bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of sclerotic changes on stress concentration in early‐stage osteonecrosis: A patient‐specific, 3D finite element analysis
Authors: Utsunomiya Takeshi , Motomura Goro , Ikemura Satoshi , Kubo Yusuke , Sonoda Kazuhiko , Hatanaka Hiroyuki , Baba Shoji , Kawano Koichiro , Yamamoto Takuaki , Nakashima Yasuharu
Published: August 2018

Stress distribution remains unclear in early‐stage osteonecrosis of the femoral head (ONFH). To clarify this issue, we generated patient‐specific finite element models (FEMs) from 51 patients with ONFH. Patients’ hips were classified into three groups: ONFH without a sclerotic boundary (Stage 1, n = 6), ONFH with a sclerotic boundary (Stage 2, n = 10), and ONFH with both a sclerotic boundary and <2 mm collapse (Stage 3, n = 35). Four hips without ONFH were used as controls. Stress distribution in each FEM was compared with magnetic resonance imaging (MRI) and computed tomography (CT) results. Fifteen wholly resected femoral heads in Stage 3 hips were assessed by micro‐CT. Furthermore, we histologically examined three Stage 2 femoral heads that subsequently developed subchondral fractures after FEM analyses. In all FEMs of both control and Stage 1 hip, stress was equally distributed on the femoral head surface. However, in all FEMs of both Stages 2 and 3 hips, stress was concentrated at the lateral boundary of the femoral head surface, corresponding to both a low‐intensity band on T1‐weighted MRI images and sclerotic changes on CT. On micro‐CT, subchondral fractures consistently began at the lateral boundary with sclerotic changes, in which bone volume fraction was increased. Histology showed breakage of subchondral plates at the junction between necrotic and reparative zones. In early‐stage ONFH, sclerotic changes caused stress concentration, which can trigger subchondral fractures at the lateral boundary. Clinical Significance: Our results will clarify the pathogenic mechanism of collapse in ONFH. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3169–3177, 2018.
Correlation between high FBXW7 expression in pretreatment biopsy specimens and good response to chemoradiation therapy in patients with locally advanced esophageal cancer: A retrospective study
Authors: Gombodorj Navchaa , Yokobori Takehiko , Tanaka Naritaka , Suzuki Shigemasa , Kuriyama Kengo , Kumakura Yuji , Yoshida Tomonori , Sakai Makoto , Sohda Makoto , Baatar Seded , Miyazaki Tatsuya , Nishiyama Masahiko , Shirabe Ken , Kuwano Hiroyuki
Published: August 2018

Background and Objectives

Esophageal squamous cell carcinoma (ESCC) exhibits good reactivity to chemoradiation therapy (CRT). The dysregulation of F‐Box and WD Repeat Domain Containing 7 (FBXW7) is associated with therapeutic resistance in cancer cells. However, the correlation between FBXW7 expression and CRT sensitivity in patients with clinical ESCC has been investigated only in few studies. Therefore, this study aimed to elucidate the significance of FBXW7 expression in pretreatment biopsy specimens from patients with ESCC receiving CRT.

Methods

We investigated the relationship between FBXW7 expression and CRT sensitivity in 30 pretreatment biopsy specimens with histological grades of post‐CRT surgically resected tumors. Furthermore, we evaluated the effects of high FBXW7 expression on the sensitivity to cytotoxic agents, including docetaxel and nedaplatin, and radiation in ESCC cells in vitro.

Results

High FBXW7 expression before CRT correlated with a good pathological CRT response in patients with advanced ESCC (P < .05). Further, our in vitro data showed that both chemo and radiation sensitivity increased in TE‐8 and KYSE140 cells overexpressing FBXW7 compared with mock cells because of the degradation of the anti‐apoptotic protein MCL1.

Conclusions

The evaluation of FBXW7 expression before CRT treatment is a potential predictor of good responders among patients with ESCC receiving CRT.
Fluorescence‐guided surgery for liver tumors
Authors: Nakaseko Yuichi , Ishizawa Takeaki , Saiura Akio
Published: August 2018

In hepatobiliary surgery, fluorescence imaging enables identification of subcapsular liver tumors through accumulation of indocyanine green after preoperative intravenous injection in cancerous tissues of hepatocellular carcinoma and in noncancerous hepatic parenchyma around intrahepatic cholangiocarcinoma and liver metastases. Indocyanine green‐fluorescence imaging can also be used for visualizing extrahepatic bile duct anatomy and hepatic segmental boundaries, enhancing the accuracy of open and laparoscopic hepatectomy.
The effect of contralateral prophylactic mastectomy on breast‐related charges: A 5‐year analysis
Authors: Smith Jesse R. , Jaffe Jennifer , Pruitt Jaclyn , Yao Katharine , Sisco Mark , Kuchta Kristine , Wang Chi E. , Howard Michael A.
Published: August 2018

Background and Objectives

The purpose of this study was to determine charges following unilateral mastectomy (UM) and bilateral mastectomy (BM) for patients with unilateral breast cancer (UBC). We hypothesized that BM may be associated with fewer charges over time.

Methods

A retrospective review was conducted of patients with UBC treated between 2006 and 2010 with UM and BM in a large healthcare system. Institutional billing data were investigated for 5 years postoperatively to calculate the immediate and subsequent charges of all inpatient and outpatient breast‐related care associated with the initial diagnosis for a subset of patients identified using propensity score matching method.

Results

A subset of matched patients (n = 320) undergoing UM (n = 160) or BM (n = 160) were included in this analysis. At 1 year, there was a trend toward lower total charges following UM as compared with BM (median, $125 230 vs $138 467; P = .6075). However, during years 2 to 5, total charges were significantly higher following UM vs BM ($22 128 vs $13 478; P = .0116).

Conclusions

While initially higher, overall charges for BM are lower than UM between 2 and 5 years out from surgery. Further study is necessary to determine if this trend is sustained over the long term. These data can inform patient decision making regarding mastectomy for their breast cancer.
Introducing the subdermal free flap: Preserving the ultrathin–free skin flap option in morbidly obese patients
Authors: Patel Ketan M. , Shauly Orr , Gould Daniel J.
Published: August 2018

In the morbidly obese population (BMI > 35), distal extremity defects are difficult to reconstruct. Traditional skin flaps are several centimeters in thickness in obese patients; however, a new plane superficial to the scarpal plane has demonstrated success in these patients. In this report, we present a 62‐year‐old female (BMI = 44.81) with a chronic lower extremity wound. A suprascarpal thin flap (approximately 1 cm in thickness) was harvested from the thigh and transferred successfully with no wound‐healing issues.
Innovations in reconstructive microsurgery: Reconstructive transplantation
Authors: Kollar Branislav , Tasigiorgos Sotirios , Dorante Miguel I. , Carty Matthew J. , Talbot Simon G. , Pomahac Bohdan
Published: August 2018

In the past 20 years, reconstructive transplantation (RT) has emerged as a viable reconstructive option for carefully selected patients. More than 100 upper extremity and 40 face transplants have been performed worldwide to date. Concomitantly, the portfolio of reconstructive transplantation has been extended by additional procedures such as lower extremities, abdominal wall, neck, uterus, genitourinary, and pediatric transplants. In the present review article, we aim to summarize the current state of knowledge about this exciting field.
Intraoperative fluorescence imaging in thoracic surgery
Authors: Newton Andrew D. , Predina Jarrod D. , Nie Shuming , Low Philip S. , Singhal Sunil
Published: August 2018

Intraoperative fluorescence imaging (IFI) can improve real‐time identification of cancer cells during an operation. Phase I clinical trials in thoracic surgery have demonstrated that IFI with second window indocyanine green (TumorGlow®) can identify subcentimeter pulmonary nodules, anterior mediastinal masses, and mesothelioma, while the use of a folate receptor‐targeted near‐infrared agent, OTL38, can improve the specificity for diagnosing tumors with folate receptor expression. Here, we review the existing preclinical and clinical data on IFI in thoracic surgery.
Prognostic utility of atypical mitoses in patients with breast cancer: A comparative study with Ki67 and phosphohistone H3
Authors: Ohashi Ryuji , Namimatsu Shigeki , Sakatani Takashi , Naito Zenya , Takei Hiroyuki , Shimizu Akira
Published: August 2018

Background and Objectives

Emerging evidence suggests that the presence of atypical mitoses is associated with poor prognosis in some types of cancer, but its clinical significance remains uncertain. Here, we investigated the occurrence of atypical mitoses in breast cancers.

Methods

Mitotic figures, including normal and atypical mitoses, were assessed in resected histological sections from 109 patients with invasive carcinoma of no special type (ICNST). Comparisons with clinicopathological features and biomarkers such as Ki67 and phosphohistone H3 (PHH3) were performed.

Results

The total number of mitotic figures, including atypical mitoses, was higher in situ and invasive ductal carcinoma components than in normal ducts. Morphological characteristics of atypical mitoses included multipolar, lagged, ring, asymmetrical mitoses, and anaphase bridge. Patients with higher total mitoses and PHH3, and the presence of atypical mitoses showed reduced overall survival (OS), compared to those with lower total mitoses and PHH3, and without atypical mitoses (P = 0.03, 0.02, and <0.001, respectively). In multivariate analysis, the presence of atypical mitoses alone attained significant correlation with shorter OS (P < 0.001).

Conclusions

Atypical mitoses in routinely resected specimens have a robust prognostic value for ICNST of the breast, but its clinical utility remains to be validated in a multicenter large material.
National practice patterns of completion lymph node dissection for sentinel node‐positive melanoma
Authors: Hewitt D. Brock , Merkow Ryan P. , DeLancey John Oliver , Wayne Jeffrey D. , Hyngstrom John R. , Russell Maria C. , Gerami Pedram , Balch Charles M. , Bilimoria Karl Y.
Published: August 2018

Background and Objectives

Close observation may be an appropriate alternative to completion lymph node dissection (CLND) for selected patient populations, especially those with minimal tumor burden in the sentinel lymph node (SLN). In this study, we examined the practice patterns of CLND utilization.

Methods

Using the National Cancer Database, we examined CLND utilization in SLN‐positive patients diagnosed with clinically node‐negative Stage III melanoma from 2012 to 2015. Hierarchical logistic regression models were constructed to assess the factors associated with observation after positive SLN biopsy (SLNB).

Results

Of the 131 171 patients identified, 55 688 (42.5%) underwent SLNB and 7200 (12.9%) had an SLN with a metastatic disease. CLND was performed in 57.0% of the patients with a positive SLNB. Patients were more likely to forgo CLND if the primary tumor was located on the lower extremity (odds ratio [OR], 1.65, 95% confidence interval [CI], 1.40‐1.94), were older (P < 0.001), had multiple comorbidities (OR, 1.61, 95% CI, 1.19‐2.20), or were diagnosed with melanoma in 2015 (OR, 1.33, 95% CI, 1.13‐1.56 vs 2012).

Conclusions

CLND utilization varied based on patient factors and decreased over time. As evidence supports close observation in selected patient populations with low SLN tumor burden, monitoring is needed to ensure that CLND is performed in the appropriate patient populations. However, this will require improvements in the data collected by cancer registries.
Lymphovenous bypass for the treatment of lymphedema
Authors: Garza Rebecca M. , Chang David W.
Published: August 2018

Lymphovenous bypass (LVB) is a form of physiological lymphedema surgery, which was described decades ago, but recently it is gaining popularity with improved microsurgical technology available. Benefits of the procedure are its effectiveness in treating early stage lymphedema of either the upper or lower extremity and having low complication profile. In the following article, the history of the procedure, mechanism, and details of various LVB techniques, and outcomes will be discussed.
Short‐ and long‐term outcomes of middle hepatic vein–oriented hepatectomy for advanced perihilar cholangiocarcinoma
Authors: Ji Gu‐Wei , Zhang Yao‐Dong , Wang Ke , Zhang Hui , Shao Zi‐Cheng , Jiang Wang‐Jie , Li Xiang‐Cheng , Wang Xue‐Hao
Published: August 2018

Background

This study aimed to compare clinical outcomes of the middle hepatic vein (MHV)‐oriented versus conventional hemihepatectomy for perihilar cholangiocarcinoma (PHC).

Methods

From 2008 to 2017, medical records of patients undergoing hemihepatectomy with caudate lobectomy for advanced PHC were reviewed retrospectively. MHV‐oriented hepatectomy was defined as full exposure of the MHV on the dissection plane. Predictors of morbidity and survival were identified.

Results

A total of 125 patients were enrolled. MHV‐oriented and conventional hepatectomies were performed in 44 and 81 patients, respectively. The curative resection rate, blood loss, transfusion, and survival were comparable between two groups; however, severe morbidity rate was significantly lower in the MHV‐oriented group (9.1% vs 38.3%, P < 0.001). MHV‐oriented approach was an independent predictor of severe morbidity, as were the age, bilirubin level, and blood transfusion. Severe morbidity was associated with significantly decreased overall survival and recurrence‐free survival (RFS) (median 29.0 vs 46.9 months, P = 0.011 and 20.3 vs 31.1 months, P = 0.003, respectively). Multivariate analysis revealed that severe morbidity independently predicted shorter RFS (P = 0.025).

Conclusions

MHV‐oriented approach for advanced PHC is safe and associated with a significant decrease in severe morbidity. Severe morbidity adversely affects survival after surgery; therefore, optimal preoperative preparation and MHV‐oriented hepatectomy with meticulous dissection remain of critical importance.
Effects of grazing on the northern three‐toed jerboa pre‐ and post‐hibernation
Authors: Yuan Shuai , Fu Heping , Wu Xiaodong , Yang Suwen , Malqin Xingan , Yue Xiuxian
Published: August 2018

Resource availability pre‐hibernation and post‐hibernation may be crucial phases for the survival of hibernators. However, the effects of grazing on food availability in pre‐hibernation and on the winter survival of hibernating rodents remains unstudied. The objective of this study was to investigate the effects of domestic sheep grazing on northern three‐toed jerboa (Dipus sagitta) populations pre‐, post‐, and during hibernation. We conducted a grazing exclusion experiment with randomized complete block design in the Alxa Desert, Inner Mongolia, China, from April to October 2006 to 2011. We live‐trapped jerboas in 3 grazed plots and 3 ungrazed plots. We measured the quantity of vegetation in grazed and ungrazed plots to determine the relationship between jerboas and plant food resources. We observed higher jerboa densities both pre‐ and post‐hibernation, and heavier individual body mass pre‐hibernation, in ungrazed sites. More food availability contributed to higher jerboa body mass in ungrazed areas during pre‐hibernation, and attracted more jerboas immigrating to ungrazed areas during the post‐hibernation period. These results demonstrate that grazing negatively affects the northern three‐toed jerboa population by adjusting food availability pre‐ and post‐hibernation; survival rates were not affected by grazing. © 2018 The Wildlife Society.
Endonasal anatomy of the olfactory neural network: Surgical implications
Authors: Gomez Galarce Matias , Yanez‐Siller Juan C. , Carrau Ricardo L. , Montaser Alaa , Lima Lucas Ramos , Servian Diego , Otto Bradley A. , Prevedello Daniel M. , Naudy Cristian A.
Published: August 2018

Objectives/Hypothesis

Define the anatomic distribution of the olfactory filaments within specific mucosal regions of the nasal cavity.

Study Design

Cadaveric study.

Methods

Seventeen cadaveric specimens (34 sides) were dissected to study the anatomical distribution and density of olfactory fila within different regions of the nasal cavity. Olfactory fila were dissected retrogradely to their point of entry into the anterior cranial fossa through the cribriform plate. Anatomic relationships among various components of the olfactory system and their corresponding arterial supply were determined subjectively.

Results

The highest density of olfactory fila was found at the mucosa of the ethmoid roof and superior turbinates. Olfactory fila were found at regions not previously considered to be part of the olfactory system: lateral wall of the nose, ethmoidal bullae, and between the os sphenoidale and arc of the posterior choana. Furthermore, at the septum, 20% of the olfactory fila crossed contralaterally before exiting the nose. The anterior ethmoidal arteries were the primary blood supply to the olfactory epithelium.

Conclusions

This study suggests that olfactory filaments extend beyond previously established boundaries. These findings may have clinical implications regarding oncologic resections and could serve as the foundation for the development of techniques that better preserve olfactory function.

Level of Evidence

NA Laryngoscope, 2473–2477, 2018
An investigation of left–right vocal fold symmetry in rheological and histological properties
Authors: Xu Chet C. , Gao Ang , Zhang Song
Published: August 2018

Objectives

The primary objective was to investigate the left–right vocal fold symmetry in rheological and histological properties using a rabbit model. The other objective was to develop statistical models for the comparison of rheological properties between paired vocal folds.

Methods

Viscoelastic shear properties of six pairs of vocal fold lamina propria specimens were measured over a frequency range of 1 to 250 Hz by a linear, controlled‐strain, simple‐shear rheometer. The rheological data of the left and right vocal folds was statistically compared using the mixed‐effects model approach. Six additional rabbit larynges were histologically analyzed for left–right symmetry in distribution patterns and relative densities of major extracellular matrix constituents.

Results

There were no significant differences in elastic shear modulus (P = 0.1069) and dynamic viscosity (P = 0.944) of the lamina propria between the two vocal folds of the same larynx. Left–right vocal fold symmetry in densities and distribution patterns of the key molecular constituents was also demonstrated in histological results.

Conclusion

By showing that the left and right vocal folds were rheologically and histologically symmetrical in rabbit, this study validated an underlying assumption made in many previous reports. Statistical models for the analysis of hierarchically correlated left–right vocal fold rheological data were also presented.

Level of Evidence

NA. Laryngoscope, 128:E359–E364, 2018
Clinical Implications of Tumor‐Associated Tissue Eosinophilia in Tongue Squamous Cell Carcinoma
Authors: De Paz Dante , Chang Kai‐Ping , Kao Huang‐Kai , Lao William Wei‐Kai , Huang Yu‐Chen , Chang Yu‐Liang , Huang Yenlin
Published: August 2018

Objectives/Hypothesis

The role of tumor‐associated tissue eosinophilia (TATE) in oral cavity cancer remains quite controversial. This study investigated the potential role of TATE in tongue squamous cell carcinoma (TSCC).

Study Design

Retrospective case series.

Methods

This study retrospectively enrolled 259 consecutive TSCC patients who underwent surgery between July 2004 and December 2015. Histopathological examinations for TATE in TSCC tumors were reviewed, and the association of TATE with different clinicopathological factors was evaluated. A nomogram was generated based on several major clinicopathological factors and TATE to improve the accuracy of prognostic prediction.

Results

Higher levels of TATE were significantly associated with male sex, alcohol consumption, cigarette smoking, higher pT classification, advanced disease stage, and tumor depth (P = .006, .003, .024, .041, .013 and .006, respectively). Our results indicated that extranodal extension, cell differentiation, and TATE were independent predictors of overall survival (P < .001, .004, and .032, respectively) and disease‐free survival (P < .001, .012, and .013, respectively). TATE levels significantly correlated with circulating eosinophils (r = 0.139, P = .040), and the c‐index of our nomogram foroverall survival was 0.786, which demonstrates better accuracy in prognosis prediction than the TNM stage only (c‐index = 0.738).

Conclusions

Higher levels of TATE were associated with several clinicopathological factors and poorer survival rates, and a nomogram incorporating TATE levels may strengthen the prediction accuracy of prognosis in TSCC patients.

Level of Evidence

4 Laryngoscope, 129:1123–1129, 2019
Analysis of Risk Factors for Unplanned Reoperation Following Free Flap Surgery of the Head and Neck
Authors: Zhao Eric H. , Nishimori Kalin , Brady Jacob , Siddiqui Sana H. , Eloy Jean Anderson , Baredes Soly , Park Richard Chan W.
Published: August 2018

Objectives/Hypothesis

Evaluate risk factors for unplanned reoperation following free flap surgery of the head and neck.

Study Design

Retrospective database review.

Methods

The National Surgical Quality Improvement Program database was queried for free flap surgeries of the head and neck between 2010 and 2014. Bivariate and multivariate analyses were performed to compare perioperative variables and postoperative complications in patients with and without unplanned reoperation.

Results

A total of 1,796 patients were identified, with an overall unplanned reoperation rate of 20.0% (n = 359) within 30 days after surgery. Upon multivariate analysis, independent preoperative risk factors for unplanned reoperation include smoking (odds ratio [OR]: 1.389, 95% confidence interval [CI]: 1.042‐1.850), hypertension (OR: 1.443, 95% CI: 1.096‐1.901), and prior open wound/wound infection (OR: 1.675, 95% CI: 1.123‐2.499). Intraoperative risk factors include prolonged operative time (OR: 1.045, 95% CI: 1.021‐1.070). Surgical site infection (OR: 6.518, 95% CI: 2.728‐15.574), wound disruption (OR: 17.034, 95% CI: 8.373‐34.654), blood transfusion (OR: 1.561, 95% CI: 1.062‐2.296), and ventilation > 48 hours (OR: 3.626, 95% CI: 1.955‐6.723) were significant postoperative predictors of unplanned reoperation.

Conclusions

In patients with free flap surgeries of the head and neck, preoperative smoking, hypertension, and prior open wound/wound infection, along with prolonged operative time, are risk factors for 30‐day unplanned reoperation. In addition, postoperative surgical site infection, wound disruption, blood transfusion, and ventilation >48 hours are independently associated with unplanned reoperation.

Level of Evidence

4 Laryngoscope, 128:2790–2795, 2018
The Relationships Between the Nasolacrimal Duct and the Anterior Wall of the Maxillary Sinus
Authors: Wang Xiangdong , Chen Xinjun , Zheng Ming , Liu Chengyao , Wang Chengshuo , Zhang Luo
Published: August 2018

Objectives/Hypothesis

To examine the anatomic relationships between the lower end opening into the inferior meatus of the bony nasolacrimal duct (NLD) and the anterior wall of the maxillary sinus.

Study Design

Anatomical investigation.

Methods

A total of 206 individuals were recruited for detailed anatomic investigation of the lower end of the bony NLD and their relation to the anterior wall of the maxillary sinus by high‐resolution computed tomography (HRCT) imaging. The observed features were classified as either a fusion type or separation type, according to the HRCT images. Additionally, the angle between the anterior and medial wall of the maxillary sinus was classified as either an anterior mode or lateral mode.

Results

The NLD anatomical fusion type was found in 40.05% and the separation type in 59.95% of the HRCT imaging scans available. The anterior mode of angle between the anterior and medial wall of the maxillary sinus was present in 64.1% of the images, and the lateral mode in 35.9% of the images. In 165 cases of anatomical fusion, the anterior mode of angle was present in 15.8% and the lateral mode in 84.2% of cases. In 247 cases of anatomical separation, the anterior mode was present in 97.2% and the lateral mode in 2.8% of cases.

Conclusions

The surgical anatomy of the lower end of the bony NLD and anterior wall of the maxillary sinus displays varied relationships. Preoperative use of HRCT and an awareness of the particular type of anatomical feature present are likely to aid in planning and performing successful endoscopic medial maxillectomy.

Level of Evidence

4Laryngoscope, 129:1030–1034, 2019
Initial and Long‐term Retention of Robotic Technical Skills in an Otolaryngology Residency Program
Authors: Shay Sophie G. , Chrin Jonathan D. , Wang Marilene B. , Mendelsohn Abie H.
Published: August 2018

Objectives/Hypothesis

To objectively assess the initial and long‐term retention of robotic surgical skills of otolaryngology residents.

Study Design

This study was performed in an academic otolaryngology residency training program. Between October 2015 and November 2016, residents were invited to complete a prospective, multiphase robotic surgical skills training course: 1) online da Vinci Surgical System Assessment and didactic, 2) faculty‐supervised robotic simulator training, 3) robotic docking and draping training, 4) robotic dry‐lab exercises. To optimize surgical skill retention, the training laboratory was repeated 2 weeks after the initial training session.

Methods

Twenty otolaryngology residents were included. Primary outcome was measured as robotic skill assessment scores on three tasks: camera targeting, peg board, and needle targeting. Skill assessments were completed prior to training, between the two training sessions, and at 1 month and 6 months after training. Residents were also asked to complete a self‐assessment questionnaire.

Results

Camera targeting scores were improved at midtraining (P < .001) and 1‐month posttraining (P = .010). Peg board scores were improved at 1 month training (P = .043). Needle targeting scores were improved at midtraining (P = .002), 1 month (P = .002), and 6 months posttraining (P < .001). Resident self‐assessment scores demonstrating comfort with using the robotic console (P < .01) and docking/draping (P < .01) improved significantly following the training.

Conclusions

Following a multiphase robotic training program, otolaryngology residents demonstrated significant, objective skill acquisition and retention at 1 month and 6 months follow‐up. Although the proposed training strategy may be considered an important step in otolaryngology residency training, additional innovations are being designed toward a formal robotic training curriculum.

Level of Evidence

NA

Laryngoscope, 129:1380–1385, 2019
Upper Airway Stimulation in Patients With Obstructive Sleep Apnea and an Elevated Body Mass Index: A Multi‐institutional Review
Authors: Huntley Colin , Steffen Armin , Doghramji Karl , Hofauer Benedikt , Heiser Clemens , Boon Maurits
Published: August 2018

Objectives/Hypothesis

An elevated body mass index (BMI) influences the severity of disease and treatment options utilized for obstructive sleep apnea (OSA). With this study, we aim to evaluate a cohort of patients undergoing upper airway stimulation (UAS) for treatment of OSA and assess the impact of BMI on surgical and quality of life outcomes.

Methods

We designed a case‐control, retrospective review, of all patients undergoing UAS at two academic institutions between 2014 and 2017. We compare those with an elevated BMI to those without. We included patients with moderate–severe OSA, who were unable to tolerate therapy with continuous positive airway pressure (CPAP), were treated with UAS, and had a postoperative sleep study performed. We evaluated postoperative sleep study data including apnea‐hypopnea index (AHI), O2 desaturation nadir, rate of cure, and rate of success in those with an elevated BMI to those without an elevated BMI. Success was defined as a drop in the postoperative AHI by 50% compared to the preoperative value and to less than 20. We also assessed daytime sleepiness using the Epworth Sleepiness Scale.

Results

When defining an elevated BMI as greater than 32, we found no difference between elevated and nonelevated BMI cohorts in postoperative AHI, O2 desaturation nadir, daytime sleepiness, rate of surgical success, or rate of cure.

Conclusions

Patients with obstructive sleep apnea, unable to tolerate CPAP, and with an elevated BMI can be successfully treated with upper airway stimulation therapy.

Level of Evidence

3. Laryngoscope, 128:2425–2428, 2018
First Successful Mechanical Splint for Obstructive Sleep Apnea With an Orally Administrable Pharyngeal Stenting Device
Authors: Neu Daniel , Nawara Grégory , Newell Johan , Bouchez David , Mairesse Olivier
Published: August 2018

We report the case of obstructive sleep apnea in a 19‐year‐old, otherwise healthy male presenting with persistent daytime sleepiness and nonrestorative sleep after velo‐ and uvuloplasty. An individually tailored prototype of an orally inserted pharyngeal stenting device was proposed in the framework of a first clinical feasibility trial. The noninvasive, easily self‐administered device is mounted on a simple inferior dental guard. Baseline total apnea‐hypopnea index (AHI) was 15.5 and 24.4 per hour of rapid eye movement (REM) sleep. With the device, total AHI dropped to 6.7 per hour (56.8% reduction) and 1.4 per hour of REM (94.3% reduction). Recorded sleep efficiency during treatment was excellent at 96.5%.

Laryngoscope, 129:1945–1948, 2019
Trigger Reduction Prior to Systemic Drugs for Neurogenic Chronic Cough
Authors: Zalvan Craig , Berzofsky Craig , Tiwari Raj , Geliebter Jan
Published: August 2018

Objective/Hypothesis

Neurogenic chronic cough typically presents as a postviral chronic cough, often with paroxysms of coughing preceded by a tickle sensation with multiple triggers and often recalcitrant to multiple treatments for reflux disease, sinus disease, and asthma. Current treatment uses neuromodulating agents with moderate success. Post nasal drainage and laryngopharyngeal reflux can be triggers in the setting of laryngopharyngeal hypersensitivity. Treatment will focus on trigger reduction using nasal toilet and a dietary regimen for laryngopharyngeal reflux.

Study Design

Systematic review of retrospective cohort studies

Methods

One‐year retrospective review of new patients with cough (R05.0) excluding asthma, proton pump inhibitor response, and sinus or pulmonary disease. Cough severity index (CSI) and reflux symptom index (RSI) were evaluated initially and 6 weeks after trigger‐reduction treatment using nasal saline irrigation, nasal steroids, nasal antihistamines, and a plant‐based diet with alkaline water.

Results

Of 119 patients, 29 met the criteria. Using the six‐point reduction (improvement) in RSI as an accepted response, 20 of 29 patients (68.9%, P = .0014) experienced a clinical response. Using reduction in RSI and CSI as a continuous variable to assess response, patients experienced a 10 (95% confidence interval [CI]: 6.75‐13.2) and 10.9 (95% CI: 7.4‐14.3) mean point reduction, respectively. The mean percent reduction in RSI following 6 weeks of treatment was 54.7% (95% CI: 41.5‐68.0; P = .0001). These patients experienced a 59.8% (95% CI: 43.4‐76.2; P = .0001) reduction in CSI.

Conclusions

A trigger‐reduction approach using nasal toilet and a plant‐based diet in patients with neurogenic chronic cough prior to the initiation of systemic neuromodulating medications should be considered.

Level of Evidence

4 Laryngoscope, 129:198–202, 2019
Long‐term afforestation significantly improves the fertility of abandoned farmland along a soil clay gradient on the Chinese Loess Plateau
Authors: Zhang Yan , Wei Liyun , Wei Xiaorong , Liu Xuetong , Shao Mingan
Published: August 2018

In China, almost half of the total land area is degraded, mainly due to the unreasonable use of land for agricultural production. During the past half‐century, afforestation has become a popular management option to remedy degraded soils. In this paper, we studied the long‐term effects of afforestation on the major properties of soils with different textures. We measured the changes in soil physical, chemical, and fertility properties after 10, 20, and 30 years of afforestation with black locust (Robinia pseudoacacia) on abandoned farmland at five sites on the Loess Plateau, China, which is characterized by a temperate monsoon climate. The soil clay contents varied significantly among sites. The objectives were to understand how long‐term afforestation affects soil properties and whether such effects depend on the soil texture. Averaged across the five sites and the depths of 0–10 and 10–20 cm, afforestation resulted in significant increases in the proportion of macroaggregates (+22.5%), saturated hydraulic conductivity (+185.4%), organic matter content (+110.5%), and total nitrogen content (+110.5%) but significant decreases in the proportion of microaggregates (−21.9%) and bulk density (−10.8%). The silt + clay fraction, soil pH, and nitrate content were minimally affected by afforestation. The effects of afforestation were greater at 0–10 cm than at 10–20 cm, but they varied between sites. Furthermore, most soil metrics linearly responded to the time of afforestation, and such responses were dependent on the soil clay content. Our results suggest that long‐term afforestation improves soil fertility better in soils with a clay content of approximately 20%.
Low‐fat versus ketogenic diet in Parkinson's disease: A pilot randomized controlled trial
Authors: Phillips Matthew C.L. , Murtagh Deborah K.J. , Gilbertson Linda J. , Asztely Fredrik J.S. , Lynch Christopher D.P.
Published: August 2018

Background: Preliminary evidence suggests that diet manipulation may influence motor and nonmotor symptoms in PD, but conflict exists regarding the ideal fat to carbohydrate ratio.

Objectives: We designed a pilot randomized, controlled trial to compare the plausibility, safety, and efficacy of a low‐fat, high‐carbohydrate diet versus a ketogenic diet in a hospital clinic of PD patients.

Methods: We developed a protocol to support PD patients in a diet study and randomly assigned patients to a low‐fat or ketogenic diet. Primary outcomes were within‐ and between‐group changes in MDS‐UPDRS Parts 1 to 4 over 8 weeks.

Results: We randomized 47 patients, of which 44 commenced the diets and 38 completed the study (86% completion rate for patients commencing the diets). The ketogenic diet group maintained physiological ketosis. Both groups significantly decreased their MDS‐UPDRS scores, but the ketogenic group decreased more in Part 1 (−4.58 ± 2.17 points, representing a 41% improvement in baseline Part 1 scores) compared to the low‐fat group (−0.99 ± 3.63 points, representing an 11% improvement) (P < 0.001), with the largest between‐group decreases observed for urinary problems, pain and other sensations, fatigue, daytime sleepiness, and cognitive impairment. There were no between‐group differences in the magnitude of decrease for Parts 2 to 4. The most common adverse effects were excessive hunger in the low‐fat group and intermittent exacerbation of the PD tremor and/or rigidity in the ketogenic group.

Conclusions: It is plausible and safe for PD patients to maintain a low‐fat or ketogenic diet for 8 weeks. Both diet groups significantly improved in motor and nonmotor symptoms; however, the ketogenic group showed greater improvements in nonmotor symptoms. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
Metabotypes Related to Meat and Vegetable Intake Reflect Microbial, Lipid and Amino Acid Metabolism in Healthy People
Authors: Wei Runmin , Ross Alastair B. , Su MingMing , Wang Jingye , Guiraud Seu‐Ping , Draper Colleen Fogarty , Beaumont Maurice , Jia Wei , Martin Francois‐Pierre
Published: August 2018

Scope

The objective of this study is to develop a new methodology to identify the relationship between dietary patterns and metabolites indicative of food intake and metabolism.

Methods and results

Plasma and urine samples from healthy Swiss subjects (n= 89) collected over two time points are analyzed for a panel of host–microbial metabolites using GC– and LC–MS. Dietary intake is evaluated using a validated food frequency questionnaire. Dietary pattern clusters and relationships with metabolites are determined using Non‐Negative Matrix Factorization (NNMF) and Sparse Generalized Canonical Correlation Analysis (SGCCA). Use of NNMF allows detection of latent diet clusters in this population, which describes a high intake of meat or vegetables. SGCCA associates these clusters to i) diet‐host microbial and lipid associated bile acid metabolism, and ii) essential amino acid metabolism.

Conclusion

This novel application of NNMF and SGCCA allows detection of distinct metabotypes for meat and vegetable dietary patterns in a heterogeneous population. As many of the metabolites associated with meat or vegetable intake are the result of host–microbiota interactions, the findings support a role for microbiota mediating the metabolic imprinting of different dietary choices.
New technique for designing wideband one layer frequency selective surface in X‐band with stable angular response
Authors: Rahzaani Mahdiye , Dadashzadeh Gholamreza , Khorshidi Mohammadreza
Published: August 2018

In this article, a new method is presented for designing frequency wideband unit cell to use in frequency selective surfaces (FSSs). A double slot square loop (DSSL), which has 2 resonant frequencies, is selected as a primary FSS unit cell and its frequency bandwidth is increased with the proposed method. The effect of the applied innovation on frequency response of DSSL unit cell is investigated by equivalent circuit presented in this paper. Simulated frequency response of the designed unit cell shows that frequency bandwidth of this unit cell increases in comparison with that of primary unit cell. A FSS structure with the designed unit cell is fabricated and its measured return loss confirms that, the frequency bandwidth of the proposed structure is about 50% in X‐band. In addition, frequency response of this FSS structure is stable during 45 degree angle deviation of the incident wave from normal axis of the FSS surface. High frequency bandwidth, low fabrication complexity and stable angular response are the favorable characteristics of the proposed FSS structure which make it suitable for using in microwave filters.
Design of a narrow band and wideband absorbers using resistive FSS concept for the X and Ku band application
Authors: Silva M. W. B. , Araujo H. X. , Campos A. L. P. S.
Published: August 2018

In this work thin narrow band and wideband electromagnetic absorbers based on the resonant behavior of a high‐impedance surface (HIS) are proposed. The absorbing structures consist of a resistive frequency selective surface over a grounded dielectric substrate. In this configuration, the HIS input impedance is equal to the parallel connection between the capacitive impedance of the FSS and the inductive impedance of the grounded dielectric. Simulated results are compared to experimental ones to validate the proposed methodology.
Compact low‐profile body worn and wrist worn lightweight antenna for ISM and GPS band navigation and medical applications
Authors: Das Saumya , Islam Hashinur , Bose Tanushree
Published: August 2018

This article investigates the performance of a compact dual band flexible antenna for wrist wearable applications of ISM and GPS frequencies. A semi rigid, lightweight material “Arlon foam clad 100” is chosen as a substrate for designing this wearable antenna. Analysis results from past journal papers are taken in verifying permittivity of the substrate material. Simulation tool is used to measure significant antenna parameters under three different cases named as flat wearable, cylindrical wearable, and wrist wearable for accepting the proposed conformal radiator in the application of navigation, animal tracking, health monitoring, and so on. Moreover, a prototype of this wearable antenna is developed and tested under all three above mentioned cases to confirm the simulated results.
Reflection and transmission of microwaves in reinforced concrete specimens irradiated by modified antipodal Vivaldi antenna
Authors: Esmati Zahra , Moosazadeh Mahdi
Published: August 2018

In this article, the reflection and transmission properties of reinforced concrete specimens irradiated by a modified, high‐gain, ultra‐wideband antipodal Vivaldi antenna (MAVA) are investigated numerically and experimentally. First, the influence of the interfaces between free space and concrete and a reinforced bar (rebar) cell embedded in concrete on the reflection property is investigated at frequency range from 0.65 to 3.5 GHz. Second, the transmission property of the reinforced concrete specimens is investigated at 2.45 GHz using a small resonant microstrip patch antenna embedded in concrete at the location of a rebar cell with different values of cell parameter. It is shown that the reflection from the free space–concrete interface of specimens with and without rebars provides the most critical effect on the reflection and transmission properties of the specimens. It is also shown that maximum transmission can be achieved when the patch antenna is located in the center of the rebar cell. The measured results are in good agreement with the numerical results. The results of this article can be used for nondestructive testing of reinforced concrete specimens and for wireless power transmission to sensors embedded in reinforced concrete.
Controlled high‐gain of an UWB antenna using cross dipole RFSS based on PIN diode
Authors: Lucena Francisco Ariaildo C. S. , de Oliveira M. R. T. , Filho Pedro H. B. Cavalcanti , Silva Crislane P. N. , Araujo Jorge A. I. , de Melo M. T.
Published: August 2018

This work presents an ultra‐wideband antenna with controlled gain. The gain control of antenna is achieved by employing a Reconfigurable Frequency Selective Surface (RFSS) as superstrate which is formed by 4 × 4 array of cross dipole. The filtering characteristics of the FSS are variable and depend on the PIN diodes state. The RFSS behaves as an array of cross dipole elements with stop‐band response when all diodes are in the OFF‐state and as an array of square slots with pass‐band response when the diodes are in the ON‐state. The gain improvement depends on the PIN diodes biasing. Simulation and measurements of return loss and antenna gain are presented, demonstrating changes and improvement in the antenna gain.
Design of a wide band six port reflectometer using broadside coupled lines
Authors: Hassan Ali , Abbas Omran
Published: August 2018

The authors present in this article an overview of the six port reflectometer (SPR). They realized SPR using broadside coupled lines for achieving ultrawide band, which is essential for its working as an alternative network analyzer.
Nanobeam extraction with periodic optical grating staircase structure
Authors: Sorathiya Vishal , Patel Shobhit Kumar , Kosta Yogeshwar , Dhamecha Hardik
Published: August 2018

We propose the unique design of nanobeam focusing on multiple grating with two‐dimensional silicon waveguide staircase structures. Beam focusing is also employed with two‐dimensional Finite Difference Time Domain simulations. Nanobeam extraction is achieved on 15 µm × 35 µm wafer size. Single mode fiber of 9 µm size is focused to the 50 nm optical beam. It is also observed that 50 nm focusing can be achieved irrespective of different grating periodicity. The device operates with Transverse Electric polarization mode. The proposed focusing structure works on 1550 nm wavelength. Simulation results of the propose design shows the good focusing efficiency at the waveguide end for nanophotonics structure. Reported results show the mathematical and simulation similarities for multiple designs. This focusing structure is highly compatible with next‐generation photonics circuits because of its linear focusing on nanowaveguide.
An electrical equivalent circuit to simulate the output power of an AlGaAs/GaAs planar gunn diode oscillator
Authors: Maricar Mohamed Ismaeel , Khalid Ata , Dunn Geoff , Greedy Steve , Thomas Dave , Cumming David R. S. , Oxley Chris H.
Published: August 2018

The planar Gunn diode offers the potential of microwave, milli‐metric and THz‐based oscillators, which can be fabricated as part of a microwave monolithic integrated circuit (mmic). The paper develops an electrical representation of an aluminum gallium arsenide (AlGaAs) based planar Gunn diode with an active channel length of approximately 4 μm and width of 120 μm, embedded in an oscillator circuit. The work indicates a maximum simulated RF output power of +5 dBm compared with published experimental results of −19 dBm for similar diodes.
Advanced monopole antenna with a wide beamwidth for the assessment of outdoor 5G wireless communication environments
Authors: Nam In‐Joong , Lee Seok‐Min , Kim Dongho
Published: August 2018

We propose an advanced monopole antenna to investigate non‐stationary outdoor wireless channel environments of 5G mobile communications. Our antenna has an omni‐directional beam pattern in the azimuth plane and a wide half‐power beamwidth (HPBW) in the elevation plane, respectively. To minimize blind angles along the axis of the monopole, we intentionally add a metallic annular ring around the monopole, which operates as a secondary source of our antenna. Then, the circumferential field from the secondary source appropriately interferes with the primary field from the monopole to widen the HPBW with a relatively high antenna gain in a far‐field region. An input signal is applied to a standard WR‐28 waveguide, and it is transferred to the monopole antenna through a coaxial waveguide. However, because impedance looking into the monopole and the waveguides are all different, we insert a mode converter between the rectangular and the coaxial waveguides. For better impedance matching, the coaxial waveguide is also used as an impedance transformer between the mode converter and the monopole antenna. Consequently, we can obtain the required omni‐directional radiation pattern with a wide HPBW and a high gain. All measurement data show good agreement with simulations, which proves the validity of our approach.
Integrated triple‐wideband triple‐inverted‐F antenna covering 617–960/1710–2690/3300–4200 MHz for 4G/5G communications in the smartphone
Authors: Wong Kin‐Lu , Chang Hsuan‐Jui , Li Wei‐Yu
Published: August 2018

An integrated triple‐inverted‐F antenna (TIFA) with 3 radiating strips and 2 hybrid (inductive and capacitive) shorting strips having a compact structure to provide a triple‐wideband operation in the smartphone for the fourth‐generation/fifth‐generation (4G/5G) communications is presented. The integrated TIFA can cover the 4G long‐term evolution low band (LTE LB) in 617–960 MHz, the 4G LTE middle/high bands (LTE M/HB) in 1710–2690 MHz, and the 5G bands in 3300–4200 MHz. The 3 widebands can be respectively controlled by 3 inverted‐F antenna structures (IFA1, IFA2, IFA3) integrated in the proposed TIFA, making it easy to implement for practical applications. It is also shown that by disposing 2 TIFAs at the top and bottom short edges of the smartphone, acceptable isolation there between in the LTE LB, LTE M/HB, and 5G bands is obtained, leading to good multi‐input multi‐output performance for the 4G/5G applications. The antenna structure and operating principle of the proposed TIFA are elaborated. Experimental results of the 2 fabricated TIFAs at the top and bottom short edges are presented and discussed.