bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Accuracy of Single-shot 2-Dimensional Multisegment Late Gadolinium Enhancement in Ischemic and Nonischemic Cardiomyopathy
Authors: Muscogiuri Giuseppe , Gatti Marco , Dell’Aversana Serena , Andreini Daniele , Guaricci Andrea I. , Guglielmo Marco , Baggiano Andrea , Mushtaq Saima , Conte Edoardo , Annoni Andrea , Formenti Alberto , Mancini Maria Elisabetta , Gripari Paola , Rabbat Mark G. , Pepi Mauro , Pontone Gianluca
Published: March 2019

Purpose:

The aim of this study was to assess the reliability of single-shot 2-dimensional multislice late gadolinium enhancement (2D-MSLGE) compared with gold standard single-slice 2D inversion recovery segmented gradient echo (2D-SSLGE).

Materials and Methods:

Sixty-seven patients prospectively underwent clinically indicated cardiac magnetic resonance (CMR) imaging and were enrolled. The image quality was assessed using a 4-point scale. Segments positive for LGE were classified as ischemic or nonischemic for 2D-MSLGE and 2D-SSLGE. Interobserver and intraobserver variability was assessed for both sequences by 2 readers. The endpoints were as follows: (a) detection of myocardial segments involved by LGE and (b) classification of LGE as ischemic and nonischemic pattern. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy value were calculated for the 2 endpoints.

Results:

2D-MSLGE and 2D-SSLGE were successfully performed in all patients with comparable image quality (1.56±0.59 vs. 1.54±0.58, P=0.84). For the overall population, 2D-MSLGE correctly identified 1093 of 1139 myocardial segments positive for LGE (96%; 95% confidence interval [CI]: 95%-97%), as compared with 2D-SSLGE. Similarly, 2D-MSLGE correctly identified 1128 of 1139 (99%; 95% CI: 98%-99%) and 1108 of 1139 (97%; 95% CI: 96%-98%) of nonischemic and ischemic LGE patterns.

Interobserver and intraobserver variability for quantification of LGE using 2D-MSLGE was 0.98 and 0.99, respectively. The acquisition time was shorter for 2D-MSLGE as compared with 2D-SSLGE (2.0±0.5 vs. 6.0±2.0 min, P: 0.01).

Conclusions:

As compared with 2D-SSLGE, 2D-MSLGE is a reliable tool in both ischemic and nonischemic cardiac disease; it is associated with shorter scan times without the need for prolonged breath holding and may be beneficial for those with dysrhythmia.
Posterior Tibial Artery Perforator Flaps Carrying Partial Gastrocnemius Muscle for Repair of Soft Tissue Defects With Dead Space in the Ankle and Foot
Authors: Li Pandeng , Shen Guoliang
Published: March 2019

Background

Soft tissue defects with dead space in the ankle and foot remain a challenge for surgeons. The aim of the study was to evaluate the surgical technique and clinical significance of posterior tibial artery perforator flaps carrying partial gastrocnemius muscle for patients with soft tissue defects with dead space in the ankle area.

Methods

Between August 2015 and August 2017, 14 patients (2 women and 12 men) between 20 and 58 years old (median age, 42 years) were hospitalized in The First Affiliated Hospital of Soochow University. All injuries involved damage to the ankle area and formation of soft tissue defects with dead space. In all patients, posterior tibial artery perforator flaps carrying partial gastrocnemius muscle were transplanted to cover soft tissue defects with dead spaces.

Results

Hospitalization duration ranged from 10 to 20 days (mean, 16 days). All flaps survived and healed well. At follow-up after 6 to 24 months, all cases had recovered successfully in terms of aesthetic and functional aspects.

Conclusions

Posterior tibial artery perforator flaps carrying partial gastrocnemius muscle can be an optimal reconstruction method for repairing soft tissue defects with dead space in the ankle and foot.
Correction of Congenital Telecanthus by Extended Medial Epicanthoplasty With Skin Redraping Method
Authors: Choi Jong-Woo , Gaxiola-García Miguel Angel , Kang Min-Kyu , Kim Sung-Chan , Jeong Woo Shik , Koh Kyung S.
Published: March 2019

Background

Recently, skin-redraping medial epicanthoplasty has emerged as an extremely effective way to minimize the resultant scar. We found that the novel skin-redraping medial epicanthoplasty technique, which has been applied to aesthetic surgery, could also be suitable for the correction of congenital epicanthus and telecanthus.

Methods

We retrospectively identified patients who had an epicanthoplasty from December 2007 to August 2017. Among 47 patients, we identified 19 cases with congenital pathologies (nonaesthetic cases). Overall, 7 patients with at least 2 anthropometric measurements were selected.

Results

There was a mean presurgical intercanthal distance of 35.85 mm (range, 24–52 mm) and a mean intercanthal distance of 26.85 mm (range, 17–36 mm) with a mean difference of 9 mm following postsurgical revision. To better categorize this difference, statistical analysis was conducted using a paired t test, which showed a significant result with P = 0.008.

Conclusions

Our results revealed that the skin-redraping medial epicanthoplasty technique could be a better option even in the reconstruction of congenital telecanthus as well as aesthetic plastic surgery. It could correct mild to severe telecanthus and minimize scar formation.
Recurrent Breast Cerebrospinal Fluid Pseudocyst
Authors: Zawadiuk Luke R. R. , Van Slyke Aaron C. , Macadam Sheina A.
Published: March 2019

Ventriculoperitoneal (VP) shunt complications involving the breast are rare, with the majority involving the formation of a cerebrospinal fluid pseudocyst. We present the case of a 22-year-old woman with recurrent cerebrospinal fluid pseudocyst secondary to fracture of a VP shunt at the time of breast surgery for breast asymmetry. We review the literature on this topic and present our case that highlights the need of the breast surgeon to take into account the position of VP shunts placed at birth. Shunts placed on the chest wall may result in breast asymmetry requiring surgery in the adolescent. Shunts in place since birth may be at greater risk of fracture during breast implant placement due to manipulation of a calcified and fragile shunt leading to formation of a cerebrospinal fluid pseudocyst.
The Utility of Google Trends Data for Analyzing Public Interest in Breast Procedures
Authors: Tijerina Jonathan D. , Morrison Shane D. , Vail Daniel G. , Lee Gordon K. , Nazerali Rahim
Published: March 2019

Background

Google Trends (GT) is a free, open-source tool that permits customizable analysis of search term volumes entered into the Google search engine. Google Trends data may offer useful and actionable insight to plastic surgeons pertaining to worldwide, national, and regional evolution of patient interest for breast procedures and other common surgeries.

Methods

Search terms were generated using the “related queries” feature of GT. Google Trends data were collected for breast lift, breast reduction, breast reconstruction, and male breast reduction from January 2004 to September 2017. Case volumes for respective procedures were obtained from the American Society of Plastic Surgeons (ASPS) annual statistics reports for the calendar year 2006 to 2016. Trend analysis was performed using univariate linear regression analysis of ASPS statistics and GT search data.

Results

Total search volume varied geographically and temporally during the study period. Statistically significant positive correlations between GT and ASPS data were as follows: breast lift: “mastopexy” (R
2 = 0.445, P = 0.025); male breast reduction: “gynecomastia surgery” (R
2 = 0.45, P = 0.024); and breast reconstruction: “tissue expander” (R
2 = 0.806, P ≤ 0.001) and “TRAM flap reconstruction” (R
2 = 0.764, P = 0.002). For several search terms, no significant correlation was detected, highlighting the importance for careful selection of terms.
Effects of Perioperative Venous Thromboembolism on Outcomes in Soft Tissue Reconstruction of Traumatic Lower Extremity Injuries
Authors: Badash Ido , Burtt Karen , Leland Hyuma , Gould Daniel , Rounds Alexis , Patel Ketan , Carey Joseph
Published: March 2019

Background

Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, represents a significant perioperative complication. However, the outcomes of lower extremity salvage in the setting of perioperative VTE are not well reported.

Methods

A retrospective review of lower extremity trauma patients requiring soft tissue reconstruction between July 2007 and December 2015 at an urban trauma center was performed. Patients with clinically apparent VTE during inpatient stay were identified. Outcomes compared included success of limb salvage, flap survival, and flap complications. Comorbidities, injury characteristics and perioperative data were also compared between patients with and without VTE.

Results

One hundred ninety patients with lower extremity injuries underwent local and free flap procedures, with 12 (6.3%) patients developing clinically apparent VTE during hospitalization. Nine VTEs (75.0%) were diagnosed prior to soft tissue reconstruction, and 3 (25.0%) VTEs were diagnosed postreconstruction. The limb salvage rate in patients with VTE was 100%. There were no flap losses in patients with VTE, and the overall flap complication rate was similar between VTE and non-VTE groups (P = 0.26). However, there was an increased risk of postoperative hematoma in patients undergoing free flap transfer with diagnosed VTE compared with patients receiving free flaps without VTE (40.0% vs 2.6%, P = 0.02). Additionally, 1 patient died as a result of pulmonary embolism, and another patient experienced an ischemic stroke from a paradoxical embolism.

Conclusions

These results suggest that successful limb salvage and flap survival may be achieved in the setting of perioperative VTE, although anticoagulation prophylaxis and treatment are critical in this population due to significant morbidity and mortality associated with VTE.
Do Intubation Devices Affect Middle Ear Pressure Dynamics?
Authors: Torun Mümtaz Taner , Kuşderci Hatice Selçuk , Öterkuş Mesut
Published: March 2019

Our study aimed to investigate the effects of different intubation devices on middle ear pressure (MEP) dynamics by evaluating MEP during stages of anesthesia.

Sixty-one consecutive patients were randomly assigned to 2 groups: the classical endotracheal intubation group and the Baska Mask (a new laryngeal mask [LMA]) group. All patients received the same anesthesia protocol. The right and left MEP values of the patients were measured and recorded preoperatively, during the induction of anesthesia, at the time of intubation and at 5th minute of anesthesia.

In group 1, the pressure values measured in the right ear during anesthesia induction, at the time of intubation and at 5th minute of anesthesia were 10.97 ± 27.06, 16.77 ± 29.40, and 21.64 ± 90.31, respectively, compared to left ear values of 8.61 ± 26.39, 18.77 ± 37.84, and 38.61 ± 56.96 daPa, respectively. In group 2, MEP values measured in the right ear during anesthesia induction, at the time of intubation, and at 5th minute of anesthesia were 9.53 ± 20.43, 22.30 ± 41.50, and 20.60 ± 46.85 daPa, respectively, compared to left ear values of −4.26 ± 25.17, 6.20 ± 26.56, and 30.30 ± 65.17 daPa, respectively. MEP was statistically significantly increased in the classical endotracheal intubation group compared to the LMA group.

We found that the increase in pressure is lower in patients receiving LMA compared to classical endotracheal intubation. The Baska Mask LMA is recommended in selected patients to prevent complications of MEP elevation.
Craniofacial Approaches to Pediatric Orbital Tumors
Authors: Kaderbhai Jameel , Lo William , Rodrigues Desiderio , White Nicholas , Evans Martin , Nishikawa Hiroshi , Dover Michael Stephen
Published: March 2019

Primary pediatric orbital tumors requiring surgery are uncommon and often require multidisciplinary management. Commonly used surgical approaches to the orbit include transconjunctival, transcutaneous (eyelid), transcranial, or extracranial osteotomies. This paper reviews a 10-year experience of cases that required a transcranial or extracranial surgical approach at the Birmingham Children's Hospital. A total of 9 patients were identified between the years 2008 to 2017. Pathologies included rhabdomyosarcoma, juvenile ossifying fibroma, optic nerve glioma, and retinoblastoma. Surgical approaches to the orbit included supraorbital bar osteotomy (transcranial) or lateral orbitotomy (extracranial). Surgical team members included neurosurgery, craniofacial surgery, and ophthalmology. This study aims to review the role of surgery in management as well as the specific indications for performing transcranial or extracranial osteotomies. It also highlights the excellent access achieved with the use of these osteotomies in certain cases, especially when compared with transconjunctival or transcutaneous approaches.
A Static Facial Sling Technique Restoring Nasolabial Sulcus in Facial Paralysis
Authors: Dornhoffer James , Vural Emre
Published: March 2019

Static facial sling techniques are useful rehabilitation modalities where dynamic rehabilitation methods are not feasible in the management of facial paralysis. The authors present their technique as an alternative static sling method, which may give the patient a more natural nasolabial sulcus restoration in addition to suspension of the oral commisure.
Introducing A Family With Tens of Rare Craniofacial Clefts
Authors: Kalantar-Hormozi Abdoljalil , Abbaszadeh-Kasbi Ali , Shalbaf Shervin , Davai Nazanin Rita
Published: March 2019

Background:

Craniofacial clefts are one of the rarest congenital malformations. When it comes to genetic inheritance patterns of craniofacial clefts, there are few studies on this subject due to the rarity and sporadic nature. In this study an extended family whose members have multiple craniofacial clefts has been introduced.

Methods:

The authors haphazardly found a family whose members have craniofacial clefts, either Tessier no. 0 or both Tessier nos. 0 and 14, and, consequently, they were categorized into 3 groups based on the severity of clefts.

Results:

Forty-two craniofacial clefts were noticed within the family. Twenty-two (52.3%) of patients were females and 20 (47.6%) were males. Twenty-three (54.8%) members had isolated Tessier no. 0 cleft, whereas 19 (45.2%) members had both Tessier nos. 0 and 14. Of all 42 patients, 18 (42.8%), 3 (7.1%), and 21 (50%) patients had severe, intermediate, and mild clefts, respectively.

Conclusion:

The present study reveals that in some patients genetic background is likely to be the cause of clefts.
Hydrocephalus Due to Idiopathic Fourth Ventricle Outflow Obstruction
Authors: Bai Jianfeng , Yu Qingqing , Sun Xiaoyu , Xiao Huaming , Wang Kai , Sun Feng , Sui Qiangbo
Published: March 2019

The fourth ventricle outlet obstruction (FVOO) is a rare but well-established cause of obstructive tetra-ventricular hydrocephalus, characterizing with dilatation or large cerebrospinal fluid collection of the foramina of Magendie and Luschka. In children, it is usually the consequence of posterior cerebral fossa malformations; while in adult, the occlusion is rather acquired than congenital, mostly linked to an inflammatory process, intraventricular hemorrhage, head trauma, brain tumors or Arnold-Chiari malformation. However, idiopathic FVOO is extremely rare, and only 6 such cases have been reported in the English literature. Hereby, we described an extraordinarily rare case of idiopathic FVOO in a 15-year-old patient successfully treated with direct microsurgical excision of the obstruction membrane. Furthermore, the clinical characteristics and treatment for this rare disease were investigated and reviewed.
A Life Threatening Subglottic and Mediastinal Hemangioma in an Infant
Authors: Onder Serap Sahin , Gergin Ozgul , Karabulut Burak
Published: March 2019

Subglottic and mediastinal hemangioma are rare benign vascular tumors of childhood. They cause potentially life threatening condition which requires intervention. Several therapeutic options have been described in the literature with varying degrees of success and complications. We report a case of a stridulous 2-month old female infant with mediastinal and subglottic hemangioma. The child was treated with propranolol without the need for tracheostomy or any other surgical intervention, and with no reported side effects. Propranolol is an effective, non-invasive treatment for life threatening infantile hemangiomas compressing the airway, should be used as a firstline treatment for subglottic hemangiomas when intervention is required.
The Superficial Temporal Artery Island Flap: An Option for Moustache Reconstruction
Authors: Fatma Bilgen , Alper Ural , Mehmet Bekerecioglu
Published: March 2019

Vascular anomalies are a group of lesions originating from blood vessels and lymphatics with varying histology and clinical behavior. They form the most common congenital anomalies in infants and children. The reconstructive method for the facial region defects varies depending on the size and position of the defect, as well as the patient's age, health status and aesthetic concerns. In this case, the authors present a male patient who underwent a wide resection of his mustache area because of vascular malformation and reconstructed with hair-bearing temporal artery island flap.

A 42-year-old male patient presented with swelling and ongoing color change in the cheek and lip area on the left side of the face. His examination revealed a vascular malformation extending from the preauricular region to the left side of the nose, to the upper lip and to the medial canthal region. Superficial temporal artery island flap was designed to reconstruct the upper lip area while full thickness skin graft planned for the defect on nose and cheek.

STA island flap has been applied in many areas such as forehead, eyebrow, eyelid, cheek, and nose reconstruction due to its advantages such as providing good color and texture harmony, reliable and constant pedicle, simple and fast dissection, wide rotation arc and low donor area morbidity. Superficial temporal artery island flap should be considered as a favorable reconstruction option in upper and middle face region for moderate and small sized defects
The Frontalis Muscle Flap: As a Salvage Procedure for Upper Eyelid in a Burn Patient
Authors: Iğde Murat , Tapan Mehmet , Ergani Hasan Murat , Yaşar Burak
Published: March 2019

The ugly face of civil war shows itself in the desperate patients and their extreme sequellae. The options for reconstruction of patients with late-term serious sequellae decrease and their treatments also become more difficult. A 31-year-old male patient was injured 18 months ago due to a bomb explosion and received long-term treatment through local wound care in his country. A patient who is referred to us with such late-term ectropion and lagophthalmos is likely to have both morphologic and functional deterioration. A frontal muscle flap was planned for this patient. The frontal muscle flap has been used for a long time in ptosis surgery and was used in the treatment of the patient to repair both lagophthalmos and ptosis. Satisfactory results were obtained at the end of a 6-month period during which the patient was monitored.
Computer-Aided Design/Computer-Aided Manufacturing Milling of Allogeneic Blocks Following Three-Dimensional Maxillofacial Graft Planning
Authors: Gialain Ivan Onone , Pinhata-Baptista Otavio Henrique , Cavalcanti Marcelo Gusmão Paraíso , Cortes Arthur Rodriguez Gonzalez
Published: March 2019

Despite the advent of stereolithography in craniofacial surgery for creating surgical guides and custom synthetic scaffolds, little is known about the feasibility of computer-aided design/computer-aided manufacturing (CAD/CAM) milling of freeze-dried allogeneic bone blocks following previously designed volumetric graft plans. The aim of this technical report is to present a methodology for CAD/CAM milling to achieve the volume and shape of allogeneic bone blocks as estimated by using a virtual planning software. To perform the current methodology, an ex vivo simulation was performed. The milled allogeneic block presented satisfactory dimensional accuracy as compared with the respective three-dimensional virtual model.
Novel Simple Strategy for Cartilage Tissue Engineering Using Stem Cells and Synthetic Polymer Scaffold
Authors: Uz Uzdan , Gunhan Kivanc , Vatansever Seda , Kivanc Mujde , Yuceturk Ali Vefa
Published: March 2019

Cartilage created by tissue engineering is a promising new development in facial reconstructive surgery. The purpose of this study was to evaluate the histological results of implantation of synthetic polymer scaffold with chondrocytes differentiated from adipose-derived mesenchymal stem cells. Adipose tissue obtained from Wistar albino rats was dissociated, incubated and placed in culture medium. After a sufficient level of stem cell proliferation, the differentiation phase was started. Cells were collected on the 7th and 21st day of culture for chondrogenic characterization. After the 21st day of the differentiation phase of chondrocytes, they were transferred onto poly(dl-lactide-epsilon-caprolactone) synthetic polymer and culture continued for 24 hours. The scaffold with chondrocytes was then implanted into a subcutaneous area of skin on the back of the neck of the rat. Six weeks after implantation, all rats were sacrificed and the implantation areas were analyzed. Chondrocytes derived from adipogenic mesenchymal stem cells were stained positively with collagen II, aggrecan and Sox-9 after the differentiation stages. Histological examination of the excised material showed that chondrocytes were present, and the scaffold had been completely absorbed. The results of this study indicate that the differentiation method from mesenchymal stem cells to chondrogenic lineage was straightforward and scaffold with cells was easily accessible. This technique may be a good option for cartilage tissue engineering.
Adipogenic Mesenchymal Stem Cells and Hyaluronic Acid as a Cellular Compound for Bone Tissue Engineering
Authors: Boeckel Daniel Goncalves , Sesterheim Patrícia , Peres Thiago Rodrigues , Augustin Adolpho Herbert , Wartchow Krista Minéia , Machado Denise Cantarelli , Fritscher Guilherme Genehr , Teixeira Eduardo Rolim
Published: March 2019

This study investigates the applicability of adipose mesenchymal stem cells (mADSCs) and hyaluronic acid (HA) as a cellular compound for bone tissue engineering. A critical bone defect was created on each femur of 25 rats in vivo, receiving the following 5 graft treatments: I—Control-defect; II—HA; III—mADSCs; IV—mADSCs+HA; and V—previously osteoinduced mADSCs+HA. Evaluation using microcomputed tomography, histomorphometry, and RT-PCR analysis was performed 23 days after implantation. Microcomputed tomography analysis indicated higher means of bone contact surface (BCS) and bone surface density (BSD) for the mADSCs+HA group compared with Control and the HA groups (P < 0.05). Histomorphometric findings showed higher means of bone regeneration in the mADSCs+HA compared with HA and Control groups (P < 0.05). The RT-PCR ratios showed no difference in type 1 collagen (Col1A) gene expression or osteopontin (OP) gene expression, whereas for the osteonectin gene (ON) higher means were found in the HA and mADSCs osteoin+HA groups (P < 0.05). These results suggest that a combination of HA and mADSCs without prior osteoinduction might be applicable for bone tissue regeneration.
Indocyanine Green Sentinel Node in Merkel Cell Carcinoma of the Cheek
Authors: Gabriele Guido , Aboh Ikenna Valentine , Cascino Flavia , Zerini Federico , Amadi Jude Ugochukwu , Del Frate Rossella , Xu Junfeng , Gennaro Paolo
Published: March 2019

Merkel cell carcinoma (MCC) is a rare malignant tumor with a neuroendocrine phenotype. The authors report a case of MCC of the left cheek region in an 85-year-old Caucasian woman who also received sentinel node biopsy using both Technectium-99m-labeled (99mTc) lymphoscintigraphy and indocyanine green lymphography.
External Jugular Vein Aneurysm in a Child With Hemophilia A
Authors: Lee Dong Hoon , Baek Hee Jo , Yoon Tae Mi , Lee Joon Kyoo , Lim Sang Chul
Published: March 2019

An external jugular vein (EJV) aneurysm is an extremely rare disease. Ultrasonography with color doppler methods is considered the criterion standard for diagnosis of a venous aneurysm. The treatment of choice for an EJV aneurysm is surgical excision. Herein, we report an unusual case of an EJV aneurysm in a child with hemophilia A. Because the incidence of an EJV aneurysm is low, it is important to distinguish it from other neck lesions, including congenital disease. In addition, it should be noted that in hemophilia patients, an EJV aneurysm may occur in a spontaneous or small trauma.
The Relationship Between Ocular Protrusion and Craniofacial Structures
Authors: Gulsen Ayse , Uzuner Fatma Deniz , Sibar Serhat
Published: March 2019

Objective:

This study aimed to evaluate the relationships between ocular protrusion and other craniofacial structures.

Methods:

The lateral cephalograms of 124 nonsyndromic white adults were assessed. Two orbital and 13 craniofacial parameters were measured. Subgroups were constructed according to sex, anteroposterior position of maxilla, and mandibular plane angle values.Anatomical parameters and their relationships were statistically analyzed by analysis of variance and multivariate stepwise regression analysis.

Results:

There were no significant differences in ocular protrusion distances between sexes, and between individuals with different maxillary anteroposterior position and mandibular plane angle values. Ocular protrusion distances, the distance between the eyeball apex and the lateral orbital margin (Eyeball apex—LOr: OP1) and inferior orbital margin (Eyeball apex—IOr: OP2), were found to be 20.6 ± 2.8 and 16.5 ± 3.1, respectively. However, regression analysis showed that the ocular protrusion distances had weak correlation with a few craniofacial structures. The OP1 had a low negative relationship with the maxillary anteroposterior position (N-Aperp) (r: −0.289) (P < 0.05). The OP2 had a low negative relationship with the palatal plane angle (FH/PP) (r: −0.291) (P < 0.01) but had a positive relationship with the cranial base angle (BSN) (r: 0.304) (P < 0.01) and posterior facial height (SGo) (r: 0.299) (P < 0.01).

Conclusions:

Ocular protrusion distances did not differ by sex, maxillary anteroposterior position, and amount of mandibular plane angle and showed weak correlation with a few craniofacial structures. Ocular protrusion amounts can be used for diagnosis and treatment plan in craniofacial syndromic or nonsyndromic anomalies.
A Patient With Toxoplasmosis as a Cause of Submental Lymphadenopathy
Authors: Sireci Federico , Bruno Rocco , Martines Francesco , Freni Francesco , Cicciù Marco , Galletti Francesco
Published: March 2019

Submental mass secondary to toxoplasmosis is a rare condition and physicians rarely consider its diagnosis. The presented case reports a 43-year-old woman referred with a constant, painless, edema located in the submental area for 2 weeks. Diagnosis of toxoplasmosis was established by the positive serological finding after an accurate medical history of the infectious disease specialist (the patient had eaten raw meat). The patient underwent antimicrobial therapy with resolution of lymphadenopathy. According to review of literature, the article aims to remind clinicians, maxillofacial surgeons, and otolaryngologists that a neck mass can be related to the infectious cause with involving of lymph node like as toxoplasmosis. Therefore, a serological diagnosis should be considered before moving to needle biopsy or excisional biopsy of neck mass.
Regional disparities in access to verified burn center care in the United States
Authors: Carmichael Heather , Wiktor Arek J. , McIntyre Robert C. , Lambert Wagner Anne , Velopulos Catherine G.
Published: March 2019

BACKGROUND

Burn injuries result in 50,000 annual admissions. Despite joint referral criteria from the American College of Surgeons (ACS) and American Burn Association (ABA), many severely injured patients are not treated at verified centers with specialized care. Only one prior study explores regional variation in access to burn centers, focusing on flight or driving distance without considering the size of the population accessing that center. We hypothesize that disparities exist in access to verified centers, measured at a population level. We aim to identify a subset of nonverified centers that, if verified, would most impact access to the highest level of burn care.

METHODS

We collected ABA data for all verified and nonverified adult burn centers and geocoded their locations. We used county-level population data and a two-step floating catchment method to determine weighted access in terms of total beds available locally per population. We compared regions, as defined by the ABA, in terms of overall access. Low access was calculated to be less than 0.3 beds per 100,000 people using a conservative estimate.

RESULTS

We identified 113 centers, 59 verified and 54 nonverified. Only 2.9% of the population lives in areas with no verified center in 300 miles; however, 24.7% live in areas with low access. Significant regional disparities exist, with 37.3% of the population in the Southern Region having low access as compared with just 10.5% in the Northeastern Region. We identified 8 nonverified centers that would most impact access in areas with no or low access.

CONCLUSION

We found significant disparities in access to verified center burn care and determined nonverified centers with the greatest potential to increase access, if verified. Our future directions include identifying barriers to verification, such as lack of fellowship-trained burn surgeons or lack of hospital commitment.

LEVEL OF EVIDENCE

Epidemiological, level III.
Diagnostic Yield of 2-Hour EEG Is Similar With 30-Minute EEG in Patients With a Normal 30-Minute EEG
Authors: Mahuwala Zabeen , Ahmadi Saumel , Bozoky Zoltan , Hays Ryan , Agostini Mark , Ding Kan
Published: March 2019

Purpose:

Current literature suggests that longer duration of EEG recording increases the yield of detecting interictal epileptiform discharges. However, optimal duration for a repeat study in patients with initially normal 30-minute EEG is not clear. Thus, the purpose of this study is to determine whether a 2-hour EEG has a diagnostic advantage over a routine 30-minute EEG in detecting epileptiform abnormalities in patients who had a first normal 30-minute EEG.

Methods:

This is a single-center, retrospective study done at UT Southwestern Medical Center at Dallas and Parkland Memorial Hospital. The data from 1997 to 2015 were extracted from the existing EEG report database for patients who had a first normal 30-minute EEG recording. EEG was interpreted by board-certified clinical neurophysiologists, who classified each EEG as normal or abnormal, with relevant subsequent subclassification.

Results:

Over 18 years, a total of 12,425 individual 30-minute EEGs were performed. Of these, 1,023 patients had at least one repeated EEG after the first normal EEG. Among these patients, 763 had a 30-minute EEG as the second study and 260 had a 2-hour EEG as the second study. The yield of epileptiform discharges was 3.3% in the 30-minute EEG group and 4.2% in the 2-hour EEG group (P = 0.5) in the repeating studies.

Conclusions:

Two-hour EEG has a similar yield as 30-minute EEG to detect epileptiform discharges in patients with a normal 30-minute EEG.
Effects of Diurnal Intermittent Fasting on Daytime Sleepiness Reflected by EEG Absolute Power
Authors: Almeneessier Aljohara S. , BaHammam Abdulrahman A. , Olaish Awad H. , Pandi-Perumal Seithikurippu R. , Manzar Md Dilshad , BaHammam Ahmed S.
Published: March 2019

Purpose:

We hypothesized that diurnal intermittent fasting would not increase slow frequency EEG waves, which reflect increased sleepiness. Therefore, this study aimed at performing a quantitative EEG analysis of young healthy volunteers with and without diurnal intermittent fasting while controlling for potential confounders.

Methods:

Eight young healthy volunteers (mean age: 24.4 ± 3.7 years) reported to the laboratory during the following five occasions: (1) adaptation, (2) 4 weeks before Ramadan while performing diurnal intermittent fasting (fasting from dawn to sunset) for 1 week (fasting outside Ramadan), (3) 1 week before Ramadan (nonfasting baseline), (4) during the second week of Ramadan while fasting (Ramadan), and (5) 2 weeks after Ramadan (recovery). Frontal, central, and occipital EEG signals were monitored four times (09:15, 11:15, 13:15, and 15:15 for 15 minutes each time) while the participants were awake to assess EEG spectral power of the delta, theta, alpha, and beta frequency bands.

Results:

During wakefulness, no difference in EEG slowing was observed between nonfasting baseline and fasting during and outside Ramadan. There were no differences in the mean absolute power of each band in any studied brain region in any of the four study periods. Moreover, there was no difference in EEG absolute powers in the delta, theta, alpha, and beta frequency bands for any individual brain region during the four study periods.

Conclusions:

Spectral analysis of EEG power indicates that diurnal intermittent fasting does not increase sleepiness. Future larger studies are needed to confirm the current findings.
Improving imputation quality in BEAGLE for crop and livestock data
Authors: Pook T. , Mayer M. , Geibel J. , Weigend S. , Cavero D. , Schoen C.C. , Simianer H.
Published: March 2019

Imputation is one of the key steps in the preprocessing and quality control protocol of any genetic study. Most imputation algorithms were originally developed for the use in human genetics and thus are optimized for a high level of genetic diversity. Different versions of BEAGLE were evaluated on genetic datasets of doubled haploids of two European maize landraces, a commercial breeding line and a diversity panel in chicken, respectively, with different levels of genetic diversity and structure which can be taken into account in BEAGLE by parameter tuning. Especially for phasing BEAGLE 5.0 outperformed the newest version (5.1) which in turn also lead to improved imputation. Earlier versions were far more dependent on the adaption of parameters in all our tests. For all versions, the parameter ne (effective population size) had a major effect on the error rate for imputation of ungenotyped markers, reducing error rates by up to 98.5%. Further improvement was obtained by tuning of the parameters affecting the structure of the haplotype cluster that is used to initialize the underlying Hidden Markov Model of BEAGLE. The number of markers with extremely high error rates for the maize datasets were more than halved by the use of a flint reference genome (F7, PE0075 etc.) instead of the commonly used B73. On average, error rates for imputation of ungenotyped markers were reduced by 8.5% by excluding genetically distant individuals from the reference panel for the chicken diversity panel. To optimize imputation accuracy one has to find a balance between representing as much of the genetic diversity as possible while avoiding the introduction of noise by including genetically distant individuals.
Reduced proteasome activity in the aging brain results in ribosome stoichiometry loss and aggregation
Authors: Sacramento Erika Kelmer , Kirkpatrick Joanna M. , Mazzetto Mariateresa , Baumgart Mario , Bartolome Aleksandar , Di Sanzo Simone , Caterino Cinzia , Sanguanini Michele , Papaevgeniou Nikoletta , Lefaki Maria , Childs Dorothee , Bagnoli Sara , Tozzini Eva Terzibasi , Di Fraia Domenico , Romanov Natalie , Sudmant Peter , Huber Wolfgang , Chondrogianni Niki , Vendruscolo Michele , Cellerino Alessandro , Ori Alessandro
Published: March 2019

A progressive loss of protein homeostasis is characteristic of aging and a driver of neurodegeneration. To investigate this process quantitatively, we characterized proteome dynamics during brain aging in the short-lived vertebrate Nothobranchius furzeri combining transcriptomics and proteomics. We detected a progressive reduction in the correlation between protein and mRNA, mainly due to post-transcriptional mechanisms that account for over 40% of the age-regulated proteins. These changes cause a progressive loss of stoichiometry in several protein complexes, including ribosomes, which show impaired assembly / dis-assembly and are enriched in protein aggregates in old brains. Mechanistically, we show that reduction of proteasome activity is an early event during brain aging and is sufficient to induce proteomic signatures of aging and loss of stoichiometry in vivo. Using longitudinal transcriptomic data, we show that the magnitude of early life decline in proteasome levels is the major risk factor for mortality. Our work defines causative events in the aging process that can be targeted to prevent loss of protein homeostasis and delay the onset of age-related neurodegeneration.

Highlights

Progressive loss of stoichiometry affects multiple protein complexes

Ribosomes aggregate in old brains

Partial reduction of proteasome activity is sufficient to induce loss of stoichiometry

Reduced proteasome levels are a major risk factor for early death in killifish
Bayesian population receptive field modeling in human somatosensory cortex
Authors: Puckett Alexander M. , Bollmann Saskia , Junday Keerat , Barth Markus , Cunnington Ross
Published: March 2019

Somatosensation is fundamental to our ability to sense our body and interact with the world. Our body is continuously sampling the environment using a variety of receptors tuned to different features, and this information is routed up to primary somatosensory cortex. Strikingly, the spatial organization of the peripheral receptors in the body are well maintained, with the resulting representation of the body in the brain being referred to as the somatosensory homunculus. Recent years have seen considerable advancements in the field of high-resolution fMRI, which have enabled an increasingly detailed examination of the organization and properties of this homunculus. Here we combined advanced imaging techniques at ultra-high field (7T) with a recently developed Bayesian population receptive field (pRF) modeling framework to examine pRF properties in primary somatosensory cortex. In each subject, vibrotactile stimulation of the fingertips (i.e., the peripheral mechanoreceptors) modulated the fMRI response along the post-central gyrus and these signals were used to estimate pRFs. We found the pRF center location estimates to be in accord with previous work as well as evidence of other properties in line with the underlying neurobiology. Specifically, as expected from the known properties of cortical magnification, we find a larger representation of the index finger compared to the other stimulated digits (middle, index, little). We also show evidence that the little finger is marked by the largest pRF sizes. The ability to estimate somatosensory pRFs in humans provides an unprecedented opportunity to examine the neural mechanisms underlying somatosensation and is critical for studying how the brain, body, and environment interact to inform perception and action.
Neurophysiological predictors of memory impairment in schizophrenia: decoupled slow-wave dynamics during non-REM sleep
Authors: Bartsch Ullrich , Simpkin Andrew , Demanuele Charmaine , Wamsley Erin , Marston Hugh , Jones Matthew W
Published: March 2019

The slow-waves (SW) of non-rapid eye movement sleep (NREM) reflect neocortical components of network activity during sleep-dependent information processing; their disruption may therefore contribute to impaired memory consolidation. Here, we quantify SW dynamics relative to motor sequence memory in patients suffering schizophrenia and healthy volunteers.

Patients showed normal intrinsic SW properties but impaired SW coherence, which failed to exhibit the learning-dependent increases evident in healthy volunteers. SW-spindle phase amplitude coupling across distributed EEG electrodes was also dissociated from experience in patients, with long-range fronto-parietal and -occipital networks most severely affected. Partial least squares regression modelling confirmed distributed SW coherence and SW-spindle coordination as predictors of overnight memory consolidation in healthy controls, but not in patients.

Quantifying the full repertoire of NREM EEG oscillations and their long-range covariance therefore presents learning-dependent changes in distributed SW and spindle coordination as fingerprints of impaired cognition in schizophrenia.
The homeostatic dynamics of feeding behaviour identify novel mechanisms of anorectic agents
Authors: McGrath Thomas M , Spreckley Eleanor , Rodriguez Aina Fernandez , Viscomi Carlo , Alamshah Amin , Akalestou Elina , Murphy Kevin G , Jones Nick S
Published: March 2019

Better understanding of feeding behaviour will be vital in reducing obesity and metabolic syndrome, but we lack a standard model that captures the complexity of feeding behaviour. We construct an accurate stochastic model of rodent feeding at the bout level in order to perform quantitative behavioural analysis. Analysing the different effects on feeding behaviour of PYY3-36, lithium chloride, GLP-1 and leptin shows the precise behavioural changes caused by each anorectic agent. Our analysis demonstrates that the changes in feeding behaviour evoked by the anorectic agents investigated not mimic satiety. In thead libitumfed state during the light period, meal initiation is governed by complete stomach emptying, whereas in all other conditions there is a graduated response. We show how robust homeostatic control of feeding thwarts attempts to reduce food intake, and how this might be overcome.In silicoexperiments suggest that introducing a minimum intermeal interval or modulating gastric emptying can be as effective as anorectic drug administration.
Circuits that encode and predict alcohol associated preference
Authors: Scaplen Kristin M. , Talay Mustafa , Salamon Sarah , Nuñez Kavin M. , Waterman Amanda G. , Gang Sydney , Song Sophia L. , Barnea Gilad , Kaun Karla R.
Published: March 2019

Substance use disorders are chronic relapsing disorders often impelled by enduring memories and persistent cravings. Alcohol, as well as other addictive substances, remolds neural circuits important for memory to establish obstinate preference despite aversive consequences. How pertinent circuits are selected and shaped to result in these unchanging, inflexible memories is unclear. Using neurogenetic tools available inDrosophila melanogasterwe define how circuits required for alcohol associated preference shift from population level dopaminergic activation to select dopamine neurons that predict behavioral choice. During memory expression, these dopamine neurons directly, and indirectly via the mushroom body (MB), modulate the activity of interconnected glutamatergic and cholinergic output neurons. Transsynaptic tracing of these output neurons revealed at least two regions of convergence: 1) a center of memory consolidation within the MB implicated in arousal, and 2) a structure outside the MB implicated in integration of naïve and learned responses. These findings provide a circuit framework through which dopamine neuron activation shifts from reward delivery to cue onset, and provides insight into the inflexible, maladaptive nature of alcohol associated memories.
5-methoxy-N,N-dimethyltryptamine: An ego-dissolving endogenous neurochemical catalyst of creativity
Authors: Germann Christopher B.
Published: March 2019

5-Methoxy-N,N-dimethyltryptamine (acronymized as 5-MeO-DMT) is sui generis among the numerous naturally-occurring psychoactive substances due to its unparalleled ego-dissolving effects which can culminate in a state of nondual consciousness (which is phenomenologically similar to transformative peak experiences described in various ancient contemplative traditions, e.g., Advaita Vedānta, Mahāyāna Buddhism). The enigmatic molecule is endogenous to the human brain and has profound psychological effects which are hitherto only very poorly understood due to the absence of scientifically controlled human experimental trials. Its exact neuronal receptor binding profile is a matter of ongoing scientific research, however, its remarkable psychoactivity is presumably mediated via agonism of the 5-HT2A (serotonin) receptor subtype. Anthropological/ethnopharmacological evidence indicates that various cultures utilized 5-MeO-DMT containing plants for medicinal, psychological, and spiritual purposes for millennia. In this paper we argue that this naturally occurring serotonergic compound could be fruitfully utilized as a neurochemical research tool which has the potential to significantly advance our understanding of the cognitive and neuronal processes which underpin cognition and creativity (downregulation of the default-mode network, increased neuronal functional connectivity, etc.). An eclectic interdisciplinary perspective is adopted, and we present converging evidence from a plurality of sources in support of this conjecture. Specifically, we suggest that 5-MeO-DMT has great potential in this respect due to its incommensurable capacity to completely disintegrate self-referential cognitive/neuronal processes (viz., “ego death”). The importance of unbiased systematic scientific research on naturally occurring endogenous psychoactive compounds is discussed from a Jamesian radical empiricism perspective and potential scenarios of abuse are discussed (particularly in the context of military torture).
Adaptation to seasonal reproduction and temperature-associated factors drive temporal and spatial differentiation in northwest Atlantic herring despite gene flow
Authors: Fuentes-Pardo Angela P. , Stanley Ryan , Bourne Christina , Singh Rabindra , Emond Kim , Pinkham Lisa , McDermid Jenni L. , Andersson Leif , Ruzzante Daniel E.
Published: March 2019

Natural selection can maintain local adaptation despite the presence of gene flow. However, the genomic basis and environmental factors involved in adaptation at fine-spatial scales are not well understood. Here, we address these questions using Atlantic herring (Clupea harengus), an abundant, migratory, and widely distributed marine species with substantial genomic resources including a chromosome-level genome assembly and genomic data from the eastern Atlantic and Baltic populations. We analysed whole-genome sequence and oceanographic data to examine the genetic variation of 15 spawning aggregations across the northwest Atlantic Ocean (∼1,600 km of coastline) and the association of this variation with environmental variables. We found that population structure lies in a small fraction of the genome involving adaptive genetic variants of functional importance. We discovered 10 highly differentiated genomic regions distributed across four chromosomes. Two of these loci appear to be private to the northwest, four loci share a large number of adaptive variants between northwest and northeast Atlantic, and four shared loci exhibit an outstanding diversity in haplotype composition, including a novel putative inversion on chromosome 8. Another inversion on chromosome 12 underlies a latitudinal genetic pattern discriminating populations north and south of a biogeographic transition zone on the Scotian Shelf. Our genome-environment association analysis indicates that sea water temperature during winter is the environmental factor that best correlates with the latitudinal pattern of this inversion. We conclude that the timing and geographic location of spawning and early development are under diverse selective pressures related to environmental gradients. Natural selection appears to act on early-life performance traits with differential fitness across environments. Our study highlights the role of genomic architecture, ancestral haplotypes, and selection in maintaining adaptive divergence in species with large population sizes and presumably high gene flow.