bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant Melanoma in Association With a Thymic Nevus in a Patient With a Giant Congenital Nevus
Authors: Shvartser-Beryozkin Yulia , Yakobson Alexander , Benharroch Daniel , Saute Milton , Feinmesser Meora
Published: December 2016

Nevi and melanocytic proliferations are known to appear in multiple extracutaneous sites, including lymph nodes and meninges. We report a case of an anterior mediastinal mass in a patient with a giant congenital nevus and neurofibromatosis type I. Histologically, the tumor was found to be a malignant melanoma in the thymus arising in association with a nevus that involved most of the thymic tissue. There was no sign of cutaneous melanoma on skin examination. We suggest that the tumor originated from the benign nevus in the thymus, a rare extracutaneous location for nevi and malignant melanoma.
A Retrospective Comparison of Home Telehealth and Nursing Care With or Without Rehabilitation Therapy on Rehospitalization Rates of Individuals With Heart Failure
Authors: Martin Stacy , Anderson Bill , Vincenzo Jennifer L. , Zai Sajid Yousuf
Published: December 2016

PURPOSE:

Congestive heart failure (CHF) is the most common reason for rehospitalization among the aging population, accounting for one-fifth of all hospital admissions. To date, there is no research comparing the rehospitalization rates between patients with CHF (PWCHF) who receive telehealth and home health nursing care versus a multidisciplinary team consisting of telehealth, home nursing, physical therapy (PT), and/or occupational therapy (OT).

METHODS:

A retrospective analysis was performed with 132 Medicare Part A home health patients discharged from an inpatient setting with a primary or secondary diagnosis of CHF receiving daily telehealth over the course of 1 year. Allscripts Home Care and Lifestream software was used to query data from patient records. Rehospitalization rates were analyzed using Cochran-Mantel-Haenszel tests. Patients were divided into 3 groups: (1) nursing only; (2) nursing and PT or OT; or (3) nursing, PT, and OT.

RESULTS:

A total of 41 of the 132 patients (31.06%) were rehospitalized during their home health 60-day episode of care. This percentage includes all-cause rehospitalizations. Cochran-Mantel-Haenszel tests indicated there were no differences in rehospitalization rates between the 3 groups after controlling for the confounding variables: (1) multiple hospitalizations (P = .15); (2) history of falls (P = .16); or (3) depression (P = .18).

CONCLUSIONS:

There was no statistically significant difference between the 3 groups for all-cause rehospitalization rates. Further prospective research is required to determine best practices and multidisciplinary protocols to further reduce rehospitalization rates in this population.
OUTCOMES OF PARS PLANA VITRECTOMY IN THE MANAGEMENT OF REFRACTORY AQUEOUS MISDIRECTION SYNDROME
Authors: Al Bin Ali Ghada Y. , Al-Mahmood Ammar M. , Khandekar Rajiv , Abboud Emad B. , Edward Deepak P. , Kozak Igor
Published: December 2016

Purpose:

To determine the efficacy and complications of pars plana vitrectomy (PPV) and adjunct surgeries for aqueous misdirection refractory to medical therapy.

Methods:

A retrospective review of consecutive eyes with refractory aqueous misdirection at the King Khaled Eye Specialist Hospital between 2002 and 2010. Patients underwent two-port and three-port pars plana vitrectomy (PPV) with adjunct procedures including pars plana lensectomy combined with posterior capsulectomy, hyaloido-zonulo-iridectomy, and synechiolysis. Main outcome measures included anatomical success, functional success, and factors associated with the outcomes.

Results:

Sixty-nine eyes were evaluated over a mean follow-up period of 17.6 ± 3.8 months (3–156 months). Anatomical success was achieved in 62 eyes (90%) and functional success in 54 eyes (78%) that underwent PPV as a primary surgery. The factors associated with the altering misdirected aqueous flow and reducing intraocular pressure significantly associated with a two-line improvement of best-corrected visual acuity included surgical treatment within 4 weeks of presentation (P = 0.004) and preoperative intraocular pressure (P = 0.001). The success of two-port PPV and standard three-port PPV was similar (P = 0.7). The intraoperative and postoperative complications included retinal detachment in two eyes and endophthalmitis in one eye.

Conclusion:

The PPV was effective for managing aqueous misdirection refractory to medical therapy. Two-port or three-port PPV did not change the success rate but early surgery improved both anatomical and functional outcomes.
CHOROIDAL THICKNESS CHANGES AFTER VITRECTOMY WITH SILICONE OIL TAMPONADE FOR PROLIFERATIVE VITREORETINOPATHY RETINAL DETACHMENT
Authors: Odrobina Dominik , Gołębiewska Joanna , Maroszyńska Iwona
Published: December 2016

Purpose:

To access the potential effect of vitrectomy and silicone oil tamponade on the choroid.

Methods:

Eighteen patients (18 eyes) who had undergone pars plana vitrectomy with 1,000-cSt silicone oil tamponade for proliferative vitreoretinopathy retinal detachment were included in this retrospective study. All patients underwent ophthalmologic examinations before treatment and 1 week and 1, 3, and 6 months after vitrectomy with silicone oil tamponade. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography (Spectralis; Heidelberg Engineering) in a horizontal and vertical section beneath the fovea.

Results:

Choroidal thickness statistically significantly decreased till 3 months after pars plana vitrectomy with silicone oil tamponade: under the center of the fovea (P = 0.014) and in the temporal (P = 0.029), superior (P = 0.046), and inferior areas, determined at 1,500 μm from the center of the fovea (P = 0.030). After 6 months, the desired effect in the form of a decrease in the choroidal thickness was even more prominent, both under the center of the fovea (P < 0.001) and in the nasal (P < 0.001), temporal (P < 0.001), superior (P < 0.001), and inferior areas at 1,500 μm from the center of the fovea (P < 0.001).

Conclusion:

Choroidal thickness is reduced in eyes receiving silicone oil intraocular tamponade. Silicone oil tamponade may have an impact on the structure and proper functioning of the choroid. The measurements of the choroidal thickness by optical coherence tomography might be a very good tool to detect early changes in choroidal thickness and impact the decision when to remove silicone oil.
MOBILE SUBRETINAL CYSTICERCUS IMAGED BY SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY WITH MOTION TRACKER
Authors: Bypareddy Ravi , Takkar Brijesh , Chawla Rohan , Sachdeva Neha , Azad Shorya V. , Tripathy Koushik
Published: December 2016

Purpose:

To report optical coherence tomography–based videoimaging of alive subretinal cysticercus along with its mobile scolex.

Methods:

Spectral-domain optical coherence tomography was used to record high-definition videoimages, using the inbuilt motion tracker, in a 12-year-old boy with history of neurocysticercosis.

Result:

The scolex was found to be sensitive to light, and contractile movements were seen in the cyst wall and the germinative layers. The patient underwent vitrectomy, and the diagnoses were confirmed with histopathologic assessment.

Conclusion:

Optical coherence tomography is a useful tool for diagnosing posterior segment cysticercosis. The intense motion of scolex does not impact the surrounding ocular structures.
RETINAL VASCULITIS ASSOCIATED WITH EPSTEIN–BARR VIRUS INFECTION, A CASE REPORT
Authors: Victor Andi A. , Sukmana Nanang
Published: December 2016

Purpose:

To report a case of retinal vasculitis associated with Epstein–Barr virus infection.

Methods:

Case report.

Results:

A 26-year-old woman came with blurry vision. Funduscopy illustrated vasculitis with frosted branch-like appearance. The patient was treated with systemic acyclovir and topical steroid. Circulating polymerase chain reaction was positive for Epstein–Barr virus antibodies. Two months of treatment resolved the clinical manifestations.

Conclusion:

Epstein–Barr infection should be considered as the etiology of retinal vasculitis with similar clinical manifestations.
SERPIGINOUS CHOROIDITIS IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: El Ameen Ala'a , Herbort Carl P.
Published: December 2016

Purpose:

To report a case of serpiginous choroiditis imaged with optical coherence tomography angiography (OCT-A).

Methods:

Case report.

Results:

Multimodal imaging and OCT-A were performed to investigate serpiginous choroiditis in a 65-year-old patient. Comparison between OCT-A images and intermediate and late phase indocyanine green angiography revealed that the hypofluorescent areas on indocyanine green angiography corresponded topographically to the dark areas seen in the choriocapillaris layer of OCT-A.

Conclusion:

The OCT-A was shown to be able to detect vascular nonperfusion at the level of the choriocapillaris and could be helpful, especially for follow-up purposes, in clinical practice for choriocapillaritis such as serpiginous choroiditis.
ANTERIOR LENS CAPSULE IN THE MANAGEMENT OF CHRONIC FULL-THICKNESS MACULAR HOLE
Authors: Yepez Juan B. , Murati Felipe A. , De Yepez Jazmin , Petitto Michele , Arevalo J. Fernando
Published: December 2016

Purpose:

To report the use of anterior lens capsule flap transplantation in two cases with chronic full-thickness macular hole (MH).

Methods:

Case series.

Results:

Two cases of chronic MH with a new treatment approach were reported. In the first case, a 66-year-old man presented with a chronic idiopathic MH in the left eye for 2 years. Presenting visual acuity was hand motion. The patient underwent phacoemulsification and vitrectomy with anterior lens capsule flap transplantation in the MH. At 5 months postoperatively, the visual acuity was 20/200 with MH closure. In the second case, a 68-year-old woman presented with decreased visual acuity for 2 years. Her visual acuity was hand motion in the right eye. The patient underwent phacoemulsification and vitrectomy with anterior lens capsule flap transplantation in the MH. Visual acuity improved to 20/400 with reduction in the MH diameter. Vision and MH diameter remained stable over 5 months postoperatively.

Conclusion:

Lens capsular flap transplantation is useful in closing chronic MH in the short term.
Brachial Plexus Palsy in Young Infants Harboring Osteomyelitis of the Humerus
Authors: Zimmermann Petra , Curtis Nigel
Published: December 2016

We present an infant with brachial plexus palsy who had osteomyelitis of the humerus and summarize previously reported cases. Although Staphylococcus aureus is the most common pathogen in osteomyelitis in infants, group B Streptococcus is responsible for 40% of humeral osteomyelitis. Early diagnosis is critical to prevent long-term sequalae but is hampered by infants frequently being well and afebrile at presentation.
Successful Introduction of Fine Needle Aspiration Biopsy for Diagnosis of Pediatric Lymphadenopathy
Authors: Sher-Locketz Candice , Schubert Pawel T. , Moore Samuel W. , Wright Colleen A.
Published: December 2016

Accurate and rapid diagnosis of extrapulmonary nodal tuberculosis in children is of paramount importance. This retrospective study performed at Tygerberg Hospital using data from the laboratory records between January 1, 2004 and June 30, 2014 demonstrates how since the introduction laboratory-run FNAB service; fine needle aspiration biopsy has become an acceptable and routine diagnostic procedure for triage of pediatric lymphadenopathy.
Central Nervous System Blastomycosis in Children
Authors: Madigan Theresa , Fatemi Yasaman , Theel Elitza S. , Moodley Amaran , Boyce Thomas G.
Published: December 2016

We present a 7-year-old boy with chronic meningitis caused by Blastomyces dermatitidis. A review of the literature revealed 32 cases of central nervous system blastomycosis in children between 1983 and 2016, of which 18 represented parenchymal disease of the brain or spinal cord. Blastomycosis affecting the central nervous system is rare but should be considered in children with chronic meningitis.
Seroprevalence of Hepatitis E Virus Antibodies in Portuguese Children
Authors: Oliveira Ricardo , Mesquita João Rodrigo , Pereira Sara , Abreu-Silva Joana , Teixeira Joana , Nascimento Maria São José
Published: December 2016

Background:

Hepatitis E virus (HEV) has become a growing public health concern in industrialized countries. Most of the HEV seroprevalence studies have focused on adult populations, and reports regarding HEV seroepidemiology among children are scarce in these countries. The aims of this work were to perform a nationwide seroprevalence study on HEV infection in Portuguese children and to compare the HEV seropositivity in this 2015 children cohort with results in sera performed 20 years earlier.

Methods:

Sera (N = 352) from children collected in 2015 from all regions of Portugal were screened for anti-HEV IgG and IgM using the commercial enzyme-linked immunosorbent assay recomWell HEV IgG/IgM (2015 version; Mikrogen, Neuried, Germany), and positive samples were retested by immunodot assay recomLine HEV IgG/IgM (2015 version; Mikrogen, Neuried, Germany). For the comparative assessment of HEV seropositivity of the 2 children cohorts, children’s sera (N = 71) archived since 1995 were screened for anti-HEV IgG and results were compared with that of the 2015 cohort, matched by sex, age and region.

Results:

Anti-HEV antibodies were detected in 4 children giving an overall HEV seroprevalence in the 2015 cohort of 1.1%. A healthy 10–15-year-old female was found positive for anti-HEV IgM indicating a current or recent HEV infection. No statistically significant difference was observed in HEV seroprevalence regarding gender, age group and region of residence. Comparison of the HEV seropositivity of the 2 children cohorts showed a statistical significant decrease with time (P = 0.024).

Conclusions:

This is the first national study of HEV seroprevalence in Portuguese children and the first to demonstrate a decrease of anti-HEV antibodies in this age group over time.
SBIRT (Screening, Brief Intervention, and Referral to Treatment) Among Trauma Patients: A Review of the Inpatient Process and Patient Experience
Authors: Gormican Erin K , Hussein Zahra S.
Published: December 2016

Screening, brief intervention, and referral to treatment (SBIRT) is an important and effective strategy among injury prevention measures aimed at reducing risky alcohol use (N. Bertholet, J. B. Daeppen, V. Wietlisbach, M. Fleming, & B. Burnand, 2005). The trauma patient population is at significant risk for alcohol-related trauma recidivism (J. Nunn, M. Erdogan, & R. S. Green, 2016) and is therefore a priority group in which to implement SBIRT. Vancouver General Hospital (VGH) implemented SBIRT on its 2 inpatient trauma units in the fall of 2014. The alcohol use disorders screening test (AUDIT-C) was chosen as the screening tool for nurses to complete with new patients. A brief intervention was conducted by the trauma social workers in the cases where a patient scored positive on the AUDIT-C. To evaluate the implementation and effectiveness of SBIRT on the 2 inpatient trauma units at VGH and to provide recommendations for improvement, a telephone survey of past trauma patients and a review of the screening process were undertaken in May 2016. Patient follow-up was conducted via a telephone survey. Of the 79 patients who met the follow-up criteria, a total of 19 were successfully contacted. Results from the survey showed that the majority of patients did not recall being screened with the AUDIT-C and were either unsure or did not recall receiving a brief intervention by the social worker. Despite these findings, a rescreening with the AUDIT-C tool revealed that 68% of patients who participated in the survey had a lower score than when they were inpatients. Recommendations for improvement include optimizing the timing of SBIRT with trauma inpatients and implementing a follow-up system. The literature suggests that following up with patients to provide an SBIRT “booster” increases the effectiveness of brief interventions (C. Field et al., 2014).
Probiotics for Trauma Patients: Should We Be Taking a Precautionary Approach?
Authors: Vitko Heather A. , Sekula L. Kathleen , Schreiber Martin A.
Published: December 2016

The use of probiotics in the hospital setting is largely understudied and highly controversial. Probiotics are living organisms that, when taken internally, can produce an immunomodulating effect and improve the gastrointestinal (GI) mucosal barrier. Although used for centuries by healthy individuals for GI health, their use in the hospital setting is now gaining wide attention for the prevention of infectious complications such as antibiotic-associated diarrhea, Clostridium difficile infections, multiple-organ dysfunction syndrome, and ventilator-associated pneumonia. However, current understanding of the efficacy of probiotics in the acute care setting is confounded by the inconsistencies in the literature with regard to the strain of probiotic being studied, optimal dosage, and timing and duration of dosing, which make the formulation of clinical practice guidelines difficult. Although the safety of probiotics has been confirmed when used for the prevention and treatment of certain diseases, practitioners remain hesitant to administer them to their patients, citing the lack of high-quality studies clearly demonstrating efficacy and safety. Infection is a cause of late death in trauma patients, but only recently has research been conducted on the use of probiotics specifically for the prevention of hospital-acquired infections in trauma patients. In the face of such limited but promising research, is it reasonable to use probiotics for the prevention of infection in hospitalized trauma patients and improve outcomes? Use of the “precautionary principle” may be useful in this instance.
Relative Difficulties of Daily Living Tasks with Retinitis Pigmentosa
Authors: Latham Keziah , Baranian Mohammad , Timmis Matthew A. , Fisher Andy , Pardhan Shahina
Published: December 2016

Purpose

To determine the relative difficulty of activity of daily living tasks for people with retinitis pigmentosa (RP).

Methods

Participants with RP (n = 166) rated the difficulty of tasks (n = 43) underpinning the Dutch Activity Inventory goals of mobility indoors and outdoors, shopping, and using public transport. Demographic characteristics were also determined. Responses were Rasch analyzed to determine properties of the scale, derive unidimensional subscales, and consider differential item functioning (DIF).

Results

After removal of one ill-fitting item, the remaining 42 tasks formed a scale with reasonable Rasch parameters but poor unidimensionality. The most difficult tasks were orienting in poor and bright light both indoors and outdoors, and avoiding peripheral obstacles outdoors. Eight subscales were derived with unidimensional properties, each of which could be considered as requiring similar skills. DIF identified that tasks from the “poor light and obstacles” subscale were more difficult for those younger than the median age, nonusers of mobility aids, and those not registered or registered sight impaired. Tasks from the “finding products” and “public transport” subscales were more difficult for those older than the median age, with longer duration of visual loss, users of mobility aids, and those registered severely sight impaired.

Conclusions

The most difficult tasks for people with RP of orienting in poor light and avoiding peripheral obstacles are relatively more difficult for those not registered as “severely sight impaired,” but are less difficult for those who use mobility aids. Mobility aids (guide dog or cane), therefore, do benefit users in their perceived ability in these particular tasks. The derived unidimensional subscales reorganize the tasks from those grouped together by goal (researcher driven) to those perceived as requiring similar skills by people with RP (patient driven) and can be used as an evidence base for orientation and mobility training protocols.
Cancer Risk after Fat Transfer: A Multicenter Case-Cohort Study
Authors: Myckatyn Terence M. , Wagner I. Janelle , Mehrara Babak J. , Crosby Melissa A. , Park Julie E. , Qaqish Bahjat F. , Moore Dominic T. , Busch Evan L. , Silva Amanda K. , Kaur Surinder , Ollila David W. , Lee Clara N.
Published: December 2016

Background:

Fat transfer is an increasingly popular method for refining postmastectomy breast reconstructions. However, concern persists that fat transfer may promote disease recurrence. Adipocytes are derived from adipose-derived stem cells and express adipocytokines that can facilitate active breast cancer cells in laboratory models. The authors sought to evaluate the association between fat transfer to the reconstructed breast and cancer recurrence in patients diagnosed with local or regional invasive breast cancers.

Methods:

A multicenter, case-cohort study was performed. Eligible patients from four centers (Memorial Sloan Kettering, M. D. Anderson Cancer Center, Alvin J. Siteman Cancer Center, and the University of Chicago) were identified by each site’s institutional tumor registry or cancer data warehouse. Eligibility criteria were as follows: mastectomy with immediate breast reconstruction between 2006 and 2011, age older than 21 years, female sex, and incident diagnosis of invasive ductal carcinoma (stage I, II, or III). Cases consisted of all recurrences during the study period, and controls consisted of a 30 percent random sample of the study population. Cox proportional hazards regression was used to evaluate for association between fat transfer and time to recurrence in bivariate and multivariate models.

Results:

The time to disease recurrence unadjusted hazard ratio for fat transfer was 0.99 (95 percent CI, 0.56 to 1.7). After adjustment for age, body mass index, stage, HER2/Neu receptor status, and estrogen receptor status, the hazard ratio was 0.97 (95 percent CI, 0.54 to 1.8).

Conclusion:

In this population of breast cancer patients who had mastectomy with immediate reconstruction, fat transfer was not associated with a higher risk of cancer recurrence.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction
Authors: Sinha Indranil , Pusic Andrea L. , Wilkins Edwin G. , Hamill Jennifer B. , Chen Xiaoxue , Kim Hyungjin M. , Guldbrandsen Gretchen , Chun Yoon S.
Published: December 2016

Background:

Surgical-site infection causes devastating reconstructive failure in implant-based breast reconstructions. Large national database studies offer insights into complication rates, but only capture outcomes within 30 days postoperatively. This study evaluates both early and late surgical-site infection in immediate implant-based reconstruction and identifies predictors.

Methods:

As part of the Mastectomy Reconstruction Outcomes Consortium Study, 1662 implant-based breast reconstructions in 1024 patients were evaluated for early versus late surgical-site infection. Early surgical-site infection was defined as infection occurring within 30 days postoperatively; late surgical-site infection was defined as infection occurring 31 days to 1 year postoperatively. Minor infection required oral antibiotics only, and major infection required hospitalization and/or surgical treatment. Direct-to-implant patients had 1-year follow-up, and tissue expander patients had 1-year post-exchange follow-up.

Results:

Among 1491 tissue expander and 171 direct-to-implant reconstructions, overall surgical-site infection rate for tissue expander was 5.7 percent (85 of 1491) after first-stage, 2.5 percent (31 of 1266) after second-stage, and 9.9 percent (17 of 171) for direct-to-implant reconstruction. Over 47 to 71 percent of surgical-site infection complications were late surgical-site infection. Multivariate analysis identified radiotherapy and increasing body mass index as significant predictors of late surgical-site infection. No significant difference between the direct-to-implant and tissue expander groups in the occurrence of early, late, or overall surgical-site infection was found.

Conclusions:

The majority of surgical-site infection complications in immediate implant-based breast reconstructions occur more than 30 days after both first-stage and second-stage procedures. Radiotherapy and obesity are significantly associated with late-onset surgical-site infection. Current studies limited to early complications do not present a complete assessment of infection associated with implant-based breast reconstructions or their long-term clinical outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
The Effect of Neoadjuvant Chemotherapy Compared to Adjuvant Chemotherapy in Healing after Nipple-Sparing Mastectomy
Authors: Frey Jordan D. , Choi Mihye , Karp Nolan S.
Published: December 2016

Background:

Nipple-sparing mastectomy is the latest advancement in the treatment of breast cancer. The authors aimed to investigate the effects of neoadjuvant and adjuvant chemotherapy in nipple-sparing mastectomy.

Methods:

Patients undergoing nipple-sparing mastectomy from 2006 to June of 2015 were identified. Results were stratified by presence of neoadjuvant or adjuvant chemotherapy.

Results:

A total of 840 nipple-sparing mastectomies were performed. Twenty-eight were in those who received neoadjuvant chemotherapy and 93 were in patients receiving adjuvant chemotherapy. Patients receiving both neoadjuvant and adjuvant chemotherapy were included in the neoadjuvant group. Nipple-sparing mastectomies that received neoadjuvant (with or without adjuvant) chemotherapy were compared to those in patients who received adjuvant chemotherapy. Those with neoadjuvant (with or without adjuvant) chemotherapy were more likely to have explantation (p = 0.0239) and complete nipple-areola complex necrosis (p = 0.0021). Those with neoadjuvant (with or without adjuvant) chemotherapy were more likely to have implant explantation (p = 0.0015) and complete nipple-areola complex necrosis (p = 0.0004) compared to those with no chemotherapy. Compared to nipple-sparing mastectomies in patients with no chemotherapy, those with adjuvant chemotherapy were more likely to have a hematoma (p = 0.0021). Those that received both neoadjuvant and adjuvant chemotherapy were more likely to have complete nipple-areola complex necrosis compared with both the neoadjuvant chemotherapy–only and adjuvant chemotherapy–only groups (p < 0.0001).

Conclusions:

Nipple-sparing mastectomy is safe to perform in the setting of neoadjuvant and adjuvant chemotherapy. As a whole, neoadjuvant (with or without adjuvant) chemotherapy increases risk of complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Evidence-Based Medicine: The Evaluation and Treatment of Pressure Injuries
Authors: Ricci Joseph A. , Bayer Lauren R. , Orgill Dennis P.
Published: December 2016

Learning Objective:

After studying this article, the participant should be able to: 1. Discuss the approach to and rationale for pressure injury management, including specific techniques for prevention and preoperative evaluation. 2. Develop a management algorithm for these wounds that includes operative and nonoperative modalities. 3. Understand how to identify and manage the complications of surgical intervention for pressure injuries, including recurrence.

Pressure injuries are a common problem associated with great morbidity and cost, often presenting as complex challenges for plastic surgeons. Although the cause of these wounds is largely prolonged pressure, the true pathogenesis involves many other factors, including friction, shear, moisture, nutrition, and infection. This article outlines a systematic approach to evaluating and staging pressure injuries, and provides strategies for treatment and prevention. Critical to surgical intervention is thorough débridement, including any involved or causative bony tissues, and postoperative management to prevent wound dehiscence and recurrence.
Evidence-Based Medicine: Cutaneous Facial Malignancies: Nonmelanoma Skin Cancer
Authors: Connolly Karen L. , Nehal Kishwer S. , Disa Joseph J.
Published: December 2016

Learning Objectives:

After studying this article, the participant should be able to: 1. Identify clinical features of nonmelanoma skin cancer; 2. Distinguish low-risk versus high-risk basal cell carcinoma and squamous cell carcinoma; 3. Define appropriate management based on current guidelines for various types of basal cell and squamous cell carcinoma.

Skin malignancies are the most prevalent cancers, and plastic surgeons are often the primary physicians engaged in diagnosis and management of these lesions. Proper management includes distinguishing between high-risk and low-risk lesions and determining treatment accordingly. The aim of this Continuing Medical Education article is to review the diagnosis and management of common and uncommon facial skin malignancies, including basal cell carcinoma, squamous cell carcinoma, actinic keratosis, keratoacanthoma, Merkel cell carcinoma, atypical fibroxanthoma, sebaceous carcinoma, and microcystic adnexal carcinoma.
Evidence-Based Medicine: Options for Dupuytren’s Contracture: Incise, Excise, and Dissolve
Authors: Denkler Keith A. , Vaughn Carolyn J. , Dolan Estelle L. , Hansen Scott L.
Published: December 2016

Learning Objectives:

After studying this article, the participant should be able to: 1. Understand updates in the basic science, epidemiology, and treatment of Dupuytren’s disease. 2. Understand treatment with needle aponeurotomy, collagenase, and fasciectomy. 3. Understand advanced needle techniques for Dupuytren’s contracture. 4. Understand the safety and effectiveness of a new treatment, collagenase.

The literature on Dupuytren’s disease encompasses many specialties. Its treatment is generally by perforating, excising, or dissolving the affected tissues. This article reviews the changing understanding of this disease and treatment options.
Evidence-Based Medicine: Thumb Basal Joint Arthritis
Authors: Baker Richard H. J. , Al-Shukri Jaber , Davis Tim R. C.
Published: December 2016

Learning Objectives:

After studying this article, the participant should be able to: 1. Assess the patient’s history, clinical examination, and radiographic findings to diagnose and stage basilar joint arthritis. 2. Recall the cause and epidemiology of the condition. 3. Formulate a management plan including nonoperative management, and evaluate the candidacy for surgical treatment. 4. Understand the rationale for the various surgical options available (including rehabilitation), their potential complications, and the evidence related to outcomes.

This article has been prepared to accompany practice-based assessment with ongoing surgical education for the Maintenance of Certification for the American Board of Plastic Surgery. It is designed for clinicians to analyze and structure their care of a patient with arthritis of the trapeziometacarpal joint.
Complementary Effects of Negative-Pressure Wound Therapy and Pulsed Radiofrequency Energy on Cutaneous Wound Healing in Diabetic Mice
Authors: Chen Bin , Kao Huang-Kai , Dong Ziqing , Jiang Zhaohua , Guo Lifei
Published: December 2016

Background:

Negative-pressure wound therapy and pulsed radiofrequency energy are two clinical modalities used to treat soft-tissue wounds. They are purported to affect healing differently. The aim of this experimental study was to contrast the two modalities at a mechanistic level and to investigate whether their combined therapy could achieve additive and complementary effects on wound healing.

Methods:

Full-thickness dorsal cutaneous wounds of diabetic,db/db, mice were treated with either negative-pressure wound therapy, pulsed radiofrequency energy, or combined therapies. Macroscopic healing kinetics were examined. Epidermal regeneration (proliferation rate and length of reepithelialization) and neovascularization (blood vessel density) were investigated. Messenger RNA levels indicative of angiogenic (basic fibroblast growth factor), profibrotic (transforming growth factor-β), epidermal proliferative (keratinocyte growth factor), and extracellular matrix remodeling (collagen 1) processes were measured in wound tissues.

Results:

All three treatment groups displayed faster wound healing. The negative-pressure wound therapy/pulsed radiofrequency energy combined therapy led to significantly faster healing than either the negative-pressure wound therapy or pulsed radiofrequency energy therapy alone. Epidermal regeneration and neovascularization were enhanced in all three groups. The two negative-pressure wound therapy groups (alone and combined with pulsed radiofrequency energy) demonstrated more significant increases in expression of all assayed growth factors than the pulsed radiofrequency energy group. Furthermore, the combined therapy exhibited a more profound elevation in collagen 1 expression than either of the two therapies alone.

Conclusion:

Combining the negative-pressure wound therapy and pulsed radiofrequency energy modalities can achieve additive benefits in cutaneous healing, and the two therapies can be easily used together to complement each other in clinical wound treatments.
Skoog Primary Periosteoplasty versus Secondary Alveolar Bone Grafting in Unilateral Cleft Lip and Alveolus: Long-Term Effects on Alveolar Bone Formation and Maxillary Growth
Authors: Jabbari Fatima , Hakelius Malin M. , Thor Andreas L. I. , Reiser Erika A. , Skoog Valdemar T. , Nowinski Daniel J.
Published: December 2016

Background:

Clefts involving the alveolus are treated using one of two strategies: primary periosteoplasty at the time of lip repair or secondary alveolar bone grafting at mixed dentition. Most teams favor secondary alveolar bone grafting because of its high success rate, and concerns have been raised that primary periosteoplasty may interfere with maxillary growth. However, primary periosteoplasty may obviate the need for future bone grafting and is still practiced in some centers. Few studies compare the long-term outcomes of these two strategies.

Methods:

Fifty-seven consecutive patients born with unilateral cleft lip and alveolus were studied retrospectively. All patients underwent primary lip repair using Skoog’s method; 28 patients underwent primary periosteoplasty at the time of lip repair and the remaining 29 underwent secondary alveolar bone grafting at mixed dentition. Occlusal radiographs obtained at ages 10 and 16 years were analyzed for alveolar bone height. Cephalometric analysis assessed growth at ages 5, 10, and 18 years.

Results:

Seventeen of 28 patients treated using primary periosteoplasty required later secondary bone grafting, and the bone height at age 16 years was lower in the primary periosteoplasty group (p < 0.0001). There was a more pronounced decrease in maxillary protrusion from ages 5 to 10 years in the primary periosteoplasty group (p < 0.03). However, at age 18 there was no significant difference in maxillary growth between the two groups.

Conclusion:

Primary periosteoplasty did not seem to inhibit long-term maxillary growth but was ineffective as a method of reconstructing the alveolar cleft.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
The Lipo–Body Lift: A New Circumferential Body-Contouring Technique Useful after Bariatric Surgery
Authors: Bertheuil Nicolas , Chaput Benoit , De Runz Antoine , Girard Paul , Carloni Raphael , Watier Eric
Published: December 2016

Background:

After bariatric surgery, lifting of the lower body involves a contouring technique used to achieve optimal lower trunk reconstruction. The authors describe an innovative procedure applicable after massive weight loss: the lipo–body lift method. The authors describe their experience with this novel, safe procedure.

Methods:

Twenty-five abdominal body-contouring reconstructions following massive weight loss were treated by means of circumferential lipo–body lift. The authors describe the indications for the procedure and their perioperative and postoperative management.

Results:

The mean patient age was 39.4 years. The mean pre–body lift body mass index was 26.71 kg/m2; the average weight loss before surgery was 56.6 kg, with a mean delta body mass index loss of 20.82 kg/m2. The average hospital stay was 3.52 days and the drainage duration 3.56 days. No patient experienced any major complication (e.g., hematoma, thromboembolism, bleeding, skin necrosis, or a need for revision surgery to treat complications). Minor complications including wound dehiscence, wound infection, and fat necrosis were reported in 40 percent of patients. The occurrence of complications was associated with smoking status (p = 0.0280), the volume of liposuction (p = 0.0399), and the liposuction volume per unit of body mass index (p = 0.0071).

Conclusions:

The authors’ novel technique is less invasive than the traditional lower body-lifting method, as shown by the absence of major complications, and allows excellent conservation of connective tissue and vessels; undermining is minimal. As obesity becomes a major problem worldwide, lifting procedures that are safe and effective are important components of reconstructive strategies and should be widely offered to patients who experience massive weight loss.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Molecular epidemiology and antimicrobial resistance phenotypes of Acinetobacter baumannii isolated from patients in three hospitals in southern Vietnam
Authors: Tuan Anh Nguyen , Nga Tran Vu Thieu , Tuan Huynh Minh , Tuan Nguyen Si , Y Dao Minh , Vinh Chau Nguyen Van , Baker Stephen , Duong Ho Huynh Thuy
Published: December 2016

Multidrug resistance in the nosocomial pathogen Acinetobacter baumannii limits therapeutic options and impacts on clinical care. Resistance against carbapenems, a group of last-resort antimicrobials for treating multidrug-resistant (MDR) A. baumannii infections, is associated with the expression (and over-expression) of carbapenemases encoded by the bla
OXA genes. The aim of this study was to determine the prevalence of antimicrobial-resistant A. baumannii associated with infection in three hospitals in southern Vietnam and to characterize the genetic determinants associated with resistance against carbapenems. We recovered a total of 160 A
. baumannii isolates from clinical samples collected in three hospitals in southern Vietnam from 2012 to 2014. Antimicrobial resistance was common; 119/160 (74 %) of isolates were both MDR and extensively drug resistant (XDR). High-level imipenem resistance (>32 µg ml−1) was determined for 109/117 (91.6 %) of the XDR imipenem-nonsusceptible organisms, of which the majority (86.7 %) harboured the bla
OXA-51 and bla
OXA-23 genes associated with an ISAba1 element. Multiple-locus variable number tandem repeat analysis segregated the 160 A
. baumannii into 107 different multiple-locus variable number tandem repeat analysis types, which described five major clusters. The biggest cluster was a clonal complex composed mainly of imipenem-resistant organisms that were isolated from all three of the study hospitals. Our study indicates a very high prevalence of MDR/XDR A. baumannii causing clinically significant infections in hospitals in southern Vietnam. These organisms commonly harboured the bla
OXA-23 gene with ISAba1 and were carbapenem resistant; this resistance phenotype may explain their continued selection and ongoing transmission within the Vietnamese healthcare system.
Criticality in Cell Differentiation
Authors: Bose Indrani , Pal Mainak
Published: December 2016

Cell differentiation is an important process in living organisms. Differentiation is mostly based on binary decisions with the progenitor cells choosing between two specific lineages. The differentiation dynamics have both deterministic and stochastic components. Several theoretical studies suggest that cell differentiation is a bifurcation phenomenon, well-known in dynamical systems theory. The bifurcation point has the character of a critical point with the system dynamics exhibiting specific features in its vicinity. These include the critical slowing down, rising variance and lag-1 autocorrelation function, strong correlations between the fluctuations of key variables and non-Gaussianity in the distribution of fluctuations. Recent experimental studies provide considerable support to the idea of criticality in cell differentiation and in other biological processes like the development of the fruit fly embryo. In this Review, an elementary introduction is given to the concept of criticality in cell differentiation. The correspondence between the signatures of criticality and experimental observations on blood cell differentiation in mice is further highlighted.
A-to-I RNA editing promotes developmental stage–specific gene and lncRNA expression
Authors: Goldstein Boaz , Agranat-Tamir Lily , Light Dean , Ben-Naim Zgayer Orna , Fishman Alla , Lamm Ayelet T.
Published: December 2016

A-to-I RNA editing is a conserved widespread phenomenon in which adenosine (A) is converted to inosine (I) by adenosine deaminases (ADARs) in double-stranded RNA regions, mainly noncoding. Mutations in ADAR enzymes in Caenorhabditis elegans cause defects in normal development but are not lethal as in human and mouse. Previous studies in C. elegans indicated competition between RNA interference (RNAi) and RNA editing mechanisms, based on the observation that worms that lack both mechanisms do not exhibit defects, in contrast to the developmental defects observed when only RNA editing is absent. To study the effects of RNA editing on gene expression and function, we established a novel screen that enabled us to identify thousands of RNA editing sites in nonrepetitive regions in the genome. These include dozens of genes that are edited at their 3′ UTR region. We found that these genes are mainly germline and neuronal genes, and that they are down-regulated in the absence of ADAR enzymes. Moreover, we discovered that almost half of these genes are edited in a developmental-specific manner, indicating that RNA editing is a highly regulated process. We found that many pseudogenes and other lncRNAs are also extensively down-regulated in the absence of ADARs in the embryo but not in the fourth larval (L4) stage. This down-regulation is not observed upon additional knockout of RNAi. Furthermore, levels of siRNAs aligned to pseudogenes in ADAR mutants are enhanced. Taken together, our results suggest a role for RNA editing in normal growth and development by regulating silencing via RNAi.
Learning from Singapore’s effective anti-corruption strategy
Authors: Quah Jon S.T.
Published: December 2016

Purpose

The purpose of this paper is to explain why Singapore has succeeded in curbing corruption and to recommend three measures for enhancing South Korea’s anti-corruption strategy.

Design/methodology/approach

The paper compares the contextual differences between Singapore and South Korea before analysing Singapore’s effective anti-corruption strategy and identifying the weaknesses of South Korea’s anti-corruption strategy.

Findings

Singapore’s success in minimising corruption is the result of its government’s strong political will and the adequate budget, personnel and operational autonomy given to the Corrupt Practices Investigation Bureau to enable it to enforce the anti-corruption laws impartially. To improve South Korea’s anti-corruption strategy, the Korea Anti-Corruption Agency should be established and adequately staffed and funded to investigate corruption cases. Those found guilty of corruption offences should be punished according to the law, without suspending their jail sentences or being pardoned by the president. Finally, the existing public outreach anti-corruption programmes should be evaluated to identify their weaknesses and improve their effectiveness.

Originality/value

This paper recommends three measures for South Korean policy-makers to improve their anti-corruption strategy by learning from Singapore’s success.
Emigration after socialist regime in Lithuania: why the West is still the best?
Authors: Kumpikaitė-Valiūnienė Vilmantė , Žičkutė Ineta
Published: December 2016

Purpose

The purpose of this paper is to review the emigration situation after the socialist regime and to reveal the main reasons for emigration in present-day Lithuania answering the question why “the West is still the best” remains important to modern Lithuania.

Design/methodology/approach

Statistical analysis of emigration during 1980-2015 in Lithuania was presented. Reasons for emigration were identified through a review of the scientific literature on emigration theories and push-pull factors. A questionnaire was prepared according to the proposed model to reveal the main reasons for Lithuanian emigration. In total, 1,586 migrants from Lithuania participated in the survey during October-November 2015.

Findings

The results revealed the main reasons for emigration according to push and pull factors related to economic issues, such as too low wages, differences between wages and income inequality, price policies and unemployment rates. However, non-economic reasons, particularly having relatives living abroad, influence the decision to migrate as well. A comparative analysis was made according to respondents’ occupation in the home country, their age and gender. In addition, it was found that emigration has become a community value and norm in Lithuania.

Research limitations/implications

The study was conducted over the internet. Therefore, only people using the internet participated in this study. Moreover, it is noted that only 21 percent of the respondents were male.

Practical implications

Based on migration theories, a list of push and pull migration reasons were identified. The findings present the main reasons for migration, which are based not only on statistical data, but also on survey responses in the case of Lithuania. Differences among demographic groups of respondents according to their occupation, gender and age were highlighted and targeted solutions could be applied in practice. Potential measures for decreasing emigration could also be designed based on these findings.

Social implications

Migration was proposed as a community value and norm in Lithuania.

Originality/value

Based on the migration theories and a questionnaire survey, the paper discusses reasons for emigration after the end of the socialist regime in Lithuania concentrating on the main reasons for emigration in contemporary Lithuania. In addition, it offers insights into demographic differences in reasons for emigration in relation to occupation, age and gender.