bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative Evaluation of Pancreatic Fibrosis and Lipomatosis
Authors: Schawkat Khoschy , Eshmuminov Dilmurodjon , Lenggenhager Daniela , Endhardt Katharina , Vrugt Bart , Boss Andreas , Petrowsky Henrik , Clavien Pierre-Alain , Reiner Caecilia S.
Published: September 2018

Objectives

The purpose of this study was to evaluate the diagnostic performance of magnetization transfer (MT) imaging and multigradient echo magnetic resonance imaging (MRI) to quantify pancreatic fibrosis and lipomatosis in patients before pancreatoduodenectomy for postoperative risk stratification with histopathology as the reference standard.

Materials and Methods

Twenty-four patients (age, 68 ± 8 years, 16 males) prospectively underwent quantitative MT imaging using a 2-dimensional gradient echo sequence with and without MT prepulse and multigradient echo imaging on a 3 T MRI 1 day before pancreatoduodenectomy due to adenocarcinoma of the pancreatic head region (n = 20), neuroendocrine tumor (n = 3), or intraductal papillary mucinous neoplasm (n = 1). Magnetization transfer ratio (MTR) and proton density fat fraction (PDFF) were measured in pancreatic tail (PT) and at the resection margin (RM). Histopathologically, pancreatic fibrosis was graded as mild, moderate, or severe (F1–F3), lipomatosis was graded as 0% to 10%, 11% to 30%, and greater than 30% fat deposition (L1–L3). In addition, MTR and histopathologic fibrosis was assessed in pancreatic adenocarcinoma. Mann-Whitney U test and Spearman correlation were used.

Results

Patients with advanced pancreatic fibrosis (F3) showed a significantly higher MTR compared with the F1 group at the RM and PT (38 ± 4 vs 32.3 ± 1.6, P = 0.018 and 39.7 ± 5.5 vs 31.2 ± 1.7, P = 0.001). Spearman correlation coefficient of MTR and fibrosis grade was r = 0.532 (P = 0.011) and 0.554 (P = 0.008), respectively. Pancreatic parenchyma with advanced fat deposition (L2–L3) showed significantly higher PDFF compared with lipomatosis grade L1 (RM: P = 0.002 and PT: P = 0.001). Proton density fat fraction of pancreatic parenchyma exhibited a moderate and significant correlation with histopathologic lipomatosis grade (RM: r = 0.668 and PT: r = 0.707, P < 0.001). Magnetization transfer ratio was significantly higher in pancreatic adenocarcinoma compared with pancreatic parenchyma (44 ± 5.5 vs 36.0 ± 4.4 and 37.4 ± 5.4, P = 0.004).

Conclusions

Multiparametric MRI of the pancreas including MTR and PDFF maps may provide quantitative and noninvasive information on pancreatic fibrosis and lipomatosis before surgery.
Thyroid Metastasis From Hepatocellular Carcinoma Visualized by 18F-FDG PET/CT Imaging
Authors: Yin Hongyan , Luo Rongkui , Xiu Yan , Hu Yan , Shi Hongcheng
Published: September 2018

Thyroid metastasis from hepatocellular carcinoma (HCC) is very rare. We present a case of a 41-year-old man with a markedly elevated serum α-fetoprotein (2,297 ng/mL) and a left neck mass 6 months after a hepatolobectomy for a primary HCC. 18F-FDG PET/CT imaging showed a focal uptake in the left thyroid lobe corresponding to a mass. The patient underwent a left hemithyroidectomy. Subsequent pathology confirmed HCC metastasis to the thyroid.
Venous Congestion in Pedicled Frontal Branch Superficial Temporal Artery Flaps Reconstructions for Head and Neck Defects
Authors: Loh Charles Yuen Yung , Shanmugakrishnan R. Raja , Nizamoglu Metin , Tan Alethea , Duarte Marco , Khan Waseem Ullah , El-Muttardi Naguib
Published: September 2018

The superficial temporal artery (STA) flap is a versatile flap for head and neck defect reconstruction. It can be based on the frontal branch of the STA and an islanded 360-degree rotation arc for various defects on the scalp, cheek, and auricular region. It provides a nonmicrosurgical option for reconstructing such defects, which is itself relatively easy to perform. However, venous congestion is a problem than often can cause worry to the clinician and hence preclude its use. In this review, we revisit this flap in head and neck reconstruction, with case examples used for reconstruction of defects on the scalp, maxilla, lip, ear, and retroauricular area. The STA flap in our review can be used either as a fasciocutaneous flap or with its fascia alone. The main issue with the STA flap is that it is generally a high-inflow flap with variable outflow. Venous congestion is frequently encountered in our practice, and adequate management of the venous drainage in the postoperative period is crucial in ensuring its success as a versatile and viable option for head and neck reconstruction.
Nasal Reconstruction
Authors: Fernandes Justin R. , Pribaz Julian J. , Lim Alan A. , Guo Lifei
Published: September 2018

The nose, with its conspicuous location, intricate convexities, and delicate 3-dimensional structure, continues to challenge the reconstructive surgeon. Today, there are a myriad of options available for reconstruction. The practitioner must take into account the location of the defect as well as the components needed to be restored. This article addresses the current practices in nasal reconstruction, including the different strategies for skin coverage, nasal lining, and structural support. We discuss both the newest techniques as well as basic principles of this long-standing procedure.
Body Wall Reconstruction for Conjoined Twins
Authors: Wu Shun , Guo Ke , Xiao Peng , Yang Jie , Sun Jiaming
Published: September 2018

Background

Conjoined twinning is a rare congenital malformation, and the resultant huge body wall defects after separation of conjoined twins represent a real challenge to surgeons.

Methods

From 2004 to 2009, authors performed body wall reconstruction for 2 pairs of thoraco-omphalopagus twins and 1 pair of ischiopagus tetrapus twins. Before separation, the techniques of tissue expansion and tractive training were adopted to acquire sufficient skin for final coverage. After separation, the defects of thoracic cage and abdominal myofascial system were repaired with synthetic materials. The closure of the wounds was performed with artificial skin temporarily or by the use of local flaps in 1 stage.

Results

The first pair of thoraco-omphalopagus twins died of circulatory and respiratory failure after emergency surgery, and the other 2 pairs of conjoined twins survived. The second pair of thoraco-omphalopagus twins had wound dehiscence and partial flap necrosis after surgery. The expanded polytetrafluoroethylene mesh in 1 sister of the ischiopagus twins was removed because of local infection 4 years after surgery.

Conclusions

Compressive anatomical understandings and advanced skills in plastic surgery are required for body wall reconstruction in the separation of conjoined twins. In addition, the multidisciplinary team approach has an important role for obtaining satisfactory final surgical outcome.
Effect of Posthospital Syndrome on Health Care Utilization After Abdominal Contouring Surgery
Authors: Swiatek Peter R. , Johnson Shepard P. , Wang Lu , Liu Mochuan , Chung Ting-Ting , Chung Kevin C.
Published: September 2018

Background

Posthospital syndrome (PHS) is a transient condition after acute hospitalizations when patients are physiologically deconditioned. The objective of this study was to determine if having PHS at the time of abdominal contouring surgery increased the incidence of postoperative adverse medical events.

Methods

We conducted a retrospective cohort study of patients enrolled in the MarketScan Databases who underwent outpatient functional or cosmetic abdominal contouring surgery (ie, abdominoplasty, liposuction, or panniculectomy) from April 2010 to August 2015. Patients were separated into 2 groups based upon PHS exposure, defined by hospitalization within 90 days before surgery. Differential health care utilization within 30 days after surgery was compared between cohorts.

Results

Among the 18,947 patients included in the final cohort, 1045 patients (6%) had PHS at the time of abdominal contouring surgery. Patients with PHS experienced more emergency department visits (0.16 vs 0.08 visits; adjusted odds ratio, 1.60; P < 0.001) and more episodes of hospitalization (0.11 vs 0.04 episodes; adjusted odds ratio, 1.70; P < 0.001) within 30 days postoperatively. The mean unadjusted health care utilization after abdominal contouring surgery for patients with PHS was US $7888 (SD, 17,659) versus US $2943 (SD, 9096) in patients without PHS. After controlling for confounders, such as comorbidity burden, PHS was associated with US $3944 greater cost than patients without PHS (P < 0.001).

Conclusions

Among patients undergoing outpatient abdominal contouring surgery, having PHS increased the incidence of adverse medical events requiring medical attention in the 30-day postoperative period. These findings support the inclusion of PHS in preoperative evaluation and preparation for patients seeking abdominal contouring surgery.
Vascularized Fibula Epiphysis Transfer for Pediatric Extremity Reconstruction
Authors: Kurlander David E. , Shue Shirley , Schwarz Graham S. , Ghaznavi Amir M.
Published: September 2018

Background

Vascularized fibula epiphysis transfer for pediatric extremity reconstruction intends to preserve growth potential. However, few cases are reported, and outcomes are poorly characterized.

Methods

Systematic review was performed through a MEDLINE search using keywords “pediatric” or “epiphyseal” and “vascularized fibula.” Patients were divided into upper extremity or lower extremity groups. Functional and growth outcomes were assessed, and indications, pedicle, complications, and need for secondary surgery were recorded.

Results

Twenty publications with 62 patients were included. Mean age was 5.9 years, and mean follow-up was 5.8 years. Indications included sarcoma (60%), congenital deformity (21%), trauma (13%), and infection (6%). Anterior tibial pedicle was most common (63%) and was associated with significantly improved growth outcomes compared with the peroneal pedicle (23%; P < 0.001). Fifty-three patients underwent upper extremity reconstruction, with the most common complication being fracture (35%) and most common secondary surgery flap salvage (7%). Among upper extremity patients, full function was achieved in 25% and impaired function in 75%. Full growth was observed in 63% of patients, partial growth in 31%, and no growth in 4%. Nine patients underwent lower extremity reconstruction, with the most common complication being fracture (22%) and most common secondary surgery derotational osteotomy (22%). Among lower extremity patients, full function was achieved in 44% and impaired function in 56%. Full growth was observed in 56% of patients, partial growth in 22%, and no growth in 22%.

Conclusions

Vascularized fibula epiphysis transfer can accomplish full long-term growth and function. However, complications, revision surgery, and chronic impairment are common.
Patient-specific 3D Printing
Authors: Chandak Pankaj , Byrne Nicholas , Coleman Andrew , Karunanithy Narayan , Carmichael Jim , Marks Stephen D. , Stojanovic Jelena , Kessaris Nicos , Mamode Nizam
Published: September 2018

Objective:

The authors investigated a novel application of patient-specific three-dimensional (3D) printing, to enhance preoperative, multidisciplinary planning in complex, living-donor pediatric renal transplantation.

Summary Background Data:

For children with end-stage kidney disease, the transplantation of adult-sized, living-donor kidneys into small recipients (<20 kg) with increasingly complex structural anomalies can be difficult. Establishing the operative feasibility in such cases demands a surgical understanding of anatomy to be derived from medical imaging. However, this is hampered by the representation of complex structures in 2D, the inherent interpretive expertise this demands, and the challenge of conveying this appreciation to others.

Methods:

We report the novel use of patient-specific 3D printed models to achieve personalized management for 3 children who underwent living-donor renal transplantation. Each presented a unique surgical challenge that would otherwise prevent preoperative determination of transplantation feasibility. Patient-specific geometries were segmented from imaging data and fabricated using polyjet, 3D printing technology. Models were verified by an expert radiologist and presented during multidisciplinary discussion and surgical simulation.

Results:

3D printed models enhanced preoperative deliberation and surgical simulation and allowed on-table exploration of a small child to be avoided. We have critically determined specific clinical indications, technical insights, limitations, and outcomes of this approach. At latest follow-up (>16 mo) all patients remain well with functioning renal allografts.

Conclusions:

We report the new and safe integration of patient-specific 3D printing into complex pediatric renal transplantation. This technique enhances surgical planning and can inform operative feasibility in those cases which would otherwise be uncertain.
Circulating Tumor Cells are an Independent Predictor of Shorter Survival in Patients Undergoing Resection for Pancreatic and Periampullary Adenocarcinoma
Authors: Hugenschmidt Harald , Labori Knut Jørgen , Brunborg Cathrine , Verbeke Caroline Sophie , Seeberg Lars Thomas , Schirmer Cecilie Bendigtsen , Renolen Anne , Borgen Elin Faye , Naume Bjørn , Wiedswang Gro
Published: September 2018

Objective:

We evaluated the prognostic impact of circulating tumor cells (CTCs) for patients with presumed resectable pancreatic and periampullary cancers.

Summary of Background Data:

Initial treatment decisions for this group are currently taken without a reliable prognostic marker. The CellSearch system allows standardized CTC-testing and has shown excellent specificity and prognostic value in other applications.

Methods:

Preoperative blood samples from 242 patients between September 2009 and December 2014 were analyzed. One hundred seventy-nine patients underwent tumor resection, of whom 30 with stage-I tumors and duodenal cancer were assigned to the low-risk group, and the others to the high-risk group. Further 33 had advanced disease, 30 benign histology. Observation ended in December 2016. Cancer-specific survival (CSS) and disease-free survival (DFS) were calculated by log-rank and Cox regression.

Results:

CTCs (CTC-positive; ≥1 CTC/7.5 mL) were detected in 6.8% (10/147) of the high-risk patients and 6.2% (2/33) with advanced disease. No CTCs (CTC-negative) were detected in the low-risk patients or benign disease. In high-risk patients, median CSS for CTC-positive versus CTC-negative was 8.1 versus 20.0 months (P < 0.0001), and DFS 4.0 versus 10.5 months (P < 0.001). Median CSS in advanced disease was 7.7 months. Univariate hazard ratio (HR) of CTC-positivity was 3.4 (P < 0.001). In multivariable analysis, CTC-status remained independent (HR: 2.4, P = 0.009) when corrected for histological type (HR: 2.7, P = 0.030), nodal status (HR: 1.7, P = 0.016), and vascular infiltration (HR: 1.7, P = 0.001).

Conclusion:

Patients testing CTC-positive preoperatively showed a detrimental outcome despite successful tumor resections. Although the low CTC-rate seems a limiting factor, results indicate high specificity. Thus, preoperative analysis of CTCs by this test may guide treatment decisions and warrants further testing in clinical trials.
Clinical Outcome After Rectal Replacement With Side-to-End, Colon-J-Pouch, or Straight Colorectal Anastomosis Following Total Mesorectal Excision
Authors: Marti Walter R. , Curti Gaudenz , Wehrli Heinz , Grieder Felix , Graf Michael , Gloor Beat , Zuber Markus , Demartines Nicolas , Fasolini Fabrizio , Lerf Bruno , Kettelhack Christoph , Andrieu Christiane , Bigler Martin , Hayoz Stefanie , Ribi Karin , Hamel Christian
Published: September 2018

Objective:

To compare, in a phase 3, prospective, randomized, multi-center clinical trial functional outcome of reconstruction procedures following total mesorectal excision (TME).

Summary Background Data:

Intestinal continuity reconstruction following TME is accompanied by postoperative defecation dysfunctions known as “anterior resection syndrome.” Commonly used reconstruction techniques are straight colorectal anastomosis (SCA), colon J -pouch (CJP), and side-to-end anastomosis (SEA). Comparison of their functional outcomes in prospective, randomized, multi-center studies, including long-term assessments, is lacking.

Methods:

Patients requiring TME for histologically proven rectal tumor, with or without neoadjuvant treatment, age ≥ 18 years, normal sphincter function without history of incontinence, any pretreatment staging or adenoma, expected R0-resection, were randomized for standardized SCA, CJP, or SEA procedures. Primary endpoint was comparison of composite evacuation scores 12 months after TME. Comparison of composite evacuation and incontinence scores at 6, 18 and 24 months after surgery, morbidity, and overall survival represented secondary endpoints. Analysis was based on “per protocol” (PP) population, fully complying with trial requirements, and intention-to treat (ITT) population.

Results:

Three hundred thirty-six patients from 15 hospitals were randomized. PP population included 257 patients (JCP = 63; SEA = 95; SCA = 99). Composite evacuation scores of PP and ITT populations did not show statistically significant differences among the 3 groups at any time point. Similarly, composite incontinence scores for PP and ITT populations showed no statistically significant difference among the 3 trial arms at any time point.

Conclusions:

Within boundaries of investigated procedures, surgeons in charge may continue to perform reconstruction of intestinal continuity following TME at their technical preference.
The Learning Curve for Surgeons Regarding Endoscopic Thyroidectomy via the Oral-vestibular Approach
Authors: Qu Rui , Wang Jianxue , Li Jinyi , Dong Zhiyong , Yang Jingge , Liu Daosheng , Wang Cunchuan
Published: September 2018

Background:

For selected patients, endoscopic thyroidectomy via the oral-vestibular approach (ETOVA) can be used to achieve a very good esthetic effect. This study aimed to assess the learning curve for ETOVA and identify improvements.

Patients and Methods:

This retrospective study evaluated the outcomes of 101 patients who underwent ETOVA by surgeons A and B. The patients were classified according to whether they had undergone surgery during the primary or advanced stage of the learning curve, respectively. Proficiency with the procedure in various types of cases and the operation time, operative blood loss, hospital stay length, and postoperative complications were analyzed.

Results:

In total, 56 and 45 patients were treated by surgeons A and B, respectively. For both surgeons, the operation times decreased considerably after 20 cases. Statistically significant differences with respect to stage were observed in terms of operation time (P<0.05) and drainage tube reservation (P<0.05). By contrast, significant differences were not observed between stages in terms of operative blood loss (P>0.05) or postoperative hospital stay length (P>0.05). The total postoperative complication rate was low and comparable with that of open surgery.

Conclusions:

The specific learning curve identified for ETOVA suggests that surgeons with sufficient endoscopic surgery experience could achieve a stable proficiency after ∼20 cases. A standardized training program and exposure to more cases would reduce the learning curve.
Comparison of Efficacy of Laparoscopic and Open Splenectomy Combined With Selective and Nonselective Pericardial Devascularization in Portal Hypertension Patients
Authors: Chen Hao , Yang Fang , Li Ting-ting , Zhang Ke-nan , Sun Zhen-gang , Yu Chun-zhao , Sun Yuan
Published: September 2018

Background:

Recent advances in laparoscopic techniques have demonstrated that laparoscopy is superior for managing portal hypertension. This study aimed to compare the efficacy of laparoscopic splenectomy plus selective pericardial devascularization (LSSD) and open splenectomy and nonselective pericardial devascularization (OSD) in patients with portal hypertension.

Methods:

A total of 127 patients with portal hypertension underwent either LSSD or OSD at Jingzhou Central Hospital from January 2014 to December 2016. A total of, 55 patients received LSSD, including 29 male and 26 female individuals (age, 56.0±11.6 y); 72 patients received OSD, including 45 male and 27 female individuals (age, 53.4±10.9 y). The parameters of operation and outcomes were measured and compared.

Results:

Intraoperative blood loss, postoperative complications, and hospital stay were significantly lower in LSSD group but operation time was significantly lower in OSD group. Postoperative Child-Pugh score was significantly lower in LSSD group than in OSD group.

Conclusions:

LSSD is a safe and effective treatment for liver cirrhosis patients with portal hypertension.
Use of Ultrasound Urodynamics to Identify Differences in Bladder Shape Between Individuals With and Without Overactive Bladder
Authors: Glass Clark Stephanie , Nagle Anna S. , Bernardo Rachel , Vinod Naomi , Carucci Laura , Carroll Ashley , Speich John , Klausner Adam P.
Published: September 2018

Objectives

The objective of this study was to identify differences in bladder shape changes between individuals with overactive bladder (OAB) and unaffected individuals during ultrasound urodynamics.

Methods

A prospective urodynamic study was performed with concurrent transabdominal ultrasound (ultrasound urodynamics) on individuals with and without OAB based on validated International Consultation on Incontinence Questionnaire - OAB survey scores. Three-dimensional ultrasound images were acquired at 1-minute increments during filling and used to measure bladder diameters in the height, width, and depth orientations. The engineering strain for each diameter was compared between participants with OAB and controls during urodynamic filling. The height-to-width ratio at capacity was used to determine if individuals were shape outliers.

Results

A total of 22 subjects were enrolled, including 11 with OAB and 11 without OAB. During urodynamic filling in both groups, the greatest degree of geometric strain was found in the height orientation, indicating that bladders generally fill in a craniocaudal shape. The mean ± SD height-to-width ratio of the control group was 1.06 ± 0.12 yielding a 95% confidence interval of 0.82 to 1.30. Five (45.5%) of 11 OAB subjects had height-to-width ratios outside this interval as compared with none of the control subjects, identifying a potential shape-mediated subgroup of OAB.

Conclusions

Three-dimensional ultrasound urodynamics can be used to identify differences in bladder shape comparing individuals with and without OAB. This method may be used to identify a subset of OAB patients with abnormal bladder shapes which may play a role in the pathophysiology of their OAB symptoms.
To shunt or not to shunt in combined orthopedic and vascular extremity trauma
Authors: Wlodarczyk Jordan R. , Thomas Alexander S. , Schroll Rebecca , Campion Eric M. , Croyle Caroline , Menaker Jay , Bradley Matthew , Harvin John A. , Collum Morgan L. , Cho Jayin , Seamon Mark J. , Leonard Jennifer , Tiller Michael , Inaba Kenji , Moore Margaret M.
Published: September 2018

BACKGROUND

There exists a long established but not validated practice of placing temporary intravascular shunts (TIVS) in cases of combined vascular and orthopedic extremity trauma. Though logical to prioritize blood flow, large-scale data to support this practice is lacking. We hypothesize that the order of repair yields no difference in outcomes in combined vascular and orthopedic extremity trauma and offer a larger-scale analysis than is previously available.

METHODS

A retrospective chart review was conducted at six Level I trauma centers from 2004 to 2015 comparing patients who received a TIVS during their initial surgery versus those who did not. Nonshunted patients were further divided into initial definitive vascular repair versus initial orthopedic fixation groups. Metrics were used to control for sampling bias while revision rate, amputation, hospital length of stay (HLOS), and development of thrombosis and compartment syndrome were used to assess outcomes.

RESULTS

Of 291 total patients, 72 had TIVS placement, 97 had initial definitive vascular repair, and 122 had initial orthopedic fixation. The shunted group had a higher Abbreviated Injury Scale (3.0 vs. 2.8 p = 0.04) and Mangled Extremity Severity Score (6.1 vs. 5.7 p = 0.006) and a significantly lower rate of compartment syndrome (15% vs. 34% p = 0.002). Among patients who developed compartment syndrome, those who were shunted were younger (23 vs. 35 yrs, p = 0.03) and were more likely sustain a penetrating injury (p = 0.007). Those receiving initial orthopedic fixation had a longer HLOS (HLOS >15 days in 61% vs. 38%, p = 0.049) and a higher amputation rate (20% vs. 7%, p = 0.006) when compared with those undergoing initial definitive vascular repair.

CONCLUSION

Lack of TIVS was associated with a significant increase in the development of compartment syndrome. Though it seems to have become common practice to proceed directly to vascular repair during the initial surgery, morbidity is improved with the placement of a TIVS.

LEVEL OF EVIDENCE

Therapeutic cohort, level III.
Traumatic rectal injuries: Is the combination of computed tomography and rigid proctoscopy sufficient?
Authors: Trust Marc D. , Veith Jacob , Brown Carlos V.R. , Sharpe John P. , Musonza Tashinga , Holcomb John , Bui Eric , Bruns Brandon , Andrew Hopper H. , Truitt Michael , Burlew Clay , Schellenberg Morgan , Sava Jack , Vanhorn John , Eastridge Brian , Cross Alicia M. , Vasak Richard , Vercuysse Gary , Curtis Eleanor E. , Haan James , Coimbra Raul , Bohan Phillip , Gale Stephen , Bendix Peter G.
Published: September 2018

BACKGROUND

There are no clear guidelines for the best test or combination of tests to identify traumatic rectal injuries. We hypothesize that computed tomography (CT) and rigid proctoscopy (RP) will identify all injuries.

METHODS

American Association for the Surgery of Trauma multi-institutional retrospective study (2004–2015) of patients who sustained a traumatic rectal injury. Patients with known rectal injuries who underwent both CT and RP as part of their diagnostic workup were included. Only patients with full thickness injuries (American Association for the Surgery of Trauma grade II-V) were included. Computed tomography findings of rectal injury, perirectal stranding, or rectal wall thickening and RP findings of blood, mucosal abnormalities, or laceration were considered positive.

RESULTS

One hundred six patients were identified. Mean age was 32 years, 85(79%) were male, and 67(63%) involved penetrating mechanisms. A total of 36 (34%) and 100 (94%) patients had positive CT and RP findings, respectively. Only 3 (3%) patients had both a negative CT and negative RP. On further review, each of these three patients had intraperitoneal injuries and had indirect evidence of rectal injury on CT scan including pneumoperitoneum or sacral fracture.

CONCLUSION

As stand-alone tests, neither CT nor RP can adequately identify traumatic rectal injuries. However, the combination of both test demonstrates a sensitivity of 97%. Intraperitoneal injuries may be missed by both CT and RP, so patients with a high index of suspicion and/or indirect evidence of rectal injury on CT scan may necessitate laparotomy for definitive diagnosis.

LEVEL OF EVIDENCE

Diagnostic, level IV.
The Efficiency of Evaluating Candidates for Living Kidney Donation: A Scoping Review
Authors: Habbous Steven , Woo Justin , Lam Ngan N. , Lentine Krista L. , Cooper Matthew , Reich Marian , Garg Amit X.
Published: September 2018

Introduction

The process of evaluating candidates for living kidney donation can be inefficient. A structured review of existing information on this topic can provide a necessary foundation for quality improvement.

Methods

We conducted a scoping review to map the published literature to different themes related to an efficient donor candidate evaluation. We reviewed the websites of living donor programs to describe information provided to candidates about the nature and length of the evaluation process.

Results

We reviewed of 273 published articles and 296 websites. Surveys of living donor programs show variability in donor evaluation protocols. Computed tomography (a routinely done test for all successful candidates) may be used to assess split renal volume instead of nuclear renography when the 2 kidneys differ in size. Depending on the candidate’s estimated glomerular filtration rate, a nuclear medicine scan for measured glomerular filtration rate may not be needed. When reported, the time to complete the evaluation varied from 3 months to over a year. The potential for undesirable outcomes was reported in 23 studies, including missed opportunities for living donation and/or preemptive transplants. According to living donor websites, programs generally evaluate 1 candidate at a time when multiple come forward for assessment, and few programs describe completing most of the evaluation in a single in-person visit.

Conclusions

Data on the efficiency of the living donor evaluation are limited. Future efforts can better define, collect, and report indicators of an efficient living donor evaluation to promote quality improvement and better patient outcomes.
Optic Perineuritis Due to Tuberculosis
Authors: Yates William B. , Nothling Simon , Lawlor Mitchell
Published: September 2018

A 30-year-old man experienced subacute peripheral visual field loss with preserved central vision in his right eye. He was diagnosed with optic perineuritis due to tuberculosis. Optic perineuritis is an uncommon disorder and, at times, can be difficult to distinguish from optic neuritis. The differentiation can have significant impact on diagnostic testing and patient management.
EEG Reactivity Evaluation Practices for Adult and Pediatric Hypoxic-Ischemic Coma Prognostication in North America
Authors: Amorim Edilberto , Gilmore Emily J. , Abend Nicholas S. , Hahn Cecil D. , Gaspard Nicolas , Herman Susan T. , Hirsch Lawrence J. , Lee Jong Woo , Cash Sydney S. , Westover M. Brandon ,   on behalf of the Critical Care EEG Monitoring Consortium (CCEMRC)
Published: September 2018

Purpose:

The aim of this study was to assess the variability in EEG reactivity evaluation practices during cardiac arrest prognostication.

Methods:

A survey of institutional representatives from North American academic hospitals participating in the Critical Care EEG Monitoring Research Consortium was conducted to assess practice patterns involving EEG reactivity evaluation. This 10-question multiple-choice survey evaluated metrics related to technical, interpretation, personnel, and procedural aspects of bedside EEG reactivity testing and interpretation specific to cardiac arrest prognostication. One response per hospital was obtained.

Results:

Responses were received from 25 hospitals, including 7 pediatric hospitals. A standardized EEG reactivity protocol was available in 44% of centers. Sixty percent of respondents believed that reactivity interpretation was subjective. Reactivity bedside testing always (100%) started during hypothermia and was performed daily during monitoring in the majority (71%) of hospitals. Stimulation was performed primarily by neurodiagnostic technologists (76%). The mean number of activation procedures modalities tested was 4.5 (SD 2.1). The most commonly used activation procedures were auditory (83.3%), nail bed pressure (63%), and light tactile stimuli (63%). Changes in EEG amplitude alone were not considered consistent with EEG reactivity in 21% of centers.

Conclusions:

There is substantial variability in EEG reactivity evaluation practices during cardiac arrest prognostication among North American academic hospitals. Efforts are needed to standardize protocols and nomenclature according with national guidelines and promote best practices in EEG reactivity evaluation.
Frugivores and the evolution of fruit colour
Authors: Nevo Omer , Valenta Kim , Razafimandimby Diary , Melin Amanda D. , Ayasse Manfred , Chapman Colin A.
Published: September 2018

The ecological function of fruit colour has been the focus of many studies. The most commonly tested hypothesis is that fruit colour has evolved to facilitate detection by seed-dispersing animals. We tested whether distributions of fruit colours are consistent with the hypothesis that colour is an evolved signal to seed dispersers using a comparative community approach. We compared the contrast between ripe fruits and leaf backgrounds at two sites, one in Madagascar where seed dispersers are primarily night-active, red–green colour-blind lemurs, and the other in Uganda, where most vertebrate seed dispersers are day-active primates and birds with greater capacity for colour vision. We show that fruits in Uganda have higher contrast against leaf background in the red–green and luminance channels whereas fruits in Madagascar contrast more in the yellow–blue channel. These results indicate that fruit colour has evolved to contrast against background leaves in response to the visual capabilities of local seed disperser communities.
Vision fine-tunes preparation for landing in the cane toad,Rhinella marina
Authors: Ekstrom Laura J. , Panzini Chris , Gillis Gary B.
Published: September 2018

In toad hopping, the hindlimbs generate the propulsive force for take-off while the forelimbs resist the impact forces associated with landing. Preparing to perform a safe landing, in which impact forces are managed appropriately, likely involves the integration of multiple types of sensory feedback. In toads, vestibular and/or proprioceptive feedback is critical for coordinated landing; however, the role of vision remains unclear. To clarify this, we compare pre-landing forelimb muscle activation patterns before and after removing vision. Specifically, we recorded EMG activity from two antagonistic forelimb muscles, the anconeus and coracoradialis, which demonstrate distance-dependent onset timing and recruitment intensity, respectively. Toads were first recorded hopping normally and then again after their optic nerves were severed to remove visual feedback. When blind, toads exhibited hop kinematics and pre-landing muscle activity similar to when sighted. However, distance-dependent relationships for muscle activity patterns were more variable, if present at all. This study demonstrates that blind toads are still able to perform coordinated landings, reinforcing the importance of proprioceptive and/or vestibular feedback during hopping. But the increased variability in distance-dependent activity patterns indicates that vision is more responsible for fine-tuning the motor control strategy for landing.
Carotenoid-based skin ornaments reflect foraging propensity in a seabird,Sula leucogaster
Authors: Michael Nathan P. , Torres Roxana , Welch Andreanna J. , Adams Josh , Bonillas-Monge Mario Erandi , Felis Jonathan , Lopez-Marquez Laura , Martínez-Flores Alejandro , Wiley Anne E.
Published: September 2018

Carotenoid-based ornaments are common signalling features in animals. It has long been proposed that such ornaments communicate information about foraging abilities to potential mates. However, evidence linking foraging with ornamentation is largely missing from unmanipulated, free-ranging populations. To investigate this relationship, we studied a coastal population of brown booby (Sula leucogaster brewsteri), a seabird with a carotenoid-based gular skin ornament.δ13C values from both feathers and blood plasma were negatively correlated with male gular colour, indicating birds that consumed more pelagic prey in offshore locations had more ornamented skin than those that fed on nearshore, benthic prey. This relationship was supported by our GPS tracking results, which revealed longer, more offshore foraging trips among highly ornamented males. Our data show that brown booby ornaments are honest indicators of foraging propensity; a link consistent with the rarity hypothesis and potentially driven by the concentration of carotenoids found in phytoplankton versus benthic algae. Carotenoid-based ornaments may reflect foraging tendencies in animals such as coastal predators that use food webs with distinct carotenoid profiles.
Higher divorce risk when mates are plentiful? Evidence from Denmark
Authors: Uggla Caroline , Andersson Gunnar
Published: September 2018

Work from social and biological sciences has shown that adult sex ratios are associated with relationship behaviours. When partners are abundant, opportunities for mate switching may increase and relationship stability decrease. To date, most of the human literature has used regional areas at various levels of aggregation to define partner markets. But, in developed countries, many individuals of reproductive age spend a considerable amount of time outside their residential areas, and other measures may better capture the opportunities to meet a (new) partner. Here, we use Danish register data to test whether the sex ratio of the occupational sector is linked to divorce. Our data cover individuals in Denmark who married during 1981–2002 and we control for age at and duration of marriage, education and parity. Results support the prediction that a higher proportion of opposite-sex individuals in one's occupational sector is associated with higher divorce risk. This holds for both men and women, but associations are somewhat stronger for men and vary by education. Our results highlight the need to study demographic behaviours of men and women simultaneously, and to consider partner markets beyond geographical areas so that differing strategies for males and females may be examined.
Comparing chimpanzees' preparatory responses to known and unknown future outcomes
Authors: Lambert Megan L. , Osvath Mathias
Published: September 2018

When humans plan for the future, we recognize not only that one particular event may occur, but that the future can have different, mutually exclusive possible outcomes. A recent study by Suddendorf
et al
. (Suddendorf 2017
Biol. Lett.
13
, 20170170 (
doi:10.1098/rsbl.2017.0170
)) suggests that young children (less than 3 years) and apes lack this capacity, as demonstrated by their failure to cover each of two tube openings to ensure catching an object that would drop randomly from one of the tubes. Before drawing conclusions based on these negative results, however, it is important to assess subjects’ failures and test the reliability of the task itself. To explore whether the apes' performance resulted from an inability to represent mutually exclusive futures or from extraneous factors related to the task, we replicated the methods of Suddendorf
et al
. (Suddendorf 2017
Biol. Lett.
13
, 20170170 (
doi:10.1098/rsbl.2017.0170
)) with a group of six chimpanzees but included a key control condition in which subjects were expected to cover both tubes on every trial (i.e. the rewards would consistently emerge from both tubes). We show that even in this straightforward condition in which the outcome of the trial was known, only four of the six subjects ever covered both tubes, typically doing so after a minimum of 17 trials, and often reverting back to covering one tube on later trials. We conclude that this task is not valid for testing the ability to represent mutually exclusive futures. We discuss what potential factors may explain the results and outline a new suggested method to continue testing for this capacity in the future.
Body and tail-assisted pitch control facilitates bipedal locomotion in Australian agamid lizards
Authors: Clemente Christofer J. , Wu Nicholas C.
Published: September 2018

Certain lizards are known to run bipedally. Modelling studies suggest bipedalism in lizards may be a consequence of a caudal shift in the body centre of mass, combined with quick bursts of acceleration, causing a torque moment at the hip lifting the front of the body. However, some lizards appear to run bipedally sooner and for longer than expected from these models, suggesting positive selection for bipedal locomotion. While differences in morphology may contribute to bipedal locomotion, changes in kinematic variables may also contribute to extended bipedal sequences, such as changes to the body orientation, tail lifting and changes to the ground reaction force profile. We examined these mechanisms among eight Australian agamid lizards. Our analysis revealed that angular acceleration of the trunk about the hip, and of the tail about the hip were both important predictors of extended bipedal running, along with increased temporal asymmetry of the ground reaction force profile. These results highlight important dynamic movements during locomotion, which may not only stabilize bipedal strides, but also to de-stabilize quadrupedal strides in agamid lizards, in order to temporarily switch to, and extend a bipedal sequence.
Cell-resolved blood flow simulations of saccular aneurysms: effects of pulsatility and aspect ratio
Authors: Czaja B. , Závodszky G. , Azizi Tarksalooyeh V. , Hoekstra A. G.
Published: September 2018

We study the effect of pulsatile flow on the transport of red blood cells (RBCs) and platelets into aneurysm geometries with varying dome-to-neck aspect ratios (AR). We use a validated two-dimensional lattice Boltzmann model for blood plasma with a discrete element method for both RBCs and platelets coupled by the immersed boundary method. Flow velocities and vessel diameters were matched with measurements of cerebral perforating arteries and flow was driven by a synthetic heartbeat curve typical for such vessel sizes. We observe a flow regime change as the aspect ratio increases from a momentum-driven regime in the small aspect ratio to a shear-driven regime in the larger aspect ratios. In the small aspect ratio case, we see the development of a re-circulation zone that exhibits a layering of high (greater than or equal to 7 s) and low (less than 7 s) residence cells. In the shear-driven regime, we see high and low residence cells well mixed, with an increasing population of cells that are trapped inside the aneurysm as the aspect ratio increases. In all cases, we observe aneurysms that are platelet-rich and red blood cell-poor when compared with their respective parental vessel populations. Pulsatility also plays a role in the small aspect ratio as we observe a smaller population of older trapped cells along the aneurysm wall in the pulsatile case when compared with a steady flow case. Pulsatility does not have a significant effect in shear-driven regime aspect ratios.
Multiscale impact of researcher mobility
Authors: Petersen Alexander M.
Published: September 2018

International mobility facilitates the exchange of scientific, institutional and cultural knowledge. Yet whether globalization and advances in virtual communication technologies have altered the impact of researcher mobility is a relevant and open question that we address by analysing a broad international set of 26 170 physicists from 1980 to 2009, focusing on the 10-year period centred around each mobility event to assess the impact of mobility on research outcomes. We account for secular globalization trends by splitting the analysis into three periods, measuring for each period the effect of mobility on researchers' citation impact, research topic diversity, collaboration networks and geographical coordination. In order to identify causal effects we leverage statistical matching methods that pair mobile researchers with non-mobile researchers that are similar in research profile attributes prior the mobility event. We find that mobile researchers gain up to a 17% increase in citations relative to their non-mobile counterparts, which can be explained by the simultaneous increase in their diversity of co-authors, topics and geographical coordination in the period immediately following migration. Nevertheless, we also observe that researcher's completely curtail prior collaborations with their source country in 11% of the cross-border mobility events. As such, these individual-level perturbations fuel multiscale churning in scientific networks, e.g. rewiring the connectivity of individuals and ideas and affecting international integration. Together these results provide additional clarity on the complex relationship between human capital mobility and the dynamics of social capital investment, with implications for immigration and national innovation system policy.
Ar–Ar dating for hydrothermal quartz from the 2.4 Ga Ongeluk Formation, South Africa: implications for seafloor hydrothermal circulation
Authors: Saito Takuya , Qiu Hua-Ning , Shibuya Takazo , Li Yi-Bing , Kitajima Kouki , Yamamoto Shinji , Ueda Hisahiro , Komiya Tsuyoshi , Maruyama Shigenori
Published: September 2018

Fluid inclusions in hydrothermal quartz in the 2.4 Ga Ongeluk Formation, South Africa, are expected to partially retain a component of the ancient seawater. To constrain the origin of the fluid and the quartz precipitation age, we conducted Ar–Ar dating for the quartz via a stepwise crushing method. The obtained argon isotopes show two or three endmembers with one or two binary mixing lines as the crushing proceeds, suggesting that the isotopic compositions of these endmembers correspond to fluid inclusions of each generation, earlier generated smaller
40
Ar- and K-rich inclusions, moderate
40
Ar- and
38
Ar
Cl
(neutron-induced
38
Ar from Cl)-rich inclusions and later generated larger atmospheric-rich inclusions. The K-rich inclusions show significantly different
40
Ar/
38
Ar
Cl
values compared to the
38
Ar
Cl
-rich inclusions, indicating that it is difficult to constrain the quartz formation age using only fluid inclusions containing excess
40
Ar. The highest obtained
40
Ar/
36
Ar value from the fluid inclusions is consistent with an expected value of the Ongeluk plume source, suggesting that the quartz precipitation was driven by Ongeluk volcanism. Considering the fluid inclusion generations and their compositions, the hydrothermal system was composed of crustal fluid and magmatic fluid without seawater before the beginning of a small amount of seawater input to the hydrothermal system.
Automatic adaptation of model neurons and connections to build hybrid circuits with living networks
Authors: Reyes-Sanchez Manuel , Amaducci Rodrigo , Elices Irene , Rodríguez Francisco B. , Varona Pablo
Published: September 2018

Hybrid circuits built by creating mono- or bi-directional interactions among living cells and model neurons and synapses are an effective way to study neuron, synaptic and neural network dynamics. However, hybrid circuit technology has been largely underused in the context of neuroscience studies mainly because of the inherent difficulty in implementing and tuning this type of interactions. In this paper, we present a set of algorithms for the automatic adaptation of model neurons and connections in the creation of hybrid circuits with living neural networks. The algorithms perform model time and amplitude scaling, drift compensation, goal-driven synaptic and model tuning/calibration and also automatic parameter mapping. These algorithms have been implemented in RTHybrid, an open-source library that works with hard real-time constraints. We provide validation examples by building hybrid circuits in a central pattern generator. The results of the validation experiments show that the proposed dynamic adaptation facilitates building hybrid circuits and closed-loop communication among living and artificial model neurons and connections. Furthermore contributes to characterize system dynamics, achieve control, automate experimental protocols and extend the lifespan of the preparations.