Analysis of T1 Bladder Cancer on Biopsy and Transurethral Resection Specimens: Comparison and Ranking of T1 Quantification Approaches to Predict Progression to Muscularis Propria Invasion

Urothelial carcinoma of the bladder invasive into lamina propria on biopsy or transurethral resection of bladder tumor, termed "T1" disease, progresses to muscularis propria invasion in a subset of patients. Prior studies have proposed histopathologic metrics to predict progression, although methods vary widely and it is unclear which method is most robust. This poses a challenge since recent World Health Organization and American Joint Commission on Cancer editions encourage some attempt to substratify T1 disease. To address this critical problem, we analyzed T1 specimens to test which T1 quantification method is best to predict progression and to then establish the optimal cut-off. Progression was analyzed for all patients or for patients with definitive muscularis propria only. Multivariate analysis and outcomes modeling controlled for additional histopathologic features. Our results suggest that aggregate linear length of invasive carcinoma (ALLICA) measured by optical micrometer is far superior to other methods (P=3.067×10−6) and could be applied to 100% of specimens. ALLICA retained significance in multivariate analysis and eliminated contribution of other histopathologic features to progression. The best cut-off for ALLICA using a 30% false-positive threshold was 2.3 mm and using a 10% false-positive threshold at 25 mm, although the latter severely limited patients who could achieve this threshold. After comparison of all proposed methods of T1 quantification, we recommend the adoption of the ALLICA measurement and a cut-off of ≥2.3 mm as the best predictor of progression, acknowledging that additional nonhistopathologic methods may be required to increase broad applicability and further reduce the false-positive threshold. M.Z.L. and D.S. contributed equally. Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Donna E. Hansel, MD, PhD, 9500 Gilman Drive, MC 0612, La Jolla, CA 92093 (e-mail: dhansel@ucsd.edu). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Molecular Profiling of Mammary Analog Secretory Carcinoma Revealed a Subset of Tumors Harboring a Novel ETV6-RET Translocation: Report of 10 Cases

ETV6 gene abnormalities are well described in tumor pathology. Many fusion partners of ETV6 have been reported in a variety of epithelial, mesenchymal, and hematological malignancies. In salivary gland tumor pathology, however, the ETV6-NTRK3 translocation is specific for (mammary analog) secretory carcinoma, and has not been documented in any other salivary tumor type. The present study comprised a clinical, histologic, and molecular analysis of 10 cases of secretory carcinoma, with typical morphology and immunoprofile harboring a novel ETV6-RET translocation. Conflicts of Interest and Source of Funding: Supported in parts by the National Sustainability Program I (NPU I) Nr. LO1503 and by the grant SVV–2017 No. 260 391 provided by the Ministry of Education Youth and Sports of the Czech Republic. The NGS analysis was in part supported by Ignyta Inc., San Diego, CA. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Alena Skalova, MD, PhD, Sikl's Department of Pathology, Medical Faculty of Charles University, Faculty Hospital, E. Benese 13, Plzen 305 99, Czech Republic (e-mail: skalova@fnplzen.cz). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Clear Cell Carcinoma of Salivary Glands is Frequently p16 Positive: A Pitfall in the Interpretation of Oropharyngeal Biopsies

Clear cell carcinoma (CCC) is a low-grade malignancy that commonly arises in minor salivary glands of the oropharynx and other sites. EWSR1-ATF1 gene fusions seem to be specific for this salivary neoplasm. Testing for EWSR1-ATF1 has expanded the histologic spectrum of CCC. As one important example, many CCCs have a predominantly squamous phenotype with few clear cells, a finding that can cause confusion with squamous cell carcinoma (SqCC). P16 immunohistochemical staining to determine human papillomavirus (HPV) status has become standard practice for all oropharyngeal carcinomas showing squamous differentiation. The purpose of this study was to determine whether this practice could contribute to the difficulty in distinguishing CCC from p16-positive SqCC. The authors' surgical pathology archives were searched for cases of CCC. All cases were evaluated with p16 immunohistochemistry, high-risk HPV RNA in situ hybridization (ISH), and EWSR1 gene break-apart fluorescence ISH. Sixteen CCCs were identified. All harbored an EWSR1 rearrangement. Eleven patients were women and 5 were men. They ranged in age from 30 to 85 years (mean, 58 y). The CCCs arose in the oropharynx (tongue base or tonsil) (n=8, 50%), oral cavity (n=4, 25%), and nasopharynx (n=4, 25%). Each case demonstrated clear cells, but the proportion was highly variable (10% to 90%, mean 48%), with 7 of 16 cases having

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Ovarian Microcystic Stromal Tumors are Characterized by Alterations in the Beta-Catenin-APC Pathway and May be an Extracolonic Manifestation of Familial Adenomatous Polyposis

No abstract available

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Loss of BAP1 Expression in Atypical Mesothelial Proliferations Helps to Predict Malignant Mesothelioma

Distinguishing reactive mesothelial proliferation from malignant mesothelioma (MM) can be difficult, particularly on small biopsies. In this scenario, a diagnosis of atypical mesothelial proliferation might be rendered. However, the distinction between a reactive process and MM is important for prognosis and treatment. Recently, loss of BRCA1-associated protein 1 (BAP1) expression and/or homozygous deletion of CDKN2A were identified in some MM, but not in reactive mesothelial proliferations. We studied 34 cases of atypical mesothelial proliferation from our institutional files (1993 to 2016) for BAP1 expression, deletion of CDKN2A, and clinical outcome. Fifteen of 34 patients (44%) were subsequently diagnosed with MM. BAP1 expression was lost in 6 of these 15 (40%) patients. Ten of 15 (67%) patients died of disease within a median time of 18.2 months. BAP1 expression was also lost in 1 case of probable MM. In this case atypical mesothelial proliferation was identified in the pleura during a lobectomy procedure for lung adenocarcinoma. Follow-up of 57.0 months was remarkable for visceral and parietal pleural thickening with continued unilateral effusion identified on imaging studies but no subsequent definitive diagnosis of MM. CDKN2A studies by fluorescence in situ hybridization (performed in 31 cases) found no homozygous deletion of that gene in any case. In conclusion, loss of BAP1 expression in atypical mesothelial proliferation helps to predict MM and is a useful adjunct test in these cases. Homozygous deletion of CDKN2A in mesothelial cell proliferations did not prove to be useful to predict MM in cases of atypical mesothelial proliferation. Presented at the Annual Meeting of the United States and Canadian Academy of Pathology, San Antonio, March 2017, as abstract. Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in any commercial companies pertaining to this article. Correspondence: Anja C. Roden, MD, Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Hilton 11, 200 First St SW, Rochester, MN 55905 (e-mail: roden.anja@mayo.edu). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Olfactory Epithelial Hamartoma: A New Subtype of Sinonasal Hamartoma

Sinonasal epithelial hamartomas occurring in adults are classified as seromucinous hamartoma (SMH) or respiratory epithelial adenomatoid hamartoma (REAH). We describe herein a novel subtype of adult sinonasal hamartoma that contains olfactory epithelium, a histologic feature not previously reported in the literature. Our pathology department database was retrospectively searched for sinonasal hamartomas containing areas of olfactory epithelium. Six relevant cases (3 male and 3 female patients; age, 30 to 77 y) were retrieved, and available pathology slides and clinical and imaging data from patient charts were reviewed. Five of the lesions were unilateral solitary, polypoid, pedunculated masses, 38 to 80 mm in length, lodged in the nasal olfactory cleft. The sixth lesion was associated with bilateral nasal polyposis, and its precise localization was not known. All patients were treated by transnasal endoscopic surgery. None of the 3 patients who had received adequate follow-up evaluation exhibited recurrence. Histologically, all lesions resembled SMH or REAH, with areas of olfactory epithelium comprising olfactory receptors and sustentacular and basal cells. Olfactory epithelium was observed at the lesion surface or in invaginated gland-like structures, and it contained focal aggregates of filamentous cell processes. Some olfactory receptor cells or cell processes were also present in the seromucinous gland component of lesions. Olfactory receptor cells expressed CD56 (neural cell adhesion molecule), and the filamentous aggregates contained CD56, neurofilaments, and synaptophysin. Aside from SMH and REAH, we have described a third subtype of adult sinonasal hamartoma—olfactory epithelial hamartoma—which shares the benign character of the other 2. Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Michel Wassef, MD, Department of Pathology, Lariboisière Hospital, 2 rue Ambroise Paré, Cedex 10, Paris 75475, France (e-mail: michel.wassef@aphp.fr). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The Role of Molecular Testing in the Differential Diagnosis of Salivary Gland Carcinomas

Salivary gland neoplasms are a morphologically heterogenous group of lesions that are often diagnostically challenging. In recent years, considerable progress in salivary gland taxonomy has been reached by the discovery of tumor type-specific fusion oncogenes generated by chromosome translocations. This review describes the clinicopathologic features of a selected group of salivary gland carcinomas with a focus on their distinctive genomic characteristics. Mammary analog secretory carcinoma is a recently described entity characterized by a t(12;15)(p13;q25) translocation resulting in an ETV6-NTRK3 fusion. Hyalinizing clear cell carcinoma is a low-grade tumor with infrequent nodal and distant metastasis, recently shown to harbor an EWSR1-ATF1 gene fusion. The CRTC1-MAML2 fusion gene resulting from a t(11;19)(q21;p13) translocation, is now known to be a feature of both low-grade and high-grade mucoepidermoid carcinomas associated with improved survival. A t(6;9)(q22-23;p23-34) translocation resulting in a MYB-NFIB gene fusion has been identified in the majority of adenoid cystic carcinomas. Polymorphous (low-grade) adenocarcinoma and cribriform adenocarcinoma of (minor) salivary gland origin are related entities with partly differing clinicopathologic and genomic profiles; they are the subject of an ongoing taxonomic debate. Polymorphous (low-grade) adenocarcinomas are characterized by hot spot point E710D mutations in the PRKD1 gene, whereas cribriform adenocarcinoma of (minor) salivary glands origin are characterized by translocations involving the PRKD1-3 genes. Salivary duct carcinoma (SDC) is a high-grade adenocarcinoma with morphologic and molecular features akin to invasive ductal carcinoma of the breast, including HER2 gene amplification, mutations of TP53, PIK3CA, and HRAS and loss or mutation of PTEN. Notably, a recurrent NCOA4-RET fusion has also been found in SDC. A subset of SDC with apocrine morphology is associated with overexpression of androgen receptors. As these genetic aberrations are recurrent they serve as powerful diagnostic tools in salivary gland tumor diagnosis, and therefore also in refinement of salivary gland cancer classification. Moreover, they are promising as prognostic biomarkers and targets of therapy. Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Alena Skálová, MD, PhD, Sikl's Department of Pathology, Faculty of Medicine, Charles University, Faculty Hospital, E. Benese 13, 305 99 Plzen, Czech Republic (e-mail: skalova@fnplzen.cz). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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BCOR-CCNB3 Fusion Positive Sarcomas: A Clinicopathologic and Molecular Analysis of 36 Cases With Comparison to Morphologic Spectrum and Clinical Behavior of Other Round Cell Sarcomas

BCOR-CCNB3 sarcoma (BCS) is a recently defined genetic entity among undifferentiated round cell sarcomas, which was initially classified as and treated similarly to the Ewing sarcoma (ES) family of tumors. In contrast to ES, BCS shows consistent BCOR overexpression, and preliminary evidence suggests that these tumors share morphologic features with other tumors harboring BCOR genetic alterations, including BCOR internal tandem duplication (ITD) and BCOR-MAML3. To further investigate the pathologic features, clinical behavior, and their relationship to other round cell sarcomas, we collected 36 molecularly confirmed BCSs for a detailed histologic and immunohistochemical analysis. Four of the cases were also analyzed by RNA sequencing (RNAseq). An additional case with BCOR overexpression but negative CCNB3 abnormality showed a novel KMT2D-BCOR fusion by targeted RNAseq. The patients ranged in age from 2 to 44 years old (mean and median, 15), with striking male predominance (M:F=31:5). The tumor locations were slightly more common in bone (n=20) than soft tissue (n=14), with rare visceral (kidney, n=2) involvement. Histologically, BCS showed a spectrum of round to spindle cells with variable cellularity, monomorphic nuclei and fine chromatin pattern, delicate capillary network, and varying amounts of myxoid or collagenous stroma. The morphologic features and immunoprofile showed considerable overlap with other round cell sarcomas with BCOR oncogenic upregulation, that is, BCOR-MAML3 and BCOR ITD. Follow-up available in 22 patients showed a 5-year overall survival of 72%, which was relatively similar to ES (79%, P=0.738) and significantly better than CIC-DUX4 sarcomas (43%, P=0.005) control groups. Local recurrences occurred in 6 patients and distant metastases (lung, soft tissue/bone, pancreas) in 4. Seven of 9 cases treated with an ES chemotherapy regimen with evaluable histologic response showed >60% necrosis in posttherapy resections. Unsupervised clustering by RNAseq data revealed that tumors with BCOR genetic alterations, including BCOR-CCNB3, BCOR-MAML3, and BCOR ITD, formed a tight genomic group distinct from ES and CIC-rearranged sarcomas. Conflicts of Interest and Source of Funding: Supported in part by P50 CA140146-01 (C.R.A.), P30 CA008748 (C.R.A.), Kristen Ann Carr Foundation (C.R.A.), and Cycle for Survival (C.R.A.). The remaining authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Cristina R. Antonescu, MD, Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (e-mail: antonesc@mskcc.org). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Characterization of IDH1 p.R132H Mutant Clones Using Mutation-specific Antibody in Myeloid Neoplasms

Isocitrate dehydrogenase 1 (IDH1) and IDH2 mutations occur in a variety of myeloid neoplasms. Immunohistochemistry (IHC)-based direct visualization of mutant clones of hematopoietic cells can be useful for rapid diagnostic screening and for monitoring treatment response. In this study, we first evaluated the sensitivity and specificity of the IDH1 p.R132H mutation-specific antibody by IHC. All IDH1 wild type cases (n=11) and IDH1 mutant cases with a non-p.R132H mutation (n=30) were negative by IHC, demonstrating 100% antibody specificity. All the initial diagnostic specimens with IDH1 p.R132H mutation including acute myeloid leukemia (n=30), myelodysplastic syndromes (MDS) (n=10), MDS/myeloproliferative neoplasms (MPN) (n=4), and MPN (n=5) were positive by IHC, demonstrating 100% antibody sensitivity. Both immature and mature myeloid cells showed immunoreactivity. Erythroid precursors, lymphoid cells, endothelial cells, and osteoblasts were consistently negative by IHC. We then evaluated the follow-up specimens with a known IDH1 mutation status including acute myeloid leukemia (n=23), MDS (n=2), MDS/MPN (n=2), and MPN (n=2). Thirty-three IDH1 p.R132H mutant cases were positive by IHC and 12 IDH1 mutation negative cases were negative by IHC. However, IHC reactivity in up to 25% of bone marrow cells was noted in 8 of 20 polymerase chain reaction-negative cases, all from patients with a known history of IDH1 p.R132H mutation indicating sampling error or a sensitivity issue with molecular tests. These data indicate that IHC is a highly specific and sensitive tool to detect IDH1 p.R132H mutation in bone marrow involved by myeloid neoplasms. In addition, IDH1 p.R132H IHC also allows localization and assessment of the maturation stage of the clones carrying the mutation. K.P.P. and H.K: designed the study and collected the data. H.K., C.E.B.-R., and K.P.P: analyzed the data. H.K., K.P.P., and L.J.M.: wrote the manuscript. Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Keyur P. Patel, MD, PhD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 6565 MD Anderson Blvd. Unit 1062, Houston, TX 77030 (e-mail: kppatel@mdanderson.org). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Recurrent RET Gene Rearrangements in Intraductal Carcinomas of Salivary Gland

Intraductal carcinoma (IC) is the World Health Organization designation for lesions previously called low-grade cribriform cystadenocarcinoma. The relationship of IC to salivary duct carcinoma (SDC) is controversial, but currently these are considered distinct entities. It is hypothesized that IC and SDC should have different genomic signatures that may be identifiable by next-generation sequencing. A total of 23 ICs were identified: 14 pure IC and 9 invasive carcinomas with an intraductal component. Five invasive carcinomas were subjected to next-generation paired-end RNA sequencing. Data analysis was performed using FusionSeq and Mutation detection algorithms (MuTect and VarScan) for variant callers. Gene fusion candidates were validated by fluorescence in situ hybridization and reverse transcription polymerase chain reaction, and mutations by Sanger sequencing. Among the 9 invasive carcinomas, all except 1 were apocrine SDCs with an intraductal component. The remaining case showed typical intercalated duct type IC with invasive adenocarcinoma. The 14 pure ICs had typical intercalated duct features (2 showed hybrid intercalated/apocrine features). RNA sequencing predicted a NCOA4-RET fusion, confirmed by reverse transcription polymerase chain reaction, in the intercalated duct type IC invasive component. Six additional cases of pure IC showed RET rearrangement by fluorescence in situ hybridization (7/15=47%). No apocrine carcinomas showed RET rearrangement. RNA sequencing and Sanger sequencing identified PIK3CA (p.E545K/p.H1047R) and/or HRAS (p.Q61R) hotspot mutations in 6 of 8 (75%) apocrine carcinomas. In conclusion, 2 distinctive types of intraductal lesions are emerging based on molecular analysis. Classic intercalated type ICs commonly harbor fusions involving RET and rarely show widespread invasion. Apocrine intraductal lesions are typically associated with widespread invasion with no pure examples and show similar PIK3CA and HRAS mutations to SDC. Conflicts of Interest and Source of Funding: Supported in part by P01CA47179 (C.R.A.) and P50 CA 140146-01 (C.R.A.). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Ilan Weinreb, MD, Department of Pathology, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada M5N-1N7 (e-mail: ilan.weinreb@uhn.ca). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Melanocytic Myxoid Spindle Cell Tumor With ALK Rearrangement (MMySTAR): Report of 4 Cases of a Nevus Variant With Potential Diagnostic Challenge

Melanocytic tumors rarely display extensive dermal myxoid deposits except in the myxoid variant of melanoma. We describe in 4 patients the unusual association of morphologic and genetic features. All cases occurred in males and were located on the limbs or proximal girdle area. Age at diagnosis ranged from 8 to 47 years. Size ranged from 6 to 11 mm. Microscopic analysis showed compound, but mainly dermal melanocytic nevi, all presenting a deep dermal expansion with fascicules of amelanotic spindled cells floating in a myxoid background. Cytologic atypia and mitotic activity were low. The superficial portion was either of spitzoid or nevoid cytology with a limited junctional component. In the initial case, the dermal myxoid component was predominant with rare, barely visible, superficial melanocytic nests. This peculiar morphology was responsible for a delayed diagnostic, which required an extensive panel of antibodies ruling out most, potentially myxoid, soft tissue tumors. We later observed the presence of similar, but more limited, dermal morphologic features in 3 other cases. Immunohistochemistry in the deep myxoid areas was melanA−, ALK+, SOX10+, and MiTF+. Molecular studies confirmed the ALK rearrangement by an ALK break-apart fluorescence in situ hybridization technique and by RNA sequencing. The latter identified 4 different 5'-fusion partners. Two gene fusions were undescribed: FBXO28(e2)-ALK(e19) and NPAS2(e2)-ALK(e19), and 2 previously described: TPM3(e7)-ALK(e20) and PPFIBP1(e9)-ALK(e19). No relapse or metastatic evolution was seen during follow-up (3 to 24 mo). We denominated this potentially challenging new variant of compound nevus linked to a kinase fusion: Melanocytic Myxoid Spindle Cell Tumor with ALK Rearrangement. Conflicts of Interest and Source of Funding: E.P. gratefully acknowledges the "Bourse McLaughlin du Doyen de la Faculté de médecine de l'Université Laval" and the TEVA Innovation Canada fellowship grants. For the remaining authors none were declared. Correspondence: Arnaud de la Fouchardière, MD, Phd, Departement of Biopathology, Centre Léon Bérard, 28 rue Laennec, Lyon 69008, France (e-mail: arnaud.delafouchardiere@lyon.unicancer.fr). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The Spectrum of Thyroid Gland Pathology in Carney Complex: The Importance of Follicular Carcinoma

The initial description of Carney complex (CNC) in 1985 included myxomas, spotty skin pigmentation, and endocrine overactivity (of the adrenal, the pituitary, and the testis). In 1997, thyroid neoplasms were found in 3 patients with CNC and involvement of the gland in the syndrome was apparent. Herein, we describe the clinical, pathologic, and follow-up findings in 26 patients with CNC and a disorder of the thyroid gland. The patients were predominantly middle-aged women with an asymptomatic thyroid mass. Four patients had hyperthyroidism, which was caused by follicular hyperplasia in 2 patients and by toxic adenoma in 2 others. Pathologic findings included benign lesions (follicular hyperplasia, nodular hyperplasia, and follicular adenoma) in 16 patients and carcinomas (follicular or papillary) in 10 patients. The follicular carcinomas had unusual features, multifocality, bilaterality, and lymph node metastasis. The tumor was fatal in 3 of 4 patients with a tumor ≥3 cm in diameter. One patient had an unusual multifocal microscopic follicular hyperplasia. Detection and treatment of the thyroid neoplasms in patients with CNC requires long-term follow-up of patients with the syndrome. Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: J. Aidan Carney, MD, PhD, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail: carney.aidan@mayo.edu). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Analysis of GNA13 Protein in Follicular Lymphoma and its Association With Poor Prognosis

GNA13 is a G protein involved in modulating tumor proliferative capacity, infiltration, metastasis, and migration. Genomic alteration of GNA13 was frequently observed in follicular lymphoma (FL). In this study, we examined 167 cases of FL by immunostaining of GNA13 using tissue microarray to evaluate the clinical significance. There were 26 GNA13-positive cases (15.6%) and 141 GNA13-negative cases (84.4%). GNA13-positive cases had a higher incidence of early progression of disease for which disease progression was recognized within 2 years compared with GNA13-negative cases (P=0.03). There were no significant differences in other clinicopathologic factors including histological grade, BCL2-IGH translocation, immunohistochemical phenotype, and Follicular Lymphoma International Prognostic Index. In addition, overall survival and progression-free survival were poorer in GNA13-positive cases than in GNA13-negative cases (P=0.009 and 0.005, respectively). In multivariate analysis, GNA13 positivity was found to be a poor prognostic factor for overall survival and progression-free survival. Thus, GNA13 protein expression was an independent prognostic factor and may affect disease progression in FL. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/1hexVwJ Present address: Noriaki Yoshida, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA. J.S., H.M., and N.Y. were responsible for conception and design. T.K., T.S, K.M., Y.I., K. Kato, K.N., and K.A. provided study materials or patients. J.S., H.M., N.Y., T.K., Y.S., D.K., and K. Kawamoto performed collection and assembly of data. J.S., H.M., N.Y., K.S., T.T., M.S., and K.O. performed data analysis and interpretation. J.S. wrote the manuscript. Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Hiroaki Miyoshi, MD, PhD, Department of Pathology, School of Medicine, Kurume University, Kurume, Japan 830-0011 (e-mail: miyoshi_hiroaki@med.kurume-u.ac.jp). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Median Nerve Area Measurements Using Ultrasound: Importance of Proper Technique and Interpretation.

No abstract available

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Complications From Surgically Assisted Rapid Maxillary Expansion With HAAS and HYRAX Expanders.

The current study aimed at comparing the number and type of undesired outcomes during and after the maxillary expansion performed with HYRAX and HAAS expanders. A total of 90 patients (41 males and 49 females, 45.6% and 54.4%, respectively) aged 18 to 59 (mean age of 26.1; standard deviation [SD] = 7.4) underwent subtotal Le Fort I osteotomy and pterygomaxillary disjunction following surgically assisted rapid maxillary expansion (SARME) carried out using HAAS (n = 29; 48.3% male and 51.7% female; mean age = 27: SD = 7.7) and HYRAX (n = 61; 44.3% male and 55.7% female; mean age = 26; SD = 7.2) expanders. Post-SARME dento-gingival, radiographic, and clinical undesired outcomes were evaluated. A total of 16 (17.8%) patients experienced at least 1 undesired outcome-7 (7.8%) and 9 (10.0%) in HAAS and HYRAX group, respectively. The most common undesired outcomes were radiographic asymmetric expansion-2 (2.2%) and 3 (3.3%) in HAAS and HYRAX group, respectively-followed by pain during out-of-clinic expansion 4 (4.4%) in HAAS group only-dental darkening 5 (5.5%) in HYRAX group, only, requiring root canal treatment, and local infection-2 (2.2%), 1 in each HAAS and HYRAX groups. Excepting for complications arising from the acrylic stop plate in HAAS expander, the number and severity of complications observed in the current study did not differ due to the use of HAAS and HYRAX appliances to perform maxillary expansion. Hygiene issues do not rule out the use of HAAS. The wider maxillary expansion performed, the more frequent are the cases of asymmetric expansion. (C) 2017 by Mutaz B. Habal, MD.

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The Impact of Type-D Personality on Oral Health-Related Quality of Life in Cleft Lip and Palate Adolescents.

The purpose of this study was to investigate the oral health-related quality of life and type-D personality in cleft lip/palate (CLP) patients and the relationship between type-D personality and oral health-related quality of life (OHRQoL) in CLP patients. Fifty patients with CLP within age range from 8 to 15 years were chosen and asked to complete both Child Oral Health Impact Profile (COHI) and Type-D scale (DS14) questionnaire. Moreover, the participants of a control group matched with CLP patients were asked to complete the DS14 questionnaire. A significant difference between boys and girls on the subscale "emotional well-being" of COHIP (P = 0.001) and a positive significant correlation between "oral symptoms" and age (P = 0.029) were found among CLP patients. The prevalence of type-D personality was equal between clefts and nonclefts groups. However, there was a significant relationship between type-D personality and OHRQoL in CLP patients regarding mean scores of overall COHIP and its subscales (P

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One-Stage Treatment of Giant Condylar Osteoma: Alloplastic Total Temporomandibular Joint Replacement Aided by Digital Templates.

Objectives: To introduce the surgical techniques and evaluate the effect of alloplastic total temporomandibular joint (TMJ) replacement aided by digital templates in giant condylar osteoma. Methods: Three patients with giant condylar osteoma were enrolled in this study. The maximal mouth opening was 1.9 cm on average. All the patients were underwent the computed tomography scan (slice thickness 1 mm) and the data were imported to Proplan 1.3 software for 3-dimensional bony segmentation and reconstruction. Osteotomy line and digital template according the 3-dimensional measurement were designed. All the joints were replaced with Biomet standard prosthesis under general anesthesia. Results: All the operations were successfully performed. The follow-up period was from 6 to 18 months (average, 12 months). Pain relief of the joint and mouth-opening improvement were significant in 3 patients. No infection or loosening the prostheses was occurred. The occlusal relationship kept stable in all patients. Conclusions: Total TMJ replacement with standard prosthesis is a good strategy for TMJ reconstruction after giant condylar osteoma excision. The joint pain and the mouth-opening limitation resulted from giant condylar osteoma were markedly improved. Long-term effect remains to be evaluated based on a long-term follow-up. (C) 2017 by Mutaz B. Habal, MD.

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A Novel 3-Step Method for Correction of Type 1 Stahl Ear.

Background: Stahl ear, a rare congenital auricular anomaly, occurs when a third crus crosses the scaphoid fossa. Optimal elimination of the third crus and reconstruction the superior crus in type 1 Stahl ear remain undercharacterized. We present a novel 3-step technique to reliably correct a type 1 Stahl ear as a case report. Methods: A 10-year-old male with bilateral prominent type 1 Stahl ears is presented. An anterior curvilinear helical fold incision and posterior V wedge excision was used for exposure. Step 1, the third crus cartilage was excised as a full-thickness wedge and the gap approximated with posteriorly everting horizontal mattress sutures to create a flattened scaphoid fossa. Step 2, the superior crus was created using anteriorly placed horizontal mattress sutures for direct shaping. Step 3, the skin was redraped without excess trimming to minimize the visible scar. Results: The 3-step approach effectively eliminated the third crura and recreated the superior crura of the type 1 Stahl ears, and resulted in minimal visible anterior scarring. Discussion: The anterior approach provided excellent visualization and permitted tactical suture placement. The wedge excisions successfully removed the third crura. The horizontal mattress sutures to flatten the scaphoid fossa, enhance the natural antihelical curves, and form the superior crura were simple and effective. (C) 2017 by Mutaz B. Habal, MD.

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Myoepithelioma of the Soft Palate.

Myoepitheliomas are extremely rare salivary gland tumors. Myoepithelioma of salivary glands comprised only 1% of all salivary tumors, most commonly occurring in the parotid gland followed by the minor salivary glands in the oral cavity. Involvement of the soft palate is a rare occurrence. This tumor is usually benign, and its treatment is total lesion excision. Here, the author reports a case of myoepithelioma of the soft palate in a 42-year-old Turkish man. The mass was removed by local excision under general anesthesia. There was no recurrence during the follow-up period of 10 months. (C) 2017 by Mutaz B. Habal, MD.

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Nasopharyngoscopic Analyses through Anterior Maxillary Distraction Osteogenesis for Adolescent Patients With Cleft Palate.

Anterior maxillary distraction osteogenesis (AMDO) is a novel technique for correcting hypoplastic maxilla by sagittal expansion of the maxilla. Recent reports suggest that AMDO does not have an effect on fragile velopharyngeal function in patients with cleft palate. Furthermore, no studies have evaluated the impact of AMDO on velopharyngeal function. We adopted AMDO to correct severe hypoplastic maxilla in adolescent patients with cleft palate and evaluated its impact on velopharyngeal space and function in 8 patients aged 12 to 21 years who underwent AMDO from 2006 to 2014. All the patients had received treatment for cleft palate; however, they still exhibited marginal velopharyngeal insufficiency. The mean activation of the distractor was 10.9 +/- 0.9 mm. We determined changes in velopharyngeal closure ratio and closure pattern via nasopharyngoscopy. Additionally, skeletal changes were evaluated using lateral cephalograms. The mean horizontal advancement in the cephalogram obtained 1 year after the distraction was +6.4 mm. Nasopharyngoscopic examination revealed that no deterioration of velopharyngeal gap had occurred after AMDO in all 8 patients. The velopharyngeal closure pattern changed from coronal to circular in 1 patient. Our results indicate that AMDO achieved correction of hypoplastic maxilla without deterioration in velopharyngeal gap and function. Therefore, AMDO is an effective and optimal approach for correcting hypoplastic maxilla especially in patients with fragile velopharyngeal function, such as those with cleft palate. (C) 2017 by Mutaz B. Habal, MD.

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Oxygen, Left/Right Asymmetry, and Cleft Lip and Palate.

Cleft lip and palate is the most common craniofacial birth defect, and its etiology has been the focus of many reports in the literature. It is well accepted that both genetics and environment play a role in the condition; however, the authors still have not been able to translate what have been learned into clinical applications. This paper provides an interpretation of 2 possible mechanisms leading to cleft lip and palate in humans. First, the authors reflect on the known association between maternal cigarette smoking and risk for cleft lip and palate and the proposed hypoxic mechanism put forward to explain this association. Second, the authors reflect on the difference in frequency between left and right cleft lip and propose that without more extensive clinical definitions, it will be difficult to definitely unveil genetic targets that can be used for counseling. (C) 2017 by Mutaz B. Habal, MD.

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Accessory Mental Foramen and Maxillofacial Surgery.

Accessory mental foramens should be considered in surgical procedures performed in mandibular body and symphysis. Location and content of these foramina has significant impact on the result of surgery. Lip numbness is the catastrophic result if these foramina are violated while their content is nerves that carry sensory inputs from lower lip. Examples of interferences with dental implant, orthognathic, and periapical surgeries are presented and it is discussed in which conditions they complicate oral surgical procedures. (C) 2017 by Mutaz B. Habal, MD.

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Autogenous Partial Bone Chip Grafting on the Exposed Inferior Alveolar Nerve After Cystic Enucleation.

This prospective study evaluated the clinical effectiveness of the new approach of partial autogenous bone chip grafts for the treatment of mandibular cystic lesions related to the inferior alveolar nerve (IAN). A total of 38 patients treated for mandibular cysts or benign tumors were included in this prospective study and subsequently divided into 3 groups depending on the bone grafting method used: cystic enucleation without a bone graft (group 1), partial bone chip graft covering the exposed IAN (group 2), and autogenous bone graft covering the entire defect (group 3). We evaluated the symptoms, clinical signs, and radiographic changes using dental panorama preoperatively, immediate postoperatively, and at 1, 3, 6, and 12 months postoperatively. Radiographic densities were compared using Adobe Photoshop CS5 (Adobe Systems Inc., San Jose, CA). Repeated measures analysis of variance was used for statistical evaluation with SPSS 22.0 (SPSS Inc, Chicago, IL), and P

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Neuroplastic Surgery.

No abstract available

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Autologous Tissue Graft in Revision Medial Epicanthoplasty Using Subciliary Fat and Orbicularis Oculi Muscle.

The medial epicanthal fold is one of the racial anatomic characteristics of Asians. As medial epicanthoplasty has become one of the most common cosmetic surgeries among Asians, the need for revision of overcorrected medial epicanthus also increased. In revision medial epicanthoplasty, an autologous tissue graft to the subcutaneous plane is used to reduce postoperative scar. Medial epicanthoplasty, using V-Y advancement and rotation flap, was performed in 93 patients (revision medial epicanthoplasty with autologous tissue graft, 60 patients; revision medial epicanthoplasty only, 33 patients). A V-Y and rotation flap was designed to cover the overexposed lacrimal lake. A small amount of fat tissue and orbicularis oculi muscle were harvested from the upper eyelid through the double-fold line and grafted to the subcutaneous space of the medial epicanthal area. We evaluated the patients' satisfaction with the overall outcome and scar. The mean intercanthal distance increased from 32.3 mm before surgery to 34.6 mm after surgery. Satisfaction with the scar and overall outcome was higher in the patient group who underwent medial epicanthoplasty with autologous tissue graft. No complication was observed in the autologous tissue graft group, whereas 1 patient who underwent medial epicanthoplasty without autologous tissue graft showed recurrence of the medial epicanthal fold, 5 months after surgery. Medial epicanthoplasty with autologous tissue graft is a simple and reliable method to repair the overcorrected medial epicanthus that can efficiently increase the intercanthal distance and prevent scar contracture. (C) 2017 by Mutaz B. Habal, MD.

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Proteus Syndrome With a Cranial Intraosseous Lipoma.

Intraosseous lipomas are almost exclusively seen in the long bones. Presence in the craniofacial skeleton is extremely rare. A 7-year-old male is presented with a marked craniofacial deformation from a bony tumor containing an intraosseous lipoma. This finding established a clinical diagnosis of Proteus syndrome. Given the size of the tumor, producing an extensive deformity, three-dimensional modeling was used to generate a three-dimensional printed implant. The process to achieve a successful outcome is herein described. (C) 2017 by Mutaz B. Habal, MD.

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Effects of Sedentary Aging and Lifelong Exercise on Left Ventricular Systolic Function.

Purpose: The current study examined whether age-related changes in left ventricular (LV) longitudinal systolic function is an adaptation to a more sedentary lifestyle and can be preserved by lifelong exercise training. Methods: A cross-sectional examination of 18 sedentary young (37+/-6 years), 29 sedentary seniors (71+/-5 years, 0-3 exercise sessions/wk), and 26 seniors (68+/-5 years) who had performed a committed level (4-7 exercise sessions/wk) of lifelong (>25 years) exercise. Invasive right heart catheterization (pulmonary capillary wedge pressure) and non-invasive measures of LV function were collected at the following conditions: 1) supine rest, 2) during LV unloading (lower body negative pressure), and 3) LV loading (saline infusion). Ejection fraction (EF) and preload-recruitable stroke work (PRSW) were used to describe global LV systolic function, while peak systolic tissue velocity (S') and longitudinal strain (LS) indicate LV longitudinal systolic function. To adjust LS for aging and training-related differences in LV preload and afterload, LV end-diastolic volume and end-systolic pressure (ESP) were included as covariates in ANCOVA models. Results: EF and PRSW were unaffected by aging or lifelong exercise (P=0.22, P=0.08, respectively). S' decreased with aging (P

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Contralateral Repeated Bout Effect of the Knee Flexors.

Purpose: Eccentric exercise of the elbow flexors (EF) confers protective effect against muscle damage of the same exercise performed by the opposite arm at 1, 7 or 28 days later. This is known as the contralateral repeated bout effect (CL-RBE), but it is not known whether CL-RBE is evident for the knee flexors (KF). The present study tested the hypothesis that KF CL-RBE would be observed at 1, 7 and 28 days after the initial bout. Methods: Young untrained men were assigned to a control or one of three experimental groups (n=13/group). The experimental groups performed 60 maximal KF eccentric contractions (60MaxEC) by one leg followed 1 (1d), 7 (7d) or 28 days (28d) by 60MaxEC using the opposite leg. The control group used the non-dominant leg to repeat 60MaxEC separated by 14 days. Changes in several indirect muscle damage markers after 60MaxEC were compared between bouts and among the groups by mixed-design two-way ANOVAs. Results: Changes in maximal voluntary isokinetic concentric contraction torque, range of motion, muscle soreness, and plasma creatine kinase activity after the first 60MaxEC were similar among the groups. These changes were smaller after the second than the first 60MaxEC for the control, 1d and 7d groups, and the changes after the second 60MaxEC were smaller for the control than both 1d and 7d groups (P

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Gait Kinematics in Individuals with Acute and Chronic Patellofemoral Pain.

Purpose: This study aimed to identify the discriminating kinematic gait characteristics between individuals with acute and chronic patellofemoral pain (PFP), and healthy controls. Methods: Ninety-eight runners with PFP (39 male, 59 female) and 98 healthy control runners (38 male, 60 female) ran on a treadmill at a self-selected speed while three-dimensional lower limb kinematic data were collected. Runners with PFP were split into acute (n = 25) and chronic (n = 73) sub-groups based on whether they had been experiencing pain for less or greater than three months, respectively. Principal component analysis and linear discriminant analysis were used to determine the combination of kinematic gait characteristics that optimally separated individuals with acute PFP, chronic PFP, and healthy controls. Results: Compared to controls, both the acute and chronic PFP sub-groups exhibited greater knee flexion across stance and greater ankle dorsiflexion during early stance. The acute PFP sub-group demonstrated greater transverse plane hip motion across stance compared to healthy controls. In contrast, the chronic PFP sub-group demonstrated greater frontal plane hip motion, greater knee abduction, and reduced ankle eversion/greater ankle inversion across stance when compared to healthy controls. Conclusions: This study identified characteristics that discriminated between individuals with acute and chronic PFP when compared to healthy controls. Certain discriminating characteristics were shared between both the acute and chronic sub-groups when compared to healthy controls, while others were specific to the duration of PFP. (C) 2017 American College of Sports Medicine

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Short Trail Running Race: Beyond the Classic Model for Endurance Running Performance.

Purpose: To examine the extent to which the classical physiological variables of endurance running performance [VO2max, %VO2max at ventilatory threshold (VT), and running economy (RE)], but also muscle strength factors contribute to short trail running (TR) performance. Methods: A homogeneous group of nine highly-trained trail runners performed an official TR race (27-km) and laboratory-based sessions to determine VO2max, %VO2max at VT, level RE (RE0%) and RE on a +10% slope (RE+10%), voluntary concentric and eccentric knee extension torques (MVCCon and MVCEcc, respectively), local endurance assessed by a fatigue index (FI) and a time to exhaustion at 87.5% of the velocity associated with VO2max. A simple regression method and commonality analysis identifying unique and common coefficients of each independent variable were used to determine the best predictors for the TR race time (dependent variable). Results: Pearson correlations showed that FI and VO2max had the highest correlations (r = 0.91 and r = -0.76, respectively) with TR performance. The other selected variables were not significantly correlated with TR performance. The analysis of unique and common coefficients of relative VO2max, %VO2max at VT and RE0% provides a low prediction of TR performance (R2 = 0.48). However, adding FI and RE+10% (instead of RE0%) markedly improved the predictive power of the model (R2 = 0.98). FI and VO2max showed the highest unique (respectively 49.7 and 21.0% of total effect) and common (27.0% of total effect) contributions to the regression equation. Conclusions: The classic endurance running model does not allow meaningful prediction of short TR performance. Incorporating more specific factors to TR such as local endurance and gradient-specific RE testing procedures should be considered to better characterize short TR performance. (C) 2017 American College of Sports Medicine

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Risk and Causes of Death among Former National Football League Players (1986-2012).

PURPOSE: Previous research identified decreased overall and cardiovascular mortality for National Football League (NFL) players from the 1959-1988 era. The present study explored the mortality risk among recent NFL players who played in an era of heavier linemen and nearly year-round physical conditioning. METHODS: This cohort study included 9778 former NFL players with at least one year in the NFL whose last season was between 1986 and 2012. Players' pension fund records were matched to the National Death Index (NDI) to determine vital status, date of death, and cause of death. Standardized mortality ratios (SMRs) compared player mortality through 2014 with US men of the same age, race, and calendar year. Cox proportional hazards models assessed the effect of player characteristics on overall and cardiovascular mortality. RESULTS: Two percent (n=227) of players were deceased with a median age at death of 38 years (range: 23-61). The most common major causes of death were diseases of the heart (n=47, 21%), violence (n=39, 17%), and transportation injuries (n=34, 15%). Risk of death was significantly lower than the general population for overall mortality (SMR 0.46, 95% CI 0.40-0.52), cardiovascular disease (SMR 0.65, 95% CI 0.50-0.84), and other major causes. Players with playing-time BMI>35 kg/m2 had significantly higher cardiovascular disease mortality (SMR 2.20, 95% CI 1.32-3.44) than the general population and higher overall mortality risk (SRR 3.84, 95% CI 2.66-5.54) than players with BMI

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Physical Activity Device Reliability and Validity during Pregnancy and Postpartum.

Current physical activity (PA) recommendations for women experiencing a normal pregnancy reflect recent research showing numerous health benefits for mother and offspring. However, few studies have evaluated PA devices' reliability and validity during pregnancy, as anatomical and physiological changes throughout gestation could affect an instrument's accuracy. PURPOSE: To determine the reliability and validity of PA devices worn on the hip, ankle, and triceps during pregnancy and post-partum. METHODS: Thirty-three women performed six activities of daily living and one treadmill walk at approximately 21 and 32 weeks of pregnancy, and 12 weeks post-partum. There were two visits at each time-period, one week apart. Energy expenditure (VO2) was measured by indirect calorimetry (IC; criterion measure), while PA was quantified by accelerometers and pedometers placed at the right hip and ankle and left triceps. Interclass reliability and monitor validity compared to IC in relative (ml[middle dot]kg-1[middle dot]min-1) terms was calculated via Pearson correlation (PC). Both multi and single-trial intraclass reliabilities (ICC) were estimated from analysis of variance (ANOVA) to assess monitor reliability at each time-period. Standard errors of measurement (SEM) were calculated in relative terms for each time-period. RESULTS: The reliability of the devices was moderate/strong as 66% of the PCs were between 0.6-1.0. Multi-trial ICCs were largely in the moderate/strong range as 38% of the ICCs were between 0.6-0.79 and 50% were between 0.8-1.0. The SEMs for each device between visits ranged from 7-23% of the mean values. Comparison between IC and devices showed 40 and 46% of the validity coefficients were between 0.4-0.59 and 0.6-0.79, respectively. CONCLUSION: PA devices show moderate/strong reliability and moderate validity for measuring PA during pregnancy and post-partum. (C) 2017 American College of Sports Medicine

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Wilson's Disease in Children: A position paper by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee.

Background: Clinical presentations of Wilson's disease (WD) in childhood ranges from asymptomatic liver disease to cirrhosis or acute liver failure, while neurological and psychiatric symptoms are rare. The basic diagnostic approach includes serum ceruloplasmin and 24h-urinary copper excretion. Final diagnosis of WD can be established using a diagnostic scoring system based on symptoms, biochemical tests assessing copper metabolism and molecular analysis of mutations in the ATP7B gene. Pharmacological treatment is life-long and aims at removal of copper excess by chelating agents as D-penicillamine, trientine or inhibition of intestinal copper absorption with zinc salts. Acute liver failure often requires liver transplantation. This publication aims to provide recommendations for diagnosis, treatment and follow-up of WD in children. Methods: Questions addressing the diagnosis, treatment and follow-up of WD in children were formulated by a core group of ESPGHAN members. A systematic literature search on WD using MEDLINE, EMBASE, Cochrane Database from 1990 to 2016 was peformed focusing on prospective and retrospective studies in children. Quality of evidence was assessed according to the GRADE system. Expert opinion supported recommendations where the evidence was regarded as weak. The ESPGHAN core group and ESPGHAN Hepatology Committee members voted on each recommendation, using the nominal voting technique. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Family Health Related Quality of Life in Pediatric Cyclic Vomiting Syndrome.

Objective: To evaluate the relationship of disease characteristics and child anxiety symptoms to family health related quality of life (FHRQoL) in youth with cyclic vomiting syndrome (CVS). Methods: Forty-two parents of youth aged 8-18 years diagnosed with CVS completed the Family Impact Module of the PedsQL, a measure of the impact of the child's illness on the family. We evaluated the relationship of disease characteristics and child and parent proxy reports of anxiety symptoms on the Screen for Childhood Anxiety and Related Emotional Disorders (SCARED) to FHRQoL. Results: Parent report of child anxiety symptoms and missed school days (Mean = 11.93, SD = 14.62) were the strongest predictors of FHRQoL (R2 = .33, df = 1,39, F = 8.51, p = .006). Other disease characteristics, including frequency, duration, chronicity of CVS episodes, and delay in initial CVS diagnosis were not significantly associated with the FHRQoL Total score. Child anxiety symptoms by either parent and/or child report were associated with subscales of the FHRQoL, including family physical functioning, family communication, and family daily activities. Conclusions: HRQoL for the families assessed in this study was associated with anxiety symptoms to a greater extent than disease characteristics, indexing the importance of a biopsychosocial approach to CVS management. Screening for anxiety symptoms and support for school absences due to illness are indicated to help lessen the impact of CVS on the family as a whole. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Resolving Malnutrition with Parenteral Nutrition Prior to Liver Transplant in Biliary Atresia.

Objective: Malnutrition is a common complication of end-stage liver disease (ESLD) associated with poor liver transplant outcomes. Nasogastric feeds are used for nutritional supplementation, but some patients remain malnourished. Parenteral nutrition (PN) can be effective, but has potential complications. The primary objective was to evaluate the effect of PN on anthropometric measures in children with ESLD awaiting liver transplant. Secondary objectives were evaluation of PN associated complications, liver function tests, PELD scores, waitlist time, and post-transplant length of stay (total and time in the intensive care unit). Methods: A single-center, retrospective chart review analyzing pediatric patients with ESLD receiving PN who were transplanted over a 6-year period. Data were trended and described over time, as were the relationships between anthropometric data and time receiving PN. Results: 44 patients with ESLD were transplanted between January 2010 and December 2015. 18 (41%) received PN before transplant; all had biliary atresia with median age at transplant of 10 months (range, 5-18 months). Mid-upper arm circumference and triceps skinfold thickness showed resolution of malnutrition in 7 patients (39%) with normalization of one measure in another 4 patients (22%). Of the remaining, 6 had improved z-scores and one had worsening malnutrition. No deaths occurred in patients receiving PN. Central line infection rates were 3.8/1000 catheter days with 8 total infections in 6 patients over a total of 2117 catheter days. Conclusions: Children with ESLD and malnutrition who have failed enteral feeding may benefit from PN to improve and/or resolve malnutrition prior to liver transplant. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Sarcopenia in Children With End-stage Liver Disease.

Background: Sarcopenia, reflected by decreased psoas muscle surface area (PMSA), has been identified as a novel and independent predictor of waitlist mortality and outcomes in adult liver transplantation (LT). We hypothesized that children with end-stage liver disease (ESLD) would have smaller PMSA than healthy controls. Methods: Images of children (0-18y) listed for LT in 2015 and a control group comprised of 2:1 age- and gender-matched healthy pediatric trauma victims were reviewed. PMSA was determined at two intervertebral disc levels (L3/4; L4/5). A subset of images was reviewed by 2 radiologists to determine inter-rater correlation. Results: 23 children with ESLD were included, and the most prevalent diagnosis was biliary atresia (61%). On both lumbar levels, median PMSA was significantly smaller in ESLD subjects compared to the 46 healthy controls (L4/5; median tPMSA 407 mm2 (IQR 339, 537) vs. Controls 513 mm2 (IQR 437, 672); p = 0.004), independent of participants' weight z-scores (r = 0.01; p = 0.95). Excellent inter-rater correlation was seen (ICC 0.99). Conclusion: In this retrospective pilot study, PMSA was significantly lower in children with ESLD compared to healthy age- and gender-matched controls. Since this finding was independent of growth in ESLD subjects, PMSA may represent a novel objective nutritional biomarker in children with advanced liver disease. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Long-term Exposure of Children to a Mixed Lipid Emulsion is Less Hepatotoxic Than Soybean-Based Lipid Emulsion.

Lipid emulsions have been associated with liver injury. Newer mixed emulsions (ML), such as SMOFlipid(R) (Fresenius Kabi, Germany), are thought to be more hepatoprotective than soybean-based emulsions (SL), such as Intralipid(R) (Baxter, U.S.A.). Pediatric studies comparing long-term use between the two are limited. This study compares the severity of hepatic injury between a prospective cohort of hospitalized children on ML (n = 20) and a historical age- and diagnosis-matched cohort of hospitalized children on SL (n = 20). Median exposure to ML and SL were 10 vs. 6 weeks (p = 0.030), respectively, at similar median lipid doses (2.2 g/kg/d vs. 2.1 g/kg/d). Using a generalized estimating equations approach, conjugated bilirubin trajectory was found to be lower in patients on ML compared to SL (p =4 weeks) to ML is associated with decreased liver injury compared to SL in hospitalized children. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Splenic Rupture in Children With Portal Hypertension.

Introduction: Massive splenomegaly from portal hypertension (PHTN) in children raises the specter of splenic rupture, however the incidence, etiology, and risk of rupture has not been studied, nor have existing practices to reduce risk. We therefore performed an international survey in order to describe the splenic rupture cases in PHTN and to describe the existing empirical practice among hepatologists. Methods: A questionnaire was constructed to elicit cases of splenic rupture and collect hepatologists' common practices for prevention of splenic rupture. Pediatric hepatologists working in selected tertiary academic centers in the USA, Canada and the United Kingdom were contacted. Results: Hepatologists from 30 out of 35 centers who met the inclusion criteria replied to the survey. Thirteen cases of splenic rupture were described of which 11 resulted from trauma. In the opinion of the practitioners, high risk activities were football, hockey, and wrestling. Sixty-one percent recommended total restriction from high risk activities. Seventy-four percent stated that platelet count had no effect on this decision and 61% advised a spleen guard for certain activities. Conclusion: Splenic rupture in patients with PHTN and splenomegaly seems to be rare. The reported splenic rupture cases were mostly related to falling (and not to participation in sports). There was general agreement among hepatologists about restricting high impact sports. There was variation in recommendations regarding the use of a spleen guard. The authors recommend use of spleen guards in children with splenomegaly from PHTN for physical activities with risk of fall or blunt abdominal trauma. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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How Much Free Sugars Intake Should Be Recommended for Children Younger Than Two Years Old?.

No abstract available

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Response to Letter: How Much Free Sugars Intake Should Be Recommended for Children Younger Than Two Years Old?.

No abstract available

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Lack of Correlation of Liver Tests with Fibrosis Stage at Diagnosis in Pediatric Primary Sclerosing Cholangitis.

Objectives: The aims of this study were to characterize pediatric primary sclerosing cholangitis (PSC) at a regional referral based institution, including scoring of biliary stricturing and liver fibrosis and correlation analyses of scores with serum liver tests, in order to identify biomarkers of disease severity. Methods: A retrospective review of 39 PSC subjects was performed, with collection of demographic and outcomes data. Magnetic resonance cholangiopancreaticogram (MRCP) and liver biopsies were re-reviewed and scores of stricturing and fibrosis were correlated with serum liver tests. Results: Average age at PSC diagnosis was 11.2 years, 74% had inflammatory bowel disease and 51% had autoimmune hepatitis. Despite 83% with symptoms at presentation, only ~1/3 were symptomatic at a mean follow-up of 4.1 years. Using a validated MRCP biliary scoring system, the mean intrahepatic score was 1.1 (out of 4) and extrahepatic score was 1.0 (out of 3). The mean Ishak liver fibrosis stage was 3.5 (out of 6) and 33% had cirrhosis. 92% were alive with their native liver and 5% had a liver transplant. Serum biomarker analyses revealed no correlation between Ishak liver fibrosis stage or MRCP score and laboratory values. Conclusions: Pediatric PSC patients cared for at a regional referral center had relatively mild disease compared to previously published reports, with low MRCP stricture scores despite significant liver fibrosis. Liver tests at presentation did not correlate with MRCP stricture score or liver fibrosis stage, suggesting the need for future studies to identify potential biomarkers of disease severity. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Multidirectional Cranial Distraction Osteogenesis with Simplified Modifications for Treating Sagittal Synostosis

Background: Multidirectional cranial distraction osteogenesis (MCDO) is a procedure of ours developed earlier for treating craniosynostosis. However, the numerous bone flaps led to prolonged operative time and occasional bone detachment from dura. We have since simplified the osteotomy design. In treating sagittal synostosis, required bone flaps have been reduced to 11 (from ~20). Methods: In a 2-year period (2014–2015), 5 boys with sagittal synostosis underwent MCDO using our simplified and fixed-form osteotomy. Mean age at surgery was 9.4 months (range, 8–11 months). Pre- and postoperative cranial morphology was assessed by cephalic index and by mid-sagittal vector analysis. Results: Improved cranial shape was confirmed by 3-dimensional CT scans and by mid-sagittal vector index. Mean preoperative cephalic index (68.7) progressively increased to means of 78.5 immediately after distraction device removal, 75.2 at postoperative month 6, and 75.1 at 1 year postoperatively. There were no major complications, although transient cerebrospinal fluid leakage and loosening of anchor pins occurred in 1 patient. Conclusions: Simplified MCDO has a number of advantages over conventional distraction procedures such as discretionary reshaping/expansion of cranium and predictable osteogenesis and is a valid treatment option for patients with sagittal synostosis. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 26 October 2017. Received for publication March 24, 2017; accepted August 17, 2017. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Supplemental digital content is available for this article. Clickable URL citations appear in the text. Ataru Sunaga, MD, Department of Pediatric Plastic Surgery, Jichi Children's Medical Center Tochigi, 3311-1, Yakushiji, Shimotsuke, 329–0498, Tochigi, Japan, E-mail: atarusuna@jichi.ac.jp Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Association of High-Volume Surgeons Working in High-Volume Hospitals with Cost of Free Flap Surgeries

Background: We examined the associations of surgeon and hospital volume with total cost, length of stay (LOS), and cost per day for free tissue transfer (FTT) surgeries. Evidence demonstrates a higher likelihood of success for FTT in higher volume hospitals. Little, however, is known about volume-outcome associations for surgical costs and LOS. We hypothesized that higher provider volume is associated with lower cost and shorter LOS. Methods: Using Taiwan's national data (2001–2012), we conducted a retrospective cohort study of all adults 18–64 years of age who underwent FTT during the study period. We used hierarchical regression modeling for our analyses. Our 3 outcome variables were total cost of FTT surgery, LOS in hospital, and cost per day. Results: Except for functional muscle flap, in which LOS was 12 days shorter in high-volume compared with low-volume hospitals (P = 0.017), no association between hospital volume and LOS was found. Contrary to our hypothesis, our results for all FTT cases demonstrate positive associations of medium-volume hospitals (OR = 1.31; CI, 1.11–1.55) and high-volume surgeons (OR = 1.16; CI,1.03–1.32) with total cost and cost per day, respectively. The interactions of hospital volume and surgeon volume show that in medium- and high-volume hospitals, surgeons with the highest volume had the lowest predicted cost per day among hospitals in that category; but all differences in cost were small. Conclusions: There were no substantial variations based on different hospital or surgeon volume in LOS, total cost, or cost per day for FTT operations performed in Taiwan. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 25 October 2017. Received for publication April 4, 2017; accepted August 21,2017. Disclosure: Supported by the Plastic Surgery Foundation National Endowment for Plastic Surgery Grant (to Dr. Elham Mahmoudi), a Midcareer Investigator Award in Patient-Oriented Research from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (2 K24-AR053120-06) (to Dr. Kevin C. Chung), and The Integration and Maintenance Program of Health Information Application and Collaborative Research Award (to Drs. Ming-Huei Cheng and Chee-Jen Chang) (CIRPD1D0032). The Article Processing Charge was paid for by the authors. Supplemental digital content is available for this article. Clickable URL citations appear in the text. Elham Mahmoudi, PhD, University of Michigan North Campus Research Complex, 2800 Plymouth Rd Building 16, Room G024W, Ann Arbor, MI 48109, E-mail: Mahmoudi@med.umich.edu Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Depressive Symptoms among Plastic Surgery Residents

Background: A literature review did not reveal any study investigating the prevalence of depression among plastic surgery residents. Methods: We conducted a cross-sectional mail survey and included all Saudi Plastic Surgery residents in our local program in Saudi Arabia. The Beck Depression Inventory II was used. Results: The inventory showed that mild, moderate, and severe depressive symptoms were prevalent in 20.6%, 38.2%, and 11.8%, respectively. Junior residents were more prone to depression. Conclusions: The high prevalence rate of depression among plastic surgery residents is alarming, and further studies are warranted. The problem has received no attention in the plastic surgery literature. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 25 October 2017. Received for publication May 31, 2017; accepted August 11,2017. Supported by the College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Mohammad M. Al-Qattan, MBBS, King Saud University, PO Box 18097, Riyadh 11415, Saudi Arabia, E-mail: moqattan@hotmail.com Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Filling the Spectrum Expander with Air—A New Alternative

Summary: The Spectrum adjustable saline implant is optimal for prepectoral breast reconstruction as it can be placed virtually empty and thus flat, applying no pressure on the overlying skin flap. However, when saline is added, it tends to pool at the bottom of the implant resulting in its uneven surface and rippling. Air filling results in the uniform distribution within the implant shell and smooth even implant surface, which facilitates acellular dermal matrix adhesion. Pressure to the skin flap is averted, patients are more comfortable, and rippling is not seen. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 25 October 2017. Received for publication June 6, 2017; accepted September 1,2017. Disclosure: Dr. Becker is a consultant for Mentor Corp. Dr. Zhadan declares no disclosures. No funding was received for this article. The Article Processing Charge was paid for by the authors. The patients provided verbal and written consent for the use of the images. Hilton Becker, MD, FACS, Hilton Becker Clinic of Plastic Surgery, 670 Glades Road #220, Boca Raton, FL 33431, E-mail: hbecker100@aol.com Olga Zhadan, MD, MS, Hilton Becker Clinic of Plastic Surgery, 670 Glades Road #220, Boca Raton, FL 33431, E-mail: olgazhadan.md@gmail.com Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Long-Term Patency of Twisted Vascular Pedicles in Perforator-Based Propeller Flaps

Background: Propeller flaps require torsion of the vascular pedicle of up to 180 degrees. Contrary to free flaps, where the relevance of an intact vascular pedicle has been documented, little is known regarding twisted pedicles of propeller flaps. As secondary surgeries requiring undermining of the flap are common in the extremities, knowledge regarding the necessity to protect the pedicle is relevant. The aim of this study was a long-term evaluation of the patency of vascular pedicle of propeller flaps. Methods: In a retrospective clinical study, 22 patients who underwent soft-tissue reconstruction with a propeller flap were evaluated after 43 months. A Doppler probe was used to locate and evaluate the patency of the vascular pedicle of the flap. Results: The flaps were used in the lower extremity in 19 cases, on the trunk in 3 cases. All flaps had healed. In all patients, an intact vascular pedicle could be found. Flap size, source vessel, or infection could therefore not be linked to an increased risk of pedicle loss. Conclusions: The vascular pedicle of propeller flaps remains patent in the long term. This allows reelevation and undermining of the flap. We therefore recommend protecting the pedicle in all secondary cases to prevent later flap loss. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 25 October 2017. Received for publication July 26, 2017; accepted August 30,2017. Supported by the German Research Foundation (DFG) and the University of Wuerzburg in the funding program Open Access Publishing. Disclosure: The authors have no financial interest to declare in relation to the content of this article. This publication was funded by the German Research Foundation (DFG) and the University of Wuerzburg in the funding programme Open Access Publishing. The Article Processing Charge was paid for by the authors. Rafael G. Jakubietz, MD, Department of Trauma, Hand, Plastic and Reconstructive Surgery, ZOM, Oberduerrbacherstr. 6, DE-97080 Wuerzburg, Germany, E-mail: Jakubietz_R@ukw.de Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Pedicle-to-Perforator Bypass Using Supermicrosurgical Technique for Deep Inferior Epigastric Artery Perforator Flap Salvage

No abstract available

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Strategies for Reducing Fatal Complications in Liposuction

Background: Liposuction has become one of the most common cosmetic surgical procedures, and severe complications secondary to this procedure have also increased significantly. That is why we carry out a research work to know the most frequent severe complications reported in the scientific literature to indicate criteria for prevention. Methods: English-language scientific publications about liposuction and its complications were analyzed using the PubMed.gov, from the beginning of PubMed's history through June 10, 2017. Five terms were used to define liposuction and its complications: "liposuction," "liposuction AND complications," liposuction AND major complications," "liposuction AND complications AND death," and "liposuction AND death." The quantities of results for the 5 phrases were analyzed, along with their contents. Results: One thousand sixty-three results were obtained from 1973 through June 10, 2017 for the phrase "Liposuction and Complications" in humans; for "Liposuction and Major Complications," 153 articles were found; for "Liposuction and Deaths," 89 articles were found; and 42 articles were obtained with the terms "Liposuction and Major Complications and Deaths." After final depuration, all those that were not specific to severe liposuction complications were eliminated, leaving a total of 39 articles that were included in our study. Five problems proved to be the most serious complications when performing liposuction: Thromboembolic disease, fat embolism, pulmonary edema, lidocaine intoxication, and intraabdominal visceral lesion. Conclusions: The 5 most important complications that can cause death in liposuction are easily preventable using simple measures and proper safety protocols that are described in this work. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 25 October 2017. Received for publication August 8, 2017; accepted August 29,2017. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Lázaro Cárdenas-Camarena, Innovare Cirugía Plástica Especializada, Av Verona 7412, Fraccionamiento Viila Verona, Zapopan, Jalisco, México, E-mail: drlazaro@drlazarocardenas.com Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Anatomical Analysis of Cutaneous Perforator Distribution in the Forearm

Background: Few reports describe the distribution of cutaneous perforators from the radial and ulnar arteries in the forearm. This study aimed to map the location of the cutaneous perforators that arise directly from the radial and ulnar arteries in cadavers. Methods: Twenty-nine human cadaveric forearms were dissected. All radial and ulnar arteries cutaneous perforators were analyzed for total number and distribution. To define the distribution of each cutaneous perforator, the forearm was divided into 10 sections, with the sections labeled as 10%, 20%, 30%, and so on, beginning at the wrist. Results: From the radial artery, there were a total of 262 skin perforators with an average of 9.03 ± 2.28 (mean ± SD) per limb, whereas the total was 159 from the ulnar artery, with an average of 5.48 ± 1.49 per limb. Additionally, 128 (49%) radial artery cutaneous perforators and 75 (47%) from the ulnar artery were concentrated in the 0–30% section of the forearm. Both the radial and ulnar arteries had many cutaneous perforators in the forearm section labeled 70%, with 32 of 262 (12%) cutaneous perforators of the radial artery and 27 of 159 (17%) cutaneous perforators of the ulnar artery located here. Conclusions: There were more cutaneous perforators from the radial artery than from the ulnar artery, and both were concentrated in the distal one-third of the forearm and in the forearm section labeled 70%. This information could be helpful when harvesting forearm flaps. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 26 October 2017. Received for publication June 16, 2017; accepted September 6, 2017. To be presented at the Annual meeting of the Japan Society of Plastic and Reconstructive Surgery, 2017, Osaka, Japan. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Tomomi Kimura, MD, Department of Plastic and Reconstructive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama 701-0192 Japan, E-mail: tomomix0711@yahoo.co.jp Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Intravenous Access in Infants Undergoing Bilateral Sural Nerve Grafts for Primary Brachial Plexus Exploration

Background: Intravenous access (IVA) in infants undergoing primary brachial plexus exploration may be difficult. Both lower limbs are prepared and draped for sural nerve graft harvesting. The injured upper limb is also prepared and draped and is not available for IVA. In difficult IVA from the remaining upper limb, we have been using one of the feet for IVA. The infection rate and problems of intravenous infusions in this setting have never been studied in the literature. This study documents the infection rate and problems of intravenous infusions in these infants when a foot (within the sterile field) is used for IVA. Methods: This is a retrospective study of 63 consecutive infants undergoing primary brachial plexus exploration, and in whom IVA was obtained from one of the feet. Infection rate and problems of intravenous infusions were recorded. Results: No surgical wound infection and no infection of the IVA site were noted. There were no instances of accidental dislodgement of the intravenous cannula and no instances of extravasation. Conclusion: The use of one of the feet (within the sterile filed) for IVA is safe and acceptable in infants undergoing primary brachial plexus exploration and bilateral sural nerve grafting. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 25 October 2017. Received for publication July 22, 2017; accepted August 29,2017. Disclosure: Supported by the College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia. The Article Processing Charge was paid for by the authors. Mohammad M. Al-Qattan, MBBS, Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia, E-mail: moqattan@hotmail.com Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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The Idea of Beauty and Its Biases: Critical Notes on the Aesthetics of Plastic Surgery

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. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 25 October 2017. Received for publication April 3, 2017; accepted August 18,2017. Disclosure: This work is funded by the Institute of Philosophy of Scientific and Technological Practice, Università Campus Bio-Medico di Roma, under 2015 Grant on "Embodiment". The Article Processing Charge was paid for by the author. Nicola Di Stefano, PhD, FAST – Institute of Philosophy of Scientific and Technological Practice, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy, E-mail: n.distefano@unicampus.it Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Occlusal Plane Altering 2 Jaw Surgery Based on the Clockwised Rotational Surgery-First Orthognathic Approach

No abstract available

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Hearing Aid Startup to Receive $45 Million Funding

​Eargo (https://eargo.com/), a direct-to-consumer hearing technology company, has announced the closing of the first tranche of an aggregate $45 million Series C investment round, which the company said will be used to accelerate their product innovation. The new investment was led by Nan Fung Life Sciences. New Enterprise Associates, Charles and Helen Schwab, and Maveron have also provided investments. Eargo is designed for consumers with on-the-go lifestyles and the desire for simplicity. Christian Gormsen, the CEO of Eargo, said, "We believe people shouldn't feel that they need a hearing aid.  They should feel that they want one.  Eargo was created with this in mind and we're just getting started."​

Published: 10/27/2017 2:07:00 PM

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"Gan To Kagaku Ryoho"[jour]; +37 new citations

37 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

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Unilateral rhinorrhoea: An atypical aetiology

Publication date: Available online 27 October 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C. Aussedat, C. Dorbeau, D. Bakhos




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EEG-Annotate: Automated identification and labeling of events in continuous signals with applications to EEG

Publication date: 1 January 2018
Source:Journal of Neuroscience Methods, Volume 293
Author(s): Kyung-min Su, W. David Hairston, Kay Robbins
BackgroundIn controlled laboratory EEG experiments, researchers carefully mark events and analyze subject responses time-locked to these events. Unfortunately, such markers may not be available or may come with poor timing resolution for experiments conducted in less-controlled naturalistic environments.New methodWe present an integrated event-identification method for identifying particular responses that occur in unlabeled continuously recorded EEG signals based on information from recordings of other subjects potentially performing related tasks. We introduce the idea of timing slack and timing-tolerant performance measures to deal with jitter inherent in such non-time-locked systems. We have developed an implementation available as an open-source MATLAB toolbox (http://ift.tt/2iFcyzY) and have made test data available in a separate data note.ResultsWe applied the method to identify visual presentation events (both target and non-target) in data from an unlabeled subject using labeled data from other subjects with good sensitivity and specificity. The method also identified actual visual presentation events in the data that were not previously marked in the experiment.Comparison with existing methodsAlthough the method uses traditional classifiers for initial stages, the problem of identifying events based on the presence of stereotypical EEG responses is the converse of the traditional stimulus-response paradigm and has not been addressed in its current form.ConclusionsIn addition to identifying potential events in unlabeled or incompletely labeled EEG, these methods also allow researchers to investigate whether particular stereotypical neural responses are present in other circumstances. Timing-tolerance has the added benefit of accommodating inter- and intra- subject timing variations.

Graphical abstract

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Histomorphometric analyses of area fraction of different ratios of Bio-Oss® and bone prior to grafting procedures – An in vitro study to demonstrate a baseline

Abstract

Objective

The objective of this study was to estimate the area fraction of different ratios of Bio-Oss^® and bone, prior to grafting in an in vitro model to demonstrate a histomorphometric baseline.

Methods

Bio-Oss^® particles were mixed with autogenous bone from pig jaw in three different ratios (50:50, 80:20 and 100:0) and packed in rice paper in a standardized procedure. Histomorphometric analyses were performed in 25 specimens and 74 regions of interest. The area percentage of Bio-Oss^®, bone, and non-mineralized tissue (NMT) were calculated. Results were reported as mean values and 95% confidence interval (CI).

Results

The mean area fraction of Bio-Oss^® was 20.6% (CI: 18.2–23) in the 50:50 mixture, 33.6% (CI: 29.7–37.6) in the 80:20 mixture, and 43.4% (CI: 40.5–46.3) in the 100:0 mixture. The mean area fraction of NMT was 60.5% (CI: 57.9–63.1) in the 50:50 mixture, 59.6% (CI: 56.4–62.7) in the 80:20 mixture, and 56.6% (CI: 53.7–59.5) in the 100:0 mixture. The mean area fraction of bone was 18.9% (CI: 16.9–20.9) in the 50:50 mixture and 6.8% (CI: 5–8.6) in the 80:20 mixture.

Conclusion

There is a great difference in the clinically estimated percentage and the histomorphometrically evaluated percentage of Bio-Oss^® at baseline, prior to grafting. The area fraction of different tissues presented in this study may be beneficial as guidance for histomorphometrical baseline calculations when different mixtures of Bio-Oss^® and autogenous bone are used as grafting materials.

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5. Epilepsy and EEG activity in early-onset Alzheimer’s disease

The aim of this review was to evaluate and summarize the current literature regarding the incidence and features of epileptic seizures in early onset Alzheimer's disease (AD) as well as its epileptiform characteristics as described by electroencephalography (EEG).

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4. Prevention of trauma-induced epileptogenesis in mice via manipulation of the network excitability

A large proportion of patients with severe brain damage become epileptic several months to years after the trauma. The mechanisms leading to the development of epilepsy (epileptogenesis) are unknown. We hypothesize that brain damage leads to partial deafferentation and a drop in excitability of the affected area. To compensate, the brain employs a variety of mechanisms to restore this drop of excitability and if not properly controlled, this leads to epilepsy. We performed undercut in the somatosensory area in adult C57/BL6 mice and implanted LFP and EMG electrodes for continuous electrographic recordings for at least two months.

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Editorial Board

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3. Asymmetric hypsarrythmia: An insight into the pathophysiology of infantile spasms. A retrospective cohort

Infantile spasms (IS) is a catastrophic epilepsy where treatment precocity improves outcome. Previous studies demonstrated an association between asymmetric hypsarrhythmia on EEG and ipsilateral hemispheric lesions on MRI, suggesting a possible role of cortical lesions in the initiation of IS. Epileptiform abnormalities appearing during early infancy have also been linked to IS emergence. We hypothesized that focal lateralized EEG abnormalities during the prehyspasrrhythmic period will be associated with asymmetric hypsarrhythmia at IS onset.

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2. Do repeated limbic seizures induce depression-like behavior in rats?

It has been reported that rapid kindling of the hippocampus produces lasting depression-like behavior in rats, as evidenced by increased immobility in the forced swim test and a loss of preference for sweetened water (Mazarati et al., 2007). This might suggest that repeated limbic seizure activity could be the cause of the depression often seen in patients with temporal lobe epilepsy.Sixty-day old male Wistar rats were implanted with electrodes in the amygdala and ventral hippocampus and kindled (or sham kindled) daily to a criterion of 10 stage 5 seizures.

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1. Across all the seven seas: Fifty years in neurology, EEG and epilepsies

Since the 1960s, major neuroscience advances have facilitated the development of new antiepilepsy drugs (AEDs) targeting specific neurotransmitter-receptor systems, particularly the GABAergic, the NMDA-receptors and voltage-gated ion channels. In addition to the classical AEDs, carbamazepine and cogeners act at the voltage-gates sodium channels, while ethosuxumide acts at the calcium channel, improving the treatment of partial and generalized seizures. But approximately 30% of partial complex seizures remain refractory to AEDs, leading to novel AEDs: levetiracetam, tiagabine, lacosamide, perampanel and others.

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Contents

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Announcement

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Ultrasound in polyneuropathies – Is size or structure all that matters?

Polyneuropathies (PNPs) are systemic disorders of the peripheral nervous system, that may variably affect motor, sensory and autonomic nerve fibers. The etiological classification of PNPs still remains a challenging aspect of ongoing research, especially taking into account, that the early identification and therapy of immune-mediated causes may improve the functional outcome of the patient (Viala et al., 2010; Joint Task Force of the EFNS and the PNS, 2010). The continuous need for objective, morphological description of pathological peripheral nerve conditions led over the time to the development of different ultrasound measures and protocols, capable of quantifying and scoring the examiner's observations (Kerasnoudis et al., 2014a, 2016; Grimm et al., 2016; Padua et al., 2012).

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Machine-Based Classification of ADHD and nonADHD Participants Using Time/Frequency Features of Event-Related Neuroelectric Activity

Biological signals are a challenge to analyse. Among these signals, the electrophysiological activity of the human brain during cognitive processing is undoubtedly the most challenging. For decades, neuroscientists have been studying the brain-mind relationship based on the electrophysiological responses of the brain. Most studies have been performed on signals in the time domain in the form of event-related potentials (ERPs). The starting point of a second approach was based on the principle that complex signals are composed of oscillatory responses of different frequencies (for a review, see Başar, 2011; Karakaş and Barry, 2017; Karakaş and Başar, 2004).

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Feasibility of Deep Brain Stimulation for Controlling the Lower Urinary Tract Functions: An Animal Study

Lower urinary tract (LUT) dysfunction is an increasingly common symptom worldwide. Neurological disorders are one of the main causes of LUT dysfunction. Specifically, aging-induced central neurodegeneration affects neurological control of bladder function. Since complex networks of the autonomic nervous system and central nervous system control micturition reflexes (Gomez-Pinilla et al., 2007), central neuromodulations are a potential approach for treating various troublesome of LUT disorders (Ju and Liao, 2016).

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Laser-evoked potentials in painful radiculopathy

Painful radiculopathy is induced by pathology of the nerve root or its ganglion and is perceived along the length of the lower limb most frequently in the L5/S1 dermatomal distribution. The current pathophysiological concepts of dorsal root damage differentiate between biochemical and mechanical processes. Mechanical compression can lead to fibrosis and total functional loss of the affected nerve fibers, which is often accompanied by a reduced number of axons. The compression might reduce neuronal impulse synchronization or induce a complete conduction block (Yoshii et al., 2010).

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Intraoperative direct cortical stimulation motor evoked potentials: Stimulus parameter recommendations based on rheobase and chronaxie

One elicits intraoperative direct cortical stimulation (DCS) muscle motor evoked potentials (MEPs) with a short train of monophasic rectangular electrical pulses having a user-selected interstimulus interval (ISI) and pulse duration (D). While practitioners commonly choose 4ms ISI and 0.5msD, reported parameters vary and none have been proven optimal, leaving no consistent scientific rationale for the selection (Taniguchi et al., 1993; Cedzich et al., 1996; Kombos et al., 2000; Neuloh et al., 2004; Kombos et al., 2009; Kamada et al., 2009; Szelényi et al., 2010; Nossek et al., 2011).

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Plasticity induced by non-invasive transcranial brain stimulation: A position paper

Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are the most commonly used methods of non-invasive transcranial brain stimulation that has been abbreviated by previous authors as either as NIBS or NTBS. Here we use NIBS since it seems to be the most common term at the present time. When it was first introduced in 1985, TMS was employed primarily as a tool to investigate the integrity and function of the human corticospinal system (Barker et al., 1985). Single pulse stimulation was used to elicit motor evoked potentials (MEPs) that were easily evoked and measured in contralateral muscles (Rothwell et al., 1999).

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