bluuebunny/crossref_metadata_2025 huggingface dataset:
Elevated Hemoglobin Level Is Associated With Advanced Fibrosis in Pediatric Nonalcoholic Fatty Liver Disease
Authors: Giorgio Valentina , Mosca Antonella , Alterio Arianna , Alisi Anna , Grieco Antonio , Nobili Valerio , Miele Luca
Published: April 2017

Objectives:

Hemoglobin (Hb) and red blood cell distribution width (RDW) have been reported to be a risk marker of metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). No study exists on pediatric populations. We aimed to determine the association between hematological parameters, and the severity of disease in children with biopsy‐proven NAFLD.

Methods:

A total of 117 children (85 boys, mean age 12 years) with ultrasound evidence of NAFLD undergoing liver biopsy for diagnosis of nonalcoholic steatohepatitis (NASH), were prospectively enrolled between January 2011 and May 2013 in the setting of a tertiary care center. Children were screened for routine hematological and metabolic parameters, and causes of liver steatosis other than nonalcoholic were excluded, before liver biopsy was performed.

Results:

A total of 41 NAFLD (boys 29, mean age 11.2 years) and 76 NASH (boys 56, mean age 12.8 years) children were studied. Alanine transaminase levels were significantly higher in NASH group compared with NAFLD group (P = 0.05), and homeostatic model assessment of insulin resistance and triglycerides levels (P = 0.03 and 0.02, respectively). Regarding hematological components: red cell count, Hb, hematocrit, and RDW values were all significantly higher in NASH group compared with NAFLD group (P < 0.05 for each parameter).

Conclusions:

Children with NASH were more likely to have high levels of RDW compared to those with steatosis only. Moreover, NASH was associated with higher red cell count, Hb, and hematocrit. If confirmed in future follow‐up studies, hematological parameters may be introduced in algorithms for NASH risk prediction.
Challenges to Breastfeeding Initiation and Duration for Teen Mothers
Authors: Cota-Robles Sonia , Pedersen Laura , LeCroy Craig Winston
Published: April 2017

Purpose:

The purpose of this study was to evaluate breastfeeding practices of teen mothers in a pre- and postnatal education and support program.

Study Design and Methods:

We studied breastfeeding practices of primarily Hispanic and non-Hispanic White teen mothers who participated in the Teen Outreach Pregnancy Services (TOPS) program, which promoted breastfeeding through prenatal programming and postpartum support. Analyses identified the most common reasons participants had not breastfed and, for those who initiated breastfeeding, the most common reasons they stopped.

Results:

Participants (g = 314) reported on whether and for how long they breastfed. Nearly all participants reported initiating breastfeeding but few breastfed to 6 months. For the most part, reasons they reported stopping breastfeeding paralleled those previously reported for adult mothers across the first several months of motherhood.

Clinical Implications:

We found that teen mothers can initiate breastfeeding at high rates. Results highlight areas in which teen mothers' knowledge and skills can be supported to promote breastfeeding duration, including pain management and better recognizing infant cues. Our findings expand limited previous research investigating reasons that teen mothers who initiate breastfeeding stop before 6 months.
Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q
Authors: Mundy Lily R. , Homa Karen , Klassen Anne F. , Pusic Andrea L. , Kerrigan Carolyn L.
Published: April 2017

Background:

The BREAST-Q is a patient-reported outcome instrument used to evaluate outcomes in patients undergoing breast cancer surgery and reconstruction. Normative values for the BREAST-Q breast cancer modules have not been established, limiting data interpretation.

Methods:

Participants were recruited by means of the Army of Women, an online community of women (with and without breast cancer), to complete Mastectomy, Breast Conserving Therapy, and Reconstruction preoperative BREAST-Q scales. Inclusion criteria were women aged 18 years or older without a history of breast surgery or breast cancer. Analysis included descriptive statistics, a linear multivariate regression, and a comparison of the generated normative data to previously published BREAST-Q findings.

Results:

The BREAST-Q was completed by 1201 women. The mean patient age was 54 ± 13 years, mean body mass index 26 ± 6 kg/m2, and 38 percent (n = 455) had a bra cup size of D or greater. Mean ± SD scores for BREAST-Q scales were as follows: Satisfaction with Breasts (58 ± 18), Psychosocial Well-being (71 ± 18), Sexual Well-being (56 ± 18), Physical Well-being-Chest (93 ± 11), and Physical Well-being Abdomen (78 ± 20). Women with a body mass index of 30 kg/m2 or greater, cup size of D or greater, age younger than 40 years, and annual income less than $40,000 reported lower scores. Comparing normative scores to published data in breast cancer patients, Satisfaction with Breasts scores were higher after autologous reconstruction and lower after mastectomy; Sexual Well-being scores were lower after mastectomy and breast conserving therapy; and Physical Well-being Chest scores were lower after mastectomy, breast conserving therapy, and reconstruction.

Conclusion:

These are the first published normative scores for the BREAST-Q breast cancer modules and provide a clinical reference point for the interpretation of data.
What Is the Standard Volume to Increase a Cup Size for Breast Augmentation Surgery? A Novel Three-Dimensional Computed Tomographic Approach
Authors: King Nina-Marie , Lovric Vedran , Parr William C. H. , Walsh W. R. , Moradi Pouria
Published: April 2017

Background:

Breast augmentation surgery poses many challenges, and meeting the patient’s expectations is one of the most important. Previous reports equate 100 cc to a one-cup-size increase; however, no studies have confirmed this between commercially available bras. The aim of this study was to identify the volume increase between cup sizes across different brands and the relationship with implant selection.

Methods:

Five bra cup sizes from three different companies were analyzed for their volume capacity. Three methods were used to calculate the volume of the bras: (1) linear measurements; (2) volume measurement by means of water displacement; and (3) volume calculation after three-dimensional reconstruction of serial radiographic data (computed tomography). The clinical arm consisted of 79 patients who underwent breast augmentation surgery from February 1, 2014, to June 30, 2016. Answers from a short questionnaire in combination with the implant volume were analyzed.

Results:

Across all three brands, the interval volume increase varied between sizes, but not all were above 100 cc. There was some variation in the volume capacity of the same cup size among the different brands. The average incremental increase in bra cup size across all three brands in the laboratory arm was 135 cc. The mean volume increase per cup size was 138.23 cc in the clinical arm.

Conclusions:

This article confirms that there is no standardization within the bra manufacturing industry. On the basis of this study, patients should be advised that 130 to 150 cc equates to a one-cup-size increase. Bras with narrower band widths need 130 cc and wider band widths require 150 cc to increase one cup size.
Correcting Concavity of Rabbit Auricular Cartilage: Comparison of Single Scoring Incisions with Butyl Cyanoacrylate–Aided Techniques
Authors: Yontar Yalcin , Özyazgan İrfan
Published: April 2017

Background:

The authors present the results of an experimental study in which four different techniques were used for the correction of concave rabbit auricular cartilage.

Methods:

Sixteen New Zealand adult male rabbits were used in the study. Butyl cyanoacrylate–aided cartilage graft fixation and butyl cyanoacrylate–aided bone graft fixation and scoring technique, alone or combined with butyl cyanoacrylate application, were performed to correct the concavity of rabbit auricular cartilage.

Results:

Angle measurements showed that all four techniques were efficient for correction of the cartilage concavities. However, the mean postsacrifice angles of the graft fixation groups were significantly higher than those of the other study groups, reflecting the fact that graft fixation with butyl cyanoacrylate application was more efficient for preserving the final cartilage shape. Furthermore, in the ninth month, graft fixation groups had the lowest chondrocyte densities, the highest degree of inflammation, the highest degree of foreign body reaction, and the highest butyl cyanoacrylate density.

Conclusions:

Fibrosis or chondrocyte proliferation on scoring incision lines is not an associated feature of this technique. When the incision depths were standardized, the scoring technique provided efficacy similar to that of the scoring incisions combined with butyl cyanoacrylate application for correction of the cartilage concavity. The scoring incision plus butyl cyanoacrylate group showed less toxicity than the graft fixation groups because of rapid removal of toxic breakdown products. Graft fixation techniques were superior to other corrective procedures with regard to preservation of the final cartilage shape. Although they resulted in greater toxicity, the cartilage correction was not affected unfavorably.
Effect of Human Fat Graft on Breast Cancer Metastasis in a Murine Model
Authors: Moltó-García Roberto , González-Alonso Virina , Villaverde-Doménech María Eloísa , Novella-Maestre Edurne
Published: April 2017

Background:

Isolated adipose stem cells have been reported to encourage migration and early metastasis of breast cancer. Mimicking a surgical situation, the authors developed a human breast cancer model to evaluate in vivo whether human adipose tissue promotes tumor growth and invasion.

Methods:

Human adipose tissue was obtained from four patients. The MDA-MB-468 cell line was cultured with a lentiviral vector encoding a puromycin resistance gene and mCherry fluorescent protein. Virus-infected cells were selected. Animals were injected in the left renal capsule and divided into three experimental groups: group A, MDA-MB-468 cells (n = 4); group B, MDA-MB-468 cells/human adipose tissue (n = 4); and group C, Dulbecco’s Modified Eagle Medium/F-12 medium (negative control, n = 4). Metastatic development was monitored using an in vivo imaging system. Small breast epithelial mucin (SBEM), human hypoxanthine-guanine phosphoribosyltransferase (HPRTh), and murine hypoxanthine-guanine phosphoribosyltransferase (HPRTm) expression were analyzed by real-time polymerase chain reaction to detect multifocal metastases in right/left renal capsule, liver, spleen, and pancreas.

Results:

Metastasis was observed between postinjection days 37 and 44. No significant differences were found in survival rates between groups (group A, 157 ± 42.60 days; group B, 169 ± 40.17 days). All samples expressed HPRTm. HPRTh and SBEM were expressed in left renal capsules from all group A and B mice, whereas in spleen, liver, pancreas, and right renal capsule the HPRTm and SBEM expression was not constant in all samples of group A and B mice. Differences were found between groups in HPRTh and SBEM expression but were not statistically significant.

Conclusion:

Human adipose tissue used to restore breast defects after oncologic resection did not increase metastasis development risk when there were residual breast cancer cells in proximity.
Longitudinal Photogrammetric Analysis of the Columellar-Labial Angle following Primary Repair of Bilateral Cleft Lip and Nasal Deformity
Authors: Rottgers S. Alex , Lim So Young , Hall Amber M. , Zurakowski David , Mulliken John B.
Published: April 2017

Background:

The changing nasolabial dimensions after repair of bilateral cleft lip and nasal deformity can be documented by anthropometry; however, the columellar-labial angle is rarely measured.

Methods:

This is a study of white patients who had synchronous repair of bilateral cleft lip performed by one surgeon (J.B.M.). The columellar-labial angle was measured on lateral photographs with the subject in neutral head position. Average values for columellar-labial angle at two or more time points were analyzed with a general estimating equation and cubic modeling. Values for complete and incomplete bilateral cleft lips were compared to each other and to Farkas’ norms. Direct anthropometric measurements of intraoperative columellar length were compared to the postoperative columellar-labial angle using Pearson correlation analysis.

Results:

Eighty-five patients were studied (64 complete and 21 incomplete clefts). The average photographic follow-up interval was 10 years (range, 1.8 to 19.5 years). The columellar-labial angle in bilateral complete clefts was significantly greater than in incomplete forms (p = 0.002). Although the angles decreased with time, they remained significantly greater than Farkas’ normative values in both cleft groups (all p < 0.05). There was no correlation between the magnitude of columellar lengthening achieved during primary nasal correction and the postoperative columellar-labial angle.

Conclusions:

An obtuse columellar-labial angle can occur following synchronous nasolabial repair of a bilateral cleft lip, particularly in patients with a complete deformity. Although the angle narrows in time, it remains 1 to 2 SD greater than normal values. Secondary nasal correction may be needed if there is excessive tip rotation after completion of growth and orthognathic surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Auricular Reconstruction in Hemifacial Microsomia with an Expanded Two-Flap Method
Authors: Qian Jin , Li Zhibin , Liu Tun , Zhou Xu , Zhang Qingguo
Published: April 2017

Background:

Reconstruction of external ear is important for the child/adult with craniofacial deformities to achieve balance and harmony of the face and head. The aim of this study was to investigate the clinical application of an expanded two-flap method for auricular reconstruction in hemifacial microsomia.

Methods:

Between January of 2014 and November of 2015, 111 hemifacial microsomia patients with microtia underwent auricular reconstruction with an expanded two-flap method. The clinical data of these patients were reviewed retrospectively. Thirty-two patients (28.8 percent) underwent auricular reconstruction in combination with simultaneous mandibular lengthening. Microtia was treated by an expanded two-flap method, which includes three stages. In the first stage, the retroauricular skin was expanded using a kidney-shaped tissue expander. In the second stage, the costal cartilage was harvested and the framework was fabricated. The anterior surface of the framework was enveloped by the expanded skin flap. The posterior surface and the helical rim of the framework is covered by a retroauricular fascial flap and a full-thickness skin graft. In the third stage, the tragus was reconstructed, the lobule was formed, and the concha was excavated. The surgical planning and skills of auricular reconstruction—especially for hemifacial microsomia—were described and analyzed. The median duration of follow-up was 8.3 months.

Results:

There were nine cases (8.1 percent) of complications in our study. During follow-up, 103 patients (92.8 percent) had satisfactory outcomes, seven (6.3 percent) had partially satisfactory outcomes, and one patient (0.9 percent) had an unsatisfactory outcome.

Conclusion:

Auricular reconstruction using an expanded two-flap method in hemifacial microsomia is safe and effective, with satisfying middle-term results.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
A Formidable Foe Is Sabotaging Your Results: What You Should Know about Biofilms and Wound Healing
Authors: Barker Jenny C. , Khansa Ibrahim , Gordillo Gayle M.
Published: April 2017

Learning Objectives:

After reading this article, the participant should be able to: 1. Describe biofilm pathogenesis as it relates to problem wounds. 2. Understand the preclinical and clinical evidence implicating biofilm in problem wounds. 3. Explain the diagnostic and treatment challenges that biofilms create for problem wounds. 4. Demonstrate a basic understanding of emerging strategies aimed at counteracting these processes.

Biofilm represents a protected mode of growth for bacteria, allowing them to evade standard diagnostic techniques and avoid eradication by standard therapies. Although only recently discovered, biofilm has existed for millennia and complicates nearly every aspect of medicine. Biofilm impacts wound healing by allowing bacteria to evade immune responses, prolonging inflammation and disabling skin barrier function. It is important to understand why problem wounds persist despite state-of-the-art treatment, why they are difficult to accurately diagnose, and why they recur. The aim of this article is to focus on current gaps in knowledge related to problem wounds, specifically, biofilm infection.
The Effect of HIV-Centered Obstetric Care on Perinatal Outcomes Among a Cohort of Women Living With HIV
Authors: Powell Anna M. , DeVita Julia M. , Ogburu-Ogbonnaya Amartha , Peterson Andrea , Lazenby Gweneth B.
Published: April 2017

Background:

Elimination of perinatal transmission is possible but limited by missed care opportunities. Our objective was to investigate the effects of HIV-centered obstetric care (HCC) on missed care opportunities and perinatal HIV transmission in 2 obstetric cohorts at our institution from 2000 to 2014.

Methods:

This was a retrospective cohort study of HIV-exposed mother–infant pairs delivering from 2000 to 2014, analyzed according to SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines. Before 2009, women received care in high-risk obstetric care (HRC); subsequently, an HCC service was established. Women who received HRC vs HCC obstetric care were compared to determine differences in maternal and neonatal outcomes. Continuous variables were compared with Student t test and Wilcoxon rank sum tests. Categorical variables were compared using χ2 test and Fisher exact test. Logistic regression analyses were performed to determine factors associated with outcomes of interest.

Results:

Over 14 years, 161 women delivered 217 HIV-exposed infants; 78 (36%) women received HCC. Two perinatal HIV transmissions (1.5%) occurred in HRC group compared with none in the HCC group (P = 0.3). Women in HCC were more likely to have HIV RNA viral load <1000 copies per milliliter at delivery (12% vs 26%, P = 0.02), have a contraception plan before delivery (93% vs 60%, P < 0.001), return for postpartum evaluation (80% vs 63%, P = 0.01), and have undetectable HIV viral load postpartum (50 copies per milliliter vs 2067, P < 0.0001).

Conclusions:

HCC can potentially reduce the risk of perinatal HIV transmission by improving maternal virologic control during pregnancy and postpartum and increasing postpartum contraceptive use.
Left Atrium Measurements via Computed Tomography Pulmonary Angiogram as a Predictor of Diastolic Dysfunction
Authors: Lick Adam N. , Danrad Raman , Smith David L. , Lammi Matthew R.
Published: April 2017

Purpose

Left atrium (LA) enlargement on echocardiography may be an indicator of diastolic dysfunction (DD). It is not well known if computed tomography pulmonary angiography (CTPA) can detect DD.

Methods

A total of 127 patients who underwent both CTPA and echo within 48 hours were analyzed retrospectively. Left atrium diameters from CTPA were correlated with echo and evaluated against degrees of DD. Computed tomography pulmonary angiography pulmonary artery (PA)/aorta ratio was analyzed as a tool to detect pulmonary hypertension.

Results

There were 42% of patients who had DD. There was a strong correlation between LA size on CTPA and echo (r = 0.78). An LA greater than 4.0 cm gave a sensitivity of 68.1% and specificity of 73.9% for DD detection. A PA/aorta cutoff greater than 0.84 yielded a sensitivity of 84% and specificity of 33% for pulmonary hypertension.

Conclusions

Computed tomography pulmonary angiography measurements of LA and PA/aorta ratio correlate strongly with equivalent findings on echo. We suggest that LA and PA/aorta measurements be included on chest CTPA reports.
Dynamic Contrast-Enhanced Magnetic Resonance Imaging of Ocular Melanoma as a Tool to Predict Metastatic Potential
Authors: Wei Wenbo , Jia Guang , von Tengg-Kobligk Hendrik , Heverhagen Johannes T. , Abdel-Rahman Mohamed , Wei Lai , Christoforidis John B. , Davidorf Frederick , Knopp Michael V.
Published: April 2017

Purpose

This study explores the capability of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to differentiate tumor characteristics of metastatic and nonmetastatic choroidal melanoma as a potential tool for patient management.

Materials and Methods

A total of 13 patients (69 ± 9 years) with choroidal melanoma were imaged using DCE-MRI on a 3-T MRI system with a 16-channel head coil. The Tofts 2-compartment model was chosen for quantification, and parameters K
trans (the transfer constant from the blood plasma to the extracellular space) and K
ep (the transfer constant from the extracellular space to the blood plasma) were calculated and compared. Metastasis was excluded by subsequent clinical work-up or confirmed by histology after targeted biopsy.

Results

Six patients were diagnosed with metastatic melanoma and 7 without. All orbital tumors were at least larger than 2 mm. A significant difference was identified in K
trans between patients with (0.73 ± 0.18/min) and without (1.00 ± 0.21/min) metastatic melanoma (P = 0.03), whereas the difference was not significantly shown in K
ep (2.58 ± 1.54/min of metastatic patients vs 2.98 ± 1.83/min of nonmetastatic patients, P = 0.67).

Conclusions

Dynamic contrast-enhanced magnetic resonance imaging has the potential to differentiate orbital melanomas with metastatic and nonmetastatic spread. Thus, DCE-MRI has the potential to be an in vivo imaging technique to predict early which patients are prone to metastatic disease.
Usefulness of a Low Tube Voltage: Knowledge-Based Iterative Model Reconstruction Algorithm for Computed Tomography Venography
Authors: Iyama Yuji , Nakaura Takeshi , Iyama Ayumi , Kidoh Masafumi , Oda Seitaro , Tokuyasu Shinichi , Yamashita Yasuyuki
Published: April 2017

Objectives

The objective of this study was to evaluate the use of 80-kVp scans with knowledge-based iterative model reconstruction (IMR) for computed tomography venography (CTV).

Methods

This prospective study received institutional review board approval; a previous informed consent was obtained from all participants. We enrolled 30 patients with suspected deep venous thrombosis or pulmonary embolism who were to undergo 80-kVp CTV studies. The images were reconstructed with filtered back projection (FBP), hybrid iterative reconstruction (HIR), and IMR. The venous attenuation, image noise, and contrast-to-noise ratio at the iliac, femoral, and popliteal veins were compared on FBP, HIR, and IMR images. We performed qualitative image analysis (image noise, image contrast, image sharpness, streak artifacts, and overall image quality) of the 3 reconstruction methods and measured their reconstruction times.

Results

There was no significant difference in venous attenuation among the 3 reconstruction methods (P > 0.05). On IMR images, the image noise was lowest at all 3 venous locations, and the contrast-to-noise ratio was highest. Qualitative evaluation scores were also highest for IMR images. The reconstruction time for FBP, HIR, and IMR imaging was 25.4 ± 1.9 seconds, 43.3 ± 3.3 seconds, and 78.7 ± 6.0 seconds, respectively.

Conclusions

At clinically acceptable reconstruction times, 80-kVp CTV using the IMR technique yielded better qualitative and quantitative image quality than HIR and FBP.
Electrocardiography-Gated Computed Tomography of the Bronchial Arteries With Iterative Image Reconstruction: Clinical Evaluation and Image Quality
Authors: Gang Qiangqiang , Xu Jun , Wang Junling , Hao Peng , Xu Yikai
Published: April 2017

Background

The aim of this study was to apply electrocardiography (ECG)-gated prospective-triggered multidetector row computed tomography angiography with iterative model reconstruction (IMR) to optimize imaging of the bronchial arteries in patients with the chief complaint of hemoptysis.

Methods

This was a prospective observational study. Between August 2015 and June 2016, we enrolled 31 consecutive patients with the chief complaint of hemoptysis who were scheduled to undergo computed tomography of the bronchial artery. Patients were randomly divided into 3 groups: group A, with filtered back-projection reconstruction; group B, with iDose reconstruction; and group C, with ECG-gated prospective-triggered multidetector row computed tomography angiography with IMR. Image quality, visibility, and traceability were compared.

Results

Image quality, including signal-to-noise and contrast-to-noise ratios, visibility, and traceability, was best in group C.

Conclusions

With the help of IMR and ECG-synchronized prospective-triggered technology, the bronchial artery anatomy can be accurately depicted in patients with massive hemoptysis.
Iterative Reconstruction Designed for Brain CT: A Correlative Study With Filtered Back Projection for the Diagnosis of Acute Ischemic Stroke
Authors: Iyama Yuji , Nakaura Takeshi , Oda Seitaro , Kidoh Masafumi , Utsunomiya Daisuke , Yoshida Morikatsu , Yuki Hideaki , Hirata Kenichiro , Funama Yoshinori , Harada Kazunori , Awai Kazuo , Hirai Toshinori , Yamashita Yasuyuki
Published: April 2017

Objectives

The objective of this study is to evaluate the usefulness of iterative model reconstruction designed for brain computed tomography (CT) (IMR-Neuro) for the diagnosis of acute ischemic stroke.

Methods

This retrospective study included 20 patients with acute middle cerebral artery infarction who have undergone brain CT and 20 nonstroke patients (control). We reconstructed axial images with filtered back projection (FBP) and IMR-Neuro (slice thickness, 1 and 5 mm). We compared the CT number of the infarcted area, the image noise, contrast, and the contrast to noise ratio of the infarcted and the noninfarcted areas between the different reconstruction methods. We compared the performance of 10 radiologists in the detection of parenchymal hypoattenuation between 2 techniques using the receiver operating characteristic (ROC) techniques with the jackknife method.

Results

The image noise was significantly lower with IMR-Neuro [5 mm: 2.5 Hounsfield units (HU) ± 0.5, 1 mm: 3.9 HU ± 0.5] than with FBP (5 mm: 4.9 HU ± 0.5, 1 mm: 10.1 HU ± 1.4) (P < 0.01). The contrast to noise ratio was significantly greater with IMR-Neuro (5 mm: 2.6 ± 2.1, 1 mm: 1.6 ± 1.3) than with FBP (5 mm: 1.2 ± 1.0; 1 mm: 0.6 ± 0.5) (P < 0.01). The value of the average area under the receiver operating curve was significantly higher with IMR-Neuro than FBP (5 mm: 0.79 vs 0.74, P = 0.04; 1 mm: 0.76 vs 0.69, P = 0.04).

Conclusions

Compared with FBP, IMR-Neuro improves the image quality and the performance for the detection of parenchymal hypoattenuation with acute ischemic stroke.
Extended Right Thoracic Approach Compared With Limited Left Thoracic Approach for Patients With Middle and Lower Esophageal Squamous Cell Carcinoma
Authors: Li Bin , Hu Hong , Zhang Yawei , Zhang Jie , Miao Longsheng , Ma Longfei , Luo Xiaoyang , Zhang Yiliang , Ye Ting , Li Hecheng , Zhou Jianhua , Li Yuan , Shen Lei , Zhao Kuaile , Fan Min , Zhu Zhengfei , Wang Jialei , Xu Jie , Deng Youjia , Lu Qiong , Jia Huixun , Cheng Xinghua , Li Hang , Zhang Yang , Li Chenguang , Pan Yunjian , Liu Shilei , Hu Haichuan , Shao Longlong , Sun Yihua , Xiang Jiaqing , Chen Haiquan
Published: April 2017

Objective:

To investigate whether survival is improved by using the right thoracic approach (extended lymphadenectomy) compared with the left thoracic approach (limited lymphadenectomy) for esophageal cancer.

Background:

The optimal surgical technique for esophageal cancer remains unclear.

Methods:

Between May 2010 and July 2012, 300 patients with middle and lower thoracic esophageal carcinoma were randomized to receive esophagectomy through either the right or left thoracic approach. Of these, 286 patients with squamous cell carcinoma determined by postoperative pathology were included in this analysis. Disease-free survival (DFS) and overall survival (OS) were compared between the right (n = 146) and left thoracic groups (n = 140).

Results:

The median follow-up was 55.9 months [95% confidence interval (CI): 53.1–58.6]. The 3-year DFS rates were 62% and 52% in the right and left thoracic arms, respectively [hazard ratio (HR) 0.709; 95% CI, 0.506–0.995; P = 0.047, log-rank test]. The 3-year OS rates were 74% and 60%, respectively (HR, 0.663; 95% CI, 0.457–0.961; P = 0.029). Subgroup analyses revealed longer DFS in the right thoracic arm (vs left thoracic arm) in patients with lymph node involvement (HR, 0.632; 95% CI, 0.412–0.969, P = 0.034), but not in patients without lymph node involvement (HR, 0.757; 95% CI, 0.434–1.320, P = 0.325), and in patients with R1–2 resection margins (HR, 0.495; 95% CI, 0.290–0.848, P = 0.009), but not R0 margins (HR, 0.944; 95% CI, 0.603–1.477, P = 0.801).

Conclusions:

Compared with the left thoracic approach, the right thoracic approach associated with increased DFS and OS in esophageal squamous cell carcinoma patients, particularly in those with lymph node involvement and/or R1–2 resection margins.
A Placebo-Controlled Crossover Trial of Gastrin-Releasing Peptide in Childhood Autism
Authors: Marchezan Josemar , Becker Michele , Schwartsmann Gilberto , Ohlweiler Lygia , Roesler Rafael , Renck Luiza Brusius , Gonçalves Marcela Matos Monteiro , Ranzan Josiane , Riesgo Rudimar dos Santos
Published: April 2017

Objectives

The aim of this study was to evaluate the efficacy, safety, and tolerability of gastrin-releasing peptide (GRP) compared with placebo in autism spectrum disorder symptoms.

Methodology

This is a randomized, double-blind, placebo-controlled crossover trial using GRP 160 pmol/kg for 4 consecutive days in 10 children with autism. Outcomes were measured by the Aberrant Behavior Checklist (ABC) scale.

Results

All participants were boys, aged between 4 and 9 years. There was a reduction in the scores of the ABC range and its subscales after use GRP and placebo. The reduction was more prominent with GRP, particularly in the subscale “hyperactivity and noncompliance,” but there was no statistical difference between the results (P = 0.334). After a week of infusion, 5 children showed improvement of 25% or greater in the total score of the ABC scale with GRP use and 2 with placebo use; however, there was no statistical difference (P = 0.375). There were no adverse effects, changes in vital signs, or laboratory abnormalities associated with the use of GRP.

Conclusions

The results of this study, despite the small sample size, reinforce previous data on the safety of the GRP in short-term use. There is a need for further research with other designs and a larger sample size to evaluate the efficacy and safety of GRP in children with autism.
A Systematic Nomenclature for theDrosophilaVentral Nervous System
Authors: Court Robert , Namiki Shigehiro , Armstrong J Douglas , Börner Jana , Card Gwyneth , Costa Marta , Dickinson Michael , Duch Carsten , Korff Wyatt , Mann Richard , Merritt David , Murphey Rod K , Seeds Andrew , Shirangi Troy , Simpson Julie H. , Truman James W , Tuthill John , Williams Darren , Shepherd David
Published: April 2017

The fruit fly,Drosophila melanogaster, is an established and powerful model system for neuroscience research with wide relevance in biology and medicine. Until recently, research on theDrosophilabrain was hindered by the lack of a complete and uniform nomenclature. Recognising this problem, the Insect Brain Name Working Group produced an authoritative hierarchical nomenclature system for the adult insect brain, usingDrosophila melanogasteras the reference framework, with other taxa considered to ensure greater consistency and expandability (Ito et al., 2014). Here, we extend this nomenclature system to the sub-gnathal regions of the adultDrosophilanervous system, thus providing a systematic anatomical description of the ventral nervous system (VNS). This portion of the nervous system includes the thoracic and abdominal neuromeres that were not included in the original work and contains the motor circuits that play essential roles in most fly behaviours.
Photoacoustic molecular rulers based on DNA nanostructures
Authors: Joseph James , Koehler Philipp , Zuehlsdorff Tim J. , Cole Daniel J. , Baumann Kevin N. , Weber Judith , Bohndiek Sarah E. , Hernández-Ainsa Silvia
Published: April 2017

Molecular rulers that rely on the Förster resonance energy transfer (FRET) mechanism are widely used to investigate dynamic molecular processes that occur on the nanometer scale. However, the capabilities of these fluorescence molecular rulers are fundamentally limited to shallow imaging depths by light scattering in biological samples. Photoacoustic tomography (PAT) has recently emerged as a high resolution modality forin vivoimaging, coupling optical excitation with ultrasound detection. In this paper, we report the capability of PAT to probe distance-dependent FRET at centimeter depths. Using DNA nanotechnology we created several nanostructures with precisely positioned fluorophore-quencher pairs over a range of nanoscale separation distances. PAT of the DNA nanostructures showed distance-dependent photoacoustic signal generation and experimentally demonstrated the ability of PAT to reveal the FRET process deep within tissue mimicking phantoms. Further, we experimentally validated these DNA nanostructures as providing a novel and biocompatible strategy to augment the intrinsic photoacoustic signal generation capabilities of small molecule fluorescent dyes.
Ecological Network Metrics: Opportunities for Synthesis
Authors: Lau Matthew K. , Borrett Stuart R. , Baiser Benjamin , Gotelli Nicholas J. , Ellison Aaron M.
Published: April 2017

Network ecology provides a systems basis for approaching ecological questions, such as factors that influence biological diversity, the role of particular species or particular traits in structuring ecosystems, and long-term ecological dynamics (e.g., stability). Whereas the introduction of network theory has enabled ecologists to quantify not only the degree, but also the architecture of ecological complexity, these advances have come at the cost of introducing new challenges, including new theoretical concepts and metrics, and increased data complexity and computational intensity. Synthesizing recent developments in the network ecology literature, we point to several potential solutions to these issues: integrating network metrics and their terminology across sub-disciplines; benchmarking new network algorithms and models to increase mechanistic understanding; and improving tools for sharing ecological network research, in particular “model” data provenance, to increase the reproducibility of network models and analyses. We propose that applying these solutions will aid in synthesizing ecological subdisciplines and allied fields by improving the accessibility of network methods and models.
Demographic consequences of climate variation along an elevational gradient for a montane terrestrial salamander
Authors: Caruso Nicholas M. , Rissler Leslie J.
Published: April 2017

Climate change represents a significant threat to amphibians, which are already imperiled. However, for many species, the relationship between demographic vital rates (survival and growth) and climate is unknown, which limits predictive models. Here we describe the life history variation ofPlethodon montanususing capture-recapture data over a period of four years, at five sites along an elevational gradient to determine how survival and growth vary with temperature, precipitation, and how these relationships vary with elevation. We used a hierarchical model to estimate asymptotic size and growth rate, and used a spatial Cormack-Jolly-Seber model to estimate probability of capture and survival, as well as dispersal variance. Our results show that during the active season, growth and survival rates are both positively affected by precipitation, while survival was positively affected by temperature at all elevations, the relationship between growth rates and temperature varied along the elevational gradient. Generally at lower elevations, higher temperatures led to a decrease in growth while at higher elevations the opposite was true. During the inactive season we found elevational variation in the relationship between survival and the amount of snow; at low elevations snowfall was low but survival decreased with increasing snowfall while at higher elevations increasing snowfall lead to higher survival. Our results demonstrate that understanding how the environment can affect salamander demography to develop mechanistic models, will require knowledge of the actual environmental conditions experienced by a given population as well as an understanding of the overall differences in climate at a given site.
Sparse Tensor Decomposition for Haplotype Assembly of Diploids and Polyploids
Authors: Hashemi Abolfazl , Zhu Banghua , Vikalo Haris
Published: April 2017

A framework that formulates haplotype assembly as sparse tensor decomposition is proposed. The problem is cast as that of decomposing a tensor having special structural constraints and missing a large fraction of its entries into a product of two factors, U and; tensorreveals haplotype information while U is a sparse matrix encoding the origin of erroneous sequencing reads. An algorithm, AltHap, which reconstructs haplotypes of either diploid or poly-ploid organisms by solving this decomposition problem is proposed. Starting from a judiciously selected initial point, AltHap alternates between two optimization tasks to recover U andby relying on a modified gradient descent search that exploits salient structural properties of U and. The performance and convergence properties of AltHap are theoretically analyzed and, in doing so, guarantees on the achievable minimum error correction scores and correct phasing rate are established. AltHap was tested in a number of different scenarios and was shown to compare favorably to state-of-the-art methods in applications to haplotype assembly of diploids, and significantly outperform existing techniques when applied to haplotype assembly of polyploids.
apterous Aspecifies dorsal wing patterns and sexual traits in butterflies
Authors: Prakash Anupama , Monteiro Antónia
Published: April 2017

Butterflies have evolved different color patterns on their dorsal and ventral wing surfaces to serve different signaling functions, yet the developmental mechanisms controlling surface-specific patterning are still unknown. Here, we mutate both copies of the transcription factorapterousinBicyclus anynanabutterflies using CRISPR/Cas9 and show thatapterous Afunctions both as a repressor and modifier of ventral wing color patterns, as well as a promoter of dorsal sexual ornaments in males. We propose that the surface-specific diversification of wing patterns in butterflies proceeded via the co-option ofapterous Ainto various gene regulatory networks involved in the differentiation of discrete wing traits. Further, interactions betweenapterousand sex-specific factors such asdoublesexmay have contributed to the origin of sexually dimorphic surface-specific patterns. Finally, we discuss the evolution of eyespot pattern diversity in the family Nymphalidae within the context of developmental constraints due toapterousregulation.

Significance statement

Butterflies have evolved different wing patterns on their dorsal and ventral wing surfaces that serve different signaling functions. We identify the transcription factor,apterous A, as a key regulator of this surface-specific differentiation in butterflies. We also show a role forapterous Ain restricting the developmental origin of a novel trait, eyespots, to just the ventral wing surface. Dorsal-ventral differentiation of tissues is not just restricted to butterfly wings but occurs in many other organs and organisms from arthropods to humans. Thus, we believe that our work will be of interest to a diverse group of biologists and layman alike interested in the role of development in shaping biodiversity.
Faster growth with shorter antigens explains a VSG hierarchy during African trypanosome infections: a feint attack by parasites
Authors: Liu Dianbo , Albergante Luca , Horn David , Newman Timothy
Published: April 2017

The parasitic African trypanosome,Trypanosoma brucei, evades the adaptive host immune response by a process of antigenic variation that involves the clonal switching of variant surface glycoproteins (VSGs). The VSGs that periodically come to dominatein vivodisplay a hierarchy, but how this hierarchy arises is not well-understood. Combining publicly available genetic data with mathematical modelling, we report a VSG-length-dependent hierarchical timing of clonal VSG dominance in a mouse model, revealing an inverse correlation between VSG length and trypanosome growth-rate. Our analysis indicates that, among parasites switching to new VSGs, those expressing shorter VSGs preferentially accumulate to a detectable level that is sufficient to trigger an effective immune response. Subsequent elimination of faster-growing parasites then allows slower parasites with longer VSGs to accumulate. This interaction between the host and parasite is able by itself to explain the temporal distribution of VSGs observedin vivo. Thus, our findings reveal a length-dependent hierarchy that operates duringT. bruceiinfection, representing a ‘feint attack’ diversion tactic utilised during infection by these persistent parasites to out-maneuver the host immune system.

Significance Statement

The protozoan parasiteTrypanosoma bruceicauses devastating and lethal diseases in humans and livestock. This parasite continuously evades the host adaptive immune response by drawing on a library of variant surface proteins but the mechanisms determining the timing of surface protein – host interactions are not understood. We report a simple mechanism, based on differential growth of parasites with surface proteins of different lengths, which can explain the hierarchy of variants over time. This allows parasites to evade host immune responses for extended timeframes using limited cohorts of surface proteins. We liken this strategy to a military ‘feint attack’, that enhances the parasites ability to evade the host immune response. A similar mechanism may also operate in other important pathogens.
Spatially explicit approach to population abundance estimation in field surveys
Authors: Takashina Nao , Kusumoto Buntarou , Beger Maria , Rathnayake Suren , Possingham Hugh P.
Published: April 2017

The abundance of species is a fundamental consideration in ecology and conservation biology. Although broad models have been proposed to estimate the population abundance using existing data, available data is often limited. With no information available, a population estimation will rely on time consuming field surveys. Typically, time is a critical constraint in conservation and often management decisions must be made quickly under the data limited situation. Depending on time and budgetary constraints, the required accuracy of field survey changes significantly. Hence, it is desirable to set up an effective survey design to minimize time and effort of sampling given required accuracy. We examine a spatially-explicit approach to population estimation using spatial point processes, enabling us to explicitly and consistently discuss various sampling designs. We find that the accuracy of abundance estimation varies with both ecological factors and survey design. Although the spatial scale of sampling does not affect estimation accuracy when the underlying individual distribution is random, it decreases with the sampled unit size if individuals tend to form clusters. These results are derived analytically and checked numerically. Obtained insights provide a benchmark to predict the quality of population estimation, and improve survey designs for ecological studies and conservation.
The human oral microbiome is shaped by shared environment rather than genetics: evidence from a large family of closely-related individuals
Authors: Shaw Liam , Ribeiro Andre L. R. , Levine Adam P. , Pontikos Nikolas , Balloux Francois , Segal Anthony W. , Roberts Adam P. , Smith Andrew M.
Published: April 2017

The human microbiome is affected by multiple factors, including the environment and host genetics. In this study, we analyzed the oral microbiome of an extended family of Ashkenazi Jewish individuals living in several cities and investigated associations with both shared household and host genetic similarities. We found that environmental effects dominated over genetic ones. While there was weak evidence of geographic structuring at the level of cities, we observed a large and significant effect of shared household on microbiome composition, supporting the role of immediate shared environment in dictating the presence or absence of taxa. This effect was also seen when including adults who had grown up in the same household but moved out prior to the time of sampling, suggesting that the establishment of the oral microbiome earlier in life may affect its long-term composition. We found weak associations between host genetic relatedness and microbiome dissimilarity when using family pedigrees as proxies for genetic similarity. However this association disappeared when using more accurate measures of kinship based on genome-wide genetic markers, indicating that environment rather than host genetics is the dominant factor affecting the composition of the oral microbiome in closely-related individuals. Our results support the concept that there is a consistent core microbiome conserved across global scales, but that small-scale effects due to shared living environment significantly affect microbial community composition.

IMPORTANCE

Previous research shows that relatives have a more similar oral microbiome composition than non-relatives, but it remains difficult to distinguish the effects of relatedness and shared household environment. Furthermore, pedigree measures may not accurately measure host genetic similarity. In this study, we include genetic relatedness based on genome-wide SNPs (rather than pedigree measures) and shared environment in the same analysis. We quantify the relative importance of these factors by studying the oral microbiome in members of a large extended Ashkenazi Jewish family who share a similar diet and lifestyle despite living in different locations. We find that host genetics plays no significant role and that the dominant factor is shared environment at the household level. We also find that this effect appears to persist in individuals who have moved out of the parental household, suggesting that the oral microbiome established earlier in life persists long-term.