bluuebunny/crossref_metadata_2025 huggingface dataset:
Simultaneous Orthognathic Surgery and Mandibular Contour Osteoplasty for Treating Mandibular Protrusion With High Gonial Angle
Authors: Zhang Yaoyao , Sun Xiumei , Wang Lin , Chen Kai , Wang Xiangshen , Wu Guomin
Published: April 2020

Objective:

The purpose of this study was to confirm the effectiveness and feasibility of simultaneous orthognathic surgery and mandibular contour osteoplasty with the help of the accurate surgical templates to treat mandibular protrusion with high gonial angle.

Methods:

Ten patients diagnosed as mandibular protrusion with high gonial angle were included in this study. Besides the traditional orthognathic surgery, mandibular contour osteoplasty was performed simultaneously. Models of the mandible were fabricated via 3D printing technology. Accurate surgical templates were produced on the 3D printing model according to preoperative design. Radiographs and medical photographs preoperatively and postoperatively were taken to compare the effectiveness of the operation. Measurement items include gonial angle (Ar-Go-Me), midlines of maxilla and mandible. The clinical manifestation of the temporomandibular joint and condylar process were observed.

Results:

Radiographs and photographs of the face were taken after surgery showed satisfactory esthetic outcomes. The right gonial angle improved from 128.20° ± 5.67° to 120.35° ± 0.46°, and the left gonial angle improved from 129.91° ± 2.78° to 120.74° ± 0.59°. The midlines of the maxilla and mandibular basically consisted of the facial midline. After surgery, patients’ clinical manifestation of the temporomandibular joint was no significant difference compared with the preoperative and the condylar process had no absorption.

Conclusion:

The results of this study showed it was possible to perform orthognathic surgery and mandibular contour osteoplasty simultaneously with the help of surgical templates in the treatment of mandibular protrusion with high gonial angle.
Correlation of Intracranial Volume With Head Surface Volume in Patients With Multisutural Craniosynostosis
Authors: Ramdat Misier Karan R.R. , Breakey Richard W.F. , Caron Cornelia J.J.M. , Schievano Silvia , Dunaway David J. , Koudstaal Maarten J. , Jeelani Owase N.U. , Borghi Alessandro
Published: April 2020

Intracranial volume (ICV) is an important parameter for monitoring patients with multisutural craniosynostosis. Intracranial volume measurements are routinely derived from computed tomography (CT) head scans, which involves ionizing radiation. Estimation of ICV from head surface volumes could prove useful as 3D surface scanners could be used to indirectly acquire ICV information, using a non-invasive, non-ionizing method.

Pre- and postoperative 3D CT scans from spring-assisted posterior vault expansion (sPVE) patients operated between 2008 and 2018 in a single center were collected. Patients were treated for multisutural craniosynostosis, both syndromic and non-syndromic. For each patient, ICV was calculated from the CT scans as carried out in clinical practice. Additionally, the 3D soft tissue surface volume (STV) was extracted by 3D reconstruction of the CT image soft tissue of each case, further elaborated by computer-aided design (CAD) software. Correlations were analyzed before surgery, after surgery, combined for all patients and in syndrome subgroups.

Soft tissue surface volume was highly correlated to ICV for all analyses: r = 0.946 preoperatively, r = 0.959 postoperatively, and r = 0.960 all cases combined. Subgroup analyses for Apert, Crouzon-Pfeiffer and complex craniosynostosis were highly significant as well (P < 0.001).

In conclusion, 3D surface model volumes correlated strongly to ICV, measured from the same scan, and linear equations for this correlation are provided. Estimation of ICV with just a 3D surface model could thus be realized using a simple method, which does not require radiations and therefore would allow closer monitoring in patients through multiple acquisitions over time.
Prefabricated Composite Tissues for the Reconstruction of Complex Maxillary Defects: Functional and Aesthetic Principles
Authors: Vinzenz Kurt , Cohen Mimis
Published: April 2020

The anatomical structures of the maxilla include the mucosa lining attached to the bone in a pneumatized “light weight construction” to support facial tissues and to provide physiological oral and nasal function. Therefore, the anatomically correct restoration of the maxilla in the case of “full thickness defects“ still represents a barely resolved surgical challenge from a functional and aesthetic point of view. Since exactly similar tissues are hardly available for reconstructive purposes, reconstruction with various flaps remains highly accepted.

As there is no clear evidence, that any reconstructive option is superior to another, the surgeon's preference remains the main factor determining the treatment of choice for maxillary defects.

In order to provide for an anatomically correct reconstruction the concept of prefabrication of bone grafts accompanying soft tissues flaps could have a valuable option. This concept has been presented in the past but still has not gained wide acceptance. In this review paper, the authors will discuss the philosophy of our rational and approach, present details of the reconstruction to achieve improved functional and aesthetic results for full thickness maxillary defects based in almost 30 years of experience.
Evaluation of Morphological Characteristics of the Human Ear in Young Adults
Authors: Rani Deepika , Krishan Kewal , Sahani Ramesh , Baryah Neha , Kanchan Tanuj
Published: April 2020

Introduction and Objectives:

Human external ear is a morphologically complex structure and plays a vital role in the collection of sound. The present study would provide the information regarding the shape and size of the various morphological structures of the ear in normal individuals which may help the plastic surgeons to reconstruct the anatomy of the deformed ear and the physical and forensic anthropologists to study variations and establishing its use as a biometrics. The aim of the study was the morphological examination of the ear and its features to investigate the biological variations, sex differences, bilateral variations and further attempt to provide a database of external ears of a normal north Indian population.

Methods:

A cross-sectional sample of 71 males and 69 females aged between 18 to 25 years were collected from Nahan city of Sirmaur District in Himachal Pradesh state of North India. Various anthroposcopic parameters were considered and evaluated through personal observation such as ear shape, form of the helix, lobule shape and its attachment to the cheeks, strength of the anti-helix, etc and were sub-divided on the basis of form, shape, elevation, etc. The SPSS statistic (IBM, Armonk, NY) software version 16 was used to evaluate the sexual dimorphism and bilateral differences.

Results and Conclusion:

The frequencies of various morphological characters of the human external ear were calculated using Crosstabs. The results indicate the oval and round shaped ears were reported in 37.3%; 35.92% males and 23.92%; 38.41% females, respectively. Normally rolled helix was more frequent (73.24% in males and 84.06% in females) and possessed frequently occurring Darwin's tubercle with nodosity form (88.03% in males and 90.58% in females). Hypertrichosis was mostly present on the complete helix in case of males (66.20%). Single knob tragus (40.14% in males and 52.90% in females) and double knob tragus (33.10% in males and 36.23% in females) were found to be with higher frequency in the studied population. Partially free earlobes (53.52% in males and 46.38% in females) were more common than the attached one (38.03% in males and 47.83% in females) in case of males only. The present study provides a database of morphoscopy of the external ears of North Indian population. The database may be useful in the reconstruction of the deformed ears and in the anthropological and forensic research for comparison purposes. The study may also be utilized in the prediction of ear shape and size of the studied population for facial reconstruction in forensic examinations.
Surgical Outcomes of Endoscopic Conjunctivodacryocystorhinostomy Using a Castroviejo Double-Ended Lacrimal Dilator
Authors: Woo Minji , Yang Sungwon , Park Jinhwan , Lee Hwa , Baek Sehyun
Published: April 2020

Purpose:

The aim of this study was to describe the surgical method of endoscopic conjunctivodacryocystorhinostomy with Jones tube insertion using a Castroviejo double-ended lacrimal dilator and to elucidate the surgical outcomes.

Methods:

Under general anesthesia and preoperative epinephrine soaking, a monopolar needle cautery instrument was used to remove the nasal mucosa over the lacrimal and maxillary bone junction. After the lacrimal and maxillary bone junction was exposed, an oval osteotomy was formed. A Castroviejo double-ended lacrimal dilator was then inserted to create a direct fistula from the conjunctiva to the nasal cavity through the bony ostium. The dilator was grasped and withdrawn using smooth forceps to determine the tube length. The selected tube was then inserted into the fistula with a guide probe. Following removal of the probe, the inserted tube was fixed with 7-0 Ethilon suturing.

Results:

Among 39 patients, a total of 49 cases were examined. The success rate was 73.4% (36/49 eyes). The average surgical time was 29.1 minutes for single-eye operations and 47.3 minutes for double-eye operations. Lateral migration (6/13; 46.2%), medial migration (3/13; 23.1%), granulation tissue obstruction (2/13; 15.4%), inflammation (1/13; 7.7%), and malpositioning (1/13; 7.7%) were the noted complications that led to reoperation.

Conclusions:

In conclusion, surgical management of endoscopic conjunctivodacryocystorhinostomy using a Castroviejo double-ended lacrimal dilator has several advantages. Using this device, easier surgical procedure, shorter surgical time, and more favorable success rate can be achieved without serious complications.
Characterization of the Upper Tarsal Plate Growth in Children: Implication in Pediatric Eyelid Surgery
Authors: Park Seo Yeon , Baek Sehyun , Lee Hwa
Published: April 2020

Introduction:

To measure the height, length, and area of the upper tarsal plate in Korean children between 6 months and 13 years of age and analyze growth of the tarsal plate.

Methods:

Children who underwent lower epiblepharon correction surgery and congenital nasolacrimal duct obstruction were included. Under general anesthesia, the upper eyelid was everted and a photograph was taken with a reference ruler using a digital camera. Tarsal plate central height, upper border length, lower border length, and area were measured using Image J software. Objectives were classified into 4 groups according to age. Mean analysis and comparison between groups were performed using the SPSS program.

Results:

One hundred two tarsal plates in 51 patients were measured. Mean central tarsal height was 6.92 ± 1.09 in the 0 to 3 years old group, 7.25 ± 0.81 in the 4 to 6 years old group, 7.64 ± 0.71 in the 7 to 9 years old group, and 8.11 ± 0.46 in the 10 to 13 years old group. The height and area of the tarsal plate gradually increased with age (P = 0.001), but the lower length of the 0 to 3 years old group differed from the other groups and showed abrupt increase between the 0 to 3 years and 4 to 6 years old groups (P < 0.001 by the Kruskall-Wallis test and post-hoc analysis). There was a statistically significant difference between the central tarsal height of 0 to 6 years old groups and that of the 10 to 13 years old groups (P = 0.001).

Conclusions:

The height and length of the tarsal plate increase in children with age and it reached adult size between the ages of 10 and 13 years. In the 0 to 3 years old group, tarsal height and length are shorter than that of the 10 to 13 years old group and this difference should be considered when performing upper lid surgery.
Delayed-Onset Familial Sagittal Suture Synostosis
Authors: Kitabata Reina , Sakamoto Yoshiaki , Miwa Tomoru , Yoshida Kazunari , Kishi Kazuo
Published: April 2020

Sagittal craniosynostosis is the most common of all craniosynostoses. Patients with sagittal craniosynostosis exhibit a typical cranial appearance, including scaphocephaly, and an elongated head, with a fused and ridged sagittal suture. Moreover, some recent reports described atypical sagittal craniosynostosis accompanied by autism, speech delay, and hyperactivity. This condition, known as delayed-onset craniosynostosis, is rarely reported, given that it is difficult to determine if the condition is congenital or has a delayed-onset.

This report describes the clinical course and treatment of 2 brothers with atypical sagittal synostosis. The shapes of their heads were not indicative of scaphocephaly and the younger brother exhibited delayed-onset sagittal synostosis. Their father and paternal grandmother exhibited similar cranial morphologies. Therefore, we hypothesized the involvement of a familial factor in the etiology of atypical sagittal synostosis in these patients.
An Orbital Abscess Secondary to Intraoral Impalement
Authors: Glass Graeme Ewan , Neri Pedro Mattar , Abdulkader Faisal , Bradshaw Karen
Published: April 2020

Penetrating orbital trauma in the pediatric population is rare. Even more unusual is a secondary orbital infection following penetrating trauma. Here we present a highly unusual case of fulminant facial cellulitis with an orbital abscess in an otherwise healthy 3-year-old boy following a penetrating injury to the orbit from a point of entry on the gingiva-buccal sulcus, sustained during a fall while carrying a wooden lollipop stick. Examination of the retina revealed a focal injury at the inferior pole of the globe. The organisms cultured from pus sampled from the abscess and from the discharging intraoral wound revealed the same oral commensals while the MRI revealed a track in continuity with the orbital collection.
A three-tier Rescue stent improves outcomes over balloon occlusion in a porcine model of noncompressible hemorrhage
Authors: Go Catherine , Elsisy Moataz , Chun Youngjae , Thirumala Parthasarathy D. , Clark William W. , Cho Sung Kwon , Demetris Anthony J. , Tillman Bryan W.
Published: April 2020

BACKGROUND

Noncompressible hemorrhage remains a high-mortality injury, and aortic balloon occlusion poses limitations in terms of distal ischemic injury. Our hypothesis was that a retrievable Rescue stent would confer improved outcome over aortic balloon occlusion.

METHODS

A three-tier, retrievable stent graft was laser welded from nitinol and polytetrafluoroethylene to provide rapid thoracic and abdominal coverage with an interval bare metal segment to preserve visceral flow. Anesthetized swine had injury of the thoracic or abdominal aorta followed by balloon occlusion or a Rescue stent. A 1-hour long damage-control phase with blood repletion was used to simulate the prolonged interval between injury and repair, especially in the battlefield setting. Following the damage-control phase, the balloon or stent were retrieved followed by vascular repair and recovery to 48 hours. Animals were compared in terms of hemodynamics, blood loss, neurophysiologic spinal cord ischemia, ischemic organ injury, and survival.

RESULTS

Despite antegrade hemorrhage control, balloon occlusion averaged 3.5 L of retrograde hemorrhage, loss of visceral perfusion, and permanent spinal cord ischemia by neurophysiology in six of seven animals. After permanent repair, all balloon occlusion animals died with only a single short term (5 hours) survivor. Conversely, Rescue stent animals revealed rapid hemorrhage control (in under 2 minutes) whether the injury was thoracic or abdominal with improved hemodynamics, preserved visceral flow, reduced spinal cord ischemia, negligible histologic organ injury and survival to end of study in all abdominal injured animals (n = 6) and four of six thoracic injured animals, with two deaths related to arrhythmia.

CONCLUSION

Compared with aortic balloon occlusion, a Rescue stent offers superior hemorrhage control and survival by virtue of reduced ischemic injury and direct control of the hemorrhagic injury. The Rescue stent may become a useful tool for damage control, especially on the battlefield where definitive repair presents logistical challenges.
Fresh frozen plasma attenuates lung injury in a novel model of prolonged hypotensive resuscitation
Authors: Chipman Amanda M. , Wu Feng , Pati Shibani , Burdette Alexander J. , Glaser Jacob J. , Kozar Rosemary A.
Published: April 2020

BACKGROUND

Hemorrhagic shock remains a leading cause of early death among severely injured in both civilian and military settings. As future military operations will require strategies allowing prolonged field care of the injured, we sought to develop an in vivo model of prolonged hypotensive resuscitation (PHR) and to evaluate the role of plasma-based resuscitation in this model. We hypothesized that resuscitation with fresh frozen plasma (FFP) would mitigate lung injury when compared with Hextend in a rodent model of PHR.

METHODS

Mice underwent laparotomy and hemorrhagic shock (mean arterial blood pressure, 35 ± 5 mm Hg × 90 minutes) followed by PHR with either FFP or Hextend to maintain a mean arterial blood pressure of 55 mm Hg to 60 mm Hg for 6 hours. Sham animals underwent cannulation only. At the end of 6 hours, animals were euthanized, and lung tissue harvested for measurement of histopathologic injury, inflammation and permeability using hematoxylin and eosin staining, myeloperoxidase immunofluorescence staining and Evans Blue dye. Pulmonary syndecan-1 immunostaining was assessed as an indicator of endothelial cell integrity.

RESULTS

All animals in the FFP, Hextend, and sham groups survived to the end of resuscitation. Resuscitation with FFP mitigated lung histopathologic injury compared with Hextend (histologic injury score of 4.38 ± 2.07 vs. 7.5 ± 0.93, scale of 0–9, p = 0.002) and was comparable to shams (histologic injury score of 4.0 ± 1.93, scale of 0–9, p = 0.99). Fresh frozen plasma also reduced lung inflammation (0.116 ± 0.044 vs. 0.308 ± 0.054 relative fluorescence of myeloperoxidase, p = 0.002) and restored pulmonary syndecan-1 (0.514 ± 0.061 vs. 0.059 ± 0.021, relative syndecan-1 fluorescence, p < 0.001) when compared with Hextend. Consistently, FFP mitigated lung hyperpermeability compared with Hextend (7.30 ± 1.34 μg vs. 14.91 ± 5.55 μg Evans blue/100 mg lung tissue, p = 0.005).

CONCLUSION

We have presented a novel model of PHR of military relevance to the prolonged field care environment. In this model, FFP maintains its pulmonary protective effects using a PHR strategy compared with Hextend, which supports the need for further development and implementation of plasma-based resuscitation in the forward environment.

LEVEL OF EVIDENCE

Basic science.
Neuro-Ophthalmic Manifestations of Intracranial Malignancies
Authors: Dermarkarian Christopher R. , Kini Ashwini T. , Al Othman Bayan A. , Lee Andrew G.
Published: April 2020

Background:

To describe the various neuro-ophthalmic presentations, key exam features, and clinical findings associated with 5 common primary and secondary intracranial malignancies.

Evidence Acquisition:

Retrospective PubMed search and review of published case reports, case series, observational studies, book chapters, and review articles examining the neuro-ophthalmic features of intracranial malignancies including primary glial neoplasms (e.g., glioblastoma multiforme), primary and secondary lymphoma, intracranial metastases, carcinomatous/lymphomatous meningitis, and intracranial germ cell tumors. The search strategy used to perform the retrospective review included the aforementioned tumor type (e.g., glioblastoma multiforme) and the following terms and Boolean operators: AND (“visual loss” OR “papilledema” OR “diplopia” OR “ophthalmoplegia” or “neuro-ophthalmology” OR “proptosis”).

Results:

The rate of growth and the location of an intracranial tumor are essential factors in determining the neuro-ophthalmic presentation of certain intracranial malignancies. Primary malignant brain glial neoplasms commonly present with visual afferent complaints (e.g., unilateral or bilateral visual acuity or visual field defects, bitemporal or homonymous hemianopsia), pupil abnormalities (relative afferent pupillary defect), and optic atrophy or papilledema. Primary intraocular lymphoma (with or without central nervous system lymphoma) typically presents as a painless bilateral vitritis. Secondary intracranial malignancies have variable afferent and efferent visual pathway presentations. Carcinomatous/lymphomatous meningitis is associated with diplopia (e.g., multiple ocular motor cranial neuropathies with or without vision loss from papilledema or compressive/infiltrative optic neuropathy). Intracranial germ cell tumors can present with a chiasmal syndrome or dorsal midbrain syndrome.

Conclusion:

Intracranial malignancies can present with neuro-ophthalmic symptoms or signs depending on topographical localization. Specific neuro-ophthalmic presentations are associated with different malignant intracranial tumors. Clinicians should be aware of the common malignant intracranial tumors and their associated clinical presentations in neuro-ophthalmology.
Alpha-naphthylisothiocyanate-induced cholestatic mice display anxiety-like behavior closely related with enhanced serotoninergic signaling transduction in central nervous system
Authors: Zhou Jin , Tao Yanlin , Zhu Han , Wu Hui , Shi Hailian , Huang Fei , Wu Xiaojun
Published: April 2020

Cholestasis is a pathophysiological process caused by the damage of hepatocytes or obstruction of bile flow, which often leads to emotional disorder in central nervous system. Alpha-naphthylisothiocyanate (ANIT) is the most widely used chemical to induce cholestatic models; however, the neurobehavior of ANIT-induced cholestatic model has not been investigated. The present study was designed to evaluate the anxiety-like behavior of cholestatic mice induced by a single (i.p.) injection of ANIT and its potential mechanism. For validating the model, the alanine aminotransferase, glutamic oxaloacetic transaminase, alkaline phosphatase, and total bile acid in the serum of mice were detected, and the pathological sections of hepatic lobes were also observed. After that, a series of behavioral tests were used to detect the anxiety-like behavioral changes of the ANIT-induced cholestatic mice, and then the level of 5-hydroxytryptamine and 5-hydroxyindole acetic acid in serum and prefrontal cortex were detected. Our data showed that ANIT-induced cholestatic mice exhibited increased anxiety-like behaviors in the open-field test and elevated plus maze test. Moreover, the concentration of 5-hydroxyindole acetic acid significantly decreased in the serum and the prefrontal cortex of ANIT-induced cholestatic mice compared with the control group. In addition, the expression of 5-hydroxytryptamine 1A, 5-hydroxytryptamine 2C, 5-hydroxytryptamine 3A, and 5-hydroxytryptamine 7 receptors increased in the prefrontal cortex of the model mice compared to their controls. Our results suggest that ANIT-induced cholestatic mice can display anxiety-like behavior closely related with enhanced serotoninergic signaling transduction in central nervous system.
Does circadian rhythm disruption during their early development have lasting effects on cognition of the elder rats?
Authors: Zhang Yuge , Wang Wenzhu , Li Yi , Shen Jiayi , Zhang Tong
Published: April 2020

Objectives

This study aimed to investigate the changes in learning and memory after chronic circadian disruption followed by a long period of circadian recovery.

Materials and methods

Eleven adult male spontaneously hypertensive rats were randomly divided into control group, 12-h light/12-h dark circadian disruption group (12L/12D) and 6-h light/6-h dark circadian disruption group (6L/6D). Rats in control group remained under the original 12-h light/12-h dark cycle throughout the experiment; rats in the 12L/12D group were exposed to 12-h light/12-h dark cycle with light–dark order changed every 3 days; rats in the 6L/6D group were exposed to 6-h light/6-h dark cycle. The disruption period continued for 18 weeks. Then after 8 weeks and 32 weeks of circadian re-entrainment, all animals were tested by Morris Water Maze (MWM), respectively, followed by an MRI examination.

Results

Rats in the 12L/12D group demonstrated longer escape latency and swim distance in the MWM test than rats in the other two groups (P < 0.05). The MRI results showed volume% reduction and concentration% decrease of brain regions in the two circadian disruptive groups, while the changes were more significant and comprehensive in the 12L/12D group (P < 0.05).

Conclusions

Circadian disruption during early life accelerates cognition decline in later life in rats. Frequent light–dark order shift is more harmful.
Distinct clinicopathological differences between early gastric cardiac and non-cardiac carcinomas: A single-center retrospective study of 329 radical resection cases
Authors: Wang Yao Hui , Li Xiu Qing , Gao Li Li , Wang Chen Xi , Zhang Yi Fen , Huang Qin
Published: April 2020

Background

Early gastric carcinoma is heterogeneous and can be divided into early gastric cardiac carcinoma (EGCC) and early gastric non-cardiac carcinoma (EGNCC) groups. At present, differences in clinicopathology remains obscure between EGCC and EGNCC fundus-corpus and antrum-angularis-pylorus subgroups, especially between EGCC with and without esophageal invasion.

Methods

In this study, we studied 329 consecutive early gastric carcinoma radical gastrectomies with 70 EGCCs and 259 EGNCCs.

Results

Compared to the EGNCC antrum-angularis-pylorus (n=181), but not fundus-corpus (n=78), sub-group, EGCC showed significantly older age, lower prevalence of the grossly depressed pattern, better tumor differentiation, higher percentage of tubular/papillary adenocarcinoma, but lower frequency of mixed poorly cohesive carcinoma with tubular/papillary adenocarcinoma, and absence of LNM in tumors with invasion up to superficial submucosa (SM1). In contrast, pure poorly cohesive carcinoma was less frequently seen in EGCCs than in EGNCCs, but mixed poorly cohesive carcinoma with tubular/papillary adenocarcinomas was significantly more common in the EGNCC antrum-angularis-pylorus sub-group than in any other group. No significant differences were found between EGCC and EGNCC sub-groups in gender, tumor size,H. pyloriinfection rate, and lymphovascular/perineural invasion. EGCC with oesophageal invasion (n=22), compared to EGCC without (n=48), showed no significant differences in theH. pyloriinfection rate and oesophageal columnar, intestinal, or pancreatic metaplasia, except for a higher percentage of the former in size > 2 cm and tubular differentiation.

Conclusions

There exist distinct clinicopathologic features between EGCC and EGNCC sub-groups; EGCC was indeed of gastric origin. Further investigations with larger samples are needed to validate these findings.
Quantify the Requirements to Achieve Grain Zn Biofortification of High-yield Wheat on Calcareous Soils
Authors: Wang Sen , Wang Zhaohui , Li Shasha , Diao Chaopeng , Liu Lu , Huang Ning , Huang Ming , Hui Xiaoli , Luo Laichao , He Gang , Cao Hanbing
Published: April 2020

The solution to address global human Zn deficiency is Zn biofortification of staple food crops, aimed at high grain Zn concentration as well as high yield. However, the desired high grain Zn concentration above 40 mg kg-1is rarely observed for high-yield wheat on worldwide calcareous soils, due to inadequate Zn uptake or Zn distribution to grain. The present study aims to investigate how much Zn uptake or distribution is adequate to achieve the Zn.t of high-yield wheat on calcareous soils with low available Zn (∼ 0.5 mg kg-1). Of the 123 cultivars tested in a three-year field experiment, 19 high-yield cultivars were identified with similar yields around 7.0 t ha-1and various grain Zn concentrations from 9.3 to 26.7 mg kg-1. The adequate Zn distribution to grain was defined from the view of Zn biofortification, as the situation where the Zn distribution to grain (Zn harvest index) increased to the observed maximum of ∼ 91.0% and the Zn concentration of vegetative parts (straw Zn concentration) decreased to the observed minimum of ∼ 1.5 mg kg-1(Zn.m). Under the assumed condition of adequate Zn distribution to grain (∼ 91.0%), all the extra Zn above Zn.m was remobilized from straw to grain and the grain Zn concentration would be increased to its highest attainable level, which was 14.5 ∼ 31.3 mg kg-1for the 19 high-yield cultivars but still lower than 40 mg kg-1. Thus, even with the adequate Zn distribution to grain, the current Zn uptake is still not adequate and needs to be increased to 308 g ha-1or higher to achieve Zn.t for high-yield wheat (7.0 t ha-1) on low-Zn calcareous soils. Besides, the established method here can also provide the priority measures and quantitative guidelines to achieve Zn biofortification in other wheat production regions.
Reactive flow simulations for a LOX/CH4 rocket engine
Authors: French Ainslie , Cutrone Luigi , Schettino Antonio , Marini Marco , Battista Francesco , Natale Pasquale
Published: April 2020

Purpose

This paper aims to detail the reactive flow simulations of a LOX/CH4 multi-element rocket engine. The work has been conducted within the framework of the HYPROB-BREAD project whose main objective is the design, manufacture and testing of a LOX/LCH4 regeneratively cooled ground demonstrator.

Design/methodology/approach

Numerical simulations have been carried out with both commercial software and CIRA software developed in house. Two sets of boundary conditions, nominal and experimental, have been applied from which a code-to-code validation has been effected with the former and a code-to-experiment validation with the latter.

Findings

The results presented include both flow data and heat fluxes as well as parameters associated with engine performance, and indicate an excellent agreement with experimental data of a LOX/CH4 multi-element rocket engine.

Originality/value

The research is unique as the CIRA code Numerical Experimental Tool (NExT) has been validated with the commercial software FLUENT as well as with experimental values from the firing of the LOX/CH4 rocket engine demonstrator.
Leaders or organisations?
Authors: Nazarian Alireza , Atkinson Peter , Foroudi Pantea , Edirisinghe Dilini
Published: April 2020

Purpose

Managers of independent hotels need to maximise organisational citizenship behaviour (OCB) among employees to gain sufficient competitive advantage in an increasingly competitive environment, so it is important to understand what affects it. To achieve this, the purpose of this paper is to test if servant leadership, OCB and other related constructs have the same relationships between them in two contrasting parts of the world.

Design/methodology/approach

Survey data were gathered from managers of independent hotels in Spain (451) and Iran (429). Spain was selected because it is a developed country that is a leading destination for tourists. Iran was chosen as a contrast, as it is a developing country with a growing tourist industry.

Findings

The findings show that Spain and Iran demonstrate different patterns of relationships in the selected variables, suggesting that Iranians trust their leaders more than the organisational systems, whereas the Spanish trust organisational systems more than their leaders. These results are consistent with Spanish culture having higher individualism than Iranian culture. They are also consistent with Iranian culture prioritising traditional values, such as personal loyalty to managers, and Spanish culture prioritising modern values, such as impersonal rules and objective processes.

Research limitations/implications

This study suggests that leadership and justice affect OCB in different ways where modern values prevail compared to where traditional values prevail. It suggests that managers of independent hotels in Iran should follow the example of Spanish hotel managers by adopting more objective and fair procedures while showing that inward investors and expatriate managers in Iran should be aware of the importance of personal leadership style. Further research is needed in different countries and regions to improve the generalisability of our findings.

Originality/value

This study contributes to the literature on the application of the servant leadership construct, which was developed in the West, to other regional contexts. It also adds to the literature of independent hotels, which is an important yet under-researched part of the hospitality industry.
Otherness as a form of intersubjective social exclusion
Authors: Romero-Rodriguez Luis M. , Civila Sabina , Aguaded Ignacio
Published: April 2020

Purpose

This study aims to review the theory based on «otherness» as a form of social exclusion and symbolic violence from the constructions of realities of the media, with particular emphasis on the ethics and aesthetics of language and its role in materializing identity differences.

Design/methodology/approach

A search for specific criteria andbooleanalgorithms is carried out in Web of Science and Scopus on «otherness» [AND] «social exclusion», to then submit the emerging results to a co-occurrence matrix by citations with VOSViewer v. 1.6.13. From the relation tree of the most cited documents [min = 7] of the downloaded articles, a critical/analytical reading is made.

Findings

«Otherness» is reviewed to a greater extent from a Western perspective, and more specifically, from a Eurocentric one. This implies that the study of «otherness» is not sufficiently analyzed by Asian or African authors, who are excluded from the analysis. In this sense, «otherness» is understood as a theoretical construct and as any symbolic construction of the other (phenotypically, but also in ideology, values and customs), but which carries a load of stereotypes that can become polarization, demonization, ergo and violence.

Originality/value

Revisiting «otherness» as an informative construct becomes imperative in light of the emergence of extremist groups and xenophobic parties, as well as separatist policies such as Brexit or the Catalan split in Spain. Few articles contribute to elaborating a complete conceptual construct on «otherness» as an epistemological category of communication and information, so this research effort attempts to compile its theoretical discussion.
Vitiligo expansion and extent correlate with durable response in anti‐programmed death 1 antibody treatment for advanced melanoma: A multi‐institutional retrospective study
Authors: Matsuya Taisuke , Nakamura Yasuhiro , Matsushita Shigeto , Tanaka Ryota , Teramoto Yukiko , Asami Yuri , Uehara Jiro , Aoki Megumi , Yamamura Kentaro , Nakamura Yoshiyuki , Fujisawa Yasuhiro , Livingstone Elisabeth , Zimmer Lisa , Schadendorf Dirk , Kagamu Hiroshi , Fujimoto Manabu , Honma Masaru , Ishida‐Yamamoto Akemi , Araki Ryuichiro , Yamamoto Akifumi
Published: April 2020

Vitiligo is an autoimmune disorder resulting from the destruction of melanocytes. Several reports indicate the association between vitiligo and treatment response in advanced melanoma during immunotherapy. It has not been investigated, however, if an increase of vitiligo while on treatment with anti‐programmed death 1 (PD‐1) antibodies is associated with more durable responses. The aim of this study is to evaluate the correlation between the vitiligo dynamics and clinical efficacy of anti‐PD‐1 antibodies. This study included advanced melanoma patients who were treated with nivolumab or pembrolizumab and developed vitiligo thereafter. Correlation between vitiligo expansion (defined as an increase of lesion size at two separate time points at least 4 weeks apart) as well as vitiligo extent (body surface area [BSA] affected) and clinical efficacy based on response rate, progression‐free survival and overall survival was assessed. We retrospectively reviewed 29 patients. The median time from the initiation of anti‐PD‐1 antibody to vitiligo onset was 4.3 months in patients who showed a response and 5.5 months in patients who showed no response (P = 0.31). Twelve patients showed vitiligo expansion, and in nine of these patients, vitiligo increased to grade 2 (covering ≥ 10% BSA). Vitiligo expansion and grade 2 vitiligo showed no improvement in treatment response (P = 0.59 and 0.25) but were associated with prolonged progression‐free survival (P = 0.019 and 0.04). Grade 2 vitiligo also showed a trend for prolonged overall survival (P = 0.07). Trend of expansion and larger vitiligo extent may be predictive factors of prolonged survival during anti‐PD‐1 antibody in melanoma patients.
‘They don't know themselves, so how can they tell us?’: parents navigating uncertainty at the frontiers of neonatal surgery
Authors: Hinton Lisa , Armstrong Natalie
Published: April 2020

When a baby is diagnosed with a condition needing surgery they, and their family, start down an uncertain and unknown path. Living with uncertainty underpins every stage of the journey from hospital to home. These journeys span the highly technical to the mundane. They are likely to involve, at crucial points, medicalised and specialised neonatal and surgical care in paediatric centres of excellence where parents are mere spectators. Yet ultimately parents are able to take their baby home, confident experts in their daily care. Drawing on narrative interviews with 42 UK parents whose baby underwent neonatal surgery, this paper explores how parents navigate this uncertainty through acquiring experiential and lay knowledge and developing expertise in their baby's condition and treatment options. These conditions are rare. Building on sociological understandings of the work of chronic illness, as well as more recent work on newborn screening, sharing information online and examinations of experiential knowledge, we explore lay knowledge and expertise as it intersects with biomedical and surgical frontiers. We demonstrate how the development of expertise is an emergent, three‐stage process supported by both biomedical and lay knowledge and elucidate this process of knowledge‐building as a scaffold through which to manage uncertainty.
‘No screens, no money’ proclaims fats
Authors: Thorp John M
Published: April 2020

Deputy Editor‐in‐Chief, Dr John M Thorp, discusses the latest thinking in women’s health and highlights articles from this issue in an audio podcast available at: https://soundcloud.com/bjog/may-editorial-2020
Simulation with RADinitio improves RADseq experimental design and sheds light on sources of missing data
Authors: Rivera‐Colón Angel G. , Rochette Nicolas C. , Catchen Julian M.
Published: April 2020

Restriction‐site associated DNA sequencing (RADseq) has become a powerful and versatile tool in modern population genomics, enabling large‐scale evolutionary and genomic analyses in otherwise inaccessible biological systems. With its widespread use, different variants on the protocol have been developed to suit specific experimental needs. Researchers face the challenge of choosing the optimal molecular and sequencing protocols for their reduced representation experimental design, an often‐complicated process. Strategic errors can lead to biased data generation that has reduced power to answer biological questions. Here, we present RADinitio, simulation software for the selection and optimization of RADseq experiments via the generation of sequencing data that behave similarly to empirical sources. RADinitio provides an evolutionary simulation of populations, implementation of various RADseq protocols with customizable parameters, and thorough assessment of missing data. We test the efficacy of the software using different RAD protocols across several organisms, highlighting the importance of protocol selection on the magnitude and quality of data acquired. Additionally, we test the effects of RAD library preparation and sequencing on allelic dropout, observing that library preparation and sequencing often contributes more to missing alleles than population‐level variation.
A new microdialysis probe for continuous lactate measurement during fetal monitoring: Proof of concept in an animal model
Authors: Tigchelaar Froukje , Groen Henk , Westgren Magnus , Huinink Kirsten D. , Cremers Thomas , van den Berg Paul P.
Published: April 2020

Introduction

Cardiotocography (CTG) is currently the most commonly used method for intrapartum fetal monitoring during labor. However, a high false‐positive rate of fetal acidosis indicated by CTG leads to an increase in obstetric interventions. We developed a microdialysis probe that is integrated into a fetal scalp electrode allowing continuous measurement of lactate subcutaneously, thus giving instant information about the oxygenation status of the fetus. Our aim was to establish proof of concept in an animal model using a microdialysis probe to monitor lactate subcutaneously.

Material and methods

We performed an in vivo study in adult male wild‐type Wistar rats. We modified electrodes used for CTG monitoring in human fetuses to incorporate a microdialysis membrane. Optimum flow rates for microdialysis were determined in vitro. For the in vivo experiment, a microdialysis probe was inserted into the skin on the back of the animal. De‐oxygenation and acidosis were induced by lowering the inspiratory oxygen pressure. Oxygenation and heart rate were monitored. A jugular vein cannula was inserted to draw blood samples for analysis of lactate, pH, pco2, and saturation. Lactate levels in dialysate were compared with plasma lactate levels.

Results

Baseline blood lactate levels were around 1 mmol/L. Upon de‐oxygenation, oxygen saturation fell to below 40% for 1 h and blood lactate levels increased 2.5‐fold. Correlation of dialysate lactate levels with plasma lactate levels was 0.89 resulting in an R2 of .78 in the corresponding linear regression.

Conclusions

In this animal model, lactate levels in subcutaneous fluid collected by microdialysis closely reflected blood lactate levels upon transient de‐oxygenation, indicating that our device is suitable for subcutaneous measurement of lactate. Microdialysis probe technology allows the measurement of multiple compounds in the dialysate, such as glucose, albumin, or inflammatory mediators, so this technique may offer the unique possibility to shed light on fetal physiology during the intrapartum period.
Late Quaternary glacier and sea‐ice history of northern Wijdefjorden, Svalbard
Authors: Allaart Lis , Müller Juliane , Schomacker Anders , Rydningen Tom A. , Håkansson Lena , Kjellman Sofia E. , Mollenhauer Gesine , Forwick Matthias
Published: April 2020

The deglaciation history and Holocene environmental evolution of northern Wijdefjorden, Svalbard, are reconstructed using sediment cores and acoustic data (multibeam swath bathymetry and sub‐bottom profiler data). Results reveal that the fjord mouth was deglaciated prior to 14.5±0.3 cal. ka BP and deglaciation occurred stepwise. Biomarker analyses show rapid variations in water temperature and sea ice cover during the deglaciation, and cold conditions during the Younger Dryas, followed by minimum sea ice cover throughout the Early Holocene, until c. 7 cal. ka BP. Most of the glaciers in Wijdefjorden had retreated onto land by c. 7.6±0.2 cal. ka BP. Subsequently, the sea‐ice extent increased and remained high throughout the last part of the Holocene. We interpret a high Late Holocene sediment accumulation rate in the northernmost core to reflect increased sediment flux to the site from the outlet of the adjacent lake Femmilsjøen, related to glacier growth in the Femmilsjøen catchment area. Furthermore, increased sea ice cover, lower water temperatures and the re‐occurrence of ice‐rafted debris indicate increased local glacier activity and overall cooler conditions in Wijdefjorden after c. 0.5 cal. ka BP. We summarize our findings in a conceptual model for the depositional environment in northern Wijdefjorden from the Late Weichselian until present.
Power dynamics and new directions in the recent evolution of CBNRM in Botswana
Authors: Cassidy Lin
Published: April 2020

Recently, the limited control of Botswana's community conservation organizations, or trusts, over resources has been further eroded. Community trusts now exist solely to disburse funds allocated by central government. The absence of any rights to control access to or use of their resources suggests the complete collapse of Botswana's original community‐based natural resources management (CBNRM) model. This collapse could facilitate fresh approaches that return to the original intentions currently lost behind the CBNRM acronym. Access and control can be more clearly framed through broader environmental stewardship frameworks that include moving below the homogenized community identity to specific resource user groups; broadening the conservation focus beyond monetized wildlife to include other resources and ecosystem processes; and establishing formal conservation agreements separately for specific resources, with the trust coordinating adherence to the rights and responsibilities held by individual users on the one hand, and government or public agencies on the other.
Epithelioid angiomyolipoma mimicking metastatic melanoma in a liver tumor
Authors: Ronen Shira , Prieto Victor G. , Aung Phyu P.
Published: April 2020

It is well known to pathologists that melanoma is “the great mimicker,” looking like almost any other tumor, and able to metastasize anywhere in the body. We report a case of a 48‐year‐old female with a history of metastatic melanoma 4 years before, who presented with a hepatic mass. Microscopic examination of the liver mass revealed sheets of pleomorphic, epithelioid cells, which expressed a pan‐melanocytic cocktail (MART1, HMB45, and tyrosinase). These findings were initially interpreted as metastatic melanoma and the case was transferred for dermatopathology consultation. We compared the morphology of this tumor to the primary melanoma and noticed that the primary melanoma showed nevoid cytology, morphologically distinct from the liver lesion. Consequently, we performed additional immunohistochemical studies, which determined that the liver mass was negative for S100 and SOX10, and established a final diagnosis of epithelioid angiomyolipoma. The key for reaching the correct diagnosis was the morphologic comparison with the original lesion and the evaluation of a wider immunohistochemical profile. For appropriate management in patients with new lesions, even in the context of a patient with known metastatic disease, it is essential to consider other neoplasms in the differential diagnosis.
Does low‐pay persist across different regimes? Evidence from German Unification
Authors: Gürtzgen Nicole , Diegmann (né Nolte) André
Published: April 2020

Using German administrative data, we study across‐regime low‐pay persistence in the context of an economic transformation process. We first show that individuals' initial allocation to the post‐unification low‐wage sector was close to random in terms of market‐regime unobservables. Consistent with a weak connection between individuals' true productivity and their pre‐unification low‐wage status, the extent of across‐regime state dependence is found to be small and appears to vanish over time. For males, across‐regime state dependence is most pronounced among the medium‐ and high‐skilled, suggesting the depreciation of human capital as an explanation.
Are children an incentive or a disincentive for migration? Evidence from Vietnam
Authors: Nguyen Cuong , Tran Anh
Published: April 2020

This study analyzes the influence of children on household migration decisions using data on current internal movement in Vietnam a country that has experienced significant rural–urban migration in the recent years. Families with children usually have three migration choices: move together, stay together or send only one parent to work afar. Using an instrumental variable approach, we show that having an additional child reduces the probability of household migration by 0.0115, while it increases the likelihood of fathers’ migration by 0.0121. These effects suggest that households with more children may be less mobile but may have a greater economic need for migration.