Rheumatology

Editorial introductions No abstract available

Implications of juvenile idiopathic arthritis genetic risk variants for disease pathogenesis and classification Purpose of review We assess the implications of recent advances in the genetics of juvenile idiopathic arthritis (JIA) for the evolving understanding of inflammatory arthritis in children. Recent findings JIA exhibits prominent genetic associations with the human leukocyte antigen (HLA) region, extending perhaps surprisingly even to the hyperinflammatory systemic JIA category. Some HLA associations resemble those for adult-onset inflammatory arthritides, providing evidence for pathogenic continuity across the age spectrum. Genome-wide association studies have defined an increasing number of JIA-linked non-HLA loci, many again shared with adult-onset arthritis. As most risk loci contain only noncoding variants, new experimental methods such as SNP-seq and innovative big-data strategies help identify responsible causative mutations, termed functional SNPs (fSNPs). Alternately, gene hunting in multiplex families implicates new genes in monogenic childhood arthritis, including MYD88 and the intriguing innate immune gene LACC1. Summary Genetic data indicate a continuity between JIA and adult arthritis poorly reflected in current nomenclature. Advancing methodologies will help to identify new pathogenic mechanisms that inform the understanding of biologic subdivisions within JIA. Resulting insights will facilitate the application of lessons learned across the age spectrum to the treatment of arthritis in children and adults.

Cutaneous manifestations of pediatric lupus Purpose of review To review recent evidence on cutaneous manifestations of lupus, with a focus on evidence for pediatric patients. Recent findings Cutaneous manifestations of SLE are common and may precede signs or symptoms of systemic disease. Early recognition and initiation of therapy improves quality of life by reducing cutaneous disease activity. Antimalarials are first line for moderate-to-severe disease. Photo protection is a critical component of therapy and perhaps the only modifiable risk factor for SLE. Recognition of cutaneous vasculopathy may reduce mortality from vascular occlusion. Summary There is a critical need for better understanding of pathogenesis, risk factors and outcomes in cutaneous lupus to determine optimal treatment and surveillance strategies. Correlation of clinical phenotypes with biomarkers may help to stratify patients, optimize targeted interventions, and influence prognosis.

Interleukin-18 in pediatric rheumatic diseases Purpose of review IL-18 is a pleiotropic cytokine involved in the regulation of innate and adaptive immune responses. IL-18 pro-inflammatory activities are finely regulated in vivo by the inhibitory effects of the soluble IL-18-binding protein (IL-18BP). The elevation of circulating levels of IL-18 has been described in children with systemic juvenile idiopathic arthritis (sJIA). In the recent years, the role of IL-18 in the pathogenesis of secondary haemophagocytic lymphohistiocytosis (sHLH), also referred to as macrophage activation syndrome (MAS), in the context of autoinflammatory diseases, including sJIA, is emerging. Recent findings A large number of studies in patients and animal models pointed to the imbalance in IL-18/IL-18BP levels, causing increased systemic levels of free bioactive IL-18, as a predisposing factor in the development of MAS. Although the exact mechanisms involved in the development of MAS are not clearly understood, increasing evidence demonstrate the role of IL-18 in upregulating the production of interferon (IFN)-γ. Summary On the basis of the first emerging data on the possibility of blocking IL-18, we here discuss the scientific rationale for neutralizing the IL-18/IFNγ axis in the prevention and treatment of sHLH and MAS.

Treatment of juvenile idiopathic arthritis: what’s new? Purpose of review The present review highlights the advances in disease outcome achieved with currently available biologic medications and future perspectives for JIA management. Recent findings In the last two decades, the management of juvenile idiopathic arthritis (JIA) has been revolutionized by appropriate legislative initiatives, the existence of very large collaborative networks and the increased availability of the novel biologic medications. Summary A more rational approach to the management of JIA is being fostered by the recent publication of therapeutic recommendations, consensus treatment plans and for a treat-to-target strategy.

Predicting disease severity and remission in juvenile idiopathic arthritis: are we getting closer? Purpose of review To summarize current research on the prediction of severe disease or remission in children with juvenile arthritis, and define further steps needed towards developing prediction tools with sufficient accuracy for clinical use. Recent findings High disease activity, poor patient-reported outcomes, ankle or wrist involvement, and a longer time from onset to the start of treatment herald a severe disease course and a low chance of remission. Other studies confirmed that age less than 7 years and positive ANA are the strongest predictors of uveitis development. Preliminary evidence suggests ultrasound findings may predict flare in patients with clinically inactive disease, and several new biomarkers show promise. A few prediction tools that combine predictors to estimate the chance of remission or a severe disease course in the medium-term to long-term have shown good accuracy when internally validated in the population in which they were developed. Summary Promising candidate tools for predicting disease severity and long-term remission in juvenile arthritis are now available. These tools need external validation in other populations, and ideally formal trials to assess whether their use in practice improves patient outcomes. We are definitively getting closer, but we are not there yet.

The role of epigenetics in paediatric rheumatic disease Purpose of review Autoimmune/inflammatory disorders can be stratified along a spectrum based on the primary involvement of innate vs. adaptive mechanisms. Stratifying patients based on molecular mechanisms rather than clinical phenotypes may allow for target-directed and individualized treatment. Recent findings Epigenetic events are gene regulatory mechanisms that contribute to inflammation across inflammatory diseases and resemble shared mechanisms that may be used as disease biomarkers and treatment targets. Significant progress has been made dissecting the epigenome in paediatric rheumatic diseases and identifies associations with clinical phenotypes, treatment responses and disease outcomes. Here, we will summarize and discuss epigenetic patterns in autoimmune/inflammatory disorders, underlying molecular alterations and their effects on gene expression and immune phenotypes. Summary Structured investigation of epigenetic events, their causes and effects on immune phenotypes in autoimmune/inflammatory, will improve our understanding of disease, deliver new diagnostic tools and treatment options.

Update on the treatment and outcome of systemic lupus erythematous in children Purpose of review Provide an update of studies published in last 2 years on the outcomes and therapies in childhood-onset systemic lupus erythematous (cSLE). Recent findings Additional evidence has been provided about the benefits of universal hydroxychloroquine in SLE patients, although antimalarial maculopathy may be more prevalent than previously thought. Recent studies support lower glucocorticoid doses than used in the past may provide comparable therapeutic benefits, and cSLE patients can mount adequate immunogenic response and sustain long-term seroprotective titers when vaccinated. Long-term studies of adults with cSLE confirmed that damage accrual increases with disease duration. Cardiovascular disease, renal transplants, replacement arthroplasties, and myocardial infarctions occur between 20 and 40 years of age. Higher prednisone doses predicted higher damage trajectory and antimalarial exposure was protective. There were no prospective clinical trials published in pediatric patients with cSLE, but positive results from phase II trials with bariticinib and ustekinumab in adult SLE may raise the expectation that these drugs could be beneficial when used in cSLE. Summary The dire need for more clinical trials and licensed medications for cSLE persist as well as decreasing damage accrual.

Microbiome and autoimmune diseases: cause and effect relationship Purpose of review The human body is the host of trillions of different prokaryotic microorganisms that colonize the skin and the mucosae. The interaction between human cells and these organisms is mediated by the immune system, sustaining a very complex and fragile balance. The immune cells need to prevent uncontrolled growth of pathogenic microbes and promote tolerance toward the existence of the beneficial ones. Growing evidence associates the disruption of this symbiotic relationship with the development of autoimmune diseases. Recent findings Human studies led to the identification of gut dysbiosis patterns in patients with rheumatoid arthritis, lupus and multiple sclerosis. Interestingly, the inoculation of pathogenic bacteria in animal models was associated with the development of these autoimmune diseases. Summary A better understanding of the microbiota–human interaction will enable the development of novel treatment choices. Currently, new molecules using helminth compounds are under investigation and have already revealed promising results.

The role of Epstein–Barr virus infection in primary Sjögren’s syndrome Purpose of review The purpose of this article is to draw attention to the role of Epstein–Barr virus (EBV) virus in the pathogenesis of the primary Sjögren’s syndrome. The article introduces the problem of consequences of EBV acute infection, and its reactivation, in association with the immune response modulation by the virus and with an increased risk of developing systemic autoimmune diseases and EBV-associated cancers. Recent findings The knowledge about the mechanisms by which the virus may stay for years in a latent phase, unrecognized by the host response immune cells is constantly expanding. There are several mechanisms and theories about EBV influence on the autoimmune process in Sjogren’s syndrome (pSS), including the similarity (molecular mimicry) between viral EBNA-2 protein and Ro-60 antigen or EBER-1 and EBER-2 viral proteins and La antigen. Summary The influence of EBV infection on the development and course of pSS has been proven. It has also been established that both EBV and pSS result in the increased risk of tumor (especially lymphoma) development. In the light of these findings, new ways to manage EBV infections are being sought. Optimal methods for assessing EBV infection status are being devised. Research also aims at finding therapies, which target EBV through the inhibition of the autoimmune process and of viral activity. The present article is an attempt to discuss the most important phenomena and elements linking EBV infection to the primary Sjögren’s syndrome.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Anaesthesiology

Analgesic efficacy of ultrasound-guided interscalene block vs. supraclavicular block for ambulatory arthroscopic rotator cuff repair: A randomised noninferiority study BACKGROUND Ultrasound-guided interscalene block (ISB) is the reference technique for pain control after ambulatory upper limb surgery, but supraclavicular block (SCB) is an alternative. OBJECTIVES The aim of this study was to compare the efficacy of SCB vs. ISB in patients undergoing ambulatory arthroscopic rotator cuff repair (ARCR), with the hypothesis of noninferiority of SCB analgesia compared with ISB. DESIGN A randomised, single-blind, noninferiority study. SETTING Hôpital Privé Jean Mermoz, Centre Paul Santy, Lyon, France. PATIENTS Ambulatory ARCR patients. INTERVENTION Patients were randomly allocated (1 : 1) to receive a single injection SCB or ISB, as well as general anaesthesia. All patients received a postoperative analgesic prescription for home use before leaving hospital (including fast-acting oral morphine sulphate). Patients completed a telephone questionnaire on days 1 and 2 postsurgery. MAIN OUTCOME MEASURES Primary endpoint was oral morphine consumption (mg) during the first 2 days postsurgery. If the difference between mean morphine consumption in the SCB vs. ISB group was less than 30 mg, noninferiority of SCB compared with ISB would be demonstrated. Secondary evaluation criteria included pain scores (numerical rating scale), duration of motor and sensory blockade, and satisfaction with treatment. RESULTS The per-protocol cohort included 103 patients (SCB = 52, ISB = 51) (57% men, median age 58 years). Mean morphine consumption in the 48 h postsurgery was 9.4 vs. 14.7 mg in the SCB and ISB groups, respectively (difference −5.3, P < 0.001). The upper limit of the 95% CI was less than 30 mg, demonstrating noninferiority of SCB compared with ISB. No difference was observed between the two groups in terms of pain scores or the duration of motor or sensory blockade. Overall, 98% of patients in the SCB group vs. 90% in the ISB group were satisfied with their treatment. CONCLUSION SCB is as effective as ISB in terms of postoperative analgesia based on oral morphine consumption in patients undergoing ambulatory ARCR. Trial registration: EudraCT number: 2016-A00747-47. Correspondence to Julien Cabaton, MD, Department of Anaesthesiology, Hôpital Privé Jean Mermoz, Centre Paul Santy, 24, avenue Paul Santy, Lyon 69008, France E-mail: cabaton.md This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 © 2019 European Society of Anaesthesiology

Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised controlled trial BACKGROUND Pre-operative anxiety in children is very common and is associated with adverse outcomes. OBJECTIVE The aim of this study was to investigate if virtual reality exposure (VRE) as a preparation tool for elective day care surgery in children is associated with lower levels of anxiety, pain and emergence delirium compared with a control group receiving care as usual (CAU). DESIGN A randomised single-blind controlled trial. SETTING A single university children’s hospital in the Netherlands from March 2017 to October 2018. PATIENTS Two-hundred children, 4 to 12 years old, undergoing elective day care surgery under general anaesthesia. INTERVENTION On the day of surgery, children receiving VRE were exposed to a realistic child-friendly immersive virtual version of the operating theatre, so that they could get accustomed to the environment and general anaesthesia procedures. MAIN OUTCOME MEASURES The primary outcome was anxiety during induction of anaesthesia (modified Yale Preoperative Anxiety Scale, mYPAS). Secondary outcomes were self-reported anxiety, self-reported and observed pain, emergence delirium, need for rescue analgesia (morphine) and parental anxiety. RESULTS A total of 191 children were included in the analysis. During induction of anaesthesia, mYPAS levels (median [IQR] were similar in VRE, 40.0 [28.3 to 58.3] and CAU, 38.3 [28.3 to 53.3]; P = 0.862). No differences between groups were found in self-reported anxiety, pain, emergence delirium or parental anxiety. However, after adenoidectomy/tonsillectomy, children in the VRE condition needed rescue analgesia significantly less often (55.0%) than in the CAU condition (95.7%) (P = 0.002). CONCLUSION In children undergoing elective day care surgery, VRE did not have a beneficial effect on anxiety, pain, emergence delirium or parental anxiety. However, after more painful surgery, children in the VRE group needed rescue analgesia significantly less often, a clinically important finding because of the side effects associated with analgesic drugs. Options for future research are to include children with higher levels of anxiety and pain and to examine the timing and duration of VRE. TRIAL REGISTRATION Netherlands Trial Registry: NTR6116 (e.utens This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 © 2019 European Society of Anaesthesiology

Comparison of neostigmine vs. sugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery: A randomised controlled trial BACKGROUND Postoperative residual neuromuscular blockade or curarisation (PORC) is a risk directly related to the use of neuromuscular blocking agents during surgical procedures. Acceleromyography is distressing for conscious patients when assessing PORC. Diaphragm ultrasonography could be a valid alternative. OBJECTIVES The primary objective was to achieve a 28% lower incidence of PORC in patients who, after rocuronium administration, received neostigmine or sugammadex at 30 min after surgery. To assess PORC, diaphragm ultrasonography was used, and thickening fractioning [the difference of thickness at the end of inspiration (TEI) and at the end of expiration (TEE), normalised for TEE (TEI − TEE/TEE)] was measured. PORC was defined as thickening fractioning of 0.36 or less. The secondary object was the comparison, in the two treatment groups, of the return to baseline thickening fractioning at 30 min after surgery (ΔTF30). DESIGN Prospective, double-blind, single-centre randomised study. SETTING University Hospital Careggi, Florence, Italy. PATIENTS Patients of American Society Anesthesiologists’ physical status 1 or 2, 18 to 80 years, receiving rocuronium during microlaryngeal surgery. INTERVENTIONS At the end of surgery participants were randomised to receive neostigmine (NEO group) or sugammadex (SUG group) as the reversal drug. Thickening fractioning and ΔTF30 were evaluated at baseline and at 0, 10 and 30 min after surgery. MAIN OUTCOME MEASURES TEE and TEI at each time point. RESULTS A total of 59 patients with similar demographic characteristics were enrolled. An association between lack of recovery (thickening fractioning ≤0.36) and drug treatment was only observed at 0 min (SUG vs. NEO, P < 0.05). Concerning ΔTF, at 30 min more patients in the SUG group returned to baseline than those in the NEO group (P < 0.001), after adjusting for side (P = 0.52), baseline thickening fractioning (P < 0.0001) and time of measurement (P < 0.01). CONCLUSION We found an early (0 min) but not long-lasting (30 min) association between diaphragm failure and treatment allocation; a full recovery in baseline diaphragm function was observed only in patients receiving sugammadex. We cannot exclude that further differences have not been found due to interpatients variability in assessing diaphragm contractility by ultrasonography. TRIAL REGISTRATION EudraCT Identifier: 2013-004787-62, Clinicaltrials.gov Identifier: NCT02698969. Correspondence to Iacopo Cappellini, Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy E-mail: jacopocappellini © 2019 European Society of Anaesthesiology

Neuraxial labour analgesia is associated with a reduced risk of maternal depression at 2 years after childbirth: A multicentre, prospective, longitudinal study BACKGROUND Severe labour pain is an important risk factor of postpartum depression, and early depression is associated with an increased risk of long-term depression; whereas the use of epidural analgesia during labour decreases the risk of postpartum depression. OBJECTIVE To investigate whether neuraxial labour analgesia was associated with a decreased risk of 2-year depression. DESIGN This was a multicentre, prospective, longitudinal study. SETTING The study was performed in Peking University First Hospital, Beijing Obstetrics and Gynecology Hospital and Haidian Maternal and Child Health Hospital in Beijing, China, between 1 August 2014 and 25 April 2017. PATIENTS Five hundred ninety-nine nulliparous women with single-term cephalic pregnancy preparing for vaginal delivery were enrolled. MAIN OUTCOME MEASURE Depressive symptoms were screened with the Edinburgh Postnatal Depression Scale at delivery-room admission, 6-week postpartum and 2 years after childbirth. A score of 10 or higher was used as the threshold of depression. The primary endpoint was the presence of depression at 2 years after childbirth. The association between the use of neuraxial labour analgesia and the development of 2-year depression was analysed with a multivariable logistic regression model. RESULTS Five hundred and eight parturients completed 2-year follow-up. Of these, 368 (72.4%) received neuraxial analgesia during labour and 140 (27.6%) did not. The percentage with 2-year depression was lower in those with neuraxial labour analgesia than in those without (7.3 [27/368] vs. 13.6% [19/140]; P = 0.029). After correction for confounding factors, the use of neuraxial analgesia during labour was associated with a significantly decreased risk of 2-year depression (odds ratio 0.455, 95% confidence interval 0.230 to 0.898; P = 0.023). CONCLUSION For nulliparous women with single-term cephalic pregnancy planning for vaginal delivery, the use of neuraxial analgesia during labour was associated with a reduced risk of maternal depression at 2 years after childbirth. TRIAL REGISTRATION wangdongxin Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Website (www.ejanaesthesiology.com). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 © 2019 European Society of Anaesthesiology

Guidewire-assisted vs. direct radial arterial cannulation in neonates and infants: A randomised controlled trial BACKGROUND Cannulation of the radial artery is challenging to perform in neonates and infants because of the small vessel size. OBJECTIVE To compare guidewire-assisted with direct radial artery cannulation in neonates and infants. DESIGN A randomised controlled study. SETTING A tertiary university hospital from 7 August 2017 to 4 July 2018. PATIENTS Ninety neonates and infants who required radial artery cannulation during general anaesthesia. INTERVENTIONS All patients were allocated randomly into the guidewire group (guidewire-assisted cannulation, n=45) or control group (direct cannulation, n=45). Radial artery cannulation was performed under general anaesthesia. The contralateral radial artery was used if the arterial cannulation was not successful within two attempts. After the second failure in the contralateral radial artery, the case was considered a failure. MAIN OUTCOME MEASURES The primary outcome was the first-attempt success rate of radial artery cannulation. The secondary outcomes included the overall success rate, overall procedure time, number of attempts and use of the contralateral radial artery for radial artery cannulation. RESULTS The guidewire group showed a higher first-attempt success rate [76 vs. 56%; P = 0.046; odds ratio (OR) 2.47, 95% confidence interval (CI) of odds 1.01 to 6.08] and overall success rate (96 vs. 76%; P = 0.007; OR 6.96; 95% CI 1.44 to 33.52) than the control group. The overall procedure time was not significantly different between the guidewire group (median [IQR] 36 [28.0 to 70.5] s) and control group (98 [23.5 to 465.0] s; P = 0.400). There was no difference in the median number of attempts between the two groups (P = 0.454). However, use of the contralateral radial artery was significantly lower in the guidewire group (17.8%) than in the control group (40%; P = 0.020; OR 0.324, 95% CI 0.12 to 0.86). Kaplan–Meier analysis of the overall procedure time to successful radial artery cannulation showed that the overall success rate was significantly higher in the guidewire group than in the control group (P = 0.019). CONCLUSION For radial artery cannulation in neonates and infants, guidewire-assisted radial artery cannulation showed superiority over the direct technique in terms of first-attempt success rate and overall success rate without delaying the procedure time. TRIAL REGISTRATION Clinicaltrials.gov (identifier: NCT03217019). Correspondence to Prof Jin-Tae Kim, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakno, Jongnogu, Seoul 03080, Republic of Korea Tel: +82 2 2072 3295; fax: +82 2 745 5587; e-mail: jintae73 © 2019 European Society of Anaesthesiology

Does programmed intermittent epidural bolus improve childbirth conditions of nulliparous women compared with patient-controlled epidural analgesia?: A multicentre, prospective, controlled, randomised, triple-blind study BACKGROUND Epidural analgesia may change the mechanics of childbirth. These changes are related to the concentration of the local anaesthetic used epidurally but probably also to its mode of delivery into the epidural space. OBJECTIVE To determine whether the administration of programmed intermittent epidural boluses (PIEB) improves the mechanics of second-stage labour compared with patient-controlled epidural analgesia (PCEA) with a background infusion. DESIGN Prospective, controlled, randomised, triple-blind study. SETTING Multicentre study including four level III maternity units, January 2014 until June 2016. PATIENTS A total of 298 nulliparous patients in spontaneous labour were randomised to a PIEB or PCEA group. INTERVENTION After epidural initiation with 15 ml of 0.1% levobupivacaine containing 10 μg of sufentanil, patients received either an hourly bolus of 8 ml (PIEB) or a continuous rate infusion of 8 ml h−1 (PCEA): the drug mixture used was levobupivacaine 0.1% and sufentanil 0.36 μg ml−1. MAIN OUTCOME MEASURES The primary outcome was a composite endpoint of objective labour events: a posterior occiput position in the second stage, an occiput position at birth, waiting time at full cervical dilatation before active maternal pushing more than 3 h, maternal active pushing duration more than 40 min, and foetal heart rate alterations. Vaginal instrumental delivery rates, analgesia and motor blockade scores were also recorded. RESULTS From the 298 patients randomised, data from 249 (124 PIEB, 125 PCEA) were analysed. No difference was found in the primary outcome: 48.0% (PIEB) and 45.5% (PCEA) of patients, P = 0.70. In addition, no difference was observed between the groups for each of the individual events of the composite endpoint, nor in the instrumental vaginal delivery rate, nor in the degree of motor blockade. Despite an equivalent volume of medication in the groups, a significantly higher analgesia score at full dilatation was observed in the PIEB group, odds-ratio = 1.9 (95% confidence interval, 1.0 to 3.5), P = 0.04. CONCLUSION The mechanics of the second stage did not differ whether PIEB or PCEA was used. Analgesic conditions appeared to be superior with PIEB, especially at full dilation. TRIAL REGISTRATION Clinical trial number: NCT01856166. Correspondence to Estelle Morau, CHU Arnaud de Villeneuve, 34295 Montpellier Cedex 5, France E-mail: estelle.morau © 2019 European Society of Anaesthesiology

Comparison of a simplified nasal continuous positive airways pressure device with nasal cannula in obese patients undergoing colonoscopy during deep sedation: A randomised clinical trial BACKGROUND Continuous positive airways pressure (CPAP) with a CPAP machine and mask has been shown to be more effective at minimising hypoxaemia than other devices under deep sedation. However, the efficacy of a new and simple CPAP device for spontaneously breathing obese patients during colonoscopy is unknown. OBJECTIVE We hypothesised that oxygenation and ventilation in obese patients under deep sedation during colonoscopy using CPAP via a new nasal mask (SuperNO2VA) would be better than routine care with oxygen supplementation via a nasal cannula. DESIGN Randomised study. SETTING Single-centre, June 2017 to October 2017. PATIENTS A total of 174 patients were enrolled and randomly assigned to Mask group or Control group. Thirty-eight patients were excluded and data from 136 patients underwent final analysis. INTERVENTION Patients in the Mask group were provided with nasal CPAP (10 cmH2O) at an oxygen flow rate of 15 l min−1. In the Control group, patients were given oxygen via a nasal cannula at a flow rate of 5 l min−1. MAIN OUTCOME MEASURES The primary outcome was elapsed time from anaesthesia induction to the first airway intervention. RESULTS The elapsed time from anaesthesia induction to the first airway intervention was 19 ± 10 min in the Mask group (n=63) vs. 10 ± 12 min in the Control group (n=73, P < 0.001). In all, 87.5% (56/64) of patients achieved the target CPAP value. More patients in the Control group (63%) received airway intervention than in the Mask group (22%) (P < 0.001). Hypoxaemia (pulse oximeter oxygen saturation, SpO2 < 90%) occurred more frequently in the Control group (22%) than in the Mask group (5%) (P = 0.004). Minute ventilationPostinduction/minute ventilationBaseline and minute ventilationProcedure-end/minute ventilationBaseline was lower in the Control group than in the Mask group (P = 0.007 and 0.001, respectively). CONCLUSION Application of a nasal mask at a target CPAP of 10 cmH2O improves ventilation and decreases the frequency and severity of hypoxaemia. TRIAL REGISTRATION NCT03139448, registered at ClinicalTrials.gov. Correspondence to Koffi Kla, MD, Department of Anaesthesiology, Vanderbilt University Medical Centre, 1301 Medical Centre Drive, 4648 TVC, Nashville, TN 37232-5614, USA Tel: +1 615 343 9419; e-mail: koffi.m.kla © 2019 European Society of Anaesthesiology

Functional MRI: basic principles and emerging clinical applications for anaesthesiology and the neurological sciences No abstract available

Validation of 3-minute diagnostic interview for CAM-defined Delirium to detect postoperative delirium in the recovery room: A prospective diagnostic study BACKGROUND Recent guidelines on postoperative delirium (POD) recommend POD screening in all patients, using a validated tool, starting in the recovery room. An operationalisation of the Confusion Assessment Method (CAM) criteria, the 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM), has been developed for use in general medical units. OBJECTIVES The aim of this study was to evaluate 3D-CAM performance in an adult patient population to detect POD in the recovery room. DESIGN A prospective diagnostic study. SETTING Recovery room of a tertiary care university hospital in Berlin, Germany, in 2017. PATIENTS Patients at least 18 years of age undergoing elective surgery. MAIN OUTCOME MEASURES Patients were subjected to evaluation by blinded investigators using the 3D-CAM and the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5, reference standard). Sensitivity, specificity and positive predictive value (PPV) and negative predictive value (NPV) were analysed for 3D-CAM, in addition to test–retest and inter-rater reliability analyses. RESULTS Sixteen out of 176 patients (9.1%) developed POD. The 3D-CAM demonstrated strong test performance (specificity 0.88, sensitivity 1.0, area under the curve 0.94, PPV 0.44 and NPV 1.0), with a test–retest reliability of 90% (n = 10) and inter-rater reliability of 80% (n = 10). CONCLUSION In this diagnostic study, 3D-CAM showed strong performance for detection of POD in the recovery room. Due to the low training requirements, fast application and high sensitivity, it might be particularly appropriate for clinical staff with limited experience in the assessment of POD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02992717 Correspondence to Claudia D. Spies, MD, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin D-13353, Germany Tel: +49 30 450 551102/+49 30 450 531012; e-mail: claudia.spies Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Website (www.ejanaesthesiology.com). © 2019 European Society of Anaesthesiology

Comparison of low and high positive end-expiratory pressure during low tidal volume ventilation in robotic gynaecological surgical patients using electrical impedance tomography: A randomised controlled trial BACKGROUND The appropriate level of positive end-expiratory pressure (PEEP) during intra-operative mechanical ventilation remains unclear. OBJECTIVE The aim of this study was to investigate the effects of different levels of PEEP with low tidal volume (low-VT) ventilation in a steep Trendelenburg position (30°) and pneumoperitoneum on oxygenation, respiratory mechanics and ventilation distribution using electrical impedance tomography. DESIGN A randomised controlled trial. SETTING Single university secondary care centre, conducted from January 2017 to December 2017. PATIENTS Forty female patients, aged 20 to 60 years, and of American Society of Anesthesiologists’ (ASA) physical status 1 or 2, undergoing elective robotic gynaecological surgery were included. INTERVENTION Forty patients were allocated randomly to a PEEP4 (PEEP 4 cmH2O) group or a PEEP8 (PEEP 8 cmH2O) group. MAIN OUTCOME MEASURES The primary outcomes were respiratory mechanics. The secondary outcomes included changes in ventilation distribution across the ventral and dorsal regions of interest and postoperative pulmonary complications (PPCs) using a modified clinical pulmonary infection score. RESULTS There was no difference in PaO2 at any time point. The peak inspiratory pressure (PIP) and mean airway pressure (Paw) of the PEEP4 group were lower than those of the PEEP8 group (P < 0.001). The oxygenation factor in the PEEP4 group was higher than that in the PEEP8 group during mechanical ventilation at all times. There was no difference in the fractional distribution of end-expiratory ventilation according to region of interest between the two groups. CONCLUSION Both 4 and 8 cmH2O of PEEP with low-VT ventilation can be used for robotic gynaecological surgery that requires a steep Trendelenburg position and pneumoperitoneum. However, 8 cmH2O of PEEP had no benefit over 4 cmH2O of PEEP with respect to oxygenation and improvement of dorsal regional ventilation. TRIAL REGISTRATION The trial was registered at the Clinical Trial Registry of Korea (KCT0002255). baikhj © 2019 European Society of Anaesthesiology

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Cardiovascular Medicine

Percutaneous coronary interventions for stable ischemic heart disease in Italy Aims Although the benefits of percutaneous coronary interventions (PCIs) in patients with stable chronic ischemic heart disease (SIHD) are controversial, a large number of PCIs are currently performed in SIHD patients, frequently after coronary angiography (ad-hoc procedures), without the use of fractional flow reserve (FFR) to identify patients most likely to benefit from PCI. Methods Assessment of regional variations in PCI for SIHD performed in Italy in 2017 and correlation of the regional number of PCI per million inhabitants with the use of FFR were performed using the data reported in the registry of the Italian Society of Interventional Cardiology (SICI-GISE) registry for the year 2017. Results PCI for SIHD accounted for 44.5% of all PCI performed in Italy with large variations among the Italian regions. There was a significant and inverse relationship between the use of FFR and the PCI number per million inhabitants performed for SIHD in the various Italian regions (P = 0.01). In the Veneto region, where local authorities mandated Heart Team reports to select the most appropriate treatment choice in multivessel disease patients, the rate of ad-hoc procedures was significantly lower than the national average. Conclusion PCI for SIHD patients represent almost half of all procedures currently performed in Italy with regional variations inversely related to physiologic guidance use. The mandatory assessment by the Heart Team to select the most appropriate treatment choice in multivessel disease patients is associated with a significantly lower number of ad-hoc procedures. Correspondence to Stefano De Servi, MD, FESC, Unita’ di Cardiologia, IRCCS Multimedica, Milan, Italy Tel: +39 02 24209590; e-mail: stefano.deservi Received 24 February, 2019 Revised 25 March, 2019 Accepted 28 April, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.

Does mitral regurgitation reduce the risk of thrombosis in atrial fibrillation and flutter? Aims Blood stasis is the main cause of left atrial thrombosis (LAT) in atrial tachyarrhythmias. The high-velocity flow inside the left atrium, due to mitral valve regurgitation, may prevent clot formation but the topic has never been investigated in large-scale studies. The aim of our study was to evaluate whether the presence and degree of mitral regurgitation have a protective role against LAT risk. Methods A total of 1302 consecutive adult patients with paroxysmal or persistent atrial fibrillation or flutter undergoing cardioversion, submitted to transesophageal echocardiography, were retrospectively enrolled in the study. The study population was divided into three groups according to the mitral regurgitation degree: absent, mild-to-moderate and severe. Results Among 1302 patients enrolled in the study, patients without mitral regurgitation were 248 (19%), those with mild-to-moderate 970 (75%), whereas 84 had severe mitral regurgitation (6%). LAT incidence was significantly lower in patients with severe mitral regurgitation compared with those with mild-to-moderate (mitral regurgitation) (2.4 vs. 8.9%, P < 0.05), and similar to subjects without mitral regurgitation (2.4%). Conclusion Despite patients with severe regurgitation having clinical and echo characteristics predisposing to LAT (higher age, heart failure, higher atrial size, lower ventricular function) thrombosis prevalence was significantly lower than for those with mild-to-moderate mitral regurgitation. The percentage of LAT in severe mitral regurgitation cases was very low and similar to that of cases without regurgitation which were characterized by lower age, normal left ventricular function or other risk factors, reinforcing the hypothesis of a protecting role against atrial thrombosis of mitral regurgitation. Correspondence to Ugo Limbruno, MD, Cardiological Department, Misericordia Hospital, Via Senese, 58100 Grosseto, Italy E-mail: ulimbru Received 26 March, 2019 Revised 1 May, 2019 Accepted 1 July, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.

Reliability of noninvasive hemodynamic assessment with Doppler echocardiography: comparison with the invasive evaluation Aims The study aimed at evaluating the reliability and reproducibility of various noninvasive echocardiographic techniques for the estimation of the main hemodynamic parameters in clinical practice. Methods A total of 84 patients with a generic indication of right heart catheterization (RHC) executed a transthoracic echocardiography shortly before or after the RHC. All the parameters necessary for a noninvasive hemodynamic evaluation of right atrial pressure, pulmonary artery pressure (PAP), pulmonary capillary wedge pressure, pulmonary vascular resistance and cardiac output were acquired and the agreement with the invasive measures was evaluated by a Bland–Altman analysis. Results Noninvasive evaluation of right atrial pressure showed a moderate and low correlation with RHC using inferior vena cava parameters (r = 0.517) and tricuspid E/E′ ratio (sensitivity 0.23, specificity 0.72), respectively. PAPs estimation from the tricuspid regurgitation peak velocity had a good correlation (r = 0.836) and feasibility (82.1%), as well as PAPm from tricuspid regurgitation mean gradient (r = 0.78, applicability 72.6%) and from pulmonary acceleration time (sensitivity 0.85, specificity 0.5, applicability 92.9%). Pulmonary capillary wedge pressure multiparametric evaluation, as suggested by the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations, showed a good correlation (sensitivity 0.96, specificity 0.59). The noninvasive evaluation of pulmonary vascular resistance and cardiac output did not prove to be clinically accurate. Conclusion Various hemodynamic parameters can be adequately estimated with noninvasive methods. In particular, a multiparametric approach for the evaluation of left ventricle filling pressures is advisable and the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations are reliable even in a heterogeneous population with a significant quota of precapillary pulmonary hypertension. Correspondence to Marco de Scordilli, Department of Medical Science, Surgery and Health (DCSMCS), University of Trieste, Ospedale di Cattinara, Via Rossetti, 51, 34141 Trieste, Italy Tel: +39 3497644274; e-mail: marco.descordilli Received 14 March, 2019 Revised 4 July, 2019 Accepted 7 July, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.

Multimodality imaging for early diagnosis and treatment of primary cardiac diffuse ‘double-expressor’ lymphoma Primary cardiac double-expressor lymphoma represents a rare subtype of diffuse large B-cell lymphoma, especially in immunocompetent patients. To date, only a few sporadic cases of primary cardiac double-expressor lymphoma have been reported in medical literature. Multimodality imaging can be very helpful in these patients for early diagnosis and treatment of this type of lymphoma, allowing potential improvement of the outcome. Correspondence to Loris Roncon, MD, Department of Cardiology, Santa Maria della Misericordia Hospital, Via Tre Martiri 140, 45100 Rovigo, Italy Tel: +39 0425393286; e-mail: loris.roncon Received 30 April, 2019 Revised 9 July, 2019 Accepted 10 July, 2019 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Website (www.jcardiovascularmedicine.com). © 2019 Italian Federation of Cardiology. All rights reserved.

Mid-term repair durability after MitraClip implantation in patients with functional mitral regurgitation Background The aim of this study was to identify variables that are associated with the durability of percutaneous repair of secondary mitral regurgitation at 6-month follow-up. Methods and results Thirty-five consecutive patients with functional mitral regurgitation scheduled for MitraClip implant were enrolled. Left ventricular (LV) volumes and function and mitral valve characteristics were assessed before and immediately after MitraClip implantation using three-dimensional transesophageal echocardiography. Five patients with an unsuccessful procedure were excluded. The other patients were subdivided according to repair durability: group 1 with a durable repair (19 patients, 65%) and group 2 with significant mitral regurgitation recurrence (11 patients, 35%). At baseline, group 1 patients had smaller and more elliptical mitral valve annulus (1055 ± 241 vs. 1273 ± 359 mm2, P = 0.02 and 125 ± 11 vs. 117 ± 16%, P = 0.02), a smaller left atrial volume (54.1 ± 26 vs. 71.5 ± 20 ml, P = 0.005) and lower systolic pulmonary artery pressure (38 ± 11 vs. 49 ± 12 mmHg, P = 0.03). Baseline LV end systolic volume had a linear correlation with the 3D annulus area (P = 0.048) and an inverse correlation with annulus ellipticity (P = 0.021). Group 1 patients showed an increase in annulus ellipticity after MitraClip (125 ± 17 vs. 141 ± 23%, P = 0.014). Conclusion Percutaneous mitral valve repair leads to a significant and stable mitral regurgitation reduction in a large number of patients. Annulus dimensions and remodeling as well as left atrial area and pulmonary hypertension seem to be associated with durability of the procedure. Correspondence to Sara Cimino, MD, Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Roma, Italy Tel: +39 6 49979048; fax: +39 6 49979060; e-mail: sara.cimino Received 3 January, 2019 Revised 1 July, 2019 Accepted 7 July, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.

Prognosis in patients with microvascular angina: a clinical follow-up The prognosis of patients with microvascular angina (MVA) has been reported to be good. In 10–20% of the cases, the symptoms of angina progressively worsen during follow-up, becoming more frequent and prolonged, absorbing lower workloads or even increasing at rest and becoming less sensitive, or even refractory, to drug therapy. The frequency and intensity of angina episodes require frequent medical visits, hospital admissions, absences from work, thus determining a high social cost of the disease. To obtain further information on this clinical controversy, we performed a clinical follow-up of of 132 patients with diagnosis of microvascular angina. Correspondence to Vincenzo Sucato, MD, Unit of Cardiology, ProMISE Department, Paolo Giaccone Hospital, University of Palermo, Via Del Vespro n 129, 90127 Palermo, Italy E-mail: odisseos86 Received 11 February, 2019 Accepted 7 July, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.

Performance of the Durata implantable cardioverter defibrillator lead: results of an independent multicenter study Aims The high rate of implantable cardioverter defibrillator (ICD) lead failures related to the Sprint Fidelis’ and Riata’s design have raised serious concerns about the reliability of ICD leads. The St. Jude Medical Durata family of leads replaced the preceding Riata line following increased rates of lead failure (1.17% per year). The aim of our study was to evaluate the long-term performance of the Durata lead. Methods Eight hundred and eighteen Durata ICD leads were implanted in 11 Italian centers. The incidence of lead failure, defined as a sudden rise in long-term pacing or defibrillation impedance and/or a sudden change in R-wave amplitude and capture thresholds, was assessed. The incidences of lead dislodgment and lead perforation were also evaluated. Results During a median follow-up of 1353 days (3.7 years; 25–75th interquartile range 806–1887 days) lead failure occurred in 16/818 leads (0.54%/year). The overall survival, free of lead failure, was 98.9% at 3 years, 98.2% at 4 years and 97.5% at 5 years. Lead dislodgment occurred in 12/818 leads with an incidence of 0.4%/year. No cases of cardiac perforation were reported. No major adverse events were reported except for two cases of inappropriate shocks as a consequence of failure or dislodgment. Conclusion Our study suggests that the Durata lead does not engender a higher risk of failure. Overall survival, free from lead failure, was found to be higher than previously reported for the Riata lead. Correspondence to Roberto Rordorf, MD, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology – Foundation IRCCS Policlinico San Matteo, P.le Golgi 19, 27100 Pavia, Italy Tel: +39 0382 501276; fax: +39 0382 503161; e-mail: r.rordorf Received 19 February, 2019 Revised 27 May, 2019 Accepted 7 July, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.

Unresolved issues in left ventricular postischemic remodeling and progression to heart failure In the past decades, myocardial infarction periacute mortality markedly declined since coronary reperfusion therapy has been adopted. Despite immediate benefits of coronary blood flow restoration, the percentage of new onset heart failure has increased over time suggesting that ischemia can run detrimental consequences beyond the immediate anoxic hit. By accepting to aggregate all types of heart failure regardless of underlying cause, the current practice did not help to shed light on the complex postischemic cardiac biology indicating that heart failure is somewhat unavoidable. In the ischemic sequel, the activated mechanisms aim to repair the infarcted zone and to compensate for the lost myocyte functions, thus allowing the heart to maintain the efficient cardiac output for vital organs. The variety of underlying preexisting conditions, as well as the multifaceted components of cardiac molecular structure, cellular state, and electrophysiological postischemic events pave the way for long-term adverse cardiac remodeling. We focused our attention on multiple factors, which include myocyte loss, hypertrophy, hyperplasia, extracellular matrix changes linked to myocardial fibrosis and scar, metabolic imbalance, as well as immunologic response occurring in the acute myocardial aftermath. Moreover, we reported both current pharmacological strategies and future perspectives that might be useful in clinical practice. Furthermore, we discussed the cardiac magnetic resonance as the most promising noninvasive imaging tool, which could be helpful in identifying the amount of myocardial damage. Despite the redundancy of molecular pathogenic mechanisms making it impossible to estimate the proportionate contributions in generating the heart failure phenotype, a deeper understanding will contribute to more customized patient management. Correspondence to Dr Giuditta Benincasa, Department of Advanced Clinical and Surgical Sciences, University of Campania ‘Luigi Vanvitelli’, 80138 Naples, Italy Tel: +39 0815667916; fax: +39 08119700943; e- mail: dr.benincasa.giuditta Received 21 March, 2019 Revised 17 May, 2019 Accepted 20 June, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.

The silent cardiac mass Primary tumours of the heart are a very rare finding. We present a case of cardiac lipoma wherein multimodality images allowed the diagnosis, preventing unnecessary surgery. Typical echocardiography, computed tomographic scan and cardiac magnetic resonance findings are reviewed and discussed. Correspondence to Massimo Slavich, Department of Cardiology, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy Tel: +390226437395; e-mail: massimo.slavich Received 25 April, 2019 Revised 5 June, 2019 Accepted 7 July, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.

Constrictive pericarditis: a common physiopathology for different macroscopic anatomies No abstract available

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Endocrine

LncRNA MCM3AP-AS1 promotes proliferation and invasion through regulating miR-211-5p/SPARC axis in papillary thyroid cancer Abstract Background Long non-coding RNAs (lncRNAs) are an emerging class of regulators in cancer. A lncRNA, MCM3AP-AS1, has been demonstrated as a versatile mediator in many cancers, except papillary thyroid cancer. The aim of this study is to investigate the role and mechanism of MCM3AP-AS1 in papillary thyroid cancer. Methods Quantitative real-time PCR was used to assess the level of MCM3AP-AS1 and miR-211-5p in papillary thyroid cancer tissues and cells. Western blot was used to detect E-cadherin and secreted protein acidic and cysteine rich (SPARC) protein levels. CCK-8, scratch wound assay, and transwell assay were used to evaluate papillary thyroid cancer cell proliferation, migration, and invasion, respectively. BLAST alignment and luciferase assay were used to explore the interaction among MCM3AP-AS1, mi/r-211, and SPARC. Results In papillary thyroid cancer, MCM3AP-AS1 was upregulated, while miR-211 was downregulated. MCM3AP-AS1 overexpression promoted papillary thyroid cancer proliferation, migration, and invasion. Further, MCM3AP-AS1 was shown to be negatively correlated with miR-211-5p. We next validated that miR-211-5p overexpression could reverse the promoting role of MCM3AP-AS1 in papillary thyroid cancer, whereby SPARC plays an important regulating role. In vivo, we confirmed the anti-tumor role of MCM3AP-AS1 silencing and the close relation among MCM3AP-AS1, miR-211-5p, and SPARC. Conclusions MCM3AP-AS1 promotes papillary thyroid cancer by regulating the MCM3AP-AS1/miR-211-5p/SPARC axis, which could potentially be a therapeutic target in papillary thyroid cancer.

Extended cycle streptozotocin/5-FU chemotherapy for maintenance therapy in pancreatic neuroendocrine tumors Abstract Purpose The standard of care treatment for patients with advanced pancreatic neuroendocrine tumors (pNET) is a combination of streptozotocin and 5-FU. Although widely used, little is known about the best long-term strategy with these substances. Methods We here report our experience of 28 patients treated with streptozotocin/5-FU for advanced pNET with special consideration for long-term management using an extended cycle protocol. Results Standard 6-weekly Moertel protocol resulted in a median progression-free survival of 21 months (range 3–128) and a median overall survival of 69 months (range 3–157+) in the whole cohort. Thirteen of the 28 patients were switched to an extended 3-month cycle protocol for maintenance therapy. Of these 13 patients, 2 achieved complete remission, 1 partial remission, and 8 stable disease as best response while 2 showed progressive disease following switch to the extended protocol, resulting in an additional median progression-free survival of 23 months. Median overall survival after the start of chemotherapy in this patient group was 69 months (21–157+). Patients benefitted from extended periods free of chemotherapy-associated side effects after switching to the extended cycle protocol. Conclusions Switching to an extended cycle protocol of 3 months for maintenance therapy following initial standard cycles may achieve long-term disease stabilization in selected patients with advanced pNET with good patient acceptance.

Impact of adrenomedullin blockage on lipid metabolism in female mice exposed to high-fat diet Abstract Purpose Adrenomedullin (ADM) levels are elevated in gestational and type 2 diabetic patients. ADM also stimulates lipolysis in vitro. Disturbed lipid metabolism has been implicated in the pathogenesis of diabetes. Here, we explore whether blockade of ADM is beneficial for metabolic homeostasis in a diabetic mouse model. Methods C57BL/6J female mice were placed on either a control or a high fat high sucrose (HFHS) diet for 8 weeks. At week 4, osmotic mini-pumps were implanted for constant infusion of either saline or ADM antagonist, ADM22–52. Glucose tolerance tests were performed prior to infusion and 4 weeks after infusion began. Animals were then sacrificed and visceral adipose tissue collected for further analysis. Results Mice fed HFHS displayed glucose intolerance, increased mRNA expressions in VAT for Adm and its receptor components, Crlr. HFHS fed mice also had increased basal and isoprenaline-induced glycerol release by VAT explants. ADM22–52 did not significantly affect glucose intolerance. ADM22–52 did suppress basal and isoprenaline-induced glycerol release by VAT explants. This alteration was associated with enhanced mRNA expression of insulin signaling factors Insr and Glut4, and adipogenic factor Pck1. Conclusions HFHS diet induces glucose intolerance and enhances ADM and its receptor expressions in VAT in female mice. ADM22–52 treatment did not affect glucose intolerance in HFHS mice, but reduced both basal and isoprenaline-induced lipolysis, which is associated with enhanced expression of genes involved in adipogenesis. These results warrant further research on the effects of ADM blockade in improving lipid homeostasis in diabetic patients.

Relationship between metabolic syndrome and thyroid nodules and thyroid volume in an adult population Abstract Purpose The effects of metabolic syndrome (MetS) on thyroid nodules (TN) and thyroid volume (TV), especially the related gender and age disparities, are controversial. In this study, we aimed to assess the relationships between MetS and TN and TV in an adult population. Methods This cross-sectional study was performed in an adult population in Tianjin. A total of 2606 subjects were enrolled. TV and TN were measured by thyroid ultrasonography. Blood samples were collected to measure biochemical and metabolic parameters. Results The prevalence of TN was significantly higher in the MetS (+) group than in the MetS (−) group (P < 0.0001). MetS was independently associated with increased TN risk (OR: 1.24, 95% CI: 1.01–1.51). When stratified by gender, MetS was associated with higher prevalence of TN in males (OR: 1.38, 95% CI: 1.05–1.81) compared with females (OR: 1.02, 95% CI: 0.75–1.39). However, the interaction effect of gender and MetS on TN was not statistically significant (Pfor interaction = 0.94). MetS was associated with the greater risks of TN in both the <60-year-old group (OR: 1.32, 95% CI: 1.05–1.68) and the ≥60-year-old group (OR: 1.84, 95% CI: 1.24–2.73), while the OR value was significantly higher in the elderly group (P for interaction = 0.03). Additionally, TV was significantly higher in subjects with TN (β = 1.94, P < 0.0001) and MetS (β = 0.94, P = 0.0037). Conclusions This study suggested positive relationships between MetS and an increased risk of TN and enlarged TV. Elderly people (≥60 years old) with MetS were associated with a higher risk of TN than younger people (<60 years old). The effect of MetS on TN was not significantly affected by gender.

SDHx -related pheochromocytoma/paraganglioma – genetic, clinical, and treatment outcomes in a series of 30 patients from a single center Abstract Purpose Germline mutations in the four genes that encode the succinate dehydrogenase complex (SDHx) are a risk factor for developing pheochromocytomas and/or paragangliomas. The precise genotype–phenotype correlations are still uncertain and the most common SDHx genetic defects in the Portuguese population are poorly described. The objectives of our study were to characterize the genetic alterations, clinical features, and treatment outcomes of a cohort of SDHx-related pheochromocytomas and/or paragangliomas patients. Methods Single center, retrospective analysis based on the presence of a SDHx mutation in cases diagnosed from 1986 until October 2016. Results Thirty cases were included. The mean age at diagnosis was 36.8 years (±15.4 years) and 53.3% were females. Remission was observed in 33.3% and stable disease (including partial responses) in 53.0%. SDHC and SDHD patients were prone to develop single and multiple head and neck paragangliomas, respectively. SDHB patients carried an increased risk of malignancy. Deletions in SDHB exon-1 and in SDHD exon-4 were the most common genetic findings. SDHB patients and head and neck paragangliomas had the worse prognosis, the former related to malignancy, and the latter to cranial nerve deficits, unresectable disease, and multimodality interventions. Peptide receptor radionuclide therapy and radioactive iodine MIBG therapy proved to be ineffective. Radiotherapy represented a good alternative in unresectable head and neck paragangliomas and in bone metastases. Conclusion This single center study is the most complete Portuguese cohort in the literature and helps to understand the behavior of tumors based on their genotype and anatomical location.

Genetic analysis of adult Slovenian patients with combined pituitary hormone deficiency Abstract Purpose Among genetic causes of combined pituitary hormone deficiency (CPHD), mutations of genes coding for transcription factors involved in pituitary development have been implicated. Congenital CPHD is a rare disease; therefore, it is important to expand the knowledge about incidence and regional distribution of specific mutations. The aim of this paper is to report results of genetic analyses of adult Slovenian patients with CPHD. Methods Twenty-three adult Slovenian patients with early childhood onset CPHD were included in the study. Blood samples were collected through the GENHYPOPIT network to assess possible mutations of six genes (PROP1/HESX1/LHX4/LHX3/POU1F1) involved in the pituitary development following an established algorithm. Results In seven out of 23 patients (30%) a specific mutation in genes encoding pituitary transcription factors was discovered. In five patients, two different mutations of the PROP1 gene (c.150delA and c.301-302delAG) were identified. One patient was heterozygous for a missense variant in the LHX4 gene. Additionally, one patient was positive for a mutation in the gene coding for prokineticin receptor-2. Conclusions Our study confirms that the two most common mutations of the PROP1 gene globally are also the most frequent mutations in the cohort of adult Slovenian patients with CHPD. Other mutations of pituitary transcription factor genes are extremely rare.

Copeptin relates to a fatty liver and measures of obesity in a South African population with mixed ethnicities Abstract Purpose Elevated copeptin, a vasopressin marker, is linked to metabolic disease, and obese rats with low-vasopressin concentration had a decreased risk of liver steatosis. We here investigated the association between copeptin and nonalcoholic fatty liver disease (NAFLD) and possible differences in copeptin concentration between ethnicities. Methods In this cross-sectional study of 361 South Africans (n = 172 African black, 189 = Caucasian) with a mean age of 45 years and 45% men, plasma copeptin was measured and associated with NAFLD according to a validated fatty liver index accounting for measures of BMI, waist, triglycerides, and gamma-glutamyltransferase. Results There was no significant difference in copeptin concentrations between ethnicities after age and gender adjustment (p = 0.24). Increasing copeptin tertile levels were significantly associated with obesity, overweight, and abdominal obesity, respectively, after multivariate adjustment for age, gender, ethnicity, and high HOMA-IR (p = 0.02 for all). Individuals in the second and third copeptin tertile had an increased odds (95% CI) of NAFLD of 1.77 (1.04–3.02) and 2.97 (1.74–5.06), respectively, compared to the bottom tertile (p < 0.001). The association between increasing copeptin tertile and NAFLD remained significant after adjustment for age, gender, ethnicity, high HOMA-IR, self-reported current alcohol intake, and statin treatment (p = 0.01). Conclusions Elevated plasma copeptin is independently associated with NAFLD in a population with mixed ethnicities, pointing at the pharmacologically modifiable vasopressin system as a new mechanism behind NAFLD.

True MEN1 or phenocopy? Evidence for geno-phenotypic correlations in MEN1 syndrome Abstract Purpose Multiple endocrine neoplasia type 1 is a rare tumor syndrome caused by germline mutations of MEN1 gene. Phenotype varies widely, and no definitive correlation with the genotype has been observed. Mutation-negative patients with MEN1-associated tumors represent phenocopies. By comparing mutation-positive and mutation-negative patients, we aimed to identify phenotype features predictive for a positive genetic test and to evaluate the role of MEN1mutations in phenotype modulation. Methods Mutation screeening of MEN1 gene by Sanger sequencing and assessment of clinical data of 189 consecutively enrolled probands and relatives were performed at our national and European Reference Center. Multiple ligation probe amplification analysis of MEN1 gene and Sanger sequencing of CDKN1B were carried out in clinically suspicious but MEN1-negative cases. Results Twenty-seven probands and twenty family members carried MEN1 mutations. Five mutations have not been described earlier. Pronouncedly high number of phenocopies (>70%) was observed. Clinical suspicion of MEN1 syndrome emerged at significantly earlier age in MEN1-positive compared to MEN1-negative probands. Gastroenteropancreatic neuroendocrine tumors developed significantly earlier and more frequently in carriers compared to non-carriers. Probands with high-impact (frameshift, nonsense, large deletions) mutations, predicted to affect menin function significantly, developed GEP-NETs more frequently compared to low-impact (inframe and missense) mutation carriers. Conclusions MEN1 phenocopy is common and represents a significant confounder for the genetic testing. GEP-NET under 30 years best predicted a MEN1 mutation. The present study thus confirmed a previous proposal and suggested that GEP-NET under 30 years should be considered as a part of the indication criteria for MEN1 mutational analysis.

High-intensity focused ultrasound (HIFU) for benign thyroid nodules: 2-year follow-up results Abstract Background High-intensity focused ultrasound (HIFU) is the last introduced thermal treatment of thyroid nodules. Here we evaluated the results at 24 months after HIFU. Methods Since 2016, HIFU was considered as a therapeutic option at our institute in patients with benign thyroid nodules presenting local symptoms. We searched in our database all patients who had undergone thyroid HIFU and selected for the study only cases followed-up for at least 24 months after the treatment. Volume reduction rate (VRR) was evaluated. A reduction above 50% defined the success of HIFU. Results Thirty-one nodules of 31 patients (24 females and 7 males, median age 67 years) with median major diameter from 17 to 34 mm and estimated nodule volume of 5.48 mL were included. HIFU was performed with median power of 42 W/site (interquartile range 25–45) and median energy of 263 J/site (interquartile range 225–273). Median duration of the procedure was 6 min (interquartile range 5–7). At 2 years after HIFU, nodule volume was significantly (p < 0.0001) lower (i.e., 3.40 mL) with VRR of 43.3%, and 26 (83.9%) lesions were reduced. A reduction by at least 50% was observed at 6, 12, and 24 months in 2 (6.4%), 5 (16.1%), and 7 (22.5%) nodules, respectively. Visual analog score showed a significant improvement (p < 0.0001). No complications were recorded. Conclusions A reduction of benign thyroid nodule by more than 40% could be reached within 1 year by HIFU. Given the non-significant size increase of some lesions later, a larger study with a longer follow-up is necessary.

Abnormal expression of Pappa2 gene may indirectly affect mouse hip development through the IGF signaling pathway Abstract Introduction Developmental dysplasia of the hip (DDH) is a major cause of disability in children, and the genetic mechanism of this disease remains unclear. In our previous study, we found that pregnancy-associated plasma protein-A2 (PAPP-A2) was associated with DDH significantly. Objectives The aim of this study was to investigate the insulin-like growth factor (IGF) expression and collagen synthesis as well as cartilage proliferation-related proteins in the case of abnormal expression of Pappa2 in mice to research the relationship between PAPP-A2 and the pathological changes of DDH. Methods In vivo animal experiments, the mice were directly injected with 50 µl of Cas9/PAPP-A2 sgRNA lentiviruses around the hip to downregulate the Pappa2 gene expression and injected with control lentiviruses on the other side, then to observe the expression and localization of related proteins. And in an in vitro experiment, mice fibroblasts and primary chondrocytes were cultured with insulin-like growth factor binding protein-5 (IGFBP-5) protein, PAPP-A2 protein and Cas9/PAPP-A2 sgRNA lentiviruses to detect of related proteins and mRNA expression. Results Cartilage proliferation-related proteins demonstrated a significant decrease in the PAPP-A2 knockdown hips acetabulum and femoral head cartilage, meanwhile the IGF expression was also downregulated in the soft tissue around the acetabulum compared with the control hips. Furthermore, the role PAPP-A2 played in chondrocytes and fibroblasts was the same as in the in vivo experiments, downregulation of PAPP-A2 expression or upregulation of IGFBP-5 expression can reduce collagen synthesis and cartilage proliferation. Conclusions PAPP-A2 may be involved in the development of the mouse hip joint by interfering the fibrous and cartilaginous metabolism via IGF pathway-associated proteins pathway.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Musculoskeletal Surgery

Minimally invasive plate osteosynthesis (MIPO) in AO/OTA type B displaced clavicle fractures Abstract Introduction Open reduction and plate fixation is known to reduce chances of malunion and symptomatic nonunion in displaced middle-third clavicle fractures. However, this treatment modality is also associated with several complications, such as hardware irritation, numbness around the surgical scar, infection, nonunion and implant failure. The minimally invasive plate osteosynthesis (MIPO) technique may reduce these complications. Objective To study clinical, radiological and functional outcomes of MIPO in AO/OTA type B displaced clavicle fractures and report any complications. Materials and methods A total of 22 patients underwent internal fixation of acute displaced AO/OTA type B clavicle fractures from Jan 2014 to Dec 2015 by MIPO using locking compression plates. Patients were followed up at a regular interval and assessed clinically and radiologically. The clavicle length difference was measured. Functional assessment was done at the end of 2 year using constant shoulder score (CSS) and disability of the arm, shoulder and hand score (Quick DASH) and complications if any were noted. Results All fractures united at a mean of 12.5 weeks. One (4.5%) patient had numbness around the surgical scar. None of the patients had wound-related complications. In four patients, hardware irritation was noted. The difference in clavicle length was not significant. All patients had excellent CSS and Quick DASH score at the final follow-up. Conclusion Internal fixation of displaced AO/OTA type B clavicle fractures by MIPO showed high fracture union rates and good functional outcomes.

Clinical outcomes in periarticular knee fractures with flexible fixation using far cortical locking screws in locking plate: a prospective study Abstract Purpose Periarticular fractures around the knee joint are treated traditionally by locking plates which provide excellent stability but suppress callus formation. Far cortical locking (FCL) screws allow axial motion and enhance uniform callus formation. Our study aims to evaluate the outcomes of FCL screws in traditional locking plate in periarticular fractures of the knee. Methods Thirty patients with periarticular fractures of the knee joint were operated with locking plate using FCL screws. All patients were evaluated clinically and radiographically using X-rays at 6, 12, 24 weeks, 1 year and with CT scan at 12-weeks follow-up. Results The average time for complete union was 20 weeks in tibial fractures and 24 weeks in femur fractures. Average time to full weight bearing ambulation was 4.8 ± 0.93 weeks. One patient had delayed union in which union was complete after 9 months. Conclusion This study shows that FCL screws in locking plates allow uniform callus formation and fracture union with minimal complication rates.

Surgical strategy in extensive proximal brachial plexus palsies Abstract Purpose To describe and assess an overall surgical strategy addressing extensive proximal brachial plexus injuries (BPI). Methods Forty-five consecutive patients’ charts with C5–C6–C7 and C5–C6–C7–C8 BPI were reviewed. Primary procedures were nerve transfers to restore elbow function and grafts to restore shoulder function when a cervical root was available; when nerve surgery was not possible or had failed, tendon transfers were conducted at the elbow while addressing shoulder function with glenohumeral arthrodesis or humeral osteotomy. Tendon transfers were used to restore finger extension. Results Forty-one patients underwent elbow flexion reanimation: thirty-eight had nerve transfers and eight received tendon transfers, including five cases secondary to nerve surgery failure; grade-3 strength or greater was reached in thirty-seven cases (90%). Twenty-nine patients had nerve transfers to restore elbow extension: twenty-five recovered grade-3 or grade-4 strength (86%). Forty-one patients underwent shoulder surgery: fourteen had nerve surgery and thirty-one received palliative procedures, including four cases secondary to nerve surgery failure; thirty patients recovered at least 60° of abduction and rotation (73%). Distal reconstruction was performed in thirty-seven patients, providing finger full extension in all cases but two (95%). Conclusions A standardized strategy may be used in extensive proximal BPI, providing overall satisfactory outcomes.

Passive anterior tibia translation in anterior cruciate ligament-injured, anterior cruciate ligament-reconstructed and healthy knees: a systematic review Abstract Anterior tibia translation (ATT) is mainly prevented by the anterior cruciate ligament. Passive ATT tests are commonly used to diagnose an anterior cruciate ligament (ACL) injury, to select patients for an ACL reconstruction (ACLR), and as an outcome measure after an ACLR. The aim of this review was to present an overview of possible factors determining ATT. A second purpose was to give a summary of the ATT measured in the literature in healthy, ACL-injured and ACLR knees and a comparison between those groups. A literature search was conducted with PubMed. Inclusion criteria were full-text primary studies published in English between January 2006 and October 2016. Studies included reported ATT in explicit data in healthy as well as ACL-injured or ACLR knees or in ACL-injured as well as ACLR knees. Sixty-one articles met inclusion criteria. Two articles measured the ATT in healthy as well as ACL-injured knees, 51 in ACL-injured as well as in ACLR knees, three in ACLR as well as in healthy knees and three in healthy, ACL-injured and ACLR knees. A difference in ATT is found between healthy, contralateral, ACLR and ACL-injured knees and between chronic and acute ACL injury. Graft choices and intra-articular injuries are factors which could affect the ATT. The mean ATT was lowest to highest in ACLR knees using a bone–patella tendon–bone autograft, ACLR knees using a hamstring autograft, contralateral healthy knees, healthy knees, ACLR knees with an allograft and ACL-injured knees. Factors which could affect the ATT are graft choice, ACL injury or reconstruction, intra-articular injuries and whether an ACL injury is chronic or acute. Comparison of ATT between studies should be taken with caution as a high number of different measurement methods are used. To be able to compare studies, more consistency in measuring devices used should be introduced to measuring ATT. The clinical relevance is that an autograft ACLR might give better results than an allograft ACLR as knee laxity is greater when using an allograft tendon. Level of evidence III.

The role of poor oral health in surgical site infection following elective spinal surgery Abstract Study design Cross-sectional study. Objectives To describe oral health and hygiene as a risk factor for surgical site infection (SSI). Methods This cross-sectional study was conducted on patients over 18 years of age who were candidates for elective spinal surgery. The exclusion criteria were immunodeficiency, history of cancer, history of previous infection at the surgical site, cutaneous diseases and long-term use of corticosteroids. Questionnaires were filled out for patients via an interview in order to collect the demographic data of patients. Oral and dental examinations were performed using DMFT (D: decayed, M: missing, F: filled, T: total) and PUFA (P: pulp, U: ulcer, F: fistula, A: abscess) indices. Data were analyzed using Fisher’s exact test and Mann–Whitney test. Results A total of 78 patients were evaluated. There were 59 females (75.6%) and 19 males (24.6%). Eight patients were positive for SSI. Teeth caries (P = 0.016) and periodontal disease (P = 0.049) were significantly correlated with SSI. No significant association was noted between PUFA and SSI (P > 0.05). Sixty-five patients (83.3%) had a history of dental infection before surgery. Fifty% of patients being positive for SSI had a history of dental abscess (P = 0.023). Conclusions A significant association exists between SSI and caries, gingivitis/periodontitis and history of dental abscess.

Tension band wiring versus locking plate fixation for simple, two-part Mayo 2A olecranon fractures: a comparison of post-operative outcomes, complications, reoperations and economics Abstract Purpose Simple displaced transverse olecranon fractures are traditionally managed operatively with a tension band wire device (TBW). We compared clinical outcomes, morbidity and the cost of treatment of TBW versus pre-countered low-profile locking plates for the treatment of Mayo 2A fractures. Patient and methods All olecranon fractures admitted to our unit between 2008 and 2014 were identified (n = 129). Patient notes and radiographs were studied from presentation to final follow-up. Patient outcomes were recorded using the QuickDASH (Disabilities of Arm, Shoulder and Hand) score. Patient demographics and nature of complications were recorded as were the rate and nature of any repeat operation. Results Eighty-nine patients had Mayo 2A fractures (69%). Sixty-four underwent TBW (n = 48) or locking plate fixation (n = 16). The mean ages of both groups were similar at 57 (15–93) and 60 (22–80), respectively. In the TBW group, the mean post-injury QuickDASH was 12.9, compared with 15.0 for the locking plate group. There was no statistically significant difference between the outcomes for either group. Nineteen of the 48 TBW patients had complications (39.6%). Sixteen of the 48 TBW patients had reoperations (33.3%). In particular, we would highlight that 13 (27.1%) of patients treated with TBW underwent subsequent removal of metalwork for hardware irritation. There were no complications and or reoperations in the 16 patients who received locking plate fixation. Both complication and reoperation rates were statistically significantly different. Despite being initially more expensive, when the cost of reoperation for TBW group was included, locking plates were found to be on average £236.33 less per patient than for TBW. Conclusions We suggest that locking plates are superior to TBW concerning post-operative morbidity, reoperation rate and cost for Mayo 2A fractures in contrast to previous articles. Level of evidence Therapeutic study, III.

Minimally invasive fixation for displaced intra-articular fractures of calcaneum: a short-term prospective study on functional and radiological outcome Abstract Introduction Studies have demonstrated a decrease in the incidence of late consequences and the socio-economic burden of intra-articular fractures of calcaneum when treated by surgical fixation. Operative management of displaced intra-articular calcaneal fractures (DIACF) pose significant challenges such as technical difficulty, wound healing and long-term pain and disability. Materials and methods All patients presenting to the ER with DIACF over a period of 2 years and matching the inclusion criteria were enrolled in the study. Percutaneous fixation with 4 mm CC screw was undertaken with a minimally invasive sinus tarsi approach. All patients were available for a minimum follow-up of 24 months. Six radiological parameters were assessed, and functional outcome was evaluated using AOFAS score. Results Thirty-four patients with 42 calcaneal fractures were included in the study, and all patients were available for minimum follow-up period. All radiological parameters were attained within anatomic normal range and maintained at 24 months of follow-up. AOFAS score showed a mean value of 90.10 which is considered an excellent outcome. Superficial wound infection was seen in two patients, but no patients required a revision surgery. Conclusion Displaced intra-articular fractures pose a treatment dilemma, more so in cases of soft tissue complications like open injury or blisters. Percutaneous screw fixation with limited sinus tarsi incision has shown good functional and radiological outcome with minimal complications and can be undertaken without delay.

Reverdin–Isham procedure for mild or moderate hallux valgus: clinical and radiographic outcomes Abstract Background In the last decade, interests in minimal incision surgery have been growing. Theoretically, this kind of procedure could decrease time to recovery and rehabilitation, with a reduction in morbidity. The present study assessed clinical and radiological outcomes and complications of percutaneous surgery for mild-to-moderate hallux valgus using Reverdin–Isham and Akin osteotomies without fixation after 60 months of follow-up. Methods A series of 48 patients (57 cases) with medium-to-moderate hallux valgus underwent the same percutaneous surgery, between 2003 and 2011. Data collection involved preoperative dorsal flexion, plantar flexion, M1P1, M1M2, DMAA angles, AOFAS scale score, and subjective satisfaction. Results AOFAS scale score rose from a preoperative median of 55.9–89.2/100 postoperatively (p < 0.001); 51 surgical procedures (89.5%) were considered as satisfactory or very satisfactory by patients at the end of follow-up. Hallux valgus and distal metatarsal articular angle (DMAA) were significantly reduced (29.3° and 14.1°–15.4° and 7.7°, p < 0.001, respectively). There was a significant increase in MTPJ 1 stiffness (p < 0.001). Discussion Percutaneous correction by Reverdin–Isham and Akin osteotomies seems to be effective in isolated medium-to-moderate hallux valgus. Stiffness observed is comparable to other percutaneous and open procedures but needs to be compared in a randomized controlled clinical trial to extra-articular percutaneous procedures without capsule detachment in association with an internal fixation which allows an early mobilization. Level of clinical evidence IV.

Surgical treatment of pediatric supracondylar humerus fracture could be safely performed by general orthopedists Abstract Purpose Displaced pediatric supracondylar humerus fracture (SCHF) requires a reduction and instrumentation. The trend is to send the cases to a fellowship-trained pediatric orthopedist. This study reviewed the outcomes and complications of SCHF surgically managed by orthopedic surgeons with different backgrounds of subspecialty training. Methods The medical records of 87 children (87 elbows) with an average age of 5.9 ± 3.1 (range 1.3–14.1) years with SCHF Gartland 2 and 3 who underwent operative fixation were reviewed. The demographics data and operative details were obtained. Radiographically, the Baumann and humerocapitella angles were measured. The lateral rotational percentage of Gordon was calculated. The Griffet index 1 and 2 were retrieved. The parameters were compared among groups of surgeons with a pediatric fellowship-trained background and surgeons with other subspecialty training. A univariate analysis was calculated for the risk of postoperative complications. Results The demographics data were comparable between the two groups. Children who were treated by non-pediatric fellowship-trained orthopedists showed higher but not significant degrees of postoperative Baumann angles; however, the proportion of children with an acceptable range of Baumann angle were similar. The overall complications rate was 17.5% and comparable between the two groups. Only SCHF Gartland 3 was associated with complications (P = 0.01). Conclusions Pediatric SCHF could be efficiently managed by a general orthopedic surgeon because the radiographic outcomes and complications were comparable to pediatric fellowship-trained orthopedists. Extra precautions need to be exercised in SCHF Gartland type 3 because the chance of complications is higher among these types of injuries. Level of evidence Level III.

Goldthwait technique for patellar instability: surgery of the past or here to stay procedure? A systematic review of the literature Abstract Patellar instability is the pathologic condition where the patella is prone to recurrent lateral dislocation. The clinical results on large series of patients and long-term outcome of Goldthwait techniques have not been described in the literature. The aim of this systematic review is: (1) to analyze and summarize the available literature focused on Goldthwait procedure in the treatment of recurrent patellar dislocation and (2) to evaluate the clinical and functional outcomes of patients treated with this surgical procedure. A systematic review of the literature was performed to investigate the results of Goldthwait procedure according to the PRISMA 2009 guidelines. A total of 7 articles published were systematically reviewed. A total of 197 knees (182 patients: 86 males and 96 females) have been treated with Goldthwait procedure. The mean reported follow-up was 6.8 years. The mean age at surgery was 18 years old. The Goldthwait procedure was associated with open lateral retinacular release in 127 (64.5%) knees to arthroscopic lateral retinacular release in 20 (10.1%) knees, and with retinacular plasty and a vastus medialis advancement in 33 (16.7%) knees. Only in 17 (8.6%) knees the Goldthwait procedure was performed as an isolated procedure. Poor standardization of methodological assessment has been observed. Despite the limitations of the available literature, the Goldthwait technique provides satisfying results for the treatment of patellar instability even in pediatric population. More high-quality studies are necessary to evaluate the long-term complications and the real incidence of long-term PF osteoarthritis.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Cardiology

Electrical Storm: Current Evidence, Clinical Implications, and Future Perspectives Abstract Purpose of Review Electrical storm (ES) is a life-threatening medical emergency of repetitive episodes of sustained ventricular arrhythmias within a short period. Its occurrence is associated with poor short- and long-term survival, even in patients with implantable cardioverter defibrillators (ICD). Management of ES is challenging and mainly based on retrospective studies. This article reviews the existing literature on ES, presents the available data regarding its management, and proposes a new algorithm based on current evidence. Recent Findings Recent research could modify the management of ES supporting the role of non-selective β1 and β2 blockade and the early intervention with catheter ablation as well as strengthening the role of cardiac sympathetic denervation. Summary A multipronged approach should be considered for the management of ES including identification and correction of reversible causes, ICD reprogramming, drug therapy (beta-blockers—especially non-selective ones—and other anti-arrhythmic drugs) and non-pharmacologic therapies such as catheter ablation and techniques of neuroaxial modulation. Although current data suggest early aggressive management, further research is required to clarify the optimal order and combination of therapies for the prevention of future events.

Do Thiazide Diuretics Increase the Risk of Skin Cancer? A Critical Review of the Scientific Evidence and Updated Meta-Analysis Abstract Purpose of Review We reviewed the hypothesised mechanisms of skin cancerogenesis for thiazide diuretics; conducted an updated meta-analysis of studies focusing on their association with skin cancer risk; critically appraised the quality of available studies and identified knowledge gaps; and discussed implications for health professionals and patients. Recent Findings Thiazide diuretics possess well-described photosensitizing properties and a causal association with skin cancer is biologically plausible. The epidemiological evidence is stronger for squamous cell cancer; however, diversity in design among studies, methodological concerns potentially affecting the validity of results, and scarcity of data on dose-relation relationship suggest caution in drawing conclusions. Only few, unbalanced, and/or heterogeneous data exist to date for melanoma and basal cell cancer. Summary Patients effectively treated with thiazide diuretics are currently not advised to stop treatment, but encouraged to limit exposure to sunlight and regularly check their skin. While endorsing these recommendations, we believe that well-designed studies are urgently needed to overcome persistent knowledge gaps.

Current Role of the CardioMEMS Device for Management of Patients with Heart Failure Abstract Purpose of Review Heart failure (HF) remains a significant burden to our healthcare system and a leading cause of hospitalizations. Current reactive strategies to treat and manage HF have failed to reduce hospitalizations and improve survival. The CardioMEMS device has recently been demonstrated to improve quality of life in HF and reduce HF-related hospitalizations. Current HF management strategies are reviewed with a particular emphasis on the current role of the CardioMEMS device. Recent Findings The CHAMPION trial is the only randomized trial looking at the CardioMEMS device. Patients managed with targeted pulmonary artery pressures resulted in 28% reduction in the primary end-point of HF-related hospitalization at 6 months (HR 0.72, 95% CI 0.60–0.85, p = 0.0002) and 37% reduction during the entire follow-up period, which averaged 15 months (HR 0.63, 95% CI 0.52–0.77, p < 0.0001). The prospective open-label post-approval study recently presented a 58% reduction in HF hospitalizations per patient year (HR 0.42, 95% CI 0.38–0.47, p < 0.0001). Summary Management of HF using the CardioMEMS device has been shown to reduce HF hospitalizations and improve quality of life regardless of ejection fraction. Patients best suited for this device are those with recurrent congestive symptoms despite optimal medical therapy.

Strategies for Appropriate Selection of SGLT2-i vs. GLP1-RA in Persons with Diabetes and Cardiovascular Disease Abstract Purpose of Review This review will serve to highlight the clinical rationale used in the selection of sodium-glucose cotransporter 2 inhibitors (SGLT2-i) or glucagon-like peptide 1 receptor agonists (GLP1-ra). Recent Findings SGLT2-i and GLP1-ra are the first anti-hyperglycemics to demonstrate significant cardiovascular benefit in multiple cardiovascular outcomes trials (CVOTs), with benefits that are consistent across class of medication. Summary Diabetes is a major risk factor for morbidity and mortality from cardiovascular disease. Sodium-glucose cotransporter 2 inhibitors (SGLT2-i) and glucagon-like peptide 1 receptor agonists (GLP1-ra) are the first anti-hyperglycemics to demonstrate significant cardiovascular benefit. Given the unique side effect and benefit profiles, appropriate consideration of these agents with a focus on cardiovascular risk reduction requires an individualized approach.

The Challenges of Redo Aortic Coarctation Repair in Adults Abstract Purpose of Review Aortic coarctation is a common congenital abnormality causing significant morbidity and mortality if not corrected. Re-coarctation or restenosis of the aorta following treatment is a relatively common long-term problem and the optimal therapy has not been elucidated. In this review, we identify the challenges associated with and the optimal management for recurrent aortic coarctation and the most appropriate therapy for different patient cohorts. Recent Findings Open surgery provides a durable long-term aortic repair, however, given the complex nature of the procedure, has a somewhat higher rate of serious complications. Endovascular repair, although less invasive and relatively safe, has limitations in treated complex anatomy and is more likely to require repeat intervention. Summary Open surgical repair is more appropriate for infants that have not been intervened on and endovascular therapy should be reserved for older children and adults and those that require repeat intervention.

Imaging Strategies for Evaluating Low-Flow, Low-Gradient Aortic Stenosis with Reduced and Preserved Left Ventricular Ejection Fraction Abstract Purpose of Review Aortic stenosis (AS) is one of the most common valvular heart diseases, and aortic valve replacement (AVR) provides both symptomatic and survival benefit in symptomatic severe AS patients. The purpose of this review is to discuss low-flow low-gradient AS which is still a challenging diagnostic entity. Recent Findings Thirty–forty percent of patients with AS have low flow which makes it difficult to differentiate truly severe AS that benefits from AVR compared to pseudo-severe AS which is currently managed conservatively. Patients with low-flow low-gradient AS (LF-LG AS) include those with reduced left ventricular systolic function (classical LF-LG AS) and those with preserved left ventricular systolic function (paradoxical LF-LG AS). Low-dose dobutamine stress echocardiography (DSE) helps to identify truly severe stenosis in patients with classical LF-LG AS. Aortic valve calcium scoring with multidetector computed tomography plays a major role in patients with paradoxical LF-LG AS and also among classical LF-LG AS patients who have reduced contractile reserve on DSE. Summary This article will provide an overview of imaging strategies for evaluating LF-LG AS with reduced and preserved left ventricular ejection fraction.

Stroke Risk in Atrial Fibrillation: Beyond the CHA 2 DS 2 -VASc Score Abstract Purpose of Review Stroke prevention is the cornerstone of atrial fibrillation (AF) management and the anticoagulation decision is currently based on CHA2DS2-VASc risk score. We discuss several novel risk factors besides those included in CHA2DS2-VASc score and alternative models for stroke prediction. Recent Findings Several clinical markers including obstructive sleep apnea and renal failure, laboratory markers like brain natriuretic peptide, imaging criteria including left atrial appendage morphology, spontaneous echo contrast, and coronary artery calcium score may predict stroke in AF patients. Addition of African American ethnicity to CHA2DS2-VASc score also improves stroke prediction in AF. Finally, novel models including TIMI-AF score, ATRIA score, and GARFIELD-AF scores have potential roles in risk stratification for stroke. Summary While CHA2DS2-VASc score is the currently recommended risk stratification model for stroke prediction in AF, use of additional clinical, laboratory, imaging markers, ethnicity, and novel stroke prediction models may further assist in decision to anticoagulate the AF patient for stroke prevention.

Effectiveness of Changes in Diet Composition on Reducing the Incidence of Cardiovascular Disease Abstract Purpose of Review To highlight dietary changes shown to be associated with a lower risk of cardiovascular events in epidemiological studies and that have been proven to be effective in preventing cardiovascular diseases in clinical trials Recent Findings Since dietary changes always involve multiple variables, recent observational and intervention studies on dietary prevention of cardiovascular disease focus not only to the limitation of a single nutrient/food intake but also to the other dietary changes implemented to replace it. Summary The available evidence supports three major dietary strategies for cardiovascular disease prevention: (1) the replacement of saturated fat with unsaturated fat and/or fiber-rich carbohydrate foods; (2) the reduction of salt intake; (3) the implementation of dietary patterns resembling the traditional Mediterranean diet. This support derives not only from RCTs but also from the combination of large observational cohort studies and relatively short-term randomized trials on cardiovascular risk factors.

Cardiac Magnetic Resonance Fingerprinting: Technical Developments and Initial Clinical Validation Abstract Purpose of Review Magnetic resonance imaging (MRI) has enabled non-invasive myocardial tissue characterization in a wide range of cardiovascular diseases by quantifying several tissue specific parameters such as T1, T2, and T2* relaxation times. Simultaneous assessment of these parameters has recently gained interest to potentially improve diagnostic accuracy and enable further understanding of the underlying disease. However, these quantitative maps are usually acquired sequentially and are not necessarily co-registered, making multi-parametric analysis challenging. Magnetic resonance fingerprinting (MRF) has been recently introduced to unify and streamline parametric mapping into a single simultaneous, multi-parametric, fully co-registered, and efficient scan. Feasibility of cardiac MRF has been demonstrated and initial clinical validation studies are ongoing. Provide an overview of the cardiac MRF framework, recent technical developments and initial undergoing clinical validation. Recent Findings Cardiac MRF has enabled the acquisition of co-registered T1 and T2 maps in a single, efficient scan. Initial results demonstrate feasibility of cardiac MRF in healthy subjects and small patient cohorts. Current in vivo results show a small bias and comparable precision in T1 and T2 with respect to conventional clinical parametric mapping approaches. This bias may be explained by several confounding factors such as magnetization transfer and field inhomogeneities, which are currently not included in the cardiac MRF model. Initial clinical validation for cardiac MRF has demonstrated good reproducibility in healthy subjects and heart transplant patients, reduced artifacts in inflammatory cardiomyopathy patients and good differentiation between hypertrophic cardiomyopathy and healthy controls. Summary Cardiac MRF has emerged as a novel technique for simultaneous, multi-parametric, and co-registered mapping of different tissue parameters. Initial efforts have focused on enabling T1, T2, and fat quantification; however this approach has the potential of enabling quantification of several other parameters (such as T2*, diffusion, perfusion, and flow) from a single scan. Initial results in healthy subjects and patients are promising, thus further clinical validation is now warranted.

Contributions of Interactions Between Lifestyle and Genetics on Coronary Artery Disease Risk Abstract Purpose of the Review To summarize current knowledge on interactions between genetic variants and lifestyle factors (G×L) associated with the development of coronary artery disease (CAD) and prioritize future research. Recent Findings Genetic risk and combined lifestyle factors and behaviors have a log-additive effect on the risk of developing CAD. Summary First, we describe genetic and lifestyle factors associated with CAD and then focus on G×L interactions. The majority of G×L interaction studies are small-scale candidate gene studies that lack replication and therefore provide spurious results. Only a few studies, of which most use genetic risk scores or genome-wide approaches to test interactions, are robust in number and analysis strategy. These studies provide evidence for the existence of G×L interactions in the development of CAD. Further G×L interactions studies are important as they contribute to our understanding of disease pathophysiology and possibly provide insights for improving interventions or personalized recommendations.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Morphology of the Middle Ear Ossicles in the Rodent Perimys (Neoepiblemidae) and a Comprehensive Anatomical…
Morphology of the Middle Ear Ossicles in the Rodent Perimys (Neoepiblemidae) and a Comprehensive Anatomical and Morphometric Study of the Phylogenetic Transformations of these Structures in CaviomorphsAbstractThe extinct clade of caviomorph rodents Neoepiblemidae includes forms that lived in South America from the early Miocene to Pliocene. Among them is Perimys. The exceptional preservation of ear ossicles in this rodent is described and analyzed in a study of the phylogenetic transformations of…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:41

Dual PPARα/γ agonist aleglitazar confers stroke protection in a model of mild focal brain ischemia…
Dual PPARα/γ agonist aleglitazar confers stroke protection in a model of mild focal brain ischemia …..in miceAbstractPeroxisome proliferator-activated receptors (PPARs) control the expression of genes involved in glucose homeostasis, lipid metabolism, inflammation, and cell differentiation. Here, we analyzed the effects of aleglitazar, a dual PPARα and PPARγ agonist with balanced affinity for either subtype, on subacute stroke outcome. Healthy young adult mice were subjected to transient 30 min…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:38

Thermo mammogram as a tool to assess response to neoadjuvant chemotherapy in breast carcinoma Subbiah…
Thermo mammogram as a tool to assess response to neoadjuvant chemotherapy in breast carcinomaSubbiah Shanmugam, Gopu Govindasamy, Sujay Susikar, Muniasamy PalaniyandiIndian Journal of Medical and Paediatric Oncology 2019 40(5):25-32Introduction: Response to neoadjuvant chemotherapy (NACT) is predicted by clinical examination alone in locally advanced breast carcinoma. This study uses thermo mammogram (TMG) to assess the response. Aim and Objectives: The aim is to study TMG changes during NACT in…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:37

Head and neck squamous cell carcinoma in young adults: A hospital-based study Jagannath Dev Sharma,…
Head and neck squamous cell carcinoma in young adults: A hospital-based studyJagannath Dev Sharma, Nizara Baishya, Amal Chandra Kataki, Chandi Ram Kalita, Ashok Kumar Das, Tashnin RahmanIndian Journal of Medical and Paediatric Oncology 2019 40(5):18-22Background: Head and neck cancers (HNCs) account for 30% of all cancers in India. In north eastern India, tobacco-related cancers are very common because of the widespread use of tobacco. The paucity of any study from this region in young head and neck…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:36

Coalescence Models Reveal the Rise of the White-Bellied Rat ( Niviventer confucianus ) Following the…
Coalescence Models Reveal the Rise of the White-Bellied Rat ( Niviventer confucianus ) Following the Loss of Asian MegafaunaAbstractRodents are the major remaining mammals in many terrestrial ecosystems after the historical loss of megafauna and large-bodied taxa. Niviventer confucianus is a dominant habitat generalist in natural forests in most of China. It is also recorded as an important vector of diverse zoonotic diseases. Here, three mitochondrial and one nuclear DNA fragments were sequenced…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:36

Introduction to the multi-author review on methylation in cellular physiology Abstract Protein post-translational…
Introduction to the multi-author review on methylation in cellular physiologyAbstractProtein post-translational modifications (PTMs) have long been a topic of intensive investigation. Covalent additions to the 20 genetically encoded amino acids can alter protein interactions and can even change enzymatic function. In eukarya, PTMs can amplify both the complexity and functional paradigms of the cellular environment. Therefore, PTMs have been of substantial research interest, both for understanding…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:35

Avoiding Brooms, Forks, and Butterflies in the Linear Lattices Abstract Let n be a positive integer, q a…
Avoiding Brooms, Forks, and Butterflies in the Linear LatticesAbstractLet n be a positive integer, q a power of a prime, and \(\mathcal {L}_{n}({q})\) the poset of subspaces of an n-dimensional vector space over a field with q elements. This poset is a normalized matching poset and the set of subspaces of dimension ⌊n/2⌋ or those of dimension ⌈n/2⌉ are the only maximum-sized antichains in this poset. Strengthening this well-known and celebrated result, we show that, except in the case of \(\mathcal…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:35

Elevated expression of CST1 promotes breast cancer progression and predicts a poor prognosis In Figure…
Elevated expression of CST1 promotes breast cancer progression and predicts a poor prognosisIn Figure 7f the panel for c-myc of MDA-MB-468 was erroneously duplicated. The corrected version of the figure is shown in this paper. This correction does not influence the conclusion of the study and we sincerely apologize for this oversight.Correction to: STIM1 deficiency is linked to Alzheimer’s disease and triggers cell death in SH-SY5Y cells by upregulation of L-type voltage-operated Ca 2+ entryThe original…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:32

Bone marrow infiltration by nonhematopoetic small round cell tumors: A clinicopathological study from…
Bone marrow infiltration by nonhematopoetic small round cell tumors: A clinicopathological study from a tertiary care centre in South IndiaTriveni Bhopal, Abid Hussain, Sai Mallikarjun, Sree Lakshmi, Sudha SinhaIndian Journal of Medical and Paediatric Oncology 2019 40(5):1-5Objectives: The objective of this study to comprehensively analyze bone marrow (BM) infiltration by nonhematological round cell tumors. Materials and Methods: A total of 206 diagnosed cases of small round blue cell tumors (excluding…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:31

Inferring the history of surname Ye based on Y chromosome high-resolution genotyping and sequencing…
Inferring the history of surname Ye based on Y chromosome high-resolution genotyping and sequencing dataZhen Zeng, Jiaoyang Tian, Chuangui Jiang, Weijian Ye, Kaijun Liu et al. Journal of Human Genetics 2019 64 :703 – 709; May 15, 2019; 10.1038/s10038-019-0616-2Abstract | Full TextClinical and genetic analysis of patients with primary ciliary dyskinesia caused by novel DNAAF3 mutationsZhuoyao Guo, Weicheng Chen, Jianfeng Huang, Libo Wang & Liling Qian Journal of Human Genetics 2019 64 :711 – 719;…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:29

National Cancer Institute theNCI25 JulRT @NCIDrDougLowy: At @theNCI we are training the next generation…
National Cancer Institute theNCI25 JulRT @NCIDrDougLowy: At @theNCI we are training the next generation of cancer researchers—both in our intramural program and by funding train…Details | RetweetNational Cancer Institute theNCI25 JulA program called #NCICONNECT from @NIHBrainTumor aims to study 12 rare brain and spine tumors to improve approaches… https://t.co/xQeSRnX6jTDetails | RetweetNational Cancer Institute theNCI24 JulNeuroblastoma is a cancer of immature nerve cells that most often occurs…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:27

First-in-human gene therapy launches for pediatric patient with rare neurogenerative disease In May,…
First-in-human gene therapy launches for pediatric patient with rare neurogenerative disease In May, a ten-year-old girl named JoJo received gene therapy for an extremely rare neurogenerative disease called GM1 gangliosidosis. GM1 progressively destroys nerve cells (neurons) in the brain and spinal cord, leading to muscle and movement weakness, difficulty swallowing and a shortened life expectancy.

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:16

Fermentative Escherichia coli makes a substantial contribution to H2 production in coculture with phototrophicRhodopseudomonas…
Fermentative Escherichia coli makes a substantial contribution to H2 production in coculture with phototrophicRhodopseudomonas palustris Amee A Sangani; Alexandra L McCully; Breah LaSarre ; James B McKinlay

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:15

Case fatality ratio estimates for the 2013 – 2016 West African Ebola epidemic: application of Boosted…
Case fatality ratio estimates for the 2013 – 2016 West African Ebola epidemic: application of Boosted Regression Trees for imputation Alpha Forna, MSc ; Pierre Nouvellet, PhD; Ilaria Dorigatti, PhD; Christl A Donnelly, ScD Plazomicin: A New Aminoglycoside Louis D Saravolatz, MD, MACP, FIDSA; Gary E Stein, PharmD

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:15

Notes on Church-State Affairs David W Hendon; Scott Prather
Notes on Church-State Affairs David W Hendon; Scott Prather

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:15

Space as Testimony: Collecting Oral Histories Among Nigerian Seamen Lynn Schler
Space as Testimony: Collecting Oral Histories Among Nigerian Seamen Lynn Schler

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:14

Unity and Plurality. Logic, Philosophy, and Linguistics Riccardo Baratella The Possibility of Unity H…
Unity and Plurality. Logic, Philosophy, and Linguistics Riccardo Baratella The Possibility of Unity H W Noonan Manipulated Agents: A Window to Moral Responsibility Taylor W Cyr Working from Within: The Nature and Development of Quine’s Naturalism Ali Hossein Khani Deflating Deflationary Truthmaking Jamin Asay; Sam Baron Determined by Reasons: A Competence Account of Acting for a Normative Reason J J Cunningham

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:14

Fanconi anemia study using eltrombopag Volunteers at least 4 years of age with Fanconi anemia are…
Fanconi anemia study using eltrombopagVolunteers at least 4 years of age with Fanconi anemia are needed for a research study.Fanconi anemia is a rare genetic disorder that mostly affects children and often leads to bone marrow failure. Researchers at the National Institutes of Health (NIH) are investigating a new drug to improve blood counts in individuals diagnosed with Fanconi anemia. Eltrombopag is an oral drug that mimics a special protein that causes the body to make more platelets. Currently…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:13

Comparison of Original and 2018 Lake Louise Criteria for Diagnosis of Acute Myocarditis: Results…
Comparison of Original and 2018 Lake Louise Criteria for Diagnosis of Acute Myocarditis: Results of a Validation Cohort The 2018 Lake Louise criteria provide a high diagnostic accuracy for the diagnosis of acute myocarditis and significantly increase the sensitivity compared with the original score. Julian A. Luetkens, Anton Faron… Daniel Thomas

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:13

Realizing Shared Decision-making in Practice Mary Catherine Beach, MD, MPH; Jeremy Sugarman, MD,…
Realizing Shared Decision-making in Practice Mary Catherine Beach, MD, MPH; Jeremy Sugarman, MD, MPH, MAHarms From Uninformative Clinical TrialsDeborah A. Zarin, MD; Steven N. Goodman, MD, MHS, PhD; Jonathan Kimmelman, PhDShared Decision Making and the Importance of Time

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:12

JAMA Otolaryngology–Head & Neck Surgery
ORIGINAL INVESTIGATIONAssociation Between Annual Surgeon Total Thyroidectomy Volume and Transient and Permanent ComplicationsCharles Meltzer, MD; Michaela Hull, MS; Alvina Sundang, MBA; et alComparison of 3- vs 2-Dimensional Endoscopy Using Eye Tracking and Assessment of Cognitive Load Among Surgeons Performing Endoscopic Ear SurgeryLukas Anschuetz, MD; Laura Niederhauser, MSc; Wilhelm Wimmer, PhD; et alREVIEWAssociation of Preoperative, Subjective Pediatric Tonsil Size With Tonsillectomy Outcomes: A…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:11

Serious Bacterial Infections in Neonates Presenting Afebrile With History of Fever Sriram Ramgopal,…
Serious Bacterial Infections in Neonates Presenting Afebrile With History of Fever Sriram Ramgopal, Lorne W. Walker, Melissa M. Tavarez, Andrew J. Nowalk and Melissa A. VitaleMonthly FeatureThe Fight Over the Juvenile Giant: Contesting Growth in the 1930sSamuel V. SchotlandQuality ReportUsing Quality Improvement to Implement a Standardized Approach to Neonatal Herpes Simplex VirusLaura H. Brower, Paria M. Wilson, Eileen Murtagh Kurowski, David Haslam, Joshua Courter, Neera Goyal, Michelle Durling,…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:09

Impact of an Outpatient Cardiology-managed Urgent Access and Observation Unit on Hospital Admissions…
Impact of an Outpatient Cardiology-managed Urgent Access and Observation Unit on Hospital AdmissionsIntroduction: Alternatives to the emergency department (ED) for expedient and high-value team-based cardiology care for patients with chest pain, volume overload, palpitations, and other urgent, but not life-threatening cardiac conditions are lacking. Here, we report on the development of the Cardiac Direct Access Unit (CDAc), an ambulatory cardiology unit with exam rooms, observation bays, and an…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:04

Negative priming is diminished under high blood pressure in healthy subjects Abstract The ability to…
Negative priming is diminished under high blood pressure in healthy subjectsAbstractThe ability to ignore distracting objects is a core mechanism in selective attention and has been analyzed particularly with respect to its clinical implications (e.g., depression, schizophrenia, or unhealthy life-style). Here, we investigated the correlation between an established experimental task to measure distractor-processing and participants’ blood pressure. We used the negative priming (NP) task in which participants…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:03

Strategic cooperation for transnational adaptation: lessons from the economics of climate change mitigation…
Strategic cooperation for transnational adaptation: lessons from the economics of climate change mitigationAbstractThe literature on climate adaptation has so far conceptualized it as a domestic issue, to be governed somewhere between the local and the national scale. By contrast, scholars have shown little interest in exploring the case of cross-boundary adaptation spillovers, where adaptation by one country affects other countries. Two decades of the economic literature on climate mitigation may…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:03

Design of a synthetic miniR1 plasmid and its production by engineered Escherichia coli Abstract A synthetic…
Design of a synthetic miniR1 plasmid and its production by engineered Escherichia coliAbstractA synthetic plasmid consisting of the minimal elements for replication control of the R1 replicon and kanamycin resistance marker, which was named pminiR1, was developed. pminiR1 production was tested at 30 °C under aerobic and microaerobic conditions in Escherichia coli W3110 recA− (W1). The plasmid DNA yields from biomass (YpDNA/X) were only 0.06 ± 0.02 and 0.22 ± 0.11 mg/g under aerobic and microaerobic…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:02

White Matter Lesion Penumbra Shows Abnormalities on Structural and Physiologic MRIs in the Coronary…
White Matter Lesion Penumbra Shows Abnormalities on Structural and Physiologic MRIs in the Coronary Artery Risk Development in Young Adults CohortI.M. Nasrallah, M.-K. Hsieh, G. Erus, H. Battapady, S. Dolui, J.A. Detre, L.J. Launer, D.R. Jacobs, C. Davatzikos and R.N. BryanAJNR Am J Neuroradiol first published on 25 July 2019 doi:10.3174/ajnr.A6119 OPEN ACCESS ARTICLEhttp://www.ajnr.org/content/early/2019/07/25/ajnr.A6119.abstractSignal Hyperintensity on Unenhanced T1-Weighted Brain and Cervical…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:02

Shiraz Organ Transplant Center: The Largest Liver Transplant Center in the World No abstract available…
Shiraz Organ Transplant Center: The Largest Liver Transplant Center in the WorldNo abstract availableResearch HighlightsNo abstract availableB Cell Recruitment Follows Kidney Injury and Maladaptive RepairNo abstract availablePeople in TransplantationNo abstract availableVisual Abstracts (#VisualAbstract): A New Journal Initiative to Disseminate ResearchNo abstract availableOrgans From Executed People Are Not a Source of Scientific DiscoveryNo abstract availablePatient Selection and Ethical Considerations—Justifying…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:01

Does Women’s Health Matter? No abstract available Restriction in Pelvis and Trunk Motion in Postpartum…
Does Women’s Health Matter?No abstract availableRestriction in Pelvis and Trunk Motion in Postpartum Runners Compared With Pre-pregnancyBackground: Biomechanical changes in gait during pregnancy have been well studied in walking but not in running. Objective: To specifically examine adaptations in running biomechanics pre- to post-pregnancy, especially in the pelvis and trunk. Study Design: Pilot study. Methods: Five regular runners who were pregnant for the first time participated in this study….

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

09:00

Vegetarian Diet Patterns and Chronic Disease Risk: What We Know and What We Don’t Vegetarianism continues…
Vegetarian Diet Patterns and Chronic Disease Risk: What We Know and What We Don’tVegetarianism continues to increase globally due, in part, to perceived health benefits. Results from observational studies indicate that vegetarian dietary patterns are associated with favorable cardiometabolic risk factor profiles and lower risks of chronic diseases including obesity, diabetes mellitus type 2, cardiovascular disease, and cancer. Aside from avoidance of meat and the compensatory dietary alterations,…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:59

Trauma
Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled TrialObjective: To assess the safety and efficacy of tranexamic acid (TXA) use in fractures of the pelvic ring, acetabulum, and proximal femur. Design: Prospective, randomized controlled trial. Setting: Single Level 1 trauma center. Patients: Forty-seven patients were randomized to the study group, and 46 patients comprised the control group. Intervention:…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:57

Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum,…
Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled TrialObjective: To assess the safety and efficacy of tranexamic acid (TXA) use in fractures of the pelvic ring, acetabulum, and proximal femur. Design: Prospective, randomized controlled trial. Setting: Single Level 1 trauma center. Patients: Forty-seven patients were randomized to the study group, and 46 patients comprised the control group. Intervention:…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:57

Toward Achieving Risk-Appropriate Maternity Care: Maternal Morbidity Prediction No abstract available…
Toward Achieving Risk-Appropriate Maternity Care: Maternal Morbidity PredictionNo abstract availablePredictive Model of Factors Associated With Maternal Intensive Care Unit AdmissionOBJECTIVE: Severe maternal morbidity has increased in the United States over the past two decades by approximately 200%, to 144 cases per 10,000 delivery hospitalizations. There are limited data available to assist in identifying at-risk women before parturition. We sought to evaluate risk factors associated with maternal…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:56

Breast Reconstruction
Fat Grafting and the Palpable Breast Mass in Implant-Based Breast Reconstruction: Incidence and ImplicationsBackground: Fat grafting is a powerful and increasingly used technique in breast reconstruction. However, fat necrosis can lead to palpable postoperative changes that can induce anxiety and lead to unplanned diagnostic studies. The authors’ aim in this study was to evaluate the incidence, type, and timing of these unanticipated studies; the specialty of the ordering provider; and the factors…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:54

Plastic and Reconstructive Surgery
Pediatric/Craniofacial Article: Focus of Live Facebook #PRSJournalClub Q&ASurvival Following Self-inflicted Gunshots to the FaceSpecial Topic Article with an Expert DiscussionThe Use of Emotional Artificial Intelligence in Plastic SurgeryCosmetic Article Featured in the PressAppreciation of Postpartum Changes of the Rectus Muscles in Primary and Re-Do AbdominoplastyHead and Neck Article Featured in a Plastic Surgery Hot Topic VideoFacial Transplantation for an Irreparable Central and Lower Face…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:53

Fat Grafting and the Palpable Breast Mass in Implant-Based Breast Reconstruction: Incidence and Implications…
Fat Grafting and the Palpable Breast Mass in Implant-Based Breast Reconstruction: Incidence and ImplicationsBackground: Fat grafting is a powerful and increasingly used technique in breast reconstruction. However, fat necrosis can lead to palpable postoperative changes that can induce anxiety and lead to unplanned diagnostic studies. The authors’ aim in this study was to evaluate the incidence, type, and timing of these unanticipated studies; the specialty of the ordering provider; and the factors…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:53

Prolyl Tripeptidylpeptidase Yoshitaka Nakajima, … Tadashi Yoshimoto, in Handbook of Proteolytic…
Prolyl Tripeptidylpeptidase Yoshitaka Nakajima, … Tadashi Yoshimoto, in Handbook of Proteolytic Enzymes (Third Edition), 2013Biological AspectsPorphyromonas gingivalis is a Gram-negative anaerobic bacteriumand is considered to be a major pathogen associated with periodontitis. Since this bacterium is known to be a very poor carbohydrate utilizer and cannot take up free amino acids, it only utilizes short oligopeptides as carbon and energy sources. P. gingivalis produces gingipains R and K, collagenase,…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:50

Rheumatoid Arthritis and Infections Hussein Mahajna, … Howard Amital, in Infection and Autoimmunity…
Rheumatoid Arthritis and Infections Hussein Mahajna, … Howard Amital, in Infection and Autoimmunity (Second Edition), 2015Gingival infection caused by is another that is associated with RA. It is postulated that this microbe causes a citrullination process in human proteins that leads to a cascade causing autoimmunity.26Periodontitis, in which P. gingivalis is a major pathogenic bacterium, has been linked to RA in epidemiological studies, and they share similar genomic and environmental associations….

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:49

Karilysin Jan Potempa, … Abdulkarim Y. Karim, in Handbook of Proteolytic Enzymes (Third Edition),…
Karilysin Jan Potempa, … Abdulkarim Y. Karim, in Handbook of Proteolytic Enzymes (Third Edition), 2013Name and HistoryTannerella forsythia (formerly Bacteroides forsythus), together withand Treponema denticola, are considered to be the major periodontal pathogens [1]. A common feature of these organisms is the production of high levels of proteolytic activity. This activity is considered an important virulence factor contributing to pathological chronic inflammation, which drives tissue damage…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:49

Metallocarboxypeptidase G (Porphyromonas gingivalis) Yu-Yen Chen, … Eric C. Reynolds, in Handbook…
Metallocarboxypeptidase G (Porphyromonas gingivalis) Yu-Yen Chen, … Eric C. Reynolds, in Handbook of Proteolytic Enzymes (Third Edition), 2013Name and HistoryThe first isolated carboxypeptidase from Porphyromonas gingivaliswas reported in 2002 by two independent research groups. Masuda et al. [1] reported the isolation of ‘Arg carboxypeptidase’ (RCP) from strain W381, which was resolved by SDS-PAGE into three major bands of 43, 33 and 32 kDa with identical N-terminal amino acid sequences (YEWNAYPTYEAYISMMEEFQTKYPSLXTXS)….

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:49

Acute orofacial pain Yair Sharav, Rafael Benoliel, in Orofacial Pain and Headache, 2008Pathophysiology…
Acute orofacial pain Yair Sharav, Rafael Benoliel, in Orofacial Pain and Headache, 2008PathophysiologyHigh prevalences of putative periodontal pathogens including Fusobacterium nucleatum, Peptostreptococcus micros, Porphyromonas gingivalis, Prevotella intermedia and Bacteroides forsythus were found in periodontal abscesses (Herrera et al 2000a).Significant differences in the levels of prostaglandin E2 (PGE2) and LTB4 were found between patients with and without periodontitis. The PGE2 and LTB4 levels…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:48

Phage therapy against Enterococcus faecalis in dental root canals
J Oral Microbiol. 2016; 8: 10.3402/jom.v8.32157.Published online 2016 Sep 16. doi: 10.3402/jom.v8.32157PMCID: PMC5027333PMID: 27640530Leron Khalifa,1 Mor Shlezinger,2 Shaul Beyth,3 Yael Houri-Haddad,2 Shunit Coppenhagen-Glazer,1 Nurit Beyth,2,†and Ronen Hazan1,*†Author information Article notes Copyright and License information Disclaimer1Institute of Dental Science, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel2Department of Prosthodontics, The Hebrew University Hadassah…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:47

Bilateral intermittent nasal obstruction in adolescent rats leads to the growth defects of mandibular…
Bilateral intermittent nasal obstruction in adolescent rats leads to the growth defects of mandibular condyle Publication date: October 2019Source: Archives of Oral Biology, Volume 106Author(s): Xiaoling Wang, Huijun Sun, Yanfei Zhu, Yanmei Tang, Xiaochen Xue, Ping Nie, Min Zhu, Bing WangAbstractObjectiveThis study aimed to evaluate the effects of nasal obstruction on mandibular growth, especially condyle, in adolescent rats and explore the possible mechanism with a focus on mesenchymal stem cells…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:45

Porphyromonas gingivalis: An Overview of Periodontopathic Pathogen below the Gum Line, Kah Yan How,1,* Keang…
Porphyromonas gingivalis: An Overview of Periodontopathic Pathogen below the Gum Line, Kah Yan How,1,* Keang Peng Song,2 and Kok Gan Chan1Author information Article notes Copyright and License information Disclaimer1Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia2School of Science, Monash University Sunway Campus, Subang Jaya, MalaysiaEdited by: Laurel L. Lenz, University of Colorado School of Medicine,…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:44

Porphyromonas gingivalis lipopolysaccharide promotes T- helper 17 cell differentiation from human CD4+ naïve…
Porphyromonas gingivalis lipopolysaccharide promotes T- helper 17 cell differentiation from human CD4+ naïve T cells via toll-like receptor-2 in vitroPublication date: November 2019Source: Archives of Oral Biology, Volume 107Author(s): Liping Zhang, Li Gao, Chenrong Xu, Xiting Li, Panpan Wang, Chi Zhang, Chuanjiang ZhaoAbstractObjectivesThe persistence of T-helper 17 (Th17) cells has been shown to support chronic inflammation and mediate tissue destruction in periodontitis. However, little is known…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:40

Carabid community stability is enhanced by carabid diversity but reduced by aridity in Chinese steppes…
Carabid community stability is enhanced by carabid diversity but reduced by aridity in Chinese steppesPublication date: August 2019Source: Acta Oecologica, Volume 99Author(s): Noelline Tsafack, Letizia Di Biase, Yingzhong Xie, Xinpu Wang, Simone FattoriniAbstractCarabids (Coleoptera, Carabidae) are an important arthropod component of grassland ecosystems, where they are involved in many important ecosystem services. Grasslands are the most widespread ecosystems in China, where they are under increasing…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:38

Brain tissue segmentation using improved kernelized rough-fuzzy C-means with spatio-contextual information…
Brain tissue segmentation using improved kernelized rough-fuzzy C-means with spatio-contextual information from MRIPublication date: October 2019Source: Magnetic Resonance Imaging, Volume 62Author(s): Anindya Halder, Nur Alom TalukdarAbstractSegmentation of brain tissues from MRI often becomes crucial to properly investigate any region of the brain in order to detect abnormalities. However, the accurate segmentation of the brain tissues is a challenging task as the different tissue regions are usually…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:38

Thoughts and Words

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:37

Health of asylum-seeking immigrants: Providing medical care from a volunteer’s perspective No abstract…
Health of asylum-seeking immigrants: Providing medical care from a volunteer’s perspectiveNo abstract availableUsing pharmacogenetics in primary carePharmacogenetics offers a way to personalize medication prescribing for patients. Through the use of genetic tests that identify variations in enzymes important to drug metabolism, PAs can have patients’ genetic information before prescribing a medication. This may reduce the risks of adverse reactions and lost treatment time when patients are given…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

08:34

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
A comparison of the academic performance and intelligence scores of asthmatic and nonasthmatic primary…A comparison of the academic performance and intelligence scores of asthmatic and nonasthmatic primary school pupils in Enugu State, NigeriaObinna Chukwuebuka NduagubamNigerian Medical Journal 2019 60(1):1-8Background: Children with asthma (subjects), just as their non asthmatic colleagues, are expected to perform optimally academically and with a good intelligent score. A number of activities…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

Thu Jul 25, 2019 12:51

Urogynecology
Commentary to: Prospective comparative study on the effects of lidocaine on urodynamic and sensory parameters in bladder-pain syndromeCommentary on: "Does spinal anesthesia lead to postoperative urinary retention in same day urogynecology surgery: a retrospective review"Treatment of subacute rectosigmoid obstruction secondary to uterosacral ligament suspensionThe transition from resident to consultantA live porcine model for robotic sacrocolpopexy trainingAbstractIntroduction and hypothesisRobotic…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

Thu Jul 25, 2019 09:18

Clinical Oncology,Pediatric Hematology/Oncology
Maintenance Therapy in Metastatic Solid Tumors: Innovative Strategy or Simple Second-line Treatment?Managing metastatic diseases involves defining the best strategy that is supposed to take into account both efficacy and quality of life. To this end, clinicians use stop and go or maintenance strategies. As a matter of fact, 2 maintenance strategies can be distinguished: continuation maintenance using a drug already present in induction treatment and switch maintenance with a newly introduced drug….

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

Thu Jul 25, 2019 09:12

Clinical Rheumatology
Folate Supplementation for Methotrexate Therapy in Patients With Rheumatoid Arthritis: A Systematic ReviewObjective To review the evidence for benefits and harms of folate (folic acid or folinic acid) supplementation on methotrexate (MTX) treatment for rheumatoid arthritis (RA), to assess whether or not folate supplementation would reduce MTX toxicity or reduce MTX benefits, and to decide whether a higher MTX dosage is essential. Methods We performed a sensitive search strategy and searched systematically…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

Thu Jul 25, 2019 09:04

Clinical Obstetrics and Gynecology
Contributors: Burnout and Resilience in Obstetrics and GynecologyNo abstract availableForeword: Burnout and Resilience in Obstetrics and GynecologyNo abstract availableBurnout in Obstetricians and GynecologistsProfessional burnout threatens all high-functioning professionals and affects not only the individual, but, by extension, the patients they serve. The characteristics that make someone competitive for medical school, residency, or successful in academics or practice, make us particularly vulnerable…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

Thu Jul 25, 2019 09:03

Implant Dentistry
Device Legislation…… Now Tread CautiouslyNo abstract availableThe Sinus Bone Graft— Third Edition 2019No abstract availableRidge Architecture Preservation Following Minimally Traumatic Exodontia Techniques and Guided Tissue RegenerationObjective: To compare hard-tissue healing after 3 exodontia approaches. Materials and Methods: Premolars of dogs were extracted: (1) flapless, (2) flap, and (3) flap + socket coverage with polytetrafluoroethylene (dPTFE) nonresorbable membrane (flap + dPTFE). Animals…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

Thu Jul 25, 2019 09:00

Dermatologic Surgery
Use of Autologous, Noncultured Melanocyte–Keratinocyte Transplantation in Patients With Stable Genital LeucodermaNo abstract availableA Closure Option for Sinuous Hairline Preservation on the Upper ForeheadNo abstract availableSharp Debulking and Nonbeveled Layers in Mohs Micrographic Surgery, A Video Walkthrough: How We Do ItNo abstract availableVulvar Lichen Sclerosus: Consider Treatment With Heterologous Type I CollagenNo abstract availableEfficacy, Patient-Reported Outcomes, and Safety in Male…

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,

Thu Jul 25, 2019 08:55

Trauma

Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled Trial Objective: To assess the safety and efficacy of tranexamic acid (TXA) use in fractures of the pelvic ring, acetabulum, and proximal femur. Design: Prospective, randomized controlled trial. Setting: Single Level 1 trauma center. Patients: Forty-seven patients were randomized to the study group, and 46 patients comprised the control group. Intervention: The study group received 15 mg/kg IV TXA before incision and a second identical dose 3 hours after the initial dose. Main Outcome Measurements: Transfusion rates and total blood loss (TBL) [via hemoglobin-dilution method and rates of venous thromboembolic events (VTEs)]. Results: TBL was significantly higher in the control group (TXA = 952 mL, no TXA = 1325 mL, P = 0.028). The total transfusion rates between the TXA and control groups were not significantly different (TXA 1.51, no TXA = 1.17, P = 0.41). There were no significant differences between the TXA and control groups in inpatient VTE events (P = 0.57). Conclusion: The use of TXA in high-energy fractures of the pelvis, acetabulum, and femur significantly decreased calculated TBL but did not decrease overall transfusion rates. TXA did not increase the rate of VTE. Further study is warranted before making broad recommendations for the use of TXA in these fractures. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Validation of PROMIS Physical Function Instruments in Patients With an Orthopaedic Trauma to a Lower Extremity Objectives: To evaluate the reliability, convergent validity, known-groups validity, and responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility Computer Adaptive Test (CAT) and PROMIS Physical Function 8a Short Form. Design: Prospective cohort study. Setting: Two Level-I trauma centers. Patients: Eligible adults with an isolated lower extremity trauma injury receiving treatment were approached consecutively (n = 402 consented at time 1, median = 80 days after treatment). After 6 months, 122 (30.3%) completed another assessment. Intervention: Cross-sectional and longitudinal monitoring of patients. Main Outcome Measurements: Floor and ceiling effects, reliability (marginal reliability and Cronbach’s alpha), convergent validity, known-groups discriminant validity (weight-bearing status and fracture severity), and responsiveness (Cohen’s d effect size) were evaluated for the PROMIS Mobility CAT, PROMIS Physical Function 8a Short Form, and 5 other measures of physical function. Results: PROMIS PFSF8a and Foot and Ankle Ability Measure Activities of Daily Living Index had ceiling effects. Both PROMIS measures demonstrated excellent internal consistency reliability (mean marginal reliability 0.94 and 0.96; Cronbach’s alpha = 0.96). Convergent validity was supported by high correlations with other measures of physical function (r = 0.70–0.87). Known-groups validity by weight-bearing status and fracture severity was supported as was responsiveness (Mobility CAT effect size = 0.81; Physical Function Short Form 8a = 0.88). Conclusions: The PROMIS Mobility CAT and Physical Function 8a Short Form demonstrated reliability, convergent and known-groups discriminant validity, and responsiveness in a sample of patients with a lower extremity orthopaedic trauma injury.

A Randomized Controlled Trial Comparing rhBMP-2/Absorbable Collagen Sponge Versus Autograft for the Treatment of Tibia Fractures With Critical Size Defects Objectives: To compare radiographic union of tibia fractures with bone defects treated with recombinant bone morphogenetic protein‐2 (rhBMP‐2) with allograft to autogenous iliac crest bone graft (ICBG). Design: FDA-regulated multicenter randomized trial. Setting: Sixteen US trauma centers. Patients/Participants: Thirty patients (18–65 years of age) with Type II, IIIA, or IIIB open tibia fracture and bone defect treated with an intramedullary nail. Intervention: rhBMP-2 (n = 16) versus ICBG (n = 14). Main Outcome Measurements: Radiographic union within 52 weeks. Secondary outcomes included clinical healing, patient-reported function, major complications, and treatment cost. Equivalence was evaluated by testing whether a 90% two‐sided confidence interval for the difference in the probability of radiographic union between rhBMP‐2 or ICBG is contained with the interval [220% to +20%]. A post hoc Bayesian analysis, using data from a previous trial, was also conducted. Results: Twenty-three patients had union data at 52 weeks: 7/12 (58.3%) rhBMP-2 were radiographically united compared with 9/11 (81.8%) ICBG, resulting in a treatment difference of −0.23 (90% CI: −0.55 to 0.10). Patients treated with rhBMP-2 had lower rates of clinical healing at 52 weeks (27% vs. 54%), higher mean Short Musculoskeletal Function Assessment scores (dysfunction: 33.3 vs. 23.7; bother score: 32.8 vs. 21.4) and experienced more complications (5 vs. 3). Mean treatment cost for rhBMP-2 was estimated at $14,155 versus $9086 for ICBG. Conclusions: These data do not provide sufficient evidence to conclude that ICBG and rhBMP-2 are equivalent regarding radiographic union. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Extreme Nailing: Is It Safe to Allow Immediate Weightbearing After Intramedullary Nail Fixation of Extra-articular Distal Tibial Fractures (OTA/AO 43-A)? Objectives: To determine whether immediate weightbearing after intramedullary (IM) fixation of extra-articular distal tibial fractures (OTA/AO 43-A) results in a change in alignment before healing. Design: Retrospective review. Setting: Level 1 trauma center. Intervention: IM nailing of distal tibial fractures. Patients/Participants: Fifty-three patients with 54 fractures, all of whom could bear weight as tolerated postoperatively. Eighteen fractures were OTA/AO 43-A1, 20 OTA/AO 43-A2, and 16 OTA/AO 43-A3; 20 fractures were open. Main Outcome Measurements: Change in fracture alignment or loss of position. Results: Average change from initial angulation at final follow-up was 0.52 ± 1.49 degrees of valgus and 0.48 ± 3.14 degrees of extension. Final alignment was excellent in 14, acceptable in 28, and poor in 12; 2 fractures went from acceptable initial alignment to poor final alignment; and 2 fractures went from excellent to acceptable alignment. Seven fractures had an improvement in alignment over time. Two fractures required free-flap coverage and 4 required staged grafting because of bone loss. Ten fractures had an unplanned return to the operating room (5 for infected nonunion requiring implant exchange, 3 for infection requiring debridement without implant revision, and 2 for aseptic nonunion). No patient had revision for implant failure. Conclusions: Immediate weightbearing after IM fixation of extra-articular distal tibial fractures (OTA/AO 43-A) led to minimal change in alignment and seems to be safe for most patients. Complications were consistent with those reported in previous non-weightbearing cohorts. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Importance of Syndesmotic Reduction on Clinical Outcome After Syndesmosis Injuries Objectives: To evaluate the relationship between syndesmosis reduction and outcome. Design: Retrospective cohort study. Setting: One Level 1 and 1 Level 3 Trauma Center. Patients: Ninety-seven patients with syndesmosis injury. Intervention: Stabilization of syndesmosis injury. Open reduction and internal fixation of malleolar fracture, if present. Main Outcome Measurements: Anterior, central, and posterior measures of syndesmosis width on computed tomography scans, Olerud–Molander Ankle score, American Orthopaedic Foot and American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score, and range of motion measurements. Results: Eighty-seven patients completed 2 years of follow-up. The difference in anterior tibiofibular distance (aTFD) between the injured and noninjured ankle postoperatively had a significant effect on the Olerud-Molander Ankle score after 6 weeks [b = −2.6, 95% confidence interval (CI), −4.8 to −0.4; P = 0.02], 1 year (b = −2.7, 95% CI, −4.7 to −0.8; P < 0.001), and 2 years (b = −2.6, 95% CI, −4.6 to −0.6; P = 0.009) and on American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score after 6 weeks (b = −2.2, 95% CI, −3.7 to −0.7; P = 0.004), 1 year (b = −1.7, 95% CI, −3.0 to −0.4; P = 0.04), and 2 years (b = −1.9, 95% CI, −3.2 to −0.5; P = 0.006). The effect of computed tomography measurements on range of motion was inconsistent. Receiver operating characteristic (ROC) curves demonstrated that aTFD had adequate discriminatory performance (area under the ROC curve ≥ 0.7) 1 and 2 years after surgery and the central measurement at only 2 years after surgery. ROC analyses indicate a cutoff value for syndesmosis malreduction of 2 mm. The postoperative rate of malreduction was 32%. Conclusions: The aTFD correlated with clinical outcome. A 2-mm difference in aTFD seems to predict poorer clinical outcome. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Quantification of Postoperative Posterior Malleolar Fragment Reduction Using 3-Dimensional Computed Tomography (Q3DCT) Determines Outcome in a Prospective Pilot Study of Patients With Rotational Type Ankle Fractures Objective: To correlate Q3DCT measurements of residual step-off, gap, and 3D multidirectional displacement of postoperative posterior malleolar fracture fragment reduction in patients with rotational type ankle fractures, with patients’ clinical outcome using standardized patient- and physician-based outcome measures. Design: Prospective cohort study. Setting: Level-I Trauma Center. Patients: Thirty-one patients with ankle fractures including a posterior malleolar fracture (OTA/AO type 44) were included. Intervention: All patients underwent open reduction internal fixation of their ankle fracture, of which 18 patients (58%) had direct fixation of the posterior malleolar fragment. Decision of (direct) fixation of the posterior malleolar fragment was not standardized and guided by surgeons’ preference. Main Outcome Measurements: Quality of postoperative reduction was quantified using Q3DCT: posterior fragment size (% of joint surface), residual step-off (mm), postoperative gaps (mm2), and overall multidirectional displacement were quantified. Foot and Ankle Outcome Score pain and symptoms subscales and quality of life (Short Form-36) at 1 year postoperatively were included as the main outcome measures. Results: Step-off (mean 0.6 mm, range 0.0–2.7, SD 0.8) showed a significant correlation with worse Foot and Ankle Outcome Score pain and symptoms subscales. Residual fracture gap (mean 12.6 mm2, range 0.0–68.8, SD 19.5) and 3D multidirectional displacement (mean 0.96 mm, range 0.0–2.8, SD 0.8) showed no correlation. Conclusions: In patients with rotational type ankle fractures involving a posterior malleolar fracture, contemporary Q3DCT measurements of posterior fragment size and residual intra-articular step-off—but not gap—show significant correlation with patient-reported pain and symptoms. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Biomechanical Analysis of Instability in Rotational Distal Fibula Fractures (OTA/AO 44-B1) With an Intact Deltoid Ligament Objectives: To biomechanically analyze instability in supination external rotation (SER) II/III patterns. Methods: Nineteen cadaver legs were tested in a mechanical jig. One, 2, 3, and 4 Nm of external rotation were applied to intact ankles, SER II injuries, and SER III injuries. The talar position relative to the tibia was recorded using 3D motion tracking. Change from the unloaded state in each condition and the torque level was calculated. Results were analyzed using analysis of variance with post hoc paired t tests. Results: SER II showed statistically significant differences from the intact state with coronal translation (2, 3, and 4 Nm), sagittal translation (1 and 2 Nm), axial rotation (1, 2, 3, and 4 Nm), and coronal rotation (3 and 4 Nm). SER III showed statistically significant differences from the intact state with coronal translation (2, 3, and 4 Nm), sagittal translation (1, 2, and 3 Nm), axial rotation (1, 2, 3, and 4 Nm), and coronal rotation (3 and 4 Nm). SER II and SER III differed significantly from each other with coronal translation (1, 2, and 3 Nm), axial rotation (2, 3, and 4 Nm), and coronal rotation (1, 3, and 4 Nm). Conclusion: Instability in SER injuries has only been described with coronal translation and suggests that deltoid rupture is necessary. Our data demonstrate instability in SER II/III in sagittal translation and axial rotation as well as subtle instability in coronal translation. The clinical impact is unclear, but better understanding of long-term sequelae of this instability is needed.

Hook Plate Fixation for Acute Unstable Distal Clavicle Fracture: A Systematic Review and Meta-analysis Objectives: To compare the outcome of hook plate fixation with other techniques in surgical fixation of acute unstable distal clavicle fractures. Data Sources: In July 2018, a systematic search of electronic databases (PubMed, Medline, Embase, and Cochrane databases for systematic reviews) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Articles were limited to English language. Study Selection: Studies were included if they compared the results of hook plate fixation of acute unstable distal clavicle fracture in adults with other surgical techniques. Data Extraction: Data on the study setting, functional outcome, union, and complication rates were extracted. A quality assessment was performed using the Newcastle–Ottawa Scale. Data Synthesis: Eleven studies were found that met the inclusion criteria. Six hundred thirty-four patients were pooled using a random effects model. There were 397 male and 237 female patients. Primary outcome measure was functional result, and the secondary outcome measures were union and complication rates. There was no significant difference between the functional outcome and union rate between hook plate fixation, coracoclavicular (CC) stabilization, and locking plate fixation. Hook plate fixation resulted in a higher Constant–Murley score compared with tension band wiring (TBW) [odds ratio (OR), 3.52; 95% confidence interval (CI), 0.79–6.26]. It was also associated with a higher complication rate compared with CC stabilization (OR, 3.68; 95% CI, 1.19–11.33) and the locking plate (OR, 5.19; 95% CI, 1.58–17.06). Compared with TBW, hook plate fixation was associated with a lower complication rate (OR, 0.28; 95% CI, 0.10–0.77). Conclusions: Hook plate fixation achieves a similar functional outcome and union rate compared with CC stabilization and locking plate fixation. However, it has a superior functional result compared with TBW. The complication rate is higher compared with CC stabilization and locking plate fixation and is lower compared with TBW. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Treatment Discrepancy for Pelvic Fracture Patients With Urethral Injuries: A Survey of Orthopaedic and Urologic Surgeons Objectives: In patients with traumatic pelvic fracture urethral injuries (PFUI), the interaction between urethral management and orthopaedic decision making remains unknown. We aimed to survey orthopaedic and urologic surgeons to assess interdisciplinary interactions in the management of PFUI. Methods: An anonymous cross-sectional survey of members of the Orthopaedic Trauma Association (OTA) and the Society of Genitourinary Reconstructive Surgeons (GURS) was conducted between September 2017 and August 2018. Participants were queried regarding the impact of urethral injuries and their management on orthopaedic operative decision making. Results: Fifty-three GURS and 64 OTA members responded (17% response rate). For urethral injury management, 73% of OTA respondents preferred that suprapubic tubes (SPTs) were not placed for urethral injury management, whereas 43% of GURS respondents preferred SPTs (P = 0.08). Ninety-two percent of OTA respondents stated that SPTs increase hardware infection risks in patients undergoing pelvic open reduction with internal fixation (ORIF), whereas only 8% of GURS respondents agreed (P < 0.01). Although 66% of GURS respondents reported not considering the operative plans of orthopaedics when determining urethral management, 75% of OTA respondents reported that they were less inclined to proceed with ORIF, and 70% would perform external fixation in the setting of an SPT, despite 78% believing that this resulted in an inferior outcome for the patient. Conclusions: There is discordance between urologists and orthopaedists as to the optimal management of PFUI patients, with significant disagreement regarding the infectious risks of SPT in the setting of ORIF. Improved data and interdisciplinary dialogue are required to maximize patient outcomes. Level of Evidence: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

Delaying Surgery in Type III Supracondylar Humerus Fractures Does Not Lead to Longer Surgical Times or More Difficult Reduction Objective: To determine if delay in surgical treatment of type III supracondylar humerus fracture would affect the length of operative time. Design: Retrospective cohort study. Setting: Level 1 trauma center. Patients/Participants: This is a series of 309 modified Gartland type III supracondylar fractures treated operatively from 2011 to 2013. Intervention: Fifteen hours was defined as the cutoff between early and delayed treatment. A total of 53.7% (166/309) fractures were treated early, and 46.4% (143/309) were delayed. Main Outcome Measurements: Surgical time was defined as “incision start” to “incision close.” Fluoroscopy time was used as a surrogate for difficulty of reduction. Results: Time from injury to operating room was shorter for high-energy fractures (fractures with soft-tissue or neurovascular injury) versus low-energy fractures (12.9 vs. 15.3 hours, P < 0.0001); however, surgical time (37.3 vs. 31.8 minutes, P = 0.004) and fluoroscopy time (54.6 vs. 48.6 seconds, P = 0.027) were longer in high-energy fractures versus low-energy fractures. Among low-energy fractures, no significant difference was detected in the surgical time between the early and delayed treatment groups or in the fluoroscopy time. In addition, there was no statistically significant difference found in the surgical or fluoroscopy time with the presence of a surgical assistant. Conclusions: Delay in surgery did not result in a longer surgical time or more difficult reduction for type III supracondylar humerus fracture. Patients with low-energy fractures still underwent a shorter operative time even with delay from injury to surgery. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled Trial
Clay A. Spitler, Elliot R. Row, Warren E. Gardner, II, Rachel E. Swafford, Michael J. Hankins, Peter J. Nowotarski, Dirk W. Kiner

Validation of PROMIS Physical Function Instruments in Patients With an Orthopaedic Trauma to a Lower Extremity
Nan E. Rothrock, Aaron J. Kaat, Mark S. Vrahas, Robert V. O’Toole, Sarah K. Buono, Suzanne Morrison, Richard C. Gershon

A Randomized Controlled Trial Comparing rhBMP-2/Absorbable Collagen Sponge Versus Autograft for the Treatment of Tibia Fractures With Critical Size Defects
The Major Extremity Trauma Research Consortium (METRC)

Extreme Nailing: Is It Safe to Allow Immediate Weightbearing After Intramedullary Nail Fixation of Extra-articular Distal Tibial Fractures (OTA/AO 43-A)?
Michael J. Beebe, Michael Morwood, Rafael Serrano, Jonathan H. Quade, Darryl A. Auston, David T. Watson, Roy W. Sanders, Hassan R. Mir

Importance of Syndesmotic Reduction on Clinical Outcome After Syndesmosis Injuries
Mette R. Andersen, Lien M. Diep, Frede Frihagen, Johan Castberg Hellund, Jan E. Madsen, Wender Figved

Quantification of Postoperative Posterior Malleolar Fragment Reduction Using 3-Dimensional Computed Tomography (Q3DCT) Determines Outcome in a Prospective Pilot Study of Patients With Rotational Type Ankle Fractures
Diederik T. Meijer, Robert-Jan O. de Muinck Keizer, Sjoerd A. S. Stufkens, Tim Schepers, Inger N. Sierevelt, Gino M. M. J. Kerkhoffs, J. Carel Goslings, Job N. Doornberg

Biomechanical Analysis of Instability in Rotational Distal Fibula Fractures (OTA/AO 44-B1) With an Intact Deltoid Ligament
Eric Hempen, Bennet Butler, Mauricio Barbosa, Muturi Muriuki, Robert Havey, Anish Kadakia

Delaying Surgery in Type III Supracondylar Humerus Fractures Does Not Lead to Longer Surgical Times or More Difficult Reduction
Pooja Prabhakar, Christine A. Ho

Evaluating the Utility of Follow-up Radiographs for Isolated Radial Head Fractures Undergoing Initial Nonoperative Treatment
Amy K. Fenoglio, Andrew R. Stephens, Chong Zhang, Angela P. Presson, Andrew R. Tyser, Nikolas H. Kazmers

Nonunited Lower Extremity Fractures Initially Repaired Outside the Developed Western World Develop a High Rate of Postoperative Complications After Nonunion Repair
Kurtis D. Carlock, Kyle R. Hildebrandt, Sanjit R. Konda, Kenneth A. Egol

Radiographic Evaluation of Bone Remodeling Around Osseointegration Implants Among Transfemoral Amputees
Seamus Thomson, Alasdair Thomson, Kevin Tetsworth, William Lu, Hala Zreiqat, Munjed Al Muderis

Drilling Technique Can Minimize Plunging
Anthony Ding, Meir Marmor

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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Correlation between ki-67 labeling index and mitotic index in oral squamous cell carcinoma Archana…
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11q23 translocation in children with acute lymphocytic leukemia following primary response to chemotherapy:…
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HIV estimates through 2018: data for decision making, Background: Global targets call for a reduction…
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Changes in Fatigue Are the Same for Trained Men and Women after Resistance Exercise, Purpose To measure…
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Kasr AL-Ainy’s psoriasis unit protocol for the treatment of psoriasis, part II: biological therapies…
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Moving Towards Wellness in Long-term Care: Considerations for Dementia-Associated Aggression, Abstract…
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NEUROLOGICAL HEALTH The Role of Seizures in Alzheimer’s Disease Is Gaining Overdue Attention,PUBLIC…
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18m

Semiotics of Animals in Culture Zoosemiotics 2.0
Front MatterPages i-viPDFIntroduction: Towards Zoosemiotics 2.0Gianfranco MarronePages 1-18Animal as Food, Food for AnimalsFront MatterPages 19-19PDFWhen to Eat Meat? Toward a Diet of CaringNicola PerulloPages 21-32Anti-speciesist RhetoricMatteo MeschiariPages 33-41Aesthetics of Nutrition, Ethics of Animality: The Packaging of Vegan and Vegetarian Products in the Italian Organised Distribution MarketIlaria Ventura BordencaPages 43-54Forms of Animality: The DogDario ManganoPages 55-72Pet Food Communication:…

Αλέξανδρος Γ. Σφακιανάκης

24m

A Biosemiotic Ontology The Philosophy of Giorgio Prodi
IntroductionFelice CimattiPages 1-4LifeFelice CimattiPages 5-13Scientist Because Philosopher, Philosopher Because ScientistFelice CimattiPages 15-22The Line and the CircleFelice CimattiPages 23-34The Biological Model: For an Anti-Cartesian SemioticsFelice CimattiPages 35-48PDFFrom Complementarity to SemiosisFelice CimattiPages 49-68The Origin of LanguageFelice CimattiPages 69-80Attention and ConsciousnessFelice CimattiPages 81-88Breaking the CircleFelice CimattiPages 89-97Language and EthicsFelice…

Αλέξανδρος Γ. Σφακιανάκης

25m

Biosemiotics of Mimicry: Introductory Notes Timo Maran Pages 1-10 First Excursion: The History of…
Biosemiotics of Mimicry: Introductory NotesTimo MaranPages 1-10First Excursion: The History of the Mimicry ConceptTimo MaranPages 11-13The Structure of MimicryTimo MaranPages 15-34PDFSemiotics of MimicryTimo MaranPages 35-53Iconicity and MimicryTimo MaranPages 55-63Second Excursion: Importance of the ObjectTimo MaranPages 65-67Different Perspectives in Mimicry SystemTimo MaranPages 69-82Modelling MimicryTimo MaranPages 83-99Mimicry and Semiotic EvolutionTimo MaranPages 101-117Third Excursion: An…

Αλέξανδρος Γ. Σφακιανάκης

26m

Key Book Series: Biosemiotics Biosemiotics Series Editors: Kalevi Kull, Alexei Sharov, Jesper Hoffmeyer…
Key Book Series: Biosemiotics Biosemiotics Series Editors: Kalevi Kull, Alexei Sharov, Jesper HoffmeyerThe Springer book series Biosemiotics draws together contributions from leading scholars. It is an unparalleled series that will appeal to all those interested in the origins and evolution of life, including molecular and evolutionary biologists, ecologists, anthropologists, psychologists, philosophers and historians of science, linguists, semioticians and researchers in artificial life, information…

Αλέξανδρος Γ. Σφακιανάκης

26m

Kidney palliative care can help meet gaps in care A care program combining palliative care with…
Kidney palliative care can help meet gaps in care A care program combining palliative care with nephrology care in an ambulatory setting has the potential to meet gaps in care and achieving patient satisfaction, according to a study in Journal of Palliative Medicine. Jennifer S. Scherer, MD, at New York University School of Medicine, was the lead author of a study involving 55 patients most with stage IV or V chronic kidney disease. Eighty-seven percent of initial visits included an advance care…

Αλέξανδρος Γ. Σφακιανάκης

27m

WHO withdraws opioid guidance as groups urge revisions The World Health Organization (WHO) has withdrawn…
WHO withdraws opioid guidance as groups urge revisions The World Health Organization (WHO) has withdrawn two pain management guidelines, citing new scientific evidence since the guidelines were released in 2011 and 2012. In a statement WHO acknowledged the need for opioids but also that the need must be balanced with concerns about harm and misuse of the drugs. The organization withdrew the guidelines after two members of the U.S. Congress released a report accusing the WHO guidelines of having…

Αλέξανδρος Γ. Σφακιανάκης

28m

Inpatient palliative care patients often return to hospital Patients discharged from an inpatient…
Inpatient palliative care patients often return to hospital Patients discharged from an inpatient palliative care unit with a poor prognosis and limited survival often return to the hospital or emergency department, even though they have supports in place, according to a study in Journal of Palliative Medicine. Colleen Webber, PhD, at the Ottawa Hospital Research Institute in Ontario, Canada, was the lead author for the retrospective cohort study of medical records for 75 patients at one institution….

Αλέξανδρος Γ. Σφακιανάκης

28m

Antibacterial activity of new atraumatic restorative treatment materials incorporated with Azadirachta…
Antibacterial activity of new atraumatic restorative treatment materials incorporated with Azadirachta indica (Neem) against Streptococcus mutansPublication date: October–December 2019Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 4Author(s): P. Divya Kumari, Shilpa M. Shenoy, Shahnawaz Khijmatgar, Avidyuti Chowdhury, Edward Lynch, Chitta R. ChowdhuryAbstractBackgroundThe antibacterial property of new atraumatic restorative treatment (ART) materials incorporated with Azadirachta…

Αλέξανδρος Γ. Σφακιανάκης

29m

A cone beam computed tomographic analysis of the greater palatine foramen
in a cohort of Sri LankansPublication date: October–December 2019Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 4Author(s): Manil C.N. Fonseka, P.V.Kalani S. Hettiarachchi, Rasika M. Jayasinghe, Ruwan D. Jayasinghe, C. Deepthi NanayakkaraAbstractObjectivesTo determine the size and position of the Greater Palatine Foramen using CBCTMaterials and methodGPF was evaluated on 50 CBCT’s which were obtained at the Division of Oral Medicine and Radiology, FDS, University of Peradeniya,…

Αλέξανδρος Γ. Σφακιανάκης

30m

Proposed clinical definition for oral submucous fibrosis Publication date: October–December 2019 Source: Journal…
Proposed clinical definition for oral submucous fibrosis Publication date: October–December 2019Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 4Author(s): Chandramani B. More, Naman R. RaoAbstractOral Submucous Fibrosis (OSMF) is an insidious, chronic, complex, crippling, debilitating, irreversible, progressive, scarring, potentially malignant and collagen metabolic disorder, induced by a known carcinogen areca nut; wherein the oral mucosa, and occasionally the pharynx…

Αλέξανδρος Γ. Σφακιανάκης

30m

The interrelationship between urinary cotinine and nicotine dependence among tobacco users in an Indian…
The interrelationship between urinary cotinine and nicotine dependence among tobacco users in an Indian de-addiction centre: A cohort pilot studyPublication date: October–December 2019Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 4Author(s): Nalini M. Vinoth Kumar, Shahnawaz Khijmatgar, Avidyuti Chowdhury, Martin Gootveld, Edward Lynch, Chitta ChowdhuryFactors influencing fluoride release in atraumatic restorative treatment (ART) materials: A reviewPublication date: October–December…

Αλέξανδρος Γ. Σφακιανάκης

31m

Patient Recruitment in Radiation Therapy Research: An Evaluation of Local Challenges Publication date:…
Patient Recruitment in Radiation Therapy Research: An Evaluation of Local ChallengesPublication date: Available online 18 July 2019Source: Journal of Medical Imaging and Radiation SciencesAuthor(s): Yobelli Alexandra Jimenez, Rachael Beldham-Collins, Sarah Jayne LewisAbstractIntroductionLocally-initiated research studies in radiation therapy (RT) aim to substantiate clinical processes and are an effective approach to gather evidence for advances in patient care, new techniques, and protocols. The…

Αλέξανδρος Γ. Σφακιανάκης

31m

Certain Textured Breast Implants by Allergan: Safety Communication – Due to an Increased Risk of Breast…
Certain Textured Breast Implants by Allergan: Safety Communication – Due to an Increased Risk of Breast Implant-Associated Anaplastic Large Cell LymphomaAUDIENCE: Patient, Consumer, Health Professional, Surgery, Risk ManagerISSUE: The FDA requested that Allergan recall all BIOCELL textured breast implants and tissue expanders marketed in the U.S. based on newly submitted Medical Device Reports (MDRs) reporting worldwide cases of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)…

Αλέξανδρος Γ. Σφακιανάκης

32m

Population Health: The Diabetes Educator’s Evolving Role Teresa L. Pearson, MS, RN, CDE, FAADE, Joan…
Population Health: The Diabetes Educator’s Evolving RoleTeresa L. Pearson, MS, RN, CDE, FAADE, Joan Bardsley, MBA, RN, CDE, FAADE, Susan Weiner, MS, RDN, CDE, FAADE, Leslie Kolb, MBA, RN, BSNFirst Published June 23, 2019; pp. 333–348AbstractHide PreviewPurposeThe US health care system’s focus on high-quality, efficient, and cost-effective care has led payers and provider groups to identify new models with a shift toward value-based care. This perspective on clinical practice describes the population…

Αλέξανδρος Γ. Σφακιανάκης

33m

Challenges to Diabetes Self-Management in Emerging Adults With Type 1 Diabetes Neesha Ramchandani, PNP,…
Challenges to Diabetes Self-Management in Emerging Adults With Type 1 DiabetesNeesha Ramchandani, PNP, CDE, Niobe Way, EdD, Gail D’Eramo Melkus, EdD, C-NP, FAAN, Susan Sullivan-Bolyai, DNSc, CNS, RN, FAANhttps://doi.org/10.1177/0145721719861349 | First Published July 13, 2019AbstractHide PreviewPurposeThe purpose of this qualitative descriptive study undergirded by Meleis’s Transition Framework was to explore developmental, situational, and organizational challenges experienced by a diverse group…

Αλέξανδρος Γ. Σφακιανάκης

34m

C57BL/6 congenic mouse NRASQ61K melanoma cell lines are highly sensitive to the combination of Mek…
C57BL/6 congenic mouse NRASQ61K melanoma cell lines are highly sensitive to the combination of Mek and Akt inhibitors in vitro and in vivo, Valérie Petit, Jeremy Raymond, Christophe Alberti, Marie Pouteaux, Stuart J. Gallagher, Mai Q. Nguyen, Andrew E. Aplin, Véronique Delmas, Lionel LarueVersion of Record online: 15 July 2019

Αλέξανδρος Γ. Σφακιανάκης

37m

Osteoblasts contribute to a protective niche that supports melanoma cell proliferation and survival, Jennifer…
Osteoblasts contribute to a protective niche that supports melanoma cell proliferation and survival, Jennifer Ferguson, Daniel J. Wilcock, Sophie McEntegart, Andrew P. Badrock, Mitch Levesque, Reinhard Dummer, Claudia Wellbrock, Michael P. SmithFirst Published: 19 July 2019ORIGINAL ARTICLESExtracellular acidosis triggers a senescence‐like phenotype in human melanoma cells,Ines Böhme, Anja BosserhoffFirst Published: 16 July 2019

Αλέξανδρος Γ. Σφακιανάκης

37m

How is the term haemangioma used in the literature? An evaluation against the revised ISSVA classification, Lloyd…
How is the term haemangioma used in the literature? An evaluation against the revised ISSVA classification, Lloyd Steele MBChB, BMedSci, MRCP, Sarah Zbeidy MD, Jason Thomson MBBS, MA(Cantab), MSc, Carsten Flohr PhD, FRCP, FRCPCH, MPhil, MB, BCh, MScVersion of Record online: 18 July 2019BRIEF REPORTSPanniculitis in a 3‐year‐old child with Fanconi anemia‐associated bone marrow hypoplasia heralds transformation to acute myeloid leukemiaLucy Webber BMedSci, BM, MRCP, Michelle Cummins MBBS, MRCP, MRCPath, Rebecca…

Αλέξανδρος Γ. Σφακιανάκης

37m

Effectiveness of monovalent rotavirus vaccine against hospitalization with acute rotavirus gastroenteritis…
Effectiveness of monovalent rotavirus vaccine against hospitalization with acute rotavirus gastroenteritis in Kenyan children Sammy Khagayi ; Richard Omore; Grieven P Otieno; Billy Ogwel; John B Ochieng …

Αλέξανδρος Γ. Σφακιανάκης

38m

The Respiratory Modulation of Memory , Ludovic Molle and Charles-Étienne Benoit Journal of Neuroscience…
The Respiratory Modulation of Memory , Ludovic Molle and Charles-Étienne BenoitJournal of Neuroscience 24 July 2019, 39 (30) 5836-5838; DOI: https://doi.org/10.1523/JNEUROSCI.0224-19.2019

Αλέξανδρος Γ. Σφακιανάκης

40m

Michel Jeanneret (1940–2019), François Lecercle Nicholas Hewitt (1945–2019), Michael Kelly ‘Les…
Michel Jeanneret (1940–2019), François Lecercle Nicholas Hewitt (1945–2019), Michael Kelly ‘Les Français ne Savent Pas Où me Mettre’: Placing Michaël Ferrier’s Petits Portraits from Japan Hannah Holtzman Collage as form and Idea in the Art Criticism of Tristan Tzara Kathryn Brown

Αλέξανδρος Γ. Σφακιανάκης

40m

The Respiratory Modulation of Memory, Ludovic Molle and Charles-Étienne Benoit The Journal of Neuroscience,…
The Respiratory Modulation of Memory, Ludovic Molle and Charles-Étienne BenoitThe Journal of Neuroscience, 24 July 2019, 39(30):5836-5838; doi:10.1523/JNEUROSCI.0224-19.2019http://www.jneurosci.org/content/39/30/5836Perception and Cognition in Absolute Pitch: Distinct yet InseparableSimon Leipold, Marielle Greber and Stefan ElmerThe Journal of Neuroscience, 24 July 2019, 39(30):5839-5841; doi:10.1523/JNEUROSCI.0653-19.2019http://www.jneurosci.org/content/39/30/5839Research ArticlesCellular/MolecularSensory…

Αλέξανδρος Γ. Σφακιανάκης

41m

Nano‐WO3‐SO3H as a New Photocatalyst Insight Through Covalently Grafted Brønsted Acid: Highly Efficient…
Nano‐WO3‐SO3H as a New Photocatalyst Insight Through Covalently Grafted Brønsted Acid: Highly Efficient Selective Oxidation of Benzyl Alcohols to AldehydesSaber Hosseini, Ali Amoozadeh, Yasaman AkbarzadehFirst Published: 16 July 2019Research ArticlesSensing Plant Physiology and Environmental Stress by Automatically Tracking Fj and Fi Features in PSII Chlorophyll Fluorescence InductionQian Xia, Jinglu Tan, Shengyang Cheng, Yongnian Jiang, Ya GuoFirst Published: 15 July 2019

Αλέξανδρος Γ. Σφακιανάκης

42m

Supply Chain Delays in Antimicrobial Administration After the Initial Clinician Order and Mortality…
Supply Chain Delays in Antimicrobial Administration After the Initial Clinician Order and Mortality in Patients With Sepsis,Objectives: There is mounting evidence that delays in appropriate antimicrobial administration are responsible for preventable deaths in patients with sepsis. Herein, we examine the association between potentially modifiable antimicrobial administration delays, measured by the time from the first order to the first administration (antimicrobial lead time), and death among people…

Αλέξανδρος Γ. Σφακιανάκης

42m

Photocatalytic Degradation of a Chlorinated Organic Chemical Using Activated Carbon Fiber Coupled…
Photocatalytic Degradation of a Chlorinated Organic Chemical Using Activated Carbon Fiber Coupled with Semiconductor, Ashitha Gopinath, Kadirvelu KrishnaVersion of Record online: 19 July 2019 A reusable photocatalyst developed based on activated carbon fibre and semiconductor was successfully utilized for degradation of 2, 4‐dichlorophenol which is priority pollutant listed by US EPA. Degradation efficiency of 94.3% was achieved when ratio of pollutant to Zn load was 1.37:1. Photogenerated holes…

Αλέξανδρος Γ. Σφακιανάκης

43m

The role of rehabilitation in patients with pulmonary arterial hypertension, Purpose of review The current…
The role of rehabilitation in patients with pulmonary arterial hypertension,Purpose of review The current review summarizes the latest evidence of the effects of exercise training for pulmonary hypertension patients demonstrated by six randomized controlled trails and 20 further studies. As the availability of exercise training is still limited it is important to raise awareness of the body of evidence showing the benefit for the patients and the limitations. Recent findings The effects of exercise…

Αλέξανδρος Γ. Σφακιανάκης

50m

Pathogenesis and complications of chronic eye rubbing in ocular allergy, Purpose of review To review…
Pathogenesis and complications of chronic eye rubbing in ocular allergy,Purpose of review To review the updated literature regarding eye rubbing complications and its association with ocular allergy disorders. Recent findings Atopy and ocular allergy disorders, mainly vernal keratoconjunctivitis (VKC), are strongly associated with rubbing-related complications, most probably via itching and watery eye sensations that trigger the habit of chronic eye rubbing. Vigorous and prolonged rubbing may lead…

Αλέξανδρος Γ. Σφακιανάκης

51m

The anti-oxidant roles of Taurine and Hypotaurine on acrosome integrity, HBA and HSPA2 of the human…
The anti-oxidant roles of Taurine and Hypotaurine on acrosome integrity, HBA and HSPA2 of the human sperm during vitrification and post warming in two different temperaturePublication date: Available online 19 July 2019Source: CryobiologyAuthor(s): Mohammad Seify, Mahsa Zarabadipour, Leila Rashki Ghaleno, AliReza Alizadeh, Mojtaba Rezazadeh ValojerdiAbstractDespite advances in vitrification techniques for sperm cryopreservation, cryo-damages of sperm caused by generation of reactive oxygen species…

Αλέξανδρος Γ. Σφακιανάκης

51m

Urinary Stone Detection on CT Images Using Deep Convolutional Neural Networks: Evaluation of…
Urinary Stone Detection on CT Images Using Deep Convolutional Neural Networks: Evaluation of Model Performance and Generalization, A cascading convolutional neural network model, enriched with labeled CT images, detected the presence of urinary tract stones on unenhanced abdominopelvic CT scans with high accuracy (area under receiver operating characteristic curve, 0.954). Anushri Parakh, Hyunkwang Lee… Synho Do

Αλέξανδρος Γ. Σφακιανάκης

52m

Preclinical safety evaluation of the aqueous extract from Mangifera indica Linn. (Anacardiaceae): genotoxic,…
Preclinical safety evaluation of the aqueous extract from Mangifera indica Linn. (Anacardiaceae): genotoxic, clastogenic and cytotoxic assessment in experimental models of genotoxicity in rats to predict potential human risksPublication date: 28 October 2019Source: Journal of Ethnopharmacology, Volume 243Author(s): Gustavo Roberto Villas Boas, João Marcos Rodrigues Lemos, Matheus William de Oliveira, Rafael Claudino dos Santos, Ana Paula Stefanello da Silveira, Flávia Barbieri Bacha, Caren Naomi…

Αλέξανδρος Γ. Σφακιανάκης

53m

Single-Cell RNA Sequencing Provides Insight Into Heart Development in MicePublished on Jul 24, 2019 DARPA…
Single-Cell RNA Sequencing Provides Insight Into Heart Development in MicePublished on Jul 24, 2019 DARPA Awards ASU $38.8M to Build Epigenetic-Based Device to Measure WMD ExposurePublished on Jul 24, 2019 Medulloblastoma Molecular Subtypes Refined With Single-Cell Transcriptome DataPublished on Jul 24, 2019Featured in Depth Dutch Startup Gen-X Offers Functional Genome Annotation ServicesPublished on Jul 24, 2019 Dutch Startup Cyclomics Developing Liquid Biopsy Assay Using Nanopore SequencingPublished…

Αλέξανδρος Γ. Σφακιανάκης

54m

Herbal Doctor Remedies Issues Voluntary Nationwide Recall of All Drug Products Due to Marketing Without…
Herbal Doctor Remedies Issues Voluntary Nationwide Recall of All Drug Products Due to Marketing Without FDA Approval and Concerns with Manufacturing Practices,Herbal Doctor Remedies is voluntarily recalling all drug products (see table below) within expiry to the consumer level. These products have been marketed without FDA approval and were manufactured outside of the controls required by current Good Manufacturing Practices (cGMP).These products could potentially result in risk to consumers as…

Αλέξανδρος Γ. Σφακιανάκης

54m

MEDICAL NEWS & PERSPECTIVES, Mounting Evidence and Netflix’s Decision to Pull a Controversial Suicide…
MEDICAL NEWS & PERSPECTIVES,Mounting Evidence and Netflix’s Decision to Pull a Controversial Suicide SceneRebecca Voelker, MSJJAMA Psychiatry: Association of Increased Youth Suicides in the United States With the Release of 13 Reasons WhyQuick UptakesFor Mortality, Busting the Myth of 10 000 Steps per DayJennifer AbbasiJAMA Internal Medicine: Association of Step Volume and Intensity With All-Cause Mortality in Older WomenAuthor Interview: Association of Increased Youth Suicides With Release of 13…

Αλέξανδρος Γ. Σφακιανάκης

55m

Insights in Pediatric Research, Eleanor J. Molloy & Cynthia F. Bearer Pediatric Research 2019…
Insights in Pediatric Research, Eleanor J. Molloy & Cynthia F. Bearer Pediatric Research 2019 86 :140 – 140; April 12, 2019; 10.1038/s41390-019-0394-8Abstract | Full TextCORRESPONDENCEProposed endocrine funding priorities for the NICHD strategic plan: expert opinion from the Pediatric Endocrine SocietyKanakadurga Singer, Michelle L. Katz & Steven D. Mittelman Pediatric Research 2019 86 :141 – 143; April 17, 2019; 10.1038/s41390-019-0401-0Abstract | Full TextCOMMENTAugust 2019 ECI biocommentaryMelissa…

Αλέξανδρος Γ. Σφακιανάκης

55m

Royal Society Publishing— Proceedings of the Royal Society B Vol. 286, No. 1907, (July 2019) The above…
Royal Society Publishing— Proceedings of the Royal Society BVol. 286, No. 1907, (July 2019) The above issue is now available online at:https://royalsocietypublishing.org/toc/rspb/2019/286/1907?ai=aqlf&ui=cbwb&af=HClick the links below to view the abstract for each article, or click the link above to view all Just Released articles for this journal.BehaviourResearch articles: Sun, age and test location affect spatial orientation in human foragers in rainforestsHaneul Jang , Christophe Boesch, Roger…

Αλέξανδρος Γ. Σφακιανάκης

57m

American Journal of Roentgenology, Medical Physics and Informatics Original ResearchRadiation Dose…
American Journal of Roentgenology, Medical Physics and InformaticsOriginal ResearchRadiation Dose for Multiregion CT Protocols: Challenges and LimitationsRamandeep Singh, et al. | American Journal of Roentgenology | Jul 24, 2019Ahead of PrintNuclear Medicine and Molecular ImagingOriginal ResearchIdentification of Axillary Lymph Node Metastasis in Patients With Breast Cancer Using Dual-Phase FDG PET/CTShinsuke Sasada, et al. | American Journal of Roentgenology | Jul 24, 2019Ahead of PrintSpecial ArticlesTechnical…

Αλέξανδρος Γ. Σφακιανάκης

58m

Academic Medicine
Using Longitudinal Milestones Data and Learning Analytics to Facilitate the Professional Development of Residents: Early Lessons from Three SpecialtiesPurpose: To investigate the effectiveness of using national, longitudinal milestones data to provide formative assessments to identify residents at risk of not achieving recommended competency milestone goals by residency completion. The investigators hypothesized that specific, lower milestone ratings at earlier time points in residency would be predictive…

Αλέξανδρος Γ. Σφακιανάκης

59m

Cardiovascular Medicine
Mid-term repair durability after MitraClip implantation in patients with functional mitral regurgitationBackground The aim of this study was to identify variables that are associated with the durability of percutaneous repair of secondary mitral regurgitation at 6-month follow-up. Methods and results Thirty-five consecutive patients with functional mitral regurgitation scheduled for MitraClip implant were enrolled. Left ventricular (LV) volumes and function and mitral valve characteristics were assessed…

Αλέξανδρος Γ. Σφακιανάκης

3h

Incidental finding of tongue cancer in a PET scan: A fusion of anatomic and metabolic imaging
Oral OncologyAvailable online 24 July 2019In Press, Corrected ProofWhat are Corrected Proof articles?Oral OncologyLetter to the editorFigures (2)Author links open overlay panelSameep S.ShettyHealth Care Global Enterprises Ltd, Bangalore 560027, IndiaManipal College of Dental Sciences, Mangalore 575001, IndiaLight House Hill Road Manipal Academy of Higher Education, IndiaAuthor links open overlay panelAkshayKudpajeHead and Neck Oncologist, Health Care Global Enterprises Ltd, Bangalore, IndiaAuthor…

Αλέξανδρος Γ. Σφακιανάκης

3h

Correlation Between Electroencephalography and Automated Pupillometry in Critically Ill Patients: A…
Correlation Between Electroencephalography and Automated Pupillometry in Critically Ill Patients: A Pilot Study,Background: Electroencephalography (EEG) is widely used in the monitoring of critically ill comatose patients, but its interpretation is not straightforward. The aim of this study was to evaluate whether there is a correlation between EEG background pattern/reactivity to stimuli and automated pupillometry in critically ill patients. Methods: Prospective assessment of pupillary changes to…

Αλέξανδρος Γ. Σφακιανάκης

3h

Neurosurgical Anesthesiology
Erector Spinae Plane Block For Postoperative Analgesia in Lumbar Spine Surgery: Is There a Better Option?No abstract availableGeneral Anesthetic Agents Are Not Neuroprotective and May be NeurotoxicNo abstract availableIn Remembrance of Hiroshi Takeshita, MD, Pioneering NeuroanesthesiologistNo abstract availableCorrelation Between Electroencephalography and Automated Pupillometry in Critically Ill Patients: A Pilot StudyBackground: Electroencephalography (EEG) is widely used in the monitoring of critically…

Αλέξανδρος Γ. Σφακιανάκης

3h

Predictive Validity of the CRAFFT for Substance Use Disorder, Rohit P. Shenoi, James G. Linakis, Julie…
Predictive Validity of the CRAFFT for Substance Use Disorder,Rohit P. Shenoi, James G. Linakis, Julie R. Bromberg, T. Charles Casper, Rachel Richards, Michael J. Mello, Thomas H. Chun, Anthony Spirito and PEDIATRIC EMERGENCY CARE APPLIED RESEARCH NETWORKSpecial ArticleWhen Parents Take Conflicts to Digital MediaBryanna Moore and John D. Lantos

Αλέξανδρος Γ. Σφακιανάκης

3h

Featured Job of the Week, Internal Medicine — Florida Memorial Healthcare System, a leading 1,900-bed…
Featured Job of the Week,Internal Medicine — Florida Memorial Healthcare System, a leading 1,900-bed healthcare system located in South Florida, is seeking a BE/BC internal medicine physician for employment in one of its many primary care clinics spread throughout southern Broward County. The successful candidate must exhibit strong interpersonal and professional skills, have an understanding and willingness to practice in a family- and patient-centered care environment, and have an interest in…

Αλέξανδρος Γ. Σφακιανάκης

3h

Respiratory Papillomatosis
IMAGES IN CLINICAL MEDICINENicola Dentale, M.D., Ph.D., and Rocco Trisolini, M.D.A 63-year-old man presented to the pulmonary clinic with a 3-month history of worsening dry cough and exertional dyspnea. He had a history of infection with the human immunodeficiency virus and had been receiving prescribed antiretroviral treatment intermittently for several years. His CD4 count was 81 cells per cubic millimeter. Expiratory wheezing was noted on lung auscultation. Computed tomography of the chest revealed…

Αλέξανδρος Γ. Σφακιανάκης

3h

All cases of suspected measles should be reported immediately — without waiting for diagnostic test results — to the local or state health department, which can assist with obtaining tests and take actions to minimize spread of virus. United States travelers to other countries account for a high proportion of imported cases of measles, which emphasizes the importance of measles vaccination of U.S. residents who are 6 months of age or older before international travel.
Teaching TopicMeaslesCLINICAL PRACTICEMeaslesP.M. Strebel and W.A. Orenstein All cases of suspected measles should be reported immediately — without waiting for diagnostic test results — to the local or state health department, which can assist with obtaining tests and take actions to minimize spread of virus. United States travelers to other countries account for a high proportion of imported cases of measles, which emphasizes the importance of measles vaccination of U.S. residents who…

Αλέξανδρος Γ. Σφακιανάκης

3h

The use of vena cava filters has become widespread in many trauma centers as a primary means to prevent pulmonary embolism in patients who are at high risk for bleeding. Most studies evaluating the clinical efficacy of vena cava filters in trauma patients have been observational. Ho et al. conducted a multicenter, randomized, controlled trial that evaluated whether early placement of a retrievable vena cava filter reduced the risk of symptomatic pulmonary embolism or death in severely injured patients in whom prophylactic anticoagulation was contraindicated.
A Multicenter Trial of Vena Cava Filters in Severely Injured Patients, K.M. Ho and OthersN Engl J Med 2019;381:328-337 | Published Online July 7, 2019Teaching TopicVena Cava Filters in Severely Injured PatientsORIGINAL ARTICLEA Multicenter Trial of Vena Cava Filters in Severely Injured PatientsK.M. Ho and OthersCME Exam Quick Take The use of vena cava filters has become widespread in many trauma centers as a primary means to prevent pulmonary embolism in patients who are at high risk for bleeding….

Αλέξανδρος Γ. Σφακιανάκης

3h

A 48-year-old man presented to the dermatology clinic with a 6-month history of painful hand ulcerations…
A 48-year-old man presented to the dermatology clinic with a 6-month history of painful hand ulcerations and shortness of breath. He has no muscle weakness or arthritis. What is the diagnosis?CREST syndrome17% Anti-MDA5 dermatomyositis34% Pyoderma gangrenosum16% Cutaneous polyarteritis nodosa19% Behcet’s disease13% Back to Poll8916 Total Responseshttps://www.nejm.org/image-challenge?ci=20190725&query=TOC

Αλέξανδρος Γ. Σφακιανάκης

3h

The New England Journal of Medicine
Health Care Autonomy of Women Living with HIVR.R. Redfield and OthersDOI: 10.1056/NEJMp1908843 | July 24, 2019Combating EPA Rollbacks — Health Care’s Response to a Retreat on ClimateG. McCarthy and A. BernsteinDOI: 10.1056/NEJMp1909643 | July 24, 2019The Opportunity of CBD — Reforming the LawP.A. Cohen and J. SharfsteinN Engl J Med 2019;381:297-299 | Published Online June 12, 2019Implications of an Aging Rural Physician WorkforceL. Skinner, D.O. Staiger, D.I. Auerbach, and P.I. BuerhausN Engl J Med…

Αλέξανδρος Γ. Σφακιανάκης

3h

A Woman with Palpitations, Abdominal Pain, and Vomiting A 39-year-old woman with cyclic vomiting syndrome…
A Woman with Palpitations, Abdominal Pain, and VomitingA 39-year-old woman with cyclic vomiting syndrome and polysubstance use disorder presented with abdominal pain and agitation. In the emergency department, she had a sudden episode of tachycardia with a narrow QRS complex, with a heart rate of more than 200 beats per minute. What is the most likely diagnosis?Presentation of CaseDr. Kelsey Hills-Evans (Medicine): A 39-year-old woman with cyclic vomiting syndrome and polysubstance use disorder was…

Αλέξανδρος Γ. Σφακιανάκης

3h

Blueberry intake included in hypocaloric diet decreases weight, glucose, cholesterol, triglycerides…
Blueberry intake included in hypocaloric diet decreases weight, glucose, cholesterol, triglycerides and adenosine levels in obese subjectsPublication date: September 2019Source: Journal of Functional Foods, Volume 60Author(s): María Fernanda Higuera-Hernández, Elena Reyes-Cuapio, Marissa Gutiérrez-Mendoza, Henning Budde, Carlos Blanco-Centurión, André Barciela Veras, Nuno Barbosa Rocha, Tetsuya Yamamoto, Diogo Monteiro, Jaime Zaldívar-Rae, Dalila Aldana-Aranda, Sérgio Machado, Eric Murillo-RodríguezAbstractObesity…

Αλέξανδρος Γ. Σφακιανάκης

3h

Journal of Functional Foods
Curcumin metabolism by human intestinal bacteria in vitroPublication date: October 2019Source: Journal of Functional Foods, Volume 61Author(s): Toshio Niwa, Shin-ichiro Yokoyama, Mika Mochizuki, Toshihiko OsawaAbstractWe tried to isolate metabolite in curcumin by incubation with human feces in vitro for the better understanding of curcumin activity in vivo. One group containing some bacteria, referred as 1C, produced a metabolite other than tetrahydrocurcumin. Structural analysis revealed that this…

Αλέξανδρος Γ. Σφακιανάκης

3h

Environmental Contamination and Toxicology
The Adsorption Behavior of Atrazine in Common Soils in Northeast ChinaAbstractThe objective of this study was to evaluate the adsorption capacity of atrazine and the effects of different environmental conditions such as temperature, pH, Ca2+ and biochar on the adsorption characteristics of atrazine in different types of soil using the intermittent adsorption method. The kinetic experiment showed that the adsorption of atrazine in albic, black and saline–alkaline soils reached equilibrium within 24 h….

Αλέξανδρος Γ. Σφακιανάκης

3h

Urogynecology
Commentary to: Prospective comparative study on the effects of lidocaine on urodynamic and sensory parameters in bladder-pain syndromeCommentary on: "Does spinal anesthesia lead to postoperative urinary retention in same day urogynecology surgery: a retrospective review"Treatment of subacute rectosigmoid obstruction secondary to uterosacral ligament suspensionThe transition from resident to consultantA live porcine model for robotic sacrocolpopexy trainingAbstractIntroduction and hypothesisRobotic…

Αλέξανδρος Γ. Σφακιανάκης

3h

Historical Archaeology
Archaeologies of the British in Latin AmericaHistorical Archaeology and EnvironmentDaniel G. Roberts Award for Excellence in Public Historical Archaeology: The U.S. Forest Service Passport in Time ProgramHistorical Archaeology of Early Modern Colonialism in Asia-Pacific: The Southwest Pacific and Oceanian RegionsThe Shore is a Bridge: The Maritime Cultural Landscape of Lake OntarioJohn L. Cotter Award in Historical Archaeology: John M. ChenowethHaven to the East, Haven to the North: Great Barrington…

Αλέξανδρος Γ. Σφακιανάκης

3h

Probiotic Supplementation Decreases Chemotherapy-induced Gastrointestinal Side Effects in Patients…
Probiotic Supplementation Decreases Chemotherapy-induced Gastrointestinal Side Effects in Patients With Acute Leukemia,Introduction: In children with acute leukemia, gut microbiota is modified secondary to chemotherapy administration, leading to gastrointestinal side effects. Probiotics are microorganisms that can restore gut microbiota and may help alleviate gastrointestinal symptoms. The aim of this pilot study was to assess the effects of probiotic supplementation on chemotherapy-induced gastrointestinal…

Αλέξανδρος Γ. Σφακιανάκης

3h

Metabolic Changes in Children that Received Chemotherapy, Cancer treatments are associated with short…
Metabolic Changes in Children that Received Chemotherapy,Cancer treatments are associated with short and long-effects. Epidemiological reports have revealed clinical features of metabolic syndrome (MS), obesity or overweight in young cancer survivors. The aim of the study was to examine the prevalence of unhealthy weight status and risk factors associated with MS related to chemotherapy. We study 52 pediatric cancer patients and analyze cholesterol, triglycerides, glycosylated hemoglobin, body mass…

Αλέξανδρος Γ. Σφακιανάκης

3h

Clinical Oncology,Pediatric Hematology/Oncology
Maintenance Therapy in Metastatic Solid Tumors: Innovative Strategy or Simple Second-line Treatment?Managing metastatic diseases involves defining the best strategy that is supposed to take into account both efficacy and quality of life. To this end, clinicians use stop and go or maintenance strategies. As a matter of fact, 2 maintenance strategies can be distinguished: continuation maintenance using a drug already present in induction treatment and switch maintenance with a newly introduced drug….

Αλέξανδρος Γ. Σφακιανάκης

3h

Combined Intermittent Pneumatic Leg Compression and Pharmacological Prophylaxis for Prevention of Venous…
Combined Intermittent Pneumatic Leg Compression and Pharmacological Prophylaxis for Prevention of Venous Thromboembolism

Αλέξανδρος Γ. Σφακιανάκης

3h

Orthopaedic Nursing
Engage Your Core: Excellence in ResearchNo abstract availableWriting for Publication: Your Professional JourneyNo abstract availableLetter to the EditorNo abstract availableKeeping Up With Current Orthopaedic Nursing Practice: Results of the ONCB 2016 Role Delineation StudyBACKGROUND: The Orthopaedic Nurses Certification Board (ONCB) conducts a role delineation study (RDS), also known as a job task analysis, every 5 years. Results identify tasks performed by orthopaedic registered nurses and nurse…

Αλέξανδρος Γ. Σφακιανάκης

3h

Presbyphagia Versus Dysphagia: Normal Versus Abnormal Swallowing Symptoms in Older Adults With Parkinson…
Presbyphagia Versus Dysphagia: Normal Versus Abnormal Swallowing Symptoms in Older Adults With Parkinson Disease and Multiple Sclerosis,The purpose of this article is to describe normal, age-related changes in the swallowing mechanism, clinically referred to as “presbyphagia.” The authors compare presbyphagia in the oral, pharyngeal, and esophageal phases of the swallow to abnormal, or impaired swallowing, termed “dysphagia.” This article focuses on how older persons with Parkinson disease and multiple…

Αλέξανδρος Γ. Σφακιανάκης

3h

Geriatric Rehabilitation
Foreword: Aging With a Progressive Neurologic Condition-Implications for RehabilitationNo abstract availableAging With a Progressive Neurologic Disease: Rehabilitation Management of the Adult Aging With Parkinson Disease or Multiple SclerosisThe confluence of an aging population and increasing life expectancy of people with neurodegenerative diseases such as Parkinson disease and multiple sclerosis means that there is a growing segment of the population who are aging with a neurodegenerative disease….

Αλέξανδρος Γ. Σφακιανάκης

3h

Folate Supplementation for Methotrexate Therapy in Patients With Rheumatoid Arthritis: A Systematic…
Folate Supplementation for Methotrexate Therapy in Patients With Rheumatoid Arthritis: A Systematic Review,Objective To review the evidence for benefits and harms of folate (folic acid or folinic acid) supplementation on methotrexate (MTX) treatment for rheumatoid arthritis (RA), to assess whether or not folate supplementation would reduce MTX toxicity or reduce MTX benefits, and to decide whether a higher MTX dosage is essential. Methods We performed a sensitive search strategy and searched systematically…

Αλέξανδρος Γ. Σφακιανάκης

3h

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis–Like Lupus Erythematosus, Background/Objective…
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis–Like Lupus Erythematosus,Background/Objective Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN)–like lupus erythematosus is a hyperacute and life-threatening form of cutaneous lupus erythematosus. Because of its rarity, little is known about this entity. We aimed to evaluate the clinical characteristics, laboratory findings, systemic manifestations, treatments, and outcome of SJS/ TEN-like lupus erythematosus. Methods We conducted…

Αλέξανδρος Γ. Σφακιανάκης

3h

Clinical Rheumatology
Folate Supplementation for Methotrexate Therapy in Patients With Rheumatoid Arthritis: A Systematic ReviewObjective To review the evidence for benefits and harms of folate (folic acid or folinic acid) supplementation on methotrexate (MTX) treatment for rheumatoid arthritis (RA), to assess whether or not folate supplementation would reduce MTX toxicity or reduce MTX benefits, and to decide whether a higher MTX dosage is essential. Methods We performed a sensitive search strategy and searched systematically…

Αλέξανδρος Γ. Σφακιανάκης

3h

Clinical Obstetrics and Gynecology
Contributors: Burnout and Resilience in Obstetrics and GynecologyNo abstract availableForeword: Burnout and Resilience in Obstetrics and GynecologyNo abstract availableBurnout in Obstetricians and GynecologistsProfessional burnout threatens all high-functioning professionals and affects not only the individual, but, by extension, the patients they serve. The characteristics that make someone competitive for medical school, residency, or successful in academics or practice, make us particularly vulnerable…

Αλέξανδρος Γ. Σφακιανάκης

3h

Nursing2019
Pressure injuries: A nursing-sensitive indicator?No abstract availableDrug NewsNo abstract availableAdvice P.R.N.No abstract availableCan medications become harmful after the expiration date?No abstract availableBalancing academic freedom with academic dutyNo abstract availableClinical RoundsNo abstract availableNew Drugs 2019, part 3Abstract: This article reviews seven drugs recently approved by the FDA, including indications, precautions, adverse reactions, and nursing considerations.New Drugs…

Αλέξανδρος Γ. Σφακιανάκης

3h

The Health Care Manager
Medicare Access and CHIP Reauthorization Act and Rural HospitalsThe cost of health care within the United States has continued to increase, whereas the quality of patient care has generally decreased in some areas. With the continued use of Medicare’s former physician reimbursement algorithm, termed sustainable growth rate, national expenditures within the United States have been expected to increase 5.6% annually. To modernize the delivery and financing of care, Congress has introduced the Medicare…

Αλέξανδρος Γ. Σφακιανάκης

3h

Implant Dentistry
Device Legislation…… Now Tread CautiouslyNo abstract availableThe Sinus Bone Graft— Third Edition 2019No abstract availableRidge Architecture Preservation Following Minimally Traumatic Exodontia Techniques and Guided Tissue RegenerationObjective: To compare hard-tissue healing after 3 exodontia approaches. Materials and Methods: Premolars of dogs were extracted: (1) flapless, (2) flap, and (3) flap + socket coverage with polytetrafluoroethylene (dPTFE) nonresorbable membrane (flap + dPTFE). Animals…

Αλέξανδρος Γ. Σφακιανάκης

3h

Cone-Beam Computed Tomography Evaluation of the Submandibular Fossa in a Group of Dental Implant Patients,…
Cone-Beam Computed Tomography Evaluation of the Submandibular Fossa in a Group of Dental Implant Patients,Objective: In the mandibular posterior region, presurgical imaging can provide valuable information of anatomical variants. The aim of this study is to evaluate submandibular fossa anatomy in the posterior mandible using cone-beam computed tomography (CBCT) scans. Study Design: One hundred thirty-two preimplant CBCT examinations were used. Several morphometric measurements were performed in the…

Αλέξανδρος Γ. Σφακιανάκης

3h

Transplantation
Visual Abstracts (#VisualAbstract): A New Journal Initiative to Disseminate ResearchNo abstract availableEculizumab as Primary Therapy for Active Antibody-Mediated Rejection of Renal Allografts: A Matter of Timing, Severity, and Donor-Specific AntibodiesNo abstract availableUltrasound Molecular Imaging of Lymphocyte-endothelium Adhesion Cascade in Acute Cellular Rejection of Cardiac AllograftsBackground: Acute cellular rejection is one of the main reasons for graft failure after heart transplantation….

Αλέξανδρος Γ. Σφακιανάκης

3h

Treatment of Nasal Scars Caused by Skin Necrosis From Hyaluronic Acid Injections Using Stromal Vascular…
Treatment of Nasal Scars Caused by Skin Necrosis From Hyaluronic Acid Injections Using Stromal Vascular Fraction Gel, a Novel Fat Tissue–Derived Product,

Αλέξανδρος Γ. Σφακιανάκης

3h

Efficacy and Safety of 3 New Resilient Hyaluronic Acid Fillers, Crosslinked With Decreased BDDE, for…
Efficacy and Safety of 3 New Resilient Hyaluronic Acid Fillers, Crosslinked With Decreased BDDE, for the Treatment of Dynamic Wrinkles: Results of an 18-Month, Randomized Controlled Trial Versus Already Available ComparatorsBACKGROUND Three new hyaluronic acid (HA)-based fillers made of long chains crosslinked with reduced amounts of 1,4-butanediol diglycidyl ether (BDDE) were developed for the treatment of dynamic facial areas. Their resilience and increased stretching ability were optimized to…

Αλέξανδρος Γ. Σφακιανάκης

3h

Dermatologic Surgery
Use of Autologous, Noncultured Melanocyte–Keratinocyte Transplantation in Patients With Stable Genital LeucodermaNo abstract availableA Closure Option for Sinuous Hairline Preservation on the Upper ForeheadNo abstract availableSharp Debulking and Nonbeveled Layers in Mohs Micrographic Surgery, A Video Walkthrough: How We Do ItNo abstract availableVulvar Lichen Sclerosus: Consider Treatment With Heterologous Type I CollagenNo abstract availableEfficacy, Patient-Reported Outcomes, and Safety in Male…

Αλέξανδρος Γ. Σφακιανάκης

3h

Efficacy, Patient-Reported Outcomes, and Safety in Male Subjects Treated With OnabotulinumtoxinA for…
Efficacy, Patient-Reported Outcomes, and Safety in Male Subjects Treated With OnabotulinumtoxinA for Improvement of Moderate to Severe Horizontal Forehead LinesBACKGROUND Men represent a growing segment of the facial aesthetic market. OBJECTIVE To evaluate investigator-assessed efficacy, patient-reported outcomes, and safety after onabotulinumtoxinA treatment of forehead lines (FHL) in men. METHODS Subjects with moderate to severe FHL received onabotulinumtoxinA (frontalis: 20 U; glabellar complex:…

Αλέξανδρος Γ. Σφακιανάκης

3h

Nature Photonics
Guide for the perplexed to the Shockley–Queisser model for solar cells pp501 – 505 Jean-Francois Guillemoles, Thomas Kirchartz, David Cahen & Uwe Rau doi:10.1038/s41566-019-0479-2 In memory of Mikhail Gorodetsky pp506 – 508 Igor Bilenko, Vladimir Ilchenko, Farid Khalili & Tobias J. Kippenberg doi:10.1038/s41566-019-0490-7 NEWS & VIEWSStriving for extreme solitons pp509 – 511 Benjamin Wetzel & Fetah Benabid doi:10.1038/s41566-019-0497-0 T-ray modulation of light for future…

Αλέξανδρος Γ. Σφακιανάκης

3h

Cultural Sociology
Career gatekeeping in cultural fieldsAbstractThis paper presents a comparative analysis of career gatekeeping processes in two cultural fields. Drawing on data on appointment procedures in German academia and booking processes in North American stand-up comedy, we compare how gatekeepers in two widely different contexts evaluate and select candidates for established positions in their respective field and validate their decisions. Focusing on three types of gatekeeping practices that have been documented…

Αλέξανδρος Γ. Σφακιανάκης

3h

Inspecting the Foundation of Mystery House, John Aycock, Katie Biittner Issued Date: 24 Jul 2019 Abstract…
Inspecting the Foundation of Mystery House,John Aycock, Katie BiittnerIssued Date: 24 Jul 2019AbstractComputer games are recent artifacts that have had, and continue to have, enormous cultural impact. In this interdisciplinary collaboration between computer science and archaeology, we closely examine one such artifact: the 1980 Apple II game Mystery House, the first graphical adventure. We focus on implementation rather than gameplay, treating the game as a digital artifact. What can we learn about…

Αλέξανδρος Γ. Σφακιανάκης

4h

Red,Orange,Yellow,Green,Blue,Indigo
The evolutionary races of color

Αλέξανδρος Γ. Σφακιανάκης

4h

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
Amniotic band syndrome with Tessier number 4 and 7 clefts: a case report, Author links open overlay…Amniotic band syndrome with Tessier number 4 and 7 clefts: a case report,Author links open overlay panelZ.YangStomatological Hospital, Southern Medical University, Guangzhou 510280, ChinaAuthor links open overlay panelQ.LiangK.OuyangZ.PiaoKey Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, ChinaAvailable online…

Αλέξανδρος Γ. Σφακιανάκης

1d

Sexuality & Culture
So from Here Where Do We Go? A Focus on the Sexuality of Women with Disabilities in Africa: A Narrative ReviewAbstractThis article is a narrative review of literature pertaining to the sexuality of women with disabilities in Africa. The review was undertaken through searching electronic databases namely, CINAHL, African e-Journals, MEDLINE, JSTOR, PubMed, and Web of Science; a general internet search was also undertaken. Focus was mainly on literature written in English over the past three decades…

Αλέξανδρος Γ. Σφακιανάκης

1d

Drugs & Aging
Statins for Primary Prevention in Those Aged 70 Years and Older: A Critical Review of Recent Cholesterol GuidelinesAbstractThe risk of atherosclerotic cardiovascular disease rises with age and remains the leading cause of death in older adults. Evidence for the use of statins for primary prevention in older adults is limited, despite the possibility that this population may derive significant clinical benefit given its increased cardiovascular risk. Until publication of the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA…

Αλέξανδρος Γ. Σφακιανάκης

1d

Fudan Journal of the Humanities and Social Sciences
Intellectual Humility and Owning One’s LimitationsAbstractIntellectual humility is a worthwhile virtue. Whitcomb et al. (Philos Phenomenol Res 94(3):520, 2017) recently propose a novel account of intellectual humility. According to this account, intellectual humility consists of proper attentiveness to and owning of one’s intellectual limitations. We argue that this account is in accordance with empirical work on intellectual humility, but it has two problems. It leaves open the possibility that…

Αλέξανδρος Γ. Σφακιανάκης

1d

Anesthesia & Analgesia
Time-Out and Distraction: Performing Checklists After the Plane Has Taken OffNo abstract availableVentilator Mode Does Not Influence Blood Loss or Transfusion Requirements During Major Spine Surgery: A Retrospective StudyBACKGROUND: Blood loss during adult spinal deformity surgery is multifactorial. Anesthetic-related factors, such as mode of mechanical ventilation, may contribute to intraoperative blood loss. The aim of this study was to determine the influence of ventilator mode and ventilator…

Αλέξανδρος Γ. Σφακιανάκης

1d

RETINA – Current Issue
Understanding Intravitreal Silicone Oil Droplets Due to Intravitreal InjectionsNo abstract availableATYPICAL MACULAR HOLESPurpose: To study the etiology, clinical features, management options, and visual prognosis in various types of atypical macular holes (MHs). Methods: A review of the literature was performed, which focused on the etiopathogenesis of atypical or secondary MHs, their differentiating clinical features, management strategies, and varied clinical outcomes. Idiopathic or age-related,…

Αλέξανδρος Γ. Σφακιανάκης

1d

Advances in Skin & Wound Care – Current Issue
Treating Persons Who Inject Drugs: The Need for Holistic and Respectful CareNo abstract availableAre You Following Your Reimbursement "Playbook"?No abstract availableNonviral Injection-Related Injuries in Persons Who Inject Drugs: Skin and Soft Tissue Infection, Vascular Damage, and WoundsGENERAL PURPOSE To explore skin and soft-tissue infections and vascular damage in persons who inject drugs and relate these changes to wound development and care. TARGET AUDIENCE This continuing education activity…

Αλέξανδρος Γ. Σφακιανάκης

1d

Dermatopathology
Histopathology of Cutaneous AgingAbstract: Aging is (so far) an inexorable and irreversible path in all species and organisms. In human beings, aging involving the skin has a special meaning because our appearance has become crucial for our social life in the modern world. Knowledge of the morphologic changes that happen during the aging process is crucial for understanding its pathogenesis, which in turn is necessary to approach it and even revert it. Skin aging happens because of 2 main sets of…

Αλέξανδρος Γ. Σφακιανάκης

1d

Implant Dentistry

Device Legislation…… Now Tread Cautiously No abstract available

The Sinus Bone Graft— Third Edition 2019 No abstract available

Ridge Architecture Preservation Following Minimally Traumatic Exodontia Techniques and Guided Tissue Regeneration Objective: To compare hard-tissue healing after 3 exodontia approaches. Materials and Methods: Premolars of dogs were extracted: (1) flapless, (2) flap, and (3) flap + socket coverage with polytetrafluoroethylene (dPTFE) nonresorbable membrane (flap + dPTFE). Animals were euthanized at 1 and 4 weeks. Amount of bone formation within socket and socket total area were measured. Results: Amount of bone formation revealed significant difference between 1 and 4 weeks; however, there was no differences among groups. Socket total area decreased after 4 weeks, and the flap + dPTFE group showed significantly higher socket total area. As a function of time and group, flap + dPTFE 4 weeks presented similar socket total area values relative to flap + dPTFE at 1 week, and significantly higher socket total area than flapless and flap. The histological sections revealed almost no bone formation within socket after 1 week, which increased for all groups at 4 weeks. Conclusion: Socket coverage with polytetrafluoroethylene (dPTFE) membrane showed to effectively preserve bone architecture. Bone formation within sockets was not influenced by tooth extraction technique.

Cone-Beam Computed Tomography Evaluation of the Submandibular Fossa in a Group of Dental Implant Patients Objective: In the mandibular posterior region, presurgical imaging can provide valuable information of anatomical variants. The aim of this study is to evaluate submandibular fossa anatomy in the posterior mandible using cone-beam computed tomography (CBCT) scans. Study Design: One hundred thirty-two preimplant CBCT examinations were used. Several morphometric measurements were performed in the submandibular fossa. Moreover, each patient was classified according to the Kennedy classification. Statistical analysis was used to test the relationship among measurements, sex, side, and each tooth. Results: A total of 2412 measurements were performed from all patients. The deepest concavity at the submandibular fossa in all Kennedy Class groups was in the 1st and 2nd molars. The concavity depth was statistically higher in class I group for 1st and 2nd molars than the other Kennedy Class groups. Class IV group showed less depth than the other groups. When compared with female patients, all measurements in male patients were statistically higher. The patients older than 35 years showed higher measurements than the patients younger than 35 years. Conclusions: Mandibles with any lingual concavity pose a potential increased risk of lingual cortical perforation during surgery. This study revealed that the alveolar bone resorption occurs both vertically and horizontally, and the preservation of teeth can limit the bone resorption.

Distribution of Trabecular Bone Density in the Maxilla and Mandible Introduction: Implant osseointegration is strongly influenced by the bone quality at the implant insertion site. The present work aims to create distribution diagrams showing the average bone density at each position within the jaws. Materials and Methods: Data were retrospectively collected from 4 oral surgeons who sought bone-density measurements during implant placement using a torque-measuring implant micromotor. Statistical analyses were performed to investigate whether bone density correlated with the patients’ sex and age and whether the bone-density values at different positions within each arch correlated to each other. Results: Records of 2408 patients and 6060 bone-density readings were retrieved, and density distribution diagrams were created. Density values showed a significant variation within subjects. Within the same jaw, density between adjacent positions showed significant differences. Density at a given position correlated significantly with that at the other positions in most cases. Bone density was significantly lower in women than in men; no significant correlation was found between bone density and the patient age. Conclusions: Bone density of patients displays significant interindividual variation, thus meaningful assessment must be conducted on a patient-by-patient basis.

Alveolar Ridge Expansion by Osseodensification-Mediated Plastic Deformation and Compaction Autografting: A Multicenter Retrospective Study Introduction: Osseodensification preserves bone bulk, facilitates compaction autografting, and deforms trabecular bone in an outward strain, which result in alveolar ridge plastic expansion. The aim of this retrospective study was to evaluate ridge expansion after osseodensification. Materials and Methods: Patients treated with implant placement through osseodensification were evaluated. The alveolar ridge width was measured at the level of the crest and 10 mm apical to the crest before and after osseodensification. Insertion torque and implant stability quotient (ISQ) values were recorded at implant placements. Expansion values were grouped into the following 3 groups according to the initial alveolar ridge width: group 1: 3 to 4 mm (n = 9), group 2: 5 to 6 mm (n = 12), and group 3: 7 to 8 mm (n = 7). Results: Twenty-one patients who received 28 implants were included. Twenty-six implants were integrated, resulting in a survival rate of 92.8%. There was a significant difference in the mean expansion value at the coronal aspect of the ridge between group 1, group 2, and group 3 (2.83 ± 0.66 mm, 1.5 ± 0.97 mm, 1.14 ± 0.89 mm, P < 0.05). The mean torque and ISQ values were 61.2 ± 13.9 Ncm and 77 ± 3.74. Conclusion: Osseodensification can alter ridge dimensions and allow for ridge expansion. Greater expansion can be expected at the crest in narrow ridges with adequate trabecular bone volume.

Prevalence of Maxillary Sinus Pathology Based on Cone-Beam Computed Tomography Evaluation of Multiethnicity Dental School Population Objective: The goal of the study was to evaluate prevalence of maxillary sinus pathology among populations considered for possible sinus augmentation procedures for dental implants. Study Design: Eight hundred twenty-one cone-beam computed tomography (CBCT) scans were retrospectively evaluated for prevalence of maxillary sinus pathology. Scans were classified based on the type of sinus pathology detected. Categories of sinus findings were healthy, mucosal thickening larger than 3 mm, polypoidal mucosal thickening, partial opacification, complete opacification, and others. Age, sex, ethnicity, and dentition status were evaluated to determine associated relationships with the incidence of pathology. Results: Sixty-two percent (62.79%) of scans presented with bilateral healthy sinuses and 37.21% of scans exhibited pathology. 73.38% of sinuses were classified as clinical healthy, 14.93% presented with mucosal thickening, 8.53% with polypoidal mucosal thickening, 2.13% with partial opacification, 0.66% with complete opacification, and 0.37% with a foreign body. Sex is found to be a significant factor with higher pathology incidence rates in male patients. Age is a significant factor with higher pathology incidence rates in older subjects. Dentition status and ethnicity did not have a significant association with pathology incidence rates. Conclusions: The prevalence of maxillary sinus pathologies and associations with age, sex, ethnicity, and dentition status were obtained. Thirty-seven percent of scans would require further medical consultation before proceeding with maxillary sinus augmentation surgery for dental implants.

Feasibility of Assessing Maxillary and Mandibular Bone Mineral Density for Dental Implantation by Using Multidetector Computed Tomography Purpose: The purpose of this study was to evaluate the feasibility of measuring bone mineral density (BMD) of the maxillary and mandibular bones for dental implantation by using multidetector computed tomography (MDCT). Materials and Methods: We performed MDCT in 141 patients (78 women and 63 men) at the lumbar vertebrae and at the maxillary and mandibular bones, with a view to dental implantation, from July 2015 to June 2017. Quantitative CT (QCT) using MDCT was performed to obtain Hounsfield unit (HU) values for the maxillary and mandibular bones and to obtain T scores for the lumbar vertebrae. We statistically analyzed the relationships among HU values, and the correlations of QCT values with T scores and of T scores with HU values. Results: There were statistically significant correlations among all these parameters. Conclusions: QCT using MDCT of the maxillary and mandibular bones seems to be a feasible method for measuring BMD before dental implantation.

Effect of Steam Heat Sterilization on the Accuracy of 3D Printed Surgical Guides Introduction: Steam heat sterilization could be one of the factors that affects the dimensional accuracy of surgical guides, leading to an error during guided implant surgery. Objective: The purpose of this study was to investigate the effect of steam heat sterilization on the dimensional changes of surgical guides. Materials and Methods: A total of 27 surgical guides, which were made by either Formlabs printer (Formlabs Inc., Somerville, MA) or Simplant (DENTSPLY Implants NV, Hasselt, Belgium), were scanned using an intraoral scanner before and after sterilization. The dimensional changes at the center of the implant sleeves were analyzed using the computer-aided design interactive software for 65 implant sites before and after steam heat sterilization at 121°C for 20 minutes. Results: There was no significant difference between the mean x, y, and z axes of the center of the sleeves when measured before and after sterilization (P values were 0.37, 0.24, and 0.29, respectively). Nonparametric analysis showed no significant difference between the mean deviations of either surgical guide (P = 0.908). Conclusion: Steam heat sterilization has a nonsignificant effect on the dimensional changes of the tested surgical guides.

Fracture of Zirconia Abutments in Implant Treatments: A Systematic Review Purpose: The purpose of this systematic review was to identify and summarize clinical studies related to the fracture of zirconia abutments in implant treatments. Material and Methods: Medline, Embase, and Cochrane library searches were performed and complemented by manual searches from database inception to February 11, 2018, for title and abstract analysis. Results: Initially, 645 articles were obtained through database searches. Fifty-three articles were selected for full-text analysis, and 15 studies met the inclusion criteria. The selected studies were analyzed regarding fracture rate, abutment-implant connection, time point of fracture, location of critical crack, causes, managements, and preventive measures with respect to zirconia abutment fracture. Conclusions: Lower fracture rates were reported for internal connection with metal component (2-piece) zirconia abutments compared with external and internal full-zirconia connection (one-piece) zirconia abutments. Overpreparation and overload should be avoided in case of zirconia abutments.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia