bluuebunny/crossref_metadata_2025 huggingface dataset:
The Integrative Biology of Gecko Adhesion: Historical Review, Current Understanding, and Grand Challenges
Authors: Russell Anthony P , Stark Alyssa Y , Higham Timothy E
Published: April 2019

Geckos are remarkable in their ability to reversibly adhere to smooth vertical, and even inverted surfaces. However, unraveling the precise mechanisms by which geckos do this has been a long process, involving various approaches over the last two centuries. Our understanding of the principles by which gecko adhesion operates has advanced rapidly over the past 20 years and, with this knowledge, material scientists have attempted to mimic the system to create artificial adhesives. From a biological perspective, recent studies have examined the diversity in morphology, performance, and real-world use of the adhesive apparatus. However, the lack of multidisciplinarity is likely a key roadblock to gaining new insights. Our goals in this paper are to 1) present a historical review of gecko adhesion research, 2) discuss the mechanisms and morphology of the adhesive apparatus, 3) discuss the origin and performance of the system in real-world contexts, 4) discuss advancement in bio-inspired design, and 5) present grand challenges in gecko adhesion research. To continue to improve our understanding, and to more effectively employ the principles of gecko adhesion for human applications, greater intensity and scope of interdisciplinary research are necessary.
Heterochronic Shifts Mediate Ecomorphological Convergence in Skull Shape of Microcephalic Sea Snakes
Authors: Sherratt Emma , Sanders Kate L , Watson Amy , Hutchinson Mark N , Lee Michael S Y , Palci Alessandro
Published: April 2019

Morphological variation among the viviparous sea snakes (Hydrophiinae), a clade of fully aquatic elapid snakes, includes an extreme “microcephalic” ecomorph that has a very small head atop a narrow forebody, while the hind body is much thicker (up to three times the forebody girth). Previous research has demonstrated that this morphology has evolved at least nine times as a consequence of dietary specialization on burrowing eels, and has also examined morphological changes to the vertebral column underlying this body shape. The question addressed in this study is what happens to the skull during this extreme evolutionary change? Here we use X-ray micro-computed tomography and geometric morphometric methods to characterize cranial shape variation in 30 species of sea snakes. We investigate ontogenetic and evolutionary patterns of cranial shape diversity to understand whether cranial shape is predicted by dietary specialization, and examine whether cranial shape of microcephalic species may be a result of heterochronic processes. We show that the diminutive cranial size of microcephalic species has a convergent shape that is correlated with trophic specialization to burrowing prey. Furthermore, their cranial shape is predictable for their size and very similar to that of juvenile individuals of closely related but non-microcephalic sea snakes. Our findings suggest that heterochronic changes (resulting in pedomorphosis) have driven cranial shape convergence in response to dietary specializations in sea snakes.
Utilization of maternity waiting homes: before, during, and after the Ebola virus disease outbreak in Bong County, Liberia
Authors: Perosky Joseph E , McLean Karina Z , Kofa Alphonso , Nyanplu Aloysius , Munro-Kramer Michelle L , Lori Jody R
Published: April 2019

Background

Maternity waiting homes (MWHs) are used to increase the number of women delivering at health care facilities. The first MWHs in Liberia were opened in 2012, prior to the Ebola virus disease (EVD) outbreak.

Methods

Longitudinal data were collected from registries on MWH use, antenatal care, postnatal care and facility deliveries from 2012 to 2016 to assess MWH utilization.

Results

All indicators examined declined during the EVD outbreak, but within 6 months of the cessation of the outbreak they returned to pre-EVD levels.

Conclusions

Findings suggest MWH utilization remained stable after international funding ceased and EV affected the region.
Tryptophan requirements in small, medium, and large breed adult dogs using the indicator amino acid oxidation technique1
Authors: Templeman James R , Mansilla Wilfredo D , Fortener Lisa , Shoveller Anna K
Published: April 2019

Tryptophan (Trp) is an indispensable amino acid (AA) for dogs of all life stages; however, although Trp requirements for growing dogs are derived from 3 dose–response studies, there are no empirical data on Trp requirements for adult dogs at maintenance. The study objective was to determine Trp requirements of adult dogs of 3 different breeds using the indicator amino acid oxidation (IAAO) technique. Four spayed or neutered Miniature Dachshunds (5.28 ± 0.29 kg BW), 4 spayed Beagles (9.32 ± 0.41 kg BW), and 5 neutered Labrador Retrievers (30.51 ± 2.09 kg BW) were used. After a 14-d adaptation to a Trp-adequate basal diet (Trp = 0.482% dry matter), all dogs were fed a mildly Trp-deficient diet for 2 d (Trp = 0.092% dry matter) before being randomly allocated to receiving 1 of 7 concentrations of Trp supplementation (final Trp content in experimental diets was 0.092, 0.126, 0.148, 0.182, 0.216, 0.249, and 0.283% dry matter) and all dogs received all Trp treatments. After 2-d adaptation to the experimental diets, dogs underwent individual IAAO studies. Total feed was divided in 13 equal meals; at the sixth meal, dogs were fed a bolus of L-[1-13C]-Phenylalanine (Phe) (9.40 mg/kg BW), and thereafter, L-[1-13C]-Phe was supplied (2.4 mg/kg BW) with every meal. Total production of 13CO2 during isotopic steady state was determined by enrichment of 13CO2 in breath samples and total production of CO2 measured using indirect calorimetry. The maintenance requirement for Trp and the 95% confidence interval (CI) were determined using a 2-phase linear regression model. Mean Trp requirements were estimated at 0.154, 0.218, and 0.157% (dry-matter) for Dachshunds, Beagles, and Labradors, respectively. The upper 95% CI were 0.187, 0.269, and 0.204% (dry-matter) for Dachshunds, Beagles, and Labradors. In conclusion, estimated Trp requirements are higher for Beagles compared with Labradors or Dachshunds, and all estimated requirements are higher than those currently recommended by the NRC and AAFCO.
Growth and biomechanics of shoot organs
Authors: Echevin Emilie , Le Gloanec Constance , Skowrońska Nikolina , Routier-Kierzkowska Anne-Lise , Burian Agata , Kierzkowski Daniel
Published: April 2019

Plant organs arise through complex interactions between biological and physical factors that control morphogenesis. While there has been tremendous progress in the understanding of the genetics behind development, we know much less about how mechanical forces control growth in plants. In recent years, new multidisciplinary research combining genetics, live-imaging, physics, and computational modeling has begun to fill this gap by revealing the crucial role of biomechanics in the establishment of plant organs. In this review, we provide an overview of our current understanding of growth during initiation, patterning, and expansion of shoot lateral organs. We discuss how growth is controlled by physical forces, and how mechanical stresses generated during growth can control morphogenesis at the level of both cells and tissues. Understanding the mechanical basis of growth and morphogenesis in plants is in its early days, and many puzzling facts are yet to be deciphered.
An Analysis of Multirules for Monitoring Assay Quality Control
Authors: Walker Brandon S , Pearson Lauren N , Schmidt Robert L
Published: April 2019

Background

Multirules are often employed to monitor quality control (QC). The performance of multirules is usually determined by simulation and is difficult to predict. Previous studies have not provided computer code that would enable one to experiment with multirules. It would be helpful for analysts to have computer code to analyze rule performance.

Objective

To provide code to calculate power curves and to investigate certain properties of multirule QC.

Methods

We developed computer code in the R language to simulate multirule performance. Using simulation, we studied the incremental performance of each rule and determined the average run length and time to signal.

Results

We provide R code for simulating multirule performance. We also provide a Microsoft Excel spreadsheet with a tabulation of results that can be used to create power curves. We found that the R4S and 10x rules add very little power to a multirule set designed to detect shifts in the mean.

Conclusion

QC analysts should consider using a limited-rule set.
A dual role of the ribosome-bound chaperones RAC/Ssb in maintaining the fidelity of translation termination
Authors: Gribling-Burrer Anne-Sophie , Chiabudini Marco , Zhang Ying , Qiu Zonghao , Scazzari Mario , Wölfle Tina , Wohlwend Daniel , Rospert Sabine
Published: April 2019

The yeast ribosome-associated complex RAC and the Hsp70 homolog Ssb are anchored to the ribosome and together act as chaperones for the folding and co-translational assembly of nascent polypeptides. In addition, the RAC/Ssb system plays a crucial role in maintaining the fidelity of translation termination; however, the latter function is poorly understood. Here we show that the RAC/Ssb system promotes the fidelity of translation termination via two distinct mechanisms. First, via direct contacts with the ribosome and the nascent chain, RAC/Ssb facilitates the translation of stalling-prone poly-AAG/A sequences encoding for polylysine segments. Impairment of this function leads to enhanced ribosome stalling and to premature nascent polypeptide release at AAG/A codons. Second, RAC/Ssb is required for the assembly of fully functional ribosomes. When RAC/Ssb is absent, ribosome biogenesis is hampered such that core ribosomal particles are structurally altered at the decoding and peptidyl transferase centers. As a result, ribosomes assembled in the absence of RAC/Ssb bind to the aminoglycoside paromomycin with high affinity (KD = 76.6 nM) and display impaired discrimination between stop codons and sense codons. The combined data shed light on the multiple mechanisms by which the RAC/Ssb system promotes unimpeded biogenesis of newly synthesized polypeptides.
Changes in Use Patterns Over 1 Year Among Smokers and Dual Users of Combustible and Electronic Cigarettes
Authors: Piper Megan E , Baker Timothy B , Benowitz Neal L , Jorenby Douglas E
Published: April 2019

Background

Dual use of combustible and electronic cigarettes (e-cigarettes) is a growing use pattern; more than half of e-cigarette users are dual users. However, little is known regarding the course of dual use; for example, the likelihood of discontinuation of either combustible or e-cigarettes or both.

Methods

Adult daily smokers and dual users (daily smokers who also vaped at least once per week) who did not intend to quit use of either product in the next 30 days participated in a longitudinal, observational study (N = 322, 51.2% women, 62.7% white, mean age = 42.27 [SD = 14.05]). At baseline, participants completed demographics and smoking and vaping history assessments. They also reported daily cigarette and e-cigarette use via timeline follow-back assessment and provided a breath sample for carbon monoxide assay at 4-month intervals for 1 year.

Results

Of those who completed the year 1 follow-up, 1.9% baseline smokers and 8.0% dual users achieved biochemically confirmed seven-day point-prevalence abstinence from combustible cigarettes (χ2 = 4.57, p = .03). Of initial dual users, by 1 year 43.9% were smoking only, 48.8% continued dual use, 5.9% were vaping only, and 1.4% abstained from both products. Among baseline smokers, 92.3% continued as exclusive smokers. Baseline dual users who continued e-cigarette use were more likely to be white and report higher baseline e-cigarette dependence.

Conclusions

In this community sample, the majority of dual users transitioned to exclusive smoking. A higher percentage of dual users quit smoking than smokers, but attrition and baseline differences between the groups compromise strong conclusions. Sustained e-cigarette use was related to baseline e-cigarette dependence.

Implications

This research suggests that dual use of combustible and e-cigarettes is not a sustained pattern for the majority of dual users, but it is more likely to be a continued pattern if the user is more dependent on e-cigarettes. There was evidence that dual users were more likely to quit smoking than exclusive smokers, but this may be due to factors other than their dual use.
Examples and non-examples of polyhedral Kähler surfaces
Authors: Gachet Cécile
Published: April 2019

Polyhedral Kähler surfaces are a class of complex surfaces, which are flat everywhere except on a two-dimensional skeleton. They are defined as a generalization of the ‘gluing a polygon side by side’ construction of flat Riemann surfaces. In this article, we introduce two classes of polyhedral Kähler surfaces with trivial holonomy: products of polyhedral Kähler curves with zero holonomy and ramified coverings of tori, and prove that none of these classes is contained in the other.
Spaces of novelty: Can universities play a catalytic role in less developed regions?
Authors: Marques Pedro , Morgan Kevin , Healy Adrian , Vallance Paul
Published: April 2019

Over the past few decades, universities have been asked to become ever more involved in the development of their regions and countries, through knowledge dissemination, contribution to policy debates or even by becoming leaders in stakeholder coalitions. However, as has been often pointed out, for universities to have an impact on regional fortunes it is necessary to have an appropriate innovation ecosystem, which is often lacking in less developed regions. We approach this issue by discussing the three interrelated dimensions of knowledge supply, demand, and translational activities, through two case studies of university–business engagement in Wales. We also distinguish between narrow forms of engagement, based strictly on the commercialisation of knowledge, and contrast them with broader forms of engagement. Finally, we discuss the practical and normative challenges associated with these interactions, such as the danger of appropriation of public resources by private organisations.
Limit feeding as a strategy to increase energy efficiency in intensified cow–calf production systems1
Authors: Trubenbach Levi A , Wickersham Tryon A , Bierschwale Lauren N , Morrill Jessie C , Baber Jessica R , Sawyer Jason E
Published: April 2019

Two experiments were conducted to measure efficiency of energy use in limit-fed cows. In Exp. 1, 32 pregnant, crossbred cows were used to examine the effects of dietary energy concentration and intake level on energy utilization and digestion. In a 2 × 2 factorial treatment arrangement, cows received diets formulated at either 1.54 Mcal NEm/kg high energy (H) or 1.08 Mcal NEm/kg low energy (L); amounts of each diet were fed at amounts to achieve either 80% (80) or 120% (120) of maintenance energy requirements. Fecal grab samples were collected on days 14, 28, 42, and 56 for determination of energy digestion and metabolizable energy (ME) intake. Acid detergent insoluble ash and bomb calorimetry were used to estimate fecal energy production. Cow body weight and 12th rib fat thickness were used to estimate body energy, using 8 different methods, at the beginning and end of a 56-d feeding period. Energy retention (RE) was calculated as the difference in body energy on days 0 and 56. Heat energy (HE) was calculated as the difference in ME intake and RE. Energy digestion increased (P = 0.04) with intake restriction. Cows consuming H tended to have greater (P = 0.08) empty body weight (EBW) gain than cows consuming L, but no difference was observed (P = 0.12) between cows fed 120 compared with cows fed 80. Estimates of HE were greater for L than H (P < 0.01) and greater for 120 than 80 (P < 0.01), such that estimated fasting heat production of H (57.2 kcal/kg EBW0.75) was lower than that of L (73.3 kcal/kg EBW0.75). In Exp. 2, 16 ruminally cannulated, crossbred steers were used to examine the effects of dietary energy concentration and intake level on energy digestion. Treatment arrangement and laboratory methods were replicated from Exp. 1. Following a 14-d adaptation period, fecal samples were collected, such that samples were represented in 2-h intervals post-feeding across 24 h. Diet × intake interactions were observed for nutrient digestibility. Energy digestibility was greater in steers fed H than in steers fed L (P < 0.01); however, digestibility of each nutrient increased by approximately 10% in steers fed H80 vs. those fed H120 (P ≤ 0.03); nutrient digestibility was similar among levels of intake in steers fed L (P = 0.54). These results suggest that intake restriction may increase diet utilization and that the magnitude of change may be related to diet energy density.
Clinical Updates in Women’s Health Care Summary: Acute Cough
Authors: Oat-Judge Julia
Published: April 2019

Acute cough is a common presenting symptom in the ambulatory care setting in the United States. It imposes a significant symptom burden on patients and financial burden on the health care system. In most cases, acute cough is caused by a benign viral infection that will resolve without intervention. When needed, there are few evidence-based interventions to hasten the resolution of cough symptoms. Patients may request antibiotics or prescription cough syrups; however, these medications have little evidence of benefit and can be potentially harmful to the patient. It can be challenging for the clinician to provide reassurance while minimizing unnecessary prescriptions. The health care provider also must be alert to signs and symptoms that could signal a high-risk diagnosis that requires urgent evaluation. This monograph provides a review of the differential diagnosis for acute cough, an algorithmic approach to the evaluation of cough, and evidence-based treatment recommendations. Also, it highlights warning signs and symptoms that should trigger an emergent referral and special clinical considerations in more vulnerable patient populations, including pregnant patients and geriatric patients.
Cross-cultural Adaptation and Validation of the Hausa Version of the Oswestry Disability Index 2.1a for Patients With Low Back Pain
Authors: Adamu Aisha S. , Ibrahim Aminu A. , Ahmad Rufa’i Y. , Akindele Mukadas O. , Kaka Bashir , Mukhtar Naziru B.
Published: April 2019

Study Design.

Validation of a translated, culturally adapted questionnaire.

Objective.

To translate the Oswestry Disability Index (ODI) version 2.1a into Hausa Language and to validate its use in a cohort of patients with low back pain (LBP).

Summary of Background Data.

The ODI is one of the most commonly used condition-specific questionnaires for assessing functional disability in patients with LBP, yet, no formal cross-culturally adapted and validated Hausa version exists.

Methods.

The Hausa version of the ODI 2.1a (ODI-H) was developed according to established guidelines. Validation was performed among 200 patients with LBP recruited from both rural and urban Nigeria. Reliability was assessed using internal consistency (Cronbach α), test–retest reliability by computing intraclass correlation coefficient, standard error of measurement, and minimal detectable change. Convergent validity was assessed by correlating the ODI-H with Visual Analogue Scale for pain, Fear-Avoidance Beliefs Questionnaire, and finger-floor distance test. Divergent validity was assessed by correlating the ODI-H with age, educational level, and occupational status. Exploratory factor analysis (EFA) and confirmatory factor analysis were also performed. Confirmatory factor analysis was performed with three models: 1) one-factor theory-driven model, 2) two-factor theory-driven model (dynamic and static factors), and 3) a model based on our EFA.

Results.

The ODI-H had high internal consistency (Cronbach α = 0.87) and excellent test–retest reliability (intraclass correlation coefficient  = 0.937) with standard error of measurement and minimal detectable change being 3.69 and 10.2 respectively. The construct validity (convergent and divergent validity) is supported as all (6:6, 100%) the a priori hypotheses were confirmed. The EFA yielded a two-factor model explaining 54.3% of the total variance but demonstrated poor fit. The one-factor and two-factor theory-driven model had acceptable fit but the one-factor theory-driven model was better.

Conclusion.

The ODI-H version 2.1a was transculturally equivalent, reliable, and valid tool for assessing functional disability among Hausa-speaking patients with LBP. The use of this tool can be recommended for future clinical and research purposes.

Level of Evidence: 3
Comparison of Anterior Cervical Foraminotomy and Posterior Cervical Foraminotomy for Treating Single Level Unilateral Cervical Radiculopathy
Authors: Kim Shin-Jae , Seo Jin-Suk , Lee Sang-Ho , Bae Junseok
Published: April 2019

Study Design.

Retrospective study.

Objective.

To compare clinical and radiological outcomes after two surgical procedures.

Summary of Background Data.

Anterior cervical discectomy and fusion is the gold standard treatment for cervical radiculopathy. Cervical foraminotomy is an alternative decompressive treatment option to preserve segmental motion and avoid fusion-related complications. Anterior cervical foraminotomy (ACF) and posterior cervical foraminotmy (PCF) has been introduced to achieve foraminal decompression. The objective of this study was to compare long-term clinical and radiological outcomes after two surgical procedures for the treatment of single-level cervical radiculopathy.

Methods.

A retrospective review of patients undergoing ACF or PCF for the treatment of single-level unilateral cervical radiculopathy from 2010 to 2012 was performed. Demographic, perioperative, and clinical outcomes of 40 patients for each group were collected from the electronic medical records. Clinical outcomes were assessed by visual analog scores, while disc height (DH), cervical lordosis (CL), and C2–7 sagittal vertical axis (C2–7 SVA) data were obtained from pre- and postoperative radiography data.

Results.

Both groups showed similar clinical improvements after surgery. Radiographically, the ACF groups showed profound decrease in DH only at the first month after surgery, and there was no significant change in DH after 1 year. The PCF group showed no significant changes in DH at follow-up. With respect to CL, ACF showed a significant decrease. There was no statistically significant change in C2–7 SVA before or after surgery in both groups.

Conclusion.

Both ACF and PCF showed significant clinical improvement of radiculopathy. In the ACF group, the DH decreased, and CL decreased during the early postoperative period. Radiological parameters were preserved in the PCF group after surgery. However, this group showed greater intraoperative bleeding and revision rates. Care should be taken to manage complications according to the specific surgical treatment.

Level of Evidence: 3
Academic Ethos in Physical Therapy Education
Authors: Carey James R.
Published: April 2019

Background and Purpose.

Academic ethos is the character or virtuousness of the academic institution and its programs that drives scholastic accomplishments. Ethos is obscure yet real and contains emotional energy or passion that gives meaning and moral worth to universities, colleges and academic health centers in contributing to the public good. Little information on academic ethos exists in the higher education literature, likely because it is an elusive concept that does not lend itself to a precise definition. The purpose of this paper is to describe the importance of academic ethos in physical therapy's role in the enterprise of higher education.

Position and Rationale.

Emphasis includes the responsibilities academic ethos imposes upon academics for being vigilant on matters of character/virtuousness to sustain higher education's noble mission of promoting the public good. Also, threats intrinsic and extrinsic to the academy that weaken academic ethos are described in the form of diminished commitment to intellectualism, corporatization of higher education, political forces, and Faustian bargaining.

Discussion and Conclusion.

Reflecting on academic ethos will assist physical therapy faculty in congealing their own programmatic ethos, as well as contributing to their institution's ethos, thus enabling them to optimize their role in the academy in serving the public good.
An innovative method for measuring the femoral arch
Authors: Ren Dong , Wang Tianci , Li Ming , Liu Yueju , Huang Yajie , Wang Pengcheng
Published: April 2019

A mismatch between the femoral bow and intramedullary nails causes a series of complications. Previous investigations have sought to determine the curvature of the femur using the radius of the femoral bow. However, the radius of the curvature is affected by femur length. To eliminate the influence of femur length, we instead used an angle to indicate femoral curvatures.

Forty patients with intertrochanteric fractures who underwent a surgical procedure at our institution were enrolled in this study. We conducted a lateral X-ray of the contralateral femur before operation. We drew a triangle in the X-ray images using Digimizer software. The tangent values of the acute angle were used to indicate femoral curvature. The tangent values were then compared with the dimensions of currently used nails.

The average tangent value of the femurs was 0.0835 ± 0.0147, as measured from the inner cortex and 0.0798 ± 0.0150, as measured from the outer cortex. The tangent values were related to sex, with males having straighter femurs than females, and there was no obvious correlation between tangent values and age or femur length. Tangent value is a reliable method with a high intersurveyor consistency; femur curvatures were significantly greater than the curvatures of currently used nails.
Effectiveness comparisons of acupuncture for chronic prostatitis/chronic pelvic pain syndrome
Authors: Lei Yi , He Xueyun , Wang Jingshang , Gong Xiaoyong , Zheng Wei , Xue Yahui , Li Yongqiang , Zhang Bao , Ma Jiajia , Xue Chaohui
Published: April 2019

Background:

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common urinary system disease in the male population. Recent studies have shown that acupuncture can alleviate the pain caused by CP/CPPS to a certain extent and improve the quality of life of patients. This study used a network meta-analysis (NMA) to compare the effectiveness and safety of different forms of acupuncture on CP/CPPS.

Methods and analysis:

We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database, China Biomedical Literature CD-ROM Database, and related randomized controlled trials (RCTs) included in the China Resources Database. The time is limited from the construction of the library to December 2018. The quality of the included RCTs will be evaluated with the risk of bias tool and evidence will be evaluated by grading of recommendations assessment, development, and evaluation. STATA 13.0 and WinBUGS 1.4.3 through the GeMTC package will be used to perform a NMA to synthesize direct and indirect evidence.

Results:

The results of this NMA will be submitted to a peer-reviewed journal for publication.

Trial registration number:

PROSPERO CRD42018111408.
Dextrocardia with complete AV block and the implantation of a temporary pacemaker before cesarean section
Authors: Yao Changfang , Wang Xiaoqing , Zhang Jinggang , Qiu Lan , Ye Wenfeng , Wang Chaoping
Published: April 2019

Rationale:

Patients with situs inversus totalis (SIT) and complete atrioventricular (AV) block are extremely rare, and only few cases have been reported up to now. Due to the rarity of such condition and its anatomical complexity, we reported this case as a reference for obstetricians, providing valuable insights into potential clinical treatment.

Patient concerns:

We reported a case of 30-year-old patient with complete AV block, and her heart rate was only about 45 beats per minute.

Diagnoses:

The patient was diagnosed with term delivery with SIT and complete AV block.

Interventions:

A temporary pacemaker (TPM) was implanted before cesarean section (CS) because of complete AV block.

Outcomes:

CS was performed successfully after the implantation of a TPM. The heart rate remained stable, and the 24-hour blood loss was limited.

Lessons:

This study presents a complex heart disease case which needed more frequent antenatal examination and restriction of physical activity. To reduce the risk of pregnancy, basic disease needed to be cured before pregnancy. Our findings could provide guidance for future clinical studies.
Efficacy and safety of grain moxibustion in hemiplegia
Authors: Chen Guoming , Huang Chuyao , Liu Yunyun , Zhang Zhaoping , Qi Xiangjun , Shi Peiyu , Li Dan , Lv Huiye , Zhang Bin
Published: April 2019

Background:

The increasing morbidity of stroke brings enormous social and economic pressure to the countries. Hemiplegia is the common sequela of stroke patients, which affects their physical activities and daily life, and its optimal treatment is still an urgent problem. In Asian countries, moxibustion therapy is widely combined with rehabilitation in poststroke hemiplegia. Among them, grain moxibustion, due to its concentration on stimulating the acupoints and deep heat penetration, can promote neurorehabilitation after stroke. Therefore, based on the current literatures, the effectiveness and safety of grain moxibustion were systematically evaluated to provide possible alternative therapy for the rehabilitation of hemiplegia.

Methods:

Studies search for eligible randomized controlled trials (RCTs) that use grain moxibustion as the sole treatment for hemiplegia and their data extraction will be done by two researchers. Mean difference (MD) or relative risk (RR) with fixed or random effect model in terms of 95% confidence interval (CI) will be adopted for the data synthesis. To evaluate the risk of bias, the Cochrane's risk of bias assessment tool will be utilized. The sensitivity or subgroup analysis will also be conducted when meeting high heterogeneity (I
2 > 50%).

Results:

This meta-analysis will provide an authentic synthesis of the grain moxibustion's effect for hemiplegia.

Conclusion:

The findings of the review offer updated evidence and identify whether grain moxibustion can be an effective treatment for hemiplegia.

PROSPERO registration number:

PROSPERO CRD 42018117765
Challenges in management of unusual acquired factor V deficiency
Authors: Takemoto Kiyoshi , Hamada Osamu , Kitamura Koichi , Fujiwara Naoki , Miyakawa Yoshitaka
Published: April 2019

Rationale:

Acquired inhibitors of coagulation are antibodies that either inhibit the activity or increase the clearance of a clotting factor. Acquired factor V deficiency is a rare coagulation disorder, and it can sometimes be life threatening.

Patient concerns:

We describe a case of a 90-year-old Japanese male with acquired factor V deficiency. He was previously misdiagnosed with congenital factor V deficiency when he presented with hemoptysis and a negative factor V inhibitor test result at a different hospital 5 years earlier. Coagulopathy recurred with ecchymosis when he sustained a bruise after falling on a bush.

Diagnosis:

Although the factor V inhibitor test result was negative and a mixing study suggested a deficiency pattern, we diagnosed the patient with acquired factor V deficiency on the basis of no history of bleeding diathesis, a lack of response to multiple fresh frozen plasma transfusion, and clinical response to corticosteroid therapy.

Interventions:

Intravenous methylprednisolone was administered at 500 mg/day for 3 days, followed by oral prednisolone at 1 mg/kg/day.

Outcomes:

Coagulation test results improved and symptoms resolved 2 weeks after corticosteroid administration.

Lessons:

This case report suggests that clearance-facilitating antibodies exist without the presence of neutralizing inhibitors. When patients present with coagulation factor V deficiency in the absence of coagulation inhibitors, acquired factor V deficiency should also be considered.
Acute parkinsonism as an unexpected consequence of pituitary adenoma resection
Authors: Ho Pei-Lin , Chen Yin-Chun , Teng Chun-hsin , Wu Chiao-Chuan , Huang Poyin
Published: April 2019

Introduction:

Transsphenoidal resection of pituitary tumors is a surgery performed through the nose and sphenoid sinus to remove pituitary tumors. Disorders of sodium balance are common after transsphenoidal surgery involving the pituitary gland. Here, we report the clinical features of an original case of acute onset parkinsonism later confirmed to be secondary to transsphenoidal resection of pituitary adenoma.

Patient concerns:

A 36-year-old female had received transsphenoidal pituitary resection for pituitary adenoma. Eight days after the surgery, she suffered from acute onset general weakness and nausea/vomiting. She was diagnosed with hyponatremia for which she was treated. Acute onset ataxia, bilateral hand tremor, and dysarthria were then noted on the 4th day of hyponatremia treatment.

Diagnosis:

Based on history, clinical manifestation, and MRI brain images, a diagnosis of acute parkinsonism caused by isolated extrapontine myelinolysis (EPM) was made.

Interventions:

Patient was treated with levodopa/carbidopa.

Outcomes:

Patient's symptoms and signs improved gradually and 2 month follow-up MRI brain showed significant resolution of the bilateral lentiform nuclei hyperintensities on the T2-weighted images. Her neurological deficits had subsided completely.

Lessons:

This case highlights an unexpected association between transsphenoidal resection of pituitary tumors and acute parkinsonism which is a treatable manifestation of EPM. Correction of hyponatremia following transsphenoidal pituitary resections should be preceded cautiously because even gradual correction of hyponatremia can produce myelinolysis.
Middle cerebral artery stenosis is associated with the increased risk of intracerebral hemorrhage in Chinese
Authors: Shen Lin , Zhou Huchuan , Wei Fei , Shuai Jie
Published: April 2019

Intracerebral hemorrhage (ICH) is a major cause of morbidity and mortality throughout the world. It is reported that the incidence of deep ICH and intracranial artery stenosis (ICAS) are higher in Asian countries. Thus, there are concerns regarding a potential relationship between ICAS and ICH. This study was aimed to investigate this potential relationship between intracranial artery (middle cerebral artery, MCA) stenosis and ICH in the lateral lenticulostriate artery (LLA) territory in Chinese. Totally, 973 in-hospital subjects were retrospectively enrolled including subjects with the diagnosis of ICH, acute ischemic stroke (IS), and prior IS and subjects without cerebral diseases. These subjects were divided into four groups: ICH, acute IS, prior IS, and normal group (without cerebral diseases). Multiple logistic regression analysis showed that severe MCA stenosis was associated with the increased risk of ICH (OR = 5.070) and acute IS (OR = 5.406) in the LLA territory. The moderate MCA stenosis was associated with the increased risk of ICH (OR = 9.899) and was not associated with acute IS in the LLA territory. The increased perfusion pressure to the LLA may be the cause. In conclusion, MCA stenosis, especially moderate MCA stenosis, is associated with ICH in the LLA territory in Chinese.
Glomerulocystic kidney identified in older patients by magnetic resonance imaging
Authors: Amano Yasuo , Omori Yuko , Yanagisawa Fumi , Takagi Ryo
Published: April 2019

Glomerulocystic kidney (GCK) is often associated with genetic disorders and identified in children or adolescents. However, there are some case reports describing sporadic adult GCK identified by magnetic resonance imaging (MRI). The purpose of this study was to evaluate relationship of GCK identified by MRI in older patients to renal function and renal corticomedullary differentiation (CMD) assessed by MRI.

GCK was identified in 16 older patients (mean age, 79.2 years) by T2-weighted imaging. The cysts of GCK were numerous, homogeneously small, and located in the renal cortex on T2-weighted images. Ten of the 16 patients with GCK had renal impairment (estimated glomerular filtration rate <60 ml/min/1.73 m2). Six patients who had GCK, chronic liver disease, and renal impairment showed moderate or good CMD.

GCK identified by MRI may be related to renal impairment in some older patients, including those with preserved CMD as a result of chronic liver diseases.
Effectiveness comparisons of acupuncture for psoriasis
Authors: Xie Zhi-yin , Zhou Yu , Deng Sheng , Ding Wei , Duan Xing-wu , Yang Li-rong
Published: April 2019

Background:

Psoriasis is an immune-mediated polygenic hereditary skin disease quality of the patients’ life because of the great trouble it causes to patients. Whereas there is variability when we regard the selection of acupuncture treatments in practice and most choices are made based on personal experience or preference of clinician. This study uses network meta-analysis to compare the effectiveness of different forms of acupuncture for psoriasis and assesses the evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Methods:

We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to April 2019. The quality of the included RCTs will be evaluated by the risk of bias (ROB) tool and the evidence will be evaluated by GRADE. STATA 13.0 and WinBUGS 1.4.3 through the GeMTC package will be used to perform a network meta-analysis to synthesize direct and indirect evidence.

Results:

The results of this network meta-analysis (NMA) will be submitted to a peer-reviewed journal for publication.

Trial registration number:

PROSPERO CRD42019123437
Comprehensive Molecular Characterization of Adamantinoma and OFD-like Adamantinoma Bone Tumors
Authors: Ali Naser M. , Niada Stefania , Morris Mark R. , Brini Anna T. , Huen David , Sumathi Vaiyapuri , Latif Farida
Published: April 2019

Adamantinoma and osteofibrous dysplasia (OFD)-like adamantinoma are rare primary bone tumors that are predominantly confined to the tibia. These 2 entities show similarities in location, histology, and radiologic appearance; however, adamantinoma is malignant and therefore differentiating between these bone tumors is essential for optimal patient care. To elucidate their genomic and transcriptomic alteration profiles and expand their etiological mechanisms, whole exome sequencing (WES) and RNA sequencing (RNA-Seq) were conducted on adamantinoma and OFD-like adamantinoma tumors. Copy number variation analysis using WES data revealed distinct chromosomal alteration profiles for adamantinoma tumors compared with OFD-like adamantinomas, allowing molecular differentiation between the 2 tumor subtypes. Combining WES and copy number variation analyses, the chromatin remodelling-related gene KMT2D was recurrently altered in 3/8 adamantinoma tumors (38%), highlighting the potential involvement of deregulated chromatin structure and integrity in adamantinoma tumorigenesis. RNA-Seq analysis revealed a novel somatic gene fusion (EPHB4-MARCH10) in an adamantinoma, the gene fusion was fully characterized. Hierarchical clustering analysis of RNA-Seq data distinctly clustered adamantinoma tumors from OFD-like adamantinomas, allowing to molecularly distinguish between the 2 entities. David Gene Ontology analysis of differentially expressed genes identified distinct altered pathways in adamantinoma and OFD-like adamantinoma tumors, highlighting the different histopathologic characteristics of these bone tumor subtypes. Moreover, RNA-Seq expression profiling analysis identified elevated expression of DLK1 gene in adamantinomas, serving as a potential molecular biomarker. The present study revealed novel genetic and transcriptomic insights for adamantinoma and OFD-like adamantinoma tumors, allowing to differentiate genetically and transcriptomically between the 2 lesions and identifying a potential diagnostic marker for adamantinomas.
Third Trimester Vitamin D Status Is Associated With Birth Outcomes and Linear Growth of HIV-Exposed Uninfected Infants in the United States
Authors: Sudfeld Christopher R. , Jacobson Denise L. , Rueda Noé M. , Neri Daniela , Mendez Armando J. , Butler Laurie , Siminski Suzanne , Hendricks Kristy M. , Mellins Claude A. , Duggan Christopher P. , Miller Tracie L. ,   for the Pediatric HIV/AIDS Cohort Study
Published: April 2019

Background:

Vitamin D status in pregnancy may influence the risk of prematurity, birth size, and child postnatal growth, but few studies have examined the relationship among pregnant women living with HIV.

Methods:

We conducted a prospective cohort study of 257 HIV-infected mothers and their HIV-exposed uninfected infants who were enrolled in the 2009–2011 nutrition substudy of the Surveillance Monitoring for ART Toxicities (SMARTT) study. HIV-infected pregnant women had serum 25-hydroxyvitamin D (25(OH)D) assessed in the third trimester of pregnancy, and their infants' growth and neurodevelopment were evaluated at birth and approximately 1 year of age.

Results:

The mean third trimester serum 25(OH)D concentration was 35.4 ± 14.2 ng/mL with 15% of women classified as vitamin D deficient (<20 ng/mL) and 21% as insufficient (20–30 ng/mL). In multivariable models, third trimester vitamin D deficiency and insufficiency were associated with −273 g [95% confidence interval (CI): −450 to −97] and −203 g (95% CI: −370 to −35) lower birth weights compared with vitamin D sufficient women, respectively. Maternal vitamin D deficiency was also associated with shorter gestation (mean difference −0.65 weeks; 95% CI: −1.22 to −0.08) and lower infant length-for-age z-scores at 1 year of age (mean difference: −0.65; 95% CI: −1.18 to −0.13). We found no association of vitamin D status with infant neurodevelopment at 1 year of age.

Conclusion:

Third trimester maternal vitamin D deficiency was associated with lower birth weight, shorter length of gestation, and reduced infant linear growth. Studies and trials of vitamin D supplementation in pregnancy for women living with HIV are warranted.
Heating Injection Drug Preparation Equipment Used for Opioid Injection May Reduce HIV Transmission Associated With Sharing Equipment
Authors: Ball Laura J. , Venner Colin , Tirona Rommel G. , Arts Eric , Gupta Kaveri , Wiener Joshua C. , Koivu Sharon , Silverman Michael S.
Published: April 2019

Background:

London, Canada, experienced an HIV outbreak among persons who inject drugs despite widespread distribution of harm reduction equipment. Hydromorphone controlled-release (HMC) is the local opioid of choice. Injection drug preparation equipment (IDPE; ie, cookers and filters) is often shared and reused because of the perception that there is residual HMC in the IDPE after use. The purpose of this study was to investigate the mechanisms of HIV transmission in this context.

Methods:

Residual hydromorphone, (controlled-release or immediate-release), remaining in the IDPE, was measured with liquid chromatography–tandem mass spectrometry, in conditions replicating persons who inject drug use. HIV was added to IDPE in the presence HMC, hydromorphone immediate-release, or microcrystalline cellulose (an HMC drug excipient). HIV viral persistence was measured by reverse transcriptase activity and infectivity of indicator Tzm-bl cells.

Results:

Forty-five percent of HMC remained in the IDPE after the first aspiration of solution, with no change after heating. HIV persistence and infectivity were preserved in the presence of HMC, and less so with microcrystalline cellulose. Heating the IDPE rapidly inactivated HIV.

Conclusions:

Sharing of IDPE is a potential means of HIV transmission. HMC encourages IDPE sharing because of the residual drug in the IDPE, and the HMC excipients preserve HIV viability. Heating IDPE before aspiration of the opioid may be a harm reduction strategy.
Adipofascial Radial Forearm Free Flap for Anterior Skull Base Reconstruction in Complicated Forebrain Oncological Surgery
Authors: Pangrazi Pier Paolo , De Francesco Francesco , Di Rienzo Alessandro , Riccio Michele
Published: April 2019

Background:

Radical resections of ethmoidal tumors with intracranial extension present highly complex surgical and reconstructive problems. The purpose of report is to describe the authors’ use of adipofascial radial forearm free flaps following unsuccessful anterior cranial fossa oncological surgery.

Methods:

Adipofascial radial forearm free flaps were used to treat 3 similar cases of cutaneous fistula following bone resorption with communication to anterior cranial fossa and nasal cavity.

Results:

No flap loss, no deaths, and no postoperative complications were observed. All patients underwent a nasal endoscopy, revealing adequate vitality and integration of the free flaps. One of the patients consented to additional surgery to improve outcome.

Conclusions:

Meticulous preoperative selection and an experienced interdisciplinary team are required to achieve the best surgical outcomes in complex cases. Free adipofascial forearm flaps could be an excellent therapeutic option in the reconstruction of the anterior skull base, notably in cases involving major postoperative complications.