bluuebunny/crossref_metadata_2025 huggingface dataset:
Facial Contour Symmetry Outcomes after Site-Specific Facial Fat Compartment Augmentation with Fat Grafting in Facial Deformities
Authors: Denadai Rafael , Buzzo Celso Luiz , Raposo-Amaral Cesar Augusto , Raposo-Amaral Cassio Eduardo
Published: July 2019

Background:

The purposes of this study were to evaluate facial symmetry after the first fat grafting session in patients with unilateral facial contour deformities and to identify independent predictors of 12-month postoperative facial symmetry.

Methods:

A prospective analysis was conducted of consecutive patients (n = 167) that underwent fat grafting to restore facial contour symmetry. Computerized photogrammetric facial symmetry analyses were performed. Bivariate and multivariate analyses were executed to identify independent predictors of 12-month postoperative facial symmetry.

Results:

There were significant (all p < 0.05) postoperative facial symmetry enhancements (preoperative less than postoperative) after facial fat grafting. The facial symmetry was maintained (all p > 0.05) from 3 to 12 months postoperatively, with a 12-month facial symmetry of 91.2 ± 6.9 percent (ranging from 79.8 to 99.3 percent). Sixty-six complementary facial fat grafts (39.5 percent) were performed for residual asymmetry. Age, Parry-Romberg syndrome, previous facial bone surgery at the site that received fat grafting, and injected volume were independently negative (all p < 0.05) predictors of 12-month postoperative facial symmetry.

Conclusion:

A significant improvement of facial contour symmetry was obtained after the first facial fat grafting session, but a subset of patients required complementary fat graft procedures for residual asymmetry, with age, Parry-Romberg syndrome, previous bone surgery, and injected volume affecting postoperative facial contour symmetry.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Intraoperative Tissue Perfusion Measurement by Laser Speckle Imaging: A Potential Aid for Reducing Postoperative Complications in Free Flap Breast Reconstruction
Authors: To Cynthia , Rees-Lee Jacqueline E. , Gush Rodney J. , Gooding Kim M. , Cawrse Nicholas H. , Shore Angela C. , Wilson Andrew D. H.
Published: July 2019

Adequate tissue perfusion is essential to minimize postoperative complications following microsurgery. Intraoperative knowledge of tissue perfusion could aid surgical decision-making and result in reduced complications. Laser speckle imaging is a new, noninvasive technique for mapping tissue perfusion. This article discusses the feasibility of using laser speckle imaging during free flap breast reconstruction and its potential to identify areas of inadequate perfusion, thus reducing surgical complications. Adult patients scheduled to undergo free flap breast reconstruction were recruited into the study. Laser speckle images were obtained from the abdominal and breast areas at different stages intraoperatively. Zonal perfusion was compared with the Holm classification and clinical observations. Twenty patients scheduled to undergo free flap breast reconstruction were recruited (23 reconstructed breasts) (mean age, 50 years; range, 32 to 68 years). Flap zonal perfusion was 238 (187 to 313), 222 (120 to 265), 206 (120 to 265), and 125 (102 to 220) perfusion units for zones I, II, III, and IV, respectively (analysis of variance, p < 0.0001). Zonal area with perfusion below an arbitrary perfusion threshold were 20 (0.3 to 75), 41 (3 to 99), 49 (9 to 97), and 99 (25 to 100) percent, respectively (analysis of variance, p < 0.0001). One example is presented to illustrate potential intraoperative uses for laser speckle imaging. This study shows that laser speckle imaging is a feasible, noninvasive technique for intraoperative mapping of tissue perfusion during free flap breast reconstruction. Zonal tissue perfusion was reduced across the Holm classification. Observations indicated the potential for laser speckle imaging to provide additional information to augment surgical decision-making by detection of inadequate tissue perfusion. This highlights the opportunity for surgeons to consider additional aids for intraoperative tissue perfusion assessment to help reduce perfusion-related complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, IV.
Role of Early Application of Pressure Garments following Burn Injury and Autografting
Authors: DeBruler Danielle M. , Baumann Molly E. , Blackstone Britani N. , Zbinden Jacob C. , McFarland Kevin L. , Bailey J. Kevin , Supp Dorothy M. , Powell Heather M.
Published: July 2019

Background:

Pressure garment therapy, used for reduction of postburn scarring, is commonly initiated after complete healing of the wound or autograft. Although some clinicians have suggested that earlier treatment may improve outcomes, the effect of early initiation of therapy has not been studied in a controlled environment.

Methods:

Full-thickness burns were created on red Duroc pigs, burn eschar was excised, and the wound bed was grafted with split-thickness autografts. Grafts were treated with pressure garments immediately, 1 week (early), or 5 weeks (delayed) after grafting with nontreated grafts as controls. Scar morphology, biomechanics, and gene expression were measured at multiple time points up to 17 weeks after grafting.

Results:

Grafts that received pressure within 1 week after grafting exhibited no reduction in engraftment rates. Immediate and early application of pressure resulted in scars with decreased contraction, reduced scar thickness, and improved biomechanics compared with controls. Pressure garment therapy did not alter expression of collagen I, collagen III, or transforming growth factor β1 at the time points investigated; however, expression of matrix metalloproteinase 1 was significantly elevated in the immediate pressure garment therapy group at week 3, whereas the delayed pressure garment therapy and control groups approached baseline levels at this time point.

Conclusions:

Early application of pressure garments is safe and effective for reducing scar thickness and contraction and improving biomechanics. This preclinical study suggests that garments should be applied as soon as possible after grafting to achieve greatest benefit, although clinical studies are needed to validate the findings in humans.
Optimizing DIEP Flap Insetting for Immediate Unilateral Breast Reconstruction: A Prospective Cohort Study of Patient-Reported Aesthetic Outcomes
Authors: Razzano Sergio , Marongiu Francesco , Wade Ryckie , Figus Andrea
Published: July 2019

Background:

To improve the aesthetic outcome of deep inferior epigastric perforator (DIEP) flap breast reconstruction, flaps should be tailored to the patient’s characteristics. A single method of DIEP flap insetting will not suffice for all women seeking breast reconstruction. The authors share the outcomes of a prospective longitudinal study on DIEP flap insetting and present an algorithm for reconstruction.

Methods:

Over 4 years, 70 consecutive immediate unilateral DIEP flap breast reconstructions were prospectively evaluated. DIEP insetting was based on the characteristics of the donor site and contralateral breast, according to the authors’ algorithm. Baseline and outcome data were collected. Aesthetic outcomes were evaluated by a panel of three independent assessors, and patient-reported outcomes were quantified using the BREAST-Q at 1 year after reconstruction.

Results:

Seventy women underwent reconstruction. There were no total or partial flap failures, four cases of fat necrosis, and 14 revision operations. Women reported a mean overall BREAST-Q score of 82 of 100, representing excellent satisfaction but poor satisfaction with sexual well-being. BREAST-Q scores were not associated with age or body mass index. Fat necrosis reduced satisfaction with the chest (absolute mean reduction, 13; 95 percent CI, 8 to 18; p = 0.002). Independent assessors scored the outcomes favorably, but there was no agreement between surgeons, nurses, and lay assessors.

Conclusions:

The authors’ algorithm can support surgeons in selecting individually tailored DIEP flap insetting to achieve excellent aesthetic outcomes. Further research is needed as to the relevance of scores from BREAST-Q in relation to interventions.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Assessing the Relationship between Anxiety and Revision Surgery following Autologous Breast Reconstruction
Authors: Orr Jonah P. , Sergesketter Amanda R. , Shammas Ronnie L. , Thomas Analise B. , Cason Roger W. , Zhao Ruya , Broadwater Gloria , Hollenbeck Scott T.
Published: July 2019

Background:

Revision procedures address contour irregularities and aesthetic concerns following autologous breast reconstruction. Mental health diagnoses are known to influence patient satisfaction with reconstruction. The authors aimed to identify oncologic, reconstructive, and demographic factors, including mental health diagnoses, associated with the number of revisions after autologous breast reconstruction.

Methods:

The medical records of all adult women undergoing abdominal free flap–based breast reconstruction at a major academic institution between 2011 and 2016 were reviewed. Multivariate logistic regression was used to identify factors associated with receipt of revisions. Negative binomial regression was used to identify characteristics associated with number of revisions received.

Results:

Of 272 patients identified, 55.2 percent received one revision, 23.2 percent received two revisions, and 10.3 percent received three or more revisions after autologous breast reconstruction (median, one; range, zero to five). After adjustment on multivariate analysis, anxiety (OR, 4.34; p = 0.016) and bilateral reconstruction (OR, 3.10; p = 0.017) were associated with receipt of any revisions; other oncologic and reconstructive factors including breast cancer stage, receipt of radiation therapy, and type or timing of free flap reconstruction were not associated with revisions. Using univariate negative binomial regression, anxiety (incidence rate ratio, 1.34; p = 0.006), Caucasian race (incidence rate ratio, 1.24; p = 0.02), and bilateral reconstruction (incidence rate ratio, 1.39; p = 0.04) were predictive of increased numbers of revisions received. After stepwise selection on multivariate analysis, anxiety remained the only significant predictor of increased numbers of revisions.

Conclusions:

Preoperative anxiety significantly influences the number of revisions after autologous breast reconstruction. Further research is necessary to better understand the interplay among mental health, patient preference, and outcomes in breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Conformity of the Actual to the Planned Result in Orthognathic Surgery
Authors: Wilson Alex , Gabrick Kyle , Wu Robin , Madari Sarika , Sawh-Martinez Rajendra , Steinbacher Derek
Published: July 2019

Background:

Virtual surgical planning has facilitated preoperative planning, splint accuracy, and intraoperative efficiency in orthognathic surgery. The translation of the virtual surgical plan to the actual result has not been adequately examined. The authors examined the conformity of the virtual surgical plan to the postoperative result. They hypothesize that the greatest conformity exists in the anteroposterior dimensions.

Methods:

The authors examined patients who underwent Le Fort I maxillary advancement, bilateral sagittal split osteotomy, and genioplasty. The preoperative virtual surgical planning file and postoperative cone beam computed tomographic scan were registered in Mimics using unchanged landmarks. The conformity to the virtual surgical plan was quantified using linear and angular measurements between bone surface landmarks. Results were compared using t tests, with p < 0.05 considered statistically significant

Results:

One hundred patients who underwent Le Fort I maxillary advancement, bilateral sagittal split osteotomy, and genioplasty were included. Three-dimensional analysis showed significant differences between the plan and outcome for the following landmarks: A point (y, p = 0.04; z, p = 0.04), B point (y, p = 0.02; z, p = 0.02), pogonion (y, p = 0.04), menton (x, p = 0.02; y, p = 0.01; z, p = 0.03), and anterior nasal spine (x, p = 0.04; y, p = 0.04; z, p = 0.01). Angular measurements sella-nasion-A point, sella-nasion-B point, and A point-nasion-B point were not statistically different.

Conclusions:

There is a high degree of conformity comparing the orthognathic virtual surgical plan to the actual postoperative result. However, some incongruency is seen vertically (maxilla) and sagittally (mandible, chin). Departures of the actual position compared with the plan could be the result of condylar position changes, osteotomy locations, aesthetic intraoperative decisions, and/or play in the system.
Outcomes Utilizing Inspira Implants in Primary Aesthetic and Reconstructive Surgery
Authors: Warren Peled Anne , Disa Joseph J.
Published: July 2019

The evolution of silicone implants has included advances in both gel and shell technology to improve the clinical outcomes of the implants. The newest generation of implants includes implants with thick, strong shells and highly cohesive gel fill. These advancements allow for better maintenance of implant form and shape over time and improved implant safety. The Natrelle Inspira product line offers 3 different levels of gel cohesivity in a range of profiles to provide a wide variety of options for use in both breast augmentation and postmastectomy breast reconstruction. This article will review the use of Inspira implants in primary aesthetic and reconstructive breast surgery.
Implementing a Mandated Program Across a Regional Health Care System: A Rapid Qualitative Assessment to Evaluate Early Implementation Strategies
Authors: Sperber Nina R. , Bruening Rebecca A. , Choate Ashley , Mahanna Elizabeth , Wang Virginia , Powell Byron J. , Damush Teresa , Jackson George L. , Van Houtven Courtney H. , Allen Kelli D. , Hastings Susan N.
Published: July 2019

Background:

Rapid qualitative assessment was used to describe early strategies to implement an evidence-based walking program for hospitalized older adults, assiSTed eaRly mobIlity for hospitalizeD older vEterans (STRIDE), mandated by a regional Department of Veterans Affairs health care system office (Veterans Integrated Service Network [VISN]).

Methods:

Data were collected from 6 hospital sites via semistructured interviews with key informants, observations of telephone-based technical assistance, and review of VISN-requested program documents (eg, initial implementation plans). An overarching framework of actionable feedback for VISN leadership and specification of locally initiated implementation strategies, using the Expert Recommendations for Implementing Change (ERIC) compilation, was used. Actionable feedback was shared with VISN leadership 1 month after the initiative.

Results:

ERIC implementation strategies identified were as follows: (1) promoting adaptability—4 sites had physical therapists/kinesiotherapists instead of assistants walk patients; (2) promoting network weaving—strengthening nursing and PT/KT partnership with regular communication opportunities or a point person was important for implementation; (3) distributing educational materials—2 sites distributed information about STRIDE via e-mail and in person; and (4) organizing clinician implementation team meetings—3 sites used interdisciplinary team meetings to communicate with the clinical staff about STRIDE.

Conclusion:

This qualitative study sheds light on early experiences with implementing STRIDE; the results have been instructive for ongoing implementation and future dissemination of STRIDE, and the approach can be applied across contexts to inform implementation of other programs.
Spectral Computed Tomographic Parameters Predict the Therapeutic Efficacy and Overall Survival of the Angiogenesis Inhibitor AL3818 in Hepatic Lesions: Preliminary Animal Study
Authors: Zhou Yue , Gong Yi , Wang Mingyue , Xu Han , Hou Ping , Dong Junqiang , Wang Feng , Gao Jian-bo
Published: July 2019

Objective

This study aimed to investigate the predictive and prognostic values of repeated spectral computed tomographic (CT) parameter changes for the prediction of treatment responses to the angiogenesis inhibitor AL3818 in hepatic tumors.

Methods

A total of 30 rabbits with VX2 hepatic tumors that underwent spectral contrast-enhanced abdominal CT before and during treatment were included in the study. The percent change (Δ, %) of the normalized iodine concentration (nIC) during the arterial phase (AP) and venous phase (VP) was used to predict the tumor response and to calculate the overall survival (OS). The threshold of the nIC for tumor response prediction and prognostic significance was determined by a receiver operating characteristic curve and Kaplan-Meier analysis.

Results

After treatment, there were 43% (13/30) responders and 57% (17/30) nonresponders. When ΔnICAP ≥ −13.10% was used as the threshold, the sensitivity and specificity for the prediction of tumor response were 82.41% and 92.31%, respectively. ΔnICVP resulted in 88.20% sensitivity and 76.92% specificity for cutoff values ≥10.78%. Kaplan-Meier analyses showed that high ΔnICAP and ΔnICVP were associated with improved OS.

Conclusions

The current study shows the capability of the changes (Δ) in repeated spectral CT parameters to predict the tumor response during antiangiogenesis therapy in small hepatic tumors. ΔnICAP and ΔnICVP were predictors for treatment response and were associated with OS.
Novel Characteristic Skull Magnetic Resonance Imaging Features Associated With Meningioma
Authors: Matsushima Satoshi , Shimizu Tetsuya , Fukasawa Nei , Ojiri Hiroya
Published: July 2019

Objective

Meningioma-related skull magnetic resonance imaging findings other than hyperostosis are not widely recognized. We evaluated the novel findings of the skull adjacent to meningiomas.

Methods

Records from patients with meningiomas located adjacent to the skull on magnetic resonance imaging (n = 32) were included. Three skull findings (intramedullary prominent vessel, intramedullary enhancement, intramedullary T2-hyperintensity) and the widely known hyperostosis were retrospectively visually assessed. The frequency of these 3 findings and the relevance to each other, and their relationships with hyperostosis, size, length adjacent to the skull, and relative signal intensity of the meningioma were examined.

Results

The incidence of the three findings was 46.88%, 53.13%, and 62.5%, respectively, and that of hyperostosis was 46.88%. Each association involving the findings was strong, and they were significantly related to the size and length.

Conclusions

Intramedullary prominent vessel, intramedullary enhancement, and intramedullary T2-hyperintensity may be novel characteristic skull findings associated with meningioma.
Von Meyenburg Complex: Current Concepts and Imaging Misconceptions
Authors: Guo Yang , Jain Dhanpat , Weinreb Jeffrey
Published: July 2019

Von Meyenburg complexes, also known as biliary hamartomas, are ductal plate malformations that are usually diagnosed on imaging studies when there are multiple as small hepatic cysts. However, because of variations in histology, they actually have a wide spectrum of imaging appearances ranging from solid, to mixed solid and cystic, to cystic lesions. The objective of the review is to provide up-to-date information about the embryopathogenesis of von Meyenburg complexes, their imaging appearances, diagnostic pitfalls, and clinical significance.
Differentiation of Hepatic Sclerosed Hemangiomas From Cavernous Hemangiomas Based on Gadoxetic Acid–Enhanced Magnetic Resonance Imaging Features
Authors: Hwang Jeong Ah , Kang Tae Wook , Cha Dong Ik , Kim Seong Hyun , Ha Sang Yun , Kim Seon Woo
Published: July 2019

Objective

The objective of this study was to evaluate the imaging features of a hepatic sclerosed hemangioma by comparing them with those of a cavernous hemangioma using magnetic resonance imaging with gadoxetic acid enhancement.

Methods

Nine patients with hepatic sclerosed hemangiomas and 36 patients with cavernous hemangiomas (control group) who underwent gadoxetic acid–enhanced magnetic resonance imaging were included. Qualitative values (imaging findings and enhancement pattern [typical vs atypical enhancement]) and quantitative values (apparent diffusion coefficient) were evaluated.

Results

Patients with sclerosed hemangiomas showed significantly more irregular tumor margin on hepatobiliary phase images, peritumoral arterial enhancement, and a lower proportion of hyperintensity on heavily T2-weighted images compared with controls (all P values <0.05). In addition, the sclerosed hemangioma group had significantly more frequent atypical enhancement patterns than did the control group (88.9% vs 33.3%; P = 0.006). However, the mean apparent diffusion coefficient value of hemangiomas was not significantly different between the 2 groups (P = 0.639).

Conclusions

Gadoxetic acid–enhanced magnetic resonance images can help in differentiating between hepatic sclerosed hemangiomas and cavernous hemangiomas.
Tumor Contrast Enhancement and Whole-Body Elimination of the Manganese-Based Magnetic Resonance Imaging Contrast Agent Mn-PyC3A
Authors: Erstad Derek J. , Ramsay Ian A. , Jordan Veronica Clavijo , Sojoodi Mozhdeh , Fuchs Bryan C. , Tanabe Kenneth K. , Caravan Peter , Gale Eric M.
Published: July 2019

Objectives

The goals of this study were to compare the efficacy of the new manganese-based magnetic resonance imaging (MRI) contrast agent Mn-PyC3A to the commercial gadolinium-based agents Gd-DOTA and to Gd-EOB-DTPA to detect tumors in murine models of breast cancer and metastatic liver disease, respectively, and to quantify the fractional excretion and elimination of Mn-PyC3A in rats.

Methods

T1-weighted contrast-enhanced MRI with 0.1 mmol/kg Mn-PyC3A was compared with 0.1 mmol/kg Gd-DOTA in a breast cancer mouse model (n = 8) and to 0.025 mmol/kg Gd-EOB-DTPA in a liver metastasis mouse model (n = 6). The fractional excretion, 1-day biodistribution, and 7-day biodistribution in rats after injection of 2.0 mmol/kg [52Mn]Mn-PyC3A or Gd-DOTA were quantified by 52Mn gamma counting or Gd elemental analysis. Imaging data were compared with a paired t test; biodistribution data were compared with an unpaired t test.

Results

The postinjection-preinjection increases in tumor-to-muscle contrast-to-noise ratio (ΔCNR) 3 minutes after injection of Mn-PyC3A and Gd-DOTA (mean ± standard deviation) were 17 ± 3.8 and 20 ± 4.4, respectively (P = 0.34). Liver-to-tumor ΔCNR values at 8 minutes postinjection of Mn-PyC3A and Gd-EOB-DTPA were 28 ± 9.0 and 48 ± 23, respectively (P = 0.11). Mn-PyC3A is eliminated with 85% into the urine and 15% into the feces after administration to rats. The percentage of the injected doses (%ID) of Mn and Gd recovered in tissues after 1 day were 0.32 ± 0.12 and 0.57 ± 0.12, respectively (P = 0.0030), and after 7 days were 0.058 ± 0.051 and 0.19 ± 0.052, respectively (P < 0.0001).

Conclusions

Mn-PyC3A provides comparable tumor contrast enhancement to Gd-DOTA in a mouse breast cancer model and is more completely eliminated than Gd-DOTA; partial hepatobiliary elimination of Mn-PyC3A enables conspicuous delayed phase visualization of liver metastases.
18F-DCFPyL Uptake in an Incidentally Detected Follicular Lymphoma by PET/CT Performed for Biochemically Recurrent Prostate Cancer
Authors: Meijer Dennie , Wondergem Maurits , Knol Remco J.J. , Broos Wouter A.M. , van der Zant Friso M.
Published: July 2019

A 75-year-old man, treated with curative intent for histopathologically proven prostate cancer (initial prostate-specific antigen, 27 ng/mL; Gleason 4 + 5 = 9) through external beam radiation therapy in 2010 in combination with 3 years of androgen deprivation therapy (leuprorelin), underwent 18F-DCFPyL PET/CT for biochemical recurrence with a prostate-specific antigen of 4.1 ng/mL in February 2019. Multiple pelvic and some para-aortic lymph nodes showed highly increased 18F-DCFPyL uptake, suspicious for metastases. Incidentally, a solid mesenteric mass and mesenteric lymph nodes with moderately increased 18F-DCFPyL uptake were found. Upon histopathological evaluation, this proved to be a low-grade follicular lymphoma.
Telemedicine Based Remote Home Monitoring After Liver Transplantation
Authors: Lee Tiffany C. , Kaiser Tiffany E. , Alloway Rita , Woodle Ervin Steve , Edwards Michael J. , Shah Shimul A.
Published: July 2019

Objective:

This study assesses the impact of a telemedicine-based home management program (THMP) on patient adherence, hospital readmissions, and quality of life (QOL) after liver transplantation (LT).

Summary of Background Data:

Telemedicine interventions represent an opportunity to personalize care and can lead to improved adherence and patient satisfaction. However, there is limited data on impact of these interventions on outcomes after LT. Therefore, we conducted the first randomized controlled trial (RCT) of a THMP compared to standard of care (SOC) after LT.

Methods:

One hundred six consecutive LT recipients were randomized (1:1) to 1 of 2 posttransplant care strategies: SOC or THMP. The THMP included an electronic tablet and bluetooth devices to support daily text messages, education videos, and video FaceTime capability; data was cyber-delivered into our electronic medical record daily. Endpoints were THMP participation, 90-day hospital readmission rate, and QOL.

Results:

One hundred patients completed the study with 50 enrolled in each arm. Participation and adherence with telemedicine was 86% for basic health sessions (vital sign recording), but only 45% for using messaging or FaceTime. The THMP group had a lower 90-day readmission rate compared to SOC (28% vs 58%; P = 0.004). The THMP cohort also showed improved QOL in regards to physical function (P = 0.02) and general health (P = 0.05) at 90 days.

Conclusions:

To our knowledge, this is the first RCT demonstrating the impact of THMP after LT. The magnitude of effect on LT outcomes, hospital readmissions, and QOL suggests that the adoption of telemedicine has great potential for other major operations.
Hereditary Susceptibility for Triple Negative Breast Cancer Associated With Western Sub-Saharan African Ancestry
Authors: Newman Lisa A. , Jenkins Brittany , Chen Yalei , Oppong Joseph K. , Adjei Ernest , Jibril Aisha S. , Hoda Syed , Cheng Esther , Chitale Dhananjay , Bensenhaver Jessica M. , Awuah Baffour , Bekele Mahteme , Abebe Engida , Kyei Ishmael , Aitpillah Frances , Adinku Michael , Nathanson Saul David , Jackson LaToya , Jiagge Evelyn , Merajver Sofia , Petersen Lindsay F. , Proctor Erica , Gyan Kofi K. , Martini Rachel , Kittles Rick , Davis Melissa B.
Published: July 2019

Objective:

To investigate subtype-specific risk of germline alleles associated with triple negative breast cancer (TNBC) in African ancestry populations.

Background:

Breast cancer (BC) mortality is higher in African American (AA) compared to White American (WA) women; this disparity is partly explained by 2-fold higher TNBC incidence.

Methods:

We used a surgically maintained biospecimen cohort of 2884 BC cases. Subsets of the total (760 AA; 962 WA; 910 West African/Ghanaian; 252 East African/Ethiopian) were analyzed for genotypes of candidate alleles. A subset of 417 healthy controls were also genotyped, to measure associations with overall BC risk and TNBC.

Results:

TNBC frequency was highest in Ghanaian and AA cases (49% and 44% respectively; P < 0.0001) and lowest in Ethiopian and WA cases (17% and 24% respectively; P < 0.0001). TNBC cases had higher West African ancestry than non-TNBC (P < 0.0001). Frequency of the Duffy-null allele (rs2814778; an African ancestral variant adopted under selective pressure as protection against malaria) was associated with TNBC-specific risk (P < 0.0001), quantified West African Ancestry (P < 0.0001) and was more common in AA, Ghanaians, and TNBC cases. Additionally, rs4849887 was significantly associated with overall BC risk, and both rs2363956 and rs13000023 were associated with TNBC-specific risk, although none as strongly as the Duffy-null variant.

Conclusions:

West African ancestry is strongly correlated with TNBC status, as well as germline variants related to BC risk. The Duffy-null allele was associated with TNBC risk in our cohort.
Intraoperative Increase of Portal Venous Pressure is an Immediate Predictor of Posthepatectomy Liver Failure After Major Hepatectomy
Authors: Bogner Andreas , Reissfelder Christoph , Striebel Fabian , Mehrabi Arianeb , Ghamarnejad Omid , Rahbari Mohammad , Weitz Jürgen , Rahbari Nuh N.
Published: July 2019

Objectives:

The aim of this study was to assess intraoperative changes of hepatic macrohemodynamics and their association with ascites and posthepatectomy liver failure (PHLF) after major hepatectomy.

Summary of Background Data:

Large-scale ascites and PHLF remain clinical challenges after major hepatectomy. No study has concomitantly evaluated arterial and venous liver macrohemodynamics in patients undergoing liver resection.

Methods:

Portal venous pressure (PVP), portal venous flow (PVF), and hepatic arterial flow (HAF) were measured intraoperatively pre- and postresection in 67 consecutive patients with major hepatectomy (ie, resection of ≥3 liver segments). A group of 30 patients with minor hepatectomy served as controls. Liver macrohemodynamics and their intraoperative changes (ie, Δ) were analyzed as predictive biomarkers of ascites and PHLF using Fisher exact, t test, or Wilcoxon rank sum test for univariate and logistic regression for multivariate analyses.

Results:

Major hepatectomy increased PVP by 26.9% (P = 0.001), markedly decreased HAF by 40.7% (P < 0.001), and slightly decreased PVF by 13.4% (P = 0.011). Minor resections had little effects on hepatic macrohemodynamics. There was no significant association of liver macrohemodynamics with ascites. While middle hepatic vein resection caused higher postresection PVP after right hepatectomy (P = 0.04), the Pringle maneuver was associated with a significant PVF (P = 0.03) and HAF reduction (P = 0.03). Uni- and multivariate analysis revealed an intraoperative PVP increase as an independent predictor of PHLF (P = 0.025).

Conclusion:

Intraoperative PVP kinetics serve as independent predictive biomarker of PHLF after major hepatectomy. These data highlight the importance to assess intraoperative dynamics rather than the pre- and postresection PVP values.
Effect of Remote Ischemic Preconditioning Conducted in Living Liver Donors on Postoperative Liver Function in Donors and Recipients Following Liver Transplantation
Authors: Jung Kyeo-Woon , Kang Jiwon , Kwon Hye-Mee , Moon Young-Jin , Jun In-Gu , Song Jun-Gol , Hwang Gyu-Sam
Published: July 2019

Objective:

This study aimed to assess the effects of remote ischemic preconditioning (RIPC) on liver function in donors and recipients after living donor liver transplantation (LDLT).

Background:

Ischemia reperfusion injury (IRI) is known to be associated with graft dysfunction after liver transplantation. RIPC is used to lessen the harmful effects of IRI.

Methods:

A total of 148 donors were randomly assigned to RIPC (n = 75) and control (n = 73) groups. RIPC involves 3 cycles of 5-minute inflation of a blood pressure cuff to 200 mm Hg to the upper arm, followed by 5-minute reperfusion with cuff deflation. The primary aim was to assess postoperative liver function in donors and recipients and the incidence of early allograft dysfunction and graft failure in recipients.

Results:

RIPC was not associated with any differences in postoperative aspartate aminotransferase (AST) and alanine aminotransferase levels after living donor hepatectomy, and it did not decrease the incidence of delayed graft hepatic function (6.7% vs 0.0%, P = 0.074) in donors. AST level on postoperative day 1 [217.0 (158.0, 288.0) vs 259.5 (182.0, 340.0), P = 0.033] and maximal AST level within 7 postoperative days [244.0 (167.0, 334.0) vs 296.0 (206.0, 395.5), P = 0.029) were significantly lower in recipients who received a preconditioned graft. No differences were found in the incidence of early allograft dysfunction (4.1% vs 5.6%, P = 0.955) or graft failure (1.4% vs 5.6%, P = 0.346) among recipients.

Conclusions:

RIPC did not improve liver function in living donor hepatectomy. However, RIPC performed in liver donors may be beneficial for postoperative liver function in recipients after living donor liver transplantation.
Comparing Perioperative Mortality and Morbidity of Minimally Invasive Esophagectomy Versus Open Esophagectomy for Esophageal Cancer
Authors: Sakamoto Takashi , Fujiogi Michimasa , Matsui Hiroki , Fushimi Kiyohide , Yasunaga Hideo
Published: July 2019

Objective:

We compared the surgical outcomes of minimally invasive esophagectomy (MIE) and open esophagectomy (OE) for esophageal cancer.

Summary Background Data:

MIE has become a widespread procedure. However, the definitive advantages of MIE over OE at a nationwide level have not been established.

Methods:

We analyzed patients who underwent esophagectomy for clinical stage 0 to III esophageal cancer from April 2014 to March 2017 using a Japanese inpatient database. We performed propensity score matching to compare in-hospital mortality and morbidities between MIE and OE, accounting for clustering of patients within hospitals.

Results:

Among 14,880 patients, propensity matching generated 4572 pairs. MIE was associated with lower incidences of in-hospital mortality (1.2% vs 1.7%, P = 0.048), surgical site infection (1.9% vs 2.6%, P = 0.04), anastomotic leakage (12.8% vs 16.8%, P < 0.001), blood transfusion (21.9% vs 33.8%, P < 0.001), reoperation (8.6% vs 9.9%, P = 0.03), tracheotomy (4.8% vs 6.3%, P = 0.002), and unplanned intubation (6.3% vs 8.4%, P < 0.001); a shorter postoperative length of stay (23 vs 26 days, P < 0.001); higher incidences of vocal cord dysfunction (9.2% vs 7.5%, P < 0.001) and prolonged intubation period after esophagectomy (23.2% vs 19.3%, P < 0.001); and a longer duration of anesthesia (408 vs 363 minutes, P < 0.001).

Conclusion:

MIE had favorable outcomes in terms of in-hospital mortality, morbidities, and the postoperative hospital stay.
Therapeutic Hypothermia in Organ Donors: Follow-up and Safety Analysis
Authors: Malinoski Darren , Patel Madhukar S. , Axelrod David A. , Broglio Kristine , Lewis Roger J. , Groat Tahnee , Niemann Claus U.
Published: July 2019

Background.

In a recent trial, targeted mild hypothermia in brain-dead organ donors significantly reduced the incidence of delayed graft function after kidney transplantation. This trial was stopped early for efficacy. Here, we report long-term graft survival for all organs along with donor critical care end points.

Methods.

We assessed graft survival through 1 year of all solid organs transplanted from 370 donors who had been randomly assigned to hypothermia (34–35°C) or normothermia (36.5–37.5°C) before donation. Additionally, changes in standardized critical care end points were compared between donors in each group.

Results.

Mild hypothermia was associated with a nonsignificant improvement in 1-year kidney transplant survival (95% versus 92%; hazard ratio, 0.61 [0.31–1.20]; P = 0.15). Mild hypothermia was associated with higher 1-year graft survival in the subgroup of standard criteria donors (97% versus 93%; hazard ratio, 0.39 [0.15 to −1.00]; P = 0.05). There were no significant differences in graft survival of extrarenal organs. There were no differences in critical care end points between groups.

Conclusions.

Mild hypothermia in the donor safely reduced the rate of delayed graft function in kidney transplant recipients without adversely affecting donor physiology or extrarenal graft survival. Kidneys from standard criteria donors who received targeted mild hypothermia had improved 1-year graft survival.
Assessing Predictors of Early and Late Hospital Readmission After Kidney Transplantation
Authors: Hogan Julien , Arenson Michael D. , Adhikary Sandesh M. , Li Kevin , Zhang Xingyu , Zhang Rebecca , Valdez Jeffrey N. , Lynch Raymond J. , Sun Jimeng , Adams Andrew B. , Patzer Rachel E.
Published: July 2019

Background.

A better understanding of the risk factors of posttransplant hospital readmission is needed to develop accurate predictive models.

Methods.

We included 40 461 kidney transplant recipients from United States renal data system (USRDS) between 2005 and 2014. We used Prentice, Williams and Peterson Total time model to compare the importance of various risk factors in predicting posttransplant readmission based on the number of the readmissions (first vs subsequent) and a random forest model to compare risk factors based on the timing of readmission (early vs late).

Results.

Twelve thousand nine hundred eighty-five (31.8%) and 25 444 (62.9%) were readmitted within 30 days and 1 year postdischarge, respectively. Fifteen thousand eight hundred (39.0%) had multiple readmissions. Predictive accuracies of our models ranged from 0.61 to 0.63. Transplant factors remained the main predictors for early and late readmission but decreased with time. Although recipients’ demographics and socioeconomic factors only accounted for 2.5% and 11% of the prediction at 30 days, respectively, their contribution to the prediction of later readmission increased to 7% and 14%, respectively. Donor characteristics remained poor predictors at all times. The association between recipient characteristics and posttransplant readmission was consistent between the first and subsequent readmissions. Donor and transplant characteristics presented a stronger association with the first readmission compared with subsequent readmissions.

Conclusions.

These results may inform the development of future predictive models of hospital readmission that could be used to identify kidney transplant recipients at high risk for posttransplant hospitalization and design interventions to prevent readmission.
Behavioural valuation of landscapes using movement data
Authors: Wittemyer George , Northrup Joseph M. , Bastille-Rousseau Guillaume
Published: July 2019

Wildlife tracking is one of the most frequently employed approaches to monitor and study wildlife populations. To date, the application of tracking data to applied objectives has focused largely on the intensity of use by an animal in a location or the type of habitat. While this has provided valuable insights and advanced spatial wildlife management, such interpretation of tracking data does not capture the complexity of spatio-temporal processes inherent to animal behaviour and represented in the movement path. Here, we discuss current and emerging approaches to estimate the behavioural value of spatial locations using movement data, focusing on the nexus of conservation behaviour and movement ecology that can amplify the application of animal tracking research to contemporary conservation challenges. We highlight the importance of applying behavioural ecological approaches to the analysis of tracking data and discuss the utility of comparative approaches, optimization theory and economic valuation to gain understanding of movement strategies and gauge population-level processes. First, we discuss innovations in the most fundamental movement-based valuation of landscapes, the intensity of use of a location, namely dissecting temporal dynamics in and means by which to weight the intensity of use. We then expand our discussion to three less common currencies for behavioural valuation of landscapes, namely the assessment of the functional (i.e. what an individual is doing at a location), structural (i.e. how a location relates to use of the broader landscape) and fitness (i.e. the return from using a location) value of a location. Strengthening the behavioural theoretical underpinnings of movement ecology research promises to provide a deeper, mechanistic understanding of animal movement that can lead to unprecedented insights into the interaction between landscapes and animal behaviour and advance the application of movement research to conservation challenges.

This article is part of the theme issue ‘Linking behaviour to dynamics of populations and communities: application of novel approaches in behavioural ecology to conservation’.
Mechanisms driving phenological and range change in migratory species
Authors: Gill Jennifer A. , Alves José A. , Gunnarsson Tómas G.
Published: July 2019

Many migratory systems are changing rapidly in space and time, and these changes present challenges for conservation. Changes in local abundance and site occupancy across species' ranges have raised concerns over the efficacy of the existing protected area networks, while changes in phenology can potentially create mismatches in the timing of annual events with the availability of key resources. These changes could arise either through individuals shifting in space and time or through generational shifts in the frequency of individuals using different locations or on differing migratory schedules. Using a long-term study of a migratory shorebird in which individuals have been tracked through a period of range expansion and phenological change, we show that these changes occur through generational shifts in spatial and phenological distributions, and that individuals are highly consistent in space and time. Predictions of future rates of changes in range size and phenology, and their implications for species conservation, will require an understanding of the processes that can drive generational shifts. We therefore explore the developmental, demographic and environmental processes that could influence generational shifts in phenology and distribution, and the studies that will be needed to distinguish among these mechanisms of change.

This article is part of the theme issue ‘Linking behaviour to dynamics of populations and communities: application of novel approaches in behavioural ecology to conservation’.
Invisible barriers: anthropogenic impacts on inter- and intra-specific interactions as drivers of landscape-independent fragmentation
Authors: Berger-Tal Oded , Saltz David
Published: July 2019

Anthropogenically induced fragmentation constitutes a major threat to biodiversity. Presently, conservation research and actions focus predominantly on fragmentation caused directly by physical transformation of the landscape (e.g. deforestation, agriculture, urbanization, roads, etc.). While there is no doubt that landscape features play a key role in fragmenting populations or enhancing connectivity, fragmentation may also come about by processes other than the transformation of the landscape and which may not be readily visible. Such landscape-independent fragmentation (LIF) usually comes about when anthropogenic disturbance alters the inter- and intra-specific interactions among and within species. LIF and its drivers have received little attention in the scientific literature and in the management of wildlife populations. We discuss three major classes of LIF processes and their relevance for the conservation and management of species and habitats: (i) interspecific dispersal dependency, in which populations of species that rely on other species for transport and propagation become fragmented as the transporting species declines; (ii) interspecific avoidance induction, where species are excluded from habitats and corridors owing to interspecific interactions resulting from anthropogenically induced changes in community structure (e.g. exclusions by increased predation pressure); and (iii) intraspecific behavioural divergence, where populations become segregated owing to anthropogenically induced behavioural differentiation among them.

This article is part of the theme issue ‘Linking behaviour to dynamics of populations and communities: application of novel approaches in behavioural ecology to conservation'.
Animal learning may contribute to both problems and solutions for wildlife–train collisions
Authors: St. Clair Colleen Cassady , Backs Jonathan , Friesen Alyssa , Gangadharan Aditya , Gilhooly Patrick , Murray Maureen , Pollock Sonya
Published: July 2019

Transportation infrastructure can cause an ecological trap if it attracts wildlife for foraging and travel opportunities, while increasing the risk of mortality from collisions. This situation occurs for a vulnerable population of grizzly bears (Ursus arctos) in Banff National Park, Canada, where train strikes have become a leading cause of mortality. We explored this problem with analyses of rail-associated food attractants, habitat use of GPS-collared bears and patterns of past mortality. Bears appeared to be attracted to grain spilled from rail cars, enhanced growth of adjacent vegetation and train-killed ungulates with rail use that increased in spring and autumn, and in areas where trains slowed, topography was rugged, and human density was low. However, areas with higher grain deposits or greater use by bears did not predict sites of past mortality. The onset of reported train strikes occurred amid several other interacting changes in this landscape, including the cessation of lethal bear management, changes in the distribution and abundance of ungulates, increasing human use and new anthropogenic features. We posit that rapid learning by bears is critical to their persistence in this landscape and that this capacity might be enhanced to prevent train strikes in future with simple warning devices, such as the one we invented, that signal approaching trains.

This article is part of the theme issue ‘Linking behaviour to dynamics of populations and communities: application of novel approaches in behavioural ecology to conservation’.
Can hyena behaviour provide information on population trends of sympatric carnivores?
Authors: Green David S. , Farr Matthew T. , Holekamp Kay E. , Strauss Eli D. , Zipkin Elise F.
Published: July 2019

Mammalian carnivores are declining worldwide owing to human activities. Behavioural indicators have the potential to help identify population trends and inform conservation actions, although this area of research is understudied. We investigate whether behaviour is linked to abundance in a community of carnivores in the Masai Mara National Reserve, Kenya. Anthropogenic disturbance increased exponentially in parts of the Reserve between 1988 and 2017, mainly owing to daily incursions by large numbers of livestock and tourists. Previous research showed that hyena behaviour changed markedly during this period. Through a series of vignettes, we inquire whether hyena behaviours correlate with changes in abundance of hyenas themselves, or those of other carnivore species in the region. We find that changes in spotted hyena behaviour in disturbed areas, but not in undisturbed areas, can be linked to changes in their demography (vignette 1). We also find that declines in observed lion–hyena interactions, as well as increases in spotted hyena abundance, are probably caused by competitive release of hyenas from declining lion abundance (vignette 2). Finally, we demonstrate that in some cases, hyena behaviour and demography is linked to the density and distribution of sympatric carnivores, and that behavioural changes in hyenas can provide information on shifts within the carnivore community (vignettes 3 and 4). Our vignettes reveal intriguing relationships between behaviour and demography that should be explored in future research. Pairing behavioural studies with more traditional monitoring efforts can yield useful insights regarding population and community trends, and aid wildlife conservation and management.

This article is part of the theme issue ‘Linking behaviour to dynamics of populations and communities: application of novel approaches in behavioural ecology to conservation'.