bluuebunny/crossref_metadata_2025 huggingface dataset:
Catheter removal and outcomes of multidrug-resistant central-line-associated bloodstream infection
Authors: Burnham Jason P. , Rojek Rebecca P. , Kollef Marin H.
Published: October 2018

Central-line-associated bloodstream infections (CLABSIs) are responsible for ∼1/3 of all deaths from healthcare-associated infections in the United States. Of these, multidrug-resistant organisms (MDROs) are responsible for 20% to 67%. However, whether catheter removal affects clinical outcomes for MDRO CLABSIs has not been studied. Our objective was to determine the relationship between failure to remove a central venous catheter (CVC) and 30-day all-cause mortality in patients with MDRO CLABSIs. We used a retrospective cohort from Barnes-Jewish Hospital (1/1/2009–10/1/2015) to study patients with a multidrug-resistant Staphylococcus aureus, Enterococcus species, Enterobacteriaceae, Acinetobacter species, or Pseudomonas aeruginosa CLABSI. Risk factors for 30-day mortality, including catheter removal, were assessed for association with 30-day mortality using Cox proportional hazards models. The CLABSIs were assessed prospectively at the time of occurrence by infection prevention specialists. A total of 430 patients met inclusion criteria, 173 (40.2%) with Enterococcus, 116 (27.0%) Enterobacteriaceae, 81 (18.8%) S aureus, 44 (10.2%) polymicrobial, 11 (2.6%) P aeruginosa, and 5 (1.2%) Acinetobacter CLABSIs. Removal of a CVC occurred in 50.2% of patients, of which 4.2% died by 30 days (n = 9). For patients whose CVC remained in place, 45.3% died (n = 97). Failure to remove a CVC was strongly associated with 30-day all-cause mortality with a hazard ratio of 13.5 (6.8–26.7), P < .001. Other risk factors for 30-day mortality included patient comorbidities (cardiovascular disease, congestive heart failure, cirrhosis), and being in an intensive care unit at the time of MDRO isolation. Failure to remove a CVC was strongly associated with 30-day all-cause mortality for patients with MDRO CLABSIs in this single center retrospective cohort. This suggests that patients presenting with MDRO CLABSIs should all undergo CVC removal.
Gene pair based prognostic signature for colorectal colon cancer
Authors: Shu Peng , Wu Jianping , Tong Yao , Xu Chunxia , Zhang Xingguo
Published: October 2018

Background:

The identification of high-risk colorectal cancer (CRC) patient is key to individualized treatment after surgery and reliable prognostic biomarkers are needed identifying high-risk CRC patients.

Methods:

We developed a gene pair based prognostic signature that could can the prognosis risk in patients with CRC. This study retrospectively analyzed 4 public CRC datasets, and 1123 patients with CRC were divided into a training cohort (n = 300) and 3 independent validation cohorts (n = 507, 226, and 90 patients).

Results:

A signature of 9 prognosis-related gene pairs (PRGPs) consisting of 17 unique genes was constructed. Then, a PRGP index (PRGPI) was constructed and divided patients into high- and low-risk groups according to the signature score. Patients in the high-risk group showed a poorer relapse-free survival than the low-risk group in both the training cohort [hazard ratio (HR) range, 4.6, 95% confidence interval (95% CI), 2.55–8.32; P < .0001] and meta-validation set (hazard ratio range, 4.09, 95% CI, 1.99–8.39; P < .0001). The PRGPI signature achieved a higher accuracy [mean concordance index (C-index): 0.6∼0.74] than a commercialized molecular signature (mean C-index, 0.48∼0.56) for estimation of relapse-free survival in comparable validation sets.

Conclusion:

The gene pair based prognostic signature is a promising biomarker for estimating relapse-free survival of CRC.
Relapsing polychondritis patients were divided into three subgroups: patients with respiratory involvement (R subgroup), patients with auricular involvement (A subgroup), and overlapping patients with both involvements (O subgroup), and each group had distinctive clinical characteristics
Authors: Shimizu Jun , Yamano Yoshihisa , Kawahata Kimito , Suzuki Noboru
Published: October 2018

Relapsing polychondritis (RP) is a multisystem disorder of cartilaginous tissues. Previously, we found that patients with respiratory involvement and patients with auricular involvement were mutually exclusive in the RP cohort, which suggests a strong inverse relationship between respiratory and auricular involvement. Here, we examined the clinical manifestation patterns in a subgroup of patients with respiratory involvement (R subgroup) and a subgroup of patients with auricular involvement (A subgroup) and investigated the clinical and laboratory characteristics of each subgroup.

There were 47 patients (19.7%) and 118 patients (49.4%) allocated to the R and A subgroups, respectively. Saddle nose deformity and a progressive disease course were observed frequently in the R subgroup. Arthritis, conjunctivitis, and CNS involvement were observed frequently in the A subgroup.

The remaining RP patients formed a third subgroup of patients that had both respiratory involvement and auricular involvement. We designated this subgroup as the O (overlap) subgroup, and 75 patients (31.4%) were allocated to the O subgroup. Disease duration in the O subgroup (5.70 ± 0.64 years) was significantly longer than that in the A subgroup (4.12 ± 0.45 years) and relatively longer than that in the R subgroup (4.80 ± 0.63 years).

We found that cardiovascular involvement was more predominant in the O subgroup than in the R and A subgroups. Higher concentrations of serum matrix metalloproteinase (MMP)3 were observed in the O subgroup than in the R and A subgroups.

We measured serum MMP3 concentrations in another patient cohort including 22 newly recruited RP patients. MMP3 concentrations were significantly higher in the O subgroup (n = 10) than those in the R subgroup (n = 6) and A subgroup (n = 10).

RP patients in the R and A subgroups had different characteristics from each other, and the overlap of respiratory and auricular involvement was an important prognostic factor in patients with RP. Cardiovascular involvement was not observed in the R subgroup in RP patients. The current study may provide insights into the classification and treatment of RP.
Monocyte-to-high density lipoprotein ratio is associated with a decreased compound muscle action potential amplitude in patients with diabetic axonal polyneuropathy
Authors: Vural Gönül , Gümüsyayla Şadiye
Published: October 2018

The monocyte-to-high density lipoprotein ratio (MHR) has recently been implemented as an indicator of inflammation and oxidative stress. The present study characterized MHR in patients with diabetic polyneuropathy (DPN), in which oxidative stress and microvascular damage play a role in pathogenesis, relative to patients with non-DPN, diabetic patients without polyneuropathy, and healthy individuals. We further aimed to evaluate the association between MHR and the decreased compound muscle action potential (CMAP) amplitude of patients with diabetic axonal polyneuropathy.

We enrolled 90 patients with DPN, 75 patients with nonDPN, 92 diabetic patients without polyneuropathy, and 67 healthy individuals; The monocyte, high-density lipoprotein cholesterol (HDL-C) values were obtained for all participants and MHR was calculated for each individual. Intergroup comparison was performed. The relationship between MHR and the posterior tibial nerve CMAP amplitudes was examined.

Statistically significant negative correlation was observed between MHR and the posterior tibial nerve CMAP amplitudes of patients with DPN. The MHR values of the patients with DPN were significantly higher than those of the patients with non-DPN, diabetic patients without polyneuropathy and the control group.

This study demonstrated that diabetic patients with higher MHR values may be more likely to develop polyneuropathy.
Application of lateral tarsoconjunctival flap to correct ocular complications of Madelung's disease
Authors: Lee Lung-Chi , Weng Tsu-Heng , Huang Ke-Hao , Lin Hsin-Ting , Liang Chang-Min , Tai Ming-Cheng , Chen Jiann-Torng , Chien Ke-Hung
Published: October 2018

Rationale:

Madelung's disease is a specific type of benign symmetric lipomatosis, which is characterized by overgrowing fat distributed at the neck and shoulder. This excessive fat accumulation may occur in different regions, including vital organs, such as the larynx, trachea, or the orbits. Surgery is usually performed to correct the esthetic or functional concern of the affected area. There are only few case reports mentioned about the orbital involvement of this disease. This study aimed to describe a case of Madelung's disease with ocular complications and the successful treatment using tarsoconjunctival flap.

Patient concerns:

A 90-year-old obese male presented with decreased visual acuity accompanied with severe band form punctate epithelial erosions and ciliary injections in both eyes. Exophthalmos and ectropion of the lower eyelids were observed.

Diagnoses:

Orbital computed tomography revealed a rare entity of Madelung's disease with significant massive deposits of lipomas located symmetrically around the orbit and neck region.

Interventions:

Bilateral lateral tarsoconjunctival flaps with lateral tarsal strip procedures were performed to correct the lower eyelid ectropion-related exposure keratopathy.

Outcomes:

The patient obtained improved visual acuity, intact and clear corneal surfaces, and perfect lower eyelid positions over both eyes.

Lessons:

Madelung's disease is a rare condition. There are few reports to describe its ocular complications, due to lipoma overgrowing in the orbit. We shared our successful experience to correct ocular complications using tarsoconjunctival flap technique.
Bilateral cataracts as the first manifestation of type 1 diabetes mellitus
Authors: Wu Juan , Zeng Haixia , Xuan Rui , Lei Shuihong , Li Jing , Lai Xiaoyang , Liu Jianping
Published: October 2018

Rationale:

Cataracts can occur in children and adolescents with Type 1 Diabetes Mellitus who have poorly controlled glycemia. Here, we report a case of a 16-year-old female, who was diagnosed with bilateral cataracts, and genetic screening identified a mutation in the PRRC2A gene which is rarely reported. After surgery, retinopathy was found in this patient, combined with the published literature, we encourage that postoperative monitoring for retinal lesions during the follow-up visits should be conducted.

Patient concerns:

In this article, we present an adolescent diagnosed with bilateral cataracts, and developed retinopathy during the follow-up visits. Genetic screening identified a mutation in the PRRC2A gene.

Diagnoses:

The diagnoses of Diabetic cataracts, Type 1 diabetes and Diabetic retinopathy was made.

Interventions:

The patient underwent surgery in both eyes, and hypoglycemic treatment was provided.

Outcomes:

The surgery achieved satisfactory results, during the follow-up visits, her visual acuity was reported as 0.8 in the right eye and 1.0 in the left eye. Besides, her blood glucose was well controlled, and her glycated hemoglobin was reduced to 6.9% after three months of continuous treatment.

Lessons:

This case highlights the importance of genetic screening for detecting mutations in diabetes-related genes, and postoperative monitoring for retinal lesions during the follow-up visits.
Comparison of 3 assessment modes of acupuncture effect on patients with chronic prostatitis/chronic pelvic pain syndrome
Authors: Zhou Jing , Liu Yan , Li Chunbin , Liu Zhishun
Published: October 2018

Background:

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder. Some studies have indicated that acupuncture may ameliorate the symptoms of CP/CPPS. However, results are varied and range widely, perhaps due to different modes of assessment including timepoints, places of assessment, and especially subjective scales. We propose to determine the efficacy of acupuncture relative to sham acupuncture for patients with CP/CPPS, and compare different modes of assessment regarding the therapeutic effects of acupuncture.

Methods:

Sixty patients with CP/CPPS will be randomly assigned to receive either acupuncture or sham-acupuncture (30 patients, each). Treatment will be conducted 3 times/week, for 4 weeks. The coprimary outcomes will each be the change from baseline of the total NIH (National Institutes of Health) CPSI (Chronic Prostatitis Symptom Index) score associated with 3 modes of assessment: Mode 1, the scale recorded at the hospital within 10 minutes after the last session of 4 weeks of acupuncture treatment, in the company of the outcome assessors; Mode 2, the scale recorded the same day, but not at the hospital; and Mode 3, the scale recorded at the hospital 1 to 3 days after the last acupuncture session. The 3 key secondary outcomes include will be the 3 modes assessment of the changes from baseline of the NIH-CPSI total scores in the acupuncture group at week 4 after treatment. Analysis was by intention-to-treat, and multiplicity was controlled for with a step-down closed-testing procedure.

Discussion:

To our knowledge, previous studies did not include the details of assessment scales when determining the efficacy of acupuncture in CP/CPPS. Furthermore, it is not clear which mode was used to assess the effect. The answers provided by the proposed study may improve the reproducibility of acupuncture research and the reliability of results.
CT-guided special approaches of drainage for intraabdominal and pelvic abscesses
Authors: Zhao Ning , Li Qian , Cui Jing , Yang Zhiyong , Peng Tao
Published: October 2018

Background

To explore the safety and efficacy of several special approaches of drainage for deep inaccessible intraabdominal and pelvic abscesses.

Methods

By searching of our institutional database, the clinical and radiologic information of all patients with special approaches of abscesses drainage was collected, consisting of etiology, diameter of abscess, duration of drainage, major complications, rates of success, failure and death, and pre-procedure, intra-procedure and post-procedure computed tomography scans.

Results

A total of 124 patients are eligible for the criterion in our center between January 2010 and January 2018. The mean diameter of abscess was 5.6 cm (range 3.0–9.8 cm) and mean duration of drainage was 10.3 days (range 4–43 days). Pain was complained in 6 patients (4.8%) and hemorrhage was observed in one patient. Complete resolution of the abscess following drainage was observed in 115 patients (92.7%). A total of 9 patients (7.3%) failed to percutaneous abscess drainage and 3 patients died of catheter-unrelated diseases. Transintestinal afferent loop of drainage was firstly attempted in six patients and complete resolution of abscess was achieved in five patients.

Conclusion

Special approaches, including transgluteal, presacral space, transhepatic, multiplane reconstruction (MPR)-assisted oblique approach and transintestinal afferent loop approach for those deep inaccessible intraabdominal and pelvic abscesses are safe and feasible.
Subtrochanteric femoral shortening osteotomy concomitantly performed with revision total hip arthroplasty
Authors: Takeda Yu , Fukunishi Shigeo , Nishio Shoji , Fujihara Yuki , Yoshiya Shinichi
Published: October 2018

Rationale:

Total hip arthroplasty (THA) concomitant with subtrochanteric femoral shortening osteotomy for Crowe type IV dysplastic hip has been reported. However, the combination of subtrochanteric femoral osteotomy and revision THA has only been mentioned in one case report.

Patient concerns:

A 67-year-old female had a history of congenital dislocation of both hips.

Diagnoses:

Right hip was diagnosed the aseptic loosening of THA with extremely high replacement of the acetabular component.

Interventions:

Revision THA concomitant with subtrochanteric femoral shortening osteotomy using a cement stem was performed. Before the revision surgery, primary THA with subtrochanteric shortening osteotomy was performed on the opposite side. Regarding leg length, the actual leg length of the affected side was 9 mm longer, and the subjective leg length discrepancy was 45 mm shorter in the affected limb due to pelvic obliquity. Subtrochanteric osteotomy was performed with an amount of osteotomy equal to the amount of distal translation of the hip center to the original acetabulum.

Outcomes:

As a result, pelvic obliquity improved, and the subjective leg length discrepancy disappeared after revision surgery.

Lessons:

The combination of subtrochanteric femoral shortening osteotomy with revision THA resulted in a satisfactory outcome.
Clinical and Genetic Study of Children With Peutz‐Jeghers Syndrome Identifies a High Frequency of STK11 De Novo Mutation
Authors: Zhao Hong‐Mei , Yang Yong‐Jia , Duan Jia‐Qi , Ouyang Hong‐Juan , Liu Li , Yi Li‐Chun , Xiao Zheng‐Hui , Zheng Yu , Peng Lv , Attard Thomas M. , Li Ding‐You , You Jie‐Yu
Published: October 2018

Objectives:

The present study aims to identify the genotype‐phenotype correlation in children with Peutz‐Jeghers Syndrome (PJS) through the analysis of STK11 gene mutations in the context of clinical and pathological characteristics.

Method:

In this observational cohort study, the clinical characteristics of 18 families diagnosed with pediatric PJS were collected. Genomic DNA from the peripheral blood of affected children and their family members was collected. The coding region of STK11 was amplified by PCR and screened for mutation by Sanger sequencing. The families that were negative for STK11 mutation were further assessed by multiplex ligation‐dependent probe amplification (MLPA).

Result:

Initial presentation in affected children was at 1.6 to 14.2 years and included anemia in 8 patients whereas 6 presented for screening by virtue of family history. All patients underwent endoscopy, colonoscopy, and polypectomy. Polyps were distributed throughout the gastrointestinal (GI) tract, including the small intestine, stomach, colon, and rectum.

In the 18 pediatric PJS families, STK11 mutations were detected in 8 families by Sanger sequencing, and large deletions were detected in 3 by MLPA, respectively. Nine of the 11 STK11 mutations were de novo, 3 were novel (c.419T>C:p.L140P, c.314T>G:p.L105X), and (c.488_489insACGG p.L164fs).

Conclusions:

Although the main clinical features of pediatric PJS were similar to those of PJS cases in adults, a high frequency of STK11 de novo mutations were encountered in our population of patients with PJS.
Where Do People Go for Gonorrhea and Chlamydia Tests: A Cross-Sectional View of the Central Indiana Population, 2003–2014
Authors: Batteiger Teresa A. , Dixon Brian E. , Wang Jane , Zhang Zuoyi , Tao Guoyu , Tong Yan , Tu Wanzhu , Hoover Sarah A. , Arno Janet N.
Published: October 2018

Background

Despite major efforts to control their spread, reported sexually transmitted infections (STI) are increasing. Using data from a mid-sized Midwest metropolitan area, we examined the settings in which individuals are tested for gonorrhea and chlamydia in relation to demographics and test result to determine where interventions may best be focused.

Methods

A deidentified and integrated registry, containing records from all patients tested for an STI from 2003 to 2014, was created by combining data from a large health information exchange and the reporting district's STI Program located in Indianapolis, IN. Individual characteristics and visit settings where gonorrhea and chlamydia testing was performed were analyzed.

Results

We identified 298,946 individuals with 1,062,369 visits where testing occurred at least once between the ages of 13 and 44 years. Females were tested significantly more often than males and received testing more often in outpatient clinics whereas males were most often tested in the STI clinic. Individuals who used both STI and non-STI settings were more likely to have a positive test at an STI or emergency department visit (6.4–20.8%) than outpatient or inpatient setting (0.0–11.3%) (P < 0.0001). Test visits increased over the study period particularly in emergency departments, which showed a substantial increase in the number of positive test visits.

Conclusions

The most frequent testing sites remain STI clinics for men and outpatient clinics for women. Yet, emergency departments (ED) are increasingly a source of testing and morbidity. This makes them a valuable target for public health interventions that could improve care and population health.
Renal Replacement Therapy Modalities in Critically Ill Children*
Authors: Beltramo Fernando , DiCarlo Joseph , Gruber Joshua B. , Taylor Thom , Totapally Balagangadhar R.
Published: October 2018

Objectives:

The objective of this study is to describe the relative frequency of use of continuous renal replacement therapy, intermittent hemodialysis, and peritoneal dialysis and to analyze characteristics and outcomes of critically ill children receiving renal replacement therapies admitted to PICUs that participate in the Virtual PICU (VPS LLC, Los Angeles, CA) registry.

Design:

Retrospective, database analysis.

Setting:

PICUs that participate in the Virtual PICU (VPS LLC) registry.

Patients:

Critically ill children admitted to PICUs that participate in the Virtual PICU (VPS LLC) registry and received renal replacement therapy from January 1, 2009, to December 31, 2015.

Interventions:

None.

Measurements and Main Results:

A total of 7,109 cases (53% males) received renal replacement therapy during the study period. The median age was 72.3 months (interquartile range, 8.4–170 mo) and median length of stay was 8.7 days (interquartile range, 3.3–21.2 d). Caucasians comprised 42% of the cohort and blacks and Hispanics were 16% each. Continuous renal replacement therapy was used in 46.5%, hemodialysis in 35.5% and peritoneal dialysis in 18%. Of the 7,109 cases, 1,852 (26%) were postoperative cases (68% cardiac surgical) and 981 (14%) had a diagnosis of cancer. Conventional mechanical ventilation was used in 64%, high-frequency oscillatory ventilation in 12%, noninvasive ventilation in 24%, and extracorporeal membrane oxygenation in 5.8%. The overall mortality was 22.3%. Patients who died were younger 40.8 months (interquartile range, 1.5–159.4 mo) versus 79.9 months (interquartile range, 12.6–171.7 mo), had a longer length of stay 15 days (interquartile range, 7–33 d) versus 7 days (interquartile range, 3–18 d) and higher Pediatric Index of Mortality 2 score –2.84 (interquartile range, –3.5 to –1.7) versus –4.2 (interquartile range, –4.7 to –3.0) (p < 0.05). On multivariate logistic regression analysis, higher mortality was associated with the presence of cancer (32.7%), previous ICU admission (32%), requiring mechanical ventilation (33.7%), receiving high-frequency oscillatory ventilation (67%), or extracorporeal membrane oxygenation (58.4%), admission following cardiac surgical procedure (29.4%), and receiving continuous renal replacement therapy (38.8%), and lower mortality was associated with hemodialysis (9.8%), and peritoneal dialysis (12.3%) (p < 0.0001).

Conclusions:

Continuous renal replacement therapy is an increasingly prevalent renal replacement therapy modality used in critically ill children admitted to an ICU. Higher mortality rate with the use of continuous renal replacement therapy should be interpreted with caution.
Surgical Safety Checklists in Children’s Surgery: Surgeons’ Attitudes and Review of the Literature
Authors: Roybal Jessica , Tsao KuoJen , Rangel Shawn , Ottosen Madelene , Skarda David , Berman Loren
Published: October 2018

Introduction:

Surgical safety checklists (SSCs) aim to create a safe operating room environment for surgical patients. Provider attitudes toward checklists affect their ability to prevent harm. Pediatric surgeons’ perceptions surrounding SSCs, and their role in improving patient safety, are unknown.

Methods:

American Pediatric Surgical Association members conducted an online survey to evaluate the use of and attitudes toward SSCs. The survey measured surgeons’ perceptions of checklists, including the components that make them effective and barriers to participation. To better evaluate the available data on SSCs, the authors performed a systematic literature review on the use of SSCs with a focus on pediatric studies.

Results:

Of the 353 survey respondents, 93.6% use SSCs and 62.6% would want one used in their own child’s operation, but only 54.7% felt that checklists improve patient safety. Reasons for checklist skepticism included the length of the checklist process, a distraction from thoughtful patient care, and lack of data supporting use. Literature review shows that checklists improve communication, promote teamwork, and identify errors, but do not necessarily decrease morbidity. Staff perception is a major barrier to implementation.

Conclusions:

Almost all pediatric surgeons participate in SSCs at their institutions, but many question their benefit. Better pediatric surgeon engagement in checklist use is needed to change the safety culture, improve operating room communication, and prevent harm.
Sexual Risk Compensation in a Pre-exposure Prophylaxis Demonstration Study Among Individuals at Risk of HIV
Authors: Milam Joel , Jain Sonia , Dubé Michael P. , Daar Eric S. , Sun Xiaoying , Corado Katya , Ellorin Eric , Blumenthal Jill , Haubrich Richard , Moore David J. , Morris Sheldon R. ,   the CCTG Team
Published: October 2018

Background:

A public health concern regarding HIV pre-exposure prophylaxis (PrEP) is sexual risk compensation (ie, increased unsafe sex among PrEP users that may undermine prevention efforts).

Methods:

This demonstration study (NCT#01761643; initiated in 2013) included 398 men who have sex with men who initiated PrEP and were followed over 48 weeks at 4 sites in Southern California. Wilcoxon signed-rank tests compared previous 30-day number of sex partners and condomless insertive anal sex and receptive anal sex (CIAS and CRAS, respectively) acts at weeks 4, 12, 24, 36, and 48 to baseline. At 2 sites, PrEP users were also compared with a lagged, comparison group of 99 men who have sex with men who did not receive PrEP over 24 weeks using linear regression models, adjusting for age, race/ethnicity, education, and respective baseline scores. Logistic regression compared week 24 sexually transmitted infection (STI) rates.

Results:

Over 48 weeks in the PrEP group, there were significant decreases in the number of unknown HIV status sex partners and increases in CRAS at all study visits; there was no consistent change in number of HIV+ sex partners or CIAS. Among participants at 2 sites, there were no significant differences between PrEP and non-PrEP users in change in number of partners, CIAS, CRAS, or STI rates at week 24.

Conclusions:

Among early adopters of PrEP, there is some evidence for sexual risk compensation. Results support current guidelines of regular STI screening and behavioral risk reduction and adherence counseling with the provision of PrEP.
In Their Own Words: Caregiver and Patient Perspectives on Stressors, Resources, and Recommendations in Craniofacial Microsomia Care
Authors: Johns Alexis L. , Luquetti Daniela V. , Brajcich Michelle R. , Heike Carrie L. , Stock Nicola M.
Published: October 2018

This study describes stressors, resources, and recommendations related to craniofacial microsomia (CFM) care from the perspective of caregivers of children with CFM and adults with CFM to inform improved quality of healthcare delivery. A mixed method design was used with fixed-response and open-ended questions from an online survey in English. The survey included demographics, CFM phenotypic information, and items about CFM-related experiences across settings. Themes were identified by qualitative analysis of responses to open-ended questions. Respondents (n = 51) included caregivers (n = 42; 90% mothers) and adults with CFM (n = 9; 78% female), who had a mean age of 45 ± 6 years. Most children were male (71%) with an average age of 7 ± 4 years. Respondents were primarily white (80%), non-Hispanic (89%), from the United States (82%), had a college degree (80%), and had private health insurance (80%). Reflecting the high rate of microtia (84%) in the sample, themes centered on the impact of hearing difficulties across settings with related language concerns. Negative social experiences were frequently described and school needs outlined. Multiple medical stressors were identified and corresponding suggestions included: providers need to be better informed about CFM, treatment coordination among specialists, and preference for a family-centered approach with reassurance, empathy, and clear communication. Advice offered to others with CFM included positive coping strategies. Overall, caregivers’ and patients’ responses reflected the complexity of CFM treatment. Incorporating these perspectives into routine CFM care has the potential to reduce family distress while improving their healthcare.
Distraction Sugosteogenesis: Its Biologic Bases and Therapeutic Principles
Authors: Castro-Núñez Jaime
Published: October 2018

Purpose:

Recently, the terms sugosteogenesis and distraction sugosteogenesis have been introduced to the scientific literature. While the former describes a biologic phenomenon, the latter refers to the clinical technique which relies on the accelerated normal bone healing process that takes place at the osseous walls surrounding a cystic cavity when active negative pressure is applied. The purpose of this study is to provide the biologic bases and the therapeutic principles of this emerging technique. Employing well-stablished biologic principles, clinical evidence from analogous techniques, emerging experimental data, and circumstantial evidence, this study presents the possible mechanism of action of the evacuator for odontogenic cysts (Evocyst), a closed, vacuum-like drain system intended to treat cystic conditions using negative pressure.

Methods:

A review of the literature was done. Keywords for the Medline search were: marsupialization, decompression, odontogenic cysts, effects of negative pressure on bone, and negative pressure wound therapy. In addition, relevant publications from the reference list of the retrieved studies were considered. The matches were evaluated for relevance and analyzed accordingly. Clinical reports used to illustrate the concept of distraction sugosteogenesis were performed following the Declaration of Helsinki on medical protocol and ethics.

Results:

Currently, the standard of care to manage odontogenic cystic lesions includes marsupialization, enucleation and curettage, decompression, and surgical resection. However, there is a need for an alternative option in which the entity could be treated while promoting bone formation. With large odontogenic cystic conditions treated in a short period of time, distraction sugosteogenesis appears to be a choice.

Conclusion:

The application of negative pressure to osseous cells produces a stretching that creates mechanical cues that trigger signaling pathways, promotes fluid flow, and enhances angiogenesis. All of them, combined, may explain sugosteogenesis. The clinical application of such parameters may explain the good clinical results obtained with the Evocyst.
Assessment of Vertical Triangular Spreader Graft Technique for Reconstruction of Middle Vault and Internal Nasal Valve Angle
Authors: Kocak Omer Faruk , Düzenli Ufuk
Published: October 2018

Background:

Rhinoplasty is a surgical procedure to smooth out the nasal deformities and to fix nasal breathing problems. Spreader grafts and flaps are used to prevent some complications such as middle vault collapse, narrowing the internal nasal valve and inverted V deformity. To obtain more stable middle vault, spreader grafts and flaps could be used together. Many researchers have tried different graft and flap techniques to reach more successful aesthetic and functional results. In this research, we investigated effects of triangular graft on the internal nasal valve angle, nasal breathing, and aesthetic outcomes when it used together with sprader flap.

Methods:

In this prospective study, 3 different groups were formed as: the spreader flap group (group 1); the spreader flap with the rectangular spreader graft group (group 2); and the spreader flap with the triangular spreader graft group (group 3). Preoperative nasal obstruction symptom evaluation (NOSE) scale was used to evaluate nasal breathing and visual analog scale (VAS) was used to evaluate aesthetic appearance. And also, measurement of the internal nasal valve angle was performed for each patients. These evaluations were repeated at postoperative 3rd month. Preoperative and postoperative comparisons between study groups were performed.

Results:

There were 12 patients in group 1, 14 patients in group 2, and 10 patients in group 3. In each group, statistically significant decrease in NOSE scores (P < 0.05) and statistical significant increase in VAS scores (P < 0.05) were observed. And also, increased internal nasal valve angle after surgery was detected in all groups (P < 0.05). Postoperative NOSE and VAS scores were found similar in 3 different groups (P > 0.05). On the contrary, the internal nasal valve angles were found statistically significant increased in group 3 according to other groups (P < 0.05).

Conclusion:

The results of this prospective study presented that the use of triangular spreader graft with spreader flap was an appropriate technique to obtain successful aesthetic and functional outcomes with widening the internal nasal valve angle.
Multi-robot replication of ant collective towing behaviours
Authors: Wilson Sean , Buffin Aurélie , Pratt Stephen C. , Berman Spring
Published: October 2018

In this work, teams of small mobile robots are used to test hypotheses about cooperative transport by ants. This study attempts to explain a decrease in steady-state transport speed with increasing team size that was previously observed in the ant
Novomessor cockerelli
. Two models of one-dimensional collective towing are compared: one in which transporters with different maximum speeds pull the payload with continuous, variable forces and another in which transporters with identical speeds pull with intermittent, unsynchronized forces. A statistical analysis of ant data supports the hypothesis that ants behave according to the first model, in which the steady-state transport speed is the maximum speed of the slowest teammate. By contrast, the ant data are not consistent with the second model, which predicts constant speed regardless of team size. To verify these predictions, the ant behaviours in each model are translated into decentralized controllers and implemented on teams of two to four robots. The controller for the first model incorporates a real-time reinforcement learning algorithm that successfully reproduces the observed relationship between ant team size and transport speed. The controller for the second model yields the predicted invariance of transport speed with team size. These results show the value of robotic swarms for testing mechanistic hypotheses about biological collectives.
Variations in power of opinion leaders in online communication networks
Authors: Adalat Mohsin , Niazi Muaz A. , Vasilakos Athanasios V.
Published: October 2018

Online social media has completely transformed how we communicate with each other. While online discussion platforms are available in the form of applications and websites, an emergent outcome of this transformation is the phenomenon of ‘opinion leaders’. A number of previous studies have been presented to identify opinion leaders in online discussion networks. In particular, Feng (2016Comput. Hum. Behav.54, 43–53. (doi:10.1016/j.chb.2015.07.052)) has identified five different types of central users besides outlining their communication patterns in an online communication network. However, the presented work focuses on a limited time span. The question remains as to whether similar communication patterns exist that will stand the test of time over longer periods. Here, we present a critical analysis of the Feng framework both for short-term as well as for longer periods. Additionally, for validation, we take another case study presented by Udanoret al.(2016Program50, 481–507. (doi:10.1108/PROG-02-2016-0011)) to further understand these dynamics. Results indicate that not all Feng-based central users may be identifiable in the longer term. Conversation starter and influencers were noted as opinion leaders in the network. These users play an important role as information sources in long-term discussions. Whereas network builder and active engager help in connecting otherwise sparse communities. Furthermore, we discuss the changing positions of opinion leaders and their power to keep isolates interested in an online discussion network.
Rapid detection of cocaine using aptamer-based biosensor on an evanescent wave fibre platform
Authors: Qiu Yong , Tang Yunfei , Li Bing , He Miao
Published: October 2018

The rapid detection of cocaine has received considerable attention because of the instantaneous and adverse effects of cocaine overdose on human health. Aptamer-based biosensors for cocaine detection have been well established for research and application. However, reducing the analytic duration without deteriorating the sensitivity still remains as a challenge. Here, we proposed an aptamer-based evanescent wave fibre (EWF) biosensor to rapidly detect cocaine in a wide working range. At first, the aptamers were conjugated to complementary DNA with fluorescence tag and such conjugants were then immobilized on magnetic beads. After cocaine was introduced to compete against the aptamer-DNA conjugants, the released DNA in supernatant was detected on the EWF platform. The dynamic curves of EWF signals could be interpreted by the first-order kinetics and saturation model. The semi-log calibration curve covered a working range of 10–5000 µM of cocaine, and the limit of detection was approximately 10.5 µM. The duration of the full procedure was 990 s (16.5 min), and the detection interval was 390 s (6.5 min). The specified detection of cocaine was confirmed from four typical pharmaceutic agents. The analysis was repeated for 50 cycles without significant loss of sensitivity. Therefore, the aptamer-based EWF biosensor is a feasible solution to rapidly detect cocaine.
Two sources of bias explain errors in facial age estimation
Authors: Clifford Colin W. G. , Watson Tamara L. , White David
Published: October 2018

Accurate age estimates underpin our everyday social interactions, the provision of age-restricted services and police investigations. Previous work suggests that these judgements are error-prone, but the processes giving rise to these errors are not understood. Here, we present the first systematic test of bias in age estimation using a large database of standardized passport images of heterogeneous ages (
n
= 3948). In three experiments, we tested a range of perceiver age groups (
n
= 84), and found average age estimation error to be approximately 8 years. We show that this error can be attributed to two separable sources of bias. First, and accounting for the vast majority of variance, our results show an assimilative serial dependency whereby estimates are systematically biased towards the age of the preceding face. Second, younger faces are generally perceived to be older than they are, and older faces to be younger. In combination, these biases account for around 95% of variance in age estimates. We conclude that perception of age is modulated by representations that encode both a viewer's recent and normative exposure to faces. The finding that age perception is subject to strong top-down influences based on our immediate experience has implications for our understanding of perceptual processes involved in face perception, and for improving accuracy of age estimation in important real-world tasks.
On critical dynamics and thermodynamic efficiency of urban transformations
Authors: Crosato Emanuele , Nigmatullin Ramil , Prokopenko Mikhail
Published: October 2018

Urban transformations within large and growing metropolitan areas often generate critical dynamics affecting social interactions, transport connectivity and income flow distribution. We develop a statistical–mechanical model of urban transformations, exemplified for Greater Sydney, and derive a thermodynamic description highlighting critical regimes. We consider urban dynamics at two time scales: fast dynamics for the distribution of population and income, modelled via the maximum entropy principle, and slower dynamics evolving the urban structure under spatially distributed competition. We identify phase transitions between dispersed and polycentric phases, induced by varying the
social disposition
—a factor balancing the suburbs’ attractiveness—in contrast with the
travel impedance
. Using the Fisher information, we identify critical thresholds and quantify the thermodynamic cost of urban transformation, as the minimal work required to vary the underlying parameter. Finally, we introduce the notion of
thermodynamic efficiency of urban transformation
, as the ratio of the order gained during a change to the amount of required work, showing that this measure is maximized at criticality.
Finding the weakest link: mechanical sensitivity in a fish cranial linkage system
Authors: Baumgart A. , Anderson P.
Published: October 2018

Understanding the physical mechanics behind morphological systems can offer insights into their evolution. Recent work on linkage systems in fish and crustaceans has suggested that the evolution of such systems may depend on mechanical sensitivity, where geometrical changes to different parts of a biomechanical system have variable influence on mechanical outputs. While examined at the evolutionary level, no study has directly explored this idea at the level of the mechanism. We analyse the mechanical sensitivity of a fish cranial linkage to identify the influence of linkage geometry on the kinematic transmission (KT) of the suspensorium, hyoid and lower jaw. Specifically, we answer two questions about the sensitivity of this linkage system: (i) What changes in linkage geometry affect one KT while keeping the other KTs constant? (ii) Which geometry changes result in the largest and smallest changes to KT? Our results show that there are ways to alter the morphology that change each KT individually, and that there are multiple ways to alter a single link that have variable influence on KT. These results provide insight into the morphological evolution of the fish skull and highlight which structural features in the system may have more freedom to evolve than others.
Magnetoliposomes containing magnesium ferrite nanoparticles as nanocarriers for the model drug curcumin
Authors: Cardoso Beatriz D. , Rio Irina S. R. , Rodrigues Ana Rita O. , Fernandes Francisca C. T. , Almeida B. G. , Pires A. , Pereira A. M. , Araújo J. P. , Castanheira Elisabete M. S. , Coutinho Paulo J. G.
Published: October 2018

Magnesium ferrite nanoparticles, with diameters around 25 nm, were synthesized by coprecipitation method. The magnetic properties indicate a superparamagnetic behaviour, with a maximum magnetization of 16.2 emu g
−1
, a coercive field of 22.1 Oe and a blocking temperature of 183.2 K. These MgFe
2
O
4
nanoparticles were used to produce aqueous and solid magnetoliposomes, with sizes below 130 nm. The potential drug curcumin was successfully incorporated in these nanosystems, with high encapsulation efficiencies (above 89%). Interaction by fusion between both types of drug-loaded magnetoliposomes (with or without PEGylation) and models of biological membranes was demonstrated, using FRET or fluorescence quenching assays. These results point to future applications of magnetoliposomes containing MgFe
2
O
4
nanoparticles in cancer therapy, allowing combined magnetic hyperthermia and chemotherapy.
Novel elucidation and treatment of pancreatic chronic graft-versus-host disease in mice
Authors: Mukai Shin , Ogawa Yoko , Urano Fumihiko , Kawakami Yutaka , Tsubota Kazuo
Published: October 2018

Chronic graft-versus-host disease (cGVHD) is a severe complication of allogeneic haematopoietic stem cell transplantation. There is a growing understanding of cGVHD, and several effective therapies for cGVHD have been reported. However, pancreatic cGVHD is a potentially untapped study field. Our thought-provoking study using a mouse model of cGVHD suggested that the pancreas could be impaired by cGVHD-induced inflammation and fibrosis and that endoplasmic reticulum (ER) stress was augmented in the pancreas affected by cGVHD. These findings urged us to treat pancreatic cGVHD through reduction of ER stress, and we used 4-phenylbutyric acid (PBA) as an ER stress reducer. A series of experiments has indicated that PBA can suppress cGVHD-elicited ER stress in the pancreas and accordingly alleviate pancreatic cGVHD. Furthermore, we focused on a correlation between epithelial to mesenchymal transition (EMT) and fibrosis in the cGVHD-affected pancreas, because EMT was conceivably implicated in various fibrosis-associated diseases. Our investigation has suggested that the expression of EMT markers was increased in the cGVHD-disordered pancreas and that it could be reduced by PBA. Taken together, we have provided a clue to elucidate the pathogenic process of pancreatic cGVHD and created a potentially effective treatment of this disease using the ER stress alleviator PBA.
A global cline in a colour polymorphism suggests a limited contribution of gene flow towards the recovery of a heavily exploited marine mammal
Authors: Hoffman J. I. , Bauer E. , Paijmans A. J. , Humble E. , Beckmann L. M. , Kubetschek C. , Christaller F. , Kröcker N. , Fuchs B. , Moreras A. , Shihlomule Y. D. , Bester M. N. , Cleary A. C. , De Bruyn P. J. N. , Forcada J. , Goebel M. E. , Goldsworthy S. D. , Guinet C. , Hoelzel A. R. , Lydersen C. , Kovacs K. M. , Lowther A.
Published: October 2018

Evaluating how populations are connected by migration is important for understanding species resilience because gene flow can facilitate recovery from demographic declines. We therefore investigated the extent to which migration may have contributed to the global recovery of the Antarctic fur seal (Arctocephalus gazella), a circumpolar distributed marine mammal that was brought to the brink of extinction by the sealing industry in the eighteenth and nineteenth centuries. It is widely believed that animals emigrating from South Georgia, where a relict population escaped sealing, contributed to the re-establishment of formerly occupied breeding colonies across the geographical range of the species. To investigate this, we interrogated a genetic polymorphism (S291F) in the melanocortin 1 receptor gene, which is responsible for a cream-coloured phenotype that is relatively abundant at South Georgia and which appears to have recently spread to localities as far afield as Marion Island in the sub-Antarctic Indian Ocean. By sequencing a short region of this gene in 1492 pups from eight breeding colonies, we showed that S291F frequency rapidly declines with increasing geographical distance from South Georgia, consistent with locally restricted gene flow from South Georgia mainly to the South Shetland Islands and Bouvetøya. The S291F allele was not detected farther afield, suggesting that although emigrants from South Georgia may have been locally important, they are unlikely to have played a major role in the recovery of geographically more distant populations.
On the computation of hybrid modes in planar layered waveguides with multiple anisotropic conductive sheets
Authors: Michalski K. A. , Mustafa M. M.
Published: October 2018

A reliable method is presented for the computation of the propagation constants and the corresponding hybrid modal fields in multilayered planar dielectric stacks comprising multiple anisotropic conducting sheets. The appropriate dispersion functions (DFs) are formulated and evaluated using a numerically stable scattering matrix methodology. The roots of the DFs are computed by the Cauchy integration method with automatic differentiation of the DF.