bluuebunny/crossref_metadata_2025 huggingface dataset:
A Milky Way with a massive, centrally concentrated thick disc: new Galactic mass models for orbit computations
Authors: Pouliasis E. , Di Matteo P. , Haywood M.
Published: November 2016

In this work, two new axisymmetric models for the Galactic mass distribution are presented. Motivated by recent results, these two models include the contribution of a stellar thin disc and of a thick disc, as massive as the thin counterpart but with a shorter scale-length. Both models satisfy a number of observational constraints: stellar densities at the solar vicinity, thin and thick disc scale lengths and heights, rotation curve(s), and the absolute value of the perpendicular force Kz as a function of distance to the Galactic centre. We numerically integrate into these new models the motion of all Galactic globular clusters for which distances, proper motions, and radial velocities are available, and the orbits of about one thousand stars in the solar vicinity. The retrieved orbital characteristics are compared to those obtained by integrating the clusters and stellar orbits in pure thin disc models. We find that, due to the possible presence of a thick disc, the computed orbital parameters of disc stars can vary by as much as 30–40%. We also show that the systematic uncertainties that affect the rotation curve still plague computed orbital parameters of globular clusters by similar amounts.
Endovascular Approach of a Proximal Anterior Inferior Cerebellar Artery Aneurysm: Case Report
Authors: Cardoso Arquimedes , Lemos Luiz , Marques Júnior Marcos
Published: November 2016

Anterior inferior cerebellar artery (AICA) aneurysms are extremely rare, accounting for only 0.75% of all intracranial aneurysms. The average age of patients suffering from those aneurysms found in the literature was 44 years, with no significant difference between the sexes. These aneurysms can manifest clinically through expansive symptoms in cerebellopontine angle or through signs and symptoms of subarachnoid hemorrhage, such as nausea, vomiting, headache, nystagmus and paresis. The gold standard exam for diagnosis is cerebral angiography. The treatment of these lesions is controversial. The main difficulty of the surgical treatment of these aneurysms is the location of the AICA, which lies close to critical neurovascular structures. In this article, we describe a proximal AICA aneurysm embolization without occlusion of the parent artery, with excellent results in the postoperative period.
Non-Invasive Intracranial Pressure Evaluation in an Emergency Room – Point-of-Care Ultrasonography
Authors: Damiani Daniel , Damiani Durval
Published: November 2016

Point-of-care ultrasound is modifying conducts in emergency care. The various medical specialties, in addition to traditional indications in cases of multiple trauma, are using this technique for rapid diagnosis at the bedside without patient mobilization and without radiation. Point-of-care ultrasound in neurocritical patients, through its transorbital window, can estimate the intracranial pressure by a non-invasive method. Through the measurement of the diameter of the optic nerve sheath 3 mm posterior to the retina, the intracranial pressure is estimated if the value of the diameter is > 5 mm, as it has been verified in other studies. The present article describes the most current data on this topic, and it also highlights the need for more multicentric and randomized trials to determine the correct cut-off points that represent the high sensibility and specificity of the method.
Effect of pulsed ultrasonic on arc acoustic binding in pulsed ultrasonic wave-assisted pulsed gas tungsten arc welding
Authors: Wang Jianfeng , Sun Qingjie , Liu Jinping , Wang Bin , Feng Jicai
Published: November 2016

This paper investigated the effect of pulsed ultrasonic on the microstructure and mechanical properties of weld joints using novel pulsed ultrasonic wave-assisted pulsed gas tungsten arc welding. The principle of proposed method was to apply pulsed ultrasonic to the welding process during background current. The results indicated that arc contraction degree, weld pool oscillation, and weld penetration were remarkably enhanced by applying pulsed ultrasonic. The microstructure refined by pulsed ultrasonic was much finer than those refined by continuous ultrasonic due to the more stable ultrasonic field in arc zone and consequent stronger fluid flow in weld pool. Furthermore, tensile strength of the joints with pulsed ultrasonic was significantly improved compared with that of the joints with no and continuous ultrasonic.
Optimisation of interpass temperature and heat input for wire and arc additive manufacturing 5A06 aluminium alloy
Authors: Geng Haibin , Li Jinglong , Xiong Jiangtao , Lin Xin
Published: November 2016

Undulated surface appearance and inconsistent layer cross-sectional dimensions are two common types of appearance defects, which are formed owing to insufficient heat input and nonlinear time-varying thermal boundary condition of molten pool. Appropriate interpass temperature control and heat input regulations are effective ways to realise and maintain the consistent thermal boundary condition during bottom-up additive manufacturing process. Equivalent heat dissipation factor is used to synthetically characterise the variation of heat dissipation in process of additive manufacturing. Combing with Rosenthal's analytical solution, a theoretical model is developed to optimise interpass temperature and heat input for each layer deposition, so as to realise stable additive manufacturing. Finally a specification for the wire and arc additive manufacture procedure was designed according to the developed model which was verified effectively by manufacturing a wall part. It could also be a process design reference for other kinds of metal additive manufacturing.
Resource-related inequalities in mothers’ employment in two family-policy regimes: evidence from Switzerland and West Germany
Authors: Liechti Lena
Published: November 2016

Using data from the Swiss Household Panel (1999–2012) and the German Socio-Economic Panel (1994–2010), this paper compares the impact of mothers’ education and her partners’ income on maternal employment within the second to the fourth year after childbirth in Switzerland and West Germany. The broadly similar institutional context in the two countries makes for a more controlled and narrower comparison. Around the turn of the millennium, both family-policy regimes did little to foster dual-earner families. However, they differed in their support for families’ caring role (familialistic policies), with West Germany being much more generous. It is expected that these familialistic policies widen the educational gap in maternal employment, by selectively encouraging less-educated mothers to stay at home. Moreover, they are also expected to lower the economic pressure on low-income families to have a second income, thus diminishing the impact of partners’ income. Results confirm this expectation only within the fourth year after childbirth but not within the years before. This is somehow surprising, as central country-differences with respect to familialistic policies refer to the first three years after childbirth.
Learning from observation, feedback, and intervention in linear and non-linear task environments
Authors: Henriksson Maria P. , Enkvist Tommy
Published: November 2016

This multiple-cue judgment study investigates whether we can manipulate the judgment strategy and increase accuracy in linear and non-linear cue–criterion environments just by changing the training mode. Three experiments show that accuracy in simple linear additive task environments are improved with feedback training and intervention training, while accuracy in complex multiplicative tasks are improved with observational training. The observed interaction effect suggests that the training mode invites different strategies that are adjusted as a function of experience to the demands from the underlying cue–criterion structure. Thus, feedback and the intervention training modes invite cue abstraction, an effortful but successful strategy in combination with simple linear task structures, and observational training invites exemplar memory processes, a simple but successful strategy in combination with complex non-linear task structures. The study discusses adaptive cognition and the implication of the different training modes across a life span and for clinical populations.
Validation of semantic illusions independent of anomaly detection: evidence from eye movements
Authors: Cook Anne E , Walsh Erinn K , Bills Margaret A A , Kircher John C , O’Brien Edward J
Published: November 2016

Several theorists have argued that readers fail to detect semantic anomalies during reading, and that these effects are indicative of “shallow processing” behaviours. Previous studies of semantic anomalies such as the Moses illusion have focused primarily on explicit detection tasks. In the present study, we examined participants’ eye movements as they read true/false statements that were non-anomalous, or contained a semantic anomaly that was either high- or low-related to the correct information. Analyses of reading behaviours revealed that only low-related detected anomalies resulted in initial processing difficulty, but both detected and undetected anomalies, regardless of whether they were high- or low-related, resulted in delayed processing difficulty. The results extend previous findings on semantic anomalies and are discussed in terms of the RI-Val model of text processing.
Therapy-activated stromal cells can dictate tumor fate
Authors: Kerbel Robert S. , Shaked Yuval
Published: November 2016

In this issue of JEM, Chan et al. describe a novel way by which an investigational form of chemotherapy known as low-dose metronomic chemotherapy can inhibit tumor growth, which also has therapeutic implications for targeting tumor-initiating cells (TICs), the tumor stroma, and chemokine receptors, as well as invasion and metastasis.
Local pulsatile contractions are an intrinsic property of the myosin 2A motor in the cortical cytoskeleton of adherent cells
Authors: Baird Michelle A. , Billington Neil , Wang Aibing , Adelstein Robert S. , Sellers James R. , Fischer Robert S. , Waterman Clare M.
Published: November 2016

The role of nonmuscle myosin 2 (NM2) pulsatile dynamics in generating contractile forces required for developmental morphogenesis has been characterized, but whether these pulsatile contractions are an intrinsic property of all actomyosin networks is not known. Here we used live-cell fluorescence imaging to show that transient, local assembly of NM2A “pulses” occurs in the cortical cytoskeleton of single adherent cells of mesenchymal, epithelial, and sarcoma origin, independent of developmental signaling cues and cell–cell or cell–ECM interactions. We show that pulses in the cortical cytoskeleton require Rho-associated kinase– or myosin light chain kinase (MLCK) activity, increases in cytosolic calcium, and NM2 ATPase activity. Surprisingly, we find that cortical cytoskeleton pulses specifically require the head domain of NM2A, as they do not occur with either NM2B or a 2B-head-2A-tail chimera. Our results thus suggest that pulsatile contractions in the cortical cytoskeleton are an intrinsic property of the NM2A motor that may mediate its role in homeostatic maintenance of tension in the cortical cytoskeleton of adherent cells.
Benchmarks for measurement of duplicate detection methods in nucleotide databases
Authors: Chen Qingyu , Zobel Justin , Verspoor Karin
Published: November 2016

Duplication of information in databases is a major data quality challenge. The presence of duplicates, implying either redundancy or inconsistency, can have a range of impacts on the quality of analyses that use the data. To provide a sound basis for research on this issue in databases of nucleotide sequences, we have developed new, large-scale validated collections of duplicates, which can be used to test the effectiveness of duplicate detection methods. Previous collections were either designed primarily to test efficiency, or contained only a limited number of duplicates of limited kinds. To date, duplicate detection methods have been evaluated on separate, inconsistent benchmarks, leading to results that cannot be compared and, due to limitations of the benchmarks, of questionable generality. In this study, we present three nucleotide sequence database benchmarks, based on information drawn from a range of resources, including information derived from mapping to two data sections within the UniProt Knowledgebase (UniProtKB), UniProtKB/Swiss-Prot and UniProtKB/TrEMBL. Each benchmark has distinct characteristics. We quantify these characteristics and argue for their complementary value in evaluation. The benchmarks collectively contain a vast number of validated biological duplicates; the largest has nearly half a billion duplicate pairs (although this is probably only a tiny fraction of the total that is present). They are also the first benchmarks targeting the primary nucleotide databases. The records include the 21 most heavily studied organisms in molecular biology research. Our quantitative analysis shows that duplicates in the different benchmarks, and in different organisms, have different characteristics. It is thus unreliable to evaluate duplicate detection methods against any single benchmark. For example, the benchmark derived from UniProtKB/Swiss-Prot mappings identifies more diverse types of duplicates, showing the importance of expert curation, but is limited to coding sequences. Overall, these benchmarks form a resource that we believe will be of great value for development and evaluation of the duplicate detection or record linkage methods that are required to help maintain these essential resources.

Database URL  :  https://bitbucket.org/biodbqual/benchmarks
Deep Brain Stimulation Programming
Authors: Montgomery, Jr Erwin B
Published: November 2016

This second edition of the book continues the basic premise that a thorough knowledge of the mechanisms by which neurons respond to electrical stimulation, how to control the stimulation and the regional anatomy allows the Deep Brain Stimulation (DBS) programmer to effectively and efficiently help patients reach optimal control of their disorder. There are a great many variables that influence the patient’s response to DBS, such as the exact nature of the patient’s individual symptoms and disabilities and the variability of the surgical placement of stimulating leads. The complexity has expanded because rapid increases in technology, both current and anticipated. The book makes no assumptions as to the prior knowledge or expertise. As the brain fundamentally is an electrical device, the book begins explaining the relevant electronics, building a nearly intuitive knowledge of how electrons are affected by electrical and magnetic forces and how the actions of the programmer controls electrical charges that ultimately activate neurons, which themselves are electrical devices.
Intimacy Post-Injury
Authors: Cameron Ritchie Elspeth
Published: November 2016

Since terrorist attacks on September 11, 2001, a total of 2.7 million US service members have served in the wars in Afghanistan and Iraq. Often discussed during this period have been post-traumatic stress disorder and traumatic brain injury, the so-called “invisible wounds of war.” These injuries directly affect intimate relationships, and the treatment of these injuries involves medications that often have sexual side effects. Another set of wounds are those that directly involve sexual functioning, including lower extremity amputations and genitourinary injuries. This volume encourages medical personnel to discuss sexual health with their patients; learn how to evaluate and treat erectile dysfunction, including side effects from medications; and understand how to mitigate the effects of physical injury, pain, and disability on sexual functioning. The target medical audience includes all providers who treat injured service members and veterans. Service members and their families should benefit from the information in this book as well.
Vertigo
Authors: Baloh Robert W.
Published: November 2016

Benign paroxysmal positional vertigo (BPPV) is by far the most common cause of vertigo, and approximately one in five people will have it at some time during their lifetime. Sudden violent spells of vertigo are triggered by a change in position, such as turning over in bed, getting in and out of bed, bending down and straightening up, and extending the head back to look up. During an attack, both eyes oscillate in a characteristic pattern, called nystagmus. Indeed, understanding the mechanism for nystagmus production was key to developing a cure for BPPV. It is difficult to say who exactly deserves credit for discovery of the cure for BPPV, but as with most discoveries in medicine, there is a long list of contributors, each providing a small piece to the puzzle. To tell the story, this book focuses on five remarkable physician scientists who made key discoveries leading up to the cure for BPPV: Prosper Ménière (1799–1862), Josef Breuer (1842–1925), Robert Bárány (1876–1936), Charles Hallpike (1900–1979), and Harold Schuknecht (1917–1996). The final section brings the reader up to the present time, describing the contributions of recent investigators and our current approach to treating BPPV.
Learning While Caring
Authors: Hellman Samuel B.
Published: November 2016

Learning While Caring is about what the author has learned during his half-century career as a cancer doctor. During this time, medicine has changed greatly. It has become more scientifically based, more institutionally located, and now comprises almost one-fifth of the US economy. Despite these changes, much remains the same, especially the primary obligation of the doctor to the patient. Also during this period, most of the developed world has recognized health care as a right for all its members. This has been resulted in greatly improved care for many, but not for all. For the last 25 years the United States has been experimenting on how this should be achieved, beginning with the proposed but not enacted Clinton Health Security proposal and currently with the Affordable Care Act. While efficiency and cost control are essential, cost cannot be the only parameter of success. Access to high-quality health care must be made available to all. Proper education for an informed public must include an understanding of the general principles of biology, while that of a doctor must result in a familiarity with the humanities and social sciences. An academic physician has three responsibilities: patient care, teaching, and research. These latter two, while essential, must not conflict, compromise, or limit the doctor-patient relationship. This book is about the author’s activities in all three endeavors. Since his specialty is oncology, this is the major subject, but most of the information is applicable to all caring physicians.
The Syringe Driver
Authors: Dickman Andrew , Schneider Jennifer
Published: November 2016

A syringe driver, or pump, represents a simple and cost-effective method of delivering a continuous subcutaneous infusion (CSCI). A CSCI provides a safe and effective way of drug administration and can be used to maintain symptom control in patients who are no longer able to take oral medication.
There have been several developments in this field since the third edition of this highly successful book. The text in this edition has been completely revised, including a new chapter describing the compatibility and stability of drugs in addition to incorporating new treatment options and an extensive list of new compatibility data.
This book serves as a valuable reference source, providing a comprehensive review of syringe pump use and administration of drugs via CSCI. The first chapter provides an overview of syringe pumps and CSCIs, including a useful array of frequently asked questions and reference to needlestick injuries. The new second chapter discusses the reasons why drugs in solution are at risk of compatibility and stability issues. The third chapter incorporates revised and referenced information relating to most drugs likely to be administered via a CSCI using a syringe pump. The fourth chapter briefly discusses the control of specific symptoms that are often encountered when CSCIs are required. The fifth and final chapter contains an extensive, referenced (where possible) list of physical and chemical stability data relating to drug combinations administered via CSCI.
Accurate Identification of Infection Source in Burn Trauma Patients With Central Line Infection to Determine Appropriate Treatment Option As Well As Proper Public Reporting
Authors: Hampe Holly M. , Graper Lisa , Hayes-Leight Kathy , Olszewski Deborah , Moffa Matthew , Bremmer Derek N.
Published: November 2016

With the advent of the Patient Safety Movement in the late 1990s and the CMS (Centers for Medicare & Medicaid Services) nonreimbursement program for never events, there has been much focus on the prevention and accurate identification of health care–associated infections such as central line–associated bloodstream infections (CLABSIs). There has certainly been a national effort to decrease the occurrence of these infections. With the implementation of patient safety initiatives such as the central line prevention bundle, there has been a considerable reduction in the number of CLABSIs except for patients with burn trauma. Because of the compromised nature of these patients, the number of CLABSIs has not decreased similarly to other types of patients. In addition, these patients may have a secondary infection that was not accurately or timely identified. With CLABSIs, proper identification of primary and secondary infections is very important, particularly when identifying treatment options and ensuring accurate public reporting of health care–associated infection information.
Comparative Efficacy of Radiofrequency and Pulsed Dye Laser in the Treatment of Rosacea
Authors: Kim Sue-Jeong , Lee Young , Seo Young-Joon , Lee Jeung-Hoon , Im Myung
Published: November 2016

BACKGROUND

Laser and light-based therapies have been used successfully in the treatment of rosacea; however, evidence is lacking regarding the efficacy of radiofrequency (RF).

OBJECTIVE

This study evaluated the efficacy of RF in the treatment of rosacea compared with pulsed dye laser (PDL).

METHODS

Thirty patients with rosacea (erythematotelangiectatic rosacea [ETR], n = 20; papulopustular rosacea [PPR], n = 10) were enrolled in a randomized, controlled, split-face study. The patients were treated with RF on one side and PDL on the other side. Each treatment consisted of 3 sessions at 4-week intervals and followed up until 4 weeks after the last treatment. Efficacy was assessed by rosacea severity score, erythema index, lesion counts, physician's subjective evaluation, and patient's satisfaction.

RESULTS

Radiofrequency and PDL resulted in significant improvement in severity scores and erythema and 70% of the patients receiving RF treatment showed a clinical improvement of >50%. No significant difference was noted between RF and PDL treatment in ETR. However, RF treatment led to a significantly greater decrease in papulopustular lesion count and rosacea severity score in PPR compared with PDL treatment.

CONCLUSION

RF therapy was effective in the treatment of rosacea. It should be considered an alternative therapeutic option, especially in PPR.
Embryonic Stem Cell–like Population in Dupuytren’s Disease
Authors: Koh Sabrina P. , On Nicholas , Brasch Helen D. , Chibnall Alice M. , Armstrong James R. , Davis Paul F. , Tan Swee T. , Itinteang Tinte
Published: November 2016

Background:

Recent research has identified mesenchymal stem cells (MSCs) within Dupuytren’s disease (DD) tissue and they have been proposed to give rise to the myofibroblasts, implicated in the progression of this condition. The aim of this study was to identify and characterize the primitive population that might be upstream of the MSC population, within DD.

Methods:

Formalin-fixed paraffin-embedded 4-µm-thick sections of DD cords and nodules obtained from 6 patients underwent 3,3-diaminobenzidine and immunofluorescent immunohistochemical staining for embryonic stem cell (ESC) markers OCT4, NANOG, SOX2, pSTAT3, and SALL4 and endothelial markers CD34 and ERG. NanoString gene expression analysis was performed to determine the transcriptional activation of these markers.

Results:

Immunohistochemical staining demonstrated the expression of ESC markers OCT4, NANOG, SOX2, pSTAT3, and SALL4 on the endothelium of the microvessels expressing CD34 and ERG, particularly those surrounding the DD nodules. NanoString analysis confirmed the transcriptional activation of OCT4, NANOG, STAT3, and SALL4, but not SOX2.

Conclusion:

This article demonstrates the novel finding of an ESC-like population expressing ESC markers OCT4, NANOG, SOX2, pSTAT3, and SALL4, localized to the endothelium of the microvessels within DD tissue, suggesting a potential therapeutic target for this condition.
Endoscopic Adipofascial Radial Forearm Flap Reconstruction of a Clival Defect
Authors: Hackman Trevor G.
Published: November 2016

Skull base surgical defects present unique challenges to anatomic and functional reconstruction. Fortunately, many endonasal skull base defects are successfully managed with a variety of local and regional reconstructive techniques. However, when prior surgery or radiotherapy eliminates the use of these local and regional reconstructive options, more elaborate free tissue transfer techniques are required. Managing endoscopic skull base defects of the anterior cranial fossa and clivus is further complicated by the limited access afforded for flap inset. The following case report describes durable reconstruction of a clival defect with an endoscopically-tunneled adipofascial radial forearm tissue transfer. The case highlights importance of a multidisciplinary surgical team approach with strong foundations in endonasal skull base and reconstructive surgery to achieve successful reconstruction of complex endonasal defects.
Barriers to Reconstructive Hand Surgery for Rheumatoid Arthritis in China: A Multicenter Survey of Patients and Physicians
Authors: Franzblau Lauren E. , Liang Xuebing , Wang Keming , Li Zhanguo , Li Yingni , Shauver Melissa , Chung Kevin C.
Published: November 2016

Background:

China has a similar rheumatoid arthritis (RA) disease burden compared with other countries, yet RA patients rarely receive surgical treatment for hand deformities that limit function and impact appearance. We investigated potential barriers to rheumatoid hand surgery in China.

Methods:

Patients with RA, rheumatologists, and hand surgeons at 3 large tertiary hospitals in Beijing completed questionnaires that assess knowledge and attitudes surrounding RA hand surgery. We calculated descriptive statistics and compared responses among groups using chi-square and Fisher exact tests as appropriate.

Results:

One hundred RA patients with hand deformities and 94 physicians completed the surveys. No patients had received hand surgery, and just 13% were aware of this treatment option. Patients and physicians most frequently cited uncertain effectiveness of surgery, high cost, and risk of surgical complications as potential barriers to hand reconstruction. Rheumatologists reported low rates of referral to hand surgeons (39% referred <5% of the time and 31% never referred). Most hand surgeons (69%) had not performed metacarpophalangeal arthroplasty, a common procedure for RA hand deformities, within the past year. Some had never performed this operation.

Conclusions:

This survey revealed multiple barriers that support previous observations of infrequent reconstruction of RA hand deformities in China. These obstacles can be addressed through patient education, coordination between specialists, and more robust hand surgeon training in common RA procedures through the application of international plastic surgery collaborations.
New B-cell Lymphomas in the Setting of a Previous Rare Breast Implant–Associated B-cell Lymphoma
Authors: Messer Alison , Jenkinson Helena , Wang Wei , Duvic Madeleine
Published: November 2016

We present a follow-up of a patient who underwent right-sided subtotal mastectomy and placement of right-sided saline implant in 1968 for a phyllodes tumor and then in 2012 was diagnosed with a rare B-cell type lymphoma of the right breast. In 2015, she was diagnosed with diffuse large B-cell lymphoma involvement of the left breast and left leg and experienced subsequent self-regression of leg lesions without therapy.
COUGHING-INDUCED SUPRACHOROIDAL HEMORRHAGE SIMULATING MELANOMA IN TWO CASES
Authors: Marous Charlotte L. , Sioufi Kareem , Shields Carol L. , Mashayekhi Arman , Shields Jerry A.
Published: November 2016

Purpose:

To describe two cases of coughing-induced suprachoroidal hemorrhage referred as choroidal melanoma.

Methods:

Observational case reports.

Results:

Two female patients (ages 54 and 60 years) were referred with possible choroidal melanoma. Both gave a history of 1 day of heavy coughing with Valsalva maneuver within 2 weeks before discovery of the tumor. In one case, the patient used anticoagulants for aortic valve replacement and the other patient used antiasthma medications. One patient noted sharp ocular pain one week before presentation to this service. In both cases, the choroidal lesion was at the globe equator, near a vortex ampulla, and appeared homogeneously dark brown and with acoustic hollowness on ultrasonography, concerning for choroidal melanoma. However, neither lesion demonstrated intrinsic vascularity on fluorescein angiography or indocyanine angiography. Both lesions showed isoautofluorescence and optical coherence tomography evidence of shallow choroidal folds with inner choroidal elevation over a dome-shaped, optically-lucent deep choroidal mass, consistent with suprachoroidal hemorrhage. Fine needle aspiration biopsy in 1 case confirmed blood without melanoma. Both cases were observed with complete spontaneous resolution of the hemorrhage and normal-appearing choroid within 2 months.

Conclusion:

Coughing-induced suprachoroidal hemorrhage can simulate melanoma. Clinical and imaging features can assist in diagnosis. The hemorrhage generally resolves within few months.
Effect of oxygen therapy on myocardial salvage in ST elevation myocardial infarction: the randomized SOCCER trial
Authors: Khoshnood Ardavan , Carlsson Marcus , Akbarzadeh Mahin , Bhiladvala Pallonji , Roijer Anders , Nordlund David , Höglund Peter , Zughaft David , Todorova Lizbet , Mokhtari Arash , Arheden Håkan , Erlinge David , Ekelund Ulf
Published: November 2016

Objective

Recent studies suggest that administration of O2 in patients with acute myocardial infarction may have negative effects. With the use of cardiac MRI (CMR), we evaluated the effects of supplemental O2 in patients with ST elevation myocardial infarction (STEMI) accepted for acute percutaneous coronary intervention (PCI).

Materials and methods

This study was a randomized-controlled trial conducted at two university hospitals in Sweden. Normoxic STEMI patients were randomized in the ambulance to either supplemental O2 (10 l/min) or room air until the conclusion of the PCI. CMR was performed 2–6 days after the inclusion. The primary endpoint was the myocardial salvage index assessed by CMR. The secondary endpoints included infarct size and myocardium at risk.

Results

At inclusion, the O2 (n=46) and air (n=49) patient groups had similar patient characteristics. There were no significant differences in myocardial salvage index [53.9±25.1 vs. 49.3±24.0%; 95% confidence interval (CI): −5.4 to 14.6], myocardium at risk (31.9±10.0% of the left ventricle in the O2 group vs. 30.0±11.8% in the air group; 95% CI: −2.6 to 6.3), or infarct size (15.6±10.4% of the left ventricle vs. 16.0±11.0%; 95% CI: −4.7 to 4.1).

Conclusion

In STEMI patients undergoing acute PCI, we found no effect of high-flow oxygen compared with room air on the size of ischemia before PCI, myocardial salvage, or the resulting infarct size. These results support the safety of withholding supplemental oxygen in normoxic STEMI patients.
A case of scrofuloderma complicated with genital elephantiasis and saxophone penis
Authors: Afsar Fatma Sule , Seremet Sila , Afsar Ilhan , Karakuzu Ali , Ermete Murat
Published: November 2016

Scrofuloderma is a type of secondary tuberculosis from an endogenous source, and it occurs by contagious spread from tuberculous lymph nodes, bones, or joints. Genital elephantiasis is a common sequela of filariasis and lymphomagranuloma venereum, and rarely does it follow tuberculosis. We report a case of a 29-year-old male patient diagnosed as scrofuloderma with genital elephantiasis and saxophone penis.
Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust
Authors: Umotong Eno
Published: November 2016

The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability.
Stacked Thoracodorsal Artery Perforator Flaps for Unilateral Breast Reconstruction
Authors: Angrigiani Claudio , Rancati Alberto , Artero Guillermo , Khouri Roger K. , Walocko Frances M.
Published: November 2016

The thoracodorsal artery perforator flap is reliable and safe for breast reconstruction, but stacking bilateral thoracodorsal artery perforator flaps for unilateral reconstruction to achieve greater volumes has not been reported. To create a stacked thoracodorsal artery perforator flap, the ipsilateral flap is transferred as an island, and the contralateral flap is transferred as a microvascular free flap. In this article, the authors present their 8-year 14- patient experience with stacked thoracodorsal artery perforator flaps for unilateral breast reconstruction. Patients’ ages ranged from 33 to 72 years (mean, 52.6 years). Mean follow-up time was 48.1 months (range, 1 to 98 months). Flaps measured between 22 × 6 cm and 32 × 8 cm and weighed between 110 and 550 g. Two of the island flaps had steatofibrosis of the distal 3 cm, which was resected and closed directly. The rest of the island flaps and all 14 free flaps healed uneventfully. At the time of follow-up, all flaps appeared healthy, and the reconstructed breast had a similar appearance and volume as the contralateral side. The donor areas had almost no functional deficit, and the final scar was aesthetically acceptable, especially when the ascending oblique design was used. This represents the first description of stacked thoracodorsal artery perforator flaps for unilateral breast reconstruction. This novel addition to the reconstructive surgeon’s selection of methods is a safe and reliable option for large-volume unilateral breast reconstruction. It allows for symmetry without requiring prostheses or reduction of the contralateral side.
Comparison of Ulnar Intrinsic Function following Supercharge End-to-Side Anterior Interosseous–to–Ulnar Motor Nerve Transfer: A Matched Cohort Study of Proximal Ulnar Nerve Injury Patients
Authors: Baltzer Heather , Woo Alice , Oh Christine , Moran Steven L.
Published: November 2016

Background:

There are few studies supporting supercharge end-to-side nerve transfer for high ulnar nerve injury. The current study hypothesized that patients with a supercharge end-to-side anterior interosseous nerve–to–ulnar motor nerve transfer would demonstrate superior return of intrinsic function compared with conventional treatment only.

Methods:

A retrospective matched-cohort study matched supercharge end-to-side transfer patients based on age, level of injury, and mechanism to ulnar nerve injury patients who did not have the transfer. The primary outcome was return of ulnar intrinsic function, based on clinical examination and/or electromyography. Dichotomous and continuous variables were compared with Fisher’s exact and t tests, respectively.

Results:

Thirteen supercharge end-to-side patients were identified (>1 year follow-up). The average age of both cohorts was 35 years. Ulnar nerve transection above the proximal third of the forearm represented 54 percent of patients; compressive injuries represented 46 percent. Eleven supercharge end-to-side transfer patients (84 percent) demonstrated intrinsic function recovery compared with five (38 percent) non–supercharge end-to-side patients (p < 0.05). Average time to initial motor recovery was similar between the two groups (supercharge end-to-side, 2.9 months; non–supercharge end-to-side, 3.8 months; p > 0.2). Intrinsic function return was more likely following nerve transection with the supercharge end-to-side procedure (85 percent versus 14 percent; p = 0.03), whereas compression injuries had comparable intrinsic function return regardless of the supercharge end-to-side transfer (67 percent versus 67 percent; p = 1.0).

Conclusions:

This matched cohort study demonstrates that the supercharge end-to-side transfer results in increased ulnar intrinsic reinnervation following ulnar nerve injury. This finding may be most relevant following transection injuries. Improved outcomes associated with supercharge end-to-side and ulnar nerve repair warrant further investigation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Health-Related Quality of Life following Reconstruction for Common Head and Neck Surgical Defects
Authors: Cohen Wess A. , Albornoz Claudia R. , Cordeiro Peter G. , Cracchiolo Jennifer , Encarnacion Elizabeth , Lee Meghan , Cavalli Michele , Patel Snehal , Pusic Andrea L. , Matros Evan
Published: November 2016

Background:

Improved understanding and management of health-related quality of life represents one of the greatest unmet needs for patients with head and neck malignancies. The purpose of this study was to prospectively measure health-related quality of life associated with different anatomical (head and neck) surgical resections.

Methods:

A prospective analysis of health-related quality of life was performed in patients undergoing surgical resection with flap reconstruction for stage II or III head and neck malignancies. Patients completed the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire-30 and the European Organization for Research and Treatment of Cancer Head and Neck Cancer Module-35 preoperatively, and at set postoperative time points. Scores were compared with a paired t test.

Results:

Seventy-five patients were analyzed. The proportion of the cohort not alive at 2 years was 53 percent. Physical, role, and social functioning scores at 3 months were significantly lower than preoperative values (p < 0.05). At 12 months postoperatively, none of the function or global quality-of-life scores differed from preoperative levels, whereas five of the symptom scales remained below baseline. At 1 year postoperatively, maxillectomy, partial glossectomy, and oral lining defects had better function and fewer symptoms than mandibulectomy, laryngectomy, and total glossectomy. From 6 to 12 months postoperatively, partial glossectomy and oral lining defects had greater global quality of life than laryngectomies (p < 0.05).

Conclusions:

Postoperative health-related quality of life is associated with the anatomical location of the head and neck surgical resection. Preoperative teaching should be targeted for common ablative defects, with postoperative expectations adjusted appropriately. Because surgery negatively impacts health-related quality of life in the immediate postoperative period, the limited survivorship should be reviewed with patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Triptolide Reduces the Required Dose of Tacrolimus by Attenuating Inflammation, Enhancing Immunosuppression, and Increasing Donor Chimerism in a Heterotopic Hindlimb Transplantation Model
Authors: Gu Chuan , Liu Fei , Luo Xusong , Zhou Xianyu , Yang Jun , Levin L. Scott
Published: November 2016

Background:

Induction of tolerance and minimizing the toxicity of immunosuppression are two fundamental goals in vascularized composite allotransplantation. Accumulating data indicate that triptolide is an agent that may have the capacity to suppress inflammation and immunologic rejection.

Methods:

A heterotopic hindlimb allotransplantation model from Brown Norway to Lewis rats was established and treated with different doses of tacrolimus combined with or without triptolide. Mean survival time of the transplants was monitored, and histopathologic examination of the skin was performed. The level of inflammatory cytokine interleukin-1β, interleukin-6, and tumor necrosis factor-á in peripheral blood was assayed. The percentage of T lymphocytes and its subsets was measured using flow cytometry. The level of recipient peripheral chimerism and the apoptosis of donor bone marrow cells were evaluated. The apoptotic related genes bcl-2 and Bax were detected by real-time polymerase chain reaction.

Results:

The authors’ results showed that triptolide not only reduces the dose of tacrolimus required for immunosuppression, but also decreased drug side effects in terms of weight gain and diarrhea. Triptolide had an obvious effect on proinflammatory cytokine expression and T-lymphocyte proliferation in the peripheral blood. Interestingly, triptolide could increase the mixed chimerism level of recipients, possibly by inhibiting the apoptosis of transplanted bone marrow cells by means of regulation of the apoptotic genes bcl-2 and Bax.

Conclusions:

Triptolide reduces the dose of tacrolimus required for immunosuppression by attenuating inflammation and by T-cell suppression. Furthermore, triptolide increases the chimerism level, which might contribute to acceptance of the allografts.
Breast Tissue Expanders with Magnetic Ports: Clinical Experience at 1.5 T
Authors: Thimmappa Nanda Deepa , Prince Martin R. , Colen Kari L. , Ahn Christina Y. , Dutruel Silvina P. , Boddu Srikanth R. , Greenspun David T. , Vasile Julie V. , Chen Constance M. , Usal Hakan , Rohde Christine H. , Redstone Jeremiah S. , LoTempio Maria M. , Lerman Oren Z. , Nath Anik K. , Allen Robert J. , Levine Joshua L.
Published: November 2016

Background:

The purpose of this study was to evaluate breast tissue expanders with magnetic ports for safety in patients undergoing abdominal/pelvic magnetic resonance angiography before autologous breast reconstruction.

Methods:

Magnetic resonance angiography of the abdomen and pelvis at 1.5 T was performed in 71 patients in prone position with tissue expanders with magnetic ports labeled “MR Unsafe” from July of 2012 to May of 2014. Patients were monitored during magnetic resonance angiography for tissue expander–related symptoms, and the chest wall tissue adjacent to the tissue expander was examined for injury at the time of tissue expander removal for breast reconstruction. Retrospective review of these patients’ clinical records was performed. T2-weighted fast spin echo, steady-state free precession and gadolinium-enhanced spoiled gradient echo sequences were assessed for image artifacts.

Results:

No patient had tissue expander or magnetic port migration during the magnetic resonance examination and none reported pain during scanning. On tissue expander removal (71 patients, 112 implants), the surgeons reported no evidence of tissue damage, and there were no operative complications at those sites of breast reconstruction.

Conclusion:

Magnetic resonance angiography of the abdomen and pelvis in patients with certain breast tissue expanders containing magnetic ports can be performed safely at 1.5 T for pre–autologous flap breast reconstruction perforator vessel mapping.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Carbon Dioxide–Based versus Saline Tissue Expansion for Breast Reconstruction: Results of the XPAND Prospective, Randomized Clinical Trial
Authors: Ascherman Jeffrey A. , Zeidler Kamakshi , Morrison Kerry A. , Appel James Z. , Berkowitz R. L. , Castle John , Colwell Amy , Chun Yoon , Johnson Debra , Mohebali Khashayar
Published: November 2016

Background:

AeroForm is a new type of remote-controlled, needle-free, carbon dioxide–based expander involving a potentially faster method of tissue expansion. Results are presented here from the AirXpanders Patient Activated Controlled Tissue Expander pivotal trial comparing AeroForm to saline tissue expanders.

Methods:

Women undergoing two-stage breast reconstruction were randomized at 17 U.S. sites in this U.S. Food and Drug Administration–approved investigational device exemption trial. Expansion in the investigational arm was performed by the patient in 10-cc increments up to 30 cc/day of carbon dioxide and in the control arm by the physician with periodic bolus injections of saline. Safety endpoints, expansion and reconstruction times, pain, and satisfaction were assessed.

Results:

One hundred fifty women were treated: 98 with carbon dioxide expanders (n = 168) and 52 with saline expanders (n = 88). The treatment success rate (all breasts exchanged successfully excluding non–device-related failures) was 96.1 percent for carbon dioxide and 98.8 percent for saline. Median time to full expansion and completion of the second-stage operation was 21.0 and 108.5 days (carbon dioxide) versus 46.0 and 136.5 days (saline), respectively, with a similar rate of overall complications. Ease of use for the carbon dioxide expander was rated high by patients (98 percent) and physicians (90 percent).

Conclusions:

The AirXpanders Patient Activated Controlled Tissue Expander trial results demonstrate that a carbon dioxide–based expander is an effective method of tissue expansion with a similar overall adverse event rate compared to saline expanders, and provides a more convenient and expedient expansion.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, I.