bluuebunny/crossref_metadata_2025 huggingface dataset:
Correction of phase errors due to leakage currents in wideband EIT field measurements on soil and sediments
Authors: Zimmermann E , Huisman J A , Mester A , van Waasen S
Published: July 2019

Electrical impedance tomography (EIT) is a promising method to characterize important hydrological properties of soil, sediments, and rocks. The characterization is based on the analysis of the phase response of the complex electrical conductivity in a broad frequency range (i.e. mHz to kHz). However, it is challenging to measure the small phase response of low-polarizable soils and rocks in the higher frequency range up to 10 kHz. In order to achieve the required phase accuracy in the kHz frequency range, an optimized measurement system and advanced model-based processing methods have been developed. Recently, EIT measurements at sites with low electrical conductivity have shown a new dominating phase error related to capacitive leakage currents between cable shields and soil. In order to correct this phase error, we developed an advanced finite element model that considers both leakage currents and capacitive coupling between the soil and the cable shields in the reconstruction of the complex electrical conductivity distribution. This advanced model also takes into account potential measurement errors due to high electrode impedances. The use of this advanced model reduced the new dominating error for media with low electrical conductivity. It was also found that the amount of leakage current is an additional indicator for data quality that can be used for data filtering. After application of a novel data filter based on the leakage current and the use of the advanced modelling approach, the phase error of the measured transfer impedances above 100 Hz was significantly reduced by a factor of 6 or more at 10 kHz. In addition, physically implausible positive phase values were effectively eliminated. The new correction method now enables the reconstruction of the complex electrical conductivity for frequencies up to 10 kHz at field sites with a low electrical conductivity.
Contemporary science as context for teaching nature of science: teachers’ development of popular science articles as a teaching resource
Authors: Hansson Lena , Leden Lotta , Pendrill Ann-Marie
Published: July 2019

Most of the physics (as well as the other sciences) taught in school can be described as well-established or consensus science. This is the kind of science knowledge that was mostly developed over a century ago. The inclusion of contemporary science research in compulsory school science teaching could be justified from a variety of reasons: increasing students’ interest and motivation; providing insights into modern research practice; and as a frame for teaching nature of science (NOS) perspectives. The present article focuses on the latter—contemporary science as a means to teach NOS. The article builds on data from an in-service teacher training course that focused on ways to include contemporary science in lower secondary physics education. Each course participant chose a research area, interviewed a scientist, and wrote a popular science article based on the interview. The article was written with secondary students (13–15 years old) as a target audience. By the end of the course the participants designed, implemented and evaluated a teaching unit which was based on the popular science article. The present article analyses what NOS perspectives that have been included in the popular science articles. The results show a high diversity of NOS aspects, which indicate a great potential for taking contemporary science research as a starting point for NOS teaching.
Triboelectric proximity and contact detection using soft planar spiral electrodes
Authors: Helseth L E
Published: July 2019

In this study, planar spiral electrodes for triboelectric contact and proximity detection are investigated. The spiral electrodes are created using liquid metal in a soft elastomer in order to make the sensor flexible and stretchable. When the metallic object to be detected comes in contact with the silicon elastomer surrounding the electrodes, charge transfer occurs, and this can be utilized for contact and noncontact sensing of the metallic object in flat or curved geometries. An equivalent electrical circuit model for the noncontact system is proposed and found to be in good agreement with the experimental data. A comparison between triboelectric proximity detection and eddy current resonance frequency proximity detection, using the same electrode geometry, shows that the two methods have comparable sensitivity. An added advantage of the triboelectric system is that it transforms mechanical into electrical energy and thereby allows one to monitor the triboelectrical signal upon impact of a metal object, and the experimental data show that the generated current scales with the impact force.
Review on biogas from palm oil mill effluent (POME): Challenges and opportunities in Indonesia
Authors: Rajani A , Kusnadi  , Santosa A , Saepudin A , Gobikrishnan S , Andriani D
Published: July 2019

Palm oil mill effluent (POME) is a remarkably contaminating effluent that generated from three principle processes such as the sterilization, condensation, and hydrocyclone of palm oil in mills. The high biological oxygen demand (BOD), chemical oxygen demand (COD) and acidic pH of POME create an environmental issue if it is discharged into the aquatic and terrestrial ecosystem without treatment. However, by proper handling POME is also considered as a potential substrate for a renewable energy source. Biogas consisting mostly of methane and carbon dioxide has been produced using anaerobic digestion of POME. The process of biogas production involves the indigenous microbial community through hydrolysis, acidogenesis, acetogenesis, and methanogenesis. This study will elaborate on the potential of POME as a renewable energy source as well as the challenges and opportunities to develop biogas from POME in Indonesia. By proper handling and technology, from around (31 to 41) × 106 t of palm oil products in Indonesia from the year 2015 to 2017 it is theoretically calculated that 150.93 MW, 173.37 MW, and 203.92 MW of power plant capacity can be generated, respectively.
Fermentation quality of Pennisetum purpureum cv. Mott ensiled with Lactobacillus plantarum and sugarcane molasses in tropic
Authors: Wahyudi A , Hendraningsih L , Sutawi  , Setyobudi R H , Mel M
Published: July 2019

Fermentation quality of Pennisetum purpureum (Schumach) cv. Mott ensiled with Lactobacillus plantarum [(Orla-Jensen) Bergey et al.] and sugarcane molasses in tropical condition was evaluated. Approximately 100 g portion of wilted material chopped into 20 mm lengths packed into plastic film bags and sealed with a vacuum sealer. T0 was untreated silage, T1 silage with 50 μL L. plantarum without molasses, and T2, T3, and T4 treated silage with 50 μL L. plantarum and 1 %, 2 %, and 3 % molasses respectively. The bag silos were stored in room temperature (average 25 °C) for 30 d of incubation. This study showed the chemical characteristics were not significantly differ among treatments, eventhough T3 and T4 showed higher organic matter (OM) and water soluble carbohydrate (WSC) contents, meanwhile the highest crude protein (CP) was reached in T3. In general, molasses increased population of lactid acid bacteria (LAB) and decreased pathogen (coliform and aerob bacteria). The favour pH for silages (< 4) were only reached in addition 2 % and 3 % of molasses. It could be concluded that in tropical condition, L. plantarum it self could not improve silage quality. Addition 1 % to 3 % molasses improved silage quality, so that molasses were needed to improve fermentation quality of the grass silage with L. plantarum inoculation.
Menthol from the stem and leaf in-vitro Mentha piperita Linn.
Authors: Wijaya B K , Hardjo P H , Emantoko S
Published: July 2019

The need for menthol in Indonesia is increasing annually, but it is not followed by increases the availability in the country, so the number of imports is increasing each year. Therefore, in this research conducted a study using plant tissue culture techniques to produce secondary metabolite especially menthol using shoot multiplication. A single node of Mentha piperita L. was inoculated on three kinds of growth medium, which are MS + 0.1 mg L-1 NAA + 0.1 mg L-1 BA, MS + 0.5 mg L-1 BA, and MS + 2 mg L-1 BA. Based on fresh weight and morphological observation, MS + 0.1 mg L-1 NAA + 0.1 mg L-1 BA was the best growth medium. Based on the previous experiment, the study was aiming to continue observing the concentration of menthol found in M. piperita shoot. Stems and leaves of M. piperita were dried in room temperature, the dried stems and leaves were extracted using steam distillation method with ratio 0.3 g of dried stems and leaves in 25 mL aquadest. The crude extract was analyzed by gas chromatography (HP 6890) using INNOWAX 19095N-123 column. The results showed that 2 wk was the best amount of time to obtain the highest concentration of menthol specifically (1 218.5 ± 47.1) mg L−1 (yield = 9.748 %).
Physiology and genotyping of adaptive and sensitive oil palm progenies under unwatered stress condition
Authors: Yono D , Purwanti E , Sahara A , Nugroho Y A , Tanjung Z A , Aditama R , Dewi C , Sihotang A E , Utomo C , Liwang T
Published: July 2019

Increasing of dry areas for Oil Palm plantation due to climate change led the breeders to develop drought stress, tolerant palm. Characterization of genetic materials for their physiological and genetic properties is required. Two distinct progenies derived from Tanzanian origin used for more adaptive to unwatered stress, and Nigerian origin used for more sensitive, were subjected for analysis. Physiological related variables were observed for sap flow, water potential, soil water content, greenhouse temperature and relative humidity, stomatal density, stomatal pore width, and proline content. The Tanzanian origin has more stable in sap flow, longer water potential detected, more adaptive in stomatal closure, and a lower in proline content than Nigerian origins. The genome comparison of both materials was performed by double digest Restriction Associated DNA and captured 299 294 SNPs. It found 9.3 % of those SNPs that were having a different allele with a minor frequency between progenies. And, 0.7 % from filtered SNPs were located and distributed in 167 genes. Two SNP markers were located in aquaporin NIP1-1 gene that related to water translocation between cells. One SNP marker was located in glutamate receptor 2.7-like gene that related to glutamate release and proline biosynthesis. The remaining SNPs will be in further analyzed.
Callus induction and in vitro mass culture of adventitious roots from leaf segment explants of Dendropanax morbifera Lev.
Authors: Sukweenadhi J , Choi J Y , Kim Y J , Kaliraj L , Abid S , Ahn J C , Yang D C
Published: July 2019

Dendropanax morbifera Lev. is a unique species and natively found in Korea and distributed in the South regions, such as Jeju, Goheung, and Wando. In this study, tissue culture system for native D. morbifera was developed. The callus from native D. morbifera leaves was cultured on Woody Plant Media (WPM) supplemented with 30 g L−1 of sucrose, with addition of 2.4-D and bA [(0.5, 1.0, 2.0) mg L−1], separately and mixed. After 5 wk of culture, the highest induction of callus was obtained from 0.5 mg L−1 of 2.4-D mixed with 2.0 mg L1 of BA. Adventitious root formation on different media (MS, WPM, B5) with various auxins (IBA, IAA, and NAA) and different concentration [(0, 1, 3, 5) mg L−1] were tested. After 8 wk of culture, WPM showed better induction of adventitious root. The highest induction of adventitious root was obtained on 3.0 mg L−1 IBA. Root growth was best in WPM liquid medium with 3.0 mg L−1 of IBA and 30 g L−1 of sucrose. The same formulation with modified ½ WPM was successfully established in vitro adventitious roots culture in 18-L bioreactor system. This study also proposed as the mass production technique of adventitious roots from native D. morbifera.
Genome-wide identification of oil palm (Elaeis guineensis Jacq.) chitinases and their response to Ganoderma boninense Pat. infection
Authors: Aditama R , Tryono R , Tanjung Z A , Utomo C , Liwang T
Published: July 2019

The basal stem rot disease caused by Ganoderma boninense Pat. is a serious problem in oil palm plantation. Naturally, plant cells produce chitinases to protect themselves from chitin-containing parasites, particularly fungi. This study employed the advance of sequencing technology and availability of oil palm genomic and transcriptomic data to identify all chitinases in oil palm genome. Homology study using the combination of BLAST and HMM methods successfully identified 35 chitinases in oil palm which comprised of 22 GH18 and 13 GH19 family members. A multiple sequence alignment method classified those chitinases into class I, II, III, IV, V, VII and an unknown class. Chitinase domains analysis against PFAM databases showed more than half of chitinases possess partial domains of GH 18 or GH 19 in their sequences. Transcriptome analysis revealed that most of GH 18 family members were expressed specifically in roots under G. boninense infection treatment. Differently, most of GH 19 members were expressed constitutively in any tissues and under biotic stress conditions. This suggests that some GH 18 members might play an important role during host defence mechanism
Legal Change in the Face of Risk-Averse Subjects: A Generalization of the Theory
Authors: Franzoni Luigi Alberto
Published: July 2019

This study investigates the optimal nature of lawmaking under uncertainty. I focus on a case in which a harmful activity will be subjected to some regulatory measures (a standard, exposure to liability, or a corrective tax). The benefits and costs of precaution are ex ante uncertain, and this places a risk burden on both injurers and victims. The optimal policy should, at the same time, strike a balance between benefits and costs of the measures, and attenuate the ex ante risk. Whether measures should be made stronger or softer depends on the size and the sign of the shocks affecting the parties (positive or negative) and their disposition towards risk. With corrective taxes, it also depends on the elasticity of precautions with respect to the tax rate.
Functional analysis of the heterotrimeric NF-Y transcription factor complex in cassava disease resistance
Authors: He Xinyi , Liu Guoyin , Li Bing , Xie Yanwei , Wei Yunxie , Shang Sang , Tian Libo , Shi Haitao
Published: July 2019

Background and Aims

The nuclear factor Y (NF-Y) transcription factor complex is important in plant growth, development and stress response. Information regarding this transcription factor complex is limited in cassava (Manihot esculenta). In this study, 15 MeNF-YAs, 21 MeNF-YBs and 15 MeNF-YCs were comprehensively characterized during plant defence.

Methods

Gene expression in MeNF-Ys was examined during interaction with the bacterial pathogen Xanthomonas axonopodis pv. manihotis (Xam). The yeast two-hybrid system was employed to investigate protein–protein interactions in the heterotrimeric NF-Y transcription factor complex. The in vivo roles of MeNF-Ys were revealed by virus-induced gene silencing (VIGS) in cassava.

Key Results

The regulation of MeNF-Ys in response to Xam indicated their possible roles in response to cassava bacterial blight. Protein–protein interaction assays identified the heterotrimeric NF-Y transcription factor complex (MeNF-YA1/3, MeNF-YB11/16 and MeNF-YC11/12). Moreover, the members of the heterotrimeric NF-Y transcription factor complex were located in the cell nucleus and conferred transcriptional activation activity to the CCAAT motif. Notably, the heterotrimeric NF-Y transcription factor complex positively regulated plant disease resistance to Xam, confirmed by a disease phenotype in overexpressing plants in Nicotiana benthamiana and VIGS in cassava. Consistently, the heterotrimeric NF-Y transcription factor complex positively regulated the expression of pathogenesis-related genes (MePRs).

Conclusions

The NF-Y transcription factor complex (MeNF-YA1/3, MeNF-YB11/16 and MeNF-YC11/12) characterized here was shown to play a role in transcriptional activation of MePR promoters, contributing to the plant defence response in cassava.
Flowers up! The effect of floral height along the shoot axis on the fitness of bat-pollinated species
Authors: Diniz Ugo M , Domingos-Melo Arthur , Machado Isabel Cristina
Published: July 2019

Background and Aims

Bat-pollination is an important system in terms of occurrence and distribution, although it remains little studied. Thus, the role of particular flower traits in this interaction remains uncertain. Flower height along the shoot axis, associated with flower exposure, has often been deemed a key trait in this system, but its effect on fitness has not previously been assessed. We aimed to test its role and propose that taller flowers attain higher fitness due to a higher degree of accessibility and conspicuity to foraging bats.

Methods

We assessed the effect of floral height on bat visiting rates to individual flowers of Crescentia cujete (Bignoniaceae), a cauliflorous model bat-pollinated species with a marked gradient in flower height along the shoot axis. Additionally, we tested the effect of this variable on seed/ovule ratio measurements from seven other species from different families along a herb–tree gradient. Hypotheses were tested through mixed-effect linear models.

Key Results

Bat visiting rates varied positively as a function of flower height in C. cujete, but significance was found only for the subset of flowers located on the trunk, closer to the ground. Similarly, seed/ovule ratios were positively correlated with flower height only for the three species with the shortest statures along the height gradient and shortest average floral heights. These results suggest that proximity to the ground, associated with herbaceous or bushy surrounding vegetation, may be an obstacle to the foraging of nectar-feeding bats, which in turn should explain the morphological convergence of inflorescence length and exposure strategies of short-statured bat-pollinated plants.

Conclusions

Flower height has a species-specific effect on plant fitness. This study provides a novel numerical perspective to the role of an unexplored trait in bat-pollination, and has elucidated some aspects of the adaptive importance of flower height based on limitations imposed by ecologically complex pollinators.
Ontogenetic and ecotypic variation in the coloration and morphology of rainbow trout (Oncorhynchus mykiss) in a stream–lake system
Authors: Arostegui M C , Quinn T P
Published: July 2019

Alternative ecotypes of diverse animal taxa exhibit distinct, habitat-specific phenotypes. Rainbow trout (Oncorhynchus mykiss), a salmonid fish, exhibits stream-resident (fluvial), lake-migrant (adfluvial) and ocean-migrant (anadromous) ecotypes throughout its range. We investigated the coloration, and morphology associated with swimming performance of wild, native non-anadromous rainbow trout in connected stream and lake habitats of a south-west Alaskan watershed to assess if they exhibited phenotypic diversity consistent with the presence of alternative fluvial and adfluvial ecotypes. Colour differences among rainbow trout of different size classes and habitats (stream or lake) indicated ecotype-specific pathways, diverging at the same point in ontogeny and resulting in different terminal coloration patterns. Specifically, lake-caught fish exhibited distinct silvering of the body, whereas stream-caught fish displayed banded coloration when small and bronze colour when larger. The morphology of lake-caught rainbow trout also differed from that of stream-caught fish in features associated with swimming performance, and they exhibited both shared and unique morphological patterns compared to sympatric Salvelinus species in those habitats [Dolly Varden (S. malma) in streams, and Arctic char (S. alpinus) in the lake]. Greater morphological variation within stream- than lake-caught rainbow trout, and their limited overlap in morphology, suggested population-specific partial migration. This study highlights the intraspecific diversity of migratory behaviour and how conservation of particular phenotypes depends on managing both for genotypes and for habitats.
Bioethics and Human Flourishing: Christian Wisdom in a Secular Age
Authors: Iltis Ana
Published: July 2019

The gulf between Christian and secular bioethics has far-reaching implications for public policy, healthcare organizations, clinicians, and patients and their families. There also are significant differences among various Christian approaches to bioethics. Differences and similarities between Christian and secular bioethics as well as among Christian approaches to bioethics are evident across three domains explored in this issue of Christian Bioethics. The first concerns different approaches to or methods for resolving ethical questions. The second concerns the ways in which understandings of health and disease and human anthropology shape our judgments about what we may do in the pursuit of health or in response to disease. The third concerns how our perceptions of and regard for others affect judgments of moral worth and can influence healthcare decision-making.
Purpose and Providence: An Outline for Christian Practical Wisdom in Health Care
Authors: Kaldjian Lauris Christopher
Published: July 2019

Decision-making in health care is often challenging and therefore requires practical wisdom. The domains of such wisdom involve goals, perception, ethics, deliberation, and motivation. For Christian patients, there is a need for practical wisdom founded on Christian commitments that shape and guide these domains according to a Christian understanding of life, health, technology, illness, suffering, and death. In this essay, I outline a Christian approach to practical wisdom in health care by infusing Christian beliefs and values into a general framework for practical wisdom in medicine I have described previously. I organize this approach by referring to Christian purpose, vision, ethics, piety, and practice. The result is a framework that intends to integrate faith and reason so that what we believe as Christians forms how we think about health and guides what we choose or decline when considering the possibilities that come before us in health care.
Association between marital status and insomnia-related symptoms: findings from a population-based survey in Japan
Authors: Kawata Yumi , Maeda Mitsuya , Sato Tomoyo , Maruyama Koutatsu , Wada Hiroo , Ikeda Ai , Tanigawa Takeshi
Published: July 2019

Background

Marital status is one of the socio-economic factors associated with health. Several studies have indicated a significant association between marital status and insomnia. The increases in the percentages of unmarried people in Japan are expected to produce a significant impact on insomnia. The purpose of this study was to examine the association between marital status and insomnia.

Methods

The participants were 35 288 people aged 30–59 years selected from the 2010 comprehensive survey of living conditions. We categorized marital status into five groups: single, married couples living with other family members, married couples living without other family members, widowed and divorced. Insomnia-related symptoms (IRS) were based on the participants who chose the answer, ‘I couldn’t sleep’. Sex-specific multivariable odds ratios (ORs) and 95% confidence intervals (CI) of IRS according to marital status were calculated using the logistic regression model, which was adjusted for potential confounding factors.

Results

The proportions of people with IRS were 2.5% in men and 2.8% in women. The multivariable ORs (95% CI) were 1.15 (0.89–1.49) for single, 1.69 (1.11–2.58) for divorced and 1.01 (0.73–1.39) for married couples living without other family members in men, and 1.56 (1.20–2.03) for single, 2.43 (1.83–3.22) for divorced and 1.31 (1.01–1.71) for married couples living without other family members in women.

Conclusions

We found divorced men and single, divorced and married women living without other family members had higher IRS than those who were married couples living with other family members in Japanese. This association was more evident in unemployed men.
Effects of Arbuscular Mycorrhiza Fungi on the Growth Characteristics, Root Morphology, and Ion Distribution of Pyrus betulaefolia Bunge under Saline-Alkaline Stress
Authors: Yang Xiuyan , Li Huanyong , Jiang Lei , Tang Xiaoqian , Liu Xiaowei , Zhang Huaxin
Published: July 2019

In this study, Pyrus betulaefolia Bunge seedlings were used to investigate the effects of an arbuscular mycorrhiza fungus (AMF; Funneliformis mosseae) on plant-growth characteristics, root morphology, salt tolerance, and ion distribution under saline-alkaline stress. An indoor pot experiment was conducted in which seedlings were inoculated with Funneliformis mosseae under treatments of four different concentrations of Na2CO3 solution. The results show that AMF could establish symbiotic relations with the P. betulaefolia root system under Na2CO3 stress. Under the same Na2CO3 stress, AMF significantly increased the height growth and biomass accumulation of P. betulaefolia seedlings. AMF also promoted the root growth of P. betulaefolia seedlings. AMF inoculation significantly affected the absorption and distribution of K+ and Na+ in P. betulaefolia. The K/Na ratios in the roots and leaves of seedlings inoculated with AMF were higher than those of seedlings without inoculation. The results of this study show that inoculation with AMF had a positive effect on enhancing the saline-alkaline tolerance of P. betulaefolia, and root treatment of P. betulaefolia seedlings with Funneliformis mosseae has the potential for application in the development of saline-alkaline soil vegetation.
Primary angiosarcoma of the breast presenting with a benign vascular skin-like lesion and expanding hematoma: a case report of an extremely rare tumor
Authors: Burusapat Chairat , wongprakob Nutthadon , Sapruangthong Rapeepat , Pruksapong Chatchai , Kaewkangsadan Viriya , Wongchansom Kittisak , Satayasoontorn Kantang
Published: July 2019

Primary breast angiosarcoma is an extremely rare tumor type (0.05% of primary breast cancers) for which diagnosis can be difficult. They arise within the breast parenchyma and typically present as a breast mass. Here, we present the case of a 30-year-old female with spontaneous hypervascular skin on her right breast with progressive enlargement presenting as an expanding hematoma. A chest computed tomography revealed a hypervascular mass in the right breast abutting the pectoralis muscle and cystic changes within the mass. A core needle biopsy revealed an angiosarcoma. In this case study, we report a patient who, with no history of any known risk factors, presented with a benign vascular skin lesion as the first sign of angiosarcoma followed by an expanding hematoma, which is an extremely rare manifestation of the disease. Microscopic examination demonstrated a low-grade angiosarcoma on the skin, while a high-grade angiosarcoma was found in the breast parenchyma.
Serum magnesium, hepatocyte nuclear factor 1β genotype and post-transplant diabetes mellitus: a prospective study
Authors: van der Burgh Anna C , Moes Arthur , Kieboom Brenda C T , van Gelder Teun , Zietse Robert , van Schaik Ron H N , Hesselink Dennis A , Hoorn Ewout J
Published: July 2019

Background

Retrospective studies suggest that tacrolimus-induced hypomagnesaemia is a risk factor for post-transplant diabetes mellitus (PTDM), but prospective studies are lacking.

Methods

This was a prospective study with measurements of serum magnesium and tacrolimus at pre-specified time points in the first year after living donor kidney transplantation (KT). The role of single nucleotide polymorphisms (SNPs) in hepatocyte nuclear factor 1β (HNF1β) was also explored because HNF1β regulates insulin secretion and renal magnesium handling. Repeated measurement and regression analyses were used to analyse associations with PTDM.

Results

In our cohort, 29 out of 167 kidney transplant recipients developed PTDM after 1 year (17%). Higher tacrolimus concentrations were significantly associated with lower serum magnesium and increased risk of hypomagnesaemia. Patients who developed PTDM had a significantly lower serum magnesium trajectory than patients who did not develop PTDM. In multivariate analysis, lower serum magnesium, age and body mass index were independent risk factors for PTDM. In recipients, the HNF1β SNP rs752010 G > A significantly increased the risk of PTDM [odds ratio (OR) = 2.56, 95% confidence interval (CI) 1.05–6.23] but not of hypomagnesaemia. This association lost significance after correction for age and sex (OR = 2.24, 95% CI 0.90–5.57). No association between HNF1β SNPs and PTDM was found in corresponding donors.

Conclusions

A lower serum magnesium in the first year after KT is an independent risk factor for PTDM. The HNF1β SNP rs752010 G > A may add to this risk through an effect on insulin secretion rather than hypomagnesaemia, but its role requires further confirmation.
An unusual case of deep venous thrombosis in a young patient: congenital absence of the infrarenal portion of the inferior vena cava
Authors: Osborne Thomas , Sheehan Frances
Published: July 2019

Deep venous thrombosis (DVT) is a commonly encountered diagnosis in clinical practice with a variety of well-established risk factors. Congenital absence of the inferior vena cava (IVC) is an extremely rare but established risk factor for DVT. Patients who develop DVTs are at high risk of long-term complications, including DVT recurrence and post-thrombotic syndrome. Here we report a rare case of a 27-year-old female who presented with an extensive DVT of the right lower extremity secondary to complete absence of the infrarenal portion of the IVC, confirmed on computed tomography. There is little consensus regarding the appropriate management of this patient population, and a brief review of the current evidence follows.
Breast abscess in a competitive high school swimmer: a case of toxic shock syndrome
Authors: Taylor Gregory M , Vieder Sanford J , Cooley Christopher N , Fan Wiley C , Alper Michael E
Published: July 2019

Toxic shock syndrome (TSS) is a severe, acute, toxin-mediated disease process characterized by fever, diffuse erythroderma, hypotension, multisystem organ dysfunction and desquamation of skin. TSS represents the most severe form of disease caused by exotoxin-producing strains of Streptococcus pyogenes and Staphylococcus aureus. Menstrual and non-menstrual TSS become significant causes of morbidity and mortality. As a result of public awareness and various campaigns, the majority of TSS cases tend to be non-menstrual related. The clinical course is fulminant and can result in abrupt decompensation and death. Management within the emergency department (ED) includes removal of the potential foreign body, fluid resuscitation, appropriate antibiotics, potential vasopressor support and possible surgical intervention. We present the unique case of a 16-year-old female competitive swimmer who presented to the ED twice, demonstrating the fulminant course of TSS. She initially presented with non-specific symptoms with an unremarkable evaluation. She returned within hours of discharge with an abrupt onset of diffuse macular erythroderma, placed on norepinephrine and was diagnosed with TSS secondary to a breast abscess.
Altered structural brain network resulting from white matter injury in obstructive sleep apnea
Authors: Lee Min-Hee , Yun Chang-Ho , Min Areum , Hwang Yoon Ho , Lee Seung Ku , Kim Dong Youn , Thomas Robert J , Han Bong Soo , Shin Chol
Published: July 2019

Study Objectives

To assess, using fractional anisotropy (FA) analysis, alterations of brain network connectivity in adults with obstructive sleep apnea (OSA). Abnormal networks could mediate clinical functional deficits and reflect brain tissue injury.

Methods

Structural brain networks were constructed using diffusion tensor imaging (DTI) from 165 healthy (age 57.99 ± 6.02 years, male 27.9%) and 135 OSA participants (age 59.01 ± 5.91 years, male 28.9%) and global network properties (strength, global efficiency, and local efficiency) and regional efficiency were compared between groups. We examined MRI biomarkers of brain tissue injury using FA analysis and its effect on the network properties.

Results

Differences between groups of interest were noted in global network properties (p-value < 0.05, corrected), and regional efficiency (p-value < 0.05, corrected) in the left middle cingulate and paracingulate gyri, right posterior cingulate gyrus, and amygdala. In FA analysis, OSA participants showed lower FA values in white matter (WM) of the right transverse temporal, anterior cingulate and paracingulate gyri, and left postcentral, middle frontal and medial frontal gyri, and the putamen. After culling fiber tracts through WM which showed significant differences in FA, we observed no group difference in network properties.

Conclusions

Changes in WM integrity and structural connectivity are present in OSA participants. We found that the integrity of WM affected brain network properties. Brain network analysis may improve understanding of neurocognitive deficits in OSA, enable longitudinal tracking, and provides explanations for specific symptoms and recovery kinetics.
Preadmission Statin Use and 90-day Mortality in the Critically Ill
Authors: Kyu Oh Tak , Song In-Ae , Lee Jae Ho , Lim Cheong , Jeon Young-Tae , Bae Hee-Joon , Jo You Hwan , Jee Hee-Jung
Published: July 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

This study aimed to examine the association between preadmission statin use and 90-day mortality in critically ill patients and to investigate whether this association differed according to statin type and dose. We hypothesized that preadmission statin use was associated with lower 90-day mortality.

Methods

This retrospective cohort study analyzed the medical records of all adult patients admitted to the intensive care unit in a single tertiary academic hospital between January 2012 and December 2017. Data including preadmission statin use, statin subtype, and daily dosage were collected, and the associations between these variables and 90-day mortality after intensive care unit admission were examined. The primary endpoint was 90-day mortality.

Results

A total of 24,928 patients (7,396 statin users and 17,532 non–statin users) were included. After propensity score matching, 5,354 statin users and 7,758 non–statin users were finally included. The 90-day mortality rate was significantly higher in non–statin users (918 of 7,758; 11.8%) than in statin users (455 of 5,354; 8.5%; P < 0.001). In Cox regression analysis, the 90-day mortality rate was lower among statin users than among non–statin users (hazard ratio: 0.70, 95% CI: 0.63 to 0.79; P < 0.001). Rosuvastatin use was associated with 42% lower 90-day mortality (hazard ratio: 0.58, 95% CI: 0.47 to 0.72; P < 0.001). There were no specific significant differences in the association between daily statin dose and 90-day mortality. In competing risk analysis, the risk of noncardiovascular 90-day mortality in statin users was 32% lower than that in non–statin users (hazard ratio: 0.68, 95% CI: 0.60 to 0.78; P < 0.001). Meanwhile, cardiovascular 90-day mortality was not significantly associated with statin use.

Conclusions

Preadmission statin use was associated with a lower 90-day mortality. This association was more evident in the rosuvastatin group and with noncardiovascular 90-day mortality; no differences were seen according to daily dosage intensity.
SFKs/p38 Pathway is Involved in Radicular Pain by Promoting Spinal Expression of Pro-Inflammatory Cytokines in a Rat Model of Lumbar Disc Herniation
Authors: Zhong Yi , Huang Yangliang , Hu Yuming , Xu Mingxian , Zhu Lirong , Deng Zhen
Published: July 2019

Study Design.

A controlled, randomized, animal study.

Objective.

The aim of this study was to investigate the role of src-family kinases/p38 pathway in a rat model of lumbar disc herniation (LDH).

Summary of Background Data.

LDH always generates radicular pain, and the mechanism remains unclear. We have reported that spinal src-family kinases (SFKs) may be involved in the process, but the downstream mechanism needs further investigation.

Methods.

LDH was induced by implantation of autologous nucleus pulposus (NP), harvest from the tail, in lumbar 4/5 spinal nerve roots of rat. Von Frey filaments and radiant heat tests were performed to determine mechanical and thermal pain threshold respectively. Basso, Beattie, and Bresnahan (BBB) scale was assessed to test the locomotor function. The protein level of p-SFKs, t-SFKs, p-p38, t-p38 in spinal cord was examined by western blotting analysis. Cellular location of p-p38 was determined by immunochemistry staining. Spinal tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, and IL-6 levels were detected by enzyme-linked immunosorbent assay (ELISA).

Results.

Rats with NP implantation showed persistent ipsilateral mechanical allodynia and thermal hyperalgesia, which manifested as obvious decrease of paw withdrawal threshold (PWT) and paw withdrawal latency (PWL). BBB scale indicated the locomotor function of hindpaws in rats with NP implantation kept intact. Western blotting and immunohistochemistry staining revealed that phosphorylated SFKs (p-SFKs) and phosphorylated p38 MAPK (p-p38) were sequentially upregulated in ipsilateral spinal dorsal horn, but not in contralateral side of rats with NP. Intrathecal delivery of SFKs inhibitor reduced spinal p-p38 expression. Both SFKs and p38 inhibitors alleviated pain behaviors in a dose-responsive manner without disturbing locomotor function and reduced spinal expression of TNF-α, IL-1β, and IL-6 in rats with NP.

Conclusion.

Spinal SFKs contribute to radicular pain by activation of p38 MAPK and increasing pro-inflammatory cytokines expression in rats with NP implantation. Targeting SFKs/p38 pathway may be helpful for alleviating radicular pain.

Level of Evidence: N/A
Marginal zone lymphomas: second most common lymphomas in older patients
Authors: Bron Dominique , Meuleman Nathalie
Published: July 2019

Purpose of review

Choosing an optimal treatment in older patients with indolent lymphomas is a challenge for hematooncologists. They must concomitantly treat some potentially curable entities, manage other symptomatic incurable diseases and protect their patients from life-threatening toxicities. Specific recommendations for older patients with different subtypes of marginal zone lymphomas are thus required in terms of treatment and supportive care.

Recent findings

All the data in the literature agree that the therapeutic approach of older patients with malignant hemopathies should include the appraisal of their life expectancy and of the prognostic factors of their tumor, the evaluation of their physiological and cognitive functions and their socioeconomic environment, and their expectancy in terms of quality of life. Major progresses have, therefore, been achieved in the management of lymphoma patients of 80 years and older.

With an optimal ‘geriatric assessment’, most of the recommended treatments are also appropriate in older marginal zone lymphoma patients. Extranodal MALT lymphoma: eradication of the pathogen is a major part of the first-line therapy. Prognosis is excellent in early stages. In advanced stages, observation and anti-CD20 antibodies with or without cytostatic drugs are recommended. Nodal MZL: Usually confined to lymph nodes, bone marrow and peripheral blood, they should be managed as follicular lymphomas. Splenic MZL: in this unique entity involving the spleen, the bone marrow and the peripheral blood. Hepatitis infection should be eradicated before considering treatment. Only symptomatic patients require to be treated by splenectomy and/or anti-CD20 antibodies.
Molecular screening programs in different countries: what we learned and perspectives
Authors: Borcoman Edith , Le Tourneau Christophe , Kamal Maud
Published: July 2019

Purpose of review

Precision medicine arised as a new paradigm in oncology in which molecular profiling aims at guiding therapy in oncology. The implementation of precision medicine necessitates setting up molecular tumor boards (MTBs) that coordinate the workflow of tumor samples to efficiently seek for actionable molecular alterations. We review here the main precision medicine initiatives that involve MTBs and decipher challenges that still need to be overcome along with future perspectives for a broader implementation of precision medicine in routine patient care.

Recent findings

MTBs have been implemented in multiple countries. They identify actionable molecular alteration in up to 50% of patients. However, around 10–20% receive matched therapy and less than 6% of patients experience an objective response. The challenges that need to be overcome for a successful implementation of precision medicine include an earlier molecular profiling of patients during their disease course, the use of liquid biopsies that allow sequential analyses, along with more exhaustive gene panels and extended access to drugs.

Molecular screening programs allow to successfully guiding patients to individualized therapy in a minority of patients, and few patients actually benefit from these programs.
Application of SPY Angiography in the Management of a Chronic Sternal Wound
Authors: Lu Karen B. , Sanniec Kyle , Amirlak Bardia
Published: July 2019

The SPY angiography system has several surgical uses. Often, surgeons may experience difficult cases in which the viability and perfusion of tissue is questioned. By using the SPY angiography system intraoperatively, this system may provide additional information allowing the surgeon to make calculated real-time decisions which may lead to improved patient outcomes. This study describes a case of a chronic sternal wound treated with reconstruction using intraoperative SPY angiography. Adequate perfusion of the flap was determined via SPY angiography intraoperatively. The flap was thereafter successfully utilized to cover the chronic wound. The patient was followed postoperatively with progression of wound closure. Sternal wounds often pose a complex problem for patients and physicians. The use of intraoperative SPY angiography provided critical information to the operating team allowing for the successful identification of a viable flap. The use of SPY angiography provided the patient an opportunity to achieve a successful outcome and reduced the risk of skin necrosis or reoperation.
Getting Better Results in Facelifting
Authors: Rohrich Rod J. , Sinno Sammy , Vaca Elbert E.
Published: July 2019

The facelift has significantly evolved over the past several decades. What was once considered a skin only operation is now a sophisticated, elegant procedure that requires meticulous preoperative analysis, understanding of underlying anatomically based aging changes, and extreme attention to detail. According to the American Society of Plastic Surgeons, 125,697 facelifts were performed in 2017. It is not surprising that given these advances that facial rejuvenation surgery is still a very common procedure with a high degree of patient satisfaction despite the increase in nonsurgical facial aging treatments. With an improved understanding of facial anatomy including the facial retaining ligaments and intervening superficial and deep fat compartments, the modern facelift requires an anatomically targeted approach. Furthermore, the modern facelift surgeon must achieve consistently excellent results with reasonably little downtime while being aware of methods to improve the safety of this popular elective procedure. Hematoma is the most common complication after rhytidectomy with an incidence between 0.9% and 9%, with a higher incidence in males. Other potential complications include seroma, nerve injury, skin flap necrosis, siaolocele as a consequence of submandibular gland debulking, and skin flap rhytid and hairline distortion. This review aims to discuss safe, consistent, and reproducible methods to achieve success with facelift.
Sensitivity and Specificity of the Stemmer Sign for Lymphedema: A Clinical Lymphoscintigraphic Study
Authors: Goss Jeremy A. , Greene Arin K.
Published: July 2019

Background:

The Stemmer sign is a physical examination finding used to diagnose lymphedema. If the examiner cannot pinch the skin of the dorsum of the foot or hand then this positive finding is associated with lymphedema. The purpose of the study was to determine the accuracy of the Stemmer sign to predict lymphedema.

Methods:

All patients referred to our Lymphedema Program between 2016 and 2018 were tested for the Stemmer sign and underwent lymphoscintigraphy to define the patient’s lymphatic function. Patient age, lymphedema type (primary and secondary), disease location (arm and leg), lymphoscintigraphy findings, stage, severity, and body mass index were recorded. Comparison of predictive variables and Stemmer sign result was performed using Fisher’s exact test and Student’s t test.

Results:

One hundred ten patients were studied: patients with a positive Stemmer sign (n = 87) exhibited abnormal (n = 80) or normal (n = 7) lymphatic function by lymphoscintigraphy (sensitivity = 92%). False-positive Stemmer signs included individuals with obesity (n = 6) or spinal muscle atrophy (n = 1). Subjects with a negative Stemmer sign (n = 23) had normal (n = 13) or abnormal (n = 10) lymphatic function by imaging (specificity = 57%). Patients with a false-negative Stemmer sign were more likely to have a normal body mass index (P = 0.02) and Stage 1 disease (P = 0.01).

Conclusions:

A positive Stemmer sign is a sensitive predictor for primary and secondary lymphedema of the arms or legs and, thus, is a useful part of the physical examination. Because the test exhibits moderate specificity, lymphoscintigraphy should be considered for patients with a high suspicion of lymphedema that have a negative Stemmer sign.
Psychological perspectives to early surgery in the management of disorders/differences of sex development
Authors: Wisniewski Amy B. , Tishelman Amy C.
Published: July 2019

Purpose of review

The review focuses on genitoplasty, performed on young children with disorders/differences of sex development (DSD) to ‘typify’ ambiguous external genitalia and intended to result in either male or female-appearing genitals. Consensus on whether or not early genitoplasty is optimal or appropriate has yet to be achieved. This article reviews arguments in favor of early surgery as well as those disputing their justification.

Recent findings

Arguments supporting early genitoplasty include the assumption that a child's genital anatomy should match their gender of rearing for optimal psychosocial development and that outcomes are better physically and psychologically than when surgery is deferred. Those disputing their justification argue that they deny patients the right to participate in irreversible decisions related to anatomy and gender, revoke the possibility of an open future, and violate basic human rights. Clinical management includes recommendations for interdisciplinary care integrating psychologists, and shared decision-making processes to assist families in carefully considering options.

Early genital surgery in DSD care is controversial with compelling arguments put forth by both proponents and opponents. Relevant issues can be examined from ethical, psychological, cultural and medical perspectives – all of which need to be accounted for in both research and standard of care development.