bluuebunny/crossref_metadata_2025 huggingface dataset:
The Crisis of Sovereignty, Ruptured Domination, and the Kurdish Quest for Democratic Self-Government in Syria
Authors: Vali Abbas
Published: January 2019

Despite the consensus that both the political crisis in Syria and the emergence of the Kurdish autonomous region have serious implications for the viability of the nation-state in Syria, no attempt has been made to provide a theoretical explanation worthy of the name. Informed discussions of the crisis and its likely outcomes often resort to political history in order to trace the roots of a chronic crisis of legitimacy, identified as the primary cause of the current crisis. Syria, this chapter argues, is gripped by a crisis of sovereignty, signified by a rupture in the structure of domination necessary to ensure the reproduction of state power and the working of the apparatuses created to sustain its effective exercise and application. The rupture runs deep in the tissue of sovereign power, ripping open its legal façade and going down to its violent core. It lays bare the founding act of the state, an act of pure violence which is also the moment of the birth of the stateless, the suppressed other of the sovereign. In this sense, therefore, the rupture is the intersection of crisis of sovereignty and the Kurdish quest for democratic autonomy; they are interrelated, historically and logically.
Queer Patriotism in the Eurovision Song Contest
Authors: Raykoff Ivan
Published: January 2019

The Eurovision Song Contest, the long-running annual televised popular music show watched by millions of viewers around the world, was first broadcast in the United States in 2016, six decades after its founding in 1956. This considerable delay reflects the musical tastes of American audiences, but even more significantly, it reveals how ideals of national belonging and expressions of patriotism operate very differently in the United States than in contemporary Europe. Through its songs, performers, and rituals, Eurovision plays with notions of the nation-state in ways that call into question conventionally heteronormative and particularly American experiences of national identity and patriotic feeling. Considering Dana International’s 1998 win for Israel, the drag acts of Sestre for Slovenia in 2002 and Verka Serduchka for Ukraine in 2007, Marija Šerifović’s win for Serbia in 2007, and Conchita Wurst’s victory for Austria in 2014, this chapter explores how Eurovision enacts an alternative patriotism through a deliberate crossing and queering of national and sexual identities. This dynamic of “queer patriotism” is one reason that this song contest is so often dismissed by those who resist a more progressive and inclusive notion of global belonging.
Out in the Undercurrents
Authors: Chow Yiu Fai , Kloet Jeroen de
Published: January 2019

Queer culture in Hong Kong was characterized by a playful politics of invisibility, opacity, and ambivalence, proposed as a queer alternative to the confrontational, identity-based politics often advocated in the West. The coming out of pop star Anthony Wong and other celebrities in 2012 marks a turning point. Taking Hong Kong as a lens, this chapter investigates the articulation between sexuality and popular music in the context of China. It traces the emergence of a Chinese movement to find postcolonial, indigenous—tongzhi, ku’er—ways of understanding sexual diversity, leading to the disruptive surprise of public figures coming out, apparently in accordance with Western models and in contrast to earlier local sexual politics of ambivalence and invisibility. The discussion presents an inquiry into global queer theory and local popular music cultures, showing how the latter holds the potential to upset, or at least surprise, the conceptual premises of the former.
Boscalid Resistance inBlumeriella jaapii: Distribution, Effect on Field Efficacy, and Molecular Characterization
Authors: Outwater Cory A. , Proffer Tyre J. , Rothwell Nikki L. , Peng Jingyu , Sundin George W.
Published: January 2019

Cherry leaf spot (CLS), caused by the fungus Blumeriella jaapii, is a major disease of tart cherry (Prunus cerasus L.) trees, leading to early defoliation that results in uneven ripening and poor fruit quality in the current season, reduced fruit set in the following season, and increased potential for winter injury and tree death. Pristine (BASF Corporation, Research Triangle Park, NC), a commonly used fungicide for CLS management in Michigan, is a premix of boscalid, a succinate dehydrogenase inhibitor, and pyraclostrobin, a quinone outside inhibitor. Reduced efficacy of Pristine for CLS control was observed in field trials and commercial orchards and highlights the importance of fungicide resistance monitoring. A total of 1,189 isolates from 31 commercial orchards in Michigan, 111 isolates from nontreated trees (four locations in Michigan and two locations in Ohio), and 133 isolates from a research orchard were collected during 2010, 2011, and 2012 and assayed on boscalid-amended media at concentrations ranging from 0 to 25 μg ml−1. Because of the very slow growth rate of B. jaapii in culture, we determined the minimum inhibitory concentration (MIC) of boscalid as opposed to the effective concentration that inhibits mycelial growth to 50% of the control. Isolates from nontreated trees had MIC values ranging from 0.1 to 0.5 μg ml−1; the MIC of isolates from commercial orchards ranged from 0.1 to >25 μg ml−1, and isolates from the research orchard ranged from 2.5 to >25 μg ml−1. Isolates with MIC values ≥25 μg ml−1were considered boscalid resistant and comprised 0% of the nontreated isolates, 30.4% of the commercial isolates, and 42.1% of the research orchard isolates. Sequencing of the sdhB gene of resistant isolates led to the detection of the amino acid mutation H260R, which is known to confer boscalid resistance in other phytopathogenic fungi. Our results indicate that the occurrence of the H260R mutation in Michigan populations of B. jaapii is correlated with the reduction in sensitivity to boscalid observed in commercial orchards.
Early diagnosis and treatment of familial hypercholesterolemia
Authors: Elkins J. Casey , Fruh Sharon
Published: January 2019

If undiagnosed and untreated, familial hypercholesterolemia can lead to serious cardiac complications, such as premature atherosclerotic cardiovascular disease. NPs should be familiar with the clinical presentation of this inherited metabolic disease to diagnose patients as early as possible and promptly begin treatment that may include lifestyle changes, statin therapy, and/or nonstatin therapy.
Evidence-based updates to the 2016 Surviving Sepsis Guidelines and clinical implications
Authors: Lehman Karen D.
Published: January 2019

Despite numerous advances in understanding the pathophysiology of sepsis and its treatment, sepsis morbidity and mortality remain high. The 2016 Surviving Sepsis Campaign guidelines incorporated the latest research to formulate new sepsis diagnoses and updated treatment recommendations. This article reviews how to manage patients with sepsis and provides insight into the 2016 guidelines, updates, and suggestions.
Safety of the Balloon Catheter for Cervical Ripening in Outpatient Care: Complications During the Period From Insertion to Expulsion of a Balloon Catheter in the Process of Labour Induction: A Systematic Review
Authors: Diederen M. , Gommers J. S. M. , Wilkinson C. , Turnbull D. , Mol B. W. J.
Published: January 2019

(Abstracted from BJOG 2018;125:1086–1095)

It has been suggested that cervical ripening with a balloon catheter for labor induction can be done in an outpatient setting in low-risk pregnancies. Introduction of such an approach needs to be accompanied with monitoring of potential complications.
Labor Induction Versus Expectant Management in Low-Risk Nulliparous Women
Authors: Grobman William A. , Rice Madeline M. , Reddy Uma M. , Tita Alan T. N. , Silver Robert M. , Mallett Gail , Hill Kim , Thom Elizabeth A. , El-Sayed Yasser Y. , Perez-Delboy Annette , Rouse Dwight J. , Saade George R. , Boggess Kim A. , Chauhan Suneet P. , Iams Jay D. , Chien Edward K. , Casey Brian M. , Gibbs Ronald S. , Srinivas Sindhu K. , Swamy Geeta K. , Simhan Hyagriv N. , Macones George A.
Published: January 2019

(Abstracted from N Engl J Med 2018;379:513–523)

The perinatal and maternal consequences of induction of labor at 39 weeks among low-risk nulliparous women are uncertain. The ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management) was designed to test the hypothesis that elective induction of labor at 39 weeks would result in a lower risk of a composite outcome of perinatal death or severe neonatal complications than expectant management among low-risk nulliparous women.
Resolution of a Low-Lying Placenta and Placenta Previa Diagnosed at the Midtrimester Anatomy Scan
Authors: Durst Jennifer K. , Tuuli Methodius G. , Temming Lorene A. , Hamilton Owen , Dicke Jeffrey M.
Published: January 2019

(Abstracted from J Ultrasound Med 2018;37:2011–2019)

Placenta previa or low-lying placenta is identified on a significant number of midtrimester ultrasounds (USs), and the large majority of these resolve by term. While guidelines recommend follow-up US at 32 weeks' gestation to assess for resolution of midtrimester previa, limited data exist to support this recommendation.
Use of a Total Leg Fillet Flap to Cover Multiple Pelvic Pressure Ulcers
Authors: Georgiou Iakovos , Kruppa Philipp , Ghods Mojtaba
Published: January 2019

The authors present the surgical strategy in the treatment of a morbidly obese paraplegic patient with a massive sacral pressure ulcer as well as bilateral trochanteric ulcers in a 1-step leg-sacrificing procedure utilizing the “spare-part” concept. It is the intention of the authors to reinforce the use of fillet flaps as a last resort option in paraplegic patients with pressure sores.
The Effects of Optic Nerve Head Tilt on Visual Field Defects in Myopic Normal Tension Glaucoma: The Intereye Comparison Study
Authors: Choi Jae Hwan , Han Jong Chul , Kee Changwon
Published: January 2019

Purpose:

To evaluate whether optic nerve head (ONH) tilt has relations with the visual field (VF) defect in myopic normal tension glaucoma (NTG).

Materials and Methods:

Comparisons of variables were performed between less and more advanced VF defect groups in bilateral myopic NTG. Vertical, horizontal, maximal ONH tilt angles and angular location of maximal ONH tilt were measured using fundus photography and spectral-domain optical coherence tomography. Logistic regression analysis was performed to evaluate variables associated with more advanced VF defect in bilateral myopic NTG.

Results:

In total, 112 patients who have bilateral myopic NTG were included. Significant correlation was found between horizontal ONH tilt angle and angular location of maximal ONH tilt (R=0.45; P<0.001). In logistic regression analysis, a larger number of medications, greater horizontal ONH tilt, and greater angular location of maximal ONH tilt were associated with more advanced VF defect in myopic NTG (P=0.004, 0.014, 0.037, respectively). The location of VF defect was associated with the horizontal ONH tilt direction and angular location of maximal ONH tilt (κ=0.63, P<0.001; κ=0.48, P<0.001, respectively).

Conclusions:

The horizontal ONH tilt and angular location of maximal ONH tilt correlated with the severity and location of VF defects in myopic NTG eyes.
The Effect of Acetazolamide and Weight Loss on Intraocular Pressure in Idiopathic Intracranial Hypertension Patients
Authors: Banik Rudrani , Kupersmith Mark J. , Wang Jui-Kai , Garvin Mona K.
Published: January 2019

Purpose:

Acetazolamide (ACZ) lowers intraocular pressure (IOP), acutely in normal eyes and both acutely and chronically in eyes with glaucoma, and cerebrospinal fluid pressure (CSFp), chronically in patients with idiopathic intracranial hypertension (IIH). We hypothesize chronic daily ACZ would significantly reduce IOP and contribute to a translaminar pressure gradient change reflected by alteration in the CSFp-IOP difference and the deformation of the neural canal in patients with IIH and no glaucoma.

Patients and Methods:

Before randomization to ACZ or placebo treatment for 6 months, 165 participants in the IIH Treatment Trial had evaluations that included Goldmann applanation, CSFp measurement, and optical coherence tomography determination of the neural canal deformation. These measures were repeated at the 6-month outcome.

Results:

The IOP was not significantly decreased from baseline at 1, 3, or 6 months in eyes in both treatment groups. At month 6, the amount of ACZ or weight modification did not correlate with any IOP change. The 6-month mean change in neural canal deformation was 0.96 and −0.04 (P=0.001) and in CSFp was −128 and −38 mm H2O (P=0.001), but CSFp-IOP difference change was not significant, in the ACZ and placebo groups, respectively.

Conclusions:

ACZ does not reduce the IOP in eyes without glaucoma but does decrease the pathologic elevated CSFp, providing evidence that normal systems can compensate for chronic medication effects. The CSFp-IOP is not a direct marker of translaminar pressure gradient and the ACZ normalization of the neural canal deformation appears due to CSFp reduction alone.
Clinical utility of urinary neutrophil gelatinase-associated lipocalin and serum cystatin C in a cohort of liver cirrhosis patients with renal dysfunction: a challenge in the diagnosis of hepatorenal syndrome
Authors: Gomaa Salwa H. , Shamseya Mohammed M. , Madkour Marwa A.
Published: January 2019

Objectives

This study aimed to assess urinary neutrophil gelatinase-associated lipocalin (uNGAL) and serum cystatin C (sCys C) in liver cirrhosis patients with renal dysfunction and to evaluate their role in the diagnosis of the hepatorenal syndrome (HRS).

Patients and methods

Forty-five liver cirrhosis patients were enrolled in the study and they were divided into three groups; the first group included 15 patients with normal renal function, the second group included 15 patients with HRS; and the third group included 15 patients with chronic kidney disease (CKD). There was a fourth group, which included 15 healthy controls. Liver and renal function tests, as well as the estimated glomerular filtration rate were determined. uNGAL was measured using the enzyme-linked immunosorbent assay, and the uNGAL/urinary creatinine concentration (UCC) ratio was calculated. sCys C was measured using the particle-enhanced immunoturbidimetric assay.

Results

The ratios of uNGAL and uNGAL/UCC were the highest among HRS patients. The combined uNGAL/UCC ratio and sCys C improved the sensitivity of diagnosis to 93.33% and specificity to 76.67%, with the highest area under the curve of 0.944, 95% confidence interval of 0.879–1.0 (P<0.001). The three biomarkers could successfully identify HRS at the following cutoffs: 84.94 ng/ml, 0.6 ng/mg, and 1.6 mg/l, respectively. Significant positive correlations were found between uNGAL, uNGAL/UCC ratios as well as sCys C and KDIGO stage in liver cirrhosis patients with CKD.

Conclusion

uNGAL and a better uNGAL/UCC ratio can be used alone or together with serum cystatin C as early biomarkers for HRS among patients with decompensated liver cirrhosis. Moreover, uNGAL, uNGAL/UCC as well as serum cystatin C could aid the prognostic assessment of cirrhotic patients with CKD.
Increase of Tumor Infiltrating γδ T-cells in Pancreatic Ductal Adenocarcinoma Through Remodeling of the Extracellular Matrix by a Hyaluronan Synthesis Suppressor, 4-Methylumbelliferone
Authors: Suto Akiko , Kudo Daisuke , Yoshida Eri , Nagase Hayato , Suto Shinichiro , Mimura Junsei , Itoh Ken , Hakamada Kenichi
Published: January 2019

Objectives

Desmoplastic changes of extracellular matrix (ECM) containing large amounts of hyaluronan (HA) are of interest in chemo- and immunoresistance of pancreatic ductal adenocarcinoma (PDAC). The goal of this study was to evaluate the effects of 4-methylumbelliferone (MU), a selective inhibitor of HA, on ECM and to examine how MU affects adoptive immunotherapy.

Methods

The effect of MU on cell proliferation, HA synthesis and formation of ECM were investigated in four PDAC cell lines. In addition, the cytotoxicity of γδ T-cell-rich peripheral blood mononuclear cells (PBMCs) collected from healthy donors and stimulated with zoledronate and interleukin-2 was examined in the presence of MU. The amount of HA and tumor-infiltrating lymphocytes were also investigated in mice xenograft models.

Results

In vitro, 1.0 mM MU inhibited cell proliferation by 45–70% and HA synthesis by 55–80% in all four PDAC cell lines, and enhanced γδ T-cell-rich PBMC-mediated cytotoxicity against PDAC cells. In vivo, MU reduced intratumoral HA and promoted infiltration of inoculated γδ T-cells into tumor tissue, and consequently suppressed tumor growth.

Conclusions

4-methylumbelliferone may be an effective immunosensitizer against PDAC through induction of structural changes in the ECM.
Progressive Resistance Training to Impact Physical Fitness and Body Weight in Pancreatic Cancer Patients
Authors: Wiskemann Joachim , Clauss Dorothea , Tjaden Christine , Hackert Thilo , Schneider Lutz , Ulrich Cornelia M. , Steindorf Karen
Published: January 2019

Objectives

Maintaining or improving muscle mass and muscle strength is an important treatment goal in pancreatic cancer (PC) patients because of high risk of cachexia. Therefore, we assessed feasibility and effectivity of a 6-month progressive resistance training (RT) in PC patients within a randomized controlled trial.

Methods

Sixty-five PC patients were randomly assigned to either supervised progressive RT (RT1), home-based RT (RT2), or usual care control group (CON). Both exercise groups performed training 2 times per week for 6 months. Muscle strength for knee, elbow, and hip extensors and flexors and cardiorespiratory fitness and body weight were assessed before and after the intervention period.

Results

Of 65 patients, 43 patients were analyzed. Adherence rates were 64.1% (RT1) and 78.4% (RT2) of the prescribed training sessions. RT1 showed significant improvements in elbow flexor/extensor muscle strength and in maximal work load versus CON and RT2 (P < 0.05). Further, knee extensors were significantly improved for RT1 versus CON (P < 0.05). Body weight revealed no significant group differences over time.

Conclusions

Progressive RT was feasible in PC patients and improved muscle strength with significant results for some muscle groups. Supervised RT seemed to be more effective than home-based RT.
Global Patterns and Trends in Pancreatic Cancer Incidence
Authors: Luo Ganfeng , Zhang Yanting , Guo Pi , Ji Huanlin , Xiao Yuejiao , Li Ke
Published: January 2019

Objectives

We aim to provide a global geographical picture of pancreatic cancer incidence and temporal trends from 1973 to 2015 for 41 countries.

Methods

Joinpoint regression and age-period-cohort model was used.

Results

In 2012, the highest age-adjusted rate was in Central and Eastern Europe for males and North America for females. Most regions showed sex disparities. During the recent 10 years, increasing trends were observed in North America, Western Europe, and Oceania. The greatest increase occurred in France. For recent birth cohorts, cohort-specific increases in risk were pronounced in Australia, Austria, Brazil, Canada, Costa Rica, Denmark, Estonia, France, Israel, Latvia, Norway, Philippines, Republic of Korea, Singapore, Spain, Sweden, the Netherlands, United States, and US white male populations and in Australia, Austria, Brazil, Bulgaria, Canada, China, Czech Republic, Finland, France, Italy, Japan, Lithuania, Norway, Republic of Korea, Singapore, Spain, The Netherlands, United Kingdom, United States, and US white female populations.

Conclusions

In contrast to the favorable effect of the decrease in smoking prevalence, other factors, including the increased prevalence of obesity and diabetes and increased physical inactivity, increased intake of red or processed meat and inadequate intake of fruits and vegetables are likely to have an unfavorable role in pancreatic cancer incidence worldwide.
Autologous Intestinal Reconstructive Surgery in the Management of Total Intestinal Aganglionosis
Authors: Fusaro Fabio , Morini Francesco , Mutanen Annika , De Angelis Paola , Tambucci Roberto , Capriati Teresa , Hermans Dominique , Candusso Manila , Diamanti Antonella , Bagolan Pietro , Pakarinen Mikko
Published: January 2019

Objectives:

Total/near total intestinal aganglionosis (TIA/NTIA) is the most uncommon and life‐threatening form of Hirschsprung disease (HD). The management of TIA/NTIA is challenging and the role of autologous intestinal reconstructive (AIR) surgery is controversial. The objective is to evaluate the effectiveness of AIR in patients with TIA/NTIA.

Methods:

Records from children affected by TIA and enrolled in the multicenter international Pediatric Intestinal Rehabilitation and Transplantation Registry were retrospectively reviewed.

Results:

Fourteen patients with TIA were identified. TIA diagnosis was confirmed histologically at the median age of 14 days of life. All received a proximal decompressive jejunostomy. Two patients died, 4 patients had satisfactory stoma output with enteral tolerance without additional procedures, 8 underwent 10 AIR procedures (4 Ziegler myotomy‐myectomy, 3 transposition of aganglionic ileum with or without myotomy, 2 simple tapering, 1 longitudinal lengthening and tailoring procedure with associated myotomy). AIR significantly reduced median stoma output, from 197 to 31 mL · kg−1 · day−1 (P = 0.0001). The reduction was seen in all patients. In addition, AIR improved enteral tolerance in the long term in 5 of 8 patients (63%), and temporarily in 1, leading to a reduction of parenteral nutrition requirement from 100% to 70% (P = 0.0231).

Conclusions:

AIR surgery in carefully selected patients may be useful and effective way to enhance residual bowel absorptive function and to reduce parenteral nutrition requirements. AIR and intestinal transplantation are complementary surgical tools in the complex treatment algorithm of TIA/NTIA.
High Global Burden and Costs of Bacterial Vaginosis: A Systematic Review and Meta-Analysis
Authors: Peebles Kathryn , Velloza Jennifer , Balkus Jennifer E. , McClelland R. Scott , Barnabas Ruanne V.
Published: January 2019

Background

Bacterial vaginosis (BV) is the most common vaginal infection among women of reproductive age and is associated with important adverse health outcomes. Estimates of the burden of BV and associated costs are needed to inform research priorities.

Methods

We conducted a systematic review and meta-analysis of global BV prevalence among reproductive-aged women in the general population. We searched PubMed and Embase and used random effects models to estimate BV prevalence by global regions. We estimated the direct medical costs of treating symptomatic BV. Assuming a causal relationship, we also estimated the potential costs of BV-associated preterm births and human immunodeficiency virus cases in the United States.

Results

General population prevalence of BV is high globally, ranging from 23% to 29% across regions (Europe and Central Asia, 23%; East Asia and Pacific, 24%; Latin America and Caribbean, 24%; Middle East and North Africa, 25%; sub-Saharan Africa, 25%; North America, 27%; South Asia, 29%). Within North America, black and Hispanic women have significantly higher (33% and 31%, respectively) prevalence compared with other racial groups (white, 23%; Asian, 11%; P < 0.01). The estimated annual global economic burden of treating symptomatic BV is US $4.8 (95% confidence interval, $3.7–$6.1) billion. The US economic burden of BV is nearly tripled when including costs of BV-associated preterm births and human immunodeficiency virus cases.

Conclusions

The BV prevalence is high globally, with a concomitant high economic burden and marked racial disparities in prevalence. Research to determine the etiology of BV and corresponding prevention and sustainable treatment strategies are urgently needed to reduce the burden of BV among women. Additionally, the exceptionally high cost of BV-associated sequelae highlights the need for research to understand potential causal linkages between BV and adverse health outcomes.
Single Versus Simultaneous Double Free Flaps for Head and Neck Reconstruction
Authors: Stalder Mark W. , Mundinger Gerhard S. , Bartow Matthew , Pharo Austin , Patterson Charles , Sharma Silpa , Aslam Rizwan , St Hilaire Hugo
Published: January 2019

Introduction

Ablative procedures of the head and neck often result in substantial defects that require large-volume tissue transfer for restoration of form and function. Multiple simultaneous free flaps may be required for complex defects, but these procedures are often avoided because of the perception of an increase in associated surgical complications and morbidity. We present our experience with the use of simultaneous multiple free flaps as compared with single free flaps (SFFs) for head and neck reconstruction.

Methods

Thirty-seven patients with a history of head and neck malignancy underwent SFF reconstruction, and 21 patients underwent double free flap (DFF) reconstruction. Statistical analysis was conducted comparing demographics, comorbidities, etiology of disease, and surgical outcomes between the 2 patient groups.

Results

Operative time and length of hospital stay were both significantly longer in the DFF group versus the SFF group. Despite significantly higher rates of preoperative radiation, osteoradionecrosis, and operation for secondary malignancy in DFF group, no significant differences in flap survival, partial flap loss, recipient site complications, or donor site complications were found. Overall flap-related reoperation rates were low, as were total flap losses. There were 10 complications (24%) that required reoperation in the DFF group, and 1 total flap loss (2.4%), on per-flap basis. There were 10 complications (27%) that required reoperation in the SFF group and 3 total flap losses (8.1%). Per-flap incidence of donor site morbidity in the DFF group was significantly lower than that in the SFF group (23.8% vs 56.8%, respectively,P= 0.011).

Conclusions

The use of multiple free flaps for reconstruction of major head and neck tissue defects is sometimes necessary to achieve adequate reconstructive results. These procedures have no significant associated increase in overall flap-related complications. Our findings suggest that donor site morbidity can be minimized in double-flap reconstructions by thoughtful flap selection.
Normal Speech Should be the Expected Outcome in the Adopted Cleft Child
Authors: Dempsey Robert Feigenbaum , Elsherbiny Ahmed , Amerson Meghan , Sconyers Laura , Grant John
Published: January 2019

Background

Significantly worse speech outcomes and higher complication rates are reported among internationally adopted cleft patients. We evaluated our cohort to provide more accurate counseling to adoptive parents.

Methods

We reviewed internationally adopted children with unrepaired cleft palate who had 2-flap palatoplasty with radical intravelarveloplasty from 2003 to 2015 in a single-surgeon, consecutive series.

Results

Seventy-two children adopted with unrepaired cleft palate were identified, 2 with syndromic association. The average age at palatoplasty was 28.1 months. Meaningful speech assessment was available in 58 patients. Successful speech was defined by a competent or borderline-competent velopharyngeal mechanism (Pittsburgh Weighted Speech Score <2). Twenty-five patients (43%) had successful speech outcomes. Twenty-nine patients (50%) were recommended secondary operation for nasality. Nonfistula repair secondary operation was performed using the following: fat grafting (9 patients, 43%), intravelarveloplasty (8 patients, 38%), and sphincter pharyngoplasty (4 patients, 19%). The average Pittsburgh Weighted Speech Score improved 5.8 to 1.3 (P = 1.3E-6); 4.8 to 1.0 (P = 0.0009) with fat grafting alone. After all interventions, normal speech was achieved in 43 (74%) of 58 patients. Palatal fistula (9.2% vs 0.9%, P = 0.001) and velopharyngeal insufficiency (50% vs 6.7%, P = 0.0004) rates were both significantly higher in the internationally adopted cohort than our nonadopted population data. The need for secondary surgery was independent of cleft type (P = 0.89), age (P = 0.78), or presence of a “wide” cleft (P = 1).

Conclusions

Our results demonstrate higher fistula and secondary surgery rates. Successful speech outcomes were achieved in most patients with minimally invasive secondary procedures.
What Have We Learned From Malpractice Claims Involving the Surgical Management of Benign Biliary Disease?
Authors: Gartland Rajshri M. , Bloom Jordan P. , Fong Zhi Ven , DeRoo Courtney , Dwyer Kathy , Quinn Gene , Lillemoe Keith , Mort Elizabeth
Published: January 2019

Objective:

We aimed to study the contributing factors and costs of malpractice claims involving the surgical management of benign biliary disease given the emotional, physical, and financial toll of these claims on patients, providers, and the healthcare system.

Summary Background Data:

Cholecystectomy complications carry significant morbidity and rank among the leading sources of surgical malpractice claims.

Methods:

Using the CRICO Strategies’ Comparative Benchmarking System database, representing approximately 30% of all paid and unpaid malpractice claims in the United States, 4081 closed claims filed against general surgeons from 1995 to 2015 were reviewed to isolate 745 cholecystectomy-related claims. A multivariable model was used to determine factors associated with claim outcome.

Results:

The most common associated complications included bile duct injury (n = 397), bowel perforation (n = 96), and hemorrhage (n = 78). Bile duct injuries were recognized intraoperatively only 19% of the time and required biliary reconstruction surgery 77% of the time. The total cost for all claims over the study period was over $128 M and the median time from event to case close was over 3 years. 40% of claims resulted in patient payout; of these, most claims were settled out of court and the median cost per claim was $264,650. For the 60% of claims not resulting in patient payout, most cases were denied, dropped, or dismissed, yet still averaged over $15,000 per claim in legal and administrative fees. On multivariable analysis, bile duct injury, bowel perforation, and high clinical severity were associated with patient payout, while a resident or fellow being named in a claim was negatively associated with patient payout (P < 0.05).

Conclusion:

Cholecystectomy-related claims are costly and time-consuming. Strategies that reduce the risk and aid in recognition of cholecystectomy complications, as well as advance support of patients and families after poor outcomes, may improve clinical care and reduce claim burden.
Randomized Trial of Near-infrared Incisionless Fluorescent Cholangiography
Authors: Dip Fernando , LoMenzo Emanuelle , Sarotto Luis , Phillips Edward , Todeschini Hernan , Nahmod Mario , Alle Lisandro , Schneider Sylke , Kaja Ludwig , Boni Luigi , Ferraina Pedro , Carus Thomas , Kokudo Norihiro , Ishizawa Takeaki , Walsh Mathew , Simpfendorfer Conrad , Mayank Roy , White Kevin , Rosenthal Raul J.
Published: January 2019

Background:

Incisionless near-infrared fluorescent cholangiography (NIFC) is emerging as a promising tool to enhance the visualization of extrahepatic biliary structures during laparoscopic cholecystectomies.

Methods:

We conducted a single-blind, randomized, 2-arm trial comparing the efficacy of NIFC (n = 321) versus white light (WL) alone (n = 318) during laparoscopic cholecystectomy. Using the KARL STORZ Image1 S imaging system with OPAL1 technology for NIR/ICG imaging, we evaluated the detection rate for 7 biliary structures—cystic duct (CD), right hepatic duct (RHD), common hepatic duct, common bile duct, cystic common bile duct junction, cystic gallbladder junction (CGJ), and accessory ducts —before and after surgical dissection. Secondary calculations included multivariable analysis for predictors of structure visualization and comparing intergroup biliary duct injury rates.

Results:

Predissection detection rates were significantly superior in the NIFC group for all 7 biliary structures, ranging from 9.1% versus 2.9% to 66.6% versus 36.6% for the RHD and CD, respectively, with odds ratios ranging from 2.3 (95% CI 1.6–3.2) for the CGJ to 3.6 (1.6–9.3) for the RHD. After dissection, similar intergroup differences were observed for all structures except CD and CGJ, for which no differences were observed. Significant odds ratios ranged from 2.4 (1.7–3.5) for the common hepatic duct to 3.3 (1.3–10.4) for accessory ducts. Increased body mass index was associated with reduced detection of most structures in both groups, especially before dissection. Only 2 patients, both in the WL group, sustained a biliary duct injury.

Conclusions:

In a randomized controlled trial, NIFC was statistically superior to WL alone visualizing extrahepatic biliary structures during laparoscopic cholecystectomy.

Registration number:

NCT02702843
Determinants of the Use of Oral Rehydration Solution by Children During Diarrheal Episode
Authors: Tanweer Afifa , Imran Samra , Kaleem Rameeza , Saeed Ayesha
Published: January 2019

Oral rehydration is strongly recommended for the management of childhood diarrhea. To assess factors linked to Oral Rehydration Solution usage, data for the current study were collected from a purposive sample of 322 children younger than 5 years, using an indigenously developed questionnaire. Results showed 60% oral rehydration coverage that was significantly associated with maternal characteristics: age, literacy, and employment status but not with child's gender, birth order, or parent income level. Oral Rehydration Solution and sweetened beverages consumption were negatively correlated. Promotion of oral rehydration remains an area in urgent need to target interventions for reducing the social and economic burdens of childhood diarrhea.
Moonlight cycles synchronize oyster behaviour
Authors: Payton Laura , Tran Damien
Published: January 2019

Organisms possess endogenous clock mechanisms that are synchronized to external cues and orchestrate biological rhythms. Internal timing confers the advantage of being able to anticipate environmental cycles inherent in life on Earth and to prepare accordingly. Moonlight-entrained rhythms are poorly described, being much less investigated than circadian and circannual rhythms synchronized by sunlight. Yet focus on these lunar rhythms is highly relevant to understanding temporal organization of biological processes. Here, we investigate moonlight cycle effects on valve activity behaviour of the oyster
Crassostrea gigas
. Our results show that oysters modulate valve behaviour according to both intensity and direction of the lunar illumination cycle. As a consequence, valve opening amplitude is significantly increased at third quarter Moons (decreasing lunar illumination) compared with first quarter Moons (increasing lunar illumination) despite identical lunar illumination, and this indicates that oyster modulation of valve behaviour by moonlight cycles is not a direct response to lunar illumination. We propose that oysters use moonlight cycles to synchronize behaviour and also other physiological and ecological aspects of this benthic mollusc bivalve.
Increased expression diversity buffers the loss of adaptive potential caused by reduction of genetic diversity in new unfavourable environments
Authors: Liu Wei , Kang Lifang , Xu Qin , Tao Chengcheng , Yan Juan , Sang Tao
Published: January 2019

Mechanisms underlying adaptation to rapid environmental change are issues in evolutionary biology. It is widely accepted that reduction in genetic diversity when suddenly exposed to an unfavourable environment limits the adaptive potential of populations. With growing empirical evidence that expression diversity is likely to increase in the new environment, the role that expression diversity plays in adaptation needs to be theorized. Here, we first established a negative exponential relationship between expression diversity and genetic diversity using a phenomenological differential equation. We then derived a complex trade-off relationship between the changes of expression and genetic diversity, which followed a combination of exponential functions. Furthermore, we found the increase in expression diversity could buffer the loss of adaptive potential as genetic diversity decreased to a certain extent. These theoretical deductions were validated by transcriptomic data of
Miscanthus lutarioriparius
grown in two experimental fields and supported by good fit and random simulation. These results suggest that increased expression diversity may compensate the loss of genetic diversity and allow the populations to maintain a certain level of phenotypic variation to cope with sudden environmental change. This may buffer the quick diminishing of adaptive potential and consequently increases the change of adaptation to the new environment.
Vertical differentiation in tropical forest butterflies: a novel mechanism generating insect diversity?
Authors: Nice Chris C. , Fordyce James A. , Bell Katherine L. , Forister Matthew L. , Gompert Zachariah , DeVries Phil J.
Published: January 2019

Many tropical fruit-feeding nymphalid butterflies are associated with either the forest canopy or the understorey; however, the exceptions offer insights into the origins of tropical diversity. As it occurs in both habitats of tropical forests in Ecuador and Peru,Archaeoprepona demophonis one such exception. We compared patterns of occurrence ofA. demophonin the canopy and understorey and population genomic variation for evidence of ecological and genetic differentiation between habitats. We found that butterfly occurrences in the canopy were largely uncorrelated with occurrences in the understorey at both localities, indicating independent demographic patterns in the two habitats. We also documented modest, significant genome-level differentiation at both localities. Genetic differentiation between habitat types (separated by approx. 20 m in elevation) was comparable to levels of differentiation between sampling locations (approx. 1500 km). We conclude that canopy and understorey populations ofA. demophonrepresent incipient independent evolutionary units. These findings support the hypothesis that divergence between canopy and understorey-associated populations might be a mechanism generating insect diversity in the tropics.
Hydrodynamic functionality of the lorica in choanoflagellates
Authors: Asadzadeh Seyed Saeed , Nielsen Lasse Tor , Andersen Anders , Dölger Julia , Kiørboe Thomas , Larsen Poul S. , Walther Jens H.
Published: January 2019

Choanoflagellates are unicellular eukaryotes that are ubiquitous in aquatic habitats. They have a single flagellum that creates a flow toward a collar filter composed of filter strands that extend from the cell. In one common group, the loricate choanoflagellates, the cell is suspended in an elaborate basket-like structure, the lorica, the function of which remains unknown. Here, we use Computational Fluid Dynamics to explore the possible hydrodynamic function of the lorica. We use the choanoflagellateDiaphaoneca grandisas a model organism. It has been hypothesized that the function of the lorica is to prevent refiltration (flow recirculation) and to increase the drag and, hence, increase the feeding rate and reduce the swimming speed. We find no support for these hypotheses. On the contrary, motile prey are encountered at a much lower rate by the loricate organism. The presence of the lorica does not affect the average swimming speed, but it suppresses the lateral motion and rotation of the cell. Without the lorica, the cell jiggles from side to side while swimming. The unsteady flow generated by the beating flagellum causes reversed flow through the collar filter that may wash away captured prey while it is being transported to the cell body for engulfment. The lorica substantially decreases such flow, hence it potentially increases the capture efficiency. This may be the main adaptive value of the lorica.
Some fluid mechanical constraints on crystallization and recharge within sills
Authors: Woods Andrew W. , Stock Michael J.
Published: January 2019

The injection of hot magma into a sill can lead to heating and melting of the walls and roof of the reservoir while the injected magma cools and crystallizes. If the crystals are relatively dense, they will try to sediment from the injected magma to form a cumulate layer. In this cumulate layer, the crystals form a porous framework which traps the melt as it is built up. As the melt within the sill continually cools and precipitates dense crystals, there will be a gradual reduction in the density of the remaining silicate liquid. As a result, the melt which is progressively trapped in the pore space of the cumulate layer will become stably stratified in density. Using an idealized model of the fluid mechanical and thermodynamical principles, we explore some of the controls on the thickness and density stratification of cumulate layers following replenishment of a sill-like magma chamber. We show the balance between jamming of the crystal laden melt to form a homogeneous layer and the formation of a stratified cumulate zone depends on the cooling time scale compared to the sedimentation time scale. A key finding is that the composition and stratification in a packed crystal–melt suspension and the associated cumulate layer formed by cooling an intrusion of hot melt injected into the crust may have considerable variability, depending on the properties of the overlying roof melt and the size and hence fall speed of crystals which form in the melt.

This article is part of the Theo Murphy meeting issue ‘Magma reservoir architecture and dynamics’.
Characterization of a vascular bundle localizing Gossypium hirsutum NAC4 transcription factor promoter for its role in environmental stress responses
Authors: Trishla Vikas Shalibhadra , Marriboina Sureshbabu , Boyidi Prasanna , Gudipalli Padmaja , Kirti Pulugurtha Bharadwaja
Published: January 2019

We have studied the expression of GhNAC4, a NAC domain-containing transcription factor from Gossypium hirsutum. The expression of GhNAC4 was upregulated by ABA, cytokinin, JA, GA, auxin, and ethylene. Its expression was also highly induced by drought, osmotic stress, oxidative stress, salinity, high and low-temperature stress, and wounding. To corroborate these observations, we isolated the promoter of GhNAC4 and fused it transcriptionally with uidA (GUS) gene for analyzing its patterns of expression in transgenic tobacco. The Promoter-GUS fusion was also induced by various phytohormones and environmental stresses. The spatio-temporal analysis of the promoter of the GhNAC4 gene revealed that GUS expression was mostly localized to the vascular bundles along with shoot apical meristem and guard cells. We also observed intense staining in other cells upon wounding. A sequence analysis of the promoter revealed the presence of several motifs pertaining to phytohormone responsiveness, stress-inducibility, light and sugar-responsiveness and tissue-specificity. These data were corroborated by a detailed bioinformatic analysis of the promoter sequence of GhNAC4 for identifying the conserved sequences that are associated with the expression of genes in a spatio-temporal or inducive manner. All these data suggests that GhNAC4 is a vascular tissue localizing NAC transcription factor, which might act as a node integrating environmental stress signals for modulating plant growth and development with the aid of phytohormonal stimuli.

Key message

GhNAC4 transcription factor from cotton localizes to vascular bundles and is highly upregulated by phytohormones and environmental stresses.
A ribosome assembly stress response regulates transcription to maintain proteome homeostasis
Authors: Albert Benjamin , Kos-Braun Isabelle C. , Henras Anthony , Dez Christophe , Rueda Maria Paula , Zhang Xu , Gadal Olivier , Kos Martin , Shore David
Published: January 2019

Ribosome biogenesis is a complex and energy-demanding process requiring tight coordination of ribosomal RNA (rRNA) and ribosomal protein (RP) production. Alteration of any step in this process may impact growth by leading to proteotoxic stress. Although the transcription factor Hsf1 has emerged as a central regulator of proteostasis, how its activity is coordinated with ribosome biogenesis is unknown. Here we show that arrest of ribosome biogenesis in the budding yeast S. cerevisiae triggers rapid activation of a highly specific stress pathway that coordinately up-regulates Hsf1 target genes and down-regulates RP genes. Activation of Hsf1 target genes requires neo-synthesis of RPs, which accumulate in an insoluble fraction, leading to sequestration of the RP transcriptional activator Ifh1. Our data suggest that levels of newly-synthetized RPs, imported into the nucleus but not yet assembled into ribosomes, work to continuously balance Hsf1 and Ifh1 activity, thus guarding against proteotoxic stress during ribosome assembly.
Rigorous equations for isothermal titration calorimetry: theoretical and practical consequences
Authors: Dumas Philippe
Published: January 2019

The author has withdrawn his manuscript because:

The withdrawn preprint was about methodological aspects in Isothermal Titration Calorimetry (ITC) used to obtain thermodynamic information about reactions like A + B ⇄ C where A is initially in the cell and B injected from a syringe. The preprint considered the two possible methods in ITC:

1/ the Multiple Injection Method (MIM) making use of short-time injections separated by sufficient time to allow the reaction to reach equilibrium before a new injection.

2/ the Single Injection Method (SIM) making use of a slow continuous injection.

The first result mentioned is about a new equation linking the rate of heat evolution with the injected volume (equations 9 and 10). With this equation and with the hypothesis that there is always perfect mixing of the cell content it was concluded that an ideal titration curve (i.e. not affected by any external influence) for a simple reaction like A + B ⇄ C cannot change sign (section 3.2). This conclusion turns out to be incorrect when taking in consideration real conditions with imperfect mixing, particularly with MIM using injections often of very short duration, which prevents from reaching perfect mixing. The major problem is that this erroneous conclusion was accompanied with comparisons of the results from well-established programs, which led to the conclusion that these were in error on this point (section 3.6).

I therefore felt necessary to withdraw this preprint to avoid casting doubts unduly on these programs used extensively.

Note that many other aspects in this preprint remain correct (section 3.8). A new version of this work, limited to SIM and considering imperfect mixing, will be submitted for publication under the title: “Isothermal titration calorimetry in the single-injection mode with imperfect mixing”.

If you have any questions, please contact me at dumasp@igbmc.fr or at p.dumas@unistra.fr

Sorry for the inconvenience.

Philippe Dumas

November 6, 2021