bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional Screening Tests: Interrelationships and Ability to Predict Vertical Jump Performance
Authors: Loturco Irineu , Pereira Lucas , Kobal Ronaldo , Abad Cesar , Komatsu William , Cunha Ronaldo , Arliani Gustavo , Ejnisman Benno , Pochini Alberto de Castro , Nakamura Fábio , Cohen Moises
Published: December 2017

There are several methods used in sports science to identify asymmetries in athletes, given their purported relevance to injury prevention and performance optimization. We aimed to verify whether asymmetries provided by isokinetic assessments, jump tests, and tensiomyography (TMG) are associated with each other, and whether their respective functional indices are related to jumping ability. TMG parameters, unilateral and bilateral squat-jump (SJ) and countermovement-jump (CMJ) performances, and peak torque in knee-extension and flexion with angular velocities of 60o/s and 300o/s for twenty-four soccer players were retained for analyses. Asymmetry was detected by examining the percentage difference between dominant and non-dominant legs. The median-split technique was used to identify the best and worst performers in SJ and CMJ tests. Results revealed that the asymmetries detected in the three different methods were not interrelated. Curiously, better performances in SJ and CMJ tests were associated with higher asymmetry levels. Furthermore, only the knee-extension peak torque at both angular velocities was correlated moderately to largely (r=0.48-0.66) with jump performance. Despite their recognized ability to predict the risk of injury, the absence of interrelationships between TMG, isokinetic tests, and unilateral jumps precludes their single use as a unique functional screening diagnostic. Finally, and very importantly, lower-limb asymmetry is not necessarily related to impaired vertical jump performance in soccer players.
Post-TAVI Follow-Up with MDCT of the Valve Prosthesis: Technical Application, Regular Findings and Typical Local Post-Interventional Complications
Authors: Soschynski Martin , Capilli Fabio , Ruile Philipp , Neumann Franz-Josef , Langer Mathias , Krauss Tobias
Published: December 2017

Background Transcatheter aortic valve implantation (TAVI) has evolved into an alternative procedure to surgical valve replacement for high-risk patients with aortic valve stenosis. Despite technical innovations, there is still a risk of complications during and after the intervention. After a TAVI procedure, ECG-gated multidetector computed tomography (MDCT) plays an important role in the early diagnosis of local complications. In this article, we explain for the first time how the technical acquisition of MDCT in the region of the aortic root is performed as post-interventional control of the TAVI prosthesis. In the second part normal post-interventional findings of different prosthetic valves as well as classic and uncommon complications in the implant area will be illustrated in several case studies.

Methods In this review the current literature from PubMed about ECG-gated MDCT after TAVI is summarized and structured. It is supplemented by several case studies from our institution.

Results and Conclusion Using retrospectively ECG-gated MDCT, an aortic valve prosthesis after TAVI can be visualized with high spatial resolution in several phases of the cardiac cycle. Images of the implanted aortic valve at all time points of the cardiac cycle enable a functional analysis of prosthetic leaflets similar to echocardiography. MDCT is superior to transthoracic echocardiography with respect to the direct detection of prosthetic leaflet thrombosis. The position of the device in relation to the coronary ostia and correct unfolding of the stent frame need to be evaluated. There are different types of stents carrying the valve leaflets with distinct ideal positions. Any stent should cover the left ventricular outflow tract (LVOT) along its whole circumference. Life-threatening complications in the implant area, such as annulus rupture, can be diagnosed reliably with CT.

Key points 

Citation Format
Electrical resistivity across the tricriticality in itinerant ferromagnet
Authors: Opletal P. , Prokleška J. , Valenta J. , Sechovský V.
Published: December 2017

We investigate the discontinuous ferromagnetic phase diagram near tricritical point in UCo1-xRuxAl compounds by electrical resistivity measurements. Separation of phases in UCo0.995Ru0.005Al at ambient pressure and in UCo0.990Ru0.010Al at pressure of 0.2 GPa and disappearance of ferromagnetism at 0.4 GPa is confirmed. The exponent of temperature dependence of electrical resistivity implies change from Fermi liquid-like behavior to non-Fermi liquid at 0.2 GPa and reaches minimum at 0.4 GPa. Our results are compared to results obtained on the pure UCoAl and explanation for different exponents is given.
Nanomodified composite magnetic materials and their molding technologies
Authors: Timoshkov I. , Gao Q. , Govor G. , Sakova A. , Timoshkov V. , Vetcher A.
Published: December 2017

Advanced electro-magnetic machines and systems require new materials with improved properties. Heterogeneous 3D nanomodified soft magnetic materials could be efficiently applied. Multistage technology of iron particle surface nanomodification by sequential oxidation and Si-organic coatings will be reported. The thickness of layers is 0.5-5 nm. Compaction and annealing are the final steps of magnetic parts and components shaping. The soft magnetic composite material shows the features: resistivity is controlled by insulating coating thickness and equals up to ρ =10-4 Ω⋅m for metallic state and ρ =104 Ω⋅m for insulator state, maximum magnetic permeability is μm = 2500 and μm = 300 respectively, induction is up to Bm=2.1 T. These properties of composite soft magnetic material allow applying for transformers, throttles, stator-rotor of high-efficient and powerful electric machines in 10 kHz–1MGz frequency range. For microsystems and microcomponents application, good opportunity to improve their reliability is the use of nanocomposite materials. Electroplating technology of nanocomposite magnetic materials into the ultra-thick micromolds will be presented. Co-deposition of the soft magnetic alloys with inert hard nanoparticles allows obtaining materials with magnetic permeability up to μm=104, magnetic induction of Bs=(0.62–1.3) T. Such LIGA-like technology will be applied in MEMS to produce high reliable devices with advanced physical properties.
Probing the interaction between 2,2′-bithiophene-5-carboxylic acid and TiO2 by photoelectron spectroscopy: A joint experimental and theoretical study
Authors: Dervaux J. , Cormier P.-A. , Struzzi C. , Scardamaglia M. , Bittencourt C. , Petaccia L. , Cornil D. , Lasser L. , Beljonne D. , Cornil J. , Lazzaroni R. , Snyders R.
Published: December 2017

The interaction between 2,2′-bithiophene-5-carboxylic acid (PT2) sublimed under ultra-high vacuum conditions and anatase (101) and rutile (110) TiO2 single crystal surfaces is investigated by studying the electronic spectral density near the Fermi level with synchrotron-based spectroscopy. The experimental results are compared to density functional theory calculations of the isolated PT2 molecule and of the molecule adsorbed on an anatase TiO2 (101) cluster. The relative concentrations of Ti, C, and S atoms indicate that the adsorbed molecule remains intact upon deposition, which is typical of a Stranski-Krastanov growth mode. The analysis of the O1s spectrum suggests a predominant bidentate geometry of the adsorption with both rutile and anatase surfaces, as supported by previous theoretical simulations. It is also theoretically and experimentally demonstrated that the PT2 adsorption causes the appearance of new electronic states in the gap near the TiO2 valence band. A pinning effect of the LUMO level of the dye is also theoretically predicted.
Aridity weakens population-level effects of multiple species interactions onHibiscus meyeri
Authors: Louthan Allison M. , Pringle Robert M. , Goheen Jacob R. , Palmer Todd M. , Morris William F. , Doak Daniel F.
Published: December 2017

Significance

Predicting the impacts of global change on biodiversity requires understanding the factors that regulate population growth and set species’ range boundaries. Darwin proposed that abiotic factors limit population growth in stressful areas, whereas species interactions dominate in less stressful environments because of an increased density and diversity of enemies (consumers, parasites, pathogens). We present experimental support for this hypothesized shift in the strength of species interactions with climate, but we also show that this pattern does not arise from Darwin’s proposed mechanism. Our work implies that effects of species interactions on population growth rate decrease with stress, with implications for how different range boundaries are likely to respond to climatic change.
Metabolomics technology and bioinformatics for precision medicine
Authors: Azad Rajeev K , Shulaev Vladimir
Published: December 2017

Precision medicine is rapidly emerging as a strategy to tailor medical treatment to a small group or even individual patients based on their genetics, environment and lifestyle. Precision medicine relies heavily on developments in systems biology and omics disciplines, including metabolomics. Combination of metabolomics with sophisticated bioinformatics analysis and mathematical modeling has an extreme power to provide a metabolic snapshot of the patient over the course of disease and treatment or classifying patients into subpopulations and subgroups requiring individual medical treatment. Although a powerful approach, metabolomics have certain limitations in technology and bioinformatics. We will review various aspects of metabolomics technology and bioinformatics, from data generation, bioinformatics analysis, data fusion and mathematical modeling to data management, in the context of precision medicine.
ChopStitch: exon annotation and splice graph construction using transcriptome assembly and whole genome sequencing data
Authors: Khan Hamza , Mohamadi Hamid , Vandervalk Benjamin P , Warren Rene L , Chu Justin , Birol Inanc
Published: December 2017

Motivation

Sequencing studies on non-model organisms often interrogate both genomes and transcriptomes with massive amounts of short sequences. Such studies require de novo analysis tools and techniques, when the species and closely related species lack high quality reference resources. For certain applications such as de novo annotation, information on putative exons and alternative splicing may be desirable.

Results

Here we present ChopStitch, a new method for finding putative exons de novo and constructing splice graphs using an assembled transcriptome and whole genome shotgun sequencing (WGSS) data. ChopStitch identifies exon-exon boundaries in de novo assembled RNA-Seq data with the help of a Bloom filter that represents the k-mer spectrum of WGSS reads. The algorithm also accounts for base substitutions in transcript sequences that may be derived from sequencing or assembly errors, haplotype variations, or putative RNA editing events. The primary output of our tool is a FASTA file containing putative exons. Further, exon edges are interrogated for alternative exon-exon boundaries to detect transcript isoforms, which are represented as splice graphs in DOT output format.

Availability and implementation

ChopStitch is written in Python and C++ and is released under the GPL license. It is freely available at https://github.com/bcgsc/ChopStitch.

Supplementary information

Supplementary data are available at Bioinformatics online.
Early Tracheostomy in Patients With Traumatic Cervical Spinal Cord Injury Appears Safe and May Improve Outcomes
Authors: Flanagan Christopher D. , Childs Benjamin R. , Moore Timothy A. , Vallier Heather A.
Published: December 2017

Study Design.

Retrospective case series.

Objective.

To characterize outcomes associated with tracheostomy timing following traumatic cervical spinal cord injury (CSCI).

Summary of Background Data.

The morbidity associated with cervical spine trauma is substantially increased in the setting of concomitant CSCI. Despite recent evidence, it remains uncertain if early tracheostomy following traumatic CSCI can improve outcomes.

Methods.

From January 1, 2007 to December 31, 2015, retrospective chart review identified 70 patients who presented to a single Level 1 trauma center with traumatic CSCI and received tracheostomy for management of respiratory compromise. Patients were subdivided into two groups based on time from initial intubation to tracheostomy procedure: early (tracheostomy ≤7 d from initial intubation) and late (>7 d from initial intubation).

Results.

This series included 75.7% males and 24.3% females with mean age 50.5 years. A chest injury was present in 31.4% of patients. AIS A was the most common AIS score (41.4%), and 70.1% of patients had an injury level at C4 or above. Early tracheostomy was performed in 52.4% of patients. Factors most predictive of early tracheostomy were more severe AIS score (odds ratio [OR] = 1.72) and higher neurological level of injury (OR = 1.91) (P < 0.001, pseudo-R
2 = 0.241). Controlling for AIS and neurological level of injury, early tracheostomy was associated with fewer ventilator days (23.9 vs. 36.9, P = 0.0268), fewer days to decannulation (53.0 vs. 74.3, P = 0.0075), and shorter intensive care unit (ICU) stays (20.7 vs. 26.0, P = 0.0217). Rates of pneumonia, surgical site infection, in-hospital mortality, 90-day mortality, and 90-day readmission rates were not different between groups.

Conclusion.

Tracheostomy within 7 days of intubation may improve respiratory outcomes in patients with traumatic CSCI, regardless of level or severity of injury, without increasing complication rates.

Level of Evidence: 4
DYNAMIC RETINA VESSEL COLOR CHANGE DURING OCULAR COMPRESSION IN SEVERE LIPEMIA RETINALIS
Authors: Benson Maria , Wong Robert W. , Young Ryan C. , Gibson James B. , Fan Yuxin , Harper Clio Armitage
Published: December 2017

Purpose:

The aim of this study was to describe dynamic color change in retinal vessels from white to coral pink due to externally applied ocular pressure in a 6-week-old infant with lipemia retinalis secondary to type 1b familial hyperlipoproteinemia.

Methods:

Fundus images and fluorescein angiogram were taken with RetCam3 camera. Color photographs of pooled blood were taken during phlebotomy.

Results:

Genetic analysis revealed a rare genetic mutation in the APOC2 gene, a lipoprotein lipase activator. Intraocular pressure applied to the globe induced a color change in the retinal arteries from white to coral pink. Disruption in laminar flow leading to this change is described.

Conclusion:

This is the first report to attribute the retinal vessel color change to disrupted laminar flow and the intermixing of larger erythrocytes and smaller chylomicrons in a patient with lipemia retinalis. In addition, this is a rare example of congenital hyperlipidemia in the offspring of nonconsanguineous parents.
Evaluation of Use of Prosthesis, Mobility, and Quality of Life in Young and Adult Persons with Unilateral Above-Knee Amputation 7 Years after the 2008 Sichuan Earthquake
Authors: Chan SzeYing , Li WingSum , Chau WaiWang , Law SheungWai , Chan KaiMing
Published: December 2017

Background

The 2008 Sichuan earthquake resulted in many casualties, also leaving a great number of persons with amputation who require long-term rehabilitation.

Objectives

This study aims to evaluate the use of prostheses, mobility, and quality of life and to determine factors associated with better rehabilitation outcomes 7 years after the earthquake for individuals from the StandTall rehabilitation program with traumatic unilateral above-knee amputation due to earthquake injuries.

Method

This is a cross-sectional study. Twenty-four individuals with unilateral above-knee amputation were recruited either at home visits or during clinic sessions between December 2014 and May 2015. Main outcome measures were 12-Item Short Form Survey Version 2, Amputee Mobility Predictor, Houghton Scale, and Trinity Amputation and Prosthesis Experience Scales.

Results

Adults with unilateral above-knee amputation experienced worse psychological adjustment to limitation (p = 0.018), more social activity restrictions (p = 0.072), and suffered from more residual limb pain (p = 0.024), and phantom pain (p = 0.044). Rehabilitation success was associated with less athletic restriction (p = 0.053), less functional restriction (p = 0.077), and greater prosthetic satisfaction (p = 0.085).

Conclusions

Adults with unilateral above-knee amputation experienced greater difficulties in psychological adjustment to limitation and social activities, even 7 years after the amputation. Residual limb and phantom pain were greatly affected by age. Prosthetic daily wearing time correlated with better functional outcome for individuals with unilateral transfemoral amputation. This study provides information regarding long-term rehabilitation outcomes of individuals with traumatic unilateral above-knee amputation. Age, daily prosthetic wearing time, and residual limb pain and phantom pain are main factors affecting rehabilitation outcomes of individuals with amputation. Physical quality of life and psychosocial quality of life are both impaired by amputation.
Vestibular Outcome After Cochlear Implantation Is Not Related to Surgical Technique: A Double Blinded, Randomized Clinical Trial of Round Window Approach Versus Cochleostomy
Authors: Korsager Leise Elisabeth Hviid , Schmidt Jesper Hvass , Faber Christian , Wanscher Jens Højberg
Published: December 2017

Objective:

To establish whether the round window approach (RWA) leads to less vestibular dysfunction and dizziness than the standard cochleostomy approach (SCA) during cochlear implant (CI) surgery, as assessed using the video head impulse test (vHIT).

Additionally, objective findings were compared with the subjective dizziness perceived by the patient.

Study Design:

Double blinded, clinical randomized trial.

Setting:

University Hospital.

Patients:

Fifty-two ears from 46 patients were included. Inclusion criterion was a gain value more than 0.50.

Intervention:

Patients were randomized to the RWA or the SCA. Evaluation with the vHIT was performed before surgery, 1 day after surgery, and 1 month after surgery. Subjective dizziness was measured using a visual analogue scale (VAS) and the dizziness handicap inventory (DHI).

Main Outcome Measures:

Gain values and the incidence of catch-up saccades.

Results:

Three out of 23 patients in the SCA group experienced catch-up saccades compared with no patients in the RWA group, indicating the occurrence of objective vestibular dysfunction after CI surgery; the difference was not statistically significant. The VAS increased in both groups the day after surgery. The difference between the groups was not statistically significant. No statistically significant changes in the gain value or the DHI score could were observed between the two groups.

Conclusion:

No statistically significant difference between the cochleostomy approach and the round window approach using the vHIT and subjective dizziness perceived by the patient was found.
Cochlear Implantation After Partial or Subtotal Cochleoectomy for Intracochlear Schwannoma Removal—A Technical Report
Authors: Plontke Stefan K. , Kösling Sabrina , Rahne Torsten
Published: December 2017

Objective:

To describe the technique for surgical tumor removal, cochlear implant (CI) electrode placement and reconstruction of the surgical defect in patients with intracochlear schwannomas.

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Ten patients (five men, five women, mean age 48 ± 12 yr) with profound or severe to profound hearing loss due to intralabyrinthine schwannomas with intracochlear location.

Interventions:

Surgical tumor removal through extended round window approach, partial or subtotal cochleoectomy with or without labyrinthectomy and reconstruction of the surgical defect with cartilage, perichondrium or temporal muscle fascia, and bone pâté. Eight patients received a cochlear implant in the same procedure.

Main Outcome Measures:

Retrospective evaluation of clinical outcome including safety aspects (adverse events) and audiological performance at early follow up in cases of cochlear implantation.

Results:

The tumor was successfully removed in all cases without macroscopic (operation microscope and endoscope) tumor remnants in the bony labyrinth apart from one case with initial transmodiolar growth. One patient needed revision surgery for labyrinthine fistula. At short-term follow up (3-month post-surgery), good hearing results with the cochlear implant were obtained in all but one patient with a word recognition score of 100% for numbers, and 64 ± 14% for monosyllables (at 65 dB SPL in quiet).

Conclusions:

Surgical tumor removal and cochlear implantation is a promising treatment strategy in the management of intralabyrinthine schwannoma with intracochlear location, further extending the indication range for cochlear implantation. It is, however, of importance to observe the long-term outcome in these patients and to address challenges like follow up with magnetic resonance imaging.
Bone Mineral Density of Very Long‐term Survivors After Childhood Liver Transplantation
Authors: Ee Looi C. , Noble Charlton , Fawcett Jonathan , Cleghorn Geoffrey J.
Published: December 2017

Objectives:

Liver transplant patients are at risk of osteopenia and fractures but limited information is available in long‐term survivors after childhood transplantation. This study aimed to assess bone mineral density (BMD) of very long‐term, >5 years, survivors after liver transplantation in childhood.

Methods:

Patients aged <18 years at transplant, having survived >5 years after transplant were potentially eligible but only those with ongoing review in our state were included. Dual‐energy x‐ray absorptiometry (DXA) was used to measure BMD. Patients aged <20 years had lumbar spine (LS) and total body (TB) measurements whereas those aged 20 years or more had LS and femoral neck but not TB. BMD z‐scores for LS and TB, if available, were used in this study. BMD z‐score ⩽−2.0 was considered reduced. Pre‐pubertal children had radiologic bone age assessment.

Results:

Forty‐two patients, 17 boys, participated of whom 64% had biliary atresia. Median age at transplant was 2.22 (range 0.38–14.25) years; time since transplant 10.10 (5.01–25.98) years; and age at DXA 14.64 (6.59–38.07) years. Mean BMD z‐scores were LS −0.15 ± 1.07, and TB −0.76 ± 1.14, with no sex difference noted. Four (9.5%) patients had reduced LS BMD, and although ongoing steroid use was more frequent in these patients, other comorbidities were likely important. Age at transplant, time since transplant, height, weight, and body mass index at DXA did not predict LS BMD. Pathologic fractures occurred in 2 of 42 (5%) patients; all within 18 months of transplant.

Conclusions:

Very long‐term survivors after childhood liver transplant have LS BMD within the normal range.
The Local Health Department Mandate and Capacity for Community Engagement in Emergency Preparedness: A National View Over Time
Authors: Schoch-Spana Monica , Nuzzo Jennifer , Ravi Sanjana , Biesiadecki Laura , Mwaungulu Geoffrey
Published: December 2017

Context:

Local health departments (LHDs) perform the highly valued, yet time- and staff-intensive work of community engagement in public health emergency preparedness (CE-PHEP) when the Great Recession has had lingering effects on their organizational capacity.

Objective:

Track the extent to which LHDs still embrace collaborative, whole community approaches to PHEP in a historically low resource environment.

Design:

National survey in 2015 of LHDs using a self-administered online questionnaire regarding LHD practices and resources for CE-PHEP first fielded in 2012 (“The Community Engagement for Public Health Emergency Preparedness Survey”). Differences in 2015 survey responses were reviewed, and comparisons made between 2012 and 2015 responses.

Setting:

Randomized sample of 811 LHDs drawn from 2565 LHDs that were invited to participate in the 2010 National Profile of LHDs and participated in the 2012 CE-PHEP survey. Sample selection was stratified by geographic location and size of population served.

Participants:

Emergency preparedness coordinators reporting on the LHDs they serve.

Main Outcome Measure:

Community engagement in public health emergency preparedness intensity as measured by a scoring system that valued specific practices on the basis of the community capacity and public participation they represented.

Results:

Survey response was 30%; 243 LHDs participated. The CE-PHEP activities and intensity scores remained unchanged from 2012 to 2015. Local health departments that reported having an explicit CE-PHEP policy and experienced CE-PHEP staff member-–2 of the top 3 predictors of CE-PHEP intensity-–have dropped between 2012 and 2015. The numbers of LHDs with a CE-PHEP budget, also an important predictor of intensity, have not increased in a statistically significant way during that same period.

Conclusions:

Local health departments appear to be in a CE-PHEP holding pattern, presumably pushed forward by the doctrinal focus on partner-centered preparedness but held back by capacity issues, in particular, limited staff and partner support. Local health departments operating in low-resource environments are encouraged to formalize their CE-PHEP policy to advance performance in this arena.
Outcome Analysis of Free Flap Salvage in Outpatients Presenting with Microvascular Compromise
Authors: Largo Rene D. , Selber Jesse C. , Garvey Patrick B. , Chang Edward I. , Hanasono Matthew M. , Yu Peirong , Butler Charles E. , Baumann Donald P.
Published: December 2017

Background:

Extensive flap salvage attempts are routinely performed in patients with late-onset flap vascular crisis despite low flap survival rates. A knowledge gap exists in management of compromised free flaps in patients who present with perfusion-related complications after hospital discharge.

Methods:

A retrospective review of 7443 free flaps used in 7128 cancer patients at a single institution from January of 2001 to March of 2015 was performed.

Results:

Of 7443 free flap reconstructions, 856 patients (12 percent) were taken back to the operating room. Also, 261 patients (4 percent) suffered from microvascular compromise, of whom 110 (1 percent) experienced total flap loss. The authors identified 17 patients (10 breast cancer patients and seven head and neck cancer patients) who had vascular flap compromise and underwent reoperation after hospital discharge (median, 10 days; range, 4 to 107 days) after free flap reconstruction. Of these 17 patients, nine breast cancer patients and two head and neck cancer patients underwent flap salvage attempts. Salvage procedures included thrombectomy, thrombolytic and heparin injections, and reanastomoses (11 patients); vein grafting (four patients); vein supercharging with cephalic turndown (two patients); and change of recipient vessels (two patients). Sixteen of the 17 patients (94 percent) experienced total flap loss, and one patient (6 percent) had partial flap loss requiring long-lasting wound treatment.

Conclusions:

Outpatient free flap salvage has a low success rate regardless of flap type, recipient site, or patient population. The authors’ study suggests that immediate second-line reconstruction is more effective for late-onset flap vascular crisis than extensive flap salvage procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Postoperative Nausea and Vomiting with Plastic Surgery: A Practical Advisory to Etiology, Impact, and Treatment
Authors: Manahan Michele A. , Johnson Debra J. , Gutowski Karol A. , Bonawitz Steven C. , Ellsworth Warren A. , Zielinski Marta , Thomsen Robert W. , Basu C. Bob
Published: December 2017

Ambulatory surgery is common in plastic surgery, where many aesthetic and reconstructive procedures can be performed in hospitals, ambulatory surgery centers, or office-based surgery facilities. Outpatient surgery offers advantages to both the patient and the surgeon by increasing accessibility, flexibility, and convenience; lowering cost; and maintaining high-quality care. To optimize a patient’s experience and comfort, postoperative nausea and vomiting (PONV) should be prevented. However, in those patients who develop PONV, it must be appropriately managed and treated. The incidence of PONV is variable. It is often difficult to accurately predict those patients who will develop PONV or how they will manifest symptoms. There are a variety of recommended “cocktails” for PONV prophylaxis and treatments that are potentially effective. The decision regarding the type of treatment given is often more related to provider preference and determination of side-effect profile, rather than targeted to specific patient characteristics, because of the absence of large volumes of reliable data to support specific practices over others. Fortunately, there are several tenets for the successful prevention and treatment of PONV we have extracted from the literature and summarize here. The following is a summary for the practicing plastic surgeon of the current state of the literature regarding PONV cause, risk factors, prophylaxis, and treatment that may serve as a guide for further study and practice management.
MBN 2016 Aesthetic Breast Meeting BIA-ALCL Consensus Conference Report
Authors: Nava Maurizio Bruno , Adams William P. , Botti Giovanni , Campanale Antonella , Catanuto Giuseppe , Clemens Mark W. , Del Vecchio Daniel A. , De Vita Roy , Di Napoli Arianna , Hall-Findlay Elisabeth , Hammond Dennis , Heden Per , Mallucci Patrick , Martin del Yerro Josè Luis , Muti Egle , Rancati Alberto , Randquist Charles , Salgarello Marzia , Stan Constantin , Rocco Nicola
Published: December 2017

Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon neoplasia occurring in women with either cosmetic or reconstructive breast implants. The actual knowledge about BIA-ALCL deriving from the literature presents several limits, and it remains difficult to make inferences about BIA-ALCL epidemiology, cause, and pathogenesis. This is the reason why the authors decided to organize an evidence-based consensus conference during the Maurizio Bruno Nava (MBN 2016) Aesthetic Breast Meeting held in Milan in December of 2016. Twenty key opinion leaders in the field of plastic surgery from all over the world have been invited to express and discuss their opinion about some key questions on BIA-ALCL, trying to reach a consensus about BIA-ALCL cause, pathogenesis, diagnosis, and treatment in light of the actual best evidence.
Staying Safe during Gluteal Fat Transplantation
Authors: Villanueva Nathaniel L. , Del Vecchio Daniel A. , Afrooz Paul N. , Carboy Jourdan A. , Rohrich Rod J.
Published: December 2017

Gluteal augmentation with fat transplantation is increasing in demand but has been associated with a concerning number of fatality reports. Despite these reports, various surgeons have safely performed gluteal fat transplantation on a large number of patients with no reported mortality. The important aspects of safely performing gluteal fat transplantation are reviewed. Proper patient selection, favorable instrumentation, patient positioning, proper technique, and knowledge of anatomy are critical to improving the safety of this procedure. Adherence to these key principles should allow a reduction in mortality from this procedure, which would safely allow its continued offering in the setting of increasingly high demand.
Thenar Dysplasia in Radial Polydactyly Depends on the Level of Bifurcation
Authors: Saito Susumu , Ueda Maho , Murata Mai , Suzuki Shigehiko
Published: December 2017

Background:

Little is known about thenar dysplasia in radial polydactyly, other than that thenar hypoplasia occasionally occurs in radial polydactyly with triphalangism. In particular, the phenotype and level of duplication associated with thenar dysplasia remain unclear.

Methods:

The abductor pollicis brevis and flexor pollicis brevis muscles were visualized using three-dimensional ultrasound, and their horizontal geometry was assessed using a biaxial level classification system. Subjects were categorized into three phenotypes according to the developmental condition of the radial thumb. The relationship between the level of distribution of the muscles and the level of the bifurcation of the radial thumb was investigated.

Results:

Nineteen patients with radial polydactyly without triphalangism were included. There were 10 patients with the nonfloating type, three with the floating type, and six with the rudimentary type. All patients with bifurcation at or more distal to the metacarpophalangeal joint had normal thenar muscle distribution, but the muscles in patients with bifurcation at or more proximal to the level of the metacarpals were confined, regardless of phenotype. The level of muscle distribution was strongly correlated with the level of the bifurcation of the radial thumb.

Conclusions:

These findings suggest that formation of the thenar muscles in the longitudinal direction in radial polydactyly might depend on the level of bifurcation of the radial thumb. The presence of thenar dysplasia even in floating-type or rudimentary-type duplications is of clinical and etiologic importance.
Ability to Cope with Pain Puts Migraine Surgery Patients in Perspective
Authors: Gfrerer Lisa , Lans Jonathan , Faulkner Heather R. , Nota Sjoerd , Bot Arjan G. J. , Austen William Gerald
Published: December 2017

Background:

Candidates for migraine surgery are chronic pain patients with significant disability. Currently, migraine-specific questionnaires are used to evaluate these patients. Analysis tools widely used in evaluation of better understood pain conditions are not typically applied. This is the first study to include a commonly used pain questionnaire, the Pain Self-Efficacy Questionnaire (PSEQ) that is used to determine patients’ pain coping abilities and function. It is an important predictor of pain intensity/disability in patients with musculoskeletal pain, as low scores have been associated with poor outcome.

Methods:

Ninety patients were enrolled prospectively and completed the Migraine Headache Index and PSEQ preoperatively and at 12 months postoperatively. Scores were evaluated using paired t tests and Pearson correlation. Representative PSEQ scores for other pain conditions were chosen for score comparison.

Results:

All scores improved significantly from baseline (p < 0.01). Mean preoperative pain coping score (PSEQ) was 18.2 ± 11.7, which is extremely poor compared with scores reported for other pain conditions. Improvement of PSEQ score after migraine surgery was higher than seen in other pain conditions after treatment (112 percent). Preoperative PSEQ scores did not influence postoperative outcome.

Conclusions:

The PSEQ successfully demonstrates the extent of debility in migraine surgery patients by putting migraine pain in perspective with other known pain conditions. It further evaluates functional status, rather than improvement in migraine characteristics, which significantly adds to our understanding of outcome. Poor preoperative PSEQ scores do not influence outcome and should not be used to determine eligibility for migraine surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Teaching Palatoplasty Using a High-Fidelity Cleft Palate Simulator
Authors: Cheng Homan , Podolsky Dale J. , Fisher David M. , Wong Karen W. , Lorenz H. Peter , Khosla Rohit K. , Drake James M. , Forrest Christopher R.
Published: December 2017

Background:

Cleft palate repair is a challenging procedure for cleft surgeons to teach. A novel high-fidelity cleft palate simulator has been described for surgeon training. This study evaluates the simulator’s effect on surgeon procedural confidence and palatoplasty knowledge among learners.

Methods:

Plastic surgery trainees attended a palatoplasty workshop consisting of a didactic session on cleft palate anatomy and repair followed by a simulation session. Participants completed a procedural confidence questionnaire and palatoplasty knowledge test immediately before and after the workshop.

Results:

All participants reported significantly higher procedural confidence following the workshop (p < 0.05). Those with cleft palate surgery experience had higher procedural confidence before (p < 0.001) and after (p < 0.001) the session. Palatoplasty knowledge test scores increased in 90 percent of participants. The mean baseline test score was 28 ± 10.89 percent and 43 ± 18.86 percent following the workshop. Those with prior cleft palate experience did not have higher mean baseline test scores than those with no experience (30 percent versus 28 percent; p > 0.05), but did have significantly higher scores after the workshop (61 percent versus 35 percent; p < 0.05). All trainees strongly agreed or agreed that the simulator should be integrated into training and they would use it again.

Conclusions:

This study demonstrates the effective use of a novel cleft palate simulator as a training tool to teach palatoplasty. Improved procedural confidence and knowledge were observed after a single session, with benefits seen among trainees both with and without previous cleft experience.
PHD-2 Suppression in Mesenchymal Stromal Cells Enhances Wound Healing
Authors: Ko Sae Hee , Nauta Allison C. , Morrison Shane D. , Hu Michael S. , Zimmermann Andrew S. , Chung Michael T. , Glotzbach Jason P. , Wong Victor W. , Walmsley Graham G. , Peter Lorenz H. , Chan Denise A. , Gurtner Geoffrey C. , Giaccia Amato J. , Longaker Michael T.
Published: December 2017

Background:

Cell therapy with mesenchymal stromal cells is a promising strategy for tissue repair. Restoration of blood flow to ischemic tissues is a key step in wound repair, and mesenchymal stromal cells have been shown to be proangiogenic. Angiogenesis is critically regulated by the hypoxia-inducible factor (HIF) superfamily, consisting of transcription factors targeted for degradation by prolyl hydroxylase domain (PHD)-2. The aim of this study was to enhance the proangiogenic capability of mesenchymal stromal cells and to use these modified cells to promote wound healing.

Methods:

Mesenchymal stromal cells harvested from mouse bone marrow were transduced with short hairpin RNA (shRNA) against PHD-2; control cells were transduced with scrambled shRNA (shScramble) construct. Gene expression quantification, human umbilical vein endothelial cell tube formation assays, and wound healing assays were used to assess the effect of PHD knockdown mesenchymal stromal cells on wound healing dynamics.

Results:

PHD-2 knockdown mesenchymal stromal cells overexpressed HIF-1α and multiple angiogenic factors compared to control (p < 0.05). Human umbilical vein endothelial cells treated with conditioned medium from PHD-2 knockdown mesenchymal stromal cells exhibited increased formation of capillary-like structures and enhanced migration compared with human umbilical vein endothelial cells treated with conditioned medium from shScramble-transduced mesenchymal stromal cells (p < 0.05). Wounds treated with PHD-2 knockdown mesenchymal stromal cells healed at a significantly accelerated rate compared with wounds treated with shScramble mesenchymal stromal cells (p < 0.05). Histologic studies revealed increased blood vessel density and increased cellularity in the wounds treated with PHD-2 knockdown mesenchymal stromal cells (p < 0.05).

Conclusions:

Silencing PHD-2 in mesenchymal stromal cells augments their proangiogenic potential in wound healing therapy. This effect appears to be mediated by overexpression of HIF family transcription factors and up-regulation of multiple downstream angiogenic factors.
The Best of Abdominal Wall Reconstruction
Authors: Patel Nakul Gamanlal , Ratanshi Imran , Buchel Edward W.
Published: December 2017

Learning Objectives:

After reviewing this article, the participant should be able to: 1. List major risk factors for hernia formation and for failure of primary repair. 2. Outline an algorithmic approach to anterior abdominal wall reconstruction based on the degree of contamination, components involved in the deficit, and width of the hernia defect. 3. Describe appropriate indications for synthetic and biological mesh products. 4. List common flaps used in anterior abdominal wall reconstruction, including functional restoration strategies. 5. Describe the current state of the art of vascularized composite tissue allotransplantation strategies for abdominal wall reconstruction.

Plastic surgeons have an increasingly important role in abdominal wall reconstruction—from recalcitrant, large incisional hernias to complete loss of abdominal wall domain. A review of current algorithms is warranted to match evolving surgical techniques and a growing number of available implant materials. The purpose of this article is to provide an updated review of treatment strategies to provide an approach to the full spectrum of abdominal wall deficits encountered in the modern plastic surgery practice.
Bovine Acellular Dermal Matrix in Immediate Breast Reconstruction: A Retrospective, Observational Study with SurgiMend
Authors: Scheflan Michael , Grinberg-Rashi Helena , Hod Keren
Published: December 2017

Background:

Acellular dermal matrices can be combined with implant-based breast reconstruction to help optimize outcomes. SurgiMend PRS is a fetal bovine dermis–derived acellular dermal matrix composed of type I collagen and approximately 30 percent type III collagen, sharing many of the properties of human cadaveric acellular dermal matrix.

Methods:

This was a retrospective, single-center analysis of 111 adult patients (147 breasts) undergoing one-stage (83.7 percent) or two-stage (16.3 percent) immediate breast reconstruction after mastectomy. The aims were to characterize the safety profile of SurgiMend and investigate associations between risk factors and complications.

Results:

The mean age of the patients was 47.9 years and the mean body mass index was 24.7 kg/m2. After a median follow-up of 24.3 months, the overall rates of minor and major complications were 25.2 percent (n = 37 of 147) and 12.9 percent (n = 19 of 147), respectively. The most common major complications were seroma [n = 12 (8.2 percent)] and necrosis [n = 9 (6.1 percent)]. All occurred within 3 months after surgery. The rate of capsular contracture was 2.7 percent (n = 4). A total of 2.7 percent of implanted breasts (n = 4) required explantation. In a univariate analysis, smokers had a greater risk of major complications (p = 0.013), and postoperative radiation therapy and obesity were associated with an increased risk of capsular contracture (p = 0.006) and explantation (p = 0.006), respectively. In a multivariate analysis, several factors were associated with complications or explantation, including obesity (p < 0.05), preoperative chemotherapy (p < 0.001), and mastectomy weight (p < 0.05). These associations align with other studies of implant-based reconstruction and do not appear to be specific to this acellular dermal matrix.

Conclusion:

The results are consistent with previous analyses of SurgiMend, and support its value in implant-based breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Does Computed Tomography Have the Ability to Differentiate Aggressive From Nonaggressive Solid Pseudopapillary Neoplasm?
Authors: Rastogi Ashita , Assing Mathew , Taggart Mellisa , Rao Brinda , Sun Jia , Elsayes Khaled , Tamm Eric , Bhosale Priya
Published: December 2017

Objective

The aim of the study was to assess the ability of contrast-enhanced computed tomography (CECT) to differentiate aggressive from nonaggressive solid pseudopapillary neoplasms (SPNs).

Materials and Methods

Forty treatment-naive patients with pathologically proven pancreatic SPNs were included. Imaging characteristics were determined by consensus of 3 radiologists blinded to histopathologic aggressiveness. All patients underwent 4-phase CECT using a pancreatic protocol. The regions of interest of the tumor and the normal pancreas were documented on all phases. Lymph nodes were considered metastatic if greater than 1.0 cm in short-axis diameter.

Fisher exact and Wilcoxon rank-sum tests were used to compare between aggressive and nonaggressive tumors.

Results

No significant difference was noted between imaging covariates, such as internal hemorrhage, calcification, wall thickness perceptibility, vascular invasion, margins, cystic component, and pancreatic and biliary ductal dilation. Tumors with greater than 62.5 Hounsfield units and progressive enhancement during the delayed phase had aggressive characteristics (P = 0.03).

Conclusions

On delayed phase CECT, pathologically aggressive SPNs may show greater enhancement than nonaggressive SPNs.
Single-Shot Version of FLAIR Sequence in the Detection of Intraventricular Anomalies: Preliminary Experience in Fetal MR Imaging
Authors: Falanga Giorgia , Moscatelli Marco , Izzo Giana , Parazzini Cecilia , Doneda Chiara , Righini Andrea
Published: December 2017

Objective

To evaluate single-shot (ss) FLAIR sequence in the detection of intraventricular anomalies in a series of fetuses showing mild–moderate ventriculomegaly at ultrasound.

Subjects and Methods

Fetuses with mild–moderate isolated ventriculomegaly, which underwent MR imaging between 2003 and 2014 were considered eligible. Fetuses were examined by standard MR protocol and ss-FLAIR sequence, tailored for snapshot imaging. Two paediatric neuroradiologists evaluated MR images.

Results

542 cases were selected. MR imaging was performed at mean 26 weeks of gestation. ss-FLAIR sequence detected intraventricular findings, consistent with cysts in 10 cases. In 3/10 intraventricular cysts were also evident on ss-FSE T2 and FSE T1-weighted images. In no case diffusion weighted imaging was able to detect cyst. No cyst was highlighted on ss-FSE-T2 and FSE-T1-weighted images, without being visible also on ss-FLAIR.

Conclusion

ss-FLAIR sequence may be useful to detect intraventricular anomalies especially when fetal position or maternal obesity prevents adequate visualization by ultrasound.
Immediate Hypoglossal-Facial Anastomosis in Patients With Facial Interruption
Authors: Yetiser Sertac
Published: December 2017

Hypoglossal-facial anastomosis provides excellent motor supply to the mimetic muscles of the face when there is no chance of recovery of the damaged facial nerve. However, to achieve optimal results, the timing of facial nerve surgery based on electrophysiological testing and clinical evaluation requires close follow-up of the patient. Functional results after delayed surgery are not predictable and depend on the number of surviving fibers, type of injury, severity of damage, degree of infiltration of inflammatory cells, and local fibrosis. Facial hypertonia, synkinesis, and involuntary mass movement are the major problems of delayed reanimation of the facial nerve. Surgery in the vicinity of the facial nerve always aims to preserve neural integrity. However, immediate facial nerve grafting is sometimes required. We present our experience with 4 patients having normal facial function prior to surgery. The facial nerve was severed due to tumor infiltration and instantaneously reconstructed with the hypoglossal nerve. Two patients had House-Brackmann grade-II 10 days and 28 months after surgery, respectively, and another 2 patients had House-Brackmann grade-III facial paralysis 2 weeks and 6 months after surgery, respectively.