bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interplay of structure, elasticity, and dynamics in actin-based nematic materials
Authors: Zhang Rui , Kumar Nitin , Ross Jennifer L. , Gardel Margaret L. , de Pablo Juan J. 
Published: December 2017

SignificanceThermotropic liquid crystals (LCs) are central to a wide range of commercial and emerging technologies. Lyotropic, aqueous-based LCs are common in nature, but applications have been scarce. The current understanding of their behavior is limited, and manipulating their mechanical and dynamic characteristics has been challenging. Here we show that the elasticity and temporal evolution of biopolymer-based nematic systems can be inferred from simple optical microscopy measurements, and that their mechanical properties can be manipulated by adjusting certain molecular characteristics, such as the product of length and concentration. It is also shown that the dynamic evolution of the resulting materials can be understood and predicted on the basis of a free energy functional originally developed for the study of thermotropic systems.
Elizabethkingia anophelis: Clinical Experience of an Academic Health System in Southeastern Wisconsin
Authors: Figueroa Castro Carlos E , Johnson Carrie , Williams Mary , VanDerSlik April , Graham Mary Beth , Letzer David , Ledeboer Nathan , Buchan Blake W , Block Timothy , Borlaug Gwen , Munoz-Price L Silvia 
Published: December 2017

Abstract
In late 2015 and early 2016, 11 patients were identified with cultures positive for Elizabethkingia anophelis in our health system. All patients had positive blood cultures upon admission. Chart review showed that all had major comorbidities and recent health care exposure. The attributable mortality rate was 18.2%.
Objective Validation of Perfusion-Based Human Cadaveric Simulation Training Model for Management of Internal Carotid Artery Injury in Endoscopic Endonasal Sinus and Skull Base Surgery
Authors: Shen Jasper , Hur Kevin , Zhang Zhipeng , Minneti Michael , Pham Martin , Wrobel Bozena , Zada Gabriel 
Published: December 2017

Abstract

BACKGROUND
The emergence of minimally invasive endoscopic endonasal skull base surgery has necessitated reproducible and realistic simulators of rare vascular injuries.

OBJECTIVE
To assess the face and content validity of an innovative perfusion-based cadaveric model developed to simulate internal carotid artery (ICA) injury during endoscopic surgery.

METHODS
Otolaryngology and neurosurgery trainees attempted 3 consecutive trials of endoscopic control of a parasellar ICA injury, with standardized technical feedback. Time to hemostasis (TTH) and blood loss were trended. All participants completed validated questionnaires using a 5-point Likert scale to assess the domains of confidence gain, face validity, content validity, and curriculum applicability.

RESULTS
Among all participants (n = 35), TTH and mean blood loss significantly decreased between first vs second attempt (P = .005), and first vs third attempt (P = .03). Following the first attempt, trainees experienced an average 63% reduction in blood loss and 59% reduction in TTH. In the quartile of most improved participants, average blood loss reduction was 1115 mL (84% reduction) and TTH of 259 s (84% reduction). There were no significant differences between trainees of varying postgraduate year or specialty. Average pre and postprocedural confidence scores were 1.38 and 3.16, respectively (P < .0001). All trainees reported model realism, which achieved mean face validity 4.82 ± 0.41 and content validity 4.88 ± 0.33.

CONCLUSION
The perfusion-based human cadaveric ICA injury model achieves high ratings of face and content validity across all levels of surgical trainees, and enables safe, realistic simulation for standardized skull base simulation and future curriculum development. Objective improvements in performance metrics may translate to improved patient outcomes.
Where and When to Cut? Fluorescein Guidance for Brain Stem and Spinal Cord Tumor Surgery—Technical Note
Authors: Suero Molina Eric , Stummer Walter 
Published: December 2017

Abstract

BACKGROUND
Spinal cord and brain stem lesions require a judicious approach with an optimized trajectory due to a clustering of functions on their surfaces. Intraoperative mapping helps locate function. To confidently locate such lesions, neuronavigation alone lacks the desired accuracy and is of limited use in the spinal cord.

OBJECTIVE
To evaluate the clinical value of fluoresceins for initial delineation of such critically located lesions.

METHODS
We evaluated fluorescein guidance in the surgical resection of lesions with blood-brain barrier disruption demonstrating contrast enhancement in magnet resonance imaging in the spinal cord and in the brain stem in 3 different patients. Two patients harbored a diffuse cervical and thoracic spinal cord lesion, respectively. Another patient suffered metastatic lesions in the brain stem and at the floor of the fourth ventricle. Low-dose fluorescein (4 mg/kg body weight) was applied after anesthesia induction and visualized using the Zeiss Pentero 900 Yellow560 filter (Carl Zeiss, Oberkochen, Germany).

RESULTS
Fluorescein was helpful for locating lesions and for defining the best possible trajectory. During resection, however, we found unspecific propagation of fluorescein within the brain stem up to 6 mm within 3 h after application. As these lesions were otherwise distinguishable from surrounding tissue, monitoring resection was not an issue.

CONCLUSION
Fluorescein guidance is a feasible tool for defining surgical entry zones when aiming for surgical removal of spinal cord and brain stem lesions. Unselective fluorescein extravasation cautions against using such methodology for monitoring completeness of resection. Providing the right timing, a window of pseudoselectivity could increase fluoresceins’ clinical value in these cases.
Effect of Blast Injury on Auditory Localization in Military Service Members
Authors: Kubli Lina R. , Brungart Douglas , Northern Jerry 
Published: December 2017

Objectives:
Among the many advantages of binaural hearing are the abilities to localize sounds in space and to attend to one sound in the presence of many sounds. Binaural hearing provides benefits for all listeners, but it may be especially critical for military personnel who must maintain situational awareness in complex tactical environments with multiple speech and noise sources. There is concern that Military Service Members who have been exposed to one or more high-intensity blasts during their tour of duty may have difficulty with binaural and spatial ability due to degradation in auditory and cognitive processes. The primary objective of this study was to assess the ability of blast-exposed Military Service Members to localize speech sounds in quiet and in multisource environments with one or two competing talkers.

Design:
Participants were presented with one, two, or three topic-related (e.g., sports, food, travel) sentences under headphones and required to attend to, and then locate the source of, the sentence pertaining to a prespecified target topic within a virtual space. The listener’s head position was monitored by a head-mounted tracking device that continuously updated the apparent spatial location of the target and competing speech sounds as the subject turned within the virtual space. Measurements of auditory localization ability included mean absolute error in locating the source of the target sentence, the time it took to locate the target sentence within 30 degrees, target/competitor confusion errors, response time, and cumulative head motion. Twenty-one blast-exposed Active-Duty or Veteran Military Service Members (blast-exposed group) and 33 non-blast-exposed Service Members and beneficiaries (control group) were evaluated.

Results:
In general, the blast-exposed group performed as well as the control group if the task involved localizing the source of a single speech target. However, if the task involved two or three simultaneous talkers, localization ability was compromised for some participants in the blast-exposed group. Blast-exposed participants were less accurate in their localization responses and required more exploratory head movements to find the location of the target talker.

Conclusions:
Results suggest that blast-exposed participants have more difficulty than non-blast-exposed participants in localizing sounds in complex acoustic environments. This apparent deficit in spatial hearing ability highlights the need to develop new diagnostic tests using complex listening tasks that involve multiple sound sources that require speech segregation and comprehension.
Effects of Amplification on Neural Phase Locking, Amplitude, and Latency to a Speech Syllable
Authors: Jenkins Kimberly A. , Fodor Calli , Presacco Alessandro , Anderson Samira 
Published: December 2017

Objective:Older adults often have trouble adjusting to hearing aids when they start wearing them for the first time. Probe microphone measurements verify appropriate levels of amplification up to the tympanic membrane. Little is known, however, about the effects of amplification on auditory-evoked responses to speech stimuli during initial hearing aid use. The present study assesses the effects of amplification on neural encoding of a speech signal in older adults using hearing aids for the first time. It was hypothesized that amplification results in improved stimulus encoding (higher amplitudes, improved phase locking, and earlier latencies), with greater effects for the regions of the signal that are less audible.Design:Thirty-seven adults, aged 60 to 85 years with mild to severe sensorineural hearing loss and no prior hearing aid use, were bilaterally fit with Widex Dream 440 receiver-in-the-ear hearing aids. Probe microphone measures were used to adjust the gain of the hearing aids and verify the fitting. Unaided and aided frequency-following responses and cortical auditory-evoked potentials to the stimulus /ga/ were recorded in sound field over the course of 2 days for three conditions: 65 dB SPL and 80 dB SPL in quiet, and 80 dB SPL in six-talker babble (+10 signal to noise ratio).Results:Responses from midbrain were analyzed in the time regions corresponding to the consonant transition (18 to 68 ms) and the steady state vowel (68 to 170 ms). Generally, amplification increased phase locking and amplitude and decreased latency for the region and presentation conditions that had lower stimulus amplitudes—the transition region and 65 dB SPL level. Responses from cortex showed decreased latency for P1, but an unexpected decrease in N1 amplitude. Previous studies have demonstrated an exaggerated cortical representation of speech in older adults compared to younger adults, possibly because of an increase in neural resources necessary to encode the signal. Therefore, a decrease in N1 amplitude with amplification and with increased presentation level may suggest that amplification decreases the neural resources necessary for cortical encoding.Conclusion:Increased phase locking and amplitude and decreased latency in midbrain suggest that amplification may improve neural representation of the speech signal in new hearing aid users. The improvement with amplification was also found in cortex, and, in particular, decreased P1 latencies and lower N1 amplitudes may indicate greater neural efficiency. Further investigations will evaluate changes in subcortical and cortical responses during the first 6 months of hearing aid use.
Bending the Arc of the Trilobed Flap Through External Interlobe Angle Inequality
Authors: Wang Chang Ye , Armbrecht Eric S. , Burkemper Nicole M. , Glaser Dee Anna , Maher Ian A. 
Published: December 2017

BACKGROUND
The trilobed flap is a useful repair option for distal nasal defects. In certain cases, however, the placement of its quaternary defect may risk compression of the internal nasal valve or induction of ectropion. In this study, we propose a modified design of the trilobed flap, which uses unequal external interlobe angles.

OBJECTIVE
To present the design principles and results of our modified trilobed flap for the reconstruction of difficult distal nasal Mohs defects.

MATERIALS AND METHODS
Mohs defects of 26 patients were reconstructed (21 with long-term follow-up) using our modified trilobed flap over 1 year. Two independent masked raters graded postoperative photographs for alar symmetry and overall cosmesis.

RESULTS
Median alar symmetry scores were excellent and overall cosmesis grades were between excellent and very good.

CONCLUSION
The modified trilobed flap with unequal external angles offers an excellent option for reconstruction of Mohs defect of the distal nose that may not be well-suited for other repairs. Over 1 year, 21 modified trilobed repairs were performed with overall excellent outcomes.
A systematic review of intravaginal testosterone for the treatment of vulvovaginal atrophy
Authors: Bell Robin J. , Rizvi Farwa , Islam Rakabul M. , Davis Susan R. 
Published: December 2017

Abstract

Objectives:
Intravaginal testosterone has emerged as a potential treatment for vulvovaginal atrophy (VVA) in women, in general, and women taking an aromatase inhibitor (AI). A systematic review of the literature was undertaken to determine whether available clinical trial data support efficacy and safety of intravaginal testosterone for the treatment of VVA.

Methods:
Scopus, MEDLINE, EMBASE, and the Cochrane Library databases were systematically searched on July 26, 2017, for human studies published in English of clinical trials of intravaginal testosterone.

Results:
Six separate clinical trials were identified that ranged in size from 10 to 80 participants, with either single dose, or durations of 4 to 12 weeks. Only one study incorporated a double-blind design. Three studies were of women taking an AI.
Taken together, the studies suggest that intravaginal testosterone may lower vaginal pH, increase the proportion of vaginal lactobacilli, and possibly improve the vaginal maturation index. The lack of a placebo treatment in four studies, and failure to adjust for baseline differences, resulted in uncertainty of the effect on sexual function. Safety remains uncertain because of the small number of women exposed, short study durations, and inconsistent and incomplete outcome reporting for sex steroid levels.

Conclusion:
Adequately powered double-blind, placebo-controlled clinical trials of intravaginal testosterone therapy are needed to establish both efficacy and safety.
Descriptive Analysis of the Arterial Supply to the Auricle in Patients with Unilateral Microtia
Authors: Márquez-Gutiérrez Erik Agustín , Gutiérrez-Gómez del Hierro Claudia , Rodríguez-Quintero Jorge Humberto , Pereyra-Arzate Jorge Enrique , Rivera-Martínez Rodolfo 
Published: December 2017

Background:
Microtia is a congenital auricular deformity that occurs in 1:5,000–10,000 births. It can cause severe impairment to the patient’s self-esteem and problems regarding social integration. Multiple measures have been described in attempt to better operative outcomes of these patients. We used computed tomography (CT) angiography to analyze the vascular pattern of the auricular region before surgery.

Methods:
Fourteen patients with unilateral microtia were included. All underwent CT angiogram plus tridimensional reconstruction. Both healthy and microtic auricles were analyzed descriptively in terms of main arterial supply, pattern, diameter of subbranches, and angulation. The sample was divided in 2 age groups for better understanding of the data.

Results:
Blood supply to the auricle was found to depend on 2 main vessels: temporal superficial artery (TSA) and its subbranches (superior, middle, and lower branch) and posterior auricular (PA) artery. In the microtic group, TSA was the dominant artery in 13 of 14 cases (92%). Superior, middle, and inferior branches were present in 4, 3, and 0 cases, respectively. Three of the microtic auricles presented supply from PA artery, from which in 1 case, it represented the only supply to the region.

Conclusions:
There is wide variability in the blood supply of both healthy and microtic auricles; however, we were able to identify some tendencies in our sample. Further research is needed to prove the benefit of a preoperative imaging study in these patients. Still, in our experience, we found it useful as a complement for surgical planning.
Active Voluntary Contraction of the Ruptured Muscle Tendon during the Wide-awake Tendon Reconstruction
Authors: Zukawa Mineyuki , Osada Ryusuke , Makino Hiroto , Kimura Tomoatsu 
Published: December 2017

Purpose:
The purpose of this study was to measure the active voluntary contraction distances of ruptured musculotendinous units during wide-awake tendon reconstruction surgery and to investigate the relationships between active contraction distance and the passive distraction distance and the time elapsed before reconstruction.

Methods:
The passive distraction distance and active contraction distance of 36 tendons of 22 patients who underwent forearm tendon transfer or tendon graft during wide-awake surgery were measured.

Results:
The passive distraction distance was significantly related to the active contraction distance of the ruptured musculotendinous unit (r = 0.60, P < 0.05). The passive distraction distance accounted for approximately half of the total excursion of the musculotendinous unit. There was no significant correlation between each distance and the time elapsed before reconstruction.

Conclusions:
The passive distraction distance was significantly related to the active contraction distance of the ruptured musculotendinous unit in vivo during wide-awake surgery. Active musculotendinous unit contraction distance may be a useful index to evaluate ruptured musculotendinous unit degeneration and donor muscle function in standard tendon reconstruction. This study suggested that the advantages of the wide-awake approach were not just as a clinical tool but also as an in vivo research tool.
Internal Mammary Vessels’ Impact on Abdominal Skin Perfusion in Free Abdominal Flap Breast Reconstruction
Authors: Nergård Solveig , Mercer James B. , de Weerd Louis 
Published: December 2017

Background:
Wound healing problems at the donor site in free abdominal flap breast reconstruction cause significant morbidity to patients. No studies have investigated what impact the use of the internal mammary artery in free abdominal flap breast reconstruction has on abdominal skin perfusion. We hypothesized that harvesting the internal mammary vessels (IMV) has a negative effect on abdominal skin perfusion.

Methods:
The abdomen and anterior thoracic wall of 17 patients scheduled for secondary free abdominal flap breast reconstruction using IMV was pre-, intra-, and postoperatively examined with dynamic infrared thermography. Qualitative and quantitative analyses of the rate and pattern of recovery in Huger’s vascular zones were made with each patient being its own control. Zone III on the side where IMV were used was numbered zone IV. The contralateral zone III was used as reference.

Results:
Postoperative abdominal skin perfusion in zone IV was always significantly reduced compared with zone III (1-tailed t test, P < 0.05). The difference between zones II and III was statistically significant for day 1 and 3, but not for day 6 (2-tailed t test, P < 0.05). Skin perfusion in zones II and IV increased during consecutive postoperative days with an increase of hot spots in these areas.

Conclusions:
Using the IMV in free abdominal flap breast reconstruction had a significant effect on abdominal skin perfusion and may contribute to abdominal wound healing problems. The reperfusion of the abdominal skin was a dynamic process showing an increase in perfusion in the affected areas during the postoperative days.
COLORADO AGE-RELATED MACULAR DEGENERATION REGISTRY
Authors: Lynch Anne M. , Patnaik Jennifer L. , Cathcart Jennifer N. , Mathias Marc T. , Siringo Frank S. , Lacey Echalier E. , Wagner Brandie D. , Oliver Scott C.N. , Pecen Paula E. , Olson Jeffrey L. , Fine Stuart L. , Palestine Alan G. , Mandava Naresh 
Published: December 2017

Purpose:
To study new and existing risk factors related to age-related macular degeneration (AMD) phenotypes in a Colorado cohort.

Methods:
Age-related macular degeneration was categorized into early, intermediate, or advanced forms. Controls (n = 180) were patients with cataract and no AMD. Demographic and clinical data were gathered by patient interview and verified by chart review. Image data were reviewed by vitreoretinal specialists. Statistical analysis included univariable and multivariate logistic regression analysis (P < 0.05).

Results:
Among the 456 patients with AMD, 157 (34.4%), 80 (17.6%), and 219 (48.0%) had the early/intermediate, geographic atrophy, and neovascular forms of the disease, respectively. Adjusted for age, African-American race was associated with a reduced risk of early/intermediate (adjusted odds ratio [AOR] = 0.08, confidence interval [CI] = 0.01–0.67) and neovascular AMD (AOR = 0.15, CI = 0.03–0.72). A family history of AMD was a risk factor for early/intermediate (AOR = 4.08, CI = 2.30–7.25), geographic atrophy (AOR = 8.62, CI = 3.77–19.7), and neovascular AMD (AOR = 3.76, CI = 2.16–6.56). A history of asthma was related to the early/intermediate form of AMD (AOR = 2.34, CI = 1.22–4.46).

Conclusion:
Studying AMD in specific populations may reveal novel risk factors such as our finding of a relationship between asthma history and AMD.
INVISIBLE, HONEYCOMB-LIKE, CAVITARY RETINAL ASTROCYTIC HAMARTOMA
Authors: Mellen Phoebe L. , Sioufi Kareem , Shields Jerry A. , Shields Carol L. 
Published: December 2017

Purpose:
To report a patient with clinically invisible retinal astrocytic hamartomas (RAHs) detected on optical coherence tomography (OCT) and studied with OCT angiography (OCTA).

Method:
Case report.

Results:
An 11-year-old healthy girl was evaluated for reduced visual acuity in the right eye. On examination, best-corrected visual acuity was 20/50 in the right eye and 20/20 in the left eye. Fundus examination revealed blunted foveal reflex in the right eye and normal findings in the left eye. Optical coherence tomography disclosed an abruptly elevated, honeycomb-like macular mass with thin filamentous walls in the right eye, limited to the nerve fiber layer and measuring 756 μm in thickness. The numerous intralesional cavities (optically empty spaces) displayed no calcification. These findings were consistent with Type IV RAH. Optical coherence tomography of the left eye revealed intact foveola and focal nerve fiber layer thickening inferiorly without cavity, measuring 136 μm in thickness, consistent with Type I RAH. En face OCTA detected microvascular flow within the walls of the cavitary RAH in the right eye. Bilateral RAH in a child with no systemic evidence of tuberous sclerosis syndrome was established.

Conclusion:
Multimodal imaging is important in revealing causes of visual loss and in the detection of subclinical fundus tumors. In this case, clinically invisible RAHs were detected only by OCT and surrounding vascular flow by OCTA.