bluuebunny/crossref_metadata_2025 huggingface dataset:
Near-infrared-traceable DNA nano-hydrolase: specific eradication of telomeric G-overhang in vivo
Authors: Sun Yuhuan , Zhao Chuanqi , Cui Tingting , Qin Hongshuang , Niu Jingsheng , Ren Jinsong , Qu Xiaogang
Published: August 2020

Telomeric DNA, whose length homeostasis is closely correlated with immortality of cancer cells, is regarded as a molecular clock for cellular lifespan. Regarding the capacity in forming G-quadruplex, G-rich 3′-overhang (G-overhang) has been considered as an attractive anticancer target. However, it is still challenging to precisely target telomeric G-overhang with current ligands because of the polymorphism of G-quadruplexes in cells. Herein, we construct a telomeric G-overhang-specific near-infrared-traceable DNA nano-hydrolase, which is composed of four parts: (i) dexamethasone for targeting cell nuclei; (ii) complementary DNA for hybridizing with G-overhang; (iii) multinuclear Ce(IV) complexes for hydrolyzing G-overhang; and (iv) upconversion nanoparticles for real-time tracking. The multivalent targeted DNA nano-hydrolase can be traced to precisely digest telomeric G-overhang, which contributes to telomeric DNA shortening and thereby causes cell aging and apoptosis. The anticancer treatment is further proved by in vivo studies. In this way, this design provides a telomeric G-overhang-specific eradication strategy based on a non-G-quadruplex targeting manner.
The Rise of Shadow Banking: Evidence from Capital Regulation
Authors: Irani Rustom M , Iyer Rajkamal , Meisenzahl Ralf R , Peydró José-Luis
Published: August 2020

We investigate the connections between bank capital regulation and the prevalence of lightly regulated nonbanks (shadow banks) in the U.S. corporate loan market. For identification, we exploit a supervisory credit register of syndicated loans, loan-time fixed effects, and shocks to capital requirements arising from surprise features of the U.S. implementation of Basel III. We find that less-capitalized banks reduce loan retention, particularly among loans with higher capital requirements and at times when capital is scarce, and nonbanks step in. This reallocation is associated with important adverse effects during the 2008 crisis: loans funded by nonbanks with fragile liabilities are less likely to be rolled over and experience greater price volatility.
New Asian and NearcticHypechiniscusspecies (Heterotardigrada: Echiniscidae) signalize a pseudocryptic horn of plenty
Authors: Gąsiorek Piotr , Oczkowski Artur , Blagden Brian , Kristensen Reinhardt M , Bartels Paul J , Nelson Diane R , Suzuki Atsushi C , Michalczyk Łukasz
Published: August 2020

The cosmopolitan echiniscid genus Hypechiniscus contains exclusively rare species. In this contribution, by combining statistical morphometry and molecular phylogeny, we present qualitative and quantitative aspects of Hypechiniscus diversity, which remained hidden under the two purportedly cosmopolitan species: H. gladiator and H. exarmatus. A neotype is designated for H. gladiator from Creag Meagaidh (Scotland), and an informal re-description is provided for H. exarmatus based on animals from Creag Meagaidh and the Isle of Skye (Inner Hebrides). Subspecies/forms of H. gladiator are suppressed due to the high developmental variability of the cirrus dorsalis. At the same time, four species of the genus are described: H. daedalus sp. nov. from Roan Mountain and the Great Smoky Mountains (Southern Appalachian Mountains, USA), H. flavus sp. nov. and H. geminus sp. nov. from the Yatsugatake Mountains (Honshu, Japan), and H. cataractus sp. nov. from the Malay Archipelago (Borneo and the Moluccas). Dorsal and ventral sculpturing, together with morphometric traits, are shown to be the key characters that allow for the phenotypic discrimination of species within the genus. Furthermore, the morphology of Hypechiniscus is discussed and compared to that of the most similar genera, Pseudechiniscus and Stellariscus. Finally, a diagnostic key to all recognized Hypechiniscus species is provided.
A Lipid Transfer Protein has Antifungal and Antioxidant Activity and Suppresses Fusarium Head Blight Disease and DON Accumulation in Transgenic Wheat
Authors: McLaughlin John E. , Darwish Noura I. , Garcia-Sanchez Jeffrey , Tyagi Neerja , Trick Harold N. , McCormick Susan , Dill-Macky Ruth , Tumer Nilgun E.
Published: August 2020

Trichothecene mycotoxins such as deoxynivalenol (DON) are virulence factors of Fusarium graminearum, which causes Fusarium head blight, one of the most important diseases of small grain cereals. We previously identified a nonspecific lipid transfer protein (nsLTP) gene, AtLTP4.4, which was overexpressed in an activation-tagged Arabidopsis line resistant to trichothecin, a type B trichothecene in the same class as DON. Here we show that overexpression of AtLTP4.4 in transgenic wheat significantly reduced F. graminearum growth in ‘Bobwhite’ and ‘RB07’ lines in the greenhouse and reduced fungal lesion size in detached leaf assays. Hydrogen peroxide accumulation was attenuated on exposure of transgenic wheat plants to DON, indicating that AtLTP4.4 may confer resistance by inhibiting oxidative stress. Field testing indicated that disease severity was significantly reduced in two transgenic ‘Bobwhite’ lines expressing AtLTP4.4. DON accumulation was significantly reduced in four different transgenic ‘Bobwhite’ lines expressing AtLTP4.4 or a wheat nsLTP, TaLTP3, which was previously shown to have antioxidant activity. Recombinant AtLTP4.4 purified from Pichia pastoris exhibited potent antifungal activity against F. graminearum. These results demonstrate that overexpression of AtLTP4.4 in transgenic wheat suppresses DON accumulation in the field. Suppression of DON-induced reactive oxygen species by AtLTP4.4 might be the mechanism by which fungal spread and mycotoxin accumulation are inhibited in transgenic wheat plants.
Influence of Topical Anesthesia on Superficial Sensitivity: A Double-Blind, Randomized, Placebo-Controlled Study on 48 Healthy Subjects
Authors: Illg Claudius , Krauss Sabrina , Kersten Anabel , Daigeler Adrien , Wenger Andrea
Published: August 2020

BACKGROUND

Topical anesthetics are used in noninvasive transdermal anesthesia to decrease the superficial pain sensation threshold during dermatologic surgery. Combined pain relief and sensitivity loss can avoid discomfort during the surgery.

OBJECTIVE

The aim of this placebo-controlled study was to compare the efficacy of 3 commonly used topical agents by collating loss of sensitivity over time.

MATERIALS AND METHODS

Three topical anesthetic creams, a topical anti-inflammatory cream, and a moisturizing cream were applied on the left volar forearm of each of the 48 healthy Caucasian participants. Sensitivity was assessed with the dynamic 2-point discrimination and the Semmes–Weinstein test at 0, 60, 90, 120, 150, and 180 minutes after cream application.

RESULTS

After 180 minutes, benzocaine showed a significantly lower 2-point discrimination reduction than lidocaine alone and a lidocaine and prilocaine mixture. Sensory threshold measurements by the Semmes–Weinstein test after 60 minutes revealed a significantly higher effect with lidocaine alone and with the lidocaine and prilocaine mixture than with benzocaine.

CONCLUSION

The authors found a stronger skin sensitivity reduction by the eutectic lidocaine and prilocaine mixture and lidocaine alone compared with benzocaine. We suggest increased discomfort reduction in topical anesthetic supported dermatologic surgery by the eutectic mixture and lidocaine alone.
Generational Status, Language Use, Parental Limit Setting, and Screen Time in US Latinx Children
Authors: Sharma Neil P. , Documėt Patricia I. , Gibbs Bethany Barone , Taverno Ross Sharon E.
Published: August 2020

Latinx children engage in excessive screen time and are disproportionately affected by obesity. We examined the effect of generational status and language use on screen time in 6- to 11-year-old Latinx children and whether parental limit setting mediated that relationship. Participants included 3127 children (aged 9.2 ± 2.0 years; 54% male) from the 2011-2012 National Survey of Children's Health. Spanish language use was associated with 14.0 more minutes per day of screen time (P = .038); parental limit setting partially mediated this relationship (11.4%). Future research should explore the protective role of parental limit setting in reducing screen time in Latinx children.
Recovering Patient Trust We Lost in the Pandemic
Authors: Sharieff Ghazala Q.
Published: August 2020

The question of how to engender patient trust in a pandemic is not easy to answer, and yet it is a critical question that requires a convincing response. On March 14, 2020, the surgeon general of the United States called for a stop to elective procedures. Ultimately, that led us at Scripps Health to close some clinics to protect personal protective equipment supplies and then furlough staff because of the decrease in patient visits. It soon became evident, however, that patients needed our care more than ever, and we had to pivot to provide the services they needed—but in a very different way. Our team rose to the challenge and quickly redesigned the entire organizational approach to accelerate telehealth services for the convenience of our patients. In the process, we also targeted a patient outreach program to our high-risk patients, which turned out to be an important aspect of our COVID-19 patient care initiative.
Prevent, Detect, and Treat: The Military’s Flexible Approach for a Whole-of-Nation Pandemic Response
Authors: McGee LTC Jarrod , Michael COL Tracy
Published: August 2020

As community transmission of COVID-19 first emerged in the United States and then quickly spread, America’s military accepted an important role in responding to the growing pandemic. The Department of Defense (DOD) rapidly mobilized and deployed personnel, expeditionary medical capabilities, supplies, and equipment to hot spots across the country. How does a military with an expeditionary focus and armed for war abroad quickly pivot to support national response efforts to a public health crisis here at home? Coinciding with the DOD’s established flexible response methodology, the US Army adapted a three-pronged approach to prevent, detect, and treat COVID-19 while protecting the force and safeguarding the American people. This approach is providing strategic and operational lessons for improving healthcare delivery, informing public health decisions, and allocating healthcare resources for future pandemic response and civil emergency support efforts.
Continuing Care for Older Adults Through and Beyond a Pandemic
Authors: Capasso John
Published: August 2020

COVID-19 will remain a threat to millions of older adults for the foreseeable future, challenging healthcare providers to find successful ways to address this population's special needs. Thanks to well-defined core values and an experienced and innovative team of colleagues, Trinity Health's Continuing Care division has been able to adroitly support thousands of older adults throughout the COVID-19 pandemic. Our response has also included working to maintain the safety and well-being of thousands of staff who serve in this space every day. The pandemic is less than a year old, yet we have learned lessons that an organization typically takes many years to learn, and we are pleased to share them here. One of the greatest lessons is that, to best respond to a pandemic, everyone in an organization should have a clear understanding of purpose and strategy. In other words, know why you exist and what you need to do to weather the unknown until a vaccine or cure is available for all.
Hybrid coronary revascularization: are we there yet?
Authors: McKiernan Maureen , Halkos Michael E.
Published: August 2020

Purpose of review

With advances in minimally invasive surgical and percutaneous coronary therapies, hybrid coronary revascularization (HCR) is well positioned to be an ideal strategy for revascularization in selected patients with multivessel coronary artery disease (CAD). The purpose of this review is to highlight recent outcomes and comparative effectiveness studies of HCR.

Recent findings

Patients undergoing HCR have comparable outcomes compared with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The major benefits compared with CABG appear to be related to short-term morbidity and resource utilization. Compared with PCI, HCR may decrease repeat revascularization rates by decreasing reintervention of the left anterior descending coronary artery.

Although HCR is associated with a significant learning curve, specifically with minimally invasive CABG techniques, the early outcomes remain promising and should be considered as a viable option for revascularization in select patients with multivessel CAD.
Revisiting the Direct Brow Lift in Patients With Facial Palsy: 4 Key Modifications
Authors: Butler Daniel P. , Nagendran Sonali , Malhotra Raman
Published: August 2020

Purpose:

The direct brow lift is a simple and popular technique, particularly in patients with brow ptosis secondary to facial palsy. It provides a high degree of control in determining the degree of brow elevation and shape achieved. However, it is arguably the least debated in terms of addressing some of its sequelae, namely the risks of a visible or indrawn scar and forehead paraesthesia. In this article, we report outcomes using four alternative principles to those outlined in current published literature.

Methods:

All patients undergoing a primary direct brow lift for brow ptosis secondary to facial palsy between January 2015 and December 2019 under a single surgeon (R.M.) were included in the study. The technical refinements of the procedure included a W-plasty type stealth skin incision, counter-bevelling of the upper and lower incision lines, skin excision in the subcutaneous plane only with minimal excision of fat and browpexy to the frontal periosteum through small linear puncture incisions in the frontalis.

Results:

A total of 23 patients undergoing 24 direct brow lifts were included in the study. The mean follow-up was 1.3 years (range 0.5–3 years). No patients reported postoperative forehead paraesthesia or brow alopecia. One patient required a further temporal browlift 15 months later. Brow height was rated excellent (0–1.5 mm difference) in 71% of brows and good (1.6–4.9 mm difference) in 14% of brows. The average Manchester scar scale was 8.6/28.

Conclusion:

The technical modifications presented substantially reduce the rates of postoperative paraesthesia, whilst achieving satisfactory aesthetic outcomes.
Intravenous Catheter Employed in Peritrochlear Injection of Triamcinolone in the Treatment of Trochleitis
Authors: Rubenstein Jordan A. , Chang Chih-Chiun , Idowu Oluwatobi O. , Winn Bryan J.
Published: August 2020

Purpose:

Injection of corticosteroid into the peritrochlear region is a widely practiced and highly successful treatment option for trochleitis, conventionally using a 25- or 27-gauge needle for the steroid injection. Injection into the vascular-rich peritrochlear region poses a risk, albeit rare, of central retinal artery occlusion or orbital hemorrhage. We describe a potentially safer method of delivering triamcinolone to the peritrochlear region using a 24-gauge intravenous catheter.

Methods:

Interventional retrospective case series including all patients who received peritrochlear injections of triamcinolone via intravenous catheter for trochleitis by a single surgeon (BJW). Surgical technique: After a subcutaneous wheel of local anesthetic was delivered to the medial upper eyelid skin nearest to the trochlea, a 24-gauge intravenous catheter was used to penetrate the skin and orbital septum. Once past the septum, the needle was removed and the blunt catheter was advanced into the peritrochlear region. A 1-ml syringe filled with 40 mg/ml triamcinolone was attached to the catheter. After pulling back to ensure that the catheter was not intravascular, triamcinolone was delivered to the orbit. The catheter was then removed.

Results:

Ten catheter injections were performed on 3 patients over an 8-year period. There were no complications.

Conclusion:

Injection of corticosteroid into the peritrochlear region using the commonly available 24-gauge intravenous catheter is an effective and theoretically safer alternative to typical injection using a 25-gauge needle for treatment of trochleitis. Use of nonparticulate steroid solutions may further decrease the risk of adverse events.
Arthroscopic Primary Repair for Partial Proximal Anterior Cruciate Ligament Tear in Military Personnel
Authors: Liao Weixiong , Zhang Qiang
Published: August 2020

Objective:

To evaluate the short-term clinical outcomes of arthroscopic primary repair for partial proximal anterior cruciate ligament (ACL) tear in a young, active duty military population.

Design:

Retrospective cohort study.

Setting:

A national tertiary-level medical and academic institution.

Patients:

Nineteen active duty military patients with partial proximal ACL tears and excellent tissue quality were included and 18 were finally analyzed.

Interventions:

All patients underwent arthroscopic primary repair using a suture anchor technique between March 2014 and June 2016.

Main Outcome Measures:

Clinical outcomes were evaluated using anterior drawer test (ADT), Lachman test, pivot shift test, 3-km run test, 10 m × 5 shuttle run test, physical readiness test (PRT) score, Tegner activity score, Lysholm score, modified Cincinnati score, International Knee Documentation Committee (IKDC) subjective score, and magnetic resonance imaging.

Results:

At final follow-up, 17 patients had negative ADT, Lachman, and pivot shift examination findings, and 1 patient had a 1+ ADT, negative Lachman, and pivot shift result. Mean 3-km run time at final follow-up was not statistically different from that preinjury (12:55 vs 12:39, P = 0.071), nor were the 10 m × 5 shuttle run time (23.4 vs 22.9, P = 0.235), PRT score (82.5 vs 85.1, P = 0.086), and Tegner activity score (7.8 vs 7.9, P = 0.083). Mean Lysholm score at final follow-up was significantly improved compared with that preoperative (93.1 vs 70.7, P < 0.001), so were the modified Cincinnati score (90.4 vs 58.6, P < 0.001) and IKDC subjective score (88.3 vs 67.4, P < 0.001).

Conclusions:

Arthroscopic primary repair can achieve short-term clinical success in high-demand military patients with partial proximal ACL tears and excellent tissue quality.
Dynamic Loading Assessment at the Fifth Metatarsal in Elite Athletes With a History of Jones Fracture
Authors: Hunt Kenneth J. , Goeb Yannick , Bartolomei Jonathan
Published: August 2020

Objective:

We hypothesize that athletes who have suffered Jones fractures will apply significantly higher loads at the fifth metatarsal base during athletic activities compared with matched uninjured athletes.

Design:

Sixteen athletes were recruited to participate. Eight athletes had a history of Jones fracture, and 8 age, gender, and position-matched athletes without a history of foot injury were recruited as controls.

Setting:

Institutional study at Stanford University.

Participants:

Sixteen athletes with/without a history of foot injury from Stanford University.

Interventions:

Athletes performed a standardized series of movements while wearing calibrated, wireless pressure mapping insoles, and then again with their custom corrective insoles.

Main Outcome Measures:

Peak pressure, mean pressure, maximum force, and force-time integral (ie, impulse) were recorded for each activity.

Results:

Athletes with a history of Jones fracture showed a significantly increased peak pressure (183 ± 23 vs 138 ± 7 kPA), mean pressure (124 ± 14 vs 95 ± 4 kPA), and maximum force (15 ± 1.2 vs 12 ± 1.2%BW) at the fifth metatarsal base during walking and running compared with uninjured matched controls (all P < 0.05).

Conclusions:

Athletes with a history of Jones fracture exert significantly increased peak and mean forces at the base of the fifth metatarsal during common athletic activities. Custom orthoses do not seem to offload this region in all cases. Increased loads may contribute to the development of stress injury to the fifth metatarsal during repetitive loading, and ultimately fracture of the bone.
Investigation of dry eye symptoms of medical staffs working in hospital during 2019 novel coronavirus outbreak
Authors: Long Yan , Wang XiaWei , Tong Qian , Xia JianHua , Shen Ye
Published: August 2020

The aim of this study was to survey the prevalence of dry eye symptoms (DES) among doctors and nurses in the period of 2019, novel coronavirus (COVID-19) outbreak.

To evaluate the DES of doctors and nurses worked at front-line hospitals with protective glasses for a mean time of 4 to 6 hours, a questionnaire developed by the researchers with the Ocular Surface Disease Index (OSDI) was used. These data were evaluated using descriptive statistics and correlation test with SPSS 22.0.

The study included 13 doctors and 40 nurses, among which 16 were male and 37 were female, and the mean age of the participants was 32.43 ± 5.15 years old. According to the OSDI scores, 64.15, 24.52, 7.54, and 3.77% of the participants experienced occasional, mild, moderate, and severe DES, respectively. The factors significantly correlated with OSDI scores were age and duration of wearing protective glasses, while the duration of wearing protective glasses may be a protective factor of dry eye symptoms.

Our study showed that most of the doctors and nurses worked at the front-line of combating COVID-19 did not experience DES, while the symptoms of those who experienced DES might be improved by wearing protective glasses.
Prognostic Relevance of Macrophage Phenotypes in High-grade Oral Tongue Squamous Cell Carcinomas
Authors: Agarbati Silvia , Mascitti Marco , Paolucci Eleonora , Togni Lucrezia , Santarelli Andrea , Rubini Corrado , Fazioli Francesca
Published: August 2020

Tumor-associated macrophages (TAMs) are part of the tumor microenvironment, broadly divided into M1 and M2 phenotypes. M1 macrophages, commonly identified by staining the CD11c antigen, have an antitumour immunity role, while M2 macrophages, expressing the CD163 antigen, are involved in tumor progression. Little is known about M1 and M2 phenotypes in the context of the oral tongue squamous cell carcinomas (OTSCC), a subgroup of oral cancer with peculiar clinical behavior. This study evaluated the macrophage polarization in OTSCC specimens to examine their prognostic relevance. To this end, specimens from 71 OTSCC patients graded as G1 or G3 were investigated for CD11c and CD163 expression. Immunohistochemical staining of TAMs was evaluated in tumor nests, tumor inflammation area (TIA), and tumor stroma. To analyze the expression of CD11c and CD163, the percentage of positive cells was scored as 0 (negative), 1 (<10%), 2 (11% to 50%), 3 (51% to 80%), and 4 (>80%). The staining intensity was scored as 0 (negative), 1 (weak), 2 (moderate), and 3 (intense). Higher expression of both CD163+ and CD11c+ macrophages in inflammation area positively correlated with G3 grade, both in extension and intensity. Focusing on G3 tumors, survival curves showed better disease-free survival in patients with high CD11c expression in the TIA. Presence of CD163 expression in TIA was associated with worse disease-free survival. This study evaluated, for the first time, the distribution of M1 and M2 macrophages in relation to the pathologic grade in OTSCC, highlighting the prognostic relevance of analyzing the localization of TAMs.
Association of Acute Kidney Injury With Subsequent Sepsis in Critically Ill Children
Authors: Formeck Cassandra L. , Joyce Emily L. , Fuhrman Dana Y. , Kellum John A.
Published: August 2020

Objectives:

Acute kidney injury is a major cause of morbidity and mortality in critically ill children. A growing body of evidence has shown that acute kidney injury affects immune function, yet little is known about the association between acute kidney injury and subsequent infection in pediatric patients. Our objective was to examine the association of non-septic acute kidney injury with the development of subsequent sepsis in critically ill children.

Design:

A single-center retrospective cohort study.

Setting:

The pediatric and cardiac ICUs at a tertiary pediatric care center.

Patients:

All patients 0–18 years old without a history of chronic kidney disease, who did not have sepsis prior to or within the initial 48 hours of ICU admission.

Interventions:

None.

Measurements and Main Results:

We analyzed data for 5,538 children (median age, 5.3 yr; 58.2% male), and identified 255 (4.6%) with stage 2 or 3 acute kidney injury. Suspected sepsis occurred in 46 children (18%) with stage 2 or 3 acute kidney injury compared to 286 children (5.4%) with stage 1 or no acute kidney injury. On adjusted analysis, children with stage 2 or 3 acute kidney injury had 2.05 times greater odds of developing sepsis compared to those with stage 1 or no acute kidney injury (95% CI, 1.39–3.03; p < 0.001). Looking at acute kidney injury severity, children with stage 2 and 3 acute kidney injury had a 1.79-fold (95% CI, 1.15–2.79; p = 0.01) and 3.24-fold (95% CI, 1.55–6.80; p = 0.002) increased odds of developing suspected sepsis, respectively.

Conclusions:

Acute kidney injury is associated with an increased risk for subsequent infection in critically ill children. These results further support the concept of acute kidney injury as a clinically relevant immunocompromised state.
Comparison of Patient Symptomatology before and after Labiaplasty
Authors: Sorice-Virk Sarah , Li Alexander Y. , Canales Francisco L. , Furnas Heather J.
Published: August 2020

Background:

Labiaplasty has grown in popularity, but it remains controversial. Few studies have quantified the change in specific symptomatology from before to after labiaplasty to establish its effectiveness in improving quality of life.

Methods:

In a prospective study, 62 patients undergoing labiaplasty completed written surveys privately in an examination room preoperatively and postoperatively about the presence of 11 physical and appearance-related symptoms.

Results:

Mean patient age was 33.5 years (range, 17 to 61 years). Two patients were of minority age. All patients presented with at least one symptom, averaging 6.5 (range, one to 11). Most (82.2 percent) had a trim labiaplasty, and the rest (17.7 percent) had a wedge. After labiaplasty, 93.5 percent of patients were symptom-free, with the average dropping to 0.23 of 11 symptoms. Symptom-prevalence changes from preoperatively to postoperatively included self-consciousness, dropping from 93 percent to 6.5 percent; tugging (from 66.1 percent to 0 percent); feeling less attractive (from 66.1 percent to 0 percent); negative impact on self-esteem (from 64.5 percent to 1.6 percent); negative impact on intimacy (from 62.5 percent to 0 percent); twisting (from 58.1 percent to 3.2 percent); being uncomfortable (from 56.5 percent to 4.8 percent); clothing restriction (from 54.8 percent to 3.2 percent); visible outline (from 46.8 percent to 1.6 percent); pain (from 43.5 percent to 1.6 percent); and exposure in swimsuits (from 38.7 percent to 1.6 percent). No major complications occurred. Two patients felt their labia were still too long and revision was offered. Average follow-up was 13.3 months (range, 6 to 24 months).

Conclusions:

Patients with elongated labia have a high incidence of functional and appearance-related symptoms. Labiaplasty is a safe procedure that yields significant improvement in quality of life.

CLINICAL QUESTIONS/LEVEL OF EVIDENCE:

Therapeutic, IV.
Melting the Plastic Ceiling: Where We Currently Stand on Measures to Support Women in Academic Plastic Surgery
Authors: Robinson Isabel S. , Silva Amanda K. , Abdou Salma A. , Daar David A. , Hazen Alexes , Thanik Vishal
Published: August 2020

Background:

Previous studies have provided recommendations for increasing female leadership in academic plastic surgery. This study quantifies the extent to which these recommendations have been met in plastic surgery residency programs and identifies remaining institutional barriers to the advancement of women in academic plastic surgery.

Methods:

An electronic survey was designed to quantify select recommendations for promoting female leadership in academic plastic surgery. The survey was distributed to either a female faculty member or a male program director at each academic plastic surgery program. An optional phone interview discussing current barriers to women’s advancement followed the survey.

Results:

Forty-nine of 92 survey recipients participated (52.7 percent response rate). Women constituted 25 percent of faculty, 22 percent of program directors, and 20 percent of program leaders of participating programs. Programs on average provided three of 11 resources. Programs with female leaders provided 6.20 resources versus 2.28 resources at departments with male chairs (p = 0.015). Programs with female program directors provided 5.50 resources versus 2.18 resources at programs with male program directors (p = 0.008). Of the 49 survey respondents, nine completed the interview (18.4 percent completion rate). The most frequently identified barriers to aspiring women leaders were opaque promotion criteria (cited by 77.8 percent of interviewees), motherhood bias (77.8 percent), and unequal recruitment practices (55.6 percent).

Conclusions:

The presence of a female chair or program director is associated with a greater quantity of resources for promoting female leaders. Remaining barriers to women seeking academic leadership positions include compensation and promotion disparities, motherhood bias, and unequal recruitment practices.
Interstitial Lung Fibrosis Imaging Reporting and Data System: What Radiologist Wants to Know?
Authors: Razek Ahmed Abdel Khalek Abdel , El Badrawy Mohamed Khairy , Alnaghy Eman
Published: August 2020

The aim of this work is to review interstitial lung fibrosis Imaging Reporting and Data System (ILF-RADS) that was designed for reporting of interstitial lung fibrosis (ILF). Findings include pulmonary and extrapulmonary findings and is subsequently designed into 4 categories. Pulmonary findings included lung volume, reticulations, traction bronchiectasis, honeycomb, nodules, cysts, ground glass, consolidation, mosaic attenuation and emphysema, and distribution of pulmonary lesions; axial (central, peripheral and diffuse), and zonal distribution (upper, middle, and lower zones). Complications in the form of acute infection, acute exacerbation, and malignancy were also assessed. Extrapulmonary findings included mediastinal, pleural, tracheal, and bone or soft tissue lesions. The lexicon of usual interstitial pneumonia (UIP) was classified into 4 categories designated as belonging in 1 of 4 categories. Lexicon of ILF-RADS-1 (typical UIP), ILF-RADS-2 (possible UIP), ILF-RADS-3 (indeterminate for UIP), and ILF-RADS-4 (inconsistent with UIP).
Conventional and Advanced Magnetic Resonance Imaging Features of Supratentorial Extraventricular Ependymomas
Authors: Jabeen Shumyla , Konar Subhas K. , Prasad Chandrajit , Mahadevan Anita , Beniwal Manish , Sadashiva Nishanth , Santosh Vani , Saini Jitender
Published: August 2020

Objective

To describe the magnetic resonance imaging characteristics of supratentorial ependymomas.

Methods

The magnetic resonance imaging and computed tomography imaging characteristics of 49 cases of supratentorial ependymomas were analyzed retrospectively. The location, size, degree of perilesional edema, gross appearance, computed tomography attenuation characteristics, T1 and T2 signal intensity characteristics, degree of diffusion restriction, presence of calcification, and hemorrhage were documented for each lesion. The intratumoral susceptibility scores (ITSS), apparent diffusion coefficient (ADC) values, relative cerebral blood volume, and choline/N-acetyl aspartate ratios were documented where available.

Results

The frontal lobe was the most common location with a mean size of 6.37 × 4.8 cm. Severe perilesional edema was evident in 30%. Heterogenous, solid-cystic appearance was present in 96% lesions, with 95% of extraventricular lesions extending from pial surface to the ventricular margin. Calcification was seen in 55% of cases. The ITSS was 3 in 85.7% of lesions. The mean ADC value calculated was 600 × 10−6 mm2/s. The mean relative cerebral blood volume on dynamic susceptibility contrast perfusion was 4.83. The mean choline/N-acetyl aspartate ratio was 5.87. Leptomeningeal dissemination was demonstrable in 5 lesions. Four lesions were abutting the dura with frank dural invasion in one. One patient presented with disseminated disease without evidence of a primary lesion.

Conclusions

A large lesion with relatively well-defined margins, heterogeneous solid cystic appearance, extending from the pial surface to the ventricular margin, presence of calcification, and ADC values approaching those of white matter should raise a suspicion of supratentorial ependymoma. High ITSS, MR perfusion parameters, and magnetic resonance spectroscopy characteristics are similar to those of other high-grade gliomas.
Differentiation of Crystals Associated With Arthropathies by Spectral Photon-Counting Radiography
Authors: Huber Florian Alexander , Becce Fabio , Gkoumas Spyridon , Thüring Thomas , Steinmetz Sylvain , Letovanec Igor , Guggenberger Roman
Published: August 2020

Objectives

The aims of this study were to test whether spectral photon-counting radiography (SPCR) is able to identify and distinguish different crystals associated with arthropathies in vitro and to validate findings in a gouty human third toe ex vivo.

Materials and Methods

Industry-standard calibration rods of calcium pyrophosphate, calcium hydroxyapatite (HA), and monosodium urate (MSU) were scanned with SPCR in an experimental setup. Each material was available at 3 different concentrations, and a dedicated photon-counting detector was used for SPCR, whereas validation scans were obtained on a clinical dual-energy computed tomography (DECT) scanner. Regions of interest were placed on SPCR images and consecutive DECT images to measure x-ray attenuation characteristics, including effective atomic numbers (Z
eff). Statistical tests were performed for differentiation of Z
eff between concentrations, materials, and imaging modalities. In addition, a third toe from a patient with chronic gouty arthritis was scanned with SPCR and DECT for differentiation of MSU from HA.

Results

In both SPCR and DECT, significant differences in attenuation and Z
eff values were found for different concentrations among (P < 0.001) and between different materials (P < 0.001). Overall, quantitative measurements of Z
eff did not differ significantly between SPCR- and DECT-derived measurements (P = 0.054–0.412). In the human cadaver toe, gouty bone erosions were visible on standard grayscale radiographic images; however, spectral image decomposition revealed the nature and extent of MSU deposits and was able to separate it from bone HA by Z
eff.

Conclusions

Identification and differentiation of different crystals related to arthropathies are possible with SPCR at comparable diagnostic accuracy to DECT. Further research is needed to assess diagnostic accuracy and clinical usability in vivo.
MRI-Guided Focused Ultrasound of Osseous Metastases
Authors: Bitton Rachel R. , Rosenberg Jarrett , LeBlang Suzanne , Napoli Alessandro , Meyer Joshua , Butts Pauly Kim , Hurwitz Mark , Ghanouni Pejman
Published: August 2020

Background

A phase 3 multicenter trial demonstrated that magnetic resonance imaging (MRI)–guided focused ultrasound (US) is a safe, noninvasive treatment that alleviated pain from bone metastases. However, outcomes varied among institutions (from 0%–100% treatment success).

Purpose

The aim of this study was to identify patient selection, technical treatment, and imaging parameters that predict successful pain relief of osseous metastases after MRI-guided focused US.

Materials and Methods

This was a secondary analysis of a phase 3 clinical study that included participants who received MRI-guided focused US treatment for painful osseous metastases. Noncontrast CT was obtained before treatment. T2-weighted and T1-weighted postcontrast MRIs at 1.5 T or 3 T were obtained before, at the time of, and at 3 months after treatment. Numerical Rating Scale pain scores and morphine equivalent daily dose data were obtained over a 3-month follow-up period. At the 3-month endpoint, participants were categorized as pain relief responders or nonresponders based on Numerical Rating Scale and morphine equivalent daily dose data. Demographics, technical parameters, and imaging features associated with pain relief were determined using stepwise univariable and multivariable models. Responder rates between the subgroup of participants with all predictive parameters and that with none of the parameters were compared using Fisher exact test.

Results

The analysis included 99 participants (mean age, 59 ± 14 years; 56 women). The 3 variables that predicted successful pain relief were energy density on the bone surface (EDBS) (P = 0.001), the presence of postprocedural periosteal devascularization (black band, BB+) (P = 0.005), and female sex (P = 0.02). The subgroup of participants with BB+ and EDBS greater than 5 J/mm2 had a larger decrease in mean pain score (5.2; 95% confidence interval, 4.6–5.8) compared with those without (BB−, EDBS ≤ 5 J/mm2) (1.1; 95% confidence interval, 0.8–3.0; P < 0.001). Participants with all 3 predictive variables had a pain relief responder rate of 93% compared with 0% in participants having none of the predictive variables (P < 0.001).

Conclusions

High EDBS during treatment, postprocedural periosteal devascularization around the tumor site (BB+), and female sex increased the likelihood of pain relief after MRI-guided focused US of osseous metastasis.
Uncovering the Hidden Penis
Authors: Ngaage Ledibabari Mildred , Lopez Joseph , Wu Yinglun , Nam Arthur , Boyle Karen , Rasko Yvonne , Goldberg Nelson
Published: August 2020

Introduction

A hidden penis can interfere with normal hygiene, prevent effective voiding, restrict sexual activity, and cause great embarrassment to the patient. The terms “hidden,” “buried,” and “trapped” penis are used interchangeably. To date, there is no classification system that adequately characterizes the spectrum of this condition. In this study, we propose a simplified nomenclature and classification system for adult-acquired hidden penis.

Methods

We performed a retrospective review of all adult patients treated surgically for hidden penis by the senior author from 2009 to 2019. Patients were classified into either “buried” or “trapped” categories. A “buried” penis was defined as a hidden penis concealed by suprapubic fat without fibrous tethering. These patients were managed with panniculectomy, monsplasty, or both. In contrast, those with a “trapped” penis presented with scarred or fibrous tissue, which required surgical lysis, phalloplasty, and penile skin resurfacing.

Results

Thirteen patients met the inclusion criteria. The cohort was aged 53 ± 15.7 years with a mean body mass index of 37.4 ± 4.3 kg/m2. Two patients required repeat operations, yielding a total of 15 operative encounters. Six were defined as buried, and 9 as trapped. Inability to achieve erection was the most common preoperative complaint in those with buried penis (67%), whereas difficulties in voiding were most common with trapped penis (78%). Patients with trapped penises had a significantly larger body habitus than those with a buried penis (39.8 vs 34.2 kg/m2, P = 0.0088). Operative duration and length of hospital stay were comparable between the trapped and buried penis groups (206 vs 161 minutes, P = 0.3664) (5 vs 1 day, P = 0.0836). One third experienced wound complications, but this was not significantly different between buried and trapped penises (17% vs 44%, P = 0.5804). Postoperatively, 5 patients experienced spontaneous erections, and 7 were able to void while standing.

Conclusions

Patients with a trapped penis present with a different preoperative symptom profile and body type than those with a buried penis. Our nomenclature and classification system offer a simple and clear algorithm for the management of hidden penis. Large cohort studies are warranted to assess differences in clinical outcomes between trapped and buried penises.
On the vital role of enamel prism interfaces and graded properties in human tooth survival
Authors: Borrero-Lopez Oscar , Constantino Paul J. , Bush Mark B. , Lawn Brian R.
Published: August 2020

Teeth of omnivores face a formidable evolutionary challenge: how to protect against fracture and abrasive wear caused by the wide variety of foods they process. It is hypothesized that this challenge is met in part by adaptations in enamel microstructure. The low-crowned teeth of humans and some other omnivorous mammals exhibit multiple fissures running longitudinally along the outer enamel walls, yet remain intact. It is proposed that inter-prism weakness and enamel property gradation act together to avert entry of these fissures into vulnerable inner tooth regions and, at the same time, confer wear resistance at the occlusal surface. A simple indentation experiment is employed to quantify crack paths and energetics in human enamel, and an extended-finite-element model to evaluate longitudinal crack growth histories. Consideration is given as to how tooth microstructure may have played a vital role in human evolution, and, by extension, to other omnivorous mammals.
Investigating persistent measles dynamics in Niger and associations with rainfall
Authors: Blake Alexandre , Djibo Ali , Guindo Ousmane , Bharti Nita
Published: August 2020

Measles is a major cause of child mortality in sub-Saharan Africa. Current immunization strategies achieve low coverage in areas where transmission drivers differ substantially from those in high-income countries. A better understanding of measles transmission in areas with measles persistence will increase vaccination coverage and reduce ongoing transmission. We analysed weekly reported measles cases at the district level in Niger from 1995 to 2004 to identify underlying transmission mechanisms. We identified dominant periodicities and the associated spatial clustering patterns. We also investigated associations between reported measles cases and environmental drivers associated with human activities, particularly rainfall. The annual and 2–3-year periodicities dominated the reporting data spectrum. The annual periodicity was strong with contiguous spatial clustering, consistent with the latitudinal gradient of population density, and stable over time. The 2–3-year periodicities were weaker, unstable over time and had spatially fragmented clustering. The rainy season was associated with a lower risk of measles case reporting. The annual periodicity likely reflects seasonal agricultural labour migration, whereas the 2–3-year periodicity potentially results from multiple mechanisms such as reintroductions and vaccine coverage heterogeneity. Our findings suggest that improving vaccine coverage in seasonally mobile populations could reduce strong measles seasonality in Niger and across similar settings.
A registered report on how implicit pro-rich bias is shaped by the perceiver's gender and socioeconomic status
Authors: Mattan Bradley D. , Cloutier Jasmin
Published: August 2020

Although high status is often considered a desirable quality, this may not always be the case. Different factors may moderate the value of high status along a dimension such as wealth (e.g. gender, perceiver income/education). For example, studies suggest men may value wealth and control over resources more than women. This may be especially true for high-income men who already have control over substantial resources. Other work suggests that low-income men and women may have different experiences in educational contexts compared to their richer peers who dominate norms at higher levels of education. These experiences may potentially lead to different attitudes about the wealthy among low-income men and women. In this registered report, we proposed two key predictions based on our review of the literature and analyses of pilot data from the Attitudes, Identities and Individual Differences (AIID) study (
n
= 767): (H1) increasing income will be associated with increased pro-wealthy bias for men more than for women and (H2) income will also moderate the effect of education on implicit pro-wealthy bias, depending on gender. Overall, men showed greater implicit pro-wealthy bias than did women. However, neither of our hypotheses that income would moderate the effects of gender on implicit pro-wealthy bias were supported. These findings suggest implicit pro-wealthy bias among men and are discussed in the context of exploratory analyses of gender differences in self-reported beliefs and attitudes about the rich and the poor.
Young but not defenceless: antifungal activity during embryonic development of a social insect
Authors: Cole Erin L. , Bayne Haley , Rosengaus Rebeca B.
Published: August 2020

Termites live in environments heavily colonized by diverse microorganisms, including pathogens. Eggs laid within the nest are likely to experience similar pathogenic pressures as those experienced by older nest-mates. Consequently, eggs may be under selective pressures to be immune-competent. Through
in vitro
experiments using developing embryos of the dampwood termite,
Zootermopsis angusticollis
, we tested the ontogeny, location and strength of their antifungal activity against the fungus,
Metarhizium brunneum
. Exterior washes of the chorion (extra-chorionic) and components within the chorion (intra-chorionic) were incubated with fungal conidia, which were then scored for viability. The fungistatic activity was location and developmental stage dependent. Extra-chorionic washes had relatively weak antifungal activity. Intra-chorionic homogenates were highly antifungal, exhibiting increased potency through development. The positive correlation between intra-chorionic fungistasis and developmental stage is probably due to the expression of endogenous proteins during embryogenesis. Boiling of both the extra-chorionic washes and the intra-chorionic contents rescued conidia viability, indicating the antifungal agent(s) is (are) heat-sensitive and probably proteinaceous. This study is the first to address embryonic antifungal activity in a hemimetabolous, eusocial taxon. Our results support the hypothesis that microbes have been significant agents of selection in termites, fostering the evolution of antifungal properties even in the most immature stage of development.