bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Posterior Trench Approach Involving Percutaneous Endoscopic Cervical Discectomy for Central Cervical Intervertebral Disc Herniation
Authors: Yu Ke-Xiao , Chu Lei , Chen Liang , Shi Lei , Deng Zhong-Liang
Published: July 2018

Objective:

This report describes a novel posterior trench approach involving percutaneous endoscopic cervical discectomy (PECD) for central cervical intervertebral disc herniation (CIVDH) and an evaluation of the feasibility, safety, and short-term clinical effect of this approach.

Background Context:

Central CIVDH is considered the contraindication for posterior PECD.

Materials and Methods:

A single-center retrospective observational study was performed with 30 patients managed with posterior PECD using the trench approach for symptomatic single-level central CIVDH. Primary outcomes included the measures of bodily pain and physical function based on the SF-36 and modified MacNab criteria. Radiographical follow-up included the static and dynamic cervical plain radiographs, computed tomographic scans, and magnetic resonance images.

Results:

A positive clinical response for symptom relief was achieved in all patients. The postoperative MRI showed total removal of the herniated disc.

Conclusions:

As a supplement to the described surgical techniques of PECD, this trench approach provides novel access for the treatment of CIVDH, especially for the central type. The advantages of this technique include the provision of access to decompress the ventral region of the thecal sac and the ability to avoid damage to the facet joint. The steep learning curve might be a major disadvantage, and the sample volume is a limitation of the study; the effectiveness and reliability of the trench approach should be further verified in a comparative cohort study with a large volume of patients.
Variation in Sedation and Neuromuscular Blockade Regimens on Outcome After Cardiac Arrest*
Authors: May Teresa L. , Riker Richard R. , Fraser Gilles L. , Hirsch Karen G. , Agarwal Sachin , Duarte Christine , Friberg Hans , Søreide Eldar , McPherson John , Hand Robert , Kent David , Nielsen Niklas , Seder David B.
Published: July 2018

Objectives:

Sedation and neuromuscular blockade protocols in patients undergoing targeted temperature management after cardiac arrest address patient discomfort and manage shivering. These protocols vary widely between centers and may affect outcomes.

Design:

Consecutive patients admitted to 20 centers after resuscitation from cardiac arrest were prospectively entered into the International Cardiac Arrest Registry between 2006 and 2016. Additional data about each center’s sedation and shivering management practice were obtained via survey. Sedation and shivering practices were categorized as escalating doses of sedation and minimal or no neuromuscular blockade (sedation and shivering practice 1), sedation with continuous or scheduled neuromuscular blockade (sedation and shivering practice 2), or sedation with as-needed neuromuscular blockade (sedation and shivering practice 3). Good outcome was defined as Cerebral Performance Category score of 1 or 2. A logistic regression hierarchical model was created with two levels (patient-level data with standard confounders at level 1 and hospitals at level 2) and sedation and shivering practices as a fixed effect at the hospital level. The primary outcome was dichotomized Cerebral Performance Category at 6 months.

Setting:

Cardiac arrest receiving centers in Europe and the United states from 2006 to 2016

Patients:

Four-thousand two-hundred sixty-seven cardiac arrest patients 18 years old or older enrolled in the International Cardiac Arrest Registry.

Interventions:

None.

Measurements and Main Results:

The mean age was 62 ± 15 years, 36% were female, 77% out-of-hospital arrests, and mean ischemic time was 24 (± 18) minutes. Adjusted odds ratio (for age, return of spontaneous circulation, location of arrest, witnessed, initial rhythm, bystander cardiopulmonary resuscitation, defibrillation, medical history, country, and size of hospital) was 1.13 (0.74–1.73; p = 0.56) and 1.45 (1.00–2.13; p = 0.046) for sedation and shivering practice 2 and sedation and shivering practice 3, respectively, referenced to sedation and shivering practice 1.

Conclusion:

Cardiac arrest patients treated at centers using as-needed neuromuscular blockade had increased odds of good outcomes compared with centers using escalating sedation doses and avoidance of neuromuscular blockade, after adjusting for potential confounders. These findings should be further investigated in prospective studies.
Late-Onset Facial Papular Elastorrhexis
Authors: Santonja Carlos , Salinas Silvia , Requena Luis , Kutzner Heinz , Valverde Ricardo
Published: July 2018

Papular elastorrhexis, a rare defect of dermal elastic fibers of unknown origin, usually involves the trunk and extremities of children or young adults. We report the case of a 62-year-old woman with multiple soft, skin-colored facial papules with histological findings characteristic of papular elastorrhexis. Awareness of this entity may allow for its proper identification outside the usual clinical setting.
LONG-TERM VISUAL CHANGES IN INITIALLY STRONGER FELLOW EYES IN PATIENTS WITH UNILATERAL TYPE 3 NEOVASCULARIZATION
Authors: Kim Jae Hui , Chang Young Suk , Kim Jong Woo , Kim Chul Gu , Lee Dong Won , Kim Hyoung Seok
Published: July 2018

Purpose:

To evaluate long-term visual changes in initially stronger fellow eyes in patients with unilateral Type 3 neovascularization.

Methods:

This retrospective study included 102 patients who were newly diagnosed with unilateral Type 3 neovascularization and in whom the best-corrected visual acuity (BCVA) of the fellow eye was initially better than that of the involved eye. All patients were treated with intravitreal anti–vascular endothelial growth factor injections. The BCVAs were compared at diagnosis, 12 months, 24 months, and the final visit. In patients who experienced ≥3 lines of visual deterioration in the BCVA of the fellow eye, the reason for visual deterioration was also verified.

Results:

The patients were followed for 45.9 ± 18.5 months after diagnosis. At diagnosis, the fellow-eye BCVA was better than that of the initially involved eye in all 102 patients. However, the fellow-eye visual acuity was the same or worse than that of the initially involved eye in 13 patients (12.7%) at 12 months, in 20 patients (19.6%) at 24 months, and in 24 patients (23.5%) at the final visit. At the final visit, 53 patients (51.9%) had experienced ≥3 lines of deterioration in the BCVA of the fellow eye. Fellow-eye neovascularization occurred in 42 patients, and geographic atrophy involving the fovea was noted in the remaining 11 patients.

Conclusion:

Deterioration of the visual acuity of the fellow eye is frequently noted in unilateral Type 3 neovascularization. As a result of this deterioration, the initially stronger fellow eye did not remain stronger in 23.5% of the patients, suggesting the need for long-term strict treatment of the initially involved eye even when the visual acuity of the fellow eye is good.
Refractive Stability After Deep Anterior Lamellar Keratoplasty for Keratoconus
Authors: Javadi Mohammad Ali , Feizi Sepehr , Rahmani Saeed , Khajuee-Kermani Pejman
Published: July 2018

Purpose:

To evaluate the long-term stability of subjective refraction after deep anterior lamellar keratoplasty (DALK) performed in keratoconus-affected eyes.

Methods:

This retrospective, comparative interventional case series analyzed the data of 73 eyes in 69 patients with keratoconus who underwent DALK. Only patients with clear grafts who had all sutures removed for at least 12 months were enrolled. The corrected distance visual acuity (CDVA) and manifest refraction were measured several months after all sutures were removed. The CDVA, spherical equivalent refraction, refractive astigmatism, and vector components of refractive astigmatism (J0 and J45) were recorded and compared at different time points.

Results:

Mean age of patients was 28.3 ± 8.3 years at the time of keratoplasty. No significant changes in the CDVA were observed during the follow-up period. Spherical equivalent refraction measured at 1 month (−3.18 ± 3.41 D) and 3 months (−4.29 ± 4.26 D) after complete suture removal differed significantly from that measured at the last examination (−4.70 ± 3.75 D; P = 0.001 and 0.03, respectively). This measurement stabilized from 6 months after complete suture removal onward. Refractive astigmatism and its vector components (J0 and J45) did not change over time after complete suture removal.

Conclusions:

Refraction stabilized 6 months after complete DALK suture removal. Therefore, postponing refractive surgery until this time is advisable to manage post-DALK refractive errors.
Goniotomy Using the Kahook Dual Blade in Severe and Refractory Glaucoma: 6-Month Outcomes
Authors: Salinas Lauriane , Chaudhary Ankita , Berdahl John P. , Lazcano-Gomez Gabriel S. , Williamson Blake K. , Dorairaj Syril K. , Seibold Leonard K. , Smith Sanjay , Aref Ahmad A. , Darlington Jason K. , Jimenez-Roman Jesus , Mahootchi Ahad , Boucekine Mohamed , Mansouri Kaweh
Published: July 2018

Purpose:

The purpose of the study is to describe short-term efficacy and safety of goniotomy with trabecular meshwork excision using the Kahook Dual Blade (KDB, New World Medical Inc., Rancho Cucamonga, CA) in patients with severe or refractory glaucoma.

Method:

Retrospective multicentric case series of 53 eyes with severe or refractory glaucoma as defined by ICD-10 conducted in the United States, Mexico, and Switzerland. Primary efficacy outcome was a ≥20% decrease in intraocular pressure (IOP) from baseline at 6 months. Secondary efficacy outcome measures were probability of achieving an IOP≤14 or 18 mm Hg at 6 months and the mean IOP change from baseline at 6 months. Medication use required to obtain target IOP at last follow up and adverse effects were analyzed.

Results:

The proportion of eyes achieving an IOP reduction of >20% from preoperative baseline at 6 months was 57.7% (n=30). The mean IOP decreased from 18.4±6.1 mm Hg at baseline to 13.9±3.5 mm Hg at month 6 (23.9% reduction; P<0.001). At 6 months, 63.5% and 92.3% achieved an IOP≤14 and ≤18 mm Hg, respectively, and the mean number of glaucoma medications was reduced by 1.2±1.3 (36.6%) compared with baseline (P<0.001). The most common adverse event was hyphema (n=29, 34.9%) with spontaneous resolution in all cases. No severe complications were reported. One case presented with uncontrolled IOP and required glaucoma drainage device surgery at 1 month.

Conclusions:

Goniotomy with trabecular meshwork excision using the KDB could be an alternative surgery for severe or refractory glaucoma, significantly reducing IOP and medication use at 6 months, with a low rate of complications.
Lateral Canthotomy and Cantholysis in Operations Iraqi Freedom and Enduring Freedom: 2001–2011
Authors: Jaksha Alexandria F. , Justin Grant A. , Davies Brett W. , Ryan Denise S. , Weichel Eric D. , Colyer Marcus H.
Published: July 2018

Purpose:

To describe outcomes and associated ocular injuries of lateral canthotomy and cantholysis (LCC) as performed in combat ocular trauma.

Methods:

Data from the Walter Reed Ocular Trauma Database of patients requiring LCC during Operations Iraqi Freedom and Enduring Freedom was reviewed as a retrospective cohort. Primary outcome measures included final visual acuity (VA) and Ocular Trauma Score. Secondary outcome measures were associated injuries and timing of surgery.

Results:

Thirty-six LCCs were recorded on a total of 890 eyes (4.04 %) in the Walter Reed Ocular Trauma Database. Eighteen out of 36 eyes (50.00%) had a final VA of the affected eye of 20/200 or worse vision. From the initial available VA measured either at the time of injury or at Walter Reed Army Medical Center, 13 eyes (40.63%) had no change in VA, 15 eyes (46.88%) had improvement, and 4 (12.5%) had a decrease in VA (n = 32, data unavailable for 4 eyes). Ocular Trauma score 0–65 was noted in 14 (38.9%) and 66–100 (61.1%). Retinal detachment (6, 16.67%), optic nerve injuries (7, 19.44%), orbital fractures (20, 55.56%), and retrobulbar hematoma (25, 69.44%) were commonly associated injuries. Of the 36 LCC, 18 (50.00%) were performed as the first surgery performed at the combat support hospital, 13 (36.11%) as the second, 4 (11.11%) as the third, and 1 (2.78%) as the fourth.

Conclusions:

The largest subgroup of patients had an improvement in VA associated with performance of LCC; however, half of patients remained with a final VA of equal to or worse than 20/200 due to severe ocular trauma.
Ultra-long-acting insulins: A review of efficacy, safety, and implications for practice
Authors: Davis Courtney S. , Fleming Joshua W. , Malinowski Scott S. , Brown Meagan A. , Fleming Laurie W.
Published: July 2018

Background and purpose:

In the past decade, there has been much advancement in oral antidiabetic agents, but few changes in insulin therapy. With the addition of the ultra-long-acting insulins, insulin glargine U300 (IGlar 300) and insulin degludec (IDeg 100 and IDeg 200), it is important to understand key aspects in the agents' clinical properties, efficacy, safety, dosing, packaging, and place in therapy.

Methods:

A literature review was conducted using PubMed database and was limited to English, full-text articles published from January 2000 to January 2018. The following search terms were used: insulin glargine 300, insulin degludec, Toujeo, Tresiba, and ultra-long-acting insulin.

Conclusions:

These agents are longer acting with sustained insulin coverage as compared with other basal insulins while having a low potential for hypoglycemia. Efficacy and safety profiles are quite good, and potential for weight gain was similar to IGlar 100.

Implications for practice:

Depending on the patient's needs, these newer agents may offer some advantages. Insulin glargine U300 and IDeg 200 are concentrated, allowing for administration of large doses by less volume, thereby theoretically improving absorption. For patients needing flexible dosing, IDeg may be beneficial. The ultra-long-acting agents may also be useful if it is suspected that the basal insulin is not lasting the entire day.
Robotic pancreas transplantation: the state of the art
Authors: Cantrell Leigh A. , Oberholzer José
Published: July 2018

Purpose of review

Robotic pancreas transplantation is a novel procedure that aims to reduce surgical invasiveness, and thereby limit complications related to the surgical access. Given that few centers are providing robotic transplantation, this review serves as a state of the science article to outline early experiences and highlight areas for future research.

Recent findings

Pancreas transplantation results in relatively high rates of wound and other surgical complications that are known to deleteriously impact outcomes. The minimally invasive, robotic-assisted approach decreases wound complications. Because of the obesity epidemic, overweight and obese status is encountered in an increasing number of transplant candidates. These candidates are subject to increased wound-related complications and most benefit from a robotic approach. The first clinical reports on laparoscopic, robotic-assisted kidney and pancreas transplantation indicate a significant decrease in wound complications and excellent outcomes in obese patients otherwise denied access to transplantation.

With excellent results achieved in surgically challenging patients and further accumulation of experience, laparoscopic, robotic-assisted pancreas and kidney transplantation may evolve to a new standard approach.
The road less traveled: how to grow a pancreas transplant program
Authors: Abrams Peter , Cooper Matthew , Odorico Jon S.
Published: July 2018

Purpose of review

The volume of pancreas transplants performed annually in the United States (US) has steadily declined for more than a decade. In the face of this negative trend, efforts at several centers are underway to expand their pancreas transplant volumes through alterations in the structure and function of their pancreas transplant programs. We highlight these programmatic changes and emphasize the culture and characteristics of these high volume centers to serve as models for other centers to emulate. As the results of modern-day pancreas transplantation are excellent and continue to improve, pancreas transplant remains an outstanding option for selected patients suffering from diabetes mellitus and end stage renal disease (ESRD) or symptomatic hypoglycemic events (SHEs). Through strong leadership commitment and programmatic restructuring, the transformation of low-volume pancreas transplant centers into high-volume programs is achievable without the need for cost-prohibitive investment.

Recent findings

Multiple examples may be cited of transplant centers reinvigorating their pancreas transplant programs, increasing their pancreas transplant evaluations and transplant rates, through personnel reorganization and operational restructuring. As a means of providing a roadmap to encourage other transplant centers to re-energize their pancreas transplant programs, we will outline strategies that can be readily instituted to transform a pancreas transplant program, and delineate the basic steps that any transplant center can take to achieve high-volume success.

The negative trends in access to pancreas transplantation in the US may ultimately be addressed by low-volume pancreas transplant programs re-committing themselves through easily achievable institutional changes without substantial added capital investment, thereby maximizing access to pancreas transplantation for their diabetic patients and maintaining excellent outcomes.
Decreasing Urinary Incontinence in Home Healthcare
Authors: Albertson Maureen
Published: July 2018

Urinary incontinence (UI) in older adult patients poses a risk for complications and hospitalization. The aim of this quality improvement project was to develop and implement a protocol to promote continence in older adults with UI. Data were collected from a convenience sample of 26 participants, 80 years of age or older, in a midsize suburban home care agency. All participants were diagnosed with UI as documented in the Outcomes and Assessment Information Set (OASIS). OASIS question M1610 was used to identify patients with UI status, and M1650 was used, to identify UI frequency. The outcomes for these questions were assessed to examine change over time in UI status and frequency. Eligible patients completed a 3-day bladder diary, then patient education was conducted on UI, risk factors, bladder training, pelvic floor exercises, and hydration/nutrition parameters. Patients then completed 3-day bladder diaries postintervention. At pretest, 100% of the participants were incontinent. At posttest, 24 participants (92.3%) were incontinent. The results suggest that the median frequency of UI declined overtime from 2 (range: 1-4) at pretest to 1 (range: 0-4) at posttest. This decline was statistically significant (z = -3.83; p < .001). Future studies should examine changes in the UI complications and hospitalization rates.
Comparing Functional Status Oasis Ratings Between Occupational Therapists, Physical Therapists, and Registered Nurses in Home Healthcare
Authors: Morgan Rod , Madigan Elizabeth A.
Published: July 2018

The Outcome and Assessment Information Set (OASIS) is mandated for use in home healthcare. The purpose of this descriptive study was to compare occupational therapy (OT) OASIS rating of functional status items compared with registered nurse (RN) and physical therapy (PT) ratings. Functional status data were collected on 80 patients: 40 patients comparing RN with OT and 40 patients comparing PT with OT. RN and PT visits were made first and the OT visit followed. There were no items with perfect agreement. The highest agreement was for feeding (76.3%) and the lowest items were for toileting hygiene and ambulation (37.5%). The largest discrepancy scores were for grooming and dressing lower body. Discipline-specific discrepancy scores were mixed. Krippendorff's α scores were almost all above the required minimum of 0.80. There are substantial differences in the functional status items that may reflect differences in the disciplinary training and approaches to patient care. These findings also raise some concerns about OASIS reliability and consistency of measurement.
Comprehensive Proteomic Profiling–derived Immunohistochemistry-based Prediction Models for BRCA1 and BRCA2 Germline Mutation-related Breast Carcinomas
Authors: Vos Shoko , Elias Sjoerd G. , van der Groep Petra , Smolders Yvonne H. , van Gils Carla H. , van Diest Paul J.
Published: July 2018

Heredity, mostly due to BRCA germline mutations, is involved in 5% to 10% of all breast cancer cases. Potential BRCA germline mutation carriers may be missed following the current eligibility criteria for BRCA genetic testing. The purpose of this study was to, therefore, develop an immunohistochemistry-based model to predict likelihood of underlying BRCA1 and BRCA2 germline mutations in unselected female breast cancer patients. The study group consisted of 100 BRCA1-related, 46 BRCA2-related, and 94 sporadic breast carcinomas. Tumor expression of 44 proteins involved in (BRCA-related) breast carcinogenesis was assessed by immunohistochemistry. A prediction model for BRCA-related versus non–BRCA-related breast cancer was developed using Lasso logistic regression analysis with cross-validation. The model was assessed for its discriminative value and clinical usefulness. The optimal prediction model included 14 predictors (age, cyclinD1, ERα, ERβ, FGFR2, FGFR3, FGFR4, GLUT1, IGFR, Ki67, mitotic activity index, MLH1, p120, and TOP2A), showed excellent discriminative performance (area under the receiving operating characteristic curve=0.943; 95% confidence interval=0.909-0.978), and reasonable calibration. To enhance possible implementation, we developed an alternative model only considering more widely available immunostains. This model included 15 predictors (age, BCL2, CK5/6, CK8/18, cyclinD1, E-cadherin, ERα, HER2, Ki67, mitotic activity index , MLH1, p16, PMS2, PR, and vimentin), and still showed very good discriminative performance (area under the receiving operating characteristic curve=0.853; 95% confidence interval=0.795-0.911). We present a well-applicable and accurate tool to predict which breast cancer patients may have an underlying BRCA germline mutation, largely consisting of immunohistochemical markers independent of clinical characteristics. This may improve identification of potential BRCA germline mutation carriers and optimize referral for germline mutation testing.
Use of Composite Arterial and Venous Grafts in Microsurgical Breast Reconstruction: Technical Challenges and Lessons Learned
Authors: Cho Min-Jeong , Haddock Nicholas T. , Gassman Andrew A. , Teotia Sumeet S.
Published: July 2018

The success of microvascular reconstruction depends on many factors. Although many factors cannot be dictated by a surgeon, the success of anastomosis can be maximized by honing skill with performing anastomoses. However, size discrepancy of vessels remains a common challenge, given the lack of an ideal technique. In this study, the authors introduce their experience in using composite deep inferior epigastric arterial and venous grafts to overcome the vessel size and pedicle length discrepancy in lateral thigh and superficial inferior epigastric artery (SIEA) flaps. Of the 1095 flaps performed, the authors identified a total of 12 flaps (one lateral thigh flap and 11 SIEA flaps) on nine patients for breast reconstruction. The authors used deep inferior epigastric vessels to act as interposition grafts between the internal mammary artery and flap pedicle. For the SIEA flaps, the authors anastomosed the SIEA system to the deep inferior epigastric arterial system, checked the viability of the flap, and then transferred the flap to the internal mammary artery and flap pedicle. For the SIEA flaps, the authors anastomosed the SIEA system to the deep inferior epigastric arterial system, checked the viability of the flap, and then transferred the flap to the internal mammary artery system in three patients. In the last five patients, the authors anastomosed the deep inferior epigastric vessels to the internal mammary artery system first, and then transferred the SIEA flap. For the lateral thigh flap, the authors anastomosed grafts to the internal mammary artery system first as well. There were no flap losses or fat necrosis. Although the authors’ outcomes are limited to only breast reconstruction, they believe this method could be expanded to different types of reconstruction, especially reconstruction of the head and neck.
Fate of Free Fat Grafts with or without Adipogenic Adjuncts to Enhance Graft Outcomes
Authors: Tang Howard H. , Han Xiao-Lian , Debels Heidi , Tan Beryl , Palmer Jason , Poon Christopher , Abberton Keren , Morrison Wayne
Published: July 2018

Background:

Free fat grafting is popular, but it is still unclear how it works. Although focusing on graft survival seems an obvious direction for improving clinical results, the authors’ research suggests that long-term volume retention is in part attributable to new fat regeneration. Measures to facilitate adipogenesis may therefore be equally important.

Methods:

To investigate the relative roles of survival and regeneration of fat grafts, the authors measured the fate of human lipoaspirate implanted into the scalps of immunodeficient mice, with and without stromal vascular fraction and a porcine extracellular matrix (Adipogel). Specifically, the authors were interested in volume retention, and the composition of implanted or regenerated tissue at 6 and 12 weeks.

Results:

Free fat grafts exhibited poor volume retention and survival. Almost all of the injected human adipocytes died, but new mouse fat formed peripheral to the encapsulated fat graft. Adipogel and stromal vascular fraction improved proliferation of murine fat and human vasculature. Human CD34+ stromal cells were present but only in the periphery, and there was no evidence that these cells differentiated into adipocytes.

Conclusions:

In the authors’ model, most of the implanted tissue died, but unresorbed dead fat accounted substantially for the long-term, reduced volume. A layer of host-derived, regenerated adipose tissue was present at the periphery. This regeneration may be driven by the presence of dying fat, and it was enhanced by addition of the authors’ adipogenic adjuncts. Future research should perhaps focus not only on improving graft survival but also on enhancing the adipogenic environment conducive to fat regeneration.
Feasibility of Diffusion Tensor and Morphologic Imaging of Peripheral Nerves at Ultra-High Field Strength
Authors: Schmid Annina B. , Campbell Jon , Hurley Samuel A. , Jbabdi Saad , Andersson Jesper L. , Jenkinson Mark , Bangerter Neal K. , Bennett David L. , Tracey Irene , Frost Robert , Clare Stuart
Published: July 2018

Objectives

The aim of this study was to describe the development of morphologic and diffusion tensor imaging sequences of peripheral nerves at 7 T, using carpal tunnel syndrome (CTS) as a model system of focal nerve injury.

Materials and Methods

Morphologic images were acquired at 7 T using a balanced steady-state free precession sequence. Diffusion tensor imaging was performed using single-shot echo-planar imaging and readout-segmented echo-planar imaging sequences. Different acquisition and postprocessing methods were compared to describe the optimal analysis pipeline. Magnetic resonance imaging parameters including cross-sectional areas, signal intensity, fractional anisotropy (FA), as well as mean, axial, and radial diffusivity were compared between patients with CTS (n = 8) and healthy controls (n = 6) using analyses of covariance corrected for age (significance set at P < 0.05). Pearson correlations with Bonferroni correction were used to determine association of magnetic resonance imaging parameters with clinical measures (significance set at P < 0.01).

Results

The 7 T acquisitions with high in-plane resolution (0.2 × 0.2mm) afforded detailed morphologic resolution of peripheral nerve fascicles. For diffusion tensor imaging, single-shot echo-planar imaging was more efficient than readout-segmented echo-planar imaging in terms of signal-to-noise ratio per unit scan time. Distortion artifacts were pronounced, but could be corrected during postprocessing. Registration of FA maps to the morphologic images was successful. The developed imaging and analysis pipeline identified lower median nerve FA (pisiform bone, 0.37 [SD 0.10]) and higher radial diffusivity (1.08 [0.20]) in patients with CTS compared with healthy controls (0.53 [0.06] and 0.78 [0.11], respectively, P < 0.047). Fractional anisotropy and radial diffusivity strongly correlated with patients' symptoms (r = −0.866 and 0.866, respectively, P = 0.005).

Conclusions

Our data demonstrate the feasibility of morphologic and diffusion peripheral nerve imaging at 7 T. Fractional anisotropy and radial diffusivity were found to be correlates of symptom severity.
Imaging of Thoracoabdominal Aortic Aneurysms
Authors: Green Daniel B. , Palumbo Maria C. , Lau Christopher
Published: July 2018

Untreated thoracoabdominal aortic aneurysms are associated with an exceedingly high mortality rate, and surgery carries a high complication rate. Crawford’s classification system of thoracoabdominal aortic aneurysms describes aneurysm morphology and stratifies patients on the basis of risk of major postoperative complications including mortality, spinal cord injury, and renal failure. Computed tomography and magnetic resonance angiography are essential for classifying thoracoabdominal aortic aneurysms and identifying other important features that impact prognosis and surgical management. Four-dimensional flow-sensitive magnetic resonance imaging is an emerging technique that may help predict complications and further impact timing of intervention.
Refinement and Evaluation of Modified Minimally Invasive Harvest Technique for Subepithelial Connective Tissue
Authors: Wang Lei , Liu Lingshuang , Song Wenbin , Hu Fang , Zhou Jia , Ji Qiuxia
Published: July 2018

Introduction:

The aim of this paper was to refine the modified minimally invasive single-incision technique (MSIT) into 6 steps that are easy to execute. The advantage of this modification was evaluated and compared with the traditional trap-door incision technique (TDIT). Several other harvesting techniques, suturing techniques, indications, contraindications, and limitations were also summarized.

Materials and Methods:

A total of 40 patients presenting with multiple areas of gingival recession were recruited for this study. All patients were randomly assigned to either the MSIT or TDIT group. Standard periodontal instruments and crossed horizontal suspension sutures were used for both procedures. Harvesting and suturing time, verbal rating scale (VRS), and an early wound-healing index (EHI) were recorded.

Results:

The total operating time, and particularly the suturing time, was shorter in the MSIT group (267.70 ± 20.24 seconds) than the TDIT group (298.20 ± 21.07 seconds), and the difference was statistically significant (P < 0.05). However, there was no significant difference in pain level between the 2 groups according to the VRS evaluation (P = 0.3658). One week postsurgery, the EHI of the MSIT group (2.00 ± 0.95) was significantly lower than the TDIT group (2.85 ± 1.15) (P < 0.05).

Discussion:

The 6-step MSIT is more predictable and easy to execute, which decreases the challenge for both dentists and patients. Favorable outcomes occurred because of the streamlined minimally invasive procedure and favorable postoperative recovery.
Downregulated Pancreatic Beta Cell Genes Indicate Poor Prognosis in Patients With Pancreatic Neuroendocrine Neoplasms
Authors: Kudo Atsushi , Akahoshi Keiichi , Ito Sakiko , Akashi Takumi , Shimada Shu , Ogura Toshiro , Ogawa Kosuke , Ono Hiroaki , Mitsunori Yusuke , Ban Daisuke , Tateishi Ukihide , Tanaka Shinji , Tanabe Minoru
Published: July 2018

Objective:

To predict metachronous liver metastasis after pancreatectomy for pancreatic neuroendocrine neoplasms (Pan-NENs).

Summary of Background Data:

Liver metastasis determines the prognosis of patients with Pan-NENs, but no index exists in the WHO 2017 classification for this prediction.

Methods:

Between April 2014 and March 2018, resected primary tumors from 20 patients with or without simultaneous liver metastasis were examined using genome-wide gene expression analysis. For validation analysis, resected primary tumors from 62 patients without simultaneous liver metastasis were examined for PAX6 expression.

Results:

Gene expression profiling revealed pancreatic beta cell genes (NES, −2.0; P < 0.001) as the most downregulated set in patients with simultaneous liver metastasis. In the test study, PAX6 was the most valuable index for liver metastasis (log FC, −3.683; P = 0.0096). Multivariate analysis identified PAX6 expression (hazard ratio, 0.2; P = 0.03) as an independent risk factor for metachronous liver metastasis-free survival (mLM-FS). The 5-year mLM-FS of patients with high versus low PAX6 expression was significantly better (95% vs 66%, respectively; P < 0.0001). The 5-year overall survival rate of was also better than in those with high versus low PAX6 expression (100% vs 87%, respectively). Patients with low PAX 6 expression were significantly younger and leaner, had a higher Ki-67 index (P = 0.01, 0.007, 0.008, respectively), and showed a higher mitotic rate than patients with high PAX6 expression.

Conclusions:

Downregulated pancreatic beta cell genes involving PAX6 in primary tumors may predict mLM and poor overall survival after primary tumor resection in Pan-NEN patients.
Comparison of Patient Impact and Clinical Characteristics Between Urgency and Passive Fecal Incontinence Phenotypes
Authors: Pahwa Avita K. , Khanijow Kavita D. , Harvie Heidi S. , Arya Lily A. , Andy Uduak U.
Published: July 2018

Objective

To determine if categorizing fecal incontinence (FI) as urgency or passive FI is clinically meaningful, we compared clinical severity, quality of life, physical examination findings, and functional and anatomic deficits between women with urgency and passive FI.

Methods

This study is a prospective cross-sectional study of women with at least monthly FI. All women completed the St Mark’s Vaizey and the Fecal Incontinence Quality of Life questionnaires and underwent anorectal manometry and endoanal ultrasound. We compared women with urgency FI to women with passive FI.

Results

Forty-six women were enrolled, 21 (46%) with urgency FI and 25 (54%) with passive FI. Clinical severity by Vaizey score did not differ between groups (urgency 11.7 ± 1.6 vs passive 11.0 ± 1.0, P = 0.51). Women with urgency FI had worse median (range) lifestyle and coping scores than passive FI (Fecal Incontinence Quality of Life: lifestyle domain 2.5 [1, 4] vs 3.8 [1, 4], P = 0.04; coping domain 1.7 [1, 3] vs 2.4 [0.9, 4], P < 0.01). Women with urgency FI had higher anal resting and squeeze pressure than passive FI (60 ± 4 mm Hg vs 49 ± 3 mm Hg, P = 0.03; 78 [48, 150] mm Hg vs 60 [40, 103], P = 0.05). Internal anal sphincter defects were more common in women with passive FI (41.7% vs 30.0%, P = 0.53) and external anal sphincter defects more common in women with urgency FI (25% vs 16.7%, P = 0.71), but this did not reach statistical significance.

Conclusions

We identified functional and anatomic differences between women with urgency FI and passive FI. Pheonotyping women with FI into these subtypes is clinically meaningful.
Fluoxetine-Induced Sleep Bruxism Rapidly Treated With Once-Nightly Dosing of Buspirone in a 6-Year-Old Girl
Authors: Akbaş Betül , Bilgiç Ayhan
Published: July 2018

Fluoxetine is a selective serotonin reuptake inhibitor that is commonly used in children and adolescents. Several reports exist regarding the relationship of fluoxetine use and sleep bruxism. We report the case of a 6-year-old girl who was successfully treated with once-nightly dosing of buspirone for fluoxetine-induced sleep bruxism, which was confirmed with clear on-off-on treatment sequence.
Seneca and the First Description of Anton Syndrome
Authors: André Charles
Published: July 2018

Seneca was a Roman philosopher, politician, and mentor to the young Nero. He later fell in disgrace and was sentenced to death by the Emperor. Seneca left many texts, one of the most influential being his Moral Letters to Lucilius (63 CE). In Letter 50, he describes the case of Harpaste, his wife's foolish slave who acutely became blind. She denied her illness and argued irrationally about room darkness, constantly asking attendants to change her quarters. Harpaste's case, consisting of acutely acquired blindness and anosognosia in the presence of relatively well-preserved cognition, fulfills the clinical criteria for the diagnosis of Anton syndrome, and probably constitutes its first description.
The asymptotic coarse-graining formulation of slender-rods, bio-filaments and flagella
Authors: Moreau Clément , Giraldi Laetitia , Gadêlha Hermes
Published: July 2018

The inertialess fluid–structure interactions of active and passive inextensible filaments and slender-rods are ubiquitous in nature, from the dynamics of semi-flexible polymers and cytoskeletal filaments to cellular mechanics and flagella. The coupling between the geometry of deformation and the physical interaction governing the dynamics of bio-filaments is complex. Governing equations negotiate elastohydrodynamical interactions with non-holonomic constraints arising from the filament inextensibility. Such elastohydrodynamic systems are structurally convoluted, prone to numerical errors, thus requiring penalization methods and high-order spatio-temporal propagators. The asymptotic coarse-graining formulation presented here exploits the momentum balance in the asymptotic limit of small rod-like elements which are integrated semi-analytically. This greatly simplifies the elastohydrodynamic interactions and overcomes previous numerical instability. The resulting matricial system is straightforward and intuitive to implement, and allows for a fast and efficient computation, more than a hundred times faster than previous schemes. Only basic knowledge of systems of linear equations is required, and implementation achieved with any solver of choice. Generalizations for complex interaction of multiple rods, Brownian polymer dynamics, active filaments and non-local hydrodynamics are also straightforward. We demonstrate these in four examples commonly found in biological systems, including the dynamics of filaments and flagella. Three of these systems are novel in the literature. We additionally provide a Matlab code that can be used as a basis for further generalizations.
We-T classification of diesel fuel droplet impact regimes
Authors: Jadidbonab Hesamaldin , Malgarinos Ilias , Karathanassis Ioannis , Mitroglou Nicholas , Gavaises Manolis
Published: July 2018

A combined experimental and computational investigation of micrometric diesel droplets impacting on a heated aluminium substrate is presented. Dual view high-speed imaging has been employed to visualize the evolution of the impact process at various conditions. The parameters investigated include wall-surface temperature ranging from 140 to 400°C, impact Weber and Reynolds numbers of 19–490 and 141–827, respectively, and ambient pressure of 1 and 2 bar. Six possible post-impact regimes were identified, termed asStick, Splash, Partial-Rebound, Rebound, Breakup-Rebound and Breakup-Stick, and plotted on theWe-Tmap. Additionally, the temporal variation of the apparent dynamic contact angle and spreading factor have been determined as a function of the impact Weber number and surface temperature. Numerical simulations have also been performed using a two-phase flow model with interface capturing, phase-change and variable physical properties. Increased surface temperature resulted to increased maximum spreading diameter and induced quicker and stronger recoiling behaviour, mostly attributed to the change of liquid viscosity.
Evolution of thermal tolerance and its fitness consequences: parallel and non-parallel responses to urban heat islands across three cities
Authors: Diamond Sarah E. , Chick Lacy D. , Perez Abe , Strickler Stephanie A. , Martin Ryan A.
Published: July 2018

The question of parallel evolution—what causes it, and how common it is—has long captured the interest of evolutionary biologists. Widespread urban development over the last century has driven rapid evolutionary responses on contemporary time scales, presenting a unique opportunity to test the predictability and parallelism of evolutionary change. Here we examine urban evolution in an acorn-dwelling ant species, focusing on the urban heat island signal and the ant's tolerance of these altered urban temperature regimes. Using a common-garden experimental design with acorn ant colonies collected from urban and rural populations in three cities and reared under five temperature treatments in the laboratory, we assessed plastic and evolutionary shifts in the heat and cold tolerance of F1 offspring worker ants. In two of three cities, we found evolved losses of cold tolerance, and compression of thermal tolerance breadth. Results for heat tolerance were more complex: in one city, we found evidence of simple evolved shifts in heat tolerance in urban populations, though in another, the difference in urban and rural population heat tolerance depended on laboratory rearing temperature, and only became weakly apparent at the warmest rearing temperatures. The shifts in tolerance appeared to be adaptive, as our analysis of the fitness consequences of warming revealed that while urban populations produced more sexual reproductives under warmer laboratory rearing temperatures, rural populations produced fewer. Patterns of natural selection on thermal tolerances supported our findings of fitness trade-offs and local adaptation across urban and rural acorn ant populations, as selection on thermal tolerance acted in opposite directions between the warmest and coldest rearing temperatures. Our study provides mixed support for parallel evolution of thermal tolerance under urban temperature rise, and, importantly, suggests the promising use of cities to examine parallel and non-parallel evolution on contemporary time scales.
Artificial light at night decreases metamorphic duration and juvenile growth in a widespread amphibian
Authors: Dananay Kacey L. , Benard Michael F.
Published: July 2018

Artificial light at night (ALAN) affects over 20% of the earth's surface and is estimated to increase 6% per year. Most studies of ALAN have focused on a single mechanism or life stage. We tested for indirect and direct ALAN effects that occurred by altering American toads' (
Anaxyrus americanus
) ecological interactions or by altering toad development and growth, respectively. We conducted an experiment over two life stages using outdoor mesocosms and indoor terraria. In the first phase, the presence of ALAN reduced metamorphic duration and periphyton biomass. The effects of ALAN appeared to be mediated through direct effects on toad development, and we found no evidence for indirect effects of ALAN acting through altered ecological interactions or colonization. In the second phase, post-metamorphic toad growth was reduced by 15% in the ALAN treatment. Juvenile-stage ALAN also affected toad activity: in natural light, toads retreated into leaf litter at night whereas ALAN toads did not change behaviour. Carry-over effects of ALAN were also present; juvenile toads that had been exposed to larval ALAN exhibited marginally increased activity. In this time frame and system, our experiments suggested ALAN's effects act primarily through direct effects, rather than indirect effects, and can persist across life stages.
Getting ahead of the curve: cities as surrogates for global change
Authors: Lahr Eleanor C. , Dunn Robert R. , Frank Steven D.
Published: July 2018

Urbanization represents an unintentional global experiment that can provide insights into how species will respond and interact under future global change scenarios. Cities produce many conditions that are predicted to occur widely in the future, such as warmer temperatures, higher carbon dioxide (CO2) concentrations and exacerbated droughts. In using cities as surrogates for global change, it is challenging to disentangle climate variables—such as temperature—from co-occurring or confounding urban variables—such as impervious surface—and then to understand the interactive effects of multiple climate variables on both individual species and species interactions. However, such interactions are also difficult to replicate experimentally, and thus the challenges of cities are also their unique advantage. Here, we review insights gained from cities, with a focus on plants and arthropods, and how urban findings agree or disagree with experimental predictions and historical data. We discuss the types of hypotheses that can be best tested in cities, caveats to urban research and how to further validate cities as surrogates for global change. Lastly, we summarize how to achieve the goal of using urban species responses to predict broader regional- and ecosystem-level patterns in the future.
A shady phytoplankton paradox: when phytoplankton increases under low light
Authors: Yamamichi Masato , Kazama Takehiro , Tokita Kotaro , Katano Izumi , Doi Hideyuki , Yoshida Takehito , Hairston Nelson G. , Urabe Jotaro
Published: July 2018

Light is a fundamental driver of ecosystem dynamics, affecting the rate of photosynthesis and primary production. In spite of its importance, less is known about its community-scale effects on aquatic ecosystems compared with those of nutrient loading. Understanding light limitation is also important for ecosystem management, as human activities have been rapidly altering light availability to aquatic ecosystems. Here we show that decreasing light can paradoxically increase phytoplankton abundance in shallow lakes. Our results, based on field manipulation experiments, field observations and models, suggest that, under competition for light and nutrients between phytoplankton and submersed macrophytes, alternative stable states are possible under high-light supply. In a macrophyte-dominated state, as light decreases phytoplankton density increases, because macrophytes (which effectively compete for nutrients released from the sediment) are more severely affected by light reduction. Our results demonstrate how species interactions with spatial heterogeneity can cause an unexpected outcome in complex ecosystems. An implication of our findings is that partial surface shading for controlling harmful algal bloom may, counterintuitively, increase phytoplankton abundance by decreasing macrophytes. Therefore, to predict how shallow lake ecosystems respond to environmental perturbations, it is essential to consider effects of light on the interactions between pelagic and benthic producers.