bluuebunny/crossref_metadata_2025 huggingface dataset:
Blepharoplasty
Authors: Grob Seanna R. , Park D. J. John
Published: July 2019

Upper and lower blepharoplasties are some of the most common cosmetic surgical procedures. The eyelids function in ocular protection and lubrication and are capable of expressing a wide range of emotions in nonverbal communication. As such, the goals of surgery are to impart a natural rejuvenated appearance with adequate symmetry while preserving the normal function of the eyelids. Patients seeking blepharoplasty can present with any number of chief complaints that can be categorized as functional or aesthetic in nature. The two are, however, intimately intertwined and the surgeon must consider both the function and appearance of the eyelids. Herein, we discuss various approaches to the clinical management of patients for blepharoplasty, including preoperative evaluation, operative approaches, and postoperative care.
Traumatic Total or Partial Ear Loss
Authors: Bourgeois Jenna Martin , Hurvitz Keith A.
Published: July 2019

Total or partial ear loss injuries remain commonplace in society, and proper management is the key to a successful outcome. Acquired ear defects are becoming increasingly more common following trauma, which can include motor vehicle accidents, assaults, and workplace injuries. Reconstruction of the external ear following traumatic amputation remains an extremely challenging procedure for plastic surgeons. This chapter covers the intricacies of managing these deformities. It outlines the initial assessment of the injured patient followed by a review of the available operative techniques. After reading this chapter, the reader will have a better appreciation for managing patients presenting with traumatic total or partial ear loss.
Microneurovascular Reconstruction for Facial Reanimation
Authors: Klebuc Michael
Published: July 2019

Microneurovascular muscle flaps can be effectively employed to reanimate the paralyzed mid-face. This chapter explores the indications and contraindications for free muscle flap smile restoration. Various sources of innervation are examined including the motor nerve to masseter and cross-face nerve grafts, as are different muscle flap donor sites. A detailed description of facial nerve exploration, sural nerve graft harvest, and the cross-face nerve graft procedure are provided. Single and two-staged facial reanimation procedures utilizing free gracilis muscle flaps are also described in detail, including technical nuances, postoperative care, and physical therapy. The technique is well suited for individuals whose native muscles of facial expression have failed to develop in utero, undergone irreversible atrophy, sustained significant trauma, or have been sacrificed during oncologic resection.
Cleft Palate Repair
Authors: Garland Catharine B. , Losee Joseph E.
Published: July 2019

Cleft palate repair is performed to allow for normal speech production, development, and social interactions. The goal of surgery is to restore the normal anatomic relationship of the tissues and muscles. The history of cleft palate repair has evolved from techniques that simply closed the mucosal layers to those that return the musculature of the palate to its normal anatomic position. A variety of techniques remain in common use today. This chapter reviews the relevant anatomy, preoperative and postoperative care, and the operative technique. The authors emphasize their preferred method of repair, the Furlow palatoplasty, and discuss in detail the steps for reconstruction of the hard and soft palate, with modifications as necessary to suit different cleft anatomy. Alternative techniques for cleft palate repair are reviewed in brief.
Approach to Upper Maxillofacial Fractures
Authors: Murariu Daniel , McMahon Heather A. , Lin Kant Y.
Published: July 2019

Upper maxillofacial fractures primarily involve the frontal sinus. The paired frontal sinuses consist of an anterior table, a posterior table, and a frontonasal duct also known as the nasofrontal outflow tract (NFOT). Diagnosis of frontal sinus fractures is best done with a computed tomographic (CT) scan. Indications for repair of fractures of the frontal sinus depend on the location of the fracture, the degree of displacement of the fractures, and the patency of the NFOT. The three mainstays in fracture treatment are open reduction and internal fixation of anterior table fractures when there is no NFOT obstruction, which can be combined with obliteration and/or cranialization of the sinus with posterior table fractures in the presence of NFOT obstruction. Indications and surgical techniques will be reviewed along with some illustrative case examples.
Reduction Mammoplasty
Authors: Mofid M. Mark , D’Souza Gehaan , Cohen Benjamin E. , Ciaravino Michael E.
Published: July 2019

Breast reduction is one of the more common plastic surgery operations performed in the United States. There were 1,00,000 operations performed in 2015. The etiology of breast hypertrophy is unclear and likely involves some combination of hormonal, genetic, and developmental factors. Patients with mammary hypertrophy complain of intertriginous infections, back and shoulder pain, shoulder notching, physical inactivity, dissatisfaction with breast appearance, poor sexual well-being, and poor psychological well-being. The goals of breast reduction surgery are to reduce overall breast volume, maintain nipple-areola viability, and achieve a shape that is aesthetically pleasing. Breast reduction improves patient satisfaction with breast appearance as well as physical and psychosocial well-being. Overall patient satisfaction is most strongly correlated with happiness with the appearance of the breasts. A number of techniques have been developed that effectively meet these goals. Three techniques are described in this chapter: inferior pedicle Wise pattern reduction mammaplasty, vertical pattern breast reduction, and partial breast amputation with free nipple-areola grafting.
Groin Dissection and Regional Lymphadenectomy
Authors: Sparkman Darlene M. , Kitzmiller W. John
Published: July 2019

Groin dissection with regional lymphadenectomy is indicated as a diagnostic or therapeutic procedure in patients who have a primary malignant neoplasm that has known or suspected lymphatic drainage to the superficial or deep inguinal lymph nodes. These pathologic entities can include anal, vaginal, urethral, vulvar, uterine, penile, ovarian, rectal, and cutaneous cancers. The most common of these neoplasms plastic surgeons must manage is melanoma. The recommended method for lymph node analysis continues to evolve. All patients should undergo basic clinical evaluation for the presence of palpable nodes. This chapter gives an updated practical guide to patient selection, preparation, operative technique, and postoperative care for groin dissection and regional lymphadenectomy.
Gastrocnemius Flap for Proximal Leg Reconstruction
Authors: Langstein Howard N. , Chen Elaina Y. , Wingate Nicholas A.
Published: July 2019

The gastrocnemius muscle flap has long been known as a workhorse flap for leg reconstruction given its reliability and ease of harvest. Its utility is varied, but it is especially useful for deep wounds of the proximal third of the leg with exposed vital structures or hardware. This chapter describes the preoperative markings and operative technique for the standard harvest of the medial head of the gastrocnemius muscle, with variations such as island muscle flap, lateral head of gastrocnemius muscle flap, and gastrocnemius myocutaneous flap. Alternatives such as propeller flaps are discussed as well. The gastrocnemius flap is one of many reliable and versatile flaps that plastic surgeons have in their armamentarium of options to reconstruct any defect of the leg.
Metacarpal and Phalangeal Fractures
Authors: Netscher David T. , Hamilton Kristy L.
Published: July 2019

Phalangeal and metacarpal fractures are the most common fractures in the hand and wrist. Selecting the most appropriate treatment is guided by a thorough physical examination and history-taking, followed by indicated radiographic views. Nondisplaced fractures are splinted, while displaced but stable fractures are usually treated with closed reduction and immobilization. Unstable fractures or more complex injuries often require open reduction and fixation via a number of surgical options. The surgical techniques and tools necessary for each individual fracture pattern are thoroughly outlined by the authors, as is the associated postoperative care and rehabilitation.
Carpal Fractures and Dislocations
Authors: Ko Jason H. , Vedder Nicholas B. , Kasukurthi Rahul
Published: July 2019

Nearly 1.5 million hand and wrist fractures are treated in the United States annually. Wrist fractures encompass fractures to the carpal bones, distal radius, and ulna. Most hand and forearm fractures occur in the home and are not work related. The scaphoid bone is most commonly involved, accounting for 60–85% of carpal fractures. The burden of wrist fractures is projected to increase as the population ages, and prompt and accurate diagnosis and treatment are necessary to avoid long-term disability. This chapter will focus on pathophysiology, diagnosis, imaging, and treatment of carpal injuries with emphasis on scaphoid fractures and perilunate dislocations.
Constraining the evolution of [C ii] intensity through the end stages of reionization
Authors: Padmanabhan Hamsa
Published: July 2019

We combine available constraints on the local [C ii] 158 $\mu$m line luminosity function from galaxy observations (Hemmati et al. 2017), with the evolution of the star formation rate density and the recent [C ii] intensity mapping measurement in Pullen et al. (2018, assuming detection), to derive the evolution of the [C ii] luminosity–halo mass relation over z ∼ 0–6. We develop convenient fitting forms for the evolution of the [C ii] luminosity–halo mass relation and forecast constraints on the [C ii] intensity mapping power spectrum and its associated uncertainty across redshifts. We predict the sensitivities to detect the power spectrum for upcoming PIXIE-, STARFIRE-, EXCLAIM-, CONCERTO-, TIME-, and CCAT-p-like surveys, as well as possible future intensity mapping observations with the ALMA (Atacama Large Millimetre Array) facility.
Assessing the effect of lens mass model in cosmological application with updated galaxy-scale strong gravitational lensing sample
Authors: Chen Yun , Li Ran , Shu Yiping , Cao Xiaoyue
Published: July 2019

By comparing the dynamical and lensing masses of early-type lens galaxies, one can constrain both the cosmological parameters and the density profiles of galaxies. We explore the constraining power on cosmological parameters and the effect of the lens mass model in this method with 161 galaxy-scale strong lensing systems, which is currently the largest sample with both high-resolution imaging and stellar dynamical data. We assume a power-law mass model for the lenses, and consider three different parametrizations for γ (i.e. the slope of the total mass density profile) to include the effect of the dependence of γ on redshift and surface mass density. When treating δ (i.e. the slope of the luminosity density profile) as a universal parameter for all lens galaxies, we find the limits on the cosmological parameter Ωm are quite weak and biased, and also heavily dependent on the lens mass model in the scenarios of parametrizing γ with three different forms. When treating δ as an observable for each lens, the unbiased estimate of Ωm can be obtained only in the scenario of including the dependence of γ on both the redshift and the surface mass density, that is $\Omega _\mathrm{ m} = 0.381^{+0.185}_{-0.154}$ at 68 per cent confidence level in the framework of a flat ΛCDM model. We conclude that the significant dependencies of γ on both the redshift and the surface mass density, as well as the intrinsic scatter of δ among the lenses, need to be properly taken into account in this method.
Constraints on the interacting vacuum–geodesic CDM scenario
Authors: Martinelli Matteo , Hogg Natalie B , Peirone Simone , Bruni Marco , Wands David
Published: July 2019

We investigate an interacting dark sector scenario in which the vacuum energy is free to interact with cold dark matter (CDM), which itself is assumed to cluster under the sole action of gravity, i.e. it is in freefall (geodesic), as in ΛCDM. The interaction is characterized by a dimensionless coupling qV(z), in general a function of redshift. Aiming to reconstruct the evolution of the coupling, we use cosmic microwave background data from Planck 2015, along with baryon acoustic oscillation, redshift space distortion, and Type Ia supernova measurements to constrain various parametrizations of qV(z). We present the full linear perturbation theory of this interacting scenario and use Monte Carlo Markov Chains (MCMC) sampling to study five different cases: two cases in which we have ΛCDM evolution in the distant past, until a set redshift ztrans, below which the interaction switches on and qV is the single-sampled parameter, with ztrans fixed at ztrans = 3000 and 0.9, respectively; a case where we allow this transition redshift to vary along with qV; a case in which the vacuum energy is zero for z > ztrans and then begins to grow once the interaction switches on; and the final case in which we bin qV(z) in four redshift bins to investigate the possibility of a dynamical interaction, reconstructing the redshift evolution of the function using Gaussian processes. We find that, in all cases where the high-redshift evolution is not modified, the results are compatible with a vanishing coupling, thus finding no significant deviation from ΛCDM.
Metallicity gradients in small and nearby spiral galaxies
Authors: Bresolin Fabio
Published: July 2019

Spectra of H ii regions obtained with Gemini/GMOS are used to derive the radial metallicity gradients of four small, low-mass spiral galaxies. The analysis of the outer disc of one of them, NGC 1058, uncovers the characteristic flattening found in similar extended disc galaxies. After combining these data with published long-slit observations of nearby spiral galaxies, no evidence for a dependence of the disc scale length-normalized metallicity gradients with stellar mass is found, down to log (M⋆/M⊙) ∼ 8.5. The abundance gradients derived from these observations are compared to predictions from recent cosmological simulations of galaxy evolution, finding that in several cases the simulations fail to reproduce the mean steepening of the gradients, expressed in dex kpc−1, with decreasing stellar mass for present-day galaxies, or do not extend to sufficiently small stellar masses for a meaningful comparison. The mean steepening of the abundance gradients (in dex kpc−1) with decreasing disc scale length is in qualitative agreement with predictions from the inside-out model of Boissier & Prantzos, although the predicted slopes are systematically steeper than observed. This indicates the necessity of including processes such as outflows and radial mixing in similar models of galactic chemical evolution. Published spatially resolved metallicity and photometric data of dwarf irregular galaxies suggest that significant, but transitory, metallicity gradients can develop for systems that have experienced recent (t < 100 Myr) enhanced star formation in their inner discs.
2PBC J0658.0–1746: a hard X-ray eclipsing polar in the orbital period gap
Authors: Bernardini F , de Martino D , Mukai K , Falanga M , Masetti N
Published: July 2019

The hard X-ray source 2PBC J0658.0–1746 was proposed as an eclipsing magnetic cataclysmic variable of the polar type, based on optical follow-ups. We present the first spectral and timing analysis at X-ray energies with XMM–Newton, complemented with archival X-ray, optical, infrared (IR) photometry, and spectroscopy. The X-ray emission shows bright and faint phases and total eclipses recurring every 2.38 h, consistent with optical properties. This firmly identifies 2PBC J0658.0–1746 as an eclipsing polar, the second hard X-ray selected in the orbital period gap. The X-ray orbital modulation changes from cycle-to-cycle and the X-ray flux is strongly variable over the years, implying a non-stationary mass accretion rate both on short and long time-scales. The X-ray eclipses allow to refine the orbital ephemeris with period 0.09913398(4) d, and to constrain the binary inclination $79^{\circ}\lesssim i \lesssim 90^{\circ}$ and the mass ratio 0.18$\lt M_2/M_{\mathrm{ WD}}\lt $0.40. A companion mass M$_{2}=0.2-0.25\rm \, M_{\odot }$ with a radius R$_{2}=0.24-0.26\rm \, R_{\odot }$ and spectral type ∼M4, at D$=209^{+3}_{-2}\rm \, pc$, is derived. A lower limit to the white dwarf mass of $\sim 0.6\, \rm \, M_{\odot }$ is obtained from the X-ray spectrum. An upper limit to the magnetic colatitude, $\beta \lesssim 50^{\circ}$, and a shift in azimuth, $\psi \sim 14^{\circ}$, of the main accreting pole are also estimated. The optical/IR spectral energy distribution shows large excess in the mid-IR due to lower harmonics of cyclotron emission. A high-state mass accretion rate $\rm \, \sim 0.4-1\times 10^{-10}\, M_{\odot }\, yr^{-1}$, lower than that of cataclysmic variables above the gap and close to that of systems below it, is estimated. With 2PBC J0658.0–1746, the number of hard X-ray-selected polars increases to 13 members, suggesting that they are not as rare as previously believed.
Simulating radial velocity observations of trappist-1 with SPIRou
Authors: Klein Baptiste , Donati J-F
Published: July 2019

We simulate a radial velocity (RV) follow-up of the TRAPPIST-1 system, a faithful representative of M dwarfs hosting transiting Earth-sized exoplanets to be observed with SPIRou in the months to come. We generate an RV curve containing the signature of the seven transiting TRAPPIST-1 planets and a realistic stellar activity curve statistically compatible with the light curve obtained with the K2 mission. We find a ±5 m s−1 stellar activity signal comparable in amplitude with the planet signal. Using various sampling schemes and white noise levels, we create time-series from which we estimate the masses of the seven planets. We find that the precision on the mass estimates is dominated by (i) the white noise level for planets c, f, and e and (ii) the stellar activity signal for planets b, d, and h. In particular, the activity signal completely outshines the RV signatures of planets d and h that remain undetected regardless of the RV curve sampling and level of white noise in the data set. We find that an RV follow-up of TRAPPIST-1 using SPIRou alone would likely result in an insufficient coverage of the rapidly evolving activity signal of the star, especially with bright-time observations only, making statistical methods such as Gaussian Process Regression hardly capable of firmly detecting planet f and accurately recovering the mass of planet g. In contrast, we show that using bi-site observations with good longitudinal complementary would allow for a more accurate filtering of the stellar activity RV signal.
The estrogen-regulated lncRNA H19/miR-216a-5p axis alters stromal cell invasion and migration via ACTA2 in endometriosis
Authors: Xu Zhen , Zhang Liping , Yu Qian , Zhang Yanan , Yan Lei , Chen Zi-Jiang
Published: July 2019

Fibrotic tissue may contribute to the origin of some endometriosis-related symptoms, such as chronic pelvic pain and infertility. Alterations in the H19/miR-216a-5p/ACTA2 pathway may mediate the regulation of eutopic endometrial stromal cell (euESC) invasion and migration and may represent a potential mechanism underlying fibrous tissue formation or fibrosis in women with endometriosis. In this study, we aimed to determine the expression of H19 and ACTA2 in endometrial tissues of women with endometriosis. Two groups of 23 infertile women with endometriosis and 23 matched infertile women without endometriosis were investigated. Primary cultured cells of endometrial tissues were analyzed using RT-PCR and western blotting (WB) to determine expression of H19 and ACTA2. 5-Ethyl-2′-deoxyuridine, CCK8 and Transwell assays were used to study the functions of H19 and ACTA2. Human embryonic kidney 293 cells were used for luciferase assays to study miR-216a-5p binding sites with H19 and ACTA2. We found that H19 and ACTA2 levels were significantly higher in endometriosis euESCs than in control euESCs (P < 0.05) and were positively correlated in endometriosis euESCs. Luciferase assays indicated that H19 regulates ACTA2 expression via competition for inhibitory miR-216a-5p binding sites. Our results indicate that alterations in the estrogen/H19/miR-216a-5p/ACTA2 pathway regulated endometriosis euESC invasion and migration. Downregulation of H19 or ACTA2 inhibited endometriosis euESC invasion and migration; however, estrogen promoted endometriosis euESC invasion and migration via H19. The main limitation of our study was that experiments were conducted in vitro and further in vivo studies are required in the future. However, our study showed that primary cultured cells represented endometriosis cells more clearly than cell lines.
ChIP-exo analysis highlights Fkh1 and Fkh2 transcription factors as hubs that integrate multi-scale networks in budding yeast
Authors: Mondeel Thierry D G A , Holland Petter , Nielsen Jens , Barberis Matteo
Published: July 2019

The understanding of the multi-scale nature of molecular networks represents a major challenge. For example, regulation of a timely cell cycle must be coordinated with growth, during which changes in metabolism occur, and integrate information from the extracellular environment, e.g. signal transduction. Forkhead transcription factors are evolutionarily conserved among eukaryotes, and coordinate a timely cell cycle progression in budding yeast. Specifically, Fkh1 and Fkh2 are expressed during a lengthy window of the cell cycle, thus are potentially able to function as hubs in the multi-scale cellular environment that interlocks various biochemical networks. Here we report on a novel ChIP-exo dataset for Fkh1 and Fkh2 in both logarithmic and stationary phases, which is analyzed by novel and existing software tools. Our analysis confirms known Forkhead targets from available ChIP-chip studies and highlights novel ones involved in the cell cycle, metabolism and signal transduction. Target genes are analyzed with respect to their function, temporal expression during the cell cycle, correlation with Fkh1 and Fkh2 as well as signaling and metabolic pathways they occur in. Furthermore, differences in targets between Fkh1 and Fkh2 are presented. Our work highlights Forkhead transcription factors as hubs that integrate multi-scale networks to achieve proper timing of cell division in budding yeast.
The human 18S rRNA m6A methyltransferase METTL5 is stabilized by TRMT112
Authors: van Tran Nhan , Ernst Felix G M , Hawley Ben R , Zorbas Christiane , Ulryck Nathalie , Hackert Philipp , Bohnsack Katherine E , Bohnsack Markus T , Jaffrey Samie R , Graille Marc , Lafontaine Denis L J
Published: July 2019

N6-methyladenosine (m6A) has recently been found abundantly on messenger RNA and shown to regulate most steps of mRNA metabolism. Several important m6A methyltransferases have been described functionally and structurally, but the enzymes responsible for installing one m6A residue on each subunit of human ribosomes at functionally important sites have eluded identification for over 30 years. Here, we identify METTL5 as the enzyme responsible for 18S rRNA m6A modification and confirm ZCCHC4 as the 28S rRNA modification enzyme. We show that METTL5 must form a heterodimeric complex with TRMT112, a known methyltransferase activator, to gain metabolic stability in cells. We provide the first atomic resolution structure of METTL5–TRMT112, supporting that its RNA-binding mode differs distinctly from that of other m6A RNA methyltransferases. On the basis of similarities with a DNA methyltransferase, we propose that METTL5–TRMT112 acts by extruding the adenosine to be modified from a double-stranded nucleic acid.
DNA skybridge: 3D structure producing a light sheet for high-throughput single-molecule imaging
Authors: Kim Daehyung , Rashid Fahad , Cho Yeonmo , Zaher Manal S , Cho I I Hwan , Hamdan Samir M , Jeong Cherlhyun , Lee Jong-Bong
Published: July 2019

Real-time visualization of single-proteins or -complexes on nucleic acid substrates is an essential tool for characterizing nucleic acid binding proteins. Here, we present a novel surface-condition independent and high-throughput single-molecule optical imaging platform called ‘DNA skybridge’. The DNA skybridge is constructed in a 3D structure with 4 μm-high thin quartz barriers in a quartz slide. Each DNA end is attached to the top of the adjacent barrier, resulting in the extension and immobilization of DNA. In this 3D structure, the bottom surface is out-of-focus when the target molecules on the DNA are imaged. Moreover, the DNA skybridge itself creates a thin Gaussian light sheet beam parallel to the immobilized DNA. This dual property allows for imaging a single probe-tagged molecule moving on DNA while effectively suppressing interference with the surface and background signals from the surface.
Translation-dependent unwinding of stem–loops by UPF1 licenses Regnase-1 to degrade inflammatory mRNAs
Authors: Mino Takashi , Iwai Noriki , Endo Masayuki , Inoue Kentaro , Akaki Kotaro , Hia Fabian , Uehata Takuya , Emura Tomoko , Hidaka Kumi , Suzuki Yutaka , Standley Daron M , Okada-Hatakeyama Mariko , Ohno Shigeo , Sugiyama Hiroshi , Yamashita Akio , Takeuchi Osamu
Published: July 2019

Regnase-1-mediated mRNA decay (RMD), in which inflammatory mRNAs harboring specific stem–loop structures are degraded, is a critical part of proper immune homeostasis. Prior to initial translation, Regnase-1 associates with target stem–loops but does not carry out endoribonucleolytic cleavage. Single molecule imaging revealed that UPF1 is required to first unwind the stem–loops, thus licensing Regnase-1 to proceed with RNA degradation. Following translation, Regnase-1 physically associates with UPF1 using two distinct points of interaction: The Regnase-1 RNase domain binds to SMG1-phosphorylated residue T28 in UPF1; in addition, an intrinsically disordered segment in Regnase-1 binds to the UPF1 RecA domain, enhancing the helicase activity of UPF1. The SMG1-UPF1–Regnase-1 axis targets pioneer rounds of translation and is critical for rapid resolution of inflammation through restriction of the number of proteins translated by a given mRNA. Furthermore, small-molecule inhibition of SMG1 prevents RNA unwinding in dendritic cells, allowing post-transcriptional control of innate immune responses.
Hallmarks of ribosomopathies
Authors: Kampen Kim R , Sulima Sergey O , Vereecke Stijn , De Keersmaecker Kim
Published: July 2019

Ribosomopathies are diseases caused by defects in ribosomal constituents or in factors with a role in ribosome assembly. Intriguingly, congenital ribosomopathies display a paradoxical transition from early symptoms due to cellular hypo-proliferation to an elevated cancer risk later in life. Another association between ribosome defects and cancer came into view after the recent discovery of somatic mutations in ribosomal proteins and rDNA copy number changes in a variety of tumor types, giving rise to somatic ribosomopathies. Despite these clear connections between ribosome defects and cancer, the molecular mechanisms by which defects in this essential cellular machinery are oncogenic only start to emerge. In this review, the impact of ribosomal defects on the cellular function and their mechanisms of promoting oncogenesis are described. In particular, we discuss the emerging hallmarks of ribosomopathies such as the appearance of ‘onco-ribosomes’ that are specialized in translating oncoproteins, dysregulation of translation-independent extra-ribosomal functions of ribosomal proteins, rewired cellular protein and energy metabolism, and extensive oxidative stress leading to DNA damage. We end by integrating these findings in a model that can provide an explanation how ribosomopathies could lead to the transition from hypo- to hyper-proliferation in bone marrow failure syndromes with elevated cancer risk.
Treatment of Anterior Circulation Aneurysms in the Internal Carotid Artery With Flow Diverters
Authors: Vakharia Kunal , Munich Stephan A , Waqas Muhammad , Levy Elad I , Siddiqui Adnan H
Published: July 2019

Several studies have shown the efficacy and feasibility of flow diversion for the endovascular treatment of wide-necked and otherwise anatomically challenging intracranial aneurysms (IA). Technological advances have led to successful long-term occlusion rates and a safety profile for flow-diverter stents that parallels other endovascular and open surgical options for these lesions. With growing indications for use of the Pipeline Embolization Device (PED, Medtronic, Dublin, Ireland) to include IAs up to the internal carotid artery (ICA) terminus, understanding the nuances of this technology is increasingly relevant. Furthermore, there is a growing body of literature on the use of flow diversion to treat distal (up to A2, M2, and P2), ruptured, and posterior circulation aneurysms, although these applications are “off-label” at present. In this manuscript, we discuss the expanding role of flow diversion in the ICA and compare this technique with other endovascular options for the treatment of ICA IAs. We also discuss technical nuances of the deployment of flow diverters for the treatment of challenging lesions and in difficult and tortuous anatomy.
Experience with tofacitinib in Canada: patient characteristics and treatment patterns in rheumatoid arthritis over 3 years
Authors: Pope Janet , Bessette Louis , Jones Niall , Fallon Lara , Woolcott John , Gruben David , Crooks Michael , Gold David , Haraoui Boulos
Published: July 2019

Objectives

To describe characteristics, treatment patterns and persistence in patients with RA treated with tofacitinib, an oral Janus kinase inhibitor, in Canadian clinical practice between 1 June 2014 and 31 May 2017.

Methods

Data were obtained from the tofacitinib eXel support programme. Baseline demographics and medication history were collected via patient report/special authorization forms; reasons for discontinuation were captured by patient report. Treatment persistence was estimated using Kaplan–Meier methods, with data censored at last follow-up. Cox regression was applied to analyse baseline characteristics associated with treatment discontinuation.

Results

The number of patients with RA enrolled from 2014 to 2017 was 4276; tofacitinib utilization increased during that period, as did the proportion of biologic (b) DMARD-naïve patients prescribed tofacitinib. Of patients who initiated tofacitinib, 1226/3678 (33.3%) discontinued, mostly from lack of efficacy (35.7%) and adverse events (26.9%). Persistence was 62.7% and 49.6% after 1 and 2 years of treatment, respectively. Prior bDMARD experience predicted increased tofacitinib discontinuation (vs bDMARD-naïve, P < 0.001). Increased retention was associated with older age (56–65 years and >65 years vs ⩽45 years; P < 0.05), and time since diagnosis of 15 to <20 years (vs <5 years; P < 0.01). In bDMARD-naïve, post-1 bDMARD, post-2 bDMARD and post-⩾3 bDMARD patients, median survival was >730, 613, 667 and 592 days, respectively.

Conclusion

Since 2014, tofacitinib use in Canadian patients with RA increased, especially among bDMARD-naïve/post-1 bDMARD patients. Median drug survival was ∼2 years. Likelihood of persistence increased for bDMARD-naïve (vs bDMARD-experienced) patients and those aged ⩾56 (vs ⩽45) years.
Alkali addition and roughage inclusion effect on performance and carcass characteristics of feedlot steers fed diets containing 60% dried distillers grains with solubles
Authors: Lancaster Nicholas A , Muegge Chris R , Reis de Carvalho Jose R , Cistolo Lopes Rodrigo , Narumiya Rafael S , Pinese Fabio , Baird A Nickie , Schoonmaker Jon P
Published: July 2019

Three experiments were conducted to determine the effectiveness of calcium hydroxide (Ca(OH)2) addition and roughage inclusion on digestibility, performance, and carcass characteristics of steers fed 60% dried distillers grains with solubles (DGS). Statistical analyses for studies were conducted using the MIXED procedures of SAS. In experiment 1, 48 steers (353.5 ± 7.55 kg) were allotted to individual pens and fed 1 of 3 diets (dry matter [DM] basis) containing 60% dried DGS, 20% corn silage, and 4% supplement with: 1) 14.5% corn and no Ca(OH)2; 2) 14% corn and 2% Ca(OH)2; and 3) 14.5% additional corn silage and no Ca(OH)2. Steers fed Ca(OH)2 consumed the least (P = 0.03) and steers fed added corn silage consumed the most and had the least gain:feed (P = 0.02). Gain and carcass quality were not affected by treatment (P ≥ 0.48). In experiment 2, 112 steers (375.3 ± 19.25 kg) were allotted to pens (four pens per treatment; seven steers per pen) arranged as a 2 × 2 factorial (roughage × Ca(OH)2) and fed one of four diets (DM basis) containing 60% dried DGS, 17% corn silage, and 4% supplement with: 1) 17.5% corn silage and no Ca(OH)2; 2) 17% corn silage and 2% Ca(OH)2; 3) 17.25% corn stover and no Ca(OH)2; and 4) 17% corn stover and 2% Ca(OH)2. Added stover decreased average daily gain (ADG) compared to added corn silage (P = 0.04). Ca(OH)2 increased ADG when steers were fed stover, but not when steers were fed only corn silage (P = 0.05; interaction). In experiment 3, six ruminally cannulated steers (initial body weight = 352 ± 14.8 kg) were randomly allotted to a 6 × 6 Latin square design to determine the effects of roughage inclusion (corn, corn silage, stover) and Ca(OH)2 addition (0% or 2%) on ruminal characteristics. Feeding stover decreased total volatile fatty acid(s) (VFA) concentration and DM digestibility compared to corn silage or corn (P < 0.01), whereas Ca(OH)2 resulted in greater total VFA concentrations and DM digestibility (P ≤ 0.02). Stover increased rate of DM degradation (Kd) and rate of particle outflow from the rumen (P ≤ 0.04) but decreased extent of DM digestion and mean retention time (P ≤ 0.02) compared to corn or silage. Ca(OH)2 increased Kd (P < 0.01) and tended to increase (P = 0.06) liquid passage rate. In conclusion, added roughage did not improve performance of cattle fed 60% dried DGS. Ca(OH)2 may decrease intake and maintain performance of cattle fed 60% dried DGS with corn silage as the roughage source and increases ADG when corn stover replaces a portion of the corn silage.
Gender differences in anaphylaxis
Authors: Salvati Lorenzo , Vitiello Gianfranco , Parronchi Paola
Published: July 2019

Purpose of review

Is sexual dimorphism also true in anaphylaxis as described in other allergic diseases? Possible gender differences in the epidemiology, triggers, severity, outcomes of anaphylaxis as well as in the pathogenesis of the disease are discussed.

Recent findings

Hormonal status and the X-chromosome-coded factors deeply involved in the regulation of T-cell and B-cell responses may influence the gender difference noticed in allergic diseases, such as asthma and rhinitis. Little is known if sex is also relevant for anaphylaxis, although the description of catamenial anaphylaxis is intriguing. However, epidemiologic bias, lack of reliable animal models for the human disease, differences into diagnostic codes and not harmonized clinical grading unfortunately represent hurdles to obtain meaningful information on this topic.

The female sex predisposes to a dysregulation of the immune response as suggested by the increased prevalence of autoimmunity and atopy. In anaphylaxis, pathomechanisms are not fully disclosed, triggers are numerous and IgE-dependent mast cell degranulation only represents a part of the story. Improvement into the definition of the disease including a more careful coding system and better investigations about triggers seem the only way to allow a more precise assessment of the possible different risk for women to develop anaphylaxis.
Tryptase values in anaphylaxis and insect allergy
Authors: Bonadonna Patrizia , Scaffidi Luigi , Boni Elisa
Published: July 2019

Purpose of review

To recognize the relevance of serum tryptase measurement as a useful tool for the diagnosis of allergic diseases and mast cell disorders.

Recent findings

Recent data on the role of mast cells and tryptase in allergic and other diseases provide new understanding into the mechanisms and causes of anaphylaxis.

Measurement of transiently elevated tryptase levels shortly after a severe reaction can help elucidate mechanism behind the reaction in identifying mast cell activation. Hymenoptera venom allergy represents an important cause of morbidity and mortality worldwide. Venom allergy is a typical IgE-mediated reaction because of sensitization to one or more allergens of the venom, and accounts for 1.5–34% of all cases of anaphylaxis. There is a preferential association between insect venom allergy and mastocytosis. The diagnosis of a clonal mast cell disease leads to therapeutic consequences concerning the treatment of venom allergy. In conclusion, baseline tryptase levels support the clinical diagnosis of anaphylaxis and mast cell disorders, determine venom immunotherapy treatment and are relevant in deciding on lifelong treatment.
Tension band plate-guided growth of knee-flexion deformity in arthrogryposis multiplex congenita in which metaphyseal funnelization induced screw encroachment upon the neurovascular bundle
Authors: Oleas-Santillán Geovanny , Bowen James Richard
Published: July 2019

Knee-flexion deformity in arthrogryposis multiplex congenita is treated by serial casting into extension, distal femoral osteotomies, distal femoral-guided growth, hemiepiphysiodesis, external fixation, capsulotomy, and soft-tissue releases. We are aware of four cases treated by distal anterior femoral-guided growth with tension band plates in which an unreported complication occurred: the screws of the tension band plates penetrated the posterior cortex of the femur during remodeling with metaphyseal funnelization risking the neurovascular bundle. Inclusion criteria were cases with arthrogryposis multiplex congenita and knee-flexion deformity, treatment at our institution by distal anterior femoral-guided growth with tension band plates, and radiographic evidence of posterior cortex screw penetration during remodeling from growth. Six knees (four cases) met the inclusion criteria. The average age at the distal anterior femoral-guided growth with tension band plate operation was 5.8 years. Radiographs after 6.6 years of follow-up showed that the screws of the tension band plates, which at surgery were intrametaphyseal, had penetrated the posterior cortex of the femur. Four knees (two cases) had diffuse pain around the knee to lower leg area, and instrumentation removal alleviated the symptoms. During distal anterior femoral-guided growth with tension band plate operation for knee-flexion deformity in arthrogryposis multiplex congenita, we found that the screws of the tension band plates, which were initially located inside the metaphysis, may protrude through the posterior bone cortex during metaphyseal funnelization with growth, and may encroach upon the neurovascular tissues. Level of evidence: Level IV – case series.
Do wrist buckle fractures in children need follow-up? Buckle fractures’ follow-up
Authors: Riera-Álvarez Luis , Pons-Villanueva Juan
Published: July 2019

Buckle or torus fractures in the distal forearm are characterized by a bulging of the cortical bone. They are a frequent reason for consultation in pediatric emergencies. The treatment and follow-up of this type of fractures varies from soft immobilizations to a plaster cast. The purpose of this study is to assess the stability of buckle fractures of the distal radius. We reviewed 106 pediatric patients with buckle fractures and analyzed the radiographs at the time of initial consultation and at the last follow-up. None of these fractures displaced further, regardless of the treatment given. Buckle or torus fractures do not need follow-up radiographs. As they are stable, the simpler immobilization treatment is sufficient.
Deltoid Insufficiency and Flatfoot—Oh Gosh, I’m Losing the Ankle! What Now?
Authors: Fonseca Lucas F. , Baumfeld Daniel , Mansur Nacime , Nery Caio
Published: July 2019

Adult acquired flatfoot deformity is a severe condition in which the ankle is markedly affected by medial instability and valgus deformity. Unbalanced forces pose high stress on the tibiotalar joint, and different levels of arthritis may develop. Correcting valgus tilt in the ankle, at the time of flatfoot reconstruction, is imperative to prevent future collapse and the need for ankle arthrodesis or arthroplasty. Unfortunately, there has been no universal procedure adapted by foot and ankle surgeons for repair or augmentation of the deltoid ligament. We recommend a technique of reconstruction of the superficial and deep deltoid ligaments using suture tapes and, eventually, the combination with autograft tendon, in conjunction with spring complex reconstruction.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Direct Drop-Down Anterior Approach to Subaxial Cervical Spine
Authors: Dagar Ashish , Kumar Vishal , Dhatt Sarvdeep S.
Published: July 2019

Background:

Subaxial cervical spine comprises C3-C7 levels. Southwick and Robinson’s is most commonly used surgical approach for subaxial cervical spine. We are describing a new technique of approaching cervical vertebrae using same planes as in classical approach by Southwick and Robinson.

Material and Methods:

A total of 35 cases with cervical spine pathologies requiring anterior cervical approach were included in the study. Patients requiring posterior based surgeries, >2-disk level anterior exposure and with history of any previous anterior based cervical spine surgery were excluded from the study.

Surgical Technique:

The patients were positioned supine on operating table. A 3 cm transverse skin incision is given starting from midline and extending laterally at desired vertebral level. Langenbeck’s retractor of appropriate size is used by surgical assistant to apply gentle constant lateral traction on trachea. The esophagus being invaginated by same pretracheal layer of deep cervical fascia, moves along with trachea. Soft tissue is bluntly dissected with peanut sponge. Steps are repeated till vertebra is reached.

Result:

Of the 35 cases included in the study, maximum cases (19) were traumatic cervical spine fractures. The average surgical time, intraoperative blood loss in negative suction drains, postoperative hospital stays in this group of cohort was similar to the cohort in which typical traditional approach was used.

Discussion:

Perceived advantages include—smaller skin incision, less chances to damage carotid sheath and its contents, safe, easy and less time-consuming technique, cosmetically better due to smaller incision size along Langer’s lines.
Implementation of a Bundled Consent Process in the ICU: A Single-Center Experience*
Authors: Anandaiah Asha M. , Stevens Jennifer P. , Sullivan Amy M.
Published: July 2019

Objectives:

A bundled consent process, where patients or surrogates provide consent for all commonly performed procedures on a single form at the time of ICU admission, has been advocated as a method for improving both rates of documented consent and patient/family satisfaction, but there has been little published literature about the use of bundled consent. We sought to determine how residents in an academic medical center with a required bundled consent process actually obtain consent and how they perceive the overall value, efficacy, and effects on families of this approach.

Design:

Single-center survey study.

Setting:

Medical ICUs in an urban academic medical center.

Subjects:

Internal medicine residents.

Interventions:

We administered an online survey about bundled consent use to all residents. Quantitative and qualitative data were analyzed.

Measurements and Main Results:

One-hundred two of 164 internal medicine residents (62%) completed the survey. A majority of residents (55%) reported grouping procedures and discussing general risks and benefits; 11% reported conducting a complete informed consent discussion for each procedure. Respondents were divided in their perception of the value of bundled consent, but most (78%) felt it scared or stressed families. A minority (26%) felt confident that they obtained valid informed consent for critical care procedures with the use of bundled consent. An additional theme that emerged from qualitative data was concern regarding the validity of anticipatory consent.

Conclusions:

Resident physicians experienced with the use of bundled consent in the ICU held variable perceptions of its value but raised concerns about the effect on families and the validity of consent obtained with this strategy. Further studies are necessary to further explore what constitutes best practice for informed consent in critical care.
How to assimilate the tsunami of immune checkpoints inhibitors data into clinical practice?
Authors: Castelo-Branco Luís , Aspeslagh Sandrine , Kotecki Nuria , Awada Ahmad
Published: July 2019

Purpose of review

Immune checkpoint inhibitors (ICIs) are rapidly changing practice across different tumor settings. With this article, we reflect on how to assimilate the tsunami of ICIs data into clinical practice.

Recent findings

A tremendous increase on approvals, number of publications, and clinical trials ongoing with ICIs on many different tumor types.

ICIs are innovative treatments that are showing a significant benefit on different tumors. More approvals and an explosive increase of knowledge around the usage of ICI are to be expected in the near future, bringing new challenges on how to integrate this fast-growing evidence with ICI into clinical practice. To be updated, oncologists could follow approved guidelines from relevant societies and complement it with an appropriate search from publication databases. There are also some available courses, conferences and online material that are useful to improve knowledge in this so rapidly changing environment. In the future, we believe the integration of artificial intelligence and learning machines will play an important role to facilitate best clinical practices in different fields of medicine but particularly for oncology.
Patient Safety in the Traditional and Evolving Nontraditional Office Setting
Authors: KEATS JOHN P. , GAMBONE JOSEPH C.
Published: July 2019

Patient safety remains a concern for practice in traditional office settings as well as emerging forms of telehealth. Effective leadership is required to establish a culture of safety in office practice, with all staff undergoing appropriate credentialing and privileging. Key areas of focus for office safety are documentation and follow-up of patient encounters, medication safety, and surgical safety. Medication safety standards include prescribed medications, office administered injections and samples given to patients. Similar rules of patient safety apply to both hospital-based and office-based surgical procedures. Telehealth will present new challenges for maintaining patient safety, for which more study is needed.
Practical Cancer Genetics and Genomics in Women’s Health
Authors: MODESITT SUSAN , PEDERSON HOLLY J. , ADKINS ROYCE T.
Published: July 2019

There have been rapid advances in precision medicine since the Human Genome Project was completed in 2003, including several noteworthy advances in Women’s Health. This includes significant advances in predicting individualized cancer risk based on hereditary cancer genetic testing, with the number of known cancer-predisposition genes extending well beyond BRCA1 and BRCA2. This has been coupled with gene-specific management guidelines for several gynecologic cancers. In addition, genetic testing can also inform therapy selection for women with gynecologic cancers. Here we address hereditary cancer and practical cancer genetics as it relates to the practicing Obstetrician/Gynecologist.