bluuebunny/crossref_metadata_2025 huggingface dataset:
Tailoring the structural and magnetic properties of masked CoPt thin films using ion implantation
Authors: Kumar Durgesh , Gupta Surbhi , Jin Tianli , Nongjai R. , Asokan K. , Piramanayagam S. N.
Published: December 2017

The effects of ion implantations through a mask on the structural and magnetic properties of Co80Pt20 films were investigated. The mask was patterned using the self-assembly of diblock copolymers. For implantation, high (40 keV for 14N+ and 100 keV for 40Ar+) and low (7.5 keV for 14N+ and 4.5 keV for 40Ar+) energy 14N+ and 40Ar+ ions were used to modify the structural and magnetic properties of these films. X-ray diffraction and TRIM simulations were performed for understanding the structural changes due to ion implantations. These results revealed the intermixing of Co atoms in lower layers and lattice expansion in Co80Pt20 magnetic and Ru layers. A lateral straggling of Co caused an increase in the exchange coupling in the masked region. Depletion of Co atoms in Co80Pt20 layer caused a decrease in the anisotropy constant, which were further confirmed by the alternating gradient force magnetometer and magnetic force microscopy results. The magnetic force microscopy images showed an increase in domain width and domain wall width confirming the above-mentioned effects.
Non-critically phase-matched second harmonic generation and third order nonlinearity in organic crystal glucuronic acid γ-lactone
Authors: Saripalli Ravi Kiran , Katturi Naga Krishnakanth , Soma Venugopal Rao , Bhat H. L. , Elizabeth Suja
Published: December 2017

The linear, second order, and third order nonlinear optical properties of glucuronic acid γ-lactone single crystals were investigated. The optic axes and principal dielectric axes were identified through optical conoscopy and the principal refractive indices were obtained using the Brewster's angle method. Conic sections were observed which is perceived to be due to spontaneous non-collinear phase matching. The direction of collinear phase matching was determined and the deff evaluated in this direction was 0.71 pm/V. Open and closed aperture Z-scan measurements with femtosecond pulses revealed high third order nonlinearity in the form of self-defocusing, two-photon absorption, as well as saturable absorption.
Microwave SQUID multiplexer demonstration for cosmic microwave background imagers
Authors: Dober B. , Becker D. T. , Bennett D. A. , Bryan S. A. , Duff S. M. , Gard J. D. , Hays-Wehle J. P. , Hilton G. C. , Hubmayr J. , Mates J. A. B. , Reintsema C. D. , Vale L. R. , Ullom J. N.
Published: December 2017

Key performance characteristics are demonstrated for the microwave superconducting quantum interference device (SQUID) multiplexer (μmux) coupled to transition edge sensor (TES) bolometers that have been optimized for cosmic microwave background (CMB) observations. In a 64-channel demonstration, we show that the μmux produces a white, input referred current noise level of 29 pA/Hz at a microwave probe tone power of −77 dB, which is well below the expected fundamental detector and photon noise sources for a ground-based CMB-optimized bolometer. Operated with negligible photon loading, we measure 98 pA/Hz in the TES-coupled channels biased at 65% of the sensor normal resistance. This noise level is consistent with that predicted from bolometer thermal fluctuation (i.e., phonon) noise. Furthermore, the power spectral density is white over a range of frequencies down to ∼100 mHz, which enables CMB mapping on large angular scales that constrain the physics of inflation. Additionally, we report cross-talk measurements that indicate a level below 0.3%, which is less than the level of cross-talk from multiplexed readout systems in deployed CMB imagers. These measurements demonstrate the μmux as a viable readout technique for future CMB imaging instruments.
Shade access in combination with sprinkling and ventilation effects performance of Holstein cows in early and late lactation
Authors: Román Lorena , Saravia Celmira , Astigarraga Laura , Bentancur Oscar , La Manna Alejandro
Published: December 2017

The negative effect of heat stress on dairy cows, with a temperature humidity index (THI) over 72, has been extensively studied. However, there are few studies on THI values under 72 that compare the effect of heat stress in different lactation stages. The objective of this study was to determine the heat stress effect on two lactation stages with a THI below the threshold 72. Thirty-nine multiparous, non-pregnant Holstein cows with more than 30 kg/cow.day of solid-corrected milk were used in a randomised complete block design to evaluate six treatments. The experimental design had a 3 by 2 factorial arrangement with three heat stress mitigation strategies: No shade (CON), access to shade only, and access to shade combined with sprinkling and ventilation, and two stages of lactation: early (S1) and late (S2), 12 ± 10.3 and 201 ± 45.8 days in milk respectively, for a duration of 81 consecutive days. All treatments, except CON had access to artificial shade from 0900 hours to 0500 hours next day. From 0500 hours to 0900 hours all cows were managed together in a grazing session. Additionally, sprinkling and ventilation cows had two 30-min sessions of ventilation and spray (0900 hours, 1530 hours). The average THI was 70.1 ± 4.46 (minimum THI: 60.4; maximum THI: 81.7) and the average hours above 72 were 7.8 ± 5.98. Animals in S1 presented higher solids-corrected milk reduction (P < 0.0001; 5.4 and 1.9 kg/cow.day), and protein yield (<0.0001; 0.13 and 0.54 kg/cow.day) than animals in S2 when shade was not allowed (CON). It was concluded that under these conditions, animal productivity is more negatively affected in early lactation animals. The use of shade with or without spray and ventilation mitigates heat stress effects on both stages of lactation.
Fairies, banshees, and the church
Authors: Peters Arne
Published: December 2017

The present paper approaches Irish English from a cultural linguistic perspective. It illustrates how the study of cultural schemas, cultural categories, cultural conceptualisations, and conceptual metaphors/metonymies can contribute to the understanding of Irish English as a variety of English whose speech community shares a unique cultural cognition, which is instantiated in linguistic patterns that appear to be ‘marked’ for everybody from outside of Ireland. Drawing from two corpora (ICE-Ireland, Corpus of Galway City Spoken English) as well as from ethnographic research (Wentz 1911;National Folklore Collection 1939/2017), the paper discusses possible cultural keywords of Irish English, cultural schemas involvingbansheesandfairiesas well as conceptual metonymies such asthe church is authority, all of which can be understood to express particular Irish cultural experiences. The paper also illustrates how cultural conceptualisations are constantly being negotiated and renegotiated through time and across generations within the Irish English speech community. The paper illustrates the applicability of the cultural linguistic paradigm to the study of Irish English, offering a new perspective on a well-studied variety of English.
Conceptualizations of respect in business negotiations
Authors: Oliveira Milene Mendes de
Published: December 2017

International business negotiations are prone to several difficulties, one of the most fundamental of which being differences in cultural conceptualizations (Sharifian 2011). In order to explore how Brazilians and Germans conceptualizerespect in business negotiations, interviews in English with business negotiators were conducted and cultural conceptualizations analyzed. Following an ‘organic’ (Quinn 2005) and (mainly) qualitative approach to data, this paper presents: (a) the main conceptualizations found for both groups; (b) a cognitive-linguistic analysis of collocations of ‘respect’ found in the interviews; and (c) a preliminary sketch of group-level conceptualizations ofrespect in business negotiationsfor both groups. For Brazilians, the source domainslocationandvertical splittingwere salient, which points to the relevance of hierarchy. For Germans, the source domainhorizontal splittingand thesphere separationcultural schema were recurrent, which signals appreciation for the public-private sphere separation. These conceptual differences might have practical consequences in international negotiation scenarios.
Effects of heat input on microstructure and mechanical properties of Fe–2Cr–Mo–0.12C steel
Authors: Wang Qi-wen , Li Chang-sheng , Chen Jie , Tu Xing-yang
Published: December 2017

Thermal simulated specimens with the heat inputs of 20, 50 and 80 kJ/cm were used to investigate the effects of heat input on the microstructure and mechanical properties of the Fe–2Cr–Mo–0.12C pressure-vessel steel. The results indicated that the microstructures in the coarse-grained heat affected zone of tested steels with various heat inputs were mainly consisted of lath martensite and bainite ferrite. As the heat input increased, the fraction of martensite decreased and the bainite ferrite fraction increased. The toughness (tested at −40°C) and hardness for the heat input of 50 kJ/cm were 102 J and 346 HV, respectively, which was attributed to the high-volume fraction (60%) of the high-angle grain-boundary and the fine bainite lath.

This paper is part of a thematic issue on Nuclear Materials.
Microstructure and strength of high nitrogen steel joints brazed with Ni-Cr-B-Si filler
Authors: Zhu Weiwei , Jiang Haifeng , Zhang He , Sun Shicheng , Liu Yaodong
Published: December 2017

Brazing of high nitrogen austenitic stainless steels was carried out by using Ni-Cr-B-Si filler metal. The effects of brazing temperature (1020–1100°C) on the microstructure and shear strength of the joints were investigated. The results show that BN compounds with hexagonal structure are formed at the interface by the reaction of N from substrate and B from filler. The brittle Cr5B3 compounds with high microhardness are observed in the centre of brazing seam. The BN content increases and the Cr5B3 content decreases with the increase in brazing temperature. However, the content of BN compounds played a determinable role on the joint strength. The optimal shear strength of joints was 176.7 MPa when the joining temperature was 1020°C.
Mechanical characteristics and bioactivity of porous Ni50−xTi50Cux (x = 0, 5 and 10) prepared by P/M
Authors: Sharma Neeraj , Kumar Kamal
Published: December 2017

The present research work investigates and analyses the effect of compaction pressure, sintering temperature and time on mechanical characteristics, namely compressive strength and Young's modulus of Ni50− xTi50Cu x ( x = 0, 5 and 10) alloys fabricated using powder metallurgy technology. The effect of process parameters on mechanical characteristics was evaluated using the Taguchi method and analysis of variance. Using the Taguchi approach, optimised values of process parameters were found for higher compressive strength and lower Young's modulus in each set of Ni50Ti50, Ni45Ti50Cu5 and Ni40Ti50Cu10 alloys. With the addition of copper in NiTi alloy, a little improvement in mechanical characteristics was observed, but bioactivity was decreased at 10%of Cu. Therefore, above 5% of Cu in NiTi alloy was not proved successful for biomedical applications.
The characteristics of TiAl-based alloys melted in graphite crucibles
Authors: Szkliniarz Wojciech , Szkliniarz Agnieszka
Published: December 2017

In the paper, the phase composition, microstructure, and selected mechanical and operational properties at room and elevated temperature of a TiAl intermetallic alloy from the TNB group – Ti–45Al–8Nb–0.5(B, C), induction melted in special graphite crucibles, are characterised. Selected properties of this alloy were compared to those of the reference TNB-V2 alloy with similar chemical composition, prepared with technologies currently used in the world. The result of this comparison was a positive recommendation for the proposed melting technology as an alternative to this and other groups of TiAl-based alloys.

This paper is part of a thematic issue on Titanium.
Assessment of the mechanical and tribological performance of a ZrN PVD coating
Authors: Staia M. H. , Trocelis A. , Zairi A. , Suarez M. , Puchi-Cabrera E. S. , Iost A. , Montagne A.
Published: December 2017

The present work has been conducted in order to assess the mechanical and tribological performance of a ZrN/Mo2N coating deposited onto a H13 steel by means of a closed field unbalanced magnetron-sputtering ion-plating process. The hardness and elastic modulus of the coated system have been determined employing nanoindentation techniques. Dry and wet (3.5 wt-% NaCl solution) sliding wear tests were carried out making use of an alumina ball as counterpart. It has been determined that, during testing under the corrosive solution, the coating experiences a severe abrasive wear mechanism, due to the combined action of the alumina ball, the hard ‘debris’ and a coating localised corrosion attack. On the other hand, it has been shown that the coated system is able to increase the wear resistance of the substrate by more than one order of magnitude, if the wear tests are carried out in air under the same conditions.
Organ-specific lymphatic vasculature: From development to pathophysiology
Authors: Petrova Tatiana V. , Koh Gou Young
Published: December 2017

Recent discoveries of novel functions and diverse origins of lymphatic vessels have drastically changed our view of lymphatic vasculature. Traditionally regarded as passive conduits for fluid and immune cells, lymphatic vessels now emerge as active, tissue-specific players in major physiological and pathophysiological processes. Lymphatic vessels show remarkable plasticity and heterogeneity, reflecting their functional specialization to control the tissue microenvironment. Moreover, alternative developmental origins of lymphatic endothelial cells in some organs may contribute to the diversity of their functions in adult tissues. This review aims to summarize the most recent findings of organotypic differentiation of lymphatic endothelial cells in terms of their distinct (patho)physiological functions in skin, lymph nodes, small intestine, brain, and eye. We discuss recent advances in our understanding of the heterogeneity of lymphatic vessels with respect to the organ-specific functional and molecular specialization of lymphatic endothelium, such as the hybrid blood-lymphatic identity of Schlemm’s canal, functions of intestinal lymphatics in dietary fat uptake, and discovery of meningeal lymphatic vasculature and perivascular brain lymphatic endothelial cells.
Sameness and Separability in Gauge Theories
Authors: Dougherty John
Published: December 2017

In the philosophical literature on Yang-Mills theories, field formulations are taken to have more structure and to be local, while curve-based formulations are taken to have less structure and to be nonlocal. I formalize the notion of locality at issue and show that theories with less structure are nonlocal. However, the amount of structure had by some formulation is independent of whether it uses fields or curves. The relevant difference in structure is not a difference in set-theoretic structure. Rather, it is a difference in the structure of the category of models of the theory.
Intimate Connections: Symmetries and Conservation Laws in Quantum versus Classical Mechanics
Authors: Ruiz de Olano Pablo
Published: December 2017

In this article, I use a number of remarks made by Eugene Wigner to defend the claim that the nature of the connection between symmetries and conservation laws is different in quantum and in classical mechanics. In particular, I provide a list of three differences that obtain between the Hilbert space formulation of quantum mechanics and the Lagrangian formulation of classical mechanics. I also show that these differences are due to the fact that conservation laws are not the only consequence that symmetries have in quantum mechanics and to the fact that, in classical mechanics, the connection between symmetries and conservation laws does not always obtain.
Unreal Observables
Authors: Roberts Bryan W.
Published: December 2017

This article argues that quantum observables can include not just self-adjoint operators but any member of the class of normal operators, including those with nonreal eigenvalues. Concrete experiments, statistics, and symmetries are all expressed in this more general context. However, this more general class of observables also requires a new restriction on sets of operators that can be interpreted as observables at once, called ‘sharp sets’.
Thermodynamic analysis of steam-injected advanced gas turbine cycles
Authors: Pandey Devendra , Bade Mukund H.
Published: December 2017

This paper deals with thermodynamic analysis of steam-injected gas turbine (STIGT) cycle. To analyse the thermodynamic performance of steam-injected gas turbine (STIGT) cycles, a methodology based on pinch analysis is proposed. This graphical methodology is a systematic approach proposed for a selection of gas turbine with steam injection. The developed graphs are useful for selection of steam-injected gas turbine (STIGT) for optimal operation of it and helps designer to take appropriate decision. The selection of steam-injected gas turbine (STIGT) cycle can be done either at minimum steam ratio (ratio of mass flow rate of steam to air) with maximum efficiency or at maximum steam ratio with maximum net work conditions based on the objective of plants designer. Operating the steam injection based advanced gas turbine plant at minimum steam ratio improves efficiency, resulting in reduction of pollution caused by the emission of flue gases. On the other hand, operating plant at maximum steam ratio can result in maximum work output and hence higher available power.
4. How universities and colleges work
Authors: Palfreyman David , Temple Paul
Published: December 2017

‘How universities and colleges work’ considers how the university and college actually work in terms of their structures, funding, governance, and management. Universities and colleges are complex operations trying to fulfil a multitude of potentially conflicting tasks and expectations, with a wide variety of demanding stakeholders. Despite facing numerous challenges today, universities and colleges continue to predominantly focus on teaching and research. Many also contribute, through consultancy and the exploitation of intellectual property, to their local economy, pursuing ‘civic engagement’. The balance of power or influence within the triangle of academic staff (faculty), managers (the executive), and lay-members (the trustees) varies greatly from one university and college to another.
JASPAR RESTful API: accessing JASPAR data from any programming language
Authors: Khan Aziz , Mathelier Anthony
Published: December 2017

JASPAR is a widely used open-access database of curated, non-redundant transcription factor binding profiles. Currently, data from JASPAR can be retrieved as flat files or by using programming language-specific interfaces. Here, we present a programming language-independent application programming interface (API) to access JASPAR data using the Representational State Transfer (REST) architecture. The REST API enables programmatic access to JASPAR by most programming languages and returns data in eight widely used formats. Several endpoints are available to access the data and an endpoint is available to infer the TF binding profile(s) likely bound by a given DNA binding domain protein sequence. Additionally, it provides an interactive browsable interface for bioinformatics tool developers.

Availability and implementation

This REST API is implemented in Python using the Django REST Framework. It is accessible at http://jaspar.genereg.net/api/ and the source code is freely available at https://bitbucket.org/CBGR/jaspar under GPL v3 license.

Supplementary information

Supplementary data are available at Bioinformatics online.
fMLC: fast multi-level clustering and visualization of large molecular datasets
Authors: Vu D , Georgievska S , Szoke S , Kuzniar A , Robert V
Published: December 2017

Motivation

Despite successful applications of data clustering and visualization techniques in molecular sequence identification, current technologies still do not scale to large biological datasets.

Results

We address this problem by a new multi-threaded tool, fMLC, primarily developed to cluster DNA sequences, that is supplemented with an interactive web-based visualization component, DiVE. fMLC enabled to compare, cluster and visualize 350K ITS fungal sequences at the species level. It took less than two hours to compare and cluster the dataset, which is twelve times faster than the time reported previously.

Availability and implementation

https://github.com/FastMLC/fMLC (doi: 10.5281/zenodo.926820)
Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)
Authors: McDonald L Clifford , Gerding Dale N , Johnson Stuart , Bakken Johan S , Carroll Karen C , Coffin Susan E , Dubberke Erik R , Garey Kevin W , Gould Carolyn V , Kelly Ciaran , Loo Vivian , Shaklee Sammons Julia , Sandora Thomas J , Wilcox Mark H
Published: December 2017

A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.
Quantitative Runge Approximation and Inverse Problems
Authors: Rüland Angkana , Salo Mikko
Published: December 2017

In this short note, we provide a quantitative version of the classical Runge approximation property for second-order elliptic operators. This relies on quantitative unique continuation results and duality arguments. We show that these estimates are essentially optimal. As a model application, we provide a new proof of the result from [8], [2] on stability for the Calderón problem with local data.
Health Conditions in an Adult Population in Sierra Leone: Data Reported From the Sierra Leone Trial to Introduce a Vaccine Against Ebola (STRIVE)
Authors: Fombah Augustin E , Goldstein Susan T , Jarrett Olamide D , Jalloh Mohamed I , El-Khorazaty Jill , Lisk Durodami Radcliffe , Legardy-Williams Jennifer , Pratt Dudley A , George Peter M , Russell James B W , Schrag Stephanie J , Dawson Peter , Deen Gibrilla F , Carr Wendy , Lindblad Robert , James Faustine , Bah Mohamed M , Yillia John F , Sandy Jibao D , Turay Patrick E , Conteh Muhammad-Abbas , Slutsker Laurence , Mahon Barbara E , Samai Mohamed , Seward Jane F
Published: December 2017

The Sierra Leone Trial to Introduce a Vaccine Against Ebola (STRIVE), a clinical trial of the investigational recombinant vesicular stomatitis virus–based Ebola virus vaccine (rVSV∆ZEBOV-GP; Merck), provided an opportunity to assess health conditions in a cohort of healthy Sierra Leonean adults before vaccination. Of the 8793 healthcare and frontline Ebola response workers screened for study enrollment, 7 (0.1%) self-reported human immunodeficiency virus infection or another significant immunodeficiency disorder and 11 of 3190 (0.3%) women 18–49 years old had a positive urine pregnancy test. Of the 440 participants included in a safety substudy, 124 (28.2%) reported at least 1 medical condition at baseline, most commonly drug hypersensitivity (11.6%), arthralgia (3.9%), arthropathy (2.7%), or gastric (3.0%) or peptic (2.7%) ulcer disease. We calculated the incidence per 100 person-years (PY) and 95% confidence intervals (CIs) of new medical conditions among the 4297 participants followed for 18–24 weeks from enrollment to scheduled vaccination. The most commonly reported conditions were headache (32.4 PY [95% CI, 29.7–35.3 PY]), pain (unspecified) (17.3 PY [95% CI, 15.4–19.4 PY]), arthralgia (9.3 PY [95% CI, 7.9–10.8 PY]), and abdominal pain (9.1 PY [95% CI, 7.7–10.7 PY]). Nasopharyngitis (7.0 PY [95% CI, 5.8–8.4 PY]) and malaria (1.9 PY [95% CI, 1.3–2.7 PY]) were the most commonly reported infectious conditions. Several cases of hypertension, diabetes mellitus, and cancer were also reported.

Clinical Trials Registration

ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].
Extracellular Matrix Applications in the Treatment of Open Fractures With Complex Wounds and Large Soft Tissue Defects
Authors: Fokin Alexander A. , Puente Ivan , Hus Nir , Rodriguez Eugenio , Weisz Russell D.
Published: December 2017

Use of biologic scaffolds such as extracellular matrix (ECM) is a promising trend in the treatment of complex wounds in orthopedic trauma patients. In this clinical series we describe the technique of the successful application of porcine urinary bladder ECM products in the treatment of open fractures of the extremities with complex wounds and large soft tissue defects. The clinical outcomes demonstrated that even in challenging cases where local flap coverage of bone or neurovascular structures is not possible, sequential xenograft implantation allowed us to achieve a stable soft tissue envelope. Different forms of ECM products are easy to apply in the presence of orthopedic hardware. In certain wounds, complete closure can be achieved even without subsequent skin grafting. We recommend relatively earlier application of xenograft.
Effects of Propofol on Cellular Bioenergetics in Human Skeletal Muscle Cells
Authors: Krajčová Adéla , Løvsletten Nils Gunnar , Waldauf Petr , Frič Vladimír , Elkalaf Moustafa , Urban Tomáš , Anděl Michal , Trnka Jan , Thoresen G. Hege , Duška František
Published: December 2017

Objectives:

Propofol may adversely affect the function of mitochondria and the clinical features of propofol infusion syndrome suggest that this may be linked to propofol-related bioenergetic failure. We aimed to assess the effect of therapeutic propofol concentrations on energy metabolism in human skeletal muscle cells.

Design:

In vitro study on human skeletal muscle cells.

Settings:

University research laboratories.

Subjects:

Patients undergoing hip surgery and healthy volunteers.

Interventions:

Vastus lateralis biopsies were processed to obtain cultured myotubes, which were exposed to a range of 1–10 μg/mL propofol for 96 hours.

Measurements and Main Results:

Extracellular flux analysis was used to measure global mitochondrial functional indices, glycolysis, fatty acid oxidation, and the functional capacities of individual complexes of electron transfer chain. In addition, we used [1-14C]palmitate to measure fatty acid oxidation and spectrophotometry to assess activities of individual electron transfer chain complexes II–IV. Although cell survival and basal oxygen consumption rate were only affected by 10 μg/mL of propofol, concentrations as low as 1 μg/mL reduced spare electron transfer chain capacity. Uncoupling effects of propofol were mild, and not dependent on concentration. There was no inhibition of any respiratory complexes with low dose propofol, but we found a profound inhibition of fatty acid oxidation. Addition of extra fatty acids into the media counteracted the propofol effects on electron transfer chain, suggesting inhibition of fatty acid oxidation as the causative mechanism of reduced spare electron transfer chain capacity. Whether these metabolic in vitro changes are observable in other organs and at the whole-body level remains to be investigated.

Conclusions:

Concentrations of propofol seen in plasma of sedated patients in ICU cause a significant inhibition of fatty acid oxidation in human skeletal muscle cells and reduce spare capacity of electron transfer chain in mitochondria.
Advanced PET imaging in oncology: status and developments with current and future relevance to lung cancer care
Authors: Voigt Wieland
Published: December 2017

Purpose of review

This review highlights the status and developments of PET imaging in oncology, with particular emphasis on lung cancer. We discuss the significance of PET for diagnosis, staging, decision-making, monitoring of treatment response, and drug development. The PET key advantage, the noninvasive assessment of functional and molecular tumor characteristics including tumor heterogeneity, as well as PET trends relevant to cancer care are exemplified.

Recent findings

Advances of PET and radiotracer technology are encouraging for multiple fields of oncological research and clinical application, including in-depth assessment of PET images by texture analysis (radiomics). Whole body PET imaging and novel PET tracers allow assessing characteristics of most types of cancer. However, only few PET tracers in addition to 18F-fluorodeoxyglucose have sufficiently been validated, approved, and are reimbursed for a limited number of indications. Therefore, validation and standardization of PET parameters including tracer dosage, image acquisition, post processing, and reading are required to expand PET imaging as clinically applicable approach.

Considering the potential of PET imaging for precision medicine and drug development in lung and other types of cancer, increasing efforts are warranted to standardize PET technology and to provide evidence for PET imaging as a guiding biomarker in nearly all areas of cancer treatment.
The prevalence of occult leiomyosarcoma in women undergoing presumed fibroid surgery and outcomes after morcellation
Authors: Pritts Elizabeth A.
Published: December 2017

Purpose of review

To review the data-derived prevalence rates for occult leiomyosarcoma (LMS), and outcomes for women who have these tumors inadvertently morcellated.

Recent findings

In 2014, the Food and Drug Administration presented data showing the prevalence rates of occult LMS at 2.02/1000 surgeries for presumed benign fibroids. They also attributed poorer outcomes for women undergoing power morcellation of these tumors. Two more recent meta-analyses have shown much lower rates, as low as one in 8300 surgeries when including only prospective studies, and one in 1428 surgeries when including both prospective and retrospective studies. When looking at outcomes, both studies show no difference in outcomes when comparing power or any other type of morcellation. The most recent data suggest that even intact removal has no advantage when looking at mortality rates.

Prevalence of occult LMS remains quite rare, but outcomes after intact removal or any type of morcellation appear to be no different.
Progressive Tightening of Pulley Sutures for Primary Repair of Large Scalp Wounds
Authors: Malone C. Helen , McLaughlin Jillian M. , Ross Lindy S. , Phillips Linda G. , Wagner Richard F.
Published: December 2017

Scalp defects greater than 2 cm in diameter are not usually amenable to primary closure and require local tissue rearrangement, grafting, tissue expansion, or prolonged second intention healing. Scalp flap reconstruction is a significant undertaking that requires elevation of a total flap surface area that is 3–6 times the size of the defect, often involves profuse bleeding, and can be challenging to perform without conscious sedation or general anesthesia. Anticoagulated and medically complex patients pose additional challenges and limit options for treatment. The pulley suture uses the mechanical advantage of the pulley to distribute tension across a wound and is useful in areas of high tension such as scalp wounds. For scalp wounds greater than 2 cm, pulley sutures are placed along the length of the wound. An assistant exerts equal tension on the pulley sutures, and the surgeon sequentially ties the sutures. The sutures are tightened and retied weekly until complete scalp closure is achieved. The pulley sutures can be used for rapid primary closure of scalp wounds up to 2.5–3.0 cm in diameter under local anesthesia. For scalp wounds larger than 3 cm, we have also found that pulley sutures can be progressively tightened yielding additional tissue expansion every week. Scalp wounds greater than 3.0 cm can be easily closed via primary repair and weekly tightening of pulley sutures without the need for flap reconstruction, traditional tissue expander placement, or second intention healing.
Multiple Pustules on the Foot
Authors: Gust Peter , Jacob Sharon E.
Published: December 2017

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of multiple pustules presenting on the foot.
In Vivo 5 Day Animal Studies of a Compact, Wearable Pumping Artificial Lung
Authors: Madhani Shalv P. , Frankowski Brian J. , Ye Sang-Ho , Burgreen Greg W. , Wagner William R. , Kormos Robert , D’Cunha Jonathan , Federspiel William J.
Published: December 2017

Recent studies show improved outcomes in ambulated lung failure patients. Ambulation still remains a challenge in these patients. This necessitates development of more compact and less cumbersome respiratory support specifically designed to be wearable. The Paracorporeal Ambulatory Assist Lung (PAAL) is being designed for providing ambulatory support in lung failure patients during bridge to transplant or recovery. We previously published in vitro and acute in vivo results of the PAAL. This study further evaluates the PAAL for 5 days. Five-day in vivo studies with the PAAL were conducted in 50–60 kg sheep after heparinization (activated clotting time range: 190–250 s) and cannulation with a 27 Fr. Avalon Elite dual-lumen cannula. The animals were able to move freely in a stanchion while device flow, resistance, and hemodynamics were recorded hourly. Oxygenation and hemolysis were measured daily. Platelet activation, blood chemistry, and comprehensive blood counts are reported for preoperatively, on POD 0, and POD 5. Three animals survived for 5 days. No study termination resulted from device failure. One animal was terminated on POD 0 and one animal was terminated at POD 3. The device was operated between 1.93 and 2.15 L/min. Blood left the device 100% oxygenated. Plasma-free hemoglobin ranged 10.8–14.5 mg/dl. CD62-P expression was under 10%. Minimal thrombus was seen in devices at explant. Chronic use of the PAAL in awake sheep is promising based on our study. There were no device-related complications over the study course. This study represents the next step in our pathway to eventual clinical translation.
Prognostic Significance of Periadnexal Extension in Cutaneous Melanoma and its Implications for Pathologic Reporting and Staging
Authors: Dodds Tristan J. , Lo Serigne , Jackett Louise , Nieweg Omgo , Thompson John F. , Scolyer Richard A.
Published: December 2017

Tumor thickness is the strongest predictor of outcome for clinically localized melanoma. Therefore, accurate assessment is critical for appropriate staging, reliable estimation of prognosis, and management. When melanoma extends alongside skin adnexal structures more deeply than the main tumor mass (periadnexal extension), it is currently unknown whether the prognosis is more accurately reflected by the deepest point of periadnexal tumor extension or the main tumor mass. This study sought to address this question. Survival outcomes of 257 primary cutaneous melanoma patients with periadnexal extension diagnosed between 2005 and 2015 and managed at Melanoma Institute Australia were identified and compared with a control cohort of 514 patients who were matched for tumor thickness, sex, age, mitotic rate, ulceration status, and year of diagnosis but lacked periadnexal extension. The incidence of periadnexal extension at Melanoma Institute Australia was 1.5% (257/16,692 cutaneous melanomas diagnosed between 2005 and 2015). The patient characteristics between the 2 groups were otherwise very similar; median Breslow thickness was 0.9 mm for the periadnexal group and 1.0 mm for the control group. The median extension beyond the Breslow thickness in the tumors with periadnexal extension was 0.45 mm (mean, 0.4 mm). Median follow-up was 46 months for the periadnexal group and 44 months for the control group. Measures of clinical outcomes all showed trends for improved survival in the periadnexal extension group; these were melanoma-specific survival (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.44, 1.38), overall survival (HR, 0.91; 95% CI, 0.59, 1.41), disease-free survival (HR, 0.68; 95% CI, 0.45, 1.03), and distant disease-free survival (HR, 0.69; 95% CI, 0.4, 1.17), although none were statistically significant. There was a higher rate of sentinel lymph node (SLN) metastasis in the periadnexal group versus the control group in patients whose tumors were >1 mm thick (24/100=24% vs. 23/187=12.3%). Periadnexal extension was significantly associated with SLN metastasis on univariate logistic regression analysis (odds ratio [95% CI], 2.25 [1.20, 4.24], P=0.01). If the periadnexal extension had been included in the measurement of tumor thickness, 42.8% of patients would have been upstaged to a higher American Joint Committee on Cancer T category. The findings of this study indicate that periadnexal involvement that extends more deeply than the thickness of the main tumor mass increases the risk of SLN metastasis in tumours >1 mm thick, however, does not worsen clinical outcomes overall, and tumor thickness measurements should not include deeper foci of periadnexal tumor.
A Measure of the Potential Impact of Hospital Community Health Activities on Population Health and Equity
Authors: Begun James W. , Kahn Linda M. , Cunningham Brooke A. , Malcolm Jan K. , Potthoff Sandra
Published: December 2017

Context:

Many hospitals in the United States are exploring greater investment in community health activities that address upstream causes of poor health.

Objective:

Develop and apply a measure to categorize and estimate the potential impact of hospitals' community health activities on population health and equity.

Design, Setting, and Participants:

We propose a scale of potential impact on population health and equity, based on the cliff analogy developed by Jones and colleagues. The scale is applied to the 317 activities reported in the community health needs assessment implementation plan reports of 23 health care organizations in the Minneapolis-St Paul, Minnesota, metropolitan area in 2015.

Main Outcome Measure:

Using a 5-point ordinal scale, we assigned a score of potential impact on population health and equity to each community health activity.

Results:

A majority (50.2%) of health care organizations' community health activities are classified as addressing social determinants of health (level 4 on the 5-point scale), though very few (5.4%) address structural causes of health equity (level 5 on the 5-point scale). Activities that score highest on potential impact fall into the topic categories of “community health and connectedness” and “healthy lifestyles and wellness.” Lower-scoring activities focus on sick or at-risk individuals, such as the topic category of “chronic disease prevention, management, and screening.” Health care organizations in the Minneapolis-St Paul metropolitan area vary substantially in the potential impact of their aggregated community health activities.

Conclusions:

Hospitals can be significant contributors to investment in upstream community health programs. This article provides a scale that can be used not only by hospitals but by other health care and public health organizations to better align their community health strategies, investments, and partnerships with programming and policies that address the foundational causes of population health and equity within the communities they serve.
Low-Dose Insulin as an Antiscarring Therapy in Breast Surgery: A Randomized Controlled Trial
Authors: Hallam Marc-James , Pitt Elizabeth , Thomas Alexis , Nduka Charles
Published: December 2017

Background:

The role of insulin in expediting wound healing is firmly established within the context of major trauma and burns; however, only limited clinical evidence exists as to its effects on scar formation. This study aims to build on previous laboratory work to examine the potential antiscarring properties of insulin in a clinical environment.

Methods:

Ninety-one patients undergoing bilateral aesthetic breast operations were recruited to receive low-dose insulin and placebo injections to the medial 3 cm of their submammary incisions within the context of a randomized, intrapatient, placebo-controlled trial, and scar quality was assessed at 3-, 6-, and 12-month reviews using the Manchester Scar Scale.

Results:

Across the cohort at 12-month review, the insulin-treated scars had lower scar scores (p = 0.055) compared with placebo. Subgroup analysis of individuals with heavier scars showed that median scar scores were significantly lower for the insulin-treated scars with regard to both scar contour (p = 0.048) and scar distortion (p = 0.045).

Conclusions:

Subcutaneous insulin injections reduced the appearance of scarring in this study compared with placebo. The greatest effect was seen in those participants who showed heavier scars and, as such, insulin has a role as an antiscarring therapy in individuals likely to be affected by heavier scarring. Further research is required to more precisely delineate which subjects may benefit most from this treatment.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
The Boomerang Lift: A Three-Step Compartment-Based Approach to the Youthful Cheek
Authors: Schreiber Jillian E. , Terner Jordan , Stern Carrie S. , Beut Javier , Jelks Elizabeth B. , Jelks Glenn W. , Tepper Oren M.
Published: December 2017

Autologous fat grafting is an important tool for plastic surgeons treating the aging face. Malar augmentation with fat is often targeted to restore the youthful facial contour and provides support to the lower eyelid. The existence of distinct facial fat compartments suggests that a stepwise approach may be appropriate in this regard. The authors describe a three-step approach to malar augmentation using targeted deep malar fat compartmental augmentation, termed the “boomerang lift.” Clinical patients undergoing autologous fat grafting for malar augmentation were injected in three distinct deep malar fat compartments: the lateral sub–orbicularis oculi fat, the medial sub–orbicularis oculi fat, and the deep medial cheek (n = 9). Intraoperative three-dimensional images were taken at baseline and following compartmental injections (Canfield VECTRA H1). Images were overlaid between the augmented and baseline captures, and the three-dimensional surface changes were analyzed, which represented the resulting “augmentation zone.” Three-dimensional analysis demonstrated a unique pattern for the augmentation zone consistent across patients. The augmentation zone resembled a boomerang, with the short tail supporting the medial lower lid and the long tail extending laterally along the zygomatic arch. The upper border was restricted by the level of the nasojugal interface, and the lower border was defined medially by the nasolabial fold and laterally by the level of the zygomaticocutaneous ligament. Lateral and medial sub–orbicularis oculi fat injections defined the boundaries of the boomerang shape, and injection to the deep medial cheek provided maximum projection. This is the first description of deep malar augmentation zones in clinical patients. Three-dimensional surface imaging was ideal for analyzing the surface change in response to targeted facial fat grafting. The authors’ technique resulted in a reproducible surface shape, which they term the boomerang lift.
Temporally Distinct Regulation of Pathways Contributing to Cardiac Proteostasis During the Acute and Recovery Phases of Sepsis
Authors: Crowell Kristen T. , Moreno Samantha , Steiner Jennifer L. , Coleman Catherine S. , Soybel David I. , Lang Charles H.
Published: December 2017

Background:

Cardiac dysfunction is a common manifestation of sepsis and is associated with early increases in inflammation and decreases in myocardial protein synthesis. However, little is known regarding the molecular mechanisms regulating protein homeostasis during the recovery phase after the removal of the septic nidus. Therefore, the purpose of this study was to investigate diverse signal transduction pathways that regulate myocardial protein synthesis and degradation.

Methods:

Adult male C57BL/6 mice were used to identify potential mechanisms mediating the acute (24 h) effect of cecal ligation and puncture as well as long-term changes that manifest during the chronic (10 days) recovery phase.

Results:

Sepsis acutely decreased cardiac protein synthesis that was associated with reduced phosphorylation of S6K1/S6 but not 4E-BP1. Sepsis also decreased proteasome activity, although with no change in MuRF1 and atrogin-1 mRNA expression. Sepsis acutely increased apoptosis (increased caspase-3 and PARP cleavage), autophagosome formation (increased LC3B-II), and canonical inflammasome activity (increased NLRP3, TMS1, cleaved caspase-1). In contrast, during the recovery phase, independent of a difference in food consumption, global protein synthesis was increased, the early repression in proteasome activity was restored to basal levels, whereas stimulation of apoptosis, autophagosome formation, and the canonical inflammasome pathway had abated. However, during recovery there was a selective stimulation of the noncanonical inflammasome pathway as evidenced by activation of caspase-11 with cleavage of Gasdermin D.

Conclusions:

These data demonstrate a temporally distinct homeostatic shift in the cardiac proteostatic response to acute infection and recovery.
Horner Syndrome as the Only Focal Neurologic Manifestation of Hypothalamic Hemorrhage
Authors: Sahin Cansu B. , Chaudhary Neeraj , Trobe Jonathan D.
Published: December 2017

A 70-year-old woman suffered an anterior dorsal hypothalamic hemorrhage that caused an ipsilateral Horner syndrome (HS) as the only focal neurologic manifestation. This is only the second reported case of hypothalamic hemorrhage producing HS. Because HS was the sole focal neurologic manifestation, its confirmation with topical apraclonidine drops was a valuable clue toward prompt localization of the patient's confusional state.