bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of supplementing low-quality hay with groundnut foliage and cassava tops on feed intake, apparent digestibility and rumen fermentation in crossbred cattle
Authors: Samkol Pok , Sath Keo , Patel Mikaela , Seng Mom , Holtenius Kjell
Published: November 2018

Four adult crossbred cattle, fitted with rumen fistula in the dorsal sac, were randomly allocated to four treatments in a 4 × 4 Latin-square design to study the effects of supplementing sun-dried groundnut (Arachis hypogea L.) foliage (DGF) and sun-dried cassava (Manihot esculenta, Crantz) tops (DCT) on feed intake, apparent digestibility and rumen fermentation. All animals were fed a basal diet of rice straw ad libitum and para grass (Brachiaria mutica) at 1% of liveweight (LW). The four experimental diets were as follows: (1) control, basal diet without supplement; (2) DGF, basal diet + DGF; (3) DCT, basal diet + DCT; and (4) DGF+DCT, basal diet + DGF + DCT. The supplementary feeds were fed to the level of 2 g crude protein (CP)/kg LW in Diets 2 and 3 and 1 g CP/kg LW of each feed in Diet 4. The results indicated that total intake of dry matter (DM), organic matter and CP increased with DGF and DGF+DCT diets, while neutral detergent fibre (NDF) intake was highest in the DGF diet. Digestibilities of DM, organic matter, CP and NDF were improved in DGF and DGF+DCT treatments. However, the diet with DCT supplement had lowest CP and NDF digestibility. Ruminal NH3-N and total volatile fatty acids increased in all diets with supplements, but ruminal pH, volatile fatty acid profile and in sacco losses of DM, CP and NDF of sun-dried para grass in the rumen did not differ among the treatments.
Microstructural properties of the vertical occipital fasciculus explain the variability in human stereoacuity
Authors: Oishi Hiroki , Takemura Hiromasa , Aoki Shuntaro C. , Fujita Ichiro , Amano Kaoru
Published: November 2018

Stereopsis is a fundamental visual function that has been studied extensively. However, it is not clear why depth discrimination (stereoacuity) varies more significantly among people than other modalities. Previous studies have reported the involvement of both dorsal and ventral visual areas in stereopsis, implying that not only neural computations in cortical areas but also the anatomical properties of white matter tracts connecting those areas can impact stereopsis. Here, we studied how human stereoacuity relates to white matter properties by combining psychophysics, diffusion MRI (dMRI), and quantitative MRI (qMRI). We performed a psychophysical experiment to measure stereoacuity and, in the same participants, we analyzed the microstructural properties of visual white matter tracts on the basis of two independent measurements, dMRI (fractional anisotropy, FA) and qMRI (macromolecular tissue volume; MTV). Microstructural properties along the right vertical occipital fasciculus (VOF), a major tract connecting dorsal and ventral visual areas, were highly correlated with measures of stereoacuity. This result was consistent for both FA and MTV, suggesting that the behavioral–structural relationship reflects differences in neural tissue density, rather than differences in the morphological configuration of fibers. fMRI confirmed that binocular disparity stimuli activated the dorsal and ventral visual regions near VOF endpoints. No other occipital tracts explained the variance in stereoacuity. In addition, the VOF properties were not associated with differences in performance on a different psychophysical task (contrast detection). These series of experiments suggest that stereoscopic depth discrimination performance is, at least in part, constrained by dorso-ventral communication through the VOF.
Global impacts of chromosomal imbalance on gene expression in
Arabidopsis
and other taxa
Authors: Hou Jie , Shi Xiaowen , Chen Chen , Islam Md. Soliman , Johnson Adam F. , Kanno Tatsuo , Huettel Bruno , Yen Ming-Ren , Hsu Fei-Man , Ji Tieming , Chen Pao-Yang , Matzke Marjori , Matzke Antonius J. M. , Cheng Jianlin , Birchler James A.
Published: November 2018

Changes in dosage of part of the genome (aneuploidy) have long been known to produce much more severe phenotypic consequences than changes in the number of whole genomes (ploidy). To examine the basis of these differences, global gene expression in mature leaf tissue for all five trisomies and in diploids, triploids, and tetraploids of
Arabidopsis thaliana
was studied. The trisomies displayed a greater spread of expression modulation than the ploidy series. In general, expression of genes on the varied chromosome ranged from compensation to dosage effect, whereas genes from the remainder of the genome ranged from no effect to reduced expression approaching the inverse level of chromosomal imbalance (2/3). Genome-wide DNA methylation was examined in each genotype and found to shift most prominently with trisomy 4 but otherwise exhibited little change, indicating that genetic imbalance is generally mechanistically unrelated to DNA methylation. Independent analysis of gene functional classes demonstrated that ribosomal, proteasomal, and gene body methylated genes were less modulated compared with all classes of genes, whereas transcription factors, signal transduction components, and organelle-targeted protein genes were more tightly inversely affected. Comparing transcription factors and their targets in the trisomies and in expression networks revealed considerable discordance, illustrating that altered regulatory stoichiometry is a major contributor to genetic imbalance. Reanalysis of published data on gene expression in disomic yeast and trisomic mouse cells detected similar stoichiometric effects across broad phylogenetic taxa, and indicated that these effects reflect normal gene regulatory processes.
TRPA1 ankyrin repeat six interacts with a small molecule inhibitor chemotype
Authors: Tseng Wei Chou , Pryde David C. , Yoger Katrina E. , Padilla Karen M. , Antonio Brett M. , Han Seungil , Shanmugasundaram Veerabahu , Gerlach Aaron C.
Published: November 2018

Significance

TRPA1 channels are expressed primarily in sensory neurons with human genetic linkage to pain disorders. Despite the strong confidence for TRPA1 as a therapeutic target, few modulators have advanced to the clinic being hindered by poor physiochemical properties and narrow structure-activity relationships related to their site of interaction. We report the discovery of a potent and selective thiadiazole small molecule class of TRPA1 inhibitor that interacts with the N-terminal ankyrin repeat (ankyrinR) domain. The discovery of this interaction site provides opportunities to broaden TRPA1 small molecule drug discovery for the treatment of pain and adds insight into TRPA1 channel gating mechanisms.
Genetic variant at coronary artery disease and ischemic stroke locus 1p32.2 regulates endothelial responses to hemodynamics
Authors: Krause Matthew D. , Huang Ru-Ting , Wu David , Shentu Tzu-Pin , Harrison Devin L. , Whalen Michael B. , Stolze Lindsey K. , Di Rienzo Anna , Moskowitz Ivan P. , Civelek Mete , Romanoski Casey E. , Fang Yun
Published: November 2018

Biomechanical cues dynamically control major cellular processes, but whether genetic variants actively participate in mechanosensing mechanisms remains unexplored. Vascular homeostasis is tightly regulated by hemodynamics. Exposure to disturbed blood flow at arterial sites of branching and bifurcation causes constitutive activation of vascular endothelium contributing to atherosclerosis, the major cause of coronary artery disease (CAD) and ischemic stroke (IS). Conversely, unidirectional flow promotes quiescent endothelium. Genome-wide association studies (GWAS) have identified chromosome 1p32.2 as strongly associated with CAD/IS; however, the causal mechanism related to this locus remains unknown. Using statistical analyses, assay of transposase accessible chromatin with whole-genome sequencing (ATAC-seq), H3K27ac/H3K4me2 ChIP with whole-genome sequencing (ChIP-seq), and CRISPR interference in human aortic endothelial cells (HAECs), our results demonstrate that rs17114036, a common noncoding polymorphism at 1p32.2, is located in an endothelial enhancer dynamically regulated by hemodynamics. CRISPR-Cas9–based genome editing shows that rs17114036-containing region promotes endothelial quiescence under unidirectional shear stress by regulating phospholipid phosphatase 3 (PLPP3). Chromatin accessibility quantitative trait locus (caQTL) mapping using HAECs from 56 donors, allelic imbalance assay from 7 donors, and luciferase assays demonstrate that CAD/IS-protective allele at rs17114036 in PLPP3 intron 5 confers increased endothelial enhancer activity. ChIP-PCR and luciferase assays show that CAD/IS-protective allele at rs17114036 creates a binding site for transcription factor Krüppel-like factor 2 (KLF2), which increases the enhancer activity under unidirectional flow. These results demonstrate that a human SNP contributes to critical endothelial mechanotransduction mechanisms and suggest that human haplotypes and related
cis
-regulatory elements provide a previously unappreciated layer of regulatory control in cellular mechanosensing mechanisms.
The Impulse to Rhetoric in India: Rhetorical and Deliberative Practices and Their Relation to the Histories of Rhetoric and Democracy
Authors: Lloyd Keith
Published: November 2018

Scholars of rhetoric have long held that there is such a thing as a “rhetorical tradition” and that that tradition began within the context of ancient Athenian democracy. Recently this tradition has been expanded to “traditions” that include “non-Western” approaches. Scholars of democracy have similarly dislodged the notion that democracy, broadly understood, developed only in ancient Greece. This essay expands our understanding of both rhetorical traditions and their relation to democracy by studying the interrelation of rhetorical and deliberative practices found in the history of India. Specifically, it explores how one highly influential school of Indian deliberation, Nyaya, grew alongside practices of public reasoning and self-rule in the gaṇa/saṁgha (so-called ancient Indian “republics”), revealing a similar, but unique, impulse to rhetoric beyond the Athenian/Western context. From this study we also gain insight into the current struggle for democracy worldwide.
The Pluralistic Style and the Demands of Intercultural Rhetoric: Swami Vivekananda at the World’s Parliament of Religions
Authors: Stroud Scott R.
Published: November 2018

Intercultural contexts introduce unique sources of complexity into our theories of rhetoric and persuasion. This study examines one of the most successful cases of intercultural rhetoric concerning religion: the case of Swami Vivekananda, a Hindu monk from India who came to the United States in 1893 for the World’s Parliament of Religions. He arrived as an unknown monk, but he left America years later as the nationally known face of Hinduism. Facing a tense scene in 1893 that featured a plurality of religions and American organizers and audiences who judged Hinduism as inferior to Christianity, Vivekananda enacted a unique rhetoric of pluralism to assert the value of his form of Hinduism while simultaneously respecting other religions. This study extracts from Vivekananda’s popular performance at the parliament a pluralistic style of rhetorical advocacy, one that builds upon his unique reading of Hindu religious-philosophical traditions. This pluralistic style can be used to unravel some of the theoretical issues created by invitational rhetoric’s reading of persuasion as inherently violent to disagreeing others.
Enterprise culture and the ethics of entitlement: How ‘indispensable’ employees turn into disruptive mavericks
Authors: Ekman Susanne
Published: November 2018

This paper contributes to the debate about the enterprise culture by analysing the work ethic among talented employees who are seen as indispensable by their organisations. It describes the drama surrounding the ‘high talent’ IT-consultant Clark, a real individual used as emblematic here, and his quest for power and influence at work. The analysis adds nuance to the claims of both proponents and critics of the enterprise culture by showing how it leads neither to win-win scenarios nor to culturally duped employees. Instead, the enterprise ethic, with its focus on talent and excellence, has produced a group of elite workers who are driven by a sense of entitlement. This leads them to display maverick and disruptive behaviour that endangers the social cohesion of their organisations. But they are still driven by a deep sense of dedication and thus cannot be considered simply self-serving.
On Calabi’s extremal metric and properness
Authors: He Weiyong
Published: November 2018

In this paper we extend a recent breakthrough of Chen and Cheng on the existence of a constant scalar Kähler metric on a compact Kähler manifold to Calabi’s extremal metric. There are no new a priori estimates needed, but rather there are necessary modifications adapted to the extremal case. We prove that there exists an extremal metric with extremal vector

V
V

if and only if the modified Mabuchi energy is proper, modulo the action of the subgroup in the identity component of the automorphism group which commutes with the flow of

V
V

. We introduce two essentially equivalent notions, called reductive properness and reduced properness. We observe that one can test reductive properness/reduced properness only for invariant metrics. We prove that existence of an extremal metric is equivalent to reductive properness/reduced properness of the modified Mabuchi energy.
Clinical outcomes, edoxaban concentration, and anti-factor Xa activity of Asian patients with atrial fibrillation compared with non-Asians in the ENGAGE AF-TIMI 48 trial
Authors: Chao Tze-Fan , Chen Shih-Ann , Ruff Christian T , Hamershock Rose A , Mercuri Michele F , Antman Elliott M , Braunwald Eugene , Giugliano Robert P
Published: November 2018

Aims

Prior studies suggested that the risks of ischaemic stroke and bleeding in patients of Asian race with atrial fibrillation (AF) may be higher than that of non-Asians. In the analysis of ENGAGE AF-TIMI 48 trial, we compared clinical outcomes, edoxaban concentration, and anti-factor Xa (anti-FXa) activity, between Asian and non-Asian races.

Methods and results

There were 2909 patients of Asian race and 18 195 non-Asian race in the ENGAGE AF-TIMI 48 trial. The risks of thromboembolism and bleeding events were compared for Asians and non-Asians treated with warfarin. The trough levels of edoxaban concentration and anti-FXa activity were also compared and correlated with the efficacy and safety of edoxaban vs. warfarin. Compared to non-Asian patients, the Asian population was on average 2 years younger and 20 kg lighter. In the warfarin group, the adjusted risk of ischaemic stroke did not differ significantly for patients of Asian and non-Asian race [adjusted hazard ratio (aHR) = 1.12, P = 0.56). Asians treated with warfarin had a higher-adjusted risk of intracranial haemorrhage (ICH: aHR 1.71, P = 0.03) compared with non-Asians. The trough edoxaban concentration and anti-FXa activity were 20–25% lower for Asians compared with non-Asians. Compared to warfarin, higher dose edoxaban significantly reduced ICH while preserving the efficacy of stroke prevention in both Asians and non-Asians. Two of three net clinical outcomes appeared to be more favourably reduced with edoxaban in Asians compared with non-Asians (P  int = 0.063 for primary, 0.037 for secondary, and 0.032 for third net clinical outcomes, respectively).

Conclusion

Compared to warfarin, higher dose edoxaban preserved the efficacy for stroke prevention and was associated with a favourable safety profile for Asians, which may be due to the lower trough edoxaban concentration and anti-FXa activity achieved in patients of Asian race.
β-blockers, calcium antagonists, and mortality in stable coronary artery disease: an international cohort study
Authors: Sorbets Emmanuel , Steg Philippe Gabriel , Young Robin , Danchin Nicolas , Greenlaw Nicola , Ford Ian , Tendera Michal , Ferrari Roberto , Merkely Bela , Parkhomenko Alexander , Reid Christopher , Tardif Jean-Claude , Fox Kim M ,   for the CLARIFY investigators
Published: November 2018

Aims

The effect of first-line antianginal agents, β-blockers, and calcium antagonists on clinical outcomes in stable coronary artery disease (CAD) remains uncertain.

Methods and results

We analysed the use of β-blockers or calcium antagonists (baseline and annually) and outcomes in 22 006 stable CAD patients (enrolled 2009–2010) followed annually to 5 years, in the CLARIFY registry (45 countries). Primary outcome was all-cause death. Secondary outcomes were cardiovascular death and the composite of cardiovascular death/non-fatal myocardial infarction (MI). After multivariable adjustment, baseline β-blocker use was not associated with lower all-cause death [1345 (7.8%) in users vs. 407 (8.4%) in non-users; hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.84–1.06; P = 0.30]; cardiovascular death [861 (5.0%) vs. 262 (5.4%); HR 0.91, 95% CI 0.79–1.05; P = 0.20]; or cardiovascular death/non-fatal MI [1272 (7.4%) vs. 340 (7.0%); HR 1.03, 95% CI 0.91–1.16; P = 0.66]. Sensitivity analyses according to β-blocker use over time and to prescribed dose produced similar results. Among prior MI patients, for those enrolled in the year following MI, baseline β-blocker use was associated with lower all-cause death [205 (7.0%) vs. 59 (10.3%); HR 0.68, 95% CI 0.50–0.91; P = 0.01]; cardiovascular death [132 (4.5%) vs. 49 (8.5%); HR 0.52, 95% CI 0.37–0.73; P = 0.0001]; and cardiovascular death/non-fatal MI [212 (7.2%) vs. 59 (10.3%); HR 0.69, 95% CI 0.52–0.93; P = 0.01]. Calcium antagonists were not associated with any difference in mortality.

Conclusion

In this contemporary cohort of stable CAD, β-blocker use was associated with lower 5-year mortality only in patients enrolled in the year following MI. Use of calcium antagonists was not associated with superior mortality, regardless of history of MI.
Anti-Ace monoclonal antibody reduces Enterococcus faecalis aortic valve infection in a rat infective endocarditis model
Authors: Singh Kavindra V , Pinkston Kenneth L , Gao Peng , Harvey Barrett R , Murray Barbara E
Published: November 2018

Ace (Adhesin to collagen from Enterococcus faecalis) is a cell-wall anchored protein that is expressed conditionally and is important for virulence in a rat infective endocarditis (IE) model. Previously, we showed that rats immunized with the collagen binding domain of Ace (domain A), or administered anti-Ace domain A polyclonal antibody, were less susceptible to E. faecalis endocarditis than sham-immunized controls. In this work, we demonstrated that a sub nanomolar monoclonal antibody (mAb), anti-Ace mAb70, significantly diminished E. faecalis binding to ECM collagen IV in in vitro adherence assays and that, in the endocarditis model, anti-Ace mAb70 pre-treatment significantly reduced E. faecalis infection of aortic valves. The effectiveness of anti-Ace mAb against IE in the rat model suggests it might serve as a beneficial agent for passive protection against E. faecalis infections.
Filtering strategic coupling: territorial intermediaries in oil and gas global production networks in Southeast Asia
Authors: Breul Moritz , Revilla Diez Javier , Sambodo Maxensius Tri
Published: November 2018

The Global Production Network (GPN) approach has not yet considered the importance of territorial intermediaries for strategic coupling. This article demonstrates how the prospects of strategic coupling for the case of Vietnam and Indonesia with the oil and gas GPN are affected by the gateway role of Singapore. Based on interviews, the analysis reveals how Singapore influences regional economic development along the GPN through different filtering mechanisms, limiting the potential for strategic coupling for Vietnam and Indonesia. For GPN research, the identified filtering mechanisms illustrate how the territoriality of GPNs contributes to differentiated territorial outcomes. The findings therefore indicate the need to intensify the appreciation of the particular territorial configuration of GPNs as this yields considerable explanatory power for understanding the unequal contours of the global economy.
New insights into IgG4-related disease: emerging new CD4+ T-cell subsets
Authors: Kamekura Ryuta , Takahashi Hiroki , Ichimiya Shingo
Published: November 2018

Purpose of review

New insights into IgG4-related disease (IgG4-RD) have recently been obtained. A better understanding of the mechanisms underlying this disease is important for identification of therapeutic targets, which will lead to the development of specific strategies for treatment.

Recent findings

Infiltration of activated T follicular helper (Tfh) cells is observed in affected tissues of IgG4-RD. Such Tfh cells have a greater capacity than tonsillar Tfh cells to help B cells produce IgG4. Circulating PD-1hiCXCR5- peripheral T helper (Tph)-like cells are also increased in patients with IgG4-RD. Because Tph-like cells express high levels of chemokine receptors and granzyme A, they have the capacity to infiltrate affected tissues and exert a cytotoxic function. Tph-like cells can also produce CXCL13, and CXCR5+ Tfh cells and B cells are therefore preferentially recruited to form ectopic lymphoid structures in the sites. Tph cells may have a role to ignite inflammation and maintain persistent fibroinflammation in collaboration with Tfh cells in lesions of IgG4-RD.

Recent advances in understanding the pathogenesis of IgG4-RD are remarkable. In this review, we summarize and discuss the possible pathologic role of CD4+ T-cell subsets in IgG4-RD.
Satisfactory Response With Achieving Maintenance Low-Dose Prednisone in Generalized Myasthenia Gravis
Authors: Abuzinadah Ahmad R. , Jabari Duaa , Jawdat Omar , Pasnoor Mamatha , Glenn Melanie , Herbelin Laura , McVey April L. , Barohn Richard J. , Dimachkie Mazen M.
Published: November 2018

Objectives:

To estimate the satisfactory response rate (SR%) with achieving maintenance, low-dose prednisone in acetylcholine receptor antibody–positive generalized myasthenia gravis.

Methods:

In this retrospective study, we estimate the SR% as defined by (remission/minimal manifestations status for at least 6 months using 7.5 mg or less of prednisone daily, for maintenance treatment at 2, 4, and 6 years after symptoms onset) for patients who were not taking steroid-sparing immunosuppressant (SSI) as a primary outcome and for patients taking an SSI as a secondary outcome.

Results:

Forty-five patients were not taking an SSI at 2 years, 34 patients at 4 years, and 17 patients at 6 years; SR% was 44.4%, 64.7%, and 58.8%, respectively. Thirty-six patients were taking an SSI at 2 years, 22 patients at 4 years, and 15 patients at 6 years; the SR% was 50.0%, 45.4%, and 66.7%, respectively.

Conclusions:

Nearly half of the generalized myasthenia gravis patients who were not taking an SSI achieved an SR.
Gender Differences in Skin Biopsy Findings in Small Fiber Neuropathy: A Retrospective Chart Review
Authors: Weaver Joshua , Kim Kyung-Wha , Carey Bridget T. , Langsdorf Jennifer A. , Chin Russell L.
Published: November 2018

Objectives:

To determine whether there are gender differences in the clinical presentation or skin biopsy measures of nerve fiber density in patients with small fiber neuropathy (SFN).

Methods:

Retrospective chart review of subjects with suspected SFN.

Results:

Of 218 cases (137 women and 81 men) with suspected SFN, 96 (44%), including 63% of the men and 33% of the women (P < 0.05), had low epidermal nerve fiber density (ENFD) or sweat gland nerve fiber density (SGNFD). There were no differences in the clinical presentation between men and women. In those with abnormal findings, low ENFD alone was more frequent in women than men (51.1% vs. 7.8%, P < 0.05), whereas abnormal SGNFD alone was more frequent in men than women (68.6% vs. 11.1%, P < 0.05). Both SGNFD and ENFD were low in 23.5% of men and 33.3% of women. Skin biopsy findings were independent of clinical presentation or etiology.

Conclusions:

The clinical presentation of SFN is similar in men and women. In skin biopsy studies, low ENFD is more common in women and low SGNFD in men.
Toxic Myopathy due to Antidopaminergic Medication Without Neuroleptic Malignant Syndrome
Authors: Harada Yohei , Virmani Tuhin , Gokden Murat , Stefans Vikki
Published: November 2018

Severe recurrent proximal muscle weakness without neuroleptic malignant syndrome secondary to antidopaminergic medication has rarely been reported. We report a 29-year-old man with history of obsessive compulsive disorder and Tourette syndrome who presented with 2 months of worsening dyspnea 3 weeks after starting ziprasidone 40 mg daily that required mechanical ventilation. A year before, after an increased risperidone dose from 0.5 to 1 mg daily, he had developed proximal muscle weakness that spontaneously improved 2 months after discontinuation of risperidone. On this admission, his creatine kinase (CK) was 3318 units/L, and ziprasidone was discontinued. He fully recovered 2 months after discontinuation of ziprasidone, and his CK was 62 units/L. Genetic testing for limb–girdle muscular dystrophy was negative. This case highlights the importance of evaluating CK level in patients taking antidopaminergic medication with any suggestion of muscle weakness to prevent potentially life-threatening complication.
Maternal Social and Economic Factors and Infant Morbidity, Mortality, and Congenital Anomaly
Authors: Kosowan Leanne , Mignone Javier , Chartier Mariette , Piotrowski Caroline
Published: November 2018

Experiences during infancy create durable and heritable patterns of social deprivation and illness producing health disparities. This retrospective cohort study of 71 836 infants from Winnipeg, Manitoba, assessed associations between maternal social and economic factors and infant mortality, morbidity, and congenital anomaly. This study found that newborn and postneonatal hospital readmissions are inversely associated with geography. Additionally, social context, including maternal history of child abuse, is associated with infant postneonatal hospital readmissions. Geography and education are associated with infant mortality. Income was not associated with infant mortality or morbidity following adjustment for social support. Interestingly, congenital anomaly rates are 1.2 times more common among 2 parent families and male infants. Understanding associations between infant health and maternal social and economic factors may contribute to interventions and policies to improve health equity.
Reconstruction of Complex Maxillary Defects Using Patient-specific 3D-printed Biodegradable Scaffolds
Authors: Han Hyun Ho , Shim Jin-Hyung , Lee Hyungseok , Kim Bo Young , Lee Jeong-Seok , Jung Jin Woo , Yun Won-Soo , Baek Chung Hwan , Rhie Jong-Won , Cho Dong-Woo
Published: November 2018

Reconstruction of maxilla defects has remained one of the most challenging problems in craniomaxillofacial reconstruction because it typically requires harvesting and grafting of autologous bone, which poses limitations related to the difficulties in accurately reconstructing the defected bone and the highly prolonged duration of surgery. We employed tissue-engineered, patient-specific, 3-dimensional (3D)-printed biodegradable scaffolds for maxillofacial bone reconstruction in patients with complex maxillary defects after surgical removal of cancer. A customized polycaprolactone (PCL) scaffold was designed and fabricated for each patient. For this purpose, we used computer-aided design and manufacturing combined with 3D printing technology. The patients implanted with the PCL scaffolds were followed up for up to 2 years with careful evaluation of morphological changes in the face. We confirmed that the patient-specific 3D-printed PCL scaffold effectively filled the maxillary defect and promoted regeneration of the deficient tissue while remaining stable in the body for a relatively long period. Employing customized tissue-engineered scaffolds built using the patient’s computed tomography data and an extrusion-based 3D printing system is safe and clinically feasible, helping create and maintain improved morphological features of the face, which represents the most important aspect from the perspective of the patients.
Building a Resilient Workforce: Promoting Joy in Clinical Care
Authors: West Page , Gee Perry M.
Published: November 2018

At Dignity Health, one of the nation’s largest healthcare systems, we believe that all people deserve access to quality medical care regardless of their background, ethnicity, or circumstances. Healing is our calling, and “Hello humankindness” is our brand purpose, which supports our mission to deliver compassionate, high-quality, and affordable patient-centered care with special attention to the poor and underserved. Through teamwork and innovation, faith and compassion, and advocacy and action, we endeavor every day to keep our patients and staff members healthy and fulfilled. This article highlights efforts at Dignity Health to reduce burnout and increase resilience in our employees. Our team is focusing on evidence-based interventions and strategic partnerships to tackle these complicated issues.
Microbiological Evaluation of Bandage Soft Contact Lenses Used in Management of Persistent Corneal Epithelial Defects
Authors: Feizi Sepehr , Masoudi Ali , Hosseini Seyed-Bagher , Kanavi Mozhgan Rezaei , Javadi Mohammad Ali
Published: November 2018

Purpose:

To investigate the rate and agents of contamination in bandage soft contact lenses fitted for management of persistent corneal epithelial defects.

Methods:

This prospective comparative case series enrolled 57 consecutive eyes fitted with bandage contact lenses for treatment of persistent corneal epithelial defects. The lenses were collected at the time of epithelial closure or when it was necessary to exchange contact lenses and were immediately placed in sterile tubes containing an enriched thioglycolate liquid medium. When contamination of the contact lens was detected, the microorganism was cultured in different media and identified based on various tests. All isolates were tested for susceptibility to various antibiotics. Univariate analyses were used to evaluate the influence of different variables (duration of contact lens use, use of topical corticosteroids, presence of blepharitis, contact lens deposits, and presence of sutures) on bandage contact lens contamination.

Results:

Seventeen of the contact lenses (29.8%) were contaminated. The most commonly isolated pathogen was Staphylococcus epidermidis (n = 10), followed by Enterobacter cloacae (n = 3), Staphylococcus aureus (n = 1), Streptococcus viridans (n = 1), and Alcaligenes spp. (n = 1). One contact lens yielded a mixed infection with E. cloacae and Candida spp. Infectious keratitis was not observed in any eyes. Correlations between contact lens contamination and patient- and lens-related variables were not statistically significant.

Conclusions:

Most bandage contact lenses (70.2%) used for treatment of persistent corneal epithelial defects did not show bacterial growth. Staphylococcus epidermidis was the most common microorganism isolated from the contaminated contact lenses.
Do Hospital and Physician Volume Thresholds for the Volume-Outcome Relationship in Heart Failure Exist?
Authors: Chou Ying-Yi , Yu Tsung-Hsien , Tung Yu-Chi
Published: November 2018

Background:

Although volume-outcome relationships have been explored for various procedures and interventions, limited information is available concerning the effect of hospital and physician volume on heart failure mortality. Most importantly, little is known about whether there are optimal hospital and physician volume thresholds to reduce heart failure mortality.

Objectives:

We used nationwide population-based data to identify the optimal hospital and physician volume thresholds to achieve optimum mortality and to examine the relative and combined effects of the volume thresholds on heart failure mortality.

Methods:

We analyzed all 20,178 heart failure patients admitted in 2012 through Taiwan’s National Health Insurance Research Database. Restricted cubic splines and multilevel logistic regression were used to identify whether there are optimal hospital and physician volume thresholds and to assess the relative and combined relationships of the volume thresholds to 30-day mortality, adjusted for patient, physician, and hospital characteristics.

Results:

Hospital and physician volume thresholds of 40 cases and 15 cases a year, respectively, were identified, under which there was an increased risk of 30-day mortality. Patients treated by physicians with previous annual volumes <15 cases had higher 30-day mortality compared with those with previous annual volumes ≥15 cases, and the relationship was stronger in hospitals with previous annual volumes <40 cases.

Conclusions:

This is the first study to identify both the hospital and physician volume thresholds that lead to decreases in heart failure mortality. Identifying the hospital and physician volume thresholds could be applied to quality improvement and physician training.
Sexuality in Muslim Women With Gynecological Cancer
Authors: Serçekuş Ak Pinar , Partlak Günüşen Neslihan , Göral Türkcü Sinem , Özkan Sevgi
Published: November 2018

Background

Sexuality is a multidimensional subject that can be negatively affected after a diagnosis of gynecological cancer.

Objective

The aim of this study was to reveal what sexuality difficulties Muslim women with gynecological cancers experience and how they overcome them.

Interventions/Methods

A qualitative approach was used. Data were gathered through semistructured interviews and analyzed by using a content analysis method. Eighteen Muslim women with gynecological cancers participated in the study.

Results

The study findings were grouped into 3 major categories: situations that make sexual life difficult, impact of cancer on sexual life, and coping.

Conclusions

Women with gynecological cancers experience sexual reluctance, orgasmic incapacity, lack of enjoyment of sexual intercourse, and decreased frequency of sexual intercourse. In individuals with cancer, social support is important to facilitate coping; however, some women do not receive sufficient support. Women who consider sexuality to be a taboo topic and feel shame about asking sexuality-related questions are not likely to seek or receive relevant information from health professionals.

Implications for Practice

Health professionals should provide information to women diagnosed with gynecological cancers about changes that they are likely to experience in their bodies and possible difficulties in sexuality. These women should be encouraged to talk about their sexual problems, and religious and cultural differences should be reflected in their cancer care.
Prospective Patterns of Help-Seeking Behavior Among Military Veterans With Probable Posttraumatic Stress Disorder and Major Depressive Disorder
Authors: Currier Joseph M. , McCormick Wesley H. , Carroll Timothy D. , Sims Brook M. , Isaak Steven L.
Published: November 2018

This study examined help-seeking behavior from professional, informal, and religious sources in veterans with a probable need for treatment. In total, 93 veterans who screened positive for posttraumatic stress disorder/major depressive disorder completed assessments of help-seeking at two time points spaced apart by 6 months. Less than half (40%) reached out to a mental health professional or physician; only 1 in 10 engaged with providers who specialize in evidence-based therapies to a minimally adequate degree. Although roughly two thirds pursued help from informal sources, less than 10% similarly sought help nine or more times. Veterans with high willingness to seek help from specific sources at baseline were more likely to report sustained engagement in help-seeking behavior along these same lines at follow-up. Assessing veterans' help-seeking intentions may add prognostic value in predicting engagement in services. Veterans may also benefit from tailoring service delivery models according to preferred sources of help in their families and communities.
Scurvy—Characteristic Features and Forensic Issues
Authors: Byard Roger W. , Maxwell-Stewart Hamish
Published: November 2018

Scurvy is a multisystem condition that arises from vitamin C deficiency. As humans cannot synthesize vitamin C, serum and tissue levels depend on bioavailability, utilization, and renal excretion. Deficiencies result in defective collagen formation with swelling of gums, leg ulceration, and bleeding manifestations. Death most often results from infection and hemorrhage. In a forensic context, scurvy may mimic inflicted injuries and may be responsible for sudden death by mechanisms that remain unclear. Cardiac failure and rhythm disturbances with chest pain, hypotension, cardiac tamponade, and dyspnea are associated with vitamin C deficiency. In addition, syncope and seizures may occur. Although far less common than in previous centuries, scurvy is still present in high-risk populations that include alcoholics, isolated elderly individuals, food faddists, institutionalized patients, those with mental illness, and those who have had bariatric surgery or with underlying gastrointestinal conditions. Scurvy should therefore be a diagnosis to consider in medicolegal cases of apparent trauma and sudden death.
Assessment of Pelvic Floor Anatomy for Male-to-Female Vaginoplasty and the Role of Physical Therapy on Functional and Patient-Reported Outcomes
Authors: Manrique Oscar J. , Adabi Kian , Huang Tony Chieh-Ting , Jorge-Martinez Jorys , Meihofer Laura E. , Brassard Pierre , Galan Ricardo
Published: November 2018

Background

Rapid increase in number of male-to-female vaginoplasties emphasizes the need for preoperative measures to optimize final surgical and patient-reported outcomes. Hormonal therapy and socioeconomic factors may contribute to a higher incidence of pelvic floor dysfunction in patients undergoing male-to-female vaginoplasty. The purpose of this study was to evaluate the incidence of pelvic floor dysfunction in this population and the role of physical therapy in its treatment.

Methods

From July 2016 to July 2018, patients scheduled to undergo male-to-female vaginoplasty were evaluated by a physical therapist for pelvic floor dysfunction. Patient charts were reviewed for demographics, comorbidities, and length of hormonal therapy. Those with and without symptoms were compared. Symptomatic patients underwent therapy. Assessment of symptom severity and its impact on daily living were completed at 2- to 3-month intervals with physical therapy using the 6-item Urinary Distress Index 6 and 8-item Colorectal Anal Distress Index components of the 20-item Pelvic Floor Distress Inventory (PFDI-20) before and after surgery. A third component of the PFDI-20, the 6-item Pelvic Organ Prolapse Distress Inventory, was also included in the postoperative assessment.

Results

Over a 24-month period, a total of 40 patients with a mean age of 40.7 (19–72) years and body mass index of 27.1 kg/m2(22–39 kg/m2) were enrolled. Comorbidities included 4 patients (10%) with diabetes and 6 patients (15%) with hypertension. Patients with symptoms had a significantly higher mean age (P< 0.01). Only 1 patient (2.5%) had new-onset pelvic floor dysfunction after surgery, and there was no significant increase in severity of symptoms in those with a previous pelvic floor dysfunction postoperatively. Physical therapy significantly (P< 0.01) reduced severity of symptoms and its impact on daily living as assessed by the Urinary Distress Index and Colorectal Anal Distress Index before and after surgery and by the PFDI-20 and 7-item Pelvic Floor Dysfunction Index postoperatively.

Conclusions

A high incidence of pelvic floor dysfunction may exist in patients undergoing male-to-female vaginoplasty preoperatively. Screening at this early stage with both preoperative and postoperative therapy can significantly reduce pelvic floor dysfunction and improve symptoms and quality of life for this population.
Nipple-sparing Mastectomy and Immediate Breast Reconstruction After Recurrence From Previous Breast Conservation Therapy
Authors: Lee Che-Hsiung , Cheng Ming-Huei , Wu Chih-Wei , Kuo Wen-Ling , Yu Chi-Chang , Huang Jung-Ju
Published: November 2018

Purpose

Breast conservation therapy (BCT) is widely accepted for breast cancer treatment. Nipple-sparing mastectomy has been newly developed to preserve the nipple-areolar complex and enhance aesthetic results. The purpose of this study was to evaluate the oncological safety and results of nipple-sparing mastectomy (NSM) after previous BCT.

Methods

Eighteen patients who received NSM and immediate breast reconstruction for local recurrence after BCT were identified. An additional 127 affected breasts with NSM and immediate breast reconstruction for primary breast cancer were selected as the control group. The patient disease status, reconstructive method, postoperative complications, and oncological outcome were investigated.

Results

No apparent significant differences between the 2 groups were found regarding patient demographic data, tumor stage, reconstructive method, surgical complication, or tumor recurrence rate (all P values >0.05), except preoperative radiotherapy was higher in secondary NSM group (0% vs 77.8%, P < 0.001). The further nipple and secondary deep inferior epigastric artery perforator flap reconstruction rate was higher in the secondary NSM group (11.1% vs 0.8%, P = 0.041 and 16.7% vs 2.4%, P = 0.026, respectively).

Conclusions

Prior BCT did not contribute to higher surgical complications in patients who received NSM and immediate reconstruction as a salvage procedure after tumor local recurrence. The oncological safety, general surgical result, and postoperative patient-reported satisfaction remain safe and reliable despite prior ipsilateral surgery and radiation. Care should be taken for possible higher nipple necrosis in the secondary NSM patients.
Sparse identification of nonlinear dynamics for model predictive control in the low-data limit
Authors: Kaiser E. , Kutz J. N. , Brunton S. L.
Published: November 2018

Data-driven discovery of dynamics via machine learning is pushing the frontiers of modelling and control efforts, providing a tremendous opportunity to extend the reach of model predictive control (MPC). However, many leading methods in machine learning, such as neural networks (NN), require large volumes of training data, may not be interpretable, do not easily include known constraints and symmetries, and may not generalize beyond the attractor where models are trained. These factors limit their use for the online identification of a model in the low-data limit, for example following an abrupt change to the system dynamics. In this work, we extend the recent sparse identification of nonlinear dynamics (SINDY) modelling procedure to include the effects of actuation and demonstrate the ability of these models to enhance the performance of MPC, based on limited, noisy data. SINDY models are parsimonious, identifying the fewest terms in the model needed to explain the data, making them interpretable and generalizable. We show that the resulting SINDY-MPC framework has higher performance, requires significantly less data, and is more computationally efficient and robust to noise than NN models, making it viable for online training and execution in response to rapid system changes. SINDY-MPC also shows improved performance over linear data-driven models, although linear models may provide a stopgap until enough data is available for SINDY. SINDY-MPC is demonstrated on a variety of dynamical systems with different challenges, including the chaotic Lorenz system, a simple model for flight control of an F8 aircraft, and an HIV model incorporating drug treatment.
Early bursts of disparity and the reorganization of character integration
Authors: Wagner Peter J.
Published: November 2018

‘Early bursts' of morphological disparity (i.e. diversity of anatomical types) are common in the fossil record. We typically model such bursts as elevated early rates of independent character change. Developmental theory predicts that modules of linked characters can change together, which would mimic the effects of elevated independent rates on disparity. However, correlated change introducing suboptimal states should encourage breakup (parcellation) of character suites allowing new (or primitive) states to evolve until new suites arise (relinkage). Thus, correlated change–breakup–relinkage presents mechanisms for early bursts followed by constrained evolution. Here, I analyse disparity in 257 published character matrices of fossil taxa. For each clade, I use inverse-modelling to infer most probably rates of independent change given both time-homogeneous and separate ‘early versus late' rates. These rates are used to estimate expected disparity given both independent change models. The correlated change–breakup–relinkage model also predicts elevated frequencies of compatible character state-pairs appearing out of order in the fossil record (e.g. 01 appearing after 00 and 11; = low stratigraphic compatibility), as one solution to suboptimal states induced by correlated change is a return to states held before that change. As predicted by the correlated change–breakup–relinkage model, early disparity in the majority of clades both exceeds the expectations of either independent change model and excess early disparity correlates with low stratigraphic compatibility among character-pairs. Although it is possible that other mechanisms for linking characters contribute to these patterns, these results corroborate the idea that reorganization of developmental linkages is often associated with the origin of groups that biologists recognize as new higher taxa and that such reorganization offers a source of new disparity throughout the Phanerozoic.
Calcium transfer across the outer mantle epithelium in the Pacific oyster,Crassostrea gigas
Authors: Sillanpää J. Kirsikka , Sundh Henrik , Sundell Kristina S.
Published: November 2018

Calcium transport is essential for bivalves to be able to build and maintain their shells. Ionized calcium (Ca2+) is taken up from the environment and eventually transported through the outer mantle epithelium (OME) to the shell growth area. However, the mechanisms behind this process are poorly understood. The objective of the present study was to characterize the Ca2+transfer performed by the OME of the Pacific oyster,Crassostrea gigas,as well as to develop an Ussing chamber technique for the functional assessment of transport activities in epithelia of marine bivalves. Kinetic studies revealed that the Ca2+transfer across the OME consists of one saturable and one linear component, of which the saturable component fits best to Michaelis–Menten kinetics and is characterized by aKmof 6.2 mM and aVmaxof 3.3 nM min−1. The transcellular transfer of Ca2+accounts for approximately 60% of the total Ca2+transfer across the OME ofC. gigas at environmental Ca2+concentrations. The use of the pharmacological inhibitors: verapamil, ouabain and caloxin 1a1 revealed that voltage-gated Ca2+-channels, plasma-membrane Ca2+-ATPase and Na+/Ca2+-exchanger all participate in the transcellular Ca2+transfer across the OME and a model for this Ca2+transfer is presented and discussed.