bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic value of the systematic immune-inflammation index among patients with operable colon cancer
Authors: Tao Ming-Yue , Wang Zhong-Hong , Zhang Meng-Hui , Ma Tian-Heng , Yang Xiao-Zhong , Wu Shang-Nong , Chen Xiao-Fei , Wang Hong-Gang
Published: November 2018

The systematic immune-inflammation index (SII) has been used to predict the prognosis of patients with various cancers. This study aimed to determine whether the preoperative SII was associated with postoperative survival among patients with operable colon cancer.

This retrospective study included 118 age- and sex-matched healthy subjects and 118 patients who underwent radical surgery for colon cancer between January 2011 and December 2013. The preoperative SII was calculated based on counts of neutrophils, lymphocytes, and platelets in the peripheral blood. Pearson correlation analysis was used to analyze the relationships between the SII and carcinoembryonic antigen (CEA) concentration, average length of stay (ALOS), and medical costs during hospitalization. The χ2 test or Fisher exact test was used to analyze the relationship between the preoperative SII and the postoperative survival rate.

The median SII value was 667.75 among patients with colon cancer, which was higher than the value among healthy subjects. A high SII (>667.75) was associated with a large tumor size and advanced TNM stage, although it was not associated with age, sex, tumor location, or pathological grade. Pearson correlation analysis revealed that the SII was positively correlated with serum CEA concentration, ALOS, and medical costs. Relative to a low SII, a high SII was significantly associated with a lower overall survival rate at 3 years and 5 years after surgery.

The present study's findings suggest that the preoperative SII is a useful prognostic index for patients with operative colon cancer.
An evidence-based approach to assess the accuracy of intravoxel incoherent motion imaging for the grading of brain tumors
Authors: Li Wen-fei , Niu Chen , Shakir Tahir Mehmood , Chen Tao , Zhang Ming , Wang Zhanqiu
Published: November 2018

Background:

Differentiation of high-grade gliomas (HGGs) and low-grade gliomas (LGGs) is an important clinical problem because treatment strategies vary greatly. This study was performed to investigate the potential diagnostic value of incoherent intravoxel motion imaging (IVIM) to distinguish HGG from LGG by meta-analysis.

Methods:

A computerized search of the literature was performed using the free-access PubMed database, Web of Science, and Chinese biomedical database, and relevant articles until September 18, 2018 that used IVIM to distinguish HGG from LGG were included. All analyses were performed using Review Manager 5.3 and Stata. Mean difference (MD) at 95% confidence interval (CI) of the apparent diffusion coefficient (ADC), diffusion coefficient value (D), perfusion fraction value (f), and perfusion coefficient value (D∗) were summarized.

Results:

Nine studies were used for general data pooling. In the tumor parenchyma (TP) regions, subgroup analysis revealed D∗ in HGG is higher than in LGG (MD = 1.19, P = .002), and D in HGG is lower than in LGG (MD = −1.06, P = .001). However, no significant difference in f (MD = 0.89, P = .056) was detected between HGG and LGG. In the white matter regions, HGG had higher D∗ (MD = 0.76, P = .04) compared with LGG, while no marked differences between the D value (P = .07) and f (P = .09) values.

Conclusion:

The present meta-analysis shows that the ADC, D, and D∗ values derived from IVIM may be useful in differentiating HGG from LGG. Considering the small sample of this study, we need to be cautious when interpreting the results of this study. Other prospective and large-sample randomized controlled trials were needed to establish the value of IVIM in differentiating HGG from LGG.
The clinical consequences of neutrophil priming
Authors: Vogt Katja L. , Summers Charlotte , Condliffe Alison M.
Published: November 2018

Purpose of review

Neutrophils priming has been long studied in vitro. Recent studies describe it in vivo. In pathophysiological conditions, complex, heterogeneous characteristics of priming are described in the last few years.

Recent findings

Priming can occur systemically when insults such as sepsis or trauma result in an array of circulating mediators and circulating primed neutrophils seem to exert detrimental effects either directly, or indirectly by interacting with other cells, thereby contributing to the development of organ dysfunction. Local priming of neutrophils augments their ability to clear infection, but may also lead to local bystander tissue injury, for example, in the inflamed joint. The complexity, heterogeneity and dynamic nature of inflammatory responses and the accessibility of cells from local sites make neutrophil priming challenging to study in human disease; however, recent advances have made significant progress to this field.

Herein, we summarize the literature regarding neutrophil priming in selected conditions. In some diseases and in the setting of specific genetic influences, the priming repertoire seems to be restricted, with only some neutrophil functions upregulated. A greater understanding of the nature of neutrophil priming and its role in human disease is required before this process becomes tractable to therapeutic intervention.
Acculturation Into Nursing for Hispanic/Latino Prelicensure Nursing Students and New Graduates
Authors: Woodley Lisa K. , Lewallen Lynne P.
Published: November 2018

Background

Increasing recruitment and retention of Hispanic/Latino nursing students is urgently needed to increase the diversity of the nursing profession and address persisting health disparities.

Purpose

This integrative review describes current knowledge of Hispanic/Latino prelicensure nursing student and new graduate experiences.

Methods

A comprehensive literature review was performed using several online databases.

Results

The Theory of Cultural Marginality provides structure for organizing and synthesizing the literature. Several concepts from the theory are prominent in the literature, including marginal living and across-culture conflict, easing cultural tension and adjustment responses, and contextual, independent, and personal influences.

Conclusions

The process that Hispanic/Latino prelicensure nursing students and new graduates experience as they acculturate into the profession of nursing is complex. Understanding this process is paramount for nurse educators and should be the foundation on which to design, measure, and evaluate educational strategies aimed at fostering student success.
Clinicopathologic Features of CIC-NUTM1 Sarcomas, a New Molecular Variant of the Family of CIC-Fused Sarcomas
Authors: Le Loarer François , Pissaloux Daniel , Watson Sarah , Godfraind Catherine , Galmiche-Rolland Louise , Silva Karen , Mayeur Laetitia , Italiano Antoine , Michot Audrey , Pierron Gaëlle , Vasiljevic Alexandre , Ranchère-Vince Dominique , Coindre Jean Michel , Tirode Franck
Published: November 2018

CIC-fused sarcomas represent an emerging family of tumors, for long connected to the Ewing family group of tumors, but underlined by distinct CIC fusions with different partners. 3′ Fusion partners include DUX4, FOXO4, and, as recently emphasized, NUTM1. In this study, we report the clinicopathologic and molecular features of a series of 6 CIC-NUTM1 sarcomas. Mean age at diagnosis was 6 years (2 to 27 y), and 4 patients were male individuals. Primary tumors were located in the central nervous system (n=3), paravertebral soft tissue and epidural spaces (n=1, each), and lung (n=1). Median overall survival was 17.5 months (7 to 37 mo), and all but one patient died of disease. All tumors displayed classic features of CIC-DUX4 sarcomas with round cell to epithelioid microscopic appearance. Most tumors expressed ETV4 and NUTM1 (n=5/6 and 6/6, respectively), whereas WT1cter was positive in only 2 cases. All tested tumors were positive for break-apart fluorescence in situ hybridization for CIC and NUTM1. Apart from CIC or NUTM1 genomic breakpoints, no other recurrent copy number alteration was seen on genomic profiles. Fusion transcripts were identified by RNA-sequencing on either formalin-fixed paraffin-embedded or frozen material. CIC and NUTM1 breakpoints were located between exons 16 and 20 and exons 2 and 5, respectively. Altogether, CIC-NUTM1 sarcomas represent a new molecular variant of CIC-fused sarcomas with a predilection for the central nervous system and younger pediatric population. Its phenotype may be confused with NUT carcinomas.
Derivation and Validation of an Objective Effort of Breathing Score in Critically Ill Children
Authors: Shein Steven L. , Hotz Justin , Khemani Robinder G.
Published: November 2018

Objectives:

To derive and validate a score that correlates with an objective measurement of a child’s effort of breathing.

Design:

Secondary analysis of a previously conducted observational study.

Setting:

The pediatric and cardiothoracic ICUs of a quaternary-care children’s hospital.

Patients:

Patients more than 37 weeks gestational age to age 18 years who were undergoing extubation.

Interventions:

Effort of breathing was measured in patients following extubation using esophageal manometry to calculate pressure rate product. Simultaneously, members of a multidisciplinary team (nurse, physician, and respiratory therapist) assessed respiratory function using a previously validated tool. Elements of the tool that were significantly associated with pressure rate product in univariate analysis were identified and included in a multivariate model. An Effort of Breathing score was derived from the results of the model using data from half of the subjects (derivation cohort) and then validated using data from the remaining subjects (validation cohort) by calculating the area under the receiver operator characteristic curve for pressure rate product greater than 90th percentile and for the need for reintubation.

Measurements and Main Results:

Among 409 subjects, the median age was 5 months, and nearly half were cardiac surgery patients (49.1%). Retractions, stridor, and pulsus paradoxus were included in the Simple Score. Area under the receiver operator characteristic curve for pressure rate product greater than 90th percentile was 0.8359 (95% CI, 0.7996–0.8722) in the derivation cohort and 0.7930 (0.7524–0.8337) in the validation cohort. Area under the receiver operator characteristic curve for reintubation was 0.7280 (0.6807–0.7752) when all scores were analyzed individually and was 0.7548 (0.6644–0.8452) if scores from three clinicians from different disciplines were summated. Results were similar regardless of provider discipline or training.

Conclusions:

A scoring system was derived and validated, performed acceptably to predict increased effort of breathing or need for advanced respiratory support and may function best when used by a team.
Patterns of Use of Heated Humidified High-Flow Nasal Cannula Therapy in PICUs in the United Kingdom and Republic of Ireland*
Authors: Morris Jenny V. , Kapetanstrataki Melpo , Parslow Roger C. , Davis Peter J. , Ramnarayan Padmanabhan
Published: November 2018

Objectives:

To 1) describe patterns of use of high-flow nasal cannula therapy, 2) examine differences between patients started on high-flow nasal cannula and those started on noninvasive ventilation, and 3) explore whether patients who failed high-flow nasal cannula therapy were different from those who did not.

Design:

Retrospective analysis of data collected prospectively by the Paediatric Intensive Care Audit Network.

Setting:

All PICUs in the United Kingdom and Republic of Ireland (n = 34).

Patients:

Admissions to study PICUs (2015–2016) receiving any form of respiratory support at any time during PICU stay.

Interventions:

None.

Measurements and Main Results:

Eligible admissions were classified into nine groups based on the combination of the first-line and second-line respiratory support modes. Uni- and multivariate analyses were performed to test the association between PICU and patient characteristics and two outcomes: 1) use of high-flow nasal cannula versus noninvasive ventilation as first-line mode and 2) high-flow nasal cannula failure, requiring escalation to noninvasive ventilation and/or invasive ventilation. We analyzed data from 26,423 admissions; high-flow nasal cannula was used in 5,951 (22.5%) at some point during the PICU stay. High-flow nasal cannula was used for first-line support in 2,080 (7.9%) and postextubation support in 978 admissions (4.5% of patients extubated after first-line invasive ventilation). High-flow nasal cannula failure occurred in 559 of 2,080 admissions (26.9%) when used for first-line support. Uni- and multivariate analyses showed that PICU characteristics as well as patient age, primary diagnostic group, and admission type had a significant influence on the choice of first-line mode (high-flow nasal cannula or noninvasive ventilation). Younger age, unplanned admission, and higher admission severity of illness were independent predictors of high-flow nasal cannula failure.

Conclusions:

The use of high-flow nasal cannula is common in PICUs in the United Kingdom and Republic of Ireland. Variation in the choice of first-line respiratory support mode (high-flow nasal cannula or noninvasive ventilation) between PICUs reflects the need for clinical trial evidence to guide future practice.
Pediatric Injuries Treated at a Level 1 Trauma Center After an F5 Tornado
Authors: Watts Jennifer
Published: November 2018

Background

On May 22, 2011, an F5 tornado ripped through the city of Joplin, Mo, resulting in over 150 fatalities and over 750 injuries. Pediatric trauma centers in the region needed to be prepared to receive patients. Little data exist on the types of patients who are received at pediatric trauma centers after disasters such as tornados.

Objective

The purpose of this study is to describe the patients received at the nearest level 1 pediatric trauma center after the tornado.

Methods

Cases were identified through the trauma registry. Data regarding patient demographics, past medical history, characteristics of injury, treatment received, and outcomes were obtained retrospectively from medical records.

Results

A total of 10 patients were received at the pediatric trauma center. Traumatic brain injury was the most common diagnosis followed by orthopedic and maxillofacial injuries. Seven patients required surgical procedures in the operating room, but only 1 patient required surgery within the first 24 hours of arrival. Eight patients were intubated and were in the pediatric intensive care unit. The average length of stay in the hospital was 19.4 days with a range of 14 hours to 94 days.

Conclusions

Immediately after a significant tornado in the referral region, pediatric trauma centers need to prepare to receive patients. Head injuries will likely be common, and pediatric trauma centers will likely receive multiple intubated patients. Knowledge of injuries received and resources needed can better prepare these trauma centers for future devastating tornadoes.
An Update on Pediatric Stroke Protocol
Authors: McKinney Shane M. , Magruder Jessica T. , Abramo Thomas J.
Published: November 2018

Pediatric stroke is relatively rare, with approximately 1000 childhood strokes in the United States per year. However, the occurrence of stroke in children leads to significant morbidity and mortality, warranting the development proven screening tools, protocols, and treatment options. Because significant delays in seeking medical attention can occur, time to recognition of pediatric stroke in the emergency department is uniquely challenging and critical. Once recognized, a trained multidisciplinary team with a multifaceted approach is needed to provide the best possible outcome for the patient. Key elements of the pediatric stroke protocol should include recognition tools, stroke alert mechanism, stroke order sets, timely imaging, laboratory evaluation, and treatment options. Substantial advancements have been made in the field of pediatric stroke protocols mainly due to formation of international consortiums and clinical trial. Despite significant progress, treatment options remain controversial.
Management of Primary Lymph Nodal Gastrinoma With Liver Metastases Resulting in Zollinger-Ellison Syndrome
Authors: Singh Deepa , Lal Sadhna B. , Sood Ashwani , Gupta Rajesh , Kumar Rajender , Vashishta Rakesh K. , Mittal Bhagwant Rai
Published: November 2018

Primary lymph node gastrinoma has been defined as gastrin-producing tumor present in lymph nodes and predominantly found in well-defined anatomical region known as gastrinoma triangle. They are usually localized preoperatively with imaging, and their surgical resection results in long-term relief. The authors report a case of unresectable primary lymph nodal gastrinoma with liver metastases in a 14-year-old adolescent boy with proven histopathology detected on 68Ga-DOTANOC whole-body PET/CT scan followed by preoperative multiple 177Lu-DOTATATE cycles for cytoreduction. Subsequent surgical resection of residual mass resulted in complete response with a follow-up of around 4 years in this unusual case of Zollinger-Ellison syndrome.
18F-FDG PET/CT Imaging in an Adolescent Patient With Primary Prostatic Stromal Sarcoma
Authors: Lai Ruihe , Ding Chongyang
Published: November 2018

Primary prostatic stromal sarcoma is an extremely rare disease that predominantly occurs in adults, accounting for only 0.1% of all prostate cancers. Prostatic stromal sarcoma is quite aggressive and can spread to lung, liver, bone, and other organs. Metastasis is one of the most important predictors for prognosis. Here, we reported a case of a 17-year-old adolescent boy diagnosed with primary prostatic stromal sarcoma through prostate biopsy, and stage was confirmed by 18F-FDG PET/CT.
Dental Implants With a Platform-Switched Morse Taper Connection and an Osteo Growth Induction Surface
Authors: Ghensi Paolo , Tonetto Gianmarco , Soldini Costanza , Bettio Elia , Mortellaro Carmen , Soldini Claudio
Published: November 2018

Aim:

The aim of this study was to analyze the clinical outcomes after using an innovative implant system characterized by a modern platform-switched Morse taper connection and an osteo growth induction titanium surface (a particular type of SLA surface). Peri-implant bone loss (PBL) and implant success rate were examined after a 1- to 3-year follow-up.

Methods:

The study was conducted as a cross-sectional analysis on all patients treated from January 2011 to December 2014 using CLC CONIC implants. Implants were divided into 3 main groups, based on the duration of the follow-up (1 year, 2 years, and 3 years), then subgrouped by diameter, length, and type of prosthetic rehabilitation to compare differences in PBL. X-rays were taken at the time of surgery, at prosthetic loading, at 1 year, and then annually thereafter. Previously-established success criteria were used to assess the implants. Frequency analyses and comparisons between the means (with 95% CI) were conducted for the statistical analysis of the data collected.

Results:

One hundred twenty patients met inclusion and exclusion criteria, and completed the follow-up, and were thus eligible for the study, with a total of 261 CLC CONIC implants. The mean follow-up was 22.45 months. No implants failed, giving an overall success rate of 100%. The average PBL at 1-year follow-up was 0.047 mm, at 2 years it was 0.128 mm, and at 3 years it was 0.236 mm.

Conclusions:

The CLC CONIC implant system had a high success rate after 1 to 3 years of follow-up, in line with previous reports in the scientific literature. Combining platform switching with the Morse taper connection enabled stable bone levels to be achieved in the short to medium term.
Preliminary Study to Evaluate Marginal Bone Loss in Cases of 2- and 3-Implant-Supported Fixed Partial Prostheses of the Posterior Mandible
Authors: Segal Pnina , Makhoul Areej , Eger Michal , Lucchina Alberta Greco , Winocur Ephraim , Mijiritsky Eitan
Published: November 2018

Purpose:

The purpose of this study was to evaluate, by radiographic examinations, the marginal bone resorption around implants in cases of 2 and 3 implant-supported fixed partial prostheses (FPPs) at the posterior mandible.

Methods:

A retrospective study of 41 patients (23 males, 18 females) of an average age of 67 years (range, 53–85), with 2 and 3 implants-supported FPPs in the posterior mandible that were treated during 2006 to 2015. The mean follow-up time was 6.32 years (range, 2–10). Twenty-four patients had FPPs on 2 implants (a total of 48 implants). Seventeen patients had FPPs on 3 implants (a total of 51 implants). Clinical and radiographic follow-up examinations were performed. All radiographs were analyzed for changes in marginal bone height surrounding the implants.

Results:

The mean marginal bone loss around the most mesial implant was slightly higher in the 2-implant group (0.833 mm) compared with the 3-implant group (0.431 mm). The correlation between the mean marginal bone loss around the most mesial implant and the number of implants was of borderline value (P = 0.055).

Conclusions:

Considering the limitations of this preliminary study, the authors found that the mesial implant in the 2-implant group is more susceptible to marginal bone loss.
Multisuture Craniosynostosis and Papilledema in Pycnodysostosis: A Paradox?
Authors: Thomas Gregory P. L. , Magdum Shailendra A. , Saeed Nad R. , Johnson David
Published: November 2018

Pycnodysostosis (PYCD) is a rare autosomal-recessive skeletal disorder that typically presents with osteosclerosis of the majority of the postcranial skeleton and osteolysis of the calvarium, manifesting as persistent open cranial fontanelles and widely spaced cranial sutures. Craniosynsostosis in PYCD is a somewhat paradoxical feature, and has only been rarely reported. The authors present a unique case of a 6-year-old girl with PYCD, multisuture craniosynostosis involving the coronal and sagittal sutures, severe obstructive sleep apnoea, and raised intracranial pressure presenting as papilledema. She underwent a frontofacial monobloc distraction advancement which successfully corrected her papilledema and obstructive sleep apnoea.

Pycnodysostosis is caused by a loss of function mutation in the CTSK gene that codes for the lysosomal cysteine protease, cathepsin K (CTSK). Loss of CTSK impairs the ability of osteoclasts to degrade bone extracellular matrix. Differences in osteoclast phenotype and extracellular matrix composition between membranous and cartilaginous bone may explain the clinical features of PYCD. Animal model studies suggest that craniosynostosis may arise due to variations in patient genetic background.
Full-Thickness Skin Grafting for Local Defect Coverage Following Scalp Adjacent Tissue Transfer in the Setting of Cranioplasty
Authors: Wolff Amir Y. , Santiago Gabriel F. , Belzberg Micah , Manson Paul N. , Huang Judy , Brem Henry , Gordon Chad R.
Published: November 2018

Introduction:

Numerous techniques have been described to overcome scalp deficiency and high-tension closure at time of cranioplasty. However, there is an existing controversy, over when and if a free flap is needed during complex skull reconstruction (ie, cranioplasty). As such the authors present here our experience using full-thickness skin grafts (FTSGs) to cover local defects following scalp adjacent tissue transfer in the setting of cranioplasty.

Methods:

By way of an institutional review board-approved database, the authors identified patients treated over a 3-year period spanning January 2015 to December 2017, who underwent scalp reconstruction using the technique presented here. Patient demographics, clinical characteristics, technical details, outcomes, and long-term follow up were statistically analyzed for the purpose of this study.

Results:

Thirty-three patients, who underwent combined cranioplasty and scalp reconstruction using an FTSG for local donor site coverage, were identified. Twenty-five (75%) patients were considered to have “high complexity” scalp defects prior to reconstruction. Of them, 12 patients (36%) were large-sized and 20 (60%) medium-sized; 21 (64%) grafts were inset over vascularized muscle or pericranium while the remaining grafts were placed over bare calvarial bone. In total, the authors found 94% (31/33) success for all FTSGs in this cohort. Two of the skin grafts failed due to unsuccessful take. Owing to the high rate of success in this series, none of the patient's risk factors were found to correlate with graft failure. In addition, the success rate did not differ whether the graft was placed over bone verses over vascularized muscle/pericranium.

Conclusion:

In contrary to previous studies that have reported inconsistent success with full-thickness skin grafting in this setting, the authors present a simple technique with consistent results—as compared to other more complex reconstructive methods—even in the setting of highly complex scalp reconstruction and simultaneous cranioplasty.
The External Jugular Vein Used as Recipient Vessel in Head and Neck Free Flap Reconstruction: Outcomes Compared to the Internal Jugular Vein
Authors: Ibrahim Amir E. , Adelman David M , Parham Christopher , Hong Zhang , Villa Mark , Chahine Fadel M. , Ghieh Fadi M.
Published: November 2018

Background:

Contradictory data exists on the success rates of employing the external jugular (EJ) vein as a recipient vessel for venous outflow in free flap head and neck reconstruction compared with the internal jugular (IJ) vein. The authors hereby present a retrospective study of prospectively collected data over a 14-year period.

Methods:

Five hundred seventy-eight patients underwent 639 free flap head and neck over 14 years. Two hundred seventy-eight free flaps employed the EJ vein as the recipient vessel while 326 free flaps employed the IJ vein. Rates of acute and late complications were compared.

Results:

There were no differences in rates of complications: flap loss, venous thrombosis, arterial thrombosis, bleeding, hematoma, or infection between the EJ and IJ vein groups.

Conclusion:

The external jugular vein as a recipient vessel for venous outflow in head and neck free flap reconstruction of postoncologic resection defects is a valid option for both primary reconstructions and secondary surgeries.
Reconstructions With Different and New Techniques of Large and Extensive Myelomeningocele Defects
Authors: Emsen Ilteris M.
Published: November 2018

Background:

Myelomeningocele and/or meningocele is a defect of spine and spinal cord, and it is congenital. Although meningocele is a mild form of spina bifida, myelomeningocele is a more complex and serious form. There is a sac in both forms at the back. Difference is that myelomeningocele contains neural structures or spinal cord elements, and meningocele does not contain these neural or spinal cord elements.

Methods:

Between 2012 and 2018, 77 (45 females, 32 males) newborns with myelomeningocele were operated by mean age 35 days. The O-S flap (26 patients) method was used in patients who have circular defect. The Emsen 1 flap (31 patients) was used in patients who have elliptic defect. The Emsen 2 flap (20 patients) was also used in patients who have triangular defect. Mean follow-up was 22 months (9–50 months).

Results:

A successful tension-free closure was made with these methods. Defects of the newborn were divided the subgroups as circular, elliptic, and triangular. Hydrocephalus was detected in 19 patients. Ventriculoperitoneal shunt was done at the same time with the myelomeningocele surgical procedure. All complications were noted in patients with hydrocephalus such as cerebrospinal fluid leakage (in 8 patients), wound infection (in 3 patients), and partially wound dehiscence (in 4 patients).

Conclusion:

There are many techniques about myelomeningocele closure in literature. The problem is not number of techniques. Literature presents different geometric flap design, muscle flaps, and musculocutaneous flaps on these defects. Large or extensive skin defects need more complex flap methods, and unfortunately, number of these is too limited. Three methods on large or extensive myelomeningocele skin defects are presented in this study. With these flaps, large or extensive skin defects could be easily closed. In all techniques, major advantages are no skin grafting, no abnormal blood loss, no muscle sacrificing, short operation time, and most important one is that 1-step surgery could be sufficient.
A Patient With Schimmelpenning Syndrome and Mosaic KRAS Mutation
Authors: Mitchell Benjamin J. , Rogers Gary F. , Wood Benjamin C.
Published: November 2018

Schimmelpenning syndrome is a neurocutaneous disorder characterized by craniofacial nevus sebaceus that fall along embryonic cutaneous lines and tend to be associated with neurological, ocular, skeletal, and vascular abnormalities. We report a child with extensive nevus sebaceus of the scalp, face, and thorax and other unusual physical findings who was found to have a mosaic mutation of KRAS c.35G>A p.12D pathognomonic of Schimmelpenning syndrome.
The Morphology of the Infraorbital Nerve and Foramen in the Presence of an Accessory Infraorbital Foramen
Authors: Polo Carolina L. , Abdelkarim Ahmed Z. , von Arx Thomas , Lozanoff Scott
Published: November 2018

Background:

The accessory infraorbital foramen (AIOF) is an anatomical variation associated with the infraorbital foramen (IOF) and nerve (ION). Its occurrence and neural contents have clinical implications regarding failure of loco-regional anesthesia and risk of neural damage during surgical interventions involving the maxillary region. Thus, morphologic characterization of the AIOF and neural contents as well as the spatial relationships to the IOF are potentially useful for optimizing surgical procedures. Additionally, predictive features of the AIOF based on its relationship to IOF morphology could enable the surgeon to anticipate its presence and proceed accordingly. The purpose of this study was to determine whether the presence of an AIOF and its neural contents affected the size, shape, and composition of the IOF and ION. The specific hypothesis tested was that the topography and fascicular composition of the ION and IOF differs between individuals possessing an AIOF and those lacking this anatomical variant.

Methods:

Gross topographic features of the IOF (42 crania) were compared between specimens possessing (test) or lacking (control) an AIOF. Nerve fascicles of ION (60 cadaveric sides) were examined histologically and compared morphometrically between specimens presenting or lacking an AIOF. An additional sample of 30 crania was subjected to cone-beam computed tomography (CBCT) analysis to determine the course of the canal leading to the AIOF.

Results:

The AIOF incidence was 47.6% (20 crania) and 32.1% of the sides (27 sides). A single AIOF was observed in 24 sides and double AIOF in three sides. The AIOF occurred bilaterally in 7 specimens (16.7%). The majority of AIOF (86.7%) were located superomedial to IOF. A slightly higher frequency of the AIOF was found in left side compared to the right. Using CBCT, a patient sample showed an AIOF incidence in 21 sides of 16 patients (65.6%). A single AIOF was observed in 19 sides. Only 1 double AIOF was found in the scans, whereas 3 were found in the dry skull group. The AIOF occurred bilaterally in 3 scans (10%). The majority of AIOF (90.4%) were located superomedial to the IOF based on the CBCT scans. The AIOF was consistently seen connected to the infraorbital canal and progressed superiorly and medially from the infraorbital canal to the maxillary surface. The size of the ION without an AIOF was not significantly different than the ION in the presence of an AIOF (1.45 × 106/1.32 × 106 μm2, P < 0.35) based on fascicular area. However, the number of ION fascicles was greater in specimens without an AIOF compared to those showing this feature (15.15/12.71, P < 0.04)

Conclusion:

Results indicate that the area of the ION is not affected by an AIOF, suggesting that the field of innervation of this area is not modified by its occurrence. However, the ION appears to divide more proximally into its component branches when the AIOF is present.
Emergent Themes for Instructional Design
Authors: Lee-Jayaram Jannet J. , Berg Benjamin W. , Sy Angela , Hara Kristine M.
Published: November 2018

Introduction

Instructional design is an established discipline for designing educational activities for learners and is applied during the development of simulation-based healthcare educational activities. Although the iterative process is already being used with alpha/beta testing during development of the simulation, the process has not been described in detail. We sought to describe this process of design changes made during a novice faculty development course for simulation-based healthcare education where participants routinely design scenarios and conduct alpha/beta testing.

Methods

Using a mixed methods study, participant written narratives and checklist/rating scales were collected on changes made during both alpha and beta testing. Narratives were analyzed using the qualitative grounded theory approach to identify emergent themes. Checklist/rating scales were analyzed for changes made to previously identified areas and how critical these changes were to the success of the scenario.

Results

Several themes of frequent changes made during the alpha/beta testing process emerged from the participant narratives that included REALISM, PROTOCOLS, INTRODUCTIONS and ROLES. The quantitative analysis of potential areas for change correlated with the emergent themes.

Conclusions

Novice scenario designers make similar changes in thematic areas during the instructional design process. Faculty development courses for novice simulation healthcare educators should anticipate attention to these areas during discussions and consider specific didactics to avoid common design pitfalls of novice educators.
Augmented Reality Future Step Visualization for Robust Surgical Telementoring
Authors: Andersen Daniel S. , Cabrera Maria E. , Rojas-Muñoz Edgar J. , Popescu Voicu S. , Gonzalez Glebys T. , Mullis Brian , Marley Sherri , Zarzaur Ben L. , Wachs Juan P.
Published: November 2018

Introduction

Surgical telementoring connects expert mentors with trainees performing urgent care in austere environments. However, such environments impose unreliable network quality, with significant latency and low bandwidth. We have developed an augmented reality telementoring system that includes future step visualization of the medical procedure. Pregenerated video instructions of the procedure are dynamically overlaid onto the trainee's view of the operating field when the network connection with a mentor is unreliable.

Methods

Our future step visualization uses a tablet suspended above the patient's body, through which the trainee views the operating field. Before trainee use, an expert records a “future library” of step-by-step video footage of the operation. Videos are displayed to the trainee as semitransparent graphical overlays. We conducted a study where participants completed a cricothyroidotomy under telementored guidance. Participants used one of two telementoring conditions: conventional telestrator or our system with future step visualization. During the operation, the connection between trainee and mentor was bandwidth throttled. Recorded metrics were idle time ratio, recall error, and task performance.

Results

Participants in the future step visualization condition had 48% smaller idle time ratio (14.5% vs. 27.9%, P < 0.001), 26% less recall error (119 vs. 161, P = 0.042), and 10% higher task performance scores (rater 1 = 90.83 vs. 81.88, P = 0.008; rater 2 = 88.54 vs. 79.17, P = 0.042) than participants in the telestrator condition.

Conclusions

Future step visualization in surgical telementoring is an important fallback mechanism when trainee/mentor network connection is poor, and it is a key step towards semiautonomous and then completely mentor-free medical assistance systems.
Anterior Wall Success at 1 Year After Vaginal Uterosacral Ligament Suspension and Sacral Colpopexy
Authors: Bastawros Dina A. , Tarr Megan E. , Templin Megan A. , Stepp Kevin J. , Taylor G. Bernard , Myers Erinn M.
Published: November 2018

Objectives

The primary objective was to evaluate 1-year anterior wall anatomic success rates for vaginal uterosacral ligament suspension (USLS) and minimally invasive sacral colpopexy (SCP) using delayed-absorbable suture. Secondary objectives included assessment of apical success, mesh or suture exposure, and postoperative quality of life (QoL) measures 12 months after surgery.

Methods

This was a retrospective cohort study including women who underwent a hysterectomy with concomitant USLS or SCP with delayed-absorbable suture from January 2011 to December 2015 with 1-year follow-up. Successful anterior vaginal wall support was defined as Ba of less than 0. Successful apical support was defined as no apical descent (point C) greater than one half of the total vaginal length. In addition, 1-year QoL questionnaires were measured postoperatively.

Results

A total of 282 women were identified. Sixty-two women (31 vaginal USLS and 31 SCP) met inclusion criteria. Demographics were similar between groups except for a higher body mass index in the USLS group (27.5 ± 5.6 kg/m2 vs 24.1 ± 3.3 kg/m2, P < 0.05). Preoperative POP-Q was mostly stage II and III. At 1-year, anatomic success rates for the anterior compartment were 66.7% versus 90.3% for USLS and SCP groups, respectively (P = 0.02). There was no significant difference in apical success (P = 1.00) or QoL scores between groups at 1 year.

Conclusions

Anatomic success rates at 1 year using delayed-absorbable suture were better for SCP when using the anterior wall as a measure of success, but there were no significant differences in apical success rates, mesh or suture exposure, and QoL measures between groups.
Biliary Bicarbonate, pH, and Glucose Are Suitable Biomarkers of Biliary Viability During Ex Situ Normothermic Machine Perfusion of Human Donor Livers
Authors: Matton Alix P.M. , de Vries Yvonne , Burlage Laura C. , van Rijn Rianne , Fujiyoshi Masato , de Meijer Vincent E. , de Boer Marieke T. , de Kleine Ruben H.J. , Verkade Henkjan J. , Gouw Annette S. H. , Lisman Ton , Porte Robert J.
Published: November 2018

Background.

Ex situ normothermic machine perfusion (NMP) can be used to assess viability of suboptimal donor livers before implantation. Our aim was to assess the diagnostic accuracy of bile biochemistry for the assessment of bile duct injury (BDI).

Methods.

In a preclinical study, 23 human donor livers underwent 6 hours of end-ischemic NMP to determine biomarkers of BDI. Livers were divided into groups with low or high BDI, based on a clinically relevant histological grading system. During NMP, bile was analyzed biochemically and potential biomarkers were correlated with the degree of BDI. Receiver operating characteristics curves were generated to determine optimal cutoff values. For clinical validation, identified biomarkers were subsequently included as viability criteria in a clinical trial (n = 6) to identify transplantable liver grafts with low BDI.

Results.

Biliary bicarbonate and pH were significantly higher and biliary glucose was significantly lower in livers with low BDI, compared with high BDI. The following cutoff values were associated with low BDI: biliary bicarbonate greater than 18 mmol/L (P = 0.002), biliary pH greater than 7.48 (P = 0.019), biliary glucose less than 16 mmol/L (P = 0.013), and bile/perfusate glucose ratio less than 0.67 (P = 0.013). In the clinical trial, 4 of 6 livers met these criteria and were transplanted, and none developed clinical evidence of posttransplant cholangiopathy.

Conclusions.

Biliary bicarbonate, pH, and glucose during ex situ NMP of liver grafts are accurate biomarkers of BDI and can be easily determined point of care, making them suitable for the pretransplant assessment of bile duct viability. This may improve graft selection and decrease the risk of posttransplant cholangiopathy.
Management of Penile Calciphylaxis
Authors: Zillioux Jacqueline M. , Geisenhoff Alexander , Gray Mikel
Published: November 2018

BACKGROUND:

Calciphylaxis, also called calcific uremic arteriolopathy, is a highly morbid syndrome characterized by calcium deposition and occlusion of small arterial vessels of the dermis and subdermal adipose tissue, leading to necrosis and gangrene. Penile involvement is rare and its management presents considerable challenges.

CASE:

We review the case of a 47-year-old man with end-stage renal disease managed with hemodialysis, diabetes mellitus, and urinary incontinence who presented with a painful necrotic lesion on his glans penis, and the second and third toes of his right foot. Following diagnosis of calciphylaxis of the toes and penis, he was conservatively managed with topical wound care, sodium thiosulfate adjustment of hemodialysis, and phosphate binder medications. Over the course of 2 months, his wound worsened in the setting of continued urinary incontinence, and before planned diversion with a suprapubic catheter, he progressed to gangrene and sepsis. After a goals-of-care discussion with the patient and family, he elected to forego debridement and was discharged on home-based palliative care.

CONCLUSIONS:

Penile calciphylaxis is a rare, life-threatening disease that portends a poor prognosis. Conservative principles for management include normalization of calcium phosphate levels and local wound care. Penectomy may not impact survival. Ultimately, each case is individualized, and we encourage establishing goals of care in collaborative discussion with an interdisciplinary care team, patient, and family.
Conformational dynamics of active site loops 5, 6 and 7 of enzyme Triosephosphate Isomerase: A molecular dynamics study
Authors: Dantu Sarath Chandra , Groenhof Gerrit
Published: November 2018

Triosephosphate Isomerase is a glycolytic enzyme catalyzing the interconversion of Dihydroxyacetone phosphate to Glyceraldehyde-3-phosphate. The active site is comprised of three distinct loops loop-6, loop-7 and loop-8. Based on loop-6 and loop-7 conformation we describe the enzyme as Open TIM and Closed TIM. Various NMR, X-ray crystallography and QM/MM simulation techniques have provided glimpses of individual events of what is essentially a dynamic process. We studied the conformational changes of two distinct loops (loop-6 and loop-7) enveloping the active site, in the presence of natural substrate, reaction intermediates and inhibitor molecules, by means of microsecond atomistic MD simulations in solution and crystal environment. Our studies have revealed that loop-6 samples open and closed conformations in both apo and holo TIM structures. As seen in solution state NMR experiments, we also observe that loop-6 N-terminus and C-terminus move independently. In our simulations we have also observed that backbone dihedrals of loop-7 residues G210 (G210-phi, G210-psi) and G211 (G211-phi) sample open and closed states in both apo and holo TIM structures. Whereas backbone dihedral angles of G211 (G211-psi) and S212 (S212-phi) adopt closed conformation only when the ligand is bound to the active site. As observed in chain-B of 1R2R crystal structures, we also observe that water molecules can also initiate flip of G211-psi and S212-phi dihedral angles into closed conformation. Except, loop-5, which has a dominant effect on the conformational behaviour of loop-6 N-terminus, we do not observe any influence of either loop-6 or loop-7 on the conformational dynamics of the other.
The LIM-Only Protein FHL2 is involved in autophagy to regulate the development of skeletal muscle cell
Authors: Liu Zihao , Han Shunshun , Wang Yan , Cui Can , Zhu Qing , Jiang Xiaosong , Yang Chaowu , Du Huarui , Yu Chunlin , Li Qingyun , He Haorong , Shen Xiaoxu , Chen Yuqi , Zhang Yao , Ye Lin , Zhang Zhichao , Li Diyan , Zhao Xiaoling , Yin Huadong
Published: November 2018

Four and a half LIM domain protein 2 (FHL2) is a LIM domain protein expressed in muscle tissue whose deletion is causative of myopathies. Although FHL2 has a confirmed important role in muscle development, its autophagy-related function in muscle differentiation has not been fully determined. To explore the role of FHL2 in autophagy-related muscle regulation, FHL2-silenced and -overexpressing C2C12 mouse cells were examined. Immunofluorescence and co-immunoprecipitation assay findings showed that FHL2 silencing reduced LC3-Ⅱ protein expression and the amount of LC3 that co-immunoprecipitated with FHL2, indicating that FHL2 interacts with LC3-Ⅱ in the formation of autophagosomes. Moreover, the expression of muscle development marker genes such as MyoD1 and MyoG was lower in FHL2-silenced C2C12 cells but not in FHL2-overexpressing C2C12 cells. Electron microscopy analysis revealed large empty autophagosomes in FHL2-silenced myoblasts, while flow cytometry suggested that FHL2 silencing made cells more vulnerable to staurosporine-induced cell death. In conclusion, we propose that FHL2 interacts with LC3-Ⅱ in autophagosome formation to regulate the development of muscle cells.
Age-related changes in MEG theta and alpha oscillatory signatures of attentional control
Authors: Huizeling Eleanor , Wang Hongfang , Holland Carol , Kessler Klaus
Published: November 2018

In our recent behavioural research (Callaghan et al., 2017), we reported age-related changes in the costs of switching between from a temporal (rapid serial visual presentation) to a spatial (visual search) attention task. Using magnetoencephalography, we have now compared the neural signatures of attention refocusing between three age groups (19-30, 40-49 and 60+ years) and found differences in task-related modulation and cortical localisation of alpha and theta oscillations. Efficient, faster switching between the temporal and spatial attention tasks in the youngest group compared to both older groups was reflected in parietal theta effects that were significantly reduced in the older groups. Residual parietal theta activity in older individuals was, however, beneficial to attentional switching, and could reflect the preservation of attention mechanisms. Difficulties in refocusing attention in the older and middle-aged adults (slowed response times) were accompanied by reduced theta power modulation in occipital and cerebellar regions. In addition to this posterior theta deficit, older and middle-aged adults presented with increased recruitment of frontal (both groups) and temporal (older group) areas. Theta oscillations therefore demonstrated a posterior to anterior processing shift, which may reflect the engagement of alternative strategies in older- and middle-age, such as top-down attentional control in an attempt to compensate for posterior processing deficits. Additional frontal theta recruitment indeed appeared to be beneficial for faster performance, as reflected by correlational analysis. Temporal theta (in older-age), however, did not correlate with performance, but could reflect strategies unrelated to speeded performance (e.g. silent vocalisation to maintain task goals). Alpha oscillations did not significantly correlate with task performance, possibly reflecting decreased neural precision or de-differentiation, but require further investigation.