bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic dispersive solid‐phase extraction based on modified magnetic nanoparticles for the detection of cocaine and cocaine metabolites in human urine by high‐performance liquid chromatography–mass spectrometry
Authors: Yang Feiyu , Zou Yun , Ni Chunfang , Wang Rong , Wu Min , Liang Chen , Zhang Jiabin , Yuan Xiaoliang , Liu Wenbin
Published: August 2017

An easy‐to‐handle magnetic dispersive solid‐phase extraction procedure was developed for preconcentration and extraction of cocaine and cocaine metabolites in human urine. Divinyl benzene and vinyl pyrrolidone functionalized silanized Fe3O4 nanoparticles were synthesized and used as adsorbents in this procedure. Scanning electron microscopy, vibrating sample magnetometry, and infrared spectroscopy were employed to characterize the modified adsorbents. A high‐performance liquid chromatography with mass spectrometry method for determination of cocaine and its metabolites in human urine sample has been developed with pretreatment of the samples by magnetic dispersive solid‐phase extraction. The obtained results demonstrated the higher extraction capacity of the prepared nanoparticles with recoveries between 75.1 to 105.7% and correlation coefficients higher than 0.9971. The limits of detection for the cocaine and cocaine metabolites were 0.09–1.10 ng/mL. The proposed magnetic dispersive solid‐phase extraction method provided a rapid, environmentally friendly and magnetic stuff recyclable approach and it was confirmed that the prepared adsorbents material was a kind of highly effective extraction materials for the trace cocaine and cocaine metabolites analyses in human urine.
Use of pharyngeal packs in functional endoscopic sinus surgery: A randomized controlled trial
Authors: Green Ross , Konuthula Neeraja , Sobrero Maximiliano , Saini Alok , Parasher Arjun , Pool Christopher , Levine Adam I. , DeMaria Samuel , Tufts Ryan , Govindaraj Satish , Iloreta Alfred Marc
Published: August 2017

Objective

To determine if pharyngeal packs have an effect on postoperative pain and postoperative nausea and vomiting in functional endoscopic sinus surgery (FESS).

Study Design

Forty‐six patients scheduled for routine endoscopic sinus surgery were recruited into this study. The patients were randomly allocated to have or to not have pharyngeal packing prior to surgery.

Methods

The placement of pharyngeal packs during FESS is controversial. Theoretically, pharyngeal packs may prevent postoperative nausea and vomiting by preventing ingestion of blood during sinus surgery. However, prior studies have not conclusively demonstrated this to be the case in FESS. Pharyngeal packs have been associated with complications including throat pain, aspiration, and death. The objective of this randomized control trial was to determine if pharyngeal packs have an effect on postoperative throat pain, nausea, and vomiting in order to determine their importance during FESS.

Patients were blinded to intervention. Postoperatively, throat pain and nausea/vomiting scores were recorded.

Results

There was no significant difference in mean throat pain at 4 hours following surgery (P = 0.860). At 24 hours after surgery, patients without pharyngeal packing experienced more pain than those who had a throat pack placed (P = 0.002). There was no significant difference in the level of nausea at 4 hours after surgery (P = 0.315) or at 24 hours after surgery (P = 0.315).

Conclusion

We recommend against the routine use of placing pharyngeal packs during FESS.

Level of Evidence

1b. Laryngoscope, 127:2460–2465, 2017
Three‐dimensional tissue‐engineered skeletal muscle for laryngeal reconstruction
Authors: Brookes Sarah , Voytik‐Harbin Sherry , Zhang Hongji , Halum Stacey
Published: August 2017

Objective

There is an unmet need for tissue‐engineered three‐dimensional (3D) muscle constructs for laryngeal reconstruction. Functional engineered muscle could be used to repair postoncologic or traumatic defects or to medialize the vocal fold in cases of paresis/paralysis. Autologous, organized, engineered muscle that has adequate bulk integrates into host tissue and restores function currently does not exist.

Methods

Primary skeletal muscle progenitor cells (MPCs) were isolated from F344 rats. Three‐dimensional muscle constructs were created by encapsulating MPCs via flow alignment in a customized collagen formulation and cultured under passive tension. Muscle‐specific immunohistochemistry and confocal microscopy were used to evaluate muscle tissue differentiation. After 2 weeks of culture, muscle constructs were implanted into surgically created defects in the rat larynx. Postmortem function testing and histology was performed at 1 and 3 months.

Results

Immunohistochemistry with confocal microscopy demonstrated well‐differentiated myotubes, which were well aligned and distributed throughout the engineered construct in vitro. There was evidence of restoration of normal laryngeal function at 1 month postoperative, as indicated by safe swallow (no aspiration events), weight gain, and excellent animal survival. Postmortem specimens demonstrated functional muscle contraction on ex vivo testing, and histology confirmed integration into host tissue.

Conclusion

This is the first study to demonstrate that functional, 3D tissue‐engineered skeletal muscle can be developed from primary MPCs and standardized oligomeric collagen. Collectively, these findings may have tremendous clinical implications for autologous laryngeal muscle repair and reconstruction.

Level of Evidence

NA. Laryngoscope, 128:603–609, 2018
Postoperative IPTH compared with IPTH gradient as predictors of post‐thyroidectomy hypocalcemia
Authors: Al Khadem Mai G. , Rettig Eleni M. , Dhillon Vaninder K. , Russell Jonathon O. , Tufano Ralph P.
Published: August 2017

Objectives/Hypothesis

Predicting patients' risk for hypocalcemia after thyroidectomy may allow for same‐day discharge. This study was designed to compare postoperative intact parathyroid hormone (IPTH) alone with percentage change in IPTH (IPTH gradient) in predicting post‐thyroidectomy hypocalcemia.

Study Design

Retrospective cohort study.

Methods

Patients undergoing total thyroidectomy by the senior author from May 2015 to May 2016 were included. Serum IPTH was measured preoperatively and 1 hour postoperatively, and IPTH gradient was calculated. Postoperative hypocalcemia was mild (≥8.0, <8.4) or severe (<8.0 and/or hypocalcemic symptoms). Postoperative IPTH and IPTH gradient were compared with hypocalcemia using logistic regression. Receiver operating characteristic analysis of IPTH measures as predictors of hypocalcemia was performed, and the area under the curve (AUC) was calculated.

Results

Overall, 119 patients were included. Forty‐seven percent of the patients developed postoperative hypocalcemia, including 26 (22%) with mild and 30 (25%) with severe hypocalcemia. Thirteen patients had hypocalcemic symptoms. Median IPTH gradient and postoperative IPTH each differed significantly by category of hypocalcemia (P < .001). Higher IPTH gradient was significantly associated with odds of severe and symptomatic hypocalcemia (adjusted odds ratio [aOR]: 1.21, 95% confidence interval [CI]: 1.06‐1.39 and aOR: 1.34, 95% CI: 1.05‐1.71 per 10% increase), whereas lower postoperative IPTH was not (aOR: 1.27, 95% CI: 0.95‐1.68 and aOR: 1.44, 95% CI: 0.90‐2.31 per 10 pg/mL decrease). The AUC for predicting severe hypocalcemia was nonsignificantly higher for IPTH gradient than postoperative IPTH (AUC = 0.77 vs. 0.69, P = .10). The AUC for predicting symptomatic hypocalcemia was significantly higher for IPTH gradient (AUC = 0.75 vs. 0.72, P = .03).

Conclusions

Our results suggest that the IPTH gradient may be more useful than postoperative IPTH alone in predicting risk of post‐thyroidectomy hypocalcemia.

Level of Evidence

4. Laryngoscope, 128:769–774, 2018
Rethinking the laryngopharyngeal reflux treatment algorithm: Evaluating an alternate empiric dosing regimen and considering up‐front, pH‐impedance, and manometry testing to minimize cost in treating suspect laryngopharyngeal reflux disease
Authors: Carroll Thomas L. , Werner Astrid , Nahikian Kael , Dezube Aaron , Roth Douglas F.
Published: August 2017

Objectives/Hypothesis

Empiric proton pump inhibitor (PPI) trials for laryngopharyngeal reflux (LPR) are common. A majority of the patients respond to acid suppression. This work intends to evaluate once‐daily, 40 mg omeprazole and once‐nightly, 300 mg ranitidine (QD/QHS) dosing as an alternative regimen, and use this study's cohort to evaluate empiric regimens prescribed for LPR as compared to up‐front testing with pH impedance multichannel intraluminal impedance (MII) with dual pH probes and high‐resolution manometry (HRM) for potential cost minimization.

Study Design

Retrospective cohort review and cost minimization study.

Methods

A chart review identified patients diagnosed with LPR. All subjects were treated sequentially and outcomes recorded. Initial QD/QHS dosing increased after 3 months to BID if no improvement and ultimately prescribed MII and HRM if they failed BID dosing. Decision tree diagrams were constructed to determine costs of two empiric regimens and up‐front MII and HRM.

Results

Ninety‐seven subjects met the criteria. Responders and nonresponders to empiric therapy were identified. Seventy‐two subjects (74%) responded. Forty‐eight (67% of responders and 49% of all) improved with QD/QHS dosing. Forty‐nine (51%) subjects escalated to BID dosing. Twenty‐four subjects (33% of responders and 25% of all) improved on BID therapy. Twenty‐five subjects (26%) did not respond to acid suppression. Average weighted cost was $1,897.00 per patient for up‐front testing, $3,033.00 for initial BID, and $3,366.00 for initial QD/QHS.

Conclusions

An alternate QD/QHS regimen improved the majority who presented with presumed LPR. Cost estimates demonstrate that the QD/QHS regimen was more expensive than the initial BID high‐dose PPI for 6 months. Overall per‐patient cost appears less with up‐front MII and HRM.

Level of Evidence

4. Laryngoscope, 127:S1–S13, 2017
Consulting Dr. Google: Quality of Online Resources About Tympanostomy Tube Placement
Authors: Harris Vandra C. , Links Anne R. , Hong Paul , Walsh Jonathan , Schoo Desi P. , Tunkel David E. , Stewart Charles M. , Boss Emily F.
Published: August 2017

Objective

Tympanostomy tube (TT) placement is common in children; however, family‐centeredness and utility of online information used for decision making and understanding is unknown. We evaluate the quality of leading Internet resources describing TT placement.

Study Design

Cross‐sectional descriptive design.

Methods

We performed a Google (Menlo Park, CA) search for terms related to TTs. We defined quality using scaled readability measures (Flesch Reading Ease and Flesch‐Kincaid Grade‐Level), understandability and actionability (Patient Education Materials Assessment Tool), shared decision‐making centrality (Center for Medicare and Medicaid Services informed consent guidelines), and clinical practice guideline (CPG) compatibility. Three reviewers coded each measure. Fleiss κ interrater reliability analysis was performed.

Results

Ten most frequently encountered websites were analyzed. One of 10 met national health literacy standards (mean 10th‐grade level reading, median 9th, range 6–15th). All sites were understandable (mean understandability 81.9%, range 73%–92%). Most had low actionability scores (7 of 10, median 47%, mean 44.6%, range 0–80). Shared decision‐making centrality was high (mean 5, range 4–6), but most did not list alternative treatment options. Although CPG compatibility was high (mean 3.4, range 1–4), many websites contained inconsistent recommendations about tube duration, follow‐up, and water precautions. There was inter‐rater agreement for understandability scoring (κ = 0.20; P = 0.02).

Conclusion

Internet resources about TT placement vary in quality pertaining to health literacy, principles of shared decision making, and consistency with practice guidelines. With growing emphasis on patient‐/family‐centered engagement in healthcare decision making, standardization of content and improved usability of educational materials for common surgical procedures in children such as tympanostomy tube placement should be a public health priority.

Level of Evidence

NA. Laryngoscope, 128:496–501, 2018
Directional DBS increases side‐effect thresholds—A prospective, double‐blind trial
Authors: Dembek Till A. , Reker Paul , Visser‐Vandewalle Veerle , Wirths Jochen , Treuer Harald , Klehr Martin , Roediger Jan , Dafsari Haidar S. , Barbe Michael T. , Timmermann Lars
Published: August 2017

Objective

The objective of this study was to investigate whether directional deep brain stimulation (DBS) of the subthalamic nucleus in Parkinson's disease (PD) offers increased therapeutic windows, side‐effect thresholds, and clinical benefit.

Methods

In 10 patients, 20 monopolar reviews were conducted in a prospective, randomized, double‐blind design to identify the best stimulation directions and compare them to conventional circular DBS regarding side‐effect thresholds, motor improvement, and therapeutic window. In addition, circular and best‐directional DBS were directly compared in a short‐term crossover. Motor outcome was also assessed after an open‐label follow‐up of 3 to 6 months.

Results

Stimulation in the individual best direction resulted in significantly larger therapeutic windows, higher side‐effect thresholds, and more improvement in hand rotation than circular DBS. Rigidity and finger tapping did not respond differentially to the stimulation conditions. There was no difference in motor efficacy or stimulation amplitudes between directional and circular DBS in the short‐term crossover. Follow‐up evaluations 3 to 6 months after implantation revealed improvements in motor outcome and medication reduction comparable to other DBS studies with a majority of patients remaining with a directional setting.

Conclusion

Directional DBS can increase side‐effect thresholds while achieving clinical benefit comparable to conventional DBS. Whether directional DBS improves long‐term clinical outcome needs to be investigated in the future. © 2017 International Parkinson and Movement Disorder Society
It's not just the basal ganglia: Cerebellum as a target for dystonia therapeutics
Authors: Tewari Ambika , Fremont Rachel , Khodakhah Kamran
Published: August 2017

Dystonia is a common movement disorder that devastates the lives of many patients, but the etiology of this disorder remains poorly understood. Dystonia has traditionally been considered a disorder of the basal ganglia. However, growing evidence suggests that the cerebellum may be involved in certain types of dystonia, raising several questions. Can different types of dystonia be classified as either a basal ganglia disorder or a cerebellar disorder? Is dystonia a network disorder that involves the cerebellum and basal ganglia? If dystonia is a network disorder, how can we target treatments to alleviate symptoms in patients? A recent study by Chen et al, using the pharmacological mouse model of rapid‐onset dystonia parkinsonism, has provided some insight into these important questions. They showed that the cerebellum can directly modulate basal ganglia activity through a short latency cerebello‐thalamo‐basal ganglia pathway. Further, this article and others have provided evidence that in some cases, aberrant cerebello‐basal ganglia communication can be involved in dystonia. In this review we examine the evidence for the involvement of the cerebellum and cerebello‐basal ganglia interactions in dystonia. We conclude that there is ample evidence to suggest that the cerebellum plays a role in some dystonias, including the early‐onset primary torsion dystonia DYT1 and that further studies examining the role of this brain region and its interaction with the basal ganglia in dystonia are warranted. © 2017 International Parkinson and Movement Disorder Society
Clinicopathologic discrepancies in a population‐based incidence study of parkinsonism in olmsted county: 1991‐2010
Authors: Turcano Pierpaolo , Mielke Michelle M. , Josephs Keith A. , Bower James H. , Parisi Joseph E. , Boeve Bradley F. , Savica Rodolfo
Published: August 2017

Objective: The purpose of this study was to examine the discrepancies between the clinical diagnosis of parkinsonism and neuropathological findings in a population‐based cohort with parkinsonian disorders.

Background: The specific clinical diagnosis of parkinsonism is challenging, and definite confirmation requires neuropathological evaluation. Currently, autopsies are seldom performed, and most brain autopsies represent atypical or diagnostically unresolved cases.

Methods: We used a defined population‐based incidence cohort with clinical parkinsonism (n = 669) from the Rochester Epidemiology Project in Olmsted County, Minnesota, 1991‐2010. We reviewed reports of all patients who underwent neuropathologic examination at autopsy (n = 60; 9%) and applied consensus pathologic guidelines for neurodegenerative disease diagnosis.

Results: Among the 60 patients examined pathologically, the median time from the last recorded clinical diagnosis to death was 7 years (range from 2 to 17 years). Clinical–pathological concordance was found in 52 cases (86.7%), whereas 8 (13.3%) had a clinical‐pathological discrepancy. Four patients with a clinical diagnosis of idiopathic Parkinson's disease had no pathological evidence of Lewy bodies or α‐synucleinopathy; of these, pathological diagnoses were Alzheimer's disease (2 cases), progressive supranuclear palsy (1 case), and vascular parkinsonism (1 case). Two patients with clinical diagnoses of "dementia with Lewy bodies" and one patient with an "unspecified parkinsonism" had a pathological diagnosis of Alzheimer's disease without concomitant α‐synuclein lesions. One patient with clinically diagnosed "progressive supranuclear palsy" had indeterminate pathological findings without α‐synuclein or Aβ‐ or tau‐immunoreactive lesions at autopsy.

Conclusions: Overall, the clinical diagnoses of parkinsonian subtypes had good concordance with pathological confirmation (86.7%). However, clinical–pathological discrepancies were documented in 13.3%. © 2017 International Parkinson and Movement Disorder Society
Motor hyperactivity of the iron‐deficient rat — an animal model of restless legs syndrome
Authors: Lai Yuan‐Yang , Cheng Yu‐Hsuan , Hsieh Kung‐Chiao , Nguyen Darian , Chew Keng‐Tee , Ramanathan Lalini , Siegel Jerome M.
Published: August 2017

Background

Abnormal striatal dopamine transmission has been hypothesized to cause restless legs syndrome. Dopaminergic drugs are commonly used to treat restless legs syndrome. However, they cause adverse effects with long‐term use. An animal model would allow the systematic testing of potential therapeutic drugs. A high prevalence of restless legs syndrome has been reported in iron‐deficient anemic patients. We hypothesized that the iron‐deficient animal would exhibit signs similar to those in restless legs syndrome patients.

Methods

After baseline polysomnographic recordings, iron‐deficient rats received pramipexole injection. Then, iron‐deficient rats were fed a standard rodent diet, and polysomnographic recording were performed for 2 days each week for 4 weeks.

Results

Iron‐deficient rats have low hematocrit levels and show signs of restless legs syndrome: sleep fragmentation and periodic leg movements in wake and in slow‐wave sleep. Iron‐deficient rats had a positive response to pramipexole treatment. After the iron‐deficient rats were fed the standard rodent diet, hematocrit returned to normal levels, and sleep quality improved, with increased average duration of wake and slow‐wave sleep episodes. Periodic leg movements decreased during both waking and sleep. Hematocrit levels positively correlated with the average duration of episodes in wake and in slow‐wave sleep and negatively correlated with periodic leg movements in wake and in sleep. Western blot analysis showed that striatal dopamine transporter levels were higher in iron‐deficient rats.

Conclusions

The iron‐deficient rat is a useful animal model of iron‐deficient anemic restless legs syndrome. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society
Cerebrospinal fluid β‐glucocerebrosidase activity is reduced in parkinson's disease patients
Authors: Parnetti Lucilla , Paciotti Silvia , Eusebi Paolo , Dardis Andrea , Zampieri Stefania , Chiasserini Davide , Tasegian Anna , Tambasco Nicola , Bembi Bruno , Calabresi Paolo , Beccari Tommaso
Published: August 2017

Background

Reduced β‐glucocerebrosidase activity was observed in postmortem brains of both GBA1 mutation carrier and noncarrier Parkinson's disease patients, suggesting that lower β‐glucocerebrosidase activity is a key feature in the pathogenesis of PD. The objectives of this study were to confirm whether there is reduced β‐glucocerebrosidase activity in the CSF of GBA1 mutation carrier and noncarrier PD patients and verify if other lysosomal enzymes show altered activity in the CSF.

Methods

CSF β‐glucocerebrosidase, cathepsin D, and β‐hexosaminidase activities were measured in 79 PD and 61 healthy controls from the BioFIND cohort. The whole GBA1 gene was sequenced.

Results

Enzyme activities were normalized according to CSF protein content (specific activity). β‐glucocerebrosidase specific activity was significantly decreased in PD versus controls (‐28%, P < 0.001). GBA1 mutations were found in 10 of 79 PD patients (12.7%) and 3 of 61 controls (4.9%). GBA1 mutation carrier PD patients showed significantly lower β‐glucocerebrosidase specific activity versus noncarriers. β‐glucocerebrosidase specific activity was also decreased in noncarrier PD patients versus controls (‐25%, P < 0.001). Cathepsin D specific activity was lower in PD versus controls (‐21%, P < 0.001). β‐Hexosaminidase showed a similar trend. β‐Glucocerebrosidase specific activity fairly discriminated PD from controls (area under the curve, 0.72; sensitivity, 0.67; specificity, 0.77). A combination of β‐glucocerebrosidase, cathepsin D, and β‐hexosaminidase improved diagnostic accuracy (area under the curve, 0.77; sensitivity, 0.71; specificity, 0.85). Lower β‐glucocerebrosidase and β‐hexosaminidase specific activities were associated with worse cognitive performance.

Conclusions

CSF β‐glucocerebrosidase activity is reduced in PD patients independent of their GBA1 mutation carrier status. Cathepsin D and β‐hexosaminidase were also decreased. The possible link between altered CSF lysosomal enzyme activities and cognitive decline deserves further investigation. © 2017 International Parkinson and Movement Disorder Society
How does parkinson's disease begin? Perspectives on neuroanatomical pathways, prions, and histology
Authors: Borghammer Per
Published: August 2017

Parkinson's disease (PD) is a multisystem disorder with involvement of the peripheral nervous system. Misfolding and aggregation of α‐synuclein is central to the pathogenesis of PD, and it has been postulated that the disease may originate in olfactory and gastrointestinal nerve terminals. The prion‐like behavior of α‐synuclein has been convincingly demonstrated in vitro and in animal models of PD. Lewy‐type pathology have been detected in peripheral organs many years prior to PD diagnosis, and 2 independent studies have now suggested that truncal vagotomy may be protective against the disorder. Other lines of evidence are difficult to reconcile with a peripheral onset of PD, most importantly the relative scarcity of post mortem cases with isolated gastrointestinal α‐synuclein pathology without concomitant CNS pathology. This Scientific Perspectives article revisits some important topics with implications for the dual‐hit hypothesis. An account of the neuroanatomical pathways necessary for stereotypical α‐synuclein spreading is presented. Parallels to the existing knowledge on true prion disorders, including Creutzfeld‐Jakob disease, are examined. Finally, the vagotomy studies and the somewhat inconsistent findings in the growing literature on peripheral α‐synuclein pathology are discussed. It is concluded that the dual‐hit hypothesis remains a potential explanation for PD pathogenesis, but several issues need to be resolved before more firm conclusions can be drawn. © 2017 International Parkinson and Movement Disorder Society
Reconstruction of midface defects with the osteocutaneous radial forearm flap: Evaluation of long term outcomes including patient reported quality of life
Authors: Connolly Timothy M. , Sweeny Larissa , Greene Benjamin , Morlandt Anthony , Carroll William R. , Rosenthal Eben L.
Published: August 2017

Background

Maxillectomy defects significantly impair quality of life. Prosthetics can overcome some of these issues, but has limitations. The role of the osteocutaneous radial forearm free flap (OC‐RFFF) has been established for reconstruction of smaller maxillectomy defects, but its role in larger defects is not well defined. We aim to evaluate outcomes after midface reconstruction utilizing the OC‐RFFF.

Methods

Retrospective review of prospective database collected between 2005 and 2014 of midface reconstruction using OC‐RFFF in a tertiary care centre. Donor site complications and acute and long‐term recipient site complications were measured. Health related quality of life was assessed using the University of Washington Quality of Life (UW‐QOL) Questionnaire.

Results

A total of 68 midface defects were reconstructed using the OC‐RFFF. Acute recipient site complications included three flap failures (4%), and two additional microvascular revision cases for vascular compromise. Late recipient complications included fistula (n = 10, 14%), ectropion (n = 7, 10%), diplopia (n = 6, 9%) and exposed hardware (n = 5, 7%). Resection of cheek skin or orbital rim correlated with orbital complications. The incidence of fistula was not affected by defect size or prior radiation. There were two donor site infections and no instances of forearm fracture. Patients undergoing OC‐RFFF repair had mean scores for UW‐QOL outcomes higher than published rates of obturator quality of life.

Conclusion

The OC‐RFFF is suited to a variety of midface defects and can be combined with hardware to reconstruct the orbital floor. Recipient site complications are common, but donor site morbidity is low and outcomes, including HR‐QOL, are acceptable.
Breast reconstruction with DIEP and SIEA flaps in patients with prior abdominal liposuction
Authors: Zavlin Dmitry , Jubbal Kevin T. , Ellsworth Warren A. , Spiegel Aldona J.
Published: August 2017

Introduction

Suction‐assisted lipectomy (SAL) has been considered a relative contraindication for autologous breast reconstruction due to reservations about size and integrity of perforator vessels. Such patients are often not considered ideal candidates for breast reconstruction utilizing deep inferior epigastric perforator (DIEP) and superficial inferior epigastric artery (SIEA) flaps. The aim of this article is to describe our experience with these flaps after SAL.

Methods

Retrospectively, patient charts from 2005 to 2015 were analyzed and 9 patients (13 flaps) were identified who received breast reconstruction after prior donor‐site SAL. Eight patients underwent DIEP and 1 patient an SIEA flap breast reconstruction. The patients' average age was 47.7 (ranging 33–64) years and their BMI 26.0 (ranging 21.1–36.5). Preoperative radiologic studies were obtained for all patients via either Doppler ultrasound or cross‐sectional imaging to assess abdominal perforators. Abdominal SAL took place between 2 and 20 years before reconstruction.

Results

On average, 2.4 (ranging 1–4) perforators with a mean diameter of 0.68 mm (ranging 0.2–2.5 mm) were included per DIEP flap and anastomosed to the internal mammary arteries. Median follow‐up period was 1.2 (ranging 0.5–9.6) years without any flap loss, flap necrosis, hematoma, or unplanned reoperation. One breast seroma and one fat necrosis occurred. All patients had a successful reconstruction and finished treatment at our institution.

Conclusion

Our results show that DIEP and SIEA flaps are safe and effective options for breast reconstruction in patients with previous abdominal SAL. Extensive preoperative patient evaluation and perforator imaging is important in identifying suitable candidates within this patient population.
The bipedicled medial plantar flap: Vascular enhancement of a reverse flow Y–V medial plantar flap by the inclusion of a metatarsal artery perforator for the reconstruction of a forefoot defect—A case report
Authors: Scaglioni Mario F. , Franchi Alberto , Uyulmaz Semra , Giovanoli Pietro
Published: August 2017

The pedicled medial plantar (MP) flap is an optimal solution for defects involving the weight‐bearing areas of the foot. However, venous congestion is a frequently encountered complication, especially with the reverse‐flow variants of the flap, and several strategies have been reported in literature both to prevent and to manage it. In this article, we present the use of a medial plantar flap based distally on the lateral plantar artery with the adjunct of an extra metatarsal perforator from the dorsalis pedis artery as a vascular enhancement to avoid the venous congestion and to improve the overall circulation. This bipedicled flap was successfully advanced to cover a 5 × 3 cm soft‐tissue defect located at the level of the first and second metatarsal heads of the right foot resulting from the excision of a squamous cell carcinoma in an 80‐year‐old male patient with a history of cardiovascular disease. The postoperative course was uneventful. The patient was discharged 7 days after the operation and was able to walk after 6 weeks wearing normal shoes. We believe that preserving plantar metatarsal perforators during the harvesting of an MP flap based distally on the lateral plantar artery may be a precious adjunct as it increases blood supply, especially the venous drainage of the flap.
An updated annotated bibliography on arc routing problems
Authors: Mourão M. Cândida , Pinto Leonor S.
Published: August 2017

The number of arc routing publications has increased significantly in the last decade. Such an increase justifies a second annotated bibliography, a sequel to Corberán and Prins (Networks 56 (2010), 50–69), discussing arc routing studies from 2010 onwards. These studies are grouped into three main sections: single vehicle problems, multiple vehicle problems and applications. Each main section catalogs problems according to their specifics. Section 2 is therefore composed of four subsections, namely: the Chinese Postman Problem, the Rural Postman Problem, the General Routing Problem (GRP) and Arc Routing Problems (ARPs) with profits. Section 3, devoted to the multiple vehicle case, begins with three subsections on the Capacitated Arc Routing Problem (CARP) and then delves into several variants of multiple ARPs, ending with GRPs and problems with profits. Section 4 is devoted to applications, including distribution and collection routes, outdoor activities, post‐disaster operations, road cleaning and marking. As new applications emerge and existing applications continue to be used and adapted, the future of arc routing research looks promising. © 2017 Wiley Periodicals, Inc. NETWORKS, Vol. 70(3), 144–194 2017
Mathematical analysis and numerical simulation of chaotic noninteger order differential systems with Riemann‐Liouville derivative
Authors: Owolabi Kolade M.
Published: August 2017

This article deals with the design, analysis, and implementation of a robust numerical scheme when applied to time‐fractional reaction‐diffusion system. Stability analysis and numerical treatment of chaotic fractional differential system in Riemann‐Liouville sense are considered in this article. Simulation results show that chaotic phenomena can only occur if the reaction or local dynamics of such system is coupled or nonlinear in nature. Illustrative examples that are still of current and recurring interest to economists, engineers, mathematicians and physicists are chosen, to describe the points and queries that may arise. Numerical results presented agree with the theoretical findings.
Novel Body Shape Descriptors for Abdominal Adiposity Prediction Using Magnetic Resonance Images and Stereovision Body Images
Authors: Sun Jingjing , Xu Bugao , Lee Jane , Freeland‐Graves Jeanne H.
Published: August 2017

Objective

The purpose of this study was to design novel shape descriptors based on three‐dimensional (3D) body images and to use these parameters to establish prediction models for abdominal adiposity.

Methods

Sixty‐six men and fifty‐five women were recruited for abdominal magnetic resonance imaging (MRI) and 3D whole‐body imaging. Volumes of abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured from MRI sequences by using a fully automated algorithm. The shape descriptors were measured on the 3D body images by using the software developed in this study. Multiple regression analysis was employed on the training data set (70% of the total participants) to develop predictive models for VAT and SAT, with potential predictors selected from age, BMI, and the body shape descriptors. The validation data set (30%) was used for the validation of the predictive models.

Results

Thirteen body shape descriptors exhibited high correlations (P < 0.01) with abdominal adiposity. The optimal predictive equations for VAT and SAT were determined separately for men and women.

Conclusions

Novel body shape descriptors defined on 3D body images can effectively predict abdominal adiposity quantified by MRI.
High‐dose treatment for malignant rhabdoid tumor of the kidney: No evidence for improved survival—The Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) experience
Authors: Furtwängler Rhoikos , Kager Leo , Melchior Patrick , Rübe Christian , Ebinger Martin , Nourkami‐Tutdibi Nasenien , Niggli Felix , Warmann Steven , Hubertus Jochen , Amman Gabriele , Leuschner Ivo , Vokuhl Christian , Graf Norbert , Frühwald Michael C.
Published: August 2017

Background

Malignant rhabdoid tumor of the kidney (MRTK) is the most aggressive childhood renal tumor with overall survival (OS) rates ranging from 22% to 42%. Whether high‐dose chemotherapy with autologous stem‐cell transplantation (HDSCT) in an intensive first‐line treatment offers additional benefit is an ongoing discussion.

Methods

A retrospective analysis of all 58 patients with MRTK from Austria, Switzerland, and Germany treated in the framework of consecutive, prospective renal/rhabdoid tumor studies SIOP9/GPO, SIOP93‐01/GPOH (where SIOP is International Society of Pediatric Oncology and GPOH is German Society of Pediatric Oncology and Hematology), SIOP2001/GPOH, and European Rhabdoid Tumor Registry from 1991 to 2014.

Results

Median age at diagnosis was 11 months. Fifty percent of patients had metastases or multifocal disease at diagnosis (Stage IV). Local stage distribution was as follows: not done/I/II/III—1/6/11/40. Fifteen (26%) patients underwent upfront surgery. Thirty‐seven (64%) patients achieved a complete remission, 17 (29%) relapsed, 34 (59%) died of disease progression, and two (3%) died of treatment‐related complication. Mean time to the first event was 3.5 months. Two‐year EFS/OS (where EFS is event‐free survival) for the whole group was 37 ± 6%/38 ± 6%. Metastases/multifocal disease, younger age, and local stage III were associated with significantly inferior survival. Eleven (19%) patients underwent HDSCT (carboplatin + thiotepa, n = 6; carboplatin + etoposide + melphalan, n = 4; others, n = 1); 2‐year OS in this group was 60 ± 15% compared to 34 ± 8% in the non‐HDSCT group (P = 0.064). However, the time needed from radiologic to histologic diagnosis, stem‐cell harvest, and HDSCT must also be taken into account to avoid selection bias by excluding the highest risk group with early progression (<90 days). Thus, 2‐year EFS only for patients without progression until day 90 was 60 ± 16% consolidated by HDSCT compared to 62 ± 11% without (P = 0.8).

Conclusion

Our retrospective analysis suggests comparable outcomes for patients with and without HDSCT, if adjusted for early disease progression.
Exercise right heart catheterization for pulmonary hypertension identified on screening echocardiography in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort
Authors: Armstrong Gregory T. , Tolle James J. , Piana Robert , Santucci Aimee , Leathers James , Ness Kirsten K. , Mulrooney Daniel A. , Green Daniel M. , Joshi Vijaya M. , Robison Leslie L , Hudson Melissa M. , Lenihan Daniel
Published: August 2017

Pulmonary hypertension, determined noninvasively by tricuspid regurgitant jet velocity on Doppler echocardiography, was previously identified in 25% of long‐term survivors who received chest‐directed radiotherapy. To validate noninvasively defined pulmonary hypertension, survivors (mean age 48 years), exposed to chest radiotherapy, underwent right heart catheterization with planned cardiopulmonary exercise testing during catheterization. Eight participants had an elevated mean pulmonary artery pressure at rest (≥25 mm Hg) or with subsequent exercise (>30 mm Hg), evidence of hemodynamically confirmed pulmonary hypertension by right heart catheterization. Cardiopulmonary exercise testing further defined the magnitude and etiology of cardiopulmonary limitations in this life‐threatening late effect.
Oral health and hematopoietic stem cell transplantation: A longitudinal evaluation of the first 28 days
Authors: Doss Laura M. , Dandoy Christopher E. , Kramer Kathi , Pate Abigail , Flesch Laura , El‐Bietar Javier , Lane Adam , Davies Stella M. , Thikkurissy Sarat
Published: August 2017

Background

Mucositis is well described after pediatric hematopoietic stem cell transplant (HSCT) but other aspects of oral health such as dental plaque and gingivitis are poorly understood. The aim of this study was to describe dental plaque, gingivitis, and mucositis early after HSCT.

Methods

We conducted a prospective longitudinal observational study to describe dental plaque, gingivitis, and mucositis in the peritransplant period. We conducted comprehensive oral evaluations that included the Miyazaki tongue coating, modified simplified oral hygiene, modified gingivitis of Suomi and Barbano, and mucosal ulceration indices at baseline on days 0, +7, +14, and +28.

Results

Data were collected from 19 patients with a median age of 8.0 years (5.1–12.8) at time of HSCT. Sixteen patients (85%) had plaque accumulation that progressively worsened, 16 (85%) developed severe gingival inflammation, 13 (68%) developed mucositis, and 11 (58%) had oral ulcerations. All oral indices worsened from baseline during the study period. Gingivitis and oral plaque persisted in most patients at day +28 while mucositis and oral ulcerations slightly improved.

Discussion

Gingivitis, dental plaque, mucositis, and oral ulcerations are common after HSCT. Additional studies are needed to ascertain methods that decrease plaque and gingivitis development and severity.
Hypercalcaemia secondary to ectopic parathyroid hormone expression in an adolescent with metastatic alveolar rhabdomyosarcoma
Authors: Brooks Rachael , Lord Christopher , Davies Justin H. , Gray Juliet C.
Published: August 2017

We report the case of a 14‐year‐old male with metastatic alveolar rhabdomyosarcoma, presenting with hypercalcaemia (3.89 mmol/l) and elevated parathyroid hormone (PTH) level (10.2 pmol/l). Imaging demonstrated extensive bony lytic damage, with “floating teeth” in the mandible. Normalisation of calcium levels and bony reformation of the mandible occurred following chemotherapy; PTH levels decreased initially but remained above normal levels. Imaging did not demonstrate any evidence of parathyroid abnormality. Tumour ectopic PTH secretion is a very rare cause of hypercalcaemia of malignancy in children. Hypercalcaemia with an elevated PTH, in the absence of parathyroid‐related cause, should prompt investigation for underlying malignancy.
Sirolimus therapy in the treatment of pseudomyogenic hemangioendothelioma
Authors: Gabor Krisztina Mita , Sapi Zoltan , Tiszlavicz Lilla Gyorgyi , Fige Anita , Bereczki Csaba , Bartyik Katalin
Published: August 2017

Pseudomyogenic hemangioendothelioma (PMH) is a rare, mostly indolent vascular tumor. Extensive cases are treated with amputation as chemotherapy seems to be ineffective. Recently, promising results were published using mammalian target of rapamycin (mTOR) inhibitors in tumors of vascular origin. Here, we present a case of a child with advanced PMH relapsing after surgery and chemotherapy. Sirolimus achieved significant clinical improvement and stabilization of the lesions without any remarkable toxicity. This case contributes to the growing evidence regarding the efficacy of mTOR inhibitors, such as sirolimus, in multifocal PMH.
The amniotic fluid as a source of mesenchymal stem cells with lung‐specific characteristics
Authors: Lesage Flore , Zia Silvia , Jiménez Julio , Deprest Jan , Toelen Jaan
Published: August 2017

What is already known about this topic?

Fetal tissues are interesting sources of stem cells for autologous therapy in a neonatal context.

AF‐MSC are a heterogeneous stem cell population of which the exact origin remains elusive.

What does this study add?

This study identifies AF‐MSC with lung‐specific characteristics.

This study provides a reliable culture method that supports the expansion of lung‐specific AF‐MSC.
Chitosan for wastewater treatment
Authors: Desbrières Jacques , Guibal Eric
Published: August 2017

Chitosan (an amino‐polysaccharide obtained from deacetylation of chitin, the major constituent of crustaceous shells and insect cuticles) presents a cationic character in acidic media allowing its dissolution, its shaping and possible ion‐exchange interactions with anionic compounds (a property applied in adsorption and coagulation–flocculation processes). In neutral media, non‐protonated amino groups allow complexation of metal cations or organic chemicals. These different properties explain the interest taken by the scientific community in using this biopolymer. In solution it contributes to complex metals and their recovery by complexation‐assisted ultrafiltration. It can also be used to coagulate–flocculate organic compounds (as anionic dyes). In the solid state, it can be used for metal ion adsorption, as well as adsorption of organic compounds (dyes, pesticides, drugs, endocrine disruptors, etc.). The adsorption and coagulation–flocculation processes will be compared and examples considered. Moreover, it is noteworthy that the thermal degradation of this type of material is also more environmentally friendly than that of conventional synthetic resins (production of hazardous by‐products, etc.), a supplementary advantage of these biopolymer‐based sorbents. Combined with its ability to be chemically or physically modified improving the potential and phase separation of chitosan‐based materials, all these properties mean it is an excellent candidate for wastewater treatment. © 2017 Society of Chemical Industry
Insulin Mediated Activation of PI3K/Akt Signalling Pathway Modifies the Proteomic Cargo of Extracellular Vesicles
Authors: Liem Michael , Ang Ching‐Seng , Mathivanan Suresh
Published: August 2017

Epidemiological studies suggest that diabetes and obesity increases the risk of colorectal cancer (CRC) and lowers the patient survival rate. An important attribute in diabetes and obesity is the presence of high levels of growth factors including insulin in blood which can activate the PI3K/Akt signalling pathway. Dysregulation of PI3K/Akt signalling pathway leads to sustained proliferative signals thereby allowing the cells susceptible to cancer. Extracellular vesicles (EVs), secreted nanovesicles of endocytic origin, are implicated in mediating the transfer of oncogenic cargo in the tumour microenvironment. In this study, CRC cells were treated with insulin to activate PI3K/Akt signaling pathway. Insulin treatment significantly increased the number of EVs secreted by CRC cells. Furthermore, pAkt was exclusively packaged in EVs secreted by PI3K/Akt activated cells. Quantitative proteomics analysis confirmed that the protein cargo of EVs are modified upon activation of PI3K/Akt signaling pathway. Bioinformatics analysis highlighted the enrichment of proteins implicated in cell proliferation in EVs secreted by PI3K/Akt activated cells. Furthermore, incubation of EVs secreted by PI3K/Akt activated cells induced proliferation in recipient CRC cells. These findings suggest that EVs can amplify the signal provided by the growth factors in the tumor microenvironment and hence aid in cancer progression.
Side chain engineering of naphthalene diimide–bithiophene‐based polymer acceptors in all‐polymer solar cells
Authors: Wu Xia , Tang Yumin , Wang Yuxi , Liu Xiaoyuan , Liu Changmei , Zhang Xiaonan , Yang Yingguo , Gao Xingyu , Chen Fei , Guo Xugang , Chen Zhi‐Kuan
Published: August 2017

Two novel polymeric acceptors based on naphthalene diimide (NDI) and 2.2′‐bithiophene, named as P(NDI2THD‐T2) and P(NDI2TOD‐T2), were designed and synthesized for all polymer solar cells application. The structural and electronic properties of the two acceptors were modulated through side‐chain engineering of the NDI units. The optoelectronic properties of the polymers and the morphologies of the blend films composed of the polymer acceptors and a donor polymer PTB7‐Th were systemically investigated. With thiophene groups introduced into the side chains of the NDI units, both polymers showed wider absorption from 350 nm to 900 nm, compared with the reference polymer acceptor of N2200. No redshift of absorption spectra from solutions to films indicated reduced aggregation of the polymers due to the steric hindrance effect of thiophene rings in the side chains. The photovoltaic performance were characterized for devices in a configuration of ITO/PEDOT:PSS/PTB7‐Th:acceptors/2,9‐bis(3‐(dimethylamino)propyl)anthra[2,1,9‐def:6,5,10‐def]diisoquinoline‐1,3,8,10(2H,9H)‐tetraone (PDIN)/Al. With the addition of diphenyl ether as an additive, the power conversion efficiencies (PCEs) of 2.73% and 4.75% for P(NDI2THD‐T2) and P(NDI2TOD‐T2) based devices were achieved, respectively. The latter showed improved Jsc, Fill Factor (FF), and PCE compared with N2200 based devices. © 2017 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2017, 55, 3679–3689
Protective effects of the egg stalk ofParatrioza sinica(Hemiptera: Psyllidae) at various angles and spacings against three predaceous coccinellids,Harmonia axyridis,Coccinella septempunctataandHippodamia variegata(Coleoptera: Coccinellidae)
Authors: Wu Pengxiang , Ma Baoxu , Yan Shuo , Xu Jing , He Jia , Zhang Rong , Zhang Runzhi
Published: August 2017

BACKGROUND

Paratrioza sinicais a major pest of wolfberry (Lycium barbarum). Coccinellids can effectively control various developmental stages ofP. sinicabut not the stalked egg. To investigate the protective role of egg stalks against the predaceous coccinellidsHarmonia axyridis,Coccinella septempunctataandHippodamia variegata, we studied the functional responses to, and effects of, two factors: the angle between the egg stalk and the leaf plane, and the spacing between egg stalks.

RESULTS

The searching rate, handling time and theoretical maximum egg consumption ofH. variegatawere optimal among the three ladybug species. Egg consumption by coccinellids was maximum and minimum at stalk angles of 0° and 90°, respectively. The average reduction in the rate of egg consumption when the stalk angle was 90° relative to 0° was significantly smaller for larvae of coccinellids compared with adults, and forH. variegatacompared with the other two species. Optimal spacing of eggs for consumption by predators varied with the predator species and their developmental stage, and was close to the body length of the predators.

CONCLUSION

The egg stalk serves as a physical protection against predators. The evolutionary selective advantage of the egg stalk in providing protection against predators requires more attention. Appropriate selection of predators and irrigation strategies may improve control ofP. sinica. © 2017 Society of Chemical Industry