bluuebunny/crossref_metadata_2025 huggingface dataset:
Near doubling of Brazil’s intensive row crop area since 2000
Authors: Zalles Viviana , Hansen Matthew C. , Potapov Peter V. , Stehman Stephen V. , Tyukavina Alexandra , Pickens Amy , Song Xiao-Peng , Adusei Bernard , Okpa Chima , Aguilar Ricardo , John Nicholas , Chavez Selena
Published: December 2018

Significance

As Brazil’s cropland expands as a result of increasing demand for commodity crops, new croplands replace existing land covers and land uses. Our study employs the most spatially detailed historical record of satellite imagery available to show that the area of intensive row cropping in Brazil nearly doubled from 2000 to 2014 mainly because of the repurposing of pastures (80% of new cropland) rather than conversion of natural vegetation (20%). Trends of cropland expansion through time may be linked to land use policies, market conditions, and other factors. Although evidence suggests that land use policies slowed cropland expansion within Amazon rainforests, no such decrease was found for Cerrado savannas, which experienced 2.5 times the natural vegetation conversion of the Amazon biome.
Estimating the proportion of bystander selection for antibiotic resistance among potentially pathogenic bacterial flora
Authors: Tedijanto Christine , Olesen Scott W. , Grad Yonatan H. , Lipsitch Marc
Published: December 2018

Bystander selection—the selective pressure for resistance exerted by antibiotics on microbes that are not the target pathogen of treatment—is critical to understanding the total impact of broad-spectrum antibiotic use on pathogenic bacterial species that are often carried asymptomatically. However, to our knowledge, this effect has never been quantified. We quantify bystander selection for resistance for a range of clinically relevant antibiotic–species pairs as the proportion of all antibiotic exposures received by a species for conditions in which that species was not the causative pathogen (“proportion of bystander exposures”). Data sources include the 2010–2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, the Human Microbiome Project, and additional carriage and etiological data from existing literature. For outpatient prescribing in the United States, we find that this proportion over all included antibiotic classes is over 80% for eight of nine organisms of interest. Low proportions of bystander exposure are often associated with infrequent bacterial carriage or concentrated prescribing of a particular antibiotic for conditions caused by the species of interest. Applying our results, we roughly estimate that pneumococcal conjugate vaccination programs result in nearly the same proportional reduction in total antibiotic exposures of
Streptococcus pneumoniae
,
Staphylococcus aureus
, and
Escherichia coli
, despite the latter two organisms not being targeted by the vaccine. These results underscore the importance of considering antibiotic exposures of bystanders, in addition to the target pathogen, in measuring the impact of antibiotic resistance interventions.
Catalyst discovery through megalibraries of nanomaterials
Authors: Kluender Edward J. , Hedrick James L. , Brown Keith A. , Rao Rahul , Meckes Brian , Du Jingshan S. , Moreau Liane M. , Maruyama Benji , Mirkin Chad A.
Published: December 2018

Significance

Discovering new materials is traditionally a slow process, as the materials genome encompasses a massive parameter space, particularly on the nanoscale where synthesis methods are less universal. To overcome this challenge, a cantilever-free lithography method has been used to deposit millions of discrete nanoreactors on a substrate, which can be transformed into millions of nanoparticles spatially encoded in terms of composition and size. These compositions were screened for their ability to catalytically grow carbon nanotubes, and a composition (Au
3
Cu) was identified as optimum for this application. More generally, this combinatorial method of synthesizing nanoparticle megalibraries offers researchers a platform for identifying structures with desired properties at a rate not previously possible.
Structural determinants driving homoserine lactone ligand selection in the
Pseudomonas aeruginosa
LasR quorum-sensing receptor
Authors: McCready Amelia R. , Paczkowski Jon E. , Henke Brad R. , Bassler Bonnie L.
Published: December 2018

Quorum sensing is a cell–cell communication process that bacteria use to orchestrate group behaviors. Quorum sensing is mediated by signal molecules called autoinducers. Autoinducers are often structurally similar, raising questions concerning how bacteria distinguish among them. Here, we use the
Pseudomonas aeruginosa
LasR quorum-sensing receptor to explore signal discrimination. The cognate autoinducer, 3OC
12
homoserine lactone (3OC
12
HSL), is a more potent activator of LasR than other homoserine lactones. However, other homoserine lactones can elicit LasR-dependent quorum-sensing responses, showing that LasR displays ligand promiscuity. We identify mutants that alter which homoserine lactones LasR detects. Substitution at residue S129 decreases the LasR response to 3OC
12
HSL, while enhancing discrimination against noncognate autoinducers. Conversely, the LasR L130F mutation increases the potency of 3OC
12
HSL and other homoserine lactones. We solve crystal structures of LasR ligand-binding domains complexed with noncognate autoinducers. Comparison with existing structures reveals that ligand selectivity/sensitivity is mediated by a flexible loop near the ligand-binding site. We show that LasR variants with modified ligand preferences exhibit altered quorum-sensing responses to autoinducers in vivo. We suggest that possessing some ligand promiscuity endows LasR with the ability to optimally regulate quorum-sensing traits.
Cysteinyl leukotriene 2 receptor promotes endothelial permeability, tumor angiogenesis, and metastasis
Authors: Duah Ernest , Teegala Lakshminarayan Reddy , Kondeti Vinay , Adapala Ravi K. , Keshamouni Venkateshwar G. , Kanaoka Yoshihide , Austen K. Frank , Thodeti Charles K. , Paruchuri Sailaja
Published: December 2018

Significance

Cysteinyl leukotrienes (cys-LTs) are proinflammatory mediators and regulate endothelial cell contraction, permeability, and angiogenesis via a cys-LT receptor, CysLT
2
R. In response to the challenges of finding therapies that can combat tumor angiogenesis and metastases, we explored the advantage of targeting this receptor. We show that CysLT
2
R mediates tumor angiogenesis and contributes to metastasis in vivo independent of VEGF by enhancing leakiness and permeability of blood vessels. We propose that a CysLT
2
R antagonist, BayCysLT
2
, can normalize vessels, reducing tumor growth and metastasis.
Structure of the lipoprotein lipase–GPIHBP1 complex that mediates plasma triglyceride hydrolysis
Authors: Birrane Gabriel , Beigneux Anne P. , Dwyer Brian , Strack-Logue Bettina , Kristensen Kristian Kølby , Francone Omar L. , Fong Loren G. , Mertens Haydyn D. T. , Pan Clark Q. , Ploug Michael , Young Stephen G. , Meiyappan Muthuraman
Published: December 2018

Lipoprotein lipase (LPL) is responsible for the intravascular processing of triglyceride-rich lipoproteins. The LPL within capillaries is bound to GPIHBP1, an endothelial cell protein with a three-fingered LU domain and an N-terminal intrinsically disordered acidic domain. Loss-of-function mutations in
LPL
or
GPIHBP1
cause severe hypertriglyceridemia (chylomicronemia), but structures for LPL and GPIHBP1 have remained elusive. Inspired by our recent discovery that GPIHBP1’s acidic domain preserves LPL structure and activity, we crystallized an LPL–GPIHBP1 complex and solved its structure. GPIHBP1’s LU domain binds to LPL’s C-terminal domain, largely by hydrophobic interactions. Analysis of electrostatic surfaces revealed that LPL contains a large basic patch spanning its N- and C-terminal domains. GPIHBP1’s acidic domain was not defined in the electron density map but was positioned to interact with LPL’s large basic patch, providing a likely explanation for how GPIHBP1 stabilizes LPL. The LPL–GPIHBP1 structure provides insights into mutations causing chylomicronemia.
Leisure experience in protected areas as a source of sense of place: what do visitors say? / La experiencia de ocio en áreas silvestres protegidas como fuente de sentidos del lugar: ¿Qué dicen los visitantes?
Authors: Ried Andrés , Ayala Cristián , Carmody Stephanie , Le Bon Anne , Santos Rodrigo , Smart Ignacia
Published: December 2018

The literature has approached the issue of leisure experience in protected areas from different theoretical and methodological angles, establishing, among other questions, the need to explore approaches capable of explaining the sense of place established by visitors to natural protected areas based on their leisure experiences and the influence exerted on this construction by sociodemographic variables and preferences. Taking a quantitatively driven mixed approach, a total of 704 tourists were surveyed in three national parks in Chile, and the findings included the following: (1) the most significant variable when it comes to constructing senses of place lies in the opportunity for visitors to enjoy their desired leisure experiences; (2) the levels of the different dimensions of sense of place vary according to gender, age, ethnic origin and quality of the leisure offer; and (3) confirmation of the emerging and multidimensional nature of leisure experience in contact with nature.
What are the politics of love?
Authors: Mitchell Roger Haydon
Published: December 2018

Beginning with the examples of Jeremy Corbyn's and Bishop Michael Curry's appeal to love, the article exposes love as an alternative power to sovereignty. Taking three seminal insights from African American Professor Bell Hooks on the importance of love's definition, love as a force and the rootedness of love in childhood experience, the article examines the etymology of the word love and the political implications of recent sociological research. Then taking note of alternative voices, contemporary advocates of the politics of love are considered and focus brought to the critical issue of breaking free from the normative default to sovereign power. Resources for societal restoration and well-being are presented with particular reference to the Christian myths of incarnation and trinity and their practical application in the post-secular world. Finally tools for healing and restoration at both the individual and corporate level are considered, and their impact within contemporary initiatives.
Research progress in protein posttranslational modification site prediction
Authors: He Wenying , Wei Leyi , Zou Quan
Published: December 2018

Posttranslational modifications (PTMs) play an important role in regulating protein folding, activity and function and are involved in almost all cellular processes. Identification of PTMs of proteins is the basis for elucidating the mechanisms of cell biology and disease treatments. Compared with the laboriousness of equivalent experimental work, PTM prediction using various machine-learning methods can provide accurate, simple and rapid research solutions and generate valuable information for further laboratory studies. In this review, we manually curate most of the bioinformatics tools published since 2008. We also summarize the approaches for predicting ubiquitination sites and glycosylation sites. Moreover, we discuss the challenges of current PTM bioinformatics tools and look forward to future research possibilities.
Controlled Human Malaria Infection of Healthy Adults With Lifelong Malaria Exposure to Assess Safety, Immunogenicity, and Efficacy of the Asexual Blood Stage Malaria Vaccine Candidate GMZ2
Authors: Dejon-Agobe Jean Claude , Ateba-Ngoa Ulysse , Lalremruata Albert , Homoet Andreas , Engelhorn Julie , Nouatin Odilon Paterne , Edoa Jean Ronald , Fernandes José F , Esen Meral , Mouwenda Yoanne Darelle , Betouke Ongwe Eunice M , Massinga-Loembe Marguerite , Hoffman Stephen L , Sim B Kim Lee , Theisen Michael , Kremsner Peter G , Adegnika Ayôla A , Lell Bertrand , Mordmüller Benjamin
Published: December 2018

Background

GMZ2 is a recombinant malaria vaccine inducing immune responses against Plasmodium falciparum (Pf) merozoite surface protein-3 and glutamate-rich protein. We used standardized controlled human malaria infection (CHMI) to assess the efficacy of this asexual blood-stage vaccine.

Methods

We vaccinated 50 healthy, adult volunteers with lifelong exposure to Pf 3 times, at 4-week intervals, with 30 or 100 µg GMZ2 formulated in CAF01, a liposome-based adjuvant; 100 µg GMZ2, formulated in Alhydrogel; or a control vaccine (Verorab). Approximately 13 weeks after the last vaccination, 35/50 volunteers underwent CHMI by direct venous inoculation of 3200 Pf sporozoites (Sanaria® PfSPZ Challenge).

Results

Adverse events were similarly distributed between GMZ2 and control vaccinees. Baseline-corrected anti-GMZ2 antibody concentrations 4 weeks after the last vaccination were higher in all 3 GMZ2-vaccinated arms, compared to the control group. All GMZ2 formulations induced similar antibody levels. CHMI resulted in 29/34 (85%) volunteers with Pf parasitemia and 15/34 (44%) with malaria (parasitemia and symptoms). The proportion of participants with malaria (2/5 control, 6/10 GMZ2-Alhydrogel, 2/8 30 µg GMZ2-CAF01, and 5/11 100 µg GMZ2-CAF01) and the time it took them to develop malaria were similar in all groups. Baseline, vaccine-specific antibody concentrations were associated with protection against malaria.

Conclusions

GMZ2 is well tolerated and immunogenic in lifelong–Pf-exposed adults from Gabon, with similar antibody responses regardless of formulation. CHMI showed no protective effect of prior vaccination with GMZ2, although baseline, vaccine-specific antibody concentrations were associated with protection. CHMI with the PfSPZ Challenge is a potent new tool to validate asexual, blood-stage malaria vaccines in Africa.

Clinical Trials Registration

Pan-African Clinical Trials: PACTR201503001038304
Global Typhoid Fever Incidence: A Systematic Review and Meta-analysis
Authors: Marchello Christian S , Hong Chuen Yen , Crump John A
Published: December 2018

Background

Contemporary incidence estimates of typhoid fever are needed to guide policy decisions and control measures and to improve future epidemiological studies.

Methods

We systematically reviewed 3 databases (Ovid Medline, PubMed, and Scopus) without restriction on age, country, language, or time for studies reporting the incidence of blood culture–confirmed typhoid fever. Outbreak, travel-associated, and passive government surveillance reports were excluded. We performed a meta-analysis using a random-effects model to calculate estimates of pooled incidence, stratifying by studies that reported the incidence of typhoid fever and those that estimated incidence by using multipliers.

Results

Thirty-three studies were included in the analysis. There were 26 study sites from 16 countries reporting typhoid cases from population-based incidence studies, and 17 sites in 9 countries used multipliers to account for underascertainment in sentinel surveillance data. We identified Africa and Asia as regions with studies showing high typhoid incidence while noting considerable variation of typhoid incidence in time and place, including in consecutive years at the same location. Overall, more recent studies reported lower typhoid incidence compared to years prior to 2000. We identified variation in the criteria for collecting a blood culture, and among multiplier studies we identified a lack of a standardization for the types of multipliers being used to estimate incidence.

Conclusions

Typhoid fever incidence remains high at many sites. Additional and more accurate typhoid incidence studies are needed to support country decisions about typhoid conjugate vaccine adoption. Standardization of multiplier types applied in multiplier studies is recommended.
The hospital results and 1-year outcomes of transcatheter aortic valve-in-valve procedures and transcatheter aortic valve implantations in the native valves: the results from the Swiss-TAVI Registry
Authors: Ferrari Enrico , Stortecky Stefan , Heg Dik , Muller Olivier , Nietlispach Fabian , Tueller David , Toggweiler Stefan , Noble Stéphane , Maisano Francesco , Roffi Marco , Jeger Raban , Grünenfelder Jürg , Huber Christoph , Windecker Stephan , Wenaweser Peter
Published: December 2018

OBJECTIVES

The SwissTAVI Registry includes all consecutive patients undergoing transcatheter aortic valve implantation (TAVI) and valve-in-valve (VinV) procedures for a failed bioprosthesis in Switzerland. We report the real world, all-comers, 30-day and 1-year outcomes of patients undergoing VinV and standard TAVI procedures.

METHODS

Prospectively collected data from the 2 groups (VinV and standard TAVI patients) were retrospectively analysed. In an adjusted analysis, in-hospital and 1-year outcomes of VinV patients were compared with those of patients undergoing TAVI for native aortic valve disease in the same registry. A subanalysis of VinV procedures in stenotic or regurgitant bioprosthesis was also performed.

RESULTS

Between February 2011 and December 2016, 4599 and 157 consecutive patients underwent TAVI in native aortic valves and VinV procedures in degenerate bioprosthesis, respectively. VinV patients were younger (78 ± 9.1 years vs 82.2 ± 6.3 years; P < 0.001) but at a higher risk for surgery (the logistic EuroSCORE: 28.48 ± 15.3% vs 18.2 ± 13.6%; P < 0.001; the Society of Thoracic Surgery (STS) score: 6.4 ± 5% vs 5.5 ± 4.3%; P = 0.008). Valve predilatation was less frequently performed during VinV procedures (22.9% vs 69.1%; P < 0.001), and the hospital stay was shorter after VinV procedure (8.46 ± 4.2 days vs 9.83 ± 6 days; P = 0.005). VinV patients showed higher predischarge transvalvular mean gradients (14.14 ± 7.9 mmHg vs 8.42 ± 5.0 mmHg; P < 0.001), smaller mean valve surface area (1.54 ± 0.7 cm2 vs 1.83 ± 0.5 cm2; P < 0.001) and a lower risk of moderate/severe paravalvular leak (1.3% vs 5%). Post-procedural kidney injury (1.3% vs 4.8%; P = 0.06) and new pacemakers for conduction abnormalities (3.3% vs 18.5%; P < 0.001) were higher after TAVI. All-cause mortality and cardiovascular mortality at 30 days were similar between the 2 groups (1.9% vs 3.8%; P = 0.242 and 1.9% vs 3.4%; P = 0.321), whereas after 1 year, all-cause mortality was lower for VinV patients (6.8% vs 13%; P = 0.035). The bioprosthetic valve size correlated inversely with postoperative gradients after VinV procedures.

CONCLUSIONS

VinV aortic procedures showed favourable 30-day and 1-year clinical outcomes compared with TAVI procedures for the native aortic valve disease. Despite higher transvalvular mean gradients following VinV implants, this appears not to impact the early clinical outcomes.
The effect of interactions between proteinuria, activity of fibroblast growth factor 23 and serum phosphate on renal progression in patients with chronic kidney disease: a result from the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease study
Authors: Kim Hyoungnae , Park Jimin , Nam Ki Heon , Jhee Jong Hyun , Yun Hae-Ryong , Park Jung Tak , Han Seung Hyeok , Chung Wookyung , Oh Kook-Hwan , Park Sue Kyung , Kim Soo Wan , Kang Shin-Wook , Choi Kyu Hun , Ahn Curie , Yoo Tae-Hyun
Published: December 2018

Background

Recent experimental study reported that proteinuria increases serum phosphate by decreasing biologic activity of fibroblast growth factor 23 (FGF-23). We examined this relationship in a large chronic kidney disease (CKD) cohort and evaluated the combined effect of proteinuria, FGF-23 activity and serum phosphate on CKD progression.

Methods

The activity of FGF-23, measured by the fractional excretion of phosphate (FEP)/FGF-23 ratio, was compared according to the degree of proteinuria in 1909 patients with CKD. Primary outcome was CKD progression defined as ≥50% decline of estimated glomerular filtration rate, doubling of serum creatinine and start of dialysis.

Results

There was a negative relationship between 24-h urine protein (24-h UP) and FEP/FGF-23 ratio (γ −0.07; P = 0.005). In addition, after matching variables associated with serum phosphate, patients with more proteinuria had higher serum phosphate (P < 0.001) and FGF-23 (P = 0.012), and lower FEP/FGF-23 ratio (P = 0.007) compared with those with less proteinuria. In the matched cohort, low FEP/FGF-23 ratio was an independent risk factor for CKD progression (hazard ratio 0.87 per 1 log increase; 95% confidence interval 0.79–0.95; P = 0.002), and there was significant interaction between 24-h UP and FEP/FGF-23 ratio (P = 0.039). Furthermore, 24-h UP and serum phosphate also had a significant interaction on CKD progression (P < 0.001).

Conclusions

Proteinuria is associated with decreased biologic activity of FGF-23 and increased serum phosphate. Furthermore, diminished activity of FGF23 is an independent risk factor for renal progression in proteinuric CKD patients.
Limited Dorsal Myeloschisis: Reconsideration of its Embryological Origin
Authors: Kim Joo Whan , Wang Kyu-Chang , Chong Sangjoon , Kim Seung-Ki , Lee Ji Yeoun
Published: December 2018

BACKGROUND

Limited dorsal myeloschisis (LDM) is postulated to be a result of incomplete dysjunction in primary neurulation. However, clinical experience of LDM located below the first-second sacral (S1-S2) vertebral level, which is formed from secondary neurulation (S2-coccyx), suggested that LDM may not be entirely explained as an error of primary neurulation.

OBJECTIVE

To elucidate the location and characteristics of LDM to investigate the possible relation of its pathoembryogenesis to secondary neurulation.

METHODS

Twenty-eight patients were surgically treated for LDM from 2010 to 2015. Since the level where the LDM stalk penetrates the interspinous ligament is most clearly defined on the preoperative MRI and operative field, this level was assessed to find out whether the lesions can occur in the region of secondary neurulation.

RESULTS

Eleven patients (39%) with typical morphology of the stalk had interspinous defect levels lower than S1-S2. These patients were not different from 17 patients with classic LDMs at a level above or at S1-S2. This result shows that other than the low level of the interspinous level, 11 patients had lesions that could be defined as LDMs

CONCLUSION

By elucidating the location of LDM lesions (in particular, the interspinous level), we propose that LDM may be caused by errors of secondary neurulation. The hypothesis seems more plausible due to the supportive fact that the process of separation between the cutaneous and neural ectoderm is present during secondary neurulation. Hence, incomplete disjunction of the two ectoderms during secondary neurulation may result in LDM, similar to the pathomechanism proposed during primary neurulation.
Carcass traits and consumer acceptability of striploin steaks from band-castrated, intratesticular zinc-injected, or sexually intact beef cattle1
Authors: Ball Jase J , Kegley Elizabeth B , Lawrence Ty E , Roberts Shelby L , Powell Jeremy G , Richeson John T
Published: December 2018

One hundred and eighty beef bulls (BW = 337 ± 10.9 kg) were blocked by BW (6 blocks) and assigned randomly to one of three treatments on day 0: 1) INJ; received 1 mL (100 mg Zn) of a Zn solution in each testis, 2) BAN; received blood-restrictive rubber band placed upon the dorsal aspect of the scrotum, and 3) BUL; bulls with testicles remaining intact. Cattle were grouped by weight block in a randomized complete block design (three treatment pens/block and 10 cattle/pen) and harvested by block on three separate dates when blocks reached similar BW and visual subcutaneous fat thickness depth. Striploins were removed from the left carcass sides, vacuum packaged and aged for 14 d, and then frozen at −20 °C. Frozen striploins were sliced into 2.54-cm-thick steaks and remained frozen until analyses. Steaks (n = 3/animal) were used to assess consumer acceptability via consumer taste panel (n = 152 panelists), Warner-Bratzler shear force, percentage cook loss, and cooked color values. Data were analyzed using mixed model procedures; pen was the experimental unit for all dependent variables. Hot carcass weights and LM area were greater (P < 0.01) for the INJ and BUL treatments compared with BAN. Mean yield grade did not differ between treatments (P = 0.12), although BAN carcasses had smaller LM area (P < 0.01) than BUL or INJ carcasses. Percentage of USDA Choice or better carcasses was greater (P < 0.01) for BAN than INJ and BUL treatments. Consumer panelists detected a difference in perceived tenderness; BAN steaks had greater (P = 0.02) tenderness scores than BUL steaks, whereas INJ steaks were intermediate. Panelists rated juiciness of BAN steaks greater (P < 0.01) than either BUL or INJ steaks. Panelists rated beef flavor greater (P = 0.01) for BAN and BUL steaks than INJ steaks. Overall acceptability was greater (P < 0.01) for BAN compared with INJ steaks, whereas BUL steaks were intermediate. Percentage cook loss of striploin steaks (P = 0.47) and Warner-Bratzler shear force values (P = 0.11) did not differ. Cooked color lightness (L*) and redness (a*) values were not affected (P ≥ 0.23) by treatment. Striploin steaks from BAN and BUL treatments had greater (P = 0.02) yellowness values (b*) than INJ steaks. The ratio of red-to-brown (630:580 nm) of cooked striploin steaks was greater (P = 0.05) for INJ than either BAN or BUL treatments. Carcass and palatability outcomes of INJ were more similar to BUL than BAN, suggesting limited efficacy of INJ in mature beef bulls at feedlot entry.
Discussions about contralateral prophylactic mastectomy among surgical oncology providers and women with sporadic breast cancer: a content analysis
Authors: D’Agostino Thomas A , Brewster Abenaa M , Peterson Susan K , Bedrosian Isabelle , Parker Patricia A
Published: December 2018

Rates of contralateral prophylactic mastectomy (CPM) have risen substantially, yet little is known about how and to what extent CPM is discussed within surgical oncology visits at the time of treatment decision-making. We examined CPM discussions in naturally occurring interactions between sporadic breast cancer patients and their surgical oncology providers. Women with early-stage unilateral disease were recruited before their first surgical visit and completed brief questionnaires to determine study eligibility and interest in treatment options. After their visits, enrolled patients and their providers completed questionnaires assessing discussion of and interest in CPM. Audio-recorded visits from 36 unique patients were randomly selected, transcribed, and analyzed. A CPM discussion was present in 28 transcripts. Approximately half of CPM discussions were initiated by the patient or the oncology provider. The topic of CPM was most frequently introduced while reviewing available treatment options. Patients were most interested in pursuing CPM to reduce the risk of future breast cancer. Providers most frequently responded by offering information (e.g., about risk of contralateral disease). A high level of agreement was found among patient, provider, and observer ratings of whether or not CPM was discussed. CPM discussions were consistently present within our sample. Results can be used to build providers' skills and bring provider–patient communication more in line with best practices and recommendations from leading professional medical societies.
Vascular Anatomy of the Medial Femoral Neck and Implications for Surface Plate Fixation
Authors: Putnam Sara M. , Collinge Cory A. , Gardner Michael J. , Ricci William M. , McAndrew Christopher M.
Published: December 2018

Objectives:

To describe the inferior retinacular artery (IRA) as encountered from an anterior approach, to define its intraarticular position, and to define a safe zone for buttress plate fixation of femoral neck fractures.

Methods:

Thirty hips (15 fresh cadavers) were dissected through an anterior (Modified Smith-Petersen) approach after common femoral artery injection (India ink, blue latex). The origin of the IRA from the medial femoral circumflex artery and the course to its terminus were dissected. The IRA position relative to the femoral neck was described using a clock-face system: 12:00 cephalad, 3:00 anterior, 6:00 caudad, and 9:00 posterior.

Results:

The IRA originated from the medial femoral circumflex artery and traveled within the Weitbrecht ligament in all hips. The IRA positions were 7:00 (n = 13), 7:30 (n = 15), and 8:00 (n = 2). The IRA was 0:30 anterior to (n = 24) or at the same clock-face position (n = 6) as the lesser trochanter. The mean intraarticular length was 20.4 mm (range 11–65, SD 9.1), and the mean extraarticular length was 20.5 mm (range 12–31, SD 5.1).

Conclusions:

The intraarticular course of the IRA lies within the Weitbrecht ligament between the femoral neck clock-face positions of 7:00 and 8:00. A medial buttress plate positioned at 6:00 along the femoral neck is anterior to the location of the IRA and does not endanger the blood supply of the femoral head. The improved understanding of the IRA course will facilitate preservation during intraarticular approaches to the femoral neck and head.
Bundled Payment Initiative for Hip Fracture Arthroplasty Patients: One Institution's Experience
Authors: Lott Ariana , Haglin Jack M. , Belayneh Rebekah , Konda Sanjit , Egol Kenneth A.
Published: December 2018

Objectives:

To analyze the effectiveness of a Bundled Payments for Care Improvement (BPCI) initiative at a large urban medical center for hip fracture patients included in the bundle payment program with respect to improving patient outcomes and reducing cost.

Design:

Retrospective cohort.

Setting:

Single Academic Institution.

Patients/Participants:

Patients discharged with the diagnosis-related group codes 469–470 performed for hip fractures between July 2011 and September 2014 were evaluated. A BPCI initiative focused on optimizing care coordination, patient education, expectations, and minimizing postacute facility and resource utilization was initiated in October 2013. Patient outcomes before the introduction of the BPCI initiative were compared with those who participated in the initiative.

Intervention:

Application of BPCI principles.

Main Outcome Measures:

Length of stay, location of discharge, readmission within 90 days, and 90-day episode of care costs.

Results:

Sixty-one patients received care before the initiative, and 44 patients were treated with the initiative. The mean length of stay decreased from 6.8 to 5.3 days and the percentage of patients discharged home increased by nearly 10% with the introduction of the BPCI initiative (6.6% vs. 15.9%). There was a 13.1% reduction in total 90-day episode of care cost ($57,546 vs. $49,993, P = 0.210) on introduction of the initiative. There was no significant difference in readmission rate between the 2 cohorts.

Conclusions:

This study demonstrates the success of one such program for hip fracture arthroplasty patients aimed at care coordination and minimizing postacute hospitalization facility care both with respect to improved patient outcomes and substantial cost reduction.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Correlation of serum tryptase levels with total number of nevi, Breslow thickness, ulceration, and mitotic index in melanoma patients: evaluation of a promising prognostic marker
Authors: Crincoli Emanuele , Moliterni Elisa , Catania Fiammetta , Didona Dario , Calvieri Stefano , Paolino Giovanni
Published: December 2018

Current evidences suggest that mast cells contribute to the proliferation and differentiation of skin melanocytes. According to these findings, we carried out an observational cross-sectional study to investigate the correlation between the total number of nevi (TN), Breslow thickness (BT), and serum tryptase (ST) levels in a cohort of 35 melanoma (MM) patients. A Mann–Whitney test was performed to compare ST values within each variable. Subsequently, the independent predictive factors were assessed by multiple logistic regression. Pearson’s
χ

2-test was chosen to detect statistically significant findings on the TN and the histopatological variables (Breslow, ulceration, and mitotic index). The TN was assessed using a dichotomous scale (≤ 10 or > 10). Patients with TN of 10 or less (3.48 vs. 6.05 ng/ml; P = 0.045), patients with a Breslow thickness of at least 1.01 mm (2.99 vs. 5.67 ng/ml; P = 0.1), and ulcerated MM (2.37 vs. 6.05 ng/ml; P < 0.001) showed lower median ST levels. Similarly, MM with mitotic index of at least 1/mm2 had median ST levels lower than MM with mitotic index less than 1/mm2 (P = 0.005). Multiple logistic regression confirmed the statistical significance for the variables ulceration, TN, and mitotic index. Pearson’s
χ

2-test showed a statistically significantly (P = 0.003) increased prevalence of MMs with a BT of at least 1.01 mm in patients with a TN of 10 or less. Patients with a TN of 10 or less also showed a higher prevalence of ulceration and mitotic index of at least 1/mm2 in comparison with the rest of the cohort. Our study highlights lower median ST levels in patients whose MM thickness is at least 1.01 mm; this may encourage new studies on the role of ST in MM also according to the number of nevi.
Follicle-stimulating hormone is associated with lipids in postmenopausal women
Authors: Serviente Corinna , Tuomainen Tomi-Pekka , Virtanen Jyrki , Witkowski Sarah , Niskanen Leo , Bertone-Johnson Elizabeth
Published: December 2018

Objective:

The purpose of this study was to evaluate the relation between FSH and lipid levels in postmenopausal women from the Kuopio Ischaemic Heart Disease Risk Factor Study.

Methods:

Postmenopausal women (n = 588) aged 53 to 73 years and not using hormone therapy were included. The relation between FSH and total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs) was evaluated using linear regression, adjusting for estradiol, body mass, smoking, and other hormonal and lifestyle factors. The relation between FSH, dyslipidemia, and abnormal lipid levels were also evaluated.

Results:

FSH was positively and linearly associated with TC (P = 0.001) and LDL-C (P = 0.01) in all participants, with stronger relations seen in younger compared with older postmenopausal women. FSH was less strongly associated with HDL-C and TG. FSH was not associated with dyslipidemia; however, higher FSH was associated with increased risk of high TC (P = 0.02) and high LDL-C (P = 0.03).

Conclusions:

These data suggest that higher FSH in postmenopausal women is related to higher levels of both TC and LDL-C.
Vaginal ring pessary use for pelvic organ prolapse: continuation rates and predictors of continued use
Authors: Manonai Jittima , Sarit-apirak Sirirat , Udomsubpayakul Umaporn
Published: December 2018

Objectives:

The aim of the study was (1) to evaluate continuation rates of vaginal ring pessary for pelvic organ prolapse (POP), and (2) to identify predictors for continued pessary use.

Methods:

This retrospective chart review study was conducted in a tertiary center. Women who had a ring with support pessary successfully fitted between January 2009 and December 2013 and had completed up to 3 years of follow-up care were included in the analysis. Demographic and obstetric data, body weight, pelvic organ prolapse stage, and associated symptoms were evaluated. All the women were followed until February 28, 2017, unless surgery to correct POP surgery was required, pessary use was discontinued, or the women died.

Results:

A total of 289 women with symptomatic POP (stages II, III, and IV) were evaluated. The median age was 71 years (range 34-83 y), and the median parity was 3 (range 0-8). Among the women with a successful initial fitting, the failure rate was 5.88% (17/289) at 6 months with most of these women choosing to have surgical intervention. This analysis indicates that the probability of the successful continuation of pessary use after 1, 2, 3, 4, and 5 years was 83.0%, 78.2%, 71.3%, 65.3%, and 61.7%, respectively, reported using a Kaplan–Meier plot. The main cause for discontinuation of pessary use before 3 years was the election for surgical intervention. With regard to predictors for continued pessary use, self-care was the only factor that influenced compliance rates after treatment of 3 years.

Conclusion:

A ring with support pessary can be used successfully to alleviate symptoms of advanced stage prolapse for 3 years or longer. In addition, proper self-management was found to be a strong predictor for prolonged pessary use.
Conduit-based Nerve Repairs Provide Greater Resistance to Tension Compared with Primary Repairs: A Biomechanical Analysis on Large Animal Samples
Authors: Rasappan Kumaran , Rajaratnam Vaikunthan , Wong Yoke-Rung
Published: December 2018

Background:

When primary repair of transected peripheral nerves is not possible due to large gaps, nerve grafts or repair using conduits are other options to bridge the gap such that the nerve is repaired without tension. When nerve gaps are repaired primarily, there is a worry about tension, failure, and poor healing. In this biomechanical study comparing nerves repaired primarily versus those repaired with conduits, we hypothesized that conduit repair provided greater mechanical breaking strength.

Methods:

We dissected fresh cadaveric sheep hooves and transacted their peripheral nerves. Subsequently, we divided these transacted nerves into 2 groups: primary repair versus repair using a nerve conduit. After repair using a standardized technique, we tensioned each of these repairs via a load tester and recorded the force required till repair failure occurred.

Results:

Six nerves using primary nerve repair and 6 nerves repaired with a nerve conduit (10 mm length × 2.5 mm diameter) were studied. The average breaking strength of the nerves repaired with the nerve conduit was 0.92 N and that using the primary nerve repair technique was 0.46 N (P = 0.001). All the nerves repaired using nerve conduit repair had an additional 5 mm added to their total length as compared with the nerves in the other group.

Conclusions:

Nerve repair using a nerve conduit ensures a higher breaking strength and potentially a greater tension-free repair as compared with primary nerve repairs in a sheep model. This study supports the use of conduits in the bridging of nerve gaps.
Polydactyly MAS Classification
Authors: Althobaity Adil Nasir , Alkabbaa Saud Abdullah , Aljaied Sarah S. , AlKahtani Mohammed M.
Published: December 2018

Background:

Polydactyly is considered to be one of the common congenital hand anomalies. Classification of congenital hand anomalies by Swanson groups similar forms of deficits affected by specific embryological failures. Each type of polydactyly has its separate classification. This case series suggested classification that could include the radial and ulnar variants of polydactyly in one classification and direct the management in algorithmic approach.

Methods:

Case series of 11 cases, who were diagnosed with polydactyly of the hand consecutively at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Cases were described by physical assessment and x-ray, then categorized by the proposed MAS classification.

Results:

Description of 11 cases by the suggested MAS classification: A- Soft tissue attachment. B-Bone attachment. I. Attached to metacarpal bone. II. Attached to the proximal phalanx. III. Attached to the middle phalanx. IV. Attached to the distal phalanx. C- Joint attachment. I. Attached to carpometacarpal joint. II. Attached to metacarpophalangeal joint. III. Attached to the proximal interphalangeal joint. IV. Attached to the distal interphalangeal joint. Treatment according to the algorithmic approach: type A, treat it with soft-tissue excision; type B, bony excision with or without reinsertion of abnormal muscle attachment; and type C, excision of collateral ligaments and reconstruction with or without K wire fixation and reinsertion of abnormal muscle attachment.

Conclusions:

MAS classification demonstrates a potential to be applied to both ulnar and radial polydactyly. It is simple, easy to recall, anatomically and surgically oriented for practical purposes. Thus, it needs to be validated in extensive studies.
Direct-to-implant Breast Reconstruction with Autoderm
Authors: McFadden Eoin M. , Lopez-Obregon Beatriz , Stone Jill P. , Webb Carmen E. , Temple-Oberle Claire F.
Published: December 2018

Background:

Traditional transverse mastectomies yield suboptimal results in women with higher body mass index, wide breast footprint, and ptotic breasts. An option for this patient population is a reduction-pattern style mastectomy, and recruiting an inferiorly based dermal flap using the lower mastectomy flap. This is analogous to a vascularized dermal matrix supporting the lower pole of the implant, termed “Autoderm” breast reconstruction. This allows for aesthetically appealing skin reduction mastectomies with the added safety of a vascularized dermal flap to facilitate an immediate direct-to-implant breast reconstruction. This study assesses patient satisfaction using the validated BRECON-31 questionnaire to enhance shared-decision making with women contemplating breast reconstruction.

Methods:

A 2-year retrospective review of women who underwent Autoderm direct-to-implant breast reconstruction comparing patients who underwent unilateral and bilateral reconstruction in terms of characteristics, complications, and BRECON-31 scoring.

Results:

Overall patient scores were high (81.6 of 100). In particular, women scored very high on self-image (85.0), arm concerns (86.4), intimacy (87.4), satisfaction (88.3), and expectations subscales (85.5). Women choosing bilateral reconstruction outperformed unilateral reconstruction in every subgroup, but only attained statistical significance in the “self-consciousness” subgroup. Compared with a historical cohort of a mix of implant reconstruction types, Autoderm patients showed improved satisfaction (88.3 versus 82.5;P= 0.07) and breast appearance (73.9 versus 66.8;P= 0.06), approaching significance. Safety was demonstrated by low major complications (4.7%) and low implant loss rates (2.3%).

Conclusions:

Autoderm breast reconstruction is a safe option in women with large, ptotic breasts, with patients reporting high satisfaction using a validated instrument.
Managing Postoperative Infection following Breast Reconstruction with the Sientra AlloX2 Tissue Expander
Authors: Momeni Arash
Published: December 2018

Background:

Implant-based breast reconstruction is the most common reconstructive modality in the United States. Significant advances in surgical technique and technology have resulted in improvement of clinical outcomes. A recent innovation has been the introduction of a tissue expander with an integral drain that permits access to the periprosthetic space. A new use for this drain port is presented in patients with postoperative surgical-site infection.

Methods:

Patients who underwent staged implant-based breast reconstruction with the Sientra AlloX2 tissue expander and experienced postoperative infection that warranted inpatient management with intravenous antibiotics were included in the study. The integral drain port was used in these patients to perform washout of the periprosthetic space at the bedside. The ability to salvage the tissue expander in the setting of infection without the need for surgical revision in the operating room was determined.

Results:

Of 31 patients who underwent a total of 52 staged breast reconstructions with the Sientra AlloX2 tissue expander, 3 patients (8.7%) with a mean age of 50.3 years (range, 34–76 years) and mean body mass index of 23.3 kg/m2 (range, 22.3–24.1 kg/m2) met inclusion criteria. Salvage of the device with successful progression through expansion and eventual expander-implant exchange was achieved in 2 patients. One patient failed the salvage attempt and required removal of the device.

Conclusion:

Using the integral drain port of the AlloX2 tissue expander has the potential for device salvage in a subset of patients with surgical-site infection without the need for surgical revision.
Necrotic Herpes Simplex Virus Infection of the Nose and Orbit
Authors: Dryden Stephen C. , Fleming James C.
Published: December 2018

This is the first reported case of necrotizing nasal and sinus herpes infection with orbital involvement. A 94-year-old male with a past medical history of hypertension, congestive heart failure, and chronic kidney disease presented with necrotic nasal cellulitis and a red left eye with blurry vision. Onset was 2 weeks prior with an upper lip fever blister. He was admitted to medicine and started on antimicrobials. Maxillofacial computed tomography scan revealed pansinusitis with involvement of bilateral medial orbital walls. Initial nasal biopsy was negative. Repeat biopsy was positive for herpes simplex virus 1. His nose was debrided with full-thickness skin grafting. While there are reports of necrotizing herpes simplex, none were to the extent of our patient nor raised suspicion for invasive fungal sinusitis. Differentiating is important as this patient made a full recovery in comparison to patients with mucormycosis where mortality is often as high as 80%.
Industry funding effect on positive results of probiotic use in the management of acute diarrhea: a systematized review
Authors: Saa Camila , Bunout Daniel , Hirsch Sandra
Published: December 2018

Several investigations have found that industry-funded studies tend to inform results favoring the sponsored products. The pressure to demonstrate that a drug or a product causes a favorable outcome may result in investigation biases from industry-funded research. One example of this could be found in the probiotic research funded by the industry. The aim of this study was to assess the effect of industry funding on positive outcomes of the use of probiotics in the management of acute diarrhea. A systematized review of clinical trials on the use of probiotics in the management of acute diarrhea was performed. The associations between the source of funding, clinical outcomes, probiotic genus, and quality of the study were assessed using theχ2-test and Fisher’s exact test. Sixty-six clinical trials were included; 27 were industry funded, 18 were nonindustry funded, and 21 did not disclose their funding source. There were 48 positive and 30 negative clinical outcomes. There was no significant association between the source of funding and clinical outcomes (P=0.491). No association between the rest of the studied variables and outcomes was observed either (P>0.05). In clinical trials on the use of probiotics in the management of acute diarrhea, the source of funding has no influence on positive clinical outcomes.
Overview in the clinical management of patients with seronegative villous atrophy
Authors: Schiepatti Annalisa , Sanders David S. , Zuffada Martina , Luinetti Ombretta , Iraqi Adam , Biagi Federico
Published: December 2018

Differential diagnosis and management of enteropathies found in the context of seronegative villous atrophy (VA) are still a clinical challenge. Although seronegative coeliac disease may be the most frequent cause of serology-negative VA, other conditions must be taken into account in the differential diagnosis of seronegative VA. The rarity of these enteropathies with frequent overlapping of histological features may result in misclassification of such patients as affected by a seronegative or a refractory form of coeliac disease with consequent inappropriate treatments and long-term morbidity. The aim of this review is to summarize the current knowledge and to provide an evidence base and practical algorithmic approach for the investigation and management of seronegative VA.