bluuebunny/crossref_metadata_2025 huggingface dataset:
Short‐stay hospital admission after free tissue transfer for head and neck reconstruction
Authors: Devine Conor M. , Haffey Timothy M. , Trosman Samuel , Fritz Michael A.
Published: July 2016

Objectives/Hypothesis

To show that, for patients with few medical comorbidities and at low risk for airway compromise or fistula formation, early discharge after free tissue transfer for head and neck reconstruction is a safe and viable option.

Study Design

Retrospective chart review.

Methods

A cohort of patients who underwent free tissue transfer for head and neck reconstruction between February 2010 and December 2014 and who were discharged from the hospital by postoperative day 3 were reviewed.

Results

Fifty patients undergoing 51 free‐tissue transfer surgeries were discharged by postoperative day 3. The surgeries performed included anterolateral thigh free flaps (ALT) (n = 46), radial forearm free flaps (n = 2), latissimus myogenous and myocutaneous free flaps (n = 1), supraclavicular free flap (n = 1), and serratus free flap (n = 1). All ALT flaps were harvested exclusively as perforator free flaps; and the vast majority used superficial temporal, angular, or facial vessels. All free flaps were viable without evidence of vascular compromise at discharge and the initial follow‐up appointment.

One patient required take‐back for successful flap salvage. One patient experienced late flap failure (between 2–3 weeks postoperatively), requiring another surgery. This resulted in an overall success rate of 98% in this cohort. No other postoperative complications related to early discharge were identified.

Conclusion

In a carefully selected subset of patients undergoing free tissue transfer, early discharge has been shown to be possible without compromising patient safety or surgery success rates.

Level of Evidence

4. Laryngoscope, 126:2679–2683, 2016
A direct approach to quaternionic manifolds
Authors: Gentili Graziano , Gori Anna , Sarfatti Giulia
Published: July 2016

The recent definition of slice regular function of several quaternionic variables suggests a new notion of quaternionic manifold. We give the definition of quaternionic regular manifold, as a space locally modeled on , in a slice regular sense. We exhibit some significant classes of examples, including manifolds which carry a quaternionic affine structure.
Convergence for a family of neural network operators in Orlicz spaces
Authors: Costarelli Danilo , Vinti Gianluca
Published: July 2016

In this paper, we develop the theory for a family of neural network (NN) operators of the Kantorovich type, in the general setting of Orlicz spaces. In particular, a modular convergence theorem is established. In this way, we study the above family of operators in many instances of useful spaces by a unique general approach. The above NN operators provide a constructive approximation process, in which the coefficients, the weights, and the thresholds of the networks needed in order to approximate a given function f, are known. At the end of the paper, several examples of Orlicz spaces, and of sigmoidal activation functions for which the present theory can be applied, are studied in details.
Permittivity and loss characteristics of SU8‐quartz composite photoresist at THz frequencies
Authors: Kim Jung‐Mu , Llamas‐Garro Ignacio , Espinosa‐Espinosa Moisés I. , Ke Maolong , Lancaster Michael , de Melo Marcos T.
Published: July 2016

An SU8‐quartz composite photoresist has been fabricated and characterized from 1.2 to 1.4 THz; the material contains quartz particles from 0 to 50 wt%. The composite can reduce the inherent losses of SU8 photoresist at terahertz frequencies. Calculated and measured data is presented and compared with SU8 without quartz inclusions. The results show a reduction in losses and an increase in permittivity in the composite material as the density of quartz particles increases. This initial experiment proves the possibility of modifying the electrical parameters of SU8; increasing the quartz density of the composite will modify these parameters further at THz frequencies. © 2016 Wiley Periodicals, Inc. Microwave Opt Technol Lett 58:2329–2330, 2016
Reduced‐size gysel power dividers using lumped‐element components
Authors: Tang Bo , Hayashi Hitoshi , Ueda Ryo
Published: July 2016

This letter presents two novel prototypes of reduced‐size Gysel power dividers using 90° and ±180° lumped‐element components. The first design is a Gysel power divider using 90° and 180° lumped‐element components. The ideal divider designed at a frequency of 590 MHz exhibits power splits of −3.2 ± 0.2 dB and return losses of greater than 15 dB for the frequency range of 530 to 710 MHz. The second design is a Gysel power divider using 90° and −180° lumped‐element components. The ideal divider designed at a frequency of 590 MHz exhibits power splits of −3.2 ± 0.2 dB and return losses of greater than 15 dB for the frequency range of 520 to 700 MHz. To verify the purposed designs, two miniaturized broadband Gysel power dividers were simulated, fabricated, and measured. The sizes of both proposed Gysel power dividers are reduced to 3.1 cm × 3.2 cm. © 2016 Wiley Periodicals, Inc. Microwave Opt Technol Lett 58:2341–2344, 2016
Metamaterial loaded vivaldi antenna with high gain and equal beamwidths at KA band
Authors: Tan Guan‐Nan , Yang Xue‐Xia , Lu Zhong‐Liang , Jiang Xin‐Sheng
Published: July 2016

A high gain and broadband Vivaldi antenna with end‐fire and equal beamwidth radiation pattern at Ka band is presented in this paper. The Vivaldi slot is fed by the microstrip line‐to‐substrate integrated waveguide (SIW) transformer. The SIW transmission performance is enhanced by another row of metal vias beside the original one. On both sides of the Vivaldi conductor planes, 8 parallel slots with gradually increasing length are etched to improve the front‐to‐back ratios. Under the microstrip feed line, three pairs of split ring resonators (SRRs) are etched on the ground to suppress the secondary harmonic. In order to improve the antenna gain and obtain the equal E‐ and H‐plane beamwidths, the special designed zero‐epsilon metamaterial (ZEM) units are loaded on the Vivaldi slot with a maximum gain increment of 3.4dB being obtained. The antenna exhibits a broad bandwidth of 38.5% at 35GHz ranging from 26.5GHz to 40GHz with the reflection coefficient less than −10dB, and the gain varying between 9.7dBi and 12.2dBi. The proposed antenna is fabricated and measured to validate the design. The measured results are in good agreement with the simulated ones. © 2016 Wiley Periodicals, Inc. Microwave Opt Technol Lett 58:2337–2341, 2016
Comparative analysis of microwave low‐noise amplifiers under laser illumination
Authors: Caddemi Alina , Cardillo Emanuele , Crupi Giovanni
Published: July 2016

This article deals with the analysis of the effects of 650 nm laser light exposure of AlGaAs/GaAs HEMTs employed in X‐band low‐noise amplifiers (LNAs). The devices have scaled gate widths of 100, 200, and 300 μm and a gate length of 0.25 μm. They were characterized under dark and illuminated conditions through scattering and noise parameter measurements in the 2–18 GHz frequency range. Starting from the experimental data, LNAs have then been designed and tailored to each device type in dark mode operation over the 7.5–8.5 GHz frequency range. Subsequently, the performance of the LNAs under light exposure has been evaluated by employing the illuminated device data. Therefore, a comparative analysis of the observed variations is here reported to assess the influence of the red laser beam on the amplifier's response with a special concern for the noise behavior due to the inherent interest in optical control of microwave circuitry for high‐data‐rate, low‐noise telecommunication systems. © 2016 Wiley Periodicals, Inc. Microwave Opt Technol Lett 58:2437–2443, 2016
A new design method of the unequal Wilkinson power divider using an arbitrarily resistor value
Authors: Lee Daeung , Do Hanju , Jang Youna , Kim Heehwang , Han Sang‐Min , Lim Jongsik , Choi Kwansun , Ahn Dal
Published: July 2016

In this article, we suggest a new design method of the unequal Wilkinson power divider. The line impedances of the proposed formula are decided after the resistor value is arbitrarily chosen, while the isolation resistor of the conventional unequal Wilkinson power divider is derived by the power ratio. Therefore, using the proposed formula, the more accurate resistor value is applicable to the Wilkinson power divider, and a narrow line width is improved up to 46.5% in 10:1 Wilkinson power divider. The proposed design formula of the Wilkinson power divider is derived, and the proposed formula is verified by the fabrication and measurement results. © 2016 Wiley Periodicals, Inc. Microwave Opt Technol Lett 58:2450–2452, 2016
Numerical de‐embedding and experimental validation of propagation properties of corrugated substrate integrated waveguide
Authors: Liu Zheng , Xiao Gaobiao , Zhu Lei
Published: July 2016

In this article, a corrugated substrate integrated waveguide (CSIW) with no metallic vias is proposed, and its propagation characteristics are theoretically investigated via our numerical short‐open calibration (SOC) de‐embedding method. In our analysis, dominant operating modes in this CSIW at different frequencies are extensively discussed. Its complex propagation constant is derived to demonstrate its frequency‐dispersive transmission and attenuation performance. Then, the design rules are described to analyze and design CSIW line. In final, the fabricated CSIW with the microstrip‐line feeders are measured to validate the numerically de‐embedded attenuation constant over a wide frequency range. © 2016 Wiley Periodicals, Inc. Microwave Opt Technol Lett 58:2456–2460, 2016
A 2.45‐GHz frequency‐selective rectenna for wireless energy harvesting
Authors: Ashtari Reza , Baginski Michael , Dean Robert
Published: July 2016

In this article a novel 2.45‐GHz ISM rectenna is presented. The linearly polarized rectenna uses two square patch antennas matched using a frequency selective surface before a dual diode rectification in series with the load resistance. Measurements showed a broad angle of energy reception and 79% RF‐to‐DC conversion efficiency. © 2016 Wiley Periodicals, Inc. Microwave Opt Technol Lett 58:2508–2512, 2016
Tunable matching network for accurate impedance measurement of on‐chip and PCB millimeter‐wave antennas
Authors: Sandoval Granados L. K. , Murphy Arteaga R. S.
Published: July 2016

A tunable matching network is proposed to match antenna to ground‐signal‐ground probes allowing antennas measurement without further analysis or additional test structures. Excellent correlation for proposed model is achieved when compared with numerical electromagnetic analysis tool and one port S‐parameters measurements for millimeter‐wave on‐wafer and printed circuit board (PCB) antennas. © 2016 Wiley Periodicals, Inc. Microwave Opt Technol Lett 58:2516–2518, 2016
Evidence for dying‐back axonal degeneration in age‐associated skeletal muscle decline
Authors: Chung Tae , Park Jae Sung , Kim Sangri , Montes Nataly , Walston Jeremy , Höke Ahmet
Published: July 2016

Introduction

Age‐associated muscle strength decline is a major contributing factor to increased late‐life functional decline and comorbidity, and is strongly associated with early mortality. Although all parts of the neuromuscular system seem to be affected by aging, dying‐back of motor axons likely plays a major role.

Methods

We compared the degeneration in ventral roots and neuromuscular junction denervation in young and aged mice and correlated the findings with strength and electrophysiological measures.

Results

With normal aging, there is little decline in motor axon numbers in the ventral roots, but the neuromuscular junctions show marked partial denervation that is associated with increased jitter on stimulated single fiber electromyography and a decrease in muscle strength.

Conclusions

These findings suggest that dying‐back axonal degeneration may be partially responsible for the electrophysiological and strength changes observed with aging. Muscle Nerve 55: 894–901, 2017
Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications
Authors: Rac Goran , Younger Austin , Clemens James Q. , Kobashi Kathleen , Khan Aqsa , Nitti Victor , Jacobs Ilana , Lemack Gary E. , Brown Elizabeth T. , Dmochowski Roger , MacLachlan Lara , Mourtzinos Arthur , Ginsberg David , Koski Michelle , Rames Ross , Rovner Eric S.
Published: July 2016

Aims

To investigate the possible effects of the Food and Drug Administration (FDA) Public Health Notifications in 2008 and 2011 regarding surgical trends in transvaginal mesh (TVM) placement for stress urinary incontinence (SUI) and related mesh revision surgery in Female Pelvic Medicine & Reconstructive Surgery (FPMRS) practice in tertiary care academic medical centers in the United States.

Methods

Surgical volume for procedures performed primarily by FPMRS surgeons at eight academic institutions across the US was collected using Current Procedural Terminology (CPT) codes for stress urinary incontinence repair and revision surgeries from 2007 to 2013. SAS statistical software was used to assess for trends in the data.

Results

There was a decrease in the use of synthetic mesh sling for the treatment of SUI at academic tertiary care centers over the past 7 years; however, this was not statistically significant. While the total number of surgical interventions for SUI remained stable, there was an increase in the utilization of autologous fascia pubovaginal slings (AFPVS). The number of mesh sling revision surgeries, including urethrolysis and removal or revision of slings, increased almost three‐fold at these centers.

Conclusions

These observed trends suggest a possible effect of the FDA Public Health Notifications regarding TVM on surgical practice for SUI in academic centers, even though they did not specifically warn against the use of synthetic mesh for this indication. Indications for surgery, complications, and outcomes were not evaluated during this retrospective study. However, such data may provide alternative insights into reasons for the observed trends. Neurourol. Urodynam. 36:1155–1160, 2017. © 2016 Wiley Periodicals, Inc.
Multi‐level hp‐adaptivity for cohesive fracture modeling
Authors: Zander Nils , Ruess Martin , Bog Tino , Kollmannsberger Stefan , Rank Ernst
Published: July 2016

Discretization‐induced oscillations in the load–displacement curve are a well‐known problem for simulations of cohesive crack growth with finite elements. The problem results from an insufficient resolution of the complex stress state within the cohesive zone ahead of the crack tip. This work demonstrates that the hp‐version of the finite element method is ideally suited to resolve this complex and localized solution characteristic with high accuracy and low computational effort. To this end, we formulate a local and hierarchic mesh refinement scheme that follows dynamically the propagating crack tip. In this way, the usually applied static a priori mesh refinement along the complete potential crack path is avoided, which significantly reduces the size of the numerical problem. Studying systematically the influence of h‐refinement, p‐refinement, and hp‐refinement, we demonstrate why the suggested hp‐formulation allows to capture accurately the complex stress state at the crack front preventing artificial snap‐through and snap‐back effects. This allows to decrease significantly the number of degrees of freedom and the simulation runtime. Furthermore, we show that by combining this idea with the finite cell method, the crack propagation within complex domains can be simulated efficiently without resolving the geometry by the mesh. Copyright © 2016 John Wiley & Sons, Ltd.
Rasch analysis of Stamps's Index of Work Satisfaction in nursing population
Authors: Ahmad Nora , Oranye Nelson Ositadimma , Danilov Alyona
Published: July 2016

Aim

One of the most commonly used tools for measuring job satisfaction in nursing is the Stamps Index of Work Satisfaction. Several studies have reported on the reliability of the Stamps' tool based on traditional statistical model. The aim of this study was to apply the Rasch model to examine the adequacy of Stamps's Index of Work Satisfaction for measuring nurses' job satisfaction cross‐culturally and to determine the validity and reliability of the instrument using the Rasch criteria.

Design

A secondary data analysis was conducted on a sample of 556 registered nurses from two countries.

Methods

The RUMM 2030 software was used to analyse the psychometric properties of the Index of Work Satisfaction.

Results

The persons mean location of ‐0.018 approximated the items mean of 0.00, suggesting a good alignment of the measure and the traits being measured. However, at the items level, some items were misfiting to the Rasch model.
Body mass index: Has epidemiology started to break down causal contributions to health and disease?
Authors: Corbin Laura J. , Timpson Nicholas J.
Published: July 2016

Objectives

To review progress in understanding the methods and results concerning the causal contribution of body mass index (BMI) to health and disease.

Methods

In the context of conventional evidence focused on the relationship between BMI and health, this review considers current literature on the common, population‐based, genetic contribution to BMI and how this has fed into the developing field of applied epidemiology.

Results

Technological and analytical developments have driven considerable success in identifying genetic variants relevant to BMI. This has enabled the implementation of Mendelian randomization to address questions of causality. The product of this work has been the implication of BMI as a causal agent in a host of health outcomes. Further breakdown of causal pathways by integration with other “omics” technologies promises to deliver additional benefit.

Conclusions

Gaps remain in our understanding of BMI as a risk factor for health and disease, and while promising, applied genetic epidemiology should be considered alongside alternative methods for assessing the impact of BMI on health. Potential limitations, relating to inappropriate or nonspecific measures of obesity and the improper use of genetic instruments, will need to be explored and incorporated into future research aiming to dissect BMI as a risk factor.
Inverse association between carbohydrate consumption and plasma adropin concentrations in humans
Authors: Stevens Joseph R. , Kearney Monica L. , St‐Onge Marie‐Pierre , Stanhope Kimber L. , Havel Peter J. , Kanaley Jill A. , Thyfault John P. , Weiss Edward P. , Butler Andrew A.
Published: July 2016

Objective

The role of metabolic condition and diet in regulating circulating levels of adropin, a peptide hormone linked to cardiometabolic control, is not well understood. In this study, weight loss and diet effects on plasma adropin concentrations were examined.

Methods

This report includes data from (1) a weight loss trial, (2) an evaluation of acute exercise effects on mixed‐meal (60% kcal from carbohydrates) tolerance test responses, and (3) a meta‐analysis to determine normal fasting adropin concentrations.

Results

Distribution of plasma adropin concentrations exhibited positive skew and kurtosis. The effect of weight loss on plasma adropin concentrations was dependent on baseline plasma adropin concentrations, with an inverse association between baseline and a decline in concentrations after weight loss (Spearman's ρ = −0.575; P < 0.001). When ranked by baseline plasma adropin concentrations, only values in the upper quartile declined with weight loss. Plasma adropin concentrations under the main area of the bell curve correlated negatively with habitual carbohydrate intake and plasma lipids. There was a negative correlation between baseline values and a transient decline in plasma adropin during the mixed‐meal tolerance test.

Conclusions

Plasma adropin concentrations in humans are sensitive to dietary macronutrients, perhaps due to habitual consumption of carbohydrate‐rich diets suppressing circulating levels. Very high adropin levels may indicate cardiometabolic conditions sensitive to weight loss.
Mechanical properties of phenol/formaldehyde resin composites reinforced by cellulose microcrystal with different aspect ratio extracted from sisal fiber
Authors: Wei Chun , Wang Wu , Liu Hongxia , Qin Aimiao , Yu Chuanbai , Wang Bo
Published: July 2016

Sisal cellulose fiber (SCF) and sisal fiber cellulose microcrystal (SFCM), produced with sulfate pulping method and ball‐milling approach separately, were in‐situ polymerized and dispersed into phenol/formaldehyde (PF) resin, to manufacture SCF/PF and SFCM/PF composites via rolling and molding method and investigate the effect of SCF and SFCM on the impact, flexural, and dynamic mechanical properties of the SCF/PF and SFCM/PF composites. As a result, under the condition of same content, SFCM could preferably enhance these properties maybe resulting from the better dispersion in resin matrix than SCF. In particular, when SFCM content was 7%, the impact strength and equilibrium relaxation modulus of the SFCM/PF composite were increased by 26.5% and 37.7%, while the creep deformation was decreased by 26.5%. In addition, when SFCM content was 5%, the flexural strength, initial storage modulus and glass transition temperature of SFCM/PF composite were increased by 8.5%, 22.6%, and 13°C. Copyright © 2016 John Wiley & Sons, Ltd.
Treatment of children with acute lymphoblastic leukemia with risk group based intensification and omission of cranial irradiation: A Korean study of 295 patients
Authors: Lee Jae Wook , Kim Seong‐koo , Jang Pil‐Sang , Jeong Dae‐Chul , Chung Nack‐Gyun , Cho Bin , Kim Hack‐Ki
Published: July 2016

Background

Recent studies indicate 70–80% event‐free survival (EFS) for pediatric acute lymphoblastic leukemia (ALL). In this study, we report the outcome of 295 children and adolescents treated at our institution, with stratification into four risk groups, and omission of cranial irradiation in all patients.

Procedure

Patients were diagnosed from January 2005 to December 2011 and classified and treated as low, standard, high, and very high risk groups. A delayed intensification phase was given twice for high and very high risk groups. None of the patients received cranial irradiation for central nervous system (CNS) prophylaxis.

Results

The 10‐year EFS and overall survival (OS) were 78.5 ± 2.5% and 81.9 ± 2.7%, respectively. EFS according to risk group was as follows: low risk 91.2 ± 3.7%, standard risk 98.1 ± 1.9%, high risk 81.5 ± 4.3%, very high risk 59.4 ± 5.3%. In a multivariate analysis, high hyperdiploidy and infant ALL were significant predictors of EFS. Cumulative incidence of any relapse, isolated CNS relapse, and any CNS relapse were 17.1 ± 2.3%, 1.5 ± 0.7%, and 2.3 ± 0.9%, respectively. Other events included infection‐related deaths during remission induction chemotherapy (3), primary refractory disease (2), and treatment‐related deaths in first complete remission (8).

Conclusions

In this single‐institution study of Korean pediatric ALL patients, risk group based intensification with omission of cranial irradiation resulted in EFS comparable to previous studies, excellent survival of low‐ and standard‐risk patients, and a low rate of CNS relapse.
Thermal and mechanical properties of ureaurethane elastomer composites with hollow glass spheres
Authors: Mizera Kamila , Chrząszcz Michał , Ryszkowska Joanna
Published: July 2016

Polyurethane elastomers (PUR) are used for the production of components subjected to abrasion. In many of these applications, the strength of polyurethane elastomers is not sufficient in spite of their modifications. In use PUR deteriorate as a result of mechanical and/or thermal degradation due to high loads and heat accumulation. To increase the strength properties of PUR and limit the accumulation of energy in the deformable material it is proposed to introduce to the PUR hollow glass spheres (HGSs). As part of the study the effect of these fillers on the properties of ureaurethanes was assessed. The resulting composites were characterized using thermal analysis techniques (DSC, TGA, and DMA), the chemical constitution was described via FTIR and the structure with use of SEM. The results of investigations of strength and tribological properties were presented. The filler is combined with the matrix by hydrogen bonding forming an additional cross‐linking of the macromolecules. Introduction of HGSs reduces the ability of the composites to suppress vibrations. POLYM. COMPOS., 39:2019–2028, 2018. © 2016 Society of Plastics Engineers
Modeling Wear in Cylinder Liners
Authors: Hermann Simone , Ruggeri Fabrizio
Published: July 2016

We present and discuss a stochastic model describing the wear process of cylinder liners in a marine diesel engine. The model is based on a stochastic differential equation, and Bayesian inference is illustrated. Corrosive action and measurement error, both quite negligible, are modeled with a Wiener process whereas a jump process is used to describe the contribution of soot particles to the wear process. The model can be used to forecast the wear process and, consequently, plan condition‐based maintenance activities. In the paper, we provide a critical illustration of the mathematical and computational aspects of the model. We propose a strategy that, implemented for simulated and real data, allows for stable parameter estimation and forecasts. Copyright © 2016 John Wiley & Sons, Ltd.
An advanced ionizing radiation monitoring network based on using SrI2(Eu)/MPPC module
Authors: Nagai Shigekazu , Kawamura Ken , Kimura Yoshihide , Yoshii Junji , Ikeda Renzo , Shimizu Ryuichi
Published: July 2016

An advanced ionizing radiation monitoring network (AIRMN) system using a single‐crystal SrI2(Eu) scintillator has been developed. The SrI2(Eu)‐scintillator (25 mmφ × 25 mm) has excellent material properties, including a high light yield (>80 000 photons/MeV), a high photoelectric cross section, and high energy resolution (<4%). The system has a multi‐pixel photon counter as a light detector. The resolution and sensitivity of the new AIRMN allow the radioactive Cs originating from the Fukushima Daiichi Nuclear Power Plant accident to be distinguished from other radioactive species, leading to the precise assessment of the ambient dose originating from 134Cs and 137Cs radiation. Furthermore, a software platform is described that is adopted in the AIRMN and based on the use of the ANSI N42‐42 Data File Format published by the National Institute of Standards and Technology. It allows for the standardization of ionizing radiation monitoring. Copyright © 2016 John Wiley & Sons, Ltd.
Infant circumcision and adult penile sensitivity: implications for sexual experience
Authors: Earp Brian D.
Published: July 2016

A recent study reported that neonatal circumcision is not associated with changes in adult penile sensitivity, leading to viral coverage in both traditional and online media. In this commentary the author questions the conclusions drawn from the study and explores the relationship between objective assessments of penile sensitivity and subjective sexual experience and satisfaction. The author concludes with suggestions for improving future research.
John Pryor: at the forefront of andrology
Authors: Hodgson Dominic
Published: July 2016

John Pryor, known to many as ‘JP’, was at the forefront of the specialty of andrology. As Dominic Hodgson describes, he played an important part in the significant developments in the management of both erectile dysfunction and infertility.
Temporary Intraoperative Porto‐Caval Shunts in Piggy‐Back Liver Transplantation Reduce Intraoperative Blood Loss and Improve Postoperative Transaminases and Renal Function: A Meta‐Analysis
Authors: Pratschke Sebastian , Rauch Alexandra , Albertsmeier Markus , Rentsch Markus , Kirschneck Michaela , Andrassy Joachim , Thomas Michael , Hartwig Werner , Figueras Joan , Del Rio Martin Juan , De Ruvo Nicola , Werner Jens , Guba Markus , Weniger Maximilian , Angele Martin K.
Published: July 2016

Background

The value of temporary intraoperative porto‐caval shunts (TPCS) in cava‐sparing liver transplantation is discussed controversially. Aim of this meta‐analysis was to analyze the impact of temporary intraoperative porto‐caval shunts on liver injury, primary non‐function, time of surgery, transfusion of blood products and length of hospital stay in cava‐sparing liver transplantation.

Methods

A systematic search of MEDLINE/PubMed, EMBASE and PsycINFO retrieved a total of 909 articles, of which six articles were included. The combined effect size and 95 % confidence interval were calculated for each outcome by applying the inverse variance weighting method. Tests for heterogeneity (I2) were also utilized.

Results

Usage of a TPCS was associated with significantly decreased AST values, significantly fewer transfusions of packed red blood cells and improved postoperative renal function. There were no statistically significant differences in primary graft non‐function, length of hospital stay or duration of surgery.

Conclusion

This meta‐analysis found that temporary intraoperative porto‐caval shunts in cava‐sparing liver transplantation reduce blood loss as well as hepatic injury and enhance postoperative renal function without prolonging operative time. Randomized controlled trials investigating the use of temporary intraoperative porto‐caval shunts are needed to confirm these findings.
Pleural Empyema Following Liver Resection: A Rare But Serious Complication
Authors: Goumard Claire , Fuks David , Cauchy François , Belghiti Jacques , Paugam‐Burtz Catherine , Castier Yves , Soubrane Olivier
Published: July 2016

Background

Postoperative pleural empyema following liver resection has not been thoroughly described in the literature yet. Hence, we aimed to describe characteristics of patients experiencing this complication.

Methods

Characteristics and outcomes of 21 patients who developed pleural empyema after hepatectomy, defined as a bacteriologically proven pleural infection with clinical and biological inflammatory signs requiring antibiotherapy and thoracic drainage, from 2001 to 2014, were retrospectively analyzed.

Results

Overall incidence of pleural empyema was 1 %. Nineteen (90.5 %) patients underwent right or extended right hepatectomy. All 21 patients developed postoperatively pleural effusion and 13 (62 %) infected abdominal collection. They had significantly more bile leakage and intra‐abdominal abscesses compared to a matched control group of patients undergoing a right hepatectomy. Accidental diaphragmatic opening was observed in six patients (intra‐operatively n = 4, transdiaphragmatic abdominal drainage n = 2). Treatment included percutaneous pleural drainage and in six (29 %) patients a thoracotomy for surgical drainage. Three patients (14 %) died due to sepsis and multiorgan failure. No patient treated by thoracotomy died postoperatively.

Conclusion

Postoperative pleural empyema is a rare but serious complication occurring mostly after right hepatectomy complicated with intraabdominal sepsis. Pleural paracentesis for diagnosis and treatment should be rapidly considered. Early thoracotomy for optimal drainage would reduce postoperative mortality.
ALPPS Procedure in Insufficient Hypertrophy After Portal Vein Embolization (PVE)
Authors: Ulmer T. F. , de Jong C. , Andert A. , Bruners P. , Heidenhain C. M. , Schoening W. , Schmeding M. , Neumann U. P.
Published: July 2016

Background

The main limiting factor for major liver resections is the volume and function of the future remnant liver (FLR). Portal vein embolization (PVE) is now standard in most centers for preoperative hypertrophy of FLR. However, it has a failure rate of about 20–30 %. In these cases, the “Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy” (ALPPS) may represent a suitable and possibly the only alternative.

Methods

We performed a retrospective analysis of nine patients who had ALPPS following an insufficient hypertrophy after PVE. Computed tomography volumetry were performed before and after PVE as well as the first step of ALPPS. Furthermore, complications, 30‐day mortality and outcome were analyzed.

Results

The FLR volume rose significantly by 77.7 ± 40.7 % (FLR/TLV: 34.9 ± 9.7 %) as early as 9 days after the first stage despite insufficient hypertrophy after preoperative portal vein embolization. Major complications (Grade > IIIb) occurred in 33 % of the patients, and 30‐day mortality was 11.1 %. The OS at 1 and 2 years was 78 and 44 %. Four patients are presently still alive at a median of 33.4 (range 15–48) months (survival rate 44.4 %).

Conclusion

The ALPPS procedure could be a suitable alternative for patients following insufficient PVE or indeed the last chance of a potentially curative treatment in this situation. Nevertheless, the high morbidity and mortality rates and the lack of data on the long‐term oncological outcome must also be taken into account.
Learning Curve for Pilonidal Sinus Surgery: The Best Option for Budding Surgeons
Authors: Gupta Anurakshat , Anand Sunil , Mehrotra Sandeep , Khidtta Kamalkant
Published: July 2016

Background

Surgery for pilonidal sinus has no gold standard, and results depend purely on surgeon preference of procedure and experience. Till date, there has been no study comparing the surgical outcomes when performed by residents. Therefore, we designed our study to compare the short‐term outcomes of Karydakis’ and Limberg’s flap procedures in the treatment of pilonidal disease when performed by surgical residents.

Method

A prospective, double‐blinded, observational study was carried out at Command Hospital, Pune, India. Twenty‐five consecutive patients undergoing each of the Karydakis’ and Limberg’s flap procedures (n = 50) were enrolled in the study. All patients had a primary sinus opening. Patients with a frank pilonidal abscess were excluded, but patients with history of intermittent purulent discharge even during time of surgery were included.

Results

There was a significantly higher rate of infection in the Karydakis’ group (9/25) as compared to the Limberg’s flap group (3/25) and also a higher rate of complete wound dehiscence (2/25 vs 1/25).

Conclusion

Limberg’s flap procedure appears to be superior to Karydakis’ procedure, and the results are reproducible even by budding surgeons with little experience in the procedure.
Convex billiards on convex spheres
Authors: Zhang Pengfei
Published: July 2016

In this paper we study the dynamical billiards on a convex 2D sphere. We investigate some generic properties of the convex billiards on a general convex sphere. We prove that

C^{\infty }

generically, every periodic point is either hyperbolic or elliptic with irrational rotation number. Moreover, every hyperbolic periodic point admits some transverse homoclinic intersections. A new ingredient in our approach is Herman's result on Diophantine invariant curves that we use to prove the nonlinear stability of elliptic periodic points for a dense subset of convex billiards.
A Sociology of Transnational Constitutions
Authors: Thornhill Chris
Published: July 2016

This volume focuses on the rise of transnational constitutional laws, primarily created by the interaction between national and international courts, and by the domestic transformation of international law. Through detailed analysis of patterns of institutional formation at key historical junctures in a number of national societies, it examines the social processes that have locked national states into an increasingly transnational constitutional order, and it explains how the growth of global constitutional norms has provided a stabilizing framework for the functions of state institutions. The book adopts a distinctive historical-sociological approach to these questions, examining the deep continuities between national constitutional law and contemporary models of global law. The volume makes an important contribution to the sociology of constitutional law, to the sociology of post-national legal processes, and to the sociology of human rights law. This title is also available as Open Access.
Herpes Zoster Overlying Recently Placed Central Venous Access Site: A Case Report
Authors: Hess Rebecca A. , Gunnerson Kyle , Kahler John
Published: July 2016

Herpes zoster, commonly called shingles, is a disease that results from the reactivation of varicella zoster virus. Local trauma has been reported as a precipitant for reactivation, but this condition is rarely seen localized to a fresh surgical incision. We present the case of a patient who developed shingles overlying the incision site of a recently buried central venous access port, illustrating the need to consider this diagnosis as a unique imposter of localized infection or reaction at sites of recent procedural trauma.
Local perceptions of the impact of group interpersonal psychotherapy in rural Uganda
Authors: Lewandowski R. E. , Bolton P. A. , Feighery A. , Bass J. , Hamba C. , Haroz E. , Stavrou V. , Ndogoni L. , Jean-Pierre A. , Verdeli H.
Published: July 2016

Background.

This study investigated local perceptions of changes stemming from a long-standing Group Interpersonal Psychotherapy (IPT-G) program for the treatment of depression in rural Uganda. The study was conducted in a low-income, severely HIV/AIDS-affected area where in 2001 the prevalence of depression was estimated at 21% among adults.

Method.

Data were collected using free-listing and key informant qualitative interviews. A convenience sample of 60 free-list respondents was selected from among IPT-G participants, their families, and other community members from 10 Ugandan villages. Twenty-two key informants and six IPT-G facilitators were also interviewed.

Results.

Content analysis yielded five primary categories of change in the community related to the IPT-G program: (1) improved school attendance for children; (2) improved productivity; (3) improved sanitation in communities; (4) greater cohesion among community members; and (5) reduced conflict in families. Community members and IPT-G facilitators suggested that as depression remitted, IPT-G participants became more hopeful, motivated and productive.

Conclusion.

Results suggest that providing treatment for depression in communities with high depression prevalence rates may lead to positive changes in a range of non-mental health outcomes.
Early Devonian (Pragian) vertebrates from the northern Roberts Mountains, Nevada
Authors: Burrow Carole J. , Murphy Michael A.
Published: July 2016

Fossil fish are poorly represented in middle Lower Devonian deposits of the western United States. Here we describe vertebrate microremains from mid-Pragian levels in the Kobeh Member, McColley Canyon Formation, central Nevada. The species diversity of the assemblages is low and dominated by the acanthodianNostolepis costataGoujet, 1976. This species is found in older (late Lochkovian–early Pragian) deposits in France and Spain and mid-Pragian or slightly younger deposits in Saudi Arabia. This distribution suggests dispersal to the west from the Armorica terrane around the south of Laurussia to the Nevada region, and southeastward to Arabia, on the northern margin of Gondwana.
Conflicting perspectives on neurobehavioral theories of the depressive disorders and drug actions
Authors: Katz Martin M.
Published: July 2016

Objective

A prominent theory of depression focusses on neural plasticity and stress as central issues in seeking to develop a pattern of identifiable biological markers for the depressive disorders. Relative neglect, however, of clinical factors in that theory limits the uncovering of markers and opens to question their methodological approach. A conflicting theory, the ‘opposed neurobehavioral states’, based on dimensional analysis of monoamine neurotransmitter systems and behavioural factors is presented. This perspectives paper contrasts the two approaches viewing the biomarkers theory as premature at this point in the progress of depression research.

Method

Studies developed to support the biomarkers theory and the opposed neurobehavioral states theory are examined for their strengths and limitations in explaining the nature of the disorder and the actions of therapeutic drugs. Reference is made to reviews of the many studies on biomarkers and the recent work that supports the opposed neurobehavioral states theory.

Discussion

Main issue: the biomarkers theory sets important goals, but despite the many advances in the neural investigations of factors underlying depression, is still not successful in specifying markers. Thus, it is believed to be applying the wrong methodologic approach and premature in its claims. Perspective: the ‘opposed neurobehavioral’ theory is limited in its breadth of research. It applies, however, the dimensional approach to the clinical side of the problem, a methodological approach more likely to be effective in selecting the best clinical treatment and open to a more productive path to understanding of the nature of the disorder in future research.
Renal Blood Flow in Twins
Authors: Kornacka M. K. , Burzyńska E. , Gadzinowski J.
Published: July 2016

The aim of this preliminary study was the estimation of renal blood flow in 16 premature newborns from twin pregnancies with mean body weight 1270 g and mean gestational age 29 weeks.

In control group we have 16 singleton newborns with mean gestational age 29 weeks and mean birth weight 1240 g. In both intervention and control group we have the similar clinical symptoms. The renal blood flow was carried out in the first day of life with the Acuson 128 XP Colour Doppler using the 6 and 7 MHz linear transducer. The renal blood flow parameters-PI, RI, Vmax, Vmin Vmean were measured in right and left renal arteries in theirs courses from the aorta to the renal hilus, by color sinal. In the investigation group the mean value of RI in right and left renal artery was 0,88. Mean PI in right vessel was 1,67 and in left 1,56. Mean V min in right and in left artery was 0,03 and mean V max in right artery was 0,34 and in left 0,33. Mean value of mean velocity in right vessels was 0,18 and in left 0,19.

In control group we observed in right artery mean value of PI 1,74 and in left 1,6. Mean RI was 0,86 and 0,86 in right vessel in left vessel. Mean V min was 0,05 in right and 0,04 in left artery. Mean V max was 0,37 in right and 0,34 in left artery. Mean value of V mean was 0,19 in right artery and 0,18 in left artery.

Using the student, Mann-Whitney and Shapiro-Wilk tests we have not observed statistically significant difference of Doppler parameters between control and investigation group and between the left and right artery. Although in newborns with broad PDA we noted significant higher value of RI (0,97, 0,98) than in newborns without PDA (0,78, 0,81).
Multiple Pregnancy: Factors Contributing to Early Infant's Breast-feeding – Own Experience
Authors: Czeszyńska M.B. , Kowalik K.
Published: July 2016

The aims of the study were as follows: 1. to evaluate the effectiveness of current program to promote breast-feeding in our population of infants from multiple pregnancy; 2. to define factors responsible for failure in early breast-feeding establishing and /or maintaining breastfeed during the hospitalization of the babies in neonatal department. 122 newborn infants (2 sets of triplets and 58 twin pairs) born in the Clinic for Pathology of Pregnancy and Labor in Szczecin, Poland, in the years 1995 (January) – 1999 (May) from multiple pregnancy were included in the study. In the examined material there were estimated neonatal conditions at birth, neonatal complications, which may disturb successful breast-feeding as well as other factors contributing to early breast-feeding, the way of feeding the babies during neonatal period and the mean time of starting breast-feeding. It was found that most of the examined babies were born with the features of prematurity: mean gestational age was 35,6 ± 2,2 weeks and mean birthweight – 2225,3 ± 193,2 grams. Only 57,4% of babies were born in good conditions according to Apgar scores. Factors which influence in a negative way early breast-feeding were as follows: respiratory disturbance (22,1%), temporary oral nutrition intolerance due to sickness of the baby or early onset of infections (27,5%), operative delivery (62,3%), medicine taken by mothers (13,9%) and failure in maternal lactation (8,2%). Factors disturbing a normal course of breast-feeding were: fototherapy due to hyperbilirubinemia (20,5%) and late onset of infections (1,6%). In most cases breast-feeding was started 3-4 days after birth and the most frequent way of feeding was formula followed or in combination with maternal milk (at discharge in 86,9% of babies).

We concluded that exclusive breast-feeding, despite program of promotion, is a rarity in population of newborn babies born from multiple pregnancy; time to start breast-feeding in this population is usually 3-4 days after delivery. Most pre-term and full-term twins are discharged from neonatal department on maternal milk – exclusively or in combination with formula in situation of scarce maternal milk for two or more infants – what should be considered as our professional success.
Quantitative Estimates of ABH Secretion in Saliva of Human Twins
Authors: Sharma K. , Sharma S.
Published: July 2016

Blood and saliva samples of 122 like-sexed twin pairs (65 MZ and 57 DZ) living in Chandigarh (India) were analyzed for ABH polymorphism. The results indicated that ABH secretions were independent of ABO blood groups though there was an indication of higher incidence of non-secretors among ‘O’ blood group twin individuals. No significant differences were observed between twins and singletons in secretor gene frequency estimates. The quantitative data revealed that mean titre scores for H substances were lower than that for A and B substances. F test contrasting intra-pair variance between zygosities for ABH quantitative secretions was highly significant indicating stronger genetic component of variation. The results suggested that quantitative assay of ABH secretions would be a better indicator for zygosity determination than mere qualitative differentiation.
Mosaic Partial Trisomy of Chromosome 5 (q33-q ter) Associated with Fetal Polycystic Kidneys
Authors: Kriplani A. , Banerjee N. , Jobanputra V. , Kucheria K.
Published: July 2016

A case of de novo mosaic partial trisomy of chromosome 5 (q33-q ter) in a stillborn male fetus with bilateral polycystic kidneys, and atrial septal defect, is reported. Fetal cord blood sampling was carried out at 25 weeks of gestation because of bilateral polycystic kidneys with severe oligohydramnios observed on ultrasound examination of the fetus. The family history was notable for the presence of similar phenotypic abnormality in the mother and sibling. However, no chromosomal abnormality was detected in other family members. Significance of this rare chromosomal abnormality and its association with congenital malformations in the fetus and in the family is being discussed.
Etiology and Management of Monoamniotic Twin Discordant for Anencephaly
Authors: Kriplani A. , Banerjee N. , Takkar D.
Published: July 2016

A case of monoamniotic monochorionic (MAMC) female twins, with one twin being anencephalic, and the co-twin being normal, is reported. Twin to twin transfusion syndrome was also noted. The reasons for anencephaly in association with monozygotic (MZ) twinning are discussed. The management of such a case is presented.