bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Resident Involvement on Postoperative Short-Term Surgical Outcomes in Immediate Breast Reconstruction: A National Surgical Quality Improvement Program Study of 24,005 Patients
Authors: Sebai Mohamad E. , Bello Ricardo J. , Lifchez Scott D. , Cooney Damon S. , Rosson Gedge D. , Cooney Carisa M. 
Published: May 2017

Background:
The association between resident involvement and surgical morbidity in immediate breast reconstruction is not fully elucidated, and prior studies have had conflicting results. The authors studied whether resident involvement in immediate breast reconstruction is associated with the most important short-term outcomes: increased 30-day surgical morbidity, readmission and reoperation rates, operative time, and length of stay.

Methods:
Patients undergoing immediate breast reconstruction were identified in the 2005 to 2012 American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files. The authors used simple and multivariable regression to assess surgical complications and secondary outcomes, stratifying by training level and reconstruction type.

Results:
A total of 24,191 patients underwent immediate breast reconstruction; 17,840 had resident involvement. Thirty-day surgical morbidity was observed in 5.25 percent (95 percent CI, 4.92 to 5.58 percent) of cases with resident involvement and 5.12 percent (95 percent CI, 4.59 to 5.58 percent) of cases without, with no evidence of association between resident involvement and 30-day morbidity (adjusted OR, 0.97; 95 percent CI, 0.85 to 1.11; p = 0.652). Resident involvement was not associated with an increase in complications in implant-based or mixed types of reconstruction, and was associated with lower odds of complications in autologous reconstructions (OR, 0.70; 95 percent CI, 0.53 to 0.91; p = 0.008). It was associated with longer operative times (an average of 24 additional minutes for implant-based and 54 additional minutes for autologous reconstructions; p < 0.001); this was balanced by a shorter length-of-stay for patients undergoing implant-based reconstruction (adjusted OR, 0.88; 95 percent CI, 0.79 to 0.96; p = 0.010).

Conclusion:
In immediate breast reconstruction patients, resident involvement was not associated with increased postoperative surgical morbidity or complications, although operative time was significantly increased with resident involvement across all levels of training.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Predicting Thrombosis Formation in 1-mm-Diameter Arterial Anastomoses with Transit-Time Ultrasound Technology
Authors: Shaughness Gabrielle , Blackburn Collin , Ballestín Alberto , Akelina Yelena , Ascherman Jeffrey A. 
Published: May 2017

Background:
Thrombosis is a common source of failure in anastomoses, flaps, and vascular grafts. Ensuring vessel patency is critical to the success of microvascular procedures. Any tool that can accurately predict the patency of an anastomosis intraoperatively would enable the surgeon to detect and correct flow restrictions while the patient is still in the operating room.

Methods:
The authors used transit-time ultrasound technology in this pilot study to investigate whether a minimal cutoff value for quantitative postoperative blood flow (in milliliters per minute) could be established that would reliably predict sustained vessel patency at 24 hours postoperatively. Surgical end-to-end anastomoses were performed on 56 Sprague-Dawley rat femoral arteries with diameters ranging from 0.6 to 1.2 mm. Postoperative blood volume flow measurements were taken at 20-minute intervals up to 1 hour, and then again at 24 hours, to assess patency.

Results:
Forty-seven anastomoses (83.9 percent ) were patent 24 hours after surgery. Nine anastomoses (16.1 percent ) thrombosed within 24 hours. Based on a receiver operating characteristic curve analysis, the optimal cutoff value for immediate postoperative flow for predicting thrombosis within 24 hours of microvascular anastomosis is 0.21 ml/minute.

Conclusions:
At 20 minutes postoperatively, blood flows greater than 0.30 ml/minute are highly suggestive of patency, and flows less than 0.21 ml/minute are highly suggestive of failure. The authors therefore recommend a minimal cutoff flow value of 0.30 ml/minute for vessels ranging from 0.6 to 1.2 mm in diameter to predict long-term postoperative vascular patency.
Angiosome-Based Allografts: Vascularized Composite Allotransplantation for Tailored Subunit Reconstruction with Volkmann Ischemic Contracture as a Case in Point
Authors: Taylor G. Ian , Sparks David S. , Gascoigne Adam C. , Corlett Russell J. , Ashton Mark W. 
Published: May 2017

Background:
As we enter an age with new approaches to tissue reconstruction, the emphasis on the adage “like for like” has become even more relevant. This study illustrates the potential for several tailored vascularized composite allotransplantation reconstructive techniques and, in particular, for the management of Volkmann contracture.

Methods:
Twenty fresh cadaver dissections and 30 archival lead oxide radiographic studies were examined to (1) identify potential upper limb vascularized composite allotransplantation donor sites (i.e., elbow, forearm, and flexor tendon complex) and (2) demonstrate a “mock transplant” of the vascularized volar forearm allograft for a severe Volkmann ischemia defect. They were designed without skin to reduce antigenicity.

Results:
The elbow joint was supplied within the brachial angiosome and the flexor tendon complex of the flexor digitorum superficialis and flexor digitorum profundus by the superficial palmar arch of the ulnar angiosome. The forearm allograft of flexor muscles, median, ulnar, and anterior interosseous nerves, when harvested on the brachial vessels, was supplied within the radial, ulnar, and anterior interosseous angiosomes but could be based on the ulnar artery alone because of intramuscular connections with the other territories. A mock transplant was performed with a distal-to-proximal dissection of the allograft, facilitating the best and fastest technique.

Conclusions:
This application of the angiosome concept highlights the anatomical feasibility of the volar forearm vascularized composite allotransplantation donor site focusing on a complex subunit problem in the upper limb—severe Volkmann ischemic contracture. It demonstrates the potential use and immunologic advantage of subdivided and modified nonskin variations of vascularized composite allotransplantation in reconstructive transplantation surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
The Effects of Motorcycle Helmet Legislation on Craniomaxillofacial Injuries
Authors: Adams Nicholas S. , Newbury Patrick A. , Eichhorn Mitchell G. , Davis Alan T. , Mann Robert J. , Polley John W. , Girotto John A. 
Published: May 2017

Background:
Motorcycle helmet legislation has been a contentious topic for over a half-century. Benefits of helmet use in motorcycle trauma patients are well documented. In 2012, Michigan repealed its universal motorcycle helmet law in favor of a partial helmet law. The authors describe the early clinical effects on facial injuries throughout Michigan.

Methods:
Retrospective data from the Michigan Trauma Quality Improvement Program trauma database were evaluated. Included were 4643 motorcycle trauma patients presenting to 29 Level I and II trauma centers throughout Michigan 3 years before and after the law repeal (2009 to 2014). Demographics, external cause of injury codes, International Classification of Diseases, Ninth Revision diagnosis codes, and injury details were gathered.

Results:
The proportion of unhelmeted trauma patients increased from 20 percent to 44 percent. Compared with helmeted trauma patients, unhelmeted patients were nearly twice as likely to sustain craniomaxillofacial injuries (relative risk, 1.90), including fractures (relative risk, 2.02) and soft-tissue injuries (relative risk, 1.94). Unhelmeted patients had a lower Glasgow Coma Scale score and higher Injury Severity Scores. Patients presenting after helmet law repeal were more likely to sustain craniomaxillofacial injuries (relative risk, 1.46), including fractures (relative risk, 1.28) and soft-tissue injuries (relative risk, 1.56). No significant differences were observed for age, sex, Injury Severity Score, or Glasgow Coma Scale score (p > 0.05).

Conclusions:
This study highlights the significant negative impact of relaxed motorcycle helmet laws leading to an increase in craniomaxillofacial injuries. The authors urge state and national legislators to reestablish universal motorcycle helmet laws.
The Management of Trigonoscaphocephaly as a Result of Combined Metopic and Sagittal Synostosis
Authors: Dobbs Thomas D. , Salahuddin Omer , Jayamohan Jayaratnam , Richards Peter , Magdum Shailendra , Wall Steven A. , Johnson David 
Published: May 2017

Background:
The combination of sagittal and metopic synostosis is rare, resulting in a scaphocephalic shape, but with an absence of frontal bossing and therefore varying degrees of trigonocephaly and occipital prominence. Treatment is primarily surgical, with a combination of procedures to address both the scaphocephaly and trigonocephaly required involving multiple operations. The authors discuss their experience of treating combined trigonoscaphocephaly in a single-stage procedure and propose a management strategy based on the severity of the presenting deformity.

Methods:
The Oxford Craniofacial Unit database was searched from inception in October of 2004 to August of 2013 to identify all patients with combined sagittal and metopic synostosis. Case notes were then manually searched to identify those patients who had true trigonoscaphocephaly.

Results:
Of 2856 patients in the authors’ database, a total of nine were identified as having had true trigonoscaphocephaly. Seven of these patients underwent a combined single-stage procedure with an average cephalic index of 68.7 percent preoperatively and 80.3 percent postoperatively.

Conclusions:
Management of trigonoscaphocephaly has been traditionally performed by multiple, staged surgical procedures. The authors propose that it can instead be managed in a single surgical procedure, with the choice of procedure determined by the severity of the deformity. If the deformity is mild to moderate with no occipital bullet, a combined fronto-orbital advancement remodeling and subtotal calvarial remodeling can be performed; however, if there is an occipital bullet, the authors propose the combination of fronto-orbital advancement remodeling and total calvarial remodeling performed in one operation with the patient turned from prone to supine intraoperatively.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Anatomy of the Facial Vein: Implications for Plastic, Reconstructive, and Aesthetic Procedures
Authors: Cotofana Sebastian , Steinke Hanno , Schlattau Alexander , Schlager Markus , Sykes Jonathan M. , Roth Malcolm Z. , Gaggl Alexander , Giunta Riccardo E. , Gotkin Robert H. , Schenck Thilo L. 
Published: May 2017

Background:
Anatomical knowledge of the facial vasculature is crucial for successful plastic, reconstructive, and minimally invasive procedures of the face. Whereas the majority of previous investigations focused on facial arteries, the precise course, variability, and relationship with adjacent structures of the facial vein have been widely neglected.

Methods:
Seventy-two fresh frozen human cephalic cadavers (32 male and 40 female cadavers; mean age, 75.2 ± 10.9 years; mean body mass index, 24.2 ± 6.6 kg/m2; 99 percent Caucasian ethnicity) were investigated by means of layer-by-layer anatomical dissection. In addition, 10 cephalic specimens were investigated using contrast agent–enhanced computed tomographic imaging.

Results:
The facial vein displayed a constant course in relation to the adjacent anatomical structures. The vein was identified posterior to the facial artery, anterior to the parotid duct, and deep to the zygomaticus major muscle. The angular vein formed the lateral boundary of the deep medial cheek fat and the premaxillary space, and the medial boundary of the deep lateral cheek fat and the sub–orbicularis oculi fat. The mean distance of the inferior and superior labial veins, of the deep facial vein, and of the angular vein from the inferior orbital margin was 51.6 ± 3.1, 42.6 ± 2.3, 27.4 ± 3.0, and 4.2 ± 0.7 mm, respectively.

Conclusions:
This work provides detailed information on the course of the facial vein in relation to neighboring structures. The presented clinically relevant anatomical observations and descriptions of landmarks will serve as helpful information for plastic, reconstructive, and aesthetic surgeons.
In-Depth Review of Symptoms, Triggers, and Treatment of Occipital Migraine Headaches (Site IV)
Authors: Ascha Mona , Kurlander David E. , Sattar Abdus , Gatherwright James , Guyuron Bahman 
Published: May 2017

Background:
This study reports the surgical technique and efficacy of deactivation of occipital-triggered migraine headaches. In addition, it reports the effect of surgical deactivation of occipital-triggered migraine headaches on migraine triggers and associated symptoms other than pain.

Methods:
One hundred ninety-five patients undergoing surgery for occipital-triggered migraine headaches performed by a single surgeon, and followed for at least 1 year, were analyzed. Median regression adjusted for age, sex, and follow-up time was used to determine postoperative reduction in occipital-specific Migraine Headache Index, which is the product of migraine duration, frequency, and severity. Reduction in migraine-days was also measured. The association between symptom or trigger resolution and occipital-specific Migraine Headache Index reduction was studied by logistic regression. Details of surgical treatment are discussed and complication rates reported.

Results:
Eighty-two percent of patients (n = 160) reported successful surgery at least 12 months postoperatively (mean follow-up, 3.67 years). Eighty-six percent (n = 168) had successful surgery as measured by migraine-days. Fifty-two percent reported complete occipital-triggered migraine headaches elimination. Symptoms resolving with successful surgery beyond headache include being bothered by light and noise, feeling lightheaded, difficulty concentrating, vomiting, blurred/double vision, diarrhea, visual aura, numbness and tingling, speech difficulty, and limb weakness (p < 0.05). Triggers resolving with successful surgery include missed meals; bright sunshine; loud noise; fatigue; certain smells; stress; certain foods; coughing, straining, and bending over; letdown after stress; and weather change (p < 0.05).

Conclusions:
Surgical deactivation of occipital-triggered migraine headaches provides long-lasting migraine relief. Successful site IV surgery is associated with changes in specific symptoms and triggers. This can assist in trigger avoidance and aid occipital-triggered migraine headache trigger-site identification.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Beyond SNP Heritability: Polygenicity and Discoverability of Phenotypes Estimated with a Univariate Gaussian Mixture Model
Authors: Holland Dominic , Frei Oleksandr , Desikan Rahul , Fan Chun-Chieh , Shadrin Alexey A. , Smeland Olav B. , Sundar V. S. , Thompson Paul , Andreassen Ole A. , Dale Anders M. 
Published: May 2017

AbstractEstimating the polygenicity (proportion of causally associated single nucleotide polymorphisms (SNPs)) and discoverability (effect size variance) of causal SNPs for human traits is currently of considerable interest. SNP-heritability is proportional to the product of these quantities. We present a basic model, using detailed linkage disequilibrium structure from an extensive reference panel, to estimate these quantities from genome-wide association studies (GWAS) summary statistics. We apply the model to diverse phenotypes and validate the implementation with simulations. We find model polygenicities ranging from ≃ 2 × 10−5to ≃ 4 × 10−3, with discoverabilities similarly ranging over two orders of magnitude. A power analysis allows us to estimate the proportions of phenotypic variance explained additively by causal SNPs reaching genome-wide significance at current sample sizes, and map out sample sizes required to explain larger portions of additive SNP heritability. The model also allows for estimating residual inflation (or deflation from over-correcting of z-scores), and assessing compatibility of replication and discovery GWAS summary statistics.Author SummaryThere are ~10 million common variants in the genome of humans with European ancestry. For any particular phenotype a number of these variants will have some causal effect. It is of great interest to be able to quantify the number of these causal variants and the strength of their effect on the phenotype.Genome wide association studies (GWAS) produce very noisy summary statistics for the association between subsets of common variants and phenotypes. For any phenotype, these statistics collectively are difficult to interpret, but buried within them is the true landscape of causal effects. In this work, we posit a probability distribution for the causal effects, and assess its validity using simulations. Using a detailed reference panel of ~11 million common variants – among which only a small fraction are likely to be causal, but allowing for non-causal variants to show an association with the phenotype due to correlation with causal variants – we implement an exact procedure for estimating the number of causal variants and their mean strength of association with the phenotype. We find that, across different phenotypes, both these quantities – whose product allows for lower bound estimates of heritability – vary by orders of magnitude.
Overexpression of hypoxia-inducible factor 1 alpha improves immunomodulation by dental mesenchymal stem cells
Authors: Martínez VG. , Ontoria-Oviedo I. , Ricardo CP. , Harding SE. , Sacedón R. , Varas A. , Zapata A. , Sepúlveda P. , Vicente A. 
Published: May 2017

AbstractBackgroundHuman dental mesenchymal stem cells (MSCs) are considered as highly accessible and attractive MSCs for use in regenerative medicine, yet some of their features are not as well characterized as in other MSCs. Hypoxia-preconditioning and hypoxia inducible factor 1 alpha (HIF-1 alpha) overexpression significantly improve MSC therapeutics, but the mechanisms involved are not fully understood. In the present study, we characterize immunomodulatory properties of dental MSCs and determine changes in their ability to modulate adaptive and innate immune populations after HIF-1 alpha overexpression.MethodsHuman dental MSCs were stably transduced with GFP (MSCs) or GFP-HIF-1 alpha lentivirus vectors (HIF-MSCs). Hypoxic-like metabolic profile was confirmed by mitochondrial and glycolysis stress test. Capacity of HIF-MSCs to modulate T cell activation, dendritic cell differentiation, monocyte migration and polarizations towards macrophages and NK cell lytic activity was assessed by a number of functional assays in co-cultures. Expression of relevant factors were determined by PCR analysis and ELISA.ResultsWhile HIF-1 alpha overexpression did not modify inhibition of T cell activation by MSCs, HIF-MSCs impaired dendritic cell differentiation more efficiently. HIF-MSCs induced also higher attraction of monocytes, which differentiate into suppressor macrophages, and exhibited enhanced resistance to NK cell-mediated lysis, which support the improved therapeutic capacity of HIF-MSCs. HIF-MSCs also displayed a pro-angiogenic profile characterized by increased expression ofCXCL12/SDF1andCCL5/RANTESand complete loss ofCXCL10/IP10transcription.ConclusionsImmunomodulation and expression of trophic factors by dental MSCs make them perfect candidates for cell therapy. Overexpression of HIF-1 alpha enhances these features and increases their resistance to allogenic NK cell lysis and, hence, their potentialin vivolifespan. Our results further support the use of HIF-1 alpha-expressing dental MSCs for cell therapy in tissue injury and immune disorders.
Disruption of ankyrin B and caveolin-1 interaction sites alters Na+,K+-ATPase lateral diffusion in HEK293 cell plasma membranes
Authors: Junghans Cornelia , Vukojević Vladana , Tavraz Neslihan N. , Maksimov Eugene G. , Zuschratter Werner , Schmitt Franz-Josef , Friedrich Thomas 
Published: May 2017

AbstractThe Na+,K+-ATPase is a plasma membrane ion transporter of high physiological importance for ion homeostasis and cellular excitability in electrically active tissues. Mutations in the genes coding for Na+,K+-ATPase α-subunit isoforms lead to severe human pathologies including Familial Hemiplegic Migraine type 2 (FHM2), Alternating Hemiplegia of Childhood (AHC), Rapid Dystonia Parkinsonism (RDP) or epilepsy. Many of the reported mutations lead to change- or loss-of-function effects, whereas others do not alter the functional properties, but lead to e.g. reduced protein stability, reduced protein expression or defective plasma membrane targeting. Na+,K+-ATPase frequently assembles with other membrane transporters or cellular matrix proteins in specialized plasma membrane microdomains, but the effects of these interactions on targeting or protein mobility are elusive so far. Mutational disruption of established interaction motifs of the Na+,K+-ATPase with ankyrin B and caveolin-1 are expected to result in changes in plasma membrane targeting, changes of the localization pattern, and of the diffusion behavior of the enzyme. We studied the consequences of mutations in these binding sites by monitoring diffusion of eGFP-labeled Na+,K+-ATPase constructs in the plasma membrane of living HEK293T cells by fluorescence correlation spectroscopy (FCS) as well as fluorescence recovery after photobleaching (FRAP) or photoswitching (FRAS) and observed significant differences compared to the wild-type enzyme, with synergistic effects for combinations of interaction site mutations. These measurements expand the possibilities to study the consequences of Na+,K+-ATPase mutations and provide information about the interaction of Na+,K+-ATPase α2-isoform with cellular matrix proteins, the cytoskeleton or other membrane protein complexes.
A Feedback Motif that Breaks the Fundamental Limit on Noise Suppression to Stabilize Fate
Authors: Wen Winnie Y. , Ingerman Elena , Hansen Maike M. K. , Razooky Brandon S. , Dar Roy D. , Chin Charles , Simpson Michael , Weinberger Leor S. 
Published: May 2017

ABSTRACTDiverse biological systems utilize gene-expression fluctuations (‘noise’) to drive lineage-commitment decisions1-5. However, once a commitment is made, noise becomes detrimental to reliable function6,7and the mechanisms enabling post-commitment noise suppression are unclear. We used time-lapse imaging and mathematical modeling, and found that, after a noise-driven event, human immunodeficiency virus (HIV) strongly attenuated expression noise through a non-transcriptional negative-feedback circuit. Feedback is established by serial generation of RNAs from post-transcriptional splicing, creating a precursor-product relationship where proteins generated from spliced mRNAs auto-deplete their own precursor un-spliced mRNAs. Strikingly, precursor auto-depletion overcomes the theoretical limits on conventional noise suppression—minimizing noise far better than transcriptional auto-repression—and dramatically stabilizes commitment to the active-replication state. This auto-depletion feedback motif may efficiently suppress noise in other systems ranging from detained introns to non-sense mediated decay.