bluuebunny/crossref_metadata_2025 huggingface dataset:
Broadband rectangular TEn mode exciter with H-plane power dividers for 100 GHz confocal gyro-devices
Authors: Yao Yelei , Wang Jianxun , Li Hao , Liu Guo , Luo Yong
Published: July 2017

A generic approach to excite TEn0 (n ≥ 1) modes in a rectangular waveguide for confocal gyro-devices is proposed. The exciter consists of a 3 dB H-plane power divider (n ≥ 3) and a mode-converting section. The injection power is split into two in-phase signals with equal amplitudes which simultaneously excite the secondary waveguide via two sets of multiple slots. Both the position and width of the slot are symmetrically distributed with respect to the center line for each set of slots. The slot width complies with a geometry sequence, with adjacent slots being spaced a quarter wavelength apart to cancel the backward wave out. A TE40 mode exciter at 100 GHz is numerically simulated and optimized, achieving a 1 dB and a 3 dB transmission bandwidth of 18.2 and 21 GHz, respectively. The prototype is fabricated and measured. The cold test is carried out utilizing two identical back-to-back connected mode exciters, and the measured performances are in good agreement with the numerical simulation results when taking into account the wall loss and assembly tolerance.
Large area conductive nanoaperture arrays with strong optical resonances and spectrally flat terahertz transmission
Authors: Krewer K. L. , Jiang K. , Bley K. , Jin Z. , Mics Z. , Weiss C. K. , Landfester K. , Elmers H.-J. , Bonn M. , Turchinovich D.
Published: July 2017

Using simple and inexpensive nanosphere lithography, we produce large, centimeter-squared sized thin golden films patterned with a hexagonal array of nanoapertures with controllable dimensions on the order of 100–300 nm, spaced by a 350–375 nm pitch distance. The optical transmission spectra of our samples are dominated by the resonant plasmonic features in the spectral range 500–700 nm, caused by the nanostructure in the film. At the same time, the transmission at terahertz (THz) radiation is as high as ∼10% and is spectrally flat. Our measurements are in agreement with finite difference time domain simulations. Such thin metal hole array films allow for very efficient injection of optical energy, while at the same time maintaining reasonably high transparency of THz waves. These structures can be used in any application combining strong optical sensitivity and THz transparency, in optical biomolecular sensing, or as optically transparent electrodes.
Simulation of alnico coercivity
Authors: Ke Liqin , Skomski Ralph , Hoffmann Todd D. , Zhou Lin , Tang Wei , Johnson Duane D. , Kramer Matthew J. , Anderson Iver E. , Wang C.-Z.
Published: July 2017

Micromagnetic simulations of alnico show substantial deviations from Stoner-Wohlfarth behavior due to the unique size and spatial distribution of the rod-like Fe-Co phase formed during spinodal decomposition in an external magnetic field. The maximum coercivity is limited by single-rod effects, especially deviations from ellipsoidal shape, and by interactions between the rods. Both the exchange interaction between connected rods and magnetostatic interaction between rods are considered, and the results of our calculations show good agreement with recent experiments. Unlike systems dominated by magnetocrystalline anisotropy, coercivity in alnico is highly dependent on size, shape, and geometric distribution of the Fe-Co phase, all factors that can be tuned with appropriate chemistry and thermal-magnetic annealing.
High-performance pentacene OTFT by incorporating Ti in LaON gate dielectric
Authors: Ma Y. X. , Han C. Y. , Tang W. M. , Lai P. T.
Published: July 2017

Pentacene organic thin-film transistors (OTFT) using high-k LaTiON gate dielectric with different Ti contents are investigated. The LaxTi(1-x)ON films (with x = 1, 0.87, 0.76, and 0.67) are deposited by reactive sputtering followed by an annealing in N2 at 200 °C. The OTFT with La0.87Ti0.13ON can achieve a high carrier mobility of 2.6 cm2/V·s, a small threshold voltage of −1.5 V, a small sub-threshold swing of 0.07 V/dec, and a small hysteresis of 0.17 V. AFM and X-ray photoelectron spectroscopy reveal that Ti can suppress the hygroscopicity of La oxide to achieve a smoother dielectric surface, which can result in larger pentacene grains and thus higher carrier mobility. All the devices show a clockwise hysteresis because both the LaOH formation and Ti incorporation can generate acceptor-like traps in the gate dielectric.
Dynamics of ferroelectric 180° domain walls at engineered pinning centers
Authors: McGilly Leo J. , Feigl Ludwig , Setter Nava
Published: July 2017

The interaction between domain walls and pinning centers in ferroelectrics is of great interest from both fundamental and practical points of view. In this work, we show that, counter to intuition, the apparent velocity of domain walls can increase as the defect density increases. However, when we closely investigate the propagating front of the domain wall, we find that it is not unified but can be rough, indicating the presence of multiple nucleated domains in advance of the primary wall. We therefore ascribe the increased apparent velocity with defect density to actually derive from nucleation-aided motion. To further investigate the effect of engineered pinning centers, we spatially confined the defect regions and then propagated domain walls in that direction. We found that, given a sufficiently high defect density, walls can be pinned indefinitely at sub-threshold voltages. Finally, we outline a method to create domain wall propagation channels in which the wall is confined to a low defect region bordered by high defect density regions.
Loss-of-function mutation in
Mirta22/Emc10
rescues specific schizophrenia-related phenotypes in a mouse model of the 22q11.2 deletion
Authors: Diamantopoulou Anastasia , Sun Ziyi , Mukai Jun , Xu Bin , Fenelon Karine , Karayiorgou Maria , Gogos Joseph A.
Published: July 2017

Significance

Despite substantial progress in the field of schizophrenia (SCZ) genetics, the heterogeneity of genetic etiology and neural complexity has rendered the task of developing improved treatments inauspicious. Thus, there is need to identify convergent neural substrates and underlying molecular mechanisms that can serve the prevention or reversal of disease progression. Our extensive characterization of an animal model of the 22q11.2 deletion, one of the strongest genetic risk factors for SCZ, when combined with a loss-of-function (LoF) mutation for a microRNA-dependent upregulated target, offers a proof of principle for such approaches. Hence, identification of variants that confer protection against disease by disabling protein function via LoF effects holds great promise for devising therapeutic schemes to restore or prevent disease symptoms.
Polar delivery of
Legionella
type IV secretion system substrates is essential for virulence
Authors: Jeong Kwangcheol C. , Ghosal Debnath , Chang Yi-Wei , Jensen Grant J. , Vogel Joseph P.
Published: July 2017

Significance

Legionella pneumophila
is a bacterial pathogen that causes a potentially fatal form of pneumonia (Legionnaires' disease) by replicating within human alveolar macrophages, immune cells that typically kill microorganisms in the lung.
Legionella
avoids intracellular death by injecting many protein effectors into the host cell cytoplasm via a specialized export apparatus called the “Dot/Icm type IVB system.” We showed that the Dot/Icm (defect in organelle trafficking/intracellular multiplication) secretion system is restricted to both poles of the bacterium and its localization is a key feature of
L. pneumophila
's virulence, because nonpolar export of Dot/Icm effectors is ineffectual. Polar export of factors from a specialized secretion system uninvolved with bacterial motility has not previously been shown to be required for the virulence of a bacterial pathogen.
Early Paleocene landbird supports rapid phylogenetic and morphological diversification of crown birds after the K–Pg mass extinction
Authors: Ksepka Daniel T. , Stidham Thomas A. , Williamson Thomas E.
Published: July 2017

Significance

Molecular (DNA) studies suggest that birds radiated rapidly in the wake of the Cretaceous–Paleogene mass extinction (66 Ma), diversifying into nearly all the major groups we recognize today. However, fossil evidence for this pattern has been difficult to find because of the poor fossilization potential of small, delicate-boned birds. We report a tiny species of bird from ∼62.5 million-year-old rocks in New Mexico.
Tsidiiyazhi abini
(Navajo for “little morning bird”) is an ancient species of mousebird (Coliiformes). The fossil provides evidence that many groups of birds arose just a few million years after the mass extinction and had already begun evolving specializations of the foot for different ecological roles.
Caffeine induces gastric acid secretion via bitter taste signaling in gastric parietal cells
Authors: Liszt Kathrin Ingrid , Ley Jakob Peter , Lieder Barbara , Behrens Maik , Stöger Verena , Reiner Angelika , Hochkogler Christina Maria , Köck Elke , Marchiori Alessandro , Hans Joachim , Widder Sabine , Krammer Gerhard , Sanger Gareth John , Somoza Mark Manuel , Meyerhof Wolfgang , Somoza Veronika
Published: July 2017

Significance

This study shows that caffeine's effect on gastric acid secretion (GAS) is more complex than has been previously thought. Oral and gastric bitter taste receptors are involved in the regulation of GAS in humans. This regulatory process can be modified by the bitter-masking compound homoeriodictyol. Practical applications of the results may include treatment of gastroesophageal reflux disease or peptic ulcer by manipulating gastric pH by means of bitter tastants and inhibitors.
mTORC1 activates SREBP-2 by suppressing cholesterol trafficking to lysosomes in mammalian cells
Authors: Eid Walaa , Dauner Kristin , Courtney Kevin C. , Gagnon AnneMarie , Parks Robin J. , Sorisky Alexander , Zha Xiaohui
Published: July 2017

Significance

Through unknown mechanisms mTORC1 triggers translocation of SREBP-2, an endoplasmic reticulum (ER) resident protein, to the Golgi to produce mature SREBP-2, which translocates to the nucleus to act as a transcription factor. Low ER cholesterol is a well-known inducer of SREBP-2 activation. We thus investigated whether mTORC1 activates SREBP-2 by reducing ER cholesterol levels. We report that, in cultured mammalian cells, an increase in mTORC1 activity is accompanied by a decrease in ER cholesterol and by SREBP-2 activation. Conversely, a decrease in mTORC1 activity coincides with higher ER cholesterol and lower SERBP-2 activity. We demonstrate that, by suppressing autophagy and by maintaining endosomal recycling, mTORC1 actively prevents membrane-derived cholesterol from reaching lysosomes, thereby reducing cholesterol ER and activating SREBP-2.
Antibody-induced uncoating of human rhinovirus B14
Authors: Dong Yangchao , Liu Yue , Jiang Wen , Smith Thomas J. , Xu Zhikai , Rossmann Michael G.
Published: July 2017

Significance

Rhinoviruses (RVs) frequently cause respiratory infections in humans. However, there are currently no approved antiviral treatments or vaccines available. Using cryo-electron microscopy (cryo-EM), we have shown that the antigen-binding fragment of a neutralizing antibody, C5, binds to RV-B14 and causes significant structural rearrangements of the capsid to allow release of the viral genome. C5-induced virus uncoating depends upon temperature and virus–Fab molar ratio. These results present so far the highest resolution cryo-EM structures of a virus–antibody complex and suggest a conserved mechanism whereby antibodies neutralize infections by RVs and related viruses via induction of premature genome release from the capsid.
TRPM7 senses oxidative stress to release Zn
2+
from unique intracellular vesicles
Authors: Abiria Sunday A. , Krapivinsky Grigory , Sah Rajan , Santa-Cruz Ana G. , Chaudhuri Dipayan , Zhang Jin , Adstamongkonkul Pichet , DeCaen Paul G. , Clapham David E.
Published: July 2017

Significance

TRPM7 (transient receptor potential cation channel subfamily M member 7) is required for normal organ development but also mediates anoxic neuronal death. TRPM7 contains a channel that conducts cations into the cytosol and C-terminal kinase that can phosphorylate multiple substrates. The kinase is cleaved to regulate gene expression and apoptosis. The link between TRPM7’s channel and its organismal function remains the least understood aspect of TRPM7. Here, we identify intracellular Zn
2+
storage vesicles that contain the majority of TRPM7 protein. TRPM7 senses reactive oxygen species (ROS) to release Zn
2+
from these vesicles. Just as the endoplasmic reticulum sequesters and releases Ca
2+
, we propose that these vesicles fulfill a similar function for Zn
2+
and that TRPM7 coordinates fluctuations in cellular [Zn
2+
] and ROS during development and injury.
Differential vergence movements in reading Chinese and English: Greater fixation-initial binocular disparity is advantageous in reading the denser orthography
Authors: Hsiao Yi-ting , Shillcock Richard , Obregón Mateo , Kreiner Hamutal , Roberts Matthew AJ , McDonald Scott
Published: July 2017

We explore two aspects of exovergence: we test whether smaller binocular fixation disparities accompany the shorter saccades and longer fixations observed in reading Chinese, and we test whether potentially advantageous psychophysical effects of exovergence transfer to text reading. We report differential exovergence in reading Chinese and English: Chinese readers begin fixations with more binocular disparity, but end fixations with a disparity closely similar to that of the English readers. We conclude that greater fixation-initial binocular disparity can be adaptive in the reading of visually and cognitively denser text.
Tissue microenvironment dictates the fate and tumor-suppressive function of type 3 ILCs
Authors: Nussbaum Kathrin , Burkhard Sara H. , Ohs Isabel , Mair Florian , Klose Christoph S.N. , Arnold Sebastian J. , Diefenbach Andreas , Tugues Sonia , Becher Burkhard
Published: July 2017

Innate lymphoid cells (ILCs) have been classified into “functional subsets” according to their transcription factor and cytokine profiles. Although cytokines, such as IL-12 and IL-23, have been shown to shape plasticity of ILCs, little is known about how the tissue microenvironment influences the plasticity, phenotype, and function of these cells. Here, we show clearly demarcated tissue specifications of Rorc-dependent ILCs across lymphoid and nonlymphoid organs. Although intestinal Rorc fate map–positive (Rorcfm+) ILCs show a clear ILC3 phenotype, lymphoid tissue–derived Rorcfm+ ILCs acquire an natural killer (NK) cell/ILC1-like phenotype. By adoptively transferring Rorcfm+ ILCs into recipient mice, we show that ILCs distribute among various organs and phenotypically adapt to the tissue environment they invade. When investigating their functional properties, we found that only lymphoid-tissue resident Rorcfm+ ILCs can suppress tumor growth, whereas intestinal Rorcfm− ILC1s or NK cells fail to inhibit tumor progression. We thus propose that the tissue microenvironment, combined with ontogeny, provides the specific function, whereas the phenotype is insufficient to predict the functional properties of ILCs.
Interarm Systolic and Diastolic Blood Pressure Difference Is Diversely Associated With Cerebral Atherosclerosis in Noncardioembolic Stroke Patients
Authors: Chang Yoonkyung , Choi Gyeong Seon , Lim Soo Mee , Kim Yong-Jae , Song Tae-Jin
Published: July 2017

BACKGROUND

Interarm systolic and diastolic blood pressure differences (IASBD, IADBD) are not infrequent in various populations. Cerebral atherosclerosis, including extracranial cerebral atherosclerosis (ECAS) and intracranial cerebral atherosclerosis (ICAS), is an important risk factor for stroke. In this study, we aimed to investigate the relationship of IASBD, IADBD with presence and burden of ICAS and ECAS.

METHODS

This was a retrospective hospital-based cross-sectional study. In total, 1,063 consecutive noncardioembolic ischemic stroke patients, who were checked for bi-brachial blood pressures from ankle–brachial index and brain magnetic resonance angiographic images of cerebral arteries, were included. The IASBD and IADBD were defined as absolute value of the blood pressure difference in both arms.

RESULTS

In all included patients, patients with IASBD ≥10 and IADBD ≥10 were noted in 9.4% (100/1,063) and 5.3% (56/1,063). The patients with IASBD ≥10 mm Hg were more frequently burdened with ICAS (P = 0.001) and ECAS (P = 0.027) and patients with IADBD ≥10 mm Hg were more frequently burdened with ICAS (P = 0.042) but not ECAS (P = 0.187). Multivariate analysis after adjusting gender, age, and a P value <0.1 in univariate analysis showed IASBD ≥10 mm Hg was associated with the presence of both ECAS and ICAS [odds ratio (OR): 2.96, 95% confidence interval (CI): 1.65–5.31]. The IADBD ≥10 mm Hg was related with presence of ICAS only (OR: 1.87, 95% CI: 1.05–3.37) but not with ECAS only (OR: 1.50, 95% CI: 0.73–3.06).

CONCLUSIONS

Our study showed IASBD and IADBD were diversely associated with cerebral atherosclerosis. In noncardioembolic stroke patients with IASBD ≥10 or IADBD ≥10, the possibility of accompanying cerebral atherosclerosis should be considered.
NuNec™ Cervical Disc Arthroplasty Improves Quality of Life in Cervical Radiculopathy and Myelopathy: A 2-yr Follow-up
Authors: Turner Isobel , Choi David
Published: July 2017

BACKGROUND

Anterior cervical disc replacement is an alternative to fusion for the treatment of selected cases of radiculopathy and myelopathy. We report clinical and radiological outcomes after disc replacement with the NuNec™ artificial cervical disc (Pioneer® Surgical Technology, Marquette, Michigan) with subgroup analysis.

OBJECTIVE

To review clinical and radiological outcomes after anterior cervical disc replacement with the NuNec™ artificial cervical disc.

METHODS

A consecutive case series of patients undergoing cervical disc replacement with the NuNec™ artificial disc was conducted. Clinical outcomes were assessed by questionnaires preoperatively and up to 2 yr postoperatively including neck and arm pain, Neck Disability Index, Euroqol 5-dimensions, and Short Form-36; x-rays from the same period were analyzed for range of movement and presence of heterotopic ossification.

RESULTS

A total of 44 NuNec™ discs were implanted in 33 patients. Clinical improvements were seen in all outcomes; significant improvements on the Neck Disability Index, Euroqol 5-dimensions, and physical domain of the Short Form-36 were maintained at 2 yr. There was a mean of 4° range of movement at the replacement disc level at 2 yr, a significant reduction from baseline; there was also progression in levels of heterotopic ossification. Complications included temporary dysphagia (10%) and progression of disease requiring foraminotomy (6%); no surgery for adjacent level disease was required. There was no significant difference in the outcomes of the radiculopathy and myelopathy groups.

CONCLUSION

Clinical outcomes using the NuNec™ disc replacement are comparable with other disc replacements. Although the range of movement is reduced, the reoperation rate is very low.
Gluten Aggregation Behavior in High‐Shear‐Based GlutoPeak Test: Impact of Flour Water Absorption and Strength
Authors: Wang Kun , Dupuis Brigitte , Fu Bin Xiao
Published: July 2017

Gluten aggregation behaviors of wheat flour were evaluated using a high‐shear‐based method with the GlutoPeak instrument and related to flour functional properties. GlutoPeak peak time (PT) and peak area (PA) were positively associated with gluten strength but negatively affected by farinograph absorption (FAB). GlutoPeak maximum torque (Tmax) was highly positively (P < 0.001) correlated with FAB regardless of gluten strength. PT and PA increased with the decrease of FAB. This could result in overestimation of gluten strength owing to water absorption. To account for the impact of FAB, a new parameter GlutoPeak strength index (GSI) was introduced for predicting gluten strength. GSI was obtained by multiplying Tmax and PA. This arithmetic product was found to provide greater correlation (r = 0.91) with dough strength than those of PA (r = 0.84) or PT (r = 0.57) based on the analysis of 56 advanced breeding lines with wide range of FAB. Moreover, significant relationships were found between GSI and flour mixing and baking properties. Using 8 g of flour and with a test time of less than 10 min, the GlutoPeak instrument shows great potential as a rapid tool for gluten strength selection.
Ninety-Day Mortality as a Reporting Parameter for High-Grade Serous Ovarian Cancer Cytoreduction Surgery
Authors: Spencer Ryan J. , Hacker Kari E. , Griggs Jennifer J. , Rice Laurel W. , Reynolds R. Kevin , Uppal Shitanshu
Published: July 2017

OBJECTIVE:

To evaluate the utility of using 90-day as an adjunct to 30-day mortality rates after surgical cytoreduction for serous ovarian cancer and to compare them across hospitals of differing case volumes over time.

METHODS:

We performed a retrospective cohort study using the National Cancer Database of women undergoing cytoreductive surgery for high-grade serous carcinoma between 2004 and 2012. The primary outcome of the study was mortality rate by hospital volume. The secondary outcome was to evaluate the performance of hospital rankings based on 30- and 90-day mortality rates. Hospitals were categorized by cases per year as low volume (10 or fewer), intermediate (11–20), high (21–30), and ultra-high (31 or more).

RESULTS:

A total of 24,827 women from 602 hospitals were included. Overall 30-day mortality was 2.1% (95% CI 1.95–2.3) compared with 90-day mortality of 5.1% (95% CI 4.8–5.4%, P<.001). For each hospital volume category, the 90-day mortality was approximately double that of the 30-day mortality. Substituting 90-day in place of 30-day mortality for hospital ranking, 57 hospitals (9.5%) changed ranks (26 worsened and 31 improved). Based on the logistic regression model (after controlling for age, race–ethnicity, income, Charlson comorbidity index, insurance status, hospital volume, distance from place of residence to the hospital, receipt of neoadjuvant chemotherapy, and year of diagnosis), care at the ultra–high-volume centers was an independent predictor of lower odds of death at 90 days [adjusted odds ratios (OR) 0.60, 95% CI 0.38–0.96, P=.034] but not at 30 days (adjusted OR 0.64, 95% CI 0.35–1.18).

CONCLUSION:

Compared with low-volume centers, ultra–high-volume centers are associated with significantly lower 30- and 90-day risk-adjusted mortality. The 90-day mortality rate is double that of the 30-day rate and may be a better metric for assessing the initial quality of care for patients with ovarian cancer.
Lipschütz Ulcers
Authors: Wolters Vera , Hoogslag Isabella , van' t Wout Jan , Boers Kim
Published: July 2017

BACKGROUND:

Lipschütz ulcers are characterized by painful vulvar ulceration, most commonly in young women. Because these lesions are so rarely seen, the diagnosis can be challenging.

CASE:

An 18-year-old woman, without any prior sexual activity, developed painful blue vulval lesions. These became necrotizing ulcers, and she began antiviral therapy for presumptive herpes infection. Herpes cultures, however, were negative. Serology consistent with a recent Epstein-Barr virus infection resulted in a diagnosis of Lipschütz ulcers.

CONCLUSION:

Lipschütz ulcers, associated with acute Epstein-Barr virus infection or other viral and bacterial infections, are a type of nonsexually transmitted vulvar ulceration. It is important to avoid selective attention to sexually transmitted infections as the etiology to avoid unnecessary antiviral therapy and immune suppressants. By considering other etiologies, the patient will be spared potentially embarrassing persistent questioning about her sexual history.
ORIF Patella Fracture With a Tension Band Construct
Authors: Blum Laura , Hake Mark
Published: July 2017

Patellar fractures can occur as a result of direct or indirect injuries. Indirect injury is more common and occurs when the patella fails in tension when the force exerted by the extensor mechanism exceeds that of the bone. Common mechanism of indirect injury is rapid knee flexion with fully contracted quadriceps muscle. Treatment with a tension band construct is indicated for transverse patella fractures without significant comminution. This can be performed with 18-gauge wire and either 2 parallel, longitudinally oriented cannulated screws or 2 Kirschner wires. Biomechanical studies have shown higher load to failure when performed with cannulated screws. We presented our technique for management of a transverse patella fracture with disrupted extensor mechanism using tension banding technique with cannulated screws.
Acute Compartment Syndrome of the Leg
Authors: Konda Sanjit R. , Kester Benjamin S. , Fisher Nina , Behery Omar A. , Crespo Alexander M. , Egol Kenneth A.
Published: July 2017

Introduction:

Acute compartment syndrome (ACS) is well known among orthopaedic surgeons. The timely diagnosis and management of ACS is crucial to avoiding its sequelae, including renal failure, ischemic contractures, and limb loss. Despite its relative importance, ACS poses a challenge to many residents and clinicians as diagnosis relies largely on clinical judgment.

Methods:

Timely diagnosis and thorough compartment release are essential to optimizing outcomes in ACS. This video highlights a clinical case in which compartment syndrome of the leg was considered, diagnosed, and surgically managed.

Results:

This video will present the indications for compartment release and a video-guided demonstration of compartment checks using an arterial line transducer, a 4-compartment fasciotomy with 2 incisions, and temporizing vessel loop closure.

Conclusions:

Compartment syndrome can be a devastating complication of common fractures. It is essential that orthopaedic practitioners understand the immediacy of intervention. We have a responsibility to provide timely, accurate diagnosis along with expedient surgical management.
Exchange Nailing for Hypertrophic Femoral Nonunion
Authors: Marquez-Lara Alejandro , Luo T. David , Senehi Rebecca , Aneja Arun , Beard Hoyt Randy , Carroll Eben A.
Published: July 2017

Exchange nailing has proven to be a reliable surgical technique for the management of aseptic femoral shaft nonunions. Similar to primary intramedullary nail fixation for femur fractures, exchange nailing for aseptic hypertrophic nonunions of the femur relies on successful navigation of the starting point and proper nail trajectory to minimize coronal and sagittal plane deformities. Compared with the supine position, the lateral decubitus position has the advantage of allowing gravity to displace the soft tissue around the piriformis start site to facilitate nail entry. In addition, the C-arm position and access to the affected limb from both sides by the surgeon and surgical assistant facilitate visualization of existing deformities and the ability to perform correction maneuvers. The purpose of this review is to highlight technical pearls associated with exchange nailing in a lateral decubitus position. Although other techniques are available, and should be used when indicated, exchange nailing provides patients with the opportunity to an early return to activity, improvement in pain and disability, and ultimate bony union.
Intramedullary Fixation of Midshaft Clavicle Fractures
Authors: Fritz Erik M. , van der Meijden Olivier A. , Hussain Zaamin B. , Pogorzelski Jonas , Millett Peter J.
Published: July 2017

Clavicle fractures are among the most common fractures occurring in the general population, and the vast majority are localized in the midshaft portion of the bone. Management of midshaft clavicle fractures remains controversial. Although many can be managed nonoperatively, certain patient populations and fracture patterns, such as completely displaced and shortened fractures, are at risk of less optimal outcomes with nonoperative management; surgical intervention should be considered in such cases. The purpose of this article is to demonstrate our technique of midshaft clavicle fixation using minimally invasive intramedullary fixation.
Optimizing Length-Tension Relationship Using Unicortical Button Fixation for Subpectoral Biceps Tenodesis
Authors: Heckert Reed , Anderson Ashley B. , Dickens Jonathan F. , McCabe Michael P.
Published: July 2017

Many techniques for tenodesis of the long head of the biceps tendon have been described in the orthopedic literature. However, few focus on restoring the native length-tension relationship of each patient’s individual anatomy and instead recommend fixing the tendon based on predetermined anatomic landmarks. We present a method of biceps tenodesis using a unicortical button, which allows for anatomic tensioning and dynamic adjustment of the tension by the surgeon based on intraoperative observation.
Sterile Adhesive Tape: An Effective Traction Device for Bennett’s Fracture Fixation
Authors: Mohammad Noor A. , Shah Nasir , Badge Ravindra
Published: July 2017

Adhesive tape can be effectively utilised to provide traction to reduce bennett's fracture. It's a simple technique with low cost and avoids unnecessary radiation exposure.
Re-irradiation of cervical and endometrial cancer
Authors: Llewelyn Megan , Taylor Alexandra
Published: July 2017

Purpose of review

Re-irradiation historically has been associated with unacceptable toxicity and limited benefit. Recent advances in radiotherapy can change the treatment paradigm to provide new salvage treatments for recurrences of cervical and endometrial cancer.

Recent findings

Image-guided brachytherapy is an effective method for salvaging central pelvic recurrence, although it has resulted in 20–25% severe late toxicity. Pelvic sidewall disease is not accessible to brachytherapy, so a combined modality approach with radical surgery and intraoperative radiotherapy is an alternative approach. Stereotactic body radiotherapy (SBRT) now provides the option of radical re-irradiation with local control rates of 50–80% and a low incidence of severe late complications.

Initial outcomes using SBRT and image-guided brachytherapy for re-irradiation of gynaecological cancer are encouraging. There has been good local control and acceptable toxicity. Further, large-scale studies are required to define optimal target doses and OAR limits.
Comparative Study of Shrinkage in Human Skin, Artificial Human Skin, and Mouse Skin
Authors: Blasco-Morente Gonzalo , Lizana-Moreno Antonio , Fernández-González Ana , Aneiros-Fernández José , Arrabal Miguel , García José M. , Buendía-Eisman Agustín , Tercedor-Sánchez Jesús , Arias-Santiago Salvador
Published: July 2017

Introduction:

The shrinkage of surgical specimens (SS) is known in human skin (HS) but has not been studied in an artificial skin (AS) or mouse skin (MS).

Objectives:

To quantify the degree of shrinkage of SS and establish its timing in HS and an in vitro and animal model to explore the possible causes of this phenomenon.

Methodology:

We collected 100 SS of HS, 50 SS of AS synthesized with fibrin-agarose biomaterials and 21 SS of MS. The width and length of specimens were measured before the surgical excision (pre-SE), at 5 minutes postsurgery (ex vivo), and after 24 hours of fixation in formalin (postfixation). Histological staining was performed to analyze the differences between HS, AS, and MS that may explain the differences in shrinkage.

Results:

Between pre-SE and postfixation, the width and length shrank by 16.1% and 17.1% in HS, 14.5% and 8.5% in AS, and 26.5% and 23.1% in MS (P < 0.01), respectively. Shrinkage largely occurred between pre-SE and ex vivo. Cells and interstitial fibers were scant in AS and abundant in MS.

Conclusions:

Almost all of the shrinkage occurred during the first 5 minutes postsurgery. According to the AS model findings, 53.6% of SS shrinkage would be explained by the action of dermal fibers and other cellular components of the dermis.
Development of a Simple and Rapid Method to Measure Free Fraction of Valproic Acid in Plasma Using Ultrafiltration and Ultra High Performance Liquid Chromatography–Mass Spectroscopy: Application to Therapeutic Drug Monitoring
Authors: Xu Shansen , Chen Yanan , Zhao Mingming , Zhao Limei
Published: July 2017

Background:

Valproic acid (VPA) is widely used as an antiepileptic drug in children, and it is usually coadministered with other antiepileptic drugs. Because of its narrow therapeutic range and large variations in pharmacokinetic/pharmacodynamic behavior in different individuals, therapeutic drug monitoring of the trough total VPA concentration is commonly used to guide dosing. However, as only the free fraction of VPA that exerts pharmacological and toxic effects, it may be more meaningful to determine the unbound VPA concentration in plasma.

Methods:

Free fraction of VPA in plasma was extracted by ultrafiltration. Ultra high performance liquid chromatography coupled with mass spectroscopy was used to measure VPA in the negative ionization mode. This method was validated by studies of its selectivity, linearity, lower limit of quantification, accuracy, precision, recovery, matrix effect, and stability.

Results:

The method was validated over a linear range of 0.2–25 mcg/mL, and its lower limit of quantification was 0.2 mcg/mL. The method's relative standard deviations for intra- and inter-day precision were <15%, and its accuracy (relative error) was ±3.22%. The recoveries and matrix effect of unbound VPA at 3 different concentrations satisfied our requirements for the analysis of biological samples, and no significant degradation of VPA was observed under different storage conditions.

Conclusions:

Simple ultra high performance liquid chromatography coupled with mass spectroscopy showed good performance when used to measure unbound VPA concentration, this method may be used to study the relationship between unbound VPA concentrations and its effectiveness by the use of therapeutic drug monitoring.
Depressive symptoms and weight in midlife women: the role of stress eating and menopause status
Authors: Schreiber Dana R. , Dautovich Natalie D.
Published: July 2017

Objective:

Obesity is prevalent in midlife women and contributes to poor health outcomes. Understanding mechanisms leading to weight gain in this population is of importance for prevention and intervention. The current study investigated the association between depressive symptoms and weight in midlife women by examining stress eating as a mediator between depressive symptoms and weight; and menopause status as a moderator of the associations of depressive symptoms, stress eating, and weight.

Methods:

An archival analysis was performed using data from the Midlife in the United States II study. The sample consisted of 815 premenopausal and postmenopausal women. Measures included the Composite International Diagnostic Interview–Short Form, a coping questionnaire, and body mass index.

Results:

Moderated mediation analyses were conducted with ordinary least squares path analyses using Hayes’ PROCESS macro. Controlling for covariates, depressive symptoms were not directly associated with weight (b 
= −0.4, 95% confidence interval [CI] −0.4, 0.1). However, stress eating was a significant mediator between depressive symptoms and weight (b = 0.3, 95% CI 0.06, 0.3).The mediation was conditional on menopausal stage (b 
= 0.2, 95% CI 0.05, 0.4), with depressive symptoms and stress eating significantly associated in postmenopausal, not premenopausal women (b = 0.3, 95% CI 0.2, 0.5).

Conclusions:

Both stress eating and menopause status significantly contributed to the depressive symptom—weight association. Psychosocial factors play an important role in the association between depressive symptoms and weight, and the results highlight the need to focus on both behavioral factors, and also menopause status, when identifying who is at risk for the development of poor weight outcomes.
The association of surgical versus natural menopause with future left ventricular structure and function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Appiah Duke , Schreiner Pamela J. , Nwabuo Chike C. , Wellons Melissa F. , Lewis Cora E. , Lima Joao A.
Published: July 2017

Objective:

To evaluate the association between surgical menopause (SM) versus natural menopause (NM) in relation to later left ventricular (LV) structure and function, while taking into account the LV parameters and other cardiovascular disease risk factor (CVDRF) levels that predate the menopausal transition.

Methods:

We studied 825 premenopausal women from the Coronary Artery Risk Development in Young Adults study in 1990 to 1991 (baseline, mean age 32 years) who later reached menopause by 2010 to 2011 and had echocardiograms at these two time points.

Results:

During 20 years of follow-up, 508 women reached NM, whereas 317 underwent SM (34% had bilateral oophorectomy). At baseline, women who later underwent SM were more likely to be black, younger, have greater parity, and higher mean values of systolic blood pressure, body mass index, and also lower mean high-density lipoprotein cholesterol and physical activity than women who reached NM. No significant differences in LV structure/function were found between groups. In 2010 to 2011, SM women had significantly higher LV mass, LV mass/volume ratio, E/e’ ratio, and impaired longitudinal and circumferential strain than NM women. SM women with bilateral oophorectomy had adverse LV measures than women with hysterectomy with ovarian conservation. Controlling for baseline echocardiographic parameters and CVDRF in linear regression models eliminated these differences between groups. Further adjustment for age at menopause/surgery and hormone therapy use did not change these results.

Conclusion:

In this study, the adverse LV structure and function observed among women with SM compared with NM were explained by their unfavorable presurgical CVDRF profiles, suggesting that premenopausal CVDRF rather than gynecologic surgery predispose SM women to elevated future cardiovascular disease risk.
Fully implantable, battery-free wireless optoelectronic devices for spinal optogenetics
Authors: Samineni Vijay K. , Yoon Jangyeol , Crawford Kaitlyn E. , Jeong Yu Ra , McKenzie Kajanna C , Shin Gunchul , Xie Zhaoqian , Sundaram Saranya S. , Li Yuhang , Yang Min Young , Kim Jeonghyun , Wu Di , Xue Yeguang , Feng Xue , Huang Yonggang , Mickle Aaron D. , Banks Anthony , Ha Jeong Sook , Golden Judith P. , Rogers John A. , Gereau Robert W.
Published: July 2017

The advent of optogenetic tools has allowed unprecedented insights into the organization of neuronal networks. Although recently developed technologies have enabled implementation of optogenetics for studies of brain function in freely moving, untethered animals, wireless powering and device durability pose challenges in studies of spinal cord circuits where dynamic, multidimensional motions against hard and soft surrounding tissues can lead to device degradation. We demonstrate here a fully implantable optoelectronic device powered by near-field wireless communication technology, with a thin and flexible open architecture that provides excellent mechanical durability, robust sealing against biofluid penetration and fidelity in wireless activation, thereby allowing for long-term optical stimulation of the spinal cord without constraint on the natural behaviors of the animals. The system consists of a double-layer, rectangular-shaped magnetic coil antenna connected to a microscale inorganic light-emitting diode (μ-ILED) on a thin, flexible probe that can be implanted just above the dura of the mouse spinal cord for effective stimulation of light-sensitive proteins expressed in neurons in the dorsal horn. Wireless optogenetic activation of TRPV1-ChR2 afferents with spinal μ-ILEDs causes nocifensive behaviors and robust real-time place aversion with sustained operation in animals over periods of several weeks to months. The relatively low-cost electronics required for control of the systems, together with the biocompatibility and robust operation of these devices will allow broad application of optogenetics in future studies of spinal circuits, as well as various peripheral targets, in awake, freely moving and untethered animals, where existing approaches have limited utility.
Influence of the Learning Effect on the Diagnostic Yield of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration of Mediastinal and Hilar Lymph Nodes
Authors: Fuso Leonello , Varone Francesco , Magnini Daniele , Pecoriello Antonietta , Montemurro Giuliano , Angeletti Giulia , Valente Salvatore
Published: July 2017

Background:

The diagnostic yield of conventional transbronchial needle aspiration (TBNA) is characterized by a learning effect. The aim of this retrospective study was to verify whether a learning curve similarly affected the yield of endobronchial ultrasound-guided (EBUS)-TBNA. To this end, we evaluated the sensitivity and diagnostic accuracy of EBUS-TBNA during the first 3 years of activity.

Methods:

EBUS-TBNA was performed by 2 operators with no previous experience in this technique. Cytologic samples were obtained from mediastinal and hilar lymph nodes enlarged at a chest computed tomography scan and/or with increased fluorodeoxyglucose uptake at computed tomography/positron emission tomography scan in patients with suspected lung cancer. The cytologic diagnosis of EBUS-TBNA samples has been compared with the final diagnosis obtained from further diagnostic procedures, surgery, or clinical-radiologic follow-up.

Results:

From October 2012 to October 2015, we collected 408 EBUS-TBNA cytologic samples from 313 patients: 223 samples were positive for metastatic involvement and 185 were nonmetastatic. The latter included 137 true-negative and 48 false-negative results. The final diagnosis comprised 271 metastatic and 137 nonmetastatic lymph nodes. The overall sensitivity for cancer was 82% and diagnostic accuracy was 88%. Sensitivity and accuracy per year were as follows: first year, 78% and 82% in 90 nodal samples; second year, 83% and 89% in 144 nodal samples; third year, 85% and 91% in 174 nodal samples.

Conclusions:

EBUS-TBNA can be considered as a reliable tool even if performed by operators without previous experience in this procedure, and the diagnostic yield continues to increase progressively over a long time.
Mucin Expression in the Esophageal Malignant and Pre-malignant States
Authors: Niv Yaron , Ho Samuel B. , Fass Ronnie , Rokkas Theodore
Published: July 2017

Background:

Mucins are heavily glycosylated glycoproteins, synthesized by mucosal surfaces and have an important role in healthy state and malignant diseases. Change in mucins synthesis or secretion may be primary event or secondary to inflammation or carcinogenesis.

Aim:

The aim of this study is to assess the current knowledge about mucin expression in esophageal lesions, and to establish a role for different mucin expressions as prognostic markers.

Method:

English Medical literature searches were conducted for “mucin” and “esophagus.” Observational studies were included. Meta-analysis was performed using comprehensive meta-analysis software. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated.

Results:

In the random-effect model, mucin expression was significantly higher in esophageal lesions than in normal esophageal mucosa with OR=5.456 (95% CI, 1.883-15.807, P=0.002). Measure of heterogeneity, demonstrated in the included studies, was high: Q=287.501, df (Q)=44.00, P<0.0001, I
2=84.696%. There is a gradient of mucin expression and complexity in esophageal premalignant to malignant lesions, lower in Barrett’s mucosa with low grade dysplasia (LGD), increased in high grade dysplasia (HGD), and highest in esophageal adenocarcinoma (EAC). MUC2, MUC3, MUC5AC, and MUC6 expression was higher in EAC than HGD, and higher in HGD than in LGD mucosa. The opposite was found for MUC1 and MUC4.

Conclusion:

Increased expression of certain mucin genes in esophageal mucosa may be further studied as a potential diagnostic tool, and this may add important information in the surveillance of Barrett’s esophagus.
Postoperative Adjuvant Therapy for Resectable Pancreatic Cancer With Gemcitabine and Adoptive Immunotherapy
Authors: Matsui Hiroto , Hazama Shoichi , Sakamoto Kazuhiko , Shindo Yoshitaro , Kanekiyo Shinsuke , Nakashima Masao , Matsukuma Satoshi , Tokuhisa Yoshihiro , Iida Michihisa , Suzuki Nobuaki , Yoshimura Kiyoshi , Takeda Shigeru , Ueno Tomio , Yoshino Shigefumi , Oka Masaaki , Nagano Hiroaki
Published: July 2017

Objectives

We previously described adoptive immunotherapy (AIT) with cytotoxic T lymphocytes (CTLs) stimulated by the mucin 1 (MUC1)–expressing human pancreatic cancer cell line YPK-1 (MUC1-CTLs) and demonstrated that MUC1-CTLs might prevent liver metastasis. In the present study, we combined gemcitabine (GEM) and AIT for the treatment of pancreatic cancer.

Methods

A total of 43 patients who underwent radical pancreatectomy received treatment with MUC1-CTLs and GEM. After surgery, MUC1-CTLs were induced and administered intravenously 3 times, and GEM administered according to the standard regimen for 6 months. The patients whose relative dose intensity of GEM was 50% or more and who received 2 or more MUC1-CTL treatments were used as the adequate treatment group (n = 21).

Results

In the adequate treatment group, disease-free survival was 15.8 months, and overall survival was 24.7 months. Liver metastasis was found only in 7 patients (33%), and local recurrence occurred in 4 patients (19%). The independent prognostic factor of long-term disease-free survival on multivariate analysis was the average number of CTLs administered (P = 0.0133).

Conclusions

The combination therapy with AIT and GEM prevented liver metastasis and local recurrence. Moreover, the disease free-survival was improved in patients who received sufficient CTLs.
Variability in Imaging Practices and Comparative Cumulative Effective Dose for Neuroblastoma and Nephroblastoma Patients at 6 Pediatric Oncology Centers
Authors: Morel Baptiste , Jaudeau-Collart Anne C. , Proisy Maia , Leiber Louis M. , Tissot Valentin , Quéré Marie P. , Mergy Martine , Pellier Isabelle , Vallin Clara , Sirinelli Dominique
Published: July 2017

The purpose of this study was to estimate the cumulative effective dose (CED) from diagnosis and posttherapy computed tomographic (CT) scans performed on children treated for neuroblastoma or nephroblastoma (Wilms tumor) and to examine the different imaging practices used in 6 regional pediatric oncology centers between January 2010 and December 2013. We analyzed retrospectively the CT scan acquisition data in children aged 10 years or younger at diagnosis. The use of nonionizing imaging modalities was reported. The CT examinations of 129 children, with a mean age at diagnosis of 36 months, treated for 66 neuroblastomas and 63 nephroblastomas, were analyzed. The mean follow-up period was 28 months (minimum, 8 months, maximum, 41 mo). There were 600 CT scans, with a total of 1039 acquisitions. The mean CED from CT scans was 27 mSv (minimum=18.25, maximum=45). Abdominal CT examinations contributed 85% of the total CED. A median of 4.6 CT scans, 10.3 sonograms, and 0.4 magnetic resonance imaging examinations per child were performed. Our results suggest a reduction in radiation exposure but variability in the imaging modality choice and acquisition protocols. We emphasize the need for consensus and standardization in oncologic pediatric imaging procedures. When feasible, we encourage the substitution of nonionizing examinations for CT.