bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reconstructions With Different and New Techniques of Large and Extensive Myelomeningocele Defects
Authors: Emsen Ilteris M. 
Published: November 2018

Background:
Myelomeningocele and/or meningocele is a defect of spine and spinal cord, and it is congenital. Although meningocele is a mild form of spina bifida, myelomeningocele is a more complex and serious form. There is a sac in both forms at the back. Difference is that myelomeningocele contains neural structures or spinal cord elements, and meningocele does not contain these neural or spinal cord elements.

Methods:
Between 2012 and 2018, 77 (45 females, 32 males) newborns with myelomeningocele were operated by mean age 35 days. The O-S flap (26 patients) method was used in patients who have circular defect. The Emsen 1 flap (31 patients) was used in patients who have elliptic defect. The Emsen 2 flap (20 patients) was also used in patients who have triangular defect. Mean follow-up was 22 months (9–50 months).

Results:
A successful tension-free closure was made with these methods. Defects of the newborn were divided the subgroups as circular, elliptic, and triangular. Hydrocephalus was detected in 19 patients. Ventriculoperitoneal shunt was done at the same time with the myelomeningocele surgical procedure. All complications were noted in patients with hydrocephalus such as cerebrospinal fluid leakage (in 8 patients), wound infection (in 3 patients), and partially wound dehiscence (in 4 patients).

Conclusion:
There are many techniques about myelomeningocele closure in literature. The problem is not number of techniques. Literature presents different geometric flap design, muscle flaps, and musculocutaneous flaps on these defects. Large or extensive skin defects need more complex flap methods, and unfortunately, number of these is too limited. Three methods on large or extensive myelomeningocele skin defects are presented in this study. With these flaps, large or extensive skin defects could be easily closed. In all techniques, major advantages are no skin grafting, no abnormal blood loss, no muscle sacrificing, short operation time, and most important one is that 1-step surgery could be sufficient.
A Patient With Schimmelpenning Syndrome and Mosaic KRAS Mutation
Authors: Mitchell Benjamin J. , Rogers Gary F. , Wood Benjamin C. 
Published: November 2018

Abstract
Schimmelpenning syndrome is a neurocutaneous disorder characterized by craniofacial nevus sebaceus that fall along embryonic cutaneous lines and tend to be associated with neurological, ocular, skeletal, and vascular abnormalities. We report a child with extensive nevus sebaceus of the scalp, face, and thorax and other unusual physical findings who was found to have a mosaic mutation of KRAS c.35G>A p.12D pathognomonic of Schimmelpenning syndrome.
The Morphology of the Infraorbital Nerve and Foramen in the Presence of an Accessory Infraorbital Foramen
Authors: Polo Carolina L. , Abdelkarim Ahmed Z. , von Arx Thomas , Lozanoff Scott 
Published: November 2018

Background:
The accessory infraorbital foramen (AIOF) is an anatomical variation associated with the infraorbital foramen (IOF) and nerve (ION). Its occurrence and neural contents have clinical implications regarding failure of loco-regional anesthesia and risk of neural damage during surgical interventions involving the maxillary region. Thus, morphologic characterization of the AIOF and neural contents as well as the spatial relationships to the IOF are potentially useful for optimizing surgical procedures. Additionally, predictive features of the AIOF based on its relationship to IOF morphology could enable the surgeon to anticipate its presence and proceed accordingly. The purpose of this study was to determine whether the presence of an AIOF and its neural contents affected the size, shape, and composition of the IOF and ION. The specific hypothesis tested was that the topography and fascicular composition of the ION and IOF differs between individuals possessing an AIOF and those lacking this anatomical variant.

Methods:
Gross topographic features of the IOF (42 crania) were compared between specimens possessing (test) or lacking (control) an AIOF. Nerve fascicles of ION (60 cadaveric sides) were examined histologically and compared morphometrically between specimens presenting or lacking an AIOF. An additional sample of 30 crania was subjected to cone-beam computed tomography (CBCT) analysis to determine the course of the canal leading to the AIOF.

Results:
The AIOF incidence was 47.6% (20 crania) and 32.1% of the sides (27 sides). A single AIOF was observed in 24 sides and double AIOF in three sides. The AIOF occurred bilaterally in 7 specimens (16.7%). The majority of AIOF (86.7%) were located superomedial to IOF. A slightly higher frequency of the AIOF was found in left side compared to the right. Using CBCT, a patient sample showed an AIOF incidence in 21 sides of 16 patients (65.6%). A single AIOF was observed in 19 sides. Only 1 double AIOF was found in the scans, whereas 3 were found in the dry skull group. The AIOF occurred bilaterally in 3 scans (10%). The majority of AIOF (90.4%) were located superomedial to the IOF based on the CBCT scans. The AIOF was consistently seen connected to the infraorbital canal and progressed superiorly and medially from the infraorbital canal to the maxillary surface. The size of the ION without an AIOF was not significantly different than the ION in the presence of an AIOF (1.45 × 106/1.32 × 106 μm2, P < 0.35) based on fascicular area. However, the number of ION fascicles was greater in specimens without an AIOF compared to those showing this feature (15.15/12.71, P < 0.04)

Conclusion:
Results indicate that the area of the ION is not affected by an AIOF, suggesting that the field of innervation of this area is not modified by its occurrence. However, the ION appears to divide more proximally into its component branches when the AIOF is present.
Emergent Themes for Instructional Design
Authors: Lee-Jayaram Jannet J. , Berg Benjamin W. , Sy Angela , Hara Kristine M. 
Published: November 2018

Introduction
Instructional design is an established discipline for designing educational activities for learners and is applied during the development of simulation-based healthcare educational activities. Although the iterative process is already being used with alpha/beta testing during development of the simulation, the process has not been described in detail. We sought to describe this process of design changes made during a novice faculty development course for simulation-based healthcare education where participants routinely design scenarios and conduct alpha/beta testing.

Methods
Using a mixed methods study, participant written narratives and checklist/rating scales were collected on changes made during both alpha and beta testing. Narratives were analyzed using the qualitative grounded theory approach to identify emergent themes. Checklist/rating scales were analyzed for changes made to previously identified areas and how critical these changes were to the success of the scenario.

Results
Several themes of frequent changes made during the alpha/beta testing process emerged from the participant narratives that included REALISM, PROTOCOLS, INTRODUCTIONS and ROLES. The quantitative analysis of potential areas for change correlated with the emergent themes.

Conclusions
Novice scenario designers make similar changes in thematic areas during the instructional design process. Faculty development courses for novice simulation healthcare educators should anticipate attention to these areas during discussions and consider specific didactics to avoid common design pitfalls of novice educators.
Augmented Reality Future Step Visualization for Robust Surgical Telementoring
Authors: Andersen Daniel S. , Cabrera Maria E. , Rojas-Muñoz Edgar J. , Popescu Voicu S. , Gonzalez Glebys T. , Mullis Brian , Marley Sherri , Zarzaur Ben L. , Wachs Juan P. 
Published: November 2018

Introduction
Surgical telementoring connects expert mentors with trainees performing urgent care in austere environments. However, such environments impose unreliable network quality, with significant latency and low bandwidth. We have developed an augmented reality telementoring system that includes future step visualization of the medical procedure. Pregenerated video instructions of the procedure are dynamically overlaid onto the trainee's view of the operating field when the network connection with a mentor is unreliable.

Methods
Our future step visualization uses a tablet suspended above the patient's body, through which the trainee views the operating field. Before trainee use, an expert records a “future library” of step-by-step video footage of the operation. Videos are displayed to the trainee as semitransparent graphical overlays. We conducted a study where participants completed a cricothyroidotomy under telementored guidance. Participants used one of two telementoring conditions: conventional telestrator or our system with future step visualization. During the operation, the connection between trainee and mentor was bandwidth throttled. Recorded metrics were idle time ratio, recall error, and task performance.

Results
Participants in the future step visualization condition had 48% smaller idle time ratio (14.5% vs. 27.9%, P < 0.001), 26% less recall error (119 vs. 161, P = 0.042), and 10% higher task performance scores (rater 1 = 90.83 vs. 81.88, P = 0.008; rater 2 = 88.54 vs. 79.17, P = 0.042) than participants in the telestrator condition.

Conclusions
Future step visualization in surgical telementoring is an important fallback mechanism when trainee/mentor network connection is poor, and it is a key step towards semiautonomous and then completely mentor-free medical assistance systems.
Anterior Wall Success at 1 Year After Vaginal Uterosacral Ligament Suspension and Sacral Colpopexy
Authors: Bastawros Dina A. , Tarr Megan E. , Templin Megan A. , Stepp Kevin J. , Taylor G. Bernard , Myers Erinn M. 
Published: November 2018

Objectives
The primary objective was to evaluate 1-year anterior wall anatomic success rates for vaginal uterosacral ligament suspension (USLS) and minimally invasive sacral colpopexy (SCP) using delayed-absorbable suture. Secondary objectives included assessment of apical success, mesh or suture exposure, and postoperative quality of life (QoL) measures 12 months after surgery.

Methods
This was a retrospective cohort study including women who underwent a hysterectomy with concomitant USLS or SCP with delayed-absorbable suture from January 2011 to December 2015 with 1-year follow-up. Successful anterior vaginal wall support was defined as Ba of less than 0. Successful apical support was defined as no apical descent (point C) greater than one half of the total vaginal length. In addition, 1-year QoL questionnaires were measured postoperatively.

Results
A total of 282 women were identified. Sixty-two women (31 vaginal USLS and 31 SCP) met inclusion criteria. Demographics were similar between groups except for a higher body mass index in the USLS group (27.5 ± 5.6 kg/m2 vs 24.1 ± 3.3 kg/m2, P < 0.05). Preoperative POP-Q was mostly stage II and III. At 1-year, anatomic success rates for the anterior compartment were 66.7% versus 90.3% for USLS and SCP groups, respectively (P = 0.02). There was no significant difference in apical success (P = 1.00) or QoL scores between groups at 1 year.

Conclusions
Anatomic success rates at 1 year using delayed-absorbable suture were better for SCP when using the anterior wall as a measure of success, but there were no significant differences in apical success rates, mesh or suture exposure, and QoL measures between groups.
Biliary Bicarbonate, pH, and Glucose Are Suitable Biomarkers of Biliary Viability During Ex Situ Normothermic Machine Perfusion of Human Donor Livers
Authors: Matton Alix P.M. , de Vries Yvonne , Burlage Laura C. , van Rijn Rianne , Fujiyoshi Masato , de Meijer Vincent E. , de Boer Marieke T. , de Kleine Ruben H.J. , Verkade Henkjan J. , Gouw Annette S. H. , Lisman Ton , Porte Robert J. 
Published: November 2018

Background.
Ex situ normothermic machine perfusion (NMP) can be used to assess viability of suboptimal donor livers before implantation. Our aim was to assess the diagnostic accuracy of bile biochemistry for the assessment of bile duct injury (BDI).

Methods.
In a preclinical study, 23 human donor livers underwent 6 hours of end-ischemic NMP to determine biomarkers of BDI. Livers were divided into groups with low or high BDI, based on a clinically relevant histological grading system. During NMP, bile was analyzed biochemically and potential biomarkers were correlated with the degree of BDI. Receiver operating characteristics curves were generated to determine optimal cutoff values. For clinical validation, identified biomarkers were subsequently included as viability criteria in a clinical trial (n = 6) to identify transplantable liver grafts with low BDI.

Results.
Biliary bicarbonate and pH were significantly higher and biliary glucose was significantly lower in livers with low BDI, compared with high BDI. The following cutoff values were associated with low BDI: biliary bicarbonate greater than 18 mmol/L (P = 0.002), biliary pH greater than 7.48 (P = 0.019), biliary glucose less than 16 mmol/L (P = 0.013), and bile/perfusate glucose ratio less than 0.67 (P = 0.013). In the clinical trial, 4 of 6 livers met these criteria and were transplanted, and none developed clinical evidence of posttransplant cholangiopathy.

Conclusions.
Biliary bicarbonate, pH, and glucose during ex situ NMP of liver grafts are accurate biomarkers of BDI and can be easily determined point of care, making them suitable for the pretransplant assessment of bile duct viability. This may improve graft selection and decrease the risk of posttransplant cholangiopathy.
Management of Penile Calciphylaxis
Authors: Zillioux Jacqueline M. , Geisenhoff Alexander , Gray Mikel 
Published: November 2018

BACKGROUND:
Calciphylaxis, also called calcific uremic arteriolopathy, is a highly morbid syndrome characterized by calcium deposition and occlusion of small arterial vessels of the dermis and subdermal adipose tissue, leading to necrosis and gangrene. Penile involvement is rare and its management presents considerable challenges.

CASE:
We review the case of a 47-year-old man with end-stage renal disease managed with hemodialysis, diabetes mellitus, and urinary incontinence who presented with a painful necrotic lesion on his glans penis, and the second and third toes of his right foot. Following diagnosis of calciphylaxis of the toes and penis, he was conservatively managed with topical wound care, sodium thiosulfate adjustment of hemodialysis, and phosphate binder medications. Over the course of 2 months, his wound worsened in the setting of continued urinary incontinence, and before planned diversion with a suprapubic catheter, he progressed to gangrene and sepsis. After a goals-of-care discussion with the patient and family, he elected to forego debridement and was discharged on home-based palliative care.

CONCLUSIONS:
Penile calciphylaxis is a rare, life-threatening disease that portends a poor prognosis. Conservative principles for management include normalization of calcium phosphate levels and local wound care. Penectomy may not impact survival. Ultimately, each case is individualized, and we encourage establishing goals of care in collaborative discussion with an interdisciplinary care team, patient, and family.
Conformational dynamics of active site loops 5, 6 and 7 of enzyme Triosephosphate Isomerase: A molecular dynamics study
Authors: Dantu Sarath Chandra , Groenhof Gerrit 
Published: November 2018

AbstractTriosephosphate Isomerase is a glycolytic enzyme catalyzing the interconversion of Dihydroxyacetone phosphate to Glyceraldehyde-3-phosphate. The active site is comprised of three distinct loops loop-6, loop-7 and loop-8. Based on loop-6 and loop-7 conformation we describe the enzyme as Open TIM and Closed TIM. Various NMR, X-ray crystallography and QM/MM simulation techniques have provided glimpses of individual events of what is essentially a dynamic process. We studied the conformational changes of two distinct loops (loop-6 and loop-7) enveloping the active site, in the presence of natural substrate, reaction intermediates and inhibitor molecules, by means of microsecond atomistic MD simulations in solution and crystal environment. Our studies have revealed that loop-6 samples open and closed conformations in both apo and holo TIM structures. As seen in solution state NMR experiments, we also observe that loop-6 N-terminus and C-terminus move independently. In our simulations we have also observed that backbone dihedrals of loop-7 residues G210 (G210-phi, G210-psi) and G211 (G211-phi) sample open and closed states in both apo and holo TIM structures. Whereas backbone dihedral angles of G211 (G211-psi) and S212 (S212-phi) adopt closed conformation only when the ligand is bound to the active site. As observed in chain-B of 1R2R crystal structures, we also observe that water molecules can also initiate flip of G211-psi and S212-phi dihedral angles into closed conformation. Except, loop-5, which has a dominant effect on the conformational behaviour of loop-6 N-terminus, we do not observe any influence of either loop-6 or loop-7 on the conformational dynamics of the other.
The LIM-Only Protein FHL2 is involved in autophagy to regulate the development of skeletal muscle cell
Authors: Liu Zihao , Han Shunshun , Wang Yan , Cui Can , Zhu Qing , Jiang Xiaosong , Yang Chaowu , Du Huarui , Yu Chunlin , Li Qingyun , He Haorong , Shen Xiaoxu , Chen Yuqi , Zhang Yao , Ye Lin , Zhang Zhichao , Li Diyan , Zhao Xiaoling , Yin Huadong 
Published: November 2018

AbstractFour and a half LIM domain protein 2 (FHL2) is a LIM domain protein expressed in muscle tissue whose deletion is causative of myopathies. Although FHL2 has a confirmed important role in muscle development, its autophagy-related function in muscle differentiation has not been fully determined. To explore the role of FHL2 in autophagy-related muscle regulation, FHL2-silenced and -overexpressing C2C12 mouse cells were examined. Immunofluorescence and co-immunoprecipitation assay findings showed that FHL2 silencing reduced LC3-Ⅱ protein expression and the amount of LC3 that co-immunoprecipitated with FHL2, indicating that FHL2 interacts with LC3-Ⅱ in the formation of autophagosomes. Moreover, the expression of muscle development marker genes such as MyoD1 and MyoG was lower in FHL2-silenced C2C12 cells but not in FHL2-overexpressing C2C12 cells. Electron microscopy analysis revealed large empty autophagosomes in FHL2-silenced myoblasts, while flow cytometry suggested that FHL2 silencing made cells more vulnerable to staurosporine-induced cell death. In conclusion, we propose that FHL2 interacts with LC3-Ⅱ in autophagosome formation to regulate the development of muscle cells.
Age-related changes in MEG theta and alpha oscillatory signatures of attentional control
Authors: Huizeling Eleanor , Wang Hongfang , Holland Carol , Kessler Klaus 
Published: November 2018

AbstractIn our recent behavioural research (Callaghan et al., 2017), we reported age-related changes in the costs of switching between from a temporal (rapid serial visual presentation) to a spatial (visual search) attention task. Using magnetoencephalography, we have now compared the neural signatures of attention refocusing between three age groups (19-30, 40-49 and 60+ years) and found differences in task-related modulation and cortical localisation of alpha and theta oscillations. Efficient, faster switching between the temporal and spatial attention tasks in the youngest group compared to both older groups was reflected in parietal theta effects that were significantly reduced in the older groups. Residual parietal theta activity in older individuals was, however, beneficial to attentional switching, and could reflect the preservation of attention mechanisms. Difficulties in refocusing attention in the older and middle-aged adults (slowed response times) were accompanied by reduced theta power modulation in occipital and cerebellar regions. In addition to this posterior theta deficit, older and middle-aged adults presented with increased recruitment of frontal (both groups) and temporal (older group) areas. Theta oscillations therefore demonstrated a posterior to anterior processing shift, which may reflect the engagement of alternative strategies in older- and middle-age, such as top-down attentional control in an attempt to compensate for posterior processing deficits. Additional frontal theta recruitment indeed appeared to be beneficial for faster performance, as reflected by correlational analysis. Temporal theta (in older-age), however, did not correlate with performance, but could reflect strategies unrelated to speeded performance (e.g. silent vocalisation to maintain task goals). Alpha oscillations did not significantly correlate with task performance, possibly reflecting decreased neural precision or de-differentiation, but require further investigation.
Rapid geometric feature signaling in the spiking activity of a complete population of tactile nerve fibers
Authors: Delhaye Benoit P. , Xia Xinyue , Bensmaia Sliman J. 
Published: November 2018

AbstractTactile feature extraction is essential to guide the dexterous manipulation of objects. The longstanding theory is that geometric features at each location of contact between hand and object are extracted from the spatial layout of the response of populations of tactile nerve fibers. However, recent evidence suggests that some features (edge orientation, e.g.) are extracted very rapidly (<200ms), casting doubt that this information relies on a spatial code, which ostensibly requires integrating responses over time. An alternative hypothesis is that orientation is conveyed in precise temporal spiking patterns. Here, we simulate, using a recently developed and validated model, the responses of tactile fibers from the entire human fingertip (∼800 afferents) to edges indented into the skin. We show that edge orientation can be quickly (<50 ms) and accurately (<3°) decoded from the spatial pattern of activation across the afferent population, starting with the very first spike. Next, we implement a biomimetic decoder of edge orientation, consisting of a bank of oriented Gabor filters, designed to mimic the documented responses of cortical neurons. We find that the biomimetic approach leads to orientation decoding performance that approaches the limit set by optimal decoders and is actually more robust to changes in other stimulus features. Finally, we show that orientation signals, measured from single units in non-human primate cortex (2 macaque monkeys, 1 female), follow a time course consistent with that of their counterparts in the nerve. We conclude that a spatial code is fast and accurate enough to support object manipulation.
From predictive models to cognitive models: Separable behavioral processes underlying reward learning in the rat
Authors: Miller Kevin J. , Botvinick Matthew M. , Brody Carlos D. 
Published: November 2018

AbstractCognitive models are a fundamental tool in computational neuroscience, embodying in software precise hypotheses about the algorithms by which the brain gives rise to behavior. The development of such models is often a hypothesis-first process, drawing on inspiration from the literature and the creativity of the individual researcher to construct a model, and afterwards testing the model against experimental data. Here, we adopt a complementary approach, in which richly characterizing and summarizing the patterns present in a dataset reveals an appropriate cognitive model, without recourse to an a priori hypothesis. We apply this approach to a large behavioral dataset from rats performing a dynamic reward learning task. The revealed model suggests that behavior in this task can be understood as a mixture of three components with different timescales: a quick-learning reward-seeking component, a slower-learning perseverative component, and a very slow “gambler’s fallacy” component.