bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changing the Paradigm in Medial Canthal Reconstruction: The Bridge Principle and the Croissant-Like Keystone Island Perforator Flap as An Alternative for Medium Size Soft Tissue Defects in Internal Canthus Reconstruction
Authors: Kostopoulos Epameinondas , Agiannidis Christos , Konofaos Petros , Kotsakis Ioannis , Hatzigianni Panagiota , Georgopoulos Gerasimos , Papadatou Zoe , Konstantinidou Chara , Champsas Gregorios , Papadopoulos Othon , Casoli Vincent 
Published: March 2018

Introduction:
Medial canthus is a common area of skin cancer prevalence. Defects in this region represent a challenging reconstructive task. The nasal version of keystone perforator island flap (KPIF) has proven its versatility. The aim of the present study was to expand its utilization in the neighbor medial canthus area. A modified croissant-like KPIF (CKPIF) was used resolving inner convexity-related problems. The presence of procerus in the glabella area, bridging a surface from nasalis up to the frontalis, changed the traditional dissecting flap technique. Thus, the authors introduce the bridge principle, which consists of the indirect transfer of the flap to the defect site through a muscular “bridge” (the procerus). The authors report their experience in medial canthal reconstruction combining a modified KPIF with a new dissecting “principle.”

Methods:
From November 2016 to July 2017, a series of patients presenting soft tissue defects of various dimensions in the medial canthus, secondary to tumor extirpation, sustained reconstruction with a CKPIF dissected with the bridge principle.

Results:
A total of 15 patients were treated with this new technique. Their mean age was 75.3 years. The mean size of the defect was 2.08 cm (length) × 1.5 cm (width). All flaps survived without any sign of venous congestion. A transient epiphora presented in 4 patients (4/15 or 26.6%), which was subsided 2 months later.

Conclusion:
A new approach following a novel paradigm was introduced to resolve an old problem. Initial outcomes are encouraging. However, longer series are needed to extract definitive and safer conclusion.
Comparison of the Recurrence Rates of Nonparasitic Hepatic Cysts Treated With Laparoscopy or With Open Fenestration: A Meta-Analysis
Authors: Zhang Jian-Ying , Liu Yan , Liu Hong-Yan , Chen Long , Su Dai-Wen , Wang Yun-Bing 
Published: March 2018

Objective:
This study aimed to compare the recurrence rates of nonparasitic hepatic cysts that were treated with laparoscopy or open fenestration.

Materials and Methods:
PubMed, Embase, Cochrane Library, Web of Science, Wan-fang data, CNKI, CqVip, and CBM were searched for randomized controlled trials, cohort, and case-control studies that reported on the treatment of nonparasitic hepatic cysts with laparoscopy or with open fenestration. Studies that were published from the establishment of the databases to October 1, 2016 were retrieved. STATA software (version 13) was utilized for statistical analysis.

Results:
A total of 31 studies were included. Meta-analysis showed that the recurrence rates of hepatic cysts between the laparoscopy-deroofing and open-deroofing groups had no difference (odds ratio, 0.72; 95% confidence interval, 0.50-1.02; P=0.061). This result was in agreement with the result of subgroup analysis for solitary and multiple hepatic cyst.

Conclusions:
These findings underscore the distinct role of laparoscopy deroofing in the treatment of hepatic cysts because of the certainty of its long-term curative effect.
Pelvic Drain After Laparoscopic Low Anterior Resection for Rectal Cancer in Patients With Diverting Stoma
Authors: Matsuda Kenji , Yokoyama Shozo , Hotta Tsukasa , Watanabe Takashi , Tamura Koichi , Iwamoto Hiromitsu , Mizumoto Yuki , Yamaue Hiroki 
Published: March 2018

Background:
This study is intended to assess whether the use of pelvic drain reduces incidence of pelvic sepsis in the era of laparoscopic low anterior resection (LAR).

Patients and Methods:
In total, 200 of consecutive patients who underwent laparoscopic LAR for rectal cancer with diverting stoma were analyzed.

Results:
Pelvic sepsis occurred in 14 of 110 patients (12.7%) in the drain group and in 9 of 90 patients (10.0%) in the no drain group (P=0.548). Furthermore, there were no differences in the incidence of anastomotic leakage, time to diagnosis of pelvic sepsis, and type of treatments for pelvic sepsis.

Conclusions:
Prophylactic pelvic drain use after laparoscopic LAR in patients with diverting stoma does not reduce incidence of pelvic sepsis. Routine use of pelvic drain is not recommended. This study was registered at UMIN (Registration Number: UMIN000026076).
A selective placement strategy for surgical feeding tubes benefits trauma patients
Authors: Marcotte Joseph , Hazelton Joshua P. , Arya Chirag , Dalton Michael , Batool Amber , Gaughan John , Nguyen Linh , Porter John , Fox Nicole 
Published: March 2018

BACKGROUND
The indications for surgical feeding tube (SFT) placement in trauma patients are poorly defined. Patient selection is critical as complications from SFTs have been reported in up to 70% of patients. A previous analysis by our group determined that 25% of the SFTs we placed were unnecessary and that older patients, patients with head and spinal cord injuries, and patients who needed a tracheostomy were more likely to require long-term SFTs. Following this study, we modified our institutional guidelines for SFT placement. We hypothesized that a more selective placement strategy would result in fewer unnecessary SFTs.

METHODS
A retrospective review of all adult patients from 2012 to 2016 with an intensive care unit length of stay longer than 4 days and an SFT placed during admission was conducted. This group was compared to data collected prior to our change in practice (2007–2010). Data from 2011 were excluded as a washout period. “Necessary” SFT use was defined per established guidelines as either daily use of the SFT through discharge or for 28 days or longer and “unnecessary” SFT use as all others.

RESULTS
Two hundred fifty-seven SFTs were placed from 2007 to 2010 and 244 from 2012 to 2016. Following implementation of our selective SFT placement strategy, unnecessary SFT placement decreased from 25% in 2007 to 2010 to 8% in 2012 to 2016 (p < 0.0001). Significant predictors of necessary SFT placement by univariate regression were as follows: increasing age (odds ratio [OR] 1.03/year; 95% confidence interval [CI], 1.01–1.04), head injury (OR, 2.80; 95% CI, 1.71–4.60), cervical spinal cord injury (OR, 4.42; 95% CI, 1.34–14.50), and need for tracheostomy (OR, 1.41; 95% CI, 2.21–7.67). The overall complication rate was 11% (9% in the selective group vs. 13% in the preselective group, p = 0.2574) and was highest following open SFT placement (22%).

CONCLUSION
A selective placement strategy for SFTs in our trauma population resulted in fewer unnecessary SFTs and a trend toward fewer complications. Surgical feeding tubes should be placed through a percutaneous approach whenever possible.

LEVEL OF EVIDENCE
Therapeutic study, level IV.
A negative computed tomography may be sufficient to safely discharge patients with abdominal seatbelt sign from the emergency department: A case series analysis
Authors: Barmparas Galinos , Patel Deven C. , Linaval Nikhil T. , Dhillon Navpreet K. , Patel Kavita A. , Margulies Daniel R. , Ley Eric J. 
Published: March 2018

BACKGROUND
The presence of an abdominal seatbelt sign (ASBS) following a motor vehicle collision (MVC) is associated with a high risk for occult intra-abdominal injury, prompting imaging studies and a prolonged period of clinical observation. The aim of this study was to determine how a negative computed tomography (CT) of the abdomen/pelvis (A/P) can serve in the safe disposition of these patients. Our hypothesis was that in the setting of a negative CT, the presence of occult intra-abdominal injuries requiring a delayed intervention is extremely unlikely.

METHODS
The medical charts of patients admitted from January 2014 to December 2016 to a Level I trauma center following an MVC were reviewed for a documentation of an ASBS. Patients who did not have a CT A/P upon admission were excluded. The CT A/P of the remaining patients were then classified as negative if there were no findings of acute vascular, visceral or bony injury or positive if any of these findings was present. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CT A/P for the presence of an intra-abdominal injury were calculated.

RESULTS
Over the 3-year study period, 1,108 patients were admitted after an MVC. Of those, 196 (17.7%) had an ASBS upon presentation and 183 (93.4%) of 196 underwent a CT A/P. A total of 114 (62.3%) of 183 had a negative CT A/P. These patients remained hospitalized for a median of 2 (1–35) days with none (0.0%) requiring a delayed laparotomy. The sensitivity of CT A/P in identifying patients requiring an exploratory laparotomy was 100.0%, specificity was 67.9%, NPV was 100.0%, and PPV was 21.7%. The negative likelihood ratio was 0.00.

CONCLUSION
For patients with an ASBS following an MVC, a negative CT A/P may be sufficient for safe discharge from the emergency department without any need for additional clinical observation.

LEVEL OF EVIDENCE
Therapuetic, level IV.
The contemporary timing of trauma deaths
Authors: Bardes James M. , Inaba Kenji , Schellenberg Morgan , Grabo Daniel , Strumwasser Aaron , Matsushima Kazuhide , Clark Damon , Brown Niquelle , Demetriades Demetrios 
Published: March 2018

BACKGROUND
The distribution of trauma deaths was classically described as trimodal. With advances in both technology and trauma systems, this was reevaluated and found to be bimodal in the early 2000s. Over the last decade there have been continued improvements in trauma and intensive care unit (ICU) care, related to damage control techniques and evidence based ICU pathways. A better understanding of the distribution of trauma deaths may be used to improve trauma systems. This study aimed to evaluate the contemporary distribution of trauma deaths after the widespread implementation of modern trauma and critical care principles.

METHODS
This study included patients entered in the NTDB from 2008 to 2014. For dead patients, hospital length of stay was equated to time until death. Additional data was collected to include demographics, mechanism of injury, Injury Severity Score, and Abbreviated Injury Scale score. Histograms were plotted to demonstrate peaks in deaths. Survival analysis was performed with Kaplan-Meier curves and Gehan-Breslow generalized Wilcoxon tests.

RESULTS
4,185,009 patients were analyzed. Thirty-four percent of all deaths occurred within the first 24 hours of admission. The factors most associated with death in the first 24 hours were severe abdominal trauma (73%), penetrating trauma (55%), and severe extremity trauma (58%). Among patients with penetrating trauma and an abdominal Abbreviated Injury Scale score of 4 or higher, 83% of deaths occurred within 24 hours. When plotted, the distribution of deaths was seen to fall rapidly after the first 24 hours and continued to be flat for 30 days in all subgroups analyzed.

CONCLUSION
In this study, the distribution of trauma deaths no longer appears to be trimodal. This may reflect advances in trauma and ICU care, and the widespread adaption of damage control principles. Early deaths, however, remains a significant challenge, specifically from non-compressible abdominal hemorrhage and extremity trauma. Primary prevention and early hemorrhage control must continue to be a focus of research and trauma systems.

LEVEL OF EVIDENCE
Epidemiologic, level IV.
Harbour seals are regaining top-down control in a coastal ecosystem
Authors: Aarts Geert , Brasseur Sophie , Poos Jan Jaap , Schop Jessica , Kirkwood Roger , van Kooten Tobias , Mul Evert , Reijnders Peter , Rijnsdorp Adriaan D. , Tulp Ingrid 
Published: March 2018

ABSTRACTHistoric hunting has led to severe reductions of many marine mammal species across the globe. After hunting ceased, some populations have recovered to pre-exploitation levels, and may again act as a top-down regulatory force on marine ecosystems. Also the harbour seal population in the international Wadden Sea grew at an exponential rate following a ban on seal hunting in 1960’s, and the current number ∼38,000 is close to the historic population size. Here we estimate the impact of the harbour seal predation on the fish community in the Wadden Sea and nearby coastal waters.Fish remains in faecal samples and published estimates on the seal’s daily energy requirement were used to estimate prey selection and the magnitude of seal consumption. Estimates on prey abundance were derived from demersal fish surveys, and fish growth was estimated using a Dynamic Energy Budget model. GPS tracking provided information on where seals most likely caught their prey.Harbour seals from the Dutch Wadden Sea fed predominantly on demersal fish, e.g. flatfish species (flounder, sole, plaice, dab), but also sandeel, cod and whiting. Total fish biomass in the Wadden Sea was insufficient to sustain the estimated prey consumption of the entire seal population year-round. This probably explains why seals also acquire prey further offshore in the adjacent North Sea, only spending 13% of their diving time in the Wadden Sea. Still, seal predation was estimated to cause an average annual mortality of 43% and 60% on fish in the Wadden Sea and adjacent coastal zone, respectively. There were however large sources of uncertainty in the estimate, including the migration of fish between the North Sea and Wadden Sea, and catchability estimates of the fish survey sampling gear, particularly for sandeel and other pelagic fish species.Our estimate suggested a considerable top-down control by harbour seals on demersal fish. However predation by seals may also alleviate density-dependent competition between the remaining fish, increasing fish growth, and partly compensating for the reduction in fish numbers. This study shows that recovering coastal marine mammal populations could potentially become an important component in the functioning of shallow coastal systems.
Coupling magnetically induced electric fields to neurons: longitudinal and transverse activation
Authors: Wang B. , Grill W. M. , Peterchev A. V. 
Published: March 2018

ABSTRACTWe present a theory and computational models to couple the electric field induced by magnetic stimulation to neuronal membranes. The response of neuronal membranes to induced electric fields is examined under different time scales, and the characteristics of the primary and secondary electric fields from electromagnetic induction and charge accumulation on conductivity boundaries, respectively, are analyzed. Based on the field characteristics and decoupling of the longitudinal and transverse field components along the neural cable, quasi-potentials are a simple and accurate approximation for coupling of magnetically induced electric fields to neurons and a modified cable equation provides theoretical consistency for magnetic stimulation. The conventional and modified cable equations are used to simulate magnetic stimulation of long peripheral nerves by circular and figure-8 coils. Activation thresholds are obtained over a range of lateral and vertical coil positions for two nonlinear membrane models representing unmyelinated and myelinated axons and also for undulating myelinated axons. For unmyelinated straight axons, the thresholds obtained with the modified cable equation are significantly lower due to transverse polarization, and the spatial distributions of thresholds as a function of coil position differ significantly from predictions by the activating function. For myelinated axons, the transverse field contributes negligibly to activation thresholds, whereas axonal undulation can increase or decrease thresholds depending on coil position. The analysis provides a rigorous theoretical foundation and implementation methods for the use of the cable equation to model neuronal response to magnetically induced electric fields. Experimentally observed stimulation with the electric fields perpendicular to the nerve trunk cannot be explained by transverse polarization alone and is likely due to nerve fiber undulation and other geometrical inhomogeneities.
Comparison between O and OH intermediates of cytochrome c oxidase studied by FTIR spectroscopy
Authors: Gorbikova E. , Kalendar R. 
Published: March 2018

AbstractCytochrome c oxidase is terminal enzyme in the respiratory chain of mitochondria and many aerobic bacteria. It catalyzes reduction of oxygen to water. During its catalysis, CcO proceeds through several quite stable intermediates (R, A, PR/M, O/OH, E/EH). This work is concentrated on the elucidation of the differences between structures of oxidized intermediates O and OH in different CcO variants and at different pH values. Oxidized intermediates of wild type and mutated CcO from Paracoccus denitrificans were studied by means of static and time-resolved Fourier-transform infrared spectroscopy in acidic and alkaline conditions in the infrared region 1800-1000 cm-1. No reasonable differences were found between all variants in these conditions, and in this spectral region. This finding means that the binuclear center of oxygen reduction keeps a very similar structure and holds the same ligands in the studied conditions. The further investigation in search of differences should be performed in the 4000-2000 cm-1 IR region where water ligands absorb.AbbreviationsAferrous-oxy intermediateATRAttenuated total reflectanceBGbackgroundBNCbinuclear centerCcOCytochrome c oxidaseEone-electron reduced intermediateFferryl intermediateFRCOfully-reduced CO-inhibited enzymeFTIRFourier transform infraredIRinfraredNHENormal Hydrogen ElectrodeN-sidenegatively charged side of the membranePR/M“peroxy”intermediates; P-sidepositively charged side of the membraneRfully-reduced intermediateTRtime-resolvedWTwild type
Adhesion of active cytoskeletal vesicles
Authors: Maan R. , Loiseau E. , Bausch A. R. 
Published: March 2018

AbstractRegulation of adhesion is a ubiquitous feature of living cells, observed during processes such as motility, antigen recognition or rigidity sensing. At the molecular scale, a myriad of mechanisms are necessary to recruit and activate the essential proteins, while at the cellular scale efficient regulation of adhesion relies on the cell’s ability to adapt its global shape. To understand the role of shape remodeling during adhesion, we use a synthetic biology approach to design a minimal model, starting with a limited number of building blocks. We assemble cytoskeletal vesicles whose size, reduced volume, and cytoskeleton contractility can be independently tuned. We are able to show that these cytoskeletal vesicles can sustain strong adhesion to solid substrates only if molecular motors are able to actively remodel the actin cortex. When the cytoskeletal vesicles are deformed under hypertonic osmotic pressure, they develop a crumpled geometry with huge deformations. In the presence of molecular motors, these deformations are dynamic in nature and can compensate for an absence of excess membrane area needed for adhesion to take place. When the cytoskeletal deformations are able to compensate for lack of excess membrane area, the cytoskeletal vesicles are able to attach to the rigid glass surfaces even under strong adhesive forces. The balance of deformability and adhesion strength is identified to be key to enable cytoskeletal vesicles to adhere to solid substrates.
Transition from actin-driven to water-driven cell migration dependson external hydraulic resistance
Authors: Li Y. , Sun S.X. 
Published: March 2018

AbstractIn vivo, cells can reside in diverse physical and biochemical environments. For example, epithelial cells typically live in a two-dimensional (2D) environment while metastatic cancer cells can move through dense three-dimensional (3D) matrices. These distinct environments impose different kinds of mechanical forces on cells, and thus potentially can influence the mechanism of cell migration. For example, cell movement on 2D flat surfaces is mostly driven by forces from focal adhesion and actin polymerization, while in confined geometries, it can be driven by water permeation. In this work, we utilize a two-phase model of the cellular cytoplasm, where the mechanics of the cytosol and the F-actin network are treated on an equal footing. Using conservation laws and simple force balance considerations, we are able to describe the contribution of water flux, actin polymerization and flow, and focal adhesions to cell migration in both 2D surfaces and in confined spaces. The theory shows how cell migration can seamlessly transition from a focal adhesion- and actin-based mechanism on 2D surfaces to a water-based mechanism in confined geometries.
Fast Parallel Algorithm for Large Fractal Kinetic Models with Diffusion
Authors: Popov A. A. , Lee S.-C. , Kuksa P. P. , Glickson J. D. , Shestovb A. A. 
Published: March 2018

ABSTRACTChemical kinetic simulations are usually based on the law of mass action that applies to behavior of particles in solution. Molecular interactions in a crowded medium as in a cell, however, are not easily described by such conventional mathematical treatment. Fractal kinetics is emerging as a novel method for simulating kinetic reactions in such an environment. To date, there has not been a fast, efficient, and, more importantly, parallel algorithm for such computations. Here, we present an algorithm with several novel features for simulating large (with respect to size and time scale) fractal kinetic models. We applied the fractal kinetic technique and our algorithm to a canonical substrate-enzyme model with explicit phase-separation in the product, and achieved a speed-up of up to 8 times over previous results with reasonably tight bounds on the accuracy of the simulation. We anticipate that this technique and algorithm will have important applications to simulation of intra-cell biochemical reactions with complex dynamic behavior.
Investigating established EEG parameter during real-world driving
Authors: Protzak Janna , Gramann Klaus 
Published: March 2018

AbstractIn real life, behavior is influenced by dynamically changing contextual factors and is rarely limited to simple tasks and binary choices. For a meaningful interpretation of brain dynamics underlying more natural cognitive processing in active humans, ecologically valid test scenarios are essential. To understand whether brain dynamics in restricted artificial lab settings reflect the neural activity in complex natural environments, we systematically tested the eventrelated P300 in both settings. We developed an integrative approach comprising an initial P300-study in a highly controlled laboratory set-up and a subsequent validation within a realistic driving scenario. Using a simulated dialog with a speech-based input system, increased P300 amplitudes reflected processing of infrequent and incorrect auditory feedback events in both the laboratory setting and the real world setup. Environmental noise and movement-related activity in the car driving scenario led to higher data rejection rates but revealed no effect on signal-to-noise ratio in theta and alpha frequency band or the amplitudes of the event-related P300. Our results demonstrate the possibility to investigate cognitive functions like context updating in highly adverse driving scenarios and encourage the consideration of more realistic task settings in prospective brain imaging approaches.