bluuebunny/crossref_metadata_2025 huggingface dataset:
AMOT130 drives BMP-SMAD signaling at the apical membrane in polarized cells
Authors: Brunner Patrizia , Hastar Nurcan , Kaehler Christian , Burdzinski Wiktor , Jatzlau Jerome , Knaus Petra
Published: December 2019

We found that the tight-junction protein angiomotin (AMOT130) interacts with the BMP receptor BMPR2 and thereby supports BMP/SMAD signaling exclusively at the apical side of polarized epithelial and endothelial cells. BMP-mediated internalization of AMOT discerns BMPs as novel regulators of AMOT function.
Financial impact of an analgosedation protocol for mechanically ventilated patients in a cardiovascular intensive care unit
Authors: Devabhakthuni Sandeep , Kapoor Karan , Verceles Avelino C , Netzer Giora , Ludmir Jonathan , Ramani Gautam , Chaudhry Amal , Bolgiano Mary , Pollock Jeremy S , Mccurdy Michael T
Published: December 2019

Purpose

The primary objective was to evaluate the impact of an analgosedation protocol in a cardiac intensive care unit (CICU) on daily doses and costs of analgesic, sedative, and antipsychotic medications.

Methods

We conducted a single-center quasi-experimental study in 363 mechanically ventilated patients admitted to our CICU from March 1, 2011, to April 13, 2013. On March 1, 2012, an analgosedation protocol was implemented. Patients in the pre-implementation group were managed at the cardiologist’s discretion, which consisted of a continuous sedative-hypnotic approach and opioids as needed. Patients in the implementation group were managed using this protocol.

Results

The mean ± S.D. per-patient doses (mg/day) of propofol, lorazepam, and clonazepam decreased with the use of an analgosedation protocol (propofol 132,265.7 ± 12,951 versus 87,980.5 ± 10,564 [p = 0.03]; lorazepam 10.5 ± 7.3 versus 3.3 ± 4.0 [p < 0.001]; clonazepam 9.9 ± 8.3 versus 1.1 ± 0.5 [p = 0.03]). The mean daily cost of propofol and lorazepam also significantly decreased (33.5% reduction in propofol cost [p = 0.03]; 69.0% reduction in lorazepam cost [p < 0.001]). The per-patient dose and cost of fentanyl (mcg/day) declined with analgosedation protocol use (fentanyl 2,274.2 ± 2317.4 versus 1,026.7 ± 981.4 [p < 0.001]; 54.8% decrease in fentanyl cost [p < 0.001]).

Conclusion

The implementation of an analgosedation protocol significantly decreased both the use and cost of propofol, lorazepam, and fentanyl. Further investigation of the clinical impact and cost-effectiveness of a critical care consultation service with implementation of an analgosedation protocol is warranted in the CICU.
Apolipoprotein B is a risk factor for end-stage renal disease
Authors: Kwon Soie , Kim Dong Ki , Oh Kook-Hwan , Joo Kwon Wook , Lim Chun Soo , Kim Yon Su , Han Seung Seok
Published: December 2019

Background

Apolipoprotein B (ApoB), a constituent of lipid particles, is known to increase the risk of cardiovascular diseases. However, the association between ApoB and end-stage renal disease (ESRD) remains to be resolved. Our objective was to determine whether the ApoB concentration has an association with the risk of ESRD.

Methods

Serum ApoB, ApoA1, conventional lipid parameters and lipid subfractions were analyzed in 9403 subjects. The hazard ratio (HR) for the risk of ESRD was calculated using tertiles of ApoB concentration.

Results

ESRD developed in 110 patients (1.2%) during 10 years of follow-up. Several lipid parameters were compared for their association with the risk of ESRD, of which ApoB was best and its relationship was also independent of other clinical parameters. Individuals in the second and third ApoB tertiles had a higher risk of ESRD than those in the first tertile, with HRs of 1.5 [95% confidence interval (CI) 0.89–2.61] and 2.6 (1.56–4.20), respectively. A high ApoB:ApoA1 ratio was associated with a higher risk of ESRD, but ApoA1 had no independent association. Even after adjusting the competing risk for all-cause death, high ApoB concentrations had an association with the risk of ESRD.

Conclusions

High ApoB concentration is associated with a higher risk of ESRD, despite adjustment for other lipid and clinical parameters. Accordingly, the monitoring of ApoB may be helpful for the prediction of ESRD.
DAISY: A Data Information System for accountability under the General Data Protection Regulation
Authors: Becker Regina , Alper Pinar , Grouès Valentin , Munoz Sandrine , Jarosz Yohan , Lebioda Jacek , Rege Kavita , Trefois Christophe , Satagopam Venkata , Schneider Reinhard
Published: December 2019

Background

The new European legislation on data protection, namely, the General Data Protection Regulation (GDPR), has introduced comprehensive requirements for the documentation about the processing of personal data as well as informing the data subjects of its use. GDPR's accountability principle requires institutions, projects, and data hubs to document their data processings and demonstrate compliance with the GDPR. In response to this requirement, we see the emergence of commercial data-mapping tools, and institutions creating GDPR data register with such tools. One shortcoming of this approach is the genericity of tools, and their process-based model not capturing the project-based, collaborative nature of data processing in biomedical research.

Findings

We have developed a software tool to allow research institutions to comply with the GDPR accountability requirement and map the sometimes very complex data flows in biomedical research. By analysing the transparency and record-keeping obligations of each GDPR principle, we observe that our tool effectively meets the accountability requirement.

Conclusions

The GDPR is bringing data protection to center stage in research data management, necessitating dedicated tools, personnel, and processes. Our tool, DAISY, is tailored specifically for biomedical research and can help institutions in tackling the documentation challenge brought about by the GDPR. DAISY is made available as a free and open source tool on Github. DAISY is actively being used at the Luxembourg Centre for Systems Biomedicine and the ELIXIR-Luxembourg data hub.
The Reich Military Court and Its Values: Wehrmacht Treatment of Jehovah’s Witness Conscientious Objectors
Authors: Kehoe Thomas J
Published: December 2019

Between 1939 and 1945, the highest Wehrmacht court—the Reichskriegsgericht (RKG)—condemned hundreds of Jehovah’s Witness conscientious objectors to death. Though the law permitted lesser sentences, in the majority of cases judges opted for capital punishment. Debate about their motivations persists. Were they Nazi ideologues? Did Nazi laws constrain their judgements? Or do other factors explain their decisions? This examination of the legal reasoning of RKG jurists suggests that the judges held to a totalizing military value system that aligned with Nazi thinking, but did not derive from it. As opposed to civilian courts such as the Volksgerichte, military priorities guided the RKG. Sentences in both court systems were, however, similar for Witnesses who remained dedicated to their beliefs, as courts meted out the harshest sentences possible.
The CINP Guidelines on the Definition and Evidence-Based Interventions for Treatment-Resistant Bipolar Disorder
Authors: Fountoulakis Konstantinos N , Yatham Lakshmi N , Grunze Heinz , Vieta Eduard , Young Allan H , Blier Pierre , Tohen Mauricio , Kasper Siegfried , Moeller Hans Jurgen
Published: December 2019

Background

Resistant bipolar disorder is a major mental health problem related to significant disability and overall cost. The aim of the current study was to perform a systematic review of the literature concerning (1) the definition of treatment resistance in bipolar disorder, (2) its clinical and (3) neurobiological correlates, and (4) the evidence-based treatment options for treatment-resistant bipolar disorder and for eventually developing guidelines for the treatment of this condition

Materials and Methods

The PRISMA method was used to identify all published papers relevant to the definition of treatment resistance in bipolar disorder and the associated evidence-based treatment options. The MEDLINE was searched to April 22, 2018.

Results

Criteria were developed for the identification of resistance in bipolar disorder concerning all phases. The search of the literature identified all published studies concerning treatment options. The data were classified according to strength, and separate guidelines regarding resistant acute mania, acute bipolar depression, and the maintenance phase were developed.

Discussion

The definition of resistance in bipolar disorder is by itself difficult due to the complexity of the clinical picture, course, and treatment options. The current guidelines are the first, to our knowledge, developed specifically for the treatment of resistant bipolar disorder patients, and they also include an operationalized definition of treatment resistance. They were based on a thorough and deep search of the literature and utilize as much as possible an evidence-based approach.
Asymptotic stabilization for a wave equation with periodic disturbance
Authors: Wei Jing , Feng Hongyinping , Guo Bao-Zhu
Published: December 2019

In this paper, we consider boundary stabilization for a one-dimensional wave equation subject to periodic disturbance. By regarding the periodic signal as a boundary output of a free wave equation, we transform the controlled plant into a coupled wave system. We first design a state observer for the coupled system to estimate the disturbance and the system state simultaneously. An output feedback control is then designed to stabilize the original system. As an application, the result is applied to the stabilization of a wave equation with periodic disturbance suffering in output. Finally, some simulations are presented to validate the theoretical results.
Compactness and Rigidity of λ-Surfaces
Authors: Sun Ao
Published: December 2019

In this paper we develop the compactness theorem for $\lambda $-surface in $\mathbb R^3$ with uniform $\lambda $, genus, and area growth. This theorem can be viewed as a generalization of Colding–Minicozzi’s compactness theorem for self-shrinkers in $\mathbb R^3$. As an application of this compactness theorem, we prove a rigidity theorem for convex $\lambda $-surfaces.
Effects of restricted availability of drinking water on body weight and feed intake by Dorper, Katahdin, and St. Croix sheep from different regions of the USA
Authors: Hussein Ali , Puchala Ryszard , Portugal Italo , Wilson Blake K , Gipson Terry A , Goetsch Arthur L
Published: December 2019

Resilience to restricted availability of drinking water was evaluated with 44 Dorper (DOR; initial age = 3.7 ± 0.34 yr), 42 Katahdin (KAT; 3.9 ± 0.36 yr), and 42 St. Croix (STC; 2.7 ± 0.29 yr) sheep from 46 farms in 4 regions of the USA (Midwest, MW; Northwest, NW; Southeast, SE; central Texas, TX). Ad libitum water intake was determined during 2 wk of period 1, with 75% of this amount offered in 2 wk of period 2 and 50% in 5 wk (i.e., 5 to 9) of period 3. Body weight and DMI in week 2 of period 1 and week 9 of period 3 were analyzed with a mixed effects model. There was a breed × period interaction (P = 0.023) in water intake relative to BW (6.17, 6.69, and 7.19 in period 1 and 3.04%, 3.26%, and 3.36% BW in period 3 for DOR, KAT, and STC, respectively; SEM = 0.219). There were 3-way interactions of breed, region, and period in BW and DMI in g/d (P < 0.010). For STC, BW was greater (P < 0.05) in period 3 vs. 1 for all regions (50.1, 47.6, 42.4, and 45.8 kg in period 1 and 51.9, 49.3, 44.5, and 47.7 kg in period 3), whereas there was only a period difference for DOR from the MW and SE (61.4, 66.0, 64.6, and 59.6 kg in period 1 and 60.6, 66.5, 65.7, and 62.4 kg) and for KAT from TX (50.1, 47.6, 42.4, and 45.8 kg in period 1 and 51.9, 49.3, 44.5, and 47.7 kg in period 3 for MW, NW, SE, and TX, respectively; SEM = 2.57). In accordance, DMI by STC was similar (P > 0.05) between periods for all regions (1.25, 1.17, 1.06, and 1.16 kg/d in period 1 and 1.12, 1.08, 1.02, and 1.02 kg/d in period 3), as was also the case for DOR from MW and SE but not from NW or TX (1.54, 1.50, 1.30, and 1.41 kg/d in period 1 and 1.41, 1.13, 1.25, and 1.18 kg/d in period 3) and KAT from TX though not from the other 3 regions (1.47, 1.52, 1.48, and 1.40 kg/d in period 1 and 1.06, 1.15, 1.30, and 1.33 kg/d in period 3 for MW, NW, SE, and TX, respectively; SEM = 0.061). In conclusion, based on BW and DMI with water intake restricted at 50% of ad libitum consumption by individual animals, STC appeared more consistent in display of high resilience to restricted water availability, although DOR from 2 regions and KAT from 1 also were relatively resilient. The results suggest benefit to breed comparisons of inclusion of animals from multiple areas and that environmental conditions of regions may have disparate effects with different breeds of hair sheep.
Investigating Male Aedes aegypti (Diptera: Culicidae) Attraction to Different Oviposition Containers Using Various Configurations of the Sound Gravid Aedes Trap
Authors: Staunton Kyran M , Rohde Barukh B , Townsend Michael , Liu Jianyi , Desnoyer Mark , Howell Paul , Amos Brogan , Crawford Jacob , Snoad Nigel , Ritchie Scott A
Published: December 2019

Aedes aegypti (Linnaeus), the primary vectors of the arboviruses dengue virus and Zika virus, continue to expand their global distributions. In efforts to better control such species, several mosquito control programs are investigating the efficacy of rearing and releasing millions of altered male Aedes throughout landscapes to reduce populations and disease transmission risk. Unfortunately, little is known about Ae. aegypti, especially male, dispersal behaviors within urban habitats. We deployed Sound-producing Gravid Aedes Traps (SGATs) in Cairns, northern Australia, to investigate male Ae. aegypti attraction to various oviposition container configurations. The traps were arranged to include: 1) water only, 2) organically infused water, 3) infused water and L3 larvae, 4) infused water and a human-scented lure, and lastly 5) no water or olfactory attractant (dry). Our data suggest that males were more attracted to SGATs representing active larval sites than potential larval sites, but were equally attracted to dry SGATs relative to those containing water and/or infusion. Additionally, we found that female Ae. aegypti were equally attracted to wet SGATs, with or without infusion, but not dry ones. These results suggest that male Ae. aegypti within northern Australia are more attracted to active larval sites and equally attracted to dry containers as wet or infused ones. Additionally, female Ae. aegypti are unlikely to enter dry containers. Such findings contribute to our understanding of potentially attractive features for local and released Ae. aegypti throughout the northern Australian urban landscape.
Adolescent/Young Adult Perspectives of a Therapeutic Music Video Intervention to Improve Resilience During Hematopoietic Stem Cell Transplant for Cancer*
Authors: Haase Joan E , Robb Sheri L , Burns Debra S , Stegenga Kristin , Cherven Brooke , Hendricks-Ferguson Verna , Roll Lona , Docherty Sharron L , Phillips Celeste
Published: December 2019

This empirical phenomenology study reports adolescents/young adults (AYA) experiences of the therapeutic music video (TMV) intervention arm of a randomized controlled clinical trial (Children’s Oncology Group; COG-ANUR0631; R01 NR008583) during hospitalization for a hematopoietic stem cell transplant. A purposive subsample of 14 AYA were interviewed using a broad open-ended data-generating question about their TMV intervention experiences. At the end of each interview, we also asked AYA for suggestions on how to improve the TMV. Analysis of the narrative data resulted in four theme categories: (a) An Interwoven Experience of the Transplant and TMV Intervention; (b) TMV as a Guided Opportunity for Reflection, Self-Expression, and Meaning-Making; (c) Telling My Story: The Work of Deriving Meaning; and (d) A Way to Overcome the Bad Side of Cancer. AYA suggestions for improving the TMV are also summarized. Findings provide insight into ways the TMV supports AYA efforts to overcome distress and challenges by providing opportunities to reflect on what is meaningful, connect with others, and explore/identify personal strengths. Findings also inform our understanding about how the TMV may have functioned (i.e., mechanisms of action) to bring about significant change in AYA self-reported outcomes (i.e., positive coping, social support, and family function) for this trial.
Estimation of internal dose from tap water after the Fukushima Daiichi Nuclear Power Station accident using newly obtained data
Authors: Miyatake Hirokazu , Kawai Masaki , Yoshizawa Nobuaki , Suzuki Gen
Published: December 2019

Massive release of radioactive materials into the atmosphere occurred due to the Fukushima Daiichi Nuclear Power Station (FDNPS) accident in March 2011. The World Health Organization (WHO) and the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) reported the results of dose estimation to assess the health effect of the accident and both reports state that their assessments of internal and external exposure doses contain certain uncertainties due to uncertainties inherent to the basic data. Therefore, estimation of the internal dose from tap water was conducted in this study by utilizing a database of deposition calculated by an atmospheric transfer, dispersion and deposition model (ATDM) in conjunction with the newly obtained data on the volume of daily water intake obtained by a web-based survey. The median mean and 95-percentile of thyroid equivalent doses were estimated for 1-year and 10-year children and adults in 12 municipalities in the evacuation area in Fukushima prefecture. The present mean thyroid dose estimations for 1-year children (0.4–16.2 mSv) are smaller than the corresponding values in the UNSCEAR 2013 report (1.9–49 mGy). Dose-modifying factors in the Japanese or local community are discussed.
Effects of Outcome and Response Models on Single-Step Calibration Estimators
Authors: Han Daifeng , Valliant Richard
Published: December 2019

Calibration directly to population control totals, bypassing any explicit nonresponse adjustments, is one option for correcting for nonresponse bias. Poststratification, raking, and general regression estimation are alternative methods for single-step nonresponse adjustment through calibration. The models that underlie the response mechanism and the structure of outcome variables collected in a survey both affect the efficacy of these estimators. Consistent with earlier literature, we demonstrate that the model for the outcome variables is most important in determining bias, standard errors, and confidence interval coverage. However, if the predictive power of the model for an outcome variable is weak, properties of the aforementioned estimators of totals will be very similar.
Development of anIn VitroHuman Thyroid Microtissue Model for Chemical Screening
Authors: Deisenroth Chad , Soldatow Valerie Y , Ford Jermaine , Stewart Wendy , Brinkman Cassandra , LeCluyse Edward L , MacMillan Denise K , Thomas Russell S
Published: December 2019

Thyroid hormones (TH) are essential for regulating a number of diverse physiological processes required for normal growth, development, and metabolism. The US EPA Endocrine Disruptor Screening Program (EDSP) has identified several molecular thyroid targets relevant to hormone synthesis dynamics that have been adapted to high-throughput screening (HTS) assays to rapidly evaluate the ToxCast/Tox21 chemical inventories for potential thyroid disrupting chemicals (TDCs). The uncertainty surrounding the specificity of active chemicals identified in these screens and the relevance to phenotypic effects on in vivo human TH synthesis are notable data gaps for hazard identification of TDCs. The objective of this study was to develop a medium-throughput organotypic screening assay comprised of reconstructed human thyroid microtissues to quantitatively evaluate the disruptive effects of chemicals on TH production and secretion. Primary human thyroid cells procured from qualified euthyroid donors were analyzed for retention of NK2 homeobox 1 (NKX2-1), Keratin 7 (KRT7), and Thyroglobulin (TG) protein expression by high-content image analysis to verify enrichment of follicular epithelial cells. A direct comparison of 2-dimensional (2D) and 3-dimensional (3D) 96-well culture formats was employed to characterize the morphology, differential gene expression, TG production, and TH synthesis over the course of 20 days. The results indicate that modeling human thyroid cells in the 3D format was sufficient to restore TH synthesis not observed in the 2D culture format. Inhibition of TH synthesis in an optimized 3D culture format was demonstrated with reference chemicals for key molecular targets within the thyroid gland. Implementation of the assay may prove useful for interpreting phenotypic effects of candidate TDCs identified by HTS efforts currently underway in the EDSP.
A drone delivery network for antiepileptic drugs: a framework and modelling case study in a low-income country
Authors: Mateen Farrah J , Leung K H Benjamin , Vogel Andre C , Cissé Abass Fode , Chan Timothy C Y
Published: December 2019

Background

In urbanized, low-income cities with high rates of congestion, delivery of antiepileptic drugs (AEDs) by unmanned aerial vehicles (drones) to people with epilepsy for both emergency and non-urgent distribution may prove beneficial.

Methods

Conakry is the capital of the Republic of Guinea, a low-income sub-Saharan African country (2018 per capita gross national income US$830). We computed the number of drones and delivery times to distribute AEDs from a main urban hospital to 27 pre-identified gas stations, mosques and pharmacies and compared these to the delivery times of a personal vehicle.

Results

We predict that a single drone could serve all pre-identified delivery locations in Conakry within a 20.4-h period. In an emergency case of status epilepticus, 8, 20 and 24 of the 27 pre-identified destinations can be reached from the hub within 5, 10 and 15 min, respectively. Compared with the use of a personal vehicle, the response time for a drone is reduced by an average of 78.8% across all times of the day.

Conclusions

Drones can dramatically reduce the response time for both emergency and routine delivery of lifesaving medicines. We discuss the advantages and disadvantages of such a drone delivery model with relevance to epilepsy. However, the commissioning of a trial of drones for drug delivery in related diseases and geographies is justified.
Type specimens matter: new insights on the systematics, taxonomy and nomenclature of the subalpine warbler (Sylvia cantillans) complex
Authors: Zuccon Dario , Pons Jean-Marc , Boano Giovanni , Chiozzi Giorgio , Gamauf Anita , Mengoni Chiara , Nespoli Davide , Olioso Georges , Pavia Marco , Pellegrino Irene , Raković Marko , Randi Ettore , Rguibi Idrissi Hamid , Touihri Moez , Unsöld Markus , Vitulano Severino , Brambilla Mattia
Published: December 2019

We revise the taxonomy of the Sylvia cantillans complex, a group of phenotypically distinct warblers with mainly parapatric distributions around a large part of the Mediterranean basin. We redefine the species limits using a combination of mitochondrial and nuclear markers and we objectively link available names to the genetically defined lineages by genotyping the surviving type specimens. In addition, the study of archival documents clarifies the exact composition of type series and provides further evidence for the identification of lost types. These results support the recognition of three species-level taxa: Moltoni’s warbler, Sylvia subalpina (north-central Italy, Corsica, Sardinia and the Balearics); the western subalpine warbler, S. iberiae (North Africa, Iberia, southern France and extreme north-west Italy); and the eastern subalpine warbler, S. cantillans, with subspecies S. cantillans cantillans (southern Italy, Sicily) and S. cantillans albistriata (Balkans, Greece, western Turkey).
Onset, Trajectory, and Pattern of Feeding Difficulties in Toddlers Later Diagnosed with Autism
Authors: Ashley Kevin , Steinfeld Mary Beth , Young Gregory S. , Ozonoff Sally
Published: December 2019

Objective:

To examine the emergence and trajectory of feeding difficulties in young children who are later diagnosed with autism spectrum disorder (ASD).

Methods:

The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was administered to a sample of 93 toddlers with an older sibling with ASD—the high-risk group—and 62 toddlers with no known familial ASD—the low-risk group—as part of a larger infant sibling study. The BPFAS was completed by parents at 15, 18, 24, and 36 months of age. At 36 months, participants underwent a diagnostic assessment and were classified into 1 of the following 4 outcome groups: ASD, nontypical development, high-risk typically developing, and low-risk typically developing. The BPFAS was scored for total frequency of feeding difficulties and autism-specific factor scores previously described in the literature.

Results:

The frequency of feeding difficulties increased significantly more rapidly in the ASD group between 15 and 36 months of age, and by 36 months, they exhibited a significantly higher total frequency score than all other groups. Analysis of the factor scores revealed a similar pattern for the food acceptance and mealtime behavior domains but no significant differences in the medical/oral motor domain.

Conclusion:

Feeding difficulties develop significantly more rapidly in children with ASD, with longitudinal monitoring revealing the steeper trajectory earlier than can be detected with cross-sectional analysis. Children with ASD are at risk of health and social consequences of poor feeding behavior that may potentially be minimized if addressed early and appropriately.
Make Your Own Deep Inferior Epigastric Artery Perforator Flap: Perforator Delay Improves Deep Inferior Epigastric Artery Perforator Flap Reliability
Authors: Shakir Sameer , Spencer Amy B. , Kozak Geoffrey M. , Jablonka Eric M. , Kanchwala Suhail K.
Published: December 2019

Background:

Abdominal-based autologous breast reconstruction remains a conflict between blood supply and donor site complication. Optimizing esthetics and minimizing recovery and postoperative pain add further complexity. We present a 2-stage technique of deep inferior epigastric artery perforator flap reconstruction to (1) reliably harvest single-vessel flaps while minimizing fat necrosis, (2) decrease abdominal wall morbidity, and (3) improve breast and donor site esthetics.

Methods:

Female subjects presenting between August 2017 and January 2019 to the senior surgeon for abdominal-based breast reconstruction were included. After mastectomy, the subjects underwent subcutaneous placement of tissue expanders and in situ selection of a low, centrally located perforator based on preoperative computed tomographic angiography imaging through an infraumbilical “T” incision with ligation of all other perforators and superficial system. Subjects underwent tissue expander explant and flap transfer at a second stage.

Results:

One hundred thirty-five subjects undergoing 215 free flaps met criteria. Mean age and body mass index were 52.1 years and 29.3 kg/m2, respectively. Seven perforator complications (3.3%) occurred with 2 (0.9%) total and 5 (2.3%) partial flap losses. There were 20 (14.8%) readmissions and 26 (19.3%) reoperations. Breast complications included arterial thrombosis (0.5%), venous congestion (1.9%), and fat necrosis (5.1%). The mastectomy skin flap necrosis rate decreased from 14.9% to 2.3% following staged reconstruction. Abdominal donor site complications included delayed healing (11.1%), seroma (5.9%), and hematoma (2.2%).

Conclusions:

The 2-stage delayed deep inferior epigastric artery perforator flap technique represents a safe, efficacious modality to allow for reliable harvest of single-vessel flaps with low rates of fat necrosis while improving donor site esthetics and morbidity.
HYPERREFLECTIVE FOCI AS A PATHOGENETIC BIOMARKER IN CHOROIDEREMIA
Authors: Romano Francesco , Arrigo Alessandro , MacLaren Robert E. , Charbel Issa Peter , Birtel Johannes , Bandello Francesco , Battaglia Parodi Maurizio
Published: December 2019

Purpose:

To assess hyperreflective foci (HF) number and distribution in choroideremia (CHM) using spectral domain optical coherence tomography.

Methods:

Observational, cross-sectional case series. Consecutive patients and matched controls (20 eyes each) underwent best-corrected visual acuity measurement, fundoscopy, blue-light autofluorescence (BL-FAF) and spectral domain optical coherence tomography. Hyperreflective foci were assessed on a horizontal spectral domain optical coherence tomography scan, in the 500-µm area centered on the umbo, and in the 500-μm-wide areas internal (preserved border) and external (pathologic border) to the chorioretinal atrophy of CHM patients, and in the parafovea of controls. Hyperreflective foci were subclassified as retinal or choroidal. The spared central islet was measured on BL-FAF. Primary outcome was HF quantification in CHM. Secondary outcomes included their relationships with atrophy extent.

Results:

Choroideremia eyes disclosed a significantly higher HF number across the pathologic border and in the fovea when compared with controls; in particular, these HF were primarily located in the choroid (59–87%). Moreover, choroidal HF in the pathologic border inversely correlated with the area of the preserved central islet.

Conclusion:

Hyperreflective foci might turn out to be a potential biomarker of CHM activity or severity. In this regard, we hypothesize that HF may be related to macrophages activation or progressive retinal pigment epithelium degeneration.
RATES AND RISK FACTORS FOR RECURRENCE OF RETINOPATHY OF PREMATURITY AFTER LASER OR INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR MONOTHERAPY
Authors: Ling Kiet-Phang , Liao Pei-Ju , Wang Nan-Kai , Chao An-Ning , Chen Kuan-Jen , Chen Tun-Lu , Hwang Yih-Shiou , Lai Chi-Chun , Wu Wei-Chi
Published: December 2019

Purpose:

To determine the rates and risk factors of recurrent retinopathy of prematurity (ROP) treated by laser photocoagulation, intravitreal bevacizumab (IVB) monotherapy, or intravitreal ranibizumab (IVR) monotherapy.

Methods:

In this retrospective cohort study, consecutive infants with Type 1 ROP who received laser, IVB, or IVR treatments were followed for at least 75 weeks of postmenstrual age. Data analysis was performed between March 2010 and February 2017 in Chang Gung Memorial Hospital, Linkou, Taiwan.

Results:

A total of 176 infants (340 eyes) were included in this study. The mean follow-up was 197.3 ± 110 weeks. All of the baseline demographic and ROP characteristics among the laser, IVB, and IVR groups were similar. The overall recurrence rate after treatment was 44 of 340 eyes (12.9%). The IVB group had a recurrence rate of 10.0%, followed by the laser group (18.0%) and the IVR group (20.8%); however, these rates were not significantly different (P = 0.0528). Compared with the laser group, the IVB and IVR groups exhibited recurrence at later ages (43.4 ± 3.5 weeks for the IVB group, 42.3 ± 2.0 weeks for the IVR group, and 39.5 ± 2.8 weeks for the laser group; P = 0.0058). The mean interval of recurrence from initial treatment in the laser group was 3.6 ± 1.4 weeks compared with 8.8 ± 3.9 weeks and 8.3 ± 1.6 weeks in the IVB and IVR groups, respectively (P = 0.0001). Overall, the independent risk factors of recurrence included an early postmenstrual age at initial treatment (P = 0.0160), Zone I (P = 0.0007), low Apgar score (P = 0.0297), and multiple births (P = 0.0285). There was no significant difference in progression to retinal detachment among the three groups (laser: 3/61, 4.9%; IVB: 2/231, 0.9%;and IVR: 1/48, 2.1%; P = 0.2701).

Conclusion:

Laser, IVR, and IVB are effective for Type 1 ROP. Retinopathy of prematurity recurrence requiring re-treatment was encountered as late as 50 weeks of postmenstrual age after IVB or IVR but earlier after laser. Longer follow-up for infants treated with anti–vascular endothelial growth factor is needed, especially in patients with significant risk factors such as an early postmenstrual age at initial treatment, Zone I ROP, low Apgar score, and multiple births.
DARK ADAPTATION IN MACULAR TELANGIECTASIA TYPE 2
Authors: Tzaridis Simone , Hess Kristina , Heeren Tjebo F. C. , Nadal Jennifer , Mai Clarissa , Herrmann Philipp , Charbel Issa Peter , Holz Frank G.
Published: December 2019

Purpose:

To evaluate dark adaptation (DA) in patients with macular telangiectasia Type 2 (MacTel).

Methods:

After a local photobleach (4 × 4° size, 83% bleach), DA was measured using a test stimulus (2° diameter) projected at 5° eccentricity horizontal from the foveal center within the temporal parafovea. Cone plateau, rod intercept time, and rod recovery rate (S2) were calculated from the resulting DA curves. Findings were correlated with disease stages (according to Gass and Blodi), the area of ellipsoid zone loss in optical coherence tomography, and macular pigment loss (“MP-Classes 1–3”).

Results:

Fifty-nine eyes of 59 patients were compared with 18 eyes of 18 healthy controls. Dark adaptation was significantly impaired in patients with MacTel. Although differences were most pronounced for parameters indicating rod-mediated recovery, cone-mediated recovery was also decreased, yet to a lesser extent. Dark adaptation parameters were only weakly associated with disease stages and ellipsoid zone loss. A better association was found between rod-mediated recovery (S2 and rod intercept time) and macular pigment loss (Kendall's tau for rod intercept time: 0.69 and S2: −0.51; both P < 0.0001).

Conclusion:

Dark adaptation is significantly impaired in patients with MacTel. Our results indicate an association of reduced macular pigment and rod dysfunction in MacTel.
SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY, FLUORESCEIN ANGIOGRAPHY, AND INDOCYANINE GREEN ANGIOGRAPHY COMPARISONS REVISITED
Authors: Told Reinhard , Reiter Gregor S. , Orsolya Angeli , Mittermüller Tamara J. , Eibenberger Katharina , Schlanitz Ferdinand G. , Arikan Mustafa , Pollreisz Andreas , Sacu Stefan , Schmidt-Erfurth Ursula
Published: December 2019

Purpose:

To compare area measurements between swept source optical coherence tomography angiography (SSOCTA), fluorescein angiography (FA), and indocyanine green angiography (ICGA) after applying a novel deep-learning-assisted algorithm for accurate image registration.

Methods:

We applied an algorithm for the segmentation of blood vessels in FA, ICGA, and SSOCTA images of 24 eyes with treatment-naive neovascular age-related macular degeneration. We trained a model based on U-Net and Mask R-CNN for each imaging modality using vessel annotations and junctions to estimate scaling, translation, and rotation. For fine-tuning of the registration, vessels and the elastix framework were used. Area, perimeter, and circularity measurements were performed manually using ImageJ.

Results:

Choroidal neovascularization lesion size, perimeter, and circularity delineations showed no significant difference between SSOCTA and ICGA (all P > 0.05). Choroidal neovascularization area showed excellent correlation between SSOCTA and ICGA (r = 0.992) and a Bland–Altman bias of −0.10 ± 0.24 mm2. There was no significant difference in foveal avascular zone size between SSOCTA and FA (P = 0.96) and an extremely small bias of 0.0004 ± 0.04 mm2 and excellent correlation (r = 0.933). Foveal avascular zone perimeter was not significantly different, but foveal avascular zone circularity was significantly different (P = 0.047), indicating that some small cavities or gaps may be missed leading to higher circularity values representing a more round-shaped foveal avascular zone in FA.

Conclusion:

We found no statistically significant differences between SSOCTA and FA and ICGA area measurements in patients with treatment-naive neovascular age-related macular degeneration after applying a deep-learning-assisted approach for image registration. These findings encourage a paradigm shift to using SSOCTA as a first-line diagnostic tool in neovascular age-related macular degeneration.
Analysis of prognostic factors in patients receiving transarterial radioembolization for unresectable hepatocellular carcinoma
Authors: Soydal Cigdem , Araz Mine , Nak Demet , Akkus Pinar , Baltacioğlu Muhammet Halil , Bilgic Sadik , Kucuk Nuriye Ozlem
Published: December 2019

Aim

This study aimed to analyze the prognostic factors of patients receiving transarterial radioembolization for unresectable hepatocellular carcinoma.

Material and method

Eighty-six (73 M and 13F; mean age: 64.3 ± 9.8 years) patients who received transarterial radioembolization for unresectable hepatocellular carcinoma were included. Relationship between serum alpha-fetoprotein and international normalization ratio level, albumin-bilirubin grade, neutrophil-lymphocyte ratio, presence of portal venous thrombosis and extrahepatic metastases, the dimension of index lesion and OS were analyzed.

Results

Neutrophil lymphocyte ratio was ≤ 5 in 76 (88%) and >5 in 10 (12%) of patients. Sixty-two (72%) patients died during a mean of 25.6± 9.7 months follow-up. Mean OS for all patients was calculated as 12.9 ± 14.6 months. In univariate analysis, albumin-bilirubin grade (22.3 ± 3.8 vs. 11.6 ± 4.2; P = 0.03), neutrophil-lymphocyte ratio (21.8 ± 3.6 vs. 7.3 ± 2.6; P =0.04), presence of extrahepatic metastases (30.1 ± 5.4 vs. 7.4 ± 2.0; P = 0.001) and portal venous thrombosis (26.5± 4.8 vs. 10.5 ± 2.1; P = 0.01) had significant effect on OS. In multivariate analysis, serum international normalization ratio (P = 0.005) and alpha-fetoprotein level (P = 0.004), albumin-bilirubin grade (P = 0.05), neutrophil-lymphocyte ratio (P = 0.007), Child-Pugh score (0.006) and presence of ascites (P = 0.005) were significantly correlated with OS.

Conclusion

Patients with low basal albumin-bilirubin grade and neutrophil-lymphocyte ratio survive longer after transarterial radioembolization for unresectable hepatocellular carcinoma. Presence of extrahepatic metastases and portal venous thrombosis seems to have a prognostic value.
Current Approach to the Evaluation and Management of Abdominal Compartment Syndrome in Pediatric Patients
Authors: Gottlieb Michael , Davenport Dayle V. , Adams Shayna , Chien Nicholas
Published: December 2019

Abdominal compartment syndrome is an emergent condition caused by increased pressure within the abdominal compartment. It can be caused by a number of etiologies, which are associated with decreased abdominal wall compliance, increased intraluminal or intraperitoneal contents, or edema from capillary leak or fluid resuscitation. The history and physical examination are of limited utility, and the criterion standard for diagnosis is intra-abdominal pressure measurement, which is typically performed via an intravesical catheter. Management includes increasing abdominal wall compliance, evacuating gastrointestinal or intraperitoneal contents, avoiding excessive fluid resuscitation, and decompressive laparotomy in select cases.
Breast Reconstruction Does Not Increase the Incidence of Postmastectomy Pain Syndrome
Authors: Reghunathan Meera , Rahgozar Paymon , Sbitany Hani , Srinivasa Dhivya R.
Published: December 2019

Background

Postmastectomy pain syndrome (PMPS) is characterized by neuropathic pain from direct nerve injury during oncologic breast surgery causing chronic pain, often leading to chronic opioid dependence and long-term disability. To our knowledge, this study represents the first meta-analysis that defines the incidence of PMPS in patients undergoing mastectomy, with and without breast reconstruction.

Methods

The Cochrane, Embase, MEDLINE, and PubMed databases were queried. A total of 166 citations from 1991 to 2017 were reviewed to identify 22 unique manuscripts. Inclusion criteria required: (i) minimum 3-month follow-up, (ii) pain in breast, (iii) pain after mastectomy, (iv) documentation of any reconstruction, and (v) minimum of level three evidence.Comprehensive Meta- Analysis Softwareand Microsoft Excel were used for statistical calculations.

Results

Sixteen manuscripts described the prevalence of postmastectomy pain and 11 described the prevalence of postreconstruction pain (5 had data for both). Study population size ranged from 32 to 1165 patients. All studies were classified as level 2 or level 3 evidence. The mean prevalence of pain after mastectomy alone using a random-effects model is 35.6% (30.3%–41.3%). Mean prevalence of pain after mastectomy with reconstruction using the random-effects model is 32.8% (24.4% - 42.5%). Analysis of variance analysis showed no significant difference between prevalence of chronic pain after mastectomy alone versus mastectomy and reconstruction (P= 0.88).

Conclusions

Our meta-analysis establishes that postmastectomy reconstruction does not increase the incidence of PMPS. However, because this neuropathic pain often persists after reconstructive surgery, it is incumbent on the plastic surgeon to counsel patients on PMPS. Moving forward, prospective studies on the effects of reconstruction type and adjunct procedures are warranted.
Lymphovenous Anastomosis for the Treatment of Thoracic Duct Lesion
Authors: Lindenblatt Nicole , Puippe Gilbert , Broglie Martina A. , Giovanoli Pietro , Grünherz Lisanne
Published: December 2019

Background

Chylous leak is an uncommon complication after head and neck surgery and typically results from a lesion of the thoracic duct (TD). Beside conservative treatment, different minimally invasive and surgical procedures exist, of which almost all lead to a total closure of the TD.

Methods

We report on a rare case of microsurgical lymphovenous anastomosis to treat a TD lesion. An additional systematic review on surgical procedures to treat TD lesions with special attention to lymphovenous anastomoses was performed according to the PRISMA guidelines.

Results

A 52-year-old patient with a chylous fistula after modified radical neck dissection was successfully treated by a lymphovenous anastomosis of the TD and external jugular vein with additional coverage by sternocleidomastoid muscle flap. The patient showed a complete resolution of chylous leak with an uneventful postoperative course.

The systematic search of literature yielded 684 articles with 4 case reports on lymphovenous anastomosis in chylous leak with a high success rate. Other surgical techniques include transcervical, thoracoscopic, or video-assisted thoracoscopic TD ligation, either alone or combined with a local muscle flap.

Conclusions

Lymphovenous anastomosis of the TD is a feasible and safe technique allowing for treatment of cervical TD lesions, especially if minimally invasive procedures fail. Compared with other techniques, lymphatic circulation can successfully be maintained.
Dickkopf 2–Expressing Adenovirus Increases the Survival of Random-Pattern Flaps and Promotes Vasculogenesis in a Rat Model
Authors: Choi Se Woon , Jeon Yeo Reum , Baek Wooyeol , Yun Chae-Ok , Roh Tai Suk , Lee Won Jai
Published: December 2019

Background

Dickkopf 2 (DKK2) has important roles in vertebrate development; it inhibits Wnt signaling-related processes, such as axial patterning, limb development, somitogenesis, and eye formation. However, DKK2 also acts as a Wnt signaling agonist. Dickkopf 2, induced during endothelial cell morphogenesis, promotes angiogenesis in cultured human endothelial cells. In this study, we explored the effect of DKK2-expressing adenovirus on random-pattern flaps using a rodent model.

Methods

A DKK2-expressing (dE1-RGD/DKK2) adenovirus was generated and 20 Sprague-Dawley rats were randomly divided into 2 groups: a DKK2 group and a control group. Each group was intradermally injected with 1 × 107 plaque-forming units of DKK2-expressing adenovirus (DKK2 group) or control virus (control group) 48 hours before and immediately before surgery. Then, random-pattern dorsal cutaneous flaps of 3 × 9 cm were elevated. Flap survival rates and cutaneous blood flow were measured over time, and immunohistochemical staining was performed 10 days after surgery to detect CD31 and vascular endothelial growth factor (VEGF).

Results

Immunofluorescence staining confirmed the expression of DKK2 in the DKK2 group. The flap survival rate was higher in the DKK2 group (80.0 ± 4.49%) than in the control group (57.5 ± 4.21%; P < 0.05). Blood flow to the most distal compartment was higher in the DKK2 group than the control group during the early postoperative period. Although vascular density was greater in the DKK2 group, there was no difference in the VEGF concentration between groups.

Conclusions

The findings of the present study suggest that the DKK2-expressing adenovirus increases the survival of the random-pattern cutaneous flap independently of VEGF. The administration of the DKK2-expressing adenovirus into elevated skin flaps increased the number of capillaries and blood flow, thereby improving skin flap survival.
Surgical Decompression or Corticosteroid Treatment of Indirect Traumatic Optic Neuropathy
Authors: Chen Hsin-Hung , Lee Min-Chao , Tsai Chia-Hsuan , Pan Chun-Hao , Lin Yu-Te , Chen Chien-Tzung
Published: December 2019

Background

Traumatic optic neuropathy (TON) is a rare cause of severe permanent visual impairment after injury. Traumatic optic neuropathy may occur due to sharp trauma (direct injury) that damages the optic nerve directly or due to damage from the transmitted forces after a concussive blow to the head or orbit (indirect injury). The management of indirect TON remains controversial. Either surgical decompression or mega dose corticosteroid is used for managing indirect TON. However, no consensus exists regarding the definitive treatment.

Materials and Methods

We designed a randomized controlled trial study to investigate this issue. Only patients with indirect TON and normal vision before the injury were enrolled. The patients' data were recorded, and fine cut facial computed tomography scan was performed to exclude those with retrobulbar hematoma. All the study subjects were randomly allocated to either the mega dose steroid (30 mg/kg stat and 15 mg/kg every 6 hours for 3 days) group or the surgical decompression group. The patients were followed up at 1 week, 1 month, 3 months, 6 months, and 9 months. During each follow-up, the Snellen visual acuity (VA), visual field, color change, fundus findings, and intraocular pressure were evaluated. These data were compared and analyzed using the Mann-Whitney U test and odds ratio. The short form questionnaire was used to analyze the lift quality difference between the two groups.

Results

Thirty patients were enrolled, 12 in the surgical group and 18 in the steroid treatment group. There were no significant differences in the improvement rate, improvement degree, and life quality between the groups. However, the odds ratios are 5, 10, 2.5, and nonavailable in the cutoff points of no light perception (NLP), light perception (LP), hand movement, and counting finger in surgery group. In steroid group, they are 1, 1, 1, 1.83 in each cutoff points. Patients with better VA than NLP had better life quality than those with NLP VA (P = 0.005). Other cutoff point groups had no significant difference.

Conclusions

Patients with worse initial VA (eg, NLP and LP) had a higher chance of benefiting from surgical treatment and experiencing improvements in the life quality.