bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of a cry1Ab Gene for Control of Maruca vitrata (Lepidoptera: Crambidae) in Cowpea (Fabales: Fabaceae)
Authors: Addae Prince C , Ishiyaku Mohammad F , Tignegre Jean-Batiste , Ba Malick N , Bationo Joseph B , Atokple Ibrahim D K , Abudulai Mumuni , Dabiré-Binso Clémentine L , Traore Fousséni , Saba Mohammed , Umar Muhammed L , Adazebra Gloria A , Onyekachi Francis N , Nemeth Margaret A , Huesing Joseph E , Beach Larry R , Higgins Thomas J V , Hellmich Richard L , Pittendrigh Barry R
Published: December 2019

Cowpea [Vigna unguiculata (L) Walp.] is an important staple legume in the diet of many households in sub-Saharan Africa. Its production, however, is negatively impacted by many insect pests including bean pod borer, Maruca vitrata F., which can cause 20–80% yield loss. Several genetically engineered cowpea events that contain a cry1Ab gene from Bacillus thuringiensis (Bt) for resistance against M. vitrata were evaluated in Nigeria, Burkina Faso, and Ghana (West Africa), where cowpea is commonly grown. As part of the regulatory safety package, these efficacy data were developed and evaluated by in-country scientists. The Bt-cowpea lines were planted in confined field trials under Insect-proof netting and artificially infested with up to 500 M. vitrata larvae per plant during bud formation and flowering periods. Bt-cowpea lines provided nearly complete pod and seed protection and in most cases resulted in significantly increased seed yield over non-Bt control lines. An integrated pest management strategy that includes use of Bt-cowpea augmented with minimal insecticide treatment for protection against other insects is recommended to control pod borer to enhance cowpea production. The insect resistance management plan is based on the high-dose refuge strategy where non-Bt-cowpea and natural refuges are expected to provide M. vitrata susceptible to Cry1Ab protein. In addition, there will be a limited release of this product until a two-toxin cowpea pyramid is released. Other than South African genetically engineered crops, Bt-cowpea is the first genetically engineered food crop developed by the public sector and approved for release in sub-Saharan Africa.
Delhi High Court orders global removal of defamatory content on consideration of inappropriateness of sole geo-blocking
Authors: Kumaresan Mathangi
Published: December 2019

Swami Ramdev and Another v Facebook, Inc and Others (2019) 263 DLT 689

The Delhi High Court has recently ordered the global removal of defamatory content by social media platforms and ruled that geo-blocking would not be a valid alternative.
Morphometric analysis of skull shape reveals unprecedented diversity of African Canidae
Authors: Machado Fabio Andrade , Teta Pablo
Published: December 2019

We conducted a geometric morphometric analysis to investigate the morphological variation of the golden wolf, Canis lupaster, and to clarify the morphological and taxonomic affinities of different taxa of the genera Canis and Lupulella. We suggest that the variation observed within the complex of Canis lupaster may be incompatible with what would be expected for a single species. We hypothesize that the nominal form C. l. soudanicus is a synonym of Lupulella adusta rather than being part of the golden wolf complex. The subspecies C. l. bea has a generalized jackal morphology (i.e., clusters together with L. mesomelas and C. aureus) and C. l. lupaster occupies an intermediate morphospace position, between jackal-like forms and wolf-like forms. These results contrast with previously published molecular analysis in which mitochondrial data failed to identify differences among golden wolf populations, and nuclear evidence points to the existence of groups that are incompatible with those recovered by morphological analysis. Regarding other jackals, our results depict the absence of morphological overlap between L. m. mesomelas and L. m. schmidti and no differences between putative subspecies of L. adusta. We call attention to the need for more integrative approaches to solve the taxonomic questions in various African Canidae.
A chromatin scaffold for DNA damage recognition: how histone methyltransferases prime nucleosomes for repair of ultraviolet light-induced lesions
Authors: Gsell Corina , Richly Holger , Coin Frédéric , Naegeli Hanspeter
Published: December 2019

The excision of mutagenic DNA adducts by the nucleotide excision repair (NER) pathway is essential for genome stability, which is key to avoiding genetic diseases, premature aging, cancer and neurologic disorders. Due to the need to process an extraordinarily high damage density embedded in the nucleosome landscape of chromatin, NER activity provides a unique functional caliper to understand how histone modifiers modulate DNA damage responses. At least three distinct lysine methyltransferases (KMTs) targeting histones have been shown to facilitate the detection of ultraviolet (UV) light-induced DNA lesions in the difficult to access DNA wrapped around histones in nucleosomes. By methylating core histones, these KMTs generate docking sites for DNA damage recognition factors before the chromatin structure is ultimately relaxed and the offending lesions are effectively excised. In view of their function in priming nucleosomes for DNA repair, mutations of genes coding for these KMTs are expected to cause the accumulation of DNA damage promoting cancer and other chronic diseases. Research on the question of how KMTs modulate DNA repair might pave the way to the development of pharmacologic agents for novel therapeutic strategies.
Side-to-Side Superficial Temporal Artery to Middle Cerebral Artery Bypass Technique: Application of Fourth Generation Bypass in a Case of Adult Moyamoya Disease
Authors: Lang Michael J , Kan Peter , Baranoski Jacob F , Lawton Michael T
Published: December 2019

BACKGROUND

Moyamoya disease (MMD) is a rare cause of cerebral hemorrhage and ischemia. Spontaneous development of collateral supply from the external carotid artery (ECA) may limit the use of donor arteries used in standard direct bypass techniques.

OBJECTIVE

To identify the technical feasibility of side-to-side (S-S) superficial temporal artery to middle cerebral artery (STA-MCA) bypass and demonstrate the application of fourth generational bypass techniques in the treatment of MMD.

METHODS

S-S bypass was performed in order to maintain distal outflow in the donor STA. Fourth generation bypass techniques, including atypical anastomosis construction and intraluminal suturing were utilized.

RESULTS

The novel S-S STA-MCA bypass was performed, with patent flow in both recipient MCA and endogenous ECA-ICA collaterals supplied by the distal STA. Technical nuances, including proper alignment of donor vessel, tension reduction, and S-S anastomosis construction with intraluminal suturing technique are essential for successful bypass. Unique flow properties of this bypass were identified, resulting in flow augmentation to the recipient territory compared to standard end-to-side (E-S) techniques.

CONCLUSION

Fourth generational bypass techniques can be successfully applied to MMD, allowing for novel bypass construction. S-S anastomosis can result in potentially beneficial flow properties compared to standard E-S constructions.
Lumbar 3–Lumbar 5 Robotic-Assisted Endoscopic Transforaminal Lumbar Interbody Fusion: 2-Dimensional Operative Video
Authors: Liounakos Jason I , Wang Michael Y
Published: December 2019

Minimally invasive spine surgery has the potential to reduce soft tissue destruction, blood loss, postoperative pain, and overall perioperative morbidity while accelerating recovery. Robotic guidance systems are relatively new tools in the minimally invasive surgeon's armamentarium, striving to increase accuracy of instrumentation placement, decrease complications, reduce radiation burden, and enhance surgical ergonomics in order to improve efficiency and maximize patient outcomes. We present the case of a 78-yr-old male with intractable lower back and bilateral lower extremity pain with multilevel degenerative spondylosis. The procedure performed was a L3-5 robotic-assisted endoscopic transforaminal lumbar interbody fusion (TLIF) utilizing the Mazor X robotic guidance system (Medtronic) for both percutaneous pedicle screw placement, as well as trajectory localization for endoscopic discectomy and percutaneous interbody delivery. Previously, clinical and radiographic success has been published regarding the awake, endoscopic TLIF.
1
We document the first use of robotic guidance for disc space localization and its combination with endoscopy to achieve interbody fusion, utilizing an expandable, allograft-filled mesh interbody device.
2
This video demonstrates appropriate patient positioning, work flow for this unique technique, and the benefits of using robotic guidance to plan and execute percutaneous trajectories through Kambin's triangle. This procedure involves the off-label use of recombinant human bone morphogenetic protein-2 (Infuse™, Medtronic), OptiMesh® graft containment device (Spineology), and liposomal bupivacaine (Exparel®, Pacira).
Patients’ Experiences with Telecare for Chronic Pain and Mood Symptoms: A Qualitative Study
Authors: Matthias Marianne S , Evans Erica , Porter Brian , McCalley Stephanie , Kroenke Kurt
Published: December 2019

Objective

Pain, anxiety, and depression commonly co-occur, can have reciprocal effects, and are associated with substantial disability and health care costs. However, few interventions target treatment of pain and mood disorders as a whole. The Comprehensive vs. Assisted Management of Mood and Pain Symptoms (CAMMPS) trial was a randomized trial comparing two pragmatic telecare interventions, a high- vs low-resource approach to pain and anxiety/depression treatment. The purpose of the current study is to better understand patients’ perspectives on both intervention approaches, including intervention components, delivery, patient experiences, and patient outcomes.

Design

Qualitative, semistructured interviews.

Setting

A Veterans Affairs Medical Center.

Subjects

Twenty-five patients were purposefully sampled from both study arms.

Methods

Patients were interviewed about their experiences with pain and mood treatment, perceived benefits and changes, and experiences with the intervention model to which they were randomized. The constant comparison method guided analysis.

Results

Pain was more important than mood for most participants. Participants described developing increased awareness of their symptoms, including connecting pain and mood, which enabled better management. Participants in the high-resource intervention described the added value of the study nurse in their symptom management.

Conclusions

Patients in a telecare intervention for chronic pain and mood symptoms learned to connect pain and mood and be more aware of their symptoms, enabling more effective symptom management. Patients in the high-resource intervention described the added benefits of a nurse who provided informational and motivational support. Implications for tradeoffs between resource intensity and patient outcomes are discussed.
NUMBER OF PRIME FACTORS OVER ARITHMETIC PROGRESSIONS
Authors: Meng Xianchang
Published: December 2019

Numerical experiments suggest that there are more prime factors in certain arithmetic progressions than others. Greg Martin conjectured that the function $\sum _{n\leq x, n\equiv 1 \bmod 4} \omega (n)-\sum _{n\leq x, n\equiv 3 \bmod 4} \omega (n)$ will attain a constant sign as $x\rightarrow \infty $, where $\omega (n)$ is the number of distinct prime factors of $n$. In this paper, we prove explicit formulas for both $\sum _{n\leq x}\chi (n)\Omega (n)$ and $\sum _{n\leq x}\chi (n)\omega (n)$ under some reasonable assumptions, where $\chi (n)$ is a Dirichlet character and $\Omega (n)$ is the number of prime factors of $n$ counted with multiplicity. Our results give strong evidence for Martin’s conjecture.
A LESSON FROM AUTOMATIC TUBE VOLTAGE SELECTION: FEASIBILITY OF 100 kVp IN PORTAL VENOUS PHASE ABDOMINAL CT
Authors: Choi Moon Hyung , Lee Young Joon , Jung Seung Eun
Published: December 2019

Purpose: To evaluate the relationship between ATVS-recommended tube voltage and patient body habitus and to compare radiation dose and diagnostic performance between fixed 120-kVp and ATVS protocols in portal venous phase abdomen CT. Methods: A total of 907 portal venous phase abdominal CTs were evaluated. Radiation dose in the ATVS protocol was compared according to tube voltage (80, 100 or 120 kVp). Quantitative image analysis and diagnostic performance were compared between 81 pairs of CT using ATVS and fixed 120-kVp protocols. Results: Most CT examinations with ATVS were performed with 80 or 100 kVp. The average reduction rate of radiation dose in the ATVS protocol was 15.4%. There was no significant difference in diagnostic performance (p = 0.388) between ATVS and fixed 120-kVp protocols. Conclusions: In conclusion, ATVS frequently selected 80 or 100 kVp for portal venous phase abdominal CT without impairing the diagnostic performance, even with filtered back projection.
Variability in Discharge Disposition Across US Trauma Centers After Treatment for High-Energy Lower Extremity Injuries
Authors: Gitajn Ida L. , Reider Lisa , Scharfstein Daniel O. , O'Toole Robert V. , Bosse Michael J. , Castillo Renan C. , Jevsevar David S. , Pollak Andrew N. ,   on behalf of METRC
Published: December 2019

Objective:

To evaluate the association between patient- and center-level characteristics and discharge to an inpatient facility versus home after treatment for lower extremity trauma, as well as examine the variability in discharge disposition across clinical centers after controlling for these factors.

Design:

This is an analysis of data collected prospectively across 5 multicenter studies of extremity trauma.

Setting:

US Trauma Centers.

Participants:

Patients 18–80 years with lower extremity trauma treated at 1 of 55 participating centers.

Main Outcome Measure:

Discharge disposition.

Results:

Among 2365 patients treated at 1 of 55 centers across 13 states, 673 (28.5%) were discharged to an inpatient facility, and 1692 (71.5%) were discharged home. Individuals who were older, female, unmarried, insured, higher body mass index, history of severe alcohol abuse, Gustilo type IIIB or IIIC open injuries, bilateral, spine and upper extremity injuries, higher injury severity score scores, or intensive care unit stay were more likely to be discharged to an inpatient facility. Even after accounting for patient- and center-level characteristics, there was substantial variation in discharge disposition across centers (likelihood ratio test: P < 0.001).

Conclusion:

Variation in discharge disposition may represent a potential for improvement in resource utilization and cost savings. Further studies are needed to examine the relationship between utilization of postdischarge inpatient facility after trauma and outcomes.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Dual Mini-Fragment Plating Is Comparable With Precontoured Small Fragment Plating for Operative Diaphyseal Clavicle Fractures: A Retrospective Cohort Study
Authors: DeBaun Malcolm R. , Chen Michael J. , Campbell Sean T. , Goodnough L. Henry , Lai Cara , Salazar Brett P. , Bishop Julius A. , Gardner Michael J.
Published: December 2019

Objectives:

To compare precontoured (Pc) small fragment plating to dual mini-fragment plating (DmF) for open reduction and internal fixation of diaphyseal clavicle fractures.

Design:

Retrospective cohort.

Setting:

Level 1 trauma center.

Patients/Participants:

A total of 133 patients with displaced fractures of the diaphyseal clavicle (OTA/AO 15-B1, -2, and -3) treated with open reduction and internal fixation with a minimum of 1 year follow-up or until radiographic and clinical union.

Intervention:

Two patient cohorts were identified: (1) patients treated with orthogonal DmF plate constructs and (2) patients treated with Pc clavicle-specific plates.

Outcome Measurements:

Union rate and implant removal were assessed using standard descriptive statistics. Odds ratios, 95% confidence intervals, and P values (P) were calculated.

Results:

There were 60 DmF and 74 Pc patients. There were no significant differences between groups with respect to age, sex, surgeon, body mass index, or mode of fixation. There was no significant difference in union (98.3% DmF; 100% Pc, P = 0.45) or maintenance of reduction (98.3% DmF; 100% Pc, P = 0.45). A total of 8% of DmF patients had symptomatic implant removal compared with 20% of Pc patients (odds ratio 0.36, confidence interval 0.12–1.05, P = 0.061).

Conclusions:

This retrospective comparative study found no difference in union or maintenance of reduction for diaphyseal clavicle fractures fixed with DmF compared with Pc plating. Patients treated with DmF plates may have lower rates of symptomatic implant removal.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Protocol on transcranial alternating current stimulation for the treatment of major depressive disorder: a randomized controlled trial
Authors: Wang Hong-Xing , Wang Kun , Zhang Wen-Rui , Zhao Wen-Feng , Yang Xiao-Tong , Wang Li , Peng Mao , Sun Zhi-Chao , Xue Qing , Jia Yu , Li Ning , Dong Kai , Zhang Qian , Zhan Shu-Qin , Min Bao-Quan , Fan Chun-Qiu , Zhou Ai-Hong , Song Hai-Qing , Yin Lu , Si Tian-Mei , Huang Jing , Lu Jie , Leng Hai-Xia , Ding Wei-Jun , Liu Yuan , Yan Tian-Yi , Wang Yu-Ping
Published: December 2019

Background:

Transcranial alternating current stimulation (tACS) offers a new approach for adult patients with major depressive disorder (MDD). The study is to evaluate the efficacy and safety of tACS treating MDD.

Methods:

This is an 8-week, double-blind, randomized, placebo-controlled study. Ninety-two drug-naive patients with MDD aged 18 to 65 years will receive 20 daily 40-min, 77.5-Hz, 15-mA sessions of active or sham tACS targeting the forehead and both mastoid areas on weekdays for 4 consecutive weeks (week 4), following a 4-week observation period (week 8). The primary outcome is the remission rate defined as the 17-item Hamilton depression rating scale (HDRS-17) score ≤7 at week 8. Secondary outcomes are the rates of response at weeks 4 and 8 and rate of remission at week 4 based on HDRS-17, the proportion of participants having improvement in the clinical global impression-improvement, the change in HDRS-17 score (range, 0–52, with higher scores indicating more depression) over the study, and variations of brain imaging and neurocognition from baseline to week 4. Safety will be assessed by vital signs at weeks 4 and 8, and adverse events will be collected during the entire study.

Discussion:

The tACS applied in this trial may have treatment effects on MDD with minimal side effects.

Trial registration:

Chinese Clinical Trial Registry, ChiCTR1800016479; http://www.chictr.org.cn/showproj.aspx?proj=22048.
Severe Hypoglycemia and Risk of Subsequent Cardiovascular Events: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Malik Aaqib H. , Yandrapalli Srikanth , Aronow Wilbert S. , Jain Diwakar , Frishman William H. , Panza Julio A. , Cooper Howard A.
Published: December 2019

Intensive glycemic control significantly increases the risk of hypoglycemia in patients with diabetes mellitus. Recent data have shown that hypoglycemia may also be a marker of cardiovascular disease in these patients. We performed a systemic review and a meta-analysis to evaluate the relationship between severe hypoglycemic events (SHEs) and the subsequent risk of mortality and major adverse cardiovascular events (MACE) in patients with diabetes mellitus. PubMed, Cochrane library, and Embase were searched for randomized controlled trials between January 2006 and December 17, 2018 that reported cardiovascular outcomes in diabetic patients with a history of SHEs. The primary outcomes of interest were all-cause mortality, cardiovascular mortality, and MACE. Other outcomes assessed included myocardial infarction and hospitalization for unstable angina or heart failure. Data from 9 RCTs and 3,462 randomized patients were available. Patients who suffered an SHE were found to have a significantly increased risk of subsequent all-cause mortality (hazard ratio [HR] 2.24; 95% confidence interval [CI] 1.70, 2.95; P-value <0.01), cardiovascular mortality (HR 2.32; 95% CI 1.67, 3.22; P-value <0.01), and MACE (HR 1.66; 95% CI 1.35, 2.06; P-value <0.01) compared to the patients without an SHE. The increased risks of subsequent stroke and arrhythmic death (P-value<0.05) were also found. There was no significant association between SHE and the risk of subsequent myocardial infarction or hospitalization for unstable angina or heart failure. In conclusion, the occurrence of an SHE in patients with diabetes mellitus was associated with a significantly increased risk for subsequent cardiovascular morbidity and mortality.
Primary Aldosteronism
Authors: Pillai Padma Raghavan , Griffith Mindy , Schwarcz Monica D. , Weiss Irene A.
Published: December 2019

Primary aldosteronism remains a leading cause of secondary hypertension, and its diagnosis and management continue to pose a challenge for clinicians. In this article, we review the diagnosis of primary aldosteronism along with its cardiovascular manifestations. Treatment is described depending on the diagnostic outcome, focusing on medical management with mineralocorticoid receptor antagonists and unilateral adrenalectomy. Although screening and diagnosing hyperaldosteronism follows well-known algorithms, in practice, physicians may find difficulty establishing the best course of action due to complexity in testing and confirming laterality of aldosterone production by the adrenals. Recognizing and treating primary aldosteronism requires a multidisciplinary approach with primary care physicians, cardiologists, endocrinologists, and radiologists working collaboratively.
Role of NFATc1 in the Bone-Vascular Axis Calcification Paradox
Authors: Gu Wen , Wang Zhongqun , Sun Zhen , Bao Zhengyang , Zhang Lili , Geng Yue , Jing Lele , Mao Xiang , Li Lihua
Published: December 2019

Nuclear factor of activated T cell cytoplasmic 1 (NFATc1), a crucial member of the transcription factor NFAT family, is indispensable in the immune system and the morphogenesis of cardiac valves and septa and is also vital in osteoclasts and atherosclerotic calcification. Currently, osteoporosis and vascular diseases are severely hazardous to health and quality of life, and the 2 conditions always coincide with each other. The bone-vascular axis calcification paradox serves as a bridge between bone and vascular diseases, linking these 2 seemingly separate diseases, and the receptor activator of NF-κB (RANK)/receptor activator of nuclear factor kappa-B ligand (RANKL)/osteoprotegerin (OPG) system may be the common mechanism of the bone-vascular axis calcification paradox. NFATc1 provides a new therapeutic target for bone and vascular diseases. However, the specific mechanism by which NFATc1 acts on the bone-vascular axis calcification paradox, whether NFATc1 is related to the RANK/RANKL/OPG system, and how to use NFATc1 as a therapeutic target to avoid its side effects in other systems requires further study.
Restoration of Adiponectin-Connexin43 Signaling Mitigates Myocardial Inflammation and Dysfunction in Diabetic Female Rats
Authors: Leffler Korin E. , Abdel-Rahman Abdel A.
Published: December 2019

ur preclinical findings replicated women's hypersensitivity to type-2 diabetes mellitus (T2DM)-evoked cardiac dysfunction along with demonstrating estrogen (E2)-dependent disruption of the cardiac adiponectin (APN)-connexin43 (Cx43) signaling. Whether the latter molecular anomaly underlies this women's cardiovascular health problem remains unknown. We hypothesized that restoration of the disrupted APN-Cx43 signaling alleviates this sex/E2-dependent cardiac dysfunction in diabetic female rats. To test this hypothesis, we administered the adiponectin receptor 1 (AdipoR1) agonist AdipoRon (30 mg/kg/d for 10 days) to female sham operated (SO) and ovariectomized (OVX) rats, which exhibited and lacked the T2DM left ventricular (LV) dysfunction, respectively, when fed high-fat diet and received low dose streptozotocin regimen; nondiabetic control SO and OVX rats received control diet and vehicle for streptozotocin. In T2DM SO rats, LV dysfunction, AdipoRon mitigated: (1) LV hypertrophy, (2) reductions in fractional shortening, LV developed pressure, dP/dtmax, dP/dtmin, and Tau. In LV tissues of the same rats, AdipoRon reversed reduction in Cx43 and elevations in TNFα, heme-oxygenase 1 (HO-1), and circulating cardiovascular risk factor asymmetric dimethylarginine. The findings also revealed ovarian hormones independent effects of AdipoRon, which included dampening of the pro-oxidant enzyme HO-1. These novel findings yield new insight into a causal role for compromised APN-Cx43 signaling in the E2-dependent hypersensitivity to T2DM-evoked cardiac inflammation and dysfunction. Equally important, the findings identify restoration of Cx43 signaling as a viable therapeutic modality for alleviating this women's cardiovascular health-related problem.
Adenocarcinoma Arising in the Conjunctiva With Periparotid Lymph Node Metastases
Authors: Mazzini Cinzia , Pieretti Giulia , Vicini Giulio , Nicolosi Cristina , Spinelli Giuseppe , Maio Vincenza , Portelli Francesca
Published: December 2019

Purpose:

To report a rare case of adenocarcinoma (ADC) arising in the conjunctiva which locally recurred and metastasized to the periparotid lymph nodes.

Methods:

This is a single observational case report.

Results:

A 79-year-old male patient was referred to us for a suspected recurrence of conjunctival carcinoma of the right eye. At presentation, we observed an elevated conjunctival lesion with corneal involvement. He was treated with neoadjuvant mitomycin C 0.04% eye drops, followed by surgical excision of the lesion, cryotherapy of the excision margins, and reconstruction with amniotic membrane graft. The tumor was histologically diagnosed as ADC. The negative systemic evaluation and the immunoprofile led us to believe the primitive nature of the tumor. The excision margins were positive, and the patient was lost to follow up for 7 months, and when he came back, a new local recurrence was diagnosed. Then, he received rescue treatment with mitomycin C 0.04% eye drops with complete regression of the lesion. No local recurrence was observed until the 14-month follow-up visit, during which the patient complained of swelling in the right parotid region. Subsequently, he underwent total parotidectomy with neck dissection. Metastasis was found in 3 periparotid lymph nodes. The patient did not receive further treatments, and no recurrences were observed over the following 20 months.

Conclusions:

ADC arising in the conjunctiva is a very rare occurrence. Additional observation is required for the management of this rare conjunctival tumor.
Changing in a GIF (Graphics Interchange Format): Innovations in Before and After Photography
Authors: Akella Sruti S. , Goldstein Tova , Kumar Shaina , Patel Parth , Heo Moonseong , Barmettler Anne
Published: December 2019

Purpose:

Before and after images are an important part of aesthetic counseling, but no studies have examined ways to optimize change detection through the layout of displayed images. This study compares 3 different image layouts to determine which presentation style improves perception of postprocedure changes.

Methods:

In this prospective, randomized study, participants viewed sequential images of patients who either had or had not undergone upper eyelid blepharoptosis repair or blepharoplasty (“change” and “no-change,” respectively). These paired images were randomly presented in 1 of 3 formats: side-by-side, up-and-down, or alternation flicker (in which 2 images are superimposed and alternated in a graphics interchange format). Participants were asked if a procedure had been performed based on the 2 photographs. Paired t tests were used to compare response times and change detection rates between individual-level pairs of presentation modes.

Results:

Of 299 recruited patients, 286 completed the study. Rate of change detection trended toward increased sensitivity for alternation flicker over static images. This became statistically significant for patients less than 45 years old. Detection rates did not differ significantly between the 2 static layouts (side-by-side and up-and down).

Conclusions:

Enhancing and customizing aesthetics counseling for different ages can improve patient understanding, expectations, and advertising. When using static photography, the layout, whether side-by-side or up-and-down, can be chosen to fit the mode of presentation with no statistically significant difference. To optimize detection of changes in before and after photography in a demographic less than 45 years old, the animated, alternation flicker format was statistically significantly more effective.
Repair of a Full-thickness Eyelid Defect With a Bilamellar Full-thickness Autograft in a Porcine Model (Sus scrofa)
Authors: Reed Donovan , Soeken Timothy , Brundridge Wesley , Gallagher Colin , DeMartelaere Sheri , Davies Brett
Published: December 2019

Purpose:

It has been demonstrated the pedicle of a tarsoconjunctival flap advancement does not appear to supply the flap itself and the vascularization of the remaining eyelid/tear film is thought to offer adequate nourishment for survival of the flap; as such, a swine model was constructed to assess the viability of a bilamellar autograft for repair of large full-thickness eyelid defects.

Methods:

Full-thickness defects of varying sizes were created in each lower eyelid of 4 Yorkshire/Yorkshire crossed swine. The defects were then closed with a full-thickness ipsilateral graft from the upper eyelid. Large full-thickness defects were then created in the upper and lower eyelids of 8 Yorkshire/Yorkshire crossed swine and closed with bilamellar autografts from the contralateral eyelids. The subjects were then monitored postoperatively and assessed clinically for graft viability at postoperative days 1, 7, and 30. At the conclusion of the 30-day postoperative monitoring period, necropsy was performed and histopathologic analysis utilized to assess cell morphology and vessel ingrowth of the graft sites.

Results:

In total, 28 full-thickness bilamellar grafts were constructed and examined. At the conclusion of the postoperative monitoring period, 27 of the grafts were deemed clinically viable and vascular ingrowth was determined to be equivalent to unaffected eyelid sections by histopathologic analysis. One case of postoperative hematoma was noted in the failed graft. One case of postoperative wound dehiscence required subsequent surgical repair. No clinically significant notching of the graft sites was noted. No cases of wound infection, corneal decompensation, or forniceal shortening were identified.

Conclusions:

This analysis demonstrates the viability of a full-thickness bilamellar autograft as a surgical alternative in the repair of large full-thickness eyelid defects in a porcine model. The postoperative outcomes are consistent with the recent literature. Additional studies need to be performed to assess the procedure’s clinical utility in human subjects before incorporation into clinical practice.
Orbital Lymphangioma Confined to an Extraocular Muscle
Authors: Kothari Pankti , Mirani Neena , Langer Paul D.
Published: December 2019

A 48-year-old woman presented with a 1-year history of an enlarging, nontender right lateral intrapalpebral mass overlying the insertion of the right lateral rectus muscle, associated with a 3-month history of worsening right orbital pain and retrobulbar headaches. MR imaging revealed an isointense right orbital mass contained entirely within the right lateral rectus muscle and indistinguishable from it. Transconjunctival biopsy established the diagnosis of lymphangioma. To the authors’ knowledge, this case represents the first reported orbital lymphangioma contained entirely within an extraocular muscle.
Is Higher Work Engagement Associated With Healthy Behaviors? A Longitudinal Study
Authors: Amano Hoichi , Fukuda Yoshiharu , Kawachi Ichiro
Published: December 2019

Objectives:

We conducted a longitudinal study to examine whether work engagement promotes healthy employee behaviors (smoking cessation, drinking moderation, and regular exercise) among Japanese workers.

Methods:

The study was part of the Japanese Study of Health, Occupation, and Psychosocial Factors Related to Equity (J-HOPE). The survey measured work engagement of 8050 employees from 12 workplaces. A multivariable logistic analysis was used to examine the odds ratio and 95% confidence intervals after adjusting for job stress, psychological distress, and other confounders.

Results:

The mean age of the sample was 40.6 years and 77.4% of the participants were men. The mean work engagement score was 2.9. Higher work engagement was significantly positively associated with drinking moderation and weekly exercise behavior, but not smoking cessation.

Conclusions:

Higher work engagement was associated with healthier employee behaviors after 1 year.
Decentralized Virtual Reality Training of Mastoidectomy Improves Cadaver Dissection Performance: A Prospective, Controlled Cohort Study
Authors: Frendø Martin , Konge Lars , Cayé-Thomasen Per , Sørensen Mads Sølvsten , Andersen Steven Arild Wuyts
Published: December 2019

Objective:

Virtual reality (VR) simulation training can improve temporal bone (TB) cadaver dissection skills and distributed, self-regulated practice is optimal for skills consolidation. Decentralized training (DT) at the trainees’ own department or home offers more convenient access compared with centralized VR simulation training where the simulators are localized at one facility. The effect of DT in TB surgical training is unknown. We investigated the effect of decentralized VR simulation training of TB surgery on subsequent cadaver dissection performance.

Study Design:

Prospective, controlled cohort study.

Setting:

Otorhinolaryngology (ORL) teaching hospitals and the Danish national TB course.

Participants:

Thirty-eight ORL residents: 20 in the intervention cohort (decentralized training) and 18 in the control cohort (standard training during course).

Intervention:

Three months of access to decentralized VR simulation training at the local ORL department or the trainee's home. A freeware VR simulator (the visible ear simulator [VES]) was used, supplemented by a range of learning supports for directed, self-regulated learning.

Main Outcome Measure:

Mastoidectomy final-product scores from the VR simulations and cadaver dissection were rated using a modified Welling Scale by blinded expert raters.

Results:

Participants in the intervention cohort trained decentrally a median of 3.5 hours and performed significantly better than the control cohort during VR simulation (p < 0.01), which importantly also transferred to a 76% higher performance score during subsequent cadaver training (mean scores: 8.8 versus 5.0 points; p < 0.001).

Conclusions:

Decentralized VR simulation training of mastoidectomy improves subsequent cadaver dissection performance and can potentially improve implementation of VR simulation surgical training.
The Direct Costs of Microsurgical Resection of Vestibular Schwannomas
Authors: Saliba Joe , Mohammadzadeh Amir , Tawfik Kareem O. , Carriere Junie S. , Schwartz Marc S. , Nguyen Quyen T. , Friedman Rick A.
Published: December 2019

Objective:

To determine and itemize surgical costs associated with the translabyrinthine (TL), retrosigmoid (RS), and middle cranial fossa (MCF) approaches for microsurgical excision of vestibular schwannoma (VS).

Study Design:

Retrospective cost analysis study.

Setting:

Tertiary referral center.

Patients:

Thirty consecutive adult patients underwent microsurgical excision of VS by either TL, RS, or MCF approach (10 per approach).

Interventions:

Microsurgical excision of VS by one of the three major approaches. Medical and financial data were collected.

Main Outcome Measures:

Total operating room time (minutes), skin-to-skin time (minutes), operating room cost ($US), and surgical supplies cost ($US).

Results:

The MCF approach was associated with the shortest skin-to-skin time (230.3 min, p < 0.001). Mean overall nonsurgical room time was 94.7 minutes and not significantly different among approaches (p = 0.55). Mean total surgical supplies cost was $5,028 and was the highest for the RS ($7,116; p < 0.001) but not significantly different between TL and MCF. Mean operating room services charges were $68,417 overall and were the lowest for the MCF group ($53,306; p = 0.01). Tumor size was not correlated with surgical supplies cost (p = 0.74). The items associated with the highest average cost per case were the surgical aspirator ($1,062), drill burs ($928), and titanium implants ($575). There was redundancy in multiple surgical items such as drill burs, hemostatic agents, and sutures.

Conclusion:

This study is the first to provide a detailed itemization of the surgical expenses specific to VS resection. Elevated nonsurgical room time and supply redundancy provides the opportunity for decreasing surgical costs and waste.
Effect of Head-of-Bed Elevation on Nocturnal Reflux Symptoms of Esophageal Cancer Patients With Esophagectomy and Reconstruction
Authors: Huang Hui-Chen , Chang Ying-Ju , Tseng Yau-Lin , Fang Su-Ying
Published: December 2019

Background

Studies revealed the symptom of gastroesophageal reflux (GE reflux) disturb patients following esophageal reconstruction.

Objective

To examine the effect of head-of-bed elevation by using the wedge-shaped pillow (WSP) on the reflux symptoms of patients with esophageal cancer following esophagectomy and reconstruction.

Methods

Fourteen patients with nocturnal reflux symptoms following esophagectomy and gastric tube reconstruction were enrolled and randomized into 2 groups. A 2-week crossover trial was performed using 2 sequences (drug only and drug plus WSP). The WSP was designed with a height of 20 cm, a length of 62 cm, and an elevation angle of 20 degrees and used with fabricated from memory foam. After 2 weeks, all of the patients received combined drug and WSP intervention for 3 months. Reflux symptoms were measured by Dysfunction After Upper Gastrointestinal Surgery for Cancer and examined by endoscopic observations prior to intervention and follow-up for 3 months.

Result

The average reflux symptom score for the combined drug and WSP treatment in the beginning 2 weeks was lower than that for the drug-only sequence. The severity of esophagitis was improved in 46.1%, and 38.5% showed a stabilization after 3 months.

Conclusions

Combined drug and WSP treatment may be beneficial in improving GE reflux symptoms.

Implications for Practice

Nursing care professionals would suggest patients find a similar WSP to elevate the head of the bed to reduce the severity of nocturnal reflux symptoms after esophagectomy and gastric tube reconstruction.
Urological Evidence of Tick Bites in Children
Authors: Shields Lisa B.E. , Peppas Dennis S. , Rosenberg Eran
Published: December 2019

Ticks pose a serious threat to individuals of all ages owing to numerous physical illnesses including chills, aches, and a rash. Tick-borne illnesses range from a mild fever that may be treated at home to a severe disease necessitating hospitalization. Children are at an increased risk of tick bites owing to to their exposure to tick-infested areas during the summer. We report 2 cases of boys aged 3 and 8 years who sustained tick bites to the hemiscrotum and penis. Overnight hospitalization and a course of antibiotics were mandatory. In the first case, the child experienced significant scrotal cellulitis with erythema and edema extending to the suprapubic area with induration of the right anterior scrotum at the site of the tick bite. A scrotal ultrasound demonstrated swelling of the scrotal wall. In the second case, considerable swelling and induration of the distal penis and glans, pruritis of the left groin and penis, and an erythematous rash over the entire anterior pelvis were observed. A high index of suspicion is warranted because a tick bite may present as penile edema. Pediatric emergency physicians should be aware of the risks associated with tick bites and accurately diagnose and initiate treatment to prevent morbidity and mortality.
Focusing on Families and Visitors Reduces Healthcare Associated Respiratory Viral Infections in a Neonatal Intensive Care Unit
Authors: Linam W. Matthew , Marrero Elizabeth M. , Honeycutt Michele D. , Wisdom Christy M. , Gaspar Anna , Vijayan Vini
Published: December 2019

Introduction:

Healthcare-associated respiratory viral infections (HARVIs) result in significant harm to infants in the neonatal intensive care unit (NICU). Healthcare workers and visitors can serve as transmission vectors to patients. We hypothesized that improved family and visitor hand hygiene (FVHH) and visitor screening would reduce HARVIs by at least 25%.

Methods:

This quality improvement project took place in a large tertiary NICU to reduce HARVIs. Interventions primarily focused on improving FVHH and reducing visitation by symptomatic family members and visitors. We defined correct FVHH as hand hygiene performed immediately before touching their child. Hand hygiene observations were performed by direct observation by NICU staff using a standardized tool. Interventions to improve FVHH included education of staff and visitors, reminder signs, and immediate reminders to families to prevent lapses in hand hygiene. Staff screened family and visitors before NICU entry. Symptomatic individuals were asked to defer visitation until symptoms resolved. HARVIs were identified during prospective surveillance by infection preventionists using standard definitions.

Results:

Baseline FVHH was 27% in 2015. After May 2017, the average FVHH remained at 85%. When reminded, family members and visitors performed hand hygiene 99% of the time. Staff screened ~129,000 people for FVHH. Between January 2013 and March 2019, there were 74 HARVIs; 80% were rhinovirus/enterovirus. After the implementation of improved FVHH, the HARVI rate decreased from 0.67 to 0.23/1,000 patient days.

Conclusions:

Adding interventions to improve FVHH and visitor management to existing healthcare worker prevention efforts can help reduce HARVIs in the NICU.
PULP-NN: accelerating quantized neural networks on parallel ultra-low-power RISC-V processors
Authors: Garofalo Angelo , Rusci Manuele , Conti Francesco , Rossi Davide , Benini Luca
Published: December 2019

We present PULP-NN, an optimized computing library for a parallel ultra-low-power tightly coupled cluster of RISC-V processors. The key innovation in PULP-NN is a set of kernels for quantized neural network inference, targeting byte and sub-byte data types, down to INT-1, tuned for the recent trend toward aggressive quantization in deep neural network inference. The proposed library exploits both the digital signal processing extensions available in the PULP RISC-V processors and the cluster’s parallelism, achieving up to 15.5 MACs/cycle on INT-8 and improving performance by up to 63 × with respect to a sequential implementation on a single RISC-V core implementing the baseline RV32IMC ISA. Using PULP-NN, a CIFAR-10 network on an octa-core cluster runs in 30 × and 19.6 × less clock cycles than the current state-of-the-art ARM CMSIS-NN library, running on STM32L4 and STM32H7 MCUs, respectively. The proposed library, when running on a GAP-8 processor, outperforms by 36.8 × and by 7.45 × the execution on energy efficient MCUs such as STM32L4 and high-end MCUs such as STM32H7 respectively, when operating at the maximum frequency. The energy efficiency on GAP-8 is 14.1 × higher than STM32L4 and 39.5 × higher than STM32H7, at the maximum efficiency operating point.

This article is part of the theme issue ‘Harmonizing energy-autonomous computing and intelligence’.
The regression Tsetlin machine: a novel approach to interpretable nonlinear regression
Authors: Darshana Abeyrathna K. , Granmo Ole-Christoffer , Zhang Xuan , Jiao Lei , Goodwin Morten
Published: December 2019

Relying simply on bitwise operators, the recently introduced
Tsetlin machine
(TM) has provided competitive pattern classification accuracy in several benchmarks, including text understanding. In this paper, we introduce the
regression Tsetlin machine
(RTM), a new class of TMs designed for continuous input and output, targeting nonlinear regression problems. In all brevity, we convert continuous input into a binary representation based on thresholding, and transform the propositional formula formed by the TM into an aggregated continuous output. Our empirical comparison of the RTM with state-of-the-art regression techniques reveals either superior or on par performance on five datasets.

This article is part of the theme issue ‘Harmonizing energy-autonomous computing and intelligence’.
Developing a pseudotype model to test infectivity among different Zika virus mutants
Authors: Jimenez Fernando Ruiz , Olais Jose Humberto Perez , Ball Jonathan
Published: December 2019

Viral infections pose a massive threat to the public health; recently several viral outbreaks had occurred across the globe, including Ebola virus, Middle East respiratory syndrome and Zika virus (ZIKV). ZIKV had great importance due to the appearance of malformation and neurological syndromes in newborns. One of the things that are worth noting is that ZIKV has been present in nature since the second half of the 1900s but only until the outbreak of 2015 in Brazil it gained a prominent spot in the public health surveillance.

The main goal of the project was to develop a suitable method to test different mutations that occurred naturally throughout several outbreaks of the virus across the globe, with particular emphasis in the Asian and American epidemics between 2007 and 2016. To achieve the objectives, the strategy previously used in other viruses known as pseudotyping was proposed. Pseudotyping poses a safe alternative to life virus work due to the lack of a productive infectious cycle, the use of a retroviral backbone supplemented with the glycoprotein of interest has been used in hazardous viruses such as Ebola or Hepatitis C. This system also allows to test individual mutations and the impact in the infectivity of the virus discarding any other accessory protein within the wild type virus. HIV-1 and MLV backbones were tested using a matrix of different ratios of glycoprotein and retrovirus plasmid to find the best set of concentrations; different cell lines were also tested, and protein expression viral proteins were detected.