bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative Study of Intercostal Nerve and Contralateral C7 Nerve Transfers for Elbow Extension After Global Brachial Plexus Avulsion
Authors: Xiao Feng , Lao Jie 
Published: March 2020

Introduction
Elbow extensive reconstruction was essential for the patients with brachial plexus avulsion. Nerve transfer was applied to repair elbow extension, but the ultimate recovery was quite different. The purpose of this study was to compare the effects of elbow extension in patients with global brachial plexus avulsion after repaired by intercostal nerve (ICN) and contralateral cervical 7 (cC7) nerve transfer to the long head branch of triceps and to analyze the possible influencing factors.

Materials and Methods
A retrospective review of 24 patients treated with ICN and cC7 nerve transfer for elbow extension in posttraumatic global brachial plexus avulsion was carried out. Two ICNs were used as donors in 17 patients, and cC7 nerve was used in the other 7 patients. We evaluated the recovery of elbow extension by the British Medical Research Council grading system and electromyography. The correlation between age, preoperative interval, and prognosis was analyzed in this study.

Results
Efficiency of elbow extensor strength in the ICN transfer group was 47.06%, and it was 28.57% in the cC7 nerve transfer group, but there was no significant difference (P = 0.653). The effective recovery of electromyography in ICN transfer group was 82.35%, whereas in the group cC7 nerve transfer, it was 28.57%, there was a statistical difference between the 2 groups (P = 0.021). Age and interval were negatively correlated with prognosis.

Conclusions
Intercostal nerve or cC7 nerve transfer to the long head branch of triceps could reconstruct elbow extension to some extent. Compared with cC7 nerve transfer, ICN transfer had a greater result for elbow extension, but the difference in extension power was not significant, whereas there was difference in electromyography recovery. Patient's age and interval were negatively correlated with the results.
An Alternative Internal Le Fort I Distractor: Early Results With a New Trans-Nasal Device
Authors: Lypka Michael , Hendricks Heather 
Published: March 2020

Purpose:
To report the early experience using a new internal trans-nasal Le Fort I distractor in patients with cleft lip and palate.

Methods:
Patients with cleft lip and palate and severe maxillary deficiency, who were treated with the trans-nasal Le Fort I distractor, were retrospectively reviewed. Cephalometric images were evaluated preoperatively and at least 6 months postoperatively. Speech outcomes were measured before and at least 6 months after surgery. Patient experience with the device was documented and complications were recorded.

Results:
Five male patients with bilateral cleft lip and palate (ages 11–19) underwent the maximum advancement allowed by the device (25 mm). Follow-up averaged 2 years. Average SNA changed from 75.5°preoperatively to 84.6°postoperatively. Average ANB angle changed from −2.8° to 7.4°, or a tendency to Class 2 overcorrection. There was an overall increase in upper anterior facial height by 7.5 mm. All patients achieved acceptable postoperative occlusions. Two patients with borderline velopharyngeal function preoperatively developed velopharyngeal insufficiency postoperatively that did not resolve 6 months postoperatively, necessitating further surgery. Families reported ease of turning with minimal discomfort reported by patients. All patients maintained normal mouth opening during and after the distraction phase. Two of the patients developed localized pin site infections after the distraction phase that were treated successfully with oral antibiotics.

Conclusion:
The trans-nasal Le Fort I distractor can be an effective device to advance the deficient maxilla and is well tolerated by patients.
Eyes Versus Faces: Morphologic Characteristics of Human Eyes in Different Facial Forms
Authors: Jena Ashok Kumar , Sharan Jitendra , Anusuya Venkatachalapathy 
Published: March 2020

Objective:
To evaluate the static eye characteristics of female patients with short, normal, and long faces.

Methods:
Standardized full face frontal photographs of 163 female patients in the age range of 15 to 25 years were screened to evaluate their facial index (FI). Based on FI, 27 were short face (group I), 31 were normal face (group II), and 26 were long face (group III) photographs. All 84 photographs were then analyzed manually to determine various static eye characteristics. Descriptive statistics, 1-way analysis of variance and posthoc test (Bonferroni) for multiple comparisons were used. A P-value of 0.05 was considered as level of significance.

Results:
The eye index was significantly different in group I, group II, and group III patients (P < 0.001). The position of the eyes in relation to width of face was significantly less in short (P < 0.05) faces and more in long (P < 0.001) faces compared to normal faces. The intereye distance was equal to the length of 1 eye in all 3 types of faces. Among all types of faces, the intereye distance was nearly half of the interpupillary distance and approximately one-fourth of the face width. The eye divergence was significantly less in long faces compared to short (P < 0.001) and normal faces (P < 0.05).

Conclusion:
The static morphologic characteristics of eyes were significantly different among females with different facial morphologies.
Current Evidence Related to Intermittent Catheterization
Authors: Engberg Sandra , Clapper Jynae , McNichol Laurie , Thompson Donna , Welch Valre W. , Gray Mikel 
Published: March 2020

PURPOSE:
The purpose was to summarize evidence related to adherence to intermittent catheterization (IC), complication rates, satisfaction with IC, and its effect on health-related quality of life.

PROBLEM:
Intermittent catheterization is frequently used to manage lower urinary tract dysfunctions including urinary retention and urinary incontinence, but research suggests that care for patients using IC may not always be based on evidence.

METHODS:
Scoping review.

SEARCH STRATEGY:
We searched the PubMed, EMBASE, CINAHL databases, and the Cochrane Database for Systematic Reviews to identify studies published between January 2009 and March 2019. Seventy studies met inclusion criteria and were evaluated for adherence, complication rates, satisfaction, and health-related quality in adults and children using IC for bladder management.

FINDINGS:
Recent research was variable in both quantity and quality. The evidence suggests that (1) most patients can successfully master IC and that functional status is likely the most important predictor of success; (2) adherence to IC probably decreases over time; (3) urinary tract infections (UTIs) are the most common complication of IC and that prophylactic antibiotic therapy may reduce the risk of recurrent UTIs; (4) urinary incontinence is also a common complication; and (5) other complications such as urethral strictures, bladder stones, hematuria, and urethral false passage do occur but are less prevalent than UTIs and incontinence between catheterizations. Our review also revealed multiple gaps in the evidence to support care for patients using IC.

CONCLUSIONS:
Research priorities include a need for prospective studies of the epidemiology and risk factors for IC-related complications, along with intervention studies to determine how to improve outcomes for patients using IC to manage bladder function.
Carrierless amplitude and phase modulation in wireless visible light communication systems
Authors: Bamiedakis N. , Penty R. V. , White I. H. 
Published: March 2020

Visible light communications (VLCs) have attracted considerable interest in recent years owing to the potential to simultaneously achieve data transmission and illumination using low-cost light-emitting diodes (LEDs). However, the high-speed capability of such links is typically limited by the low bandwidth of LEDs. As a result, spectrally efficient advanced modulation formats have been considered for use in VLC links in order to mitigate this issue and enable higher data rates. Carrierless amplitude and phase (CAP) modulation is one such spectrally efficient scheme that has attracted significant interest in recent years owing to its good potential and practical implementation. In this paper, we introduce the basic features of CAP modulation and review its use in the context of indoor VLC systems. We describe some of its attributes and inherent limitations, present related advances aiming to improve its performance and potential and report on recent experimental demonstrations of LED-based VLC links employing CAP modulation.
This article is part of the theme issue ‘Optical wireless communication’.
Capacity of optical wireless communication channels
Authors: Chaaban A. , Hranilovic S. 
Published: March 2020

Optical wireless communications are realized by modulating the intensity of a light source and detecting intensity fluctuations at the receiver. This mode of operation, known as intensity modulation and direct detection (IM/DD), is simple to implement in practice. However, computing the channel capacity of the underlying channel is not straightforward because of the amplitude constraints that arise due to IM/DD operation. In particular, the transmit signal must be non-negative, while the peak and average amplitudes are constrained due to practical and safety considerations. Though a closed form for the capacity of IM/DD channels is not known, much work has been done to find capacity bounds and asymptotic capacity expressions. In this paper, a description of the IM/DD channel and its physical constraints is presented, followed by a review of recent progress pertaining to the capacity of IM/DD channels. Additionally, capacity-achieving distributions are discussed along with simple constructions that approach capacity.
This article is part of the theme issue ‘Optical wireless communication’.
Some practical constraints and solutions for optical camera communication
Authors: LIU Weijie , Xu Zhengyuan 
Published: March 2020

Mobile wireless communication heavily relies on the radio frequency to convey message and data. However, its limited spectrum can hardly meet the demands for the future high data rate applications. Optical wireless communication, in particular visible light communication, opens up vast optical spectrum for communication, and meanwhile can retrofit the light sources as the communication transmitters in the existing working or living environments. In conjunction with the ubiquitous cameras in hand-held consumer electronics such as smartphones and pads, optical camera communication (OCC) further takes advantages of image sensors as the communication receivers and realizes low-cost communication systems. This article first provides an overview of OCC systems. It then addresses some practical constraints, ranging from sensor low frame rate and instability, rolling shutter readout, to visual qualities of displayed images and videos, and link blockage between the transmitter and receiver. Accordingly, it introduces existing and new solutions to deal with those constraints by data modulation, newly developed camera structures, post-processing of sensed signals and non-line of sight OCC as a new form. In particular, indirect paths by either the indoor surface reflection or the outdoor atmospheric scattering are explored for link connectivity under blockage. Finally, some future research directions are suggested.
This article is part of the theme issue ‘Optical wireless communication’.
How can a medical educational initiative address the evolving problem of vaccine hesitancy?
Authors: Costello Paul , Bouchet Julien , Boyd Melanie , Oakley Simon 
Published: March 2020

Background
Current surveillance data suggests that vaccine coverage rates (VCRs) in children are declining, potentially contributing towards outbreaks of vaccine-preventable diseases at levels not commonplace in the UK in recent years. This observed decline in VCRs can be attributed to a number of reasons, one of which is the increasing momentum in vaccine hesitancy.
Insights we have obtained from healthcare professionals (HCPs) demonstrated a paucity of accessible medical education specifically addressing this complex issue. This led Sanofi Pasteur to develop a contemporary, non-promotional ‘Vaccination Educational Initiative’ for HCPs, called Lumiere, part of which focuses on increasing vaccine confidence and addressing vaccine hesitancy.
Objective
Equip HCPs with evidence-based techniques which help them address the concerns of the public and improve vaccine confidence amongst patients.

Method
Five symposia were held across the UK. The faculty comprised both academic experts and specialist nurses with relevant clinical experience who presented proven techniques that can help increase vaccine confidence.
Attendee feedback from the first symposium suggested additional examples on how to apply these techniques in clinical practice would be helpful. Subsequent symposia were modified to include real life cases.
Summary of results
The symposia attracted a total of 443 attendees of which 37% (162) completed evaluation forms.
92% of respondents rated the symposia as good or excellent with 93% indicating they would change clinical practice based on their learnings.
From the initial roll out of Lumiere we have demonstrated that medical education can help support HCPs play an active role in restoring vaccine confidence.
Rifampicin-eluting biodegradable PLGA coatings can significantly inhibit in vitro biofilm formation for 10 weeks
Authors: Fraser Justine , McCormick Christopher , Maclean Michelle 
Published: March 2020

Biofilm infection is a challenging complication of implanted medical devices due to difficulties in delivering a concentrated dose of antimicrobial to the infection site. To prevent biofilm pathogenesis, a local drug-delivery method, such as drug-eluting technology using biodegradable polymers to coat implantable devices, may be favourable.
Implantable medical-grade polyester was coated in formulations of Poly(lactic-co-glycolic acid) and rifampicin (50:50, 60:40) and placed in PBS (37°C; 120rpm). To characterise release, media was collected periodically over 10 weeks and analysed (UV-spectrophotometry; 334nm). To examine biofilm inhibition, material was removed and submerged in Staphylococcus aureus and Escherichia coli suspensions (37°C; 24hrs) to stimulate biofilm formation. Biofilms were recovered using agitation/sonication, and enumerated.
Release data revealed that both formulations had an initial burst-release phase during the first 24 hours, releasing 92% (50:50) and 88% (60:40) of their respective rifampicin loads. For both formulations, this was followed by slow-release for the remainder of the examined time, reaching 98.9% (50:50) and 97.9% release (60:40). Despite a small fraction of loaded rifampicin remaining, the formulations were able to significantly inhibit S. aureus biofilm formation (up to 99%) for 10 weeks, and E. coli biofilm formation (up to 57%) for 6 weeks.
Drug-eluting polymer technology has already seen success in medical devices, such as coronary stents, to prevent restenosis. Here it has been indicated that this technology has potential in the field of infection prevention, by demonstrating the ability to inhibit in vitro biofilm formation to a significant degree for up to 10 weeks.
Treatment Failure in a Case of Fully Susceptible Tuberculous Lymphadenitis; Time to Consider Dual Pathology
Authors: Hudson Alyssa , Jenkins Megan , Heys Izak , Moran Ed 
Published: March 2020

Background
The clinical presentation of tuberculous lymphadenitis (TBL) can mimic that of other pathologies; obtaining a tissue diagnosis is therefore essential. Dual pathology can manifest as apparent treatment failure and rare cases of coexistent lymphoma have been reported.

Case description
A 54-year-old fit and well man of African-Caribbean origin presented with an 8-week history of dysphagia, breathlessness and weight loss. He was tachypnoeic and thin with right supraclavicular and axillary lymphadenopathy.
An HIV test was negative. A CT thorax demonstrated clear lung fields and a 7.2cm mediastinal soft tissue mass compressing the oesophagus and trachea.
US-guided core biopsies of a supraclavicular lymph node showed necrotising granulomatous inflammation. There was no evidence of lymphoma on immunohistochemistry. An acid-fast bacillus was seen on Wade-Fite staining.
Voractiv was commenced for suspected TBL. Tissue culture subsequently grew Mycobacterium tuberculosis. Susceptibility to treatment was confirmed by whole genome sequencing.
After two months of treatment he remained symptomatic with continued weight loss. The possibility of dual pathology was considered, and the index biopsy revisited. Steroids were commenced for a possible paradoxical reaction, resulting in some initial clinical improvement.
Ten weeks into treatment, he further deteriorated requiring artificial nutrition and tracheal stenting. Repeat CT imaging showed enlargement of the mediastinal mass, now extending into the oesophageal lumen. Oesophageal biopsy demonstrated adenocarcinoma.

Conclusions
We report a case of TBL with coexistent adenocarcinoma, which whilst rare highlights the importance of reassessment for dual pathology in cases of biopsy proven TBL that fails to respond to appropriate anti-tuberculous therapy.
Physician-initiated HIV testing leads to missed opportunities in an East London Hospital Acute Admissions Unit
Authors: Lamprianidis Konstantinos Teopoulos , Soothill Germander Sarah , Jakubowska Agnieszka , Thomas Sherine 
Published: March 2020

Background
The United Kingdom National Guidelines for Human Immunodeficiency Virus (HIV) Testing 2008 suggest that an HIV test should be considered in all general medical admissions, when diagnosed HIV prevalence exceeds 2 in 1000 in the local population. We evaluated physician-initiated HIV testing rates in the Acute Assessment Unit of an East London hospital.
Methods
All acute presentations over one month were reviewed retrospectively, using electronic records. Patients with confirmed HIV were identified and the requested diagnostic HIV tests were measured. The number of patients with clinical indicator conditions for adult HIV infection, as defined in the United Kingdom National Guidelines for HIV Testing 2008, who did not receive appropriate testing, was calculated.

Results
In the cohort of 1023 patients, two patients had known HIV. 58 diagnostic HIV tests were performed, including 40 tests in patients with no clinical indicator diseases. There were five admissions with ‘AIDS-defining conditions’, all of which were pulmonary tuberculosis and four out of five (80.0%) were tested. There were 118 admissions with ‘conditions where HIV testing should be offered’, 14 of which (11.9%) were tested. All HIV tests were negative.

Conclusion
Physician-initiated HIV testing was inadequate for such a high prevalence area, even in clinical indicator diseases. Physician-initiated HIV testing should be replaced with routine opt-out HIV testing in acute medical admissions units in areas of high HIV prevalence, as suggested by BHIVA (British HIV Association) guidelines, as we progress towards ending the HIV epidemic in the United Kingdom.
Chronicle of migrant hyperinfective Strongyloides stercolaris larvae and associated bacteremia in a patient suffering from Idiopathic Thrombocytopenic Purpura
Authors: Tak Vibhor , Kolita Jitu Moni , Nag Vijaya Lakshmi , Bohra Gopal Krishna , Kumar Deepak 
Published: March 2020

Background:
Strongyloidiasis is a neglected nematode infestation and can lead to hyperinfection syndrome. The onset of strongyloides hyper-infection syndrome is associated with a myriad of seemingly unrelated symptoms including diarrhoea, abdominal pain, urticaria, anaemia, sepsis and acute respiratory distress syndrome.

Case report:
A 65-year-old female patient presenting with chief complaints of nausea, vomiting, abdominal cramps, diarrhea, fever and cough and was admitted to a teaching hospital on 2nd May 2019. The patient was a diagnosed case of idiopathic thrombocytopenic purpura on Azathioprine (50mg, BD) and oral corticosteroid therapy (Prednisolone 60mg, OD) and was on treatment from the same hospital. The patient developed these symptoms after 23 days of immunosuppressive therapy. Patient was continued with previous medication along with supportive management after admission. Blood and urine sample was received in the department of Microbiology on 3rd May 2019 for culture and sensitivity testing. Urine sample was sterile after 24 hours of aerobic incubation. Escherichia coli grew in blood culture and the isolate was susceptible to gentamicin, amikacin and colistin. Stool sample was received on 6th of May 2019 for routine microscopy. With wet mount preparation of stool specimen, numerous larvae of Strongyloides stercoralis were seen. Modified Ziehl-Neelsen staining was performed and oocysts of Cryptosporidium species were also seen. Wet mount preparation of sputum sample was also performed in which few larvae of S. stercoralis were seen.

Conclusion:
As corticosteroid is the mainstay of treatment in idiopathic thrombocytopenic purpura an early diagnosis and prompt specific anti-parasitic therapy is required to eradicate these infections
Brewer’s Yeast as a cause of infective endocarditis
Authors: Hammond Robert , Aggarwal Dinesh , Hurt Will , Ferran Elena , Satta Giovanni , Abbara Aula 
Published: March 2020

Background: Molecular tests are increasingly used in culture negative endocarditis and may be helpful adjuncts to diagnosis; here we report the case of Saccharomyces cerevisiae mitral valve endocarditis in an immunocompetent patient.
Case History: A previously well 63 year old man presented with a ten day history of fever, nights sweats and progressive shortness of breath. On arrival, he was in acute respiratory distress, in pulmonary oedema and had a pansystolic murmur. A transoesophageal echocardiogram showed severe mitral regurgitation and a mass on the posterior leaflet of the mitral valve. He was treated for a presumed native valve endocarditis with Amoxicillin, Flucloxacillin and Gentamicin. He had a minimally invasive mitral valve repair; a vegetation was noted. All initial cultures and serologies were negative. He improved and was discharged on ceftriaxone and doxycycline on OPAT. Results three weeks post-surgery showed a Beta D Glucan of >500pg/mL (cut off 80) and an 18S PCR on the valve positive for Saccharomyces cerevisiae. No histology was available from the vegetation and fungal cultures were negative. He was much improved at that point and received 6 weeks of voriconazole to treat invasive infection; his Beta D Glucan fell to less than 30 and he was well on follow-up.
Conclusion: Saccharomyces cerevisae is an unusual cause of an endocarditis in an immunocompetent patient. This case illustrates the importance of considering non-bacterial causes of endocarditis in such cases and the utility of molecular diagnostics as adjuncts to traditional culture techniques.