bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermal stability of winds driven by radiation pressure in super-Eddington accretion discs
Authors: Pinto C , Mehdipour M , Walton D J , Middleton M J , Roberts T P , Fabian A C , Guainazzi M , Soria R , Kosec P , Ness J-U
Published: December 2019

Ultraluminous X-ray sources (ULXs) are mainly powered by accretion in neutron stars or stellar-mass black holes. Accreting at rates exceeding the Eddington limit by factors of a few up to hundreds, radiation pressure is expected to inflate the accretion disc, and drive fast winds that have in fact been observed at significant fractions of the speed of light. Given the super-Eddington luminosity, the accretion disc will be thicker than in sub-Eddington accretors such as common active galactic nuclei and X-ray binaries, leading to a different spectral energy distribution and, possibly, a different thermal status of the wind. Here, we show the first attempt to calculate the photoionization balance of the winds driven by strong radiation pressure in thick discs with a focus on ULXs hosting black holes or non-magnetic neutron stars. We find that the winds are generally in thermally stable equilibrium, but long-term variations in the accretion rate and the inclination due to precession may have significant effects on the wind appearance and stability. Our model trends can explain the observed correlation between the spectral residuals around 1 keV and the ULX spectral state. We also find a possible correlation between the spectral hardness of the ULX, the wind velocity, and the ionization parameter in support of the general scenario.
Paralogization and New Protein Architectures in Planctomycetes Bacteria with Complex Cell Structures
Authors: Mahajan Mayank , Yee Benjamin , Hägglund Emil , Guy Lionel , Fuerst John A , Andersson Siv G E
Published: December 2019

Bacteria of the phylum Planctomycetes have a unique cell plan with an elaborate intracellular membrane system, thereby resembling eukaryotic cells. The origin and evolution of these remarkable features is debated. To study the evolutionary genomics of bacteria with complex cell architectures, we have resequenced the 9.2-Mb genome of the model organism Gemmata obscuriglobus and sequenced the 10-Mb genome of G. massiliana Soil9, the 7.9-Mb genome of CJuql4, and the 6.7-Mb genome of Tuwongella immobilis, all of which belong to the family Gemmataceae. A gene flux analysis of the Planctomycetes revealed a massive emergence of novel protein families at multiple nodes within the Gemmataceae. The expanded protein families have unique multidomain architectures composed of domains that are characteristic of prokaryotes, such as the sigma factor domain of extracytoplasmic sigma factors, and domains that have proliferated in eukaryotes, such as the WD40, leucine-rich repeat, tetratricopeptide repeat and Ser/Thr kinase domains. Proteins with identifiable domains in the Gemmataceae have longer lengths and linkers than proteins in most other bacteria, and the analyses suggest that these traits were ancestrally present in the Planctomycetales. A broad comparison of protein length distribution profiles revealed an overlap between the longest proteins in prokaryotes and the shortest proteins in eukaryotes. We conclude that the many similarities between proteins in the Planctomycetales and the eukaryotes are due to convergent evolution and that there is no strict boundary between prokaryotes and eukaryotes with regard to features such as gene paralogy, protein length, and protein domain composition patterns.
A green, efficient and precise hydrogen therapy of cancer based on in vivo electrochemistry
Authors: Qi Guohua , Wang Bo , Song Xiangfu , Li Haijuan , Jin Yongdong
Published: December 2019

By combined use of traditional Chinese acupuncture Fe needle electrode and in vivo electrochemistry, we achieved in vivo H2 generation in tumors in a controllable manner and exploited it for effective and green therapy of tumors for the first time. The cathodic acupuncture electrodes working under an applied voltage of ∼3 V (with minimal damage to the living body) undergo effective electrochemical reactions in the acidic tumor area that produce sufficient H2 locally to cause cancer cells to burst and die. Due to puncture positioning, the acidic tumor microenvironment and gas diffusion effect, the developed H2 generation electrochemotherapy (H2-ECT) strategy enables precise and large-scale tumor therapy, as demonstrated by in vivo treatment of diseased mice (glioma and breast cancers). Such green H2-ECT is simple, highly efficient and minimally invasive, requiring no expensive medical equipment or nano materials and medication, and is therefore very promising for potential clinical applications.
A Different Story in the Anthropocene: Brazil’s Post-Colonial Quest for Oil (1930–1975)*
Authors: Acker Antoine
Published: December 2019

This article aims to identify new historical causes for the making of the Anthropocene (the rise of humans to a geological force) by addressing Brazil’s transformation into an oil producer and an oil-dependent country between 1930 and 1975. This example allows an escape from the essentialist explanation of the Anthropocene as the result of humans’ insatiable appetite for consumption, commonly rooted in an analysis of Western industrial society, and to focus instead on the notion of freedom in a former colony. Indeed, in the context of nation-building and modernization debates, petroleum appeared to many Brazilians as an opportunity to emancipate the country from its peripheral role as global raw material provider. The rise of petroleum gave a post-colonial sense to the nation-founding myth of Brazil’s exceptional nature, which served as romantic background for a movement towards resource sovereignty embedded into a global anti-imperialist context. In Brazil specifically, oil production became an opportunity for a process of ecological transformation that promised to rid the country of colonial landscapes of exploitation, and even appeared as a solution for stopping the unsustainable destruction of tropical forests. Ultimately, these petro-ideals of emancipation, by positively linking nature and the nation, also hindered fully detecting the scope of the pollution problems that oil was generating. As argued in the article’s conclusion, this example should rekindle the discussion about the unintended link between freedom and geological change in the analysis of Anthropocene causalities.
A Positive Tropism of Rice Roots toward a Nutrient Source
Authors: Yamazaki Kiyoshi , Ohmori Yoshihiro , Fujiwara Toru
Published: December 2019

Plants take up water and nutrients through roots, and uptake efficiency depends on root behavior. Roots recognize the moisture gradient in the soil and grow toward the direction of high moisture. This phenomenon is called hydrotropism, and it contributes to efficient water uptake. As nutrients in soil are also unevenly distributed, it is beneficial for plants to grow their roots in the direction of increasing nutrient concentrations, but such a phenomenon has not been demonstrated. Here, we describe the directional growth of roots in response to a nutrient gradient. Using our assay system, the gradient of a nitrogen nutrient, NH4+, was sufficient to stimulate positive tropic responses of rice lateral roots. This phenomenon is a tropism of plant roots to nutrients; hence, we propose the name ‘nutritropism’. As well as other tropisms, differential cell elongation was observed before the elongation zone during nutritropism, but the pattern promoting cell elongation preferentially on the non-stimulated side was opposite to those in root hydrotropism and gravitropism. Our evaluation of the NH4+ gradient suggested that the root tips responded to a sub-micromolar difference in NH4+ concentration on both sides of the root. Hydrotropism, gravitropism and phototropism were described in plants as the ‘power of movement’ by Charles and Francis Darwin in 1880, and these three tropisms have attracted the attention of plant scientists for more than 130 years. Our discovery of nutritropism represents the fourth ‘power of movement’ in plants and provides a novel root behavioral property used by plants to acquire nutrients efficiently.
GH3 Auxin-Amido Synthetases Alter the Ratio of Indole-3-Acetic Acid and Phenylacetic Acid in Arabidopsis
Authors: Aoi Yuki , Tanaka Keita , Cook Sam David , Hayashi Ken-Ichiro , Kasahara Hiroyuki
Published: December 2019

Auxin is the first discovered plant hormone and is essential for many aspects of plant growth and development. Indole-3-acetic acid (IAA) is the main auxin and plays pivotal roles in intercellular communication through polar auxin transport. Phenylacetic acid (PAA) is another natural auxin that does not show polar movement. Although a wide range of species have been shown to produce PAA, its biosynthesis, inactivation and physiological significance in plants are largely unknown. In this study, we demonstrate that overexpression of the CYP79A2 gene, which is involved in benzylglucosinolate synthesis, remarkably increased the levels of PAA and enhanced lateral root formation in Arabidopsis. This coincided with a significant reduction in the levels of IAA. The results from auxin metabolite quantification suggest that the PAA-dependent induction of GRETCHEN HAGEN 3 (GH3) genes, which encode auxin-amido synthetases, promote the inactivation of IAA. Similarly, an increase in IAA synthesis, via the indole-3-acetaldoxime pathway, significantly reduced the levels of PAA. The same adjustment of IAA and PAA levels was also observed by applying each auxin to wild-type plants. These results show that GH3 auxin-amido synthetases can alter the ratio of IAA and PAA in plant growth and development.
Comparative Genomics to Develop a Specific Multiplex PCR Assay for Detection of Clavibacter michiganensis
Authors: Thapa Shree P. , O’Leary Michael , Jacques Marie-Agnès , Gilbertson Robert L. , Coaker Gitta
Published: December 2019

Clavibacter michiganensis is a Gram-positive bacterial pathogen that proliferates in the xylem vessels of tomato, causing bacterial wilt and canker symptoms. Accurate detection is a crucial step in confirming outbreaks of bacterial canker and developing management strategies. A major problem with existing detection methods are false-positive and -negative results. Here, we report the use of comparative genomics of 37 diverse Clavibacter strains, including 21 strains sequenced in this study, to identify specific sequences that are C. michiganensis detection targets. Genome-wide phylogenic analyses revealed additional diversity within the genus Clavibacter. Pathogenic C. michiganensis strains varied in plasmid composition, highlighting the need for detection methods based on chromosomal targets. We utilized sequences of C. michiganensis-specific loci to develop a multiplex PCR-based diagnostic platform using two C. michiganensis chromosomal genes (rhuM and tomA) and an internal control amplifying both bacterial and plant DNA (16s ribosomal RNA). The multiplex PCR assay specifically detected C. michiganensis strains from a panel of 110 additional bacteria, including other Clavibacter spp. and bacterial pathogens of tomato. The assay was adapted to detect the presence of C. michiganensis in seed and tomato plant materials with high sensitivity and specificity. In conclusion, the described method represents a robust, specific tool for detection of C. michiganensis in tomato seed and infected plants.
Functional characterization of 3D contractile smooth muscle tissues generated using a unique microfluidic 3D bioprinting technology
Authors: Dickman Christopher T. D. , Russo Valerio , Thain Katherine , Pan Sheng , Beyer Simon T. , Walus Konrad , Getsios Spiro , Mohamed Tamer , Wadsworth Sam J.
Published: December 2019

Conditions such as asthma and inflammatory bowel disease are characterized by aberrant smooth muscle contraction. It has proven difficult to develop human cell‐based models that mimic acute muscle contraction in 2D in vitro cultures due to the nonphysiological chemical and mechanical properties of lab plastics that do not allow for muscle cell contraction. To enhance the relevance of in vitro models for human disease, we describe how functional 3D smooth muscle tissue that exhibits physiological and pharmacologically relevant acute contraction and relaxation responses can be reproducibly fabricated using a unique microfluidic 3D bioprinting technology. Primary human airway and intestinal smooth muscle cells were printed into rings of muscle tissue at high density and viability. Printed tissues contracted to physiological concentrations of histamine (0.01‐100 μM) and relaxed to salbutamol, a pharmacological compound used to relieve asthmatic exacerbations. The addition of TGFβ to airway muscle rings induced an increase in unstimulated muscle shortening and a decreased response to salbutamol, a phenomenon which also occurs in chronic lung diseases. Results indicate that the 3D bioprinted smooth muscle is a physiologically relevant in vitro model that can be utilized to study disease pathways and the effects of novel therapeutics on acute contraction and chronic tissue stenosis.
Tuberculosis facts
Authors: Perkins Amanda
Published: December 2019

This airborne infectious disease is believed to be more than 3 million years old. Here's what you need to know.
Not Really “The Same Thing”
Authors: Schonwald Alison , Chan Eugenia , Nyp Sarah S.
Published: December 2019

CASE:

Susie is a 10-year-old girl who is followed by a developmental-behavioral pediatrician for attention-deficit/hyperactivity disorder (ADHD), combined type and challenging behaviors. Susie has been treated with extended-release methylphenidate HCl 36 mg daily and extended-release guanfacine 1 mg daily for the past year. Susie attended an evidence-based summer treatment program for ADHD for 8 weeks over the summer, and the family has continued to attend monthly behavioral therapy visits with a local child psychologist.

Parents report that, until recently, Susie's symptoms of ADHD were well controlled. Susie had a positive start to the school year but has had increasing difficulties over the past month. Specifically, Susie's classroom teacher has communicated that she is having difficulty maintaining attention, is easily distracted, and is missing several homework assignments. While obtaining a careful interim history, Susie's parents report that there have not been any changes or new stresses in the home or school environments. They were pleased with the behavioral guidance provided during the summer treatment program and have continued to use those strategies.

Further discussion revealed that parents noticed a change in the appearance of Susie's methylphenidate tablets when the prescription was last filled. Although the previous prescriptions were filled with oblong, white tablets, the most recent prescription was filled with round, white tablets. Susie's parents contacted the pharmacy and were told that Susie's prescription was filled with “the same thing as before.” The pharmacist explained that the tablets looked different because the manufacturer had changed in order to comply with the preferences of Susie's insurance provider. What would be your next steps in Susie's care?
Reducing Wound Hemorrhage: Use of Bilayer Collagen Matrix in Chronic Myelogenous Leukemia
Authors: Lo Alexis L. , Tyrell Richard O. , Golarz Scott R. , Jones Christine M.
Published: December 2019

Summary: Donor site preparation is a critical step before the application of an autologous split-thickness skin graft (STSG). Comorbidities can lead to complications and graft loss, including that due to hematoma. In this case, a bilayer collagen matrix was used as a temporary wound dressing in a 25-year-old woman with active chronic myelogenous leukemia. She presented with a bleeding diathesis and spontaneous intramuscular and intracompartmental hematomas of the right leg. She experienced ongoing high-volume blood loss from her fasciotomy wounds, requiring wound care to be performed in the operating room under general anesthesia, and requiring multiple blood and platelet transfusions. Instead of immediate STSG, a bilayer collagen matrix was placed to reduce the bleeding and further prepare the wound bed over a 9-week period while she underwent medical optimization. Once stabilized from a hematologic standpoint, STSG was performed with total graft take. Both uncontrolled chronic myelogenous leukemia and its therapy, tyrosine kinase inhibitors, have a risk of hemorrhagic and thrombotic complications. Bilayer collagen matrix serves as an adjunct in the limb salvage algorithm that can reduce transfusion needs whereas a temporary bleeding diathesis is medically corrected before the application of an autologous skin graft.
Role of Peer Learning in Students’ Skill Acquisition and Interest in Plastic Surgery
Authors: ElHawary Hassan , Salimi Ali , Abdelhamid Kenzy , Sarfaraz Ziyab , Gilardino Mirko S.
Published: December 2019

Background:

Although the number of plastic surgery residency positions increased over the past decade, interest among Canadian medical students experienced the opposite trajectory. The aim of this study was to assess the effect of a low intensity, basic surgical skills workshop on medical students’ confidence and interest in surgery in general, and plastic surgery in particular.

Methods:

Before and after participating in a 60-minute suturing workshop, preclinical medical students completed a cloud-based questionnaire that evaluated the changes in their suturing confidence and interest in pursuing a career in different surgical subspecialties.

Results:

Eighty-five medical students (52 females and 33 males), with an average age of 22.9 ± 3.6 years participated in this study. Before the workshop, 95% of participants perceived their suturing ability to be at a beginner’s level and reported that they have not received sufficient suturing training during their medical education to date. Their self-reported confidence in suturing was 1.9 ± 2.1 out of 10. Following the workshop, participants’ confidence in their surgical skills increased by 165% (P < 0.001, partial eta2 = 0.695). Moreover, 82% reported increased interest in a career in surgery associated with their participation in the workshop. Plastic surgery, general surgery, and otolaryngology were the top 3 specialties that experienced an augmented increase in interest following the workshop. Finally, plastic surgery was the specialty perceived as requiring the most surgical skills by the majority of the students.

Conclusion:

A 60-minute basic skills suturing workshop significantly improved preclinical medical students’ confidence in their surgical skills, and increased their interest in surgery.
RELATIVE QUIESCENCE OF EXUDATIVE AGE-RELATED MACULAR DEGENERATION AFTER RESOLUTION OF POSTINJECTION ENDOPHTHALMITIS
Authors: Arnett Justin J. , Brodowska Katarzyna , Gallagher Denise S. , Eller Andrew W. , Friberg Thomas R. , Anetakis Alexander J. , Martel Joseph N.
Published: December 2019

Purpose:

To evaluate alterations in treatment burden and course of exudative age-related macular degeneration in patients who contracted endophthalmitis from intravitreal anti–vascular endothelial growth factor (anti-VEGF) injections.

Methods:

Retrospective study at the University of Pittsburgh Medical Center examining frequency of anti-VEGF injections, activity of choroidal neovascularization, and visual acuity before and after endophthalmitis treatment.

Results:

Twenty-one patients meeting inclusion criteria were identified, of whom 7 (33%) patients did not restart anti-VEGF treatment 12 months after endophthalmitis because of quiescence of exudative age-related macular degeneration without significant visual acuity loss (P > 0.05). Patients who resumed anti-VEGF treatment exhibited 32% and 38% decreases in injection frequency by 12 and 24 months after endophthalmitis, respectively (P < 0.05). On first optical coherence tomography follow-up, 10 patients exhibited quiescence of choroidal neovascularization activity, although there were no measurable changes in macular thickness (P > 0.05). No differences in post-endophthalmitis exudative age-related macular degeneration progression or treatment burden were observed when factoring adjuvant intravitreal steroid therapy, culture results, nor choroidal neovascularization subtypes.

Conclusion:

Endophthalmitis resolution is associated with a decrease in choroidal neovascularization activity and a reduction of anti-VEGF treatment burden in patients with exudative age-related macular degeneration.
PRESENCE OF PERIPHERAL LESIONS AND CORRELATION TO MACULAR PERFUSION, OXYGENATION AND NEURODEGENERATION IN EARLY TYPE II DIABETIC RETINAL DISEASE
Authors: Hafner Julia , Pollreisz Andreas , Egner Berit , Pablik Eleonore , Schmidt-Erfurth Ursula
Published: December 2019

Purpose:

The impact of peripheral retinal lesions (PL) visualized with ultra–wide-field imaging on diabetic retinopathy (DR) remains unclear. The purpose of this study was to assess the presence of PL and their association with macular microvasculopathy, metabolic dysfunction, and neurodegeneration in patients with Type II diabetes and early retinal disease.

Methods:

Forty-five degree color fundus (Topcon) and 200° ultra–wide-field images (Optos) were assessed for the presence and severity of DR. Lesions anterior to the 45° were considered peripheral. The foveal avascular zone area, perimeter and acircularity index, and foveal full-retina and parafoveal superficial/deep complex vessel density were evaluated with RTVue optical coherence tomography angiography. Vessel oxygen saturation was measured with oximetry. Peripapillary retinal nerve fiber and individual macular retinal layer thicknesses were measured with Spectralis optical coherence tomography.

Results:

Among the 161 eyes (80 left eyes) of 81 patients (34 female), 64 (39.8%) showed higher levels of DR on ultra–wide-field than on 45° fundus images (P < 0.0001). PL were identified in 97 eyes (60.3%) and in 59 among 115 eyes without central signs of DR. No significant correlation to biomarkers of central microvascular disease (foveal avascular zone/vessel density variables), oxygen saturation, and retinal layer thickness was found.

Conclusion:

Ultra–wide-field imaging helps to detect more eyes with early DR due to the detection of PL, which appear independently of biomarkers of macular microvascular impairment, metabolic function, and neuropathy in eyes without central signs of DR. These results suggest that the evaluation of the retinal periphery may become crucial in DR screening if PL are proven to influence disease outcomes.
IPSILATERAL BULLOUS EXUDATIVE RETINAL DETACHMENT ASSOCIATED WITH EXTRACORPOREAL MEMBRANE OXYGENATION
Authors: Abdelhakim Aliaa H. , Sebrow Dov , Bearelly Srilaxmi , Horowitz Jason D. , Chen Royce W. S.
Published: December 2019

Purpose:

To describe the first known case of an extracorporeal membrane oxygenation (ECMO)–related complication in an adult.

Methods:

Case report.

Results:

A 34-year-old man awaiting a lung transplant for interstitial lung disease was connected to an ECMO circuit as a bridge to lung transplant, with a drainage catheter attached to his right internal jugular vein. Shortly after he was cannulated, he developed blurred vision in his right eye and was found to have a progressively worsening bullous exudative retinal detachment. After receiving a lung transplant and getting decannulated from ECMO, his bullous detachment rapidly improved. The patient's clinical course as well as his ophthalmic testing showed findings inconsistent with alternative diagnoses such as central serous chorioretinopathy. His findings were best explained as a complication of ECMO cannulation.

Conclusion:

Extracorporeal membrane oxygenation may be associated with bullous exudative retinal detachment in rare cases where there is a possible anatomical or physiological predisposition.
RETINAL NEURONAL ECTOPIA: A NEW ENTITY IN THE DIFFERENTIAL DIAGNOSIS OF RETINOBLASTOMA
Authors: Tsimpida Maria , Dharmaraj Sharola , Luthert Philip J. , Reddy Maddy A. , Sagoo Mandeep S.
Published: December 2019

Background:

To present a rare retinal disorder that should be considered in the differential diagnosis of retinoblastoma.

Methods:

A 2-year-old boy presented with left ocular discomfort, leukocoria, and a left divergent squint. Examination of the left eye revealed abnormalities in the anterior segment, and fundoscopy showed an irregular white calcified mass with fibrosis and traction toward the lens. As the ocular discomfort worsened, enucleation of the left eye was performed.

Results:

Histopathological and immunohistochemical assessment of the enucleated eye established the diagnosis of retinal neuronal ectopia.

Conclusion:

We believe that this case is unique in the human retina and highlights the need for specialist differential diagnosis. Although rare, retinal neuronal ectopia should be considered in the differential diagnosis of retinoblastoma.
PNEUMATIC WITHOUT PEXY: A CASE REPORT OF A RETINAL DETACHMENT REPAIR
Authors: Tanaka Adam C. , Goldberg Roger A.
Published: December 2019

Purpose:

To present a case of pneumatic retinal detachment repair that did not require retinal pexy.

Methods:

Report of a case and review of the literature.

Results:

Pneumatic retinopexy was performed with a plan for photocoagulation of the retinal tear once the retina was reattached. During postoperative evaluation, the superotemporal retinal tear had operculated and the retina was reattached. No laser or cryopexy was performed, and the retina remained attached during long-term follow-up.

Discussion:

Addressing traction on the retina and intraocular microcurrents that allow subretinal fluid accumulation is the core principle of detachment repair; if the traction is released, pexy may not be necessary.
Clinic-Based Community Health Worker Integration
Authors: Lee Lily , Lewis Charlotte M. , Montgomery Susanne
Published: December 2019

Clinic-based community health workers (cCHWs) are a growing workforce who can facilitate medical and social support services, particularly for patients with complex, chronic conditions. We assessed CHWs', employers', and patients' perceptions and readiness for CHW integration into clinical settings. We found varying levels of readiness between the groups, offset by conditional implementation concerns, such as need for clearer training, role delineation, expectations, and trust. Integrating CHWs as members of the complex care team holds promise for optimal patient engagement. Maximizing CHWs' potentials through readiness efforts can further support the triple/quadruple aims and goals for the Health Home Program.
Exosomal miR-451 from human umbilical cord mesenchymal stem cells attenuates burn-induced acute lung injury
Authors: Liu Ji-Song , Du Juan , Cheng Xiu , Zhang Xiang-Zhou , Li Yong , Chen Xu-Lin
Published: December 2019

Background:

The aim of this study was to investigate the molecular mechanism of human umbilical cord mesenchymal stem cells (MSCs)-derived exosomes (hUCMSC-Exos) in regulating burn-induced acute lung injury (ALI).

Methods:

In this study, we initially isolated exosomes from hUCMSCs and identified them by transmission electron microscopy. The expression of the protein markers CD9 and CD63 in the exosomes was determined by western blot analysis. The expression of miR-451 in the hUCMSC-Exos was determined by qRT-PCR. The levels of TNF-α, IL-1β, and IL-6 in lung tissues and serum as well as the levels of malondialdehyde, myeloperoxidase, superoxide dismutase in lung tissues were detected by ELISA. Hematoxylin–eosin stain was used to observe the morphological changes of lung tissues after burn. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assays were performed to detect apoptosis in lung tissues after burn. The expression of proteins related to the Toll-like receptor 4 (TLR4)/NF-κB signaling pathway in lung tissues after burn was analyzed by western blotting.

Results:

Our results showed that hUCMSC-Exos successfully decreased TNF-α, IL-1β, and IL-6 levels in rats after burn, and this reduction was reversed when the miR-451 expression in the hUCMSC-Exo group was inhibited. HUCMSC-Exo-derived miR-451 improves ALI via the TLR4/NF-κB pathway.

Conclusion:

We demonstrated that exosomes derived from hUCMSCs mediate miR-451 to attenuate burn-induced ALI.
Perioperative Homeopathic Arnica and Bromelain
Authors: Knackstedt Rebecca , Gatherwright James
Published: December 2019

Introduction

Arnica and bromelain, two of the most widely recommended homeopathic medications to improve perioperative outcomes, have yet to be widely adopted by allopathic practitioners. A significant barrier to utilization of herbal medications by allopathic doctors is that the preparations and dosing regimens are not widely known or understood. The goal of this review was to critically analyze studies that have examined the perioperative efficacy of arnica and bromelain with a focus on treatment regimen and outcomes.

Methods

A triple database search was conducted with the keywords “arnica,” “bromelain,” and “surgery.” References for each identified article were analyzed for additional articles. Articles were analyzed for methodology, outcomes, and conclusion. Articles were excluded if they did not involve human subjects, were published before 1990, and if they were not available in English. Level of evidence was determined based on methodology.

Results

A total of 29 articles met inclusion criteria, with 20 and 9 in the arnica and bromelain treatment groups, respectively. There was marked heterogeneity with regard to surgical procedure, dosing regimen, outcomes measured, and results. Arnica seems to have a mitigating effect on ecchymosis, most notably following rhinoplasty and facelifts/facial procedures. Bromelain is well supported across numerous studies in reducing trismus, pain, and swelling following molar extractions. However, there was no effect demonstrated when evaluating topical arnica following blepharoplasty procedures.

Discussion

A systematic review of the literature demonstrates the potential for arnica and bromelain to improve perioperative outcomes including edema, ecchymosis, and pain control. Future studies are required to determine safety and efficacy of dosing and interactions with other medications. We hope this article stimulates surgeons to consider using these interventions to improve perioperative outcomes in the context of well-done studies with an objective analysis of results.
An Analysis of Specialty-Specific Microsurgical Head and Neck Reconstruction
Authors: Kozak Geoffrey M. , Katzel Evan B. , Rose Jessica F. , Nathan Shelby L. , Wu Liza C.
Published: December 2019

Introduction

Head and neck free flap (HNFF) reconstructions have historically utilized a multidisciplinary approach between otolaryngology head and neck surgery (OHNS) and plastic surgery (PS). However, there seems to be a trend toward both the extirpative and reconstructive portions being performed by OHNS. We aimed to elucidate the volume trend in HNFF reconstruction over the last decade.

Methods

Data were collected by 3 modalities: electronic medical record search of patients who underwent HNFF surgery at our institution (2013–2018), survey data from microsurgery fellowship programs (2007–2017), and National Surgical Quality Improvement Program (NSQIP) query of cases receiving designated HNFF Current Procedural Terminology codes (2011–2016). Data were analyzed with trends in HNFF reconstruction as our primary outcome.

Results

At our institution, HNFF reconstructions increased 4-fold (59–227). Percentage of cases by PS decreased from 18.6% to 6.0%, whereas that of OHNS increased 81.4% to 94.0% (P = 0.009). Survey data, completed by microsurgery fellowship program directors (23/81 [27.2%]), revealed the number of OHNS programs in 2007 performing 100 or more HNFF cases compared with PS was 40% (6/15) to 12.5% (1/8) (P = 0.172). By 2016, that number increased significantly for OHNS to 73.3% (11/15), whereas that of PS remained stagnant at 12.5% (1/8) (P = 0.005). According to NSQIP data, the percentage of cases performed by PS in 2011 was 52%, which was greater than OHNS's share of 43%. The other 5% was allotted to either orthopedic, oral and maxillofacial surgery, or general surgery. In 2013, those numbers reached a peak for PS at 55% and a nadir for OHNS at 36%. However, by 2016, the percentage of HNFF cases reversed. where 58% of cases were performed by OHNS and only 38% by PS. When comparing the 2011 data to the 2016 data, OHNS had a 134% increase, whereas PS had a 27% decrease (P = 0.003).

Conclusions

Head and neck free flap reconstruction has grown dramatically over the last 10 years. Plastic surgeons are performing fewer cases, whereas otolaryngology head and neck surgeons perform more as indicated by institutional, microsurgery fellowship program director survey, and NSQIP data.
Free Serratus Fascia Flap for Reconstruction of Soft Tissue Defects Involving the Distal Upper and Lower Extremity
Authors: Tuncer Serhan , Sezgin Billur , Sencan Ayse , Sari Alper
Published: December 2019

Background

Free fascial flaps are widely used for the reconstruction of defects located on the distal extremities as they provide thin yet durable soft tissue coverage. The serratus anterior fascia flap stands out from other fascial flap alternatives as it has optimal anatomical properties that can provide ideal coverage in a wide range of reconstructive challenges. The purpose of this study was to present our experience with the serratus anterior fascia flap in a variety of complex soft tissue defects.

Methods

A retrospective review was conducted on patients who underwent reconstruction with the free serratus anterior fascia flap for complex soft tissue defects involving the distal extremities.

Results

Complex soft tissue defects of 13 patients were reconstructed using the free serratus fascia flap. No major postoperative complications such as flap loss, dehiscence, infection, or hematoma were encountered in any of the patients. All of the patients demonstrated durable and harmonious long-term flap coverage that facilitated movement without any signs of scar contractures and tendon adhesions at the site of reconstruction.

Conclusions

The serratus anterior fascia flap demonstrates versatility and stability for the closure of complex distal extremity defects. It creates thin yet durable coverage that facilitates underlying tendon gliding while providing harmony with the natural contours of these anatomic areas and has low donor site morbidity, making it a primary choice in the reconstruction complex soft tissue defects involving the hands and feet.
Rupture Rates Between 2-Strand and 4-Strand Flexor Tendon Repairs
Authors: Shaharan Shazrinizam , Bage Timothy , Ibrahim Nada , Diamantopoulos Antonios , Doswell Kirsty , Dheansa Baljit
Published: December 2019

The purpose of this study was to explore the difference in clinical outcome of 2-strand and 4-strand flexor tendon repairs in a single unit in adult population. A total of 109 complete divisions of a single flexor tendon were analyzed from 2016 to 2018 retrospectively. Thirty flexor tendons were repaired with 2-strand and 79 tendons were repaired with 4-strand technique. There was no significant difference in the complication rate including rupture, infection, and adhesions. These results support that 4-strand is not superior than 2-strand and that lower volume type of repair would be preferable.
A Study on Breast Reconstruction in a Developing Country
Authors: Kaviani Ahmad , Tabary Mohammadreza , Zand Sanaz , Araghi Farnaz , Nouraie Mehdi
Published: December 2019

Background

Breast cancer, with an incidence of 33.2 per 100,000 in Iranian population, is considered as the most common cancer in Iranian women. Nowadays, with the increasing survival rates, breast reconstruction has been integrated into surgical techniques of breast cancer treatment. The aim of this study was to evaluate the current status of breast reconstruction in Iranian population.

Patients and Methods

This retrospective study was conducted in Imam Hospital between January 2008 and June 2018. All the patients underwent breast reconstruction surgery. The trend of reconstruction and complication rates were 2 major outcomes. Logistic regression model was used to predict complications. Student t test was used to compare means.

Results

Fifty-five patients underwent 60 autologous breast reconstruction surgeries and 152 patients underwent 193 prosthesis-based reconstruction surgeries. Most of cases were invasive ductal carcinoma ± ductal carcinoma in situ (126 cases, 68%). Among 253 surgeries in 207 patients, 98 cases (38.7%) were 2-stage implant, 91 (36.0%) were 1-stage implant, 3 (1.2%) were acellular dermal matrix + prosthesis, 31 (12.2%) were pedicled transverse rectus abdominis myocutaneous flap, 25 (9.8%) were latissimus dorsi flap ± prosthesis, and 4 (15.8%) were latissimus dorsi flap. Among prosthesis-based reconstructions, chemotherapy could predict the occurrence of complications (odds ratio, 2.87; 95% CI, 1.07–7.68), whereas none of these factors could predict the occurrence of complications in autologous reconstructions. The most prevalent complication was seroma formation (48.5% of all complications). Overall complication rates (including major and minor) were higher among autologous reconstructions compared with prosthesis-based reconstructions (45.8% and 21.1%, respectively, P < 0.001).

Conclusions

The trend of breast reconstruction is changing in Islamic Republic of Iran as a developing country. Implant-based reconstruction has surpassed autologous reconstructions in recent years. In terms of complications, we observed higher rates among autologous reconstructions.
Complications After Immediate 2-Stage Tissue Expander/Implant Breast Reconstruction
Authors: Park Jin-Woo , Jung Jae Hoon , Jeon Byung-Joon , Mun Goo-Hyun , Bang Sa Ik , Pyon Jai-Kyong
Published: December 2019

Background

Complications after 2-stage tissue expander/implant breast reconstruction have been studied as outcomes of a single procedure. We separately evaluated complications after the second stage and assessed factors associated with the outcomes of the second stage of breast reconstruction.

Methods

Patients who underwent immediate 2-stage breast reconstruction between February 2010 and April 2017 were retrospectively reviewed. Patient demographics, surgical factors of the first stage of breast reconstruction, and complications and number of revision surgeries after the second stage were recorded. Factors associated with postoperative complications were analyzed, and a risk-scoring system was devised.

Results

We analyzed 619 patients who underwent 653 immediate 2-stage breast reconstructions. Multivariate analysis showed that complications were associated independently with smoking history, radiotherapy, and a final inflation volume of 450 mL or greater. Each factor contributed 1 point in the creation of a risk-scoring system. The overall complication rate was increased as the risk score increased (1.2%, 4.7%, and 16.0% for 0, 1, and 2 risk scores, respectively, P < 0.001). Revision operation rate was also significantly different across the 3 groups (0.2%, 1.6%, and 12.0% for 0, 1, and 2 risk scores, respectively, P < 0.001). The area under the receiver operating characteristic curve was 0.732 and 0.731 for the logistic regression model and risk-scoring system, respectively (P = 0.975).

Conclusions

In the second stage of immediate 2-stage tissue expander/implant breast reconstruction, the rate of complication and revision surgery can be predicted by a novel risk-scoring system. Greater attention and preventive measures for complications are needed for high-risk patients.
Primary Open Versus Closed Implantation Strategy for Totally Implantable Venous Access Ports
Authors: Hüttner Felix J. , Bruckner Tom , Hackbusch Matthes , Weitz Jürgen , Bork Ulrich , Kotschenreuther Peter , Heupel Oliver , Kümmel Sabine , Schlitt Hans J. , Mattulat Matthias , Pintér László , Seiler Christoph M. , Gutt Carsten N. , Nottberg Hubertus S. , Pohl Alexander , Ghanem Firas , Meyer Thomas , Imdahl Andreas , Neudecker Jens , Müller Verena A. , Gehrig Tobias , Reineke Mario , von Frankenberg Moritz , Schumacher Guido , Hennes Roland , Mihaljevic André L. , Rossion Inga , Klose Christina , Kieser Meinhard , Büchler Markus W. , Diener Markus K. , Knebel Phillip
Published: December 2019

Objectives:

PORTAS-3 was designed to compare the frequency of pneumothorax or haemothorax in a primary open versus closed strategy for port implantation.

Background Data:

The implantation strategy for totally implantable venous access ports with the optimal benefit/risk ratio remains unclear.

Methods:

PORTAS-3 was a multicentre, randomized, controlled, parallel-group superiority trial. Adult patients with oncological disease scheduled for elective port implantation were randomized to a primary open or closed strategy. Primary endpoint was the rate of pneumothorax or haemothorax. Assuming a difference of 2.5% between the 2 groups, a sample size of 1154 patients was needed to prove superiority of the open group. A logistic regression model after the intention-to-treat principle was applied for analysis of the primary endpoint.

Results:

Between November 9, 2014 and September 5, 2016, 1205 patients were randomized. Of these, 1159 (open n = 583; closed n = 576) were finally analyzed. The rate of pneumothorax or haemothorax was significantly reduced with the open strategy [odds ratio 0.27, 95% confidence interval (CI) 0.09–0.88; P = 0.029]. Operation time was shorter for the closed strategy. Primary success rates, tolerability, morbidity, dose rate of radiation, and 30-day mortality did not differ significantly between the groups.

Conclusion:

A primary open strategy by cut-down of the cephalic vein, if necessary enhanced by a modified Seldinger technique, reduces the frequency of pneumothorax or haemothorax after central venous port implantation significantly compared with a closed strategy by primary puncture of the subclavian vein without routine sonographic guidance. Therefore, open surgical cut-down should be the reference standard for port implantation in comparable cohorts.

Trial Registration:

German Clinical Trials Register DRKS 00004900.
Inflammation and Cognitive Function in Overweight and Obese Chinese Individuals
Authors: Fan Rong , Zhao Lei , Tong Chao , Qian Xiao-meng , Xiao Rong , Ma Wei-wei
Published: December 2019

Background:

The role(s) of inflammation in obesity-associated cognitive decline in overweight or obese populations is not completely understood.

Objective:

To investigate the profile of plasma inflammatory cytokines in overweight and obese Chinese individuals and to assess the relationship between inflammation and cognitive function.

Methods:

We evaluated the cognitive domains of 282 Chinese adults, aged 35 to 64 years, using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The participants were classified into three groups according to their body mass index. Inflammatory cytokines were determined by immune turbidimetric analysis and enzyme-linked immunosorbent assay. Data were analyzed using covariance and partial correlation analyses after adjusting for gender, age, education level, hypertension, and hyperlipemia.

Results:

The total MoCA scores of the overweight and obese groups were significantly lower than that of the control group. The obese group displayed a significantly higher level of tumor necrosis factor-α than the overweight and control groups and a significantly higher level of transforming growth factor-β than the control group. The overweight group displayed a significantly higher interleukin-4 level than the control and obese groups. After adjusting for confounding factors, however, we found no significant correlation between the level of plasma inflammatory cytokines and MMSE or MoCA total score.

Conclusions:

Compared to normal-weight Chinese participants, overweight and obese Chinese participants revealed significant differences in their inflammatory cytokines profile; however, the inflammatory cytokine levels did not correlate with the significantly lower cognitive scores observed in the overweight and obese groups.
Emotion Recognition in Patients With Parkinson Disease
Authors: Wu Dong-Dong , Li Shu-Hua , He Jing , Su Wen , Chen Hai-Bo
Published: December 2019

Background:

Individuals with Parkinson disease (PD) display cognitive dysfunction. However, few studies have investigated how facial and musical emotion recognition are affected in individuals with PD.

Objective:

To explore the relationship between facial and musical emotion recognition and executive functions in Chinese individuals with PD.

Methods:

We showed 40 Chinese individuals with PD and 40 Chinese healthy controls 24 black-and-white portraits and 24 musical excerpts that were designed to express happiness, sadness, fear, and anger. Then, we used four tests to assess the participants’ executive functions, including the Trail Making Test (TMT), Clock Drawing Test (CDT), semantic Verbal Fluency Test (VFT), and Digit Span Test (DST).

Results:

The PD group showed significant impairment in recognizing anger from facial expressions, although their emotion recognition from musical excerpts was similar to that of the control group. Recognition of an angry face was significantly correlated to scores on the TMT and DST. Recognition of happy music was significantly correlated to the Hamilton Rating Scale for Depression score, whereas recognition of angry music was significantly correlated to musical knowledge background. Recognition of happy, sad, or angry music was significantly correlated to tests of executive function, whereas recognition of fearful music was not.

Conclusions:

The PD group showed impaired recognition of angry faces, which may be related to executive dysfunction. However, the PD group did not show any difficulties in recognizing emotions in music. This dissociation indicates that the mechanisms underlying the recognition of emotions in faces and music are partly independent.
Efficiency of RNA interference is improved by knockdown of dsRNA nucleases in tephritid fruit flies
Authors: Tayler Alison , Heschuk Daniel , Giesbrecht David , Park Jae Yeon , Whyard Steve
Published: December 2019

RNA interference (RNAi) in insects is routinely used to ascertain gene function, but also has potential as a technology to control pest species. For some insects, such as beetles, ingestion of small quantities of double-stranded RNA (dsRNA) is able to knock down a targeted gene's expression. However, in other species, ingestion of dsRNA can be ineffective owing to the presence of nucleases within the gut, which degrade dsRNA before it reaches target cells. In this study, we observed that nucleases within the gut of the Queensland fruit fly (
Bactrocera tryoni
) rapidly degrade dsRNA and reduce RNAi efficacy. By complexing dsRNA with liposomes within the adult insect's diet, RNAi-mediated knockdown of a melanin synthesis gene,
yellow
, was improved significantly, resulting in strong RNAi phenotypes. RNAi efficiency was also enhanced by feeding both larvae and adults for several days on dsRNAs that targeted two different dsRNase gene transcripts. Co-delivery of both dsRNase-specific dsRNAs and
yellow
dsRNA resulted in almost complete knockdown of the
yellow
transcripts. These findings show that the use of liposomes or co-feeding of nuclease-specific dsRNAs significantly improves RNAi inhibition of gene expression in
B. tryoni
and could be a useful strategy to improve RNAi-based control in other insect species.