bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical and situational inequality on airplanes predicts air rage
Authors: DeCelles Katherine A. , Norton Michael I.
Published: May 2016

Significance

We suggest that physical and situational inequality are built into people’s everyday environments—such as the modern airplane—and that exposure to these forms of inequality can trigger antisocial behavior. Analyses reveal that air rage is more common in economy class on airplanes, where inequality is physically present, and in both economy and first class when inequality is situationally salient. We extend research demonstrating that the salience of inequality decreases prosocial behavior by higher class individuals, showing that temporary exposure to physical and situational inequality predicts antisocial behavior among individuals in both higher and lower classes. Moreover, we explore a novel predictor of inequality-induced antisocial behavior—the design of physical environments—augmenting research on macrostructural forms of inequality.
Living biofouling-resistant membranes as a model for the beneficial use of engineered biofilms
Authors: Wood Thammajun L. , Guha Rajarshi , Tang Li , Geitner Michael , Kumar Manish , Wood Thomas K.
Published: May 2016

Significance

Biofouling is a significant problem for membrane-based systems because it reduces flow and increases energy consumption. This work shows a previously unreported approach to prevent membrane biofouling by using a beneficial biofilm. The beneficial strain was engineered to have a dispersal “feedback circuit,” based on secretion and uptake of a communication signal, limiting its own biofilm formation by self-monitoring and selective dispersal. The beneficial strain was also engineered to produce nitric oxide, which prevents biofilm formation by harmful bacteria; biofouling by the two most prevalent organisms was shown to be controlled by the beneficial strain. Moreover, the beneficial biofilm was engineered to produce an evolved epoxide hydrolase to enable it to remove the environmental pollutant epichlorohydrin.
Spontaneous recovery of superhydrophobicity on nanotextured surfaces
Authors: Prakash Suruchi , Xi Erte , Patel Amish J.
Published: May 2016

Significance

Due to its aversion to the hydrophobic surface texture, a water droplet makes minimal contact with, and readily rolls off of, a superhydrophobic surface, conferring it with beneficial properties such as water repellency and self-cleaning. However, the surface texture can readily wet in response to conditions such as elevated pressures, leading to a breakdown of superhydrophobicity that is widely believed to be irreversible. By using specialized molecular simulations to study surfaces with nanoscale texture, here we find that the dewetting of the surface texture is strongly influenced by water density fluctuations. Furthermore, an understanding of the dewetting pathways allows us to design novel surface textures on which fluctuations can facilitate a spontaneous recovery of superhydrophobicity.
Structure of a prereaction complex between the nerve agent sarin, its biological target acetylcholinesterase, and the antidote HI-6
Authors: Allgardsson Anders , Berg Lotta , Akfur Christine , Hörnberg Andreas , Worek Franz , Linusson Anna , Ekström Fredrik J.
Published: May 2016

Significance

Enzymatic reactions can be difficult to study using X-ray crystallography, because conformations and reacting species are temporally and spatially averaged, and many reactions proceed to completion before intermediates can be trapped. Here, we describe the combined use of diffusion trap cryocrystallography, density functional theory calculations, and kinetic measurements to investigate the reactivation of the essential cholinergic enzyme acetylcholinesterase by the nerve agent antidote HI-6 after covalent inhibition by the nerve agent sarin. We have determined prereaction conformations of HI-6 and propose that the reactivating cleavage of the enzyme–sarin bond is preceded by a change in the sarin adduct’s binding pose. The structures presented in this work will facilitate additional mechanistic analysis and the development of novel antidotes.
Strain-enhanced stress relaxation impacts nonlinear elasticity in collagen gels
Authors: Nam Sungmin , Hu Kenneth H. , Butte Manish J. , Chaudhuri Ovijit
Published: May 2016

Significance

The extracellular matrix is a complex assembly of structural proteins that provides physical support and biochemical signaling to cells within our tissues. One of the key structural components of the extracellular matrix is collagen, and matrices of collagen exhibit remarkable mechanical properties. Their resistance to deformation is enhanced as deformation is increased over short timescales, a behavior termed strain stiffening, yet they exhibit some characteristics of viscous fluids at longer timescales. Strikingly, we show that the strain stiffening of collagen matrices is coupled with their liquid-like behavior: at greater deformations, these matrices become stiffer but then flow more rapidly to relax this increase in stiffness. These complex mechanical behaviors are likely to be relevant to cellular interactions with these matrices.
Peptidoglycan-linked protein A promotes T cell-dependent antibody expansion duringStaphylococcus aureusinfection
Authors: Kim Hwan Keun , Falugi Fabiana , Missiakas Dominique M. , Schneewind Olaf
Published: May 2016

Significance

Staphylococcus aureusinfection of humans is associated with immunoglobulin expansions but not with the development of immunity against recurrent disease. The mechanism whereby staphylococci manipulate the host immune system to block adaptive immunity is not known. We show here thatS. aureusinfection of mice is also associated with immunoglobulin expansions and that staphylococcal protein A (SpA), a molecule that cross-links B-cell receptors, is both necessary and sufficient for this immune evasion mechanism. Further, SpA requires covalent linkage to bacterial peptidoglycan and CD4 T-cell help to manipulate the immunoglobulin responses of infected hosts. Our results provide insights into microbial signaling mechanisms for B-cell activation and antibody development.
Extreme cellular adaptations and cell differentiation required by a cyanobacterium for carbonate excavation
Authors: Guida Brandon Scott , Garcia-Pichel Ferran
Published: May 2016

Significance

Microorganisms can play a significant role as agents of erosion. Euendolithic cyanobacteria, photosynthetic microorganisms that bore their way into carbonate substrates, are among the most important bioerosive agents known. The mechanism by which they dissolve and excavate carbonate rocks has remained a mystery for decades, but is now known to involve calcium transport from cell to cell. Herein we show that the mechanism involves two adaptations unprecedented in prokaryotic biology: the polar placement of calcium and proton transporting enzymes in a manner that is coordinated between cells and the differentiation of a novel type of cell that is able to accumulate calcium at levels some 500-fold those found in normal cells.
Roles for ROS and hydrogen sulfide in the longevity response to germline loss in
Caenorhabditis elegans
Authors: Wei Yuehua , Kenyon Cynthia
Published: May 2016

Significance

Signals from reproductive tissues and germ cells influence the lifespans of many organisms, including mammals. How germ cells, which give rise to the next generation, control the aging of the animal in which they reside is poorly understood. Counter-intuitively, we found that removing germ cells in
Caenorhabditis elegans
triggers the generation of two potentially toxic substances, reactive oxygen species and hydrogen sulfide, in nonreproductive somatic tissues. These substances, in turn, induce protective responses that slow aging.
DNA-based nanoparticle tension sensors reveal that T-cell receptors transmit defined pN forces to their antigens for enhanced fidelity
Authors: Liu Yang , Blanchfield Lori , Ma Victor Pui-Yan , Andargachew Rakieb , Galior Kornelia , Liu Zheng , Evavold Brian , Salaita Khalid
Published: May 2016

Significance

T cells protect the body against pathogens and cancer by recognizing specific foreign peptides on the cell surface. Because antigen recognition occurs at the junction between a migrating T cell and an antigen-presenting cell (APC), it is likely that cellular forces are generated and transmitted through T-cell receptor (TCR)-ligand bonds. Here we develop a DNA-based nanoparticle tension sensor producing the first molecular maps of TCR-ligand forces during T cell activation. We find that TCR forces are orchestrated in space and time, requiring the participation of CD8 coreceptor and adhesion molecules. Loss or damping of TCR forces results in weakened antigen discrimination, showing that T cells harness mechanics to optimize the specificity of response to ligand.
Mode of action uncovered for the specific reduction of methane emissions from ruminants by the small molecule 3-nitrooxypropanol
Authors: Duin Evert C. , Wagner Tristan , Shima Seigo , Prakash Divya , Cronin Bryan , Yáñez-Ruiz David R. , Duval Stephane , Rümbeli Robert , Stemmler René T. , Thauer Rudolf Kurt , Kindermann Maik
Published: May 2016

Significance

Methane emission from the ruminant livestock sector—a by-product from enteric fermentation of plant biomass in the ruminant digestive system—is produced by methanogenic archaea and represents not only a significant amount of anthropogenic greenhouse gases contributing to climate change but also an energy loss and a reduction in feed efficacy. The present study elucidates the development and the unique mode of action of the highly specific inhibitor 3-nitrooxypropanol (3-NOP), which is targeting the nickel enzyme methyl-coenzyme M reductase in rumen archaea that catalyzes the methane-forming reaction. At the very low effective concentrations recently applied in vivo (dairy and beef cattle), 3-NOP appears to inhibit only methanogens and thus to be attractive for development as a feed supplement.
Control of active liquid crystals with a magnetic field
Authors: Guillamat Pau , Ignés-Mullol Jordi , Sagués Francesc
Published: May 2016

Significance

Active liquid crystals are aqueous in vitro suspensions of cytoskeletal proteins that self-assemble into elongated fibers and develop sustained flows at the continuous expense of ATP. When they condense on soft interfaces, the aligned fibers organize into nonequilibrium analogs of passive liquid crystals. However, proteins do not respond to external electromagnetic fields, unlike liquid crystals, which are readily reconfigured inside devices. We demonstrate a reversible and biocompatible experimental protocol to align an active liquid crystal with a uniform magnetic field, allowing the transition between turbulent and laminar flow regimes. The active liquid crystal senses the interfacial viscous anisotropy of a lamellar hydrophobic liquid crystal, not unlike the adaptation of cells to the mechanical features of their environment.
PI3K-resistant GSK3 controls adiponectin formation and protects from metabolic syndrome
Authors: Chen Hong , Fajol Abul , Hoene Miriam , Zhang Bingbing , Schleicher Erwin D. , Lin Yun , Calaminus Carsten , Pichler Bernd J. , Weigert Cora , Häring Hans U. , Lang Florian , Föller Michael
Published: May 2016

Significance

The PI3 kinase-dependent inactivation of glycogen synthase kinase (GSK) 3 is an important aspect of normal insulin signaling. Surprisingly, transgenic mice expressing PI3 kinase-resistant GSK3 (gsk3
KI
) have been found not to be insulin-resistant. We show that gsk3
KI
mice are even protected from the development of metabolic syndrome characterized by insulin resistance, obesity, and dyslipidemia, which all could readily be induced by a high-fat diet in gsk3
WT
mice. The metabolic syndrome affects millions of patients and is associated with a high prevalence of cardiovascular disease and a significant reduction of life span. Exploring the underlying mechanism, we found that the production of the hormone adiponectin, which provides protection from metabolic syndrome, is controlled by a GSK3-dependent pathway.
Hsp70 biases the folding pathways of client proteins
Authors: Sekhar Ashok , Rosenzweig Rina , Bouvignies Guillaume , Kay Lewis E.
Published: May 2016

Significance

Hsp70 (70-kDa heat shock protein) chaperones bind cognate substrates to prevent their aggregation and guide them toward their correctly folded, functional states. Here we use NMR spectroscopy to understand how this is achieved by studying a complex of Hsp70 with a folding competent substrate. Using an NMR experiment presented here, we show that long-range transient contacts are established in the unfolded, unbound state of the substrate. These contacts are greatly attenuated in the bound form of the substrate that also exists as an unfolded ensemble. Our results establish that Hsp70 binding can significantly bias the folding mechanism of client substrate molecules toward pathways where secondary structure is first generated, followed by the establishment of longer-range interactions in a distance-dependent fashion.
Aquaporin gene therapy corrects Sjögren’s syndrome phenotype in mice
Authors: Lai Zhennan , Yin Hongen , Cabrera-Pérez Javier , Guimaro Maria C. , Afione Sandra , Michael Drew G. , Glenton Patricia , Patel Ankur , Swaim William D. , Zheng Changyu , Nguyen Cuong Q. , Nyberg Fred , Chiorini John A.
Published: May 2016

Significance

Recent reports of increases in the prevalence and incidence of autoimmune diseases make this disease group a pressing public health concern. Patients suffering from Sjögren’s syndrome experience debilitating oral and ocular dryness due to dysfunction within the salivary and lacrimal glands. Due to our lack of knowledge regarding the underlying mechanisms, no effective treatments are available and affected organs gradually degenerate. In this study, we identify the loss of water permeability as a mechanism associated with xerostomia in a subset of patients. We demonstrate that a novel therapy, aquaporin 1 replacement, can increase the water permeability of the gland and restore fluid movement while relieving the dry mouth and eye phenotypes associated with this disease in addition to disease-associated inflammation.
Imaging through plasmonic nanoparticles
Authors: Tanzid Mehbuba , Sobhani Ali , DeSantis Christopher J. , Cui Yao , Hogan Nathaniel J. , Samaniego Adam , Veeraraghavan Ashok , Halas Naomi J.
Published: May 2016

Significance

How is an image transmitted through a material consisting of subwavelength structures? We use two distinct methods to obtain quantitative answers to that question. The first, structural similarity index, is a method related to human perception, initially developed to quantify transmitted image quality following image compression in digital image transmission systems. The second method treats the medium as an optical component itself, where we determine the spatial frequency content of the image transmitted by the medium. This study opens the door to analyzing images transmitted through particulate media that absorb and/or scatter light, which applies generally to imaging systems whose components are composed of subwavelength structures, such as those composed of random particulates or nanoengineered flat-optics metasurface lenses.
Preventing diet-induced obesity in mice by adipose tissue transformation and angiogenesis using targeted nanoparticles
Authors: Xue Yuan , Xu Xiaoyang , Zhang Xue-Qing , Farokhzad Omid C. , Langer Robert
Published: May 2016

Significance

Obesity has been recognized by the American Medical Association to be a disease affecting significant portions of the population and is related to an expansion and proliferation of white adipose tissue (WAT) in the body. The primary function of WAT is to store energy, whereas brown adipose tissue (BAT) generates heat through energy expenditure. Transforming WAT into BAT is of tremendous interest for obesity treatment. Herein, we describe a targeted nanoparticle approach encapsulating either a PPARgamma activator or a prostaglandin E2 analog, each of which induces adipose tissue transformation and angiogenesis, facilitating the transformation of WAT into BAT. Targeted nanoparticles show antiobesity effects compared with free drug and the nontargeted nanoparticle controls in a mouse model.
Development of potent small-molecule inhibitors to drug the undruggable steroid receptor coactivator-3
Authors: Song Xianzhou , Chen Jianwei , Zhao Mingkun , Zhang Chengwei , Yu Yang , Lonard David M. , Chow Dar-Chone , Palzkill Timothy , Xu Jianming , O’Malley Bert W. , Wang Jin
Published: May 2016

Significance

Steroid receptor coactivator-3 (SRC-3) sits at the nexus of many intracellular signaling pathways critical for cancer formation and proliferation. Although the oncogenic role of SRC-3 has been well established in breast and other cancers, coactivators are usually considered as “undruggable” because of their large and flexible structures. Herein, we developed SI-2 as a new class of potent small-molecule inhibitors for SRC-3. SI-2 can selectively reduce the transcriptional activities and the protein concentrations of SRC-3 in cells and significantly inhibit primary tumor growth in a breast cancer mouse model. This work not only has the potential to improve breast cancer treatment, but also to provide a viable strategy to target often “undruggable but important” protein targets without ligand-binding sites.
Nitrogenase-mimic iron-containing chalcogels for photochemical reduction of dinitrogen to ammonia
Authors: Liu Jian , Kelley Matthew S. , Wu Weiqiang , Banerjee Abhishek , Douvalis Alexios P. , Wu Jinsong , Zhang Yongbo , Schatz George C. , Kanatzidis Mercouri G.
Published: May 2016

Significance

In nature, nitrogenase fixes nitrogen into biologically usable forms under ambient conditions. Today, half of the world’s nitrogen fixation is achieved through the industrial Haber–Bosch process, which operates at elevated temperature and pressure. Here, we present a synthetic nitrogenase mimic in the form of chalcogel composed of molybdenum and iron-containing biomimetic clusters that can accomplish photocatalytic N
2
fixation and conversion to NH
3
at ambient temperature and pressure. Surprisingly, the iron–sulfur chalcogels without molybdenum are observed to have a higher activity toward N
2
reduction. The results reported here will greatly expand the scope of materials design and engineering for the creation of highly active iron-based N
2
reduction catalysts operating in mild conditions.
Cell wall structure and biogenesis inAspergillusspecies
Authors: Yoshimi Akira , Miyazawa Ken , Abe Keietsu
Published: May 2016

Aspergillus species are among the most important filamentous fungi from the viewpoints of industry, pathogenesis, and mycotoxin production. Fungal cells are exposed to a variety of environmental stimuli, including changes in osmolality, temperature, and pH, which create stresses that primarily act on fungal cell walls. In addition, fungal cell walls are the first interactions with host cells in either human or plants. Thus, understanding cell wall structure and the mechanism of their biogenesis is important for the industrial, medical, and agricultural fields. Here, we provide a systematic review of fungal cell wall structure and recent findings regarding the cell wall integrity signaling pathways in aspergilli. This accumulated knowledge will be useful for understanding and improving the use of industrial aspergilli fermentation processes as well as treatments for some fungal infections.
Wasabi leaf extracts attenuate adipocyte hypertrophy through PPARγ and AMPK
Authors: Oowatari Yasuo , Ogawa Tetsuro , Katsube Takuya , Iinuma Kiyohisa , Yoshitomi Hisae , Gao Ming
Published: May 2016

Hypertrophy of adipocytes in obese adipose tissues causes metabolic abnormality by adipocytokine dysregulation, which promotes type 2 diabetes mellitus, hypertension, and dyslipidemia. We investigated the effects of wasabi (Wasabia japonica Matsum) leaf extracts on metabolic abnormalities in SHRSP.Z-Leprfa/IzmDmcr rats (SHRSP/ZF), which are a model of metabolic syndrome. Male SHRSP/ZF rats aged 7 weeks were divided into two groups: control and wasabi leaf extract (WLE) groups, which received water or oral treatment with 4 g/kg/day WLE for 6 weeks. WLE improved the body weight gain and high blood pressure in SHRSP/ZF rats, and the plasma triglyceride levels were significantly lower in the WLE group. Adipocyte hypertrophy was markedly prevented in adipose tissue. The expression of PPARγ and subsequent downstream genes was suppressed in the WLE group adipose tissues. Our data suggest that WLE inhibits adipose hypertrophy by suppressing PPARγ expression in adipose tissue and stimulating the AMPK activity by increased adiponectin.
Rebuilding multi-ethnic communities in post-conflict nations: returnee assessment of municipal services in Bosnia and Herzegovina
Authors: Rende Sevinc , Rosenberg Dorothy J.
Published: May 2016

Local administrative units are crucial to the reconstruction of a sustainable multi-ethnic social consensus in fragile states. Using the delivery of public goods and social services in Bosnia and Herzegovina as our case study, we ask whether the level of heterogeneity in community composition has any effect on resident opinion of public services at the municipal level. We find that post-war residency status is not the only factor defining community-level heterogeneity and that evaluations of public services at the local level are not neutral to community composition.
Flat extensions in ∗-algebras
Authors: Mourrain Bernard , Schmüdgen Konrad
Published: May 2016

The main result of the paper is a flat extension theorem for positive linear functionals on

∗
*

-algebras. The theorem is applied to truncated moment problems on cylinder sets, on matrices of polynomials and on enveloping algebras of Lie algebras.
Boston Children’s Hospital approach to brachial plexus birth palsy
Authors: Vuillermin Carley , Bauer Andrea S.
Published: May 2016

The treatment of infants with brachial plexus birth palsy (BPBP) continues to be a focus at Boston Children’s Hospital. Over the last 15 years, there have been many developments in the treatment of infants with BPBP. Some of the greatest changes have emerged through technical advances such as the advent of distal nerve transfers to allow targeted reinnervation as well as through research to understand the pathoanatomical changes that lead to glenohumeral dysplasia and how this dysplasia can be remodeled. This review will discuss our current practice of evaluation of the infant with BPBP, techniques for microsurgical reconstruction, and prevention and treatment of secondary glenohumeral dysplasia.
Magnetic Resonance Imaging in Symptomatic Children With Hereditary Multiple Exostoses of the Hip
Authors: Duque Orozco Maria d.P. , Abousamra Oussama , Rogers Kenneth J. , Thacker Mihir M.
Published: May 2016

Background:

Magnetic resonance imaging (MRI) is useful in evaluating nontraumatic hip pain. It provides information about associated injuries like labral/chondral tears or ischiofemoral impingement (IFI). However, in hereditary multiple exostoses (HME) there has been no report about MRI findings in symptomatic children with hip involvement.

Methods:

Records of children with HME and hip osteochondromas, who had hip MRI/magnetic resonance arthrography, were reviewed. The presence of chondral lesions and labral tears, as well the presence of IFI, was recorded. IFI was defined as edema or fatty replacement/atrophy in the quadratus femoris muscle or decrease of the space for this muscle between the ischium and the proximal femur. The measurements used to determine the space included the ischiofemoral space, the quadratus femoris space, and the minimum ischiofemoral space (MIFS). All measurements were performed on axial T1-weighted images.

Results:

Ten children were included (4 males, 6 females). In 2 patients, MRI was unilateral, therefore a total of 18 hips were analyzed. The indication for MRI was hip pain. Mean age, when MRI was performed, was 11.7 years. Labral tears were found in 44% (8/18) and chondral lesions in 33% (6/18) of the hips. The mean ischiofemoral space was 17.2 mm (SD, 7.3), the mean quadratus femoris space was 14.9 mm (SD, 5.3), and the mean MIFS was of 12.8 mm (SD, 5.9). IFI was seen in 44% (8/18) of hips. Two patients had bilateral IFI. MIFS was <10 mm in all hips with IFI (8/8). Of these hips, 88% (7/8) had edema of the quadratus femoris muscle and 38% (3/8) had fatty replacement/atrophy in the muscle. Osteochondromas were seen in the lesser trochanter in all hips with IFI (8/8) and in the ischium in 50% of them (4/8).

Conclusions:

In symptomatic children with HME of the hip, MRI is helpful in detecting the source of pain. A high percentage of these children have IFI and intra-articular lesions. These findings can play an important role in the indication and planning of the surgical approach.

Level of Evidence:

Level IV—diagnostic study.
Flexible Intramedullary Nails for Femur Fractures in Pediatric Patients Heavier Than 100 Pounds
Authors: Shaha James , Cage Jason M. , Black Sheena , Wimberly Robert L. , Shaha Steven H. , Riccio Anthony I.
Published: May 2016

Background:

Flexible intramedullary nailing (FIMN) of femoral shaft fractures in children >100 pounds remains controversial. The purpose of this study is to assess the relationship between patient weight and alignment at radiographic union following Ender’s FIMN of pediatric femoral shaft fractures.

Methods:

An IRB approved, retrospective review of all patients who sustained a femoral shaft fracture treated by retrograde, stainless-steel Ender’s FIMN was performed at a level 1 pediatric trauma center from 2005 to 2012. Preoperative radiographs were analyzed to determine fracture pattern, location, and isthmic canal diameter. Patient weight was measured on presentation to the emergency room. Radiographs at bony union were reviewed to measure shortening, coronal angulation, and sagittal angulation.

Results:

A total of 261 children underwent Ender’s FIMN for femoral shaft fractures during the study period. There were 24 patients who weighed ≥100 lbs and 237 patients who weighed <100 lbs. There were no significant differences in sex (75% vs. 73% male), fracture stability (42.6% vs. 41.7% length unstable), or fracture patterns between the 2 groups. The ≥100 lbs group was significantly older (10.6 vs. 8.0 y, P<0.001). There were no significant differences in final coronal angulation (1.5 vs. 3.0 degrees), sagittal angulation (2.8 vs. 3.1 degrees), or shortening (3.4 vs. 3.5 mm) between the 2 groups. There were significantly more nail removals in the <100 lbs group (81.4% vs. 66.7%, P<0.01). Four percent of the population (10 patients) weighed ≥120 lbs and aside from age (11.4 vs. 8.1 y, P<0.01), there were no significant demographic or fracture pattern differences between this group and the remaining population. This heaviest group demonstrated no significant difference in shortening (3.3 vs. 3.5 mm), coronal angulation (0.8 vs. 3.0 degrees), or sagittal angulation (0.7 vs. 3.2 degrees) at radiographic union when compared with the lighter patients.

Conclusions:

Stainless-steel Ender’s FIMN is an effective treatment for pediatric femoral shaft fractures in patients ≥100 pounds with excellent radiographic outcomes and no increased risk for malunion.

Level of Evidence:

Therapeutic Level III.
Three-dimensional EOS Analysis of Apical Vertebral Rotation in Adolescent Idiopathic Scoliosis
Authors: Kato So , Debaud Charlotte , Zeller Reinhard D.
Published: May 2016

Background:

Apical vertebral rotation (AVR) is increasingly recognized as one of the important radiographic parameters in adolescent idiopathic scoliosis (AIS). EOS enables us to precisely measure AVR by 3-dimensional reconstruction. The objective of the present study was to describe the postoperative correction and the long-term follow-up of AVR in posterior spinal fusion with direct vertebral rotation and elucidate the factors that affected the correction.

Methods:

We retrospectively reviewed 153 consecutive posterior spinal fusion surgeries for AIS performed between 2009 and 2012. Among them, 55 patients who fulfilled the study inclusion criteria with complete preoperative, immediate postoperative, and last follow-up (>1 y) EOS images were included in the present study. EOS 3-dimentional reconstructions were undertaken for each patient. Postoperative AVR correction and the loss of correction were calculated.

Results:

Preoperative AVR of the major curve averaged 19 degrees (SD=7 degrees), and AVR on immediate postoperative images averaged 9 degrees (SD=6 degrees, P<0.001). AVR at final follow-up averaged 11 degrees (SD=6 degrees, P=0.06). Postoperative correction was larger in all-screw construct than in hybrid construct (55% vs. 36%, P=0.03).

Conclusions:

The present study is the first study to measure AVR in a large population of AIS patients using EOS 3-dimensional reconstruction. We report the correction magnitude was significantly affected by the construct.

Level of Evidence:

Level IV—therapeutic study (case series).
Pseudarthrosis Repair Using Autologous Cultured Osteoblasts in Complex Type-1 Neurofibromatosis Spinal Deformity
Authors: Kim Young-Hoon , Reoyan Genriech N. , Ha Kee-Yong , Kim Chul-Kyu
Published: May 2016

Study Design.

A case report and literature review.

Objective.

To report a late dislocation of the vertebra caused by progressive dural ectasia combined with type-1 neurofibromatosis (NF-1) and the clinical results of pseudarthrosis repairs using autologous cultured osteoblasts.

Summary of Background Data.

NF-1 is a well-known genetic disorder that is commonly characterized by spinal deformities including kyphoscoliosis. Late dislocation of the vertebra resulting from progressive dural ectasia after surgical correction of NF-1 scoliosis is a very rare occurrence, and pseudarthrosis frequently develops after surgical intervention for this complex spinal deformity.

Methods.

A 32-year-old female patient with NF-1 scoliosis underwent surgical correction with posterior instrumented fusion. Seventeen years later, dislocation of the lumbar spine with implant failure resulting from massive progressive dural ectasia was observed. She underwent anterior interbody fusion three times and posterior instrumented fusion four times for pseudarthrosis followed by surgical deformity correction. For the last operation, autologous cultured osteoblasts were used as a therapeutic approach to repair the pseudarthrosis, and a three-dimensional printing technique was used to understand the surgical anatomy of the dislocated lumbar spine in detail.

Results.

After the final operation, bone union was achieved and confirmed by clinical and radiological examination.

Conclusion.

Spine surgeons should be knowledgeable about the possibility of late destabilization of the spine, due to pulsatile dural ectasia, and a high rate of pseudarthrosis in neurofibromatosis. Autologous cultured osteoblasts may prove to be a modality that can be applied pseudarthrosis repair to treat complex spinal deformity.

Level of Evidence: 5
Checkpoint inhibitors and gastrointestinal immune-related adverse events
Authors: Pernot Simon , Ramtohul Toulsie , Taieb Julien
Published: May 2016

Purpose of review

Recent development of checkpoint inhibitors is a challenge for oncologists. Indeed, it leads to specific immune adverse events, close to autoimmune disorders, which require a specific management. Colitis is one of the most frequent immune adverse events, in particular with anticytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) therapy.

Recent findings

Severe colitis is frequent with immune checkpoint inhibitors and leads in a few cases to bowel perforation and death. This review focuses on specific pathogenic pathway and recent findings on risk factors and managements of colitis.

Anti-CTLA-4 antibodies are the most involved immune checkpoint inhibitors in colitis, and the combinations with anti-programmed death ligand 1 dramatically increase the rate of colitis. The early use of budesonide, and in some cases corticosteroids and/or infliximab should be recommended, as colitis is responsive to infliximab in almost all cases. Immune-related colitis shares some characteristics with inflammatory bowel disease but with little specificity. In particular, it has been recently showed that gut microbiota could interact with anti-CTLA-4 treatment to modulate efficacy but also to induce colitis. This opens the way for preventive or curative treatments capable of inducing modulation of the microbiota or fecal transplantation.
Dietary patterns and endometrial cancer: a meta-analysis
Authors: Si Cai-Juan , Shu Long , Zheng Pei-Fen , Zhang Xiao-Yan , Yu Xiao-Long , Gao Wei , Zhang Lun
Published: May 2016

Previous studies have attempted to assess the relation between different dietary patterns and the risk of endometrial cancer (EC); however, a consistent perspective has not been established to date. Therefore, we carried out this meta-analysis to evaluate the associations between dietary patterns and the risk of EC. The most common dietary patterns with high loadings of foods and/or nutrients were selected. A total of 27 studies fulfilled the inclusion criteria and were included in the present meta-analysis. There was evidence of a decreased risk of EC in the highest compared with the lowest categories of healthy dietary pattern [odds ratio (OR)=0.74; confidence interval (CI): 0.62–0.88; P=0.008]. An increased risk of EC was shown for the highest compared with the lowest category of a western-style dietary pattern (OR=1.37; CI: 1.15–1.64; P=0.0005). No significant association with the risk of EC was found in the highest compared with the lowest category of alcohol-drinking pattern (OR=0.98; CI: 0.73–1.30; P=0.87). The results of this meta-analysis indicate that some dietary patterns may be associated with the risk of EC.
High prevalence of frequent attendance in the over 65s
Authors: McMahon C. Geraldine , Power Foley Megan , Robinson David , O’Donnell Kate , Poulton Miriam , Kenny Rose A. , Bennett Kathleen
Published: May 2016

Introduction

Characteristics of older frequent users of Emergency Departments (EDs) are poorly understood. Our aim was to examine the characteristics of the ED frequent attenders (FAs) by age (under 65 and over 65 years).

Methods

We examined the prevalence of FA attending the ED of an Urban Teaching Hospital in a cross-sectional study between 2009 and 2011. FA was defined as an individual who presented to the ED four or more times over a 12-month period. Randomly selected groups of FA and non-FA from two age groups (under 65 and over 65 years) were then examined to compare the characteristics between older FAs and non-FAs and older FAs and younger FAs. Logistic regression was used to calculate the odds ratio and 95% confidence intervals for 12-month mortality in FA compared with non-FA aged at least 65 years.

Results

Overall, 137 150 ED attendances were recorded between 2009 and 2011. A total of 21.6% were aged at least 65 years, 4.4% of whom were FAs, accounting for 18.4% of attendances by patients older than 65 years. There was a bimodal age distribution of FA (mean±SD; under 65 years 40±12.7; and over 65 years 76.9±7.4). Older FAs were five times more likely to present outside normal working hours and 5.5 times more likely to require admission. Cardiovascular emergencies were the most common complaint, in contrast with the younger FA group, where injury and psychosocial conditions dominated. The odds ratio for death at 12 months was 2.07 (95% confidence interval 0.93–4.63; P=0.07), adjusting for age and sex.

Conclusion

One-in-five ED patients older than 65 years of age are FAs. Older FAs largely present with complex medical conditions. Enhanced access to expert gerontology assessment should be considered as part of effective intervention strategies for older ED users.
Menstrual management and reproductive concerns in adolescent and young adult women with underlying hematologic or oncologic disease
Authors: Quinn Sheila M. , Louis-Jacques Jennifer
Published: May 2016

Purpose of review

Heavy menstrual bleeding is common among adolescent and young adult women, and can affect health-related quality of life. The cause of heavy menstrual bleeding is not uncommonly because of an underlying hematologic or oncologic disease process, which substantially influences the way patients are counseled and treated.

Recent findings

Options for menstrual management are more numerous today than ever before and range from minimizing monthly blood loss to suppressing the cycle altogether. However, an underlying bleeding disorder or malignancy can introduce many nuances and limits in individual patient care, which this review highlights. Additionally, because survival rates for adolescent and young adult cancers are improving, more of these patients are planning for lives after their disease, which may include starting or adding to a family. Options for fertility preservation during cancer therapy regimens are solidifying and both primary practitioners and subspecialists should be aware of the possibilities.

Patients with underlying hematologic or oncologic disease require management of menstrual bleeding, but also deserve a comprehensive evaluation and counseling regarding their individualized contraceptive needs and fertility preservation options during their reproductive years. This review employs the latest evidence from current literature to help guide clinicians caring for this unique demographic.
Nongenomic regulation of gene expression
Authors: Iglesias-Platas Isabel , Monk David
Published: May 2016

Purpose of review

The purpose of this review is to highlight the recent advances in epigenetic regulation and chromatin biology for a better understanding of gene regulation related to human disease.

Recent findings

Alterations to chromatin influence genomic function, including gene transcription. At its most simple level, this involves DNA methylation and posttranscriptional histone modifications. However, recent developments in biochemical and molecular techniques have revealed that transcriptional regulation is far more complex, involving combinations of histone modifications and discriminating transcription factor binding, and long-range chromatin loops with enhancers, to generate a multifaceted code. Here, we describe the most recent advances, culminating in the example of genomic imprinting, the parent-of-origin monoallelic expression that utilizes the majority of these mechanisms to attain one active and one repressed allele.

It is becoming increasingly evident that epigenetic mechanisms work in unison to maintain tight control of gene expression and genome function. With the wealth of knowledge gained from recent molecular studies, future goals should focus on the application of this information in deciphering their role in developmental diseases.
Comparison of Primary Care Provider Office Hours and Pediatric Emergency Department Return Visits
Authors: Rogers Brent D. , Attia Magdy W.
Published: May 2016

Objective

The aim of this study was to evaluate the influence of primary care office hours of operation on 48-hour return visits (RVs) to a pediatric emergency department (ED). We compared characteristics of patients who return with those who follow up outpatient to determine the feasibility of opening off-hour clinics to decrease the RV rate.

Methods

The study was a retrospective chart review of patients presenting to a pediatric ED for a 3-year period. A subset of patients with a hospital-affiliated primary care provider was evaluated to compare those with 48-hour ED RVs with those with office follow-up.

Results

Patients with a hospital-affiliated primary care provider had 30,231 visits, of whom 842 had a 48-hour return (2.79%). A significant number (48.5%) of those who returned had seen their primary care doctor between emergency visits. The percentage of RVs occurring at night (55.7%) was slightly lower than the percentage of all visits occurring off hours (58.1%). Patients with more acute presentation at initial visit (emergency severity index level acuity 2, >20 orders placed) were more likely to follow up with their provider than return to the ED.

Conclusions

The findings from this study show no significant increase in RVs during the evening and overnight hours and many patients with outpatient follow-up before returning to the ED. Opening a clinic at our hospital during nontraditional hours would not likely significantly decrease RV rate.
Auricular Acupuncture for the Treatment of Pediatric Migraines in the Emergency Department
Authors: Graff Danielle M. , McDonald Mark J.
Published: May 2016

Objectives

Headache remains a frequent complaint for children presenting to a pediatric emergency department (ED). Typical treatments include oral or intravenous medications, but do not always relieve pain. An alternative intervention is auricular acupuncture. It has been shown to be effective in the treatment of migraines in adults. The objective of this study was to evaluate the utility and adverse effects of auricular acupuncture in the treatment of pediatric migraines in the ED.

Methods

This was a prospective, interventional, cohort study of patients 8 to 18 years of age. Efficacious ear points were located by needle contact or electrical point finder with attention to 2 migraine lines on the ear. ASP gold semipermanent ear needles were placed in the efficacious points and patients were monitored for 15 minutes. The primary outcome was the change in preintervention and postintervention pain scores using a numerical self-reported pain visual analog scale (VAS).

Results

Nineteen patients elected to enroll in the study. The mean change in the VAS scores was both clinically and statistically significant at 7.03 (interquartile range, 6–8.5) with a P value of less than 0.001. Two patients elected to withdraw from the study secondary to incomplete resolution of migraine pain despite improvement in VAS scores. There were no known adverse events.

Conclusions

With all subjects showing improvement or resolution of migraine headache, this pilot study introduces an alternative intervention to pediatric migraine management. Further studies are needed to evaluate the duration of symptom resolution and comparative effectiveness; auricular acupuncture seems to be a valid alternative.
Correction of Severely Contracted Nose
Authors: Oh Young Hwan , Seo Je Won , Oh Se Joon , Oum Ick Tae , Kim Gukjin , Kim Jun , Kim Sa Yong , Shin Seung Woo , Park DaEun , Kim Kenneth K.
Published: May 2016

Background:

Severely contracted nose is manifested with a tight and hardened nasal envelope. Expansion of the contracted skin is an important first step in correcting these revision cases. The underlying weak lower lateral cartilage makes the tip projection structurally difficult to achieve and maintain without rigid supporting cartilage grafting.

Methods:

A total 59 of patients were treated with isolated adipose-derived stromal cells before revision surgery to soften the nasal envelope. Adipose tissues were digested at 37°C with sterile 0.075% collagenase type 2. The average isolated adipose-derived stromal cell count of each serial injection was 5 × 106 cells (total injection volume, 0.5 ml; 1 × 107 cells/ml). Intraoperatively, the lower lateral cartilage was released from surrounding scar tissue to allow for advancement. Rib cartilage and other autologous grafts were used in reconstruction of the internal framework.

Results:

The follow-up period ranged from January of 2009 to April of 2014. The mean follow-up period was 10 months. Fifty-one of 59 patients were satisfied with their results. Eight patients underwent revision surgery for the following: infection (two patients), deviation (one patient), warping (two patients), and cosmetic dissatisfaction (three patients). There were two cases of additional warping, but the patients refused revision surgery. Nine patients required additional adipose-derived stromal cell injections at the tip.

Conclusions:

The combination of isolated fat grafting to soften the nasal skin envelope and rigid tip support results in correction of silicone-induced contracted nose. There were no incidences of recurrent nasal contraction or ischemic injury.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Evaluation of a Sickle Cell Disease Educational Website for Emergency Providers
Authors: Kayle Mariam , Brennan-Cook Jill , Carter Brigit M. , Derouin Anne L. , Silva Susan G. , Tanabe Paula
Published: May 2016

Sickle cell disease (SCD) is a complex multisystem debilitating disease. Despite its complexity, health care providers who are not SCD experts receive little formal education on SCD. An open-access, educational website, “Emergency Department Sickle Cell Disease: Crisis Management and Beyond,” was created to provide education about SCD to emergency department (ED) providers who are not SCD experts but who provide care for patients with SCD. Electronic surveys were used to conduct a formal evaluation of the accuracy and relevance of the website's content, as well as the effectiveness of the education modules in improving knowledge among health care providers. The evaluation consisted of (1) individual module pre- and post-knowledge assessment, (2) content validity assessment of educational modules, (3) overall website content assessment, and (4) overall website assessment (Health on the Net core principles). A convenient sample of ED providers, accelerated bachelor of science in nursing students, SCD experts, and website experts completed the anonymous surveys. Descriptive statistics and paired t tests were used to compare mean difference in post- minus pre-knowledge test scores. Knowledge scores statistically improved for nursing students (p value less than 0.0001). Emergency department providers showed a mean improvement of 3.2 points on the eight-item knowledge assessment. Both SCD experts and ED providers agreed that the module content was clear and easy to understand, accurate, comprehensive, relevant, and met module objectives. Participants agreed that the website was clear, easy to navigate, and visually appealing. Website experts stated that the website met much of the Health on the Net criteria. The website is a useful resource for providers and nursing students, especially those who serve or plan to serve in EDs.
Outcomes of Living Donor Liver Transplantation Alone for Patients on Maintenance Renal Replacement Therapy in Japan
Authors: Eguchi Susumu , Furukawa Hiroyuki , Uemoto Shinji , Umeshita Koji , Imamura Hajime , Soyama Akihiko , Shimamura Tsuyoshi , Isaji Shuji , Ogura Yasuhiro , Egawa Hiroto , Kawachi Shigeyuki , Kasahara Mureo , Nagano Hiroaki , Ku Yonson , Ohdan Hideki , Maehara Yoshihiko , Sato Shuntaro , Inomata Yukihiro
Published: May 2016

Background

Because simultaneous liver and kidney transplantation has been limited as a standard practice because of a severe shortage of deceased donors in Japan, living donor (LD) liver transplantation alone (LTA) is indicated in most recipients with maintenance renal replacement therapy (MRRT).

Methods

A retrospective nationwide survey of LD LTA was performed for liver transplant patients on MRRT. The characteristics of donors and recipients, postoperative complications, survival rate, and causes of death were analyzed.

Results

In the adult cases (n = 28), the overall survival rate at 1 year and 5 years were 66.1% and 57.3%, respectively. When compared with those adults without MRRT (n = 237), it was significantly worse. In the 7 pediatric cases, the overall survival rate at 1 and 5 years were both 83.3%. Three adult recipients died of nonaneurysm cerebral hemorrhage after 1 year and 1 adult recipient died of acute heart failure after 7 months. In adult recipients with MRRT, graft weight versus standard liver volume, and duration and blood loss in LTA surgery were associated with poor outcomes after LD LTA. Multivariate analysis revealed that MRRT was highest hazard ratio on patient survival after LD LTA.

Conclusions

Early post-LD LTA mortality was higher in patients with MRRT than in those without MRRT with characteristic causes. Smaller grafts for size and a complicated surgery were associated with poor outcome after LD LTA. Thus, LD LTA in adult patients on MRRT should be carefully treated with meticulous postoperative management and follow-up.