bluuebunny/crossref_metadata_2025 huggingface dataset:
Nickel-Catalyzed Difunctionalization of Alkynyl Bromides with Thiosulfonates and N-Arylthio Succinimides: A Convenient Synthesis of 1,2-Thiosulfonylethenes and 1,1-Dithioethenes
Authors: Reddy Raju Jannapu , Kumari Arram Haritha , Kumar Jangam Jagadesh , Krishna Gamidi Rama
Published: April 2021

An efficient nickel-catalyzed vicinal thiosulfonylation of 1-bromoalkynes with thiosulfonates in the presence of cesium carbonate is described. An operationally simple and highly regioselective atom transfer radical addition (ATRA) of alkynyl bromides provides a wide range of (E)-1,2-thiosulfonylethenes (α-aryl-β-thioarylvinyl sulfones) in moderate to high yields. The extensive substrate scope of both alkynyl bromides and thiosulfonates is explored with a broad range of functional groups. Indole-derived 1,1-bromoalkenes were also successfully explored in this 1,2-thiosulfonylation process. Moreover, the nickel-catalyzed geminal-dithiolation of alkynyl bromides with N-arylthio succinimides provides 1,1-dithioalkenes in high yields. The present protocol is reliable on gram scale, and a sequential one-pot bromination and thiosulfonylation of phenylacetylene is achieved in a scale-up synthesis. Following control experiments, a plausible mechanism is proposed to rationalize the experimental outcome and the vicinal thio­sulfonylation.
Reactions of 4-Pyrones with Azomethine Ylides as a Chemo­selective Method for the Construction of Multisubstituted Pyrano[2,3-c]pyrrolidines
Authors: Obydennov Dmitrii L. , Steben’kov Vyacheslav D. , Obydennov Konstantin L. , Usachev Sergey A. , Moshkin Vladimir S. , Sosnovskikh Vyacheslav Y.
Published: April 2021

4-Pyrones bearing electron-donating and electron-withdrawing groups react with nonstabilized azomethine ylides to form pyrano[2,3-c]pyrrolidines in moderate to good yields. The reaction proceeds chemoselectively as a 1,3-dipolar cycloaddition of the azomethine ylide at the carbon–carbon double bond of the pyrone activated by the electron-withdrawing substituent. The reactivity of 4-pyrones toward azomethine ylides was rationalized by computational studies with the use of reactivity indexes. The pyrano[2,3-c]pyrrolidine moiety could be modified, for example by a ring-opening transformation under the action of hydrazine to provide pyrazolyl-substituted pyrrolidines.
Copper-Catalyzed Alkynylation of Benzylic C–H Bonds with Alkynylboronic Esters
Authors: Kramer Søren , Buendia Mikkel B. , Balin Jan-Georges J. , Andersen Mette E. , Lian Zhong
Published: April 2021

We report a simple method for copper-catalyzed benzylic C–H alkynylation that uses alkynylboronic esters as nucleophilic coupling partners. The catalytic system is readily available and the reaction takes place under mild conditions. Different substrates for the C–H functionalization, as well as various alkynylboronic ester nucleophiles, were evaluated. Finally, three examples of enantioselective C–H alkynylations are presented.
Sample Size Calculation in Medical Research: A Primer
Authors: Charan Jaykaran , Kaur Rimplejeet , Bhardwaj Pankaj , Singh Kuldeep , Ambwani Sneha R. , Misra Sanjeev
Published: April 2021

Quality of research is determined by many factors and one such climacteric factor is sample size. Inability to use correct sample size in study might lead to fallacious results in the form of rejection of true findings or approval of false results. Too large sample size is wastage of resources and use of too small sample size might fail to answer the research question or provide imprecise results and may question the validity of study. Despite being such a paramount aspect of research, the knowledge about sample size calculation is sparse among researchers. Why is it important to calculate sample size; when to calculate it; how to calculate it and what details about sample size calculation should be reported in research protocols or articles; are the lesser known basics to majority of researchers. The present review is directed to address these aforementioned fundamentals about sample size. Sample size should be calculated during the initial phase of planning of study. Several components are required for sample size calculation such as effect size, type-1 error, type-2 error, and variance. Researchers must be aware that there are different formulas for calculating sample size for different types of study designs. The researcher must include details about sample size calculation in the methodology section, so that it can be justified and it also adds to the transparency of the study. The literature about calculation of sample size for different study designs is scattered over many textbooks and journals. Scrupulous literature search was conducted to find the passable information for this review. This paper presents the sample size calculation formulas in a single review in a simplified manner with relevant examples, so that researchers may adequately use them in their research.
Midterm Surgical Outcomes for ALCAPA Repair in Infants and Children
Authors: Hu Renjie , Zhang Wen , Yu Xiafeng , Zhu Hongbin , Zhang Haibo , Liu Jinfen
Published: April 2021

Background Surgical correction of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) has been associated with excellent survival during recent years. The purpose of this study was to evaluate the effectiveness of reimplantation of the coronary artery and to investigate the recovery of postoperative cardiac and mitral valve (MV) function.

Methods From 2005 to 2015, 80 patients who had ALCAPA received surgical correction. Among them, 49 were infants. The median patient age was 7.8 months. Operative strategies included reimplantation of the coronary artery in 71 patients, the Takeuchi procedure in another 7 patients, and coronary artery ligation in the remaining 2 patients.

Results There were 11 hospital deaths and 2 late deaths. Six patients required intraoperative or postoperative mechanical circulatory support. A significant improvement in the ejection fraction (EF) and shortening fraction (SF) was present in all surviving patients at discharge, at a 3-month follow-up and at a 1-year follow-up. MV function improved gradually after surgical repair with no late secondary intervention.

Conclusions The repair of ALCAPA can be accomplished by establishment of a dual-coronary system, which offers an acceptable mortality rate and will rarely require a second surgery. Left ventricular (LV) recovery is a progressive process, especially for infants with impaired LV function. Concomitant MV annuloplasty is safe and reliable and can be performed as necessary in patients with moderate or severe mitral valve regurgitation.
Lipomas as an Extremely Rare Cause for Brachial Plexus Compression: A Case Series and Systematic Review
Authors: Gembruch Oliver , Ahmadipour Yahya , Chihi Mehdi , Dinger Thiemo F. , Rauschenbach Laurèl , Pierscianek Daniela , Jabbarli Ramazan , Sure Ulrich , Wrede Karsten H. , Uerschels Anne-Kathrin
Published: April 2021

Introduction Brachial plexus lipomas are extremely rare benign tumors that may cause slow progression of neurological deficits leading to thoracic outlet syndrome. Up to now, surgery remains challenging. The aim of this study is to present our surgical treatment regime and long-term neurological outcome in three cases of giant brachial plexus lipomas and to show results of systematic review.

Patients and Methods Retrospective analysis of our database “peripheral nerve lesion” to identify patients suffering from brachial plexus lipomas between January 1, 2012, and December 31, 2019. Systematic review was performed for literature published until March 31, 2020, analyzing PubMed, Google Scholar, Scopus, and the Cochrane Collaboration Library independently by two authors.

Results Over the past years, three patients suffering from giant brachial plexus lipomas attended to our neurosurgical department. All patients underwent preoperative magnetic resonance imaging (MRI), ultrasound examinations, and electrophysiological testing. Tumors were removed microsurgically via anterior/posterior, supraclavicular/infraclavicular, and combined approaches. The patients were accessed postoperatively by MRI and clinical follow-up. Systematic review of the literature revealed 22 cases, which were analyzed in regard to demographics, surgical treatment, and neurological outcome.

Conclusion Brachial plexus lipomas are an extremely rare cause for brachial plexus compression. Total microsurgical removal with intraoperative electrophysiological monitoring is the treatment of choice with excellent long-term MRI and clinical outcome.
Birth and Growth of Neuroimaging and Vascular Intervention at Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram—Part II
Authors: Vedula Rajanikanth Rao , Kolathu Ravi Mandalam
Published: April 2021

This is the second part of the two-part paper on the history of development of neuroradiology at the Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram. In this part, the authors describe the evolution of interventional procedures at their institute from the initial techniques of free-flow embolization as a palliative procedure for large arteriovenous malformations (AVMs) to the more refined techniques of selective embolization using microcatheters, calibrated leak balloons and liquid polymerizing embolic agents. The authors acknowledge the immense encouragement and support provided to them by the French neurointervention pioneers Prof. Luc Picard and Prof. Jacques Moret in this endeavor.
Radiosurgery for Trigeminal Neuralgia Secondary to Dolichoectatic Vessels: Case Series and Review of Literature
Authors: Tripathi Manjul , Mohindra Sandeep , Madan Renu , Ahuja Chirag K. , Batish Aman , Kaur Rupinder , Dutta Sushant , Patil Ninad R. , Rangan Vasundhara S. , Aulakh Sonikpreet
Published: April 2021

Even for seasoned neurosurgeons who have mastered the microvascular decompression (MVD) techniques, trigeminal neuralgia (TGN) secondary to vertebrobasilar dolichoectatic vessels remains a challenge. Often, patient is either medically infirm or unwilling for invasive surgical interventions. Alternative treatment options including Gamma Knife radiosurgery (GKRS) are considered in such a situation with variable success. This study aimed to evaluate the role of GKRS in patients with trigeminal neuralgia with dolichoectatic vessels and severe cross compression. We prospectively managed three male patients of intractable TGN secondary to dolichoectatic vascular compression with single-session GKRS. The cisternal component of the trigeminal nerve was targeted with 90 Gy radiation at 100% isodose with a single 4-mm collimator. The patients were regularly evaluated on clinical parameters for pain relief (Barrow Neurological Institute (BNI) score), sensory complaints, and outcome. All patients had satisfactory pain control (BNI I–IIIa) at 3 months of interval only to get recurrent pain (BNI IV–V) after 6 months. The treatment was eventually considered a failure after 6-month duration and one patient needed MVD for pain control. Post-GKRS pain control remains inferior in patients with dolichoectasia compared with typical TGN. GKRS should be offered only as a salvage or rescue procedure and should not be used as an alternative treatment of MVD in patient population with dolichoectatic vessels.
Cerebrovascular Disease and Cognitive Outcome in Patients with Cardiac Disease
Authors: Johansen Michelle C. , Gottesman Rebecca F.
Published: April 2021

The pace of understanding cognitive decline and dementia has rapidly accelerated over the past decade, with constantly evolving insights into the vascular contributions to cognitive impairment and dementia (VCID). Notably, more overlap has been discovered in the pathophysiology between what was previously understood to be Alzheimer's disease and VCID, leading to a heightened emphasis on disease prevention through early and aggressive control of vascular risk factors. One particularly vulnerable population may be those with cardiac disease, as they are at risk for cerebrovascular disease, which itself can lead to dementia, and increasing evidence supports cognitive impairment in disease processes such as heart failure and atrial fibrillation, independent of ischemic stroke, suggesting other potential mechanisms. In this article, we review the evidence supporting the relationship between cardiac disease, cerebrovascular disease, and cognitive decline and discuss the ongoing and future research efforts aimed at defining the important relationship between these entities.
Antithrombotic Therapy for Stroke Patients with Cardiovascular Disease
Authors: Gusdon Aaron M. , Farrokh Salia , Grotta James C.
Published: April 2021

Prevention of ischemic stroke relies on the use of antithrombotic medications comprising antiplatelet agents and anticoagulation. Stroke risk is particularly high in patients with cardiovascular disease. This review will focus on the role of antithrombotic therapies in the context of different types of cardiovascular disease. We will discuss oral antiplatelet medications and both IV and parental anticoagulants. Different kinds of cardiovascular disease contribute to stroke via distinct pathophysiological mechanisms, and the optimal treatment for each varies accordingly. We will explore the mechanism of stroke and evidence for antithrombotic therapy in the following conditions: atrial fibrillation, prosthetic heart values (mechanical and bioprosthetic), aortic arch atherosclerosis, congestive heart failure (CHF), endocarditis (infective and nonbacterial thrombotic endocarditis), patent foramen ovale (PFO), left ventricular assist devices (LVAD), and extracorporeal membrane oxygenation (ECMO). While robust data exist for antithrombotic use in conditions such as atrial fibrillation, optimal treatment in many situations remains under active investigation.
Atrial Fibrillation and Ischemic Stroke: A Clinical Review
Authors: Migdady Ibrahim , Russman Andrew , Buletko Andrew B.
Published: April 2021

Atrial fibrillation (AF) is an important risk factor for ischemic stroke resulting in a fivefold increased stroke risk and a twofold increased mortality. Our understanding of stroke mechanisms in AF has evolved since the concept of atrial cardiopathy was introduced as an underlying pathological change, with both AF and thromboembolism being common manifestations and outcomes. Despite the strong association with stroke, there is no evidence that screening for AF in asymptomatic patients improves clinical outcomes; however, there is strong evidence that patients with embolic stroke of undetermined source may require long-term monitoring to detect silent or paroxysmal AF. Stroke prevention in patients at risk, assessed by the CHA2DS2-VASc score, was traditionally achieved with warfarin; however, direct oral anticoagulants have solidified their role as safe and effective alternatives. Additionally, left atrial appendage exclusion has emerged as a viable option in patients intolerant of anticoagulation. When patients with AF have an acute stroke, the timing of initiation or resumption of anticoagulation for secondary stroke prevention has to be balanced against the risk of hemorrhagic conversion. Multiple randomized clinical trials are currently underway to determine the best timing for administration of anticoagulants following acute ischemic stroke.
Use of Preoperative High-Resolution Ultrasound System to Facilitate Elevation of the Superficial Circumflex Iliac Artery Perforator Flap
Authors: Yoshimatsu Hidehiko , Karakawa Ryo , Fuse Yuma , Okada Akira , Hayashi Akitatsu , Yano Tomoyuki
Published: April 2021

Background During elevation of the superficial circumflex iliac artery (SCIA) perforator (SCIP) flaps, the flap pedicle must often be converted from the superficial branch to the deep branch of the SCIA, complicating and prolonging the procedure. The goal of the present study was to demonstrate the effectiveness of high-resolution ultrasonography to decrease the conversion rate on which no previous report has focused, by making a comparison with a conventional method.

Methods Forty-five consecutive cases where free SCIP flap transfer was performed for reconstruction were retrospectively reviewed. To preoperatively mark the course of the superficial branch, handheld Doppler ultrasonography was used in 27 cases (group 1) and a high-resolution ultrasound system in 18 cases (group 2).

Results The conversion rate was significantly greater in group 1 than in group 2 (10/27 [37%] vs. 0/18 [0%], p = 0.003]. The frequency of use of multiple venous anastomoses was significantly higher in group 1 than in group 2 (21/27 [78%] vs. 2/18 [11%], p < 0.001). The operative time was significantly longer in group 1 than in group 2 (p = 0.038). There were no significant differences in postoperative complication rates (1/27 [4%] versus 0/18 [0%], p = 1.0).

Conclusion The use of a preoperative high-resolution ultrasound system significantly decreased the rate from of intraoperative conversion from the superficial branch to the deep branch of the SCIA. It also resulted in significantly fewer venous anastomoses and a shorter operative time, while maintaining a low incidence of postoperative complications.
A Comparison of Patient-Reported Outcomes in Bipedicled Total Abdominal versus Unipedicled Hemiabdominal Free Flaps for Unilateral Breast Reconstruction
Authors: Sergesketter Amanda R. , Shammas Ronnie L. , Taskindoust Mahsa , Glener Adam D. , Pyfer Bryan J. , Rezak Kristen , Phillips Brett T. , Hollenbeck Scott T.
Published: April 2021

Background While bipedicled free flaps enable increased soft tissue volume and potential for contralateral symmetry in unilateral breast reconstruction, the influence of bipedicled flap reconstruction on patient-reported outcomes remains unclear.

Methods Patients undergoing unilateral free flap breast reconstruction at a single institution from 2014 to 2019 were retrospectively reviewed and sent the BREAST-Q and Decision Regret Scale. Complication rates and the BREAST-Q and Decisional Regret Scale scores (0–100) were compared between patients receiving bipedicled total abdominal and unipedicled hemiabdominal free flaps.

Results Sixty-five patients undergoing unilateral breast reconstruction completed the BREAST-Q and Decision Regret Scale with median (interquartile range [IQR]) follow-up time of 32 [22–55] months. Compared with bipedicled flaps, patients receiving unipedicled hemiabdominal flaps had higher mean body mass index (BMI; p = 0.009) and higher incidence of fat grafting (p = 0.03) and contralateral reduction mammaplasties (p = 0.03). There was no difference in incidence of major or minor complications, abdominal hernias or bulges, or total operative time between bipedicled and unipedicled flaps (p > 0.05). Overall, BREAST-Q scores for satisfaction with breast, sexual wellbeing, psychosocial wellbeing, physical wellbeing (chest), and physical wellbeing (abdomen) and the Decision Regret Scale scores did not significantly vary between bipedicled and unipedicled reconstructions (all p > 0.05). However, among large-breasted patients (≥C cup), mean (standard deviation [SD]) sexual wellbeing was significantly higher after bipedicled total abdominal free flap reconstruction ([60.2 (23.3) vs. 46.2 (22.0)]; p = 0.04), though this difference did not reach significance after multivariate adjustment.

Conclusion Unilateral breast reconstruction with bipedicled total abdominal free flaps results in similar complication risk, patient satisfaction, and decisional regret without the need for as many contralateral reduction procedures.
Potential Risk Factors for Autism in Children Requiring Neonatal Intensive Care Unit
Authors: Matos Marília Barbosa de , Bara Tiago S. , Felden Érico P. G. , Cordeiro Mara L.
Published: April 2021

Background The etiology of autism spectrum disorder (ASD) is complex and involves the interplay of genetic and environmental factors.

Aim We sought to identify potential prenatal, perinatal, and neonatal risk factors for ASD in a unique population of children who had perinatal complications and required care in a neonatal intensive care unit (NICU).

Methods This prospective cohort study included 73 patients discharged from a NICU who received long-term follow-up at the largest children's hospital in Brazil. Potential risk factors were compared between 44 children with a diagnosis of ASD and 29 children without using the Mann–Whitney U test. Proportions were analyzed using the chi-square test. Simple and multiple logistic regression tests were performed.

Results Of 38 factors analyzed, the following 7 were associated with ASD: family history of neuropsychiatric disorders (p = 0.049); maternal psychological distress during pregnancy (p = 0.007); ≥ 26 days in the NICU (p = 0.001); feeding tube for ≥ 15 days (p = 0.014); retinopathy of prematurity (p = 0.022); use of three or more antibiotics (p = 0.008); and co-sleeping until up to 2 years of age (p = 0.004).

Conclusion This study found associations between specific risk factors during critical neurodevelopmental periods and a subsequent diagnosis of ASD. Knowledge of the etiologic factors that may influence the development for ASD is paramount for the development of intervention strategies and improvement of prognoses.
A Morphometric Analysis of Hamate Autograft for Proximal Scaphoid Reconstruction
Authors: Thayer Mary Kate , Bluth Benjamin , Huang Jerry I.
Published: April 2021

Objective Recently, authors have investigated using the proximal hamate as osteochondral autograft for proximal pole scaphoid reconstruction in the case of nonunion with avascular necrosis. The aim of our study was to analyze the morphology and anatomic fit of the proximal hamate compared with the proximal pole of the scaphoid using cadaveric specimens.

Materials and Methods Ten cadaver specimens (five males and five females) were dissected. Scaphoid and proximal hamate bones were measured by two independent investigators using electronic calipers and radius of curvature gauges. After measurements were determined to have good correlation, the average value of the two observers' measurements were used for further analysis. Sagittal radius of curvature (ROC), coronal ROC, depth, width, and maximum graft length were compared.

Results The average depth of the scaphoid proximal pole was 12.3 mm (standard deviation [SD] = 1.12) compared with 11.3 mm (SD = 1.24) for the proximal hamate (p = 0.36). The average width was 7.8 mm (SD = 1.00) in the scaphoids compared with 8.6 (SD = 1.05) in the hamates (p = 0.09). There was also no significant difference in the sagittal ROC between hamates (9.1 mm, SD = 1.13) and scaphoids (9.5 mm, SD = 0.84; p = 0.36). All of these average measurements were within 1 mm. There was a significant difference between the coronal ROC of the hamate (23.4 mm) and scaphoid (21.1 mm) bones in our samples (p = 0.03). Females were on average smaller than their males, but there was no significant difference in fit based on sex alone.

Conclusion The proximal pole of the hamate has similar morphology and size as the scaphoid, with similar depth, width, and sagittal ROC. It has potential as an osteochondral autograft for proximal pole scaphoid reconstruction.
Preventing Brain Damage from Hypoxic–Ischemic Encephalopathy in Neonates: Update on Mesenchymal Stromal Cells and Umbilical Cord Blood Cells
Authors: Nabetani Makoto , Mukai Takeo , Shintaku Haruo
Published: April 2021

Neonatal hypoxic–ischemic encephalopathy (HIE) causes permanent motor deficit “cerebral palsy (CP),” and may result in significant disability and death. Therapeutic hypothermia (TH) had been established as the first effective therapy for neonates with HIE; however, TH must be initiated within the first 6 hours after birth, and the number needed to treat is from 9 to 11 to prevent brain damage from HIE. Therefore, additional therapies for HIE are highly needed. In this review, we provide an introduction on the mechanisms of HIE cascade and how TH and cell therapies such as umbilical cord blood cells and mesenchymal stromal cells (MSCs), especially umbilical cord-derived MSCs (UC-MSCs), may protect the brain in newborns, and discuss recent progress in regenerative therapies using UC-MSCs for neurological disorders.

The brain damage process “HIE cascade” was divided into six stages: (1) energy depletion, (2) impairment of microglia, (3) inflammation, (4) excitotoxity, (5) oxidative stress, and (6) apoptosis in capillary, glia, synapse and/or neuron. The authors showed recent 13 clinical trials using UC-MSCs for neurological disorders.

The authors suggest that the next step will include reaching a consensus on cell therapies for HIE and establishment of effective protocols for cell therapy for HIE.

Key Points
The Spectrum of KCNQ2- and KCNQ3-Related Epilepsy
Authors: Portale Anna , Comella Mattia , Salomone Giulia , Di Nora Alessandra , Marino Lidia , Leonardi Roberta , Praticò Andrea D. , Falsaperla Raffaele
Published: April 2021

KCNQ genes encode for a family of six transmembrane domains, single pore-loop, and K+ channel α-subunits that have a wide range of physiological correlates. In the brain, KCNQ2 and KCNQ3 heteromultimers are thought to underlie the M-current which is essential in raising the threshold for firing an action potential; mutations in these genes may cause several types of infantile epilepsies. KCNQ2-related disorders represent a continuum of overlapping neonatal epileptic phenotypes that range from KCNQ2 benign familial neonatal epilepsy (BFNE), a seizure disorder that occur in children who typically have a normal psychomotor development and are inherited as an autosomal dominant trait, to KCNQ2 early-onset epileptic encephalopathy (EOEE) as the result of a de novo pathogenic variant. KCNQ3-related disorders are rarer and include BFNE, benign familial infantile epilepsy and KCNQ3-related epileptic encephalopathy with intellectual disability with or without seizures and/or cortical visual impairment. For both KCNQ2- and KCNQ3-related disorders, it is possible to use several drugs for different classes of mutations (i.e., gain of function vs. loss of function), and usually their effects vary in relation to the clinical presentation and the phenotype of the patient. However, KCNQ2-EOEE patients have a worse response to treatment than KCNQ2-BFNE patients and usually become drug resistant with multiple daily seizures.
Risk Factors for Infection and Revision Surgery following Patellar Tendon and Quadriceps Tendon Repairs: An Analysis of 3,442 Patients
Authors: Lewis Daniel C. , Athoff Alyssa D. , Kamalapathy Pramod , Yarboro Seth R. , Miller Mark D. , Werner Brian C.
Published: April 2021

Disruption of the extensor mechanism is debilitating with surgical repair being the accepted treatment. The incidence of infection and reoperation after extensor mechanism repair are not well reported in the literature. Thus, the objective of the current study was to (1) determine the incidence of surgical site infection and reoperation within 1 year of primary extensor mechanism repair and (2) identify independent risk factors for infection and reoperation following patellar and quadriceps tendon repair. A retrospective review of the 100% Medicare Standard Analytic files from 2005 to 2014 was performed to identify patients undergoing isolated patellar tendon repair and quadriceps tendon repair. Diagnosis of infection within 1 year of operative intervention and revision repair were assessed. Extensor mechanism injuries in the setting of total knee arthroplasty and polytrauma were excluded. Multivariate logistic regression analysis was performed to evaluate risk factors for postoperative infection and reoperation within 1 year. Infection occurred in 6.3% of patients undergoing patellar tendon repair and 2.6% of patients undergoing quadriceps tendon repair. Diabetes mellitus (odds ratio [OR] = 1.89, p = 0.005) was found to be an independent risk factor for infection following patellar tendon repair. Reoperation within 1 year occurred in 1.3 and 3.9% following patellar tendon and quadriceps tendon repair, respectively. Age less than 65 years (OR = 2.77, p = 0.024) and obesity (OR = 3.66, p = 0.046) were significant risk factors for reoperation after patellar tendon repair. Hypertension (OR = 2.13, p = 0.034), hypothyroidism (OR = 2.01, p = 0.010), and depression (OR = 2.41, p = 0.005) were significant risk factors for reoperation after quadriceps tendon repair. Diabetes mellitus was identified as a risk factor for infection after patellar tendon repair. Age less than 65 years, peripheral vascular disease, and congestive heart failure were risk factors for infection after quadriceps tendon repair. The current findings can be utilized to counsel patients regarding preoperative risk factors for postoperative complications prior to surgical intervention for extensor mechanism injuries.
Autologous Blood Pleurodesis: What Is the Optimal Time Interval and Amount of Blood?
Authors: Campisi Alessio , Dell'Amore Andrea , Zhang Yonghui , Gu Zhitao , Ciarrocchi Angelo Paolo , Faccioli Eleonora , Bertolaccini Luca , Rea Federico , Stella Franco , Fang Wentao
Published: April 2021

Background Air leak is the most common complication after lung resection and leads to increased length of hospital (LOH) stay or patient discharge with a chest tube. Management by autologous blood patch pleurodesis (ABPP) is controversial because few studies exist, and the technique has yet to be standardized.

Methods We retrospectively reviewed patients undergoing ABPP for prolonged air leak (PAL) following lobectomy in three centers, between January 2014 and December 2019. They were divided into two groups: Group A, 120 mL of blood infused; Group B, 60 mL. Propensity score-matched (PSM) analysis was performed, and 23 patients were included in each group. Numbers and success rates of blood patch, time to cessation of air leak, time to chest tube removal, reoperation, LOH, and complications were examined. Univariate and multivariate analysis of variables associated with an increased risk of air leak was performed.

Results After the PSM, 120 mL of blood is statistically significant in reducing the number of days before chest tube removal after ABPP (2.78 vs. 4.35), LOH after ABPP (3.78 vs. 10.00), and LOH (8.78 vs. 15.17). Complications (0 vs. 4) and hours until air leak cessation (6.83 vs. 3.91, range 1–13) after ABPP were also statistically different (p < 0.05). Air leaks that persisted for up to 13 hours required another ABPP. No patient had re-operation or long-term complications related to pleurodesis.

Conclusion In our experience, 120 mL is the optimal amount of blood and the procedure can be repeated every 24 hours with the chest tube clamped.
Transcatheter Aortic Valve Implantation in Patients Who Cannot Undergo Transfemoral Access
Authors: Useini Dritan , Beluli Blerta , Christ Hildegard , Schlömicher Markus , Patsalis Polykarpos , Haldenwang Peter , Strauch Justus
Published: April 2021

Introduction Though transfemoral (TF) access has emerged as a gold standard access for patients with aortic stenosis who undergo transcatheter aortic valve implantation (TAVI), there has been no study that has characterized patients who cannot undergo TF access in detail. We aim to evaluate the contraindications for TF access, their incidence, classify them, and provide the outcomes of patients who failed to be TF candidates.

Methods From 925 patients who underwent TAVI between February 2014 and May 2020 at our heart center, 130 patients failed to be TF candidates and underwent transapical-transcatheter aortic valve implantation (TA-TAVI). In this study, we included all those patients who failed to be TF candidates and underwent TA-TAVI using the third-generation balloon expandable valve (Edwards SAPIEN 3 valve [S3]) (116 patients; STS score 6.07 ± 4.4; age 79.4 ± 7).

Results The incidence of patients unsuitable for TF access at our heart center was 14%. We classified this TAVI population into absolute contraindication for TF access n = 84 (72.5%) and increased interventional risk for TF access n = 32 (27.5%). After TA-TAVI of this specific population using S3, the in-hospital mortality and stroke were 1.7 and 1.7%, respectively. The vascular injury rate was 1.7%. We registered no paravalvular leakage ≥2. The pacemaker rate was 7.4%. The mean transvalvular pressure gradient was 8.7 mm Hg.

Conclusion The incidence of patients who cannot undergo TF access or who are at high interventional risk is considerably high. TA-TAVI, supported with sufficient interventional experience and appropriate valve system, represents an excellent alternative for patients with distinct vasculopathy.
CDKL5 Gene: Beyond Rett Syndrome
Authors: Ciccia Lina Maria , Scalia Bruna , Venti Valeria , Pizzo Francesco , Pappalardo Maria Grazia , La Mendola Flavia Maria Consuelo , Falsaperla Raffaele , Praticò Andrea D.
Published: April 2021

CDKL5 is a gene located in the X-chromosome (Xp22) encoding a serine/threonine kinase involved in various signaling pathways, implicated in cell proliferation, axon development, dendrite growth, synapse formation, and maintenance. Mutations occurring in this gene have been associated with drug-resistant early-onset epilepsy, with multiple seizures type, and deep cognitive and motor development delay with poor or absent speech, ataxic gait or inability to walk, hand stereotypies and in a few cases decrement of head growth. Many aspects remain unclear about the CDKL5 deficiency disorders, research will be fundamental to better understand the pathogenesis of neurological damage and consequently developed more targeted and profitable therapies, as there is not, at the present, a gene-based treatment and the seizures are in most of the cases drug resistant. In this article, we summarize the actual knowledge about CDKL5 gene function and mostly the consequence given by its dysfunction, also examining the possible therapeutic approaches.
Astaxanthin Reduces the Severity of Intestinal Damage in a Neonatal Rat Model of Necrotizing Enterocolitis
Authors: Akduman Hasan , Tayman Cuneyt , Korkmaz Veli , Akduman Filiz , Fettah Nurdan D. , Gürsoy Başak K. , Turkmenoglu Tugba T. , Çağlayan Murat
Published: April 2021

Objective This study aimed to ascertain the effects of astaxanthin (ASX) in an experimental necrotizing enterocolitis (NEC) model using rat pups.

Study Design Forty-two pups born from five Wistar albino rats were randomly divided into three groups as the control group, NEC + placebo (saline), and NEC + ASX. Pups in the NEC + ASX group were given 100 mg/kg/day oral ASX from day 1 to day 4 of the study. Saline of 2 mL/kg was given to the NEC + placebo group. Histopathological, immunohistochemical (caspase-3), and biochemical evaluations including the total antioxidant status (TAS), total oxidant status (TOS), superoxide dismutase (SOD), glutathione (GSH), lipid hydroperoxide (LPO), 8-hydroxydeoxyguanosine (8-OHdG), advanced oxidation protein products (AOPP), myeloperoxidase (MPO), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and nuclear factor erythroid 2–related factor 2 (Nfr-2) activities were all performed.

Results A better survival rate and weight gain were demonstrated in the NEC + ASX group (p < 0.05). In the histopathological evaluation, the severity of intestinal damage was significantly reduced in the NEC + ASX group, as well as decreased apoptosis (enzyme-linked immunosorbent assay [ELISA] for caspase-3; p = 0.001). The biochemical analyses of intestinal tissue TOS, oxidative stress index (OSI; TOS/TAS), IL-1β, LPO, 8-OHdG, AOPP, caspase-3 (p < 0.001 for all), and TNF-α and MPO (p = 0.001 for both parameters) levels were lower in the NEC + ASX group than in the NEC + placebo group. Nrf-2, TAS, GSH, and SOD levels were higher in the NEC + ASX group than in the NEC + placebo group (p = 0.001, 0.001, <0.001, and 0.01, respectively).

Conclusion ASX treatment has been shown to effectively reduce the severity of intestinal damage in NEC due to its antioxidant, anti-inflammatory, and antiapoptotic properties.

Key Points
Use of Single Chimeric Free Flaps or Double Free Flaps for Complex Head and Neck Reconstruction
Authors: Raghuram Anjali C. , Manfro Gabriel , Teixeira Gilberto V. , Cernea Claudio R. , Dias Fernando L. , Marco Mauricio De , Polo Róger , Abu-Ghname Amjed , Maricevich Marco
Published: April 2021

Background Free flaps have become the preferred reconstructive approach to restore form and function for patients presenting with complex head and neck defects. For composite, complex defects for which a regular free flap might not meet all reconstructive demands, adequate coverage can be achieved with either a single chimeric free flap or a double free flap.

Methods We performed a single-center retrospective chart review of patients who underwent either single chimeric free flap or double free flap reconstruction. Indications for reconstruction included defects resultant from head and neck tumor or osteoradionecrosis resections. We extracted the following variables: tumor location, defect, flap(s) performed, and postoperative complications. Unpaired t-tests were performed to evaluate for statistically significant differences in complications encountered between the single chimeric versus the double free flap patient groups.

Results In our series of 44 patients, a total of 55 single chimeric and double free flaps were performed. We found no significant difference in overall complications (p = 0.41) or flap/skin paddle loss (p = 0.45) between the groups. There were three total flap losses; two patients underwent successful salvage procedures and one patient died. The anterolateral thigh (ALT) was the most common free flap (70%) used in our series, and 98% of our patients completed successful reconstruction.

Conclusion As the initial reconstructive effort is critical for achieving favorable long-term outcomes in complex head and neck cases, effective and safe techniques should be employed to ensure optimal delivery of care. We believe that single chimeric and double free flap techniques should be appropriately utilized as part of the armamentarium of head and neck reconstructive microsurgeons.
Redefining the Reconstructive Ladder in Vulvoperineal Reconstruction: The Role of Pedicled Perforator Flaps
Authors: Elia Jhonatan , Do Nicholas T. K. , Chang Tommy N.-J. , Lai Chyong-Huey , Chou Hung-Hsueh , Chang Frank C.-S. , Huang Jung-Ju
Published: April 2021

Background Gynecological reconstruction is difficult, particularly in cases with recurrence and received previous surgeries and/or radiotherapy and necessitate secondary reconstruction. Perforator flaps can preserve other donor sites for potential later reconstruction, and they also can be better tailored to the defect. We hypothesized that the use of perforator-based flaps can better restore the defect with less complications.

Methods A retrospective review was conducted of all patients who underwent vulvar–perineum reconstruction between 2011 and 2018 by the senior author, and oncologic and reconstructive outcomes and complications were analyzed.

Results Thirty-three patients underwent 55 soft tissue reconstructions for vulvar–perineum defects during the study period. The mean follow-up time was 27.6 ± 28.9 months. Squamous cell carcinoma was the most common cancer (45.5%). For 11 patients (33.3%), the procedures were performed for the treatment of recurrent cancer. The average defect size was 39.8 ± 34.3 cm2. The overall survival rate was 90.3%. Profunda artery perforator flaps were the most commonly applied flap for reconstruction in both the primary and recurrent groups. Poor wound healing was the most common complication which occurred in 10 of the 55 flaps (18.2%). Perforator flaps presented fewer complications than myocutaneous flaps or traditional random flaps. Similarly, Island pedicle flap design also presented fewer complications than traditional rotation flaps. With proper reconstruction, previous surgery or radiotherapy did not contribute to an increase in complications.

Conclusion In our experience, perforator flaps can provide satisfactory reconstruction for perineum reconstruction with low postoperative complications while preserving other donor sites in the event of disease recurrence for repeat resection and reconstruction. Previous surgery or radiotherapy did not increase the complications or preclude its usage. A redefined reconstructive ladder was created to help selecting the best state-of-the-art technique for reconstruction to achieve better results.
SCN1B Gene: A Close Relative to SCN1A
Authors: Pasquetti Elisa , Lo Bianco Manuela , Sullo Federica , Patanè Francesca , Sciuto Laura , Polizzi Agata , Praticò Andrea D. , Zanghì Antonio , Falsaperla Raffaele
Published: April 2021

One of the first reported genes associated with epilepsy was SCN1B, which encodes for β-subunit of voltage-gated sodium channel of excitable cells and it is critical for neuronal function in both central and peripheral nervous system. β-subunits modulate the expression levels and functional properties of sodium channels and though their immunoglobulin domains may mediate interactions between channels and other proteins. Traditionally, SCN1B mutations were associated with generalized epilepsy with febrile seizures plus, a familial epilepsy syndrome characterized by heterogeneous phenotypes including febrile seizures (FS), febrile seizures plus (FS + ), mild generalized epilepsies, and severe epileptic encephalopathies. Throughout the years, SCN1B mutations have been also associated with Dravet syndrome and, more recently, with developmental and epileptic encephalopathies, expanding the spectrum associated with this gene mutations to more severe phenotypes.
Antegrade Approach of Percutaneous Coronary Intervention for Chronic Total Occlusion
Authors: Raghu C. , Ghogre Rahul K. , Mandepudi Alekhya
Published: April 2021

Chronic total occlusion (CTO) is a common challenge accounting for 10% of coronary lesions found on coronary angiography. Patients are frequently referred for bypass surgery because percutaneous coronary intervention is challenging in this subset. Recent advances in the hardware as well as the technical expertise and an algorithm approach have improved the success to more than 90%.

Antegrade approach is the cornerstone for managing CTO and has two distinct strategies: antegrade wire escalation, and antegrade dissection and reentry strategy. Step-wise approach to perform these procedures and the use of adjunct imaging are discussed.
Rate Constants for Abstraction of H from the Fluoromethanes by H, O, F, and OH
Authors: Burgess Donald R. , Manion Jeffrey A.
Published: April 2021

In this work, we compiled and critically evaluated rate constants from the literature for abstraction of H from the homologous series consisting of the fluoromethanes (CH3F, CH2F2, and CHF3) and methane (CH4) by the radicals H atom, O atom, OH, and F atom. These reactions have the form RH + X → R + HX. Rate expressions for these reactions are provided over a wide range of temperatures (300–1800 K). Expanded uncertainty factors f (2σ) are provided at both low and high temperatures. We attempted to provide rate constants that were self-consistent within the series—evaluating the system, not just individual reactions. For many of the reactions, the rate constants in the literature are available only over a limited temperature range (or there are no reliable measurements). In these cases, we predicted the rate constants in a self-consistent manner employing relative rates for other reactions in the homologous series using empirical structure–activity relationships, used empirical correlations between rate constants at room temperature and activation energies at high temperatures, and used relative rates derived from ab initio quantum chemical calculations to assist in rate constant predictions.
Skyrmion battery effect via inhomogeneous magnetic anisotropy
Authors: Hao Xiawei , Zhuo Fengjun , Manchon Aurélien , Wang Xiaolin , Li Hang , Cheng Zhenxiang
Published: April 2021

Magnetic skyrmions are considered a promising candidate for the next-generation information processing technology. Being topologically robust, magnetic skyrmions are swirling spin textures that can be used in a broad range of applications from memory devices and logic circuits to neuromorphic computing. In a magnetic medium lacking inversion symmetry, magnetic skyrmion arises as a result of the interplay among magnetic exchange interaction, Dzyaloshinskii-Moriya interaction, and magnetic anisotropy. Instrumental to the integrated skyrmion-based applications are the creation and manipulation of magnetic skyrmions at a designated location, absent any need of a magnetic field. In this paper, we propose a generic design strategy to achieve that goal and a model system to demonstrate its feasibility. By implementing a disk-shaped thin film heterostructure with an inhomogeneous perpendicular magnetic anisotropy, stable sub-100-nm size skyrmions can be generated without magnetic field. This structure can be etched out via, for example, focused ion beam microscope. Using micromagnetic simulation, we show that such heterostructure not only stabilizes the edge spins of the skyrmion but also protects its rotation symmetry. Furthermore, we may switch the spin texture between skyrmionic and vortex-like ones by tuning the slope of perpendicular anisotropy using a bias voltage. When embedded into a magnetic conductor and under a spin polarized current, such heterostructure emits skyrmions continuously and may function as a skyrmion source. This unique phenomenon is dubbed a skyrmion battery effect. Our proposal may open a novel venue for the realization of all-electric skyrmion-based devices.
Room temperature memristive switching in nano-patterned LaAlO3/SrTiO3 wires with laterally defined gates
Authors: Miller K. , Hartmann F. , Leikert B. , Kuhn S. , Gabel J. , Sing M. , Claessen R. , Höfling S.
Published: April 2021

We present room temperature memristive switching in a nano-patterned LaAlO3/SrTiO3 wire with laterally defined gates in proximity to the wire. Closed bias voltage sweeps show pinched hysteresis loops with zero bias resistance values of up to Ron = 8 MΩ and Roff = 1.2 GΩ for the on and off state, respectively. The maximum Roff/Ron ratio is 150. Frequency dependent measurements show a cutoff frequency of around 10 Hz, and the alteration of set point voltages enables us to precisely set and control the resistance off-on ratio. We explain the memristive switching by charge localization on the laterally defined gates, which couple capacitively to the wire and enhance or decrease the resistance dependent on the amount of transferred charges. Our finding enables the realization of geometry-based memristive switching devices, which make use of the form-dependent wire-gate capacitance.
A 100 kV, 50 Hz repetitive high-voltage pulse lifetime test platform
Authors: Yu Binxiong , Su Jiancang , Li Rui , Cheng Jie , Zhao Liang , Zhang Yu , Qiu Xudong
Published: April 2021

The pulse lifetime characteristics of solid materials have been widely concerned in the field of pulse power technology. In this paper, a repetitive high-voltage pulse lifetime test platform for the pulse lifetime test of insulation materials is set up. The platform contains a closed magnetic-core transformer and a sample cavity. The transformer insulated by transformer oil was stably operated at the 100 kV/50 Hz mode with maximum rise time of 45 µs. The sample cavity insulated by SF6 gas includes a gas switch with an amplitude jitter less than 3% at the 50 Hz mode. The platform has advantages of high efficiency and reliability. First, it can generate three kinds of different pulses simultaneously, which satisfied the insulation test requirements under different pulse conditions. The first kind of the generated pulse is a sinusoidal pulse with an amplitude of 100 kV when the gas switch keeps open. The second one is a unipolar microsecond pulse when the gas switch closes. The last one is a nanosecond pulse generated by secondary capacitor discharge. Second, long-time operation of the platform including the pulse transformer is realized. The platform was stably operated for more than 20 × 106 pulses at the 50 Hz/100 kV mode for pulse lifetime tests of solid pulse forming lines and other solid materials.