bluuebunny/crossref_metadata_2025 huggingface dataset:
Augmented Reality Museum Visiting Application based on the Microsoft HoloLens
Authors: Hou Weiting
Published: July 2019

Immersive technologies such as the Augmented Reality (AR), which attaches the virtual information to the real environment, are extending the research space and attracting various domain experts including museum experts. Applying the AR technology in the 3D relic information visualization and helping visitors to visit the museum are also hot research issues. Current museum solutions are mainly based on the website, smart phone and Virtual Reality (VR) technology, AR museum applications are also mainly deployed on the smart phone. In this paper, an AR museum application based on the Microsoft HoloLens is presented, and the Microsoft HoloLens is a kind of head mounted device (HMD). Besides, multiple user interaction forms are supported in this solution, such as gaze, voice command, voice speech and hand gesture. Evaluation about this solution has also done, and the conclusion can be drawn that most participants appreciated this solution in clear interface and completion aspects.
Research and Improvement of Isolation Forest in Detection of Local Anomaly Points
Authors: Gao Rongfang , Zhang Tiantian , Sun Shaohua , Liu Zhanyu
Published: July 2019

Three algorithms of classification-based, density-based, and isolation-based are researched and compared in this paper. It is concluded that Isolation Forest algorithm has characteristics of low time complexity and quantitative description of anomalies, which is obviously superior to other algorithms. However, it has disadvantage in detecting local anomaly point, which affects the accuracy of algorithm. Therefore, an improved algorithm based on Isolation Forest is proposed, of which the main idea is the K-means algorithm divides samples into different clusters, and the local anomalies before clustering are transformed into global anomalies of adjacent clusters, and finally the anomaly scores of the samples are calculated in each cluster. Experimental results are that the improved algorithm is better than Isolation Forest algorithm in detecting local anomaly points.
Research Progress Of Quantum Repeaters
Authors: Ruihong Qiao , Ying Meng
Published: July 2019

At present, the main components of quantum communication channels are optical fibers and free space. However, whether it is a fiber channel or a free-space channel, the channel in which it propagates is affected by noise, resulting in loss or absorption of photons. Experimental studies have shown that the quantum key can basically meet the requirements of the local area network, and the safety distance is about 100km. However, if you want to achieve longer distance distribution, you can’t do without quantum repeaters. The quantum repeater can divide the long-distance communication distance into several segments, and then perform quantum key distribution in several segments respectively; then establish a longer-distance EPR pair between adjacent nodes, and establish an EPR pair to utilize entanglement switching and Entanglement purification technology; finally repeat the above steps, and finally achieve long-distance information transmission. The development of quantum repeaters can solve the communication problems facing the world and promote the replacement of global communication methods.
Reducing the background of secondary ions in an ion-counting nanodosimeter
Authors: Hilgers G. , Rabus H.
Published: July 2019

In previous investigations using the PTB Ion Counter nanodosimeter, significant deviations for large cluster sizes were found in the comparison between measured and simulated data of ionisation cluster size distributions. These deviations could be explained quantitatively using a simple parametric model for a background of secondary ions, which are produced within the transport system of the target gas ions to the ion detector. To correct for these secondary ions, unfolding procedures were applied to the measured data to remove the effects of this background. However, the parameters of the model describing the background of secondary ions strongly depend on operational parameters of the nanodosimeter, and any change in these operational parameters requires a new characterisation of the model's parameters. In this work, the influence of the nanodosimeter's operational parameters on the background of secondary ions and the collection efficiency of the detected ions was therefore systematically investigated. At the end of this process operational conditions were found where the background of secondary ions is reduced substantially while the effect on the spatial distribution of the collection efficiency is still acceptable. For some beam geometries of particular relevance for radiation biology, cluster size distributions measured with these new operational parameters can be used directly so that the unfolding procedures, and consequently the characterisation of the secondary ion background with respect to the parameters required by the corresponding model used in the unfolding, can be omitted.
Transient Stability Analysis of Ocean Wave Energy Fed to a Power Grid Using a SSSC
Authors: Lu Kai-Hung , Xu Qiangqiang , Chen Ziwen
Published: July 2019

This paper proposes the design of a closed-loop vector control structure based on Recurrent Functional Link based Elman Neural Network (RFLENN) for a Static Synchronous Series Compensator (SSSC), linking to a Seashore Wave Energy System (SWES) driven Doubly-Fed Induction Generator (DFIG) is connected. A RFLENN controller for a SSSC in order to reduce the power fluctuations, voltage support and damping for a hybrid power system. The proposed RFLENN is a functional link-based recurrent Elman Neural Network. Analysis of the performance of the proposed controller shows that it can achieve better damping characteristics. The internal power fluctuations to the power system can effectively stabilize the network under unstable conditions. This paper presents a closed-loop vector control structure based on RFLENN for a grid-connected SWES driven DFIG. This paper presents the transient stability improvement and power-flow control results of a DFIG-based SWES connected to a SSSC connected in series with one of two parallel transmission lines.
Achieving a Youthful Midface: Examination of Midface Anatomy Improvement Following Lower Blepharoplasty With Fat Transposition and Transtemporal Midface Lift With Lower Lid Skin Pinch
Authors: Weng Catherine , Quatela Vito
Published: July 2019

Background

Numerous methods have been described to treat midfacial aging. The authors compared 2 surgical methods aimed to improve the appearance of midface aging via their ability to improve midface contour: the transtemporal midface lift (with lower lid skin pinch) and lower blepharoplasty with fat transposition.

Objectives

The authors conducted a retrospective cohort study of all patients who underwent transtemporal midface lift and lower blepharoplasty with fat transposition performed by the senior author (V.Q.) from January 2014 to December 2015. Preoperative and 6-month postoperative profile photos were objectively examined for both surgical groups and compared. A total of 16 patients underwent lower blepharoplasty with fat transposition and 15 patients underwent trans temporal midface lift.

Methods

For comparison 1, the authors compared the angle at the orbital rim within each surgical group before and after surgery. For comparison 2, the degree of improvement in the midfacial contour was quantitatively compared between the 2 surgical groups.

Results

This study demonstrated that both procedures achieved a statistically significant improvement in the midfacial contour. There was no statistically significant difference between groups in severity of deformity preoperatively (mean preoperative orbital rim angle 131.5° for lower blepharoplasty group and 132.2° for transtemporal midface lift group, P = 0.90). Degree of improvement between the groups also did not significantly differ (P = 0.28).

Conclusions

Both approaches (transtemporal midface lift and lower blepharoplasty with fat transposition) can successfully improve the lower lid midface contour, as the authors demonstrated statistically significant improvement at 6 months postoperatively.

Level of Evidence: 4
The Interplay of Nutrition, Physical Activity, Severity of Illness, and Mortality in Critically Ill Burn Patients: Is There a Connection?
Authors: Shields Beth A , Carpenter Jennifer N , Bustillos Brenda D , Jordan Alicia N , Cunningham Kyle B , Vega Saul J , Aden James K , Rowan Matthew P , Rizzo Julie A , Dewey William S , Gurney Jennifer M , Ainsworth Craig R , Cancio Leopoldo C
Published: July 2019

The purpose of this project was to evaluate the relationships between nutrition, physical activity levels (PALs), severity of illness (SOI), and survival in critically ill burn patients. We conducted a retrospective evaluation of consecutively admitted adult patients who had an intensive care unit stay ≥8 days after ≥20% TBSA burns. Linear regression was used to assess the association between SOI (sequential organ failure assessment scores) and PALs as well as between SOI and nutritional intake. After univariate analysis comparing survivors and nonsurvivors, factors with P < .10 were analyzed with multiple logistic regression. Characteristics of the 45 included patients were: 42 ± 15 years old, 37 ± 17% TBSA burns, 22% mortality. Factors independently associated with survival were burn size (negatively) (P = .018), height (positively) (P = .006), highest PAL during the first eight intensive care unit days (positively) (P = .016), and kcal balance during the fifth through the eighth intensive care unit days (positively) (P = .012). Sequential organ failure assessment scores had a significant (P < .001) but weak association with nutrition intake (R2 = 0.05) and PALs (R2 = 0.25). Higher nutritional intake and activity were significantly associated with lower mortality in critically ill burn patients. Given the weak associations between both nutritional intake and PALs with SOI, the primary barrier in achieving nutrition and activity goals was not SOI. We recommend that physical rehabilitation and nutritional intake be optimized in an effort to improve outcomes in critically ill burn patients.
Poetics Ashore
Authors: Rivera Mayra
Published: July 2019

This article focuses on distinctive traits of poetics in the works of Caribbean thinkers, its critique of colonialism and slavery, its orientation toward the world and attention to the creativity of survival. It draws on writers who have influenced my work—particularly Aimé Césaire, Édouard Glissant, and Sylvia Wynter—to give the reader a sense of the textures of their works.
Introduction
Authors: Evans Gregory R. D.
Published: July 2019

Plastic surgery techniques, developed over the preceding 5,000 years, outline the chapters in the second edition of this original book, along with patient considerations. Chapters address the assessment of the defect, the preoperative factors in addressing the problem at hand, the influence of medical or adjuvant therapy, the pathology of the defect, the role of trauma in operative repair, and the correct marriage of donor to recipient tissue. Contributors also address operative indications, operative room setup, and postoperative care and details of pertinent dressings. Plastic surgery has evolved from the transfer of local, pedicle, and free flaps to the understanding of the requirements for angiogenesis and the physiology of tissue molding. Future discoveries will open new avenues for treatment and care.
Principles of Microsurgery
Authors: Evans Gregory R. D. , Kaplan Jordan
Published: July 2019

Free tissue transfer is a common reconstructive surgical technique used to treat a wide variety of defects and injuries. Distant donor tissue, which can include bone, muscle, skin, and fascia, is recruited in order to restore both form and function. Inherent to these procedures are the challenges involved in revascularizing donor tissue as well as monitoring flap viability during the operative and postoperative period. This chapter details the process that microsurgeons go through as they assess patients and their need for free tissue transfer in addition to describing operative techniques and equipment used in microsurgery for both vessel anastomosis and free flap monitoring.
Iliac Crest and Rib Bone Grafts
Authors: Mittermiller Paul , Baylan Joseph , Johns Dana N. , Wan Derrick , Lorenz H. Peter
Published: July 2019

The iliac crest and ribs are valuable sites for harvesting bone that can be used in a variety of plastic and reconstructive operations. Bone from the iliac crest is most commonly harvested through an open approach, but it can also be harvested through a percutaneous approach. The open approach offers cortical and cancellous bone, whereas the percutaneous approach yields only cancellous bone. Full-thickness bone from the ribs can also be harvested safely and efficiently. This chapter describes the techniques for these procedures, the tools routinely used, and common pitfalls and complications that the plastic surgeon must be aware of.
Basic Techniques of Fat Grafting
Authors: Gal Shaili , Pu Lee L. Q.
Published: July 2019

In this chapter, the authors describe a standardized approach to fat grafting based on available scientific studies to obtain the best results for patients. Assessment of the defect and choosing the appropriate fat graft method is essential to achieving the desired result for different patients’ needs. Thus, fat grafting can be classified into small, large, and mega-volume fat grafting for an individualized approach. Once the indication for fat grafting is identified, the fat grafting technique can then be chosen based on the defect or contour deformity. Operative technique is detailed in terms of proper selection of donor site, proper harvest and processing of fat based on the fat grafting method chosen, along with proper placement of fat grafts and postoperative care.
Advances in Hair Transplantation
Authors: Barrera Alfonso
Published: July 2019

This chapter presents a brief review of the history of hair transplantation and the anatomy and physiology of hair follicular units. Also presented is a step-by-step description of the author’s preferred technique and pearls learned over the past 25 years to consistently accomplish natural and aesthetically pleasing results. This very labor-intensive procedure requires a team of skillful assistants to be able to do this well and comfortably. The author also describes the details of equipment and instrumentation needed, from surgical blades to the dissection microscopes, and more. The most frequent cases seen in practice include male pattern baldness, female pattern alopecia, and scarring alopecias secondary to previous surgeries (i.e., post rhytidectomy). The restoration of lost sideburns and a temporal hairline will demonstrate some of these examples.
Scalp Reconstruction
Authors: Disa Joseph J. , Ray Edward
Published: July 2019

The scalp serves both protective and aesthetic functions. Injury or loss of the scalp may lead to desiccation and osteonecrosis of the underlying calvarium as well as potentially life-threatening osteomyelitis and meningitis. Reconstruction of the scalp starts with a systematic approach, beginning with definition of the defect, identification of the reconstructive priorities, and a thorough assessment of the patient’s anatomy and history. Comorbidities, history of radiation or prior reconstruction, physical condition, and patient compliance are important factors to consider as well. Depending on each of these considerations, options available to the reconstructive surgeon include single- and multiple-stage procedures, grafts, local/regional flaps, and free tissue transfer.
Modified and Radical Neck Surgery
Authors: Luce Edward A.
Published: July 2019

The multiple anatomic structures of the neck are encased in a relatively small region. In turn, radical neck operation is designed as an extirpative procedure directed toward removal of lymph nodes potentially involved by metastases. The operation follows distinct anatomical boundaries, with each unit or compartment dissected with preservation of the important structures contained within. The purpose of this chapter is to illustrate the technique of a standard “classical” radical neck dissection with an emphasis on unit, or compartmental, approaches to the dissection, including an outline of the important anatomic structures of each compartment.
Scapular Osseous Free Flap
Authors: Mericli Alexander F. , Garvey Patrick B.
Published: July 2019

The scapula flap is a workhorse flap for midface reconstruction. The flap is based on a robust and versatile vascular system which readily allows for the creation of chimeric flaps that include bone, muscle, skin, fat, and fascia. The soft tissue elements of a chimeric scapula flap can be more aggressively thinned, making it an ideal option for augmentation of facial atrophy or contour depressions. The scapula bone is thin and wide near the angle and thick and hearty along its lateral border near the glenohumeral joint, which allows the bone flap to be used for a myriad of bony defects.
Otoplasty for Protruding Ears, Cryptotia, or Stahl’s Ear
Authors: Furnas David W.
Published: July 2019

If the neonate with protruding ears, mildly constricted ears, a Stahl’s ear, or even cryptotia is seen by the plastic surgeon during the child’s first days of life, the timing is auspicious. By initiating immediate steps to mold the ear with tapes and splints, complete correction of the problem without surgery is a realistic expectation. The urgency and the effectiveness of early nonsurgical treatment of such ears is not yet widely appreciated by those responsible for primary medical care of neonates. It is the plastic surgeon’s task to heighten awareness of such treatment.
Mandible Fractures
Authors: Thelekkat Yeshaswini , Schubert Warren
Published: July 2019

This chapter summarizes the treatment options for different fractures of the mandible with emphasis on early mobilization and restitution of form and function. Emphasis in the management of mandibular fractures includes the establishment of the premorbid occlusion, surgical anatomy, the course of the inferior alveolar nerve, and biomechanics of the mandible. The principles of plating and the concepts of load-sharing and load-bearing osteosynthesis have also been discussed so that the reader will better understand the application of each in different fracture situations. The chapter concludes by briefly describing the complications of mandible fractures and their management.
Augmentation Mammoplasty
Authors: Slezak Sheri
Published: July 2019

Breast augmentation is the most frequently performed aesthetic surgical procedure in the United States. Recent advances have provided more choices for both the surgeon and the patient. This chapter reviews the physical findings that are important in augmentation, as well as the advantages and disadvantages of various implants, incisions, and pocket location. These decisions, as well as the size of the implant, must be prudently chosen with full patient participation. A complete discussion of implant longevity as well as other possible complications will lead to a well-informed and highly satisfied postoperative patient.
Mastopexy
Authors: Chang Bernard W. , Bhatt Nishant
Published: July 2019

Mastopexy is a skin tightening procedure to restore shape to the ptotic (sagging) breast. Patients must be willing to accept scars as a tradeoff for improved shape. Various patterns of skin tightening procedures are available with the Weiss pattern still being the most commonly used procedure. Patients must be assessed carefully preoperatively and have realistic expectations for scars and recurrent ptosis over time. Patient satisfaction is usually very good in the properly selected patient. The authors emphasize the importance of assessing the patient’s needs as carefully as possible so that both patient and physician are satisfied with the outcome of surgery.
Breast Reconstruction with the TRAM Flap
Authors: Olaya Windy A.
Published: July 2019

Breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap offers a completely autogenous tissue reconstruction for women requesting either a delayed or immediate breast restoration. The donor site scar on the lower abdomen is hidden by most clothing styles. The flap can be harvested as a pedicle flap based on the superior epigastric vessels, including one or both rectus muscles, depending on the volume of tissue required. During immediate reconstruction, both the oncologic and reconstructive surgeons can operate simultaneously, continuously communicating during the surgical procedure about the incisions and mastectomy defect. The match between the tissue volume of the patient’s abdominal TRAM flap and her desired breast size determines the eventual aesthetic success of the reconstruction.
Nipple-Areola Reconstruction
Authors: Clemens Mark W. , Bengtson Bradley P.
Published: July 2019

The nipple and areola complex typically provides the final finishing touch of the breast reconstruction, and most surgeons and patients do not believe the breast has been completely reconstructed until this step is completed. There have been literally hundreds of different types of nipple-areolar reconstructions described, along with variations. This chapter reviews the anatomy, timing, options, and the most common techniques used in reconstruction today. In addition, the authors review tattooing options and caveats for success, including choosing a method to best match the contralateral side and bringing in some additional tissue that may be used in the future for the nipple reconstruction.
Chest Wall Reconstruction
Authors: Reece Gregory P. , Goldberg Daniel
Published: July 2019

This chapter summarizes the various surgical treatment options that can be used to restore the integrity of the chest wall after trauma or tumor resection and to assist with wound healing problems associated with infection and radiation therapy. Emphasis is placed on several considerations for patients undergoing chest wall reconstruction. The authors discuss the indications, contraindications, limitations, surgical anatomy, and technique of each flap type and the effective postoperative care and rehabilitation needed in order to prevent postoperative pulmonary problems. This chapter reviews some of the commonly used flaps for chest wall reconstruction. These flaps include the latissimus dorsi, rectus abdominis, and pectoralis major myocutaneous flaps and the omental flap.
Gluteal Flap for Pressure Sores
Authors: Zahedi Sanam , McLaughlin Jillian M. , Phillips Linda G.
Published: July 2019

Pressure sores usually occur over bony prominences. Based on the distribution of pressure, sacral pressure sores are more common in supine patients, and ischial pressure sores are more common in sitting patients. Patients in acute care settings, in nursing homes, or with spinal cord injuries are among the most commonly affected populations. Pressure sores are a recurrent problem with multiple risk factors including direct pressure, friction, shearing forces, immobility, and moisture. Malnutrition, anemia, and chronic illness can also contribute to their formation by the impairment of blood supply and delayed wound healing. This chapter reviews the operative technique for using different types of gluteal flaps as coverage for sacral pressure sores. It highlights essential components of preoperative, operative, and postoperative decision-making and common postoperative complications encountered.
Tensor Fasciae Lata for Groin Reconstruction
Authors: Neligan Peter C.
Published: July 2019

Because the groin combines elements of myofascial strength, which influences the integrity of the abdominal cavity, with the role of being a conduit for neurovascular structures to the lower limb, reconstruction demands that the repair be strong as well as provide adequate soft tissue to protect these structures. The tensor fasciae lata (TFL) flap is supplied by the transverse or ascending branch of the lateral femoral circumflex artery. It is usually used as a pedicled flap and reaches the trochanteric area and the groin. It is one of the workhorse flaps for treatment of decubitus ulcers and is very durable. The flap consists of skin and fascia lata. The fascial component can be extended to include more fascia while still allowing closure of the skin donor defect
Penile (Re)Construction with the Radial Forearm Free Flap
Authors: Gottlieb Lawrence J. , Shenaq Deana S.
Published: July 2019

The radial forearm free flap provides a relatively thin, potentially sensate, minimally hair-bearing septocutaneous flap with reliable anatomy and enough flexibility that it can be fashioned into a construct resembling a penis. The tube-within-a-tube design incorporates a centrally placed vascularized neourethra with a distal extension that gets folded over to create a semblance of a neoglans. Although this design eliminates any distal meatal stenosis, proximal urethral stenosis and fistulae continue to be the most frequent complication, especially in transgender men. An unsightly donor site scar is the primary disadvantage of the radial forearm free flap phalloplasty.
Latissimus Dorsi Flap for Leg Reconstruction
Authors: Dobke Marek K. , Mackert Gina A.
Published: July 2019

Variants of the latissimus dorsi flap are quite versatile and offer multiple reconstructive options for creative surgeons. The latissimus dorsi flap may be raised as a muscle flap or together with the overlying skin as a musculocutaneous unit. Apart from its use as a pedicled flap or for microvascular free flap transfer, the latissimus dorsi can be raised with portions of ribs and may include the serratus anterior muscle. Different customized chimeric (muscle and perforator flap) or perforator flap techniques find application for repair difficult with large three-dimensional defects or when large and thin, skin-only tissue is needed, respectively. Different designs of the flap, dissection techniques, and flap variant applications in the context of a systematic approach to reconstructive problems are described.
Plantar Flap for Foot Reconstruction
Authors: Lemelman Benjamin T. , Chang David W.
Published: July 2019

The medial plantar flap is an axial pattern flap from the non–weight-bearing area of the sole of the foot between the heel and the metatarsal heads. The flap can be raised as a pedicle or a free flap, based on either the medial or lateral plantar arteries, or both. Sensory function is provided by branches of the medial plantar nerve. The donor site defect in the foot has caused no difficulty except for occasional marginal hyperkeratosis.
Extensor Tendon Repair
Authors: Oates Scott D.
Published: July 2019

Because of their location on the dorsum of the hand, the extensor tendons are particularly vulnerable to injury. This is even more likely over the joints since the dorsal skin is particularly thin there. Injuries can occur from both sharp and blunt trauma. Untreated extensor tendon injuries can result in significant functional impairment and potential long-term permanent deformities of the hand. There are significant differences in treatment for extensor tendon injuries involving the finger zones versus the hand. This chapter will describe the most common treatment modalities for extensor tendon injuries to the hand and forearm.
Flexor Tendon Repair
Authors: Neumeister Michael W. , Brown Richard E.
Published: July 2019

The disruption and subsequent repair of flexor tendons presents a formidable challenge to the hand surgeon. In an effort to regain excursion of the involved tendons, the definitive outcome depends on a number of variables, including the level of injury, the mechanism of injury, and associated trauma to the skin, pulleys, neurovascular bundles, and bone. The ultimate result, however, is directly proportional to scarring, fibrosis, adhesions, and gap formation that limit the return of normal tendon excursion and the final composite motion of the digit.
Nerve Repair
Authors: Moore Amy M. , Brandt Keith E.
Published: July 2019

Successful nerve repair requires an appropriate assessment of the injury combined with a functional examination that may need to be repeated over time. In this chapter, the authors review the key principles of nerve repair in order to maximize functional outcomes in patients with devastating nerve injuries. Managing nerve injuries requires careful patient evaluation; an understanding of the degree, timing, and extent of nerve injury; and consideration of the mechanism of injury. This chapter discusses the advantages and disadvantages of primary nerve repair, nerve autografts, synthetic nerve conduits, and processed nerve allografts. The indication for each of these techniques is discussed. Also discussed is the postoperative management of the reconstructed nerve patient.
Trigger Finger
Authors: Sood Rajiv , Adkinson Joshua M. , Hartman Brett C.
Published: July 2019

Stenosing flexor tenosynovitis of the digits, commonly known as trigger finger, is one of the most common conditions affecting the hand. It is characterized by a painful locking or clicking of the finger during flexion or extension. This can lead to significant pain or eventual flexion deformity. Treatment varies based on the duration, severity, and etiology and can be either conservative or operative. The complication rate of surgical intervention remains low, with the most common being pain at the operative site. Treatment of trigger finger in the patient with rheumatoid disease should be approached with caution. Overall management of trigger finger, whether conservative or operative, is routinely successful with the final result of a satisfied patient.
Detailed Analysis of Hydrocephalus and Hindbrain Herniation After Prenatal and Postnatal Myelomeningocele Closure: Report From a Single Institution
Authors: Flanders Tracy M , Heuer Gregory G , Madsen Peter J , Buch Vivek P , Mackell Catherine M , Alexander Erin E , Moldenhauer Julie S , Zarnow Deborah M , Flake Alan W , Adzick N Scott
Published: July 2019

BACKGROUND

The Management of Myelomeningocele Study (MOMS) demonstrated that fetal myelomeningocele (fMMC) closure results in improved hydrocephalus and hindbrain herniation when compared to postnatal closure.

OBJECTIVE

To report on the outcomes of a single institution's experience in the post-MOMS era, with regard to hydrocephalus absence and hindbrain herniation resolution.

METHODS

A single-center retrospective study of a subset of post-MOMS patients who underwent fetal/postnatal myelomeningocele closure was performed. Primary outcomes included cerebrospinal fluid (CSF) diversion status and hindbrain herniation resolution. Families were contacted via telephone for outcome information if care was transitioned to outside institutions. Univariate/multivariable analyses were performed using several prenatal and postnatal variables.

RESULTS

From January 2011 to May 2016, data were reviewed from families of 62 postnatal and 119 fMMC closure patients. In the postnatal group, 80.6% required CSF diversion compared to 38.7% fetal cases (P < .01). Hindbrain herniation resolution occurred in 81.5% fetal repairs compared to 32.6% postnatal (P < .01). In the fetal group, fetal/premature neonatal demise occurred in 6/119 (5.0%) patients. There was a 42.0% decrease (95% CI –55.2 to –28.8) and 48.9% increase (95% CI 33.7 to 64.1) in risk difference for CSF diversion and hindbrain herniation resolution, respectively, in the fetal group. On univariate analysis for both groups, prenatal atrial diameter, frontal–occipital horn ratio, and hindbrain herniation resolution were significantly associated with the absence of clinical hydrocephalus. The treatment of hydrocephalus was significantly delayed in the fetal group compared to the postnatal group (10 mo vs 13.8 d).

CONCLUSION

This study demonstrates the benefits of fMMC closure with regard to CSF dynamics.
Scalp Cirsoid Aneurysms: Case Illustration and Systematic Review of Literature
Authors: Sofela Agbolahan , Osunronbi Temidayo , Hettige Samantha
Published: July 2019

BACKGROUND

Scalp cirsoid aneurysms are rare subcutaneous arteriovenous fistulae affecting the scalp. They can be easily misdiagnosed and mistreated.

OBJECTIVE

To review reported cases of scalp cirsoid aneurysms for their incidence, etiology, clinical presentation, treatment, and outcomes using an illustrative case.

METHODS

We conducted a PUBMED, SCOPUS, OVID SP, SciELO, and INFORMA search using the keywords; “cirsoid,” “aneurysm,” “arteriovenous,” “malformation,” “scalp,” “vascular,” and “fistula.” We identified 74 pertinent papers, reporting 242 cases in addition to our reported index case.

RESULTS

Median age at presentation was 25 yr (range 1-72 yr); male to female ratio was 2.5:1. The most common symptoms were a pulsatile mass (94% of patients), headaches (25%), and tinnitus (20%). The median duration of symptoms was 3 yr (6 d to 31 yr), with 60.2% occurring spontaneously, 32.23% traumatic, and the rest iatrogenic. A total of 58.5% of cases were managed with surgical excision only, 21.6% with endovascular embolization only, and 14.5% with a combination of both methods. The complication rate observed in the endovascular embolization treatment cohort (55.8%) was significantly higher than that observed in the surgical excision only cohort (9.9%) (P < .00001) and in the combined therapy cohort (0%) (P < .00001). There is a low recurrence rate after treatment irrespective of modality: surgical excision only (6.3%), endovascular embolization only (8.3%), and combined therapy (0%).

CONCLUSION

Scalp cirsoid aneurysms are associated with good prognoses when recognized and managed appropriately. We suggest combining surgery with endovascular embolization as the optimum treatment modality.
Successful endovascular recanalization of massive cerebral venous sinus thrombosis in a patient with tuberous sclerosis and protein S deficiency: a case report
Authors: Nishiyama Yasuhiro , Ueda Masayuki , Muraga Kanako , Ota Takahiro , Horikawa Hiroshi , Kimura Kazumi
Published: July 2019

Here, we report the case of a 27-year-old woman with tuberous sclerosis complex who underwent successful endovascular intervention for cerebral venous thrombosis at the superior sagittal sinus. She had protein S deficiency and a long-term history of anemia caused by menorrhagia from uterine fibroids, possibly leading to a hypercoagulable state. Cerebral venous sinus thrombosis accounts for ~0.5–1% of all strokes. Several cases of venous thrombosis in patients with tuberous sclerosis complex and protein S or protein C deficiency have been reported, but further studies are needed to identify whether an association of this rare combination may be explained.
Two Novel Genomospecies in the Agrobacterium tumefaciens Species Complex Associated with Rose Crown Gall
Authors: Mafakheri Hamzeh , Taghavi S. Mohsen , Puławska Joanna , de Lajudie Philippe , Lassalle Florent , Osdaghi Ebrahim
Published: July 2019

In this study, we explored the pathogenicity and phylogenetic position of Agrobacterium spp. strains isolated from crown gall tissues on annual, perennial, and ornamental plants in Iran. Of the 43 strains studied, 10 strains were identified as Allorhizobium vitis (formerly Agrobacterium vitis) using the species-specific primer pair PGF/PGR. Thirty-three remaining strains were studied using multilocus sequence analysis of four housekeeping genes (i.e., atpD, gyrB, recA, and rpoB), from which seven strains were identified as A. larrymoorei and one strain was identified as A. rubi (Rer); the remaining 25 strains were scattered within the A. tumefaciens species complex. Two strains were identified as genomospecies 1 (G1), seven strains were identified as A. radiobacter (G4), seven strains were identified as A. deltaense (G7), two strains were identified as A. nepotum (G14), and one strain was identified as “A. viscosum” (G15). The strains Rnr, Rnw, and Rew as well as the two strains OT33 and R13 all isolated from rose and the strain Ap1 isolated from apple were clustered in three atypical clades within the A. tumefaciens species complex. All but eight strains (i.e., Nec10, Ph38, Ph49, fic9, Fic72, R13, OT33, and Ap1) were pathogenic on tomato and sunflower seedlings in greenhouse conditions, whereas all but three strains (i.e., fic9, Fic72, and OT33) showed tumorigenicity on carrot root discs. The phylogenetic analysis and nucleotide diversity statistics suggested the existence of two novel genomospecies within the A. tumefaciens species complex, which we named “G19” and “G20.” Hence, we propose the strains Rew, Rnw, and Rnr as the members of “G19” and the strains R13 and OT33 as the members of G20, whereas the phylogenetic status of the atypical strain Ap1 remains undetermined.
Functional outcomes after selective dorsal rhizotomy followed by minimally invasive tendon lengthening procedures in children with spastic cerebral palsy
Authors: Limpaphayom Noppachart , Stewart Sara , Wang Lin , Liu Jenny , Park Tae S. , Dobbs Matthew B.
Published: July 2019

Many surgical options have been proposed to improve the ambulatory status of children with spastic cerebral palsy (CP), but none have focused on addressing both spasticity and lower extremity tendon contractures. The purpose of this study is to evaluate the results of selective dorsal rhizotomy (SDR) followed by minimally invasive tendon lengthening allowing immediate return to ambulation. Two hundred fifty-five spastic CP patients (who received SDR procedure at an average age of 6.9±2.6  years and tendon lengthening procedure at an average age of 7.2±2.5  years) were retrospectively reviewed. Patients were grouped by the gross motor function classification system (GMFCS) 1–3 and 4–5. Kaplan–Meier analysis and Cox proportional hazard model using a requirement for additional tendon lengthening as an end point were conducted. Tendon lengthening followed SDR at an average of 4.3±10.7  months. On an average of 4.9±1.2  years after tendon lengthening, GMFCS was improved in 28 and maintained in 213 patients, respectively. There was no difference of variables and joint angles between the two GMFCS groups. A repeat tendon lengthening was required in 19 patients. The Kaplan–Meier analysis showed 81% success rate. Cox proportional hazard model identified age at tendon lengthening [hazards ratio (HR), 0.53; 95% confidence interval (CI), 0.37–0.76] and duration between SDR and tendon lengthening of more than 6  months (HR, 2.96; 95% CI, 1.05–8.33) associated with need for a repeat tendon lengthening procedure. Our novel approach of SDR/tendon lengthening results in improved joint angles as well as stable or improved GMFCS. Longer follow-up is necessary to determine if this approach could prolong ambulatory ability and reduced need for more invasive orthopedic surgeries.
Contralateral slip after unilateral slipped capital femoral epiphysis is associated with acetabular retroversion but not increased acetabular depth and overcoverage
Authors: Maranho Daniel A. , Miller Patricia , Kim Young-Jo , Novais Eduardo N
Published: July 2019

Overcoverage of the femoral head by the acetabulum, increased acetabular depth and retroversion have been associated with the etiology of slipped capital femoral epiphysis (SCFE). However, limited evidence exists about the impact of the acetabular morphology on the development of a contralateral slip following an initial presentation of unilateral SCFE. We aimed to investigate whether acetabular overcoverage as assessed by an increased lateral center-edge angle (LCEA) and low Tönnis angle, increased acetabular depth assessed by the acetabular depth-width ratio (ADR) and the presence of coxa profunda; and acetabular retroversion assessed by the presence of the crossover sign were associated with a contralateral slip in patients presenting with unilateral SCFE. We evaluated 250 patients with initial diagnosis of unilateral SCFE (average age, 12.5 ± 1.7 years), who had not undergone prophylactic fixation on the contralateral hip for a median follow-up of 49 months (interquartile range: 25–76 months). Endpoints were the development of a contralateral slip (70 patients, 28%) or skeletal maturity assessed by complete closure of the proximal femoral growth plate (180 patients, 72%). We measured the LCEA, Tönnis angle, ADR, and the coxa profunda sign on an anteroposterior pelvic radiograph. The crossover sign was assessed in 208 hips who had a secondary ossification center in the posterior acetabular rim. For each additional degree of LCEA, the odds of contralateral slip decreased 8% [odds ratio = 0.92; 95% confidence interval (CI), 0.87–0.98; P = 0.009]. Tönnis angle (P = 0.11), ADR (P = 0.20) and coxa profunda (p = 0.37) had no association with a contralateral slip. The presence of crossover sign increased two and half times the odds for a contralateral slip (odds ratio = 2.5; 95% CI = 1.12–5.64; P = 0.03). Acetabular retroversion, but not acetabular overcoverage or increased acetabular depth, was associated with contralateral SCFE development in patients with unilateral SCFE. Level of evidence: prognostic level II.
Acute and Chronic Renal Insufficiency in the Total Joint Arthroplasty Patient
Authors: Sarpong Nana O. , Neuwirth Alexander L. , Geller Jeffrey A.
Published: July 2019

With the projected increase in joint replacement in the next few decades, along with the increased prevalence of renal insufficiency, arthroplasty surgeons must have a good understanding of the routine management of renal impairment in the perioperative setting. Multiple studies have demonstrated significant effect on arthroplasty outcomes, morbidity, and mortality. We highlight several key strategies in the perioperative management of both acute and chronic renal insufficiency. A multidisciplinary approach should be pursued in the perioperative management of renal disease, with important considerations for cardiovascular, hematopoietic, anesthetic, and infection prevention.
Antimicrobial Disposition During Pediatric Continuous Renal Replacement Therapy Using an Ex Vivo Model
Authors: Purohit Prashant J. , Elkomy Mohammed H. , Frymoyer Adam , Sutherland Scott M. , Drover David R. , Hammer Gregory B. , Su Felice
Published: July 2019

Objectives:

Little is known on the impact of continuous renal replacement therapy on antimicrobial dose requirements in children. In this study, we evaluated the pharmacokinetics of commonly administered antimicrobials in an ex vivo continuous renal replacement therapy model.

Design:

An ex vivo continuous renal replacement therapy circuit was used to evaluate drug-circuit interactions and determine the disposition of five commonly used antimicrobials (meropenem, piperacillin, liposomal amphotericin B, caspofungin, and voriconazole).

Setting:

University research laboratory.

Patients:

None.

Interventions:

Antimicrobials were administered into a reservoir containing whole human blood. The reservoir was connected to a pediatric continuous renal replacement therapy circuit programmed for a 10 kg child. Continuous renal replacement therapy was performed in the hemodiafiltration mode and in three phases correlating with three different continuous renal replacement therapy clearance rates: 1) no clearance (0 mL/kg/hr, to measure adsorption), 2) low clearance (20 mL/kg/hr), and 3) high clearance (40 mL/kg/hr). Blood samples were drawn directly from the reservoir at baseline and at 5, 20, 60, and 180 minutes during each phase. Five independent continuous renal replacement therapy runs were performed to assess inter-run variability. Antimicrobial concentrations were measured using validated liquid chromatography-mass spectrometry assays. A closed-loop, flow-through pharmacokinetic model was developed to analyze concentration-time profiles for each drug.

Measurements and Main Results:

Circuit adsorption of antimicrobials ranged between 13% and 27%. Meropenem, piperacillin, and voriconazole were cleared by the continuous renal replacement therapy circuit and clearance increased with increasing continuous renal replacement therapy clearance rates (7.66 mL/min, 4.97 mL/min, and 2.67 mL/min, respectively, for high continuous renal replacement therapy clearance). Amphotericin B and caspofungin had minimal circuit clearance and did not change with increasing continuous renal replacement therapy clearance rates.

Conclusions:

Careful consideration of drug-circuit interactions during continuous renal replacement therapy is essential for appropriate drug dosing in critically ill children. Antimicrobials have unique adsorption and clearance profiles during continuous renal replacement therapy, and this knowledge is important to optimize antimicrobial therapy.
Aesthetic Outcomes of Nasal Burow's Grafts With Interdomal Sutures After Mohs Micrographic Surgery
Authors: Pelster Michael W. , Gibbons Mitchell S. , Patel Payal M. , Behshad Ramona , Semchyshyn Natalie , Maher Ian A.
Published: July 2019

BACKGROUND

Post-Mohs reconstruction of distal nasal defects is challenging. Many repair options exist, each with advantages and disadvantages. Utilization of a Burow's graft in combination with manipulation of the underlying nasal cartilages with interdomal sutures is an underreported yet effective repair option.

OBJECTIVE

To present the authors' experience with Burow's grafts facilitated by interdomal sutures for repair of nasal defects after Mohs micrographic surgery (MMS).

MATERIALS AND METHODS

Patients who underwent repair with Burow's grafts and interdomal sutures from 2013 to 2017 at a single university were identified. Demographics, follow-up, and complications were recorded. Two independent, board-certified dermatologists evaluated photographs for cosmesis and alar symmetry.

RESULTS

Thirty-one patients were identified. A total of 5/31 patients (16.1%) experienced minor complications without permanent sequelae. A total of 4/31 (12.9%) patients underwent cosmetic revision. No incidences of pincushioning, nasal valve dysfunction, or graft necrosis occurred. Aesthetic ratings were good to excellent with mean visual analog score of 80.8. Alar symmetry was excellent.

CONCLUSION

A Burow's full-thickness skin graft facilitated by an interdomal suture to maintain nasal tip orientation and projection is an elegant repair technique for distal nasal oncologic defects with good to excellent aesthetic outcomes. It should be considered in the armamentarium for repair of distal nasal defects after MMS.