Recommendations in Second Opinion Reports of Neurologic Head and Neck Imaging: Frequency, Referring Clinicians' Compliance, and Diagnostic Yield.

BACKGROUND AND PURPOSE: Second opinion reports of neurologic head and neck imaging are requested with increased regularity, and they may contain a recommendation to the clinician. Our aim was to investigate the frequency and determinants of the presence of a recommendation and the adherence by the referring physician to the recommendation in a second opinion neurology head and neck imaging report and the diagnostic yield of these recommendations. MATERIALS AND METHODS: This retrospective study included 994 consecutive second opinion reports of neurology head and neck imaging examinations performed at a tertiary care center. RESULTS: Of the 994 second opinion reports, 12.2% (121/994) contained a recommendation. An oncologic imaging indication was significantly (P = .030) associated with a lower chance of a recommendation in the second opinion report (OR = .67; 95% CI, 0.46-0.96). Clinicians followed 65.7% (88/134) of the recommendations. None of the investigated variables (patient age, sex, hospitalization status, indication for the second opinion report, experience of the radiologist who signed the second opinion report, strength of the recommendation, and whether the recommendation was made due to apparent quality issues of the original examination) were significantly associated with the compliance of the referring physician to this recommendation. The 134 individual recommendations eventually led to the establishment of 52 (38.2%) benign diagnoses and 28 (20.6%) malignant diagnoses, while no definitive diagnosis could be established in 56 (41.2%) cases. CONCLUSIONS: Recommendations are relatively common in second opinion reports of neurology head and neck imaging examinations, though less for oncologic indications. They are mostly followed by requesting physicians, thus affecting patient management. In most cases, they also lead to the establishment of a diagnosis, hence adding value to patient care.

DNA Origami Nano-Sheets and Nano-Rods Alter the Orientational Order in a Lyotropic Chromonic Liquid Crystal.

Rod-like and sheet-like nano-particles made of desoxyribonucleic acid (DNA) fabricated by the DNA origami method (base sequence-controlled self-organized folding of DNA) are dispersed in a lyotropic chromonic liquid crystal made of an aqueous solution of disodium cromoglycate. The respective liquid crystalline nanodispersions are doped with a dichroic fluorescent dye and their orientational order parameter is studied by means of polarized fluorescence spectroscopy. The presence of the nano-particles is found to slightly reduce the orientational order parameter of the nematic mesophase. Nano-rods with a large length/width ratio tend to preserve the orientational order, while more compact stiff nano-rods and especially nano-sheets reduce the order parameter to a larger extent. In spite of the difference between the sizes of the DNA nano-particles and the rod-like columnar aggregates forming the liquid crystal, a similarity between the shapes of the former and the latter seems to be better compatible with the orientational order of the liquid crystal.

Ferroelectric Liquid Crystals in Microcapillaries: Observation of Different Electro-optic Switching Mechanisms.

Ferroelectric liquid crystals (FLCs) can provide fast electro-optic switching effects in photonic crystal fibers, which are promising for developing integrated optical modulators to be used for optical telecommunication. The present study describes experiments on capillaries filled with FLCs, which pave the way toward application of FLCs in state-of-the-art solid core microstructured optical fibers. A method to achieve uniform alignment of the helix axis and the appearance of two different switching modes with switching times in the submillisecond range are found. An additional slow relaxation that was reported recently can be attributed to space charge fields, which may appear due to the migration of ions.

[The Significance of Early Reposition in Patients with Visible Malposition of the Upper Ankle Joint]. / Stellenwert der frühzeitigen Reposition bei sichtbarer Luxation im oberen Sprunggelenk.

Background: Protracted dislocation of the upper ankle joint can lead to substantial damage to the surrounding soft tissue, possibly followed by local complications and longer hospitalisation. Although reposition is usually easy to conduct, it is commonly recommended that this should only be performed by an experienced specialist, as long as there is no neurovascular restriction. There are however no exact data or studies on this problem. The aim of the present study is to examine whether early reposition is of benefit for subsequent treatment. Methods: Retrospective study of all patients in a supra-regional trauma centre during the period from January 2009 to July 2015, with either prehospital reposition of the ankle joint because of visible malposition or documented visible malposition on arrival at hospital. Patients with relevant concomitant injuries elsewhere were excluded. Data on the duration of dislocation were matched with diagnostic findings at the time of hospital admission, the kind of primary care, local complications and the time of hospitalisation, using linear regression analysis and ANOVA calculations. Results: Of a total of 391 patients with a dislocation or a fracture dislocation of the ankle joint within this period, 132 fulfilled the inclusion criteria. These patients were divided into 5 groups on the basis of the time of dislocation. Time to reposition was less than one hour for 39 patients, between one and two hours for 29 patients, between two and six hours for 41 patients, between six and 24 hours for 13 patients and more than 24 hours for 10 patients, all with a visible dislocation. The results on admission showed a significant increase in skin bruises and tension bullae with increasing time of dislocation. A longer time of dislocation was associated with more two stage surgical procedures with external fixators and a decreasing number of single stage procedures. While there was immediate definitive treatment of 79.5 % of the patients in the first group, this figure decreased continuously to 10.0 % in the last group. The number of local complications increased significantly in every group with the duration of dislocation. In particular, the incidence of severe swelling, wound healing disorders, skin necrosis and the need for revision surgery and plastic reconstruction exhibit a significant linear increase within the groups (p < 0.05). The incidence of severe swelling rose from 10.3 % in the first group, to 31.0 % in the second group, to 100 % in the last group. The incidence of wound healing disorders rose from 7.7 to 13.8 to 80 % and the incidence of skin necrosis from 2.6 to 3.5 to 30.0 %. The duration of hospitalisation also exhibited a significant linear increase with group affiliation (p < 0.001), from 8.3 days in the first group to 12.5 days in the second group and 30.5 days in the last group. Conclusion: This study shows the importance of conducting reposition of the ankle joint as soon as possible if there is visible malposition, in order to avoid local complications and longer hospitalisation. If there is visible malposition of the ankle joint, the best procedure is immediate - ideally prehospital - reposition and in-axis splinting, in order to preserve soft tissue.

Influence of Proton and Salt Concentration on the Chromonic Liquid Crystal Phase Diagram of Disodium Cromoglycate Solutions: Prospects and Limitations of a Host for DNA Nanostructures.

Lyotropic chromonic liquid crystals have recently been suggested for use as a self-organized host for dispersing and aligning self-organized DNA origami nanostructures. However, an appropriate pH value and a suitable cation concentration are necessary to stabilize such nanostructures and to avoid unfolding of the DNA. The present study shows that the nematic and columnar liquid crystal phases appearing in aqueous solutions of disodium cromoglycate are robust against the replacement of deionized water by a neutral or alkaline buffer solution. However, disodium cromoglycate precipitates when an acidic buffer is used or when the concentration of magnesium cations exceeds a critical concentration of about 0.6-0.7 mmol/L.

Self-organized assemblies of colloidal particles obtained from an aligned chromonic liquid crystal dispersion.

The behavior of mono-disperse colloidal particles in a chromonic liquid crystal was investigated. Poly(methyl methacrylate) spherical particles with three different functionalizations, with and without surface charges, were utilized in the nematic and columnar phases of disodium cromoglycate solutions. The nematic phase was completely aligned parallel to the glass substrates by a simple rubbing technique, and the columnar phase showed regions of similar alignment. The behavior of the colloidal particles in the chromonic liquid crystal depended critically on the functionality, with bromine functionalized particles not dispersing at all, and cationic trimethylammonium and epoxy functionalized particles dispersing well in the isotropic phase of the liquid crystal. At the transition to the nematic and especially the columnar phase, the colloidal particles were expelled into the remaining isotropic phase. Since the columnar phase grew in parallel ribbons, the colloidal particles ended up in chain-like assemblies. Such behavior opens the possibility of producing patterned assemblies of colloidal particles by taking advantage of the self-organized structure of chromonic liquid crystals.

Columnar molecular aggregation in the aqueous solutions of disodium cromoglycate.

Stack, chimneylike, and threadlike assemblies have previously been proposed for the structure of disodium cromoglycate (DSCG) aggregates in aqueous solutions. The results of the synchrotron x-ray scattering investigations reported here reveal the formation of simple columnar assemblies with π-π stacking at a separation of 3.4 Å between the DSCG molecules. Lateral separation between the assemblies is concentration and temperature dependent, varying from ∼35 to 42 Å in the orientationally ordered nematic (N) phase and from 27 to 32 Å in the columnar or middle (M) phase having long range lateral positional order. The assemblies' length depends on concentration and consists of ∼23 molecules in the N phase, becoming three to ten times larger in the M phase. The scission energy is concentration dependent in the N phase with values ∼7.19 ± 0.14 k_{B}T (15 wt %), 2.73 ± 0.4 k_{B}T (20 wt %), and 3.05 ± 0.2 k_{B}T (25 wt %). Solutions of all concentrations undergo a spinodal decomposition at temperatures above ∼40 °C, resulting in DSCG-rich regions with the M phase and water-rich regions in the N and isotropic phases.

Synthesis of liquid crystal silane-functionalized gold nanoparticles and their effects on the optical and electro-optic properties of a structurally related nematic liquid crystal.

Chemically and thermally robust liquid crystal silane-functionalized gold nanoparticles (i.e. AuNP1-AuNP3) were synthesized through silane conjugation. Colloidal dispersions of these particles with mesogenic ligands that are structurally identical (as in AuNP1, AuNP2) or compatible (as in AuNP3) with molecules of the nematic liquid crystal (N-LC) host showed superior colloidal stability and dispersibility. The thermal, optical, and electro-optic behaviors of the N-LC composites at different concentrations of each gold nanoparticle were investigated. All dispersions showed lower values for the rotational viscosity and elastic constant, but only AuNP3 with a dissimilar structure between the nanoparticle ligand and the host displayed the most drastic thermal effects and overall strongest impact on the electro-optic properties of the host. The observed results were explained considering both the structure and the density of the surface ligands of each gold nanoparticle.

Nanoparticle doping in nematic liquid crystals: distinction between surface and bulk effects by numerical simulations.

Doping nematic liquid crystals with small amounts of nanoparticles can significantly alter the electro-optic response of the nematic host. Some of these effects result from nanoparticles influencing the liquid crystal/substrate interface, while other effects are caused by nanoparticles in the bulk. So far, little attention has been paid to the influence of surface interactions on the determination of bulk properties. In the present study, these effects are investigated experimentally and confirmed by numerical simulations. The splay-type Fréedericksz-transition of the nematic liquid crystal 5CB doped with CdSe quantum dots is investigated, as these dispersions are known from earlier studies to affect the initial alignment layers. In comparison, dispersions of chemically and thermally stable silanized gold nanoparticles in the apolar nematic host FELIX-2900-03 are analyzed, which are expected to be bulk-active only. A data fitting routine is presented which allows a distinction between bulk and surface effects of nanoparticle doping. For the quantum dots, an increase of pretilt angle proportional to the doping concentration is found, as well as a slight decrease of the anchoring energy of molecules at the confining substrates. The silanized gold particles show no influence on the boundary conditions up to doping concentrations of 2.5 % (w). For higher concentrations an increase of pretilt angle is reported.

Effect of natural genetic variation on enhancer selection and function.

The mechanisms by which genetic variation affects transcription regulation and phenotypes at the nucleotide level are incompletely understood. Here we use natural genetic variation as an in vivo mutagenesis screen to assess the genome-wide effects of sequence variation on lineage-determining and signal-specific transcription factor binding, epigenomics and transcriptional outcomes in primary macrophages from different mouse strains. We find substantial genetic evidence to support the concept that lineage-determining transcription factors define epigenetic and transcriptomic states by selecting enhancer-like regions in the genome in a collaborative fashion and facilitating binding of signal-dependent factors. This hierarchical model of transcription factor function suggests that limited sets of genomic data for lineage-determining transcription factors and informative histone modifications can be used for the prioritization of disease-associated regulatory variants.

X-ray scattering of nematic liquid crystal nanodispersion with negative dielectric anisotropy [Invited].

A nematic liquid crystal (LC) mixture was doped with harvested ferroelectric BaTiO3 nanoparticles and investigated with wide- and small-angle x-ray scattering upon heating from the nematic to the isotropic phase. At moderate temperatures, colloidal crystallites were observed. LC test cells with homeotropic anchoring were placed in the x-ray beam and the realignment of the LC director was investigated upon applying an electric field.

Hydrophobic gold nanoparticles via silane conjugation: chemically and thermally robust nanoparticles as dopants for nematic liquid crystals.

We examine for the first time how chemically and thermally stable gold nanoparticles (NPs), prepared by a silane conjugation approach, affect both the thermal and the electro-optical properties of a nematic liquid crystal (LC), when doped at concentrations ranging from 0.25 to 7.5 wt%. We find that the octadecylsilane-conjugated gold NPs stabilize both the enantiotropic nematic and the monotropic smectic-A phases of the LC host with a maximum stabilization of 2(°)C for the nematic and 3.5(°)C for the smectic-A phases for the mixture containing 1 wt% of the silanized particles. The same mixture shows the lowest values for the Fréedericksz transition threshold voltage and the highest value for the dielectric anisotropy. Generally, all NP-containing mixtures, except mixtures with NP concentrations exceeding 5 wt%, reduce the threshold voltage, increase the dielectric anisotropy and reduce both rise and decay time; the latter particularly at temperatures at least 10(°)C below the isotropic-nematic phase transition on cooling.

Bilayers in nanoparticle-doped polar mesogens.

Structures of the mesophases of five members of the 4-n-alkyl-4'-cyanobiphenyl homologous series (4-n-butyl-4'-cyanobiphenyl to 4-n-octyl-4'-cyanobiphenyl) doped with milled BaTiO_{3} nanoparticles were investigated by x-ray scattering. Clear solutions of each of the 4-n-alkyl-4'-cyanobiphenyls were first prepared in n-heptane and then doped with an n-heptane/nanoparticle dispersion, which led to gelation. The nanogels were found to be one-dimensional, multilayered, smectic nanostructures in each case. Surprisingly, a characteristic layer spacing of 4.5 nm was observed in all five homologues. Synchrotron x-ray scattering study of the multilayer structures of doped 4-n-pentyl-4'-cyanobiphenyl and 4-n-octyl-4'-cyanobiphenyl revealed nine orders of the primary Bragg reflection which were used to calculate the electron density profiles of the multilayers by Fourier analysis. The multilayers were found to consist of molecular bilayers wherein the mesogens were arranged in a head-to-head assembly of the polar head groups. The alkyl tails of the mesogenic molecules were freely movable and the tail-to-tail assembly was stabilized by heptane. The dissolved nanoparticles clearly induced a new self-assembled nanostructure in which the rigid aromatic part, and not the overall length, of the molecules defined the layer spacing.

Planar anchoring strength and pitch measurements in achiral and chiral chromonic liquid crystals using 90-degree twist cells.

Chromonic liquid crystals are formed by molecules that spontaneously assemble into anisotropic structures in water. The ordering unit is therefore a molecular assembly instead of a molecule as in thermotropic liquid crystals. Although it has been known for a long time that certain dyes, drugs, and nucleic acids form chromonic liquid crystals, only recently has enough knowledge been gained on how to control their alignment so that studies of their fundamental liquid crystal properties can be performed. In this article, a simple method for producing planar alignment of the nematic phase in chromonic liquid crystals is described, and this in turn is used to create twisted nematic structures of both achiral and chiral chromonic liquid crystals. The optics of 90-degree twist cells allows the anchoring strength to be measured in achiral systems, which for this alignment technique is quite weak, about 3×10(-7) J/m(2) for both disodium cromoglycate and Sunset Yellow FCF. The addition of a chiral amino acid to the system causes the chiral nematic phase to form, and similar optical measurements in 90-degree twist cells produce a measurement of the intrinsic pitch of the chiral nematic phase. From these measurements, the helical twisting power for L-alanine is found to be (1.1±0.4)×10(-2) µm(-1) wt%(-1) for 15 wt% disodium cromoglycate.

Doping a mixture of two smectogenic liquid crystals with barium titanate nanoparticles.

A mixture of two smectic liquid crystals was doped with harvested ferroelectric barium titanate nanoparticles and investigated with wide- and small-angle X-ray scattering during cooling from the isotropic phase. A decrease in the isotropic to nematic and in the nematic to partially bilayer smectic-A(d) (SmA(d)) phase transition temperatures was observed accompanied by an increase of the layer spacing in the SmA(d) phase.

Doping the nematic liquid crystal 5CB with milled BaTiO3 nanoparticles.

The simple nematic mesogen 5CB was doped with milled BaTiO3 nanoparticles and was investigated with x-ray scattering. Doping with BaTiO3 nanoparticles of 9 nm in diameter led to the formation of crystallites. These crystallites precipitated and formed a waxlike nanodispersion of 5CB and nanoparticles, which led to intense x-ray scattering signals characteristic of a multilayer structure. Surprisingly, the multilayers possess unusual interlayer spacing, which cannot be explained by simple smectic order of the calamitic molecules.

Bilateral ovarian well-differentiated Sertoli-Leydig cell tumors with heterologous elements associated with unilateral serous cystadenoma--a case report.

Bilateral Sertoli-Leydig cell tumors (SLCTs) of the ovary, especially in association with a cystadenoma, are exceedingly rare. Some SLCTs, usually of poor differentiation, show heterologous elements. We present a case of a 61-year-old woman with bilateral well-differentiated SLCTs in which the Sertoli-Leydig cell component showed leiomyogenic (heterologous) differentiation. Furthermore, on the left side it also was associated with a serous cystadenoma.

Tuning quantum-dot based photonic devices with liquid crystals.

Microdisks made from GaAs with embedded InAs quantum dots are immersed in the liquid crystal 4-cyano-4'-pentylbiphenyl (5CB). The quantum dots serve as emitters feeding the optical modes of the photonic cavity. By changing temperature, the liquid crystal undergoes a phase transition from the isotropic to the nematic state, which can be used as an effective tuning mechanism of the photonic modes of the cavity. In the nematic state, the uniaxial electrical anisotropy of the liquid crystal molecules can be exploited for orienting the material in an electric field, thus externally controlling the birefringence of the material. Using this effect, an electric field induced tuning of the modes is achieved. Numerical simulations using the finite-differences time-domain (FDTD) technique employing an anisotropic dielectric medium allow to understand the alignment of the liquid crystal molecules on the surface of the microdisk resonator.