bluuebunny/crossref_metadata_2025 huggingface dataset:
A Focus Group Study of Provider and Patient Perceptions of Communicating Advanced Care Planning Wishes Using Digital Storytelling
Authors: Hutson Sadie P. , Hankins Lauren R.
Published: January 2019

Advanced care planning (ACP) and end-of-life discussions are especially difficult among persons living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) as a result of patients' lack of trust in family and providers, HIV-related stigma, misunderstood spirituality concerns, social isolation, and other factors. Previous research has demonstrated that relatively few persons living with HIV/AIDS engage in ACP, yet developing culturally sensitive methods of ACP is imperative. One such method is digital storytelling, a video narrative that can be used to share ideas or aspects of a life story.

The aim of this study was to examine perspectives from providers and persons living with HIV/AIDS about the acceptability, benefits, and technological challenges of and barriers to using digital storytelling for ACP. A qualitative descriptive design was employed using focus groups of 21 participants in South Central Appalachia. Transcribed data were analyzed using qualitative content analysis. Findings revealed patient and provider ideas about ACP, factors related to digital story acceptability, stigma against persons living with HIV/AIDS, and concern for the legality of ACPs expressed in digital story format. Future research should focus on the process of creating digital stories as an intervention to improve ACP in this unique aggregate.
Evaluation of the Pronouncement of Death Policy Implementation and Outcomes
Authors: Jackson Hazel Anita , Oliver JoAnn S. , House Kim
Published: January 2019

In 2011, the Veterans Health Administration mandated that Veterans Affairs (VA) Medical Centers develop and implement a policy that allowed registered nurses (RNs) and advanced practice registered nurses (APRNs) to pronounce the death of residents who die in Veterans Affairs community living centers, previously known as nursing homes, provided that there is a written do-not-resuscitate order in their medical record. The purpose of this quality improvement project was to determine the extent to which the implementation of the RN/APRN death pronouncement policy affected death pronouncement time for residents who die after 5 pm and before 7:30 am, on weekends and holidays. This project is significant because the previous physician-only death pronouncement policy was found to cause unnecessary delays in death pronouncement. A chart review of the medical records of all veterans' deaths pronounced by physicians 3 years before the implementation of the policy and 4 years after the RN/APRN policy was reviewed and implemented. The data analysis was conducted using descriptive analysis. A significant difference was found in the results (P < .05). The maximum for prepolicy deaths was 125 minutes. The maximum for postpolicy deaths was 7 minutes. The results supported the assumption that RN/APRN pronounced death without delay.
End-of-Life Nursing and Education Consortium Communication Curriculum for Nurses
Authors: Buller Haley , Virani Rose , Malloy Pamela , Paice Judith
Published: January 2019

Nurses have unique clinical responsibilities and opportunities with patients that require strong communication skills. However, many nurses lack effective communication skills and often receive inadequate palliative care communication training and education. To promote communication education for palliative care nurses, the End-of-Life Nursing and Education Consortium created a Communication Curriculum for nurses and developed an in-person train-the-trainer course. Organized by the 8 domains of the National Consensus Project Guidelines for Quality Palliative Care, a 1-day course was provided in August 2018 to 46 nurses representing 38 institutions. Completion of precourse surveys demonstrated participants’ institutional resources for palliative care communication education and their greatest communication challenges. Immediate postcourse evaluations demonstrated that the course improved nurses’ knowledge and confidence in communication and their ability to educate others. Palliative care nurses can incorporate communication skills into their practice and provide communication skills training to their institution.
Women's Experiences of Breastfeeding-Related Pain
Authors: Jackson Kimberley T. , Mantler Tara , O'Keefe-McCarthy Sheila
Published: January 2019

Purpose:

Breastfeeding-related pain is commonly experienced early in the postpartum period and is an important contributor to breastfeeding cessation, yet little is known about what this pain means to women and how it is experienced. The purpose of this study was to gain a better understanding of the phenomenon of breastfeeding-related pain, how women experience this pain, and the meaning it holds for them.

Study Design and Methods:

Interpretive descriptive methods and inductive content analysis were used. Women were recruited using purposive sampling with a snowball approach. Data were collected via one-to-one interviews using a semistructured interview guide with postpartum women having experienced breastfeeding-related pain in the past 2 months.

Results:

Fourteen postpartum women who met inclusion criteria were interviewed. They were predominantly Caucasian, well educated, and had greater than average Canadian annual household incomes. The dominant emerging discourse revealed three key themes: (a) interplay between breastfeeding pain and context, (b) action enablers and/or barriers, and (c) breastfeeding outcomes.

Clinical Implications:

Breastfeeding-related pain is an unpleasant sensory and affective experience for women during the postpartum period. Availability and accessibility of breastfeeding supports are essential to enable women to achieve their breastfeeding goals. Providing anticipatory guidance may help women to cope more effectively with their breastfeeding-related pain.
Intraorbital Dermoid Cyst With Zygomaticofrontal Suture Erosion in an Adult
Authors: Howard Brittany E. , Masood Maheer M. , Clark Joseph M. , Thorp Brian D.
Published: January 2019

Background:

Dermoid cysts are squamous epithelium-lined sacs that result from abnormal migration of ectodermal cells. They are typically superficial and present in children. This study reviews a rare patient with a congenital dermoid cyst occurring as a superolateral intraorbital and extraconal mas.

Method:

Clinical report and review of the literature.

Results:

A 27-year-old male presented with progressive left hypoglobus, proptosis, and diplopia. On computed tomography, a 2.0 × 2.1 × 1.1 cm well circumscribed mass centered on, and extended into, the frontozygomatic suture with smooth remodeling of the frontal bone. Magnetic resonance imaging showed heterogeneous T1 and T2 hyperintensity with hypointensity on fat suppression. A dermoid cyst originating from the frontozygomatic suture was suspected. Excision was performed through a left orbitocranial approach with a lateral orbitotomy through an upper eyelid crease incision. The mass occurred in the superior-lateral portion of the left orbit and originated from the intraorbital surface of the zygomaticofrontal suture line with significant bony remodeling without osseous transgression. The mass was removed completely including the lateral portion of the zygomaticofrontal suture. Pathologic examination was consistent with a dermoid cyst. Postoperative examination revealed resolution of his presenting headaches and diplopia.

Conclusion:

Congenital dermoid cysts occurring within the craniofacial region occur most commonly in the lateral orbit involving the superficial surface of the frontozygomatic suture. This patient represents the rare occurrence of a dermoid cyst originating from the deep surface of the frontozygomatic suture, resulting in delayed presentation and orbital symptoms of hypoglobus and diplopia. Definitive treatment remains complete surgical excision.
Facial Masculinization Surgery and its Role in the Treatment of Gender Dysphoria
Authors: Sayegh Farah , Ludwig David C. , Ascha Mona , Vyas Krishna , Shakir Afaaf , Kwong Jeffrey W. , Swanson Marco , Evans Morgan W. , Gatherwright James , Morrison Shane D.
Published: January 2019

Background:

Interest in facial masculinization surgery is expected to increase as gender-affirming surgery becomes more widely accepted and available. The purpose of this study is to summarize the current literature describing operative techniques in facial masculinization surgery and provide an algorithmic approach to treating this patient population.

Methods:

PubMed, EMBASE, and Medline databases were queried for literature on operative techniques and outcomes of facial masculinization surgery in transgender and cisgender patients, published through July 2018. Data on patient demographics, follow-up, operative techniques, complications, and outcomes were collected.

Results:

Fifteen of the 24 identified studies met inclusion criteria. Two studies discussed the outcomes of 7 subjects (6 trans-male and 1 cis-male) who underwent facial masculinization procedures. No objective outcomes were reported in either study; however, subjects were generally satisfied and there were no complications. The remaining studies reviewed operative techniques utilized in the cisgender population.

Conclusion:

A summary of considerations for each facial anatomic subunit and respective operative techniques for facial masculinization is presented. Current facial masculinization procedures in cisgender patients may be considered in the transgender patient population with favorable outcomes. However, further research is needed on techniques and objective outcome measures of facial masculinization procedures in the transgender population.
Study on Tooth Movement After the Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate
Authors: Yang Chenjie , Qian Yufen , Chen Zhenqi , Yang Yusheng , Yu Quan
Published: January 2019

Objectives:

The aim of the study was to explore the effectiveness of the cleft-adjacent teeth moved into the grafted alveolar bone in unilateral cleft lip and palate (UCLP) patients, and to evaluate the alveolar bone support of the teeth.

Methods:

Twenty unilateral cleft lip and palate patients were recruited in this study. The average age was 12 years and 8 months. Periapical radiographs were taken for the cleft-adjacent teeth 3 months after bone grafting (T1) and after teeth moving into the grafted bone (T2), and for the contralateral teeth (T3) when teeth aligned. Alveolar bone support of the moved teeth and the contralateral teeth were measured using the ratio of bone support height to root length. Paired t test was performed for statistical analysis with SPSS17.0 software package.

Results:

All the cleft-adjacent teeth were bodily moved into the grafted area. Average alveolar bone support ratio for the moved teeth was 86.48% (T1), 87.11% (T2), and 90.81% (T3) for the contralateral teeth. There was no statistically significant difference between T1 and T2 (P > 0.05). Although the contralateral teeth had the highest alveolar bone support ratio, significant differences were found between T3 and T2 (P < 0.05).

Conclusions:

Cleft-adjacent teeth could be bodily moved into the grafted bone from the iliac crest in UCLP patients. A successful level of alveolar bone support for the moved teeth was achieved. Moved-in teeth could be functionally loaded and may be benefit to the reduction of the resorption of grafted bone.
The Evaluation of Anthropometric Measurements of Young Polish Women's Faces
Authors: Lipiec Katarzyna , Ryniewicz Wojciech I. , Groch Magdalena , Wieczorek Aneta , Loster Jolanta E.
Published: January 2019

Face proportions are under constant evaluation during prosthetic or surgical diagnostics and treatment. The aim was to evaluate the proportions of the faces of young Polish women as compared with other ethnic groups.

Materials and methods:

The evaluation included 60 photographs of the faces of women, average age 17.9 years. En face images were made with the camera lens situated at the same distance from the photographed subjects. Using Adobe Photoshop software, midsaggital and even anthropometric points were determined in the photographs and then the distance between these points was measured. Four relationships between vertical measurements, 3 between horizontal measurements, and 4 proportions between vertical and horizontal measurements were calculated. The results were evaluated in comparison with the golden ratio (1.618) and the measurements performed for native Americans and Latin American beauty contests winners described in the relevant literature.

Results:

The result for the average vertical face proportion value of the examined women was close to the golden ratio (GR) and amounted to 1.592 for the proportions between nasion-stomion and stomion-gnation (98% of GR) and 1.372 for nasion-subnasale and subnasale-gnation (85% of GR).

Average measurement results for young Polish women's faces were not statistically significantly different for 6 out of 11 relationships under evaluation as compared with the population of native American females and only 2 face proportions were the same as for beauty contests winners from Latin America.

Conclusion:

Face proportions of young Polish women were different from those of the females living in the American continent.
Micro-Autologous Fat Transplantation Combined With Platelet-Rich Plasma for Facial Filling and Regeneration: A Clinical Perspective in the Shadow of Evidence-Based Medicine
Authors: Ozer Kadri , Colak Ozlem
Published: January 2019

Despite the popularity of lipofilling procedures in recent years, the presence of older habits still in fat graft harvesting and processing seems to be the biggest obstacle to the final better outcome of fat grafting. Our study is aimed to highlight some strategies what should be done in fat grafting in the shadow of evidence-based medicine and patient-reported outcomes which might be of interest to the clinicians. Between 2015 and 2017, 14 patients were included who underwent facial micro-autologous fat transplantation with platelet-rich plasma injection. The outcome was determined by the difference in presurgery and postsurgery FACE-Q modules, which were designed as patient-reported outcome instrument to evaluate the unique outcomes of patients undergoing facial cosmetic procedures. Surveys conducted were modules of satisfaction with facial appearance, satisfaction with cheeks, satisfaction with skin, psychological function, social function, aging appearance appraisal, and satisfaction with the outcome. All patients were followed up minimum 9 months. No major complications were recorded. The patient-reported FACE-Q satisfaction and FACE-Q quality-of-life presurgery and postsurgery results showed statistically significant improvement (<0.001). Overall satisfaction with the outcome was 87.6 ± 16.8 (range 55–100). A combination of platelet-rich plasma and micro-fat grafting with soft harvesting and processing could be seen a good surgical technique to restore volume and enhance skin quality in facial soft tissue augmentation. The authors believe that with minimum detrimental effect on fat grafting while harvesting, processing, and with the addition of platelet-rich plasma while applying may increase the surgeon's and patient's satisfaction with the outcome.
A Novel Approach for Horizontal Augmentation of Posterior Maxilla Using Ridge Split Technique
Authors: Karan Nazife Begüm , Akinci Hüseyin Ozan
Published: January 2019

Over the years, there have been a series of innovative approaches to the alveolar bone augmentation techniques. These have led to the modifications of the existing methods and the establishment of more efficient ways to obtain sufficient bone mass that is necessary for the implant procedure. The aim of this paper is to propose a novel augmentation technique, and to investigate its efficacy, particularly during the healing process of the maxillary alveolar bone prior to the implant treatment. During the application of the proposed methodology, first, the ridge-split technique was applied to the posterior maxilla. Then, a horizontal augmentation procedure was performed with an autogenous bone graft. Implants were placed at the second month of the surgery. Prosthetic rehabilitation was completed after the osseointegration of the implants. The technique was compared with the ridge-split method with simultaneous implant placement in 14 patients. The groups were divided into 2, the control group and the experimental group, each containing 7 patients. The aimed success criteria for the status of the endosteal implants were fulfilled and there were not any complications observed in the second year of follow-up.

The basic practical innovation offered by the proposed surgical technique is to achieve the required horizontal dimension and to change the quality of the bone conveniently. The press-fit insertion leads to multipoint contact healing of the transported bone and the use of cortical block bone in posterior maxilla, led to a significantly advantageous higher stability level for both the placement and the survival of the implants.
Effect of Platelet-Rich Fibrin and Bone Morphogenetic Protein on Dental Implant Stability
Authors: Alhussaini Ali H. Abbas
Published: January 2019

Recombinant human bone morphogenetic protein-2 (rhBMP-2) and platelet-rich fibrin (PRF) bioactive materials have been used to enhance healing and improve dental implant stability. This study aimed to compare the effect of rhBMP-2 and PRF bioactive materials on dental implant stability at different intervals and to evaluate the correlation of implant length and diameter with implant stability.

Two bioactive materials were compared to evaluate their effect on dental implant stability. A total of 32 patients (102 dental implants) were divided into 3 groups: 24 dental implants with bone morphogenetic protein (BMP), 27 dental implants with PRF, and 51 dental implants without BMP or PRF (control group). Data were statistically analyzed to determine the bioactive material with the best effect on implant stability.

Implant stability did not significantly differ between the groups immediately after implant insertion (first reading; P > 0.05). The implant stability of the rhBMP-2 group was significantly better than those of the PRF and control groups 6 weeks after implant insertion (second reading; P = 0.001). After 12 weeks, the effect of rhBMP-2 on implant stability was highly significant and better than that of the other groups (third reading; P < 0.001).

Dental implants coated with BMP have a better effect on stability than those with PRF alone and those without PRF or BMP.
The Role of Voice Therapy and Phonosurgery in Transgender Vocal Feminization
Authors: Nolan Ian T. , Morrison Shane D. , Arowojolu Omotayo , Crowe Christopher S. , Massie Jonathan P. , Adler Richard K. , Chaiet Scott R. , Francis David O.
Published: January 2019

Objective:

Nonsurgical and surgical options are available for transgender vocal feminization. This systematic review explores the efficacy of feminizing voice therapy and phonosurgery.

Methods:

A systematic review was performed using PubMed, Cinahl Plus, Ovid SP, Web of Science, Science Direct, and Google Scholar with terms related to transgender phonosurgery and voice therapy. Included studies were outcomes-based vocal feminization interventions for transgender women. Data were collected on pre- and postintervention fundamental frequency (F0), externally measured vocal femininity, patient satisfaction, and complications.

Results:

Two hundred twelve studies were identified and 20 met inclusion criteria. Postintervention patient satisfaction was approximately 80% to 85% for voice therapy, endoscopic shortening, and cricothyroid approximation. Complications were reported for each phonosurgery technique, most commonly decreased mean phonation time and loudness. Of the 20 studies, 17 were used for meta-analysis of F0 change. F0 increased by 31 Hz with voice therapy alone, 26 Hz with laser reduction glottoplasty, 39 Hz with cricothyroid approximation, and 72 Hz with endoscopic shortening.

Conclusion:

The literature supports both voice therapy and phonosurgery, depending on a patient's magnitude of desired pitch change and tolerance for cost and potential complications. Most will likely benefit from voice therapy, as it is highly satisfactory, raises vocal pitch, and is noninvasive. However, endoscopic shortening is also highly satisfactory and provides the greatest absolute increase in vocal pitch. If surgery is chosen, postoperative voice therapy may additionally increase F0, stabilize the voice, and create a more female timbre. However, further studies will be necessary to provide definitive clinical recommendations.
Accelerated Return to Play for Professional Rugby Players After Facial Fractures
Authors: Hada Shinnosuke , Seto Hiroaki , Kaketa Takefumi , Nagayama Masataka , Kawasaki Takayuki , Takazawa Yuji , Tomita Yoshimasa , Kaneko Kazuo
Published: January 2019

Background:

Facial fractures may result in a significant time away from competition for professional rugby players. An understanding of the return-to-play times is an integral part of clinical decision making when treating professional athletes. A period of 8 to 12 weeks has been conventionally recommended for returning to collision sports after facial fractures. The conventional time to return to sports of 8 to 12 weeks is usually too long for professional players. However, the time of return to play after such facial fractures in elite athletes has not been well described.

Purpose:

To investigate the return to play after facial fractures in professional rugby players with an accelerated rehabilitation protocol.

Methods:

Ten professional rugby players with facial fractures were identified and analyzed. The authors investigated the number of days required to return to training and full-contact play according to the trauma type. The authors also determined the presence or absence of refractures and sequelae.

Results:

The average age of the patients was 26.9 years. Medial orbital wall fractures were the most represented pattern, followed by orbital floor fractures and zygomatic arch fractures. The players returned to jogging after 9.9 days, to sports-specific training after a mean of 10.8 days, and to full-contact training after 18.3 days. There were no cases of refractures and sequelae.

Conclusion:

Players were able to return to their regular rugby activities, earlier than the time commonly allowed to return to full activity.
Fronto-Orbital Advancement: Description of Surgical Technique to Complement the Procedural Cognition Simulation in the Craniofacial Interactive Virtual Assistant-Professional Edition
Authors: Staffenberg David A. , Diaz-Siso J. Rodrigo , Flores Roberto L.
Published: January 2019

The surgical treatment of nonsyndromic craniosynostosis is one of the most common procedures performed by craniofacial surgeons. However, for residents and fellows, the high degree of difficulty and complex anatomy may result in slow progress along a steep learning curve. This is particularly important in the context of contemporary academic practice, where work-hour limits and other factors restrict operative exposure and opportunities for trainees to learn. These issues have prompted the development of surgical simulation modalities that, while prevalent in other surgical specialties, have not been fully adopted in reconstructive surgery.

Among these resources is the Craniofacial Interactive Virtual Assistant - Professional Edition (CIVA-Pro), a procedural cognition simulator that is free of charge. By integrating 3-dimensional virtual animation, voice over, and high-definition intraoperative video, CIVA-Pro describes cardinal craniofacial surgery procedures in an engaging platform. In this study, a detailed, step-by-step description of the fronto-orbital advancement surgical technique to complement the corresponding CIVA-Pro module was presented. This synergistic combination of multimedia educational resources provides a unique didactic option for current trainees to prepare for surgery.
Polymethyl Methacrylate in Patient-Specific Implants: Description of a New Three-Dimension Technique
Authors: Ridwan-Pramana Angela , Idema Sander , te Slaa Sjoerd , Verver Frank , Wolff Jan , Forouzanfar Tymour , Peerdeman Saskia
Published: January 2019

Polymethyl methacrylate (PMMA), an easily moldable and economical synthetic resin, has been used since the 1940s. In addition, PMMA has good mechanical properties and is one of the most biocompatible alloplastic materials currently available. The PMMA can serve as a spacer and as a delivery vehicle for antibiotics. Prior studies have indicated that no significant differences in infection rates exist between autologous and acrylic cranioplasty. Although inexpensive, the free-hand cranioplasty technique often yields unsatisfactory cosmetic results. In the present study, the application of a recently developed, economic modality for the perioperative application, and molding of PMMA to ensure a precise fit in 16 patients using computer-aided design, computer-aided manufacturing, and rapid prototyping was described.

The mean defect size was 102.0 ± 26.4 cm2. The mean volume of PMMA required to perform the cranioplasty procedure was 51 mL. The cost of PMMA was approximately 6 Euro (€) per mL. The costs of fabricating the implants varied from 119.8 € to 1632.0 € with a mean of 326.4 € ± 371.6. None of the implants required removal during the follow-up period.
In Vivo Degradation of Forged-Unsintered Hydroxyapatite and Poly-l-lactide Mesh Used for Orbital Reconstruction
Authors: Hwang Kun
Published: January 2019

The aim of this study was to assess compositional changes in a forged-unsintered hydroxyapatite and poly-l-lactide (uHA/PLLA) mesh at 651 days after insertion into human body.

A 35-year-old female patient had left tripod fracture, orbital medial wall and floor fracture, and superficial lateral palpebral ligament rupture. On the 9th posttrauma day, the tripod fracture was reduced and fixed with plates, and the orbital wall and floor were reconstructed with a resorbable mesh. The floor and medial wall were reconstructed with a trimmed mesh made of uHA/PLLA (Osterotrans-MX; Takiron Co, Umeda, Japan). On postoperative day 620, she complained of enophthalmos of left eye (right eye, 18 mm; left eye, 16 mm). Secondary reconstruction of the orbital floor was performed with an iliac bone graft 651 days after insertion. During the secondary operation, the uHA/PLLA mesh that had been previously inserted was removed. The mesh was removed and analyzed using gel permeation chromatography (GPC) and Fourier transform infrared spectroscopy (FTIR).

The GPC revealed that the weight average molecular weight (Mw) decreased from 542,000 to 83,300 Da and the number average molecular weight (Mn) decreased from 124,000 to 20,200 Da in the specimen from the operation. In the postinsertion FTIR spectrum, weak 1648.6 and 1656.1/cm peaks newly appeared. The strong 1038/cm peak of the initial specimen changed slightly into a less strong 1041.8/cm peak.

In conclusion, the reduced Mw and Mn in the postinsertion specimen suggest that uHA/PLLA has one of the favorable degradation properties. The newly appeared bands are thought to be carbon-carbon double bonds of alkenes.
Pharyngeal Flap Versus Sphincter Pharyngoplasty for Velopharyngeal Insufficiency: A Review of the 2014 and 2015 American College of Surgeons National Surgical Quality Improvement Project-Pediatrics Data
Authors: Horton Joshua D. , Gnagi Sharon H. , Atwood Carlyn M. , Nguyen Shaun A. , White David R.
Published: January 2019

The authors sought to compare hospital utilization and complications in patients undergoing pharyngeal flap (PF) or sphincter pharyngoplasty (SP) for velopharyngeal insufficiency (VPI). A retrospective analysis of the 2014 and 2015 American College of Surgeons National Surgical Quality Improvement Project-Pediatrics (ACS NSQIP-P) was performed. Current procedural terminology codes were used to identify children undergoing PF (42225, 42226) and SP (42950) for VPI (International Classification of Diseases version 9: 478.29, 528.9, or 750.29). Four hundred forty-six patients were treated for VPI with either PF (n = 250) or SP (n = 196). The groups were demographically similar in age, gender, race, and preoperative comorbidity. Pharyngeal flap was performed less often as an outpatient procedure than SP (96/250 [38.4%] vs 130/196 [66.3%], P < 0.0001) and had a longer total length of hospital stay (mean 1.76 ± 1.29 vs 0.98 ± 0.91 days, P < 0.0001). No difference in total complications (10/250 [4.0%] vs 3/196 [1.5%], P = 0.124) was identified. The reduction in hospital resource utilization (fewer admissions, shorter length of stay) is notable. No difference in complications was identified between the 2 procedures.
Endoscopically Assisted Middle Cranial Fossa Reconstruction Following Traumatic Intracranial Intrusion of the Mandibular Condyle
Authors: Liau Isaac , Sambrook Paul , Cheng Andrew
Published: January 2019

Traumatic intracranial intrusions of the mandibular condyle are a rare injury pattern that carries significant morbid outcomes due to potential for neurological, otological, temporomandibular joint damage, or joint ankylosis. Treatment modalities involve either closed reduction, open approaches via transcranial or subtemporal approaches, or delayed total joint replacement. This paper presents a clinical report of a traumatic intracranial intrusion of the mandibular condyle treated with an endoscopically assisted preauricular approach to reconstruct the middle cranial fossa and temporomandibular articular disc. Endoscopically assisted techniques allow for minimally invasive and less morbid surgical interventions to this pathology, with greater precision than closed reduction techniques.
Postoperative Changes in Orbital Dysmorphology in Patients With Unicoronal Synostosis
Authors: Domeshek Leahthan F. , Woo Albert , Skolnick Gary B. , Naidoo Sybill , Segar David , Smyth Matthew , Proctor Mark , Patel Kamlesh B.
Published: January 2019

Orbital asymmetry in unicoronal synostosis impacts craniofacial appearance and can potentiate functional visual disturbances, such as strabismus. Surgical treatment aims to normalize overall cranial morphology, including that of the orbits. The purpose of this study was to compare postoperative changes in orbital asymmetry following 2 common procedures.

Preoperative and 1-year postoperative computed tomography scans for patients with isolated, nonsyndromic unicoronal synostosis treated from 2007 to 2012, at 2 academic institutions were analyzed. Only patients treated by endoscopic suturectomy and postoperative helmeting or bilateral fronto-orbital advancement were included. Orbital index, depth, and volume asymmetry were determined for each patient both pre- and 1-year postoperatively. Student's t-tests were used to compare pre- and postoperative asymmetries within each treatment group. Regression analyses were used to examine postoperative change in asymmetry between treatment groups.

Scans from 12 patients treated by fronto-orbital advancement and 23 treated by endoscopic suturectomy were analyzed. Differences between synostotic and nonsynostotic orbital index, depth, and volume were statistically significant both pre- and postoperatively. Statistically significant postoperative improvements in asymmetry were observed for orbital index, depth, and volume following suturectomy. Regression analysis indicated that the amount of pre- to postoperative change in all measures of asymmetry did not depend on surgical technique. Residual asymmetry following both procedures was apparent at 1 year postoperatively.

Orbital asymmetry is improved, but not resolved following both fronto-orbital advancement and endoscopic suturectomy. Degree of improvement in symmetry is independent of surgical technique used.
Understanding the Learning Disabilities Linked to Sagittal Craniosynostosis
Authors: Cabrejo Raysa , Lacadie Cheryl , Brooks Eric , Beckett Joel , Sun Alexander , Yang Jenny , Chuang Carolyn , Eilbott Jeffrey , Duncan Charles , Steinbacher Derek , Alperovich Michael , Ventola Pamela , Pelphrey Kevin , Constable Todd , Persing John
Published: January 2019

Objective:

The purpose of this study is to investigate further findings that corroborate similarities between corrected sagittal craniosynostosis and attention deficit hyperactivity disorder (ADHD). The aim is to further characterize the neurocognitive deficits seen in adolescents with corrected craniosynostosis by comparing it to established learning deficits such as ADHD.

Methods:

A total of 30 functional magnetic resonance imaging (fMRI) of 10 sagittal nonsyndromic craniosynostosis (sNSC), 10 ADHD-combined, and 10 control adolescents were studied. The fMRI scans were analyzed utilizing Statistical Parametric Mapping (University College London, UK) and analyzed with BioImageSuite (Yale University, New Haven, CT).

Results:

The ADHD has lower connectivity to Brodmann area (BA) 11 (Montreal Neurological Institution [MNI]: −12,26,−21), BA20 (MNI: 62,−24,−25), and BA21 (MNI: 62,−32,−23) compared to sNSC and controls (P < 0.001). The sNSC has a unique visuospatial defect, compared to ADHD, created by decreased connectivity to BA31 (MNI: −3,−68,37), BA7 (MNI: −4,−68,41), BA19 (MNI: 0,−83,31), visual association cortex (MNI: −4,−78,22), and primary visual cortex (MNI: 7,−74,21) (P < 0.001).

Conclusion:

Patients born with sNSC have different neural connections than children born with ADHD. Patients born with sNSC have decreased connections in areas of visual processing and increased connections in areas of attention and auditory processing than patients with ADHD. Therefore, children with sagittal craniosynsotosis may have learning difficulties that, similar, yet different from ADHD.
The Facial Artery Perforator Flap as a New Option for Reconstruction of Intraoral Defects: Surgical Tips and Clinical Series
Authors: Horta Ricardo , Barreiro Diogo , Nascimento Ricardo , Silva Alvaro
Published: January 2019

Background:

The authors have recently 1st described the use of the facial artery perforator flap (FAP) for intraoral reconstruction. In this study, they discuss technical notes and surgical tips associated with the procedure and the application of this flap in 4 patients with intraoral defects resulting from cancer or osteoradionecrosis.

Methods:

A retrospective study of 4 consecutive patients was performed on all patients who underwent reconstruction of an intraoral defect with a FAP flap, over a 12-month period from March 2017 to March 2018.

The flap was designed according to the size of the defect centered on the perforator and was tunneled intraorally by means of a 90° rotation or advanced medially. The most constantly encountered perforator 1.5 cm lateral to the oral commissure was used in 3 cases; a cranial perforator was selected in 1 patient.

Results:

Four FAP flaps were used in 4 patients with intraoral defects. Follow-up was 6 to 12 months. Median defect size was 9.15 cm2 (range, 3.4–21.5 cm2). All reconstructions were successful, without major flap loss or infections. One patient with severe osteoradionecrosis and fungal infection developed minor flap loss and dehiscence, which was treated conservatively. There were no signs of local recurrence and functional outcomes were satisfactory.

Conclusions:

The FAP flap is an effective and versatile solution for reconstruction of intraoral defects until 5 cm × 4 cm (20 cm2) without significant donor-site morbidity. It may be considered a new reconstructive option for intraoral defects, which warrants further study in a larger series or patients.
Baclofen Neurotoxicity: A Metabolic Encephalopathy Susceptible to Exacerbation by Benzodiazepine Therapy
Authors: Triplett James D. , Lawn Nicholas D. , Dunne John W.
Published: January 2019

Purpose:

Baclofen has been reported to cause both a metabolic encephalopathy and nonconvulsive status epilepticus. Baclofen is typically used in the management of muscle spasticity but is being increasingly used to manage alcohol withdrawal and opiate dependency. Given the increasing use of baclofen we describe the clinical and electrographical features of baclofen neurotoxicity seen at our institution.

Methods:

The clinical and EEG features of patients with an encephalopathy in the setting of baclofen therapy were analyzed. Patients were identified via our hospital EEG database.

Results:

Fourteen patients were identified having presented with an acute confusional state without identifiable cause other than baclofen use. Five patients took a deliberate overdose, three of whom were baclofen naive, two patients presented after medication prescription error, and seven patients were on stable doses (30–140 mg daily). All patients presented with an encephalopathy, one patient was reported to have clinical seizures, and seven had multifocal myoclonus. EEGs were abnormal in all patients and showed moderate to severe generalized slowing. Generalized triphasic waves occurring at 1 to 2 Hz, sometimes with an anterior to posterior phase lag, were present in 10 patients (71%), and intermittent generalized suppression of the background was seen in three patients. Three patients received small doses of intravenous benzodiazepines, resulting in a marked depression of consciousness and respiration. All patients recovered within 48 hours of baclofen discontinuation.

Conclusions:

Baclofen toxicity can produce an acute encephalopathy even at modest doses, with the EEG showing generalized slowing and triphasic waves consistent with a toxic encephalopathy. Management consists of supportive care and cessation of baclofen. Patients with baclofen neurotoxicity exhibit a marked vulnerability to the depressant effects of benzodiazepines.
MagC, magnetic collection of ultrathin sections for volumetric correlative light and electron microscopy
Authors: Templier T.
Published: January 2019

The non-destructive collection of ultrathin sections onto silicon wafers for post-embedding staining and volumetric correlative light and electron microscopy traditionally requires exquisite manual skills and is tedious and unreliable. In MagC introduced here, sample blocks are augmented with a magnetic resin enabling remote actuation and collection of hundreds of sections on wafer. MagC allowed the correlative visualization of neuroanatomical tracers within their ultrastructural volumetric electron microscopy context.
The cytoprotective role of antioxidants in mammalian cells under rapidly varying temperature, pressure and UV conditions during stratospheric balloon campaign
Authors: Przystupski Dawid , Górska Agata , Rozborska Paulina , Bartosik Weronika , Michel Olga , Rossowska Joanna , Szewczyk Anna , Drąg-Zalesińska Małgorzata , Kasperkiewicz Paulina , Górski Jędrzej , Kulbacka Julita
Published: January 2019

1.

Currently ongoing age of the dynamic development of the space industry brings the mankind closer to the routine manned space flights and space tourism. That progress leads to a demand for intensive astrobiological research aimed at improving strategies of the pharmacological protection of the human cells against extreme conditions. Although routine research in space remain out of our reach, it is worth noticing that unique severe environment of the Earth’s stratosphere have been found to mimic subcosmic conditions, giving rise to the opportunity for use of stratospheric surface as a research model for the astrobiological studies. Our study included launching balloon into the stratosphere containing the human normal and cancer cells treated with various compounds to examine whether these medicines are capable to protect the cells against the stress caused by rapidly varying temperature, pressure and radiation, especially UV. Due to oxidative stress caused by irradiation and temperature shock, we used natural compounds which display antioxidant properties, namely catechin isolated from green tea, honokiol derived from magnolia, curcumin from turmeric and cinnamon extract. “After-flight” laboratory tests displayed the most active antioxidants as potential agents which can minimize harmful impact of extreme conditions to the human cells.
Regional fat depot masses are influenced by protein-coding gene variants
Authors: Neville Matt J. , Wittemans Laura BL. , Pinnick Katherine E. , Todorčević Marijana , Kaksonen Risto , Pietiläinen Kirsi H. , Luan Jian’an , Scott Robert A. , Wareham Nicholas J. , Langenberg Claudia , Karpe Fredrik
Published: January 2019

With the identification of a large number of genetic loci associated with human fat distribution and its importance for metabolic health, the question arises as to what the genetic drivers for discrete fat depot expansion might be. To date most studies have focussed on conventional anthropometric measures such as waist-to-hip ratio (WHR) adjusted for body mass index. We searched for genetic loci determining discrete fat depots mass size using an exome-wide approach in 3 large cohorts.

Here we report an exome-wide analysis of non-synonymous genetic variants in 17,212 participants in which regional fat masses were quantified using dual-energy X-ray absorptiometry. The missense variant CCDC92S70C, previously associated with WHR, is associated specifically with reduced visceral and increased leg fat masses. Allele-specific expression analysis shows that the deleterious minor allele carrying transcript also has a constitutively higher expression. In addition, we identify two variants associated with the transcriptionally distinct fat depot arm fat (SPATA20K422R and UQCC1R51Q). SPATA20K422R, a rare novel locus with a large effect size specific to arm, and UQCC1R51Q, a common variant exome-wide significant in arm but showing similar trends in other subcutaneous fat depots. In terms of the understanding of human fat distribution, these findings suggest distinct regulation of discrete fat depot expansion.

Author summary

Human fat storing tissues are heterogeneous and comprise functionally and structurally distinct regional fat depots, the relative size of which appear to have significant implications for health. Whilst it is known that inter-individual differences in fat distribution have genetic drivers, studies to date have focussed on crude anthropometric approximations of region fat masses rather than precise measures. Here we describe an exome-wide analysis of a large collection of men and women who have undergone body scanning using dual-energy X-ray absorptiometry (DXA) to better define regional fat masses and identify new genetic drivers for human fat distribution. With this approach we identify three gene regions associated with distinct fat depots which can help to explain the variation in fat distribution between people and may lead to a better understanding of the depot specific fat tissue expansion.
Analysis of Vibrio cholerae genomes using a novel bioinformatic tool identifies new, active Type VI Secretion System gene clusters
Authors: Crisan Cristian V. , Chande Aroon T. , Williams Kenneth , Raghuram Vishnu , Rishishwar Lavanya , Steinbach Gabi , Yunker Peter , Jordan I. King , Hammer Brian K.
Published: January 2019

Background

Like many bacteria, Vibrio cholerae, which causes fatal cholera, deploys a harpoon-like Type VI Secretion System (T6SS) to compete against other microbes in environmental and host settings. The T6SS punctures adjacent cells and delivers toxic effector proteins that are harmless to bacteria carrying cognate immunity factors. Only four effector/immunity pairs encoded on one large and three auxiliary gene clusters have been characterized from largely clonal, patient-derived strains of V. cholerae.

Results

We sequenced two dozen V. cholerae strain genomes from diverse sources and developed a novel and adaptable bioinformatic tool based on Hidden Markov Models. We identified two new T6SS auxiliary gene clusters; one, Aux 5, is described here. Four Aux 5 loci are present in the host strain, each with an atypical effector/immunity gene organization. Structural prediction of the putative effector indicated it is a lipase, which we name TleV1 (Type VI lipase effector Vibrio, TleV1). Ectopic TleV1 expression induced toxicity in E. coli, which was rescued by co-expression of the TleV1 immunity factor. A clinical V. cholerae reference strain expressing the Aux 5 cluster used TleV1 to lyse its parental strain upon contact via its T6SS but was unable to kill parental cells expressing TleV1’s immunity factor.

Conclusion

We developed a novel bioinformatic method and identified new T6SS gene clusters in V. cholerae. We also showed the TleV1 toxin is delivered in a T6SS-manner by V. cholerae and can lyse other bacterial cells. Our web-based tool may be modified to identify additional novel T6SS genomic loci in diverse bacterial species.
Identifying Severe Stroke Patients Likely to Benefit From Thrombectomy Despite Delays of up to a Day
Authors: González R. Gilberto , Silva Gisele Sampaio , He Julian , Sadaghiani Saloomeh , Wu Ona , Singhal Aneesh B.
Published: January 2019

Selected patients with large vessel occlusions (LVO) can benefit from thrombectomy up to 24 hours after onset. Identifying patients who might benefit from late intervention after transfer from community hospitals to thrombectomy-capable centers would be valuable. We searched for presentation biomarkers to identify such patients. Frequent MR imaging over 2 days of 38 untreated LVO patients revealed logarithmic growth of the ischemic infarct core. In 24 patients with terminal internal carotid artery or the proximal middle cerebral artery occlusions we found that an infarct core growth rate (IGR) <4.1 ml/hr and initial infarct core volumes (ICV) <19.9 ml had accuracies >89% for identifying patients who would still have a core of <50ml 24 hours after stroke onset, a core size that should predict favorable outcomes with thrombectomy. Published reports indicate that up to half of all LVO stroke patients have an IGR<4.1 ml/hr. Other potentially useful biomarkers include the NIHSS and the perfusion measurements MTT and Tmax. We conclude that many LVO patients have a stroke physiology that is favorable for late intervention, and that there are biomarkers that can accurately identify them at early time points as suitable for transfer for intervention.
H7N6 Low Pathogenic Avian Influenza outbreak in commercial turkey farms in Chile caused by a native South American Lineage
Authors: Mathieu C. , Gonzalez A. , Garcia A. , Johow M. , Badia C. , Jara C. , Nuñez P. , Neira V. , Montiel N.A. , Killian M.L. , Brito B.P.
Published: January 2019

In December of 2016, low pathogenic avian influenza (LPAI) caused by an H7N6 subtype was confirmed in a grow-out turkey farm located in Valparaiso Region, Chile. Depopulation of exposed animals, zoning, animal movement control and active surveillance were implemented to contain the outbreak. Two weeks later, a second turkey grow-out farm located 70 km north of the first site was also infected by H7N6 LPAI, which subsequently spilled over to one backyard poultry flock. The virus involved in the outbreak shared a close genetic relationship with viruses collected from Chilean aquatic birds’ viruses. The A/turkey/Chile/2017(H7N6) LPAI virus belonged to a native South American lineage. Based on the H7 and most of the internal genes phylogenies, these viruses were also closely related to the viruses that caused a highly pathogenic avian influenza outbreak in Chile in 2002. Results from this study help understand the regional dynamics of influenza outbreaks, highlighting the importance of local native viruses circulating in the natural reservoir hosts.