bluuebunny/crossref_metadata_2025 huggingface dataset:
Gondwanan Heritage
Authors: F. Recher Harry
Published: May 2016

Gondwanan Heritage is dedicated to two inspirational Western Australian biologists, Bert Main and Sid James. Let me therefore add my appreciation for the efforts of Bert Main and Sid James. Bert is probably most revered for his wit and commitment to scientifically based environmental management and conservation. His research on evolutionary ecology is that of a true naturalist with publications on plants, fish, invertebrates, reptiles, fire ecology, biodiversity, and the history of science to mention just a few of his interests. Sid James is a plant evolutionist and geneticist and, as Steve Hopper puts it, his work provides "compelling reasons for conserving all that remains of Western Australia's remnant vegetation".
How secure is the Lord Howe Island Woodhen? A population viability analysis using VORTEX
Authors: W. Brook Barry , Lim Leong , Harden Robert , Frankham Richard
Published: May 2016

The Lord Howe Island Woodhen is a flightless rail endemic to Lord Howe Island that became endangered due to human over-exploitation and predation from wild pigs. It has recently recovered from a population size of 20?30 to around 200 as a result of a captive breeding and reintroduction programme. Its classification has been downgraded from endangered to vulnerable, but no quantitative assessment of its future prospects had been undertaken. A population viability analysis (PVA) was performed on the Lord Howe Island Woodhen to project its possible fate using VORTEX, a package that realistically reflects the woodhen's recent history. Prospective analyses showed the woodhen to be acutely sensitive to minor changes in mortality and fecundity, and to catastrophes, due to exotic species, inbreeding, or disease. A remote population needs to be established if the likelihood of the woodhen's extinction is to be minimized. According to the most recent IUCN Red List categories, the woodhen satisfies the criteria for endangered status.
Conservation and management of Australasian birds
Authors: F. Recher H.
Published: May 2016

This is a special issue of Pacific Conservation Biology on the conservation and management of Australasian birds. Originally, the papers were presented at the Southern Hemisphere Ornithological Congress (SHOC) held in October 1996 at Albany, Western Australia. The Congress was organized by the Royal Australasian Ornithologists Union following discussions in 1990 at the International Ornithological Congress in Christchurch, New Zealand on the need for regular, scientific ornithological meetings in Australia. The intent of those discussions was for a meeting of Australian/New Zealand ornithologists every two years.
Taxonomy, genetics and conservation: a preliminary study of the variation in Actephila lindleyi (Euphorbiaceae) a rainforest shrub
Authors: Shapcott A.
Published: May 2016

Actephila lindleyi is a highly morphologically variable species. It occurs in disjunct populations in rainforests from Cape York to central New South Wales. Preliminary tests have shown variation between populations is matched by genetic variation at the enzyme and chromosome levels. Thus, taxonomic revision of this species should take this into account. Such taxonomic decisions have implications for conservation and management. For example, the overall conservation status of a widespread species with endangered populations might be much lower than the conservation status of each population when elevated to species status.
The Big-headed Ant Pheidole megacephala: a new threat to monsoonal northwestern Australia
Authors: D. Hoffmann Benjamin
Published: May 2016

The Big-headed Ant Pheidole megacephala is a major threat to native invertebrate assemblages and to agricultural production world-wide. This paper reviews its known biology including its foraging ecology, colony founding and dispersal behaviour. A case study is presented to illustrate its potential conservation significance for northern Australia. At Howard Springs Nature Park in the Darwin region of the Northern Territory, an infestation of P. megacephala was found to cover 25 ha and is continuing to spread, with its distribution centred on a rainforest patch. The abundance of P. megacephala within the rainforest was 37?110 times that of total native ant abundance at uninfested sites. Only two individuals of a single native ant species were found in the highest abundance of P. megacephala and abundance of other invertebrates was only 15% of natural levels. Pheidole megacephala is a serious potential threat to native biodiversity in monsoonal Australia. Successful eradication on a large scale is a realistic option and control methods are discussed, including chemicals and fire.
Physiology of Woody Plants
Authors: Gurner Ryan
Published: May 2016

Plant physiology is the scientific study of how plants grow and respond to environmental factors and cultural treatments in terms of their physiological processes and conditions. This book aims to explain how physiological processes (such as photosynthesis, respiration, transpiration, carbohydrate, nitrogen and mineral relations) are involved in the growth of woody plants and how they are affected by the environment, in addition to explaining the mechanisms of the processes themselves.
Conservation status of New Caledonia palms
Authors: Pintaud J.-C. , Jaffré T. , Veillon J.-M.
Published: May 2016

An assessment of the conservation status of the palm species occuring in New Caledonia is provided, based on the new IUCN Red List categories. To determine the conservation status of each species, their extent of occurrence was determined using locality data on herbarium collections. Area of occupancy, number of adults, regeneration, and threats were evaluated on 62 localities throughout the Territory, including all types of palm habitats and all localities of species occurring at less than five sites. Among the 37 palm species known in New Caledonia, all are endemic and 13 are in a threatened category, including four critically endangered, one endangered, and eight vulnerable. Only four of the threatened species are represented in a reserve. Six species are listed as LRcd since they are adequately protected in a reserve despite an acute restriction of their range. Recommendations are given to improve the network of protected areas to include more threatened species.
Environmental Management: the Precautionary Principle and Null Hypotheses
Authors: W. Goodall David
Published: May 2016

A recent paper (Calver et al. 1999) exemplifies an approach to environmental problems which, though common, is often inappropriate, and may indeed be counterproductive in confrontational situations. An examination seems called for.
HIV incidence and associated risk factors in men who have sex with men in Mainland China: an updated systematic review and meta-analysis
Authors: Zhang Wei , Xu Jun-Jie , Zou Huachun , Zhang Jing , Wang Ning , Shang Hong
Published: May 2016

Background: The national annually reported proportion of men who have sex with men (MSM) among people living with HIV (PLWH) is growing in China. To better inform the public health sector how to improve HIV prevention strategies, it is necessary to understand the current level of HIV incidence and its correlates. Methods: Google Scholar, PubMed, Web of Science and three major Chinese electronic publication databases (http://qikan.cqvip.com/, http://g.wanfangdata.com.cn/, http://www.cnki.net/, respectively) were searched for studies reporting HIV incidence. Comprehensive Meta-Analysis (CMA) 2.0 statistical software (Biostat, Inc. Englewood, NJ, USA) was used to calculate the pooled HIV incidence and perform subgroup-analysis to find correlates for HIV seroconversion in Chinese MSM. Random effects modelling was then conducted. Results: Twenty-five eligible studies were included in this meta-analysis. The calculated pooled HIV incidence was 5.61/100 person years (PY), with an increasing trend over time (3.24/100PY, 5.29/100PY, 5.50/100PY in 2005–2008, 2009–2011, 2012–2014 respectively, χ2 test for trend P = 0.04). Subgroup analyses indicated that age <25 years (rate ratio (RR) = 1.85), junior college education and below (RR = 1.87), having ≥ 2 male sexual partners in past 6 months (RR = 2.50), baseline syphilis infection (RR = 2.99), homosexual orientation (RR = 1.91), preferred bottom/versatile roles in anal sexual intercourse (RR = 2.33), and having unprotected anal intercourse in the past 6 months (RR = 2.16) significantly increased the risk for HIV seroconversion (each P < 0.05). Uncircumcised MSM had a marginal statistically significant higher HIV incidence (RR = 3.35, P = 0.051). Conclusion: HIV incidence is still alarmingly high among Chinese MSM. Stronger HIV intervention strategies should be implemented, in particular targeting young, less educated and syphilis-infected MSM.
Fire effects on pollination in a sexually deceptive orchid
Authors: Brown Julian , York Alan , Christie Fiona
Published: May 2016

Research into the effectiveness of prescribed fire in managing pollination has only recently begun. The effects of fire on pollination have not been explored in sexually deceptive systems. Further, the potential for multiple effects operating at different spatial scales has not been explored in any pollination system despite multiscale effects on pollination observed in agricultural landscapes. We observed the frequency of pollinator visitation to flowers of sexually deceptive Caladenia tentaculata and related it to the post-fire age class of the vegetation at local and landscape scales. We also related the number of the pollinator’s putative larval hosts (scarab beetles) captured at these sites to age class. At the local scale (i.e. the sample location), visitation was highest in recently burnt sites. At the landscape scale, positive associations were observed between (1) putative pollinator hosts and vegetation burnt 36–50 years ago, and (2) pollinator visitation and vegetation burnt ≥50 years ago. Local- and landscape-scale effects on visitation were synergistic, such that visitation was greatest when fire age was heterogeneous within pollinator foraging range.
Molecular tandem repeat strategy for elucidating mechanical properties of high-strength proteins
Authors: Jung Huihun , Pena-Francesch Abdon , Saadat Alham , Sebastian Aswathy , Kim Dong Hwan , Hamilton Reginald F. , Albert Istvan , Allen Benjamin D. , Demirel Melik C.
Published: May 2016

Significance

Squid have teeth-like structural [squid ring teeth (SRT)] proteins inside their suckers, which have segmented semicrystalline morphology with repetitive amorphous and crystalline domains. These proteins have high elastic modulus and toughness. However, a clear relationship between molecular structure and mechanical properties of this material remains elusive. To investigate the genetic basis of material properties in SRT sequences, we developed a new approach for the design and production of structural proteins. We show that the toughness and flexibility of these synthetic SRT mimics increase as a function of molecular weight, whereas the elastic modulus and yield strength remain unchanged. These results suggest that artificial proteins produced by our approach can help to illuminate the genetic basis of protein material behavior in SRT.
Single-cell twitching chemotaxis in developing biofilms
Authors: Oliveira Nuno M. , Foster Kevin R. , Durham William M.
Published: May 2016

Significance

Bacterial biofilms affect many aspects of our lives, from causing disease to promoting health and shaping many key processes in the environment. Despite this, surface-attached cells in biofilms are often portrayed as static and sluggish, a stark contrast to the energetic swimming they exhibit in liquid. Here we use microfluidic devices and automated cell tracking to challenge this view: We find that individual cells will actively move toward nutrients within a developing biofilm. This ability not only allows cells to seek out favored positions on a surface but our analyses show that they can regulate their movement with remarkable submicron precision. Our findings suggest we can systematically engineer biofilms by manipulating the movement of the cells from which they are founded.
Cellular folding pathway of a metastable serpin
Authors: Chandrasekhar Kshama , Ke Haiping , Wang Ning , Goodwin Theresa , Gierasch Lila M. , Gershenson Anne , Hebert Daniel N.
Published: May 2016

Significance

The activity of some proteins requires dramatic conformational movements. The ability to undergo these movements can be enabled by folding of these proteins to constrained higher free energy or metastable states. Metastable proteins are particularly susceptible to misfolding and are therefore associated with a number of pathologies. Here the cellular folding pathway of the serpin antithrombin III (ATIII), which inhibits proteases involved in the coagulation cascade, was determined. ATIII uses a large conformational movement in a mousetrap-like mechanism to bind and distort its target protease, resulting in protease inhibition. This work establishes that folding to an active, cocked state requires early stabilization of the C-terminal region, which is the last sequence translated, explaining how the serpin or mousetrap is set.
Analysis of complex neural circuits with nonlinear multidimensional hidden state models
Authors: Friedman Alexander , Slocum Alanna F. , Tyulmankov Danil , Gibb Leif G. , Altshuler Alex , Ruangwises Suthee , Shi Qinru , Toro Arana Sebastian E. , Beck Dirk W. , Sholes Jacquelyn E. C. , Graybiel Ann M.
Published: May 2016

Significance

In analyzing complex networks, we are commonly interested in quantifying the influence that the network nodes exert on each other and in decoding the behavior of the network. We present the nonlinear multidimensional hidden state (NMHS) model, which addresses both of these unmet challenges by simultaneously decoding activity from parallel data streams and calculating the interaction strength among them. In NMHS models, each node in a network acts as a stochastic process that can influence the progression of other nodes in the network. We show that our procedure matches or outperforms state-of-the-art techniques in a multitude of scenarios, notably in systems with nonlinear interactions.
Zonal flow generation and its nonlinear dynamics in trapped electron mode turbulence of flat density tokamak plasmas
Authors: Guo Z.B. , Hahm T.S.
Published: May 2016

We investigate zonal flow (ZF) generation in ion temperature gradient driven trapped-electron-mode (ITG-driven TEM) turbulence via modulational instability analysis. We show that the acceleration of a seed ZF is a consequence of the competition of negative radiation pressure (NRP, acting as a driving force) and positive radiation pressure (PRP, acting as a retarding force) of the ITG-driven TEM turbulence. A critical dimensionless ion temperature logarithmic gradient (

R
/

L

T
i

,
c

) normalized to the major radius is obtained by balancing the NRP- and PRP effects. For

R

L

T
i

<

R

L

T
i

,
c

, the NRP effect is dominant and the seed ZF is accelerated. Otherwise, the PRP effect is dominant and the seed ZF is decelerated. In addition, a new nonlinear evolution mechanism of the ZF is also proposed. It is shown that the turbulence energy intensity spectrum gets steepened in k-space due to the ZF shearing, which in turn induces nonlinear growth of the ZF.
Terminating ₂𝐹₁(4)-series perturbed by two integer parameters
Authors: Chu Wenchang
Published: May 2016

By means of generating functions and the linearization method, we establish analytical formulae for a class of terminating

2

F
1

(
4
)

_2F_1(4)

-series perturbed by two integer parameters. Under the Pfaff transformation, these formulae confirm, unexpectedly, a conjecture about evaluation of the

2

F
1

(
−
3
)

_2F_1(-3)

-series made by Apagodu and Zeilberger (2008).
Absolutely summing operators and atomic decomposition in bi-parameter Hardy spaces
Authors: Müller Paul , Penteker Johanna
Published: May 2016

For

f
∈

H
p

(

δ
2

)

f \in H^p(\delta ^2)

,

0
>
p
≤
2

0>p\leq 2

, with Haar expansion

f
=
∑

f

I
×
J

h

I
×
J

f=\sum f_{I \times J}h_{I\times J}

we constructively determine the Pietsch measure of the

2
2

-summing multiplication operator
\[
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="script upper M Subscript f Baseline colon script l Superscript normal infinity Baseline right-arrow upper H Superscript p Baseline left-parenthesis delta squared right-parenthesis comma left-parenthesis phi Subscript upper I times upper J Baseline right-parenthesis right-arrow from bar sigma-summation phi Subscript upper I times upper J Baseline f Subscript upper I times upper J Baseline h Subscript upper I times upper J Baseline period">

M

f

:

ℓ

∞

→

H
p

(

δ
2

)
,

(

φ

I
×
J

)
↦
∑

φ

I
×
J

f

I
×
J

h

I
×
J

.

\mathcal {M}_f:\ell ^{\infty } \rightarrow H^p(\delta ^2), \quad (\varphi _{I\times J}) \mapsto \sum \varphi _{I\times J}f_{I \times J}h_{I \times J}.

\]
Our method yields a constructive proof of Pisier’s decomposition of

f
∈

H
p

(

δ
2

)

f \in H^p(\delta ^2)

\[
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="StartAbsoluteValue f EndAbsoluteValue equals StartAbsoluteValue x EndAbsoluteValue Superscript 1 minus theta Baseline StartAbsoluteValue y EndAbsoluteValue Superscript theta Baseline and double-vertical-bar x double-vertical-bar Subscript upper X 0 Superscript 1 minus theta Baseline double-vertical-bar y double-vertical-bar Subscript upper H squared left-parenthesis delta squared right-parenthesis Superscript theta Baseline less-than-or-equal-to upper C double-vertical-bar f double-vertical-bar Subscript upper H Sub Superscript p Subscript left-parenthesis delta squared right-parenthesis Baseline comma">

|

f

|

=

|

x

|

1
−
θ

|

y

|

θ

 and 

‖
x

‖

X
0

1
−
θ

‖
y

‖

H
2

(

δ
2

)

θ

≤
C
‖
f

‖

H
p

(

δ
2

)

,

|f|=|x|^{1-\theta }|y|^{\theta }\quad \quad \text { and }\quad \quad \|x\|_{X_0}^{1-\theta }\|y\|^{\theta }_{H^2(\delta ^2)}\leq C\|f\|_{H^p(\delta ^2)},

\]
where

X
0

X_0

is Pisier’s extrapolation lattice associated to

H
p

(

δ
2

)

H^p(\delta ^2)

and

H
2

(

δ
2

)

H^2(\delta ^2)

. Our construction of the Pietsch measure for the multiplication operator

M

f

\mathcal {M}_f

involves the Haar coefficients of

f
f

and its atomic decomposition. We treated the one-parameter

H
p

H^p

-spaces in Houston Journal Math. 41 (2015), 639–668.
Specific functional pathologies of Cx43 mutations associated with oculodentodigital dysplasia
Authors: Kelly John J. , Esseltine Jessica L. , Shao Qing , Jabs Ethylin Wang , Sampson Jacinda , Auranen Mari , Bai Donglin , Laird Dale W.
Published: May 2016

Oculodentodigital dysplasia (ODDD) is a rare genetic disease that affects the development of multiple organs in the human body. More than 70 mutations in the gap junction connexin43 (Cx43) gene, GJA1, are associated with ODDD, most of which are inherited in an autosomal dominant manner. Many patients exhibit similar clinical presentations. However, there is high intrafamilial and interfamilial phenotypic variability. To better understand this variability, we established primary human dermal fibroblast cultures from several ODDD patients and unaffected controls. In the present study, we characterized three fibroblast lines expressing heterozygous p.L7V, p.G138R, and p.G143S Cx43 variants. All ODDD fibroblasts exhibited slower growth, reduced migration, and defective cell polarization, traits common to all ODDD fibroblasts studied so far. However, we found striking differences in overall expression levels, with p.L7V down-regulated at the mRNA and protein level. Although all of the Cx43 variants could traffic to the cell surface, there were stark differences in gap junction plaque formation, gap junctional intercellular communication, Cx43 phosphorylation, and hemichannel activity among Cx43 variants, as well as subtle differences in myofibroblast differentiation. Together these findings enabled us to discover mutation-specific pathologies that may help to predict future clinical outcomes.
Three-dimensional simulations of rapidly rotating core-collapse supernovae: finding a neutrino-powered explosion aided by non-axisymmetric flows
Authors: Takiwaki Tomoya , Kotake Kei , Suwa Yudai
Published: May 2016

We report results from a series of three-dimensional (3D) rotational core-collapse simulations for 11.2 and 27  M⊙ stars employing neutrino transport scheme by the isotropic diffusion source approximation. By changing the initial strength of rotation systematically, we find a rotation-assisted explosion for the 27 M⊙ progenitor , which fails in the absence of rotation. The unique feature was not captured in previous two-dimensional (2D) self-consistent rotating models because the growing non-axisymmetric instabilities play a key role. In the rapidly rotating case, strong spiral flows generated by the so-called low T/|W| instability enhance the energy transport from the proto-neutron star (PNS) to the gain region, which makes the shock expansion more energetic. The explosion occurs more strongly in the direction perpendicular to the rotational axis, which is different from previous 2D predictions.
Transcranial Doppler to Predict Neurologic Outcome after Mild to Moderate Traumatic Brain Injury
Authors: Bouzat Pierre , Almeras Luc , Manhes Pauline , Sanders Laurence , Levrat Albrice , David Jean-Stephane , Cinotti Raphael , Chabanne Russel , Gloaguen Aurélie , Bobbia Xavier , Thoret Sophie , Oujamaa Lydia , Bosson Jean-Luc , Payen Jean-François ,   for the TBI-TCD Study Investigators
Published: May 2016

Background

To assess the performance of transcranial Doppler (TCD) in predicting neurologic worsening after mild to moderate traumatic brain injury.

Methods

The authors conducted a prospective observational study across 17 sites. TCD was performed upon admission in 356 patients (Glasgow Coma Score [GCS], 9 to 15) with mild lesions on cerebral computed tomography scan. Normal TCD was defined as a pulsatility index of less than 1.25 and diastolic blood flow velocity higher than 25 cm/s in the two middle cerebral arteries. The primary endpoint was secondary neurologic deterioration on day 7.

Results

Twenty patients (6%) developed secondary neurologic deterioration within the first posttraumatic week. TCD thresholds had 80% sensitivity (95% CI, 56 to 94%) and 79% specificity (95% CI, 74 to 83%) to predict neurologic worsening. The negative predictive values and positive predictive values of TCD were 98% (95% CI, 96 to 100%) and 18% (95% CI, 11to 28%), respectively. In patients with minor traumatic brain injury (GCS, 14 to 15), the sensitivity and specificity of TCD were 91% (95% CI, 59 to 100%) and 80% (95% CI, 75 to 85%), respectively. The area under the receiver operating characteristic curve of a multivariate predictive model including age and GCS was significantly improved with the adjunction of TCD. Patients with abnormal TCD on admission (n = 86 patients) showed a more altered score for the disability rating scale on day 28 compared to those with normal TCD (n = 257 patients).

Conclusions

TCD measurements upon admission may provide additional information about neurologic outcome after mild to moderate traumatic brain injury. This technique could be useful for in-hospital triage in this context. (Anesthesiology 2016; 125:346-54)
The Effect of Vancomycin and Gentamicin Antibiotics on Human Osteoblast Proliferation, Metabolic Function, and Bone Mineralization
Authors: Philp Ashleigh M. , Raja Saroop , Philp Andrew , Newton Ede Matthew P. , Jones Simon W.
Published: May 2016

Study Design.

The present study investigates the effect of vancomycin and gentamicin antibiotics on primary human osteoblasts. Osteoblasts were incubated with vancomycin, gentamicin, or with povidone-iodine (PVI), at concentrations advocated for wound irrigation. Osteoblast proliferation, metabolic function, and bone mineralization were measured.

Objective.

The aim of the study was to model gentamicin and vancomycin wound irrigation in vitro and to examine the effect on osteoblast viability and cellular function in comparison to 0.35% PVI.

Summary of Background Data.

Vancomycin, gentamicin, and dilute PVI are employed as wound irrigants in spinal surgery to reduce infection. We have, however, recently demonstrated that 0.35% PVI has a detrimental effect on osteoblast cellular function and bone mineralization. Studies to determine the effects of antibiotic wound irrigation solutions on osteoblasts and bone mineralization are therefore warranted.

Methods.

Primary human osteoblasts were exposed for 20 minutes to phosphate buffered saline (PBS) control, vancomycin (35 or 3.5 mmol/L), gentamicin (34 or 3.4 mmol/L), or 0.35% PVI for 3 minutes. Cellular proliferation was measured during 7 days by MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assay. Osteoblast metabolic function was determined using a Seahorse XFe24 Bioanalyzer. Mineralized bone nodules were quantified using Alizarin red.

Results.

At concentrations advocated for wound irrigation, both gentamicin (3.4 mmol/L) and vancomycin (3.5 mmol/L) induced a transient 15% to 20% reduction in osteoblast proliferation, which returned to control values within 72 hours. This was in marked contrast to the effect of 0.35% PVI, which resulted in a sustained reduction in osteoblast proliferation of between 40% and 50% during 7 days. Neither gentamicin nor vancomycin at concentrations up to 10× clinical dose had any effect on osteoblast oxygen consumption rate, or significantly affected mineralized bone nodule formation.

Conclusion.

Vancomycin and gentamicin solutions, at concentrations advocated for intrawound application in spinal surgery, have a small but transient effect on osteoblast proliferation, and no effect on either osteoblast metabolic function or bone nodule mineralization.

Level of Evidence: N/A
Low-Grade Malignant Proliferating Tricholemmal Tumor Associated With Occult Ductal Carcinoma In Situ of the Breast
Authors: Lopez Jonathan J. , Chen Beiyun , Ghosh Karthik , Peters Margot S.
Published: May 2016

Malignant proliferating tricholemmal tumor (MPTT) is a rare adnexal neoplasm most commonly located on the scalp. We a 62-year-old woman who presented to her local physician with a palpable but not visible nodule of the left breast, initially diagnosed as squamous cell carcinoma. Histopathological evaluation of the reexcision specimen incidentally revealed ductal carcinoma in situ. On referral to our institution, the skin biopsy specimen was reviewed and interpreted as a low-grade MPTT. This patient and 2 previously reported cases of MPTT involving breast skin highlight presentation of a rare tumor at an unusual site and the potential for misdiagnosis as squamous cell carcinoma. Reexcision provided the unexpected benefit for our patient of early diagnosis of ductal carcinoma in situ not revealed by imaging.
Folliculocentric Herpes: A Clinicopathological Study of 28 Patients
Authors: Crowson A. Neil , Saab Jad , Magro Cynthia M.
Published: May 2016

Background:

The cutaneous manifestations of herpes infection are primarily in the context of active infection and of the post-herpetic zosteriform eruption. The former manifests cytopathic alterations diagnostic of herpes. The latter includes lichen planus–like and granuloma annulare–like eruptions and lymphocytoma cutis.

Methods:

We encountered skin biopsies from 28 patients whose acute or chronic herpetic or post-herpetic zosteriform lesions manifested folliculocentricity. The clinical appearance of the lesions was correlated with the histopathologic and immunohistochemical features of paraffin-embedded skin biopsies to determine the specific viral etiology. A history of underlying medical disease was noted if present.

Results:

There were 16 men and 12 women with a folliculocentric eruption occurring after a known herpetic eruption or manifesting cytopathic changes and/or immunohistochemical findings compatible with herpes virus in lesional skin biopsies. Underlying immune dysregulatory states were present in most cases, namely, malignancy, anticonvulsant or antidepressant therapy, diabetes mellitus, psoriasis, Crohn disease, and other conditions. All biopsies demonstrated dense lymphohistiocytic infiltrates in or around hair follicles with variable necrosis, while active infections also showed cytopathic and/or immunohistochemical evidence of herpetic alterations, most commonly varicella zoster. Other features included interfollicular interface dermatitis, lymphocytic eccrine hidradenitis, neuritis, and folliculocentric vasculitis.

Conclusions:

Cutaneous herpetic eruptions can evoke a predominantly folliculocentric mononuclear cell reaction and vasculitis; there is an association with underlying endogenous and/or iatrogenic immune dysregulation. Most cases are secondary to reactivation of varicella zoster. The histomorphology suggests a role for cell-mediated immunity. Antigenic homology of an endogenous 72-kd heat shock protein in follicles with that of a herpetic heat shock protein, in concert with an intrafollicular proliferative response of γ-δ T lymphocytes, may explain the follicular localization and composition of the infiltrate.
Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers
Authors: Spector William D. , Limcangco Rhona , Owens Pamela L. , Steiner Claudia A.
Published: May 2016

Background:

Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs).

Objective:

To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics.

Research Design and Subjects:

Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the cost distribution using Simultaneous Quantile Regression.

Results:

We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ∼$8200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics. This is an ∼44% addition to the cost of a major surgical stay but less than half of the unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added ∼$12,100, whereas for low-cost stays (25th percentile) HAPUs added ∼$3900.

Conclusions:

This paper suggests that HAPUs add ∼44% to the cost of major surgical hospital stays, but the amount varies depending on the total cost of the visit.
Social Determinants of Health, Cost-related Nonadherence, and Cost-reducing Behaviors Among Adults With Diabetes
Authors: Patel Minal R. , Piette John D. , Resnicow Kenneth , Kowalski-Dobson Theresa , Heisler Michele
Published: May 2016

Background:

Cost-related nonadherence (CRN) is prevalent among individuals with diabetes and can have significant negative health consequences. We examined health-related and non–health-related pressures and the use of cost-reducing strategies among the US adult population with and without diabetes that may impact CRN.

Methods:

Data from the 2013 wave of National Health Interview Survey (n=34,557) were used to identify the independent impact of perceived financial stress, financial insecurity with health care, food insecurity, and cost-reducing strategies on CRN.

Results:

Overall, 11% (n=4158) of adults reported diabetes; 14% with diabetes reported CRN, compared with 7% without diabetes. Greater perceived financial stress [prevalence ratio (PR)=1.07; 95% confidence interval (CI), 1.05–1.09], financial insecurity with health care (PR=1.6; 95% CI, 1.5–1.67), and food insecurity (PR=1.30; 95% CI, 1.2–1.4) were all associated with a greater likelihood of CRN. Asking the doctor for a lower cost medication was associated with a lower likelihood of CRN (PR=0.2; 95% CI, 0.2–0.3), and 27% with CRN reported this. Other cost-reducing behavioral strategies (using alternative therapies, buying prescriptions overseas) were associated with a greater likelihood of CRN.

Conclusions:

Half of the adults with diabetes perceived financial stress, and one fifth reported financial insecurity with health care and food insecurity. Talking to a health care provider about low-cost options may be protective against CRN in some situations. Improving screening and communication to identify CRN and increase transparency of low-cost options patients are pursuing may help safeguard from the health consequences of cutting back on treatment.
Not All Clefts Are Created Equal: Patterns of Hospital-Based Care Use among Children with Cleft Lip and Palate within 4 Years of Initial Surgery
Authors: Ligh Cassandra A. , Fox Justin P. , Swanson Jordan , Yu Jason W. , Taylor Jesse A.
Published: May 2016

Background:

This study compares hospital-based care and associated charges among children with cleft lip, cleft palate, or both, and identifies subgroups generating the greatest cumulative hospital charges.

Methods:

The authors conducted a retrospective cohort study of cleft lip, cleft palate, or cleft lip and palate who underwent initial surgery from 2006 to 2008 in four U.S. states. Primary outcome was hospital-based care—emergency, outpatient, inpatient—within 4 years of surgery. Regression models compared outcomes and classification tree analysis identified patients at risk for being in the highest quartile of cumulative hospital charges.

Results:

The authors identified 4571 children with cleft lip (18.2 percent), cleft palate (39.2 percent), or cleft lip and palate (42.6 percent). Medical comorbidity was frequent across all groups, with feeding difficulty (cleft lip, 2.4 percent; cleft palate, 13.4 percent; cleft lip and palate, 6.0 percent; p < 0.001) and developmental delay (cleft lip, 1.8 percent; cleft palate, 9.4 percent; cleft lip and palate, 3.6 percent; p < 0.001) being most common. Within 30 days of surgery, those with cleft palate were most likely to return to the hospital (p < 0.001). Hospital-based care per 100 children within 4 years was lowest among the cleft lip group, yet comparable among those with cleft palate and cleft lip and palate (p < 0.001). Cumulative 4-year charges, however, were highest among the cleft palate cohort (cleft lip, $56,966; cleft palate, $106,090; cleft lip and palate, $91,263; p < 0.001). Comorbidity, diagnosis (cleft lip versus cleft palate with or without cleft lip), and age at initial surgery were the most important factors associated with the highest quartile of cumulative hospital charges.

Conclusions:

Cleft lip and palate children experience a high rate of hospital-based care early in life, with degree of medical comorbidity being a significant burden. Understanding this relationship and associated needs may help deliver more efficient, patient-centered care.
The Effect of Norepinephrine and Dopamine on Radial Forearm Flap Partial Tissue Oxygen Pressure and Microdialysate Metabolite Measurements: A Randomized Controlled Trial
Authors: Raittinen Lassi , Kääriäinen Minna T. , Lopez Jenny F. , Pukander Juhani , Laranne Jussi
Published: May 2016

Background:

Patients undergoing ablative and reconstructive head and neck surgery with a microvascular flap have multiple factors that potentially decrease postoperative mean arterial pressure, which may endanger flap survival. The safety of vasopressor use has long been a topic of discussion. The authors analyzed the effect of vasopressors on microvascular flap perfusion after head and neck cancer reconstruction.

Methods:

A total of 27 patients were enrolled in a randomized, controlled, clinical trial. A microvascular radial forearm flap was used for reconstruction. Patients were allocated into one of three groups: dopamine, norepinephrine, and control. The intervention groups received the vasoactive drug, aiming to maintain the mean arterial pressure between 80 and 90 mmHg. Normovolemia was maintained according to central venous pressure. Flap perfusion was monitored with continuous tissue partial pressure of oxygen and microdialysate metabolite (lactate-to-pyruvate ratio) measurements.

Results:

No adverse effects were observed, and postoperative recovery was free of complications in all groups. Neither the lactate-to-pyruvate ratio nor continuous tissue partial pressure of oxygen values differed significantly between groups during the first 24 hours of the vasoactive drug infusion period or during the 72-hour follow-up.

Conclusions:

Norepinephrine and dopamine are safe and effective vasopressors for use during the postoperative period following head and neck cancer surgery with microvascular reconstruction. Dopamine should be used with caution, however, because of the risk of side effects.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Percutaneous Aponeurotomy and Lipofilling (PALF) versus Limited Fasciectomy in Patients with Primary Dupuytren’s Contracture: A Prospective, Randomized, Controlled Trial
Authors: Kan Hester J. , Selles Ruud W. , van Nieuwenhoven Christianne A. , Zhou Chao , Khouri Roger K. , Hovius Steven E. R.
Published: May 2016

Background:

As an alternative to needle aponeurotomy release and limited fasciectomy treatment of Dupuytren’s contracture, the authors introduced an extensive percutaneous aponeurotomy and lipofilling (PALF) procedure. In their previous study, the authors reported that contractures significantly improved and most patients returned to normal use of the hand within 2 to 4 weeks. To establish the safety and efficacy of PALF, the authors compared it to the standard limited fasciectomy in a single-blind, multicenter, prospective, randomized, controlled trial.

Methods:

Patients with a primary Dupuytren’s contracture were assigned randomly to the limited fasciectomy group or the PALF group. Patients were measured at baseline and at 2 weeks, 3 weeks, 6 months, and 1 year postoperatively. Primary outcome of the trial was contracture correction and convalescence time. Groups were compared using a mixed models approach.

Results:

Eighty patients were randomized to PALF or limited fasciectomy. In both groups, almost full metacarpophalangeal joint contracture correction was obtained, whereas for the proximal interphalangeal joint, some residual contracture remained. Patients in the PALF group returned significantly earlier to their normal daily activity. At 1 year after surgery, no significant differences in recurrence rate or hand function were present. However, limited fasciectomy seems to have a higher incidence of permanent complications.

Conclusions:

PALF demonstrates a significantly shorter convalescence, similar operative contracture correction, lower incidence of long-term complications, and no significant difference regarding 1-year postoperative results compared with limited fasciectomy. It is therefore a valuable, minimally invasive alternative to limited fasciectomy in the treatment of Dupuytren’s disease.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Dynamics of the Subdomal Graft
Authors: Lee Michelle , Guyuron Bahman
Published: May 2016

Background:

The authors examined the dynamics of the subdomal graft and its frequency of use in primary and secondary rhinoplasty in detail.

Methods:

One hundred consecutive primary and 100 consecutive secondary rhinoplasty patients with at least 1 year of follow-up were reviewed retrospectively. The nose sheet containing a detailed intraoperative recording of all rhinoplasty maneuvers was reviewed to analyze the frequency of subdomal graft use. Intraoperative observations of the effects of the subdomal graft on the nasal tip and the surrounding structures were recorded. Data were tabulated in an Excel file and analyzed.

Results:

The subdomal graft was used in 77 percent of 100 primary rhinoplasty patients and 31 percent of 100 secondary rhinoplasty patients. After placement of the subdomal graft, the intraoperative changes included (1) improved dome symmetry in all three dimensions, (2) precise control of interdomal distance, (3) lateral and cephalic rotation of the lateral crura of the lower lateral cartilages, (4) widening of the nostrils secondary to lateral rotation of the lower lateral cartilages, (5) external valve function improvement, (6) prevention of lateral crura concavity by preventing overtightening of the transdomal suture, and (7) prevention of excessive narrowing of the domal arch.

Conclusions:

The subdomal graft improves domal symmetry, precisely controls the interdomal distance, reorients the domes/lateral crura, widens the nostrils, prevents excessive narrowing of the medial genu angle, and prevents lateral crura concavity from transdomal sutures. The graft should be strongly considered in primary and secondary rhinoplasty patients with (1) pinched tip deformity, (2) excessive narrowing of the interdomal distance, (3) asymmetric domes, (4) caudally positioned lower lateral cartilages, and (5) narrow nostrils with external valve dysfunction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Design for Natural Breast Augmentation: The ICE Principle
Authors: Mallucci Patrick , Branford Olivier Alexandre
Published: May 2016

Background:

The authors’ published studies have helped define breast beauty in outlining key parameters that contribute to breast attractiveness. The “ICE” principle puts design into practice. It is a simplified formula for inframammary fold incision planning as part of the process for determining implant selection and placement to reproduce the 45:55 ratio previously described as fundamental to natural breast appearance. The formula is as follows: implant dimensions (I) − capacity of the breast (C) = excess tissue required (E). The aim of this study was to test the accuracy of the ICE principle for producing consistent natural beautiful results in breast augmentation.

Methods:

A prospective analysis of 50 consecutive women undergoing primary breast augmentation by means of an inframammary fold incision with anatomical or round implants was performed. The ICE principle was applied to all cases to determine implant selection, placement, and incision position. Changes in parameters between preoperative and postoperative digital clinical photographs were analyzed.

Results:

The mean upper pole–to–lower pole ratio changed from 52:48 preoperatively to 45:55 postoperatively (p < 0.0001). Mean nipple angulation was also statistically significantly elevated from 11 degrees to 19 degrees skyward (p ≤ 0.0005). Accuracy of incision placement in the fold was 99.7 percent on the right and 99.6 percent on the left, with a standard error of only 0.2 percent. There was a reduction in variability for all key parameters.

Conclusion:

The authors have shown using the simple ICE principle for surgical planning in breast augmentation that attractive natural breasts may be achieved consistently and with precision.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Takayasu Arteritis in Major Rheumatology Centers in Malaysia
Authors: Khor Chiew Gek , Tan Bee Eng , Kan Sow Lai , Tsang Esther Ee Ling , Lim Ai Lee , Chong Eleen Yun Yin , Rachel Thundyil , Teh Cheng Lay , Loh Yet Lin , Ch'ng Shereen Suyin , d'Souza Beryl Agnes , Mohd Mokhtar Ainon , Ong Swee Gaik , Mohd Isa Liza
Published: May 2016

Objective

There is paucity of data for Takayasu arteritis (TAK) among South Asians. We aimed to evaluate the clinical features, angiographic findings, as well as treatment and outcome of TAK among Malaysian multiethnic groups.

Methods

This is a retrospective review of 40 patients with TAK seen in major rheumatology centres in Malaysia between April 2006 and September 2013.

Results

Majority were female patients (92.5%), with a female-to-male ratio of 12:1. Median duration of disease from diagnosis was 66 months (interquartile range, 33–177 months). Fifteen (37.5%) were Malays, 9 (22.5%) each were Indians and indigenous from East Malaysia and 7 (17.5%) were Chinese. Indian and indigenous from East Malaysia were overrepresented in this disease. The mean (SD) age of symptom onset and diagnosis were 25.5 (8.1) and 27.4 (8.4), respectively. The 3 most common clinical presentations at diagnosis were diminished or absent pulse, which occurred in 80% of the patients, followed by blood pressure discrepancy (60%) and arterial bruit (52.5%). There was no difference in clinical presentation among ethnic groups. The subclavian artery was the commonest vessel involved (72.5%), followed by the carotid artery (65%) and renal artery (47.5%). Eight patients had coronary artery involvement, and 2 patients had pulmonary artery involvement. Type I arterial involvement was the commonest (80.0%), followed by type IV (35%), present in isolation or mixed type. Glucocorticoid was the main medical treatment (90.0%). Nineteen patients (47.5%) underwent revascularization procedures. Five patients died during the follow-up period.

Conclusions

The Malaysian TAK cohort had similarities with and differences from other published TAK cohort. A nationwide TAK registry is needed to determine the prevalence of the disease among different ethnic groups.
Hepatic and Mesenteric Vasculitis as Presenting Manifestation of Mixed Cryoglobulinemia Related to Chronic Hepatitis C Virus Infection in a Female Patient
Authors: Calle Toro Juan S. , Davalos Diana M. , Charry Jose D. , Arrunategi Ana M. , Tobon Gabriel
Published: May 2016

Approximately 80% of patients with hepatitis C virus infection develop chronic liver disease as cirrhosis, and 40% develop autoimmune complications as mixed cryoglobulinemia (MC). Gastrointestinal involvement in MC is rare, and even more so is hepatic involvement. We report a case of an 87-year-old woman with a 10-year history of blood transfusion–acquired hepatitis C virus infection, without treatment. She consulted the emergency department for diffuse abdominal pain, associated with vomiting. After 2 weeks of hospitalization in the intensive care unit, a diagnosis of MC was made; cirrhosis and secondary mesenteric and hepatic vasculitis were confirmed by a diagnostic laparoscopy. Unfortunately the condition of the patient worsened with sepsis and resulted in death in the fourth week from admission. This case highlights the importance of having in mind gastrointestinal tract vasculitis as a medical cause of abdominal pain in patients with chronic hepatitis C virus infection and using data laboratory tests, images, and histopathologic studies to aid with the diagnosis.
Predicting biotic interactions and their variability in a changing environment
Authors: Kadowaki Kohmei , Barbera Claire G. , Godsoe William , Delsuc Frédéric , Mouquet Nicolas
Published: May 2016

Global environmental change is altering the patterns of biodiversity worldwide. Observation and theory suggest that species' distributions and abundances depend on a suite of processes, notably abiotic filtering and biotic interactions, both of which are constrained by species' phylogenetic history. Models predicting species distribution have historically mostly considered abiotic filtering and are only starting to integrate biotic interaction. However, using information on present interactions to forecast the future of biodiversity supposes that biotic interactions will not change when species are confronted with new environments. Using bacterial microcosms, we illustrate how biotic interactions can vary along an environmental gradient and how this variability can depend on the phylogenetic distance between interacting species.