered an equivalent of the signal. Continuous noise is produced by spontaneous fluctuations of the catalytic activity of the cGMP phosphodiesterase. This masks both SPR and spontaneous SPR-like responses. Circadian rhythms affect photoreceptors, among other systems by periodically increasing intracellular cAMP levels ([cAMP]in), which increases the size and changes the shape of SPRs. Here, we show that forskolin, a tool that increases [cAMP]in, affects the magnitude and frequency spectrum of the continuous and discrete components of dark noise in photoreceptors. By changing both components of rod signaling, the signal and the noise, cAMP is able to increase the photoreceptor signal-to-noise ratio by twofold. We propose that this results in a substantial improvement of signal detection, without compromising noise rejection, at the rod bipolar cell synapse.
GfaPy: a flexible and extensible software library for handling sequence graphs in Python
Authors: Gonnella Giorgio , Kurtz Stefan
Published: June 2017

GFA 1 and GFA 2 are recently defined formats for representing sequence graphs, such as assembly, variation or splicing graphs. The formats are adopted by several software tools. Here, we present GfaPy, a software package for creating, parsing and editing GFA graphs using the programming language Python. GfaPy supports GFA 1 and GFA 2, using the same interface and allows for interconversion between both formats. The software package provides a simple interface for custom record types, which is an important new feature of GFA 2 (compared to GFA 1). This enables new applications of the format.

Availability and implementation

GfaPy is available open source at https://github.com/ggonnella/gfapy and installable via pip.

Supplementary information

Supplementary data are available at Bioinformatics online.
Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription
Authors: Sharifzadeh Yasamin , Kao Ming-Chih , Sturgeon John A. , Rico Thomas J. , Mackey Sean , Darnall Beth D.
Published: June 2017

Background

Pain catastrophizing is a maladaptive response to pain that amplifies chronic pain intensity and distress. Few studies have examined how pain catastrophizing relates to opioid prescription in outpatients with chronic pain.

Methods

The authors conducted a retrospective observational study of the relationships between opioid prescription, pain intensity, and pain catastrophizing in 1,794 adults (1,129 women; 63%) presenting for new evaluation at a large tertiary care pain treatment center. Data were sourced primarily from an open-source, learning health system and pain registry and secondarily from manual review of electronic medical records. A binary opioid prescription variable (yes/no) constituted the dependent variable; independent variables were age, sex, pain intensity, pain catastrophizing, depression, and anxiety.

Results

Most patients were prescribed at least one opioid medication (57%; n = 1,020). A significant interaction and main effects of pain intensity and pain catastrophizing on opioid prescription were noted (P < 0.04). Additive modeling revealed sex differences in the relationship between pain catastrophizing, pain intensity, and opioid prescription, such that opioid prescription became more common at lower levels of pain catastrophizing for women than for men.

Conclusions

Results supported the conclusion that pain catastrophizing and sex moderate the relationship between pain intensity and opioid prescription. Although men and women patients had similar Pain Catastrophizing Scale scores, historically “subthreshold” levels of pain catastrophizing were significantly associated with opioid prescription only for women patients. These findings suggest that pain intensity and catastrophizing contribute to different patterns of opioid prescription for men and women patients, highlighting a potential need for examination and intervention in future studies.
Corrective Osteotomy for Symptomatic Clavicle Malunion Using Patient-specific Osteotomy and Reduction Guides
Authors: Haefeli Mathias , Schenkel Matthias , Schumacher Ralf , Eid Karim
Published: June 2017

Midshaft clavicular fractures are often treated nonoperatively with good reported clinical outcome in a majority of patients. However, malunion with shortening of the affected clavicle is not uncommon. Shortening of the clavicle has been shown to affect shoulder strength and kinematics with alteration of scapular position. Whereas the exact clinical impact of these factors is unknown, the deformity may lead to cosmetic and functional impairment as for example pain with weight-bearing on the shoulder girdle. Other reported complications of clavicular malunion include thoracic outlet syndrome, subclavicular vein thrombosis, and axillary plexus compression. Corrective osteotomy has therefore been recommended for symptomatic clavicular malunions, generally using plain x-rays for planning the necessary elongation. Particularly in malunited multifragmentary fractures it may be difficult to exactly determine the plane of osteotomy intraoperatively to restore the precise anatomic shape of the clavicle. We present a technique for corrective osteotomy using preoperative computer planning and 3-dimensional printed patient-specific intraoperative osteotomy and reduction guides based on the healthy contralateral clavicle.
Indocyanine Green Angiography: A Helpful Tool for Intraoperative Assessment of Upper Extremity Perfusion
Authors: Ghareeb Paul A. , Neustein Thomas M. , Fang Robert C. , Payne Diane E.
Published: June 2017

Assessment of tissue perfusion can be a challenge for the hand surgeon. Indocyanine green (ICG) angiography has been shown to be a valuable adjunct to physical examination and clinical judgment when there is a concern for tissue perfusion. The use of this technology has risen sharply in recent years in reconstructive surgery. Applications of ICG angiography have been developed throughout the field of surgery, including breast surgery, free tissue transfer, bowel surgery, neurosurgery, and lymphatic reconstruction. In this study, we discuss the novel applications of ICG angiography within the field of upper extremity surgery, and provide specific case examples of its successful use.
Cancer in pregnancy: safety and efficacy of systemic therapies
Authors: Boere Ingrid , Lok Christianne , Vandenbroucke Tineke , Amant Frédéric
Published: June 2017

Purpose of review

Cancer in pregnancy has become increasingly frequent. It has become clear that for specific cancers under well defined circumstances, oncological treatment in pregnancy can be well tolerated and feasible for both mother and fetus. Continued critical assessment of the available literature and registration of cancer in pregnancy cases and outcomes for mother and child are necessary to work toward implementing optimal cancer treatment during pregnancy.

Recent findings

Physiologic changes in pregnancy may alter distribution and efficacy of systemic therapy. Data on systemic therapy including, chemotherapy, hormonal therapy, and targeted therapy during pregnancy are available but incomplete. Outcomes of fetuses exposed to chemotherapy in utero are generally reassuring, but new targeted therapies are mostly discouraged in pregnancy.

Cancer treatment during pregnancy is possible, depending on type and timing of systemic therapy and treatment modality. Available data are reassuring with a modest increase in complications such as growth restriction and preterm birth. The effect of new targeted therapies is often still unclear and therefore discouraged.
Cutaneous Collagenous Vasculopathy: Report of Two Cases Presenting as Disseminated Telangiectasias and Review of the Literature
Authors: Bondier Laure , Tardieu Mathilde , Leveque Perrine , Challende Isabelle , Pinel Nicole , Leccia Marie T.
Published: June 2017

Cutaneous collagenous vasculopathy is a recently described idiopathic microangiopathy characterized by acquired diffuse cutaneous telangiectasias and specific histological features: dilated capillaries in the superficial dermis, with walls thickened by hyaline material containing collagen IV by immunohistochemistry. The authors describe 2 cases and review all cases reported in the literature to date, 34 cases including our own. Cases were mainly observed in women (sex ratio 0.41), median age 63.5 (16–85). Hypertension and diabetes seem more frequent in these patients than in the general population. Typical clinical presentation is fine hair telangiectasias appearing on the lower limbs and progressing toward the trunk and upper limbs, sparing the face. Facial and neck involvement are however reported. When faced with isolated acquired diffuse cutaneous telangiectasias, clinicians should perform a skin biopsy to rule out cutaneous collagenous vasculopathy.
Phosphohistone-H3 and Ki67: Useful Markers in Differentiating Dermatofibroma From Dermatofibrosarcoma Protuberans and Atypical Fibrohistiocytic Lesions
Authors: Agarwal Atin , Gopinath Arun , Tetzlaff Michael T. , Prieto Victor G.
Published: June 2017

Dermatofibromas (DF) are common, benign, skin tumors, usually easily differentiated from dermatofibrosarcoma protuberans (DFSP) by the presence of a relative low cellularity, lesser degree of infiltration of subcutaneous tissue, and immunohistochemical pattern (eg, FXIIIa in DF and CD34 in DFSP). Atypical fibrohistiocytic lesions (AFL) have features intermediate to DF and DFSP (trunk location, storiform pattern, infiltration of the subcutaneous tissue, and focal expression of both CD34 and Factor XIIIa). It is unclear if mitotic counts/degree of proliferation is helpful to distinguish DF from DFSP. To study the mitotic rate and proliferation index in DF, AFL/DFSP, anti-ki67, and anti-PHH3 were performed on 10 cases of DF (including 4 cellular DF), 10 standard DFSP, and 2 AFL. The proliferation index and mitotic figures were counted per square millimeter in a “hotspot” (in a fashion similar to mitotic counts in melanoma). All cases of DF showed much higher Ki67 proliferation index (P = 0.0001) along with increased mitotic figures both on H&E and with anti-PHH3 (P = 0.0001) when compared to AFL/DFSP. Our data indicate that DF has a higher proliferation index and mitotic counts when compared to superficial/peripheral portion of AFL and DFSP. This finding may be helpful in the differential diagnosis among these fibrohistiocytic lesions.
Plaque-Like Pilar Sheath Acanthoma: Histopathologic and Immunohistochemical Study of 3 Unusual Cases
Authors: Jo-Velasco Margarita , Corrales-Rodríguez Araceli , Francés-Rodríguez Laura , Alegría-Landa Victoria , Eraña-Tomás Itziar , Rütten Arno , Requena Luis
Published: June 2017

Pilar sheath acanthoma is an uncommon, benign follicular neoplasm that frequently presents as a solitary lesion. This neoplasm usually appears on the skin around the upper lip of elderly patients. Histopathologically, the neoplasm usually shows a cystic configuration with epithelial lobules resembling to those of the outer root sheath of the hair follicle at the level of the isthmus emanating radially from the cyst wall. We present 3 peculiar cases of a pilar sheath acanthoma showing a plaque-like architecture because the lesions exhibited a horizontal configuration. To our knowledge, there are no previously reported examples of plaque-like pilar sheath acanthoma.
Promotion and marketing of bioidentical hormone therapy on the internet: a content analysis of websites
Authors: Yuksel Nese , Treseng Laetitia , Malik Bushra , Ogbogu Ubaka
Published: June 2017

Objective:

To evaluate the quality of information presented and claims made on websites offering bioidentical hormone therapy (BHT) products or services.

Methods:

A quantitative content analysis was completed on 100 websites promoting or offering BHT products or services. Websites were identified through Google search engine from September to October 2013. Search terms included “bioidentical hormone therapy” or “bioidentical progesterone,” accompanied by “purchase or buy,” “service,” or “doctors.” The Brief DISCERN instrument was used to determine the quality of the health information.

Results:

Websites were from Canada (59%), United States (38%), and other countries (3%). Almost half of the websites originated from medical clinics (47%), and healthcare professionals offering BHT services included physicians (50%), pharmacists (19%), and naturopaths (16%). Majority of websites promoted BHT as custom-compounded formulations (62%), with only 27% indicating that BHT is also commercially available. Websites overall claimed that BHT had less risk compared with conventional hormone therapy (62%). BHT was described as having less breast cancer risk (40%), whereas over a quarter of websites described BHT as “protective” for breast cancer. Websites mainly targeted women (99%), with males mentioned in 62% of websites. Product descriptors used to promote BHT included individualization (77%), natural (70%), hormone imbalance (56%), and antiaging (50%). The mean Brief DISCERN score was 15, indicating lower quality of information.

Conclusions:

Claims made about BHT on the internet are misleading and not consistent with current professional organizations’ recommendations. Understanding how BHT may be promoted on the internet can help healthcare professionals when educating patients.
Evaluation of depressive symptoms in mid-aged women: report of a multicenter South American study
Authors: Salazar-Pousada Danny , Monterrosa-Castro Alvaro , Ojeda Eliana , Sánchez Sandra C. , Morales-Luna Ingrid F. , Pérez-López Faustino R. , Chedraui Peter
Published: June 2017

Objective:

To evaluate depressive symptoms and related factors among mid-aged women using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10).

Methods:

This was a cross-sectional multicenter study in which women aged 40 to 65 from various South American countries were surveyed with the CESD-10 and a general questionnaire containing personal and partner data.

Results:

In all, 864 women were interviewed from Colombia (Afro-Colombian, n = 215), Ecuador (Mestizo, n = 202), Perú (Quechua at high altitude, n = 231), and Paraguay (Mestizo, n = 216). Mean age of the whole sample was 49.1 ± 6.0 years. Although the rate of postmenopausal status was similar among studied sites, differences were observed in relation to age, parity, hormone therapy use, hot flush rate, sedentary lifestyle, chronic medical conditions, habits, and partner aspects. Median total CESD-10 score for all sites was 7.0, with a 36.0% (n = 311) having scores equal to 10 or more (suggestive of depressed mood). Higher scores were observed for Afro-Colombian and Quechua women, and also for postmenopausal and perimenopausal ones. Multivariate linear regression analysis found that depressed mood (higher CESD-10 total scores) was significantly associated with ethnicity (Afro-Colombian), hot flush severity, hormone therapy use, sedentary lifestyle, postmenopause, perceived unhealthy status, and lower education. Higher monthly coital frequency and having a healthy partner without premature ejaculation was related to lower scores, hence less depressed mood.

Conclusion:

In this mid-aged female South American sample, depressive symptoms correlated to menopausal status and related aspects, ethnicity, and personal and partner issues. All these features require further research.
Burnout and Mindfulness Self-Compassion in Nurses of Intensive Care Units
Authors: Gracia-Gracia Pilar , Oliván-Blázquez Bárbara
Published: June 2017

Nursing staff has been identified as one of the main risk groups for the development of burnout. The objective of this study is to analyze the ability of self-compassion mindfulness related to burnout in nurses of intensive care units. The results show that the level of burnout of nursing staff is inversely related to their level of self-compassion.
Motivators, Facilitators, and Barriers to Physical Activity in Older Adults
Authors: Miller Wendy , Brown Patrick R.
Published: June 2017

In this descriptive, qualitative research study, the researchers used semistructured interviews with older adults who engaged in regular physical activity to identify common motivators, facilitators, and barriers to participating in regular exercise. The authors used these interviews to identify major themes and discuss implications for population health.
Dose–response study of topical allyl isothiocyanate (mustard oil) as a human surrogate model of pain, hyperalgesia, and neurogenic inflammation
Authors: Andersen Hjalte H. , Lo Vecchio Silvia , Gazerani Parisa , Arendt-Nielsen Lars
Published: June 2017

Despite being a ubiquitous animal pain model, the natural TRPA1-agonist allyl isothiocyanate (AITC, also known as “mustard oil”) has only been sparsely investigated as a potential human surrogate model of pain, sensitization, and neurogenic inflammation. Its dose–response as an algogenic, sensitizing irritant remains to be elucidated in human skin. Three concentrations of AITC (10%, 50%, and 90%) and vehicle (paraffin) were applied for 5 minutes to 3 × 3 cm areas on the volar forearms in 14 healthy volunteers, and evoked pain intensity (visual analog scale 0-100 mm) and pain quality were assessed. In addition, a comprehensive battery of quantitative sensory tests was conducted, including assessment of mechanical and thermal sensitivity. Neurogenic inflammation was quantified using full-field laser perfusion imaging. Erythema and hyperpigmentation were assessed before, immediately after, and ≈64 hours after AITC exposure. AITC induced significant dose-dependent, moderate-to-severe spontaneous burning pain, mechanical and heat hyperalgesia, and dynamic mechanical allodynia (P < 0.05). No significant differences in induced pain hypersensitivity were observed between the 50% and 90% AITC concentrations. Acute and prolonged inflammation was evoked by all concentrations, and assessments by full-field laser perfusion imaging demonstrated a significant dose-dependent increase with a ceiling effect from 50% to 90%. Topical AITC application produces pain and somatosensory sensitization in a dose-dependent manner with optimal concentrations recommended to be >10% and ≤50%. The model is translatable to humans and could be useful in pharmacological proof-of-concept studies of TRPA1-antagonists, analgesics, and anti-inflammatory compounds or for exploratory clinical purposes, eg, loss- or gain-of-function in peripheral neuropathies.
Nonhistaminergic and mechanical itch sensitization in atopic dermatitis
Authors: Andersen H. H. , Elberling J. , Sølvsten H. , Yosipovitch G. , Arendt-Nielsen L.
Published: June 2017

Chronic or episodic severe itch is recurrent in atopic dermatitis (AD). Nonhistaminergic itch pathways are suggested to dominate in AD itch, contributing to an “itch-scratch-itch cycle” that prolongs and worsens itch, pain, and skin lesions. We hypothesized that nonhistaminergic neuronal sensitization contributes to itch in AD. Hence, we compared sensitivity with thermal, mechanical, and chemical pruritic stimuli in patients with AD and controls. The study comprised 25 patients with AD with chronic itch and 25 healthy controls. Questionnaires on itch characteristics were administered, and sensory tests were conducted intralesionally, extralesionally, and in homologous areas of controls. Thermal and mechanical quantitative sensory testing (QST) as well as histamine and cowhage provocations were performed. Subsequently, hyperknesis and vasomotor reactivity were assessed. Average itch and associated pain among patients with AD were 60.7 ± 4.3 and 39.7 ± 5.2 (VAS0-100), respectively. Patients experienced significantly higher itch from cowhage both intralesionally and extralesionally compared with controls, whereas histamine-evoked itch intensity was not significantly different between groups. No group differences were found for thermal quantitative sensory testings or pain evoked by itch provocations. Patients had decreased mechanical detection thresholds intralesionally and increased mechanical pain sensitivity intralesionally and extralesionally. Lastly, patients exhibited intralesional and extralesional hyperknesis before chemical itch provocations and augmented hyperknesis after itch provocations. Increased itch in response to cowhage (but not histamine) suggests nonhistaminergic pathway-specific itch sensitization in AD, whereas increased susceptibility to mechanically evoked itch and pain, particularly intralesionally suggests sensitization of mechanosensitive circuitry not normally associated with itch. Drugs targeting the nonhistaminergic (PAR2/TRPA1+) itch pathway and itch sensitization are promising for treating AD itch.
Multiple Drug-Intolerant Hypertension
Authors: Neculau Andrea E. , Rogozea Liliana M. , Andreescu Oana , Jinga Loredana , Dinu Eleonora A. , Tint Diana
Published: June 2017

Clinical Features:

The term multiple drug intolerance (MDI) is attributed to patients who experience adverse drug reactions to more than 3 different classes of medication without a known immunological mechanism. A special attention should be given to multiple drug-intolerant hypertension (MDI-HTN) that is a cause of drop out from treatment and consequent poor blood pressure control. Patients with MDIs account for 2%–5% of all population. The patient we present is a 63-year-old man with third-degree hypertension identified with intolerance to drugs from 4 major classes of antihypertensive medication.

Therapeutic Challenge:

Patients with MDIs are difficult to treat. They frequently also have numerous comorbidities and high cardiovascular risk. It is recognized that guidelines for the management of hypertension do not include an algorithm of action in situations of MDIs to medication.

Solution:

We chose to use a recently proposed four-step algorithm for the management of MDI-HTN. A 1-month follow-up program was established. Weekly visits were scheduled to elicit about side effects and measure blood pressure . Ambulatory blood pressure monitoring was performed after a month. The strategy was first to reuse medication from classes the patient was intolerant to, but in smaller doses and in combinations. Among same class members, we have chosen those with less adverse effects. Not all steps within the algorithm were followed since our patient did not need alternative formulation as liquid or transdermal ones. Anxiety medication was prescribed as nonlicensed antihypertensive medication. At the end of the follow-up month, blood pressure control was satisfactory, 24-hour ambulatory blood pressure monitoring was 135.5/83.0 mm Hg, and the patient did not claim any adverse drug reactions.
Gender Differences of Stressful Life Events, Coping Style, Symptom Severity, and Health-Related Quality of Life in Patients With Panic Disorder
Authors: Kim Ji Eun , Song In Han , Lee Sang-Hyuk
Published: June 2017

Although affective disorders have been known to have sex differences in the associated clinical characteristics and quality of life (QOL), sex differences among patients with panic disorder (PD) have remained relatively unexplored in Korea. We examined the sex differences in different types of stressful life events (SLEs), coping styles, symptom severity, and health-related QOL (HRQOL) in patients with PD. Data from 291 female and 254 male participants diagnosed with PD were analyzed using a structured clinical interview following the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. Females with PD reported more SLEs including separation issues, physical illness or disability, and pregnancy-related problems than males. They also reported lower levels of confrontation and help-seeking coping strategies and higher levels of agoraphobia in symptom severity than males. The HRQOL of females with PD was significantly lower than male in physical functioning of HRQOL. This study suggests that the patient's sex is relevant to the assessment and treatment of PD.
Attention-Deficit/Hyperactivity Disorder Symptoms and Life Satisfaction in a Representative Adolescent and Adult Sample
Authors: Hennig Timo , Koglin Ute , Schmidt Sören , Petermann Franz , Brähler Elmar
Published: June 2017

Although it is well documented that attention-deficit/hyperactivity disorder (ADHD) is associated with reduced life satisfaction, the mechanisms that might explain this co-occurrence are unclear. We examined the correlation of ADHD symptoms with life satisfaction and whether this association is mediated by (lacking) social support and depressive symptoms. Self-reported ADHD symptoms, life satisfaction, social support, and depressive symptoms were assessed in a representative, predominantly adult sample from the general population (14–91 years, N = 2517). Attention-deficit/hyperactivity disorder symptoms correlated negatively with life satisfaction (r = −0.41, p < 0.01), even after demographic factors (gender, age, income) and common risk factors (not being in a relationship, being unemployed) were controlled for (r = −0.39, p < 0.01). Social support mediated up to 23% and depressive symptoms up to 44% in the association between ADHD symptoms and life satisfaction. Counteracting problems with social relationships and treating depressive symptoms may help to increase life satisfaction in adults with ADHD symptoms.
Comparing Corticosteroid Preparation and Dose in the Improvement of Shoulder Function and Pain
Authors: Carroll Matthew B. , Motley Spencer A. , Smith Benjamin , Ramsey Bryan C. , Baggett Alan S.
Published: June 2017

Introduction

Shoulder pain may arise from inflammation of the bursa separating the supraspinatus tendon from the coracoacromial ligament and acromion. The optimal treatment dose and preparation of intrabursal corticosteroid injection are unknown.

Methods

This single-blinded equivalence study recruited 62 subjects randomizing them to one of following four arms: methylprednisolone 20 mg, methylprednisolone 40 mg, triamcinolone acetonide 20 mg, or triamcinolone acetonide 40 mg. QuickDASH, subject-reported pain, and adverse events were recorded in time of injection, 3 days later, 3 wks later, and 6 wks later. Primary outcome was QuickDASH improvements 6 wks after injection.

Results

All four groups were equally matched regarding age, sex, ethnicity, and site injected. Six weeks after injection, no statistically significant changes were noted in QuickDASH improvement (as compared with time of injection) among the four arms. There were no statistically significant differences at 6 wks regarding improvement in pain. There were no statistically significant differences noted in adverse events among the four arms.

Conclusions

Neither dose nor preparation of injectable corticosteroid influences magnitude of improvement in function or pain experienced. Although this study provides clinically relevant insight regarding corticosteroid dose and type when managing shoulder pain, the modest sample size may limit the conclusions that can be made about efficacy and adverse effects.
Antithrombotic Therapies in Digit Replantation with Papaverine Administration: A Prospective, Observational Study
Authors: Zhu Hongyi , Zhu Xiaozhong , Zheng Xianyou
Published: June 2017

Background:

The primary objective of this study was to investigate whether the application of antithrombotic therapies affects the success rate of digit replantation.

Methods:

A total 477 digits of 319 patients who received dextran with low-molecular-weight heparin, dextran with prostaglandin E1, or no antithrombotic therapy after replantation of complete amputated digits from January 1, 2012, to January 1, 2016, were included in this study. Papaverine was given by intramuscular injection to all patients at a dosage of 90 mg/day postoperatively.

Results:

There was no significant difference in any of the potential risk factors, including age, smoking, Tamai level of amputation, causes of injury, and warm ischemia time among groups. The survival rates of digits from patients who received dextran with low-molecular-weight heparin, dextran with prostaglandin E1, or no antithrombotic therapy were not significantly different.

Conclusion:

Antithrombotic therapies showed no significant benefit for digit replantation in patients receiving papaverine.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetric Brachial Plexus Injury
Authors: O’Grady Kathleen M. , Power Hollie A. , Olson Jaret L. , Morhart Michael J. , Harrop A. Robertson , Watt M. Joe , Chan K. Ming
Published: June 2017

Background:

Upper trunk obstetric brachial plexus injury can cause profound shoulder and elbow dysfunction. Although neuroma excision with interpositional sural nerve grafting is the current gold standard, distal nerve transfers have a number of potential advantages. The goal of this study was to compare the clinical outcomes and health care costs between nerve grafting and distal nerve transfers in children with upper trunk obstetric brachial plexus injury.

Methods:

In this prospective cohort study, children who underwent triple nerve transfers were followed with the Active Movement Scale for 2 years. Their outcomes were compared to those of children who underwent nerve graft reconstruction. To assess health care use, a cost analysis was also performed.

Results:

Twelve patients who underwent nerve grafting were compared to 14 patients who underwent triple nerve transfers. Both groups had similar baseline characteristics and showed improved shoulder and elbow function following surgery. However, the nerve transfer group displayed significantly greater improvement in shoulder external rotation and forearm supination 2 years after surgery (p < 0.05). The operative time and length of hospital stay were significantly lower (p < 0.05), and the overall cost was approximately 50 percent less in the nerve transfer group.

Conclusion:

Triple nerve transfer for upper trunk obstetric brachial plexus injury is a feasible option, with better functional shoulder external rotation and forearm supination, faster recovery, and lower cost compared with traditional nerve graft reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Implications of Left-sided Gallbladder in the Emergency Setting: Retrospective Review and Top Tips for Safe Laparoscopic Cholecystectomy
Authors: Abongwa Hariscine K. , De Simone Belinda , Alberici Laura , Iaria Maurizio , Perrone Gennaro , Tarasconi Antonio , Baiocchi Gianluca , Portolani Nazario , Di Saverio Salomone , Sartelli Massimo , Coccolini Federico , Manegold Jennifer E. , Ansaloni Luca , Catena Fausto
Published: June 2017

Background:

Left-sided gallbladder without situs viscerum inversus (LSG-woSVI) is a rare congenital anomaly. Clinical features and routine presurgical imaging could miss the anomalous position, thereby producing complications during surgery. Laparoscopic cholecystectomy can be performed safely, but the risk of bile duct injury (BDI) is greater than in cholecystectomy of the orthotopic gallbladder. We present a retrospective review of all scientific literature for diagnosed cases of LSG-woSVI undergoing cholecystectomy from 1996 to 2014. Our objectives were to outline empirical top tips for a safe cholecystectomy in incidentally diagnosed LSG-woSVI.

Methods:

We carried a comprehensive search of PubMed using medical subject headings “left-sided gallbladder,” “right-sided ligamentum teres” “situs viscerun inversus,” “preoperative diagnoses,” “cholecystectomy,” and “bile duct injury.” We considered a classification of the LSG-woSVI in 2 groups: True LSG-woSVI and LSG-woSVI in patients with right-sided ligamentum teres.

Results:

Our retrospective review revealed 55 cases of LSG-woSVI. The mean age was 51 years ±17 SD, male/female ratio was 2:1, clinical presentation was pain in the right upper abdominal quadrant in 75.5%, preoperative diagnosis was reached in 16.3%, True LSG was diagnosed in 83%, acute cholecystitis was found in 50%, laparoscopic cholecystectomy was performed in 79.6%, fundus-first dissection technique was used in 16.7%, intraoperative cholangiography was performed in 39.1%, and BDI occurred in 7.3% of the reported cases.

Conclusions:

Increased awareness of the anatomic aberrations in LSG-woSVI associated with improved preoperative diagnosis and a good knowledge about safe surgical techniques for cholecystectomy could indubitably reduce the incidence of BDI.
The Relationship Between the Number of Intersections of Staple Lines and Anastomotic Leakage After the Use of a Double Stapling Technique in Laparoscopic Colorectal Surgery
Authors: Lee SeungHun , Ahn ByungKwon , Lee SeungHyun
Published: June 2017

Purpose:

Laparoscopic intracorporeal colorectal anastomosis with double stapling technique is difficult because of unsuitable cutting angle in narrow pelvic cavity. For reasons of tilted and long linear staple line of rectal stump, circular anastomotic plane can make multiple intersections. The present study was designed to assess whether multiple intersections after double stapling technique is the risk factor of anastomotic complication in laparoscopic colorectal surgery.

Materials and Methods:

In total, 128 consecutive left colon and rectal cancer patients who underwent laparoscopic rectal resection with double stapling technique were enrolled in this study. In all cases, operator tried to reduce intersections by inversion and invagination techniques. They were subdivided into 3 groups: 58 patients with no intersection of staple lines (group A), 62 patients with 1 point of intersection (group B) and 8 patients with 2 points of intersection (group C). Intraoperative air leakage, incomplete cut ring, postoperative bleeding, anastomotic stenosis, and leakage were compared between the 3 groups.

Results:

Clinical anastomotic leakage was identified in 1 (group C) of 128 patients (0.7%). Overall anastomotic leakage rate was 0% (0/58) in group A, 0% (0/62) in group B, and 12.5% (1/8) in group C (P=0.001). In univariate analysis, intersections of staple lines were associated with anastomotic complications. There were no statistically significant differences between the 3 groups in multivariate analysis.

Conclusions:

The number of intersections of staple lines is associated with anastomotic leakage, and the inversion technique is a useful method for avoiding anastomotic leakage. Using an appropriate technique by skilled operator, double stapling technique for laparoscopic anterior resection is safe and feasible.
Impact of Resected Colon Site on Quality of Bowel Preparation in Patients Who Underwent Prior Colorectal Resection
Authors: Chung Eric , Kang Jeonghyun , Baik Seung Hyuk , Lee Kang Young
Published: June 2017

Background and Aim:

Various factors are known to be associated with quality of bowel preparation (QBP), but have rarely been investigated in patients with prior colorectal resection. The aim of this study was to investigate variables associated with bowel preparation in patients with prior colorectal resection.

Materials and Methods:

A total of 247 patients with prior colorectal resection and undergone surveillance colonoscopy were consecutively chosen. One clinician performed endoscopy for all patients. QBP was rated using Aronchick grade and was categorized as either satisfactory (Aronchick grades, 1 to 3) or unsatisfactory (Aronchick grades, 4 and 5). Factors associated with QBP were analyzed.

Results:

Unsatisfactory bowel preparation was detected in 49 patients (19.8%). There was no difference in QBP on the basis of sex, age, body mass index, hypertension history, diabetes mellitus history, smoking habits, time after surgery, resected colon length, or bowel preparation method. Operation method was marginally associated with QBP (P=0.056). When we dichotomized patients into right-side colon preservation or not, the right colon preservation group showed a significant association with poor QBP on univariate (22.3% vs. 7.5%, P=0.028) and multivariate analysis (odds ratio, 3.6; 95% confidence interval, 1.0-12.3; P=0.038).

Conclusion:

Patients with a preserved right colon were associated with poor bowel preparations compared with patients who underwent right-side colon resection. When preparing patients with history of colorectal resection for colonoscopy, these differences should be considered for better bowel preparation.
Pediatric moped-related injuries in the United States from 2002 to 2014: Age-related comparisons of mechanisms and outcomes
Authors: Johnson Nathaniel K. , Johnson Brandon M. , Denning Gerene M. , Jennissen Charles A.
Published: June 2017

Mopeds are a popular means of transportation, especially in urban areas. However, few studies have investigated moped-related injuries in the United States. This study's goal was to compare the crash mechanisms and injuries suffered in moped-related crashes involving youth versus adults, as well as between younger and older children.

INTRODUCTION

Mopeds are a popular means of transportation, especially in urban areas. However, few studies have investigated moped-related injuries in the United States. This study's goal was to compare the crash mechanisms and injuries suffered in moped-related crashes involving youth versus adults, as well as between younger and older children.

METHODS

Descriptive and comparative analyses were performed using National Electronic Injury Surveillance System (NEISS) data and additional variables coded from injury narratives. Multivariate regression analyses were used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for categorical outcomes, controlling for significant covariates.

RESULTS

From 2003 to 2014, there were 779 youth (17 years or younger) and 2,453 adult moped-related emergency department visits in the database. The number of youth injured remained relatively constant over time, while the number of adult victims doubled. Relative to 14- to 17-year olds, victims younger than 14 years were more commonly female (p = 0.037) and non-Caucasian (p = 0.008). Victims 14 to 17 years of age had a higher proportion of brain injuries (p = 0.012) and were more commonly in motor vehicle collisions (p = 0.02), as compared to younger victims. Relative to adults, youth crashes occurred more commonly in the summer (p < 0.0001), and off the street/road (p < 0.0001). Logistic regression analysis showed crashes on streets/roads were two and a half times more likely to involve victims who were 14 to 17 years of age as compared to those younger (aOR, 2.55; CI, 1.64–3.97). Additionally, male youths were twice as likely as females to have a motor vehicle collision (aOR, 1.97; CI, 1.19–3.24), and pediatric crashes were approximately twice as likely to result in extremity injuries as compared to adult crashes (aOR, 1.95; CI, 1.19–3.20).

CONCLUSION

Differences in crash mechanism and injuries sustained between two youth age groups and between youths and adults indicate the importance of targeted injury prevention efforts. This would include improved operator training and standardized, evidence-based, well-enforced safety legislation.

LEVEL OF EVIDENCE

Epidemiologic study, level III.
Remote ischemic conditioning preserves cognition and motor coordination in a mouse model of traumatic brain injury
Authors: Sandweiss Alexander J. , Azim Asad , Ibraheem Kareem , Largent-Milnes Tally M. , Rhee Peter , Vanderah Todd W. , Joseph Bellal
Published: June 2017

INTRODUCTION

Management of traumatic brain injury (TBI) is focused on minimizing or preventing secondary brain injury. Remote ischemic conditioning (RIC) is an established treatment modality that has been shown to improve patient outcomes in different clinical settings by influencing inflammatory insults. In a clinical trial, RIC showed amelioration of SB100 and neuron-specific enolase. The aim of our study was to further elucidate the mechanisms and outcome when applying RIC in a mouse model of traumatic brain injury.

METHODS

We subjected 100 male C57BL mice to a closed-skull cortical-controlled impact injury. Two hours after the TBI, the animals were allocated to either the RIC group (n = 50) or the sham group (n = 50). By clamping the exposed femoral artery, we induced RIC by six 4-minute cycles of ischemia and reperfusion. Circulating levels of S100-B, neuron-specific enolase, and glial fibrillary acidic protein were measured at multiple time points. Animals were additionally observed daily for cognition and motor coordination via novel object recognition and rotarod. Brain sections were stained and evaluated for neuronal injury at post-TBI Day 5.

RESULTS

The RIC animals had a significantly higher recognition index than did sham at 24, 48, and 72 hours after intervention. Rotarod latency was higher in the RIC animals compared to the sham animals at all-time points, and statistically significant at 120 hours after intervention. The RIC group demonstrated preserved cognitive function and motor coordination compared to the sham. On hematoxylin and eosin and immunohistochemical staining of brain sections, there was less area of neuronal degeneration and astrocytosis, respectively, in the RIC group compared to the sham group. There was no significant difference in systemic neuronal markers between the RIC and sham animals.

CONCLUSION

Remote ischemic conditioning 2 hours after injury preserved cognitive functions and motor coordination in a mouse model of TBI. Remote ischemic conditioning can preserve viability of neurons and astrocytes after TBI and has potential as a clinically noninvasive and relatively easy method to improve outcome after TBI.

LEVEL OF EVIDENCE

Therapeutic studies, randomized controlled trial, level I.
Hydrogen behaviour at twist {110} grain boundaries in
α
-Fe
Authors: McEniry Eunan J. , Hickel Tilmann , Neugebauer Jörg
Published: June 2017

The behaviour of hydrogen at structural defects such as grain boundaries plays a critical role in the phenomenon of hydrogen embrittlement. However, characterization of the energetics and diffusion of hydrogen in the vicinity of such extended defects using conventional
ab initio
techniques is challenging due to the relatively large system sizes required when dealing with realistic grain boundary geometries. In order to be able to access the required system sizes, as well as high-throughput testing of a large number of configurations, while remaining within a quantum-mechanical framework, an environmental tight-binding model for the iron–hydrogen system has been developed. The resulting model is applied to study the behaviour of hydrogen at a class of low-energy {110}-terminated twist grain boundaries in
α
-Fe. We find that, for particular Σ values within the coincidence site lattice description, the atomic geometry at the interface plane provides extremely favourable trap sites for H, which also possess high escape barriers for diffusion. By contrast, via simulated tensile testing, weakly trapped hydrogen at the interface plane of the bulk-like Σ3 boundary acts as a ‘glue’ for the boundary, increasing both the energetic barrier and the elongation to rupture.

This article is part of the themed issue ‘The challenges of hydrogen and metals’.
Lattice discontinuities affecting the generation and annihilation of diffusible hydrogen and vice versa
Authors: Kirchheim Reiner
Published: June 2017

Lattice discontinuities include lattice defects and surfaces both providing traps for hydrogen atoms. It will be discussed under which conditions discontinuities of a given distribution either release trapped hydrogen to become diffusible or capture diffusible H-atoms to become trapped. It will be shown that for any distribution, the self-diffusion coefficient of hydrogen is determined by the product of the H-diffusion in the perfect lattice times the fraction of hydrogen being diffusible. In this context, the quantities diffusible hydrogen, lattice hydrogen, thermodynamic activity of hydrogen and chemical potential of hydrogen are interchangeable in a general way. New discontinuities are generated during hydrogen embritllement (fracture surfaces, voids, dislocations) and dislocations move by kink pair formation. The production rate of these discontinuities depends on the chemical potential of hydrogen within the defactant concept or the generalized Gibbs adsorption isotherm. Thus, the chemical potential of hydrogen determines both the amount of trapping and the defect generation rate. For a crack propagating by dislocations generation, the chemical potential affects its velocity independent of the accompanying concentration enhancement in front of the crack tip or the related adsorption on the freshly generated crack surface.

This article is part of the themed issue ‘The challenges of hydrogen and metals’.
Hydrogen enhanced cracking studies on Fe–3wt%Si single and bi-crystal microcantilevers
Authors: Hajilou T. , Deng Y. , Kheradmand N. , Barnoush A.
Published: June 2017

Hydrogen (H) enhanced cracking was studied in Fe–3wt%Si by means of
in situ
electrochemical microcantilever bending test. It was clearly shown that the presence of H causes hydrogen embrittlement (HE) by triggering crack initiation and propagation at the notch where stress concentration is existing. Additionally, the effect of carbon content and the presence of a grain boundary (GB) in the cantilever were studied. It was shown that in the presence of H the effect of carbon atom on pinning the dislocations is reduced. On the other hand, the presence of a GB, while the chemical composition of material kept constant, will promote the HE. Crack initiation and propagation occur in the presence of H, while the notch blunting was observed for both single and bi-crystalline beams bent in air. Post-mortem analysis of the crack propagation path showed that a transition from transgranular fracture to intragranular fracture mechanism is highly dependent on the position of the stress concentration relative to the GB.

This article is part of the themed issue ‘The challenges of hydrogen and metals’.