bluuebunny/crossref_metadata_2025 huggingface dataset:
Anticancer potential from ethanol extract of Zanthoxylum acanthopodium DC. seed to against MCF-7 cell line
Authors: Arsita E V , Saragih D E , Aldrin K
Published: July 2019

Andaliman (Zanthoxylum acanthopodium DC.) is a wild plant species from North Sumatera. Studies conducted before show that Z. acantopodium seeds contain high antioxidants. Based on International Agency for Research on Cancer (IARC) data, it is known that in 2012 the highest type of cancer in women in the world is breast cancer (38 per 100 000 women). MCF-7 cell line is one of breast cancer model cell. The purpose of this research is to identify types of secondary metabolites which can be found in Andaliman’s seed extract and to test the ability of these compound in stopping the MCF-7 cell line activity. The method used in this research is an experimental method with different concentration and MTT Assay. Secondary metabolites that has been identified are phenol, saponins, tannins, triterpenes, flavonoids, and alkaloids. The result obtained by using MTT Assay with value IC50 and the absorbance of 550 nm was 221.31 mg L−1 which indicate that ethanol extract of Andaliman’s seed has potential as an anticancer and quite actively affect the inhibition of MCF-7 cell line proliferation. Moreover, the pure extract of Andaliman seed may have a strong effect to inhibit MCF-7 cell line proliferation.
Establishment and Characterization of Bacterial Infection of Breast Implants in a Murine Model
Authors: Walker Jennifer N , Poppler Louis H , Pinkner Chloe L , Hultgren Scott J , Myckatyn Terence M
Published: July 2019

Background

Staphylococcus epidermidis and Pseudomonas aeruginosa are the most common causes of Gram-positive and Gram-negative breast implant–associated infection. Little is known about how these bacteria infect breast implants as a function of implant surface characteristics and timing of infection.

Objectives

The aim of this work was to establish a mouse model for studying the impact of various conditions on breast implant infection.

Methods

Ninety-one mice were implanted with 273 breast implant shells and infected with S. epidermidis or P. aeruginosa. Smooth, microtextured, and macrotextured breast implant shells were implanted in each mouse. Bacterial inoculation occurred during implantation or 1 day later. Implants were retrieved 1 or 7 days later. Explanted breast implant shells were sonicated, cultured, and colony-forming units determined or analyzed with scanning electron microscopy.

Results

P. aeruginosa could be detected on all device surfaces at 1- and 7- days post infection (dpi), when mice were implanted and infected concurrently or when they were infected 1- day after implantation. However, P. aeruginosa infection was more robust on implant shells retrieved at 7 dpi and particularly on the macrotextured devices that were infected 1 day post implantation. S. epidermidis was mostly cleared from implants when mice were infected and implanted concurrently. Other the other hand, S. epidermidis could be detected on all device surfaces at 1 dpi and 2 days post implantation. However, S. epidermdis infection was suppressed by 7 dpi and 8 days post implantation.

Conclusions

S. epidermidis required higher inoculating doses to cause infection and was cleared within 7 days. P. aeruginosa infected at lower inoculating doses, with robust biofilms noted 7 days later.
Plants exhibit significant effects on the rhizospheric microbiome across contrasting soils in tropical and subtropical China
Authors: Xu Shangqi , Tian Lei , Chang Chunling , Li Xiujun , Tian Chunjie
Published: July 2019

The rhizospheric microbiome appears to be one of the key determinants of plant health and productivity. In this study, to understand the assembly process of the rhizospheric microbiome, the effects of different sites, soils and plants on the rhizospheric microbiome were compared and examined using high-throughput sequencing. A series of comparisons of rhizospheric microbiomes were conducted using two plants (wild rice (Oryza rufipogon Griff.) and L. hexandra (Leersia hexandra Swartz)), two soils (high nutrient and low nutrient) and two sites (Guangdong and Hainan provinces in China). The results of the redundancy analysis, between-class analysis and coinertia analysis indicated that the factors shaping the rhizospheric microbiome (in decreasing order of strength), were the site, soil and plant. The effects of plants on the rhizospheric microbiome were slight and unobvious, with relatively low-explained variations and few core groups and indicator groups; however, the effects were significant across different sites and soils, especially for specific microbial groups that are closely associated with plants, such as pathogens, symbionts, and saprotrophs. Furthermore, rhizospheric fungi were more strongly influenced by plants than rhizospheric bacteria. Our results provide insights into the relationships among multiple factors that shape the rhizospheric microbiome in natural ecosystems and highlight the effects of plants across regional environmental shifts.
Geographic location and food availability offer differing levels of influence on the bacterial communities associated with larval sea urchins
Authors: Carrier Tyler J , Dupont Sam , Reitzel Adam M
Published: July 2019

Determining the factors underlying the assembly, structure, and diversity of symbiont communities remains a focal point of animal-microbiome research. Much of these efforts focus on taxonomic variation of microbiota within or between animal populations, but rarely test the proportional impacts of ecological components that may affect animal-associated microbiota. Using larvae from the sea urchin Strongylocentrotus droebachiensis from the Atlantic and Pacific Oceans, we test the hypothesis that, under natural conditions, inter-population differences in the composition of larval-associated bacterial communities are larger than intra-population variation due to a heterogeneous feeding environment. Despite significant differences in bacterial community structure within each S. droebachiensis larval population based on food availability, development, phenotype, and time, variation in OTU membership and community composition correlated more strongly with geographic location. Moreover, 20-30% of OTUs associated with larvae were specific to a single location while less than 10% were shared. Taken together, these results suggest that inter-populational variation in symbiont communities may be more pronounced than intra-populational variation, and that this difference may suggest that broad-scale ecological variables (e.g., across ocean basins) may mask smaller scale ecological variables (e.g., food availability).
A CC-NBS-LRR gene induces hybrid lethality in cotton
Authors: Deng Jieqiong , Fang Lei , Zhu Xiefei , Zhou Baoliang , Zhang Tianzhen
Published: July 2019

A CC-NBS-LRR gene underlies the Le4 locus for interspecific hybrid lethality between Gossypium barbadense and G. hirsutum, and appears to act by triggering autoimmune responses.
Cystoliths of Parietaria judaica can serve as an internal source of CO2 for photosynthetic assimilation when stomata are closed
Authors: Giannopoulos Andreas , Nikolopoulos Dimosthenis , Bresta Panagiota , Samantas Aris , Reppa Chrysavgi , Karaboiki Kalliopi , Dotsika Elissavet , Fasseas Constantinos , Liakopoulos Georgios , Karabourniotis George
Published: July 2019

Under certain conditions, leaf cystoliths of Parietaria judaica can decompose, and the CO2 released can be photosynthetically assimilated. This process lowers surplus energy and protects the photosynthetic apparatus.
The partial ionization zone of heavy elements in F-stars: a study on how it correlates with rotation
Authors: Brito Ana , Lopes Ilídio
Published: July 2019

We study the relation between the internal structures of 10 benchmark main-sequence F-stars and their rotational properties. Stellar rotation of main-sequence F-type stars can be characterized by two distinct rotational regimes. Early-type F-stars are usually rapid rotators with periods typically below 10 d, whereas later-type F-stars have longer rotation periods. Specifically, and since the two rotational regimes are tightly connected to the effective temperatures of the stars, we investigate in detail the characteristics of the partial ionization zones in the outer convective envelopes of these stars, which in turn, depend on the internal temperature profiles. Our study shows that the two rotational regimes might be distinguished by the relative locations of the partial ionization region of heavy elements and the base of the convective zone. Since in all these stars is expected a dynamo-driven magnetic field where the shear layer between convective and radiative zones (tachocline) plays an important role, this result suggests that the magnetic field may be related to the combined properties of convection and ionization.
The case for a high-redshift origin of GRB 100205A
Authors: Chrimes A A , Levan A J , Stanway E R , Berger E , Bloom J S , Cenko S B , Cobb B E , Cucchiara A , Fruchter A S , Gompertz B P , Hjorth J , Jakobsson P , Lyman J D , O’Brien P , Perley D A , Tanvir N R , Wheatley P J , Wiersema K
Published: July 2019

The number of long gamma-ray bursts (GRBs) known to have occurred in the distant Universe (z > 5) is small (∼15); however, these events provide a powerful way of probing star formation at the onset of galaxy evolution. In this paper, we present the case for GRB 100205A being a largely overlooked high-redshift event. While initially noted as a high-z candidate, this event and its host galaxy have not been explored in detail. By combining optical and near-infrared Gemini afterglow imaging (at t < 1.3 d since burst) with deep late-time limits on host emission from the Hubble Space Telescope, we show that the most likely scenario is that GRB 100205A arose in the range 4 < z < 8. GRB 100205A is an example of a burst whose afterglow, even at ∼1 h post burst, could only be identified by 8-m class IR observations, and suggests that such observations of all optically dark bursts may be necessary to significantly enhance the number of high-redshift GRBs known.
Endobronchial fungal infection caused by Candida albicans with main bronchus obstruction: a case report
Authors: Kim Taeyun , Jeon Yohan , Choi Hyunji , Lee Jin Young , Kim Jehun
Published: July 2019

Endobronchial fungal infection (EBFI) is a rare form of pulmonary fungal infection that especially affects immunocompromised patients. Furthermore, EBFI resulting in obstruction of the main bronchus is extremely rare. With the development of bronchoscopic techniques, rare cases of EBFI have been reported. A 68-year-old female was referred to the Department of Pulmonology for confusion and obtundation. The patient was diagnosed with septic shock due to acute pyelonephritis followed by obstructive EBFI. We performed bronchoscopic biopsy and endobronchial aspiration for culture. Biopsy showed yeast-like fungus and Candida albicans grew in the culture. EBFI has been under-recognized because of difficulties in confirming the diagnosis. Endobronchial ultrasound-guided transbronchial needle aspiration and bronchoscopy are used to improve the diagnosis of thoracic infection, such as tuberculosis. The role of bronchoscopy in the diagnosis of infectious diseases of the trachea or main bronchi is expected to widen in the future.
Social Mindscapes and the Self
Authors: Mullaney Jamie L.
Published: July 2019

While the relationship between culture and cognition has long-standing roots in sociological thought, scholars face the issue regarding how to “do” cognitive sociology. This chapter discusses the methodological approach of social pattern analysis (SPA) from Zerubavel’s social mindscapes tradition or culturalist cognitive sociology (SM/CCS), which encourages researchers to move away from content-driven inquiries toward those that explore processes across time, context, and even disciplinary boundaries. Using the specific example of virginity studies, the chapter then demonstrates how the flexible nature of SPA may serve as an asset in understanding generic identity processes more broadly.
Changing the Nature and Role of Universities
Authors: Whitley Richard
Published: July 2019

The combination of expanded participation in higher education and changing state financing and governance policies is transforming the nature and activities of research universities in many OECD countries. Historically, their strategic autonomy as discrete organizational actors and ability to develop distinctive competitive competences differed considerably between national higher education systems. Three main types of university can be distinguished in these terms: Hollow, State-Chartered, and Corporate. Limited formal delegation of authority over academic staff and other resources and responsibility for scientific and financial performance to the managers of hollow-like universities is leading to the emergence of a fourth type: State-guided. The increasing intensification of pseudo-market competition for resources and prestige between state-chartered universities together with greater state steering of research priorities is reducing their strategic independence. The growing use of performance-based funding and standardized research evaluation systems by many states encourages imitation strategies and increases tensions between university management and academics pursuing extra-institutional scientific goals.
Paul the Missionary
Authors: Schnabel Eckhard J.
Published: July 2019

The missionary work of Paul has inspired countless missionaries in the history of the church, but it has been only relatively recently that his missionary activity has become the focus of academic study. This essay considers the primary sources for Paul’s missionary activity, the event of his apostolic commissioning, his description of the missionary task, and a number of significant aspects of Paul’s missionary activity: audiences, geography, chronology, methods, and occupational hazards. It is argued that, while we certainly need to be cautious not to interpret Paul in terms of modern categories and institutions, Paul’s self-understanding as an ‘apostle’ is doubtlessly that of a missionary.
Effect of continuous positive airway pressure on inflammatory, antioxidant, and depression biomarkers in women with obstructive sleep apnea: a randomized controlled trial
Authors: Campos-Rodriguez Francisco , Asensio-Cruz Maria Isabel , Cordero-Guevara Jose , Jurado-Gamez Bernabe , Carmona-Bernal Carmen , Gonzalez-Martinez Monica , Troncoso Maria F , Sanchez-Lopez Veronica , Arellano-Orden Elena , Garcia-Sanchez Maria Isabel , Martinez-Garcia Miguel Angel ,   Spanish Sleep Network, Reyes-Nuñez Nuria , Sanchez-Armengol Angeles , Abad-Fernandez Araceli , Alonso-Alvarez Maria L , Caballero-Rodriguez Julian , Martin-Romero Mercedes , Encabo-Motiño Ana , Navarro-Esteva Javier , Sacristan-Bou Lirios , Somoza-Gonzalez Maria , Masa Juan F , Sedano Andrea Crespo
Published: July 2019

Study Objectives

The effect of continuous positive airway pressure (CPAP) on mediators of cardiovascular disease and depression in women with obstructive sleep apnea (OSA) is unknown. We aimed to assess the effect of CPAP therapy on a variety of biomarkers of inflammation, antioxidant activity, and depression in women with OSA.

Methods

We conducted a multicenter, randomized controlled trial in 247 women diagnosed with moderate-to-severe OSA (apnea–hypopnea index [AHI] ≥ 15). Women were randomized to CPAP (n = 120) or conservative treatment (n = 127) for 12 weeks. Changes in tumor necrosis factor α (TNFα), interleukin 6 (IL-6), C-reactive protein (CRP), intercellular adhesion molecule 1 (ICAM-1), catalase (CAT), superoxide dismutase (SOD), and brain-derived neurotrophic factor (BDNF) were assessed. Additional analyses were conducted in subgroups of clinical interest.

Results

Women had a median (25th–75th percentiles) age of 58 (51–65) years, body mass index 33.5 (29.0–38.3) kg/m2, and AHI 33.3 (22.8–49.3). No differences were found between groups in the baseline levels of the biomarkers. After 12 weeks of follow-up, there were no changes between groups in any of the biomarkers assessed. These results did not change when the analyses were restricted to sleepy women or to those with severe OSA. In women with CPAP use at least 5 hours per night, only TNFα levels decreased compared to the control group (−0.29 ± 1.1 vs −0.06 ± 0.53, intergroup difference −0.23 [95% CI = −0.03 to −0.50]; p = 0.043).

Conclusions

Twelve weeks of CPAP therapy does not improve biomarkers of inflammation, antioxidant activity, or depression compared to conservative treatment in women with moderate-to-severe OSA.

Trial Registration

NCT02047071.
Influence of organizational and social contexts on the implementation of culturally adapted hypertension control programs in Asian American-serving grocery stores, restaurants, and faith-based community sites: a qualitative study
Authors: Gore Radhika , Patel Shilpa , Choy Catherine , Taher Md , Garcia-Dia Mary Joy , Singh Hardayal , Kim Sara , Mohaimin Sadia , Dhar Ritu , Naeem Areeg , Kwon Simona C , Islam Nadia
Published: July 2019

Hypertension affects a third of U.S. adults and is especially high among Asian American groups. The Racial and Ethnic Approaches to Community Health for Asian AmeRicans (REACH FAR) project delivers culturally adapted, evidence-based hypertension-related programs to Bangladeshi, Filipino, Korean, and Asian Indian communities in New York and New Jersey through 26 sites: ethnic grocery stores, restaurants, and Muslim, Christian, and Sikh faith-based organizations. Knowledge of the implementation mechanisms of culturally adapted programs is limited and is critical to inform the design and execution of such programs by and in community sites. We applied four categories of the Consolidated Framework for Implementation Research—intervention and individuals’ characteristics, inner and outer setting—to analyze factors influencing implementation outcomes, that is, site leaders’ perceptions about adopting, adapting, and sustaining REACH FAR. We conducted semistructured interviews with 15 leaders, coded them for implementation outcomes, and recoded them to identify contextual factors. Our findings show that REACH FAR resonated in sites where leaders perceived unhealthy diet and lifestyles in their communities (intervention characteristics), sites had historically engaged in health programs as a public-service mission (inner setting), and leaders identified with this mission (individuals’ characteristics). Site leaders strived to adapt programs to respond to community preferences (outer setting) without compromising core objectives (inner setting). Leaders noted that program sustainability could be impeded by staff and volunteer turnover (inner setting) but enhanced by reinforcing programs through community networks (outer setting). The findings suggest that to facilitate implementation of culturally adapted health behavior programs through community sites, interventions should reinforce sites’ organizational commitments and social ties.
Tissue preservation can affect geometric morphometric analyses: a case study using fish body shape
Authors: Fruciano Carmelo , Schmidt Dominik , Ramírez Sanchez Marcia Maria , Morek Witold , Avila Valle Zamira , Talijančić Igor , Pecoraro Carlo , Schermann Legionnet Agnès
Published: July 2019

In geometric morphometrics, the extent of variation attributable to non-biological causes (i.e. measurement error) is sometimes overlooked. The effects of this variation on downstream statistical analyses are also largely unknown. In particular, it is unclear whether specimen preservation induces substantial variation in shape and whether such variation affects downstream statistical inference. Using a combination of empirical fish body shape data and realistic simulations, we show that preservation introduces substantial artefactual variation and significant non-random error (i.e. bias). Most changes in shape occur when fresh fish are frozen and thawed, whereas a smaller change in shape is observed when frozen and thawed fish are fixed in formalin and transferred to ethanol. Surprisingly, we also show that, in our case, preservation produces only minor effects on three downstream analyses of shape variation: classification using canonical variate analysis, permutation tests of differences in means and computations of differences in mean shape between groups. Even mixing of differently preserved specimens has a relatively small effect on downstream analyses. However, we suggest that mixing fish with different preservation should still be avoided and discuss the conditions in which this practice might be justified.
Ocular allergy: update on clinical trials
Authors: Bielory Leonard , Schoenberg Dovid
Published: July 2019

Purpose of review

The purpose of this article is to provide an update on the advances made through recent clinical trials regarding the treatment of the signs and symptoms of allergic conjunctivitis and its associated conditions.

Recent findings

Recent studies have demonstrated significant advancement in the various forms of immunotherapy treatments. Nutritional interventions such as probiotics have surfaced as a viable complementary treatment option. Novel delivery methods such as contact lenses have been further studied along with a new tacrolimus formulation to improve ocular levels of the drug.

Currently, the primary advances in treatment for allergic conjunctivitis has shifted from new ophthalmic agents to immunotherapy and improvement of drug delivery. This includes the classic subcutaneous and sublingual and the novel epicutaneous and intralymphatic immunotherapy delivery systems as well as an edible rice vaccine. New targets for treatment have spurred research into new antagonist drugs such as (OC000459), a prostaglandin D2 antagonist. The Marinosolv formulation using tacrolimus shows promise and may be considered for other ophthalmic agents in the future. Other nonpharmacological treatments such as stenting and mechanical barrier gel have demonstrated their usefulness in treating ocular symptoms.
Population Kinetics of 0.9% Saline Distribution in Hemorrhaged Awake and Isoflurane-anesthetized Volunteers
Authors: Nyberg Joakim , Li Husong , Wessmark Pehr , Winther Viktor , Prough Donald S. , Kinsky Michael P. , Svensén Christer H.
Published: July 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Population-based, pharmacokinetic modeling can be used to describe variability in fluid distribution and dilution between individuals and across populations. The authors hypothesized that dilution produced by crystalloid infusion after hemorrhage would be larger in anesthetized than in awake subjects and that population kinetic modeling would identify differences in covariates.

Methods

Twelve healthy volunteers, seven females and five males, mean age 28 ± 4.3 yr, underwent a randomized crossover study. Each subject participated in two separate sessions, separated by four weeks, in which they were assigned to an awake or an anesthetized arm. After a baseline period, hemorrhage (7 ml/kg during 20 min) was induced, immediately followed by a 25 ml/kg infusion during 20 min of 0.9% saline. Hemoglobin concentrations, sampled every 5 min for 60 min then every 10 min for an additional 120 min, were used for population kinetic modeling. Covariates, including body weight, sex, and study arm (awake or anesthetized), were tested in the model building. The change in dilution was studied by analyzing area under the curve and maximum plasma dilution.

Results

Anesthetized subjects had larger plasma dilution than awake subjects. The analysis showed that females increased area under the curve and maximum plasma dilution by 17% (with 95% CI, 1.08 to 1.38 and 1.07 to 1.39) compared with men, and study arm (anesthetized increased area under the curve by 99% [0.88 to 2.45] and maximum plasma dilution by 35% [0.71 to 1.63]) impacted the plasma dilution whereas a 10-kg increase of body weight resulted in a small change (less than1% [0.93 to 1.20]) in area under the curve and maximum plasma dilution. Mean arterial pressure was lower in subjects while anesthetized (P < 0.001).

Conclusions

In awake and anesthetized subjects subjected to controlled hemorrhage, plasma dilution increased with anesthesia, female sex, and lower body weight. Neither study arm nor body weight impact on area under the curve or maximum plasma dilution were statistically significant and therefore no effect can be established.
Changes in Pediatric Spine Surgery Patterns Over the Last 10 Years Among ABOS Part II Candidates
Authors: Nielsen Ena , Andras Lindsay M. , Hosseinzadeh Pooya , Mignemi Megan , Sawyer Jeffrey R. , Flynn John M. , Albanese Stephen , Skaggs David L.
Published: July 2019

Study Design.

A retrospective review of prospectively collected data.

Objective.

Our purpose was to evaluate the volume of pediatric spine cases being done by surgeons applying for American Board of Orthopaedic Surgeons (ABOS) certification.

Summary of Background Data.

Pediatric orthopedic surgery has become increasingly subspecialized over the past decade.

Methods.

Data were reviewed from the ABOS for surgeons undergoing part II of ABOS certification between 2004 and 2014. Applicants were divided into pediatric orthopedic surgeons and spine surgeons based on their self-declared subspecialty for the ABOS Part II examination. A total of 102,424 cases were reviewed to identify spine cases performed on patients <18 years old.

Results.

Between 2004 and 2014, the total number of ABOS part II pediatric candidates increased significantly, from a low of 15 to a high of 44 (r

2
 = 0.68, P = 0.001). During this time frame, there has been no significant increase in the total number of pediatric spine cases reported (r

2
 = 0.09, P = 0.19). In 2004, 46.5% (33/71) of the pediatric spine cases were done by spine surgeons, which decreased to 17.3% (28/162) in 2014. Conversely in 2004, 53.5% (38/71) of pediatric spine cases were done by pediatric orthopedists, which increased to 82.7% (134/162) in 2014. The number of pediatric candidates performing pediatric spine cases decreased 35% from 2004 to 2014, but the percentage performing >20 spine cases during their candidate year has increased from 0% to 7% (r

2
 = 0.31, P = 0.04).

Conclusion.

The share of pediatric spine surgeries performed by pediatric candidates has increased from 54% in 2004 to 83%, with a corresponding fall in the share surgeries performed by spine candidates (47% to >17%). The percentage of pediatric candidates performing more than 20 spine cases/year increased from 0% to 7%, reflecting a trend of spine subspecialization within pediatric surgery.

Level of Evidence: 3
Sagittal Reconstruction and Clinical Outcome Using Traditional ACDF, Versus Stand-alone ACDF Versus TDR
Authors: Katsuura Yoshihiro , York Philip J. , Goto Rie , Yang Jingyan , Vaishnav Avani S. , McAnany Steven , Albert Todd , Iyer Sravisht , Gang Catherine Himo , Qureshi Sheeraz A.
Published: July 2019

Study Design.

Systematic review.

Objective.

To determine the difference in postoperative sagittal alignment when single level cervical radiculopathy or myelopathy is treated with an anterior cervical discectomy and fusion (ACDF) using a structural graft and plate, a stand-alone ACDF, or a total disc arthroplasty (TDR). We also wanted to determine if postoperative sagittal alignment impacted clinical outcomes in this patient population.

Summary of Background Data.

Although there are several accepted techniques for interbody reconstruction during single level anterior cervical surgery, little is known on the impact of any of them on segmental and regional sagittal alignment.

Methods.

A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines of the PubMed, Embase, and Cochrane databases. Only studies which contained pre and postoperative C2–7 Cobb angles as well as Neck Disability Index (NDI) scores following single level traditional ACDF with plate and cage, stand-alone ACDF, or TDR with at least 1 year follow up were included.

Results.

There were 12 publications that fulfilled the inclusion criteria with a total of 658 patients. Cluster regression analysis showed no difference between treatment arms at each respective time-point or in the overall change in NDI from preoperative to postoperative (P = 0.88). Cluster regression analysis showed no difference between treatment arms at each respective time point or in the overall change in lordosis from pre-op to post-op (P = 0.93).

Conclusion.

This review provides evidence that while NDI scores improved across all devices, there was no significant difference in NDI improvement or C2–7 Cobb angle change between single level traditional ACDF, stand-alone ACDF, or TDR. Although TDR has not been considered a lordosis producing operation, our investigation shows it does not differ significantly in sagittal profile from other cervical fusion techniques. Moreover, we show that the NDI score improved, regardless of device implanted.

Level of Evidence: 1
Predictors of Poor Global Alignment and Proportion Score After Surgery for Adult Spinal Deformity
Authors: Ohba Tetsuro , Ebata Shigeto , Oba Hiroki , Koyama Kensuke , Yokomichi Hiroshi , Haro Hirotaka
Published: July 2019

Study Design.

Retrospective observational study of a cohort of consecutive patients.

Objective.

To determine 1) the correlation between clinical and radiographic outcomes and Global Alignment and Proportion (GAP) score, and 2) which preoperative parameters predominantly influence the risk for poor GAP scores.

Summary of Background Data.

Although numerous investigators have indicated their criteria for sagittal correction, it is still not unusual to observe poor outcome or complications even after ideal correction. The recently developed GAP score indicates spinopelvic alignment and setting surgical goals according to the score might decrease the prevalence of mechanical complications. However, there is no clear evidence of correlation between the GAP score and clinical outcomes, or which patient factors are preoperative predictors of poor postoperative GAP score.

Methods.

We included 128 consecutive patients treated with spinal correction surgery who had a minimum 2-year follow-up. The correlations between clinical outcomes, increased proximal junctional angle, and GAP score were determined. Univariate and multivariate logistic regression analyses were conducted to clarify potential preoperative risk factors for poor GAP score.

Results.

Based on total GAP score, 32 (25%) patients were grouped into proportioned, 50 (39.1%) into moderately disproportioned, and 44 (34.3%) into severely disproportioned spinopelvic alignment. Our present study showed a significantly positive correlation between Oswestry Disability Index, increased proximal junctional angle 2 years after surgery, and total GAP score. Uni and multivariate regression analysis showed a large global tilt was a risk factor for a poor GAP score and that the risk for a poor GAP score increased with ageing.

Conclusions.

Because GAP score correlated with Oswestry Disability Index and increased proximal junctional angle 2 years after surgery, GAP score might define targets for sagittal spinopelvic alignment for favorable outcomes of corrective spinal surgery. A large preoperative global tilt is a potential predictor of poor postoperative GAP score.

Level of Evidence: 3
Mechanical Ventilation Guided by Electrical Impedance Tomography in Children With Acute Lung Injury
Authors: Rosemeier Isabel , Reiter Karl , Obermeier Viola , Wolf Gerhard K.
Published: July 2019

Objectives:

To provide proof-of-concept for a protocol applying a strategy of personalized mechanical ventilation in children with acute respiratory distress syndrome. Positive end-expiratory pressure and inspiratory pressure settings were optimized using real-time electrical impedance tomography aiming to maximize lung recruitment while minimizing lung overdistension.

Design:

Prospective interventional trial.

Setting:

Two PICUs.

Patients:

Eight children with early acute respiratory distress syndrome (< 72 hr).

Interventions:

On 3 consecutive days, electrical impedance tomography-guided positive end-expiratory pressure titration was performed by using regional compliance analysis. The Acute Respiratory Distress Network high/low positive end-expiratory pressure tables were used as patient’s safety guardrails. Driving pressure was maintained constant. Algorithm includes the following: 1) recruitment of atelectasis: increasing positive end-expiratory pressure in steps of 4 mbar; 2) reduction of overdistension: decreasing positive end-expiratory pressure in steps of 2 mbar until electrical impedance tomography shows collapse; and 3) maintaining current positive end-expiratory pressure and check regional compliance every hour. In case of derecruitment start at step 1.

Measurements and Main Results:

Lung areas classified by electrical impedance tomography as collapsed or overdistended were changed on average by –9.1% (95% CI, –13.7 to –4.4; p < 0.001) during titration. Collapse was changed by –9.9% (95% CI, –15.3 to –4.5; p < 0.001), while overdistension did not increase significantly (0.8%; 95% CI, –2.9 to 4.5; p = 0.650). A mean increase of the positive end-expiratory pressure level (1.4 mbar; 95% CI, 0.6–2.2; p = 0.008) occurred after titration. Global respiratory system compliance and gas exchange improved (global respiratory system compliance: 1.3 mL/mbar, 95% CI [–0.3 to 3.0], p = 0.026; Pao
2: 17.6 mm Hg, 95% CI [7.8–27.5], p = 0.0039; and Pao
2/Fio
2 ratio: 55.2 mm Hg, 95% CI [27.3–83.2], p < 0.001, all values are change in pre vs post).

Conclusions:

Electrical impedance tomography-guided positive end-expiratory pressure titration reduced regional lung collapse without significant increase of overdistension, while improving global compliance and gas exchange in children with acute respiratory distress syndrome.
Advanced cutaneous squamous cell carcinoma: how is it defined and what new therapeutic approaches are available?
Authors: Soura Efthymia , Gagari Eleni , Stratigos Alexander
Published: July 2019

Purpose of review

Despite the overall excellent survival rates in patients with cutaneous squamous cell carcinoma (cSCC), advanced cutaneous SCCs are associated with high patient morbidity and mortality. Therefore, important unmet clinical needs persist: identifying high risk patients and choosing optimal treatment approaches.

Recent findings

In recent years, a better understanding of the biology of cSCC and its clinical progression have led to improved staging systems and new promising treatments for advanced disease. Such treatments include PD1 inhibitors, such as cemiplimab, which was recently approved for the treatment of cutaneous SCC, and pembrolizumab whose efficacy in the treatment cSCC is still being investigated. Other treatments, such as epidermal growth factor receptor inhibitors have also been used in the treatment of cSCC with moderate success. Several clinical and histological risk factors are considered key in estimating the risk or recurrence or metastasis in cSCCs and, therefore, influence the appropriate treatment choice and patient monitoring.

The present study reviews the current definition of advanced cSCC and discusses the new systemic approaches, including checkpoint inhibitors.
A Severe, Refractory Case of Mucous Membrane Pemphigoid After Treatment With Pembrolizumab: Brief Communication
Authors: Bezinelli Letícia Mello , Eduardo Fernanda P. , Migliorati Cesar A. , Ferreira Mariana H. , Taranto Patrícia , Sales Diogo B. , Santi Claudia G. , Macarenco Ricardo S. , Godoy Claudia P.V. , Corrêa Luciana , Buzaid Antonio C.
Published: July 2019

Pembrolizumab is a humanized antibody that targets the programmed death-1 receptor expressed in T cells with high selectivity. This therapeutic is of great importance in cancer immunotherapy yet managing the potential immune-related adverse events remains a concern. Here, we report a rare case of mucous membrane pemphigoid in the oral mucosa, upper respiratory tract, and conjunctiva of a patient with ovarian adenocarcinoma without cutaneous manifestation, which persisted even after pembrolizumab discontinuation. A brief review of pembrolizumab-related bullous pemphigoid cases is presented and possible mechanisms underlying these lesions are discussed.
Artificial Intelligence Estimates the Importance of Baseline Factors in Predicting Response to Anti-PD1 in Metastatic Melanoma
Authors: Indini Alice , Di Guardo Lorenza , Cimminiello Carolina , De Braud Filippo , Del Vecchio Michele
Published: July 2019

Objective:

Prognosis of patients with metastatic melanoma has dramatically improved over recent years because of the advent of antibodies targeting programmed cell death protein-1 (PD1). However, the response rate is ~40% and baseline biomarkers for the outcome are yet to be identified. Here, we aimed to determine whether artificial intelligence might be useful in weighting the importance of baseline variables in predicting response to anti-PD1.

Methods:

This is a retrospective study evaluating 173 patients receiving anti-PD1 for melanoma. Using an artificial neuronal network analysis, the importance of different variables was estimated and used in predicting response rate and overall survival.

Results:

After a mean follow-up of 12.8 (±11.9) months, disease control rate was 51%. Using artificial neuronal network, we observed that 3 factors predicted response to anti-PD1: neutrophil-to-lymphocyte ratio (NLR) (importance: 0.195), presence of ≥3 metastatic sites (importance: 0.156), and baseline lactate dehydrogenase (LDH) > upper limit of normal (importance: 0.154). Looking at connections between different covariates and overall survival, the most important variables influencing survival were: presence of ≥3 metastatic sites (importance: 0.202), age (importance: 0.189), NLR (importance: 0.164), site of primary melanoma (cutaneous vs. noncutaneous) (importance: 0.112), and LDH > upper limit of normal (importance: 0.108).

Conclusions:

NLR, presence of ≥3 metastatic sites, LDH levels, age, and site of primary melanoma are important baseline factors influencing response and survival. Further studies are warranted to estimate a model to drive the choice to administered anti-PD1 treatments in patients with melanoma.
Molecular Mechanisms of Adipose Tissue Survival during Severe Hypoxia: Implications for Autologous Fat Graft Performance
Authors: Wang Sheri , Gusenoff Jeffrey A. , Rubin J. Peter , Kokai Lauren
Published: July 2019

Background:

Variable retention outcomes remain a significant issue in autologous fat grafting procedures. Among seemingly similar patients, using identical harvesting procedures, variability in graft retention is noted. Recent data suggest that the inherent characteristics of donor adipose tissue dictate graft healing outcomes. The goal of this study was to elucidate intrinsic qualities of human adipose tissue that confer resistance to ischemic stress to therapeutically target such mechanisms and improve overall results of fat grafts.

Methods:

Whole fat from 5 female patients was cultured in vitro under severe (1% O2) and mild (8% O2) hypoxic conditions. Microarray analysis of 44 hypoxia-related genes was performed. Perilipin was used to visualize viable adipocytes. Macrophage phenotypes were identified using PCR.

Results:

Analysis of adipocyte survival with perilipin suggested improved viability for tissue obtained from high BMI donors. Microarray data revealed a significant positive correlation for induced expression of ANGPTL4, a survival gene, and subject BMI (P = 0.0313) during hypoxic conditions whereas HIF1α and HIF2α genes were negatively correlated with donor BMI (P = 0.0003 and 0.0303). Interestingly, induced differentiation of proinflammatory M1 macrophages was negatively correlated with BMI under hypoxia (P = 0.0177).

Conclusions:

The innate resilience of adipocytes to hypoxia and relative macrophage activation play a crucial role in fat graft retention. This study suggests that adipose tissue from high BMI donors demonstrates greater resistance to hypoxia-induced apoptosis associated with an increased expression of ANGPTL4. Therefore, therapeutic interventions that target this factor may improve clinical adipose graft survival.
Social Media and the Dissemination of Prepublication Data in Surgical Fields
Authors: Akhavan Arya A. , Ndem Idorenyin E. , Kalliainen Loree K.
Published: July 2019

Background:

This review investigates the use of social media at surgical conferences and possible effects of prepublication data release in surgical fields. Potential risks include patient harm by the preliminary application of research that lacks sufficient peer review, infringements on intellectual property, and loss of “research novelty.”

Methods:

A literature review of the current use of social media in dispersion of prepublication data was performed. Current submission guidelines for surgical conferences and journals were analyzed for data release embargos and social media use policies.

Results:

Conference abstract guidelines mentioned data embargos half of the time and the use of social media less than one third of the time. Eighty percentage of journal instructions to authors contained guidelines on both.

Conclusions:

In nonsurgical fields, the appropriateness of the use of social media to release prepublication data is increasingly being discussed. Little guidance exists on how surgical conference attendees should use social media while at conferences. Given the potential for patient harm and negative impact on intellectual property and attribution, further discussion is warranted.

Introducción:

Esta crítica investiga el uso de las redes sociales en las conferencias quirúrgicas y los efectos posibles de los datos pre-publicados en cirugía. Los riesgos probables incluyen: daño al paciente causado por la aplicación prematura de las investigaciones sin bastante análisis, violación de la propiedad intelectual, y perdido de “novedad de investigación.”

Metodología:

Un repaso fue hecho sobre el rol de las redes sociales en la propagación de los datos pre-publicados. Las normas actuales para la entrega de las conferencias y los periódicos quirúrgicos claves fueron analizadas por las reglas gobernando el uso de las redes sociales y los embargos del lanzamiento de datos.

Resultados:

Las reglas generales sobre la entrega de abstractos para las conferencias mencionaron los embargos de datos la mitad del tiempo mientras que estas mismas reglas mencionaron el uso de las redes sociales menos que un tercio el tiempo. 80% de las instrucciones de los periódicos dirigidas a los autores tuvieron las reglas generales sobre los dos: los embargos de datas y las redes sociales.

Conclusiones:

En las especialidades non-quirúrgicas, la pertinencia del uso de las redes sociales para lanzar el dato pre-publicado es discutida con más frecuencia. No existen normas sobre cómo se usan las redes sociales durante las conferencias. Dado el daño potencial al paciente y el impacto negativo en la propiedad y la atribución intelectuales, más discusión está obligatoria.
Attitudes of Pregnant Women and Healthcare Professionals Toward Clinical Trials and Routine Implementation of Antenatal Vaccination Against Respiratory Syncytial Virus: A Multicenter Questionnaire Study
Authors: Wilcox Christopher R. , Calvert Anna , Metz Jane , Kilich Eliz , MacLeod Rachael , Beadon Kirsten , Heath Paul T. , Khalil Asma , Finn Adam , Snape Matthew D. , Vandrevala Tushna , Nadarzynski Tom , Coleman Matthew A. , Jones Christine E.
Published: July 2019

Introduction:

Respiratory syncytial virus (RSV) is a common cause of infant hospitalization and mortality. With multiple vaccines in development, we aimed to determine: (1) the awareness of RSV among pregnant women and healthcare professionals (HCPs), and (2) attitudes toward clinical trials and routine implementation of antenatal RSV vaccination.

Methods:

Separate questionnaires for pregnant women and HCPs were distributed within 4 hospitals in South England (July 2017–January 2018).

Results:

Responses from 314 pregnant women and 204 HCPs (18% obstetricians, 75% midwives, 7% unknown) were analyzed. Most pregnant women (88%) and midwives (66%) had no/very little awareness of RSV, unlike obstetricians (14%). Among pregnant women, 29% and 75% would likely accept RSV vaccination as part of a trial, or if routinely recommended, respectively. Younger women (16–24 years), those of 21–30 weeks’ gestation, and with experience of RSV were significantly more likely to participate in trials [odds ratio (OR): 1.42 (1.72–9.86); OR: 2.29 (1.22–4.31); OR: 9.07 (1.62–50.86), respectively]. White-British women and those of 21–30 weeks’ gestation were more likely to accept routinely recommended vaccination [OR: 2.16 (1.07–4.13); OR: 2.10 (1.07–4.13)]. Obstetricians were more likely than midwives to support clinical trials [92% vs. 68%, OR: 2.50 (1.01–6.16)] and routine RSV vaccination [89% vs. 79%, OR: 4.08 (1.53–9.81)], as were those with prior knowledge of RSV, and who deemed it serious.

Conclusions:

RSV awareness is low among pregnant women and midwives. Education will be required to support successful implementation of routine antenatal vaccination. Research is needed to understand reasons for vaccine hesitancy among pregnant women and HCPs, particularly midwives.
Detection of Needle Dislodgement Using Extracorporeal Pressure Signals: A Feasibility Study
Authors: Holmer Mattias , Olde Bo , Sandberg Frida , Sörnmo Leif
Published: July 2019

Venous needle dislodgement (VND) during dialysis is a rarely occurring adverse event, which becomes life-threatening if not handled promptly. Because the standard venous pressure alarm, implemented in most dialysis machines, has low sensitivity, a novel approach using extracted cardiac information to detect needle dislodgement is proposed. Four features are extracted from the arterial and venous pressure signals of the dialysis machine, characterizing the mean venous pressure, the venous cardiac pulse pressure, the time delay, and the correlation between the two pressure signals. The features serve as input to a support vector machine (SVM), which determines whether dislodgement has occurred. The SVM is first trained on a set of laboratory data, and then tested on another set of laboratory data as well as on a small data set from clinical hemodialysis sessions. The results show that dislodgement can be detected after 12–17 s, corresponding to 24–143 ml blood loss. The standard venous pressure alarm used in clinical routine only detects 50% of the VNDs, whereas the novel method detects all VNDs and has a false alarm rate of 0.12 per hour, provided that the amplitude of the extracted cardiac pressure signal exceeds 1 mmHg. The results are promising; however, the method needs to be tested on a larger set of clinical data to better establish its performance.