bluuebunny/crossref_metadata_2025_split huggingface dataset:
Flexible fate commitment of E2-2high common DC progenitors implies tuning in tissue microenvironments
Authors: Onai Nobuyuki , Asano Jumpei , Kurosaki Rumiko , Kuroda Shoko , Ohteki Toshiaki 
Published: October 2017

Abstract
The basic helix-loop-helix transcription factor E2-2 is essential for the development of plasmacytoid dendritic cells (pDCs) but not conventional DCs (cDCs). Here, we generated E2-2 reporter mice and demonstrated that an E2-2high fraction among common DC progenitors, which are a major source of pDCs and cDCs in the steady state, strictly gave rise to pDCs in the presence of Flt3 (Fms-like tyrosine kinase receptor-3) ligand ex vivo or in the secondary lymphoid organs when transferred in vivo. However, in the small intestine, some of these E2-2high progenitors differentiated into cDCs that produced retinoic acid. This transdifferentiation was driven by signaling via the common β receptor, a receptor for the cytokines IL-3, IL-5 and GM-CSF, which are abundant in the gut. In the presence of GM-CSF and Flt3 ligand, E2-2high-progenitor-derived cDCs consistently induced Foxp3+ Treg cells ex vivo. Our findings reveal the commitment and flexibility of E2-2high progenitor differentiation and imply that pertinent tuning machinery is present in the gut microenvironment.
How does the inner circle shape the policy-planning network in France?
Authors: Comet Catherine 
Published: October 2017

Abstract
Policy-planning organizations have undergone significant development in France over the last two decades. Interconnecting the economic, political and intellectual elites, their study merits particular attention. This paper examines the active involvement of the business community in these organizations to highlight its role in the policy-planning process. Focusing on the top 100 corporations and the top 40 policy organizations, it analyses the structure of their interlocking directorates. The cohesion of the policy-planning network significantly relies on the brokering role of a few business leaders and economists. The network discloses a core-periphery structure and a left–right polarization. The results shed light on the relative convergence among the main policy organizations and the relegation of less consensual organizations to the network periphery.
Measuring Scholastic Production by Dermatopathologists Using the H-Index: A Cross-Sectional Study
Authors: Fraga Garth R. 
Published: October 2017

Abstract:
Academic advancement in dermatopathology requires evidence of scientific production. The H-index is a useful bibliometric for measuring scientific production because it weights both volume and impact of an individual's scholastic production. The H-index distribution among academic dermatopathologists is unknown. In this cross-sectional study of 299 dermatopathologists with academic appointments in North America, H-index, publication counts, and citation counts were retrieved from Thomas Reuters Web of Science. Analytic statistics were performed to identify best predictors of academic rank and cutoff points between academic ranks. The H-index was a superior predictor of overall academic rank than publication or citation counts. The median H-index for assistant, associate, and full professors was 4, 6, and 11, respectively. H-index cutoff scores of 8 and 10 favored associate and full professor rank, respectively. These data provide benchmarks for dermatopathologists to gauge their scientific productivity against that of their peers. Although advancement decisions will depend on a careful examination of the scope and impact of a candidate's work, assistant professors of dermatopathology with H-index scores of >7 and associate professors of dermatopathology with H-index scores of >9 may wish to consider application for promotion.
Acquisition of Somatic NRAS Mutations in Central Nervous System Melanocytes: A Predisposing Risk Factor to Primary Melanoma of the Central Nervous System, a Frequently Forgotten Pitfall in Congenital Nevi
Authors: Garrido Maria C. , Maroñas-Jiménez Lidia , Morales-Raya Carlos , Ruano Yolanda , Rodriguez-Peralto Jose L. 
Published: October 2017

Abstract:
Congenital melanocytic nevi (CMN) are benign melanocytic proliferations that are usually present at birth. A somatic mosaicism for an NRAS point mutation is responsible for the several phenotypic abnormalities that may be associated with congenital nevi. We report the case of a 7-year-old boy with a proliferative nodule (PN) arising in a Giant CMN completely excised and with several visceral and intraspinal melanoma metastases with no evidence of primary cutaneous melanoma. The careful analysis of the clinical, morphologic, and molecular features allowed the distinction of between the benign PN (BPN) and the melanoma. The BPN showed a characteristic comparative genomic hybridization pattern with gains or losses of whole chromosomes, whereas the melanoma displayed gains or losses involving complex partial chromosomal copy number gains or losses. Leptomeningeal melanocytes are more susceptible to transformation by oncogenic NRAS than cutaneous melanocytes, and central nervous system melanomas are more common than cutaneous melanomas in the setting of CMN. Thus, it has been recommended to characterize the congenital disease in patients with 2 CMN at birth, independently of size and site, with a single magnetic resonance imaging screening younger than the age of 1 year.
Ameliorative Effect of Epigallocatechin Gallate on Cardiac Hypertrophy and Fibrosis in Aged Rats
Authors: Muhammed Ibrahim , Sankar Suruthi , Govindaraj Sakthivel 
Published: October 2017

Abstract:
The objective of the present study is to evaluate the effect of epigallocatechin gallate (EGCG) on aging-mediated cardiac hypertrophy, fibrosis, and apoptosis. The Wistar albino rats were divided into 4 groups (n = 18). Group I: young (3 months), group II: aged (24–26 months), group III: aged + EGCG (200 mg/kg for 30 days), and group IV: young + EGCG. At the end of 30 days, EGCG administration to the aged animals showed significant (P < 0.001) reduction of low-density lipoprotein, very low-density lipoprotein, triglyceride, total cholesterol with concomitant increase of high-density lipoprotein (P < 0.001) when compared with aged rats. Increased (P < 0.001) heart volume, weight with concomitant increase of left ventricular wall thickness, and reduced ventricular cavity were observed in aged rats supplemented with EGCG compared with aged animals. Histology and histomorphometry study of aged animals treated with EGCG showed marked increases in the diameter and volume of cardiomyocytes with concomitant reduction of numerical density when compared with aged animals. Reduced reactive oxygen species (P < 0.001) production with association of increased antioxidant defense system (P < 0.001) in aged hearts supplemented with EGCG when compared with aged animals. TUNEL staining and fibrosis showed a marked increase in apoptotic cell death (P < 0.001) and collagen deposition (P < 0.001) in aged animals treated with EGCG when compared with aged animals. Aged animals treated with EGCG showed a marked increase in protein expression of TGFβ, TNFα, and nuclear factor kappa B (NF-κB) and significant (P < 0.001) alteration in the gene expression of TGFβ, TNFα, NF-κB, α-SMA, and Nrf2 when compared with aged animals. Taken together, it is evident that EGCG may potentially inhibit aging-induced cardiac hypertrophy, fibrosis, and apoptosis, thereby preserving cardiac function. The proposed mechanism would be inhibition of reactive oxygen species–dependent activation of TGFβ1, TNFα, and NF-κB signaling pathway. Hence, the present study suggests that EGCG can be useful to fight against aging-induced cardiac hypertrophy, fibrosis, and apoptosis.
The Idea of Beauty and Its Biases: Critical Notes on the Aesthetics of Plastic Surgery
Authors: Di Stefano Nicola 
Published: October 2017

Summary:
Two biases affect the idea of beauty often embodied in aesthetic surgery. The first one is that the living body is the sum of different parts; the second one claims that beauty results from the sum of beautiful elements. Taken together, these 2 biases explain most of the aesthetic surgery procedures, in which a localized improvement is supposed to impact on the whole body image. In this article, I put into question these 2 problematic assumptions, showing that Western and Eastern aesthetics, on one side, and philosophical reflections, on the other side, support a different conception of beauty. In particular, an alternative idea that opens to authenticity and imperfection and focuses on the living body rather than on the mere anatomical surface is proposed here as a more adequate concept of beauty for aesthetic surgery.
Direct-to-Implant versus Two-Stage Tissue Expander/Implant Reconstruction: 2-Year Risks and Patient-Reported Outcomes from a Prospective, Multicenter Study
Authors: Srinivasa Dhivya R. , Garvey Patrick B. , Qi Ji , Hamill Jennifer B. , Kim Hyungjin M. , Pusic Andrea L. , Kronowitz Steven J. , Wilkins Edwin G. , Butler Charles E. , Clemens Mark W. 
Published: October 2017

Background:
Direct-to-implant breast reconstruction offers time-saving advantages over two-stage techniques. However, use of direct-to-implant reconstruction remains limited, in part, because of concerns over complication rates.
1,2
The authors’ aim was to compare 2-year complications and patient-reported outcomes for direct-to-implant versus tissue expander/implant reconstruction.

Methods:
Patients undergoing immediate direct-to-implant or tissue expander/implant reconstruction were enrolled in the Mastectomy Reconstruction Outcomes Consortium, an 11-center prospective cohort study. Complications and patient-reported outcomes (using the BREAST-Q questionnaire) were evaluated. Outcomes were compared using mixed-effects regression models, adjusting for demographic and clinical characteristics.

Results:
Of 1427 patients, 99 underwent direct-to-implant reconstruction and 1328 underwent tissue expander/implant reconstruction. Two years after reconstruction and controlling for covariates, direct-to-implant and tissue expander/implant reconstruction patients did not show statistically significant differences in any complications, including infection. Multivariable analyses found no significant differences between the two groups in patient-reported outcomes, with the exception of sexual well-being, where direct-to-implant patients fared better than the tissue expander/implant cohort (p = 0.047).

Conclusions:
This prospective, multi-institutional study showed no statistically significant differences between direct-to-implant and tissue expander/implant reconstruction, in either complication rates or most patient-reported outcomes at 2 years postoperatively. Direct-to-implant reconstruction appears to be a viable alternative to expander/implant reconstruction. This analysis provides new evidence on which to base reconstructive decisions.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Do Bacteria and Biofilm Play a Role in Double-Capsule Formation around Macrotextured Implants?
Authors: Danino M. Alain , Nizard Nathanaël , Paek Laurence S. , Govshievich Alexander , Giot Jean-Phillipe 
Published: October 2017

Background:
The double capsule is a complication mostly described in aggressive macrotextured implants. Mechanical shear stress applied onto an immature periprosthetic capsule has been linked to their formation. The authors aim to demonstrate the role of bacterial phenotype and biofilm in the development of the double capsule.

Methods:
Seven double capsules formed at the interface of macrotextured breast expander implants were studied using scanning electron microscopy. Two samples for each surface of the inner capsule layer (the prosthesis interface and the intercapsular space) were analyzed for bacteria cell size, bacterial density, and biofilm deposition.

Results:
Although all routine bacterial cultures were negative, the prosthesis interface had both higher bacteria load and biofilm deposition compared with the intercapsular space (Mann-Whitney U test, p = 0.004 and p = 0.008, respectively). Moreover, bacteria cell sizes were significantly smaller at the prosthesis interface in six of seven samples. Comparison of bacteria density and biofilm dispersion showed an increase of biofilm extracellular matrix deposition over 2000 cells/mm2 (linear regression, p = 0.0025). These results indicate a common trend among bacteria species.

Conclusions:
Bacterial expression between the different surfaces of the double capsule displays significant differences; bacteria at the prosthesis interface are mostly in a biofilm state, whereas they demonstrate a planktonic phenotype at the intercapsular space. When a sufficient amount of bacteria are present at a specific location, quorum sensing may trigger a biofilm phenotypic switch in planktonic bacteria cells. Biofilm formation may alter capsule formation through immune response, thereby weakening capsule strength and facilitating extracellular matrix delamination and double-capsule formation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Impact of an Event Reporting System on Resident Complication Reporting in Plastic Surgery Training: Addressing an ACGME and Plastic Surgery Milestone Project Core Competency
Authors: Parikh Rajiv P. , Snyder-Warwick Alison , Naidoo Sybill , Skolnick Gary B. , Patel Kamlesh B. 
Published: October 2017

Background:
The Accreditation Council for Graduate Medical Education and Plastic Surgery Milestone Project has identified practice-based learning and improvement, which involves systematically analyzing current practices and implementing changes, as a core competency in residency education. In surgical care, complication reporting is an essential component of practice-based learning and improvement as complications are analyzed in morbidity and mortality conference for quality improvement. Unfortunately, current methods for capturing a comprehensive profile of complications may significantly underestimate the true occurrence of complications. Therefore, the objectives of this study are to evaluate an intervention for complication reporting and compare this to current practice, in a plastic surgery training program.

Methods:
This is a preintervention and postintervention study evaluating resident reporting of complications on a plastic surgery service. The intervention was an online event reporting system developed by department leadership and patient safety experts. The cohorts consisted of all patients undergoing surgery during two separate 3-month blocks bridged by an implementation period. A trained reviewer recorded complications, and this served as the reference standard. Fisher’s exact test was used for binary comparisons.

Results:
There were 32 complications detected in 219 patients from June to August of 2015 and 35 complications in 202 patients from October to December of 2015. The proportion of complications reported in the preintervention group was nine of 32 (28.1 percent). After the intervention, this significantly increased to 32 of 35 (91.4 percent) (p < 0.001).

Conclusion:
An intervention using an event reporting system, supported by departmental leadership, led to significant improvements in complication reporting by plastic surgery residents.
Lymphatic Territories (Lymphosomes) in the Rat: An Anatomical Study for Future Lymphatic Research
Authors: Suami Hiroo , Scaglioni Mario F. 
Published: October 2017

Background:
Understanding the precise anatomy in experimental animals is crucial for correct design of research projects. Rats are commonly used for scientific research in plastic surgery because of their availability in academic institutions, moderate cost, and sizable vessels for microsurgical procedures. In past publications about rat anatomy, lymphatic mapping has been limited and incomplete. The aim of this study was to comprehensively map the superficial lymphatic system in the rat.

Methods:
Twenty-seven Sprague-Dawley rats were used for this study. Indocyanine green fluorescence lymphography was used to identify the lymphatic vessels and lymph nodes. Under general anaesthesia, indocyanine green was injected intradermally at multiple spots along the dorsal and medial midlines, front and hind paws, ears, and tail. The course of the lymphatic vessels was traced on the skin with a marker pen and photographed. The superficial lymphatic vessels in each rat were sketched on a graphic template and all of the templates were superimposed using graphics software to define the relationship between the lymphatic vessel and sentinel node.

Results:
Indocyanine green fluorescence lymphography was able to demonstrate the superficial lymphatic vessels in the rat. Six groups of regional lymph node/s were identified and lymphatic pathways to those nodes delineated. The authors’ lymphosome concept was successfully applied to the rat, with six lymphosomes identified.

Conclusions:
The authors succeeded in performing superficial lymphatic mapping in the rat. The authors’ anatomical findings can provide further information about the lymphatic system in the normal state and promote understanding of pathologic changes generated by surgical manipulation for future studies.
Impact of Patient Subtype and Surgical Variables on Abdominoplasty Outcomes: A 12-Year Massachusetts General Hospital Experience
Authors: Seth Akhil K. , Lin Alex M. , Austen William G. , Gilman Robert H. , Gallico Gregory G. , Colwell Amy S. 
Published: October 2017

Background:
The traditional abdominoplasty is one of the most common surgical procedures performed. This study evaluates the impact of different surgical techniques and clinical patient factors on abdominoplasty outcomes.

Methods:
A retrospective review of consecutive patients undergoing abdominoplasty was performed.

Results:
Seven hundred seventy-nine patients with a mean age of 43.7 years and a body mass index of 27 kg/m2 underwent abdominoplasty. The majority were women (92.9 percent), and massive weight loss was present in 34.8 percent. Abdominoplasty techniques included traditional (59.4 percent), belt lipectomy (17.9 percent), fleur-de-lis (16.4 percent), umbilical float (9.2 percent), and mini-abdominoplasty (2.8 percent). Half of the study population [n = 384 (49.3 percent)] had concurrent surgical procedures. Total complications (23.0 percent) consisted primarily of wound- and scar-related complications (15.3 percent). Approximately 60 percent of patients received heparin chemoprophylaxis, with overall thromboembolic and hematoma rates less than 1 percent. Univariate analysis revealed that massive weight loss (p = 0.04), fleur-de-lis (p = 0.03) or belt lipectomy (p = 0.05) techniques, and concurrent medial thigh lift (p < 0.001) all significantly increased complications. Previous scars, amount of weight loss, operative time, liposuction, and other concurrent procedures did not affect total complications. Male sex (OR, 1.96; p = 0.04), fleur-de-lis technique (OR, 1.71; p = 0.04), and medial thigh lift (OR, 3.3; p < 0.001) were independent risk factors for total postoperative complications.

Conclusion:
This study demonstrates that abdominoplasty alone or in combination with liposuction and aesthetic breast surgery can be performed safely, with an acceptable complication profile.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Eyelid Reconstruction
Authors: Chang Edward I. , Esmaeli Bita , Butler Charles E. 
Published: October 2017

Learning Objectives:
After reading this article, the participant should be able to: 1. Describe eyelid anatomy and demonstrate full understanding of the critical structures and basic principles of eyelid reconstruction. 2. Evaluate individual defects, analyze the missing components, and formulate a reconstructive algorithm. 3. Anticipate potential complications and design effective strategies to manage and treat common complications following eyelid reconstruction.

Summary:
Defects of the eyelid can result from trauma, burns, or resection of cutaneous malignancies. Repair of eyelid defects presents unique challenges to reconstructive surgeons. A fundamental understanding of eyelid anatomy and familiarity with the myriad of options for reconstruction are critical for achieving optimal outcomes. Under ideal circumstances, the aims of reconstruction should be to restore form and function and to replace “like with like.”
Reducing and Sustaining Duplicate Medical Record Creation by Usability Testing and System Redesign
Authors: Khunlertkit Adjhaporn , Dorissaint Leonard , Chen Allen , Paine Lori , Pronovost Peter J. 
Published: October 2017

Objectives
Duplicate medical record creation is a common and consequential health care systems error often caused by poor search system usability and inappropriate user training.

Methods
We conducted two phases of scenario-based usability testing with patient registrars working in areas at risk of generating duplicate medical records. Phase 1 evaluated the existing search system, which led to system redesigns. Phase 2 tested the redesigned system to mitigate potential errors before health system-wide implementation. To evaluate system effectiveness, we compared the monthly potential duplicate medical record rates for preimplementation and postimplementation months.

Results
The existing system could not effectively handle a misspelling, which led to failed search and duplicate medical record creation. Using the existing system, 96% of registrars found commonly spelled patient names whereas only 69% successfully found complicated names. Registrars lacked knowledge and usage of a phonetic matching function to assist in misspelling. The new system consistently captured the correct patient regardless of misspelling, but search returned more potential matches, resulting in, on average, 4 seconds longer to select common names. Potential monthly duplicate medical record rate reduced by 38%, from 4% to 2.3% after implementation of the new system, and has sustained at an average of 2.5% for 2 years.

Conclusions
Usability testing was an effective method to reveal problems and aid system redesign to deliver a more user friendly system, hence reducing the potential for medical record duplication. Greater standards for usability would ensure that these improvements can be realized before rather than after exposing patients to risks.
Effective Prostate-Specific Membrane Antigen–Based 18F-DCFPyL–Guided Cryoablation of a Single Positive Site in a Patient Believed to Be More Metastatic on 11C-Choline PET/CT
Authors: Cornelis Francois H. , Durack Jeremy C. , Morris Michael J. , Scher Howard I. , Solomon Stephen B. 
Published: October 2017

Abstract
PET/CT-guided interventions using specific radiotracers are promising for detecting avid lesions not well visualized with other imaging methods. A 72-year-old man who initially presented with prostate cancer Gleason 5 + 4 (prostate-specific antigen [PSA] = 7.9 ng/mL) underwent radical prostatectomy and node dissection. Three years after radiation, a rising PSA was observed over 6 months with PSA level reaching 1.08 ng/mL. He was evaluated with prostate-specific membrane antigen–based (PSMA) 18F-DCFPyL PET/CT, conventional CT, 18F-FDG PET/CT, and 11C-choline PET/CT. The PSMA 18F-DCFPyL PET/CT successfully targeted oligometastatic prostate cancer, whereas the other imaging studies were not correct in assessing disease extent.
Unusual Uptake of 131I in a Cutaneous Benign Fibrous Histiocytoma in a Patient With Thyroid Cancer
Authors: Zhou Huijun , Yan Jiaqi , Huang Rui , Li Lin 
Published: October 2017

Abstract
A 52-year-old man with papillary thyroid cancer underwent total thyroidectomy and subsequent 131I remnant ablation. The postablation whole-body radioiodine scanning showed an unexpected focus on the upper right arm. SPECT/CT found that the abnormal focus of radioactivity was from body surface. Histopathology confirmed the diagnosis of benign fibrous histiocytoma.