bluuebunny/crossref_metadata_2025 huggingface dataset:
Cartografias ambientais do Rio Grande do Norte
Authors: Junior Raimundo Nonato , Dantas Aldo Aloísio , Gomes Rita de Cássia da Conceição
Published: September 2020

Apresentamos aqui as bases conceituais e metodológicas dos trabalhos que compõe o dossiê "Cartografias ambientais do Rio Grande do Norte". Seu objetivo é contextualizar as grandes questões que embasam as produções do grupo, bem como elucidar o trânsito conceitual entre a cartografia e os escritos crítico-analíticos que compõem o material. No conjunto dos trabalhos, a abordagem ambiental sobre o território potiguar se revela diversa ao articular conceitos e métodos da geografia física e humana, pensada sob o viés do conceito de complexo geográfico.
« Épîtres » altaïennes : histoire et vie des textes du mouvement religieux Ak-jaŋ
Authors: Arzyutov Dmitry
Published: September 2020

Les pratiques communicationnelles sont un aspect important des Nouveaux mouvements religieux. Cet article porte sur des « épîtres », des textes « envoyés d’en haut », et leur circulation dans le mouvement religieux moderne Ak-jaŋ dans la république d’Altaï, ainsi que leur interprétation anthropologique. Les épîtres sont une source pour comprendre la « philosophie » indigène qui est considérée par les participants au mouvement comme un savoir alternatif avec un double arrière-plan, altaïen et russe. L’article décrit la vie sociale des textes, au niveau local et au niveau régional en dialogue avec le pouvoir.
Penser un temps sans croyance ?
Authors: Dupuy Delphine
Published: September 2020

L’hypothèse développée par Albert Piette selon laquelle la capacité à croire, invention de l’homme moderne, aurait été étrangère à l’homme de Neandertal confronte les préhistoriens à la question épineuse des croyances religieuses. Tenter d’imaginer un humain doué d’une conscience comparable à la nôtre vivre sans croire est une expérience enrichissante car elle révèle à quel point la croyance est encrée en nous, même si l’on se pense athée. La croyance est-elle dans notre esprit le propre de l’homme ? Serions-nous incapables de concevoir des humanités non-croyantes ou tout simplement différentes de la nôtre ? Ce travail nous confronte à un questionnement essentiel qui me semble déterminer la posture de tout chercheur en sciences humaines et, plus particulièrement, celle du préhistorien sensé bâtir des représentations de ce qui existait avant notre humanité.
Clinical Asssessment of Sensorineural Hearing Loss among Diabetes Mellitus Patients
Authors: Gadag Raveendra P , Nayak Puneeth S , J Tejaswini
Published: September 2020

Background: Hearing impairment is known to hamper the quality of life among patients, especially among diabetics due to the association of neuropathy with diabetes. However, the prevalence and degree of the SNHL depends upon different factors, such as age, gender, disease duration of DM, family history and glycemic status of the patients. Therefore, this study aimed to assess the association of SNHL with DM duration and familial DM and gender preponderance among SNHL–DM patients.

Methods: Total 140 patients with DM were assessed for hearing impairment using Rinne, Weber and Absolute Bone Conduction Tests along with pure tone audiometry. Patients’ glycaemic status was determined by estimating fasting blood glucose (FBG) and post prandial blood glucose (PPBG) levels. Independent t-test, chi-square, ANOVA and Pearson’s correlation tests along with linear regression model were used to find association and correlation using R software.

Results: Out of 140 patients, 60 were suffering from SNHL and majority were suffering from bilateral minimal hearing loss. SNHL was significantly associated with family history, age, duration of DM, FBG and PPBG levels were(Pvalues:1.79E08, 4.41E-06 and 0.02), however, significant correlated with duration of DM, FBS and PPBG level (r value:0.14–0.41).Furthermore, significant SNHL at 500 and 8000Hz was observed in the present study (Pvalue:0.002).

Conclusion: A conclusive proof was drawn that family history of DM serve as a valuable variable in assessing the SNHL among DM patients.
Hyperkinetic Dysarthria with Spasmodic Torticollis
Authors: Pani Susmi , Kabra Shruti , Chakraborty Shilpi , Chatterjee Indranil
Published: September 2020

Introduction

 

Spasmodic Torticollis is a condition in which tonic or clonic spasm in the Sternocleidomastoid and Trapezius muscles, cause the head to be deviated to the right or left and has also been reported to disrupt speech production. Spasmodic Torticollis is a part of unknown etiology of Hyperkinetic Dysarthria.

Case Report

 

We report a case of 30 years old male diagnosed as Hyperkinetic Dysarthria who was treated with speech therapy and without Botulinum toxin. Post therapy status was recorded after 12 sessions (frequency twice a week) and it shows improvement in speech characteristics.

Discussion

 

Management of the patients with Hyperkinetic Dysarthria with Spasmodic Torticollis is a long term and often a lifelong process. Speech therapy is offered at intervals in order to maintain communicative competence. Reported studies suggest the use of Botulinum toxin, but in the present study treatment efficacy was proven without the use of Botulinum toxin.
Paediatric Type I Cartilage Tympanoplasty with or without Concomitant Adeno-tonsillectomy – An Institutional Experience
Authors: Dutta Santanu , Ghatak Soumya , Saha Somnath
Published: September 2020

Introduction                                                                          

In the management of COM in paediatric age group, eradication of the septic foci in the tonsil and the adenoids while addressing the dysfunction of Eustachian tube play a key role This study aims to assess the success rate of type I tympanoplasty with cartilage graft in mucosal type of chronic otits media in paediatric age group and finally, whether concomitant adeno-tonsillectomy plays any role in outcome of surgery or curing the disease process.                                   

Materials and Methods                                                         

A prospective clinical study was done over a period of one and half years amongst 59 patients, aged between 5 and 12 years, presenting with chronic otitis media with dry central perforation of ear-drum and pure conductive hearing loss. Patients were divided into two groups. Group 1 (n1= 22) underwent type I cartilage tympanoplasty with adenoidectomy/ tonsillectomy/ both in the same sitting and Group 2 (n2= 37) underwent type I cartilage tympanoplasty without any adeno-tonsillectomy.                                                                  

Results                                                                                              Graft uptake was 86.4% in Group 1 at 6 months post-operative follow up while that in Group 2 was found to be 86.5%. The mean hearing gain in two groups were found to be 15.91±6.54 dB and 17.02±8.96 dB respectively. No significant difference was found between graft uptakes and hearing gains in two groups at the end of the study.                                                 

Conclusion                                                                             

Type I cartilage shield tympanoplasty, may be considered as an effective management strategy of paediatric chronic otitis media, mucosal disease. Type I tympanoplasty with concomitant adeno-tosillectomy did not prove to be better than type I tympanoplasty alone in terms of anatomic closure of tympanic perforation and hearing gain.
Analysis of Microbes and their Sensitivity Patterns in Chronic Otitis Media in West Bengal
Authors: Ghosh Sanjoy , Banerjee Swagatam , Saha Puranjay , Sikder Biswajit
Published: September 2020

Introduction

Chronic otitis media (COM) is a commonly encountered condition in India because of socio-economic factors. Empirical antimicrobial therapy is crucial till definitive surgical management can be done. Periodic updating of prevalence and antibiogram of the etiological microorganisms of COM is thus important.This hospital based study aimed to detect the ongoing trend of microbes associated with chronic otitis media in eastern India and determination of antibiotic sensitivity patterns of bacteria.

Materials and Methods

A prospective study was conducted wherein ear swabs were taken from discharging ears of selected patients and sent for culture and antibiotic sensitivity tests.

Results

One hundred and forty two (142) samples were collected from 104 patients. 124 samples revealed monomicrobial involvement while 5 samples did not reveal any pathological organism. Pseudomonas aeruginosa and Staphylococcus aureus were the most common isolates comprising 31.33 % and 30.67 % respectively. Most organisms were susceptible to fluoroquinolones and aminoglycosides along with imipenem, meropenem followed by penicillin group of antibiotics.

Conclusion

The huge burden of chronic otitis media patients in India makes it essential to have an evidence-based protocol for initiation of empirical treatment. Hence, an idea about the microbes commonly responsible for disease and their antibiotic sensitivity patterns is helpful in clinical practice.
Clinico-Microbiological Investigation on Fosfomycin and Tigecycline Resistant Gram-Negative Bacilli Isolated from Urinary Tract Infections: A Potential Resurgence
Authors: Dastborhan Maryam , Varshochi Mojtaba , Hasani Alka , Dehghani Leila , Soltani Elghar , Nouri-Vaskeh Masoud
Published: September 2020

Background: Traditional antibiotics are no longer as effective as before for controlling pathogens associated with urinary tract infections (UTI), which shows the necessity of developing new and more effective antibiotics. Objectives: The current study aimed to evaluate in vitro susceptibility of fosfomycin and tigecycline towards common antibiotic-resistant Gram-negative bacilli isolated from the urinary tract. Besides, clinico-microbiological on fosfomycin and tigecycline resistant Gram-negative bacilli was investigated. Methods: In this descriptive cross-sectional study, 150 resistant Gram-negative bacilli were isolated from urine specimens send for culture, and antibiotic susceptibility assessment to the Division of Microbiology of Sina Hospital affiliated to Tabriz University of Medical Sciences which were collected from April-September 2017 are included. Antibiotic susceptibilities were evaluated according to the Clinical and Laboratory Standards published by the Institute and the criteria of the Food and Drug Administration. Results: Of 150 isolates, 138 (92%) were susceptible, and 2 (1.3%) were resistant to both fosfomycin and tigecycline, as confirmed by disk diffusion and Epsilonmeter tests. The difference was statistically significant (P = 0.001). Conclusions: Based on the results, resistance to the conventional antibiotics prescribed for the treatment of UTI was significantly high. Fosfomycin and tigecycline have an appropriate antimicrobial activity towards Gram-negative-resistant isolates involved in UTIs.
Blossom smart expander technology for tissue expander-based breast reconstruction facilitates shorter duration to full expansion: A pilot study
Authors: Choi Youna K. , Rochlin Danielle H. , Nguyen Dung H.
Published: September 2020

Background This study evaluated the Blossom system, an innovative self-filling, rate-controlled, pressure-responsive saline tissue expander (TE) system. We investigated the feasibility of utilizing this technology to facilitate implant-based and combined flap with implant-based breast reconstruction in comparison to conventional tissue expansion.Methods In this prospective, single-center, single-surgeon pilot study, participants underwent either implant-based breast reconstruction or a combination of autologous flap and implantbased breast reconstruction. Outcome measures included time to full expansion, complications, total expansion volume, and pain scores.Results Fourteen patients (TEs; n=22), were included in this study. The mean time to full expansion was 13.4 days (standard error of the mean [SEM], 1.3 days) in the combination group and 11.7 days (SEM, 1.4 days) in the implant group (P=0.78). The overall major complication rate was 4.5% (n=1). No statistically significant differences were found in the complication rate between the combination group and the implant group. The maximum patient-reported pain scores during the expansion process were low, but were significantly higher in the combination group (mean, 2.00±0.09) than in the implant group (mean, 0.29±0.25; P=0.005).Conclusions The reported average duration for conventional subcutaneous TE expansion is 79.4 days, but this pilot study using the Blossom system achieved an average expansion duration of less than 14 days in both groups. The Blossom system may accommodate single-stage breast reconstruction. The overall complication rate of this study was 4.5%, which is promising compared to the reported complication rates of two-stage breast reconstruction with TEs (20%–45%).
Systematic and experimental investigations of the anti‐colorectal cancer mediated by genistein
Authors: Zhang Lei , Zhang Junzhi , Gong Yizhen , Lv Lv
Published: September 2020

Recent evidences have suggested that genistein, a beneficial isoflavonoid, exerts marked anti‐proliferative action on colorectal cancer (CRC) cells. However, the exact molecular mechanisms behind anti‐CRC effect of genistein have not been elucidated. In current report, a systemic pharmacology analysis was used to disclose the anti‐CRC mechanism of genistein prior to performing experimentative certification. As shown in network pharmacology findings, a total of 189 common targets and 9 hard‐core targets of genistein‐anti‐CRC were collected and identified. And the detailed anti‐CRC functions and pathways mediated by genistein were uncovered. In further certification, human CRC samples resulted in elevated protein and mRNA expressions of myeloid leukemia cell differentiation protein (MCL1), beta amyloid A4 protein (APP), and vascular endothelial growth factor receptor 2 (KDR). In animal experiment, genistein‐treated tumor‐transplanted nude mice exhibited reduced tumor growth, accompanied with dose‐dependent down‐regulations of MCL1, APP, and KDR proteins and mRNAs. Taken together, the integrated bioinformatic and experimental findings uncover the anti‐CRC mechanisms and targets mediated by genistein. Significantly, parts of hard‐core biotargets were experimentally verified before clinical application, including MCL1, APP, and KDR.
Calibration, measurement, and characterization of soil moisture dynamics in a central Amazonian tropical forest
Authors: Negrón‐Juárez Robinson , Ferreira Savio J. F. , Mota Marcelo Crestani , Faybishenko Boris , Monteiro Maria Terezinha F. , Candido Luiz A. , Ribeiro Rubia Pereira , de Oliveira Regison Costa , de Araujo Alessandro C. , Warren Jeffrey M. , Newman Brent D. , Gimenez Bruno O. , Varadharajan Charuleka , Agarwal Deborah , Borma Laura , Tomasella Javier , Higuchi Niro , Chambers Jeffrey Q.
Published: September 2020

Soil moisture plays a key role in hydrological, biogeochemical, and energy budgets of terrestrial ecosystems. Accurate soil moisture measurements in remote ecosystems such as the Amazon are difficult and limited because of logistical constraints. Time domain reflectometry (TDR) sensors are widely used to monitor soil moisture and require calibration to convert the TDR's dielectric permittivity measurement (Ka) to volumetric water content (θv). In this study, our objectives were to develop a field‐based calibration of TDR sensors in an old‐growth upland forest in the central Amazon, to evaluate the performance of the calibration, and then to apply the calibration to determine the dynamics of soil moisture content within a 14.2‐m‐deep vertical soil profile. Depth‐specific TDR calibration using local soils in a controlled laboratory setting yielded a novel Ka–θv third‐degree polynomial calibration. The sensors were later installed to their specific calibration depth in a 14.2‐m pit. The widely used Ka–θv relationship (Topp model) underestimated the site‐specific θv by 22–42%, indicating significant error in the model when applied to these well‐structured, clay‐rich tropical forest soils. The calibrated wet‐ and dry‐season θv data showed a variety of depth and temporal variations highlighting the importance of soil textural differentiation, root uptake depths, as well as event to seasonal precipitation effects. Data such as these are greatly needed for improving our understanding of ecohydrological processes within tropical forests and for improving models of these systems in the face of changing environmental conditions.
Minimising turbine thrust variation in multi-rotor tidal fences
Authors: Stephenson T. F. L. , Vogel C. R.
Published: September 2020

Recent analysis of tidal stream energy devices has focussed on maximising power output. Studies have shown that significant performance enhancement can be achieved through the constructive interference effects that develop between tidal stream turbines by deploying them close together. However, this results in variation in the flow incident on the turbines and hence leads to thrust variation across the turbine fence. This may lead to varying damage rates across the fence with adverse impacts on operation and maintenance costs over the turbine lifetime. This study investigates strategies to reduce thrust variation across fences of tidal turbines using three-dimensional Reynolds-Averaged Navier–Stokes simulations. It is shown that the variation in turbine thrust across a fence of eight turbines can be reduced to within 1% with minimal impact on the fence power. Furthermore, by reducing the rotational speed of inboard turbines, or varying the blade pitch angle of the turbines across the fence, it is possible to reduce overall turbine loads and increase the power to thrust ratio of the turbines.
Parastomal Hernia Following Abdominoperineal Resection
Authors: Bananzadeh Alimohammad , Jaweek Ibrahim , Rezazadehkermani Mohammad , Ghahramani Leila , Bahrami Faranak , Hosseini Seyed Vahid , Izadpanah Ahmad , Tadayon Seyed Mohammad Kazem
Published: September 2020

Parastomal Hernia (PSH) is a common complication of patient who undergone ostomy especially end colostomy. Presence of hernia defect is associated with the risk of strangulation and obstruction so understanding the potential risk factor such as patient’s factor and technical issues is important. This study is evaluating the incidence of PSH hernia in patients who undergone end colostomy due to Abdominoperineal Resection (APR) in a tertiary colorectal surgery referral center and explore the possible risk factors of this complication.

The study was designed as a retrospective cross sectional study on 41 patients who undergone end colostomy due to APR. Three patient lost the follow up and 13 patients died and 25 patients were enrolled in study. Demographic data, history of smoking, steroid administration, Diabetes, obstructive pulmonary disease, transfusion, Neoadjuvant therapy, wound infection and Body mass Index (BMI) were gathered.

The mean age of participants was 58.8 and the mean BMI was 25.04 kg/m2. The incidence of PSH was 40% and 68% of operations were done with Laparoscopy. This study could not find statistically significant risk factor for PSH.

The 40% incidence of PSH is noticeable and specific strategies should be applied to reduce such complications. Larger studies is essential to investigate the possible etiologies of this complication.
The pitfalls of personalization rhetoric in time of health crisis: COVID-19 pandemic and cracks on neoliberal ideologies
Authors: Cardona Beatriz
Published: September 2020

The rise of the COVID-19 pandemic has exposed the incongruity of individualization ideologies that position individuals at the centre of health care, by contributing, making informed decisions and exercising choice regarding their health options and lifestyle considerations. When confronted with a global health threat, government across the world, have understood that the rhetoric of individualization, personal responsibility and personal choice would only led to disastrous national health consequences. In other words, individual choice offers a poor criterion to guide the health and wellbeing of a population. This reality has forced many advanced economies around the world to suspend their pledges to ‘small government’, individual responsibility and individual freedom, opting instead for a more rebalanced approach to economic and health outcomes with an increasing role for institutions and mutualization. For many marginalized communities, individualization ideologies and personalization approaches have never worked. On the contrary, they have exacerbated social and health inequalities by benefiting affluent individuals who possess the educational, cultural and economic resources required to exercise ‘responsibility’, avert risks and adopt health protecting behaviours. The individualization of the management of risk has also further stigmatized the poor by shifting the blame for poor health outcomes from government to individuals. This paper will explore how the COVID-19 pandemic exposes the cracks of neoliberal rhetoric on personalization and opens new opportunities to approach the health of a nation as socially, economically and politically determined requiring ‘upstream’ interventions on key areas of health including housing, employment, education and access to health care.
XVI American Literature: The Twentieth Century
Authors: Gifford James , Foltz Mary , Maruéjouls-Koch Sophie , Kidder Orion Ussner , Peppard Anna F , Parker Lindsay
Published: September 2020

This chapter has eight sections: 1. Poetry; 2. Fiction 1900–1945; 3. Fiction since 1945; 4. Drama; 5. Comics; 6. African American Writing; 7. Native Writing; 8. Latino/a, Asian American, and General Ethnic Writing. Section 1 is by James Gifford; section 2 will resume next year; section 3 is by Mary Foltz; section 4 is by Sophie Maruéjouls-Koch; section 5 is by Orion Ussner Kidder and Anna F. Peppard; section 6 will resume next year; section 7 is by James Gifford and Lindsay Parker; section 8 will resume next year.
Assessing mental health in vulnerable adolescents
Authors: Farley Holly R.
Published: September 2020

A dramatic shift in adolescent risks and behaviors in recent years threatens adolescents' mental well-being more than ever. This article explores vulnerable adolescent populations, describes the importance of nurses in all categories of assessment for adolescent mental health, and identifies assessment strategies and immediate interventions for successful outcomes.
Posterior vertebral column resection with short-segment fusion for the patients with congenital kyphoscoliosis
Authors: Matsumura Akira , Namikawa Takashi , Kato Minori , Hori Yusuke , Iwamae Masayoshi , Hidaka Noriaki , Nakamura Hiroaki
Published: September 2020

The purpose of this study was to assess the surgical outcomes of posterior vertebral column resection (PVCR) with short-segment fusion for pediatric patients with congenital kyphoscoliosis (CKS). The medical records of 12 consecutive pediatric patients with CKS due to hemivertebrae located in thoracolumbar and lumbar area that had undergone PVCR and presented for follow-up at a minimum of 2 years were retrospectively reviewed. The mean follow-up period was 56.2 months, and the mean age at the surgery was 9.2 years. We evaluated radiographic parameters using plain radiographs, and evaluated segmental correction using computed tomography imaging. The mean values of the preoperative Cobb angle (cranial curve, main curve, and caudal curve) were 16.0°, 41.3°, and 25.0°, respectively. The main curve was reduced 5.4° after surgery and was maintained at 6.3° at the time of the most recent follow-up. The overall correction rate of main curve was 86.6%. Spontaneous correction rate in the cranial curve and caudal curve were calculated as 55.9 and 80.8%, respectively. The mean segmental scoliosis in the osteotomized segments and fused segments at preoperative/postoperative/final follow-up (FFU) were 40.8°/7.8°/9.2° and 34.3°/3.9°/5.1°, respectively. The mean segmental kyphosis in the osteotomized segments and fused segments at the preoperative/postoperative/FFU were 36.0°/3.8°/4.0° and 27.5°/−1.3°/0.7°, respectively. Our data indicate that PVCR with short-segment fusion for CKS can provide good correction in the main curve and spontaneous correction in the compensatory curves after a minimum 2-year follow-up. Further investigation over the long term is mandatory for pediatric patients.
Intraepidermal Merkel Cell Carcinoma Mimicking Melanoma in Situ: A Case Report
Authors: Song Yali , Zheng Song , Guo Ying
Published: September 2020

Merkel cell carcinoma (MCC) is an uncommon, but aggressive neoplasm with neuroendocrine differentiation that occurs on sun-damaged skin of the elderly. Because its clinical presentation is usually nonspecific, the diagnosis is often made after histopathologic evaluation. Most cases are intradermal. Epidermal involvement is uncommon, whereas MCC limited to the epidermis is extremely rare. Here, we describe a case of MCC in an 88-year-old man with an extraordinary histopathologic presentation, namely nested intraepidermal proliferation of neoplastic cells highly resembling melanoma in situ.
Age Differences in Return-to-Work Following Injury
Authors: Fan Jonathan K. , Gignac Monique A.M. , Harris M. Anne , Smith Peter M.
Published: September 2020

Objectives:

To examine the overall association between chronological age and return-to-work (RTW), and understand if existing data could be used to better understand the role of age-related dimensions (functional, psychosocial, organizational, life-stage) in explaining these associations.

Methods:

We used survey data from a prospective cohort of injured workers in Victoria, Australia. Path models examined the relationship between chronological age and RTW, and the proportion mediated via age dimensions.

Results:

Older chronological age was associated with non-RTW, although the pattern was not observed consistently across follow-up surveys. A proportion of the overall relationship between chronological age and non-RTW was explained by functional and life-stage age and RTW status at previous time points.

Conclusions:

Findings underscore the importance of moving beyond age measured only in chronological years, towards more complex conceptual and analytical models that recognize age as a multidimensional construct.
SOARING: A Residency Program for Unlicensed Assistive Personnel
Authors: Scott Margo Preston , Bautista Marie Graziela F. , Mann Stefanie , DeVaughn-Bradley Shamaica , McFarland Nathan
Published: September 2020

A complex healthcare environment requires an optimal nursing skill mix at a reasonable cost to sustain safe, quality, and efficient patient care. An innovative, unlicensed assistive personnel residency program was developed to fill open positions with a skillful, confident, and engaged clinical technician workforce. The program resulted in highly skilled and confident clinical technicians, a 4% increase in engagement scores, and a 14% increase in retention rate.
BreastIdea Volume Estimator: A New Tool for Breast Volume Estimation—Presentation and Validation for Women
Authors: Kasielska-Trojan Anna , Mikołajczyk Maksym , Antoszewski Bogusław
Published: September 2020

Breast volume assessment is crucial in a breast surgeon’s clinical practice. The aim of this study was to present and validate a new Web application, BreastIdea Volume Estimator, a module for breast estimation of the already validated BreastIdea application. Forty breasts in 20 women were scanned using a three-dimensional scanner. They were then photographed in nonstandardized conditions, and volume estimations were calculated using BreastIdea Volume Estimator. Accuracy in addition to relative and absolute reliability of BreastIdea Volume Estimator measurements were investigated. In addition, breast volume differences were analyzed. Breast volume estimation using BreastIdea Volume Estimator yielded satisfactory accuracy and presented precision of the level of clinical measures. The mean absolute difference for both observers was 4.33 ± 3.79 cc and 6.78 ± 4.66 cc, which correspond to 1.87 ± 1.89 percent and 2.75 ± 2.05 percent errors of measurement. Similar relations were found for measurements of breast volume differences. BreastIdea Volume Estimator is a clinically oriented, reliable tool for breast volume evaluation. It provides results of appropriate accuracy regardless of chest abnormality and photograph standardization.
The Echogenic Liver
Authors: Wu Markus , Sharma Priya G. , Grajo Joseph R.
Published: September 2020

Ultrasound is the most common modality used to evaluate the liver. An echogenic liver is defined as increased echogenicity of the liver parenchyma compared with the renal cortex. The prevalence of echogenic liver is approximately 13% to 20%. In most clinical settings, increased liver echogenicity is simply attributed to hepatic steatosis. It is important to recognize other hepatic and systemic diseases including cirrhosis, viral hepatitis, glycogen storage disease, and hemochromatosis that may also cause an echogenic liver and to identify the associated findings to distinguish them from hepatic steatosis.
Outpatient Posttraumatic Auricle Reconstruction Under Local Anesthesia
Authors: Barbieri Diego , Familiari Marco , Indelicato Pietro , Bussi Mario
Published: September 2020

We described an outpatient auricle reconstruction in an elderly patient after an accidental facial trauma. The procedure was carried out under local anesthesia given patient's comorbidities and acetylsalicylic acid (ASA) therapy. The patient subsequently underwent to regular follow-up. An excellent healing of the auricle injury was achieved.
Subdural Hematoma Evacuation via Rigid Endoscopy System: A Cadaveric Study
Authors: Yakar Fatih , Egemen Emrah , Dere Umit Akin , Celtikci Emrah , Dogruel Yücel , Sahinoglu Defne , Cuneyit Ibrahim , Bakirarar Batuhan , Adiguzel Esat , Coskun Erdal
Published: September 2020

The utilization of endoscope-assisted surgery is becoming a more common modality for the surgical treatment of subdural collections. Considering the inflexible construction of the rigid endoscope, it's not clear where to perform the optimal craniotomy. Twenty four craniotomies (3 cm diameter) were performed in 8 hemicrania. The craniotomies were placed 1 cm front and behind the coronal suture and to the point where the parietal bone was the most convex. The craniotomies in the anterior (C1) and posterior (C2) of the coronal suture were in the mid pupillary line, while the posterior craniotomy (C3) was just lateral to the midpupillary line. At first, subdural distances measured, and then the distances from the craniotomy to the anterior, posterior, medial, and lateral directions in which endoscope could reach the farthest without the damage to the parenchyma were measured. The subdural distance was significantly deeper in C3 than C1 (P = 0.001); however, there was no difference between C3 and C2 (P = 0.312). The distance that could be reached with C3 was higher than C1 in anterior, posterior, lateral, and medial directions (P ≤0.001, 0.037, <0.001, and <0.001, respectively). The distance that could be reached with C3 was higher than C2 in anterior, posterior, lateral, and medial directions (P < 0.001, 0.02, 0.01 and <0.001, respectively). In subdural hematomas, especially that covers all surface of the hemisphere, the most suitable craniotomy is the posteriorly placed craniotomy to reach the most extended projection in anteroposterior line of the hematoma.
Is There Color or Sex Behind the Mask and Sterile Blue? Examining Sex and Racial Demographics Within Academic Surgery
Authors: Aggarwal Adeeti , Rosen Claire B. , Nehemiah Ariel , Maina Ivy , Kelz Rachel R. , Aarons Cary B. , Roberts Sanford E.
Published: September 2020

Background:

The lack of underrepresented minorities has been a persistent issue within the surgical workforce. Equal sex representation has also been a problem in surgery. Underrepresented minorities females face the unique challenge of being a minority in both race and sex.

Objective:

The objective of this retrospective cross-sectional study is to determine the racial and sex demographics of medical trainees and faculty and determine the degree to which minority women are underrepresented at higher ranks and leadership.

Methods:

Race and sex demographic data for all medical students, surgical residents and faculty was extracted from the AAMC data files. This data was compared to the US population using chi squared tests. Race and sex breakdowns of the different surgical subspecialties was also analyzed using chi squared tests. Demographics of surgical faculty at various ranks are also reported.

Results:

White men made up 37% of all surgical residents. Black men made up only 1.9% of all surgical residents whereas Black women made up 2.6%. The subspecialty with the smallest percentage of Black women was Orthopedic Surgery with 0.6%. The specialty with the highest representation of Black women was Ob/Gyn with 6.2%. There was a decrease in representation of Black women with each increase in professional rank, with 2.8%, 1.6%, and 0.7% for assistant, associate, and full professor, respectively, as compared to Black men, who as a percentage, remained stable at the various ranks with 2.1%, 2.4%, and 2.1% for assistant, associate, and full professor, respectively.

Conclusions:

There is a striking lack of minority women in surgery. This trend is amplified as surgeons progress from student, to resident, to attending, and then to leadership positions.
Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in Thyroiditis
Authors: Dinc Bulent , Gunduz Umut R. , Belen Nurhan H.
Published: September 2020

Background:

Parenchymal fibrosis, which develops in the case of thyroiditis, makes thyroidectomy difficult and increases complication rates. Similar concerns exist within minimally invasive thyroid surgery. This study aimed to evaluate the outcomes of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) procedure in patients with thyroiditis.

Materials and Methods:

The data of 56 patients who underwent TOETVA between February 2018 and March 2020 were analyzed retrospectively. The patients were classified as those who had lymphocytic or Hashimoto thyroiditis (group T) and those who did not (group NT) in the postoperative pathology results. Results were evaluated in terms of intraoperative, postoperative findings, and complications.

Results:

All patients were female individuals with a median age of 43 (21-76). There were 21 (37%) patients in group T and 35 (63%) patients in group NT. Mean operation times were 174.2±37.4 and 201.4±45.6 minutes in groups T and NT (P=0.025), respectively, and were statistically shorter in group T. Blood loss was 37.9±44.5 and 34.6±46.8 mL (P=0.811) in groups T and NT, respectively. Transient recurrent laryngeal nerve palsy occurred in 1 patient (5%) in group T, 1 (3%) in group NT (P=0.712), and transient hypoparathyroidism occurred in 3 patients (14%) in group T and in 7 (20%) in group NT. There was no difference in terms of intraoperative and postoperative complications.

Conclusion:

Although thyroiditis is a condition that complicates thyroidectomy, TOETVA can be applied with similar complication rates in patients with thyroiditis.
Acute Care and Treatment of Migraine
Authors: Konstantinos Spingos , Vikelis Michail , Rapoport Alan
Published: September 2020

Objective:

Migraine is a chronic neurological disease involving the brain and its vasculature, typically characterized by recurrent attacks of moderate or severe throbbing headache, accompanied by sensitivity to light and sound, and associated with nausea, vomiting, and inability to move due to worsening of pain. About 30% of migraineurs have some type of aura, most often visual. Migraine attacks, if untreated or suboptimally treated, usually result in significant disability, requiring bed rest and resulting in poor quality of life. Increased frequency of attacks and overuse of acute care medication are significant risks for chronification, resulting in the transformation of episodic migraine into chronic migraine. We aim to review most acute care treatments for migraine.

Methods:

Current treatment options for migraine attacks were reviewed from the selected literature and combined with our clinical experience.

Results:

Current acute treatment options for migraine attacks include over-the-counter analgesics, at times combined with caffeine, nonsteroidal anti-inflammatory medications, opioids, and migraine-specific medications such as triptans and ergots. In the near future, we will probably have 3 gepants (small-molecule calcitonin gene-related peptide [CGRP] receptor antagonists). The first one was just approved in the United States. A ditan acting as a stimulator of 5-HT1F receptors, was also just approved by the FDA. Stimulation of the trigeminal, vagal, occipital, and even upper arm peripheral nerves through electrical nerve stimulation devices and magnetic stimulation devices are available as alternative, nondrug treatment options. Several devices have already been FDA-allowed for treatment in the United States and/or approved elsewhere, and others will follow soon. Behavioral medicine techniques such as biofeedback training and mindfulness have been available for some time and are often helpful.

Conclusion:

A wide variety of acute care options to treat migraine are available, and others will soon be and will herein be described in further detail. Some medications have been approved by regulatory authorities in countries other than the United States, and some devices have been given a CE Mark in Europe.
Multi-system physiological dysregulation and ageing in a subsistence population
Authors: Kraft Thomas S. , Stieglitz Jonathan , Trumble Benjamin C. , Garcia Angela R. , Kaplan Hillard , Gurven Michael
Published: September 2020

Humans have the longest post-reproductive lifespans and lowest rates of actuarial ageing among primates. Understanding the links between slow actuarial ageing and physiological change is critical for improving the human ‘healthspan’. Physiological dysregulation may be a key feature of ageing in industrialized populations with high burdens of chronic ‘diseases of civilization’, but little is known about age trajectories of physiological condition in subsistence populations with limited access to public health infrastructure. To better characterize human physiological dysregulation, we examined age trajectories of 40 biomarkers spanning the immune (
n
= 13 biomarkers), cardiometabolic (
n
= 14), musculoskeletal (
n
= 6) and other (
n
= 7) systems among Tsimane forager-horticulturalists of the Bolivian Amazon using mixed cross-sectional and longitudinal data (
n
= 22 115 observations). We characterized age-related changes using a multi-system statistical index of physiological dysregulation (Mahalanobis distance;

D
m

) that increases with age in both humans and other primates. Although individual biomarkers showed varied age profiles, we found a robust increase in age-related dysregulation for Tsimane (
β
= 0.17–0.18) that was marginally faster than that reported for an industrialized Western sample (
β
= 0.14–0.16), but slower than that of other non-human primates. We found minimal sex differences in the pace or average level of dysregulation for Tsimane. Our findings highlight some conserved patterns of physiological dysregulation in humans, consistent with the notion that somatic ageing exhibits species-typical patterns, despite cross-cultural variation in environmental exposures, lifestyles and mortality.

This article is part of the theme issue ‘Evolution of the primate ageing process'.
Age-associated epigenetic change in chimpanzees and humans
Authors: Guevara Elaine E. , Lawler Richard R. , Staes Nicky , White Cassandra M. , Sherwood Chet C. , Ely John J. , Hopkins William D. , Bradley Brenda J.
Published: September 2020

Methylation levels have been shown to change with age at sites across the human genome. Change at some of these sites is so consistent across individuals that it can be used as an ‘epigenetic clock’ to predict an individual's chronological age to within a few years. Here, we examined how the pattern of epigenetic ageing in chimpanzees compares with humans. We profiled genome-wide blood methylation levels by microarray for 113 samples from 83 chimpanzees aged 1–58 years (26 chimpanzees were sampled at multiple ages during their lifespan). Many sites (greater than 65 000) showed significant change in methylation with age and around one-third (32%) of these overlap with sites showing significant age-related change in humans. At over 80% of sites showing age-related change in both species, chimpanzees displayed a significantly faster rate of age-related change in methylation than humans. We also built a chimpanzee-specific epigenetic clock that predicted age in our test dataset with a median absolute deviation from known age of only 2.4 years. However, our chimpanzee clock showed little overlap with previously constructed human clocks. Methylation at CpGs comprising our chimpanzee clock showed moderate heritability. Although the use of a human microarray for profiling chimpanzees biases our results towards regions with shared genomic sequence between the species, nevertheless, our results indicate that there is considerable conservation in epigenetic ageing between chimpanzees and humans, but also substantial divergence in both rate and genomic distribution of ageing-associated sites.

This article is part of the theme issue ‘Evolution of the primate ageing process'.
Differential ageing trajectories in motivation, inhibitory control and cognitive flexibility in Barbary macaques (Macaca sylvanus)
Authors: Rathke Eva-Maria , Fischer Julia
Published: September 2020

Across the lifespan, the performance in problem-solving tasks varies strongly, owing to age-related variation in cognitive abilities as well as the motivation to engage in a task. Non-human primates provide an evolutionary perspective on human cognitive and motivational ageing, as they lack an insight into their own limited lifetime, and ageing trajectories are not affected by customs and societal norms. To test age-related variation in inhibitory control, cognitive flexibility and persistence, we presented Barbary macaques (Macaca sylvanus), living at La Forêt des Singes in Rocamadour (France), with three problem-solving tasks. We conducted 297 trials with 143 subjects aged 2–30 years. We found no effect of age on success and latency to succeed in the inhibitory control task. In the cognitive flexibility task, 21 out of 99 monkeys were able to switch their strategy, but there was no evidence for an effect of age. Yet, the persistence in the motivation task as well as the overall likelihood to participate in any of the tasks declined with increasing age. These results suggest that motivation declines earlier than the cognitive abilities assessed in this study, corroborating the notion that non-human primates and humans show similar changes in motivation in old age.

This article is part of the theme issue ‘Evolution of the primate ageing process'.
Diversity reduces extinction risk at global scales
Authors: Weeks Brian C. , Naeem Shahid , Lasky Jesse R. , Tobias Joseph A.
Published: September 2020

Increases in biodiversity often lead to greater, and less variable, levels of ecosystem functioning. However, whether species are therefore less likely to go extinct in more diverse systems is unclear. We use comprehensive estimates of avian taxonomic, phylogenetic and functional diversity to characterize the global relationship between multiple dimensions of diversity and extinction risk in birds. We find that more diverse assemblages have lower mean IUCN threat status despite being composed of species with attributes that make them more vulnerable to extinction, such as large body size or small range size. Our analyses also reveal that this reduction of current threat status associated with greater diversity far outweighs the increased risk associated with the accumulation of extinction-prone species in more diverse assemblages. These results suggest that species conservation targets can best be achieved by maintaining high levels of overall biodiversity in natural ecosystems.
Comparative gene expression in cells competent in or lacking DNA-PKcs kinase activity following etoposide exposure reveal differences in gene expression associated with histone modifications, inflammation, cell cycle regulation, Wnt signaling, and differentiation
Authors: Ali Sk Imran , Najaf-Panah Mohammad J. , Sena Johnny , Schilkey Faye D. , Ashley Amanda K.
Published: September 2020

Maintenance of the genome is essential for cell survival, and impairment of the DNA damage response is associated with multiple pathologies including cancer and neurological abnormalities. DNA-PKcs is a DNA repair protein and a core component of the classical non-homologous end-joining pathway, but it may have roles in modulating gene expression and thus, the overall cellular response to DNA damage. Using cells producing either wild-type (WT) or kinase-inactive (KR) DNA-PKcs, we assessed global alterations in gene expression in the absence or presence of DNA damage. We evaluated differential gene expression in untreated cells and observed differences in genes associated with cellular adhesion, cell cycle regulation, and inflammation-related pathways. Following exposure to etoposide, we compared how KR versus WT cells responded transcriptionally to DNA damage. Downregulation of pathways involved in biosynthesis were observed in both genotypes, but upregulated biological pathways were divergent, again with KR cells manifesting a more robust inflammatory response compared to WT cells. To determine what major transcriptional regulators are controlling the differences in gene expression noted, we used pathway analysis and found that many master regulators of histone modifications, proinflammatory pathways, cell cycle regulation, Wnt/β-catenin signaling, and cellular development and differentiation were impacted by DNA-PKcs status. Overall, our results indicate that DNA-PKcs, in a kinase-dependent fashion, decreases proinflammatory signaling following genotoxic insult. As multiple DNA-PK kinase inhibitors are in clinical trial as cancer therapeutics utilized in combination with DNA damaging agents, understanding the transcriptional response when DNA-PKcs cannot phosphorylate downstream targets will inform the overall patient response to combined treatment.