bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Cd vacancies and unconventional spin dynamics in the Dirac semimetal Cd3As2
Authors: Koumoulis Dimitrios , Taylor Robert E. , McCormick Jeffrey , Ertas Yavuz N. , Pan Lei , Che Xiaoyu , Wang Kang L. , Bouchard Louis-S.
Published: August 2017

Cd3As2 is a Dirac semimetal that is a 3D analog of graphene. We investigated the local structure and nuclear-spin dynamics in Cd3As2 via 113Cd NMR. The wideline spectrum of the static sample at 295 K is asymmetric and its features are well described by a two-site model with the shielding parameters extracted via Herzfeld-Berger analysis of the magic-angle spinning spectrum. Surprisingly, the 113Cd spin-lattice relaxation time (T1) is extremely long (T1 = 95 s at 295 K), in stark contrast to conductors and the effects of native defects upon semiconductors; but it is similar to that of 13C in graphene (T1 = 110 s). The temperature dependence of 1/T1 revealed a complex bipartite mechanism that included a T2 power-law behavior below 330 K and a thermally activated process above 330 K. In the high-temperature regime, the Arrhenius behavior is consistent with a field-dependent Cd atomic hopping relaxation process. At low temperatures, a T2 behavior consistent with a spin-1/2 Raman-like process provides evidence of a time-dependent spin-rotation magnetic field caused by angular oscillations of internuclear vectors due to lattice vibrations. The observed mechanism does not conform to the conventional two-band model of semimetals, but is instead closer to a mechanism observed in high-Z element ionic solids with large magnetorotation constant [A. J. Vega et al., Phys. Rev. B 74, 214420 (2006)].
X-ray source development for EXAFS measurements on the National Ignition Facility
Authors: Coppari F. , Thorn D. B. , Kemp G. E. , Craxton R. S. , Garcia E. M. , Ping Y. , Eggert J. H. , Schneider M. B.
Published: August 2017

Extended X-ray absorption Fine Structure (EXAFS) measurements require a bright, spectrally smooth, and broad-band x-ray source. In a laser facility, such an x-ray source can be generated by a laser-driven capsule implosion. In order to optimize the x-ray emission, different capsule types and laser irradiations have been tested at the National Ignition Facility (NIF). A crystal spectrometer is used to disperse the x-rays and high efficiency image plate detectors are used to measure the absorption spectra in transmission geometry. EXAFS measurements at the K-edge of iron at ambient conditions have been obtained for the first time on the NIF laser, and the requirements for optimization have been established.
Vibrational relaxation beyond the linear damping limit in two-dimensional optical spectra of molecular aggregates
Authors: Perlík Václav , Šanda František
Published: August 2017

We present a computational model for the spectra of molecular aggregates with signatures of vibronic progression. Vibronic dynamics is implemented by coupling the dynamics of Frenkel excitons with underdamped vibrations. Vibrational dynamics includes linear damping resulting in the exponential decay and quadratic damping inducing subexponential or power law relaxation and increasing vibrational decoherence as demonstrated on lineshapes of the absorption spectrum. Simulations of the third-order coherent response account for bath reorganization during excitonic transport, which allows us to study the line-shape evolution of cross peaks of 2D spectra.
From dimers to the solid-state: Distributed intermolecular force-fields for pyridine
Authors: Aina Alexander A. , Misquitta Alston J. , Price Sarah L.
Published: August 2017

An anisotropic atom-atom force-field for pyridine, using distributed atomic multipoles, polarizabilities, and dispersion coefficients and an anisotropic atom-atom repulsion model derived from symmetry-adapted perturbation theory (density functional theory) dimer calculations, is used to model pyridine crystal structures. Here we show that this distributed intermolecular force-field (DIFF) models the experimental crystal structures as accurately as modelling all but the electrostatic term with an isotropic repulsion-dispersion potential that has been fitted to experimental crystal structures. In both cases, the differences are comparable to the changes in the crystal structure with temperature, pressure, or neglect of zero-point vibrational effects. A crystal structure prediction study has been carried out, and the observed polymorphs contrasted with hypothetical thermodynamically competitive crystal structures. The DIFF model was able to identify the structure of an unreported high pressure phase of pyridine, unlike the empirically fitted potential. The DIFF model approach therefore provides a model of the underlying pair potential energy surface that we have transferred to the crystalline phase with a considerable degree of success, though the treatment of the many-body terms needs improvement and the pair potential is slightly over-binding. Furthermore, this study of a system that exhibits isotopic polymorphism highlights that the use of an empirical potential has partially absorbed temperature and zero-point motion effects as well as the intermolecular forces not explicitly represented in the functional form. This study therefore highlights the complexity in modelling crystallization phenomena from a realistic pair potential energy surface.
Photodissociation dynamics of the ortho- and para-xylyl radicals
Authors: Pachner Kai , Steglich Mathias , Hemberger Patrick , Fischer Ingo
Published: August 2017

The photodissociation dynamics of the C8H9 isomers ortho- and para-xylyl are investigated in a free jet. The xylyl radicals are generated by flash pyrolysis from 2-(2-methylphenyl)- and 2-(4-methylphenyl) ethyl nitrite and are excited into the D3 state. REMPI- spectra show vibronic structure and the origin of the transition is identified at 32 291 cm−1 for the para- and at 32 132 cm−1 for the ortho-isomer. Photofragment H-atom action spectra show bands at the same energy and thus confirm H-atom loss from xylyl radicals. To gain further insight into the photodissociation dynamics, velocity map images of the hydrogen atom photofragments are recorded. Their angular distribution is isotropic and the translational energy release is in agreement with a dissociation to products in their electronic ground state. Photodissociation of para-xylyl leads to the formation of para-xylylene (C8H8), while the data for ortho-xylyl agree much better with the isomer benzocyclobutene as the dominant molecular fragment rather than ortho-xylylene. In computations we identified a new pathway for the reaction ortho-xylyl → benzocyclobutene + H with a barrier of 3.39 eV (27 340 cm−1), which becomes accessible at the employed excitation energy. It proceeds via a combination of scissoring and rotational motion of the -CH2 and -CH3 groups. However, the observed rate constants measured by delaying the excitation and ionization laser with respect to each other are significantly faster than computed ones, indicating intrinsic non-RRKM behaviour. A comparably high value of around 30% of the excess energy is released as translation of the H-atom photofragment.
Existence and upper semi-continuity of pullback attractors of a p-Laplacian equation with delay
Authors: Liu Linfang , Fu Xianlong
Published: August 2017

In this paper, we study the dynamics of a non-autonomous p-Laplacian equation with delay. We first prove the existence and uniqueness of solutions for this equation by using the Galerkin approximations. Then, applying the Sobolev compactness theorem, Ascoli-Azerla theorem, and energy method, we show the existence of pullback attractors for the associated process in space C([−h, 0]; Lp) as well as in space C([−h, 0]; L2). The upper semi-continuity result of the pullback attractors is also established here.
Optically pumped GeSn micro-disks with 16% Sn lasing at 3.1 μm up to 180 K
Authors: Reboud V. , Gassenq A. , Pauc N. , Aubin J. , Milord L. , Thai Q. M. , Bertrand M. , Guilloy K. , Rouchon D. , Rothman J. , Zabel T. , Armand Pilon F. , Sigg H. , Chelnokov A. , Hartmann J. M. , Calvo V.
Published: August 2017

Recent demonstrations of optically pumped lasers based on GeSn alloys put forward the prospect of efficient laser sources monolithically integrated on a Si photonic platform. For instance, GeSn layers with 12.5% of Sn were reported to lase at 2.5 μm wavelength up to 130 K. In this work, we report a longer emitted wavelength and a significant improvement in lasing temperature. The improvements resulted from the use of higher Sn content GeSn layers of optimized crystalline quality, grown on graded Sn content buffers using reduced pressure CVD. The fabricated GeSn micro-disks with 13% and 16% of Sn showed lasing operation at 2.6 μm and 3.1 μm wavelengths, respectively. For the longest wavelength (i.e., 3.1 μm), lasing behavior was demonstrated up to 180 K, with a threshold of 377 kW/cm2 at 25 K.
The Effect of Head and Neck Radiotherapy on Blood Pressure and Orthostatic Hypotension in Patients With Head and Neck Tumors
Authors: Leibowitz Avshalom , Grossman Ehud , Berkovitch Anat , Levartovski Meital , Appel Sarit , Sharabi Yehonatan , Gluck Iris
Published: August 2017

BACKGROUND

Radiotherapy (RT) plays a key role in the management of head and neck cancer (HNC), especially in locally advanced disease. Patients undergoing head and neck RT, especially elderly ones, are suffering from low and labile blood pressure (BP) during the treatment. They complain of weakness and fatigue and are prone to recurrent falls. The aim of this study was to characterize BP changes during RT period.

METHODS

Patients with HNC, receiving radiation to the neck, were recruited from Sheba medical center RT unit. Office BP, orthostatic measurements, 24-hour ambulatory BP monitoring, body weight, and metabolic parameters were measured at baseline after 30 days and after 90 days from beginning of therapy.

RESULTS

Nineteen patients (17 males), 64 ± 12 years old were recruited. Nine hypertensive patients continued their antihypertensive treatment during the study. Office systolic BP and diastolic BP decreased significantly after 30 days (128 ± 4/80 ± 3 to 122 ± 3/74 ± 3 mm Hg; P < 0.05). Average 24-hour BP values after 30 days of RT decreased from 130 ± 3/76 ± 2 to 123 ± 3/71 ± 2 mm Hg; P < 0.05. A similar trend was observed for day and night BP levels. Decrease in office and ambulatory BP was sustained for several months after RT completion. No orthostasis was observed during the study period. Patient lost weight significantly during the study period. However, BP changes were independent of weight loss.

CONCLUSION

There is a significant and sustained BP reduction after head and neck RT, without orthostatic changes. Clinicians should be aware of this phenomenon and consider treatment adaption accordingly.
Localizing the Lost Rectus Muscle Using the Connective Tissue Framework: Revisiting the Tunnel Technique
Authors: Jordan David R. , Stoica Bazil , Dutton Jonathan J.
Published: August 2017

Purpose:

To describe a technique for localizing a lost rectus muscle during strabismus or retinal surgery or following trauma.

Methods:

In this single center, retrospective chart review, 5 patients were identified between January 2012 and June 2016 with a lost rectus muscle; 3 during strabismus surgery and 2 post trauma. The inclusion criteria included a lost rectus muscle during strabismus surgery, or a disinserted/lacerated rectus muscle following ocular/orbital trauma. The primary outcome measure was successful reattachment of the rectus muscle.

Results:

The lost rectus muscle was identified in each patient and reattached to the globe by gently applying traction anteriorly at the conjunctiva/Tenon edge using double-pronged skin hooks and following the path of the rectus muscle through its Tenon capsule tunnel where it remained attached by suspensory ligaments. There was no instance where orbital fat was obscuring or blocking the view of the lost rectus muscles. There were no other complications associated with the procedure.

Conclusions:

The authors describe a simple and effective method in 5 patients to localize a lost rectus muscle based on knowledge of the orbital connective tissue framework.
Macrotextured Breast Implants with Defined Steps to Minimize Bacterial Contamination around the Device: Experience in 42,000 Implants
Authors: Adams William P. , Culbertson Eric J. , Deva Anand K. , R. Magnusson Mark , Layt Craig , Jewell Mark L. , Mallucci Patrick , Hedén Per
Published: August 2017

Background:

Bacteria/biofilm on breast implant surfaces has been implicated in capsular contracture and breast implant–associated anaplastic large-cell lymphoma (ALCL). Macrotextured breast implants have been shown to harbor more bacteria than smooth or microtextured implants. Recent reports also suggest that macrotextured implants are associated with a significantly higher incidence of breast implant–associated ALCL. Using techniques to reduce the number of bacteria around implants, specifically, the 14-point plan, has successfully minimized the occurrence of capsular contracture. The authors hypothesize that a similar effect may be seen in reducing the risk of breast implant–associated ALCL.

Methods:

Pooled data from eight plastic surgeons assessed the use of macrotextured breast implants (Biocell and polyurethane) and known cases of breast implant–associated ALCL. Surgeon adherence to the 14-point plan was also analyzed.

Results:

A total of 42,035 Biocell implants were placed in 21,650 patients; mean follow-up was 11.7 years (range, 1 to 14 years). A total of 704 polyurethane implants were used, with a mean follow-up of 8.0 years (range, 1 to 20 years). The overall capsular contracture rate was 2.2 percent. There were no cases of implant–associated ALCL. All surgeons routinely performed all 13 perioperative components of the 14-point plan; two surgeons do not routinely prescribe prophylaxis for subsequent unrelated procedures.

Conclusions:

Mounting evidence implicates the role of a sustained T-cell response to implant bacteria/biofilm in the development of breast implant–associated ALCL. Using the principles of the 14-point plan to minimize bacterial load at the time of surgery, the development and subsequent sequelae of capsular contracture and breast implant–associated ALCL may be reduced, especially with higher-risk macrotextured implants.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Determining the Oncologic Safety of Autologous Fat Grafting as a Reconstructive Modality: An Institutional Review of Breast Cancer Recurrence Rates and Surgical Outcomes
Authors: Cohen Oriana , Lam Gretl , Karp Nolan , Choi Mihye
Published: August 2017

Background:

The increasing use of autologous fat grafting in breast cancer patients has raised concerns regarding its oncologic safety. This study evaluated patient outcomes and tumor recurrence following mastectomy reconstruction and autologous fat grafting.

Methods:

Retrospective chart review identified patients who underwent mastectomy followed by breast reconstruction from 2010 to 2015. Eight hundred twenty-nine breasts met inclusion criteria: 248 (30.0 percent) underwent autologous fat grafting, whereas 581 (70.0 percent) breasts did not. Patient demographics, cancer characteristics, oncologic treatment, surgical treatment, surgical complications, local recurrence, and distant metastases were analyzed.

Results:

Autologous fat grafting patients and control patients were of similar body mass index, smoking status, and BRCA status. Patients who underwent fat grafting were significantly younger than control patients and were less likely to have diabetes, hypertension, or hyperlipidemia. The two groups represented similar distributions of BRCA status, Oncotype scores, and hormone receptor status. Patients underwent one to four grafting procedures: one procedure in 83.1 percent, two procedures in 13.7 percent, three in 2.8 percent, and four in 0.4 percent. Mean follow-up time from initial surgery was 45.6 months in the fat grafting group and 38.8 months in controls. The overall complication rate following fat grafting was 9.4 percent. Among breasts undergoing surgery for therapeutic indications, there were similar rates of local recurrence (fat grafting group, 2.5 percent; controls, 1.9 percent; p = 0.747). Interestingly, mean time to recurrence was significantly longer in the fat grafting group (52.3 months versus 22.8 months from initial surgery; p = 0.016).

Conclusions:

Autologous fat grafting is a powerful tool in breast reconstruction. This large, single-institution study provides valuable evidence-based support for its oncologic safety.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Breast Cancer Genetics for Plastic Surgeons
Authors: McInerney Niall M. , Narod Steven , Metcalfe Kelly , Semple John , Brown Mitchell H.
Published: August 2017

Multidisciplinary genetic clinics offer counseling and testing to those who meet criteria for familial breast cancer, and plastic surgeons become integral to this process when risk-reducing surgery and postmastectomy reconstruction are deemed appropriate. As reconstructive surgeons, it is important that plastic surgeons are aware of the risks and issues associated with the genetic variants that cause patients to present for prophylactic or therapeutic surgery.
Autologous Fat Grafting as a Novel Antiestrogen Vehicle for the Treatment of Breast Cancer
Authors: Thomas Scott , Chen Stephanie , Sbitany Hani , Kwon Edwin , Piper Merisa , Park Jeenah , Terranova Barberio Manuela , Pawlowska Nela , Munster Pamela N.
Published: August 2017

Background:

Adipose fat transfer is increasingly used for contour corrections of the tumor bed after lumpectomy and breast reconstructions after mastectomy. The lipophilic nature of the fat tissue may render adipocytes an ideal vehicle with which to deliver a high boost of an antiestrogen to the tumor bed to serve as an adjunct systemic hormonal therapy. The authors therefore tested whether adipocytes could safely be loaded with an antiestrogen and allow for release at therapeutic concentrations to treat breast cancer.

Methods:

Adipose tissue was collected from patients undergoing autologous fat grafting. The influence of adipose tissue on tumorigenesis was determined both in vitro and in vivo using breast cancer cell lines. Ex vivo, adipose tissue was assessed for its ability to depot fulvestrant and inhibit the growth of breast cancer cell lines.

Results:

Adipose tissue harvested from patients did not promote breast cancer cell growth in vitro or in an in vivo mouse model. Adipose tissue was successfully loaded with fulvestrant and released at levels sufficient to inhibit estrogen receptor signaling and growth of breast cancer cells.

Conclusions:

This work supports the hypothesis that adipose tissue used for autologous fat grafting can serve as a novel method for local drug delivery. As this technique is used to reconstruct a variety of postsurgical defects following cancer resection, this approach for local drug delivery may be an effective alternative in therapeutic settings beyond breast cancer.
Normative Values of the Michigan Hand Outcomes Questionnaire for Patients with and without Hand Conditions
Authors: Nolte Michael T. , Shauver Melissa J. , Chung Kevin C.
Published: August 2017

Background:

The Michigan Hand Outcomes Questionnaire has been widely used for nearly 20 years to assess patients with a variety of hand and upper extremity conditions. However, normative data have not previously been collected, limiting interpretation.

Methods:

The Michigan Hand Outcomes Questionnaire was administered to 579 participants recruited from the general population. In addition, participants were asked to identify any problem affecting their hand(s), including trauma, hand disease/condition, systemic illness, or nonspecific symptoms. Comorbidities and demographic data were also collected.

Results:

Total Michigan Hand Outcomes Questionnaire score for healthy individuals was indicative of generally good hand function (95.2; 95 percent CI, 94.3 to 96.1). Individuals with unilateral trauma scored for their affected hand (90.3; 95 percent CI, 87.9 to 92.6) lower than their healthy hand (mean difference, 5.7; 95 percent CI, 3.2 to 8.3). For individuals with and without hand trauma, total Michigan Hand Outcomes Questionnaire score decreased with increasing number of comorbidities. Many of the differences in Michigan Hand Outcomes Questionnaire score between the problem hand and unaffected hand were smaller than the minimal clinically important difference of 3.0 to 23.0 for known abnormalities of the hand and upper extremity.

Conclusions:

These normative data provide appropriate baseline information for individuals with and without underlying hand conditions. Most notably, these findings suggest that individuals with a unilateral problem establish new subnormative values for both their affected and unaffected hands. These data will encourage an appropriate understanding of the results of future studies using the Michigan Hand Outcomes Questionnaire.
Benefit of Local Anesthesia in Reducing Pain during Collagenase Injection for Dupuytren’s Contracture
Authors: Nordenskjöld Jesper , Waldén Markus , Kjellin Anders , Franzén Herbert , Atroshi Isam
Published: August 2017

Collagenase injection for Dupuytren’s contracture is commonly administered without anesthesia. The authors studied the benefit of injecting local anesthesia before collagenase in reducing treatment-related pain. This prospective cohort study included 187 patients (mean age, 69 years; 80 percent men) at two orthopedic departments in Sweden. At one center, 161 consecutive patients scheduled for collagenase injection were assigned to two groups by alternating outpatient clinics; 78 received collagenase without local anesthesia using a modified method (injecting 0.80 mg in multiple spots in the cord) and 83 received local anesthesia injected in the proximal palm before collagenase. At the other center, 26 consecutive patients received collagenase using the standard method (0.58 mg injected in one spot) without local anesthesia. Immediately after the first injection (collagenase or local anesthesia), the patients rated the severity of injection-related pain on a visual analogue scale from 0 (no pain) to 10 (worst pain). Before finger manipulation 1 or 2 days after injection, the patients rated the pain experienced since injection. Mean score ± SD for pain experienced during modified collagenase injection was 4.3 ± 2.5 without local anesthesia and 2.3 ± 1.7 during injection of local anesthesia (before collagenase) (age- and sex-adjusted mean difference, 2.1; 95 percent CI, 1.5 to 2.7; p < 0.001). Mean pain score ± SD during standard collagenase injection without local anesthesia was 4.8 ± 1.8. Mean pain score ± SD during the injection-manipulation interval was 2.9 ± 1.9 in the group without local anesthesia and 2.9 ± 2.3 in the local anesthesia group (p = 0.79). This study shows that local anesthesia significantly reduces the patient’s overall pain experience during collagenase treatment for Dupuytren’s contracture.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Intelligence and Academic Achievement of Adolescents with Craniofacial Microsomia
Authors: Speltz Matthew L. , Wallace Erin R. , Collett Brent R. , Heike Carrie L. , Luquetti Daniela V. , Werler Martha M.
Published: August 2017

Background:

The authors compared the IQ and academic achievement of adolescents with craniofacial microsomia (cases) and unaffected children (controls). Among cases, the authors analyzed cognitive functioning by facial phenotype.

Methods:

The authors administered standardized tests of intelligence, reading, spelling, writing, and mathematics to 142 cases and 316 controls recruited from 26 cities across the United States and Canada. Phenotypic classification was based on integrated data from photographic images, health history, and medical chart reviews. Hearing screens were conducted for all participants.

Results:

After adjustment for demographics, cases’ average scores were lower than those of controls on all measures, but the magnitude of differences was small (standardized effect sizes, −0.01 to −0.3). There was little evidence that hearing status modified case-control group differences (Wald p > 0.05 for all measures). Twenty-five percent of controls and 38 percent of cases were classified as having learning problems (adjusted OR, 1.5; 95 percent CI, 0.9 to 2.4). Comparison of cases with and without learning problems indicated that those with learning problems were more likely to be male, Hispanic, and to come from lower income, bilingual families. Analyses by facial phenotype showed that case-control group differences were largest for cases with both microtia and mandibular hypoplasia (effect sizes, −0.02 to −0.6).

Conclusions:

The highest risk of cognitive-academic problems was observed in patients with combined microtia and mandibular hypoplasia. Developmental surveillance of this subgroup is recommended, especially in the context of high socioeconomic risk and bilingual families. Given the early stage of research on craniofacial microsomia and neurodevelopment, replication of these findings is needed.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
American Society of Maxillofacial Surgeons 2006 to 2016: Another Decade of Excellence in Education and Research
Authors: Doumit Gaby , Totonchi Ali , Wexler Andy , Gosain Arun K.
Published: August 2017

Over the past 10 years, the American Society of Maxillofacial Surgeons (ASMS) has continued to advance to meet its mission of being the premier organization to represent maxillofacial and pediatric plastic surgery in the United States. These advances are focused on education of its members, to include the American Society of Maxillofacial Surgeons basic course, the preconference symposium, the annual meeting, two basic maxillofacial courses per year, advanced maxillofacial courses, a boot camp for craniofacial fellows, a cleft course, quarterly webinars, sponsored fellowships, a visiting professorship, and the ASMS journal. In addition, the ASMS has continued to advance as the premier national organization representing maxillofacial and pediatric plastic surgery in the United States, thereby positioning the organization as a primary advocate for these surgical specialties. Outreach of the ASMS has grown over the past decade and now includes representatives to the American Society of Plastic Surgeons/Plastic Surgery Foundation, the American Board of Plastic Surgeons, the American Medical Association, and most recently a seat as a governor with the American College of Surgeons. The ASMS has also initiated an annual Summer Leadership Seminar to explore topics of relevance in a changing health care environment. The present report outlines the major initiatives of the ASMS over the past 10 years.
Implications of Facial Asymmetry in Rhinoplasty
Authors: Rohrich Rod J. , Villanueva Nathaniel L. , Small Kevin H. , Pezeshk Ronnie A.
Published: August 2017

Many rhinoplasty patients present with a chief complaint of nasal deviation and are unaware of any inherent facial asymmetries; however, recognizing and discussing the interrelation between the deviated nose and facial asymmetry is an important consideration in surgical planning. The objective of this study was to evaluate whether a surgeon’s subjective assessment of facial analysis in the setting of nasal deviation correlates with objective anthropometric measurements. In addition, this study sought to further quantify the frequency of facial asymmetry associated with nasal deviation to highlight important anatomical trends for the rhinoplasty surgeon. Finally, this study presents the senior author’s (R.J.R.) method of addressing a deviated nose on an asymmetric face. In this study, the authors demonstrated that nasal deviation is closely related to facial asymmetry. Furthermore, the authors demonstrated that objective facial analysis closely correlates to anthropometric facial measurements. In addition, the wide side of the face correlates to the short side of the face and the nose tends to deviate away from the wide side of the face. During surgical correction of the deviated nose in the setting of facial asymmetry, the surgeon’s goal should be to obtain nasal symmetry and center the nose on a line between the mid glabella and the mid Cupid’s bow. This may reduce the perception of a facial asymmetry, leading to increased patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, IV.
Surgical Indications and Outcomes of Mastectomy in Transmen: A Prospective Study of Technical and Self-Reported Measures
Authors: van de Grift Tim C. , Elfering Lian , Bouman Mark-Bram , Buncamper Marlon E. , Mullender Margriet G.
Published: August 2017

Background:

Although transgender surgery constitutes a growing field within plastic surgery, prospective studies on masculinizing mastectomies are lacking. The objectives of the present study were to prospectively follow a cohort of transmen undergoing mastectomy to assess technical and self-reported outcomes and to evaluate surgical decision-making.

Methods:

Fifty-four transmen were recruited during a 10-month period at the Department of Plastic Surgery of the Centre of Expertise on Gender Dysphoria. Preoperative assessment included standardized chest examination. Six months postoperatively, participants rated their satisfaction with surgery, and 12-month postoperative surgical outcomes were reviewed independently. Surgical decision-making was evaluated by comparing indications and outcomes per technique, and assessing the clinical validity of the most-used decision aid (using the Cohen's kappa statistic).

Results:

One periareolar mastectomy, 26 concentric circular mastectomies, and 22 inframammary skin resections with free nipple graft were performed in the authors’ cohort. Five participants were still to be operated on. Concentric circular mastectomy was performed in smaller or medium-size breasts with low ptosis grade and good elasticity, whereas the inframammary skin resection group showed a wider range of physical characteristics. Despite being performed in better quality breasts, concentric circular mastectomy was associated with more secondary corrections (38.5 percent), dehiscence, seroma, and lower postoperative satisfaction compared with inframammary skin resections. Clinical decision-making was generally in line with the published decision aid.

Conclusions:

Compared with inframammary skin resections, concentric circular mastectomy—despite being performed in favorable breast types—appears to produce poorer technical and self-reported outcomes. Surgical indications and preoperative counseling regarding secondary corrections may therefore be subject to improvement.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Transabdominal Breast Augmentation: A Review of 114 Cases Performed over 14 Years
Authors: Bhatt Reena A. , Iyengar Rajiv J. , Karacaoglu Ercan , Zienowicz Richard J.
Published: August 2017

Background:

Abdominoplasty patients are frequently candidates for breast rejuvenation as well. Transabdominal breast augmentation permits insertion of breast implants through the abdominoplasty incision. This combined procedure is preferentially performed in an outpatient setting under monitored anesthesia care and nerve blocks.

Methods:

This study was a 14-year retrospective review of a single surgeon’s technique and outcomes using transabdominal breast augmentation through a low transverse abdominoplasty incision in select patients requesting simultaneous abdominoplasty and bilateral breast augmentation. Patients had minimal ptosis, smoking cessation a minimum of 4 weeks before surgery and indefinitely thereafter, and a lack of superior abdominal or significant breast surgery.

Results:

The study’s 114 patients had a mean follow-up of 19.2 months. The procedure was performed under monitored anesthesia care with intercostal nerve blocks for most patients [n = 107 (93.9 percent)] and general anesthesia [n = 7 (6.1 percent)] for a few. Seventy-nine patients [n = 74 (64.9 percent)] underwent additional procedures, with most (n = 48) undergoing suction-assisted lipectomy. Many patients underwent multiple procedures. Most complications occurred predictably along the central distal abdominoplasty flap and were minor (small wound breakdown, seroma, and mild skin infection). Major complications [n = 8 (7.0 percent)] included two patients with implant malposition requiring revision and one patient with a Baker grade III capsule; notably, this patient was a half-pack-per-day smoker with a body mass index of 27 kg/m2.

Conclusions:

Transabdominal breast augmentation is a safe, reliable procedure in the appropriately selected, healthy patient and may be used in minimally to moderately ptotic patients who request concurrent breast augmentation and abdominoplasty. Morbidity compares favorably to reported abdominoplasty series in the appropriately selected patient.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast: Is Preshaping of the Challenging Breast a Key to Success?
Authors: Gunnarsson Gudjon L. , Bille Camilla , Reitsma Laurens C. , Wamberg Peter , Thomsen Jørn Bo
Published: August 2017

Background:

Nipple-sparing mastectomy with simultaneous hammock technique direct-to-implant reconstruction is increasingly offered to patients opting for risk-reducing mastectomy. Despite this promising method, patients with macromastia and ptotic breasts remain a challenging group to treat satisfactorily and more often end up undergoing a difficult corrective procedure and experience an unacceptably high rate of failed reconstruction. The authors examined whether targeted preshaping mastopexy/reduction could prepare these patients for a successful nipple-sparing mastectomy/direct-to-implant reconstruction.

Methods:

Patients seeking risk-reducing nipple-sparing mastectomy/direct-to-implant reconstruction at the authors’ institutions deemed unfit for a one-stage procedure based on their previous experience were offered a targeted two-stage, risk-reducing mastopexy/reduction followed by a delayed secondary nipple-sparing mastectomy and direct-to-implant reconstruction. Patients were followed up at 3 weeks and 6 or 12 months.

Results:

Forty-four reconstructions were performed in 22 patients aged 43 years (range, 26 to 57 years). All 44 procedures were completed successfully without any failure or nipple-areola complex losses. Patients’ median body mass index was 30 kg/m2 (range, 22 to 44 kg/m2). Six patients were smokers and one had hypertension. Two patients underwent reoperation because of hematoma and fat necrosis.

Conclusions:

The authors’ results demonstrate that a targeted preshaping mastopexy/reduction followed by nipple-sparing mastectomy/direct-to-implant reconstruction can be safely planned in women who opt for a risk-reducing mastectomy and can be performed successfully with a 3- to 4-month time span between operations. On the basis of these results and the superior cosmetic outcome, the two-stage approach has become the authors' standard of care in all such settings.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Adipose Tissue–Preserved Skin Graft: Applicability and Long-Term Results
Authors: Chung Bryan , O’Mahony Gavin D. , Lam Gretl , Chiu David T. W.
Published: August 2017

Background:

Composite grafts consisting of adipose tissue and skin have been reported in the literature but have been restricted to areas smaller than 4 to 5 cm2. The senior author (D.T.W.C.) has developed a technique of adipose tissue–preserved full-thickness skin grafts for larger areas with success similar to that achieved with conventional full-thickness skin grafts.

Methods:

All cases of the senior author involving a full-thickness skin graft were identified and reviewed to identify cases in which adipose tissue–preserved full-thickness skin grafts were used. Indication for skin grafting, anatomical location of recipient and donor sites, size of graft, total number of grafts received by each patient, and percentage take were extracted from patient charts. Graft take was measured between days 5 and 14.

Results:

A total of 72 adipose tissue–preserved skin grafts on 47 patients were identified from 1994 to 2009, with a median follow-up of 8 years. The size of defect ranged from 0.7 to 210 cm2, with a median area of 6 cm2 (interquartile range, 2.5 to 15 cm2). Only six of 72 grafts were found to have less than 100 percent take. The lowest take percentage was 85 percent in a graft with an area of 2.6 cm2. There were no graft failures.

Conclusions:

This study confirms the proof-of-concept that both larger and distant donor- site adipose tissue–preserved skin grafts are a viable alternative to conventional defatted full-thickness skin grafting. It appears that there is a low complication rate with respect to graft failure or incomplete graft take.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Activation of Pyruvate Dehydrogenase Activity by Dichloroacetate Improves Survival and Neurologic Outcomes After Cardiac Arrest in Rats
Authors: Wang Peng , Chen Mingdi , Yang Zhengfei , Yu Tao , Zhu Jie , Zhou Lili , Lin Jiali , Fang Xiangshao , Huang Zitong , Jiang Longyuan , Tang Wanchun
Published: August 2017

No pharmacological interventions are currently available to provide neuroprotection for patients suffering from cardiac arrest. Dichloroacetate (DCA) is a pyruvate dehydrogenase kinase inhibitor, which activates pyruvate dehydrogenase (PDH), and increases cell adenosine triphosphate (ATP) production by promoting influx of pyruvate into the Krebs cycle. In this study, we investigated the effects of DCA on post-resuscitation neurological injury in an asphyxial cardiac arrest rat model. Asphyxial cardiac arrest was established by endotracheal tube clamping. A total of 111 rats were randomized into three groups: Sham group, Control group, and DCA intervention group. Animals in DCA intervention group were intraperitoneally administered DCA with a loading dose of 80 mg/kg at 15 min after return of spontaneous circulation (ROSC), whereas rats in the Control group received equivalent volume of saline. DCA treatment increased 3-day survival time, and reduced neurologic deficit scores at 24, 48, and 72 h after ROSC. It also attenuated cellular apoptosis and neuronal damage in the hippocampal cornuammonis one region by hematoxylin-eosin staining and TdT-mediated dUTP nick-end labeling assay. In addition, DCA reduced the messenger RNA expression of tumor necrosis factor α and interleukin 1β in brain hippocampus and cortex after ROSC. Furthermore, DCA treatment significantly increased ATP production, PDH activity, and decreased blood glucose, lactate, and brain pyruvate levels after ROSC. Our results suggested that DCA has neuroprotective effects on brain injury after cardiac arrest, and its salutary effects were associated with an increase of mitochondrial energy metabolism in the brain through activation of PDH activity.
Macrophage Migration Inhibitory Factor-Induced Autophagy Contributes to Thrombin-Triggered Endothelial Hyperpermeability in Sepsis
Authors: Chao Chiao-Hsuan , Chen Hong-Ru , Chuang Yung-Chun , Yeh Trai-Ming
Published: August 2017

Vascular leakage contributes to the high morbidity and mortality associated with sepsis. Exposure of the endothelium to inflammatory mediators, such as thrombin and cytokines, during sepsis leads to hyperpermeability. We recently observed that autophagy, a cellular process for protein turnover, is involved in macrophage migration inhibitory factor (MIF)-induced endothelial hyperpermeability. Even though it is known that thrombin induces endothelial cells to secrete MIF and to increase vascular permeability, the possible role of autophagy in this process is unknown. In this study, we proposed and tested the hypothesis that MIF-induced autophagy plays an important role in thrombin-induced endothelial hyperpermeability. We evaluated the effects of thrombin on endothelial permeability, autophagy induction, and MIF secretion in vitro using the human microvascular endothelial cell line-1 and human umbilical vein endothelial cells. Several mechanisms/read outs of endothelial permeability and autophagy formation were examined. We observed that blocking autophagy attenuated thrombin-induced endothelial hyperpermeability. Furthermore, thrombin-induced MIF secretion was involved in this process because MIF inhibition reduced thrombin-induced autophagy and hyperpermeability. Finally, we showed that blocking MIF or autophagy effectively alleviated vascular leakage and mortality in endotoxemic mice. Thus, MIF-induced autophagy may represent a common mechanism causing vascular leakage in sepsis.
Epidemic Potential for Human Infection with Influenza A (H7N9) Virus in China through Web Search Behaviors: A Data-Driven Study
Authors: Teng Yue , Bi Dehua , Guo Xiaocan , Feng Dan , Tong Yigang
Published: August 2017

Since the beginning of September 2016, a steep upsurge of the human cases of avian influenza A (H7N9) virus has been reported in China, which are alarming public concern for the pandemic potential of the H7N9 virus. In this study, we collected the data from H7N9 epidemics and H7N9-related Baidu Search Index (BSI) in China between September 2013 and June 2017. And we observed a strong correlation between the numbers of Influenza A (H7N9) cases and H7N9-related BSI in Guangdong province and Shanghai municipality (p<0.001). Autoregressive integrated moving average (ARIMA) models were constructed for the dynamic estimation of seasonal H7N9 outbreaks in 2016-2017 and the online search data acted as an external regressor with the historical H7N9 epidemic data in the forecasting model to improve the quality of predictions. Predictions by the models closely matched the actual numbers of reported cases during current H7N9 epidemic season. Especially, the estimated numbers of reported cases sharply increased to reach 49.88 (95% CI: 0-194.05) in Guangdong and 9.05 (95% CI: 0-37.43) in Shanghai from December 2016 to June 2017. Moreover, this accessible and flexible dynamic forecast model could be used in the monitoring of H7N9 virus to provide advanced warning of future emerging infection diseases.

Author summary

As the availability and popularity of the internet has greatly increased in recent years, an increasing number of cyber users, including patients and their family members, search online for health information on personal computers (PCs) and mobile phones (MPs) before seeking medical attention, making it possible to investigate the influenza prevalence by monitoring changes in frequencies of uses of particular search terms. In this study, we collected the data from H7N9 epidemics and H7N9-related Baidu Search Index (BSI) in China between September 2013 and June 2017. And then, we showed a strong correlation between the numbers of Influenza A (H7N9) cases and H7N9-related BSI in Guangdong province and Shanghai municipality (p<0.001). Furthermore, we reconstructed an improved dynamic forecasting method for outbreaks of H7N9 influenza using Autoregressive integrated moving average (ARIMA) models to predict future patterns of H7N9 transmission and the online search data acted as an external regressor with the historical H7N9 epidemic data in the forecasting model to improve the quality of predictions. Our results suggest that data from the Baidu search engine, combed with data from a traditional disease surveillance system, may be considered for early detection of H7N9 influenza outbreaks in mainland China.
Ttc21bis required in Bergmann glia for proper granule cell radial migration
Authors: Driver Ashley M. , Shumrick Christopher , Stottmann Rolf W.
Published: August 2017

Proper cerebellar development is dependent on tightly regulated proliferation, migration, and differentiation events. Disruptions in any of these leads to a range of cerebellar phenotypes from ataxia to childhood tumors. Animal models have shown proper regulation ofsonic hedgehog(Shh) signaling is crucial for normal cerebellar architecture and increased signaling leads to cerebellar tumor formation. Primary cilia are known to be required for the proper regulation of multiple developmental signaling pathways, includingShh.Tetratricopeptide Repeat Domain 21B(Ttc21b) is required for proper primary cilia form and function and is primarily thought to restrictShhsignaling. Here we investigated a role forTtc21bin cerebellar development. Surprisingly,Ttc21bablation in Bergmann glia resulted in accumulation of ectopic granule cells in the lower/ posterior lobes of the cerebellum and a reduction in Shh signaling.Ttc21bablation in just Purkinje cells resulted in a similar, phenotype seen in fewer cells, but across the entire extent of the cerebellum. These results suggest thatTtc21bexpression is required for Bergmann glia structure and signaling in the developing cerebellum, and in some contexts, augments, rather than attenuates,Shhsignaling.
Edge Detection of Cryptic Lamellipodia Assisted by Deep Learning
Authors: Wang Chuangqi , Kang Shawn , Kim Eunice , Zhang Xitong , Choi Hee June , Choi Aaron , Lee Kwonmoo
Published: August 2017

Cell protrusion plays important roles in cell migration by pushing plasma membrane forward. Cryptic lamellipodia induce the protrusion of submarginal cells in collective cell migration where cells are attached and move together. Although computational image analysis of cell protrusion has been done extensively, the study on protrusion activities of cryptic lamellipodia is limited due to difficulties in image segmentation. This study seeks to aid in the computational analysis of submarginal cell protrusion in collective cell migration by using deep learning to detect the cryptic lamellipodial edges from fluorescence time-lapse movies. Due to the noisy features within overlapping cells, the conventional image analysis algorithms such as Canny edge detector and intensity thresholding are limited. In this paper we combined Canny edge detector, Deep Neural Networks (DNNs), and local intensity thresholding. We were able to detect cryptic lamellipodial edges of submarginal cells with high accuracy from the fluorescence time-lapse movies of PtK1 cells using both simple convolutional neural networks and VGG-16 based neural networks. We used relatively small effort to prepare the training set to train the DNNs to detect the cryptical lamellipodial edges in fluorescence time-lapse movies. This work demonstrates that deep learning can be combined with the conventional image analysis algorithms to facilitate the computational analysis of highly complex time-lapse movies of collective cell migration.