bluuebunny/crossref_metadata_2025 huggingface dataset:
Correction: Improving the inhibitory effect of CXCR4 peptide antagonist in tumor metastasis with an acetylated PAMAM dendrimer
Authors: Liu Changliang , Duan Hongyang , Zhao Zijian , Li Wenzhe , Ma Lilusi , Fang Xiaocui , Wang Chen , Yang Yanlian
Published: December 2018

Correction for ‘Improving the inhibitory effect of CXCR4 peptide antagonist in tumor metastasis with an acetylated PAMAM dendrimer’ by Changliang Liu et al., RSC Adv., 2018, 8, 39948–39956.
Closing performance of the Thomson‐coil actuator for a 110 kV FMS
Authors: Zhou Yannan , Huang Yulong , Wen Weijie , Sun Keke , Men Bo , Zhu Jibin
Published: December 2018

In the 500 kV hybrid high‐voltage direct current (HVDC) circuit breaker, there are five 110 kV fast mechanical switches (FMSs) in the nominal current path. When the detection system detects the failure of the hybrid circuit breaker, in order to protect the disconnectors or semiconductors, the FMSs are required to close quickly. The closing drive technology can be divided into two categories, based on the closing speed of the Thomson‐coil actuator. One is based on the conventional closing drive, the open−close operating time of which is 20.0 ms. The other type is based on the fast closing drive, which is used under fault conditions and the total time is ∼7.5 ms. A 110 kV/3 kA prototype FMS employing an interrupter with a 30 mm maximum open gap and 4 kg total moving mass has been modelled based on the equivalent circuit method. Through the simulation, the effect of discharging time sequence on open−close operation has been studied, and the general timing control design principle has been provided.
Analysis of integration of multi‐terminal HVDC network to weak grids
Authors: Givaki Kamyab , Rahman Md Habibur , Vozikis Dimitrios , Giveki Ashkan
Published: December 2018

In this study, the integration of multi‐terminal high voltage direct current (HVDC) systems to weak power grids is analysed under different grid strengths and control methods. In this study, a modular multi‐level converter based MTDC network is considered. The analysis showed the importance of voltage control of DC network. The voltage control of DC network needs to be performed from the converter station connected to the strongest AC network. Furthermore, the analysis shows that either droop or proportional‐integral control can be used for controlling the DC voltage of the MTDC network connected to one or more weak grids. However, the droop control of DC voltage provides faster response compared to PI with larger steady state error. Finally, the analysis showed that the modular multi‐level converter (MMC)‐based MTDC is capable of ride‐through unbalanced AC side faults even if the faults occur in a weak grid.
Study on the influence of rainfall on the electric field distribution and switching impulse voltage of large‐size sphere–plane gap
Authors: Zhou Feifan , Ding Yujian , Wang Shenghui , Yao Xiuyuan , Lv Fangcheng
Published: December 2018

Previously, the research about the influence of rainfall on the discharge characteristics of the gap mainly focused on the severe non‐uniform electric field gap such as rod–plane, rod–rod, or tower head of which the electrode size was generally small. As the DC voltage level increases, the size of the fitting at the end of the device further increases. As a result, the impact of rain on the discharge characteristics would have significant changes. In this study, the influence of rainwater on the electric field distribution characteristics of the sphere–plane air gap was simulated and the electric field distortion characteristic formed by the rain collected at the bottom of the fitting was obtained. Then, the impulse discharge test of the fitting under different rainfalls was conducted from which the influence of different rainfall on the impulse discharge voltage of sphere–plane gap was analysed. The research results can be used to optimise the design of the end fittings of outdoor DC field equipment.
Control of central air conditioning loads to respond the fault on the HVDC transmission line
Authors: Wang Dapeng , Zhang Guohui , Jing Yugang , Liu Meng , Li Jialu , Cheng Dingyi
Published: December 2018

The high voltage direct‐current (HVDC) transmission is developed rapidly to transmit the clean energy to distant load centres. There will be serious power shortage accidents for the cities if the fault occurs on the HVDC transmission line. Demand response is one of the effective methods to cope with frequency accident. In this study, the control of central air conditioning loads is applied to respond the fault on the HVDC transmission line. The authors focus on the modelling of the central air conditioning loads including the chiller, the inlet and outlet chilled water temperature variation, the heat exchange between chilled water and air, and the space thermal model of the room. When the fault occurs, the chiller will be cut‐off immediately. After a period of time, the chiller is turn on to decrease the impact to the users, and the ampere rating of the chiller is restricted to avoid the load shock to the power systems. Simulation results show that the control of central air conditioning loads can respond the accident immediately and the load shock can be avoided in the period of power restoration. Additionally, the users’ comfort is not affected obviously.
Novel grid connection interface for utility‐scale PV power plants based on MMC
Authors: Wu Pan , Huang Wentao , Tai Nengling
Published: December 2018

The ever‐increasing integration of photovoltaic (PV) energy has led to the fast development of utility‐scale PV power plants worldwide. A novel grid connection interface for utility‐scale PV power plants based on the modular multi‐level converter (MMC) is explored. The grid connection interface is a DC boost interface by nature. It adopts the multistring topology, employs DC/DC boost converters, utilises a centralised MMC, and integrates an energy storage system. Meanwhile, the two‐level control system for the DC boost interface is also designed. Compared with the conventional AC boost interfaces, the proposed DC boost interface avoids problems regarding reactive power transmission, harmonic resonance, and synchronous stabilisation. It also improves the power quality, efficiency, and the integration capacity of the PV generation. A case study of a utility‐scale PV power plant with the DC boost interface is carried out in PSCAD/EMTDC. The simulation results validate the effectiveness and the merits of the DC boost interface under different operation conditions. The proposed DC boost interface proves more suitable for utility‐scale PV power plants in areas with high solar irradiance. It also lays a solid foundation for the future research regarding the control and protection of utility‐scale PV power plants.
Gladiatorenärzte im antiken Rom
Authors: Moog Ferdinand
Published: December 2018

Gladiators in ancient Rome were an integral part of the Roman world and were a unique phenomenon. Their bloody fight presumably originated from the cult of the dead. Later it was a feature of the self-portrayal of many Roman noblemen, especially during the election campaigns. Eventually it became an imperial privilege. Legally, gladiators were slaves. They were trained in specially equipped schools (ludus, plural: ludi). Also, special schools existed that trained fighters to compete in the arena against wild animals. Doctors at the ludi took care of the fighters: They prepared them for the fight or treated injuries. The gladiator cemeteries of Ephesus and York clearly demonstrate typical injury patterns. The most prominent and best-known gladiator physician is – due to his eminent self-portrayal – Galenus. Even though he looked after the gladiators of his hometown Pergamon only for a brief time. From ancient inscriptions we know the names of several other physicians who took care of gladiators. Especially these largely forgotten doctors are referenced in this article.
Hafertage zur Entlastung des Stoffwechsels
Authors: Remppis Bjoern Andrew
Published: December 2018

Hauptrisikofaktoren für Diabetes mellitus Typ 2 sind Übergewicht und
Bewegungsmangel. Diabetes Typ 2 muss medikamentös therapiert werden, kann jedoch
zusätzlich durch einen veränderten Lebensstil mit mehr Bewegung und angepasster
Ernährung sowie durch spezielle diätetische Interventionen verbessert werden.
Dazu gehören auch die Hafertage oder Haferkuren, die zur Entlastung des
Glucosestoffwechsels beitragen (
Abb.
1
).
Prävention und Behandlung von
Herz-Kreislauf-Erkrankungen
Authors: Kleber Marcus E.
Published: December 2018

Viele Studien haben gezeigt, dass langkettige mehrfach ungesättigte
Omega-3-Fettsäuren (ω3-PUFAs), wie z. B. Eicosapentaensäure (EPA) und
Docosahexaensäure (DHA), kardioprotektiv wirken. Man vermutet dabei einen
positiven Effekt dieser Fettsäuren auf die Eigenschaften der Zellmembran sowie
eine Funktion als Ausgangssubstrate für die Synthese antientzündlicher
Substanzen wie Prostaglandine der Serie 3 und Leukotriene der Serie 5.
Trainingstherapie in der Nephrologie
Authors: Krause Rolfdieter , Halleck Fabian , Kardasinski Michal , Wolfarth Bernd , Budde Klemens
Published: December 2018

Die chronische Niereninsuffizienz (Chronic Kidney Disease, CKD) führt über
mehrere Folge- und Begleiterkrankungen zu körperlicher Leistungsminderung, die
bis zur Dialysepflichtigkeit einen Abfall um 60–80 % betragen kann. Regelmäßige
körperliche Aktivitäten können diese Leistungsminderung aufhalten und wieder
verbessern. Dazu sind auch die Aktivitäten des täglichen Lebens gut geeignet,
wie zum Beispiel Einkaufen- und Spazierengehen, Fahrradfahren oder Gartenarbeit.
Außerdem werden bekanntermaßen koronare Herzkrankheit (KHK), Herzinsuffizienz,
Hypertonie sowie Diabetes positiv beeinflusst, und es können Medikamente
eingespart werden. (Heim-)Trainingsprogramme für chronisch Nierenkranke sind
seit vielen Jahren bekannt und haben sich bewährt. In Deutschland ist ambulanter
Rehabilitationssport auch für die chronische Niereninsuffizienz anerkannt. Eine
individuell verordnete Trainingstherapie als „Rezept für Bewegung“ sollte in
allen Stadien der CKD zum Standard der nephrologischen Behandlung gehören.
Relevanz einer Supplementation mit Mikronährstoffen für die
Herzgesundheit
Authors: Wallert Maria , Lorkowski Stefan
Published: December 2018

Die Deutschen supplementieren Mikronährstoffe so viel wie noch nie. Der Glaube an
die zahlreichen kolportierten gesundheitsfördernden Wirkungen ist stärker denn
je. Eine neue Metaanalyse, welche 179 randomisierte Humanstudien zusammenfassend
betrachtet hat, ergab jedoch für die meisten Multivitaminpräparate und
Antioxidanzien, mit Ausnahme von Vitamin-B-Komplexen, keine präventive Wirkung
hinsichtlich kardiovaskulärer Morbidität oder Mortalität.
Ex Vivo Evaluation of the ArtVentive EOS Occlusion Device for the Management of Biliary Leaks
Authors: Kuetting Daniel , Schild Hans Heinz , Pieper Claus Christian
Published: December 2018

Purpose Percutaneous treatment of biliary leaks is frequently required, yet technically challenging and limited to smaller fistulas. This study sought to evaluate the off-the-shelf use of the ArtVentive EOS device for the occlusion of biliary or cystic stump leaks.

Materials and Methods ePTFE-covered ArtVentive EOS devices were used to perform biliary leak embolization in 5 explanted porcine livers and in 3 explanted bovine livers. After establishing standard percutaneous transhepatic biliary drainage access, artificially created biliary leaks were occluded using 5 & 8 mm EOS devices. Using the 5 mm device, peripheral (n = 3), central (n = 1) and cystic duct leaks (n = 1) were occluded. Using the 8 mm device, peripheral (n = 1), central (n = 1), main (n = 1) and cystic duct leaks (n = 2) were occluded. Total leak occlusion was controlled by cholangiography.

Results Selective deployment and occlusion of central biliary leaks (3/3) and cystic stump leaks (3/3) was successful in all cases. Peripheral leaks could not be selectively catheterized in 3 out of 4 cases, making device deployment several millimeters proximal to the leaks necessary.

Conclusion Selective occlusion of the cystic stump, central biliary, and larger peripheral biliary leaks using the EOS device is technically feasible ex-vivo in a single setting.

Key points 

Citation Format
Weißdorn
Authors: Chrubasik-Hausmann Sigrun
Published: December 2018

Crataegus – wirksam bei Herzschwäche
Hijama – die Schröpftherapie in der altorientalischen Medizin
Authors: Adam Mohamad
Published: December 2018

Die „Unani-Medizin“ entwickelte sich aus dem pharaonischen und dem altpersischen Wissensschatz über die antike Medizin Griechenlands bis hin zu dem islamisch geprägten Orient parallel zur Traditionellen Chinesischen Medizin und Ayurveda-Medizin. Einer der Bestandteile der Unani-Medizin ist die Schröpftherapie. Sie hat sich über Jahrhunderte hinweg etabliert. Da sie invasiv ist, sprechen sich viele Kritiker gegen sie aus. Jedoch ist auch die ursprüngliche Indikationsstellung in Vergessenheit geraten.
Ernährungsempfehlungen bei chronischer
Niereninsuffizienz
Authors: Stange Rainer
Published: December 2018

Eine den CKD-Krankheitsstadien (CKD: chronic kidney disease, chronische
Niereninsuffizienz) angepasste Ernährung kann das dialysefreie Intervall und die
Lebensqualität günstig beeinflussen. Da der Ruheenergieumsatz der Nieren circa 7
% beträgt, sollte die Proteinzufuhr zwischen 6 und 8 g/d kg KG betragen. Ein
prognostisch ungünstiger Faktor sind auch die Störungen im Säure-Basen-Haushalt,
die zum Beispiel durch Gabe von basischen Salzen ausgeglichen werden sollten.
Eine Kochsalzzufuhr von weniger als 5,5 g/d kann den Blutdruck und die
Osteoporose günstig beeinflussen. Auf die Progression können sich auch
L-Arginin, Omega-3-Fettsäuren und Folsäure auswirken. Regelmäßige
Ernährungsberatungen und Kontrollen sind empfehlenswert.
Unani – eine vergessene traditionelle europäische Medizin
Authors: Ather Amina
Published: December 2018

Die Unani-Medizin spielt v.a. in Afghanistan, Pakistan und Indien eine Rolle in der Gesundheitsversorgung. Sie wird an Hochschulen gelehrt und an vielen Krankenhäusern praktiziert. Auch wenn die Wurzeln der Unani-Medizin in Europa liegen, ist das mehr als 2000 Jahre alte Medizinsystem hier weitgehend in Vergessenheit geraten. Der Beitrag stellt das System der Unani-Medizin vor, nimmt Bezug auf das mögliche Potenzial in der Therapie und konkretisiert die gegenwärtigen Herausforderungen für Unani-Wissenschaftler.
Attempted Nose and Lip Replantation after Partial Animal Digestion
Authors: Cuellar Trajan , Westbom Catherine , Orgill Dennis , Pribaz Julian , Caterson Edward , Talbot Simon
Published: December 2018

We report a case of a 71-year-old female patient who sustained a severe midface soft tissue avulsion injury from a family canine. The removed tissue was recovered from the canine's digestive tract and transferred to the hospital where emergent microvascular replantation was performed. The tissue survived for 72 hours, but then developed vascular compromise. Despite aggressive revision of multiple anastomoses with extensive use of vein grafting, the replanted segment was lost. Reconstruction then proceeded along traditional lines with an acceptable cosmetic outcome and good functional outcomes.
Wie würden Sie entscheiden?
Authors: Wienke A.
Published: December 2018

Die Patientenaufklärung ist mittlerweile auch in Arztkreisen zu einer allseits anerkannten und zentralen ärztlichen Verpflichtung geworden. Die Patientenaufklärung in Klinik und Praxis zählt neben der standardgemäßen Behandlung und der Dokumentation zu den Kardinalpflichten des ärztlichen Berufes. Auch der Gesetzgeber hat die Patientenaufklärung mit den Bestimmungen des Patientenrechtegesetzes zu einem zentralen Element der ärztlichen Behandlung erhoben. Ungeachtet dessen gibt es nach wie vor eine Vielzahl von sog. Arzthaftungsklagen, die sich auf eine Verletzung der ärztlichen Aufklärungspflicht stützen und damit in vielen Fällen Erfolg haben.
Erhöhter Feinstaubgehalt der Luft ist mit einem Verlust an Knochendichte und einem gesteigerten Frakturrisiko assoziiert
Authors: Pfeifer Michael
Published: December 2018

Passend zur aktuellen Diskussion um Fahrverbote in deutschen Großstädten aufgrund eines erhöhten Feinstaubgehaltes in der Luft fand sich in der aktuellen Literatur folgende Studie
3D printing in cell culture systems and medical applications
Authors: Lerman Max J. , Lembong Josephine , Gillen Greg , Fisher John P.
Published: December 2018

3D printing plays an important role in various biomedical research applications including, but not limited to, culture systems and implantable devices. In this review, we discuss recent development in the applications of 3D printing technologies for clinically motivated research, particularly focusing on the fabrication of constructs subsequently incorporated with cells. Applications of this technology include pharmaceutical delivery, bioreactor culture platforms, acellular scaffolds, imaging modalities, and organ-on-a chip systems. Emphasis is placed on technological developments not possible without 3D printing technologies: where traditional manufacturing approaches would be cumbersome to demonstrate research objectives. The clinical applications of 3D printing are rapidly moving from the research to production phases and will certainly continue to grow, with ever increasing numbers of therapies becoming commercialized. The work discussed here holds promise for various applications in structural improvements, drug delivery, and physiology research.
Tin-assisted heteroepitaxial PLD-growth of κ-Ga2O3 thin films with high crystalline quality
Authors: Kneiß M. , Hassa A. , Splith D. , Sturm C. , von Wenckstern H. , Schultz T. , Koch N. , Lorenz M. , Grundmann M.
Published: December 2018

High-quality Ga2O3 thin films in the orthorhombic κ-phase are grown by pulsed-laser deposition using a tin containing target on c-sapphire, MgO(111), SrTiO3(111), and yttria-stabilized ZrO2(111) substrates. The structural quality of the layers is studied based on the growth parameters employing X-ray diffraction 2θ-ω scans, rocking curves, ϕ scans, and reciprocal space maps. Our layers exhibit superior crystalline properties in comparison to thin films deposited in the monoclinic β-phase at nominally identical growth parameters. Furthermore, the surface morphology is significantly improved and the root-mean-squared roughness of the layers was as low as ≈0.5 nm, on par with homoepitaxial β-Ga2O3 thin films in the literature. The orthorhombic structure of the thin films was evidenced, and the epitaxial relationships were determined for each kind of the substrate. A tin-enriched surface layer on our thin films measured by depth-resolved photoelectron spectroscopy suggests surfactant-mediated epitaxy as a possible growth mechanism. Thin films in the κ-phase are a promising alternative for β-Ga2O3 layers in electronic and optoelectronic device applications.
Why the evolution of vaccine resistance is less of a concern than the evolution of drug resistance
Authors: Kennedy David A. , Read Andrew F.
Published: December 2018

Vaccines and antimicrobial drugs both impose strong selection for resistance. Yet only drug resistance is a major challenge for 21st century medicine. Why is drug resistance ubiquitous and not vaccine resistance? Part of the answer is that vaccine resistance is far less likely to evolve than drug resistance. But what happens when vaccine resistance does evolve? We review six putative cases. We find that in contrast to drug resistance, vaccine resistance is harder to detect and harder to confirm and that the mechanistic basis is less well understood. Nevertheless, in the cases we examined, the pronounced health benefits associated with vaccination have largely been sustained. Thus, we contend that vaccine resistance is less of a concern than drug resistance because it is less likely to evolve and when it does, it is less harmful to human and animal health and well-being. Studies of pathogen strains that evolve the capacity to replicate and transmit from vaccinated hosts will enhance our ability to develop next-generation vaccines that minimize the risk of harmful pathogen evolution.
Cardiomyocyte-specific loss of RNA polymerase II subunit 5-mediating protein causes myocardial dysfunction and heart failure
Authors: Zhang Jian , Sheng Jingyi , Dong Liwei , Xu Yinli , Yu Liming , Liu Yu , Huang Xiaoru , Wan Song , Lan Hui-Yao , Wang Huishan
Published: December 2018

Aims

Myocardial dysfunction is an important cause of heart failure (HF). RNA polymerase II subunit 5 (RPB5)-mediating protein (RMP) is a transcriptional mediating protein which co-ordinates cellular processes including gene expression, metabolism, proliferation, and genome stability. However, its role in cardiac disease remains unknown. We aimed to determine the role and regulatory mechanisms of RMP in cardiomyocyte function and the development of HF.

Methods and results

Myocardial RMP expression was examined in human heart tissues from healthy controls and patients with advanced HF. Compared to normal cardiac tissues, RMP levels were significantly decreased in the myocardium of patients with advanced HF. To investigate the role of RMP in cardiac function, Cre-loxP recombinase technology was used to generate tamoxifen-inducible cardiomyocyte-specific Rmp knockout mice. Unexpectedly, cardiomyocyte-specific deletion of Rmp in mice resulted in contractile dysfunction, cardiac dilatation, and fibrosis. Furthermore, the lifespan of cardiac-specific Rmp-deficient mice was significantly shortened when compared with littermates. Mechanistically, we found that chronic HF in Rmp-deficient mice was associated with impaired mitochondrial structure and function, which may be mediated via a transforming growth factor-β/Smad3-proliferator-activated receptor coactivator1α (PGC1α)-dependent mechanism. PGC1α overexpression partially rescued chronic HF in cardiomyocyte-specific Rmp-deficient mice, and Smad3 blockade protected against the loss of PGC1α and adenosine triphosphate content that was induced by silencing RMP in vitro.

Conclusions

RMP plays a protective role in chronic HF. RMP may protect cardiomyocytes from injury by maintaining PGC1α-dependent mitochondrial biogenesis and function. The results from this study suggest that RMP may be a potential therapeutic agent for treating HF.
Cardioaortic replacement for a ruptured root pseudoaneurysm with pulsatile subcutaneous extension
Authors: Wang Hanjay , Shudo Yasuhiro , Hittinger Scott A , Woo Y Joseph
Published: December 2018

Orthotopic heart transplantation with concomitant aortic surgery is rarely performed. Herein, we describe the successful management of a patient with an otherwise inoperable, ruptured aortic root pseudoaneurysm using combined cardioaortic replacement under hypothermic circulatory arrest.
Results of the Induced Membrane Technique in the Management of Traumatic Bone Loss in the Lower Limb: A Cohort Study
Authors: Giotikas Dimitris , Tarazi Nadim , Spalding Lynette , Nabergoj Marko , Krkovic Matija
Published: December 2018

Objective:

To present our technique and early results using the Masquelet technique.

Design:

Retrospective cohort study.

Patients/Participants:

Thirteen patients with 14 open fractures of the femur and tibia were included between November 2013 and December 2014.

Intervention:

A Masquelet technique was used to manage the open fractures.

Main outcome measure:

Infection and union rate.

Results:

The mean follow-up was 17 months. The mean bone defect was 56.6 mm. Eight fractures (57.1%) progressed to union at an average of 42.1 weeks. Infection developed in 3 fractures (21.4%). Overall, the induced membrane technique was abandoned in 5 (35.7%) cases.

Conclusions:

The induced membrane technique showed a substantial rate of failure in the acute trauma setting in the lower limb. In the absence of sound published evidence, the authors now use the technique in selected cases only.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Dedifferentiated Melanoma With Expression of Cytokeratin and GATA3 in a Patient With History of Breast Carcinoma
Authors: Alkhasawneh Ahmad , Nassri Ammar , John Ivy
Published: December 2018

Melanoma is one of the great mimickers in pathology because it has diverse morphologies and can be mistaken for carcinoma or sarcoma. In most cases, immunochemistry is helpful in supporting the diagnosis and excluding other differentials. However, metastatic melanoma may lose immunohistochemical melanocytic markers and express nonmelanocytic lineage markers, which often poses a diagnostic dilemma and may be misdiagnosed as a poorly differentiated carcinoma or sarcoma. We report the case of a 52-year-old woman who had a history of recurrent melanoma on her right shoulder with axillary lymph node metastasis (BRAF V600K–mutated melanoma) and right-side breast-invasive ductal carcinoma (stage pT1b N0sn). One year later, she presented with a left-sided chest wall mass and enlarging left axillary lymph nodes. Needle core biopsies were obtained from both lesions, and histologic examination showed a poorly differentiated tumor with pleomorphic/anaplastic morphology and necrosis. The tumor cells were strongly immunoreactive for GATA-3 without expression of melanocytic markers (S100, Melan A, HMB45, SOX10, MITF, and tyrosinase). The history of melanoma prompted molecular analysis, and the lesion was found to harbor the BRAF V600K mutation, consistent with metastatic dedifferentiated melanoma. Recognition of metastatic dedifferentiated melanoma is important to avoid misdiagnosis of carcinoma, especially in patients with a previous history of carcinoma.
Immediate Implant-based Breast Reconstruction with Acellular Dermal Matrix Compared with Tissue-expander Breast Reconstruction: Rate of Infection
Authors: Carminati Marcello , Sempf Darja , Bonfirraro Pier Paolo , Devalle Luca , Verga Maurizio , Righi Bernardo , Mevio Gabriele , Leone Francesco , Fenaroli Privato , Robotti Enrico
Published: December 2018

Background:

The risk of infection continues to be a subject of discussion within the field of implant-based breast reconstruction. Studies have shown the feasibility of immediate single-stage procedures with acellular dermal matrix (ADM), yet 2-stage tissue expander techniques continue to be the procedure most often performed. The purpose of this study was to evaluate postoperative infections and to identify associated predictors.

Methods:

A retrospective study at Papa Giovanni XXIII Hospital was conducted between 2013 and 2017. Patients’ demographic data were compared between single-stage and 2-stage procedures. Rate of infection and predictors were examined. Minor infections could be treated by oral antibiotics only, major infections required inpatient treatment. Healing was considered a successful treatment with antibiotics only, whereas any supplementary surgical intervention resulting in the preservation of an implant device was considered salvage. Breast reconstruction was defined a failure in case of implant loss or need for autologous reconstruction.

Results:

Three hundred ninety-three patients underwent 336 monolateral and 57 bilateral implant-based breast reconstruction. Ninety-two patients had a submuscular direct-to-implant reconstruction with ADM with an infection rate of 11.4% compared with an infection rate of 7.8% among the 268 patients with a 2-stage tissue expander procedure. Beta-binomial regression showed obesity and preoperative radiotherapy as significant predictors for infection (OR, 4.65, P = 0.038, and OR, 7.13, P = 0.015, respectively). Average time of onset of infection among the submuscular direct-to-implant with ADM group was 67.1 days compared with 80.1 days among tissue-expander group with postoperative chemotherapy and preoperative radiotherapy having a significant effect on time of infection onset (P = 0.014, P = 0.034, respectively).

Conclusions:

Direct-to-implant breast reconstruction with ADM is a procedure with acceptable risks of infection in comparison to tissue expander procedures. A profound patient selection pre- and intraoperatively is the basis of successful breast reconstruction.
Local Flaps with Negative Pressure Wound Therapy in Secondary Reconstruction of Myelomeningocele Wound Necrosis
Authors: Banda Chihena H. , Narushima Mitsunaga , Ishiura Ryohei , Fujita Minami , Furuya Megumi
Published: December 2018

Major wound necrosis is an uncommon yet critical complication of meningomyelocele surgical repair with few reports available. Management is demanding and often requires further reconstructive surgery. We report a case of a neonate who developed extensive wound necrosis with dehiscence following primary repair of myelomeningocele. The large defect was reconstructed using transposition fasciocutaneous flaps and negative pressure wound therapy applied over the flap donor sites resulting in wound closure, alleviating the need for further surgery. We report this case to highlight the importance of local flap design in reconstruction of the complex wounds seen following meningomyelocele repair wound necrosis. Additionally, we report the unique utilization of negative pressure wound therapy in the management of myelomeningocele.
Inframammary Flap Excision Method in Breast Augmentation: Improving Symmetry of NAC and IMF
Authors: Go Ju Young , Jeong Dae Kyun , Han Daniel Seungyoul , Bae Seong Hwan
Published: December 2018

Background:

When we perform a breast augmentation through the inframammary fold (IMF) approach, incision placement at the new IMF is a key element of the planning process. In the majority of the previously published methods, the new IMF was planned based on the nipple-areola complex (NAC) position. However, these methods can lead to asymmetry in the IMF if the NAC is not symmetrical.

Methods:

We present the IMF flap excision method for correction of asymmetries of NAC and IMF. The new IMF position was marked based on the ICE technique. We have redesigned the higher side IMF to the same height as the lower side. And then we removed the amount of the skin and soft tissue, which corresponded to the difference between the 2 IMF. We dissected the submuscular breast pocket higher than in the usual cases, making it easier to move the breast tissue downward.

Results:

This method was performed on 21 patients, with an average follow-up time of 6 months (range, 2–9 months). The average correction amount of asymmetry of the NAC ranged from 3 to 15 mm and was maintained throughout the follow-up period. NAC downward positioning and symmetry of IMF were observed. Almost all patients showed improvement or complete resolution of their nipple asymmetry.

Conclusion:

The IMF flap excision method corrected the asymmetries in the NAC and IMF without additional scars. This method should be strongly considered in patients undergoing a primary breast augmentation procedure with mild NAC asymmetry.
Complete Excision of a Simple Dacryops Using Fibrin Sealant and Trypan Blue Mixture
Authors: Men Clara J. , Yang Patrick , Gur Zvi , Paik Ji-Sun , Kikkawa Don O. , Korn Bobby S.
Published: December 2018

A 69-year-old woman presented to the oculofacial plastic service with a painless superotemporal subconjunctival mass in the OS. Over the past year, the lesion had been progressively enlarging, resulting in horizontal diplopia with lateral gaze. Visual acuity was within normal limits with no evidence of optic neuropathy. On examination, the lesion was tense, transilluminated, and was clinically consistent with a simple dacryops. Complete excision of the lesion was planned under local anesthesia with monitored care. To facilitate complete removal of the lesion, fibrinogen and a mixture of thrombin and trypan blue were injected to fill the cyst cavity. This blue-stained fibrin clot allowed for easy visualization of the border and ensured complete excision without collateral damage to surrounding normal tissue. Simple dacryops is often difficult to remove completely with its capsule intact and this technique allows for clear delineation of the cyst and preservation of epithelial integrity for complete and efficient removal.
Facility Design
Authors: Breedlove Ginger , Rathbun Lesley
Published: December 2018

Few maternity care clinicians are aware of the current regulations that guide design standards for childbirth facilities in the United States or the regulatory history. There is considerable variance among state regulations as well as oversight of facility standards for healthcare settings. Understanding evidence-based recommendations on how facility design affects health outcomes is critical to reversing the rise in maternal mortality and morbidity. A variety of measures can be implemented that promise to improve user satisfaction, quality of care, and efficiency for all who engage in the childbirth environment. Recommendations for change include broader assessment to better understand how clinicians and consumers simultaneously maneuver within a complex system. Key metrics include evaluation of workflow within available space, patient acuity and census patterns, integration of evidence-based recommendations, and options that promote physiologic birth. For the changes to succeed, human centered design must be implemented and diverse clinicians and consumers engaged in all phases of planning and implementation. Exploring characteristics and outcomes of low-risk women who receive care in a freestanding birth center or the European alongside maternity unit provides opportunity to reimagine and address improvements for inpatient, hospital birth.
Indications and Outcomes for Temporary Mechanical Circulatory Support in Pediatric Patients with Cardiac Failure
Authors: Bearl David W. , Jaquiss Robert D. B. , Vesel Travis P.
Published: December 2018

Temporary continuous-flow ventricular assist devices (cfVAD) and extracorporeal membrane oxygenation (ECMO) are options for temporary mechanical circulatory support in pediatric patients. Despite the increase in temporary cfVAD use, the literature describing its use in pediatrics is limited. This was a single-center retrospective review of temporary cfVAD and a cohort of similar ECMO patients between January 1, 2011, and June 30, 2016, in patients <19 years of age. Thirteen patients underwent temporary cfVAD placement and 11 patients underwent ECMO cannulation for similar indications during the study period. Precannulation data were not statistically different, except for higher lactate and lower pH in the ECMO cohort. Median length of cfVAD support was 20 days (range 6–227), compared with 9 days (range 1–15) on ECMO. Primary outcome for cfVAD patients was one decannulated with recovery, six transplanted, and six died, compared with ECMO patients with five decannulated with recovery, three transplanted after conversion to durable VAD, and three died. No patients were transplanted directly from ECMO. This review provides new evidence that temporary cfVAD use can be used to support pediatric patients more than longer periods of time compared with ECMO, with transition to durable VAD and transplant.
Comparative Analysis of Adverse Events After Esophageal Balloon and Bougie Dilations in Children
Authors: Mark Jacob A. , Anderson Bradley T. , Pan Zhaoxing , Menard‐Katcher Calies , Kramer Robert E.
Published: December 2018

Background:

Pneumatic balloon and bougie dilation are widely used methods for pediatric esophageal dilation. There are no studies directly comparing the safety of these techniques in pediatric patients. This study compared adverse events (AEs) of balloon and bougie dilation in children at a single institution.

Methods:

AEs were identified by means of a prospective clinical registry of all procedure related AEs from 2012 to 2015 at a single institution. Identified AEs underwent retrospective review of procedural and clinical details. The category of each AE was recorded and severity was assigned using a 5‐point scoring system. AEs were compared between balloon and bougie dilation for different severities.

Results:

There were 105 patients who underwent 246 dilation sessions. Balloon dilation was performed more commonly (n = 190, 77%) as compared to Maloney dilators (n = 56, 23%). Patients with balloon dilation were younger (3.0 vs 14.5 years, P = 0.0001) and more likely to have strictures from caustic ingestion (42% vs 2%, P < 0.0001) or surgical anastomoses (34% vs 5% P < 0.0001). Bougie dilation was used more commonly in patients with eosinophilic esophagitis (77% vs 7%, P < 0.0001)). In multivariate analysis, each year of increasing age was associated with a 12% increase in any AEs (P = 0.015), but no difference in clinically significant AEs (grade 2 or higher) was identified between dilation methods.

Conclusions:

Bougie and balloon dilation did not have significant differences in AE rates, but the patient populations differed between the 2 methods. The dilation method should depend on stricture characteristics and endoscopist expertise with each method.
Concordance Between Intracervical and Fundal Injections for Sentinel Node Mapping in Patients With Endometrial Cancer?
Authors: Farazestanian Marjaneh , Yousefi Zohreh , Zarifmahmoudi Leili , Hasanzadeh Mofrad Malihe , Kadkhodayan Sima , Sadeghi Ramin
Published: December 2018

Objective

A major controversy in sentinel node (SN) biopsy of endometrial cancer is the injection site of mapping material. We compared lymphatic drainage pathways of the uterine cervix and uterine body in the same patients by head-to-head comparison of intracervical radiotracer and fundal blue dye injections.

Methods

All patients with pathologically proven endometrial cancer were included. Each patient received 2 intracervical injections of 99mTc-phytate. At the time of laparotomy, the uterus was exposed, and each patient was injected with 2 aliquots of patent blue V (2 mL each) in the subserosal fundal midline locations. The anatomical locations of all hot, blue, or hot/blue SNs were recorded.

Results

Overall, 45 patients entered the study. At least 1 SN could be identified in 75 of 90 hemipelves (83.3% overall detection rate, 82.2% for radiotracer [intracervical] alone, and 81.1% for blue dye [fundal] alone). In 71 hemipelves, SNs were identified with both blue dye (fundal) and radiotracer (intracervical) injections. In 69 of these 71 hemipelves, at least 1 blue/hot SN could be identified (97.18% concordance rate). In 10 patients, para-aortic SNs were identified. All of these nodes were identified by fundal blue dye injection, and only 2 were hot.

Conclusions

Our study shows that lymphatic drainage to the pelvic area from the uterine corpus matches the lymphatic pathways from the cervix, and both intracervical and fundal injections of SN mapping materials go to the same pelvic SNs.
A Rare Case of Neutrophil-Rich, ALK-Negative Anaplastic Large Cell Lymphoma in the Lung Mimicking a Pulmonary Abscess on 18F-FDG PET/CT
Authors: Wang Li-Juan , Wu Hu-Bing , Zhang Yin , Zhou Wen-Lan , Wang Quan-Shi
Published: December 2018

A 21-year-old man complained of cough, fever, and hemoptysis for 15 days. Peripheral neutrophil cell (33.8 × 109/L) was markedly increased, and a mass in the left lung was detected by chest radiography. 18F-FDG PET/CT was referred for characterizing the lesion and found a large mass with multiple cavities in the left lung, which had markedly high uptake of 18F-FDG, mimicking pulmonary abscess. Surprisingly, the lesion was eventually proved to be neutrophil-rich anaplastic large cell lymphoma. After 4 cycles' chemotherapy, the lesion shrank significantly.
Imaging and Treatment of Post–90Y Radioembolization Radiation Dermatitis
Authors: Huang Hian Liang , Venkatanarasimha Nanda , Chan Chung Yip
Published: December 2018

90Y microspheres have been widely used for treatment of liver-dominant malignancies. There have been a few case reports of radiation dermatitis post–inadvertent falciform artery 90Y radioembolization and a few retrospective studies with prophylactic coiling or use of ice packs prior to radioembolization. Our patient had inadvertent falciform artery radioembolization, which was not predicted on pretherapy angiography or 99mTc–macroaggregated albumin SPECT/CT but was localized on posttherapy 90Y PET/CT and treated with topical betamethasone valerate 0.1% BD and ice packing immediately postprocedure. He subsequently developed a small area of periumbilical radiation dermatitis, which resolved after 4 weeks.
Anatomical Basis for Lip Reconstruction
Authors: Tong Charles C. L. , Vandegriend Zachary P. , Lee Yan H. , Lawson William
Published: December 2018

Objective

The aim of this study was to establish the anatomic basis for functional upper and lower lip reconstruction with locoregional flaps.

Design, Setting, and Participants

This article is an anatomic fresh cadaver study.

Results

For lower lip reconstruction, the modified Bernard-Webster and Karapandzic flaps preserve the modiolus, buccinator, zygomaticus major muscle, and buccal branches of the facial nerve. The Bernard-Webster flap allowed for a larger oral aperture despite a larger defect, but required transection of the lower lip depressors and orbicularis oris. For upper lip reconstruction, the reverse fan flap preserves the modiolus and its muscle attachments. The reverse Karapandzic flap required transection of the lower lip depressors, buccinator, and the zygomaticus major.

Conclusions and Relevance

Locoregional flaps remain the workhorse for lip reconstruction. This study provides the anatomic basis for the modiolus and its muscular attachments that permit techniques such as the Bernard-Webster flap and the Karapanzic flap to achieve functional lip reconstruction with innervated and denervated tissue.
Long Term Follow Up of a Vascularized Osteocutaneous Free Flap for Reconstruction in Charcot Neuroarthropathy
Authors: Abbate Olivia A. , Lakhiani Chrisovalantis , Janhofer David E. , Elmarsafi Tammer , Zarick Caitlin S. , Higgins James P. , DeFazio Michael V. , Evans Karen K.
Published: December 2018

Vascularized osteocutaneous free flaps have seen increasing use in foot and ankle surgery for the repair of bony defects secondary to chronic nonunion, osteomyelitis, and fractures. One example is the Medial Femoral Condyle (MFC) Flap. The utility of the MFC flap for the repair of a bony defect in a diabetic patient, however, has yet to be explored. We report the long-term results of a case describing the use of an MFC flap to reconstruct an osseous defect resulting from first metatarsophalangeal joint resection in a diabetic patient.
Modified V-Y Fasciocutaneous Flap Reconstruction After Abdominoperineal Resection in Irradiated Patients Prevents Wound Dehiscence and Associated Complications
Authors: Kokosis George , Phillips Brett T. , Soo Joanne , Poveromo Luke , Erdmann Detlev , Mantyh Christopher R. , Migaly John , Levinson Howard
Published: December 2018

Background

Primary perineal closure following abdominal perineal resection (APR) is reported to have a wound complication rate as high as 66%, whereas flap reconstruction reduces wound complications to 15% to 35%. A modified de-epithelialized V-Y fasciocutaneous flap aims to further improve results in this patient population.

Methods

To study the breaking force of a simple interrupted suture in either skin or subcutaneous fat, various quantitative assessments were performed in a porcine flap model using uniaxial static tensile testing with an Instron tensiometer, with a single or triple row of 3 Vicryl sutures in both skin and fat.

An outcomes analysis was performed in 24 patients who underwent modified V-Y flap reconstruction after APR. Primary outcome was wound complications including infection, dehiscence, seroma, hematoma, and pelvic fluid collections.

Results

Tensile strength of sutures anchored in skin was found to be up to 8 times stronger than sutures anchored in subcutaneous fat in a single row and 3 times as strong in 3 rows (breaking force, 500.2 N vs 263.7 N). In our patient cohort of 24 irradiated cancer patients, 10 (42%) had wound healing complications. Wound dehiscence of various degrees accounted for 80% of these complications. Five patients with wound complications (50%) had associated pelvic fluid collections (infection, 1; wound dehiscence, 4). Minor dehiscence was more likely to occur after suture removal and less likely to be associated with pelvic collections compared to patients with major dehiscence. Our study yields total complication rates lower than what is reported in the literature for anterolateral thigh or gracilis flap including much lower infection rates, and almost similar results to the commonly used vertical rectus myocutaneous muscle.

Conclusion

Tension-free de-epithelialized V-Y flap use after APR effectively reconstructs the defect while eliminating an additional donor site. Benchtop studies suggest enhanced flap integrity yielded by layered closure. Wound complications can be managed with local care in their majority (90%). Staggering or delaying suture removal can decrease minor dehiscence. Based on analysis of our results, review of the literature and consideration of donor site morbidity, we believe that modified V-Y flap is the best approach for APR reconstruction in irradiated patients.
Origins of Gender Affirmation Surgery
Authors: Siotos Charalampos , Neira Paula M. , Lau Brandyn D. , Stone Jill P. , Page James , Rosson Gedge D. , Coon Devin
Published: December 2018

Background

Gender-affirming care, including surgery, has gained more attention recently as third-party payers increasingly recognize that care to address gender dysphoria is medically necessary. As more patients are covered by insurance, they become able to access care, and transgender cultural competence is becoming recognized as a consideration for health care providers. A growing number of academic medical institutions are beginning to offer focused gender-affirming medical and surgical care. In 2017, Johns Hopkins Medicine launched its new Center for Transgender Health. In this context, history and its lessons are important to consider. We sought to evaluate the operation of the first multidisciplinary Gender Identity Clinic in the United States at the Johns Hopkins Hospital, which helped pioneer what was then called “sex reassignment surgery.”

Methods

We evaluated the records of the medical archives of the Johns Hopkins University.

Results

We report data on the beginning, aim, process, outcomes of the clinic, and the reasons behind its closure. This work reveals the function of, and the successes and challenges faced by, this pioneering clinic based on the official records of the hospital and mail correspondence among the founders of the clinic.

Conclusion

This is the first study that highlights the role of the Gender Identity Clinic in establishing gender affirmation surgery and reveals the reasons of its closure.