bluuebunny/crossref_metadata_2025 huggingface dataset:
Distracted decision makers: ship noise and predation risk change shell choice in hermit crabs
Authors: Tidau Svenja , Briffa Mark
Published: April 2019

Human-induced rapid environmental change such as noise pollution alters the ability of animals to integrate information cues. Many studies focus on how noise impacts single sensory channels but in reality animals rely on multimodal sources of information. In this study, we investigated the effect of anthropogenic noise and the visual presence of a predator on tactile information gathering during gastropod shell assessment in the European hermit crab Pagurus bernhardus. For hermit crabs, empty gastropod shells are a crucial resource affecting growth, reproduction, and survival. We measured shell assessment behavior and manipulated 1) the shell size (50% or 80% of the optimal), 2) sound condition (ship or ambient), and 3) visual predator cue (absence/presence). Overall we found that crabs were less likely to accept an optimal shell in the presence of ship noise, suggesting that exposure to ship noise disrupted the information gathering ability of the crabs. We also found a significant interaction between noise, predator presence, and shell size on the mean duration for the final decision to accept or reject the optimal shell. Hermit crabs in 50% shells took less time for their final decision when exposed to both ship noise and predator cue while crabs in 80% shells showed shorter decision time only when the predator cue was absent. Our results indicate that anthropogenic noise can interact with predation threat and resource quality to change resource acquisition, suggesting that noise pollution can disrupt behavior in a nonadditive way, by disrupting information use across multiple sensory channels.
Identifying centromeric satellites with dna-brnn
Authors: Li Heng
Published: April 2019

Human alpha satellite and satellite 2/3 contribute to several percent of the human genome. However, identifying these sequences with traditional algorithms is computationally intensive. Here we develop dna-brnn, a recurrent neural network to learn the sequences of the two classes of centromeric repeats. It achieves high similarity to RepeatMasker and is times faster. Dna-brnn explores a novel application of deep learning and may accelerate the study of the evolution of the two repeat classes.

Availability and implementation

https://github.com/lh3/dna-nn
Shifts of Spatial Attention in Visual and Tactile Working Memory are Controlled by Independent Modality-Specific Mechanisms
Authors: Katus Tobias , Eimer Martin
Published: April 2019

The question whether the attentional control of working memory (WM) is shared across sensory modalities remains controversial. Here, we investigated whether attention shifts in visual and tactile WM are regulated independently. Participants memorized visual and tactile targets in a first memory sample set (S1) before encoding targets in a second sample set (S2). Importantly, visual or tactile S2 targets could appear on the same side as the corresponding S1 targets, or on opposite sides, thus, requiring shifts of spatial attention in visual or tactile WM. The activation of WM representations in modality-specific visual and somatosensory areas was tracked by recording visual and tactile contralateral delay activity (CDA/tCDA). CDA/tCDA components emerged contralateral to the side of visual or tactile S1 targets, and reversed polarity when S2 targets in the same modality appeared on the opposite side. Critically, the visual CDA was unaffected by the presence versus absence of concurrent attention shifts in tactile WM, and the tactile CDA remained insensitive to visual attention shifts. Visual and tactile WM performance was also not modulated by attention shifts in the other modality. These results show that the dynamic control of visual and tactile WM activation processes operates in an independent modality-specific fashion.
Rates of New Human Immunodeficiency Virus (HIV) Diagnoses After Reported Sexually Transmitted Infection in Women in Louisiana, 2000–2015: Implications for HIV Prevention
Authors: Newman Daniel R , Rahman Mohammad M , Brantley Antoine , Peterman Thomas A
Published: April 2019

Background

Human immunodeficiency virus (HIV) prevention interventions for prevention interventions for women include screening, partner notification, promoting condoms, and preexposure prophylaxis (PrEP). Women’s risk of acquiring HIV can help guide recommendations.

Methods

We used data from Louisiana’s sexually transmitted infection (STI) and HIV registries to study 13- to 59-year-old women following first diagnosis of syphilis, gonorrhea, or chlamydia during 2000–2015. We measured HIV rates reported subsequent to STI (through 2016). Rates for women without STI were estimated by subtracting women with STI from reported cases and from Census estimates for the population. PrEP cost was estimated as $11 000 per year, and effectiveness estimated as 100%.

Results

STIs were syphilis (6574), gonorrhea (64 995), or chlamydia (140 034). These 211 603 women had 1 865 488 person-years of follow-up and 969 HIV diagnoses. Women with no STI had 5186 HIV diagnoses over 24 359 397 person-years. HIV rates diagnosis (per 100 000 person-years) were higher for women after syphilis (177.3), gonorrhea (73.2), or chlamydia (35.4) compared to women with no STI (22.4). Providing PrEP to all women diagnosed with syphilis or gonorrhea would cost $7 371 111 000 and could have prevented 546 HIV diagnoses. Limiting PrEP to 1 year after syphilis or gonorrhea diagnosis would cost $963 847 334, but only 143 HIV diagnoses were within 2 years after a syphilis or gonorrhea diagnosis.

Conclusions

Rates of HIV diagnosis were high after women had STI, but not high enough to make PrEP cost-effective for them. Most women diagnosed with HIV did not have previously reported STI.
Total root remodelling by the Sleeve technique for aortic regurgitation in patients with repaired tetralogy of Fallot
Authors: Eishi Junichiro , Miura Takashi , Obase Kikuko , Eishi Kiyoyuki
Published: April 2019

We report the case of a 15-year-old male patient who had developed aortic regurgitation primarily because of aortic annulus dilatation late after definitive repair of tetralogy of Fallot. Valsalva sinus dilatation was not remarkable enough for root replacement. For the purpose of total root remodelling, the Sleeve procedure was employed. This procedure not only reduced the root diameters but also augmented commissure heights. With concomitant non-coronary cusp plication, aortic regurgitation was effectively controlled. Thus, the Sleeve technique may be a preferable option for patients who develop aortic regurgitation, due to dilatation of the annulus or sinotubular junction without significant dilatation of the sinus of Valsalva, after congenital heart surgery.
Social Relationships and Functional Impairment in Aging Cancer Survivors: A Longitudinal Social Network Study
Authors: Guida Jennifer L , Holt Cheryl L , Dallal Cher M , He Xin , Gold Robert , Liu Hongjie
Published: April 2019

Background and Objectives

The intersection of cancer, treatment, and aging accelerates functional decline. Social networks, through the provision of social support and resources, may slow the progression of functional deterioration. Socioemotional selectivity theory posits that aging and major life events, like cancer, cause an intentional social network pruning to procure and maintain emotionally fulfilling bonds, while shedding weaker, less supportive relationships. However, it is relatively unknown if such network changes impact functional impairment in cancer survivors. This study examined the relationships between changes in the egocentric social network and functional impairment in older adult cancer survivors and a similarly aged group without cancer (older adults).

Research Design and Methods

Data were analyzed from 1,481 community dwelling older adults (n = 201 cancer survivors) aged 57–85 years, from Waves 1 and 2 (2005–2006 and 2010–2011) of the National Social Life, Health and Aging Project. Associations were analyzed with multiple logistic regression.

Results

Cancer survivors and older adults reported similar levels of functional impairment and social network change. Adding 2 new relationships exhibited protective effects against functional impairment, irrespective of cancer status (odds ratio [OR]: 0.64, 95% confidence interval [CI]: 0.41–0.99). Declines in frequent contact were associated with higher odds of functional impairment among cancer survivors (OR: 1.92, 95% CI: 1.15–3.20). Social network components were not significantly associated with functional impairment in older adults.

Discussion and Implications

Adding new relationships may reduce disability in older adults and increasing network contact may help cancer survivors remain independent. Social network interventions may improve quality of life for older adults.
Developing the knowledge base needed to sustainably manage mesopelagic resources
Authors: Hidalgo Manuel , Browman Howard I
Published: April 2019

Recent estimates suggest that the mesopelagic zone could contain a total fish biomass of 2-19.5 gigatonnes, roughly equivalent to 100 times the annual catch of all existing fisheries. In addition to the possibility of direct consumption of mesopelagic species, there is interest in their use for fishmeal, as a source of dietary supplements for humans, and to bio-prospect pharmaceuticals. All of this, and the demands for a global food supply that can feed an ever-growing population, has driven interest in the mesopelagic. Thus, accurate quantification of the biomass of mesopelagic resources, their nutritional and genetic composition, their links to other components of the food web, to other oceanic realms and to biological and chemical oceanographic processes and cycles, are the focus of growing research activity. This information is needed to ensure the sustainable management of these resources. In this introduction, we summarize the contributions included in this theme set and provide some “food for thought” on the state-of-the-art in research on the mesopelagic, including identifying the knowledge that must be generated to support its sustainable management (e.g. the effect that extracting significant biomass might have on the pelagic ecosystem and the flow of material and energy through it).
Physiological responses of juvenile Chilean scallops (Argopecten purpuratus) to isolated and combined environmental drivers of coastal upwelling
Authors: Ramajo Laura , Fernández Carolina , Núñez Yolanda , Caballero Paz , Lardies Marco A , Poupin María Josefina
Published: April 2019

Coastal biota is exposed to continuous environmental variability as a consequence of natural and anthropogenic processes. Responding to heterogeneous conditions requires the presence of physiological strategies to cope with the environment. Ecosystems influenced by upwelling endure naturally cold, acidic and hypoxic conditions, nevertheless they sustain major fisheries worldwide. This suggests that species inhabiting upwelling habitats possess physiological adaptations to handle high environmental variability. Here, we assessed the impact of the main upwelling drivers (temperature, pH and oxygen) in isolation and combined on eco-physiological responses of Chilean scallop Argopecten purpuratus. A. purpuratus responded to hypoxia by increasing their metabolic performance to maintain growth and calcification. Calcification was only affected by pH and increased under acidic conditions. Further, A. purpuratus juveniles prioritized calcification at the expense of growth under upwelling conditions. Increasing temperature had a significant impact by enhancing the physiological performance of A. purpuratus juveniles independently of oxygen and pH conditions, but this was associated with earlier and higher mortalities. Our results suggest that A. purpuratus is acclimated to short-term colder, acidic and hypoxic conditions, and provide important information of how this species responds to the heterogeneous environment of upwelling, which is significantly relevant in the climatic context of upwelling intensification.
Research Frontiers in Oral Toxicities of Cancer Therapies: Osteoradionecrosis of the Jaws
Authors: Spijkervet Frederik K L , Brennan Michael T , Peterson Douglas E , Witjes Max J H , Vissink Arjan
Published: April 2019

The deleterious effects of head and neck radiation on bone, with osteoradionecrosis (ORN) as the major disabling side effect of head and neck cancer treatment, are difficult to prevent and hard to treat. This review focuses on the current state of the science regarding the pathobiology, clinical impact, and management of ORN. With regard to the pathobiology underlying ORN, it is not yet confirmed whether the current radiation schedules by 3-dimensional conformal radiotherapy and intensity modified radiotherapy result in an unchanged, decreased, or increased risk of developing ORN when compared with conventional radiation treatment, the main risk factor being the total radiation dose delivered on any clinically significant surface of the mandible.

With regard to the prevention of ORN, a thorough, early pre-irradiation dental assessment is still considered the first step to reduce the hazard of developing ORN post-radiotherapy, and hyperbaric oxygen (HBO) treatment reduces the risk of developing ORN in case of dental surgery in an irradiated field.

With regard to the treatment of ORN, the focus is bidirectional: elimination of the necrotic bone and improving the vascularity of the normal tissues that were included in the radiation portal. The cure rate of limited ORN by conservative therapy is approximately 50%, and the cure rate of surgical approaches when conservative therapy has failed is approximately 40%.

Whether it is effective to support conservative or surgical treatment with HBO as an adjuvant is not set. HBO treatment is shown to increase the vascularity of hard and soft tissues and has been reported to be beneficial in selected cases. However, in randomized clinical trials comparing the preventive effect of HBO on developing ORN with, eg, antibiotic coverage in patients needing dental surgery, the preventive effect of HBO was not shown to surpass that of a more conservative approach.

More recently, pharmacologic management was introduced in the treatment of ORN with success, but its efficacy has to be confirmed in randomized clinical trials. The major problem of performing well-designed randomized clinical trials in ORN is having access to large numbers of patients with well-defined, comparable cases of ORN. Because many institutions will not have large numbers of such ORN cases, national and international scientific societies must be approached to join multicenter trials. Fortunately, the interest of funding organizations and the number researchers with an interest in healthy aging is growing. Research aimed at prevention and reduction of the morbidity of cancer treatment fits well within these programs.
Effectiveness of Psychological Interventions on Young Refugees' Social Adjustment: A Meta-analysis
Authors: Ahmadi Forooshani Sayedhabibollah , Izadikhah Zahra , Renzaho Andre M. N , O'Connor Peter J
Published: April 2019

The purpose of this study was to evaluate the effectiveness of existing psychological interventions on the social adjustment of young refugees. From 51 peer-reviewed articles identified in the literature, 11 studies with 25 therapeutic effect sizes met criteria for inclusion (N = 1,736). Hedges’ g was used to measure effect sizes and a random-effects model was conducted. The number of sessions and participant age were considered as potential moderator variables in moderator analyses through meta-regression. The effect sizes of the included studies were compared based on the type of intervention. The results showed that the aggregated effect size for all included interventions was significant, computed as g = 0.14, p < 0.01, 95% confidence interval [0.06, 0.21]. The effect size is considered small, based on Cohen's (1992) guidelines. The results of the meta-regression showed that the effectiveness of the included psychological interventions on social adjustment was not moderated by either the number of sessions (b = 0.006 p = 0.35) or age (b = –0.008, p = 0.59). Furthermore, there were no significant differences between different therapeutic approaches (Q = 7.37, df (Q) = 6; p = 0.28). This meta-analysis demonstrates that mental-health interventions in young refugees mildly improve their social adjustment. Due to the importance of social adjustment in refugees, we suggest that existing interventions place greater specific focus on improving social adjustment. The details of implications for future studies are discussed.
A rare case of lupus-related gastrointestinal vasculitis presenting as rectal gangrene
Authors: Liang Yi , Di Re Angelina , El Khoury Toufic
Published: April 2019

Systemic lupus erythematosus (SLE) related gastrointestinal vasculitis is a rare condition limited to case studies within the literature however, no cases of rectal gangrene and perforation have been previously described. A 32-year-old male presented with abdominal pain, vomiting and fevers. CT demonstrated free gas and free fluid around the rectum indicative of a perforation. He proceeded to urgent laparotomy, confirming a diagnosis of rectal infarction and perforation. Uniquely, the involved segment of gangrene extended from the rectosigmoid to the anorectal junction. A Hartmanns procedure was performed. Histopathology confirmed underlying stenosis of the rectal arteries secondary to chronic vasculitis related to the affected areas. The current case is a unique presentation of SLE-related vasculitis. It highlights the need to judiciously investigate SLE patients presenting with surgical acute abdomen.
Impaired PSII proteostasis triggers a UPR-like response in the var2 mutant of Arabidopsis
Authors: Dogra Vivek , Duan Jianli , Lee Keun Pyo , Kim Chanhong
Published: April 2019

Cellular protein homeostasis (proteostasis) is maintained through the balance between de novo synthesis and proteolysis. The unfolded/misfolded protein response (UPR) that is triggered by stressed endoplasmic reticulum (ER) also plays an important role in proteostasis in both plants and animals. Although ER-triggered UPR has been extensively studied in plants, the molecular mechanisms underlying mitochondrial and chloroplastic UPRs are largely uncharacterized despite the fact that these organelles are sites of production of harmful reactive oxygen species (ROS), which damage proteins. In this study, we demonstrate that chloroplasts of the Arabidopsis yellow leaf variegation 2 (var2) mutant, which lacks the metalloprotease FtsH2, accumulate damaged chloroplast proteins and trigger a UPR-like response, namely the accumulation of a suite of chloroplast proteins involved in protein quality control (PQC). These PQC proteins include heat-shock proteins, chaperones, proteases, and ROS detoxifiers. Given that FtsH2 functions primarily in photosystem II proteostasis, the accumulation of PQC-related proteins may balance the FtsH2 deficiency. Moreover, the apparent up-regulation of the cognate transcripts indicates that the accumulation of PQC-related proteins in var2 is probably mediated by retrograde signaling, indicating the occurrence of a UPR-like response in var2.
A wheat/rye polymorphism affects seminal root length and yield across different irrigation regimes
Authors: Howell Tyson , Moriconi Jorge I , Zhao Xueqiang , Hegarty Joshua , Fahima Tzion , Santa-Maria Guillermo E , Dubcovsky Jorge
Published: April 2019

The introgression of a small segment of wheat (Triticum aestivum L.) chromosome arm 1BS in the distal region of the rye (Secale cereale L.) 1RS.1BL arm translocation in wheat (henceforth 1RSRW) was previously associated with reduced grain yield, carbon isotope discrimination, and stomatal conductance, suggesting reduced access to soil moisture. Here we show that lines with the normal 1RS arm have longer roots than lines with the 1RSRW arm in both field and hydroponic experiments. In the 1RSRW lines, differences in seminal root length were associated with a developmentally regulated arrest of the root apical meristem (RAM). Approximately 10 d after germination, the seminal roots of the 1RSRW plants showed a gradual reduction in elongation rate, and stopped growing a week later. Seventeen days after germination, the roots of the 1RSRW plants showed altered gradients of reactive oxygen species and emergence of lateral roots close to the RAM, suggesting changes in the root meristem. The 1RSRW lines also showed reduced biomass (estimated by the normalized difference vegetation index) and grain yield relative to the 1RS lines, with larger differences under reduced or excessive irrigation than under normal irrigation. These results suggest that this genetic variation could be useful to modulate root architecture.
Genome Evolution of the Obligate Endosymbiont Buchnera aphidicola
Authors: Chong Rebecca A , Park Hyunjin , Moran Nancy A
Published: April 2019

An evolutionary consequence of uniparentally transmitted symbiosis is degradation of symbiont genomes. We use the system of aphids and their maternally inherited obligate endosymbiont, Buchnera aphidicola, to explore the evolutionary process of genome degradation. We compared complete genome sequences for 39 Buchnera strains, including 23 newly sequenced symbiont genomes from diverse aphid hosts. We reconstructed the genome of the most recent shared Buchnera ancestor, which contained 616 protein-coding genes, and 39 RNA genes. The extent of subsequent gene loss varied across lineages, resulting in modern genomes ranging from 412 to 646 kb and containing 354–587 protein-coding genes. Loss events were highly nonrandom across loci. Genes involved in replication, transcription, translation, and amino acid biosynthesis are largely retained, whereas genes underlying ornithine biosynthesis, stress responses, and transcriptional regulation were lost repeatedly. Aside from losses, gene order is almost completely stable. The main exceptions involve movement between plasmid and chromosome locations of genes underlying tryptophan and leucine biosynthesis and supporting nutrition of aphid hosts. This set of complete genomes enabled tests for signatures of positive diversifying selection. Of 371 Buchnera genes tested, 29 genes show strong support for ongoing positive selection. These include genes encoding outer membrane porins that are expected to be involved in direct interactions with hosts. Collectively, these results indicate that extensive genome reduction occurred in the ancestral Buchnera prior to aphid diversification and that reduction has continued since, with losses greater in some lineages and for some loci.
Dog10K: an international sequencing effort to advance studies of canine domestication, phenotypes and health
Authors: Ostrander Elaine A , Wang Guo-Dong , Larson Greger , vonHoldt Bridgett M , Davis Brian W , Jagannathan Vidhya , Hitte Christophe , Wayne Robert K , Zhang Ya-Ping ,   Dog10K Consortium, André Catherine , Axelsson Erik , Boyko Adam , Davis Brian W , Forman Oliver , Frantz Laurent , Hitte Christophe , Jagannathan Vidhya , Karlsson Elinor , Kidd Jeffrey , Larson Greger , Leeb Tosso , Lindblad-Toh Kerstin , Lohi Hannes , Lohmueller Kirk E , Marques-Bonet Tomas , Mellersh Catherine , Ostrander *Elaine A , Savolainen Peter , Schnabel Robert , vonHoldt Bridgett M , Wang *Guo-Dong , Wayne *Robert K , Yang Ziheng , Zhai Weiwei , Zhang *Ya-Ping
Published: April 2019

Dogs are the most phenotypically diverse mammalian species, and they possess more known heritable disorders than any other non-human mammal. Efforts to catalog and characterize genetic variation across well-chosen populations of canines are necessary to advance our understanding of their evolutionary history and genetic architecture. To date, no organized effort has been undertaken to sequence the world's canid populations. The Dog10K Consortium (http://www.dog10kgenomes.org) is an international collaboration of researchers from across the globe who will generate 20× whole genomes from 10 000 canids in 5 years. This effort will capture the genetic diversity that underlies the phenotypic and geographical variability of modern canids worldwide. Breeds, village dogs, niche populations and extended pedigrees are currently being sequenced, and de novo assemblies of multiple canids are being constructed. This unprecedented dataset will address the genetic underpinnings of domestication, breed formation, aging, behavior and morphological variation. More generally, this effort will advance our understanding of human and canine health.
A Chimeric IDD4 Repressor Constitutively Induces Immunity in Arabidopsis via the Modulation of Salicylic Acid and Jasmonic Acid Homeostasis
Authors: Vï¿½lz Ronny , Kim Soon-Kap , Mi Jianing , Mariappan Kiruthiga G , Siodmak Anna , Al-Babili Salim , Hirt Heribert
Published: April 2019

INDETERMINATE DOMAIN (IDD)/BIRD proteins belong to a highly conserved plant-specific group of transcription factors with dedicated functions in plant physiology and development. Here, we took advantage of the chimeric repressor gene-silencing technology (CRES-T, SRDX) to widen our view on the role of IDD4/IMPERIAL EAGLE and IDD family members in plant immunity. The hypomorphic idd4SRDX lines are compromised in growth and show a robust autoimmune phenotype. Hormonal measurements revealed the concomitant accumulation of salicylic acid and jasmonic acid suggesting that IDDs are involved in regulating the metabolism of these biotic stress hormones. The analysis of immunity-pathways showed enhanced activation of immune MAP kinase-signaling pathways, the accumulation of hydrogen peroxide and spontaneous programmed cell death. The transcriptome of nonelicited idd4SRDX lines can be aligned to approximately 40% of differentially expressed genes (DEGs) in flg22-treated wild-type plants. The pattern of DEGs implies IDDs as pivotal repressors of flg22-dependent gene induction. Infection experiments showed the increased resistance of idd4SRDX lines to Pseudomonas syringae and Botrytis cinerea implying a function of IDDs in defense adaptation to hemibiotrophs and necrotrophs. Genome-wide IDD4 DNA-binding studies (DAP-SEQ) combined with DEG analysis of idd4SRDX lines identified IDD4-regulated functional gene clusters that contribute to plant growth and development. In summary, we discovered that the expression of idd4SRDX activates a wide range of defense-related traits opening up the possibility to apply idd4SRDX as a powerful tool to stimulate innate immunity in engineered crops.
Combination of Suspension Array and Mycelial Growth Assay for Detecting Multiple-Fungicide Resistance in Botrytis cinerea in Hebei Province in China
Authors: Su Zehua , Zhang Xin , Zhao Jianjiang , Wang Wenqiao , Shang Lei , Ma Shengnan , Adzavon Yao Mawulikplimi , Lu Fen , Weng Mantian , Han Xiuying , Yang Lei , Zhao Qinghui , Zhao Pengxiang , Xie Fei , Ma Xuemei
Published: April 2019

To provide a high-throughput, efficient, and accurate method to monitor multiple-fungicide resistance of Botrytis cinerea in the field, we used the suspension array, sequencing, and mycelial growth assay in our research. Discriminating-dose bioassays for detecting carbendazim, diethofencarb, boscalid, and iprodione resistance (CarR, DieR, BosR, and IprR, respectively) were used to analyze 257 isolates collected from Hebei Province in China during 2016 and 2017. High resistance frequencies to carbendazim (100%), diethofencarb (92.08%), and iprodione (86.59%) were detected. BosR isolates accounted for 11.67% of the total. In addition, 103 isolates were randomly selected for phenotype and genotype detection. The high-throughput suspension array was utilized to detect eight genotypes simultaneously, including BenA-E198, BenA-198A, SdhB-H272, SdhB-272Y, BcOS1-I365, BcOS1-365S, erg27-F412, and erg27-412S, which were associated with resistance toward carbendazim or diethofencarb, boscalid, iprodione, and fenhexamid (FenR), respectively. Most of the benzimidazole-resistant isolates (81.55%) possessed the E198V mutation in the BenA gene. Ninety-three isolates with dual resistance to carbendazim and diethofencarb showed the E198V/K mutation. All BosR isolates carried the H272R mutation in the SdhB gene. The I365S and Q369P+N373S (66.99%) mutations in the BcOS1 gene were more frequently observed. No mutation was detected in the erg27 gene in Hebei isolates. There were 13 resistance profile phenotypes. Phenotypes with triple resistance were the most common (83.50%), and CarRDieRBosSIprRFenS was the major type. CarR isolates that carried E198V/K/A were all highly resistant (HR) and only one F200Y mutant was moderately resistant (MR) to carbendazim. Isolates that possessed E198V/K were MR or HR to diethofencarb. BosR isolates that possessed H272R mutation were lowly resistant (LR). IprR isolates were all LR or MR. The distribution of half maximal effective concentrations of CarR isolates with E198V/K mutations and IprR isolates with Q369P+N373S mutations significantly increased from 2016 to 2017. Combined with our observations, a combination method of the high-throughput suspension array and the mycelial growth assay was suggested to accurately monitor multiple resistance of B. cinerea in the field.
Postoperative Bladder Filling After Outpatient Laparoscopic Hysterectomy and Time to Discharge
Authors: Chao Lisa , Mansuria Suketu
Published: April 2019

OBJECTIVE:

To determine whether backfilling the bladder postoperatively will reduce time to discharge in patients undergoing outpatient laparoscopic hysterectomy.

METHODS:

In a single-blind, randomized, controlled trial among women undergoing outpatient laparoscopic hysterectomy, patients were randomly assigned to a backfill-assisted void trial or a trial of spontaneous voiding. The primary outcome was time to discharge assessed by length of time spent in the postanesthesia care unit. Secondary outcomes included time to first spontaneous void, urinary retention rates, and postoperative complications within 8 weeks. We estimated that 152 patients (76/group) would provide greater than 80% power to identify a 30-minute difference in the primary outcome with a SD of 56 minutes and a two-sided α of 0.05.

RESULTS:

Between June 2017 to May 2018, 202 women were screened, 162 women were randomized, and results were analyzed for 153 women. Seventy-five patients (group A) who had a backfill-assisted voiding trial and 78 patients (group B) who had a spontaneous voiding trial were included in the analysis. The mean time to discharge was 273.4 minutes for group A vs 283.2 minutes for group B, which was not found to be significant (P=.45). The mean time to first spontaneous void was 181.1 minutes in group A vs 206.0 minutes in group B. There was a statistically significant reduction of 24.9 minutes in time to first spontaneous void with patients randomized to the backfill group (P=.04). Five of 75 patients (6.7%) in group A and 10 of 78 patients (12.8%) in group B developed urinary retention postoperatively and required recatheterization before discharge, which was also not significant (P=.20).

CONCLUSION:

Bladder filling before removing the Foley catheter is a simple procedure shown to reduce time to first spontaneous void, but not time to discharge in patients undergoing outpatient laparoscopic hysterectomy.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03126162.
Gross and Histologic Anatomy of the Pelvic Ureter
Authors: Jackson Lindsey A. , Ramirez Denise M. O. , Carrick Kelley S. , Pedersen Rebecca , Spirtos Alexandra , Corton Marlene M.
Published: April 2019

OBJECTIVE:

To further evaluate relationships of the pelvic ureter to clinically relevant structures and to characterize the anatomy, histology, and nerve density of the distal ureter.

METHODS:

In this observational cadaveric study, 35 female cadavers were examined, 30 by gross dissections and five microscopically. Ureter length and segments of pelvic ureter were measured. Closest distances between the ureter and clinically relevant points were recorded. The distal pelvic ureter and surrounding parametrium were evaluated microscopically. Nerve density was analyzed using automated quantification of peripheral nerve immunostaining. Average measurements of nerve density in the anterior and posterior quadrants surrounding the ureter were statistically compared using a two-tailed t test. Descriptive statistics were used for analyses with distances reported as mean±SD (range).

RESULTS:

Gross dissections revealed ureter length of 26.3±1.4 (range 24–29) cm (right), 27.6±1.6 (25–30.5) cm (left). Lengths of ureter from pelvic brim to uterine artery crossover were 8.2±1.9 (4.4–11.5) cm (right), 8.5±1.5 (4.5–11.5) cm (left) and from crossover to bladder wall 3.3±0.7 (2.4–5.8) cm (right), 3.2±0.4 (2.6–4.1) cm (left). Intramural ureter length was 1.5±0.3 (1–2.2) cm (right) and 1.7±1.2 (0.8–2.5) cm (left). Distances from the ureter to uterine isthmus: median 1.7 (range 1–3.0) cm (right) and 1.7 (1.0–2.9) cm (left); lateral anterior vaginal fornix 1.5 (1.0–3.1) cm (right) and 1.7 (0.8–3.2) cm (left); lateral vaginal apex 1.3 (1.0–2.6) cm (right) and 1.2 (1.1–2.2) cm (left) were recorded. Microscopy demonstrated denser fibrovascularity posteromedial to the ureter. Peripheral nerve immunostaining revealed greater nerve density posterior to the distal ureter.

CONCLUSION:

Proximity of the ureter to the uterine isthmus and lateral anterior vagina mandates careful surgical technique and identification. The intricacy of tissue surrounding the distal ureter within the parametrium and the increased nerve density along the posterior distal ureter emphasizes the importance of avoiding extensive ureterolysis in this region.
Addressing Obstetrics and Gynecology Trainee Burnout Using a Yoga-Based Wellness Initiative During Dedicated Education Time
Authors: Babbar Shilpa , Renner Kathryn , Williams Karen
Published: April 2019

OBJECTIVE:

To estimate the feasibility of implementing a yoga-based wellness program during training and its influence on burnout, depression, anxiety, stress, and mindfulness among obstetrics and gynecology trainees.

METHODS:

We conducted a departmental quality improvement initiative consisting of weekly 1-hour yoga classes conducted during protected education time and nutrition and physical challenges for 24 obstetrics and gynecology residents and five maternal–fetal medicine fellows. Participants received a free wrist-worn fitness tracker device to record their activity. Preprogram and postprogram data collection included results from validated scales on burnout, mindfulness, depression and anxiety, blood pressure, heart rate, and weight. Wilcoxon signed rank tests were used for analysis. A P-value <.05 was considered significant.

RESULTS:

Over an 8-week period, 90% (n=26) of participants attended at least one yoga class and 68% attended at least 50% of the classes. No participant completed all sessions. Eighty percent (n=20) engaged in at least one nutrition challenge and 60% (n=15) in at least one physical challenge. After the program, a significant reduction in the depersonalization component of burnout (P=.04), anxiety (P=.02), and systolic (preprogram: 122, postprogram: 116 mm Hg; P=.01) and diastolic blood pressure (preprogram: 82, postprogram: 76 mm Hg; P=.01) occurred. Those participants who attended more than 50% of yoga classes demonstrated a significant reduction in systolic and diastolic blood pressure compared with less-frequent attendees (P=.02 and .04, respectively). A postprogram survey revealed feelings of increased camaraderie, appreciation, motivation, and overall training experience.

DISCUSSION:

Implementing a wellness program consisting of weekly yoga classes is feasible and may be beneficial. A wellness initiative that emphasizes active participation during education time with the autonomy to implement daily wellness activities may reduce burnout and improve well-being.
Second Uterine Curettage and the Number of Chemotherapy Courses in Postmolar Gestational Trophoblastic Neoplasia
Authors: Hemida Reda , Vos Elvira L. , El-Deek Basem , Arafa Mohammad , Toson Eman , Burger Curt W. , van Doorn Helena C.
Published: April 2019

OBJECTIVE:

To investigate the effect of second uterine curettage on the number of chemotherapy courses and relapse rate in low-risk postmolar gestational trophoblastic neoplasia.

METHODS:

In a phase III trial, patients with low risk gestational trophoblastic neoplasia were randomised (1:1) to a second curettage or no curettage group before methotrexate treatment. Eligibility criteria were serum human chorionic gonadotropin (hCG) level 5,000 international units/L or less and fit for treatment with methotrexate. Exclusion criteria were previous uterine perforation and life-threatening bleeding. With a two-sided 5% significance level and a power of 99%, a sample size of 44 patients per group was necessary to detect a mean reduction in 2.3 chemotherapy courses. The primary outcome was the number of chemotherapy courses required for hCG normalization. Secondary outcomes were needed for second-line treatment, toxicity, relapse rates, and variables associated with number of chemotherapy courses.

RESULTS:

From October 2011 through February 2016, 89 patients entered the study at the Mansoura Trophoblastic Clinic; in each group, 43 patients were included in the intention‐to‐treat analyses. Surgical complications did not occur. The mean number of chemotherapy courses required to reach hCG normalization was 4.4±2.2 SD in the control group vs 3.8±2.3 SD in the intervention group (P=.14). Groups were comparable in terms of second-line treatment needed to reach hCG normalization, and relapse within the first year. Only hCG levels related to the number of chemotherapy cycles required for hCG normalization.

CONCLUSION:

Second uterine curettage did not reduce the number of chemotherapy courses required or affect relapse rate in patients with low-risk postmolar gestational trophoblastic neoplasia.

CLINICAL TRIALS REGISTRATION:

Dutch Trial Registry, NTR3390.
Implementation of a Pelvic Floor Physical Therapy Program for Transgender Women Undergoing Gender-Affirming Vaginoplasty
Authors: Jiang Da David , Gallagher Sandra , Burchill Laura , Berli Jens , Dugi Daniel
Published: April 2019

OBJECTIVE:

To describe the incidence of pelvic floor dysfunction in transgender women undergoing gender-affirming vaginoplasty and outcomes in a program providing pelvic floor physical therapy (PT).

METHODS:

We conducted a retrospective, single-institution study on vaginoplasty patients between May 1, 2016, and February 28, 2018; all were referred for pelvic floor PT. We reviewed medical records for baseline demographics, medical comorbidities, prior surgeries, insurance data, attendance at pelvic floor PT, and dilation success at 3 and 12 months.

RESULTS:

Seventy-two of 77 patients (94%) attended pelvic floor PT at least once. Preoperative pelvic floor PT identified a high incidence of potential problems: 42% had pelvic floor dysfunction, 37% had bowel dysfunction. Of those patients found to have dysfunction preoperatively, the rate of resolution by the first postoperative visit of pelvic floor and bowel dysfunction were 69% and 73%, respectively. There were significantly lower rates of pelvic floor dysfunction postoperatively for those patients who attended pelvic floor PT both preoperatively and postoperatively compared with only postoperatively (28% vs 86%, P=.006). Patients reporting a history of abuse had a significantly higher rate of preoperative pelvic floor muscle dysfunction (91% vs 31%, P<.001). Successful dilation at 3 months in all patients was 89%.

CONCLUSION:

Pelvic floor physical therapists identify and help patients resolve pelvic floor-related problems before and after surgery. We find strong support for pelvic floor PT for patients undergoing gender-affirming vaginoplasty.
Prediction of the Peripheral Rim Instability of the Discoid Lateral Meniscus in Children by Using Preoperative Clinicoradiological Factors
Authors: Kang Michael Seungcheol , Kim Jong-Min , Park Soo-Sung , Bin Seong-Il
Published: April 2019

Background:

The discoid lateral meniscus (DLM) in children often presents peripheral rim instability (PRI) and is susceptible to tear or subluxation, which manifests symptoms and leads to a poor prognosis. We aimed to investigate the association between preoperative clinical and MRI findings and the intraoperative findings of PRI.

Methods:

Children and adolescents aged younger than 16 years who underwent surgical treatment for DLM were retrospectively reviewed. Cases of bucket-handle tear were not included because they would confound the stability of the peripheral rim. Total 60 knees from 47 children were included. PRI was additionally subdivided based on the location, such as anterior, middle, and posterior, during the investigation.

Results:

In multivariate analyses, both central (inward) (P=0.004) and external (outward) (P=0.029) displacement of lateral meniscal margin, and peripheral tear of the anterior body (P=0.022) were significant predictors of PRI, regardless of the location. The predictive factors for PRI based on each location were female gender (P=0.004), subjective symptom of clicking sound (P=0.023), and central displacement of the anterior meniscal margin (P=0.034) for anterior PRI; flexion contracture >10 degrees (P=0.017) and peripheral tear of the middle body (P<0.001) for middle PRI; and central displacement of the posterior meniscal margin (P=0.036) and peripheral tears of the anterior (P=0.029) and middle bodies (P=0.047) for posterior PRI.

Conclusions:

We evaluated the preoperative clinical and MRI findings that predict PRI of pediatric DLM. Displacements of the DLM, not only centrally (inward) but also externally (outward), seem to be significant predictive factors for PRI. Furthermore, some clinical findings were associated with PRI, even predicting the locations. Although the actual surgical procedure should be determined by meticulous probing during arthroscopy, preoperative prediction of the presence and location of PRI would help decrease the risk of oversight during surgery.

Level of Evidence:

Level III—Diagnostic Study.
Brace Yourselves: Outcomes of Ponseti Casting and Foot Abduction Orthosis Bracing in Idiopathic Congenital Talipes Equinovarus
Authors: Kuzma Alexander L. , Talwalkar Vishwas R. , Muchow Ryan D. , Iwinski Henry J. , Milbrandt Todd A. , Jacobs Cale A. , Walker Janet L.
Published: April 2019

Background:

Foot abduction orthoses (FAO) are believed to decrease recurrence following treatment of congenital talipes equinovarus (CTEV) as described by Ponseti. The purpose of this project is to examine the outcomes of FAO bracing following treatment by the Ponseti method in a cohort of idiopathic CTEV patients.

Methods:

After IRB approval, a cohort of patients aged 3 to 46 days with idiopathic CTEV was identified in a previous prospective study of brace compliance by family report and sensor. Dimeglio score and family demographic information were collected. Initial treatment was by the Ponseti method, with or without Achilles tenotomy. Following correction, patients had three months of full-time FAO bracing during which parents kept a log of compliance. Patients were followed until recurrence (need for further treatment) or age 5.

Results:

In total, 42 patients with 64 affected feet met the above criteria and were included in the final analysis. Twenty-six feet (40%) went on to develop recurrence requiring further treatment, including casting, bracing, or surgery. Because of poor tolerance of the original FAO, 20 feet were transitioned to an alternative FAO, and 14 of these (70%) went on to recur (P<0.01). The casting duration (P=0.02) had a statistically significant relationship to recurrence. Patients who were casted for 9 weeks or more had a higher rate of recurrence (57.1% vs. 27.8%; P=0.02). Age at treatment start, Dimeglio score, demographic factors, and compliance during full-time bracing, whether by report or sensor, did not show a significant relationship with recurrence.

Conclusions:

The study showed a statistically significant relationship between the difficulty of CTEV correction and the risk of recurrent deformity requiring treatment. This relationship could be used to provide prognostic information for patients’ families. Caregiver-reported compliance was not significantly related to recurrence.

Level of Evidence:

Level III—Prognostic Retrospective Cohort Study.
Vascular Supply to the Femoral Head in Patients With Healed Slipped Capital Femoral Epiphysis
Authors: Shore Benjamin J. , Mardam-Bey Sami W. , Kim Young-Jo , Matheney Travis , Novais Eduardo N. , Millis Michael B. , Yen Yi-Meng
Published: April 2019

Background:

Slipped capital femoral epiphysis (SCFE) is one of the most common hip disorders. The vascularity of the lateral epiphyseal vessels supplying the femoral head in patients with healed SCFE has not been well defined. The purpose of this study was to characterize the location and number of lateral epiphyseal vessels in young adults with healed SCFE.

Methods:

This was a retrospective study of 17 patients (18 hips) with a diagnosis of SCFE and a matched control group of 17 patients (17 hips) with developmental dysplasia of the hip. All patients underwent high-resolution contrast-enhanced magnetic resonance imaging to visualize the path of the medial femoral circumflex artery and the lateral epiphyseal arterial branches supplying the femoral head.

Results:

There were 5 unstable SCFEs and 13 stable SCFEs with an average slip angle of 31 degrees. (All patients had been treated with in situ pinning and screw removal). Average age at time of magnetic resonance imaging was 24.5 years (range, 15 to 34 y). The lateral epiphyseal vessels reliably inserted on the posterior-superior aspect of the femoral neck from the superior-anterior to the superior-posterior position in both the SCFE and control groups. An average of 2 (±0.8) retinacular vessels were identified in the SCFE group compared with 5.2 (±0.7) retinacular vessels in the control group (P<0.001).

Conclusions:

In healed SCFE, the lateral epiphyseal vessels reliably insert in the same anatomic region as patients with hip dysplasia; however, the overall number of vessels is significantly lower.