bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pork Belly: A Simulation Training Model for Intramuscular Perforator Dissection
Authors: Pafitanis Georgios , Veljanoski Damjan , Ghanem Ali M. , Myers Simon 
Published: February 2018

Background:
Free tissue transfer has evolved from muscle flaps to fasciocutaneous flaps. Dissection of the intramuscular course of feeding vessels is technically challenging. Simulation-based microsurgery skills acquisition is moving toward nonliving training models. Living porcine model or human cadavers are currently cost-ineffective methods for the early learning curve in teaching intramuscular dissection. The aim of this study was to validate an inexpensive ex vivo porcine model simulating harvest of the deep inferior epigastric artery perforator (DIEAP) flap, specifically including perforator intramuscular dissection.

Methods:
An initial needs analysis and anatomical dissections (characteristics of vascular anatomy) established the necessity and surgical design (step-by-step) of the ex vivo DIEAP flap harvesting model. A pilot study utilizing objective assessment methodology (time to complete flap raising and hand motion analysis) demonstrated the surgeons’ performance. A detailed feedback questionnaire was used to assess the participants’ perception of this model.

Results:
Fifty-seven participants completed the initial needs analysis. Fifteen pork bellies were dissected and the vascular anatomical characteristics of the inferior epigastric vessels are presented. Eight surgeons performed the step-by-step flap design demonstrating construct validity in flap raising and intramuscular dissection. All surgeons completed the ex vivo DIEAP harvesting and they recommend this model as the first step in training for intramuscular dissection.

Conclusions:
The pork belly simulation is a cheap, easy, ethically considerate, and high-fidelity simulation model for intramuscular dissection for the DIEAP free flap. This study guides future validation trials to explore if the absence of physiological blood flow affects skills acquisition in the intramuscular dissection learning curve. The pork belly could be the first step in perforators dissection before progressing to the in vivo porcine model.
Expression and Localization of Cathepsins B, D, and G in Dupuytren’s Disease
Authors: Tan Kirin , Brasch Helen D. , van Schaijik Bede , Armstrong James R. , Marsh Reginald W. , Davis Paul F. , Tan Swee T. , Itinteang Tinte 
Published: February 2018

Background:
The pathogenesis of Dupuytren’s disease (DD) remains unclear. An embryonic stem cell (ESC)–like population in the endothelium of the microvessels around tissues that expresses components of the renin-angiotensin system (RAS) has been reported. This study investigated if this primitive population expresses cathepsins B, D, and G, that contribute to RAS bypass loops.

Methods:
3,3-Diaminobenzidine immunohistochemical (IHC) staining for cathepsins B, D, and G was performed on sections of formalin-fixed paraffin-embedded DD cords (n = 10) and nodules (n = 10). Immunofluorescence IHC staining was utilized to demonstrate co-expression of these cathepsins with ESC markers. Protein and gene expression of these cathepsins was investigated in snap-frozen DD cords (n = 3) and nodules (n = 3) by Western blotting and NanoString analysis, respectively. Enzymatic activity of these cathepsins was investigated by enzymatic activity assays.

Results:
3,3-Diaminobenzidine IHC staining demonstrated expression of cathepsins B, D, and G in DD cords and nodules. Gene expression of cathepsins B, D, and G was confirmed by NanoString analysis. Western blotting confirmed expression of cathepsins B and D, but not cathepsin G. Immunofluorescent IHC staining demonstrated high abundance of cathepsins B and D on the OCT4+/angiotensin converting enzyme+ endothelium and the smooth muscle layer of the microvessels. Cathepsin G was localized to trypase+ cells within the stroma in DD cords and nodules with limited expression on the microvessels. Enzyme activity assays demonstrated functional activity of cathepsins B and D.

Conclusions:
Cathepsins B, D, and G were expressed in the DD tissues, with cathepsins B and D localized to the primitive population in the endothelium of the microvessels, whereas cathepsin G was localized to phenotypic mast cells, suggesting the presence of bypass loops for the RAS.
Immune Checkpoint Inhibition in Hodgkin Lymphoma
Authors: Moy Ryan H. , Younes Anas 
Published: February 2018

AbstractIntricate systems of checkpoints such as the programmed cell death protein 1 (PD‐1)/programmed death ligand 1 (PD‐L1) axis regulate adaptive immune responses to protect against tissue damage. However, diverse cancers can exploit these pathways to evade or suppress antitumor immunity, leading to tumor progression. Correspondingly, immune checkpoint inhibitors that block PD‐1/PD‐L1 signaling have shown marked therapeutic efficacy in certain cancers, such as Hodgkin lymphoma. Reed‐Sternberg cells, the hallmark cells of Hodgkin lymphoma, commonly overexpress PD‐1 ligands, and recent clinical trials have demonstrated impressive response rates with the PD‐1 inhibitors nivolumab and pembrolizumab in relapsed or refractory Hodgkin lymphoma, leading to their FDA approval in this setting. Current efforts are underway to improve clinical responses by incorporating PD‐1 inhibitors into earlier treatment regimens and identifying therapeutic agents that synergize with PD‐1 inhibitors. This review summarizes our understanding of the PD‐1/PD‐L1 axis in Hodgkin lymphoma, recent clinical studies of anti‐PD‐1 monotherapy and promising combination immunotherapy in the pipeline.
A Program's Analysis of Communication Methods With Clinical Preceptors
Authors: Hudak Nicholas M. , Stouder April , Everett Christine M. 
Published: February 2018

Purpose
Preceptors value communication with physician assistant (PA) educational programs. This study describes preceptors' perspectives about one PA program's established and new communication strategies to promote preceptor development and retention.

Methods
An electronic survey of preceptors was conducted in December 2014. Quantitative and qualitative data were analyzed using descriptive statistics.

Results
Eighty-eight of 209 preceptors completed the survey (42% response rate). Preceptors reported satisfaction with communication frequency and quality. The most preferred topics were preceptor benefits, teaching strategies, feedback about students' performance, and program policy updates. Many preceptors reported not receiving communications sent by mail. A majority of preceptors preferred site visits at least once per year and in person.

Conclusions
Understanding preceptors' preferred topics helped the study program increase its emphasis on those topics. Knowledge that many preceptors do not receive mailed communications has prompted the program to use electronic communication for all communication types. The results reinforced the program's approach to site visits.
Noncognitive Attributes in Physician Assistant Education
Authors: Brenneman Anthony E. , Goldgar Constance , Hills Karen J. , Snyder Jennifer H. , VanderMeulen Stephane P. , Lane Steven 
Published: February 2018

Abstract
Physician assistant (PA) admissions processes have typically given more weight to cognitive attributes than to noncognitive ones, both because a high level of cognitive ability is needed for a career in medicine and because cognitive factors are easier to measure. However, there is a growing consensus across the health professions that noncognitive attributes such as emotional intelligence, empathy, and professionalism are important for success in clinical practice and optimal care of patients. There is also some evidence that a move toward more holistic admissions practices, including evaluation of noncognitive attributes, can have a positive effect on diversity. The need for these noncognitive attributes in clinicians is being reinforced by changes in the US health care system, including shifting patient demographics and a growing emphasis on team-based care and patient satisfaction, and the need for clinicians to help patients interpret complex medical information. The 2016 Physician Assistant Education Association Stakeholder Summit revealed certain behavioral and affective qualities that employers of PAs value and sometimes find lacking in new graduates. Although there are still gaps in the evidence base, some tools and technologies currently exist to more accurately measure noncognitive variables. We propose some possible strategies and tools that PA programs can use to formalize the way they select for noncognitive attributes. Since PA programs have, on average, only 27 months to educate students, programs may need to focus more resources on selecting for these attributes than teaching them.
Continuing Dermatology Education for Rural Physician Assistants in Ghana: An Assessment of Needs and Effectiveness
Authors: Truong Amanda , Cobb Nadia M. , Hawkes Jason E. , Adjase Emmanuel T. , Goldgar David E. , Powell Douglas L. , Lewis Bethany K. H. 
Published: February 2018

Purpose
To assess the effectiveness of lectures for continuing medical education (CME) in dermatology in a global health setting and to determine provider and patient demographics of physician assistants (PAs) practicing in rural Ghana.

Methods
Physician assistants from Ghana who attended dermatology lectures at the International Seminar for Physician Assistants in 2011 or 2014 were included in this study. Surveys were administered to participants to determine dermatology resource availability, commonly encountered skin diseases, and management practices. Quizzes were administered before and after CME dermatology lectures to assess short-term retention of lecture material.

Results
In all, 353 PAs participated in this study. Physician assistants reported seeing an average of 55 patients per day. The most commonly seen skin diseases were infections, with antifungals and antibiotics being the most commonly prescribed medications. Dermatology-related complaints represented 9.5% of total clinic visits. Among practicing PAs, 23.2% reported having internet access. A total of 332 PAs completed the quizzes, and a statistically significant increase in test scores was noted in postlecture quizzes.

Conclusions
This study reinforces the importance of dermatology education for PAs practicing in rural areas of Ghana and lends insight to critical topics for dermatology curriculum development. In addition, the increase in test scores after CME sessions suggests that lectures are an effective tool for short-term retention of dermatology-related topics. Our study indicates that as the need for health workers increases globally and a paradigm shift away from the traditional physician model of care occurs, dermatology training of PAs is not only important but also achievable.
The Impact of Education About Cervical Cancer and Human Papillomavirus on Women's Healthy Lifestyle Behaviors and Beliefs
Authors: Koç Zeliha , Kurtoğlu Özdeş Emel , Topatan Serap , Çinarli Tuğba , Şener Asuman , Danaci Esra , Palazoğlu Cansu Atmaca 
Published: February 2018

Background
Early detection of cervical cancer improves the chances of successful treatment.

Objective
The aim of this study was to determine the effect of education about cervical cancer and human papillomavirus on the healthy lifestyle, behavior, and beliefs of Turkish women who were without cancer, using the PRECEDE education model.

Methods
This qualitative and quantitative study was conducted as a prospective, randomized, 2-group (intervention and control) trial at a community training center in north Turkey. A total of 156 Turkish women who were without cancer participated in this study. The semistructured interview form, the SF-36 Health Status Questionnaire, the Health Belief Model Scale for Cervical Cancer and Pap Smear Test, and the Healthy Lifestyle Behavior Scale II were used.

Results
The subdimension scores of the Health Belief Model Scale for Cervical Cancer and Pap Smear Test were found to be higher among women in the study group (cervical cancer seriousness, P = .001; health motivation, P = .001) as compared with the control group after the education program. The SF-36 Health Status Questionnaire domain scores for physical role limitations, mental role limitations, and general health perceptions increased in the study group after the intervention.

Conclusion
The posteducation health motivation of women in the study group was improved, the women's perceptions of obstacles to Papanicolaou testing decreased, and through increased knowledge and awareness, the rate of Papanicolaou testing increased.

Implications for Practice
Educational programs aimed at motivating women to increase their awareness of cervical cancer, preventing cervical cancer, and having Papanicolaou testing are necessary and beneficial in this sample.
Reevaluation of Mandibular Morphometry According to Age, Gender, and Side
Authors: Direk Filiz , Uysal Ismihan Ilknur , Kivrak Ali Sami , Unver Dogan Nadire , Fazliogullari Zeliha , Karabulut Ahmet Kagan 
Published: February 2018

Aim:
This study aims to reevaluation the linear and angular measurements of mandibles with multidetector computed tomography (MDCT) that is a new method and used frequently in recent years.

Materials and Methods:
The archived MDCT images of 100 adult patients (age range, 15–74 years) without mandibular operation and trauma history were evaluated retrospectively. Mandibular ramus heights, maximal mandibular length, mandibular symphysis height, mandibular angles, and mandibular foramen distance measurements were performed on MDCT images. All measurement parameters were analyzed by gender, age groups, and sides.

Results:
Mandibular linear length measurements were higher in males than in females (P < 0.05). Only mandibular symphysis height was statistically significantly different in age groups (P < 0.05). The Angle 1 (gonial angle) was found to be significantly higher in females (P < 0.05). The Angle 3 (right condyle–gnathion–left condyle angle) was observed to be significantly higher in the 60+ age group (P < 0.05). The 3 of the mandibular foramen measurements (distance from the front edge, distance to gonion, and height of lingula) were found to be higher in males than in females (P < 0.05). There were no significant differences according to age groups in these measurements. The lengths of the mandibular canals were higher in males (44.72 mm) than in females (41.68 mm). There was no statistically significant difference was found between gender, age groups, and sides of mandibular canal length.

Conclusion:
The MDCT was found to be a reliable method for the detection of mandibular morphometry when compared with the results of other radiographic images studies.
The Natural History of Cranial Morphology in Sagittal Craniosynostosis
Authors: Al-Shaqsi Sultan , Zellner Elizabeth , Ching Jessica , Forrest Chirstopher , Phillips John 
Published: February 2018

Background:
Children with craniosynostosis have abnormal head shapes. Parents frequently ask whether the abnormal head shape will get worse with time. However, there is no information in the literature to indicate whether the deformity gets worse.

Objective:
To assess the progression of cranial morphology in children with unoperated craniosynostosis.

Methods:
A retrospective review of all children with unoperated sagittal craniosynostosis who were referred to the Craniofacial Clinic at the Hospital for Sick Children (SickKids) was conducted. Serial 3D photographs of patients with sagittal craniosynostosis who have not undergone surgical correction were included in the study. There were 14 cases included, with 9 males and 5 females. Ages at time of scans ranged from 3 months to 5 years of age (mean = 28.3 months, SD = 28.2 months). Nine patients had the first scan at age of <12 months. Multiple scans for each patient were sized for volume over time and compared with a normative skull database.

Results:
The results of measuring skull volume changes over time revealed no significant difference from infants without craniosynostosis. Furthermore, there cranial index was stable over time in patients with craniosynostosis.

Conclusion:
The severity of craniosynostosis does not worsen or improve with time. Parents having difficulty in deciding to proceed with surgical correction of craniosynostosis can be reassured that the skull deformity will remain stable with the growth of their child if they decide not to proceed with surgical correction.
Single Session Facial Lipostructure by Using Autologous Fat Mixed With Platelet-Rich Fibrin Injected by Using Facial Autologous Muscular Injection Technique
Authors: Al-Chalabi Najwa Jamil Abdulrazzak , Al-Quisi Ahmed Fadhil , Abdul Lateef Thair 
Published: February 2018

Aim:
This study was designed to evaluate the role of single session autologous facial fat grafting in correcting facial asymmetries after mixing it with platelet-rich fibrin (PRF) and injecting them into rich vascular facial muscular plane.

Materials and Methods:
Fifteen patients (12 females and 3 males) with age ranging from 18 years to 40 years were included in this study and followed up during 6 months, all the patients were treated in the Al-Shaheed Ghazi Al-Hariri for specialized surgeries hospital (Medical City, Baghdad, Iraq).
Autologous fat with PRF injected in facial muscular plane was the standardized method in the treatment of acquired and congenital facial defects.
Results were evaluated by 2 plastic surgeons using visual analogue scale.
Interexaminer and intraexaminer calibration of the visual analogue scale were carried out by using paired t test.

Results:
This prospective study showed that the majority of patients (73.3%) needed only a single session for creating a noticeable improvement in facial volumes and contours.

Conclusions:
Mixing fat with PRF and injecting them by using facial autologous muscular injection technique offers better graft survival by utilizing the growth factors and cytokines in PRF clot together with rich vascular plexus in the muscular layer consequently.
Protective Effects of the Complement Inhibitor Compstatin CP40 in Hemorrhagic Shock
Authors: van Griensven Martijn , Ricklin Daniel , Denk Stephanie , Halbgebauer Rebecca , Braun Christian K. , Schultze Anke , Hönes Felix , Koutsogiannaki Sofia , Primikyri Alexandra , Reis Edimara , Messerer David , Hafner Sebastian , Radermacher Peter , Biglarnia Ali-Reza , Resuello Ranillo R.G. , Tuplano Joel V. , Mayer Benjamin , Nilsson Kristina , Nilsson Bo , Lambris John D. , Huber-Lang Markus 
Published: February 2018

ABSTRACT
Trauma-induced hemorrhagic shock (HS) plays a decisive role in the development of immune, coagulation, and organ dysfunction often resulting in a poor clinical outcome. Imbalanced complement activation is intricately associated with the molecular danger response and organ damage after HS. Thus, inhibition of the central complement component C3 as turnstile of both inflammation and coagulation is hypothesized as a rational strategy to improve the clinical course after HS.
Applying intensive care conditions, anaesthetized, monitored, and protectively ventilated nonhuman primates (NHP; cynomolgus monkeys) received a pressure-controlled severe HS (60 min at mean arterial pressure 30 mmHg) with subsequent volume resuscitation. Thirty minutes after HS, animals were randomly treated with either an analog of the C3 inhibitor compstatin (i.e., Cp40) in saline (n = 4) or with saline alone (n = 4). The observation period lasted 300 min after induction of HS.
We observed improved kidney function in compstatin Cp40-treated animals after HS as determined by improved urine output, reduced damage markers and a tendency of less histopathological signs of acute kidney injury. Sham-treated animals revealed classical signs of mucosal edema, especially in the ileum and colon reflected by worsened microscopic intestinal injury scores. In contrast, Cp40-treated HS animals exhibited only minor signs of organ edema and significantly less intestinal damage. Furthermore, early systemic inflammation and coagulation dysfunction were both ameliorated by Cp40.
The data suggest that therapeutic inhibition of C3 is capable to significantly improve immune, coagulation, and organ function and to preserve organ-barrier integrity early after traumatic HS. C3-targeted complement inhibition may therefore reflect a promising therapeutic strategy in fighting fatal consequences of HS.
The Role of Personality in a Regular Cognitive Monitoring Program
Authors: Sadeq Nasreen A. , Valdes Elise G. , Harrison Bush Aryn L. , Andel Ross 
Published: February 2018

Objectives:
This study examines the role of personality in cognitive performance, adherence, and satisfaction with regular cognitive self-monitoring.

Materials and Methods:
One hundred fifty-seven cognitively healthy older adults, age 55+, completed the 44-item Big-Five Inventory and were subsequently engaged in online monthly cognitive monitoring using the Cogstate Brief Battery for up to 35 months (M=14 mo, SD=7 mo). The test measures speed and accuracy in reaction time, visual learning, and working memory tasks.

Results:
Neuroticism, although not related to cognitive performance overall (P>0.05), was related to a greater increase in accuracy (estimate=0.07, P=0.04) and speed (estimate=−0.09, P=0.03) on One Card Learning. Greater conscientiousness was related to faster overall speed on Detection (estimate=−1.62, P=0.02) and a significant rate of improvement in speed on One Card Learning (estimate=−0.10, P<0.03). No differences in satisfaction or adherence to monthly monitoring as a function of neuroticism or conscientiousness were observed.

Conclusions:
Participants volunteering for regular cognitive monitoring may be quite uniform in terms of personality traits, with personality traits playing a relatively minor role in adherence and satisfaction. The more neurotic may exhibit better accuracy and improve in speed with time, whereas the more conscientious may perform faster overall and improve in speed on some tasks, but the effects appear small.