bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetics of Pediatric Irritability
Authors: Eastman Meridith L. , Moore Ashlee A. , Roberson-Nay Roxann
Published: April 2019

This chapter provides an overview of behavioral and molecular genetics of pediatric irritability. Literature searches using PubMed and PsycInfo databases yielded 37 relevant animal and human studies on irritability. Studies of rodent and primate models initially suggested a genetic etiology for the trait and influenced selection of candidate genes for study in human studies. Behavioral genetic studies of irritability suggest that pediatric irritability is likely influenced by additive genetic and nonshared unique environmental factors, with little to no influence of dominant genetic or shared family environmental factors. Molecular genetic studies have been largely limited to candidate genes with a few emerging genome-wide association studies (GWAS). Results from the candidate gene literature on irritability are inconclusive, and GWAS in clinical populations has yielded limited findings. Future genetic studies of irritability would benefit from the use of appropriate phenotypic measures, adequate sample sizes, and multimethod and longitudinal approaches.
Conclusion
Authors: Raz Amir , Rabipour Sheida
Published: April 2019

“Conclusion: The Case for Brain Training” explores the relative merits and shortcomings of behavioral exercises to preserve, enhance, and restore mental function. It provides the available data and allows the reader to form an educated opinion regarding the present state of affairs and how available interventions may help different crowds.
Biochemical reconstitution of UV-induced mutational processes
Authors: Sugiyama Tomohiko , Chen Yizhang
Published: April 2019

We reconstituted two biochemical processes that may contribute to UV-induced mutagenesis in vitro and analysed the mutational profiles in the products. One process is translesion synthesis (TLS) by DNA polymerases (Pol) δ, η and ζ, which creates C>T transitions at pyrimidine dimers by incorporating two dAMPs opposite of the dimers. The other process involves spontaneous deamination of cytosine, producing uracil in pyrimidine dimers, followed by monomerization of the dimers by secondary UV irradiation, and DNA synthesis by Pol δ. The mutational spectrum resulting from deamination without translesion synthesis is similar to a mutational signature found in melanomas, suggesting that cytosine deamination encountered by the replicative polymerase has a prominent role in melanoma development. However, CC>TT dinucleotide substitution, which is also commonly observed in melanomas, was produced almost exclusively by TLS. We propose that both TLS-dependent and deamination-dependent mutational processes are likely involved in UV-induced melanoma development.
An evaluation of Acute Care of at-Risk Newborns (ACoRN), a Canadian education program, in Chinese neonatal nurseries
Authors: Aziz Khalid , Ma Xiaolu , Lockyer Jocelyn , McMillan Douglas , Ye Xiang Y , Du Lizhong , Lee Shoo K , Singhal Nalini
Published: April 2019

Background

The Acute Care of at-Risk Newborns (ACoRN) program was developed in Canada to train health care providers in the identification and management of newborns who are at-risk and/or become unwell after birth. The ACoRN process follows a stepwise framework that enables evaluation, decision, and action irrespective of caregiver experience. This study examined the hypothesis that the ACoRN educational program improved clinical practices and outcomes in China.

Methods

In a before-and-after study, ACoRN training was provided to physicians, neonatal nurses, and administrators in 16 county hospitals in Zhejiang, PRC. Demographic and clinical data were collected on babies admitted to neonatal units before (May 1, 2008 to March 31, 2009) and after (June 1, 2010 to April 30, 2012) training.

Results

A total of 4,310 babies (1,865 pre- and 2,445 post-training) from 14 sites were included. There were more in-hospital births (97.8% versus 95.6%, P<0.01) in the post-training epoch, fewer babies needing resuscitation (12.7% versus 16.0%, P=0.02), and more babies finishing their care in hospital (67.4% versus 53.1%, P<0.0001). After training, significantly more babies were evaluated as having respiratory distress at admission (14.2% versus 9.4%, P<0.0001); more babies had saturation, glucose and temperature measured on admission and at discharge; and more babies received intravenous fluids (86.3% versus 72.8%, P<0.0001). No significant improvements were noted in mortality (0.49% [post] versus 0.8% [pre], P=0.19 and adjusted odds ratio 0.54, 95% confidence interval: 0.23 to 1.29).

Conclusions

ACoRN training significantly increased patient evaluations and changed clinical practices. However, we were unable to ascertain improvement in morbidity or mortality.
College Cops around the Nation: A 30-Year and 40-Year Update on the State of Higher Education in US Policing
Authors: Gardiner Christine L
Published: April 2019

This article describes the findings of a recent national survey of 958 local (municipal and county) law enforcement agencies on the subject of higher education in US policing. It is the first national study in 30 years to examine the issue and in 40 years to examine higher education in small departments. Findings reveal that minimum education requirements to be hired, which are primarily dictated by state standards, have not changed significantly since 1988 but CEO education has changed and is highly important for agency policy and practice. Although a college degree is not usually required to be hired, it is usually required to promote to higher ranks. About half (51.5%) of sworn officers in the US who work for local agencies have a 2-year degree or higher, 28.6% have a 4-year degree or higher, and 5.4% have a graduate degree but this varies considerably by agency size, type, region, Chief/Sheriff education level, and union presence. Implications for improving education in policing are discussed.
Inputs, Incentives, and Complementarities in Education: Experimental Evidence from Tanzania*
Authors: Mbiti Isaac , Muralidharan Karthik , Romero Mauricio , Schipper Youdi , Manda Constantine , Rajani Rakesh
Published: April 2019

We present results from a large-scale randomized experiment across 350 schools in Tanzania that studied the impact of providing schools with (i) unconditional grants, (ii) teacher incentives based on student performance, and (iii) both of the above. After two years, we find (i) no impact on student test scores from providing school grants, (ii) some evidence of positive effects from teacher incentives, and (iii) significant positive effects from providing both programs. Most important, we find strong evidence of complementarities between the programs, with the effect of joint provision being significantly greater than the sum of the individual effects. Our results suggest that combining spending on school inputs (the default policy) with improved teacher incentives could substantially increase the cost-effectiveness of public spending on education.
Late growing season carbon subsidy in native gymnosperms in a northern temperate forest
Authors: Li Ximeng , Xu Chengyuan , Li Zhengzhen , Feng Jinchao , Tissue David T , Griffin Kevin L
Published: April 2019

Evergreen tree species that maintain positive carbon balance during the late growing season may subsidize extra carbon in a mixed forest. To test this concept of ‘carbon subsidy’, leaf gas exchange characteristics and related leaf traits were measured for three gymnosperm evergreen species (Chamaecyparis thyoides, Tsuga canadensis and Pinus strobus) native to the oak-hickory deciduous forest in northeast USA from March (early Spring) to October (late Autumn) in a single year. All three species were photosynthetically active in Autumn. During the Summer–Autumn transition, photosynthetic capacity (Amax) of T. canadensis and P. strobus increased (T-test, P < 0.001) and was maintained in C. thyoides (T-test, P = 0.49), while dark respiration at 20 °C (Rn) and its thermal sensitivity were generally unchanged for all species (one-way ANOVA, P > 0.05). In Autumn, reductions in mitochondrial respiration rate in the daylight (RL) and the ratio of RL to Rn (RL/Rn) were observed in P. strobus (46.3% and 44.0% compared to Summer, respectively). Collectively, these physiological adjustments resulted in higher ratios of photosynthesis to respiration (A/Rnand A/RL) in Autumn for all species. Across season, photosynthetic biochemistry and respiratory variables were not correlated with prevailing growth temperature. Physiological adjustments allowed all three gymnosperm species to maintain positive carbon balance into late Autumn, suggesting that gymnosperm evergreens may benefit from Autumn warming trends relative to deciduous trees that have already lost their leaves.
Drought-induced mortality in Scots pine: opening the metabolic black box
Authors: MacAllister Sarah , Mencuccini Maurizio , Sommer Ulf , Engel Jasper , Hudson Andrew , Salmon Yann , Dexter Kyle G
Published: April 2019

Forests are sensitive to droughts, which increase the mortality rate of tree species. Various processes have been proposed to underlie drought-induced tree mortality, including hydraulic failure, carbon starvation and increased susceptibility to natural enemies. To give insights into these processes, we assessed the metabolic effects of a mortality-inducing drought on seedlings of Pinus sylvestris L. (Scots Pine), a widespread and important Eurasian species. We found divergence over time in the foliar metabolic composition of droughted vs well-watered seedlings, with the former showing increased abundance of aromatic amino acids and decreases in secondary metabolism associated with defence. We observed no significant differences amongst provenances in these effects: seedlings from drought-prone areas showed the same foliar metabolic changes under drought as seedlings from moist environments, although morphological effects of drought varied by provenance. Overall, our results demonstrate how severe drought prior to death may target particular primary and secondary metabolic pathways, weakening defences against natural enemies and contributing to the risk of drought-induced mortality in P. sylvestris.
Pediatric intervertebral disc calcification: case series and systematic review of the literature
Authors: Coppa Valentino , Marinelli Mario , Martiniani Monia , Giacchetta Anna M. , Gigante Antonio P. , Specchia Nicola
Published: April 2019

Pediatric intervertebral disc calcification (PIDC) is an uncommon disease with an unclear etiology. The clinical picture may suggest a severe spinal disease, thus involving an extensive differential diagnosis. The aim of this study was to find a diagnostic and treatment approach for PIDC on the basis of the literature. The Medline, Embase, Web of Science, and Cochrane Systematic Review databases were searched for relevant studies, whose reference lists were checked manually for additional articles. For each study, year of publication, study design, demographics, onset type, history of trauma, clinical and neurological signs and symptoms, imaging studies performed, blood test results, treatment strategies, and outcomes were recorded. The charts of eight patients with symptomatic PIDC treated at our institution from 2000 to 2016 were reviewed. Of 1522 articles identified by the search, 51 level IV studies involving 91 patients fulfilled the inclusion criteria. Most patients were treated conservatively and achieved complete recovery. Of the 13 patients who were treated surgically, one had a persistent myelopathy at the final follow-up. All the patients of our case series were treated conservatively and achieved complete symptom resolution at the final follow-up. PIDC is predominantly a benign and self-limiting condition. Surgery should be considered only in case of failure of conservative treatment in the presence of severe neurological impairment and myelopathy. Level of Evidence: IV (case series and systematic review of level IV studies).
Risk Adjustment is Necessary for Bundled TKA Patients
Authors: Greenky Max , Della Valle Craig J. , Courtney P. Maxwell
Published: April 2019

With health care costs in the United States rising at an exponential rate, providers, payers, and policymakers have all sought to develop alternative payment models to seek value in care. For procedures such as total knee arthroplasty (TKA), which accounts for Medicare’s largest inpatient expenditure, the Centers for Medicare and Medicaid Services (CMS) and private insurers have introduced bundled payment programs aimed at reducing cost and improving the quality of patient care. Although traditionally, TKA has been reimbursed by Medicare through a fee-for-service model rewarding quantity of services provided versus quality of service, the Bundled Payments for Care Improvement Initiative (BPCI) and the Comprehensive Care for Joint Replacement Model (CJR) seek to align incentives among providers and health care systems by providing a single payment for all services rendered during an episode of care for TKA. Although early published data from these programs suggests substantial cost savings to CMS without an increase in complications, concerns exist regarding access to care for patients who may utilize more resources in an episode of care. Without appropriate risk adjustment, providers are disincentivize to perform TKA on patients at risk for complications and readmissions. Alternative payment models have reduced costs and improved patient outcomes by incentivizing providers to optimize modifiable risk factors before elective TKA, including glycemic control, smoking, body mass index, and malnutrition. Several studies, however, have shown that nonmodifiable risk factors including advanced age, lower socioeconomic status, and several medical and orthopaedic comorbidities are costlier to the health care system following TKA. These patients may face difficulty obtaining quality arthroplasty care with the expansion of bundled payment programs. In order to protect access to care, alternative payment models should not penalize surgeons and hospitals for caring for complex patients and instead provide appropriate, fair, risk-adjusted payments.
Multiple primary melanoma with the Meyerson phenomenon in a young patient
Authors: Fernández-Sartorio Clara , Alós Llúcia , García-Herrera Adriana , Ferrando Juan , Carrera Cristina
Published: April 2019

Meyerson phenomenon (MP), also called halo eczema or halo dermatitis, was first described in 1971 as a symmetric eczematous halo around acquired melanocytic nevi. Since then, cases of MP have been described in any kind of melanocytic nevi and also in non-melanocytic tumors. To the best of our knowledge, only four cases of melanoma associated with MP have been reported. We report the singular case of a young adult diagnosed with two primary melanomas in the context of dysplastic nevi syndrome who presented several flares-up associated with MP in both benign and malignant melanocytic tumors. MP usually manifests as a halo of erythema and scaling similar to plaques of eczema symmetrically surrounding a central cutaneous tumor. Dermoscopic findings of MP show it as similar to other forms of dermatitis. Histopathology usually shows epidermal changes compatible with subacute eczematous dermatitis. Immunohistochemical studies have shown inflammatory infiltrate composed mainly of CD4+ lymphocytes, which supports the suggested pathogenesis of an immune-mediated reaction. It usually resolves spontaneously, and the use of topical corticosteroids has a good response. In conclusion, MP is not specific for benignity, even when multiple simultaneous lesions are affected. Inflammatory changes can make melanocytic lesions difficult to interpret, both on dermoscopic regression features and on histopathologic examination. Therefore, it is recommended to consider the complete excision of melanocytic lesions with atypical vessels and/or extensive regression phenomena more than 50%. Further studies are needed to know whether the presence of a melanoma could induce a remote immune response in other benign melanocytic lesions.
Cost-effectiveness of antiosteoporosis strategies for postmenopausal women with osteoporosis in China
Authors: Li Na , Zheng Bin , Liu Maobai , Zhou Haimei , Zhao Lingfen , Cai Hongfu , Huang Jingze
Published: April 2019

Objective:

Osteoporosis has become an important public health problem in China, especially among elderly postmenopausal women. Massive amounts of medical and health resources have been devoted to patients with osteoporosis and osteoporosis-related fractures. This study estimated the cost-effectiveness of alendronate, zoledronate, raloxifene, teriparatide, and calcium/vitamin D as treatments for osteoporosis in elderly postmenopausal women in China from the medical system perspective.

Methods:

A Markov model was constructed by using TreeAge Pro 2015 software. This model simulated the disease process over 40 years in response to the five investigated therapeutic strategies. Each cycle lasted for 1 year. The model parameters included Chinese epidemiological data, clinical effectiveness, cost, and utility. Total treatment costs and quality-adjusted life-years (QALYs) were estimated, and incremental cost-effectiveness analysis was performed. Univariate and probabilistic sensitivity analyses were conducted to verify the model.

Results:

The calcium/vitamin D strategy, zoledronate, alendronate, teriparatide, and raloxifene offered patients 10.24, 10.83, 10.70, 10.88, and 10.54 QALYs at the cost of $3,799.72, $8,425.61, $9,849.89, $34,843.72, and $13,353.33 for over 40 years, respectively. The alendronate and raloxifene strategies were eliminated because they were less effective and more expensive than the other strategies. The base-case analysis revealed that the incremental cost-effectiveness ratios (ICERs) of the zoledronate strategy relative to those of the calcium/vitamin D strategy were $7,864.59/QALY. This result indicated that the zoledronate strategy was more cost-effective than other strategies and was within the willingness-to-pay threshold of China ($28,624/QALY). The ICERs of the teriparatide versus zoledronate strategies were $4,70,797.08/QALY, which exceeded the threshold.

Conclusion:

From the perspective of the Chinese medical system, zoledronate is more cost-effective than the calcium/vitamin D strategy, alendronate, raloxifene, and teriparatide for the treatment of osteoporosis in elderly postmenopausal women. Not factoring the parameters of adherence and persistence in, and consequent variability in treatment effectiveness relative risks, seems like a major limitation, but it can be speculated that it would not change the conclusion that zoledronate is the most economical strategy.
BLOOD CHROMIUM-COBALT LEVELS IN PATIENTS AFTER TOTAL KNEE ARTHROPLASTY AND THEIR EFFECT ON THE RETINAL NERVE FIBER LAYER AND MACULAR GANGLION CELL COMPLEX
Authors: Oğurel Tevfik , Serbest Sancar , Oğurel Reyhan , Tiftikçi Uğur , Ölmez Yaşar
Published: April 2019

Purpose:

To study blood cobalt (Co) and chromium (Cr) levels in patients who have undergone total knee arthroplasty and their effect on the retinal nerve fiber layer and macular ganglion cell complex.

Methods:

One hundred patients who had undergone total knee arthroplasty and 50 healthy individuals who had no implants were included in the study. The patients were separated into two groups based on how long ago the prosthesis had been implanted (Group 1: 1 to 5 years; Group 2: 5 to 10 years). After a complete ophthalmological examination, retinal nerve fiber layer and macular ganglion cell complex of the patients were evaluated with optical coherence tomography, performed on dilated pupils. To assess the metal ion levels of the patients, venous blood samples were drawn from each patient.

Results:

The mean age of the patients was 64.72 ± 6.26 years in Group 1, 67.80 ± 8.07 years in Group 2, and 63.42 ± 7.90 years in the control group. In the comparison of age and sex, there were no statistically significant differences between the groups and the control group. Co and Cr levels were statistically higher in Group 1 and Group 2 compared with the control group (P < 0.001). Mean retinal nerve fiber layer thicknesses and mean macular ganglion cell complex thicknesses in Group 1 and Group 2 were statistically lower than in the control group.

Conclusion:

Levels of Co and Cr are higher in patients who undergone total knee arthroplasty than healthy subjects, and these higher levels were associated with changes in the retinal nerve fiber layer and macular ganglion cell complex.
Microscope-Integrated Optical Coherence Tomography-Guided Drainage of Acute Corneal Hydrops in Keratoconus Combined With Suturing and Gas-Aided Reattachment of Descemet Membrane
Authors: Siebelmann Sebastian , Händel Alexander , Matthaei Mario , Bachmann Björn , Cursiefen Claus
Published: April 2019

Purpose:

The treatment of acute corneal hydrops due to keratoconus has so far been limited to awaiting the spontaneous resorption of corneal edema, supportive care, and finally keratoplasty. A recent publication describes the surgical reattachment of Descemet Membrane (DM) facilitated by pre-Descemetic sutures and anterior chamber air/gas filling. Here, we present a novel microscope-integrated intraoperative optical coherence tomography (MI-OCT)-guided technique for the immediate reattachment of DM in corneal hydrops due to keratoconus in 2 male patients with small central DM defects.

Methods:

Case series of 2 consecutive patients with acute corneal hydrops due to keratoconus. The novel technique consists of the MI-OCT-guided puncture and drainage of intrastromal fluid pockets combined with anterior chamber sulfur hexafluoride-fill and pre-descemetic sutures using a commercially available MI-OCT (iOCT; Haag Streit Surgical, Wedel, Germany).

Results:

After uneventful surgery, corneal edema showed fast resolution and DM was reattached to the corneal stroma. In both patient's central corneal thickness decreased after surgery and visual acuity improved.

Conclusions:

MI-OCT guided micropuncture of stromal edema combined with compression sutures and SF6 tamponade is a new therapeutic option in acute corneal hydrops with small Descemet membrane defects.
Understanding the Effects of Neonatal Early Discharge on Parents
Authors: Setiawan Jennifer , Mannix Trudi , Sweet Linda
Published: April 2019

A neonatal early discharge (NED) program is a supported process where preterm infants leave hospital before they have established full sucking feeds and are gavage fed by their parents while they transition to breast- and/or bottle-feeds. While there is some evidence in the literature describing the outcomes of this process for preterm infants, there is even more limited evidence of the effects and outcomes of these NED programs on parents. The objective of this study was to summarize and critically appraise the literature regarding the effects of NED on parents. A literature search was conducted for English language publications since 2007 using MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO, and Google Scholar. A total of 20 primary articles met the inclusion criteria for the review. An integrative thematic synthesis identified 4 themes: establishing parenting skills/confidence; bonding with the newborn; psychological distress; and the need for support and resources. Findings suggest that parents have various concerns regarding discharge from the neonatal unit and therefore support from healthcare professionals and family plays a crucial role during the experience. There were also various external factors such as socioeconomic status and cultural differences that impact on parents differently, and it is therefore challenging to draw definite conclusions. This warrants further research in the area.
Barriers to Reproductive Healthcare for Women With Opioid Use Disorder
Authors: Smith Carleigh , Morse Elizabeth , Busby Steven
Published: April 2019

The health impact of opioid use disorder on women and infant health alongside persistent rates of unintended pregnancy calls for better targeted reproductive healthcare for all women, especially those receiving treatment for opioid treatment disorder and decreasing barriers to care. This cross-sectional mixed-methods study explored the reproductive intentions and contraceptive practices of women (N = 50) in medication-assisted treatment of opioid use disorder with a focus on knowledge and use of long-acting reversible contraception (LARC), specifically intrauterine devices and implants. Eighty-four percent of the 50 women interviewed had experienced at least 1 unintended pregnancy, and 30% were using contraceptive methods with high failure rates. Although approximately 75% of women indicated awareness of both forms of LARCs, only 6% reported current or past use of either device. Qualitative results found the greatest barriers to the uptake of LARC were women's expressed fears of complications and inaccurate information from family, friends, and acquaintances. Increasing awareness of the benefits of LARC as ideal contraception for women who may desire a future pregnancy is important for improving reproductive health for women receiving treatment of opioid use disorder.
Rapid Onset of Femoral Head Osteonecrosis After a Single Intra-articular Hip Joint Injection of Corticosteroid
Authors: Thompson Austin R. , Ensrud Erik R.
Published: April 2019

We outline a case in which osteonecrosis of the femoral head developed in temporal association with a single intra-articular injection of corticosteroid (triamcinolone acetonide) in a 72-yr-old woman, resulting in a total hip arthroplasty. We conclude that the risk of developing osteonecrosis after a single intra-articular injection of corticosteroid needs to be considered in the informed consent process.
Does a Web-Based Exercise Programming System Improve Home Exercise Adherence for People With Musculoskeletal Conditions?
Authors: Bennell Kim L. , Marshall Charlotte J. , Dobson Fiona , Kasza Jessica , Lonsdale Chris , Hinman Rana S.
Published: April 2019

Objective

The aim of the study was to evaluate whether a web-based exercise programming system improves adherence to a home exercise program for people with musculoskeletal conditions.

Design

Eligible patients with a musculoskeletal condition presenting to a physical therapist in private practice were randomized to the following: (a) control (home exercise prescribed by therapist’s usual methods) or (b) intervention (home exercise prescribed using a web-based exercise programming system). The primary outcome was self-rated exercise adherence measured at week 3 via 11-point Numeric Rating Scales. Secondary outcomes were satisfaction with exercise delivery and confidence in ability to undertake prescribed exercise. Process measures were also included.

Results

We enrolled 305 participants, with loss to follow-up of 14.5% (22/152) and 13.7% (21/153) in intervention and control groups, respectively. Compared with controls, the intervention group reported higher exercise adherence (mean difference Numeric Rating Scale units (95% confidence intervals): adherence overall −1.0 [−1.6 to −0.3] and regarding number of exercises in session −0.7 [−1.3 to −0.1], number of repetitions −0.8 [−1.4 to −0.2], and number of sessions −1.0 [−1.6 to −0.3]). The intervention group showed greater confidence to exercise than control, with no difference in satisfaction.

Conclusions

A web-based exercise programming system improved home exercise adherence and confidence in ability to undertake exercise, although the clinical relevance of the results needs to be established.
Anabolic-androgenic Steroid Use Among Gynecomastia Patients
Authors: Vojvodic Miliana , Xu Fang Zhou , Cai Runting , Roy Mélissa , Fielding J. Craig
Published: April 2019

Background

Anabolic-androgenic steroids (AAS) are widely implicated in gynecomastia development. Surgery is the definitive treatment for cases persisting after cessation of AAS use. Currently, the relevance of AAS use to the surgical approach of gynecomastia has not been well explored. This study aims to compare patient characteristics, surgical outcomes, and surgical management of gynecomastia correction in AAS users versus nonusers.

Methods

A retrospective cohort study was performed with patients who underwent bilateral gynecomastia reduction surgery between January 2005 and August 2015 by a single surgeon at an academic hospital. Demographic data, AAS usage details, operative documentation, and follow-up outcomes were reviewed.

Results

A total of 964 cases were reviewed. Eleven percent (n = 105) of the patients had a history of AAS use. Compared with non-AAS users, AAS users were older at time of gynecomastia onset (15 years vs 13 years, P < 0.001) and surgery (28 years vs 25 years, P < 0.001). The AAS users had higher body mass index (27.3 kg/m2 vs 25.7 kg/m2, P < 0.001) and a greater proportion of patients self-identified as bodybuilders (40.0% vs 22.4%, P = 0.002). Although no difference was found in the excised bilateral mastectomy volume (92.1 cm3 vs 76.4 cm3, P = 0.20), The AAS users had significantly less lipoaspirate fat volume (250 mL vs 300 mL, P = 0.005). No difference was found in total complication rates. However, AAS users had significantly more revision mastectomy surgeries (3.8% vs 1.1%; P = 0.02).

Conclusions

The unique breast composition of AAS users necessitates a surgical approach with meticulous intraoperative hemostasis and careful glandular excision to minimize recurrence and achieve comparable low complication rates.
Which Fat Processing Can Achieve Optimal Transplantation in Patients With Insufficient Fat Resource?
Authors: Kang Deni , Fu Su , Luan Jie
Published: April 2019

Background

Autologous fat transfer has been widely used in breast augment surgery. The breast fat graft is different form facial, it needs megavolume grafts. However, most Asian women are thin, who often encounter the fat resource insufficiency during breast augmentation. In fact, some processing methods do contribute to great loss of potential fat that could have been grafted. How to choose a best processing method to achieve optimal transfer in patients with insufficient fat resources is fairly important.

Methods

Lipoaspirate was obtained from 10 healthy female patients who underwent liposuction from abdomen. According to the processing methods, 10-mL initial fat grafts divided into 4 groups: decantation (group A), centrifugation (group B), cotton pad (group C), and cell-assisted lipotransfer (CAL) (group D). Lipoaspirate from each group was compared in the vitro and vivo experiments. The content and function of stromal vascular fraction (SVF) were compared as well as lipoaspirate survival after grafting in nude mice.

Results

The SVFs were counted in decantation group 4.32 ± 0.75 × 106/mL, centrifuge group 3.48 ± 0.78 × 106/mL, cotton pad group 1.64 ± 0.84 × 106/mL, CAL group 4.08 ± 0.73 × 106/mL. The decantation group was higher than the cotton pad group (P < 0.05). All the groups' SVFs had capability of multilineage differentiation. The fat graft weight in decantation group: 0.3908 ± 0.023 g, centrifuge group 0.3073 ± 0.015 g, cotton pad group 0.1726 ± 0.019 g, and CAL group 0.2396 ± 0.021 g. The weight of the fat graft in the decantation group was greater than that of the centrifugation group, cotton pad group and CAL group (P < 0.05). There was no significant difference in cell integrity, necrotic cysts and fibrosis between the groups. The vascularization degree in the cotton pad group was lower than that in the decantation group (P < 0.05).

Conclusions

Decantation processing can achieve optimal transplantation in patients who have insufficient fat resources.
Early Breast Angiosarcoma Development After Radiotherapy
Authors: Wei Nicholas J. J. , Crowley Timothy P. , Ragbir Maniram
Published: April 2019

This is a short clinical report depicting an exceptionally early presentation of radiation-induced angiosarcoma and overview of the literature. This case highlights the need for a high level of clinical suspicion in those patients presenting with unresolving cutaneous skin changes after radiotherapy for breast cancer.

Breast-conserving therapy, comprising breast-conserving surgery and adjuvant radiotherapy, has largely replaced mastectomy in the treatment of early-stage breast carcinoma. Breast angiosarcoma is a rare but severe long-term complication associated with postoperative radiotherapy (Int J Radiat Oncol Biol Phys. 2002;52:1231–1237). It often presents as a bluish/purple skin lesion in a breast previously treated for breast cancer. This case explores an unexpectedly early presentation of radiation-induced breast angiosarcoma, which was initially thought to be benign bruising. Management remains challenging and prognosis is poor because of its aggressive local and regional invasion and early metastasis, commonly to the lungs and liver. Early surgical resection with wide margins is the treatment of choice (J Plast Reconstr Aesthet Surg. 2011;64:1036–1042).
Buccal Myomucosal Flap Reconstruction After Resection of Palatal Mucoepidermoid Carcinoma
Authors: Kimia Rotem , Shakir Sameer , Jackson Oksana A. , Nguyen Phuong D.
Published: April 2019

Salivary gland tumors are rare, constituting approximately 0.5% of pediatric malignancies, yet account for over 50% of malignant salivary gland neoplasms, of which a majority are mucoepidermoid carcinomas (MECs). We present a case of MEC involving the palatal minor salivary gland of an adolescent patient successfully reconstructed using buccal myomucosal flap. The subject presented as a 17-year-old male with a painless left hard palatal mass found to have imaging suspicious for minor salivary gland tumor and punch biopsy consistent with a low-grade MEC. The subject underwent wide local excision of a 1.0 × 1.2 cm mass with 1.0 cm margins down to hard palate nasal mucosa excluding the abutting first and second molars of the ipsilateral maxilla. Pathology confirmed low-grade MEC confined to hard palate. Two weeks, thereafter, the subject underwent buccal myomucosal flap reconstruction inset into the palatal defect and divided 2 weeks thereafter. Postoperative course was complicated by a pinpoint oronasal fistula at the posterior aspect of the flap-palate junction requiring reelevation and advancement. The subject subsequently recovered without complication. Mucoepidermoid carcinomas represent rare, malignant minor salivary gland tumors with nonspecific presentations that require multidisciplinary workup and management. The authors recommend reconstruction of resultant palatal defects to prevent progression to oronasal fistulae or speech and swallow impairment.
Patient- and Family-Centered Electroconvulsive Therapy
Authors: Fox Herbert A.
Published: April 2019

This article builds upon prior efforts to improve the quality of electroconvulsive therapy (ECT) practice and care by encouraging the participation of family members in the ECT process. This participation included the presence of a family member or significant other (SO) in the treatment room during the ECT procedure. Suggestions for limiting that presence to the induction process and for providing limited physical contact with the patient are proposed. The participation of the SO during the pretreatment assessment process is encouraged. Because of possible impairment of memory and judgment, accurate information about the patient's condition and intercurrent life events, as provided by the SO, is often crucial. Furthermore, the patient's report may be influenced by the common experience of fear of ECT. Under these circumstances, an alliance with the SO may at times be more crucial than the alliance with the patient. The importance of establishing a therapeutic alliance with both patient and SO is emphasized. An illustrative clinical vignette is provided.
UiO-66-supported Fe catalyst: a vapour deposition preparation method and its superior catalytic performance for removal of organic pollutants in water
Authors: Zhuang Huimin , Chen Bili , Cai Wenjin , Xi Yanyan , Ye Tianxu , Wang Chuangye , Lin Xufeng
Published: April 2019

A vapour deposition (VD) method was established for preparation of the UiO-66-supported Fe (Fe/UiO-66) catalyst, which provided the first case of the metal-organic framework (MOF)-supported Fe catalyst prepared by using the vapour-based method. The Fe loading was around 7.0–8.5 wt% under the present preparation conditions. The crystal structure of UiO-66 was not obviously influenced by the Fe loading, while the surface area significantly decreased, implicating most of the Fe components resided in the pores on UiO-66. The results for the methyl orange (MO) removal tests showed that MO in aqueous solution can be removed by UiO-66 by adsorption, and in contrast, it can be oxidized by H
2
O
2
with the catalysis of Fe/UiO-66. Further catalytic tests showed that Fe/UiO-66 was rather effective to catalyse the oxidation of benzene derivatives like aniline in water in terms of chemical oxygen demand (COD) removal efficiency. The catalytic test results for Fe/UiO-66 were compared to those of Fe/Al
2
O
3
with the same Fe loading and to the catalysts reported in the literature. This paper provides a general strategy for VD preparation of MOF-supported Fe catalyst on the one hand, and new catalysts for removing organic pollutants from water, on the other hand.
Mesoporous Co

x

Sn

(1–
x
)

O
2
as an efficient oxygen evolution catalyst support for SPE water electrolyzer
Authors: Chen Gang , Li Jiakun , Lv Hong , Wang Sen , Zuo Jian , Zhu Lihua
Published: April 2019

SPE water electrolysis is a promising method of hydrogen production owing to its multiple strengths, including its high efficiency, high product purity and excellent adaptability. However, the overpotential of the oxygen evolution reaction process and consumption of Ir during charging in SPE water electrolysis will inevitably result in large energy loss and then high cost. Under these circumstances, we propose a novel 40IrO
2
/Co

x

Sn

(1−
x
)

O
2
(
x
= 0.1, 0.2, 0.3) anode catalyst, where the Co

x

Sn

(1−
x
)

O
2
support is synthesized by a hydrothermal method and IrO
2
is synthesized by a modified Adams fusion method. After modifying the component of Co

x

Sn

(1−
x
)

O
2
, the 40IrO
2
/Co

x

Sn

(1−
x
)

O
2
exhibits an increased specific surface area, electrical conductivity and surface active sites. Moreover, a single cell is fabricated by Pt/C as cathode catalyst, 40IrO
2
/Co

x

Sn

(1−
x
)

O
2
as anode catalyst and Nafion 117 membrane as electrolyte. The 40IrO
2
/Co
0.2
Sn
0.8
O
2
exhibits the lowest overpotential (1.748 V at 1000 mA cm
−2
), and only 0.18 mV h
−1
of voltage increased for 100 h durability test at 1000 mA cm
−2
. Consequently, Co

x

Sn

(1−
x
)

O
2
is a promising anode electrocatalyst support for an SPE water electrolyzer.
Towards a methodology for testing models as hypotheses in the inexact sciences
Authors: Beven Keith
Published: April 2019

This paper reviews the issues involved in treating hydrology as an example of an inexact science faced with significant epistemic uncertainties. It proposes a novel method for developing limits of acceptability for testing hydrological models as hypotheses about how a catchment hydrological system might function. The approach is based only on an analysis of the available observations and the consideration of event mass balance for successive rainfall-runoff events. It is shown that there are many events that are subject to epistemic uncertainties in the input data so that mass balance is not satisfied. The proposed approach allows taking these epistemic uncertainties into account in a pragmatic way before any model runs are made. It is an approach that might be applicable in other areas of environmental science where similar basic principles are fundamental to models, but which might not be satisfied by the observations that are used for model evaluation.
Expression of the neuropeptide SALMFamide-1 during regeneration of the seastar radial nerve cord following arm autotomy
Authors: Byrne Maria , Mazzone Franca , Elphick Maurice R. , Thorndyke Michael C. , Cisternas Paula
Published: April 2019

Arm loss through a separation at a specialized autotomy plane in echinoderms is inextricably linked to regeneration, but the link between these phenomena is poorly explored. We investigated nervous system regeneration post-autotomy in the asteriid seastarCoscinasterias muricata, focusing on the reorganization of the radial nerve cord (RNC) into the ectoneural neuroepithelium and neuropile, and the hyponeural region, using antibodies to the seastar-specific neuropeptide SALMFamide-1 (S1). Parallel changes in the associated haemal and coelomic vessels were also examined. A new arm bud appeared in 3–5 days with regeneration over three weeks. At the nerve stump and in the RNC immediately behind, the haemal sinus/hyponeural coelomic compartments enlarged into a hypertrophied space filled with migratory cells that appear to be involved in wound healing and regeneration. The haemal and coelomic compartments provided a conduit for these cells to gain rapid access to the regeneration site. An increase in the number of glia-like cells indicates the importance of these cells in regeneration. Proximal to the autotomy plane, the original RNC exhibited Wallerian-type degeneration, as seen in disorganized axons and enlarged S1-positive varicosities. The imperative to regrow lost arms quickly is reflected in the efficiency of regeneration from the autotomy plane facilitated by the rapid appearance of progenitor-like migratory cells. In parallel to its specialization for defensive arm detachment, the autotomy plane appears to be adapted to promote regeneration. This highlights the importance of examining autotomy-induced regeneration in seastars as a model system to study nervous system regeneration in deuterostomes and the mechanisms involved with the massive migration of stem-like cells to facilitate rapid recovery.
Non-native species spread in a complex network: the interaction of global transport and local population dynamics determines invasion success
Authors: Seebens Hanno , Briski Elizabeta , Ghabooli Sara , Shiganova Tamara , MacIsaac Hugh J. , Blasius Bernd
Published: April 2019

The number of released individuals, which is a component of propagule pressure, is considered to be a major driver for the establishment success of non-native species. However, propagule pressure is often assumed to result from single or few release events, which does not necessarily apply to the frequent releases of invertebrates or other taxa through global transport. For instance, the high intensity of global shipping may result in frequent releases of large numbers of individuals, and the complexity of shipping dynamics impedes predictions of invasion dynamics. Here, we present a mathematical model for the spread of planktonic organisms by global shipping, using the history of movements by 33 566 ships among 1477 ports to simulate population dynamics for the comb jelly
Mnemiopsis leidyi
as a case study. The degree of propagule pressure at one site resulted from the coincident arrival of individuals from other sites with native or non-native populations. Key to sequential spread in European waters was a readily available source of propagules and a suitable recipient environment. These propagules were derived from previously introduced ‘bridgehead’ populations supplemented with those from native sources. Invasion success is therefore determined by the complex interaction of global shipping and local population dynamics. The general findings probably hold true for the spread of species in other complex systems, such as insects or plant seeds exchanged via commercial trade or transport.
Silicified cell walls as a defensive trait in diatoms
Authors: Pančić Marina , Torres Rocio Rodriguez , Almeda Rodrigo , Kiørboe Thomas
Published: April 2019

Diatoms contribute nearly half of the marine primary production. These microalgae differ from other phytoplankton groups in having a silicified cell wall, which is the strongest known biological material relative to its density. While it has been suggested that a siliceous wall may have evolved as a mechanical protection against grazing, empirical evidence of its defensive role is limited. Here, we experimentally demonstrate that grazing by adult copepods and nauplii on diatoms is approximately inversely proportional to their silica content, both within and among diatom species. While a sixfold increase in silica content leads to a fourfold decrease in copepod grazing, silicification provides no protection against protozoan grazers that directly engulf their prey. We also found that the wall provides limited protection to cells ingested by copepods, since less than 1% of consumed cells were alive in the faecal pellets. Moreover, silica deposition in diatoms decreases with increasing growth rates, suggesting a possible cost of defence. Overall, our results demonstrate that thickening of silica walls is an effective defence strategy against copepods. This suggests that the plasticity of silicification in diatoms may have evolved as a response to copepod grazing pressure, whose specialized tools to break silicified walls have coevolved with diatoms.
Alterations in the gut microflora balance of neonatal wister rats induced with aflatoxin M1 in milk
Authors: Badmos Amina , Oluwafemi Flora
Published: April 2019

Aflatoxin M1 is a metabolite of the most potent aflatoxin, (AFB1) and thus, has been treated and rendered not so toxic, on this basis, its study has been taken for granted. It is the aim of this study to ascertain the toxic nature of AFM1 by determining its effects on microbial flora in the gut of neonatal rats. A dosing experiment was conducted on the neonates, where they were divided into groups and treated with different concentrations of AFM1 using uncontaminated milk as a carrier medium into the rats. The rats were sacrificed; the small and large intestine were harvested and cultured on appropriate selective media for growth of microorganisms. Results show samples from the control group had an uninterrupted microbial community, while the treated group, with increasing doses of AFM1 decreases and depletes the microflora in the gut samples. Lactic acid bacteria were also significantly depleted by AFM1. These findings suggest the capability AFM1 in modifying the gut microbiota in a dose-dependent manner which might result in serious health hazards in neonates.
Shining new lights on chytrid cell biology: quantitative live cell imaging of rhizoid development in an early-diverging fungus
Authors: Laundon Davis , Wheeler Glen , Mock Thomas , Cunliffe Michael
Published: April 2019

Chytridiomycota (Chytrids) are the most basal lineage within the true fungi, however they have largely remained in the dark in terms of their fundamental cell biology. In aquatic ecosystems, chytrids can dominate ‘dark matter’ surveys and are important saprotrophs of recalcitrant organic carbon. They therefore play an integral biogeochemical role in carbon cycling. Unlike ‘higher’ dikaryan fungi that feed via multicellular hyphae, chytrids are unicellular and develop an anucleate rhizoid system that acts as the trophic interface of the cell. Understanding the functions of the rhizoid has the potential to shed light on the trophic biology of ‘dark matter’ chytrids. We applied 3D and 4D live-cell confocal microscopy to morphometrically quantify rhizoid development in the model saprotrophic chytrid Rhizoclosmatium globosum under different nutrient treatments. Rhizoid branching was highest under carbon-rich conditions, whereas under carbon-starved treatments, rhizoids grew significantly longer and were less branched, in what we interpret to be a ‘search strategy’ for nutrient sources. F-actin and the cell wall were identified throughout the rhizoid system. Chemical inhibition of actin and cell wall glucan synthesis induced the development of hyperbranched paramorphs, suggesting that these components underpin rhizoid branching and organising cell polarity at the rhizoid tip. Previous studies have shown that inhibition of these components induces an identical phenotype in dikaryan fungi. These findings represent an important step in understanding the trophic biology of a biogeochemically important microbe and unveil striking similarities in cell development between early-diverging and ‘higher’ dikaryan fungi.