bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Criteria for Commotio Cordis Caused by Violent Attack
Authors: Lupariello Francesco , Curti Serena Maria , Di Vella Giancarlo 
Published: October 2018

AbstractThe diagnosis of lethal commotio cordis (CC) is really complex. The forensic pathologist's task is even more relevant when he/she has to explain a CC diagnosis caused by an assault in a trial. The purpose of this study was to analyze the literature on lethal CC as a result of violent attacks and identify relevant parameters that may help in the diagnosis. A review of the relevant articles was performed. Fifty-two cases of CC caused by violent attacks were identified. The collected data allowed to confirm the following literature's criteria for CC diagnosis in case of assaults: witnessed occurrence of a blunt, nonpenetrating blow to the chest preceding cardiovascular collapse; absence of structural damage to the sternum, ribs, or heart itself; and absence of any underlying cardiovascular abnormalities (such as other causes of sudden death). Regarding the assessment of the third criterion, the authors suggest that the pathologist should always specify the scientific autopsy guidelines that he/she used to differentiate CC from the other causes of sudden death. In addition, the authors highlight the importance of a multidisciplinary approach for a correct interpretation of clinical, autopsy, and laboratory findings.
Using a Workshop Format for Physiatry Trainees in the Management of Acute Sports-Related Concussion
Authors: Lamm Adam G. , Babu Ashwin , Zafonte Ross , Iaccarino Mary Alexis 
Published: October 2018

AbstractSelect residency and medical student training programs have developed and researched skill-based workshops, focusing on mastering a surgical or communication skill; however, they are less frequently studied in physiatry residency programs. Given the importance of concussion care in physiatric practice, this study sought to measure the effectiveness of a novel sports-related concussion workshop. Based on the 5th International Consensus Statement on Concussion in Sport, a 6-hr concussion workshop was developed. Participants were administered a preworkshop and postworkshop questionnaire to gauge level of comfort managing various aspects of concussion, case-based questions to assess participant knowledge, and questions regarding satisfaction with workshop-based training sessions. Sixteen participants, ranging from PGY-2 to PGY-5, were included in the analyses, with significant gains (P< 0.0001 toP= 0.0045) made in all measures of comfort managing sports-related concussion; the study was unable to detect a statistically significant improvement in knowledge as assessed by the patient vignettes (P= 0.17), but participants did report high levels of satisfaction with workshop-based training sessions. Thus, workshop-based physiatry trainee education sessions can be used to teach trainees certain skills or provide comprehensive training in the management of a specific condition. Participants demonstrated improved comfort managing concussion, a trend toward improved knowledge, and a high degree of satisfaction with the content's method delivery.
Costs and consequences of chronic pain due to musculoskeletal disorders from a health system perspective in Chile
Authors: Vargas Constanza , Bilbeny Norberto , Balmaceda Carlos , Rodríguez María Francisca , Zitko Pedro , Rojas Rubén , Eberhard María Eliana , Ahumada Marisol , Espinoza Manuel Antonio 
Published: October 2018

Abstract

Background:
Chronic pain is a prevalent and distressing condition caused by an unceasing pain lasting more than 3 months or a pain that persists beyond the normal healing time. There is evidence of inadequate management partly explained by the unawareness regarding the magnitude of the problem.

Objectives:
To estimate the annual expected costs and consequences of chronic pain caused by musculoskeletal diseases from the health system perspective in Chile.

Methods:
A Markov cohort model was built to represent chronic pain and estimate expected costs and consequences over 1-year time horizon. Transition probabilities were obtained through expert elicitation. Consequences examined were: years lost to disability (YLD), depression, anxiety, and productivity losses. Direct health care costs were estimated using local sources. Probabilistic sensitivity analysis was performed to characterize second-order uncertainty.

Results:
The annual expected cost due to musculoskeletal chronic pain was estimated in USD $1387.2 million, equivalent to 0.417% of the national GDP. Lower back pain and osteoarthritis of the knee explained the larger proportion of the total cost, 31.8% and 27.1%, respectively. Depression attributed to chronic pain is another important consequence accounting for USD $94 million (Bayesian credibility interval 95% $49.1–$156.26). Productivity losses were also important cost, although early retirement and presenteeism were not measured. Chronic pain causes 137,037 YLDs.

Conclusion:
Chronic pain is not only an important cause of disability but also responsible for high social and financial burden in Chile. Public health programs focused on managing chronic pain may decrease burden of disease and possibly reduce costs.
Delayed onset of severe chronic pain in CASPR2 autoantibody–associated Morvan syndrome in a former UK swine abattoir worker
Authors: Goebel Andreas , Moore Austen Peter , Jacob Anu 
Published: October 2018

Abstract

Introduction:
Autoantibody-mediated autoimmunity directed against targets within the voltage-gated potassium channel complex (VGKCC autoantibodies) has been implicated in causing neuropathic pain.

Methods:
We report the case of a 76-year-old, United Kingdom male who was diagnosed with contactin-associated protein 2 (CASPR2) autoantibody–associated Morvan syndrome, a rare neurological condition.

Results:
He had previously worked in a swine abattoir; exposure to aerosol within swine abattoirs has been reported to elicit an immune response resulting in the production of these autoantibodies; however, unusually, his manifestations emerged with several years' latency. Although this patient's Morvan syndrome–associated seizures were well-controlled with antiepileptic drugs, his neuropathic pain and painful muscle fasciculations did not respond to pharmacological interventions. He refused pain management program treatment, but high-dose immunoglobulin treatment or treatment with rituximab, reported to be sometimes effective in this group, was not initiated because of concerns regarding his general frailty.

Discussion and Conclusion:
This case highlights issues around the identification and treatment of rare patients with chronic pain who have voltage-gated potassium channel complex autoantibodies; it also emphasizes the possibility that former swine abattoir workers might be at risk of developing neuropathic pain even years after their vocational exposure.
Granulocyte-macrophage colony-stimulating factor receptor expression in clinical pain disorder tissues and role in neuronal sensitization
Authors: Donatien Philippe , Anand Uma , Yiangou Yiangos , Sinisi Marco , Fox Michael , MacQuillan Anthony , Quick Tom , Korchev Yuri E. , Anand Praveen 
Published: October 2018

Abstract

Introduction:
Granulocyte-macrophage colony-stimulating factor receptor (GM-CSFR) is highly expressed in peripheral macrophages and microglia, and is involved in arthritis and cancer pain in animal models. However, there is limited information on GM-CSFR expression in human central nervous system (CNS), peripheral nerves, or dorsal root ganglia (DRG), particularly in chronic pain conditions.

Objectives:
Immunohistochemistry was used to quantify GM-CSFR expression levels in human tissues, and functional sensory effects of GM-CSF were studied in cultured DRG neurons.

Results:
Granulocyte-macrophage colony-stimulating factor receptor was markedly increased in microglia at lesional sites of multiple sclerosis spinal cords (P = 0.01), which co-localised with macrophage marker CD68 (P = 0.009). In human DRG, GM-CSFR was expressed in a subset of small/medium diameter cells (30%) and few large cells (10%), with no significant change in avulsion-injured DRG. In peripheral nerves, there was a marked decrease in axonal GM-CSFR after chronic painful nerve injury (P = 0.004) and in painful neuromas (P = 0.0043); CD-68–positive macrophages were increased (P = 0.017) but did not appear to express GM-CSFR. Although control synovium showed absent GM-CSFR immunostaining, this was markedly increased in macrophages of painful osteoarthritis knee synovium. Granulocyte-macrophage colony-stimulating factor receptor was expressed in 17 ± 1.7% of small-/medium-sized cultured adult rat DRG neurons, and in 27 ± 3.3% of TRPV1-positive neurons. Granulocyte-macrophage colony-stimulating factor treatment sensitized capsaicin responses in vitro, which were diminished by p38 MAPK or TrkA inhibitors.

Conclusion:
Our findings support GM-CSFR as a therapeutic target for pain and hypersensitivity in clinical CNS and peripheral inflammatory conditions. Although GM-CSFR was decreased in chronic painful injured peripheral nerves, it could mediate CNS neuroinflammatory effects, which deserves study.
Synthetic 2-Dimensional Mammography Can Replace Digital Mammography as an Adjunct to Wide-Angle Digital Breast Tomosynthesis
Authors: Clauser Paola , Baltzer Pascal A.T. , Kapetas Panagiotis , Woitek Ramona , Weber Michael , Leone Federica , Bernathova Maria , Helbich Thomas H. 
Published: October 2018

Objectives
The aim of this study was to evaluate the detection rate and diagnostic performance of 2-dimensional synthetic mammography (SM) as an adjunct to wide-angle digital breast tomosynthesis (WA-DBT) compared with digital mammography (DM) alone or to DM in combination with WA-DBT.

Materials and Methods
There were 205 women with 179 lesions included in this retrospective reader study. Patients underwent bilateral, 2-view (2v) DM and WA-DBT between March and June 2015. The standard of reference was histology and/or 1-year stability at follow-up. Four blinded readers randomly evaluated images according to the BI-RADS lexicon from 3 different protocols: 2v DM alone, 2v DM with 2v WA-DBT, and 2v SM with 2v WA-DBT. Detection rate, sensitivity, specificity, and accuracy were calculated and compared using multivariate analysis. Readers' confidence and image quality were evaluated.

Results
The detection rate ranged from 68.7% to 79.9% for DM, 76.5% to 84.4% for DM with WA-DBT, and 73.2% to 84.9% for SM with WA-DBT. Sensitivity and accuracy were significantly higher when DBT was available (P < 0.001). Specificity did not differ significantly between DM only, DM with WA-DBT, or SM with WA-DBT (P ≥ 0.846). Wide-angle DBT combined readings did not differ between SM and DM in terms of sensitivity, specificity, and accuracy (P ≥ 0.341). Readers' confidence and image quality was rated good to excellent.

Conclusions
Wide-angle DBT combined with DM or SM increases sensitivity and accuracy without reducing specificity compared with DM alone. Wide-angle DBT combined readings did not differ between SM and DM; therefore, SM should replace DM for combined readings with WA-DBT.
Study on Hair Distribution in Healthy Males for Hair Restoration Design
Authors: Bao Yunqi , Wu Kejia , Lin Jinran , Chen Yuchong , Wu Wenyu 
Published: October 2018

Background:
The incidence of hair loss among Chinese male has increased to 21.3 per hundred. Hair restoration has been an effective technique. Detailed hair distribution has a tremendous impact on the surgery design.

Objective:
To investigate the pattern of hair distribution in Chinese young adult males.

Methods:
A total of 1000 males without hair disease were enrolled. We evaluated the locations of the main anatomical marks at different sites on the scalp and analyzed the hair density and follicular unit structure using the standard photographs and trichoscope.

Results:
The hairline shapes were classified as: linear (48.7%), linear with central protrusion (27.9%), round (9.8%), round with central protrusion (13.7%). The average height of the median line was 6.78 ± 0.75 cm, the ratio of the median line and the forehead height was 0.333. The average distance from the parietal whorl to the vertical bimeatal line was 7.05 ± 3.32 cm, and most of the PWs were on the right (51.4%) and had a clockwise pattern (73.3%). The hair density was 171.12 ± 18.32 hairs/cm2 in the vertex. 1-hair follicular units were (75.90% and 56.39%) in anterior hairline and temporal area.

Conclusion:
Our study clearly assisted understanding of scalp anatomy and hair distribution in Chinese young adult males.
Intracorporeal Septorhinoplasty: Technique and Outcome
Authors: Nassar Ahmed Tharwat 
Published: October 2018

Objective:
Septal deformities usually associated with functional and aesthetic nasal consequences. Multiple techniques were described to correct these deformities. Using less invasive and at the same time competent technique with loge standing results is important. This study aimed to assess intracorporeal correction for septal deviation with assessment of its competence in managing deferent degrees of deviation and to show concomitant patient-dependant internal valve manipulation used.

Methods:
Intracorporeal correction of septal deviation was used in 35 patients which was performed at plastic surgery departments of Menoufia University Hospital and Mawada Privet Hospital, Egypt. The study was carried out between July 2014 and July 2017.

Results:
Thirty-five patients with variable types of septal deformities, 16 of them were females and 19 were males, were included in the study. Age of patients was between 18 and 55 years (mean 24.9, standard deviation 7.9). Etiology was found as follows: 15 (about 43%) posttraumatic septal deviation, 8 (about 23%) patients had postcleft septal deviation, and the remaining 12 had idiopathic septal deviation. Spreader graft was in 22 (about 63%) patients. Septal hematoma followed by septal perforation occurred in 1 patient (2.8%), while dorsal irregularities were found in 3 (8.4%) patients. Recurrent septal deviation occurred in 2 (5.6%) patients. Concerning functional outcome, no residual nasal obstruction was found in all patients with negative Cottle sign postoperative.

Conclusion:
Intracorporeal correction of septal deformities in open rhinoplasty technique is still found to be effective and less invasive option even with sever septal deviation.
Incidence of Foramen Tympanicum (of Huschke): Comparing Cadaveric and Radiologic Studies
Authors: Pękala Jakub R. , Pękala Przemysław A. , Satapathy Bikash , Henry Brandon Michael , Skinningsrud Bendik , Paziewski Mateusz , Tubbs R. Shane , Tomaszewski Krzysztof A. 
Published: October 2018

Purpose:
The foramen tympanicum (FT) represents a developmental anomaly that forms due to incomplete fusion of processes of the tympanic ring. Its presence in the population is controversial and it has been associated with a number of otologic complications. The aim of this study was to systematically analyze the prevalence, anatomical characteristics, and ethnic variations of the FT and compare these parameters in cadaveric and radiologic studies.

Methods:
An extensive search was conducted through the major electronic databases, and identified articles were separated into 2 groups based on their methodology: cadaveric and radiologic studies. Data extracted included study modality, prevalence data, ethnicity, gender, side, laterality, and diameter.

Results:
A total of 8 studies (n = 2671 patients) were included into our meta-analysis. The main findings revealed that the prevalence of the FT in the population is 14.9%, it is more often unilateral (62.5%) than bilateral (37.5%), it is most often reported in Asia (21.4%), and it is more prevalent in cadavers (21.2%) than in radiologic studies (8.8%) (not statistically significant).

Conclusion:
As the FT is present in more than one-tenth of the population, it is important to consider the possibilities of its presence when undertaking surgical procedures in the temporomandibular joint and ear region and plan accordingly to avoid injuries. Clinicians should keep it as one of the possible diagnoses while confronted with patients presenting with otologic complications. The use of newer imaging techniques was recommended, such as cone-beam computer tomography to detect the FT prior to surgery.
Congenital Cleft Earlobe: Technique for Repair of a Triple-Lobe Type Defect
Authors: Stanley Sharon S. , Thaller Seth R. 
Published: October 2018

Abstract
Congenital cleft earlobe is a rare clinical entity that results from failure of fusion during embryologic development. In contrast to acquired earlobe clefts, congenital defects are usually associated with tissue loss, thereby complicating surgical repair. The authors present the case of a 22-year-old female with a triple-lobe type of congenital cleft earlobe and discuss their technique for repair.
Reconstruction of Wegener Granulomatosis Nose Deformity Using Fascia Lata Graft
Authors: Lasso Jose M. , La Cruz Esther Deleyto 
Published: October 2018

Abstract
Wegener granulomatosis (WG) is a necrotizing vasculitis that involves the upper respiratory tract, the lungs, and the kidneys. It also causes deformities of the nose in practically all patients, altering the cartilaginous and bony structure as well as the inner lining of the nose.
The surgical repair of these nasal distortions is a challenge mainly due to the impairment of wound healing and graft take that is caused both by the disease itself and by the prolonged immunosuppressant treatment.
Many different reconstruction plans have been developed, using costal or calvarial bone grafts, cartilage grafts and local skin and mucosa flaps. Results have been diverse.
The authors present the case of a 56-year-old patient who suffered from WG and consulted for nasal sequelae. She initially underwent several failed attempts at reconstruction; finally, the authors performed a nasal repair using a double strip of fascia lata as a dorsal graft, with no complications and a good aesthetic result.
Fascia lata graft is a new and good option for nasal reconstruction in patients with WG because it is easily obtainable, it can be set in place through closed rhinoplasty and it can achieve good vascularization with low risk of resorption or disease reactivation.
Impact of Heart Transplantation on the Recovery of Peripheral and Respiratory Muscle Mass and Strength in Patients With Chronic Heart Failure
Authors: Fernandes Lenise C. B. C. , de Oliveira Italo M. , Fernandes Paula Frassinetti C. B. C. , de Souza Neto João David , Farias Maria do Socorro Q. , de Freitas Nilce A. , Magalhães Nasser C. , Bacal Fernando 
Published: October 2018

Background
To assess the impact of heart transplantation (HT) on the recovery of peripheral and respiratory muscle mass and strength in patients with congestive heart failure.

Methods
The study included 23 patients with an indication for HT (patients in the waiting list [WL] group). These patients were monitored for 1.5 to 3 years after HT; 8 died before 6 months of follow-up, 15 patients completed the early follow-up period of 6 months after HT (FU6m group), 4 died between 6 months and 3 years after HT, and 11 patients completed the late follow-up period 1.5 to 3 years after HT (FU1.5-3y group). Twenty-three healthy subjects were included in the control group. The study variables included inspiratory muscle strength, expressed as the maximum inspiratory pressure (MIP); expiratory muscle strength, expressed as the maximum expiratory pressure (MEP); peripheral muscle strength, expressed as bilateral handgrip strength (bHGS); and the cross-sectional area of the bilateral psoas major muscle (CSAbPm).

Results
The results showed a reduction in the CSAbPm (1238.9 ± 312.3 mm2), a reduction in the bHGS (27.0 ± 5.7 kg/f), a reduction in the MIP (60.2 ± 29.8 cmH2O), and a reduction in the MEP (75.2 ± 33.4 cmH2O) in patients in the WL group compared with the healthy controls. In the time series comparison, for patients in the WL, FU6m, and FU1.5-3y groups, increases were found in the CSAbPm (1305.4 vs 1458.1 vs 1431.3 mm2, respectively), bHGS (27.3 vs 30.2 vs 34.7 kg/f, respectively), MIP (59.5 vs 85.5 vs 90.9 cmH2O, respectively), and MEP (79.5 vs 93.2 vs 101.8 cmH2O, respectively) (P < 0.00).

Conclusions
Sarcopenia was observed in patients in the WL group. Patients recovered peripheral and respiratory muscle mass and strength at 3 years after HT.
Diverse Pathophysiological Processes Converge on Network Disruption in Mania
Authors: Lee Ivy , Nielsen Kathryn , Hall Mei-Hua , Öngür Dost , Keshavan Matcheri , Brady Roscoe 
Published: October 2018

AbstractBackgroundNeuroimaging of psychiatric disease is challenged by the difficulty of establishing the causal role of neuroimaging abnormalities. Lesions that cause mania present a unique opportunity to understand how brain network disruption may cause mania in both lesions and in bipolar disorder.MethodsA literature search revealed 23 case reports with imaged lesions that caused mania in patients without history of bipolar disorder. We traced these lesions and examined resting-state functional Magnetic Resonance Imaging (rsfMRI) connectivity to these lesions and control lesions to find networks that would be disrupted specifically by mania-causing lesions. The results were then used as regions-of-interest to examine rsfMRI connectivity in patients with bipolar disorder (n=16) who underwent imaging longitudinally across states of both mania and euthymia alongside a cohort of healthy participants scanned longitudinally. We then sought to replicate these results in independent cohorts of manic (n=26) and euthymic (n=21) participants with bipolar disorder.ResultsMania-inducing lesions overlap significantly in network connectivity. Mania-causing lesions selectively disrupt networks that include orbitofrontal cortex, dorsolateral prefrontal cortex, and temporal lobes. In bipolar disorder, the manic state was reflected in strong, significant, and specific disruption in network communication between these regions and regions implicated in bipolar pathophysiology: the amygdala and ventro-lateral prefrontal cortex.LimitationsThe was heterogeneity in the clinical characterization of mania causing lesions.ConclusionsLesions causing mania demonstrate shared and specific network disruptions. These disruptions are also observed in bipolar mania and suggest a convergence of multiple disorders on shared circuit dysfunction to cause mania.
An information thermodynamic approach quantifying MAPK-related signaling cascades by average entropy production rate
Authors: Tsuruyama Tatsuaki 
Published: October 2018

ABSTRACTInformation thermodynamics has recently greatly developed the application for analysis of biological phenomenon. During the signal transduction, entropy production from phosphorylation of signal molecule is produced at individual step production. Using this value, average entropy production rate (AEPR) is computable.In the current study, AEPR in each signal step was analyzed using experimental data from previously reported studies of the mitogen-activated protein kinases (MAPK) cascade. The result revealed that the differences of AEPR is smaller when using ligands, suggesting that AEPR is one of the attributes of the given cascade and useful for quantitative analysis. This consistency of AEPR suggests that the number of signal events is maximized, in other words, signaling efficiency is maximized. In conclusion, the current information theoretical approach provides not only a quantitative means for comparison of responses to a specified extracellular stimulation, but also a method for evaluation of active cascades.SynopsisA variety of methods for quantifying intracellular signal transduction have been proposed. Herein, a novel method of quantification by integrated analysis consisting of kinetics, non-equilibrium thermodynamics, fluctuation theorem and graph theory was attempted.Signal transduction can be computed by entropy production amount from the fluctuation in the phosphorylation reaction of signaling molecules.By Bayesian analysis of the entropy production rates of individual steps, they are consistent through the signal cascade.