bluuebunny/crossref_metadata_2025 huggingface dataset:
Spitzer mid-infrared detections of neutron star merger GW170817 suggests synthesis of the heaviest elements
Authors: Kasliwal Mansi M , Kasen Daniel , Lau Ryan M , Perley Daniel A , Rosswog Stephan , Ofek Eran O , Hotokezaka Kenta , Chary Ranga-Ram , Sollerman Jesper , Goobar Ariel , Kaplan David L
Published: January 2019

We report our Spitzer Space Telescope observations and detections of the binary neutron star merger GW170817. At 4.5 μm, GW170817 is detected at 21.9  mag AB at +43 days and 23.9 mag AB at +74 days after merger. At 3.6 μm, GW170817 is not detected to a limit of 23.2 mag AB at +43 days and 23.1 mag AB at  +74 days. Our detections constitute the latest and reddest constraints on the kilonova/macronova emission and composition of heavy elements. The 4.5 μm luminosity at this late phase cannot be explained by elements exclusively from the first abundance peak of the r-process. Moreover, the steep decline in the Spitzer band, with a power-law index of 3.4 ± 0.2, can be explained by a few of the heaviest isotopes with half-life around 14  d dominating the luminosity (e.g. 140Ba, 143Pr, 147Nd, 156Eu, 191Os, 223Ra, 225Ra, 233Pa, 234Th) or a model with lower deposition efficiency. This data offers evidence that the heaviest elements in the second and third r-process abundance peak were indeed synthesized. Our conclusion is verified by both analytics and network simulations and robust despite intricacies and uncertainties in the nuclear physics. Future observations with Spitzer and James Webb Space Telescope will further illuminate the relative abundance of the synthesized heavy elements.
Updates in the management of intradural spinal cord tumors: a radiation oncology focus
Authors: Kotecha Rupesh , Mehta Minesh P , Chang Eric L , Brown Paul D , Suh John H , Lo Simon S , Das Sunit , Samawi Haider H , Keith Julia , Perry James , Sahgal Arjun
Published: January 2019

Primary spinal cord tumors represent a hetereogeneous group of central nervous system malignancies whose management is complex given the relatively uncommon nature of the disease and variety of tumor subtypes, functional neurologic deficits from the tumor, and potential morbidities associated with definitive treatment. Advances in neuroimaging; integration of diagnostic, prognostic, and predictive molecular testing into tumor classification; and developments in neurosurgical techniques have refined the current role of radiotherapy in the multimodal management of patients with primary spinal cord tumors, and corroborated the need for prospective, multidisciplinary discussion and treatment decision making. Radiotherapeutic technological advances have dramatically improved the entire continuum from treatment planning to treatment delivery, and the development of stereotactic radiosurgery and proton radiotherapy provides new radiotherapy options for patients treated in the definitive, adjuvant, or salvage setting. The objective of this comprehensive review is to provide a contemporary overview of the management of primary intradural spinal cord tumors, with a focus on radiotherapy.
Adipose Infiltration of the Dermis, Involving the Arrector Pili Muscle, and Dermal Displacement of Eccrine Sweat Coils: New Histologic Observations in Frontal Fibrosing Alopecia
Authors: Miteva Mariya , Castillo David , Sabiq Samar
Published: January 2019

Background:

Frontal fibrosing alopecia (FFA) is an irreversible scarring alopecia, and its incidence has reached epidemic size. Immune privilege collapse of the bulge and epithelial mesenchymal transition play a role in the pathogenesis. We have noted adipose tissue in the dermis in several specimens from FFA.

Objective:

Our primary objective was to verify the presence of adipose tissue at the isthmus level in biopsies from FFA. Additional objectives included the presence of deep inflammation and position of the sweat coils.

Methods:

Eighty-three histologic specimens of FFA diagnosed at the Dermatopathology Laboratory at the Department of Dermatology, University of Miami, within 3 years were evaluated retrospectively. All biopsies were bisected horizontally and assessed at several levels. Sixty biopsies from androgenetic alopecia served as controls. Statistical analysis was performed using the χ2 test. A P value of 0.05 or less was considered significant.

Results:

Sixty specimens met the inclusion criteria for optimal quality and classic diagnostic features. Seventy percent demonstrated fat tissue infiltration at the isthmus level as clusters of cells or small globules versus 23% of the controls. The fat infiltration in the arrector pili muscle (APM) was present in 55% versus 15% of the controls, and the sweat coils were positioned in the reticular dermis in 43% versus 1.7% of the controls. All results were statistically significant (P < 0.0001). When accounting for the simultaneous presence of any of these 3 variables, 30% of the FFA cases had triple positivity, 61.7% had double positivity, and 75% had at least 1 positive variable versus 0%, 15%, and 10%, respectively, of the controls.

Conclusion:

New histologic findings in FFA involve the presence of adipose tissue in the dermis. We believe that the close interaction of the hair follicles and the APM with the adipose tissue may play a role in APM degeneration and in epithelial mesenchymal transition.
Should They Stay or Should They Go? The Utility of C-Reactive Protein in Predicting Readmission and Anastomotic Leak After Colorectal Resection
Authors: Pantel Haddon J. , Jasak Lisa J. , Ricciardi Rocco , Marcello Peter W. , Roberts Patricia L. , Schoetz David J. , Read Thomas E.
Published: January 2019

BACKGROUND:

Hospital readmission and anastomotic leak following colorectal resection have a negative impact on patients, surgeons, and the health care system. Novel markers of patients unlikely to experience these complications are of value in avoiding readmission.

OBJECTIVE:

This study aimed to determine the predictive value of C-reactive protein for readmission and anastomotic leak within 30 days following colorectal resection.

DESIGN:

This is a retrospective review of a prospectively compiled single-institution database.

PATIENTS:

From January 1, 2013, to July 20, 2017, consecutive patients undergoing elective colorectal resection with anastomosis without the presence of proximal intestinal stoma, who had C-reactive protein measured on postoperative day 3, were included.

MAIN OUTCOME MEASURES:

The primary outcome measured was the predictive value of C-reactive protein measured on postoperative day 3 for readmission or anastomotic leak within 30 days after colorectal resection.

RESULTS:

Of the 752 patients examined, 73 (10%) were readmitted within 30 days of surgery and 17 (2%) had an anastomotic leak. Mean C-reactive protein in patients who neither had an anastomotic leak nor were readmitted (127 ± 77 mg/L) was lower than for patients who were readmitted (157 ± 96 mg/L, p = 0.002) and lower than for patients who had an anastomotic leak (228 ± 123 mg/L, p = 0.0000002). The area under the receiver operating characteristic curve for the diagnostic accuracy of C-reactive protein for readmission was 0.59, with a cutoff value of 145 mg/L, generating a 93% negative predictive value. The area under the curve for the diagnostic accuracy of C-reactive protein for anastomotic leak was 0.76, with a cutoff value of 147 mg/L generating a 99% negative predictive value.

LIMITATIONS:

This study was limited by its retrospective design and because all patients were treated at a single center.

CONCLUSIONS:

Patients with a C-reactive protein below 145 mg/L on postoperative day 3 after colorectal resection have a low likelihood of readmission within 30 days, and a very low likelihood of anastomotic leak. See Video Abstract at http://links.lww.com/DCR/A761.
Lymphovascular Invasion and Perineural Invasion Negatively Impact Overall Survival for Stage II Adenocarcinoma of the Colon
Authors: Skancke Matthew , Arnott Suzanne M. , Amdur Richard L. , Siegel Robert S. , Obias Vincent J. , Umapathi Bindu A.
Published: January 2019

BACKGROUND:

Lymphovascular invasion and perineural invasion are histopathological features associated with higher-risk colon cancer.

OBJECTIVE:

The purpose of this study was to quantify the impact of lymphovascular and perineural invasion on overall survival after diagnosis and to determine the protective effect of adjuvant chemotherapy for early adenocarcinoma with high-risk factors.

DESIGN:

This was a retrospective database review of the 2010–2014 National Cancer Database for colon cancer.

SETTINGS:

Individuals diagnosed with invasive adenocarcinoma of the colon (histology code 8140) with primary surgical resection with >12 nodes harvested and no positive nodes on pathological examination were included.

PATIENTS:

A total of 32,493 patients underwent surgical resection for stage II adenocarcinoma of the colon.

INTERVENTIONS:

The study involved multivariate Cox regression analysis of the impact of lymphovascular and perineural invasion and adjuvant chemotherapy on overall survival after a diagnosis of stage II adenocarcinoma of the colon.

MAIN OUTCOME MEASURES:

Survival after a diagnosis of stage II adenocarcinoma of the colon was measured.

RESULTS:

Five-year survival after diagnosis and surgical resection without adjuvant chemotherapy was lower for patients with lymphovascular (60.0%), perineural (56.9%), and lymphovascular and perineural invasion (55.8%) compared with double-negative disease (66.1%). Log-rank testing confirmed that adjuvant chemotherapy improved 5-year survival after diagnosis for lymphovascular (85.5%), perineural (83.6%), and lymphovascular and perineural invasion (74.3%). After controlling for differences in cohorts, Cox regression analysis showed an increased HR for mortality of 14.0% for lymphovascular (HR = 1.141 (95% CI, 1.060–1.228)), 32.1% for perineural (HR = 1.321 (95% CI, 1.176–1.483)), and 41.0% for lymphovascular and perineural invasion (HR = 1.409 (95% CI, 1.231–1.612)) compared with having neither. Chemotherapy showed a 43% reduction in hazard for mortality (HR = 0.570 (95% CI, 0.513–0.633)).

LIMITATIONS:

The study was limited by its retrospective review and observational bias.

CONCLUSIONS:

Lymphovascular and perineural invasion have a detrimental effect on survival after diagnosis of stage II adenocarcinoma of the colon. Chemotherapy may be protective specifically when lymphovascular and perineural invasion are present. See Video Abstract at http://links.lww.com/DCR/A786.
Diagnosis and Management of Parastomal Hernias
Authors: Okorji Leslie M. , Kasten Kevin R.
Published: January 2019

CASE SUMMARY:

A 63-year-old woman with history of stage II rectal adenocarcinoma status postneoadjuvant chemoradiation and subsequent abdominoperineal resection presented with worsening bulge and inability to pouch stoma. CT scan revealed a 4-cm parastomal hernia. After discussion with the patient regarding management options, she elected to undergo repair of hernia defect. A robot-assisted laparoscopic parastomal hernia repair with synthetic mesh via the Sugarbaker technique was performed. After a short stay in the hospital, the patient recovered well and reported no recurrent symptoms.
Estimating Human Immunodeficiency Virus (HIV) Prevention Effects in Low-incidence Settings
Authors: Rudolph Jacqueline E. , Cole Stephen R. , Eron Joseph J. , Kashuba Angela D. , Adimora Adaora A.
Published: January 2019

Background:

Randomized controlled trials (RCTs) for determining efficacy of preexposure prophylaxis (PrEP) in preventing human immunodeficiency virus (HIV) infection have not been conducted among US women because their lower HIV incidence requires impractically large studies. Results from higher-incidence settings, like Sub-Saharan Africa, may not apply to US women owing to differences in age, sexual behavior, coinfections, and adherence.

Methods:

We propose a novel strategy for evaluating PrEP efficacy in the United States using data from both settings to obtain four parameters: (1) intention-to-treat (ITT) and (2) per-protocol effects in the higher-incidence setting, (3) per-protocol effect generalized to the lower-incidence setting, and (4) back-calculated ITT effect using adherence data from the lower-incidence setting. To illustrate, we simulated two RCTs comparing PrEP against placebo: one in 4000 African women and another in 500 US women. We estimated all parameters using g-computation and report risk ratios averaged over 2000 simulations, alongside the 2.5th and 97.5th percentiles of the simulation results.

Results:

Twelve months after randomization, the African ITT and per-protocol risk ratios were 0.65 (0.47, 0.88) and 0.20 (0.08, 0.34), respectively. The US ITT and per-protocol risk ratios were 0.42 (0.20, 0.62) and 0.17 (0.03, 0.38), respectively. These results matched well the simulated true effects.

Conclusions:

Our simple demonstration informs the design of future studies seeking to estimate the effectiveness of a treatment (like PrEP) in lower-incidence settings where a traditional RCT would not be feasible. See video abstract at, http://links.lww.com/EDE/B506.
APPLICATION OF ADJUNCTIVE TOPICAL MITOMYCIN-C IN SCLEROSTOMY REVISION FOR REFRACTORY IDIOPATHIC UVEAL EFFUSION SYNDROME
Authors: Zhu Ivy , Haq Zeeshan , Ali Mohsin H. , Chang Peter Y. , Zahid Sarwar , Mieler William F.
Published: January 2019

Background/Purpose:

To describe the use of topical mitomycin-C in sclerostomy revision for recalcitrant idiopathic uveal effusion syndrome.

Methods:

A 50-year-old healthy man presented with painless, gradual vision loss in the right eye. He underwent multimodal retinal imaging with wide-field fundus photography, spectral domain optical coherence tomography, and B-scan and A-scan ultrasonography. He was found to have idiopathic (non-nanophthalmic) uveal effusion syndrome with choroidal and serous retinal detachments in the right eye and a peripheral choroidal detachment in the left eye. Central vision became threatened in the right eye. Medical treatment with oral corticosteroids and surgical treatment with choroidal drainage through sclerostomies and sclerostomy revision were administered.

Results:

Initial treatment with systemic corticosteroids was ineffective. Subsequent choroidal drainage through sclerostomies only partially resolved the effusion. Later sclerostomy revision with application of topical mitomycin-C led to complete resolution with anatomical stability maintained after at least 42 months of follow-up.

Conclusion:

Successful use of topical mitomycin-C in sclerostomy revision has not previously been reported in idiopathic (non-nanophthalmic) uveal effusion syndrome. We propose that topical mitomycin-C may be considered as a potential therapeutic adjunct in the treatment of refractory idiopathic uveal effusion syndrome before further sclerostomy procedures are attempted in additional quadrants of the eye.
PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH IDIOPATHIC INTRACRANIAL HYPERTENSION
Authors: Denny Matthew R. , Kalevar Ananda , Chen Judy J. , Johnson Robert N.
Published: January 2019

Purpose:

Paracentral acute middle maculopathy (PAMM) is a recently identified clinical entity with numerous retinal vascular and systemic associations. To our knowledge, this is the first reported case of PAMM associated with idiopathic intracranial hypertension.

Methods:

A case is presented with multimodal imaging.

Results:

A patient with idiopathic intracranial hypertension is found to have the characteristic clinical, spectral domain optical coherence tomography, and OCT angiography findings associated with PAMM.

Conclusion:

Paracentral acute middle maculopathy is believed to arise from a microvascular insult to the retinal deep capillary plexus. We add a previously undescribed association with idiopathic intracranial hypertension to the list of etiologies that can cause PAMM.
Are Sexually Transmitted Infection/HIV Behavioral Interventions for Women of Color Culturally Grounded? A Review of the Literature
Authors: Crooks Natasha , Muehrer Rebecca J.
Published: January 2019

Although behavioral interventions for women of color have been shown to be effective in reducing sexually transmitted infections (STIs), STI/HIV rates continue to increase. To alleviate sexual health disparities, it is necessary to understand the cultural behaviors of the target population to design culturally grounded interventions. The purposes of our review were to examine the current state of STI/HIV behavioral interventions for women of color, determine how culture has been incorporated into interventions, and identify gaps in the literature. We reviewed 17 articles targeting women of color between the ages of 13 and 65 years. Findings suggest the need for interventions that are culturally grounded, group based, and delivered face-to-face and in multiple sessions to reduce STI/HIV risk behaviors. Although many of the studies were effective, we found three major gaps: (a) the need to examine intervention sustainability, (b) limitations in the adaption of theoretical frameworks, and (c) clarity in how to infuse culture into interventions.
They Just Don't Get Me: A Qualitative Analysis of Transgender Women's Health Care Experiences and Clinician Interactions
Authors: Hines Dana D. , Laury Esther R. , Habermann Barbara
Published: January 2019

Transgender individuals face many barriers when accessing health care, including having to teach clinicians how to care for them to receive appropriate care. We conducted a secondary analysis of qualitative data collected via semistructured interviews with 18 transgender women ranging in age from 21 to 60 years and living with HIV. Data were analyzed using conventional content analysis. Participants encountered two clinician types: Those who get me and Those who don't get me. Clinicians who get me provided gender-affirming care, fostered patient engagement, performed appropriate health screenings, and were willing to learn about transgender health. Clinicians who don't get me were aloof, uninterested, and unwilling to provide care. Clinicians who don't get me and system-level factors such as fragmented care, lack of insurance, and a low volume of transgender-competent clinicians contributed to transgender women's unmet health and education needs. Recommendations for improving transgender health care are provided.
Prevalence and Risk Factors of HIV-Associated Neurocognitive Disorders in Rural Southwestern Uganda
Authors: Namagga Jane Kasozi , Rukundo Godfrey Zari , Voss Joachim G.
Published: January 2019

Advances in treatment of HIV have dramatically improved survival rates; HIV-associated neurocognitive disorders (HAND), however, remain highly prevalent and continue to represent a significant public health problem, especially in resource-limited settings. We completed a cross-sectional study to describe the prevalence and risk factors for HAND in rural Southwestern Uganda AIDS Support Organization Centers. After securing ethical clearance from relevant bodies, 393 participants were screened for HAND using the International HIV Dementia Scale. A cutoff score of ≤10 and a significance level of p ≤ .05 were set. More than half of the 393 participants (n = 229, 58.23%) screened positive for HAND. The associated risk factors were gender (odds ratio [OR] 0.54, p = .017), peasant farming (OR 1.70, p = .04), and older age (OR 1.03, p = .019). HIV-associated neurocognitive disorder remains one of the major complications of HIV despite improvement in antiretroviral therapy and life expectancies.
Health Care Experiences of Youth Living With HIV Who Were Lost to Follow-up in Western Kenya
Authors: Wolf Hilary T. , Davidoff Katharine , Auerswald Colette L. , Halpern-Felsher Bonnie L. , Bukusi Elizabeth A. , Lyon Maureen , Cohen Craig R.
Published: January 2019

HIV is the leading cause of mortality for youth in sub-Saharan Africa. Youth are more likely than any other age group to be lost to follow-up (LTFU) from care. We investigated the health care–related experiences of youth living with HIV (YLWH) who were LTFU (i.e., had not returned to care for at least 4 months), as well as the perceptions of the community health workers who supported them. Data were collected from two focus group discussions with community health workers (n = 18) who worked with YLWH and 27 semistructured interviews with YLWH (ages 15–21 years) who were LTFU. Attitudes toward health care were presented in the context of a social–ecological model. Respondents highlighted the need for improved youth-oriented services, including youth-friendly clinics and training for care providers about specific needs of YLWH. Researchers should develop and test the impact of these interventions to improve retention of YLWH in care.
Physical Activity, Depression, and Antiretroviral Therapy Adherence Among People Living With HIV: A Mediation Analysis
Authors: Bhochhibhoya Amir , Qiao Shan , Mao Yuchen , Zhou Yuejiao , Shen Zhiyong , Sui Xuemei , Li Xiaoming
Published: January 2019

The aim of our study was to explore the relationships between physical activity, depression, and antiretroviral therapy (ART) adherence. Data were obtained from a randomized controlled trial of people living with HIV (N = 658) in China. Ordinal regression and logistic regression analyses were performed to examine associations between ART adherence, depression, and physical activity. A better ART adherence was associated with higher levels of physical activity (adjusted odds ratio [aOR] = 1.36, 95% confidence interval [CI] = 1.02–1.80) and lower levels of depression (aOR = 0.95, 95% CI = 0.92–0.99). Higher levels of physical activity were also associated with lower levels of depression (aOR = 0.50, 95% CI = 0.32–0.76). Sobel Z test indicated the mediating effect of depression between physical activity and ART adherence (Sobel Z = 1.96, p < .05). This study suggests the benefit of appropriate levels of physical activity to promote both psychological health and ART adherence in people living with HIV.
Predictors of Long‐term Clinical and Endoscopic Remission in Children With Crohn Disease Treated With Infliximab
Authors: D'Arcangelo Giulia , Oliva Salvatore , Dilillo Anna , Viola Franca , Civitelli Fortunata , Isoldi Sara , Cucchiara Salvatore , Aloi Marina
Published: January 2019

Objectives:

We aimed to identify early noninvasive predictors of clinical and endoscopic remission in children with Crohn disease (CD) under infliximab (IFX).

Methods:

Prospective observational study conducted in children with moderate‐to‐severe CD starting IFX. All patients underwent weighted pediatric CD activity index (wPCDAI) assessment, C‐reactive protein and fecal calprotectin (FC) at week 0, 14, and 48. Endoscopy was performed at 0 and 48 weeks. The primary outcome was to determine the ability of 14‐week wPCDAI, C‐reactive protein, and FC to predict 1‐year steroid‐free clinical remission and mucosal healing. As a secondary outcome we evaluated their concordance with Simple Endoscopic Score for CD (SES‐CD) at week 48.

Results:

Forty‐one children were enrolled. At 1 year, 21 (51%) and 16 (39%) were in clinical and endoscopic remission. Only combined postinduction FC and wPCDAI were able to predict 1‐year clinical and endoscopic remission (hazard ratio 4.81 [95% confidence interval 1.76–20.45], P = 0.05 and hazard ratio 5.51 [95% confidence interval 1.83–26.9], P = 0.03). One‐year SES‐CD moderately correlated with FC (r = 0.52; P = 0.001). The FC cut‐off value for mucosal healing was 120.5 μg/g (area under the curve 0.863, 83% sensitivity, 75.5% specificity; P = 0.005). The concordance between wPCDAI and SES‐CD was excellent and good for severe disease and remission (k 0.87 and 0.76).

Conclusions:

Post induction FC combined with wPCDAI can predict 1‐year clinical and endoscopic response to IFX in pediatric CD. FC shows a moderate correlation with SES‐CD, whereas wPCDAI has a good concordance with endoscopic remission or severe disease, but not with mild and moderate disease.
SOX10, GATA3, GCDFP15, Androgen Receptor, and Mammaglobin for the Differential Diagnosis Between Triple-negative Breast Cancer and TTF1-negative Lung Adenocarcinoma
Authors: Laurent Elodie , Begueret Hugues , Bonhomme Benjamin , Veillon Rémi , Thumerel Matthieu , Velasco Valérie , Brouste Véronique , Hoppe Stéphanie , Fournier Marion , Grellety Thomas , MacGrogan Gaëtan
Published: January 2019

Triple-negative breast cancer (TNBC) patients have an increased risk of developing visceral metastases and other primary nonbreast cancers, particularly lung cancer. The differential diagnosis of TNBC metastases and primary cancers from other organs can be difficult due to lack of a TNBC standard immunoprofile. We analyzed the diagnostic value of estrogen receptor, progesterone receptor, human epidermal growth factor receptor, thyroid transcription factor-1 (TTF1), Napsin A, mammaglobin, gross cystic disease fluid protein 15 (GCDFP15), Sry-related HMg-Box gene 10 (SOX10), GATA-binding protein 3 (GATA3), and androgen receptor in a series of 207 TNBC and 152 primary lung adenocarcinomas (LA). All tested TNBCs were TTF1 and Napsin A-negative. When comparing TNBC and TTF1-positive or negative LA, SOX10 had the best sensitivity (62.3%) and specificity (100%) as a marker in favor of TNBC compared with LA, irrespective of TTF1 status (P<0.0001). GATA3 had moderate sensitivity (30.4%) and excellent specificity (98.7%) and misclassified only 2/152 LA (1.3%). GCDFP15 had a moderate sensitivity (20.8%) and excellent specificity (98%) and misclassified only 3/152 (2%) LA. Mammaglobin and androgen receptor had moderate sensitivities (38.2% and 30%), good specificities (81.6% and 86%), and misclassified 28/152 and 21/152 LAs, respectively. In multivariate analysis, the best markers, enabling the distinction between SOX10-negative TNBC and TTF1 and Napsin A-negative LA were GATA3 (odds ratio=33.5; 95% confidence interval, 7.3-153.5; P<0.0001) and GCDFP15 (odds ratio=31.7; 95% confidence interval, 6.9-145.6; P<0.0001). Only 13/207 (6.3%) TNBC cases did not express any aforementioned marker. On the basis of our results, the best sequential immunohistochemical analysis to differentiate TNBC from TTF1-negative LA is first SOX10 followed by GATA3, and finally GCDFP15. This order is important in the diagnostic workup of small biopsies from lung nodules in women with a previous history of TNBC.
Artifacts and Artistic Facts
Authors: Ricci Vincenzo , Soylu Abdullah Ruhi , Özçakar Levent
Published: January 2019

For innumerous reasons, ultrasound imaging is becoming more and more popular in musculoskeletal medicine. Herewith, because this imaging technique is user dependent, prompt and sufficient training is crucial for its better clinical utility. In this regard, with this article, we aimed to focus on common artifacts that are observed in routine ultrasound scanning during daily musculoskeletal practice. However, those imaging findings need to be well recognized not to be misinterpreted. Likewise, we have illustrated and discussed those artifacts in similarity with particular natural photographs. Rather than exemplifying with the same physical principles, our purpose was to provide “visual analogy” for better remembrance of these artifacts.
Transoral Finger-Retraction for Endonasal Endoscopic Resection of Masseteric and Buccal Space Lesions
Authors: Husain Qasim , Otten Marc L. , Gudis David A.
Published: January 2019

Lesions involving the masseteric and buccal spaces have traditionally required transoral or transcervical approaches. Herein, the authors describe the successful endonasal endoscopic resection of a juvenile nasopharyngeal angiofibroma (JNA) with significant extension into the masseteric and buccal spaces facilitated by transoral finger retraction. Juvenile nasopharyngeal angiofibromas are hypervascular tumors originating in the pterygopalatine fossa (PPF) with complex relationships to skull base and orbital structures. Endoscopic approaches have allowed for resection of JNAs with excellent visualization and without traditional transfacial approaches, decreasing morbidity and reducing incidence of facial deformity with similar outcomes as open approaches. While the endonasal endoscopic approach to the masseteric and buccal spaces is unconventional, encapsulated tumors in these regions can be delivered into the nasal cavity through the maxilla and PPF with the use of transoral finger-retraction. The authors present a case of a 10-year-old male referred to their tertiary care center with left-sided epistaxis, nasal obstruction, and facial swelling. Imaging demonstrated a vascular lesion in the PPF involving the left nasal cavity and paranasal sinuses, with extension into left middle cranial fossa, infratemporal fossa, orbit, and deep spaces of the neck including the masticator, masseteric, and buccal spaces. The patient underwent preoperative embolization and endoscopic endonasal surgical resection with transoral finger-retraction without complication. Transoral finger-retraction represents a supplemental technique that allows for encapsulated lesions involving the masseteric and buccal spaces to be delivered into the nasal cavity for endoscopic resection in a safe and effective fashion, preventing the need for transfacial incisions.
Giant Tongue in a Patient With Chiari Malformation and Neuroleptic-Induced Tardive Dyskinesia
Authors: Horta Ricardo , Nascimento Ricardo , Silva Alvaro
Published: January 2019

A 68-year-old woman, presented with a squamous cell carcinoma of the malar region, and underwent wide local excision. During her clinical examination, repetitive protrusion and intrusion of the tongue as well as stereotypic, abnormal movements of the mouth and lips were observed, in a pattern that resembled chewing, sucking or lip pursing; dyskinesias ceased when she was speaking or bringing food to the mouth. She was unaware of the movements and the tongue was observed to move similar to choreiform movements, while revealing a giant “snake-like” macroglossia. She had history of mental retardation and alcohol abuse, and was under classic antipsychotic medications for several years. During a previous neurological investigation, type I Chiari malformation was diagnosed. In this case, concomitant Chiari malformation and neuroleptic-induced tardive dyskinesia, may together have been responsible for giant macroglossia, and to our best knowledege no similar observation has been reported in the literature.
Changes in Nasal Tip and Lateral Nostril Characteristics After the Semi-Tongue-in-Groove Technique in Open Rhinoplasty Surgery
Authors: Atighechi Saeid , Tari Niloofar , Baradaranfar Mohammadhossein , Dadgarnia Mohammadhossein , Zand Vahid , Meybodian Mojtaba , Mandegari Mohammad , Vaziribozorg Sedighe
Published: January 2019

Introduction:

This study aimed to evaluate postsurgical changes of nasal tip and lateral nostril characteristics after semi-tongue-in-groove (TIG) technique in open rhinoplasty surgery.

Materials and Methods:

This prospective observational study was performed in a before–after setting on 22 patients who underwent open rhinoplasty surgery using semi-TIG technique. Postoperative photographs were analyzed for nasal tip and lateral nostril changes at several time points (1, 4, and 12 weeks after surgery) and were compared with preoperative photographs. Nasal tip support change after the surgery was also assessed using a purpose-designed device.

Results:

In total, 22 patients were studied (20 females, 2 males). The tip support increased by 98%, 291.8%, and 377% at certain time points after the surgery. The tip rotation increased significantly at all measuring time points, postoperatively. The length of upper lip increased at all time points after semi-TIG technique. Columellar show and nostril length and height decreased significantly after the surgery.

Conclusion:

The characteristics of the nasal tip and lateral nostrils along with nasal tip support showed significant improvement after the semi-TIG technique. Therefore, this technique is recommended in selected rhinoplasty cases to achieve more favorable objective results.
Intraoperative Management by a Craniofacial Team Anesthesiologist is Associated With Improved Outcomes for Children Undergoing Major Craniofacial Reconstructive Surgery
Authors: Reddy Srijaya K. , Patel Roshan S. , Rogers Gary F. , Gordish-Dressman Heather , Keating Robert F. , Pestieau Sophie R.
Published: January 2019

The benefits of using a dedicated team for complex surgeries are well established for certain specialties, but largely unknown for others. The aim of this study was to determine whether management by a dedicated craniofacial team anesthesiologist would impact perioperative outcomes for children undergoing major surgery for craniosynostosis. Sixty-two children undergoing complex cranial vault reconstruction were identified. Fifty-four patients were managed by the craniofacial anesthesia team, while 8 patients were not. Primary outcome measures were calculated blood loss, red blood cell transfusion volume, blood donor exposures, extubation rate, and postoperative complication rate. Secondary outcome measures included intraoperative opioid administration, crystalloid and colloid administration, intraoperative complication rate, and intensive care unit (ICU) and hospital length of stay. Children cared for by the craniofacial team had significantly lower calculated blood loss, reduced red blood cell transfusion volume, fewer blood donor exposures, less crystalloid administration, higher rate of postoperative extubation, fewer postoperative complications, and decreased ICU and hospital length of stay than patients who were managed by noncraniofacial team anesthesiologists. There were no significant differences in demographics, opioid administration, colloid volume administration, or intraoperative complication rates between the 2 groups. Management by a craniofacial team anesthesiologist was associated with improved outcomes in children undergoing major craniofacial reconstructive surgery. While some variability can be attributed to provider-volume relationship, these findings suggest that children may benefit from a subspecialty anesthesia team-based approach for the management of craniofacial surgery, and potentially other similar high-risk cases.
Mandibular Augmentation With a New Sandwich Osteotomy: A Morphologic Study
Authors: Tan Wuyuan , Yu Bing , Niu Feng , Gui Lai
Published: January 2019

Objective:

Facial asymmetry is one of common complaints in plastic and craniofacial surgery in Orient. Hemimandibular dysplasia has considered to be the key role in facial asymmetry. Despite of the undergrow of mandibular length and height, the lackness of mandibular thickness contributes to the asymmetry. The aim of this study was to describe the therapeutic efficiency of mandibular augmentation with a new sandwich osteotomy with interpositional natural coral and coralline hydroxyapatite (CHA).

Methods:

Nine goats were randomly divided into 3 groups and observed at 6, 12, and 18 months after surgery. All goats received splitting of bilateral mandibular outer cortex and interpositional grafting with natural coral and CHA, respectively (sandwich osteotomy). Data were evaluated and statistically analyzed by t-test.

Results:

All goats were observed at 3 different time points. The computed tomography images show that the area of operation was healed and the thickness of the mandible was increased in 3 time points. In the 3 groups, mandibular thickness and volume were significantly different compared with those before operation (P < 0.05). The volume of CHA group improved better than coral group (P < 0.05).

Conclusion:

This study provides a promising alternative method for mandibular augmentation with a sandwich osteotomy and interpositional grafting with natural coral and CHA. The thickness and volume of mandible had been effectively increased in follow-ups.
Comparison of Olfactory Function and Quality of Life With Different Surgical Techniques for Nasal Septum Deviation
Authors: Aydoğdu Imran , Atar Yavuz , Aydoğdu Zeynep , Saltürk Ziya , Ataç Enes , Doğan Önder , Üstün Onur , Uyar Yavuz
Published: January 2019

Objective:

To assess the nasal functions, nasal resistance, olfactory function, and quality of life in different surgical techniques for nasal septum deviation

Study Design:

Randomized controlled trial.

Methods:

This prospective controlled study was carried out on patients who underwent septoplasty. Patients participating in the study were divided into 2 groups; group 1: classic septoplasty (n: 25) and group 2: extracorporeal septoplasty (n: 14). The sinonasal outcome test-22 (SNOT-22), peak nasal flowmetry, and Connecticut Chemosensory Clinical Research Center test were applied to all patients before and 8 weeks after surgery. Surgical outcomes also assessed to evaluate complications 6 months after surgery.

Result:

In total, 39 (27 males, 12 females) patients diagnosed with nasal septum deviation were included in this study. A septoplasty was performed in all patients: 25 of them (18 males, 7 females; mean age = 29.4 [range, 23–50] years) underwent classic septoplasties and 14 (9 males, 5 females; mean age = 31.3 [range, 23–50] years) underwent extracorporeal septoplasties. Airway openness was achieved in all patients. As a result, the SNOT-22 scores, peak nasal inspiratory flowmeter results, and smell function scores showed significant improvements (P < 0.001).

Conclusion:

All corrective surgical methods for a septum deviation have positive effects on nasal airflow, quality of life, and olfaction. The rates of complications were not significantly different between 2 treatment groups.
The Effect of Anchoring the Columellar Strut Graft to the Lateral Crural Steal Suture in Patients With a Low Nasal Tip: A New Technique
Authors: Cetiner Hasan
Published: January 2019

Objective:

The achievement of consistently superior results in rhinoplasty is difficult. This study aimed to evaluate the effect of anchoring the columellar strut graft to the thread of the lateral crural steal for nasal tip projection and rotation.

Study Design:

A retrospective, case-control study.

Methods:

Two groups were created which consisted of patients who had a history of low nasal tip deformity according to the type of nasal tip surgery in rhinoplasty. In group 1, the lateral crural steal technique with the strut graft was used, whereas in group 2, a new technique, in which the strut graft was anchored to the thread of the lateral crural steal, was used. Patients with low nasal tip deformity due to intrinsic factors such as long lateral crura were included. The effects of the 2 different surgical approaches on facial parameters (the nasolabial angle, nasofacial angle, and Goode ratio) were statistically compared using the Mann–Whitney U test and Student t test, as applicable.

Results:

Sixty patients were enrolled: half of them were included in group 1 and the other half in group 2. Average postoperative increases of the nasolabial angle score were 10.9 ± 4.72° and 18.76 ± 6.30° in groups 1 and 2, respectively (P < 0.001). Average improvements of the nasofacial angle were 2.33 ± 2.12° and 3.50 ± 2.44° in groups 1 and 2, respectively (P = 0.053). Average postoperative increases of the Goode ratio were 0.02 ± 0.02 in group 1 and 0.04 ± 0.03 in group 2 (P = 0.028).

Conclusion:

The new technique provided a prominent nasal cephalic rotation with a strong effect on the nasolabial angle and a partial effect on nasal projection.
Laparoscopic Approach to Large Bowel Neoplastic Obstruction After Self-Expandable-Metal-Stent (SEMS) Placement
Authors: Berselli Mattia , Borroni Giacomo , Livraghi Lorenzo , Quintodei Valeria , Sambucci Daniele , Cortelezzi Claudio , Segato Sergio , Carcano Giulio , Cocozza Eugenio
Published: January 2019

Endoscopic self-expandable metal stent (SEMS) placement as a bridge to surgery in large bowel neoplastic obstruction is an alternative to emergency surgery for the obstructive colorectal neoplasms. This study aims to analyze postoperative and long-term outcomes in a series of patients who underwent laparoscopic colorectal resection after SEMS placement. The analysis, after the stratification based on the time elapsed between the onset of the occlusive symptoms and the SEMS positioning, revealed an interesting result, with lower mortality for patients who underwent the procedure within 24 hours of hospitalization (P=0.0159). This trend may indicate the need to reduce the endoscopic time schedules as much as possible, even if an emergency procedure is needed. The laparoscopic approach, after stent placement as bridge therapy, can be a safe alternative to emergency surgery, if the procedure is precociously applied.
ModellingTERTregulation across 19 different cancer types based on the MIPRIP 2.0 gene regulatory network approach
Authors: Poos Alexandra M. , Kordaß Theresa , Kolte Amol , Ast Volker , Oswald Marcus , Rippe Karsten , König Rainer
Published: January 2019

Background

Reactivation of the telomerase reverse transcriptase geneTERTis a central feature for the unlimited proliferation potential of the majority of cancers but the underlying regulatory processes are only partly understood.

Results

We assembled regulator binding information from different sources to construct a generic human and mouse regulatory network. Advancing our “Mixed Integer linear Programming based Regulatory Interaction Predictor” (MIPRIP) approach, we identified the most common and cancer-type specific regulators ofTERTacross 19 different human cancers. The results were validated by using the well-knownTERTregulation by the ETS1 transcription factor in a subset of melanomas with mutations in theTERTpromoter.

Conclusion

Our improved MIPRIP2 R-package and the associated generic regulatory networks are freely available athttps://github.com/network-modeling/MIPRIP. MIPRIP 2.0 identified both common as well as tumor type specific regulators ofTERT. The software can be easily applied to transcriptome datasets to predict gene regulation for any gene and disease/condition under investigation.
Neural Mediators of Altered Perceptual Choice and Confidence Using Social Information
Authors: Roy Tiasha Saha , Giri Bapun , Chowdhury Arpita Saha , Mazumder Satyaki , Das Koel
Published: January 2019

Understanding how individuals utilize social information while making perceptual decisions and how it affects their decision confidence is crucial in a society. Till date, very little is known about perceptual decision making in humans under the influence of social cues and the associated neural mediators. The present study provides empirical evidence of how individuals get manipulated by social cues while performing a face/car identification task. Subjects were significantly influenced by what they perceived as decisions of other subjects while the cues in reality were manipulated independently from the stimulus. Subjects in general tend to increase their decision confidence when their individual decision and social cues coincide, while their confidence decreases when cues conflict with their individual judgments often leading to reversal of decision. Using a novel statistical model, it was possible to rank subjects based on their propensity to be influenced by social cues. This was subsequently corroborated by analysis of their neural data. Neural time series analysis revealed no significant difference in decision making using social cues in the early stages unlike neural expectation studies with predictive cues. Multivariate pattern analysis of neural data alludes to a potential role of frontal cortex in the later stages of visual processing which appeared to code the effect of social cues on perceptual decision making. Specifically medial frontal cortex seems to play a role in facilitating perceptual decision preceded by conflicting cues.
Capturing the Diversity of Subsurface Microbiota – Choice of Carbon Source for Microcosm Enrichment and Isolation of Groundwater Bacteria
Authors: Wu Xiaoqin , Spencer Sarah , Alm Eric J. , Voriskova Jana , Chakraborty Romy
Published: January 2019

Improved and innovative enrichment/isolation techniques that yield to relevant isolates representing the true diversity of environmental microbial communities would significantly advance exploring the physiology of ecologically important taxa in ecosystems. Traditionally, either simple organic carbon (C) or yeast extract is used as C source in culture medium for microbial enrichment/isolation in laboratory. In natural environment, however, microbial population and evolution are greatly influenced by the property and composition of natural organic C. In this study, 8 types of organic C sources were fed to intrinsic groundwater microbes collected at Oak Ridge Reservation Field Research Center (ORR-FRC) background site for a 30-day incubation period to investigate the response of indigenous bacterial communities to different C sources. The tested C sources included simple organic C (glucose, acetate, benzoate, oleic acid, and cellulose) that are either traditionally used as C source in bacterial culture medium or present in natural environments; naturally occurring undefined complex C (bacterial cell lysate and sediment-derived natural organic matter (NOM)); as well as vitamin mixture which is a commonly used ingredient in culture medium. Our results clearly indicate that natural complex C substrates served better in enriching diverse bacteria compared to other C sources. Microcosms amended with small organic C (glucose, acetate, benzoate, or oleic acid) showed significantly lower biodiversity than control groups, dominated by only a few phyla of bacteria such as Proteobacteria and Bacteroidetes which are commonly isolated and already have diverse representative isolates, while those amended with natural complex C (cell lysate or NOM) displayed significantly higher biodiversity than control groups, in which three phyla (Verrucomicrobia, Planctomycetes, and Armatimonadetes) that are poorly represented in published culture collections were abundantly enriched. Further isolation of pure bacterial strains from complex C-amended enrichments led to 51 species representing 4 phyla, 13 orders. Furthermore, 5 isolates with low similarities to published strains were considered to be novel. Results from this study will aid in the design of better cultivation and isolation strategy for maximize the diversity of organisms recovered from subsurface environment.