bluuebunny/crossref_metadata_2025 huggingface dataset:
O48 PREOPERATIVE CT IMAGING IN PATIENTS WITH STRANGULATED ABDOMINAL WALL HERNIAS DELAYS SURGERY AND INCREASE RISK OF BOWEL RESECTION: A RETROSPECTIVE RECORD BASED STUDY
Authors: Ibrahim Walid , Magee Conor , Wilson Jeremy
Published: December 2021

Aim

“To investigate whether preoperative CT imaging in acute symptomatic hernia was associated with either surgical delays or increase risks of bowel ischemia and the need for resection.”

Material and Methods

“The data was collected retrospectively for patients who had emergency hernia surgeries in the period between June 2003 till January 2021. We studied the role of preoperative CT scan in delaying surgical intervention and its impaction on intra-operative surgical intervention, postoperative complication, HDU admission and hospital length of stay.”

Results

“Data analysis was performed for 505 patients, 191 had preoperative CT scan. Hernia types included inguinal in 164 patients (32.5%); umbilical in 164 (32.5%); femoral in 69 (13.7%); incisional in 69 (13.7%); epigastric in 30 (5.9%); Spigelian in 9 (1.8%). Preoperative CT scan was associated with surgery delay (22.0 hours vs 13.0 hours, P 9.77e-16). Delayed surgery had an impact on increasing postoperative complications (5.2% vs 3.5%, P 0.4741), longer mean postoperative hospital lengths of stay (9.23 days vs 5.12 days, P 2.2e-16), and increase HDU admission (11.0% vs 4.8%, P 0.01408). Increase bowel resection (12% vs 6.4%, P 0.04032) with surgery delay (20.0 hours vs 12.0 hours, P 0.003448) and also increase omentum resection (7.3% vs 5.4%, P 0.4974) with surgery delay (22.5 hours vs 13.5 hours, P 0.02083) were noted.”

Conclusions

“Pre-operative CT scan for emergent hernias leads to delay in surgical intervention. Surgery delay leads to more aggressive intra-operative intervention and worse postoperative outcomes.”
OV01 A LOW-COST HERNIA MODEL FOR THE TRAINING OF THE SHOULDICE AND THE LICHTENSTEIN INGUINAL HERNIA REPAIR
Authors: Wiggers Theo , Nazari Tahmina
Published: December 2021

Aim

Based on an international European survey, residents prefer to study inguinal hernia repair through lectures or video-demonstrations or want to practice either on simulation or cadaveric models. Simulation models in inguinal hernia are scarce or expensive.

Material and Methods

A low-cost model was developed that can be produced everywhere with the aid of the instruction video: “How to build an inguinal hernia model”. Initially, the model was designed to practice the Lichtenstein technique but after some minor modifications (adding the conjoint tendon, enough slack in the transversalis fascia) it was also possible to practice the Shouldice technique on the same model. It only needs the removal of the stitches of the third and fourth layer before the Lichtenstein can be performed.

Results

The model was used for several studies with students and residents and proved to be realistic and was approved by an international survey among experienced hernia surgeons. It has been used once in a national training session of residents.

Conclusions

The video shows the execution of both procedures on the same model.
OV11 GIANT SPIEGEL HERNIA: 3D PLANNING AND MINIMALLY INVASIVE TREATMENT
Authors: Pardo Sara , Gobbo Rafael Diaz del , Farre Roser , Sanchez Raquel , Guell Merce , Sanchon Lorena , Osorio Alexander , Guariglia Claudio , Collera Pablo
Published: December 2021

Aim

Demonstrate the advantages of 3D technology planning in complex cases of hernia surgery and technical tricks for giant Spiegel hernia repair.

Material and Methods

71 year old patient, BMI 38, asthma, hypertensive; long history of symptomatic left flank mass. Giant Spiegel hernia was diagnosed, with significant omentum and colon migration to hernial cavity. It was decided to perform minimally invasive surgery.  3D model of the abdominal scan was performed, assessing hernia size, volume and its relationship with the abdominal cavity. We were able to rule out the possibility of compartment syndrome, and foresee that we could probably close the defect.

Results

preperitoneal transabdominal repair (TAPP) is performed, beginning with herniated content reduction, a delicate step where injuries should be avoided, with careful traction of the colon and omentum. Hernial defect is assessed, coinciding with the 3D model, the peritoneum sac is reduced, taking as much as possible to facilitate its posterior closure. The entire peritoneum of the Spiegel  and inguinal region are dissected en bloc. Defect tension-free closure is performed with 2 continuous V-LOOK 2.0, subsequent placement of 15x15cm polypropylene mesh and posterior peritoneum closure. The patient is discharged the same day without incidents.

Conclusions

The 3D model allows us to assess the actual abdominal and hernia volume to simulate surgery findings. Its benefits are yet to be developed. Laparoscopic preperitoneal repair is an excellent approach for Spiegel's hernia. Complex cases are also candidates for outpatient surgery.
Radiotherapy regimens for rectal cancer: long-term outcomes and health-related quality of life in the Stockholm III trial
Authors: Erlandsson Johan , Fuentes Stina , Radu Calin , Frödin Jan-Erik , Johansson Hemming , Brandberg Yvonne , Holm Torbjörn , Glimelius Bengt , Martling Anna
Published: December 2021

Background

The Stockholm III trial randomly assigned 840 patients to short-course radiotherapy of 5 × 5 Gy with surgery within 1 week (SRT), short-course radiotherapy of 5 × 5 Gy with surgery after 4–8 weeks (SRT-delay), or long-course radiotherapy of 25 × 2 Gy with surgery after 4–8 weeks (LRT-delay). This study details the long-term oncological outcomes and health-related quality of life (HRQoL).

Methods

Patients with biopsy-proven resectable adenocarcinoma of the rectum were included. Primary outcome was time to local recurrence (LR), and secondary endpoints were distant metastases (DMs), overall survival (OS), recurrence-free survival (RFS), and HRQoL. Patients were analysed in a three-arm randomization and a short-course radiotherapy comparison.

Results

From 1998 to 2013, 357, 355, and 128 patients were randomized to the SRT, SRT-delay, and LRT-delay groups respectively. Median follow-up time was 5.7 (range 5.3–7.6) years. Comparing patients in the three-arm randomization, the incidence of LR was three of 129 patients, four of 128, and seven of 128, and DM 31 of 129 patients, 38 of 128, and 38 of 128 in the SRT, SRT-delay, and LRT-delay groups respectively. In the short-course radiotherapy comparison, the incidence of LR was 11 of 357 patients and 13 of 355, and DM 88 of 357 patients and 82 of 355 in the SRT and SRT-delay groups respectively. No comparisons showed statistically significant differences. Median OS was 8.1 (range 6.9–11.2), 10.3 (range 8.2–12.8), and 10.5 (range 7.0–11.3) years after SRT, SRT-delay, and LRT-delay respectively. Median OS was 8.1 (range 7.2–10.0) years after SRT and 10.2 (range 8.5–11.7) years after SRT-delay. There were no statistically significant differences in HRQoL.

Conclusion

After a follow-up of 5 years, delaying surgery for 4–8 weeks after radiotherapy treatment with 5 × 5 Gy was oncologically safe. Long-term HRQoL was similar among the treatment arms.

Trial registration number

NTC00904813
Aspirin suppresses breast cancer metastasis to lung by targeting anoikis resistance
Authors: Xu Ruijie , Yan Yongheng , Zheng Xu , Zhang Hao , Chen Wei , Li Haitao , Dong Zigang
Published: December 2021

Clinical evidence recently suggests that the regular use of aspirin is associated with a lower risk of breast cancer metastasis, but mechanisms remain unclear. Resistance to anoikis has been implicated in malignant transformation and metastasis. Here, we investigated whether aspirin might prevent breast cancer metastasis to lung by targeting anoikis resistance. Aspirin sensitized breast cancer cells to anoikis in vitro and lowered the circulating tumor cells as well as distant metastasis in vivo. Mechanistically, thromboxane A2 (TXA2) pathway was identified as the relevant molecular target for aspirin in anoikis sensitization. Upon detachment, both thromboxane A2 receptor (TP) and thromboxane A2 synthase 1 (TBXAS1) were up-regulated in metastatic breast cancer cells, conferred anoikis resistance through persistent activation of Akt, thereby facilitated breast cancer metastasis to lung. Consistently, either knockdown of TP in cancer cells or genetic deletion of TP in mice protected against lung metastasis in vivo. Collectively, TXA2 pathway plays a critical role in anoikis resistance and might serve as potential target for chemoprevention of breast cancer metastasis.
Long-term stress and trait anxiety affect brain network balance in dynamic cognitive computations
Authors: Liu Liangying , Wu Jianhui , Geng Haiyang , Liu Chao , Luo Yuejia , Luo Jing , Qin Shaozheng
Published: December 2021

Long-term stress has a profound impact on executive functions. Trait anxiety is recognized as a vulnerable factor accounting for stress-induced adaptive or maladaptive effects. However, the neurocognitive mechanisms underlying long-term stress and trait anxiety interactions remain elusive. Here we investigated how long-term stress and trait anxiety interact to affect dynamic decisions during n-back task performance by altering functional brain network balance. In comparison to controls, participants under long-term stress experienced higher psychological distress and exhibited faster evidence accumulation but had a lower decision-threshold when performing n-back tasks in general. This corresponded with hyper-activation in the anterior insula, less deactivation in the default-mode network, and stronger default-mode network decoupling with the frontoparietal network. Critically, high trait anxiety under long-term stress led to slower evidence accumulation through higher frontoparietal activity during cognitively demanding task, and increased decoupling between the default-mode and frontoparietal networks. Our findings suggest a neurocognitive model of how long-term stress and trait anxiety interplay to affect latent dynamic computations in executive functioning with adaptive and maladaptive changes, and inform personalized assessments and preventions for stress vulnerability.
Piperaquine-Induced QTc Prolongation Decreases With Repeated Monthly Dihydroartemisinin-Piperaquine Dosing in Pregnant Ugandan Women
Authors: Hughes Emma , Wallender Erika , Kajubi Richard , Jagannathan Prasanna , Ochieng Teddy , Kakuru Abel , Kamya Moses R , Clark Tamara D , Rosenthal Philip J , Dorsey Grant , Aweeka Francesca , Savic Radojka M
Published: December 2021

Background

Intermittent preventive treatment with monthly dihydroartemisinin-piperaquine (DHA-PQ) is highly effective at preventing both malaria during pregnancy and placental malaria. Piperaquine prolongs the corrected QT interval (QTc), and it is possible that repeated monthly dosing could lead to progressive QTc prolongation. Intensive characterization of the relationship between piperaquine concentration and QTc interval throughout pregnancy can inform effective, safe prevention guidelines.

Methods

Data were collected from a randomized controlled trial, where pregnant Ugandan women received malaria chemoprevention with monthly DHA-PQ (120/960 mg DHA/PQ; n = 373) or sulfadoxine-pyrimethamine (SP; 1500/75 mg; n = 375) during the second and third trimesters of pregnancy. Monthly trough piperaquine samples were collected throughout pregnancy, and pre- and postdose electrocardiograms were recorded at 20, 28, and 36 weeks’ gestation in each woman. The pharmacokinetics–QTc relationship for piperaquine and QTc for SP were assessed using nonlinear mixed-effects modeling.

Results

A positive linear relationship between piperaquine concentration and Fridericia corrected QTc interval was identified. This relationship progressively decreased from a 4.42 to 3.28 to 2.13 millisecond increase per 100 ng/mL increase in piperaquine concentration at 20, 28, and 36 weeks’ gestation, respectively. Furthermore, 61% (n = 183) of women had a smaller change in QTc at week 36 than week 20. Nine women given DHA-PQ had grade 3–4 cardiac adverse events. SP was not associated with any change in QTc.

Conclusions

Repeated DHA-PQ dosing did not result in increased risk of QTc prolongation and the postdose QTc intervals progressively decreased. Monthly dosing of DHA-PQ in pregnant women carries minimal risk of QTc prolongation.

Clinical Trials Registration

NCT02793622.
Different bisphenols induce non-monotonous changes in miRNA expression and LINE-1 methylation in two cell lines
Authors: Oldenburg Julia , Fürhacker Maria , Hartmann Christina , Steinbichl Philipp , Banaderakhshan Rojin , Haslberger Alexander
Published: December 2021

4,4ʹ-Isopropylidenediphenol (bisphenol A, BPA), a chemical substance that is widely used mainly as a monomer in the production of polycarbonates, in epoxy resins, and in thermal papers, is suspected to cause epigenetic modifications with potentially toxic consequences. Due to its negative health effects, BPA is banned in several products and is replaced by other bisphenols such as bisphenol S and bisphenol F. The present study examined the effects of BPA, bisphenol S, bisphenol F, p,pʹ-oxybisphenol, and the BPA metabolite BPA β-d-glucuronide on the expression of a set of microRNAs (miRNAs) as well as long interspersed nuclear element-1 methylation in human lung fibroblast and Caco-2 cells. The results demonstrated a significant modulation of the expression of different miRNAs in both cell lines including miR-24, miR-155, miR-21, and miR-146a, known for their regulatory functions of cell cycle, metabolism, and inflammation. At concentrations between 0.001 and 10 µg/ml, especially the data of miR-155 and miR-24 displayed non-monotonous and often significant dose–response curves that were U- or bell-shaped for different substances. Additionally, BPA β-d-glucuronide also exerted significant changes in the miRNA expression. miRNA prediction analysis indicated effects on multiple molecular pathways with relevance for toxicity. Besides, long interspersed nuclear element-1 methylation, a marker for the global DNA methylation status, was significantly modulated by two concentrations of BPA and p,pʹ-oxybisphenol. This pilot study suggests that various bisphenols, including BPA β-d-glucuronide, affect epigenetic mechanisms, especially miRNAs. These results should stimulate extended toxicological studies of multiple bisphenols and a potential use of miRNAs as markers.
A very rare complication of subacute pericarditis: a case report of spontaneous coronary artery rupture
Authors: Fujimoto Tomotaka , Yanishi Kenji , Zen Kan , Matoba Satoaki
Published: December 2021

Background

Spontaneous coronary artery rupture (SCAR) is an extremely rare and highly lethal disease.

Case summary

A 74-year-old man who had undergone respiratory surgery (robot-assisted thoracoscopic surgery) presented with exertional dyspnoea since postoperative day (POD) 6. Echocardiography and contrast-enhanced computed tomography showed diffuse pericardial effusion, and a 12-lead electrocardiogram showed widespread concave ST-segment elevation. The diagnosis of acute pericarditis was made based on the absence of significant elevation of cardiac enzymes and the presence of elevated C-reactive peptide levels. The patient was started on anti-inflammatory medication, including steroids; however, on POD 11, the patient developed a sudden cardiopulmonary arrest due to cardiac tamponade. Extracorporeal cardiopulmonary resuscitation was performed, and an emergency coronary angiography showed contrast extravasation from the left anterior descending artery to the epicardium. He was diagnosed with SCAR and underwent transcatheter arterial embolization (TAE) and pericardial drainage.

Discussion

In this case, SCAR occurred during the course of acute pericarditis. We speculated that the cause of SCAR was more affected with pericarditis than injury by the respiratory surgery. The clinical course of acute pericarditis generally has a good prognosis, but the rare occurrence of fatal complications should be considered, suggesting the need for careful follow-up. In addition, TAE was a less invasive and feasible treatment for SCAR.
Demand, Supply And Markup Fluctuations
Authors: Santos Carlos D , Costa Luís F , Brito Paulo B
Published: December 2021

Markup cyclicality has been central for debating policy effectiveness and understanding business cycle fluctuations. However, measuring the cyclicality of markups is as important as understanding the microeconomic mechanisms underlying that cyclicality. The latter requires measurement of firm-level markups and separating supply from demand shocks. We construct a novel dataset with detailed (multi-) product-level prices for individual firms. By estimating a structural model of supply and demand, we evaluate how companies adjust prices and marginal costs as a response to shocks. We find that price markups respond positively to supply shocks and negatively to demand shocks. The mechanism explaining the observed markup behaviour is the same for both shocks: incomplete pass-through of changes along the marginal cost curve to price adjustments. These observed price and output responses are consistent with dynamic demand considerations. Finally, we use our estimated shocks to show how aggregate markup fluctuations in the sample period are mostly explained by aggregate demand shocks.
Personality Traits Across the Life Cycle: Disentangling Age, Period and Cohort Effects*
Authors: Fitzenberger Bernd , Mena Gary , Nimczik Jan , Sunde Uwe
Published: December 2021

Economists increasingly recognise the importance of personality traits for socio-economic outcomes, but little is known about the stability of these traits over the life cycle. Existing empirical contributions typically focus on age patterns and disregard cohort and period influences. This paper contributes novel evidence for the separability of age, period and cohort effects for a broad range of personality traits based on systematic specification tests for disentangling age, period and cohort influences. Our estimates document that, for different cohorts, the evolution of personality traits across the life cycle follows a stable, though non-constant, age profile, while there are sizeable differences across time periods.
Training multilingual English language teachers: challenges for higher education
Authors: van der Walt Christa
Published: December 2021

In South Africa, English is used as a language of learning and teaching for most students from Grade 4 onwards. National policies have requirements for all teachers regarding language proficiency in English, and they also require all teachers from Grades R (pre-school) to 6 to be English language teachers. Because most teachers are not English home language speakers, it is necessary to build academic language proficiency across school subjects along the lines of multilingual content and language integrated learning (MCLIL). National policy documents show little awareness of this and constrain teacher education for multilingual contexts.
Primary care and medication management characteristics among patients receiving office-based opioid treatment with buprenorphine
Authors: Du Cindy Xinxin , Shi Julia , Tetrault Jeanette M , Madden Lynn M , Barry Declan T
Published: December 2021

Background

Office-based opioid treatment (OBOT) is an evidence-based treatment model for opioid use disorder (OUD) offered by both addiction and general primary care providers (PCPs). Calls exist for more PCPs to offer OBOT. Few studies have been conducted on the primary care characteristics of OBOT patients.

Objective

To characterize medical conditions, medications, and treatment outcomes among patients receiving OBOT with buprenorphine for OUD, and to describe differences among patients by age and by time in care.

Methods

This study is a retrospective review of medical records on or before 4/29/2019 at an outpatient primary care clinic within a nonprofit addiction treatment setting. Inclusion criterion was all clinic patients actively enrolled in the OBOT program. Patients not prescribed buprenorphine or with no OBOT visits were excluded.

Results

Of 355 patients, 42.0% had another PCP. Common comorbid conditions included chronic pain and psychiatric diagnosis. Few patients had chronic viral hepatitis or HIV. Patients reported a median of 4 medications. Common medications were cardiovascular, antidepressant, and nonopioid pain agents. Older patients had a higher median number of medications. There was no significant difference in positive opioid urine toxicology (UT) based on age, chronic pain status, or psychoactive medications. Patients retained >1 year were less likely to have positive opioid UT.

Conclusion

Clinical needs of many patients receiving OBOT are similar to those of the general population, supporting calls for PCPs to provide OBOT.
An improved auxin-inducible degron system for fission yeast
Authors: Zhang Xiao-Ran , Zhao Lei , Suo Fang , Gao Yadong , Wu Qingcui , Qi Xiangbing , Du Li-Lin
Published: December 2021

Conditional degron technologies, which allow a protein of interest to be degraded in an inducible manner, are important tools for biological research, and are especially useful for creating conditional loss-of-function mutants of essential genes. The auxin-inducible degron (AID) technology, which utilizes plant auxin signaling components to control protein degradation in nonplant species, is a widely used small-molecular-controlled degradation method in yeasts and animals. However, the currently available AID systems still have room for further optimization. Here, we have improved the AID system for the fission yeast Schizosaccharomyces pombe by optimizing all three components: the AID degron, the small-molecule inducer, and the inducer-responsive F-box protein. We chose a 36-amino-acid sequence of the Arabidopsis IAA17 protein as the degron and employed three tandem copies of it to enhance efficiency. To minimize undesirable side effects of the inducer, we adopted a bulky analog of auxin, 5-adamantyl-IAA, and paired it with the F-box protein OsTIR1 that harbors a mutation (F74A) at the auxin-binding pocket. 5-adamantyl-IAA, when utilized with OsTIR1-F74A, is effective at concentrations thousands of times lower than auxin used in combination with wild-type OsTIR1. We tested our improved AID system on 10 essential genes and achieved inducible lethality for all of them, including ones that could not be effectively inactivated using a previously published AID system. Our improved AID system should facilitate the construction of conditional loss-of-function mutants in fission yeast.
Prediction ability of genome-wide markers in Pinus taeda L. within and between population is affected by relatedness to the training population and trait genetic architecture
Authors: Lauer Edwin , Holland James , Isik Fikret
Published: December 2021

Genomic prediction has the potential to significantly increase the rate of genetic gain in tree breeding programs. In this study, a clonally replicated population (n = 2063) was used to train a genomic prediction model. The model was validated both within the training population and in a separate population (n = 451). The prediction abilities from random (20% vs 80%) cross validation within the training population were 0.56 and 0.78 for height and stem form, respectively. Removal of all full-sib relatives within the training population resulted in ∼50% reduction in their genomic prediction ability for both traits. The average prediction ability for all 451 individual trees was 0.29 for height and 0.57 for stem form. The degree of genetic linkage (full-sib family, half sib family, unrelated) between the training and validation sets had a strong impact on prediction ability for stem form but not for height. A dominant dwarfing allele, the first to be reported in a conifer species, was discovered via genome-wide association studies on linkage Group 5 that conferred a 0.33-m mean height reduction. However, the QTL was family specific. The rapid decay of linkage disequilibrium, large genome size, and inconsistencies in marker-QTL linkage phase suggest that large, diverse training populations are needed for genomic selection in Pinus taeda L.
Gene network simulations provide testable predictions for the molecular domestication syndrome
Authors: Burban Ewen , Tenaillon Maud I , Le Rouzic Arnaud
Published: December 2021

The domestication of plant species leads to repeatable morphological evolution, often referred to as the phenotypic domestication syndrome. Domestication is also associated with important genomic changes, such as the loss of genetic diversity compared with adequately large wild populations, and modifications of gene expression patterns. Here, we explored theoretically the effect of a domestication-like scenario on the evolution of gene regulatory networks. We ran population genetics simulations in which individuals were featured by their genotype (an interaction matrix encoding a gene regulatory network) and their gene expressions, representing the phenotypic level. Our domestication scenario included a population bottleneck and a selection switch mimicking human-mediated directional and canalizing selection, i.e., change in the optimal gene expression level and selection toward more stable expression across environments. We showed that domestication profoundly alters genetic architectures. Based on four examples of plant domestication scenarios, our simulations predict (1) a drop in neutral allelic diversity; (2) a change in gene expression variance that depends upon the domestication scenario; (3) transient maladaptive plasticity; (4) a deep rewiring of the gene regulatory networks, with a trend toward gain of regulatory interactions; and (5) a global increase in the genetic correlations among gene expressions, with a loss of modularity in the resulting coexpression patterns and in the underlying networks. We provide empirically testable predictions on the differences of genetic architectures between wild and domesticated forms. The characterization of such systematic evolutionary changes in the genetic architecture of traits contributes to define a molecular domestication syndrome.
Medical and Social Factors Associated With Referral for Elder Abuse Services in a National Health Care System
Authors: Makaroun Lena K , Thorpe Carolyn T , Mor Maria K , Zhang Hongwei , Lovelace Elijah , Rosen Tony , Dichter Melissa E , Rosland Ann-Marie
Published: December 2021

Background

Elder abuse (EA) is common and has devastating health consequences yet is not systematically assessed or documented in most health systems, limiting efforts to target health care-based interventions. Our objective was to examine sociodemographic and medical characteristics associated with documented referrals for EA assessment or services in a national U.S. health care system.

Methods

We conducted a national case–control study in U.S. Veterans Health Administration facilities of primary care (PC)-engaged Veterans age ≥60 years who were evaluated by social work (SW) for EA-related concerns between 2010 and 2018. Cases were matched 1:5 to controls with a PC visit within 60 days of the matched case SW encounter. We examined the association of patient sociodemographic and health factors with receipt of EA services in unadjusted and adjusted models.

Results

Of 5 567 664 Veterans meeting eligibility criteria during the study period, 15 752 (0.3%) received services for EA (cases). Cases were mean age 74, and 54% unmarried. In adjusted logistic regression models (adjusted odds ratio; 95% confidence interval), age ≥ 85 (3.56 vs age 60–64; 3.24–3.91), female sex (1.96; 1.76–2.21), child as next-of-kin (1.70 vs spouse; 1.57–1.85), lower neighborhood socioeconomic status (1.18 per higher quartile; 1.15–1.21), dementia diagnosis (3.01; 2.77–3.28), and receiving a VA pension (1.34; 1.23–1.46) were associated with receiving EA services.

Conclusion

In the largest cohort of patients receiving EA-related health care services studied to date, this study identified novel factors associated with clinical suspicion of EA that can be used to inform improvements in health care-based EA surveillance and detection.
Billiard Tables with Rotational Symmetry
Authors: Bialy Misha , Tsodikovich Daniel
Published: December 2021

We generalize the following simple geometric fact: the only centrally symmetric convex curve of constant width is a circle. Billiard interpretation of the condition of constant width reads: a planar curve has constant width, if and only if, the Birkhoff billiard map inside the planar curve has a rotational invariant curve of $2$-periodic orbits. We generalize this statement to curves that are invariant under a rotation by angle $\frac {2\pi }{k}$, for which the billiard map has a rotational invariant curve of $k$-periodic orbits. Similar result holds true also for outer billiards and symplectic billiards. Finally, we consider Minkowski billiards inside a unit disc of Minkowski (not necessarily symmetric) norm that is invariant under a linear map of order $k\ge 3$. We find a criterion for the existence of an invariant curve of $k$-periodic orbits. As an application, we get rigidity results for all those billiards.
Genomic characterization of triple-carbapenemase-producing Acinetobacter baumannii
Authors: Oinuma Ken-Ichi , Suzuki Masato , Sakiyama Arata , Tsubouchi Taishi , Saeki Kozo , Sato Kanako , Niki Mamiko , Yamada Koichi , Shibayama Keigo , Kakeya Hiroshi , Kaneko Yukihiro
Published: December 2021

Objectives

To characterize Acinetobacter baumannii OCU_Ac16a, a clinical isolate co-harbouring three acquired carbapenemase genes, blaNDM-1, blaTMB-1, and blaOXA-58, and assess the clinical significance of so-called multiple-carbapenemase producers.

Methods

OCU_Ac16a and its close relative, OCU_Ac16b, which lacks the blaNDM-1, were isolated from sputum cultures of a patient at Osaka City University Hospital. We subjected these strains to whole-genome analysis, particularly focusing on the genetic context of each carbapenemase gene. The transmissibility and functionality of each carbapenemase gene were analysed by conjugation and transformation experiments and antimicrobial susceptibility tests.

Results

bla TMB-1 was located in a class 1 integron on the chromosome, whereas blaNDM-1 and blaOXA-58 were found on plasmids named pOCU_Ac16a_2 and pOCU_Ac16a_3, respectively. pOCU_Ac16a_2 (which exhibited highly efficient self-transmissibility) and pOCU_Ac16a_3 (which did not show transmissibility but could be introduced into another A. baumannii strain via electroporation) could both confer carbapenem resistance (MICs ≥512 and ≥32 mg/L, respectively) on the recipient strain. The functionality of blaTMB-1 was evident from the high resistance of OCU_Ac16b to ceftazidime and cefepime (MICs ≥256 and 48 mg/L, respectively), and the high resistance of OCU_Ac16a to cefiderocol (MIC 32 mg/L) could be explained by the additive effect of blaNDM-1 and blaTMB-1.

Conclusions

Our data revealed the genomic organization of OCU_Ac16a and demonstrated that all the carbapenemase genes are functional, each contributing to the extremely high broad-spectrum resistance of OCU_Ac16a to β-lactams. As multiple-carbapenemase producers can be serious health threats as drug-resistant pathogens and disseminators of carbapenemase genes, close attention should be paid to their emergence.
The Role of Narrative in Environmental Law: The Nature of Tales and Tales of Nature
Authors: Hilson Chris
Published: December 2021

While narrative is a much-used term in environmental law scholarship, it is often used rather indiscriminately and interchangeably with other terms such as framing and discourse. The current article sets out to examine the various ways in which narrative features in the existing literature with a view to encouraging more critical and reflective usage. It also advocates for narrative, both to connect with the marginalised and to inject passion and emotion into environmental law – elements that can easily be lost in a discipline heavy with legislation and case law turning on fine aspects of legal doctrine. However, in the end it argues the need for a careful balance, with narrative and emotion playing a part, but not stealing the show.
Effect of Vegetation Types on Sarcophagidae (Diptera) in Ciervo de los Pantanos National Park, a Natural Remnant in a Highly Endangered Landscape
Authors: Mulieri Pablo R , Dufek Matias I , Dos Santos Josenilson Rodrigues , Torres-Domínguez Diana M , Patitucci Luciano D
Published: December 2021

Species diversity can be affected by the structure of vegetation, which may vary in height, density, and distribution of trees, shrubs, and other plant types, configuring different types of habitats. In this study, we evaluated the diversity of sarcosaprophagous Sarcophagidae communities inhabiting the remnant representative habitats protected in Ciervo de los Pantanos National Park: grasslands, forests, and wetlands. We hypothesized that the abundance and diversity of flesh flies would be higher in the grasslands and wetlands than in the forest patches. Samplings were carried out in each habitat type using baited traps during the four seasons in 2015, 2016, and 2019. We collected 585 sarcophagid flies of 17 species. Fifteen species were recorded in grasslands, twelve in the wetlands, and seven in the forests, Tricharaea (Sarcophagula) occidua (Fabricius) (Diptera: Sarcophagidae) being the most abundant (58.3% of the total sample). As expected, the highest abundance was recorded in grasslands whereas the lowest was found in forests. In addition, flesh fly abundance was affected by season. Sarcophagid assemblages differed between habitats and the overall dissimilarity was mainly explained by nestedness. This study provides important information about sarcosaprophagous sarcophagid flies in a little-studied protected natural area in Argentina, which is fundamental for their conservation and useful in forensic investigations.
Recreational Physical Activity and Outcomes After Breast Cancer in Women at High Familial Risk
Authors: Kehm Rebecca D , MacInnis Robert J , John Esther M , Liao Yuyan , Kurian Allison W , Genkinger Jeanine M , Knight Julia A , Colonna Sarah V , Chung Wendy K , Milne Roger , Zeinomar Nur , Dite Gillian S , Southey Melissa C , Giles Graham G , McLachlan Sue-Anne , Whitaker Kristen D , Friedlander Michael L , Weideman Prue C , Glendon Gord , Nesci Stephanie ,   kConFab Investigators, Phillips Kelly-Anne , Andrulis Irene L , Buys Saundra S , Daly Mary B , Hopper John L , Terry Mary Beth
Published: December 2021

Background

Recreational physical activity (RPA) is associated with improved survival after breast cancer (BC) in average-risk women, but evidence is limited for women who are at increased familial risk because of a BC family history or BRCA1 and BRCA2 pathogenic variants (BRCA1/2 PVs).

Methods

We estimated associations of RPA (self-reported average hours per week within 3 years of BC diagnosis) with all-cause mortality and second BC events (recurrence or new primary) after first invasive BC in women in the Prospective Family Study Cohort (n = 4610, diagnosed 1993-2011, aged 22-79 years at diagnosis). We fitted Cox proportional hazards regression models adjusted for age at diagnosis, demographics, and lifestyle factors. We tested for multiplicative interactions (Wald test statistic for cross-product terms) and additive interactions (relative excess risk due to interaction) by age at diagnosis, body mass index, estrogen receptor status, stage at diagnosis, BRCA1/2 PVs, and familial risk score estimated from multigenerational pedigree data. Statistical tests were 2-sided.

Results

We observed 1212 deaths and 473 second BC events over a median follow-up from study enrollment of 11.0 and 10.5 years, respectively. After adjusting for covariates, RPA (any vs none) was associated with lower all-cause mortality of 16.1% (95% confidence interval [CI] = 2.4% to 27.9%) overall, 11.8% (95% CI = -3.6% to 24.9%) in women without BRCA1/2 PVs, and 47.5% (95% CI = 17.4% to 66.6%) in women with BRCA1/2 PVs (RPA*BRCA1/2 multiplicative interaction P = .005; relative excess risk due to interaction = 0.87, 95% CI = 0.01 to 1.74). RPA was not associated with risk of second BC events.

Conclusion

Findings support that RPA is associated with lower all-cause mortality in women with BC, particularly in women with BRCA1/2 PVs.
Alterations in the RB Pathway With Inactivation of RB1 Characterize Glioblastomas With a Primitive Neuronal Component
Authors: Chkheidze Rati , Raisanen Jack , Gagan Jeffrey , Richardson Timothy E , Pinho Marco C , Raj Karuna , Achilleos Michael , Slepicka Chenelle , White Charles L , Evers Bret M , Patel Toral R , Malter James S , Hatanpaa Kimmo J
Published: December 2021

A primitive neuronal component is a feature of some glioblastomas but defining molecular alterations of this histologic variant remains uncertain. We performed next-generation sequencing of 1500 tumor related genes on tissue from 9 patients with glioblastoma with a primitive component (G/PN) and analyzed 27 similar cases from the Cancer Genome Atlas (TCGA) dataset. Alterations in the RB pathway were identified in all of our patients’ tumors and 81% of TCGA tumors with the retinoblastoma tumor suppressor gene (RB1) commonly affected. Although RB1 mutations were observed in some conventional glioblastomas, the allelic fractions of these mutations were significantly higher in tumors with a primitive neuronal component in both our and TCGA cohorts (median, 72% vs 25%, p < 0.001 and 80% vs 40%, p < 0.02, respectively). Further, in 78% of patients in our cohort, RB expression was lost by immunohistochemistry. Our findings indicate that alterations in the RB pathway are common in G/PNs and suggest that inactivation of RB1 may be a driving mechanism for the phenotype.
Late-stage primary renal angiosarcoma: an extremely rare cancer complicated by COVID-19 post-operatively
Authors: Carr Reilly , Moreland Hannah , Hsia Michael Hsueh-Ching
Published: December 2021

Primary renal angiosarcoma (AS) encompasses only 1% of soft tissue sarcomas, and it is seldom seen in literature. Because of its rarity, few risk factors for its development have been established. Due to lack of screening guidelines for kidney cancer, it is often found late when patients become symptomatic. We present the case of a male patient who presented with gross hematuria and flank pain and was discovered to have a large renal mass. Following successful resection, pathology showed it to be AS. The patient had a post-operative course complicated by two separate COVID-19 infections and expired 200 days after surgery. This case not only highlights an extremely rare renal cancer but also illustrates the challenges patients with complex medical issues faced in the era of COVID-19.
Unilateral nasal obstruction: a rare presentation of acute myeloid leukaemia
Authors: Kelly Mairead , Advani Rajeev , Schuster-Bruce James , Crossley Eleanor , Lakhani Raj
Published: December 2021

Myeloid sarcoma, and, with it, Acute Myeloid Leukaemia (AML), is a rare but important differential diagnosis in the consideration of unilateral nasal blockage. These lesions are often misdiagnosed as lymphoma or poorly differentiated carcinoma. We report the case of a patient with unilateral nasal blockage who underwent Endoscopic Sinus Surgery and biopsy. Histology revealed myeloid sarcoma and she was diagnosed with AML. Genetic testing could not be fully undertaken as the biopsy samples were preserved in formalin, which can degrade the quality of the DNA required for the more sensitive fms-like tyrosine kinase 3-internal tandem duplication (FLT3 ITD) test. Given that these levels have a significant impact on treatment decisions, a further biopsy, preserved in saline, was required. This case exemplifies the need for Ear, Nose and Throat clinicians to have a high index of suspicion for this lesion, and a working knowledge of the testing requirements for samples taken.
General Perspective on the U.S. Military Conflicts in Iraq and Afghanistan After 20 Years
Authors: Peterson Alan L
Published: December 2021

It has been 20 years since the September 11, 2001 terrorist attacks on America. The ongoing military conflicts in this region are the longest sustained conflicts in U.S. history. Almost 3 million military personnel have deployed, with over 7,000 fatalities and more than 53,000 wounded in action. The most common psychological health condition associated with combat deployments is PTSD. No data exist to compare the prevalence of PTSD across war eras. Therefore, a potential proxy for PTSD risk is the number of combat-related deaths, because this figure has been consistently tracked across U.S. military conflicts. This commentary includes a table of death statistics from major military conflicts, which shows that fewer military personnel have deployed, been killed, sustained wounds, and, one might conclude, suffered from PTSD than any other major U.S. military conflict in history. Advances in the military equipment, tactics, and healthcare programs perhaps mitigated casualties and suffering among Iraq/Afghanistan veterans compared to previous wars. The estimated causality differences across various military conflicts are not meant to minimize the significant contributions and sacrifices made by this new generation of military warriors but to help us gain perspective on military conflicts over the past century as we recognize the 20th anniversary of 9/11.
MeerKAT radio detection of the Galactic black hole candidate Swift J1842.5−1124 during its 2020 outburst
Authors: Zhang X , Yu W , Motta S E , Fender R , Woudt P , Miller-Jones J C A , Sivakoff G R
Published: December 2021

Swift J1842.5−1124 is a transient Galactic black hole X-ray binary candidate, which underwent a new outburst in 2020 May. We performed multi-epoch MeerKAT radio observations under the ThunderKAT large survey programme, coordinated with quasi-simultaneous Swift/XRT X-ray observations during the outburst, which lasted nearly a month. We were able to make the first-ever radio detection of this black hole binary with the highest flux density of 229 ± 31 $\mu$Jy when the source was in the hard state, after non-detection in the radio band in the soft state which occurred immediately after its emergence during the new X-ray outburst. Therefore, its radio and X-ray properties are consistent with the disc-jet coupling picture established in other black hole X-ray binaries. We place the source’s quasi-simultaneous X-ray and radio measurements on the radio/X-ray luminosity correlation plane; two quasi-simultaneous radio/X-ray measurements separated by 11 d were obtained, which span ∼2 dex in the X-ray luminosity. If the source follows the black hole track in the radio/X-ray correlation plane during the outburst, it would lie at a distance beyond ∼5 kpc.
Extragalactic magnetic field constraints from ultrahigh-energy cosmic rays from local galaxies
Authors: van Vliet Arjen , Palladino Andrea , Taylor Andrew , Winter Walter
Published: December 2021

We interpret the correlation between local star-forming galaxy positions and ultrahigh-energy cosmic-ray (UHECR) directions, recently detected by the Pierre Auger Observatory (PAO), in terms of physical parameters: the local density of sources and the magnetic fields governing the UHECR propagation. We include a Galactic magnetic field model on top of a random extragalactic magnetic field description to determine the level of UHECR deflections expected from an ensemble of source positions. Besides deflections in magnetic fields, we also take into account energy losses with background photon fields as well as spectrum and composition measurements by the PAO. We find consistency between the PAO anisotropy measurement and the local star-forming galaxy density for large extragalactic magnetic field strengths with $B \gt 0.2 \ \rm nG$ (for a coherence length of $1 \ \rm Mpc$) at the 5σ confidence level. Larger source densities lead to more isotropic background and consequently allow for weaker extragalactic magnetic fields. However, the acceleration of UHECR by such abundant sources is more challenging to motivate. Too large source densities and extragalactic magnetic field strengths, on the other hand, are also disfavoured as that decreases the expected level of anisotropy. This leads to upper limits of $B \lt 22 \ \rm nG$ and $\rho _0 \lt 8.4 \times 10^{-2} \ \rm Mpc^{-3}$ at the 90 per cent confidence level.
Modelling emission lines in star-forming galaxies
Authors: Baugh C M , Lacey Cedric G , Gonzalez-Perez Violeta , Manzoni Giorgio
Published: December 2021

We present a new model to compute the luminosity of emission lines in star-forming galaxies and apply this in the semi-analytical galaxy formation code galform. The model combines a pre-computed grid of H II region models with an empirical determination of how the properties of H II regions depend on the macroscopic properties of galaxies based on observations of local galaxies. The new model gives a very good reproduction of the locus of star-forming galaxies on standard line ratio diagnostic diagrams. The new model shows evolution in the locus of star-forming galaxies with redshift on this line ratio diagram, with a good match to the observed line ratios at z = 1.6. The model galaxies at high redshift have gas densities and ionisation parameters that are predicted to be ≈2–3 times higher than in local star-forming galaxies, which is partly driven by the changing selection with redshift to mimic the observational selection. Our results suggest that the observed evolution in emission line ratios requires other H II region properties to evolve with redshift, such as the gas density, and cannot be reproduced by H II model grids that only allow the gas metallicity and ionisation parameter to vary.
A 2+1 + 1 quadruple star system containing the most eccentric, low-mass, short-period, eclipsing binary known
Authors: Han E , Rappaport S A , Vanderburg A , Tofflemire B M , Borkovits T , Schwengeler H M , Zasche P , Krolikowski D M , Muirhead P S , Kristiansen M H , Terentev I A , Omohundro M , Gagliano R , Jacobs T , LaCourse D
Published: December 2021

We present an analysis of a newly discovered 2+1 + 1 quadruple system with TESS containing an unresolved eclipsing binary (EB) as part of TIC 121088960 and a close neighbour TIC 121088959. The EB consists of two very low-mass M dwarfs in a highly eccentric (e  = 0.709) short-period (P  = 3.043 58 d) orbit. Given the large pixel size of TESS and the small separation (3${_{.}^{\prime\prime}}$9) between TIC 121088959 and TIC 121088960 we used light centroid analysis of the difference image between in-eclipse and out-of-eclipse data to show that the EB likely resides in TIC 121088960, but contributes only ∼10 per cent of its light. Radial velocity data were acquired with iSHELL at NASA’s Infrared Facility and the Coudé spectrograph at the McDonald 2.7-m telescope. For both images, the measured RVs showed no variation over the 11 d observational baseline, and the RV difference between the two images was 8 ± 0.3 km s−1. The similar distances and proper motions of the two images indicate that TIC 121088959 and TIC 121088960 are a gravitationally bound pair. Gaia’s large RUWE and astrometric_excess_noise parameters for TIC 121088960, further indicate that this image is the likely host of the unresolved EB and is itself a triple star. We carried out an SED analysis and calculated stellar masses for the four stars, all of which are in the M dwarf regime: 0.19 M⊙ and 0.14 M⊙ for the EB stars and 0.43 M⊙ and 0.39 M⊙ for the brighter visible stars, respectively. Lastly, numerical simulations show that the orbital period of the inner triple is likely the range 1–50 yr.