bluuebunny/crossref_metadata_2025 huggingface dataset:
Pectoral Dimorphism Is a Pervasive Feature of Skate Diversity and Offers Insight into their Evolution
Authors: Martinez C M , Kao B H , Sparks J S , Wainwright P C
Published: June 2019

Synopsis

Mature skates (Batoidea: Rajoidei) display a unique form of sexual dimorphism in which males develop a concave anterior pectoral fin, giving them a bell-shaped appearance. Recent work has linked the male-specific transformation to differential skeletal development that is coincident with the rapid elongation of claspers, cartilage-supported intromittent organs. Still, little is known about the prevalence of pectoral dimorphism across skates or of interspecific variation in its expression. Here, we use various morphological approaches to broadly explore pectoral dimorphism in skates, with the goal of understanding its significance in their evolutionary history. We find that pectoral fin sexual dimorphism exists across skate diversity, positively identifying its presence in at least 131 species spanning 33 genera, approximately 40% of valid species. Further, we show that the nature of male–female shape change is largely consistent across species, but that it differs in its magnitude at a biologically meaningful scale. Finally, we use the pygmy skate Fenestraja plutonia as a case study to illustrate ontogenetic patterns in the development of pectoral fin dimorphism, additionally identifying sex-based differences in the pelvic girdle and jaw. Our work suggests that the diversity of pectoral dimorphism in skates is linked to comparative growth and maturation, and potentially to processes underlying reproductive and life history diversification within the group.
Increased pelvic mobility and altered hip muscles contraction patterns: two-year follow-up cam-FAIS corrective surgery
Authors: Catelli Danilo S , Kowalski Erik , Beaulé Paul E , Lamontagne Mario
Published: June 2019

Femoroacetabular impingement syndrome (FAIS) surgery can produce improvements in function and patient satisfaction; however, data on muscle assessment and kinematics of high mobility tasks of post-operative patients is limited. The purpose of this study was to evaluate kinematics and muscle activity during a deep squat task, as well as muscle strength in a 2-year follow-up FAIS corrective surgery. Eleven cam morphology patients underwent motion and electromyography capture while performing a squat task prior and 2-years after osteochondroplasty and were BMI-, age- and sex-matched to 11 healthy control (CTRL) participants. Isometric muscle strength, flexibility and patient-reported outcome measures (PROMs) were also evaluated. Post-operative FAIS was significantly weaker during hip flexion (23%) and hip flexion-with-abduction (25%) movements when compared with CTRL, no improvements in squat depth were observed. However, post-operative FAIS increased the pelvic range of motion during the squat descent (P = 0.016) and ascent (P = 0.047). They had greater peak activity for the semitendinosus and total muscle activity for the gluteus medius, but decreased peak activity for the glutei and rectus femoris during squat descent; greater total muscle activity for the tensor fascia latae was observed during squat ascent (P = 0.005). Although not improving squat depth, post-operative patients increased pelvic ROM and showed positive PROMs. The muscle weakness associated with hip flexion and flexion-with-abduction observed at the follow-up can be associated with the alterations in the muscle activity and neuromuscular patterns. Rehabilitation programs should focus on increasing pelvis and hip muscles flexibility and strength.
Is Prolonged Slow Expiration a Reproducible Airway Clearance Technique?
Authors: Nogueira Márcia C Pires , Ribeiro Simone N S , Silva Élida P , Guimarães Carolina Lopes , Wandalsen Gustavo F , Solé Dirceu , Lanza Fernanda C
Published: June 2019

Background

Prolonged slow expiration (PSE) is a manual chest physical therapy technique routinely performed in clinical practice. However, the reliability and agreement of the technique have not been tested.

Objective

The objective of this study was to assess reliability and agreement between physical therapists during the application of PSE in infants with wheezing.

Design

This was a cross-sectional study.

Methods

Infants with a mean age of 59 weeks (SD = 26 weeks) were included in this study. Two physical therapists (physical therapist 1 and physical therapist 2) randomly performed 3 PSE sequences (A, B, and C). The expiratory reserve volume (ERV) was measured with a pneumotachograph connected to a face mask. ERV was used to evaluate the reproducibility of the technique between sequences and between physical therapist 1 and physical therapist 2.

Results

The mean ERV of the infants was 63 mL (SD = 21 mL). There was no statistically significant difference between the ERV values in the 3 sequences for physical therapist 1 (A: mean = 46.6 mL [SD = 17.8 mL]; B: mean = 45.7 mL [SD = 19.9 mL]; C: mean = 53.3 mL [SD = 26.3 mL]) and physical therapist 2 (A: mean = 43.5 mL [SD = 15.4 mL]; B: mean = 43.2 mL [SD = 18.3 mL]; C: mean = 44.8 mL [SD = 25.0 mL]). There was excellent reliability between the sequences for physical therapist 1 (ICC = 0.88 [95% CI = 0.63–0.95]) and physical therapist 2 (ICC = 0.82 [95% CI = 0.48–0.93]). Moderate agreement was observed between physical therapist 1 and physical therapist 2 (ICC = 0.67 [95% CI = 0.01–0.88]). According to Bland-Altman analysis, the mean difference between physical therapist 1 and physical therapist 2 was 4.1 mL (95% CI = −38.5 to 46.5 mL).

Limitations

The data were collected in infants with wheezing who were not in crisis. This decreased lung mucus; however, it also reduced evaluation risks.

Conclusions

PSE was a reproducible chest physical therapy technique between physical therapists.
Molecular and taxonomic analyses in troglobiotic Alpioniscus (Illyrionethes) species from the Dinaric Karst (Isopoda: Trichoniscidae)
Authors: Bedek Jana , Taiti Stefano , Bilandžija Helena , Ristori Emma , Baratti Mariella
Published: June 2019

Species richness of terrestrial isopods is high in caves of the Dinaric Karst, which hosts ~10% of the world’s nominal oniscidean troglobionts. The most widespread taxon is the southern European genus Alpioniscus, which consists of two subgenera: Alpioniscus s.s. and Illyrionethes. Before this study, 14 nominal troglobiotic Illyrionethes taxa were recorded from the Dinaric Karst. Our molecular analyses using two mitochnodrial DNA (16S rRNA and COI) fragments and a nuclear gene (H3) fragment on all known Dinaric taxa identified three distinct lineages: strasseri-, heroldi- and magnus-lineage. Our results confirmed the validity of most nominal species. The exceptions are Alpioniscus balthasari, which consists of two different species including Alpioniscus iapodicus, and Alpioniscus heroldi, which is paraphyletic with respect to Alpioniscus bosniensis. The strasseri-lineage was highly supported by all phylogenetic methods used; therefore, we performed a detailed morphological analysis to distinguish and characterize the species of this group. New morphological characters, such as body part ratios, are proposed for future species identification. In addition, we redescribe three known species (Alpioniscus strasseri, Alpioniscus christiani and Alpioniscus balthasari) and describe two new ones (Alpioniscus hirci sp. nov. and Alpioniscus velebiticus sp. nov.). As a result, 15 nominal species of Illyrionethes are currently known from the Dinaric Karst.
CE: Original Research: Helping Health Care Providers and Staff Process Grief Through a Hospital-Based Program
Authors: Fallek Ronit , Tattelman Ellen , Browne Terysia , Kaplan Randi , Selwyn Peter A.
Published: June 2019

Background: Grief and loss are significant issues for health care providers, who may witness their patients’ pain and suffering, experience feelings of grief as a result of caring for sick and dying people, and reexperience their own past losses. Unaddressed grief can lead to many issues for providers, their patients, and the health care system as a whole.

Methods: Healing Loss: A Residential Workshop for Montefiore Associates is an experiential and educational program aimed at helping professional caregivers to identify and process grief and loss. Through retrospective analysis of program participation and feedback data, this study investigated the feasibility and effectiveness of offering an intensive bereavement support program to hospital employees in a large academic health system.

Results: Between 2013 and 2017, Montefiore Health System held nine Healing Loss workshops, serving 198 employees from diverse professions. These participants described multiple benefits, including being able to grieve more effectively, accessing support, and learning new tools for healing and self-care. Participants described the workshop experience as unique, cathartic, and life changing.

Conclusions: The sustainability of the Healing Loss initiative during the four years of the study, together with strong feedback from participants, indicates that bereavement support for hospital employees is both feasible and beneficial.
Changes in Sexual Functioning in Women and Men in the 5 Years After Bariatric Surgery
Authors: Steffen Kristine J. , King Wendy C. , White Gretchen E. , Subak Leslee L. , Mitchell James E. , Courcoulas Anita P. , Flum David R. , Strain Gladys , Sarwer David B. , Kolotkin Ronette L. , Pories Walter , Huang Alison J.
Published: June 2019

(Abstracted from JAMA Surg 2019; doi: 10.1001/jamasurg.2018.1162)

Adults with severe obesity who seek bariatric surgery have impairments in several domains of sexual functioning. About half are dissatisfied with their sexual life.
A Cost-Utility Analysis of Nonsurgical Treatments for Stress Urinary Incontinence in Women
Authors: Simpson Andrea N. , Garbens Alaina , Dossa Fahima , Coyte Peter C. , Baxter Nancy N. , McDermott Colleen D.
Published: June 2019

(Abstracted from Female Pelvic Med Reconstr Surg 2019;25(1):49–55)

Stress urinary incontinence (SUI) affects up to 30% of women older than 40 years and has a significant impact on a woman's quality of life. A recent study reported that a woman's lifetime risk of requiring surgery for SUI is 13.6% and increases with age.
Non-invasive Prenatal Sequencing for Multiple Mendelian Monogenic Disorders Using Circulating Cell-free Fetal DNA
Authors: Zhang Jinglan , Li Jianli , Saucier Jennifer B. , Feng Yanming , Jiang Yanjun , Sinson Jefferson , McCombs Anne K. , Schmitt Eric S. , Peacock Sandra , Chen Stella , Dai Hongzheng , Ge Xiaoyan , Wang Guoli , Shaw Chad A. , Mei Hui , Breman Amy , Xia Fan , Yang Yaping , Purgason Anne , Pourpak Alan , Chen Zhao , Wang Xia , Wang Yue , Kulkarni Shashikant , Choy Kwong Wai , Wapner Ronald J. , Van den Veyver Ignatia B. , Beaudet Arthur , Parmar Sheetal , Wong Lee-Jun , Eng Christine M.
Published: June 2019

(Abstracted from Nat Med 2019;25:439–447)

Noninvasive prenatal screening has focused on the detection of chromosomal abnormalities in the fetus. At present, screening for many dominant monogenic disorders associated with de novo mutations is not available, despite their relatively high incidence.
Prepregnancy and Early Pregnancy Calcium Supplementation Among Women at High Risk of Pre-eclampsia: A Multicentre, Double-blind, Randomised, Placebo-Controlled Trial
Authors: Hofmeyr G. Justus , Betrán Ana Pilar , Singata-Madliki Mandisa , Cormick Gabriela , Munjanja Stephen P. , Fawcus Susan , Mose Simpiwe , Hall David , Ciganda Alvaro , Seuc Armando H. , Lawrie Theresa A. , Bergel Eduardo , Roberts James M. , von Dadelszen Peter , Belizán José M.
Published: June 2019

(Abstracted from Lancet 2019;393:330–339)

Hypertension complicates 5% of all pregnancies and 11% of first pregnancies, and half of these cases are associated with preeclampsia (gestational hypertension plus proteinuria). Hypertensive disorders of pregnancy are the direct cause of death of approximately 30,000 women annually, or approximately 14% of maternal deaths, most of which occur in low-income countries.
Association Among County-Level Economic Factors, Clinician Supply, Metropolitan or Rural Location, and Neonatal Abstinence Syndrome
Authors: Patrick Stephen W. , Faherty Laura J. , Dick Andrew W. , Scott Theresa A. , Dudley Judith , Stein Bradley D.
Published: June 2019

(Abstracted from JAMA 2019;321(4):385–393)

Neonatal abstinence syndrome (NAS) has increased over the last 2 decades, likely related to the increase in opioid use in the United States from 1999 to 2014. The increased use of opioid analgesics, heroin, and fentanyl, associated with increased opioid overdose death rates, has severely impacted poor, rural counties, where residents are at risk because they have poor access to health care and other economic and social opportunities.
Minimally Invasive Cervical Pedicle Screw Fixation (MICEPS) via a Posterolateral Approach
Authors: Tokioka Takamitsu , Oda Yoshiaki
Published: June 2019

Cervical pedicle screw (PS) fixation provides great mechanical strength; however, it needs wide soft tissue detachment and has vertebral artery damage risk. Minimally invasive cervical pedicle screw (MICEPS) fixation, a new method for cervical PS fixation through a posterolateral approach, was developed to reduce soft tissue damage and avoid lateral misplacement of screws. Sixty-seven patients with cervical injury underwent MICEPS fixation. They were positioned prone on a radiolucent carbon table with a carbon Mayfield frame. A reference frame was attached to the spinous process through a small skin incision. One or 2 lateral incisions were made for screw insertion under navigation guidance. After the nuchal fascia was cut, the lateral mass was exposed with blunt dissection between the levator scapulae and splenius muscles. A self-retaining tubular retractor with illumination was applied between split muscle fibers. A 1.4-mm K-wire was inserted using an electric driver under navigation guidance. Drill and tap and cannulated PSs were sequentially inserted over the K-wire; facet fusion via bone grafting can be performed at this time. The rod was placed to the screw head. This technique can reduce intraoperative bleeding and screw deviation rate, with neither of the misplaced screws deviating laterally in the MICEPS group.
Forgiveness and Spiritual Distress
Authors: Glenn Chontay Taylor , Pieper Barbara
Published: June 2019

Spirituality, spiritual distress, and forgiveness are constructs relevant to nursing diagnoses and care planning. Forgiveness has significant implications, as it contributes to the spirituality of the individual and has been linked to positive and negative health outcomes. In clinical practice, forgiveness facilitation, grief work facilitation, and spiritual growth facilitation are evidence-based nursing interventions to address Spiritual Distress. Need exists to enhance spiritual distress and forgiveness within nursing curricula, patient assessment, and research designs.
A Theology of Neediness and Evangelism
Authors: Dorman David A.
Published: June 2019

Twentieth century theologian Karl Barth viewed human beings as more needy than any other part of creation. Human neediness leads one into relationship with God or into independence, away from God. Barth understood evangelism as speaking out of one's own deeply felt neediness to another also in need, attesting to what one has come to know of God in his/her own life. His perspective is helpful to nurses wanting to bear witness of God's work in their lives.
Aberrant Superficial Branch of the Radial Nerve–Radial Forearm Free Flap Considerations
Authors: Patel Krupal B. , Naik Akash N. , Kang Stephen Y. , Old Matthew O.
Published: June 2019

The superficial branch of the radial nerve (SBRN) is encountered and must be preserved during the harvest of a radial forearm free flap (RFFF). An abnormal course of the SBRN was encountered during the harvest of an RFFF. The nerve had an abnormal course with two branches—in the proximal forearm, one branch was anterior and the second branch was posterior to the brachioradialis muscle and in the distal forearm, both of these nerves merged together. A review of the literature was performed, with no such documented aberrant course of the SBRN being described previously. Knowledge of the SBRN anatomy and its variations is important to note during the RFFF harvest.
The Role of Fat Grafting in Alleviating Neuropathic Pain: A Critical Review of the Literature
Authors: Alessandri-Bonetti Mario , Egro Francesco M. , Persichetti Paolo , Coleman Sydney R. , Peter Rubin J.
Published: June 2019

Background:

Neuropathic pain is one of the more severe types of chronic pain and presents a great challenge as response to medical therapy remains often unpredictable. With the opioid epidemic and the search for ways to avoid narcotics, physicians are seeking other modalities to treat neuropathic pain. In recent years, surgeons have explored various surgical avenues to improve outcomes. The aim of this review was to evaluate the current clinical evidence regarding the efficacy of fat grafting for the treatment of neuropathic pain.

Methods:

A critical review was conducted to examine the current clinical evidence of fat grafting as a therapy for neuropathic pain caused by neuromas, peripheral neuralgia, migraine and headaches, neuropathic scar pain, and postmastectomy pain syndrome.

Results:

The precise mechanism role of fat grafting in modulating neuropathic pain remains unclear, but it appears to reduce pain levels through the anti-inflammatory effects of adipose-derived stem cells and mechanical cushioning by fat.

Conclusions:

Fat grafting is an emerging therapy for chronic neuropathic pain of various etiologies. Although promising results have been reported, sample size and level of evidence of current studies are low. The encouraging results, however, are worthy of further clinical and scientific study. The minimally invasive nature of fat grafting and favorable risk profile make this an attractive therapy for neuropathic pain.
Prelamellar Dissection Donor Corneal Thickness Is Associated With Descemet Stripping Automated Endothelial Keratoplasty Operative Complications in the Cornea Preservation Time Study
Authors: Ross Kevin W. , Stoeger Christopher G. , Rosenwasser George O. D. , O'Brien Robert C. , Szczotka-Flynn Loretta B. , Ayala Allison R. , Maguire Maureen G. , Benetz Beth Ann , Dahl Patricia , Drury Donna C. , Dunn Steven P. , Farazdaghi Sameera M. , Hoover Caroline K. , Macsai Marian S. , Mian Shahzad I. , Nordlund Michael L. , Penta Jeffrey G. , Soper Mark C. , Terry Mark A. , Verdier David D. , Williams Doyce V. , Lass Jonathan H. ,   on behalf of the Cornea Preservation Time Study Group
Published: June 2019

Purpose:

To identify donor and recipient factors, including eye bank tissue observations, predictive of operative complications in the Cornea Preservation Time Study.

Methods:

One thousand three hundred thirty study eyes undergoing Descemet stripping automated endothelial keratoplasty for Fuchs dystrophy or pseudophakic/aphakic corneal edema were randomized to receive a donor cornea with preservation time (PT) of 0 to 7 days (N = 675) or 8 to 14 days (N = 655). Donor factors included demographics, prelamellar corneal and postlamellar lenticule dissection thickness, central endothelial cell density, and tissue processing time. Recipient factors included demographics, intraocular pressure, and glaucoma medications or surgery (trabeculectomy, laser trabeculoplasty). Eye bank observations included donor tissue folds, pleomorphism/polymegethism, and endothelial cell abnormalities. Possible tissue-related operative complications were recorded including difficult donor lenticule unfolding and positioning. Multivariable logistic regression with backward selection was used to identify statistically significant (P < 0.01) associations between factors and operative complications.

Results:

The only factor predictive of operative complications [58 (4.4%) of 1330 surgeries] was prelamellar dissection donor corneal thickness (P = 0.002). For every 50 μm of donor corneal thickness prior to lamellar dissection, operative complication odds increased by 40% (odds ratio [99% confidence interval (CI)]: 1.40 [1.06–1.83]) adjusting for PT and whether the epithelium was on or off. The estimated mean prelamellar dissection donor corneal thickness for PT 0 to 7 days was 537 μm (99% CI: 516 μm–558 μm) compared with 567 μm (99% CI: 546 μm–588 μm) for PT 8 to 14 days (P < 0.001).

Conclusions:

Thicker donor tissue (prelamellar dissection) is associated with operative complications and should be considered in tissue selection for Descemet stripping automated endothelial keratoplasty lenticule preparation.
Altered brain morphology in chronic pancreatitis patients and its association with pain and other disease characteristics
Authors: Muthulingam Janusiya A. , Hansen Tine M. , Olesen Søren S. , Drewes Asbjørn M. , Frøkjær Jens B.
Published: June 2019

Objective

Abnormal pain processing in the central nervous system is a hallmark of chronic pancreatitis (CP). We characterized brain structure in CP patients and identified disease characteristics that impact the brain structure in CP patients.

Patients and methods

Thirty-three CP patients and 23 matched healthy controls underwent brain MRI. Total and regional gray matter volume (GMV) and cortical thickness analyses were carried out. Multivariate linear regression models were used to determine the independent predictors of total GMV.

Results

CP patients had 31.9 ± 9.3 ml (mean ± SE) (5.1%) reduced total GMV compared with the healthy controls (587.1 ± 5.8 vs. 619.0 ± 7.0 cm3, P < 0.001). Alcoholic etiology was associated independently with a decreased total GMV (P < 0.001), whereas no association was observed for pain or other disease characteristics (all P > 0.05). Similarly, regional GMV loss and cortical thinning were observed for several cortical areas in patients with alcoholic etiology compared with their nonalcoholic counterparts (P < 0.05). These regional differences were particularly evident for pain-related cortical areas; however, no significant differences in regional GMV or cortical thickness were observed between patients with and without pain (all P > 0.05).

Conclusion

Patients with CP have GMV loss that is associated with alcoholic disease etiology. No associations were detected between pain and GMV loss, likely because the potential effect of long-lasting pain on brain structure is masked by the effects of previous alcohol use. The findings imply that alcoholic etiology is the most prominent contributing factor for structural brain alterations in CP patients.
Vaginoscopy Against Standard Treatment (VAST): A Randomised Controlled Trial
Authors: Smith P. P. , Kolhe S. , O'Connor S. , Clark T. J.
Published: June 2019

(Abstracted from BJOG 2019;126:891–899)

Hysteroscopy is one of the most commonly used tests in gynecology. It is used in the diagnosis of abnormal bleeding, reproductive problems, and endometrial cancer.
Pregnancy Outcome After First Trimester Exposure to Ionizing Radiations
Authors: Guilbaud Lucie , Beghin Delphine , Dhombres Ferdinand , Blondiaux Eléonore , Friszer Stéphanie , Le Pointe Hubert Ducou , Éléfant Elisabeth , Jouannic Jean-Marie
Published: June 2019

(Abstracted from Eur J Obstet Gynecol Repr Biol 2019;232:18–21)

Exposure to ionizing radiation during pregnancy induces anxiety for both pregnant patients and their practicing physicians. The effects of radiation exposures can be classified as deterministic and stochastic.
Are Boys Ready for Human Papillomavirus Vaccine? A National Study of Boys in Malaysia
Authors: Wong L.P. , Alias H. , Yusoff R.N.A.R.M. , Sam I.C. , Zimet G.D.
Published: June 2019

Background

The aim of this study was to investigate factors associated with the willingness of boys to accept the human papillomavirus (HPV) vaccine.

Methods

A nationwide cross-sectional survey among Secondary One male students in Malaysia.

Results

Among 2823 respondents, knowledge about HPV infection and the HPV vaccine was extremely poor. The mean total knowledge score was only 3.17 (SD ± 2.14), out of a possible score of 10. The majority of respondents were unaware that vaccinating boys can help protect girls against HPV infection (81.6%), and HPV is a sexually transmitted infection (70.1%). Many had the misconception that only females get HPV (78.9%). In multivariable analysis, the factors associated with the intention to receive the HPV vaccination were: agreeing boys need to be vaccinated against HPV infection (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.57–2.68), perceiving their parents might allow them to get the HPV vaccine (OR, 1.66; 95% CI, 1.18–2.34), perceived susceptibility to HPV infection (OR, 1.63; 95% CI, 1.06–2.52), and attending a rural school (OR, 1.49; 95% CI, 1.14–1.95).

Conclusions

Public health educational programs that are focused and tailored on parents consenting to HPV vaccination for boys at a young age can be useful in improving HPV vaccination rates among boys. There is also a pressing need to educate boys about the benefits of HPV vaccination in males and about HPV disease susceptibility to facilitate adoption of the HPV vaccine by young adults in the future.
Tumor Mutation Burden and Checkpoint Immunotherapy Markers in NUT Midline Carcinoma
Authors: He Mai , Chernock Rebecca , Zhou Shengmei , Gondim Mercia , Dehner Louis P. , Pfeifer John D.
Published: June 2019

NUT midline carcinoma (NMC) is a rare, aggressive poorly differentiated carcinoma genetically defined by NUTM1 gene rearrangement. The purpose of this study was to determine the tumor mutational burden (TMB) and the expression of immunohistochemical (IHC) markers in NMCs that are generally used to identify patients that might benefit from checkpoint immunotherapy. Three cases in a 39-year-old male (case 1) and two 13-year-old females (cases 2, 3) were identified from departmental files, with confirmation by NUT IHC and 15q14 rearrangement by fluorescent in situ hybridization. Normal-tumor paired whole exome sequencing (WES) was applied to determine TMB. IHC for DNA mismatch repair proteins, Programmed cell death ligand 1, programmed cell death 1 (PD1), and CD8 was also performed. WES yielded a TMB of 7.61 and 1.52 per Mbp in the primary and pulmonary metastasis in case 1, respectively, and a TMB of 1.04 per Mbp in the primary tumor of case 2. Programmed cell death ligand 1 tumor proportion score was 20%, 1%, and 0% and combined positive score was 25, 5, and 0 in cases 1, 2, and 3, respectively; PD1 stain counts were 25, 52, and 35 per high-power field and the PD1/CD8 ratio was 95%, 95%, and 99% in cases 1, 2, and 3, respectively. The CD8 count per high-power field was 15, 33, and 30 per high-power field in cases 1, 2, and 3, respectively. Mismatch repair IHCs showed retained staining. Although the number of cases is limited, this study is the first to investigate checkpoint immunotherapy markers in NMCs and the results demonstrate no clear biomarker association. However, the results suggest that, if checkpoint therapy is under consideration, a comprehensive workup utilizing WES and IHC is warranted.
Lower Gastrointestinal Bleeds
Authors: Tejani Cena , Phatak Tej
Published: June 2019

Lower gastrointestinal bleeding in infants and children is a symptom with a broad differential diagnosis. The diagnosis depends on the quantity and quality of the bleeding and on the patient's age. We describe a case of a 10-month-old infant who presented to our pediatric emergency department 4 times with lower gastrointestinal bleeding before a diagnosis of Meckel diverticulum was made. Although this pathology was strongly suspected at an earlier visit, the initial Meckel scan result was interpreted as normal, and the result of a stool test for Clostridium difficile was positive. The case illustrates that repeat scintigraphy might be necessary when significant bleeding is present even if the results of other tests for diagnosis are positive.
Airway Analysis in Apert Syndrome
Authors: Forte Antonio J. , Lu Xiaona , Hashim Peter W. , Steinbacher Derek M. , Alperovich Michael , Persing John A. , Alonso Nivaldo
Published: June 2019

Background:

Apert syndrome is frequently combined with respiratory insufficiency, because of the midfacial deformity which, in turn, is influenced by the malformation of the skull base. Respiratory impairment resulting from Apert syndrome is caused by multilevel limitations in airway space. Therefore, this study evaluated the segmented nasopharyngeal and laryngopharyngeal anatomy to clarify subcranial anatomy in children with Apert syndrome and its relevance to clinical management.

Methods:

Twenty-seven patients (Apert syndrome, n = 10; control, n = 17) were included. All of the computed tomographic scans were obtained from the patients preoperatively, and no patient had confounding disease comorbidity. Computed tomographic scans were analyzed using Surgicase CMF. Craniometric data relating to the midface, airway, and subcranial structures were collected. Statistical significance was determined using t test analysis.

Results:

Although all of the nasal measurements were consistent with those of the controls, the nasion-to–posterior nasal spine, sphenethmoid-to–posterior nasal spine, sella-to–posterior nasal spine, and basion-to–posterior nasal spine distances were decreased 20 (p < 0.001), 23 (p = 0.001), 29 (p < 0.001), and 22 percent (p < 0.001), respectively. The distance between bilateral gonions and condylions was decreased 17 (p = 0.017) and 18 percent (p = 0.004), respectively. The pharyngeal airway volume was reduced by 40 percent (p = 0.01).

Conclusion:

The airway compromise seen in patients with Apert syndrome is attributable more to the pharyngeal region than to the nasal cavity, with a gradually worsening trend from the anterior to the posterior airway, resulting in a significantly reduced volume in the hypopharynx.
Correlations between Tracer Injection Sites and Lymphatic Pathways in the Leg: A Near-Infrared Fluorescence Lymphography Study
Authors: Shinaoka Akira , Koshimune Seijiro , Yamada Kiyoshi , Kumagishi Kanae , Suami Hiroo , Kimata Yoshihiro , Ohtsuka Aiji
Published: June 2019

Background:

The primary aim of this study was to determine the detailed anatomy of the lymphatics in the lower extremity using fresh human cadavers with indocyanine green fluorescence lymphography. The secondary aim was to apply the anatomical results to establish a new protocol for lymphography based on feasible allocations for tracer injection sites.

Methods:

One hundred lower extremities from 53 fresh human cadavers were used for this study. The authors injected indocyanine green solution subcutaneously at 19 points around the foot along the borderline between the dorsum and planta according to anatomical landmarks. Immediately after the indocyanine green injections, gentle hand massage was applied at each injection site to facilitate indocyanine green uptake into the lymphatic vessels. Fluorescent images of the lymphatics were obtained using a near-infrared camera system. Imaging data of the lymphatics were analyzed to find correlations between the injection sites and the identified lymphatic vessels.

Results:

The lymphatic system in the lower extremity was divided into four distinct lymphatic groups: anteromedial, anterolateral, posterolateral, and posteromedial. The lymphatic vessels in all except the posterolateral group connected to the inguinal nodes, and those in the posterolateral group connected to the popliteal nodes. The authors successfully elucidated correlations between the injection sites in the foot and each lymphatic group.

Conclusion:

The new classification of the four lymphatic groups in the lower extremity and identification of their origins in the foot enabled the authors to propose a new protocol for lymphography that includes four injection sites in specific circumflex locations.
A Gap Between Willingness and Uptake: Findings From Mixed Methods Research on HIV Prevention Among Black and Latina Transgender Women
Authors: Poteat Tonia , Wirtz Andrea , Malik Mannat , Cooney Erin , Cannon Christopher , Hardy W. David , Arrington-Sanders Renata , Lujan Maren , Yamanis Thespina
Published: June 2019

Background:

Black and Latina transgender women (BLTW) face significant HIV disparities with estimated HIV prevalence up to 50% and annual incidence rates as high as 2.8 per 100 person-years. However, few studies have evaluated the acceptability and uptake of high-impact HIV prevention interventions among BLTW.

Setting:

Data collection took place in Baltimore, MD and Washington, DC from May 2015 to May 2017.

Methods:

This mixed methods study included quantitative interviewer-administered surveys, key informant interviews, and focus group discussions. Rapid HIV testing followed each survey. Logistic regression models tested associations between legal gender affirmation (ie, desired name and gender marker on identity documents), transgender pride, history of exchange sex, HIV risk perception, and willingness to take pre-exposure prophylaxis (PrEP). Transcripts of qualitative data were coded to identify common themes related to engagement in HIV prevention.

Results:

Among 201 BLTW, 56% tested HIV-positive and 87% had heard of PrEP. Only 18% who had heard of PrEP had ever taken it. Of the 72 self-reported HIV-negative or status-unknown BLTW who had never taken PrEP, 75% were willing to take it. In multivariable analyses, history of exchange sex was associated with willingness to take PrEP, whereas greater HIV knowledge and transgender pride were associated with lower likelihood of willingness to take PrEP. Concern about drug interactions with hormone therapy was the most frequently reported barrier to PrEP uptake.

Conclusions:

Noting the disconnect between PrEP willingness and uptake among BLTW, HIV prevention programs could bridge this gap by responding to identified access barriers and incorporating community-derived strategies.
Bioinspired water collection methods to supplement water supply
Authors: Bhushan Bharat
Published: June 2019

Fresh water sustains human life and is vital for human health. Water scarcity affects more than 40% of the global population and is projected to rise. For some of the poorest countries, 1 in 10 people do not have access to safe and easily accessible water sources. Water consumption by man continues to grow with increasing population. Furthermore, population growth and unsafe industrial practices, as well as climate change, have put strain on ‘clean' water supply in many parts of the world, including the Americas. Current supply of fresh water needs to be supplemented to meet future needs. Living nature provides many lessons for water source. It has evolved species, which can survive in the most arid regions of the world by water collection from fog and condensation in the night. Before the collected water evaporates, species have mechanisms to transport water for storage or consumption. These species possess unique chemistry and structures on or within the body for collection and transport of water. In this paper, an overview of arid desert conditions and water collection from fog, and lessons from living nature for water collection are provided. Data on various bioinspired surfaces for water collection are also presented. Some bioinspired water purification approaches are presented. Next, consumer to military and emergency applications are discussed and water collection projections are presented.

This article is part of the theme issue ‘Bioinspired materials and surfaces for green science and technology (part 2)’.
Bioinspired oil–water separation approaches for oil spill clean-up and water purification
Authors: Bhushan Bharat
Published: June 2019

Water contamination is one of the major environmental and natural resource concerns in the twenty-first century. Oil contamination can occur during operation of machinery, oil exploration and transportation, and due to operating environment. Oil spills occasionally occur during oil exploration and transportation. Water contamination with various chemicals is a major concern with growing population and unsafe industrial practices of waste disposal. Commonly used oil–water separation techniques are either time consuming, energy intensive and/or environmentally unfriendly. Bioinspired superhydrophobic/superoleophobic and superoleophobic/superhydrophilic surfaces have been developed which are sustainable and environmentally friendly. Bioinspired oil–water separation techniques can be used to remove oil contaminants from both immiscible oil–water mixtures and oil–water emulsions. Coated porous surfaces with an affinity to water and repellency to oil and vice versa are commonly used. The former combination of affinity to water and repellency to oil is preferred to avoid oil contamination of the porous substrate. Oil–water emulsions require porous materials with a fine pore size. Recommended porous materials include steel mesh and cotton fabric for immiscible oil–water mixtures and cotton for oil–water emulsions. A review of various approaches is presented in this paper.

This article is part of the theme issue ‘Bioinspired materials and surfaces for green science and technology (part 2)’.
Droplet clusters: nature-inspired biological reactors and aerosols
Authors: Fedorets Alexander A. , Bormashenko Edward , Dombrovsky Leonid A. , Nosonovsky Michael
Published: June 2019

Condensed microdroplets play a prominent role in living nature, participating in various phenomena, from water harvesting by plants and insects to microorganism migration in bioaerosols. Microdroplets may also form regular self-organized patterns, such as the hexagonally ordered breath figures on a solid surface or levitating monolayer droplet clusters over a locally heated water layer. While the breath figures have been studied since the nineteenth century, they have found a recent application in polymer surface micropatterning (e.g. for superhydrophobicity). Droplet clusters were discovered in 2004, and they are the subject of active research. Methods to control and stabilize droplet clusters make them suitable for the
in situ
analysis of bioaerosols. Studying life in bioaerosols is important for understanding microorganism origins and migration; however, direct observation with traditional methods has not been possible. We report preliminary results on direct
in situ
observation of microorganisms in droplet clusters. We also present a newly observed transition between the hexagonally ordered and chain-like states of a droplet cluster.

This article is part of the theme issue ‘Bioinspired materials and surfaces for green science and technology (part 2)’.
Optimization of bioinspired triangular patterns for water condensation and transport
Authors: Song Dong , Bhushan Bharat
Published: June 2019

Water condenses on a surface in ambient environment if the surface temperature is below the dew point. For water collection, droplets should be transported to storage before the condensed water evaporates. In this study, Laplace pressure gradient inspired by conical spines of cactus plants is used to facilitate the transport of water condensed in a triangular pattern to the storage. Droplet condensation, transportation and water collection rate within the bioinspired hydrophilic triangular patterns with various lengths and included angles, surrounded by superhydrophobic regions, were explored. The effect of relative humidity was also explored. This bioinspired technique can be used to develop efficient water collection systems.

This article is part of the theme issue ‘Bioinspired materials and surfaces for green science and technology (part 2)’.
Bioinspired triangular patterns for water collection from fog
Authors: Song Dong , Bhushan Bharat
Published: June 2019

Cacti use spines with conical geometry to transport water to its base. A conical shape with curvature gradient generates a Laplace pressure gradient along the droplet, which is responsible for droplet motion. In this study, the triangular shape was used which also generates a Laplace pressure gradient along the droplet. A bioinspired surface, composed of a hydrophilic triangular pattern surrounded by a rim of superhydrophobic region, was used to transport water collected from the fog on the hydrophilic pattern. The growing droplets start to coalesce into bigger ones. Eventually, they are big enough to touch the superhydrophobic borders, which trigger the transport motion. Droplet mobility and water collection measurements were made on triangular patterns with various geometries to determine the most efficient configurations. Results from this study can be used to enhance the performance of water collection systems from fog.

This article is part of the theme issue ‘Bioinspired materials and surfaces for green science and technology (part 2)’.
Tree frog adhesion biomimetics: opportunities for the development of new, smart adhesives that adhere under wet conditions
Authors: Meng Fandong , Liu Quan , Wang Xin , Tan Di , Xue Longjian , Barnes W. Jon. P.
Published: June 2019

Enlarged adhesive toe pads on the tip of each digit allow tree frogs to climb smooth vertical and overhanging surfaces, and are effective in generating reversible adhesion under both dry and wet conditions. In this review, we discuss the complexities of the structure of tree frog toe pads in relation to their function and review their biomimetic potential. Of particular importance are the (largely) hexagonal epithelial cells surrounded by deep channels that cover the surface of each toe pad and the array of nanopillars on their surface. Fluid secreted by the pads covers the surface of each pad, so the pads adhere by wet adhesion, involving both capillarity and viscosity-dependent forces. The fabrication and testing of toe pad mimics are challenging, but valuable both for testing hypotheses concerning tree frog toe pad function and for developing toe pad mimics. Initial mimics involved the fabrication of hexagonal pillars mimicking the toe pad epithelial structure. More recent ones additionally replicate the nanostructures on their surface. Finally we describe some of the biomimetic applications that have been developed from toe pad mimics, which include both bioinspired adhesives and friction-generating devices.

This article is part of the theme issue ‘Bioinspired materials and surfaces for green science and technology (part 2)’.
Antiphospholipid antibody syndrome with thrombotic splenic infarcts associated with acute cytomegalovirus infection
Authors: Denham Christopher , Tissier Ginger , Golding Amit
Published: June 2019

Introduction. We describe a case of acute cytomegalovirus (CMV) infection complicated by acquired antiphospholipid antibodies and splenic thrombi. We discuss the associations between CMV infection and thrombosis risk and correlation with antiphospolipid antibodies.

Case presentation. A previously healthy 32-year-old woman is hospitalized for acute abdominal pain and fever and found to have multiple splenic infarcts on an abdominal computed tomography (CT) scan. An infectious work-up is negative except for acute CMV, and a hypercoagulable work-up is only positive for antiphospholipid antibodies. The patient is discharged and placed on anti-coagulation therapy for 6 months.

Conclusion. Co-incident thrombosis and antiphospholipid antibody syndrome can occur with acute viral infections, including CMV. We discuss the viral infection-associated increased risk of developing blood clots and antiphospholipid antibodies as being either correlative with or causative of viral-induced thrombosis.
Lineage hierarchies and stochasticity ensure the long-term maintenance of adult neural stem cells
Authors: Than-Trong Emmanuel , Kiani Bahareh , Dray Nicolas , Ortica Sara , Simons Benjamin , Rulands Steffen , Alunni Alessandro , Bally-Cuif Laure
Published: June 2019

The cellular basis and extent of neural stem cell (NSC) self-renewal in adult vertebrates, and their heterogeneity, remain controversial. To explore the functional behavior and dynamics of individual NSCs within brain germinal pools, we combined genetic lineage tracing, quantitative clonal analysis, intravital imaging and global population assessments in the adult zebrafish telencephalon. We show that adult neurogenesis is organized in a hierarchy where a subpopulation of reservoir NSCs with longterm self-renewal potential generate a pool of operational NSCs taking stochastic fates biased towards neuronal differentiation. To fuel the long-term growth of the adult germinal niche, we provide evidence for the existence of an additional, upstream, progenitor population that supports the continuous generation of new reservoir NSCs, contributing to their overall expansion. Hence, the dynamics of vertebrate neurogenesis relies on a hierarchical organization where growth, self-renewal and neurogenic functions are segregated between different NSC types.
Transdiagnostic Phenotyping Reveals a Host of Metacognitive Deficits Implicated in Compulsivity
Authors: Seow Tricia X.F. , Gillan Claire M.
Published: June 2019

Recent work suggests that obsessive-compulsive disorder (OCD) patients have a breakdown in the relationship between explicit beliefs (i.e. confidence about states) and updates to behaviour. The precise computations underlying this disconnection are unclear because case-control and transdiagnostic studies yield conflicting results. Here, a large general population sample (N = 437) completed a predictive inference task previously studied in the context of OCD. We tested if confidence, and its relationship to action and environmental evidence, were specifically associated with self-reported OCD symptoms or common to an array of psychiatric symptoms. We then investigated if a transdiagnostic approach would reveal a stronger and more specific match between metacognitive deficits and clinical phenotypes. Consistent with prior case-control work, we found that decreases in action-confidence coupling were associated with OCD symptoms, but also 5/8 of the other clinical phenotypes tested (8/8 with no correction applied). This non-specific pattern was explained by a single transdiagnostic symptom dimension characterized by compulsivity that was linked to inflated confidence and several deficits in utilizing evidence to update confidence. These data highlight the importance of metacognitive deficits for our understanding of compulsivity and underscore how transdiagnostic methods may prove a more powerful alternative over studies examining single disorders.
Differences in perceived duration between plausible biological and non-biological stimuli
Authors: Giorjiani Giuliana Martinatti , Biazoli Claudinei Eduardo , Caetano Marcelo S.
Published: June 2019

Visual motion stimuli can sometimes distort our perception of time. This effect is dependent on the apparent speed of the moving stimulus, where faster stimuli are usually perceived lasting longer than slower stimuli. Although it has been shown that neural and cognitive processing of biological motion stimuli differ from non-biological motion stimuli, no study has yet investigated whether perceived durations of biological stimuli differ from non-biological stimuli across different speeds. Here, a prospective temporal reproduction task was used to assess that question. Biological motion stimuli consisted in a human silhouette running in place. Non-biological motion stimuli consisted in a rectangle moving in a pendular way. Amount and plausibility of movement for each stimulus and frame-rate (speed) were evaluated by an independent group of participants. Although amount of movement was positively correlated to frame rate, movie clips involving biological motion stimuli were judged to last longer than non-biological motion stimuli only at frame rates in which movement was rated as plausible. These results suggest that plausible representations of biomechanical movement induce additional temporal distortions to those modulated by increases in stimulus speed. Moreover, most studies that have reported neural and cognitive differences in the processing of biological and non-biological motion stimuli acquired neurophysiological data using fMRI. The present study aimed additionally to report differences in the processing of biological and non-biological motion stimuli across different speeds using functional near infrared spectroscopy (fNIRS), a less costly and portable form of neurophysiological data acquisition.