bluuebunny/crossref_metadata_2025 huggingface dataset:
A case report of cerebral infarction caused by polycythemia vera
Authors: Ren Shan , Gao Fang , Chen Zhigang , Wang Zhiqun
Published: December 2018

Rationale:

Polycythemia vera (PV) is a cloned erythrocytotic disease manifested by high proliferation and apoptosis in the bone marrow. The clinical symptoms of PV are occult. In practice, patients with cerebral infarction caused by PV are prone to misdiagnosis and missed diagnosis.

Patient concerns:

Here, we report a misdiagnosis of PV leading to cerebral infarction. The patient was a middle-aged woman who was diagnosed with acute cerebral infarction in the outpatient hospital. After treatment, the patient still had left hemiplegia, dizziness and other symptoms and was admitted to our hospital.

Diagnosis:

We did not find sufficient evidence of atherosclerotic processes in the brain infarction. However, the patient's signs and laboratory examination indicated a high suspicion of PV. A series of further examinations confirmed the final diagnosis.

Interventions:

Bone marrow suppression medications (oral hydroxyurea and subcutaneous injection of interferon) were given and subsequent prevention of cerebral infarction was implemented.

Outcomes:

Routine blood reexamination was normal and no further cerebral infarction occurred.

Lessons:

Patients with acute cerebral infarction should be considered comprehensively, and rare causes should not be ignored. It is crucial that PV be diagnosed and treated as early as possible, which can significantly improve the prognosis of patients.
Associations between vitamin D deficiency, musculoskeletal health, and cardiometabolic risk among community-living people in Taiwan
Authors: Chen Chia-Hung , Liu Li-Kuo , Chen Mei-Ju , Lee Wei-Ju , Lin Ming-Hsien , Peng Li-Ning , Chen Liang-Kung
Published: December 2018

The role of serum vitamin D (Vit D) in cardiometabolic and muscle health remains unclear. The study aimed to evaluate associations of Vit D and factors of healthy aging among community-living middle-aged and older people in Taiwan. Analytic data on 1839 community-living older adults were excerpted from I-Lan Longitudinal Aging Study. All participants were collected demographic characteristics, serum Vit D, functional assessment, and cardiometabolic risk factors. The prevalence of Vit D insufficiency and deficiency in this study was 50.5% and 33.6%, respectively. Among 617 participants with Vit D deficiency, 72.3% of them were women. In multivariate logistic regression, the independent risk factors of Vit D deficiency were male gender (odds ratio [OR]: 0.266; 95% confidence interval [CI]: 0.213–0.333; P < 0.001), higher BMI (OR: 1.036; 95% CI: 1.005–1.067; P = 0.022), high total cholesterol (OR: 1.437; 95% CI: 1.160–1.779; P = 0.001), and high triglyceride (OR: 1.865; 95% CI: 1.446–2.404; p < 0.001). In multinomial logistic regression for 3-level Vit D status analysis, similar trend was found among participants with Vit D insufficiency. Insulin resistance increased in 2.31 and 1.71-folds in Vit D deficiency and insufficiency groups. Besides, association between Vit D deficiency and osteopenia was found only in women. In conclusion, Vit D deficiency was more common in women, and associated with poorer musculoskeletal health and higher cardiovascular and metabolic risk, including higher BMI, DBP, insulin resistance, total cholesterol, and triglyceride.
Preoperative lymphocyte-to-monocyte ratio (LMR) could independently predict overall survival of resectable gastric cancer patients
Authors: Pan Yu-Chen , Jia Zhi-Fang , Cao Dong-Hui , Wu Yan-Hua , Jiang Jing , Wen Si-Min , Zhao Dan , Zhang Song-Ling , Cao Xue-Yuan
Published: December 2018

Preoperational hemogram parameters have been reported to be associated with the prognosis of several types of cancers. This study aimed to investigate the prognostic value of hematological parameters in gastric cancer in a Chinese population. A total of 870 gastric cancer patients who underwent radical tumorectomy were recruited from January 2008 to December 2012. Preoperative hematological parameters were recorded and dichotomized by time-dependent receiver operating characteristic curves. The survival curves of patients stratified by each hematological parameter were plotted by the Kaplan–Meier method and compared by log-rank test. Multivariate Cox proportional hazards models were used to select parameters independently correlated with prognosis. The median age of the patients was 60 years. The median follow-up time was 59.9 months, and the 5-year survival rate was 56.4%. Results from the univariate analyses showed that low lymphocyte count (<2.05 × 109/L), high neutrophil-to-white blood cell ratio (NWR > 0.55), low lymphocyte-to-white blood cell ratio (LWR < 0.23), low lymphocyte-to-monocyte ratio (LMR < 5.43), high neutrophil-to-lymphocyte ratio (NLR > 1.44), and high platelet-to-lymphocyte ratio (PLR > 115) were associated with poor survival of gastric cancer patients. Multivariate analysis showed that low LMR (HR: 1.49, 95% CI: 1.17–1.89, P = .001) was the only hematological factor independently predicting poor survival. These results indicate that preoperational LMR is an independent prognostic factor for patients with resectable gastric cancer.
Methylation status of the stimulator of interferon genes promoter in patients with chronic hepatitis B
Authors: Wu Chen-Si , Zhao Qian , Zhang Jun , Wang Jing-Wen , Qian Yu , Fan Yu-Chen , Wang Kai
Published: December 2018

The stimulator of interferon genes (STING) plays a crucial role in the recognition of a viral infection and subsequent stimulation of an immune response. However, it is unclear whether methylation of the STING promoter affects STING transcription and response to antiviral therapy. The present study determined the methylation status of the STING promoter in patients with chronic hepatitis B (CHB).

This study included 198 participants, of which 159 participants had CHB and 39 were healthy controls (HCs). Methylation-specific polymerase chain reaction was performed to detect the methylation status of the STING promoter. Reverse transcription-quantitative polymerase chain reaction was performed to determine STING mRNA level in peripheral blood mononuclear cells.

The methylation frequency of the STING promoter was significantly higher and STING mRNA level was lower in the patients with CHB than in the HCs. Presence of hepatitis B virus (HBV) DNA was independently correlated with an increased risk of STING promoter methylation. Virological response frequency was higher in the patients with CHB receiving entecavir (ETV) than in those receiving adefovir (ADV). In the ETV group, the virological response frequency was evidently lower in the patients with CHB having methylated STING promoters than in those having unmethylated STING promoters. However, there was no significant difference in the virological response frequency between ADV-treated patients having methylated and unmethylated STING promoters.

These results indicate that the hypermethylation of the STING promoter and thus the transcriptional repression of STING weaken the effect of STING in inhibiting HBV replication and decreases the effectiveness of antiviral therapy.
The use of testicular prostheses in boys
Authors: Osemlak Paweł , Jędrzejewski Grzegorz , Cielecki Czesław , Kalińska-Lipert Anita , Wieczorek Andrzej , Nachulewicz Paweł
Published: December 2018

Lack of the testis is an important factor in psycho-sexual development of the boys, and implantation of the prosthesis plays a very essential role in the treatment of that group of patients. Currently there are no standards regarding when prosthesis should be implanted, and which access is connected with minimal rates of complications. We present our experience of primary prosthesis implantations in boys treated in our department.

From 2000 to 2014, primary implantation of the testicular prosthesis was performed in 290 boys. The early and late post-operative complications and long-term therapeutic results were analyzed, considering age at the time of implantation, the time between the initial operation and implantation of the prosthesis, and the surgical approach.

Best results were observed in 267 patients and bad outcome in 23 patients. Prosthesis implantation in young boys operated within the first three years of life or during the first year after primary surgery was connected with statistically fewer complications (P = .002 and P < .05, respectively). Supra-scrotal access was connected with the lowest rate of complications (P = .01).

Long-term therapeutic results in boys with testicular prostheses were good in the majority of cases. Implantation of the first prosthesis should be performed early between 1 and 3 years of life in boys with lack of the testis. Implantation of a prosthesis should also be performed within 1 year after removing of testis or during orchiectomy. Supra-scrotal access should be chosen for testicular prosthesis implantation due to the best long-term results.
Correlation analysis between depression and family fitness in chronic obstructive pulmonary disease inpatients
Authors: Deng Xuexue , Song Jinping
Published: December 2018

To explore the relationship between depression and family fitness in chronic obstructive pulmonary disease (COPD) inpatients.

COPD inpatients (280) in our hospital from Jan to June 2016 were included. Depression level and family fitness were quantified with self-rating depression scale (SDS) and Adaptability, Partnership, Growth, Affection, and Resolve (APGAR) test. The relationship and correlation of SDS value and APGAR score was analyzed.

Family fitness for all COPD inpatients was grossly well, among which 93 patients (34.87%) experienced medium-to-severe family unfitness. Further analysis shows that better fitness correlated with less depression and worse fitness correlated with more depression. Depression levels were significantly different in patients under family fitness. Inpatients were grossly in light depression, among which 186 (69.66%) patients exhibited depression symptoms. Family fitness was significantly different among patients with different levels of depression. Correlation analysis showed that depression level was negatively correlated with family fitness.

Depression in patients is significantly correlated with family fitness. The condition of patients can be improved by active family fitness and patients’ interactions with family members. Thus involvement of family member during admitting should be encouraged.
Laparoscopic total extraperitoneal inguinal hernia repair
Authors: Georgiou Efi , Schoina Elina , Markantonis Sophia-Liberty , Karalis Vangelis , Athanasopoulos Panagiotis G. , Chrysoheris Periklis , Antonakopoulos Fotis , Konstantinidis Konstantinos
Published: December 2018

Laparoscopic inguinal hernia repair is one of the most frequently performed operations. However, the search for the most appropriate prosthetic materials continues to occupy the surgical community. The purpose of this study was to evaluate the postoperative short- and mid-term effects (like duration of stay, number and type of complications, and inguinal pain) of laparoscopic inguinal hernia repair using the total extraperitoneal (TEP) approach. The evaluation encompassed different types of mesh and fixation devices, as well as medications prescribed during hospitalization.

This retrospective study was conducted at the General, Laparoendoscopic, Bariatric, and Robotic Surgical Clinic of the Athens Medical Center. Clinical data from 524 patients were evaluated. The answers from an appropriately designed questionnaire completed from each individual were used to obtain information about their postoperative course. The statistical analysis was implemented in SPSS v 23.

Analysis revealed that pain sensation on discharge decreased with increasing age (P < .05). No clear relationship was found between surgical clips and pain (P = .292), as well as mesh absorbability and chronic pain (P = .539). The major postoperative complications were annoyance and discomfort (15.9%). The recurrence rate was 1.7%.

Postoperative complications following the TEP approach were mostly found to be minor; chronic pain, as an aspect of impaired quality of life, was not experienced in the majority (89.08%). The properties of prosthetic materials used and the type of medications prescribed were not found to exert a significant role in satisfactory postoperative outcomes.
Unforeseen Dangers
Authors: Kienle Patricia C.
Published: December 2018

Antineoplastic and other hazardous drugs present a risk to health care personnel if they are not contained by appropriate facility design, personal protective equipment, and work practices that support safety. These drugs pose the risk of carcinogenicity and reproductive risks to personnel, which can be mitigated by using the proper containment practices.
Expanding the Spectrum of Pediatric NTRK-rearranged Mesenchymal Tumors
Authors: Davis Jessica L. , Lockwood Christina M. , Stohr Bradley , Boecking Carolin , Al-Ibraheemi Alyaa , DuBois Steven G. , Vargas Sara O. , Black Jennifer O. , Cox Michael C. , Luquette Mark , Turpin Brian , Szabo Sara , Laetsch Theodore W. , Albert Catherine M. , Parham David M. , Hawkins Douglas S. , Rudzinski Erin R.
Published: December 2018

Pediatric mesenchymal tumors harboring variant NTRK fusions (ETV6-negative) are being increasingly described; however, the histologic and clinical features of these variant NTRK tumors and their relationship to classic infantile fibrosarcoma are not well characterized. A better understanding of the clinicopathologic features of these tumors is necessary, and would aid in both early diagnosis and treatment. Therefore, the aim of this study was to characterize a series of pediatric NTRK-rearranged mesenchymal tumors, including classic ETV6-NTRK3 fused tumors and tumors with variant (non-ETV6) NTRK fusions. The clinical features, morphology, immunophenotype, and genetics of 12 classic ETV6-NTRK3 fused infantile fibrosarcoma and 18 variant NTRK-rearranged mesenchymal tumors were evaluated. For both classic and variant groups, the age at diagnosis ranged from birth to 15 years (median, 4 mo) with no sex predilection; the most common sites involved were the extremities and trunk. The rate of local recurrence and metastasis were not significantly different (recurrence rate: 11% classic, 40% variant; metastatic rate: 18% classic, 25% variant). Classic and variant NTRK tumors had an overlapping spectrum of histologic features, containing haphazardly arranged primitive cells in a myxoid background and/or spindle cells in long fascicles. Both groups showed diffuse pan-TRK expression by immunohistochemistry. Otherwise, the immunoprofile was nonspecific, but similar between both groups. No statistical difference was seen in any clinicopathologic feature between the classic ETV6-NTRK3 and variant fusion cohorts. Pediatric NTRK-rearranged mesenchymal tumors with both classic and variant fusions likely represent a spectrum of disease with shared, recognizable cliniopathologic features.
Ethical Issues in Aesthetic and Reconstructive Surgical Innovation: Perspectives of Plastic Surgeons
Authors: Lee Z-Hye , Reavey Patrick L. , Rodriguez Eduardo D. , Chiu Ernest S. , Caplan Arthur L.
Published: December 2018

Innovative surgery is defined as a novel procedure, a significant modification of a standard technique, or a new application of an established technique. Although innovation is a crucial part of improving patient care in plastic surgery, there are various ethical considerations and dilemmas in performing unvalidated techniques and procedures, especially for non–life-threatening indications. The aim of this study was to gain a better understanding regarding the motivations and ethical considerations of plastic surgeons in their decision to perform innovative operations. An anonymous, institutional review board–approved, online survey was sent to members of the American Society of Plastic Surgeons and other international plastic surgeons worldwide. The survey asked respondents to rank various factors that influence their decisions to perform innovative plastic surgery, both reconstructive and aesthetic, on a five-point Likert scale. Seven hundred thirty-three of 26,028 plastic surgeons (response rate, 2.9 percent) responded to the survey. Although similar factors were considered to be important for both reconstructive and aesthetic operations, only approximately 50 percent of respondents considered institutional review board approval to be an important factor when considering innovation in both reconstructive (50 percent) and aesthetic surgery (51 percent), suggesting that respondents do not consider innovation a form of research that ought be subject to standard research protections. Overall, the authors’ survey suggests that more effort must be extended to ethical training in plastic surgery to create a stronger professional atmosphere regarding innovation and, possibly, to the creation of a more formal group charged with oversight of innovation.
Volumetric Changes of the Mid and Lower Face with Animation and the Standardization of Three-Dimensional Facial Imaging
Authors: Rawlani Roshni , Qureshi Hannan , Rawlani Vinay , Turin Sergey Y. , Mustoe Thomas A.
Published: December 2018

Background:

The objective of this study was to quantify volumetric changes of the mid and lower face caused by facial expression to understand how procedural results measured by three-dimensional imaging can be influenced by lack of standardization. Secondarily, the study identified soft-tissue surface landmarks that can be used to ensure the standardization of three-dimensional images.

Methods:

Three-dimensional facial images of subjects performing 22 facial expressions or changes in head position were captured. Variable degrees of animation during smiling and frowning were also evaluated. Volumetric changes of the malar and jowl regions were quantified using a three-dimensional superimposed image subtraction technique. The translation of 14 standard soft-tissue surface landmarks was assessed during various facial animations to determine which three-dimensional landmarks can be used to standardize three-dimensional images.

Results:

Twenty subjects participated in the study. Sixteen of the 22 facial expression studies had a significant effect on malar and/or jowl volume. Significant volume changes were noted with subtle animation during smiling and frowning. A combination of five landmarks (i.e., glabella, bilateral cheilion, pogonion, and laryngeal prominence) can be used to standardize three-dimensional images for evaluation of mid and lower facial volume changes.

Conclusions:

Subtle facial expressions may cause significant volumetric changes in the mid and lower face that can mimic the desired outcomes of surgical and nonsurgical facial rejuvenation procedures. The five-point referencing system allows one to identify subtle changes in head position and facial expression and may aid in the standardization of three-dimensional images.
Porcine Acellular Peritoneal Matrix in Immediate Breast Reconstruction: A Multicenter, Prospective, Single-Arm Trial
Authors: Simpson Andrew M. , Higdon Kent K. , Kilgo Matthew S. , Tepper Donna G. , Alizadeh Kaveh , Glat Paul M. , Agarwal Jayant P.
Published: December 2018

Background:

Use of biological implants such as acellular dermal matrices in tissue expander breast reconstruction is a common adjunct to submuscular implant placement. There is a paucity of published prospective studies involving acellular matrices. The authors sought to evaluate a porcine-derived acellular peritoneal matrix product for immediate breast reconstruction.

Methods:

A prospective, single-arm trial was designed to analyze safety and outcomes of immediate tissue expander–based breast reconstruction with a novel porcine-derived acellular peritoneal matrix surgical mesh implant. Twenty-five patients were enrolled in this industry-sponsored trial. Patient demographics, surgical information, complications, histologic characteristics, and satisfaction (assessed by means of the BREAST-Q questionnaire) were evaluated.

Results:

Twenty-five patients (44 breasts) underwent mastectomy with immediate breast reconstruction using tissue expanders with acellular peritoneal matrix. Sixteen reconstructed breasts experienced at least one complication (36 percent). Seroma and hematoma occurred in one of 44 (2.3 percent) and two of 44 breasts (4.6 percent), respectively. Wound dehiscence occurred in four of 44 breasts (9.1 percent). Three subjects experienced reconstruction failure resulting in expander and/or acellular peritoneal matrix removal (6.8 percent); all failures were preceded by wound dehiscence. Histologic analysis showed cellular infiltration and product resorption. Results of the BREAST-Q demonstrated a level of postoperative patient satisfaction consistent with results in the available literature.

Conclusions:

Prepared porcine-derived acellular peritoneal matrix is a safe adjunct in immediate two-stage tissue expander-based breast reconstruction. Further studies are required to determine efficacy compared to current commercially available acellular matrices.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
The Use of Tumescent Technique in Mastectomy and Related Complications: A Meta-Analysis
Authors: Siotos Charalampos , Aston Jeffrey W. , Euhus David M. , Seal Stella M. , Manahan Michele A. , Rosson Gedge D.
Published: December 2018

Background:

Postoperative skin necrosis in surgical patients is costly to hospitals and health care providers. Tumescent dissection technique is commonly used in mastectomy and immediate breast reconstruction, as it helps reduce blood loss; however, it may increase the risk of mastectomy skin flap necrosis. In this context, the authors have conducted a systematic review of the literature to perform a meta-analysis of the relationship between tumescent technique in mastectomy with or without breast reconstruction and complication rates.

Methods:

The authors screened the PubMed (1966 to 2016), Scopus (2004 to 2016), Embase (1966 to 2016), and Web of Science (1964 to 2016) databases for relevant articles through March 30, 2017. The authors included studies on the use of tumescent technique in the context of mastectomy with or without immediate breast reconstruction. The primary outcome the authors evaluated was the rate of skin flap necrosis; the secondary outcomes were the rates of breast hematomas and infections. Because of the heterogeneity of the studies, the authors performed a meta-analysis using the random effects model.

Results:

After screening, the authors evaluated five studies including 3982 mastectomies. Mastectomies performed under the preoperative application of tumescent solution had statistically higher rates of skin flap necrosis overall (p = 0.03) and major (p < 0.01) and minor skin necrosis (p = 0.03). However, the rates of hematoma and infection were not correlated with the use of tumescent technique.

Conclusions:

The authors’ systematic review of the literature provides a better understanding of the consequences of the application of tumescent technique in mastectomy. The authors’ findings suggest that tumescent technique may increase the risk of skin necrosis in mastectomy with or without breast reconstruction.
Vascularity of the Proximal Fibula and Its Implications in Vascularized Epiphyseal Transfer: An Anatomical and High-Resolution Computed Tomographic Angiography Study
Authors: Morsy Mohamed , Sur Yoo Joon , Akdag Osman , Sabbagh M. Diya , Suchyta Marissa A. , El-Gammal Tarek A. , Lachman Nirusha , Moran Steven L.
Published: December 2018

Background:

Various vascular pedicles have been used to supply the proximal fibula for vascularized epiphyseal transfer. The optimal pedicle has, however, not been agreed on. This study aimed to describe the detailed vascular anatomy of the proximal fibula to assist the surgeon in choosing the optimal pedicle.

Methods:

Twenty-eight lower extremities were injected with latex or a mixture of latex and barium sulfate. Vessels supplying the proximal fibula were identified and dissected, and the course, diameter, anatomical relations, length, and branches were documented. In the barium group, high-resolution computed tomographic scanning was conducted before dissection. In seven specimens, branches of the deep peroneal nerve to the tibialis anterior muscle were carefully preserved, and their relation to the proximal fibular vascularity was noted.

Results:

An anastomotic vascular network supplied the proximal fibula. This was formed superiorly by branches of the inferior lateral genicular artery, and inferiorly by branches of the anterior tibial artery, the most important of which were the first and second recurrent epiphyseal arteries. One or more deep peroneal nerve branches passed deep to the first recurrent epiphyseal artery in all specimens examined. In five specimens, all of the branches were superficial to the second recurrent epiphyseal artery, whereas two had branches deep to it.

Conclusions:

The proximal fibula can be transferred using the inferior lateral genicular or anterior tibial artery because of the existing anastomosis. Factors including length of pedicle, potential for nerve injury, and diaphyseal portion to be harvested should be considered in the pedicle choice.
Targeted Muscle Reinnervation Technique in Below-Knee Amputation
Authors: Bowen J. Byers , Ruter Daniel , Wee Corinne , West Julie , Valerio Ian L.
Published: December 2018

Approximately 25 percent of major limb amputees will develop chronic localized symptomatic neuromas and phantom limb pain in the residual limb. A method to treat and possibly prevent these pain symptoms is targeted reinnervation. Previous studies prove that targeted reinnervation successfully treats and, in some cases, resolves peripheral neuropathy and phantom limb pain in patients who have undergone previous amputation (i.e., secondary targeted reinnervation). This article seeks to share the authors’ clinical indications and surgical technique for targeted muscle reinnervation in below-knee amputation, a surgical description currently absent from our literature. Targeted reinnervation for the below-knee amputee has been performed on 22 patients at the authors’ institution. Each patient has been followed on an outpatient basis for 1 year to evaluate symptoms of neuroma or phantom limb pain, patient satisfaction, and functionality. All subjects have denied neuroma pain following amputation. The majority of subjects reported phantom pain at 1 month. However, at 3 months, all patients reported resolution of this pain. Dumanian et al. first noted the improvement of symptomatic neuroma and phantom limb pain in patients undergoing targeted reinnervation to provide intuitive control of upper limb prostheses. These findings have been substantiated by multiple previous studies at various amputation levels. This study extends the success of targeted muscle reinnervation to below-knee amputations and provides a description for this technique.
Toward the Bionic Face: A Novel Neuroprosthetic Device Paradigm for Facial Reanimation Consisting of Neural Blockade and Functional Electrical Stimulation
Authors: Jowett Nate , Kearney Robert E. , Knox Christopher J. , Hadlock Tessa A.
Published: December 2018

Background:

Facial palsy is a devastating condition potentially amenable to rehabilitation by functional electrical stimulation. Herein, a novel paradigm for unilateral facial reanimation using an implantable neuroprosthetic device is proposed and its feasibility demonstrated in a live rodent model. The paradigm comprises use of healthy-side electromyographic activity as control inputs to a system whose outputs are neural stimuli to effect symmetric facial displacements. The vexing issue of suppressing undesirable activity resulting from aberrant neural regeneration (synkinesis) or nerve transfer procedures is addressed using proximal neural blockade.

Methods:

Epimysial and nerve cuff electrode arrays were implanted in the faces of Wistar rats. Stimuli were delivered to evoke blinks and whisks of various durations and amplitudes. The dynamic relation between electromyographic signals and facial displacements was modeled, and model predictions were compared against measured displacements. Optimal parameters to achieve facial nerve blockade by means of high-frequency alternating current were determined, and the safety of continuous delivery was assessed.

Results:

Electrode implantation was well tolerated. Blinks and whisks of tunable amplitudes and durations were evoked by controlled variation of neural stimuli parameters. Facial displacements predicted from electromyographic input modelling matched those observed with a variance-accounted-for exceeding 96 percent. Effective and reversible facial nerve blockade in awake behaving animals was achieved, without detrimental effect noted from long-term continual use.

Conclusions:

Proof-of-principle of rehabilitation of hemifacial palsy by means of a neuroprosthetic device has been demonstrated. The use of proximal neural blockade coupled with distal functional electrical stimulation may have relevance to rehabilitation of other peripheral motor nerve deficits.
Finesse in Face Lifting: The Role of Facial Fat Compartment Augmentation in Facial Rejuvenation
Authors: Rohrich Rod J. , Afrooz Paul N.
Published: December 2018

Much of facial aging can be attributed to volume deflation and tissue laxity. Successful surgical rejuvenation can be achieved through volume restoration with autologous fat grafting of the facial fat compartments. In conjunction with volume restoration, correction of tissue laxity and recontouring of the face and neck can be achieved. Current strategies for surgical correction of the face and neck involve superficial musculoaponeurotic system manipulation, medial platysma plication, and lateral platysma tightening through the lateral platysma window. These combined techniques facilitate optimal results in facial rejuvenation.
Early-Life Home Environment and Obesity in a Mexican American Birth Cohort: The CHAMACOS Study
Authors: Tindula Gwen , Gunier Robert B. , Deardorff Julianna , Nabaglo Kelly , Hubbard Alan , Huen Karen , Eskenazi Brenda , Holland Nina
Published: December 2018

Objective

Little is known about the impact of the home environment on biomarkers of obesity, such as adipokines, in children. In this study, we examined the relationship of maternal depressive symptoms and potentially protective social factors, including maternal support and the home learning environment, with body mass index and adipokines.

Methods

Data were obtained from 326 Mexican American participants from the Center for the Health Assessment of Mothers and Children of Salinas cohort. Plasma adipokine levels were assessed in 326 children by enzyme-linked immunoassay at birth or ages 5, 9, or 14 years. Maternal depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale when children were 1, 3.5, 7, and 9 years old; social support was assessed by the Duke-University of North Carolina Questionnaire at ages 1 and 5 years; and home learning environment by the Home Observation for the Measurement of the Environment (HOME) at ages of 6 months and 1, 2, 3.5, 7, 9, and 10.5 years.

Results

Age was significantly associated with adiponectin (B = −5.0, SE = 0.2) and leptin (B = 0.01, SE = 0.003) levels. Individual time point analyses identified significant positive associations of HOME scores in childhood with adiponectin at ages 9 years (HOME score; age 3.5 years: B = 0.9, p = .04) and 14 years (HOME score; age 7 years: B = 0.6, p = .02, age 9 years: B = 0.6, p = .05, age 10.5 years: B = 0.5, p = .04). We observed significant relationships of maternal depressive symptoms at age 9 years with adiponectin and body mass index z-score at age 14 years (B = −0.2, p = .003 and B = 0.02, p = .002, resp.), which were confirmed in longitudinal models.

Conclusions

This study adds new evidence that adverse and protective aspects of the home environment could lead to altered obesity status in children.
Nonconvulsive Status Epilepticus: Validating the Salzburg Criteria Against an Expert EEG Examiner
Authors: Krogstad Martin H. , Høgenhaven Hans , Beier Christoph P. , Krøigård Thomas
Published: December 2018

Purpose:

Rapid and correct diagnosis of nonconvulsive status epilepticus (NCSE) is crucial for optimal treatment. However, electroencephalographic diagnosis can be challenging. Salzburg Consensus Criteria (SCC) have been proposed to facilitate correct diagnosis, but their validity needs to be further established.

Methods:

We retrospectively reanalyzed the first EEG in adult patients (n = 284) referred under the suspicion of NCSE at our institution in 2014. Nonconvulsive status epilepticus or possible NCSE was diagnosed according to the SCC by an examiner specifically trained in SCC and was compared with the original diagnosis made by an expert EEG examiner, which in this context served as the reference standard, to assess the validity of the criteria. Furthermore, the clinical outcome for patients not diagnosed using SCC (false-negatives) was examined.

Results:

Nonconvulsive status epilepticus or possible NCSE was diagnosed in 40 patients by the inexperienced reader using the SCC, blinded to other clinical data, and in 47 patients by the experienced reader, not blinded to the clinical data, who did not use SCC. There were eight false-negatives, one false-positive, 39 true-positives, and 236 true-negatives. Concordance between SCC and the reference standard was high (k = 0.88 [95% confidence interval, 0.80 to 0.96]). Four of the eight false-negatives suffered from anoxic encephalopathy. The remainder had a history of epilepsy and returned to preictal functional state.

Conclusions:

The SCC for NCSE implemented by an inexperienced EEG reader, blinded to all other data, yielded results highly concordant with the evaluation of EEG by an experienced reader. False-negative diagnoses were associated with postictal states or anoxic encephalopathy.
Genome-wide association study identifies common genetic risk factors for alcohol, heroin and methamphetamine dependence
Authors: Sun Yan , Chang Suhua , Liu Zhen , Zhang Libo , Wang Fan , Yue Weihua , Sun Hongqiang , Ni Zhaojun , Chang Xiangwen , Zhang Yibin , Chen Yang , Lu Lin , Shi Jie
Published: December 2018

Background

Common molecular and cellular foundations underlie different types of substance dependence (SD). However direct evidence for common genetic factors of SD is lacking. Here we aimed to identify specific genetic variants that are shared between alcoholism, heroin and methamphetamine dependence.

Methods

We first conducted a combined case-control genome-wide association analysis (GWAS) of 521 alcoholic, 1,026 heroin and 1,749 methamphetamine patients and 2,859 healthy controls. We then replicated the significant loci using an independent cohort (146 alcoholic, 1,045 heroin, 763 methamphetamine and 1,904 controls). Second, we examined the genetic effects of these identified SNPs on gene expression, addiction characteristics and brain images (gray and white matter). Furthermore, we investigated the effects of these genetic variants on addiction behaviors using self-administration rat models.

Results

We identified and validated four genome-wide significant loci in the combined cohorts in the discovery stage: ADH1B rs1229984 (P=6.45×10−10), ANKS1B rs2133896 (P=4.09×10−8), AGBL4 rs147247472 (P=4.30×10−8) and CTNNA2 rs10196867 (P=4.67×10−8). Association results for each dependence group showed that ADH1B rs1229984 was only associated with alcoholism, while the other three loci were associated with heroin, methamphetamine addiction and alcoholism respectively. Variants that were strongly linked to rs2133896 affected ANKS1B gene expression, heroin use frequency and interacted with heroin dependence to affect gray matter of the left calcarine and white matter of the right superior longitudinal fasciculus. In addition, the reduced anks1b expression in the ventral tegmental area increased addiction vulnerability for heroin and methamphetamine in self-administration rat models.

Conclusion

Our findings revealed several novel genome-wide significant SNPs and genes that synchronously affected the vulnerability and phenotypes for alcoholism, heroin and MA dependence. These findings could shed light on the root cause and the generalized vulnerability for SD.
Inhibition of mitochondrial permeability transition by deletion of the ANT family and CypD
Authors: Karch Jason , Bround Michael J. , Khalil Hadi , Sargent Michelle A. , Latchman Nadina , Terada Naohiro , Peixoto Pablo M. , Molkentin Jeffery D.
Published: December 2018

The mitochondrial permeability transition pore (MPTP) has resisted molecular identification for decades. The original model of the MPTP had the adenine nucleotide translocator (ANT) as the inner membrane pore-forming component. Indeed, reconstitution experiments showed that recombinant or purified ANT generates MPTP-like pores in lipid bilayers. This model was challenged when mitochondria from Ant1/2 double null mouse liver still showed MPTP activity. Because mice contain and express 3 Ant genes, here we reinvestigated the genetic basis for the ANTs as comprising the MPTP. Liver mitochondria from Ant1, Ant2, and Ant4 deficient mice were highly refractory to Ca2+-induced MPT, and when also given cyclosporine A, MPT was completely inhibited. Moreover, liver mitochondria from mice with quadruple deletion of Ant1, Ant2, Ant4 and Ppif (cyclophilin D, target of CsA) lacked Ca2+-induced MPT. Finally, inner membrane patch clamping in mitochondria from Ant1, Ant2 and Ant4 triple null mouse embryonic fibroblasts (MEFs) showed a loss of MPT-like pores. Our findings suggest a new model of MPT consisting of two distinct molecular components, one of which is the ANTs and the other of which is unknown but requires CypD.

One Sentence Summary

Genetic deletion of Ant1/2/4 and Ppif in mice fully inhibits the mitochondrial permeability transition pore
Low back pain among nurses working in a clinical settings of Africa: A systematic review and meta-analysis of a 19 years of studies
Authors: Semachew Ayele , Workineh Yinager , Ayalew Emiru , Animaw Worku ,   Yinager Workineh, Emiru Ayalew and Worku Animaw
Published: December 2018

Introduction: Because of the nature of the work, healthcare providers are prone to develop different musculoskeletal problems including low back pain and hospital healthcare workers are groups of healthcare workers who suffered a lot from it. The incidence varies between countries and professions. The situation is somewhat worsen among the frontline healthcare provider in many healthcare facilities. Nurses in Africa are arguably the most important frontline health care workers available in most African healthcare facilities, performing a broad range of tasks and working in settings where no other health workers, including physicians, are available. This situation is considerably important in the causation of work load. Nursing is listed among the highly risky profession for the development of low back pain and has been ranked with in the top tenth professions which have a great risk of having susceptible to low back pain.
Objective: The aim of this systematic review and meta-analysis was to ascertain whether LBP is of a significant concern among nurses in African healthcare facilities.
Methods: A comprehensive literature search of different data bases with no date limit was conducted from September to November 2018 using the PRISMA guideline. The quality of the included studies were assessed using a 12-item rating system. Subgroup and sensitivity analysis were performed. Cochran's Q and the I2 test were used to assess heterogeneity. The presence of publication bias was evaluated by using Egger's test and visual inspection of the symmetry in funnel plots.
Result: During the period 2000–2018, nineteen studies with a sample size of 6110 have been carried out. Among them, the lowest and the highest prevalence were found to be 44.1% and 82.7%. Both the highest and the lowest prevalence of low back pain were reported from a studies done in Nigeria. The estimation of the prevalence rate of low back pain among nurses using the random effects model was found to be 64.07% (95% CI: 58.68–69.46; P-value < 0.0001). Heterogeneity of the reviewed studies was I2 = 94.2% and heterogeneity Chi-squared = 310.06 (d.f = 18), P-value < 0.0001. The subgroup analyses showed that the highest prevalence of LBP among nurses was from west African region with prevalence rates of 68.46% (95% CI: 54.94– 81.97; P-value <0.0001) and followed by north Africa region with prevalence rate of 67.95% (95% CI: 55.96–79.94; P value <0.0001) had the higher prevalence of LBP as compared to their south African counterparts, 59% (95% CI: 51–66.9; P-value <0.0001).
Conclusion: Even though the overall prevalence of the present study is lower when compared to the western and Asian studies, it indicated that the prevalence of low back pain among nurses is on the move.
Fire, grazing and climate shape plant–grasshopper interactions in a tallgrass prairie
Authors: Welti Ellen A. R. , Qiu Fan , Tetreault Hannah M. , Ungerer Mark , Blair John , Joern Anthony
Published: December 2018

Species interactions are integral to ecological community function, and the structure of species interactions has repercussions for the consequences of species extinctions. Few studies have examined the role of environmental factors in controlling species interaction networks across time.

We examined variation in plant–grasshopper network structural properties in response to three major grassland drivers: periodic fire, ungulate grazing and climate.

We sequenced a plant barcoding gene from extracted grasshopper gut contents to characterize diets of 26 grasshopper species. Resulting grasshopper species’ diets were combined with long‐term plant and grasshopper surveys to assemble plant–grasshopper networks across 13–19 years for six watersheds subjected to varying fire and grazing treatments.

Network modularity, generality and predicted grasshopper community robustness to plant species loss all increased in grazed watersheds. Temperature decreased predicted grasshopper community robustness to plant species loss.

Grasshopper communities were found to be vulnerable to climatic warming due to host plant loss. However, intermediate disturbance from ungulate grazers may maintain grasshopper diversity and buffer community robustness to species loss. Our results suggest that climate and disturbance shape the structure of ecological interaction networks and thus have many indirect effects on species persistence though direct effects on interaction partners.

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A guide to modelling priorities for managing land‐based impacts on coastal ecosystems
Authors: Brown Christopher J. , Jupiter Stacy D. , Albert Simon , Anthony Kenneth R. N. , Hamilton Richard J. , Fredston‐Hermann Alexa , Halpern Benjamin S. , Lin Hsien‐Yung , Maina Joseph , Mangubhai Sangeeta , Mumby Peter J. , Possingham Hugh P. , Saunders Megan I. , Tulloch Vivitskaia J. D. , Wenger Amelia , Klein Carissa J.
Published: December 2018

Pollution from land‐based run‐off threatens coastal ecosystems and the services they provide, detrimentally affecting the livelihoods of millions people on the world's coasts. Planning for linkages among terrestrial, freshwater and marine ecosystems can help managers mitigate the impacts of land‐use change on water quality and coastal ecosystem services.

We examine the approaches used for land‐sea planning, with particular focus on the models currently used to estimate the impacts of land‐use change on water quality and fisheries. Our findings could also be applied to other ecosystem services. This Review encompasses modelling of: large scale drivers of land‐use change; local activities that cause such change; run‐off, dispersal and transformation of pollutants in the coastal ocean; ecological responses to pollutants; socio‐economic responses to ecological change; and finally, the design of a planning response.

We find that there is a disconnect between the dynamical models that can be used to link land to sea processes and the simple tools that are typically used to inform planning. This disconnect may weaken the robustness of plans to manage dynamic processes. Land‐sea planning is highly interdisciplinary, making the development of effective plans a challenge for small teams of managers and decision makers.

Synthesis and applications. We propose some guiding principles for where and how dynamic land‐sea connections can most effectively be built into planning tools. Tools that can capture pertinent processes are needed, but they must be simple enough to be implemented in regions with limited resources for collecting data, developing models and developing integrated land‐sea plans.
Bioinformatic, phylogenetic and chemical analysis of the UV‐absorbing compounds scytonemin and mycosporine‐like amino acids from the microbial mat communities of Shark Bay, Australia
Authors: D'Agostino Paul M. , Woodhouse Jason N. , Liew Heng Tai , Sehnal Luděk , Pickford Russel , Wong Hon Lun , Burns Brendan P. , Neilan Brett A.
Published: December 2018

Shark Bay, Western Australia is a World Heritage area with extensive microbial mats and stromatolites. Microbial communities that comprise these mats have developed a range of mitigation strategies against changing levels of photosynthetically active and ultraviolet radiation, including the ability to biosynthesise the UV‐absorbing natural products scytonemin and mycosporine‐like amino acids (MAAs). To this end, the distribution of photoprotective pigments within Shark Bay microbial mats was delineated in the present study. This involved amplicon sequencing of bacterial 16S rDNA from communities at the surface and subsurface in three distinct mat types (smooth, pustular and tufted), and correlating this data with the chemical and molecular distribution of scytonemin and MAAs. Employing UV spectroscopy and MS/MS fragmentation, mycosporine‐glycine, asterina and an unknown MAA were identified based on typical fragmentation patterns. Marker genes for scytonemin and MAA production (scyC and mysC) were amplified from microbial mat DNA and placed into phylogenetic context against a broad screen throughout 363 cyanobacterial genomes. Results indicate that occurrence of UV screening compounds is associated with the upper layer of Shark Bay microbial mats, and the occurrence of scytonemin is closely dependent on the abundance of cyanobacteria.