bluuebunny/crossref_metadata_2025 huggingface dataset:
Elegy and Nasīb in the Ancient Arabic QAṢīda: The Unique Structure of an Elegy by Ibn Muqbil
Authors: Hussein Ali Ahmad
Published: March 2019

This article analyses the functions of the uniquely non-traditional structure of an elegy composed by the mukha.ram poet, Ibn Muqbil, following the assassination of the third Muslim caliph, ‘Uthmān b. ‘Affān. The poem begins with the elegiac verses, then ends with a description of several, to some degree, erotic love affairs. Classical Arab scholars condemned this structure, in which the song of love follows the weeping over a killed religious authority. In the present article, the poem is analysed then two interpretations of the function of this structure are given: firstly, it provides the poem with an allegorical expression for Ibn Muqbils yearning for the lost pre-Islamic life which was destroyed after the birth of Islam; secondly, it is a means of catharsis directed to a specific audience which was less passionate about the death of the caliph.
Brachytherapy as an Adjuvant for Recurrent Atypical and Malignant Meningiomas
Authors: Koch Matthew J , Agarwalla Pankaj K , Royce Trevor J , Shih Helen A , Oh Kevin , Niemierko Andrezj , Mauceri Thomas C , Curry William T , Barker Frederick G , Loeffler Jay S
Published: March 2019

BACKGROUND

Recurrent atypical and malignant meningiomas have poor outcomes with surgical therapy alone. Neither adjuvant chemotherapy nor postoperative radiation therapy remedies this problem.

OBJECTIVE

To evaluate our experience with the treatment of 15 patients treated with I-125 or Cs-131 brachytherapy radiation seeds as an adjuvant in these difficult cases.

METHODS

Patients with high-grade recurrent meningioma who underwent resection and intraoperative placement of brachytherapy seeds at our institution from 2002 to 2014 were identified and studied by retrospective chart review.

RESULTS

Fifteen patients with median age of 68.8 yr were treated with I-125 (n = 13) or Cs-131 (n = 2) brachytherapy seeds for cases of recurrent, grade II (n = 8), or grade III (n = 7) meningioma at our institution from 2002 to 2014. These lesions originated from a variety of locations including, convexity (3), falcine (3), frontal (2), occipital (1), parietal (2), 2 sphenoid wing (2), and temporal (2), based recurrent meningiomas. Patients had a median of 2 prior open surgical interventions and received local radiation therapy with a median dose of 55 Gy prior to brachytherapy. Survival at 2.5 yr was 56% for grade II and 17% for grade III lesions. Survival was significantly associated with patient age but not tumoral pathology. Forty percent of patients required reoperations for wound complications following brachytherapy.

CONCLUSION

Brachytherapy with implantation of permanent radiation seeds provides a viable alternative treatment for recurrent meningioma while carrying a significant clinical risk of wound infection and need for reoperation.
The Crisis of European Integration in Historical Perspective
Authors: Ross George
Published: March 2019

The European Union (EU) may be the most successful transnational cooperation in modern history. Beginning in the 1950s, it has grown from six to twenty-eight members—twenty-seven after Brexit—encompassing almost all of Europe. It is now one of the largest, most open, and wealthiest economic areas on the planet, helping to promote peace and prosperity in an area with a history of brutal warfare. Making this happen has not been easy. Periods of success have been punctuated by quarrels between member states and periods of stagnation, while successes have brought complex and unwieldy institutions that are difficult for ordinary Europeans, steeped in national lives and identities, to understand. The initial “Common Market” years saw periodic disputes between founding member states but nonetheless launched market integration. Then, after 1985, in response to the end of post–World War II growth, the European Communities (EC) forged a European Single Market committed to the free movement of goods, services, capital, and people. In the aftermath of the fall of the Berlin Wall in 1989 the EC added Economic and Monetary Union (EMU), pledged new cooperation in foreign and security policies, and changed its name to the EU. The 21st century has so far been trying, however. First came long dithering about the institutional reforms needed to enlarge to post-communist central and eastern European countries, difficulty in establishing common foreign and security policies, and low economic growth and high unemployment. Then, after 2008, the long Eurozone crisis led to costly, ineffective, and divisive EU responses, and as it abated, new crises appeared.
What Are the Headwaters of Formal Savings? Experimental Evidence from Sri Lanka
Authors: Callen Michael , de Mel Suresh , McIntosh Craig , Woodruff Christopher
Published: March 2019

The world’s poor are seeing a rapid expansion in access to formal savings accounts. What is the source of savings when households are connected to a formal account? We combine a high-frequency panel survey spanning two and a half years with an experiment in which a Sri Lankan bank used mobile Point-of-Service (POS) terminals to collect deposits directly from households each week. We find that the headwaters of formal savings lie in sacrificed leisure time: households work more, and improved savings options generate an increase in labour effort in both self-employment and in the wage market. The results suggest that the labour allocation channel is an important mechanism linking savings opportunities to income.
Experiential Learning to Engage Millennial Learners in an Undergraduate Nursing Research Course
Authors: Powell Shannon Baker , Engelke Martha Keehner
Published: March 2019

Baccalaureate-prepared nurses are expected to participate in evidence-based practice by identifying clinical questions, critiquing evidence, and integrating theory into practice. This presents a challenge for faculty to facilitate a research course in a way that is valued by nursing students and will ultimately prepare them to successfully enter the workforce. This article describes an innovative strategy to engage millennial learners in an undergraduate research course by implementing a two-part evidence-based practice project. Student feedback has been positive with expressed interest in the project’s application to practice.
Inquiry in the Medical Curriculum: A Pedagogical Conundrum and a Proposed Solution
Authors: Valbuena Gustavo , O’Brien Bridget , ten Cate Olle , O’Sullivan Patricia
Published: March 2019

Habits of inquiry are considered an essential component of the modern physician’s profile. These habits drive physicians to recognize and address the continuous challenges inherent to the practice of medicine; consequently, they meet the aims of better patient-centered care, better health of communities, and improved functioning of the health system. Many medical schools have endeavored to integrate inquiry into their curricula as a means of supporting development of adaptive expertise, a construct that encompasses habits of inquiry. However, the diversity of conceptualizations of inquiry has resulted in correspondingly diverse instructional implementations. Much of the emphasis has been on inquiry methods (e.g., engagement in research projects, courses in research methods and statistics), but the learners’ inquiry disposition and its essential attitude component have received little attention in instruction and assessment. The authors propose that both inquiry methods and attitude need to be developed explicitly and simultaneously to prepare physicians to successfully be willing and able to address the challenges of today’s health care environment. Because attitudes are established predictors of behavior, a positive inquiry attitude may be the ultimate determinant of physicians’ engagement in behaviors of adaptive expertise (i.e., recognizing when learned procedures do not apply, and learning or inventing effective solutions). Addressing the attitude toward inquiry as early as possible in medical school is critical because strong attitudes are difficult to modify. Thus, a curriculum that supports positive inquiry attitude formation and strengthening will carry well beyond medical school and residency training.
Suppressive Characteristics of Umbilical Cord Blood–derived Regulatory T Cells After Ex Vivo Expansion on Autologous and Allogeneic T Effectors and Various Lymphoblastic Cells
Authors: Vanichapol Thitinee , Pongsakul Nutkridta , Srisala Supanart , Apiwattanakul Nopporn , Chutipongtanate Somchai , Hongeng Suradej
Published: March 2019

The third-party umbilical cord blood (UCB)-derived regulatory T cells (Treg) are an alternative to donor-derived Treg as cellular therapy of graft-versus-host disease following hematopoietic stem cell transplantation. However, their suppressive characteristics against autologous and allogeneic T effector cells (Teff) have rarely been documented. The exact role of UCB-Treg in hematologic malignancies is also uncertain. Here, we investigated the direct effects of UCB-Treg on the proliferation of autologous Teff, as compared with allogeneic Teff, and also determined cellular fates of lymphoblasts after UCB-Treg co-culture. UCB-Treg were isolated from 8 UCB samples using 2-step immunomagnetic bead sorting. After 10-day ex vivo expansion, up to 60-fold increase in cell number with 76.7%±4.9% of CD4+CD25+CD127loFoxP+ UCB-Treg was obtained. Further characterization showed that ex vivo-expanded UCB-Treg contained a higher proportion of CD95+CD45RAloCCR4hiTreg-B subpopulation compared with the CD95−CD45RAhiCCR4loTreg-A subpopulation (13.0%±4.8% vs. 0.8%±0.7%; P<0.05), along with the detecting of substantial amounts of secretory IL-10 (57.7±17.8 pg/mL) and TGF-β1 (196.5±29.7 pg/mL) in culture supernatants. After 4 days co-culture with UCB-Treg (at the ratio of 1:1), the proliferation of autologous and allogeneic Teff was decreased comparably (43.6%±17.5% vs. 37.6±17.7%; P=0.437). Suppression was independent of HLA-A, B, and DRB1 compatibility between UCB-Treg and Teff. UCB-Treg co-culture with various lymphoblasts showed proliferative suppression of Jurkat T lymphoblasts (45.4%±20.5% at the ratio of 1:1), but not Namalwa and Raji B lymphoblasts. All lymphoblasts had no significant cell apoptosis or death after co-culture. In conclusion, the ex vivo-expanded UCB-Treg had no difference in autologous and allogeneic Teff suppression. UCB-Treg therapy in patients with graft-versus-host disease who have a primary disease of T-cell leukemia may have additional benefits in the prevention of relapsed disease.
Surgical Predictors of Reduced Marginal Reflex Distance After Upper Blepharoplasty
Authors: Putthirangsiwong Bunyada , Katsev Blake , Steinsapir Kenneth D. , Goldberg Robert A. , Rootman Daniel B.
Published: March 2019

The authors’ study demonstrates a 15% incidence of postoperative MRD1 reduction after upper eyelid blepharoplasty. Orbicularis oculi muscle removal was significantly associated with this occurrence.

Purpose:

Ptosis may occur in certain cases after upper blepharoplasty. The authors aim to characterize the incidence of postoperative marginal reflex distance (MRD1) reduction after upper blepharoplasty and surgical variables that may predict this occurrence.

Methods:

In this cross-sectional study, patients > 18 years old undergoing upper blepharoplasty were screened. Patients were excluded if they had any history of ptosis and brow surgery. Data regarding the excision of skin, muscle, fat, and brow fat as well as crease formation were documented. The distance in millimeter from the center of the pupil to the upper eyelid margin in the midpupillary line (MRD1) was measured digitally. The primary outcome measure was a postoperative reduction in MRD1 of >1 mm. Secondary outcome was overall mean change in MRD1 and the incidence of ptosis as defined by a final MRD1 ≤ 2.5 mm.

Results:

The final sample consisted of 100 patients (200 eyelids) and the mean age was 55.8 years. There were 65 patients with orbicularis muscle removal, 52 patients with postseptal fat removed, and 9 patients with crease formation. Overall 15 patients developed MRD1 decrease of greater than 1 mm (5 bilaterally and 10 unilaterally) with 7 eyes demonstrating a final MRD1 of ≤ 2.5 mm. In multivariate modeling, muscle removal was found to be the only variable with significant impact on the development of MRD1 reduction > 1 mm after upper blepharoplasty (p < 0.05, odds ratio = 8.2). The other variables did not significantly contribute. The overall mean (SD) MRD1 was 3.43 mm (1.1) preoperatively and 3.62 mm (1.1) postoperatively (p < 0.01).

Conclusions:

Fifteen percent of patients demonstrated a reduction in MRD1 > 1 mm after upper eyelid blepharoplasty, and those with orbicularis resection were more likely to experience this change.
Collaborative care intervention for patients with chronic heart failure
Authors: Cui Xiaoting , Dong Wenyi , Zheng Hongxiao , Li Haiyan
Published: March 2019

Introduction:

Patients with chronic heart failure (HF) show many symptoms that worsen the quality of life (QoL). Collaborative care intervention (CCI) aims to improve the QoL and symptoms by integrating psychosocial and palliative strategies in chronic care.

Methods:

The PubMed, EMBASE, and Cochrane library databases were searched from inception to September 2018. The included studies were used to determine pooled standard mean differences (SMDs) and associated 95% confidence intervals (CIs). The data were assessed by fixed- and random effects models, respectively.

Results:

Twenty-one studies including 2999 patients with chronic heart failure were included. The results showed significantly improved QoL in the CCI group compared with the routine care group (SMD = 0.60, 95%CI 0.27–0.94, P
heterogeneity < .001, I
2 = 94.1%). The patients who received face-to-face interventions experienced a significant improvement (SMD = 0.54, 95%CI 0.24–0.85, P
heterogeneity < .001, I
2 = 88.7%) in terms of QoL compared with those administered only telephone interventions. Furthermore, significantly improved anxiety level (SMD = 0.33, 95%CI 0.12–0.55, P
heterogeneity = .612, I
2 = 0%) and 6-min walk test (SMD = 0.46, 95%CI 0.29–0.64, P
heterogeneity = .458, I
2 = 0%) were found in the CCI group compared with the routine care group.

Conclusion:

These findings confirmed that collaborative care intervention effectively improves the quality of life as well as psychological (anxiety) and physical (6-min walk test) functions in patients with chronic heart failure compared with routine care. Furthermore, face-to-face interventions show a greater improvement of QoL compared with telephone-only interventions.
Successful management of lower limb nonunion using locking plates and bone graft with retention of intramedullary nail
Authors: Zhang Hong-Jun , Wang Shuai , Dong Yong-Hui , Zheng Wen-Di , Sun Zhe , Zheng Jia
Published: March 2019

This study aims to investigate the clinical effect of the combined an additional locking plate with bone graft based on retaining the original intramedullary nail for the treatment of lower limb nonunion.

From June 2008 to December 2012, 39 patients were admitted and treated, who developed non-infectious bone nonunion after intramedullary nail fixation for long bone fracture in the lower limb. Additional locking plate and autogenous iliac bone grafting were performed for these patients, in which the original intramedullary nail was retained. Follow-ups were performed once at postoperative months 1, 2, 3, 6, and 12, and every year onwards. During these follow-ups, imaging and clinical function examinations were performed, in order to observe callus growth and the fractured limb functions.

All patients have been followed-up, in which the duration of these follow-ups ranged between 8 and 24 months. All patients gained bony union within 6 to 11 months, and the healing rate was 100%. Radiographic healing time ranged between 8 and 15 months. Full weight-bearing time ranged between 2 and 10 months. According to Harris hip scores and Hospital for Special Surgery (HSS) Knee joint scores, 17 cases were excellent, 2 cases were good, and 1 case was acceptable; with an excellent and good rate of 95.00%. According to HHS score for the knee, 15 cases were excellent, 3 cases were good, and 1 case was acceptable; with an excellent and good rate of 94.74%.

The combined treatment of the additional blocking plate with bone grafting based on retaining the original intramedullary nail for bone nonunion could effectively eliminate lateral and rotatory instability of the fractured ends. This surgical method had a short operation time, high healing rate and other advantages.
Acute myeloid leukemia in an 86-year-old man with AML1/ETO treated with Homoharringtonine and Arsenic Trioxide
Authors: He Zhipeng , Chen Meiling , Huang Yiping , Chen Lili , Wang Bixin , Wang Huixian , Yang Mengting , Xiao Xueting , Lu Yanhong , Chen Jiaying , Wu Yong
Published: March 2019

Rationale:

Acute myeloid leukemia (AML) is a malignantly clonal and highly heterogeneous disease. Although the treatment of AML has brought promising outcomes for younger patients, prognosis of the elderly remains dismal. Innovative regimens are increasingly necessary to be investigated.

Patient concerns:

We present an 86-year-old AML patient with fever, cough, and sputum production.

Diagnoses:

A diagnosis of AML with maturation (AML-M2) and AML1/ETO was made.

Interventions:

The patient was treated with a regimen of Homoharringtonine coupled with arsenic trioxide.

Outcomes:

The AML-M2 patient with AML1/ETO achieved incomplete remission, but showed few toxic side effects and improved survival. Besides, we analyzed the dynamic counts of complete blood cells during the treatment. The count of white blood cell had a positive correlation with the percentage of blast cells (r = 0.65), both of which had a negative correlation with the percentage of segmented neutrophils (r = –0.63, –0.89).

Lessons:

Homoharringtonine and arsenic trioxide may induce both the apoptosis and differentiation of leukemic cells in AML-M2 with AML1/ETO.
Paediatric Colonoscopy Direct Observation of Procedural Skills
Authors: Siau Keith , Levi Rachel , Iacucci Marietta , Howarth Lucy , Feeney Mark , Anderson John T , Tzivinikos Christos , Thomson Mike , Narula Priya
Published: March 2019

Introduction:

The paediatric series of direct observation of procedural skills (DOPS) were introduced into the UK national endoscopy training curriculum in 2016, but lack validity evidence. We aimed to present validity evidence for paediatric colonoscopy DOPS and study competency development in a national trainee cohort.

Methods:

This prospective UK‐wide study analysed formative paediatric colonoscopy DOPS which were submitted to the e‐Portfolio between 2016 and 2018. Item, domain, and average DOPS scores were correlated with the overall DOPS rating to evidence internal structure validity. Overall DOPS ratings were compared over lifetime procedure count to demonstrate learning curves (discriminant validity). Consequential validity was founded on receiver operating characteristic curve analyses.

Results:

A total of 203 DOPS assessments were completed for 29 trainees from 11 UK training centres. Internal structure validity was provided through item‐total correlation analyses. DOPS scores positively correlated with trainee seniority (P < 0.001) and lifetime procedure count (P < 0.001). Competency acquisition followed the order of: “preprocedure,” “postprocedure,” “endoscopic nontechnical skills,” “management,” “procedure” domains, followed by overall DOPS competency, which was achieved in 81% of the cohort after 125 to 149 procedures. Mean DOPS scores could be used to predict overall procedure competence (area under receiver operating characteristic curve 0.969, P < 0.001), with a mean score of 3.9 demonstrating optimal sensitivity (93.5%) and specificity (87.6%).

Conclusions:

This study provides validity evidence supporting the use of paediatric colonoscopy DOPS as an in‐training competence assessment tool. DOPS may also be used to measure competency development and benchmark performance during training, which may be of value to trainees, trainers, and training programmes.
Multilocus sequence typing and antibiotic resistant patterns of the meticillin-resistant Staphylococcus aureus isolates from different clinical specimens
Authors: Valadan Tahbaz Sahel , Azimi Leila , Nowroozi Jamileh , Armin Shahnaz , Fallah Fateme
Published: March 2019

Backgrounds:

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging threat worldwide. Community-associated-MRSA strains differ from hospital-acquired MRSA strains in their genetic backgrounds, pathogenicity, and antibiotic susceptibilities. Although few studies have reported the epidemiology of the different community-associated-MRSA and hospital-acquired-MRSA clones present, there are insufficient data available on MRSA characteristics in Iran. The present cross-sectional study was conducted to explore the prevalence of MRSA, the antimicrobial susceptibility of the strains, and the molecular epidemiology of such MRSA isolates from a hospital in Tabriz, Iran.

Methods:

S. aureus isolates were collected from patients with clinical signs and symptoms of infection admitted to Imam Reza Hospital, from September 2016 to March 2017 in Tabriz, Iran. Standard conventional biochemical tests for identification of the isolates were performed on colonies from primary cultures. The antibiotic susceptibility testing was performed using the standardized Kirby–Bauer disc-diffusion method on Mueller–Hinton agar. All methicillin-resistant isolates were archived for subsequent molecular tests, including PCR for mecA gene and multilocus sequence typing.

Results:

Among 39 S. aureus isolates enrolled, 33.3% (13/39) were identified as MRSA strains. Antibiotic susceptibilities to erythromycin, ciprofloxacin, and clindamycin, were measured as, 48.7, 46.2, and 35.9%, respectively. All of the 39 isolates were susceptible to vancomycin and linezolid. Sequence type (ST)-238 was the predominant clone (15.3%), and ST585, ST1, ST88, ST45, ST158, ST1097, ST2373, and ST2873 were other detected sequence type. In addition, two undetermined sequence type (a sequence type was not matched to any sequence type identified) were detected in this study.

Conclusion:

ST238 strains, which were previously not found as MRSA, could now widely distribute in Iranian population. In addition, the resistance rate of MRSA strains against multiple classes of antibiotics should be considered when selecting empirical antibiotics for MRSA infections in Iran.
Effects of Mood Induction Using Movie Watching on Food Intake and Hormone Levels
Authors: Jampour Leila , Jafarirad Sima , Cheraghian Bahman , Behrouzian Forouzan
Published: March 2019

There is a complex connection between emotional states and food intake. The purpose of this study was to investigate the impact of short-term emotion induction on food intake and ghrelin, cortisol, and insulin levels in healthy normal-weight individuals without eating disorders. Eighty-nine participants were divided into 2 groups (drama and comedy movies). After 50 minutes of watching, the movie was stopped and blood samples were collected, and then participants were offered a snack to eat. The visual analog scale showed that the movie watching had significant effects on mood induction. However, there was no significant relationship between the kind of movie the participants had watched and their choice of food, its calorie content, or the amount of food (eg, grams) that was consumed. This parallel-design study found that a 50-minute exposure to either a dramatic or a comedy movie affected ghrelin, cortisol, and insulin levels. However, these hormonal changes were not associated with intake of food from a buffet during the last minutes of viewing.
Expanded Algorithm and Updated Experience with Breast Reconstruction Using a Staged Nipple-Sparing Mastectomy following Mastopexy or Reduction Mammaplasty in the Large or Ptotic Breast
Authors: Economides James M. , Graziano Francis , Tousimis Eleni , Willey Shawna , Pittman Troy A.
Published: March 2019

Background:

Staged nipple-sparing mastectomy following mastopexy or reduction mammaplasty was first described in 2011 by Spear et al. to expand the indications for nipple-sparing mastectomy to women with large or ptotic breasts. Since that time, the authors have revised their treatment algorithm and technique to enhance oncologic safety and improve wound healing complications.

Methods:

An institutional review board–approved retrospective review was undertaken of all patients undergoing staged nipple-sparing mastectomy following mastopexy or reduction mammaplasty at a single institution from July of 2011 through July of 2016. Management followed an updated treatment protocol to improve surgical and oncologic outcomes.

Results:

Twenty-six patients (50 breasts) were identified who underwent staged nipple-sparing mastectomy. Five breasts (10 percent) required reoperation for a complication such as infection or tissue necrosis. Two devices (4 percent), both in the therapeutic cohort, required explantation because of infection. Skin flap necrosis and nipple-areola complex necrosis were each seen in two breasts (4 percent). Infection was seen in four breasts (8 percent), and wound healing complications were seen in only two breasts (4 percent).

Conclusions:

The authors offer their updated treatment algorithm for a staged approach to nipple-sparing mastectomy for patients with macromastia or grade II or III ptosis. Their results build on previously published reports demonstrating the safety and efficacy of this approach for nipple preservation and oncologic management in this patient population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Update on fungal infections of the central nervous system: emerging pathogens and emerging diagnostics
Authors: Bloch Karen C. , Bailin Samuel S.
Published: March 2019

Purpose of review

Fungal infections of the central nervous system (CNS) are relatively uncommon but associated with significant morbidity and mortality. We reviewed recent literature highlighting new approaches to management of these complex patients.

Recent findings

Fungal infections are increasingly recognized as important causes of CNS disease in both immunocompromised and immunocompetent hosts. Globally, cryptococcal meningitis remains a leading cause of death in HIV-infected persons in resource-limited settings. Emerging fungal pathogens with increased virulence and resistance to numerous classes of antifungal agents have been identified and represent a management challenge. Newer diagnostic techniques focused on antigen detection or molecular amplification of fungal pathogens offer promise in the expediated diagnosis and treatment of CNS fungal infections.

Meningitis and brain abscess because of invasive fungal pathogens are frequently fatal infections. Newer laboratory tests allowing antigen detection or molecular amplification from cerebrospinal fluid are more sensitive than culture and allow earlier initiation of effective therapy.
Cleft Rhinoplasty Study and Evolution
Authors: Agochukwu-Nwubah Nneamaka , Boustany Ashley , Vasconez Henry C.
Published: March 2019

Background:

Most patients with a cleft lip will have a cleft lip nasal deformity. The nasal deformities are complex and are difficult to surgically correct as a result of the anatomical issues and deficiencies. In this study, the authors analyzed and reviewed nasal pathology and surgical maneuvers in patients with cleft lip nasal deformity treated by the senior author over the past 15 years.

Methods:

A retrospective review was performed on patients who underwent a rhinoplasty for a cleft nasal deformity from the years of 2002 to 2017. Patients were stratified by unilateral and bilateral cleft lip. For each variable, comparisons were made between unilateral and bilateral cases.

Results:

39 patients had a unilateral cleft lip nasal deformity, while 17 had a bilateral cleft lip nasal deformity. Patients with a unilateral cleft nasal deformity had a significantly higher incidence of vestibular stenosis and septal deviation. Regarding surgical maneuvers, unilateral cleft lip patients had a relatively higher utilization of septoplasty, spreader grafts, and alar grafts compared to bilateral cleft lip patients. Bilateral cleft lip patients had a relatively higher utilization of dorsal hump reduction, columella strut grafts, and nasal tip grafts. These differences were not statistically significant. Unilateral cleft lip patients had a statistically significant higher use of alveolar support at the time of rhinoplasty.

Conclusions:

The rhinoplasty operation in patients with cleft lip nasal deformity is uniquely challenging and rewarding. This operation has undergone an evolution in our own practice and has led to improved outcomes for these patients.
High-Velocity Ballistic Injuries Inflicted to the Maxillofacial Region
Authors: Jose Anson , Arya Saurabh , Nagori Shakil
Published: March 2019

Background & Aim:

Gun-shot trauma inflicted to the maxillofacial region results in multiple injuries which significantly impacts management and reconstructive options. The authors investigated the efficacy/outcomes of primary management of maxillofacial trauma inflicted in ballistic injuries.

Methods:

This is a retrospective descriptive study carried out solely at 15 Corps Dental Unit, a tertiary care military hospital at Srinagar between the year 2016 & 2017. At the time of enrolment age, gender, extent of injury and definitive diagnosis were recorded. Other information such as type of surgery, hospital stay was taken from in-patient hospital record documents. An informed consent was taken from all patients.

Results:

A total of 16 patients (all males) with a mean age of 29.6 ± 4.2 years were part of our study. The average time interval between trauma and surgery was 7 to 10 days. There was striking high prevalance of mandibular injuries in 62.5% patients, 18.7% patients having combined maxilla-mandibular defects and 12.5% patients with injuries around the mid-face. Complications such as immediate airway compromise were seen in 50% of the patients who suffered direct airway trauma necessitating tracheostomy. The 43.7% patients suffered nerve injuries at the time of presentation while 56.2% patients suffered scar contracture noted at follow-up of 1 year. One patient suffered a stellate wound with ragged and torn edges and also trauma to the parotid gland. Other salivary gland injuries were also noted in 18.7% patients. Reconstruction using local flaps was done in 3 patients of our series. The mean duration of hospital stay was 43.3 ± 33.5 days. An average follow up ranged from 12 ± 6 months.

Conclusions:

Early and appropriate intervention to preserve and stabilise the facial skeleton and reconstruction of the facial soft tissue envelope in high-velocity ballistic injuries is highly effective and yields superior functional and esthetic outcomes.
A multidimensional functional fitness score is a stronger predictor of type 2 diabetes than obesity parameters in cross sectional data
Authors: Patil Pramod , Lalwani Poortata S , Vidwans Harshada B , Kulkarni Shubhankar A , Bais Deepika , Diwekar-Joshi Manawa M , Rasal Mayur , Bhasme Nikhila , Naik Mrinmayee , Batwal Shweta , Watve Milind G
Published: March 2019

Objective

We examine here whether multidimensional functional fitness is a better predictor of type 2 diabetes as compared to morphometric indices of obesity such as body mass index (BMI) and waist to hip ratio (WHR).

Research design and method

We analysed retrospective data of 663 volunteer participants (285 males and 378 females between age 28 and 84), from an exercise clinic in which every participant routinely undergoes a health related physical fitness (HRPF) assessment consisting of 15 different tasks examining 8 different aspects of functional fitness.

Results

The odds of being diabetic in the highest quartile of BMI were not significantly higher than that in the lowest quartile in either of the sexes. The odds of being a diabetic in the highest WHR quartile were significantly greater than the lowest quartile in females (OR = 4.54 (1.95, 10.61) as well as in males (OR = 3.81 (1.75, 8.3). In both sexes the odds of being a diabetic were significantly greater in the lowest quartile of HRPF score than the highest (males OR = 10.52 (4.21, 26.13); females OR = 10.50 (3.53, 31.35)). HRPF was not correlated with BMI in both sexes but was negatively correlated with WHR. After removing confounding, the predictive power of HRPF was significantly greater than that of WHR.

Conclusion

Multidimensional functional fitness score was a better predictor of type 2 diabetes than obesity parameters in the Indian population.
Landscape epidemiology of ash dieback
Authors: Grosdidier M. , Scordia T. , loos R. , Marçais B.
Published: March 2019

Ash dieback caused byHymenoscyphus fraxineus, an invasive alien pathogen, has been severely damaging European ash populations. Nevertheless, a large range of disease severities was observed at the landscape scale in the field. Several studies suggested that environment, such as climate, site conditions or local tree cover strongly affects ash dieback. We characterized the landscape epidemiology of the disease at two stages of the invasion process with spatio-temporal models using Bayesian models fitted by Integrated Nested Laplace Approximation (INLA). We first analyzed the effect of landscape features on the disease arrival and establishment stage at the scale of a village in NE France in 2012, 2 years after first report of the disease in the area and then, on the disease development stage in 2016-18. Landscape features had little impact on the disease at the establishment stage but strongly determined it further development. The local fragmentation of the tree cover was the most important factor with trees isolated or in hedges in agricultural settings far less affected then trees in forest environment. We showed that they were subjected to different microclimate with higher crown temperatures unfavorable to the pathogen development. Furthermore, host density was important for disease development with ash at low density far less affected by ash dieback. Presence of ashes in the vicinity affected local disease severity up to several hundred meters. These results may help to develop management strategy for the disease.
The ability of single genes vs full genomes to resolve time and space in outbreak analysis
Authors: Dudas Gytis , Bedford Trevor
Published: March 2019

Inexpensive pathogen genome sequencing has had a transformative effect on the field of phylodynamics, where ever increasing volumes of data have promised real-time insight into outbreaks of infectious disease. As well as the sheer volume of pathogen isolates being sequenced, the sequencing of whole pathogen genomes, rather than select loci, has allowed phylogenetic analyses to be carried out at finer time scales, often approaching serial intervals for infections caused by rapidly evolving RNA viruses. Despite its utility, whole genome sequencing of pathogens has not been adopted universally and targeted sequencing of loci is common in some pathogen-specific fields. In this study we aim to highlight the utility of sequencing whole genomes of pathogens by re-analysing a well-characterised collection of Ebola virus sequences in the form of complete viral genomes (~19kb long) or the rapidly evolving glycoprotein (GP, ~2kb long) gene. We quantify changes in phylogenetic, temporal, and spatial inference resolution as a result of this reduction in data and compare these to theoretical expectations. We propose a simple intuitive metric for quantifying temporal resolution,i.e.the time scale over which sequence data might be informative of various processes as a quick back-of-the-envelope calculation of statistical power available to molecular clock analyses.
Multiple-serotype models of dengue virus transmission: simulation study and perspectives for the application of inference in epidemiological surveillance
Authors: Souto-Maior Caetano
Published: March 2019

With around 3 billion people at risk, dengue virus is endemic to many parts of the world. In the Brazilian city of Rio de Janeiro, surveillance measures require notification of new dengue virus cases, and are supplemented by serum collection from patients and sequencing of viral RNA. Phylogenetic analyses have been performed for all serotypes circulating in the country to identify viral genotypes, potentially identify new introductions, and compare viruses presently circulating in the country with those in the past, and of other countries. As a separate type of analysis, a number of mathematical models have been developed to describe dengue virus transmission – particularly qualitative incidence or prevalence patterns – although few have been tested. In this chapter, I show how different mathematical formulations could represent transmission of dengue virus by mosquitoes to humans, how the different model structures entail assumptions about the process, and how these affect outputs qualitatively. Inference from simulated data is used as proof of principle that the kind of data available could be used to accurately estimate all model parameters; however, it is shown that stochasticity may severely hamper efforts to test the models quantitatively. I further implement inference from sequence data for the different models, and compare the performance to that of time series. The methods are applied to the data available for the city of Rio de Janeiro.
The NEDD8 cycle controlled by NEDP1 upon DNA damage is a regulatory module of the HSP70 ATPase activity
Authors: Bailly Aymeric P. , Perrin Aurelien , Serrano-Macia Marina , Maghames Chantal , Leidecker Orsolya , Trauchessec Helene , Martinez-Chantar ML , Gartner Anton , Xirodimas Dimitris P.
Published: March 2019

Ubiquitin and ubiquitin-like chains are finely balanced by the action of conjugating and de-conjugating enzymes. Alterations in this balance trigger signalling events required for the response to stress conditions and are often observed in pathologies. How such changes are detected is not well-understood. We show that upon DNA damage the induction of the de-NEDDylating enzyme NEDP1 restricts the formation of poly-NEDD8 chains, mainly through lysines K11/K48. This promotes APAF1 oligomerisation and apoptosis induction, a step that requires the HSP70 ATPase activity. We found that HSP70 binds to NEDD8 and in vitro, mono-NEDD8 stimulates the ATPase activity of HSP70, counteracted upon poly-NEDDylation. This effect is independent of NEDD8 conjugation onto substrates. The studies identify the HSP70 chaperone as sensor of changes in the NEDD8 cycle, providing mechanistic insights for a cytoplasmic role of NEDD8 in the DNA damage induced apoptosis. They also indicate that the balance between mono- versus poly-NEDDylation is a regulatory module of HSP70 function. The above findings may be important in tumorigenesis, as we find that NEDP1 levels are downregulated in Hepatocellular Carcinoma with concomitant accumulation of NEDD8 conjugates.
Understanding the population structure of the GHQ-12: evidence for multidimensionality using Bayesian and Exploratory Structural Equation Modelling from a large-scale UK population survey
Authors: Griffith Gareth J , Jones Kelvyn
Published: March 2019

Mental health and its complexity, measurement and social determinants are increasingly important avenues of research for social scientists. Quantitative social science commonly investigates mental health as captured by population screening metrics. One of the most common of these metrics is the 12-Item General Health Questionnaire (GHQ-12). Despite its canonical use as an outcome of interest in social science, the traditional use of the summed scores of summed questionnaires carries empirical and substantive assumptions which are often not fully considered or justified in the research. We outline the implications of these assumptions and the restrictions imposed by traditional modelling techniques and advocate for a more nuanced approach to population mental health inference. We use novel Exploratory Structural Equation Modelling (ESEM) on a large, representative UK sample taken from the first wave of the Understanding Society Survey, totalling 40,452 respondents. We use this to exemplify the potential of traditional, restrictive assumptions to bias conclusions and policy recommendations. ESEM analysis identifies a 4-factor structure for the GHQ-12, including a newly proposed “Emotional Coping” dimension. This structure is then tested against leading proposed factor structures from the literature and is demonstrated to perform better across all metrics, under both Maximum Likelihood and Bayesian estimation. Moreover, the proposed factors are more substantively dissimilar than those retrieved from previous literature. The results highlight the inferential limitations of using simple summed scores for mental health measurement. Use of the highlighted methods in combination with population studies offers quantitative social scientists the opportunity to explore predictors and patterns of underlying processes of population mental health outcomes, explicitly addressing the complexity and measurement error inherent to mental health analysis.
Whole-genome and RNA sequencing reveal variation and transcriptomic coordination in the developing human prefrontal cortex
Authors: Werling Donna M. , Pochareddy Sirisha , Choi Jinmyung , An Joon-Yong , Sheppard Brooke , Peng Minshi , Li Zhen , Dastmalchi Claudia , Santpere Gabriel , Sousa Andre M. M. , Tebbenkamp Andrew T. N. , Kaur Navjot , Gulden Forrest O. , Breen Michael S. , Liang Lindsay , Gilson Michael C. , Zhao Xuefang , Dong Shan , Klei Lambertus , Cicek A. Ercument , Buxbaum Joseph D. , Adle-Biassette Homa , Thomas Jean-Leon , Aldinger Kimberly A. , O’Day Diana R. , Glass Ian A. , Zaitlen Noah A. , Talkowski Michael E. , Roeder Kathryn , State Matthew W. , Devlin Bernie , Sanders Stephan J. , Sestan Nenad
Published: March 2019

Variation in gene expression underlies neurotypical development, while genomic variants contribute to neuropsychiatric disorders. BrainVar is a unique resource of paired whole-genome sequencing and bulk-tissue RNA-sequencing from the human dorsolateral prefrontal cortex of 176 neurotypical individuals across prenatal and postnatal development, providing the opportunity to assay genomic and transcriptomic variation in tandem. Leveraging this resource, we identified rare premature stop codons with commensurate reduced and allele-specific expression of corresponding genes, and common variants that alter gene expression (expression quantitative trait loci, eQTLs). Categorizing eQTLs by prenatal and postnatal effect, genes affected by temporally-specific eQTLs, compared to constitutive eQTLs, are enriched for haploinsufficiency, protein-protein interactions, and neuropsychiatric disorder risk loci. Expression levels of over 12,000 genes rise or fall in a concerted late-fetal transition, with the transitional genes enriched for cell type specific genes and neuropsychiatric disorder loci, underscoring the importance of cataloguing developmental trajectories in understanding cortical physiology and pathology.

Highlights

Whole-genome and RNA-sequencing across human prefrontal cortex development in BrainVar

Gene-specific developmental trajectories characterize the late-fetal transition

Identification of constitutive, prenatal-specific, postnatal-specific, and rare eQTLs

Integrated analysis reveals genetic and developmental influences on CNS traits and disorders
Genomic data and multi-species demographic modelling uncover past hybridization between currently allopatric freshwater species
Authors: Mendes Sofia L. , Machado Miguel P. , Coelho Maria M. , Sousa Vitor C.
Published: March 2019

Evidence for ancient interspecific gene flow through hybridization has been reported in many animal and plant taxa based on genetic markers. The study of genomic patterns of closely related species with allopatric distributions allow to assess the relative importance of vicariant isolating events and past gene flow. Here, we investigated the role of gene flow in the evolutionary history of four closely related freshwater fish species with currently allopatric distributions in western Iberian rivers -Squalius carolitertii, S. pyrenaicus, S. torgalensisandS. aradensis- using a population genomics dataset of 23 562 SNPs from 48 individuals, obtained through genotyping by sequencing (GBS). We uncovered a species tree with two well differentiated clades: (i)S. carolitertiiandS. pyrenaicus; and (ii)S. torgalensisandS. aradensis. By using D-statistics and demographic modelling based on the site frequency spectrum, comparing alternative demographic scenarios of hybrid origin, secondary contact and isolation, we found that theS. pyrenaicusNorth lineage is likely the result of an ancient hybridization event betweenS. carolitertii(contributing ~84%) andS. pyrenaicusSouth lineage (contributing ~16%), consistent with a hybrid speciation scenario. Furthermore, in the hybrid lineage we identify outlier loci potentially affected by selection favouring genes from each parental lineage at different genomic regions. Our results suggest that ancient hybridization can affect speciation and that freshwater fish species currently in allopatry are useful to study these processes.
The genome of the blind soil-dwelling and ancestrally wingless dipluranCampodea augens, a key reference hexapod for studying the emergence of insect innovations
Authors: Manni Mosè , Simao Felipe A. , Robertson Hugh M. , Gabaglio Marco A. , Waterhouse Robert M. , Misof Bernhard , Niehuis Oliver , Szucsich Nikolaus U. , Zdobnov Evgeny M.
Published: March 2019

The dipluran two-pronged bristletailCampodea augensis a blind ancestrally wingless hexapod with the remarkable capacity to regenerate lost body appendages such as its long antennae. As sister group to Insecta (sensu stricto), Diplura are key to understanding the early evolution of hexapods and the origin and evolution of insects. Here we report the 1.2-Gbp draft genome ofC. augensand results from comparative genomic analyses with other arthropods. InC. augenswe uncovered the largest chemosensory gene repertoire of ionotropic receptors in the animal kingdom, a massive expansion which might compensate for the loss of vision. We found a paucity of photoreceptor genes mirroring at the genomic level the secondary loss of an ancestral external photoreceptor organ. Expansions of detoxification and carbohydrate metabolism gene families might reflect adaptations for foraging behaviour, and duplicated apoptotic genes might underlie its high regenerative potential.

TheC. augensgenome represents one of the key references for studying the emergence of genomic innovations in insects, the most diverse animal group, and opens up novel opportunities to study the under-explored biology of diplurans.