bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased sympathovagal imbalance evaluated by heart rate variability is associated with decreased T2* MRI and left ventricular function in transfusion-dependent thalassemia patients
Authors: Pattanakuhar Sintip , Phrommintikul Arintaya , Tantiworawit Adisak , Konginn Sasikarn , Srichairattanakool Somdet , Chattipakorn Siriporn C. , Chattipakorn Nipon
Published: January 2018

Early detection of iron overload cardiomyopathy is an important strategy for decreasing the mortality rate of patients with transfusion-dependent thalassemia (TDT). Although cardiac magnetic resonance (CMR) T2* is effective in detecting cardiac iron deposition, it is costly and not generally available. We investigated whether heart rate variability (HRV) can be used as a screening method of iron overload cardiomyopathy in TDT patients. HRV, evaluated by 24-h Holter monitoring, non-transferrin bound iron (NTBI), serum ferritin, left ventricular (LV) ejection fraction (LVEF), and CMR-T2* were determined. Patients with a cardiac iron overload condition had a significantly higher low frequency/high frequency (LF/HF) ratio than patients without a cardiac iron overload condition. Log-serum ferritin (r = −0.41, P=0.008), serum NTBI (r = −0.313, P=0.029), and LF/HF ratio (r = −0.286, P=0.043) showed a significant correlation with CMR-T2*, however only the LF/HF ratio was significantly correlated with LVEF (r = −0.264, P=0.043). These significant correlations between HRV and CMR-T2* and LVEF in TDT confirmed the beneficial role of HRV as a potential early screening tool of cardiac iron overload in thalassemia patients, especially in a medical center in which CMR T2* is not available. A larger number of TDT patients with cardiac iron overload are needed to confirm this finding.
Fast mode decision method based on edge feature for HEVC inter‐prediction
Authors: Tsai Tsung‐Han , Su Sheng‐Shuan , Lee Ting‐Yu
Published: January 2018

High‐efficiency video coding (HEVC) is an international video coding standard. It can reduce bit rate by almost 50% when preceding state‐of‐the‐art standard H.264/advanced video coding (AVC) with the same objective quality but increase about 40% encoding complexity. The computation complexity of HEVC largely relies on the inter‐prediction, which consumes about 60–70% of the total encoding time. This study proposes a fast mode decision method for HEVC inter‐prediction. Since current coding unit (CU) is the basic coding zone for HEVC encoding process, the authors apply the edge detection method with Sobel operator to extract the edge information inside CU. It is based on the threshold‐oriented means to compare those edge values and then predict the best partition mode for this CU. Furthermore, they define a weighting factor to adopt various resolutions of test sequence from wide quarter video graphics array (WQVGA) to 1600 p. The experimental results show that the proposed algorithm can reduce computational complexity by 50% on average compared with HEVC reference software, and appear to have almost the same coding performance.
Coplanar waveguide‐fed rose‐curve shape UWB monopole antenna with dual‐notch characteristics
Authors: Abu Safia Ousama , Nedil Mourad , Talbi Larbi , Hettak Khelifa
Published: January 2018

In this study, a new design of a planar ultra‐wideband (UWB) monopole antenna with a rose‐curve contour shape is proposed. The rose‐curve circumference of the monopole is expressed in polar coordinates as: . This function enables a flexible and easy to control layout, which directly affects the antenna's response. The arguments of the function are specified based on a simple deterministic design rule and the outputs of a parametric study. The antenna covers the 3.1–11 GHz band and has an ultra‐miniaturised size of 864 mm3 when realised on a RT/Duroid 6010LM substrate of 0.635 mm thickness. To add dual‐notch characteristics to the proposed antenna, a complementary dual‐band split ring resonator inclusion is etched on the antenna's patch near the feeding line. The inclusion is designed to operate at the two Wi‐Fi and ISM frequency bands, 3.5 and 5.8 GHz, respectively. These centre band frequencies are determined using a new hybrid method that utilises the resonant and non‐resonant design approaches of metamaterial structures. Simulated and measured return loss values, radiation patterns and gain values for the proposed antennas (with and without notching) are in very good agreements, and demonstrate satisfactory performance.
Mobile data sink‐based time‐constrained data collection from mobile sensors: a heuristic approach
Authors: Kumar Naween , Dash Dinesh
Published: January 2018

In wireless sensor network, sensors are deployed to sense useful data from environment. Sensors are energy‐constrained devices. To prolong the sensor network lifetime for large‐scale network, nowadays mobile data sinks (MDSs) (collectors/mules) are used for collecting the sensed data from the sensors. In this environment, sensor nodes can directly transfer their sensed data to the MDS. Sensors have limited memory. Therefore, to avoid buffer overflow, the data must be collected by the MDSs within a predefined time interval. The authors assume that a set of mobile sensors are moving arbitrarily on a set of paths. The authors objective is to collect data periodically from all mobile sensors using minimum number of MDSs within a fixed time interval. Here, a data‐gathering algorithm is proposed. The authors analyse the complexity of the problem, and evaluate time complexity and performances of the proposed solution.
Green approach for the synthesis of carboxycoumarins by using a highly active magnetically recyclable nanobiocomposite via sustainable catalysis
Authors: Maleki Ali , Ravaghi Parisa , Movahed Hamed
Published: January 2018

An efficient approach was reported for the synthesis of substituted 3‐carboxycoumarins via a Knoevenagel condensation reaction between Meldrum's acid and substituted salicylaldehydes in the presence of a magnetic cellulose/Ag catalyst in EtOH at room temperature. This protocol includes many advantages such as remarkable magnetic properties of the nanobiocomposite catalyst, short reaction times, high yields and simple isolation of the organic products. In addition, the nanostructure catalyst can be easily separated from the reaction mixture and reused several times efficiently. Fourier transform infrared spectra, nuclear magnetic resonance spectra, X‐ray diffraction pattern and field emission scanning electron microscopy images were performed for the characterisation of the products and the nanocatalyst.
Imaging the water snowline in a protostellar envelope with H13CO+
Authors: van ’t Hoff Merel L. R. , Persson Magnus V. , Harsono Daniel , Taquet Vianney , Jørgensen Jes K. , Visser Ruud , Bergin Edwin A. , van Dishoeck Ewine F.
Published: January 2018

Context. Snowlines are key ingredients for planet formation. Providing observational constraints on the locations of the major snowlines is therefore crucial for fully connecting planet compositions to their formation mechanism. Unfortunately, the most important snowline, that of water, is very difficult to observe directly in protoplanetary disks because of the close proximity of this snowline to the central star.

Aims. Based on chemical considerations, HCO+ is predicted to be a good chemical tracer of the water snowline because it is particularly abundant in dense clouds when water is frozen out. This work aims to map the optically thin isotopolog H13CO+ toward the envelope of the low-mass protostar NGC 1333-IRAS2A, where the snowline is at a greater distance from the star than in disks. Comparison with previous observations of H218O show whether H13CO+ is indeed a good tracer of the water snowline.

Methods. NGC 1333-IRAS2A was observed using the NOrthern Extended Millimeter Array (NOEMA) at ~0.′′9 resolution, targeting the H13CO+ J = 3 − 2 transition at 260.255 GHz. The integrated emission profile was analyzed using 1D radiative transfer modeling of a spherical envelope with a parametrized abundance profile for H13CO+. This profile was validated with a full chemical model.

Results. The H13CO+ emission peaks ~ 2′′ northeast of the continuum peak, whereas H218O shows compact emission on source. Quantitative modeling shows that a decrease in H13CO+ abundance by at least a factor of six is needed in the inner ~360 AU to reproduce the observed emission profile. Chemical modeling indeed predicts a steep increase in HCO+ just outside the water snowline; the 50% decrease in gaseous H2O at the snowline is not enough to allow HCO+ to be abundant. This places the water snowline at 225 AU, further away from the star than expected based on the 1D envelope temperature structure for NGC 1333-IRAS2A. In contrast, DCO+ observations show that the CO snowline is at the expected location, making an outburst scenario unlikely.

Conclusions. The spatial anticorrelation of H13CO+ and H218O emission provide proof of concept that H13CO+ can be used as a tracer of the water snowline.
Accurate millimetre and submillimetre rest frequencies for cis- and trans-dithioformic acid, HCSSH
Authors: Prudenzano D. , Laas J. , Bizzocchi L. , Lattanzi V. , Endres C. , Giuliano B. M. , Spezzano S. , Palumbo M. E. , Caselli P.
Published: January 2018

Context. A better understanding of sulphur chemistry is needed to solve the interstellar sulphur depletion problem. A way to achieve this goal is to study new S-bearing molecules in the laboratory, obtaining accurate rest frequencies for an astronomical search. We focus on dithioformic acid, HCSSH, which is the sulphur analogue of formic acid.

Aims. The aim of this study is to provide an accurate line list of the two HCSSH trans and cis isomers in their electronic ground state and a comprehensive centrifugal distortion analysis with an extension of measurements in the millimetre and submillimetre range.

Methods. We studied the two isomers in the laboratory using an absorption spectrometer employing the frequency-modulation technique. The molecules were produced directly within a free-space cell by glow discharge of a gas mixture. We measured lines belonging to the electronic ground state up to 478 GHz, with a total number of 204 and 139 new rotational transitions, respectively, for trans and cis isomers. The final dataset also includes lines in the centimetre range available from literature.

Results. The extension of the measurements in the mm and submm range lead to an accurate set of rotational and centrifugal distortion parameters. This allows us to predict frequencies with estimated uncertainties as low as 5 kHz at 1 mm wavelength. Hence, the new dataset provided by this study can be used for astronomical search.
An Atom-Economic and Stereospecific Access to Trisubstituted Olefins through Enyne Cross Metathesis Followed by 1,4-Hydrogenation
Authors: Schmalz Hans-Günther , Ratsch Friederike
Published: January 2018

The combination of intermolecular enyne cross metathesis and subsequent 1,4-hydrogenation opens a stereocontrolled and atom-economic access to trisubstituted olefins. By investigating different combinations of functionalized alkyne and alkene substrates, we found that the outcome (yield, E/Z ratio) of the Grubbs II-catalyzed enyne cross-metathesis step depends on the substrate’s structure, the amount of the alkene (used in excess), and the (optional) presence of ethylene. In any case, the 1,4-hydrogenation, catalyzed by 1,2-di­methoxybenzene-Cr(CO)3, proceeds stereospecifically to yield exclusively the E-products from both the E- and Z-1,3-diene intermediates obtained by metathesis. A rather broad scope and functional group compatibility of the method is demonstrated by means of 15 examples.
Ruthenium-Catalyzed Oxidative Dearomatization of Indoles for the Construction of C2-Quaternary Indolin-3-ones
Authors: Zhou Xiao-Yu , Chen Xia , Wang Liang-Guang , Yang Dan , Li Jin-Hui
Published: January 2018

A ruthenium-catalyzed oxidative dearomatization of 2-alkyl- or 2-aryl-substituted indoles has been developed. When coupled with a cascade transformation, it provides a new system for the construction of indolin-3-ones bearing a C2-quaternary functionality. The reaction occurs readily with RuCl3·3H2O as a catalyst in acetonitrile. 2-(3-Indolyl)-substituted indolin-3-ones were obtained in medium to high yields. A mechanism for the reaction is also proposed.
Hidrocefalia aguda essencial
Authors: Souza Hugo de , Doutel Francisco , Borges Carlos Augusto , de Azevedo Ronaldo Gonçalves , Junior Walter Oliveira , Ribeiro Carlos Henrique
Published: January 2018

Objetivo: Apresentar discussão sobre o tema hidrocefalia aguda e a necessidade de se identificar os subtipos com a finalidade de proporcionar subsídios para a melhor compreensão e abordagem nessas situações. Considerações: A hidrocefalia é um distúrbio da dinâmica do líquido cefalorraquidiano em que há uma expansão do compartimento liquórico encefálico, notadamente do sistema ventricular. Por meio da revisão de literatura, evidencia-se uma extensa classificação com base em parâmetros diversos. Assim, é possível se definir hidrocefalia congênita e adquirida; obstrutiva e por superprodução de liquor; interna e externa; de alta pressão e de pressão normal; aguda, subaguda e crônica; sintomática e assintomática; comunicante e não-comunicante; mono, bi, tri e tetraventricular; “ex vacuo” e “arrested hydrocephalus”. Neste contexto complexo e diversificado, a hidrocefalia aguda tem seu diagnóstico freqüentemente estabelecido com base no tempo de evolução da síndrome de hipertensão intracraniana, que normalmente a acompanha. Entretanto, como a ventriculomegalia não é um fenômeno passivamente determinado pela hipertensão liquórica intraventricular, ocorrem casos de dissociação entre o grau de dilatação ventricular e o grau de hipertensão intracraniana. Melhor seria, então, considerar como fator diagnóstico a presença de lesão obstrutiva indiscutivelmente aguda causadora da hidrocefalia. Porém, ainda assim, julgamos necessário distinguir-se um subtipo que exige uma abordagem direta independentemente da conduta adotada para a lesão expansiva inicial, a que denominamos hidrocefalia aguda essencial, em oposição ao subtipo hidrocefalia aguda não-essencial, cuja resolução é dependente da resolução da lesão expansiva que lhe deu origem. Conclusão: O conceito de hidrocefalia aguda essencial é operacional e de apurada precisão técnica, capaz de proporcionar subsídios à melhor abordagem da hidrocefalia aguda. Entretanto, ainda é necessária uma melhor compreensão do papel desempenhado pelos compartimentos estruturais encefálicos, pela ventriculomegalia e pelo hemoventrículo na fisiopatogenia das hidrocefalias em geral e das hidrocefalias agudas em particular.
Produzindo um pôster científico
Authors: Pereira Carlos Umberto , Paixão Oliveira Débora Moura da
Published: January 2018

Objetivo: Demonstrar como organizar as informações de modo que as idéias centrais de trabalhos científicos na forma pôster sejam facilmente apreendidas, bem como orientar a utilizar os recursos disponíveis para o pôster despertar o interesse do público. Apresentações no formato pôster tornam-se uma parte cada vez mais importante de conferências científicas, são excelentes para apresentadores iniciantes por ser consideradas menos desafiadoras do que as apresentações orais.

Um pôster bem desenhado dá ao público uma vista geral e concisa de pesquisa, metodologia, tamanho da amostra, resultados e suas implicações, por isso requer o esforço considerável em identificar os ingredientes vitais e rejeitar todo o material supérfluo.
Hematoma extradural espinhal espontâneo: Relato de caso
Authors: Araújo Dias Luiz Antonio , Pereira Carlos Umberto , Plastina Fernando Eduardo , Dezena Roberto Alexandre , Dias Junior Luiz Antonio Araújo , Dias Clicie Araújo
Published: January 2018

O hematoma extradural espinhal espontâneo é considerado raro. Tem sido associado com hipertensão arterial e coagulopatias. O exame de escolha para diagnóstico é a ressonância nuclear magnética. O tratamento de escolha é drenagem cirúrgica do hematoma. O prognóstico está relacionado com a etiologia, intervalo entre icto e diagnóstico e o grau de déficits neurológicos. Os autores relatam um caso de hematoma extradural espinhal espontâneo, localizado na região torácica, com quadro de choque medular, sendo submetido a tratamento cirúrgico, que evoluiu para óbito.
Plötzlicher Herztod bei 17-jährigem Mädchen – ein Fallbericht
Authors: Huscher Stefan , Trägner Peter , Jacobi Sindy , Frank Mark , Gäßler Michael , Nowak Andreas
Published: January 2018

Falldarstellung Eine 17-jährige Gymnasiastin betätigte sich in einer Freizeitsportgruppe körperlich moderat. Wenige Sekunden nach einem leichten abdominellen Anprall eines Balles bricht sie bewusstlos zusammen. Bei fehlender Atmung werden durch Laien sofort Maßnahmen der Basisreanimation durchgeführt. Ein Team aus boden- und luftgebundenen Rettungskräften konnte nach insgesamt 50 Minuten Reanimation einen Return of Spontaneous Circulation (ROSC) registrieren. Unter kontinuierlicher Noradrenalininjektion erfolgte der luftgebundene Transport in die Klinik. Die Patientin verstarb jedoch am 3. Tag nach dem Ereignis an dem in der Folge des Kreislaufstillstands aufgetretenen Hirnödem. In der Sektion und den sich anschließenden Zusatzuntersuchungen wurden ein hypoxischer Hirnschaden sowie Zeichen eines Schockgeschehens an lebenswichtigen Organen festgestellt. Außerdem fanden sich Hinweise der kardialen Manifestation einer Infektion mit Parvovirus B19 (PVB19).

Schlussfolgerungen Der plötzliche Herztod im Rahmen körperlicher Belastung, wie bspw. bei Sportveranstaltungen, ist ein extrem seltenes Ereignis. Die Anwendung der im professionellen Sportbereich üblichen umfangreichen medizinischen Betreuung wäre im Breitensport mit hohem Aufwand verbunden. Einer symptomatischen Therapie während medizinischer Notfallsituationen in diesem Bereich kommt damit große Bedeutung zu. Das Hauptaugenmerk sollte dabei auf einer funktionierenden Rettungskette mit qualitativ hochwertig ausgeführten Erst- und Folgemaßnahmen sowie einer durch die aufnehmende Rettungsleitstelle telefonisch unterstützten Laienreanimation liegen.
Dermatoskopische Muster bei Kindern mit Dermatomykosen des behaarten Kopfes oder Alopecia areata
Authors: Ufimtseva М. , Antonova S.
Published: January 2018

Ziel: Bewertung der diagnostischen Effektivität der Dermatoskopie mit zehnfacher Vergrößerung für die Differenzialdiagnose von Mykosen des behaarten Kopfes oder Alopecia areata bei Kindern. Derartige Erkrankungen kommen bei Kindern häufig vor und werden gelegentlich nicht oder erst spät erkannt. Hier werden Ergebnisse eigener Untersuchungen und Literaturangaben zum Thema besprochen.

Material und Methoden: Es wurden dermatoskopische Untersuchungen an 78 erkrankten Kindern durchgeführt und im Vergleich mit publizierten Studien ausgewertet.

Ergebnisse: Bei 49 (93 %) der Kinder mit einer Mykose waren eines oder mehrere der folgenden dermatoskopischen Muster vorhanden: kommaartige Haare bei 30 (57 %), zickzackförmige Haare bei 31 (59 %; p < 0,05).

Zudem wurden die für von Mikrosporie befallenen Haare typischen weißen, horizontalen Streifen in der Haarschaftstruktur bei 17 Kindern (60,7 %) beobachtet, die für die von Trichophytie befallenen korkenzieherartigen Haare bei 8 (32 %; p < 0,05).

Es waren bei 24 (96 %) der an Alopecia areata erkrankten Kinder eines oder mehrere der folgenden dermatoskopischen Muster vorhanden: gelbe Punkte bei 22 (88 %), schwarze Punkte (kadaverisierte Haare) bei 9 (36 %), ausrufezeichenartige Haare bei 12 (48 %) und miniaturisierte, pigmentlose Haare (Vellushärchen) bei 19 (76 %).

Es wurden bei den Kindern mit Mykosen des behaarten Kopfes keine für Alopecia areata typischen Zeichen beobachtet.
List composition effect on cognate and non-cognate word acquisition in children
Authors: Comesaña Montserrat , Moreira Ana J. , Valente Daniela , Hernández-Cabrera Juan A. , Soares Ana Paula
Published: January 2018

Previous studies on second language (L2) vocabulary acquisition with children showed that the use of a picture learning method favours the
creation of direct links between the semantic system and new lexical representations at early stages of L2 acquisition (Comesaña et al., 2009). However, recent studies found that this influence seems to vary according to
the cognate status of the words being learned (Comesaña et al., 2012), raising the question of how the type of words involved can modulate
the lexical-semantic connections between the words of both languages in the bilingual memory. The main goal of the present study was to
explore list composition effects in the establishment of L2 word-to-concept connections in Portuguese children by using a picture-based
method. Results showed no influence of list composition in the establishment of L2 lexical-semantic connections when cognates have to be
learned. Findings are discussed in light of relevant models of bilingual memory.
Of oligarchs, orientalists, and cosmopolitans: how “Armenian” israbizmusic?
Authors: Adriaans Rik
Published: January 2018

This paper examines the controversial music genrerabizin relation to political and socioeconomic developments in post-Soviet Armenia.Rabiz,an urban folk-pop genre characterized by melismatic singing and “oriental” embellishments, is a ubiquitous soundtrack to everyday life in the country, with lyrics commonly covering romance, male friendship, and family ties. Ethnographic observations suggest that its popularity draws on the affective appeal with which it captures common hardships and aspirations of post-socialist transition. In spite of this,rabizis almost universally denounced by nationalist intellectuals and liberal citizens for foreign influences, sentimentality, consumerism, and conservatism. While for the cultured classes, the rejection ofrabizas “un-Armenian” is often an integral part of the construction of a virtuous self, the alternative conceptions of performers and fans reveal the polysemy of Armenianness as a moral category.
Seasonal migration and symbolic power: The case of Muslim Meskhetians from Nasakirali
Authors: Darchiashvili Mariam
Published: January 2018

The repatriation and inclusion of Muslim Meskhetians, forcefully displaced by the Soviet government from Georgia to Central Asia during the 1940s, is still ongoing. In 1977, some Meskhetian families settled in the village of Nasakirali in western Georgia. The Soviet Georgian government built houses for the repatriates in a separate district, referred to as the “Island.” The location acquired a symbolic meaning for Meskhetians. After 40 years of repatriation, Meskhetians still remain “islanders:” isolated from the majority population, speaking a different language, practicing a different religion, and facing different employment opportunities. This study explores the coping mechanisms used by Muslim Meskhetians to sustain themselves and their families and improve their social conditions in a strictly Christian post-socialist country where “Islam is taken as a historical other.” The study primarily asks how employment/seasonal migration in Turkey changed the lives of Meskhetians by adapting their social, cultural, economic, and symbolic capital and became the only viable solution for overcoming social marginalization. The study explores how informality allows social mobility, changes gender attitudes, and helps “islanders” reach the “mainland” by becoming“Halal”—truthful and reliable. The study applies Pierre Bourdieu's concepts of “capital” and “symbolic power” for understanding Meskhetians' informal economic practices.
Reducing eutrophication increases spatial extent of communities supporting commercial fisheries: a model case study
Authors: Bauer Barbara , Meier H E Markus , Casini Michele , Hoff Ayoe , Margoński Piotr , Orio Alessandro , Saraiva Sofia , Steenbeek Jeroen , Tomczak Maciej T
Published: January 2018

In this study we investigate if eutrophication management has the potential to substantially affect which areas are going to be most suitable for commercial fishing in the future. We use a spatial ecosystem model, forced by a coupled physical-biogeochemical model, to simulate the spatial distribution of functional groups within a marine ecosystem, which depends on their respective tolerances to abiotic factors, trophic interactions, and fishing. We simulate the future long-term spatial developments of the community composition and their potential implications for fisheries under three different nutrient management scenarios and changing climate. The three nutrient management scenarios result in contrasting developments of bottom oxygen concentrations and phytoplankton abundance, with substantial effects on fish production. Nutrient load reduction increases the spatial extent of the areas suitable for the commercially most valuable demersal fish predator and all types of fisheries. This suggests that strategic planning of fishery management strategies could benefit from considering future changes in species distributions due to changes in eutrophication. We show that combining approaches from climate research, physical oceanography, biogeochemistry, biogeography, and trophic ecology with economical information provides a strong foundation to produce scientific knowledge that can support a multisectoral management of ecosystems.
Cadential Syntax and Tonal Expectation in Late Sixteenth-Century Homophony
Authors: Long Megan Kaes
Published: January 2018

This article explores the emergence of tonal languages in late-sixteenth-century homophony by considering the ways in which phrase structure, meter, and cadential rhetoric produce trajectories of expectation. Focusing on the English ballett and the French air de cour, two homophonic, secular, vernacular genres produced according to wildly different aesthetic criteria, it demonstrates how composers’ regulation of harmony and syntax transformed contrapuntal languages into tonal ones. Early tonal languages are thus defined here by the trajectories of expectation that such regulation establishes.
A Constitutional Statute?
Authors: Samuels Alec
Published: January 2018

Is there such a thing as a constitutional statute? If so, how does it differ from any other statute? If different how significant, if at all, is the difference? Is the technique of judicial interpretation the same or different?
Superficial Inferior Epigastric Artery Flap Salvage Technique Using Deep Inferior Epigastric Artery Graft
Authors: Garza Rebecca M. , Shenaq Deana , Song David H. , Park Julie E.
Published: January 2018

Superficial inferior epigastric artery (SIEA) flap salvage remains challenging, particularly in cases of arterial insufficiency due to vessel spasm, pedicle kinking, or thrombosis. The already small, short SIEA pedicle, in addition to its inherent tendency toward spasm, renders the SIEA flap more difficult to manage when anastomotic revision is required. Furthermore, arterial thrombosis will cause dilation of the internal mammary artery, exacerbating vessel mismatch. In our previously published experience with 145 SIEA flaps, no flap with postoperative arterial thrombosis was salvageable. Following this experience, a new salvage technique using deep inferior epigastric artery grafts has been utilized and is described here.
Innovative Use of Thighplasty to Improve Prosthesis Fit and Function in a Transfemoral Amputee
Authors: Kuiken Todd A. , Fey Nicholas P. , Reissman Timothy , Finucane Suzanne B. , Dumanian Gregory A.
Published: January 2018

Background:

Excess residual limb fat is a common problem that can impair prosthesis control and negatively impact gait. In the general population, thighplasty and liposuction are commonly performed for cosmetic reasons but not specifically to improve function in amputees. The objective of this study was to determine if these procedures could enhance prosthesis fit and function in an overweight above-knee amputee.

Methods:

We evaluated the use of these techniques on a 50-year-old transfemoral amputee who was overweight. The patient underwent presurgical imaging and tests to measure her residual limb tissue distribution, socket-limb interface stiffness, residual femur orientation, lower-extremity function, and prosthesis satisfaction. A medial thighplasty procedure with circumferential liposuction was performed, during which 2,812 g (6.2 lbs.) of subcutaneous fat and skin was removed from her residual limb. Imaging was repeated 5 months postsurgery; functional assessments were repeated 9 months postsurgery.

Results:

The patient demonstrated notable improvements in socket fit and in performing most functional and walking tests. Her comfortable walking speed increased 13.3%, and her scores for the Sit-to-Stand and Four Square Step tests improved over 20%. Femur alignment in her socket changed from 8.13 to 4.14 degrees, and analysis showed a marked increase in the socket-limb interface stiffness.

Conclusions:

This study demonstrates the potential of using a routine plastic surgery procedure to modify the intrinsic properties of the limb and to improve functional outcomes in overweight or obese transfemoral amputees. This technique is a potentially attractive option compared with multiple reiterations of sockets, which can be time-consuming and costly.
Clinical Significance of Interleukin-6 in the Diagnosis of Sepsis and Discriminating Sepsis Induced by Gram-negative Bacteria
Authors: Shao Wen-xia , Yu Dao-jun , Zhang Wei-ying , Wang Xian-jun
Published: January 2018

Background:

To discuss the clinical significance of interleukin (IL)-6 in the differential diagnosis of sepsis and its capability of differentiating the sepsis induced by Gram-negative bacteria from that induced by Gram-positive bacteria.

Methods:

A total of 379 children with sepsis were involved in this study to form the case group, and their C-reactive protein (CRP), procalcitonin (PCT) and IL-6 levels before antibiotics and after recovery were checked. Receiver operating characteristic curve was applied to evaluate the significance of CRP, PCT and IL-6 in the differential diagnosis of sepsis and their capability of differentiating the sepsis induced by Gram-negative bacteria from that induced by Gram-positive bacteria.

Results:

When these 3 indicators were applied to the differential diagnosis of sepsis, the area under the curve (AUC) of IL-6, PCT and CRP was 0.881, 0.877 and 0.754, respectively. The combination of IL-6 and PCT presented highest diagnostic efficiency. CRP, PCT and IL-6 levels in children with sepsis induced by Gram-negative bacteria were significantly higher than those in children with sepsis induced by Gram-positive bacteria.

Conclusions:

CRP, IL-6 and PCT are applicable to the differential diagnosis of sepsis and differentiating the sepsis induced by Gram-negative bacteria from Gram-positive bacteria. Appropriate combinations of these indicators are capable of increasing differential diagnosis efficiency. These indicators can be used as markers of antibiotics usage, but whether they can be used as markers to withdraw antibiotics is still needed to be observed.
Reversal of Intestinal Failure in Children With Tufting Enteropathy Supported With Parenteral Nutrition at Home
Authors: Ashworth Iona , Wilson Alexander , Aquilina Samuel , Parascandalo Raymond , Mercieca Victor , Gerada Jurgen , Macdonald Sarah , Simchowitz Venetia , Hill Susan
Published: January 2018

Objectives:

The aim of the study was to review long‐term outcome of intestinal epithelial dysplasia (IED)/tufting enteropathy (TE) patients treated with parenteral nutrition (PN) at home managed by an intestinal failure (IF) rehabilitation service.

Methods:

Infants presenting from 1986 to 2010 with IF, and TE histology were retrospectively reviewed for up to 30 years. Data collected included outcome, presentation, nutrition (parenteral/enteral), country of residence, race, EpCAM gene, growth, bone age, and occupation.

Results:

Thirteen patients (6 boys) in Malta and the UK with TE histology were established on home PN. Survival was 100% for UK children and 92% overall (1 death aged 13 months). Six patients (50% of the surviving 12) weaned off PN. Overall PN requirements reduced with increasing age and <7 infusions/week were needed by 10/12, 83% by 10 years, 6/8, 75% who had reached 15 years, 5/7, 71% who had reached 20, and all 4, 100% >25 years. Two of 12 cases weaned from PN by 10 years, 1 of 8 by 15 years, 3 of 7 by 20 years, and 3 of 4 or 75% >25 years. Seven Maltese patients homozygous for the same EPCAM gene abnormality had a similar outcome to the other cases. Weight, height, bone mineralization, bone age, and insulin‐like growth factor‐1 (IGF‐1) levels were low, but improved with age. Patients achieved educational levels of parents and were employed.

Conclusions:

IED cases should have >92% chance of long‐term survival and >50% chance of enteral autonomy by/in early adult life and 75% by 25 years. Even if PN dependent s/he can gain employment. Patients with IED managed on PN at home by an IF rehabilitation service should avoid intestinal transplant.
Not a Straight Line—Patients’ Experiences of Prostate Cancer and Their Journey Through the Healthcare System
Authors: Schildmeijer Kristina , Frykholm Oscar , Kneck Åsa , Ekstedt Mirjam
Published: January 2018

Background

Cancer and its treatment can severely impact quality of life, giving rise to complex needs with respect to follow-up care. To support patient needs and increase efficiency of care with limited resources, the Swedish government has launched national reforms to redesign cancer care pathways.

Objective

The aim of this study was to explore how prostate cancer patients experience their journey through the healthcare system when their care is provided according to the standardized care pathway, as described in healthcare policy documents.

Methods

A qualitative, descriptive approach with individual interviews was used. A template of a standardized prostate cancer pathway, created together with healthcare professionals, was used during interviews. Fourteen interviews were conducted with prostate cancer patients all operated on at a midsized hospital in southeast Sweden between October 2015 and April 2016. The interviews were analyzed with qualitative content analysis and illustrated in a patient journey map.

Results

We identified an overall theme, “walking a tightrope,” consisting of 4 categories: “waiting,” “becoming familiar with a troublesome body,” “adjusting to a different life,” and “information challenges.”

Conclusions

The clinical implementation of the standardized care pathway is described as a straight path through care, but patients described their experiences as walking a tightrope. Lack of information, especially about cancer treatment and its adverse effects, was the most common experience.

Implications for Practice

Our findings indicate areas where further healthcare tools could improve patient experiences of cancer treatment. This could include offering individualized information and tools to increase patient empowerment, as well as patient/caregiver collaboration (co-care).
Consequences of the U.S. Food and Drug Administration–Directed Moratorium on Silicone Gel Breast Implants: 1992 to 2006
Authors: Cole Norman M.
Published: January 2018

The U.S. Food and Drug Administration silicone gel breast implant moratorium occurred 25 years ago. The immediate and long-term consequences of the moratorium are reviewed and assessed.
The Systemic-immune-inflammation Index Independently Predicts Survival and Recurrence in Resectable Pancreatic Cancer and its Prognostic Value Depends on Bilirubin Levels
Authors: Aziz Mohammad Hosein , Sideras Kostandinos , Aziz Nasir Ahmad , Mauff Katya , Haen Roel , Roos Daphne , Saida Lawlaw , Suker Mustafa , van der Harst Erwin , Mieog Jan Sven , Bonsing Bert A. , Klaver Yarne , Koerkamp Bas Groot , van Eijck Casper H.
Published: January 2018

Objective:

Our aim was to determine the prognostic significance of the systemic-immune-inflammation index (SIII) in patients with resectable pancreatic cancer, using cancer-specific survival as the primary outcome.

Background:

Pancreatic cancer is associated with a dysfunctional immune system and poor prognosis. We examined the prognostic significance of the SIII in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and the effects of bilirubin on this index.

Methods:

We retrospectively assessed all pancreatic resections performed between 2004 and 2015 at 4 tertiary referral centers to identify pathologically confirmed PDAC patients. Baseline clinicopathologic characteristics, preoperative laboratory values such as absolute neutrophil, lymphocyte, and platelet counts, C-reactive protein, albumin, bilirubin, and CA19-9 levels, and also follow-up information, were collected. The associations of the calculated inflammatory indices with outcome were both internally and externally validated.

Results:

In all, 590 patients with resectable PDAC were included. The discovery and validation cohort included 170 and 420 patients, respectively. SIII >900 [hazard ratio (HR) 2.32, 95% confidence interval (CI) 1.55–3.48], lymph node ratio (HR 3.75, 95% CI 2.08–6.76), and CA19.9 >200 kU/L (HR 1.62, 95% CI 1.07–2.46) were identified as independent predictors of cancer-specific survival. Separate model analysis confirmed that preoperative SIII contributed significantly to prognostication. However, SIII appeared to lose its prognostic significance in patients with bilirubin levels above 200 μmol/L.

Conclusions:

SIII is an independent predictor of cancer-specific survival and recurrence in patients with resectable PDAC. SIII may lose its prognostic significance in patients with high bilirubin levels. Properly designed prospective studies are needed to further confirm this hypothesis.
Validating the Electronic Cardiac Arrest Risk Triage (eCART) Score for Risk Stratification of Surgical Inpatients in the Postoperative Setting
Authors: Bartkowiak Bartlomiej , Snyder Ashley M. , Benjamin Andrew , Schneider Andrew , Twu Nicole M. , Churpek Matthew M. , Roggin Kevin K. , Edelson Dana P.
Published: January 2018

Objective:

Assess the accuracy of 3 early warning scores for predicting severe adverse events in postoperative inpatients.

Summary of Background Data:

Postoperative clinical deterioration on inpatient hospital services is associated with increased morbidity, mortality, and cost. Early warning scores have been developed to detect inpatient clinical deterioration and trigger rapid response activation, but knowledge regarding the application of early warning scores to postoperative inpatients is limited.

Methods:

This was a retrospective cohort study of adult patients hospitalized on the wards after surgical procedures at an urban academic medical center from November, 2008 to January, 2016. The accuracies of the Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), and the electronic cardiac arrest risk triage (eCART) score were compared in predicting severe adverse events (ICU transfer, ward cardiac arrest, or ward death) in the postoperative period using the area under the receiver operating characteristic curve (AUC).

Results:

Of the 32,537 patient admissions included in the study, 3.8% (n = 1243) experienced a severe adverse outcome after the procedure. The accuracy for predicting the composite outcome was highest for eCART [AUC 0.79 (95% CI: 0.78–0.81)], followed by NEWS [AUC 0.76 (95% CI: 0.75–0.78)], and MEWS [AUC 0.75 (95% CI: 0.73–0.76)]. Of the individual vital signs and labs, maximum respiratory rate was the most predictive (AUC 0.67) and maximum temperature was an inverse predictor (AUC 0.46).

Conclusion:

Early warning scores are predictive of severe adverse events in postoperative patients. eCART is significantly more accurate in this patient population than both NEWS and MEWS.
Proposed Modification of the 8th Edition of the AJCC Staging System for Pancreatic Ductal Adenocarcinoma
Authors: Shi Si , Hua Jie , Liang Chen , Meng Qingcai , Liang Dingkong , Xu Jin , Ni Quanxing , Yu Xianjun
Published: January 2018

Objective:

The aim of this study was to improve the 8th edition (8th) of the American Joint Committee on Cancer (AJCC) staging system for pancreatic ductal adenocarcinoma (PDAC).

Background:

The new 8th AJCC staging system for PDAC was released in October, 2016, and will be applied in clinical practice in 2018.

Methods:

Two large cohorts were included in this analysis. One consisted of 45,856 PDAC patients in the Surveillance, Epidemiology, and End Results (SEER) database (2004–2014), and the other consisted of 3166 PDAC patients in the Fudan University Shanghai Cancer Center (FUSCC) database (2005–2015).

Results:

Using the 8th AJCC staging system, the median overall survival of the patients in the same stage varied widely among the different substages. We proposed a modified staging system based on median OS in which we maintained the T, N, and M definitions, but regrouped the substages. In the SEER cohort, the concordance index was higher for local disease with the modified staging system [0.637; 95% confidence interval (CI) 0.631–0.642] than with the 8th AJCC staging system (0.620, 95% CI 0.615–0.626). Similar findings were also observed in the FUSCC cohort. In addition, we verified the reliability of the modified staging system in an analysis of patients with different examined lymph node counts (≥15 or 1–14).

Conclusions:

The modified 8th AJCC staging system for PDAC proposed in this study provides improvements and may be evaluated for potential adoption in the next edition.
Preoperative 18F-FDG PET/CT in Pheochromocytomas and Paragangliomas Allows for Precision Surgery
Authors: Nockel Pavel , El Lakis Mustapha , Gaitanidis Apostolos , Merkel Roxanne , Patel Dhaval , Nilubol Naris , Prodanov Tamara , Pacak Karel , Kebebew Electron
Published: January 2018

Background:

Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging is recommended in patients with metastatic pheochromocytoma (PC) and paraganglioma (PGL). There are no data on whether routine preoperative 18F-FDG PET/CT in all patients with PC/PGL impacts surgical management.

Objective:

The aim of this study was to determine whether routine preoperative 18F-FDG PET/CT imaging affects the surgical management of patients with PC/PGLs.

Methods:

We analyzed clinical, biochemical, genetic, and anatomic imaging data in 93 consecutive patients with PC/PGL who collectively underwent a total of 100 operations and who had preoperative 18F-FDG PET/CT imaging.

Results:

Of 100 operations, preoperative 18F-FDG PET/CT showed additional lesions compared to anatomic imaging in 15 cases. These patients were more likely to undergo an open surgical approach (P < 0.05). Presence of genetic mutation, redo operations, sex, age, or tumor size had no significant association with finding additional lesions on 18F-FDG PET/CT.

Conclusions:

Additional lesions detected on preoperative 18F-FDG-PET/CT imaging have an impact on the surgical approach in patients with PC/PGLs. Therefore, surgeons should routinely obtain 18F-FDG-PET/CT imaging in patients with PC/PGL to allow for a more precise surgical intervention.
Use of French lyophilized plasma transfusion in severe trauma patients is associated with an early plasma transfusion and early transfusion ratio improvement
Authors: Nguyen Cédric , Bordes Julien , Cungi Pierre-Julien , Esnault Pierre , Cardinale Michael , Mathais Quentin , Cotte Jean , Beaume Sébastien , Sailliol Anne , Prunet Bertrand , Meaudre Eric
Published: January 2018

BACKGROUND

Early transfusion of high ratio of fresh frozen plasma (FFP) and red blood cells (RBC) is associated with mortality reduction. However, time to reach high ratio is limited by the need to thaw the FFP. French lyophilized plasma (FLYP) used by French army and available in military teaching hospital does not need to be thawed and is immediately available. We hypothesize that the use of FLYP may reduce time to reach a plasma/RBC ratio of 1:1.

METHODS

A retrospective study performed in a Level 1 trauma center between January 2012 and December 2015. Severe trauma patients who received 2 U of RBC in the emergency room were included and assigned to two groups according to first plasma transfused: FLYP group and FFP group.

RESULTS

Forty-three severe trauma patients in the FLYP group and 29 in the FFP group were included. The time until first plasma transfusion was shorter in the FLYP group than in the FFP group, respectively 15 min (10–25) versus 95 min (70–145) (p < 0.0001). Time until a 1:1 ratio was shorter in the FLYP group than in the FFP group. There were significantly fewer cases of massive transfusion in the FLYP group than in the FFP group with respectively 7% vs. 45% (p < 0.0001).

CONCLUSION

The use of FLYP provided significantly faster plasma transfusions than the use of FFP as well as a plasma and RBC ratio superior to 1:2 that was reached more rapidly in severe trauma patients. These results may explain the less frequent need for massive transfusion in the patients who received FLYP. These positive results should be confirmed by a prospective and randomized evaluation.

LEVEL OF EVIDENCE

Therapeutic, level IV.
Single Cell Observations Show Persister Cells Wake Based on Ribosome Content
Authors: Kim Jun-Seob , Wood Thomas K.
Published: January 2018

Since persister cells survive antibiotic treatments through dormancy and resuscitate to reconstitute infections, it is imperative to determine the rate at which these cells revive. Using two sets ofEscherichia colipersister cells, those arising naturally at low levels and those generated at high levels by ceasing transcription via rifampicin pretreatment (shown to be bona fide persisters through seven sets of experiments), we used microscopy of single cells to determine that persisters have low levels of antibiotic-corrupting proteins and that their resuscitation is heterogeneous and includes cells that grow immediately. In all, five phenotypes were found for persister cell resuscitation: (i) immediate division, (ii) immediate elongation followed by division, (iii) immediate elongation but no division, (iv) delayed elongation/division, and (v) no growth. In addition, once cell division begins, the growth rate is that of exponential cells. Critically, the greater the ribosome content, the faster the persister cells resuscitate.
Cancer exosomes induce tumor neo-neurogenesis potentiating tumor growth
Authors: Madeo Marianna , Colbert Paul L. , Vermeer Daniel W. , Lucido Christopher T. , Vichaya Elisabeth G. , Grossberg Aaron J. , Cain Jacob T. , Muirhead DesiRae , Rickel Alex P. , Hong Zhongkui , Spanos William C. , Lee John H. , Dantzer Robert , Vermeer Paola D.
Published: January 2018

Patients with densely innervated tumors do worse than those with less innervated cancers. We hypothesize that neural elements are acquired by a tumor-induced process, called neo-neurogenesis. Here, we use PC12 cells in a simple system to test this hypothesis. PC12 cells extend processes, called neurites, only when appropriately stimulated. Using this system, we show that patient tumors release vesicles (exosomes) which induce PC12 neurite outgrowth. Using a cancer mouse model, we show that tumor cells compromised in exosome release grow slower and are less innervated than controls indicating a contribution of innervation to disease progression. We find that neo-neurogenesis is mediated in part by the axonal guidance molecule, EphrinB1, contained in exosomes. These findings support testing EphrinB1 blockers to inhibit tumor innervation and improve survival.

One Sentence Summary

Tumors release exosomes which not only promote their own innervation but also potentiate their growth.