Ebun Omoyinmi, Iman Mohamoud, Kimberly Gilmour, Paul A. Brogan, Despina Eleftheriou (Source: Frontiers in Immunology)
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Πέμπτη 1 Νοεμβρίου 2018
Cutaneous Vasculitis and Digital Ischaemia Caused by Heterozygous Gain-of-Function Mutation in C3
Genes at the Crossroad of Primary Immunodeficiencies and Cancer
Charlotte Derpoorter, Victoria Bordon, Genevi ève Laureys, Filomeen Haerynck, Tim Lammens (Source: Frontiers in Immunology)
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Non-apoptotic Fas (CD95) Signaling on T Cells Regulates the Resolution of Th2-Mediated Inflammation
Jesse W. Williams, Caroline M. Ferreira, Kelly M. Blaine, Crystal Rayon, Francisco Vel ázquez, Jiankun Tong, Marcus E. Peter, Anne I. Sperling (Source: Frontiers in Immunology)
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Manipulation of Salmonella Typhi Gene Expression Impacts Innate Cell Responses in the Human Intestinal Mucosa
Ros ângela Salerno-Gonçalves, James E. Galen, Myron M. Levine, Alessio Fasano, Marcelo B. Sztein (Source: Frontiers in Immunology)
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Dendritic Cells Are Critical for the Activation and Expansion of V δ2+ T Cells After Allogeneic Hematopoietic Transplantation
Xiaoyu Wang, Jiangying Liu, Haitao Gao, Xiao-Dong Mo, Tingting Han, Lan-Ping Xu, Xiao-Hui Zhang, Xiao-Jun Huang (Source: Frontiers in Immunology)
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Editorial Board
Publication date: November 2018Source: Molecular Immunology, Volume 103Author(s): (Source: Molecular Immunology)
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TARBP2 negatively regulates IFN-β production and innate antiviral response by targeting MAVS
In this study, we identify transactivation response element RNA-binding protein (TARBP2), as an inhibitor of the cellular protein kinase PKR, negatively regulates virus -induced IFN-β production by targets MAVS. Overexpression of TARBP2 inhibits virus-induced IFN-β production as well as cellular antiviral response. Then knockdown of TARBP2 inhibited virus-induced IFN-β signaling. Further studies demonstrated that TARBP2 interacted with MAVS and targeted MAVS to abrogate MAVS-RIG-I and MAVS-TRAF3 association. Our findings suggest that TARBP2 is an important non-redundant virus-mediated negative regulator of typeⅠ interferon. (Source: Molecular Immunology)
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Correction: E. coli Nissle 1917 is a safe mucosal delivery vector for a birch-grass pollen chimera to prevent allergic poly-sensitization
Correction: E. coli Nissle 1917 is a safe mucosal delivery vector for a birch-grass pollen chimera to prevent allergic poly-sensitization, Published online: 01 November 2018; doi:10.1038/s41385-018-0103-7Correction: E. coli Nissle 1917 is a safe mucosal delivery vector for a birch-grass pollen chimera to prevent allergic poly-sensitization (Source: Mucosal Immunology)
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Intracellular activation of complement C3 in Paneth cells improves repair of intestinal epithelia during acute injury
Immunotherapy, Ahead of Print. (Source: Immunotherapy)
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Determination of IgE and IgG reactivity to more than 170 allergen molecules in paper-dried blood spots
The determination of allergen-specific IgE had been introduced into allergy diagnosis 50 years ago.1 In addition to clinical anamnesis and provocation testing, it represents one of the cornerstones in the diagnosis of IgE-associated allergy.2 The detailed characterization of the disease-causing allergen molecules through molecular cloning technologies3,4 has brought about new forms of molecular allergy diagnosis that allow measuring IgE specific to a large number of micro-arrayed allergen molecules comprising the most relevant allergen sources by chip technology. (Source: Journal of Allergy and Clinical Immunology)
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Perinatal antibiotic exposure alters composition of murine gut microbiota and may influence later responses to peanut antigen
Accumulating evidence suggests that the gut microbiota shapes developmental processes within the immune system. Early life antibiotic use is one factor which may contribute to immune dysfunction and the recent... (Source: Allergy, Asthma and Clinical Immunology)
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Evaluating the effectiveness of clarithromycin as an adjunct to scaling and root planing: A randomized clinical trial
Conclusions: CLM conceivably accepted as an addendum to NSPT for a shorter period. (Source: Journal of Indian Society of Periodontology)
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Single-Cell Analysis Identifies Thymic Maturation Delay in Growth-Restricted Neonatal Mice
Wendi A. Bacon, Russell S. Hamilton, Ziyi Yu, Jens Kieckbusch, Delia Hawkes, Ada M. Krzak, Chris Abell, Francesco Colucci, D. Stephen Charnock-Jones (Source: Frontiers in Immunology)
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MicroRNAs regulating mucin type O ‐glycan biosynthesis and transforming growth factor β signaling pathways in nasal mucosa of patients with chronic rhinosinusitis with nasal polyps in Northern China
International Forum of Allergy&Rhinology, EarlyView. (Source: International Forum of Allergy and Rhinology)
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Fevipiprant, a DP2 Receptor Antagonist, Inhibits Eosinophil Migration Towards Mast Cells
Clinical&Experimental Allergy,Volume 0, Issue ja, -Not available-. (Source: Clinical and Experimental Allergy)
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Anaphylactic reaction in patient allergic to mango
An allergy to mango is extremely rare. The antigenic composition of the fruit is not fully known. Profilin from mango has a structure similar to birch tree profiling: it is responsible for cross-reactions betw... (Source: Allergy, Asthma and Clinical Immunology)
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Genetic Loci Determining Total Immunoglobulin E Levels from Birth through Adulthood
Allergy,Volume 0, Issue ja, -Not available-. (Source: Allergy)
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A novel approach to emotion recognition using local subset feature selection and modified Dempster-Shafer theory
Emotion recognition is an increasingly important field of research in brain computer interactions.
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A novel approach to emotion recognition using local subset feature selection and modified Dempster-Shafer theory
Emotion recognition is an increasingly important field of research in brain computer interactions.
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Determination of IgE and IgG reactivity to more than 170 allergen molecules in paper-dried blood spots
The determination of allergen-specific IgE had been introduced into allergy diagnosis 50 years ago.1 In addition to clinical anamnesis and provocation testing, it represents one of the cornerstones in the diagnosis of IgE-associated allergy.2 The detailed characterization of the disease-causing allergen molecules through molecular cloning technologies3,4 has brought about new forms of molecular allergy diagnosis that allow measuring IgE specific to a large number of micro-arrayed allergen molecules comprising the most relevant allergen sources by chip technology.
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Determination of IgE and IgG reactivity to more than 170 allergen molecules in paper-dried blood spots
The determination of allergen-specific IgE had been introduced into allergy diagnosis 50 years ago.1 In addition to clinical anamnesis and provocation testing, it represents one of the cornerstones in the diagnosis of IgE-associated allergy.2 The detailed characterization of the disease-causing allergen molecules through molecular cloning technologies3,4 has brought about new forms of molecular allergy diagnosis that allow measuring IgE specific to a large number of micro-arrayed allergen molecules comprising the most relevant allergen sources by chip technology.
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[62/m with bee venom allergy and reddish-brown disseminated small macules and papules mainly localized on the trunk : Preparation for the specialist examination: part 5].
[62/m with bee venom allergy and reddish-brown disseminated small macules and papules mainly localized on the trunk : Preparation for the specialist examination: part 5]. Hautarzt. 2018 Nov;69(Suppl 2):96-99 Authors: Tratzmiller S, Klemke CD Abstract PMID: 30374555 [PubMed - in process] (Source: Der Hautarzt: Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete)
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Small Animal Dermatology: Clinical Updates, Emerging Diseases, and Treatment Advances
Since publication of the last dermatology issue of Veterinary Clinics of North America: Small Animal Practice in 2013, considerable advances have been made in our understanding of the pathogenesis of dermatologic disease, particularly allergic skin disease. These advances have translated into new tools for the management of canine allergic dermatitis. The goals of this issue are to provide readers with a comprehensive review of therapeutic options for allergic dermatitis (with a focus on atopic dermatitis) as well as to review other dermatologic diseases that have been more recently described or are not thoroughly reviewed elsewhere in the veterinary medical literature. (Source: Veterinary Clinics of North America: Small Animal Practice)
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[62/m with bee venom allergy and reddish-brown disseminated small macules and papules mainly localized on the trunk : Preparation for the specialist examination: part 5].
[62/m with bee venom allergy and reddish-brown disseminated small macules and papules mainly localized on the trunk : Preparation for the specialist examination: part 5]. Hautarzt. 2018 Nov;69(Suppl 2):96-99 Authors: Tratzmiller S, Klemke CD Abstract PMID: 30374555 [PubMed - in process] (Source: Der Hautarzt: Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete)
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Small Animal Dermatology: Clinical Updates, Emerging Diseases, and Treatment Advances
Since publication of the last dermatology issue of Veterinary Clinics of North America: Small Animal Practice in 2013, considerable advances have been made in our understanding of the pathogenesis of dermatologic disease, particularly allergic skin disease. These advances have translated into new tools for the management of canine allergic dermatitis. The goals of this issue are to provide readers with a comprehensive review of therapeutic options for allergic dermatitis (with a focus on atopic dermatitis) as well as to review other dermatologic diseases that have been more recently described or are not thoroughly reviewed elsewhere in the veterinary medical literature. (Source: Veterinary Clinics of North America: Small Animal Practice)
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Editorial Board
Publication date: December 2018
Source: Archives of Oral Biology, Volume 96
Author(s):
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Editorial Board
Publication date: December 2018
Source: Archives of Oral Biology, Volume 96
Author(s):
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Letter to the Editor Regarding Survey Research: A Primer for the Academic Radiologist
Publication date: Available online 31 October 2018
Source: Academic Radiology
Author(s): Christopher M. Straus, Andrew W Phillips
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Letter to the Editor Regarding Survey Research: A Primer for the Academic Radiologist
Publication date: Available online 31 October 2018
Source: Academic Radiology
Author(s): Christopher M. Straus, Andrew W Phillips
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Three-dimensional soft tissue prediction in orthognathic surgery: a clinical comparison of Dolphin, ProPlan CMF, and probabilistic finite element modelling
Publication date: Available online 31 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): P.G.M. Knoops, A. Borghi, R.W.F. Breakey, J. Ong, N.U.O. Jeelani, R. Bruun, S. Schievano, D.J. Dunaway, B.L. Padwa
Abstract
Three-dimensional surgical planning is used widely in orthognathic surgery. Although numerous computer programs exist, the accuracy of soft tissue prediction remains uncertain. The purpose of this study was to compare the prediction accuracy of Dolphin, ProPlan CMF, and a probabilistic finite element method (PFEM). Seven patients (mean age 18 years; five female) who had undergone Le Fort I osteotomy with preoperative and 1-year postoperative cone beam computed tomography (CBCT) were included. The three programs were used for soft tissue prediction using planned and postoperative maxillary position, and these were compared to postoperative CBCT. Accurate predictions were obtained with each program, indicated by root mean square distances: RMSDolphin = 1.8 ± 0.8 mm, RMSProPlan = 1.2 ± 0.4 mm, and RMSPFEM = 1.3 ± 0.4 mm. Dolphin utilizes a landmark-based algorithm allowing for patient-specific bone-to-soft tissue ratios, which works well for cephalometric radiographs but has limited three-dimensional accuracy, whilst ProPlan and PFEM provide better three-dimensional predictions with continuous displacements. Patient or population-specific material properties can be defined in PFEM, while no soft tissue parameters are adjustable in ProPlan. Important clinical considerations are the topological differences between predictions due to the three algorithms, the non-negligible influence of the mismatch between planned and postoperative maxillary position, and the learning curve associated with sophisticated programs like PFEM.
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Three-dimensional soft tissue prediction in orthognathic surgery: a clinical comparison of Dolphin, ProPlan CMF, and probabilistic finite element modelling
Publication date: Available online 31 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): P.G.M. Knoops, A. Borghi, R.W.F. Breakey, J. Ong, N.U.O. Jeelani, R. Bruun, S. Schievano, D.J. Dunaway, B.L. Padwa
Abstract
Three-dimensional surgical planning is used widely in orthognathic surgery. Although numerous computer programs exist, the accuracy of soft tissue prediction remains uncertain. The purpose of this study was to compare the prediction accuracy of Dolphin, ProPlan CMF, and a probabilistic finite element method (PFEM). Seven patients (mean age 18 years; five female) who had undergone Le Fort I osteotomy with preoperative and 1-year postoperative cone beam computed tomography (CBCT) were included. The three programs were used for soft tissue prediction using planned and postoperative maxillary position, and these were compared to postoperative CBCT. Accurate predictions were obtained with each program, indicated by root mean square distances: RMSDolphin = 1.8 ± 0.8 mm, RMSProPlan = 1.2 ± 0.4 mm, and RMSPFEM = 1.3 ± 0.4 mm. Dolphin utilizes a landmark-based algorithm allowing for patient-specific bone-to-soft tissue ratios, which works well for cephalometric radiographs but has limited three-dimensional accuracy, whilst ProPlan and PFEM provide better three-dimensional predictions with continuous displacements. Patient or population-specific material properties can be defined in PFEM, while no soft tissue parameters are adjustable in ProPlan. Important clinical considerations are the topological differences between predictions due to the three algorithms, the non-negligible influence of the mismatch between planned and postoperative maxillary position, and the learning curve associated with sophisticated programs like PFEM.
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Common Otologic Surgical Procedures: Clinical Decision-Making Pearls and the Role of Imaging
Publication date: Available online 31 October 2018
Source: Neuroimaging Clinics of North America
Author(s): Tiffany Peng, Apoorva Ramaswamy, Ana H. Kim
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Imaging of Pediatric Hearing Loss
Publication date: Available online 31 October 2018
Source: Neuroimaging Clinics of North America
Author(s): Karuna V. Shekdar, Larissa T. Bilaniuk
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Advanced MR Imaging of the Temporal Bone
Publication date: Available online 31 October 2018
Source: Neuroimaging Clinics of North America
Author(s): Sachin Jambawalikar, Michael Z. Liu, Gul Moonis
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Management of Vestibular Schwannomas for the Radiologist
Publication date: Available online 31 October 2018
Source: Neuroimaging Clinics of North America
Author(s): Apoorva T. Ramaswamy, Justin S. Golub
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Imaging of Temporal Bone Trauma: A Clinicoradiologic Perspective
Publication date: Available online 31 October 2018
Source: Neuroimaging Clinics of North America
Author(s): Joshua E. Lantos, Kristen Leeman, Elizabeth K. Weidman, Kathryn E. Dean, Tiffany Peng, Aaron N. Pearlman
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Common Otologic Surgical Procedures: Clinical Decision-Making Pearls and the Role of Imaging
Publication date: Available online 31 October 2018
Source: Neuroimaging Clinics of North America
Author(s): Tiffany Peng, Apoorva Ramaswamy, Ana H. Kim
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Otosclerosis and Dysplasias of the Temporal Bone
Publication date: Available online 31 October 2018
Source: Neuroimaging Clinics of North America
Author(s): Vanesa Carlota Andreu-Arasa, Edward K. Sung, Akifumi Fujita, Naoko Saito, Osamu Sakai
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Update on Temporal Bone Imaging with Emphasis on Clinical and Surgical Perspectives
Publication date: Available online 31 October 2018
Source: Neuroimaging Clinics of North America
Author(s): Suresh K. Mukherji
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Advanced MR Imaging of the Temporal Bone
Publication date: Available online 31 October 2018
Source: Neuroimaging Clinics of North America
Author(s): Sachin Jambawalikar, Michael Z. Liu, Gul Moonis
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Imaging of Tinnitus
Publication date: Available online 31 October 2018
Source: Neuroimaging Clinics of North America
Author(s): Mary Beth Cunnane
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Management of Vestibular Schwannomas for the Radiologist
Publication date: Available online 31 October 2018
Source: Neuroimaging Clinics of North America
Author(s): Apoorva T. Ramaswamy, Justin S. Golub
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Imaging of Temporal Bone Trauma: A Clinicoradiologic Perspective
Publication date: Available online 31 October 2018
Source: Neuroimaging Clinics of North America
Author(s): Joshua E. Lantos, Kristen Leeman, Elizabeth K. Weidman, Kathryn E. Dean, Tiffany Peng, Aaron N. Pearlman
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The application of artificial intelligence in the IMRT planning process for head and neck cancer
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Vasant Kearney, Jason W. Chan, Gilmer Valdes, Timothy D. Solberg, Sue S. Yom
Abstract
Artificial intelligence (AI) is beginning to transform IMRT treatment planning for head and neck patients. However, the complexity and novelty of AI algorithms make them susceptible to misuse by researchers and clinicians. Understanding nuances of new technologies could serve to mitigate potential clinical implementation pitfalls. This article is intended to facilitate integration of AI into the radiotherapy clinic by providing an overview of AI algorithms, including support vector machines (SVMs), random forests (RF), gradient boosting (GB), and several variations of deep learning. This document describes current AI algorithms that have been applied to head and neck IMRT planning and identifies rapidly growing branches of AI in industry that have potential applications to head and neck cancer patients receiving IMRT. AI algorithms have great clinical potential if used correctly but can also cause harm if misused, so it is important to raise the level of AI competence within radiation oncology so that the benefits can be realized in a controlled and safe manner.
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Are gingival cells more sensitive to genotoxic effects caused by dental radiography?
Publication date: Available online 31 October 2018
Source: Oral Oncology
Author(s): Mahesh Shivaji Chavan, Priti Mahesh Chavan, Digamber Sable, Suhas Pande, Harshada Inamdar, Girija Kunjir, Pallavi Channe
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The application of artificial intelligence in the IMRT planning process for head and neck cancer
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Vasant Kearney, Jason W. Chan, Gilmer Valdes, Timothy D. Solberg, Sue S. Yom
Abstract
Artificial intelligence (AI) is beginning to transform IMRT treatment planning for head and neck patients. However, the complexity and novelty of AI algorithms make them susceptible to misuse by researchers and clinicians. Understanding nuances of new technologies could serve to mitigate potential clinical implementation pitfalls. This article is intended to facilitate integration of AI into the radiotherapy clinic by providing an overview of AI algorithms, including support vector machines (SVMs), random forests (RF), gradient boosting (GB), and several variations of deep learning. This document describes current AI algorithms that have been applied to head and neck IMRT planning and identifies rapidly growing branches of AI in industry that have potential applications to head and neck cancer patients receiving IMRT. AI algorithms have great clinical potential if used correctly but can also cause harm if misused, so it is important to raise the level of AI competence within radiation oncology so that the benefits can be realized in a controlled and safe manner.
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Are gingival cells more sensitive to genotoxic effects caused by dental radiography?
Publication date: Available online 31 October 2018
Source: Oral Oncology
Author(s): Mahesh Shivaji Chavan, Priti Mahesh Chavan, Digamber Sable, Suhas Pande, Harshada Inamdar, Girija Kunjir, Pallavi Channe
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Cognitive enhancement with Salience Network electrical stimulation is influenced by network structural connectivity
Publication date: 15 January 2019
Source: NeuroImage, Volume 185
Author(s): Lucia M. Li, Ines R. Violante, Rob Leech, Adam Hampshire, Alexander Opitz, David McArthur, David W. Carmichael, David J. Sharp
Abstract
The Salience Network (SN) and its interactions are important for cognitive control. We have previously shown that structural damage to the SN is associated with abnormal functional connectivity between the SN and Default Mode Network (DMN), abnormal DMN deactivation, and impaired response inhibition, which is an important aspect of cognitive control. This suggests that stimulating the SN might enhance cognitive control. Here, we tested whether non-invasive transcranial direct current stimulation (TDCS) could be used to modulate activity within the SN and enhance cognitive control. TDCS was applied to the right inferior frontal gyrus/anterior insula cortex during performance of the Stop Signal Task (SST) and concurrent functional (f)MRI. Anodal TDCS improved response inhibition. Furthermore, stratification of participants based on SN structural connectivity showed that it was an important influence on both behavioural and physiological responses to anodal TDCS. Participants with high fractional anisotropy within the SN showed improved SST performance and increased activation of the SN with anodal TDCS, whilst those with low fractional anisotropy within the SN did not. Cathodal stimulation of the SN produced activation of the right caudate, an effect which was not modulated by SN structural connectivity. Our results show that stimulation targeted to the SN can improve response inhibition, supporting the causal influence of this network on cognitive control and confirming it as a target to produce cognitive enhancement. Our results also highlight the importance of structural connectivity as a modulator of network to TDCS, which should guide the design and interpretation of future stimulation studies.
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Morphological study of the changes after sagittal split ramus osteotomy in patients with facial asymmetry: measurements of 3-dimensional modelling
Publication date: Available online 31 October 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): Y.-L. Zhang, Y. Liu, J.-H. Shu, X.-C. Xu, Z. Liu
Abstract
The effects of bilateral sagittal split ramus osteotomy (BSSRO) on the temporomandibular joint (TMJ) are still not well understood. The aim of this study was to compare the morphological differences among unaffected subjects on the one hand, and patients with facial asymmetry before and after BSSRO on the other. Ten Chinese patients (preoperative and postoperative groups, mean (SD) age 25 (5) years) diagnosed with facial asymmetry and 10 unaffected subjects (control group, mean (SD) age 27 (5) years) were recruited prospectively. The 3-dimensional morphological measurements made on 3-dimensional models in each group were assessed by analysis-of-variance (ANOVA) and Student's t test, and probabilities of <0.05 were accepted as significant. The horizontal condylar angle (HCA), coronal condylar angle (CCA), sagittal ramus angle (SRA), medial joint space (MJS), lateral joint space (LJS), and superior joint space (SJS) differed significantly between the preoperative and control groups (HCA: p = 0.000, CCA: p = 0.000, SRA(left/undeviated side): p = 0.002, MJS(left/undeviated side): p = 0.000, MJS(right/deviated side): p = 0.007, LJS(right/deviated side): p = 0.000, SJS(left/undeviated side): p = 0.000, SJS(right/deviated side): p = 0.000). The SRA, MJS, LJS, and SJS differed significantly between the preoperative and postoperative groups (SRA(left/undeviated side): p = 0.012, MJS(left/undeviated side): p = 0.002, LJS(right/deviated side): p = 0.021, SJS(left/undeviated side): p = 0.000, SJS(right/deviated side): p = 0.001), And the SRA, MJS, and LJS in the preoperative group differed significantly between the deviated and undeviated side (SRA: p = 0.006; MJS: p = 0.003; LJS: p = 0.011). However, there were no significant differences in the postoperative and control groups between the deviated and undeviated sides. BSSRO improved the asymmetrical morphology of the TMJ and alleviated the symptoms.
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Cognitive enhancement with Salience Network electrical stimulation is influenced by network structural connectivity
Publication date: 15 January 2019
Source: NeuroImage, Volume 185
Author(s): Lucia M. Li, Ines R. Violante, Rob Leech, Adam Hampshire, Alexander Opitz, David McArthur, David W. Carmichael, David J. Sharp
Abstract
The Salience Network (SN) and its interactions are important for cognitive control. We have previously shown that structural damage to the SN is associated with abnormal functional connectivity between the SN and Default Mode Network (DMN), abnormal DMN deactivation, and impaired response inhibition, which is an important aspect of cognitive control. This suggests that stimulating the SN might enhance cognitive control. Here, we tested whether non-invasive transcranial direct current stimulation (TDCS) could be used to modulate activity within the SN and enhance cognitive control. TDCS was applied to the right inferior frontal gyrus/anterior insula cortex during performance of the Stop Signal Task (SST) and concurrent functional (f)MRI. Anodal TDCS improved response inhibition. Furthermore, stratification of participants based on SN structural connectivity showed that it was an important influence on both behavioural and physiological responses to anodal TDCS. Participants with high fractional anisotropy within the SN showed improved SST performance and increased activation of the SN with anodal TDCS, whilst those with low fractional anisotropy within the SN did not. Cathodal stimulation of the SN produced activation of the right caudate, an effect which was not modulated by SN structural connectivity. Our results show that stimulation targeted to the SN can improve response inhibition, supporting the causal influence of this network on cognitive control and confirming it as a target to produce cognitive enhancement. Our results also highlight the importance of structural connectivity as a modulator of network to TDCS, which should guide the design and interpretation of future stimulation studies.
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Morphological study of the changes after sagittal split ramus osteotomy in patients with facial asymmetry: measurements of 3-dimensional modelling
Publication date: Available online 31 October 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): Y.-L. Zhang, Y. Liu, J.-H. Shu, X.-C. Xu, Z. Liu
Abstract
The effects of bilateral sagittal split ramus osteotomy (BSSRO) on the temporomandibular joint (TMJ) are still not well understood. The aim of this study was to compare the morphological differences among unaffected subjects on the one hand, and patients with facial asymmetry before and after BSSRO on the other. Ten Chinese patients (preoperative and postoperative groups, mean (SD) age 25 (5) years) diagnosed with facial asymmetry and 10 unaffected subjects (control group, mean (SD) age 27 (5) years) were recruited prospectively. The 3-dimensional morphological measurements made on 3-dimensional models in each group were assessed by analysis-of-variance (ANOVA) and Student's t test, and probabilities of <0.05 were accepted as significant. The horizontal condylar angle (HCA), coronal condylar angle (CCA), sagittal ramus angle (SRA), medial joint space (MJS), lateral joint space (LJS), and superior joint space (SJS) differed significantly between the preoperative and control groups (HCA: p = 0.000, CCA: p = 0.000, SRA(left/undeviated side): p = 0.002, MJS(left/undeviated side): p = 0.000, MJS(right/deviated side): p = 0.007, LJS(right/deviated side): p = 0.000, SJS(left/undeviated side): p = 0.000, SJS(right/deviated side): p = 0.000). The SRA, MJS, LJS, and SJS differed significantly between the preoperative and postoperative groups (SRA(left/undeviated side): p = 0.012, MJS(left/undeviated side): p = 0.002, LJS(right/deviated side): p = 0.021, SJS(left/undeviated side): p = 0.000, SJS(right/deviated side): p = 0.001), And the SRA, MJS, and LJS in the preoperative group differed significantly between the deviated and undeviated side (SRA: p = 0.006; MJS: p = 0.003; LJS: p = 0.011). However, there were no significant differences in the postoperative and control groups between the deviated and undeviated sides. BSSRO improved the asymmetrical morphology of the TMJ and alleviated the symptoms.
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Endoscopic triple-C tympanoplasty: an alternative approach to anteriorly located tympanic membrane repair.
Endoscopic triple-C tympanoplasty: an alternative approach to anteriorly located tympanic membrane repair.
J Laryngol Otol. 2018 Oct 31;:1-3
Authors: Demirhan H, Yiğit Ö, Hamit B, Çakır M
Abstract
OBJECTIVE: Anteriorly located tympanic membrane perforations can negatively affect surgical success rates. This study aimed to present, using our case series results, endoscopic triple-C (composite chondroperichondrial clip) tympanoplasty as an alternative method in the repair of tympanic membrane anterior quadrant perforations.
METHODS: This study included patients with a perforation sized greater than 3 mm, who had an anterior quadrant dominant perforation where the anterior portion could not be seen during microscopic examination; all underwent endoscopic triple-C tympanoplasty.
RESULTS: Operating time was 30-79 minutes (mean, 46.6 minutes). The post-operative graft success rate at six months was 92 per cent (23 out of 25). Mean post-operative follow-up duration was 21.5 ± 7.3 months (range, 11-40 months), and no intratympanic cholesteatoma was observed.
CONCLUSION: Endoscopic triple-C tympanoplasty is a comfortable, minimally invasive alternative method to repair anterior tympanic membrane perforations. The graft success rate and the degree of recovery from hearing loss were in accordance with the literature. However, more reliable results may be obtained in a larger series with longer follow-up times.
PMID: 30376900 [PubMed - as supplied by publisher]
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Endoscopic triple-C tympanoplasty: an alternative approach to anteriorly located tympanic membrane repair.
Endoscopic triple-C tympanoplasty: an alternative approach to anteriorly located tympanic membrane repair.
J Laryngol Otol. 2018 Oct 31;:1-3
Authors: Demirhan H, Yiğit Ö, Hamit B, Çakır M
Abstract
OBJECTIVE: Anteriorly located tympanic membrane perforations can negatively affect surgical success rates. This study aimed to present, using our case series results, endoscopic triple-C (composite chondroperichondrial clip) tympanoplasty as an alternative method in the repair of tympanic membrane anterior quadrant perforations.
METHODS: This study included patients with a perforation sized greater than 3 mm, who had an anterior quadrant dominant perforation where the anterior portion could not be seen during microscopic examination; all underwent endoscopic triple-C tympanoplasty.
RESULTS: Operating time was 30-79 minutes (mean, 46.6 minutes). The post-operative graft success rate at six months was 92 per cent (23 out of 25). Mean post-operative follow-up duration was 21.5 ± 7.3 months (range, 11-40 months), and no intratympanic cholesteatoma was observed.
CONCLUSION: Endoscopic triple-C tympanoplasty is a comfortable, minimally invasive alternative method to repair anterior tympanic membrane perforations. The graft success rate and the degree of recovery from hearing loss were in accordance with the literature. However, more reliable results may be obtained in a larger series with longer follow-up times.
PMID: 30376900 [PubMed - as supplied by publisher]
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Genetic Loci Determining Total Immunoglobulin E Levels from Birth through Adulthood
Allergy, Volume 0, Issue ja, -Not available-.
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Genetic Loci Determining Total Immunoglobulin E Levels from Birth through Adulthood
Allergy, Volume 0, Issue ja, -Not available-.
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Validation of the LITHUANIAN version of the 19-item audit of diabetes dependent quality of life (ADDQOL – LT) questionnaire in patients with diabetes
Currently there is no diabetes-specific quality of life (QOL) instrument available in Lithuanian language. We aimed to develop a Lithuanian version of a widely-used individualised instrument - the Audit of Dia...
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Validation of the LITHUANIAN version of the 19-item audit of diabetes dependent quality of life (ADDQOL – LT) questionnaire in patients with diabetes
Currently there is no diabetes-specific quality of life (QOL) instrument available in Lithuanian language. We aimed to develop a Lithuanian version of a widely-used individualised instrument - the Audit of Dia...
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Who Should Be Gluten-Free? A Review for the General Practitioner
Historically, a gluten-free diet was recommended only for those with celiac disease or IgE-mediated wheat allergy. With changes in food allergy labeling in the United States and the publication of several best-selling books, gluten-related disorders have come to the forefront of popular culture. As a result, there has been a dramatic increase in the number of gluten-free diet followers, many for nontraditional reasons. As "going gluten-free" has become mainstream, it is imperative that health care providers acquire the knowledge to identify true gluten-related disorders to effectively counsel their patients and minimize potential complications from following such a restrictive diet. (Source: Medical Clinics of North America)
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The protective effects of nasal PcrV ‐CpG oligonucleotide vaccination against Pseudomonas aeruginosa pneumonia
Microbiology and Immunology,Volume 0, Issue ja, -Not available-. (Source: Microbiology and Immunology)
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Who Should Be Gluten-Free? A Review for the General Practitioner
Historically, a gluten-free diet was recommended only for those with celiac disease or IgE-mediated wheat allergy. With changes in food allergy labeling in the United States and the publication of several best-selling books, gluten-related disorders have come to the forefront of popular culture. As a result, there has been a dramatic increase in the number of gluten-free diet followers, many for nontraditional reasons. As "going gluten-free" has become mainstream, it is imperative that health care providers acquire the knowledge to identify true gluten-related disorders to effectively counsel their patients and minimize potential complications from following such a restrictive diet. (Source: Medical Clinics of North America)
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The protective effects of nasal PcrV ‐CpG oligonucleotide vaccination against Pseudomonas aeruginosa pneumonia
Microbiology and Immunology,Volume 0, Issue ja, -Not available-. (Source: Microbiology and Immunology)
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Contact sensitization to hydroperoxides of limonene and linalool: Results of consecutive patch testing and clinical relevance
Contact Dermatitis, EarlyView.
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Contact sensitization to hydroperoxides of limonene and linalool: Results of consecutive patch testing and clinical relevance
Contact Dermatitis, EarlyView.
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MicroRNAs regulating mucin type O‐glycan biosynthesis and transforming growth factor β signaling pathways in nasal mucosa of patients with chronic rhinosinusitis with nasal polyps in Northern China
International Forum of Allergy &Rhinology, EarlyView.
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MicroRNAs regulating mucin type O‐glycan biosynthesis and transforming growth factor β signaling pathways in nasal mucosa of patients with chronic rhinosinusitis with nasal polyps in Northern China
International Forum of Allergy &Rhinology, EarlyView.
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A differentially selective probe for trivalent chemosensor upon single excitation with cell imaging application: A Potential Applications for a Combinatorial logic circuit and memory device.†
Photochem. Photobiol. Sci., 2018, Accepted Manuscript
DOI: 10.1039/C8PP00381E, Paper
DOI: 10.1039/C8PP00381E, Paper
Dipankar Das, Rabiul Alam, Atul Katarkar, Ali Mahammad
A new rhodamine 6G-benzylamine based sensor (L1), having only hydrocarbon skeletons in the extended part, has been synthesised and characterised by single crystal X-ray crystallographic study. It exhibits an excellent...
The content of this RSS Feed (c) The Royal Society of Chemistry
A new rhodamine 6G-benzylamine based sensor (L1), having only hydrocarbon skeletons in the extended part, has been synthesised and characterised by single crystal X-ray crystallographic study. It exhibits an excellent...
The content of this RSS Feed (c) The Royal Society of Chemistry
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A differentially selective probe for trivalent chemosensor upon single excitation with cell imaging application: A Potential Applications for a Combinatorial logic circuit and memory device.†
Photochem. Photobiol. Sci., 2018, Accepted Manuscript
DOI: 10.1039/C8PP00381E, Paper
DOI: 10.1039/C8PP00381E, Paper
Dipankar Das, Rabiul Alam, Atul Katarkar, Ali Mahammad
A new rhodamine 6G-benzylamine based sensor (L1), having only hydrocarbon skeletons in the extended part, has been synthesised and characterised by single crystal X-ray crystallographic study. It exhibits an excellent...
The content of this RSS Feed (c) The Royal Society of Chemistry
A new rhodamine 6G-benzylamine based sensor (L1), having only hydrocarbon skeletons in the extended part, has been synthesised and characterised by single crystal X-ray crystallographic study. It exhibits an excellent...
The content of this RSS Feed (c) The Royal Society of Chemistry
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In Response
National Partnership for Maternal Safety Recommended Maternal Early Warning Criteria Are Associated With Maternal Morbidity
BACKGROUND: Many cases of maternal mortality and morbidity are preventable. A delayed response to clinical warning signs contributes to preventability. Therefore, the National Partnership for Maternal Safety devised maternal early warning criteria (MEWC), composed of abnormal vital signs that trigger bedside evaluation by a provider with the capacity to escalate care. The relationship of the MEWC to maternal morbidity has not been studied. We evaluated the correlation between the MEWC and maternal morbidity. METHODS: We retrospectively reviewed the first 400 deliveries at the University of Chicago in 2016. We analyzed the electronic medical record to determine whether vital signs triggered the MEWC during the admission to labor and delivery and whether patients experienced morbidity during their delivery hospitalization. The association between MEWC and morbidity was tested using χ2 analysis. We calculated the sensitivity, specificity, and positive and negative predictive values of the MEWC. RESULTS: Two hundred eighty-one (70%) of 400 patients triggered the MEWC at least once, and 198 (50%) of 400 patients had multiple or recurrent triggers. Ninety-nine (25%) of 400 patients experienced morbidity. The most common causes of morbidity were hemorrhage, suspected infection, and preeclampsia with severe features. The relative risk of maternal morbidity with at least a single trigger was 13.55 (95% confidence interval [CI], 4.38–41.91) and with recurrent or multiple triggers was 5.29 (95% CI, 3.22–8.71). The sensitivity of the MEWC in predicting morbidity was 0.97 (95% CI, 0.92–0.99) and the specificity was 0.39 (95% CI, 0.33–0.44) when patients with at least a single trigger were included. When including only patients with multiple or recurrent triggers, the sensitivity was 0.84 (95% CI, 0.75–0.90) and the specificity was 0.62 (95% CI, 0.56–0.67). The positive predictive value of the MEWC in our population was 0.34 (95% CI, 0.29–0.40), and the negative predictive value was 0.97 (95% CI, 0.93–0.99). When considering only patients with multiple or recurrent triggers, the positive predictive value was 0.42 (95% CI, 0.38–0.46) and the negative predictive value was 0.92 (95% CI, 0.88–0.95). CONCLUSIONS: The MEWC are associated with maternal morbidity. As a screening tool, they appropriately prioritize sensitivity and have an excellent negative predictive value. The criteria demonstrate low specificity, which is slightly improved by considering only patients with recurrent or multiple triggers. Additional efforts to improve the specificity of MEWC, with a focus on identifying sustained or recurrent patterns of abnormal vital signs, may be necessary before their widespread implementation. Accepted for publication September 26, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Barbara M. Scavone, MD, Departments of Anesthesia and Critical Care and Obstetrics and Gynecology, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637. Address e-mail to bscavone@dacc.uchicago.edu. © 2018 International Anesthesia Research Society
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Monitoring Mechanical Ventilation Using Ventilator Waveforms
Preoperative Echocardiography for Patients With Hip Fractures Undergoing Surgery: A Retrospective Cohort Study Using a Nationwide Database
BACKGROUND: The effect of preoperative transthoracic echocardiography on the clinical outcomes of patients with hip fractures undergoing surgical treatment remains controversial. We hypothesized that preoperative echocardiography is associated with reduced postoperative morbidity and improved patient survival after surgical repair of hip fractures. METHODS: Drawing from a nationwide administrative database, patients undergoing hip fracture surgeries between April 1, 2008 and December 31, 2016 were included. We examined the association of preoperative echocardiography with the incidence of in-hospital mortality using propensity score matching. Secondary outcomes included postoperative complications, the incidence of postoperative intensive care unit admissions, and length of hospital stay. For sensitivity analyses, we restricted the overall cohort to include only hip fracture surgeries performed within 2 days from admission. RESULTS: Overall, 34,679 (52.1%) of 66,620 surgical patients underwent preoperative echocardiography screening. The screened patients (mean [SD] age, 84.3 years [7.7 years]; 79.0% female) were propensity score matched to 31,941 nonscreened patients (mean [SD] age, 82.1 years [8.7 years]; 78.2% female). The overall in-hospital mortality, before propensity matching, was 1.8% (1227 patients). Propensity score matching created a matched cohort of 25,205 pairs of patients. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 417 [1.65%] vs 439 [1.74%]; odds ratio, 0.95; 95% confidence interval, 0.83–1.09; P = .45). Preoperative echocardiography was not associated with reduced postoperative complications and intensive care unit admissions. In sensitivity analysis, we identified 25,637 patients from the overall cohort (38.5%) with hip fracture surgeries performed within 2 days of admission. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 1.67% vs 1.80%; odds ratio, 0.93; 95% confidence interval, 0.72–1.18; P = .53). Findings were also consistent with other sensitivity analyses and subgroup analyses. CONCLUSIONS: This large, retrospective, nationwide cohort study demonstrated that preoperative echocardiography was not associated with reduced in-hospital mortality or postoperative complications. Accepted for publication September 25, 2018. Funding: Institutional/departmental. Conflicts of Interest: See Disclosures at the end of the article. 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 (https://ift.tt/KegmMq). The authors have no conflicts of interest directly relevant to the content of this article within 36 months before submission. Reprints will not be available from the authors. Address correspondence to Koji Kawakami, MD, PhD, Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto 6068501, Japan. Address e-mail to kawakami.koji.4e@kyoto-u.ac.jp. © 2018 International Anesthesia Research Society
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Is Activity Tracker–Measured Ambulation an Accurate and Reliable Determinant of Postoperative Quality of Recovery? A Prospective Cohort Validation Study
BACKGROUND: Quality of recovery (QOR) instruments measure patients' ability to return to baseline health status after surgery. Whether, and the extent to which, postoperative ambulation contributes to QOR is unclear, in part due to the lack of valid tools to measure ambulation in clinical settings. This cohort study of the cesarean delivery surgical model examines the accuracy and reliability of activity trackers in quantifying early postoperative ambulation and investigates the correlation between ambulation and QOR. METHODS: A prospective cohort of 200 parturients undergoing cesarean delivery between July 2015 and June 2017 was fitted with wrist-worn activity trackers immediately postpartum. The trackers were collected 24 hours later, along with QOR assessments (QoR-15 scale). The relationship between QOR and various covariates, including ambulation, was explored using multivariable linear regression and Spearman correlation (ρ). Forty-eight parturients fitted with 2 trackers also completed a walk exercise accompanied by a step-counting assessor, to evaluate accuracy, inter-, and intradevice reliability using interclass correlation (ICC). RESULTS: Compared to step counting, activity trackers had high accuracy (ICC = 0.93) and excellent inter- and intradevice reliability (ICC = 0.98 and 0.96, respectively). Correlation analysis suggested that early ambulation is moderately correlated with postcesarean QoR-15 scores, with a ρ (95% confidence interval) equivalent to 0.56 (0.328–0.728). Regression analysis suggested that ambulation is a determinant of postcesarean QoR-15 scores, with an effect estimate (95% confidence interval) equivalent to 0.002 (0.001–0.003). Ambulation was also associated with all QoR-15 domains, except psychological support. The patient's acceptable symptom state (subjective threshold for good ambulation) in the first 24 hours was 287 steps. CONCLUSIONS: This study demonstrated the accuracy and reliability of activity trackers in measuring ambulation in clinical settings and suggested that postoperative ambulation is a determinant of postoperative QOR. A hypothetical implication of our findings is that interventions that improve ambulation may also help to enhance QOR, but further research is needed to establish a causal relationship. Accepted for publication October 5, 2018. Funding: This work was supported by departmental funding. J.G.L., D.N.W., and F.W.A. were supported by the Merit Award Program, Department of Anesthesia, University of Toronto. F.W.A. also receives research time support from the Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa. D.N.W. is also supported by a New Investigator Award from the Canadian Institutes of Health Research. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Faraj W. Abdallah, MD, Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. Address e-mail to FAbdallah@toh.ca. © 2018 International Anesthesia Research Society
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Challenging the Traditional Definition of a Difficult Intubation: What Is Difficult?
Fundamentals of Pain Medicine, 1st ed
Do We Need Specific Certification to Use Anesthesia Information Management Systems?
Liver Anesthesiology and Critical Care Medicine, 2nd ed
Effect of chewing rate on meal intake
European Journal of Oral Sciences, EarlyView.
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Fevipiprant, a DP2 Receptor Antagonist, Inhibits Eosinophil Migration Towards Mast Cells
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
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In Response
National Partnership for Maternal Safety Recommended Maternal Early Warning Criteria Are Associated With Maternal Morbidity
BACKGROUND: Many cases of maternal mortality and morbidity are preventable. A delayed response to clinical warning signs contributes to preventability. Therefore, the National Partnership for Maternal Safety devised maternal early warning criteria (MEWC), composed of abnormal vital signs that trigger bedside evaluation by a provider with the capacity to escalate care. The relationship of the MEWC to maternal morbidity has not been studied. We evaluated the correlation between the MEWC and maternal morbidity. METHODS: We retrospectively reviewed the first 400 deliveries at the University of Chicago in 2016. We analyzed the electronic medical record to determine whether vital signs triggered the MEWC during the admission to labor and delivery and whether patients experienced morbidity during their delivery hospitalization. The association between MEWC and morbidity was tested using χ2 analysis. We calculated the sensitivity, specificity, and positive and negative predictive values of the MEWC. RESULTS: Two hundred eighty-one (70%) of 400 patients triggered the MEWC at least once, and 198 (50%) of 400 patients had multiple or recurrent triggers. Ninety-nine (25%) of 400 patients experienced morbidity. The most common causes of morbidity were hemorrhage, suspected infection, and preeclampsia with severe features. The relative risk of maternal morbidity with at least a single trigger was 13.55 (95% confidence interval [CI], 4.38–41.91) and with recurrent or multiple triggers was 5.29 (95% CI, 3.22–8.71). The sensitivity of the MEWC in predicting morbidity was 0.97 (95% CI, 0.92–0.99) and the specificity was 0.39 (95% CI, 0.33–0.44) when patients with at least a single trigger were included. When including only patients with multiple or recurrent triggers, the sensitivity was 0.84 (95% CI, 0.75–0.90) and the specificity was 0.62 (95% CI, 0.56–0.67). The positive predictive value of the MEWC in our population was 0.34 (95% CI, 0.29–0.40), and the negative predictive value was 0.97 (95% CI, 0.93–0.99). When considering only patients with multiple or recurrent triggers, the positive predictive value was 0.42 (95% CI, 0.38–0.46) and the negative predictive value was 0.92 (95% CI, 0.88–0.95). CONCLUSIONS: The MEWC are associated with maternal morbidity. As a screening tool, they appropriately prioritize sensitivity and have an excellent negative predictive value. The criteria demonstrate low specificity, which is slightly improved by considering only patients with recurrent or multiple triggers. Additional efforts to improve the specificity of MEWC, with a focus on identifying sustained or recurrent patterns of abnormal vital signs, may be necessary before their widespread implementation. Accepted for publication September 26, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Barbara M. Scavone, MD, Departments of Anesthesia and Critical Care and Obstetrics and Gynecology, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637. Address e-mail to bscavone@dacc.uchicago.edu. © 2018 International Anesthesia Research Society
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Psychometrics: Trust, but Verify
There is a continued mandate for practicing evidence-based medicine and the prerequisite rigorous analysis of the comparative effectiveness of alternative treatments. There is also an increasing emphasis on delivering value-based health care. Both these high priorities and their related endeavors require correct information about the outcomes of care. Accurately measuring and confirming health care outcomes are thus likely now of even greater importance. The present basic statistical tutorial focuses on the germane topic of psychometrics. In its narrower sense, psychometrics is the science of evaluating the attributes of such psychological tests. However, in its broader sense, psychometrics is concerned with the objective measurement of the skills, knowledge, and abilities, as well as the subjective measurement of the interests, values, and attitudes of individuals—both patients and their clinicians. While psychometrics is principally the domain and content expertise of psychiatry, psychology, and social work, it is also very pertinent to patient care, education, and research in anesthesiology, perioperative medicine, critical care, and pain medicine. A key step in selecting an existing or creating a new health-related assessment tool, scale, or survey is confirming or establishing the usefulness of the existing or new measure; this process conventionally involves assessing its reliability and its validity. Assessing reliability involves demonstrating that the measurement instrument generates consistent and hence reproducible results—in other words, whether the instrument produces the same results each time it is used in the same setting, with the same type of subjects. This includes interrater reliability, intrarater reliability, test–retest reliability, and internal reliability. Assessing validity is answering whether the instrument is actually measuring what it is intended to measure. This includes content validity, criterion validity, and construct validity. In evaluating a reported set of research data and its analyses, in a similar manner, it is important to assess the overall internal validity of the attendant study design and the external validity (generalizability) of its findings. Accepted for publication September 10, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Thomas R. Vetter, MD, MPH, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Bldg, Room 6.812, 1701 Trinity St, Austin, TX 78712. Address e-mail to thomas.vetter@austin.utexas.edu. © 2018 International Anesthesia Research Society
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Development and Pilot Testing of a Context-Relevant Safe Anesthesia Checklist for Cesarean Delivery in East Africa
BACKGROUND: Maternal mortality rate in developing countries is 20 times higher than in developed countries. Detailed reports surrounding maternal deaths have noted an association between substandard management during emergency events and death. In parallel with these findings, there is increasing evidence for cognitive aids as a means to prevent errors during perioperative crises. However, previously published findings are not directly applicable to cesarean delivery in low-income settings. Our hypothesis was that the use of obstetric anesthesia checklists in the management of high-fidelity simulated obstetrical emergency scenarios would improve adherence to best practice guidelines in low- and middle-income countries. METHODS: Accordingly, with input from East African health care professionals, we created a context-relevant obstetric anesthesia checklist for cesarean delivery. Second, clinical observations were performed to assess in a real-world setting. Third, a pilot testing of the cognitive aid was undertaken. RESULTS: Clinical observation data highlighted significant deficiencies in the management of obstetric emergencies. The use of the cesarean delivery checklist during simulations of peripartum hemorrhage and preeclampsia showed significant improvement in the percentage of completed actions (pretraining 23% ± 6% for preeclampsia and 22% ± 13% for peripartum hemorrhage, posttraining 75% ± 9% for preeclampsia, and 69% ± 9% for peripartum hemorrhage [P
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Monitoring Mechanical Ventilation Using Ventilator Waveforms
Preoperative Echocardiography for Patients With Hip Fractures Undergoing Surgery: A Retrospective Cohort Study Using a Nationwide Database
BACKGROUND: The effect of preoperative transthoracic echocardiography on the clinical outcomes of patients with hip fractures undergoing surgical treatment remains controversial. We hypothesized that preoperative echocardiography is associated with reduced postoperative morbidity and improved patient survival after surgical repair of hip fractures. METHODS: Drawing from a nationwide administrative database, patients undergoing hip fracture surgeries between April 1, 2008 and December 31, 2016 were included. We examined the association of preoperative echocardiography with the incidence of in-hospital mortality using propensity score matching. Secondary outcomes included postoperative complications, the incidence of postoperative intensive care unit admissions, and length of hospital stay. For sensitivity analyses, we restricted the overall cohort to include only hip fracture surgeries performed within 2 days from admission. RESULTS: Overall, 34,679 (52.1%) of 66,620 surgical patients underwent preoperative echocardiography screening. The screened patients (mean [SD] age, 84.3 years [7.7 years]; 79.0% female) were propensity score matched to 31,941 nonscreened patients (mean [SD] age, 82.1 years [8.7 years]; 78.2% female). The overall in-hospital mortality, before propensity matching, was 1.8% (1227 patients). Propensity score matching created a matched cohort of 25,205 pairs of patients. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 417 [1.65%] vs 439 [1.74%]; odds ratio, 0.95; 95% confidence interval, 0.83–1.09; P = .45). Preoperative echocardiography was not associated with reduced postoperative complications and intensive care unit admissions. In sensitivity analysis, we identified 25,637 patients from the overall cohort (38.5%) with hip fracture surgeries performed within 2 days of admission. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 1.67% vs 1.80%; odds ratio, 0.93; 95% confidence interval, 0.72–1.18; P = .53). Findings were also consistent with other sensitivity analyses and subgroup analyses. CONCLUSIONS: This large, retrospective, nationwide cohort study demonstrated that preoperative echocardiography was not associated with reduced in-hospital mortality or postoperative complications. Accepted for publication September 25, 2018. Funding: Institutional/departmental. Conflicts of Interest: See Disclosures at the end of the article. 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 (https://ift.tt/KegmMq). The authors have no conflicts of interest directly relevant to the content of this article within 36 months before submission. Reprints will not be available from the authors. Address correspondence to Koji Kawakami, MD, PhD, Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto 6068501, Japan. Address e-mail to kawakami.koji.4e@kyoto-u.ac.jp. © 2018 International Anesthesia Research Society
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Is Activity Tracker–Measured Ambulation an Accurate and Reliable Determinant of Postoperative Quality of Recovery? A Prospective Cohort Validation Study
BACKGROUND: Quality of recovery (QOR) instruments measure patients' ability to return to baseline health status after surgery. Whether, and the extent to which, postoperative ambulation contributes to QOR is unclear, in part due to the lack of valid tools to measure ambulation in clinical settings. This cohort study of the cesarean delivery surgical model examines the accuracy and reliability of activity trackers in quantifying early postoperative ambulation and investigates the correlation between ambulation and QOR. METHODS: A prospective cohort of 200 parturients undergoing cesarean delivery between July 2015 and June 2017 was fitted with wrist-worn activity trackers immediately postpartum. The trackers were collected 24 hours later, along with QOR assessments (QoR-15 scale). The relationship between QOR and various covariates, including ambulation, was explored using multivariable linear regression and Spearman correlation (ρ). Forty-eight parturients fitted with 2 trackers also completed a walk exercise accompanied by a step-counting assessor, to evaluate accuracy, inter-, and intradevice reliability using interclass correlation (ICC). RESULTS: Compared to step counting, activity trackers had high accuracy (ICC = 0.93) and excellent inter- and intradevice reliability (ICC = 0.98 and 0.96, respectively). Correlation analysis suggested that early ambulation is moderately correlated with postcesarean QoR-15 scores, with a ρ (95% confidence interval) equivalent to 0.56 (0.328–0.728). Regression analysis suggested that ambulation is a determinant of postcesarean QoR-15 scores, with an effect estimate (95% confidence interval) equivalent to 0.002 (0.001–0.003). Ambulation was also associated with all QoR-15 domains, except psychological support. The patient's acceptable symptom state (subjective threshold for good ambulation) in the first 24 hours was 287 steps. CONCLUSIONS: This study demonstrated the accuracy and reliability of activity trackers in measuring ambulation in clinical settings and suggested that postoperative ambulation is a determinant of postoperative QOR. A hypothetical implication of our findings is that interventions that improve ambulation may also help to enhance QOR, but further research is needed to establish a causal relationship. Accepted for publication October 5, 2018. Funding: This work was supported by departmental funding. J.G.L., D.N.W., and F.W.A. were supported by the Merit Award Program, Department of Anesthesia, University of Toronto. F.W.A. also receives research time support from the Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa. D.N.W. is also supported by a New Investigator Award from the Canadian Institutes of Health Research. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Faraj W. Abdallah, MD, Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. Address e-mail to FAbdallah@toh.ca. © 2018 International Anesthesia Research Society
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Fundamentals of Pain Medicine, 1st ed
Do We Need Specific Certification to Use Anesthesia Information Management Systems?
Liver Anesthesiology and Critical Care Medicine, 2nd ed
In Response
Effect of chewing rate on meal intake
European Journal of Oral Sciences, EarlyView.
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Evaluation of a Bio-inspired Coding Strategy for Cochlear Implant Users
Condition: Hearing Loss, Complete Intervention: Device: Coding strategy for cochlear implants Sponsor: University of Zurich Recruiting (Source: ClinicalTrials.gov)
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Evaluation of a Bio-inspired Coding Strategy for Cochlear Implant Users
Condition: Hearing Loss, Complete Intervention: Device: Coding strategy for cochlear implants Sponsor: University of Zurich Recruiting (Source: ClinicalTrials.gov)
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Personalized 3D-Printed Transparent Liver Model Using the Hepatobiliary Phase MRI: Usefulness in the Lesion-by-Lesion Imaging-Pathologic Matching of Focal Liver Lesions—Preliminary Results
Purpose The aim of this study was to investigate the usefulness of a personalized, 3-dimensional (3D)–printed, transparent liver model with focal liver lesions (FLLs) for lesion-by-lesion imaging-pathologic matching. Materials and Methods This preliminary, prospective study was approved by our institutional review board, and written informed consent was obtained. Twenty patients (male-to-female ratio, 13:7; mean age, 56 years) with multiple FLLs, including at least one presumed malignant, or an indeterminate lesion 10 mm or less on the preoperative gadoxetic acid–enhanced magnetic resonance imaging (MRI), were included. After digital segmentation of hepatobiliary phase MRI, a transparent, 3D-printed liver model with colored anatomical structures and FLLs was produced. During the gross examination of the liver specimen, the per-lesion detection rates were compared between those without (routine protocol) and those with the aid of the 3D-printed liver model. Results Among 98 MRI-detected FLLs (11.5 ± 12.5 mm), the per-lesion detection rate on gross examination using the 3D-printed liver model was 99.0% (97/98), which was significantly higher than that obtained on routine examination (82.7% [81/98]; P
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A Structured Survey on Adverse Events Occurring Within 24 Hours After Intravenous Exposure to Gadodiamide or Gadoterate Meglumine: A Controlled Prospective Comparison Study
Objective This study compares the incidence of new-onset symptoms within 24 hours after enhanced magnetic resonance imaging (eMRI) with intravenous administration of gadodiamide or gadoterate meglumine compared with a control group undergoing unenhanced MRI (uMRI). Materials and Methods A prospective cohort study (n = 1088 patients) was designed to assess the incidence of symptoms within 24 hours after administration of gadodiamide or gadoterate meglumine. The participants underwent a structured questionnaire by phone call before and 24 hours after the MRI scan to check for symptoms that were not present before the scan. The questionnaire included a list of active questions aimed to test the prevalence of symptoms that have been proposed in the debated definition of gadolinium deposition disease (GDD) and that we recorded in this study as GDD-like. In particular, the following symptoms and signs were tested: central torso pain, arm or leg pain, bone pain, headache, skin redness (any site of the body), fatigue, and mental confusion. Fisher exact test was used to test differences between groups with significance threshold set at P
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Native T1 Mapping as an In Vivo Biomarker for the Identification of Higher-Grade Renal Cell Carcinoma: Correlation With Histopathological Findings
Objectives The aims of this study were to identify higher-grade clear cell renal cell carcinoma (cRCC) with native T1 mapping and to histologically correlate the results with the collagen volume fraction. Materials and Methods For this institutional review board–approved, single-center prospective study, 68 consecutive patients received abdominal magnetic resonance imaging scans at 1.5 T between January 2017 and July 2018, using a Modified Look-Locker Inversion Recovery (MOLLI) sequence. Thirty patients with cRCC (20 men; mean age, 61.9 ± 13.1 years) who underwent partial or radical nephrectomy and histological grading according to the International Society of Urological Pathology (ISUP) classification and a separate healthy cohort of 30 individuals without renal malignancies or complex cysts (16 men; mean age, 59.7 ± 14.6 years) met the eligibility criteria. T1 values were quantitatively measured with region of interest measurements in T1 maps. Quantification of the collagen volume fraction was performed on histological sections (picrosirius red staining). Results Native T1 values were significantly lower for lower-grade cRCC (ISUP 1 and 2) compared with higher-grade cRCC (ISUP 3 and 4; P
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Personalized 3D-Printed Transparent Liver Model Using the Hepatobiliary Phase MRI: Usefulness in the Lesion-by-Lesion Imaging-Pathologic Matching of Focal Liver Lesions—Preliminary Results
Purpose The aim of this study was to investigate the usefulness of a personalized, 3-dimensional (3D)–printed, transparent liver model with focal liver lesions (FLLs) for lesion-by-lesion imaging-pathologic matching. Materials and Methods This preliminary, prospective study was approved by our institutional review board, and written informed consent was obtained. Twenty patients (male-to-female ratio, 13:7; mean age, 56 years) with multiple FLLs, including at least one presumed malignant, or an indeterminate lesion 10 mm or less on the preoperative gadoxetic acid–enhanced magnetic resonance imaging (MRI), were included. After digital segmentation of hepatobiliary phase MRI, a transparent, 3D-printed liver model with colored anatomical structures and FLLs was produced. During the gross examination of the liver specimen, the per-lesion detection rates were compared between those without (routine protocol) and those with the aid of the 3D-printed liver model. Results Among 98 MRI-detected FLLs (11.5 ± 12.5 mm), the per-lesion detection rate on gross examination using the 3D-printed liver model was 99.0% (97/98), which was significantly higher than that obtained on routine examination (82.7% [81/98]; P
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A Structured Survey on Adverse Events Occurring Within 24 Hours After Intravenous Exposure to Gadodiamide or Gadoterate Meglumine: A Controlled Prospective Comparison Study
Objective This study compares the incidence of new-onset symptoms within 24 hours after enhanced magnetic resonance imaging (eMRI) with intravenous administration of gadodiamide or gadoterate meglumine compared with a control group undergoing unenhanced MRI (uMRI). Materials and Methods A prospective cohort study (n = 1088 patients) was designed to assess the incidence of symptoms within 24 hours after administration of gadodiamide or gadoterate meglumine. The participants underwent a structured questionnaire by phone call before and 24 hours after the MRI scan to check for symptoms that were not present before the scan. The questionnaire included a list of active questions aimed to test the prevalence of symptoms that have been proposed in the debated definition of gadolinium deposition disease (GDD) and that we recorded in this study as GDD-like. In particular, the following symptoms and signs were tested: central torso pain, arm or leg pain, bone pain, headache, skin redness (any site of the body), fatigue, and mental confusion. Fisher exact test was used to test differences between groups with significance threshold set at P
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Native T1 Mapping as an In Vivo Biomarker for the Identification of Higher-Grade Renal Cell Carcinoma: Correlation With Histopathological Findings
Objectives The aims of this study were to identify higher-grade clear cell renal cell carcinoma (cRCC) with native T1 mapping and to histologically correlate the results with the collagen volume fraction. Materials and Methods For this institutional review board–approved, single-center prospective study, 68 consecutive patients received abdominal magnetic resonance imaging scans at 1.5 T between January 2017 and July 2018, using a Modified Look-Locker Inversion Recovery (MOLLI) sequence. Thirty patients with cRCC (20 men; mean age, 61.9 ± 13.1 years) who underwent partial or radical nephrectomy and histological grading according to the International Society of Urological Pathology (ISUP) classification and a separate healthy cohort of 30 individuals without renal malignancies or complex cysts (16 men; mean age, 59.7 ± 14.6 years) met the eligibility criteria. T1 values were quantitatively measured with region of interest measurements in T1 maps. Quantification of the collagen volume fraction was performed on histological sections (picrosirius red staining). Results Native T1 values were significantly lower for lower-grade cRCC (ISUP 1 and 2) compared with higher-grade cRCC (ISUP 3 and 4; P
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Τετάρτη 31 Οκτωβρίου 2018
Efficacy and Effectiveness of Advanced Hearing Aid Directional and Noise Reduction Technologies for Older Adults With Mild to Moderate Hearing Loss
Objectives: The purpose of the present study was to investigate the laboratory efficacy and real-world effectiveness of advanced directional microphones (DM) and digital noise reduction (NR) algorithms (i.e., premium DM/NR features) relative to basic-level DM/NR features of contemporary hearing aids (HAs). The study also examined the effect of premium HAs relative to basic HAs and the effect of DM/NR features relative to no features. Design: Fifty-four older adults with mild-to-moderate hearing loss completed a single-blinded crossover trial. Two HA models, one a less-expensive, basic-level device (basic HA) and the other a more-expensive, advanced-level device (premium HA), were used. The DM/NR features of the basic HAs (i.e., basic features) were adaptive DMs and gain-reduction NR with fewer channels. In contrast, the DM/NR features of the premium HAs (i.e., premium features) included adaptive DMs and gain-reduction NR with more channels, bilateral beamformers, speech-seeking DMs, pinna-simulation directivity, reverberation reduction, impulse NR, wind NR, and spatial NR. The trial consisted of four conditions, which were factorial combinations of HA model (premium versus basic) and DM/NR feature status (on versus off). To blind participants regarding the HA technology, no technology details were disclosed and minimal training on how to use the features was provided. In each condition, participants wore bilateral HAs for 5 weeks. Outcomes regarding speech understanding, listening effort, sound quality, localization, and HA satisfaction were measured using laboratory tests, retrospective self-reports (i.e., standardized questionnaires), and in-situ self-reports (i.e., self-reports completed in the real world in real time). A smartphone-based ecological momentary assessment system was used to collect in-situ self-reports. Results: Laboratory efficacy data generally supported the benefit of premium DM/NR features relative to basic DM/NR, premium HAs relative to basic HAs, and DM/NR features relative to no DM/NR in improving speech understanding and localization performance. Laboratory data also indicated that DM/NR features could improve listening effort and sound quality compared with no features for both basic- and premium-level HAs. For real-world effectiveness, in-situ self-reports first indicated that noisy or very noisy situations did not occur very often in participants' daily lives (10.9% of the time). Although both retrospective and in-situ self-reports indicated that participants were more satisfied with HAs equipped with DM/NR features than without, there was no strong evidence to support the benefit of premium DM/NR features and premium HAs over basic DM/NR features and basic HAs, respectively. Conclusions: Although premium DM/NR features and premium HAs outperformed their basic-level counterparts in well-controlled laboratory test conditions, the benefits were not observed in the real world. In contrast, the effect of DM/NR features relative to no features was robust both in the laboratory and in the real world. Therefore, the present study suggests that although both premium and basic DM/NR technologies evaluated in the study have the potential to improve HA outcomes, older adults with mild-to-moderate hearing loss are unlikely to perceive the additional benefits provided by the premium DM/NR features in their daily lives. Limitations concerning the study's generalizability (e.g., participant's lifestyle) are discussed. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: Yu-Hsiang Wu is currently receiving grants from the National Institute on Deafness and Other Communication Disorders, the National Institute on Disability, Independent Living, and Rehabilitation Research, and the Retirement Research Foundation. Octav Chipara is currently receiving grants from the National Institute on Disability, Independent Living, and Rehabilitation Research and the National Science Foundation. Jacob Oleson is currently receiving grants from the National Institute on Deafness and Other Communication Disorders, National Heart, Lung, and Blood Institute, Department of Defense, Centers for Disease Control and Prevention, Fogarty International Center, and the Iowa Department of Public Health. The current research was supported by National Institute on Deafness and Other Communication Disorders (R03DC012551) and the National Institute on Disability, Independent Living, and Rehabilitation Research (90RE5020-01-00). The current research was supported by NIH/NIDCD R03DC012551 (title: Minimal Technologies for Hearing Aid Success in Elderly Adults) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) 90RE5020-01-00 (title: RERC on Improving the Accessibility, Usability, and Performance of Technology for Individuals Who are Deaf or Hard of Hearing). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, HHS, and the reader should not assume endorsement by the Federal Government. Portions of this paper were presented at the annual conference of the American Auditory Society, March 3, 2016, Scottsdale, AZ. Y.-H.W. designed experiments, interpreted data, and wrote the article; E.S. collected data; O.C. and S.S.H. developed EMA software and processed EMA data; S.D. and J.O. provided statistical analysis. All authors discussed the results and implications and commented on the manuscript at all stages. The authors have no conflicts of interest to declare. Address for correspondence: Yu-Hsiang Wu, 125C SHC, Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, IA 52242, USA. E-mail: yu-hsiang-wu@uiowa.edu Received March 8, 2018; accepted August 29, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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Efficacy and Effectiveness of Advanced Hearing Aid Directional and Noise Reduction Technologies for Older Adults With Mild to Moderate Hearing Loss
Objectives: The purpose of the present study was to investigate the laboratory efficacy and real-world effectiveness of advanced directional microphones (DM) and digital noise reduction (NR) algorithms (i.e., premium DM/NR features) relative to basic-level DM/NR features of contemporary hearing aids (HAs). The study also examined the effect of premium HAs relative to basic HAs and the effect of DM/NR features relative to no features. Design: Fifty-four older adults with mild-to-moderate hearing loss completed a single-blinded crossover trial. Two HA models, one a less-expensive, basic-level device (basic HA) and the other a more-expensive, advanced-level device (premium HA), were used. The DM/NR features of the basic HAs (i.e., basic features) were adaptive DMs and gain-reduction NR with fewer channels. In contrast, the DM/NR features of the premium HAs (i.e., premium features) included adaptive DMs and gain-reduction NR with more channels, bilateral beamformers, speech-seeking DMs, pinna-simulation directivity, reverberation reduction, impulse NR, wind NR, and spatial NR. The trial consisted of four conditions, which were factorial combinations of HA model (premium versus basic) and DM/NR feature status (on versus off). To blind participants regarding the HA technology, no technology details were disclosed and minimal training on how to use the features was provided. In each condition, participants wore bilateral HAs for 5 weeks. Outcomes regarding speech understanding, listening effort, sound quality, localization, and HA satisfaction were measured using laboratory tests, retrospective self-reports (i.e., standardized questionnaires), and in-situ self-reports (i.e., self-reports completed in the real world in real time). A smartphone-based ecological momentary assessment system was used to collect in-situ self-reports. Results: Laboratory efficacy data generally supported the benefit of premium DM/NR features relative to basic DM/NR, premium HAs relative to basic HAs, and DM/NR features relative to no DM/NR in improving speech understanding and localization performance. Laboratory data also indicated that DM/NR features could improve listening effort and sound quality compared with no features for both basic- and premium-level HAs. For real-world effectiveness, in-situ self-reports first indicated that noisy or very noisy situations did not occur very often in participants' daily lives (10.9% of the time). Although both retrospective and in-situ self-reports indicated that participants were more satisfied with HAs equipped with DM/NR features than without, there was no strong evidence to support the benefit of premium DM/NR features and premium HAs over basic DM/NR features and basic HAs, respectively. Conclusions: Although premium DM/NR features and premium HAs outperformed their basic-level counterparts in well-controlled laboratory test conditions, the benefits were not observed in the real world. In contrast, the effect of DM/NR features relative to no features was robust both in the laboratory and in the real world. Therefore, the present study suggests that although both premium and basic DM/NR technologies evaluated in the study have the potential to improve HA outcomes, older adults with mild-to-moderate hearing loss are unlikely to perceive the additional benefits provided by the premium DM/NR features in their daily lives. Limitations concerning the study's generalizability (e.g., participant's lifestyle) are discussed. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: Yu-Hsiang Wu is currently receiving grants from the National Institute on Deafness and Other Communication Disorders, the National Institute on Disability, Independent Living, and Rehabilitation Research, and the Retirement Research Foundation. Octav Chipara is currently receiving grants from the National Institute on Disability, Independent Living, and Rehabilitation Research and the National Science Foundation. Jacob Oleson is currently receiving grants from the National Institute on Deafness and Other Communication Disorders, National Heart, Lung, and Blood Institute, Department of Defense, Centers for Disease Control and Prevention, Fogarty International Center, and the Iowa Department of Public Health. The current research was supported by National Institute on Deafness and Other Communication Disorders (R03DC012551) and the National Institute on Disability, Independent Living, and Rehabilitation Research (90RE5020-01-00). The current research was supported by NIH/NIDCD R03DC012551 (title: Minimal Technologies for Hearing Aid Success in Elderly Adults) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) 90RE5020-01-00 (title: RERC on Improving the Accessibility, Usability, and Performance of Technology for Individuals Who are Deaf or Hard of Hearing). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, HHS, and the reader should not assume endorsement by the Federal Government. Portions of this paper were presented at the annual conference of the American Auditory Society, March 3, 2016, Scottsdale, AZ. Y.-H.W. designed experiments, interpreted data, and wrote the article; E.S. collected data; O.C. and S.S.H. developed EMA software and processed EMA data; S.D. and J.O. provided statistical analysis. All authors discussed the results and implications and commented on the manuscript at all stages. The authors have no conflicts of interest to declare. Address for correspondence: Yu-Hsiang Wu, 125C SHC, Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, IA 52242, USA. E-mail: yu-hsiang-wu@uiowa.edu Received March 8, 2018; accepted August 29, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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