bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term outcome of knee hyperextension in children with cerebral palsy
Authors: Abousamra Oussama , Connor Justin , Church Chris , Taylor Daveda , Lennon Nancy , Del Pilar Duque Orozco Maria , Henley John , Sees Julieanne , Miller Freeman
Published: January 2019

This study evaluated knee hyperextension course in children with cerebral palsy over a 5-year follow-up. Knee hyperextension was identified in 308 knees, of which 97 had follow-up greater than 5 years. Between the tests, 40% of limbs had plantar flexor lengthening (PFL). Overall, knee flexion and ankle dorsiflexion in stance increased (P<0.0001). Similar changes were noted between limbs that had PFL and those that did not. PFL is indicated in cases associated with equinus. However, the role of multilevel surgery in the treatment of knee hyperextension needs to be further determined.
Outcomes of Arthroscopy-assisted Closed Reduction and Percutaneous Pinning for a Displaced Pediatric Lateral Condylar Humeral Fracture
Authors: Kang Michael S. , Alfadhil Rheema A. , Park Soo-Sung
Published: January 2019

Background:

Since 2015, we have performed arthroscopy-assisted closed reduction and percutaneous pinning (A/S-CRPP) for children with a displaced lateral condylar humeral fracture (LCF). The purpose of this study is to introduce our A/S-CRPP method and present its outcomes.

Methods:

In total, 39 displaced (>2 mm) LCFs for which A/S-CRPP was initially attempted and with available follow-up data of >12 months were retrospectively reviewed. A/S-CRPP is performed in the following order: closed reduction, 1 provisional K-wire fixation, arthroscopic verification of the reduction status, rereduction if needed, and additional fixation. Our reduction technique using articulations of the ulnohumeral and radiohumeral joints and direct compression is introduced. For rereduction, modified reduction forces were applied based on the arthroscopic findings. To evaluate the learning curve effect, the initial 6 months after the first case of A/S-CRPP was regarded as the “initial period.” There were 12 cases during this period.

Results:

Among the 39 cases, surgical method was intraoperatively converted to open reduction and percutaneous pinning in 9 and A/S-CRPP was completed in 30. Among the 9 open reduction and percutaneous pinning conversion cases, 7 conversions occurred in the initial period. Among the 30 patients who underwent A/S-CRPP alone, 10 needed rereduction after an arthroscopic examination. No patients presented with >10-degree angular deformity or elbow motion limited >20 degrees, compared with the contralateral elbow. Postoperative radial nerve palsy occurred in 2 patients, all in the initial period. Both were resolved within 5 months, postoperatively.

Conclusions:

We suggested our A/S-CRPP surgical technique for displaced pediatric LCF. It may require a 6-month learning curve period. Although more studies are needed, it seems to be a safe and appropriate surgical technique for treatment.

Level of Evidence:

Level IV—therapeutic study.
Rare Presentation of a Rare Cutaneous Neoplasm: Nonacral Sclerosing Perineuroma
Authors: Lukach Alexis J. , Donnelly Kevin M. , Cusack Carrie A.
Published: January 2019

Sclerosing perineuromas are rare, benign peripheral nerve sheath tumors classically reported on the fingers and palms of young men. We present the case of a 12-year-old boy with a slow-growing nodule on his right knee. Excision was performed, and pathology was consistent with a sclerosing perineuroma. This case highlights an atypical presentation of a rare lesion and provides useful knowledge of the clinical scenarios in which sclerosing perineuromas should be included in a differential diagnosis.
The Effect of Optimism and Connectedness on Psychological Adjustment of Children with Cancer and Comparison Peers
Authors: Ehman Anandi C. , Schepers Sasja A. , Phipps Sean
Published: January 2019

Objective:

The present study aimed to examine the relationship of optimism and connectedness with psychological adjustment outcomes in children with cancer and determine whether these relations differ for children with cancer and comparison peers.

Methods:

Participants were 155 children with cancer and 143 comparison youth without a history of cancer, aged 8 to 17 years at study entry, who were followed longitudinally over a 3-year period. Participants completed self-report measures at 3 time points: baseline optimism at study entry (T1), connectedness at 1 year after baseline (T2), and emotional symptoms at 3 years after baseline (T3). A series of regression analyses were conducted using conditional process analysis to examine whether connectedness mediated the relationship between optimism and psychological adjustment and whether this was moderated by health status (i.e., history of childhood cancer vs no history of cancer or other serious or chronic illness).

Results:

Connectedness to parents, peers, and friends significantly mediated the relationship between optimism and psychological adjustment (b parents = −0.1387, 95% confidence interval [CI] [–0.2341 to −0.0515]; b peers = –0.2021, 95% CI [–0.3575 to −0.0818]; b friends = −0.0703, 95% CI [–0.1640 to −0.0050]). However, this mediation was not significantly moderated by having a history of cancer. Cancer history did moderate the direct relationship between optimism and psychological adjustment and between connectedness to parents and psychological adjustment.

Conclusion:

Findings suggest that patients with cancer are doing remarkably well with regard to adjustment. Connectedness with parents and peers mediates the relationship between optimism and psychological adjustment. As such, children with cancer who are identified as experiencing poor adjustment may benefit from interventions to foster connectedness.
Patient-Reported Unmet Needs in Colorectal Cancer Survivors After Treatment for Curative Intent
Authors: Vu Joceline Vuong-Thu , Matusko Niki , Hendren Samantha , Regenbogen Scott E. , Hardiman Karin M.
Published: January 2019

BACKGROUND:

With improving survival from colorectal cancer, there is a growing population of patients undergoing surveillance. National accreditation organizations have increasingly endorsed formal survivorship care planning. To effectively design patient-centered survivorship programs, an understanding of the prevalence of unmet psychosocial and symptomatic needs is required.

OBJECTIVE:

The aim of this study is to understand the breadth of unmet needs among survivors of colorectal cancer.

DESIGN:

This is a cross-sectional survey of patients undergoing surveillance after curative-intent therapy for colorectal cancer.

SETTING:

This study was conducted June 2017 to January 2018 at an academic cancer center.

PATIENTS:

There were 99 patients (58 with colon cancer, 41 with rectal cancer).

MAIN OUTCOME MEASURES:

We measured patient-reported unmet needs by using a modification of the Cancer Survivor Unmet Needs instrument, within domains of emotional (stress, concerns about recurrence), relationship (fertility, interpersonal), logistical (need for accessible parking, case management), financial, treatment-related (neuropathy, bowel function), and surveillance-related needs.

RESULTS:

The mean (±SD) age was 58 (±12), and the time from diagnosis was 34 (±18) months. Overall, 74% of patients reported at least one unmet need, 49% reported emotional needs, 24% relationship needs, 24% financial needs, 25% logistical needs, and 33% surveillance needs. Thirty-six (62%) patients with colon cancer and 37 (90%) patients with rectal cancer reported at least one ongoing problem (p = 0.002). Thirty-five (82%) patients with rectal cancer reported an unmet treatment-related need in comparison with 23 (40%) patients with colon cancer (p < 0.001). The median (interquartile range) number of ongoing needs were 1 (0–5) in patients with colon cancer and 4 (2–8) in patients with rectal cancer (p = 0.007).

LIMITATIONS:

This study was limited by its small sample size and lack of generalizability, given the tertiary care setting.

CONCLUSIONS:

The majority of colorectal cancer survivors reported unmet needs years after completion of curative-intent therapy. Patients with rectal cancer were significantly more likely to have unmet needs and may benefit from additional care during survivorship. Colorectal cancer survivorship programs should incorporate psychosocial and symptomatic care in addition to cancer surveillance. See Video Abstract at http://links.lww.com/DCR/A885.
Rethinking the techno vagina: a case series of patient complications following vaginal laser treatment for atrophy
Authors: Gordon Catherine , Gonzales Savanah , Krychman Michael L.
Published: January 2019

Objective:

The treatment of genitourinary syndrome of menopause (GSM) includes prescription hormone therapy, nonhormonal over-the-counter products, and most recently, laser treatment. Although the Food and Drug Administration has cleared fractional carbon dioxide (CO2) laser for a variety of dermatologic and gynecologic indications, lasers have not to date, been approved for use for vulvar/vaginal atrophy, or sexual dysfunction.

Methods:

Four case studies that were referred to a tertiary sexual medicine center regarding laser treatment complications for GSM are reported. Patient data were Health Insurance Portability and Accountability Act of 1996 protected and informed consent was obtained by all patients.

Results:

Four cases are presented, which demonstrate complications after completion of three consecutive laser treatments for GSM. Case 1 is a 65-year-old woman with GSM and moderate vaginal stenosis who had two vaginal wall lacerations after resumption of intercourse. Case 2 is a 61-year-old woman who had persistent dyspareunia following vaginal laser treatments. Case 3 is a 68-year-old woman who reported worsening dyspareunia and had a fibrous band mid vagina that impinged on the canal. Case 4 is a 55-year-old woman who complained of dyspareunia and insertional pain, after her laser. Assessment and follow-up treatment are presented.

Conclusions:

Laser therapy for the vagina shows excellent promise for the treatment of GSM in some women; however, complications such as fibrosis, scarring, agglutination, and penetration injury have been documented. Food and Drug Administration–approved products for GSM should be considered frontline treatments until long-term, prospective, randomized, sham-controlled trials are conducted that confirm efficacy and safety for device treatments.
Plasticity of Unmyelinated Fibers in a Side-to-end Tubulization Model
Authors: Tognon-Miguel Vânia , Nascimento-Elias Adriana H. , Schiavoni Maria C. L. , Barreira Amilton A.
Published: January 2019

Background:

Histomorphometric studies of unmyelinated fibers of the rat fibular nerves are uncommon, and side-to-end neurorrhaphy studies using the fibular nerve investigate primarily motor fibers. We investigated side-to-end tubulization (SET) technique, in which occurs collateral sprouting from the intact donor nerve fibers to the distal stump of receptor nerve, with muscle reinnervation and functional rehabilitation, to assess whether there is a successful growth of unmyelinated fibers in this model.

Methods:

Adult Wistar rats fibular nerves were sectioned to create a 5-mm gap. A 6-mm silicone tube was attached between a side of the intact tibial nerve and the sectioned fibular nerve distal stump (SET group), with the left fibular nerve as normal (sham group). Seventy days postsurgery, unmyelinated fibers from the distal segment of the fibular nerve were quantified using light and transmission electron microscopy and their diameters were measured.

Results:

The number of unmyelinated fibers was similar between sham (1,882 ± 270.9) and SET (2,012 ± 1,060.8), but axons density was significantly greater in the SET (18,733.3 ± 5,668.6) than sham (13,935.0 ± 1,875.8). Additionally, the axonal diameters differed significantly between groups with mean measures in sham (0.968 ± 0.10) > SET (0.648 ± 0.08).

Conclusions:

Unmyelinated fiber growth occurred even with a 5-mm distance between the donor and receptor nerves, reaching similar axonal number to the normal nerve, demonstrating that the SET is a reliable technique that can promote a remarkable plasticity of unmyelinated axons.
CHOROIDAL NEVUS IMAGING FEATURES IN 3,806 CASES AND RISK FACTORS FOR TRANSFORMATION INTO MELANOMA IN 2,355 CASES
Authors: Shields Carol L. , Dalvin Lauren A. , Ancona-Lezama David , Yu Michael D. , Di Nicola Maura , Williams Basil K. , Lucio-Alvarez J. Antonio , Ang Su Mae , Maloney Sean , Welch R. Joel , Shields Jerry A.
Published: January 2019

Purpose:

To use multimodal imaging for identification of risk factors for choroidal nevus transformation into melanoma.

Methods:

Retrospective chart review of 3806 consecutive choroidal nevi with imaging and 2355 choroidal nevi with additional follow up to identify factors predictive of transformation of choroidal nevus into melanoma.

Results:

The median patient age was 62.5 years and Caucasian race in 3167 (95%). The choroidal nevus demonstrated median basal diameter of 4.0 mm and thickness of 1.4 mm. Imaging included optical coherence tomography (OCT) showing subretinal fluid (SRF) in 312 (9%), ultrasonography (US) with acoustic hollowness in 309 (9%), and hyper-autofluorescence (AF) in 100 (3%). Of those 2355 choroidal nevi with follow up, Kaplan-Meier estimates of nevus transformation into melanoma at 1, 5, and 10 years were 1.2%, 5.8%, and 13.9%, respectively. Multivariate analysis, using multimodal imaging for detection of factors predictive of nevus transformation into melanoma, included thickness >2 mm on US (hazard ratio (HR) 3.80, p < 0.0001), SRF on OCT as cap over nevus (HR 3.00, p < 0.0001) or SRF ≤3 mm from nevus margin (HR 3.56, p = 0.0003), symptomatic vision loss ≤20/50 on Snellen visual acuity (VA) (HR 2.28, p = 0.005), orange pigment (lipofuscin) hyperautofluorescence on AF (HR 3.07, p = 0.0004), acoustic hollowness on US (HR 2.10, p = 0.0020), and tumor diameter >5 mm on photography (HR 1.84, p = 0.0275). These factors can be recalled by the mnemonic “To Find Small Ocular Melanoma Doing IMaging” (TFSOM-DIM) representing Thickness >2 mm (US), Fluid subretinal (OCT), Symptoms vision loss (VA), Orange pigment (AF), Melanoma hollow (US), and DIaMeter >5mm (photography). The mean 5-year estimates of nevus growth into melanoma were 1% (HR 0.8) for those with 0 risk factor, 11% (HR 3.09) with 1 factor, 22% (HR 10.6) with 2 factors, 34% (HR 15.1) with 3 factors, 51% (HR 15.2) with 4 factors, 55% (HR 26.4) with 5 risk factors, and not-estimable with all 6 risk factors.

Conclusion:

In this analysis, multimodal imaging was capable of detecting risk factors for nevus transformation into melanoma, including thickness >2 mm (US), fluid subretinal (OCT), symptoms vision loss (Snellen acuity), orange pigment (AF), melanoma hollowness (US), and diameter >5 mm (photography). Increasing number of risk factors imparts greater risk for nevus transformation into melanoma, including thickness >2 mm (US), fluid subretinal (OCT), symptoms vision loss (Snellen acuity), orange pigment (AF), melanoma hollowness (US), and diameter >5 mm (photography). Increasing number of risk factors imparts greater risk for transformation.
Hedonic drinking engages a supraspinal inhibition of thermal nociception in adult rats
Authors: Davies Alexander J. , Kim Doyun , Park Jeongrak , Lee Jeong-Yun , Vang Hue , Pickering Anthony E. , Oh Seog Bae
Published: January 2019

The taste of sucrose is commonly used to provide pain relief in newborn humans and is innately analgesic to neonatal rodents. In adulthood, sucrose remains a strong motivator to feed, even in potentially hazardous circumstances (ie, threat of tissue damage). However, the neurobiological mechanisms of this endogenous reward–pain interaction are unclear. We have developed a simple model of sucrose drinking–induced analgesia in Sprague–Dawley rats (6-10 weeks old) and have undertaken a behavioral and pharmacological characterization using the Hargreaves' test of hind-paw thermal sensitivity. Our results reveal an acute, potent, and robust inhibitory effect of sucrose drinking on thermal nociceptive behaviour that unlike the phenomenon in neonates is independent of endogenous opioid signalling and does not seem to operate through classical descending inhibition of the spinal cord circuitry. Experience of sucrose drinking had a conditioning effect whereby the apparent expectancy of sucrose enabled water alone (in euvolemic animals) to elicit a short-lasting placebo-like analgesia. Sweet taste alone, however, was insufficient to elicit analgesia in adult rats intraorally perfused with sucrose. Instead, the sucrose analgesia phenomenon only appeared after conditioning by oral perfusion in chronically cannulated animals. This sucrose analgesia was completely prevented by systemic dosing of the endocannabinoid CB1 receptor antagonist rimonabant. These results indicate the presence of an endogenous supraspinal analgesic circuit that is recruited by the context of rewarding drinking and is dependent on endocannabinoid signalling. We propose that this hedonic sucrose-drinking model may be useful for further investigation of the supraspinal control of pain by appetite and reward.
7 Is the New 8: Improving Adherence to Restrictive PRBC Transfusions in the Pediatric ICU
Authors: Badke Colleen M. , Borrowman Julie A. , Haymond Shannon , Rychlik Karen , Malakooti Marcelo R.
Published: January 2019

Up to 30%–40% of children admitted to the pediatric intensive care unit (PICU) have anemia, and approximately 15% receive packed red blood cell (pRBC) transfusions. Current literature supports a pRBC transfusion threshold of hemoglobin less than or equal to seven for most PICU patients. Our objective was to determine pRBC transfusion rates, assess compliance with transfusion guidelines, understand patient-level variables that affect transfusion practices, and use cross-industry innovation to implement a practice strategy. This was a pre–post study of pediatric patients admitted to our PICU. We collected baseline data on pRBC transfusion practices. Next, we organized an innovation platform, which generated multi-industry ideas and produced an awareness campaign to effect pRBC ordering behavior. Innovative educational interventions were implemented, and postintervention transfusion practices were monitored. Statistical analysis was performed using linear mixed models. A p value < .05 was considered statistically significant. At baseline, 41% of pRBC transfusions met restrictive transfusion guidelines with a pretransfusion hemoglobin less than or equal to 7 g/dl. In the postintervention period, 53% of transfusions met restrictive transfusion guidelines (odds ratio 1.66, 95% confidence interval 1.21–2.28). Implementation of a behavioral campaign using multi-industry innovation led to improved adherence to pRBC transfusion guidelines in a tertiary care PICU.
STD Partner Services to Monitor and Promote HIV Pre-exposure Prophylaxis Use Among Men Who Have Sex With Men
Authors: Katz David A. , Dombrowski Julia C. , Barry Michael , Spellman Dawn , Bell Teal R. , Golden Matthew R.
Published: January 2019

Background:

Men who have sex with men (MSM) with bacterial sexually transmitted diseases (STDs) are at elevated risk of HIV. We evaluated the integration of pre-exposure prophylaxis (PrEP) referrals into STD partner services (PS) for MSM.

Setting:

King County, Washington.

Methods:

Disease Intervention Specialists (DIS) in King County attempt to provide PS to all MSM with early syphilis and, as resources allow, MSM with gonorrhea or chlamydia. Our health department defines MSM with any of the following as at high HIV risk: early syphilis, rectal gonorrhea, methamphetamine/poppers use, sex work, or an HIV-unsuppressed partner. DIS offer high-risk MSM referral to our STD Clinic for PrEP and other MSM referral to community providers. In 2017, we interviewed a random sample of MSM offered referrals in 2016 to assess PrEP initiation after PS.

Results:

From August 2014 to August 2017, 7546 cases of bacterial STDs were reported among HIV-negative MSM. DIS provided PS to 3739 MSM, of whom 2055 (55%) were at high risk. DIS assessed PrEP use in 1840 (90%) of these men, 895 (49%) of whom reported already using PrEP. DIS offered referrals to 693 (73%) of 945 MSM not on PrEP; 372 (54%) accepted. Among 132 interviewed for the random sample, men who accepted referrals at initial interview were more likely to report using PrEP at follow-up (32/68 = 47%) than those who did not (12/64 = 19%) (P = 0.0006). An estimated 10.4% of all interviewed MSM initiated PrEP following PS-based referral.

Conclusions:

Integrating PrEP referrals into STD PS is an effective population-based strategy to link MSM at high HIV risk to PrEP.
Procalcitonin to guide antibiotic decision making
Authors: Branche Angela , Neeser Olivia , Mueller Beat , Schuetz Philipp
Published: January 2019

Purpose of review

There is convincing evidence linking antibiotic-stewardship efforts which include the infection marker procalcitonin (PCT) to more rational use of antibiotics with improvements in side-effects and clinical outcomes. This is particularly true in the setting of respiratory infection and sepsis. Yet, some recent trials have shown no benefit of PCT-guided care. Our aim was to discuss the benefits and limitations of using PCT for early infection recognition, severity assessment and therapeutic decisions in individual patients based on most the recent study data.

Recent findings

Current evidence from randomized trials, and meta-analyses of these trials, indicates that PCT-guided antibiotic stewardship results in a reduction in antibiotic use and antibiotic side-effects, which translates into improved survival of patients with respiratory infections and sepsis. Notably, initial PCT levels have been found to be helpful in defining the risk for bacterial infection in the context of a low pretest probability for bacterial infections (i.e., patients with bronchitis or chronic bastructive pulmonary disease exacerbation). Monitoring of repeated PCT measurements over time has also been found helpful for estimating recovery from bacterial infection and prognosis in higher risk situations (i.e., pneumonia or sepsis) and results in early and safe discontinuation of antibiotic therapy. Some trials, however, did not find a strong effect of PCT guidance which may be explained by low protocol adherence, assessment using only a single rather than repeat PCT levels and lower antibiotic exposure in control group patients. Using PCT in the right patient population, with high-sensitivity assays and with adequate training of physicians is important to increase protocol adherence and reduce antibiotic exposure.

Inclusion of PCT into antibiotic stewardship algorithms has the potential to improve the diagnostic and therapeutic management of patients presenting with respiratory illnesses and sepsis, and holds great promise to mitigate the global bacterial resistance crisis and move from a default position of standardized care to more personalized treatment decisions.
Biomarkers of fungal lung infection
Authors: Paiva José-Artur , Pereira José M.
Published: January 2019

Purpose of review

The incidence of lung fungal infections, namely invasive pulmonary aspergillosis (IPA) and mucormycosis, is increasing in neutropenic and nonneutropenic patients. As they are a major cause of death, early diagnosis and antifungal therapy are crucial for outcome. The role of biomarkers in the management of this infections is the scope of this review.

Recent findings

Galactomannan in bronchoalveolar lavage shows the best discriminatory power for IPA diagnosis. At baseline, serum galactomannan may be useful to predict outcome and its kinetics may be informative to assess response to antifungal therapy. Recent standardization of PCR technology brought some improvements in IPA and mucormycosis diagnosis. Several new biomarkers are currently under investigation, but none showed a better performance than current available biomarkers. To improve diagnostic accuracy, a combination of biomarkers, including galactomannan, has been proposed.

Biomarkers may play an important role in the early diagnosis of fungal lung infections and in prognostic assessment and response monitoring, but more research is needed to determine the best strategy for their clinical use.
Composite Graft Pretreatment With Hydrogen Sulfide Delays the Onset of Acute Rejection
Authors: Fries C. Anton , Lawson Sharon D. , Wang Lin C. , Spencer Jerry R. , Roth Mark , Rickard Rory F. , Gorantla Vijay S. , Davis Michael R.
Published: January 2019

Introduction

Vascularized composite allotransplantation can reconstruct devastating tissue loss by replacing like-with-like tissues, most commonly in the form of hand or face transplantation. Unresolved technical and ethical challenges have meant that such transplants remain experimental treatments. The most significant barrier to expansion of this field is the requirement for systemic immunosuppression, its toxicity and effect on longevity.

Hydrogen sulfide (H2S) has been shown experimentally to ameliorate the ischemia reperfusion injury associated with composite tissue autotransplantation, which has been linked to acute rejection in solid organ transplantation. In this protocol, a large-animal model was used to evaluate the effect of H2S on acute rejection after composite tissue allotransplantation.

Materials and Methods

A musculocutaneous flap model in SLA-mismatched swine was used to evaluate acute rejection of allotransplants in 2 groups: control animals (n = 8) and a treatment group in which the allografts were pretreated with hydrogen sulfide (n = 8). Neither group was treated with systemic immunosuppression. Acute rejection was graded clinically and histopathologically by an independent, blinded pathologist. Data were analyzed byttests with correction for multiple comparisons by the Holm-Šídák method.

Results

Clinically, H2S-treated tissue composites showed a delay in the onset of rejection that was statistically significant from postoperative day 6. Histopathologically, this difference between groups was also apparent, although evidence of a difference in groups disappeared beyond day 10.

Conclusions

Targeted hydrogen sulfide treatment of vascularized composite allografts immediately before transplantation can delay acute rejection. This may, in turn, reduce or obviate the requirement for systemic immunosuppression.
Cheek Cutaneous Melanomas
Authors: Tas Faruk , Erturk Kayhan
Published: January 2019

Background

Most head and neck melanomas occur on the face, with the cheek being the most frequently affected site. So far, small numbers of researches on cheek melanomas have yielded insufficient and controversial results. In this trial, we aimed to define the histopathological and clinical features specific to cheek melanomas and to compare them with other head and neck melanomas by using a large group of patients from a single tertiary center.

Patients and Methods

A total of 98 cheek melanomas and 183 other (noncheek) head and neck melanoma cases were analyzed retrospectively.

Results

The median age was 62 years and malar/zygomatic was the mostly affected site (78.6%). The cheek melanomas developed more frequently in females (61.2%) and most of them were associated with lentigo maligna histopathological subtype (49.2%) and early-stage disease (stage 0–II) (77.6%). The cheek melanomas were found more significantly associated with older patients (P = 0.05), females (P = 0.0001), lentigo maligna subtype (P = 0.0001), lower vertical growth phase (P = 0.03), and early-stage of disease (P = 0.0001) compared with other lesions that developed other sites. Furthermore, they were associated with lower relapse rates (18.6% vs 39.5%, P = 0.0001) and the 5-year recurrence-free survival rate of cheek melanomas was 80% (P = 0.002). Moreover, the 5-year overall survival rate of cheek melanomas was 62%, and they were found to be associated with a favorable overall survival (P = 0.004).

Conclusions

Cheek melanomas are associated with lower relapse rates and favorable outcomes compared with other (noncheek) head and neck melanomas.
Pediatric Breast Fibroadenomas
Authors: Brownstone Nicholas D. , Celie Karel-Bart , Spigland Nitsana A. , Otterburn David M.
Published: January 2019

Background

Pediatric breast masses cause concern for both the patient and their family, although malignancy represents less than 1% of lesions in this population. No studies have systematically described resection and reconstructive methods for different sizes and locations of pediatric breast fibroadenomas. The aim of this study was to perform a recent systematic review of the literature regarding the surgical resection of pediatric breast fibroadenomas and to propose an algorithm for safe and effective treatment that maximizes both therapeutic and aesthetic goals while acknowledging possible future need for nipple-sparing mastectomy.

Methods

A search for the phrase “pediatric breast fibroadenoma” yielded 44 results through the PubMed database. Results were reviewed and filtered to only include pertinent articles published within the last 10 years, yielding 27 results. Application of exclusion criteria resulted in 5 applicable articles. A second search was conducted using the phrase “breast fibroadenoma AND resection,” which resulted in 37 studies. Fourteen articles met the inclusion and exclusion criteria from this expanded search. All 19 articles were reviewed for techniques based on the characteristics of the masses in terms of their resection patterns, and a treatment algorithm was designed.

Results

Thirty-three female subjects with an average age of 14 years were included in analysis. The average number of fibroadenomas was 1.2. The average diameter of a breast fibroadenoma was 9.1 cm, with a range from 2 to 20 cm. Resection techniques were as follows: 31% (n = 6) periareolar incision, 31% (n = 6) inframammary fold incision, 21% (n = 4) reduction mammoplasty, 10% (n = 2) mastectomy, and 5% (n = 1) mastopexy. Sixteen percent (n = 3) of studies reported the use of implants or myocutaneous flaps when breast reconstruction was warranted. No articles described long-term follow-up with regard to need for eventual mastectomy or skin complications based on prior biopsy. Based on the results of this review, an algorithm was developed to guide treatment of pediatric breast fibroadenomas.

Conclusion

This is the first time a treatment algorithm for surgical resection has been proposed in the literature. It is our hope that this systematic review will provide guidance to surgeons in the operative management of pediatric breast fibroadenomas.
Acute Breast Implant Periprosthetic Cerebrospinal Fluid Collection After Ventriculoperitoneal Shunt Migration
Authors: Zaluzec Rebekah M. , Patel Ronak Ajay , Cohen Mimis
Published: January 2019

Ventriculoperitoneal shunt (VPS) placement is a common neurosurgical procedure with a high rate of distal catheter malfunction. Rarely, the catheter may migrate to other tissues in the body including the breast pockets. There are increasing odds that a patient may undergo both breast augmentation and VPS placement, because breast augmentation is the most common aesthetic surgical procedure. Complications are possible with both surgical procedures. Proximal migration of the distal aspect of a VPS into the breast pocket containing an implant is a rare complication. We hereby present a successful management of VPS migration with implant salvage and culture-directed antibiotics using a careful no touch technique by avoiding breast incision and washout, or percutaneous drainage, and using the existing VPS as an in situ drainage access point for CSF fluid aspiration and culture.
Mitochondrial Function in the Kidney and Heart, but Not the Brain, is Mainly Altered in an Experimental Model of Endotoxaemia
Authors: Makrecka-Kuka Marina , Korzh Stanislava , Vilks Karlis , Vilskersts Reinis , Cirule Helena , Dambrova Maija , Liepinsh Edgars
Published: January 2019

Significant impairments in mitochondrial function are associated with the development of multi-organ failure in sepsis/endotoxaemia, but the data on the dynamics of simultaneous mitochondrial impairment in multiple organs are limited. The aim of this study was to evaluate the changes in heart, brain and kidney mitochondrial function in an experimental model of lipopolysaccharide (LPS)-induced endotoxaemia.

Samples were collected 4 and 24 h after single injection of LPS (10 mg/kg) in mice. Marked increases in inflammation-related gene expression were observed in all studied tissues 4 h after LPS administration. At 24 h post LPS administration, this expression of inflammation-related genes remained upregulated only in kidneys. Significantly increased concentrations of kidney function markers confirmed that kidneys were severely damaged. Echocardiographic measurements showed that the ejection fraction and fractional shortening were significantly reduced 4 h after LPS administration, whereas 24 h after LPS administration, the cardiac function was restored to baseline. A two-fold decrease in mitochondrial oxidative phosphorylation (OXPHOS) capacity in the kidney was observed 4 and 24 h after LPS administration. Significant decrease in mitochondrial fatty acid oxidation was observed in heart 4 h after LPS administration. Furthermore, 24 h after LPS administration, the respiration rates in cardiac fibers at OXPHOS and electron transport (ET) states were significantly increased, which resulted in increased ET coupling efficiency in the LPS-treated group, whereas four-fold increases in the H2O2 production rate and H2O2/O ratio were observed. The brain mitochondria demonstrated a slightly impaired mitochondrial functionality just 24 h after the induction of endotoxaemia.

In conclusion, among studied tissues kidney mitochondria are the most sensitive to endotoxaemia and do not recover from LPS-induced damage, whereas in brain, mitochondrial function was not significantly altered. In heart, endotoxaemia induces a decrease in the mitochondrial fatty acid oxidation capacity, but during the phase of suppressed inflammatory response, the ET efficiency is improved despite the marked increase in reactive oxygen species production.
Mechanistic insights into the effect of humidity on airborne influenza virus survival, transmission and incidence
Authors: Marr Linsey C. , Tang Julian W. , Van Mullekom Jennifer , Lakdawala Seema S.
Published: January 2019

Influenza incidence and seasonality, along with virus survival and transmission, appear to depend at least partly on humidity, and recent studies have suggested that absolute humidity (AH) is more important than relative humidity (RH) in modulating observed patterns. In this perspective article, we re-evaluate studies of influenza virus survival in aerosols, transmission in animal models and influenza incidence to show that the combination of temperature and RH is equally valid as AH as a predictor. Collinearity must be considered, as higher levels of AH are only possible at higher temperatures, where it is well established that virus decay is more rapid. In studies of incidence that employ meteorological data, outdoor AH may be serving as a proxy for indoor RH in temperate regions during the wintertime heating season. Finally, we present a mechanistic explanation based on droplet evaporation and its impact on droplet physics and chemistry for why RH is more likely than AH to modulate virus survival and transmission.
The histone deacetylase NlHDAC1 regulates both female and male fertility in the brown planthopper,Nilaparvata lugens
Authors: Zhang Jin-Li , Yuan Xiao-Bo , Chen Sun-Jie , Chen Hao-Hao , Xu Nan , Xue Wen-Hua , Fu Sheng-Jie , Zhang Chuan-Xi , Xu Hai-Jun
Published: January 2019

Histone acetylation is a specific type of chromatin modification that serves as a key regulatory mechanism for many cellular processes in mammals. However, little is known about its biological function in invertebrates. Here, we identified 12 members of histone deacetylases (NlHDACs) in the brown planthopper (BPH),Nilaparvata lugens. RNAi-mediated silencing assay showed thatNlHdac1,NlHdac3andNlHdac4played critical roles in female fertility via regulating ovary maturation or ovipositor development. Silencing ofNlHdac1substantially increased acetylation level of histones H3 and H4 in ovaries, indicating NlHDAC1 is the main histone deacetylase in ovaries of BPH. RNA sequencing (RNA-seq) analysis showed that knockdown ofNlHdac1impaired ovary development via multiple signalling pathways including the TOR pathway. Acoustic recording showed that males withNlHdac1knockdown failed to make courtship songs, and thus were unacceptable to wild-type females, resulting in unfertilized eggs. Competition mating assay showed that wild-type females overwhelmingly preferred to mate with control males overNlHdac1-knockdown males. These findings improve our understanding of reproductive strategies controlled by HDACs in insects and provide a potential target for pest control.
Differential consequences of balance laws in extended irreversible thermodynamics of rigid heat conductors
Authors: Rogolino P. , Cimmelli V. A.
Published: January 2019

We consider a system of balance laws arising in extended irreversible thermodynamics of rigid heat conductors, together with its differential conse- quences, namely the higher-order system obtained by taking into account the time and space derivatives of the original system. We point out some mathematical properties of the differential consequences, with particular attention to the problem of the propagation of thermal perturbations with finite speed. We prove that, under an opportune choice of the initial conditions, a solution of the Cauchy problem for the system of differential consequences is also a solution of the Cauchy problem for the original system. We investigate the thermodynamic compatibility of the system at hand by applying a generalized Coleman–Noll procedure. On the example of a generalized Guyer–Krumhansl heat-transport model, we show that it is possible to get a hyperbolic system of evolution equations even when the state space is non-local.
Basal polyphagan beetles in mid-Cretaceous amber from Myanmar: biogeographic implications and long-term morphological stasis
Authors: Cai Chenyang , Lawrence John F. , Yamamoto Shûhei , Leschen Richard A. B. , Newton Alfred F. , Ślipiński Adam , Yin Ziwei , Huang Diying , Engel Michael S.
Published: January 2019

The origin and early evolutionary history of polyphagan beetles have been largely based on evidence from the derived and diverse ‘core Polyphaga’, whereas little is known about the species-poor basal polyphagan lineages, which include Scirtoidea (Clambidae, Decliniidae, Eucinetidae, and Scirtidae) and Derodontidae. Here, we report two new species
Acalyptomerus thayerae
sp. nov. and
Sphaerothorax uenoi
sp. nov., both belonging to extant genera of Clambidae, from mid-Cretaceous Burmese amber.
Acalyptomerus thayerae
has a close affinity to
A. herbertfranzi
, a species currently occurring in Mesoamerica and northern South America.
Sphaerothorax uenoi
is closely related to extant species of
Sphaerothorax
, which are usually collected in forests of
Nothofagus
of Australia, Chile, and New Zealand. The discovery of two Cretaceous species from northern Myanmar indicates that both genera had lengthy evolutionary histories, originated at least by the earliest Cenomanian, and were probably more widespread than at present. Remarkable morphological similarities between fossil and living species suggest that both genera changed little over long periods of geological time. The long-term persistence of similar mesic microhabitats such as leaf litter may account for the 99 Myr morphological stasis in
Acalyptomerus
and
Sphaerothorax
. Additionally, the extinct staphylinoid family Ptismidae is proposed as a new synonym of Clambidae, and its only included species
Ptisma zasukhae
is placed as incertae sedis within Clambidae.
Techniques and tools for species identification in ciliates: a review
Authors: Abraham Jeeva Susan , Sripoorna S. , Maurya Swati , Makhija Seema , Gupta Renu , Toteja Ravi
Published: January 2019

Ciliates are highly divergent unicellular eukaryotic organisms with nuclear dualism and a highly specialized ciliary pattern. They inhabit all biotopes and play crucial roles in regulating microbial food webs as they prey on bacteria, protists and even on microscopic animals. Nevertheless, subtle morphological differences and tiny sizes hinder proper species identification for many ciliates. In the present review, an attempt has been made to elaborate the various approaches used by modern day ciliate taxonomists for species identification. The different approaches involved in taxonomic characterization of ciliates such as classical (using live-cell observations, staining techniques, etc.), molecular (involving various marker genes) and statistical (delimitation of cryptic species) methods have been reviewed. Ecological and behavioural aspects in species identification have also been discussed. In present-day taxonomy, it is important to use a ‘total evidence’ approach in identifying ciliates, relying on both classical and molecular information whenever possible. This integrative approach will help in the mergence of classical methods with modern-day tools for comprehensive species description in future.
Shared genome analyses of notable listeriosis outbreaks, highlighting the critical importance of epidemiological evidence, input datasets and interpretation criteria
Authors: Reimer Aleisha , Weedmark Kelly , Petkau Aaron , Peterson Christy-Lynn , Walker Matthew , Knox Natalie , Kent Heather , Mabon Philip , Berry Chrystal , Tyler Shaun , Tschetter Lorelee , Jerome Morganne , Allen Vanessa , Hoang Linda , Bekal Sadjia , Clark Clifford , Nadon Celine , Van Domselaar Gary , Pagotto Franco , Graham Morag , Farber Jeff , Gilmour Matthew
Published: January 2019

The persuasiveness of genomic evidence has pressured scientific agencies to supplement or replace well-established methodologies to inform public health and food safety decision-making. This study of 52 epidemiologically defined

Listeria monocytogenes

isolates, collected between 1981 and 2011, including nine outbreaks, was undertaken (1) to characterize their phylogenetic relationship at finished genome-level resolution, (2) to elucidate the underlying genetic diversity within an endemic subtype, CC8, and (3) to re-evaluate the genetic relationship and epidemiology of a CC8-delimited outbreak in Canada in 2008. Genomes representing Canadian

Listeria

outbreaks between 1981 and 2010 were closed and manually annotated. Single nucleotide variants (SNVs) and horizontally acquired traits were used to generate phylogenomic models. Phylogenomic relationships were congruent with classical subtyping and epidemiology, except for CC8 outbreaks, wherein the distribution of SNV and prophages revealed multiple co-evolving lineages. Chronophyletic reconstruction of CC8 evolution indicates that prophage-related genetic changes among CC8 strains manifest as PFGE subtype reversions, obscuring the relationship between CC8 isolates, and complicating the public health interpretation of subtyping data, even at maximum genome resolution. The size of the shared genome interrogated did not change the genetic relationship measured between highly related isolates near the tips of the phylogenetic tree, illustrating the robustness of these approaches for routine public health applications where the focus is recent ancestry. The possibility exists for temporally and epidemiologically distinct events to appear related even at maximum genome resolution, highlighting the continued importance of epidemiological evidence.
Stridulations of Melolontha spp. larvae open up new possibilities for species-specific pest monitoring in soils
Authors: Görres Carolyn-Monika , Chesmore David
Published: January 2019

Root-feeding Scarabaeidae larvae can pose a serious threat to agricultural and forest ecosystems, but many details of larval ecology are still unknown. We developed an acoustic data analysis method for gaining new insights into larval ecology. In a laboratory study, third instar larvae of Melolontha melolontha (n=38) and M. hippocastani (n=15) kept in soil-filled containers were acoustically monitored for 5 min each, resulting in the first known stridulation recordings for each species. Subsequent continuous monitoring of three M. hippocastani larvae over several hours showed that a single larva could stridulate more than 70 times per hour, and stridulation rates increased drastically with increasing larval abundance. The new fractal dimension-based data analysis method automatically detected audio sections with stridulations and provided a semi-quantitative estimate of stridulation activity. It is the first data analysis method specifically targeting Scarabaeidae larvae stridulations in soils, enabling for the first time non-invasive species-specific pest monitoring.

Key message

Root-feeding scarab beetle larvae, known as white grubs, can be serious agricultural and forest pests.

White grub infestation monitoring is difficult due to their cryptic lifestyle, but detailed monitoring data is essential for effective pest control.

We present the first acoustic data analysis routine targeting stridulations, using Melolontha melolontha and M. hippocastani as model organisms.

This new method provides for the first time the basis for the development of tools for non-invasive, species-specific, and rapid white grub monitoring in soils.
Multiple phase-variable mechanisms, including capsular polysaccharides, modify bacteriophage susceptibility in Bacteroides thetaiotaomicron
Authors: Porter Nathan T. , Hryckowian Andrew J. , Merrill Bryan D. , Fuentes Jaime J. , Gardner Jackson O. , Glowacki Robert W. P. , Singh Shaleni , Crawford Ryan D. , Snitkin Evan S. , Sonnenburg Justin L. , Martens Eric C.
Published: January 2019

A variety of cell surface structures, including capsular polysaccharides (CPS), dictate interactions between bacteria and their environment including their viruses (bacteriophages). Members of the prominent human gut Bacteroidetes characteristically produce several phase-variable CPS, but their contributions to bacteriophage interactions are unknown. We used engineered strains of the human symbiont Bacteroides thetaiotaomicron, which differ only in the CPS they express, to isolate bacteriophages from two locations in the United States. Testing each of 71 bacteriophages against a panel of strains that express wild-type phase-variable CPS, one of eight different single CPS, or no CPS at all, revealed that each phage infects only a subset of otherwise isogenic strains. Deletion of infection-permissive CPS from B. thetaiotaomicron was sufficient to abolish infection for several individual bacteriophages, while infection of wild-type B. thetaiotaomicron with either of two different bacteriophages rapidly selected for expression of non-permissive CPS. Surprisingly, acapsular B. thetaiotaomicron also escapes complete killing by these bacteriophages, but surviving bacteria exhibit increased expression of 8 distinct phase-variable lipoproteins. When constitutively expressed, one of these lipoproteins promotes resistance to multiple bacteriophages. Finally, both wild-type and acapsular B. thetaiotaomicron were able to separately co-exist with one bacteriophage for over two months in the mouse gut, suggesting that phase-variation promotes resistance but also generates sufficient numbers of susceptible revertants to allow bacteriophage persistence. Our results reveal important roles for Bacteroides CPS and other cell surface structures that allow these bacteria to persist despite bacteriophage predation and hold important implications for using bacteriophages therapeutically to target gut symbionts.