bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postmortem Vitreous Humor Magnesium Does Not Elevate in Salt Water Drowning When the Immersion Time Is Less Than an Hour
Authors: Tse Rexson , Kuo Ta-Chen , Kesha Kilak , Garland Jack , Garland Sarah , Anne Sravan , Elstub Hannah , Cala Allan 
Published: October 2017

Background
Elevation in postmortem vitreous humor sodium and chloride (PMVSC) in salt water drowning (SWD) when the immersion time is less than 1 hour (SWD1) is hypothesized to result from electrolyte changes in blood from salt water inhalation/ingestion during drowning. After approximately 1 hour after death, electrolytes may diffuse into the vitreous humor via the eye coverings. Another abundant element in salt water is magnesium, which is approximately 50 times higher in concentration than the blood and vitreous humor magnesium levels. Magnesium is able to diffuse across the eye coverings but not as easily through the blood-ocular barrier. With these properties, we hypothesize that postmortem vitreous magnesium (PMVM) would not be elevated in SWD1 but become elevated in SWD with immersion times greater than 1 hour (SWD>1).

Aim
The aim of this article was to investigate the differences in PMVM and PMVSC between nonimmersion deaths, SWD1, and SWD>1.

Methods
This is a 1-year retrospective study comparing PMVM and PMVSC in nonimmersion deaths, SWD1, and SWD>1.

Results
Postmortem vitreous magnesium is significantly higher in SWD>1 than SWD1 and nonimmersion deaths, with no significant difference between SWD1 and nonimmersion deaths. Postmortem vitreous humor sodium chloride is statistically higher in SWD1 and SWD>1 than nonimmersion deaths.

Conclusions
As a conclusion, PMVSC elevates and PMVM does not elevate in SWD1.
Towards a neurobiological understanding of pain in chronic pancreatitis: mechanisms and implications for treatment
Authors: Olesen Søren S. , Krauss Theresa , Demir Ihsan Ekin , Wilder-Smith Oliver H. , Ceyhan Güralp O. , Pasricha Pankaj J. , Drewes Asbjørn M. 
Published: October 2017

Abstract

Introduction:
Chronic pancreatitis (CP) is a disease characterized by inflammation of the pancreas resulting in replacement of the normal functioning parenchyma by fibrotic connective tissue. This process leads to progressively impairment of exocrine and endocrine function and many patients develop a chronic pain syndrome.

Objectives:
We aimed to characterize the neurobiological signature of pain associated with CP and to discuss its implications for treatment strategies.

Methods:
Relevant basic and clinical articles were selected for review following an extensive search of the literature.

Results:
Pathophysiological changes in the peripheral (pancreatic gland) and central nervous system characterize the pain syndrome associated with CP; involved mechanisms can be broken down to 3 main branches: (1) peripheral sensitization, (2) pancreatic neuropathy, and (3) neuroplastic changes in the central pain pathways. Disease flares (recurrent pancreatitis) may accelerate the pathophysiological process and further sensitize the pain system, which ultimately results in an autonomous and self-perpetuating pain state that may become independent of the peripheral nociceptive drive. These findings share many similarities with those observed in neuropathic pain disorders and have important implications for treatment; adjuvant analgesics are effective in a subset of patients, and neuromodulation and neuropsychological interventions may prove useful in the future.

Conclusion:
Chronic pancreatitis is associated with abnormal processing of pain at the peripheral and central level of the pain system. This neurobiological understanding of pain has important clinical implications for treatment and prevention of pain chronification.
Three-Dimensional Computer-Assisted Two-Layer Elastic Models of the Face
Authors: Ueda Koichi , Shigemura Yuka , Otsuki Yuki , Fuse Asuka , Mitsuno Daisuke 
Published: October 2017

Summary:
To make three-dimensional computer-assisted elastic models for the face, we decided on five requirements: (1) an elastic texture like skin and subcutaneous tissue; (2) the ability to take pen marking for incisions; (3) the ability to be cut with a surgical knife; (4) the ability to keep stitches in place for a long time; and (5) a layered structure. After testing many elastic solvents, we have made realistic three-dimensional computer-assisted two-layer elastic models of the face and cleft lip from the computed tomographic and magnetic resonance imaging stereolithographic data. The surface layer is made of polyurethane and the inner layer is silicone. Using this elastic model, we taught residents and young doctors how to make several typical local flaps and to perform cheiloplasty. They could experience realistic simulated surgery and understand three-dimensional movement of the flaps.
Managing Alar Flare in Rhinoplasty
Authors: Rohrich Rod J. , Malafa Menyoli M. , Ahmad Jamil , Basci Deniz S. 
Published: October 2017

Summary:Alar flare is a common feature that contributes to the width of the lower third of the nose. In the right patient, alar flare reduction can improve nasal harmony and facial aesthetic balance; however, it is also difficult to correct if conducted inappropriately or overzealously. The unique anatomy and diverse morphologies of the alar lobule, and the dynamic relationship between flare and changes in tip projection, must be considered. The authors provide guidelines for flare reduction: when it is appropriate and how to tailor the excision pattern to safely and effectively refine nasal width. Alar flare is classified into three types according to alar rim shape on basal view analysis. By designing the excision pattern based on specific flare type, the lower third of the nose is narrowed without creating an operated appearance.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, V.
The Effect of Processing Technique on Fat Graft Survival
Authors: Canizares Orlando , Thomson Jennifer E. , Allen Robert J. , Davidson Edward H. , Tutela John P. , Saadeh Pierre B. , Warren Stephen M. , Hazen Alexes 
Published: October 2017

Background:
Wide variations in fat graft survival have been reported. The authors hypothesize that treating the adipose tissue on Telfa gauze creates a processed lipoaspirate with a more functional adipokine profile that improves fat graft survival.

Methods:
Suction-assisted lipoaspirate was harvested from humans and was either processed by centrifugation, rolled on Telfa gauze, or left unprocessed. Progenitor cell populations were quantified and characterized by flow cytometry. Glycerol-3-phosphate dehydrogenase assay was used to measure the functional adipocytes. The lipoaspirates were grafted into (n = 45) wild-type mice and harvested to assess fat graft persistence. Vascular endothelial growth factor and platelet-derived growth factor-BB secretions were measured by enzyme-linked immunosorbent assay technique.

Results:
Centrifuged lipoaspirate had a greater number of progenitor cells per gram of tissue than Telfa-processed and unprocessed lipoaspirate. However, Telfa-processed lipoaspirate had a greater number of functional adipocytes (0.104 U/ml) than centrifuged (0.080 U/ml) and unprocessed lipoaspirate (0.083 U/ml) on glycerol-3-phosphate dehydrogenase assay (p < 0.05). After 10 weeks of grafting, it had greater fat graft persistence (70.9 ± 6.2 percent) than centrifuged (56.7 ± 5.5 percent) and unprocessed lipoaspirate (42.2 ± 2.7 percent) (p < 0.05). It also maintained a greater secretion of vascular endothelial growth factor and platelet-derived growth factor-BB at weeks 1 and 2 than centrifuged and unprocessed lipoaspirate. Furthermore, CD31 staining demonstrated an increase in vascular density of the Telfa-processed lipoaspirate at week 2 compared with the centrifuged lipoaspirate (37 ± 1 percent and 14 ± 4 percent per high-power field; p < 0.05).

Conclusions:
Lipoaspirate processing technique has a significant impact on fat graft survival rate. Increasing the number of functional adipocytes by processing the fat on Telfa gauze may augment the secretion of angiogenic and mitogenic adipokines within the graft, thereby improving its survivability.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Optimizing Somatostatin Receptor Imaging in Patients With Neuroendocrine Tumors
Authors: Kunikowska Jolanta , Lewington Valerie , Krolicki Leszek 
Published: October 2017

Aim
The presence of somatostatin receptors in neuroendocrine tumors allows visualization with radiolabeled somatostatin analogs in vivo. The aim of this prospective study was to compare somatostatin receptor imaging using 99mTc-HYNICTOC with 68Ga-DOTATATE (DOTA-DPhe1,Tyr3-octreotate) with respect to sensitivity, specificity, and impact upon clinical decision making.

Methods
Sixty-eight patients (30 men, 38 women; aged 56.4 ± 13.5 years) with disseminated, histologically proven neuroendocrine tumor were enrolled. All patients with previous 99mTc-HYNICTOC (Tektrotyd; POLATOM, Otwock, Poland) underwent 68Ga-DOTATATE PET/CT. Both examinations were compared on a per-patient and per-lesion basis.

Results
The sensitivity, specificity, positive and negative predictive values, and accuracy of 68Ga-DOTATATE and 99mTc-HYNICTOC were 100% versus 82%, 85% versus 69%, 97% versus 92%, 100% versus 47%, and 97% versus 79%, respectively.
Concordant results were observed in 58 patients (49/68 positive on both 68Ga-DOTATATE and 99mTc-HYNICTOC and 9/68 negative in both examinations). Ten of 68 patients had 68Ga-DOTATATE–positive, 99mTc-HYNICTOC–negative studies. Two hundred eighteen lesions were detected using 99mTc-HYNICTOC, compared with 546 lesions using 68Ga-DOTATATE (P < 0.0001). 68Ga-DOTATATE detected a higher number of lesions in bone and lymph nodes, liver, intestine, and pancreas and had a higher sensitivity for subcentimeter abnormalities than 99mTc-HYNICTOC. 68Ga-DOTATATE led to management change in 23 (34%) of 68 patients.

Conclusions

68Ga-DOTATATE has a higher sensitivity than 99mTc-HYNICTOC for the detection of neuroendocrine tumors. 68Ga-DOTATATE proved superior to 99mTc-HYNICTOC in detecting subcentimeter skeletal, lymph node, and liver metastases. 68Ga-DOTATATE PET/CT changed clinical decision making in one third of patients.
68Ga-DOTATATE Uptake in a Soft Tissue Metastasis From Clear Cell Renal Cell Cancer
Authors: Vamadevan S. , Le K. , Shen L. , Stevanovic A. , Loh H. , Mansberg R. 
Published: October 2017

Abstract
A 64-year-old man with a history of metastatic clear cell renal cell cancer was referred for progress 68Ga-DOTATATE PET/CT imaging. 68Ga-DOTATATE PET/CT imaging demonstrated increased DOTATATE uptake (SUVmax 13.8) in the left thigh localized to a soft tissue lesion. Cytopathology of the resected lesion was in keeping with a clear cell renal cell cancer metastasis. This case illustrates that 68Ga-DOTATATE accumulation in a soft tissue lesion can be due to a clear cell renal cell cancer metastasis.
Improving the Clinical Skills Performance of Graduating Medical Students Using “WISE OnCall,” a Multimedia Educational Module
Authors: Szyld Demian , Uquillas Kristen , Green Brad R. , Yavner Steven D. , Song Hyuksoon , Nick Michael W. , Ng Grace M. , Pusic Martin V. , Riles Thomas S. , Kalet Adina 
Published: October 2017

Introduction
“Transitions to residency” programs are designed to maximize quality and safety of patient care, as medical students become residents. However, best instructional or readiness assessment practices are not yet established. We sought to study the impact of a screen-based interactive curriculum designed to prepare interns to address common clinical coverage issues (WISE OnCall) on the clinical skills demonstrated in simulation and hypothesize that performance would improve after completing the module.

Methods
Senior medical students were recruited to participate in this single group prestudy/poststudy. Students responded to a call from a standardized nurse (SN) and assessed a standardized patient (SP) with low urine output, interacted with a 45-minute WISE OnCall module on the assessment and management of oliguria, and then evaluated a different SP with low urine output of a different underlying cause. Standardized patients assessed clinical skills with a 37-item, behaviorally anchored checklist measuring clinical skills (intraclass correlation coefficient [ICC], 0.55–0.81). Standardized nurses rated care quality and safety and collaboration and interprofessional communication using a 33-item literature-based, anchored checklist (ICC, 0.47–0.52). Standardized patient and SN ratings of the same student performance were correlated (r, 0.37–0.62; P < 0.01). Physicians assessed clinical reasoning quality based on the students’ patient encounter note (ICC, 0.55–0.68), ratings that did not correlate with SP and SN ratings. We compared pre-post clinical skills performance and clinical reasoning. Fifty-two medical students (31%) completed this institutional review board –approved study.

Results
Performance as measured by the SPs, SNs, and the postencounter note all showed improvement with mostly moderate to large effect sizes (range of Cohen’s d, 0.30–1.88; P < 0.05) after completion of the online module. Unexpectedly, professionalism as rated by the SP was poorer after the module (Cohen’s d, −0.93; P = 0.000).

Discussion
A brief computer-based educational intervention significantly improved graduating medical students' clinical skills needed to be ready for residency.
Surgical Simulation Training Reduces Intraoperative Cataract Surgery Complications Among Residents
Authors: Staropoli Patrick C. , Gregori Ninel Z. , Junk Anna K. , Galor Anat , Goldhardt Raquel , Goldhagen Brian E. , Shi Wei , Feuer William 
Published: October 2017

Introduction
This retrospective consecutive case series examined whether training on a surgical simulator reduces intraoperative complication rates among novice ophthalmology residents learning cataract surgery.

Methods
Beginning July 2014, training on the Eyesi simulator became mandatory for novice postgraduate year 3 ophthalmology residents before live cataract surgery at our institution. Complication rates of the 11 simulator-trained residents (study group) were compared with their immediate 11 simulator-naive predecessors (comparison group). Only straightforward cataract cases (according to standardized preoperative criteria) where postgraduate year 3 residents served as the primary surgeon were included. Complication data were obtained from Morbidity and Mortality records and compared using Fisher exact test. A survey was administered to the residents to gauge the perceived utility of simulation training.

Results
The simulator-trained group (n = 501 cataract cases) and the simulator-naive comparison group (n = 454 cases) were analyzed. The complication rate in the simulator group was 2.4% compared with 5.1% in the comparison group (P = 0.037, Fisher exact test). Both the mean posterior capsule tear rate and vitreous prolapse rate in the simulator group were 2.2% compared with 4.8% in the comparison group (P = 0.032, Fisher exact test). The survey had a response rate of 100% (11/11), and 91% (10/11) of respondents felt that the training was “extremely worthwhile” and should be mandatory.

Conclusions
The addition of surgical simulation training was associated with a significantly reduced rate of complications, including posterior capsule tears and vitreous prolapse, among novice postgraduate year 3 residents. There is a perceived utility among residents to incorporate virtual simulation into surgical training.
Considering Face, Rights, and Goals
Authors: Loo May Eng , Krishnasamy Charmaine , Lim Wee Shiong 
Published: October 2017

Summary Statement
The rapport between facilitators and learners contributes to a conducive learning environment during simulation debriefing, but a theory to guide rapport management (RM) is lacking. The RM model is a potentially relevant conceptual framework because it describes three interrelated components of rapport—face, rights, and goals—which, when threatened, affect the rapport between interactants. This critical review explores how studies in the simulation debriefing literature describing postevent facilitator-guided debriefing approaches can be viewed through the lens of the RM model. All 34 identified studies alluded to at least one component of rapport, with less than half alluding to all three. There is preliminary evidence that the management of all three components of rapport during debriefing may contribute to improving short-term learning outcomes. Future studies could explore how the RM model can be used to guide debriefing approaches in various contexts and clarify why or how these approaches work.
Successful Use of Escitalopram for the Treatment of Visual Hallucinations in Patients With Parkinson Disease
Authors: Bergman Joseph , Lerner Paul P. , Sokolik Shmuel , Lerner Vladimir , Kreinin Anatoly , Miodownik Chanoch 
Published: October 2017

Introduction
Patients with Parkinson disease (PD) frequently experience visual hallucinations (VH). Visual hallucinations are most often viewed as an adverse effect of antiparkinsonian treatment. Possible treatments for this disturbance include a reduction of antiparkinsonian medications, adding atypical antipsychotics, or cholinesterase inhibitors. Some studies demonstrated that selective serotonin reuptake inhibitors may be an optional treatment for patients experiencing psychosis or agitation in dementia. Currently, there is no standard recommended treatment for VH in patients with PD. We present here our clinical experience with escitalopram (selective serotonin reuptake inhibitor) for treating this disturbance.

Methods
Thirteen patients with PD (8 men and 5 women; age range 67–83 years) experiencing VH were openly treated with escitalopram 10 or 15 mg/d as add-on. Efficacy was assessed at baseline, then after 4 and 8 weeks of treatment using Clinical Global Impression-Severity and Clinical Global Impression-Improvement.

Results
At the end of the 4th week of treatment, of 13 patients, 11 subjects demonstrated improvement, and in only 2 patients were there no changes in their condition. After an additional 4 weeks, 2 of the responders showed very significant improvement, 6 demonstrated much improvement, and 3 patients demonstrated minimal improvement. Only 1 patient showed no change in his condition. One additional patient stopped taking escitalopram after 5 weeks because of an absence of improvement in his state.

Conclusions
Escitalopram was well tolerated as treatment of VH in PD patients. This medication could be a promising optional therapy for this disturbance; however, further randomized controlled and bigger studies are necessary.
Refractory Giant Cell Arteritis Complicated by Vision Loss From Optic Atrophy and Maculopathy Associated With Pachymeningitis
Authors: Uribe Jorge A. , Aggarwal Ishita , Witthayaweerasak Juthamat , Liao Y. Joyce , Berry Gerald J. , Sab Umesh K. , Weyand Cornelia M. 
Published: October 2017

Background:
We describe a 75-year-old woman who experienced vision loss in her left eye due to biopsy-proven giant cell arteritis (GCA). She subsequently developed pachymeningitis causing refractory headaches and bilateral optic neuropathy and maculopathy.

Methods:
Case report with literature review.

Results:
Eighteen months after the initial diagnosis of GCA, imaging studies in our patient demonstrated pachymeningeal enhancement, and meningeal biopsy confirmed lymphoplasmacytic tissue infiltrates with low frequencies of IgG4+ plasma cells. Laboratory investigation revealed the presence of 3 antiretinal antibodies and antimyeloperoxidase antibodies, consistent with autoimmune retinopathy. Treatment with B-cell–depleting anti-CD20 antibodies suppressed meningeal inflammation and prevented further vision loss.

Conclusions:
This case illustrates that bilateral vision loss and chronic headaches in patients with GCA may result from retina-directed autoimmunity and pachymeningitis.
How the human brain introspects about one’s own episodes of cognitive control
Authors: Soto David , Theodoraki Mona , Paz-Alonso Pedro M. 
Published: October 2017

AbstractMetacognition refers to our capacity to reflect upon our experiences, thoughts and actions. Metacognition processes are linked to cognitive control functions that allow keeping our actions on-task. But it is unclear how the human brain builds an internal model of one’s cognition and behaviour. We conducted 2 fMRI experiments in which brain activity was recorded ‘online’ as participants engaged in a memory-guided search task and then later ‘offline’ when participants introspected about their prior experience and cognitive states during performance. In Experiment 1 the memory cues were task-relevant while in Experiment 2 they were irrelevant. Across Experiments, the patterns of brain activity, including frontoparietal regions, were similar during on-task and introspection states. However the connectivity profile amongst frontoparietal areas was distint during introspection and modulated by the relevance of the memory cues. Introspection was also characterized by increased temporal correlation between the default-mode network (DMN), frontoparietal and dorsal attention networks and visual cortex. We suggest that memories of one’s own experience during task performance are encoded in large-scale patterns of brain activity and that coupling between DMN and frontoparietal control networks may be crucial to build an internal model of one’s behavioural performance.
Membrane Diffusion Occurs by a Continuous-Time Random Walk Sustained by Vesicular Trafficking
Authors: Goiko Maria , de Bruyn John R. , Heit Bryan 
Published: October 2017

AbstractDiffusion in cellular membranes is regulated by processes which occur over a range of spatial and temporal scales. These processes include membrane fluidity, inter-protein and inter-lipid interactions, interactions with membrane microdomains, interactions with the underlying cytoskeleton, and cellular processes which result in net membrane movement. The complex, non-Brownian diffusion that results from these processes has been difficult to characterize, and moreover, the impact of factors such as membrane recycling on membrane diffusion remains largely unexplored. We have used a careful statistical analysis of single-particle tracking data of the single-pass plasma membrane protein CD93 to show that the diffusion of this protein is well-described by a continuous-time random walk in parallel with an aging process mediated by membrane corrals. The overall result is an evolution in the diffusion of CD93: proteins initially diffuse freely on the cell surface, but over time, become increasingly trapped within diffusion-limiting membrane corrals. Stable populations of freely diffusing and corralled CD93 are maintained by an endocytic/exocytic process in which corralled CD93 is selectively endocytosed, while freely diffusing CD93 is replenished by exocytosis of newly synthesized and recycled CD93. This trafficking not only maintained CD93 diffusivity, but also maintained the heterogeneous distribution of CD93 in the plasma membrane. These results provide insight into the nature of the biological and biophysical processes that can lead to significantly non-Brownian diffusion of membrane proteins, and demonstrate that ongoing membrane recycling is critical to maintaining steady-state diffusion and distribution of proteins in the plasma membrane.