bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validity of the Tinel Sign and Prevalence of Tibial Nerve Entrapment at the Tarsal Tunnel in Both Diabetic and Nondiabetic Subjects: A Cross-Sectional Study
Authors: Rinkel Willem D. , Castro Cabezas Manuel , van Neck Johan W. , Birnie Erwin , Hovius Steven E. R. , Coert J. Henk 
Published: August 2018

Background:
Nerve entrapments like carpal tunnel syndrome are more prevalent in patients with diabetes, especially in those with diabetic polyneuropathy. Our study aims were to investigate the validity of the Tinel sign in diagnosing tibial neuropathy and determine the prevalence of tibial nerve entrapment in both a diabetic and nondiabetic population.

Methods:
Two hundred forty nonneuropathic subjects with diabetes and 176 diabetic subjects with neuropathy participating in the prospective Rotterdam Diabetic Foot Study and 196 reference subjects without diabetes and without neuropathy complaints were evaluated. All subjects underwent sensory testing of the feet, and complaints were assessed using the Michigan Neuropathy Screening Instrument. The Tinel sign was defined as discriminative and valid for diagnosing tibial nerve entrapment when the nerve-related Michigan Neuropathy Screening Instrument subscore of neuropathic symptoms differed at least 5 percent between the Tinel-positive and Tinel-negative subjects. When the sign was valid, prevalence estimates of tibial nerve entrapment at the tarsal tunnel were calculated.

Results:
Significantly more neuropathic symptoms (p < 0.002) and higher sensory thresholds (p < 0.0005) were observed in (compressed) tibial nerve–innervated areas, indicating that a positive Tinel sign at the tarsal tunnel is a valid measure of tibial nerve abnormality. The prevalence of tibial nerve entrapment in diabetic patients was 44.9 percent (95 percent CI, 40.1 to 49.7 percent) versus 26.5 percent (95 percent CI, 20.3 to 32.7 percent) in healthy controls (p < 0.0001).

Conclusions:
Tibial nerve entrapment is more prevalent in diabetic subjects than in controls. The significantly more frequently reported neuropathic complaints and concomitant sensory disturbances provide evidence for the role of superimposed entrapment neuropathy in diabetes-related neuropathy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, IV.
Intracranial Volume and Head Circumference in Children with Unoperated Syndromic Craniosynostosis
Authors: Breakey Richard William Francis , Knoops Paul G. M. , Borghi Alessandro , Rodriguez-Florez Naiara , O’Hara Justine , James Gregory , Dunaway David J. , Schievano Silvia , Jeelani N. U. Owase 
Published: August 2018

Background:
When analyzing intracranial volume gain resulting from operative intervention in craniosynostosis, it is necessary to understand the underlying growth. The authors sought to create comprehensive intracranial volume and occipitofrontal circumference growth charts, as measured on unoperated craniosynostotic children, and aimed to investigate whether intracranial volume and occipitofrontal circumference could act as proxy measures for each other.

Methods:
All preoperative Great Ormond Street Hospital patients with a diagnosis of Apert, Crouzon-Pfeiffer, or Saethre-Chotzen syndrome from the year 2004 onward were considered for this study. A control group of unaffected Great Ormond Street Hospital patients were also measured. Intracranial volume and occipitofrontal circumference were measured on the same scans. To study correlation between intracranial volume and occipitofrontal circumference, logarithmic fits were assessed.

Results:
One hundred forty-seven craniosynostotic children with 221 preoperative scans were included (81 Apert, 81 Crouzon, 31 Pfeiffer, and 28 Saethre-Chotzen). The control group comprised 56 patients with 58 scans. Apert intracranial volume curves were significantly larger than those of other syndromes from 206 days onward; occipitofrontal circumference curves were not significantly different. The correlation coefficient between intracranial volume and occipitofrontal circumference was R
2 = 0.87 for all syndromes combined and R
2 = 0.91 for the control group.

Conclusions:
Apert syndrome children have a larger intracranial volume than children with other syndromic craniosynostotic conditions and unaffected children but maintain a similar occipitofrontal circumference. This study demonstrates high correlation between intracranial volume and occipitofrontal circumference with clinical care implications. The authors’ reference growth curves can be used to monitor intracranial volume change over time and correct operative change for underlying growth.
Vascular Endothelial Growth Factor Enhances Proliferation of Human Tenocytes and Promotes Tenogenic Gene Expression
Authors: Kraus Armin , Sattler Daniel , Wehland Markus , Luetzenberg Ronald , Abuagela Nauras , Infanger Manfred 
Published: August 2018

Background:In obtaining human tenocytes for tendon tissue engineering, a low proliferation rate and phenotype loss during passaging is a problem. It was the authors’ aim to evaluate the influence of vascular endothelial growth factor (VEGF) on human tenocyte growth and gene expression.Methods:Human tenocytes were exposed to human VEGF in various concentrations (5, 10, and 20 ng/ml) for 5 days. Cell proliferation was counted and expression of tendon-related genes was analyzed.Results:Tenocyte count was 1.4 × 105/ml, 2.7 × 105/ml, 2.3 × 105/ml, and 3.7 × 105/ml for 0, 5, 10, and 20 ng/ml VEGF, respectively. Expression ofCol1was up-regulated 6.4 ± 4.2-fold, 60.1 ± 21.6-fold, and 15.8 ± 10.2-fold for 5, 10, and 20 ng/ml VEGF; all differences were significant withp< 0.05.Col3was down-regulated to 0.2 ± 0.1-fold, 0.3 ± 0.1-fold, and 0.1 ± 0.03-fold for 5, 10, and 20 ng/ml VEGF; all differences were significant.Elnwas up-regulated 2.3 ± 1.7-fold, 25.5 ± 10.9-fold, and 16.6 ± 9.0-fold for 5, 10, and 20 ng/ml VEGF; differences were significant for 10 and 20 ng/ml VEGF.TSCwas down-regulated to 0.3 ± 0.1-fold and 0.3 ± 0.1-fold for 5 and 20 ng/ml VEGF; differences were significant for 5 and 20 ng/ml.SCXwas up-regulated to 31.3 ± 8.5-fold, 49.1 ± 23.4-fold, and 20.9 ± 9.5-fold for 5, 10, and 20 ng/ml VEGF; all changes were significant.Conclusions:VEGF enhances proliferation and expression of tendon-related genes in human tenocytes. It could therefore be a useful addition for tenocyte cultivation.
Comparison of Treatment Rates of Depression After Stroke Versus Myocardial Infarction: A Systematic Review and Meta-Analysis of Observational Data
Authors: Ladwig Simon , Zhou Zien , Xu Ying , Wang Xia , Chow Clara K. , Werheid Katja , Hackett Maree L. 
Published: August 2018

ABSTRACT

Objective
Depression after stroke and myocardial infarction (MI) is common but often assumed to be undertreated without reliable evidence being available. Thus, we aimed to determine treatment rates and investigate the application of guidelines in these conditions.

Methods
Databases MEDLINE, EMBASE, PsycInfo, Web of Science, CINAHL, and Scopus were systematically searched without language restriction from inception to June 30, 2017. Prospective observational studies with consecutive recruitment reporting any antidepressant treatment in adults with depression after stroke or MI were included. Random-effects models were used to calculate pooled estimates of treatment rates.

Results
Fifty-five studies reported 32 stroke cohorts (n = 8938; pooled frequency of depression = 34%, 95% confidence interval [CI] = 29%–38%) and 17 MI cohorts (n = 10,767; pooled frequency of depression = 24%, 95% CI = 20%–28%). In 29 stroke cohorts, 24% (95% CI = 20%–27%) of 2280 depressed people used antidepressant medication. In 15 MI cohorts, 14% (95% CI = 8%–19%) of 2381 depressed people used antidepressant medication indicating a lower treatment rate than in stroke. Two studies reported use of psychosocial interventions, indicating that less than 10% of participants were treated.

Conclusions
Despite the high frequency of depression after stroke and MI and the existence of efficacious treatment strategies, people often remain untreated. Innovative strategies are needed to increase the use of effective antidepressive interventions in patients with cardiovascular disease.
Quantifying Lymph Nodes During Lymph Node Transplantation
Authors: Tran Bao Ngoc N. , Celestin Arthur R. , Lee Bernard T. , Critchlow Jonathan , Tsai Leo , Toskich Beau , Singhal Dhruv 
Published: August 2018

Abstract
Quantifying lymph nodes in vascularized lymph node transfer (VLNT) has been performed using preoperative percutaneous ultrasound. The higher resolution and accuracy of intraoperative ultrasound (IOUS) over transcutaneous ultrasound has been demonstrated in the radiology literature for the identification and characterization of finer structures including hepatic lesions, pancreatic lesions, and biliary or pancreatic ducts. We hypothesize that IOUS during VLNT would be a superior method to quantify and map lymph nodes in our flaps. A prospectively collected database of patients undergoing VLNT over 3 years (October 2014 to October 2017) was reviewed. Patients who underwent IOUS during flap harvest, before pedicle ligation to simultaneously map and quantify the number of lymph nodes were included in the study. Twenty-one patients with an average age of 58.7 years and a mean BMI of 32.3 underwent VLNT with IOUS for chronic lymphedema during the study period. Extremity lymphedema was classified as Campisi IB (n = 7), IIA (n = 7), IIB (n = 5), and IIIA (n = 2). There were 14 superficial circumflex iliac artery flaps, including 4 performed concomitantly with a deep inferior epigastric perforator flap, 1 transverse cervical artery flap, and 6 omental flaps. The average number of lymph nodes transferred per IOUS was 4.3 for superficial circumflex iliac artery flaps, 4 for the transverse cervical artery flap, and 5.2 for the omental flaps. Intraoperative ultrasound allows the lymphatic surgeon to precisely map the location of lymph nodes which can guide intraoperative decision making. As there is no data correlating the number of lymph nodes transferred and outcomes after VLNT, developing a precise intraoperative quantification method is important.
Lower Eyelid Reconstruction Using a Nasolabial, Perforator-based V-Y Advancement Flap
Authors: Gibreel Waleed , Harvey Jamison Anne , Garrity James , Bite Uldis 
Published: August 2018

Background
Reconstruction of the lower eyelid represents a unique challenge to the reconstructive surgeon. Studies evaluating the utility of the nasolabial V-Y advancement flap in lower eyelid reconstruction are limited and techniques to optimize outcomes following eyelid reconstruction with this technique are not well described. We seek to evaluate our experience and outcomes with lower eyelid reconstruction using the nasolabial perforator-based V-Y advancement flap.

Methods
After institutional review board approval, medical charts of all patients who underwent lower eyelid reconstruction using the nasolabial perforator-based V-Y advancement flap between February 2013 and October 2017 were reviewed. Data regarding etiology, location of the lesion, lower eyelid defect, methods of reconstruction, postoperative complications, and follow up duration were collected and analyzed.

Results
Over the study period, 5 patients (3 male) underwent lower eyelid reconstruction after oncologic resection of melanoma (n = 1) and nonmelanoma (n = 4) skin cancer using the nasolabial perforator-based V-Y advancement flap at a mean age of 69 years (range, 56–82 years). Median follow-up duration was 5.9 months (interquartile range, 2.25–25.9). A mean of 5.4 (range, 2–10) perforators were included in the initial flap design. After completion of flap dissection and perforator division, a mean of 4.4 (range, 2–7) perforators were preserved and included in the flap. All flaps demonstrated clinical viability with no cases of partial or total flap loss. One patient developed an asymptomatic ectropion during the follow-up period.

Conclusions
The nasolabial, perforator-based V-Y advancement flap is a reliable reconstructive method for lower eyelid defects.
A Simple and Reliable Submental Intubation Technique for Maxillofacial Fractures
Authors: Oshima Naoya , Shiraishi Tomohiro , Kawauchi Tsukasa , Oba Jun , Sato Daisuke , Fujiki Masahide , Ozaki Mine , Takushima Akihiko , Harii Kiyonori 
Published: August 2018

Abstract
In 1986, Altemir first reported the use of submental intubation to avoid tracheotomy in patients with panfacial and midfacial fractures for whom intermaxillary fixation is necessary, but orotracheal and nasotracheal intubations are not recommended. This novel technique allowed intraoperative access to perform dental occlusion and reconstruction of the nasal pyramid in patients with skull base fractures. Herein, we describe a refined technique based on Altemir's original procedure. Seven male patients with panfacial fractures underwent submental intubation using our refined technique. The technique was developed after encountering a technical error with Altemir's original procedure. In this new technique, we employed a 2-0 silk suture guide to allow the passage of both the endotracheal and cuff-inflation tubes through the same tunnel created from the oral cavity to the submental area. The success rate of the refined technique was 100%, and there were no intraoperative or postoperative complications. There was 20 seconds of ventilation outage time in total. Endotracheal and cuff-inflation tubes were easily and quickly passed through the same submental tunnel. Our refined technique is simple, easy, safe, fast, inexpensive, and does not require specific materials. Submental scars were smaller and relatively inconspicuous in this study, compared to those reportedly associated with other modified techniques.
Comparison of Mechanical Stabilization of the Mandibular Angulus Fracture Fixation, With Titanium Plates and Screws, Resorbable Plates and Screws, and Bone Adhesives
Authors: Cural Ülkem , Atalay Berkem , Yildirim Mustafa Sami 
Published: August 2018

Abstract
Mandibular fractures mostly occur at the angulus mandibula with a concurrent symphysis or corpus fracture on the opposite side. Misapplication can damage the nerves, adjacent teeth, soft tissues, and result in permanent tooth germs. In children, growth centers can be damaged, and this may result in asymmetry and retardation in growth and development. The aim of this study was to compare the mechanical stabilization after different techniques were used to create the mandibular angle fracture fixation and to create oblique fractures at mandible angles. This study included 32 hemi-mandibles that were divided into 4 groups with 8 units per group. All of the hemi-mandibles were fixated using different techniques; titanium mini plates and screws, resorbable mini plate and screws, and resorbable mini plates and cyanoacrylate bone adhesive only. The fixated mandibles were tested under molar masticatory forces, and their stabilization endurance was assessed. There were no significant differences in titanium mini plaque screw and resorbable plaque screw techniques under 40 N force. Resorbable and titanium plates and screws did not have any advantage over each other in terms of biomechanical behaviors. It is suitable to use adhesives in the reduction of complicated but nonload-bearing areas. The adhesive used in this study can adhere to the bone but should be further evolved for clinical use.
Renal Resistive Index: Response to Shock and its Determinants in Critically Ill Patients
Authors: Rozemeijer Sander , Haitsma Mulier Jelle L.G. , Röttgering Jantine G. , Elbers Paul W.G. , Spoelstra-de Man Angélique M.E. , Tuinman Pieter Roel , de Waard Monique C. , Oudemans-van Straaten Heleen M. 
Published: August 2018

ABSTRACT

Introduction:
Shock is characterized by micro- and macrovascular flow impairment contributing to acute kidney injury (AKI). Routine monitoring of the circulation regards the macrocirculation but not the renal circulation which can be assessed with Doppler ultrasound as renal resistive index (RRI). RRI reflects resistance to flow. High RRI predicts persistent AKI. Study aims were to determine whether RRI is elevated in shock and to identify determinants of RRI.

Materials and Methods:
This prospective observational cohort study included two cohorts of patients, with and without shock less than 24-h after intensive care admission. Apart from routine monitoring, three study measurements were performed simultaneously: RRI, sublingual microcirculation, and bioelectral impedance analysis.

Results:
A total of 92 patients were included (40 shock, 52 nonshock), median age was 69 [60–76] vs. 67 [59–76], P = 0.541; APACHE III was 87 [65–119] vs. 57 [45–69], P < 0.001. Shock patients had higher RRI than patients without shock (0.751 [0.692–0.788] vs. 0.654 [0.610–0.686], P < 0.001). Overall, high age, APACHE III score, lactate, vasopressor support, pulse pressure index (PPI), central venous pressure (CVP), fluid balance, and low preadmission estimated glomerular filtration rate, mean arterial pressure (MAP), creatinine clearance, and reactance/m were associated with high RRI at univariable regression (P < 0.01). Microcirculatory markers were not. At multivariable regression, vasopressor support, CVP, PPI and MAP, reactance/m, and preadmission eGFR were independent determinants of RRI (n = 92, adj. R
2 = 0.587).

Conclusions:
Patients with shock have a higher RRI than patients without shock. Independent determinants of high RRI were pressure indices of the systemic circulation, low membrane capacitance, and preadmission renal dysfunction. Markers of the sublingual microcirculation were not.
Remote Photoplethysmographic Assessment of the Peripheral Circulation in Critical Care Patients Recovering From Cardiac Surgery
Authors: Rasche Stefan , Trumpp Alexander , Schmidt Martin , Plötze Katrin , Gätjen Frederik , Malberg Hagen , Matschke Klaus , Rudolf Matthias , Baum Fabian , Zaunseder Sebastian 
Published: August 2018

ABSTRACT

Purpose:
Camera-based photoplethysmography (cbPPG) remotely detects the volume pulse of cardiac ejection in the peripheral circulation. The cbPPG signal is sourced from the cutaneous microcirculation, yields a 2-dimensional intensity map, and is therefore an interesting monitoring technique. In this study, we investigated whether cbPPG is in general sufficiently sensitive to discern hemodynamic conditions.

Methods:
cbPPG recordings of 70 patients recovering from cardiac surgery were analyzed. Photoplethysmograms were processed offline and the optical pulse power (OPP) of cardiac ejection was calculated. Hemodynamic data, image intensity, and patient movements were recorded synchronously. The effects of hemodynamic parameters and measurement conditions on the patient's individual OPP variability and their actual OPP values were calculated in mixed-effects regression models.

Results:
Mean arterial pressure (MAP), pulse pressure (PP), heart rate (HR), and central venous pressure (CVP) significantly explained the individual OPP variability. PP had the highest explanatory power (19.9%). Averaged OPP significantly increased with PP and MAP (P < 0.001, respectively) and decreased with higher HR (P = 0.024). CVP had a 2-directional, nonsignificant effect on averaged OPP. Image intensity and patient movements did significantly affect OPP. After adjustment for hemodynamic covariables and measurement conditions, the effect of PP and HR remained unchanged, whereas that of MAP vanished.

Conclusion:
cbPPG is sensitive to hemodynamic parameters in critical care patients. It is a potential application for monitoring the peripheral circulation. Its value in a clinical setting has to be determined.
Chemogenetic restoration of autonomous subthalamic nucleus activity ameliorates Parkinsonian motor dysfunction
Authors: McIver Eileen L. , Chu Hong-Yuan , Atherton Jeremy F. , Cosgrove Kathleen E. , Kondapalli Jyothisri , Wokosin David , Surmeier D. James , Mark D.Bevan 
Published: August 2018

Highlightsdecorrelating autonomous STN activity was downregulated in both toxin and genetic models of PDelevation of D2-striatal projection neuron transmission was sufficient for downregulationdownregulation was dependent on activation of STN NMDA receptors and KATP channelschemogenetic restoration of autonomous spiking reduced synaptic patterning of STN neurons and PD motor dysfunctioneToCExcessive synaptic synchronization of STN activity is linked to the symptomatic expression of PD.McIver and colleagues describe the cellular and circuit mechanisms responsible for the loss of decorrelating autonomous STN activity in PD models and demonstrate that chemogenetic rescue of autonomous spiking reduces synaptically patterned STN activity and ameliorates Parkinsonian motor dysfunction.SUMMARYExcessive, synaptically-driven synchronization of subthalamic nucleus (STN) neurons is widely thought to contribute to akinesia, bradykinesia, and rigidity in Parkinson’s disease (PD). Electrophysiological, optogenetic, chemogenetic, genetic, 2-photon imaging, and pharmacological approaches revealed that the autonomous activity of STN neurons, which opposes synaptic synchronization, was downregulated in both toxin and genetic mouse models of PD.Loss of autonomous spiking was due to increased transmission of D2-striatal projection neurons, leading in the STN to elevated activation of NMDA receptors and generation of reactive oxygen species that promoted KATP channel opening.Chemogenetic restoration of autonomous firing in STN neurons reduced synaptic patterning and ameliorated Parkinsonian motor dysfunction, arguing that elevating intrinsic STN activity is an effective therapeutic intervention in PD.
A transformation of oxygen saturation (the saturation virtual shunt) to improve clinical prediction model calibration and interpretation
Authors: Zhou Guohai , Karlen Walter , Brant Rollin , Wiens Matthew , Kissoon Niranjan , Ansermino J Mark 
Published: August 2018

ABSTRACTBackgroundThe relationship between peripheral oxygen saturation (SpO2) and the inspired oxygen concentration is non-linear. SpO2 is frequently used as a dichotomized predictor, to manage this non-linearity. We propose the saturation virtual shunt (VS) as a transformation of SpO2 to a continuous linear variable to improve interpretation of disease severity within clinical prediction models.MethodWe calculate the saturation VS based on an empirically derived approximation formula between physiological VS and SpO2. We evaluated the utility of the saturation VS in a clinical study predicting the need for facility admission in children in a low resource health-care setting.ResultsThe transformation was saturation VS = 68.864*log10(103.711 − SpO2) −52.110. The ability to predict hospital admission based on a dichotomized SpO2 produced an area under the receiver operating characteristic curve of 0.57, compared to 0.71 based on the untransformed SpO2 and saturation VS. However, the untransformed SpO2 demonstrated a lack of fit compared to the saturation VS (goodness-of-fit test p-value <0.0001 versus 0.098). The observed admission rates varied non-linearly with the untransformed SpO2 but varied linearly with the saturation VS.ConclusionThe saturation VS estimates a continuous linearly interpretable disease severity based on SpO2 and improves clinical prediction.