bluuebunny/crossref_metadata_2025 huggingface dataset:
Design and protocol of Estrogenic Regulation of Muscle Apoptosis (ERMA) study with 47 to 55-year-old women's cohort: novel results show menopause-related differences in blood count
Authors: Kovanen Vuokko , Aukee Pauliina , Kokko Katja , Finni Taija , Tarkka Ina M. , Tammelin Tuija , Kujala Urho M. , Sipilä Sarianna , Laakkonen Eija K.
Published: May 2018

Objective:

The multidisciplinary Estrogenic Regulation of Muscle Apoptosis (ERMA) study was designed to reveal how hormonal differences over the menopausal stages affect the physiological and psychological functioning of middle-aged women. This paper describes the protocol and nonrespondent analysis of ERMA and novel findings on menopausal differences in blood count variables and their association with female sex hormones.

Methods:

Women aged 47 to 55 years were assigned to pre, early peri, late peri, and postmenopausal groups based on follicle-stimulating hormone (FSH) and bleeding diary. Multivariate linear regression models were constructed to estimate the association of 17β-estradiol (E2) and FSH with the blood count variables.

Results:

In all, 3,064 women returned the prequestionnaire (ERMA phase one), 1,393 donated blood samples and were assigned to the relevant menopausal group (phase two), and 914 completed phase three, which included physiological and psychological measurements. Nonrespondents were more likely than respondents to be obese, whereas the menopausal groups showed no mean differences in body mass index. Blood count variables, while being within clinical reference values, showed significant differences between groups. E2 and FSH were associated with the white blood cell (WBC) count and neutrophil-to-lymphocyte ratio.

Conclusions:

The ERMA study was successful in recruiting and characterizing the menopausal status of a cohort sample of middle-aged women. The significant group differences found in the blood count variables and their associations with E2 and FSH verifies menopause-associated changes in WBC composition potentially being an early sign of low-grade inflammation that may develop later in life.
Efficacy of injecting platelet concentrate combined with hyaluronic acid for the treatment of vulvovaginal atrophy in postmenopausal women with history of breast cancer: a phase 2 pilot study
Authors: Hersant Barbara , SidAhmed-Mezi Mounia , Belkacemi Yazid , Darmon Franklin , Bastuji-Garin Sylvie , Werkoff Gabrielle , Bosc Romain , Niddam Jeremy , Hermeziu Oana , La Padula Simone , Meningaud Jean Paul
Published: May 2018

Objective:

Approximately 50% to 70% of breast cancer survivors are affected by one or more symptoms of vulvovaginal atrophy (VVA). For those who cannot take hormone therapy, autologous platelet-rich plasma combined with hyaluronic acid (A-PRP-HA) may provide a new alternative therapy for the treatment of VVA in postmenopausal women with history of breast cancer.

Methods:

We enrolled 20 postmenopausal breast cancers survivors with VVA and a score of <15 on the Gloria Bachman Vaginal Health Index (VHI) comprised of five items including: vaginal pH, elasticity, fluid volume (secretions), epithelial integrity, and moisture.

We administered intramucosal injections of A-PRP combined with HA (Regenkit) and performed clinical evaluations at 0, 1, 3, and 6 months. Primary endpoint: evaluation of vulvovaginal mucosa changes using the VHI; secondary endpoint: evaluation of dyspareunia and sexual dysfunction based on the Female Sexual Distress (FSD) score.

Results:

All participants (20 women) showed improvement in the clinical symptoms of vaginal dryness and dyspareunia. The VHI score showed a significant increase at 6 months, going from a total baseline score (pretreatment) of 10.7 ± 2.12 to 20.75 ± 4.8 (P < 0.0001) at 6 months. Improvement in hydration and vaginal epithelial integrity was reported. A VHI score of > 15 showed a successful treatment outcome. The FSD score decreased significantly during the study, from a baseline score of 36.35 ± 2.53 pretreatment to 30.15 ± 2.47 6 months after treatment, representing improvement of 17% (P < 0.0001, respectively). No adverse events were reported.

Conclusions:

The injection of A-PRP-HA appeared to be a promising method to improve the trophicity and hydration of vaginal mucosa for the treatment of VVA in postmenopausal breast cancer survivors with contraindications to hormone therapy.
Sutureless Prosthesis Implantation and Ascending Aorta Replacement through a Ministernotomy Approach
Authors: Lio Antonio , Ferrarini Matteo , Miceli Antonio , Glauber Mattia
Published: May 2018

A significant proportion of patients undergoing aortic valve replacement have a dilated ascending aorta; presence of an ascending aorta aneurysm is viewed as a contraindication for sutureless valve implantation for the potential risk of prosthesis dislodgment. We describe our technique of sutureless prosthesis implantation and concomitant ascending aorta replacement through an upper ministernotomy. Seven patients underwent aortic valve replacement with a sutureless prosthesis and concomitant ascending aorta replacement between November 2014 and October 2016. A J-shaped upper ministernotomy was performed in all patients. Diameter of vascular graft for the replacement of the dilated ascending aorta was chosen according to the size of the selected prosthesis, to recreate a ratio between diameters of the new sinotubular junction and the aortic annulus that should be less than 1.3. Postoperatively. no patient died in hospital. No paravalvular leakage or prosthesis dislodgment was reported. Mean ± SD cardiopulmonary bypass and cross-clamp times were 142 ± 52 minutes and 85 ± 18 minutes, respectively. In patients undergoing aortic valve replacement and ascending aorta replacement, sutureless valve implantation is a safe and reproducible procedure associated with good postoperative results.
Murine Typhus Mimicking Kawasaki Disease in a Preadolescent Girl
Authors: Karalexi Maria A. , Mitrogiorgou Marina , Atsali Erato , Theodorakopoulos Antonios , Attilakos Achilleas , Tsagris Vasileios
Published: May 2018

We report the case of an 11-year-old preadolescent girl presenting with prolonged fever, lymphadenitis, nonpurulent conjunctivitis, a generalized maculopapular rash, erythematous lips and edema of hands/feet. Although major diagnostic criteria for Kawasaki disease were met, local epidemiologic data suggested a possible vector-borne etiology. Treatment with doxycycline was initiated, and defervescence occurred. Laboratory investigation confirmed the diagnosis of Rickettsia typhi infection.
Invasive Pneumococcal Disease in Neonates Prior to Pneumococcal Conjugate Vaccine Use in South Africa: 2003–2008
Authors: Moodley Krishnee , Coovadia Yacoob Mahomed , Cohen Cheryl , Meiring Susan , Lengana Sarona , De Gouveia Linda , von Mollendorf Claire , Crowther-Gibson Penny , Quan Vanessa , Eley Brian , Reubenson Gary , Nana Trusha , von Gottberg Anne
Published: May 2018

Background:

Neonatal invasive pneumococcal disease (IPD) in developing countries is poorly described. We provide a baseline description of neonatal IPD in South Africa, before implementation of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2009.

Methods:

Data from children (age ≤ 2 years) with IPD (pneumococcus identified from a normally sterile specimen) from January 2003 to December 2008 were extracted from a national laboratory-based surveillance database. Clinical and laboratory characteristics of IPD among neonates (0–27 days old) was compared with IPD among young children (≥ 28 days ≤ 2 years). Early-onset IPD (0–6 days old) was compared with late-onset IPD (≥ 7–27 days old). Isolates were serotyped using the Quellung reaction.

Results:

Overall 27,630 IPD cases were reported. Of the 26,277 (95%) with known ages, 6583 (25%) were ≤ 2 years of age, of which 4.5% (294/6583) were neonates. The estimated annual incidence of neonatal IPD in 2008 was 5 per 100,000 live births. Fifty-one percent of neonates with IPD presented with early-onset IPD. Case fatality ratios (CFRs) were high in both groups, 31% (28/89) in neonatal IPD versus 26% (614/2383) in non-neonatal IPD (P = 0.18). Among neonates, the meningitis cases (15/37, 41%) were associated with the highest CFR. The 13-valent pneumococcal conjugate vaccine (PCV13) serotypes accounted for 69% (134/194) of neonatal IPD isolates.

Conclusions:

Pneumococcal neonatal disease in South Africa was not uncommon before PCV introduction and is associated with a high CFR. The indirect effect on neonatal IPD of PCV rollout requires further evaluation.
Purposeful Recruitment Strategies to Increase Diversity in Physical Therapist Education
Authors: Moerchen Victoria , Williams-York Bernadette , Ross Libby J. , Wise Denise , Dominguez Jesus , Kapasi Zoher , Brooks Salome
Published: May 2018

Background and Purpose.

A more diverse physical therapist (PT) workforce is needed to meet the rapidly changing demographic of the United States. To achieve this increased representation within the profession, PT education must recruit, admit, and retain a more diverse student body. A comprehensive definition of underrepresented minorities (URMs) in professional physical therapy education was recently expanded to include educational, economic, and geographic disadvantage in addition to race and ethnicity.

Position and Rationale.

The PT profession has not examined the disadvantaged profile of its applicant pool or student demographic, but this expanded URM definition now supports this effort. This position paper reports on a survey conducted by the American Council of Academic Physical Therapy's Diversity Task Force designed to examine recruitment into PT education through the lens of the new URM definition, with a focus on how students from underrepresented and disadvantaged backgrounds decide to pursue a PT career. The position taken was that identifying potential differences in how URM students achieve this decision will support the development of purposeful recruitment strategies for students from URM groups.

Discussion and Conclusion.

Students from URM backgrounds reported different critical decision ages, as well as different use of or preference for resources to learn about the PT career and to prepare for application to DPT programs. Although personal experience with physical therapy was the primary influence on white students' decision to pursue a PT career, values and interests were equally impactful on this decision for disadvantaged students. Both nonwhite and disadvantaged students were also more influenced by exposure to the patient–therapist relationship and by inclusion and diversity than white students. This paper uses these data to support the need for different strategies and tailored recruitment of URM students into physical therapy education programs.
Outcomes of Flipped Classroom Instruction in an Entry-Level Physical Therapy Course
Authors: Deprey Sara M.
Published: May 2018

Background and Purpose.

Instead of relying exclusively on traditional lecture classes, instruction known as “flipped classrooms” provides students a more interactive learning environment. In a flipped classroom, students are required to listen to prepared prerecorded course content before they come to class. Rather than homework following a lecture, students complete assignments in the classroom on concepts specifically drawn from the lecture. Flipped classrooms are gaining more popularity; however, quantitative studies on their ability to improve learning are lacking.

Case Description.

This is a retrospective review over 3 consecutive years that describe outcomes of three teaching methods within one unit of an entry-level physical therapy course. Examination scores from a traditional lecture (TRAD) classroom (n = 44), a partially flipped (pFLIP) (n = 49), and a fully integrated flipped (full FLIP) classroom (n = 50) were compared.

Outcomes.

Students receiving instruction in a full FLIP classroom demonstrated the greatest improvements from examination 1 to examination 2. The pFLIP cohort demonstrated statistically significant lower scores compared to full FLIP cohort on examination 2.

Discussion and Conclusion.

The TRAD class received in-class lectures with homework, whereas the pFLIP cohort received in-class question and discussion of content, while the full FLIP cohort received intentional in-class work. A full FLIP classroom requires active participation by students, and in doing so, it simultaneously provides an enhanced opportunity to apply new content to contextualize new information with prior knowledge to solve problems. This opportunity to apply content along with the availability of the instructor to provide feedback in real time may have led to greater understanding of the course material.
Impact of a Self-contained Clinical Learning Space on a Physical Therapist Assistant Education Program
Authors: Reese Suzanne , Brown Suzanne Robben
Published: May 2018

Background and Purpose.

Immersion within practice areas or clinical education (CE) experiences are required to be both integrated within the curriculum (ie, integrated clinical education [ICE] experiences) and at the end of the curriculum (ie, terminal clinical education [TCE] experiences) for an accredited physical therapist assistant (PTA) education program. In addition, programs must meet accreditation requirements for ICE and TCE within specified clock hour (520–720) and program length limitations (five semesters). The purpose of this article was to describe one program's model for providing integrated PTA CE in a self-contained learning space and to describe the outcomes achieved in the first 2 years of operation.

Method/Model Description and Evaluation.

Planning, administrative approval, community fund-raising, and institutional capital budget allocation commitments took 6 years before the Nate Waters Physical Therapy Clinic (NWPTC) at Tulsa Community College, Tulsa, OK, opened in August 2014. The clinic design is based on a learning spaces framework providing students an actual clinic setting to learn and practice skills. The learning space allows students to gain clinical confidence in a comfortable, supportive learning environment, in which time restraints, high productivity requirements, and reimbursement restrictions are eliminated or minimized for the novice student. A mixed-method program evaluation assessed the 2-year performance of the self-contained clinic with two quantitative and three qualitative assessments.

Outcomes.

Implementation of the self-contained clinic allowed for a curriculum reduction of clinical hours from 680 to 560. The clinic generated an average of 65 visits each month with a range of 41–124 visits. No significant difference was found on the PTA students' midterm scores from the final TCE's Clinical Performance Instrument (PTA CPI, Version 1998) for the 2015 and 2016 cohorts compared with two preclinic cohorts (2013 and 2014), despite 22% less clinical time for the studied cohorts. Qualitative interviews of faculty and students showed three parallel themes and two related themes. Parallel themes in both groups included teaching in context, confidence, and communication, whereas related themes included faculty absence of concerns or complaints and student fear of failure. Students also identified an enhanced PT/PTA role formation as a benefit of the clinic.

Discussion and Conclusion.

Student experiences in the NWPTC are aligned to support integration of learning in the classroom. Faculty supervision in the clinic reinforces the concepts taught in didactic courses. As a self-funded, self-contained teaching clinic, NWPTC allowed faculty control on curriculum alignment and scheduling, thus allowing for a reduction in required clinical contact hours with no indication of decreased student outcomes. While CE in PTA education programs continues to be predominantly outsourced, a self-contained ICE clinic can be of value to PTA programs.
Safe Intraoperative Neurophysiologic Monitoring During Posterior Spinal Fusion in a Patient With Cochlear Implants
Authors: Abiola Godwin , Ward Bryan Kevin , Bowditch Stephen , Ritzl Eva Katharina , Carey John Patrick
Published: May 2018

Objective:

Cochlear implants are generally considered a contraindication for any procedure requiring electrical stimulation near the implant. We present a case of a patient undergoing intraoperative transcranial electrical motor-evoked potential monitoring with a cochlear implant without adverse outcomes.

Patient:

A 12-year-old girl with a history of VACTERL presented with worsening congenital kyphosis and bilateral severe-to-profound hearing loss. Since age 7 the patient used a cochlear implant in the right ear and hearing aid in the left ear. Physical examination and magnetic resonance imaging in 2016 revealed a left-sided 66-degree thoracolumbar kyphosis at T11 making the patient a candidate for surgical correction.

Interventions:

She underwent a posterior spinal fusion surgery, performed with intraoperative transcranial electrical motor-evoked potential monitoring. Steps were taken to mitigate electrical stimulation of the patient's cochlear implant.

Main Outcome Measures:

Postoperative impedance of individual channels, audiometry, and neural response testing were compared with preoperative measurements.

Results:

Significant (>10%) impedance changes were observed postoperatively in channels 1, 2, 4, and 6; however, the net variation across all the channels was low (3%). The patient reported no hearing changes, and no significant changes in hearing threshold were seen in postoperative audiometric testing or neural response testing.

Conclusion:

We present a case of successful posterior spinal fusion with intraoperative neurophysiological monitoring via transcranial electrical stimulation, in a patient with a cochlear implant. With proper precautions, motor-evoked potential monitoring can be safely performed in a patient with a cochlear implant.
Incidence and Risk Factors for Sigmoid Venous Thrombosis Following CPA Tumor Resection
Authors: Shew Matthew , Kavookjian Hannah , Dahlstrom Kelly , Muelleman Thomas , Lin James , Camarata Paul , Ledbetter Luke N. , Staecker Hinrich
Published: May 2018

Objective:

Our primary aim was to determine the incidence of sigmoid venous thrombosis (SVT) and determine risks factors and sequelae of SVT following cerebellopontine angle tumor resection.

Study Design:

Retrospective cohort study.

Setting:

Academic tertiary care hospital.

Patients:

Patients over 18 years of age who underwent resection of cerebellopontine angle meningioma or vestibular schwannoma from January 2005 to April 2016 who had postoperative magnetic resonance imaging.

Intervention(s):

Diagnostic.

Main Outcome Measure(s):

Incidence of postoperative sigmoid venous thrombosis (SVT) from official radiology reports was compared with retrospective imaging review by our institutional neuroradiologists. Data collected included age, length of stay, body mass index, surgical approach, and postoperative complications.

Results:

A total of 127 patients were identified. Official radiology reads significantly underreported the incidence of postoperative SVT compared with retrospective review by our institutional neuroradiologist for patients who underwent routine postoperative imaging (n = 4 [3.1%] versus n = 22 [17.3%]; p < 0.001). There was a statistical trend toward increased risk for thrombosis in patients undergoing translabyrinthine and staged resection that did not reach significance (p = 0.068). Cerebrospinal fluid (CSF) leak incidence in patients with thrombosis was significantly increased (n = 9 [37.5%] versus n = 13 [12.6%]; p = 0.007). When controlling for approach, the presence of thrombus was associated with a more then three-fold increase in odds of CSF leak (OR = 3.28, 95% CI: 1.12–9.48, p = 0.030). There was no correlation between SVT and age (p = 0.788), body mass index (p = 0.686), length of stay (p = 0.733), preoperative tumor size (p = 0.555), or increased postoperative ICP (p = 0.645). Only one patient was symptomatic from sigmoid thrombosis compared with 21 who were not.

Conclusion:

Incidence of SVT is significantly underreported and may predispose patients to increase risk for CSF leak. Staged and translabyrinthine approaches demonstrate an increased trend toward thrombosis risk. Our findings suggest it may not be necessary to treat asymptomatic SVT.
Comparison of Clinical Characteristics and Surgical Outcomes of Cystic and Solid Vestibular Schwannomas
Authors: Han Ji Hyuk , Baek Kwang Ha , Lee Young Woo , Hur Young Kyun , Kim Hyun Ji , Moon In Seok
Published: May 2018

Objective:

The aim of this study was to compare the clinical characteristics of cystic vestibular schwannomas (CVSs) and solid vestibular schwannomas (SVSs).

Study Design:

Retrospective review.

Setting:

Tertiary care center.

Patients:

A total of 220 patients who underwent microsurgery for vestibular schwannomas between 2007 and 2016.

Intervention:

CVSs were defined as cystic components ≥1/3 of total tumor volume based on automated volume measurement. Tumors larger than 5 cm3 were defined as large tumors.

Main Outcome Measures:

Clinical characteristics and surgical outcomes, including preoperative symptoms, hearing threshold, vestibular function, tumor volume, extent of resection, facial nerve outcomes, and nonfacial complications were evaluated.

Results:

Tumor volume was significantly larger in CVSs (20.44 ± 13.85 cm3 in CVSs; 4.75 ± 6.48 cm3 in SVSs, p < 0.001) and the proportion of larger tumors was also greater in CVSs (66.0% in CVSs; 11.4% in SVSs, p < 0.001). Preoperative dizziness was highly prevalent in CVSs (32.1% in CVSs; 18.6% in SVSs, p = 0.038) and postoperative facial nerve outcomes were significantly worse in CVSs (67.9% favorable rate in CVSs; 87.4% favorable rate in SVSs, p = 0.001). When the comparison was limited to large tumors, no clinical characteristics or surgical outcomes were significantly different. Tumor volume had a greater effect than tumor type on the surgical outcomes. The odds ratios for subtotal resection and unfavorable facial nerve function with a large tumor were 5.77 (confidence interval [CI]: 1.52–21.95, p = 0.010) and 5.34 (CI: 1.41–20.22, p = 0.014), respectively.

Conclusion:

CVSs tend to be larger than SVSs. Tumor volume, not cystic component, is thought to be a major determinant of surgical outcomes.
The Effect of Obesity on the Quality of Bowel Preparation for Colonoscopy
Authors: Anklesaria Ava B. , Ivanina Elena A. , Chudy-Onwugaje Kenechukwu O. , Tin Kevin , Levine Chaya M. , Homel Peter , Rojas Mary , Mayer Ira E. , Rahmani Rabin
Published: May 2018

Background:

Obesity has been linked to suboptimal bowel preparation but this association has not been conclusively investigated in prospective studies.

Goals:

Our objective was to determine whether any relationship exists between obesity as measured by body mass index (BMI) and quality of bowel preparation.

Study:

Adult patients who presented for outpatient colonoscopy at a single urban ambulatory surgery center within a 6-month period and fulfilled inclusion criteria were prospectively enrolled for the study. Patients were divided by BMI into subcategories based on the World Health Organization international classification of obesity. The Modified Aronchick scale was used to assess bowel preparation for colonoscopy. A univariate and multivariate analysis was used to determine a possible association between BMI and poor preparation.

Results:

A total of 1429 patients were evaluated. On the basis of inclusion criteria, 1314 subjects were analyzed, out of which 73% were overweight or obese. Inadequate bowel preparation was noted in 21.1% of patients. There was no correlation between obesity and the quality of the bowel preparation. Male gender (P=0.002), diabetes mellitus (P<0.0001), liver cirrhosis (P=0.001), coronary artery disease (P=0.003), refractory constipation (P<0.0001), and current smoking (P=0.01) were found to be independently predictive of poor bowel preparation.

Conclusions:

Increased BMI is not predictive of suboptimal bowel preparation for colonoscopy. The results of our study are pivotal given the increased risk of colorectal cancer in obese patients and their known lower rate of colorectal cancer screening in certain populations. It is important to avoid subjecting these patients to an intensive bowel preparation that may further discourage screening in a patient population that requires it.
Red Meat Consumption and Serum Lipids and Fatty Acids in Toddlers
Authors: Szymlek‐Gay Ewa A. , Gray Andrew R. , Heath Anne‐Louise M. , Ferguson Elaine L. , Skeaff C. Murray
Published: May 2018

The aim of the study was to examine the effects of promoting increased lean red meat consumption on serum concentrations of total and high‐density lipoprotein (HDL) cholesterol, and serum fatty acid composition, among toddlers. In a 20‐week randomized controlled trial healthy 12 to 20‐month‐old children were assigned to: red meat (n = 90; parents were encouraged to add 56 g/day of lean red meat to their toddler's usual diet), or control (n = 90) groups. Food and nutrient intakes were assessed with 3‐day weighed food records (baseline, week 4, and week 20). Serum was analyzed for total and HDL cholesterol concentrations, and fatty acid composition (baseline and week 20). At week 20, relative to control, the red meat group had higher intakes of red meat, all meat, and carbohydrate; and lower intakes of milk, energy, cholesterol, and total, saturated, and monounsaturated fat (P = 0.043 for energy, all others P ⩽ 0.002). No effects associated with the intervention were found for total cholesterol, HDL cholesterol, total to HDL cholesterol ratio, or serum fatty acid composition (all P ≥ 0.059) aside from pentadecanoic acid (P = 0.047). An ~3‐fold increase in lean red meat intake, from ~10 to ~30 g/day, resulted in no consistent changes in serum lipids or fatty acid composition, suggesting that the addition of ~2 tablespoons/day of lean red meat to toddlers’ diets will likely not adversely affect serum lipids or serum fatty acids.
Simple Bone Cyst Mimicking Stafne Bone Defect
Authors: Aoki Eduardo Massaharu , Abdala-Júnior Reinaldo , Nagano Cibele Pidorodeski , Mendes Elisabeth Bannwart , Oliveira Jefferson Xavier de , Lourenço Silvia Vanessa , Arita Emiko Saito
Published: May 2018

Stafne bone defects (SBDs) are asymptomatic lingual bony defects in mandible, which are usually detected as an incidental finding in plain radiographs. Similarly, simple bone cysts (SBCs) are most frequently found in posterior region of the mandible and also are asymptomatic. However, due to anatomical structures overlap in plain radiographs, there is a possibility of misdiagnosing SBD that often is diagnosed by presumptive diagnosis observed in plain radiograph. This report shows an unusual case that a SBC resembles a SBD.
Deepening Fornix Technique Using Central Split-Medium Thickness Skin Graft to Treat Contracted Anophthalmic Sockets
Authors: AlHassan Sultan , Galindo-Ferreiro Alicia , Khandekar Rajiv , AlShaikh Osama , Schellini Silvana Artioli
Published: May 2018

Purpose:

The aim of thhis study was to present the outcomes of postauricular split-medium thickness skin graft (SMTSG) to treat anophthalmic sockets with contracted fornices.

Methods:

This case series enrolled patients with grade 2 or 3 anophthalmic sockets between 2015 and 2016. Data were collected on patient demographics, objective and subjective parameters preoperatively and 180 days postoperatively. Success of the surgery was graded on the height of the graft, the depth of the superior and inferior fornices, and presence/abscence of lagophthalmos, entropion, and ability to retain an external prosthesis.

Results:

Eighteen patients were enrolled with a mean age of 35.9 ± 18 years. The median height of the graft was 22 mm (25% quartile = 18.75) when removed and 20 mm (25% quartile = 16) postoperatively. The median depth of the superior fornix was 6.5 mm (25% quartile = 4.5 mm) preoperatively and 10 mm (25% quartile = 8 mm) postoperatively (P = 0.5). The median inferior fornix depth was 7 mm (25% quartile = 3.5 mm) preoperatively and 8 mm (25% quartile = 5 mm) (P = 0.27) postoperatively. Preoperatively, there were 13 (72.2%) patients with lagophthalmos, 10 (44.4%) with entropion, 3 (37.5%) with poor prosthesis retention, and 5 (62.5%) who were unable to retain the prosthesis. Postoperatively, 7 (38.9%) patients had lagophthamos, 1 (5.6%) had entropion, and all the patients could retain the prosthesis. None of the sockets had a foul odor postoperatively.

Conclusions:

Postauricular SMTSG achieves successful outcomes for the treatment of contracted anophthalmic sockets, reshaping the anterior socket surface and deepening the fornices.
Isolated Bilateral Macrostomia
Authors: Pradhan Rohan , Lin Bojie , Pan Xin-Yuan , Yin Guo-Qian
Published: May 2018

Macrostomia (Tessier's 7 cleft) is a rare congenital lip deformity. Macrostomia can occur unilateral or bilateral, isolated or associated with other syndromes. Isolated bilateral macrostomia is exceedingly rare with only a few cases reported to date. The authors report 6 cases of isolated bilateral macrostomia surgically repaired in 4-layered approaches. The traditional method was improved and the result obtained was satisfactory after longest follow-up of 3 years. The technique is easy to imitate, simple in design, aesthetically and functionally corrects the deformity.
Impact of Dexmedetomidine on Long-term Outcomes After Noncardiac Surgery in Elderly: 3-Year Follow-up of a Randomized Controlled Trial
Authors: Zhang Dan-Feng , Su Xian , Meng Zhao-Ting , Li Hong-Liang , Wang Dong-Xin , Xue-Ying Li  , Maze Mervyn , Ma Daqing
Published: May 2018

Objectives:

The aim was to compare the long-term outcomes of low-dose dexmedetomidine versus placebo in a randomized controlled trial (ChiCTR-TRC-10000802).

Background:

Low-dose dexmedetomidine infusion decreased delirium occurrence within 1 week after surgery in elderly admitted to the intensive care unit (ICU) after noncardiac surgery, but the long-term outcome of this intervention is unknown.

Methods:

Patients or their family members were telephone-interviewed for a 3-year follow-up data collection of survival, cognitive function assessed with the modified Telephone Interview for Cognitive Status, and quality of life evaluated with the World Health Organization Quality of Life.

Results:

Of the 700 patients, 23 (3.3%) were lost at 3-year follow-up. The 3-year overall survival was not statistically different between the dexmedetomidine and placebo groups [114 deaths vs 122/350; hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.68–1.13, P = 0.303]. The survival rates at 6 months, 1 year, and 2 years were significantly higher in the dexmedetomidine than in the placebo group (rate difference of 5.2%, 5.3%, and 6.7% respectively; all P < 0.05). The remaining 98.4% (434/441) 3-year survivors, the dexmedetomidine group, had significantly better cognitive function (mean difference 4.7, 95% CI 3.8–5.6, P < 0.0001) and quality of life (physical domain: 13.6 [10.6–16.6]; psychological domain: 15.2 [12.5–18.0]; social relationship domain: 8.1 [5.5–10.7]; environment domain: 13.3 [10.9–15.7]; all P < 0.0001) than in the placebo group.

Conclusions:

For elderly admitted to ICU after noncardiac surgery, low-dose dexmedetomidine infusion did not significantly change 3-year overall survival, but increased survival up to 2 years, and improved cognitive function and quality of life in 3-year survivors.
Intracorporeal Isosceles Right Triangle-shaped Anastomosis in Totally Laparoscopic Distal Gastrectomy
Authors: Nakamura Kenichi , Suda Koichi , Suzuki Atsushi , Nakauchi Masaya , Shibasaki Susumu , Kikuchi Kenji , Nakamura Tetsuya , Kadoya Shinichi , Inaba Kazuki , Uyama Ichiro
Published: May 2018

Purpose:

This study aimed to evaluate the feasibility and safety of intracorporeal anastomosis with Billroth I, Billroth II, or Roux-en-Y reconstructions in totally laparoscopic distal gastrectomy.

Materials and Methods:

A single-institution, retrospective, cohort study including 553 patients was conducted. Intracorporeal isosceles right triangle-shaped anastomosis without slack and torsion was created using linear staplers. Billroth I was primarily used. Surgical outcomes and perioperative nutritional status were assessed.

Results:

Morbidity was 11.5%. Postoperative early complications related to anastomosis occurred in 13 patients (2.4%). Operative time and reconstruction type (Billroth I vs. others) were the only significant independent risk factors determining postoperative early and late complications, respectively. No difference was observed in postoperative changes in nutritional status across the groups, although Billroth II increased reflux esophagitis requiring medication.

Conclusions:

Intracorporeal isosceles right triangle-shaped anastomosis using linear staplers in totally laparoscopic distal gastrectomy, in combination with our selection algorithm for type of reconstruction, is feasible and safe.
Tree crowns grow into self-similar shapes controlled by gravity and light sensing
Authors: Duchemin Laurent , Eloy Christophe , Badel Eric , Moulia Bruno
Published: May 2018

Plants have developed different tropisms: in particular, they reorient the growth of their branches towards the light (phototropism) or upwards (gravitropism). How these tropisms affect the shape of a tree crown remains unanswered. We address this question by developing a propagating front model of tree growth. Being length-free, this model leads to self-similar solutions after a long period of time, which are independent of the initial conditions. Varying the intensities of each tropism, different self-similar shapes emerge, including singular ones. Interestingly, these shapes bear similarities to existing tree species. It is concluded that the core of specific crown shapes in trees relies on the balance between tropisms.
Foliage motion under wind, from leaf flutter to branch buffeting
Authors: Tadrist Loïc , Saudreau Marc , Hémon Pascal , Amandolese Xavier , Marquier André , Leclercq Tristan , de Langre Emmanuel
Published: May 2018

The wind-induced motion of the foliage in a tree is an important phenomenon both for biological issues (photosynthesis, pathogens development or herbivory) and for more subtle effects such as on wi-fi transmission or animal communication. Such foliage motion results from a combination of the motion of the branches that support the leaves, and of the motion of the leaves relative to the branches. Individual leaf dynamics relative to the branch, and branch dynamics have usually been studied separately. Here, in an experimental study on a whole tree in a large-scale wind tunnel, we present the first empirical evidence that foliage motion is actually dominated by individual leaf flutter at low wind velocities, and by branch turbulence buffeting responses at higher velocities. The transition between the two regimes is related to a weak dependence of leaf flutter on wind velocity, while branch turbulent buffeting is strongly dependent on it. Quantitative comparisons with existing engineering-based models of leaf and branch motion confirm the prevalence of these two mechanisms. Simultaneous measurements of the wind-induced drag on the tree and of the light interception by the foliage show the role of an additional mechanism, reconfiguration, whereby leaves bend and overlap, limiting individual leaf flutter. We then discuss the consequences of these findings on the role of wind-mediated phenomena.
Degradation rate uniformity determines success of oscillations in repressive feedback regulatory networks
Authors: Page Karen M. , Perez-Carrasco Ruben
Published: May 2018

Ring oscillators are biochemical circuits consisting of a ring of interactions capable of sustained oscillations. The nonlinear interactions between genes hinder the analytical insight into their function, usually requiring computational exploration. Here, we show that, despite the apparent complexity, the stability of the unique steady state in an incoherent feedback ring depends only on the degradation rates and a single parameter summarizing the feedback of the circuit. Concretely, we show that the range of regulatory parameters that yield oscillatory behaviour is maximized when the degradation rates are equal. Strikingly, this result holds independently of the regulatory functions used or number of genes. We also derive properties of the oscillations as a function of the degradation rates and number of nodes forming the ring. Finally, we explore the role of mRNA dynamics by applying the generic results to the specific case with two naturally different degradation timescales.
Stochastic modelling of urban structure
Authors: Ellam L. , Girolami M. , Pavliotis G. A. , Wilson A.
Published: May 2018

The building of mathematical and computer models of cities has a long history. The core elements are models of flows (spatial interaction) and the dynamics of structural evolution. In this article, we develop a stochastic model of urban structure to formally account for uncertainty arising from less predictable events. Standard practice has been to calibrate the spatial interaction models independently and to explore the dynamics through simulation. We present two significant results that will be transformative for both elements. First, we represent the structural variables through a single potential function and develop stochastic differential equations to model the evolution. Second, we show that the parameters of the spatial interaction model can be estimated from the structure alone, independently of flow data, using the Bayesian inferential framework. The posterior distribution is doubly intractable and poses significant computational challenges that we overcome using Markov chain Monte Carlo methods. We demonstrate our methodology with a case study on the London, UK, retail system.
Modern spandrels: the roles of genetic drift, gene flow and natural selection in the evolution of parallel clines
Authors: Santangelo James S. , Johnson Marc T. J. , Ness Rob W.
Published: May 2018

Urban environments offer the opportunity to study the role of adaptive and non-adaptive evolutionary processes on an unprecedented scale. While the presence of parallel clines in heritable phenotypic traits is often considered strong evidence for the role of natural selection, non-adaptive evolutionary processes can also generate clines, and this may be more likely when traits have a non-additive genetic basis due to epistasis. In this paper, we use spatially explicit simulations modelled according to the cyanogenesis (hydrogen cyanide, HCN) polymorphism in white clover (Trifolium repens) to examine the formation of phenotypic clines along urbanization gradients under varying levels of drift, gene flow and selection. HCN results from an epistatic interaction between two Mendelian-inherited loci. Our results demonstrate that the genetic architecture of this trait makes natural populations susceptible to decreases in HCN frequencies via drift. Gradients in the strength of drift across a landscape resulted in phenotypic clines with lower frequencies of HCN in strongly drifting populations, giving the misleading appearance of deterministic adaptive changes in the phenotype. Studies of heritable phenotypic change in urban populations should generate null models of phenotypic evolution based on the genetic architecture underlying focal traits prior to invoking selection's role in generating adaptive differentiation.
Automatic Classification of Prostate Cancer Gleason Scores from Digitized Whole Slide Tissue Biopsies
Authors: Xu Hongming , Park Sunho , Hwang Tae Hyun
Published: May 2018

Histological Gleason grading of tumor patterns is one of the most powerful prognostic predictors in prostate cancer. However, manual analysis and grading performed by pathologists are typically subjective and time-consuming. In this paper, we propose an automatic technique for Gleason grading of prostate cancer from H&E stained whole slide biopsy images using a set of novel completed and statistical local bi-nary pattern (CSLBP) descriptors. First the technique divides the whole slide image into a set of small image tiles, where salient tumor tiles with high nuclei densities are selected for analysis. The CSLBP texture features that encode pixel intensity variations from circularly surrounding neighborhoods are then extracted from salient image tiles to characterize different Gleason patterns. Finally, CSLBP texture features computed from all tiles are integrated and utilized by the multi-class support vector machine (SVM) that assigns patient biopsy with different Gleason score of 6, 7 or ≥8. Experiments have been performed on 312 different patient cases selected from the cancer genome atlas (TCGA) and have achieved more than 79% classification accuracies, which is superior to state-of-the-art textural descriptors for prostate cancer Gleason grading.
Long-term seasonality of marine photoheterotrophic bacteria reveals low cohesiveness within the different phylogroups
Authors: Auladell Adrià , Sánchez Pablo , Sánchez Olga , Gasol Josep M. , Ferrera Isabel
Published: May 2018

Aerobic anoxygenic phototrophic (AAP) bacteria play a relevant role in the marine microbial food web, but little is known about their long-term seasonal dynamics. Using Illumina amplicon sequencing of thepufM gene coupled with multivariate, time series and co-occurrence analyses we examined their temporal dynamics over a decade at the Blanes Bay Microbial Observatory (NW Mediterranean). Phylogroup K (Gammaproteobacteria) was the most abundant over all seasons, with phylogroups E and G (Alphaproteobacteria) being often abundant in spring. A clear seasonal trend was observed in diversity, with maximum values in winter. Multivariate analyses showed sample clustering by season, with a relevant proportion of the variance (38%) explained by day length, temperature, salinity, phototrophic nanoflagellate abundance and phosphate concentration. Time series analysis showed that only 42% of the Amplicon Sequence Variants (ASVs) analyzed presented marked seasonality but these represented most of the abundance (92%). Interestingly, distinct temporal dynamics were observed within the same phylogroup and even within different ASVs conforming the same Operational Taxonomic Unit (OTU). Likewise, co-occurrence analysis highlighted negative associations between various ASVs within the same phylogroup. Altogether our results picture the AAP assemblage as highly seasonal, containing ecotypes with distinctive niche partitioning rather than being a cohesive functional group.
Why cooperation is not running away
Authors: Geoffroy Félix , Baumard Nicolas , André Jean-Baptiste
Published: May 2018

Abstract

A growing number of experimental and theoretical studies show the importance of partner choice as a mechanism to promote the evolution of cooperation, especially in humans. In this paper, we focus on the question of the precise quantitative level of cooperation that should evolve under this mechanism. When individuals compete to be chosen by others, their level of investment in cooperation evolves towards higher values, a process called competitive altruism, or runaway cooperation. Using a classic adaptive dynamics model, we first show that, when the cost of changing partner is low, this runaway process can lead to a profitless escalation of cooperation. In the extreme, when partner choice is entirely frictionless, cooperation even increases up to a level where its cost entirely cancels out its benefit. That is, at evolutionary equilibrium, individuals gain the same payoff than if they had not cooperated at all. Second, importing models from matching theory in economics we, however, show that, when individuals can plastically modulate their choosiness in function of their own cooperation level, partner choice stops being a runaway competition to outbid others, and becomes a competition to form the most optimal partnerships. In this case, when the cost of changing partner tends toward zero partner choice leads to the evolution of the socially optimum level of cooperation. This last result could explain the observation that human cooperation seems to be often constrained by considerations of social efficiency.
Microbial Biomarkers of Intestinal Barrier Maturation in Preterm Infants
Authors: Ma Bing , McComb Elias , Gajer Pawel , Yang Hongqiu , Humphrys Mike , Okogbule-Wonodi Adora C. , Fasano Alessio , Ravel Jacques , Viscardi Rose M
Published: May 2018

Intestinal barrier immaturity, or “leaky gut,” is the proximate cause of susceptibility to necrotizing enterocolitis in preterm neonates. However, the impact of intestinal microbiota development on intestinal mucosal barrier maturation has not been evaluated in this population. In this study, we investigated a longitudinally sampled cohort of 38 preterm infants monitored for intestinal permeability (IP) and fecal microbiota during the first two weeks of life. Rapid decrease in IP indicating intestinal barrier function maturation correlated with significant increase in community diversity. In particular, members of the Clostridiales and Bifidobacterium were highly transcriptionally active, and progressively increasing abundance in Clostridiales was significantly associated with decreased gut permeability. Further, neonatal factors previously identified to promote intestinal barrier maturation, including early exclusive breastmilk feeding and low antibiotic exposure, favor the early colonization of the gut microbiota by members of the Clostridiales, which altogether are associated with improved intestinal barrier function in preterm infants.
Link Between Short tandem Repeats and Translation Initiation Site Selection
Authors: Arabfard M , Kavousi K , Delbari A , Ohadi M
Published: May 2018

Recent work in yeast and humans suggest that evolutionary divergence incis-regulatory sequences impact translation initiation sites (TISs).Cis-elements can also affect the efficacy and amount of protein synthesis. Despite their vast biological implication, the landscape and relevance of short tandem repeats (STRs)/microsatellites to the human protein-coding gene TISs remain largely unknown. Here we characterized the STR distribution at the 120 bp cDNA sequence upstream of all annotated human protein-coding gene TISs based on the Ensembl database. Furthermore, we performed a comparative genomics study of all annotated orthologous TIS-flanking sequences across 47 vertebrate species (755,956 transcripts), aimed at identifying human-specific STRs in this interval. We also hypothesized that STRs may be used as genetic codes for the initiation of translation. The initial five amino acid sequences (excluding the initial methionine) that were flanked by STRs in human were BLASTed against the initial orthologous five amino acids in other vertebrate species (2,025,817 pair-wise TIS comparisons) in order to compare the number of events in which human-specific and non-specific STRs occurred with homologous and non-homologous TISs (i.e. ≥50% and <50% similarity of the five amino acids). We characterized human-specific STRs and a bias of this compartment in comparison to the overall (human-specific and non-specific) distribution of STRs (Mann Whitney p=1.4 × 10−11). We also found significant enrichment of non-homologous TISs flanked by human-specific STRs (p<0.00001). In conclusion, our data indicate a link between STRs and TIS selection, which is supported by differential evolution of the human-specific STRs in the TIS upstream flanking sequence.

Abbreviations

cDNA

Complementary DNA

CDS

Coding DNA sequence

STR

Short Tandem Repeat

TIS

Translation Initiation Site

TSS

Transcription Start Site