bluuebunny/crossref_metadata_2025 huggingface dataset:
What Can Breast and Plastic Surgeons Do to Help Fight the Opioid Crisis: The Interpectoral Block for Pain Control Following Aesthetic and Reconstructive Breast Surgery
Authors: Scheflan Michael , Allweis Tanir M
Published: February 2020

With the heightened awareness of the dangers of opioid administration, the importance of providing effective non-opioid postoperative pain management is evident. Regional analgesia for breast surgery has been described, but it is unclear how widely it is utilized. The authors describe a simple block performed during ablative, aesthetic, and reconstructive breast surgery to improve postoperative pain control and significantly decrease the need for postoperative pain medications. The interpectoral (PECS I) block covers the lateral and medial pectoral nerves and can be administered by the anesthesiologist under ultrasound guidance after induction of general anesthesia, or by the surgeon under direct vision, using a blunt cannula, at the time of surgery. The authors have been practicing this technique in every patient undergoing aesthetic, ablative, and reconstructive breast surgery in the last 4 years. In approximately 350 patients, none received opioids after discharge, which was either same day or the following day. The authors provide a brief review of the literature and a detailed description of the technique along with a video demonstrating the procedures. Intraoperative pectoral block is a simple and effective technique for decreasing postoperative pain and analgesic requirements and could be widely adopted as a standard of care in breast surgery.
Spontaneously occluded left atrial appendage in a patient with atrial fibrillation and stroke: a case report
Authors: Tinggaard Andreas Bugge , Korsholm Kasper , Jensen Jesper Møller , Nielsen-Kudsk Jens Erik
Published: February 2020

Background 

The left atrial appendage (LAA) is the main source of thromboembolism in atrial fibrillation (AF). Transcatheter closure is non-inferior to warfarin therapy in preventing stroke.

Case summary 

A patient with two consecutive strokes associated with AF was referred for transcatheter LAA occlusion (LAAO). Preprocedural cardiac CT and transoesophageal echocardiography demonstrated a spontaneously occluded LAA with a smooth left atrial surface, with stationary results at 6- and 12-month imaging follow-up. Warfarin was discontinued, and life-long aspirin instigated.

Discussion 

Left atrial appendage occlusion has shown non-inferiority to warfarin for prevention of stroke, cardiovascular death, and all-cause mortality. No benefits from anticoagulation have been demonstrated in patients with embolic stroke of undetermined source. In the present case, we observed that the LAA was occluded and, therefore, treated with aspirin monotherapy assuming similar efficacy as transcatheter LAAO.
A pilot study to investigate the histomorphometric changes of murine maxillary bone around the site of mini-screw insertion in regenerated bone induced by anabolic reagents
Authors: Keo Preksa , Matsumoto Yoshiro , Shimizu Yasuhiro , Nagahiro Shigeki , Ikeda Masaomi , Aoki Kazuhiro , Ono Takashi
Published: February 2020

Objective

The objective of this study was to investigate the histomorphometric changes around the site of mini-screw insertion in the regenerated bone which was induced by an anabolic-injection method using both anabolic peptide and bone morphogenetic protein 2 (BMP-2).

Methods

Twenty-seven eight-week-old C57BL/6J male mice were used. Some mice received submucosal co-injections of anabolic peptide and BMP-2 just in front of the maxillary first molar. Screw insertion was then performed 4 weeks after injection. All mice underwent a weekly in vivo micro-focal X-ray computed tomography (µCT) analysis before being sacrificed at week 8. The bone formation activity was evaluated using fluorescent labelling in the undecalcified sections. The analyses, including screw insertion, were performed in the frontal plane, in front of the site of screw insertion.

Results

Reconstructed µCT images revealed that the co-injection of anabolic reagents could lead to a gradual increase in the bone mineral density (BMD) of the injection-induced thickened bone by week 8. Both radiological and histomorphometric analyses indicated that screw insertion did not have any deleterious effects on either the BMD or the bone formation activity of the induced bone. Furthermore, the injection of anabolic reagents also led to an increase in the BMD of the underlying maxillary bone at the injection site.

Conclusion

Our histomorphometric analyses suggest that performing such anabolic injection to thicken bone could stimulate bone formation in the basal bone as well as in the induced bone. Similar augmentation of bone formation could be obtained even after subsequent screw insertion at the site of the induced bone.
Association of Biomarker Cutoffs and Endoscopic Outcomes in Crohn’s Disease: A Post Hoc Analysis From the CALM Study
Authors: Reinisch Walter , Panaccione Remo , Bossuyt Peter , Baert Filip , Armuzzi Alessandro , Hébuterne Xavier , Travis Simon , Danese Silvio , Sandborn William J , Schreiber Stefan , Berg Sofie , Zhou Qian , Kligys Kristina , Neimark Ezequiel , Suleiman Ahmed A , D’Haens Geert , Colombel Jean-Frederic
Published: February 2020

Background

CALM was a randomized phase 3 trial in patients with Crohn’s disease (CD) that demonstrated improved endoscopic outcomes when treatment was escalated based on cutoffs for inflammatory biomarkers, fecal calprotectin (FC), C-reactive protein (CRP), and CD Activity Index (CDAI) remission vs CDAI response alone. The purpose of this post hoc analysis of CALM was to identify drivers of treatment escalation and evaluate the association between biomarker cutoff concentrations and endoscopic end points.

Methods

The proportion of patients achieving CD Endoscopic Index of Severity (CDEIS) <4 and no deep ulcers 48 weeks after randomization was evaluated according to CRP <5 mg/L or ≥5 mg/L and FC <250 μg/g or ≥250 μg/g. Subgroup analyses were performed according to disease location, and sensitivity analyses were conducted in patients with elevated CRP and/or FC at baseline. The association between endoscopic end points and biomarker cutoffs was performed using χ 2 test.

Results

The proportion of patients who achieved the primary end point CDEIS <4 and no deep ulcers was significantly greater for those with FC <250 µg/g (74%; P < 0.001), with an additive effect for CRP <5 mg/L. The association of FC <250 µg/g with improved endoscopic outcomes was independent of disease location, although the greatest association was observed for ileocolonic disease. Fecal calprotectin <250 µg/g, CRP <5 mg/L, and CDAI <150 gave a sensitivity/specificity of 72%/63% and positive/negative predictive values of 86%/42% for CDEIS <4 and no deep ulcers 48 weeks after randomization.

Conclusion

This post hoc analysis of CALM demonstrated that a cutoff of FC <250 µg/g is a useful surrogate marker for mucosal healing in CD.
The effect of mean pressure on the performance of a single-stage heat-driven thermoacoustic cooler
Authors: Farikhah Irna
Published: February 2020

Waste heat is an environmental issue in the world. There are some technologies that can be used to recovery the waste heat, one of which is thermoacoustic cooler technology. Thermoacoustic technology can be divided into two parts: one is thermoacoustic engine and cooler. To design the cooler system having high efficiency and lower onset heating temperature, the effect of mean pressure is investigated. By increasing mean pressure from 0.5 to 3 MPa, the heating temperature generating acoustic power can be decreased from 831 to 580 K. Moreover, 15% of Thermodynamic upper limit value of the whole cooler system is achieved.
Monoamine Oxidase A Hypomethylation in Obsessive-Compulsive Disorder: Reversibility By Successful Psychotherapy?
Authors: Schiele Miriam A , Thiel Christiane , Deckert Jürgen , Zaudig Michael , Berberich Götz , Domschke Katharina
Published: February 2020

Background

Epigenetic markers such as DNA methylation of the monoamine oxidase A (MAOA) gene have previously been shown to be altered in anxiety- and stress-related disorders and to constitute a potential mechanism of action of psychotherapeutic interventions such as cognitive behavioral therapy in these disorders. The present study for the first time, to our knowledge, investigated MAOA methylation in patients with obsessive-compulsive disorder applying a longitudinal psychotherapy-epigenetic approach.

Methods

The present sample comprised 14 unmedicated female patients with primary obsessive-compulsive disorder and 14 age- and sex-matched healthy controls. MAOA promoter methylation was analyzed via direct sequencing of sodium bisulfite-treated DNA extracted from whole blood before and after an 8- to 10-week semi-standardized, obsessive-compulsive disorder–specific cognitive behavioral therapy. Clinical response was assessed by means of the Yale-Brown Obsessive Compulsive Scale.

Results

Significantly lower MAOA promoter methylation was discerned in obsessive-compulsive disorder patients relative to healthy controls. Data were available for 12 patients with obsessive-compulsive disorder and 14 controls. Furthermore, following cognitive behavioral therapy, clinical improvement, i.e., decreases in obsessive-compulsive disorder symptoms as indicated by lower scores on the Yale-Brown Obsessive Compulsive Scale was found to be significantly correlated with increases in MAOA methylation levels in patients (data available for n = 7).

Conclusions

The present pilot data suggest MAOA hypomethylation as a potential risk marker of obsessive-compulsive disorder and an increase in MAOA methylation levels as a possible mechanistic correlate of response to cognitive behavioral therapy in obsessive-compulsive disorder.
A Complete Classification of Unitary Fusion Categories Tensor Generated by an Object of Dimension
Authors: Edie-Michell Cain
Published: February 2020

In this paper we give a complete classification of unitary fusion categories $\otimes $-generated by an object of dimension $\frac{1 + \sqrt{5}}{2}$. We show that all such categories arise as certain wreath products of either the Fibonacci category or of the dual even part of the $2D2$ subfactor. As a by-product of proving our main classification result we produce a classification of finite unitarizable quotients of $\operatorname{Fib}^{*N}$ satisfying a certain symmetry condition.
The effect of N-acetylcysteine in a combined antibiofilm treatment against antibiotic-resistant Staphylococcus aureus
Authors: Manoharan Arthika , Das Theerthankar , Whiteley Gregory S , Glasbey Trevor , Kriel Frederik H , Manos Jim
Published: February 2020

Background

The WHO declared Staphylococcus aureus as a ‘pathogen of high importance’ in 2017. One-fifth of all bloodstream-related infections in Australia and 12 000 cases of bacteraemia in the UK (2017–18) were caused by the MRSA variant. To address the need for novel therapies, we investigated several permutations of an innovative combination therapy containing N-acetylcysteine (NAC), an antibiotic and an enzyme of choice in eradicating MRSA and MSSA biofilms.

Methods

Biofilm viability (resazurin assay) and colony count methods were used to investigate the effect of NAC, antibiotics and enzymes on S. aureus biofilm disruption and killing. The effects of NAC and enzymes on the polysaccharide content of biofilm matrices were analysed using the phenol/sulphuric acid method and the effect of NAC on DNA cleavage was determined using the Qubit fluorometer technique. Changes in biofilm architecture when subjected to NAC and enzymes were visualized using confocal laser scanning microscopy (CLSM).

Results

NAC alone displayed bacteriostatic effects when tested on planktonic bacterial growth. Combination treatments containing 30 mM NAC resulted in ≥90% disruption of biofilms across all MRSA and MSSA strains with a 2–3 log10 decrease in cfu/mL in treated biofilms. CLSM showed that NAC treatment drastically disrupted S. aureus biofilm architecture. There was also reduced polysaccharide production in MRSA biofilms in the presence of NAC.

Conclusions

Our results indicate that inclusion of NAC in a combination treatment is a promising strategy for S. aureus biofilm eradication. The intrinsic acidity of NAC was identified as key to maximum biofilm disruption and degradation of matrix components.
Antiretroviral concentrations in the presence and absence of valproic acid
Authors: Calcagno A , Cusato J , Ferrara M , De Nicolò A , Lazzaro A , Manca A , D’Avolio A , Di Perri G , Bonora S
Published: February 2020

Objectives

An unexpected drug–drug interaction has been recently reported between dolutegravir, an HIV integrase inhibitor, and valproic acid. Despite there being several potential underlying mechanisms, plasma protein displacement has been suggested. The aim of this study was to assess plasma concentrations of several antiretrovirals when administered with or without valproic acid.

Methods

We performed a therapeutic drug monitoring registry analysis and identified patients concomitantly taking antiretrovirals and valproic acid and without clinical affecting conditions or interacting drugs.

Results

One hundred and thirty-four patients were identified. Median (IQR) age and BMI were 49.7 years (45–56) and 23.4 kg/m2 (20.8–26.3) and 78 were male (58.2%). Despite small groups, we observed no major effect on antiretroviral exposure, even when considering highly protein-bound compounds (such as etravirine), with the exception of dolutegravir trough concentrations [median (IQR) = 132 ng/mL (62–227) in individuals on valproic acid versus 760 ng/mL (333–1407) in those not receiving valproic acid].

Conclusions

Valproic acid does not have a major effect on antiretrovirals other than dolutegravir. The mechanism of this unexpected drug–drug interaction may be the combination of protein displacement, reduced absorption and CYP3A4 induction.
High level of pre-treatment and acquired HIV drug resistance in Honduras: a nationally representative survey, 2016–17
Authors: Girón-Callejas Amalia , García-Morales Claudia , Mendizabal-Burastero Ricardo , Meza Rita I , Sierra Tomasa , Tapia-Trejo Daniela , Pérez-García Marissa , Quiroz-Morales Verónica S , Paredes Mayte , Rodríguez Alizon , Juárez Sandra I , Farach Nasim , Videa Geraldina , Lara Bredy , Rodríguez Edith , Ardón Elvia , Sajquim Edgar , Lorenzana Rolando , Ravasi Giovanni , Northbrook Sanny , Reyes-Terán Gustavo , Ávila-Ríos Santiago
Published: February 2020

Background

Pre-treatment HIV drug resistance (HIVDR) to NNRTIs has consistently increased in low-/middle-income countries during the last decade.

Objectives

To estimate the prevalence of pre-treatment HIVDR and acquired HIVDR among persons living with HIV (PLHIV) on ART for 12 ± 3 months (ADR12) and ≥48 months (ADR48) in Honduras.

Patients and methods

A nationwide cross-sectional survey with a two-stage cluster sampling was conducted from October 2016 to November 2017. Twenty-two of 54 total ART clinics representing >90% of the national cohort of adults on ART were included. HIVDR was assessed for protease and reverse transcriptase Sanger sequences using the Stanford HIVdb tool.

Results

A total of 729 PLHIV were enrolled; 26.3% (95% CI 20.1%–33.5%) ART initiators reported prior exposure to antiretrovirals. Pre-treatment HIVDR prevalence was 26.9% (95% CI 20.2%–34.9%) to any antiretroviral and 25.9% (19.2%–33.9%) to NNRTIs. NNRTI pre-treatment HIVDR was higher in ART initiators with prior exposure to antiretrovirals (P = 0.001). Viral load (VL) suppression rate was 89.7% (85.1%–93.0%) in ADR12 and 67.9% (61.7%–73.6%) in ADR48. ADR12 to any drug among PLHIV with VL ≥1000 copies/mL was 86.1% (48.9%–97.6%); 67.1% (37.4%–87.5%) had HIVDR to both NNRTIs and NRTIs, and 3.8% (0.5%–25.2%) to PIs. ADR48 was 92.0% (86.8%–95.3%) to any drug; 78.1% (66.6%–86.5%) to both NNRTIs and NRTIs, and 7.3% (1.8%–25.1%) to PIs.

Conclusions

The high prevalence of NNRTI pre-treatment HIVDR observed in Honduras warrants consideration of non-NNRTI-based first-line regimens for ART initiation. Programmatic improvements in HIVDR monitoring and adherence support may also be considered.
Effect of dietary supplementation of xylanase in a wheat-based diet containing canola meal on growth performance, nutrient digestibility, organ weight, and short-chain fatty acid concentration in digesta when fed to weaned pigs
Authors: Mejicanos Gustavo A , González-Ortiz Gemma , Nyachoti Charles Martin
Published: February 2020

This study was designed to determine the effect of dietary supplementation of xylanase on growth performance, nutrient digestibility, organ weight, digesta pH, and concentration of short-chain fatty acids (SCFA) of weaned pigs fed wheat–canola meal (CM) diets over a 35-d period. A total of 144 piglets (72 barrows and 72 gilts) weaned at 18 ± 2 d of age, with initial body weight (BW) of 6.2 ± 0.7 kg, received one of eight dietary treatments based on randomized complete block design. BW and feed intake were recorded weekly to calculate average daily gain (ADG), average daily feed intake (ADFI), and feed efficiency (G:F). Treatments consisted of a control wheat–soybean meal-based diet and wheat-regular (RCM), dehulled (DCM), or coarse CM (CCM) without and with 16,000 BXU/kg xylanase (Econase XT). All diets contained 500 FTU/kg of phytase (Quantum Blue 5G) and titanium dioxide (0.3%). Apparent total tract digestibility (ATTD) of neutral detergent fiber (NDF), crude protein (CP), phosphorous (P), calcium (Ca), dry matter, and diet were determined. On day 35, one pig per pen was euthanized to evaluate the main factors of protein, xylanase supplementation, and sex on organ weight, ileal and colon digesta pH, and colon digesta concentrations of SCFA. The main factors did not affect growth performance. Xylanase supplementation improved nutrient digestibilities in all diets and increased ileal and colonic digesta pH without affecting the growth performance of weaned pigs fed wheat and CM-based diets. A protein–xylanase effect (P < 0.05) resulted in increasing the ATTD of NDF from 28% to 32% and from 29% to 37% for RCM and DCM, respectively. The ATTD of CP was greater (P < 0.05) with xylanase supplementation (75% vs. 70%). Xylanase supplementation increased ATTD of P and Ca. A three-way interaction (P < 0.05) for protein–xylanase–gender for colon pH, acetic, and propionic acid in the colon digesta of pigs indicated that, in addition to the protein source, piglet sex could have influenced how xylanase works. Xylanase supplementation increased (P < 0.05) the weight of the liver and spleen and tended (P < 0.10) to increase the size of the kidney. In conclusion, dietary supplementation of xylanase increased nutrient digestibility and digesta pH but did not influence the growth performance of weaned pigs fed wheat and CM-based diets over a 35-d period.
A Prospective Study of Automated Breast Ultrasound Screening of Women with Dense Breasts in a Digital Breast Tomosynthesis-based Practice
Authors: Chough Denise M , Berg Wendie A , Bandos Andriy I , Rathfon Grace Y , Hakim Christiane M , Lu Amy H , Gizienski Terri-Ann , Ganott Marie A , Gur David
Published: February 2020

Objective

To assess prospectively the interpretative performance of automated breast ultrasound (ABUS) as a supplemental screening after digital breast tomosynthesis (DBT) or as a standalone screening of women with dense breast tissue.

Methods

Under an IRB-approved protocol (written consent required), women with dense breasts prospectively underwent concurrent baseline DBT and ABUS screening. Examinations were independently evaluated, in opposite order, by two of seven Mammography Quality Standards Act–qualified radiologists, with the primary radiologist arbitrating disagreements and making clinical management recommendations. We report results for 1111 screening examinations (598 first year and 513 second year) for which all diagnostic workups are complete. Imaging was also retrospectively reviewed for all cancers. Statistical assessments used a 0.05 significance level and accounted for correlation between participants’ examinations.

Results

Of 1111 women screened, primary radiologists initially “recalled” based on DBT alone (6.6%, 73/1111, CI: 5.2%–8.2%), of which 20 were biopsied, yielding 6/8 total cancers. Automated breast ultrasound increased recalls overall to 14.4% (160/1111, CI: 12.4%–16.6%), with 27 total biopsies, yielding 1 additional cancer. Double reading of DBT alone increased the recall rate to 10.7% (119/1111), with 21 biopsies, with no improvement in cancer detection. Double reading ABUS increased the recall rate to 15.2% (169/1111, CI: 13.2%–17.5%) of women, of whom 22 were biopsied, yielding the detection of 7 cancers, including one seen only on double reading ABUS. Inter-radiologist agreement was similar for recall recommendations from DBT (κ = 0.24, CI: 0.14–0.34) and ABUS (κ = 0.23, CI: 0.15–0.32). Integrated assessments from both readers resulted in a recall rate of 15.1% (168/1111, CI: 13.1%–17.4%).

Conclusion

Supplemental or standalone ABUS screening detected cancers not seen on DBT, but substantially increased noncancer recall rates.
Thrombolysis for acute graft occlusion during elective endovascular aortic aneurysm repair
Authors: Wohlgemut Jared M , Hennessy Martin , Hussey Keith
Published: February 2020

A 65-year-old man developed acute arterial thrombosis with stent graft occlusion, during elective endovascular aneurysm repair, with bilateral acute lower limb ischaemia. We describe successful endovascular and pharmacological management using a combination of mechanical disruption of the thrombus (using the access sheaths) followed by intra-arterial thrombolysis (Actilyse) infusion. Within 4-h the endograft had completely re-canalized. The patient made an uncomplicated recovery and was discharged on the second post-operative day.
ALMA uncovers the [C ii] emission and warm dust continuum in a z = 8.31 Lyman break galaxy
Authors: Bakx Tom J L C , Tamura Yoichi , Hashimoto Takuya , Inoue Akio K , Lee Minju M , Mawatari Ken , Ota Kazuaki , Umehata Hideki , Zackrisson Erik , Hatsukade Bunyo , Kohno Kotaro , Matsuda Yuichi , Matsuo Hiroshi , Okamoto Takashi , Shibuya Takatoshi , Shimizu Ikkoh , Taniguchi Yoshiaki , Yoshida Naoki
Published: February 2020

We report on the detection of the [C ii] 157.7 μm emission from the Lyman break galaxy (LBG) MACS0416_Y1 at z = 8.3113, by using the Atacama Large Millimeter/submillimeter Array (ALMA). The luminosity ratio of [O iii] 88 μm (from previous campaigns) to [C ii] is 9.3 ± 2.6, indicative of hard interstellar radiation fields and/or a low covering fraction of photodissociation regions. The emission of [C ii] is cospatial to the 850 μm dust emission (90 μm rest frame, from previous campaigns), however the peak [C ii] emission does not agree with the peak [O iii] emission, suggesting that the lines originate from different conditions in the interstellar medium. We fail to detect continuum emission at 1.5 mm (160 μm rest frame) down to 18 μJy (3σ). This non-detection places a strong limits on the dust spectrum, considering the 137 ± 26 μJy continuum emission at 850 μm. This suggests an unusually warm dust component (T > 80 K, 90 per cent confidence limit), and/or a steep dust-emissivity index (βdust > 2), compared to galaxy-wide dust emission found at lower redshifts (typically T ∼ 30–50 K, βdust ∼ 1–2). If such temperatures are common, this would reduce the required dust mass and relax the dust production problem at the highest redshifts. We therefore warn against the use of only single-wavelength information to derive physical properties, recommend a more thorough examination of dust temperatures in the early Universe, and stress the need for instrumentation that probes the peak of warm dust in the Epoch of Reionization.
Understanding and mitigating biases when studying inhomogeneous emission spectra with JWST
Authors: Taylor Jake , Parmentier Vivien , Irwin Patrick G J , Aigrain Suzanne , Lee Elspeth , Krissansen-Totton Joshua
Published: February 2020

Exoplanet emission spectra are often modelled assuming that the hemisphere observed is well represented by a horizontally homogenized atmosphere. However, this approximation will likely fail for planets with a large temperature contrast in the James Webb Space Telescope (JWST) era, potentially leading to erroneous interpretations of spectra. We first develop an analytic formulation to quantify the signal-to-noise ratio and wavelength coverage necessary to disentangle temperature inhomogeneities from a hemispherically averaged spectrum. We find that for a given signal-to-noise ratio, observations at shorter wavelengths are better at detecting the presence of inhomogeneities. We then determine why the presence of an inhomogeneous thermal structure can lead to spurious molecular detections when assuming a fully homogenized planet in the retrieval process. Finally, we quantify more precisely the potential biases by modelling a suite of hot Jupiter spectra, varying the spatial contributions of a hot and a cold region, as would be observed by the different instruments of JWST/NIRSpec. We then retrieve the abundances and temperature profiles from the synthetic observations. We find that in most cases, assuming a homogeneous thermal structure when retrieving the atmospheric chemistry leads to biased results, and spurious molecular detection. Explicitly modelling the data using two profiles avoids these biases, and is statistically supported provided the wavelength coverage is wide enough, and crucially also spanning shorter wavelengths. For the high contrast used here, a single profile with a dilution factor performs as well as the two-profile case, with only one additional parameter compared to the 1D approach.
Discovery of an unusually compact lensed Lyman-break galaxy from the Hyper Suprime-Cam Survey
Authors: Jaelani Anton T , More Anupreeta , Sonnenfeld Alessandro , Oguri Masamune , Rusu Cristian E , Wong Kenneth C , Chan James H H , Suyu Sherry H , Kayo Issha , Lee Chien-Hsiu , Inoue Kaiki T
Published: February 2020

We report the serendipitous discovery of HSC J0904–0102, a quadruply lensed Lyman-break galaxy (LBG) in the Survey of Gravitationally-lensed Objects in Hyper Suprime-Cam Imaging (SuGOHI). Owing to its point-like appearance, the source was thought to be a lensed active galactic nucleus. We obtained follow-up spectroscopic data with the Gemini Multi-Object Spectrographs on the Gemini South Telescope, which confirmed this to be a lens system. The deflecting foreground galaxy is a typical early-type galaxy at a high redshift of $z_{\ell}=0.957$ with stellar velocity dispersion $\sigma_v=259\pm56$ km s−1. The lensed source is identified as an LBG at $z_{\rm s}=3.403$, based on the sharp drop bluewards of Lyα and other absorption features. A simple lens mass model for the system, assuming a singular isothermal ellipsoid, yields an Einstein radius of $\theta_{\rm Ein}=1.23$ arcsec and a total mass within the Einstein radius of $M_{\rm Ein}=(5.55\pm0.24)\times10^{11}\rm M_{\odot}$ corresponding to a velocity dispersion of $\sigma_{\rm SIE}=283\pm3$ km s−1, which is in good agreement with the value derived spectroscopically. The most isolated lensed LBG image has a magnification of $\sim 6.5$. In comparison with other lensed LBGs and typical $z\sim4$ LBG populations, HSC J0904–0102 is unusually compact, an outlier at $>2\sigma$ confidence. Together with a previously discovered SuGOHI lens, HSC J1152+0047, which is similarly compact, we believe that the HSC survey is extending LBG studies down to smaller galaxy sizes.
SV40 T antigen interactions with ssDNA and replication protein A: a regulatory role of T antigen monomers in lagging strand DNA replication
Authors: Onwubiko Nichodemus O , Borst Angela , Diaz Suraya A , Passkowski Katharina , Scheffel Felicia , Tessmer Ingrid , Nasheuer Heinz P
Published: February 2020

DNA replication is a central process in all living organisms. Polyomavirus DNA replication serves as a model system for eukaryotic DNA replication and has considerably contributed to our understanding of basic replication mechanisms. However, the details of the involved processes are still unclear, in particular regarding lagging strand synthesis. To delineate the complex mechanism of coordination of various cellular proteins binding simultaneously or consecutively to DNA to initiate replication, we investigated single-stranded DNA (ssDNA) interactions by the SV40 large T antigen (Tag). Using single molecule imaging by atomic force microscopy (AFM) combined with biochemical and spectroscopic analyses we reveal independent activity of monomeric and oligomeric Tag in high affinity binding to ssDNA. Depending on ssDNA length, we obtain dissociation constants for Tag-ssDNA interactions (KD values of 10–30 nM) that are in the same order of magnitude as ssDNA binding by human replication protein A (RPA). Furthermore, we observe the formation of RPA-Tag-ssDNA complexes containing hexameric as well as monomeric Tag forms. Importantly, our data clearly show stimulation of primase function in lagging strand Okazaki fragment synthesis by monomeric Tag whereas hexameric Tag inhibits the reaction, redefining DNA replication initiation on the lagging strand.
The inflammatory microenvironment in vestibular schwannoma
Authors: Hannan Cathal John , Lewis Daniel , O’Leary Claire , Donofrio Carmine A , Evans Dafydd Gareth , Roncaroli Federico , Brough David , King Andrew Thomas , Coope David , Pathmanaban Omar Nathan
Published: February 2020

Vestibular schwannomas are tumors arising from the vestibulocochlear nerve at the cerebellopontine angle. Their proximity to eloquent brainstem structures means that the pathology itself and the treatment thereof can be associated with significant morbidity. The vast majority of these tumors are sporadic, with the remainder arising as a result of the genetic syndrome Neurofibromatosis Type 2 or, more rarely, LZTR1-related schwannomatosis. The natural history of these tumors is extremely variable, with some tumors not displaying any evidence of growth, others demonstrating early, persistent growth and a small number growing following an extended period of indolence. Emerging evidence now suggests that far from representing Schwann cell proliferation only, the tumor microenvironment is complex, with inflammation proposed to play a key role in their growth. In this review, we provide an overview of this new evidence, including the role played by immune cell infiltration, the underlying molecular pathways involved, and biomarkers for detecting this inflammation in vivo. Given the limitations of current treatments, there is a pressing need for novel therapies to aid in the management of this condition, and we conclude by proposing areas for future research that could lead to the development of therapies targeted toward inflammation in vestibular schwannoma.
Comparing Care Regimes: Worker Characteristics and Wage Penalties in the Global Care Chain
Authors: Lightman Naomi
Published: February 2020

This study uses 2010–2014 Luxembourg Income Study data to measure care work quantitatively within and across four care regimes, with a particular focus on the reliance on migrant women for low-wage, low-status work in health, education, social work, and domestic services. Care regimes are examined in order to highlight similarities and differences in twelve care economies: while liberal and corporatist care regimes are found to display a “migrant in the market” model of employment, familialistic and social democratic regimes exhibit somewhat different employment trends yet continue to financially undervalue highly feminized work in care.
Ten Years of VINQUEST: First Insight for Breeding New Apple Cultivars With Durable Apple Scab Resistance
Authors: Patocchi Andrea , Wehrli Andreas , Dubuis Pierre-Henri , Auwerkerken Annemarie , Leida Carmen , Cipriani Guido , Passey Tom , Staples Martina , Didelot Frédérique , Philion Vincent , Peil Andreas , Laszakovits Hannes , Rühmer Thomas , Boeck Klemens , Baniulis Danas , Strasser Klaus , Vávra Radek , Guerra Walter , Masny Sylwester , Ruess Franz , Le Berre Fanny , Nybom Hilde , Tartarini Stefano , Spornberger Andreas , Pikunova Anna , Bus Vincent G. M.
Published: February 2020

Apple scab, caused by Venturia inaequalis, is a major fungal disease worldwide. Cultivation of scab-resistant cultivars would reduce the chemical footprint of apple production. However, new apple cultivars carrying durable resistances should be developed to prevent or at least slow the breakdown of resistance against races of V. inaequalis. One way to achieve durable resistance is to pyramid multiple scab resistance genes in a cultivar. The choice of the resistance genes to be combined in the pyramids should take into account the frequency of resistance breakdown and the geographical distribution of apple scab isolates able to cause such breakdowns. In order to acquire this information and to make it available to apple breeders, the VINQUEST project ( www.vinquest.ch ) was initiated in 2009. Ten years after launching this project, 24 partners from 14 countries regularly contribute data. From 2009 to 2018, nearly 9,000 data points have been collected. This information has been used to identify the most promising apple scab resistance genes for developing cultivars with durable resistance, which to date are: Rvi5, Rvi11, Rvi12, Rvi14, and Rvi15. As expected, Rvi1, together with Rvi3 and Rvi8, were often overcome, and have little value for scab resistance breeding. Rvi10 may also belong to this group. On the other hand, Rvi2, Rvi4, Rvi6, Rvi7, Rvi9, and Rvi13 are still useful for breeding, but their use is recommended only in extended pyramids of ≥3 resistance genes.
Middle to long-term results of distal femoral tension band hemiepiphysiodesis in the treatment of idiopathic genu valgum
Authors: Baghdadi Soroush , Mortazavi S.M. Javad , Dastoureh Kamel , Moharrami Alireza , Baghdadi Taghi
Published: February 2020

Idiopathic genu valgum is a common deformity in children. Guided growth is the treatment of choice in severe or symptomatic cases, although long-term results are mostly unknown. The purpose of this study was to determine the middle- to long-term results and complications of tension band plating in the treatment of idiopathic genu valgum, and the association between obesity and idiopathic genu valgum. A retrospective review of patients with idiopathic genu valgum treated by tension band plating between January 2007 and September 2017 was performed. Data from 99 patients (198 limbs) were reviewed. All underwent bilateral medial distal femoral tension band plating and subsequent plate removal and were followed by a mean of 56.1 months (12–120 months) after surgery. Full correction was achieved in all patients, with a mean correction rate of 0.52° per month. No cases of infection or premature physeal closure were recorded. Screw breakage at the time of removal occurred in five limbs (2.5%). Fifteen limbs (7.5%) developed a minor overcorrection. 44.4% of our patients were either overweight or obese, which is higher than the national average. A third of our patients complained of an unsightly scar at the latest follow-up. Tension band plating is an effective, well tolerated, and reproducible technique in the treatment of idiopathic genu valgum. The risk of premature physeal closure is minimal. We recommend achieving a minor overcorrection before plate removal in patients with more than a year of expected growth. Also, predicting correction based on the mean correction rate is discouraged.
Paediatric open tibial fractures. Do children require a modified approach to that advised by the British Orthopaedic Association and British Association of Plastic Reconstructive and Aesthetic Surgeons in the UK?
Authors: Chan Yuen , Selvaratnam Veenesh , James Leroy , Nayagam Selvadurai
Published: February 2020

This study reviews the outcomes of paediatric open tibial fractures treated at a level 1 trauma centre using the British Orthopaedic Association/British Association of Plastic Reconstructive and Aesthetic Surgeons standards and compares the results to management in adults. This was a retrospective study of 60 consecutive cases over a 9-year period. The variables recorded include grade of injury, contamination and pattern of fracture. Other data recorded include time at which antibiotics were given, time to index surgery, type of skeletal fixation and time to definitive cover. Outcomes sought were infection rate, time to union, problems with union and any additional unplanned surgery. The mean time to administration of antibiotics was 3.4 h after injury with a range of 0.35–17 h. The mean time to debridement was 13.4 h (range 1–32 h, SD 7.7). The mean time to union was 4.3 months (range 1.3–15 months). There were five cases of deep infection (8.3%) and three cases of superficial infection (5%). There were no significant differences between timings of antibiotic administration, hours to debridement or days to definitive closure between those cases which became infected and those which did not. This retrospective review of a consecutive series of paediatric open tibial fractures shows a close parallel of outcomes to that from adult centres in the UK using the same standards of care. This strengthens the recommendation that, until the availability of data to suggest otherwise, open tibial fractures in children should follow the same recommendations as suggested for adults. The greater healing potential in children, seen in multiple examples of closed long bone fractures, appears to be attenuated in the higher grades of the open tibial fracture.
Prosthesis in Anterior Cervical Herniated Disc Approach Does Not Prevent Radiologic Adjacent Segment Degeneration
Authors: Yang Xiaoyu , Donk Roland , Arts Mark P. , Bartels Ronald H.M.A. , Vleggeert-Lankamp Carmen L.A.
Published: February 2020

Study Design.

Retrospective analysis using data from RCTs.

Objective.

This study aimed to report on the incidence of radiological adjacent segment degeneration (ASD) in patients with cervical radiculopathy due to a herniated disc that were randomized to receive cervical arthroplasty or arthrodesis.

Summary of Background Data.

Cervical disc prostheses were introduced to prevent ASD in the postsurgical follow-up. However, it is still a controversial issue.

Methods.

Two hundred fifty-three patients were included in two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty (ACDA), with intervertebral cage (ACDF), or without intervertebral cage (ACD) for one-level disc herniation. Neutral lateral radiographs were obtained preoperatively, at 1- and 2-year follow-up after surgery. Radiological ASD was evaluated on X-ray and defined by a decrease in disc height and the presence of anterior osteophyte formation on both the superior and the inferior level in relation to the target level.

Results.

Radiological ASD was present in 34% of patients at baseline and increased to 59% at 2-year follow-up in the arthrodesis groups (ACD and ACDF combined), and to 56% in the arthroplasty group. Progression of radiological ASD was present in 29% of patients in the arthrodesis group and in 31% of patients in the arthroplasty group for 2-year follow-up.

Conclusions.

Radiological ASD occurs in a similar manner in patients who were subjected to arthrodesis in cervical radiculopathy and in patients who received arthroplasty to maintain motion. Current data tend to indicate that the advantage of cervical prosthesis in preventing radiological ASD is absent.

Level of Evidence: 2
A Practical Cleft Palate Training Model
Authors: Ozkan Burak , Cologlu Harun , Uysal Cagri A. , Ertas Nilgun M.
Published: February 2020

Educational models are essential for training surgeons and making them familiar with experience- and skill-dependent operations such as cleft palate closure. The development of computer and 3D printer technology has allowed cleft lip and palate models to be produced and used for surgical training. However, these technology-dependent models are not affordable and reproducible for surgeons in developing countries where cleft cases are more commonly seen. Thus, we aimed to create a cleft palate educational model prepared with play-dough and latex. The play-dough is shaped in the form of a palate and the cleft is created by scissors. Then, a latex glove is cut and applied to the dough to mimic the mucosal layer. The combination of the latex glove and play-dough lets the trainee perform surgical markings, incisions, elevation of the flaps, and layer closure. We think this easily producible model might be beneficial for demonstrating cleft types, surgical techniques, and improving surgical skills, especially in developing countries.
Improving Developmental Abilities in Infants With Tuberous Sclerosis Complex
Authors: McDonald Nicole M. , Hyde Carly , Choi April Boin , Gulsrud Amanda C. , Kasari Connie , Nelson Charles A. , Jeste Shafali S.
Published: February 2020

Tuberous sclerosis complex (TSC) is a rare genetic syndrome that confers risk for neurodevelopmental disorders, including autism spectrum disorder and intellectual disability. Delays in social communication and early cognitive abilities are observable as early as 9 months of age in children with TSC; however, there have been no studies of early behavioral intervention in TSC. We conducted a pilot study of an evidence-based, parent-mediated behavioral intervention focused on improving early social communication and play skills in 5 children with TSC (aged 1–3 years). Participants showed maintenance and sometimes gains in developmental abilities, relative to peers, following intervention. Parents generally found the intervention to be helpful and were able to administer the intervention with fidelity. Preliminary results demonstrate initial feasibility of an early play-based, parent-mediated intervention and support the need for a large-scale, randomized clinical trial in TSC.
Experience and Satisfaction of Cancer Patients With a Central Venous Catheter at a Tertiary Hospital in South Korea
Authors: Park Jeong Yun , Lee Da In
Published: February 2020

As cancer chemotherapy transitions from inpatient care to outpatient care, the number of patients who receive a central venous catheter (CVC) and the interest in CVCs as a safe intravenous administration route have increased recently in South Korea. The purpose of this study was to investigate the discomforts and satisfaction that cancer patients with a CVC may experience in daily activities as an outpatient and to provide rationale for nursing interventions. Data collection was conducted between April 11, 2011, and August 31, 2011. Forty-three questionnaires were collected, and a total of 41 questionnaires were used for the final analysis. The mean age of patients was 45.1 years (SD = 11.1 years; range, 18–64 years). The average score of experience of the CVC insertion procedure, daily life experiences of patients with a CVC, the satisfaction and fear of using a CVC, and the acceptance of CVCs were 2.48 ± 0.56, 2.18 ± 0.50, 2.56 ± 0.49, and 2.35 ± 0.39, respectively. The results showed that more detailed information on CVCs, as well as sufficient emotional support, should be provided to the patient to minimize discomfort during CVC insertion. Patient-centered education helps empower patients to master CVC self-management, as well as an understanding of the cultural aspect of South Korean patients who practice the traditional Confucian ethics of “unaltering one's body” and are therefore reluctant to have CVCs inserted into their bodies.
Delirium and Developmental Disability: Improving Specificity of a Pediatric Delirium Screen*
Authors: Kaur Savneet , Silver Gabrielle , Samuels Susan , Rosen Anna H. , Weiss Meredith , Mauer Elizabeth A. , Gerber Linda M. , Greenwald Bruce M. , Traube Chani
Published: February 2020

Objectives:

Children with developmental disabilities are at high risk for developing delirium when critically ill. However, existing pediatric delirium screening tools were designed for children with typical development. The objective of this study was to improve the specificity of the Cornell Assessment for Pediatric Delirium, to allow for accurate detection of delirium in developmentally delayed children admitted to the PICU. We hypothesized that the Cornell Assessment for Pediatric Delirium, when combined with fluctuation in level of awareness as measured by the Richmond Agitation-Sedation Scale, would be valid and reliable for the diagnosis of delirium in developmentally delayed children.

Design:

Prospective observational double-blind cohort study.

Setting:

Tertiary care academic PICU.

Patients:

Children with moderate to severe developmental delay.

Interventions:

Each child was evaluated by the bedside nurse with the Cornell Assessment for Pediatric Delirium once every 12 hours and the Richmond Agitation-Sedation Scale every 4 hours. Cornell Assessment for Pediatric Delirium (score ≥ 9) + Richmond Agitation-Sedation Scale fluctuation (change in Richmond Agitation-Sedation Scale score of at least 2 points during a 24-hr period) was compared with the criterion standard psychiatric evaluation for diagnosis of delirium.

Measurements and Main Results:

Forty children participated; 94 independent paired assessments were completed. The psychiatrists’ diagnostic evaluations were compared with the detection of delirium by the Cornell Assessment for Pediatric Delirium and Richmond Agitation-Sedation Scale. Specificity of the Cornell Assessment for Pediatric Delirium + Richmond Agitation-Sedation Scale fluctuation was 97% (CI, 90–100%), positive predictive value of Cornell Assessment for Pediatric Delirium + Richmond Agitation-Sedation Scale fluctuation was 89% (CI, 65–99%); and negative predictive value remained acceptable at 87% (95% CI, 77–94%). In addition, to confirm interrater reliability of the criterion standard, 11 assessments were performed by two or more psychiatrists in a blinded fashion. There was perfect agreement (κ = 1), indicating reliability in psychiatric diagnosis of delirium in developmentally delayed children.

Conclusion:

When used in conjunction with Richmond Agitation-Sedation Scale score fluctuation, the Cornell Assessment for Pediatric Delirium is a sensitive and specific tool for the detection of delirium in children with developmental delay. This allows for reliable delirium screening in this hard-to-assess population.