bluuebunny/crossref_metadata_2025 huggingface dataset:
High thermoelectricpower factor in graphene/hBN devices
Authors: Duan Junxi , Wang Xiaoming , Lai Xinyuan , Li Guohong , Watanabe Kenji , Taniguchi Takashi , Zebarjadi Mona , Andrei Eva Y.
Published: November 2016

Significance

The miniaturization of electronic components and the excessive heating produced by the increased power densities in these small devices has heightened the need for on-chip cooling solutions. This has prompted a search for materials with large thermoelectric power factor and thermal conductivity that could be integrated in active thermoelectric coolers. Here, we report record thermoelectric power factors achieved in graphene on hexagonal boron nitride devices, corresponding to more than doubling the highest reported room temperature bulk values. In these devices, the smooth and highly efficient gating between electron- and hole-doped sectors, which facilitates switching the polarity of the Seebeck coefficient, extends a distinct advantage for on-chip thermoelectric cooling applications. Based on these results, we propose an integrated graphene-based active on-chip cooler.
Antagonists of growth hormone-releasing hormone receptor induce apoptosis specifically in retinoblastoma cells
Authors: Chu Wai Kit , Law Ka Sin , Chan Sun On , Yam Jason Cheuk Sing , Chen Li Jia , Zhang Hao , Cheung Herman S. , Block Norman L. , Schally Andrew V. , Pang Chi Pui
Published: November 2016

Significance

Our work demonstrates that the growth hormone-releasing hormone receptor (GHRH-R) is highly expressed in human retinoblastoma (RB) cells, but not in other retinal cells. GHRH-R antagonists induced apoptosis in RB cells, but not other retinal cells, suggesting the specificity of their action of this class of analogs. GHRH-R antagonists also increased the expression of apoptotic genes and suppressed expression of cell proliferation genes. These studies indicate that GHRH-R is involved in the survival and proliferation of RB. GHRH-R antagonists could possibly be developed for RB therapy.
Identifying species of symbiont bacteria from the human gut that, alone, can induce intestinal Th17 cells in mice
Authors: Tan Tze Guan , Sefik Esen , Geva-Zatorsky Naama , Kua Lindsay , Naskar Debdut , Teng Fei , Pasman Lesley , Ortiz-Lopez Adriana , Jupp Ray , Wu Hsin-Jung Joyce , Kasper Dennis L. , Benoist Christophe , Mathis Diane
Published: November 2016

Significance

Th17 cells accumulate in the gut, where they mediate barrier defenses and repair but can also provoke inflammatory disease. In mice, segmented filamentous bacteria (SFB) is sufficient to induce Th17 cells in the gut, but functionally analogous microbes in humans have not been defined. Here, we identified
Bifidobacterium adolescentis
as one of several human symbiont bacterial species that could, alone, induce Th17 cells in the small intestine of mice.
B. adolescentis
and SFB exhibited overlapping but also distinct activities, suggesting multiple routes to intestinal Th17 induction. Like SFB,
B. adolescentis
exacerbated autoimmune arthritis, arguing for its pathological relevance. Our results help to inform the search for therapeutic targets in diseases associated with Th17 responses and mucosal dysfunction.
Microstructural characteristics and mechanical properties of Al–Mg–Si alloy self-reacting friction stir welded joints
Authors: Zhou L. , Li G. H. , Liu C. L. , Wang J. , Huang Y. X. , Feng J. C. , Meng F. X.
Published: November 2016

The 5 mm thick Al–Mg–Si alloy was self-reacting friction stir welded using the specially designed tool at a constant rotation speed of 400 rev min−1 with various welding speeds. Defect-free welds were successfully obtained with welding speeds ranging from 150 to 350 mm min−1, while pore defects were formed in the weld nugget zone (WNZ) at a welding speed of 450 mm min−1. Band patterns were observed at the advancing side of WNZ. Grain size and distribution of the precipitated phase in different regions of the joints varied depending on the welding speed. The hardness of the weld was obviously lower than that of the base metal, and the lowest hardness location was in the heat affected zone (HAZ). Results of transverse tensile tests indicated that the defective joint fractured in the WNZ with the lowest tensile strength, while the fracture location of the defect-free joints changed to the HAZ.
Activating concepts by activating experiential traces: investigations with a series of anagram solution tasks
Authors: Berndt Eduard , Dudschig Carolin , Kaup Barbara
Published: November 2016

According to the experiential-simulations view of language, words automatically activate experiential traces that stem from the reader’s interactions with their referents. Here, we focus on the corresponding influence in the opposite direction. By means of an anagram-solving task we investigated whether activating spatial experiential traces would activate the corresponding concepts, which in turn facilitates access to associated words. Participants solved anagrams of nouns associated with the ocean or the sky (e.g. dolphin = “ dplhion” or cloud = “ cdulo”). In six experiments we provided additional context information such as positional information (presenting the anagram at the top or the bottom of the screen), or pictorial information that either matched the ocean and sky theme or not, or both positional and pictorial information. Anagrams were solved faster when the position of the anagram was congruent with the location of the noun’s referent in the real world, but only when presented on the background of an ocean-sky picture. Thus, activating experiential traces indeed seems to activate related concepts but positional information alone is not enough to find facilitation in an anagram solving task. Rather what is needed is a whole set of traces that sufficiently narrow down the number of related concepts.
Metronomic chemotherapy prevents therapy-induced stromal activation and induction of tumor-initiating cells
Authors: Chan Tze-Sian , Hsu Chung-Chi , Pai Vincent C. , Liao Wen-Ying , Huang Shenq-Shyang , Tan Kok-Tong , Yen Chia-Jui , Hsu Shu-Ching , Chen Wei-Yu , Shan Yan-Shen , Li Chi-Rong , Lee Michael T. , Jiang Kuan-Ying , Chu Jui-Mei , Lien Gi-Shih , Weaver Valerie M. , Tsai Kelvin K.
Published: November 2016

Although traditional chemotherapy kills a fraction of tumor cells, it also activates the stroma and can promote the growth and survival of residual cancer cells to foster tumor recurrence and metastasis. Accordingly, overcoming the host response induced by chemotherapy could substantially improve therapeutic outcome and patient survival. In this study, resistance to treatment and metastasis has been attributed to expansion of stem-like tumor-initiating cells (TICs). Molecular analysis of the tumor stroma in neoadjuvant chemotherapy–treated human desmoplastic cancers and orthotopic tumor xenografts revealed that traditional maximum-tolerated dose chemotherapy, regardless of the agents used, induces persistent STAT-1 and NF-κB activity in carcinoma-associated fibroblasts. This induction results in the expression and secretion of ELR motif–positive (ELR+) chemokines, which signal through CXCR-2 on carcinoma cells to trigger their phenotypic conversion into TICs and promote their invasive behaviors, leading to paradoxical tumor aggression after therapy. In contrast, the same overall dose administered as a low-dose metronomic chemotherapy regimen largely prevented therapy-induced stromal ELR+ chemokine paracrine signaling, thus enhancing treatment response and extending survival of mice carrying desmoplastic cancers. These experiments illustrate the importance of stroma in cancer therapy and how its impact on treatment resistance could be tempered by altering the dosing schedule of systemic chemotherapy.
NLRP2 controls age-associated maternal fertility
Authors: Kuchmiy Anna A. , D’Hont Jinke , Hochepied Tino , Lamkanfi Mohamed
Published: November 2016

Nucleotide-binding domain and leucine-rich repeat (NLR) proteins are well-known for their key roles in the immune system. Ectopically expressed NLRP2 in immortalized cell lines assembles an inflammasome and inhibits activation of the proinflammatory transcription factor NF-κB, but the physiological roles of NLRP2 are unknown. Here, we show that Nlrp2-deficient mice were born with expected Mendelian ratios and that Nlrp2 was dispensable for innate and adaptive immunity. The observation that Nlrp2 was exclusively expressed in oocytes led us to explore the role of Nlrp2 in parthenogenetic activation of oocytes. Remarkably, unlike oocytes of young adult Nlrp2-deficient mice, activated oocytes of mature adult mice developed slower and largely failed to reach the blastocyst stage. In agreement, we noted strikingly declining reproductive rates in vivo with progressing age of female Nlrp2-deficient mice. This work identifies Nlrp2 as a critical regulator of oocyte quality and suggests that NLRP2 variants with reduced activity may contribute to maternal age-associated fertility loss in humans.
Par3 integrates Tiam1 and phosphatidylinositol 3-kinase signaling to change apical membrane identity
Authors: Ruch Travis R. , Bryant David M. , Mostov Keith E. , Engel Joanne N.
Published: November 2016

Pathogens can alter epithelial polarity by recruiting polarity proteins to the apical membrane, but how a change in protein localization is linked to polarity disruption is not clear. In this study, we used chemically induced dimerization to rapidly relocalize proteins from the cytosol to the apical surface. We demonstrate that forced apical localization of Par3, which is normally restricted to tight junctions, is sufficient to alter apical membrane identity through its interactions with phosphatidylinositol 3-kinase (PI3K) and the Rac1 guanine nucleotide exchange factor Tiam1. We further show that PI3K activity is required upstream of Rac1, and that simultaneously targeting PI3K and Tiam1 to the apical membrane has a synergistic effect on membrane remodeling. Thus, Par3 coordinates the action of PI3K and Tiam1 to define membrane identity, revealing a signaling mechanism that can be exploited by human mucosal pathogens.
Oxford Handbook of Infectious Diseases and Microbiology
Authors: Török Estée , Moran Ed , Cooke Fiona
Published: November 2016

Reflecting the recent changes in postgraduate infection training, the Oxford Handbook of Infectious Diseases and Microbiology provides an integrated clincal infection overview. Practical and comprehensive, it builds on the first edition, covering the basics of antimicrobial therapy, bacteriology, virology, and parasitology, together with a detailed overview of clinical syndromes, diseases, and conditions. The authors are consultants in microbiology and infectious diseases in respected UK institutions and have worked together with trainees to produce a book that will be an essential companion for everyone caring for those with infection.
Implementing a 4C Approach to Quality Improvement
Authors: McGonigal Michelle
Published: November 2016

Designing a quality improvement activity can be labor intensive and intimidating to facilitators who have not been specially trained in process improvement methodologies. To simplify the process, a team was formed with the specific task of developing a basic model that addresses key concepts in change theory. The 2010 Institute of Medicine report stresses the importance of health care professionals working together, collaboratively, to use data to improve patient outcomes and improve care nationally. In addition, as noted in Quality and Safety Education for Nurses (2013), competencies have been developed to promote frontline problem solving including using data for quality improvement, providing safe care, functioning in collaborative teams, respecting and addressing patient and family concerns, applying evidence-based practice, and using informatics to make decisions. The team completed a search of the literature on change theory to identify the factors that are imperative to address when initiating a process improvement cycle. Kotter's Model of Change provided direction and guidance on the creation of the 4C model, which involves centering on issue, collaborating with team members, using the change process, and celebrating successes. This model has been implemented in a multihospital system as a framework for process improvement with such initiatives as preventing hospital-acquired infections, implementing patient safety initiatives, and addressing human resource concerns such as turnover and patient satisfaction.
Continuous Infusion Antiepileptic Medications for Refractory Status Epilepticus
Authors: Wiss Adam L. , Samarin Michael , Marler Jacob , Jones G. Morgan
Published: November 2016

Status epilepticus requires treatment with emergent initial therapy with a benzodiazepine and urgent control therapy with an additional antiepileptic drug (AED) to terminate clinical and/or electrographic seizure activity. However, nearly one-third of patients will prove refractory to the aforementioned therapies and are prone to a higher degree of neuronal injury, resistance to pharmacotherapy, and death. Current guidelines for refractory status epilepticus (RSE) recommend initiating a continuous intravenous (CIV) anesthetic over bolus dosing with a different AED. Continuous intravenous agents most commonly used for this indication include midazolam, propofol, and pentobarbital, but ketamine is an alternative option. Comparative studies illustrating the optimal agent are lacking, and selection is often based on adverse effect profiles and patient-specific factors. In addition, dosing and titration are largely based on small studies and expert opinion with continuous electroencephalogram monitoring used to guide intensity and duration of treatment. Nonetheless, the doses required to halt seizure activity are likely to produce profound adverse effects that clinicians should anticipate and combat. The purpose of this review was to summarize the available RSE literature focusing on CIV midazolam, pentobarbital, propofol, and ketamine, and to serve as a primer for nurses providing care to these patients.
A Review of the Surgical Management of Extrathoracic Solitary Fibrous Tumors
Authors: Kayani Babar , Sharma Aadhar , Sewell Mathew D. , Platinum Johnson , Olivier Andre , Briggs Timothy W.R. , Eastwood Deborah M.
Published: November 2016

Objectives:

Extrathoracic solitary fibrous tumors (ESFTs) are rare low-to-intermediate grade spindle-cell neoplasms of pluripotent fibroblastic or myofibroblastic origin. This review explores prognostic factors in the management of ESFTs and provides guidance on optimal treatment regimens based on the current literature.

Patients and Methods:

Electronic searches were performed using MEDLINE, Embase, and the Cochrane library to identify studies on prognostic factors in the management of ESFTs published between January 1970 and June 2016. The literature search and review process identified 100 articles that were included in this review article. This included both surgical and nonsurgical studies on the management of ESFTs.

Results:

Surgical excision with wide resection margins forms the mainstay of treatment and provides optimal long-term oncological outcomes. Large tumor size (>5 to 10 cm diameter), inadequate resection margins, malignant histologic features, dedifferentiation, and tumor location within the abdomen/pelvis are associated with adverse oncological outcomes. Radiotherapy may be used for preoperative tumor shrinkage and/or as adjuvant therapy in patients with malignant disease or incomplete surgical margins. Chemotherapy with molecular-targeted therapies has produced promising results and the results of further phase 2 trials are awaited.

Conclusions:

Routine long-term follow-up is essential for benign and malignant disease to enable early detection and treatment of recurrent disease.
Eight Years' Experience of Sentinel Lymph Node Biopsy in Melanoma Using Lymphoscintigraphy and Gamma Probe Detection After Radiocolloid Mapping
Authors: Pham Dang Nathalie , Cassier Sophie , Mulliez Aurélien , Mansard Sandrine , D'Incan Michel , Barthélémy Isabelle
Published: November 2016

BACKGROUND

Isosulfan blue dye peripheral injection is used in preoperative sentinel lymph node (SLN) identification alone or, to increase sensitivity, in conjunction with radiocolloid mapping. However, isosulfan blue dye has certain drawbacks and limitations.

OBJECTIVE

This study assesses the authors' experience of SLN biopsy using only radiocolloid tracer.

MATERIALS AND METHODS

Between 2000 and 2008, 218 patients underwent SLN biopsy with radiocolloid mapping, preoperative localization by lymphoscintigraphy and intraoperative confirmation by gamma probe in primary malignant cutaneous melanoma.

RESULTS

Mean Breslow index was 2.1 mm. The SLN biopsy success rate was above 98% at all sites and 87% in head and neck locations. The 5-year overall survival rate was 90% and that of 5-year disease-free survival was 80%. False-negative rate, with a mean follow-up time of 41 months, was 5.5%.

CONCLUSION

Sentinel lymph node biopsy can be successfully performed in patients with melanoma using only radiocolloid tracer without blue dye staining. In circumstances where blue dye cannot be used such as head and neck tumors, allergic reactions and pregnancy, radiocolloid tracer mapping alone is not a loss of chance for patients with melanoma.
The Nipple–Areola Preserving Mastectomy: The Value of Adding a Delay Procedure
Authors: Martinez Carlos A. , Reis Scott M. , Boutros Sean G.
Published: November 2016

Background:

Conservative mastectomy procedures, such as the nipple-sparing mastectomy (NSM), present appealing options for patients with small invasive or noninvasive malignancies and those needing prophylactic mastectomies. Despite outstanding postoperative cosmetic results, nipple–areola complex (NAC) and mastectomy skin flap (MSF) survival remains a concern. We present our two-stage nipple–areola preserving (NAP) mastectomy, which aims to decrease the rate of NAC loss and MSF necrosis after conservative mastectomies.

Material and Methods:

Seventy patients who underwent NSM because of malignant and benign conditions were divided into 2 groups: those who underwent our two-stage NAP mastectomy were matched to the group of mastectomy patients without preservation techniques. Demographic data and postoperative results were retrospectively assessed.

Results:

The NAP group comprised 45 flaps (24 patients), and the NSM group comprised 75 flaps (46 patients). None were actively smoking. The mean time between the delay of the flap and breast reconstruction was 17.6 days (range, of 10–35 days) in the NAP group. No signs of NAC vascular compromise were observed in the NAP group. Nipple necrosis rates were significantly greater (P = 0.0136) in the NSM group: 9 cases in the NSM group versus none within the NAP group. Two patients within the NAP group required nipple excision at the time of their mastectomies after biopsies performed at the time of the NAC delay were positive for malignancy or atypia.

Conclusions:

Vascular delay techniques favor the blood supply of a tissue after a surgical wound, effectively improving the survival of the NAC and MSF after nipple-sparing mastectomies.
EFFICACY AND SAFETY OF INTRAVITREAL CONBERCEPT INJECTIONS IN MACULAR EDEMA SECONDARY TO RETINAL VEIN OCCLUSION
Authors: Sun Zuhua , Zhou Haiying , Lin Bing , Jiao Xuan , Luo Yingdong , Zhang Feng , Tao Shanshan , Wu Quan , Ke Zunhong , Liu Xiaoling
Published: November 2016

Purpose:

To assess the efficacy and safety of intravitreal conbercept injections in patients with macular edema secondary to retinal vein occlusion (RVO).

Methods:

A prospective, Phase II clinical trial was performed on 60 patients with macular edema secondary to RVO. Thirty patients had branch RVO (BRVO) and 30 had central RVO (CRVO). Each patient received intravitreal injections of conbercept monthly up to 3 months, followed by monthly evaluation and injection pro re nata to Month 9.

Results:

The average change of best-corrected visual acuity from baseline to Month 9 was 17.83 ± 10.89 letters in BRVO and 14.23 ± 11.74 letters in CRVO. The change in best-corrected visual acuity was not statistically different between the groups (P = 0.216). The mean reduction of central retina thickness from baseline to Month 9 was 289.97 ± 165.42 μm and 420.47 ± 235.89 μm in BRVO and CRVO, respectively. The mean numbers of injections was 7.14 ± 1.90 in BRVO and 7.59 ± 1.39 in CRVO from baseline to Month 9 (P = 0.4705). There were 7 serious adverse events (SAEs) in 5 patients (8.33%, 2 BRVO and 3 CRVO). All the SAEs were nonocular and were not related to the drug or the injection procedure.

Conclusion:

Intravitreal injections of conbercept demonstrated a generally favorable safety and tolerability profile as well as efficacy in the treatment of macular edema due to RVO.
ENDOPHTHALMITIS IN A PATIENT TREATED WITH BACILLUS CALMETTE-GUÉRIN IMMUNOTHERAPY
Authors: Vadboncoeur Julie , Olivier Sébastien , Soualhine Hafid , Labbé Annie-Claude , Bélair Marie-Lyne
Published: November 2016

Background:

Intravesical Bacillus Calmette-Guérin (BCG) instillation has become one of the mainstays of adjunctive therapy in the treatment of superficial bladder cancer. Ophthalmologic complications are rare, but few cases are reported in the literature.

Methods:

Retrospective observational case report.

Results:

The authors report a case of unilateral Mycobacterium bovis BCG endophthalmitis after intravesical BCG instillations. Despite appropriate systemic antituberculous and corticosteroid therapy, the patient almost completely lost sight in the affected eye. This is the fourth case in the literature of proven M. bovis endophthalmitis suggesting a direct choroidal mycobacterial infection and not only a hypersensitivity immunologic reaction as previously suggested.

Conclusion:

This case highlights the direct choroidal mycobacterial infection of the disease after BCG instillations for bladder cancer and failure of treatment despite culture-proven drug sensitivity, thus suggesting the need to revaluate adequate treatment to avoid loss of vision.
Visual Outcomes After SMILE, LASEK, and LASEK Combined With Corneal Collagen Cross-Linking for High Myopic Correction
Authors: Hyun Sangyoon , Lee Seongjun , Kim Jae-hyung
Published: November 2016

Purpose:

To compare the visual and refractive outcomes of small-incision lenticule extraction (SMILE), laser-assisted subepithelial keratomileusis (LASEK), and LASEK combined with corneal collagen cross-linking (LASEK-CXL) surgery for high-degree myopia.

Methods:

Medical records of patients with spherical equivalent (SE) greater than −6.00 diopters (D) treated with SMILE, LASEK, and LASEK-CXL were reviewed. Uncorrected distance visual acuity (UCVA), SE, and corneal haze were followed up in the 3 groups for 6 months.

Results:

The SMILE group included 69 eyes, the LASEK group included 61 eyes, and the LASEK-CXL group included 40 eyes. At 6 months postoperatively, there were no statistically significant differences in UCVA between the SMILE, LASEK, and LASEK-CXL groups (logMAR 0.00 ± 0.00, 0.01 ± 0.08, and 0.01 ± 0.08, respectively, P = 0.69). The averages of the absolute value of SE were 0.34 ± 0.25 D, 0.50 ± 0.36 D, and 0.42 ± 0.34 D in the SMILE, LASEK, and LASEK-CXL groups, respectively (P = 0.04). The percentages of the patients with a postoperative residual refractive error within ±0.50 D were 84% in the SMILE group, 65% in the LASEK group, and 76% in the LASEK-CXL group. The percentages of the patients with greater than 20/25 postoperative UCVA were 100%, 91%, and 95%, respectively. SMILE produced no postoperative corneal haze. However, 18% of patients treated with LASEK and 25% of those treated with LASEK-CXL had corneal haze at 6 months postoperatively.

Conclusions:

SMILE, LASEK, and LASEK-CXL surgery appear to be safe and effective for high-degree myopic correction. However, the SMILE group had no haze and fewer induction of some higher-order aberrations compared with the LASEK and LASEK-CXL groups.
Kinetics of plasma triglycerides in abdominal obesity
Authors: Björnson Elias , Adiels Martin , Taskinen Marja-Riitta , Borén Jan
Published: November 2016

Purpose of review

Abdominal obesity is associated with a number of important metabolic abnormalities including liver steatosis, insulin resistance and an atherogenic lipoprotein profile (termed dyslipidemia). The purpose of this review is to highlight recent progress in understanding the pathogenesis of this dyslipidemia.

Recent findings

Recent results from kinetic studies using stable isotopes indicate that the hypertriglyceridemia associated with abdominal obesity stems from dual mechanisms: (1) enhanced secretion of triglyceride-rich lipoproteins and (2) impaired clearance of these lipoproteins. The over-secretion of large triglyceride-rich VLDLs from the liver is linked to hepatic steatosis and increased visceral adiposity. The impaired clearance of triglyceride-rich lipoproteins is linked to increased levels of apolipoprotein C-III, a key regulator of triglyceride metabolism.

Elucidation of the pathogenesis of the atherogenic dyslipidemia in abdominal obesity combined with the development of novel treatments based on apolipoprotein C-III may in the future lead to better prevention, diagnosis and treatment of the atherogenic dyslipidemia in abdominal obesity.
The Role of Theory-Specific Techniques and Therapeutic Alliance in Promoting Positive Outcomes
Authors: Haugen Peter Tejas , Werth Aditi Sinha , Foster Alyce Lauren , Owen Jesse
Published: November 2016

World Trade Center responders demonstrate high symptom burden, underscoring the importance of refining treatment approaches for this cohort. One method is examining the impact of therapy techniques on outcomes, and the interactions between technique and alliance on outcomes. This study a) examined the interaction of early treatment techniques on integrative psychotherapy outcomes and b) explored whether associations differed at varying levels of alliance. Twenty-nine adult responders diagnosed with partial or full posttraumatic stress disorder received outpatient psychotherapy and completed weekly measures of alliance, technique, and symptom distress. Analyses indicated significant interactions between 1) alliance and psychodynamic interventions on outcomes and 2) alliance and cognitive behavioral (CB) interventions on outcomes. Clients with high alliance had better outcomes when their therapist used fewer CB techniques. No meaningful differences were found between technique and outcomes for clients with lower alliance. These findings reiterate the critical roles technique and responsiveness to the alliance play in engendering successful outcomes.
Three-Dimensional Facial Averaging: A Tool for Understanding Facial Aging
Authors: Lambros Val , Amos Gideon
Published: November 2016

The progression of facial shape with aging is the subject of various theories and assumptions but remains poorly understood. The authors have used the unique capabilities of the three-dimensional camera to average the faces of large numbers of subjects to understand this complex process. What the authors present here is a technique of analysis rather than detailed results.
Postoperative Edema Resolution following Rhinoplasty: A Three-Dimensional Morphometric Assessment
Authors: Pavri Sabrina , Zhu Victor Z. , Steinbacher Derek M.
Published: November 2016

Background:

The final result of rhinoplasty may be masked for several months after surgery because of postoperative edema; however, no objective evidence supports this time estimate. The purpose of this study was to three-dimensionally quantify the decrease in postsurgical nasal edema following rhinoplasty over the first postoperative year.

Methods:

This was a retrospective, three-dimensional, morphometric study of primary, open rhinoplasty patients. Subjects with at least three postoperative three-dimensional images up to 1 year were included. Patients were excluded for closed or secondary procedures or cleft deformities. Images were assessed using three-dimensional stereophotogrammetry (Vectra) and volumetric analysis (Geomagic). Baseline nasal volume (time 0) occurred at the first postoperative visit at 1 to 2 weeks. All subsequent nasal volume measurements were calculated as a percentage of baseline values. Data points from all patients were pooled, and a six-point moving average was used to create an inverse function line of best fit.

Results:

Forty patients were included, with 146 three-dimensional photographs quantified. The equation for the inverse function line of best fit of the six-point moving average was y = 1.484 (1/x) + 0.844 (R

2
= 0.85, p < 0.01). According to this equation, approximately two-thirds of edema resolves within the first month, 95 percent after 6 months, and 97.5 percent after 1 year. A plateau is reached at 84.4 percent of the original postoperative volume.

Conclusions:

This study provides quantitative evidence to predict decrement of rhinoplasty edema with time. Three-dimensional morphometric assessment demonstrated a two-thirds decrease in edema at 1 month, a 95 percent decrease at 6 months, and a 97.5 percent decrease at 1 year.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Effects of Incisional Negative-Pressure Wound Therapy on Primary Closed Defects after Superficial Circumflex Iliac Artery Perforator Flap Harvest: Randomized Controlled Study
Authors: Peter Suh Hyun-suk , Hong Joon Pio
Published: November 2016

Background:

Prolonged hematoma or seroma after primary closure is a causative element in wound complications. This study evaluated the effects of negative-pressure wound therapy on primary closed wounds after superficial circumflex iliac artery perforator flap harvest.

Methods:

This study was a prospective, randomized, clinical trial comparing conventional dressing against a single application of negative-pressure wound therapy for 5 days after primary closure. A total of 100 patients who had superficial circumflex iliac artery perforator flap harvest were enrolled.

Results:

There was no statistical difference between the incisional negative-pressure wound therapy and conventional dressing groups in the distribution of risk factors. Significant findings were noted for duration and amount of closed suction drainage: 6.12 ± 4.99 days (median, 4 days; range, 3 to 8 days) and 100.47 ± 140.69 cc (median, 42 cc) for wounds treated with conventional dressing versus 3.34 ± 1.35 days (median, 3 days; range, 2 to 4 days) and 23.28 ±18.36 cc (median, 20 cc) for wounds in treatment group (p = 0.0077 and p = 0.0004), respectively. After closure, an increase in skin perfusion were noted on day 5 in the treatment group (p = 0.0223). There was one case of wound dehiscence in the conventional dressing group.

Conclusion:

The incisional negative-pressure wound therapy has a positive effect over primary closed surgical defects by significantly reducing the amount of fluid collected by closed suction drains, allowing earlier removal of drains and enhancing the skin perfusion on the repaired skin.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
The Effect of Written Information on Recall of Surgical Risks of Carpal Tunnel Release Surgery: A Randomized Controlled Study
Authors: Wong Alison L. , Martin Janet , Tang David , LeBlanc Martin , Morris Steven F. , Paletz Justin , Stein John , Wong Michael J. , Bezuhly Michael
Published: November 2016

Background:

Written information has been thought to help patients recall surgical risks discussed during the informed consent process, but has not been assessed for carpal tunnel release, a procedure with the rare but serious risk of complex regional pain syndrome. The authors’ objective was to determine whether providing a pamphlet would improve patients’ ability to remember the risks of surgery.

Methods:

Sixty patients seen for carpal tunnel release were included in this prospective, single-blind, randomized study. Patients received either a written pamphlet of the risks of surgery or no additional information following a standardized consultation. Two weeks after the initial consultation, patients were contacted to assess their risk recall and whether they had read about the operation from any source.

Results:

There was no difference in terms of the number of risks recalled between pamphlet (1.33 ± 1.21) or control groups (1.45 ± 1.22; p = 0.73). Recall of infection was better in the pamphlet group (p < 0.05). No patients remembered complex regional pain syndrome. There was no difference in the proportion of people who read additional information about carpal tunnel release surgery between the pamphlet (34.8 percent) and control groups (21.4 percent; p = 0.39), but reading about carpal tunnel release surgery was associated with improved recall (2.45 ± 1.13 versus 0.77 ± 0.91; p < 0.01).

Conclusions:

Reading about surgery improved risk recall, but providing this information in the form of a pamphlet did not, nor did it affect patients’ ability to recall the risk of complex regional pain syndrome. These results demonstrate that surgeons should implement additional measures to improve comprehension of surgical risks.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, I.
Intravenous Hyaluronidase with Urokinase as Treatment for Rabbit Retinal Artery Hyaluronic Acid Embolism
Authors: Chiang ChengAn , Zhou ShuangBai , Chen ChuHsin , Ho Dave S. , Zhang HuiZhong , Liu Kai
Published: November 2016

Background:

Although various salvage methods have been proposed to treat intraretinal artery hyaluronic acid embolism, their applications are still limited by various factors. The authors investigated the effectiveness of intravenous hyaluronidase with urokinase for resolving retinal artery hyaluronic acid embolism.

Methods:

The anatomy of rabbit ophthalmic and fundus arteries (retinal and choroid artery) was studied. Approximately 0.35 ml of hyaluronic acid was injected into the ophthalmic artery to create a retinal artery embolism model. The rabbits were grouped randomly (groups A, B, C, D, E, and F) and given hyaluronidase with urokinase intravenously at different postobstruction time points (10, 20, 30, 40, 50, and 60 minutes). Saline was given to the control group. Fundus vascular (retinal and choroid artery) reperfusion status and the effectiveness of the solution on the obstruction of each group were observed for 5 days.

Results:

The animal model closely imitated actual hyaluronic acid ophthalmic/retinal artery obstructions. Three vascular conditions were observed after hyaluronidase with urokinase injection: total, partial, and no reperfusion. Groups A, B, and C showed a significantly higher overall solution effectiveness rate (total/partial reperfusion) compared with the control group (p = 0.001, p = 0.001, and p = 0.005, respectively). Solution effectiveness in groups D, E, and F showed no difference compared with the control group (p = 0.628, p = 1.000, and p = 1.000, respectively). The effectiveness of the solution drops dramatically if given after 30 minutes of obstruction.

Conclusions:

The authors’ method can indeed help resolve retinal artery hyaluronic acid obstruction. Intravenous hyaluronidase with urokinase technique shows possible potential to become a standardized treatment protocol for intraretinal artery hyaluronic acid embolism with further clinical tests.
#PlasticSurgery
Authors: Branford Olivier A. , Kamali Parisa , Rohrich Rod J. , Song David H. , Mallucci Patrick , Liu Daniel Z. , Lang Dustin , Sun Kristi , Stubican Miran , Lin Samuel J.
Published: November 2016

Background:

Social media use is growing inexorably, and there is public appetite for evidence-based information. Little is known about engagement by plastic surgeons with social media. The aim of this study was to examine posting about plastic surgery on Twitter, to best inform how board-certified plastic surgeons could use the hashtag #PlasticSurgery as a tool to educate patients and the public.

Methods:

A prospective analysis of 2880 “tweets” containing the words “plastic surgery” was performed. The following were assessed: identity of author, use of the hashtag #PlasticSurgery, subject matter, whether link to study was provided, and whether posts by surgeons were self-promotional or educational.

Results:

Social media posting about plastic surgery is dominated by the public, accounting for 70.6 percent of posts versus only 6.0 percent by plastic surgeons. Only 5.4 percent of all tweets contained the hashtag #PlasticSurgery, although almost half of those that did were by plastic surgeons. Of these, 61.3 percent of posts by plastic surgeons were about aesthetic surgery; additional posts were about basic science, patient safety, and reconstruction (13.9, 4.0, and 2.3 percent, respectively). Eighteen scientific articles were referenced, with a link to the Journal site posted in two tweets. Of posts by plastic surgeons, 37.0 percent were self-promotional.

Conclusions:

The American Society of Plastic Surgeons and its Journal have recognized that social media may be used to educate and engage. Board-certified plastic surgeons have a great opportunity to promote evidence-based plastic practice by means of #PlasticSurgery in the interests of supporting patients and the profession.
Comparison of Different Acellular Dermal Matrices in Breast Reconstruction: The 50/50 Study
Authors: Pittman Troy A. , Fan Kenneth L. , Knapp Andrew , Frantz Shelby , Spear Scott L.
Published: November 2016

Background:

Acellular dermal matrix has enjoyed extensive use in primary and secondary alloplastic breast aesthetic and reconstructive surgery. The objective of this study was to examine clinical outcomes between available acellular dermal matrix products: DermACELL (LifeNet Health, Virginia Beach, Va.) and AlloDerm Ready To Use (LifeCell Corp., Branchburg, N.J.).

Methods:

A retrospective chart review was performed on 58 consecutive patients (100 breasts) reconstructed with either DermACELL (n = 30 patients; 50 breasts) or AlloDerm Ready To Use (n = 28 patients; 50 breasts). The mastectomies were performed by three different breast surgeons. All reconstructions were performed by the same plastic surgeon (T.A.P.). Statistical analysis was performed by means of Fisher’s exact test.

Results:

Differences in the average age, body mass index, percentage having neoadjuvant/adjuvant chemotherapy or breast irradiation, and numbers of therapeutic and prophylactic mastectomies between the two groups were not statistically significant (p < 0.05). Complications in both cohorts of patients were clinically recorded for 90 days after immediate reconstruction. When comparing outcomes, patients in the DermACELL group had a significantly lower incidence of “red breast syndrome” (0 percent versus 26 percent; p = 0.0001) and fewer days before drain removal (15.8 days versus 20.6 days; p = 0.017). No significant differences were seen in terms of seroma, hematoma, delayed healing, infection, flap necrosis, or explantation.

Conclusion:

Patients reconstructed with DermACELL as compared with AlloDerm Ready To Use have significantly decreased number of days to drain removal and red breast syndrome and equivalent rates of other complications, including seroma, infection, flap necrosis, and explantation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
A Comprehensive In Vitro Comparison of Preparation Techniques for Fat Grafting
Authors: Streit Libor , Jaros Josef , Sedlakova Veronika , Sedlackova Miroslava , Drazan Lubos , Svoboda Michal , Pospisil Jakub , Vyska Tomas , Vesely Jiri , Hampl Ales
Published: November 2016

Background:

Lipomodeling is a technique that uses the patient’s own fat for tissue regeneration and augmentation. The extent of regenerative effect is reported to be determined by the numbers of adipose-derived stem cells and the viability of cells in processed adipose tissue which, together with other factors, influence the degree of graft retention. This study addresses whether differences exist in properties of fat graft obtained by three commonly used techniques.

Methods:

Adipose tissue harvested from the hypogastric regions of 14 patients was processed by decantation, centrifugation, and membrane-based tissue filtration. The morphology of each preparation was assessed by electron microscopy and overall cell viability was assessed by live/dead assay. The number of adipose-derived stem cells was determined and their stem cell character was assessed by the presence of cell surface molecules (i.e., CD105, CD90, CD31, and CD45) and by their capacity to differentiate into adipogenic and osteogenic lineages.

Results:

First, morphologies of processed fat samples obtained by individual procedures differed, but no preparation caused obvious damage to cellular or acellular components. Second, although the highest numbers of adipose-derived stem cells were contained in the upper fraction of centrifuged lipoaspirates, the difference between preparations was marginal. Third, the maximal concentration of adipose fraction (removal of watery component) of lipoaspirate was achieved by membrane-based tissue filtration. Finally, no significant differences in overall viability were detected.

Conclusions:

Properties of processed lipoaspirate were influenced by the preparation procedure. However, the differences were not dramatic; both centrifugation and membrane-based filtration are methods of choice whose selection depends on other criteria (e.g., practicality) for individual surgical settings.
Study of the Medial Superficial Perforator of the Superficial Circumflex Iliac Artery Perforator Flap Using Computed Tomographic Angiography and Surgical Anatomy in 142 Patients
Authors: Suh Hyun Suk Peter , Jeong Hyung Hwa , Choi Dong Hoon , Hong Joon Pio J. P.
Published: November 2016

Background:

The two major perforators supplying the superficial circumflex iliac artery perforator flap are the medial (superficial) and lateral (deep) perforators; however, they lack detailed description. The purpose of this study was to clarify the anatomy.

Methods:

In a prospective analysis of 142 patients, computed tomographic angiograms of 284 superficial circumflex iliac artery perforator regions were evaluated, and 142 superficial circumflex iliac artery perforator flaps were surgically correlated. The origin of the superficial circumflex iliac artery, the origin of the medial perforator, the location where it penetrates the deep fascia, and its pattern of pathway after penetration of the superficial fascia were evaluated.

Results:

There was 100 percent correlation between computed tomographic angiogram and surgical findings. The superficial circumflex iliac artery originates mostly from the femoral artery in 84.8 percent. The medial perforator originated from the superficial circumflex iliac artery in 94 percent. The medial perforator typically penetrated the deep fascia within an oval of 4.2 × 2 cm located 4.5 cm lateral and 1.5 cm superior from the pelvic tubercle. After passing the superficial fascia, the medial perforator either anchored directly into skin (56 percent) or traveled in an axial pattern (44 percent) beyond the anterior superior iliac spine.

Conclusions:

Despite the origin of the medial perforator, it was constantly observed penetrating the deep fascia. However, the pathway of the medial perforator can be either anchoring directly into the dermis or extending as an axial pattern artery, implicating a different effect on the survival of the flap. These new findings will allow better understanding for elevating the superficial circumflex iliac artery perforator flap based on the medial perforator.
Super-resolution microscopy of the ß-carboxysome reveals a homogenous matrix
Authors: Niederhuber Matthew J. , Lambert Talley J. , Yapp Clarence , Silver Pamela A. , Polka Jessica K.
Published: November 2016

Carbon fixation in cyanobacteria makes a major contribution to the global carbon cycle. The cyanobacterial carboxysome is a proteinaceous microcompartment that protects and concentrates the carbon-fixing enzyme RuBisCO in a paracrystalline lattice, making it possible for these organisms to fix CO2from the atmosphere. The protein responsible for the organization of this lattice in beta-type carboxysomes of the freshwater cyanobacteriumSynechococcus elongatus, CcmM, occurs in two isoforms thought to localize differentially within the carboxysome matrix. Here we use widefield timelapse and 3D-structured illumination microscopy (3D-SIM) to study the recruitment and localization of these two isoforms. We demonstrate that this super-resolution technique is capable of successfully resolving the outer protein shell of the carboxysome from its internal cargo. We develop an automated analysis pipeline to analyze and quantify 3D-SIM images and generate a population level description of carboxysome shell protein, RuBisCO, and CcmM isoform localization. We find that both CcmM isoforms colocalize in space and time, prompting a revised model of the internal arrangement of the beta carboxysome.
Transition into inflammatory cancer-associated adipocytes in breast cancer microenvironment requires microRNA regulatory mechanism
Authors: Lee Jiwoo , Suk Ryu Han , Sil Hong Bok , Lee Han-Byoel , Lee Minju , Ae Park In , Kim Jisun , Han Wonshik , Noh Dong-Young , Moon Hyeong-Gon
Published: November 2016

ABSTRACTS

Introduction

The role of adipocytes in cancer microenvironment has gained focus during the recent years. However, the characteristics of the cancer-associated adipocytes (CAA) in human breast cancer tissues and the underlying regulatory mechanism are not clearly understood.

Method

We reviewed pathology specimens of breast cancer patients to understand the morphologic characteristics of CAA, and profiled the mRNA and miRNA expression of CAA by using indirect co-culture systemin vitro.

Results

The CAAs in human breast cancers showed heterogeneous topographic relationship with breast cancer cells within the breast microenvironment. The CAAs exhibited the characteristics of de-differentiation determined by their microscopic appearance and the expression levels of adipogenic markers. Additionally, the 3T3-L1 adipocytes co-cultured with breast cancer cells showed up-regulation of inflammation-related genes includingIl6andPtx3. The up-regulation of IL6 in CAA was further observed in human breast cancer tissues. miRNA array of co-cultured 3T3-L1 cells showed increased expression of mmu-miR-5112 which may targetCpeb1.Cpeb1is a negative regulator ofIl6. The suppressive role of mmu-miR-5112 was confirmed by dual luciferase reporter assay, and mmu-miR-5112-treated adipocytes showed up-regulation ofIl6. The transition of adipocytes into more inflammatory CAA resulted in proliferation-promoting effect in ER positive breast cancer cells such as MCF7 and ZR-75-1 but not in ER negative cells.

Conclusion

In this study, we have determined the de-differentiated and inflammatory natures of CAA in breast cancer microenvironment. Additionally, we propose a miRNA-based regulatory mechanism underlying the process of acquiring inflammatory phenotypes in CAA.