bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acellular Human Dermal Allograft as a Graft for Nasal Septal Perforation Reconstruction
Authors: Conrad Dustin J. , Zhang Han , Côté David W. J. 
Published: March 2018

Background:
Nasal septal perforations pose a troubling source of morbidity for patients and a difficult problem for the otolaryngologist. Multiple surgical techniques have been tried, with inconsistent success. Prosthetic nasal buttons also have limitations, including patient intolerance and dissatisfaction. Acellular human dermal allograft (AlloDerm) has been described as an alternative material for septal perforation repair. The authors studied objective and subjective outcomes, including quantification of the patient’s symptoms in septal perforation repair with AlloDerm.

Methods:
The authors performed a prospective cohort study of 12 patients with 1- to 2-cm anterior septal perforations who were recruited from a tertiary care practice. Patients with admitted smoking or cocaine use in the previous 3 months or vascular or granulomatous diseases were excluded. Subjective scores on the Sino-nasal Outcome Test-22, along with objective nasal endoscopy and acoustic rhinometry measures, were collected at baseline and 2, 4, and 12 weeks postoperatively. Patients were followed for reperforation 9 to 20 months postoperatively. Data were normalized to baseline values and analyzed using analysis of variance and Bonferroni correction.

Results:
Successful closure of the septal perforation was obtained in 10 of 12 patients and confirmed with rigid nasal endoscopy. Nasal symptom scores (Sino-nasal Outcome Test-22 ) were significantly reduced to 52.8 percent (95 percent CI, 35.1 to 70.5 percent; p < 0.01) of baseline symptoms at 4 weeks postoperatively. At 12 weeks postoperatively, symptoms were measured at 26.6 percent (95 percent CI, 10.9 to 42.1 percent; p < 0.01) of baseline symptoms. Acoustic rhinometry confirmed perforation closure, demonstrating a reduction in cross-sectional nasal area from baseline of 55.1 percent (95 percent CI, 37.7 to 66.8 percent; p < 0.01).

Conclusion:
This is the first study to use objective and subjective measurements to confirm success with acellular dermis allograft as an adjunct for septal perforation repair, demonstrating a statistically significant reduction in patient nasal symptoms following repair.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
New Developments Are Improving Flexor Tendon Repair
Authors: Tang Jin Bo 
Published: March 2018

Summary:
New developments in primary tendon repair in recent decades include stronger core tendon repair techniques, judicious and adequate venting of critical pulleys, followed by a combination of passive and active digital flexion and extension. During repair, core sutures over the tendon should have sufficient suture purchase (no shorter than 0.7 to 1 cm) in each tendon end and must be sufficiently tensioned to resist loosening and gap formation between tendon ends. Slight or even modest bulkiness in the tendon substance at the repair site is not harmful, although marked bulkiness should always be avoided. To expose the tendon ends and reduce restriction to tendon gliding, the longest annular pulley in the fingers (i.e., the A2 pulley) can be vented partially with an incision over its distal or proximal sheath no longer than 1.5 to 2 cm; the annular pulley over the middle phalanx (i.e., the A4 pulley) can be vented entirely. Surgeons have not observed adverse effects on hand function after judicious and limited venting. The digital extension-flexion test to check the quality of the repair during surgery has become increasingly routine. A wide-awake surgical setting allows patient to actively move the digits. After surgery, surgeons and therapists protect patients with a short splint and flexible wrist positioning, and are now moving toward out-of-splint freer early active motion. Improved outcomes have been reported over the past decade with minimal or no rupture during postoperative active motion, along with lower rates of tenolysis.
Assessing Technical Performance and Determining the Learning Curve in Cleft Palate Surgery Using a High-Fidelity Cleft Palate Simulator
Authors: Podolsky Dale J. , Fisher David M. , Wong Riff Karen W. , Szasz Peter , Looi Thomas , Drake James M. , Forrest Christopher R. 
Published: March 2018

Background:
This study assessed technical performance in cleft palate repair using a newly developed assessment tool and high-fidelity cleft palate simulator through a longitudinal simulation training exercise.

Methods:
Three residents performed five and one resident performed nine consecutive endoscopically recorded cleft palate repairs using a cleft palate simulator. Two fellows in pediatric plastic surgery and two expert cleft surgeons also performed recorded simulated repairs. The Cleft Palate Objective Structured Assessment of Technical Skill (CLOSATS) and end-product scales were developed to assess performance. Two blinded cleft surgeons assessed the recordings and the final repairs using the CLOSATS, end-product scale, and a previously developed global rating scale.

Results:
The average procedure-specific (CLOSATS), global rating, and end-product scores increased logarithmically after each successive simulation session for the residents. Reliability of the CLOSATS (average item intraclass correlation coefficient (ICC), 0.85 ± 0.093) and global ratings (average item ICC, 0.91 ± 0.02) among the raters was high. Reliability of the end-product assessments was lower (average item ICC, 0.66 ± 0.15). Standard setting linear regression using an overall cutoff score of 7 of 10 corresponded to a pass score for the CLOSATS and the global score of 44 (maximum, 60) and 23 (maximum, 30), respectively. Using logarithmic best-fit curves, 6.3 simulation sessions are required to reach the minimum standard.

Conclusions:
A high-fidelity cleft palate simulator has been developed that improves technical performance in cleft palate repair. The simulator and technical assessment scores can be used to determine performance before operating on patients.
Hepatic Epithelioid Angiomyolipoma and 18F-FDG PET/CT
Authors: Zhang Yiqiu , Li Beilei , Hou Jun , Yu Haojun , Shi Hongcheng 
Published: March 2018

Abstract
Hepatic epithelioid angiomyolipoma (AML) is rare. Although generally epithelioid AML shows benign biological behavior, it can occasionally have malignant potential. In this study, we report a case of 2 hepatic epithelioid AMLs with different 18F-FDG uptake; one is intensely FDG avid, and the other is non–FDG avid.
68Ga–Prostate-Specific Membrane Antigen PET/CT in Triple-Negative Breast Cancer
Authors: Passah Averilicia , Arora Saurabh , Damle Nishikant Avinash , Tripathi Madhavi , Bal Chandrasekhar , Subudhi T. Kishan , Arora Geetanjali 
Published: March 2018

Abstract
The prostate-specific membrane antigen (PSMA) is a transmembrane protein with elevated expression in prostate cancer cells. Breast cancer also shows PSMA expression. We present the case of a 30-year-old woman with triple-negative bilateral breast carcinoma who underwent bilateral mastectomy, chemotherapy, and radiotherapy. She developed a left chest wall and liver recurrence after primary therapy. Her recurrent disease was also triple-negative. In view of the known poor prognosis and very limited therapeutic options, we performed 68Ga-PSMA PET/CT scan to explore the possibility of PSMA-based therapy as a future option after exhausting standard-of-care treatments.
Unexpected Detection of Bone Metastases on Renal Dynamic Scintigraphy
Authors: Mi Yanxia , Huang Jianmin , Ren Yuan , Xie Peng 
Published: March 2018

Abstract
A 57-year-old man with renal mass underwent 99mTc–diethylenetriaminepentaacetic acid renal dynamic scintigraphy for evaluation of renal function. The blood flow phase images demonstrated a focus of abnormal increased tracer uptake in the region of the right lower quadrant. On the functional phase images, the activity became unimpressive gradually. This focus corresponded to an osteolytic lesion in the right ilium on the CT and MR images, which was a typical pattern of bone metastasis.
Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma
Authors: Groot Vincent P. , Gemenetzis Georgios , Blair Alex B. , Rivero-Soto Roberto J. , Yu Jun , Javed Ammar A. , Burkhart Richard A. , Rinkes Inne H. M. Borel , Molenaar I. Quintus , Cameron John L. , Weiss Matthew J. , Wolfgang Christopher L. , He Jin 
Published: March 2018

Objectives:
To establish an evidence-based cut-off to differentiate between early and late recurrence and to compare clinicopathologic risk factors between the two groups.

Summary Background Data:
A clear definition of “early recurrence” after pancreatic ductal adenocarcinoma resection is currently lacking.

Methods:
Patients undergoing pancreatectomy for pancreatic ductal adenocarcinoma between 2000 and 2013 were included. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. A minimum P-value approach was used to evaluate the optimal cut-off value of recurrence-free survival to divide the patients into early and late recurrence cohorts based on subsequent prognosis. Potential risk factors for early recurrence were assessed with logistic regression models.

Results:
Of 957 included patients, 204 (21.3%) were recurrence-free at last follow-up. The optimal length of recurrence-free survival to distinguish between early (n = 388, 51.5%) and late recurrence (n = 365, 48.5%) was 12 months (P < 0.001). Patients with early recurrence had 1-, and 2-year post-recurrence survival rates of 20 and 6% compared with 45 and 22% for the late recurrence group (both P < 0.001). Preoperative risk factors for early recurrence included a Charlson age-comorbidity index ≥4 (OR 1.65), tumor size > 3.0 cm on computed tomography (OR 1.53) and CA 19-9 > 210 U/mL (OR 2.30). Postoperative risk factors consisted of poor tumor differentiation grade (OR 1.66), microscopic lymphovascular invasion (OR 1.70), a lymph node ratio > 0.2 (OR 2.49), and CA 19-9 > 37 U/mL (OR 3.38). Adjuvant chemotherapy (OR 0.28) and chemoradiotherapy (OR 0.29) were associated with a reduced likelihood of early recurrence.

Conclusion:
A recurrence-free interval of 12 months is the optimal threshold for differentiating between early and late recurrence, based on subsequent prognosis.
Multisource Evaluation of Surgeon Behavior Is Associated With Malpractice Claims
Authors: Lagoo Janaka , Berry William R. , Miller Kate , Neal Brandon J. , Sato Luke , Lillemoe Keith D. , Doherty Gerard M. , Kasser James R. , Chaikof Elliot L. , Gawande Atul A. , Haynes Alex B. 
Published: March 2018

Objective:
We merged direct, multisource, and systematic assessments of surgeon behavior with malpractice claims, to analyze the relationship between surgeon 360-degree reviews and malpractice history.

Background:
Previous work suggests that malpractice claims are associated with a poor physician-patient relationship, which is likely related to behaviors captured by 360-degree review. We hypothesize that 360-degree review results are associated with malpractice claims.

Methods:
Surgeons from 4 academic medical centers covered by a common malpractice carrier underwent 360-degree review in 2012 to 2013 (n = 385). Matched, de-identified reviews and malpractice claims data were available for 264 surgeons from 2000 to 2015. We analyzed 23 questions, highlighting positive and negative behaviors within the domains of education, excellence, humility, openness, respect, service, and teamwork. Regression analysis with robust standard error was used to assess the potential association between 360-degree review results and malpractice claims.

Results:
The range of claims among the 264 surgeons was 0 to 8, with 48.1% of surgeons having at least 1 claim. Multiple positive and negative behaviors were significantly associated with the risk of having malpractice claims (P < 0.05). Surgeons in the bottom decile for several items had an increased likelihood of having at least 1 claim.

Conclusion:
Surgeon behavior, as assessed by 360-degree review, is associated with malpractice claims. These findings highlight the importance of teamwork and communication in exposure to malpractice. Although the nature of malpractice claims is complex and multifactorial, the identification and modification of negative physician behaviors may mitigate malpractice risk and ultimately result in the improved quality of patient care.
Stent Design Affects Femoropopliteal Artery Deformation
Authors: MacTaggart Jason , Poulson William , Seas Andreas , Deegan Paul , Lomneth Carol , Desyatova Anastasia , Maleckis Kaspars , Kamenskiy Alexey 
Published: March 2018

Background:
Poor durability of femoropopliteal artery (FPA) stenting is multifactorial, and severe FPA deformations occurring with limb flexion are likely involved. Different stent designs result in dissimilar stent–artery interactions, but the degree of these effects in the FPA is insufficiently understood.

Objectives:
To determine how different stent designs affect limb flexion-induced FPA deformations.

Methods:
Retrievable markers were deployed into n = 28 FPAs of lightly embalmed human cadavers. Bodies were perfused and CT images were acquired with limbs in the standing, walking, sitting, and gardening postures. Image analysis allowed measurement of baseline FPA foreshortening, bending, and twisting associated with each posture. Markers were retrieved and 7 different stents were deployed across the adductor hiatus in the same limbs. Markers were then redeployed in the stented FPAs, and limbs were reimaged. Baseline and stented FPA deformations were compared to determine the influence of each stent design.

Results:
Proximal to the stent, Innova, Supera, and SmartFlex exacerbated foreshortening, SmartFlex exacerbated twisting, and SmartControl restricted bending of the FPA. Within the stent, all devices except Viabahn restricted foreshortening; Supera, SmartControl, and AbsolutePro restricted twisting; SmartFlex and Innova exacerbated twisting; and Supera and Viabahn restricted bending. Distal to the stents, all devices except AbsolutePro and Innova exacerbated foreshortening, and Viabahn, Supera, Zilver, and SmartControl exacerbated twisting. All stents except Supera were pinched in flexed limb postures.

Conclusions:
Peripheral self-expanding stents significantly affect limb flexion-induced FPA deformations, but in different ways. Although certain designs seem to accommodate some deformation modes, no device was able to match all FPA deformations.
Adrenal Metastasectomy in the Presence and Absence of Extraadrenal Metastatic Disease
Authors: Russo Ashley E. , Untch Brian R. , Kris Mark G. , Chou Joanne F. , Capanu Marinela , Coit Daniel G. , Chaft Jamie E. , D’Angelica Michael I. , Brennan Murray F. , Strong Vivian E. 
Published: March 2018

Objective:
To determine if there are differences in overall survival (OS) or event-free survival (EFS) in patients with and without concomitant extra-adrenal metastases undergoing adrenal metastasectomy.

Background:
There is growing interest in the use of local therapies in patients with oligometastatic disease. Previously published series have indicated that long-term survival is possible with resection. Adrenalectomy has been used to treat adrenal metastases in select patients.

Methods:
Patients who underwent adrenal metastasectomy from 1994 to 2015 were identified from a prospectively maintained institutional database of adrenalectomy patients, excluding adrenalectomies due to tumor extension or for palliation. Sites of disease, treatment history, and survival data were extracted from chart review.

Results:
One hundred seventy-four patients were included. Tumor histology included 68 nonsmall cell lung cancer, 34 renal cancer, 18 colorectal cancer, 11 melanoma cancer, 10 hepatocellular cancer, 8 sarcoma cancer, and 25 other cancers. The median follow-up among survivors was 5.2 (1–21) years. OS at 3 and 5 years was 50% and 40%, respectively. Patients with (n = 83) and without (n = 91) extra-adrenal metastases did not differ with respect to age, adrenal tumor size, or margin status. Median OS (3.3 years for patients with concomitant extra-adrenal metastases and 3.0 years for patients with isolated adrenal metastases; P = 0.816) and EFS (9.39 vs 9.59 months; P = 0.87) were similar. Factors negatively associated with OS included adrenal tumor size (P < 0.01), renal primary versus other (P < 0.01), and adrenal margin status (P < 0.01).

Conclusions:
In selected patients undergoing adrenal metastasectomy, there were no significant differences in OS or EFS between patients with and without concomitant extra-adrenal metastases.
Positional information encoded in the dynamic differences between neighbouring oscillators during vertebrate segmentation
Authors: Boareto Marcelo , Tomka Tomas , Iber Dagmar 
Published: March 2018

AbstractHow cells track their position during the segmentation of the vertebrate body remains elusive. For decades, this process has been interpreted according to the clock-and-wavefront model, where molecular oscillators set the frequency of somite formation while the positional information is encoded in signaling gradients. Recent experiments usingex vivoexplants challenge this interpretation, suggesting that positional information is encoded in the properties of the oscillators. Here, we propose that positional information is encoded in the differential levels of neighboring oscillators. The differences gradually increase because both the oscillator amplitude and the period increase with time. When this difference exceeds a certain threshold, the segmentation program starts. Using this framework, we quantitatively fit experimental data fromin vivoandex vivomouse segmentation, and propose mechanisms of somite scaling. Our results suggest a novel mechanism of spatial pattern formation based on the local interactions between dynamic molecular oscillators.
Genome-wide survey and expression analysis of the SLAC/SLAH gene family in pear (Pyrus bretschneideri) and other members of the Rosaceae
Authors: Chen Guodong , Li Xiaolong , qiao Xin , Li Jiaming , Wang Li , Kou Xiaobing , Wu Xiao , Wang Guoming , Yin Hao , Wang Peng , Zhang Shaoling , Wu Juyou 
Published: March 2018

AbstractS-type anion channels (SLAC/SLAHs), which play important roles in plant anion (such as nitrate and chloride) transport, growth and development, abiotic stress responses and hormone signaling. However, there is far less information about this family in Rosaceae species. We performed a genome-wide analysis and identified SLAC/SLAH gene family members in pear (Pyrus bretschneideri) and four other species of Rosaceae (Malus domestica, Prunus persica, Fragaria vesca and Prunus mume). A total of 21 SLAC/SLAH genes were identified from the five Rosaceae species. Based on the structural characteristics and a phylogenetic analysis of these genes, the SLAC/SLAH gene family could be classified into three main groups (I, II and III). The evolutionary analysis showed that the SLAC/SLAH gene family was comparatively conserved during the evolution of Rosaceae species. Transcriptome data demonstrated that PbrSLAC/SLAH genes were detected in all parts of the pear. However, PbrSLAC1 showed a higher expression level in leaf, while PbrSLAH2/3 was mainly expressed in roots. In addition, PbrSLAC/SLAH genes were only located on the plasma membrane in transient expression experiments in Arabidopsis protoplasts cells. These results provide valuable information that increases our understanding of the evolution, expression and functions of the SLAC/SLAH gene family in higher plants.
Inhibition of mitochondrial ferredoxin 1 (FDX1) prevents adaptation to proteotoxic stress
Authors: Tsvetkov Peter , Detappe Alexandre , Cai Kai , Keys Heather R. , Brune Zarina , Ying Weiwen , Thiru Prathapan , Reidy Mairead , Kugener Guillaume , Tsherniak Aviad , Santagata Sandro , Whitesell Luke , Markley John L. , Ghobrial Irene M. , Lindquist Susan 
Published: March 2018

SUMMARYThe mechanisms used by cancer cells to resist the severe disruption in protein homeostasis caused by proteasome inhibitors remain obscure. Here, we show this resistance correlates with a metabolic shift from glycolysis to oxidative phosphorylation (OXPHOS). Employing small molecule screens, we identified a striking overlap between compounds that preferentially impede the growth of proteasome inhibitor-resistant cancer cells and those that block the growth of high OXPHOS cells. Elesclomol potently exhibits both characteristics. Using genome-wide CRISPR/Cas9-based screening, in vitro validation and NMR spectroscopy we identify mitochondrial protein ferredoxin 1 (FDX1), a critical component of mitochondrial iron-sulfur (Fe-S) cluster biosynthesis, as the primary target of elesclomol. In a mouse model of multiple myeloma, inhibition of FDX1 with elesclomol significantly attenuated the emergence of proteasome inhibitor-resistance and markedly prolonged survival. Our work reveals that the mitochondrial Fe-S cluster pathway is a targetable vulnerability in cancers that are resistant to increased proteotoxic burden.
Evolutionary rate coevolution between mitochondria and mitochondria-associated nuclear-encoded proteins in insects
Authors: Yan Zhichao , Ye Gongyin , Werren John H. 
Published: March 2018

AbstractThe mitochondrion is a pivotal organelle for energy production, and includes components encoded by both the mitochondrial and nuclear genomes. How these two genomes coevolve is a long-standing question in evolutionary biology. Here we initially investigate the evolutionary rates of mitochondrial components (oxidative phosphorylation (OXPHOS) proteins and ribosomal RNAs) and nuclear-encoded proteins associated with mitochondria, across the major orders of holometabolous insects. There are significant evolutionary rate correlations (ERCs) between mitochondria and mitochondria-associated nuclear-encoded proteins, which is likely driven by different rates of mitochondrial sequence evolution and compensatory changes in the interacting nuclear-encoded proteins. The pattern holds after correction for phylogenetic relationships and considering protein conservation levels. Correlations are stronger for nuclear-encoded OXPHOS proteins in contact with mitochondrial-encoded OXPHOS proteins and nuclear-encoded mitochondrial ribosomal amino acids directly contacting the mitochondrial rRNA. Mitochondrial-associated proteins show apparent rate acceleration over evolutionary time, but we suspect this pattern to be due to artifacts (e.g. rate estimation or calibration bias). We find that ERC between mitochondrial and nuclear proteins is a strong predictor of nuclear proteins known to interact with mitochondria, and therefore ERCs can be used to predict new candidate nuclear proteins with mitochondrial function. Using this approach, we detect proteins with high ERCs but not with known mitochondrial function based on gene ontology (GO). Manual screening of the literature revealed potential mitochondrial function for some of these proteins in humans or yeast. Their holometabolous ERCs therefore indicate these proteins may have phylogenetically conserved mitochondrial function. Twenty three additional candidates warrant further study for mitochondrial function based on this approach, including ERC evidence that proteins in the minichromosome maintenance helicase (MCM) complex interact with mitochondria. We conclude that the ERC method shows promise for identifying new candidate proteins with mitochondrial function.