bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of diocotron modes in toroidally trapped electron plasmas using non-destructive method
Authors: Lachhvani Lavkesh , Pahari Sambaran , Sengupta Sudip , Yeole Yogesh G. , Bajpai Manu , Chattopadhyay P. K.
Published: October 2017

Experiments with trapped electron plasmas in a SMall Aspect Ratio Toroidal device (SMARTEX-C) have demonstrated a flute-like mode represented by oscillations on capacitive (wall) probes. Although analogous to diocotron mode observed in linear electron traps, the mode evolution in toroids can have interesting consequences due to the presence of in-homogeneous magnetic field. In SMARTEX-C, the probe signals are observed to undergo transition from small, near-sinusoidal oscillations to large amplitude, non-linear “double-peaked” oscillations. To interpret the wall probe signal and bring forth the dynamics, an expression for the induced current on the probe for an oscillating charge is derived, utilizing Green's Reciprocation Theorem. Equilibrium position, poloidal velocity of the charge cloud, and charge content of the cloud, required to compute the induced current, are estimated from the experiments. Signal through capacitive probes is thereby computed numerically for possible charge cloud trajectories. In order to correlate with experiments, starting with an intuitive guess of the trajectory, the model is evolved and tweaked to arrive at a signal consistent with experimentally observed probe signals. A possible vortex like dynamics is predicted, hitherto unexplored in toroidal geometries, for a limited set of experimental observations from SMARTEX-C. Though heuristic, a useful interpretation of capacitive probe data in terms of charge cloud dynamics is obtained.
New approach to terahertz sensing offers detection of circulating tumor cells
Authors: Kim Meeri
Published: October 2017

As a first step towards detecting tumor cells circulating in blood, researchers report a microfluidic sensing technique for the terahertz frequency range that can detect nanoscale particles in liquid.
Enhanced antibacterial activity through the controlled alignment of graphene oxide nanosheets
Authors: Lu Xinglin , Feng Xunda , Werber Jay R. , Chu Chiheng , Zucker Ines , Kim Jae-Hong , Osuji Chinedum O. , Elimelech Menachem
Published: October 2017

Significance

In biomedical and environmental applications, as well as manufacture and disposal, the interaction of graphene-based nanomaterials (GBNs) with living cells is inevitable and sometimes crucial. While the cytotoxic properties of GBNs are well established, the mechanisms behind the cytotoxicity remain controversial. In this study, we first utilize a magnetic field to form films with aligned graphene oxide (GO), showing that the alignment of sharp GO edges plays a crucial role in the antibacterial activity. We then demonstrate using model systems that GO unequivocally induces physical disruption of lipid bilayers and that oxidation stems from a direct electron transfer mechanism. Altogether, our results elucidate the physicochemical, edge-based cytotoxicity of GBNs, while providing guidance for the design of engineered surfaces using GBNs.
Effect of shot peening coverage on residual stress field and surface roughness
Authors: Qiang Bin , Li Yadong , Yao Changrong , Wang Xin
Published: October 2017

Surface coverage is an important parameter in the shot peening process, exerting a significant influence on the residual stress field and surface roughness. In this study, a random-shots finite element model and a new coverage calculation method are employed to study the effect of shot peening coverage on the residual stress field and surface roughness of Q345qD steel. In addition, a shot peening experiment using a Q345qD steel specimen is designed to verify the simulation results. The results show reasonable agreement between the simulated values of the residual stress and roughness and those measured experimentally on the specimen. The obtained results revealed that coverage has significant influences on the residual stress field and surface roughness. In the actual shot peening process, engineers need to pay more attention to the stage of shot peening where coverage approaches 100%.
Preparation of Ni–P alloys super-black materials applied to baffle surface
Authors: Liu(刘丰登) Fengdeng , Xing(邢飞) Fei , You(尤政) Zheng
Published: October 2017

Super-black materials refer to the materials whose reflectivity is less than 0.5% and have many significant applications in the aerospace field. Though super-black materials have excellent optical properties, most of them cannot be directly applied to the baffle of star trackers because of all kinds of limits. We presented a method to improve the preparation of super-black materials based on Ni–P alloys which helped this material better applied to star tracker baffle. This process chose the concentration of 10% oxalic acid solution to activate the aluminium surface and enlarged the plating area of Ni–P alloys film. Meanwhile, we anodised Ni–P alloys film in the non-oxidising acid solution instead of conventional blackening process. Consequently, the method improved the controllability of blackening process and avoided the time error. Thus, this method of preparing super-black materials could be applied to star tracker baffle.
Gas tungsten arc welding of network structured titanium matrix composite
Authors: Huang Lujun , Duan Tianbo , An Qi , Chen Youyou , Bai Jiuyang , Geng Lin , Lin Sanbao
Published: October 2017

The microstructure and property evolution of TiBw/Ti6Al4V composite was investigated after gas tungsten arc welding process. The results showed that the heat affected zone (HAZ) exhibited unchanged reinforcements, while the fusion zone (FZ) exhibited refined TiBw with refined network scale. Meanwhile, the matrix in HAZ presented the transformed β microstructure, while the refined columnar grains existed in FZ. Moreover, increasing heat input can further decrease the refined network size. Consequently, the ultimate tensile strength of the welded composite reaches 98% that of the parent composite (PC); while the yield and tensile strength at 500°C are even higher than those of the PC. The refined microstructure and the transformed β phase also lead to noticeable enhancement of the microhardness.
Degree growth of rational maps induced from algebraic structures
Authors: Favre Charles , Lin Jan-Li
Published: October 2017

For a finite dimensional vector space equipped with a

C

\mathbb C

-algebra structure, one can define rational maps using the algebraic structure. In this paper, we describe the growth of the degree sequences for this type of rational maps.
HID-1 controls formation of large dense core vesicles by influencing cargo sorting andtrans-Golgi network acidification
Authors: Hummer Blake H. , de Leeuw Noah F. , Burns Christian , Chen Lan , Joens Matthew S. , Hosford Bethany , Fitzpatrick James A. J. , Asensio Cedric S.
Published: October 2017

Large dense core vesicles (LDCVs) mediate the regulated release of neuropeptides and peptide hormones. They form at the trans-Golgi network (TGN), where their soluble content aggregates to form a dense core, but the mechanisms controlling biogenesis are still not completely understood. Recent studies have implicated the peripheral membrane protein HID-1 in neuropeptide sorting and insulin secretion. Using CRISPR/Cas9, we generated HID-1 KO rat neuroendocrine cells, and we show that the absence of HID-1 results in specific defects in peptide hormone and monoamine storage and regulated secretion. Loss of HID-1 causes a reduction in the number of LDCVs and affects their morphology and biochemical properties, due to impaired cargo sorting and dense core formation. HID-1 KO cells also exhibit defects in TGN acidification together with mislocalization of the Golgi-enriched vacuolar H+-ATPase subunit isoform a2. We propose that HID-1 influences early steps in LDCV formation by controlling dense core formation at the TGN.
A Relative Version of Gieseker’s Problem on Stratifications in Characteristic $\boldsymbol{p>0}$
Authors: Esnault Hélène , Srinivas Vasudevan
Published: October 2017

We prove that the vanishing of the functoriality morphism for the étale fundamental group between smooth projective varieties over an algebraically closed field of characteristic $p>0$ forces the same property for the fundamental groups of stratifications.
Natural History and Long-Term Outcome of OCD
Authors: Bloch Michael H.
Published: October 2017

Obsessive-compulsive disorder (OCD) is often a chronic condition. Convergent evidence suggests that early-onset and adult-onset disease are importantly distinct: early-onset OCD is more highly genetic, has a male bias, and is more often associated with tic disorders and attention deficit disorder. Adult-onset OCD has an equal male–female ratio and is more often associated with anxiety and depression. Long-term follow-up studies from before institution of effective treatments suggest that a minority of individuals with adult-onset OCD remit, and many have persistent severe symptoms. There are few analogous studies of patients with childhood-onset OCD. Prognosis has improved over the past 30 years with the development of effective, evidence-based pharmacotherapy and psychotherapies. More recent long-term follow-up studies of both adult-onset and pediatric-onset OCD suggest remission rates of up to 50%. Refractory illness nevertheless remains an important clinical problem.
Symptom Heterogeneity in OCD
Authors: do Rosário Maria Conceição , Batistutto Marcelo , Ferrao Ygor
Published: October 2017

This chapter reviews the most relevant studies using the dimensional approach to describe the range of OCD symptomatology. Obsessive compulsive disorder (OCD) is a clinically and etiologically heterogeneous condition. This heterogeneity is problematic because it can make it difficult to interpret the results of clinical, genetic and neuroimaging studies and limits the development of more effective treatment strategies. Recently, a dimensional approach to dealing with the OCD heterogeneity has been proposed. Factor analytic studies have found from three to six obsessive compulsive symptom (OCS) dimensions (or factors), which represent groups of obsessions and compulsions that tend to co-occur. Many authors have reported that these OCS dimensions are similar in children, adolescents, and adults and are temporally stable. The usefulness and validity of this dimensional approach has been proven by studies reporting the association between the OCS dimensions and various genetic, neuroimaging and treatment response variables.
Disgust and OCD
Authors: Mancusi Lauren , McKay Dean , Olatunji Bunmi
Published: October 2017

This chapter discusses the available research that suggests a role for disgust in OCD, and methods for treating disgust responses associated with the condition. Obsessive-compulsive disorder (OCD) is typically associated with anxious obsessional experiences, with compulsions serving the function of anxiety reduction. However, in recent years it has been shown that disgust, an emotion designed to prevent ingestion of harmful contaminants, can be an important driver of OC symptoms generally, and of contamination fears with washing rituals in particular. Disgust-driven symptomatology may have distinct properties and require adaptations of treatment. The chapter concludes with recommendations for future research on this specific emotional response in OCD.
Pathological Responsibility, Thought-Action Fusion, and Thought Control in OCD
Authors: Purdon Christine , Psych C.
Published: October 2017

Leading models of obsessive-compulsive disorder (OCD) implicate overvalued beliefs about responsibility, beliefs about the relationship of thoughts to external events and morality (thought-action fusion), and thought control as key factors in the development and the persistence of the disorder. This chapter provides an overview of these three factors and presents case examples, empirical support, and clinical implications. Considerable empirical research indicates that people with OCD tend to endorse beliefs reflecting an overvalued responsibility and thought-action fusion (TAF). However, it is also clear that these beliefs, particularly TAF beliefs, are not unique to OCD. It has been proposed that attempts at thought suppression ironically lead to an increase in thought frequency; research has generally not yielded support for such an effect, nor for response inhibition deficits. However, there is converging evidence that suppression may have insidious effects on the appraisal of thought recurrences and mood state. Clinical implications are discussed.
Mutant Mouse Models of OCD
Authors: Tee Louis Y. , Feng Guoping
Published: October 2017

Although mutant mouse models are unable to capture the subjective experiences and full complexity of psychiatric disorders, they have nonetheless provided important insights into the pathophysiology of various endophenotypes observed in neuropsychiatric illnesses. These mouse models enable the detailed dissection of cellular, molecular and circuit mechanisms that may underlie the abnormal behaviors observed in OCD, using methods that cannot be applied to human patients for ethical, practical and technical reasons. Mouse models exhibiting repetitive OCD-like behaviors, especially grooming, include the Sapap3-null (Sapap3-/-), Slitrk5-null (Slitrk5-/-), Hoxb8-null (Hoxb8-/-), and Shank3b-null (Shank3b-/-) mouse models. Evidence from these mice implicates a defect in cortico-striatal glutamatergic transmission in compulsive behavior. Moreover, studies using these mice have shown that this impaired cortico-striatal transmission is due to the aberrant expression of silent synapses. These mouse models support the hypothesis that defective glutamatergic neurotransmission in the cortico-striatal-thalamo-cortical circuit underlies OCD.
Hoarding Disorder
Authors: Frost Randy O. , Graves Lucy , Atkins Elizabeth
Published: October 2017

Hoarding Disorder (HD), new in DSM-5, is remarkably prevalent, affecting 2% to 5% of the population. Hoarding symptoms were long considered an aspect of OCD, but it has been increasingly recognized that they differ, phenomenologically and epidemiologically; the new DSM-5 diagnosis formalizes this recognition. HD is a complex disorder consisting of problems with attachments to possessions that lead to difficulty discarding and organizing them. Together, these features lead to severely cluttered living spaces that can pose serious health and safety threats. The vast majority of those with HD acquire excessively, mostly through buying or collecting things that others have discarded. Hoarding behaviors appear early in life and typically get progressively worse over the life span. Cognitive behavioral therapy specifically designed to treat hoarding has been shown to be effective, though many still suffer from symptoms after treatment. Several medications have shown promise, but no controlled clinical trials have been conducted.
Comorbidity in Pediatric OCD
Authors: Bloch Michael H.
Published: October 2017

Tic disorders, including Tourette syndrome (TS), are not formally part of the category of “OCD-related disorders” in the DSM; but the association with OCD is sufficiently strong, and clinically important, that the OCD diagnosis now carries an optional “tic-related” specifier. Comorbidity is the norm in TS; in addition to OCD, attention deficit symptoms are particularly common. The presence of these comorbidities can affect both behavioral and pharmacological treatments, which are reviewed in this chapter. Tics commonly begin in childhood (part of the definition of TS), often improving in late adolescence. Approximately 30% of children with TS will develop OCD; the onset of OCD symptoms is usually later than that of tics, and they are more likely to persist into adulthood. Tic-associated OCD has a male preponderance and is more likely to be characterized by symmetry-related obsessions and compulsions. Like OCD, tic disorders are characterized by abnormalities in the cortico-striatal circuitry.
Differentiating Autism Spectrum Disorder and OCD
Authors: Accordino Robert E. , Bartel Philip , Green Isobel W. , Kidd Christen L. , McDougle Christopher J.
Published: October 2017

This chapter explores the overlapping clinical presentation and shared genetics and neurobiology of autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD). ASD often presents with repetitive behaviors reminiscent of OCD, whereas OCD, at times, can include autistic traits involving social and communication difficulties. This can lead to difficult diagnostic distinctions, which can at times have relevance to treatment. The distinction between compulsions and autistic stereotypies merits particular discussion. Clinical features that should lead to exploration of a diagnosis of ASD include stereotypies such as hand flapping, body rocking or twirling; fixed interests or preoccupations that are ego-syntonic; and impaired social-communicative behavior.
OCD Advocacy and Addressing Stigma
Authors: Szymanski Jeff , Bourne Carly
Published: October 2017

In order to improve outcomes for individuals struggling with obsessive compulsive disorder (OCD), structural and societal barriers to effective diagnosis and treatment must be addressed. Stigma about mental disorders and a lack of awareness about OCD among the general population, as well as in the mental health community, remain major obstacles to accessing treatment. A variety of awareness-raising campaigns and advocacy initiatives have been created to help overcome those barriers. This chapter reviews the World Health Organization’s guidelines for health advocacy and provides examples of how to apply this road map in advocating for patients with OCD. The focus of this chapter is on the following five elements: Awareness Raising, Information, Education, Training, and Mutual Help.
Movement Disorders
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: October 2017

This chapter deals with classic Parkinson’s disease and the main variants such as progressive supranuclear palsy, multiple system atrophy, and the corticobasal syndrome. Diagnostic clues from the history, such as prodromal features and symptoms occurring during the established disease phase are described, as well as features apparent on examination. Details are provided on chorea, in particular Huntington’s disease, chorea-acanthocytosis, McLeod syndrome, Sydenham’s chorea and Wilson’s disease The main varieties of tremor are described, likewise neurodegeneration with brain iron accumulation. Other sections discuss tics, restless legs syndrome, periodic movements of sleep, painful legs and moving toes. Several diagnostic clues are given for dystonia and its subdivisions, Lesch-Nyhan syndrome, gait disorders, paroxysmal dyskinesias, stereotypies, psychogenic movement disorders, and myoclonus.
Cerebellar Ataxia
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: October 2017

This chapter deals with disorders of the cerebellum and its connections. These conditions may be identified by the mode of onset—whether acute, subacute, chronic, or episodic. The chronic ataxias are inherited in various patterns: autosomal dominant; autosomal recessive; X-linked. Autosomal dominant inherited ataxias discussed include spinocerebellar ataxia, autosomal dominant episodic ataxia, and glucose transporter type I deficiency syndrome. Some episodic ataxias have variable inheritance. Other episodic ataxias without a clear genetic basis are detailed including mitochondrial spinocerebellar ataxia and epilepsy; coenzyme Q deficiency; progressive cerebellar ataxia with palatal tremor; and progressive cerebellar gait ataxia, myoclonic epilepsy, and intention tremor. Also various disorders associated with ataxia are enumerated.
Introduction
Authors: Firth Helen V. , Hurst Jane A.
Published: October 2017

This chapter introduces a number of important genetic concepts. It discusses patterns of inheritance, the approach to the consultation with a child with dysmorphism, congenital malformation, or developmental delay, communication skills, confidentiality, how to provide precise and accurate genetic diagnosis, and some of the important aspects of genetic testing. It concludes with a list of useful resources.
Pregnancy and fertility
Authors: Firth Helen V. , Hurst Jane A.
Published: October 2017

This chapter describes various genetic disorders that can present in pregnancy. It discusses, among others: anterior abdominal wall defects, bowed limbs, club-foot, congenital diaphragmatic hernia, cytomegalovirus, Dandy–Walker malformation, the effects of drugs in pregnancies, fetal alcohol syndrome, fetal anticonvulsant syndrome, hyperechogenic bowel, hypoplastic left heart syndrome, low maternal serum oestriol, and the risks associated with advanced maternal and paternal age, together with many other conditions. For each of these, it gives a suggested approach to the clinical assessment, genetic advice and management, and support groups.
Correction of Progressive Severe Cervical Kyphosis in a 21-Month-Old Patient With NF1: Surgical Technique and Review of Literature
Authors: Vigneswaran Krishanthan , Sribnick Eric A , Reisner Andrew , Chern Joshua
Published: October 2017

BACKGROUND

Severe cervical kyphosis in the setting of neurofibromatosis type 1 (NF1) is a rare manifestation of the disease in the pediatric population. Dystrophic and immature bone complicate the placement of hardware necessary for surgical correction of alignment and a review of the literature yields 4 cases of pediatric patients with NF1 requiring surgical intervention in which the youngest patient was 10 yr old.

OBJECTIVE

To report the case of an 11-mo-old female with NF1 who presented with a plexiform cervical neurofibroma and focal cervical kyphosis. A comprehensive review of the literature and a detailed description of nonsurgical and surgical management for this patient population is described.

METHODS

A literature review was completed for article reviewing management of pediatric patients with cervical spine injuries and NF1. The patient's chart was reviewed and the patient was followed for a year to provide adequate follow-up. Institutional Review Board (IRB)/ethics committee approval and patient consent were neither required nor sought for this study.

RESULTS

The literature was reviewed, summarized, and utilized for operative planning and postoperative management. Postoperative imaging and 1-yr follow-up imaging showed anterior construct and lateral mass fusion, restoration of cervical alignment, and no neurological deficits.

CONCLUSION

This is the youngest reported patient to have surgical cervical kyphosis correction in the setting of NF1. A review of the literature helped develop a long-term plan and shape a novel same-day front-back-front approach to restore alignment that will be of use to teams managing these complex patients in the future.
Multiple Actions of Phencyclidine and (+)MK-801 on Isolated Bovine Cerebral Arteries
Authors: Wendling Woodrow W. , Chen Dong , Wendling Karen S. , Kamel Ihab R.
Published: October 2017

This study examines the direct effects of 3 noncompetitive N-methyl-D-aspartate receptor antagonists, phencyclidine (PCP), (+)MK-801, and (−)MK-801, on bovine middle cerebral arteries (BMCA). Rings of BMCA were mounted in isolated tissue chambers equipped with isometric tension transducers to obtain pharmacologic dose-response curves. In the absence of endogenous vasoconstrictors, the 3 N-methyl-D-aspartate antagonists each produced direct constriction of BMCA. The thromboxane A2 receptor antagonist SQ-29,548, the TxA2 synthase inhibitor furegrelate, the calcium antagonist nimodipine, and calcium-deficient media all inhibited maximal phencyclidine or (+)MK-801-induced constriction. Direct constriction by PCP or (+)MK-801 was independent of the presence of endothelium. When BMCA were preconstricted with potassium-depolarizing solution, PCP, (+)MK-801, and (−)MK-801 each produced only concentration-dependent relaxation. When BMCA were preconstricted with the stable TxA2 analog U-46,619 and exposed to increasing concentrations of PCP, (+)MK-801, or (−)MK-801, tension increased. Thromboxane A2 may contract BMCA by acting as a potassium channel blocker; iberiotoxin and tetraethylammonium both constrict BMCA. In Ca2+-deficient media containing either potassium or U-46,619, phencyclidine and (+)MK-801 each produced competitive inhibition of subsequent Ca2+-induced constriction. In additional experiments, arterial strips were mounted in isolated tissue chambers to directly measure calcium uptake, using 45Calcium as a radioactive tracer. Both phencyclidine and (+)MK-801 blocked potassium-stimulated or U-46,619-stimulated 45Ca uptake into arterial strips. These results suggest that phencyclidine and (+)MK-801 have 2 separate actions on BMCA. They may constrict arterial rings by releasing TxA2 from cerebrovascular smooth muscle, and relax arterial rings by acting as calcium antagonists.
The Impact of Intraoperative Magnetic Resonance Imaging on Patient Safety Management During Awake Craniotomy
Authors: Kamata Kotoe , Maruyama Takashi , Iseki Hiroshi , Nomura Minoru , Muragaki Yoshihiro , Ozaki Makoto
Published: October 2017

Background:

Awake craniotomy paired with intraoperative magnetic resonance imaging (iMRI) is now the established technique for maximizing surgical resection, while preserving neurological function. However, leaving an unsecured airway patient in the iMRI gantry represents considerable risk. Our study aimed at identifying the incidence of critical adverse events in unsecured airway patients during iMRI as part of awake craniotomy.

Materials and Methods:

We conducted a clinical chart review of consecutive awake craniotomies performed between November 1999 and December 2015. Sequences of iMRI performed without invasive airway management were selected for assessment and the incidence of critical adverse events, including general convulsive seizure, respiratory arrest, nausea/vomiting and agitation, was identified.

Results:

Critical adverse events occurred in 21 of 356 unsecured airway patients within 24 of the 579 iMRI sequences. In cases using the low-field strength open MRI scanner, emergency termination of scans due to patient decline was recorded in only 4 cases: no cases of cardiac arrest, accidental death, or thermal injury were recorded. Compared with cardiovascular monitoring, patient respiratory status was poorly recorded.

Conclusions:

In terms of anesthesia, concurrent use of iMRI for awake craniotomy is clinically acceptable providing potential intraoperative complications can be controlled. Further, the configuration of the iMRI scanner as well as the reduced exposure from the lower magnetic field strength was found to impact patient safety management. Therefore when a conscious patient is left in the gantry without airway support, it is advisable that levels of oxygenation and ventilation should be monitored at all times.
Inotropic Effects of Nicorandil on Cardiac Contractility Assessed by Left Ventricular Pressure–Volume Relationship Analyses in Anesthetized Monkeys
Authors: Ishizaka Tomomichi , Yoshimatsu Yu , Maeda Yu , Chiba Katsuyoshi , Mori Kazuhiko
Published: October 2017

Nicorandil is a representative antianginal drug that has dual properties of a nitrate and adenosine triphosphate–sensitive potassium (KATP) channel agonist; however, its effects on integrated cardiac function have not been fully understood. This study was conducted to clarify the functional, hemodynamic, and electrophysiological effects of nicorandil using ventricular pressure–volume loop analysis in isoflurane-anesthetized monkeys. Nicorandil was given intravenously at therapeutic doses of 0.2 and 2 mg/kg over 10 minutes to cynomolgus monkeys (n = 5) with a pause of 10 minutes between the 2 doses. Nicorandil at 0.2 mg/kg caused decreases in systemic blood pressure and left ventricular end-diastolic pressure by its vasodilating action. Nicorandil at 2 mg/kg also exhibited positive inotropic action demonstrated by increased slopes of preload recruitable stroke work relationship, which is a load-independent inotropic parameter. In load-dependent inotropic parameters, positive inotropy of nicorandil was also indicated by the shortened QA interval and increased contractility index; however, significant changes were not observed in the maximal upstroke velocity of left ventricular pressure. Moreover, reflex tachycardia accompanied by shortening of QT/QTc intervals was observed. Overall, the isoflurane-anesthetized monkey model with pressure–volume loop analysis revealed cardiac variables of nicorandil, including a positive inotropy contributable to cardiac performance in addition to its vasodilatory effect. These findings provide useful information when considering the prescription of nicorandil in patients.
Depressive Symptoms among Plastic Surgery Residents
Authors: Andejani Doaa F. , Al-Issa Sami I. , Al-Qattan Mohammad M.
Published: October 2017

Background:

A literature review did not reveal any study investigating the prevalence of depression among plastic surgery residents.

Methods:

We conducted a cross-sectional mail survey and included all Saudi Plastic Surgery residents in our local program in Saudi Arabia. The Beck Depression Inventory II was used.

Results:

The inventory showed that mild, moderate, and severe depressive symptoms were prevalent in 20.6%, 38.2%, and 11.8%, respectively. Junior residents were more prone to depression.

Conclusions:

The high prevalence rate of depression among plastic surgery residents is alarming, and further studies are warranted. The problem has received no attention in the plastic surgery literature.
Long-Term Patency of Twisted Vascular Pedicles in Perforator-Based Propeller Flaps
Authors: Jakubietz Rafael G. , Nickel Aljoscha , Neshkova Iva , Schmidt Karsten , Gilbert Fabian , Meffert Rainer H. , Jakubietz Michael G.
Published: October 2017

Background:

Propeller flaps require torsion of the vascular pedicle of up to 180 degrees. Contrary to free flaps, where the relevance of an intact vascular pedicle has been documented, little is known regarding twisted pedicles of propeller flaps. As secondary surgeries requiring undermining of the flap are common in the extremities, knowledge regarding the necessity to protect the pedicle is relevant. The aim of this study was a long-term evaluation of the patency of vascular pedicle of propeller flaps.

Methods:

In a retrospective clinical study, 22 patients who underwent soft-tissue reconstruction with a propeller flap were evaluated after 43 months. A Doppler probe was used to locate and evaluate the patency of the vascular pedicle of the flap.

Results:

The flaps were used in the lower extremity in 19 cases, on the trunk in 3 cases. All flaps had healed. In all patients, an intact vascular pedicle could be found. Flap size, source vessel, or infection could therefore not be linked to an increased risk of pedicle loss.

Conclusions:

The vascular pedicle of propeller flaps remains patent in the long term. This allows reelevation and undermining of the flap. We therefore recommend protecting the pedicle in all secondary cases to prevent later flap loss.
Competing Flow Between Partial Circulatory Support and Native Cardiac Output: A Clinical Computational Fluid Dynamics Study
Authors: Engelke Jennifer , Karmonik Christof , Rengier Fabian , Partovi Sasan , Popov Aron-Frederik , Osswald Anja , Arif Rawa , Schmack Bastian , Raake Philip , Simon André R , Doesch Andreas , Weymann Alexander , Lotz Joachim , Karck Matthias , Ruhparwar Arjang
Published: October 2017

Partial circulatory support is a promising concept for the treatment of heart failure patients. A better understanding of induced hemodynamic changes is essential for optimizing treatment efficacy. Computational fluid dynamics (CFD) is an alternative method to gain insight into flow phenomena difficult to obtain in vivo. In 10 patients implanted with a Circulite Synergy Micro-pump (HeartWare, Framingham, Massachusetts) (a continuous flow partial circulatory assist device connecting the left atrium to the right subclavian artery), transient CFD simulations were performed. Patients were divided into two groups depending on their cardiac output (CO; high CO group: 5.5 ± 1.1 L/min, low CO group: 1.7 ± 0.7 L/min). The partial assist device provided a supporting flow of 1.5 ± 0.8 L/min. Support was highest at diastole and decreased during systole because of a collision of the blood flows from the partial assist device and the CO. Reversed flow counteracting the flow of the device was significantly higher for the high CO group (mean flow in peak systole: −2.18 ± 1.08 vs. 0.23 ± 0.59 L/min; p = 0.002) showing an inverse correlation between CO and amount of reversed flow during peak systole (R = −0.7; p < 0.02). The flow collision lead to higher total pressures at the point of collision and consequently in the Circulite outflow graft. The CFD simulations allow quantifying hemodynamic alterations in patients with partial support consisting of a flow collision, thereby reducing effectiveness of the circulatory support. Partial support in heart failure patients alternates their hemodynamics not only in providing support for the circulation but also inducing unfavorable changes in flow patterns.
Sarcopenia in Children With End‐Stage Liver Disease
Authors: Lurz Eberhard , Patel Hiten , Frimpong Richard G. , Ricciuto Amanda , Kehar Mohit , Wales Paul W. , Towbin Alexander J. , Chavhan Govind B. , Kamath Binita M. , Ng Vicky L.
Published: October 2017

Background:

Sarcopenia, reflected by decreased psoas muscle surface area (PMSA), has been identified as a novel and independent predictor of wait‐list mortality and outcomes in adult liver transplantation (LT). We hypothesized that children with end‐stage liver disease (ESLD) would have smaller PMSA than healthy controls.

Methods:

Computer tomography images of children (ages 0 to 18 years) listed for LT in 2015 and a control group comprised 2:1 age‐ and gender‐matched healthy pediatric trauma victims were reviewed. PMSA was determined at 2 intervertebral disc (L3/4; L4/5) levels. A subset of images was reviewed by 2 radiologists to determine interrater correlation.

Results:

A total of 23 children with ESLD were included, and the most prevalent diagnosis was biliary atresia (61%). On both lumbar levels, median PMSA was significantly smaller in ESLD subjects compared with the 46 healthy controls (L4/5; median total PMSA (tPMSA) 407 mm2 (interquartile range 339–537) versus controls 513 mm2 (interquartile range 437–672); P = 0.004), independent of participants’ weight z scores (r = 0.01; P = 0.95). Excellent interrater correlation was seen (intraclass correlation 0.99).

Conclusions:

In this retrospective pilot study, PMSA was significantly lower in children with ESLD compared with healthy age‐ and gender‐matched controls. Because this finding was independent of growth in ESLD subjects, PMSA may represent a novel objective nutritional biomarker in children with advanced liver disease.
Is There a Continuum of Risk for Sexually Transmitted Infections Among African American Women?
Authors: Harbison Hanne S. , Austin Erika L. , Hook Edward W. , Muzny Christina A.
Published: October 2017

This study compared sexual risk behaviors and sexually transmitted infection prevalence among African American women who have sex with women, women who have sex with men with a single male partner, women who have sex with men with 4 or more male partners, and women who have sex with women and men at a sexually transmitted disease clinic. The results suggest that, despite differences in prevalence, there was not a clear continuum of sexually transmitted infection risk among African American women in the study; all women were at risk.
Pediatric Obstructive Sleep Apnea: Consensus, Controversy, and Craniofacial Considerations
Authors: Garg Ravi K. , Afifi Ahmed M. , Garland Catharine B. , Sanchez Ruston , Mount Delora L.
Published: October 2017

Pediatric obstructive sleep apnea, characterized by partial or complete obstruction of the upper airway during sleep, is associated with multiple adverse neurodevelopmental and cardiometabolic consequences. It is common in healthy children and occurs with a higher incidence among infants and children with craniofacial anomalies. Although soft-tissue hypertrophy is the most common cause, interplay between soft tissue and bone structure in children with craniofacial differences may also contribute to upper airway obstruction. Snoring and work of breathing are poor predictors of obstructive sleep apnea, and the gold standard for diagnosis is overnight polysomnography. Most healthy children respond favorably to adenotonsillectomy as first-line treatment, but 20 percent of children have obstructive sleep apnea refractory to adenotonsillectomy and may benefit from positive airway pressure, medical therapy, orthodontics, craniofacial surgery, or combined interventions. For children with impairment of facial skeletal growth or craniofacial anomalies, rapid maxillary expansion, midface distraction, and mandibular distraction have all been demonstrated to have therapeutic value and may significantly improve a child’s respiratory status. This Special Topic article reviews current theories regarding the underlying pathophysiology of pediatric sleep apnea, summarizes standards for diagnosis and management, and discusses treatments in need of further investigation, including orthodontic and craniofacial interventions. To provide an overview of the spectrum of disease and treatment options available, a deliberately broad approach is taken that incorporates data for both healthy children and children with craniofacial anomalies.
Resurfacing Capitate Pyrocarbon Implant versus Proximal Row Carpectomy Alone: A Comparative Study to Evaluate the Role of Capitate Prosthetic Resurfacing in Advanced Carpal Collapse
Authors: Giacalone Francesco , di Summa Pietro G. , Fenoglio Alessandro , Sard Arman , Dutto Elisa , Ferrero Matteo , Bertolini Maddalena , Garcia-Elias Marc
Published: October 2017

Background:

The Resurfacing Capitate Pyrocarbon Implant associated with proximal row carpectomy has been used to treat symptomatic advanced carpal collapse, widening the indications of proximal row carpectomy to patients with capitate head arthritis. The authors retrospectively compared their case series of implant versus carpectomy alone, analyzing whether prosthetic implant outcomes could be similar to those of proximal row carpectomy even with a higher stage of osteoarthritis.

Methods:

Fifty-seven patients who underwent surgery for wrist osteoarthritis (minimum follow-up, 2 years) were selected retrospectively. Twenty-five patients (scapholunate advanced collapse/scaphoid nonunion advanced collapse stage III to IV and Kienböck disease stage IV) underwent proximal row carpectomy plus Resurfacing Capitate Pyrocarbon Implant (group A); 32 patients (scapholunate advanced collapse/scaphoid nonunion advanced collapse stage I to II and Kienböck disease stage III) underwent carpectomy alone (group B). Mean follow-up was 33 months. Patients were evaluated clinically and radiographically. Patient-Rated Wrist Evaluation and Disabilities of the Arm, Shoulder, and Hand questionnaire scores were assessed.

Results:

Group A showed consistent pain relief (visual analogue scale score of 2), while preserving wrist mobility (flexion, 27 degrees; extension, 33 degrees) and grip strength (54 percent compared with the contralateral side). Average Disabilities of the Arm, Shoulder, and Hand questionnaire score was 20, and average Patient-Rated Wrist Evaluation score was 28. No statistically significant difference was observed between groups for all outcomes, except for better extension (p < 0.05) in group B.

Conclusions:

Even starting from a higher grade of osteoarthritis, Resurfacing Capitate Pyrocarbon Implant plus proximal row carpectomy showed satisfying results, compared with those obtained with just carpectomy. Data show that indications for proximal row carpectomy can be widened by using the implant, without worsening outcomes. The implant could be a useful alternative to more aggressive salvage procedures in case of capitate head and lunate fossa osteoarthritis involvement.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Orthognathic Surgery Has a Significant Effect on Perceived Personality Traits and Emotional Expressions
Authors: Mazzaferro Daniel M. , Wes Ari M. , Naran Sanjay , Pearl Rebecca , Bartlett Scott P. , Taylor Jesse A.
Published: October 2017

Background:

The effects of orthognathic surgery go beyond objective cephalometric correction of facial and dental disproportion and malocclusion, respectively. The authors hypothesized that there is tangible improvement following surgery that alters publicly perceived personality traits and emotions.

Methods:

The authors used Amazon.com’s Mechanical Turk (MTurk), a crowdsourcing tool, to determine how preoperative and postoperative images of orthognathic surgery patients were perceived on six personality traits and six emotional expressions based on posteroanterior and lateral photographs. Blinded respondents provided demographic information and were randomly assigned to one of two sets of 20 photographs (10 subjects before and after surgery).

Results:

Data on 20 orthognathic surgery patients were collected from 476 individuals. The majority of participants were female (52.6 percent), 18 to 39 years old (67.9 percent), Caucasian (76.6 percent), had some college or technical training or graduated college (72.7 percent), and had an annual income between $20,000 and $99,999 (74.6 percent). A paired t test analysis found that subjects were perceived significantly more favorably after orthognathic surgery in 12 countenance categories: more dominant, trustworthy, friendly, intelligent, attractive, and happy; and also less threatening, angry, surprised, sad, afraid, and disgusted (p < 0.05). Raters with the highest annual income perceived a greater magnitude of dominance after surgery than those earning less (p < 0.001).

Conclusions:

There is significant improvement in the countenance of patients after orthognathic surgery, with both perceived personality traits and emotions deemed more favorable. Additional work is needed to better understand the physiologic underpinnings of such findings. Crowdsourcing technology offers a unique opportunity for surgeons to gather data regarding laypeople’s perceptions of surgical outcomes in areas such as orthognathic surgery.
Not All Gustilo Type IIIB Fractures Are Created Equal: Arterial Injury Impacts Limb Salvage Outcomes
Authors: Stranix John T. , Lee Z-Hye , Jacoby Adam , Anzai Lavinia , Avraham Tomer , Thanik Vishal D. , Saadeh Pierre B. , Levine Jamie P.
Published: October 2017

Background:

Open tibia fractures are commonly stratified by the Gustilo classification, an orthopedic grading system that does not incorporate the presence of arterial injury when limb perfusion is intact. In the authors’ experience, however, the presence of arterial injury appears to negatively impact microsurgical outcomes.

Methods:

In a retrospective review of 806 lower extremity reconstructions between 1979 and 2016, 361 soft-tissue flaps performed for Gustilo type IIIB/C coverage met inclusion criteria. Patient demographics, flap characteristics, and outcomes were analyzed.

Results:

Most patients suffered type IIIB [n = 332 (91.9 percent)] injuries; 29 (8.0 percent) had type IIIC injuries. Preoperative angiography [n = 243 (67.3 percent)] demonstrated arterial injury in 126 (51.8 percent); 27 arterial injuries were identified intraoperatively; and the overall incidence was 153 of 361 (42.4 percent). Complications occurred in 143 flaps (39.6 percent) and included 37 partial losses (10.2 percent) and 31 total losses (8.6 percent). Injured recipient arteries [n = 62 (17.2 percent)] had more complications (p = 0.004); specifically, increased take-backs (p = 0.009). Decreasing vessel runoff increased the risk of complications (p = 0.025), take-backs (p = 0.007), and total flap failures (p = 0.024) accordingly. Specifically, among grade IIIB injuries, controlling for age, sex, time since injury, and vein number, single-vessel runoff was associated with higher rates of complications (relative risk, 3.07; p = 0.012), take-backs (relative risk, 3.43; p = 0.013), and total flap failures (relative risk, 4.80; p = 0.010) compared with three-vessel runoff.

Conclusions:

Arterial injury was common among Gustilo type IIIB patients and correlated with increased reconstructive complications. Nonischemic arterial injury appears to negatively impact reconstructive outcomes and should be accounted for when considering free tissue transfer for lower extremity salvage. The authors propose a 3-2-1 modification of the Gustilo type IIIB classification to incorporate degree of arterial injury, as it appears to add prognostic value and certainly influences the reconstructive plan.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, IV.
Evidence-Based Clinical Practice Guideline: Autologous Breast Reconstruction with DIEP or Pedicled TRAM Abdominal Flaps
Authors: Lee Bernard T. , Agarwal Jayant P. , Ascherman Jeffrey A. , Caterson Stephanie A. , Gray Diedra D. , Hollenbeck Scott T. , Khan Seema A. , Loeding Lauren D. , Mahabir Raman C. , Miller Archibald S. , Perdikis Galen , Schwartz Jaime S. , Sieling Beth A. , Thoma Achilles , Wolfman Judith A. , Wright Jean L.
Published: October 2017

The American Society of Plastic Surgeons commissioned a multistakeholder Work Group to develop recommendations for autologous breast reconstruction with abdominal flaps. A systematic literature review was performed and a stringent appraisal process was used to rate the quality of relevant scientific research. The Work Group assigned to draft this guideline was unable to find evidence of superiority of one technique over the other (deep inferior epigastric perforator versus pedicled transverse rectus abdominis musculocutaneous flap) in autologous tissue reconstruction of the breast after mastectomy. Presently, based on the evidence reported here, the Work Group recommends that surgeons contemplating breast reconstruction on their next patient consider the following: the patient’s preferences and risk factors, the setting in which the surgeon works (academic versus community practice), resources available, the evidence shown in this guideline, and, equally important, the surgeon’s technical expertise. Although theoretical superiority of one technique may exist, this remains to be reported in the literature, and future methodologically robust studies are needed.
Orthognathic Surgery and Rhinoplasty to Address Nasomaxillary Hypoplasia
Authors: Veeramani Anamika , Sawh Raj , Steinbacher Derek M.
Published: October 2017

The treatment of nasomaxillary hypoplasia is challenging. The phenotype of Binder “syndrome” includes the following: midfacial hypoplasia, class III malocclusion, small or absent anterior nasal spine, flattened nose, horizontal nostrils, short columella, acute nasolabial angle, and a flat frontonasal angle. A staged approach is used, with orthognathic surgery to achieve vertical maxillary length and sagittal advancement, followed by rhinoplasty aimed to increase nasal tip projection, rotation, and columellar length. This article details the diagnosis and treatment of nasomaxillary hypoplasia, demonstrating the senior author’s (D.M.S.) preferred approach and technical steps.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.