bluuebunny/crossref_metadata_2025 huggingface dataset:
A preclinical animal model for evaluating the sealing capacity of covered stent grafts in acute vessel perforation
Authors: Öner Alper , Moerke Caroline , Wolff Anne , Kischkel Sabine , Schmidt Wolfram , Grabow Niels , Ince Hüseyin
Published: July 2020

Background

Percutaneous coronary intervention is among the most common therapeutic interventions in cardiology. This procedure may, however, be associated with a rare, though life-threatening complication: acute coronary perforation (CP). CP is primarily treated using covered stents, which are made of bare metal stents with a polytetrafluoroethylene (PTFE) or polyurethane coating. These stents’ major limitations include higher rates of thrombus formation and restenosis. Hence, there is a still unmet need for new stents regarding their design and composition. Or, to test new covered stent designs, the rabbit iliac artery has become the best-established animal model. This study sought to present a preclinical animal approach designed to test covered stents that are utilized following vessel perforation.

Methods

The animal experiments were performed using New Zealand white rabbits, each weighting 3.5–4.5 kg. The animal models described herein relied on the three most common clinical causes for CP, such as guidewire-induced, balloon catheter bursting, and device oversizing. Moreover, the sealing capacity of covered stent grafts was assessed for each of these models by means of angiography.

Results

We herein report a rabbit iliac artery perforation model using three different types of vessel perforation that closely mimic the clinical setting, such as guidewire-induced, balloon catheter rupture, and device oversizing. Using the same rabbit iliac perforation model, we additionally assessed the sealing capacity of a covered stent graft for each model.

Conclusions

The novel rabbit iliac artery perforation models, as described in this report, represent promising animal testing approaches. While their setting is very similar to the real-life context encountered in humans, all three models are based on an animal model that is ideally suited for evaluating the sealing capacity and performance of new medical devices for humans.
Different effects of constitutive and induced microbiota modulation on microglia in a mouse model of Alzheimer’s disease
Authors: Mezö Charlotte , Dokalis Nikolaos , Mossad Omar , Staszewski Ori , Neuber Jana , Yilmaz Bahtiyar , Schnepf Daniel , de Agüero Mercedes Gomez , Ganal-Vonarburg Stephanie C. , Macpherson Andrew J. , Meyer-Luehmann Melanie , Staeheli Peter , Blank Thomas , Prinz Marco , Erny Daniel
Published: July 2020

It was recently revealed that gut microbiota promote amyloid-beta (Aβ) burden in mouse models of Alzheimer’s disease (AD). However, the underlying mechanisms when using either germ-free (GF) housing conditions or treatments with antibiotics (ABX) remained unknown. In this study, we show that GF and ABX-treated 5x familial AD (5xFAD) mice developed attenuated hippocampal Aβ pathology and associated neuronal loss, and thereby delayed disease-related memory deficits. While Aβ production remained unaffected in both GF and ABX-treated 5xFAD mice, we noticed in GF 5xFAD mice enhanced microglial Aβ uptake at early stages of the disease compared to ABX-treated 5xFAD mice. Furthermore, RNA-sequencing of hippocampal microglia from SPF, GF and ABX-treated 5xFAD mice revealed distinct microbiota-dependent gene expression profiles associated with phagocytosis and altered microglial activation states. Taken together, we observed that constitutive or induced microbiota modulation in 5xFAD mice differentially controls microglial Aβ clearance mechanisms preventing neurodegeneration and cognitive deficits.
Simulation of uniaxial stress–strain response of 3D-printed polylactic acid by nonlinear finite element analysis
Authors: Alharbi Mohammed , Kong Ing , Patel Vipulkumar Ishvarbhai
Published: July 2020

Accurate simulation of mechanical properties of 3D-printed objects can provide critical inputs to designers and manufacturers. Polylactic acid, a biodegradable polymer, is particularly important in this regard due to its excellent print quality and a wide range of applications. Herein, an accurate uniaxial stress–strain profile simulation of 3D-printed PLA is reported. Nonlinear Finite Element Analysis (FEA) was used to simulate the uniaxial tensile test and build a material model for the prediction of the stress–strain response. 3D model for this nonlinear FEA study was built in SolidWorks, and several measures were taken to simulate the nonlinear stress–strain response with high accuracy. Von Mises stress, resultant displacement, and strain plots were produced. Comparison with experimental data extracted from the literature was done to validate the FEA model. Fracture behavior was predicted by FEA stress distribution. Deviations between the stress–strain plot obtained by FEA from the experimentally obtained plot were minimal. The entire curve, except the failure zone, could be precisely simulated. Furthermore, the developed von Mises plasticity material model and the boundary conditions also captured the behavior of specimen under uniaxial tension load and the deviation between experimental results was minor. These results suggest that the developed material model could be useful in non-linear FEA studies on 3D printed PLA objects which are expected to withstand tensile stress.
Sensory stimulation in the treatment of children with sleep-related rhythmic movement disorder: a feasibility and acceptability study
Authors: van Sluijs Rachel M. , Wilhelm Elisabeth , Rondei Quincy J. , Jäger Lukas , Gall Markus , Garn Heinrich , Achermann Peter , Jenni Oskar G. , Riener Robert , Hill Catherine M.
Published: July 2020

Background

Sleep-related rhythmic movement disorder is characterized by repetitive gross-motor movements at sleep onset or during sleep, which result in clinical consequences such as impact on daytime functioning and injury. No well-established therapies exist today. Substituting the patient’s movements with external sensory stimulation may offer a treatment modality. The aim of the current study was to test the feasibility and acceptability of vestibular stimulation using a rocking bed (Somnomat) in children with rhythmic movement disorder and to assess children’s movement preference.

Methods

Children with rhythmic movement disorder (n = 6, Age: 5–14 years) were studied over three nights in a sleep laboratory: adaptation night (normal bed) and randomised-order baseline (Somnomat) and intervention nights (Somnomat). Child’s preferred movement direction (head-to-toe or side-to-side) and frequency (between 0.25 and 2 Hz), determined during an afternoon protocol, were applied using the Somnomat for 1 h after lights out, and in response to subsequent episodes of rhythmic movement during intervention nights. Comfort assessed using a questionnaire, and objective sleep parameters assessed using videosomnography, were compared.

Results

The participants’ sometimes violent rhythmic movements did not disturb device performance. All children rated intervention nights equally or more comfortable than baseline nights. Self-reported sleep quality, as well as the number and duration of movement episodes did not significantly differ between baseline and intervention nights.

Conclusions

Providing rocking movements using the Somnomat is both technically feasible and acceptable to the target population. The therapeutic value of this novel stimulus substitution for rhythmic movement disorder should now be evaluated in a larger sample over a longer period in the home setting.

Trial registration

The trial was retrospectively registered at clinicaltrials.gov (NCT03528096) on May 17th 2018.
Role of circulating miR 194-5p, miR 106b, and miR 146a as potential biomarkers for epilepsy: a case-control study
Authors: Moustafa Mervat , Abokrysha Noha T. , Eldesoukey Nermeen A. , Amin Dalia Gamil , Mounir Nesma , Labib Dalia M.
Published: July 2020

Background

Epilepsy is a chronic neurological disease. A suitable biomarker for epilepsy diagnosis remains lacking. MicroRNAs (miRNAs) were pronounced as promising biomarkers for epileptogenesis.

Objectives

To analyze the expression levels of miR 194-5p, miR 106b, and miR 146a in Egyptian epileptic patients compared to control subjects and to detect their correlation to clinical characteristics.

Subjects and methods

We evaluated the expression levels of miR 106b, miR 146a, and miR 194-5p using real-time quantitative polymerase chain reaction (qRT-PCR) in 50 subjects: 15 patients with idiopathic generalized epilepsy, 15 patients with focal epilepsy (3 idiopathic and 12 cryptogenic), and 20 healthy controls.

Results

miR 106b and miR 194-5p were upregulated in the generalized epilepsy group compared to control; miR 194-5p was significantly downregulated in the focal epilepsy group compared to the generalized epilepsy group and control (p ˂ 0.05). miR 194-5p was negatively correlated to disease duration in patients with focal epilepsy; the three microRNAs were positively correlated to each other (p ˂ 0.05).

Conclusion

Serum miR 194-5P and miR 106b can be used as potential non-invasive biomarkers in the evaluation of idiopathic generalized epilepsy.
Study of ethion and lipopolysaccharide interaction on lung in a mouse model
Authors: Verma Geetika , Sethi R. S.
Published: July 2020

Ethion is an organophosphate used commonly in India despite being banned in many other countries. The present study was designed to study the interaction of ethion and lipopolysaccharide (LPS) together on lung after single low dose ethion exposure. Mice (n = 20) were alienated into control and treatment groups (n = 10 each). The treatment group was orally fed ethion (8 mg/kg/animal/day) dissolved in corn oil. The animals (n = 5 each) from both the groups were challenged with 80 μg Escherichia coli lipopolysaccharide (LPS) intranasally and the remaining animals (n = 5 each) were administered normal saline solution after 24 h. Ethion along with LPS induced lung inflammation as indicated by increased neutrophils and total leukocyte count (TLC) in broncheoalveolar lavage fluid. Ethion induced histomorphological alterations in lung as shown by increased pulmonary inflammation score in histopathology. Real time PCR analysis showed that ethion followed by LPS resulted significant (p < 0.05) increase in pulmonary Toll-like receptor (TLR)-4 (48.53 fold), interleukin (IL)-1β (7.05 fold) and tumor necrosis factor (TNF)-α (5.74 fold) mRNA expression. LPS co-exposure suggested synergistic effect on TLR4 and TNF-α mRNA expression. Ethion alone or in combination with LPS resulted genotoxicity in blood cells as detected by comet assay. The data suggested single dietary ethion exposure alone or in conjunction with LPS causes lung inflammation and genotoxicity in blood cells.
Brain Factor-7® improves learning and memory deficits and attenuates ischemic brain damage by reduction of ROS generation in stroke in vivo and in vitro
Authors: Noh Yoohun , Ahn Ji Hyeon , Lee Ji-Won , Hong Junkee , Lee Tae-Kyeong , Kim Bora , Kim Sung-Su , Won Moo-Ho
Published: July 2020

Brain Factor-7® (BF-7), silk fibroin peptide, is known to be effective in improvement of memory and learning ability. In this study, the effects of BF-7 (10 mg/kg, p.o., pre-treatment for 7 days and post-treatment for 7 days) on neuroprotection and memory and learning functions were investigated in a rat model of transient focal cerebral ischemia and a gerbil model of transient global forebrain ischemia. Furthermore, to find the mechanism of BF-7, we examined the neuroprotective and antioxidative effects of BF-7 in vitro using neuroblastoma (SH-SY5Y) cells. In vivo model, treatment with BF-7 significantly reduced the number of errors in 8-arm maze test and significantly increased latency time in passive avoidance test at 7 days after focal ischemia compared to those in the vehicle-treated group. In addition, treatment with BF-7 significantly decreased the infarct size or neuronal death at 7 day following transient ischemia compared to that in the vehicle-treated group. In vitro model, 10 or 20 μg/ml of BF-7 treatment significantly increased cell viability in dose-dependent manner. In addition, oxidative stress was significantly attenuated in the ischemic cells, showing that 10 or 20 μg/ml of BF-7 treatment significantly reduced the generation of reactive oxygen species (ROS) compared to that in the ischemic cells. These results indicate that BF-7 treatment can attenuate ischemic damages and improve memory deficits via reduction of ROS generation.
Ophiostomatoid fungi associated with mites phoretic on bark beetles in Qinghai, China
Authors: Chang Runlei , Duong Tuan A. , Taerum Stephen J. , Wingfield Michael J. , Zhou XuDong , de Beer Z. Wilhelm
Published: July 2020

Bark beetle galleries are complex ecosystems where many microbes and other arthropods co-exist with the beetles. Fungi isolated from these galleries are often referred to as ‘beetle associates’, but the nature of these associations are poorly understood. The possibility that many of these fungi might in fact be mite associates is often overlooked. Several recent studies explored the diversity of fungi from conifer-infesting bark beetles and their galleries in China, but only one study considered phoretic mites and their fungi from conifer-infesting bark beetles in Yunnan, southwestern China. We studied the mites and fungi from galleries of four spruce-infesting bark beetle species in the high altitude forests of Qinghai province, western China. Mites were identified based on morphological characteristics, and fungi based on DNA sequences of four gene regions. In total, 173 mite individuals were collected belonging to 18 species in 11 genera. A total of 135 fungal isolates were obtained from the mites, representing 14 taxa from theOphiostomatales.The most frequently isolated fungus wasOphiostoma nitidum, which represented 23.5% of the total isolates. More fungal species were found from fewer mites and bark beetle species than from the study in Yunnan. Although we could not elucidate the exact nature of interactions between mites and their fungi, our results re-enforce that these organisms should not be ignored in pest risk assessments of bark beetles, that often focus only on the beetles and their fungi. Three new species are described:Grosmannia zekuensis,O. manchongi,andO. kunlunensespp. nov., and our data revealed thatO. typographi, recently described from China, is a synonym ofO. ainoae.
Serum sclerostin in rheumatoid-induced osteoporosis
Authors: Gharbia Ola , Hegazy Aliaa , Elhelaly Rania , ElGhaweet Atif
Published: July 2020

Background

Rheumatoid arthritis (RA) is characterized by presence of localized and generalized osteoporosis. The mechanism of decreased bone mass is complex and multifactorial, a possible mechanism behind increased bone loss in RA is upregulation of sclerostin. The aim of this work was to evaluate serum sclerostin level in RA patients and its relation with bone mineral density (BMD) and disease activity.

Results

Serum sclerostin level in RA patients was significantly higher than the controls (p< 0.001). Osteopenia and osteoporosis were more prevalent in RA patients (22.5% and 7.5% respectively) compared to controls (15% and 2.5% respectively) (p= 0.006). Serum sclerostin level was significantly correlated with tender joint count (p= 0.014), swollen joint count (p= 0.036), erythrocytes sedimentation rate (p= 0.010), C reactive protein serum level (p= 0.025), disease activity score (DAS) 28-ESR (p= 0.018), DAS28-CRP (p= 0.005), and radiological modified Sharp erosion score (p= 0.049). The correlation of serum sclerostin level in RA patients with BMD and with T-score in all sites revealed an inverse relationship withpvalues insignificant.

Conclusion

Serum sclerostin is a major player in bone metabolism as a negative regulator of bone growth through inhibition of Wnt signaling that is largely influenced by the disease activity. Controlling the disease activity is a major factor for prevention of local as well as generalized osteoporosis and is essential for the reparative local and systemic bone health.
Mapping UK mental health services for adults with attention-deficit/hyperactivity disorder: national survey with comparison of reporting between three stakeholder groups
Authors: Price Anna , Janssens Astrid , Newlove-Delgado Tamsin , Eke Helen , Paul Moli , Sayal Kapil , Hollis Chris , Ani Cornelius , Young Susan , Dunn-Morua Susan , Asherson Philip , Logan Stuart , Ford Tamsin
Published: July 2020

Background

UK clinical guidelines recommend treatment of attention-deficit hyperactivity disorder (ADHD) in adults by suitably qualified clinical teams. However, young people with ADHD attempting the transition from children's to adults’ services experience considerable difficulties in accessing care.

Aims

To map the mental health services in the UK for adults who have ADHD and compare the reports of key stakeholders (people with ADHD and their carers, health workers, service commissioners).

Method

A survey about the existence and extent of service provision for adults with ADHD was distributed online and via national organisations (e.g. Royal College of Psychiatrists, the ADHD Foundation). Freedom of information requests were sent to commissioners. Descriptive analysis was used to compare reports from the different stakeholders.

Results

A total of 294 unique services were identified by 2686 respondents. Of these, 44 (15%) were dedicated adult ADHD services and 99 (34%) were generic adult mental health services. Only 12 dedicated services (27%) provided the full range of treatments recommended by the National Institute for Health and Care Excellence. Only half of the dedicated services (55%) and a minority of other services (7%) were reported by all stakeholder groups (P < 0.001, Fisher's exact test).

Conclusions

There is geographical variation in the provision of NHS services for adults with ADHD across the UK, as well as limited availability of treatments in the available services. Differences between stakeholder reports raise questions about equitable access. With increasing numbers of young people with ADHD graduating from children's services, developing evidence-based accessible models of care for adults with ADHD remains an urgent policy and commissioning priority.
Pancreatic Steatosis Associates With Impaired Insulin Secretion in Genetically Predisposed Individuals
Authors: Wagner Róbert , Jaghutriz Benjamin Assad , Gerst Felicia , Barroso Oquendo Morgana , Machann Jürgen , Schick Fritz , Löffler Markus W , Nadalin Silvio , Fend Falko , Königsrainer Alfred , Peter Andreas , Siegel-Axel Dorothea , Ullrich Susanne , Häring Hans-Ulrich , Fritsche Andreas , Heni Martin
Published: July 2020

Context

Pancreatic steatosis leading to beta-cell failure might be involved in type 2 diabetes (T2D) pathogenesis.

Objective

We hypothesized that the genetic background modulates the effect of pancreatic fat on beta-cell function and investigated genotype × pancreatic fat interactions on insulin secretion.

Design

Two observational studies.

Setting

University hospital.

Patients or participants

A total of 360 nondiabetic individuals with elevated risk for T2D (Tuebingen Family Study [TUEF]), and 64 patients undergoing pancreatectomy (Pancreas Biobank [PB], HbA1c <9%, no insulin therapy).

Main Outcome Measures

Insulin secretion calculated from 5-point oral glucose tolerance test (TUEF) and fasting blood collection before surgery (PB). A genome-wide polygenic score for T2D was computed from 484,788 genotyped variants. The interaction of magnetic resonance imaging-measured and histologically quantified pancreatic fat with the polygenic score was investigated. Partitioned risk scores using genome-wide significant variants were also computed to gain insight into potential mechanisms.

Results

Pancreatic steatosis interacted with genome-wide polygenic score on insulin secretion (P = 0.003), which was similar in the replication cohort with histological measurements (P = 0.03). There was a negative association between pancreatic fat and insulin secretion in participants with high genetic risk, whereas individuals with low genetic risk showed a positive correlation between pancreatic fat and insulin secretion. Consistent interactions were found with insulin resistance-specific and a liver/lipid-specific polygenic scores.

Conclusions

The associations suggest that pancreatic steatosis only impairs beta-cell function in subjects at high genetic risk for diabetes. Genetically determined insulin resistance specifically renders pancreatic fat deleterious for insulin secretion.
Bunching to Maximize Tax Credits: Evidence from Kinks in the US Tax Schedule
Authors: Mortenson Jacob A. , Whitten Andrew
Published: July 2020

We explore bunching at US income tax kinks using a panel of 258 million tax returns from 1996 to 2014. We find bunching at seven kinks, with nearly all bunching occurring at kinks maximizing tax credits. In our sample period, the total number of bunchers increased at an 11 percent annualized growth rate, from 134,300 in 1996 to 866,600 in 2014. Approximately two-thirds of these bunchers locate at the unique point that maximizes refunds. Some taxpayers repeatedly bunch at this point, even in consecutive years when different tax kinks are refund maximizing. (JEL H24, H26, H31)
Adopt or Innovate: Understanding Technological Responses to Cap-and-Trade
Authors: Calel Raphael
Published: July 2020

One important motivation for creating cap-and-trade programs for carbon emissions is the expectation that they will stimulate much-needed low-carbon innovation. I construct a new panel of British firms to investigate this hypothesis, finding that the European carbon market has encouraged greater low-carbon patenting and R&D spending among regulated firms without necessarily driving short-term reductions in carbon intensity of output. This stands in contrast to past cap-and-trade programs, which have primarily spurred adoption of existing pollution control technologies, with little effect on innovation. I discuss how to reconcile these contrasting findings and implications for the future of carbon markets. (JEL D22, O32, O34, Q52, Q54, Q58)
Price-Linked Subsidies and Imperfect Competition in Health Insurance
Authors: Jaffe Sonia , Shepard Mark
Published: July 2020

Policymakers subsidizing health insurance often face uncertainty about future market prices. We study the implications of one policy response: linking subsidies to prices to target a given postsubsidy premium. We show that these price-linked subsidies weaken competition, raising prices for the government and/or consumers. However, price-linking also ties subsidies to health care cost shocks, which may be desirable. Evaluating this tradeoff empirically, using a model estimated with Massachusetts insurance exchange data, we find that price-linking increases prices 1–6 percent, and much more in less competitive markets. For cost uncertainty reasonable in a mature market, these losses outweigh the benefits of price-linking. (JEL G22, H75, I13, I18)
To be or not to be an Obstetrician/Gynaecologist
Authors: Ahmed Iffat , Ashar Abid
Published: July 2020

Objectives: This qualitative study aimed to explore motivational sources of physicians, at the time of selection and while pursuing ObGyn career. Secondary aim was to explore challenges and strategies adapted by these physicians to overcome these challenges.

Methods: This is qualitative study with constrictive worldview. ObGyn residents and consultants of Aga Khan University, Karachi, were interviewed from July 2017 till Jan 2019, after ethical approval, using purposeful maximum variation sampling. Analysis were conducted by identifying keywords and phrases, these unedited verbatim with no assumptions provided basis for codes, which then clustered as trends. Emerging findings were discussed among authors and themes were finalized with consensus. Conclusion was formulated by linking these themes.

Results: Four themes emerged were, ‘grounds for selecting ObGyn as career’, ‘Motivational Factors’, ‘Demotivating Factors’ and ‘Strategies to Cope with Challenges’. Results showed that aptitude and passion not only have pivotal role in career selection but also helped in pursuance. Personal fulfilment and hands-on experience satisfy emotional needs, while family and friends supported participants in maintaining work-life balance and in over-coming challenges.

Conclusions: Considering personal preference and aptitude at the time of career selection helps in endurance and keep motivations high, while challenges in pursuance can be overcome by strong support system.

doi: https://doi.org/10.12669/pjms.36.6.3080

How to cite this:Ahmed I, Ashar A. To be or not to be an Obstetrician/Gynaecologist. Pak J Med Sci. 2020;36(6):1165-1170. doi: https://doi.org/10.12669/pjms.36.6.3080

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cost analysis of implementing HIV drug resistance testing in Kenya: a case study of a service delivery site at a tertiary level hospital in Kenya
Authors: Gachogo Rachael W. , Mwai Daniel N. , Onyambu Frank G.
Published: July 2020

Background: HIV drug resistance (HIVDR) threatens progress achieved in response to the HIV epidemic. Understanding the costs of implementing HIVDR testing programs for patient management and surveillance in resource-limited settings is critical in optimizing resource allocation. Here, we estimate the unit cost of HIVDR testing and identify major cost drivers while documenting challenges and lessons learnt in implementation of HIVDR testing at a tertiary level hospital in Kenya.

Methods: We employed a mixed costing approach to estimate the costs associated with performing a HIVDR test from the provider’s perspective. Data collection involved a time and motion study of laboratory procedures and interviewing laboratory personnel and the management personnel. Cost analysis was based on estimated 1000 HIVDR tests per year. Data entry and analysis were done using Microsoft Excel and costs converted to US dollars (2019).

Results: The estimated unit cost for a HIVDR test was $271.78 per test. The main cost drivers included capital ($102.42, 37.68%) and reagents (101.50, 37.35%). Other costs included: personnel ($46.81, 17.22%), utilities ($14.69, 5.41%), equipment maintenance costs ($2.37, 0.87%) and quality assurance program ($4, 1.47%). Costs in relation to specific laboratory processes were as follows: sample collection ($2.41, 0.89%), RNA extraction ($22.79, 8.38%), amplification ($56.14, 20.66%), gel electrophoresis ($10.34, 3.80%), sequencing ($160.94, 59.22%), and sequence analysis ($19.16, 7.05%). A user-initiated modification of halving reagent volumes for some laboratory processes (amplification and sequencing) reduced the unit cost for a HIVDR test to $233.81 (13.97%) reduction. 

Conclusions: Capital expenditure and reagents remain the most expensive components of HIVDR testing. This cost is bound to change as the sequencing platform is utilized towards maximum capacity or leveraged for use with other tests. Cost saving in offering HIVDR testing services is also possible through reagent volume reduction without compromising on the quality of test results.
Case Report: An extremely rare occurrence of recurrent inguinal low-grade fibromyxoid sarcoma involving the scrotum
Authors: Chitayat Samy , Barros Rodrigo , Ribeiro José Genilson , Silva Heleno Augusto Moreira , Sá Flávio Rondinelli , Reis Bruno de Souza Bianch , Fosse Junior Angelo Maurilio
Published: July 2020

Low-grade fibromyxoid sarcoma (LGFMS) is a rare sarcoma subtype. The most common tumor locations are the deep soft tissue of extremities or trunks. We report a rare case of recurrent LGFMS in the inguinal region involving the scrotum and both testicles. A 38-year-old male patient reported a history of multiple nodular lesions in the left inguinal region accompanied by local inflammation. The patient was submitted for local resection of the lesion at our institution, with histopathological diagnosis of LGFMS. He missed his follow-up, returning with a large bulge in the left inguinal region involving the scrotum with signs of tissue necrosis and local purulent discharge. Surgical exploration was performed and the patient underwent tumor resection in the left inguinal region and the entire scrotum, with bilateral orchiectomy, with the margins enlarged to the right inguinal region and proximal surface of the penis. Local reconstruction was performed with a left fascia lata tensor muscle flap and ipsilateral thigh coverage using partial skin graft. On microscopic examination, the tumor showed spindle cells arranged in bundles, with abundant collagen and myxoid stroma with interspersed prominent vessels. The immunohistochemical study carried out showed immunoreactivity with Ki67 (<5%), immunonegativity with desmin and S100, confirming the diagnosis of LGFMS. Postoperative recovery was good and no recurrence was seen after two years. The patient is in good health, realizing multidisciplinary outpatient follow-up and performing continuous testosterone replacement. Surgical resection with negative margins for localized disease remains the standard treatment for LGFMS.
The science of safety: complications associated with the use of mechanical circulatory support in cardiogenic shock and best practices to maximize safety
Authors: Kapur Navin K. , Whitehead Evan H. , Thayer Katherine L. , Pahuja Mohit
Published: July 2020

Acute mechanical circulatory support (MCS) devices are widely used in cardiogenic shock (CS) despite a lack of high-quality clinical evidence to guide their use. Multiple devices exist across a spectrum from modest to complete support, and each is associated with unique risks. In this review, we summarize existing data on complications associated with the three most widely used acute MCS platforms: the intra-aortic balloon pump (IABP), Impella systems, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We review evidence from available randomized trials and highlight challenges comparing complication rates from case series and comparative observational studies where a lack of granular data precludes appropriate matching of patients by CS severity. We further offer a series of best practices to help shock practitioners minimize the risk of MCS-associated complications and ensure the best possible outcomes for patients.
Plant Responses to Spring Grazing by Elk in Yellowstone National Park
Authors: Merrill Evelyn , Stanton Nancy
Published: July 2020

Management of elk on the northern winter range of Yellowstone National Park has remained a controversial subject through most of this century (Singer 1989). Until 1968 elk were artificially controlled because it was believed that ranching outside the park excluded elk from winter ranges resulting in unnaturally high populations in the Park and uncontrolled elk numbers would result in overgrazing and ecosystem degradation. However, in 1968 elk reductions were terminated and by 1971 a hypothesis of natural regulation was formulated by Park biologists (Singer 1989). The natural regulation hypothesis asserts that the Yellowstone area used by elk is an ecologically complete habitat (all required components of the habitat are present) and that density dependant factors will limit population growth of elk without major range degradation.
Ash Yellows in Zion National Park: Impact, Idenity of Pathogen Mode of Spread, and Prospects for Management
Authors: Sinclair Wayne , Treshow Michael , Davis Robert
Published: July 2020

Many velvet ash (Fraxinus velutina) in Zion Canyon have declined in vigor, and some are dying. This species is aesthetically and ecologically important in the canyon, because it is one of only three species that commonly grow to large size on the canyon floor. None of the three species is reproducing abundantly, because suitable seedbeds are scarce and young plants are severely browsed by deer. A disease known as ash yellows, which is caused by unnamed mycoplasmalike organisms (wall-less, obligately parasitic prokaryotic organisms, commonly called MLOs) was found in Zion Canyon in 1988, and is suspected to cause or contribute to the decline of velvet ash there. Until this project began, nothing was known about the ecology or epidemiology of ash yellows in the West.
Demography of the Burrowing Owl in Badlands National Park
Authors: Martell Mark , Redig Patrick , Nibe Jill
Published: July 2020

The burrowing owl (Athene cunicularia), was once widely distributed throughout the western United States and Canada (Bent 1938), and was considered common on the prairie dog towns of South Dakota and Nebraska (Cooke 1888, Over and Thomas 1920). Recently however, concern over the birds status has resulted in its being listed as; "endangered" in two states (MN and lA), "threatened" across its range in Canada, and of "special concern" in seven states (WA, OR, CA, MT, WY, ND, FL) (Martell1990). Land management practices including grazing, shooting, and poisoning on prairie dog colonies, the primary nesting habitat of burrowing owls in the Great Plains, has the potential to greatly affect owl populations. Information on population sizes and trends, the location of wintering areas, and the degree of nest site fidelity is needed to monitor and manage this species on public lands.
Blackbrush, Coleogyne ramosissima Propagation and Revegetation of Disturbed Sites
Authors: Hughes Harrison , Weglinski Eugene
Published: July 2020

Blackbrush (Coleogyne ramosissima Torr.) is a small to medium sized shrub of the Rosaceae family. It is considered to be a paleoendemic species which once disturbed on a site does not reestablish. Its distribution is a narrow band ranging from eastern California to extreme western Colontdo occupying a niche between the major species of the Great Basin and Mojave Deserts (Bjugstad 1983; Landis and Simonich 1983; and Wallace et al. 1970). The populations at Arches and Canyonlands National Parks occupy the northern most region of its range. Guidelines exist for the propagation of blackbrush by seed (Vories 1981). Problems exist, however, with the acquisition of seed due to infrequent and inconsistent seed set and establishment of seedlings due to feeding by herbivores (Bowns and West 1976). Therefore, asexual propagation by cuttings or mound layering offer potential. Asexual propagation techniques may present the answer to the revegetation problem in that a relatively large number of plants may be produced with a minimal amount of effort once a successful methodology is established. Additionally, rooted cuttings result in a mature plant more rapidly than do seedlings, reducing the mortality problem due to herbivore feeding. Finally, mother plants which are well adapted to a specific site may be reproduced, increasing the probability of success once the plantlets are reintroduced into the field. There were three primary objectives of this research. The first was to evaluate the effects of rooting hormones, season, and maturity of the wood on the rooting of cuttings of blackbrush. The second, was to evaluate response of blackbrush to mount layering with mother plants receiving normal or supplemental water. Finally, we evaluated the reintroduction of all plantlets to the field using proper planting times, soil preparation, and water harvesting techniques. The ultimate goal was to establish procedures for propagating blackbrush and reestablishing it onto disturbed sites within the National Parks.
Sedimentology and Stratigraphy of the Morrison Formation in Dinosaur National Monument
Authors: Turner Christine , Peterson Fred
Published: July 2020

The objective of this study is to establish a stratigraphic, sedimentologic, and geochronologic framework of the Upper Jurassic Morrison Formation within Dinosaur National Monument (DNM) and to tie this framework to the rest of the Colorado Plateau and other important fossil-bearing localities in the Western Interior of the U.S. The study is also designed to complement ongoing paleontological inventories of the Morrison Formation within the Monument. During the 1990 field season emphasis was placed on the larger aspects of stratigraphic and sedimentologic work and collection of samples for various types of analyses. Work during the 1991 field season was concentrated on detailed stratigraphic and sedimentologic studies of the quarry interval and on the regional studies that will relate the Morrison Formation at DNM and its contained bones to important bone-bearing localities elsewhere in the Western Interior of the U.S.
Gray Wolf Prey Base Ecology in the North Fork of the Flathead River Drainage
Authors: Marcum C. , Pletscher Daniel , Bureau Michael , Weigand John
Published: July 2020

During the reporting period, major goals of this project were to monitor elk (Cervus elaphus) in the North Fork of the Flathead River Drainage for mortality, monitor seasonal distribution and determine key areas of use, establish a repeatable index of elk abundance, and determine age/sex composition. Two radio collared elk have died during the last six months. Both elk were killed in May by mountain lions (Felis concolor). This brings the mortality totals to seven elk killed by lions, two by wolves (Canis lupus), one by grizzly bear (Ursus arctos horribilis), and one by a hunter (n=34 radio-collared elk). Lions killed elk throughout the age distribution. Wolves took a calf and an old elk. The hunter killed a prime-aged elk, while the grizzly killed a 16-year-old elk.
Succession Following the 1974 Waterfalls Canyon Fire
Authors: Doyle Kathleen , Knight Dennis
Published: July 2020

A major objective of the National Park Service is to preserve examples of natural features and processes that characterize the North American landscape. Fire is now widely recognized as a natural process in many ecosystems, but its management remains a controversial issue. Research on successional change following fire will contribute to improved fire interpretation and management. The Waterfalls Canyon (WC) fire was started by lightning in July 1974 and continued burning until December. Approximately 1414 ha were burned on the west side of Jackson Lake in Grand Teton National Park (GTNP) (Barmore et al. 1976). This fire was especially significant because it was one of the first large fires to occur in a National Park following the adoption of the revised fire management policies in 1972, allowing natural fires to burn in certain designated areas. Prior to 1972, the longÂ­standing fire management policy was to suppress both natural and human-caused fires (Barmore et al. 1976). Considerable scientific and public interest was generated by the Waterfalls Canyon fire. For example, tourists in GTNP complained about the smoke which obscured views of the Tetons. For park scientists, the Waterfalls Canyon fire provided an opportunity to initiate studies to better understand and interpret the fundamental role of fire in GTNP. During the summer of 1975, Barmore et al. (1976) established a series of permanent plots to evaluate post-fire changes in vegetation and small mammal and bird abundance. In addition, baseline data were collected in 1975 describing the soils, streamwater chemistry, and insect populations. Permanent plots were established within two stands that burned in 1974: 1) a severely burned stand (forest floor burned exposing mineral soil), and 2) a moderately burned stand (forest floor mostly unburned). In addition, permanent plots were established in two adjacent sites, both unburned in 1974, but which appeared to be very similar to the (WC) burned area. One was a mature spruce-fir forest that had not burned for more than 100 years, and the other was a stand that burned in 1932. Important data was collected by Park scientists following the Waterfalls Canyon fire, with vegetation, bird and mammal data being collected in the four study sites in 1975, 1976, 1977 and 1983.
Acoustic Signaling in Sagebrush Crickets: A Test of the Territorial Hypothesis
Authors: Petersen Kristin , Eggert Anne-Katrin , Will Michael , Sakaluk Scott
Published: July 2020

The sagebrush cricket, Cyphoderris strepitans, is one of only five extant species belonging to an ancient insect lineage, the Haglidae, believed to be ancestral to modern-day crickets and katydids (Orthoptera: Ensifera) (Morris and Gwynne 1978). C. strepitans occurs exclusively in mountainous areas of Wyoming and Colorado, where it is found primarily in high-altitude sagebrush meadow habitat. Adults become sexually active in May, shortly after snowmelt, and remain active for the next 4-6 weeks. Each night of the breeding season, males emerge from the soil litter shortly after sunset, climb into the sagebrush and begin to sing, presumably to attract sexually receptive females. Copulation is initiated when a receptive female climbs onto the dorsum of a male, at which time he attempts to transfer a spermatophore. During copulation, the female feeds on the male's fleshy metathoracic wings and ingests any haemolymph leaking from the wounds she inflicts (Sakaluk et al. 1987, Morris et al. 1989, Sakaluk and Snedden 1990). The wounds that result from wing feeding provide a convenient, permanent record of a male's mating status; through visual inspection of the metathoracic wings, it is possible to determine whether field-collected males are virgin or have mated at least once prior to their capture (Dodson et al. 1983, Morris et al. 1989).
Great Sand Dunes National Monument Vegetation Patterns
Authors: McArthur E. , Sanderson Stewart
Published: July 2020

This project is designed to chacterize and map the vegetation of the Great Sand Dunes National Monument, Colorado (GSDNM) and to determine if the vegetated areas in the dune field are permanent, temporary, or migratory. It is not known if the vegetation around the dunes is encroaching on the dunes, being replaced by the dunes or is stable. There are also concerns about the possible effect a proposed water export project adjacent to GSDNM would have on the dunes and their vegetation.
Paleontological Survey of the Jurassic Morrison Formation in Dinosaur National Monument
Authors: Engelmann George
Published: July 2020

The paleontological survey of the Morrison Formation within Dinosaur National Monument (DINO) was planned as a three-year project. The objectives of the project have been to exhaustively search the exposures of the Morrison Fm. within DINO for fossil occurrences of any sort and to document in the files of the monument all known and newly discovered localities. This is the third and final year of the project. The work of the previous two years has been described in semiannual and annual reports and summarized in the 14th and 15th Annual Reports of the Research Center (Engelmann 1991, 1992).
Exotic Plants of Theodore Roosevelt National Park
Authors: Butler Jack
Published: July 2020

The 1992 field season began in early May with a meeting between the principal investigator and NPS Unit Technical Representatives. The primary objectives of the second field season was to 1) continue with the initial survey so that the number and distribution of exotic plant species within the Park could be estimated, 2) take low-level aerial photographs (slides) of the South Unit so that general areas of leafy spurge infestations could be mapped, 3) continue to evaluate the existing ecological effects of exotics on the native constituents, and 4) estimate density and composition of exotics within the soil seed bank.
Monitoring Migratory Bird Populations in Grand Teton National Park, Northern Rocky Mountains
Authors: Cody Martin , Cain Steven
Published: July 2020

A scheme for long-term monitoring of breeding land bird populations in a wide variety of habitats representative of the northern Rockies and the Greater Yellowstone Ecosystem (GYE) was initiated in summer 1993. It is projected that the monitoring scheme, when fully established and formalized, will become a routine activity in Grand Teton National Park, where a broad range of representative vegetation types is accessible within close geographic proximity. Sixteen study sites were established within the park in pristine habitat, from the Jackson Hole lowlands to subalpine and alpine sites, from meadow, sagebrush and marshland, through willow scrub, cottonwood and aspen woodlands, to lodgepole pine and spruce-fir forests. Some of the study sites have a long history of research on the breeding birds (see below). Census sites are standardized at 5 ha in size, and mapped in detail (topography, vegetation). The locations and accessibility of the study sites permit all to be regularly and repeatedly censused during the short (6-week) breeding season. Census schedules, timing, and methodological protocols are being established and refined, to provide for strictly controlled inter-site and inter-year comparisons in breeding bird populations, species composition, and densities. In view of the projected benefits to science and resource management of this monitoring scheme, the project hopefully will be continued and the data base further expanded in future years, with a larger range of study sites (24-36).
Effects of Large-Scale Fire on Plant Regneration on Subalpine Plateaus in Yellowstone National Park
Authors: Romme William , Turner Monica , Gardner Robert , Hargrove William
Published: July 2020

The scale of the 1988 fires in Yellowstone National Park (YNP) raised numerous questions for the management of natural areas subject to large but infrequent natural disturbances. The central question that we have addressed in our postfire studies is whether the effects of large-scale fires, such as those in 1988, differ qualitatively as well as quantitatively from effects of smaller fires. The answer to this question has important implications for our understanding of the evolution of natural systems and for management of future disturbances in places like YNP (Christensen et al. 1989). We approached this question on Yellowstone's extensive subalpine plateaus by comparing patterns of plant regeneration in large vs. small fire-generated patches after the 1988 fires. This research complements our work in northern YNP that focused on the landscape-level interactions among ungulates, vegetation, and fire, and was published in the UW-NPS Report for 1992 (Turner et al. 1992). Recent research into the mechanisms of plant succession following fire or other disturbances has demonstrated that species responses may vary with different kinds and severities of disturbance and with the larger spatial and temporal context of the disturbance. For example, Rowe (1983) describes several species of Â·boreal plants that resprout from surviving belowground structures after low-severity fires and dominate early successional stages; these same species are killed by severe fires and replaced by other species having greater dispersal abilities (also see Miller 1982, Malanson 1984, and Halpern 1989). The scale and heterogeneity of the 1988 yellowstone fires provide an exceptional opportunity to evaluate the relative importance of the size and spatial patterning of fire-created patches for reestabishment of plant species representing different modes of reproduction.
Metapopulations and Feeding Selectivity of Montane and Long-Tailed Voles Microtus montanus and M. Longicaudus, and Hantavirus in the Jackson Hole Small Mammal Community
Authors: Jannett, Jr. Frederick
Published: July 2020

The purposes of the long-term research on metapopulations of voles begun in 1971 are to enumerate patterns in survivorship and reproduction across the sections of the metapopulations, and concomitant variation in morphology. The study sites for Microtus montanus were chosen to represent primary and secondary habitat, and proximate and isolated habitat patches. The purpose of the research begun in 1989 is to ascertain how selectively Microtus montanus and M. longicaudus feed, and to assess vegetation as a factor in demographic processes of the two species. The purpose of the research on hantavirus begun in 1994 is to ascertain the extent of hantavirus among as many species of small mammals as possible, to identify the strain(s), to understand the presence of hantavirus across species and among the metapopulations of voles, and to assess the potential for human contact.