bluuebunny/crossref_metadata_2025 huggingface dataset:
Obesity Predicts Lower Risk of Wound Complications following Open Reduction and Internal Fixation of Ankle Fractures
Authors: Matson Andrew P. , Morwood Michael P. , Peres-Da-Silva Ashwin B. , Cone Eugene B. , Hurwitz Shepard R. , Zura Robert D.
Published: October 2016

Category:

Trauma

Introduction/Purpose:

Ankle fractures are among the most common injuries treated by Orthopaedic Surgeons. Complications following surgical treatment of ankle fractures have been well described, however less is known about the risk factors for postoperative wound complications specifically. The purpose of the present study was to evaluate the incidence of wound complications following open reduction and internal fixation of ankle fractures in obese and non-obese patients.

Methods:

We retrospectively identified 127 consecutive patients who underwent open reduction and internal fixation for an isolated, closed ankle fracture from 2008-2012. The age, sex, height, weight, diabetes status, and tobacco use of each patient were recorded. Time from injury to surgical fixation, use of external fixation, presence of initial dislocation, energy of mechanism, and injury pattern were also recorded. Patients’ records were reviewed to identify any postoperative wound complications. Complications were categorized as major or minor based on need for subsequent surgical intervention. Complication rates were compared between groups using the chi square test, and significant results were followed up with calculation of odds ratios and 95% confidence intervals using multivariate logistic regression.

Results:

The overall rate of wound complication was 18.9% (24/127), consisting of 6 major and 18 minor complications. The rate of wound complication of any type was significantly lower in obese patients at 11.7% (7/60) compared to 25.4% (17/67) in non- obese patients (P = 0.049). Obesity was associated with a significantly lower risk of developing a wound complication (OR 0.267, 95% CI 0.087 - 0.822), even when controlling for age, sex, diabetes status, tobacco use, surgical delay, external fixation, and injury pattern. No other covariates were associated with an increased risk of a wound infection.

Conclusion:

In the present study obese patients were less likely than non-obese patients to have a postoperative wound complication following internal fixation of an ankle fracture. Obesity may be protective against wound complications following surgical treatment of ankle fractures given the additional soft-tissue overlying the ankle.
Resource Utilization After Ankle Arthritis Surgery
Authors: Ngai Jacqueline T. , Younger Alastair S. , Veljkovic Andrea , Wing Kevin , Penner Murray J. , Wong Hubert
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

As an alternative to ankle replacement, ankle arthrodesis remains a mainstay in the treatment of end- stage arthritis. Arthroscopic techniques for ankle arthrodesis have more recently been developed, although there has been limited research exploring the cost of arthroscopic (AAA) versus open ankle arthrodesis (OAA), and comparing ankle fusions to replacement (TAA). We hypothesize that resource use after AAA will be lower than that after OAA, and both will be lower than TAA.

Methods:

We performed a retrospective review of a prospectively collected database. The COFAS database was used to identify patients with >2 years of follow up who have undergone AAA, OAA or Hintegra TAA at St Paul’s Hospital between 2003-2010. Ninety patients with TAA, 52 with AAA and 56 with OAA met our inclusion criteria. The following data were documented: patient demographics (age, gender, presence of diabetes, inflammatory arthritis or any smoking history), factors related to the index surgery (type of surgery, OR time, length of stay) and factors relating to the post-operative course (number of unplanned post-operative clinic visits, OR time for re-operations, length of stay for additional hospital admissions). For all significant comparisons, p < 0.05.

Results:

AAA required less primary surgery OR time and shorter primary hospital stay vs. TAA and OAA. Patients required more additional follow-up visits for TAA and OAA vs. AAA. TAA required more additional days in hospital compared to OAA or AAA. For each primary TAA, on average an additional seven clinic visits, 60 minutes of revision surgery, three days in hospital were required on top of the cost assigned for the primary arthroplasty. For each primary AAA, an additional four clinic visits, 23 minutes of revision surgery and one day in hospital were required. For each primary OAA, an average additional five clinic visits, three minutes of revision OR time, and 0.2 days of additional hospital stay were required.

Conclusion:

Using several measures of resource use, we find that arthroscopic ankle fusions compare favourably to both ankle replacements and open ankle fusions. We also show that resource utilization measurements can be a useful surrogate for complications, and that resource utilization can demonstrate the practical implications of complications for patients, surgeons and health care providers or payers.
The Agility Total Ankle Arthroplasty
Authors: Raikin Steven , Kane Justin M. , Beck David , Sandrowski Kristin , Winters Brian S.
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

Ankle arthritis is a debilitating condition causing severe functional impairment. In contrast to degenerative arthritis of the knee and hip, ankle arthritis is typically post-traumatic and affects a younger population. While arthrodesis has been the gold standard of surgical treatment for this condition, significant improvements in total ankle arthroplasty have made it a viable alternative for select patients. As the Agility total ankle implant has the longest follow-up in the United States, the purpose of this study is to look at mid-term follow up of patients with this implant.

Methods:

Following IRB approval, a retrospective review of prospectively collected data was conducted on 127 consecutive Agility total ankle arthroplasties between 2001-2010 performed by one fellowship-trained orthopaedic surgeon. Patient charts were reviewed to collect demographics including age, gender, BMI, diabetes, inflammatory arthropathy, tobacco, FAAM, SF-12, and VAS pain scores. In addition, a five-view radiographic series was obtained to determine coronal alignment, overall arc of motion, tibiotalar component motion, zones of osteolysis, and subsidence. A Kaplan-Meier survival analysis was performed and a linear regression analysis was used to predict implant failure. A multivariate regression analysis was used to assess whether radiographic measures were predictive of patient satisfaction.

Results:

90 of 115 still had their primary implant. 105 were available to participate (average 9.1 years follow-up). Twenty-five had their implant removed. Average FAAM-ADL score was 82.4, FAAM-sport score 55.3, post-operative VAS pain score 12.7, SF-12 physical score 45.8 and SF-12 Mental 56.1. Average motion across the implant was 22.3° and 6.3° in adjacent joints. Osteolysis occurred on average at 2.3 zones, significant at zones 1 and 6. No differences were found for rate or location of subsidence. Linear regression analysis demonstrated younger patients, inflammatory and atraumatic arthritis lead to higher likelihoods of revision. No correlation was detected between radiographic parameters of implant success and outcome scores. Significant reduction in VAS pain scores was detected at an average of 8 years (mean difference of 67.64).

Conclusion:

Our results are consistent with what has been described in the literature. Survivorship approaches 70.9% at an average of 8 years. Patients that have retained their original implant are functioning at a high level of satisfaction based on statistically validated patient-centered outcome scores. Interestingly, this is independent of the radiographic appearance of their implant. Advanced age at the time of surgery was predictive of failure with younger patients having a higher likelihood of requiring secondary surgery and the pre-operative diagnosis was also predictive of failure with both inflammatory arthritis and atraumatic arthritis.
The Application of Calcaneal Z Osteotomy in Treating Type ⅡB Adult Acquired Flatfoot Deformity
Authors: Zhu Yuan
Published: October 2016

Category:

Hindfoot

Introduction/Purpose:

A retrospective control study to evaluate the application of calcaneal Z osteotomy in treating type ⅡB adult acquired flatfoot deformity.

Methods:

From September 2011 to March 2013, 20 cases of typeⅡB adult acquired flatfoot (according to Myerson’s classification) were treated by calcaneal Z osteotomy combined with medial soft tissue reconstructing. There were 4 males and 16 females with a mean age of 52.6 years (range 49 to 72 years). A Z osteotomy of the calcaneus was performed instead of a lateral column lengthening or a double calcaneal osteotomy for purpose of correct the forefoot abduction and hind foot valgus deformity. The medial soft tissue procedure included posterior tibial tendon resection and Flexor digitorum longus tendon transfer. American Orthopaedic Foot and Ankle Society (AOFAS) score and radiological assessments were used to evaluate the conditions before and after operation.

Results:

Eventually, 19 patients were followed up with an average duration of 26.5 months (range, 18-56 months). AOFAS scores were 80-90 points in 11 patients, 90-100 points in 6 patients and the excellent and good rate was 89% (17/19). The specific indexes of X-ray improved obviously (P < 0.01). The anteroposterior talocalcaneal angle decreased by 12°, lateral talar first metatarsal angle decreased by 15°, and talonavicular coverage angle decreased by 7°. There was no calcaneal-cuboid joint symptom in this group of patients. All these cases got good bone healing.

Conclusion:

The calcaneal Z osteotomy can correct the hind-foot deformity in three dimensions and can act as a lateral column lengthening in treating type ⅡB adult acquired flatfoot. The complication of this procedure is minimal.
The Extensile Lateral Approach to the Calcaneus and the Sural Nerve
Authors: Smyth Niall A. , Zachwieja Erik C. , Buller Leonard T. , Miranda Alejandro D. , Steinlauf Steven D.
Published: October 2016

Category:

Hindfoot

Introduction/Purpose:

Sural nerve related symptoms following the extensile lateral approach to the calcaneus (ELA) are a known postoperative complication despite awareness of the course the sural nerve. While the main trunk of the sural nerve and its location relative to the ELA have been previously described, the nerve gives rise to lateral calcaneal branches (LCBs) that may be at risk of injury. The relation of the LCBs to the ELA has not been previously reported in the literature. The purpose of this study was to describe the course of the sural nerve and its LCBs in relation to the ELA.

Methods:

17 cadaveric foot specimens were dissected, exposing the sural nerve and the LCBs. A line representing the ELA incision was then created. It was noted if the line crossed any of the LCBs, how many branches were crossed, and at what distance they were crossed using the distal tip of the fibula as a reference.

Results:

The sural nerve was identified in all specimens, and the main trunk was noted to cross the path of the ELA in no specimens. At least one LCB of the sural nerve was identified in all specimens. The mean number of LCBs was 2 (range, 1 – 4). The ELA crossed the path of at least one LCB in 15 specimens (88%). The mean number of LCBs that were crossed by the path of the ELA was 1 (range, 0 – 3) The mean distance from the distal tip of the fibula at which an LCB was encountered along the ELA path was 2.4 cm (+/- 1.2) posterior and 2.6 cm (+/- 1.6) inferior.

Conclusion:

The ELA traverses the paths of the LCBs in the majority of specimens, potentially accounting for the presence of sural nerve postoperative symptoms despite careful dissection.
The Subtalar Arthroscopic Findings After Osteosynthesis for Calcaneal Fractures
Authors: Tanaka Hirofumi , Nishifuru Kyota , Sakai Tatsuya , Motooka Tsutomu
Published: October 2016

Category:

Arthroscopy

Introduction/Purpose:

A Sanders type II-IV calcaneal fracture is an intrarticular fracture of the subtalar joint, which may shift to traumatic osteoarthritis. We therefore perform open reduction and plate fixation in order to obtain a good reduction in such fractures. The purpose of this study was to evaluate the effectiveness of the subtalar arthroscopy after osteosynthesis for calcaneal fractures.

Methods:

We performed subtalar arthroscopy in fifteen patients (male, n=12; female, n=3; mean age, 54.9) between September 2010 and April 2014 who had some complaints at the time of plate removal after the treatment of calcaneal fractures. The mean follow-up period was 9.1 months. The Sanders classifications were as follows: Type I (n=1), Type II (n=5), Type III (n=7) and Type IV (n=1). All of the cases had bone union. There was no cases of reduction failure. Observation and joint synovectomy was performed during subtalar arthroscopy, which was performed under lumbar anesthesia. Plate removal was performed after the completion of subtalar arthroscopy.

Results:

The average AOFAS score improved from 82 points preoperatively to 94 points postoperatively. There were no complications. The formation of intra-articular fibrous tissues and adhesion of the subtalar joint were observed during arthroscopy in all cases; traumatic articular cartilage injuries were found in 10 cases (67%); and synovitis around peroneal tendon was found in 13 cases (87%). Pain and displeasure improved after the resection of fibrous tissues and synovectomy.

Conclusion:

A patient who had an articular cartilage injury complained of low-level pain. Subtalar arthroscopy is a valuable tool after calcaneal fractures.
Alveolar macrophage development in mice requires L-plastin for cellular localization in alveoli
Authors: Todd Elizabeth M. , Zhou Julie Y. , Szasz Taylor P. , Deady Lauren E. , D’Angelo June A. , Cheung Matthew D. , Kim Alfred H. J. , Morley Sharon Celeste
Published: October 2016

Key Points

A key transition from the prealveolar macrophage precursor to mature alveolar macrophage is impaired in neonatal mice lacking LPL. Genetic impairment of neonatal alveolar macrophage development associates with impaired clearance of a pulmonary pathogen in adult animals.
Systems analysis uncovers inflammatory Th/Tc17-driven modules during acute GVHD in monkey and human T cells
Authors: Furlan Scott N. , Watkins Benjamin , Tkachev Victor , Cooley Sarah , Panoskaltsis-Mortari Angela , Betz Kayla , Brown Melanie , Hunt Daniel J. , Schell John B. , Zeleski Katie , Yu Alison , Giver Cynthia R. , Waller Edmund K. , Miller Jeffrey S. , Blazar Bruce R. , Kean Leslie S.
Published: October 2016

Key Points

The transcriptional networks controlling breakthrough acute GVHD can be mapped, and correlate closely with clinical disease. Breakthrough acute GVHD is transcriptionally controlled by T-cell persistence, inflammation, and Th/Tc17 skewing.
Replication of associations between genetic polymorphisms and chronic graft-versus-host disease
Authors: Martin Paul J. , Fan Wenhong , Storer Barry E. , Levine David M. , Zhao Lue Ping , Warren Edus H. , Flowers Mary E. D. , Lee Stephanie J. , Carpenter Paul A. , Boeckh Michael , Hingorani Sangeeta , Yan Li , Hu Qiang , Preus Leah , Liu Song , Spellman Stephen , Zhu Xiaochun , Pasquini Marcelo , McCarthy Philip , Stram Daniel , Sheng Xin , Pooler Loreall , Haiman Christopher A. , Sucheston-Campbell Lara , Hahn Theresa , Hansen John A.
Published: October 2016

Key Points

Most published SNP associations with chronic GVHD are likely to represent false-positive findings. HRs for any true-positive SNP associations are likely to be much smaller than reported previously.
Residential radon,EGFRmutations andALKalterations in never-smoking lung cancer cases
Authors: Ruano-Ravina Alberto , Torres-Durán María , Kelsey Karl T. , Parente-Lamelas Isaura , Leiro-Fernández Virginia , Abdulkader Ihab , Abal-Arca José , Montero-Martínez Carmen , Vidal-García Iria , Amenedo Margarita , Castro-Añón Olalla , Golpe-Gómez Antonio , González-Barcala Javier , Martínez Cristina , Guzmán-Taveras Rosirys , Provencio Mariano , Mejuto-Martí María José , Fernández-Villar Alberto , Barros-Dios Juan Miguel
Published: October 2016

The aim of this study was to assess if residential radon exposure might causeEGFRmutations orALKrearrangements in never-smokers.

We designed a multicentre case–control study in a radon-prone area (Galicia, Spain); only lung cancer cases were included in the study. We obtained residential radon measurements and clinical information for all the participants. We compared the median values of residential radon between patients withEGFRmutations orALKrearrangementsversusthose without them.

323 patients were included. Median age was 70 years and 19.5% were males. 42 and 15% of patients wereEGFR- andALK-positive, respectively. The most frequentEGFRalterations were exon 19 deletions and exon 21 (L858R) single-point substitution mutations.ALK-positive patients were 10 years younger thanALK-negative patients. Residential radon levels were two-fold higher in patients with exon 19 deletions compared with patients with exon 21 (L858R) single-point substitution mutations (216versus118 Bq·m−3; p=0.057). There were no differences in residential radon levels byEGFRmutation status.ALK-positive patients (n=12) essentially had two-fold residential radon levels compared withALK-negative patients (290versus164 Bq·m−3, respectively).

Residential radon may have a role in the molecular signature of lung cancer in never-smokers, although more studies with larger sample sizes are needed to support this hypothesis.
Global Lung Function Initiative 2012 reference equations for spirometry in the Norwegian population
Authors: Langhammer Arnulf , Johannessen Ane , Holmen Turid L. , Melbye Hasse , Stanojevic Sanja , Lund May B. , Melsom Morten N. , Bakke Per , Quanjer Philip H.
Published: October 2016

We studied the fit of the Global Lung Function Initiative (GLI) all-age reference values to Norwegians, compared them with currently used references (European Community for Steel and Coal (ECSC) and Zapletal) and estimated the prevalence of obstructive lung disease.

Spirometry data collected in 30 239 subjects (51.7% females) aged 12–90 years in three population-based studies were converted to z-scores.

We studied healthy non-smokers comprising 2438 adults (57.4% females) aged 20–90 years and 8725 (47.7% female) adolescents aged 12–19 years. The GLI-2012 prediction equations fitted the Norwegian data satisfactorily. Median±sdz-scores were respectively 0.02±1.03, 0.01±1.04 and −0.04±0.91 for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC in males, and −0.01±1.02, 0.07±0.97 and −0.21±0.82 in females. The ECSC and Zapletal references significantly underestimated FEV1and FVC. Stricter criteria of obstruction (FEV1/FVC <GLI-2012 lower limit of normal (LLN)) carried a substantially higher risk of obstructive characteristics than FEV1/FVC <0.7 and >GLI-2012 LLN. Corresponding comparison regarding myocardial infarction showed a four-fold higher risk for women.

The GLI-2012 reference values fit the Norwegian data satisfactorily and are recommended for use in Norway. Correspondingly, the FEV1/FVC GLI-2012 LLN identifies higher risk of obstructive characteristics than FEV1/FVC <0.7.
Exercise pulmonary haemodynamics predict outcome in patients with systemic sclerosis
Authors: Stamm Adriana , Saxer Stéphanie , Lichtblau Mona , Hasler Elisabeth D. , Jordan Suzana , Huber Lars C. , Bloch Konrad E. , Distler Oliver , Ulrich Silvia
Published: October 2016

The aim of the present study was to investigate the prognostic value of exercise haemodynamics measured during right heart catheterisation (RHC) in patients with systemic sclerosis (SSc) referred for evaluation of pulmonary hypertension.

SSc patients undergoing RHC at rest and during maximal supine incremental cycle exercise were grouped into resting precapillary pulmonary hypertension (PHrest) (mean pulmonary artery pressure (mPAP) ≥25 mmHg, pulmonary artery wedge pressure <15 mmHg), exercise-induced pulmonary hypertension (PHex) (mPAP ≥30 mmHg and mPAP/cardiac output >3 mmHg·L−1·min−1at maximal exercise), and without pulmonary hypertension (PHnone). Patients' characteristics, haemodynamics and follow up data were compared between groups.

72 SSc patients were followed for median (interquartile range) 33 (15–55) months. Mean (95% CI) survival without transplantation estimated by Kaplan-Meyer analysis was 4.4 (0.8–2.9) years in PHrest(n=17), 5.2 (4.4–6.1) years in PHex(n=28) and 9.5(8.4–10.6) years in PHnone(n=27; p<0.05versusothers). In Cox regression models, the exercise-induced increase in mPAP (hazard ratio (HR) 1.097, 95% CI 1.002–1.200) and the coefficient of pulmonary vascular distensibility alpha (HR 0.100, 95% CI 0.012–0.871) controlled for age, but not resting haemodynamics predicted transplant-free survival.

Among SSc patients with normal mPAP at rest, an excessive increase in mPAP during exercise and an impaired vascular distensibility may indicate an early stage of pulmonary vasculopathy, associated with reduced survival similar to resting pulmonary hypertension patients.
Severe asthma exists despite suppressed tissue inflammation: findings of the U-BIOPRED study
Authors: Wilson Susan J. , Ward Jonathan A. , Sousa Ana R. , Corfield Julie , Bansal Aruna T. , De Meulder Bertrand , Lefaudeux Diane , Auffray Charles , Loza Matthew J. , Baribaud Frederic , Fitch Neil , Sterk Peter J. , Chung Kian Fan , Gibeon David , Sun Kai , Guo Yi-ke , Adcock Ian , Djukanovic Ratko , Dahlen Barbro , Chanez Pascal , Shaw Dominick , Krug Norbert , Hohlfeld Jens , Sandström Thomas , Howarth Peter H.
Published: October 2016

The U-BIOPRED study is a multicentre European study aimed at a better understanding of severe asthma. It included three steroid-treated adult asthma groups (severe nonsmokers (SAn group), severe current/ex-smokers (SAs/ex group) and those with mild–moderate disease (MMA group)) and healthy controls (HC group). The aim of this cross-sectional, bronchoscopy substudy was to compare bronchial immunopathology between these groups.

In 158 participants, bronchial biopsies and bronchial epithelial brushings were collected for immunopathologic and transcriptomic analysis. Immunohistochemical analysis of glycol methacrylate resin-embedded biopsies showed there were more mast cells in submucosa of the HC group (33.6 mm−2) compared with both severe asthma groups (SAn: 17.4 mm−2, p<0.001; SAs/ex: 22.2 mm−2, p=0.01) and with the MMA group (21.2 mm−2, p=0.01). The number of CD4+lymphocytes was decreased in the SAs/ex group (4.7 mm−2) compared with the SAn (11.6 mm−2, p=0.002), MMA (10.1 mm−2, p=0.008) and HC (10.6 mm−2, p<0.001) groups. No other differences were observed.

Affymetrix microarray analysis identified seven probe sets in the bronchial brushing samples that had a positive relationship with submucosal eosinophils. These mapped toCOX-2(cyclo-oxygenase-2),ADAM-7(disintegrin and metalloproteinase domain-containing protein 7),SLCO1A2(solute carrier organic anion transporter family member 1A2),TMEFF2(transmembrane protein with epidermal growth factor like and two follistatin like domains 2) andTRPM-1(transient receptor potential cation channel subfamily M member 1); the remaining two are unnamed.

We conclude that in nonsmoking and smoking patients on currently recommended therapy, severe asthma exists despite suppressed tissue inflammation within the proximal airway wall.
Excess medical costs in patients with asthma and the role of comorbidity
Authors: Chen Wenjia , Lynd Larry D. , FitzGerald J. Mark , Marra Carlo A. , Balshaw Robert , To Teresa , Tavakoli Hamid , Sadatsafavi Mohsen
Published: October 2016

Asthmatic patients frequently have comorbidities, but the role of comorbidities in the economic burden of asthma is unclear. We examined the excess direct medical costs, including asthma- and comorbidity-related costs, in patients with asthma.

We created a propensity score-matched cohort of patients newly diagnosed with asthma and non-asthmatic comparison subjects, both aged 5–55 years, from health administrative data (1997–2012) in British Columbia, Canada. Health services use records were categorised into 16 major disease categories based on International Classification of Diseases codes. Excess costs (in 2013 Canadian dollars ($)) were estimated as the adjusted difference in direct medical costs between the two groups.

Average overall excess costs were estimated at $1058/person-year (95% CI 1006–1110), of which $134 (95% CI 132–136) was attributable to asthma and $689 (95% CI 649–730) to major comorbidity classes. Psychiatric disorders were the largest component of excess comorbidity costs, followed by digestive disorders, diseases of the nervous system, and respiratory diseases other than asthma. Comorbidity-attributable excess costs greatly increased with age but did not increase over the time course of asthma.

These findings suggest that both asthma and comorbidity-related outcomes should be considered in formulating evidence-based policies and guidelines for asthma management.
Risk of developing tuberculosis disease among persons diagnosed with latent tuberculosis infection in the Netherlands
Authors: Erkens Connie G.M. , Slump Erika , Verhagen Maurits , Schimmel Henrieke , Cobelens Frank , van den Hof Susan
Published: October 2016

Diagnosis and preventive treatment of latent tuberculosis infection (LTBI) among high-risk groups is recommended to achieve tuberculosis (TB) elimination in low-incidence countries.

We studied TB incidence rates among those notified with LTBI in the Netherlands from 2005 to 2013 and analysed associated risk factors. We stratified analyses by target group for screening, and by initiation and completion of preventive treatment.

The incidence for those completing, stopping and not receiving preventive treatment was 187, 436 and 355 per 100 000 person-years for contacts of TB patients, respectively, and 63, 96 and 110 per 100 000 person-years for other target groups. The rate ratio for TB development among contacts compared to other target groups was 3.1 (95% CI 2.0–4.9). In both groups, incidence was highest in the first year after diagnosis. Independent factors associated with progression to TB among contacts were age <5 years and stopping preventive treatment within 28 days compared to those not receiving preventive treatment. Among other target groups, being foreign born was the only risk factor associated with the risk of developing TB.

We conclude that the epidemiological impact of preventive treatment is highest in contacts of TB patients and limited in other target groups for LTBI management in the Netherlands.
Prospective validation of right ventricular role in primary graft dysfunction after lung transplantation
Authors: Pérez-Terán Purificación , Roca Oriol , Rodríguez-Palomares José , Ruiz-Rodríguez Juan C. , Zapatero Ana , Gea Joaquim , Serra Joaquim , Evangelista Arturo , Masclans Joan R.
Published: October 2016

Primary graft dysfunction is a significant cause of lung transplant morbidity and mortality, but its underlying mechanisms are not completely understood. The aims of the present study were: 1) to confirm that right ventricular function is a risk factor for severe primary graft dysfunction; and 2) to propose a clinical model for predicting the development of severe primary graft dysfunction.

A prospective cohort study was performed over 14 months. The primary outcome was development of primary graft dysfunction grade 3. An echocardiogram was performed immediately before transplantation, measuring conventional and speckle-tracking parameters. Pulmonary artery catheter data were also measured. A classification and regression tree was made to identify prognostic models for the development of severe graft dysfunction.

70 lung transplant recipients were included. Patients who developed severe primary graft dysfunction had better right ventricular function, as estimated by cardiac index (3.5±0.8versus2.6±0.7 L·min−1·m−2, p<0.01) and basal longitudinal strain (−25.7±7.3%versus−19.5±6.6%, p<0.01). Regression tree analysis provided an algorithm based on the combined use of three variables (basal longitudinal strain, pulmonary fibrosis disease and ischaemia time), allowing accurate preoperative discrimination of three distinct subgroups with low (11–20%), intermediate (54%) and high (75%) risk of severe primary graft dysfunction (area under the receiver operating characteristic curve 0.81).

Better right ventricular function is a risk factor for the development of severe primary graft dysfunction. Preoperative estimation of right ventricular function could allow early identification of recipients at increased risk, who would benefit the most from careful perioperative management in order to limit pulmonary overflow.
RStrucFam: a web server to associate structure and cognate RNA for RNA-binding proteins from sequence information
Authors: Ghosh Pritha , Mathew Oommen K. , Sowdhamini Ramanathan
Published: October 2016

Background

RNA-binding proteins (RBPs) interact with their cognate RNA(s) to form large biomolecular assemblies. They are versatile in their functionality and are involved in a myriad of processes inside the cell. RBPs with similar structural features and common biological functions are grouped together into families and superfamilies. It will be useful to obtain an early understanding and association of RNA-binding property of sequences of gene products. Here, we report a web server, RStrucFam, to predict the structure, type of cognate RNA(s) and function(s) of proteins, where possible, from mere sequence information.

Results

The web server employs Hidden Markov Model scan (hmmscan) to enable association to a back-end database of structural and sequence families. The database (HMMRBP) comprises of 437 HMMs of RBP families of known structure that have been generated using structure-based sequence alignments and 746 sequence-centric RBP family HMMs. The input protein sequence is associated with structural or sequence domain families, if structure or sequence signatures exist. In case of association of the protein with a family of known structures, output features like, multiple structure-based sequence alignment (MSSA) of the query with all others members of that family is provided. Further, cognate RNA partner(s) for that protein, Gene Ontology (GO) annotations, if any and a homology model of the protein can be obtained. The users can also browse through the database for details pertaining to each family, protein or RNA and their related information based on keyword search or RNA motif search.

Conclusions

RStrucFam is a web server that exploits structurally conserved features of RBPs, derived from known family members and imprinted in mathematical profiles, to predict putative RBPs from sequence information. Proteins that fail to associate with such structure-centric families are further queried against the sequence-centric RBP family HMMs in the HMMRBP database. Further, all other essential information pertaining to an RBP, like overall function annotations, are provided. The web server can be accessed at the following link: http://caps.ncbs.res.in/rstrucfam.
Combining graph embedding and sparse regression with structure low-rank representation for semi-supervised learning
Authors: You Cong-Zhe , Palade Vasile , Wu Xiao-Jun
Published: October 2016

In this paper, we propose a novel method for semi-supervised learning by combining graph embedding and sparse regression, termed as graph embedding and sparse regression with structure low rank representation (GESR-LR), in which the embedding learning and the sparse regression are performed in a combined approach. Most of the graph based semi-supervised learning methods take into account the local neighborhood information while ignoring the global structure of the data. The proposed GESR-LR method learns a low-rank weight matrix by projecting the data onto a low-dimensional subspace. The GESR-LR makes full use of the supervised learning information in the construction of the affinity matrix, and the affinity construction is combined with graph embedding in a single step to guarantee the global optimal solution. In the dimensionality reduction procedure, the proposed GESR-LR can preserve the global structure of the data, and the learned low-rank weight matrix can effectively reduce the influence of the noise. An effective novel algorithm to solve the corresponding optimization problem was designed and is presented in this paper. Extensive experimental results demonstrate that the GESR-LR method can obtain a higher classification accuracy than other state-of-the-art methods.
Oxidative stress during courtship affects male and female reproductive effort differentially in a wild bird with biparental care
Authors: Montoya Bibiana , Valverde Mahara , Rojas Emilio , Torres Roxana
Published: October 2016

Oxidative stress has been suggested as one of the physiological mechanisms modulating reproductive effort, including investment in mate choice. Here, we evaluated whether oxidative stress influences breeding decisions by acting as a cost of or constraint on reproduction in the brown booby (Sula leucogaster), a long-lived seabird with prolonged biparental care. We found that during courtship, levels of lipid peroxidation (LP) of males and females were positively associated with gular skin color, a trait presumably used in mate choice, while levels of reactive oxygen species (ROS) were higher as laying approached and in early breeding pairs. Evidence of a constraining effect of oxidative stress for females was suggested by the fact that females with higher ROS during courtship laid smaller first eggs and had chicks with lower rates of body mass gain, and higher female LP was associated with lower offspring attendance time. No evidence of an oxidative cost of parental effort was found; from courtship to parental care male and female' ROS decreased, and changes in LP levels were non-significant. Finally, using a cross-fostering experiment we found that offspring ROS was unrelated to rearing and genetic parents' ROS. Interestingly, offspring LP was positively associated with the LP during courtship of both the rearing parents and the genetic father, suggesting that offspring LP might have both a genetic and an environmental component. Hence, in the brown booby oxidative stress may be a cost of investment in reproductive traits before egg laying and constrain females' investment in eggs and parental care.
Size-dependent physiological responses of the branching coralPocillopora verrucosato elevated temperature andPCO2
Authors: Edmunds Peter J. , Burgess Scott C.
Published: October 2016

Body size has large effects on organism physiology, but these effects remain poorly understood in modular animals with complex morphologies. Using two trials of a∼24 d experiment conducted in 2014 and 2015, we tested the hypothesis that colony size of the coral Pocillopora verrucosa affects the response of calcification, aerobic respiration, and gross photosynthesis to temperature (∼ 26.5°C and∼29.7°C) and PCO2 (∼ 400 µatm and∼1000 µatm). Large corals calcified more than small corals, but at a slower size-specific rate; area-normalized calcification declined with size. Whole-colony and area-normalized calcification were unaffected by temperature, PCO2, or the interaction between the two. Whole-colony respiration increased with colony size, but the slopes of these relationships differed between treatments. Area-normalized gross photosynthesis declined with colony size, but whole-colony photosynthesis was unaffected by PCO2, and showed a weak response to temperature. When scaled up to predict the response of large corals, area-normalized metrics of physiological performance measured using small corals provide inaccurate estimates of physiological performance of large colonies. Together, these results demonstrate the importance of colony size in modulating the response of branching corals to elevated temperature and high PCO2.
Flow cytometry dataset for cells collected from touched surfaces
Authors: Kwon Ye Jin , Stanciu Cristina E. , Philpott M. Katherine , Ehrhardt Christopher J.
Published: October 2016

‘Touch’ or trace cell mixtures submitted as evidence are a significant problem for forensic laboratories as they can render resulting genetic profiles difficult or even impossible to interpret. Optical signatures that distinguish epidermal cell populations from different contributors could facilitate the physical separation of mixture components prior to genetic analysis, and potentially the downstream production of single source profiles and/or simplified mixtures.  This dataset comprises the results from antibody hybridization surveys using Human Leukocyte Antigen (HLA) and Cytokeratin (CK) probes, as well as surveys of optical properties of deposited cells, including forward scatter (FSC), side scatter (SSC), and fluorescence emissions in the Allophycocyanin (APC) channel.  All analyses were performed on “touch” samples deposited by several different contributors on multiple days to assess inter- and intra-contributor variability.
Metagenomic analysis of medicinal Cannabis samples; pathogenic bacteria, toxigenic fungi, and beneficial microbes grow in culture-based yeast and mold tests
Authors: McKernan Kevin , Spangler Jessica , Helbert Yvonne , Lynch Ryan C. , Devitt-Lee Adrian , Zhang Lei , Orphe Wendell , Warner Jason , Foss Theodore , Hudalla Christopher J. , Silva Matthew , Smith Douglas R.
Published: October 2016

Background: The presence of bacteria and fungi in medicinal or recreationalCannabisposes a potential threat to consumers if those microbes include pathogenic or toxigenic species. This study evaluated two widely used culture-based platforms for total yeast and mold (TYM) testing marketed by 3M Corporation and Biomérieux, in comparison with a quantitative PCR (qPCR) approach marketed by Medicinal Genomics Corporation.

Methods: A set of 15 medicinalCannabissamples were analyzed using 3M and Biomérieux culture-based platforms and by qPCR to quantify microbial DNA. All samples were then subjected to next-generation sequencing and metagenomics analysis to enumerate the bacteria and fungi present before and after growth on culture-based media.

Results: Several pathogenic or toxigenic bacterial and fungal species were identified in proportions of >5% of classified reads on the samples, includingAcinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, Ralstonia pickettii, Salmonella enterica, Stenotrophomonas maltophilia, Aspergillus ostianus, Aspergillus sydowii, Penicillium citrinumandPenicillium steckii.Samples subjected to culture showed substantial shifts in the number and diversity of species present, including the failure ofAspergillusspecies to grow well on either platform. Substantial growth ofClostridium botulinumand other bacteria were frequently observed on one or both of the culture-based TYM platforms. The presence of plant growth promoting (beneficial) fungal species further influenced the differential growth of species in the microbiome of each sample.

Conclusions: These findings have important implications for theCannabisand food safety testing industries.
Developing cardiac care: why research matters and how to become involved
Authors: Hatchett Richard
Published: October 2016

Research is one form of knowledge used to guide and enhance cardiac nursing practice. However, it follows a specific methodology and, when well-written, allows us to critique the steps and consider its application to patient groups. This first article in the series briefly reviews different types of knowledge and contrasts this to the research process, allowing the importance of this form of knowledge to be seen. The two broad research paradigms—quantitative and qualitative—are described, to highlight their value to cardiac nursing care. The various ways practitioners can be involved in research are discussed, with a need to seriously consider available time commitment and what can be brought to the process.
Revalidation and the Code: upholding dignity
Authors: Griffith Richard
Published: October 2016

The Nursing and Midwifery Council (NMC) introduced revalidation as a way to ensure that registered nurses practise safely and effectively. Revalidation encourages nurses to reflect on the role of the Code ( NMC, 2015a ) in their practice ( NMC, 2015b ). To do this successfully and maintain an active registration, cardiac nurses will need to demonstrate that they understand the laws and professional requirements that underpin the Code. In the second in a series of articles, Richard Griffith considers the first standard of the Code that requires cardiac nurses to treat people as individuals and to uphold their dignity.
A multiple case study of patient journeys in Wales from A&E to a hospital ward or home
Authors: Manning Sera Nia
Published: October 2016

The health service is having to plan for an increasingly older population putting extra demand on services, with a greater emphasis on providing care at home. A health board in Wales brought in an Early Response Service, which assessed whether patients attending accident and emergency needed to be admitted to hospital or could receive care at home. This qualitative study looked at the experiences of both patients and staff members in both settings. A multiple case study was undertaken using semi-structured interviews. The theoretical framework was derived from Kolcaba's comfort theory and the bio-psycho-social model. Staff were identifying the most suitable patients for care at home and all hospital admissions were necessary, as the patients required greater medical/surgical intervention than those cared for at home.
District nurses must do more to comply with health care sharps regulations
Authors: Griffith Richard
Published: October 2016

The Health and Safety Executive have completed an inspection initiative focussing on the prevention and management of sharps injuries in forty NHS organisations. Health and safety breaches were found in 90% of the services visited and inspectors issued improvement notices to 45% of those NHS organisations. In this article Richard Griffith sets out the key findings of the inspection initiative and considers their impact on district nursing practice.
Experiences of student midwives in the care of women with perinatal loss: A qualitative descriptive study
Authors: Alghamdi Reem , Jarrett Patricia
Published: October 2016

Background:

Student midwives often encounter perinatal loss, such as stillbirth and neonatal death, as part of their experience of clinical practice. Coping with these events can be challenging because loss and death are the antitheses of birth, which predominates midwifery practice. There has been limited research on how student midwives are supported when caring for women with bereavement; however, poor support may have repercussions for future practice.

Aim:

The aim of this study is to explore the experiences of final-year student midwives when caring for women with perinatal loss.

Methods:

Two focus groups were conducted with 10 final-year BSc (Hons) Midwifery students. The focus groups lasted approximately 1 hour and used a semi-structured interview schedule. Data were analysed using thematic analysis.

Findings:

Four key themes were identified from the data: preparation for perinatal loss; ‘just dealing with it’; contradiction and challenges with the role of the midwife; and emotional impact and coping strategies.

Conclusions:

Final-year student midwives believed they were ill-prepared in caring for women with perinatal loss, reported difficulties in communicating with women and believed they were excluded from their care. Students valued support from the bereavement midwife and identified effective strategies which helped them cope with bereavement and loss.
Investigating stillbirths
Authors: Windsor Sophie
Published: October 2016

Sophie Windsor considers whether a recent case involving the first inquest into the birth of a stillborn baby in Northern Ireland could extend UK coronial law to investigate stillbirths.
Routine childhood vaccination with Bexsero: the end of MenB?
Authors: Glennie Linda
Published: October 2016

All newborn babies in the UK are now routinely offered the jab against Meningococcal group B (MenB), but there is still work to be done in stamping out this devastating infection, explains Linda Glennie
‘Thinking beyond PE’
Authors: Cook Robert B
Published: October 2016

Whitehall Junior School in Hillingdon testifies to the success of the Active Minds programme, which empowers pupils to take control of their physical activities.
High-energy pilon fractures management
Authors: Tomás-Hernández Jordi
Published: October 2016

High-energy pilon fractures are challenging injuries. Multiple options are described for the definitive surgical management of these fractures, but there is no level I evidence for optimal management. The current management and recommendations for treatment will be reviewed in this article. Anatomical reduction of the fracture, restoration of joint congruence and reconstruction of the posterior column with a correct limb axis minimising the soft-tissue insult are the key points to a good outcome when treating pilon fractures. Even when these goals are achieved, there is no guarantee that results will be acceptable in the mid-term due to the frequent progression to post-traumatic arthritis. In high-energy fractures with soft-tissue compromise, a staged treatment is generally accepted as the best way to take care of these devastating fractures and is considered a local ‘damage control’ strategy. The axial cuts from the CT scan images are essential in order to define the location of the main fracture line, the fracture pattern (sagittal or coronal) and the number of fragments. All of this information is crucial for pre-operative planning, incision placement and articular surface reduction. No single method of fixation is ideal for all pilon fractures, or suitable for all patients. Definitive decision making is mostly dependent on the fracture pattern, condition of the soft-tissues, the patient’s profile and surgical expertise.

Cite this article: Tomás-Hernández J. High-energy pilon fractures management: state of the art. EFORT Open Rev 2016;1:354-361. DOI: 10.1302/2058-5241.1.000016.
Realising Sedgwick’s vision: theorising strategies of resistance to neoliberal mental health and welfare policy
Authors: Moth Rich , McKeown Mick
Published: October 2016

There has recently been renewed interest in non-reductive historical materialist modes for analysing social movements, of which the work of mental health activist and Marxist theorist Peter Sedgwick is a precursor. We contend that Sedgwick’s approach retains contemporary utility for theorising radical mental health movements, though we argue that this needs extension in light of intervening debates regarding the interaction of material and post-material concerns. Having established this, we will turn to an overview of recent neoliberal labour market, welfare and mental health policy reforms as a basis for consideration of the strategic implications for resistance and coalition building among survivor and worker activists. We will propose a contemporary Sedgwickian ‘transitional’ strategy as a means to realise transformative change in services and society. In conclusion, we argue that tools for promoting this strategy, such as the Social Work Action Network’s ‘Mental health charter’, may assist in binding together diverse constituencies to strengthen alliances of resistance.