bluuebunny/crossref_metadata_2025 huggingface dataset:
Fluid management in extensive liposuction
Authors: Wang Gang , Cao Wei-Gang , Zhao Tian-Lan
Published: October 2018

Tumescent anesthesia makes it feasible to perform liposuction in an office setting. There are often patients who desire extensive liposuction on approximately 30% of total body surface area, which means the potential of fluid overload. In this study, the charts of 83 patients undergoing extensive liposuction were retrospectively reviewed. The intra-operative fluid ratio was 1.66 for the extensive liposuction. There were no episodes of pulmonary edema, congestive heart failure exacerbation, or other major complications. The average urine output in the operating room, the recovery room, and while on the floors was 1.35, 2.3, and 1.4 mL/kg/hour respectively. Intravenous (IV) fluid administration during operation was minimized to approximately 300 to 500 mL. The total volume of IV injection was also reduced to less than 1500 mL when the patient was in the recovery room and on the hospital floor. Our fluid management strategy in extensive liposuction reflects minimal risk of volume overload. Foley catheters are not applied and patients could resume oral intake in usual, so they can discharge after 6 hours of recovery room stay in our daily practice.
TargetScore used to reveal potential targets of miRNA203 and miRNA-146a in psoriasis by integrating microRNA overexpression and microarray data
Authors: Chen Hai-Xia , Liu Yan-Song , Zhang Xiu-Jie
Published: October 2018

Objective:

Systematic tracking of microRNA (miRNA) targets remains a challenge. In our work, we aimed to use TargetScore to investigate the potential targets of miRNA203 and miRNA-146a in psoriasis by integrating miRNA overexpression information and sequence data, and to further uncover the functions of miRNA203 and miRNA-146a in psoriasis.

Methods:

This was a case-control bioinformatics analysis using already published microarray data of psoriasis. We calculated targetScores by combining log fold-change and sequence scores obtained from TargetScan context score, probabilities of conserved targeting, and derived the distribution of targetScores. The scoring cutoff was chosen based on the different targetScore distributions for the nonvalidated and validated targets. The potential target genes for miRNA-203 and miRNA-146a were predicted based on the targetScore threshold. To reveal the functions of miRNA-203 and miRNA-146a, we implemented pathway enrichment analyses for the targets of miRNA-203 and miRNA-146a.

Results:

TargetScore >0.4 was selected as the threshold to filter out less confidence targets because we observed little overlap between the 2 distribution at targetScore = 0.4. Based on the targetScore >0.4, 49 target genes for miRNA-203 and 17 targets for miRNA-146a were identified. Pathway enrichment results showed that the target genes of miRNA-203 (including KIR2DL1, HLA-DQA1, KIR3DL1) only participated in antigen processing and presentation. The target genes of miRNA-146a (covering ADORA3, CYSLTR2, HRH4) were only involved in neuroactive ligand-receptor interaction.

Conclusion:

MiRNA203 and miRNA-146a played important roles in psoriasis progression, partially through regulating the pathways of antigen processing and presentation, and neuroactive ligand-receptor interaction, respectively.
Richter's syndrome of the central nervous system diagnosed concurrently with chronic lymphocytic leukaemia
Authors: Xu Liye , Song Jin Cheng , Sun Xiu Hua , Gao Zi Fen , Lv Li , Zhu Jie
Published: October 2018

Rationale:

Central nervous system (CNS) infiltration of Richter's syndrome (RS) is rare and only a few cases were discussed. Of these published cases, either they were accompanied with lymph node involvement or with a history of chronic lymphocytic leukemia (CLL). To our knowledge, this is the first published case of RS of the brain and meninges diagnosed concurrently with CLL in the absence of any evidence of lymphoma outside of the CNS.

Patient concerns:

A 67-year-old female presented with slurred speech, headache, and left-sided hemiparesis. Magnetic resonance imaging of the brain revealed an irregular lesion 30 mm in diameter in the right parietal lobe. The mass was totally removed and pathology revealed diffuse large B-cell lymphoma (DLBCL) of non-germinal center type by Hans’ classification. The patient's leukocyte count was 12.1 × 109/L (76.9% lymphocytes), and fluorescence-activated cell sorting (FACS) analysis of blood revealed a clonal B-cell population (36.75% leukocytes) corresponding to the immunological CLL profile (Matutes score of 5/5). Bone marrow (BM) aspiration and biopsy also indicated CLL. The analysis of immunoglobulin heavy chain gene (IGH) and kappa chain gene (IGK) in the patient's BM and CNS tissue indicated that the DLBCL of the brain was derived from the CLL clone.

Diagnoses:

RS of the CNS diagnosed concurrently with CLL.

Interventions:

The patient received intravenous chemotherapy (6.0 g methotrexate) and intrathecal chemotherapy (10 mg methotrexate, 50 mg cytarabine, 5 mg dexamethasone).

Outcomes:

The patient returned to our department with left-sided hemiparesis and headache 2 weeks after the chemotherapy. Repeat MRI showed progression of the brain lesion. Her general condition deteriorated significantly with confusion and high fever, and she died within a few days at only 10 weeks after the onset of symptoms.

Lessons:

The survival of CNS-RS patients is very poor and and is always complicated with multiple and different genetic alterations. Because of chemotherapy insensitivity, a multidisciplinary treatment including surgery and radiotherapy together with novel agents may be an option to improving patient outcomes.
Arterial occlusion after total knee arthroplasty despite minimal invasive technique in aneurysm at popliteal artery
Authors: Cho Myung Rae , Kim Kyung Tae , Choi Won Kee
Published: October 2018

Rationale:

Arterial occlusion, a rare condition after total knee arthroplasty (TKA), may cause fatal outcomes if not treated on time. We report a case of arterial occlusion after undergoing navigated TKA with no tourniquet use, in a patient at high risk of postoperative arterial occlusion due to the patient's ipsilateral popliteal artery aneurysm.

Patients concerns:

A 79-year-old man presented with several years of left knee joint pain. Nine years earlier, the patient underwent vascular graft surgery on his right knee due to occlusion in his right popliteal artery. On physical examination, the patient showed antalgic gait due to the pain in his left knee.

Diagnosis:

Preoperative examination for arterial blood flow demonstrated reduced blood flow of the patient's right dorsalis pedis and right posterior tibial artery, with ankle-brachial index of 0.41 and 0.41. The blood flow of the left dorsalis pedis and left posterior tibial artery remained normal, with ankle-brachial index of 1.16 and 1.10. Femoral artery computed tomography (CT) scan revealed left popliteal artery aneurysm with mural thrombus, with occlusion of the left anterior tibial artery (ATA). The left peroneal artery and posterior tibial artery remained patent.

Intervention:

Total knee arthroplasty using navigation without the use of tourniquet.

Outcomes:

Occlusion of the posterior tibial artery trunk was revealed with Doppler ultrasound and femoral artery CT several hours postoperatively, and the patient underwent thromboembolectomy at the very next day.

Lessons:

In patients at high risk of postoperative arterial occlusion, such as patients with arterial aneurysm with mural thrombus, arterial occlusion may occur despite surgical techniques with minimal damage to the vessels. We found out that diseases of the artery might be a contraindication for TKA, and when TKA may be performed in high-risk patients, close cooperation with a vascular surgeon is a must.
Diagnostic challenges in T-lymphoblastic lymphoma, early T-cell precursor acute lymphoblastic leukemia or mixed phenotype acute leukemia
Authors: Wang Ping , Peng Xian’gui , Deng Xiaojuan , Gao Li , Zhang Xi , Feng Yimei
Published: October 2018

Rationale:

The diagnosis of hematological malignancies depends on laboratory analysis and often requires multiple experimental methods to judge, otherwise misdiagnosis is apt to happen. Lymph node biopsy immunohistochemistry (IHC) for T-lymphoblastic lymphoma (T-LBL) requires the establishment of antibody set screening. For identifying T-LBL and early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) by lymph node biopsy and IHC, WHO has not yet proposed a better IHC antibody combination.

Patient concerns:

Here we reported 1 case with tortuous diagnosis experience. Initially, a 51-year-old man was diagnosed as T-LBL by lymph node biopsy, but in another hospital acute myeloid leukemia (AML) was confirmed by bone marrow puncture. Finally, it was diagnosed as mixed phenotype acute leukemia (MPAL) through our comprehensive evaluation including bone marrow cell morphology, cytochemical staining and flow cytometry analysis. Importantly, the experience about differential diagnosis and our appreciation among the T-LBL, ETP-ALL and MPAL was discussed to enlighten readers.

Diagnoses:

The patient was diagnosed with mixed phenotype acute leukemia (T+My)-NOS.

Interventions:

The patient received 1 cycle of VDCLP scheme treatment firstly. The effect of chemotherapy is satisfactory, and then he received continuous treatment and was currently in good condition.

Outcomes:

This patient is alive at present. The follow-up period has been 1 year.

Lessons:

For the diagnosis of T-LBL, the molecular markers of the myeloid and lymphoid tissues need to be included, such as CD117, CD33, Lys and MPO. The bone marrow puncture also needs to be conducted to distinguish T-LBL and T-ALL. Secondly, to identify ETP-ALL and MPAL, bone marrow cell morphology, cytochemical staining as well as flow cytometric analysis were needed to make a clear diagnosis. It is recommended that at least CD8, CD1a, Lys and MPO should be included in the panel to identify ETP-ALL.
Comparative study of MR mTI-ASL and DSC-PWI in evaluating cerebral hemodynamics of patients with Moyamoya disease
Authors: Zhang Jinge , Xia Chunchao , Liu Yi , Qian Weiqiang , Peng Wanlin , Liu Keling , Li Lei , Zhao Fei , Li Zhenlin
Published: October 2018

The aim of this study was to explore the correlation between multi-inversion time arterial spin labeling (mTI-ASL) and dynamic susceptibility contrast-enhanced perfusion weighted imaging (DSC-PWI) in assessment of hemodynamics of patients with Moyamoya disease (MMD).

In this study, 24 MMD patients and 21 healthy subjects were enrolled between June 2017 and December 2017. The images of mTI-ASL and DSC-PWI in the week before revascularization surgery were retrospectively analyzed. The parameters of cerebral blood flow (CBF), time to peak (TTP), and bolus arrival time (BAT) were measured in regions of interest (ROIs) of lateral middle cerebral artery (MCA) territories, basal ganglia (BG), and cerebellum, and relative perfusion parameters (rCBF-ASL, rBAT-ASL, rCBF-DSC, and rTTP-DSC) were calculated by dividing by cerebellum value. One-way analysis of variance and Student–Newman–Keuls tests were performed to compare rCBF-ASL and rCBF-DSC in the MMD group and the control group. Unpaired t test was used to compare rBAT-ASL and rTTP-DSC in the MMD group and the control group. And we assessed the correlation between rCBF-ASL and rCBF-DSC and between rBAT-ASL and rTTP-DSC using Pearson correlation analysis.

All the relative parameters were significantly different between the MMD group and the control group (all P<.05). Meanwhile, there was significant difference between rCBF-ASL and rCBF-DSC (P<.05), and there was strong correlation between rCBF-ASL and rCBF-DSC (r = 0.839, P<.001), and moderate correlation between rBAT-ASL and rTTP-DSC (r = 0.519, P<.001).

Both mTI-ASL and DSC-PWI could be used to assess perfusion state in MMD patients before revascularization surgery effectively. As a noninvasive imaging technique, mTI-ASL could provide perfusion parameters without contrast medium injection, and the results were quite correlative with DSC-PWI.
Thoracic aggressive vertebral hemangioma with neurologic deficit
Authors: Hu Wei , Kan Shun-Li , Xu Hui-Bin , Cao Ze-Gang , Zhang Xue-Li , Zhu Ru-Sen
Published: October 2018

The aim of this study is to evaluate the safety and effectiveness in the treatment of thoracic aggressive vertebral hemangiomas (AVHs) with neurologic deficit by multiple surgical treatments.

The clinical and radiographic data of 5 patients suffering from thoracic AVHs with neurologic deficit and treated by multiple surgical treatments, including percutaneous curved vertebroplasty (PCVP) combined with pedicle screw fixation and decompressive laminectomy, were reviewed and analyzed retrospectively.

Five patients (3 women and 2 man, with a mean age of 57.40 ± 11.93) were diagnosed with AVHs from July 2010 to April 2016. All of them had objective neurologic deficit, myelopathy, and back pain. They underwent multiple surgical treatments and were followed-up for 12 to 23 months. At final follow-up, Frankel Grade D was achieved in all 5 patients. Patients were free from pain and neurologic symptoms, and the functional status was improved. No major complication was found.

The treatment of AVHs with neurologic deficit is a challenge for surgeons. PCVP combined with pedicle screw fixation and decompressive laminectomy is safe and effective, and can be used for AVHs with neurologic deficit. Further studies with more samples are required to validate the effectiveness and safety of PCVP combined with pedicle screw fixation and decompressive laminectomy.
Characteristics of contrast-enhanced ultrasound in distinguishing small (≤3 cm) hepatocellular carcinoma from intrahepatic cholangiocarcinoma
Authors: Shin Seung Kak , Choi Duck Joo , Kim Ju Hyun , Kim Yun Soo , Kwon Oh Sang
Published: October 2018

Contrast-enhanced ultrasound (CEUS) is highly accurate in depicting the vascularity of liver nodules. The aim of this study was to verify the characteristics of CEUS in distinguishing small (≤3 cm) hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICC).

A total of 65 patients with a liver nodule (HCC, n = 58; ICC, n = 7) smaller than 3 cm who underwent liver CEUS and pathologic confirmation were retrospectively reviewed. CEUS findings were compared with histopathologic and clinical data.

Arterial-phase hyperenhancement and portal-delayed-phase wash-out on CEUS were observed in 77.6% (45/58) of HCCs and 85.7% (6/7) of ICCs. Time of arterial-phase hyperenhancement (11 seconds [6–20] vs 16 seconds [14–19], P = .008), time of portal-delayed-phase wash-out (65 seconds (15–260) vs 35 secconds (27–54), P = .002), and time interval between arterial-phase hyperenhancement and portal-delayed-phase wash-out (50 seconds [5–249] vs 19 seconds [13–35], P < .001) on CEUS were significantly different between HCCs and ICCs showing arterial-phase hyperenhancement and portal-delayed-phase wash-out. The sensitivity, specificity, positive predictive value, and negative predictive value of time interval more than 25 seconds between arterial-phase hyperenhancement and portal-delayed-phase wash-out on CEUS for the differentiation of HCCs and ICCs were 91.1%, 83.3%, 97.6%, and 55.6%, respectively.

The time interval between arterial-phase hyperenhancement and portal-delayed-phase wash-out on CEUS was the most sensitive indicator in distinguishing small HCC from ICC showing arterial-phase hyperenhancement and portal-delayed-phase wash-out.
Safety and efficacy of combining capecitabine and temozolomide (CAPTEM) to treat advanced neuroendocrine neoplasms
Authors: Lu Yaoheng , Zhao Zhicheng , Wang Ji , Lv Wenhao , Lu Li , Fu Weihua , Li Weidong
Published: October 2018

Retrospective studies have suggested that capecitabine combined with temozolomide (CAPTEM) is effective for treating patients with advanced neuroendocrine neoplasms (NENs); however, the efficacy and safety of this regimen needs to be verified by high-quality evidence or results of randomized controlled trials.

We carried out a meta-analysis to evaluate the safety and effectiveness of a CAPTEM protocol for patients with advanced NENs. Systematic electronic literature searches were conducted using PubMed, EMBASE, and the Cochrane Library, and among meeting abstracts of the American Society of Clinical Oncology, European Society for Medical Oncology, European Neuroendocrine Tumor Society, and North American Neuroendocrine Tumor Society, up to June 30, 2017. We selected studies describing CAPTEM regimens for treating advanced NENs and reported on tumor response and/or toxicities according to clear World Health Organization (WHO) grading of patients. Three reviewers independently and repeatedly identified studies, extracted data, and assessed the quality of the literature. A single-proportion meta-analysis was applied to included articles.

Fifteen studies with a total of 384 individuals were included. Medium overall survival in most studies was more than 12 months, whereas medium progression-free survival was similar or slightly higher than that in studies using other treatment regimes. Disease control rate of CAPTEM administration for patients with NENs was 72.89% (95% confidence interval, 64.04–81.73%; I
2 = 82.4%; P < .01). WHO grade 3 to 4 toxicities, such as thrombocytopenia (3.36%), neutropenia (0.69%), lymphopenia (0.65%), anemia (0.59%), mucositis (0.57%), fatigue (0.54%), diarrhea (0.49%), nausea (0.39%), and transaminase elevation (0.13%) were reported in the trials included.

CAPTEM is effective and relatively safe for treating patients with advanced NENs.
Successful azathioprine treatment in an adolescent with chronic enteropathy associated with SLCO2A1 gene
Authors: Eda Keisuke , Mizuochi Tatsuki , Takaki Yugo , Ushijima Kosuke , Umeno Junji , Yamashita Yushiro
Published: October 2018

Introduction:

Chronic nonspecific multiple ulcers of the small intestine (CNSU), an entity with female preponderance and manifestations including anemia and hypoproteinemia reflecting persistent gastrointestinal bleeding and intestinal protein loss, has been considered idiopathic. Umeno et al recently reported that CNSU is caused by loss-of-function mutations in the solute carrier organic anion transporter family member 2A1 gene (SLCO2A1) encoding a prostaglandin transporter, renaming the disorder “chronic enteropathy associated with SLCO2A1 gene mutation” (CEAS). Treatments for chronic enteropathies such as inflammatory bowel disease, including 5-aminosalicylic acid, corticosteroids, azathioprine, and anti-tumor necrosis factor-α antibody, often are ineffective in CEAS, which frequently requires surgery.

Case presentation:

A 14-year-old girl had refractory anemia and hypoproteinemia for more than 2 years. Video capsule endoscopy showed nonspecific jejunal and ileal ulcers with varied sizes and shapes. She was diagnosed with CEAS resulting from compound heterozygous mutation of the SLCO2A1 gene. After corticosteroid treatment without improvement, azathioprine treatment improved her anemia and edema as hemoglobin and serum protein increased. Video capsule endoscopy 1 year after initiation of azathioprine showed improvement of small intestinal ulcers.

Conclusion:

Physicians should consider CEAS in patients with refractory anemia, hypoproteinemia, and multiple small intestinal ulcers. Why our patient responded to azathioprine but not to corticosteroids is unclear, but azathioprine might benefit some other patients with CEAS.
Gemcitabine plus S-1 for metastatic pancreatic cancer
Authors: Zhu Hong , Yi Cheng , Zhao Yaqin , Gou Hongfeng
Published: October 2018

To investigate the treatment effects of gemcitabine plus S-1 (GS) for metastatic pancreatic cancer in our institution.

Data from 41 patients with metastatic pancreatic cancer treated with GS regimen in West China Hospital, Sichuan University were reviewed. The therapeutic efficacy and toxicity were evaluated. The influencing factors of progression-free survival (PFS) and overall survival (OS) were also explored.

At the last follow-up, all patients had died. The objective response rate was 22.0% (9/41) and the disease control rate was 65.9% (27/41). The median PFS and OS times were 5.1 (range, 1.5–21) and 10.6 months (range, 1.5–40), respectively. The 0.5-, 1-, and 2-year OS rates were 65.9%, 41.5%, and 9.8%, respectively. In multivariate analysis, body mass index and carbohydrate antigen 19-9 change were the significant influencing factors of PFS, compared to tumor site and chemotherapy cycles for OS. The adverse effects were moderate and tolerable.

The effects of GS for metastatic pancreatic cancer in our institution were good. The adverse effects were moderate and tolerable. However, further investigation in future prospective clinical studies is warranted.
Disease progression of nonalcoholic steatohepatitis in Taiwanese patients: a longitudinal study of paired liver biopsies
Authors: Lin Ta-Ya , Yeh Ming-Lun , Huang Chung-Feng , Huang Ching-I , Dai Chia-Yen , Hsieh Meng-Hsuan , Chen Shinn-Chern , Huang Jee-Fu , Yu Ming-Lung , Chuang Wan-Long
Published: October 2018

Objectives

Nonalcoholic steatohepatitis (NASH) might progress to fibrosis, cirrhosis, and hepatocellular carcinoma. However, the natural history of NASH has not been fully clarified. This study aimed to investigate the disease progression in NASH patients receiving paired liver biopsies. We also aimed to examine the factors associated with NASH progression.

Patients and methods

Ten NASH patients who had received liver biopsies during June 2001 and February 2010 were consecutively enrolled. The histopathological changes were examined retrospectively, including nonalcoholic fatty liver disease activity score (NAS) and fibrosis stage. The associated clinical profiles were also analyzed.

Results

The median duration between paired biopsies was 20.5 months (range: 12–106 months). According to NAS and fibrosis stage, disease progression, stable disease, and disease regression were observed in seven patients, two patients, and one patient, respectively. Six (60%) patients had increased NAS on second biopsy, and two were lean NASH patients. The only patient with an improvement in NAS had achieved body weight reduction (13.3%) between paired biopsies. None of the 10 patients experienced an improvement in fibrosis. Five (50%) patients showed progression of fibrosis on second biopsy and the annual fibrosis progression rate was 0.32/year. Two of the five patients who showed progression of fibrosis were of the nonobese phenotype, whereas three patients were nondiabetic.

Conclusion

NASH is a progressive disease in Taiwanese patients. The disease progression should be further clarified in lean and nondiabetic NASH patients.
Evaluation of the discriminative performance of the prehospital National Advisory Committee for Aeronautics score regarding 48-h mortality
Authors: Darioli Vincent , Taffé Patrick , Carron Pierre-Nicolas , Dami Fabrice , Vallotton Laurent , Yersin Bertrand , Schoettker Patrick , Pasquier Mathieu
Published: October 2018

Objective

The National Advisory Committee for Aeronautics (NACA) score is used by many emergency medical services to assess the severity of prehospital patients. Little is known about its discriminative performance regarding short-term mortality.

Participants and methods

We retrospectively included adult missions between 2008 and 2014 in a Swiss ground and air-based emergency medical services. We excluded uninjured or dead-on-scene patients. Primary outcome was assessment of the discriminative performance of the NACA score to classify the 48-h vital status of patients. Overall discrimination was quantified using the area under receiver operating characteristic curve (AUC). We also explored the influence of epidemiological characteristics (age and sex), mechanism (trauma or nontrauma) and clinical parameters (respiratory rate, oxygen saturation, heart rate, systolic blood pressure, capillary refill time, and Glasgow Coma Scale) on its discriminative performance. We then assessed the incremental value of these variables in the classification accuracy of a rule based on these variables in addition to the NACA score.

Results

We included 11 567 patients out of 11 639 (72 exclusions for missing data). Overall AUC was 0.86. The score was more discriminant for trauma (AUC = 0.95 vs. 0.83), and for younger patients (AUC = 0.91 for 16–59 vs. 0.78 for 84–104 years). Adding age, sex, mechanism, and clinical parameters resulted in a classification rule with higher discriminative performance than NACA score alone (AUC of 0.92 vs. 0.86; P < 0.001).

Conclusion

The NACA score is an efficient way to discriminate victims regarding short-term mortality. Its performance can be enhanced by also integrating epidemiological and clinical parameters into an extended classification rule.
Natural History of Small Pancreatic Lesions Suspected to Be Nonfunctioning Pancreatic Neuroendocrine Tumors
Authors: Choi Jin Ho , Choi Young Hoon , Kang Jinwoo , Paik Woo Hyun , Lee Sang Hyub , Ryu Ji Kon , Kim Yong-Tae
Published: October 2018

Objectives

Nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) are a rare disease but have been diagnosed more frequently than before. The aim of this study was to evaluate the natural course of small NF-PNETs.

Methods

We performed a retrospective analysis of patients with incidentally found small NF-PNETs (<20 mm) from 1999 to 2015. The patients who were recommended surveillance were included.

Results

There were 69 patients with small NF-PNETs with a mean size of 10.9 (standard deviation [SD], 3.1) mm. The average follow-up period was 52.2 (SD, 38.7) months. The changes in tumor size were as follows: increased (13.0%), sustained (84.1%), and decreased (2.9%). Eighteen were evaluated with grade 1 NF-PNETs and 1 with grade 2 among the obtained tissues. Thirteen patients underwent surgery after an average 32.9 (SD, 42.6) months later. There were 7 patients of Ia, 1 of Ib, 2 of IIa, and 1 of IIb according to the pathologic stages. Two patients received reoperation for recurrent tumors, and 2 patients showed distant metastasis after surgery, but no disease-related death occurred.

Conclusions: Most of the small NF-PNETs did not increase in size and seldom showed metastasis. The wait-and-see strategy can be used for NF-PNETs less than 2 cm.
Phonemic fluency improved after inhibitory transcranial magnetic stimulation in a case of chronic aphasia
Authors: Rossetti Angela , Malfitano Calogero , Malloggi Chiara , Banco Elisabetta , Rota Viviana , Tesio Luigi
Published: October 2018

Twenty-six months after a left hemispheric ischemic stroke an aphasic patient showed a significant improvement in verbal fluency following ten daily sessions of inhibitory 1 Hz repetitive transcranial magnetic stimulation over the right cortex homologous to the Broca’s area.

No improvement was observed for other linguistic functions or for executive ones. Results confirm the segregation of neural circuitries subtending phonemic and semantic fluency and suggest a selective usefulness of the repetitive transcranial magnetic stimulation treatment.
Postmortem Diagnosis of Myocardial Infarction Due to Butane Gas Intoxication in a Child
Authors: Bugra Aytul , Das Taner
Published: October 2018

Volatile substance addiction and toxic gas inhalation are now an important health problem. The pleasure-based inhalation of butane gas, also known as lighter refill gas, is especially prevalent among children and young people. The most important reasons for this situation are that they are cheap and easy to obtain and lack of legal supervision. The exhaled gas is absorbed through the alveolar surface and rapidly enters the bloodstream and leads to clinical signs. It can cause dizziness, nausea, vomiting, confusion, hallucinations, and euphoria in the acute phase. In severe cases, bronchospasm, hypoxia, ventricular arrhythmia, cardiopulmonary arrest, and death can occur. Our case is one of the rare cases in the literature that was diagnosed by postmortem histopathological examination. Our case is a 15-year-old girl who was found in front of a tobacco product store. On gross examination, there was a hemorrhagic area under the aortic valve that continued to interventricular septum. There was no coronary artery lesion. Histopathological examination revealed hypereosinophilia and contraction band necrosis in myocardial fibers, which was more intense in papillary muscle. Immunohistochemical studies also supported early myocardial ischemic changes. Upon toxicological examination, butane gas was detected in lung and blood samples.
Recurrent Genomic Alterations in Soft Tissue Perineuriomas
Authors: Carter Jodi M. , Wu Yanhong , Blessing Melissa M. , Folpe Andrew L. , Thorland Erik C. , Spinner Robert J. , Jentoft Mark E. , Wang Chen , Baheti Saurabh , Niu Zhiyv , Mauermann Michelle L. , Klein Christopher J.
Published: October 2018

Perineuriomas are rare nerve sheath tumors, divided into intraneural and extraneural (soft tissue) types. Intraneural perineuriomas frequently contain TRAF7 mutations, and rarely, chr22q12 deletions. While chr22q losses can occur in soft tissue perineuriomas, comprehensive high-resolution molecular profiling has not been reported in these tumors and TRAF7 status is unknown. We used whole-exome sequencing and OncoScan single nucleotide polymorphism (SNP) array to evaluate 14 soft tissue perineuriomas. Thirteen cases showed 2 or more chromosomal abnormalities, composed primarily of large deletions. Recurrent chr22q deletions, containing the NF2 locus (n=6) and the previously unreported finding of chr17q deletions, with the NF1 locus (n=4) were frequent events and were mutually exclusive in all but1 case. In addition, 5 cases had varying chr2 deletions; and 4 cases had chr6 deletions. A chr10 deletion (previously reported in the sclerosing variant of soft tissue perineurioma) was observed in one case and another case had chr7 chromothripsis as the sole chromosomal abnormality. No TRAF7 mutations or alterations were identified in any case and no other evaluated gene (MAF<0.0001) had recurrent, deleterious mutations in >2 cases. The molecular genetic profiles showed no association with patient sex, age, tumoral histology or anatomic site. OncoScan SNP array analysis was performed on 10 cases and showed high concordance with the whole exome data, validating the large-scale deletions, duplications, and chr7 chromothripsis findings. In soft tissue perineuriomas, recurrent 22q12 deletions (with NF2) and 17q11 deletions (with NF1) appear to be mutually exclusive events, and alterations in NF1 or NF2 likely contribute to perineurioma pathogenesis, similar to other nerve sheath tumors. Moreover, the lack of TRAF7 mutations in soft tissue perineuriomas indicates divergent pathogenetic mechanisms from those of intraneural perineuriomas.
Three-Dimensional Topography of the Emerging Point of the Ophthalmic Artery
Authors: Cong Li-Yao , Choi You-Jin , Hu Kyung-Seok , Tansatit Tanvaa , Kim Hee-Jin
Published: October 2018

Background:

During periorbital noninvasive and surgical procedures, there is the risk of iatrogenic injury to the emerging point of the ophthalmic artery. This study aimed to determine the three-dimensional location of the emerging point of the ophthalmic artery and to provide clinicians with anatomical information that would help them to avoid associated complications.

Methods:

Seventeen hemifaces of the emerging point of the ophthalmic artery from 10 Korean and seven Thai cadavers were dissected and scanned by a three-dimensional scanner. The emerging points of the ophthalmic artery of 30 healthy Korean volunteers were also detected using an ultrasound imaging system.

Results:

The transverse distance from the medial canthus to the emerging of the ophthalmic artery was 3.8 ± 1.0 mm medially, and the vertical distance was 14.0 ± 2.9 mm superiorly. The transverse distance from the midline was 16.5 ± 1.7 mm to the emerging point of the ophthalmic artery and 20.0 ± 2.0 mm to the medial canthus. The measured depth from the skin surface to the emerging point of the ophthalmic artery was 4.8 ± 1.7 mm by means of three-dimensional scanning and 4.5 ± 1.1 mm using ultrasound detection. The vertical distance from the inferior margin of the superior orbital rim to the emerging point of the ophthalmic artery was 5.3 ± 1.4 mm.

Conclusion:

These data inform clinicians about the anatomical three-dimensional location of the emerging point of the ophthalmic artery, which will help them to avoid iatrogenic injury when they are performing periorbital clinical procedures.
Comparative Study of Choke Vessel Reconstruction With Single and Multiple Perforator–Based Flaps on the Murine Back Using Delayed Surgery
Authors: Mao Yihua , Li Hong , Ding Maochao , Hao Xiaodi , Pan Jing , Tang Maolin , Chen Shixin
Published: October 2018

Objective

Choke vessels, vascular anastomosis between adjacent angiosome, play an important role in flap expansion and survival. Here we established a flap model with single and multiple perforators to detect and compare the changes in choke vessels, discuss the effect of hemodynamics on the vascular morphology, and explore the underlying mechanism.

Methods

One hundred mice (7–8 weeks) were subjected to a “choke zone” surrounded by 4 perforators on their backs. Delayed surgery was performed by the ligation of 1, 2, or 3 perforators to establish flap models. The blood flow of the choke zone was measured by laser Doppler flowmetry preoperatively and 6 hours and 1, 3, 5, and 7 days. The morphological changes of choke vessels in the choke zone were observed by gross and histological analyses. Levels of angiogenesis-related markers such as endothelial nitric oxide synthase (eNOS), metalloproteinase 2, hypoxia-inducible factor 1α (HIF-1α), and intercellular adhesion molecule 2 (ICAM-2) were detected by Western blotting and enzyme-linked immunosorbent assay.

Results

Blood flow and microvascular count were obviously increased postoperatively and peaked and were maintained for 1 week (P < 0.01). Meanwhile, the diameters of the choke vessels expanded. The eNOS level was increased at 7 days (P < 0.05); however, the enzyme-linked immunosorbent assay results showed that the HIF-1α and ICAM-2 levels were decreased at 7 days.

Conclusions

(1) The delayed surgery that kept a single perforator had the greatest impact on the choke zone. (2) Changes in choke vessels were closely related to the shear stress caused by enhanced blood perfusion after surgery. (3) Choke vessel growth was regulated by eNOS, metalloproteinase 2, HIF-1α, and ICAM-2.
Pedicled Thoracodorsal Artery Perforator and Muscle-Sparing Latissimus Dorsi Flaps in the Axillary Reconstruction After Hidradenitis Suppurativa Excision
Authors: Marchesi Andrea , Marcelli Stefano , Zingaretti Nicola , Parodi Pier Camillo , Vaienti Luca
Published: October 2018

Background

Wide axillary reconstruction after hidradenitis suppurativa (HS) excision still represents a great challenge. Thoracodorsal artery perforator flap is one of the most reliable local reconstructive techniques. Although its anatomy and harvesting technique have been well described, specific reconstructive criteria still lack. The aim of this study was to help surgeons in planning axillary reconstruction on flaps based on the thoracodorsal artery.

Methods

Twelve patients affected by HS at Hurley stage III underwent wide “en block” excision and immediate reconstruction with 15 local thoracodorsal artery perforator flaps and 2 muscle-sparing latissimus dorsi flaps. A thorough chart review has been performed with preoperative and postoperative photographic documentations. Early and late complications have been analyzed.

Results

A total of 15 perforator flaps on thoracodorsal artery and 2 muscle-sparing latissimus dorsi flaps have been raised. The early complication rate was 29%, whereas the late complication rate was 35%. Except for one, all patients declared they were satisfied or highly satisfied from both aesthetic and functional points of view. Analyzing specific aspects, we have described several important details to consider for the reconstruction of the axilla. Through a retrospective analysis, we have classified HS axillary patients into 4 categories to better plan surgical reconstruction.

Conclusions

Axillary reconstruction is still a plastic surgery challenge. Peculiar surgical details should be considered when approaching this area. This new classification may help young surgeons during the reconstructive phase.
Peptides derived from cadherin juxtamembrane region inhibit platelet function
Authors: Golla Kalyan , Stavropoulos Ilias , Shields Denis C. , Moran Niamh
Published: October 2018

The juxtamembrane domains (JMD) of transmembrane proteins are rich in critical peptide sequences that participate in dynamic cell signalling events. Synthetic JMD peptides derived from cadherin cell adhesion proteins have previously been shown to modulate platelet function. In this study, we aimed to develop functional bioactive agents from bioinformatically identified critical peptide sequences. We synthesized overlapping 12–15 amino acid peptides from E- and N-cadherin JMD and assessed their effect on platelet aggregation and platelet ATP secretion. Peptides derived from close to the membrane proximal region inhibit platelet function. Sequential deletion of amino acids from the N- and C-termini of the inhibitory E-cadherin peptides identified the short K
756
EPLLP
763
motif as a critical bioactive sequence. Alanine scanning studies further identified that the di-leucine (LL) motif and positively charged lysine (K) are crucial for peptide activity. Moreover, scrambled peptides failed to show any effect on platelet activity. We conclude that peptides derived from JMD of E-cadherin provide potential lead peptides for the development of anti-thrombotic agents and to enable further understanding of the role of cadherins in platelet function.
Effect of the second-step voltages on the structural and corrosion properties of silicon–calcium–phosphate (Si–CaP) coatings on Mg–Zn–Ca alloy
Authors: Dou Jinhe , Zhao Yupeng , Lu Lu , Gu Guochao , Yu Huijun , Chen Chuanzhong
Published: October 2018

The applications of magnesium (Mg) alloys as biodegradable orthopedic implants are mainly restricted due to their rapid degradation rate in the physiological environment. In this study, Si–CaP micro-arc oxidation (MAO) coatings were prepared on a Mg–Zn–Ca alloy by a second-step MAO process at different voltages in order to decrease the degradation rate and increase the bioactivity of the alloy. The microstructure and morphology of the samples were characterized using XRD, FT-IR SEM and EDS. The degradation behaviours of samples were evaluated using electrochemical techniques, and immersion tests in simulated body fluid (SBF). The results indicate that the morphology of the Si–CaP coatings changed significantly with the increase in Ca/P ratio as the second-step voltage increased. The Si–CaP containing coating produced at 450 V could significantly decrease the degradation rate of Mg and caused a slow increase in pH of the SBF solution. The haemolysis test concluded that the coating C3 did not cause a haemolytic reaction. The corrosion resistance of Mg alloy was greatly improved with the Si–CaP coatings, and the Mg alloy with Si–CaP coating prepared at 450 V had the best corrosion resistance, which indicates that the Si–CaP coatings are promising for improving the biodegradation properties of Mg-based orthopedic implants. Haemolysis tests indicated that the Si–CaP coating prepared at 450 V conforms to the given standard (YY/T0127.1-93).
A new chart of hydraulic fracture height prediction based on fluid–solid coupling equations and rock fracture mechanics
Authors: Liu Xiaoqiang , Qu Zhanqing , Guo Tiankui , Wang Dongying , Tian Qizhong , Lv Wei
Published: October 2018

The conventional method to predict hydraulic fracture height depends on linear elastic mechanics, and the typical Gulrajani–Nolte chart fails to reflect fracture height when the net pressure in the fracture is too high. Based on fluid–solid coupling equations and rock fracture mechanics, a new chart is obtained by the ABAQUS extended finite-element method. Compared with the Gulrajani–Nolte chart, this new chart shows that longitudinal propagation of hydraulic fracture is still finite when the net pressure in the fracture is higher than
in situ
stress difference between reservoir and restraining barrier. The barrier has a significant shielding effect on the longitudinal propagation of hydraulic fracture, and there is a threshold for an injection rate of fracturing fluid to ensure hydraulic fracture propagates in the barrier. Fracture height decreases with the increase of
in situ
stress difference. When the ratio of net pressure to
in situ
stress difference is less than 0.56, the propagation of hydraulic fracture is completely restricted in the reservoir. Hydraulic fracturing parameters in Well Shen52 and Well Shen55 are optimized by using the new chart. Array acoustic wave logging shows that the actual fracture height is at an average error within 14.3% of the theoretical value, which proves the accuracy of the new chart for field application.
Hunter selection for larger and older male bobcats affects annual harvest demography
Authors: Allen Maximilian L. , Roberts Nathan M. , Van Deelen Timothy R.
Published: October 2018

Wildlife researchers often rely on demographic data collected from harvested animals to estimate population dynamics. But demographic data from harvested animals may be non-representative if hunters/trappers have the ability and motivation to preferentially select for certain physical traits. Hunter preference is well demonstrated for ungulates, but less so for other wildlife species such as furbearers. We used data from bobcats harvested in Wisconsin (1983–2014) to determine if harvest method and demographics (mass, male:female sex ratio and age) have changed over time, and if bobcat hunters/trappers exhibited selection. Each trait of harvested bobcats that we tested changed over time, and because these selected traits were interrelated, we inferred that harvest selection for larger size biased harvests in favour of older, male bobcats. The selection of older, male bobcats appears primarily driven by hound hunters (hereafter hunters) compared to trappers, with hunters more frequently creating taxidermy mounts from their harvested bobcats. We found an increase in the proportion of bobcats that were harvested by hunting compared to trapping over time, and this was associated with increased selectivity and substantial changes in the characteristics of harvested bobcats. Selection by hunters may bias population models that are based on the demography of harvested bobcats, and accounting for biases that may occur, including from different harvest methods, is critical when using harvest-dependent data.
Hunter–gatherer mobility and technological landscapes in southernmost South America: a statistical learning approach
Authors: Briz i Godino Ivan , Ahedo Virginia , Álvarez Myrian , Pal Nélida , Turnes Lucas , Santos José Ignacio , Zurro Débora , Caro Jorge , Galán José Manuel
Published: October 2018

The present work aims to quantitatively explore and understand the relationship between mobility types (nautical versus pedestrian), specific technological traits and shared technological knowledge in pedestrian hunter–gatherer and nautical hunter–fisher–gatherer societies from the southernmost portion of South America. To that end, advanced statistical learning techniques are used: state-of-the-art classification algorithms and variable importance analyses. Results show a strong relationship between technological knowledge, traits and mobility types. Occupations can be accurately classified into nautical and pedestrian due to the existence of a non-trivial pattern between mobility and a relatively small fraction of variables from some specific technological categories. Cases where the best-fitted classification algorithm fails to generalize are found significantly interesting. These instances can unveil lack of information, not enough entries in the training set, singular features or ambiguity, the latter case being a possible indicator of the interaction between nautical and pedestrian societies.
The left ventral premotor cortex is involved in hand shaping for intransitive gestures: evidence from a two-person imitation experiment
Authors: Reader Arran T. , Holmes Nicholas P.
Published: October 2018

The ventral premotor cortex (PMv) is involved in grasping and object manipulation, while the dorsal premotor cortex (PMd) has been suggested to play a role in reaching and action selection. These areas have also been associated with action imitation, but their relative roles in different types of action imitation are unclear. We examined the role of the left PMv and PMd in meaningful and meaningless action imitation by using repetitive transcranial magnetic stimulation (rTMS). Participants imitated meaningful and meaningless actions performed by a confederate actor while both individuals were motion-tracked. rTMS was applied over the left PMv, left PMd or a vertex control site during action observation or imitation. Digit velocity was significantly greater following stimulation over the PMv during imitation compared with stimulation over the PMv during observation, regardless of action meaning. Similar effects were not observed over the PMd or vertex. In addition, stimulation over the PMv increased finger movement speed in a (non-imitative) finger–thumb opposition task. We suggest that claims regarding the role of the PMv in object-directed hand shaping may stem from the prevalence of object-directed designs in motor control research. Our results indicate that the PMv may have a broader role in ‘target-directed’ hand shaping, whereby different areas of the hand are considered targets to act upon during intransitive gesturing.
Wild chimpanzees select tool material based on efficiency and knowledge
Authors: Lamon Noemie , Neumann Christof , Gier Jennifer , Zuberbühler Klaus , Gruber Thibaud
Published: October 2018

Some animals have basic culture, but to date there is not much evidence that cultural traits evolve as part of a cumulative process as seen in humans. This may be due to limits in animal physical cognition, such as an inability to compare the efficiency of a novel behavioural innovation with an already existing tradition. We investigated this possibility with a study on a natural tool innovation in wild chimpanzees: moss-sponging, which recently emerged in some individuals to extract mineral-rich liquids at a natural clay-pit. The behaviour probably arose as a variant of leaf-sponging, a tool technique seen in all studied chimpanzee communities. We found that moss-sponges not only absorbed more liquid but were manufactured and used more rapidly than leaf-sponges, suggesting a functional improvement. To investigate whether chimpanzees understood the advantage of moss- over leaf-sponges, we experimentally offered small amounts of rainwater in an artificial cavity of a portable log, together with both sponge materials, moss and leaves. We found that established moss-spongers (having used both leaves and moss to make sponges) preferred moss to prepare a sponge to access the rainwater, whereas leaf-spongers (never observed using moss) preferred leaves. Survey data finally demonstrated that moss was common in forest areas near clay-pits but nearly absent in other forest areas, suggesting that natural moss-sponging was at least partly constrained by ecology. Together, these results suggest that chimpanzees perceive functional improvements in tool quality, a crucial prerequisite for cumulative culture.