bluuebunny/crossref_metadata_2025 huggingface dataset:
SDSS-IV MaNGA: 3D spin alignment of spiral and S0 galaxies
Authors: Kraljic Katarina , Duckworth Christopher , Tojeiro Rita , Alam Shadab , Bizyaev Dmitry , Weijmans Anne-Marie , Boardman Nicholas Fraser , Lane Richard R
Published: April 2021

We investigate the 3D spin alignment of galaxies with respect to the large-scale filaments using the MaNGA survey. The cosmic web is reconstructed from the Sloan Digital Sky Survey using disperse and the 3D spins of MaNGA galaxies are estimated using the thin disc approximation with integral field spectroscopy kinematics. Late-type spiral galaxies are found to have their spins parallel to the closest filament’s axis. The alignment signal is found to be dominated by low-mass spirals. Spins of S0-type galaxies tend to be oriented preferentially in perpendicular direction with respect to the filament’s axis. This orthogonal orientation is found to be dominated by S0s that show a notable misalignment between their kinematic components of stellar and ionized gas velocity fields and/or by low-mass S0s with lower rotation support compared to their high-mass counterparts. Qualitatively similar results are obtained when splitting galaxies based on the degree of ordered stellar rotation, such that galaxies with high spin magnitude have their spin aligned, and those with low spin magnitude in perpendicular direction to the filaments. In the context of conditional tidal torque theory, these findings suggest that galaxies’ spins retain memory of their larger scale environment. In agreement with measurements from hydrodynamical cosmological simulations, the measured signal at low redshift is weak, yet statistically significant. The dependence of the spin-filament orientation of galaxies on their stellar mass, morphology, and kinematics highlights the importance of sample selection to detect the signal.
Ultra-compact dwarfs beyond the centre of the Fornax galaxy cluster: hints of UCD formation in low-density environments
Authors: Saifollahi Teymoor , Janz Joachim , Peletier Reynier F , Cantiello Michele , Hilker Michael , Mieske Steffen , Valentijn Edwin A , Venhola Aku , Kleijn Gijs Verdoes
Published: April 2021

Ultra-compact dwarf galaxies (UCDs) were serendipitously discovered by spectroscopic surveys in the Fornax cluster 20 yr ago. Nowadays, it is commonly accepted that many bright UCDs are the nuclei of galaxies that have been stripped. However, this conclusion might be driven by biased samples of UCDs in high-density environments, on which most searches are based. With the deep optical images of the Fornax Deep Survey, combined with public near-infrared data, we revisit the UCD population of the Fornax cluster and search for UCD candidates, for the first time, systematically out to the virial radius of the galaxy cluster. Our search is complete down to magnitude mg = 21 mag or M$_g\, \sim$ −10.5 mag at the distance of the Fornax cluster. The UCD candidates are identified and separated from foreground stars and background galaxies by their optical and near-infrared colours. This primarily utilizes the u−i/i−Ks diagram and a machine learning technique is employed to incorporate other colour combinations to reduce the number of contaminants. The newly identified candidates (44) in addition to the spectroscopically confirmed UCDs (61), increase the number of known Fornax UCD considerably (105). Almost all of the new UCD candidates are located outside the Fornax cluster core (360 kpc), where all of the known UCDs were found. The distribution of UCDs within the Fornax cluster shows that a population of UCDs may form in low-density environments. This most likely challenges the current models of UCD formation.
Three-body capture, ejection, and the demographics of bound objects in binary systems
Authors: Lehmann Benjamin V , Ross Olivia G , Webber Ava , Profumo Stefano
Published: April 2021

We study the capture of light objects of arbitrary velocity by binary systems. Extending results for the capture of comets in the Solar system, we develop a simple geometric characterization of the capture cross-section, leading directly to the distribution of orbital parameters of captured objects. We use the same framework to study the lifetimes of these bound orbits prior to ejection, and find that a simplified version of the Öpik–Arnold approach readily yields a closed-form estimate for the ejection rate that agrees well with numerical experiments. Without any detailed-balance assumptions, our results make manifest the characteristics of close encounters leading to capture and ejection. As an application of our results, we demonstrate the estimation of the equilibrium population of captured dark matter particles in a binary system.
Neutral–neutral synthesis of organic molecules in cometary comae
Authors: Cordiner M A , Charnley S B
Published: April 2021

Remote and in situ observations of cometary gases have revealed the presence of a wealth of complex organic molecules, including carbon chains, alcohols, imines, and the amino acid glycine. Such chemical complexity in cometary material implies that impacts by comets could have supplied reagents for prebiotic chemistry to young planetary surfaces. However, the assumption that some of the molecules observed in cometary comae at millimetre wavelengths originate from ices stored inside the nucleus has not yet been proven. In fact, the comae of moderately-active comets reach sufficient densities within a few thousand kilometres of the nucleus for an active (solar radiation-driven) photochemistry to ensue. Here, we present results from our latest chemical-hydrodynamic models incorporating an updated reaction network, and show that the commonly-observed HC3N (cyanoacetylene) and NH2CHO (formamide) molecules can be efficiently produced in cometary comae as a result of two-body, neutral–neutral, gas-phase reactions involving well-known coma species. In the presence of a near-nucleus distributed source of CN (similar to that observed by the Rosetta spacecraft at comet 67P), we find that sufficient HC3N and NH2CHO can be synthesized to match the abundances of these molecules observed previously in Oort cloud comets. The precise coma origins of these (and other) complex organic molecules can be verified through radio interferometric mapping observations, for example using the Atacama Large Millimeter/submillimeter Array.
Coendou vestitus(Rodentia: Erethizontidae)
Authors: Torres-Martínez María M , Aya-Cuero Carlos A , Noguera-Urbano Elkin A , Passos Fernando C , Ramírez-Chaves Héctor E
Published: April 2021

Coendou vestitus Thomas, 1899, a rodent commonly known as the brown hairy dwarf porcupine, is one of the smallest Neotropical porcupines; its body is covered by three different types of hair and a short tail. C. vestitus is endemic to the western foothills of the Eastern Cordillera (Cordillera Oriental) of the Andes region of Colombia, where it has been confirmed through museum voucher specimens from only six localities characterized by lower montane moist forest vegetation. Globally, C. vestitus is listed as “Data Deficient” (DD) by the International Union for Conservation of Nature (IUCN); however, in Colombia it is categorized as “Vulnerable” (VU) by the Minister of Environment and Sustainable Development.
SIRIUS project. II. A new tree-direct hybrid code for smoothed particle hydrodynamics/N-body simulations of star clusters
Authors: Fujii Michiko S , Saitoh Takayuki R , Wang Long , Hirai Yutaka
Published: April 2021

Star clusters form via clustering star formation inside molecular clouds. In order to understand the dynamical evolution of star clusters in their early phase, in which they are still embedded in their surrounding gas, we need accurate integration of individual stellar orbits without gravitational softening in the systems including both gas and stars, as well as modeling of individual stars with a realistic mass function. We develop a new tree-direct hybrid smoothed particle hydrodynamics/N-body code, ASURA$+$BRIDGE, in which stars are integrated using a direct N-body scheme or PeTar, a particle–particle particle-tree scheme code, without gravitational softening. In ASURA$+$BRIDGE, stars are assumed to have masses randomly drawn from a given initial mass function. With this code, we perform star cluster formation simulations starting from molecular clouds without gravitational softening. We find that artificial dense cores in star cluster centers due to the softening disappear when we do not use softening. We further demonstrate that star clusters are built up via mergers of smaller clumps. The star clusters formed in our simulations include some dynamically formed binaries with minimum semi-major axes of a few au, and the binary fraction is higher for more massive stars.
Pain Intensity Predicts Pain Catastrophizing During the Postpartum Period: A Longitudinal Random Intercept Cross-Lagged Panel Study
Authors: Román Camila , Cumsille Patricio , Gómez-Pérez Lydia
Published: April 2021

Objective

Pain catastrophizing is an important psychological predictor of pain. Recent evidence suggests the relationship between catastrophizing and pain intensity could be bidirectional, but most studies have been conducted on chronic pain patients and using criticized statistical methods. The present study aimed to examine if the relationship between pain intensity and catastrophizing was bidirectional in the context of childbirth.

Methods

A total of 504 women without chronic pain were recruited on their 32–37 gestational week. They completed measures of catastrophizing and pain intensity on the first encounter and then again at 1, 3, and 6 months postpartum. The temporal relationship between the variables was assessed using a random intercept cross-lagged panel model.

Results

The hypothesis of reciprocal association did not receive support, as pain intensity predicted catastrophizing during the postpartum period, but catastrophizing did not show an effect over pain intensity at any moment.

Conclusions

Pain intensity predicting catastrophizing is consistent with previous literature, while the lack of effect of catastrophizing over pain intensity is an unexpected result, which may suggest that catastrophizing plays a different role in the postpartum period. These results highlight the importance of timely efforts for pain management during the postpartum period and contribute to the theoretical conceptualization of catastrophizing.
DIAGNOSTIC REFERENCE LEVELS OF CARDIAC COMPUTED TOMOGRAPHY ANGIOGRAPHY IN A SINGLE MEDICAL CENTER IN TAIWAN: A 3-Y ANALYSIS
Authors: Chen Li-Guo , Wu Ping-An , Tu Hsing-Yang , Sheu Ming-Huei , Huang Li-Chuan
Published: April 2021

This study aimed to establish the diagnostic reference levels (DRLs) for coronary computed tomography angiography (CCTA) and coronary arterial calcium score (CACS) owing to a large variability in patient radiation dose and the lack of dose recommendations in Taiwan. Volume computed tomography dose index (CTDIvol) and dose-length product (DLP) were obtained using CCTAs and the CACS of 445 patients over a 3-y period in a single medical center in Taiwan. CCTAs were performed using routine protocols and 256-detector CT scanners. Electrocardiogram gating was retrospective. The obtained data were analyzed using Prism 6 to determine the 25th, 50th (median) and 75th DRL percentiles for CTDIvol and DLP. These DRL results were compared with existing DRLs from seven countries. The DRLs for CCTA determined from this survey were similar to the existing data from other countries. Such DRLs could provide a useful tool for the optimization of radiation dose for CCTA in Taiwan.
Implementation of peer recovery coach services for opioid overdose patients in emergency departments in Indiana: findings from an informal learning collaborative of stakeholders
Authors: Staton Monte D , Watson Dennis P , Thorpe Dillon
Published: April 2021

The Recovery Coach and Peer Support Initiative (RCPSI) in Indiana focused on implementing peer recovery coaches (PRCs) to engage opioid overdose patients in emergency department (ED) settings and promote entry into recovery services. State workers and researchers organized an informal learning collaborative primarily through teleconference meetings with representatives of 11 health service vendors to support implementation. This study presents qualitative analysis of the teleconference meeting discussions that guided RCPSI implementation to display how the informal learning collaborative functioned to support implementation. This informal learning collaborative model can be applied in similar situations where there is limited guidance available for a practice being implemented by multidisciplinary teams. Authors conducted a thematic analysis of data from 32 stakeholder teleconference meetings held between February 2018 and April 2020. The analysis explored the function of these collaborative teleconferences for stakeholders. Major themes representing functions of the meetings for stakeholders include: social networking; executing the implementation plan; identifying and addressing barriers and facilitators; educating on peer recovery services and target population; and working through data collection. During the last 2 months of meetings, stakeholders discussed how the COVID-19 pandemic created multiple barriers but increased use of telehealth for recovery services. Teleconference meetings served as the main component of an informal learning collaborative for the RCPSI through which the vendor representatives could speak with each other and with organizers as they implemented the use of PRCs in EDs.
From One Pain to Many
Authors: Logan Deirdre E. , Donado Carolina , Kaczynski Karen , Lebel Alyssa , Schechter Neil
Published: April 2021

Objectives:

The objective of this study was to compare children and adolescents with overlapping chronic pains (OCP) to those with single chronic pains (SCP) among youth presenting in specialized clinical settings, in an effort to identify potential risk factors for developing overlapping pains.

Methods:

A total of 1235 youth ages 8 to 18 seen in a tertiary care multidisciplinary pain clinic or a multidisciplinary headache clinic completed self-report measures of pain, disability, psychological functioning and clinical history and characteristics at the time of initial clinic visit. Information was captured in a chronic pain data repository and accessed for the current study.

Results:

Subsequent pain symptoms developed on average 11.9 months (SD=24.5 mo) after onset of the first pain symptom. Compared with patients with SCP, patients with OCP report more medical comorbidity, more developmental issues, and poorer current sleep and school functioning. They also scored significantly higher than patients with SCP on self-reported functional disability, pain catastrophizing, fear of pain, depression, anxiety, and psychological stress and lower quality of life (all Ps<0.001). In multivariate analysis, variables most strongly associated with presenting with OCP were age (odds ratio [OR]: 1.1, P<0.001), having a clinically significant high functional disability (OR: 1.4, P=0.3), and low quality of life (OR: 2.5, P<0.001).

Discussion:

Given their tendency toward more psychological and medical comorbidities, patients with OCP may require more intense and diverse treatment approaches. Some early life experiences may be a risk factor for development of OCP. Longitudinal studies are needed to fully evaluate the heightened risk for OCP associated with some of these factors.
Diagnostic Performance of Hemophagocytic Lymphohistiocytosis Criteria and HScore in Critically Ill Patients With Severe Hemophagocytic Syndrome
Authors: Valade Sandrine , Monseau Grégoire , Mariotte Eric , Darmon Michael
Published: April 2021

OBJECTIVES:

To assess whether critically ill hematologic patients without diagnosis of hemophagocytic lymphohistiocytosis may have features mimicking hemophagocytic lymphohistiocytosis according to both diagnostic scores.

DESIGN:

A retrospective case-control study.

SETTING:

Hemophagocytic syndrome diagnosis was standardized and based on a consensual diagnosis by at least two experts of a university hospital which is a reference center for hemophagocytic syndrome.

PATIENTS:

Cases (hemophagocytic syndrome+) consisted in a group of consecutive patients (n = 150) admitted in our ICU between 2007 and 2018. Control group (hemophagocytic syndrome–) consisted in patients included in a prospective multicenter cohort of hematologic patients in whom three independent experts ruled out the diagnosis of hemophagocytic syndrome (n = 1011).

MEASUREMENTS AND MAIN RESULTS:

Overall, 1,161 patients were included. Hospital mortality was 45.8% in hemophagocytic syndrome– patients (n = 66) and 38.8% in control patients (n = 392; p = 0.126). Median HScore was 235 (205–262) in hemophagocytic syndrome+ and 42 (18–62) in hemophagocytic syndrome– patients (p < 0.001); number of hemophagocytic lymphohistiocytosis criteria was 4 (4–5) vs 1 (0–1), respectively (p < 0.001). Diagnostic performances of both scores were excellent with area under receiver operating characteristic curve of 0.99 (95% CI, 0.99–0.99) and 0.99 (95% CI, 0.99–0.99) for hemophagocytic lymphohistiocytosis and HScore, respectively. After propensity score matching (n = 144 × 2), the median HScore was 234 (205–262) in hemophagocytic syndrome+ patients versus 49 (18–71) in hemophagocytic syndrome– patients (p < 0.001). Median number of hemophagocytic lymphohistiocytosis criteria was 4 (4–5) in hemophagocytic syndrome+ and 1 (0–1) in hemophagocytic syndrome– patients (p < 0.001). Area under receiver operating characteristic curve was then of 0.98 (95% CI, 0.96–0.99) for hemophagocytic lymphohistiocytosis criteria and 0.99 (95% CI, 0.99–1) for HScore.

CONCLUSIONS:

In ICU patients, several conditions share some similarities with hemophagocytic syndrome, explaining the poor predictive value of isolated biological markers such as ferritin level. Despite these potential confounding factors, our study suggests HScore and hemophagocytic lymphohistiocytosis criteria to be highly discriminant identifying hemophagocytic syndrome in critically ill patients.
Analysis of Genetic Alterations in Cutaneous Malignant Melanomas Unveils Unique Loco-Regional Variations and Novel Predictors of Metastatic Potential
Authors: Krishnamurthy Kritika , Urioste Sophia N. , Cusnir Mike , Schwartz Michael , Alghamdi Sarah , Sriganeshan Vathany , Poppiti Robert
Published: April 2021

Cutaneous malignant melanoma is an aggressive cancer that contributes significantly to cancer-related mortality. Over the years, a deeper scrutiny of melanoma biology has led to identification of diverse evolutionary patterns involving various genetic pathways. This study attempts to further understand the genetic landscape of cutaneous malignant melanoma in terms of loco-regional variations and malignant potential. Thirty-five cases of cutaneous malignant melanoma were retrieved from the archives and were classified based on location of the primary tumor and presence or absence of metastatic disease. Next-generation sequencing data consisting of base substitutions, copy number variations, indels, and rearrangements in a total of 324 genes were analyzed for recurrent genetic alterations. Statistical analysis was performed using IBM SPSS26 software. Mutations in KDM gene family were found in 62.5% of the melanomas in the head and neck as compared with 10% in melanomas of the extremity and trunk (P = 0.03). Mutations in the RAS gene family were found in 70% of melanomas in the extremities as compared to 12.5% in melanomas of the head and neck (P = 0.003). BTK gene mutations were found exclusively in melanomas of the head and neck (P = 0.032). CREBBP mutations were seen in 50% of the nonmetastatic melanomas as compared with 3.57% of metastatic melanomas (P = 0.005). This study highlights the loco-regional variations in cutaneous malignant melanoma for genetic alterations involving the KDM, RAS, and BTK gene family. In addition, the CREBBP mutational status is identified as a potential prognostic marker for predicting metastatic potential in cutaneous malignant melanomas.
Effect of lumbar epidural blockade and propofol on mean arterial pressure, cardiac output and bispectral index
Authors: Sitsen Elske , Olofsen Erik , Dahan Albert , Vuyk Jaap
Published: April 2021

BACKGROUND

It is generally accepted that a neuraxial blockade strengthens the sedative effects of propofol. Deafferentation caused by neuraxial blockade is thought to play a key role.

OBJECTIVES

The objective is to determine whether epidural blockade affects the bispectral index (BIS) of propofol and two other pharmacodynamic endpoints, mean arterial pressure (MAP) and cardiac output (CO).

DESIGN

Randomised, placebo-controlled study.

SETTING

University hospital.

PATIENTS

Patients scheduled for surgery needing epidural analgesia.

INTERVENTION

28 ASA one or two patients received 0, 50, 100 or 150 mg of epidural ropivacaine. After stabilisation of the epidural blockade, propofol was given by target-controlled infusion. The propofol plasma target concentrations were increased at 6-min intervals from 0 to 1, 2.5, 4 and 6 μg ml−1. The study was performed before surgery.

MAIN OUTCOME MEASURES

Three endpoints, BIS, mean arterial blood pressure and CO were measured from baseline (prior to the administration of epidural ropivacaine) until 2 h after the start of propofol infusion. The propofol concentration–effect data were analysed to determine the interaction between epidural blockade and propofol sedation.

RESULTS

In the absence of propofol, the increase in number of epidural blocked segments from 0 to 15.5 (range 6 to 21) reduced the MAP by 30%, without affecting BIS or CO. In the absence of epidural blockade, the increase in propofol concentration to 6 μg ml−1 reduced BIS, MAP and CO. When combined, epidural anaesthesia and intravenous propofol exhibited no pharmacodynamic interaction on any of the three endpoints. In addition, epidural blockade did not affect the propofol effect-site equilibration half-life for its haemodynamic effects (11.5 ± 0.5 min) or for its effects on the BIS (4.6 ± 0.4 min).

CONCLUSION

Epidural blockade reduces the propofol requirements for sedative end points. This is not the result of a pharmacodynamic interaction.

TRIAL REGISTRATION

Dutch trial register CCMO, Central Committee on Research Involving Human Subjects, trial number NL 32295.058.10.
Keystone Flap Reconstruction after Resection of a Large Paraspinal Venous Malformation in an Infant
Authors: Parus Anamaria , Waler Alexandria , Westmoreland Tamarah , Johnson Craig , Kellogg Brian
Published: April 2021

The keystone flap is well known to plastic surgeons and is frequently utilized for its ease of implementation, limited donor site morbidity, and favorable aesthetic outcomes. Although keystone flaps have been described in reconstruction of myelomeningocele defects, there have been no reports of their application to infants with large vascular malformations. This case illustrates the utilization of a keystone flap in reconstruction of a large posterior trunk defect that resulted from excision of a massive venous malformation in an 8-week-old infant with blue rubber bleb nevus syndrome. The patient’s consumptive coagulopathy resolved in the early postoperative period, and long-term follow-up demonstrated a favorable aesthetic outcome. This case reiterates the power and versatility of the keystone flap technique through its novel application to an infant with a life-threatening venous malformation on the posterior trunk.
Untethered and HIPAA-compliant Interactive Livestreaming of Surgery to Residents and Medical Students
Authors: Yuen James C. , Gonzalez Santiago R. , Osborn Tamara , Abu-Rmaileh Muhammad
Published: April 2021

Traditional livestreaming of surgery to an audience requires stationary video broadcasting infrastructure, with viewers congregating in front of a screen, while audiovisual technicians provide support in the background. In recent years, livestreaming technologies from cameras to teleconference platforms have advanced dramatically, even to allow for compliance with the Health Insurance Portability and Accountability Act of 1996 with web-based encryption. The objective of this article is to show that livestreaming surgery in medical education is possible using portable devices, with the resident and medical students as audience at home interacting on their computer or smart devices. The surgeon utilizes a head-mounted camera transmitting video feed using a wireless transmitter broadcasting to a laptop computer, which is hosting a Health Insurance Portability and Accountability Act–compliant version of Zoom. The entire setup is portable, and the surgeon is tethered neither to a cord nor to the institution’s audiovisual enterprise. This prototype setup allows the surgeon to broadcast live surgery interactively at any time and from any operating room with remote medical students and surgical residents. We posit that our medical education industry would need to condense the devices into a turnkey livestreaming camera system with optimized frames per second reception.
Muscle-sparing Latissimus Dorsi: A Safe Option for Postmastectomy Reconstruction in Extremely Obese Patients
Authors: Schwartz Jean-Claude D.
Published: April 2021

Background:

Postmastectomy reconstruction in obese patients has a significant risk of complications and poor outcomes after implant-based and autologous methods. Here we present 22 consecutive patients with Class III obesity [body mass index (BMI) > 40 kg/m2] who underwent reconstruction with a muscle-sparing latissimus dorsi (MSLD) flap.

Methods:

A chart review of a single surgeon experience with 22 consecutive patients with Class III obesity who underwent postmastectomy reconstruction with an MSLD flap was performed. Demographics, operative details, outcomes, and complications were evaluated.

Results:

Twenty-two patients underwent 29 mastectomy and MSLD reconstructions. There were no flap failures. The average BMI was 47.2 kg/m2, including 12 patients with BMI > 50 kg/m2. Seven breasts demonstrated partial nipple and or mastectomy flap necrosis. There was 1 (3.4%) donor site dehiscence that healed with outpatient wound care and 1 (3.4%) seroma that required multiple aspirations in the office. The average operative times were 178 and 420 minutes for unilateral and bilateral mastectomy and immediate reconstructions, respectively. The average hospital length of stay was 0.56 and 1.3 days for unilateral and bilateral surgeries, respectively.

Conclusions:

These results demonstrate the utility of the MSLD flap in reconstructing the very obese. Operative times and lengths of stay compare favorably with conventional latissimus dorsi flap and abdominal-based microvascular free tissue transfer reconstructions. While our complication rates were higher than historically seen for patients with normal BMIs, there were no instances of flap failure, making this a viable reconstructive option for these very high-risk patients.
Noncontrast Magnetic Resonance Imaging of Perforators for Preoperative Evaluation of Anterolateral Thigh Flaps
Authors: Chen Frank R. , Kerluku Jona , Mintz Douglas , Burge Alissa J. , Chen Aaron Z. , MacMahon Aoife , Osei Daniel A. , Fufa Duretti T.
Published: April 2021

Background:

The anterolateral thigh (ALT) flap is a commonly utilized perforator-based flap in reconstructive surgery. Although previous studies have used various angiographic techniques to preoperatively image ALT perforators, none have investigated the efficacy of noncontrast magnetic resonance imaging (MRI). Our study investigates the efficacy of our institutional fat suppression noncontrast MRI sequence to characterize the number, location, and course of dominant skin perforators in the ALT for preoperative planning.

Methods:

We queried our institutional database for 100 noncontrast thigh MRIs from July 2013 to July 2018 that included an axial fat suppression sequence with visualization from the lesser trochanter to the distal musculotendinous junction of the rectus femoris. Perforator course, size, and location relative to bony landmarks were determined.

Results:

Of the 100 examinations, 70 included bilateral thighs for a total of 170 thighs for perforator analysis. An estimated 277 perforators were identified, of which 101 were septocutaneous (36.5%) and 176 were musculocutaneous (63.5%). An average of 1.63 perforators were visualized in each thigh (min, 1; max, 4). The average perforator diameter at exit from the anterior thigh compartment fascia was 2.5 mm (SD, 0.5). Perforator exit location along the anterior superior iliac spine- or lesser trochanter-patella line could be determined for n = 57 perforators and mapped into 3 predictable clusters.

Conclusions:

At least 1 perforator was found in each of 170 thighs imaged. Perforator course, size, and location measured with noncontrast MRI are consistent with prior literature. Noncontrast MRI is a low-morbidity imaging modality that may serve as an effective tool in preoperative planning of the ALT flap.
Comparing the Clinical and Cost-Effectiveness of Abdominal-based Autogenous Tissue and Tissue-Expander Implant: A Feasibility Study
Authors: Thoma Achilles , Avram Ronen , Dal Cin Arianna , Murphy Jessica , Duku Eric , Xie Feng
Published: April 2021

Background:

To determine the superiority of autologous abdominal tissue (AAT) or tissue-expander implant (TE/I) reconstruction, a robust comparative cohort study is required. This study sought to determine the feasibility of a future large pragmatic cohort study comparing clinical and cost-effectiveness of AAT and TE/I at 12 months postoperative.

Methods:

Potential participants were screened during consultation with their surgeon. Three health-related quality-of-life scales, the Health Utility Index Mark 3, the 12-Item Short Form Health Survey, and the BREAST-Q were used preoperatively, 1, 6, and 12 months postoperatively. Direct medical costs and postoperative patient/caregiver productivity loss were collected using patient diaries. Feasibility was assessed through patient recruitment rates and compliance of patients and study staff to complete required study documentation.

Results:

Sixty-three patients consented to participate, 44 completed baseline questionnaires; the feasibility objective of recruiting 80% of eligible patients was not met. A 90% completion rate for patient questionnaires was seen at 1-month follow-up and decreased up to 12 months. Quality-adjusted life years were calculated at 0.77 and 0.89 for the AAT and TE/I group, respectively. Case report form completion by study staff and patient diary completion was moderate and low, respectively. Collaborating with hospital case-costing specialists to identify direct medical costs was reliable and efficient.

Conclusions:

A future large-scale study is feasible. However, due to a diminishing rate of questionnaire completion, almost twice as many patients need to be recruited than expected to have adequate power. Cost data collection from hospital sources was reliable. Case report forms need to be tailored more toward a busy hospital setting.
Ethnic and Gender Diversity Comparison between Surgical Patients and Caring Surgeons
Authors: Noel Olivier F. , Berg Arthur , Onyango Nelson , Mackay Donald R.
Published: April 2021

Background:

Diversity within the medical workforce remains a topic of discussion in academia, particularly when it comes to the underrepresentation of certain ethnic groups and gender in the surgical specialties. In this article, we look at how the gender and ethnicity of surgeons at a large academic institution in a rural setting compare with those of the population it serves.

Methods:

We looked at demographic data from 2008 to 2018 and compared population trends among surgeons and patients.

Results:

We found that while whites represent the large majority in both the surgeon and patient populations, absolute number and percentage of whites in the patient population seem to be trending downward from 2008 to 2018, but trending upward among surgeons (attendings and residents). In addition, we found that while Asians make up only 1% of the patient population, they represent the second largest group (17%) among surgeons, with more than twice the proportion percentage of the second largest group within the patient population, composed of Hispanics (6%). Finally, we found a significant gender difference between the 2 populations with almost two-thirds of the surgeons being men, compared with the nearly even split of men and women within the patient population.

Conclusions:

Ultimately, understanding how gender and ethnic diversity in the surgical workforce compares with that of the patient population being served may aid in designing training programs to address cultural competency and awareness as well as in impacting administrative decisions and hiring.
Double Spiral Dupuytren’s Disease: Case of Ulnar and Radial Spiral Cords in Shared Digit
Authors: Kator Jamie , Gopinath Rohan , Miller Nathan , Pensy Raymond
Published: April 2021

Dupuytren’s disease is a benign fibroproliferative disorder resulting in progressive contraction of palmar and digital fascia. Diseased fascia of the hand condenses into tensile cords, manifesting in various anatomical combinations. The spiral cord variant is especially troublesome, as the cord travels under the digital neurovascular bundle and places it at risk during surgical resection. In severe cases, limited fasciectomy is required to release contracture and restore finger extension. Here, we present the case of a 79-year-old right-handed man with a history of severe Dupuytren’s disease of both hands, who was found to have ulnar and radial spiral cords in his right ring finger. Diseased tissue was removed en bloc, restoring extension and function. To our knowledge, this is the first case of a digit with two spiral cords affecting both neurovascular bundles. It is important to be aware of the anatomical variations possible in Dupuytren’s disease to avoid iatrogenic injury.
Daily Quality-of-life Impact of Scars: An Interview-based Foundational Study of Patient-reported Themes
Authors: Hsieh Ji-Cheng , Maisel-Campbell Amanda L. , Joshi Chitang J. , Zielinski Eric , Galiano Robert D.
Published: April 2021

Background:

Scars negatively impact mental health. Prior patient interview studies on cutaneous scars have elicited opinions pertaining to psychosocial effects, appearance, and symptoms. There remains a need for patient-reported opinions in broader contexts, including career and sexual well-being, to better understand patients’ experiences with their cutaneous scars.

Methods:

In this qualitative study, patients with cutaneous scars participated in semi-structured interviews. Transcripts were analyzed using a constant comparative approach using the data software QDAMiner, to generate a thematic framework encompassing patients’ experience with cutaneous scars.

Results:

In total, 37 patients aged 25–79 years (mean 45, SD 17.9) were interviewed. Patients presented with keloid (2/37, 5%), hypertrophic (5/37, 14%), atrophic (4/37, 11%), and linear surgical (18/37, 49%) scars. Opinions fell under 8 overarching themes. Patients spoke commonly about psychological and social well-being (references to the frequency of thinking about a scar and talking about scars with others were mentioned 56 times by 26 patients and 103 times by 29 patients, respectively, for example). Discussions of sexual well-being and career were elicited but rarer (references to feeling uncomfortable when naked and negative impacts on professional networking were mentioned 17 times by 7 patients and 5 times by 3 patients, respectively, for example).

Conclusions:

The relationship between determinants of patients’ opinions of their scars and their impact on quality-of-life is complex. These results expand upon the existing knowledge of the effects scars have on quality-of-life and can contribute to the development and validation of future scar outcome measures.
“Trap Door” Orbital Floor Fractures in Adults: Are They Different from Pediatric Fractures?
Authors: Al-Qattan Mohammad M. , Al-Qattan Yousef M.
Published: April 2021

Background:

“Trap door” orbital floor fractures are usually seen in children. In the linear fracture type, a break occurs in the bones of the orbital floor that permits orbital tissue to prolapse into the fracture site during fracture formation. The bony fragments of the fracture then return to their original position, entrapping the prolapsed orbital tissue. In the hinged fracture type, the fractured part of the floor is minimally displaced into the maxillary sinus and acts as the hinge of a “swinging door” entrapping the orbital tissue.

Methods:

We report on a series of 10 adult patients with hinged orbital floor fractures.

Results:

The mean patient age was 35 years. Seven patients had a pure orbital floor fracture and the remaining 3 patients had fractures of both the orbital floor and the inferior orbital rim. All 10 patients had diplopia in the upgaze. None of the patients had signs of the oculocardiac reflex. None of the CT scans showed a “tear-drop” sign. However, the sagittal CT scans showed evidence of entrapment of the inferior rectus. All patients had a small area of a slightly depressed orbital floor at the site of entrapment, without a bony defect. All patients underwent surgery through an infraorbital incision and a titanium mesh was used in all patients. There were no postoperative complications. All patients regained full range of motion of the globe.

Conclusion:

This is the first series in the literature that reports on the characteristics and outcome of trap door orbital floor fractures in adults.
Effect of Foot Massages on Postpartum Comfort and Pain Level of Mothers After Vaginal Delivery
Authors: Icke Sibel , Genc Rabia
Published: April 2021

This study conducted on 66 mothers aimed to investigate the effect of foot massages postpartum using an introductory information form, the Postpartum Comfort Scale, the visual analog scale, and a drug follow-up card. It was concluded that foot massages positively improved comfort, reduced pain levels, and reduced unnecessary medications.
“Corneal Plication” for the Management of Progressive Corneal Graft Protrusion in Patients With Keratoconus: a New Technique
Authors: Petrelli Myrsini , Savopol Hélène , Blavakis Emmanouil , Petrou Petros , Droutsas Konstantinos , Kymionis George D.
Published: April 2021

Purpose:

The purpose of this study was to present a new surgical technique, namely corneal plication, for the management of high astigmatism and progressive corneal graft protrusion after penetrating keratoplasty (PKP) for keratoconus.

Methods:

New surgical approach description.

Results:

A 61-year-old woman with a history of bilateral keratoconus was referred to our institute for the management of progressive corneal graft protrusion in her left eye 25 years after PKP. On presentation, the uncorrected distance visual acuity in the involved eye was counting fingers, whereas slit-lamp examination revealed a clear graft with a crescentic area of thinning in the inferior host cornea, extending from 4 to 9 o'clock that resulted in significant graft protrusion and astigmatism. We proceeded with a novel surgical approach that included “folding” and suturing the thinned, diseased corneal tissue and thus creating a form of corneal plication. No intraoperative or postoperative complications were observed, and uncorrected distance visual acuity was 0.32 6 months after the operation.

Conclusions:

Corneal graft plication may represent a realistic alternative to more invasive procedures, currently used for the management of this long-term post-PKP complication in patients with keratoconus because it is a nonperforating technique that seems to provide satisfactory anatomical and visual outcomes without the need for any tissue excision or regrafting.
Detecting Progression in Patients With Different Clinical Presentations of Primary Open-angle Glaucoma
Authors: Abu Sampson L. , Marín-Franch Iván , Racette Lyne
Published: April 2021

Précis:

Glaucoma progression was more frequently identified by assessing retinal fiber layer thickness than by monitoring visual field (VF) loss for different baseline classifications in primary open-angle glaucoma.

Purpose:

The aim was to compare the detection of glaucoma progression by retinal nerve fiber layer thickness (RNFLT) and VF assessments for different baseline classifications of primary open-angle glaucoma.

Methods:

This study included 194 eyes from 194 patients with a minimum of 9 follow-up visits selected from the Diagnostic Innovation in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES). Each eye was classified according to baseline clinical signs: ocular hypertension (n=39), glaucomatous optic neuropathy only (n=60), glaucomatous visual field loss only (GVF, n=39) and definite glaucoma (concurrent optic disc and VF defect, n=56). We assessed progression by performing simple linear regression on global and sectorial mean deviations values generated for RNFLT (RNFLT-MD) and VF data (VF-MD). The proportion of eyes identified as progressing (positive rate) by RNFLT-MD and by VF-MD were compared within each classification.

Results:

Whereas both parameters performed similarly among glaucomatous optic neuropathy only and definite glaucoma eyes, the positive rate obtained with global RNFLT-MD was significantly greater compared with global VF-MD by 33.3% and 30.8% among ocular hypertension eyes and GVF eyes, respectively. This finding was consistent in the inferotemporal sector; however, similar positive rates were obtained for both parameters in the superotemporal sector.

Conclusions:

While both RNFLT and VF parameters showed comparable abilities to identify progression across the different classifications, RNFLT assessment may be better suited to monitor progression, particularly among patients with elevated intraocular pressure and those who present with only GVF defect at baseline.
Rotavirus Strain Surveillance in Estonia After Introduction of Rotavirus Universal Mass Vaccination
Authors: Kõivumägi Kadri , Soeorg Hiie , Toompere Karolin , Kallas Eveli , Jõegeda Ene-Ly , Lass Evely , Huik Kristi , Lutsar Irja
Published: April 2021

Background:

Estonia implemented the rotavirus (RV) vaccine into its national immunization program in July 2014. We aimed to determine circulating RV genotypes and the clinical profile by genotypes from February 1, 2015, to August 30, 2016, among children 0–18 years hospitalized due to rotavirus gastroenteritis (RVGE).

Methods:

During an observational study in 7 Estonian hospitals, we determined the RV genotypes in stool samples of RVGE patients who met predetermined criteria. Shannon’s diversity index (H´) and Simpson’s index (D) was used to evaluate genotype diversity by season and age and to compare prevaccine period data (2007–2008) for children 0–4 years of age (n = 77) to corresponding data from the postvaccine period (2015–2016, n = 346). The Vesikari Clinical Severity Scoring System was used for clinical profile evaluation.

Results:

Stool samples of 479 RVGE patients were genotyped. Seventy-seven percent of RVGE infections were caused by G4P[8] (n = 150, 31%), G1P[8] (n = 100, 21%), G9P[8] (n = 79, 16%), G2P[4] (n = 23, 5%), G4P[4] (n = 17,  4%). The prevailing genotypes varied seasonally. Diversity increased during the postvaccine period among age groups 0–4: H´1.42 (95% CI: 1.2–1.7) in the prevaccine era versus 1.8 (95% CI: 1.7–2) in the postvaccine era (P = 0.008), and D 0.6 (95% CI: 0.5–0.7) versus 0.78 (0.75–0.80) (P = 0.01), respectively. The off-season period presented higher diversity compared with in-seasons. G2P[8], G1P[8], G4P[4], G9P[8], and G8P[8] presented with a different clinical profile compared with others.

Conclusion:

Since the introduction of universal mass vaccination in Estonia, the circulating RV genotypes have changed compared with those reported in the prevaccine era. Our study adds to knowledge about RV genotype distribution in Europe and expected dynamics after RV universal mass vaccination and provides insight on the clinical profile of prevailing genotypes.
Dynamics of brain function in patients with chronic pain assessed by microstate analysis of resting-state electroencephalography
Authors: May Elisabeth S. , Gil Ávila Cristina , Ta Dinh Son , Heitmann Henrik , Hohn Vanessa D. , Nickel Moritz M. , Tiemann Laura , Tölle Thomas R. , Ploner Markus
Published: April 2021

Chronic pain is a highly prevalent and severely disabling disease that is associated with substantial changes of brain function. Such changes have mostly been observed when analyzing static measures of resting-state brain activity. However, brain activity varies over time, and it is increasingly recognized that the temporal dynamics of brain activity provide behaviorally relevant information in different neuropsychiatric disorders. Here, we therefore investigated whether the temporal dynamics of brain function are altered in chronic pain. To this end, we applied microstate analysis to eyes-open and eyes-closed resting-state electroencephalography data of 101 patients suffering from chronic pain and 88 age- and sex-matched healthy controls. Microstate analysis describes electroencephalography activity as a sequence of a limited number of topographies termed microstates that remain stable for tens of milliseconds. Our results revealed that sequences of 5 microstates, labelled with the letters A to E, consistently described resting-state brain activity in both groups in the eyes-closed condition. Bayesian analysis of the temporal characteristics of microstates revealed that microstate D has a less predominant role in patients than in controls. As microstate D has previously been related to attentional networks and functions, these abnormalities might relate to dysfunctional attentional processes in chronic pain. Subgroup analyses replicated microstate D changes in patients with chronic back pain, while patients with chronic widespread pain did not show microstates alterations. Together, these findings add to the understanding of the pathophysiology of chronic pain and point to changes of brain dynamics specific to certain types of chronic pain.
Patient outcomes after opioid dose reduction among patients with chronic opioid therapy
Authors: Hallvik Sara E. , El Ibrahimi Sanae , Johnston Kirbee , Geddes Jonah , Leichtling Gillian , Korthuis P. Todd , Hartung Daniel M.
Published: April 2021

The net effects of prescribing initiatives that encourage dose reductions are uncertain. We examined whether rapid dose reduction after high-dose chronic opioid therapy (COT) associates with suicide, overdose, or other opioid-related adverse events. This retrospective cohort study included Oregon Medicaid recipients with high-dose COT. Claims were linked with prescription data from the prescription drug monitoring program and death data from vital statistics, 2014 to 2017. Participants were placed into 4 mutually exclusive dose trajectory groups after the high-dose COT period, and Cox proportional hazard models were used to examine the effect of dose changes on patient outcomes in the following year. Of the 14,596 high-dose COT patients, 4191 (28.7%) abruptly discontinued opioid prescriptions, 1648 (11.3%) reduced opioid dose before discontinuing, 6480 (44.4%) had a dose reduction but never discontinued, and 2277 (15.6%) had a stable or increasing dose. Discontinuation, whether abrupt (adjusted hazard ratio [aHR] 3.63; 95% confidence interval [CI] 1.42-9.25) or with dose reduction (aHR 4.47, 95% CI 1.68-11.88) significantly increased risk of suicide compared with those with stable or increasing dose. By contrast, discontinuation or dose reduction reduced the risk of overdose compared with those with a stable or increasing dose (aHR 0.36–0.62, 95% CI 0.20-0.94). Patients with an abrupt discontinuation were more likely to overdose on heroin (vs. prescription opioids) than patients in other groups (P < 0.0001). Our study suggests that patients on COT require careful risk assessment and supportive interventions when considering opioid discontinuation or continuation at a high dose.