bluuebunny/crossref_metadata_2025 huggingface dataset:
Morel-Lavallée Lesion of the Knee in the Young Athlete
Authors: Divjak Natalie , Kwiatkowski Barbara , Tercier Stéphane
Published: January 2019

Background

Differential diagnosis of soft tissue swelling on exposed body parts in the young athlete is large and mostly includes benign self-limiting conditions, once underlying lesion to the bone, the cartilage, and the ligaments is excluded. Morel-Lavallée lesion represents a rare soft tissue injury requiring prompt intervention to ensure favorable outcome.

Cases

A 10-year-old boy presented with 2-week-old swelling of the medial side of the knee without recent traumatic event. Unawareness of Morel-Lavallée lesion in the differential diagnosis led to delayed diagnosis and treatment. A 16-year-old boy came to our pediatric tertiary care center with a similar presentation and history. Timely intervention allowed for favorable outcome and early return to play.

Conclusions

Morel-Lavallée lesion is a rare entity in the pediatric population, although underreporting due to unfamiliarity with the diagnosis is highly probable. Raising awareness among professionals in charge of young athletes should allow for better reporting as well as for elaboration of a standardized treatment plan, including rapid intervention and early return to play.
Subacute Gummy Vitamin Overdose as a Rare Manifestation of Child Neglect
Authors: Doyle Katherine G. , Blackstone Mercedes M. , Barrett Brett C.
Published: January 2019

We present a case of a 20-month-old girl who presented to the emergency department with anorexia, progressive weakness, and lethargy who was found to have severe hypercalcemia (20.7 mg/dL) and vitamin D hypervitaminosis. Further questioning revealed that this was secondary to a subacute toxic ingestion of “L'il Critters” calcium and vitamin D3 gummy vitamins that were being administered by the patient's mother multiple times a day for several weeks or even months. This occurred in the setting of child neglect due to the mother's mental illness. The patient required intensive care unit admission and had a prolonged hospital course complicated by hypomagnesemia, hyperphosphatemia, weight loss, and persistent weakness. Her hypercalcemia was initially refractory to standard treatment of intravenous fluids, prednisone, multiple trials of calcitonin, and zoledronic acid. Our patient had the highest calcium level we are aware of in a toddler and is the only case we know of that occurred as a result of a prolonged, intentional exposure in the setting of child neglect and a complex social situation. This case reviews the causes and management of hypercalcemia and vitamin D intoxication. It also highlights the need for a comprehensive social history and exposes the vulnerabilities of children living in homes afflicted by parental depression and severe mental illness.
Rest-Based Concussion Management of Pediatric Emergency Medicine Providers
Authors: Root Jeremy M. , Fong Jeanette , Badolato Gia , Madati Ponda Jamil
Published: January 2019

Objectives

This study aimed to survey pediatric emergency medicine (PEM) providers on their management of 2 hypothetical acute concussion scenarios. We hypothesized that most providers would recommend a management strategy based on cognitive and physical rest.

Methods

Fifty-nine percent (46/78) of PEM providers that were surveyed completed the study. The survey consisted of 2 clinical scenarios—a female patient with a mild concussion and a male patient with a moderate concussion. Practitioners were asked questions regarding how they would hypothetically manage these patients in terms of recommendations for returning to school and returning to sports.

Results

Eighty-six percent of providers recommended moderate time off from school for the moderate concussion scenario compared with 67% of providers in the mild concussion scenario (P= 0.008). In regard to return to sports, all providers recommended moderate time off in both scenarios, including 78% of providers who recommended clearance by a physician in the moderate concussion scenario.

Conclusions

In both of our hypothetical concussion scenarios, including a very mild head injury, most PEM providers surveyed recommended a management strategy that included a moderate degree of a delay of return to school and sports. Given recent evidence suggesting that prolonged rest does not reduce the risk of prolonged concussion symptoms, recommendations of periods of cognitive rest, particularly absences from school, should be approached cautiously. Future studies should examine why providers are recommending rest-based treatment strategies and the potential benefits of active rehabilitation.
Self-reported Functional Status in US Service Members After Combat-Related Amputation
Authors: Eskridge Susan L. , Clouser Mary C. , McCabe Cameron T. , Watrous Jessica R. , Galarneau Michael R.
Published: January 2019

The objective of this study was to describe the functional status of US service members after combat-related amputation. This was a cross-sectional analysis of data from a subsample of the Wounded Warrior Recovery Project, an ongoing, web-based, longitudinal examination of patient-reported outcomes of injured service members. The study sample included 82 Wounded Warrior Recovery Project participants with a combat-related lower extremity amputation who reported using a prosthetic device and completed the Orthotics and Prosthetics Users' Survey Lower Extremity Functional Status, which measures self-reported functional status in participants with a prosthetic device. Basic activities, such as walking indoors, getting on and off the toilet, and getting up from a chair, were reported by the majority of participants as “very easy/easy,” whereas higher-level activities, such as climbing stairs, walking long distances, or running, were more often reported as “slightly difficult/very difficult” or “cannot do this activity.” Functional status varied significantly by amputation site (unilateral below knee, unilateral above knee, or bilateral; P = 0.004), with significantly better function reported in those with unilateral below knee than bilateral amputation (P < 0.05). These findings highlight deficits in the functional status of US service members with combat-related amputation. Self-reported functional status of daily activities may help target important activities for patient-centered goals.
Possible Contributions of Ipsilateral Pathways From the Contralesional Motor Cortex to the Voluntary Contraction of the Spastic Elbow Flexors in Stroke Survivors
Authors: Chen Yen-Ting , Li Shengai , DiTommaso Craig , Zhou Ping , Li Sheng
Published: January 2019

Objective

The contribution of the contralesional motor cortex to the impaired limbs is still controversial. The aim of this study was to investigate the role of descending projections from the contralesional hemisphere during voluntary elbow flexion on the paretic side.

Design

Eleven healthy and 10 stroke subjects performed unilateral isometric elbow flexion tasks at various submaximal levels. Transcranial magnetic stimulation was delivered to the hotspot of biceps muscles ipsilateral to the target side (paretic side in stroke subjects or right side in controls) at rest and during elbow flexion tasks. Motor-evoked potential amplitudes of the contralateral resting biceps muscles, transcranial magnetic stimulation–induced ipsilateral force increment, and reflex torque and weakness of spastic elbow flexors were quantified.

Results

The normalized motor-evoked potential amplitude increased with force level in both healthy and stroke subjects. However, stroke subjects exhibited significantly higher force increment compared with healthy subjects only at low level of elbow flexion but similar at moderate to high levels. The greater force increment significantly correlated with reflex torque of the spastic elbow flexors, but not weakness.

Conclusions

These results provide novel evidence that ipsilateral projections are not likely to contribute to strength but are correlated to spasticity of spastic-paretic elbow flexors after stroke.
Sensitized vasoactive C-nociceptors: key fibers in peripheral neuropathic pain
Authors: Forstenpointner Julia , Naleschinski Dennis , Wasner Gunnar , Hüllemann Philipp , Binder Andreas , Baron Ralf
Published: January 2019

Introduction:

Multiple mechanisms are involved in the development and persistence of neuropathic pain. Some patients with nerve damage will remain painless and develop a “loss of function” phenotype, whereas others develop painful neuropathies.

Objectives:

The aim of this study is to investigate the role of a peripheral nervous system sensitization by analyzing patients with and without pain.

Methods:

The topical application of capsaicin was investigated in peripheral nociceptors. Two groups of patients (painful vs painless) with length-dependent neuropathies and small-fiber impairment were tested. Quantitative sensory testing was assessed before and after topical application of 0.6% capsaicin in the affected skin. In addition, blood perfusion measurements and an axon reflex flare assessment were performed.

Results:

Quantitative testing revealed that heat hyperalgesia was induced in all patients and volunteers (P < 0.01) without observing any significant differences between patient groups. By contrast, the extent of the axon reflex flare reaction (P < 0.01) as well as the blood perfusion (P < 0.05) was significantly greater in patients with pain than in neuropathy patients not experiencing pain.

Conclusion:

Hyperexcitable vasoactive nociceptive C fibers might contribute to pain in peripheral neuropathies and therefore may serve as a key player in separating into a painless or painful condition.
The Burden of Opioid-Related Adverse Drug Events on Hospitalized Previously Opioid-Free Surgical Patients
Authors: Urman Richard D. , Seger Diane L. , Fiskio Julie M. , Neville Bridget A. , Harry Elizabeth M. , Weiner Scott G. , Lovelace Belinda , Fain Randi , Cirillo Jessica , Schnipper Jeffrey L.
Published: January 2019

Objective

Opioid analgesics are a mainstay for acute pain management, but postoperative opioid administration has risks. We examined the prevalence, risk factors, and consequences of opioid-related adverse drug events (ORADEs) in a previously opioid-free surgical population.

Methods

A retrospective, observational, cohort study using administrative, billing, clinical, and medication administration data from two hospitals. Data were collected for all adult patients who were opioid-free at admission, underwent surgery between October 1, 2015, and September 30, 2016, and received postoperative opioids. Potential ORADEs were determined based on inpatient billing codes or postoperative administration of naloxone. We determined independent predictors of ORADE development using multivariable logistic regression. We measured adjusted inpatient mortality, hospital costs, length of hospital stay, discharge destination, and readmission within 30 days for patients with and without ORADEs.

Results

Among 13,389 hospitalizations where opioid-free patients had a single qualifying surgery, 12,218 (91%) received postoperative opioids and comprised the study cohort. Of these, we identified 1111 (9.1%) with a potential ORADE. Independent predictors of ORADEs included older age, several markers of disease severity, longer surgeries, and concurrent benzodiazepine use. Opioid-related adverse drug events were strongly associated with the route and duration of opioids administered postoperatively: 18% increased odds per day on intravenous opioids. In analyses adjusted for several covariates, presence of an ORADE was associated with 32% higher costs of hospitalization, 45% longer postoperative length of stay, 36% lower odds of discharge home, and 2.2 times the odds of death.

Conclusions

We demonstrate a high rate and severe consequences of potential ORADEs in previously opioid-free patients receiving postoperative opioids. Knowledge of risk factors and predictors of ORADEs can help develop targeted interventions to minimize the development of these potentially dangerous and costly events.
Acute exacerbations in chronic obstructive pulmonary disease: should we use antibiotics and if so, which ones?
Authors: Jacobs David M. , Pandit Ursula , Sethi Sanjay
Published: January 2019

Purpose of review

Acute exacerbations are a major cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD) with evidence suggesting at least 50% of exacerbations involve bacteria that benefit from antibiotic treatment. Here, we review the most relevant data regarding the use of antibiotics in exacerbations of COPD and provide insights on the selection of initial antibiotic therapy for their treatment.

Recent findings

Identification of bacterial exacerbations still relies on clinical assessment rather than laboratory biomarkers. Several recent studies, including a meta-analysis and placebo-controlled trials, demonstrate improved outcomes with antibiotics in all but mild exacerbations of COPD, including both inpatient and outpatient. A broader antibiotic regimen should be used for patients who have risk factors for poor outcomes. A risk-stratification approach can guide antibiotic choice, although the stratification algorithm still needs to be validated in a randomized controlled trial.

The use of antibiotics for the treatment of moderate-to-severe suspected bacterial exacerbations in COPD is supported by published trials and evidence-based systematic reviews. Recent trials also show differences in outcomes based on antibiotic choice. More research is necessary to evaluate risk stratification approaches when selecting initial antibiotic therapy.
Hepatoblastoma Mimicking Hemangioma in Labeled Red Blood Cell Scintigraphy
Authors: Arçay Ayça , Kintrup Gülen Tüysüz , Gelen Mustafa Tekinalp , Arslan Gökhan , Karayalçin Binnur
Published: January 2019

Although 99mTc red blood cell (RBC) scintigraphy is a very specific method to differentiate a hemangioma from other hepatic masses, several cases of false-positive 99mTc RBC scintigraphy have been previously reported throughout the literature. We report an additional case that presented in a 15-month-old boy with hepatoblastoma showing increased labeled RBC activity mimicking hemangioma.
Initial Versus Follow-up Sequential Myocardial 123I-MIBG Scintigraphy to Discriminate Parkinson Disease From Atypical Parkinsonian Syndromes
Authors: Ryu Dong-Woo , Kim Joong-Seok , Lee Jee-Eun , Oh Yoon-Sang , Yoo Sang-Won , Yoo Ie Ryung , Lee Kwang-Soo
Published: January 2019

Purpose

Previous single-center or meta-analysis studies analyzed myocardial 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy in a single image session and demonstrated low sensitivity and high specificity for discriminating Parkinson disease (PD) from atypical Parkinsonian syndromes (APS). This study aimed to assess diagnostic ability of myocardial 123I-MIBG scintigraphy at 2 phases to discriminate PD from APS.

Patients and Methods

This hospital-based prospective study enrolled 162 PD and 26 APS patients who underwent 2 sequential 123I-MIBG scintigraphy evaluations. Patients were stratified into normal and decreased 123I-MIBG groups according to early and delayed heart-to-mediastinum (H/M) ratios. Patients with PD and normal 123I-MIBG uptake (initial delayed H/M ratio, ≥1.78) were considered scans without evidence of cardiac norepinephrine deficit (SWEND). Early and delayed H/M ratios on the initial and 2-year follow-up scintigraphs were studied. The diagnostic sensitivity and specificity were calculated from these confusion matrices and were analyzed according to receiver-operating characteristic curve analysis. A repeated-measures general linear model was used to investigate differences among groups over time in H/M ratio changes and washout rates.

Results

Follow-up 123I-MIBG scintigraphy analysis had a higher diagnostic sensitivity (89.5%) than the initial imaging (72.2%). The improved sensitivity was associated with a steeper decrease in H/M ratio in the SWEND group than in the APS group.

Conclusions

Follow-up 123I-MIBG scintigraphy can identify cardiac sympathetic denervation and its progression in patients with PD and may be effective in discriminating PD from APS. A later decrease in myocardial 123I-MIBG uptake in the group with SWEND meets the Braak staging threshold hypothesis for synucleinopathy.
68Ga-DOTANOC PET/CT Detects Multifocal Hepatocellular Carcinoma
Authors: Tabacchi Elena , Campana Davide , Brighi Nicole , Fanti Stefano , Ambrosini Valentina
Published: January 2019

68Ga-DOTANOC PET/CT confirmed somatostatin receptor (SR) expression in hypervascularized liver lesions suggestive of neuroendocrine tumor that was later diagnosed as hepatocellular carcinoma (HCC). Being highly vascularized on CT, HCC lesions may mimic neuroendocrine tumors. Although HCC is not included among current indications for SR-PET/CT imaging, it may represent a pitfall in image interpretation when studying neuroendocrine tumor patients. Further studies are needed to better ascertain the potential diagnostic role of SR-imaging in HCC.
Myocardial Infarction With Nonobstructive Coronary Arteries Assessed by 11C-Acetate Cardiac PET
Authors: Cho Sang-Geon , Kim Yongcheol , Jeong Myung Ho , Bom Hee-Seung
Published: January 2019

11C-acetate PET can quantify myocardial blood flow and oxidative metabolism (k
mono) with a single imaging study. We present a 63-year-old man with myocardial infarction with nonobstructive coronary arteries due to vasospasm, who underwent 11C-acetate PET after antispastic medication. By quantifying myocardial blood flow and k
mono, 11C-acetate PET could detect the initial ischemic insult by vasospasm and sufficient amount of remaining viable myocardium, while excluding significant inducible ischemia. We suggest that 11C-acetate PET can be a clinically valuable tool for assessing the pathophysiology of myocardial infarction with nonobstructive coronary arteries.
Quality and Safety in Health Care, Part XLV
Authors: Harolds Jay A.
Published: January 2019

Burnout not only is a serious problem for physicians, but it also adversely affects the quality and safety of health care for the patients they care for. A doctor with burnout may commit more errors, exhibit unprofessional behavior and a callous attitude to others, have diminished productivity, and cause other problems for the health care system. Furthermore, the percentage of doctors who experience at least 1 symptom of burnout is increasing.
Quality and Safety in Health Care, Part L
Authors: Harolds Jay A.
Published: January 2019

There are many lessons relevant to burnout from studying the literature on positive psychology. For example, resilience can be taught. A major portion of resilience and fighting burnout is finding meaning in work. Positive thinking, optimism, positive self-talk, and ways to diminish stress and increase happiness and engagement can also be learned.
Variable 131I Activity in Multiple Hepatic Cysts in a Patient With Thyroid Cancer
Authors: Shao Fuqiang , Tang Jiali , Lan Xiaoli
Published: January 2019

Various etiologies could cause focal 131I accumulation. Hepatic cyst is one of these etiologies. Here we present a 59-year-old man with a history of papillary thyroid cancer resection who received radioiodine therapy for three times. The images after the 131I therapy of the second and third time showed variable activity uptake in the same hepatic cysts.
Heterogeneous Uptake of 18F-FDG and 68Ga-PSMA-11 in Hepatocellular Carcinoma
Authors: Perez Paola M. , Flavell Robert R. , Kelley Robin K. , Umetsu Sarah , Behr Spencer C.
Published: January 2019

We present the case of an 87-year-old man with a history of melanoma metastatic to the lungs found to have an FDG-negative liver lesion that was initially thought to be benign. Follow-up CT revealed growth of the liver lesion despite excellent response to nivolumab therapy of the pulmonary melanoma metastases. Biopsy of the lesion confirmed primary hepatocellular carcinoma. Follow-up 18F-FDG PET/CT showed minimal FDG uptake, slightly above liver background, and subsequent 68Ga-PSMA-11 PET/MR showed focal, intense uptake of radiotracer in a different region of the tumor. These imaging findings support intratumor metabolic heterogeneity with radiotracer uptake in different tumor locations.
68Ga-DOTATATE in Benign Prostate Hyperplasia
Authors: Wang Jiaqiong
Published: January 2019

A 79-year-old man had carcinoid syndrome and bilateral pulmonary nodules, which were biopsy confirmed as well-differentiated neuroendocrine tumor. PET/CT with 68Ga-[DOTA-Tyr3]-octreotate (68Ga-DOTATATE) showed multiple 68Ga-DOTATATE–avid bilateral pulmonary nodules, left hilar lymph node, as well as diffuse increased 68Ga-DOTATATE uptake in the prostate. A review of the history revealed that this patient had elevated prostate-specific antigen level. The prostate biopsy did not reveal evidence of prostate cancer but showed benign prostate hyperplasia.
Combination of Sonographic Morphology Score and Tumor Markers for Detecting Postoperative Recurrent Pelvic Ovarian Carcinoma
Authors: Shen Zhi Yong , Shen Ai Jun , Yang Shao Ling , Wu Ming Feng
Published: January 2019

To assess the efficacy of the combination of sonographic morphology score (SMS) with CA125 and HE4 for detecting recurrent pelvic ovarian carcinoma (OC). Data of 58 OC patients treated in our hospital between 2014 and 2016 were analyzed. After cytoreductive surgery and routine chemotherapy, all patients were followed up by transvaginal ultrasound examination (SMS for pelvic masses based on volume and structure scores) and tumor marker (serum CA125 and HE4) detection. Clinical diagnosis of recurrent OC was based on physical examination, magnetic resonance imaging, and punctured pathology for pelvic masses. Receiver operating characteristic (ROC) curves of SMS and the tumor markers were generated, and areas under the curve (AUC) values were assessed. There were 26 patients with tumor recurrence and 32 cases with no recurrence. Magnetic resonance imaging had 100% sensitivity and specificity. The areas under the ROC curves of SMS, CA125, HE4, and SMS-CA125-HE4 were 0.816, 0.825, 0.737, and 0.903, respectively. There was no significant difference in AUC values between SMS and CA125 or HE4. There were significant differences in AUC values between SMS-CA125-HE4 and SMS (Z = 2.48, P = 0.042), CA125 (Z = 2.38, P = 0.046), and HE4 (Z = 6.48, P = 0.016), respectively. With a cutoff value of SMS, 5; CA125, 35 U/mL; HE4, 105 pmol/L, the sensitivity, specificity, positive prognostic value, and negative prognostic value of SMS-CA125-HE4 for recurrent OC assessment were 0.9231, 0.8438, 0.8276, and 0.931, respectively. SMS-CA125-HE4 was correlated with recurrent OC (χ2 = 30.7428, P < 0.0001). Ultrasound combined with tumor markers may improve the diagnostic efficiency of recurrent OC.
Nuck Canal Hernias, Typical and Unusual Ultrasound Findings
Authors: Jedrzejewski Grzegorz , Osemlak Pawel , Wieczorek Andrzej Pawel , Nachulewicz Pawel
Published: January 2019

Background

Inguinal hernia in girls is a very rare condition. The cause of this pathology is incomplete closure of the processus vaginalis of the peritoneum, in girls named the canal of Nuck. Failed obliteration of this canal could result in hernia or hydrocele. Also less frequent findings, such as uterus herniated to the canal, were observed.

Objective

The purpose of this study was to describe the possible findings in female inguinal hernias and its ultrasound appearance.

Methods

Thirty-five patients with surgically confirmed hernias of the canal of Nuck were identified at our institution between January 2007 and November 2015. All the patients underwent ultrasonography before surgery.

Results

In 14 cases, there was hydrocele of the canal of Nuck. In 9 cases, intestinal hernia was found. In 10 patients, the hernia content appeared as mass-containing cysts and was confirmed at surgery as ovary. In 1 patient, the ovary was herniated together with uterus. In 1 patient, atypical hypoechoic lesion was found, which turned out to be angiofibrolipoma. In all patients, ultrasound diagnosis was confirmed by surgery.

Conclusions

Ultrasound examination performed with high-frequency transducer is an examination of choice in female patients with pathological mass in inguinal region.
Radiologist's Guide to Diagnosis of Fetal Cardiac Anomalies on Prenatal Ultrasound Imaging
Authors: Revels Jonathan Wesley , Wang Sherry S. , Itani Malak , Nasrullah Ayesha , Katz Douglas , Dubinsky Theodore J. , Moshiri Mariam
Published: January 2019

Congenital cardiac anomalies are a common finding during prenatal anatomical survey ultrasound examination. Cardiac anomalies are a major cause of prenatal and neonatal mortality and morbidity. If the anomaly is not lethal, most would require surgical correction. Therefore, early recognition of these abnormalities is essential for parental counseling and delivery planning, as well as analysis of neonatal treatment options. Although prenatal ultrasound plays an important role in identification of such anomalies, diagnosis and interpretation of imaging findings require familiarity and knowledge of the common imaging features. In this article, we provide a comprehensive review of ultrasound appearance of common fetal cardiac anomalies.
Main Duct Dilatation Is the Best Predictor of High-grade Dysplasia or Invasion in Intraductal Papillary Mucinous Neoplasms of the Pancreas
Authors: Del Chiaro Marco , Beckman Ross , Ateeb Zeeshan , Orsini Nicola , Rezaee Neda , Manos Lindsey , Valente Roberto , Yuan Chunhui , Ding Ding , Margonis Georgios A. , Yin Lingdi , Cameron John L. , Makary Martin A. , Burkhart Richard A. , Weiss Matthew J. , He Jin , Arnelo Urban , Yu Jun , Wolfgang Christopher L.
Published: January 2019

Objective:

The purpose of this study is to determine preoperative factors that are predictive of malignancy in patients undergoing pancreatic resection for intraductal papillary mucinous neoplasms (IPMN).

Summary Background Data:

IPMN of the pancreas may be precursor lesions to pancreatic cancer (PC) and represent a target for early diagnosis or prevention. While there has been much effort to define preoperative risk factors for malignant pathology, guidelines are ever-changing and controversy remains surrounding which patients would benefit most from resection.

Methods:

We performed a retrospective analysis of 901 consecutive patients obtained from two tertiary referral centers who underwent pancreatic resection for histologically proven IPMN between 2004 and 2017. Collected data included patient demographic characteristics, preoperative symptoms, radiological findings, and laboratory data.

Results:

Main pancreatic duct (MPD) dilatation was the only variable that was significantly associated with increased probability of malignancy (defined high-dysplasia or invasion) on both univariate and multivariate analysis. Even middle-range MPD dilatation from 5 mm to 9.9 mm (n = 286) was associated with increased odds of HG-IPMN (OR = 2.74; 95% CI = 1.80–4.16) and invasion (OR = 4.42; 95% CI = 2.55–7.66). MPD dilatation >10 mm (n = 150) had even greater odds of HG-IPMN (OR = 6.57; 95% CI = 3.94–10.98) and invasion (OR = 15.07; 95% CI = 8.21–27.65). A cutoff of 5 to 7 mm MPD diameter was determined to be the best predictor to discriminate between malignant and benign lesions.

Conclusions:

In agreement with current IPMN management guidelines, we found MPD dilatation, even low levels from 5 mm to 9.9 mm, to be the single best predictor of HG-IPMN or invasion, highlighting the critical role that MPD plays in the selection of surgical candidates.
Practice Patterns and Perioperative Outcomes of Laparoscopic Pancreaticoduodenectomy in China
Authors: Wang Min , Peng Bing , Liu Jianhua , Yin Xinmin , Tan Zhijian , Liu Rong , Hong Defei , Zhao Wenxing , Wu Heshui , Chen Rufu , Li Dewei , Huang Heguang , Miao Yi , Liu Yahui , Liang Tingbo , Wang Wei , Cai Yunqiang , Xing Zhongqiang , Cheng Wei , Zhong Xiaosheng , Zhao Zhiming , Zhang Jungang , Yang Zhiyong , Li Guolin , Shao Yue , Lin Guirong , Jiang Kuirong , Wu Pengfei , Jia Baoxing , Ma Tao , Jiang Chongyi , Peng Shuyou , Qin Renyi
Published: January 2019

Objective:

The aim of the study was to analyze the outcomes of patients who have undergone laparoscopic pancreaticoduodenectomy (LPD) in China.

Summary Background Data:

LPD is being increasingly used worldwide, but an extensive, detailed, systematic, multicenter analysis of the procedure has not been performed.

Methods:

We retrospectively reviewed 1029 consecutive patients who had undergone LPD between January 2010 and August 2016 in China. Univariate and multivariate analyses of patient demographics, changes in outcome over time, technical learning curves, and the relationship between hospital or surgeon volume and patient outcomes were performed.

Results:

Among the 1029 patients, 61 (5.93%) required conversion to laparotomy. The median operation time (OT) was 441.34 minutes, and the major complications occurred in 511 patients (49.66%). There were 21 deaths (2.43%) within 30 days, and a total of 61 (5.93%) within 90 days. Discounting the effects of the early learning phase, critical parameters improved significantly with surgeons’ experience with the procedure. Univariate and multivariate analyses revealed that the pancreatic anastomosis technique, preoperative biliary drainage method, and total bilirubin were linked to several outcome measures, including OT, estimated intraoperative blood loss, and mortality. Multicenter analyses of the learning curve revealed 3 phases, with proficiency thresholds at 40 and 104 cases. Higher hospital, department, and surgeon volume, as well as surgeon experience with minimally invasive surgery, were associated with a lower risk of surgical failure.

Conclusions:

LPD is technically safe and feasible, with acceptable rates of morbidity and mortality. Nonetheless, long learning curves, low-volume hospitals, and surgical inexperience are associated with higher rates of complications and mortality.
Liver Resection for Multiple Hepatocellular Carcinomas
Authors: Fukami Yasuyuki , Kaneoka Yuji , Maeda Atsuyuki , Kumada Takashi , Tanaka Junko , Akita Tomoyuki , Kubo Shoji , Izumi Namiki , Kadoya Masumi , Sakamoto Michiie , Nakashima Osamu , Matsuyama Yutaka , Kokudo Takashi , Hasegawa Kiyoshi , Yamashita Tatsuya , Kashiwabara Kosuke , Takayama Tadatoshi , Kokudo Norihiro , Kudo Masatoshi
Published: January 2019

Objective:

The aim of the study was to evaluate the survival benefits of liver resection (LR) compared with transarterial chemoembolization (TACE) for patients with multiple hepatocellular carcinomas (HCCs).

Background:

Despite significant improvements in diagnostic imaging and the widespread application of screening programs, some patients with HCC continue to present with multiple tumors. The surgical indications for multiple HCCs remain controversial.

Methods:

Among 77,268 patients with HCC reported in a Japanese nationwide survey, 27,164 patients had multiple HCCs. The exclusion criteria were Child-Pugh B/C, treatment other than LR and TACE, >3 tumors, and insufficient available data. Ultimately, 3246 patients (LR: n = 1944, TACE: n = 1302) were included. The survival benefit of LR for patients multiple HCCs was evaluated by using propensity score matching analysis.

Results:

The study group of 2178 patients (LR: n = 1089, TACE: n = 1089) seemed to be well matched. The overall survival rate in the LR group was 60.0% at 5 years, which was higher than that in the TACE group (41.6%, P < 0.001). Among patients with a tumor size of 30 mm or more, LR showed a survival benefit over TACE at 5 years (53.0% vs 32.7%, P < 0.001). The multivariate analysis indicated that age, serum albumin level, serum alpha-fetoprotein (AFP) level, macrovascular invasion, tumor size, and TACE were independent predictors of poor prognosis in multiple HCCs.

Conclusions:

LR could offer better long-term survival than TACE for patients with multiple HCCs (up to 3 tumors). If patients have good liver function (Child-Pugh A), LR is recommended, even for those with multiple HCCs with tumor sizes of 30 mm or more.
Multicenter Study of Age, Frailty, and Waitlist Mortality Among Liver Transplant Candidates
Authors: Haugen Christine E. , McAdams-DeMarco Mara , Holscher Courtenay M. , Ying Hao , Gurakar Ahmet O. , Garonzik-Wang Jacqueline , Cameron Andrew M. , Segev Dorry L. , Lai Jennifer C.
Published: January 2019

Objective:

To determine if the association of frailty and waitlist mortality varies by candidate age.

Background:

Frailty, a construct developed in geriatrics, is a state of decreased physiologic reserve, and is associated with mortality while awaiting liver transplantation (LT). However, older candidates have high comorbidity burden and less physiologic reserve, so the relationship between frailty and waitlist mortality may vary by candidate age.

Methods:

We studied adults listed for LT at 2 transplant centers. The liver frailty index (grip strength, chair stands, balance) was measured at evaluation, with frailty defined as liver frailty index  ≥ 4.5. We compared the prevalence of frailty in older (≥65 yr) and younger (18–64 yr) candidates. We studied the association between frailty, age, interaction between the 2, and waitlist mortality using competing risks regression adjusted for sex, BMI, and MELDNa.

Results:

Among 882 LT candidates, 16.6% were ≥ 65 years. Older candidates were more likely to be frail (33.3% vs 21.7%, P = 0.002). Older age [adjusted subhazard ratio (aSHR): 2.16, 95% CI: 1.51–3.09, P < 0.001] and frailty (aSHR: 1.92, 95% CI: 1.38–2.67, P < 0.001) were independently associated with higher risk of waitlist mortality. However, the association between waitlist mortality and frailty did not vary by candidate age (aSHR of frailty for younger patients: 1.90, 95% CI: 1.28–2.80, P = 0.001; aSHR of frailty for older patients: 1.98, 95% CI: 1.07–3.67, P = 0.03; P interaction = 0.9).

Conclusions:

Older candidates experienced higher rates of frailty than younger candidates. However, regardless of age, frailty was associated with nearly 2-fold increased risk of waitlist mortality. Our data support the applicability of the frailty concept to the whole LT population and can guide the development of prehabilitation programs targeting frailty in LT patients of all ages.
Fruit flies increase attention to their frontal visual field during fast forward optic flow
Authors: Palermo Nicholas , Theobald Jamie
Published: January 2019

Fruit flies must compensate for the limited light gathered by the tiny facets of their eyes, and image motion during flight lowers light catch even further. Motion blur is especially problematic in fast regions of the visual field, perpendicular to forward motion, but flow fields also contain slower regions, less affected by blur. To test whether fruit flies shift their attention to predictably slower regions of a flow field, we placed flies in an arena simulating forward flight and measured responses to turning cues in different visual areas. We find that during fast forward flight, fruit flies respond more strongly to turning cues presented directly in front, and less strongly to cues presented to the sides, supporting the hypothesis that flying fruit flies shift visual attention to slower moving regions less affected by motion blur.
The foot is more than a spring: human foot muscles perform work to adapt to the energetic requirements of locomotion
Authors: Riddick Ryan , Farris Dominic J. , Kelly Luke A.
Published: January 2019

The foot has been considered both as an elastic mechanism that increases the efficiency of locomotion by recycling energy, as well as an energy sink that helps stabilize movement by dissipating energy through contact with the ground. We measured the activity of two intrinsic foot muscles, flexor digitorum brevis (FDB) and abductor hallucis (AH), as well as the mechanical work performed by the foot as a whole and at a modelled plantar muscle–tendon unit (MTU) to test whether these passive mechanics are actively controlled during stepping. We found that the underlying passive visco-elasticity of the foot is modulated by the muscles of the foot, facilitating both dissipation and generation of energy depending on the mechanical requirements at the centre of mass (COM). Compared to level ground stepping, the foot dissipated and generated an additional –0.2 J kg−1and 0.10 J kg−1(bothp< 0.001) when stepping down and up a 26 cm step respectively, corresponding to 21% and 10% of the additional net work performed by the leg on the COM. Of this compensation at the foot, the plantar MTU performed 30% and 89% of the work for step-downs and step-ups, respectively. This work occurred early in stance and late in stance for stepping down respectively, when the activation levels of FDB and AH were increased between 69 and 410% compared to level steps (allp< 0.001). These findings suggest that the energetic function of the foot is actively modulated by the intrinsic foot muscles and may play a significant role in movements requiring large changes in net energy such as stepping on stairs or inclines, accelerating, decelerating and jumping.
Spatially variant microstructured adhesive with one-way friction
Authors: Suresh Srinivasan A. , Kerst Capella F. , Cutkosky Mark R. , Hawkes Elliot W.
Published: January 2019

Surface microstructures in nature enable diverse and intriguing properties, from the iridescence of butterfly wings to the hydrophobicity of lotus leaves to the controllable adhesion of gecko toes. Many artificial analogues exist; however, there is a key characteristic of the natural materials that is largely absent from the synthetic versions—spatial variation. Here we show that exploiting spatial variation in the design of one class of synthetic microstructure, gecko-inspired adhesives, enables one-way friction, an intriguing property of natural gecko adhesive. When loaded along a surface in the preferred direction, our adhesive material supports forces 100 times larger than when loaded in the reverse direction, representing an asymmetry significantly larger than demonstrated in spatially uniform adhesives. Our study suggests that spatial variation has the potential to advance artificial microstructures, helping to close the gap between synthetic and natural materials.
Steady hydrodynamic interaction between human swimmers
Authors: Yuan Zhi-Ming , Li Mingxin , Ji Chun-Yan , Li Liang , Jia Laibing , Incecik Atilla
Published: January 2019

This study focuses on the hydrodynamic interaction between two or three human swimmers in competitive swimming. Although the swimming performance of a single swimmer has been widely examined, studies on the interaction between multiple competitive swimmers are very rare. Experiments showed evidence that the drag of a swimmer could be modified by the existence of the other adjacent competitors (Chatard & Wilson. 2003Med. Sci. Sports Exerc.35, 1176–1181. (doi:10.1249/01.MSS.0000074564.06106.1F)). The following questions arise: (1) what mechanism determines the interaction; (2) which position experiences drag reduction or drag increase; (3) how much can drag be reduced or increased in a formation? According to the authors' knowledge, such questions have not been addressed by any published literature. Therefore, the main purpose of this study is to find the mechanism of the hydrodynamic interaction between human swimmers and to quantify this interactive effect by using a steady potential flow solver. The free-surface effect was fully taken into account in our calculations. We firstly calculated the wave drag of a swimmer swimming solely in an open swimming pool. Then we calculated the wave drag of the same swimmer when he/she swam in the wake region of one or two leading swimmers. The results showed that the hydrodynamic interaction made a significant contribution to the drafter's wave drag. By following a leading swimmer, a drafter at wave-riding positions could save up to 63% of their wave drag at speed of 2.0 m s−1and lateral separation of 2.0 m. Particularly, when a drafter is following two side-by-side leaders, the drag reduction could even be doubled. To the authors' knowledge, this study is the first to demonstrate that the hydrodynamic interaction between human swimmers can best be described and explained in terms of wave interference effect on the free water surface. When the wave cancellation effect is observed, the wave drag of a drafter could be minimized, and this wave cancellation effect can be achieved only when the drafter is in a wave-riding position.
Thermal efficiency extends distance and variety for honeybee foragers: analysis of the energetics of nectar collection and desiccation by
Apis mellifera
Authors: Mitchell Derek
Published: January 2019

The desiccation of nectar to produce honey by honeybees (
Apis mellifera
L.) is an energy-intensive process, as it involves a quasi-isothermal change in the concentration of sugars from typically 20 to 80% by vaporization (honey ripening). This analysis creates mathematical models for: the collected nectar to honey ratio; energy recovery ratio; honey energy margin; and the break-even distance, which includes the factors of nectar concentration and the distance to the nectar from the nest; energetics of desiccation and a new factor, thermal energy efficiency (TEE) of nectar desiccation. These models show a significant proportion of delivered energy in the nectar must be used in desiccation, and that there is a strong connection between TEE and nest lumped thermal conductance with colony behaviour. They show the connection between TEE and honeybee colony success, or failure, in the rate of return, in terms of distance or quality of foraging. Consequently, TEE is a key parameter in honeybee populations and foraging modelling. For bee keeping, it quantifies the summer benefits of a key hive design parameter, hive thermal conductance and gives a sound theoretical basis for improving honey yields, as seen in expanded polystyrene hives.
Three-dimensional analytical poromechanical solutions for an arbitrarily inclined borehole subjected to fluid injection
Authors: Chen S. L.
Published: January 2019

Hydraulic fracturing is the primary method of stimulation in unconventional reservoirs, playing a significant role in oil and gas production enhancement. A key issue for the analysis of hydraulic fracture initiation is to accurately determine the stress distributions in the vicinity of the borehole caused by the injection of pressurized fluids. This paper develops an exact, three-dimensional, poroelastic coupled analytical solution for such stress analysis of an arbitrarily inclined borehole subjected concurrently to a finite-length fluid discharge and
in situ
stresses, using Fourier expansion theorem and the Laplace–Fourier integral transform technique. The complicated boundary conditions, which involve the mixed boundary values at the borehole surface and the coupling between the total radial stress and injection-induced pore pressure over the sectioned borehole interval, as well as the fully three-dimensional far field
in situ
stresses, are addressed in a novel way and deliberately/elegantly decomposed into five fundamental, easier to handle modes. The rigour and definitive nature of the proposed analytical methodology facilitates fundamental understanding of the mechanism underlying the stress responses of the borehole and porous medium. It can be and is used here as a benchmark for the numerical solutions obtained from the finite-element analysis commercial program (ABAQUS).
A western route of prehistoric human migration from Africa into the Iberian Peninsula
Authors: González-Fortes G. , Tassi F. , Trucchi E. , Henneberger K. , Paijmans J. L. A. , Díez-del-Molino D. , Schroeder H. , Susca R. R. , Barroso-Ruíz C. , Bermudez F. J. , Barroso-Medina C. , Bettencourt A. M. S. , Sampaio H. A. , Grandal-d'Anglade A. , Salas A. , de Lombera-Hermida A. , Fabregas Valcarce R. , Vaquero M. , Alonso S. , Lozano M. , Rodríguez-Alvarez X. P. , Fernández-Rodríguez C. , Manica A. , Hofreiter M. , Barbujani G.
Published: January 2019

Being at the western fringe of Europe, Iberia had a peculiar prehistory and a complex pattern of Neolithization. A few studies, all based on modern populations, reported the presence of DNA of likely African origin in this region, generally concluding it was the result of recent gene flow, probably during the Islamic period. Here, we provide evidence of much older gene flow from Africa to Iberia by sequencing whole genomes from four human remains from northern Portugal and southern Spain dated around 4000 years BP (from the Middle Neolithic to the Bronze Age). We found one of them to carry an unequivocal sub-Saharan mitogenome of most probably West or West-Central African origin, to our knowledge never reported before in prehistoric remains outside Africa. Our analyses of ancient nuclear genomes show small but significant levels of sub-Saharan African affinity in several ancient Iberian samples, which indicates that what we detected was not an occasional individual phenomenon, but an admixture event recognizable at the population level. We interpret this result as evidence of an early migration process from Africa into the Iberian Peninsula through a western route, possibly across the Strait of Gibraltar.
ICTV Virus Taxonomy Profile: Parvoviridae
Authors: Cotmore Susan F. , Agbandje-McKenna Mavis , Canuti Marta , Chiorini John A. , Eis-Hubinger Anna-Maria , Hughes Joseph , Mietzsch Mario , Modha Sejal , Ogliastro Mylène , Pénzes Judit J. , Pintel David J. , Qiu Jianming , Soderlund-Venermo Maria , Tattersall Peter , Tijssen Peter ,   ICTV Report Consortium
Published: January 2019

Members of the family Parvoviridae are small, resilient, non-enveloped viruses with linear, single-stranded DNA genomes of 4–6 kb. Viruses in two subfamilies, the Parvovirinae and Densovirinae, are distinguished primarily by their respective ability to infect vertebrates (including humans) versus invertebrates. Being genetically limited, most parvoviruses require actively dividing host cells and are host and/or tissue specific. Some cause diseases, which range from subclinical to lethal. A few require co-infection with helper viruses from other families. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the Parvoviridae, which is available at www.ictv.global/report/parvoviridae.
Colocalization of IQGAP1 with DLC-1 and PLC-δ1; Its potential role in coronary spasm
Authors: Tanaka Makoto , Osanai Tomohiro , Homma Yoshimi , Hanada Kenji , Okumura Ken , Tomita Hirofumi
Published: January 2019

Phospholipase C (PLC)-δ1, activated by p122RhoGTPase-activating protein (GAP)/deleted in liver cancer-1 (p122RhoGAP/DLC-1), contributes to the coronary spastic angina (CSA) pathogenesis. The present study aims to further investigate the p122RhoGAP/DLC-1 protein. We examined molecules assisting this protein and identified a scaffold protein—IQ motif-containing GTPase-activating protein 1 (IQGAP1). IQGAP1-C binds to the steroidogenic acute regulatory-related lipid transfer (START) domain of p122RhoGAP/DLC-1, and PLC-δ1 binds to IQGAP1-N, forming a complex. In fluorescence microscopy, small dots of PLC-δ1 created fine linear arrays like microtubules, and IQGAP1 and p122RhoGAP/DLC-1 were colocated in the cytoplasm with PLC-δ1. Ionomycin induced the raft recruitment of the PLC-δ1, IQGAP1, and p122RhoGAP/DLC-1 complex by translocation to the plasma membrane (PM), indicating the movement of this complex is along microtubules with the motor protein kinesin. Moreover, the IQGAP1 protein was elevated in skin fibroblasts obtained from patients with CSA, and it enhanced the PLC activity and peak intracellular calcium concentration in response to acetylcholine. IQGAP1, a novel stimulating protein, forms a complex with p122RhoGAP/DLC-1 and PLC-δ1 that moves along microtubules and enhances the PLC activity.