bluuebunny/crossref_metadata_2025 huggingface dataset:
18F-FDG PET/CT Imaging Findings of Leprosy
Authors: Shao Dan , Deng Yue-Ting , Shao Fu-Qiang , Liang Jia-Wei , Wang Shu-Xia
Published: January 2020

Leprosy is a chronic infectious disease caused by Mycobacterium leprae infection in susceptible individuals. Without proper clinical diagnosis and treatment, leprosy can have a poor prognosis; however, diagnosing leprosy is challenging. We present a case of leprosy with extensive skin infiltration and involvement of the turbinate mucosa and multiple lymph nodes with increased FDG uptake on PET/CT, mimicking malignancy.
Comparison of Diagnostic Utility of Fluciclovine PET/CT Versus Pelvic Multiparametric MRI for Prostate Cancer in the Pelvis in the Setting of Rising PSA After Initial Treatment
Authors: Chen Bo , Bathala Tharakeswara K. , Xu Guofang , Teyateeti Ajalaya , Chapin Brian F. , Tang Chad , Tu Shi-Ming , Macapinlac Homer A. , Lu Yang
Published: January 2020

Purpose

The aim of this study was to investigate the imaging diagnostic performance of 18F-fluciclovine PET/CT and pelvic multiparametric MRI (mpMRI) for prostate cancer in the setting of rising PSA after initial treatment, with a focus on detection of recurrent and metastatic prostate cancer in the pelvis.

Methods

Patients with prostate cancer who had fluciclovine PET and pelvic mpMRI between October 2017 and October 2018 in our center were retrospectively reviewed. Patients were included if they had fluciclovine PET/CT and mpMRI within a 3-month interval. Patients were excluded if they had separate concurrent cancer or if the PSA were more than 2-fold difference with an absolute difference more than 1 ng/mL between the 2 image studies. For each eligible patient, we compared all abnormal lesions identified on either scan. The findings were verified by pathology or other imaging techniques within minimal 10-month clinical follow-up.

Results

A total of 129 patients with 129 paired tests were included in this study. Fluciclovine PET/CT and pelvic MRI had a high degree of concordance (121/129, 93.8%). The sensitivity, specificity, positive predictive value, and negative predictive value for fluciclovine PET/CT and mpMRI were 96.6%, 94.3%, 93.4%, and 97%, and 91.5%, 95.7%, 94.7%, and 93%, respectively. There were no statistical significant differences in diagnostic performance between the 2 imaging tests. Among the 8/129 discordant cases, although fluciclovine PET/CT provided definitive diagnosis when mpMRI was equivocal due to paramagnetic artifacts from fiducial markers and detected normal-sized regional lymph nodes, mpMRI detected subcentimeter periurethral recurrence and clarified physiological urinary artifacts that was not appreciated on fluciclovine PET/CT.

Conclusions

Our single-center study demonstrated that fluciclovine PET/CT has similar diagnostic performance with pelvic mpMRI in detecting recurrent/metastatic prostate disease in the pelvis in the setting of rising PSA after initial treatment. Moreover, fluciclovine PET/CT and mpMRI have different implications in different clinical scenario; each test has its own limitation and pitfalls, but can be complementary to each other.
Features of the Ulnar Nerve Predicting Postoperative Prognosis in Idiopathic Cubital Tunnel Syndrome
Authors: Cha Soo Min , Shin Hyun Dae
Published: January 2020

Purpose

This retrospective case-control study was performed to determine the relationships between features of the ulnar nerve and postoperative outcomes following in situ decompression in idiopathic cubital tunnel syndrome (CuTS).

Methods

The study population consisted of 86 patients who had undergone surgery for CuTS. We evaluated demographic factors, hand dominance, symptom onset time, time from diagnosis to surgery, findings of electrodiagnosis (nerve conduction velocity/electromyography), and preoperative clinical status. Intraoperatively, the ulnar nerve was defined as a definitively compressed, abnormally enlarged, or inflammatory lesion. Clinical improvements were evaluated at least 2 years after surgery.

Results

Fifty-four patients showed improvement after surgery in terms of the modified McGowan grade and were designated as group 1. Meanwhile, 32 patients with unchanged or aggravated status were classified as group 2. Preoperative status, as determined by the modified McGowan grade, Boston Symptom Severity Scale score, severity of electrodiagnosis, and predominant symptoms were similar between the groups (all, P > 0.05). On regression analysis, only the classification of nerve lesions and the time from diagnosis to surgery had an impact on postoperative outcome (all, P < 0.05). Especially, enlarged ulnar lesion predicted poor prognosis (P = 0.003).

Conclusions

Ulnar nerve enlargement, grossly detected intraoperatively, and long interval between diagnosis and surgery were independently associated with poor prognosis of CuTS. Among the anatomic structures involved in the generation of CuTS, the medial epicondyle showed a strong association with enlarged nerve lesions.
The Role of Practice Diversification in the Growth of a Burn Center Network
Authors: Lineaweaver William C. , Bennett Susan , Hills Jocelyn , Mullins Fred
Published: January 2020

Practices within the Burn and Reconstructive Centers of America network have been organized to provide immediate and secondary reconstructive plastic surgery to burn patients. These reconstructive surgery abilities have been further engaged to expand these practices with non–burn-related surgical cases.

Seven Burn and Reconstructive Centers of America practices were analyzed to quantitate the effects of nonburn reconstructive cases on practice growth over a 4-year period (2015–2018).

All surgical cases were performed during the study period and were analyzed to identify burn-related procedures and procedures not related to burn injuries. Fifty-two percent of the cases were burn-related, whereas 48% were not burn-related. Over the 4-year period, burn cases increased by 46%, whereas nonburn cases increased by 84%. The overall percentage of nonburn cases increased from 43% in 2015 to 50% and 49% in 2017 and 2018.

Nonburn cases contributed effectively to practice growth over this period. This practice model successfully engages broad reconstructive surgery skill sets to expand practice volumes.
Evaluation of Microneedling Therapy in Management of Facial Scars
Authors: Vijaya Lakshmi Yenugandula , Swetha Reddy Lingaladinne , Naga Neelima Devi Kolli , Phani Kumar Kuchimanchi , Guru Karthik Gandikota , Srinivas Chakravarthy Pandi , Nageswar Rao Kondrakunta
Published: January 2020

Background:

Appearance and beauty always have been playing a major aspect of human's lives, regardless of the era. The desire for man to look better had led to various treatment modalities. One among them is microneedling therapy, also called as percutaneous collagen induction therapy or dermaroller therapy. Henceforth, the aim of the study was to evaluate the efficacy of microneedling therapy in the management of facial scars.

Methods:

An observational clinical study was conducted with a total of 14 patients who needed treatment and presented to the out-patient department of Department of Oral and Maxillofacial Surgery. The patients who were cooperative, motivated, and esthetically conscious with facial scars due to trauma, soft-tissue injury following incision and drainage, postsurgical scars, scars following surgery of cleft lip correction, and postacne scars were randomly selected.

Results:

In the present study, a statistically significant difference was observed with pre- and postsurgical patient satisfaction scale (PSS) and observed satisfaction scale (OSS; P = 0.001). Preoperatively there were 64.3% with depressed scars and 35.7% with elevated scars. The clinical response of height of scar postoperatively was 100% flattening with the surrounding skin surface. Results showed that all atrophic and hypertrophic scars showed improvement, and color of the scar which was darker or lighter than the surrounding skin got the same color as the surrounding skin after microneedling therapy. Pain during the procedure was easily tolerable by the patient and no postoperative pain was noted.

Conclusion:

Microneedling therapy can be considered as an effective modality of treatment for facial scars in patients with an added advantage of minimal downtime and effective improvement. It is simple and cost-effective technique in the treatment of facial scars.
Reconstruction of Mandibular Defects With Bone Marrow-Derived Stem Cells in Odontogenic Myxoma
Authors: Shin Hyeon Seo , Kim Min Su , Kim Byung Hoon , Lim Hun Jun , Kim Bong Chul , Lee Jun
Published: January 2020

Odontogenic myxoma is a benign tumor, mostly located in the mandible. It shows locally aggressive behavior and requires surgical removal. Common treatment options for reconstructing the bone defects are immediate or delayed autologous bone graft or free flap. In this article, the authors present the successful reconstruction with autogenous bone graft and autologous human bone marrow mesenchymal stem, followed by distraction osteogenesis, dental implant placement and prosthodontic restoration in the mandibular defect.
Orthognathic Surgical Treatment in a Patient With Hyperimmunoglobulin E Syndrome
Authors: Dibbs Rami , Raghuram Anjali , Roy Michelle G. , Kaufman Matthew G. , Monson Laura A.
Published: January 2020

Autosomal-dominant hyperimmunoglobulin E syndrome (HIES), or Job syndrome, is a rare, multisystem, primary immunodeficiency disorder. Additionally, patients may also suffer from connective tissue, dental, and bone malformations. While current management of HIES is directed at prophylactic antibiotics to prevent infections, there is limited work describing surgical considerations for these patients, particularly with respect to hardware placement. Here we report a case of a patient with HIES who underwent orthognathic surgery for maxillary advancement and mandibular setback to address his severe class III malocclusion. The patient's postoperative course was complicated by significant infection, requiring multiple operations and ultimately, hardware removal after bone healing. Although this patient ultimately had a good outcome, the role of orthognathic surgery with implant placement in patients with HIES should be approached with caution and careful consideration.
Spontaneous and Dramatic Improvements in Open Bite Deformity Secondary to Large Maxillofacial Venous Malformation With Macroglossia After Sclerotherapy and Laser Therapy
Authors: Sun Yi , Gu Hao , Yang Xi , Hu Li , Cai Ren , Chen Hui , Lin Xiaoxi
Published: January 2020

Background:

Large maxillofacial venous malformation (VM) lesions can affect the craniofacial skeleton, causing occlusal and craniofacial deformity. Few studies have discussed the management of these skeletal disorders. It is unclear whether orthodontic treatment and orthognathic surgery are necessary after such a VM lesion has been significantly reduced.

Methods:

A 13-year-old boy with a large, extensive maxillofacial VM lesion, severe facial asymmetry, macroglossia, and lower lip hypertrophy visited our department in 2010. He received more than 100 sclerotherapy treatments and 20 laser treatments in the past 8 years.

Results:

The patient's cosmetic disfigurement greatly improved, and the VM lesion diminished by more than 80%. Changes in the bite and craniofacial skeleton progressed from “normal” to “open bite with skeletal deformity” and finally to “spontaneously close to normal”.

Conclusions:

During the progression of VM, removal of pathogenic factors can inhibit the aggravation of open bite deformity and promote the spontaneous improvement, thereby circumventing the need for complicated osteotomy, orthodontic intervention and/or orthognathic surgery.
Comparison of Facial Proportions Between Eastern and Western Attractive Young Women
Authors: Yi Chang Ryul , Kim Min Ji , Kim Sung-Chan , Gaxiola-García Miguel , Jeong Woo Shik , Koh Kyung S. , Huh Chang Hun , Kim Hee Jin , Lee Woo Sun , Choi Jong Woo
Published: January 2020

The characteristics of what is considered a beautiful face differ between Eastern and Western countries.

The authors of this study analyzed beauty pageant contestants using a three-dimensional (3D) photogrammetric analysis tool. All of the 3D photographs were taken between October and November 2016 in Seoul, Korea. The participants were 43 Miss Korea contestants (Group I) and 22 Miss Paraguay contestants (Group II).

In absolute length, those in Group I had longer upper and middle faces. In the proportions of volume and length, Group I had larger upper and middle faces than Group II. Widths of the lower face and entire face were also wider in Group I. The lower facial index was larger in Group I. Group I had longer noses and wider intercanthal distance, not only in absolute length but also in proportion to the face. Group II showed thicker lips, longer chins, and wider noses relative to the face. Group II had wide eyes, in the absolute measurement and in proportion to the face. Group I participants appeared to have an increased height of eyes and had wider angles in their faces as well as wider nasofrontal, labiomental, and nasomental angles.

The authors objectively established reference data for faces that are considered attractive in the East and the West. The data are expected to contribute to the clinical practice of plastic surgeons.
Three-Dimensional Measurement of Maxillary Involvement in Hemifacial Microsomia in Children
Authors: Xu Xi , Zhang Zhi-yong , Li Bing-hang , Tang Xiao-jun , Yin Lin , Liu Wei
Published: January 2020

In hemifacial microsomia (HFM), the aberrant mandible structure has always been the focus of attention. How the maxillary development being affected is not clear. The authors sought to comprehensively evaluate the hemifacial maxillary deficiency and to assess for Pruzansky-Kaban score correlation.

This is a retrospective research of children with HFM. Demographic information were recorded, and computed tomographic scan were reconstructed and analyzed by segmentation, volumetric and cephalometric measurements. Analyses involved pairedt-test, independent samplet-test and one-way analyses of variance.

Demographic information revealed 67 patients diagnosed with HFM were included: 10.4 percent type I, 38.8 percent IIa, 28.4 percent type IIb, 22.4 percent type III. The maxillary total volume was found to be significantly decreased on the affected side in patients with type IIa (P = 0.0426) and IIb (P = 0.0004). No notable differences in maxillary sinus volume were found. No significant differences in maxillary width measurements were found between groups type I and III. A descending trend in maxillary bone volume ratio, an increasing trend in maxillary posterior width ratio and a decreasing trend in maxillary middle height ratio was observed from group I to IIb (pmbv∗ = 0.020;pmpw∗ = 0.002;pmmh∗ = 0.004).

This study comprehensively characterized the hemifacial microsomia maxillary deficiency. For maxillary total volume and transverse development, the type III group presented characteristics similar to the type I group. We concluded that the severity of maxillary deficiency is not completely consistent with the mandibular deformity classification.
A Survey of Aesthetic Standards of the Ear
Authors: Lei Liu , Shichun Zhao , Zhenzhong Liu , Qiangwei Wu , Fangfang Huang , Zhensheng Hu , Bo Pan
Published: January 2020

Background:

The aesthetic standards of the ear are very important for evaluation of auricular surgery. Few studies have previously assessed ear aesthetics, especially in China. This study aimed to investigate aesthetic standards of the ear in a Chinese population.

Materials and Methods:

A questionnaire was administered to Chinese individuals, which included assessment of the general impressions of the ear and other facial aesthetic units, the individual aesthetic subunits of the ear, the effects of different ear subunits on ear symmetry and the degree of the subunits to which the participants wanted to change. Answers were recorded on a five-point Likert-style scale. Statistical analysis was performed using SPSS ver. 17.0.

Results:

A total of 319 responses were received, 50.3% women and 49.7% men. The external ear received the lowest degree of attention either on the front or on the lateral view of the face in both genders. Among the individual aesthetic units, the earlobe received the most attention and the fine structures the lowest. The helix had the greatest effect on the ear symmetry. The structure that participants most wanted to change was the earlobe in males and the helix in females. There were significant differences on the evaluation of the helix and crus of helix among the groups divided according to educational background (P < 0.001).

Conclusion:

The results showed that the structures that people were most concerned about were the helix and earlobe. There were gender differences in the results which were also influenced by education background.
Negative Pressure Wound Therapy With Chymotrypsin Irrigation: A Maximal Implant Retention Procedure Treating the Exposure/Infection of Titanium Mesh in Cranioplasty
Authors: Huang Zugen , Lei Chen , Zhang Ling , Xue Huadong , Shen Jian , Wu Shanying , Wang Biao , Chen Jianwu
Published: January 2020

This preliminary study aims to investigate the effects of a maximal implant retention procedure. The authors retrospectively reviewed the use of negative pressure wound therapy with chymotrypsin irrigation treating implant infection/exposure in titanium mesh cranioplasty by comparing patients with titanium mesh totally retained, partially removed, or totally removed according to the evaluation during the surgery. Negative pressure wound therapy with chymotrypsin irrigation was applied 5 days after the surgery. The negative pressure was set at −125 to −150 mmHg. A total of 21 patients were included, 4 patients treated with titanium mesh totally removed; 3 patients treated with titanium mesh partially removed; and 14 patients treated with U-shape debridement with titanium mesh preserved completely. However, 1 patient in the U-shape group required a second debridement to remove all implant. Negative pressure wound therapy with chymotrypsin irrigation is a novel procedure and could be used to treat implant-related infection without the exchange of implant.
The Preliminary Application of Augmented Reality in Unilateral Orbitozygomatic Maxillary Complex Fractures Treatment
Authors: Chen Gang , Zeng Wei , Yin Huaqiang , Yu Yunbo , Ju Rui , Tang Wei
Published: January 2020

Purpose:

Try to apply augmented reality (AR) technique which based on visual recognition artificial marks in the treatment of unilateral Orbitozygomatic Maxillary complex fractures (OZMF), and to explore the feasibility and the application value of the AR for assisting the oral and maxillofacial surgery (OMFS) treatment.

Methods:

Based on the AR application JSARToolKit developed on the web, and combining with the self-designed tooth-borne type visual recognition artificial marks to display three-dimensional (3D) image of the region of interest (ROI), virtually designed the position and direction of plate on the jaw and helped OZMF surgery. According to some results to evaluate the postoperative effects, such as imaging, occlusion, facial appearance recovery, patients’ satisfaction and operation time.

Results:

The AR achieved the 3D image of ROI in real time, satisfied information enhancement of real scene, broadened the surgeon's horizons and improved the 3D recognition ability of maxillofacial tissue. After operation, patients had no discomforts, fracture reduction were well healed through imaging examination, and the titanium plate position was consistent with the preoperative planning. What is more, patients’ facial appearance and occlusal function recovered well, significantly shorten the intraoperation time.

Conclusion:

Augmented reality technology is an effective method for OZMF treatment but there are still many technical difficulties which need to be get over, and its application in maxillofacial surgery and relevant basic theories are both worth further exploring.
Exploring Clinically-Relevant Experimental Models of Neonatal Shock and Necrotizing Enterocolitis
Authors: Nolan Lila S. , Wynn James L. , Good Misty
Published: January 2020

Neonatal shock and necrotizing enterocolitis (NEC) are leading causes of morbidity and mortality in premature infants. NEC is a life-threatening gastrointestinal illness, the precise etiology of which is not well understood, but is characterized by an immaturity of the intestinal barrier, altered function of the adaptive immune system, and intestinal dysbiosis. The complexities of NEC and shock in the neonatal population necessitate relevant clinical modeling using newborn animals that mimic the disease in human neonates to better elucidate the pathogenesis and provide an opportunity for the discovery of potential therapeutics. A wide variety of animal species—including rats, mice, piglets, and primates—have been used in developing experimental models of neonatal diseases such as NEC and shock. This review aims to highlight the immunologic differences in neonates compared with adults and provide an assessment of the advantages and drawbacks of established animal models of both NEC and shock using enteral or intraperitoneal induction of bacterial pathogens. The selection of a model has benefits unique to each type of animal species and provides individual opportunities for the development of targeted therapies. This review discusses the clinical and physiologic relevance of animal models and the insight they contribute to the complexities of the specific neonatal diseases: NEC and shock.
The Colombian Experience in Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): The Progression From a Large Caliber to a Low-Profile Device at a Level I Trauma Center
Authors: Ordoñz Carlos A. , Khan Mansoor , Cotton Bryan , Perreira Bruno , Brenner Megan , Ferrada Paula , Horer Tal , Kauvar David , Kirkpatrick Andrew , Priouzram Artai , Roberts Derek , Duchesne Juan
Published: January 2020

Purpose:

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is now performed in many trauma centers, it is used at more than 250 hospitals in the United States and there is an increase rate of publications with the experience in these centers, but there is a gap of knowledge regarding the use of REBOA in Latin-America. This paper endeavors to describe the utilization of REBOA at a high level Latin-American Trauma Center and the transition from a large caliber to a low-profile device with the concomitant reduction in the groin access complications.

Methods:

A prospective, observational, single-center study was conducted. We included all trauma patients who underwent REBOA. We recorded data from admission parameters, complications, and clinical outcomes.

Results:

Fifty patients were included. Most of the REBOA catheters were inserted in the operating room [47 (94%)], and the arterial access was done by surgical cutdown [40 (80%)]. All the complications were associated with the catheter of 11 Fr Sheath used in 36 patients [n = 8/36 (22%) vs. n = 0/14 (0%); P = 0.05].

Conclusion:

REBOA can be used safely in blunt or penetrating thoracic, abdominal, and pelvic trauma. The insertion of a 7 Fr Sheath was associated with lower complications, so its use should be preferred over larger calibers.
Laparoscopic Liver Transplantation
Authors: Dokmak Safi , Cauchy François , Sepulveda Ailton , Choinier Pierre Marie , Dondéro Fédérica , Aussilhou Béatrice , Hego Camille , Chopinet Sophie , Infantes Pauline , Weiss Emmanuel , Francoz Claire , Sauvanet Alain , Paugam-Burtz Catherine , Durand François , Soubrane Olivier
Published: January 2020

Objective:

To introduce the laparoscopic approach in liver transplant recipients.

Summary of Background Data:

Despite the increasingly frequent use of laparoscopy in living donor hepatectomy, the laparoscopic approach has never been reported in liver transplant recipients.

Methods:

A 52-year-old woman (body mass index: 18.5 kg/m2) with neuroendocrine liver metastases of a digestive origin underwent hybrid liver transplantation by pure laparoscopic total hepatectomy and liver graft implantation using a preexisting midline incision. The hepatic pedicle vessels were dissected after division of the bile duct without a porto-caval shunt. Left lateral sectionectomy and early division of the common trunk allowed near completion of caval dissection with no prolonged inflow occlusion. The liver graft was reduced and latero-lateral caval anastomosis was performed.

Results:

Surgery lasted 400 minutes with 400 mL of blood loss. The anhepatic phase lasted 43 minutes. Warm ischemia time and cold ischemia times were 38 and 466 minutes, respectively. The postoperative course was uneventful.

Conclusions:

This case study suggests that the hybrid approach may be feasible and safe in selected recipients. The decision to use this surgical approach should be made in transplant centers with significant expertise in both laparoscopic liver and pancreatic surgery. Further reducing the size of the abdominal incision is the next step, which may be achieved with the development of vascular anastomoses devices.
Outcomes After Multidisciplinary Management of Primary Mediastinal Germ Cell Tumors
Authors: Caso Raul , Jones Gregory D. , Bains Manjit S. , Hsu Meier , Tan Kay See , Feldman Darren R. , Funt Samuel A. , Reuter Victor E. , Bosl George J. , McHugh Deaglan , Huang James , Molena Daniela , Amar David , Fischer Gregory , Rusch Valerie W. , Jones David R.
Published: January 2020

Objective:

We examined management strategies, overall survival (OS), and progression-free survival (PFS) among patients with PMNSGCTs undergoing resection and multidisciplinary management at a high-volume institution.

Summary of Background Data:

Outcomes after resection of PMNSGCTs are not well-characterized, with limited data on factors associated with survival.

Methods:

We reviewed patients with PMNSGCT who underwent resection between 1980 and 2019. Median follow-up was 3.4 years. Preoperative therapy (including use of bleomycin), surgical management, recurrence, and survival were examined. Factors associated with survival were analyzed using Cox regression.

Results:

In total, 113 patients were included [median age, 28 years (range, 16–65)]. Preoperative serum tumor markers (STMs) normalized/decreased in 74% of patients. Pathology included necrosis only (25%), teratoma +/− necrosis (20%), viable nonteratomatous germ cell tumor +/− teratoma (41%), and secondary somatic-type malignancy +/− teratoma (20%). Bleomycin chemotherapy was not associated with pulmonary complications or 90-day mortality. Patients receiving second-line chemotherapy followed by resection had significantly worse OS and PFS than patients receiving first-line chemotherapy followed by resection. On multivariable analysis, R1/R2 resection (HR, 3.92; P < 0.001) and increasing postoperative STMs (HR, 4.98; P < 0.001) were associated with shorter PFS; necrosis on pathology (HR, 0.42, P = 0.043) was associated with longer PFS.

Conclusions:

In patients with PMNSGCT undergoing resection, completeness of resection, postoperative pathology, and postoperative STMs were associated with PFS. Induction bleomycin was not associated with pulmonary complications or mortality in patients undergoing resection. Patients undergoing second-line chemotherapy followed by resection have a poor prognosis, with long-term survival of 22%.
Consensus Statement on Robotic Mastectomy—Expert Panel From International Endoscopic and Robotic Breast Surgery Symposium (IERBS) 2019
Authors: Lai Hung-Wen , Toesca Antonio , Sarfati Benjamin , Park Hyung Seok , Houvenaeghel Gilles , Selber Jesse C. , Cheng Fiona Tsui-Fen , Kuo Wen-Ling , Peradze Nickolas , Song Seung Yong , Mok Chi Wei
Published: January 2020

Objectives:

To achieve a consensus statement on robotic mastectomy.

Background:

Robotic-assisted surgery has gained much attention especially the results of few case series reporting on the technical feasibility, safety and early oncologic outcomes of robotic-assisted mastectomy in a few centers worldwide. The aim of this consensus statement was to develop and provide standardized guidelines on robotic mastectomy based on consensus statement by a panel of experts from indications to outcome measures and indicators, thereby providing a valuable guide for breast surgeons worldwide.

Methodology:

An internationally representative expert panel of 10 surgeons was invited to participate in the generation of a consensus statement. 52 statements were created in 6 domains: indications, contraindications, technical considerations, patient counseling, outcome measures and indicators, training and learning curve assessment. Experts were asked to vote if they agree, disagree or of the opinion that the statement should be rephrased. Two electronic rounds via online survey of iterative rating and feedback were anonymously completed, followed by a final round of in-person meeting during the inaugural International Endoscopic and Robotic Breast Surgery Symposium 2019 from May 24 to 25, 2019. Consensus was reached when there was at least 80% agreement on each statement.

Results:

A total of 53 statements with at least 80% agreement were generated after 3 rounds of voting; 21 statements from first round of voting, 20 statements from second round of voting and 12 statements from the final round of in-person meeting. All experts agreed that the consensus statement served as expert recommendations but not mandatory for a successful and safe practice of robotic mastectomy.

Conclusion:

Robotic mastectomy is a promising technique and could well be the future of minimally invasive breast surgery whereas proving to be safe and feasible. The first consensus statement on robotic mastectomy from an international panel of experts serves as an extremely important milestone and provides recommendations for breast surgeons keen to embark on this technique.
The First Report of Laparoscopic Multivisceral Resection for a Gastrocolic Fistula Secondary to Colon Cancer
Authors: Ammori Basil J.
Published: January 2020

Background:

Colon cancer rarely presents with a gastrocolic fistula and resection, if feasible, is usually carried out by open surgery. The authors present the first literature case report of laparoscopic multivisceral resection for gastrocolic fistula secondary to locally advanced colon cancer.

Materials and Methods:

A 54-year-old man presented with feculant vomiting, cachexia, and severe iron deficiency anemia. Investigations confirmed a large nonmetastatic splenic flexure colon cancer with fistulation into the stomach. After 10 weeks of nutritional support and laparoscopic defunctioning proximal transverse loop colostomy, we proceeded to laparoscopic extended left hemicolectomy with en bloc sleeve gastrectomy and partial splenectomy.

Result:

The procedure was completed laparoscopically (operating time, 400 min; blood loss, 150 mL). He was discharged on the 6th postoperative day after an uneventful recovery. Histology showed an R0 resection of a pT4N1a (1/45 lymph nodes involved) colon cancer with gastrocolic fistula.

Conclusion:

Laparoscopic multivisceral en bloc R0 resection of locally advanced colon cancer with gastrocolic fistula can be accomplished safely in experienced hands.
Shortened Pattern Electroretinogram Latency and Impaired Autoregulatory Dynamics to Steady-State Stimuli in Patients With Multiple Sclerosis
Authors: Jiang Hong , Gameiro Giovana R. , Hu Huiling , Monsalve Pedro F. , Dong Chuanchui , Hernandez Jeffrey , Delgado Silvia R. , Porciatti Vittorio D. , Wang Jianhua
Published: January 2020

Background:

The steady-state pattern electroretinogram (PERG) is a sensitive measure of retinal ganglion cell (RGC) function that includes within-test progressive changes—adaptation—reflecting RGC autoregulatory dynamics. Comprehensive PERG assessment in patients with multiple sclerosis (MS) (with or without optic neuritis [ON]) may provide unique information about RGC dysfunction and its progression, as well as a comparison between functional loss and structural loss as measured by optical coherence tomography (OCT). The goal of this project was to measure steady-state PERG components and their associations with intraretinal layer thicknesses in MS.

Methods:

One hundred forty eyes of 70 patients with relapsing-remitting MS and 126 eyes of 63 age- and sex-matched healthy control subjects (HC) were investigated using a new-generation PERG method and ultrahigh-resolution OCT. Of MS eyes, there were 30 eyes with ON (MSON), 22 non-ON fellow eyes (MSFE), and 88 non-ON MS eyes (MSNON). PERG amplitude, phase (latency), and adaptation of amplitude and phase were measured and correlated with OCT-determined thicknesses of intraretinal layers.

Results:

The average PERG amplitude in MSON eyes was significantly lower than MSFE (P = 0.007), MSNON (P = 0.002), and HC (P < 0.001). The PERG amplitude in MSFE eyes was also significantly lower than HC (P = 0.039). The PERG latency in MSON eyes was significantly shorter than in MSFE (P = 0.001), MSNON (P = 0.002), and HC (P < 0.001). The PERG latency in MSFE (P = 0.007) and MSNON (P = 0.002) was significantly shorter than in HC. However, no significant differences were found between MSFE and MSNON (P > 0.05). PERG adaptation of amplitude in MSON was significantly lower than that in MSNON (P = 0.039) and HC (P = 0.037). Both the amplitude and latency in the MS eyes were significantly correlated with the thicknesses of the macular retinal nerve fiber layer (mRNFL) and ganglion cell-inner plexiform layer (GCIPL).

Conclusions:

Shortened PERG latency and impaired autoregulatory dynamics occurred in MS, suggesting preferential dysfunction of small, slower RGC axons and decreased ability of RGC to autoregulate their gain in response to PERG stimulus. The established relations of PERG measurements with intraretinal thickness measurements suggested that PERG losses were primarily associated with GCIPL and mRNFL thinning.
Trends in Prescriptions of Lithium and Other Medications for Patients with Bipolar Disorder in Office-based Practices in the United States: 1996-2015
Authors: Lin Yian , Mojtabai Ramin , Goes Fernando S , Zandi Peter P
Published: January 2020

Background

Studies have shown that rates of lithium use for bipolar disorder (BPD) in the United States declined through the 1990s as other mood stabilizing anticonvulsants and second-generation antipsychotics (SGAs) became more popular. We examined recent prescribing trends of medications for BPD over the past two decades.

Methods

Twenty years of data (1996-2015) from the National Ambulatory Medical Care Survey (NAMCS) were used. Weighted percentages of prescriptions of lithium, anticonvulsants, SGAs and antidepressants were calculated over two-year intervals. Logistic regression was used to examine factors related to polytherapy.

Results

Prescriptions of lithium declined from 38.1% (95%CI: 29.8% - 46.3%) in 1996-97 to 14.3% (95%CI: 10.6% - 18.1%) in 2006-07 and has remained stable since. During this time, prescriptions of SGAs more than doubled. SGAs and/or anticonvulsants were prescribed in 78.6% (95%CI: 73.0% - 84.2%) of BPD visits in 2014-2015. Polytherapy increased by approximately 4% every two years and in 2014-15 occurred in over 35% of BPD visits. Antidepressants were prescribed in 40-50% of BPD visits, but their prescriptions without other mood stabilizers decreased from 18.2% (95%CI: 11.7% - 24.8%) in 1998-99 to 5.8% (95%CI: 3.0% - 8.6%) in 2014-15.

Limitations

The sample had limited power to study the effect of individual medications or the potential for differing effects in certain subgroups of patients.

Conclusions

This study further documents the declining prescriptions of lithium for BPD, and corresponding increase in prescriptions of anticonvulsants and SGAs, despite the fact that lithium is typically recommended as a first line therapy for BPD.
InStrain enables population genomic analysis from metagenomic data and rigorous detection of identical microbial strains
Authors: Olm Matthew R. , Crits-Christoph Alexander , Bouma-Gregson Keith , Firek Brian , Morowitz Michael J. , Banfield Jillian F.
Published: January 2020

Coexisting microbial cells of the same species often exhibit genetic differences that can affect phenotypes ranging from nutrient preference to pathogenicity. Here we present inStrain, a program that utilizes metagenomic paired reads to profile intra-population genetic diversity (microdiversity) across whole genomes and compare populations in a microdiversity-aware manner, dramatically increasing genomic comparison accuracy when benchmarked against existing methods. We use inStrain to profile >1,000 fecal metagenomes from newborn premature infants and find that siblings share significantly more strains than unrelated infants, although identical twins share no more strains than fraternal siblings. Infants born via cesarean section harboredKlebsiellawith significantly higher nucleotide diversity than infants delivered vaginally, potentially reflecting acquisition from hospital versus maternal microbiomes. Genomic loci showing diversity within an infant included variants found in other infants, possibly reflecting inoculation from diverse hospital-associated sources. InStrain can be applied to any metagenomic dataset for microdiversity analysis and rigorous strain comparison.
Epigenetic gene-expression links heart failure to memory impairment
Authors: Islam Rezaul , Lbik Dawid , Sakib Sadman , Hofmann Raoul Maximilian , Berulava Tea , Mausbach Martí Jiménez , Cha Julia , Vakhtang Elerdashvili , Schiffmann Christian , Zieseniss Anke , Katschinski Dörthe Magdalena , Sananbenesi Farahnaz , Toischer Karl , Fischer Andre
Published: January 2020

In current clinical practice care of diseased patients is often restricted to separated disciplines. However, such an organ-centered approach is not always suitable. For example, cognitive dysfunction is a severe burden in heart failure patients. Moreover, these patients have an increased risk for age-associated dementias. The underlying molecular mechanisms are presently unknown and thus corresponding therapeutic strategies to improve cognition in heart failure patients are missing. Using mice as model organisms we show that heart failure leads to specific changes in hippocampal gene-expression, a brain region intimately linked to cognition. These changes reflect increased cellular stress pathways which eventually lead to loss of neuronal euchromatin and reduced expression of a hippocampal gene cluster essential for cognition. Consequently, mice suffering from heart failure exhibit impaired memory function. These pathological changes are ameliorated via the administration of a drug that promotes neuronal euchromatin formation. Our study provides first insight to the molecular processes by which heart failure contributes to neuronal dysfunction and point to novel therapeutic avenues to treat cognitive defects in heart failure patients.
Fusion of Drosophila oocytes with specified germline sister cells
Authors: Ali-Murthy Zehra , Fetter Richard D. , Kornberg Thomas B.
Published: January 2020

In many animals, oocytes develop together with sister germline cells that pass products to the developing oocyte. In Drosophila, fifteen sister germline (nurse) cells in each egg chamber are known to apoptose by stage 12-13, but we discovered that two specific nurse cells that are juxtaposed to the oocyte are eliminated precociously at stage 10B. These nurse cells fuse with the oocyte and their nuclei extrude through an opening that forms in the oocyte. These nuclei extinguish in the ooplasm, and at stage 11, egg chambers have thirteen nucleated nurse cells and the plasma membrane of the oocyte is mostly restored. In infrequent egg chambers in which nurse cells are not eliminated, oocytes do not develop normally and are not fertilized. Precocious elimination is common to other Drosophila species. We conclude that nurse cells are distinguished by position and identity, and that nurse cell dissolution proceeds in two stages.
Unacylated ghrelin and AZP531 suppress the 3D growth of breast cancers
Authors: Au CheukMan C. , Furness John B. , Britt Kara , Oshchepkova Sofya , Ladumor Heta , Soo Kai Ying , Callaghan Brid , Gérard Céline , Inghirami Giorgio , Mittal Vivek , Wang Yufeng , Huang Xin-Yun , Spector Jason A. , Andreopoulou Eleni , Zumbo Paul , Betel Doron , Dow Lukas E. , Brown Kristy A.
Published: January 2020

Breast cancer is the most common type of cancer in women and notwithstanding important therapeutic advances, it remains the second leading cause of cancer-related death in the US. Despite extensive research relating to the hormone ghrelin, responsible for the stimulation of growth hormone release and appetite, little is known of the effects of its unacylated form, especially in cancer. One major area of research relates to its reported effects to increase insulin sensitivity in diabetics, this being the basis for the development of unacylated ghrelin analog, AZP531 or livoletide, now in clinical trials for the treatment of Prader-Willi Syndrome. The mechanism of action of unacylated ghrelin is largely uncharacterized, in any system, because it does not bind to or activate the cognate ghrelin receptor, GHSR1a. The present study aimed to characterize effects of unacylated ghrelin on breast cancer cells, define its mechanism of action, and explore the therapeutic potential of unacylated ghrelin or analog AZP531. We report potent effects of unacylated ghrelin, at picomolar doses, on the growth of breast cancer cells, dependent on 3D culture and activation of Gαi. Suppression of MAPK signaling by unacylated ghrelin leads to cell cycle arrest and apoptosis. AZP531 also suppresses the growth of breast cancer cells in vitro and in xenografts, and may be a novel approach for the safe and effective treatment of breast cancer.
High-resolution transcriptional and morphogenetic profiling of cells from micropatterned human embryonic stem cell gastruloid cultures
Authors: Minn Kyaw Thu , Fu Yuheng C. , He Shenghua , George Steven C. , Anastasio Mark A. , Morris Samantha A. , Solnica-Krezel Lilianna
Published: January 2020

During mammalian gastrulation, germ layers arise and are shaped into the body plan while extraembryonic layers sustain the embryo. Human embryonic stem cells, cultured with BMP4 on extracellular matrix micro-discs, reproducibly differentiate into gastruloids, expressing markers of germ layers and extraembryonic cells with radial organization. Single-cell RNA sequencing and cross-species comparisons with mouse and cynomolgus monkey gastrulae suggest that gastruloids contain seven major cell types, including epiblast, ectoderm, mesoderm, endoderm, and extraembryonic trophoblast- and amnion-like cells. Upon gastruloid dissociation, single cells reseeded onto micro-discs were motile and aggregated with the same but segregated from distinct cell types. Ectodermal cells segregated from endodermal and extraembryonic cells but mixed with mesodermal cells. Our work demonstrates that the gastruloid system supports primate-specific features of embryogenesis, and that gastruloid cells exhibit evolutionarily conserved sorting behaviors. This work generates a resource for transcriptomes of human extraembryonic and embryonic germ layers differentiated in a stereotyped arrangement.
Microbial competition reduces interaction distances to the low µm-range
Authors: van Tatenhove-Pel Rinke J. , Rijavec Tomaž , Lapanje Aleš , van Swam Iris , Zwering Emile , Hernandez-Valdes Jhonatan A. , Kuipers Oscar P. , Picioreanu Cristian , Teusink Bas , Bachmann Herwig
Published: January 2020

Metabolic interactions between cells affect microbial community compositions and hence their function in ecosystems. It is well-known that under competition for the exchanged metabolite, concentration gradients constrain the distances over which interactions can occur. However, interaction distances are typically quantified in two-dimensional systems or without accounting for competition or other metabolite-removal, conditions which may not very often match natural ecosystems. We here analyze the impact of cell-to-cell distance on unidirectional cross-feeding in a three-dimensional system with competition for the exchanged metabolite. Effective interaction distances were computed with a reaction-diffusion model and experimentally verified by growing a synthetic consortium of 1 µm-sized metabolite producer, receiver and competitor cells in different spatial structures. We show that receivers cannot interact with producers ∼15 µm away from them, as product concentration gradients flatten close to producer cells. We developed an aggregation protocol and created variants of the receiver cells’ import system, to show that within producer-receiver aggregates even low affinity receiver cells could interact with producers. These results show that competition or other metabolite-removal of a public good in a three-dimensional system reduces the interaction distance to the low micrometer-range, highlighting the importance of concentration gradients as physical constraint for cellular interactions.
Bone morphogenetic protein 4 reduces global H3K4me3 to inhibit proliferation and promote differentiation of human neural stem cells
Authors: Nayak Sonali , Best Benjamin , Hayes Emily , Mahenthiran Ashorne , Wadhwani Nitin R , Mania-Farnell Barbara , Hashizume Rintaro , Kessler John A , James Charles David , Tomita Tadanori , Xi Guifa
Published: January 2020

Posttranslational modifications (PTMs) on histone tails spatiotemporally dictate mammalian neural stem cell (NSC) fate. Bone morphogenetic protein 4 (BMP4), a member of the transforming growth factor β (TGF-β) superfamily, suppresses NSC proliferation and fosters differentiation into astroglial cells. Whether PTMs mediate these effects of BMP4 is unknown. Here we demonstrate that BMP4 signaling causes a net reduction in cellular histone H3 lysine 4 trimethylation (H3K4me3), an active histone mark at promoters of genes associated with human NSC proliferation. We also show that H3K4me3 reduction by BMP4 is mediated by decreased expression of SETD1A and WDR82, two methyltransferase components of SETD1A-COMPASS. Down-regulation of these components decreases expression of key genes expressed in hNSCs, while ectopic expression via transfection dedifferentiates human astrocytes (HAs). These observations suggest that BMP4 influences NSC fate by regulating PTMs and altering chromatin structure.

SIGNIFICANCE STATEMENT

BMP4 is critical in determining hNSC fate. Whether histone posttranslational modifications (PTM) mediate the effects of BMP4 is unknown. Here we report that H3K4me3, brought about by its methyltransferases SETD1A and WDR82, at promoters of stem cell genes OCT4 and NESTIN is involved in human neural stem cell (hNSC) maintenance. BMP4 promotes hNSC astroglial differentiation in part through reduction of SETD1A and WDR82 and thus decreased frequency of H3K4me3 at the promoters of these genes. These results provide evidence that BMP4 promotes hNSC differentiation through a potential epigenetic mechanism and extend our understanding of the role of histone PTM in central nervous system development.