bluuebunny/crossref_metadata_2025 huggingface dataset:
Equilibrium radionuclide angiography compared with tissue doppler imaging for detection of right ventricular dyssynchrony and prediction of acute response to cardiac resynchronization therapy
Authors: Chen Yu , Xue Xue , Gu Yang , Xu Haiyan , Zhang Xiwen
Published: March 2020

Objective:

The aim of this study was to compare tissue doppler imaging (TDI) and equilibrium radionuclide angiography (ERNA) for detection of right ventricular (RV) dyssynchrony and prediction of the acute response to cardiac resynchronization therapy (CRT).

Methods:

This study was approved by the local ethics committee of Huai’an First People's Hospital. Patient consent was not provided due to the use of completely anonymous images from which the individual could not be identified in this study. Thirty-three patients with nonischemic dilated cardiomyopathy underwent both TDI and ERNA before and within 48 hour after CRT implantation. RV dyssynchrony was measured with TDI using the difference in time to peak systolic velocity between the RV free wall and ventricular septum (RV-T). With ERNA, the standard of RV mean phase angle and RV phase standard deviation (RVmPA% and RVPSD%) were assessed.

Results:

Moderate positive correlations were observed among baseline RVmPA%, RVPSD% and RV-T (r = 0.689 and 0.716, P < .001). Twenty patients (61%) with a reduction of at least 15% in LV end-systolic volume were categorized as acute responders after CRT. Responders showed significant reduction in RVmPA% and RVPSD% after CRT (53.60 ± 4.15% to 43.95 ± 6.88% and 14.00 ± 2.41% to 10.40 ± 1.67%, P < .05), whereas RV-T remained unchanged (50.10 ± 10.28 ms to 49.25 ± 13.64ms, NS). Receiver operating characteristic curve showed that the cut-off value of RV-T was 48.5ms, yielding 65% sensitivity and 77% specificity to predict acute respond to CRT. The cut-off value of RVmPA% was 49.5%, yielding 85% sensitivity and 85% specificity and the cut-off value of RVPSD% was 11.5%, yielding 85% sensitivity and 92% specificity.

Conclusion:

ERNA might be an appropriate alternative to TDI for assessment of RV dyssynchrony. Either RVmPA% or RVPSD% was highly predictive for acute response to CRT.
Fractional amplitude of low frequency fluctuation in drug-naïve first-episode patients with anorexia nervosa
Authors: Lai Jianbo , Xu Tingting , Zhang Haorong , Xi Caixi , Zhou Hetong , Du Yanli , Jiang Jiajun , Wu Lingling , Zhang Peifen , Xu Yi , Hu Shaohua , Xu Dongrong
Published: March 2020

To characterize the fractional amplitude of low-frequency fluctuation (fALFF) in drug-naïve first-episode female patients with anorexia nervosa (AN) using resting-state functional magnetic resonance imaging (rs-fMRI).

Whole brain rs-fMRI data were collected from 7 drug-naïve first-episode female patients with DSM-5 AN and 14 age-matched healthy female controls. fALFF values were calculated and compared between the two groups using a two-sample t test. Correlation analysis between the fALFF values in the entire brain and body mass index (BMI) was performed.

Compared with the healthy controls, increased fALFF values were observed in the AN patients in their right hippocampus and left superior frontal gyrus, while decreased fALFF values were observed in their left rectus and left middle occipital gyrus. Moreover, low BMI was significantly associated with decreased fALFF in the left inferior frontal gyrus but increased fALFF in the left calcarine. In particular, the z-standardized fALFF (zfALFF) value of the left rectus was positive associated with BMI.

Our findings suggest that spontaneous brain activity in the frontal region, hippocampus and rectus, characterized by fALFF values, was altered in drug-naïve, first-episode female patients with AN.
Salter-Harris type II fractures of the distal tibia
Authors: Margalit Adam , Peddada Kranti V. , Dunham Alexandra M. , Remenapp Craig M. , Lee R. Jay
Published: March 2020

We assessed factors associated with premature physeal closure (PPC) and outcomes after closed reduction of Salter-Harris type II (SH-II) fractures of the distal tibia. We reviewed patients with SH-II fractures of the distal tibia treated at our center from 2010 to 2015 with closed reduction and a non-weightbearing long-leg cast. Patients were categorized by immediate postreduction displacement: minimal, <2 mm; moderate, 2 to 4 mm; or severe, >4 mm. Demographic data, radiographic data, and Lower Extremity Functional Scale (LEFS) scores were recorded.

Fifty-nine patients (27 girls, 31 right ankles, 26 concomitant fibula fractures) were included, with a mean (±SD) age at injury of 12.0 ± 2.2 years. Mean maximum fracture displacements were 6.6 ± 6.5 mm initially, 2.7 ± 2.0 mm postreduction, and 0.4 ± 0.7 mm at final follow-up. After reduction, displacement was minimal in 23 patients, moderate in 21, and severe in 15. Fourteen patients developed PPC, with no significant differences between postreduction displacement groups. Patients with high-grade injury mechanisms and/or initial displacement ≥4 mm had 12-fold and 14-fold greater odds, respectively, of PPC. Eighteen patients responded to the LEFS survey (mean 4.0 ± 2.1 years after injury). LEFS scores did not differ significantly between postreduction displacement groups (P = .61).

The PPC rate in this series of SH-II distal tibia fractures was 24% and did not differ by postreduction displacement. Initial fracture displacement and high-grade mechanisms of injury were associated with PPC. LEFS scores did not differ significantly by postreduction displacement.

Level of Evidence: Level IV, case series
Cricothyroidotomy needle length is associated with posterior tracheal wall injury
Authors: Katayama Atsuko , Watanabe Kunitaro , Tokumine Joho , Lefor Alan Kawarai , Nakazawa Harumasa , Jimbo Ippei , Yorozu Tomoko
Published: March 2020

Background:

Cricothyroidotomy is the final strategy in the “cannot intubate, cannot oxygenate” scenario, but half of needle cricothyroidotomy attempts result in failure. The most frequent complication in needle cricothyroidotomy is posterior tracheal wall injury. We hypothesized that needle length is related to posterior wall injury and compared needle cricothyroidotomy with a commercial kit to a modified shorter needle to evaluate success and posterior wall injury rates.

Methods:

The commercial kit has a needle stopper to prevent posterior wall injury, with a penetrating length of 25 mm. We made long stopper to shorten the length by 5 mm (net 20 mm penetrating length). Residents were recruited, received a lecture about cricothyroidotomy and practiced needle cricothyroidotomy using the commercial kit on a simulator. They then performed cricothyroidotomy using the commercial kit or the shorter needle on an ex-vivo porcine larynx covered with artificial skin. An intra-tracheal endoscope recorded the procedure. The video was evaluated for success/failure or posterior wall injury by independent evaluators. Larynxes with a distance from the outer surface to the inner lumen exceeding 13 mm were excluded. The distance in each larynx was measured by dissection after the study. Success and posterior wall injury rates were analyzed using Fisher exact test (P < .05 was statistically significant).

Results:

Forty-seven residents participated in the study. Data for two residents were excluded. There was no statistically significant difference in success rate between the commercial kit (100%, 45/45) and the shorter needle (91%, 41/45, P = .12). Failure was defined if the needle tip did not reach the lumen in four trials. Cannulated but complicated by posterior wall injury occurred in 33% (15/45) with the commercial kit and 5% (2/43) with the shorter needle (P < .01).

Conclusion:

During needle cricothyroidotomy, force is needed for the needle to penetrate the cricothyroid ligament. The advancing needle sometimes cannot be stopped after penetrating the cricothyroid ligament. These data suggest that needle length is associated with posterior wall injury.
The epithelioid gastrointestinal stromal tumor with pulmonary metastasis
Authors: Xu Dan , Lin Xuyong , Qiu Xueshan
Published: March 2020

Rationale:

Available literature states that the histological subtype of the gastrointestinal stromal tumor (GIST) with pulmonary metastasis is often spindle cell type. To our knowledge, this is the first report of the GIST with pulmonary metastasis of very uncommon epithelioid subtype.

Patient concerns:

We report a 63-year-old male presenting with the symptom of bloodstained sputum without obvious inducement. The patient had no chest pain, low back pain, fatigue, fever or night sweats symptoms.

Diagnoses:

Combined chest digital radiography and the history of the patient who presented with the colon GIST of the epithelioid subtype two years ago that the mass may be a metastasis tumor. Combined with morphological and immunohistochemical staining results, a pathological diagnosis of the GIST with pulmonary metastasis was considered.

Interventions:

Right lobectomy and partial upper lobectomy were performed.

Outcomes:

The patient had not experienced any noticeable symptom and recurrent tumors at 6 months follow-up.

Lessons:

We report a rare case of the GIST with pulmonary metastasis of epithelioid subtype. This case is of great significance to the pathologist's clinical work. For pathologists, if an epithelioid tumor in the lung is found, it is necessary to check whether the gastrointestinal tract also has the tumor, which may be an epithelioid GIST with pulmonary metastasis.
Willingness to pay for a quality-adjusted life year among advanced non-small cell lung cancer patients in Viet Nam, 2018
Authors: Ha Thuy Van , Hoang Minh Van , Vu Mai Quynh , Hoang Ngoc-Anh Thi , Khuong Long Quynh , Vu Anh Nu , Pham Phuong Cam , Vu Chinh Van , Duong Lieu Huy
Published: March 2020

To examine the willingness to pay (WTP) for a quality-adjusted life year (QALY) gained among advanced non-small cell lung cancer (NSCLC) patients in Viet Nam and to analyze the factors affecting an individual's WTP.

A cross-sectional, contingent valuation study was conducted among 400 NSCLC patients across 6 national hospitals in Viet Nam. Self-reported information was recorded from patients regarding their socio-demographic status, EQ-5D (EuroQol-5 dimensions) utility, EQ-5D vas, and WTP for 1 QALY gained. To explore the factors related to the WTP, Gamma Generalized Linear Model and multiple logistic regression tools were applied to analyze data.

The overall mean and median of WTP/QALY among the NSCLC patients were USD $11,301 and USD $8002, respectively. Strong association was recorded between WTP/QALY amount and the patient's education, economic status, comorbidity status, and health utility.

Government and policymakers should consider providing financial supports to disadvantaged groups to improve their access to life saving cancer treatment.
Treatment of a high-energy transsyndesmotic ankle fracture
Authors: Yin Zhaowei , Wang Zitao , Ge Dawei , Yan Junwei , Jiang Chunzhi , Liang Bin
Published: March 2020

Introduction:

The “logsplitter injury” is a special type of ankle fractures that results from high energy violence with combined rotational forces and axial loads. So far, the diagnose and treatment of “logsplitter injury” remain largely unsettled and related literature is rare.

Patient concerns:

An 18-year-old male fell from a fence and got his left ankle injured with severe malformation and swollen condition. No open wound was observed.

Diagnosis:

Logsplitter injury, ankle fracture (AO/OTA classification 44C1.1, Lauge-Hansen classification: pronation-external rotation).

Interventions and outcomes:

The patient was initially treated by internal fixation of fibular, repair of deltoid ligaments, and 1 syndesmotic screw fixation. When the X-ray applied after surgery, another 2 syndesmotic screws were performed to enhance stability. The syndesmotic screws were removed at 12-week and 16-week respectively. The patient was allowed for full weight-bearing immediately. However, the syndesmotic space was slightly increased compared to the contralateral side in CT views at 1-year follow-up, the function outcome was satisfied.

Conclusion:

The logsplitter injury is a high-energy ankle fracture that requires both axial and rotational load. It is categorized as 44B or 44C by the AO/OTA classification. In the classification scheme of Lauge-Hansen, our case is in line with the pronation-external rotation classification. Anatomic reduction and fixation of ankle syndesmotic injuries are required to restore the biomechanics of the ankle joint so that long-term complications can be prevented. How to fixation the syndesmosis, whether to reconstruct the deltoid ligament remains in debate in the treatment of logsplitter injury, whether and when to remove the syndesmotic screws were still debated. Correct surgical intervention is successful in the treatment of “logsplitter injury”, however, the optimal fixation of syndesmosis and repair of deltoid ligaments need further investigate.
Does the ZipTightTM effective to maintain reduction after the treatment of acute acromioclavicular joint dislocation?
Authors: Kurtoglu Alper , Sukur Erhan , Cicekli Ozgur , Daldal Ismail , Kochai Alauddin , Sen Zafer , Hali Abdullah
Published: March 2020

Background:

The present study evaluated the functional and radiographic outcomes of acute acromioclavicular (AC) joint reconstruction performed using the mini-open technique and a knotless suspensory loop device

Methods:

A total of 25 patients (20 male and 5 female patients; mean age, 30.7 years; standard deviation, 10 years; range, 17–57 years) who fulfilled the inclusion criteria were included in the study. A functional assessment was performed using the Constant and University of California Los Angeles score. The radiologic assessment included standard anterior-posterior views of the AC and coracoclavicular (CC) distances.

Results:

The mean follow-up period was 18.6 months (range, 12–23 months). The mean Constant score was 87.2 ± 3.2, and the mean University of California Los Angeles score was 30.1 ± 2.4 at the final follow-up. Radiological evaluation at the last follow-up of the patients: Although there was no statistically significant increase in the AC and CC values of the patients (Fig. 2) at the last follow-up, the average CC value in 6 (24%) of the 25 patients was greater than 50% compared with the unaffected side CC and early postoperative CC values. However, there was no statistically significant difference in the Constant and UCLA scores between the 6 patients with reduction loss and the 19 patients with reduction maintenance (P = .86).

Conclusions:

Clinical results of fixation of acute AC joint dislocations using the ZipTightTM knotless suspensory loop device system and mini-open technique were favorable in terms of functional recovery and pain relief. However, the major disadvantage of this method was radiological loss of AC joint reduction when compared to the contralateral shoulder.
Analysis of the hemostatic therapy in liver transplantation guided by rotational thromboelastometry or conventional laboratory tests
Authors: Nascimento Jose C.R. , Neto Edson B.L. , da Silva Eliana L. , Nunes Rogean R. , Marinho David S. , Muniz Felipe N. , Praciano Andrea M. , Brasil Ivelise R.C.
Published: March 2020

Background

Coagulopathy is quite common in chronic liver disease patients undergoing orthotopic liver transplantation (OLT). Diagnosis of intraoperative bleeding disorders is based on conventional laboratory tests (CLTs), and thus, the patients are frequently exposed to unnecessary transfusions of blood products. The present study aimed to analyze the intraoperative administration of blood products in patients undergoing OLT, using rotational thromboelastometry (ROTEM) or CLTs.

Patients and methods

A cohort comprising 153 patients undergoing OLT, of whom 82 were evaluated with ROTEM and 71 by CLTs. Both groups were analyzed intraoperatively: the transfusion of blood products.

Results

The incidence of patients transfused with cryoprecipitate (CRYO) and/or fibrinogen concentrate (54.9 vs. 19.7%; P < 0.001) and prothrombin complex concentrate (PCC) (32.9 vs. 9.9%; P = 0.008) increased significantly in the ROTEM group than in CLT group, respectively. The amount of transfused patient with CRYO (7.6 vs. 1.2; P < 0.001), fibrinogen concentrate (0.8 vs. 0.2; P = 0.004) and PCC (1.4 vs. 0.2; P = 0.002) increased significantly in the ROTEM group than in the CLT group, respectively. In the analysis of fresh–frozen plasma (FFP), the incidence of transfused patients was significantly higher in the CLT group than in the ROTEM group (46.5 vs. 30.5%; P = 0.047, respectively), with a moderate correlation with red blood cells transfusion (r = 0.67, P < 0.001). The incidence of patients receiving antifibrinolytics was significantly higher in the CLT group than in the ROTEM group (85.9 vs. 47.6%; P < 0.001, respectively).

Conclusion

Transfusion protocol-based thromboelastometry was able to guide administration of hemostatic factors and reduced administration of FFP and antifibrinolytics.
Retinal Vessel Analysis as a Novel Screening Tool to Identify Childhood Acute Lymphoblastic Leukemia Survivors at Risk of Cardiovascular Disease
Authors: Azanan Mohamad S. , Chandrasekaran Sudhashini , Rosli Erda S. , Chua Ling Ling , Oh Lixian , Chin Tong Foh , Yap Tsiao Yi , Rajagopal Revathi , Rajasuriar Reena , MacGillivray Tom , Trucco Emanuele , Ramli Norlina , Kamalden Tengku A. , Ariffin Hany
Published: March 2020

Background:

Microvascular endothelial dysfunction is central to the pathogenesis of cardiovascular disease (CVD). The eye offers direct access for endothelial health assessment via the retinal microvasculature. The aim of the study was to investigate whether image-based retinal vessel analysis is a feasible method of assessing endothelial health in survivors of childhood acute lymphoblastic leukemia (cALL).

Materials and Methods:

Cardiovascular risk factors (CRFs) were estimated using the 30-year Framingham Risk Score in 73 childhood leukemia survivors (median age: 25; median years from diagnosis: 19) and 78 healthy controls (median age: 23). Radial arterial stiffness was measured using pulse wave analyzer, while endothelial activation markers were measured by soluble intercellular adhesion molecule 1 (sICAM-1) and soluble vascular cell adhesion molecule 1 (sVCAM-1). Retinal fundus images were analyzed for central retinal artery/vein equivalents (CRAE/CRVE) and arteriolar-venular ratio (AVR).

Results:

cALL survivors had higher CRF (P<0.0001), arterial stiffness (P=0.001), and sVCAM-1 (P=0.007) compared with controls. Survivors also had significantly higher CRVE (P=0.021) while AVR was significantly lower (P=0.026) in survivors compared with controls, compatible with endothelial dysfunction. In cALL survivors with intermediate risk for CVD, CRAE, and AVR are significantly lower, while sVCAM-1 and sICAM-1 are significantly higher when compared with survivors with low CVD risk after adjusting with covariates (age, sex, and smoking status).

Conclusions:

cALL survivors have an increased risk of CVD compared with age-matched peers. The survivors demonstrated microvasculopathy, as measured by retinal vascular analysis, in addition to physical and biochemical evidence of endothelial dysfunction. These changes predate other measures of CVD. Retinal vessel analysis may be utilized as a robust screening tool for identifying survivors at increased risk for developing CVD.
Genetic Basis of Extramedullary Plasmablastic Transformation of Multiple Myeloma
Authors: Liu Ying , Jelloul Fatima , Zhang Yanming , Bhavsar Tapan , Ho Caleb , Rao Mamta , Lewis Natasha E. , Cimera Robert , Baik Jeeyeon , Sigler Allison , Sen Filiz , Yabe Mariko , Roshal Mikhail , Landgren Ola , Dogan Ahmet , Xiao Wenbin
Published: March 2020

In patients with multiple myeloma, plasmablastic transformation in the bone marrow is rare and associated with poor outcomes. The significance of discordant extramedullary plasmablastic transformation in patients with small, mature clonal plasma cells in the bone marrow has not been well studied. Here, we report the clinicopathologic, cytogenetic, and molecular features of 10 such patients (male/female: 6/4, median age: 65 y, range: 48 to 76 y) with an established diagnosis of multiple myeloma in the bone marrow composed of small, mature plasma cells in parallel with a concurrent or subsequent extramedullary plasmablastic transformation. Eight patients with available survival data showed an overall aggressive clinical course with a median survival of 4.5 months after the diagnosis of extramedullary plasmablastic transformation, despite aggressive treatment and even in patients with low-level bone marrow involvement. Pathologically, the extramedullary plasmablastic myeloma were clonally related to the corresponding bone marrow plasma cells, showed high levels of CMYC and/or P53 expression with a high Ki-67 proliferation index by immunohistochemistry and harbored more complex genomic aberrations including frequent mutations in the RAS pathway and MYC rearrangements compared with their bone marrow counterparts. In summary, although genetic and immunohistochemical studies were not uniformly performed on all cases due to the retrospective nature of this study, our data suggest that discordant extramedullary plasmablastic transformation of multiple myeloma has an aggressive clinical course and is characterized by frequent mutations in the RAS pathway and more complex genomic abnormalities.
Association Between Resilience and Psychological Morbidity in Parents of Critically Ill Children*
Authors: Rothschild Charles B. , Rychlik Karen L. , Goodman Denise M. , Charleston Elizabeth , Brown Melanie L. , Michelson Kelly N. ,   for the Navigate Study Investigators
Published: March 2020

Objective:

To determine whether parental resilience, measured at ICU admission, is associated with parent-reported symptoms of depression, anxiety, posttraumatic stress, and satisfaction with ICU care 3–5 weeks following ICU discharge.

Design:

Planned prospective, observational study nested in a randomized comparative trial.

Setting:

PICUs and cardiac ICUs in two, free-standing metropolitan area children’s hospitals.

Participants:

English- and Spanish-speaking parents whose children were younger than 18 years old and had anticipated ICU stay of greater than 24 hours or Pediatric Index of Mortality score of greater than or equal to 4 at the time of consent. All ICU admissions were screened for inclusion. Of 4,251 admissions reviewed, 1,360 were eligible. Five hundred families were approached and 382 enrolled. Two hundred thirty-two parents from 210 families with complete data were included in analysis.

Interventions:

All participating parents completed the Connor-Davidson Resilience Scale at the time of consent and outcome measures 3–5 weeks after ICU discharge.

Measurements and Main Results:

All parents completed the Patient-Reported Outcome Measurement Information System Short Forms 8a for Depression and Anxiety, Impact of Event Scale-Revised for posttraumatic stress, and Pediatric Family Satisfaction-ICU 24 for parental satisfaction 3–5 weeks after ICU discharge. Higher parental resilience was associated with fewer symptoms of depression, anxiety, and posttraumatic stress in the final model (all p < 0.0001). Shorter length of stay, early mechanical ventilation, Latino ethnicity, and lower illness severity (both objective and parental perceptions) were associated with less morbidity in some or all measured mental health outcomes.

Conclusions:

Higher parental resilience is associated with fewer reported symptoms of anxiety, depression, and posttraumatic stress 3–5 weeks after ICU discharge. Parental resilience may impact parental post-ICU psychological morbidity. Measuring parental resilience could be one approach to identify parents at risk for post-ICU psychological morbidity. Future research into the impact of interventions designed to boost parental resilience is warranted.
The “RealSelf Effect”
Authors: Sanati-Mehrizy Paymon , Margulies Ilana G. , Sayegh Farah , Ingargiola Michael J. , Taub Peter J.
Published: March 2020

Background

Whether patient driven or surgeon driven, social media can serve as a strong marketing tool to attract plastic surgery patients. At many training programs, chief residents have the opportunity to run an independent clinic, in which patients are evaluated for aesthetic and reconstructive procedures. In this study, the authors sought to investigate the downstream effect of a single positive review on a major social review site on cosmetic surgery volume.

Methods

A retrospective pre-post intervention study was performed. Operating room case logs at an urban training program were queried for purely aesthetic cases performed through the chief resident clinic in 2012 to 2018. Procedures performed by nonplastic surgery services were excluded.

Results

A total of 1734 cases met the inclusion criteria. Before the online review, aesthetic cases grew from 61 to 82 (10% compounded annual growth rate). However, after the review was posted, 107 aesthetic cases were performed in the 2016–2017 academic year, driving a 30% growth rate. A large portion of this increase in growth can be attributed to the growth in number of rhytidectomies performed.

Discussion

This study evaluated the impact of social media on the volume of aesthetic cases performed through an established chief resident clinic and its utility in patient recruitment. Chief residents had an increase in the number of aesthetic surgery cases they performed after their clinic was featured on an online social media physician review website. This further reinforces the impact social media and an online presence have on plastic surgery training.
A Multidisciplinary Technique for Concurrent Panniculectomy–Living Donor Renal Transplantation
Authors: Ngaage Ledibabari M. , Messner Franka , McGlone Katie L. , Masters Brian M. , Highstein Mallory , Chopra Karan , Phelan Michael , Singh Devinder , Scalea Joseph , Niederhaus Silke V. , Bromberg Jonathan S. , Bartlett Stephen T. , Rasko Yvonne M.
Published: March 2020

Background

Recently, it has been shown that panniculectomy concurrent to living donor renal transplantation is a safe option for management of renal transplant recipients with a large focal pannus. This combined management requires precise coordination of teams. We describe the technique, timing, and sequence for combined renal transplantation and panniculectomy.

Methods

We conducted a retrospective chart review of adult patients (≥18 years old) who underwent simultaneous living donor renal transplantation–panniculectomy from 2015 to 2019. A multi–team approach that included urology, transplant, and plastic surgery was used to perform the combined operations. Typically, the plastic surgery team initiates the operation by performing the panniculectomy. This is followed by kidney transplantation and graft anastomosis. The plastic surgery team then completes the operation with closure of the wound.

Results

Twenty patients were identified. Most were male (12:8) with a mean age of 55 years and an average body mass index of 35 kg/m2. The mean total operative duration was 394 minutes. On average, 17% of operating time was devoted to panniculectomy. At 90 days follow-up, there was 100% graft survival and all patients had primary graft function. There was a 25% wound complications rate and a 15% reoperation rate.

Conclusion

By performing panniculectomy first in the sequence, concurrent panniculectomy provides wide exposure and a large operative field for transplantation. Wound closure by plastic surgeons may mitigate the high complication rate commonly seen in obese patients with end-stage renal disease. Future studies are needed to evaluate the cost-benefit of the combined living donor renal transplantation–panniculectomy.
Should 1 or 2 Venous Anastomoses Be Done in Microsurgical Flap Transfer?
Authors: Khan Sara , Khan Zuhera , Ali Mohsin , Shaikh Safdar Ali , Rahman Mohammad Fazlur
Published: March 2020

Background

Venous compromise is still the most common cause of free flap failure. The need of a second venous anastomosis to prevent free flap failure is controversial. It is proposed that the use of dual venous anastomoses reduces venous compromise. However, some surgeons suggest that dual venous drainage reduces venous blood flow causing a potential risk of thrombosis.

Objective

This study aimed to compare the frequency of reexploration secondary to venous thrombosis in free flap surgeries in reconstruction of soft tissue defects with 1-vein versus 2-vein anastomosis.

Materials and Methods

We performed a retrospective cohort study including 298 flaps. In 180 of these patients, 2-vein anastomosis was done, and in 118, 1-vein anastomosis was done. The study was conducted at Aga Khan University Hospital from January 2017 to December 2018.

Results

The number of venous anastomosis was not associated with flap survival. The group with dual anastomosis required more frequent reexploration as compared with 1 venous anastomosis group (8% vs 1.7%).

Outcome and salvage rate were better in the 2-vein group as compared with the 1-vein group (64% vs 50%).

Conclusion

There is no difference in flap survival in single or dual venous anastomosis, but we have noticed higher reexploration rates in the 2-vein group. However, outcome is better in the 2-vein group.
Evaluation of Auricular Cartilage Reconstruction Using a 3-Dimensional Printed Biodegradable Scaffold and Autogenous Minced Auricular Cartilage
Authors: Min Sun-Hong , Kim Jun-Hyung , Lee Mun-Ik , Kwak Ho-Hyun , Woo Heung-Myong , Shim Jin-Hyung , Choi Da-Mi , Lee Jeong-Seok , Jeong Jae-Yong , Kang Byung-Jae
Published: March 2020

Auricular cartilage reconstruction represents one of the greatest challenges for otolaryngology–head and neck surgery. The native structure and composition of the auricular cartilage can be achieved by combining a suitable chondrogenic cell source with an appropriate scaffold. In reconstructive surgery for cartilage tissue, autogenous cartilage is considered to be the best chondrogenic cell source. Polycaprolactone is mainly used as a tissue-engineered scaffold owing to its mechanical properties, miscibility with a large range of other polymers, and biodegradability. In this study, scaffolds with or without autogenous minced auricular cartilage were implanted bilaterally in rabbits for auricular regeneration. Six weeks (n = 4) and 16 weeks (n = 4) after implantation, real-time quantitative reverse transcription polymerase chain reaction and histology were used to assess the regeneration of the auricular cartilage. Quantitative reverse transcription polymerase chain reaction analysis revealed that the messenger RNA expression of aggrecan, collagen I, and collagen II was higher in scaffolds with 50% minced cartilage than the scaffold-only groups or scaffolds with 30% minced cartilage (P < 0.05). Furthermore, histological analysis demonstrated significantly superior cartilage regeneration in scaffolds with the minced cartilage group compared with the scaffold-only and control groups (P < 0.05). Autogenous cartilage can be easily obtained and loaded onto a scaffold to promote the presence of chondrogenic cells, allowing for an improvement of the reconstruction of auricular cartilage. Here, the regeneration of auricular cartilage was also successful in the 50% minced cartilage group. The results presented in this study could have clinical implications, as they demonstrate the potential of a 1-stage process for auricular reconstruction.
Anatomical Classification of Tessier Craniofacial Clefts Numbers 3 and 4
Authors: Omodan Abiola , Pillay Pamela , Lazarus Lelika , Gounden Karen , Madaree Anil , Satyapal Kapil
Published: March 2020

Background:

Craniofacial clefts are rare occurrences with an incidence of about 1.43 to 4.85 per 100,000 live births. Understanding the skeletal deformity in these clefts is basic to any reconstructive surgery of the face. This study documented the skeletal defects present in Tessier numbers 3 and 4 using anthropometric measurements to generate a subclassification which will aim to improve the means of communication between surgeons managing this anomaly.

Methods:

Seven computed tomography scans of patients who had been treated for Tessier 3 and 4 clefts between 2003 and 2017 were analyzed. Measurements of the expected defects in each cleft was taken and compared with unaffected side as the reference. Emerging patterns of their analysis was then used to generate a subclassification for these clefts. The reliability and validity of the measurements were ensured by allowing the data to be examined by both an intra- and interobserver.

Results:

The presence or absence of an alveolar cleft, the emerging patterns of comparison of the measurements of the maxilla and the orbits of the cleft side and the noncleft side as well as absence of the bone were used to arrive at a subclassification system using (a), (b), (c), (M+ O+), (M− O−), and (0).

Conclusion:

The study recommends a subclassification for Tessier clefts numbers 3 and 4 that will allow physicians anticipate the extent and the form of skeletal defects present before even seeing the patient. This can improve the communication among surgeons and team members regarding Tessier craniofacial clefts.
Pseudomyogenic Hemangioendothelioma: A Rare Vascular Tumor of the Oral Cavity
Authors: Ramos-Fuentes Hector , Ortiz-Diaz Cristina , Sifuentes-Cervantes Salvador , Castro-Núñez Jaime
Published: March 2020

Pseudomyogenic hemangioendothelioma is a vascular neoplasm that presents a borderline biological behavior, intermediate between entirely benign hemangiomas and highly malignant angiosarcomas. Up to date, only 1 case of this entity has been reported in the oral cavity.
Over the Cuckoo’s Nest
Authors: Alexander Lauren , Kelly Louisa , Doody Eimear , Brady Shane , Roddy Darren , Counihan Eimear , Delaney Liam , McLoughlin Declan , Malone Kevin
Published: March 2020

Objective

Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorder, but some aspects remain controversial. Few studies have taken an in-depth mixed methods approach toward the study of attitudes, and there are no significant studies that explore the change of attitudes before and after treatment. The aim was to compare attitudes of patients and their relatives before and after ECT using quantitative and qualitative methods.

Methods

One hundred twenty-three participants were recruited. Forty-one patient/relative participants were recruited from 2 accredited ECT centers along with 82 age- and sex-matched general population controls. A validated 22-item survey about attitudes toward ECT was administered. Patient/relative participants completed the survey before treatment with ECT and engaged in a repeat survey and a semistructured interview 1 month after completion of ECT. Control participants completed the survey on a single occasion.

Results

Control versus pre-ECT surveys and pre-ECT versus post-ECT surveys both demonstrated statistically and clinically significant positive attitudinal differences (Cohen d = 1.37, P < 0.001; Cohen d = 1.2, P < 0.001). These differences were maintained for both the patient and relative pre/post subgroups (Cohen d = 1.15, P < 0.001; Cohen d = 1.33, P < 0.001). Qualitative analysis identified 13 attitudinal transitions in cognition, emotion, and imagery domains.

Conclusions

This is the first study to examine a change in attitudes toward ECT of patients, their relatives, and with controls using mixed methods. The findings suggest a 2-phase positive attitudinal change, in which accurate information (phase 1) and experiential learning (phase 2) are both key components. These findings address stigma through accurate knowledge and experiential learning, with a positive outcome through changed attitudes.
Channel modelling for indoor visible light communications
Authors: Miramirkhani Farshad , Uysal Murat
Published: March 2020

Visible light communication (VLC) allows the dual use of light-emitting diodes (LEDs) for wireless communication purposes in addition to their primary purpose of illumination. As in any other communication system, realistic channel modelling is a key for VLC system design, analysis and testing. In this paper, we present a comprehensive survey of indoor VLC channel models. In order to set the background, we start with an overview of infrared (IR) channel modelling, which has received much attention in the past, and highlight the differences between visible and IR optical bands. In the light of these, we present a comparative discussion of existing VLC channel modelling studies and point out the relevant advantages and disadvantages. Then, we provide a detailed description of a site-specific channel modelling approach based on non-sequential ray tracing that precisely captures the optical propagation characteristics of a given indoor environment. We further present channel models for representative deployment scenarios developed through this approach that were adopted by the Institute of Electrical and Electronics Engineering (IEEE) as reference channel models. Finally, we consider mobile VLC scenarios and investigate the effect of receiver location and rotation for a mobile indoor user.

This article is part of the theme issue ‘Optical wireless communication’.
Optimum resource allocation in optical wireless systems with energy-efficient fog and cloud architectures
Authors: Aletri Osama Zwaid , Alahmadi Amal A. , Saeed Sarah O. M. , Mohamed Sanaa Hamid , El-Gorashi T. E. H. , Alresheedi Mohammed T. , Elmirghani Jaafar M. H.
Published: March 2020

Optical wireless communication (OWC) is a promising technology that can provide high data rates while supporting multiple users. The optical wireless (OW) physical layer has been researched extensively, however, less work was devoted to multiple access and how the OW front end is connected to the network. In this paper, an OWC system which employs a wavelength division multiple access (WDMA) scheme is studied, for the purpose of supporting multiple users. In addition, a cloud/fog architecture is proposed for the first time for OWC to provide processing capabilities. The cloud/fog-integrated architecture uses visible indoor light to create high data rate connections with potential mobile nodes. These OW nodes are further clustered and used as fog mini servers to provide processing services through the OW channel for other users. Additional fog-processing units are located in the room, the building, the campus and at the metro level. Further processing capabilities are provided by remote cloud sites. Two mixed-integer linear programming (MILP) models were proposed to numerically study networking and processing in OW systems. The first MILP model was developed and used to optimize resource allocation in the indoor OWC systems, in particular, the allocation of access points (APs) and wavelengths to users, while the second MILP model was developed to optimize the placement of processing tasks in the different fog and cloud nodes available. The optimization of tasks placement in the cloud/fog-integrated architecture was analysed using the MILP models. Multiple scenarios were considered where the mobile node locations were varied in the room and the amount of processing and data rate requested by each OW node was varied. The results help to identify the optimum colour and AP to use for communication for a given mobile node location and OWC system configuration, the optimum location to place processing and the impact of the network architecture.

This article is part of the theme issue ‘Optical wireless communication’.
Physical layer security in light-fidelity systems
Authors: Zhang Zhenyu , Chaaban Anas , Lampe Lutz
Published: March 2020

Light-fidelity (LiFi) is a light-based wireless communication technology which can complement radio-frequency (RF) communication technologies for indoor applications. Although LiFi signals are spatially more contained than RF signals, the broadcasting nature of LiFi also makes it susceptible to eavesdropping. Therefore, it is important to secure the transmitted data against potential eavesdroppers. In this paper, an overview of the recent developments pertaining to LiFi physical layer security (PLS) is provided, and the main differences between LiFi PLS and RF PLS are explained. LiFi achievable secrecy rates and upper bounds are then investigated under practical channel models and transmission schemes. Beamforming and jamming, which received significant research attention recently as a means to achieve PLS in LiFi, are also investigated under indoor illumination constraints. Finally, future research directions of interest in LiFi PLS are identified and discussed.

This article is part of the theme issue ‘Optical wireless communication’.
Optical spatial modulation design
Authors: Cogalan T. , Haas H. , Panayirci E.
Published: March 2020

Visible light communication (VLC) systems are inherently signal-to-noise ratio (SNR) limited due to link budget constraints. One favourable method to overcome this limitation is to focus on the pre-log factors of the channel capacity. Multiple-input multiple-output (MIMO) techniques are therefore a promising avenue of research. However, inter-channel interference in MIMO limits the achievable capacity. Spatial modulation (SM) avoids this limitation. Furthermore, the performance of MIMO systems in VLC is limited by the similarities among spatial channels. This limitation becomes particularly severe in intensity modulation/direct detection (IM/DD) systems because of the lack of phase information. The motivation of this paper is to propose a system that results in a multi-channel transmission system that enables reliable multi-user optical MIMO SM transmission without the need for a precoder, power allocation algorithm or additional optics at the receiver. A general bit error performance model for the SM system is developed for an arbitrary number of light-emitting diodes (LEDs) in conjunction with pulse amplitude modulation. Based on this model, an LED array structure is designed to result in spatially separated multiple channels by manipulating the transmitter geometry.

This article is part of the theme issue ‘Optical wireless communication’.
Morphological redescriptions and neotypification of two poorly known tintinnine ciliates (Alveolata, Ciliophora, Tintinnina), with a phylogenetic investigation based on SSU rRNA gene sequences
Authors: Wang Rui , Song Wen , Bai Yang , Warren Alan , Li Lifang , Hu Xiaozhong
Published: March 2020

Two poorly known tintinnine ciliates collected from the coastal waters of PR China, viz., Codonellopsis mobilis Wang, 1936 and Tintinnopsis chinglanensis Nie & Ch’eng, 1947, were redescribed and neotypified using live observation, protargol staining and SSU rRNA gene sequencing. Ciliature information and SSU rRNA gene sequence data of both species were revealed for the first time and improved diagnoses were given based on the original descriptions and data from the present study. Further phylogenetic analyses inferred from SSU rRNA gene sequences and morphological data suggested that the genus Tintinnopsis is polyphyletic and that the genus Codonellopsis is non-monophyletic. The approximately unbiased test, however, does not reject the possibility that Codonellopsis is monophyletic.
CRISPR-based surveillance for COVID-19 using genomically-comprehensive machine learning design
Authors: Metsky Hayden C. , Freije Catherine A. , Kosoko-Thoroddsen Tinna-Solveig F. , Sabeti Pardis C. , Myhrvold Cameron
Published: March 2020

The emergence and outbreak of SARS-CoV-2, the causative agent of COVID-19, has rapidly become a global concern and has highlighted the need for fast, sensitive, and specific tools to surveil circulating viruses. Here we provide assay designs and experimental resources, for use with CRISPR-based nucleic acid detection, that could be valuable for ongoing surveillance. We provide assay designs for detection of 67 viral species and subspecies, including: SARS-CoV-2, phylogenetically-related viruses, and viruses with similar clinical presentation. The designs are outputs of algorithms that we are developing for rapidly designing nucleic acid detection assays that are comprehensive across genomic diversity and predicted to be highly sensitive and specific. Of our design set, we experimentally screened 4 SARS-CoV-2 designs with a CRISPR-Cas13 detection system and then extensively tested the highest-performing SARS-CoV-2 assay. We demonstrate the sensitivity and speed of this assay using synthetic targets with fluorescent and lateral flow detection. Moreover, our provided protocol can be extended for testing the other 66 provided designs. Assay designs are available athttps://adapt.sabetilab.org/.
Cold Atmospheric Plasma induces silver nanoparticle uptake, oxidative dissolution and enhanced cytotoxicity in Glioblastoma multiforme cells
Authors: Manaloto Eline , Gowen Aoife , Lesniak Anna , He Zhonglei , Casey Alan , Cullen Patrick J , Curtin James F
Published: March 2020

Silver nanoparticles (AgNP) emerged as a promising reagent for cancer therapy with oxidative stress implicated in the toxicity. Meanwhile, studies reported cold atmospheric plasma (CAP) generation of reactive oxygen and nitrogen species has selectivity towards cancer cells. Gold nanoparticles display synergistic cytotoxicity when combined with CAP against cancer cells but there is a paucity of information using AgNP, prompting to investigate the combined effects of CAP using dielectric barrier discharge system (voltage of 75 kV, current is 62.5mA, duty cycle of 7.5kVA and input frequency of 50-60Hz) and 10nm PVA-coated AgNP using U373MG Glioblastoma Multiforme cells. Cytotoxicity in U373MG cells was >100-fold greater when treated with both CAP and PVA-AgNP compared with either therapy alone (IC50of 4.30 μg/mL with PVA-AgNP alone compared with 0.07 μg/mL after 25s CAP and 0.01 μg/mL 40s CAP). Combined cytotoxicity was ROS-dependent and was prevented using N-Acetyl Cysteine. A novel darkfield spectral imaging method investigated and quantified AgNP uptake in cells determining significantly enhanced uptake, aggregation and subcellular accumulation following CAP treatment, which was confirmed and quantified using atomic absorption spectroscopy. The results indicate that CAP decreases nanoparticle size, decreases surface charge distribution of AgNP and induces uptake, aggregation and enhanced cytotoxicityin vitro.