bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation of direct and social effects of feeding duration in growing pigs using records from automatic feeding stations
Authors: Angarita Belcy K , Han Junjie , Cantet Rodolfo J C , Chewning Sarah K , Wurtz Kaitlin E , Siegford Janice M , Ernst Catherine W , Steibel Juan Pedro
Published: May 2021

Automatic feeding systems in pig production allow for the recording of individual feeding behavior traits, which might be influenced by the social interactions among individuals. This study fitted mixed models to estimate the direct and social effects on visit duration at the feeder of group-housed pigs. The dataset included 74,413 records of each visit duration time (min) event at the automatic feeder from 135 pigs housed in 14 pens. The sequence of visits at the feeder was employed as a proxy for the social interaction between individuals. To estimate animal effects, the direct effect was apportioned to the animal feeding (feeding pig), and the social effect was apportioned to the animal that entered the feeder immediately after the feeding pig left the feeding station (follower). The data were divided into two subsets: “non-immediate replacement” time (NIRT, N = 6,256), where the follower pig occupied the feeder at least 600 s after the feeding pig left the feeder, and “immediate replacement” time (IRT, N = 58,255), where the elapsed time between replacements was less than or equal to 60 s. The marginal posterior distribution of the parameters was obtained by Bayesian method. Using the IRT subset, the posterior mean of the proportion of variance explained by the direct effect (Prpσ^d2) was 18% for all models. The proportion of variance explained by the follower social effect (Prpσ^f2) was 2%, and the residual variance (σ^e2) decreased, suggesting an improved model fit by including the follower effect. Fitting the models with the NIRT subset, the estimate of Prpσ^d2 was 20% but the Prpσ^f2 was almost zero and σ^e2 was identical for all models. For the IRT subset, the predicted best linear unbiased predictor (BLUP) of direct (Direct BLUP) and social (Follower BLUP) random effects on visit duration at the feeder of an animal was calculated. Feeder visit duration time was not correlated with traits, such as weight gain or average feed intake (P > 0.05), whereas for the daily feeder occupation time, the estimated correlation was positive with the Direct BLUP (r^ = 0.51, P < 0.05) and negative with the Follower BLUP (r^= −0.26, P < 0.05). The results suggest that the visit duration of an animal at the single-space feeder was influenced by both direct and social effects when the replacement time between visits was less than 1 min. Finally, animals that spent a longer time per day at the feeder seemed to do so by shortening the meal length of the preceding individual at the feeder.
Clinical health markers in dogs fed raw meat-based or commercial extruded kibble diets
Authors: Hiney Kristina , Sypniewski Lara , Rudra Pratyaydipta , Pezeshki Adel , McFarlane Dianne
Published: May 2021

The interest and demand for healthy and less processed foods for human consumption have been mirrored in the pet industry, with an explosion of alternative diets available. Several nontraditional feeding methodologies including raw meat-based diets (RMBDs) are believed by many dog owners to be superior to traditional extruded commercial dog foods. Despite the strong opinions, limited data are available comparing objective health measures among healthy dogs fed using different methods of diet preparation. Therefore, we compared health markers in client-owned dogs fed an RMBD to markers in dogs fed a high-quality extruded kibble. We hypothesized that healthy adult dogs fed RMBD would show differences in biochemical and hematological parameters and improved clinical health scores (e.g., dental, external ear canal, and integument scores) compared with dogs fed a kibble diet. A cross-sectional observational study was performed comparing hematology, serum biochemistry, urinalysis management history, and clinical health scores in healthy client-owned dogs reported as fed RMBD (n = 28) or kibble (n = 27) for >1 yr. Dental, external ear canal, and integument health scores were assigned by a single veterinary evaluator blinded to feed group, using a scale where 0 was normal and 3 was most severely affected. Spearman correlation coefficient (rs) was calculated to assess the strength and direction of the relationship of biochemical outcomes with age and body condition score (BCS), while analysis of variance was used to determine if biochemical analytes differed by breed or gender. Biochemical data were analyzed using multiple linear regression models, adjusting for the covariates gender, breed, age, and BCS. A composite clinical health score, (CCS) = 9 − (dental score + otitis score + integument score), was compared between feeding groups using Mann–Whitney test. Serum alkaline phosphatase activity (P < 0.001) and globulin concentration (P < 0.001) were lower, while lymphocyte count (P < 0.05) was higher in dogs fed RMBD. No differences were found in urinalysis between diet groups. Dogs fed RMBD showed a slight improvement in CCS compared with kibble-fed dogs (CCS: P = 0.03). Owner management significantly differed with a greater likelihood of management interventions including dietary supplements and sporting activities in the RMBD group. Further work is needed to specifically determine the impact of diet processing and nutrient content on canine health.
Nutrient digestibility of extruded canola meal in ileal-cannulated growing pigs and effects of its feeding on diet nutrient digestibility and growth performance in weaned pigs
Authors: Heyer Charlotte M E , Wang Li F , Beltranena Eduardo , Zijlstra Ruurd T
Published: May 2021

Canola meal (CM) contains less crude protein (CP) and more fiber and anti-nutritional factors such as glucosinolates than soybean meal (SBM) and consequently has a lower nutrient digestibility. Therefore, processing strategies that may increase the feeding value of CM warrant study. In two experiments, the effects of extrusion of Brassica napus CM on apparent (AID) and standardized ileal digestibility (SID) of amino acids (AA), apparent total tract digestibility (ATTD) of gross energy (GE) in growing pigs, and growth performance and diet digestibility in weaned pigs were assessed. Solvent-extracted CM was extruded using a single-screw extruder at three screw speeds: 250 (CM-250), 350 (CM-350), or 450 (CM-450) rpm. In exp. 1, in a double 4 × 4 Latin square, eight ileal-cannulated barrows (initial body weight [BW], 68.1 kg) were fed corn starch-based diets containing 50% CM or extruded CM. The CM sample contained 43.2% CP, 33.2% total dietary fiber (TDF), and 8.9 µmol of total glucosinolates/g on a dry matter (DM) basis. Extrusion increased (P < 0.05) the AID of CP, reduced (P < 0.05) apparent hindgut fermentation of CP, and decreased (P < 0.05) predicted net energy (NE) value of diets. Extrusion increased diet AID and CM SID of most indispensable AA by 3.1 to 5.3%-units. In exp. 2, 200 weaned pigs (initial BW, 8.3 kg) were fed diets containing 20% SBM, CM, or extruded CM starting 2 wk postweaning for 3 wk. The CM sample contained 42.7% CP, 28.3% TDF, and 5.3 µmol total glucosinolates/g DM. Wheat-based diets provided 2.3 Mcal NE/kg and 5.1 g SID Lys/Mcal NE. Dietary inclusion of extruded CM replacing SBM decreased (P < 0.05) diet ATTD of DM, GE and CP, and DE value. Average daily feed intake, average daily gain (ADG), and gain:feed (G:F) of pigs did not differ between extruded CM and SBM diets and were not affected by extrusion, but increasing extruder screw speed linearly increased (P < 0.05) ADG for day 1 to 7 and G:F for the entire trial. In conclusion, extrusion increased diet AID and CM SID of AA but not DE and predicted NE values of CM. However, increasing extruder speed did not further increase the SID of most of the AA of CM in growing pigs. Dietary inclusion of 20% CM or extruded CM did not affect the growth performance in weaned pigs.
Evaluation of graded levels ofBacillus coagulansGBI-30, 6086 on apparent nutrient digestibility, stool quality, and intestinal health indicators in healthy adult dogs
Authors: Acuff Heather L , Aldrich Charles G
Published: May 2021

Bacillus coagulans GBI-30, 6086 is a commercially available spore-forming non-toxigenic microorganism approved for use in dog foods with high resiliency to stresses associated with commercial manufacturing. The objectives of this research were to examine the effect of B. coagulans on stool quality, nutrient digestibility, and intestinal health markers in healthy adult dogs. Extruded diets containing graded levels of B. coagulans applied either to the base ration before extrusion or to the exterior of the kibble as a topical coating after extrusion were randomly assigned to 10 individually housed adult beagle dogs (7 castrated males and 3 spayed females) of similar age (5.75 ± 0.23 yr) and body weight (12.3 ± 1.5 kg). The study was designed as a 5 × 5 replicated Latin square with 16-d adaptation followed by 5-d total fecal collection for each period. Five dietary treatments were formulated to deliver a dose of 0-, 6-, 7-, 8-, and 9-log10 colony-forming units (CFU) per dog per day for the control (CON), extruded B. coagulans (PEX), and low, moderate, and high B. coagulans coating levels (PCL, PCM, and PCH), respectively. Food-grade TiO2 was added to all diets at a level of 0.4% to serve as an indigestible dietary marker for digestibility calculations. Data were analyzed using a mixed model through SAS (version 9.4, SAS Institute, Inc., Cary, NC) with treatment as a fixed effect and room (i.e., replicate), period, and dog(room) as random effects. Apparent total tract digestibility of organic matter, crude protein, crude fat, and gross energy calculated by the marker method were numerically greatest for dogs fed the 9-log10 dose treatment with increases (P < 0.05) observed in gross energy and organic matter digestibility compared with the negative control. No significant differences were observed in food intake, stool quality, fecal pH, fecal ammonia, fecal short-chain fatty acids, or branched-chain fatty acids for the extruded B. coagulans treatment (PEX) or the coated B. coagulans treatments (PCL, PCM, and PCH) compared with CON. These results suggest that B. coagulans has a favorable impact on nutrient digestibility and no apparent adverse effects when added to extruded diets at a daily intake level of up to 9-log10 CFU in healthy adult dogs.
Representation Matters: An Assessment of Diversity in Current Major Textbooks on Burn Care
Authors: Shivega W Gaya , McLawhorn Melissa M , Tejiram Shawn , Travis Taryn E , Shupp Jeffrey W , Johnson Laura S
Published: April 2021

Ethnic and gender disparities in healthcare have been well described. Increasing attention is paid to representative diversity in the images and educational resources used during medical training. Nearly 40% of the population of the United States identifies as a person of color, and patients of color reflect 41% of the total burn population seen in the United States. Additionally, national data on providers suggest about 5% of the Burn Team should be people of color. A better understanding of the diversity represented by burn-related medical literature could affect the management of patients with diverse backgrounds, as well as recruitment of black, indigenous, and people of color (BIPOC) into this field. The goal of this study is to investigate the representation of diverse skin tones in several leading medical textbooks of burn care. All photographs that contained people were evaluated for the number of people present and the depicted role of the person present. Diversity count was assessed in a binary fashion—was the individual represented a BIPOC? About 2579 total individuals were identified. BIPOC was represented in 363 total images (14%). There were 6 providers of color identified out of a total of 161 (3.7%); 30 providers were women (19%), of whom only 1 was a female provider of color. BIPOC patients and providers are underrepresented in the leading textbooks of burn care. Proper representation must be included in modern educational materials to better prepare providers for a diverse population of burn-injured patients and ensure effective and thoughtful care.
Ecology and epidemiology of the striped shrimp, Pandalus montagui Leach, 1814 (Decapoda: Caridea), in the northern Labrador Sea, Davis Strait, and Ungava Bay, Canada
Authors: Baker Krista D , Fifield David A , Mullowney Darrell R J , Skanes Katherine R
Published: May 2021

Despite a fishery with annual landings valued at over $50 million CAD, very little knowledge has been gathered about the ecology of the striped shrimp (Pandalus montagui Leach 1814) in the Canadian northwestern Atlantic. This information is nevertheless considered essential for developing appropriate management actions for the fishery. We used survey data collected from 2005 to 2020 in the northern Labrador Sea, Ungava Bay, and Davis Strait to examine sizes, stages of maturity, size of transition, and evidence of parasites in the striped shrimp. We also investigated potential ecological drivers affecting the presence of parasites and size of transition. We found shrimp were substantially larger than previously observed in nearby habitats. The size of transition did not remain constant throughout the time series, and instead, was a function of the average size of females and the amount of preferred habitat in the previous year. The probabilities of individuals exhibiting black gill or black shell disease, or being infected with a bopyrid parasite were generally related to sex, depth, temperature, salinity, latitude, and shrimp density. The large sizes observed in the study area and the apparent plasticity of the population to environmental changes indicate that this species should be closely monitored in the future in relation to exploitation pressure and climate change.
Perturbation of the peptidoglycan network and utilization of the signal recognition particle-dependent pathway enhances the extracellular production of a truncational mutant of CelA in Escherichia coli
Authors: Kang Tae-Gu , Hong Seok-Hyun , Jeon Gi-Beom , Yang Yung-Hun , Kim Sun-Ki
Published: May 2021

Caldicellulosiruptor bescii is the most thermophilic, cellulolytic bacterium known and has the native ability to utilize unpretreated plant biomass. Cellulase A (CelA) is the most abundant enzyme in the exoproteome of C. bescii and is primarily responsible for its cellulolytic ability. CelA contains a family 9 glycoside hydrolase and a family 48 glycoside hydrolase connected by linker regions and three carbohydrate-binding domains. A truncated version of the enzyme (TM1) containing only the endoglucanase domain is thermostable and actively degrades crystalline cellulose. A catalytically active TM1 was successfully produced via the attachment of the PelB signal peptide (P-TM1), which mediates post-translational secretion via the SecB-dependent translocation pathway. We sought to enhance the extracellular secretion of TM1 using an alternative pathway, the signal recognition particle (SRP)-dependent translocation pathway. The co-translational extracellular secretion of TM1 via the SRP pathway (D-TM1) resulted in a specific activity that was 4.9 times higher than that associated with P-TM1 overexpression. In batch fermentations, the recombinant Escherichia coli overexpressing D-TM1 produced 1.86 ± 0.06 U/ml of TM1 in the culture medium, showing a specific activity of 1.25 ± 0.05 U/mg cell, 2.7- and 3.7-fold higher than the corresponding values of the strain overexpressing P-TM1. We suggest that the TM1 secretion system developed in this study can be applied to enhance the capacity of E. coli as a microbial cell factory for the extracellular secretion of this as well as a variety proteins important for commercial production.
Fall Cankerworm (Lepidoptera: Geometridae), a Native Defoliator of Broadleaved Trees and Shrubs in North America
Authors: Darr Molly N , Coyle David R
Published: May 2021

The fall cankerworm, Alsophila pometaria (Harris), is a species endemic to North America that feeds on broadleaf trees and shrubs. Fall cankerworm is a generalist folivore and larvae feed on a wide range of deciduous trees and smaller woody plants. Common hosts include oak, maple, cherry, ash, apple, beech, and birch. This pest is prone to repeated outbreaks over large areas, can cause extensive defoliation throughout hardwood forest stands, and can be a public nuisance in developed or highly populated areas. Fall cankerworm defoliation can lead to reduced tree health and impact ecosystem function, carbon sequestration, wildlife habitat, and temperature regulation, especially in urban areas. Elevated populations often occur in areas where host trees are stressed or a high density of a preferred host species is present. Fall cankerworm management is often necessary due to their impacts on the local tree canopy and nuisance to the public. Tree banding and the use of the biological insecticide Bacillus thuringiensis (Bt) are the common management tactics used to reduce fall cankerworm populations. Here we review fall cankerworm distribution, life stages, host plants, damage, scouting and sampling procedures, management options, and discuss commonly associated and co-occurring defoliator species.
Development, Survival, and Reproduction ofOrius insidiosus(Hemiptera: Anthocoridae) Reared onFrankliniella invasor(Thysanoptera: Thripidae)
Authors: Carrillo-Arámbula Lucia , Infante Francisco
Published: April 2021

The minute pirate bug Orius insidiosus (Say) is an important predator in mango agroecosystems. It attacks several species of thrips, particularly Frankliniella invasor Sakimura, which is considered a species of economic importance in mango. We investigated the effect of six diets on the development, survival, and reproduction of O. insidiosus: 1) first instars of F. invasor, 2) second instars, 3) adults, 4) pollen, 5) pollen plus thrips larvae, and 6) water. Individuals fed on thrips larvae, with or without pollen, completed their immature development significantly faster. Nymphs of O. insidiosus were able to complete their development feeding on pollen only, while individuals that received water as a diet were unable to reach the adult stage. The highest intrinsic growth rate was obtained when O. insidiosus were fed on pollen plus thrips larvae, and the lowest when individuals were fed on thrips adults. Our studies show that a diet of pollen plus F. invasor larvae is optimal for O. insidiosus development and population growth.
Structural Variants Selected during Yak Domestication Inferred from Long-Read Whole-Genome Sequencing
Authors: Zhang Shangzhe , Liu Wenyu , Liu Xinfeng , Du Xin , Zhang Ke , Zhang Yang , Song Yongwu , Zi Yunnan , Qiu Qiang , Lenstra Johannes A , Liu Jianquan
Published: April 2021

Structural variants (SVs) represent an important genetic resource for both natural and artificial selection. Here we present a chromosome-scale reference genome for domestic yak (Bos grunniens) that has longer contigs and scaffolds (N50 44.72 and 114.39 Mb, respectively) than reported for any other ruminant genome. We further obtained long-read resequencing data for 6 wild and 23 domestic yaks and constructed a genetic SV map of 372,220 SVs that covers the geographic range of the yaks. The majority of the SVs contains repetitive sequences and several are in or near genes. By comparing SVs in domestic and wild yaks, we identified genes that are predominantly related to the nervous system, behavior, immunity, and reproduction and may have been targeted by artificial selection during yak domestication. These findings provide new insights in the domestication of animals living at high altitude and highlight the importance of SVs in animal domestication.
The nuclear periphery is a scaffold for tissue-specific enhancers
Authors: Smith Cheryl L , Poleshko Andrey , Epstein Jonathan A
Published: April 2021

Nuclear architecture influences gene regulation and cell identity by controlling the three-dimensional organization of genes and their distal regulatory sequences, which may be far apart in linear space. The genome is functionally and spatially segregated in the eukaryotic nucleus with transcriptionally active regions in the nuclear interior separated from repressive regions, including those at the nuclear periphery. Here, we describe the identification of a novel type of nuclear peripheral chromatin domain that is enriched for tissue-specific transcriptional enhancers. Like other chromatin at the nuclear periphery, these regions are marked by H3K9me2. But unlike the nuclear peripheral Lamina-Associated Domains (LADs), these novel, enhancer-rich domains have limited Lamin B interaction. We therefore refer to them as H3K9me2-Only Domains (KODs). In mouse embryonic stem cells, KODs are found in Hi-C-defined A compartments and feature relatively accessible chromatin. KODs are characterized by low gene expression and enhancers located in these domains bear the histone marks of an inactive or poised state. These results indicate that KODs organize a subset of inactive, tissue-specific enhancers at the nuclear periphery. We hypothesize that KODs may play a role in facilitating and perhaps constraining the enhancer-promoter interactions underlying spatiotemporal regulation of gene expression programs in differentiation and development.
Analytic Characterization of the Herpes Simplex Virus Type 2 Epidemic in the United States, 1950–2050
Authors: Ayoub Houssein H , Amara Ibtihel , Awad Susanne F , Omori Ryosuke , Chemaitelly Hiam , Abu-Raddad Laith J
Published: April 2021

Background

We analytically characterized the past, present, and future levels and trends of the national herpes simplex virus type 2 (HSV-2) epidemic in the United States.

Methods

A population-level mathematical model was constructed to describe HSV-2 transmission dynamics and was fitted to the data series of the National Health and Nutrition Examination Survey.

Results

Over 1950–2050, antibody prevalence (seroprevalence) increased rapidly from 1960, peaking at 19.9% in 1983 in those aged 15–49 years, before reversing course to decline to 13.2% by 2020 and 8.5% by 2050. Incidence rate peaked in 1971 at 11.9 per 1000 person-years, before declining by 59% by 2020 and 70% by 2050. Annual number of new infections peaked at 1 033 000 in 1978, before declining to 667 000 by 2020 and 600 000 by 2050. Women were disproportionately affected, averaging 75% higher seroprevalence, 95% higher incidence rate, and 71% higher annual number of infections. In 2020, 78% of infections were acquired by those 15–34 years of age.

Conclusions

The epidemic has undergone a major transition over a century, with the greatest impact in those 15–34 years of age. In addition to 47 million prevalent infections in 2020, high incidence will persist over the next 3 decades, adding >600 000 new infections every year.
Transcavernous Resection of an Upper Clival Chondrosarcoma: “Cavernous Sinus as a Route”: 2-Dimensional Operative Video
Authors: Essayed Walid Ibn , Mooney Michael A , Al-Mefty Ossama
Published: May 2021

Complete resection of skull base chondrosarcomas offers the potential for a durable, or even lifelong, cure and is best achieved at the first surgery.
1,2
When a skull base chondrosarcoma is located at the upper clivus and in the interpeduncular cistern and invading laterally toward the petrous apex and cavernous sinus, the traditional approaches, ie, endonasal endoscopic or middle fossa approaches, are not adequate for the exposure and resection. The transcavernous sinus approach has been utilized to remove tumor from the cavernous sinus and as a corridor to the interpeduncular cistern and upper clivus, originally described for the clipping of basilar apex aneurysms.

We present a case of a chondrosarcoma centered in the upper clivus and eroding the right posterior clinoid, analogous to the location of a giant basilar apex aneurysm. Detailed study of the tumor extension, bony invasion, and relationship with neuroanatomy dictated the most effective surgical approach.
3,4

Neuronavigation and intraoperative magnetic resonance imaging (MRI) facilitated the gross total resection of the tumor in the Advanced Multimodality Image-Guided Operating (AMIGO) suite. Achieving a gross total tumor removal of this World Health Organization (WHO) grade I chondrosarcoma, adjuvant irradiation can be withheld
1
and the patient monitored with serial imaging. The patient did well after the surgery. The patient consented for surgery and the use of photography.
Petrosal Approach for Giant Retrochiasmatic Craniopharyngioma: 2-Dimensional Operative Video
Authors: Erkmen Kadir , Aboud Emad , Al-Mefty Ossama
Published: May 2021

Microsurgical resection of craniopharyngiomas poses significant challenges, which are amplified with tumors in the retrochiasmatic location and larger size. Traditional pterional trans-sylvian, subfrontal translamia terminalis, or interhemispheric approaches provide narrow surgical corridors with obstructed visualization of the tumor by the prefixed chiasm and slit optic carotid window.
1–5
The superior extension of the tumor compressing the hypothalamus and third ventricle are likewise inaccessible. Dissection through these approaches requires crossing and manipulation of the already compromised optic apparatus with surgical instruments. Finally, the basilar artery and its perforating branches are often adherent to the posterior aspect of the tumor, and are invisible.

Endonasal endoscopic techniques have been utilized as a surgical approach that accesses the tumor without crossing the optic apparatus; however, these approaches have a significant risk of cerebrospinal fluid leakage and require dissection of the basilar artery and hypothalamus from long distances with lengthy instruments.
6–9
Frequently, the surgeon achieves only partial removal.

The petrosal approach is ideal for tumors in the retrochiasmatic location.
10–13
Advantages include unhindered access to the retrochiasmatic space without crossing the optic nerve and chiasm. The angle of approach allows visualization superiorly to the hypothalamus. Additionally, the approach shortens the distance to the tumor, allowing for delicate bimanual dissection of the tumor, especially at the basilar artery and hypothalamic interfaces.

This video demonstrates three cases of retrochiasmatic craniopharyngioma resection through the petrosal approach, highlighting these advantages to optimize patient outcome. The patients and guardians consented for the surgery, photography, and publication of the patient's image.

Figures from Al-Mefty et al
11
used with permission from the Journal of Neurosurgery Publishing Group.

Additional figures republished from Al-Mefty et al.
12
“The petrosal approach for the resection of retrochiasmatic craniopharyngiomas,” Neurosurgery, 2008, volume 62, issue 5 Suppl 2 (ONS), ONS331-ONS336, by permission of the Congress of Neurological Surgeons.
Surgical Treatment of Bilateral Optic Nerve Sheath Meningioma: 2-Dimensional Operative Video
Authors: Rassi Marcio S , Al-Mefty Ossama
Published: May 2021

Even though intracranial meningiomas commonly invade the optic canals, true optic nerve sheath meningiomas are extremely rare. They are insidious lesions that frequently grow in 4 stages, leading to progressive visual loss.
1–4

Frequently, management includes observation for asymptomatic patients, and fractioned stereotactic radiotherapy with progressive visual loss.
1,3
However, surgery is avoided due to the risk of perioperative visual loss.
2–4

However, many of these cases present in the early stage of tumor growth, where an arachnoidal plane is still present, and vision can be saved by microsurgical tumor resection.
2
Here we present the case of a 33-yr-old female presenting with a 3-wk history of blurred vision. Neuroimaging depicted an enhancing lesion along both optic nerves consistent with bilateral optic nerve sheath meningioma. Neuroophthalmological examination showed inferior cut of visual field bilaterally, more extensive on the left eye. Acuity was 20/20 on both eyes.

Microsurgical resection of the tumor was performed through left supraorbital craniotomy, with the goal of eliminating intracranial extension and stabilizing visual function.
5
The optic canal was unroofed with diamond bit drill under copious irrigation. A remarkable improvement of her visual field was observed with maintenance of acuity at 20/20 on follow-up. As the patient is attempting pregnancy, she is closely monitored without radiation.

Surgery can be offered as a primary treatment of optic nerve sheath meningiomas, especially in early stages, with likely preservation and, in some cases, improvement of visual function.
6

The patient consented to the procedure and the use of image.

Images at 1:46 and 3:48 reprinted from Al-Mefty O, Operative Atlas of Meningiomas. 1998: Raven Press; Philadelphia, PA, with permission from LWW.

Image at 2:57 reprinted from Rassi et al
2
; © Anil Can, 2018, used with permission.

Image at 9:27 in public domain/age.
Interhemispheric Precuneus Retrosplenial Transfalcine Approach for Falcotentorial Meningiomas: Anatomic Study and Clinical Series
Authors: Celtikci Emrah , Nunez Maximiliano , Liu James K , Gardner Paul A , Cohen-Gadol Aaron A , Fernandez-Miranda Juan C
Published: April 2021

BACKGROUND

Falcotentorial meningiomas are surgically challenging. Currently accepted approaches include occipital interhemispheric and supracerebellar infratentorial approaches, which have documented drawbacks.

OBJECTIVE

To propose an alternative approach to the posterior tentorial incisural space, the interhemispheric precuneus retrosplenial transfalcine approach (IPRTA).

METHODS

A total of 6 colored-silicone-injected adult cadaveric heads were dissected. We measured the interval between bridging veins and studied computed tomography venography scans of 20 subjects to confirm the feasibility of the IPRTA. Bony landmarks, the region's bridging veins, and the anterior and posterior borders of the approach were identified. The surgical corridor widths (veins’ interval) and lengths were compared between alternative midline approaches. We also reviewed 4 consecutive clinical cases using this approach.

RESULTS

The IPRTA provides the shortest distance to the anterior and posterior limits of the posterior tentorial incisura. Moreover, it is the only approach that provides direct visualization of the anterior and posterior limits of falcotentorial junction meningiomas. In all specimens and patients, a minimum 30-mm interval between the anterior and posterior parietal veins was found in at least one of the hemispheres. Tumor removal was successful in all 4 patients but resulted in mild paresthesia in the lower extremities of 2 patients and temporary foot drop in 1 patient.

CONCLUSION

The IPRTA offers the shortest and most direct corridor for falcotentorial meningiomas and provides excellent visualization of most of the critical structures in the region. Detailed preoperative evaluation of the deep and superficial venous structures is recommended.
Microsurgical Anatomy of the Endoscopy-Assisted Retrosigmoid Intradural Suprameatal Approach to the Meckel's Cave
Authors: Xu Yuanzhi , Hendricks Benjamin K , Nunez Maximiliano Alberto , Mohyeldin Ahmed , Fernandez-Miranda Juan C , Cohen-Gadol Aaron A
Published: April 2021

BACKGROUND

Understanding the microsurgical anatomical features of the endoscopy-assisted retrosigmoid intradural suprameatal approach (RISA) is critical for surgeons treating petroclival tumors or lesions in the cerebellopontine region that extend into Meckel's cave.

OBJECTIVE

To evaluate increased exposure for Meckel's cave in the RISA and assess the surgical landmarks for this approach.

METHODS

A standard retrosigmoid craniotomy to the cerebellopontine region was performed in 4 cadaveric specimens (8 hemispheres) with microscope-assisted endoscopy. The length and depth of the drilling region from the suprameatal tubercle to the petrous apex were analyzed. After opening Meckel's cave and mobilizing the trigeminal root completely, the landmarks for this approach were investigated.

RESULTS

The endoscopy-assisted RISA facilitates mobilization of the trigeminal root and enhances surgical exposure in the region of Meckel's cave and the petrous apex with increases of 10.1 ± 1.3 mm in depth, 21.4 ± 3.2 mm in length, and 6.4 ± 0.6 mm in height. The posterior and superior semicircular canals, internal auditory canal, superior petrous sinus, and internal carotid artery (petrous segment) served as important landmarks for this approach. One case illustration is presented to describe the application of this approach.

CONCLUSION

The RISA is suitable mainly for lesions in the posterior fossa that extend into Meckel's cave. The endoscopy-assisted reach optimizes accessibility to the petrous apex region, obviates the need for extensive drilling, and decreases the risk of internal carotid artery injury. Better realization and recognition of microsurgical landmarks and parameters of this approach are crucial for successful outcomes.
Stenting in High-Grade Internal Carotid Artery Stenosis: 2-Dimensional Operative Video
Authors: Kaye Joel M , Mejia-Munne Juan C , Grossman Aaron W , Shirani Peyman , Smith Matthew S , Prestigiacomo Charles J
Published: April 2021

Carotid artery stenosis is implicated in up to 40% of all ischemic strokes. Accordingly, symptomatic, high-grade carotid artery stenosis portends an especially high risk of future stroke. Intervention via open or endovascular approaches drastically reduces this risk. Under the appropriate conditions, carotid artery stenting serves as a safe and effective alternative to carotid endarterectomy. We present the case of a 57-yr-old male with symptomatic, high-grade stenosis of his right internal carotid artery, for whom a history of radiation to the head and neck represented a relative contraindication to carotid endarterectomy, and thus endovascular treatment with angioplasty and stenting was performed. Informed consent was obtained prior to the procedure. Intraprocedurally, stent delivery past the area of stenosis proved somewhat challenging. However, by employing several nuanced maneuvers, we utilized our guiding catheter in a nonconventional manner in order to successfully perform the procedure. As the field of neuroendovascular surgery evolves, each case provides us unique lessons, which in turn expands our interventional capabilities and adds to the armamentarium of neuroendovascular techniques. We present this surgical video both as a means to provide a general overview of carotid artery stenting, and to share a lesson learned through the implementation of an interesting technical nuance.
Medial Acoustic Tumors: Special Considerations: 2-Dimensional Operative Video
Authors: Almefty Rami O , Essayed Walid Ibn , Al-Mefty Ossama
Published: April 2021

Medial acoustic tumors are a rare distinct type of vestibular schwannoma having distinguished clinical and radiological features.
1
Originating medially in the cerebellopontine angle without extending into the lateral internal auditory meatus, they are frequently giant in size at presentation in younger patients with a relatively preserved hearing, while they have other neurological deficits from cerebellar or brainstem compression and associated hydrocephalus. Imaging typically shows a cystic tumor with local mass effect and an internal auditory canal filled with cerebrospinal fluid.
1,2
Surgical resection of theses schwannoma is particularly challenging not only due to their size and hypervascularity, but also given their particular arachnoidal rearrangement inducing marked adherence to the brainstem and facial nerve.
2

 The treatment is surgical resection, despite, however, their giant size hearing preservation should be sought and is attainable.
1–5
Transmastoid approach with squeletonization and reflection of the transverse sigmoid sinus provides lateral exposure avoiding cerebellar retraction.
6
In this report, we demonstrate the specific surgical considerations applied to the resection of a giant medial acoustic tumor in a 40-yr-old patient presenting with ataxia, vertigo, facial paresthesia, and intact hearing. The patient agreed to the surgery and photography.

 Image at 1:44 © Ossama Al-Mefty, used with permission; Image at 8:21 from Dunn et al,
2
used with permission from JNSPG.
Radical Resection of a Giant Epidermoid Tumor Associated With Miniature Chordoma Utilizing a Combined Endoscopic-Microscopic Technique: 2-Dimensional Operative Video
Authors: Tavanaiepour Daryoush , Abolfotoh Mohammad , Essayed Walid Ibn , Al-Mefty Ossama
Published: April 2021

Epidermoid tumors arise from misplaced squamous epithelium and enlarge through the accumulation of desquamated cell debris.
1
Notwithstanding the prevailing conservative attitudes to minimize morbidity, optimal treatment consists of total removal of the capsule
2,3
; therefore, giant and multicompartmental tumors are particularly challenging. The utilization of simultaneous endoscopic microscopic techniques by tandem endoscopic and microscopic dissection to overcome the shortcomings of both modalities, markedly enhances the ability of radical removal,
4
thus eliminating or at least long-delaying inevitable recurrences with subsequent accumulated morbidity. The transmastoid approach by skeletonizing and reflexing the transverse-sigmoid sinus offers wide exposure of the cerebellopontine angle avoiding cerebellar retraction and allowing 4-hands dissection.
5
The patient is a 17-yr-old male with a giant epidermoid tumor in the cerebellopontine angle, extending through the incisura. The patient underwent surgical resection with maximum pursuit of the epithelial capsule. After removing the epidermoid tumor, a miniature intra and extradural midclival tumor was encountered and removed with a proven pathology of chordoma. Patient did well postoperatively with relief of his hemifacial spasms. Patient consented for surgery and photograph publication.

Image at 1:23, ©1997, O. Al-Mefty, used with permission. All rights reserved.
Decentralizing diabetes care from tertiary to primary care: how many persons with diabetes can be down-referred to primary care settings?
Authors: Olickal Jeby Jose , Suryanarayana B S , Chinnakali Palanivel , Saya Ganesh Kumar , Ganapathy Kalaiselvan , Vivekanandhan T , Subramanian Sadhana , Subrahmanyam D K S
Published: April 2021

Background

In a cohort of persons with diabetes (PWDs) seeking care at a tertiary care center, we aimed to determine the proportion of PWDs eligible and willing for down referral to primary health centers (PHCs).

Methods

We conducted a cross-sectional analytical study among PWDs on treatment for at least 1 year. PWDs with stable blood sugar, no history of cardiovascular events and proliferative retinopathy were considered as ‘eligible’ for primary care management.

Results

Of the total 1002 PWDs, mean (SD) age was 56 (12) years; 62% were male and 81% were from rural areas. About half (49%) of them were on insulin, and 52% had comorbidities. In total, 45.6% (95% CI: 42.3–48.8%) were eligible to be managed at PHCs. Among those who were eligible, 46.6% were willing to go back to PHCs. Males (APR = 1.16), people with diabetes for more than 10 years (APR = 1.23), and the presence of comorbidities (APR = 1.13) were significantly associated with unwillingness. Quality of medicines (46%) and poor facilities (40%) at PHCs were the main reasons for unwillingness.

Conclusions

About half of the PWDs availing care at tertiary hospitals can be managed at primary care settings; of those, only half were willing to receive care at PHCs.
The value priorities of consumer innovators
Authors: Søndergaard Helle Alsted , Thøgersen John
Published: May 2021

Contributing to the understanding of drivers for innovation, we report the first study of the value base of consumer innovation. Based on a survey with representative samples across ten European countries (N ≈ 10,000), about 5 per cent of participants are engaged in innovation activities in their leisure time, which is in line with earlier, single-country studies. The study confirms that consumer innovation is significantly related to personal value priorities and as expected, consumer innovators give higher priority to openness-to-change values than non-innovators. More surprisingly, consumer innovators are less motivated by hedonistic goals (fun and enjoyment) and more by concern for other people and society (i.e. self-transcendence values) than non-innovators. This adds an important dimension to existing knowledge and understanding of what motivates consumer innovation, helps differentiate consumer innovators from other consumers, and offers important input to the development of policies for facilitating or supporting consumer innovation.
041 Alteration of Threat-Related Information Processing During Extended Sleep Deprivation
Authors: Alger Sara , Hughes John , Balkin Thomas , Doty Tracy Jill
Published: May 2021

Introduction

Threat-related information is preferentially processed, facilitating quick and efficient responses. However, the impact of extended sleep deprivation on perception of and response to threatening information is not well known. Sleep loss may increase amygdalar activity and negative mood, potentially facilitating threat processing. However, it also reduces cognitive function, possibly impairing ability to respond. The present study assessed the extent to which extended sleep deprivation modulates threat processing using a threat expectation paradigm.

Methods

Twenty-one participants underwent one baseline night of sleep followed by 62hrs total sleep deprivation (TSD) and one recovery night of sleep (12hrs). Threat expectation task performance was assessed at baseline, at multiple time points during TSD, and following recovery sleep. To control for circadian influence, performance at three 1100 sessions (baseline, 52hrs into TSD, and recovery) were compared. The threat expectation task involved determining whether a presented face was fearful (i.e., signaled threat) or neutral. Faces were presented at three expectation levels: 80%, 50%, and 20% chance of viewing a fearful face.

Results

Overall, responses were faster (F=9.77, p=0.001) and more accurate (F=11.48, p=0.001) when the type of face (fearful or neutral) was expected. Accuracy significantly decreased over TSD (t=7.71, p<0.001) and recovered following subsequent sleep. Fear bias was calculated for accuracy (accuracy for fearful face minus neutral face). Under conditions of high expectation (80%) of viewing a fearful face, fear bias increased across TSD (t=-1.95, p=0.07). Although accuracy to both fearful and neutral faces significantly declined across TSD (both p<0.001), decline for neutral faces was greater, thus increasing fear bias. Importantly, the increased bias toward fear was still evident compared to baseline following a 12-hour recovery sleep opportunity, (t=-1.93, p=0.07).

Conclusion

Extended sleep deprivation, common in operational environments where there is also high expectation of encountering threat, impairs cognitive control and is thought to enhance amygdala activity. These data show that, consequently, cognitive resources become biased toward biologically adaptive behaviors (i.e., threat processing) at the expense of attending and responding more broadly to all stimuli. This behavior is not reversed with a single extended sleep opportunity.

Support (if any)

Department of Defense Military Operational Medicine Research Program (MOMRP)
043 Sleep Restriction Affects Memory in Healthy Adults: Preliminary Findings
Authors: Zimmerman Molly , Hale Christiane , Brickman Adam , Yeung Lok-Kin , Cochran Justin , St-Onge Marie-Pierre
Published: May 2021

Introduction

Sleep loss has a range of detrimental effects on cognitive ability. However, few studies have examined the impact of sleep restriction on neuropsychological function using an experimental design. The goal of this study was to examine the extent to which maintained insufficient sleep affects cognition in healthy adults compared to habitual adequate sleep.

Methods

This study used a randomized, crossover, outpatient sleep restriction design. Adults who regularly slept at least 7 h/night, verified by 2 weeks of screening with actigraphy, completed 2 phases of 6 weeks each: habitual sleep (>7 h of sleep/night) or sleep restriction (habitual sleep minus 1.5 h) separated by a 6-week washout period. During the sleep restriction phase, participants were asked to delay their bedtime by 1.5 hours/night while maintaining their habitual wake time. Neuropsychological function was evaluated with the NIH Toolbox Cognition Battery at baseline (week 0) and endpoint (week 6) of each intervention phase. The NIH Toolbox evaluates a range of cognitive abilities, including attention, executive functioning, and working memory. General linear models with post hoc paired t-tests were used to assess demographically-adjusted test scores prior to and following each sleep condition.

Results

At the time of analyses, 16 participants were enrolled (age 34.5□14.5 years, 9 women), 10 of whom had completed study procedures. An interaction between sleep condition and testing session revealed that individuals performed worse on List Sorting, a working memory test, after sleep restriction but improved slightly after habitual sleep (p<0.001). While not statistically reliable, the pattern of test results was similar on the other tests of processing speed, executive function, and attention.

Conclusion

In these preliminary results from this randomized experimental study, we demonstrated that sleep restriction has a negative impact while stable habitual adequate sleep has a positive impact on working memory, or the ability to temporarily hold information in mind while executing task demands. This finding contributes to our understanding of the complex interplay between different aspects of sleep quality (i.e., both sleep restriction as well as the maintenance of stable sleep patterns) on cognition and underscores the importance of routine sleep screening as part of medical evaluations.

Support (if any):