bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postbariatric Brachioplasty with Posteromedial Scar: Physical Model, Technical Refinements, and Clinical Outcomes
Authors: Simone Pierfranco , Carusi Carlo , Segreto Francesco , Iannuzzi Riccardo , Buscaglione Silvia , Gizzi Alessio , Giannitelli Sara , Rainer Alberto , Filippi Simonetta , Persichetti Paolo 
Published: January 2018

Background:
Brachioplasty is an increasingly performed procedure following massive weight loss. A visible scar is the main hindrance to this surgery. The aims of the study were to develop a physical model to investigate the ideal location of the surgical incision and to present the authors’ technical refinements with the posteromedial scar approach.

Methods:
Twenty-four postbariatric patients underwent brachioplasty with posteromedial scar placement, concomitant liposuction, fascial plication, and axillary Z-plasty. Skin specimens were tested and a physical model of the arm was set up to investigate the difference in mechanical stress on the posteromedial and medial scars. The validated Patient and Observer Scar Assessment Scale, the Vancouver Scar Scale, and a questionnaire assessing subjective improvements were administered to patients. Preoperative and postoperative photographs were assessed by three independent plastic surgeons.

Results:
The physical model showed that stress intensity and distribution along the scar were reduced in the posteromedial location, with smaller scar displacement in the loading simulations. Twenty-three patients healed uneventfully. One (4.1 percent) had a 2-cm dehiscence. Mean Patient and Observer Scar Assessment Scale scores were, respectively, 2 ± 0.76 and 2.13 ± 0.64 in the patients’ and observers’ questionnaires. The mean Vancouver Scar Scale value was 3.5 ± 1.7. Questionnaires assessing the subjective outcomes showed a mean value of 3.45 ± 0.63 of 4. The surgeons’ assessment resulted in a score of 4.5 ± 0.4 of 5.

Conclusions:
The physical model demonstrated that the posteromedial scar was subjected to lower mechanical stress and displacement. The reported technical refinements allowed pleasant arm recontouring to be achieved with acceptable scarring and a low incidence of complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Keystone: Consistency in Restoring the Aesthetic Dorsum in Rhinoplasty
Authors: Afrooz Paul N. , Rohrich Rod J. 
Published: January 2018

Summary:
The keystone represents the union of six distinct anatomical structures between the bony vault and the cartilaginous midvault. In reshaping the nasal dorsum, the individual components of the nose respond variably as the fusion points of the keystone are released. In restoring the nasal dorsum, meticulous effort is made to equalize the width between the bony vault and the cartilaginous midvault. Techniques used for width equalization will yield gratifying long-term results and avoid common pitfalls such as the inverted-V deformity.
Gynecological Lymphoma: A Case Series and Review of the Literature
Authors: Slonimsky Einat , Korach Jacob , Perri Tamar , Davidson Tima , Apter Sara , Inbar Yael 
Published: January 2018

Objective
The aim of the study was to evaluate the radiological characteristics of gynecological lymphoproliferative disease (LPD) and specific imaging features that may suggest the diagnosis.

Methods
Two readers conducted a retrospective evaluation of imaging studies of 13 female patients presenting with a gynecological LPD. A literature review was also performed.

Results
Of the 13 evaluated women, 9 had ovarian involvement, 3 had cervical involvement, and 1 had uterine involvement. The most common lesion characteristics were homogenous masses (11), with mild contrast enhancement (9), followed by soft-tissue necrosis (4), prominent blood vessels displaced by the lesions (4), linear arrangement of cysts at the periphery of the ovaries (3), and “touching” ovaries in all cases of bilateral ovarian involvement.

Conclusions
A solid large homogeneous mass with mild contrast enhancement should alert the radiologist to the possibility of the differential diagnosis of LPD. Radiologists should be “the gatekeepers” by raising this possibility to avoid unnecessary surgery and enable appropriate treatment.
Dependence of Scan Parameters on Nerve Fiber Crossing Depiction in Diffusion Spectrum Imaging in Clinical Practice
Authors: Tang Minghui , Oshinomi Kazuya , Ishizaka Kinya , Tha Khin Khin , Yamamoto Toru 
Published: January 2018

Objective
The objective of this study was to show the effect of the number of sampling points (NS) and the maximum b value (b
max) on fiber crossing detection in diffusion spectrum imaging (DSI) in clinical practice.

Methods
We performed 3-Tesla DSI in which we changed the NS (62–258) while keeping b
max at 8000 s/mm2 and in which we changed the b
max (4000–8000 s/mm2) while keeping the NS at 129. The superior longitudinal fasciculus volume and the proportion of nerve voxels in which at least 2 (Rcr2) or 3 (Rcr3) nerve fiber bundles crossed were calculated.

Results
When b
max was set to 8000 s/mm2, mean Rcr2 and Rcr3 values and superior longitudinal fasciculus volumes significantly increased with higher NSs, but they did not significantly change when we varied b
max with 129 NS.

Conclusions
Depiction sensitivity of nerve fiber crossing in DSI improves at higher NS and b
max settings, but a b
max insensitivity appears at an intermediate NS such as 129.
Maximizing geographical efficiency: An analysis of the configuration of Colorado's trauma system
Authors: Jansen Jan O. , Moore Ernest E. , Wang Handing , Morrison Jonathan J. , Hutchison James D. , Campbell Marion K. , Sauaia Angela 
Published: January 2018

BACKGROUND
Trauma center designation in excess of need risks dilution of experience, reduction in research and training opportunities, and increased costs. The objective of this study was to evaluate the use of a novel data-driven approach (whole-system mathematical modeling of patient flow) to compare the configuration of an existing trauma system with a mathematically optimized design, using the State of Colorado as a case study.

METHODS
Geographical network analysis and multiobjective optimization, 105,448 patients injured in the State of Colorado between 2009 and 2013, who met the criteria for inclusion in the state-mandated trauma registry maintained by the Colorado Department of Public Health and Environment were included. We used the Nondominant Sorting Genetic Algorithm II to conduct a multiobjective optimization of possible trauma system configurations, with the objectives of minimizing total system access time, and the number of casualties who could not reach the desired level of care.

RESULTS
Modeling suggested that system configurations with high-volume Level I trauma centers could be mathematically optimized with two centers rather than the current three (with an estimated annual volume of 970–1,020 and 715–722 severely injured patients per year), four to five Level II centers, and 12 to 13 Level III centers. Configurations with moderate volume Level I centers could be optimized with three such centers (with estimated institutional volumes of 439–502, 699–947, and 520–726 severely injured patients per year), two to five Level II centers, and eight to ten Level III centers.

CONCLUSION
The modeling suggested that the configuration of Colorado’s trauma system could be mathematically optimized with fewer trauma centers than currently designated. Consideration should be given to the role of optimization modeling to inform decisions about the ongoing efficiency of trauma systems. However, modeling on its own cannot guarantee improved patient outcome; thus, the use of model results for decision making should take into account wider contextual information.

LEVEL OF EVIDENCE
Epidemiological, Level IV.
Intraoperative combination of resuscitative endovascular balloon occlusion of the aorta and a median sternotomy in hemodynamically unstable patients with penetrating chest trauma: Is this feasible?
Authors: Ordoñez Carlos A. , Parra Michael W. , Manzano-Nunez Ramiro , Herrera-Escobar Juan P. , Serna Jose J. , Rodriguez Ossa Paola , Mejia David , Del Valle Ana M. , Salcedo Alexander , Salamea Juan C. , Rodriguez Fernando 
Published: January 2018

BACKGROUND
Recent evidence suggests that resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective life-saving intervention in patients with severe torso trauma. However, the deployment of REBOA in patients with isolated penetrating intrathoracic injuries remains controversial. We propose that a median sternotomy be performed in conjunction with REBOA as a feasible and effective means of hemorrhage control in patients suffering from penetrating chest trauma who present hemodynamically unstable. The objective of our study was to present our initial experience with this approach.

METHODS
A prospectively collected case series of the use of REBOA (10 Fr) in conjunction with a median sternotomy from January 2015 to December 2016 at a Level I Trauma Center. We included hemodynamically unstable non-compressible torso hemorrhage patients with penetrating chest trauma who underwent intraoperative REBOA deployment plus median sternotomy.

RESULTS
A total of 68 trauma-related emergent thoracic surgeries were performed at our institution during the study period. Of these, seven suffered from penetrating chest trauma and non-compressible torso hemorrhage and underwent REBOA plus median sternotomy. Six out of the seven patients suffered intrathoracic vascular injuries: two subclavian arteries, two internal mammary arteries, two aortic arch, and five major central venous injuries. Four patients had an associated lung injury with AIS >3, of which two suffered a pulmonary hilar vessel disruption. REBOA-related complications included one case of upper gastrointestinal bleeding. Six out of the seven patients survived the 30-day follow-up. No adverse neurologic outcomes or deficits were observed in survivors.

CONCLUSION
The combined use of REBOA and median sternotomy could be a feasible and effective alternative to hemorrhage control in patients with non-compressible torso hemorrhage secondary to penetrating chest trauma. These findings challenge the recommendation against the use of REBOA in penetrating intrathoracic injuries. Future studies with stronger designs and larger sample sizes are required to confirm our results.

LEVEL OF EVIDENCE
Therapeutic, level V.
Avoiding Cribari gridlock: The standardized triage assessment tool improves the accuracy of the Cribari matrix method in identifying potential overtriage and undertriage
Authors: Roden-Foreman Jacob W. , Rapier Nakia R. , Yelverton Luanna , Foreman Michael L. 
Published: January 2018

BACKGROUND
The Cribari matrix method (CMM) is the standard to identify potential overtriage and undertriage but requires case reviews to correct for the fact that Injury Severity Score does not account for physiology or comorbidities, nor is it well correlated with resource consumption. Further, the secondary reviews introduce undesirable subjectivity. This study assessed if the Standardized Triage Assessment Tool (STAT)—a combination of the CMM and the Need For Trauma Intervention—could more accurately determine overtriage and undertriage than the CMM alone.

METHODS
The registry of an American College of Surgeons verified Level I adult trauma center in Texas was queried for all new emergency department traumas 2013 to 2016 (n = 11,110). Binary logistic regressions were used to test the associations between the triage determinations of each metric against indicators of injury severity (risk factors, complications, and mortality) and resource consumption (number of procedures in 3 days and total length of stay).

RESULTS
Both metrics were associated with the indicators of injury severity and resource consumption in the expected directions, but STAT had stronger or equivalent associations with all variables tested. Using the CMM, there was 50.4% overtriage and 9.1% undertriage. Using STAT, overtriage was reduced to 30.8% (relative reduction = 38.9%) and undertriage was reduced to 3.3% (relative reduction = 63.7%).

CONCLUSION
Using the CMM with secondary case reviews makes valid multi-institutional triage rate comparisons impossible because of the subjective and unstandardized nature of these reviews. STAT’s out-of-box triage determinations (i.e., without manual case review) outperformed CMM in almost every tested variable for both over- and undertriage. STAT, an automatic, standardized method offers significant improvements compared to the current subjective system. Further, by accounting for both anatomic injury severity and resource consumption, STAT may allow trauma centers to better allocate resources and predict patient needs with fewer cases requiring manual review.

LEVEL OF EVIDENCE
Prognostic, level III.
Cell adhesion and fluid flow jointly initiate genotype spatial distribution in biofilms
Authors: Martínez-García Ricardo , Nadell Carey D. , Hartmann Raimo , Drescher Knut , Bonachela Juan A. 
Published: January 2018

AbstractBiofilms are microbial collectives that occupy a diverse array of surfaces. The function and evolution of biofilms are strongly influenced by the spatial arrangement of different strains and species within them, but how spatiotemporal distributions of different genotypes in biofilm populations originate is still underexplored. Here, we study the origins of biofilm genetic structure by combining model development, numerical simulations, and microfluidic experiments using the human pathogenVibrio cholerae. Using spatial correlation functions to quantify the differences between emergent cell lineage segregation patterns, we find that strong adhesion often, but not always, maximizes the size of clonal cell clusters on flat surfaces. Counterintuitively, our model predicts that, under some conditions, investing in adhesion can reduce rather than increase clonal group size. Our results emphasize that a complex interaction of fluid flow and cell adhesiveness can underlie emergent patterns of biofilm genetic structure. This structure, in turn, has an outsize influence on how biofilm-dwelling populations function and evolve.Author summaryBiofilms are bacterial groups, often attached to surfaces, in which a broad variety of cooperative and competitive interactions typically occur. The spatial organization of different strains and species within biofilm communities strongly influences their global functioning, but little is known about how such structure arises. Combining experiments onV. choleraeand simulations of a cellular automaton, we show that the complex interaction between bacterial traits (cell adhesion) and environmental factors (fluid flow intensity) strongly influences the early origins of biofilm spatial structure. In most cases, we found that highly-adhesive strains form larger clusters than the weakly-adhesive ones. Against intuition, however, we also found the opposite outcome: weakly-adhesive tend to form larger clusters than the highly adhesive ones when flows are weak or the population density of colonizing cells is high.
The Specificity of IQGAP1 Toward the PI3K-Akt Pathway is Dependent on the IQ3 motif
Authors: Chen Mo , Wen Tianmu , Choi Suyong , Thapa Narendra , Jung Oisun , Lambert Paul F. , Rapraeger Alan C. , Anderson Richard A. 
Published: January 2018

AbstractEpidermal growth factor receptor (EGFR) and its downstream phosphatidylinositol 3-kinase (PI3K) pathway are commonly deregulated in many cancers including head and neck cancer (HNC). Recently, we have shown that the IQ motif-containing GTPase-activating protein 1 (IQGAP1) provides a molecular platform to scaffold all the components from the PI3K-Akt pathway and results in the sequential generation of phosphatidylinositol-3,4,5-triphosphate (PI3,4,5P3). This makes the IQGAP1-PI3K scaffold a promising therapeutic target. In addition to the PI3K-Akt pathway, IQGAP1 also scaffolds the Ras-ERK pathway. To identify an IQGAP1 mutant that specifically loses IQGAP1-PI3K signaling but not other functions, we have focused on the IQ3 motif since this region binds with both the PIPK1α and PI3K enzymes and a short peptide derived from this sequence blocks binding and PI3K signaling. An IQ3 deletion mutant (ΔIQ3) in IQGAP1 was functionally compared with wild-type (WT) IQGAP1. We found that the IQ3 domain specifically mediates the PI3K-Akt pathway but does not regulate the Ras-ERK pathway. The IQ3 deletion mutant lost interactions with PI3K-Akt components but retained its binding of ERK pathway components and cell surface receptors, EGFR and integrins. In addition, the IQ3 deletion mutant lost regulation of cell migration. Consistently, the IQ3 motif derived peptide blocked Akt activation and led to the blockage of invasion mediated by EGFR organized into an integrin complex by syndecan-4. Taken together, this work has defined the IQGAP1 IQ3 motif as a specific target sequence for the scaffolding of the PI3K-AKT pathway.
Coordinated downregulation of the photosynthetic apparatus as a protective mechanism against UV exposure in the diatomCorethron hystrix
Authors: Read Robert W. , Vuono David C. , Neveux Iva , Staub Carl , Grzymski Joseph J. 
Published: January 2018

AbstractThe effect of ultraviolet radiation (UVR) on photosynthetic efficiency and the resulting mechanisms against UV exposure employed by phytoplankton are not completely understood. To address this knowledge gap, we developed a novel close-coupled, wavelength-configurable platform designed to produce precise and repeatablein vitroirradiation ofCorethron hystrix, a member of a genera found abundantly in the Southern Ocean where UV exposure is high. We aimed to determine its metabolic, protective, mutative, and repair mechanisms as a function of varying levels of specific electromagnetic energy. Our results show that the physiological responses to each energy level of UV have a negative linear decrease in the photosynthetic efficiency of photosystem II proportional to UV intensity, corresponding to a large increase in the turnover time of quinone re-oxidation. Gene expression changes of photosystem II related reaction center proteins D1, CP43 and CP47 showed coordinated downregulation whereas the central metabolic pathway demonstrated mixed expression of up and downregulated transcripts after UVR exposure. These results suggest that while UVR may damage photosynthetic machinery, oxidative damage may limit production of new photosynthetic and electron transport complexes as a result of UVR exposure.
Representation of real-world event schemas during narrative perception
Authors: Baldassano Christopher , Hasson Uri , Norman Kenneth A. 
Published: January 2018

AbstractUnderstanding movies and stories requires maintaining a high-level situation model that abstracts away from perceptual details to describe the location, characters, actions, and causal relationships of the currently unfolding event. These models are built not only from information present in the current narrative, but also from prior knowledge about schematic event scripts, which describe typical event sequences encountered throughout a lifetime. We analyzed fMRI data from 44 human subjects presented with sixteen three-minute stories, consisting of four schematic events drawn from two different scripts (eating at a restaurant or going through the airport). Aside from this shared script structure, the stories varied widely in terms of their characters and storylines, and were presented in two highly dissimilar formats (audiovisual clips or spoken narration). One group was presented with the stories in an intact temporal sequence, while a separate control group was presented with the same events in scrambled order. Regions including the posterior medial cortex, medial prefrontal cortex (mPFC), and superior frontal gyrus exhibited schematic event patterns that generalized across stories, subjects, and modalities. Patterns in mPFC were also sensitive to overall script structure, with temporally scrambled events evoking weaker schematic representations. Using a Hidden Markov Model, patterns in these regions can predict the script (restaurant vs. airport) of unlabeled data with high accuracy, and can be used to temporally align multiple stories with a shared script. These results extend work on the perception of controlled, artificial schemas in human and animal experiments to naturalistic perception of complex narrative stimuli.Significance StatementIn almost all situations we encounter in our daily lives, we are able to draw on our schematic knowledge about what typically happens in the world to better perceive and mentally represent our ongoing experiences. In contrast to previous studies that investigated schematic cognition using simple, artificial associations, we measured brain activity from subjects watching movies and listening to stories depicting restaurant or airport experiences. Our results reveal a network of brain regions that is sensitive to the shared temporal structure of these naturalistic situations. These regions abstract away from the particular details of each story, activating a representation of the general type of situation being perceived.
A quantitative evaluation of MIRU-VNTR typing against whole-genome sequencing for identifying Mycobacterium tuberculosis transmission: A prospective observational cohort study
Authors: Wyllie David , Davidson Jennifer , Walker Tim , Rathod Preeti , Crook Derrick , Peto Tim , Robinson Esther , Smith Grace , Campbell Colin 
Published: January 2018

SummaryBackgroundMycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat (MIRU-VNTR) typing is widely used in high-income countries for Mycobacterium tuberculosis typing. Whole-genome sequencing (WGS) is known to deliver greater specificity, but no quantitative prospective comparison has yet been undertaken.MethodsWe studied isolates from the English Midlands, sampled consecutively between 1 January 2012 and 31 December 2015. In addition to routinely performed MIRU-VNTR typing, DNA was extracted from liquid cultures and sequenced using Illumina technology. Demographic and epidemiological data were extracted from the Enhanced Tuberculosis Surveillance system maintained by Public Health England. Closely related samples, defined using a threshold of five single nucleotide variants (SNVs), were compared to samples with identical MIRU-VNTR profiles, with shared epidemiological risk factors, and to those with both characteristics.Findings1,999 patients were identified for whom at least one M. tuberculosis isolate had been MIRU-VNTR typed and sequenced. Comparing epidemiological risk factors with close genetic relatedness, only coresidence had a positive predictive value of over 5%. Excluding co-resident individuals, 18.6% of patients with identical MIRU-VNTR profiles were within 5 SNVs. Where patients also shared social risk factors and ethnic group, this rose to 48%. Only 8% of MIRU-VNTR linked pairs in lineage 1 were within 5 SNV, compared to 31% in lineage 4.InterpretationIn the setting studied, MIRU-VNTR typing and epidemiological risk factors are poorly predictive of close genomic relatedness, assessed by SNV. MIRU-VNTR performance varies markedly by lineage.FundingPublic Health England, National Institute of Health Research Oxford Biomedical Research Centre.
Detection of de novo copy number deletions from targeted sequencing of trios
Authors: Fu Jack M. , Leslie Elizabeth J. , Scott Alan F. , Murray Jeffrey C. , Marazita Mary L. , Beaty Terri H. , Scharpf Robert B. , Ruczinski Ingo 
Published: January 2018

AbstractDe novo copy number deletions have been implicated in many diseases, but there is no formal method to date however that identifies de novo deletions in parent-offspring trios from capture-based sequencing platforms. We developed Minimum Distance for Targeted Sequencing (MDTS) to fill this void. MDTS has similar sensitivity (recall), but a much lower false positive rate compared to less specific CNV callers, resulting in a much higher positive predictive value (precision). MDTS also exhibited much better scalability, and is available as open source software at github.com/JMF47/MDTS.