bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical application of low-dose misoprostol in the induced labor of 16 to 28 weeks pathological pregnancies (a STROBE-compliant article)
Authors: Yang Yan , Wang Yan , Du Xin , Duan Jie , Huang Yan-ming
Published: October 2019

Oral mifepristone combined with rivanol lactate (rivanol) is commonly used in second-trimester pregnancy termination. However, rivanol is not suitable to premature rupture of membranes and oligohydramnios because amniocentesis is difficult. Mifepristone combined with misoprostol is suitable for the patients with oligohydramnios. In accordance with the misoprostol dosing recommendations by the International Federation of Gynecology and Obstetrics (FIGO), the incidences of uterine rupture and cervical laceration are relatively high in Chinese pregnant women. The aim of our study was to optimize misoprostol dosing regimen in terms of efficacy and safety in Chinese pregnant women.

We modified the Bishop Score, and then gave patients low-dose misoprostol according to the modified Bishop score. Based on the amniotic fluid volume (AFV) indicated by type-B ultrasonic instrument, the cases with AFV ≤2 cm receiving low-dose misoprostol combined with mifepristone and the cases with amniocentesis failure followed by receiving low-dose misoprostol combined with mifepristone were enrolled into study group, and the cases with AFV >2 cm receiving rivanol combined with mifepristone were enrolled into control group. The start time of uterine contractions, time of fetal expulsion, birth process, hospital day, successful induced labor rate, complete induced labor rate, and incomplete induced labor rate were observed and compared between the 2 groups.

There were significant differences in the start time of uterine contractions, time of fetal expulsion, birth process, and hospital day between the control group and the study group (all P < .05). The successful induced labor rate, complete induced labor rate, and incomplete induced labor rate were also significantly different between the 2 groups (all P < .05).

In the induced labor of 16 to 28 weeks pathological pregnancy, low-dose misoprostol can markedly improve the successful induced labor rate and complete induced labor rate, shorten the birth process and hospital day, and decrease uterine curettage rate and uterine rupture risk. Low-dose misoprostol combined with mifepristone is suitable to the induced labor of 16 to 28 weeks pathological pregnancy in Chinese women.
The optimal timing of laparoscopic cholecystectomy in patients with mild gallstone pancreatitis
Authors: Zhong Fu-ping , Wang Kai , Tan Xue-qin , Nie Jian , Huang Wen-feng , Wang Xiao-fang
Published: October 2019

Background:

The optimal timing of laparoscopic cholecystectomy (LC) in patients with mild acute gallstone pancreatitis (MAGP) is controversial. The aim of this study was to systematically evaluate and compare the safety and efficacy of early laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) in patients with MAGP.

Methods:

A strict search was conducted of the electronic databases, including PubMed, MEDLINE Embase, the ISI Web of Science, and Cochrane Library for all relevant English literature and RevMan5.3 software for statistical analysis was used.

Results:

A total of 19 studies comprising 2639 patients were included. There was no significant difference in intraoperative complications [risk ratio (RR) = 1.46; 95% confidence interval (CI) = 0.88–2.41; P = .14)], postoperative complications (RR = 0.81; 95% CI = 0.58–1.14; P = .23), rate of conversion to open cholecystectomy (RR = 1.00; 95% CI = 0.75–1.33; P = .99), operative time (MD = 1.60; 95% CI = −1.36–4.56; P = .29), and rate of readmission (RR = 0.63; 95% CI = 0.19–2.10; P = .45) between the ELC and DLC groups. However, the ELC group was significantly correlated with lower length of hospital stay (MD = −2.01; 95% CI = −3.15 to −0.87; P = .0006), fewer gallstone-related events rates (RR = 0.17; 95% CI = 0.07–0.44; P = .0003), and lower endoscopic retrograde cholangiopancreatography (ERCP) usage (RR = 0.83; 95% CI = 0.71–0.97; P = .02) compared with the DLC group.

Conclusion:

Early laparoscopic cholecystectomy is safe and effective for patients with MAGP, but the indications and contraindications must be strictly controlled.
Scavenger receptor class a, member 3 is associated with severity of hand, foot, and mouth disease in a case-control study
Authors: Tian Ye , Zhou Kai , Hu Jing , Shan Ming-Feng , Chen Hong-Jian , Cheng Shan , Liu Li-Fei , Mei Xiao-Li
Published: October 2019

Hand, foot, and mouth disease (HFMD) spreads rapidly and has been recognized as a public health problem in recent years in China. Unfortunately, there is no effective vaccine or antiviral drug currently for EV71 infection. In this study, we aim to identify biomarker which are associated with for severity of EV71 infection cases using high-throughput RNA sequencing approach.

RNA sequencing of samples from severe HFMD (S) patients group (n = 10) and control HFMD (C) patients group (n = 10) were performed and the results were verified by qPCR. mRNA with the highest expression level was selected to be validated in an independent cohort comprising of 45 severe EV71 infected patients and 45 control by qPCR assay.

Seventeen significant differentially expressed genes were identified. Scavenger receptor class A, member 3 (SCARA3) was one of the significantly upregulated genes with the highest expression level and was selected for validation. The mean relative expression levels in severe HFMD and control HFMD patients were 10.1-fold and 5.0-fold, respectively, P value <.001.

We found that SCARA3 is associated with severity of HFMD, and it may be a potential prognostic marker to predict the HFMD progression in EV71 infected patients.
Associations between FDG-PET and Ki 67-index in head and neck cancer
Authors: Meyer Hans-Jonas , Gundermann Peter , Surov Alexey
Published: October 2019

Background:

FDG-PET might be able to reflect histopathology features of tumors. Ki 67 in head and neck carcinomas (HNSCC). The present study sought to elucidate the association between Ki 67 index and SUVmax based upon a large patient sample.

Methods:

PubMed database was screened for studies analyzed the relationship between Ki 67 and SUV in HNSCC. Nine studies comprising 211 patients were suitable for analysis.

Results:

SUVmax increased with tumor grade and was statistically significant different between G1, G2, and G3 tumors. The ROC analysis for discrimination between G1/G2 and G3 tumors revealed an area under curve of 0.71. In the overall patient sample, SUVmax correlated statistically significant with Ki 67 index (r = 0.154, P = .032).

Conclusion:

The present study identified a weak correlation between SUV values and proliferation index Ki 67 index in HNSCC in a large patient sample. Therefore, SUVmax cannot be used as surrogate parameter for proliferation activity in HNSCC.
Association of striatal dopaminergic neuronal integrity with cognitive dysfunction and cerebral cortical metabolism in Parkinson’s disease with mild cognitive impairment
Authors: Kim Heeyoung , Oh Minyoung , Oh Jungsu S. , Moon Hyojeong , Chung Sun Ju , Lee Chong Sik , Kim Jae Seung
Published: October 2019

Objectives

Cognitive impairment is a common non-motor feature of Parkinson’s disease (PD). However, the underlying pathophysiology of cognitive decline is unclear. We investigated the association of striatal dopamine transporter (DAT) loss with cognitive function and cerebral cortical metabolism in PD.

Methods

Twenty-eight patients (63.1 ± 7.1 yrs, M:F = 15:13) with advanced stage of PD were enrolled, including 15 (53.6%) diagnosed with mild cognitive impairment (MCI). All patients underwent FP-CIT PET/CT, neuropsychological tests, and FDG PET/CT within a 2-week interval. We calculated the specific to non-specific binding ratio on FP-CIT PET images in 12 striatal subregional VOIs, using one occipital VOI template as a reference. Age-adjusted normalized specific to non-specific binding ratios (%BRs) of striatal subregions were compared in two groups: PD with MCI versus PD (without cognitive impairment).

Results

There were no statistical differences in age, age at onset, disease duration, motor symptoms, or level of education between the two groups. The PD with MCI had lower %BRs in all striatal subregions (P < 0.05) except the posterior putamen, compared with the PD. Striatal DAT availability correlated with frontal/executive function (r = 0.567, P = 0.003) and visuospatial function (r = 0.614, P = 0.001) but not with memory function. Dopamine transporter binding of striatal subregions also correlated with posterior cortical metabolism.

Conclusion

This study suggest that DAT loss in the striatum, except in the posterior putamen, is associated with cognitive dysfunction, specifically frontal/executive function and visuospatial function in PD subjects.
Food Allergy in Irish Children
Authors: Charles Ruth P.
Published: October 2019

Food allergy, most notably to cow’s milk, egg, peanut, and tree nut, affects a significant number of young children and their families. Getting a timely accurate diagnosis can be difficult, and this is often accompanied by unjustified and multiple food eliminations, which can increase the risk of faltering growth, nutrient deficiencies, and delayed development of eating and feeding skills. Quality of life for all family members is frequently very negatively affected. Registered dietitians can help to ensure that nutrition for typical growth and development is maximized. As part of an allergy team they have a role to play in managing and compensating food elimination and providing education and support in identifying and managing risk.
Performance of a Clinical Decision Support Tool to Identify PICU Patients at High Risk for Clinical Deterioration*
Authors: Dewan Maya , Muthu Naveen , Shelov Eric , Bonafide Christopher P. , Brady Patrick , Davis Daniela , Kirkendall Eric S. , Niles Dana , Sutton Robert M. , Traynor Danielle , Tegtmeyer Ken , Nadkarni Vinay , Wolfe Heather
Published: October 2019

Objectives:

To evaluate the translation of a paper high-risk checklist for PICU patients at risk of clinical deterioration to an automated clinical decision support tool.

Design:

Retrospective, observational cohort study of an automated clinical decision support tool, the PICU Warning Tool, adapted from a paper checklist to predict clinical deterioration events in PICU patients within 24 hours.

Setting:

Two quaternary care medical-surgical PICUs—The Children’s Hospital of Philadelphia and Cincinnati Children’s Hospital Medical Center.

Patients:

The study included all patients admitted from July 1, 2014, to June 30, 2015, the year prior to the initiation of any focused situational awareness work at either institution.

Interventions:

We replicated the predictions of the real-time PICU Warning Tool by retrospectively querying the institutional data warehouse to identify all patients that would have flagged as high-risk by the PICU Warning Tool for their index deterioration.

Measurements and Main Results:

The primary exposure of interest was determination of high-risk status during PICU admission via the PICU Warning Tool. The primary outcome of interest was clinical deterioration event within 24 hours of a positive screen. The date and time of the deterioration event was used as the index time point. We evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of the performance of the PICU Warning Tool. There were 6,233 patients evaluated with 233 clinical deterioration events experienced by 154 individual patients. The positive predictive value of the PICU Warning Tool was 7.1% with a number needed to screen of 14 patients for each index clinical deterioration event. The most predictive of the individual criteria were elevated lactic acidosis, high mean airway pressure, and profound acidosis.

Conclusions:

Performance of a clinical decision support translation of a paper-based tool showed inferior test characteristics. Improved feasibility of identification of high-risk patients using automated tools must be balanced with performance.
Research Collaboration in Pediatric Critical Care Randomized Controlled Trials: A Social Network Analysis of Coauthorship*
Authors: Duffett Mark , Brouwers Melissa , Meade Maureen O. , Xu Grace M. , Cook Deborah J.
Published: October 2019

Objectives:

Clinical research is a collaborative enterprise; researchers benefit from the expertise, experience, and resources of their collaborators. We sought to describe the extent and patterns of collaboration among pediatric critical care trialists, and to identify the most influential individuals, centers, and countries.

Design:

Social network analysis of coauthorship.

Data Sources:

Publications of pediatric critical care randomized controlled trials (1986–2018).

Data Extraction:

We manually extracted the names of all authors and their affiliations. We used productivity (number of randomized controlled trials), influence (number of citations), and four measures of prominence in the social network (degree, betweenness, closeness, and eigenvector centrality) to identify the most influential individuals.

Measurements and Main Results:

From 415 randomized controlled trials in pediatric critical care, we identified 2,176 trialists from 377 centers in 43 countries. The coauthorship network is highly disconnected and dominated by a single large cluster of trialists publishing 142 (34%) of the randomized controlled trials. However, 119 (29%) of the randomized controlled trials were published by 28 smaller clusters—a median (interquartile range) of 3 (2–4) randomized controlled trials each. The remaining 154 (37%) randomized controlled trials were coauthored by researchers publishing a single randomized controlled trial each. This overall structure has remained constant with the publication of new randomized controlled trials over 33 years. The most influential trialists and centers varied according to the metric we used; only one trialist and three centers ranked in the top 10 for all measures of influence. Thirty-five of the 40 trialists (88%) ranking in the top 10 of any of the measures were from the United States, the United Kingdom, and Canada.

Conclusions:

Pediatric critical care has made considerable progress in the number of trialists and randomized controlled trials, but the research enterprise remains highly clustered and fragmented, particularly geographically. Efforts to further increase the quantity and quality of research in the field should include steps to increase the level and range of collaboration.
Early Enteral Nutrition Is Associated With Improved Clinical Outcomes in Critically Ill Children: A Secondary Analysis of Nutrition Support in the Heart and Lung Failure-Pediatric Insulin Titration Trial
Authors: Srinivasan Vijay , Hasbani Natalie R. , Mehta Nilesh M. , Irving Sharon Y. , Kandil Sarah B. , Allen H. Christine , Typpo Katri V. , Cvijanovich Natalie Z. , Faustino E. Vincent S. , Wypij David , Agus Michael S. D. , Nadkarni Vinay M.
Published: October 2019

Objectives:

The impact of early enteral nutrition on clinical outcomes in critically ill children has not been adequately described. We hypothesized that early enteral nutrition is associated with improved clinical outcomes in critically ill children.

Design:

Secondary analysis of the Heart and Lung Failure-Pediatric Insulin Titration randomized controlled trial.

Setting:

Thirty-five PICUs.

Patients:

Critically ill children with hyperglycemia requiring inotropic support and/or invasive mechanical ventilation who were enrolled for at least 48 hours with complete nutrition data.

Interventions:

Subjects received nutrition via guidelines that emphasized enteral nutrition and were classified into early enteral nutrition (enteral nutrition within 48 hr of study randomization) and no early enteral nutrition (enteral nutrition after 48 hr of study randomization, or no enteral nutrition at any time).

Measurements and Main Results:

Of 608 eligible subjects, 331 (54%) received early enteral nutrition. Both early enteral nutrition and no early enteral nutrition groups had similar daily caloric intake over the first 8 study days (median, 36 vs 36 kcal/kg/d;p= 0.93). After controlling for age, body mass indexzscores, primary reason for ICU admission, severity of illness, and mean Vasopressor-Inotrope Score at the time of randomization, and adjusting for site, early enteral nutrition was associated with lower 90-day hospital mortality (8% vs 17%;p= 0.007), more ICU-free days (median, 20 vs 17 d;p= 0.02), more hospital-free days (median, 8 vs 0 d;p= 0.003), more ventilator-free days (median, 21 vs 19 d;p= 0.003), and less organ dysfunction (median maximum Pediatric Logistic Organ Dysfunction, 11 vs 12;p< 0.001).

Conclusions:

In critically ill children with hyperglycemia requiring inotropic support and/or mechanical ventilation, early enteral nutrition was independently associated with better clinical outcomes.
Greater Occipital Nerve Block for the Treatment of Chronic Migraine Headaches: A Systematic Review and Meta-Analysis
Authors: Shauly Orr , Gould Daniel J. , Sahai-Srivastava Soma , Patel Ketan M.
Published: October 2019

Background:

Few treatment options exist for chronic migraine headaches, with peripheral nerve blocks having long been used to reduce the frequency and severity of migraines. Although the therapeutic effects have been observed in clinical practice, the efficacy has never been fully studied. In the past decade, however, several randomized controlled clinical trials have been conducted to assess the efficacy of greater occipital nerve block in the treatment of chronic migraine headaches.

Methods:

A systematic review of the literature was performed in the citation databases PubMed, Embase, MEDLINE, and the Cochrane Library. The initial search of databases yielded 259 citations, of which 33 were selected as candidates for full-text review. Of these, nine studies were selected for inclusion in this meta-analysis.

Results:

Studies were analyzed that reported mean number of headache days per month in both intervention and control groups. A total of 417 patients were studied, with a pooled mean difference of −3.6 headache days (95 percent CI, −1.39 to −5.81 days). This demonstrates that greater occipital nerve block intervention significantly reduced the frequency of migraine headaches compared with controls (p < 0.00001). Pooled mean difference in pain scores of −2.2 (95 percent CI, −1.56 to −2.84) also demonstrated a significant decrease in headache severity compared with controls (p < 0.0121).

Conclusions:

Greater occipital nerve blocking should be recommended for use in migraine patients, particularly those that may require future surgical intervention. The block may act as an important stepping stone for patients experiencing migraine headache because of its usefulness for potentially assessing surgical candidates for nerve decompression.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Twenty-Four–Hour Ex Vivo Perfusion with Acellular Solution Enables Successful Replantation of Porcine Forelimbs
Authors: Krezdorn Nicco , Macleod Fiona , Tasigiorgos Sotirios , Turk, M.D. Marvee , Wo Luccie , Kiwanuka, B.A. Harriet , Lopdrup, B.I.D. Rachel , Kollar Branislav , Edelman Elazer R. , Pomahac Bohdan
Published: October 2019

Background:

A critical barrier to successful limb replantation and allotransplantation is the maximum allowable limb ischemia time of 4 to 6 hours. The current gold standard is to preserve amputated limbs on an ice slurry. Experimental machine perfusion has yielded promising results as an alternative. In particular, hypothermic acellular perfusion has enabled preservation of amputated limbs for up to 12 hours thus far.

Methods:

Amputated forelimbs of Yorkshire pigs were preserved on static cold storage at 4°C for 4 hours (static cold storage group) or perfused at 8°C for 24 hours (perfusion group) with oxygenated modified STEEN Solution perfusate before replantation. Animals were followed up for 7 days after replantation.

Results:

Eight animals underwent replantation (cold storage group, n = 4; perfusion group, n = 4). Seventy-five and 100 percent of animals in the static cold storage and perfusion groups survived for 7 days, respectively. Glycogen and adenosine triphosphate remained stable throughout perfusion. Heart and respiratory rate after replantation were increased in the static cold storage group. There was increased damage in muscle biopsy specimens obtained from animals in the static cold storage group after 7 days when compared with those from animals in the perfusion group.

Conclusions:

Hypothermic acellular ex vivo perfusion of limbs for up to 24 hours enables tissue preservation comparable to that obtained with conventional static cold storage for 4 hours and may reduce muscle damage and systemic reactions on limb replantation. Translation to human limbs may help improve limb replantation and allotransplantation outcomes.
The role of new β-lactamase inhibitors in gram-negative infections
Authors: Vena Antonio , Castaldo Nadia , Bassetti Matteo
Published: October 2019

Purpose of review

In recent years, traditional β-lactams have dramatically reduced their effectiveness against gram-negative bacteria mainly because of their ability to express multiple β-lactamase or carabapenemases that are not hydrolyzed by the old β-lactam inhibitors (BLIs) such as clavulanic acid, tazobactam, and sulbactam. New BLIs molecules have been developed to face the need of compounds that are active against multidrug or pandrug resistant gram-negative pathogens. The aim of this review is to summarize the new generation of BLIs and β-lactams combinations.

Recent findings

A number of new molecules with activity against Ambler class A (e.g., extended-spectrum β-lactamases, serine carbapenemases), class C (e.g., AmpC), or class D (e.g., oxacillinase-48) have been recently approved in combination with old β-lactams for the treatment of multidrug-resistant bacteria, and other agents are under investigation. These new compounds include diazabicyclooctanones non-β-lactam inhibitors (e.g., avibactam, relebactam, nacubactam) and boronic acid inhibitors (e.g., vaborbactam).

Newly approved and investigational new BLIs are expected to offer many advantages for the management of patients with multidrug-resistant gram-negative pathogens. Promising characteristics of new compounds include high activity against multi drug resistance gram-negative bacteria and a favorable safety profile.
In Vivo Assessment of Tau Deposition in Alzheimer Disease and Assessing Its Relationship to Regional Brain Glucose Metabolism and Cognition
Authors: Baghel Vivek , Tripathi Madhavi , Parida Girish , Gupta Ravikant , Yadav Saroj , Kumar Praveen , Dey A.B. , Damle Nishikant Avinash , Kumar Rajeev , Bal Chandrasekhar
Published: October 2019

Aim

In this study, we investigated the relationship of cerebral tau deposition (18F-tau-AD-ML 104 PET/CT) with glucose metabolism (18F-FDG PET/CT) and cognitive function in patients with Alzheimer disease (AD).

Patients and Methods

Seventy subjects (Mini Mental State Examination [MMSE] score <18 = 37 [AD]; MMSE score, 18–24 = 16 [early AD]) and 17 controls were included in this study. All participants underwent detailed neurological and neuropsychological evaluation, followed by 18F-tau-AD-ML 104 and 18F-FDG PET/CT imaging. Region-wise SUVmax ratios at 50 to 60 minutes postinjection were calculated for 18F-tau-AD-ML 104 and 18F-FDG, using the cerebellar cortex as the reference region. Linear models were used to investigate the association of regional 18F-tau-AD-ML 104 retention with 18F-FDG uptake and cognition (MMSE scores).

Results

18F-Tau-AD-ML 104 retention was observed in the parietal lobe, temporal lobe, hippocampus, parahippocampus, frontal lobe, anterior and posterior cingulate, and precuneus in advanced and early AD patient as compared with normal controls with regional hypometabolism in overlapping regions on 18F-FDG PET. Significant negative association was found between 18F-tau-AD-ML 104 regional retention and glucose metabolism in the parietal lobe, temporal lobe, hippocampus, parahippocampus, frontal lobe, anterior and posterior cingulate, and precuneus among patients with advanced and early AD. In advanced and early AD patients, a negative association was found between 18F-tau-AD-ML 104 regional retention (precuneus) and cognition (MMSE score), whereas a positive association was observed between 18F-FDG regional uptake (precuneus) and cognition (MMSE score).

Conclusions

Tau pathology overlapped with areas of hypometabolism on FDG PET in the brains of AD patients. Tau deposition was found to have negative association with cognitive scores in these patients.
Dual-Energy Computed Tomography in Thoracic Imaging—Current Practices and Utility
Authors: Rajiah Prabhakar
Published: October 2019

Purpose:

The purpose of this study was to determine the current practice patterns of utilization of dual-energy computed tomography (DECT) in thoracic imaging.

Materials and Methods:

In this IRB-approved study, the URL link for an anonymous 26-question survey was sent by email to all the members of the Society of Thoracic Radiology (STR). Survey questions focused on the practice type, case volume, DECT scanner availability, common indications, image types, and perceived utility of DECT. Study data were collected and managed using SurveyMonkey tools and analyzed with χ2 tests.

Results:

The survey response rate was 11% (104/962). DECT was available in 75% of respondents’ institutions, with 90% of these having 1 to 5 DECT scanners (P<0.001). Seventy percent performed 1 to 500 DECT chest CTs per month (P<0.001). Dual-source was the most common DECT scanner (81%) (P=0.239). DECT was opted depending on the clinical indication in 89% (P=0.433). The technologist reconstructs the additional DECT images in 75% of instances (P<0.001). Acute pulmonary embolism (PE) was the most common indication of DECT (53%) (P=0.006), while chronic PE was considered the most valuable use of DECT (33%) (P<0.001). Iodine map was the most commonly used DECT image (53%) (P<0.001) followed by low-energy virtual monoenergetic image (VMI) (29%). For VMI, 50 keV was the most commonly used energy level for improving vascular contrast (43%) (P=0.048), whereas 120 keV was the most commonly used energy in VMI for decreasing artifacts (25%) (P=0.027).

Conclusions:

There is wide variability on the utilization of DECT in thoracic imaging. PE is perceived to be the most valuable utility of DECT, and iodine map is considered the most valuable DECT image.
Modified Bilateral Pi Craniectomy Technique for Reduction Cranioplasty: Novel Technique
Authors: Abuzayed Bashar , Alawneh Khaled , Qawasmeh Majdi A.L. , Raffee Liqaa
Published: October 2019

Objective:

Severe hydrocephalic macrocephaly can cause significant morbidity in infants due to positioning difficulties, skin breakdown, and poor cosmesis. Many surgeons over the past decades have described a variety of surgical techniques of reduction cranioplasty. In this article, the authors describe a novel technique for skull reduction cranioplasty with modified bilateral Pi craniectomy.

Methods:

Anterior coronal and posterior lambdoid bone cuts are performed to extend inferiorly toward the sqamous bone. Last bone cuts are made connecting the parasagittal burr holes bilaterally, thus isolating and de-roofing of the sagittal suture. Bilateral peninsular bone flaps are reduced medially aiming to approximate the upper borders of both flaps. Edges of frontal and occipital bone can be resected and shaved to achieve smooth round contour of the reconstruct. The final reconstruct can be fixated with metal meshes.

Results:

In our technique, modified bilateral Pi craniectomy is simple and effective reduction cranioplasty technique, as the technique does not require bone graft resection and reconstruction of the grafts making the time of the surgery short with decreased possible complications. Also, the amount of bone resection, bone bending, and shaving of the bone edges can be controlled and adjusted during the. An important issue is that this technique avoids posterior skull reconstruction which is more risky, as many patients are bed ridden with secondary compressed and flat occiput.

Conclusions:

Modified bilateral Pi craniectomy is a simple and effective technique for cranial vault reduction, especially in flat-occiput cases. Good understanding of the structural abnormality and the pathophysiological mechanisms of the possible complications is very important for performing proper surgical reconstruction.
Identifying the start of a platelet aggregate by the shear rate and the cell-depleted layer
Authors: van Rooij B. J. M. , Závodszky G. , Azizi Tarksalooyeh V. W. , Hoekstra A. G.
Published: October 2019

Computer simulations were performed to study the transport of red blood cells and platelets in high shear flows, mimicking earlier published
in vitro
experiments in microfluidic devices with high affinity for platelet aggregate formation. The goal is to understand and predict where thrombus formation starts. Additionally, the need of cell-based modelling in these microfluidic devices is demonstrated by comparing our results with macroscopic models, wherein blood is modelled as a continuous fluid. Hemocell, a cell-based blood flow simulation framework is used to investigate the transport physics in the microfluidic devices. The simulations show an enlarged cell-depleted layer at the site where a platelet aggregate forms in the experiments. In this enlarged cell-depleted layer, the probability to find a platelet is higher than in the rest of the microfluidic device. In addition, the shear rates are sufficiently high to allow for the von Willebrand factor to elongate in this region. We hypothesize that the enlarged cell-depleted layer combined with a sufficiently large platelet flux and sufficiently high shear rates result in an haemodynamic environment that is a preferred location for initial platelet aggregation.
An integrated digital framework for the design, build and operation of fusion power plants
Authors: Patterson Eann A. , Purdie Sally , Taylor Richard J. , Waldon Chris
Published: October 2019

The development of a commercial fusion power plant presents a unique set of challenges associated with the complexity of the systems, the integration of novel technologies, the likely diversity and distribution of the organizations involved, and the scale of resources required. These challenges are reviewed and compared to those for other complex engineering systems. A framework for creating a digital environment that integrates research, test, design and operational data is discussed and is based on combining the integrated nuclear digital environment (INDE), proposed recently for nuclear fission power plants, with the hierarchical pyramid of test and simulation used in the aerospace industry. The framework offers the opportunity to plan modelling strategies that allow large design domains to be explored prior to optimizing a detailed design for construction; and in this context, the relationship between measurements and predictions are explored. The use of the framework to guide the socio-technical activity associated with a distributed and collaborative design process is discussed together with its potential benefits and the technology gaps that need to be addressed in order to realize them. These benefits include shorter development times, reduced costs and improvements in credibility, operability, reliability and safety.
The inhibitory effect of carboxyl-terminated polyamidoamine dendrimers on dentine host-derived matrix metalloproteinases
in vitro
in an etch-and-rinse adhesive system
Authors: Wu Qian , Shan Tiantian , Zhao Manduo , Mai Sui , Gu Lisha
Published: October 2019

The biomimetic remineralization of collagen fibrils has increased interest in restoring the demineralized dentine generated by dental caries. Carboxyl-terminated polyamidoamine dendrimers (PAMAM-COOH), hyperbranched polymeric macromolecules, can act as non-collagenous proteins to induce biomimetic remineralization on a dentine organic matrix. However,
in vivo
remineralization is an extremely time-consuming process; before complete remineralization, demineralized dentine collagen fibrils are susceptible to degradation by host-derived matrix metalloproteinases (MMPs). Therefore, we examined the effect of fourth-generation PAMAM-COOH (G4-PAMAM-COOH) on the collagenolytic activities of endogenous MMPs, the interaction between G4-PAMAM-COOH and demineralized dentine collagen and the influence of G4-PAMAM-COOH pre-treatment on resin–dentine bonding. G4-PAMAN-COOH not only inhibited exogenous soluble rhMMP9 but also hampered the proteolytic activities of dentine collagen-bound MMPs. Cooperated with the results of G4-PAMAM-COOH absorption and desorption, FTIR spectroscopy provided evidence for the exclusive electrostatic interaction rather than hydrogen or covalent bonding between G4-PAMAM-COOH and dentine collagen. Furthermore, G4-PAMAM-COOH pre-treatment showed no damage to resin–dentine bonding because it did not significantly decrease the elastic modulus of the demineralized dentine, degree of conversion, penetration of the adhesive into the dentinal tubules or ultimate tensile strength. Thus, G4-PAMAM-COOH can effectively inactivate MMPs, retard the enzymolysis of collagen by MMPs and scarcely influence the application of resin–dentine bonding.
Preparation and structure of SiOCN fibres derived from cyclic silazane/poly-acrylic acid hybrid precursor
Authors: Ren Zhongkan , Gervais Christel , Singh Gurpreet
Published: October 2019

Ceramic matrix composite (CMC) materials have been considered a desired solution for lightweight and high-temperature applications. Simultaneously, among all different CMC reinforcements, polymer-derived ceramic (PDC) fibres have gained attention for the intrinsic thermal stability and mechanical strength with simple and cost-effective synthesis techniques. Here, carbon-rich SiOCN fibres were synthesized via hand-drawing and polymer pyrolysis of a hybrid precursor of 1,3,5,7-tetramethyl-1,3,5,7-tetravinylcyclotetrasilazane (TTCSZ) and poly-acrylic acid (PAA). The type of silazane reported in this work is considered as a major precursor for SiCN; however, it is unspinnable, due to its unfavourable physical properties (low viscosity) and chemical structure (cyclic rather than linear structure). The introduction of PAA to TTCSZ to create a hybrid precursor remarkably improved the spinnability of the silazane and should be widely applicable to other unspinnable PDC pre-ceramic polymers. Investigations on the structural and compositional development of the fibres were mainly conducted via Raman spectroscopy, Fourier-transform infrared spectroscopy, scanning electron microscopy, X-ray photoelectron spectroscopy, nuclear magnetic resonance and thermo-gravimetric analysis to determine spinnability, free carbon content, cross-linking and pyrolysis behaviour of the fibres, respectively.
Persistent homology for low-complexity models
Authors: Lotz Martin
Published: October 2019

We show that recent results on randomized dimension reduction schemes that exploit structural properties of data can be applied in the context of persistent homology. In the spirit of compressed sensing, the dimension reduction is determined by the Gaussian width of a structure associated with the dataset, rather than its size, and such a reduction can be computed efficiently. We further relate the Gaussian width to the doubling dimension of a finite metric space, which appears in the study of the complexity of other methods for approximating persistent homology. We can, therefore, literally replace the ambient dimension by an intrinsic notion of dimension related to the structure of the data.
Highly heritable and functionally relevant breed differences in dog behaviour
Authors: MacLean Evan L. , Snyder-Mackler Noah , vonHoldt Bridgett M. , Serpell James A.
Published: October 2019

Variation across dog breeds presents a unique opportunity to investigate the evolution and biological basis of complex behavioural traits. We integrated behavioural data from more than 14 000 dogs from 101 breeds with breed-averaged genotypic data (n= 5697 dogs) from over 100 000 loci in the dog genome. We found high levels of among-breed heritability for 14 behavioural traits (the proportion of trait variance attributable to genetic similarity among breeds). We next identified 131 single nucleotide polymorphisms associated with breed differences in behaviour, which were found in genes that are highly expressed in the brain and enriched for neurobiological functions and developmental processes, suggesting that they may be functionally associated with behavioural differences. Our results shed light on the heritability and genetic architecture of complex behavioural traits and identify dogs as a powerful model in which to address these questions.
Detecting parasite associations within multi-species host and parasite communities
Authors: Dallas Tad A. , Laine Anna-Liisa , Ovaskainen Otso
Published: October 2019

Understanding the role of biotic interactions in shaping natural communities is a long-standing challenge in ecology. It is particularly pertinent to parasite communities sharing the same host communities and individuals, as the interactions among parasites—both competition and facilitation—may have far-reaching implications for parasite transmission and evolution. Aggregated parasite burdens may suggest that infected host individuals are either more prone to infection, or that infection by a parasite species facilitates another, leading to a positive parasite–parasite interaction. However, parasite species may also compete for host resources, leading to the prediction that parasite–parasite associations would be generally negative, especially when parasite species infect the same host tissue, competing for both resources and space. We examine the presence and strength of parasite associations using hierarchical joint species distribution models fitted to data on resident parasite communities sampled on over 1300 small mammal individuals across 22 species and their resident parasite communities. On average, we detected more positive associations between infecting parasite species than negative, with the most negative associations occurring when two parasite species infected the same host tissue, suggesting that parasite species associations may be quantifiable from observational data. Overall, our findings suggest that parasite community prediction at the level of the individual host is possible, and that parasite species associations may be detectable in complex multi-species communities, generating many hypotheses concerning the effect of host community changes on parasite community composition, parasite competition within infected hosts, and the drivers of parasite community assembly and structure.
The early elasmobranch
Phoebodus
: phylogenetic relationships, ecomorphology and a new time-scale for shark evolution
Authors: Frey Linda , Coates Michael , Ginter Michał , Hairapetian Vachik , Rücklin Martin , Jerjen Iwan , Klug Christian
Published: October 2019

Anatomical knowledge of early chondrichthyans and estimates of their phylogeny are improving, but many taxa are still known only from microremains. The nearly cosmopolitan and regionally abundant Devonian genus
Phoebodus
has long been known solely from isolated teeth and fin spines. Here, we report the first skeletal remains of
Phoebodus
from the Famennian (Late Devonian) of the Maïder region of Morocco, revealing an anguilliform body, specialized braincase, hyoid arch, elongate jaws and rostrum, complementing its characteristic dentition and ctenacanth fin spines preceding both dorsal fins. Several of these features corroborate a likely close relationship with the Carboniferous species
Thrinacodus gracia
, and phylogenetic analysis places both taxa securely as members of the elasmobranch stem lineage. Identified as such, phoebodont teeth provide a plausible marker for range extension of the elasmobranchs into the Middle Devonian, thus providing a new minimum date for the origin of the chondrichthyan crown-group. Among pre-Carboniferous jawed vertebrates, the anguilliform body shape of
Phoebodus
is unprecedented, and its specialized anatomy is, in several respects, most easily compared with the modern frilled shark
Chlamydoselachus
. These results add greatly to the morphological, and by implication ecological, disparity of the earliest elasmobranchs.
Biased movement drives local cryptic coloration on distinct urban pavements
Authors: Edelaar Pim , Baños-Villalba Adrian , Quevedo David P. , Escudero Graciela , Bolnick Daniel I. , Jordán-Andrade Aída
Published: October 2019

Explanations of how organisms might adapt to urban environments have mostly focused on divergent natural selection and adaptive plasticity. However, differential habitat choice has been suggested as an alternative. Here, we test for habitat choice in enhancing crypsis in ground-perching grasshoppers colonizing an urbanized environment, composed of a mosaic of four distinctly coloured substrates (asphalt roads and adjacent pavements). Additionally, we determine its relative importance compared to present-day natural selection and phenotypic plasticity. We found that grasshoppers are very mobile, but nevertheless approximately match the colour of their local substrate. By manipulating grasshopper colour, we confirm that grasshoppers increase the usage of those urban substrates that resemble their own colours. This selective movement actively improves crypsis. Colour divergence between grasshoppers on different substrates is not or hardly owing to present-day natural selection, because observed mortality rates are too low to counteract random substrate use. Additional experiments also show negligible contributions from plasticity in colour. Our results confirm that matching habitat choice can be an important driver of adaptation to urban environments. In general, studies should more fully incorporate that individuals are not only selective targets (i.e. selected on by the environment), but also selective agents (i.e. selecting their own environments).
The origin of the central dogma through conflicting multilevel selection
Authors: Takeuchi Nobuto , Kaneko Kunihiko
Published: October 2019

The central dogma of molecular biology rests on two kinds of asymmetry between genomes and enzymes: informatic asymmetry, where information flows from genomes to enzymes but not from enzymes to genomes; and catalytic asymmetry, where enzymes provide chemical catalysis but genomes do not. How did these asymmetries originate? Here, we show that these asymmetries can spontaneously arise from conflict between selection at the molecular level and selection at the cellular level. We developed a model consisting of a population of protocells, each containing a population of replicating catalytic molecules. The molecules are assumed to face a trade-off between serving as catalysts and serving as templates. This trade-off causes conflicting multilevel selection: serving as catalysts is favoured by selection between protocells, whereas serving as templates is favoured by selection between molecules within protocells. This conflict induces informatic and catalytic symmetry breaking, whereby the molecules differentiate into genomes and enzymes, establishing the central dogma. We show mathematically that the symmetry breaking is caused by a positive feedback between Fisher’s reproductive values and the relative impact of selection at different levels. This feedback induces a division of labour between genomes and enzymes, provided variation at the molecular level is sufficiently large relative to variation at the cellular level, a condition that is expected to hinder the evolution of altruism. Taken together, our results suggest that the central dogma is a logical consequence of conflicting multilevel selection.
Immune stability predicts tuberculosis infection risk in a wild mammal
Authors: Seguel Mauricio , Beechler Brianna R. , Coon Courtney C. , Snyder Paul W. , Spaan Johannie M. , Jolles Anna E. , Ezenwa Vanessa O.
Published: October 2019

Immunity is one of the most variable phenotypic traits in animals; however, some individuals may show less fluctuation in immune traits, resulting in stable patterns of immune variation over time. It is currently unknown whether immune variation has consequences for infectious disease risk. In this study, we identified moderately stable immune traits in wild African buffalo and asked whether the stability of these traits affected bovine tuberculosis (TB) infection risk. We found that adaptive immune traits such as the level of interferon-γ (IFN-γ) released after white blood cell stimulation, the number of circulating lymphocytes and the level of antibodies against bovine adenovirus-3 were moderately repeatable (i.e. stable) over time, whereas parameters related to innate immunity either had low repeatability (circulating eosinophil numbers) or were not repeatable (e.g. neutrophil numbers, plasma bacteria killing capacity). Intriguingly, individuals with more repeatable IFN-γ and lymphocyte levels were at a significantly higher risk of acquiring TB infection. In stark contrast, average IFN-γ and lymphocyte levels were poor predictors of TB risk, indicating that immune variability rather than absolute response level better captured variation in disease susceptibility. This work highlights the important and under-appreciated role of immune variability as a predictor of infection risk.
Optimizing future biodiversity sampling by citizen scientists
Authors: Callaghan Corey T. , Poore Alistair G. B. , Major Richard E. , Rowley Jodi J. L. , Cornwell William K.
Published: October 2019

We are currently in the midst of Earth's sixth extinction event, and measuring biodiversity trends in space and time is essential for prioritizing limited resources for conservation. At the same time, the scope of the necessary biodiversity monitoring is overwhelming funding for professional scientific monitoring. In response, scientists are increasingly using citizen science data to monitor biodiversity. But citizen science data are ‘noisy’, with redundancies and gaps arising from unstructured human behaviours in space and time. We ask whether the information content of these data can be maximized for the express purpose of trend estimation. We develop and execute a novel framework which assigns every citizen science sampling event a marginal value, derived from the importance of an observation to our understanding of overall population trends. We then make this framework predictive, estimating the expected marginal value of future biodiversity observations. We find that past observations are useful in forecasting where high-value observations will occur in the future. Interestingly, we find high value in both ‘hotspots’, which are frequently sampled locations, and ‘coldspots’, which are areas far from recent sampling, suggesting that an optimal sampling regime balances ‘hotspot’ sampling with a spread across the landscape.