bluuebunny/crossref_metadata_2025_split huggingface dataset:
SFKs/p38 Pathway is Involved in Radicular Pain by Promoting Spinal Expression of Pro-Inflammatory Cytokines in a Rat Model of Lumbar Disc Herniation
Authors: Zhong Yi , Huang Yangliang , Hu Yuming , Xu Mingxian , Zhu Lirong , Deng Zhen 
Published: July 2019

Study Design.
A controlled, randomized, animal study.

Objective.
The aim of this study was to investigate the role of src-family kinases/p38 pathway in a rat model of lumbar disc herniation (LDH).

Summary of Background Data.
LDH always generates radicular pain, and the mechanism remains unclear. We have reported that spinal src-family kinases (SFKs) may be involved in the process, but the downstream mechanism needs further investigation.

Methods.
LDH was induced by implantation of autologous nucleus pulposus (NP), harvest from the tail, in lumbar 4/5 spinal nerve roots of rat. Von Frey filaments and radiant heat tests were performed to determine mechanical and thermal pain threshold respectively. Basso, Beattie, and Bresnahan (BBB) scale was assessed to test the locomotor function. The protein level of p-SFKs, t-SFKs, p-p38, t-p38 in spinal cord was examined by western blotting analysis. Cellular location of p-p38 was determined by immunochemistry staining. Spinal tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, and IL-6 levels were detected by enzyme-linked immunosorbent assay (ELISA).

Results.
Rats with NP implantation showed persistent ipsilateral mechanical allodynia and thermal hyperalgesia, which manifested as obvious decrease of paw withdrawal threshold (PWT) and paw withdrawal latency (PWL). BBB scale indicated the locomotor function of hindpaws in rats with NP implantation kept intact. Western blotting and immunohistochemistry staining revealed that phosphorylated SFKs (p-SFKs) and phosphorylated p38 MAPK (p-p38) were sequentially upregulated in ipsilateral spinal dorsal horn, but not in contralateral side of rats with NP. Intrathecal delivery of SFKs inhibitor reduced spinal p-p38 expression. Both SFKs and p38 inhibitors alleviated pain behaviors in a dose-responsive manner without disturbing locomotor function and reduced spinal expression of TNF-α, IL-1β, and IL-6 in rats with NP.

Conclusion.
Spinal SFKs contribute to radicular pain by activation of p38 MAPK and increasing pro-inflammatory cytokines expression in rats with NP implantation. Targeting SFKs/p38 pathway may be helpful for alleviating radicular pain.

Level of Evidence: N/A
Marginal zone lymphomas: second most common lymphomas in older patients
Authors: Bron Dominique , Meuleman Nathalie 
Published: July 2019

Purpose of review
Choosing an optimal treatment in older patients with indolent lymphomas is a challenge for hematooncologists. They must concomitantly treat some potentially curable entities, manage other symptomatic incurable diseases and protect their patients from life-threatening toxicities. Specific recommendations for older patients with different subtypes of marginal zone lymphomas are thus required in terms of treatment and supportive care.

Recent findings
All the data in the literature agree that the therapeutic approach of older patients with malignant hemopathies should include the appraisal of their life expectancy and of the prognostic factors of their tumor, the evaluation of their physiological and cognitive functions and their socioeconomic environment, and their expectancy in terms of quality of life. Major progresses have, therefore, been achieved in the management of lymphoma patients of 80 years and older.

Summary
With an optimal ‘geriatric assessment’, most of the recommended treatments are also appropriate in older marginal zone lymphoma patients. Extranodal MALT lymphoma: eradication of the pathogen is a major part of the first-line therapy. Prognosis is excellent in early stages. In advanced stages, observation and anti-CD20 antibodies with or without cytostatic drugs are recommended. Nodal MZL: Usually confined to lymph nodes, bone marrow and peripheral blood, they should be managed as follicular lymphomas. Splenic MZL: in this unique entity involving the spleen, the bone marrow and the peripheral blood. Hepatitis infection should be eradicated before considering treatment. Only symptomatic patients require to be treated by splenectomy and/or anti-CD20 antibodies.
Molecular screening programs in different countries: what we learned and perspectives
Authors: Borcoman Edith , Le Tourneau Christophe , Kamal Maud 
Published: July 2019

Purpose of review
Precision medicine arised as a new paradigm in oncology in which molecular profiling aims at guiding therapy in oncology. The implementation of precision medicine necessitates setting up molecular tumor boards (MTBs) that coordinate the workflow of tumor samples to efficiently seek for actionable molecular alterations. We review here the main precision medicine initiatives that involve MTBs and decipher challenges that still need to be overcome along with future perspectives for a broader implementation of precision medicine in routine patient care.

Recent findings
MTBs have been implemented in multiple countries. They identify actionable molecular alteration in up to 50% of patients. However, around 10–20% receive matched therapy and less than 6% of patients experience an objective response. The challenges that need to be overcome for a successful implementation of precision medicine include an earlier molecular profiling of patients during their disease course, the use of liquid biopsies that allow sequential analyses, along with more exhaustive gene panels and extended access to drugs.

Summary
Molecular screening programs allow to successfully guiding patients to individualized therapy in a minority of patients, and few patients actually benefit from these programs.
Application of SPY Angiography in the Management of a Chronic Sternal Wound
Authors: Lu Karen B. , Sanniec Kyle , Amirlak Bardia 
Published: July 2019

Summary:
The SPY angiography system has several surgical uses. Often, surgeons may experience difficult cases in which the viability and perfusion of tissue is questioned. By using the SPY angiography system intraoperatively, this system may provide additional information allowing the surgeon to make calculated real-time decisions which may lead to improved patient outcomes. This study describes a case of a chronic sternal wound treated with reconstruction using intraoperative SPY angiography. Adequate perfusion of the flap was determined via SPY angiography intraoperatively. The flap was thereafter successfully utilized to cover the chronic wound. The patient was followed postoperatively with progression of wound closure. Sternal wounds often pose a complex problem for patients and physicians. The use of intraoperative SPY angiography provided critical information to the operating team allowing for the successful identification of a viable flap. The use of SPY angiography provided the patient an opportunity to achieve a successful outcome and reduced the risk of skin necrosis or reoperation.
Sensitivity and Specificity of the Stemmer Sign for Lymphedema: A Clinical Lymphoscintigraphic Study
Authors: Goss Jeremy A. , Greene Arin K. 
Published: July 2019

Background:
The Stemmer sign is a physical examination finding used to diagnose lymphedema. If the examiner cannot pinch the skin of the dorsum of the foot or hand then this positive finding is associated with lymphedema. The purpose of the study was to determine the accuracy of the Stemmer sign to predict lymphedema.

Methods:
All patients referred to our Lymphedema Program between 2016 and 2018 were tested for the Stemmer sign and underwent lymphoscintigraphy to define the patient’s lymphatic function. Patient age, lymphedema type (primary and secondary), disease location (arm and leg), lymphoscintigraphy findings, stage, severity, and body mass index were recorded. Comparison of predictive variables and Stemmer sign result was performed using Fisher’s exact test and Student’s t test.

Results:
One hundred ten patients were studied: patients with a positive Stemmer sign (n = 87) exhibited abnormal (n = 80) or normal (n = 7) lymphatic function by lymphoscintigraphy (sensitivity = 92%). False-positive Stemmer signs included individuals with obesity (n = 6) or spinal muscle atrophy (n = 1). Subjects with a negative Stemmer sign (n = 23) had normal (n = 13) or abnormal (n = 10) lymphatic function by imaging (specificity = 57%). Patients with a false-negative Stemmer sign were more likely to have a normal body mass index (P = 0.02) and Stage 1 disease (P = 0.01).

Conclusions:
A positive Stemmer sign is a sensitive predictor for primary and secondary lymphedema of the arms or legs and, thus, is a useful part of the physical examination. Because the test exhibits moderate specificity, lymphoscintigraphy should be considered for patients with a high suspicion of lymphedema that have a negative Stemmer sign.
Psychological perspectives to early surgery in the management of disorders/differences of sex development
Authors: Wisniewski Amy B. , Tishelman Amy C. 
Published: July 2019

Purpose of review
The review focuses on genitoplasty, performed on young children with disorders/differences of sex development (DSD) to ‘typify’ ambiguous external genitalia and intended to result in either male or female-appearing genitals. Consensus on whether or not early genitoplasty is optimal or appropriate has yet to be achieved. This article reviews arguments in favor of early surgery as well as those disputing their justification.

Recent findings
Arguments supporting early genitoplasty include the assumption that a child's genital anatomy should match their gender of rearing for optimal psychosocial development and that outcomes are better physically and psychologically than when surgery is deferred. Those disputing their justification argue that they deny patients the right to participate in irreversible decisions related to anatomy and gender, revoke the possibility of an open future, and violate basic human rights. Clinical management includes recommendations for interdisciplinary care integrating psychologists, and shared decision-making processes to assist families in carefully considering options.

Summary
Early genital surgery in DSD care is controversial with compelling arguments put forth by both proponents and opponents. Relevant issues can be examined from ethical, psychological, cultural and medical perspectives – all of which need to be accounted for in both research and standard of care development.
Functional Status Scale: Cross-Cultural Adaptation and Validation in Brazil
Authors: Pereira Gabriela Alves , Schaan Camila Wohlgemuth , Ferrari Renata Salatti , Normann Tatiana Coser , Rosa Nathalia Vieira , Ricachinevsky Claudia Pires , Reppold Caroline Tozzi , Lukrafka Janice Luisa 
Published: July 2019

Objective:
The goal of the present study was to perform a cross-cultural adaptation and clinical validation of the Functional Status Scale for use in the Brazilian population.

Design:
Cross-cultural adaptation study followed by a cross-sectional validation study.

Setting:
Single-center PICU at a hospital in Porto Alegre, Brazil.

Patients:
Children and adolescents of both sexes, 1 month and under 18 years old, who had been treated at the PICU.

Interventions:
The cross-cultural adaptation consisted of the following stages: translation, synthesis of the translated versions, back translations, synthesis of the back translations, committee review, and pretesting. For the clinical validation stage, the Brazilian Functional Status Scale was applied within 48 hours after discharge from the PICU. The Brazilian Functional Status Scale’s reliability and validity properties were tested.

Measurements and Main Results:
A total of 314 patients were evaluated. Median age was 24 months (7.0–105.0 mo), 54.1% were males, and their overall functional score was 9 ± 2.8. The Brazilian Functional Status Scale demonstrated excellent interobserver reliability, with an intraclass correlation coefficient of 0.98, and κ coefficients between 0.716 and 1.000 for the functional domains, which indicated good to excellent agreement. Using the Bland-Altman method, we confirmed low variability among the evaluator’s responses (0.93 to –1.06 points). Regarding the Brazilian Functional Status Scale’s content validity, there was a correlation between length of PICU stay (r = 0.378; p < 0.001) and time on invasive mechanical ventilation (r = 0.261; p < 0.05), and the test could discriminate between groups with different comorbidity levels (p < 0.001).

Conclusions:
The Functional Status Scale has been culturally adapted and validated for use in Brazil and is now available for use in the assessment of functionality in Brazilian children and adolescents.
Barriers to Communication in a PICU: A Qualitative Investigation of Family and Provider Perceptions*
Authors: Greenway Tyler L. , Rosenthal Marjorie S. , Murtha Tanya D. , Kandil Sarah B. , Talento Desmond L. , Couloures Kevin G. 
Published: July 2019

Objectives:Family and medical provider perceptions of communication barriers within the PICU are poorly understood. We designed a qualitative study to characterize the perspective of families and medical providers of critically ill children regarding communication barriers. The identified barriers may be used to direct efforts to improve communication.Design:Semi-structured interviews were conducted from August 2017 to January 2018. Interviews were audio recorded and professionally transcribed verbatim.Setting:A PICU at a tertiary care academic center.Patients:Forty-two families whose children were admitted to the PICU (excluding patients receiving end-of-life care or with protective services involvement) and 12 PICU staff members, including nurses, residents, fellows, and attending’s.Interventions:None.Measurements and Main Results:An interprofessional team of a physician, nurse manager, and medical student coded the transcripts. Interviewing continued until thematic saturation was reached. Codes were organized into common themes using a modified constant comparative method. The families interviewed represented 16 previously healthy children, and 26 children with a chronic health condition. Staff interviewed included three residents, three fellows, three attending intensivists, and three nurses. Participants’ perceptions and experiences of barriers to communication included the following: 1) Communication breakdowns related to coordination of care among several services, 2) Family-centered rounds are insufficient for effective communication, 3) Undervaluing the knowledge of families of children with chronic health conditions or special needs, and 4) Communication breakdowns occur across provider hand-offs. Theme 3 was identified by families, but not by providers.Conclusions:Families and medical providers both identified several barriers to communication. However, only families identified the barrier “Undervaluing the knowledge of families with chronically ill children.” Future work should explore these barriers and the discrepancy in perception between providers and families to determine if there are interventions that improve both family satisfaction and patient care.
Creation and Initial Validation of a Picture-Based Version of the Limitations of Activity Domain of the SF-36
Authors: Stothers Bennett , Macnab Andrew John 
Published: July 2019

Abstract
Those with limited language comprehension or literacy face problems completing written questionnaires evaluating their health or physical status on which treatment plans are based. This brief report describes how a picture-based version of the 10 items in the limitations of activities section of the short form 36 health survey questionnaire (SF-36) was developed iteratively and then piloted. Study participants were 101 community-living volunteers (58 female and 43 male volunteers aged 18–93 yrs) educated to postsecondary level (52), high school grades 10–12 (44), and grade 9 or less (5). They first completed the picture-based SF-36 LoA and described verbally and in writing what they understood each picture to mean and then completed the English text version of the SF-36 limitations of physical activities domain for comparison assessment. Additional feedback suggested where pictures could be altered to increase information capture. Subjects rated their health as 26.7% excellent, 25.7% very good, 29.8% good, 10.9% fair, and 6.9% poor. Analysis showed strong correlation between text-based SF-36 LoA questions and the picture-based visual score—VSF-36 LoA—(intraclass correlation coefficient = 0.98) with question 10 correlating highest (intraclass correlation coefficient = 0.90) and question 2 lowest (intraclass correlation coefficient = 0.82). The VSF-36 LoA is the first picture-based version of the SF-36; good correlation with the text-based version and global need warrants further development to aid those with limited literacy or language comprehension.
Brow Ptosis: Is Transblepharoplasty Internal Browpexy Suitable for Everyone?
Authors: Nemet Arie Y. 
Published: July 2019

Purpose:
Transcutaneous internal browpexy can provide patients with mild-to-moderate lateral brow ptosis, stabilization and modest lift of the lateral brow. Questions regarding effectiveness of this procedure and appropriate indications remain.

Methods:
The authors measured consecutive patients who underwent upper eyelid blepharoplasty with transblepharoplasty internal browpexy (TIB) September 2014 to December 2017. Pre- and postoperative brow elevation was assessed based on before and after photographs of each patient. Patient photographs were assessed for medial and lateral brow elevation, brow contouring and asymmetry. Optimal lateral brow elevation was classified as bilateral symmetrical and above the supraorbital rim for women, and symmetrical and at the supraorbital rim for men.

Results:
A total of 239 patients underwent bilateral TIB and 39 underwent unilateral TIB (517 eyelids in total). Pre- and post-operative measurements were taken in 98 patients (41%), with an average elevation of the lateral brow position of 2.54 mm.
Six patients had an underlying infection in the first postoperative week that resolved completely. Three patients underwent a second stage direct brow lift repair and 3 needed unrecognized ptosis repair as a second stage.

Conclusions:
Transblepharoplasty internal browpexy is an important tool that can be used in most patients with lateral and central brow ptosis, asymmetric brow ptosis and irregular contour of the brow. Additionally, browpexy adds to the success and longevity of upper blepharoplasty, while preventing early recurrence of lateral upper eyelid hooding. Patients with significant ptosis, heavy brows, medial greater than lateral ptosis, and post-facial palsy may not be good candidates for this procedure.
Defining the Zygomaticosphenoidal Angle as a Guide to Anatomic Zygomaticomaxillary Complex Fracture Reduction
Authors: De Ruiter Brandon J. , Levin Avinoam , Nash David , Kamel George , Mostafa Evan , Baghdasarian Daniel , Davidson Edward H. 
Published: July 2019

Background:
Alignment of the zygomaticosphenoid suture is fundamental to reduction of zygomaticomaxillary complex fractures. To prevent a rotational deformity, the correct angle of the zygoma relative to the cranial base must be restored. Clinically, this can be a challenge, especially when there is comminution of the zygomaticosphenoid suture. Defining a zygomaticosphenoidal angle would provide a reference for use with stereotactic navigation to achieve anatomic reduction.

Methods:
A single-center retrospective analysis of 100 patients was designed to determine normative zygomaticosphenoidal angle values. An angle subtended by the midline and a best-fit line through the zygomaticosphenoid suture on axial computed tomography was measured bilaterally in patients with isolated mandibular or nasal fractures. The mean of this measurement for 3 vertically adjacent cuts was calculated with position of central cut determined by the equator of the globe and trigone of the sphenoid. Multivariate regression was completed to identify changes in zygomaticosphenoidal angle with age, sex, and race.

Results:
The mean zygomaticosphenoidal angle was 47° (range 39°–55°). 97% of angles were within 2 standard deviations (8°) of mean. Regression analysis demonstrated no significant change in angle with age (P = 0.74) or sex (P = 0.89). For each angle, the variation across the 3 sample cuts was ≤4.5°. Patients demonstrated high fidelity in zygomaticosphenoidal angle bilaterally with mean difference of 3°.

Conclusion:
The zygomaticosphenoidal angle is a useful reference, in conjunction with stereotactic navigation, for reduction of zygomaticomaxillary complex fractures. Contralaterally obtained patient-specific data may be used to guide unilateral repair. Normative values may serve as reference in bilateral injury.
Evaluation of the Foramen Magnum Area Calculated by Different Methods: A Radioanatomic Study
Authors: Beger Orhan , Erdoğan Osman , Çetin Zeynep , Kara Engin , Vayisoğlu Yusuf , Hamzaoğlu Vural , Özalp Hakan , Dağtekin Ahmet , Bağdatoğlu Celal , Öztürk Ahmet Hakan , Talas Derya Ümit 
Published: July 2019

Purpose:
The main objective of the study was to evaluate the probable diversity in the area of the foramen magnum (FM) calculated by different measuring methods.

Methods:
The study was conducted on 24 dry skulls, present in the collection of the Anatomy Department, Faculty of Medicine, Mersin University. The area of FM was calculated by different measurement methods including automatic field setting, Teixeria and Radinsky formulas obtained from anatomic (ASM), photographic (PSM) and radiologic (RSM) skull measurements.

Results:
The areas of FMs calculated by Teixeria formula in RSM, PSM, and ASM were as follows: 857.96 ± 99.97 mm2, 796.68 ± 105.08 mm2, and 820.86 ± 96.40 mm2, respectively. The areas calculated by Radinsky formula in RSM, PSM, and ASM were as follows: 851.37 ± 99.68 mm2, 792.63 ± 104.18 mm2, and 814.85 ± 94.99 mm2, respectively. Lastly, the areas calculated by the automatic field setting of RSM and PSM software were as follows: 799.75 ± 103.38 mm2 and 752.83 ± 105.60 mm2, respectively.

Conclusion:
Statistical significance was observed between the areas of FM obtained from RSM, ASM, and PSM when calculated by the automatic field setting, Teixeria formula, and Radinsky formula. The authors think that considering the amorphous shape of FM, the automatic field setting of the software should be used to obtain the most accurate numerical data related to the area of FM.