bluuebunny/crossref_metadata_2025 huggingface dataset:
Gate-all-around junctionless silicon transistors with atomically thin nanosheet channel (0.65 nm) and record sub-threshold slope (43 mV/dec)
Authors: Thirunavukkarasu Vasanthan , Jhan Yi-Ruei , Liu Yan-Bo , Kurniawan Erry Dwi , Lin Yu Ru , Yang Shang-Yi , Cheng Che-Hsiang , Wu Yung-Chun
Published: January 2017

A silicon junctionless (JL) trench gate-all-around (GAA) nanowire field-effect transistor with an atomically thin channel thickness of 0.65 nm and a very thin oxide with a thickness of 12.3 nm are demonstrated experimentally. Experimental results indicate that this device with a channel thickness of 0.65 nm achieves a sub-threshold slope (SS) of 43 mV/decade, which is the best yet achieved by any reported JLFET. Owing to the atomically thin channel, this device has an extremely high ION/IOFF current ratio of >108. Furthermore, the atomically thin channel GAA JLFET exhibits a low threshold voltage (VTH) variation and negligible drain-induced barrier lowering (DIBL < 0.4 mV/V). The reported device with the thinnest channel has a very high band-to-band tunneling generation rate of 1.2 × 1024/cm2 s when the channel is scaled down to <1 nm, as confirmed by using the 3D quantum transport simulation tool. This quantum tunneling provides a means of achieving an SS value much lower than its fundamental physical limit.
On the magnetic anisotropy in Fe78Si9B13 ingots and amorphous ribbons: Orientation aligning of Fe-based phases/clusters
Authors: Wang X. , Ma H. J. , Sheng Z. H. , Jin S. F. , Xu W. , Ferry M. , Chen L. , Duan J. Q. , Wang W. M.
Published: January 2017

Magnetic anisotropy in Fe-based amorphous ribbon plays an important role in various applications and is still not fully understood. To gain an in-depth understanding of this phenomenon, the structure and magnetic properties of Fe78Si9B13 master alloy ingots and melt-spun amorphous ribbons were measured by various techniques. For the ingot samples, both the <100>α-Fe and <001>Fe2B axes are aligned parallel with the radial direction (RD) of the original cylindrical ingot, i.e. the maximum temperature gradient direction, and their other orthogonal axes have several preferred directions in the plane vertical to RD. The hard magnetic axis of the ingot samples is parallel to RD, which is due to the large magnetocrystalline anisotropy energy difference between <001> and {001} of the Fe2B phase. For the amorphous ribbons, there is an in-plane magnetic anisotropy: the easy or hard axis of magnetization is aligned on the plane of the ribbon, and parallel to or at an angle of about 60° to its width direction, respectively. According to the structural heredity between the melts and glasses/crystals during solidification, we deduce that the magnetic anisotropy in the ribbon plane is ascribed to the orientation alignment of Fe-Si and Fe-B clusters, i.e. a hidden order beyond short-range order, in Fe78Si9B13 amorphous ribbons.
Luminescence flash and temperature determination of the bubble generated by underwater pulsed discharge
Authors: Zhang Liancheng , Zhu Xinlei , Yan Hui , Huang Yifan , Liu Zhen , Yan Keping
Published: January 2017

An intense luminescence flash can be induced during the collapse phase of bubbles generated by pulsed discharge in water. To gain insight into this special phenomenon, we experimentally investigated the optical characteristics and luminescence temperature inside collapsing bubbles. The duration of the luminescence flash generated by pulsed discharge was around tens of microseconds, which was confirmed by high-speed recording and the photodiode output, and the inception time of the luminescence flash was approximately 32.5 μs before the bubble collapsed to its minimum size. The temperatures of the luminescence flash at discharge energies of 25 and 30 J/pulse calculated according to the two-line radiance ratio method were 6673 and 6728 K, respectively.
An impedance spectroscopy study of magnetodielectric coupling in BaTiO3-CoFe2O4 nanostructured multiferroics
Authors: Acevedo Ulises , Lopez-Noda Rene , Breitwieser Romain , Calderon Francisco , Ammar Souad , Valenzuela Raul
Published: January 2017

Granular BaTiO3-CoFe2O4 (BTO-CFO) nanocomposites were prepared by combining polyol synthesis and spark plasma sintering (SPS). This method allows samples with a high density and a very small grain size (less than 150 nm), and thus a large interface area between phases. In order to study the involved magnetoelectric effects, the impedance response of these nanomaterials was measured in the 5 Hz-10 MHz frequency range, under 0-7.5 kOe magnetic applied fields, and in the 40-170°C temperature range. The best agreement to model these results by an equivalent circuit was achieved by means of three parallel RC arrangements connected in series; by their RC values, these circuits are representative of grain boundaries. An association between each RC circuit and each interface (or grain boundary), i. e., BTO-BTO, BTO-CFO, and CFO-CFO, is proposed on the basis of their temperature and magnetic behavior.
Design and analysis of tubular permanent magnet linear generator for small-scale wave energy converter
Authors: Kim Jeong-Man , Koo Min-Mo , Jeong Jae-Hoon , Hong Keyyong , Cho Il-Hyoung , Choi Jang-Young
Published: January 2017

This paper reports the design and analysis of a tubular permanent magnet linear generator (TPMLG) for a small-scale wave-energy converter. The analytical field computation is performed by applying a magnetic vector potential and a 2-D analytical model to determine design parameters. Based on analytical solutions, parametric analysis is performed to meet the design specifications of a wave-energy converter (WEC). Then, 2-D FEA is employed to validate the analytical method. Finally, the experimental result confirms the predictions of the analytical and finite element analysis (FEA) methods under regular and irregular wave conditions.
Effect of pole number and slot number on performance of dual rotor permanent magnet wind power generator using ferrite magnets
Authors: Xu Peifeng , Shi Kai , Sun Yuxin , Zhua Huangqiu
Published: January 2017

Dual rotor permanent magnet (DRPM) wind power generator using ferrite magnets has the advantages of low cost, high efficiency, and high torque density. How to further improve the performance and reduce the cost of the machine by proper choice of pole number and slot number is an important problem to be solved when performing preliminarily design a DRPM wind generator. This paper presents a comprehensive performance comparison of a DRPM wind generator using ferrite magnets with different slot and pole number combinations. The main winding factors are calculated by means of the star of slots. Under the same machine volume and ferrite consumption, the flux linkage, back-electromotive force (EMF), cogging torque, output torque, torque pulsation, and losses are investigated and compared using finite element analysis (FEA). The results show that the slot and pole number combinations have an important impact on the generator properties.
First-principles calculation of the effects of tetragonal distortions on the Gilbert damping parameter of Co2MnSi
Authors: Pradines B. , Arras R. , Calmels L.
Published: January 2017

We present an ab initio study of the influence of the tetragonal distortion, on the static and dynamic (Gilbert damping parameter) magnetic properties of a Co2MnSi crystal. This tetragonal distortion can for instance be due to strain, when Co2MnSi is grown on a substrate with a small lattice mismatch. Using fully relativistic Korringa-Kohn-Rostoker (KKR) calculations, in conjunction with the coherent potential approximation (CPA) to describe atomic disorder and the linear response formalism to compute the Gilbert damping parameter, we show that a tetragonal distortion can substantially change the properties of Co2MnSi, in a way which depends on the kind of atomic disorder.
Study on the Acid-Induced Ring-Expansion of an Oxaphosphirane Complex with an Electron-Withdrawing C-Substituent
Authors: García Cristina Murcia , Schnakenburg Gregor , Streubel Rainer
Published: January 2017

A study on the acid-induced ring-expansion reaction of the first oxaphosphirane complexes bearing an electron-withdrawing C-substituent is described. The stereoselectively obtained 1,3,4-dioxaphospholane complexes 4a–c, representing the first examples of such fluorinated ligands, were unambiguously characterized by multinuclear NMR, elemental analysis, mass spectrometry, and single-crystal X-ray diffraction studies.
Tidal and diel movement patterns of the Atlantic stingray (Dasyatis sabina) along a stream-order gradient
Authors: Brinton Cameron Patrick , Curran Mary Carla
Published: January 2017

The behaviour of the Atlantic stingray (Dasyatis sabina) is affected by environmental cues, including time of day and tide. The purpose of the present study was to determine whether these cycles and differences in creek geomorphology affected presence and movement patterns of Atlantic stingrays near Savannah, GA, USA. Forty-five stingrays were tagged with Vemco coded-acoustic transmitters and passively tracked in two creek systems between December 2012 and December 2014. The geomorphology of the creeks was classified using the Horton stream-order concept, with the smallest tributaries assigned to the first order. Stingrays moved most at dusk (0.26±0.09 movements day–1), followed by night (0.23±0.09 movements day–1). Stingrays were found in deeper water during the cold season than during the warm season. Patterns in creek usage across tidal stages were nearly consistent across seasons. However, the diel pattern varied; stingrays utilised all creek orders throughout the diel cycle in the warm seasons, but entered only shallow creeks during the day in the cold season. Because presence and movements of stingrays were affected by tidal and diel cycles, these environmental factors could also affect their foraging patterns and their influence as an ecosystem engineer.
Opportunity for marine fisheries reform in China
Authors: Cao Ling , Chen Yong , Dong Shuanglin , Hanson Arthur , Huang Bo , Leadbitter Duncan , Little David C. , Pikitch Ellen K. , Qiu Yongsong , Sadovy de Mitcheson Yvonne , Sumaila Ussif Rashid , Williams Meryl , Xue Guifang , Ye Yimin , Zhang Wenbo , Zhou Yingqi , Zhuang Ping , Naylor Rosamond L.
Published: January 2017

China’s 13th Five-Year Plan, launched in March 2016, provides a sound policy platform for the protection of marine ecosystems and the restoration of capture fisheries within China’s exclusive economic zone. What distinguishes China among many other countries striving for marine fisheries reform is its size—accounting for almost one-fifth of global catch volume—and the unique cultural context of its economic and resource management. In this paper, we trace the history of Chinese government priorities, policies, and outcomes related to marine fisheries since the 1978 Economic Reform, and examine how the current leadership’s agenda for “ecological civilization” could successfully transform marine resource management in the coming years. We show how China, like many other countries, has experienced a decline in the average trophic level of its capture fisheries during the past few decades, and how its policy design, implementation, and enforcement have influenced the status of its wild fish stocks. To reverse the trend in declining fish stocks, the government is introducing a series of new programs for sustainable fisheries and aquaculture, with greater traceability and accountability in marine resource management and area controls on coastal development. As impressive as these new plans are on paper, we conclude that serious institutional reforms will be needed to achieve a true paradigm shift in marine fisheries management in China. In particular, we recommend new institutions for science-based fisheries management, secure fishing access, policy consistency across provinces, educational programs for fisheries managers, and increasing public access to scientific data.
A study on keyhole evolution and weld ripple formation in dissimilar welding under pulsed laser
Authors: Liang Rong , Luo Yu
Published: January 2017

A three-transient multiphase model is developed to study the dissimilar metal welding of pure niobium plate to titanium alloy Ti–6Al–4V sheet under pulsed laser. The physical process of dissimilar metal welding involves melting, resolidification, mass transfer, self-consistent keyhole, and weld bead formation. The major physical factors, such as recoil pressure induced by vapourisation, surface tension, heat transfer, fluid flow, Marangoni shear stress, buoyancy force, and their coupling are considered. The results show that the keyhole mainly occurs on the Ti–6Al–4V side due to the differences in physical properties of the materials. The effects of pulse overlapping factor on the weld bead are studied. It is found that the pulsed laser has a significant influence on the weld bead formation. The mixing of materials mostly occurred in the upper part of the molten pool. The simulated weld bead profile and the phase distribution agree well with the experimental results.
STUDY OF DARK-MATTER ADMIXED NEUTRON STARS USING THE EQUATION OF STATE FROM THE ROTATIONAL CURVES OF GALAXIES
Authors: Rezaei Z.
Published: January 2017

In this work, we employ the dark matter equations of state (DMEOSs) obtained from the rotational curves of galaxies as well as the fermionic DMEOS with

to study the structure of dark-matter admixed neutron stars (DMANSs). Applying the equation of state in the Skyrme framework for the neutron matter (NM), we calculate the mass–radius relation for different DMANSs with various DMEOSs and central pressure of dark matter (DM) to NM ratios. Our results show that for some DMEOSs, the mass–radius relations are in agreement with new observations, e.g., EXO 1745-248, 4U 1608-52, and 4U 1820-30, which are inconsistent with normal neutron stars. We conclude that both DMEOSs and central pressure ratios of DM to NM affect the slope of the mass–radius relation of DMANSs. This is because of the interaction between DM and NM, which leads to gravitationally or self-bound DMANSs. We study the radius of the NM sphere as well as the radius of the DM halo for different DMANSs. The results confirm that, in some cases, a NM sphere with a small radius is surrounded by a halo of DM with a larger radius. Our calculations verify that, due to the different degrees of DM domination in DMANSs, with a value of the visible radius of a star two possible DMANSs with different masses can exist. The gravitational redshift is also calculated for DMANSs with different DMEOSs and central pressure ratios. The results explain that the existence of DM in a DMANS leads to higher values of gravitational redshift of the star.
Sphinx: merging knowledge-based andab initioapproaches to improve protein loop prediction
Authors: Marks Claire , Nowak Jaroslaw , Klostermann Stefan , Georges Guy , Dunbar James , Shi Jiye , Kelm Sebastian , Deane Charlotte M
Published: January 2017

Motivation

Loops are often vital for protein function, however, their irregular structures make them difficult to model accurately. Current loop modelling algorithms can mostly be divided into two categories: knowledge-based, where databases of fragments are searched to find suitable conformations and ab initio, where conformations are generated computationally. Existing knowledge-based methods only use fragments that are the same length as the target, even though loops of slightly different lengths may adopt similar conformations. Here, we present a novel method, Sphinx, which combines ab initio techniques with the potential extra structural information contained within loops of a different length to improve structure prediction.

Results

We show that Sphinx is able to generate high-accuracy predictions and decoy sets enriched with near-native loop conformations, performing better than the ab initio algorithm on which it is based. In addition, it is able to provide predictions for every target, unlike some knowledge-based methods. Sphinx can be used successfully for the difficult problem of antibody H3 prediction, outperforming RosettaAntibody, one of the leading H3-specific ab initio methods, both in accuracy and speed.

Availability and Implementation

Sphinx is available at http://opig.stats.ox.ac.uk/webapps/sphinx.

Supplementary information

Supplementary data are available at Bioinformatics online.
mlo-Based Resistance: An Apparently Universal “Weapon” to Defeat Powdery Mildew Disease
Authors: Kusch Stefan , Panstruga Ralph
Published: January 2017

Loss-of-function mutations of one or more of the appropriate Mildew resistance locus o (Mlo) genes are an apparently reliable “weapon” to protect plants from infection by powdery mildew fungi, as they confer durable broad-spectrum resistance. Originally detected as a natural mutation in an Ethiopian barley landrace, this so-called mlo-based resistance has been successfully employed in European barley agriculture for nearly four decades. More recently, mlo-mediated resistance was discovered to be inducible in virtually every plant species of economic or scientific relevance. By now, mlo resistance has been found (as natural mutants) or generated (by induced mutagenesis, gene silencing, and targeted or nontargeted gene knock-out) in a broad range of monocotyledonous and dicotyledonous plant species. Here, we review features of mlo resistance in barley, discuss approaches to identify the appropriate Mlo gene targets to induce mlo-based resistance, and consider the issue of pleiotropic effects often associated with mlo-mediated immunity, which can harm plant yield and quality. We portray mlo-based resistance as an apparently universal and effective weapon to defeat powdery mildew disease in a multitude of plant species.
Suppression of Root-Knot Nematode by Vermicompost Tea Prepared From Different Curing Ages of Vermicompost
Authors: Mishra Shova , Wang Koon-Hui , Sipes Brent S. , Tian Miaoying
Published: January 2017

Suppression of root-knot nematodes (Meloidogyne spp.) by vermicompost tea (VCT) has been inconsistent. Greenhouse and laboratory trials were conducted to compare the effects of VCT prepared from different curing ages of vermicompost (VC) on root penetration, reproduction, and hatching of M. incognita. In the penetration experiment, zucchini (Cucurbita pepo) seedlings were drenched with VCT prepared from (i) uncured (UVC), (ii) partially cured (PVC), (iii) completely cured (CVC) vermicompost, and (iv) water or no vermicompost (NVC) 3 days prior to M. incognita inoculation. The experiment was repeated twice on cucumber (Cucumis sativus) and terminated one week after nematode inoculation. All three trials showed that UVC and PVC reduced (P ≤ 0.05) penetration of M. incognita compared with CVC and NVC. Two greenhouse trials showed that VCT from different curing ages of VC did not reduce the abundance of M. incognita juveniles in soil and eggs in roots 2.5 months after nematode inoculation. Two laboratory trials to examine hatching consistently showed that VCT from UVC and PVC suppressed hatching (P ≤ 0.05) compared with NVC, achieving 83.1% hatch reduction by UVC. Overall, VCT from UVC and PVC suppressed root penetration and hatching, but not the reproduction of M. incognita over time.
Insight into scabies
Authors: Razon Faye Mariz , Weidman-Evans Emily
Published: January 2017

Scabies, an infectious disease caused by the scabies mite, manifests as an intensely pruritic skin rash. Children, the underprivileged, and patients with immunocompromise are at a higher risk of acquiring this contagious disease. Infectivity occurs worldwide in patients of all races, ages, and sex. The classical appearance of papular burrows between the webbed spaces of digits or along the wrists can help distinguish scabies from other dermatologic diseases. Practitioners need to be familiar with how scabies may present so that patients can be treated and taught how to prevent spread of the disease.
A Network Analysis of Depressive Symptoms in Individuals Seeking Treatment for Chronic Pain
Authors: McWilliams Lachlan A. , Sarty Gordon , Kowal John , Wilson Keith G.
Published: January 2017

Objectives:

Major depression in the context of chronic pain has been conceptualized implicitly as a latent variable, in which symptoms are viewed as manifestations of an underlying disorder. A network approach provides an alternative model and posits that symptoms are causally connected, rather than merely correlated, and that disorders exist as systems, rather than as entities. The present study applied a network analysis to self-reported symptoms of major depression in patients with chronic pain. The goals of the study were to describe the network of depressive symptoms in individuals with chronic pain and to illustrate the potential of network analysis for generating new research questions and treatment strategies.

Materials and Methods:

Patients (N=216) admitted to an interdisciplinary chronic pain rehabilitation program provided symptom self-reports using the Patient Health Questionnaire-9. Well-established network analyses methods were used to illustrate the network of depressive symptoms and determine the centrality of each symptom (ie, the degree of connection with other symptoms in the network).

Results:

The most central symptoms were difficulty concentrating, loss of interest or pleasure, depressed mood, and fatigue, although the relative position of each symptom varied slightly, depending on the centrality measure considered.

Discussion:

Consistent with past research with patients undergoing treatment for major depression, the current findings are supportive of a model in which depressive symptoms are causally connected within a network rather than being manifestations of a common underlying disorder. The research and clinical implications of the findings, such as developing treatments targeting the most central symptoms, are discussed.
Analysis of Incident and Accident Reports and Risk Management in Spine Surgery
Authors: Kobayashi Kazuyoshi , Imagama Shiro , Ando Kei , Hida Tetsuro , Ito Kenyu , Tsushima Mikito , Ishikawa Yoshimoto , Matsumoto Akiyuki , Morozumi Masayoshi , Nishida Yoshihiro , Nagao Yoshimasa , Ishiguro Naoki
Published: January 2017

Study Design.

A review of accident and incident reports.

Objective.

To analyze prevalence, characteristics, and details of perioperative incidents and accidents in patients receiving spine surgery.

Summary of Background Data.

In our institution, a clinical error that potentially results in an adverse event is usually submitted as an incident or accident report through a web database, to ensure anonymous and blame-free reporting. All reports are analyzed by a medical safety management group. These reports contain valuable data for management of medical safety, but there have been no studies evaluating such data for spine surgery.

Methods.

A total of 320 incidents and accidents that occurred perioperatively in 172 of 415 spine surgeries were included in the study. Incidents were defined as events that were “problematic, but with no damage to the patient,” and accidents as events “with damage to the patient.“ The details of these events were analyzed.

Results.

There were 278 incidents in 137 surgeries and 42 accidents in 35 surgeries, giving prevalence of 33% (137/415) and 8% (35/415), respectively. The proportion of accidents among all events was significantly higher for doctors than non-doctors [68.0% (17/25) vs. 8.5% (25/295), P < 0.01] and in the operating room compared with outside the operating room [40.5% (15/37) vs. 9.5% (27/283), P < 0.01]. There was no significant difference in years of experience among personnel involved in all events. The major types of events were medication-related, line and tube problems, and falls and slips. Accidents also occurred because of a long-term prone position, with complications such as laryngeal edema, ulnar nerve palsy, and tooth damage.

Conclusion.

Surgery and procedures in the operating room always have a risk of complications. Therefore, a particular effort is needed to establish safe management of this environment and to provide advice on risk to the doctor and medical care team.

Level of Evidence: 4
Is there a SERM in your menopause toolkit?
Authors: Liu James H.
Published: January 2017

Over the past 3 decades, compounds called selective estrogen receptor modulators (SERMs) have been developed that block the estrogen receptor in some tissues (estrogen receptor antagonists) or stimulate the estrogen receptor in other tissues (estrogen receptor agonists). This Practice Pearl focuses on SERMs that clinicians can use for menopausal patients.
Science of intracrinology in postmenopausal women
Authors: Labrie Fernand , Bélanger Alain , Pelletier Georges , Martel Céline , Archer David F. , Utian Wulf H.
Published: January 2017

Objective:

To illustrate the marked differences between classical endocrinology that distributes hormones to all tissues of the body through the bloodstream and the science of intracrinology, whereby each cell of each peripheral tissue makes a small and appropriate amount of estrogens and androgens from the inactive precursor dehydroepiandrosterone (DHEA), DHEA being mainly of adrenal origin. Because only the inactivated sex steroids are released in the blood, influence in the other tissues is avoided.

Methods:

Molecular biology has been used for the identification/characterization of the steroid-forming and steroid-inactivating enzymes, whereas steroids have been measured by mass spectrometry-based assays validated according to the US Food and Drug Administration guidelines.

Results:

Evolution over 500 million years has engineered the expression of about 30 steroid-forming enzymes specific for each peripheral tissue. These tissue-specific enzymes transform DHEA into the appropriate small amounts of estrogens and androgens for a strictly intracellular and local action. Humans, contrary to species below primates, also possess intracellular steroid-inactivating enzymes, especially glucuronyl transferases and sulfotransferases, which inactivate the estrogens and androgens at their local site of formation, thus preventing the release of a biologically significant amount of estradiol (E2) and testosterone in the circulation. Since DHEA becomes the unique source of sex steroids after menopause, serum E2and testosterone are thus maintained at low biologically inactive concentrations with no activity outside the cells of origin. DHEA secretion, unfortunately, starts decreasing at about the age of 30 at various rates in different women. Moreover, there is no feedback mechanism to increase DHEA secretion when the concentration of serum DHEA decreases. Considering this mechanism is unique to the human, it seems logical to replace DHEA locally in women suffering from vulvovaginal atrophy (genitourinary syndrome of menopause). The clinical data obtained using a small dose of intravaginal DHEA (prasterone) confirm the mechanisms of intracrinology mentioned above which avoid biologically significant changes in serum E2and testosterone.

Conclusions:

The symptoms and signs of vulvovaginal atrophy (genitourinary syndrome of menopause) can be successfully treated by the intravaginal administration of DHEA without safety concerns. This strategy exclusively replaces in the vagina the missing cell-specific intracellular estrogens and androgens. This approach avoids systemic exposure and the potential risks of estrogen exposure for the tissues other than the vagina.
Managing Maternal Sepsis: Early Warning Criteria to ECMO
Authors: PADILLA CESAR , PALANISAMY ARVIND
Published: January 2017

Maternal sepsis is now a leading cause of direct maternal death during pregnancy. This review addresses the latest advances in the identification and management of critically ill parturients. Specifically, this review will focus on the vulnerability of pregnant women to sepsis, the utility of early warning criteria in the identification of the septic parturient, emphasize the immediate antibiotic management of suspected sepsis, and elaborate upon the latest understanding in the ventilatory management of parturients with sepsis.
PERIPAPILLARY RETINAL NERVE FIBER THICKNESS CHANGES AFTER VITRECTOMY FOR EPIRETINAL MEMBRANE IN EYES WITH AND WITHOUT VITREOUS DETACHMENT
Authors: Mariotti Cesare , Nicolai Michele , Longo Antonio , Viti Francesca , Bambini Elisa , Saitta Andrea , Pirani Vittorio , Orsini Emanuele , Baruffa Daniela , Reibaldi Michele
Published: January 2017

Purpose:

To compare the changes in postoperative peripapillary retinal nerve fiber layer (p-RNFL) thickness after vitrectomy for epiretinal membrane in eyes with preexisting posterior vitreous detachment (PVD) and eyes with surgically induced PVD.

Methods:

This study included consecutive patients who underwent 25-gauge vitrectomy for epiretinal membrane. Eyes were divided, according to intraoperative PVD status, into a preexisting PVD group and surgically induced PVD group. Best-corrected visual acuity, p-RNFL thickness, and central retinal thickness were performed before and at 1, 3, and 6 months after surgery.

Results:

One hundred and twenty eyes of 120 patients were enrolled: 64 eyes in the preexisting PVD group and 56 eyes in the surgically induced PVD group. In the preexisting PVD group at 6 months, the mean global p-RNFL thickness did not change, whereas it was reduced in the temporal sector (P = 0.034). In the surgically induced PVD group at 6 months, significant decreases were observed in global p-RNFL thickness (P = 0.027), temporal (P = 0.021), temporal inferior (P = 0.030), and nasal inferior sectors (P = 0.010). At 6 months, the two groups differed significantly in temporal (P < 0.001) and temporal inferior sectors (P = 0.004). The preoperative mean best-corrected visual acuity improved significantly at 6 months in both groups.

Conclusion:

Postoperative p-RNFL thickness after vitrectomy for epiretinal membrane tended to decrease in the temporal sector in all eyes and in the temporal inferior and nasal inferior sectors in eyes with surgically induced PVD.
ASSESSMENT OF THE INTERNAL LIMITING MEMBRANE STATUS WHEN A MACULAR EPIRETINAL MEMBRANE IS REMOVED IN A PROSPECTIVE STUDY
Authors: Vila Solà Daniel , Nienow Cristofer , Jürgens Ignasi
Published: January 2017

Purpose:

To describe the presence and integrity of the internal limiting membrane (ILM) after removal of the macular epiretinal membrane (ERM) and to investigate the accuracy of tissue identification using surgical dyes when compared to histopathology results.

Methods:

Patients with idiopathic ERM were enrolled in a prospective study and randomized to one of two surgical techniques. In one (Group M), only the ERM was deliberately removed and in the other (Group L) the ILM was also removed. Pars plana vitrectomy and extraction of the ERM with trypan blue dye were performed in all patients. The ILM status was assessed with brilliant blue G dye, and in Group L patients, the ILM was then removed. Histopathology was performed on all samples.

Results:

Twenty-six patients underwent the study procedure: 11 in the Group M and 15 in the Group L. The patients' median age was 70.65 years (53–81), and the average follow-up was 15.35 months (4.86–25.10). The ILM extraction patterns were as follows: In Group M in block in 8 of 11 patients and partial in 3 of 11 patients; In Group L in block in 9 of 15 patients, partial in 5 of 15 patients and sequential in 1 of 15 patients. In only 3.8% of patients was the ILM intact after ERM removal. Thirty-two surgical samples were analyzed, containing both ERM and ILM, ERM only, or ILM only. In 84.37% of samples, the tissue identification using surgical dyes was consistent with identification according to pathological examination. This consistency was higher still at 96.7% when focused on ILM identification.

Conclusion:

It is technically difficult to extract the ERM in isolation from the ILM. There is good consistency between the content of removed tissue as identified using surgical dyes and the histopathological results of the samples. This is higher in ILM than in ERM.
FOVEAL EXUDATE AND CHOROIDAL NEOVASCULARIZATION IN ATYPICAL CASES OF MULTIPLE EVANESCENT WHITE DOT SYNDROME
Authors: Chen Kevin C. , Marsiglia Marcela , Dolz-Marco Rosa , Zahid Sarwar , Mrejen Sarah , Pulido Jose S. , Cohen Salomon Y. , Freilich Benjamin , Yannuzzi Lawrence A. , Freund K. Bailey
Published: January 2017

Purpose:

To describe atypical cases of multiple evanescent white dot syndrome (MEWDS) associated with foveal exudation, increased choroidal thickness, and secondary Type 2 (subretinal) neovascularization.

Methods:

Four cases of atypical MEWDS were studied at a retina referral center. Patients underwent evaluation with multimodal retinal imaging, including fluorescein angiography, indocyanine green angiography, spectral-domain and enhanced depth imaging optical coherence tomography (OCT). Two patients were imaged with OCT angiography.

Results:

Four patients (3 female, 1 male) with a median age of 23.5 years presented with acute onset, painless, decreased central vision. All cases demonstrated fundus findings consistent with MEWDS on color photography, indocyanine green angiography, fluorescein angiography, fundus autofluorescence, and structural OCT imaging. On structural OCT, all 4 patients were noted to have hyperreflective subretinal material and increased subfoveal choroidal thickness ranging from 307 μm to 515 μm. Type 2 neovascularization was diagnosed in all four patients using fluorescein angiography, indocyanine green angiography, and/or OCT angiography. Two patients had poor visual acuity at the last follow-up despite resolution of characteristic clinical findings of MEWDS.

Conclusion:

A subset of patients with atypical MEWDS may develop persistent poor vision due to subfoveal exudation and secondary Type 2 neovascularization. Patients showing increased choroidal thickness at presentation may be more susceptible to this unusual presentation.
PERSISTENT OVERPRODUCTION OF INTRAOCULAR VASCULAR ENDOTHELIAL GROWTH FACTOR AS A CAUSE OF LATE VITREOUS HEMORRHAGE AFTER VITRECTOMY FOR PROLIFERATIVE DIABETIC RETINOPATHY
Authors: Wakabayashi Yoshihiro , Usui Yoshihiko , Tsubota Kinya , Ueda Shunichiro , Umazume Kazuhiko , Muramatsu Daisuke , Goto Hiroshi
Published: January 2017

Purpose:

The purpose of this study was to investigate whether vitreous levels of vascular endothelial growth factor (VEGF) predict late vitreous hemorrhage (VH) after vitrectomy for proliferative diabetic retinopathy, and how VEGF level changes in patients with postoperative late VH.

Methods:

Eighty-five eyes of 68 patients with proliferative diabetic retinopathy who underwent vitrectomy were analyzed retrospectively. Vitreous samples were collected from eyes undergoing primary vitrectomy and from eyes with late VH undergoing second vitrectomy. Vitreous VEGF levels were measured using enzyme-linked immunosorbent assay. The relationship between VEGF level and late VH (>4 weeks) occurring during follow-up as well as clinical findings, and changes in VEGF level in eyes with late VH undergoing second vitrectomy were analyzed.

Results:

Late VH occurred in 20 (24%) of 85 eyes, and 9 eyes required second vitrectomy. Vitreous levels of VEGF were significantly higher (median: 1,945 pg/mL; P < 0.0001) in eyes with late VH than in those without. Preexisting iris neovascularization (P < 0.0001), hypertension (P = 0.002), and proteinuria (P = 0.040) were also significant risk factors of late VH. Multivariate logistic regression analysis showed that a higher vitreous VEGF level was independently associated with a risk of postoperative late VH in patients with proliferative diabetic retinopathy (odds ratio: 20.8, 95% confidence interval: 2.72–159.47; P = 0.003). Vitreous VEGF level at second vitrectomy in patients with late VH was significantly lower compared with that at primary vitrectomy, but remained elevated (median: 1,610 pg/mL; P = 0.023).

Conclusion:

In patients with proliferative diabetic retinopathy, high intraocular VEGF level at primary vitrectomy was identified as an independent risk factor of postoperative late VH. Persistent overproduction of intraocular VEGF may be associated with postoperative late VH.
SIGNIFICANT REDUCTION OF PERIPAPILLARY CHOROIDAL THICKNESS IN PATIENTS WITH UNILATERAL BRANCH RETINAL VEIN OCCLUSION
Authors: Kang Hae Min , Choi Jeong Hoon , Koh Hyoung Jun , Lee Christopher Seungkyu , Lee Sung Chul
Published: January 2017

Purpose:

To evaluate changes in peripapillary choroidal thickness in patients with branch retinal vein occlusion (BRVO) over 12 months, using spectral-domain optical coherence tomography with enhanced depth imaging.

Methods:

This retrospective, interventional case series included 20 treatment-naive patients with unilateral BRVO with at least 12 months follow-up. The peripapillary choroidal thickness was measured over 12 months.

Results:

In BRVO-affected eyes, the mean peripapillary choroidal thickness was 213.5 ± 51.7 μm (126.1‒326.9 μm) at baseline and 129.6 ± 39.3 μm (65.9‒197.1 μm) at 12 months. In nonaffected contralateral eyes, the mean peripapillary choroidal thickness was 194.1 ± 39.8 μm (158.5‒238.3 μm) at baseline and 156.6 ± 56.2 μm (125.9‒213.9 μm) at 12 months. The mean peripapillary choroidal thickness decreased significantly over 12 months in both BRVO-affected and nonaffected eyes (P < 0.001, both eyes). Although the mean peripapillary choroidal thickness was not significantly different between groups at baseline (P = 0.472), it was significantly lower in BRVO-affected eyes than in nonaffected eyes at 12 months (P = 0.036).

Conclusion:

Peripapillary choroidal thickness decreased significantly over 12 months in BRVO-affected eyes and nonaffected eyes in patients with unilateral BRVO.
MULTIMODAL FUNDUS IMAGING OF OUTER RETINAL TUBULATIONS IN CHOROIDAL OSTEOMA PATIENTS
Authors: Xuan Yi , Zhang Yongjin , Wang Min , Guo Jinli , Li Lei , Liu Wei , Ye Xiaofeng
Published: January 2017

Purpose:

To evaluate the morphological findings of outer retinal tubulations (ORTs) shown on multimodal imaging modalities in patients with choroidal osteoma.

Methods:

Nineteen eyes of 17 patients with choroidal osteoma underwent full clinical and imaging assessments. Color fundus photography, spectral-domain optical coherence tomography (OCT), and en face OCT were used to identify and detect the characteristics of ORT structures, including the shape, configuration, location, and distribution in the fundus. Optical coherence tomography angiography was implemented as an assist to differentiate tumor's feeder vessels from choroidal neovascularization. The correlations between age, gender, tumor features, best-corrected visual acuity at baseline, OCT characteristics, and the presence of ORTs were analyzed.

Results:

Outer retinal tubulations were identified in five eyes (26.3%). All were located at the decalcified region of the tumor where the choroidal vessels, retinal pigment epithelium, and overlying outer retinal structures were considerably disrupted to varying degrees. With spectral-domain OCT, the ORTs appeared as one or multiple, round or ovoid, hyporeflective lumens with hyperreflective borders confined to the outer nuclear layer, sometimes with hyperreflective luminal content (four eyes, 80%). In one eye, ORTs were found at the focal choroidal excavation. On en face OCT, these tubulations exhibited different shapes, including a dendritic pattern in two eyes, a tube-like pattern in one eye, a circular pattern in one eye, and a hairpin pattern in one eye. Simultaneous OCT angiography imaging demonstrated that the area of choroidal neovascularization was underneath ORT in one eye and very close to ORT in two eyes. The ORTs of three eyes were above or adjacent to tumor's rich feeder vessels. Statistically, age (P = 0.007), greatest tumor linear dimension (P = 0.003), total tumor area (P = 0.002), decalcification area (P = 0.000), and the presence of intraretinal fluid (P = 0.01) and retinal pigment epithelium alterations (P = 0.038) within the foveola and central 1-mm region of patients with ORT were significantly different from those of patients without ORTs.

Conclusion:

The results of this study suggest that age, the greatest tumor linear dimension, total tumor area, decalcification area, and the presence of intraretinal fluid and retinal pigment epithelium alterations within the foveola and central 1-mm region might be risk factors for ORT formation. Spectral-domain OCT combined with en face OCT provides comprehensive imaging information for ORTs in choroidal osteoma.
Pathophysiology and Therapeutic Options for Fecal Incontinence
Authors: Guillaume Alexandra , Salem Ahmed E. , Garcia Patricia , Chander Roland Bani
Published: January 2017

Fecal incontinence (FI), defined as the involuntary loss of solid or liquid feces through the anus is a prevalent condition with significant effects on quality of life. FI can affect individuals of all ages and in many cases greatly impairs quality of life but, incontinent patients should not accept their debility as either inevitable or untreatable. The severity of incontinence can range from unintentional elimination of flatus to the complete evacuation of bowel contents. It is reported to affect up to 18% of the population, with a prevalence reaching as high as 50% in nursing home residents. However, FI is often underreported, thus obscuring its true prevalence in the general population. The options for treatment vary according to the degree and severity of the FI. Treatment can include dietary and lifestyle modification, certain medications, biofeedback therapy, bulking agent injections, sacral nerve stimulation as well as various types of surgery. In this article, we aim to provide a comprehensive review on the diagnosis and management of FI.
Open Abdomen Improves Survival in Patients With Peritonitis Secondary to Acute Superior Mesenteric Artery Occlusion
Authors: Ding Weiwei , Wang Kai , Liu Baochen , Fan Xinxin , Wang Shikai , Cao Jianmin , Wu Xingjiang , Li Jieshou
Published: January 2017

Background:

Damage control surgery and open abdomen (OA) have been extensively used in the severe traumatic patients. However, there was little information when extended to a nontrauma setting. The purpose of this study was to evaluate whether the liberal use of OA as a damage control surgery adjunct improved the clinical outcome in acute superior mesenteric artery occlusion patients.

Study Design:

A single-center, retrospective cohort review was performed in a national tertiary surgical referral center.

Results:

Forty-four patients received OA (OA group) and 65 patients had a primary fascial closure (non-OA group) after diagnosed as peritonitis secondary to acute superior mesenteric artery occlusion from January, 2005 to June, 2016. Revascularization was achieved through endovascular aspiration embolectomy, open embolectomy, or percutaneous stent. No difference of bowel resection length was found between groups in the first emergency surgery. However, more non-OA patients (35.4%) required a second-look enterectomy to remove the residual bowel ischemia than OA patients (13.6%, P<0.05). OA was closed within a median of 7 days (4 to 15 d). There was a mean of 134 cm residual alive bowel in OA, whereas 96 cm in non-OA. More non-OA patients suffered from intra-abdominal sepsis (23.1% vs. 6.8%, P<0.01), intra-abdominal hypertension (31% vs. 0, P<0.01), and acute renal failure (53.8% vs. 31.8%, P<0.05) than OA group after surgery. Short-bowel syndrome occurred infrequently in OA than non-OA patients (9.1% vs. 36.9%, P<0.01). OA significantly decreased the 30-day (27.3% vs. 52.3%, P<0.01) and 1-year mortality rate (31.8 % vs. 61.5%, P<0.01) compared with non-OA group.

Conclusions:

Liberal use of OA, as a damage control adjunct avoided the development of intra-abdominal hypertension, reduced sepsis-related complication, and improved the clinical outcomes in peritonitis secondary to acute SMA occlusion.
Business Education for Plastic Surgeons: A Systematic Review, Development, and Implementation of a Business Principles Curriculum in a Residency Program
Authors: Zarrabi Bahar , Burce Karen K. , Seal Stella M. , Lifchez Scott D. , Redett Richard J. , Frick Kevin D. , Dorafshar Amir H. , Cooney Carisa M.
Published: January 2017

Background:

Rising health care costs, decreasing reimbursement rates, and changes in American health care are forcing physicians to become increasingly business-minded. Both academic and private plastic surgeons can benefit from being educated in business principles. The authors conducted a systematic review to identify existing business curricula and integrated a business principles curriculum into residency training.

Methods:

The authors anonymously surveyed their department regarding perceived importance of business principles and performed a systematic literature review from 1993 to 2013 using PubMed and Embase to identify residency training programs that had designed/implemented business curricula. Subsequently, the authors implemented a formal, quarterly business curriculum.

Results:

Thirty-two of 36 physicians (88.9 percent; 76.6 percent response rate) stated business principles are either “pretty important” or “very important” to being a doctor. Only 36 percent of faculty and 41 percent of trainees had previous business instruction. The authors identified 434 articles in the systematic review: 29 documented formal business curricula. Twelve topics were addressed, with practice management/administration (n = 22) and systems-based practice (n = 6) being the most common. Four articles were from surgical specialties: otolaryngology (n = 1), general surgery (n = 2), and combined general surgery/plastic surgery (n = 1). Teaching formats included lectures and self-directed learning modules; outcomes and participant satisfaction were reported inconsistently. From August of 2013 to June of 2015, the authors held eight business principles sessions. Postsession surveys demonstrated moderately to extremely satisfied responses in 75 percent or more of resident/fellow respondents (n = 13; response rate, 48.1 percent) and faculty (n = 9; response rate, 45.0 percent).

Conclusions:

Business principles can be integrated into residency training programs. Having speakers familiar with the physician audience and a session coordinator is vital to program success.
A metaplasticity view of the interaction between homeostatic and Hebbian plasticity
Authors: Yee Ada X. , Hsu Yu-Tien , Chen Lu
Published: January 2017

Hebbian and homeostatic plasticity are two major forms of plasticity in the nervous system: Hebbian plasticity provides a synaptic basis for associative learning, whereas homeostatic plasticity serves to stabilize network activity. While achieving seemingly very different goals, these two types of plasticity interact functionally through overlapping elements in their respective mechanisms. Here, we review studies conducted in the mammalian central nervous system, summarize known circuit and molecular mechanisms of homeostatic plasticity, and compare these mechanisms with those that mediate Hebbian plasticity. We end with a discussion of ‘local’ homeostatic plasticity and the potential role of local homeostatic plasticity as a form of metaplasticity that modulates a neuron's future capacity for Hebbian plasticity.

This article is part of the themed issue ‘Integrating Hebbian and homeostatic plasticity’.