bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effectiveness of Induced Defense Responses in a Susceptible Potato Genotype Depends on the Growth Rate of Phytophthora infestans
Authors: Thomas Cécile , Mabon Romain , Andrivon Didier , Val Florence
Published: July 2018

Phytophthora infestans causes the devastating potato late blight disease, which is widely controlled with fungicides. However, the debate about chemical control is fueling a promotion toward alternative methods. In this context, the enhancement of natural plant immunity could be a strategy for more sustainable protection. We previously demonstrated that a concentrated culture filtrate (CCF) of P. infestans primes defense reactions in potato. They are genotype-dependent and metabolites produced decrease pathogen growth in vitro but not in vivo on tubers. Induced potato defenses are assumed to affect P. infestans life history traits depending on strains. This assumption was studied in vivo through induced leaflets on a susceptible genotype inoculated with four P. infestans strains differing for lesion growth rate. This study combines both defenses mechanistic analysis and ecological observations. Defense-gene expressions were thus assessed by quantitative reverse transcription-polymerase chain reaction; pathogen development was simultaneously evaluated by measuring necrosis, quantifying mycelial DNA, and counting sporangia. The results showed that CCF pretreatment reduced the pathogenicity differences between slow- and fast-growing strains. Moreover, after elicitation, PR-1, PR-4, PAL, POX, and THT induction was strain-dependent. These results suggest that P. infestans could develop different strategies to overcome plant defenses and should be considered in biocontrol and epidemic management of late blight.
A Typology of Breastfeeding Mothers of Preterm Infants
Authors: Niela-Vilén Hannakaisa , Axelin Anna , Salanterä Sanna , Melender Hanna-Leena
Published: July 2018

Background:

Breastfeeding is an important element of motherhood with a preterm infant, but the role of maternal emotions in relation to breastfeeding is vague.

Purpose:

To describe maternal emotions regarding and insights into breastfeeding during the first year after a preterm birth.

Methods:

In total, 80 mothers of preterm infants (<35 gestational weeks) participated in this secondary analysis of a larger study. The data were collected with an open question at discharge and 3, 6, and 12 months after the expected birth date and analyzed using thematic analysis.

Findings:

A typology of breastfeeding mothers of preterm infants was created. The group of survivors wished to be breastfeeding mothers, but after some unexpected difficulties, they had to give up their dream. The disappointment alleviated with time, but some of the mothers still harbored self-accusations after a year. The highfliers were mothers who succeeded in breastfeeding because of their own persistence. They described breastfeeding as enjoyable for both the mother and the infant. The pragmatist mothers breastfed because it was the general norm and a practical way to feed the infant; breastfeeding caused neither passion nor discomfort. The group of bottle-feeding–oriented mothers expressed that breastfeeding did not interest them at any point.

Implications for Practice:

Being aware of the typology could help nurses and midwives carefully observe mothers' individual counselling needs. Mothers' wishes and decisions regarding breastfeeding need to be respected and supported without any judgment.

Implications for Research:

The possibilities to tailor breastfeeding interventions based on the typology should be investigated.
A Qualitative Study on Factors Modulating Tinnitus Experience
Authors: Colagrosso Emilia M. G. , Fournier Philippe , Fitzpatrick Elizabeth M. , Hébert Sylvie
Published: July 2018

Objectives:

It is well recognized that tinnitus can severely interfere with important aspects of life such as sleep, concentration abilities, social activities, and mood. However, the impact of tinnitus may vary greatly from one individual to another, with some being severely affected and others only experiencing a slight handicap. Information from participants’ experiences with tinnitus could help explain such variability. The full experience of living with tinnitus from a patient’s perspective has been under-investigated, especially in comparison with the large and extensive body of qualitative research on hearing loss. This study aims to contribute to fill this gap and assess participants’ experience of living with tinnitus.

Design:

As part of a larger mixed design study, this inquiry used qualitative analyses to investigate participant’s experiences with tinnitus. Twenty-seven tinnitus participants of different ages, sexes, audiometric profiles, and tinnitus severities were invited to discuss their tinnitus through semistructured interviews and journal entries. The interviews took place 1 month after participants completed a 3-week trial period with tinnitus maskers.

Results:

The findings were grouped into three main themes: participants’ appraisal of their tinnitus, factors modulating tinnitus experience, and consequences of tinnitus. Regarding participants’ appraisal of their tinnitus, a dissociation between the tinnitus sensation (pitch, loudness) and tinnitus experience (annoyance/distress) was reported. Factors modulating tinnitus experience were classified as environmental factors and individual-specific factors, which were further divided into soundscape and other environmental factors for the former and attentional focus, stress level, physical state, fatigue, and auditory effort for the latter. Consequences of tinnitus included distraction, disrupted mental health and mood, headaches, fatigue, sleep disturbances, hearing difficulties, disrupted social life, and frustration.

Conclusions:

Two of the main themes (participants’ appraisal of their tinnitus and consequences of tinnitus) were consistent with findings from a few previous qualitative studies. Factors modulating tinnitus experience also emerged as a prominent theme. Indeed, participants described a plethora of factors that affected their experiences of tinnitus. On the basis of these findings, an attentional model is proposed to account for how these factors might modulate the effects of tinnitus.
INCIDENCE OF LATE AGE-RELATED MACULAR DEGENERATION IN EYES WITH RETICULAR PSEUDODRUSEN
Authors: Kong Mingui , Kim Sungmin , Ham Don-Il
Published: July 2018

Purpose:

To investigate the incidence of late age-related macular degeneration (AMD) over 3 years and risk factors for the development of late AMD in Korean patients having reticular pseudodrusen (RPD).

Methods:

Clinical records of Korean RPD patients with no late AMD at first examination and completion of 3 years of regular follow-up were retrospectively reviewed. All patients underwent complete ocular examinations, including multimodal imaging. Reticular pseudodrusen were classified as a separate lesion different from other early AMD lesions, and RPD were not considered a sign of early AMD. Risk factors for the development of late AMD were assessed.

Results:

One hundred and ninety-two RPD eyes of 104 patients were included in this study. Mean age of patients was 69.4 ± 8.9 years, and other early AMD lesions were accompanied in 152 eyes (79.2%) at baseline. During 3 years, late AMD occurred in 30 eyes (15.6%); geographic atrophy in 24 eyes (12.5%); and neovascular AMD in 6 eyes (3.1%). Eyes having early AMD at baseline revealed significantly higher incidence for late AMD than those eyes having no early AMD at baseline (18.4% vs. 5%, P = 0.048). Late AMD occurred in 5 eyes (38.5%) from 13 fellow RPD eyes of unilateral late AMD at baseline. In logistic regression analysis, thin choroidal thickness, diffuse distribution of RPD, and the presence of late AMD on fellow eye at baseline were significant risk factors for developing late AMD in RPD eyes.

Conclusion:

Reticular pseudodrusen eyes revealed various progression rates to late AMD according to AMD status of both eyes. More frequent monitoring should be considered for patients with RPD at risk of progression to late AMD.
LINEZOLID-INDUCED MITOCHONDRIAL TOXICITY PRESENTING AS RETINAL NERVE FIBER LAYER MICROCYSTS AND OPTIC AND PERIPHERAL NEUROPATHY IN A PATIENT WITH CHRONIC GRANULOMATOUS DISEASE
Authors: Pilania Rakesh K. , Arora Atul , Agarwal Aniruddha , Jindal Ankur K. , Aggarwal Kanika , Krishnan Gopala , Suri Deepti , Gupta Anju , Singh Surjit , Gupta Vishali
Published: July 2018

Purpose:

To report a case with unique changes in the retinal nerve fiber layer observed on optical coherence tomography in a 22-year-old patient on chronic linezolid therapy for recurrent pyogenic liver abscesses with underlying chronic granulomatous disease.

Methods:

History and clinical examination, laboratory evaluation, fluorescein angiography, and optical coherence tomography.

Results:

The patient presented with best-corrected visual acuity of 20/200 in the right eye and 20/125 in the left eye. He had moderate optic disk edema and superotemporal field defects bilaterally. Swept-source optical coherence tomography revealed the presence of retinal nerve fiber layer microcystic spaces. Laboratory tests showed no positive findings except for an elevated lactic acid level. Linezolid-induced optic neuropathy was suspected, and the drug was discontinued. Six weeks after termination of oral linezolid therapy, the optic disk edema and the microcystic spaces in the retinal nerve fiber layer resolved, and the best-corrected visual acuity improved to 20/50 in the right and 20/40 in the left eye, respectively.

Conclusion:

Linezolid is a widely used antibiotic with broad-spectrum action. However, chronic use can lead to mitochondrial toxicity that may have protean manifestations. Ocular examination, particularly of the optic nerve and nerve fiber layer using multimodal imaging, is critical in diagnosing such toxicity.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN ACUTE RETINAL NECROSIS
Authors: Costa de Andrade Gabriel , Marchesi Mello Luiz G. , Martines Gabriela C. , Maia André
Published: July 2018

Purpose:

To report clinical features of acute retinal necrosis (ARN) using optical coherence tomography angiography.

Methods:

A 59-year-old female patient presented with blurred vision in the left eye for 1 day. The patient presented posterior uveitis with multiple peripheral areas of retinal pallor with presumed acute retinal necrosis. Herpes simplex virus Type 1 infection was confirmed after serologic tests, and the polymerase chain reaction analysis of the aqueous humor tested positive.

Results:

The left eye examination revealed anterior chamber reaction, mild vitritis, optic disk swelling, and yellowish white retinal lesions with discrete borders along the superotemporal arcade and temporal periphery. Baseline optical coherence tomography angiography revealed decreased vascular density of superficial and deep plexuses of superotemporal macular region. One month after oral valacyclovir 2,000 mg twice daily, visual acuity and retinal lesions improved, and optical coherence tomography angiography images showed improvement of vascular density.

Conclusion:

Occlusive arterial vasculopathy is one of the main clinical characteristics of acute retinal necrosis. We herein describe for the first time the features of retinal vasculature in acute retinal necrosis revealed by optical coherence tomography angiography, showing decreased vascular density of superficial and deep plexuses.
Moderately Long-Term Safety and Efficacy of Repeat Penetrating Keratoplasty
Authors: Kitazawa Koji , Wakimasu Koichi , Kayukawa Kanae , Yokota Isao , Inatomi Tsutomu , Hieda Osamu , Sotozono Chie , Kinoshita Shigeru
Published: July 2018

Purpose:

To investigate the moderately long-term safety and efficacy of repeat penetrating keratoplasty (PK) for treatment of a failed PK graft.

Methods:

Retrospective consecutive clinical case series. Of 992 consecutive cases that underwent PK at Baptist Eye Institute, Kyoto, Japan, between April 1998 and September 2013, 96 cases that underwent repeat PK with more than 3 years postoperatively follow-up were retrospectively reviewed. Surgical outcomes including donor graft survival rate, best spectacle-corrected visual acuity, endothelial cell density, and complications afeter repeat PK were assessed.

Results:

At 1, 3, and 5 years after repeat PK, the donor graft survival rate was 91%, 75%, and 64%, respectively, and the mean endothelial cell density in those survived grafts was 1778, 1207, and 989 cells/mm2, respectively. Best spectacle-corrected visual acuity over 20/200 and 20/40 was achieved in 71% and 27% of the patients, respectively, at 1 year postoperatively, in 59% and 31% of the patients, respectively, at 3 years postoperatively, and in 53% and 29% of the patients, respectively, at 5 years postoperatively. The most common complication for repeat PK was the need for additional glaucoma surgery [n = 11 patients (11.5%)]. Cox proportional hazard regression analyses revealed that previous glaucoma surgery and a rejection episode were high risk factors for graft failure in repeat PK [hazard ratio (HR) = 6.7; 95% confidence interval (CI), 2.1–21.2 and HR = 5.6; 95% CI, 1.8–18.0, respectively].

Conclusions:

Repeat PK provided relatively safe and effective moderately long-term surgical outcomes.
Endobronchial Myxoma
Authors: Mukherjee Arindam , Agarwal Ritesh , Dhooria Sahajal , Singh Pawan , Bal Amanjit , Singh Harkant , Sehgal Inderpaul S.
Published: July 2018

A 31-year-old woman presented with progressive breathlessness since 1 year. Flexible bronchoscopy revealed a vascular tumor completely occluding the right main bronchus. A diagnosis of primary endobronchial myxoma was made. Tumor debulking was performed using rigid bronchoscopy. This enabled right lower lobectomy. A literature search yielded 12 cases of primary pulmonary myxoma, and only 2 previous reports of endobronchial myxoma. Most tumors were incidentally detected and were cured surgically. Endobronchial myxomas are rare and are usually asymptomatic. Treatment involves surgical excision. Rigid bronchoscopy serves as a bridge to surgery and can reduce the extent of surgery.
Prospective Experience of High-flow Nasal Oxygen During Bronchoscopy in 182 Patients
Authors: Service Jennifer A. , Bain Jennifer S. , Gardner Clare P. , McNarry Alistair F.
Published: July 2018

Background:

High-flow nasal oxygen (HFNO) has recently gained popularity during administration of anesthesia in a variety of circumstances, including apneic oxygenation. Fully qualified anesthesiologists provide sedation for our outpatient bronchoscopy service. We adopted this therapy to assess its efficacy providing optimal conditions (using a variety of sedation regimens) for patient and bronchoscopist.

Methods:

We aimed to conduct a prospective feasibility evaluation. We collected data from all patients undergoing outpatient bronchoscopy or endobronchial ultrasound with anesthesiologist administered sedation over 21 months. Demographic data, high-flow settings, sedation techniques, and oxygen saturations (SpO2) were collected for each patient. Feedback from the bronchoscopists and anesthesiologists was recorded. Failure of the technique was defined as abandonment of the procedure or prolonged desaturation not amenable to basic airway maneuvers or increase in oxygen flow rate.

Results:

All 182 patients underwent satisfactory bronchoscopy or endobronchial ultrasound. Mean age was 63 (±14) years. High-flow rate varied from 10 to 70 L/min. All patients received a remifentanil infusion and 175 (96%) had a propofol infusion. SpO2 before the procedure were lower (96%) than the highest saturation during the procedure with high flow (100%, P<0.0001). Ten patients transiently desaturated to <89%. Some had their flow rates increased, others required a transient jaw thrust, but all patient’s saturations rapidly returned to satisfactory levels. One patient became apneic during sedation. Respiration returned after pausing the sedation and oxygen SpO2 remained above 93% throughout. All bronchoscopists and anesthesiologists were happy with the use of HFNO.

Conclusion:

HFNO has been shown to be effective in the outpatient bronchoscopy setting. Further evaluation regarding flow rates and levels of sedation is required.
States worse than death
Authors: Hillman Ken , Athari Fakhri , Forero Roberto
Published: July 2018

Purpose of review

This review aims to discuss situations where patients would prefer to consider dying rather than survive, particularly in the context of choosing whether to be subjected to active medical management aimed at increasing their life span.

Recent findings

Obviously, there are no randomized trials on evaluating whether patients would choose death rather than life. Moreover, the topic of the review is rarely addressed in a conventional scientific way. Instead, we review the suffering that people may go through when receiving futile care in both the short and long-term in acute hospitals and how this may influence people's decisions about their own Goals of Care.

The review describes the failure of acute hospitals to recognize people at the end of life until very late and, when they are recognized, the failure to manage the dying process well. The inference is that if patients were genuinely aware of the potential short and long-term suffering involved in futile care, they would consider those states worse, may be worse than death, especially when death is almost certainly inevitable with or without conventional treatment.
An update on research examining the implications of stigma for access to and utilization of bariatric surgery
Authors: Phelan Sean M.
Published: July 2018

Purpose of review

To summarize recent literature examining the relationship between stigma and utilization of surgical treatments for obesity.

Recent findings

The stigma of obesity and stigma associated with surgical treatments for obesity can affect both healthcare providers’ recommendations of these options and patients’ likelihood of considering and choosing these treatments. Presurgical requirements of healthcare and insurance organizations and a lack of postsurgical support reflect the stigmatizing attitudes that bariatric/metabolic surgery is an ‘easy fix’ and ‘last resort’ for patients too undisciplined to lose weight in other ways.

Here we review the literature published in the last year that addresses the implications of stigma for the utilization and outcomes of surgical treatments for obesity.
Changes in Utilization and Expenditures for Medicare Beneficiaries in Patient-centered Medical Homes
Authors: Nichols Donald E. , Haber Susan G. , Romaire Melissa A. , Wensky Suzanne G.
Published: July 2018

Background:

Patient-centered medical homes are expected to reduce expenditures by increasing the use of primary care services, shifting care from inpatient to outpatient settings, and reducing avoidable utilization. Under the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare joined Medicaid and commercial payers in 8 states to support ongoing patient-centered medical home initiatives.

Objective:

To evaluate the effects of the MAPCP Demonstration on health care utilization and expenditures for Medicare beneficiaries.

Research Design:

We used difference-in-differences regression modeling to estimate changes in utilization and expenditures before and after the start of the MAPCP Demonstration, comparing beneficiaries engaged with MAPCP Demonstration practices to beneficiaries engaged with primary care practices that were not medical homes. Qualitative data collected during annual site visits provided contextual information on participating practices to inform interpretations of the demonstration outcomes.

Subjects:

Fee-for-service Medicare beneficiaries attributed to MAPCP Demonstration practices or to comparison group practices.

Measures:

Medicare claims were used to measure total Medicare expenditures and utilization and expenditures for inpatient, emergency room, primary care, and specialist services.

Results:

Despite the transformation of practices over the demonstration period, there was minimal evidence of a shift to more efficient utilization of health care services, and only 1 state saw a statistically significant reduction in total per-beneficiary expenditures.

Conclusions:

Although the MAPCP Demonstration did not have strong, consistent impacts on utilization and expenditures, this evaluation provides insights that may be useful for the design of future health care transformation models.
Pilot Analysis of Early Lactobacillus rhamnosus GG for Infant Colic Prevention
Authors: Cabana Michael D. , McKean Michelle , Beck Amy L. , Flaherman Valerie
Published: July 2018

We conducted a secondary analysis of data from a trial of Lactobacillus rhamnosus GG (LGG) supplementation as a pilot study to assess whether LGG prevents infant colic. For the first 6 months of life, infants received a daily dose of 10 billion colony‐forming units of LGG or a control (n = 184). We compared the likelihood of a diagnosis of colic before 4 months of age, based on parent‐reported symptoms or a physician diagnosis of colic. Out of the 184 infants, 18 (9.8%) had colic. There were no differences between the 2 groups in the percentage of infants with colic based on symptoms (control 5.4% vs LGG 9.8%; P = 0.19); physician diagnosis (control 3.2% vs LGG 7.6%; P = 0.26); or either symptoms or diagnosis combined (control 6.5% vs LGG 13.0%; P = 0.13). In this pilot study, early infant LGG supplementation does not appear to prevent the later development of colic.
Comparison of the Nutrient Content of Cow’s Milk and Nondairy Milk Alternatives
Authors: Schuster Margaret J. , Wang Xinyue , Hawkins Tiffany , Painter James E.
Published: July 2018

Considering the number of non-dairy milk alternatives (NDMAs), it is important to recognize the nutrients they provide and their cost in comparison to cow’s milk. Using nutrient data from the US Department of Agriculture Food Composition Databases and branded Web sites, we compared the amount of key nutrients provided by 2 categories of cow’s milk (white and flavored), with the amount of those nutrients typically found in 3 categories (unsweetened, original, and flavored) of the most popular NDMAs, including soy, rice, almond, coconut, and cashew milks. We evaluated beverages focusing on the 2015 Dietary Guidelines for Americans shortfall nutrients that are underconsumed in the United States: potassium, dietary fiber, choline, magnesium, calcium, and vitamins A, D, E, and C, although additional nutrients are considered. Nutrients that are overconsumed were also considered: added sugars, saturated fat, and sodium. If only NDMAs fortified with vitamins A, D, and calcium are considered, the NDMAs have a nutrient profile similar to cow’s milk for these nutrients. When considering the nutrients that are not fortified, soy is the only NDMA that is comparable to cow’s milk. All of the other NDMAs contain considerably less of these unfortified minerals. Fat-free cow’s milk and soy milk contain similar amounts of protein, 8 and 7 g, respectively. Almond, cashew, coconut, and rice milks provide approximately 1 g or less of protein per serving. Unfortified skim milk contains 7 nutrients greater than 10% of the daily value including protein, calcium, vitamin B12, riboflavin, niacin, phosphorus, and pantothenic acid; unfortified soy milk has 2 nutrients greater than 10% (calcium and protein), and unfortified almond, coconut, and cashew do not have any nutrients greater than 10% of the daily value. In conclusion, if the reason for consuming NDMAs is to provide a beverage that is nutritionally similar to cow’s milk for growing children, then only soy is nutritionally similar, and the other NDMAs are not a good substitute. If the goal is a vegan, sugar-free, low-calorie beverage that provides calcium, and total nutrient content is not a major factor, then an unflavored, unsweetened NDMAs may be a good alternative to cow’s milk. Overall, our conclusions agree with Singhal et al (J Pediatr Gastroenterol Nutr. 2017;64(5):799–805), if the goal is to provide a beverage nutritionally similar to cow’s milk for growing children, then, with the exception of soy, NDMAs are not nutritionally similar to cow’s milk and are not a good substitute.
Coloring the Truth: Color Additives in Nutrition and Health
Authors: Clemens Roger , Pressman Peter
Published: July 2018

Food coloring additives are widely utilized, have important functions, and are generally poorly understood in terms of their chemistry, health impact, and regulation. The following review summarizes which coloring additives are required for certification by the Food and Drug Administration and which are exempt from certification. The chemical structure of coloring agents is described, and the distinction is made between the 2 principal forms of agents: dyes and lakes. The extensive and still controversial and important history of the alleged association between artificial food colors and childhood behavioral abnormalities is critically reviewed along with the epidemiological and neuroscience components of the discussion. Finally, the regulation of food coloring additives is discussed. Apart from an updated narrative on the color of nutrition, this topic serves as an example of the importance of a rigorous and critical review of a scientific literature in order to get at “the truth.”
Esophageal Retained Lithium Battery in Children Younger than 6 Years
Authors: Lisi Gabriele , Illiceto Maria Teresa , Romeo Erminia Francesca , Lauriti Giuseppe , Faraci Simona , Lombardi Giuliano , Dall'Oglio Luigi , Chiesa Pierluigi Lelli
Published: July 2018

Objectives

Disk battery esophageal retention in children younger than 6 years represents an increasing endoscopic emergency, followed by a relevant risk of life-threatening late complications. Surgical removal after a failed endoscopic approach is rarely reported in the literature. We describe our experience in this scenario.

Methods

Two female asymptomatic patients aged 26 and 29 months presented within 4 hours after a witnessed ingestion of a 2-cm, 3-V lithium battery (CR2032) retained in the cervical esophagus. Both patients underwent a prolonged unsuccessful emergent endoscopic removal with a flexible instrument performed by an adult gastroenterologist. Both batteries fused with the esophageal wall were extracted through a longitudinal left cervical esophagotomy combined with minimal resection of necrotic tissues and repaired over a 12F feeding tube.

Results

Patients were extubated after 12 and 72 hours, respectively. Contrast study was performed after 20 and 13 days, respectively, before resuming oral feeding. At endoscopy, the first patient developed a 3-cm-long severe esophageal stenosis (35th day), followed by an asymptomatic tracheoesophageal fistula (60th day), which was conservatively treated. After spontaneous resolution of the tracheoesophageal fistula, esophageal stenosis progressed, partially responsive to esophageal stenting. Short esophagectomy is under evaluation. The second patient developed an asymptomatic limited stenosis, not requiring dilatation.

Conclusions

The emergent management of lithium battery ingestion needs a structured timely multidisciplinary approach in the emergency department, an experienced pediatric endoscopist, and a simultaneous engagement of pediatric surgical expertise, even in patients who do not show bleeding, to reduce esophageal exposure time to high-voltage current released by batteries, which represents the main factor conditioning tissue damage and prognosis.
A Sustainable and Scalable Approach to the Provision of Cleft Care: A Focus on Safety and Quality
Authors: Braun Tara L. , Louis Matthew R. , Dickey Ryan M. , Buchanan Edward P.
Published: July 2018

Background:

A global health model based on partnering with local hospitals and surgical teams, providing education and training for local providers, and mandating adherence to safety and quality standards to ensure safe surgery and anesthesia care can build local surgical capacity and strengthen existing health care systems in low- and middle-income countries. Smile Train uses this sustainable partnership model to provide responsible humanitarian aid while maintaining a bidirectional exchange with its international partners.

Methods:

A voluntary online survey is administered annually to Smile Train’s global partners. One portion of this survey focuses on how Smile Train can best support providers’ adherence to the Smile Train Safety and Quality Protocol and Anesthesia Guidelines for cleft care.

Results:

In 2014 and 2015, 1132 health care providers responded to Smile Train’s annual partner survey (77 percent response rate). When asked how Smile Train could best support partners to continually meet the safety and quality standards, most partners reported that they could benefit from additional financial support (59.6 percent) and medical professional education and training opportunities (59.2 percent).

Conclusions:

The results from the partner survey yield important insights into the programmatic needs of Smile Train partners. Smile Train uses this information to efficiently allocate and distribute resources and to strategically plan and implement training opportunities where needed. The partner survey helps to ensure that Smile Train patients around the world consistently receive safe and high-quality cleft surgery and anesthesia care.
A Shift on the Horizon: A Systematic Review of Assessment Tools for Plastic Surgery Trainees
Authors: McKinnon Victoria E. , Kalun Portia , McRae Mark H. , Sonnadara Ranil R. , Fahim Christine
Published: July 2018

Background:

As plastic surgery programs transition toward competency-based medical education curricula, it is important to critically assess current methods of evaluating trainee competence. The purpose of this systematic review was to identify and evaluate assessment tools for technical and nontechnical competencies in plastic surgery.

Methods:

A systematic search using keywords related to competency-based medical education, assessment, and plastic surgery was conducted. Two independent reviewers extracted data pertaining to study characteristics, study design, and psychometric properties. Data pertaining to the establishment of competence and barriers to tool implementation were noted.

Results:

Twenty-three studies were included in this review. Technical competencies were assessed in 16 studies. Nontechnical competencies were assessed in five studies. Two studies assessed both technical and nontechnical competence. Six tools were implemented in a simulated setting and 17 tools were implemented in a clinical setting. Thirteen studies (57 percent) did not report reliability scores and nine (39 percent) did not report validity scores. Two tools established clear definitions for competence. Common barriers to implementation included high demands on resources and time, uncertainty about simulation transferability, and assessor burnout.

Conclusions:

A number of tools exist to assess a range of plastic surgery skills, in both clinical and simulated settings. There is a need to determine the transferability of simulated assessments to clinical practice, as most available tools are simulation-based. Although additional psychometric testing of current assessment tools is required, particularly in the nontechnical domain, this review provides a base on which to build assessment frameworks that will support plastic surgery’s transition to competency-based medical education.
A Prospective Evaluation of Three-Dimensional Image Simulation: Patient-Reported Outcomes and Mammometrics in Primary Breast Augmentation
Authors: Overschmidt Bo , Qureshi Ali A. , Parikh Rajiv P. , Yan Yan , Tenenbaum Marissa M. , Myckatyn Terence M.
Published: July 2018

Background:

Outcomes in primary breast augmentation depend on careful preoperative planning and clear communication between patient and surgeon. Three-dimensional imaging with computer simulation is an evolving technology with the potential to enhance the preoperative consultation for patients considering primary breast augmentation. The purpose of this study was to prospectively evaluate the impact of three-dimensional imaging with computer simulation on patient-reported and objective, mammometric outcomes in women undergoing primary breast augmentation.

Methods:

One hundred patients were enrolled in a prospective trial with randomized and nonrandomized arms. The randomized arm was composed of a control group consisting of patients who underwent tissue-based planning without simulation (n = 13) and an intervention group consisting of patients who were simulated (n = 10). The remainder constituted the nonrandomized group who specifically sought preoperative simulation. Patient-reported outcomes (BREAST-Q) and mammometric data were recorded and compared preoperatively and 6 months postoperatively.

Results:

Over time, significantly more patients refused randomization and chose simulation (p = 0.03). Breast augmentation led to substantial improvements in satisfaction with breasts, sexual well-being, and outcome. Simulation, however, did not significantly impact patient-reported outcomes or mammometric parameters. No strong correlations were identified between patient-reported outcomes and mammometrics.

Conclusions:

Patients are likely to use novel technology such as three-dimensional photography with computer simulation if they perceive it to enhance their understanding of their final outcome. These patients may seek out practices specifically offering such technology. Incorporation of simulation into the preoperative consultation, however, did not lead to clinically meaningful changes in patient-reported outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Correcting Poland Syndrome with a Custom-Made Silicone Implant: Contribution of Three-Dimensional Computer-Aided Design Reconstruction
Authors: Chavoin Jean-Pierre , Taizou Mohcine , Moreno Benjamin , Leyx Pierre , Grolleau Jean-Louis , Chaput Benoit
Published: July 2018

Background:

Poland syndrome is historically associated with hypoplasia of the pectoral major muscle and abnormalities of the upper limbs. The authors propose an innovative procedure for correcting Poland syndrome thoracic malformations using three-dimensional modeling. Moreover, the authors evaluated aesthetic improvement, satisfaction, and quality of life after reconstruction with computer-aided design customized silicone implants.

Methods:

Since 1993, the authors have treated 129 patients for Poland syndrome. Before 2007, the implants were made from plaster molds; since 2007, they have been made using three-dimensional computer-aided design. Patient satisfaction was assessed using a standardized questionnaire, and quality of life was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey.

Results:

Lipofilling was performed in combination with computer-aided design in one-third of cases, and breast prostheses were required in 24 percent of cases. We found three exposed prostheses and two infections. Cosmetic results were excellent in more than 90 percent of cases, and more than 80 percent of patients were very satisfied or satisfied, with no significant difference between men and women (p = 0.382). The Medical Outcomes Study 36-Item Short-Form Health Survey scores revealed significant improvements in role emotional (p < 0.05), emotional well-being (p < 0.001), and social functioning (p < 0.001).

Conclusions:

Correcting Poland syndrome using a computer-aided design silicone implant fulfilled aesthetic and psychological demands, and significant improvements were seen in quality of life. The technique is simple and reliable and yields high-quality results, and three-dimensional computer-aided design has optimized the authors’ reconstructions. Nevertheless, associated procedures and secondary corrections remain necessary to obtain optimal results.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Pulmonary Infections in Immunocompromised Hosts
Authors: Vazquez Guillamet Cristina , Hsu Joe Le , Dhillon Gundeep , Vazquez Guillamet Rodrigo
Published: July 2018

Pulmonary infections in immunocompromised patients remain a significant contributor to mortality, morbidity, and health care–associated costs in such a vulnerable patient population. Their epidemiology is changing, set forth by new trends in immunosuppressive regimens and also prophylaxis. The host characteristics, presenting clinical symptomatology, along with radiographic patterns, have also evolved. The microbiology diagnostics are now enriched with nonculture methods for better identification of the causative pathogens. Chest imaging remains the cornerstone of the initial workup. Our article will examine the new trends in epidemiology, clinical findings, and diagnostics for immunocompromised patients with pulmonary infections (transplant recipients, neutropenic hosts, HIV-infected patients, and patients with autoimmune conditions). We will also review the differential diagnosis that most of the times includes malignancies and drug or radiation-related toxicities.
Early Dynamics of Plasma Dna in a Mouse Model of Sepsis
Authors: Lauková Lucia , Bertolo Estera Maria Jana , Zelinková Magdaléna , Borbélyová Veronika , Čonka Jozef , Gaál Kovalčíková Alexandra , Domonkos Emese , Vlková Barbora , Celec Peter
Published: July 2018

Concentration of extracellular DNA (ecDNA) in plasma of septic patients is higher in comparison to healthy controls and is associated with worse prognosis in intensive care patients. Decrease of ecDNA in plasma by treatment with deoxyribonuclease (DNase) showed to have beneficial effects in animal models of sepsis. A previously published study showed that timing of DNase application is crucial for the effect of DNase. No published study monitored plasma ecDNA dynamics during sepsis in detail yet. The aim of our study was to describe the early dynamics of plasma ecDNA but also plasma DNase activity in a mouse model of sepsis. Sepsis was induced using intraperitoneal injection of E. coli and mice were euthanized every hour to obtain sufficient volume of plasma. Our results show that the concentration of plasma ecDNA is rising continuously during the first 5 h after infection and is 20-fold higher 5 h after induction of sepsis in comparison to control mice. Subcellular origin of plasma ecDNA was analyzed but fundamental differences in dynamics between nuclear and mitochondrial ecDNA were not found. DNase activity in plasma seems to rise slowly until the fourth hour, but the interindividual variability is high. In conclusion, this is the first study that describes the dynamics of plasma ecDNA and DNase activity in early sepsis in detail. Our study is the basis for further studies focused on the timing of exogenous DNase treatment in sepsis. Additional studies will be needed to monitor plasma ecDNA in later time points that are more clinically relevant.
Variations of Cutaneous Capnometry and Perfusion Index During a Heating Challenge is Early Impaired in Septic Shock and Related to Prognostic in Non-Septic Shock
Authors: Vallée Fabrice , Nougué Hélène , Mari Arnaud , Vodovar Nicolas , Dubreuil Guillaume , Damoisel Charles , Dépret François , Mateo Joaquim
Published: July 2018

Introduction:

In shock, the increase in cutaneous-to-arterial carbon dioxide partial pressure (Pc-aCO2) and the decrease in the perfusion index (PI) are related to macrovascular or microvascular alterations. We hypothesized that inducing cutaneous vasodilation and local perfusion with heat could provide a noninvasive tool to monitor microvascular reactivity.

Objectives:

This study aimed to develop a noninvasive approach, the heating challenge (HC), to monitor the microvascular reactivity of patients with shock and to evaluate the potential relationship with outcome.

Methods:

After ethics committee agreement was obtained, 59 shock patients, including 37 septic shock, 22 non-septic shock (14 cardiogenic and eight hemorrhagic), 10 intensive care unit (ICU)-controls and 12 healthy volunteers, were included in this study. The HC consisted of heating the ear lobe PcCO2 sensor from 37° to 45° over 5 min and recording PcCO2 and PI variations (ΔPcCO2 and PImax/min). HC was performed on admission and during the first 48 h of hospitalization.

Results:

Pc-aCO2 was significantly higher in shock patients than ICU-controls at baseline (P < 0.05). HC led to a decrease in PcCO2 and an increase in PI in the healthy volunteers (ΔPcCO2 = −9.0 ± 4.6% and PImax/min = 5.5 ± 1.9). On admission, non-septic shock patients (cardiogenic and hemorrhagic shocks) had an HC response profile identical to that of healthy volunteers and ICU-controls. In contrast, septic shock patients had a lower ΔPcCO 2 and PImax/min compared to healthy volunteers and all other groups (P < 0.05). After the first day, the combination of a Pc-aCO2 >17 mm Hg with a positive ΔPcCO2 could predict mortality with a specificity of 82% and a sensitivity of 93%.

Conclusions:

HC appears to be a dynamic test to classify vascular reactivity alterations in shock. At baseline, HC results were impaired in septic patients and conserved in non-septic patients. After the first day, the association between Pc-aCO2 and ΔPcCO2 was strongly related to prognosis in shock patients.
Current Practices in Central Venous Catheter Position Confirmation by Point of Care Ultrasound: A Survey of Early Adopters
Authors: Ablordeppey Enyo A. , Drewry Anne M. , Theodoro Daniel L. , Tian LinLin , Fuller Brian M. , Griffey Richard T.
Published: July 2018

Purpose:

Although routine chest radiographs (CXR) to verify correct central venous catheter (CVC) position and exclude pneumothorax are commonly performed, emerging evidence suggests that this practice can be replaced by point of care ultrasound (POCUS). POCUS is advantageous over CXR because it avoids radiation while verifying correct placement and lack of pneumothorax without delay. We hypothesize that a knowledge translation gap exists in this area. We aim to describe the current clinical practice regarding POCUS alone for CVC position confirmation and pneumothorax exclusion as compared with chest radiography.

Methods:

We used a modified Dillman technique to conduct a brief web-based survey to Critical Care Medicine and Emergency Medicine physicians (targeted group of early adopters) evaluating the current practice related to CVC position confirmation and PTX exclusion via CXR or POCUS.

Results:

Of 200 post-training clinicians contacted, 136 (68%) responded to the survey. For routine CVC confirmation and PTX evaluation, 50.7% of Critical Care Medicine physicians and 65.4% of Emergency Medicine physicians reported using CXR alone while 49.3% and 33.1% respectively reported using CXR and ultrasound together. Though 84.6% of clinicians use ultrasound for CVC insertion “most of the time” or “always,” none use ultrasound alone for CVC position confirmation, and only 1% has used ultrasound alone for PTX exclusion.

Conclusions:

Though data support its utility and advantages for POCUS as a sole modality for CVC position confirmation and PTX evaluation, POCUS is rarely used for this indication. We identified several perceived barriers toward widespread utilization suggesting areas for dissemination and implementation strategy development that will benefit patient care practices.
Low-Dose Landiolol Reduces Heart Rate and Cardiac Oxygen Consumption Without Compromising Initial Hemodynamic Resuscitation in a Canine Model of Endotoxin Shock
Authors: Uemura Kazunori , Kawada Toru , Zheng Can , Li Meihua , Sugimachi Masaru
Published: July 2018

In septic shock, it is not known whether β-blocker can be used to reduce heart rate (HR) safely during the initial phase of hemodynamic resuscitation. The purpose of this study was to experimentally investigate the effects of low-dose landiolol, a β-blocker, on initial hemodynamic resuscitation in dogs with endotoxin shock. In 13 anesthetized dogs [n = 7 in control (CT) group, n = 6 in β-blockade (BB) group], after endotoxin shock was induced by intravenous infusion of lipopolysaccharide (4 mg kg−1), we started hemodynamic resuscitation to restore mean arterial pressure (AP) and cardiac output (CO) by infusing noradrenaline (NA) and Ringer acetate solution (RiA). During 4 h of hemodynamic resuscitation, dose of NA and RiA were automatically titrated with use of a computer-controlled drug infusion system that we developed previously. In BB group, landiolol was administered at a low-dose range (1–10 μg kg−1 min−1) to lower HR to lower than 140 bpm. Hemodynamic resuscitation using the system restored AP to 70 mmHg and CO to greater than 90% of baseline level similarly in both groups. Throughout resuscitation, HR and indices of cardiac contractility were significantly lower in BB group than in CT group. However, there were no significant intergroup differences in the dose of NA and RiA. During First 2 h of resuscitation, cardiac oxygen consumption was significantly lower in BB group than in CT group. In conclusion, low-dose landiolol may reduce HR without compromising initial hemodynamic resuscitation in septic shock. To clearly establish this, large-size randomized study using animal models more relevant to septic shock is needed.
Plasma Adenylate Levels are Elevated in Cardiopulmonary Arrest Patients and May Predict Mortality
Authors: Sumi Yuka , Ledderose Carola , Li Linglin , Inoue Yoshiaki , Okamoto Ken , Kondo Yutaka , Sueyoshi Koichiro , Junger Wolfgang G. , Tanaka Hiroshi
Published: July 2018

Cerebral and cardiac dysfunction cause morbidity and mortality in postcardiac arrest syndrome (PCAS) patients. Predicting clinical outcome is necessary to provide the optimal level of life support for these patients. In this pilot study, we examined whether plasma ATP and adenylate levels have value in predicting clinical outcome in PCAS patients. In total, 15 patients who experienced cardiac arrest outside the hospital setting and who could be reanimated were enrolled in this study. Healthy volunteers (n = 8) served as controls. Of the 15 PCAS patients, 8 died within 4 days after resuscitation. Of the 7 survivors, 2 lapsed into vegetative states, 1 survived with moderate disabilities, and 4 showed good recoveries. Arterial blood samples were drawn immediately after successful resuscitation and return of spontaneous circulation (ROSC). The concentrations of ATP and other adenylates in plasma were assessed with high-performance liquid chromatography. PCAS patients had significantly higher ATP levels than healthy controls. Plasma ATP levels correlated with lactate levels, Acute Physiology and Chronic Health Evaluation II scores, and the time it took to ROSC (time-to-ROSC). Plasma adenylate levels in patients who died after resuscitation were significantly higher than in survivors. Based on our results and receiver-operating characteristic curve analysis, we conclude that plasma adenylate levels may help predict outcome in PCAS patients.