bluuebunny/crossref_metadata_2025 huggingface dataset:
Arabidopsis Class I Formin FH1 Relocates between Membrane Compartments during Root Cell Ontogeny and Associates with Plasmodesmata
Authors: Oulehlov� Denisa , Koll�rov� Eva , Cifrov� Petra , Pejchar Přemysl , Ž�rsk� Viktor , Cvrčkov� Fatima
Published: May 2019

Formins are evolutionarily conserved eukaryotic proteins engaged in actin nucleation and other aspects of cytoskeletal organization. Angiosperms have two formin clades with multiple paralogs; typical plant Class I formins are integral membrane proteins that can anchor cytoskeletal structures to membranes. For the main Arabidopsis housekeeping Class I formin, FH1 (At3g25500), plasmalemma localization was documented in heterologous expression and overexpression studies. We previously showed that loss of FH1 function increases cotyledon epidermal pavement cell shape complexity via modification of actin and microtubule organization and dynamics. Here, we employ transgenic Arabidopsis expressing green fluorescent protein-tagged FH1 (FH1-GFP) from its native promoter to investigate in vivo behavior of this formin using advanced microscopy techniques. The fusion protein is functional, since its expression complements the fh1 loss-of-function mutant phenotype. Accidental overexpression of FH1-GFP results in a decrease in trichome branch number, while fh1 mutation has the opposite effect, indicating a general role of this formin in controlling cell shape complexity. Consistent with previous reports, FH1-GFP associates with membranes. However, the protein exhibits surprising actin- and secretory pathway-dependent dynamic localization and relocates between cellular endomembranes and the plasmalemma during cell division and differentiation in root tissues, with transient tonoplast localization at the transition/elongation zones border. FH1-GFP also accumulates in actin-rich regions of cortical cytoplasm and associates with plasmodesmata in both the cotyledon epidermis and root tissues. Together with previous reports from metazoan systems, this suggests that formins might have a shared (ancestral or convergent) role at cell–cell junctions.
A new in vitro model of polymyositis reveals CD8+ T cell invasion into muscle cells and its cytotoxic role
Authors: Kamiya Mari , Mizoguchi Fumitaka , Takamura Akito , Kimura Naoki , Kawahata Kimito , Kohsaka Hitoshi
Published: May 2019

Objectives

The hallmark histopathology of PM is the presence of CD8+ T cells in the non-necrotic muscle cells. The aim of this study was to clarify the pathological significance of CD8+ T cells in muscle cells.

Methods

C2C12 cells were transduced retrovirally with the genes encoding MHC class I (H2Kb) and SIINFEKL peptide derived from ovalbumin (OVA), and then differentiated to myotubes (H2KbOVA-myotubes). H2KbOVA-myotubes were co-cultured with OT-I CD8+ T cells derived from OVA-specific class I restricted T cell receptor transgenic mice as an in vitro model of PM to examine whether the CD8+ T cells invade into the myotubes and if the myotubes with the invasion are more prone to die than those without. Muscle biopsy samples from patients with PM were examined for the presence of CD8+ T cells in muscle cells. The clinical profiles were compared between the patients with and without CD8+ T cells in muscle cells.

Results

Analysis of the in vitro model of PM with confocal microscopy demonstrated the invasion of OT-I CD8+ T cells into H2KbOVA-myotubes. Transmission electron microscopic analysis revealed an electron-lucent area between the invaded CD8+ T cell and the cytoplasm of H2KbOVA-myotubes. The myotubes invaded with OT-I CD8+ T cells died earlier than the uninvaded myotubes. The level of serum creatinine kinase was higher in patients with CD8+ T cells in muscle cells than those without these cells.

Conclusion

CD8+ T cells invade into muscle cells and contribute to muscle injury in PM. Our in vitro model of PM is useful to examine the mechanisms underlying muscle injury induced by CD8+ T cells.
Transcriptomic and metabolomic profiling of Camellia sinensis L. cv. ‘Suchazao’ exposed to temperature stresses reveals modification in protein synthesis and photosynthetic and anthocyanin biosynthetic pathways
Authors: Shen Jiazhi , Zhang Dayan , Zhou Lin , Zhang Xuzhou , Liao Jieren , Duan Yu , Wen Bo , Ma Yuanchun , Wang Yuhua , Fang Wanping , Zhu Xujun
Published: May 2019

To determine the mechanisms in tea plants responding to temperature stresses (heat and cold), we examined the global transcriptomic and metabolomic profiles of the tea plant cultivar ‘Suchazao’ under moderately low temperature stress (ML), severely low temperature stress (SL), moderately high temperature stress (MH) and severely high temperature stress (SH) using RNA-seq and high performance liquid chromatography tandem mass spectrometry/mass spectrometry (HPLC-MS/MS), respectively. The identified differentially expressed genes indicated that the synthesis of stress-resistance protein might be redirected to cope with the temperature stresses. We found that heat shock protein genes Hsp90 and Hsp70 played more critical roles in tea plants in adapting to thermal stress than cold, while late embryogenesis abundant protein genes (LEA) played a greater role under cold than heat stress, more types of zinc finger genes were induced under cold stress as well. In addition, energy metabolisms were inhibited by SH, SL and ML. Furthermore, the mechanisms of anthocyanin synthesis were different under the cold and heat stresses. Indeed, the CsUGT75C1 gene, encoding UDP-glucose:anthocyanin 5-O-glucosyl transferase, was up-regulated in the SL-treated leaves but down-regulated in SH. Metabolomics analysis also showed that anthocyanin monomer levels increased under SL. These results indicate that the tea plants share certain foundational mechanisms to adjust to both cold and heat stresses. They also developed some specific mechanisms for surviving the cold or heat stresses. Our study provides effective information about the different mechanisms tea plants employ in surviving cold and heat stresses, as well as the different mechanisms of anthocyanin synthesis, which could speed up the genetic breeding of heat- and cold-tolerant tea varieties.
Characterization of the developmental dynamics of the elongation of a bamboo internode during the fast growth stage
Authors: Wei Qiang , Guo Lin , Jiao Chen , Fei Zhangjun , Chen Ming , Cao Junjie , Ding Yulong , Yuan Qisen
Published: May 2019

Previous studies on the fast growth of bamboo shoots mainly focused on the entire culm. No work about the fast elongation of a single internode, which is the basic unit for the fast growth of bamboo shoots, has been reported so far according to our knowledge. In this study, we have systematically investigated the regulating mechanisms underlying the fast growth of a single bamboo internode of Bambusa multiplex (Lour.) Raeusch. ex Schult. We discovered that the growth of the internode displays a logistic pattern, and the two sections located in the bottom of the internode, one for cell division and, another for cell elongation, each with an ~1-cm length, comprise the effective zones for the internode growth. RNA-Seq analysis identified a number of genes potentially involved in regulating the fast growth of bamboo internode such as those that have positive roles in promoting cell growth or division, which were dramatically down-regulated in the internode at fast growth decreasing stage. Further analysis revealed that sugar plays an important role in promoting the fast growth of bamboo internodes through inhibition of BmSnf1. Mechanical stress is found to be involved in the triggering of the internode growth decrease through activation of the generation of reactive oxygen species by upregulating Calmodulins. These results provide systematic insight into the biological mechanisms underlying the fast growth of bamboo shoots based on the behavior of a single internode.
Opioid Prescribing Patterns Among Postpartum Women
Authors: Badreldin N. , Grobman W.A. , Chang K.T. , Yee L.M.
Published: May 2019

(Am J Obstet Gynecol. 2018;219:103.e1–103.e8)

The United States is experiencing an opioid epidemic, which is thought to be caused in part by an increase in opioid prescriptions. There is a lack of data regarding opioid prescriptions after vaginal delivery. This study examined patterns of opioid prescription at the time of discharge for women delivering via cesarean section or vaginally, and related those patterns to measures of pain before discharge.
Dantrolene and Malignant Hyperthermia Carts
Authors: Wong C.A.
Published: May 2019

(Anesthesiology. 2018;129:225–227)

Malignant hyperthermia (MH) is unpredictable, rare, and has a high fatality rate. Fortunately, mortality related to MH has decreased in the past 3 decades, primarily because of increased availability of dantrolene and the education of operating room staff and anesthesia providers. The Malignant Hyperthermia Association of the United States has specified that dantrolene must be available within 10 minutes of all anesthetizing locations.
A Review of the Impact of Obstetric Anesthesia on Maternal and Neonatal Outcomes
Authors: Lim G. , Facco F.L. , Nathan N. , Waters J.H. , Wong C.A. , Eltzschig H.K.
Published: May 2019

(Anesthesiology. 2018;129:192–215)

Since the beginning of obstetric anesthesiology in 1847, the discipline has gone through many changes and employed many different techniques, connecting the fields of obstetrics, maternal fetal medicine, general surgery, neonatology and anesthesiology. Obstetric anesthesia includes a wide range of patient care issues. Clinicians concern themselves with both maternal and neonatal outcomes, and with the prevention as well as management of complications during labor and delivery. This review summarizes advancements in obstetric anesthesia over the past 20 years, including the areas of labor analgesia and anesthesia, anesthesia for cesarean delivery, obstetric anesthesia outcomes, and maternal safety.
Diagnostic Point-of-Care Ultrasound: Applications in Obstetric Anaesthetic Management
Authors: Zieleskiewicz L. , Bouvet L. , Einav S. , Duclos G. , Leone M.
Published: May 2019

(Anaesthesia. 2018;73:1265–1279)

Even in low-risk centers, pregnancies can become complicated seriously and quickly, without time to obtain diagnostic help from specialists. While ultrasound has been routinely used in fetal monitoring, it can also be a useful tool in maternal bedside diagnosis and screening. This report reviews the use of ultrasound in assessing patients’ gastric contents and airways, managing breathless patients, diagnosing shock, and predicting fluid responsiveness.
Increased Single-balloon Foley Catheter Volume for Induction of Labor and Time to Delivery: A Systematic Review and Meta-Analysis
Authors: Schoen C.N. , Saccone G. , Backley S. , Sandberg E.M. , Gu N. , Delaney S. , Berghella V.
Published: May 2019

(Acta Obstet Gynecol Scand. 2018;97:1051–1060)

The Foley catheter is commonly used for cervical ripening in women undergoing labor induction. In an attempt to raise the Bishop score at a faster rate and decrease the time to delivery, Foley balloons are often overinflated, or balloons that accept larger volumes are used. This systematic review and meta-analysis examined randomized controlled trials to determine whether or not this practice is effective in decreasing the time between the start of labor induction and delivery.
Cardiac Arrest During Pregnancy: Ongoing Clinical Conundrum
Authors: Zelop C.M. , Einav S. , Mhyre J.M. , Martin S.
Published: May 2019

(Am J Obstet Gynecol. 2018;219(1):52–61)

Maternal mortality is complex and involves many factors, including comorbidities, access to health care, and racial, socioeconomic, and ethnic disparities. While the global maternal mortality ratio has declined, the maternal mortality ratio in the United States has increased over the last 25 years. The rate of survival of maternal cardiac arrest (MCA) has previously been seen as poor; however, new evidence suggests the pregnant population may have greater survival than others requiring cardiopulmonary resuscitation. This report reviewed techniques for the clinical management of MCA while highlighting existing knowledge gaps. As there is a lack of randomized clinical trials for guiding management of cardiac arrest during pregnancy, data for this review largely came from expert opinions, small case series, simulation studies, and cohort studies.
Hematoma and Abscess After Neuraxial Anesthesia: A Review of 647 Cases
Authors: Bos E.M.E. , Haumann J. , de Quelerij M. , Vandertop W.P. , Kalkman C.J. , Hollmann M.W. , Lirk P.
Published: May 2019

(Br J Anaesth. 2018;120:693–704)

Incidences of spinal hematoma or abscess after central neuraxial block (CNB) are estimated to be low, with the former being 1:154,730 and the latter being so rare, it could not even be calculated in a major 2016 study. Because of the rarity, there is no evidence on which to base recommendations for management strategies. However, these adverse events could result in permanent injury for patients, with the incidence of paraplegia or death being 1.8 per 100,000 patients. Therefore, the authors of the present study reviewed all cases reported regarding spinal hematomas or abscesses after CNB, identified potential factors that may predispose patients to these adverse outcomes, and predicted persistent neurological damage.
Can Oxytocin Augmentation Modify the Risk of Epidural Analgesia by Maternal Age in Cesarean Sections?
Authors: Rossen J. , Klungsøyr K. , Albrechtsen S. , Løkkegård E. , Rasmussen S. , Bergholt T. , Skjeldestad F.E.
Published: May 2019

(Acta Obstet Gynecol Scand. 2018;97:872–879)

Oxytocin augmentation of labor is often used in the setting of labor dystocia to increase the likelihood of vaginal delivery, and therefore avoid cesarean section. Increasing maternal age is an established risk factor for cesarean section. Oxytocin augmentation has been found to occur more frequently among women receiving epidural analgesia, and the authors of this study proposed associations may exist among epidural analgesia, oxytocin augmentation, and maternal age and the correlation with cesarean section. This study examined the effects and interactions of oxytocin augmentation, epidural analgesia and maternal age on the risk of cesarean section in nulliparous women.
Maternal Body Mass Index and Use of Labor Neuraxial Analgesia: Population-based Retrospective Cohort Study
Authors: Butwick A.J. , Wong C.A. , Guo N.
Published: May 2019

(Anesthesiology. 2018;129:448–458)

Maternal obesity is a risk factor for many pregnancy and peripartum complications, and affects one in 4 deliveries in the United States. Neuraxial labor analgesia may offer important benefits to obese women, such as attenuate sympathetically mediated cardiovascular responses and optimize maternal respiratory function. However, the extent to which obese women receive neuraxial labor analgesia is unknown. This study hypothesized that, compared with nonobese parturients, maternal obesity was associated with a higher rate of neuraxial labor analgesia, and aimed to estimate the difference in analgesia rates between the 2 groups.
Antidepressant Use During Pregnancy and the Risk of Attention-deficit/Hyperactivity Disorder in the Children: A Meta-Analysis of Cohort Studies
Authors: Jiang H.Y. , Peng C.T. , Zhang X. , Ruan B.
Published: May 2019

(BJOG. 2018;125(9):1077–1084)

Approximately 10% of pregnant women use antidepressants during pregnancy. Evidence for the relationship between antidepressant use during pregnancy and the risk of attention-deficit/hyperactivity disorder (ADHD) in their offspring is conflicting. ADHD is heritable yet there are environmental factors that may be involved in the development of the disorder. This was a systematic literature review and meta-analysis to assess the association between fetal exposure to antidepressant drugs and the subsequent development of ADHD.
The Incidence, Characteristics, Management, and Outcomes of Anaphylaxis in Pregnancy: A Population-based Descriptive Study
Authors: McCall S.J. , Bunch K.J. , Brocklehurst P. , D’Arcy R. , Hinshaw K. , Kurinczuk J.J. , Lucas D.N. , Stenson B. , Tuffnell D.J. , Knight M.
Published: May 2019

(BJOG. 2018;125:965–971)

Anaphylaxis in pregnancy is characterized by life-threatening breathing, circulatory or airway problems stemming from a systemic hypersensitivity reaction, often caused by exposure to allergens including antibiotics or latex. The incidence of anaphylaxis in pregnancy is unknown but thought to be rising. There is a lack of guidelines for the management of anaphylaxis in pregnancy. This study aimed to describe the incidence, characteristics, management and outcomes of anaphylaxis in pregnancy in the United Kingdom.
Trends in Practice and Safety Measures of Epidural Analgesia: Report of a National Survey
Authors: Bos E.M.E. , Schut M.E. , de Quelerij M. , Kalkman C.J. , Hollmann M.W. , Lirk P.
Published: May 2019

(Acta Anaesthesiol Scand. 2018;62:1466–1472)

There is a trend to move away from neuraxial blocks in favor of truncal blocks, peripheral nerve blocks, and local anesthetic wound infiltration in the Netherlands. Furthermore, recent epidural “alert systems” have been introduced, meant to aid in the early detection of spinal hematoma or abscess after neuraxial anesthesia. However, these changes have not been investigated on a national level. The authors of the present study thus quantified trends in the practice of epidural analgesia and assessed the extent to which these epidural alert systems have been introduced in clinical practice.
Trainability of Cricoid Pressure Force Application: A Simulation-based Study
Authors: Noll E. , Shodhan S. , Varshney A. , Gallagher C. , Diemunsch P. , Florence F.B. , Romeiser J. , Bennett-Guerrero E.
Published: May 2019

(Anesth Analg. 2019;128:109–116)

Cricoid pressure (CP) force has been suggested as a protective means of preventing aspiration of gastric contents during anesthesia. It is widely used for rapid sequence intubation (RSI). Current national guidelines recommend the use of 10 N when the patient is awake, increasing to 30 N once the patient loses consciousness (LOC). However, studies have shown that few clinicians are proficient at achieving such targets, and individual learning curves during simulation training have not been studied. In the present study, the authors determined the extent to which experienced clinicians accurately apply force targets and established individual learning curves during training on a CP simulator.
Vitamin D and Risk of Pregnancy-related Hypertensive Disorders: Mendelian Randomization Study
Authors: Magnus M.C. , Miliku K. , Bauer A. , Engel S.M. , Felix J.F. , Jaddoe V.W.V. , Lawlor D.A. , London S.J. , Magnus P. , McGinnis R. , Nystad W. , Page C.M. , Rivadeneira F. , Stene L.C. , Tapia G. , Williams N. , Bonilla C. , Fraser A.
Published: May 2019

(BMJ. 2018;361:k2477)

Pregnant women commonly have low vitamin D levels, and this might be a causal factor in the development of gestational hypertension and preeclampsia. Previous meta-analyses have suggested an association between a low 25-hydroxyvitamin D concentration and an increased risk of preeclampsia, but these results may be biased. One recent meta-analysis did not find strong evidence that vitamin D supplementation during pregnancy had a protective effect in preventing preeclampsia or gestational hypertension. This current study used mendelian randomization to triangulate findings from studies varying in design and investigate the causal effect of 25-hydroxyvitamin D levels on pregnancy-related hypertensive disorders.
Subsequent Reproductive Outcome Among Women With Peripartum Cardiomyopathy: A Nationwide Study
Authors: Guldbrandt Hauge M. , Johansen M. , Vejlstrup N. , Gustafsson F. , Damm P. , Ersbøll A.S.
Published: May 2019

(BJOG. 2018;125:1018–1025)

Peripartum cardiomyopathy (PPCM) is a condition characterized by idiopathic heart failure late in pregnancy or within 6 months postpartum. It is diagnosed when no other identifiable cause of heart failture is identified and left ventricular systolic function is impaired with left ventricular ejection fraction (LVEF) of 45% of lower. Women who have developed PPCM must receive counseling on potential risks in subsequent pregnancies, but there are not clear guidelines or literature on reproductive outcomes after PPCM. Previous studies reported increased relapse rates if LVEF was still impaired. This study used a Danish cohort of women to investigate perinatal outcomes in women with prior PPCM.
Cesarean Scar Pregnancy, Incidence, and Recurrence: Five-Year Experience at a Single Tertiary Care Referral Center
Authors: Grechukhina O. , Deshmukh U. , Fan L. , Kohari K. , Abdel-Razeq S. , Bahtiyar M.O. , Sfakianaki A.K.
Published: May 2019

(Obstet Gynecol. 2018;132:1285–1295)

Cesarean scar pregnancy, in which a gestational sac implants on the site of a previous hysterotomy, is associated with life-threatening complications. Although numerous treatment modalities have been described (expectant management, methotrexate, intrauterine balloon compression, resection, and more), data on optimal treatment modalities, pregnancy outcomes, treatment decisions, and patient counseling are limited. In order to add to the available literature, the authors of the present study described the treatment and follow-up of women with cesarean scar pregnancy at Yale-New Haven Hospital, a tertiary care center, from 2013 to 2018.
Anesthetic Management for Caesarean Delivery in Patient With Uncorrected Pulmonary Atresia, Ventricular Septal Defect, and Major Aortopulmonary Collateral Arteries
Authors: Gang S.P. , Fang K.Y. , Ma Y. , Zhang F.X. , Xiang D.K. , Liu X.L. , Wang R.P. , Chen D.D. , Ma X.W.
Published: May 2019

(Int J Obstet Anesth. 2018;36:125–129)

Pulmonary atresia with ventricular septal defect and major aortopulmonary arteries (PA/VSD/MAPCAs) is a rare cyanotic cardiac malformation that is associated with a high mortality rate. In this condition, there is no pulmonary valve, and the pulmonary vascular bed is supplied by aortopulmonary collateral arteries. The management of anesthesia for cesarean delivery in a woman with this uncorrected congenital heart defect is challenging. It is essential that a management plan is developed before the patient presenting in labor. This report detailed the anesthetic management of a 24-year-old primigravid woman with PA/VSD/MAPCAs.
Quantification of Postoperative Posterior Malleolar Fragment Reduction Using 3-Dimensional Computed Tomography (Q3DCT) Determines Outcome in a Prospective Pilot Study of Patients With Rotational Type Ankle Fractures
Authors: Meijer Diederik T. , de Muinck Keizer Robert-Jan O. , Stufkens Sjoerd A. S. , Schepers Tim , Sierevelt Inger N. , Kerkhoffs Gino M. M. J. , Goslings J. Carel , Doornberg Job N.
Published: May 2019

Objective:

To correlate Q3DCT measurements of residual step-off, gap, and 3D multidirectional displacement of postoperative posterior malleolar fracture fragment reduction in patients with rotational type ankle fractures, with patients' clinical outcome using standardized patient- and physician-based outcome measures.

Design:

Prospective cohort study.

Setting:

Level-I Trauma Center.

Patients:

Thirty-one patients with ankle fractures including a posterior malleolar fracture (OTA/AO type 44) were included.

Intervention:

All patients underwent open reduction internal fixation of their ankle fracture, of which 18 patients (58%) had direct fixation of the posterior malleolar fragment. Decision of (direct) fixation of the posterior malleolar fragment was not standardized and guided by surgeons' preference.

Main Outcome Measurements:

Quality of postoperative reduction was quantified using Q3DCT: posterior fragment size (% of joint surface), residual step-off (mm), postoperative gaps (mm2), and overall multidirectional displacement were quantified. Foot and Ankle Outcome Score pain and symptoms subscales and quality of life (Short Form-36) at 1 year postoperatively were included as the main outcome measures.

Results:

Step-off (mean 0.6 mm, range 0.0–2.7, SD 0.8) showed a significant correlation with worse Foot and Ankle Outcome Score pain and symptoms subscales. Residual fracture gap (mean 12.6 mm2, range 0.0–68.8, SD 19.5) and 3D multidirectional displacement (mean 0.96 mm, range 0.0–2.8, SD 0.8) showed no correlation.

Conclusions:

In patients with rotational type ankle fractures involving a posterior malleolar fracture, contemporary Q3DCT measurements of posterior fragment size and residual intra-articular step-off—but not gap—show significant correlation with patient-reported pain and symptoms.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Life cycle assessment as decision support tool for environmental management in hospitals: A literature review
Authors: Seifert Christin , Koep Lisa , Wolf Patrick , Guenther Edeltraud
Published: May 2019

Background

Life cycle assessment (LCA) is an environmental accounting tool aimed at determining environmental impacts of products, processes, or organizational activities over the entire life cycle. Although this technique already provides decision-makers in other sectors with valuable information, its application in the health care setting has not yet been examined.

Purpose

The aim of this study was to provide a comprehensive overview of scientific research on the application of LCA in hospitals and its contribution to management decision-making.

Method

We perform a systematic literature review by searching a range of databases with synonyms of “LCA” in combination with the term “hospital” in order to identify peer-reviewed studies. The final sample of 43 studies were then subjected to a content analysis.

Results

We categorize existing research and show that single and multi-indicator LCA approaches are used to examine several products and processes in hospitals. The various approaches are favored by different scientific communities. Whereas researchers from environmental sciences perform complex multi-indicator LCA studies, researchers from health care sciences focus on footprints. The studies compare alternatives and identify environmental impacts and harmful hotspots.

Practice Implications

LCA results can support health care managers’ traditional decision-making by providing environmental information. With this additional information regarding the environmental impacts of products and processes, managers can implement organizational changes to improve their environmental performance. Furthermore, they can influence upstream and downstream activities. However, we recommend more transdisciplinary cooperation for LCA studies and to place more focus on actionable recommendations when publishing the results.
Radiologic complications in a long-term survivor with Wilms tumor: a case report
Authors: Yasui Toshihiro , Suzuki Tatsuya , Urano Makoto , Tahara Sayumi , Kuroda Makoto , Hara Fujio , Watanabe Shunsuke , Uga Naoko , Naoe Atsuki , Kondo Yasuhiro , Tuchiya Tomonori
Published: May 2019

Wilms tumor is a child-specific cancer with a 5-year survival rate exceeding 90%. We report the case of a 48-year-old man who survived after he was diagnosed with Wilms tumor at 3 years but died due to a circulatory disorder after radiation therapy. At 34 years of age, he was diagnosed with arteriosclerosis obliterans. He received interventional radiology twice, but his vascular stent became occluded. Finally, septic shock occurred and he died. Our case study shows that the mortality risk of circulatory system increases with age in childhood cancer survivors, and they should be advised to lead healthy lifestyles.
Transposition Upper Blepharoplasty With Orbital Retaining Ligament Release
Authors: Huggins Alison , Somogyi Marie , Nakra Tanuj
Published: May 2019

Purpose:

Volume restoration is an important component of aesthetic facial rejuvenation, particularly in the brow and upper eyelid regions. In this study, the authors describe transposition of the central, preaponeurotic fat pad in the sub-brow preperiosteal plane with full release of the brow during upper blepharoplasty.

Methods:

A retrospective review including all patients who underwent transposition of the upper eyelid central, preaponeurotic fat pad at the time of upper blepharoplasty. Patients with simultaneous brow lifting surgeries were excluded. The surgical technique involved placement of the preaponeurotic fat pad pedicle in the sub-brow space after full brow release for augmentation of sub-brow volume after performing upper blepharoplasty.

Results:

Nineteen patients (n = 36 eyelids) were identified who underwent this transposition upper blepharoplasty technique. No complications or adverse events related to this procedure were observed. All patients were satisfied with their outcome.

Conclusions:

Transposition upper blepharoplasty with complete brow release is a safe, effective adjunct to blepharoplasty for upper eyelid and periorbital rejuvenation.
Gender differences in nurse practitioners: job satisfaction and patterns of care
Authors: Bumbach Michael D. , Harman Jeffrey S. , Lucero Robert , Cimiotti Jeannie P. , Felber Neff Donna
Published: May 2019

Background:

Although workforce diversity has been cited as an important workforce issue, the contemporary U.S. nurse practitioner (NP) workforce is dominated by females. Provider diversity, specifically gender, has been found to directly influence patient preference. However, lack of gender diversity in the NP workforce has never been specifically evaluated in terms of job satisfaction and patterns of care.

Purpose:

The purpose of this study was to assess and evaluate NP gender, job satisfaction and practice patterns of care for U.S. clinical NPs.

Methods:

This study used the 2012 National Sample Survey of Nurse Practitioners (NSSNP). Participants meeting inclusion criteria totaled 8,978 NPs, of which 92.8% were female.

Results:

Although overall job satisfaction was not shown to be significantly different between genders, several patterns of care were found to be significant. Of the 11 measured patterns of care in the NSSNP, six were significantly different between genders, with a female majority indicating that they performed these services most often. In only one rendered service, performed medical procedures, did male NPs indicate that they did more than females.

Implications for practice:

This study suggests the importance of a gender-diversified U.S. nurse practitioner workforce. This is indicated by differences highlighted in patterns of care by NP gender, which has been postulated to influence patient outcomes, including perceived quality of care and engagement in the health care process. Patient preferences for same-gender NPs, particularly patients with privacy issues, warrant further exploration.
Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence
Authors: Pineton de Chambrun Marc , Bréchot Nicolas , Combes Alain
Published: May 2019

Purpose of review

Temporary circulatory support (TCS) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of VA-ECMO principles, indications, management, complications, and discusses the results of recent case series and trials.

Recent findings

VA-ECMO is utilized as a bridge to ‘decision’ that includes weaning after cardiac function recovery, transplantation, long-term mechanical circulatory support, and withdrawal in case of futility. VA-ECMO is considered the first-line TCS as it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella (Abiomed, Danvers, MA, USA) or intra-aortic balloon pump support with VA-ECMO might decrease left ventricular pressure and improve outcomes. Massive pulmonary embolism, sepsis-associated cardiomyopathy, and refractory cardiac arrest are among emerging indications for TCS.

TCS have become the cornerstone of the management of patients with cardiogenic shock, although the evidence supporting their efficacy is limited. VA-ECMO is considered the first-line option, with a growing number of accepted and emerging indications. Randomized clinical trials are now needed to determine the place VA-ECMO in cardiogenic shock treatment strategies.
Why do parents present to the Paediatric Emergency Department with conditions suitable for management in less acute settings? A qualitative study
Authors: McLauchlan Kirsty , Ramlakhan Shammi , Irving Andy
Published: May 2019

Objective:

To determine the factors influencing attendance at a Paediatric Emergency Department with conditions suitable for management in less acute settings.

Methods:

Semi-structured interviews exploring parental decision-making processes surrounding care-seeking behaviours in urgent situations were undertaken with parents of children allocated to the two lowest triage categories at a type-1 urban Paediatric Emergency Department over two 2-week periods.

Results:

All parents expressed a desire to access care from the most appropriate service for their child in unscheduled situations. A number of factors influenced parental perceptions of appropriateness: (1) perceptions concerning the urgency or severity of a condition; (2) uncertainty regarding their assessment of the severity or urgency of a problem; (3) the possibility that a condition may require resources available solely at the Paediatric Emergency Department; and (4) awareness of alternative services. Parents reported that previous utilisation of alternative services, which lead to them being referred onwards to the Paediatric Emergency Department, influenced their decision to attend the Paediatric Emergency Department on this occasion.

Conclusion:

Parental uncertainty and a low tolerance of risk among parents and healthcare professionals increases the likelihood of emergency department attendance. Parents are likely to continue to utilise the Paediatric Emergency Department for minor conditions. Future strategies should focus on improving outcomes for children with non-urgent problems who access care at the emergency department rather than discouraging utilisation.
Clostridioides difficile in transplant patients: early diagnosis, treatment, and prevention
Authors: Revolinski Sara L. , Munoz-Price L. Silva
Published: May 2019

Purpose of review

Clostridioides difficile infection is common in solid organ transplant and hematopoietic stem-cell transplant recipients and is associated with significant morbidity and mortality. These populations are also underrepresented in clinical trials, making optimal management difficult. Because of this, management of these populations follows national guideline recommendations. This review aims to summarize the recent relevant literature pertaining to the clinical management of C. difficile infection in transplant patients, with a particular focus on diagnosis, treatment, and prevention.

Recent findings

Early diagnosis of C. difficile colonization may mitigate both horizontal and vertical transmission (progression from colonization to colitis) of infection. Once diagnosed, recent literature suggests antibiotic treatment should align with that recommended by national guidelines. Fecal microbiota transplant is an emerging therapy for recurrent C. difficile infection, and recent data have demonstrated safety and efficacy. Prevention strategies including antimicrobial stewardship, probiotic administration, antibiotic administration, and bezlotoxumab may be beneficial in transplant populations, but more data are needed to confirm recent findings.

Studies evaluating C. difficile infection in transplant patients are only recently starting to emerge. Further research is needed to identify optimal treatment and prevention strategies, and to examine novel strategies such as microbiome manipulation.
Development and Evaluation of a Cognitive Aid Booklet for Use in Rapid Response Scenarios
Authors: Mitchell Oscar J. L. , Lehr Andrew , Lo Michelle , Kam Lily M. , Andriotis Anthony , Felner Kevin , Kaufman Brian , Madeira Charles
Published: May 2019

Introduction

Rapid response teams (RRTs) have become ubiquitous among hospitals in North America, despite lack of robust evidence supporting their effectiveness. Many RRTs do not yet use cognitive aids during these high-stakes, low-frequency scenarios, and there are no standardized cognitive aids that are widely available for RRTs on medicine patients. We sought to design an emergency manual to improve resident performance in common RRT calls.

Methods

Residents from the New York University School of Medicine Internal Medicine Residency Program were asked to volunteer for the study. The intervention group was provided with a 2-minute scripted informational session on cognitive aids as well as access to a cognitive aid booklet, which they were allowed to use during the simulation.

Results

Resident performance was recorded and scored by a physician who was blinded to the purpose of the study using a predefined scoring card. Residents in the intervention group performed significantly better in the simulated RRT, by overall score (mean score = 7.33/10 and 6.26/10, respectively, P = 0.02), and by performance on the two critical interventions, giving the correct dose of naloxone (89% and 39%, respectively, P < 0.001) and checking the patient's blood glucose level (93% and 52%, respectively, P = 0.001).

Conclusions

In a simulated scenario of opiate overdose, internal medicine residents who used a cognitive aid performed better on critical tasks than those residents who did not have a cognitive aid. The use of an appropriately designed cognitive aid with sufficient education could improve performance in critical scenarios.
Conditions for transient epidemics of waterborne disease in spatially explicit systems
Authors: Mari Lorenzo , Casagrandi Renato , Bertuzzo Enrico , Rinaldo Andrea , Gatto Marino
Published: May 2019

Waterborne diseases are a diverse family of infections transmitted through ingestion of—or contact with—water infested with pathogens. Outbreaks of waterborne infections often show well-defined spatial signatures that are typically linked to local eco-epidemiological conditions, water-mediated pathogen transport and human mobility. In this work, we apply a spatially explicit network model describing the transmission cycle of waterborne pathogens to determine invasion conditions in metacommunities endowed with a realistic spatial structure. Specifically, we aim to define conditions under which pathogens can temporarily colonize a set of human communities, thus triggering a transient epidemic outbreak. To that end, we apply generalized reactivity analysis, a recently developed methodological framework for the study of transient dynamics in ecological systems subject to external perturbations. The study of pathogen invasion is complemented by the detection of the spatial signatures associated with the perturbations to a disease-free system that are expected to be amplified the most over different time scales. Understanding the drivers of waterborne disease dynamics over time scales that are relevant to epidemic and/or endemic transmission is a crucial, cross-disciplinary challenge, as large portions of the developing world still struggle to cope with the burden of these infections.
Scenario-led modelling of broadleaf forest expansion in Wales
Authors: Manzoor Syed Amir , Griffiths Geoffrey , Latham James , Lukac Martin
Published: May 2019

Significant changes in the composition and extent of the UK forest cover are likely to take place in the coming decades. Current policy targets an increase in forest area, for example, the Welsh Government aims for forest expansion by 2030, and a purposeful shift from non-native conifers to broadleaved tree species, as identified by the UK Forestry Standard Guidelines on Biodiversity. Using the example of Wales, we aim to generate an evidence-based projection of the impact of contrasting policy scenarios on the state of forests in the near future, with the view of stimulating debate and aiding decisions concerning plausible outcomes of different policies. We quantified changes in different land use and land cover (LULC) classes in Wales between 2007 and 2015 and used a multi-layer perceptron–Markov chain ensemble modelling approach to project the state of Welsh forests in 2030 under the current and an alternative policy scenario. The current level of expansion and restoration of broadleaf forest in Wales is sufficient to deliver on existing policy goals. We also show effects of a more ambitious afforestation policy on the Welsh landscape. In a key finding, the highest intensity of broadleaf expansion is likely to shift from southeastern to more central areas of Wales. The study identifies the key predictors of LULC change in Wales. High-resolution future land cover simulation maps using these predictors offer an evidence-based tool for forest managers and government officials to test the effects of existing and alternative policy scenarios.
Complex patterns of sex-biased demography in canines
Authors: Phung Tanya N. , Wayne Robert K. , Wilson Melissa A. , Lohmueller Kirk E.
Published: May 2019

The demographic history of dogs is complex, involving multiple bottlenecks, admixture events and artificial selection. However, existing genetic studies have not explored variance in the number of reproducing males and females, and whether it has changed across evolutionary time. While male-biased mating practices, such as male-biased migration and multiple paternity, have been observed in wolves, recent breeding practices could have led to female-biased mating patterns in breed dogs. For example, breed dogs are thought to have experienced a popular sire effect, where a small number of males father many offspring with a large number of females. Here we use genetic variation data to test how widespread sex-biased mating practices in canines are during different evolutionary time points. Using whole-genome sequence data from 33 dogs and wolves, we show that patterns of diversity on the X chromosome and autosomes are consistent with a higher number of reproducing males than females over ancient evolutionary history in both dogs and wolves, suggesting that mating practices did not change during early dog domestication. By contrast, since breed formation, we found evidence for a larger number of reproducing females than males in breed dogs, consistent with the popular sire effect. Our results confirm that canine demography has been complex, with opposing sex-biased processes occurring throughout their history. The signatures observed in genetic data are consistent with documented sex-biased mating practices in both the wild and domesticated populations, suggesting that these mating practices are pervasive.
Combined effects of mutualistic rhizobacteria counteract virus-induced suppression of indirect plant defences in soya bean
Authors: Pulido Hannier , Mauck Kerry E. , De Moraes Consuelo M. , Mescher Mark C.
Published: May 2019

It is increasingly clear that microbial plant symbionts can influence interactions between their plant hosts and other organisms. However, such effects remain poorly understood, particularly under ecologically realistic conditions where plants simultaneously interact with diverse mutualists and antagonists. Here, we examine how the effects of a plant virus on indirect plant defences against its insect vector are influenced by co-occurrence of other microbial plant symbionts. Using a multi-factorial design, we manipulated colonization of soya bean using three different microbes: a pathogenic plant virus (bean pod mottle virus (BPMV)), a nodule-forming beneficial rhizobacterium (
Bradyrhizobium japonicum
) and a plant growth-promoting rhizobacterium (
Delftia acidovorans
). We then assessed recruitment of parasitoids (
Pediobious foveolatus
(Eulophidae)) and parasitism rates following feeding by the BPMV vector
Epilachna varivestis
(Coccinellidae). BPMV infection suppressed parasitoid recruitment, prolonged parasitoid foraging time and reduced parasitism rates in semi-natural foraging assays. However, simultaneous colonization of BPMV-infected hosts by both rhizobacteria restored parasitoid recruitment and rates of parasitism to levels similar to uninfected controls. Co-colonization by the two rhizobacteria also enhanced parasitoid recruitment in the absence of BPMV infection. These results illustrate the potential of plant-associated microbes to influence indirect plant defences, with implications for disease transmission and herbivory, but also highlight the potential complexity of such interactions.
Evolutionary design of a flexible, seasonally migratory, avian phenotype: why trade gizzard mass against pectoral muscle mass?
Authors: Mathot Kimberley J. , Kok Eva M. A. , Burant Joseph B. , Dekinga Anne , Manche Petra , Saintonge Darren , Piersma Theunis
Published: May 2019

Migratory birds undergo impressive body remodelling over the course of an annual cycle. Prior to long-distance flights, red knots (Calidris canutus islandica) reduce gizzard mass while increasing body mass and pectoral muscle mass. Although body mass and pectoral muscle mass are functionally linked via their joint effects on flight performance, gizzard and pectoral muscle mass are thought to be independently regulated. Current hypotheses for observed negative within-individual covariation between gizzard and pectoral muscle mass in free-living knots are based on a common factor (e.g. migration) simultaneously affecting both traits, and/or protein limitation forcing allocation decisions. We used diet manipulations to generate within-individual variation in gizzard mass and test for independence between gizzard and pectoral muscle mass within individuals outside the period of migration and under conditions of high protein availability. Contrary to our prediction, we observed a negative within-individual covariation between gizzard and pectoral muscle mass. We discuss this result as a potential outcome of an evolved mechanism underlying body remodelling associated with migration. Although our proposed mechanism requires empirical testing, this study echoes earlier calls for greater integration of studies of function and mechanism, and in particular, the need for more explicit consideration of the evolution of mechanisms underlying phenotypic design.
Dental microwear texture reflects dietary tendencies in extant Lepidosauria despite their limited use of oral food processing
Authors: Winkler Daniela E. , Schulz-Kornas Ellen , Kaiser Thomas M. , Tütken Thomas
Published: May 2019

Lepidosauria show a large diversity in dietary adaptations, both among extant and extinct tetrapods. Unlike mammals, Lepidosauria do not engage in sophisticated mastication of their food and most species have continuous tooth replacement, further reducing the wear of individual teeth. However, dietary tendency estimation of extinct lepidosaurs usually rely on tooth shape and body size, which allows only for broad distinction between faunivores and herbivores. Microscopic wear features on teeth have long been successfully applied to reconstruct the diet of mammals and allow for subtle discrimination of feeding strategies and food abrasiveness. Here, we present, to our knowledge, the first detailed analysis of dental microwear texture on extant lepidosaurs using a combination of 46 surface texture parameters to establish a framework for dietary tendency estimation of fossil reptilian taxa. We measured dental surface textures of 77 specimens, belonging to herbivorous, algaevorous, frugivorous, carnivorous, ovivorous, insectivorous, molluscivorous, as well as omnivorous species. Carnivores show low density and shallow depth of furrows, whereas frugivores are characterized by the highest density of furrows. Molluscivores show the deepest wear features and highest roughness, herbivores have lower surface roughness and shallower furrows compared to insectivores and omnivores, which overlap in all parameters. Our study shows that despite short food–tooth interaction, dental surface texture parameters enable discrimination of several feeding strategies in lepidosaurs. This result opens new research avenues to assess diet in a broad variety of extant and extinct non-mammalian taxa including dinosaurs and early synapsids.