bluuebunny/crossref_metadata_2025 huggingface dataset:
Whole Genome Sequences of the Raspberry and Strawberry Pathogens Phytophthora rubi and P. fragariae
Authors: Tabima Javier F. , Kronmiller Brent A. , Press Caroline M. , Tyler Brett M. , Zasada Inga A. , Grünwald Niklaus J.
Published: July 2017

Phytophthora rubi and P. fragariae are two closely related oomycete plant pathogens that exhibit strong morphological and physiological similarities but are specialized to infect different hosts of economic importance, namely, raspberry and strawberry. Here, we report the draft genome sequences of these two Phytophthora species as a first step toward understanding the genomic processes underlying plant host adaptation in these pathogens.
Effects of Row Spacing and Nitrogen Rate on Wheat Grain Yield and Profitability as Influenced by Diseases
Authors: Salgado Jorge David , Lindsey Laura E. , Paul Pierce A.
Published: July 2017

In Ohio, changes in nitrogen (N) fertilizer application rates and row spacing in combination with fungicide applications have been proposed as possible strategies for increasing wheat productivity and profitability. Field experiments were conducted in 2013, 2014, and 2015 to evaluate the benefits of increasing row spacing and N rates in soft red winter wheat as influenced by diseases. Combinations of narrow (19 cm) and wide (38 cm) row spacings, N rates ranging from 34 to 180 kg ha−1, and the fungicide prothioconazole + tebuconazole applied at flag leaf emergence, boot, or early anthesis represented different management programs. Linear mixed model analyses were performed to evaluate the effects of N, row spacing, and fungicide timing on leaf rust, Fusarium head blight (FHB), and deoxynivalenol (DON), and to quantify relationships among leaf rust, N, grain yield (YLD), and test weight (TW). YLD, TW, grain prices and price discounts, as well as input costs were used to estimate net cash income (NCI) for each management program. Wide row wheat had statistically higher mean FHB and DON, and lower mean yield and test weight than narrow row wheat in 2014 and 2015 but not in 2013. There were significant positive linear relationships between leaf rust and N as well as YLD and TW with N. Differences in FHB and DON among N rates were not statistically significant. Leaf rust severity was consistently lower in treated plots, with efficacy influenced by N rate and application timing. Programs with narrow row spacing and treated with the fungicide generally resulted in the highest mean YLD and TW across N rates. Price discounts due to high FDK and DON, and low TW were higher, and consequently, NCIs were lower in 2014 and 2015 than in 2013. The highest NCIs were obtained for programs with the highest YLD and lowest price discounts, consequently programs with wide row spacing, a fungicide treatment, and high N rates were only economically beneficial when FHB levels were low and grain prices were high.
Timing of Strobilurin Fungicide for Control of Top Dieback in Corn
Authors: Adee Eric , Duncan Stewart
Published: July 2017

Significant yield losses can result from top dieback (TDB) in dent corn (Zea mays L.), which is caused by infection by the fungus Colletotrichum graminicola, which also causes anthracnose. Research on the effectiveness of fungicide application is limited because of the unpredictable nature of the disease. Three field studies were established to assess the timing of fungicide application for foliar diseases that developed TDB, one in Illinois (2010) and the other two in Kansas (2015 and 2016). Fungicide applications at tasseling and later were effective in reducing the incidence of TDB by over 20% and increasing yield over 900 kg/ha, or over 7%, while earlier applications (V5 to V8) did not reduce TDB nor increase yield compared with the untreated check.
Association of the Carrot Pathogen Alternaria dauci With New Diseases, Alternaria Leaf Speck, of Lettuce and Celery in California
Authors: Koike Steven T. , Smith Richard F. , Cahn Michael D. , Pryor Barry M.
Published: July 2017

In 2014 an unidentified disease was found on lettuce and celery grown in the Salinas Valley, Monterey Co., CA. Lettuce leaf symptoms were round to oval spots, 2 to 4 mm in diameter, white to tan, with a brown border. Celery leaf spots were round to oval, 2 to 4 mm in diameter, white to tan, with a chlorotic border. Initially it was thought that the damage was caused by chemical drift; however, field personnel noted the association of the disease with nearby carrots infected with Alternaria leaf blight. Microscopic examination of lettuce and celery leaves showed obclavate, brown, multicelled conidia in the spot centers, and a fungus was consistently isolated from this tissue. Cultural, morphological, and molecular analyses confirmed the fungus to be Alternaria dauci. Isolates of A. dauci from lettuce, celery, and carrot were pathogenic on all three crops. Field surveys showed that disease severity was greatest on the side of the lettuce or celery field closest to carrots. This is the first documentation that the carrot pathogen A. dauci can cause a disease on lettuce and celery grown in the field. The disease is designated as Alternaria leaf speck. Alternaria dauci was consistently isolated from nearby spinach plants showing identical symptoms and signs. However, pathogenicity tests were inconsistent and additional studies are needed to document A. dauci on spinach.
Posterior Tibial Artery as an Alternative to the Radial Artery for Arterial Cannulation Site in Small Children
Authors: Kim Eun-Hee , Lee Ji-Hyun , Song In-Kyung , Kim Jin-Tae , Lee Won-Jong , Kim Hee-Soo
Published: July 2017

Background

We evaluated the posterior tibial artery as an alternative arterial cannulation site to the radial artery in small children.

Methods

A two-stage study was conducted. First, we evaluated the anatomical characteristics of the posterior tibial artery compared with the radial and dorsalis pedis arteries. Next, a parallel-arm single-blind randomized controlled study compared the initial success rate of ultrasound-guided arterial cannulation among three arteries as a primary outcome.

Results

Sixty patients were analyzed in the observational study. The diameter of the posterior tibial artery (1.5 ± 0.2 mm) was similar to that of the radial artery (1.5 ± 0.2 mm) and larger than that of the dorsalis pedis artery (1.2 ± 0.2 mm; P < 0.001). The posterior tibial artery has a larger cross-sectional area (2.8 ± 1.1 mm2) compared with the radial (2.3 ± 0.8 mm2; P = 0.013) and dorsalis pedis arteries (1.9 ± 0.6 mm2; P = 0.001). In total, 234 patients were analyzed in the randomized study. The first-attempt success rate of the posterior tibial artery (75%) was similar to that of the radial (83%; P = 0.129; odds ratio, 1.53; 95% CI, 0.69 to 3.37) and higher than that of the dorsalis pedis artery (45%; P < 0.001; odds ratio, 3.95; 95% CI, 1.99 to 7.87). Median cannulation time of the posterior tibial artery (21 s; interquartile range, 14 to 30) was similar to that of the radial artery (27 s; interquartile range, 17 to 37) and shorter than that of the dorsalis pedis artery (34 s; interquartile range, 21 to 50).

Conclusions

The posterior tibial artery is a reasonable alternative to the radial artery for ultrasound-guided arterial cannulation in small children.
Comparison of Different Hearing Aid Prescriptions for Children
Authors: Marriage Josephine E. , Vickers Deborah A. , Baer Thomas , Glasberg Brian R. , Moore Brian C. J.
Published: July 2017

Objectives:

To assess whether there are significant differences between speech scores for different hearing aid prescription methods, specifically DSL i/o, DSL V, and NAL-NL1, using age-appropriate closed- and open-set speech tests with young children, designed to avoid floor and ceiling effects.

Design:

Participants were 44 children with moderate or severe bilateral hearing loss, 8 aged 2 to 3 years, 15 aged 4 to 5 years, and 21 aged 6 to 9 years. Children wore bilateral hearing aids fitted with each prescription method in turn in a balanced double-blind design. The speech tests used with each child (and for some tests the levels) were chosen so as to avoid floor and ceiling effects. For the closed-set tests, the level used was selected for each child based on their hearing loss. The tests used were: (1) The closed-set Consonant Confusion Test of word identification; (2) The closed-set Chear Auditory Perception Test (CAPT) of word identification. This has separate sections assessing discrimination of consonants and vowels and detection of consonants; (3) The open-set Cambridge Auditory Word Lists for testing word identification at levels of 50 and 65 dBA, utilizing 10 consonant–vowel–consonant real words that are likely to be familiar to children aged 3 years or older; (4) The open-set Common Phrases Test to measure the speech reception threshold in quiet; (5) Measurement of the levels required for identification of the Ling 5 sounds, using a recording of the sounds made at the University of Western Ontario.

Results:

Scores for the Consonant Confusion Test and CAPT consonant discrimination and consonant detection were lower for the NAL-NL1 prescription than for the DSL prescriptions. Scores for the CAPT vowel-in-noise discrimination test were higher for DSL V than for either of the other prescriptions. Scores for the Cambridge Auditory Word Lists did not differ across prescriptions for the level of 65 dBA, but were lower for the NAL-NL1 prescription than for either of the DSL prescriptions for the level of 50 dBA. The speech reception threshold measured using the Common Phrases Test and the levels required for identification of the Ling 5 sounds were higher (worse) for the NAL-NL1 prescription than for the DSL prescriptions.

Conclusions:

The higher gains prescribed by the DSL i/o and DSL V prescription methods relative to NAL-NL1 led to significantly better detection and discrimination of low-level speech sounds.
Characteristics and Outcome of Cancer Patients Admitted to the ICU in England, Wales, and Northern Ireland and National Trends Between 1997 and 2013*
Authors: Ostermann Marlies , Ferrando-Vivas Paloma , Gore Carmen , Power Sarah , Harrison David
Published: July 2017

Objective:

To describe trends in outcomes of cancer patients with an unplanned admission to the ICU between 1997 and 2013 and to identify risk factors for mortality of those admitted between 2009 and 2013.

Design:

Retrospective analysis.

Setting:

Intensive Care National Audit & Research Centre Case Mix Programme Database including data of ICUs in England, Wales, and Northern Ireland.

Patients:

Patients (99,590) with a solid tumor and 13,538 patients with a hematological malignancy with an unplanned ICU admission between 1997 and 2013; 39,734 solid tumor patients and 6,652 patients with a hematological malignancy who were admitted between 2009 and 2013 were analyzed in depth.

Interventions:

None.

Measurements and Main Results:

In solid tumor patients admitted between 2009 and 2013, hospital mortality was 26.4%. Independent risk factors for hospital mortality were metastatic disease (odds ratio, 1.99), cardiopulmonary resuscitation before ICU admission (odds ratio, 1.63), Intensive Care National Audit & Research Centre Physiology score (odds ratio, 1.14), admission for gastrointestinal (odds ratio, 1.12), respiratory (odds ratio, 1.48) or neurological (odds ratio, 1.65) reasons, and previous ICU admission (odds ratio, 1.18). In patients with a hematological malignancy admitted between 2009 and 2013, hospital mortality was 53.6%. Independent risk factors for hospital mortality were age (odds ratio, 1.02), cardiopulmonary resuscitation before ICU admission (odds ratio, 1.90), Intensive Care National Audit & Research Centre Physiology Score (odds ratio, 1.12), admission for hematological (odds ratio, 1.48) or respiratory (odds ratio, 1.56) reasons, bone marrow transplant (odds ratio, 1.53), previous ICU admission (odds ratio, 1.43), and mechanical ventilation within 24 hours of admission (odds ratio, 1.33). Trend analysis showed a significant decrease in ICU and hospital mortality and length of stay between 1997 and 2013 despite little change in severity of illness during this time.

Conclusions:

Between 1997 and 2013, the outcome of cancer patients with an unplanned admission to ICU improved significantly. Among those admitted between 2009 and 2013, independent risk factors for hospital mortality were age, severity of illness, previous cardiopulmonary resuscitation, previous ICU admission, metastatic disease, and admission for respiratory reasons.
Endoscopic Submucosal Tunnel Dissection: A Feasible Solution for Large Superficial Rectal Neoplastic Lesions
Authors: Yang Jin-Lin , Gan Tao , Zhu Lin-Lin , Wang Yi-Ping , Yang Li , Wu Jun-Chao
Published: July 2017

BACKGROUND:

Although endoscopic submucosal tunnel dissection has been used for the resection of esophageal and stomach neoplastic lesions, there are still no reports about large superficial rectal neoplastic lesions. Compared with esophageal and stomach endoscopic submucosal dissection, the dissection of large superficial rectal neoplastic lesions is more difficult because of the flimsy bowel wall with abundant vasculature in the submucosal region, which results in poor endoscopic maneuverability and serious complications, such as bleeding and perforation.

OBJECTIVE:

The study aimed to assess the efficacy and safety of endoscopic submucosal tunnel dissection for large superficial rectal neoplastic lesions over 5 to 24 months in selected patients.

DESIGN:

This was a prospective, single-center evaluation.

SETTINGS:

The study was conducted at a digestive endoscopic center.

PATIENTS:

Patients with large superficial rectal neoplastic lesions were included.

INTERVENTIONS:

Endoscopic submucosal tunnel dissection was performed in all of the patients with large, superficial rectal neoplastic lesions. The submucosal tunnel was created via a submucosal incision from the anal incision to the oral incision. Next, tunnel wall resection was performed to completely remove the lesion.

MAIN OUTCOME MEASURES:

Dissection speed, complications, and recurrence rate were measured.

RESULTS:

A total of 19 patients, including 13 men and 6 women, with an average age of 60.1 ± 12.2 years (range, 34.0–75.0 y) underwent endoscopic submucosal tunnel dissection. The average size of lesions was 17.54 ± 13.47 cm2. The mean operative time was 84.84 ± 53.49 minutes, and the operating speed was 21.01 ± 9.00 mm2/min. En bloc resections with negative basal margins were achieved in all cases without serious intraoperative complications. No recurrence was observed in any patient within 5 to 24 months after the operations.

LIMITATIONS:

This was a single-center study.

CONCLUSIONS:

Endoscopic submucosal tunnel dissection is feasible, safe, and effective for the treatment of large, superficial rectal neoplastic lesions in selected patients. See Video Abstract at http://links.lww.com/DCR/A321.
Management of Low Colorectal Anastomotic Leakage in the Laparoscopic Era: More Than a Decade of Experience
Authors: Boyce Stephen Alexander , Harris Craig , Stevenson Andrew , Lumley John , Clark David
Published: July 2017

BACKGROUND:

Anastomotic leak after colorectal surgery increases postoperative mortality, cancer recurrence, permanent stoma formation, and poor bowel function. Anastomosis between the colon and rectum is a particularly high risk. Traditional management mandates laparotomy, disassembly of the anastomosis, and formation of an often-permanent stoma. After laparoscopic colorectal surgery it may be possible to manage anastomotic failure with laparoscopy, thus avoiding laparotomy.

OBJECTIVE:

The purpose of this study was to determine the feasibility of the laparoscopic management of failed low colorectal anastomoses.

SETTING:

This was a single-institute case series.

PATIENTS:

A total of 555 laparoscopic patients undergoing anterior resection with primary anastomosis within 10 cm of the anus in the period 2000–2012 were included.

MAIN OUTCOME MEASURES:

Anastomotic failure, defined as any clinical or radiological demonstrable defect in the anastomosis; complications using the Clavien–Dindo system; mortality within 30 days; and patient demographics and risk factors, as defined by the Charlson index, were measured.

RESULTS:

Leakage occurred in 44 (7.9%) of 555 patients, 16 patients with a diverting ileostomy and 28 with no diverting ileostomy. Leakage was more common in those with anastomoses <5 cm form the anus, male patients, and those with a colonic J-pouch and rectal cancer. Diverting ileostomy was not protective of anastomotic leakage. In those patients with anastomotic leakage and a primary diverting ileostomy, recourse to the peritoneal cavity was required in 4 of 16 patients versus 24 of 28 without a diverting ileostomy (p = 0.0002). In 74% of those cases, access to the peritoneal cavity was achieved through laparoscopy. Permanent stoma rates were very low, including 14 (2.5%) of 555 total patients or 8 (18.0%) of 44 patients with anastomotic leakage. Thirty-day mortality was rare (0.6%).

LIMITATIONS:

This study was limited by the lack of a cohort of open cases for comparison.

CONCLUSIONS:

Laparoscopic anterior resection is associated with low levels of complications, including anastomotic leak, postoperative mortality, and permanent stoma formation. Anastomotic leakage can be managed with laparoscopy in the majority of cases. See Video Abstract at http://links.lww.com/DCR/A353.
Multimodal Therapy of Squamous Cell Carcinoma of the Anus With Distant Metastasis: A Single-Institution Experience
Authors: Evesque Ludovic , Benezery Karen , Follana Philippe , Tuan Falk Alexander , Doyen Jerome , Reure Juliette , Cavaglione Gerard , François Eric
Published: July 2017

BACKGROUND:

Because of the rarity of the condition, studies concerning the management of patients with squamous cell carcinoma of the anus with distant metastasis are scarce. The available studies indicate poor outcomes with exclusive chemotherapy.

OBJECTIVE:

Our aim was to evaluate the impact of multidisciplinary treatment on overall survival among patients presenting with metastatic squamous cell carcinoma of the anus.

DESIGN:

This was a retrospective study.

SETTINGS:

The study was conducted at a single French institution between 2000 and 2014.

PATIENTS:

Consecutive patients with histologically proven, newly diagnosed, or recurrent metastatic squamous cell carcinoma of the anus were included.

INTERVENTIONS:

Study interventions included multimodal therapy combining systemic chemotherapy and local ablative treatment to remove all metastases through surgery, radiofrequency ablation, or radiotherapy.

MAIN OUTCOME MEASURES:

The primary outcome measure was overall survival.

RESULTS:

Fifty patients (median age, 62 years; men/women: 8/42) fulfilled the inclusion criteria, and 39 were available for Response Evaluation Criteria in Solid Tumors. Forty had metastatic relapse after previous treatment of localized disease, and 10 presented with synchronous metastasis. P16 status was not available. Patients received at least 1 chemotherapy regimen, including 5-fluorouracil–mitomycin C (n = 22), cisplatin–5-fluorouracil (n = 20), or 5-fluorouracil alone (n = 3). Thirteen also had surgical metastasectomy, 11 had radiotherapy, and 6 had radiofrequency ablation. Median overall survival was 20.0 months (95% CI, 18.2–21.8 mo), and median time to failure of strategy was 6.0 months (95% CI, 2.9–9.1 mo). Overall response rate was 56% (95% CI, 40%–73%). Outcomes from the 5-fluorouracil–mitomycin C and cisplatin regimens did not statistically differ. Patients treated with multimodal therapy had a median overall survival of 22.0 months (95% CI, 15.3–28.6 mo) versus 13.0 months (95% CI, 9.5–16.5 mo; p = 0.002). Median time to failure of strategy was 10.0 months (95% CI, 4.2–15.7 mo) versus 5.0 months (95% CI, 2.8–7.2; p = 0.007). After 2 years, 40% of patients with multimodal treatment and 20% of those without ablative treatment were alive.

LIMITATIONS:

This study is limited by its retrospective design and modest sample size.

CONCLUSIONS:

Stage IV squamous cell carcinoma of the anus outcomes are poor, but first-line chemotherapy can enable good response rates. Other treatment modalities, including surgery, radiotherapy, and thermoablation, should be considered, because they may provide a survival advantage. See Video Abstract at http://links.lww.com/DCR/A336.
Early Colonoscopy Improves the Outcome of Patients With Symptomatic Colorectal Cancer
Authors: Alonso-Abreu Inmaculada , Alarcón-Fernández Onofre , Gimeno-García Antonio Z. , Romero-García Rafael , Carrillo-Palau Marta , Nicolás-Pérez David , Jiménez Alejandro , Quintero Enrique
Published: July 2017

BACKGROUND:

Long waiting times from early symptoms to diagnosis and treatment may influence the staging and prognosis of patients with colorectal cancer. We analyzed the effect of colonoscopy timing on the outcome of these patients.

OBJECTIVE:

This study aimed to compare the outcome (tumoral staging and long-term survival) of patients with suspected colorectal cancer according to diagnostic colonoscopy timing.

DESIGN:

This study is an analysis of a prospectively maintained database.

SETTINGS:

The study was conducted at the Open Access Endoscopy Service of the tertiary public healthcare center Hospital Universitario de Canarias, in the Spanish island of Tenerife.

PATIENTS:

Consecutive patients diagnosed of colorectal cancer between February 2008 and October 2010, fulfilling 1 or more National Institute for Health and Clinical Excellence criteria, were assigned to early colonoscopy (<30 days from referral) or to standard-schedule colonoscopy at the discretion of the referring physician. Tumor staging (TNM classification) at diagnosis and long-term survival after treatment were compared in both strategies.

MAIN OUTCOME MEASURES:

The primary outcomes measured were the stage at presentation and overall survival, as determined by prompt or standard referral.

RESULTS:

Overall, 257 patients with colorectal cancer were diagnosed (101 at early colonoscopy and 156 at standard-schedule colonoscopy). TNM stages I and II were found in 52 (54.2%) and 60 (41.7%) patients in the early colonoscopy group and standard-schedule colonoscopy group. Stage IV was confirmed in 13 patients (13.5%) diagnosed in the early colonoscopy group and in 40 (28%) detected in the standard-schedule colonoscopy group. Survival rates at 12 and 60 months after treatment were significantly higher in the early colonoscopy group compared with the standard-schedule colonoscopy group (p< 0.001).

LIMITATIONS:

Controlled randomization of early versus standard-referral colonoscopy, size and scope of analysis, the time interval from symptom onset to first physician assessment, and the different locations of colorectal cancer between groups were limitations of the study.

CONCLUSIONS:

Colonoscopy within 30 days from referral improves outcome in patients with symptomatic colorectal cancer. SeeVideo Abstractat http://journals.lww.com/dcrjournal/Pages/videogallery.aspx.
Critical Evaluation of Risk Factors of Infection Following 2-Stage Implant-Based Breast Reconstruction
Authors: Long Chao , Sue Gloria R. , Chattopadhyay Arhana , Huis In’t Veld Eva , Lee Gordon K.
Published: July 2017

Background:

Infection is a dreaded complication following 2-stage implant-based breast reconstruction that can prolong the reconstructive process and lead to loss of implant. This study aimed to characterize outcomes of reconstructions complicated by infection, identify patient and surgical factors associated with infection, and use these to develop an infection management algorithm.

Methods:

We performed a retrospective review of all consecutive implant-based breast reconstructions performed by the senior author (2006–2015) and collected data regarding patient demographics, medical history, operative variables, presence of other complications (necrosis, seroma, hematoma), and infection characteristics. Univariate and multivariate binomial logistic regression analyses were performed to identify independent predictors of infection.

Results:

We captured 292 patients who underwent 469 breast reconstructions. In total, 14.1% (n = 66) of breasts were complicated by infection, 87.9% (n = 58) of those were admitted and given intravenous antibiotics, 80.3% (n = 53) of all infections were cleared after the first attempt, whereas the remaining recurred at least once. The most common outcome was explantation (40.9%; n = 27), followed by secondary implant insertion (21.2%; n = 14) and operative salvage (18.2%; n = 12). Logistic regression analysis demonstrated that body mass index (P = 0.01), preoperative radiation (P = 0.02), necrosis (P < 0.001), seroma (P < 0.001), and hematoma (P = 0.03) were independent predictors of infection.

Conclusions:

We observed an overall infectious complication rate of 14.1%. Heavier patients and patients who received preoperative radiation were more likely to develop infectious complications, suggesting that closer monitoring of high risk patients can potentially minimize infectious complications. Further, more aggressive management may be warranted for patients whose operations are complicated by necrosis, seroma, or hematoma.
A Limited Submuscular Direct-to-Implant Technique Utilizing AlloMax
Authors: Brichacek Michal , Dalke Kimberly , Buchel Edward , Hayakawa Thomas E.J.
Published: July 2017

Background:

This study evaluates a novel limited submuscular direct-to-implant technique utilizing AlloMax where only the upper few centimeters of the implant is covered by the pectoralis, whereas the majority of the implant including the middle and lower poles are covered by acellular dermal matrix.

Methods:

The pectoralis muscle is released off its inferior and inferior-medial origins and allowed to retract superiorly. Two sheets of AlloMax (6 × 16 cm) are sutured together and secured to the inframammary fold, serratus fascia, and the superiorly retracted pectoralis. Thirty-seven breasts in 19 consecutive patients with follow-up at 6 months were reviewed.

Results:

Nineteen consecutive patients with 37 reconstructed breasts were studied. Average age was 50 years, average BMI was 24.3. Ptosis ranged from grade 0–III, and average cup size was B (range, A–DDD). Early minor complications included 1 seroma, 3 minor postoperative hematomas managed conservatively, and 3 minor wound healing problems. Three breasts experienced mastectomy skin flap necrosis and were managed with local excision. There were no cases of postoperative infection, red breast, grade III/IV capsular contractures, or implant loss. A single patient complained of animation postoperatively. One patient desired fat grafting for rippling.

Conclusions:

The limited submuscular direct-to-implant technique utilizing AlloMax appears to be safe with a low complication rate at 6 months. This technique minimizes the action of the pectoralis on the implant, reducing animation deformities but still providing muscle coverage of the upper limit of the implant. Visible rippling is reduced, and a vascularized bed remains for fat grafting of the upper pole if required.
The Supra-Inframammary Fold Approach to Breast Augmentation: Avoiding a Double Bubble
Authors: Swanson Eric
Published: July 2017

Background:

The inframammary incision for breast augmentation is commonly made at or below the existing inframammary fold (IMF) in an effort to keep the scar in the crease. In recent studies, surgeons inferiorly relocate the IMF, center the implant at nipple level, and attempt to secure the new IMF with sutures. The fascial attachments (also called ligaments) holding the IMF are released, risking a bottoming-out deformity or a double bubble.

Methods:

This retrospective study evaluated 160 consecutive women undergoing primary subpectoral breast augmentation. An incision was made 0.5–1.0 cm above the IMF. Dissection proceeded directly to the pectoralis margin, preserving IMF fascial attachments. The pectoralis origin was released from the lower sternum. Surveys were administered to obtain patient-reported outcome data. Ninety-eight patients (61%) participated.

Results:

Implants often appear high on the chest at early follow-up appointments but gradually settle. One patient (0.6%) developed a double bubble. No reoperations were needed for implant malposition. One patient had a mild animation deformity. There were no cases of symmastia. The mean result rating was 9.1/10. Four percent of surveyed patients found their implants too high; 8% found them too low. Ninety-two patients (94%) reported that their scars were well-hidden. Ninety-six women (98%) said that they would redo the surgery.

Conclusions:

A supra-IMF approach anticipates the normal descent of implants after augmentation. Scars remain hidden both in standing and supine positions. This method reduces the short-term risk of reoperation for implant malposition or a double bubble.
INTEROCULAR ASYMMETRY IN CHOROIDAL THICKNESS AND RETINAL SENSITIVITY IN HIGH MYOPIA
Authors: Alzaben Zeyad , Cardona Genís , Zapata Miguel A. , Zaben Ahmad
Published: July 2017

Purpose:

To investigate the normal range of interocular asymmetry in choroidal thickness and retinal sensitivity in high myopia without ocular fundus manifestations and to determine the relationship between interocular asymmetry and refractive error.

Methods:

Forty-three patients (35.07 ± 13.31 years) with high myopia and 45 healthy participants (39.9 ± 14.1 years) were administered an ocular coherence tomography and a microperimetry examination to determine choroidal thickness and retinal sensitivity at the foveal region and at 1, 2, and 3 mm, nasally, temporally, superiorly, and inferiorly. Absolute interocular differences were calculated to determine the normal range of asymmetry, in 95% confidence intervals.

Results:

The choroid was thinner in the myopic group at all explored locations (all P < 0.05), with larger absolute interocular differences in most of the choroidal locations under evaluation (all P < 0.05). Similarly, retinal sensitivity was reduced in the myopic group, although statistically significant differences were only encountered at the subfoveal location (P = 0.001). Retinal sensitivity asymmetry was found to increase with refractive error.

Conclusion:

The expanded range of choroidal thickness and retinal sensitivity asymmetry found in high myopia in the absence of disease is of relevance when exploring these patients for early signs of ocular pathology.
Nicotinic modulation of descending pain control circuitry
Authors: Umana Iboro C. , Daniele Claire A. , Miller Brooke A. , Abburi Chandrika , Gallagher Keith , Brown Meghan A. , Mason Peggy , McGehee Daniel S.
Published: July 2017

Along with the well-known rewarding effects, activation of nicotinic acetylcholine receptors (nAChRs) can also relieve pain, and some nicotinic agonists have analgesic efficacy similar to opioids. A major target of analgesic drugs is the descending pain modulatory pathway, including the ventrolateral periaqueductal gray (vlPAG) and the rostral ventromedial medulla (RVM). Although activating nAChRs within this circuitry can be analgesic, little is known about the subunit composition and cellular effects of these receptors, particularly within the vlPAG. Using electrophysiology in brain slices from adult male rats, we examined nAChR effects on vlPAG neurons that project to the RVM. We found that 63% of PAG-RVM projection neurons expressed functional nAChRs, which were exclusively of the α7-subtype. Interestingly, the neurons that express α7 nAChRs were largely nonoverlapping with those expressing μ-opioid receptors (MOR). As nAChRs are excitatory and MORs are inhibitory, these data suggest distinct roles for these neuronal classes in pain modulation. Along with direct excitation, we also found that presynaptic nAChRs enhanced GABAergic release preferentially onto neurons that lacked α7 nAChRs. In addition, presynaptic nAChRs enhanced glutamatergic inputs onto all PAG-RVM projection neuron classes to a similar extent. In behavioral testing, both systemic and intra-vlPAG administration of the α7 nAChR-selective agonist, PHA-543,613, was antinociceptive in the formalin assay. Furthermore, intra-vlPAG α7 antagonist pretreatment blocked PHA-543,613-induced antinociception via either administration method. Systemic administration of submaximal doses of the α7 agonist and morphine produced additive antinociceptive effects. Together, our findings indicate that the vlPAG is a key site of action for α7 nAChR-mediated antinociception.
Genetics of pancreatic cyst-cancer progression: standing on the shoulders of giants
Authors: Giri Bhuwan , Sethi Vrishketan , Dudeja Vikas , Banerjee Sulagna , Livingstone Alan , Saluja Ashok
Published: July 2017

Purpose of review

Pancreatic cancer, despite years of study and some progress, presents with a grim prognosis in almost all cases. In the current review, we have discussed recent studies that have attempted to decipher the genetic makeup of pancreatic ductal adenocarcinoma and preneoplastic pancreatic cystic neoplasms.

Recent findings

With the advent of high throughput sequencing, the genetic code of pancreatic cancer is beginning to unravel and this new-found information heralds an era of precision cancer care where treatment will be guided by the genetic code of the neoplasm. Results from these studies have pointed towards the complexity and heterogeneity of the pancreatic cancer genome, provided avenues to “tailor therapy” based as well as shed light on progression of preneoplastic pancreatic neoplasms into full blown invasive pancreatic ductal adenocarcinoma.

While this progress has made us closer to the model of precision medicine, significant obstacles need to be overcome to use this new-found information to change the way we manage patients with pancreatic cancer.
Mechanisms of erosion of atherosclerotic plaques
Authors: Quillard Thibaut , Franck Grégory , Mawson Thomas , Folco Eduardo , Libby Peter
Published: July 2017

Purpose of review

The present review explores the mechanisms of superficial intimal erosion, a common cause of thrombotic complications of atherosclerosis.

Recent findings

Human coronary artery atheroma that give rise to thrombosis because of erosion differ diametrically from those associated with fibrous cap rupture. Eroded lesions characteristically contain few inflammatory cells, abundant extracellular matrix, and neutrophil extracellular traps (NETs). Innate immune mechanisms such as engagement of Toll-like receptor 2 (TLR2) on cultured endothelial cells can impair their viability, attachment, and ability to recover a wound. Hyaluronan fragments may serve as endogenous TLR2 ligands. Mouse experiments demonstrate that flow disturbance in arteries with neointimas tailored to resemble features of human eroded plaques disturbs endothelial cell barrier function, impairs endothelial cell viability, recruits neutrophils, and provokes endothelial cells desquamation, NET formation, and thrombosis in a TLR2-dependent manner.

Mechanisms of erosion have received much less attention than those that provoke plaque rupture. Intensive statin treatment changes the characteristic of plaques that render them less susceptible to rupture. Thus, erosion may contribute importantly to the current residual burden of risk. Understanding the mechanisms of erosion may inform the development and deployment of novel therapies to combat the remaining atherothrombotic risk in the statin era.
Removal of Peripheral Intravenous Catheters Due to Catheter Failures Among Adult Patients
Authors: Murayama Ryoko , Uchida Miho , Oe Makoto , Takahashi Toshiaki , Oya Maiko , Komiyama Chieko , Sanada Hiromi
Published: July 2017

This prospective observational study was designed to clarify the rate of peripheral intravenous catheter, especially short peripheral catheter, failures among adult patients in medical and surgical wards. The study was conducted during a 2-month period at a university hospital in Tokyo, Japan. A total of 5316 catheters from 2442 patients were studied. The rate of catheter removal as a result of catheter failure was 18.8%. The reasons for removal in catheter failures were infiltration (41.3%) and pain (19.3%). Pain was a major reason for catheter failure and removal. For this reason, observing changes under the skin before signs and symptoms appear might help prevent catheter failures.
Age Differences and the Acceptance of Infusion Pump Technology
Authors: Perrigino Matthew B. , Dunford Benjamin B. , Vermace Beverly J. , Tucker Sharon J. , Rempher Kenneth J.
Published: July 2017

Previous studies demonstrate that age and receptiveness to new technologies tend to be negatively correlated. Using data from a sample of 311 nurses in a large teaching hospital in the midwestern United States, this study sought to determine whether age predicted satisfaction perceptions of infusion pump technology. Hierarchical regression indicated that the relationship between age and infusion pump satisfaction was not statistically significant, but it also revealed interesting moderation effects. When perceived support for infusion pump use was low, age was negatively related to infusion pump satisfaction. However, when perceived support was high, age was positively related to infusion pump satisfaction.
Report of Modification for Peripherally Inserted Central Catheter Placement
Authors: Ostroff Matthew D. , Moureau Nancy L.
Published: July 2017

The majority of peripherally inserted central catheters (PICCs) are currently inserted with the aid of ultrasound guidance in the middle third of the upper arm. A growing patient population is presenting with challenging vessel access requiring placement of the PICC in the high upper third of the arm. To avoid this suboptimal exit site, a subcutaneous tunneling of the PICC is established away from the axilla to a more appropriate skin exit site. A prospective evaluation was performed in a single facility for all PICC placements from September 2014 to June 2015. Of the results of 685 PICC requests received during the study, 50 (7.2%) were placed with the modified Seldinger tunneling technique with 96% success. There were no reports of increased pain, insertion complications, or therapy failures. Subcutaneous tunneling, when applied to bedside PICC insertions, provides a safe, effective, and cost-efficient option for a select, more challenging patient population.
Posttransplant Outcomes of Kidneys Donated After Brain Death Followed by Circulatory Death: A Cohort Study of 128 Chinese Patients
Authors: Na Ning , Li Ke , Huang Zhengyu , Miao Bin , Hu Cheng , Li Heng , Wang Dejuan , Qiu Jianguang
Published: July 2017

Background

Donation after brain death followed by circulatory death (DBCD) is a new class in the unique Chinese donor classification system. Currently, in China, the organ transplantation of DBCD is rising. However, there is a dearth of research on the characteristics and outcomes of DBCD kidney transplantation.

Method

We collected 128 DBCD renal transplant patients who underwent surgery between June 2013 and May 2016 at our center to analyze clinical outcomes and to share our experience to enhance perioperative management in DBCD kidney transplantation.

Results

At the end of follow-up, no patients experienced primary nonfunction, but delayed graft function occurred in 25.8%. One- and 3-year graft survivals were 97.7% and 94.5%, respectively. The average length of stay was 20.88 ± 14.6 days, the incidence of posttransplant complications was 46.1% (59 patients), and 31 patients suffered more than 1 complication. In addition, the average length of stay of patients without complications and with at least 1 complication was 13.07 ± 2.01 days and 30.02 ± 17.4 days, respectively. There was a significantly higher incidence of complications associated with the postoperative hospital stay in DBCD patients.

Conclusions

Patients who received a DBCD kidney demonstrated a good outcome in terms of both graft survival and graft function. Hence, DBCD is suitable for national reality and conditions and offers a feasible option for deceased-donor kidney transplantation in China. To prevent complications and reduce the duration of hospital stay, we should strengthen preoperative and postoperative management.
Hearing Safety From Single- and Double-Pulse Transcranial Magnetic Stimulation in Children and Young Adults
Authors: Kukke Sahana N. , Brewer Carmen C. , Zalewski Christopher , King Kelly A. , Damiano Diane , Alter Katharine E. , Hallett Mark
Published: July 2017

Purpose:

Concerns regarding hearing safety have limited the number of studies using transcranial magnetic stimulation (TMS) in children and young adults. The objective of this study was to examine the safety of TMS with regards to hearing in a group of 16 children and young adults (17.3 ± 4.9 years) with and without brain injury.

Methods:

Pure-tone hearing thresholds and distortion-product otoacoustic emissions were measured before and after exposure to single- and paired-pulse TMS (1–2 sessions of 149–446 TMS pulses at a median of 49%–100% maximum stimulator output over a 2.2 hours period).

Results:

No mean change in hearing outcomes was noted. In addition, no clinically significant change in hearing threshold was observed in any participant, and participants did not experience a subjective change in hearing after TMS exposure.

Conclusions:

Single- and double-pulse TMS administered within the parameters used in this study, which included hearing protection, can be used in children and young adults without impacting hearing. This study provides further evidence for hearing safety after TMS exposure in children and young adults.
Invasive Investigation of Insular Cortex Epilepsy
Authors: Ryvlin Philippe , Picard Fabienne
Published: July 2017

Invasive long-term EEG investigations of the insula have been performed since the mid-nineties in an expanding range of focal epilepsies suspected to involve the insular cortex. The various clinical forms of insular epilepsies were delineated during the last 2 decades, and include the following presentations: perisylvian epilepsy, temporal plus epilepsy, sleep hypermotor epilepsy, MRI-negative frontal and parietal lobe epilepsies, and insular lesions. In fact, a majority of complex stereoelectroencephalography procedures will include at least one electrode targeting the insula. Stereoelectroencephalography is currently the preferred method to investigate the insula, using orthogonal, oblique, or a combination of both trajectories, with no evidence of higher risk of intracranial bleeding than in other brain regions. Orthogonal trajectories allow to sample the overlaying opercula, while oblique trajectories offer a better sampling of the insular cortex. Intrainsular ictal EEG pattern are often characterized by a prolonged focal discharge restricted to one of the five insular gyri, militating for a dense enough sampling of the insular cortex in suspected insular epilepsies. Stereoelectroencephalography offers the potential to perform thermolesion of insular epileptogenic zones which, together with MRI-guided laser ablation, represent a possibly safer alternative treatment to open-skull surgical resection of the insula.
Striatal cholinergic receptor activation causes a rapid, selective, & state-dependent rise in corticostriatalβactivity
Authors: Pittman-Polletta Benjamin R. , Quach Allison , Mohammed Ali I. , Romano Michael , Kondabolou Krishnakanth , Kopell Nancy J. , Han Xue , McCarthy Michelle M.
Published: July 2017

Cortico-basal ganglia-thalamic (CBT)βoscillations (15–30 Hz) are elevated in Parkinson’s disease and correlated with movement disability. To date, no experimental paradigm outside of loss of dopamine has been able to specifically elevateβoscillations in the CBT loop. Here, we show that activation of striatal cholinergic receptors selectively increasedβoscillations in mouse striatum and motor cortex. In individuals showing simultaneousβincreases in both striatum and M1,βpartial directed coherence (PDC) increased from striatum to M1 (but not in the reverse direction). In individuals that did not show simultaneousβincreases,βPDC increased from M1 to striatum (but not in the reverse direction), and M1 was characterized by persistentβ-HFO phase-amplitude coupling. Finally, the direction ofβPDC distinguished betweenβsubbands. This suggests: (1) striatal cholinergic tone exerts state-dependent and frequency-selective control over CBTβpower and coordination; (2) ongoing rhythmic dynamics can determine whether elevatedβoscillations are expressed in striatum and M1; (3) altered striatal cholinergic tone differentially modulates distinctβsubbands.
Improved accuracy of lesion to symptom mapping with multivariate sparse canonical correlations
Authors: Pustina Dorian , Avants Brian , Faseyitan Olufunsho , Medaglia John , Coslett H. Branch
Published: July 2017

Lesion to symptom mapping (LSM) is a crucial tool for understanding the causality of brain-behavior relationships. The analyses are typically performed by applying statistical methods on individual brain voxels (VLSM), a method called the mass-univariate approach. Several authors have shown that VLSM suffers from limitations that may decrease the accuracy and reliability of the findings, and have proposed the use of multivariate methods to overcome these limitations. In this study, we propose a multivariate optimization technique known as sparse canonical correlation analysis for neuroimaging (SCCAN) for lesion to symptom mapping. To validate the method and compare it with mass-univariate results, we used data from 131 patients with chronic stroke lesions in the territory of the middle cerebral artery, and created synthetic behavioral scores based on the lesion load of 93 brain regions (putative functional units). LSM analyses were performed with univariate VLSM or SCCAN, and the accuracy of the two methods was compared in terms of both overlap and and displacement from the simulated functional areas. Overall, SCCAN produced more accurate results - higher dice overlap and smaller average displacement - compared to VLSM. This advantage persisted at different sample sizes (N=20-131) and different multiple comparison corrections (false discovery rate, FDR; Bonferroni; permutation-based family wise error rate, FWER). These findings were replicated with a fully automated SCCAN routine that relied on cross-validated predictive accuracy to find the optimal sparseness value. Simulations of one, two, and three brain regions showed a systematic advantage of SCCAN over VLSM; under no circumstance could VLSM exceed the accuracy obtained with SCCAN. When considering functional units composed of multiple brain areas VLSM identified fewer areas than SCCAN. The investigation of real scores of aphasia severity (aphasia quotient and picture naming) showed that SCCAN could accurately identify known language-critical areas, while VLSM either produced diffuse maps (FDR correction) or few scattered voxels (FWER correction). Overall, this study shows that a multivariate method, such as, SCCAN, outperforms VLSM in a number of scenarios, including functional dependency on single or multiple areas, different sample sizes, different multi-area combinations, and different thresholding mechanisms (FWER, Bonferroni, FDR). These results support previous claims that multivariate methods are in general more accurate than mass-univariate approaches, and should be preferred over traditional VLSM approaches. All the methods described in this study are available in the newly developed LESYMAP package for R.