bluuebunny/crossref_metadata_2025 huggingface dataset:
X-Linked Signature of Reproductive Isolation in Humans is Mirrored in a Howler Monkey Hybrid Zone
Authors: Baiz Marcella D , Tucker Priscilla K , Mueller Jacob L , Cortés-Ortiz Liliana
Published: July 2020

Reproductive isolation is a fundamental step in speciation. While sex chromosomes have been linked to reproductive isolation in many model systems, including hominids, genetic studies of the contribution of sex chromosome loci to speciation for natural populations are relatively sparse. Natural hybrid zones can help identify genomic regions contributing to reproductive isolation, like hybrid incompatibility loci, since these regions exhibit reduced introgression between parental species. Here, we use a primate hybrid zone (Alouatta palliata × Alouatta pigra) to test for reduced introgression of X-linked SNPs compared to autosomal SNPs. To identify X-linked sequence in A. palliata, we used a sex-biased mapping approach with whole-genome re-sequencing data. We then used genomic cline analysis with reduced-representation sequence data for parental A. palliata and A. pigra individuals and hybrids (n = 88) to identify regions with non-neutral introgression. We identified ~26 Mb of non-repetitive, putatively X-linked genomic sequence in A. palliata, most of which mapped collinearly to the marmoset and human X chromosomes. We found that X-linked SNPs had reduced introgression and an excess of ancestry from A. palliata as compared to autosomal SNPs. One outlier region with reduced introgression overlaps a previously described “desert” of archaic hominin ancestry on the human X chromosome. These results are consistent with a large role for the X chromosome in speciation across animal taxa and further, suggest shared features in the genomic basis of the evolution of reproductive isolation in primates.
Evol2Circos: A Web-Based Tool for Genome Synteny and Collinearity Analysis and its Visualization in Fishes
Authors: Pandey Manmohan , Kushwaha Basdeo , Kumar Ravindra , Srivastava Prachi , Saroj Suman , Singh Mahender
Published: July 2020

The advent of high throughput next-generation sequencing technologies and improved assembly algorithms have resulted in the accumulation of voluminous genomic data in public domains. These technologies have opened up entries for large scale comparative genome studies, especially the identification of conserved syntenic blocks among species, facilitating studies of the evolutionary importance of the conservation and variation in genomic organization. Synteny construction and visualization require computational and bioinformatics skills to prepare input files for the synteny analysis pipeline. The syntenic information for fishes is still in a juvenile stage and is scattered among different research domains. Here, we present a web-based tool “Evol2Circos” to provide a user-friendly graphical user interface (GUI) to analyze user-specific data for synteny construction and visualization, and to facilitate the browsing of syntenic information of different fishes using the Circos, bar, dual, and dot plots. The information generated from the tool can also be used for further downstream analyses. Evol2Circos software tool is tested under Ubuntu Linux. The web-browser, source code, documentation, user manual, example dataset and scripts are available online at 203.190.147.148/evole2circos/
Sampling Efficacy and Survival Rates of Labarrus pseudolividus (Coleoptera: Scarabaeidae) and Onthophagus taurus (Coleoptera: Scarabaeidae) Using Flotation and Sieve-Separation Methodology
Authors: Fowler Fallon , Wilcox Tashiana , Orr Stephanie , Watson Wes
Published: July 2020

Understanding collection methodologies and their limitations are essential when targeting specific arthropods for use in habitat restoration, conservation, laboratory colony formation, or when holistically representing local populations using ecological surveys. For dung beetles, the most popular collection methodology is baited traps, followed by light traps and unbaited flight-intercept traps during diversity surveys. A less common collection method, flotation, is assumed to be laborious and messy, and so only a handful of papers exist on its refinement and strengths. Our purpose was threefold: First, we tested the recovery and survival rates of Labarrus (=Aphodius) pseudolividus (Balthasar) and Onthophagus taurus (Schreber) when floating beetle-seeded dung pats to determine potential collection and safety issues. We collected 72.4 and 78% of the seeded L. pseudolividus and O. taurus, respectively, with >95% survival rating. Second, we developed a flotation-sieving technique that enables users to rapidly collect and passively sort dung beetles with less time and effort. Specifically, we often collected 50–100 g of wild dung beetles within a couple of hours of gathering dung and sorted them in a couple more by allowing dung beetles to sort themselves by size within a series of sieves; Third, we reviewed flotation-based advantages and disadvantages in comparison to other methodologies.
Advance care planning in Asian culture
Authors: Cheng Shao-Yi , Lin Cheng-Pei , Chan Helen Yue-lai , Martina Diah , Mori Masanori , Kim Sun-Hyun , Ng Raymond
Published: July 2020

Ageing has been recognized as one of the most critically important health-care issues worldwide. It is relevant to Asia, where the increasing number of older populations has drawn attention to the paramount need for health-care investment, particularly in end-of-life care. The advocacy of advance care planning is a mean to honor patient autonomy. Since most East Asian countries are influenced by Confucianism and the concept of ‘filial piety,’ patient autonomy is consequently subordinate to family values and physician authority. The dominance from family members and physicians during a patient’s end-of-life decision-making is recognized as a cultural feature in Asia. Physicians often disclose the patient’s poor prognosis and corresponding treatment options to the male, family member rather to the patient him/herself. In order to address this ethical and practical dilemma, the concept of ‘relational autonomy’ and the collectivism paradigm might be ideally used to assist Asian people, especially older adults, to share their preferences on future care and decision-making on certain clinical situations with their families and important others. In this review article, we invited experts in end-of-life care from Hong Kong, Indonesia, Japan, South Korea, Singapore and Taiwan to briefly report the current status of advance care planning in each country from policy, legal and clinical perspectives. According to the Asian experiences, we have seen different models of advance care planning implementation. The Asian Delphi Taskforce for advance care planning is currently undertaken by six Asian countries and a more detailed, culturally sensitive whitepaper will be published in the near future.
Genome-Wide Screening ofAedes aegypti(Culicidae: Diptera) Populations From Northwestern Argentina: Active and Passive Dispersal Shape Genetic Structure
Authors: Maffey Lucía , Garzón Maximiliano J , Confalonieri Viviana , Chanampa Mariana M , Hasson Esteban , Schweigmann Nicolás
Published: July 2020

Aedes aegypti is the primary vector of arboviruses of great impact on human health. Our goal was to assess the spatial genetic structure of Ae. aegypti at the regional and local levels in Northwestern Argentina, an area with high prevalence of dengue fever. We analyzed 59 Ae. aegypti individuals collected from six locations in Northwestern Argentina using nuclear genome-wide Single Nucleotide Polymorphisms (SNPs) generated with double digest Restriction-site Associated DNA Sequencing. We also performed an entomological survey in 70 households in the cities of Orán and Tartagal. An analysis at the regional level indicated that the populations of Ae. aegypti in Northwestern Argentina are spatially structured and present a significant IBD pattern. Our results suggest that passive transport of eggs/immature stages, in both northward and southward directions, plays an important role in structuring Ae. aegypti populations at a regional scale and also as a source for the introduction of novel genetic variants through migration events into established populations. At a local level, we found neither spatial genetic structure nor significant isolation by distance (IBD) in Tartagal, indicating high gene flow within the city and active dispersal. In contrast, samples from Orán formed two clusters with a significant IBD pattern, although weaker than that at a regional level. Both populations showed signs of recent bottleneck events, probably coincident with past eradication campaigns. The entomological survey revealed a high prevalence of Ae. aegypti in both cities, although significantly higher in Tartagal.
New evidence defining the evolutionary path of aquaporins regulating silicon uptake in land plants
Authors: Deshmukh Rupesh , Sonah Humira , Belanger Richard R
Published: July 2020

Understanding the evolution events defining silicon (Si) uptake in plant species is important for the efficient exploration of Si-derived benefits. In the present study, Si accumulation was studied in 456 diverse plant species grown in uniform field conditions, and in a subset of 151 species grown under greenhouse conditions, allowing efficient comparison among the species. In addition, a systematic analysis of nodulin 26-like intrinsic proteins III (NIP-III), which form Si channels, was performed in >1000 species to trace their evolutionary path and link with Si accumulation. Significant variations in Si accumulation were observed among the plant species studied. For their part, species lacking NIP-IIIs systematically showed low Si accumulation. Interestingly, seven NIP-IIIs were identified in three moss species, namely Physcomitrella patens, Andreaea rupestris, and Scouleria aquatica, indicating that the evolution of NIP-IIIs dates back as early as 515 million years ago. These results were further supported from previous reports of Si deposition in moss fossils estimated to be from around the Ordovician era. The taxonomical distribution provided in the present study will be helpful for several other disciplines, such as palaeoecology and geology, that define the biogeochemical cycling of Si. In addition to the prediction of Si uptake potential of plant species based on sequence information and taxonomical positioning, the evolutionary path of the Si uptake mechanism described here will be helpful to understand the Si environment over the different eras of land plant evolution.
The HD-ZIP IV transcription factor Tril regulates fruit spine density through gene dosage effects in cucumber
Authors: Du Hui , Wang Gang , Pan Jian , Chen Yue , Xiao Tingting , Zhang Leyu , Zhang Keyan , Wen Haifan , Xiong Liangrong , Yu Yao , He Huanle , Pan Junsong , Cai Run
Published: July 2020

Trichomes and fruit spines are important traits that directly affect the appearance quality and commercial value of cucumber (Cucumis sativus). Tril (Trichome-less), encodes a HD-Zip IV transcription factor that plays a crucial role in the initiation of trichomes and fruit spines, but little is known about the details of the regulatory mechanisms involved. In this study, analysis of tissue expression patterns indicated that Tril is expressed and functions in the early stages of organ initiation and development. Expression of Tril under the control of its own promoter (the TrilPro::Tril-3*flag fragment) could partly rescue the mutant phenotypes of tril, csgl3 (cucumber glabrous 3, an allelic mutant of tril), and fs1 (few spines 1, a fragment substitution in the Tril promoter region), providing further evidence that Tril is responsible for the initiation of trichomes and fruit spines. In lines with dense spine, fs1-type lines, and transgenic lines of different backgrounds containing the TrilPro::Tril-3*flag foreign fragment, spine density increased in conjunction with increases in Tril expression, indicating that Tril has a gene dosage effect on fruit spine density in cucumber. Numerous Spines (NS) is a negative regulatory factor of fruit spine density. Characterization of the molecular and genetic interaction between Tril and NS/ns demonstrated that Tril functions upstream of NS with respect to spine initiation. Overall, our results reveal a novel regulatory mechanism governing the effect of Tril on fruit spine development, and provide a reference for future work on breeding for physical quality in cucumber.
Nutritional status and eating habits of people who use drugs and/or are undergoing treatment for recovery: a narrative review
Authors: Mahboub Nadine , Rizk Rana , Karavetian Mirey , de Vries Nanne
Published: July 2020

A comprehensive overview is presented of the nutritional issues faced by people who use drugs or are undergoing treatment for recovery. Chronic substance use affects a person’s nutritional status and body composition through decreased intake, nutrient absorption, and dysregulation of hormones that alter the mechanisms of satiety and food intake. Anthropometrics alone is not the best indicator of nutritional status, because this population has hidden deficiencies and disturbed metabolic parameters. Socioeconomic factors (eg, higher education, higher income, presence of a partner, living at home) positively affect nutritional status. Scarce available data on users undergoing treatment indicate improvement in anthropometric and metabolic parameters but with micronutrient intake remaining suboptimal. Weight gain is noted especially among women who use drugs and potentially increases their risk of relapse. Finally, specific amino acids and omega-3 fatty acids are promising in decreasing relapse and improving mental health during treatment; however, additional high-quality studies are needed. Nutrition intervention for people who use drugs or are undergoing treatment for recovery is underused; comprehensive programs addressing this population’s unique needs are necessary. Future research will identify which components are needed.
Influence of organizational stress on reported depressive symptoms among police
Authors: Chan J F , Andersen J P
Published: July 2020

Background

There is a growing body of research on operational stress injuries (OSIs) among police officers and first responders. Most studies focus on operational stressors’ contribution to OSI and the development of post-traumatic stress disorder. However, preliminary research shows that organizational stressors may uniquely contribute to OSI and depression, and thus should be examined more closely.

Aims

This study explored the influence of organizational stress on symptoms of depression in a sample of police officers from a large urban region.

Methods

Front-line (n = 109) police officers completed questionnaires measuring police organizational and operational stress, depression, anxiety, hostility, rumination, perceived social support and social desirability. Using negative binomial regression (NBR), a best subset model of self-reported depression symptoms was derived from the full model (a function of gender, age, police experience (years), organizational stress, operational stress, anxiety, anger, rumination and social support), based on Akaike Information Criterion (AIC) goodness of fit.

Results

Organizational stress and anxiety were positively associated with self-reported depression symptoms. A paired t-test revealed no significant difference between reported organizational and operational stress levels.

Conclusions

Organizational stress may uniquely contribute to OSI and depressive symptoms and should be examined in future research. Findings support prior literature suggesting that initiatives to treat OSI among police should address workplace environment and organizational stressors. Addressing organizational issues in police culture and developing long-lasting initiatives is key in the future of OSI prevention and treatment for police officers.
Pyroxenite Xenoliths Record Complex Melt Impregnation in the Deep Lithosphere of the Northwestern North China Craton
Authors: Dai Hong-Kun , Zheng Jian-Ping , Griffin William L , O’Reilly Suzanne Y , Xiong Qing , Ping Xian-Quan , Chen Fu-Kun , Lu Jiang-Gu
Published: July 2020

Transformation of refractory cratonic mantle into more fertile lithologies is the key to the fate of cratonic lithosphere. This process has been extensively studied in the eastern North China Craton (NCC) while that of its western part is still poorly constrained. A comprehensive study of newly-found pyroxenite xenoliths from the Langshan area, in the northwestern part of this craton is integrated with a regional synthesis of pyroxenite and peridotite xenoliths to constrain the petrogenesis of the pyroxenites and provide an overview of the processes involved in the modification of the deep lithosphere.

The Langshan pyroxenites are of two types, high-Mg# [Mg2+/(Mg2++Fe2+)*100 = ∼90, atomic ratios] olivine-bearing websterites with high equilibration temperatures (880–970 oC), and low-Mg# (70–80) plagioclase-bearing websterites with low equilibration temperatures (550–835 oC). The high-Mg# pyroxenites show trade-off abundances of olivine and orthopyroxene, highly depleted bulk Sr–Nd (εNd = +11·41, 87Sr/86Sr = ∼0·7034) and low clinopyroxene Sr isotopic ratios (mean 87Sr/86Sr = ∼0·703). They are considered to reflect the reaction of mantle peridotites with silica-rich silicate melts derived from the convective mantle. Their depletion in fusible components (e.g., FeO, TiO2 and Na2O) and progressive exhaustion of incompatible elements suggest melt extraction after their formation. The low-Mg# pyroxenites display layered structures, convex-upward rare earth element patterns, moderately enriched bulk Sr–Nd isotopic ratios (εNd = -14·20– -16·74, 87Sr/86Sr = 0·7070–0·7078) and variable clinopyroxene Sr-isotope ratios (87Sr/86Sr = 0·706–0·711). They are interpreted to be crustal cumulates from hypersthene-normative melts generated by interaction between the asthenosphere and heterogeneous lithospheric mantle.

Combined with studies on regional peridotite xenoliths, it is shown that the thinning and refertilization of the lithospheric mantle was accompanied by crustal rejuvenation and that such processes occurred ubiquitously in the northwestern part of the NCC. A geodynamic model is proposed for the evolution of the deep lithosphere, which includes long-term mass transfer through a mantle wedge into the deep crust from the Paleozoic to the Cenozoic, triggered by subduction of the Paleo-Asian Ocean and the Late Mesozoic lithospheric extension of eastern Asia.
Neurophysiological, Oculomotor, and Computational Modeling of Impaired Reading Ability in Schizophrenia
Authors: Dias Elisa C , Sheridan Heather , Martínez Antígona , Sehatpour Pejman , Silipo Gail , Rohrig Stephanie , Hochman Ayelet , Butler Pamela D , Hoptman Matthew J , Revheim Nadine , Javitt Daniel C
Published: July 2020

Schizophrenia (Sz) is associated with deficits in fluent reading ability that compromise functional outcomes. Here, we utilize a combined eye-tracking, neurophysiological, and computational modeling approach to analyze underlying visual and oculomotor processes. Subjects included 26 Sz patients (SzP) and 26 healthy controls. Eye-tracking and electroencephalography data were acquired continuously during the reading of passages from the Gray Oral Reading Tests reading battery, permitting between-group evaluation of both oculomotor activity and fixation-related potentials (FRP). Schizophrenia patients showed a marked increase in time required per word (d = 1.3, P < .0001), reflecting both a moderate increase in fixation duration (d = .7, P = .026) and a large increase in the total saccade number (d = 1.6, P < .0001). Simulation models that incorporated alterations in both lower-level visual and oculomotor function as well as higher-level lexical processing performed better than models that assumed either deficit-type alone. In neurophysiological analyses, amplitude of the fixation-related P1 potential (P1f) was significantly reduced in SzP (d = .66, P = .013), reflecting reduced phase reset of ongoing theta-alpha band activity (d = .74, P = .019). In turn, P1f deficits significantly predicted increased saccade number both across groups (P = .017) and within SzP alone (P = .042). Computational and neurophysiological methods provide increasingly important approaches for investigating sensory contributions to impaired cognition during naturalistic processing in Sz. Here, we demonstrate deficits in reading rate that reflect both sensory/oculomotor- and semantic-level impairments and that manifest, respectively, as alterations in saccade number and fixation duration. Impaired P1f generation reflects impaired fixation-related reset of ongoing brain rhythms and suggests inefficient information processing within the early visual system as a basis for oculomotor dyscontrol during fluent reading in Sz.
Longitudinal association of nighttime sleep duration with emotional and behavioral problems in early childhood: results from the Danish Healthy Start Study
Authors: Zheng Miaobing , Rangan Anna , Olsen Nanna Julie , Heitmann Berit L
Published: July 2020

Study Objectives

To examine the longitudinal and bidirectional association between nighttime sleep duration and emotional and behavioral problems (EBPs) over 15 months among preschool children.

Methods

Data of children aged 2 to 6 years from the control group of the Danish Healthy Start Study, a 15-month obesity prevention intervention, were used. Nighttime sleep duration was measured using a 7-day sleep record. EBPs were assessed by the Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) score and Prosocial Behavior (SDQ-PSB) score. Multivariable regression models were conducted to examine the bidirectional associations between changes in nighttime sleep duration and SDQ scores.

Results

With adjustment for child, family factors, and parental stress level, every hour extra nighttime sleep at baseline was associated with a 1.02 decrease in SDQ-TD score and 77% lower odds of having an abnormal SDQ-TD score (≥90th percentile) at the follow-up (p = 0.01). Children who increased their nighttime sleep duration over the 15-month demonstrated a similar concurrent reduction in SDQ-TD score (β = −1.28, p = 0.02) compared with those who decreased or had no change in nighttime sleep duration. After additional adjustment for sleep problem and habit variables, the significant associations remained. No associations were found between nighttime sleep duration and SDQ-PSB scores. Examination of SDQ scores as predictors of subsequent changes in nighttime sleep duration showed no significant associations.

Conclusions

Among preschool children, longer nighttime sleep duration was associated with a decline in EBPs, but not vice versa. Our study provides new longitudinal evidence to support sleep interventions to improve EBPs in early childhood.

Clinical trials: The Healthy Start Study: https://clinicaltrials.gov/ct2/show/NCT01583335

Trial registration: ID NCT01583335
Cannabis and acute myocardial infarction
Authors: Emanuel Tatiana , Varney Shawn M. , McRoy Georgia , Tanaka Kaori
Published: July 2020

Marijuana is one of the most commonly consumed psychotropic drugs in the world. It has been associated with adverse cardiovascular reactions including acute coronary syndrome, but this information is not widely known among emergency medicine clinicians. This article describes cannabis use as a contributing factor to acute myocardial infarction in a young woman with chest pain.
Intrathecal hydromorphone as an analgesia option for gynecology patients
Authors: Gajarawala Shilpa , Wells Ali , Watkins Elyse , Rust Bartley , Archambault Mark
Published: July 2020

Enhanced recovery after surgery (ERAS) is a multimodal perioperative strategy originally developed to attenuate the postsurgical stress response in patients after colorectal surgery. Patients undergoing gynecologic surgery who had ERAS had significantly shorter hospital length of stay, reduced hospital-related costs, and acceptable pain management with reduced opioid use, without compromising patient satisfaction. Intrathecal hydromorphone is an effective alternative ERAS protocol analgesia for these patients and will not compromise patient outcomes or healthcare costs.
Confronting vaccine hesitancy
Authors: Anderson Pamela , Bryson Jaylynn
Published: July 2020

This article reviews the origins of vaccine hesitancy, explores common misconceptions about vaccines, and discusses strategies for overcoming vaccine hesitancy.
Preliminary results of reconstruction of proximal humeral bone loss with a reverse total shoulder prosthesis using a modular endoprosthetic reconstruction system: a case series
Authors: Feldman John J. , Duquin Thomas R. , Azar Frederick M. , Throckmorton Thomas W.
Published: July 2020

Background:

Osteoarticular allografts and allograft-prosthesis composites have decreased some complications but have introduced others, prompting development of implants that combine a reverse total shoulder arthroplasty (RTSA) prosthesis with a modular endoprosthetic reconstruction system.

Methods:

Data were collected prospectively from two institutions for all patients with massive proximal humeral bone loss who had reconstruction with RTSA using a single modular endoprosthetic system. The primary outcome measure was failure of the reconstruction, defined as need for revision surgery or radiographic evidence of component failure. Preoperative and postoperative functional outcomes and patient-reported outcomes, determined through preoperative and postoperative Quick Disabilities of Arm, Shoulder and Hand (quickDASH) scores, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores, and visual analog scores (VAS), were compared.

Results:

Seven female and five male patients met inclusion criteria. The most common reason for proximal bone loss was failure of a previous arthroplasty procedure (six patients). Average forward flexion and internal rotation improved significantly, as did the average quickDASH, ASES and VAS scores. Failure of humeral component fixation occurred in three patients.

Conclusions:

Early results show that a RTSA prosthesis using a modular endoprosthetic reconstruction system is a viable option for massive proximal humeral bone loss. Further studies are needed to investigate longevity and longer-term outcomes.

Level of Evidence:

Level IV.
Increase in dural ectasia size in scoliosis patients with Marfan syndrome
Authors: Ito Kenyu , Kawakami Noriaki , Ohara Tetsuya , Saito Toshiki , Tauchi Ryoji
Published: July 2020

Increased dural ectasia and vertebral thinning in the lumbosacral spine are common in Marfan syndrome. Dural ectasia is unchanged in middle-aged patients, who have stopped growing. Therefore, evaluation from childhood to adulthood is mandatory. Sixteen patients [four men and 12 women; mean age:17.7 (8.6–33.5) years] with dural ectasia at final follow-up [mean follow-up: 10.4 (5.0–16.7) years] were enrolled. Dural sac diameter (DD)/vertebral diameter (VD) were measured on MRI or CT images of midline sagittal slices at the level of dural ectasia between L5 and S3. The widest part of the dural sac was evaluated with Fattori grading: grade 0, normal; 1, mild; 2, moderate; and 3, severe dural ectasia. At final follow-up, dural ectasia was observed at L5 in 3, S1 in 9, S2 in 14, and S3 in 11 patients. Respective changes in DD/VD from primary to final follow-up were L5: 21.7–24.2 mm/29.1–27.9 mm; S1: 17.0–18.6 mm/21.0–19.5 mm; S2: 15.5–19.6 mm (P < 0.01)/9.6–7.5 mm; and S3: 15.6–17.9 mm (P < 0.05)/6.2–3.3 mm (P < 0.05). Four patients had grade 0 dural ectasia, seven had grade 1, two had grade 2, and three had grade 3. Grade was increased in nine patients with juvenile to young adult patients but did not with adults. During follow-up, dural ectasia size changed in the juvenile to young adult patients with Marfan syndrome, particularly at the S2–S3 level in our series.
The presence of the ossific nucleus and its relation to avascular necrosis rates and the number of secondary procedures in late-presenting developmental dysplasia of the hip
Authors: Apostolides Michael , Gowda Sush R. , Roslee Charline , Beamish Becky , Burby Nick , Richards Rob H.
Published: July 2020

Late-presenting developmental dysplasia of the hip (DDH) has an incidence reported between 0.07 and 2:1000 live births. Avascular necrosis (AVN) of the femoral head secondary to treatment of DDH is a feared complication and may lead to adverse long-term sequelae. This study aims to investigate the relationship between the ossific nucleus (ON) presence and AVN in late-presenting DDH. This is a retrospective study of prospectively collected data over a 24-year period, at a single UK centre. Late-presenting DDH who were treated surgically with a closed or open reduction were included in the series. The presence of ON was monitored, and outcomes measured included AVN and whether delaying surgery affected the number of secondary procedures. Seventy-six patients with 79 hips (mean age at presentation 13.8 months) were included in the analysis. The mean age at presentation was 13.8 months. About 45.5% of hips with no ON present developed clinically significant AVN (Kalamchi and MacEwen grades 2–4, P = 0.12), compared to 20.6% of hips with the ON present. Delaying surgery did not affect AVN rates or the number of secondary procedures. Looking at long-term outcomes, 86.7% of hips had a Severin grade of I or II and 13.3% had a grade ≥III. Factors that affected long-term outcomes were absent ON (P = 0.04) and open reduction (P = 0.03). In the multiple logistic regression model, only open reduction could increase AVN rates (P value 0.027). The presence of ON at the time of surgery may have an impact on the rate and significance of AVN. Absence of the ON at the time of reduction negatively affects long-term outcomes in late-presenting DDH.
Blount’s disease – an up-to-date insight with contemporary treatment guidelines deduced from critical analysis of a large 146 surgical case series
Authors: Khanfour Ashraf A.
Published: July 2020

To elucidate an up-to-date insight and derive clear treatment guidelines for Blount’s disease deduced from critical analysis of 146 surgical case series. Cases were presented and analyzed separately under its two basic clinical groups and the author further derived four subcategories under each of these two groups; the first basic group was the early onset clinical variant; infantile tibia vara (ITV) included 56 cases. The second group was the late onset clinical variant; late onset tibia vara (LOTV) included 90 cases. Different operative procedures used for treatment of these cases were proximal tibial osteotomy (PTO), temporary eight-plate proximal lateral tibial hemiepiphyseodesis (PLTH), or medial plateau elevation either on a monomodal or multimodal line of treatment. After a mean follow-up period of ~5 (2–12) years, the results were critically analyzed using case series descriptive analysis. In ITV variant, both PTO and temporary eight-plate PLTH monomodal line of treatment gave satisfactory results for de-novo (stages I, II, and III) subcategory while multimodal line of treatment was needed for achieving satisfactory results for neglected (stages IV, V, and VI) and relapsed subcategories. For LOTV variant, PTO monomodal line of treatment gave satisfactory results when applied for treatment of its de-novo subcategory. The derived treatment guidelines for Blount’s disease can be of value for recruiting the most suitable treatment modality for each case entity of the disease, leading to satisfactory outcome with prevention of recurrence.
Clinical and radiological outcomes of combined acetabuloplasty with acetabular redirectional osteotomy and femoral shortening for children older than 9 years of age with developmental dysplasia of the hip: a retrospective case series
Authors: Lyu Xuemin , Fu Gang , Feng Chao , Yang Jie , Wang Yukun , Zhu Zhenhua
Published: July 2020

Developmental dysplasia of the hip (DDH) is a challenging pediatric condition. This study aimed to investigate the feasibility and the efficacy of Dega osteotomy in combination with pelvic triple osteotomy or periacetabular osteotomy and femoral shortening with derotational osteotomy for the treatment of severe acetabular deformity secondary to DDH in children older than 9 years of age. The clinical data of 22 children treated at our institution were retrospectively collected. Pre- and postoperative hip radiographs were evaluated. Center-edge (CE) angle was measured, and Severin classification and McKay criteria were used to evaluate the final outcome. Twenty-two patients (including 21 female patients) were treated during the study period. The mean age was 10.9 years (range 9.1–14.8). All patients had preoperative Tonnis grades III and IV dislocated hips. Mean follow-up time was 25.7 months (range 14–48). All but three hips underwent open reduction. All had concomitant proximal femoral shortening and derotation osteotomy. At last follow-up visit, all hips remained located and no cases of avascular necrosis were recorded. All patients had Severin grade I–II hips at last follow-up. According to McKay criteria, clinical outcome was excellent in three patients, good in seven, and fair in 12 patients. Acetabuloplasty in combination with periacetabular osteotomy and femoral shortening with derotational osteotomy is a valid and effective treatment for children older than 9 years of age with severe acetabular deformity secondary to DDH. Although the early clinical outcome of the reported procedure is favorable, further studies are necessary to evaluate the long-term effects of the reported technique.
Transolecranon Exposure of Monteggia Variant Fracture-dislocations of the Elbow
Authors: Colliton Eileen , Leung Nicky
Published: July 2020

Posterior Monteggia fracture-dislocations are uncommon injuries that can result from a fall onto an outstretched hand. Often, these injuries are associated with coronoid and/or radial head fractures. When this is the case, direct fixation can require 3 separate fascial incisions: posterior to address the proximal ulnar fracture, lateral to address the radial head fracture, and medial to address the coronoid fracture. We illustrate a transolecranon surgical approach for fixation of a type IIA posterior Monteggia fracture-dislocation with associated radial head and coronoid fractures. In this approach, the 3 associated fractures can be addressed through a single posterior incision, thereby minimizing soft tissue disruption around the elbow.
Pre-activation with TLR7 in combination with thioridazine and loratadine promotes tumoricidal T-cell activity in colorectal cancer
Authors: Lin Xiaotan , Zhang Junfang , Wang Xiaomei , Lin Guimiao , Chen Tingting
Published: July 2020

Colorectal cancer (CRC) is the third most common malignancy worldwide. Our previous studies have shown that combinatorial treatment with thioridazine and loratadine may effectively inhibit CRC. However, the translation of these research findings to clinical practice was impaired by issues related to a lack of therapeutic specificity and to immune evasion. Toll-like receptor (TLR) agonists have been used as adjuvants to enhance the effectiveness of cancer vaccines. The aim of this study was to evaluate the therapeutic efficiency of immunotherapy with thioridazine and loratadine in combination with resiqumiod (R848), a small-molecule TLR7 agonist, in suppressing CRC growth in a mouse model. Twenty-four BALB/c mice were randomly assigned to treatment with PBS, R848, thioridazine + loratadine, or thioridazine + loratadine + R848. Cytokine levels were measured with ELISA. Overall survival, as well as tumor volume and tumor weight, was recorded. Cytotoxicity was measured by counting the numbers of CD8 and CD3-positive (CD8+CD3+) or CD4 and CD3-positive (CD3+CD4+) T-cells. The immune response induced by cytokines (as interferon-γ, interleukin-6, and tumor necrosis factor-α) was significantly stronger in mice treated with thioridazine + loratadine + R848. Moreover, thioridazine + loratadine + R848 significantly delayed tumor development and prolonged survival, which was associated with enhanced immune response and dendritic cell maturation. This study suggested that thioridazine + loratadine + R848 combinatorial treatment may be effective in overcoming immune evasion by tumor cells, with promising therapeutic potential in CRC.
Barriers and facilitators towards colonoscopy: a qualitative systematic review
Authors: Lim Kia Teng , Ng Cheng Han , Decruz Glenn Moses , Lim Tian Zhi , Devi Kamala , Tan Ker-Kan , Chong Choon Seng
Published: July 2020

Objectives

Colonoscopy is integral in the early detection of colorectal cancer (CRC), be it for screening, diagnostic or therapeutic intentions. Despite the presence of multiple screening modalities, colonoscopy remains integral in providing a definitive CRC diagnosis. However, uptake rates remain low worldwide with minimal understanding towards stakeholders’ perspectives. This systematic review is the first to outline the barriers and facilitators faced by providers and patients in receiving colonoscopy specifically.

Methods

Using PRISMA guidelines, our systematic review consolidates findings from Medline, Embase, CINAHL, PsycINFO and Web of Science Core collection. All perceptions of healthcare providers and screening participants aged 45 and above towards colonoscopy were included.

Results

Forty-five articles were included in our review. Five major analytical themes were identified – procedural perceptions, personal experiences, thoughts and concerns, societal influences, doctor-patient relationship and healthcare system. The discrepancies in knowledge between patients and providers have evidently reduced in the present decade, potentially attributable to the rising influence of social media. The sharing of providers’ personal experiences, involvement of patients’ family in colonoscopy recommendations and propagation of patients’ positive recounts were also more apparent in the past compared to the present decade, highlighting the need to reevaluate the balance between medical confidentiality and personal touch. Additionally, Asian patients were reportedly more apathetic towards CRC diagnosis due to their strong belief in destiny, a crucial association consistent with present studies.

Conclusion

This study highlights pertinent gaps in our healthcare system, providing crucial groundwork for interventions to be enacted in engendering higher colonoscopy uptake rates.
Metabolic syndrome and gastric cancer risk: a systematic review and meta-analysis
Authors: Mariani Marco , Sassano Michele , Boccia Stefania
Published: July 2020

Introduction

Gastric cancer (GC) is the fifth diagnosed cancer worldwide and the third leading cause of death for cancer. Recent reports suggest that metabolic syndrome (MetS) has a role in etiology, progression or prognosis on GC. The aim of this study is to systematically review the evidence on the association between MetS and GC risk and prognosis.

Methods

Literature search was performed using the electronic databases Pubmed, Web of Knowledge, Embase and Cinahl Complete until December 2019. Cohort and case-control studies were included. Study-specific association measures were pooled using a random-effect model.

Results

A total of 14 studies included in the qualitative synthesis of which nine were meta-analyzed. The majority were cohort studies (92%) and set in Asia (57%). The pooled analysis reported no association between MetS and GC risk [hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.92–1.18; I
2 = 74.2%, P < 0.001], however when the analysis was stratified according to the geographic area and sex, Western women with MetS had an increased risk of GC (HR 1.24, 95% CI 1.05–1.47; I
2 = 4.6%, P = 0.351). We did not observe an increased risk of unfavorable prognosis for individuals with MetS (HR 1.23, 95% CI 0.25–6.08).

Conclusion

This systematic review and meta-analysis suggests that GC risk might be associated with MetS in women although larger studies are needed. Preventing and treating MetS, however, might have overall beneficial effect on several noncommunicable diseases and in this sense should be pursued.
Fractional Pixel CO2 laser treatment for decubitus ulcer in advanced pelvic organ prolapse: a case report
Authors: Murina Filippo , Soligo Marco , Stellio Leonardo Nelva , Cetin Irene
Published: July 2020

Objective:

Cervicovaginal decubitus ulceration is a complication of advanced pelvic organ prolapse that is very difficult to manage. Here, we report on the effectiveness of fractional CO2 laser treatment for a wide decubitus ulcer over an apical vaginal vault prolapse.

Methods:

We report a case of a postmenopausal woman with a wide decubitus ulcer over a vaginal vault prolapse. A fractional microablative CO2 Pixel laser system (Alma Lasers, Cesarea, Israel), equipped with an appropriate probe for the vulva, was used to treat the ulceration of a 78-year-old patient across three laser sessions with 30-day intervals.

Results:

A significant improvement in the decubitus ulcer was noted in a check-up held 2 months after the final laser session, with approximately 95% wound healing observed. No side effects were reported during or after the laser therapy.

Conclusions:

This case demonstrates that fractional Pixel CO2 laser treatment is a viable option for managing decubitus ulcers before definitive surgery in postmenopausal women with advanced pelvic organ prolapse.
JAK Inhibition for the Treatment of Myelofibrosis: Limitations and Future Perspectives
Authors: Bose Prithviraj , Verstovsek Srdan
Published: July 2020

The 2011 approval of ruxolitinib ushered in the Janus kinase (JAK) inhibitor era in the treatment of myelofibrosis (MF), and 2019 saw the US approval of fedratinib. The first therapeutic agents approved by regulatory authorities for MF, these drugs attenuate the overactive JAK‐signal transducer and activator of transcription (STAT) signaling universally present in these patients, translating into major clinical benefits in terms of spleen shrinkage and symptom improvement. These, in turn, confer a survival advantage on patients with advanced disease, demonstrated in the case of ruxolitinib, for which long‐term follow‐up data are available. However, JAK inhibitors do not improve cytopenias in most patients, have relatively modest effects on bone marrow fibrosis and driver mutation allele burden, and clinical resistance eventually develops. Furthermore, they do not modify the risk of transformation to blast phase; indeed, their mechanism of action may be more anti‐inflammatory than truly disease‐modifying. This has spurred interest in rational combinations of JAK inhibitors with other agents that may improve cytopenias and drugs that could potentially modify the natural history of MF. Newer JAK inhibitors that are distinguished from ruxolitinib and fedratinib by their ability to improve anemia (eg, momelotinib) or safety and efficacy in severely thrombocytopenic patients (eg, pacritinib) are in phase 3 clinical trials. There is also interest in developing inhibitors that are highly selective for mutant JAK2, as well as “type II” JAK2 inhibitors. Overall, although current JAK inhibitors have limitations, they will likely continue to form the backbone of MF therapy for the foreseeable future.
POSTERIOR TRACTIONAL MEMBRANES FOLLOWING ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR FOR RETINOPATHY OF PREMATURITY
Authors: Al-Khaled Tala , Cole Emily , Valikodath Nita G. , Khanifar Aziz A. , Johnson Dina , Scripsema Nicole K. , Chau Felix Y. , Capone Antonio , Chan Robison Vernon Paul
Published: July 2020

Purpose:

To report two cases of tractional membrane formation following treatment with anti–vascular endothelial growth factor therapy in infants with Stage-3 retinopathy of prematurity.

Methods:

Retrospective review of electronic medical record for historical information, clinical examination documentation, and imaging from fundus photography, retinal ultrasonography, and fluorescein angiography.

Results:

Two patients with Stage-3 retinopathy of prematurity, previously treated with laser therapy and intravitreal bevacizumab, were referred to our institution for tractional membranes. The first case is of a male infant with Zone-II disease that progressed to Stage 4A with evidence of inferotemporal tractional retinal detachment only in the left eye. The second case is of a male infant with stable Zone-I disease with an epiretinal membrane in the left eye.

Pars plicata vitrectomy and membranectomy were required for both cases because of the concern for subsequent tractional retinal detachment.

Conclusion:

Formation of tractional retinal membranes has been associated with anti–vascular endothelial growth factor therapy. These cases describe the formation of posterior tractional membranes after anti–vascular endothelial growth factor therapy. This potential ocular outcome should be considered when determining treatment plans for retinopathy of prematurity.
Incorporating a virtual curriculum into ophthalmology education in the coronavirus disease-2019 era
Authors: Mishra Kapil , Boland Michael V. , Woreta Fasika A.
Published: July 2020

Purpose of review

The purpose of this review is to describe the transition of ophthalmology education to a virtual curriculum during the COVID-19 pandemic. We highlight innovative solutions ophthalmic educators implemented for medical students, residents, and fellows.

Recent findings

Clinical and surgical ophthalmology volume abruptly decreased in March 2020 as a result of the COVID-19 public health crisis. All didactics, grand rounds, and journal clubs shifted to an online format. Ophthalmic educators collaborated with other institutions in the United States and abroad on shared virtual curricula and seminars, and simulation-based training tools were better emphasized for surgical skill acquisition. We share the latest literature written by ophthalmic educators on successful adaptation of these new instructional strategies.

The COVID-19 pandemic transformed ophthalmology education overnight and accelerated the adoption of innovative e-virtual learning resources for trainees. These changes will undoubtedly remain part of the new paradigm of medical education in the post-COVID era.
Intraoperative wavefront aberrometry to determine planar endpoint for the repositioning of vaulted accommodative IOLs
Authors: Page Timothy P.
Published: July 2020

Accommodative intraocular lenses (IOLs) are suitable options for patients desiring less dependence on spectacles after cataract surgery. Accommodative IOLs do not require diffractive optics and, therefore, might be used in a wider range of patients who have mild comorbidities or wish to avoid photopsia associated with diffractive IOLs. However, a small percentage of patients have experienced vault, or capsular contraction syndrome (CCS), due to fibroblastic metaplasia of lens epithelial cells. Early detection of CCS might be managed with Nd:YAG capsulotomy; however, accommodative IOLs with significant CCS have required viscodissection of the fibrosis and placement of a capsular tension ring. A challenge with this maneuver is using the operating microscope to determine whether the accommodative IOL has returned to planar position. This article describes a new technique using serial intraoperative wavefront aberrometry measurements of lenticular astigmatism during accommodative IOL repositioning to determine a planar endpoint in the reduction of vault.