bluuebunny/crossref_metadata_2025 huggingface dataset:
First Place Award: A radiographic analysis of closed reduction and casting of distal radial fractures with consideration of candidacy
Authors: Trouw Arie G. , Mulchandani Neil B. , Kelly John J. , Eldib Ahmed M. , Shah Neil V. , Banning George K. , Chatterjee Dipal , Scollan Joseph P. , Yang Andrew , Kapadia Bhaveen H. , Diebo Bassel G. , Illical Emmanuel M. , Urban William P.
Published: June 2019

Background:

Distal radial fractures (DRF) are treated by internal fixation or closed reduction and casting (CRC). Over the years, various DRF classification systems and radiographic thresholds have been developed to guide management for orthopaedic surgeons, yet no gold standard has been established. This study sought to identify patients who presented with DRF and received treatment with CRC and determine if the process of selecting CRC-managed patients had improved by analyzing radiographic maintenance of reduction through final bone union.

Methods:

Retrospective review of a single-site database from 2012-2015 identified CRC-managed DRF with pre-CRC, post-CRC, and final-union radiographs. Outcomes compared included radial height (RH), radial inclination (RI), volar tilt (VT), teardrop angle (TDA), and ulnar variance (UV).

Results:

Post-CRC RH increased (7.5 to 10.4 mm, P<0.01) and regressed by 1.3 mm by union. RI increased (14.4 to 19.4 degrees, P<0.01) and returned to 17.3 degrees by union. Mean VT changed from −9.9 to 7.9 degrees (P<0.01) and to 1.1 degrees by union (P<0.05). TDA increased by union (34.1 to 44.5 degrees, P<0.01). UV changed from 1.2 to −0.2 mm (P<0.02) to 1.2 mm by union (P<0.01). At presentation the following parameters had differences when considering established favorable and unfavorable values at final-union: RH (9.58 vs. 5.26 mm), RI (16.9 vs. 8.1 degrees), and UV (0.4 vs. 3.9 mm) (all P<0.0005).

Conclusions:

Current literature demonstrated substantial variation in DRF management and expectations after CRC. This study revealed that RH greater than 9.5 mm and UV less than 3.8 mm at presentation were associated with successful reductions without functional deficit.
Does an Implant Usage Report Card Impact Orthopaedic Trauma Implant Stewardship?
Authors: Morellato John , Baker Mitchell , Isaac Marckenley , Mixa Patrick , O'Hara Nathan N. , Okike Kanu , Manson Theodore T. , LeBrun Christopher T. , Slobogean Gerard P. , Nascone Jason W. , O'Toole Robert V. , Sciadini Marcus F. , Pollak Andrew N.
Published: June 2019

Objectives:

As hospitals seek to control variable expenses, orthopaedic surgeons have come under scrutiny because of relatively high implant costs. We aimed to determine whether feedback to surgeons regarding implant costs results in changes in implant selection.

Methods:

This study was undertaken at a statewide trauma referral center and included 6 fellowship-trained orthopaedic trauma surgeons. A previously implemented implant stewardship program at our institution using a “red-yellow-green” (RYG) implant selection tool classifies 7 commonly used trauma implant constructs based on cost and categorizes each implant as red (used for patient-specific requirements, most expensive), yellow (midrange), and green (preferred vendor, least expensive). The constructs included were femoral intramedullary nail, tibial intramedullary nail, long and short cephalomedullary nails, distal femoral plate, proximal tibial plate, and lower-limb external fixator. Baseline implant usage from the previous year was obtained and provided to each surgeon. Each surgeon received a monthly feedback report containing individual implant utilization and overall ranking.

Results:

The overall RYG score increased from 68.7 to 79.1 of 100 (P < 0.001). Three of the 7 implants (tibial and femoral nails and lower-limb external fixation) had significant increases in their RYG scores; implant selections for the other 4 implants were not significantly altered. A decrease of 1.8% (95% confidence interval, 0.4–3.2, P = 0.01) was noted in overall implant costs over the study period.

Conclusion:

Our intervention resulted in changes in surgeons' implant selections and cost savings. However, surgeons were unwilling to change certain implants despite their being more expensive.
National Trends and Complications in the Surgical Management of Ossification of the Posterior Longitudinal Ligament (OPLL)
Authors: Bernstein David N. , Prong Michelle , Kurucan Etka , Jain Amit , Menga Emmanuel N. , Riew K. Daniel , Mesfin Addisu
Published: June 2019

Study Design.

A retrospective database analysis.

Objective.

The aim of this study was to analyze US trends in surgical approaches for ossification of the posterior longitudinal ligament (OPLL); and to compare US patient and hospital characteristics, length of stay, total charges, and 30-day complications by surgical approach in OPLL management.

Summary of Background Data.

A robust literature on surgical management of OPLL in East Asian countries, where OPLL has a higher prevalence, exists. However, there is a paucity of literature evaluating the surgical management of OPLL in non-Asian countries.

Methods.

Using the Nationwide Inpatient Sample (NIS), we identified surgically treated OPLL patients from 2003 to 2014. Data on patient characteristics, surgical approaches, complications, hospital characteristics, length of stay, and hospital charges were extracted and analyzed. Analysis of variance (ANOVA) and Chi-squared tests were used to assess variation across categorical variables. Linear regression was used to evaluate the trend of surgical management for OPLL over the study timeframe.

Results.

Five thousand two hundred twelve patients fit our inclusion criteria. The overall complication rate was 21.5%, but the highest complication rate was for patients undergoing a combined anterior-posterior decompression/fusion (44.7%). Patients undergoing a combined anterior-posterior decompression/fusion had a longer length of stay and higher total charges (P < 0.01). Overall, surgical OPLL cases significantly increased from 2003 to 2014 (336–920; P < 0.01).

Conclusion.

To our knowledge, this is the largest study examining the surgical treatment of OPLL in a non-Asian country. OPLL surgical cases increased over the study timeframe and the overall surgical complication rate was 21.5%. The percentage of Asians or Pacific Islanders with OPLL undergoing surgical intervention was 10.8%, which is higher than the prevalence in the US population (4.9%). This suggests a potential genetic component to OPLL. Future work is warranted to determine how best to decrease the high complication rate.

Level of Evidence: 4
Clinical Outcomes Following Stereotactic Body Radiation Therapy (SBRT) for Stage I Medically Inoperable Small Cell Lung Carcinoma
Authors: Singh Raj , Ansinelli Hayden , Sharma Dana , Jenkins Jan , Davis Joanne , Vargo John A. , Sharma Sanjeev
Published: June 2019

Objectives:

To utilize the RSSearch Patient Registry (RSSPR) to examine local control (LC), overall survival (OS), and toxicities following stereotactic body radiation therapy (SBRT) for stage I (T1-T2/N0) medically inoperable small cell lung carcinoma (SCLC).

Materials and Methods:

We searched the RSSPR for medically inoperable stage I SCLC patients treated with definitive SBRT. Potential predictive factors of OS were estimated using the Kaplan-Meier method as well as a Cox proportional hazards model.

Results:

Twenty-one patients were identified with medically inoperable stage I SCLC that met inclusion criteria. Fourteen patients had stage IA SCLC (T1N0) and 7 patients had stage IB SCLC (T2N0) with a median gross tumor volume of 10.1 cm3 (range: 0.72 to 41.4 cm3). The median number of fractions was 4 (range: 3 to 5), and the median BED10 was 105.6 Gy10 (range: 72 to 239.7 Gy10). Four patients received adjuvant chemotherapy. One- and 2-year actuarial OS rates were 73.1% (95% confidence interval [CI]: 36.8%-90.1%) and 36.6% (95% CI: 9.0%-65.7%), respectively. Factors found to be associated with 1-year OS on univariate analysis included T2 disease (85.5% vs. 33.3%; P=0.03), adjuvant chemotherapy (100% vs. 66.3%; P=0.11), and gross tumor volume ≥10 cm3 (100% vs. 52.5%; P=0.10). On multivariate analysis, adjuvant chemotherapy was associated with improved OS (hazard ratio=0.07 [95% CI: 0.13-0.37; P=0.002]). The 1-, 2-, and 3-year LC rates were 100%, and 1- and 2-year progression-free survival (PFS) rates were 85.7% (95% CI: 33.4-97.9%) and 42.9% (95% CI: 1.1-85.3%), respectively. Similar to OS, patients with T1N0 disease had superior PFS as compared to T2N0 disease (P=0.01). Toxicities were reported by 3/21 (14.3%) of patients with none ≥ grade 3 and no esophageal toxicities.

Conclusions:

SBRT was well-tolerated in the treatment of stage I SCLC with excellent LC achieved. Patients with T1N0 stage IA SCLC were noted to have improved PFS and OS following SBRT as compared with T2N0 Stage IB SCLC. Adjuvant chemotherapy was found to result in improved OS for stage I SCLC patients over SBRT alone.
Proactive Psychiatry Intervention Using a Nurse-Led Behavioral Response Model for Hospitalized Patients With Behavioral Disturbances
Authors: Afriyie-Boateng Mavis , Loftus Carla , Wiesenfeld Lesley , Hunter Meghan , Lawson Andrea
Published: June 2019

Background:

The health care sector has one of the highest rates of workplace violence, putting staff at risk and impeding care. To deliver quality health care, staff need targeted resources. This article describes a program to improve staff safety and reduce barriers to care for patients with behavioral disturbances.

Program Description:

A nurse-led behavioral response team was created to identify high-risk patients and offer prompt targeted interventions. The Behavioral Optimization and Outcomes Support Team (BOOST) was implemented in November 2012, in conjunction with a proactive model of care, enabling psychiatric intervention. Advanced practice nurses in psychiatry respond to requests from staff on medical/surgical units to assist with management of behavioral disturbances.

Methods:

Consultation and intervention data were reviewed, and staff satisfaction surveys were completed to evaluate the program.

Results:

The program has contributed to staff feeling more supported and safer at work. There has also been a reduction in staff's experience of perceived burden in the care of patients with behavioral disturbances although they are caring for more of these patients.

Conclusions:

Although violence risk in health care continues to be a significant issue, programs to intervene early can be effective in supporting staff to minimize these risks.
Interfacility patient transfers in Lebanon—A culture-changing initiative to improve patient safety and outcomes
Authors: El Sayed Mazen , El Sibai Rayan , Bachir Rana , Khalil Diana , Dishjekenian Maggy , Haydar Lili , Aguehian Rosanne , Mouawad Ramzi
Published: June 2019

Organizing interfacility transfers is an essential component of regionalized care to improve patient outcomes. This study examines transfer characteristics after establishing a transfer center in a tertiary care center in Beirut Lebanon, and identifies predictors of success in patient transfers.

This retrospective observational chart review examined all transfer center requests to and from the tertiary care center over a 4-year period (2013–2017). Descriptive analysis was done, followed by a bivariate analysis comparing transfers based on final decision (accepted yes/no) and by a multivariate logistic regression to identify predictors of successful transfers.

A total of 4100 transfer requests were analyzed. Incoming transfer requests were more common than outgoing requests (56.5% vs 43.4%) and were mainly for adult patients (71.0% incoming and 78.7% outgoing). Reasons of transfers were mostly medical (99.4%) for incoming transfers and financial (73.1%) and medical (17.9%) for outgoing transfers. Requested level of care was most commonly intensive care unit for incoming transfers (61.6%) and regular floor for outgoing transfers (48.6%). Outgoing transfers were more successful than incoming transfers (59.9% vs 39.6%). Predictors of success in patient transfers within the healthcare system were identified: These included specific types of financial coverage, diagnoses, levels of care, and medical services for incoming transfers in addition to age groups and receiving hospital location for outgoing transfers.

Transfer centers can be implemented successfully in any healthcare system to improve patient care and safety. Identifying facilitators and barriers to successful transfers can help healthcare administrators and policymakers address gaps in the system and improve access to care.
Effects of probucol on contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention
Authors: Wang Yong , Shi Yun , Xu Xuesheng , Ge Wenkun , Yang Shuo , Lu Chengzhi
Published: June 2019

Objective:

This study was performed to explore the effects of probucol on contrast-induced acute kidney injury (CIAKI) in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI).

Methods:

In total, 220 patients undergoing PCI were randomly assigned to either the control group (hydration from 12 hours before to 12 hours after contrast administration; n = 110) or the probucol group (hydration plus probucol 500 mg twice daily 1 day before and 3 days after the operation; n = 110). The primary endpoint was the occurrence of serum creatinine (Scr)-based CIAKI, defined as an absolute increase in Scr by 0.5 mg/dl (44.2 μmol/L) or a relative 25% increase from baseline within 48 to 72 hours after exposure to contrast medium. The secondary outcomes were composite variations in Scr, blood urea nitrogen (BUN), creatinine clearance rate (Ccr) within 48 to 72 hours, and major adverse events during hospitalization or the 7-day follow-up period after PCI.

Results:

The overall incidence of Scr-based CIAKI was 7.3% (16/220): 5.5% (6/110) in the control group and 9.1% (10/110) in the probucol group (χ2 = 1.078, P = .298). There were no significant differences in the occurrence rate of major adverse events during hospitalization or the 7-day follow-up period after PCI between the groups. Multivariate logistic regression analysis showed that probucol was not an independent protective factor for CIAKI (odds ratio, 1.825; 95% confidence interval, 0.639–5.212; P = .261). However, hydration was an independent protective factor (odds ratio, 0.997; 95% confidence interval, 0.995–0.999; P = .004).

Conclusion:

Probucol cannot effectively reduce the incidence of CIAKI through its anti-inflammatory and antioxidative stress effects.
Blood and cerebrospinal fluid characteristics in neonates with a suspected central nervous system infection
Authors: de Blauw Dirkje , Bruning AHL , Vijn LJ , Wildenbeest JG , Wolthers KC , Biezeveld MH , van Wermeskerken Anne-Marie , Nauta Femke , Pajkrt Dasja
Published: June 2019

Clinical signs and symptoms of central nervous system (CNS) infections in neonates are often nonspecific. Therefore, cerebrospinal fluid (CSF) analysis is performed to diagnose CNS infections. Data on combined microbiological results and their correlation with biochemical characteristics in CSF and blood in infants younger than 90 days are limited. This study provides an overview of microbiological test results, CSF- and hematological characteristics among infants with a clinically suspected CNS infection.

This retrospective study included infants younger than 90 days, with a clinically suspected CNS infection who underwent a diagnostic lumbar puncture between January 2012 and January 2014. Data on the presence of microbiological pathogens in CSF, CSF inflammation markers (white blood cell [WBC] counts, protein levels and glucose CSF/serum ratio) and blood inflammatory responses (WBC count, C-reactive protein [CRP], neutrophil percentage) were collected by reviewing patient files.

We included data from 576 infants (median age 12.5 days, interquartile range, 6–27 days) of whom 383 (66.5%) were born prematurely. In total, 16 bacterial pathogens (3.0%) and 21 viruses (5.5%) were detected in CSF. Escherichia coli was detected in 5 cases (1.0%), Enterovirus was detected in 12 cases (3.1%). Leucocytosis in CSF was associated with identification of a pathogen in CSF. Increased CRP was associated with the identification of a bacterial pathogen in CSF.

Bacterial or viral pathogens were only identified in a small proportion of infants with a clinically suspected CNS infection. Leucocytosis in CSF was associated with CNS infection in infants. An increased CRP was indicative of bacterial meningitis.
Spectral CT in patients with acute thoracoabdominal bleeding—a safe technique to improve diagnostic confidence and reduce dose?
Authors: Kahn Johannes , Fehrenbach Uli , Böning Georg , Feldhaus Felix , Maurer Martin , Renz Diane , Streitparth Florian
Published: June 2019

Computed tomography (CT) protocols for the detection of bleeding sources often include unenhanced CT series to distinguish contrast agent extravasation from calcification. This study evaluates whether virtual non-contrast images (VNC) can safely replace real non-contrast images (RNC) in the search for acute thoracoabdominal bleeding and whether monoenergetic imaging can improve the detection of the bleeding source.

The 32 patients with active bleeding in spectral CT angiography (SCT) were retrospectively analyzed. RNC and SCT series were acquired including VNC and monoenergetic images at 40, 70, and 140 keV. CT numbers were measured in regions of interest (ROIs) in different organs and in the bleeding jet for quantitative image analysis (contrast-to-noise ratios [CNR] and signal-to-noise ratio [SNR]). Additionally, 2 radiologists rated detectability of the bleeding source in the different CT series. Wilcoxon rank test for related samples was used.

VNC series suppressed iodine sufficiently but not completely (CT number of aorta: RNC: 33.3±12.3, VNC: 44.8 ± 9.5, P = .01; bleeding jet: RNC: 43.1 ± 16.9, VNC: 56.3 ± 16.7, P = .02). VNC showed significantly higher signal-to-noise ratios than RNC for all regions investigated. Contrast-to-noise ratios in the bleeding jet were significantly higher in 40 keV images than in standard 140 keV images. The 40 keV images were also assigned the best subjective ratings for bleeding source detection.

VNC can safely replace RNC in a CT protocol used to search for bleeding sources, thereby reducing radiation exposure by 30%. Low-keV series may enhance diagnostic confidence in the detection of bleeding sources.
Reliability and validity of the mandarin version of the tinnitus primary function questionnaire
Authors: Lu Tao , Liu Jie-Hai , Li Gang , Xiang Ting , Ma Ying , Zhong Juan , Chen Jia-Mei , He Yu-Rui , Huang He-Mei , Zhang Zong-Yun , Liu Pan , Zheng Yun
Published: June 2019

Tinnitus is a prevalent condition among different populations. As the nature of tinnitus is subjective, self-reported measures have been validated and utilized to assess psychometric properties of tinnitus patients. Without exception, Chinese clinicians have administered these measures to patients in mainland China after cross-cultural adaptation. However, shortcomings of these Mandarin measures limited the widespread use of them. Measures which can be fully adapted to the context of Chinese tinnitus patients are still needed. The objective of this study was to evaluate the reliability and validity of the Mandarin Tinnitus Primary Function Questionnaire (TPFQ-M) in a Chinese population.

In this observational questionnaire study, we recruited 350 subjects with primary tinnitus from hearing clinics of West China Hospital and administered the TPFQ-M, Mandarin Tinnitus Handicap Inventory (THI-M), and a systematic hearing test battery.

The subjects finished the TPFQ-M within 3 minutes. Exploratory and confirmatory factor analyses demonstrated that a 4-factor model was close to fit. The Cronbach alpha of TPFQ-M was 0.925, and test-retest reliability was reasonable with a 7-day test interval (ICC = 0.857, P < .001; 95% CI: 0.764–0.915). Test-retest reliabilities of subdomains were not parallel to each other, with 0.612 for Emotion, 0.766 for Sleep, 0.860 for Concentration, and 0.897 for Hearing. The convergent validity of TPFQ-M compared to the THI-M was moderate (r = 0.705, P < .001; 95% CI: 0.647–0.754).

The TPFQ-M, which shows high internal consistency and good factor structure, is simple and relatively easy to administer in busy clinics. Additional in-depth research involving multiple centers in mainland China is warranted.
Application of deep learning (3-dimensional convolutional neural network) for the prediction of pathological invasiveness in lung adenocarcinoma
Authors: Yanagawa Masahiro , Niioka Hirohiko , Hata Akinori , Kikuchi Noriko , Honda Osamu , Kurakami Hiroyuki , Morii Eiichi , Noguchi Masayuki , Watanabe Yoshiyuki , Miyake Jun , Tomiyama Noriyuki
Published: June 2019

To compare results for radiological prediction of pathological invasiveness in lung adenocarcinoma between radiologists and a deep learning (DL) system.

Ninety patients (50 men, 40 women; mean age, 66 years; range, 40–88 years) who underwent pre-operative chest computed tomography (CT) with 0.625-mm slice thickness were included in this retrospective study. Twenty-four cases of adenocarcinoma in situ (AIS), 20 cases of minimally invasive adenocarcinoma (MIA), and 46 cases of invasive adenocarcinoma (IVA) were pathologically diagnosed. Three radiologists of different levels of experience diagnosed each nodule by using previously documented CT findings to predict pathological invasiveness. DL was structured using a 3-dimensional (3D) convolutional neural network (3D-CNN) constructed with 2 successive pairs of convolution and max-pooling layers, and 2 fully connected layers. The output layer comprises 3 nodes to recognize the 3 conditions of adenocarcinoma (AIS, MIA, and IVA) or 2 nodes for 2 conditions (AIS and MIA/IVA). Results from DL and the 3 radiologists were statistically compared.

No significant differences in pathological diagnostic accuracy rates were seen between DL and the 3 radiologists (P >.11). Receiver operating characteristic analysis demonstrated that area under the curve for DL (0.712) was almost the same as that for the radiologist with extensive experience (0.714; P = .98). Compared with the consensus results from radiologists, DL offered significantly inferior sensitivity (P = .0005), but significantly superior specificity (P = .02).

Despite the small training data set, diagnostic performance of DL was almost the same as the radiologist with extensive experience. In particular, DL provided higher specificity than radiologists.
The impact of level of the American College of Surgeons Committee on Trauma verification and state designation status on trauma center outcomes
Authors: Elkbuli Adel , Dowd Brianna , Flores Rudy , Boneva Dessy , McKenney Mark
Published: June 2019

The American College of Surgeons (ACS) Committee on Trauma (COT) verification and State designation of trauma centers (TCs) into Level 1 or 2 establishes a distinction based on resources, trauma volume, and educational commitment. The ACS COT and individual states each verify TCs to differentiate performance levels. We aim to determine the relationship between ACS and State Level 1 versus 2, and injury-adjusted, all-cause mortality in a national sampling.

TCs were identified by review of the National Sample Program (NSP) from the National Trauma Data Bank (NTDB)—the largest validated trauma database in the nation—of the year 2013. TCs were categorized by ACS or State Level 1 or 2 status, all others were excluded. Adjusted mortality was determined using observed/expected mortality (O/E) ratios, derived by trauma and injury severity score (TRISS) methodology. Chi-squared and t test analyses were used for categorical variables, with a statistical significance defined as P-value <.05.

Of the 94 TCs in the NSP, 67 had ACS and 80 had State designations. There were 38 ACS Level 1 TCs and 29 ACS Level 2. For State designations, there were 45 as State Level 1 and 35 State Level 2. ACS Level 1 TCs had a similar O/E compared with ACS Level 2 verified centers (0.73 vs 0.75, chi-square, P = .36). Level 1 TCs designated by their state, had a similar O/E compared with State Level 2 centers (0.70 vs 0.74, chi-square, P = .08).

Both ACS and State Level 1 and 2 trauma centers performed similarly on injury adjusted, all-cause mortality.
Comparison of curettage and bone grafting combined with elastic intramedullary nailing vs curettage and bone grafting in the treatment of long bone cysts in children
Authors: Zhang Ke , Wang ZhongLiang , Zhang Zheng
Published: June 2019

To compare the efficacy of curettage and bone grafting combined with elastic intramedullary nailing (EIN) vs curettage and bone grafting in the treatment of long bone cysts in children and to clarify the necessity of using EIN in the treatment of bone cysts.

Sixty-two patients were involved in this study from Jan. 2009 to Sept. 2017 (43 males, 19 females; 27 humeri, 35 femurs); the patients were assigned to an EIN group, comprising 30 patients who underwent curettage and bone grafting combined with EIN, or to a non–elastic intramedullary nailing (NEIN) group, comprising 32 patients who underwent curettage and bone grafting alone. The prognosis of the 2 groups was assessed with reference to the standard of Capanna.

No statistically significant differences in sex, age, location, activity, pathological fracture, cyst volume, operative time and intraoperative blood loss were found between the 2 groups (P > .05). The effective rate was 90.0% in the EIN group and 68.8% in the NEIN group, and the difference was statistically significant (P < .05).

Compared to simple curettage and bone grafting, curettage and bone grafting combined with EIN treatment can significantly improve the prognosis of children with bone cysts. It is recommended that EIN be added to bone cyst curettage and bone grafting.
Primary hepatic melanoma
Authors: Ao Weiqun , Wang Jian , Mao Guoqun , Yang Guangzhao , Han Xiaoyu , Jia Yuzhu , Cheng Yougen
Published: June 2019

Rationale:

Malignant melanoma predominantly develops in middle-aged and older adults, most commonly occurring on the skin and rarely on internal organs. Malignant melanoma originating in the liver is extremely rare. Imaging findings of primary hepatic melanoma (PHM) are scarce in relevant literature.

Patient concerns:

The patient was a 69-year-old woman from Zhejiang, China, who was admitted to the hospital because of upper abdominal pain that persisted for >10 days.

Diagnoses:

Computed tomography (CT) findings indicated the presence of a circular low-density shadow of approximately 7.5 × 8.0 cm in the hepatic hilar region. Magnetic resonance imaging (MRI) indicated a heterogeneous solid cystic mass in the hepatic hilar region. The mass exhibited heterogeneous low-signal intensity on a T1-weighted image (T1WI) and slightly higher signal intensity on a T2-weighted image (T2WI). The tumor appeared as multiple irregular strips with high-signal intensity on T1WI and low-signal intensity on T2WI. The diffusion-weighted image revealed increased signal intensity. The tumor continued to be enhanced after enhancement. Clinical data suggested that the tumor was a malignant liver tumor.

Interventions:

The patient underwent a CT guide puncture hepatic biopsy. The tumor was located in the hepatic hilar region adjacent to the large blood vessels and invaded the portal vein. Because a resection was highly risky, conservative treatment was conducted.

Outcomes:

Postoperative pathology and clinical examination confirmed that the tumor was malignant PHM. The patient has been followed up for 6 months. The patient underwent CT reexamination 2 months after conservative treatment, the results of which revealed that the tumor progressed. Multiple lesions were identified; moreover, the tumor size had increased and the tumor had invaded the portal vein and intrahepatic bile duct. The patient was reexamined by CT in another hospital 6 months after conservative treatment. The results revealed peritoneal, omental metastases and multi bone metastases.

Lessons:

To our best knowledge, this is the first reported case of a PHM with complete imaging data, including preoperative CT and MRI examinations and a follow-up CT examination. From compiling the CT and MRI findings of this patient and those of relevant studies, this study can serve as a reference for the preoperative diagnosis and differential diagnosis of PHM.
Auto-Allo Graft Parallel Juxtaposition for Improved Neuroregeneration in Peripheral Nerve Reconstruction Based on Acellular Nerve Allografts
Authors: Boriani Filippo , Savarino Lucia , Fazio Nicola , Pedrini Francesca Alice , Fini Milena , Nicoli Aldini Nicolò , Martini Lucia , Zini Nicoletta , Bernardini Marco , Bolognesi Federico , Marchetti Claudio , Baldini Nicola
Published: June 2019

Introduction

Nerve repair poses a significant surgical challenge, and much research on this topic for improvement in reconstruction of segmental defects is ongoing. The aims of the study were to reconfirm the accuracy and safety of a previously described nerve decellularization method on a larger experimental population of rabbits, as well as on human nerves, and to establish in vivo the efficacy of a new-concept mixed graft, comprising autologous and acellular nerve allograft components within the same graft.

Methods

Acellular nerve allografts were implanted into tibial nerve defects of 5 rabbits (group A), autografts were implanted, representing the criterion standard, in other 5 animals (group B), and the innovative technique was used in the remaining 5 (group C). Twelve weeks postoperatively, nerve conduction evaluations were performed; animals were euthanatized, and grafts were harvested and morphologically, histomorphometrically, and immunohistochemically analyzed. Eventually, a preliminary in vitro validation of the decellularization method was performed on human nerves from a cadaver.

Results

No clinical adverse effect was revealed during all the experimental times. No tissue reaction was observed, and in all groups, regenerated fascicles and bundles were shown by histology. However, both histology and histomorphometry demonstrated a better regenerative efficiency in group C. The morphological evaluation of the human nerve treated with the novel method showed complete decellularization.

Conclusion

The microsurgical combined model demonstrated a better neuroregeneration than did pure autografts and acellular nerve allografts. The decellularization method seemed effective also on human nerves. Deeper investigations are necessary to further validate and transfer this new encouraging protocol to the clinical arena.
Two-Dimensional Ablation of Apocrine Glands With the Use of Hydrosurgical Treatment of Axillary Osmidrosis
Authors: Wu Michael , Wu Wen-Horng
Published: June 2019

Axillary osmidrosis is a distressing social problem. Topical antiperspirants are only transient solutions. Permanent solutions always need invasive operation. In this study, we evaluated the effectiveness and complications of a minor surgical procedure. From January 2010 to December 2017, 480 patients (376 females and 104 males) whose ages ranged from 8 to 72 years, with an average age of 28 years, were treated for axillary osmidrosis with hydrosurgery (Versajet unit surgical instruments) under local anesthesia on an outpatient basis. Patients were followed for 4 to 80 months with an average of 24 months. The total satisfaction rate was 99.6% (478/480). The patient complication rate was 2.7% (13/480) and the wound complication rate was 1.8% (17/960). There was 2 patient (3 axillae) got recurrent malodor cured with second operation. There were no contracture scars, arm abduction limitation, or any nerve injury in our series. The minor procedure can be an efficient and predictable treatment choice for axillary osmidrosis.
Emergency Repair of Severe Limb Injuries With Free Flow-Through Chimeric Anterolateral Thigh Perforator Flap
Authors: Zheng Xiaoju , Zhan Yi , Li Haijun , Zhang Zhong , Xue Xuewen , Wang Baoshan , Qi Jian
Published: June 2019

Background

Complex limb trauma often involves both soft tissue and vascular defects, and is challenging for surgeons. The traditional musculocutaneous flap cannot achieve a 3-dimensional wound repair. Here we report our experience with a single-stage reconstruction and revascularization performed on complex extremity injuries using a free flow-through chimeric anterolateral thigh perforator (ALTP) flap.

Patients and Methods

Seventeen patients (16 men; aged 19–55 years) with complex soft tissue defects attended our hospital from January 2010 to November 2017. All patients underwent reconstruction based on free flow-through chimeric ALTP flap for complex injuries in their extremities. The wound size ranged from 16 × 8 to 45 × 30 cm. The injured artery was flow-through anastomosed with the descending branch of the lateral femoral circumflex artery to regain blood flow. The muscle flap was used to fill the deep dead space on the injury site. The skin and fascial flaps were used for superficial cover. The donor site defects were sutured directly in 6 patients; simultaneous skin grafts were applied in the remaining 11 patients.

Results

The ALTP flaps survived in 15 patients. Failure necessitated limb amputation in 2 patients. Six patients received both skin and fasciae flaps; 11 received flaps comprising the skin, fasciae, and vastus lateralis muscle. Partial necrosis after skin grafting was observed in 11 patients, and the wounds healed either by dressing change (1 patient) or second skin graft (10 patients). All donor sites healed without complications. All patients were followed up for 5 to 60 months (mean, 21.8 months).

Conclusions

The flow-through chimeric ALTP flap can be used for 1-stage reconstruction of 3-dimensional soft tissue defects and vascular gap. It is feasible for managing complex injuries of both the upper and lower extremities in emergency settings.
Posterior Perichondrioadipodermal flap
Authors: Ersen Burak
Published: June 2019

Introduction

Complications after otoplasty procedure can be divided into early- and late-period complications, with the former occurring up to 14 days postoperatively and the latter occurring after the initial 14-day period. Indications for revision surgery of ear deformations after primary otoplasty are generally related to late complications. The majority of patients demand secondary treatment because of unsatisfactory cosmetic results.

Methods

A total of 32 patients (18 male and 14 female patients) underwent revision otoplasty with the same surgeon between May 2015 and May 2018. Patient ages ranged from 24 to 70 years. In total, 21 patients underwent bilateral revision otoplasty, whereas 11 patients underwent unilateral revision otoplasty. Patients were also evaluated for complaint and deformity type such as suture extrusion, recurrence, asymmetry, and postauricular area sensitivity or pain. Patients were also evaluated for previously performed primary otoplasty technique.

Results

There were mainly 4 long-term complications for revision otoplasty: suture extrusion, asymmetry, recurrence, and long-term pain and sensitivity in the posterior auricular area. In 12 cases, the complaint was suture extrusion; in 8 cases, patients complained about both suture extrusion and asymmetry. Bilateral recurrence was present in 10 cases, and in 2 cases, revision otoplasty was performed because of long-term pain and sensitivity.

Discussion

In this study, it was aimed to demonstrate that posterior perichondrioadipodermal flap is a safe and simple method for revision otoplasty. The technique is highly advantageous if the primary otoplasty technique is a cartilage-sparing method. However, if the primary otoplasty technique is a cartilage-sculpting method, the efficiency of this technique remains unknown because no patient in this study had cartilage-sculpting otoplasty as primary otoplasty, which is possibly the main drawback of this study.
Comparative Analysis of the Healing Effects of the Transplanted Cell Sheets to the Experimentally Injured Maxillary Sinuses
Authors: Topdag Murat , Karaoz Erdal , Kara Ahmet , Subasi Cansu , Duman Busra Oncel , Demir Necdet , Konuk Esma , Ozturk Murat , Iseri Mete
Published: June 2019

Background:

In our study, the authors aimed to obtain a live and functional sinus epithelium with mesenchymal stem cells and nasal mucosa epithelial cells from rabbits which are cultured in temperature-responsive culture plates to get a single-layer.

Methodology/Principal:

Twenty-two female New Zealand rabbits were included in the study. Two of them were used to obtain mesenchymal stem cells. A total of 40 maxillary sinuses were randomly divided into 5 groups: 1) control group which is used to investigate normal rabbit maxillary mucosa, 2) secondary healing group, 3) mesenchymal stem cell graft group, 4) differentiated mesenchymal stem cell group, and 5) nasal mucosal graft group. The animals were sacrificed at the 28th day after the surgery.

Scanning electron microscopy, transmission electron microscopy, and immunohistochemical investigations were performed.

Results:

With these investigations, it was shown that; all graft groups were histologically better than secondary healing group and when the authors compared the graft groups, differentiated mesenchymal stem cell group were the best.

Conclusion:

Our study results showed that endoscopic sinus surgery and treatment with cell sheets, which were generated in temperature-responsive culture dishes, had more functional respiratory epithelium.
Extended Central Artery Perforator Propeller Flap for Large Nasal Defects
Authors: Baltu Yahya , Dölen Utku C. , Aydin Orhan
Published: June 2019

Various local flaps have been defined for small skin defects of the nose. However, the repair of large nasal defects is only possible with flaps allowing a large tissue transfer, such as a free flap, forehead flap, and nasolabial flap. In this study, large nasal defects were reconstructed with extended central artery perforator propeller (CAPP) flaps in an attempt to describe a single-stage procedure as an alternative technique to the median forehead flap. Thirteen large nasal skin defects, including dorsum and nasal sidewall and/or dome, were repaired with a CAPP flap between January 2015 and March 2018. A total of 13 patients aged 19 to 92 years were included. The mean follow-up period was 14.9 months. Pathological diagnoses were basal cell carcinoma in 5 patients, squamous cell carcinoma in 6 patients, and trauma in 2 patients. Defect size ranged between 3 × 3 and 4 × 5 cm. Flap size ranged between 3 × 7 and 5 × 10 cm. No major complications including total flap failure, hematoma, or infection were observed. However, a partial flap necrosis occurred in 1 patient. In 3 patients, scar revision surgery was performed at the postoperative period. In conclusion, CAPP flap use is a safe and reliable option to repair large nasal defects. This flap is able to cover large nasal defects including dorsal, dome, and nasal sidewall defects in a single-stage procedure. Requiring no pedicle separation, this flap is an alternative option to the conventional median forehead flap.
A Descriptive Study of Data Collection Systems Used in Electroconvulsive Therapy Units in the Province of Quebec, Canada
Authors: Haesebaert Julie , Moreno Alexander , Lesage Alain , Patry Simon , Lemasson Morgane
Published: June 2019

Objectives

This study aimed to describe the data collection systems routinely used by electroconvulsive therapy (ECT) units across the province of Quebec, Canada.

Methods

We conducted a descriptive, cross-sectional study. Using an online survey, 31 ECT units delivering inpatient or outpatient ECT treatments in the province of Quebec provided information on the data collection systems used, data recorded, data collection strategies, indicators of satisfaction, limitations of the current data collection systems, and expectations toward the improvement of ECT data collection.

Results

Most units routinely collected information on individuals receiving ECT treatments, mainly on the medical chart (80%) and in paper format (71%). Most units (88.9%) collected ECT data manually. Electroconvulsive therapy parameters are collected by 66% to 80% of units, but only 16% of them have computerized records. The main limitations of the current systems are as follows: (a) the low frequency of computerization, (b) the underutilization of data, and (c) difficulties in the integration of information from different ECT units. Although 83.3% were satisfied with the current data collection strategies, 80% had a very positive opinion about the development and implementation of an innovative ECT provincial data collection registry.

Conclusions

An integrated ECT provincial data collection system could overcome the variability documented in existing strategies and respond to the current provincial needs and expectations. Also, an integrated ECT provincial data collection system could support both clinical research and quality assurance necessary to inform standards of ECT practice in Quebec.
Repetitive Transcranial Magnetic Stimulation in the Treatment of Skin Picking Disorder
Authors: Aydin Efruz Pirdoğan , Kenar Jülide Güler , Altunay İlknur Kivanc , Kaymak Derya , Özer Ömer Akil , Karamustafalioğlu Kayihan Oğuz
Published: June 2019

Objectives

Skin picking disorder (SPD) falls into the category of “obsessive-compulsive disorder and related disorders” in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Repetitive transcranial magnetic stimulation (rTMS) treatment has been reported to be a promising therapy in obsessive-compulsive disorder–related disorders. The purpose of this study was to demonstrate the efficacy of rTMS treatment in patients with SPD.

Methods

Fifteen patients with SPD were assigned to receive 3 weeks' treatment with either active (n = 8) or sham rTMS targeting the pre–supplementary motor area. Patients were evaluated using the Beck Depression Inventory, Beck Anxiety Inventory, Skin Picking Impact Scale, and the Yale-Brown Obsessive Compulsive Scale Modified for Neurotic Excoriation. Response to treatment was defined as a ≥35% decrease on Yale-Brown Obsessive Compulsive Scale modified for Neurotic Excoriation.

Results

Treatment response was achieved in 62.5% of patients (5/8) in the active group and 33.3% of patients (2/6) in the sham group. However, there were no significant differences between the groups in terms of primary and secondary outcomes.

Conclusions

In this exploratory study, active rTMS could not be demonstrated to be superior over sham in treatment of SPD. The results of this study indicate the need for further rTMS studies to be conducted with larger sample sizes and subtypes of SPD.
Landscape of the Dark Transcriptome Revealed through Re-mining Massive RNA-Seq Data
Authors: Li Jing , Singh Urminder , Arendsee Zebulun , Wurtele Eve Syrkin
Published: June 2019

The “dark transcriptome” can be considered the multitude of sequences that are transcribed but not annotated as genes. We evaluated expression of 6,692 annotated genes and 29,354 unannotated ORFs in theSaccharomyces cerevisiaegenome across diverse environmental, genetic and developmental conditions (3,457 RNA-Seq samples). Over 48% of the transcribed ORFs have translation evidence. Phylostratigraphic analysis infers most of these transcribed ORFs would encode species-specific proteins (“orphan-ORFs”); hundreds have mean expression comparable to annotated genes. These data reveal unannotated ORFs most likely to be protein-coding genes. We partitioned a co-expression matrix by Markov Chain Clustering; the resultant clusters contain 2,468 orphan-ORFs. We provide the aggregated RNA-Seq yeast data with extensive metadata as a project in MetaOmGraph, a tool designed for interactive analysis and visualization. This approach enables reuse of public RNA-Seq data for exploratory discovery, providing a rich context for experimentalists to make novel, experimentally-testable hypotheses about candidate genes.
Accurate, ultra-low coverage genome reconstruction and association studies in Hybrid Swarm mapping populations
Authors: Weller Cory A. , Tilk Susanne , Rajpurohit Subhash , Bergland Alan O.
Published: June 2019

Genetic association studies seek to uncover the link between genotype and phenotype, and often utilize inbred reference panels as a replicable source of genetic variation. However, inbred reference panels can differ substantially from wild populations in their genotypic distribution, patterns of linkage-disequilibrium, and nucleotide diversity. As a result, associations discovered using inbred reference panels may not reflect the genetic basis of phenotypic variation in natural populations. To address this problem, we evaluated a mapping population design where dozens to hundreds of inbred lines are outbred for few generations, which we call the Hybrid Swarm. The Hybrid Swarm approach has likely remained underutilized relative to pre-sequenced inbred lines due to the costs of genome-wide genotyping. To reduce sequencing costs and make the Hybrid Swarm approach feasible, we developed a computational pipeline that reconstructs accurate whole genomes from ultra-low-coverage (0.05X) sequence data in Hybrid Swarm populations derived from ancestors with phased haplotypes. We evaluate reconstructions using genetic variation from the Drosophila Genetic Reference Panel as well as variation from neutral simulations. We compared the power and precision of GWAS using the Hybrid Swarm, inbred lines, recombinant inbred lines, and highly outbred populations across a range of allele frequencies, effect sizes, and genetic architectures. Our simulations show that these different mapping panels vary in their power and precision, largely depending on the architecture of the trait. The Hybrid Swam and RILs outperform inbred lines for quantitative traits, but not for monogenic ones. Taken together, our results demonstrate the feasibility of the Hybrid Swarm as a cost-effective method of fine-scale genetic mapping.
One step towards bioremediating a heavily polluted river: Metagenomic insights on the function of microbial community
Authors: Breton-Deval Luz , Sanchez-Reyes Ayixon , Sánchez-Flores Alejandro , Juárez Katy , Mussali-Galante Patricia
Published: June 2019

The objective of this study is to understand the functional potential of the microbial community related to bioremediation activity and its relationship with the pollution of each site to enhance the future design of more accurate bioremediation processes. Water samples were collected at four sampling sites along the Apatlaco River (S1-S4), and a whole metagenome shotgun sequencing was performed to know and understand the microbial community involved in bioremediation. Additionally, HMMER was used for searching sequence homologs related to PET and polystyrene biodegradation and metal transformation in Apatlaco River metagenomes. The Apatlaco River is characterized by the presence of a broad spectrum of microorganisms with the metabolic potential to carry out bioremediation activities. Every site along the Apatlaco River has a particular community to perform bioremediation activities. The first site S1 has Thiomonas, Polaromonas, Pedobacter, and Myroides, S2 has Pedobacter, Myroides, Pseudomonas and Acinetobacter, S3, Thiomonas, Myroides, Pseudomonas, Acinetobacter and Aeromonas; S4, Thiomonas, Myroides and Pseudomonas, Thauera.

Furthermore, every site is rich in specific enzymes such as S1 has dioxygenase and dehydrogenase, which can degrade Catechol, Biphenyl, Naphthalene, and Phthalate. While, S2 and S3 are rich in dioxygenase and decarboxylating dehydrogenases to degrade Toluene, Fluorobenzoate, Xylene, Phenylpropanoate, and Phenol. S3 also has monooxygenases which degrade Benzene, and all the earlier mentioned enzymes were also found at S4.