bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Validation of an Abbreviated Questionnaire to Easily Measure Cognitive Failure in ICU Survivors: A Multicenter Study
Authors: Wassenaar Annelies , de Reus Jorn , Donders A. Rogier T. , Schoonhoven Lisette , Cremer Olaf L. , de Lange Dylan W. , van Dijk Diederik , Slooter Arjen J. C. , Pickkers Peter , van den Boogaard Mark
Published: October 2017

Objectives:

To develop and validate an abbreviated version of the Cognitive Failure Questionnaire that can be used by patients as part of self-assessment to measure functional cognitive outcome in ICU survivors.

Design:

A retrospective multicenter observational study.

Setting:

The ICUs of two Dutch university hospitals.

Patients:

Adult ICU survivors.

Interventions:

None.

Measurements and Main Results:

Cognitive functioning was evaluated between 12 and 24 months after ICU discharge using the full 25-item Cognitive Failure Questionnaire (CFQ-25). Incomplete CFQ-25 questionnaires were excluded from analysis. Forward selection in a linear regression model was used in hospital A to assess which of the CFQ-25 items should be included to prevent a significant loss of correlation between an abbreviated and the full CFQ-25. Subsequently, the performance of an abbreviated Cognitive Failure Questionnaire was determined in hospital B using Pearson’s correlation. A Bland-Altman plot was used to examine whether the reduced-item outcome scores of an abbreviated Cognitive Failure Questionnaire were a replacement for the full CFQ-25 outcome scores. Among 1,934 ICU survivors, 1,737 were included, 819 in hospital A, 918 in hospital B. The Pearson’s correlation between the abbreviated 14-item Cognitive Failure Questionnaire (CFQ-14) and the CFQ-25 was 0.99. The mean of the difference scores was –0.26, and 95% of the difference scores fell within +5 and –5.5 on a 100-point maximum score.

Conclusions:

It is feasible to use the abbreviated CFQ-14 to measure self-reported cognitive failure in ICU survivors as this questionnaire has a similar performance as the full CFQ-25.
The Smurf transition: new insights on ageing from end-of-life studies in animal models
Authors: Rera Michael , Vallot Céline , Lefrançois Christel
Published: October 2017

Purpose of review

Over the past 5 years, many articles were published concerning the prediction of high risk of mortality in apparently healthy adults, echoing the first description in 2011 of the Smurf phenotype, a harbinger of natural death in drosophila.

Recent findings

These recent findings suggest that the end-of-life is molecularly and physiologically highly stereotyped, evolutionarily conserved and predictable.

Taken altogether, these results from independent teams using multiple organisms including humans draw the lines of future directions in ageing research. The ability to identify and study individuals about to die of natural causes with no apparent diseases is a game-changer in this field. In addition, the public health applications are potentially of tremendous impact in our ageing societies and raise important ethical questions.
Signs of Facial Aging in Men in a Diverse, Multinational Study: Timing and Preventive Behaviors
Authors: Rossi Anthony M. , Eviatar Joseph , Green Jeremy B. , Anolik Robert , Eidelman Michael , Keaney Terrence C. , Narurkar Vic , Jones Derek , Kolodziejczyk Julia , Drinkwater Adrienne , Gallagher Conor J.
Published: October 2017

BACKGROUND

Men are a growing patient population in aesthetic medicine and are increasingly seeking minimally invasive cosmetic procedures.

OBJECTIVE

To examine differences in the timing of facial aging and in the prevalence of preventive facial aging behaviors in men by race/ethnicity.

METHODS

Men aged 18 to 75 years in the United States, Canada, United Kingdom, and Australia rated their features using photonumeric rating scales for 10 facial aging characteristics. Impact of race/ethnicity (Caucasian, black, Asian, Hispanic) on severity of each feature was assessed. Subjects also reported the frequency of dermatologic facial product use.

RESULTS

The study included 819 men. Glabellar lines, crow's feet lines, and nasolabial folds showed the greatest change with age. Caucasian men reported more severe signs of aging and earlier onset, by 10 to 20 years, compared with Asian, Hispanic, and, particularly, black men. In all racial/ethnic groups, most men did not regularly engage in basic, antiaging preventive behaviors, such as use of sunscreen.

CONCLUSION

Findings from this study conducted in a globally diverse sample may guide clinical discussions with men about the prevention and treatment of signs of facial aging, to help men of all races/ethnicities achieve their desired aesthetic outcomes.
The effect of nicotine pre-exposure on demand for cocaine and sucrose in male rats
Authors: Schwartz Lindsay P. , Kearns David N. , Silberberg Alan
Published: October 2017

The aim of the present study was to determine how nicotine pre-exposure affects the elasticity of demand for intravenous cocaine and for sucrose pellets in adult male rats. In Experiment 1, demand for cocaine was assessed in rats that had nicotine in their drinking water. Nicotine pre-exposure significantly decreased rats’ willingness to defend cocaine consumption as the price (measured as the number of responses per cocaine infusion) increased compared with a control group with no nicotine pre-exposure. That is, nicotine increased the elasticity of demand for cocaine infusions. Experiment 2 repeated the first experiment, but with rats working for sucrose pellets instead of cocaine. Nicotine pre-exposure had no effect on the elasticity of demand for sucrose. This pattern of results suggests that nicotine pre-exposure can reduce the reinforcing effects of cocaine, but not sucrose, in adult male rats.
Tissue Augmentation with Allograft Adipose Matrix For the Diabetic Foot in Remission
Authors: Shahin Tala B. , Vaishnav Kairavi V. , Watchman Marcy , Subbian Vignesh , Larson Ethan , Chnari Evangelia , Armstrong David G.
Published: October 2017

Background:

Repetitive stress on the neuropathic plantar foot is the primary cause of diabetic foot ulcers. After healing, recurrence is common. Modulating plantar pressure has been associated with extension of ulcer free days. Therefore, the goal of this study was to determine the effects of an injectable allograft adipose matrix in providing a protective padding and reducing the pressure in the plantar foot.

Methods:

After healing his recurrent ulcer using total contact casting, a 71-year-old man with a 9-year history of recurrent diabetic foot ulcers was treated with injection of allograft adipose matrix, procured from donated human tissue. This was delivered under postulcerative callus on the weight-bearing surface of the distal end of the first ray resection. As is standard in our clinic for tissue augmentation procedures, our patient underwent serial plantar pressure mapping using an in-shoe pressure monitoring system.

Results:

There was a 76.8% decrease in the mean peak pressure due to the fat matrix injected into the second metatarsal region and a 70.1% decrease in mean peak pressure for the first ray resection at the site of the postulcerative callus. By 2 months postoperatively, there was no evidence of residual callus. This extended out to the end of clinical follow-up at 4 months.

Conclusion:

The results from this preliminary experience suggest that allograft adipose matrix delivered to the high risk diabetic foot may have promise in reducing tissue stress over pre- and postulcerative lesions. This may ultimately assist the clinician in extending ulcer-free days for patients in diabetic foot remission.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY TO DETECT MACULAR CAPILLARY ISCHEMIA IN PATIENTS WITH INNER RETINAL CHANGES AFTER RESOLVED DIABETIC MACULAR EDEMA
Authors: Moein Hamid-Reza , Novais Eduardo A. , Rebhun Carl B. , Cole Emily D. , Louzada Ricardo N. , Witkin André J. , Baumal Caroline R. , Duker Jay S. , Waheed Nadia K.
Published: October 2017

Purpose:

To compare foveal vascular anatomy between patients with and without disorganization of retinal inner layers (DRILs) after resolved diabetic macular edema using optical coherence tomography angiography (OCTA).

Methods:

Twenty-four eyes of 21 age- and sex-matched patients with resolved diabetic macular edema were included in this retrospective, cross-sectional study. All eyes were imaged with enhanced high-definition line or cross-line structural B scans and 3 × 3-mm OCTA scans. Optical coherence tomography B scans were analyzed for the presence of DRIL, and based on this, eyes were classified as either DRIL present or DRIL absent. The foveal avascular zone area on OCTA was compared between patients with and without DRIL. The foveal avascular zone area was correlated with visual acuity.

Results:

Nine eyes with DRIL and resolved diabetic macular edema were compared with 15 control eyes without DRIL and resolved diabetic macular edema. Area of ischemia on OCTA scans corresponded to the area of DRIL as determined on OCT B scans. The foveal avascular zone area in full retina as well as superficial and deep retinal plexuses OCTA slabs were significantly larger in patients with DRIL as compared to those without DRIL (P = 0.005, P < 0.001, and P = 0.004, respectively). The larger foveal avascular zone in full retinal segmentation (r = 0.72, P = 0.03) and superficial plexus (r = 0.74, P = 0.02) were positively correlated with lower visual acuity.

Conclusion:

Optical coherence tomography angiography can visualize retinal ischemia in patients with and without DRIL. Correspondence of impaired blood flow with DRIL suggests that retinal ischemia and loss of normal vasculature contributes to DRIL.
ACQUIRED VITELLIFORM LESIONS THAT RESPOND TO IMMUNE SUPPRESSION IN A PATIENT WITH SARCOIDOSIS
Authors: Heymann Hans B. , Jampol Lee M.
Published: October 2017

Purpose:

To describe a patient with sarcoid uveitis who developed bilateral vitelliform lesions with subretinal fluid that responded to immune suppression on three occasions.

Methods:

Chart review was performed on a single patient to collect all relevant clinical information and diagnostic imaging.

Results:

A case of sarcoidosis with acquired vitelliform lesions is described.

Conclusion:

Patients with ocular sarcoidosis can rarely develop vitelliform lesions. Our patient responded to systemic immune suppression.
Adult T-Cell Leukemia/Lymphoma With Primary Lacrimal Gland Involvement
Authors: Sabundayo Maria Suzanne , Takahashi Yasuhiro , Kakizaki Hirohiko
Published: October 2017

A 69-year-old Japanese male presented with a 3-month history of bilateral ptosis with lacrimal gland bulge. He came from western Japan, an area endemic for human T-lymphotropic virus Type 1 infection. Physical examination and imaging revealed bilaterally enlarged lacrimal glands. Hematologic testing, biopsy with histopathology, and immunohistochemistry were all consistent with adult T-cell leukemia/lymphoma.
De-novo versus recurrent hepatocellular carcinoma following direct-acting antiviral therapy for hepatitis C virus
Authors: Abdelaziz Ashraf O. , Nabil Mohamed M. , Abdelmaksoud Ahmed H. , Shousha Hend I. , Cordie Ahmed A. , Hassan Eman M. , Omran Dalia A. , Leithy Rania , Elbaz Tamer M.
Published: October 2017

Introduction

A recent appearance of direct-acting antivirals (DAAs) led to a surge in hepatitis C virus (HCV) management. Nowadays, a large proportion of treated patients have cirrhosis with a retained possibility to develop hepatocellular carcinoma (HCC) even after complete cure. We aimed to study tumoral differences between patients who developed HCC after DAAs as either a recurrence or de-novo HCC.

Methods

We retrospectively analyzed 89 patients who presented to our HCC multidisciplinary clinic with HCC lesions following DAA therapy. A total of 45 patients had complete response to HCC according to the modified Response Evaluation Criteria in Solid Tumors before DAAs intake. Another 44 patients developed de-novo lesions after DAA treatment. Both groups were compared regarding their baseline characteristics, tumor criteria, response to DAAs as well response to HCC treatment.

Results

Both groups showed no significant difference regarding their baseline characteristics (age, sex, Child–Pugh score, and performance status) or response to DAAs (P=0.5). No significant difference was present between groups according to number, site, and size of lesions. However, time elapsed between the end of DAAs therapy and first diagnosis of HCC was significantly longer in de-novo group (15.22±16.39 months) versus recurrence group (6.76±5.1 months) (P=0.008). In addition, response to ablation was significantly better in de-novo lesions compared with recurrent HCC (P=0.03).

Conclusions

Although de-novo HCC lesions significantly developed later than recurrent lesions in DAAs-treated patients, their response rates were significantly better. No differences were detected between both groups in their response to DAAs and their tumoral characteristics.
Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-income Adults
Authors: Koma Jonathan W. , Donohue Julie M. , Barry Colleen L. , Huskamp Haiden A. , Jarlenski Marian
Published: October 2017

Introduction:

Expanding Medicaid coverage to low-income adults may have increased smoking cessation through improved access to evidence-based treatments. Our study sought to determine if states’ decisions to expand Medicaid increased recent smoking cessation.

Methods:

Using pooled cross-sectional data from the Behavioral Risk Factor Surveillance Survey for the years 2011–2015, we examined the association between state Medicaid coverage and the probability of recent smoking cessation among low-income adults without dependent children who were current or former smokers (n=36,083). We used difference-in-differences estimation to examine the effects of Medicaid coverage on smoking cessation, comparing low-income adult smokers in states with Medicaid coverage to comparable adults in states without Medicaid coverage, with ages 18–64 years to those ages 65 years and above. Analyses were conducted for the full sample and stratified by sex.

Results:

Residence in a state with Medicaid coverage among low-income adult smokers ages 18–64 years was associated with an increase in recent smoking cessation of 2.1 percentage points (95% confidence interval, 0.25–3.9). In the comparison group of individuals ages 65 years and above, residence in a state with Medicaid coverage expansion was not associated with a change in recent smoking cessation (−0.1 percentage point, 95% confidence interval, −2.1 to 1.8). Similar increases in smoking cessation among those ages 18–64 years were estimated for females and males (1.9 and 2.2 percentage point, respectively).

Conclusion:

Findings are consistent with the hypothesis that Medicaid coverage expansions may have increased smoking cessation among low-income adults without dependent children via greater access to preventive health care services, including evidence-based smoking cessation services.
Diagnosis-based Cost Groups in the Dutch Risk-equalization Model
Authors: Eijkenaar Frank , van Vliet René C.J.A. , van Kleef Richard C.
Published: October 2017

Background:

The risk-equalization (RE) model in the Dutch health insurance market has evolved to a sophisticated model containing direct proxies for health. However, it still has important imperfections, leaving incentives for risk selection. This paper focuses on refining an important health-based risk-adjuster in this model: the diagnosis-based costs groups (DCGs). The current (2017) DCGs are calibrated on “old” data of 2011/2012, are mutually exclusive, and are essentially clusters of about 200 diagnosis-groups (“dxgroups”).

Methods:

Hospital claims data (2013), administrative data (2014) on costs and risk-characteristics for the entire Dutch population (N≈16.9 million), and health survey data (2012, N≈387,000) are used. The survey data are used to identify subgroups of individuals in poor or in good health. The claims and administrative data are used to develop alternative DCG-modalities to examine the impact on individual-level and group-level fit of recalibrating the DCGs based on new data, of allowing patients to be classified in multiple DCGs, and of refraining from clustering.

Results:

Recalibrating the DCGs and allowing enrolees to be classified into multiple DCGs lead to nontrivial improvements in individual-level and group-level fit (especially for cancer patients and people with comorbid conditions). The improvement resulting from refraining from clustering does not seem to justify the increase in model complexity this would entail.

Conclusions:

The performance of the sophisticated Dutch RE-model can be improved by allowing classification in multiple (clustered) DCGs and using new data. Irrespective of the modality used, however, various subgroups remain significantly undercompensated. Further improvement of the RE-model merits high priority.
Impact of Nursing Home Palliative Care Teams on End-of-Life Outcomes
Authors: Temkin-Greener Helena , Mukamel Dana B. , Ladd Heather , Ladwig Susan , Caprio Thomas V. , Norton Sally A. , Quill Timothy E. , Olsan Tobie H. , Cai Xueya
Published: October 2017

Background:

Deficits in end-of-life care in nursing homes (NHs) are reported, but the impact of palliative care teams (PCTeams) on resident outcomes remains largely untested.

Objective:

Test the impact of PCTeams on end-of-life outcomes.

Research Design:

Multicomponent strategy employing a randomized, 2-arm controlled trial with a difference-in-difference analysis, and a nonrandomized second control group to assess the intervention’s placebo effect.

Subjects:

In all, 25 New York State NHs completed the trial (5830 decedent residents) and 609 NHs were in the nonrandomized group (119,486 decedents).

Measures:

Four risk-adjusted outcome measures: place of death, number of hospitalizations, self-reported moderate-to-severe pain, and depressive symptoms. The Minimum Data Set, vital status files, staff surveys, and in-depth interviews were employed. For each outcome, a difference-in-difference model compared the pre-post intervention periods using logistic and Poisson regressions.

Results:

Overall, we found no statistically significant effect of the intervention. However, independent analysis of the interview data found that only 6 of the 14 treatment facilities had continuously working PCTeams throughout the study period. Decedents in homes with working teams had significant reductions in the odds of in-hospital death compared to the other treatment [odds ratio (OR), 0.400; P<0.001), control (OR, 0.482; P<0.05), and nonrandomized control NHs (0.581; P<0.01). Decedents in these NHs had reduced rates of depressive symptoms (OR, 0.191; P≤0.01), but not pain or hospitalizations.

Conclusions:

The intervention was not equally effective for all outcomes and facilities. As homes vary in their ability to adopt new care practices, and in their capacity to sustain them, reforms to create the environment in which effective palliative care can become broadly implemented are needed.
Low Expression of miR-18a as a Characteristic of Pediatric Acute Lymphoblastic Leukemia
Authors: Mosakhani Neda , Missiry Mohamed El , Vakkila Emmi , Knuutila Sakari , Vakkila Jukka
Published: October 2017

Background:

Acute lymphoblastic leukemia (ALL) occurs in both adults and children but the response to chemotherapy and survival is significantly worse in the adults. We aimed to study whether the expression of immune system-associated miRNAs would differ between adult and pediatric patients with ALL at the time of diagnosis.

Materials and Methods:

Inflammation-associated miRNA analysis was performed in 19 adults and 79 pediatric patients with ALL and involved miR-10, miR-15, miR-16, miR-17-92 cluster, miR-33, miR-146a, miR-150, miR-155, miR-181a, miR-222, miR-223, and miR-339. MiRNAs were first analyzed by miRNA microarray and thereafter validated by qRT-PCR. Sufficient RNA for qRT-PCR was available for 42 pediatric and 19 adult patients.

Results:

Of the studied miRNAs, only miR-18a differed significantly in microarray analysis between adult and pediatric ALL, being lower in children (FC, −3.74; P, 0.0037). Results were confirmed by qRT-PCR (down-regulated in pediatric patients, P 0.003161). The other members of the miR-17-92 cluster did not differ significantly.

Conclusions:

Pediatric and adult patients with ALL have remarkably similar patterns of immune-cell–associated miRNAs in their bone marrow at diagnosis. However, the low expression of miR-18a in pediatric ALL is interesting and demands further study.
Elevated Serum Interleukin-6 Predicts Favorable Response to Immunosuppressive Therapy in Children With Aplastic Anemia
Authors: Lu Shuanglong , Qiao Xiaohong , Xie Xiaotian
Published: October 2017

Background:

Immunosuppressive therapy (IST) is the standard treatment for aplastic anemia (AA) children who lack a sibling donor, but the clinical response rate to IST varies. Predictors of response to IST are valuable for stratifying AA patients and making clinical decisions.

Methods:

The serum interleukin (IL)-6 levels of 41 AA patients were measured at the time of diagnosis and the response rate of the patients to IST was evaluated at 3, 6, and 12 months after IST. Receiver-operator characteristic (ROC) analysis was used to calculate the predictive value of initial IL-6 levels in determining response at 6 months after IST.

Results:

The initial IL-6 levels were significant higher in responders than nonresponders at 6 months after IST (211.89 vs. 18.09 pg/mL; P=0.005), using 36.8 pg/mL as a threshold, there were 80% sensitivity and 81% specificity for discriminating responders and nonresponders to IST. Patients with initial high IL-6 level (>36.8 pg/mL) have favorable response rates than those with initial low IL-6 level (<36.8 pg/mL) at 3, 6, and 12 months after IST (P<0.01).

Conclusion:

High levels of IL-6 at the time of diagnosis predict a favorable response to IST in children with AA and this may be helpful for patient’s stratification and clinical decisions.
Breast Reconstruction and Radiation Therapy: An Update
Authors: Nelson Jonas A. , Disa Joseph J.
Published: October 2017

With the indications for radiation therapy in the treatment of breast cancer continuing to expand, many patients present for reconstruction having previously had radiation or having a high likelihood of requiring radiation following mastectomy. Both situations are challenging for the plastic surgeon, with different variables impacting the surgical outcome. To date, multiple studies have been performed examining prosthetic and autologous reconstruction in this setting. The purpose of this article was to provide a general platform for understanding the literature as it relates to reconstruction and radiation through an examination of recent systematic reviews and relevant recent publications. We examined this with a focus on the timing of the radiation, and within this context, examined the data from the traditional surgical outcomes standpoint as well as from a patient-reported outcomes perspective. The data provided within will aid in patient counseling and the informed consent process.
Lower Extremity Free Flaps for Breast Reconstruction
Authors: Dayan Joseph H. , Allen Robert J.
Published: October 2017

Thigh-based flaps are typically a secondary option for breast reconstruction because of concerns regarding limited tissue volume and donor-site morbidity. In recent years, there have been a number of new techniques and insights that have resulted in greater flexibility and improved outcomes. This article reviews lessons learned from a large collective experience using the following 4 flaps: transverse upper gracilis also known as transverse myocutaneous gracilis, diagonal upper gracilis, profunda artery perforator, and lateral thigh perforator flaps. Flap selection considerations include the patient’s fat distribution and skin laxity, perforator anatomy, and scar location. Pearls to minimize donor-site morbidity include avoiding major lymphatic collectors in the femoral triangle and along the greater saphenous vein and respecting the limits of flap dimension to reduce wound healing complications and distal ischemia. Limited flap volume may be addressed with stacking another flap from the contralateral thigh or primary fat grafting as opposed to overaggressive flap harvest from a single thigh. A detailed review of the benefits and disadvantages of each flap and strategies to improve results is discussed. With careful planning and selection, thigh-based flaps can provide a reliable option patients desiring autologous breast reconstruction.
Nipple-Sparing Mastectomy and Direct-to-Implant Breast Reconstruction
Authors: Colwell Amy S. , Christensen Joani M.
Published: October 2017

Breast reconstruction following mastectomy has evolved to preserve the native skin and nipple of the breast and create a natural-appearing reconstruction in 1 or 2 surgeries. Nipple-sparing procedures appear to be oncologically safe with low risks of cancer recurrence. In our series of 2,182 nipple-sparing mastectomies, there was no development or recurrence of cancer in the nipple. Direct-to-implant single-stage surgery offers the patient a complete reconstruction at the time of mastectomy. Patient selection centers on preoperative breast anatomy combined with postoperative goals for size and uplift of the breast. The best candidates for nipple-sparing mastectomy and direct-to-implant breast reconstruction include those with grade I–II breast ptosis and those desiring to stay approximately the same breast size. The choice of incision and width of the implant play key roles in nipple centralization. Partial muscle coverage with acellular dermal matrix remains the most common technique to support the implant and offers the advantage of more soft-tissue coverage in the upper pole. With experience, complications and revisions are similar in this approach compared with more traditional 2-stage tissue expander-implant reconstruction. Thus, nipple-sparing mastectomy and direct-to-implant breast reconstruction is emerging as a preferred method of breast reconstruction when the breast skin envelope is sufficiently perfused.
Updated Evidence on the Oncoplastic Approach to Breast Conservation Therapy
Authors: Losken Albert , Hart Alexandra M. , Chatterjee Abhishek
Published: October 2017

The oncoplastic approach to breast conservation therapy has become a useful and popular option for women with breast cancer who wish to preserve their breast. The initial driving forces were aimed at minimizing the potential for a breast conservation therapy deformity; however, various other benefits have been identified that include broadening the indications for breast conservation therapy in some patients and improved margin control. The various techniques can be categorized into glandular rearrangement techniques such as breast reductions usually in patients with larger breasts or flap reconstruction such as the latissimus dorsi muscle usually in patients with smaller breasts. As the acceptance continues to increase, we are starting to see more outcomes evidence in terms of patient satisfaction, quality of life, complications, and recurrence, to further support the safety and efficacy of the oncoplastic approach.
Updates in Head and Neck Reconstruction
Authors: Largo Rene D. , Garvey Patrick B.
Published: October 2017

Learning Objectives:

After reading this article, the participant should be able to: 1. Have a basic understanding of virtual planning, rapid prototype modeling, three-dimensional printing, and computer-assisted design and manufacture. 2. Understand the principles of combining virtual planning and vascular mapping. 3. Understand principles of flap choice and design in preoperative planning of free osteocutaneous flaps in mandible and midface reconstruction. 4. Discuss advantages and disadvantages of computer-assisted design and manufacture in reconstruction of advanced oncologic mandible and midface defects.

Virtual planning and rapid prototype modeling are increasingly used in head and neck reconstruction with the aim of achieving superior surgical outcomes in functionally and aesthetically critical areas of the head and neck compared with conventional reconstruction. The reconstructive surgeon must be able to understand this rapidly-advancing technology, along with its advantages and disadvantages. There is no limit to the degree to which patient-specific data may be integrated into the virtual planning process. For example, vascular mapping can be incorporated into virtual planning of mandible or midface reconstruction. Representative mandible and midface cases are presented to illustrate the process of virtual planning. Although virtual planning has become helpful in head and neck reconstruction, its routine use may be limited by logistic challenges, increased acquisition costs, and limited flexibility for intraoperative modifications. Nevertheless, the authors believe that the superior functional and aesthetic results realized with virtual planning outweigh the limitations.
Innovative Cardiac Devices on Chest Imaging
Authors: Brixey Anupama G. , Fuss Cristina
Published: October 2017

Over the past decade, a rapidly increasing number of new cardiac devices have been created. Remaining current with these devices and how they appear on chest radiographs and other modalities used in chest imaging can be a challenge for the interpreting radiologist. This review is provides a concise summary of various common cardiac devices as well as recently developed devices that will be increasing in frequency over the coming years.
An Algorithm for Managing Intraosseous Vascular Anomalies of the Craniofacial Skeleton
Authors: Isaac Kathryn V. , Teshima Tara Lynn , Aviv Richard I. , Fazl Mahmood , da Costa Leodante , Mainprize Todd , Antonyshyn Oleh
Published: October 2017

Background:

Intraosseous vascular anomalies (IOVA) are rare in the craniofacial skeleton and present a diagnostic and therapeutic challenge. This study aims to describe the clinical management based on a large case series.

Methods:

A retrospective chart review was performed and 9 IOVA were identified over a 15-year period. Data on demographics, diagnostic features, clinical management, and outcomes were reviewed.

Results:

Five frontal bone IOVA and 4 orbital IOVA were identified. The postoperative follow-up ranged from 4 months to 4 years. All 9 lesions were diagnosed with computed tomography (CT) imaging. Magnetic resonance imaging (MRI) was used to delineate soft tissue involvement in 2 patients presenting with oculo-orbital dystopia and ophthalmoplegia. En bloc excision was performed in all patients. Preoperative interventional embolization was critical in the successful resection of an orbital IOVA following 2 previously failed attempts that were aborted secondary to hemorrhage. Intraoperative 3-dimensional stereotactic navigation was used for the accurate en bloc excision of a frontal IOVA to prevent injury to the frontal sinus. Reconstruction of esthetic and functional deformities was successfully accomplished.

Conclusion:

The diagnosis of IOVA relies primarily on clinical assessment and CT imaging. Further interpretation of the involvement of periorbital, facial, and intracranial soft tissue is best defined by MRI. Multidisciplinary care with interventional radiology and neurosurgery must be considered for ensuring the safe and adequate en bloc excision of craniofacial IOVA.
Defining and Correcting Asymmetry in Isolated Unilateral Frontosphenoidal Synostosis: Differences in Orbital Shape, Facial Scoliosis, and Skullbase Twist Compared to Unilateral Coronal Synostosis
Authors: Mundinger Gerhard S. , Skladman Rachel , Wenger Tara , Birgfeld Craig C. , Gruss Joseph S. , Lee Amy , Ellenbogen Richard , Hopper Richard A.
Published: October 2017

Introduction:

Isolated frontosphenoidal synostosis (FS) is a rare cause of fronto-orbital plagiocephaly that can be challenging to distinguish from isolated unicoronal synostosis (UC). The purpose of this paper is to analyze differences in fronto-orbital dysmorphology between the 2 conditions, to describe approaches for surgical correction, and to report surgical outcomes between FS and UC patients in a casecontrol fashion.

Methods:

Patients treated for craniosynostosis over a 12-year period at our institution were retrospectively evaluated under institutional review board approval. Frontosphenoidal synostosis patients who underwent bilateral fronto-orbital correction of anterior plagiocephaly with minimum 2-year follow-up, adequate pre-, and minimum 2-year postoperative computed tomography scans were included in the case-control portion of the study. These patients were randomly age-matched to UC patients meeting the same inclusion criteria. Preoperative and postoperative orbital shape and volumetric analysis was performed using Mimics software.

Results:

Twelve FS patients were treated during the study period. Seven of these patients met casecontrol inclusion criteria with average follow-up of 47.5 months. The characteristic FS orbit was a relatively wide, short, and shallow trapezoid, while the characteristic UC orbit was a relatively narrow, tall, and deep parallelogram. Frontosphenoidal synostosis orbits were significantly wider, shorter, shallower, and smaller than UC orbits. Surgical correction tailored to the differential dysmorphologies resulted in statistical equalization of these differences between affected and contralateral control orbits at follow-up, with the exception of UC orbital width, which remained significantly narrower than unaffected contralateral control. One patient in each group required cranioplasty for skull defects at follow-up, while no patient underwent surgical readvancement.

Conclusions:

Frontosphenoidal synostosis and UC orbital shape differ significantly, and can be normalized using fronto-orbital advancement tailored to the distinct orbital dysmorphologies of these 2 groups.
Cell Polarity and PAR Complex Likely to Be Involved in Dexamethasone-Induced Cleft Palate
Authors: Ma Li , Shi Bing , Zheng Qian
Published: October 2017

Accumulating studies demonstrated that PAR complex contributed to the establishment and maintenance of cell polarity which was fundamental to many aspects of cell and developmental biology. The purpose of this study was to investigate whether dexamethasone (DEX) could downregulate the PAR complex and disrupt cell polarity in palatal epithelium during palatal fusion in mice. The C57BL/6J mice were selected for the experiment. Pregnant mice in control group and DEX-treated group were injected intraperitoneally with 0.9% sodium chloride 0.1 mL, which contained DEX 6 mg/kg respectively, every day from E10 to E12. The palatal epithelia morphology was observed with hematoxylin and eosin and scanning electron microscopy. Immunofluorescence staining, western blot, and real-time polymerase chain reaction were performed to detect the expression of PAR3/PAR6/aPKC. After being treated with DEX, the palatal shelves showed delayed development and became shorter and smaller. During the process of palatogenesis, PAR3 and PAR6 expressed in the palatal epithelium, and aPKC expressed in both the epithelium and the mesenchyme. Dexamethasone could downregulate the expression levels of PAR3/PAR6/aPKC in both protein and gene level. In conclusions, DEX affected the PAR complex of mouse embryonic palate, and could perturb the PAR complex and the cell polarity of medial edge epithelium cells, and caused the failure of palatal fusion.
Rigid External Distractor-Aided Advancement After Simultaneously Performed LeFort-III Osteotomy and Fronto-Orbital Advancement
Authors: Safi Ali-Farid , Kreppel Matthias , Kauke Martin , Grandoch Andrea , Nickenig Hans-Joachim , Zöller Joachim
Published: October 2017

Due to the complex development of the craniofacial skull, corrective surgery is a major challenge for patients with severe craniofaciostenosis. Although fronto-orbital advancement and simultaneous LeFort-III osteotomy in combination with distraction osteogenesis have been reported as a safe and successful method to obtain good esthetic and functional results, there is a lack of studies evaluating this method.

Our retrospective study included 12 patients with syndromic craniofaciostenosis, who were primarily treated at our department in accordance with a standardized treatment protocol, consisting of a simultaneous fronto-orbital advancement with LeFort-III osteotomy in combination with a rigid external distractor (RED-II). Distraction distance, duration of operation, postoperative complications, perioperative hemoglobin concentration, esthetic outcome, and the subjective Whitaker Scale were used to evaluate the success of our surgical method.

The esthetic outcome of all of our patients was assessed as good. Furthermore, the surgical outcome was assigned I for 11 patients and II for 1 patient, who suffered from wound healing disturbance at the left temporal site, which required revision 2 weeks postoperatively. The mean skeletal advancement of the midface was 16.4 mm, ranging from 12 to 20 mm.

Our standardized treatment protocol, consisting of fronto-orbital advancement in combination with LeFort-III osteotomy and application of a rigid external distractor device (RED-III) for patients with severe syndromic craniofaciostenosis, goes along with low infection rates and more predictable and precise esthetic and functional outcomes than the conventional surgical technique without distraction osteogenesis.
How Many Observations are Needed to Assess a Surgical Trainee's State of Operative Competency?
Authors: Williams Reed G. , Swanson David B. , Fryer Jonathan P. , Meyerson Shari L. , Bohnen Jordan D. , Dunnington Gary L. , Scully Rebecca E. , Schuller Mary C. , George Brian C.
Published: October 2017

Objective:

To establish the number of operative performance observations needed for reproducible assessments of operative competency.

Background:

Surgical training is transitioning from a time-based to a competency-based approach, but the number of assessments needed to reliably establish operative competency remains unknown.

Methods:

Using a smart phone based operative evaluation application (SIMPL), residents from 13 general surgery training programs were evaluated performing common surgical procedures. Two competency metrics were investigated separately: autonomy and overall performance. Analyses were performed for laparoscopic cholecystectomy performances alone and for all operative procedures combined. Variance component analyses determined operative performance score variance attributable to resident operative competency and measurement error. Generalizability and decision studies determined number of assessments needed to achieve desired reliability (0.80 or greater) and determine standard errors of measurement.

Results:

For laparoscopic cholecystectomy, 23 ratings are needed to achieve reproducible autonomy ratings and 17 ratings are needed to achieve reproducible overall operative performance ratings. For the undifferentiated mix of procedures, 60 ratings are needed to achieve reproducible autonomy ratings and 40 are needed for reproducible overall operative performance ratings.

Conclusion:

The number of observations needed to achieve reproducible assessments of operative competency far exceeds current certification requirements, yet remains an important and achievable goal. Attention should also be paid to the mix of cases and raters in order to assure fair judgments about operative competency and fair comparisons of trainees.
Carotid Artery Reactivity Predicts Events in Peripheral Arterial Disease Patients
Authors: van Mil Anke C. C. M. , Pouwels Sjaak , Wilbrink Jelmer , Warlé Michiel C. , Thijssen Dick H. J.
Published: October 2017

Objective:

Patients with peripheral arterial disease (PAD) have increased risk on future cerebro- and cardiovascular events. Our aim was to examine whether carotid artery reactivity (CAR; a novel, simple procedure to examine endothelial function) predicts cardiovascular events in PAD patients.

Background:

Increased risk for future cardiovascular events in PAD patients is likely related to endothelial dysfunction, highlighting the necessity for simple assessment of endothelial function.

Methods:

A total of 172 PAD patients (68 ± 10 years, 67% male) underwent the CAR, which involves ultrasound measurement of carotid artery diameter during sympathetic stimulation produced by 90-second hand immersion in 4°C ice-water (ie, cold pressor test). CAR-responses were dichotomized into carotid constriction or dilation. We recorded cardiac and cerebrovascular events, mortality, and clinical progression to percutaneous transluminal angioplasty or loss of patency during 12-month follow-up.

Results:

Eighty-two PAD patients demonstrated carotid constriction and 90 patients demonstrated dilation. PAD patients with carotid constriction showed more cardiovascular events compared to patients with dilation (Kaplan-Meier Log rank; P < 0.05). Cox proportional hazard models showed that patients with carotid constriction continued to show higher risk for cardiovascular events [hazard ratio: 4.1; 95% confidence interval (CI), 1.3–12.5] and clinical progression (hazard ratio: 2.0; 95% CI, 1.2–3.3), even after adjustment for other risk factors. Ankle brachial pressure index and carotid intima-medial thickness alone did not predict (cardiovascular) event or improve risk assessment beyond that provided by CAR.

Conclusion:

Carotid vasoconstriction identifies PAD patients with a 4-fold increased risk for future cardiovascular events and 2-fold increased risk for clinical deterioration. CAR provides a simple, novel strategy to predict cardiovascular events and progression in PAD patients.

Clinical Trial Registration:

www.trialregister.nl/trialreg/index.asp, NTR-4117.
Usefulness of the Transoral Anvil Delivery System for Esophagojejunostomy After Laparoscopic Total Gastrectomy: A Single-institution Comparative Study of Transoral Anvil Delivery System and the Overlap Method
Authors: Yoshikawa Kozo , Shimada Mitsuo , Higashijima Jun , Tokunaga Takuya , Nishi Masaaki , Takasu Chie , Kashihara Hideya , Ishikawa Daichi
Published: October 2017

Purpose:

Many reconstruction techniques have been reported after laparoscopic total gastrectomy (LTG), but it is not clear which anastomosis technique is most useful, and no standard methods have been established. This study examined whether LTG using the transoral anvil delivery system (TOADS) is a feasible and safe procedure for gastric cancer.

Materials and Methods:

A series of 47 patients underwent the overlap method and 36 underwent the hemi-double-stapling technique with TOADS. Intraoperative and postoperative outcomes were compared between the 2 groups.

Results:

In the TOADS group, operation time for reconstruction was shorter (16±3 vs. 45±10 min, P=0.003), and blood loss was reduced (45±15 vs. 126±13 mL, P=0.0002). There were no significant differences in intraoperative complications, conversion to open surgery, and intraoperative anastomosis-related complications between the 2 groups. Furthermore, there were no significant differences in the incidence of complications, reoperation, mortality, and postoperative hospital stay.

Conclusion:

LTG using TOADS for gastric cancer may be a technically feasible surgical procedure with acceptable morbidity.
Innovation and the growth of human population
Authors: Weinberger V. P. , Quiñinao C. , Marquet P. A.
Published: October 2017

Biodiversity is sustained by and is essential to the services that ecosystems provide. Different species would use these services in different ways, or adaptive strategies, which are sustained in time by continuous innovations. Using this framework, we postulate a model for a biological species (
Homo sapiens
) in a finite world where innovations, aimed at increasing the flux of ecosystem services (a measure of habitat quality), increase with population size, and have positive effects on the generation of new innovations (positive feedback) as well as costs in terms of negatively affecting the provision of ecosystem services. We applied this model to human populations, where technological innovations are driven by cumulative cultural evolution. Our model shows that depending on the net impact of a technology on the provision of ecosystem services (
θ
), and the strength of technological feedback (
ξ
), different regimes can result. Among them, the human population can fill the entire planet while maximizing their well-being, but not exhaust ecosystem services. However, this outcome requires positive or green technologies that increase the provision of ecosystem services with few negative externalities or environmental costs, and that have a strong positive feedback in generating new technologies of the same kind. If the feedback is small, then the technological stock can collapse together with the human population. Scenarios where technological innovations generate net negative impacts may be associated with a limited technological stock as well as a limited human population at equilibrium and the potential for collapse. The only way to fill the planet with humans under this scenario of negative technologies is by reducing the technological stock to a minimum. Otherwise, the only feasible equilibrium is associated with population collapse. Our model points out that technological innovations
per se
may not help humans to grow and dominate the planet. Instead, different possibilities unfold for our future depending on their impact on the environment and on further innovation.

This article is part of the themed issue ‘Process and pattern in innovations from cells to societies’.
Information theory, evolutionary innovations and evolvability
Authors: Wagner Andreas
Published: October 2017

How difficult is it to ‘discover’ an evolutionary adaptation or innovation? I here suggest that information theory, in combination with high-throughput DNA sequencing, can help answer this question by quantifying a new phenotype's information content. I apply this framework to compute the phenotypic information associated with novel gene regulation and with the ability to use novel carbon sources. The framework can also help quantify how DNA duplications affect evolvability, estimate the complexity of phenotypes and clarify the meaning of ‘progress’ in Darwinian evolution.

This article is part of the themed issue ‘Process and pattern in innovations from cells to societies’.
The conceptual foundations of network-based diffusion analysis: choosing networks and interpreting results
Authors: Hoppitt Will
Published: October 2017

Network-based diffusion analysis (NBDA) is a statistical technique for detecting the social transmission of behavioural innovations in groups of animals, including humans. The strength of social transmission is inferred from the extent to which the diffusion (spread) of the innovation follows a social network. NBDA can have two goals: (a) to establish whether social transmission is occurring and how strong its effects are; and/or (b) to establish the typical pathways of information transfer. The technique has been used in a range of taxa, including primates, cetaceans, birds and fish, using a range of different types of network. Here I investigate the conceptual underpinnings of NBDA, in order to establish the meaning of results using different networks. I develop a model of the social transmission process where each individual observation of the target behaviour affects the rate at which the observer learns that behaviour. I then establish how NBDAs using different networks relate to this underlying process, and thus how we can interpret the results of each. My analysis shows that a different network or networks are appropriate depending on the specific goal or goals of the study, and establishes how the parameter estimates yielded from an NBDA can be interpreted for different networks.

This article is part of the themed issue ‘Process and pattern in innovations from cells to societies’.