bluuebunny/crossref_metadata_2025 huggingface dataset:
Searching for solar siblings in APOGEE and Gaia DR2 with N-body simulations
Authors: Webb Jeremy J , Price-Jones Natalie , Bovy Jo , Portegies Zwart Simon , Hunt Jason A S , Mackereth J Ted , Leung Henry W
Published: March 2020

We make use of APOGEE and $Gaia\,$ data to identify stars that are consistent with being born in the same association or star cluster as the Sun. We limit our analysis to stars that match solar abundances within their uncertainties, as they could have formed from the same giant molecular cloud (GMC) as the Sun. We constrain the range of orbital actions that solar siblings can have with a suite of simulations of solar birth clusters evolved in static and time-dependent tidal fields. The static components of each galaxy model are the bulge, disc, and halo, while the various time-dependent components include a bar, spiral arms, and GMCs. In galaxy models without GMCs, simulated solar siblings all have JR < 122 km $\rm s^{-1}$ kpc, 990 < Lz < 1986 km $\rm s^{-1}$ kpc, and 0.15 < Jz < 0.58 km $\rm s^{-1}$ kpc. Given the actions of stars in APOGEE and $Gaia\,$, we find 104 stars that fall within this range. One candidate in particular, Solar Sibling 1, has both chemistry and actions similar enough to the solar values that strong interactions with the bar or spiral arms are not required for it to be dynamically associated with the Sun. Adding GMCs to the potential can eject solar siblings out of the plane of the disc and increase their Jz, resulting in a final candidate list of 296 stars. The entire suite of simulations indicate that solar siblings should have JR < 122 km $\rm s^{-1}$ kpc, 353 < Lz < 2110 km $\rm s^{-1}$ kpc, and Jz < 0.8 km $\rm s^{-1}$ kpc. Given these criteria, it is most likely that the association or cluster that the Sun was born in has reached dissolution and is not the commonly cited open cluster M67.
Reproducing the Universe: a comparison between the EAGLE simulations and the nearby DustPedia galaxy sample
Authors: Trčka Ana , Baes Maarten , Camps Peter , Meidt Sharon E , Trayford James , Bianchi Simone , Casasola Viviana , Cassarà Letizia P , De Looze Ilse , De Vis Pieter , Dobbels Wouter , Fritz Jacopo , Galametz Maud , Galliano Frédéric , Katsianis Antonios , Madden Suzanne C , Mosenkov Aleksandr V , Nersesian Angelos , Viaene Sébastien , Xilouris Emmanuel M
Published: March 2020

We compare the spectral energy distributions (SEDs) and inferred physical properties for simulated and observed galaxies at low redshift. We exploit UV-submillimetre mock fluxes of ∼7000 z = 0 galaxies from the EAGLE suite of cosmological simulations, derived using the radiative transfer code skirt. We compare these to ∼800 observed galaxies in the UV-submillimetre range, from the DustPedia sample of nearby galaxies. To derive global properties, we apply the SED fitting code cigale consistently to both data sets, using the same set of ∼80 million models. The results of this comparison reveal overall agreement between the simulations and observations, both in the SEDs and in the derived physical properties, with a number of discrepancies. The optical and far-infrared regimes, and the scaling relations based upon the global emission, diffuse dust, and stellar mass, show high levels of agreement. However, the mid-infrared fluxes of the EAGLE galaxies are overestimated while the far-UV domain is not attenuated enough, compared to the observations. We attribute these discrepancies to a combination of galaxy population differences between the samples and limitations in the subgrid treatment of star-forming regions in the EAGLE-skirt post-processing recipe. Our findings show the importance of detailed radiative transfer calculations and consistent comparison, and provide suggestions for improved numerical models.
Supermassive star formation via super competitive accretion in slightly metal-enriched clouds
Authors: Chon Sunmyon , Omukai Kazuyuki
Published: March 2020

Direct collapse black hole (DCBH) formation with mass ≳105 M⊙ is a promising scenario for the origin of high-redshift supermassive black holes. It has usually been supposed that the DCBH can only form in the primordial gas since the metal enrichment enhances the cooling ability and causes the fragmentation into smaller pieces. What actually happens in such an environment, however, has not been explored in detail. Here, we study the impact of the metal enrichment on the clouds, conducting hydrodynamical simulations to follow the cloud evolution in cases with different degree of the metal enrichment Z/Z⊙ = 10−6 to 10−3. Below Z/Z⊙ = 10−6, metallicity has no effect and supermassive stars form along with a small number of low-mass stars. With more metallicity $Z/\mathrm{ Z}_{\odot } \gtrsim5 \times 10^{-6}$, although the dust cooling indeed promotes fragmentation of the cloud core and produces about a few thousand low-mass stars, the accreting flow preferentially feeds the gas to the central massive stars, which grows supermassive as in the primordial case. We term this formation mode as the super competitive accretion, where only the central few stars grow supermassive while a large number of other stars are competing for the gas reservoir. Once the metallicity exceeds 10−3 Z⊙ and metal-line cooling becomes operative, the central star cannot grow supermassive due to lowered accretion rate. Supermassive star formation by the super competitive accretion opens up a new window for seed BHs, which relaxes the condition on metallicity and enhances the seed BH abundance.
Deep into the core of dense star clusters: an astrometric and photometric test case for ELT
Authors: Fiorentino G , Bellazzini M , Spera M , Sabha N B , Mapelli M , Schreiber L , Dall’Ora M , Inno L , Patti M , Braga V F , Lombini M , Diolaiti E , Cortecchia F , Arcidiacono C , Plantet C , Agapito G
Published: March 2020

We present a novel analysis of a young star cluster in the Large Magellanic cloud, R136-like, as seen by the Extremely Large Telescope (ELT). The main aim of this study is to quantify precision and accuracy of stellar proper motion measurements in crowded field when using an ELT working at its diffraction limit. This can serve as a reference study for future development of ELT scientific cases. In particular, we investigate our future ability to detect the dynamical signature of intermediate-mass black holes (IMBHs) with mass ∼104 M⊙ through detailed measurements of stellar proper motions. We have simulated two N-body dynamical cluster models with and without an IMBH. For each model, we have chosen two snapshots temporally spaced by 5 yr. Stellar fluxes in IJHK filters and star positions have been used to create ELT mock images for both single- and multiconjugate adaptive optics observing modes following the requierements given by ESO technical specifications for the first light imager. These images have been analysed using a classical software for seeing-limited data reduction, daophot/allstar. We make accurate photometry till the very faint pre-main-sequence stars, i.e. depending on the adaptive optics (AO) mode, magnitudes down to K ∼ 24 mag (single-conjugate AO) or K ∼ 22 mag (multiconjugate AO) in a total integration time of 20 min on target. Although daophot suite of programs is not devoted to precise astrometry, the astrometric accuracy is impressive, reaching few μas yr−1 or km s−1. In these assumptions, we are able to detect the IMBH signature at the centre of the cluster.
Does Nature use neutral beams for interstellar plasma heating around compact objects?
Authors: Churazov E , Khabibullin I , Sunyaev R
Published: March 2020

A neutral beam injection technique is employed in all major TOKAMAK facilities for heating of magnetically confined plasma. The question then arises, whether a similar mechanism might work in astrophysical objects? For instance, a hyper-Eddington Galactic binary SS433 possesses baryonic jets, moving at a quarter of the speed of light, and observations revealed signs of gas cooling and recombination on sub-pc scales and equally strong signs of powerful energy deposition on much larger scales ∼100 pc. Here, we consider a model where neutral atoms transport this energy. A sub-relativistic beam of neutral atoms penetrates the interstellar medium; these atoms gradually get ionized and deposit their energy over a region, whose longitudinal dimension is set by the ‘ionization length’. The channel, where the energy is deposited, expands sideways and drives a shock in the lateral direction. Once the density in the channel drops, the heating rate by the beam drops accordingly, and the region of the energy release moves along the direction of the beam. We discuss distinct features associated with this scenario and speculate that such configuration might also boost shock acceleration of the ‘pick-up’ protons that arise due to ionization of neutral atoms both upstream and downstream of the shock.
Machine learning predicts new anti-CRISPR proteins
Authors: Eitzinger Simon , Asif Amina , Watters Kyle E , Iavarone Anthony T , Knott Gavin J , Doudna Jennifer A , Minhas Fayyaz ul Amir Afsar
Published: March 2020

The increasing use of CRISPR–Cas9 in medicine, agriculture, and synthetic biology has accelerated the drive to discover new CRISPR–Cas inhibitors as potential mechanisms of control for gene editing applications. Many anti-CRISPRs have been found that inhibit the CRISPR–Cas adaptive immune system. However, comparing all currently known anti-CRISPRs does not reveal a shared set of properties for facile bioinformatic identification of new anti-CRISPR families. Here, we describe AcRanker, a machine learning based method to aid direct identification of new potential anti-CRISPRs using only protein sequence information. Using a training set of known anti-CRISPRs, we built a model based on XGBoost ranking. We then applied AcRanker to predict candidate anti-CRISPRs from predicted prophage regions within self-targeting bacterial genomes and discovered two previously unknown anti-CRISPRs: AcrllA20 (ML1) and AcrIIA21 (ML8). We show that AcrIIA20 strongly inhibits Streptococcus iniae Cas9 (SinCas9) and weakly inhibits Streptococcus pyogenes Cas9 (SpyCas9). We also show that AcrIIA21 inhibits SpyCas9, Streptococcus aureus Cas9 (SauCas9) and SinCas9 with low potency. The addition of AcRanker to the anti-CRISPR discovery toolkit allows researchers to directly rank potential anti-CRISPR candidate genes for increased speed in testing and validation of new anti-CRISPRs. A web server implementation for AcRanker is available online at http://acranker.pythonanywhere.com/.
Technological innovations at the onset of the Mid-Pleistocene Climate Transition in high-latitude East Asia
Authors: Yang Shi-Xia , Wang Fa-Gang , Xie Fei , Yue Jian-Ping , Deng Cheng-Long , Zhu Ri-Xiang , Petraglia Michael D
Published: March 2020

The interplay between Pleistocene climatic variability and hominin adaptations to diverse terrestrial ecosystems is a key topic in human evolutionary studies. Early and Middle Pleistocene environmental change and its relation to hominin behavioural responses has been a subject of great interest in Africa and Europe, though little information is available for other key regions of the Old World, particularly from Eastern Asia. Here we examine key Early Pleistocene sites of the Nihewan Basin, in high-latitude northern China, dating between ∼1.4 and 1.0 million years ago (Ma). We compare stone-tool assemblages from three Early Pleistocene sites in the Nihewan Basin, including detailed assessment of stone-tool refitting sequences at the ∼1.1-Ma-old site of Cenjiawan. Increased toolmaking skills and technological innovations are evident in the Nihewan Basin at the onset of the Mid-Pleistocene Climate Transition (MPT). Examination of the lithic technology of the Nihewan sites, together with an assessment of other key Palaeolithic sites of China, indicates that toolkits show increasing diversity at the outset of the MPT and in its aftermath. The overall evidence indicates the adaptive flexibility of early hominins to ecosystem changes since the MPT, though regional abandonments are also apparent in high latitudes, likely owing to cold and oscillating environmental conditions. The view presented here sharply contrasts with traditional arguments that stone-tool technologies of China are homogeneous and continuous over the course of the Early Pleistocene.
Evaluation of the Host Genetic Effects of Tuberculosis-Associated Variants Among Patients With Type 1 and Type 2 Diabetes Mellitus
Authors: Zhong Huimin , Magee Matthew J , Huang Yunfeng , Hui Qin , Gwinn Marta , Gandhi Neel R , Sun Yan V
Published: March 2020

Background

Understanding the link between tuberculosis (TB) and diabetes is increasingly important as public health responds to the growing global burden of noncommunicable diseases. Genetic association studies have identified numerous host genetic variants linked to TB; however, potential host genetic mechanisms linking TB and diabetes remain unexplored.

Methods

We used genetic and phenotypic data from the UK Biobank to evaluate the association of 6 previously reported TB-related host genetic variants (genome-wide significant associations from published studies) with diabetes. The study included 409 692 adults of European ancestry including 2177 with type 1 diabetes mellitus (T1DM) and 13 976 with type 2 diabetes mellitus (T2DM), defined by ICD-10 diagnosis codes.

Results

Of the 6 TB-associated single nucleotide polymorphisms (SNPs), 2 were associated with T1DM and 3 with T2DM, after adjusting for age, sex, body mass index, smoking, alcohol use, and population structure. After correction for multiple testing, SNPs rs2894257 and rs3135359 (HLA-DRA-DQA1) were associated with T1DM (rs2894257: odds ratio [OR], 1.32; 95% confidence interval [CI], 1.21–1.45; rs3135359: OR, 1.72; 95% CI, 1.57–1.88) and T2DM (rs2894257: OR, 1.11; 95% CI, 1.08–1.15; rs3135359: OR, 1.06; 95% CI, 1.025–1.096). The associations with T2DM weakened for rs2894257 and rs3135359 after further exclusion of probable T1DM cases defined by International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes. SNP rs4733781 on chromosome 8 (ASAP1 gene) was associated with T2DM after exclusion of T1DM cases.

Conclusions

Our findings suggest that common host genetic effects may play a role in the molecular mechanism linking TB and diabetes. Future large genetic studies of TB and diabetes should focus on developing countries with high burdens of infectious and chronic diseases.
Poor Outcomes of Acute Hepatitis E in Patients With Cirrhotic Liver Diseases Regardless of Etiology
Authors: Wang Yijin , Liu Hongyang , Jiang Yiyun , Pan Qiuwei , Zhao Jingmin
Published: March 2020

Background: Chronic liver diseases (CLDs) have been documented to exacerbate clinical outcomes of acute hepatitis E (AHE). This study aimed to uncover the role of etiology and status of CLD in the adverse outcomes of AHE. We found that superinfection with hepatitis E virus (HEV) in patients with cirrhotic CLD can cause a worsen outcome, leading to exacerbation of AHE, compared with HEV-infected patients without CLD or with noncirrhotic CLD. Additional analysis revealed that the etiology of CLD is not associated with outcomes of AHE patients. These finding suggests that the overall liver status plays a predominant role in determining the outcomes of AHE.
Measuring Ex Ante Welfare in Insurance Markets
Authors: Hendren Nathaniel
Published: March 2020

The willingness to pay for insurance captures the value of insurance against only the risk that remains when choices are observed. This article develops tools to measure the ex ante expected utility impact of insurance subsidies and mandates when choices are observed after some insurable information is revealed. The approach retains the transparency of using reduced-form willingness to pay and cost curves, but it adds one additional sufficient statistic: the percentage difference in marginal utilities between insured and uninsured. I provide an approach to estimate this additional statistic that uses only the reduced-form willingness to pay curve, combined with a measure of risk aversion. I compare the approach to structural approaches that require fully specifying the choice environment and information sets of individuals. I apply the approach using existing willingness to pay and cost curve estimates from the low-income health insurance exchange in Massachusetts. Ex ante optimal insurance prices are roughly 30% lower than prices that maximize observed market surplus. While mandates reduce market surplus, the results suggest they would actually increase ex ante expected utility.
Sleep–wake behaviors exhibited by shift workers in normal operations and predicted by a biomathematical model of fatigue
Authors: Riedy Samantha M , Roach Gregory D , Dawson Drew
Published: March 2020

Study Objectives

To compare rail workers’ actual sleep–wake behaviors in normal operations to those predicted by a biomathematical model of fatigue (BMMF). To determine whether there are group-level residual sources of error in sleep predictions that could be modeled to improve group-level sleep predictions.

Methods

The sleep–wake behaviors of 354 rail workers were examined during 1,722 breaks that were 8–24 h in duration. Sleep–wake patterns were continuously monitored using wrist-actigraphy and predicted from the work–rest schedule using a BMMF. Rail workers’ actual and predicted sleep–wake behaviors were defined as split-sleep (i.e. ≥2 sleep periods in a break) and consolidated-sleep (i.e. one sleep period in a break) behaviors. Sleepiness was predicted from the actual and predicted sleep–wake data.

Results

Consolidated-sleep behaviors were observed during 1,441 breaks and correctly predicted during 1,359 breaks. Split-sleep behaviors were observed during 280 breaks and correctly predicted during 182 breaks. Predicting the wrong type of sleep–wake behavior resulted in a misestimation of hours of sleep during a break. Relative to sleepiness predictions derived from actual sleep–wake data, predicting the wrong type of sleep–wake behavior resulted in a misestimation of sleepiness predictions during the subsequent shift.

Conclusions

All workers with the same work–rest schedule have the same predicted sleep–wake behaviors; however, these workers do not all exhibit the same sleep–wake behaviors in real-world operations. Future models could account for this group-level residual variance with a new approach to modeling sleep, whereby sub-group(s) may be predicted to exhibit one of a number of sleep–wake behaviors.
Persistent hypoglycemia
Authors: Rabener Michael J. , Howell Christopher M.
Published: March 2020

Glycogen storage disease is a rare congenital disorder that can lead to hypoglycemic events. This article focuses on a patient in acute distress secondary to hypoglycemia that failed to respond to initial interventions. Because symptoms can be similar to severe hyperglycemia, a thorough history and physical examination are key to prompt diagnosis and appropriate management.
My Supporting Role
Authors: Nolan Judy
Published: March 2020

Updated several times a week with posts by a wide variety of authors, AJN's blog Off the Charts allows us to provide more timely—and often more personal—perspectives on professional, policy, and clinical issues. Best of the Blog is a regular column to draw the attention of AJN readers to posts we think deserve a wider audience. To read more, please visit: www.ajnoffthecharts.com.
Rotationplasty Rehabilitation Protocol: A Complex Case Report
Authors: Compston Amy M. , Zak Jacqueline , Alexander John H. , West Julie M. , Scharschmidt Thomas J. , Valerio Ian L. , Mayerson Joel L.
Published: March 2020

Background and Purpose:

Rotationplasty is a rare, complex limb salvage surgery that creates opportunity for physical therapists to develop a unique rehabilitation plan focusing on functional mobility and independence. To date, there is no comprehensive rehabilitation-specific protocol documented in the literature for individuals who have undergone rotationplasty. This case report describes the first novel comprehensive rehabilitation protocol, interventional strategies, and optimal functional outcome of a patient who underwent rotationplasty.

Case Description:

The patient was a 20-year-old man with a history of high-grade osteosarcoma of left distal femur who underwent numerous limb-sparing procedures resulting in pain and debility necessitating rotationplasty. Rehabilitation protocol and focused physical therapy interventions were implemented pre- and postsurgery based on functional limitations.

Outcomes:

The Toronto Extremity Salvage Score (TESS), Musculoskeletal Tumor Society (MSTS) assessment, Timed Up and Go (TUG) test, range of motion, and strength testing of the affected lower extremity all demonstrated significant improvement from prerotationplasty to postsurgery to 1-year follow-up. A 41.8% improvement in TESS outcome was found from postsurgery to 1-year follow-up. MSTS assessment showed a 60% improvement from presurgery to 1-year follow-up. TUG score improved by 0.7 seconds with no assistive device by final discharge. The patient met all therapy goals and reported no functional limitations at discharge.

Discussion:

Implementation of a rehabilitation protocol for this unique population guides clinicians' decision making while developing congruency between providers. This protocol paired with targeted interventions promotes successful patient outcome and aids as a framework for clinicians to be used in treating this complex patient population.
Exercise Interventions for Survivors of Cancer Living in Rural or Remote Settings: A Scoping Review
Authors: Smith-Turchyn Jenna , Gravesande Janelle , Sabiston Catherine M.
Published: March 2020

Background:

Survivors of cancer who are considered “hard to reach” have less engagement in survivorship programming and lower overall health status, well-being, quality of life, and survival. These include individuals who live in rural areas. There is a need to determine the availability, characteristics, feasibility, and effectiveness of exercise programs for individuals with cancer living in rural settings.

Purpose:

To conduct a scoping review describing the current literature on available exercise programming for survivors of cancer who live in rural or remote settings.

Methods:

Data Sources: Six databases were searched for studies. Study Selection: 105 abstracts were identified through literature searches; 84 studies remained for title and abstract screening after duplicates were removed. Thirty-three articles were included in full-text review. Data Extraction: Data related to participant characteristics, intervention characteristics, study design, and outcomes were extracted from full texts. Data Synthesis: Descriptive quantitative summaries are provided for result variables, and a narrative analysis was performed.

Discussion and Limitations:

Thirteen articles were selected for data extraction. The majority of interventions were phone-based walking programs for survivors of breast cancer. The interventions described were held in only 2 countries. The most common outcomes assessed were physical activity level, quality of life, and anxiety/depression.

Conclusion:

This scoping review highlighted the lack of accessible exercise programs for this subset of hard-to-reach survivors of cancer. This review found that there are few exercise programs accessible for survivors living in rural and remote areas, suggesting one reason for low engagement in physical activity and highlighting the need to devise novel means to implement exercise interventions for this population.
Can EOS Imaging Substitute for Conventional Radiography in Measurement of Acetabular Morphology in the Young Dysplastic Hip?
Authors: Powell Jenna , Gibly Romie F. , Faulk Leonard W. , Carry Patrick , Mayer Stephanie W. , Selberg Courtney M.
Published: March 2020

Background:

EOS imaging offers a low-radiation alternative to conventional radiography (CR) and has little to no magnification effects. However, it is unclear how radiographic measures may be affected using EOS. The present study aims to determine the reproducibility of measures of acetabular morphology on EOS images as compared with CR, and to directly compare the 2 imaging modalities.

Methods:

A total of 21 consecutive patients (66.7% female; 14.4±4.7 y) indicated for an open hip preservation procedure with both an anterior-posterior pelvis radiograph and EOS image performed preoperatively were included. Three orthopaedic surgeons measured Tönnis angle, lateral center edge angle (LCEA), acetabular depth-width ratio (ADR), and extrusion index (EI). Measurements were performed twice, 2 weeks apart. Reliability between observers and time points was measured using intraclass correlation coefficients, and agreement between time points and modalities was measured using Bland-Altman analysis.

Results:

On EOS images, inter-rater reliability was 0.86 for Tönnis angle, 0.86 for LCEA, 0.74 for ADR, and 0.93 for EI. On CR, inter-rater reliability was 0.86 for Tönnis anlge, 0.90 for LCEA, 0.82 for ADR, and 0.84 for EI. In the agreement analysis, biases between imaging modalities were observed. On average, raters measured Tönnis angle and EI higher on EOS images than CR (2.22 degrees, 1.09%, respectively); and LCEA and ADR lower on EOS images than CR (1.54 degrees, 1.14% respectively). Limits of agreement (LOA) between modalities were similar to that of LOA observed in intra-rater analysis.

Conclusions:

Measures of acetabular morphology performed on EOS images have similarly high intra-rater and inter-rater reliability compared with CR. Measures performed on EOS also have similar intra-rater agreement as compared with CR. Intermodality agreement had similar LOA as intra-rater agreement on either individual imaging modality. Small biases between imaging modalities were detected.

Levels of Evidence:

Level I—diagnostic study: investigating a diagnostic test.
Sex differences of the association between marital status and coronary artery disease in patients experiencing chest pain: The Korean Women's Chest Pain Registry
Authors: Kim Hyun-Jin , Kim Myung-A , Kim Hack-Lyoung , Park Seong Mi , Kim Mina , Yoon Hyun Ju , Shin Mi Seung , Park Sang Min , Hong Kyung-Soon , Shim Wan-Joo
Published: March 2020

Objective:

Marriage is an important social practice that predicts various health outcomes, including those of cardiovascular disease. This study investigated the sex-specific association between marital status and coronary artery disease (CAD) in patients experiencing chest pain.

Methods:

Study data were obtained from a nationwide registry of patients with suspected CAD who underwent coronary angiography. We dichotomized all participants according to marital status as follows: without a spouse (single, divorced, or widowed), and with a spouse. Significant CAD was defined as greater than 50% narrowing of the lumen diameter in any of the coronary arteries.

Results:

The presence of significant CAD was significantly higher in female participants without a spouse than in female participants with a spouse. However, there was no significant difference in the presence of CAD in men between the two groups. Interestingly, there was also no significant difference in the presence of CAD between women without a spouse and men without a spouse. After adjustment for all possible confounding factors, women without a spouse had a 1.62-fold increased hazard for significant CAD in multivariate regression analysis.

Conclusions:

In contrast to men, a without spouse status is independently associated with significant CAD in women experiencing chest pain. Women with a spouse had the lowest presence of CAD among all groups. In the management of female patients experiencing chest pain, clinicians should consider their social characteristics, including marital status, to predict subsequent cardiovascular disease and determine the appropriate treatment.

Video Summary:

http://links.lww.com/MENO/A567.
Genetic predictors to acupuncture response for hot flashes: an exploratory study of breast cancer survivors
Authors: Romero Sally A.D. , Li Qing Susan , Orlow Irene , Gonen Mithat , Su Hui-Chun Irene , Mao Jun J.
Published: March 2020

Objective:

Because hot flashes are a common symptom experienced by women with breast cancer, we sought to explore genetic predictors associated with response to acupuncture for the treatment of hot flashes.

Methods:

Using data from our completed randomized controlled trial (Clinicaltrials.gov identifier: NCT01005108) on hot flashes among breast cancer survivors who provided biomarker collection (N = 108), we extracted and assayed DNA for single nucleotide polymorphisms in genes involved in neurotransmission, thermoregulation, and inflammation (ADORA1, COMT, TCL1A, and TRPV1). For our primary outcome we classified individuals with a 50% or more reduction in their hot flash composite score at the end of treatment as responders. We used Fisher exact test to identify individual and combined single nucleotide polymorphisms associated with treatment response.

Results:

Among women (N = 57) who received acupuncture treatment (electro or sham), we found that women who were carriers of at least one of these six genotypes (ADORA1 rs41264025-GA or rs16851029-GG or rs12744240-GT, COMT rs6269-GA, TCL1A rs2369049-GG, and TRPV1 rs8065080-TT) were more likely to respond to acupuncture for hot flashes than noncarriers (70.3% vs 37.5%, P = 0.035). These six genotypes were not associated with response in women (N = 51) who received pharmacological hot flash treatment (gabapentin or placebo pill; 37.5% vs 37.5%, P = 1.0).

Conclusions:

In this exploratory, proof of concept study, we identified six genotypes that may predict response to acupuncture for hot flashes in breast cancer survivors. If confirmed by future studies, these findings may inform the development of personalized acupuncture for managing hot flashes.
Keloids: Which Types Can Be Excised without Risk of Recurrence? A New Clinical Classification
Authors: Lemperle Gottfried , Schierle Johannes , Kitoga Kakubindi Eric , Kassem-Trautmann Katja , Sachs Christoph , Dimmler Arno
Published: March 2020

Background:

A surgical team from Interplast-Germany removed 387 keloids in 302 patients during 4 visits to Goma, Democratic Republic of the Congo, from 2015-2018. Preoperative and postoperative photographs and a thorough anamnesis of keloids were done for all patients. In addition, 18 selected biopsies from 4 types of keloids were histologically examined in Germany.

Methods:

Treatment options were tested and keloid recurrence rates were compared with data from questionnaires, photographs, and histology.

Results:

Keloids were classified accordingly as follows: (1) fresh nodular (continuously growing) keloids had a 30% recurrence rate after surgery: no common adjuvant therapy but triamcinolone acetonide (TAC) injections on onset, only; (a) earlobe keloids had the lowest recurrence rate after complete excision with negative resection margins; (2) superficial spreading (or butterfly) keloids were treated with TAC injections only; (3) mature (nongrowing or burned-out) keloids had also a low recurrence rate of 4.5%, which were then treated with TAC on onset, only; and (4) multiple keloids comprise various types in different stages.

Conclusions:

According to this classification, about 50% of keloids may be removed surgically without risk of recurrence in the examined patient population in Africa, where only TAC injections, but no radiation, are available. Adjuvant TAC or radiation should be started at the onset of recurrence and not generally.
“Mirror Face Lift”: Concept, Description, and Evaluation 1 Year Postoperatively
Authors: Divaris Marc , Sabri Ebaa , Ohana Sydney
Published: March 2020

Background:

The mirror facelift
1,2
is a new concept of mid-face rejuvenation that we apply during the preoperative consultation to explain and show the patient the possible results that can be achieved postoperatively and have this result stay stable over time and in different positions. It is characterized by (1) the use of a mirror during the preoperation visit and the taking of pictures from different angles, allowing for a precise analysis of the redistribution of the facial soft tissues on each hemi-skeleton; (2) the Divaris et al
2
locked cheek lift technique (Locked Cheek-Lift), which is done with 2 vectors that achieve a tri-dimensional redistribution of the soft tissues; and (3) postoperative photographs which are very useful in precisely evaluating the results and comparing them with the preoperative pictures.

Methods:

Two hundred and sixty patients (216 women and 44 men), average age 53 (34 to 73 years old), were operated on between 2010 and 2016, applying the concept of mirror lift in the consultation to show the patients the expected possible results after the surgery. The patients see for themselves the deterioration of the facial condition (looking older) with the anti-mirror position as well as the younger appearance of the face following the mirror position. Surgically, the locked cheek lift technique was performed by the same surgeons. The follow-up 1 year later was done by the same team. The fat compartment positions were evaluated during this period.

Results:

The fat compartments’ stability was evaluated 3 months and a year postoperatively to assess the stability of the result over time. The mean value is 4.62 out of 5 in anti-mirror position before surgery and 1 year postoperatively. The mean value is 4.34 out of 5 after 1 year measured in both standing and lying positions. Postoperative edema and ecchymosis were limited.

Conclusions:

The concept of the Mirror Facelift is to precisely reposition the soft tissues of the face on the bone structure by correcting the fat compartments that have migrated over years. It harmoniously redistributes the soft tissues without any palpebral cutaneous incision, thus allowing for a short recovery period free of any risk of palpebral complications.
The Role of Emotional Intelligence in Predicting a Successful Career for Plastic Surgeons: A Systematic Review
Authors: Thacoor Amitabh , Smith Oliver , Nikkhah Dariush
Published: March 2020

The definition of a successful career in plastic surgery is both a highly variable and personal one. Career success is underpinned by a combination of skills and is often multifactorial in nature. Although clinical and academic factors have long been key determinants of success, modern medical practice is now underlining the previously understated non-clinical skills as a major contributory element. Emotional intelligence (EI) has shown clear benefits in a successful career in the business world, where it was originally popularized. As a successful career in surgery also requires proficient understanding of human emotions, the clear similarities drawn with corporate success have resulted in a growing interest in EI in the medical domain. Despite such interest, the role of EI as a predictor of career success in plastic surgery has been poorly defined. This systematic review aims to define EI, to explore its role in medical and nonmedical fields, and to investigate its impact on a successful career in plastic surgery.
Resection and Reconstruction of Giant Abdominoscrotal Arteriovenous Malformation
Authors: Danno Kanako , Narushima Mitsunaga , Iida Takuya , Banda Chihena , Todokoro Takeshi , Tashiro Kensuke , Ishiura Ryohei , Mitsui Kohei , Tone Shine , Mori Harushi
Published: March 2020

Genital arteriovenous malformations are rare and present unique surgical challenges in preserving urogenital function, abdominal wall integrity, and lower limb perfusion. A 32-year-old man with a giant abdominoscrotal arteriovenous malformation presented with recurrent heavy bleeding. Due to the high risk of rebleeding and fatal hemorrhage, surgery with curative intent was proposed and the patient was counseled on the risks of ischemia to the lower limb, testes, and penis. Preoperative embolization of the feeding vessels was performed. Three days later, surgical excision of the mass with the affected scrotum, left rectus muscle, sheath, and overlying abdominal skin followed. The testes were dissected from the malformation and preserved along with the right internal pudendal artery. The left thigh skin was advanced to the scrotal remnants and a neoscrotum created. The resulting large abdominal wall defect was reconstructed in layers with a pedicled anterolateral thigh flap, including innervated vastus lateralis muscle, to prevent herniation. Recovery was uneventful, and a 4-year follow-up revealed no significant clinical or radiological recurrence with recovery of flap sensation, retained erectile function, and no herniation. We report this case due to rarity of giant abdominoscrotal arteriovenous malformations and present preoperative embolization, surgical resection, and functional anterolateral thigh flap reconstruction as a valuable treatment option of this life-threatening illness.
Enhancing induced pluripotent stem cell toward differentiation into functional cardiomyocytes
Authors: Chien Chian-Shiu , Wang Chien-Ying , Leu Hsin-Bang , Chien Yueh , Yang Yi-Ping , Wang Chia-Lin , Tai Hsiao-Yun , Ko Yu-Ling , Tsai Fu-Ting , Chou Shih-Jie , Yu Wen-Chung , Yang Meng-Yin
Published: March 2020

Background:

Heart diseases, especially myocardial ischemia, remain one of the leading causes of mortality worldwide and usually result in irreparable cardiomyocyte damage and severe heart failure. Recent advances in induced pluripotent stem cell (iPSC) technologies for applied regenerative medicine and stem cell research, especially for iPSC-derived cardiomyocytes have increased the hope for heart repair. However, the driver molecules of myocardial differentiation and the functional reconstruction capacity of iPSC-derived cardiomyocytes are still questionable.

Methods:

Herein, we established a rapid differentiated platform that is involved in cardiomyogenic differentiation and maturation from iPSCs in vitro. Functional analysis is performed in miR-181a-transfected iPSC-derived cardiomyocyte (iPSC-cardio/miR-181a) under a time-lapse microscope. In addition, we calculated the beating area and frequency of iPSC-cardio/miR-181a cells in the presence of HCN4 shRNA or miR-181a SPONGE.

Results:

miR-181a enhanced the beating area and maintained the beating frequency of iPSC-derived cardiomyocytes by enhancing HCN4 expression.

Conclusion:

miR-181a would play a key role on maintaining proper beating function in iPSC-derived cardiomyocytes.
Risk of hepatitis C virus infection in injecting and noninjecting drug users receiving opioid substitution therapy
Authors: Wang Chih-Wen , Chuang Hung-Yi , Chiang Hung-Che , Huang Po-Chin , Yu Ming-Lung , Dai Chia-Yen
Published: March 2020

Background:

Hepatitis C virus (HCV) is the most common viral infection among illicit drug users in the world. Although intervention of needle and syringe program and opioid substitution therapy had engaged to prevent HCV infection, the prevalence of HCV infection does not seem to decline. The aim of this study was to estimate the risk of HCV infection in injecting drug users (IDUs) and noninjecting drug users (NIDUs) receiving opioid substitution therapy.

Methods:

We recruited 1179 heroin-dependent patients (age: 20-66 years) under opioid substitution therapy from 2012 to 2015 in a Psychiatric Center, Southern Taiwan. The data of HCV, hepatitis B virus and HIV infection and liver biochemical examination were obtained. We used multivariate logistic regression analysis to predict the risk of HCV infection.

Results:

There were 93.1% of IDUs and 68.1% of NIDUs positive for HCV infection. In IDUs, HIV infection, age of heroin initiation, duration and dose of heroin use, frequency of detoxification, and number of criminal conviction were significantly associated with HCV infection. In NIDUs, snort/sniff heroin exhibited a significantly increased risk of HCV infection. Intravenous injecting (odds ratio [OR] = 23.10, 95% CI = 8.04-66.40,p< 0.001), intravenous injecting combined snort/sniff (OR = 12.95, 95% CI = 3.90-42.97,p< 0.001), and snort/sniff (OR = 4.14, 95% CI = 1.30-13.18,p= 0.016) were significantly associated with increased risk of HCV infection compared with smoking. The trend was significant (pfor trend <0.001).

Conclusion:

In Taiwan, IDUs had harmful characteristics compared with NIDUs and both had extremely high prevalence of HCV infection. We provided evidence that snort/sniff is a possible way of leak in HCV infection despite needle-syringes supplement program been provided. Opioid substitution therapy program should include HCV assessment and treatment in the new direct-acting antiviral therapy era.
Is the risk of idiopathic sudden sensorineural hearing loss higher in nasopharyngeal carcinoma than in hypopharyngeal cancer? A population-based study
Authors: Chang Hung , Tu Tzong-Yang , Wu Chuan-Song , Kuo Ting-Yu , Huang Chii-Yuan
Published: March 2020

Background:

The aim of this study was to compare the risk of developing sudden sensorineural hearing loss (SSHL) in patients with hypopharyngeal cancer with that in patients with nasopharyngeal carcinoma (NPC).

Methods:

A population-based, retrospective cohort study was performed using the Taiwan National Health Research Database databank. Patients selected for this study were diagnosed with hypopharyngeal cancer or NPC and treated with radiotherapy in the period from 2001 to 2004. Routine follow-up was conducted for 8 years (2004–2012), and the incidence of SSHL was calculated at the final follow-up.

Results:

There was no significant difference in the risk of developing SSHL between the hypopharyngeal cancer group and its control group (p = 1.000). In hypopharyngeal cancer and NPC groups, the rates of SSHL were 0.12% and 1.00%, respectively (p < 0.001). The cumulative hazard of SSHL during the follow-up period was significantly higher in the NPC group than in the control group (p < 0.001).

Conclusion:

Radiotherapy in patients with hypopharyngeal cancer did not increase the risk of developing SSHL, but postirradiation NPC was significantly associated with an increased incidence of SSHL.
Prognostic factors and survival in conventional chondrosarcoma: A single institution review
Authors: Chen Yi-Chou , Wu Po-Kuei , Chen Chao-Ming , Tsai Shang-Wen , Chen Cheng-Fong , Chen Wei-Ming
Published: March 2020

Background:

Chondrosarcoma is the second most common primary sarcoma of the bone. Surgery remains the gold standard for treatment due to chemotherapy and radiotherapy resistance in chondrosarcoma. The main aim of our study was to analyze patients with primary chondrosarcoma of the bone who were treated in a single tumor center. Our study team identified the prognostic factors for overall survival, metastasis-free survival, and recurrence-free survival.

Methods:

From 1998 to 2012, 55 consecutive patients were treated surgically. All patients were followed for local recurrence or distant metastasis. Uni- and multivariate analyses were performed for overall, metastasis-free, and recurrence-free survival.

Results:

Local recurrence developed in 29 of the 55 patients (52.7%). Recurrence-free survival in the multivariate analysis showed a significant association with the surgical margin, and high-grade lesions were an independent factor for local recurrence. In total, 11 patients died of the disease in the study, and the 5- and 10-year survival rates were 84.4% and 78.1%, respectively. The tumor grade and local recurrence were significant factors in the univariate analysis but were insignificant in the Cox regression with time-dependent covariates (p = 0.327 and p = 0.82, respectively). The development of distant metastasis was a significant poor prognostic factor in both the uni- and multivariate analyses.

Conclusion:

Chondrosarcoma of the bone is a disease with surgery-dependent outcomes; but, however, patients often develop subsequent recurrence of the disease. The surgical margins were statistically associated with the risk of subsequent local recurrence but did not predict survival. The development of distant metastases was an independent prognostic factor for poor survival.
A Theoretical Framework and Process for Implementing a Spiral Integrated Curriculum in a Physical Therapist Education Program
Authors: Jette Diane U. , Macauley Kelly , Levangie Pamela K.
Published: March 2020

Background and Purpose.

In 2016, faculty at the MGH Institute of Health Professions implemented a new physical therapist education curriculum based on contemporary theoretical models of learning to address shortcomings of the existing, traditional curriculum. Course content was siloed, students were spending too much time in class to the detriment of self-directed learning, and there was unwarranted repetition of content. Students seemed to emphasize superficial learning in an effort to pass numerous examinations across multiple courses, and they were learning factual knowledge in isolation. The purpose of this article is to describe a new curricular model framed within theoretical perspectives on learning, including cognitive load theory and constructivism. We also describe how we structured decisions about curriculum at the program, course, session, and assessment levels.

Method/Model Description and Evaluation.

We developed a curriculum that represents spiral integration, including integration of the foundational, clinical, and behavioral sciences at the program, course, session, and assessment levels. Courses employ increasingly complex patient narratives that present patients holistically. Course objectives focus on the higher levels of the learning taxonomies.

Outcomes.

The curriculum not only integrates content within and across courses but also uses constructivist learning theory by explicitly engaging students in iterative learning with emphasis on depth versus breadth of information.

Discussion and Conclusion.

The approach to teaching is focused on stimulating curiosity and motivating learning through patient narratives and early focus on clinical reasoning. Cognitive load is addressed by reducing in-class time and having students take only 1 course at a time. An ongoing process of critical study, review, and revision of the curriculum will continue to improve students’ learning experiences, environment, and outcomes.
Partnership Across Transitions to Improve Outcomes in the Lower Extremity Total Joint Population
Authors: Ketchum Amy
Published: March 2020

BACKGROUND:

With the urgency related to improving quality and creating efficiency in healthcare, partnership is emerging as a critical concept related to transitions of care.

PURPOSE:

This quality improvement project included facilitation of hospital partnership with skilled nursing facilities to improve outcomes associated with the lower extremity total joint arthroplasty population.

METHODS:

The clinical nurse specialist (CNS) utilized a standardized framework to implement partnership strategies with multidisciplinary teams. Outcomes were monitored for the 2 quarters of partnership activities.

RESULTS:

All recommendations for developing a partnership model were facilitated within the project timeline. Patient experience and quality measures remained at, or improved, from baseline and met all strategic targets. Efficiency through episode payment demonstrated improvement at each interval during the study period. Analysis revealed a significant (p < .05) reduction in the mean hospital length of stay.

CONCLUSION:

The CNS practice outcomes suggest that the use of structured partnership strategies between agencies improves efficiency of care and accelerates rapid spread of innovation.