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Ankylosing spondylitis (AS) is rarely accompanied by other autoimmune diseases and/or hematologic disorders. We herein report a 46-year-old man with AS coexisting with relapsing polychondritis (RP), antiphospholipid syndrome (APS) and myelodysplastic syndrome (MDS). While receiving anti-TNF therapy for AS, the patient developed anemia and was diagnosed with MDS. After six months, he developed swelling and redness of the nose and both auricles. RP was diagnosed by an ear biopsy. Afterward, during the evaluation of a repeated fever, APS was diagnosed. This case of AS with multiple autoimmune diseases and hematologic malignancy successfully responded to a Janus kinase inhibitor (baricitinib).

The hole density of individual copper sulfide nanocrystals (Cu2-xS NCs) is determined from the stoichiometric mismatch (x) between copper and sulfide atoms. Consequently, the electronic properties of the material vary over a range of x. To exploit Cu2-xS NCs in devices, assemblies of NCs are typically required. Herein, we investigate the influence of x, referred to as the stoichiometric doping effect, on the structural, optical, electrical, and thermoelectric properties of electronically coupled Cu2-xS NC assemblies. The doping process is done by immersing the solid NC assemblies into a solution containing a Cu(I) complex for different durations (0-10 min). As Cu+ gradually occupied the copper-deficient sites of Cu2-xS NCs, x could be controlled from 0.9 to less than 0.1. Consequently, the near-infrared (NIR) absorbance of Cu2-xS NC assemblies changes systematically with x. With increasing x, electrical conductivity increased and the Seebeck coefficient decreased systematically, leading to the maximal thermoelectric power factor from a film of Cu2-xS NCs at an optimal doping condition yielding x = 0.1. The physical characteristics of the Cu2-xS NC assemblies investigated herein will provide guidelines for exploiting this emerging class of nanocrystal system based on doping.

Anaphylaxis is a potentially life-threatening condition that occurs in the emergency department (ED). Although anaphylaxis is rapidly recognized and treated in the hospital compared with that in the community, in some cases, it does not respond to proper management.The aim of this study is to describe our experience of cases of refractory anaphylaxis leading to cardiac arrest in hospital, to review their characteristics compared with those seen in the community, and to discuss the best management practices for anaphylaxis-induced cardiac arrest with a literature review.We reviewed the medical records of patients referred to the ED with possible in-hospital anaphylaxis between January 2017 and May 2021. According to the anaphylaxis protocol, epinephrine, corticosteroid, and antihistamine were administered immediately on-site at our institution before the study period. Refractory anaphylaxis was defined as the development of anaphylaxis-induced cardiac arrest even after following the anaphylaxis protocol.A total of 246 cases were evaluated for possible anaphylaxis, with 236 cases meeting the criteria for a diagnosis of anaphylaxis. Among them, 178 patients showed the signs and symptoms of shock, and cardiac arrest occurred in 6 patients (2.5%). Of the six patients, three had a return of spontaneous circulation before admission to the ED, while two died due to refractory cardiac arrest despite resuscitation in the ED. Following post-cardiac arrest care, including temperature management, one patient who received extracorporeal cardiopulmonary resuscitation survived neurologically intact.We present our case series to highlight the risk of developing refractory anaphylaxis with subsequent in-hospital cardiac arrest. Patients may progress to cardiac arrest within minutes despite prompt recognition and management. If patients present with potentially fatal symptoms, a more aggressive approach, including intravenous adrenaline infusion, should be taken.

The hole density of individual copper sulfide nanocrystals (Cu

Stakeholder engagement has been an important research topic across many disciplines. In this study, we examined the concept of stakeholder engagement in corporate social responsibility (CSR) and identified how organizations engage stakeholders in their CSR communication by analyzing successful CSR programs. Two coders conducted a content analysis of 146 Public Relations Society of America (PRSA) Silver Anvil Award-winning CSR campaigns implemented during the past ten years. The results show that many organizations have engaged stakeholders in their CSR programs in various ways to increase awareness about social issues, change stakeholder behavior, and create favorable attitudes toward the organizations. As for CSR communication strategies, stakeholder response strategies were frequently observed, which is relevant to the two-way asymmetric communication model. Many organizations receive feedback from their stakeholders and demonstrate how they integrate their stakeholders’ concerns. The result also shows that social media is widely used for digital engagement. However, despite its potential to become an interactive, dialogic space, response strategy is used more often than involvement strategy. Although co-creating a CSR strategy with stakeholders and making a shared decision (i.e., stakeholder involvement strategy) is ideal for building a mutually beneficial relationship between an organization and its stakeholders, few organizations have employed this strategy. This study also found that partnership is a common stakeholder engagement strategy in CSR communication. Many organizations have used third-party endorsement and engaged nonprofits, opinion leaders, and social media influencers in their CSR communication.

A novel injectable methylcellulose (MC) hydrogel containing calcium phosphate nanoparticles (CaP NPs) was prepared by an in situ formation process, in which the precursor salts induced a salt-out effect in the MC solution. The thermo-sensitive properties of MC-CaP NPs composite hydrogels with different crystalline phases were characterized by rheometry, infrared spectroscopy and injectability test. The as-prepared MC hydrogels with bioactive CaP NPs had a suitable injectability at the body temperature, irrespective of the crystalline phases of CaP NPs. At the physiological pH condition, the structure of the MC hydrogel containing CaP NPs was analyzed by scanning electron microscopy, X-ray diffraction (XRD). The XRD results indicate that the in situ synthesized CaP NPs had a crystalline phase of hydroxyapatite (HAP). The in vitro study using mesenchymal stem cells showed that MC-HAP NPs composite hydrogel was biocompatible. The in vivo study indicated that the regeneration rate of new mature bone was also higher in the MC-HAP NPs composite hydrogel than in the pure MC hydrogel. The results of this study indicate that injectable MC-HAP NPs composite hydrogel has a great potential for bone tissue regeneration.

Given the importance of communication in the realm of corporate associations, this study analyzes the roles that communication strategies play in the formation of corporate associations. The study examines (1) whether particular types of associations (corporate ability or corporate social responsibility associations) can be developed through CA- or CSR-based communication strategies, and (2) the relative effectiveness of these two association types at amplifying favorable consumer responses across three different industries (consumable goods, durable goods, and stigmatized goods). An experiment was conducted to test the proposed model with six Fortune 500 companies. The results demonstrate that communication strategies can effectively facilitate a particular type of association. Differing levels of association effectiveness were found within each industry. For the consumable goods industry, CA associations are found to be more effective than CSR associations. For the durable goods industry, CSR as...

In addition to trauma center levels and types, trauma volume may be an important factor impacting outcomes in severe pediatric trauma.All severely injured pediatric patients treated at adult trauma centers were identified from the National Trauma Data Bank. All qualifying centers were stratified into four groups based on the cumulative pediatric trauma case volumes with ISS15: lowest (group 1), lower (group 2), higher (group 3), and highest (group 4) volume centers. Mortality rates among the groups were compared.A total of 3747 patients were stratified into group 1 (n=2122, median annual pediatric trauma volume 3 cases/year), group 2 (n=842, 15 cases/year), group 3 (n=494, 24 cases/year), and group 4 (n=289, 43 cases/year). In the hierarchical logistic regression analysis, the highest volume centers (group 4) were shown to have improved mortality (odds ratio 0.474, 95% confidence interval [CI] 0.301-0.747) compared to the lowest volume centers (group 1). Odds ratios of group 4 against group 1 for subgroups were 0.634 (age10, 95% CI 0.335-1.198), 0.491 (blunt injury, 95% CI 0.310-0.777), and 0.495 (level 1 center, 95% CI 0.312-0.785).In severe pediatric trauma treated at adult trauma centers, higher volume centers were associated with improved mortality in comparison to the lower volume centers.Level III, therapeutic/care management, retrospective comparative study without negative criteria.

A thermo-sensitive hydrogel based on calcium phosphate nanoparticles was prepared using a novel one-pot method in which added precursor salts induced a salt-out effect in the methylcellulose (MC) solution. The calcium phosphate nanoparticles were synthesized in situ from precursor ions (Ca2+ and HPO42-) in the hydrogel, and residual ions (HPO42- and Cl-) in the formation of the nanoparticles decreased the gelation temperature of the MC solution. This one-pot synthesis was an effective way to streamline the previous multi-step process and to easily prepare a thermo-sensitive hydrogel containing bioactive nanoparticles. The thermo-sensitive properties of different concentrations of MC hydrogels were characterized by a rheometer and infrared (IR) spectroscopy. The gelation behavior of MC according to the addition of various salts was monitored by rheometer. With respect to a selected concentration and precursor, the structure of the MC hydrogel containing calcium phosphate nanoparticles was analyzed by scanning electron microscopy (SEM), X-ray diffraction (XRD) and IR.

Contribution of autophagy and regulation of related proteins to the degeneration of retinal pigment epithelium (RPE) in age-related macular degeneration (AMD) remain unknown. We report that upregulation of KRT8 (keratin 8) as well as its phosphorylation are accompanied with autophagy and attenuated with the inhibition of autophagy in RPE cells under oxidative stress. KRT8 appears to have a dual role in RPE pathophysiology. While increased expression of KRT8 following autophagy provides a cytoprotective role in RPE, phosphorylation of KRT8 induces pathologic epithelial-mesenchymal transition (EMT) of RPE cells under oxidative stress, which is mediated by MAPK1/ERK2 (mitogen-activated protein kinase 1) and MAPK3/ERK1. Inhibition of autophagy further promotes EMT, which can be reversed by inhibition of MAPK. Thus, regulated enhancement of autophagy with concurrent increased expression of KRT8 and the inhibition of KRT8 phosphorylation serve to inhibit oxidative stress-induced EMT of RPE cells as well as to prevent cell death, suggesting that pharmacological manipulation of KRT8 upregulation through autophagy with combined inhibition of the MAPK1/3 pathway may be attractive therapeutic strategies for the treatment of AMD.

This paper presents the results of soil characterization and element tests of Ottawa F65 sand. The data presented is intended to be used as calibration material for the prediction exercise conducted as part of the Liquefaction Experiments and Analysis Project (LEAP 2017). The databank generated includes soil specific gravity tests, particle size analysis, hydraulic conductivity tests, maximum and minimum void ratio tests, and cyclic triaxial stress-controlled tests. An effort was made to ensure the consistency and repeatability of the test results by reducing the sources of variability in the sample preparations and increasing the number of tests. The uniformity of the soil was evaluated by conducting tests on samples from five different batches. The results showed that the sand is uniform among the five batches. Due to significant variability in previously reported maximum and minimum void ratio results, the effects of the test operator were studied by comparing test results obtained from three different operators. For the triaxial tests, a constant height dry pluviation method was used for sample preparation. To eliminate the effect of the human error in maintaining a constant drop height and to ensure consistency of the sand fabric between different samples, a device was developed to facilitate the sample preparation. The cyclic triaxial experiments were performed using three different soil densities, and a liquefaction strength curve was obtained for each density based on a 2.5% single amplitude axial strain criteria. The developed databank in this study was made publicly available for the community through DesignSafe.

Robotic colorectal surgery was first performed at our institution in January 2014. The objective of this study is to present our initial experience with robotic colorectal surgery. This is a retrospective review of the prospectively collected data of all patients who underwent robotic colorectal surgery from January 2014 to April 2015. Baseline, perioperative, and postoperative data were obtained for analysis. A total of 101 patients with a mean age of 56 and a body mass index of 31 underwent robotic colorectal surgery between January 2014 and April 2015. The indication for surgery was malignancy in approximately 40 per cent, diverticulitis in 40 per cent, and benign diseases in 20 per cent of the patients. The most common operation was sigmoidectomy (40%) followed by low anterior resection (36%), abdominoperineal resection (7%), right hemicolectomy (6%), rectopexy (6%), total colectomy (4%), and left hemicolectomy (1%). The mean operative and docking time was 226 (range, 104–496) minutes and 3 (range, 1–18) minutes, respectively. The median number of lymph nodes harvested was 19 (range, 0–34). The median length of stay was 3 (range, 1–18) days. Anastomotic leak occurred in one patient and surgical site infection in two patients. Robotic colorectal surgery is safe and technically feasible.

Incidental appendectomy (IA) could potentially increase the risk of morbidity after abdominal procedures; however, such effect is not clearly established. The aim of our study is to test the association of IA with morbidity after abdominal procedures. We identified 743 (0.37%) IA among 199,233 abdominal procedures in the National Surgical Quality Improvement Program database (2005–2009). Cases with and without IA were matched on the index current procedural terminology code. Patient characteristics were compared using chi-squared test for categorical variables and Student t test for continuous variables. Multivariate logistic regression analysis was performed. Emergency and open surgeries were associated with performing IA. Multivariate analysis showed no association of IA with mortality [odds ratio (OR) = 0.51, 95% confidence interval (CI) = 0.26–1.02], overall morbidity (OR = 1.16, 95% CI = 0.92–1.47), or major morbidity (OR = 1.20, 95% CI = 0.99–1.48). However, IA increased overall morbidity among patients undergoing elective surgery (OR = 1.31,95% CI = 1.03–1.68) or those ≥30 years old (OR = 1.23, 95% CI = 1.00–1.51). IA was also associated with higher wound complications (OR = 1.46,95% CI = 1.05–2.03). In conclusion, IA is an uncommonly performed procedure that is associated with increased risk of postoperative wound complications and increased risk of overall morbidity in a selected patient population.

This study examines effective crisis response strategies using Coombs’ SCCT as a theoretical framework. Results of an experiment show that base responses (instructing and adjusting information) could mitigate reputational decline for a company during a severe, preventable crisis. The sole use of bolstering (reminding) strategy or no response is ineffective because it negatively influences consumers’ trust in the company, attitudes toward the company, perceived corporate reputation, and supportive behavioral intentions.

The stress-strain-strength response of soils is of significant interest to development and calibration of realistic constitutive models that can be used in numerical simulation of geotechnical engineering problems. An extensive characterization of Ottawa F65 sand along with various monotonic and cyclic tests conducted during the course of the Liquefaction Experiments and Analysis Projects (LEAP) are presented here. The specimens in these tests were prepared using a meticulous sample preparation technique to facilitate their consistency and repeatability. Monotonic drained and undrained triaxial tests shed light on the steady-state (critical state) of Ottawa sand, while stress-controlled and strain-controlled cyclic triaxial and direct simple shear tests provide key information on the cyclic stress-strain behavior and liquefaction strength of this soil. The triaxial tests identify the liquefaction strength of the soil at different densities, while the direct simple shear tests evaluate the effect of overburden pressure on the cyclic response. The results of these experiments are also compared to the experimental results available in the literature. The data obtained from the cyclic triaxial and direct simple shear tests were further analyzed by plotting the computed shear modulus degradation and damping curves. The results show how the soil stiffness degrades as cyclic shear stress is applied for soil at different densities and confining stresses. It can be seen that the rate of shear modulus degradation increases with the increase of confining stress and decreases with the increase of soil density. The damping curves consistently show an increasing in damping ratio until a shear strain of about 0.05%, followed by a plateau at about 20–25% damping ratio for shear strain between 0.05 and 0.5%, and ending with a decrease in damping until reaching a final damping ratio of about 10%.

A thermo-sensitive methylcellulose (MC) hydrogel was prepared using three types of vitamin derivatives with or without phosphate groups. The gelation behavior of each MC hydrogel containing vitamin or vitamin derivatives was monitored using a rheometer. The gelation rate and mechanical strength of the MC hydrogels were improved by vitamin derivatives with phosphate groups due to their salting-out effects, whereas their injectabilities retained proper maximum forces. Also, the vitamin derivatives with phosphate groups were released slower from the MC hydrogel than the vitamins without phosphate groups due to higher physical crosslinking densities. Therefore, this thermo-responsive MC hydrogel containing vitamin derivatives has a great potential as an injectable hydrogel for drug delivery.

BACKGROUND Congenital muscular torticollis is a common childhood musculoskeletal anomaly that might result in permanent craniofacial deformity, facial asymmetry, and changes in the cervical vertebrae, if not treated during early childhood. Although there have been many studies on cervical vertebral changes, their onset in children has not been previously studied. METHODS Fifteen patients (aged

Combination of drug delivery and specific targeting has the potential for treating cancers. To achieve this goal, specific ligands targeting cancer cells and bioconjugate vehicles for drug delivery are necessary. Liposomes constitute successful drug-delivery materials because they can reduce toxicity and enhance the stability of drugs by encapsulation. Previously, we have developed an RNA aptamer-conjugated liposome (named as aptamosome) that specifically targeted prostate cancer cells expressing prostate-specific membrane antigen (PSMA). Using the aptamosome, the anticancer drug doxorubicin (Dox) was specifically and efficiently delivered to the prostate tumors. The PSMA-specific RNA aptamer by itself has been also recognized as tumor-specific drug delivery material by intercalating Dox. In this study, we compared two different methods for Dox delivery toward PSMA-positive cancer cells, namely intercalation of Dox into the aptamer (Apt-Dox), and encapsulation of Dox in the aptamosome (Apm-Dox). We observed that the Apm-Dox was superior to the Apt-Dox in specificity and Dox delivery efficiency toward PSMA(+) cancer cells.

Thermo-reversible hydrogels have been widely studied in biomedical research fields, because of their potential performance in drug delivery and tissue engineering. In this study, a novel thermo-sensitive methylcellulose (MC) hydrogel based on calcium phosphate nanoparticles (CaP NPs) was prepared by in situ formation process in which precursor salts induced a salt-out effect in the MC solution. Based on the Hofmeister series, CaCl2, Na2HPO4, and NaH2PO4 precursor salts with a good salt-out effect were used as the precursor salts for CaP NPs. The gelation of MC solution was accelerated by the salt addition, and its effect varied with the salt type. When CaP precursor salts with two different Ca/P ratios (0.8/1 and 1.6/1) were added into the MC solution, more elastic MC hydrogel was formed at 1.6/1 Ca/P ratio. The CaP NPs were rectangular in shape (40–50 nm), and evenly distributed in the MC gel. The X-ray diffraction (XRD) observation indicates that dicalcium phosphate dehydrate (DCPD) and octacalcium phosphate (OCP) were synthesized at 0.8/1 Ca/P ratio, whereas DCPD was synthesized at 1.6/1 Ca/P ratio. This indicates that the CaP NPs with different crystalline phases were in situ synthesized in accordance with the Ca/P ratio and pH condition (pH 7.4, 9.0). Moreover, the DCPD and OCP crystalline phases were converted to the hydroxyapatite (HAP) crystalline phase, as the pH was changed to alkaline region. Therefore, the resulting MC composite hydrogel containing HAP NPs will be suitable for bone regeneration as an injectable hydrogel.

A thermo-sensitive methylcellulose (MC) hydrogel containing silver oxide nanoparticles (NPs) was prepared via one-pot synthesis in which a silver acetate precursor salt (CH3COOAg) induces a salt-out effect in the MC solution. The silver oxide NPs were synthesized in situ from Ag+ ions during the MC hydrogelation, and the residual CH3COO- ions decreased the gelation temperature of the MC solution through the salt-out effect. The gelation behavior of the MC solution varied according to the CH3COOAg content and was monitored. Also, the formation and structure of the silver oxide NPs in the MC hydrogel was confirmed. From the results, silver oxide NPs was successfully incorporated in MC hydrogels, simultaneously, acetate ion which was counter ion of Ag was affected gelation behavior of Ag. Finally, the antimicrobial activity and wound healing effect was examined using the shaking flask method and burn wound test, respectively. The MC hydrogel with silver oxide NPs showed excellent antimicrobial activity and burn wound healing. Therefore, this thermo-responsive MC hydrogel has great potential as an injectable hydrogel for wound regeneration.

Non-small-cell lung cancer (NSCLC) is commonly caused by a mutation in the epidermal growth factor receptor (EGFR) and subsequent aberrant EGFR signaling with uncontrolled kinase activity. A deletion mutation in EGFR exon 19 is frequently observed in EGFR gene mutations. We designed a DNAzyme to suppress the expression of mutant EGFR by cleaving the mutant EGFR mRNA. The DNAzyme (named Ex19del Dz) specifically cleaved target RNA and decreased cancer cell viability when transfected into gefitinib-resistant lung cancer cells harboring EGFR exon 19 deletions. The DNAzyme decreased EGFR expression and inhibited its downstream signaling pathway. In addition to EGFR downregulation, Ex19del Dz containing CpG sites activated Toll-like receptor 9 (TLR9) and its downstream signaling pathway via p38 kinase, causing an immunostimulatory effect on EGFR-mutated NSCLC cells. Thus, dual effects of this DNAzyme harboring the CpG site, such as TLR9 activation and EGFR downregulation, leads to apoptosis of EGFR-mutated NSCLC cells. [BMB Reports 2018; 51(1): 27-32].

The integration of advertising and public relations is a topic of interest to their practitioners and educators. For years, both have recommended ways to integrate these functions. In accordance with this trend, some advertising and public relations schools decided to merge and to change the names of their programs to Integrated Marketing Communication (IMC) or Strategic Communication. This study was designed to investigate the trend of integration between advertising and public relations programs in U.S. higher education. To achieve this purpose, we analyzed the contents of 113 advertising, public relations, IMC, and strategic communication programs that described in these schools’ official websites. Although a few schools have begun to use the terms IMC, or strategic communication for the names of their schools or programs, the terms advertising and/or public relations remain in the mainstream. Nine institutions use strategic communication, and most of them use this term as an umbrella term, which includes both advertising and public relations majors. Regarding curriculum, a majority of the programs offering advertising, public relations, or strategic communication tend to offer separate introductory, writing, design, and campaign courses for both advertising and public relations majors, while a small portion of schools provide combined courses for both majors. Implications for curricular integration and design in advertising and public relations are discussed.

With growing demand for low-power mobile applications, such as wearable devices, smart phones and tablet PCs, low-power mobile DRAM has been identified as a mandatory requirement for low-power system designs. The recently developed LPDDR4 [1] is still a power efficient solution because of its architectural approaches and low-voltage-swing terminated logic (LVSTL). However, demand for enhanced power-efficiency beyond LPDDR4 is still increasing for mobile applications. In this work, a 5.0Gbp/s/pin 8Gb LPDDR4X memory with power-isolated low-voltage-swing terminated logic (PI-LVSTL) and a split-die architecture is proposed to enhance power-efficiency and mass production yield.

The goal of this investigation was to construct a comprehensive instrument for measuring strategic decisionmaking in non-profit membership organizations. Based on a literature review, the multiple-item measurement development procedures suggested as a guideline and philosophy by Churchill and Spector were used to identify eight dimensions to measure strategic decision-making: decision quality, decision routines, procedural rationality, procedural justice, affective conflict, cognitive conflict, understanding, and decision commitment. Confirmatory factor analysis (CFA) validated the constructed measures.

일반적으로 모든 전문분야 의사들은 어느 정도 표준화된 진단 , 치료 방식을 취하고 있다. 그러나 세부적인 처방 및 검사, 입원일수 등은 병원 규모 및 시스템, 의료 장비 구축정도에 따라 차이가 발생할 수 있다 . 이러한 차이를 줄이기 위해 최근 진료지침의 표준화에 대한 관심이 높아지면서 다양한 연구가 진행되고 있다 . 표준화된 진료지침은 의료의 질을 보장하고 의사의 자율성을 보장하기 위해 병원규모 및 구축된 시스템 등에 상관없이 똑같은 진료지침을 제공하는 것이 아니라 각 병원의 상황과 환경에 맞도록 임상데이터를 기반으로 진단 및 처치 , 검사 등을 제공할 수 있어야 한다. 따라서 본 논문에서는 병원 내 같은 과의 두 전문의의 임상데이터를 분석하고 이를 기반으로 해당 질병 및 병원에 맞춘 표준 진료지침을 자동으로 생성할 수 있는 시스템을 연구 및 구현하여 적용 가능한 표준 진료지침을 제시하고자 한다.Key Words : Clinical Pathway, medical data, Hospital Information System, Electronic Health Record,non-negative matrix factorizationABSTRACT

Background Congenital muscular torticollis (CMT) is a benign condition. With early diagnosis and appropriate management, it can be cured completely, leaving no residual deformity. However, long-standing, untreated CMT can lead to permanent craniofacial deformities and asymmetry. Methods Four adult patients presented to the author with long-standing, untreated CMT. Initial clinical assessment demonstrated tightness of the sternocleidomastoid muscle on the affected side. Investigation of cervical spine using 3-dimensional computed tomography scans with cervical segmentation allowed a 3-dimensional module to be separately created for each vertebra to detect any anatomical changes. Results A change in the axis of the vertebral column was noted when compared to that of the skull. Also, there were apparent anatomical changes affecting the vertebrae, which were most noticeable at the level of the atlas and axis vertebrae. These changes decreased gradually till reaching the seventh cervical vertebra, which appeared to be normal in all patients. The changes in the atlas vertebra were mostly due to its intimate relation with the skull base. The changes of the axis were the most significant, affecting mainly the superior articular facet, the lamina, and the body. Conclusions There were seemingly permanent changes along the cervical spine region in the adult patients with long-standing, untreated CMT in the form of bending and rotation deformities that might result in residual torticollis postoperatively.

Deformational plagiocephaly (DP) refers to cranial asymmetry resulting from uneven external forces. A strong association exists between DP and developmental delay. We investigated the effect of DP severity on developmental delay.Between 2010 and 2016, data from 155 patients with DP were reviewed retrospectively. Two indices were used to evaluate the deformation quantitatively: cranial index (CI) and cranial vault asymmetry index (CVAI). The Bayley Scales of Infant Development-II was used to evaluate the neurodevelopment of patients.According to the CI of the study population, 2 patients showed scaphocephaly, 12 showed mesocephaly, and 141 showed brachycephaly. For CVAI, 10 patients showed values of3.5, 10 patients showed mild deformity (3.5-6.25), 27 patients showed moderate deformity (6.25-8.75), and 108 patients showed severe deformity. The means of the mental development index (MDI) and psychomotor development index (PDI) were 91.69 ± 16.8 and 92.28 ± 17.59, respectively; after the exclusion of patients with confounding factors, the values were 96.26 and 92.9, respectively. The Spearman correlation coefficients between MDI and CI and CVAI were -0.019662 and 0.118916, respectively, whereas for PDI, the values were -0.195428 and -0.012386, respectively.There was a statistically significant neurodevelopmental delay in patients with DP. However, accelerated neurodevelopment was also encountered in many patients. MDI was found to be more affected by multiple confounding factors than PDI, whereas PDI was only affected by congenital anomalies. There was no definitive relationship between the severity of DP and the degree of developmental delay in our study group.

Background/purpose While pediatric trauma centers are shown to have lower splenectomy rate as compared to adult trauma centers, it remains unknown whether other institutional factors such as case volumes would have an impact on the splenectomy rate in pediatric blunt splenic injury (BSI). Methods Pediatric patients who sustained BSI were identified from the National Trauma Data Bank 2007–2014. A hierarchical logistic regression model was built to evaluate differences in risk-adjusted splenectomy rate and in-hospital mortality in between trauma centers with different pediatric BSI case volumes. Results A total of 7621 children who met criteria were treated at trauma centers with different pediatric BSI case volumes (0–60, 61–120, 121–180, 181–240 cases during 2007–2014 for Group 1, 2, 3, and 4, respectively). High volume centers were shown to have decreased splenectomy rates (odds ratios [OR] 0.50 and 0.64, 95% confidence intervals [CI] 0.30–0.83, 0.44–0.95 for Groups 3 and 4, respectively) with an additional survival benefit in Group 4 (OR 0.452, 95%CI 0.257–0.793) when compared to the lowest volume centers (Group 1). Conclusions Higher pediatric BSI case volume was associated with lower splenectomy rate with an additional survival benefit. Trauma centers' volume in pediatric BSI may be an important factor for the improved splenic preservation. Level of evidence Retrospective comparative study, Level III.

Incidental appendectomy (IA) could potentially increase the risk of morbidity after abdominal procedures; however, such effect is not clearly established. The aim of our study is to test the association of IA with morbidity after abdominal procedures. We identified 743 (0.37%) IA among 199,233 abdominal procedures in the National Surgical Quality Improvement Program database (2005-2009). Cases with and without IA were matched on the index current procedural terminology code. Patient characteristics were compared using chi-squared test for categorical variables and Student t test for continuous variables. Multivariate logistic regression analysis was performed. Emergency and open surgeries were associated with performing IA. Multivariate analysis showed no association of IA with mortality [odds ratio (OR) = 0.51, 95% confidence interval (CI) = 0.26-1.02], overall morbidity (OR = 1.16, 95% CI = 0.92-1.47), or major morbidity (OR = 1.20, 95% CI = 0.99-1.48). However, IA increased overall morbidity among patients undergoing elective surgery (OR = 1.31, 95% CI = 1.03-1.68) or those ≥30 years old (OR = 1.23, 95% CI = 1.00-1.51). IA was also associated with higher wound complications (OR = 1.46, 95% CI = 1.05-2.03). In conclusion, IA is an uncommonly performed procedure that is associated with increased risk of postoperative wound complications and increased risk of overall morbidity in a selected patient population.

Purpose Safety profile of different gastrostomy procedures in small children has not been well studied. This study was conducted to investigate whether complication and mortality rates differ between surgical gastrostomy (G-tube) and percutaneous endoscopic gastrostomy (PEG) in infants and neonates. Methods In this retrospective study utilizing the Kids' Inpatient Database, all infants who underwent either G-tube or PEG as a sole procedure were identified. Variables included age, gender, race, presence of neurological impairment, prematurity, complex chronic condition, and severity of illness/risk of mortality subclasses. Postoperative complication, reoperation, and mortality rates were compared between G-tube and PEG. A subgroup of neonates was also analyzed. Results A total of 1456 infants were identified (G-tube n=874, PEG n=582). In univariate analysis, the rates of adverse outcomes were not significantly different (G-tube vs PEG complication rate was 7.3% and 6.7%, p =0.65; mortality rate 1.3% and 0.7%, p =0.29, respectively). Adjusted odds ratios (ORs) for complication were 1.07 (G-tube vs PEG, 95% confidence interval [CI] 0.700–1.620) for overall infants and 1.19 (95% CI 0.601–2.350) for the neonatal subgroup. Similarly, adjusted ORs for mortality did not differ significantly both in infants (OR 1.749, 95% CI 0.532–5.755) and in the neonatal subgroup (OR 2.153, 95% CI 0.566–8.165). Conclusions When G-tube and PEG were performed as the only procedure throughout a hospitalization in infants and neonates, the two techniques had comparable risks of postoperative complications and mortalities. Level of evidence Retrospective comparative study, Level III.

Microangiopathic hemolytic anemia (MAHA) can be an uncommon presentation of an underlying malignancy, most often due to signet-ring cell carcinoma (SRCC). Additionally, pure SRCC in a breast primary-tumor comprises

The effect of methylcellulose (MC) concentration and calcium phosphate precursor salt concentration on the gelation of MC solution was studied by rheometer and attenuated total reflectance infrared (ATR-IR) spectroscopy. It was found that thermally induced gelation of MC was dependent on the concentration of MC and water hydration abilities of precursor salt for inorganic nanoparticle. At the constant concentration of MC, the gelation temperature was lowered with increasing salt concentration. This behavior had a similar tendency with MC concentration. From these results, the gelation temperature of MC could be simply controlled by changing the concentration of precursor salt or MC.