bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmental Concentrations of Antibiotics May Diminish Wolbachia infections in Aedes aegypti (Diptera: Culicidae)
Authors: Endersby-Harshman Nancy M , Axford Jason K , Hoffmann Ary A
Published: March 2019

Wolbachia-infected Aedes aegypti (L.) mosquitoes for control of dengue transmission are being released experimentally in tropical regions of Australia, south-east Asia, and South America. To become established, the Wolbachia Hertig (Rickettsiales: Rickettsiaceae) strains used must induce expression of cytoplasmic incompatibility (CI) in matings between infected males and uninfected females so that infected females have a reproductive advantage, which will drive the infection through field populations. Wolbachia is a Rickettsia-like alphaproteobacterium which can be affected by tetracycline antibiotics. We investigated whether exposure of Wolbachia-infected mosquitoes to chlortetracycline at environmentally relevant levels during their aquatic development resulted in loss or reduction of infection in three strains, wAlbB, wMel, and wMelPop. Wolbachia density was reduced for all three strains at the tested chlortetracycline concentrations of 5 and 50 µg/liter. Two of the strains, wMel and wMelPop, showed a breakdown in CI. The wAlbB strain maintained CI and may be useful at breeding sites where tetracycline contamination has occurred. This may include drier regions where Ae. aegypti can utilize subterranean water sources and septic tanks as breeding sites.
Effects of endophyte infection on the competitive ability of Achnatherum sibiricum depend on endophyte species and nitrogen availability
Authors: Zhou Yong , Li Xia , Liu Hui , Gao Yubao , Mace Wade J , Card Stuart D , Ren Anzhi
Published: March 2019

Aims

The leaves of almost all terrestrial plant species are colonized by endophytic fungi. Compared to agronomic grasses, which usually harbor few endophytes, native grasses generally possess greater endophyte species diversity. Existing studies examining endophyte effects on natural grasses under competition normally considered the infection status (infected or uninfected), and rarely considered endophyte species.

Methods

We examined the effects of endophyte infection and of endophyte species on the interspecific competitive ability of a subdominant species, Achnatherum sibiricum, at two nitrogen levels (high nitrogen and low nitrogen). Achnatherum sibiricum plants infected by two different species of endophyte (Epichloë sibirica and E. gansuensis) and uninfected plants were grown in monoculture and binary mixtures with a dominant species, Stipa grandis (six individuals per species for monocultures and three + three individuals of each species in mixtures). Shoot and root biomass, tiller number and total phenolic concentration were measured after 3 months. Moreover, the aggressivity index was calculated to compare the competitive ability of A. sibiricum relative to S. grandis.

Important Findings

Both E. gansuensis (Eg)- and E. sibirica (Es)-infected A. sibiricum plants showed a greater competitive ability than the uninfected plants under high nitrogen supply, while the opposite result occurred under low nitrogen supply. At high nitrogen levels, Eg plants had a higher tiller number and a greater shoot biomass inhibitory effect on S. grandis than Es plants had when growing in mixture, while Es plants showed better root growth performance than Eg and uninfected plants under mixture conditions at all nitrogen levels. A higher concentration of phenolic compounds in Eg plants than in Es plants might contribute to the higher inhibitory effect of Eg plants on competing plants. Our study indicates that the interaction between endophyte infection and nitrogen availability can alter the competitive ability of the host plant A. sibiricum but that these two endophyte species work in different ways, which may influence the coexistence of A. sibiricum with the dominant species.
Experiences of Discrimination and Self-reported Health
Authors: Rapp Carolin , Cardozo Valentina , Eikemo Terje Andreas , Stathopoulou Theoni
Published: March 2019

Asylum seekers and refugees are confronted with multiple challenges before, during and after their flight from their home countries. The aim of this article is to shed more light on the distinct relationship between experiences of discrimination and self-reported health. On the basis of the REHEAL (Refugee Health) data, we are able to distinguish different reasons of discrimination, such as ethnicity, language or religion, as well as when the discrimination took place, e.g. before or during the flight or within the refugee camps. We are thereby particularly interested in the experience of discrimination in the refugee camps. In a first step, we aim to assess who is more likely to be discriminated against, for example women or members of the ethnic minority within the camps. In the second step, we analyse the relationship between discrimination and self-reported health. Our results reveal that discrimination is an important additional source for reporting poor health. Moreover, we find that women in particular suffer more from discrimination and thus bad health.
Black hole accretion discs and luminous transients in failed supernovae from non-rotating supergiants
Authors: Quataert E , Lecoanet D , Coughlin E R
Published: March 2019

We show that for supergiants, net angular momentum is not a necessary condition for forming accretion discs during core collapse. Even absent net rotation, convective motions in the outer parts of supergiants generate mean horizontal flows at a given radius with velocities of ${\sim } 1 \, {\rm km \, s}^{-1}$; the direction of the mean flow will vary as a function of height through the convection zone. We confirm these analytic estimates using Cartesian Boussinesq convection simulations. These mean horizontal flows lead to a random angular momentum in supergiant convection zones that exceeds that of the last stable circular orbit of a black hole by a factor of ∼10. As a result, failed explosions of supergiants – in which the accretion shock on to the neutron star does not revive, leading to black hole formation – may often produce accretion discs that can power day–week (blue supergiants) or week–year (yellow and red supergiants) non-thermal and thermal transients through winds and jets. These transients will be especially time variable because the angular momentum of the accreting material will vary substantially in time. Observed sources such as Swift J1644+57, iPTF14hls, and SN 2018cow, as well as energetic Type II supernovae (OGLE-2014-SN-073), may be produced by this mechanism.
From ridges in the velocity distribution to wiggles in the rotation curve
Authors: Martinez-Medina Luis , Pichardo Barbara , Peimbert Antonio , Valenzuela Octavio
Published: March 2019

Recently, the Gaiadata release 2 (DR2) showed us the richness in the kinematics of the Milky Way disc. Of particular interest is the presence of ridges covering the stellar velocity distribution, Vϕ–R; as shown by others, it is likely that these ridges are the signature of phase mixing, transient spirals, or the bar. Here, with a Galactic model containing both, bar and spirals, we found the same pattern of ridges extending from the inner to the outer disc. Interestingly, ridges in the Vϕ–R plane correlate extremely well with wiggles in the computed rotation curve (RC). Hence, although the DR2 reveals (for the first time) such substructures in a wide spatial coverage, we notice that we have always seen such a pattern of ridges, but projected into the form of wiggles in the RC. The separation and amplitude of the wiggles strongly depend on the extension and layout of ridges in the Vϕ–R plane. This means that within the RC are encoded the kinematic state of the disc and information about the bar and spiral arms. The amplitude of the wiggles suggests that similar features currently observable in external galaxies' RCs have similar origins, triggered by spirals and bars.
DNA damage in human whole blood caused by radiopharmaceuticals evaluated by the comet assay
Authors: Schmeiser Heinz H , Muehlbauer Karl-Rudolf , Mier Walter , Baranski Ann-Christin , Neels Oliver , Dimitrakopoulou-Strauss Antonia , Schmezer Peter , Kratochwil Clemens , Bruchertseifer Frank , Morgenstern Alfred , Kopka Klaus
Published: March 2019

Radiopharmaceuticals used for diagnosis or therapy induce DNA strand breaks, which may be detectable by single-cell gel electrophoresis (called comet assay). Blood was taken from patients before and at different time points after treatment with radiopharmaceuticals; blood cells were investigated by the comet assay using the percentage of DNA in the tail as the critical parameter. Whereas [225Ac]Ac-prostate-specific membrane antigen (PSMA)-617 alpha therapy showed no difference relative to the blood sample taken before treatment, beta therapy with [177Lu]Lu-PSMA-617 3 h post-injection revealed a small but significant increase in DNA strand breaks. In blood of patients who underwent positron emission tomography (PET) with either [18F]2-fluor-2-deoxy-D-glucose (FDG) or [68Ga]Ga-PSMA-11, an increase of DNA migration determined by the comet assay was not found when analysed at different time points (2–70 min) after intravenous tracer injection. Human whole blood was incubated with the targeted clinically relevant therapeutic radiopharmaceuticals [225Ac]Ac-PSMA-617, [177Lu]Lu-PSMA-617 and [90Y]Y-DOTA(0)-Phe(1)-Tyr(3)-octreotide (DOTA-TOC) at different activity concentrations (kBq/ml) for 5 days and then analysed by the comet assay. DNA damage increased with higher concentrations of all radiolabeled compounds tested. [177Lu]Lu-PSMA-617 caused higher blood cell radiotoxicity than equal activity concentrations of [90Y]Y-DOTA-TOC. Likewise, whole human blood was exposed to the positron emitters [18F]FDG and [68Ga]Ga-PSMA-11 in vitro for 24 h with activity concentrations ranging between 5 and 40 MBq/ml. The same activity concentration dependent elevated DNA migration was observed for both compounds although decay energies are different. This study demonstrated that the amount of DNA damage detected by the comet assay in whole human blood is similar among different positron emitters and divergent by a factor of 200 between alpha particles and beta radiation.
Nicotine Self-administration Is Not Increased in the Methylazoxymethanol Acetate Rodent Model of Schizophrenia
Authors: Weeks Jillian J , Rupprecht Laura E , Grace Anthony A , Donny Eric C , Sved Alan F
Published: March 2019

Introduction

Patients with schizophrenia (SCZ) smoke at a rate of 4–5 times higher than the general population, contributing to negative health consequences in this group. One possible explanation for this increased smoking is that individuals with SCZ find nicotine (NIC) more reinforcing. However, data supporting this possibility are limited.

Methods

The present experiments examined self-administration of NIC, alone or in combination with other reinforcers, across a range of doses in the methylazoxymethanol acetate (MAM) rodent model of SCZ.

Results

MAM and control animals did not differ in NIC self-administration across a range of doses and schedules of reinforcement, in both standard 1-hour self-administration sessions and 23-hour extended access sessions. However, MAM animals responded less for sucrose or reinforcing visual stimuli alone or when paired with NIC.

Conclusions

To the extent that MAM-treated rats are a valid model of SCZ, these results suggest that increased NIC reinforcement does not account for increased smoking in SCZ patients.

Implications

This study is the first to utilize nicotine self-administration, the gold standard for studying nicotine reinforcement, in the methylazoxymethanol acetate model of schizophrenia, which is arguably the most comprehensive animal model of the disease currently available. Our assessment found no evidence of increased nicotine reinforcement in methylazoxymethanol acetate animals, suggesting that increased reinforcement may not perpetuate increased smoking in schizophrenia patients.
Percutaneous Endoscopic Transforaminal Approach for Far Lateral Lumbar Discectomy: 2-Dimensional Operative Video
Authors: Kashlan Osama Nezar , Kim Hyeun Sung , Khalsa Siri Sahib S , Singh Ravindra , Yong Zhang , Oh Sung Woon , Noh Jeong Hoon , Jang Il-Tae , Oh Seong-Hoon
Published: March 2019

The conventional surgical approach to far lateral lumbar disk herniations is a paraspinal Wiltse approach. During the Wiltse approach, it is sometimes necessary to resect some of the facet or pars interarticularis to achieve an adequate exposure. The endoscopic transforaminal route can be of benefit in far lateral disk herniations due to direct access to the epidural space through Kambin's triangle, without the need for any bony removal or nerve retraction. In this video, we describe a percutaneous endoscopic transforaminal approach for far lateral discectomy in a patient presenting with a left L4 radiculopathy due to a far lateral L4-5 disk herniation. We describe Kambin's triangle anatomy and its relevance to the transforaminal route. The steps of the procedure are then described: dissection of soft tissue and removal of free disk fragments on the inferior aspect of the foramen far from the compressed exiting nerve route above to decrease the risk of retraction injury, gentle maneuvering of endoscope superiorly with removal of further compressive disk fragments, exposure of the exiting nerve root superiorly after adequate decompression is achieved and removal of any remaining fragments in close proximity to the nerve, and finally evaluation of traversing nerve root for any compressive lesions. The presentation ends with postoperative imaging confirming decompression of the far lateral disk herniation.
Reflective Practice in Physical Therapy: A Scoping Review
Authors: Ziebart Christina , MacDermid Joy C
Published: March 2019

Background

Many practitioners experience complex, uncertain, and unique clinical practice situations that can be navigated with reflection. Little is known about the theoretical and pragmatic perspectives of reflection in physical therapy.

Purpose

The purpose of this paper was to examine the literature on reflection in physical therapy and identify gaps in the literature.

Data Source

The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, EMBASE, Scopus, and PsycINFO were used to identify articles.

Study Selection

Studies were selected to describe: (1) theoretical concepts related to reflection, (2) examples of reflection, and (3) the use of reflection in clinical or educational contexts.

Data Extraction

Authors, year of publication, country of origin, publication type or source, methodology, conceptual approach (including terminology used, definition of terminology used), and practical approach (including theoretical underpinning, context of reflection/reflective practice, and target group) guided the data extraction.

Data Synthesis

A total of 46 articles were reviewed spanning from 1992 to 2017, which included research studies, field articles, editorials, and a review article. Theoretical underpinnings of reflection were based on the thoughts of Donald Schön. Written approaches to reflection were most common, and reflection was used to inform education, clinical practice, and professional growth.

Limitations

As with any review paper, there is a certain level of interpretation required when collating and interpreting data.

Conclusions

Reflection in physical therapy could be advanced by a thorough conceptualization of reflective practice, a broader and deeper pool of research to inform optimal implementation of reflection across the career span from learners to experts, and a clear definition and linkage of reflection to epistemologies of physical therapy practice.
Synergistic Effect of Combined Application of a New Fungicide Fluopimomide with a Biocontrol Agent Bacillus methylotrophicus TA-1 for Management of Gray Mold in Tomato
Authors: Ji Xiaoxue , Li Jingjing , Meng Zhen , Zhang Shouan , Dong Bei , Qiao Kang
Published: March 2019

Gray mold caused by Botrytis cinerea can be a severe disease of tomato infecting leaves and fruits of tomato plants. Chemical control is currently the most effective and reliable method; however, application of fungicides has many drawbacks. The combination of biological control agents with newly developed fungicides may be a practicable method to control B. cinerea. Fluopimomide is a newly developed fungicide with a novel mode of action. Bacillus methylotrophicus TA-1, isolated from rhizosphere soil of tomato, is a bacterial strain with a broad spectrum of antimicrobial activities. Little information is currently available about the effect of fluopimomide and its integrated effect on B. cinerea. Therefore, laboratory, pot, and field experiments were carried out to determine the effects of fluopimomide alone and in combination with B. methylotrophicus TA-1 against gray mold on tomato. The in vitro growth of B. methylotrophicus TA-1 was unaffected by 100 mg liter−1 fluopimomide. Inhibition of B. cinerea mycelial growth was significantly increased under combined treatment of fluopimomide and B. methylotrophicus TA-1. In greenhouse experiments, efficacy against gray mold was significantly greater by an integration of fluopimomide and B. methylotrophicus TA-1 than by either alone; control efficacy of fluopimomide at 50 and 100 g ha−1 in combination with B. methylotrophicus TA-1 at 108 colony-forming units (cfu) ml−1 reached 70.16 and 69.32%, respectively, compared with the untreated control. In both field trials during 2017 and 2018, control efficacy was significantly higher for the combination of fluopimomide at 50 and 100 g ha−1 in combination with B. methylotrophicus TA-1 than for either treatment alone. The results from this study indicated that integration of the new fungicide fluopimomide with the biocontrol agent B. methylotrophicus TA-1 synergistically increased control efficacy of the fungicide against gray mold of tomato.
An Axiological Analysis of One Medical School’s Admissions Process: Exploring Individual Values and Value Systems
Authors: Ellaway Rachel H. , Malhi Rebecca L. , Woloschuk Wayne , de Groot Janet M. , Doig Christopher J. , Myhre Douglas
Published: March 2019

Purpose

Values and value systems are fundamental to medical school admissions processes. An axiological analysis was carried out to explore the individual values and value systems found within the University of Calgary’s Cumming School of Medicine’s undergraduate admissions process.

Method

A mixed-methods case study methodology was developed with a focus on applicant characteristics viewed as desirable, the relative value ascribed to applicant characteristics, the values that participants in admissions processes brought to bear, the values that were reflected in the artifacts and procedures used in support of admissions processes, and the values that were expressed at a system, program, or institutional level. The study employed a descriptive audit of admissions processes, a stakeholder survey, stakeholder interviews, and a discourse analysis of admissions materials (all carried out between June and September 2017).

Results

The study found that, despite a general sense of satisfaction with the rigor of the admissions process, there was less satisfaction with the final selection it produced. Participants wanted to see more attention paid to responsibilities to patients and society than to gender and ethnic balance.

Conclusions

Those involved with medical school admissions need to be mindful of their value systems and use them to align intent with process and outcomes in selecting tomorrow’s physicians. Axiological analysis of medical education processes can play a central role in reviewing and refocusing efforts on meeting an institution’s social mission and medical education’s social contract.
Conceptualizing Learning Environments in the Health Professions
Authors: Gruppen Larry D. , Irby David M. , Durning Steven J. , Maggio Lauren A.
Published: March 2019

The learning environment (LE) is an important and frequently discussed topic in the health professions education literature. However, there is considerable inconsistency in how the LE is defined and described. The authors propose a definition of the LE and a conceptual framework to facilitate health professions educators in understanding, studying, and designing interventions to improve the LE. To arrive at this conceptual framework, the authors employed a living systems perspective that draws on various frameworks and theories, including ecological psychology, workplace learning, situated cognition, and sociomateriality theory. The conceptual framework identifies five overlapping and interactive core components that form two dimensions: the psychosocial dimension and material dimension. The psychosocial dimension comprises three components: the personal, social, and organizational. Intertwined with the psychosocial dimension at each level is the material dimension, which encompasses physical and virtual spaces. This theoretical lens can facilitate identifying and analyzing problems in the LE and guide development of interventions to mitigate them. The authors conclude with several practical suggestions for health professions educators, investigators, and editors.
Treatment of neuromyelitis optica spectrum disorders
Authors: Romeo Andrew R. , Segal Benjamin M.
Published: March 2019

Purpose of review

This review discusses concepts for diagnosing neuromyelitis optica spectrum disorders (NMOSD), distinguishing NMOSD from other inflammatory diseases of the central nervous system, and highlights recent and forthcoming data on acute and maintenance therapy of NMOSD.

Recent findings

The neurologic manifestations of NMOSD are heterogenous, extending beyond classic presentations of optic neuritis and longitudinally extensive transverse myelitis. NMOSD may be comorbid with rheumatologic diseases, such as systemic lupus erythematosus, but is recognized as a distinct entity. Recent studies of acute treatment of NMOSD support early use of plasmapheresis. Relapse prevention is essential, as relapses can be disabling and patients may have only partial recovery. Current practice generally recommends at least 5 years of maintenance treatment. Recent randomized data demonstrates superiority of rituximab over azathioprine. Phase 3 trials have recently been completed or are underway studying novel therapies employing B-cell depletion, complement inhibition, and cell-based mechanisms (among other mechanisms) for maintenance therapy of NMOSD.

NMOSD is a heterogeneous but well-defined clinical entity, distinct from other neurologic and systemic inflammatory diseases, and treatment is poised for expansion.
Management of scleroderma renal crisis
Authors: Nagaraja Vivek
Published: March 2019

Purpose of review

Scleroderma renal crisis (SRC) is a life-threatening manifestation in systemic sclerosis (SSc) and is usually presented by an acute onset of severe hypertension together with an acute kidney injury. We can conceptualize SRC as a systemic syndrome with features that extend beyond the involvement of the kidney. The goal of this review is to inform clinicians about the risk factors for SRC in patients with SSc and to emphasize the importance of early identification and initiation of treatment.

Recent findings

For the past 3 decades, the use of angiotensin-converting enzyme inhibitors (ACE-I) to treat SRC, has been rightfully synonymized with a good outcome, and has changed the trajectory of mortality in SRC. Despite this, SRC still figures in one of the top four causes of mortality in patients with SSc. There is a need for additional therapeutic agents to treat SRC that is refractory to ACE-I. There has been a recent interest in combining ACE-I with endothelin receptor blockers and agents targeting the complement component 5. There is no role for using ACE-I prophylactically in high-risk patients.

Early diagnosis of SRC is the key, and early initiation of ACE-I is life-saving and associated with a better prognosis. We should consider renal transplantation in selected patients, especially those on long-term dialysis.
Defining Usage and Clinical Outcomes Following Perioperative Fresh Frozen Plasma and Platelet Administration in Spine Surgery Patients
Authors: Purvis Taylor E. , Wang Timothy Y. , Sankey Eric W. , Frank Steven M. , Goodwin C. Rory , Sciubba Daniel M.
Published: March 2019

Study Design:

This was a retrospective study.

Objectives:

The main objectives of this study were to characterize the utilization of fresh frozen plasma (FFP) and platelets in spine surgery and the clinical outcomes following their administration.

Summary of Background Data:

Blood component transfusion is often a crucial therapy during spine surgery. Little is known about the association between transfusion with FFP and/or platelets and perioperative morbidity in patients undergoing spine surgery.

Materials and Methods:

At a single large tertiary medical center, the surgical billing database was retrospectively queried for patients undergoing spinal surgery from 2008 to 2015. A univariate analysis compared patient characteristics for those who received FFP and/or platelets perioperatively and those who did not. To determine independent predictors of FFP and platelet administration and independent predictors of perioperative complications, both univariate and multivariate analyses were used.

Results:

In total, 6931 patients met inclusion criteria. One thousand seven (14.5%) patients received perioperative FFP transfusion and 432 (6.2%) received platelets. In multivariate analysis, Charlson Comorbidity Index (CCI) ≥4, preoperative hemoglobin <12 g/dL, preoperative international normalized ratio (INR) ≥1.7, higher estimated blood loss, and receipt of packed red blood cell or platelet transfusion were associated with perioperative FFP administration (all P≤0.001). More than half of all patients received FFP with an INR trigger of <1.7. Those who received perioperative FFP were more likely to experience infection, increased length of stay, and ischemic, respiratory, thrombotic, and renal complications (all P<0.0001). Perioperative FFP [odds ratio (OR): 2.43], platelet transfusion (OR: 1.81), American Society of Anesthesiologists (ASA) grade 3 or 4 (OR: 1.84), CCI≥4 (OR: 1.75), and receipt of packed red blood cells (OR: 1.73) were independent predictors of experiencing any complication (all P≤0.008).

Conclusions:

The majority of patients were given FFP with a liberal INR trigger of >1.7. Perioperative FFP and platelet administration are independent predictors of perioperative complications following spine surgery.
Management of treatment-related toxicities in advanced medullary thyroid cancer
Authors: Tsang Venessa H.M.
Published: March 2019

Purpose of review

Tyrosine kinase inhibitors (TKI), predominantly vandetanib and cabozantinib, are increasingly used for management of advanced medullary thyroid cancer. This review aims to discuss the major and serious adverse events associated with TKI.

Recent findings

The choice of TKI depends on the patient's existing comorbidities. Patients who have long QT interval should avoid vandetanib and those at risk of gastrointestinal perforation should avoid cabozantinib. Hypertension is common during the first 3 months. Treatments include ACE inhibitors, calcium channel blockers (avoiding verapamil and diltiazem, which are CYP3A4 inhibitors), and beta blockers. Diuretics should be second line because of derangement of electrolytes, which may exacerbate QT interval. As nitric oxide (NO) blockade and ET1 are implicated in the mechanism of hypertension, nitrates and endothelin receptor antagonists may be used. Thromboembolism may require anticoagulation or revascularization procedures. Prolonged QT interval should be treated by dose interruption and reduction, correction of electrolytes, and avoidance of medications, which prolong QTc interval. Diarrhoea is managed symptomatically and with electrolyte replacement, dermatological adverse events with avoidance of exacerbating factors and topical therapies. Thyroid function should be monitored.

Toxicities are common with TKI use, and management involves symptomatic treatment, avoidance of triggers, dose interruption, and dose reduction.
Mechanical Strain of the Nasal Bilobed Transposition Flap—Graduated Changes in Skin Thickness Superiorly Displace the Location of the Pivot Point
Authors: Gruber Paul J. , Armbrecht Eric , Pelster Michael W. , Maher Ian A.
Published: March 2019

BACKGROUND

The bilobed transposition flap recruits the relatively thinner and laxer skin of the nasal dorsum and sidewall to reconstruct defects of the more sebaceous nasal tip and alae. There have been no studies performed to quantify how the material properties of skin alter the bilobed flap's performance during nasal reconstruction.

OBJECTIVE

To determine the effects of skin thickness and stiffness on bilobed flap mechanics to help guide flap design principles and optimize surgical outcomes.

MATERIALS AND METHODS

Two-dimensional artificial silicone skin models of varying thickness were created. The bilobed flap was incised, transposed, and secured in standard fashion. Digital image correlation was used to translate model deformation and displacement into local stress and mechanical strain forces within the bilobed flap pedicle.

RESULTS

Qualitatively, the center of rotation of the bilobed flap rotates superiorly up the flap pedicle as model skin thickness increased.

CONCLUSION

Location of the bilobed flap's pivot point may be dependent on local tissue characteristics—oversizing of the primary lobe can be considered in stiff, immobile tissue such as highly sebaceous Zone II nasal skin.
Platelet-Rich Plasma as a Treatment for Androgenetic Alopecia
Authors: Gupta Aditya K. , Cole John , Deutsch David P. , Everts Peter A. , Niedbalski Robert P. , Panchaprateep Ratchathorn , Rinaldi Fabio , Rose Paul T. , Sinclair Rodney , Vogel James E. , Welter Ryan J. , Zufelt Michael D. , Puig Carlos J.
Published: March 2019

BACKGROUND

Platelet-rich plasma (PRP) treatment may encourage hair growth by promoting cellular maturation, differentiation, and proliferation.

OBJECTIVE

The objective of this study was to evaluate the effectiveness of PRP as a treatment for androgenetic alopecia (AGA).

MATERIALS AND METHODS

A literature search combined with meta-analysis was used to calculate the overall standardized mean difference (SMD) in hair density in patients treated with PRP injections in comparison with baseline and placebo treatment. Chi squared analysis and Fisher exact test were used to investigate variation in protocols.

RESULTS

The overall SMD in hair density was 0.58 (95% confidence interval [CI]: 0.35–0.80) and 0.51 (95% CI: 0.23–0.80, p < .0004) in favor of PRP treatment when compared with baseline and placebo treatment, respectively.

CONCLUSION

Platelet-rich plasma is beneficial in the treatment of AGA. It is recommended that 3 monthly sessions of PRP (once monthly ×3 treatments) be used followed by a 3- to 6-month maintenance period.
A 1064-nm Neodymium-doped Yttrium Aluminum Garnet Picosecond Laser for the Treatment of Hyperpigmented Scars
Authors: Koren Amir , Niv Roni , Cohen Sarit , Artzi Ofir
Published: March 2019

BACKGROUND

Pigmentation is one of the few major characteristics according to which scars are evaluated. Data on the treatment of the hyperpigmented component of scars are sparse.

OBJECTIVE

The authors aimed at evaluating the efficacy of the fractional 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) picosecond laser in the treatment of the hyperpigmented component of scars.

METHODS

Sixteen patients with hyperpigmented scars underwent 3 to 8 treatment sessions at 3- to 6-week intervals with the 1,064-nm Nd:YAG picosecond laser (PicoWay, Candela, Resolve handpiece). The treatment response was evaluated by 2 noninvolved dermatologists on a global assessment scale (GAS) of 1 to 4. A Mexameter quantitatively evaluated the melanin content of the scar before and after laser treatments.

RESULTS

The average GAS score of the 2 noninvolved dermatologists was 3.31 ± 0.57. The patients assessed their level of tolerance as good or excellent and their satisfaction level as moderate or high. The Mexameter showed that the melanin index decreased considerably (by 39.11 ± 11.58%) in all patients after treatment.

CONCLUSION

The fractionated nonablative picosecond Nd:YAG laser was effective for the treatment of the hyperpigmented component of scars.
Fertility preservation options for transgender and gender-nonconforming individuals
Authors: Moravek Molly B.
Published: March 2019

Purpose of review

To provide an overview of the current state of knowledge of fertility risks of gender-affirming therapy, review fertility preservation options for transgender individuals and ways to minimize gender dysphoria during fertility treatment, and identify gaps in knowledge.

Recent findings

Recent studies have corroborated older data that gender-affirming hormone therapy creates histopathological changes in the gonads; however, the newer data suggests that some function of the gametes may be preserved. One study in transgender men reported successful in-vitro maturation of testosterone-exposed oocytes with normal spindle structures, and recent studies in transgender women reveal early spermatogenesis in estradiol-exposed testes and some recovery of semen parameters following cessation of hormones. Particular attention has recently been given to fertility preservation in transgender adolescents, revealing unmet informational needs in this population and very few are actually pursuing fertility preservation, even with counseling.

There is currently a paucity of data on the fertility effects of gender-affirming hormones, necessitating fertility preservation counseling prior to initiation of therapy. Several modifications can be made to fertility preservation protocols and procedures to decrease gender dysphoria or distress in transgender individuals, but outcome data is still lacking. Achieving high-quality data collection will likely require cooperation across multiple institutions.
Endocrine and reproductive profile of boys and young adults conceived after ICSI
Authors: Belva Florence , Bonduelle Maryse , Tournaye Herman
Published: March 2019

Purpose of review

The impact of intracytoplasmic sperm injection (ICSI), on the reproductive health of the offspring is largely unknown. Here we provide a comprehensive overview of the endocrine and reproductive profile in boys and young male adults born after ICSI using ejaculated spermatozoa alleviating male factor infertility in their parents.

Recent findings

Levels of testosterone, anti-Müllerian hormone and inhibin B were found comparable in prepubertal and pubertal boys conceived by ICSI when compared with levels in boys conceived spontaneously. Also, at young adulthood, mean levels of reproductive hormones did not differ from control peers. However, semen analysis showed significantly lower sperm concentration, total sperm count and total motile sperm count when compared with controls. Furthermore, the risk of having sperm concentration and sperm count below the reference values was increased in ICSI offspring while sperm parameters did not correlate in paired father-son semen analysis.

Although endocrine gonadal function was normal at puberty, exocrine function at young adulthood was not. We observed decreased semen quality and quantity in young adults conceived by ICSI performed to circumvent male factor infertility. The possibility of transgenerational transmission of impaired spermatogenesis after ICSI needs further investigation.
Successful Management of Herpes Simplex Keratitis With Oral Valganciclovir in Patients Unresponsive or Allergic to Conventional Antiviral Therapy
Authors: Koseoglu Neslihan Dilruba , Strauss Benjamin R. , Hamrah Pedram
Published: March 2019

Purpose:

To describe 4 cases of presumably immunocompetent patients with herpes simplex virus (HSV) keratitis unresponsive (n = 3) or allergic (n = 1) to conventional antiviral therapy that improved with oral valganciclovir treatment.

Methods:

Retrospective case series of 4 patients with HSV keratitis treated with oral valganciclovir between March 2016 and June 2018.

Results:

We reviewed the records of 4 patients with recurrent epithelial HSV keratitis. Three patients were on antiviral prophylaxis because of a history of HSV keratitis. All patients were on oral acyclovir, valacyclovir, and/or famciclovir treatment with/without topical antiviral therapy for 4 to 6 months for prophylaxis and/or recurrent dendriform epithelial keratitis. While 3 patients had recurrent episodes during their active prophylaxis with oral antiviral therapies, one patient had a recurrence after she discontinued her oral prophylactic antiviral therapy due to recurrent self-reported allergic reactions. The patients presented with recurrent dendriform epithelial keratitis despite conventional antiviral therapy. We initiated oral valganciclovir 900 mg twice a day for 10 days as a treatment dose, followed by 900 mg daily for prophylaxis. The corneal epithelium subsequently healed within the first 2 weeks in all patients. The mean follow-up time for patients on valganciclovir prophylaxis was 8 months (range: 6–12 months), and none of the patients presented with any further recurrences.

Conclusions:

In case of treatment-related side effects or failure with conventional antiviral therapies, oral valganciclovir may present an alternative for the treatment and prophylaxis of HSV keratitis.
Simple Hysterectomy for Cervical Cancer: Risk Factors for Failed Screening and Deviation From Screening Guidelines
Authors: Castellano Tara , Ding Kai , Moore Kathleen N. , Landrum Lisa M.
Published: March 2019

Objective

The aim of this study is to describe risk factors associated with either false-negative cervical cancer screening or deviations from screening guidelines that result in incidentally found invasive cervical cancer at the time of simple hysterectomy for benign indications.

Materials and Methods

This is a retrospective review from 1990 to 2017 of subjects with incidental cervical cancer. Baseline demographics, preoperative evaluations, surgical data, and histopathologic characteristics were recorded. Deviations from screening guidelines or false-negative screenings were identified. Associations of independent risk factors according to age, insurance status, and histology were assessed.

Results

Fifty-nine subjects with a median age of 43 years were found. Abnormal uterine bleeding was the most common indication for hysterectomy (61%, n = 36) and cervical dysplasia was present in 42% (n = 25) of these cases. Of those with inappropriate screening, 38% (n = 17) did not have documented Pap test, 22% (n = 10) had Pap that was not triaged appropriately, 18% (n = 8) received Pap and colposcopy but no indicated excisional procedure, and 22% (n = 10) had an excisional procedure that was not managed according to guidelines. False-negative screening occurred in 25% subjects (n = 15). There was no significant association between age, insurance status, or histology and risk of false-negative screening or inadequate screening.

Conclusions

The most common cause of incidental cervical cancer at the time of simple hysterectomy was failure to properly adhere to screening guidelines. Less frequently, false-negative screening was the cause. No independent risk factor in either group was identified in this single institutional study. Illustrated is the importance of continuing education of surgeons about adequate screening in the preoperative evaluation for benign hysterectomy.
Relationship Between State Policy and Anesthesia Provider Supply in Rural Communities
Authors: Martsolf Grant R. , Baird Matthew , Cohen Catherine C. , Koirala Nirabh
Published: March 2019

Background:

There is a significant geographic variation in anesthesia provider supply. Lower supply in rural communities raises concerns about access to procedures that require anesthesia in rural areas. State policies related to certified registered nurse anesthetist (CRNA) practice may help to alleviate rural supply concerns.

Objectives:

To estimate the association between state CRNA policy and anesthesia provider supply especially in rural communities.

Research Design:

Repeated cross-sectional design using ordinary least squares and 2-stage least squares regressions.

Subjects:

All counties in the United States from 2010 to 2015.

Measures:

Dependent variables include anesthesia provider counts per 100,000 people, calculated separately for anesthesiologists, CRNAs, and their sum. Key variables of interest include state-level CRNA policy based on scope of practice (SOP) regulations and Medicare opt-out status.

Results:

Opt-out status and less restrictive SOP regulations were consistently correlated with a greater supply of CRNAs, especially in rural counties. Furthermore, we found that anesthesiologists and CRNAs tend to be complements to each other, but less restrictive SOP and opt-out status tend to weaken the importance of this relationship.

Conclusions:

State regulations may lead to increased supply of CRNAs in rural communities. However, the design of our study makes causality difficult to assert. So, it is also possible that states set CRNA policy as a response to counts of anesthesia providers in rural areas. Furthermore, given supply of anesthesiologists and CRNAs are complementary to one another, improving access to anesthesia services may require addressing issues pertaining to the supply of all anesthesia provider types.
The Korean–Advance Directive Model and Factors Associated With Its Completion Among Patients With Hematologic Disorders
Authors: Lee Mee Ok , Park Jinny , Park Eun Young , Kim Youngji , Bang Eunjoo , Heo Seongkum , Kim JinShil
Published: March 2019

The objective of this pilot study was to examine factors associated with the completion of advance directives (ADs) among patients with hematologic disorders in Korea. Using a descriptive design, patients with largely hematologic malignancies completed the questionnaires, including the Korean–Advance Directive (K-AD) model, which pertains to values, treatment wishes, and proxy appointment. Of 45 patients (aged 48.7 ± 10.7 years, 51.1% men), two-thirds had leukemia (40.0%) and lymphoma (26.7%). “Dying comfortably” was the most frequently selected value (n = 20). Regarding treatment wishes, hospice care was the most desired type (n = 22), whereas aggressive treatments, such as cardiopulmonary resuscitation, were less preferred (n = 3). The patient’s spouse was most frequently appointed as a proxy (n = 27). Patients who completed all the 3 components of the K-AD model (51.1%) were less depressed (t = −2.31; P = .028) and more likely to perceive the benefits of the K-AD model (t = 2.07; P = .045), compared with the noncompleters (48.9%). Further, being male (odds ratio [OR], 6.42; P = .031), having higher scores on depressive symptoms (OR, 1.28; P = .016), and perceived barriers (OR, 1.08; P = .040) were associated with lower tendency to complete the K-AD model. These findings support the need for earlier introduction of ADs in hematologic disorders, with consideration of modifiable factors such as depression or barriers to end-of-life care decisions.
Preferences for Expedited Partner Therapy Among Adolescents in an Urban Pediatric Emergency Department
Authors: Shamash Zohar , Catallozzi Marina , Dayan Peter S. , Chernick Lauren S.
Published: March 2019

Objectives

Expedited partner therapy (EPT) refers to treating sexual partners of patients with sexually transmitted infections by providing prescriptions or medications to give to their partners. Expedited partner therapy is not routinely prescribed in the emergency department (ED). Our objective was to explore adolescent preferences for EPT use in the ED.

Methods

We conducted a mixed-methods study using surveys and semistructured interviews in one urban ED. Sexually active patients aged 15 to 19 years completed an anonymous survey eliciting (1) sexual history and risky sexual behaviors, (2) preferences for partner notification when hypothetically testing positive for an STI, and (3) preferences for EPT. A subsample of survey respondents participated in the interviews, which were conducted until no new perspectives emerged. Investigators analyzed interviews using thematic analysis.

Results

A total of 247 participants completed surveys; the majority were female (183/247, 74%), Hispanic (209/243, 86%), and did not use a condom at last intercourse (129/243, 53%). Two thirds of participants (152/236, 64%) did not prefer EPT for partner notification. Preference for EPT was not associated with sex, age, ethnicity, condom use, a steady sexual partner, or STI history. Qualitative data from both surveys and interviews revealed the following reasons for not preferring EPT: concern for partner safety, importance of determining partner STI status, perceived benefit of clinical interaction, and partner accountability. Reasons for preferring EPT included increased treatment accessibility and convenience.

Conclusions

The majority of adolescent patients in a pediatric ED did not prefer EPT. Emergency department practitioners should address common concerns regarding EPT to increase EPT adherence if prescribed.
Motor corticospinal excitability: a novel facet of pain modulation?
Authors: Granovsky Yelena , Sprecher Elliot , Sinai Alon
Published: March 2019

Introduction:

Increase in excitability of the primary motor cortex (M1) is associated with pain inhibition by analgesics, which is, in turn, associated with the psychophysical antinociceptive pain modulation profile. However, the relationship between neurophysiological M1 excitability and psychophysical pain modulation has not yet been explored.

Objectives:

We aim to study these relationships in healthy subjects.

Methods:

Forty-one young healthy subjects (22 women) underwent a wide battery of psychophysical testing that included conditioned pain modulation (CPM) and pain temporal summation, and a transcranial magnetic stimulation neurophysiological assessment of the motor corticospinal excitability, including resting motor threshold, motor-evoked potentials (MEPs), and cortical silent period.

Results:

Increased motor corticospinal excitability in 2 parameters was associated with more efficient CPM: (1) higher MEP amplitude (r = −0.574; P
_Bonferroni = 0.02) and (2) longer MEP duration (r = −0.543; P
_Bonferroni = 0.02). The latter also correlated with the lower temporal summation magnitude (r = −0.421; P = 0.007); however, on multiplicity adjustment, significance was lost.

Conclusions:

Increased corticospinal excitability of the primary motor cortex is associated with more efficient inhibitory pain modulation as assessed by CPM, in healthy subjects. Motor-evoked potential amplitude and duration may be considered as an additional, objective and easy to measure parameter to allow for better individual assessment of pain modulation profile.