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Background: Follicular dendritic cell sarcoma (FDCS) is a rare lymphoid neoplasm presenting in the head and neck. There are no pooled analyses of head and neck FDCS cases in the English language literature., Methods: A MEDLINE and PubMed review of cases from 1978 to February 2014 was performed. Demographics, clinicopathologic data, and outcomes were summarized., Results: We presented 2 patients and analyzed 97 cases. The mean age was 42.7 years (SD = 16.3 years). Outcomes were available for 76 patients. Tumors ≤4 cm had better disease-free survival (63% vs 28% at 5 years; p = .0282). Locoregional recurrence was significantly less likely with surgery and radiation compared to surgery alone (15% vs 45%; p = .019) and in patients receiving a neck dissection (10% vs 43%; p = .046)., Conclusion: This pooled analysis provides the largest sample size of FDCS of the head and neck to date and suggests that radiation and neck dissection may be beneficial to locoregional oncologic control. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2241-E2249, 2016., (© 2015 Wiley Periodicals, Inc.)

Using the non-linear optimal velocity models as an example, we show that there exists an emergent intrinsic scale that characterizes the interaction strength between multiple clusters appearing in the solutions of such models. The interaction characterizes the dynamics of the localized quasisoliton structures given by the time derivative of the headways, and the intrinsic scale is analogous to the "charge" of the quasisolitons, leading to non-trivial cluster statistics from the random perturbations to the initial steady states of uniform headways. The cluster statistics depend both on the quasisoliton charge and the density of the traffic. The intrinsic scale is also related to an emergent quantity that gives the extremum headways in the cluster formation, as well as the coexistence curve separating the absolute stable phase from the metastable phase. The relationship is qualitatively universal for general optimal velocity models.

OBJECT Total en bloc sacrectomy is a dramatic procedure that results in extensive sacral defects. The authors present a series of patients who underwent flap reconstruction after total sacrectomy, report clinical outcomes, and provide a treatment algorithm to guide surgical care of this unique patient population. METHODS After institutional review board approval, data were collected for all patients who underwent total sacrectomy between 2002 and 2012 at The Johns Hopkins Hospital. Variables included demographic data, medical history, tumor characteristics, surgical details, postoperative complications, and clinical outcomes. All subtotal sacrectomies were excluded. RESULTS Between 2002 and 2012, 9 patients underwent total sacrectomy with flap reconstruction. Diagnoses included chordoma (n = 5), osteoblastoma (n = 1), sarcoma (n = 2), and metastatic colon cancer (n = 1). Six patients received gluteus maximus (GM) flaps with a prosthetic rectal sling following a single-stage, posterior sacrectomy. Four required additional paraspinous muscle (PSM) or pedicled latissimus dorsi (LD) fasciocutaneous flaps. Three patients underwent multistage sacrectomy with an anterior-posterior approach, 2 of whom received pedicled vertical rectus abdominis myocutaneous (VRAM) flaps, and 1 of whom received local GM, LD, and PSM flaps. Flap complications included dehiscence (n = 4) and infection (n = 1). During the 1st year of follow-up, 2 of 9 patients (22%) were able to ambulate with an assistive device by the 1st postoperative month, and 6 of 9 (67%) were ambulatory with a walker by the 3rd postoperative month. By postoperative Month 12, 5 of 9 patients (56%)-or 5 of 5 patients not lost to follow-up (100%)-were able to able to ambulate independently. CONCLUSIONS The authors' experience suggests that the GM and pedicled VRAM flaps are reliable options for softtissue reconstruction of total sacrectomy defects. For posterior-only operations, GM flaps with or without a prosthetic rectal sling are generally used. For multistage operations including a laparotomy, the authors consider the pedicled VRAM flap to be the gold standard for simultaneous reconstruction of the pelvic diaphragm and obliteration of dead space.

Kidney transplantation alone in clinically compensated patients with cirrhosis is not well documented. Current guidelines list cirrhosis as a contraindication for kidney transplantation alone. This is an Institutional Review Board-approved retrospective study. We report our experience with a retrospective comparison between transplants in hepatitis C virus-positive (HCV(+)) patients without cirrhosis and HCV(+) patients with cirrhosis. All of the patients were followed for at least a full 3-year period. All of the deaths and graft losses were recorded and analyzed using Kaplan-Meier methodology. One- and three-year cumulative patient survival rates for noncirrhotic patients were 91% and 82%, respectively. For cirrhotic patients, one- and three-year cumulative patient survival rates were 100% and 83%, respectively (P = NS). One- and three-year cumulative graft survival rates censored for death were 94% and 81%, and 95% and 82% for the noncirrhosis and cirrhosis groups, respectively (P = NS). Comparable patient and allograft survival rates were observed when standard kidney allograft recipients were analyzed separately. This study is the longest follow-up document in the literature showing that HCV(+) clinically ompensated patients with cirrhosis may undergo kidney transplantation alone as a safe and viable practice.

Cleft lip and palate can be associated with coagulopathy. Here, we report the first known case of congenital platelet disorder and von Willebrand disease presenting as prolonged bleeding after cleft lip and palate repair. After identifying the underlying pathology, platelet infusions and aminocaproic acid were given to decrease bleeding from a second surgical procedure. Whole exome sequencing identified a von Willebrand factor gene mutation, an adenine to guanine substitution at the c.475A location. A high index of suspicion should be had for coagulopathy in patients with syndromic cleft lip and palate.

The objective of this study was to determine whether PGE1 or PGE2 prevents a premature luteolysis when oxytocin is given on Days 1 to 6 of the ovine estrous cycle. Oxytocin given into the jugular vein every 8 hours on Days 1 to 6 postestrus in ewes decreased (P ≤ 0.05) luteal weights on Day 8 postestrus. Plasma progesterone differed (P ≤ 0.05) among the treatment groups; toward the end of the experimental period, concentrations of circulating progesterone in the oxytocin-only treatment group decreased (P ≤ 0.05) when compared with the other treatment groups. Plasma progesterone concentrations in ewes receiving PGE1 or PGE1 + oxytocin were greater (P ≤ 0.05) than in vehicle controls or in ewes receiving PGE2 or PGE2 + oxytocin and was greater (P ≤ 0.05) in all treatment groups receiving PGE1 or PGE2 than in ewes treated only with oxytocin. Chronic intrauterine treatment with PGE1 or PGE2 also prevented (P ≤ 0.05) oxytocin decreases in luteal unoccupied and occupied LH receptors on Day 8 postestrus. Oxytocin given alone on Days 1 to 6 postestrus in ewes advanced (P ≤ 0.05) increases in PGF2α in inferior vena cava or uterine venous blood. PGE1 or PGE2 given alone did not affect (P ≥ 0.05) concentrations of PGF2α in inferior vena cava and uterine venous blood when compared with vehicle controls or oxytocin-induced PGF2α increases (P ≤ 0.05) in inferior vena cava or uterine venous blood. We concluded that PGE1 or PGE2 prevented oxytocin-induced premature luteolysis by preventing a loss of luteal unoccupied and occupied LH receptors., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: An abdominoperineal resection is an invasive procedure that leaves the patient with vast pelvic dead space. Traditionally, the vertical rectus abdominus myocutaneous flap is used to reconstruct these defects. Oftentimes, this flap cannot be used because of multiple ostomy placements or previous abdominal surgery. The anterolateral thigh flap can be used; however, the efficacy of this flap has been questioned., Objective: We report a single surgeon's experience with perineal reconstruction in patients with cancer with the use of either the vertical rectus abdominus myocutaneous flap or the anterolateral thigh flap to demonstrate acceptable outcomes with either repair modality., Design: From 2010 to 2012, 19 consecutive patients with perineal defects secondary to cancer underwent flap reconstruction. A retrospective chart review of prospectively entered data was conducted to determine the frequency of short-term and long-term complications., Settings: This study was conducted at an academic, tertiary-care cancer center., Patients: Patients in the study were patients with cancer who were receiving perineal reconstruction., Interventions: Interventions were surgical and included either abdomen- or thigh-based reconstruction., Main Outcome Measures: The main outcome measures included infection, flap failure, length of stay, and time to radiotherapy., Results: Of the 19 patients included in our study, 10 underwent anterolateral thigh flaps and 9 underwent vertical rectus abdominus myocutaneous flaps for reconstruction. There were no significant differences in demographics between groups (p > 0.05). Surgical outcomes and complications demonstrated no significant differences in the rate of infection, hematoma, bleeding, or necrosis. The mean length of stay after reconstruction was 9.7 ± 3.4 days (± SD) in the anterolateral thigh flap group and 13.4 ± 7.7 days in the vertical rectus abdominus myocutaneous flap group (p > 0.05)., Limitations: The limitations of this study include a relatively small sample size and retrospective evaluation., Conclusion: This study suggests that the anterolateral thigh flap is an acceptable alternative to the vertical rectus abdominus myocutaneous flap for perineal reconstruction (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A134).

Background: The medicolegal aspects of bariatric surgery are very difficult to analyze scientifically because there is no central, searchable database of closed case claims and little incentive for malpractice insurers to divulge data. Examining medicolegal data may provide insight into the financial and psychological burden on physicians. Detailed data also may be used to improve patient safety and determine common causes of negligence., Methods: All U.S.-based members of the American Society of Metabolic and Bariatric Surgeons were asked to complete a survey regarding their bariatric-related medical malpractice experience., Results: Of the 1672 eligible members that received the survey, 330 responded (19.7%). Mean years in practice was 15.3 ± 9. Mean annual cost of malpractice insurance was $59,200 ± $52,000 (N = 197). The respondent surgeons experienced 1.5 ± 3.2 lawsuits on average over the course of their practice. Of the 330 respondents, 144 (48%) did not report a bariatric-related lawsuit filed against them. Of the 464 lawsuits reported by 156 surgeons, 126 were settled out of court (27%), 249 were dropped (54%), and 54 (18%) went to trial. Seventy-two percent of cases that went to trial were found to be in favor of the defense. The mean lifetime amount paid for suits was $250,000±$660,000. The probability of a bariatric surgeon experiencing a lawsuit was independently associated with the years in practice (P = .03) and number of total cases the surgeon has performed (P = .01). The annual cost of malpractice insurance was independently predicted by the amount paid in previous claims (P = .01)., Conclusions: The probability of a medical malpractice lawsuit correlates positively to the number of procedures performed and the number of years the surgeon has been in practice., (Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Vascular and microvascular anastomoses are critical components of reconstructive microsurgery, vascular surgery, and transplant surgery. Intraoperative surgical guidance using a surgical imaging modality that provides an in-depth view and three-dimensional (3-D) imaging can potentially improve outcome following both conventional and innovative anastomosis techniques. Objective postoperative imaging of the anastomosed vessel can potentially improve the salvage rate when combined with other clinical assessment tools, such as capillary refill, temperature, blanching, and skin turgor. Compared to other contemporary postoperative monitoring modalities--computed tomography angiograms, magnetic resonance (MR) angiograms, and ultrasound Doppler--optical coherence tomography (OCT) is a noninvasive high-resolution (micron-level), high-speed, 3-D imaging modality that has been adopted widely in biomedical and clinical applications. For the first time, to the best of our knowledge, the feasibility of real-time 3-D phase-resolved Doppler OCT (PRDOCT) as an assisted intra- and postoperative imaging modality for microvascular anastomosis of rodent femoral vessels is demonstrated, which will provide new insights and a potential breakthrough to microvascular and supermicrovascular surgery., (© 2013 Society of Photo-Optical Instrumentation Engineers (SPIE))

The radial forearm free flap has gained popularity in head and neck reconstruction after oncologic resection because of its versatility. This popularity has only intensified with the advances in technique and instrumentation. Although debated in the past, the success of using the deep venae comitantes system for flap drainage is well documented. Although the use of couplers in a variety of flap anastomoses has been described in the literature, to our knowledge this is the first series presented on the use of couplers in small, deep system venae comitantes. We retrospectively examined our experience in 61 patients who underwent radial forearm free flaps for head and neck reconstruction. Of the 61 patients, 22 anastomoses were hand sewn, and 39 anastomoses were performed using venous couplers. No flap losses occurred in the group in whom venous couplers were used. In addition, no intraoperative thromboses, arterial or venous, were noted with coupler use. Our series demonstrates that the venous coupler is a safe and effective alternative to the hand-sewn anastomosis of the radial forearm free flap venous comitantes in head and neck reconstruction., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Introduction: The "July effect" is a widely discussed phenomenon of worse patient outcomes at teaching hospitals in July due to inexperienced house staff., Methods: We conducted a retrospective review of Organ Procurement and Transplantation Network data from Oct 1, 1987 to June 30, 2011, including longitudinal censored data of 360,330 transplantations. Demographic and comorbid variables for donors and recipients were collected. Primary outcomes were graft loss, patient death, and delayed graft function. Secondary outcomes were surgical complications, length of stay, and graft rejection. We compared survival indicators (1-month, 1-, 3-, and 5-year survival and median survival times) for both grafts and patients. We also analyzed death-censored graft survival., Results: There were fewer July donors with diabetes (p = 0.003), hypertension (p = 0.000), and extended criteria (p<0.0001). Graft survival (p = 0.000), death-censored graft survival (p = 0.001), and patient survival (p = 0.002) were statistically higher in July. After adjusting the Cox model for extended criteria donors, there was no difference in outcomes (p>0.05 for graft, death-censored graft survival, and patient survival)., Conclusion: We conclude that there is no July effect. Initially identified, superior outcomes in July may be attributed to more conservative allografts selection in the beginning of the academic year., (Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

It is believed that the crucial step towards preparation of electrical conductive polymer-carbon nanotube (CNT) composites is dispersing CNTs with a high length-to-diameter aspect ratio in a well-aligned manner. However, this process is extremely challenging when dealing with long and entangled CNTs. Here in this study, a new approach is demonstrated to fabricate conductive polymer-CNT composite fibers without involving any dispersion process. Well-aligned CNT films were firstly drawn from CNT arrays, and then directly coated on polycaprolactone fibers to form polymer-CNT composite fibers. The conductivity of these composite fibers can be as high as 285 S m(-1) with only 2.5 wt% CNT loading, and reach 1549 S m(-1) when CNT loading is 13.4 wt%. As-prepared composite fibers also exhibit 82% retention of conductivity at a strain of 7%, and have improved mechanical properties.

Pneumatosis intestinalis (PI) is a radiologic finding associated with multiple conditions and a high mortality rate (33-40%, 1-3). The current literature addressing PI is limited to an unselected population. This is the first study addressing the management of PI in cirrhotics, a population in which surgical intervention is particularly risky. While nonoperative management is acceptable in the general population, it is unknown whether the same is true when managing patients with underlying cirrhosis. We retrospectively identified cases of PI found on computed tomography (CT) scans performed on cirrhotics from 2004 to 2011. Chart review included comorbidities, hospital course, serum lactate levels, APACHE scores and MELD scores. Nine cirrhotics with PI were identified. Eight were managed conservatively. One patient with MELD score of 18 underwent exploration and died. In total, six patients died. The mean MELD score in patients who died was higher than in those who survived (28 vs. 14). Mortality was 100% in cirrhotic patients with PI whose MELD was greater than 16. Mean lactate levels (33 mg/dL vs. 21 mg/dL) and mean APACHE scores (28 vs. 15) were also higher in those who died. Serum bicarbonate levels and white blood cell counts were not consistently elevated. Our results suggest that the MELD score is an important predictor of mortality in cirrhotics with PI. Serum lactate and APACHE scores are also important markers. Larger studies are required to determine whether there is a role for operative management in cirrhotic patients with a MELD lower than 16., (Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

Electrochemical electrodes based on dense and vertically aligned arrays of multi-walled carbon nanotubes (MWCNTs) were produced. The open tips of individual hollow nanotubes are exposed as active sites while the entangled nanotube stems encapsulated in epoxy collectively provide multiplexed and highly conductive pathways for charge transport. This unique structure together with the extraordinary electrical and electrochemical properties of MWCNTs offers a high signal-to-noise ratio (thus high sensitivity) and a large detection range, compared with other carbon-based electrodes. Our electrodes can detect K(3)FeCN(6) and dopamine at concentrations as low as 5 nM and 10 nM, respectively, and are responsive in a large dynamic range that spans almost 5 orders of magnitude.

Cell death plays an essential role during Drosophila embryogenesis. However, it remains an enigma as to what mechanisms determine (or select) the specific cells to be eliminated at a particular developmental stage. Is it mostly dependent on the lineage of the cell, signifying genetic predetermination, or is it due to the failure of a cell to compete for growth factors, which is more or less by chance? Recent developments in studying the molecular mechanism of cell death during Drosophila embryogenesis has provided much insight into our understanding of the relative importance of, and the interaction between, these two mechanisms in shaping the embryo.

A finite element formulation for a digital image correlation method is presented that will determine directly the complete, two-dimensional displacement field during the image correlation process on digital images. The entire interested image area is discretized into finite elements that are involved in the common image correlation process by use of our algorithms. This image correlation method with finite element formulation has an advantage over subset-based image correlation methods because it satisfies the requirements of displacement continuity and derivative continuity among elements on images. Numerical studies and a real experiment are used to verify the proposed formulation. Results have shown that the image correlation with the finite element formulation is computationally efficient, accurate, and robust.

Background: Concomitant moderate obstructive left main (LM) disease is associated with future cardiac events and poor prognosis in patients undergoing percutaneous intervention (PCI). Whether prognosis is similarly effected by LM disease not detected by angiography, but evident on intravascular ultrasound (IVUS) imaging, is not known. The purpose of this study was to evaluate the long-term prognosis of patients with angiographically insignificant LM coronary artery disease undergoing PCI., Methods and Results: One hundred and seven consecutive patients undergoing PCI with angiographically normal or mild LM disease had 2- and 3-dimensional IVUS imaging. IVUS images were digitized, and 3-dimensional reconstruction was performed. Percent diameter and area stenosis by angiography were 4.8% +/- 3.5% and 18.2% +/- 9.8%, respectively. IVUS mean luminal area and area stenosis were 17.9 +/- 5.6 mm2 and 30.2% +/- 14.7%, respectively. Long-term follow-up was available in 102 (95%) patients at a median of 29 (range 8-52) months. Major adverse cardiac events, defined as death (6), myocardial infarction (4), repeat PCI (13), or CABG (16), were associated with female sex (P =.04), diabetes (P =.02), angiographic minimum lumen diameter (P =.04), and IVUS minimum (P =.01) and mean (P =.01) lumen area. Multivariate predictors of late cardiac events were diabetes (hazard ratio 2.69, P =.014) and minimum lumen area by IVUS (hazard ratio 0.59, P =.015)., Conclusions: Despite being angiographically silent, LM disease detected by IVUS is an independent predictor of cardiac events and may serve as a marker for such events. These data extend the spectrum of LM disease severity and its relationship to cardiac prognosis in patients undergoing PCI.