bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychosocial Treatments for Posttraumatic Stress Disorder
Authors: Najavits Lisa M. , Anderson Melissa L.
Published: October 2017

Treatments for posttraumatic stress disorder (PTSD) work better than treatment as usual; average effect sizes are in the moderate to high range. A variety of treatments have been established as effective, with no one treatment having superiority. Both present-focused and past-focused treatment models work (neither consistently outperforms the other). Areas of future development include training, dissemination, client access to care, optimal delivery modes, and mechanisms of action. Methodological issues include improving research reporting, broadening study samples, and greater use of active comparison conditions.
Correlation between the luminosity and spin-period changes during outbursts of 12 Be binary pulsars observed by the MAXI/GSC and the Fermi/GBM
Authors: Sugizaki Mutsumi , Mihara Tatehiro , Nakajima Motoki , Makishima Kazuo
Published: October 2017

To study observationally the spin-period changes of accreting pulsars caused by the accretion torque, the present work analyzes X-ray light curves of 12 Be binary pulsars obtained by the MAXI Gas-Slit Camera all-sky survey and their pulse periods measured by the Fermi Gamma-ray Burst Monitor pulsar project, both covering more than six years, from 2009 August to 2016 March. The 12 objects were selected because they are accompanied by clear optical identification and accurate measurements of surface magnetic fields. The luminosity L and the spin-frequency derivatives $\dot{\nu }$, measured during large outbursts with L ≳ 1 × 1037 erg s−1, were found to follow approximately the theoretical relations in the accretion torque models, represented by $\dot{\nu } \propto L^{\alpha }$ (α ≃ 1), and the coefficient of proportionality between $\dot{\nu }$ and Lα agrees, within a factor of ∼3, with that proposed by Ghosh and Lamb (1979b, ApJ, 234, 296). In the course of the present study, the orbital elements of several sources were refined.
Comparison of Marker-Based Genomic Estimated Breeding Values and Phenotypic Evaluation for Selection of Bacterial Spot Resistance in Tomato
Authors: Liabeuf Debora , Sim Sung-Chur , Francis David M.
Published: October 2017

Bacterial spot affects tomato crops (Solanum lycopersicum) grown under humid conditions. Major genes and quantitative trait loci (QTL) for resistance have been described, and multiple loci from diverse sources need to be combined to improve disease control. We investigated genomic selection (GS) prediction models for resistance to Xanthomonas euvesicatoria and experimentally evaluated the accuracy of these models. The training population consisted of 109 families combining resistance from four sources and directionally selected from a population of 1,100 individuals. The families were evaluated on a plot basis in replicated inoculated trials and genotyped with single nucleotide polymorphisms (SNP). We compared the prediction ability of models developed with 14 to 387 SNP. Genomic estimated breeding values (GEBV) were derived using Bayesian least absolute shrinkage and selection operator regression (BL) and ridge regression (RR). Evaluations were based on leave-one-out cross validation and on empirical observations in replicated field trials using the next generation of inbred progeny and a hybrid population resulting from selections in the training population. Prediction ability was evaluated based on correlations between GEBV and phenotypes (rg), percentage of coselection between genomic and phenotypic selection, and relative efficiency of selection (rg/rp). Results were similar with BL and RR models. Models using only markers previously identified as significantly associated with resistance but weighted based on GEBV and mixed models with markers associated with resistance treated as fixed effects and markers distributed in the genome treated as random effects offered greater accuracy and a high percentage of coselection. The accuracy of these models to predict the performance of progeny and hybrids exceeded the accuracy of phenotypic selection.
The Economic Burden of Pathological Gambling and Co-occurring Mental Health and Substance Use Disorders
Authors: Rodriguez-Monguio Rosa , Brand Evelyn , Volberg Rachel
Published: October 2017

Objectives:

Disordered gambling often co-occurs with psychiatric and substance use disorders. The study aim was to assess the healthcare costs of pathological gambling (PG) and co-occurring mental health and substance use disorders by payer. This is the first-of-its-kind economic analysis of addictive behaviors and mental health disorders.

Methods:

Study data were derived from the Massachusetts All-Payer Claims Data—a representative health claims database—for the period 2009 to 2013. The study analytical sample contained all medical and pharmaceutical claims for commercially insured Massachusetts residents who were aged ≥18 years, had health insurance coverage, had a diagnosis of PG, and sought care in the Commonwealth. Healthcare cost components included outpatient, inpatient, emergency room visits, and prescription drugs. Bootstrap analysis was performed to account for skewed distribution of cost data. All costs were adjusted to constant dollars.

Results:

The study sample included 599 patients over the study period. The most prevalent principal diagnoses were disorders of impulse control (50%), episodic mood disorders (31%), anxiety disorders (14%), and psychoactive substance (9%). The mean annual total expenditures on health care per patient with diagnosis of pathological gambling were $7993 ± $11,847 (bias-corrected 95% confidence interval) in 2009, $10,054 ± $14,555 in 2010, $9093 ± $13,422 in 2011, and $9523 ± $14,505 in 2012. Pharmaceutical expenditures represented 16% to 22% of total healthcare expenditures. In the study period, prescription drug co-pays represented approximately 16% of the pharmaceutical expenditures.

Conclusions:

Psychiatric comorbidity and substance use disorders, and nondependent abuse of drugs are highly prevalent among pathological gamblers. These disorders pose an economic burden to patients and healthcare payers.
Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System
Authors: Joosten Alexandre , Delaporte Amelie , Ickx Brigitte , Touihri Karim , Stany Ida , Barvais Luc , Van Obbergh Luc , Loi Patricia , Rinehart Joseph , Cannesson Maxime , Van der Linden Philippe
Published: October 2017

Background

The type of fluid and volume regimen given intraoperatively both can impact patient outcome after major surgery. This two-arm, parallel, randomized controlled, double-blind, bi-center superiority study tested the hypothesis that when using closed-loop assisted goal-directed fluid therapy, balanced colloids are associated with fewer postoperative complications compared to balanced crystalloids in patients having major elective abdominal surgery.

Methods

One hundred and sixty patients were enrolled in the protocol. All patients had maintenance-balanced crystalloid administration of 3 ml · kg–1 · h–1. A closed-loop system delivered additional 100-ml fluid boluses (patients were randomized to receive either a balanced-crystalloid or colloid solution) according to a predefined goal-directed strategy, using a stroke volume and stroke volume variation monitor. All patients were included in the analysis. The primary outcome was the Post-Operative Morbidity Survey score, a nine-domain scale, at day 2 postsurgery. Secondary outcomes included all postoperative complications.

Results

Patients randomized in the colloid group had a lower Post-Operative Morbidity Survey score (median [interquartile range] of 2 [1 to 3] vs. 3 [1 to 4], difference –1 [95% CI, –1 to 0]; P < 0.001) and a lower incidence of postoperative complications. Total volume of fluid administered intraoperatively and net fluid balance were significantly lower in the colloid group.

Conclusions

Under our study conditions, a colloid-based goal-directed fluid therapy was associated with fewer postoperative complications than a crystalloid one. This beneficial effect may be related to a lower intraoperative fluid balance when a balanced colloid was used. However, given the study design, the mechanism for the difference cannot be determined with certainty.
Provisional Plating of Subtrochanteric Femur Fractures Before Intramedullary Nailing in the Lateral Decubitus Position
Authors: Robertson Ryan , Tucker Michael , Jones Thomas
Published: October 2017

Subtrochanteric femur fractures remain a challenge for surgeons to obtain and maintain adequate reduction and stable fixation. For this reason, multiple techniques have been described, but we are unaware of a detailed contemporary description of the combination of provisional plating before intramedullary fixation in the lateral decubitus position. We present our technique as it was used from 2011 to 2015 to treat 22 fractures and how it compared clinically to the other 48 subtrochanteric femur fractures treated during that period. The clinical and radiographic outcomes for all fractures were evaluated. The operative time was shorter when no open reduction was used but open cases showed no significant difference when using a provisional plate. Those patients treated with provisional plating were shown to have higher blood loss values and longer operative times, but when looking at the outcomes, the rate of malunion, which was defined as >5 degrees of angulation on postoperative radiographs, was significantly lower at 0% in the provision plating in the lateral decubitus position subset compared with the remaining subtrochanteric fractures, 27.7% (P= 0.013). As the quality of reduction and stability of fixation are the most significant factors in determining outcomes of subtrochanteric femur fractures, this study shows that this technique is a valuable tool in an orthopaedist's armamentarium and present it as such.
Publication of Podium Presentations at the Orthopaedic Trauma Association Annual Meetings: 2008–2012
Authors: Williams Benjamin R. , MacCormick Lauren M. , McCreary Dylan L. , Dugarte Anthony J. , Cunningham Brian P.
Published: October 2017

Objective:

To determine journal publication rates of podium presentations from the OTA Annual Meetings between 2008 and 2012.

Methods:

Podium presentations from the 2008 to 2012 OTA annual meeting were compiled from the Annual Meeting archives. During December 2016, and Google Scholar were performed using individual keywords in the abstract title and content. The results were reviewed for matches to the meeting abstracts with regard to the title, authors, and abstract content. Yearly publication rates were calculated, along with time to publication and common journals for publication.

Results:

The publication rate for the 357 podium abstracts presented at the OTA between 2008 and 2012 was 72.8%. Eighty-one percent of abstracts were from the US institutions. The mean time to publication from podium presentation was 23.4 months, and the most common journals of publication were Journal of Orthopaedic Trauma (45.4%) and The Journal of Bone & Joint Surgery (15.3%).

Conclusions:

The publication rate of the podium presentations at the OTA Annual Meeting from 2008 to 2012 has increased since previous years. Compared with other orthopaedic subspecialty and nonorthopaedic specialty meetings, the OTA publication rate is among the highest in the medical field. OTA annual meetings are an opportunity for early access to high-quality research in the area of orthopaedic trauma.
Cadaveric Biomechanical Analysis of 3 Lateral Ulnar Collateral Ligament Reconstructions
Authors: Chauhan Aakash , Baratz Mark E. , Schimoler Patrick , Ruch David , Miller Mark C.
Published: October 2017

Objective:

To biomechanically assess the angular stability provided by 3 techniques for reconstruction of the lateral ulnar collateral ligament.

Methods:

Eight cadaveric elbows were tested with the lateral collateral ligament complex intact, disrupted from the origin at the lateral epicondyle, and reconstructed with 3 different techniques using ulnar bone tunnels: a suture “lasso” or palmaris longus tendon “lasso” both docked with a metal button at the origin, and a doubled-over palmaris longus tendon docked with metal buttons at both the origin and ulnar insertion. Elbows were tested with a physiologic elbow simulator, and varus angular position was quantified with an optical tracking system. Statistical analysis was performed using a repeated measures analysis of variance test to determine whether significance existed, and a Tukey post hoc analysis to compare statistical difference between native, disrupted, and repair states.

Results:

There was a statistically significant difference between all repairs and the disrupted state (P < 0.05). The varus angulation after the repairs showed that the suture reconstruction was closest to the native case. The tendon reconstructions were similar to each other but less similar to the native elbow. Quantitatively, the suture reconstruction was within an average of 0.86 degrees of the native elbow throughout range of motion.

Conclusions:

A suture reconstruction was most similar to a native elbow, but both tendon reconstructions significantly improved angular stability under varus gravitational loads.
Long-Term Sustainability of Functional Improvement Following Central Corpectomy for Cervical Spondylotic Myelopathy and Ossification of Posterior Longitudinal Ligament
Authors: Sarkar Sauradeep , Rajshekhar Vedantam
Published: October 2017

Study Design.

Retrospective study.

Objective.

To examine predictors of long-term outcome and sustainability of initial functional improvement in patients undergoing corpectomy for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL).

Summary of Background Data.

There are limited data on the predictors of outcome and sustainability of initial functional improvement on long-term follow-up after cervical corpectomy.

Methods.

We studied the functional outcome at more than 1-year follow-up after central corpectomy in 352 patients with CSM or OPLL. Functional status was evaluated with the Nurick grading system. Analysis was directed at identifying factors associated with both improvement in functional status and the achievement of a “cure” (improvement to a follow-up Nurick grade of 0 or 1). A survival analysis was performed to identify factors associated with sustained functional improvement in patients with serial follow-up evaluations.

Results.

Nurick grade improved from 3.2 ± 0.1 to 1.9 ± 0.1 over a mean follow-up period of 57.1 months (range 12–228 mo). On multivariate analysis, age ≥50 years (P = 0.008) and symptom duration ≥1 year (P < 0.001) were negatively associated with functional improvement by ≥1 Nurick grade. Independent factors negatively associated with “cure” after surgery included age 50 years or older (P = 0.005), preoperative Nurick grade of 4 or higher (P < 0.001) and symptom duration of 1 or more years (P < 0.001). Early improvement in functional status was maintained in 90.5% and 76.3% of patients at 5 and 10 years follow-up, respectively. On survival analysis, patients with shorter preoperative symptom duration (<1 yr) were more likely to demonstrate sustained improvement in functional status after surgery (P = 0.022).

Conclusion.

Initial gains in functional status after central corpectomy for CSM and OPLL are maintained in more than 75% of patients at 10 years after surgery. Overall, the most favorable long-term outcomes are achieved in younger patients who present early and with good preoperative functional status.

Level of Evidence: 4
Quantitative Magnetization Transfer MRI Measurements of the Anterior Spinal Cord Region are Associated With Clinical Outcomes in Cervical Spondylotic Myelopathy
Authors: Cloney Michael Brendan , Smith Zachary A. , Weber Kenneth A. , Parrish Todd B.
Published: October 2017

Study Design.

A case-control study.

Objective.

The aim of this study was to understand the role of magnetization transfer ratio (MTR) in identifying patients with clinically significant myelopathy and disability.

Summary of Background Data.

MTR is a quantitative measure that correlates with myelin loss and neural tissue destruction in a variety of neurological diseases. However, the usefulness of MTR in patients with cervical spondylotic myelopathy (CSM) has not been examined.

Methods.

We prospectively enrolled seven CSM patients and seven age-matched controls to undergo magnetic resonance imaging (MRI) of the cervical spine. Nurick, Neck Disability Index (NDI), and modified Japanese Orthopedic Association (mJOA) scores were collected for all patients. Clinical hyperreflexia was tested at the MCP joint, using a six-axis load cell. Reflex was simulated by quickly moving the joint from maximum flexion to maximum extension (300°/second). Anterior, lateral, and posterior cord MTR measurements were compared with clinical outcomes.

Results.

Compared with controls, CSM patients had lower anterior cord MTR (38.29 vs. 29.97, Δ = −8.314, P = 0.0022), and equivalent posterior cord (P = 0.2896) and lateral cord (P = 0.3062) MTR. Higher Nurick scores were associated with lower anterior cord MTR (P = 0.0205), but not lateral cord (P = 0.5446) or posterior cord MTR (P = 0.1222). Lower mJOA was associated with lower anterior cord MTR (P = 0.0090), but not lateral cord (P = 0.4864) or posterior cord MTR (P = 0.4819). There was no association between NDI and MTR of the anterior (P = 0.4351), lateral (P = 0.7557), or posterior cord (P = 0.9171). There was a linear relationship between hyperreflexia and anterior cord MTR (slope = -117.3, R = 0.6598, P = 0.0379), but not lateral cord (P = 0.1906, R = 0.4511) or posterior cord (P = 0.2577, R = 0.3957) MTR.

Conclusion.

Anterior cord MTR correlates with clinical outcomes as measured by mJOA index, Nurick score, and quantitative hyperreflexia, and could play a role in the preoperative assessment of CSM.

Level of Evidence: 2
Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: A Nationwide Linked Analysis*
Authors: Rush Barret , Tyler Patrick D. , Stone David J. , Geisler Benjamin P. , Walley Keith R. , Celi Leo Anthony
Published: October 2017

Objectives:

The outcomes of critically ill patients who undergo interhospital transfer are not well understood. Physicians assume that patients who undergo interhospital transfer will receive more advanced care that may translate into decreased morbidity or mortality relative to a similar patient who is not transferred. However, there is little empirical evidence to support this assumption. We examined country-level U.S. data from the Nationwide Readmissions Database to examine whether, in mechanically ventilated patients with sepsis, interhospital transfer is associated with a mortality benefit.

Design:

Retrospective data analysis using complex survey design regression methods with propensity score matching.

Setting:

The Nationwide Readmissions Database contains information about hospital admissions from 22 States, accounting for roughly half of U.S. hospitalizations; the database contains linkage numbers so that admissions and transfers for the same patient can be linked across 1 year of follow-up.

Patients:

From the 2013 Nationwide Readmission Database Sample, 14,325,172 hospital admissions were analyzed. There were 61,493 patients with sepsis and on mechanical ventilation. Of these, 1,630 patients (2.7%) were transferred during their hospitalization. A propensity-matched cohort of 1,630 patients who did not undergo interhospital transfer was identified.

Interventions:

None.

Measurements and Main Results:

The exposure of interest was interhospital transfer to an acute care facility. The primary outcome was hospital mortality; the secondary outcome was hospital length of stay. The propensity score included age, gender, insurance coverage, do not resuscitate status, use of renal replacement therapy, presence of shock, and Elixhauser comorbidities index. After propensity matching, interhospital transfer was not associated with a difference in in-hospital mortality (12.3% interhospital transfer vs 12.7% non–interhospital transfer;p= 0.74). However, interhospital transfer was associated with a longer total hospital length of stay (12.8 d interquartile range, 7.7–21.6 for interhospital transfer vs 9.1 d interquartile range, 5.1–17.0 for non–interhospital transfer;p< 0.01).

Conclusions:

Patients with sepsis requiring mechanical ventilation who underwent interhospital transfer did not have improved outcomes compared with a cohort with matched characteristics who were not transferred. The study raises questions about the risk-benefit profile of interhospital transfer as an intervention.
Efficacy of IncobotulinumtoxinA for the Treatment of Glabellar Frown Lines in Male Subjects: Post-Hoc Analyses From Randomized, Double-Blind Pivotal Studies
Authors: Jones Derek H. , Kerscher Martina , Geister Thorin , Hast Michael A. , Weissenberger Petra
Published: October 2017

BACKGROUND

Males are increasingly seeking minimally invasive cosmetic procedures such as botulinum toxin injection. However, few studies have specifically examined the efficacy of such procedures among men.

OBJECTIVE

To assess the efficacy of incobotulinumtoxinA for treating glabellar frown lines (GFLs) in men.

METHODS

Three incobotulinumtoxinA studies were included in post hoc analyses of responder rates: 2 pivotal Phase 3 US registration studies for GFLs (n = 55 males in a pooled analysis) and a European pivotal Phase 3 study for upper facial lines (UFLs; n = 21 males).

RESULTS

In the pooled analysis of Phase 3 GFL studies, 55.9% of males and 81.4% of females were responders on the Facial Wrinkle Scale (FWS) at 30 days. Similarly, 54.5% and 88.0% of males and females, respectively, treated for GFLs in the upper facial line study were responders on the Merz Aesthetics Scales (MAS) at 30 days. Lower proportions of male responders on the Facial Wrinkle Scale /Merz Aesthetics Scales were consistent with results from onabotulinumtoxinA and abobotulinumtoxinA GFL studies.

CONCLUSION

Compared with females, males demonstrate lower response rates on wrinkle severity scales in studies on all 3 available botulinum toxins. Variations in treatment response are potentially associated with key male anatomic differences (e.g., muscle mass). Results emphasize the need for customized treatment plans.
Hair Transplantation Controversies
Authors: Avram Marc R. , Finney Robert , Rogers Nicole
Published: October 2017

BACKGROUND

Hair transplant surgery creates consistently natural appearing transplanted hair for men. It is increasingly popular procedure to restore natural growing hair for men with hair loss.

OBJECTIVE

To review some current controversies in hair transplant surgery.

MATERIALS AND METHODS

Review of the English PubMed literature and specialty literature in hair transplant surgery.

RESULTS

Some of the controversies in hair transplant surgery include appropriate donor harvesting technique including elliptical donor harvesting versus follicular unit extraction whether manual versus robotic, the role of platelet-rich plasma and low-level light surgery in hair transplant surgery.

CONCLUSION

Hair transplant surgery creates consistently natural appearing hair. As with all techniques, there are controversies regarding the optimal method for performing the procedure. Some of the current controversies in hair transplant surgery include optimal donor harvesting techniques, elliptical donor harvesting versus follicular unit extraction, the role of low-level light therapy and the platelet-rich plasma therapy in the procedure. Future studies will further clarify their role in the procedure.
Optimizing Male Periorbital Rejuvenation
Authors: Scheuer Jack F. , Matarasso Alan , Rohrich Rod J.
Published: October 2017

BACKGROUND

Facial rejuvenation continues to be an increasing trend among males. The periorbital region deserves special mention given the overall differences in aesthetics between sexes.

OBJECTIVE

To examine the aesthetics of the upper eyelid, lower eyelid, lateral canthus, and brow with respect to male periorbital rejuvenation.

METHODS

The upper eyelid, lower eyelid, lateral canthus, and brow are examined, highlighting aesthetic differences in males and females.

RESULTS

The authors outline principles so as to maintain a masculine appearance when treating the male upper eyelid, lower eyelid, lateral canthus, and brow.

CONCLUSION

With guiding principles, the male upper lid, lower lid, brow, and lateral canthus can be managed to achieve optimal, consistent results.
Male Surgical Neck Rejuvenation: [RETRACTED]
Authors: Moy Ronald L. , Moy Lauren
Published: October 2017

BACKGROUND

Patients who are aging, with weight gain, and increased skin laxity, request dermatologists to improve their neck area. Surgical and nonsurgical options are reviewed as well as benefits and side effects. This article will focus on how surgical techniques can be applied for male patients in particular.

OBJECTIVE

To review surgical neck rejuvenation therapies available currently to find the best option for male patients.

CONCLUSION

Surgical treatment of the male neck to improve mandibular contour and loose neck skin requires tightening of the platysmal muscle and usually skin removal in the postauricular sulcus and into the hairline. Most patients choose to have this performed underline tumescent anesthesia when given the choice of sedation versus local anesthesia. The other surgical variations of improving the neck contour on a male include using a direct excision by a midline incision starting in the submental crease and extending down the anterior neck. This approach allows for maximum tightening of the platysmal bands. The incision line can be minimized using intraoperative laser resurfacing immediately after suturing. Chin implants are necessary in some patients to give good neck improvement. The isolated neck lift is one the most common procedures requested by men asking for neck improvement.
Aesthetic Treatment With Botulinum Toxin: Approaches Specific to Men
Authors: Green Jeremy B. , Keaney Terrence C.
Published: October 2017

BACKGROUND

Men are increasingly seeking aesthetic treatment with neuromodulators.

OBJECTIVE

To successfully treat the male patient, it is imperative to understand anatomical and dosing differences from his, perhaps more familiar, female counterpart.

CONCLUSION

After reading this review including male-specific botulinum toxin technique tips derived from their own practices, the authors hope injectors are able to approach their male patients with increased confidence to deliver superior outcomes.
Considerations When Treating Cosmetic Concerns in Men of Color
Authors: Awosika Olabola , Burgess Cheryl M. , Grimes Pearl E.
Published: October 2017

BACKGROUND

Men of color include a diverse population encompassing individuals with Fitzpatrick skin Types IV through VI. Yet, there is a paucity of data describing the cosmetic concerns of this population.

OBJECTIVE

To review the basic science of advantages and disadvantages of skin of color and pathophysiology, incidence, and treatment of disorders of cosmetic concern in men of color.

METHODS

A MEDLINE search was performed for publications on sex and racial differences in basic science of skin, common disorders in men of color, and evidence-based treatments.

RESULTS

There are intrinsic differences in skin and hair of darker-complexioned men, particularly in Hispanics, African Americans, Asians, and Afro-Caribbeans. Advantages of darker skin include increased photoprotection, slowed aging, and a lower incidence of skin cancer. However, the increased content of melanin is associated with myriad dyschromias including melasma and postinflammatory hyperpigmentation (PIH). Additional common skin conditions of concern in men of color include pseudofolliculitis barbae, acne keloidalis nuchae, and keloids.

CONCLUSION

A skin color conscious approach should be administered in caring for the cosmetic concerns of men of color that is cognizant of differences in biology of the skin and hair, associated PIH of disorders, and cultural/social practices among this population.
Effect of varenicline on behavioral deficits in a rat model of Parkinson’s disease induced by unilateral 6-hydroxydopamine lesion of substantia nigra
Authors: Tan Rüyal , Bölükbaşi Hatip Funda , Açikalin Öznur , Yamauchi Atsushi , Kataoka Yasufumi , Hatip-Al-Khatib Izzettin
Published: October 2017

Nicotinic acetylcholine receptors (nAChRs) are implicated in the pathogenesis of Parkinson’s disease (PD). Varenicline tartrate is a partial agonist at α4β2 and full agonist at α7 neuronal nAChR subunits. A unilateral lesion of the substantia nigra (SN) has been used as a reliable model of PD. This study aimed to investigate the effect of varenicline on locomotor and nonlocomotor behavioral deficits induced by a unilateral lesion of the SN induced by 6-hydroxydopamine (6-OHDA) (8 µg/4 µl). Varenicline (1 mg/kg) was administered to the lesioned rats daily for 2 weeks, which commenced 3 weeks after 6-OHDA administration. The results showed that varenicline improved motor deficits induced by 6-OHDA. It improved locomotor and nonlocomotor activities such as forelimb use, rotarod performance, and forelimb asymmetry. Varenicline did not change rearing or vibrissae-elicited forelimb placing but did increase apomorphine-induced rotation. In conclusion, the present results suggest that drugs with specific partial/full agonistic activity on nAChR subunits could be of value in the treatment of neurodegenerative disorders such as PD.
Preconditioning and Postconditioning by Cardiac Glycosides in the Mouse Heart
Authors: Duan Qiming , Xu Yunhui , Marck Pauline V. , Kalisz Jennifer , Morgan Eric E. , Pierre Sandrine V.
Published: October 2017

Ouabain preconditioning (OPC) initiated by low concentrations of the cardiac glycoside (CG) ouabain binding to Na/K-ATPase is relayed by a unique intracellular signaling and protects cardiac myocytes against ischemia/reperfusion injury. To explore more clinically applicable protocols based on CG properties, we tested whether the FDA-approved CG digoxin could trigger cardioprotective effects comparable with those of ouabain using PC, preconditioning and PostC, postconditioning protocols in the Langendorff-perfused mouse heart subjected to global ischemia and reperfusion. Ouabain or digoxin at 10 μmol/L inhibited Na/K-ATPase activity by approximately 30% and activated PKCε translocation by approximately 50%. Digoxin-induced PC (DigPC), initiated by a transient exposure before 40 minutes of ischemia, was as effective as OPC as suggested by the recovery of left ventricular developed pressure, end-diastolic pressure, and cardiac Na/K-ATPase activity after 30 minutes of reperfusion. DigPC also significantly decreased lactate dehydrogenase release and reduced infarct size, comparable with OPC. PostC protocols consisting of a single bolus injection of 100 nmoles of ouabain or digoxin in the coronary tree at the beginning of reperfusion both improved significantly the recovery of left ventricular developed pressure and decreased lactate dehydrogenase release, demonstrating a functional and structural protection comparable with the one provided by OPC. Given the unique signaling triggered by OPC, these results suggest that DigPostC could be considered for patients with risk factors and/or concurrent treatments that may limit effectiveness of ischemic PostC.
The Delay Phenomenon: Is One Surgical Delay Technique Superior?
Authors: Gersch Robert P. , Fourman Mitchell S. , Dracea Cristina , Bui Duc T. , Dagum Alexander B.
Published: October 2017

Background:

Surgical delay remains a common method for improving flap survival. However, the optimal surgical technique has not been determined. In this article, we compare flap perfusion, viable surface area, and flap contraction of 2 surgical delay techniques.

Methods:

Male Sprague-Dawley rats were divided into 3 groups. In the incisional surgical delay group (n = 9), a 9 × 3 cm dorsal flap was incised on 3 sides without undermining, leaving a cranial pedicle. In the bipedicle surgical delay group (BSD, n = 9), a 9 × 3 cm dorsal flap was incised laterally and undermined, leaving cranial and caudal pedicles. Control group (n = 16) animals did not undergo a delay procedure. Ten days following surgical delay, all flaps for all groups were raised, leaving a cranial pedicle. A silicone sheet separated the flap and the wound bed. On postoperative day (POD) 7, viable surface area was determined clinically. Contraction compared to POD 0 was measured with ImageJ software. Perfusion was measured with Laser Doppler Imaging. The Kruskal-Wallis with Dunn’s multiple comparisons test was performed for group comparisons.

Results:

BSD preserved significantly more viable surface area on POD 7 (13.7 ± 4.5 cm2) than Control (8.7 ± 1.8 cm2; P = 0.01). BSD also showed significantly less contraction (21.0% ± 13.5%) than Control (45.9% ± 19.7%; P = 0.0045). BSD and incisional surgical delay showed significantly increased perfusion compared with Control on POD 0 (P = 0.02 and 0.049, respectively), which persisted on POD 3. This trend resolved by POD 7.

Conclusion:

BSD showed improved early perfusion, increased viable surface area, and reduced contraction compared to control, suggesting that BSD is the superior flap design for preclinical modeling.
The Reconstruction of the Donor Site of DP Flap Using Thoracodorsal Artery Perforator Flap
Authors: Okochi Masayuki , Okochi Hiromi , Sakaba Takao , Ueda Kazuki
Published: October 2017

We performed a new procedure for reconstruction of donor site of a deltopectoral (DP) flap. A 58-year-old man presented with a wide subcutaneous abscess, which was caused by acute mandibular osteomyelitis due to dental caries. On admission, the patient received a neck incision for drainage. However, necrosis of the neck skin was observed after drainage. The patient had an 8 × 10 cm skin and soft-tissue defect, which we covered with a DP flap (15 × 7 cm). The DP flap donor site was reconstructed using a 16 × 8 cm pedicled thoracodorsal artery perforator (TDAP) flap. There was no flap necrosis, abscess formation, or scar contracture of the DP region. Debulking of the TDAP flap was not required. The pedicled TDAP flap is useful for the reconstruction of the donor site of DP flap. In this report, we describe our operative procedure.
YOUNGER AGE AT PRESENTATION IN CHILDREN WITH COATS DISEASE IS ASSOCIATED WITH MORE ADVANCED STAGE AND WORSE VISUAL PROGNOSIS
Authors: Daruich Alejandra , Matet Alexandre , Munier Francis L.
Published: October 2017

Purpose:

To determine the age distribution of children with Coats disease and the impact of age at diagnosis on the visual prognosis.

Methods:

Consecutive Coats disease cases aged 18 years or younger at diagnosis were retrospectively included. Clinical and imaging parameters were analyzed by comparative, correlation, survival, univariate, and multivariate statistics.

Results:

Ninety-eight patients were included. At diagnosis, mean age was 5.4 years ± 4.3 years (1 month-18 years). Younger age at diagnosis was correlated with more severe disease stage (P < 0.0001, r = −0.52), which was confirmed by survival analysis (P < 0.0001). Comparative analysis was performed between patients younger and older than 4 years at diagnosis. Leukocoria or strabismus was more frequent at presentation in patients younger than 4 years (P < 0.0001). Areas of peripheral nonperfusion and peripheral telangiectasia were more extensive at presentation in younger than older patients (P = 0.0003 and P = 0.039). Foveal sparing at diagnosis was less frequent in younger than older patients (2% vs. 23%, P = 0.002). The incidence of structural complications or enucleation during follow-up (mean duration: 5.9 years ± 4.5 years) was higher, and last-recorded visual acuity was lower in younger than older patients (P = 0.001 and P = 0.0009). Final logarithm of the minimal angle of resolution visual acuity was negatively correlated with age at diagnosis (P = 0.001, Spearman r = −0.42). Multivariate analysis indicated that disease stage (P < 0.0001), but not age at diagnosis (P = 0.07), independently influenced the last-recorded visual acuity.

Conclusion:

Onset of Coats disease in children of younger age is associated with more severe manifestations, more advanced stage, and worse visual outcome. Age, correlated with disease stage, should be considered a prognostic marker in Coats disease.
VISUAL ACUITY IN PATIENTS WITH STARGARDT DISEASE AFTER AGE 40
Authors: Collison Frederick T. , Fishman Gerald A.
Published: October 2017

Purpose:

To better define visual acuity loss in patients with Stargardt disease later in life.

Methods:

The most recent best-corrected visual acuities in the better-seeing eye of 221 patients with Stargardt disease over 40 years of age were recorded. Also included were the age at subjective onset for symptoms and duration of symptoms. Juvenile onset was defined as onset before age 21; adult onset was defined as onset between 21 and 40 years; and late onset was defined as onset at age 41 or later.

Results:

The median age of the patients with Stargardt disease was 53.1 years. Twenty-four patients (10.9%) had worse than 20/400 best-corrected visual acuity, and none had either light perception or no light perception vision. Whereas 17 of the 52 juvenile onset patients had best-corrected visual acuity worse than 20/400, only 4 of 80 adult-onset patients and 1 of 70 late-onset patients reached this level of acuity loss.

Conclusion:

Although many patients with Stargardt disease lose visual acuity to the 20/200 to 20/400 range, and some lose visual acuity beyond 20/400, none of these patients reached either light perception or no light perception. The numbers found in this study will be valuable in counseling patients with Stargardt disease and could have value in planning treatment trials.
Neonatal Rhizomelic Chondrodysplasia Punctata Type 1
Authors: Landino Jessica , Jnah Amy J. , Newberry Desi M. , Iben Sabine C.
Published: October 2017

Rhizomelic chondrodysplasia punctata (RCDP) is a rare genetic peroxisome biogenesis disorder with a reported incidence of 1 in 100 000 live births. The 3 genetic subtypes of RCDP are acquired by an autosomal recessive inheritance pattern. RCDP type 1 accounts for greater than 90% of all aggregate cases. Differentiating between the 3 subtypes of RCDP, as well as disorders characterized by similar punctate cartilaginous changes, is essential to guide an appropriate postnatal plan of care. Management strategies are focused toward associated clinical manifestations and require an interdisciplinary approach including ophthalmology, cardiovascular, endocrine, physical and occupational therapy, and neurology. Purposeful and frequent collaboration among all members of the neonatal/pediatric interdisciplinary team is necessary to optimize outcomes for the neonate and the family unit. The purpose of this article is to anticipate the needs of both patients with known and prenatal diagnosis of RCDP type 1 and patients with suspected clinical diagnosis of RCDP type 1 in the immediate neonatal period and to guide the appropriate plan of care. This article presents a case report of type I RCDP, as well as describes genetic influences, symptoms, diagnosis, management, and prognosis.
“Recognize and Remove”: A Universal Principle for the Management of Sports Injuries
Authors: Fuller Colin W.
Published: October 2017

Objective:

To identify the locations and types of injury that result in players not being immediately removed from the field of play when injured and to quantify the magnitude of the situation.

Design:

Prospective cohort epidemiological study with definitions and procedures compliant with the international consensus statement for studies in rugby.

Setting:

Sevens World Series (SWS) (2008-2016) and Rugby World Cup (RWC) (2007, 2011, 2015).

Participants:

Players from 17 countries taking part in the SWS and 22 countries taking part in the RWC.

Main Outcome Measures:

Location, type, and mean severity of injury, period of match when the injury occurred and whether players were removed from the field of play when injured.

Results:

Injured players (51.5%) in the SWS and 33.1% of injured players in the RWC were immediately removed from the field of play at the time of injury. The percentages of players immediately removed varied from 16.7% for hand fractures (severity: 71 days) to 96.7% for shoulder dislocations/subluxations (severity: 105 days) during the SWS and from 4.5% for shoulder ligament sprains (severity: 25 days) to 65.9% for concussions (severity: 9 days) during the RWC. The percentage of players immediately removed from play when injured was not related to the severity of the injury sustained.

Conclusions:

A high proportion of players continue to play (in the same game) after sustaining an injury although the likelihood of being removed from play is not dependent on injury severity.
High Incidence of Bell's Palsy After Mastoidectomy: A Longitudinal Follow-up Study
Authors: Choi Hyo Geun , Sim Songyong , Hong Sung Kwang , Park Su-kyoung , Lee Hyo-Jeong , Chang Jiwon
Published: October 2017

Objective:

The objective of this study was to compare the prevalence of Bell's palsy in participants who underwent mastoidectomy (to treat chronic otitis media) and nonmastoidectomy participants (control).

Methods:

Using the national cohort study from the Korean Health Insurance Review and Assessment Service, mastoidectomy patients (2,045) and control participants (8,180) were matched 1:4 for age, sex, income, and region of residence. The prevalence of Bell's palsy in both the groups was measured from 0 to 10 years postoperation.

Results:

In a sample of 1,025,340 Korean individuals, 7,070 were diagnosed or treated with Bell's palsy between 2002 and 2013; the annual incidence of Bell's palsy was 0.057%. The overall prevalence of Bell's palsy was three times higher in the mastoidectomy group (1.27%) than control group (0.49%) (p < 0.001). The prevalence of Bell's palsy was different between the two groups in postoperative 0 year: 0.78% for the mastoidectomy group versus 0.01% for the control group (p < 0.001).

Conclusion:

Although we could not verify the laterality, the prevalence of Bell's palsy was increased in chronic otitis media patients treated with mastoidectomy patients compared with controls, especially within a year after surgery.
The outcome of transanal endoscopic microsurgery in obese patients
Authors: Fenig Yaniv , Khoury Mansour , Schmilovitz-Weiss Hemda , Gingold-Belfer Rachel , Nissim Bachar Gil , Issa Nidal
Published: October 2017

Background

The prevalence of obesity is as high as one-third of the adult population in the ultrasound. Obese patients operated for rectal cancer are less likely to undergo sphincter-preserving surgery, and have an increased morbidity and mortality. We aim to report the outcomes of transanal-endoscopic-microsurgery (TEM) in obese patients with benign and malignant neoplasms.

Materials and methods

An analysis was carried out of all patients undergoing TEM at a single institution between 2004 and 2015. Clinical, demographic, and pathologic data were analyzed in respect to BMI; a dichotomous variable was created categorizing the patients in this retrospective case series as either obese (BMI≥30) or nonobese (BMI<30).

Results

Of the 158 patients who underwent TEM during the study period, 51 (32%) were obese and 107 (68%) were nonobese. No significant differences were found in terms of patients’ demographics and tumor characteristics. There were no significant differences in operative time [105 min (range: 75–170) and 98 (range: 56–170), respectively, P=0.2], hospital length of stay [3 days (range: 2–6) and 4 (range: 2–12), respectively, P=0.48], or complication rates (20 and 23%, respectively, P=0.68).

Conclusion

TEM is a safe procedure for rectal neoplasms in the obese population. We found no difference in surgical time and completeness of specimen resection, and no increase in complications or length of stay in the hospital in obese versus nonobese patients. As for selected high risk patients, the TEM may be of benefit in obese patients with T1/T2N0M0 rectal cancer.
Epidemiology of Reduced Visual Acuity among Chinese Multiethnic Students
Authors: Qian Deng-Juan , Hu Min , Zhong Hua , Nie Qiao , Li Jun , Yuan Yuansheng , Pan Chen-Wei
Published: October 2017

SIGNIFICANCE

Data regarding the epidemiology of reduced visual acuity (VA) among multiethnic children and adolescents in China are few. Understanding the vision-related health inequalities among different ethnic groups is crucial for health resource allocations and clinical managements for eye diseases.

PURPOSE

We aim to determine the prevalence, main causes, and health inequalities of reduced VA in multiethnic school students in rural China.

METHODS

A school-based eye survey including 7681 multiethnic school students aged 5 to 16 years in the southwestern part of China was conducted. Detailed ocular examinations including VA measurements, ocular motility evaluations, bilateral postcycloplegic refractions, and the assessments of the external eye, anterior segment, media, and retinal fundus were carried out by trained research vision professionals. Visual acuity was measured using a logarithm of the minimum angle of resolution E-chart, and reduced VA was defined as a presenting VA of worse than 20/40. Concentration index was initiatively utilized to measure health inequalities among different ethnic groups.

RESULTS

The prevalence of reduced VA was 11.4 per 100 children (95% confidence interval, 10.7 to 12.1%) based on the worse-seeing eye data. The prevalence of reduced VA increased with increasing age (P < .001 for trend) and was higher among girls compared with boys (P < .0001). Uncorrected refractive error was the principal cause for reduced VA, which accounted for 87.3% of the participants with reduced VA. The concentration index for reduced VA was 0.07 among different ethnic groups.

CONCLUSIONS

Compared with the estimates reported from previous studies on Chinese children and adolescents, a relatively lower prevalence of reduced VA was observed among multiethnic school students in rural China. Ethnic variations and health inequalities of reduced VA were not significant in this study.
Forensic Features of Clothing-Related Deaths
Authors: Byard Roger W.
Published: October 2017

Clothing may both cause death and contribute to ongoing lethal mechanisms by a variety of quite disparate mechanisms. The manner of death may be accidental, suicidal, or homicidal. Accidental deaths include burning from clothing catching on fire, strangulation from clothing tangling in vehicle wheels or exposed machinery, and drowning. Entanglement of clothing in machinery may also result in significant injuries, which are not uncommon in farming communities. Excessive clothing, or its absence, may significantly alter body temperature, and hanging from clothing is a feature in the young or in mentally or physically handicapped adults, or in adults who are intoxicated with alcohol or drugs. In previous years, potentially lethal amounts of arsenic were present in clothing and accessories from dyes. Clothing may also be used to form nooses or to pad ropes in suicides and may be used in cases of strangulation, suffocation, or choking in homicides. The contribution of clothing to mortality has changed over the years with changes in fashions and in manufacturing techniques. Geographical differences in clothing-related deaths persist because of variable social and cultural practices and legislative frameworks.