bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of sclerotic changes on stress concentration in early‐stage osteonecrosis: A patient‐specific, 3D finite element analysis
Authors: Utsunomiya Takeshi , Motomura Goro , Ikemura Satoshi , Kubo Yusuke , Sonoda Kazuhiko , Hatanaka Hiroyuki , Baba Shoji , Kawano Koichiro , Yamamoto Takuaki , Nakashima Yasuharu 
Published: August 2018

ABSTRACTStress distribution remains unclear in early‐stage osteonecrosis of the femoral head (ONFH). To clarify this issue, we generated patient‐specific finite element models (FEMs) from 51 patients with ONFH. Patients’ hips were classified into three groups: ONFH without a sclerotic boundary (Stage 1, n = 6), ONFH with a sclerotic boundary (Stage 2, n = 10), and ONFH with both a sclerotic boundary and <2 mm collapse (Stage 3, n = 35). Four hips without ONFH were used as controls. Stress distribution in each FEM was compared with magnetic resonance imaging (MRI) and computed tomography (CT) results. Fifteen wholly resected femoral heads in Stage 3 hips were assessed by micro‐CT. Furthermore, we histologically examined three Stage 2 femoral heads that subsequently developed subchondral fractures after FEM analyses. In all FEMs of both control and Stage 1 hip, stress was equally distributed on the femoral head surface. However, in all FEMs of both Stages 2 and 3 hips, stress was concentrated at the lateral boundary of the femoral head surface, corresponding to both a low‐intensity band on T1‐weighted MRI images and sclerotic changes on CT. On micro‐CT, subchondral fractures consistently began at the lateral boundary with sclerotic changes, in which bone volume fraction was increased. Histology showed breakage of subchondral plates at the junction between necrotic and reparative zones. In early‐stage ONFH, sclerotic changes caused stress concentration, which can trigger subchondral fractures at the lateral boundary. Clinical Significance: Our results will clarify the pathogenic mechanism of collapse in ONFH. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3169–3177, 2018.
Correlation between high FBXW7 expression in pretreatment biopsy specimens and good response to chemoradiation therapy in patients with locally advanced esophageal cancer: A retrospective study
Authors: Gombodorj Navchaa , Yokobori Takehiko , Tanaka Naritaka , Suzuki Shigemasa , Kuriyama Kengo , Kumakura Yuji , Yoshida Tomonori , Sakai Makoto , Sohda Makoto , Baatar Seded , Miyazaki Tatsuya , Nishiyama Masahiko , Shirabe Ken , Kuwano Hiroyuki 
Published: August 2018

Background and ObjectivesEsophageal squamous cell carcinoma (ESCC) exhibits good reactivity to chemoradiation therapy (CRT). The dysregulation of F‐Box and WD Repeat Domain Containing 7 (FBXW7) is associated with therapeutic resistance in cancer cells. However, the correlation between FBXW7 expression and CRT sensitivity in patients with clinical ESCC has been investigated only in few studies. Therefore, this study aimed to elucidate the significance of FBXW7 expression in pretreatment biopsy specimens from patients with ESCC receiving CRT.MethodsWe investigated the relationship between FBXW7 expression and CRT sensitivity in 30 pretreatment biopsy specimens with histological grades of post‐CRT surgically resected tumors. Furthermore, we evaluated the effects of high FBXW7 expression on the sensitivity to cytotoxic agents, including docetaxel and nedaplatin, and radiation in ESCC cells in vitro.ResultsHigh FBXW7 expression before CRT correlated with a good pathological CRT response in patients with advanced ESCC (P < .05). Further, our in vitro data showed that both chemo and radiation sensitivity increased in TE‐8 and KYSE140 cells overexpressing FBXW7 compared with mock cells because of the degradation of the anti‐apoptotic protein MCL1.ConclusionsThe evaluation of FBXW7 expression before CRT treatment is a potential predictor of good responders among patients with ESCC receiving CRT.
The effect of contralateral prophylactic mastectomy on breast‐related charges: A 5‐year analysis
Authors: Smith Jesse R. , Jaffe Jennifer , Pruitt Jaclyn , Yao Katharine , Sisco Mark , Kuchta Kristine , Wang Chi E. , Howard Michael A. 
Published: August 2018

Background and ObjectivesThe purpose of this study was to determine charges following unilateral mastectomy (UM) and bilateral mastectomy (BM) for patients with unilateral breast cancer (UBC). We hypothesized that BM may be associated with fewer charges over time.MethodsA retrospective review was conducted of patients with UBC treated between 2006 and 2010 with UM and BM in a large healthcare system. Institutional billing data were investigated for 5 years postoperatively to calculate the immediate and subsequent charges of all inpatient and outpatient breast‐related care associated with the initial diagnosis for a subset of patients identified using propensity score matching method.ResultsA subset of matched patients (n = 320) undergoing UM (n = 160) or BM (n = 160) were included in this analysis. At 1 year, there was a trend toward lower total charges following UM as compared with BM (median, $125 230 vs $138 467; P = .6075). However, during years 2 to 5, total charges were significantly higher following UM vs BM ($22 128 vs $13 478; P = .0116).ConclusionsWhile initially higher, overall charges for BM are lower than UM between 2 and 5 years out from surgery. Further study is necessary to determine if this trend is sustained over the long term. These data can inform patient decision making regarding mastectomy for their breast cancer.
Prognostic utility of atypical mitoses in patients with breast cancer: A comparative study with Ki67 and phosphohistone H3
Authors: Ohashi Ryuji , Namimatsu Shigeki , Sakatani Takashi , Naito Zenya , Takei Hiroyuki , Shimizu Akira 
Published: August 2018

Background and ObjectivesEmerging evidence suggests that the presence of atypical mitoses is associated with poor prognosis in some types of cancer, but its clinical significance remains uncertain. Here, we investigated the occurrence of atypical mitoses in breast cancers.MethodsMitotic figures, including normal and atypical mitoses, were assessed in resected histological sections from 109 patients with invasive carcinoma of no special type (ICNST). Comparisons with clinicopathological features and biomarkers such as Ki67 and phosphohistone H3 (PHH3) were performed.ResultsThe total number of mitotic figures, including atypical mitoses, was higher in situ and invasive ductal carcinoma components than in normal ducts. Morphological characteristics of atypical mitoses included multipolar, lagged, ring, asymmetrical mitoses, and anaphase bridge. Patients with higher total mitoses and PHH3, and the presence of atypical mitoses showed reduced overall survival (OS), compared to those with lower total mitoses and PHH3, and without atypical mitoses (P = 0.03, 0.02, and <0.001, respectively). In multivariate analysis, the presence of atypical mitoses alone attained significant correlation with shorter OS (P < 0.001).ConclusionsAtypical mitoses in routinely resected specimens have a robust prognostic value for ICNST of the breast, but its clinical utility remains to be validated in a multicenter large material.
National practice patterns of completion lymph node dissection for sentinel node‐positive melanoma
Authors: Hewitt D. Brock , Merkow Ryan P. , DeLancey John Oliver , Wayne Jeffrey D. , Hyngstrom John R. , Russell Maria C. , Gerami Pedram , Balch Charles M. , Bilimoria Karl Y. 
Published: August 2018

Background and ObjectivesClose observation may be an appropriate alternative to completion lymph node dissection (CLND) for selected patient populations, especially those with minimal tumor burden in the sentinel lymph node (SLN). In this study, we examined the practice patterns of CLND utilization.MethodsUsing the National Cancer Database, we examined CLND utilization in SLN‐positive patients diagnosed with clinically node‐negative Stage III melanoma from 2012 to 2015. Hierarchical logistic regression models were constructed to assess the factors associated with observation after positive SLN biopsy (SLNB).ResultsOf the 131 171 patients identified, 55 688 (42.5%) underwent SLNB and 7200 (12.9%) had an SLN with a metastatic disease. CLND was performed in 57.0% of the patients with a positive SLNB. Patients were more likely to forgo CLND if the primary tumor was located on the lower extremity (odds ratio [OR], 1.65, 95% confidence interval [CI], 1.40‐1.94), were older (P < 0.001), had multiple comorbidities (OR, 1.61, 95% CI, 1.19‐2.20), or were diagnosed with melanoma in 2015 (OR, 1.33, 95% CI, 1.13‐1.56 vs 2012).ConclusionsCLND utilization varied based on patient factors and decreased over time. As evidence supports close observation in selected patient populations with low SLN tumor burden, monitoring is needed to ensure that CLND is performed in the appropriate patient populations. However, this will require improvements in the data collected by cancer registries.
Lymphovenous bypass for the treatment of lymphedema
Authors: Garza Rebecca M. , Chang David W. 
Published: August 2018

AbstractLymphovenous bypass (LVB) is a form of physiological lymphedema surgery, which was described decades ago, but recently it is gaining popularity with improved microsurgical technology available. Benefits of the procedure are its effectiveness in treating early stage lymphedema of either the upper or lower extremity and having low complication profile. In the following article, the history of the procedure, mechanism, and details of various LVB techniques, and outcomes will be discussed.
Short‐ and long‐term outcomes of middle hepatic vein–oriented hepatectomy for advanced perihilar cholangiocarcinoma
Authors: Ji Gu‐Wei , Zhang Yao‐Dong , Wang Ke , Zhang Hui , Shao Zi‐Cheng , Jiang Wang‐Jie , Li Xiang‐Cheng , Wang Xue‐Hao 
Published: August 2018

BackgroundThis study aimed to compare clinical outcomes of the middle hepatic vein (MHV)‐oriented versus conventional hemihepatectomy for perihilar cholangiocarcinoma (PHC).MethodsFrom 2008 to 2017, medical records of patients undergoing hemihepatectomy with caudate lobectomy for advanced PHC were reviewed retrospectively. MHV‐oriented hepatectomy was defined as full exposure of the MHV on the dissection plane. Predictors of morbidity and survival were identified.ResultsA total of 125 patients were enrolled. MHV‐oriented and conventional hepatectomies were performed in 44 and 81 patients, respectively. The curative resection rate, blood loss, transfusion, and survival were comparable between two groups; however, severe morbidity rate was significantly lower in the MHV‐oriented group (9.1% vs 38.3%, P < 0.001). MHV‐oriented approach was an independent predictor of severe morbidity, as were the age, bilirubin level, and blood transfusion. Severe morbidity was associated with significantly decreased overall survival and recurrence‐free survival (RFS) (median 29.0 vs 46.9 months, P = 0.011 and 20.3 vs 31.1 months, P = 0.003, respectively). Multivariate analysis revealed that severe morbidity independently predicted shorter RFS (P = 0.025).ConclusionsMHV‐oriented approach for advanced PHC is safe and associated with a significant decrease in severe morbidity. Severe morbidity adversely affects survival after surgery; therefore, optimal preoperative preparation and MHV‐oriented hepatectomy with meticulous dissection remain of critical importance.
Effects of grazing on the northern three‐toed jerboa pre‐ and post‐hibernation
Authors: Yuan Shuai , Fu Heping , Wu Xiaodong , Yang Suwen , Malqin Xingan , Yue Xiuxian 
Published: August 2018

ABSTRACTResource availability pre‐hibernation and post‐hibernation may be crucial phases for the survival of hibernators. However, the effects of grazing on food availability in pre‐hibernation and on the winter survival of hibernating rodents remains unstudied. The objective of this study was to investigate the effects of domestic sheep grazing on northern three‐toed jerboa (Dipus sagitta) populations pre‐, post‐, and during hibernation. We conducted a grazing exclusion experiment with randomized complete block design in the Alxa Desert, Inner Mongolia, China, from April to October 2006 to 2011. We live‐trapped jerboas in 3 grazed plots and 3 ungrazed plots. We measured the quantity of vegetation in grazed and ungrazed plots to determine the relationship between jerboas and plant food resources. We observed higher jerboa densities both pre‐ and post‐hibernation, and heavier individual body mass pre‐hibernation, in ungrazed sites. More food availability contributed to higher jerboa body mass in ungrazed areas during pre‐hibernation, and attracted more jerboas immigrating to ungrazed areas during the post‐hibernation period. These results demonstrate that grazing negatively affects the northern three‐toed jerboa population by adjusting food availability pre‐ and post‐hibernation; survival rates were not affected by grazing. © 2018 The Wildlife Society.
Endonasal anatomy of the olfactory neural network: Surgical implications
Authors: Gomez Galarce Matias , Yanez‐Siller Juan C. , Carrau Ricardo L. , Montaser Alaa , Lima Lucas Ramos , Servian Diego , Otto Bradley A. , Prevedello Daniel M. , Naudy Cristian A. 
Published: August 2018

Objectives/HypothesisDefine the anatomic distribution of the olfactory filaments within specific mucosal regions of the nasal cavity.Study DesignCadaveric study.MethodsSeventeen cadaveric specimens (34 sides) were dissected to study the anatomical distribution and density of olfactory fila within different regions of the nasal cavity. Olfactory fila were dissected retrogradely to their point of entry into the anterior cranial fossa through the cribriform plate. Anatomic relationships among various components of the olfactory system and their corresponding arterial supply were determined subjectively.ResultsThe highest density of olfactory fila was found at the mucosa of the ethmoid roof and superior turbinates. Olfactory fila were found at regions not previously considered to be part of the olfactory system: lateral wall of the nose, ethmoidal bullae, and between the os sphenoidale and arc of the posterior choana. Furthermore, at the septum, 20% of the olfactory fila crossed contralaterally before exiting the nose. The anterior ethmoidal arteries were the primary blood supply to the olfactory epithelium.ConclusionsThis study suggests that olfactory filaments extend beyond previously established boundaries. These findings may have clinical implications regarding oncologic resections and could serve as the foundation for the development of techniques that better preserve olfactory function.Level of EvidenceNA Laryngoscope, 2473–2477, 2018
An investigation of left–right vocal fold symmetry in rheological and histological properties
Authors: Xu Chet C. , Gao Ang , Zhang Song 
Published: August 2018

ObjectivesThe primary objective was to investigate the left–right vocal fold symmetry in rheological and histological properties using a rabbit model. The other objective was to develop statistical models for the comparison of rheological properties between paired vocal folds.MethodsViscoelastic shear properties of six pairs of vocal fold lamina propria specimens were measured over a frequency range of 1 to 250 Hz by a linear, controlled‐strain, simple‐shear rheometer. The rheological data of the left and right vocal folds was statistically compared using the mixed‐effects model approach. Six additional rabbit larynges were histologically analyzed for left–right symmetry in distribution patterns and relative densities of major extracellular matrix constituents.ResultsThere were no significant differences in elastic shear modulus (P = 0.1069) and dynamic viscosity (P = 0.944) of the lamina propria between the two vocal folds of the same larynx. Left–right vocal fold symmetry in densities and distribution patterns of the key molecular constituents was also demonstrated in histological results.ConclusionBy showing that the left and right vocal folds were rheologically and histologically symmetrical in rabbit, this study validated an underlying assumption made in many previous reports. Statistical models for the analysis of hierarchically correlated left–right vocal fold rheological data were also presented.Level of EvidenceNA. Laryngoscope, 128:E359–E364, 2018
Clinical Implications of Tumor‐Associated Tissue Eosinophilia in Tongue Squamous Cell Carcinoma
Authors: De Paz Dante , Chang Kai‐Ping , Kao Huang‐Kai , Lao William Wei‐Kai , Huang Yu‐Chen , Chang Yu‐Liang , Huang Yenlin 
Published: August 2018

Objectives/HypothesisThe role of tumor‐associated tissue eosinophilia (TATE) in oral cavity cancer remains quite controversial. This study investigated the potential role of TATE in tongue squamous cell carcinoma (TSCC).Study DesignRetrospective case series.MethodsThis study retrospectively enrolled 259 consecutive TSCC patients who underwent surgery between July 2004 and December 2015. Histopathological examinations for TATE in TSCC tumors were reviewed, and the association of TATE with different clinicopathological factors was evaluated. A nomogram was generated based on several major clinicopathological factors and TATE to improve the accuracy of prognostic prediction.ResultsHigher levels of TATE were significantly associated with male sex, alcohol consumption, cigarette smoking, higher pT classification, advanced disease stage, and tumor depth (P = .006, .003, .024, .041, .013 and .006, respectively). Our results indicated that extranodal extension, cell differentiation, and TATE were independent predictors of overall survival (P < .001, .004, and .032, respectively) and disease‐free survival (P < .001, .012, and .013, respectively). TATE levels significantly correlated with circulating eosinophils (r = 0.139, P = .040), and the c‐index of our nomogram foroverall survival was 0.786, which demonstrates better accuracy in prognosis prediction than the TNM stage only (c‐index = 0.738).ConclusionsHigher levels of TATE were associated with several clinicopathological factors and poorer survival rates, and a nomogram incorporating TATE levels may strengthen the prediction accuracy of prognosis in TSCC patients.Level of Evidence4 Laryngoscope, 129:1123–1129, 2019
Analysis of Risk Factors for Unplanned Reoperation Following Free Flap Surgery of the Head and Neck
Authors: Zhao Eric H. , Nishimori Kalin , Brady Jacob , Siddiqui Sana H. , Eloy Jean Anderson , Baredes Soly , Park Richard Chan W. 
Published: August 2018

Objectives/HypothesisEvaluate risk factors for unplanned reoperation following free flap surgery of the head and neck.Study DesignRetrospective database review.MethodsThe National Surgical Quality Improvement Program database was queried for free flap surgeries of the head and neck between 2010 and 2014. Bivariate and multivariate analyses were performed to compare perioperative variables and postoperative complications in patients with and without unplanned reoperation.ResultsA total of 1,796 patients were identified, with an overall unplanned reoperation rate of 20.0% (n = 359) within 30 days after surgery. Upon multivariate analysis, independent preoperative risk factors for unplanned reoperation include smoking (odds ratio [OR]: 1.389, 95% confidence interval [CI]: 1.042‐1.850), hypertension (OR: 1.443, 95% CI: 1.096‐1.901), and prior open wound/wound infection (OR: 1.675, 95% CI: 1.123‐2.499). Intraoperative risk factors include prolonged operative time (OR: 1.045, 95% CI: 1.021‐1.070). Surgical site infection (OR: 6.518, 95% CI: 2.728‐15.574), wound disruption (OR: 17.034, 95% CI: 8.373‐34.654), blood transfusion (OR: 1.561, 95% CI: 1.062‐2.296), and ventilation > 48 hours (OR: 3.626, 95% CI: 1.955‐6.723) were significant postoperative predictors of unplanned reoperation.ConclusionsIn patients with free flap surgeries of the head and neck, preoperative smoking, hypertension, and prior open wound/wound infection, along with prolonged operative time, are risk factors for 30‐day unplanned reoperation. In addition, postoperative surgical site infection, wound disruption, blood transfusion, and ventilation >48 hours are independently associated with unplanned reoperation.Level of Evidence4 Laryngoscope, 128:2790–2795, 2018
The Relationships Between the Nasolacrimal Duct and the Anterior Wall of the Maxillary Sinus
Authors: Wang Xiangdong , Chen Xinjun , Zheng Ming , Liu Chengyao , Wang Chengshuo , Zhang Luo 
Published: August 2018

Objectives/HypothesisTo examine the anatomic relationships between the lower end opening into the inferior meatus of the bony nasolacrimal duct (NLD) and the anterior wall of the maxillary sinus.Study DesignAnatomical investigation.MethodsA total of 206 individuals were recruited for detailed anatomic investigation of the lower end of the bony NLD and their relation to the anterior wall of the maxillary sinus by high‐resolution computed tomography (HRCT) imaging. The observed features were classified as either a fusion type or separation type, according to the HRCT images. Additionally, the angle between the anterior and medial wall of the maxillary sinus was classified as either an anterior mode or lateral mode.ResultsThe NLD anatomical fusion type was found in 40.05% and the separation type in 59.95% of the HRCT imaging scans available. The anterior mode of angle between the anterior and medial wall of the maxillary sinus was present in 64.1% of the images, and the lateral mode in 35.9% of the images. In 165 cases of anatomical fusion, the anterior mode of angle was present in 15.8% and the lateral mode in 84.2% of cases. In 247 cases of anatomical separation, the anterior mode was present in 97.2% and the lateral mode in 2.8% of cases.ConclusionsThe surgical anatomy of the lower end of the bony NLD and anterior wall of the maxillary sinus displays varied relationships. Preoperative use of HRCT and an awareness of the particular type of anatomical feature present are likely to aid in planning and performing successful endoscopic medial maxillectomy.Level of Evidence4Laryngoscope, 129:1030–1034, 2019
Initial and Long‐term Retention of Robotic Technical Skills in an Otolaryngology Residency Program
Authors: Shay Sophie G. , Chrin Jonathan D. , Wang Marilene B. , Mendelsohn Abie H. 
Published: August 2018

Objectives/HypothesisTo objectively assess the initial and long‐term retention of robotic surgical skills of otolaryngology residents.Study DesignThis study was performed in an academic otolaryngology residency training program. Between October 2015 and November 2016, residents were invited to complete a prospective, multiphase robotic surgical skills training course: 1) online da Vinci Surgical System Assessment and didactic, 2) faculty‐supervised robotic simulator training, 3) robotic docking and draping training, 4) robotic dry‐lab exercises. To optimize surgical skill retention, the training laboratory was repeated 2 weeks after the initial training session.MethodsTwenty otolaryngology residents were included. Primary outcome was measured as robotic skill assessment scores on three tasks: camera targeting, peg board, and needle targeting. Skill assessments were completed prior to training, between the two training sessions, and at 1 month and 6 months after training. Residents were also asked to complete a self‐assessment questionnaire.ResultsCamera targeting scores were improved at midtraining (P < .001) and 1‐month posttraining (P = .010). Peg board scores were improved at 1 month training (P = .043). Needle targeting scores were improved at midtraining (P = .002), 1 month (P = .002), and 6 months posttraining (P < .001). Resident self‐assessment scores demonstrating comfort with using the robotic console (P < .01) and docking/draping (P < .01) improved significantly following the training.ConclusionsFollowing a multiphase robotic training program, otolaryngology residents demonstrated significant, objective skill acquisition and retention at 1 month and 6 months follow‐up. Although the proposed training strategy may be considered an important step in otolaryngology residency training, additional innovations are being designed toward a formal robotic training curriculum.Level of EvidenceNALaryngoscope, 129:1380–1385, 2019