bluuebunny/crossref_metadata_2025 huggingface dataset:
Childhood diabetes in Africa
Authors: Piloya-Were Thereza , Sunni Muna , Ogle Graham D. , Moran Antoinette
Published: May 2016

Purpose of review

This review summarizes the current state of diabetes in African children.

Recent findings

Type 1 diabetes is the most common form of pediatric diabetes in Africa. Significant improvements have been achieved over the last 6 years, including the training of more than 60 pediatric endocrinologists who are now practicing in 14 African nations, greater training of other healthcare providers, increased availability of insulin through the efforts of philanthropic organizations and industry, modestly better availability of testing supplies, and the introduction of patient education materials in native languages. However, there is still a long way to go before the standard-of-care available to children in resource-rich nations is available to children with diabetes in Africa.

Here, we review the known epidemiology, pathophysiology, complications, and treatment of diabetes in children in Africa.
The Impact of Integrated Case Management on Health Services Use and Spending Among Nonelderly Adult Medicaid Enrollees
Authors: Sabik Lindsay M. , Bazzoli Gloria J. , Carcaise-Edinboro Patricia , Chandan Priya , Harpe Spencer E.
Published: May 2016

Background:

Medicaid plans, whose patients often have complex medical, social, and behavioral needs, seek tools to effectively manage enrollees and improve access to quality care while containing costs.

Objectives:

The aim of this study is to examine the effects of an integrated case management (ICM) program operated by a Medicaid managed care plan on health service use and spending for nonelderly, nonpregnant adults.

Research Design:

We estimate the relationship between intensity of ICM program involvement and changes in utilization and spending for patients who participated in ICM. We examine whether effects differ between high-risk and lower-risk individuals and between the early and late stages of the program, given that the latter relied on more targeted and patient-centered approaches. Specifically, we estimate linear regressions modeling changes in utilization and spending outcomes as a function of number of program contacts, conditional on number of days over which contacts occurred, as well as individual-level covariates and case manager fixed effects.

Results:

In the late ICM program period, we observe significant decreases in outpatient utilization associated with program involvement intensity among high-risk ICM participants. We also observe decreases in spending associated with program involvement intensity among the lower-risk group in the late period, although there is no significant impact on spending among high-risk enrollees.

Conclusions:

ICM can be a successful strategy for impacting health services use and spending. Our findings suggest that careful program targeting, well-structured client engagement, and direct one-on-one contact are vitally important for achieving program objectives.
Dental Care in an Equal Access System Valuing Equity
Authors: Boehmer Ulrike , Glickman Mark , Jones Judith A. , Orner Michelle B. , Wheler Carolyn , Berlowitz Dan R. , Kressin Nancy R.
Published: May 2016

Background:

Racial disparities in dental care have previously been shown in the Veterans Health Administration (VA)—a controlled access setting valuing equitable, high-quality care.

Objectives:

The aim of this study is to examine current disparities in dental care by focusing on the receipt of root canal therapy (RCT) versus tooth extraction.

Research Design:

This is a retrospective analysis of data contained in the VA’s electronic health records. We performed logistic regressions on the independent measures along with a facility-specific random effect, using dependent binary variables that distinguished RCT from tooth extraction procedures.

Subjects:

VA outpatients who had at least 1 tooth extraction or RCT visit in the VA in fiscal year 2011.

Measures:

A dependent binary measure of tooth extraction or RCT. Other measures are medical record data on medical comorbidities, dental morbidity, prior dental utilization, and demographic characteristics.

Results:

The overall rate of preferred tooth-preserving RCT was 18.1% during the study period. Black and Asian patients were most dissimilar with respect to dental morbidity, medical and psychological disorders, and black patients had the least amount of eligibility for comprehensive dental care. After adjustment for known confounding factors of RCT, black patients had the lowest RCT rates, whereas Asians had the highest.

Conclusions:

Current quality improvement efforts and a value to improve the equity of care are not sufficient to address racial/ethnic disparities in VA dental care; rather more targeted efforts will be needed to achieve equity for all.
Unnecessary Emergency Transfers for Evaluation by a Plastic Surgeon: A Burden to Patients and the Health Care System
Authors: Drolet Brian C. , Tandon Vickram J. , Ha Austin Y. , Guo Yifan , Phillips Benjamin Z. , Akelman Edward , Schmidt Scott T.
Published: May 2016

Background:

Plastic surgeons are frequently consulted for hand and facial injuries, and patients are often transferred to trauma centers for evaluation of these problems. The authors sought to identify the frequency and impact of “unnecessary” transfers for emergency evaluation by a plastic surgeon at a Level I trauma center.

Methods:

The authors reviewed more than 32,000 consecutive emergency department encounters at their institution between April of 2009 and April of 2013 and found 1181 patients transferred for evaluation by plastic surgery. Using a retrospective chart review, necessity of transfer was determined based on the intervention performed at the authors’ institution and the availability of resources at the transferring site.

Results:

Of all the patients referred for “emergency” evaluation, 860 (74.1 percent) were unnecessary. Transfers for hand-related issues were more likely to be coded as unnecessary compared with referrals for facial trauma and infection (76 percent versus 66 percent; p < 0.001). The average time from referral to discharge from the emergency department was 412 minutes. The expense for these unnecessary transfers exceeded $4.6 million.

Conclusions:

This is the first intervention-based study evaluating the impact of unnecessary transfer for evaluation of hand and facial emergencies. Using a framework based on objective outcomes, the authors found that fewer than one-third of patients required emergent transfer for evaluation by a plastic surgeon, and almost half did not receive an intervention following transfer. Based on patient time and financial expenses for these unnecessary evaluations, improvements could be made in both quality and cost of care by limiting inappropriate emergency department referrals.
Surgical Management of Polyostotic Craniofacial Fibrous Dysplasia: Long-Term Outcomes and Predictors for Postoperative Regrowth
Authors: Boyce Alison M. , Burke Andrea , Cutler Peck Carolee , DuFresne Craig R. , Lee Janice S. , Collins Michael T.
Published: May 2016

Background:

The mainstay of treatment for craniofacial fibrous dysplasia is surgical; however, optimal indications and techniques are poorly understood, particularly in polyostotic disease and McCune-Albright syndrome. This study investigated surgical indications and risk factors for recurrence in a large cohort.

Methods:

One hundred thirty-three craniofacial fibrous dysplasia subjects in a natural history study were evaluated. Radiographic studies, operative reports, and clinical records were reviewed.

Results:

Thirty-six subjects underwent 103 craniofacial procedures (mean, 2.8 operations per subject), with 13.5 ± 10.5-year follow-up (range, 0 to 39 years). The most common indication was craniofacial deformity (n = 61 operations), including 36 initial operations (59 percent) and 26 reoperations (41 percent). Mean time to reoperation was 3.4 ± 3.2 years (range, 0.3 to 13.3 years). Regrowth occurred after 42 operations (68 percent), and was more frequent after operations in subjects with McCune-Albright syndrome growth hormone excess [22 of 25 operations (88 percent)] than without growth hormone excess [15 of 36 operations (58 percent); p = 0.02]. Of 11 subjects with growth hormone excess, nine (82 percent) were undiagnosed at the time of their initial operation. Regrowth was more frequent after debulking procedures [31 of 38 (82 percent)] than after more aggressive reconstructions [nine of 20 (45 percent); p = 0.007]. Eleven subjects underwent treatment for aneurysmal bone cysts, with recurrence in one subject. Eleven subjects underwent biopsies and none had complications or regrowth.

Conclusions:

Craniofacial fibrous dysplasia regrowth and reoperation are common, particularly after debulking procedures. Outcomes are favorable for aneurysmal bone cysts and biopsies. McCune-Albright syndrome growth hormone excess is a risk factor for regrowth, and may be underdiagnosed in surgical patients. Surgeons should be aware of appropriate screening for endocrinopathies in fibrous dysplasia. These findings highlight the importance of a multidisciplinary approach to craniofacial fibrous dysplasia, and individualized care with long-term follow-up.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Simultaneous Scalp, Skull, Kidney, and Pancreas Transplant from a Single Donor
Authors: Selber Jesse C. , Chang Edward I. , Clemens Mark W. , Gaber Lilian , Hanasono Matthew M. , Klebuc Michael , Skoracki Roman J. , Trask Todd , Yu Peirong , Gaber A. Osama
Published: May 2016

Background:

Vascularized composite allotransplantation is an emerging field, but the complications of lifelong immunosuppression limit indications. Vascularized composite allotransplantation in solid organ recipients represents a unique opportunity because immunosuppression has already been accepted. This report of a simultaneous scalp, skull, kidney, and pancreas transplant represents both the first skull-scalp transplant and combination of a vascularized composite allotransplantation with double organ transplantation.

Methods:

A previous recipient of a kidney-pancreas transplant presented with osteoradionecrosis of the calvaria and a large area of unstable scalp following successful, curative treatment of a scalp tumor. His kidney and pancreas functions were also critically poor. A multidisciplinary, multi-institutional plan was developed to perform a simultaneous scalp, skull, and repeated kidney and pancreas transplantation, all from a single donor.

Results:

Eighteen months after the patient was listed with the United Network for Organ Sharing, a donor was identified and the multiorgan vascularized composite allotransplantation was performed. Twenty physicians and 15 hours were required to perform donor and recipient procedures. The patient recovered well and was discharged on postoperative day 15. He has had one episode of scalp rejection confirmed by biopsy and treated successfully. His creatinine value is currently 0.8 mg/dl, from 5.0 mg/dl, and his blood glucose levels are normal without supplemental insulin. Aesthetic outcome is very satisfactory. The patient is now 1 year post-transplantation and doing well.

Conclusions:

Vascularized composite allotransplantation in solid organ recipients is an expansion of current indications to already immunosuppressed patients. Rejection of the vascularized composite allotransplant without solid organ rejection can occur and is treatable. Methodical planning, an interdisciplinary approach, and careful management of all organs are critical to success.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Breast Cancer–Related Lymphedema: Quality of Life after Lymph Node Transfer
Authors: De Brucker Ben , Zeltzer Assaf , Seidenstuecker Katrin , Hendrickx Benoit , Adriaenssens Nele , Hamdi Moustapha
Published: May 2016

Background:

Breast cancer–related lymphedema affects multiple aspects of patients’ daily lives. The main aim of this study was to assess the impact of vascularized lymph node transfer on the quality of life in patients with lymphedema.

Methods:

Between 2007 and 2012, 25 female patients with breast cancer–related lymphedema underwent vascularized lymph node transfer. In 22 cases, the patients underwent a simultaneous deep inferior epigastric artery perforator flap breast reconstruction based on the superficial circumflex iliac artery. The influence on quality of life was evaluated using the Upper Limb Lymphedema-27 questionnaire, which includes physical, psychological, and social dimensions. The authors also investigated risk factors for lymphedema, such as body mass index, smoking, age, and time between start of lymphedema and vascularized lymph node transfer, and their impact on quality of life.

Results:

Twenty-one patients (84 percent) had an improvement of quality of life after vascularized lymph node transfer. The mean physical, psychological, and social scores were significantly improved postoperatively (p < 0.001). Risk factors for the development of lymphedema did not influence quality of life among patients with breast cancer–related lymphedema. Skin infections disappeared in 50 percent of the cases. Eleven patients (44 percent) discontinued compression therapy at a mean postoperative time interval of 29 months (range, 8 to 64 months). In the other patients (56 percent), the average frequency of compression therapy decreased from three sessions to one session per week.

Conclusion:

Vascularized lymph node transfer significantly improves quality of life among patients with breast cancer–related lymphedema.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Revisions in Implant-Based Breast Reconstruction: How Does Direct-to-Implant Measure Up?
Authors: Clarke-Pearson Emily M. , Lin Alex M. , Hertl Catherine , Austen William G. , Colwell Amy S.
Published: May 2016

Background:

Immediate direct-to-implant breast reconstruction is increasingly performed for breast cancer treatment or prevention. The advantage over traditional tissue expander/implant reconstruction includes the potential for fewer surgical procedures.

Methods:

Retrospective, single-institution, three-surgeon review identified patients undergoing implant-based reconstruction from 2006 to 2011.

Results:

Six hundred eighty-two reconstructions were performed in 432 women with an average follow-up of 5 years. Four hundred sixty-five were direct-to-implant reconstructions with acellular dermal matrix while 217 were tissue expander/implant reconstructions without acellular dermal matrix. The overall revision rate in direct-to-implant reconstruction was 20.9 percent. There was no difference in total revision rates between direct-to-implant and tissue expander reconstruction (20.9 percent versus 20.3 percent; p = 0.861). Subgroup analysis showed no difference in revision for malposition (3.4 percent versus 5.5 percent; p = 0.200), size change (6.7 percent versus 5.5 percent; p = 0.569), fat grafting (8.6 percent versus 9.7 percent; p = 0.647), or capsular contracture (4.5 percent versus 3.2 percent; p = 0.429). Multivariable logistic regression analysis showed complications were associated with higher rates of revision for malposition or size in both groups (OR, 2.8; 95 percent CI, 1.56 to 5.13; p = 0.001). Smoking, preoperative irradiation, skin necrosis, and one surgeon were associated with higher rates of fat grafting, whereas increasing body mass index was associated with lower rates. Postoperative radiotherapy and hematoma were predictive of revision for capsular contracture.

Conclusions:

The 5-year revision rate in this series of direct-to-implant reconstruction was approximately 21 percent and similar to the revision rate in tissue expander/implant reconstruction. Surgical complications, radiotherapy, and the surgeon influenced the rate of revision similarly in both groups.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Application of Computed Tomography Angiography Mapping and Located Template for Accurate Location of Perforator in Head and Neck Reconstruction with Anterolateral Thigh Perforator Flap
Authors: Shen Yi , Huang Jian , Dong Min-jun , Li Jun , Ye Wei-min , Sun Jian
Published: May 2016

Background:

The authors introduce a new method of preoperative computed tomography angiography mapping and virtual and printed located template for accurate location of perforators in the anterolateral thigh perforator flap for head and neck reconstruction.

Methods:

Between April and December of 2014, a cohort study was performed with 29 patients who underwent head and neck reconstruction with anterolateral thigh perforator flaps. Computed tomography angiography images were processed for maximum intensity projection and volume rendering to obtain and evaluate the perforator information. The virtual and printed templates with grid were used to transfer the perforator information for intraoperative guidance during flap harvest. The preoperative angiography results were compared with the high-frequency color Doppler results and with the intraoperative real-time findings to evaluate the accuracy of computed tomography angiography mapping.

Results:

The source vessel, origin, location, direction, number, and caliber of the perforators were determined by preoperative computed tomography angiography mapping. All of the perforator data were accurately mapped on a virtual template and printed on the located template to guide flap harvest. The flap was actually used and survived successfully in 20 patients. The results for perforators identified by mapping were more accurate than those for perforators identified by Doppler. There was no significant difference between the preoperative computed tomography angiography results and the intraoperative findings (p > 0.05).

Conclusions:

The role of preoperative computed tomography angiography mapping in guiding anterolateral thigh perforator flap harvest and reducing the unpredictable risk of surgery is acceptable. Located virtual and printed template with grid can transform preoperative computed tomography angiography information to the intraoperative setting accurately and easily.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, II.
Management of the Salivary Glands and Facial Nerve in Face Transplantation
Authors: Frautschi Russell , Rampazzo Antonio , Bernard Steven , Djohan Risal , Papay Francis , Gharb Bahar Bassiri
Published: May 2016

Background:

Since the first face transplant in 2005, 35 cases have been performed worldwide with acceptable graft survival and satisfactory return of function and appearance. With increasing experience, it is emerging that the salivary glands can contribute to the challenges encountered in the perioperative period.

Methods:

A comprehensive review of the literature regarding management of the salivary glands and facial nerve in facial transplantation was performed. Data gathered included inclusion or exclusion of submandibular and parotid glands in the recipient and allograft, extent of mucosal inclusion in the allograft, salivary complications and treatment, level and method of facial nerve repair, and motor nerve outcomes.

Results:

Information on salivary gland management was available for 25 cases. Undesirable salivary events were documented in 12 cases (48 percent). The source of complications was the parotid in five cases (42 percent), a combination of the parotid and submandibular glands in three cases (25 percent), and minor salivary glands in four cases (33 percent). Postoperative botulinum toxin injections resolved salivary collections in four cases. Facial nerve continuity was restored at the level of the trunk/primary divisions (66 percent) or the terminal branches (34 percent), with inclusion of the whole parotid dictating a trunk repair and exclusion of the parotid dictating a terminal branch repair.

Conclusions:

The salivary glands warrant increased attention in surgical planning and postoperative care. Exclusion of the salivary glands from the facial allograft with repair of the terminal branches of the facial nerve appears to be preferable. Botulinum toxin should be considered for prophylaxis and treatment of salivary collections.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Modified Furlow Palatoplasty Using Small Double-Opposing Z-Plasty: Surgical Technique and Outcome
Authors: Yamaguchi Kazuaki , Lonic Daniel , Lee Che-Hsiung , Yun Claudia , Lo Lun-Jou
Published: May 2016

Background:

A smaller Z-plasty is applied in a modified Furlow palatoplasty. The purpose of this study was to assess its surgical and functional outcome.

Methods:

The surgical technique included mucoperiosteal flap elevation in the hard palate, complete pedicle dissection and release, double-opposing Z-plasty using 5-mm limbs and muscle dissection in the soft palate, and the buccal fat pad covering lateral relaxing wounds. A retrospective chart review was conducted for 231 consecutive nonsyndromic patients undergoing modified palatoplasty from May of 2007 to December of 2014. The demographic, postoperative, and follow-up data were collected. Statistical analyses were performed.

Results:

Average age at palatoplasty was 8.3 months. The overall oronasal fistula rate was 0.4 percent; oronasal fistula occurred in only one case with bilateral cleft. Other complications included postoperative bleeding in two cases (0.8 percent), postoperative airway obstruction in one case (0.4 percent), obstructive sleep apnea in one case (0.4 percent), stitch abscess in one case (0.4 percent), and distal uvula dehiscence in two cases (0.8 percent). One hundred twenty-seven patients had full speech evaluation, and seven (5.5 percent) were diagnosed with velopharyngeal insufficiency requiring surgical correction.

Conclusion:

This modified palatoplasty using a small double-opposing Z-plasty provided adequate cleft palate closure, with a low fistula rate and satisfactory speech outcome.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
The Effects of Mucoperichondrial Flap Elevation on Septal L-Strut Cartilage: A Biomechanical and Histologic Analysis in a Rabbit Model
Authors: Basaran Karaca , Basat Salih Onur , Ozel Asuman , Yazar Memet , Bozdag Ergun , Tuna Meral , Sar Mehmet , Pilanci Ozgur
Published: May 2016

Background:

The harvesting of septal cartilage following mucoperichondrial flap elevation has almost become a standard step in rhinoplasty. However, the strength of the remaining septum has not yet been evaluated. In the current experimental study of a rabbit rhinoplasty model, the remaining septum following a graft harvest was analyzed both biomechanically and pathologically.

Methods:

Forty New Zealand rabbits were classified into four equal groups. Group 1 consisted of the animals in which unilateral elevation of the mucoperichondrial flaps was undertaken before the graft harvest, group 2 consisted of the animals in which bilateral elevation was undertaken, group 3 included the animals where the septum was exposed and left untouched after a bilateral mucosal flap elevation, and group 4 was designated as the control group. Specimens were analyzed under light microscopy for multiple parameters. Biomechanical analyses were performed with a universal testing device at the Department of Engineering, Biomechanical Laboratories, Istanbul Technical University.

Results:

Biomechanical analysis in terms of maximum tension revealed significant results among the groups (p = 0.008). Although insignificant results were observed overall using a pathologic analysis, the amount of chondrocytes was lower in group 2 than in group 1 (p = 0.099). The amounts of matrix collagen (p = 0.184) and fibrosis were (p = 0.749) higher in group 2 than in group 1.

Conclusions:

From these data, the authors conclude that mucoperichondrium integrity plays a crucial role in the biomechanical strength of the septum. More sophisticated studies with further pathologic analysis are required to determine the exact mechanism of strength loss observed with mucoperichondrial flap elevation.
Chikungunya Virus Disease
Authors: Vijayan Vini , Sukumaran Sukesh
Published: May 2016

Chikungunya is caused by an alphavirus that is transmitted to humans via the Aedes species mosquito. Chikungunya is endemic to tropical Africa and South and Southeast Asia, but over the past decade, the geographic distribution of the virus has been expanding rapidly. The disease is characterized by fever and severe polyarthritis, and although symptoms typically resolve within 7 to 10 days, some patients experience persistent arthritis and arthralgias for months to years.

In December 2013, the first local transmission of chikungunya virus in the Americas was identified in the Caribbean Island of Saint Martin. Since then, the number of afflicted individuals has spread throughout the Caribbean and Central America, as well as into South America. The United States reported 2788 chikungunya virus disease cases among travelers returning from affected areas in 2014. In addition, 11 locally acquired cases were reported in Florida. Further spread and establishment of the disease in the Americas are likely considering the high levels of viremia in infected individuals, widespread distribution of effective vectors, lack of immunity among people living in the Americas, and the popularity of international travel.

Considering the prominent rheumatic manifestations of chikungunya, rheumatologists are likely to encounter patients with the disease in their practice. We recommend that rheumatologists consider chikungunya in their differential diagnosis when evaluating patients presenting with fever and joint pain following travel to a chikungunya endemic area. Early diagnosis would ensure timely management and reduction of polypharmacy and its associated complications. In this article, we briefly describe the epidemiology of chikungunya, the clinical features, laboratory testing, prevention, and treatment of disease.
Does a Simplified 6-Joint Ultrasound Index Correlate Well Enough With the 28-Joint Disease Activity Score to Be Used in Clinical Practice?
Authors: Rosa Javier , Ruta Santiago , Saucedo Carla , Navarta David A. , Catoggio Luis J. , García-Mónaco Ricardo , Soriano Enrique R.
Published: May 2016

Objective

Ultrasound (US) has become an important tool in the management of rheumatoid arthritis (RA) but it is time consuming in clinical practice. We compared 3 US indices (with different numbers of joints) with disease activity measured by the 28-Joint Disease Activity Score (DAS28) in order to find the most parsimonious index still useful in clinical practice.

Methods

Sixty consecutive RA patients were included. The DAS28 score was calculated by the attending rheumatologist, and later in the day, they underwent US examination by another rheumatologist trained in US (bilateral gray-scale and power Doppler examination of the wrist and metacarpophalangeal and proximal interphalangeal joints). Three different US indices were constructed: index A (22 joints), index B (10 joints), and index C (6 joints).

Results

All 3 US indices were significantly higher in patients with active disease versus inactive disease (P < 0.05 for all 3). Ultrasound index C showed the best correlation with DAS28 (rho = 0.5020, P < 0.0001) and a very good discriminative value for moderate to high disease activity (DAS28 >3.2) and for absence of remission (DAS28 >2.6) (areas under receiver operating characteristic curve = 0.75 and 0.80, respectively). A cutoff value of 3 in US index C showed sensitivity of 88.89% and specificity of 66.67% for absence of remission. Correlation between the 3 US indices was excellent.

Conclusions

A US index of 6 joints (both wrists and second and third metacarpophalangeal joints bilaterally) correlated well with disease activity measured by DAS28 and may be used to evaluate RA patients in daily practice.
Joint Hypermobility and Joint Range of Motion in Young Dancers
Authors: Steinberg Nili , Hershkovitz Israel , Zeev Aviva , Rothschild Bruce , Siev-Ner Itzhak
Published: May 2016

Background

Joint range of motion (ROM) refers to the extent of movement of the joint, recorded using standard goniometers. Joint hypermobility (JHM) is a condition in which most of the synovial joints move beyond the “normal” limits. Joint hypermobility is recognized as a feature of heritable disorders of the connective tissue and can be identified mostly by the Beighton scale. Data on the possible relationship between JHM and joint ROM are lacking in the literature. The main objective of the present study was to evaluate the relationship between JHM and joint ROM in the different lower-extremity joints in young dancers.

Methods

Joint hypermobility and ROM were assessed among 240 female dancers, aged 8 to 16 years, and 226 nondancers of similar age.

Results

The prevalence of JHM is significantly higher among dancers compared with the control subjects (P < 0.001). Joints’ ROM is higher among dancers with JHM compared with dancers without JHM (P < 0.05). This phenomenon, however, is age dependent; as in young dancers (aged 8–10 years), this pertains only to the ankle dorsiflexion ROM. In adolescent dancers (aged 11–13 years), this relationship has been observed in most joints: ankle/foot en pointe, ankle dorsiflexion, hip external rotation, hip abduction, and hip extension. In mature dancers (aged 14–16 years), dancers with JHM had greater ROM in ankle/foot en pointe, hip abduction, and knee flexion (P < 0.05).

Conclusions

(1) Joint ROM and JHM are associated one with the other; (2) the relationship between joint ROM and JHM is age dependent; and (3) JHM is common among young nonprofessional dancers compared with control subjects. The main clinical implications of the current study are to try and reduce the risk of injuries among JHM dancers by developing proprioceptive trainings to improve the correct alignment of the hyperextended joints, to increase their muscle strength for better stabilization of the hypermobile joints, and to provide them additional balancing and stabilizing exercises for their supporting muscles.
Anti-Angiotensin II Type 1 Receptor and Anti-Endothelial Cell Antibodies: A Cross-Sectional Analysis of Pathological Findings in Allograft Biopsies
Authors: Philogene Mary Carmelle , Bagnasco Serena , Kraus Edward S. , Montgomery Robert A. , Dragun Duska , Leffell Mary S. , Zachary Andrea A. , Jackson Annette M.
Published: May 2016

Background

This is a cross-sectional study designed to evaluate the histologic characteristics of graft injury in the presence of anti-angiotensin II type 1 receptor antibody (AT1R-Ab) and anti-endothelial cell antibody (AECA).

Methods

Non-HLA antibody testing was included in the posttransplant evaluation for 70 kidney recipients. Biopsies were performed for cause for 47 patients and as protocol for the remaining 23 patients. Biopsy-proven rejection was defined according to the Banff 2009-2013 criteria. AT1R-Ab was measured on an ELISA platform. Patients were divided into 3 groups based on AT1R-Ab levels (>17, 10-17, and <10 U/ml). AECA was evaluated using an endothelial cell crossmatch (ECXM) in patients whose HLA antibody level was insufficient to cause a positive flow cytometric crossmatch.

Results

AT1R-Ab levels were higher in patients diagnosed with antibody mediated rejection compared to those with no rejection (P = 0.004). Glomerulitis (g) and peritubular capillaritis (ptc) scores were independently correlated with increased AT1R-Ab concentrations in the presence or absence of HLA-DSA (P = 0.007 and 0.03 for g scores; p = 0.005 and 0.03 for ptc scores). Patients with a positive ECXM had higher AT1R-Ab levels compared to those with a negative ECXM (P = 0.005). Microcirculation inflammation (MCI = g + ptc score) was higher in patients with a positive ECXM and with AT1R-Ab >17 U/ml, although this did not reach statistical significance (P = 0.07).

Conclusions

The data show an association between non-HLA antibodies detected in the ECXM and AT1R ELISA and microvascular injury observed in antibody mediated rejection.
The Prevalence of Electroconvulsive Therapy Use Since 1973
Authors: Lesage Alain , Lemasson Morgane , Medina Karen , Tsopmo Jackson , Sebti Nedjma , Potvin Stephane , Patry Simon
Published: May 2016

Objectives

A formal meta-analysis of the use of electroconvulsive therapy (ECT) has never been conducted before in literature reviews or syntheses. Such a study would be hampered by heterogeneity and potential reporting biases. However, it would provide a single comparable measure to allow an analysis of statistical key dimensions such as trends across time and psychiatric resources available. It would also help planners and decision makers to set standards and benchmarks for national and regional guidelines for quality assurance and research in health services.

Methods

We surveyed different databases for relevant studies, limited from 1973 to October 2013. Data were extracted independently by 4 reviewers. The articles retrieved were peerreviewed studies (data-based studies or surveys) presenting ECT population rates (annual patient rates calculated from the general population) or number of patients receiving ECT during or after 1973 and attending a psychiatric establishment (either hospitals or approved ECT delivery centers for inpatients and outpatients in well-defined geographic areas).

Results

This meta-analysis includes a total of 18 studies from 12 countries. A composite event rate of 16.9/100,000 inhabitants emerged, characterized by high heterogeneity. Across the countries assessed, the prevalence of ECT was higher in older studies.

Conclusions

By its prevalence, ECT remains rare to exceptional as a specialist treatment for mental disorders. Heterogeneity across regions or countries could best be explained by insufficient standardization of ECT procedures and practices. Linked health databases and audits could help strengthen the effectiveness of ECT in relation to primary outcomes such as suicide and help determine the gap in ECT provision, if any.
Disentangling endogenous versus exogenous pattern formation in spatial ecology: a case study of the ant
Azteca sericeasur
in southern Mexico
Authors: Li Kevin , Vandermeer John H. , Perfecto Ivette
Published: May 2016

Spatial patterns in ecology can be described as reflective of environmental heterogeneity (exogenous), or emergent from dynamic relationships between interacting species (endogenous), but few empirical studies focus on the combination. The spatial distribution of the nests of
Azteca sericeasur
, a keystone tropical arboreal ant, is thought to form endogenous spatial patterns among the shade trees of a coffee plantation through self-regulating interactions with controlling agents (i.e. natural enemies). Using inhomogeneous point process models, we found evidence for both types of processes in the spatial distribution of
A. sericeasur
. Each year's nest distribution was determined mainly by a density-dependent relationship with the previous year's lagged nest density; but using a novel application of a Thomas cluster process to account for the effects of nest clustering, we found that nest distribution also correlated significantly with tree density in the later years of the study. This coincided with the initiation of agricultural intensification and tree felling on the coffee farm. The emergence of this significant exogenous effect, along with the changing character of the density-dependent effect of lagged nest density, provides clues to the mechanism behind a unique phenomenon observed in the plot, that of an increase in nest population despite resource limitation in nest sites. Our results have implications in coffee agroecological management, as this system provides important biocontrol ecosystem services. Further research is needed, however, to understand the effective scales at which these relationships occur.
RETRACTED: Reef fishes can recognize bleached habitat during settlement: sea anemone bleaching alters anemonefish host selection
Authors: Scott Anna , Dixson Danielle L.
Published: May 2016

Understanding how bleaching impacts the settlement of symbiotic habitat specialists and whether there is flexibility in settlement choices with regard to habitat quality is essential given our changing climate. We used five anemonefishes (
Amphiprion clarkii
,
Amphiprion latezonatus
,
Amphiprion ocellaris
,
Amphiprion percula
and
Premnas biaculeatus
) and three host sea anemones (
Entacmaea quadricolor
,
Heteractis crispa
and
Heteractis magnifica
) in paired-choice flume experiments to determine whether habitat naive juveniles have the olfactory capabilities to distinguish between unbleached and bleached hosts, and how this may affect settlement decisions. All anemonefishes were able to distinguish between bleached and unbleached hosts, and responded only to chemical cues from species-specific host anemones irrespective of health status, indicating a lack of flexibility in host use. While bleached hosts were selected as habitat, this occurred only when unbleached options were unavailable, with the exception of
A. latezonatus
, which showed strong preferences for
H. crispa
regardless of health. This study highlights the potential deleterious indirect impacts of declining habitat quality during larval settlement in habitat specialists, which could be important in the field, given that bleaching events are becoming increasingly common.
Australian spiny mountain crayfish and their temnocephalan ectosymbionts: an ancient association on the edge of coextinction?
Authors: Hoyal Cuthill Jennifer F. , Sewell Kim B. , Cannon Lester R. G. , Charleston Michael A. , Lawler Susan , Littlewood D. Timothy J. , Olson Peter D. , Blair David
Published: May 2016

Australian spiny mountain crayfish (
Euastacu
s, Parastacidae) and their ecotosymbiotic temnocephalan flatworms (Temnocephalida, Platyhelminthes) may have co-occurred and interacted through deep time, during a period of major environmental change. Therefore, reconstructing the history of their association is of evolutionary, ecological, and conservation significance. Here, time-calibrated Bayesian phylogenies of
Euastacus
species and their temnocephalans (
Temnohaswellia
and
Temnosewellia
) indicate near-synchronous diversifications from the Cretaceous. Statistically significant cophylogeny correlations between associated clades suggest linked evolutionary histories. However, there is a stronger signal of codivergence and greater host specificity in
Temnosewellia
, which co-occurs with
Euastacus
across its range. Phylogeography and analyses of evolutionary distinctiveness (ED) suggest that regional differences in the impact of climate warming and drying had major effects both on crayfish and associated temnocephalans. In particular,
Euastacus
and
Temnosewellia
show strong latitudinal gradients in ED and, conversely, in geographical range size, with the most distinctive, northern lineages facing the greatest risk of extinction. Therefore, environmental change has, in some cases, strengthened ecological and evolutionary associations, leaving host-specific temnocephalans vulnerable to coextinction with endangered hosts. Consequently, the extinction of all
Euastacus
species currently endangered (75%) predicts coextinction of approximately 60% of the studied temnocephalans, with greatest loss of the most evolutionarily distinctive lineages.
Clostridium baratii: a rare case of pneumonia associated with an Alzheimer patient in Rio de Janeiro, Brazil
Authors: Lima Carla Ormundo Gonçalves Ximenes , da Rocha Vinicius Magno , Ferreira Eliane de Oliveira , Filho Joaquim Santos , Serradas Lucia Rodrigues , Silva Rodrigo Otávio Silveira , Lobato Francisco Carlos Faria , Domingues Regina Maria Cavalcanti Pilotto
Published: May 2016

Introduction:

Clostridium baratii is rarely associated with human diseases. Infection is usuallcaused by ingestion of contaminated food, and infant botulism is the most common clinical presentation.

Case Report:

Here we report a case of pneumonia by a non-toxigenic strain of C. baratii in an Alzheimer 70-year-old male with sepsis in Rio de Janeiro, Brazil. The micro-organism was identified by phenotypical tests, mass spectrometry (MALDI-TOF), DNA amplification (PCR) and sequencing of the 16S rRNA gene. Testing for the presence of botulinum F toxin was made using multiplex PCR. Bioassay for a large number of colonies was performed in mice to evaluate the production of any lethal toxin, but the results were negative.

Conclusion:

To our knowledge, there are no cases of C. baratii infection reported in Brazil and we highlight the importance of anaerobic lab tests in the standard routine of diagnosis.
Monomorphic genotypes within a generalist lineage ofCampylobacter jejunishow signs of global dispersion
Authors: Llarena Ann-Katrin , Zhang Ji , Minna Vehkala , Välimäki Niko , Hakkinen Marjaana , Hänninen Marja-Liisa , Roasto Mati , Mäesaar Mihkel , Taboada Eduardo , Barker Dillon , Garfolo Giuliano , Cammà Cesare , Di Giannatale Elisabetta , Corander Jukka , Rossi Mirko
Published: May 2016

The decreased costs of genome sequencing have increased capability to apply whole-genome sequence on epidemiological surveillance of zoonoticCampylobacter jejuni. However, knowledge about how genetically similar epidemiologically linked isolates can be is vital for correct application of this methodology. To address this issue inC. jejuniwe investigated the spatial and temporal signals in the genomes of a major clonal complex and generalist lineage, ST-45 CC, by exploiting the population structure and genealogy and applying genome-wide association analysis of 340 isolates from across Europe collected over a wide time-range. The occurrence and strength of the geographical signal varied between sublineages and followed the clonal frame when present, while no evidence of a temporal signal was found. Certain sublineages of ST-45 CC formed discrete and genetically isolated clades to which geography and time had left only negligible traces in the genomes. We hypothesize that these ST-45 CC clades form globally expanded monomorphic clones possibly spread across Europe by migratory birds. In addition, we observed an incongruence between the genealogy of the strains and MLST typing, thereby challenging the existing clonal complex definition and use of a common MLST-based nomenclature for the ST-45 CC ofC. jejuni.
Dissection of Major Depressive Disorder using polygenic risk scores for Schizophrenia in two independent cohort
Authors: Whalley HC , Adams MJ , Hall LS , Clarke T-K , Fernandez-Pujals AM , Gibson J , Wigmore E , Hafferty Jonathan , Hagenaars SP , Davies G , Campbell A , Hayward C , Lawrie SM , Porteous DJ , Deary IJ , McIntosh AM
Published: May 2016

Major depressive disorder (MDD) is known for its substantial clinical and suspected causal heterogeneity. It is characterised by low mood, psychomotor slowing, and increased levels of the personality trait neuroticism; factors which are also associated with schizophrenia (SCZ). It is possible that some cases of MDD may have a substantial genetic loading for SCZ. A sign of the presence of SCZ-like MDD sub-groups would be indicated by an interaction between MDD status and polygenic risk of SCZ on cognitive, personality and mood measures. In the current study, we hypothesised that higher SCZ-polygenic risk would define larger MDD case-control differences in cognitive ability, and smaller differences in distress and neuroticism. Polygenic risk scores (PGRS) for SCZ and their association with cognitive variables, neuroticism, mood, and psychological distress were estimated in a large population-based cohort (Generation Scotland: Scottish Family Health Study, GS:SFHS). Individuals were divided into those with, and without, depression (n=2587 & n=16,764 respectively) to test whether there was an interaction between MDD status and schizophrenia risk. Replication was sought in UK Biobank (n=33,525). In both GS:SFHS and UK Biobank we found significant interactions between SCZ-PGRS and MDD status for measures of psychological distress and neuroticism. In both cohorts there was a reduction of case-control differences on a background of higher genetic risk of SCZ. These findings suggest that depression on a background of high genetic risk for SCZ may show attenuated associations with distress and neuroticism. This may represent a causally distinct form of MDD more closely related to SCZ.
Activity flow over resting-state networks shapes cognitive task activations
Authors: Cole Michael W. , Ito Takuya , Bassett Danielle S. , Schultz Douglas H.
Published: May 2016

Resting-state functional connectivity (FC) has helped reveal the intrinsic network organization of the human brain, yet its relevance to cognitive task activations has been unclear. Uncertainty remains despite evidence that resting-state FC patterns are highly similar to cognitive task activation patterns. Identifying the distributed processes that shape localized cognitive task activations may help reveal why resting-stateFC is so strongly related to cognitive task activations. We found that estimating task-evoked activity flow (the spread of activation amplitudes) over resting-state FC networks allows prediction of cognitive task activations in a large-scale neural network model. Applying this insight to empirical functional MRI data, we found that cognitive task activations can be predicted in held-out brain regions (and held-out individuals via estimated activity flow over resting-state FC networks. This suggests that task-evoked activity flow over intrinsic networks is a large-scale mechanism explaining the relevance of resting-state FC to cognitive task activations.
Highly functionalized alkenes produced from base-free organocatalytic Wittig reactions: (E)-3-benzylidenepyrrolidine-2,5-dione, (E)-3-benzylidene-1-methylpyrrolidine-2,5-dione and (E)-3-benzylidene-1-tert-butylpyrrolidine-2,5-dione
Authors: Schirmer Marie-Luis , Spannenberg Anke , Werner Thomas
Published: May 2016

The Wittig reaction is a fundamental transformation for the preparation of alkenes from carbonyl compounds and phosphonium ylides. The ylides are prepared prior to the olefination step from the respective phosphonium salts by deprotonation utilizing strong bases. A first free-base catalytic Wittig reaction for the preparation of highly functionalized alkenes was based on tributylphosphane as the catalyst. Subsequently we developed a system employing a phospholene oxide as a pre-catalyst and trimethoxysilane as reducing agent which operates under milder conditions. The title compounds, (E)-3-benzylidenepyrrolidine-2,5-dione, C11H9NO2, (I), the methylpyrrolidine derivative, C12H11NO2, (II), and thetert-butylpyrrolidine derivative, C15H17NO2, (III), have been synthesized by base-free catalytic Wittig reactions. In the crystal of (I), molecules are linked into centrosymmetric dimersviapairs of N—H...O hydrogen bonds. Furthermore, in the crystal structure of (III), there are two molecules in the asymmetric unit, whereas in (I) and (II), only one molecule is present.