bluuebunny/crossref_metadata_2025 huggingface dataset:
Coherent control using kinetic energy and the geometric phase of a conical intersection
Authors: Liekhus-Schmaltz Chelsea , McCracken Gregory A. , Kaldun Andreas , Cryan James P. , Bucksbaum Philip H.
Published: October 2016

Conical intersections (CIs) between molecular potential energy surfaces with non-vanishing non-adiabatic couplings generally occur in any molecule consisting of at least three atoms. They play a fundamental role in describing the molecular dynamics beyond the Born-Oppenheimer approximation and have been used to understand a large variety of effects, from photofragmentation and isomerization to more exotic applications such as exciton fission in semiconductors. However, few studies have used the features of a CI as a tool for coherent control. Here we demonstrate two modes of control around a conical intersection. The first uses a continuous light field to control the population on the two intersecting electronic states in the vicinity of a CI. The second uses a pulsed light field to control wavepackets that are subjected to the geometric phase shift in transit around a CI. This second technique is likely to be useful for studying the role of nuclear dynamics in electronic coherence phenomena.
Hyperthermal molecular beam source using a non-diaphragm-type small shock tube
Authors: Yoshimoto Yuta , Osuka Kenichi , Miyoshi Nobuya , Kinefuchi Ikuya , Takagi Shu , Matsumoto Yoichiro
Published: October 2016

We have developed a hyperthermal molecular beam source employing a non-diaphragm-type small shock tube for gas–surface interaction studies. Unlike conventional shock-heated beam sources, the capability of repetitive beam generation without the need for replacing a diaphragm makes our beam source suitable for scattering experiments, which require signal accumulation for a large number of beam pulses. The short duration of shock heating alleviates the usual temperature limit due to the nozzle material, enabling the generation of a molecular beam with higher translational energy or that containing dissociated species. The shock-heated beam is substantially free from surface-contaminating impurities that are pronounced in arc-heated beams. We characterize the properties of nitrogen and oxygen molecular beams using the time-of-flight method. When both the timing of beam extraction and the supply quantity of nitrogen gas are appropriately regulated, our beam source can generate a nitrogen molecular beam with translational energy of approximately 1 eV, which corresponds to the typical activation energy of surface reactions. Furthermore, our beam source can generate an oxygen molecular beam containing dissociated oxygen atoms, which can be a useful probe for surface oxidation. The dissociation fraction along with the translational energy can be adjusted through the supply quantity of oxygen gas.
Development of an apparent face-shear mode (d36) piezoelectric transducer for excitation and reception of shear horizontal waves via two-dimensional antiparallel poling
Authors: Li Faxin , Miao Hongchen
Published: October 2016

The non-dispersive fundamental shear horizontal (SH0) wave is extremely useful in guided-wave-based inspection techniques. However, the generation or reception of the SH0 wave by using a piezoelectric transducer is always a challenge. In this work, first, we realized the apparent face-shear (d36) mode in PbZr1-xTixO3 (PZT) ceramics via two-dimensional antiparallel poling. Then, we demonstrated via finite element simulations that the apparent d36 mode PZT wafer can behave as both a SH0 wave actuator and a SH0 wave sensor. Next, by using the apparent d36 PZT wafer as an actuator and a face-shear d36 0.72[Pb(Mg1/3Nb2/3)O3]-0.28[PbTiO3] crystal as the sensor, almost a pure SH0 wave with a high signal-to-noise ratio was successfully excited in an aluminum plate from 180 kHz to 200 kHz. Later, experiments showed that the proposed apparent d36 PZT wafer can also serve as a sensor to detect the SH0 wave over a wide frequency range (160 kHz to 230 kHz). Finally, the amplitude directivity of the SH0 wave generated by the apparent d36 PZT wafer was also investigated. The wave amplitude reaches its maxima at the main direction (0° and 90°) and then decreases monotonically when the propagation direction deviates from the main directions, with the symmetric axis along the 45° direction. The proposed apparent d36 PZT wafer is very suitable for severing as SH0 wave actuators and sensors in structural health monitoring systems.
A source of hard X-ray radiation based on hybrid X pinches
Authors: Shelkovenko T. A. , Pikuz S. A. , Hoyt C. L. , Cahill A. D. , Atoyan L. , Hammer D. A. , Tilikin I. N. , Mingaleev A. R. , Romanova V. M. , Agafonov A. V.
Published: October 2016

X pinches are well known to produce very small, dense plasma pinches (“hot spots”) that emit sub-nanosecond bursts of 1–8 keV radiation. Hard X-ray radiation in the range from 8 to 300 keV or more is also emitted, and only a small portion of which is associated with the X-pinch hot spot. In hybrid X-pinches (HXP), the  10 ns hard X-ray pulse is terminated by fast closure of the gap between the two conical electrodes of the HXP by rapidly expanding electrode plasmas. The temporal, spectral, and spatial properties of this higher energy radiation have been studied. This radiation was used for point-projection imaging with magnification between 1.5 and 6, and spatial resolution of 20–100 μm was demonstrated.
Effect of weaning age and milk feeding level on pre- and post-weaning growth performance of Sahiwal calves
Authors: Cheema Ahsan Tasawar , Bhatti Shaukat Ali , Akbar Ghulam , Wynn Peter C. , Muhammad Ghulam , Warriach Hassan Mahmood , McGill David
Published: October 2016

The Sahiwal cow is a tropical dairy breed native to Pakistan. The objective of the present study was to evaluate pre- and post-weaning growth of Sahiwal calves weaned either at 8 or 12 weeks and offered milk at either 10% or 15% of bodyweight (BW) from birth to weaning. Colostrum fed Sahiwal calves (n = 48) were randomly allocated to four treatments of 12 calves each. Calves were offered milk either at 10% (low-milk) or 15% (high-milk) of BW in two weaning programs (early or late). Early weaned calves were offered milk until Day 35, adjusted weekly for liveweight and then reduced by one-third in each subsequent week until weaned at Day 56 (early weaned). Late-weaned calves were offered milk until Day 63 and were weaned at Day 84 (late-weaned) by reducing milk offered by one-third in each subsequent week. Calves were offered a concentrate ration (21% crude protein and 2.93 metabolisable energy, Mcal/kg) from Day 28 to Day 112. Final BW at 16 weeks was highest (77.6 ± 1.8 kg; P < 0.01) in high milk-fed late-weaned calves and lowest in low milk-fed early weaned calves (60.2 ± 1.8 kg). High-milk early weaned and low milk late-weaned calves had comparable final BW (70.7 ± 1.8 vs 72.0 ± 1.8 kg), although lower than that of high-milk late-weaned calves, but still at an acceptable lower feeding cost to gain per kg liveweight (US$ 3.2 vs 2.5). Thus, offering milk to Sahiwal calves at 15% of BW and weaning at 8 weeks saves milk and labour required for additional days to feed these calves.
Transforming valences through transitive inference: How are faces emotionally dissonant?
Authors: Amd Micah , Roche Bryan
Published: October 2016

Information that is emotionally incongruous with self-concepts can produce feelings of unease. This implies that embedding incongruous information in newly formed relational structures would have little effect on their previous emotive properties. Alternatively, Relational Frame Theory highlights the importance of contextualized stimulus-stimulus relations, where the structure of a relational series is key in determining the function of its elements. To see whether series membership can mitigate ‘dissonance’ when a salient element is employed, the present investigation trained and tested a seven-term relational series (X>A>B>C>D>E>Y) using blurred faces as stimuli. Specifically, Stimuli X, A, B, D, E and Y were blurred unfamiliar faces and Stimulus C constituted of the participant's own blurred face, assumed to be more salient than the former. To assess how the valences of the related stimuli were transformed by relational series membership, self-report ratings and electroencephalographic (EEG) recordings were collected before and after training the X>A>B>C>D>E>Y series. These pre vs. post contrasts revealed that, for unfamiliar faces, stimulus valence transformed as a function of relational structure. Conversely, the lack of difference in pre vs. post contrasts of Stimulus C, which maintained a high valence, suggest that relational series membership may not suffice to mitigate emotionally dissonant information.
Stimulus dependence and cross-modal interference in sequence learning
Authors: Kemény Ferenc , Németh Kornél
Published: October 2016

A central issue in sequence learning is whether learning operates on stimulus-independent abstract elements, or whether surface features are integrated, resulting in stimulus-dependent learning. Using the serial reaction-time (SRT) task, we test whether a previously presented sequence is transferrable from one domain to another. Contrary to previous artificial grammar learning studies, there is mapping between pre- and posttransfer stimuli, but contrary to previous SRT studies mapping is not obvious. In the pre-transfer training phase, participants face a dot-counting task in which the location of the dots follows a predefined sequence. In the test phase, participants face an auditory SRT task in which the spatial organization of the response locations is either the same as spatial sequence in the training phase, or not. Sequence learning is compared to two control conditions: one with a non-sequential random-dot counting in the training phase, and one with no training phase. Results show that sequential training proactively interferes with later sequence learning, regardless of whether the sequence is the same or different in the two phases. Results argue for the existence of a general sequence processor with limited capacity, and that sequence structures and sequenced elements are integrated into a single sequential representation.
Narrative structure, context and translation in Paulo Coelho’sO Alquimistain English, Arabic and Turkish
Authors: Aljahdali Sawsan A.
Published: October 2016

The contentious bestsellerdom of Coelho’sO Alquimista(published in 1988) has not only placed it endurably on top of the prestigious bestseller lists, but also made it subject to severe criticism. With copyrights sold in 80 languages, the narrative creates a unique form of communication implementing a prolonged, interactive language–culture relationship, and recreating appealingly unique narrative structures addressing readers in new contexts. This study attempts a functional semantico–semiotic reading of the narrative structures ofO Alquimistain English, Arabic and Turkish, relating the “recreated texts” to their sociocultural “context of interpretation”, and viewing them as the outcome of twoseparateacts of communication functioning successively on the samesemantic content. The study argues that rediscoursing the narrative cross-culturally yields variant narrative structures, each constructed twice–internally, in the act of encoding through writing, andexternallythrough the reader–text interaction in reading.
The circadian coordination of cell biology
Authors: Chaix Amandine , Zarrinpar Amir , Panda Satchidananda
Published: October 2016

Circadian clocks are cell-autonomous timing mechanisms that organize cell functions in a 24-h periodicity. In mammals, the main circadian oscillator consists of transcription–translation feedback loops composed of transcriptional regulators, enzymes, and scaffolds that generate and sustain daily oscillations of their own transcript and protein levels. The clock components and their targets impart rhythmic functions to many gene products through transcriptional, posttranscriptional, translational, and posttranslational mechanisms. This, in turn, temporally coordinates many signaling pathways, metabolic activity, organelles’ structure and functions, as well as the cell cycle and the tissue-specific functions of differentiated cells. When the functions of these circadian oscillators are disrupted by age, environment, or genetic mutation, the temporal coordination of cellular functions is lost, reducing organismal health and fitness.
GEF-H1 is necessary for neutrophil shear stress–induced migration during inflammation
Authors: Fine Noah , Dimitriou Ioannis D. , Rullo Jacob , Sandí María José , Petri Björn , Haitsma Jack , Ibrahim Hisham , La Rose Jose , Glogauer Michael , Kubes Paul , Cybulsky Myron , Rottapel Robert
Published: October 2016

Leukocyte crawling and transendothelial migration (TEM) are potentiated by shear stress caused by blood flow. The mechanism that couples shear stress to migration has not been fully elucidated. We found that mice lacking GEF-H1 (GEF-H1−/−), a RhoA-specific guanine nucleotide exchange factor (GEF), displayed limited migration and recruitment of neutrophils into inflamed tissues. GEF-H1−/− leukocytes were deficient in in vivo crawling and TEM in the postcapillary venules. We demonstrated that although GEF-H1 deficiency had little impact on the migratory properties of neutrophils under static conditions, shear stress triggered GEF-H1–dependent spreading and crawling of neutrophils and relocalization of GEF-H1 to flotillin-2–rich uropods. Our results identify GEF-H1 as a component of the shear stress response machinery in neutrophils required for a fully competent immune response to bacterial infection.
Pulmonary thromboendarterectomy in the setting of a mediastinal venous malformation with a congenitally absent left subclavian vein
Authors: Tejwani Vickram , Karuppasamy Karunakaravel , Gomes Marcelo P. , Levitin Abraham , Luethke James M. , Morin Christopher J. , Smedira Nicholas G. , Heresi Gustavo A. , Yakes Wayne F.
Published: October 2016

Venous malformations have static venous lakes that predispose to spontaneous venous thrombosis within the malformation due to its low‐flow static state. Thrombi of varying sizes can then embolize continually into the pulmonary arterial circulation, and occlude and narrow elastic pulmonary arteries causing chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary thromboendarterectomy (PTE) is potentially curative in CTEPH, but has not been previously reported in the setting of mediastinal and chest wall venous malformations. We report the case of a 21‐year‐old female with such a large malformation treated successfully with PTE. The patient underwent complete endovascular reconstruction of her subclavian vein system from the axillary vein to the innominate vein stump with covered stent grafts to exclude the malformations from causing recurrent pulmonary emboli. This was followed by embolization of the malformation to allow for the surgical approach. The series of events in this case serves as a novel approach in managing such rare patients.
The poly(ADP-ribose)-dependent chromatin remodeler Alc1 induces local chromatin relaxation upon DNA damage
Authors: Sellou Hafida , Lebeaupin Théo , Chapuis Catherine , Smith Rebecca , Hegele Anna , Singh Hari R. , Kozlowski Marek , Bultmann Sebastian , Ladurner Andreas G. , Timinszky Gyula , Huet Sébastien
Published: October 2016

Chromatin relaxation is one of the earliest cellular responses to DNA damage. However, what determines these structural changes, including their ATP requirement, is not well understood. Using live-cell imaging and laser microirradiation to induce DNA lesions, we show that the local chromatin relaxation at DNA damage sites is regulated by PARP1 enzymatic activity. We also report that H1 is mobilized at DNA damage sites, but, since this mobilization is largely independent of poly(ADP-ribosyl)ation, it cannot solely explain the chromatin relaxation. Finally, we demonstrate the involvement of Alc1, a poly(ADP-ribose)- and ATP-dependent remodeler, in the chromatin-relaxation process. Deletion of Alc1 impairs chromatin relaxation after DNA damage, while its overexpression strongly enhances relaxation. Altogether our results identify Alc1 as an important player in the fast kinetics of the NAD+- and ATP-dependent chromatin relaxation upon DNA damage in vivo.
Effects of juglone and lawsone on oxidative stress in maize coleoptile cells treated with IAA
Authors: Kurtyka Renata , Pokora Wojciech , Tukaj Zbigniew , Karcz Waldemar
Published: October 2016

Naphthoquinones are secondary metabolites widely distributed in nature and produced by bacteria, fungi and higher plants. Their biological activity may result from induction of oxidative stress, caused by redox cycling, or direct interaction with cellular macromolecules, in which quinones act as electrophiles. The redox homeostasis is known as one of factors involved in auxin-mediated plant growth regulation. To date, however, little is known about the crosstalk between reactive oxygen species (ROS) produced by quinones and the plant growth hormone auxin (IAA). In this study, redox cycling properties of two naphthoquinones, juglone (5-hydroxy-1,4-naphthoquinone) and lawsone (2-hydroxy-1,4-naphthoquinone), were compared in experiments performed on maize coleoptile segments incubated with or without the addition of IAA. It was found that lawsone was much more effective than juglone in increasing both H2O2 production and the activity of antioxidative enzymes (SOD, POX and CAT) in coleoptile cells, regardless of the presence of IAA. An increase in the activity of Cu/Zn-SOD isoenzymes induced by both naphthoquinones suggest that juglone- and lawsone-generated H2O2 was primarily produced in the cytosolic and cell wall spaces. The cell potential to neutralize hydrogen peroxide, determined by POX and CAT activity, pointed to activity of catalase as the main enzymatic mechanism responsible for degradation of H2O2. Therefore, we assumed that generation of H2O2, induced more efficiently by LW than JG, was the major factor accounting for differences in the toxicity of naphthoquinones in maize coleoptiles. The role of auxin in the process appeared negligible. Moreover, the results suggested that oxidative stress imposed by JG and LW was one of mechanisms of allelopathic action of the studied quinones in plants.
OGLE16aaa - a Signature of a Hungry Super Massive Black Hole
Authors: Wyrzykowski Łukasz , Zieliński M. , Kostrzewa-Rutkowska Z. , Hamanowicz A. , Jonker P.G. , Arcavi I. , Guillochon J. , Brown P.J. , Kozłowski S. , Udalski A. , Szymański M.K. , Soszyński I. , Poleski R. , Pietrukowicz P. , Skowron J. , Mróz P. , Ulaczyk K. , Pawlak M. , Rybicki K.A. , Greiner J. , Krühler T. , Bolmer J. , Smartt S.J. , Maguire K. , Smith K.
Published: October 2016

We present the discovery and first three months of follow-up observations of a currently on-going unusual transient detected by the OGLE-IV survey, located in the centre of a galaxy at redshift z=0.1655. The long rise to absolute magnitude of -20.5 mag, slow decline, very broad He and H spectral features make OGLE16aaa similar to other optical/UV Tidal Disruption Events (TDEs). Weak narrow emission lines in the spectrum and archival photometric observations suggest the host galaxy is a weak-line Active Galactic Nucleus (AGN), which has been accreting at higher rate in the past. OGLE16aaa, along with SDSS J0748, seems to form a sub-class of TDEs by weakly or recently active super-massive black holes (SMBHs). This class might bridge the TDEs by quiescent SMBHs and flares observed as “changing-look QSOs”, if we interpret the latter as TDEs. If this picture is true, the previously applied requirement for identifying a flare as a TDE that it had to come from an inactive nucleus, could be leading to observational bias in TDE selection, thus affecting TDE-rate estimations.
The origin of type-I profiles in cluster lenticulars: An interplay between ram pressure stripping and tidally-induced spiral migration
Authors: Clarke Adam J. , Debattista Victor P. , Roškar Rok , Quinn Tom
Published: October 2016

Using N-body+SPH simulations of galaxies falling into a cluster, we study the evolution of their radial density profiles. When evolved in isolation, galaxies develop a type II (down-bending) profile. In the cluster, the evolution of the profile depends on the minimum cluster-centric radius the galaxy reaches, which controls the degree of ram pressure stripping. If the galaxy falls to ∼50% of the virial radius, then the profile remains type II, but if the galaxy reaches down to ∼20% of the virial radius the break weakens and the profile becomes more type I like. The velocity dispersions are only slightly increased in the cluster simulations compared with the isolated galaxy; random motion therefore cannot be responsible for redistributing material sufficiently to cause the change in the profile type. Instead we find that the joint action of radial migration driven by tidally-induced spirals and the outside-in quenching of star formation due to ram pressure stripping alters the density profile. As a result, this model predicts a flattening of the age profiles amongst cluster lenticulars with type I profiles, which can be observationally tested.
BMI Trumps Age in Decision for Endometrial Biopsy: Cohort Study of Symptomatic Premenopausal Women
Authors: Wise Michelle R. , Gill Premjit , Lensen Sarah , Thompson John M. D. , Farquhar Cynthia M.
Published: October 2016

(Abstracted from Am J Obstet Gynecol 2016; doi: 10.1016/j.ajog.2016.06.006)

The most common reason for referral to a gynecologist is abnormal uterine bleeding (AUB). Heavy or irregular vaginal bleeding often leads to an invasive diagnostic test such as endometrial biopsy or hysteroscopy.
Single Deepest Vertical Pocket or Amniotic Fluid Index as Evaluation Test for Predicting Adverse Pregnancy Outcome (SAFE Trial): A Multicenter, Open-Label, Randomized Controlled Trial
Authors: Kehl S. , Schelkle A. , Thomas A. , Puhl A. , Meqdad K. , Tuschy B. , Berlit S. , Weiss C. , Bayer C. , Heimrich J. , Dammer U. , Raabe E. , Winkler M. , Faschingbauer F. , Beckmann M. W. , Sütterlin M.
Published: October 2016

(Abstracted from Ultrasound Obstet Gynecol 2016;47:674–679)

One of the important aspects of fetal well-being assessment is amniotic fluid volume, lack of which leads to oligohydramnios and consequently adverse perinatal outcomes. Amniotic fluid estimation by ultrasound can be performed by assessment of the amniotic fluid index (AFI) or the single deepest vertical pocket (SDP) technique.
Trends and Characteristics of United States Out-of-Hospital Births 2004–2014: New Information on Risk Status and Access to Care
Authors: MacDorman Marian F. , Declercq Eugene
Published: October 2016

(Abstracted from Birth 2016;43(2):116–124)

Out-of-hospital births in the United States increased rapidly after 2004. This study aimed to examine trends in out-of-hospital births over the past decade and to analyze recently available data on risk status and access to care for out-of-hospital births, including birth center and planned home births, and to compare them with hospital births.
Tenofovir to Prevent Hepatitis B Transmission in Mothers With High Viral Load
Authors: Pan Calvin Q. , Duan Zhongping , Dai Erhei , Zhang Shuqin , Han Guorong , Wang Yuming , Zhang Huaihong , Zou Huaibin , Zhu Baoshen , Zhao Wenjing , Jiang Hongxiu
Published: October 2016

(Abstracted from N Engl J Med 2016;374:2324–2334)

Hepatitis B virus (HBV), a leading cause of cirrhosis and liver cancer, is a serious health threat, and prevention of HBV transmission is an important part of the strategy to alleviate infection and its outcomes. Hepatitis B virus can be vertically transmitted from mothers to fetuses during childbirth, and infants who are untreated can consequently develop chronic infection.
Validation and Modification of a Severity of Illness Score for Children With Acute Hematogenous Osteomyelitis
Authors: Athey Alexander G. , Mignemi Megan E. , Gheen William T. , Lindsay Eduardo A. , Jo Chan-Hee , Copley Lawson A.
Published: October 2016

Background:

Children with osteomyelitis demonstrate a wide spectrum of illness. Objective measurement of severity is important to guide resource allocation and treatment decisions, particularly for children with advanced illness. The purpose of this study is to validate and improve a previously published severity of illness scoring system for children with acute hematogenous osteomyelitis (AHO).

Methods:

Children with AHO were prospectively studied during evaluation and treatment by a multidisciplinary team who provided care according to evidence-based guidelines to reduce variation. A severity of illness score was calculated for each child and correlated with surrogate measures of severity. Univariate analysis was used to assess the significance of each parameter within the scoring model along with new parameters, which were evaluated to improve the model. The scoring system was then modified by the addition of band count to replace respiratory rate. The modified score was calculated and applied to the prospective cohort followed by correlation with the surrogate measures of severity.

Results:

One hundred forty-eight children with AHO were consecutively studied. The original severity of illness score correlated well with length of stay and other established measures of severity. Band percent of the white blood cell differential ≥1.5% was found to be significantly associated with severity and chosen to replace respiratory rate in the model. The modified calculated severity scores correlated well with the chosen surrogate measures and significantly differentiated children with osteomyelitis on the basis of causative organism, length of stay, intensive care, surgeries, bacteremia, and disseminated or multifocal disease.

Conclusions:

The findings of this study validate the previously published severity of illness scoring tool in large cohort of children who were prospectively evaluated. The replacement of respiratory rate with band count improved the scoring system.
Intraoperative Radiotherapy in the Era of Intensive Neoadjuvant Chemotherapy and Chemoradiotherapy for Pancreatic Adenocarcinoma
Authors: Keane Florence K. , Wo Jennifer Y. , Ferrone Cristina R. , Clark Jeffrey W. , Blaszkowsky Lawrence S. , Allen Jill N. , Kwak Eunice L. , Ryan David P. , Lillemoe Keith D. , Fernandez-del Castillo Carlos , Hong Theodore S.
Published: October 2016

Objectives:

Improved outcomes with FOLFIRINOX or gemcitabine with nab-paclitaxel in the treatment of metastatic pancreatic adenocarcinoma (PDAC) have prompted incorporation of these regimens into neoadjuvant treatment of locally advanced unresectable PDAC. Whereas some patients remain unresectable on surgical exploration, others are able to undergo resection after intensive neoadjuvant treatment. We evaluated outcomes and toxicity associated with use of intensive neoadjuvant treatment followed by intraoperative radiotherapy (IORT) in combination with resection or exploratory laparotomy.

Methods:

We retrospectively analyzed patients with locally advanced unresectable or borderline-resectable PDAC who received intensive neoadjuvant treatment with induction chemotherapy and chemoradiotherapy followed by exploratory laparotomy in an IORT-equipped operating suite between 2010 and 2015. Surgical outcomes and overall survival (OS) were compared.

Results:

Of 68 patients, 41 (60.3%) underwent resection, 18 (26.5%) had unresectable disease, and 9 (13.2%) had distant metastases. Of 41 resectable patients, 22 received IORT for close/positive resection margins on intraoperative frozen section. There was no significant difference in operative times or morbidity with addition of IORT to resection. Median OS was 26.6 months for all patients who underwent resection, 35.1 months for patients who underwent resection and IORT, and 24.5 months for patients who underwent resection alone (P=NS). Of 18 patients with unresectable disease, all but 1 received IORT, with median OS of 24.8 months. IORT was associated with increased hospital stay (4 vs. 3.5 d), but no significant difference in operative times or morbidity.

Conclusions:

IORT in addition to intensive neoadjuvant chemotherapy and chemoradiotherapy was not associated with increased toxicity when used with resection or exploratory laparotomy, and was associated with encouraging survival rates in patients with close/positive margins and patients with unresectable disease.
Decellularized Matrix and Supplemental Fat Grafting Leads to Regeneration following Traumatic Fingertip Amputation
Authors: Sivak Wesley N. , Ruane Edward J. , Hausman Steven J. , Rubin J. Peter , Spiess Alexander M.
Published: October 2016

Decellularized scaffold materials are capable of regenerating missing tissues when utilized under appropriate conditions. Fat grafting also has reported advantages in revitalizing damaged tissue beds. This report details a case of traumatic fingertip amputation treated with a combination of decellularized materials in conjunction with fat grafting, resulting in a supple and functional reconstruction of the affected digit. After traumatic fingertip amputation, a patient was initially treated with decellularized porcine urinary bladder matrix powder. As a second stage, the healed tip scar tissue was reexcised, and a second application of powder was applied. As a third stage, the tip scar tissue was reexcised and a decellularized bilayer was sewn into the soft tissues of the debrided tip, resulting in an improved soft tissue envelope. As a final stage, the restored fingertip soft tissue envelope was fat grafted for additional bulk. Patient underwent treatment every other day with decellularized porcine urinary bladder matrix (powder and bilayer) and was able to reasonably regenerate the traumatic fingertip soft tissue envelope. This resulted in an envelope that was further enhanced with fat grafting. The resulting digit was sensate with maintained length, and possessed a more normal appearance than would be achieved by healing by secondary intention, or local flap or graft coverage. Decellularized materials can be utilized in conjunction with fat grafting to treat traumatic fingertip amputations in select patients. This combination approach is able to achieve a sensate fingertip and regain length lost in the affected digit. Additionally, we describe a novel technique that can be employed to maximize the amount of soft tissue regenerated by the decellularized products.
Team Training and Institutional Protocols to Prevent Shoulder Dystocia Complications
Authors: SMITH SAMUEL
Published: October 2016

Shoulder dystocia is an obstetrical emergency that may result in significant neonatal complications. It requires rapid recognition and a coordinated response. Standardization of care, teamwork and communication, and clinical simulation are the key components of patient safety programs in obstetrics. Simulation-based team training and institutional protocols for the management of shoulder dystocia are emerging as integral components of many labor and delivery safety initiatives because of their impact on technical skills and team performance.
Systemic Therapies for Nonmetastatic Breast Cancer: The Role of Neoadjuvant and Adjuvant Chemotherapy and the Use of Endocrine Therapy
Authors: BYCHKOVSKY BRITTANY L. , DIZON DON S. , SIKOV WILLIAM M.
Published: October 2016

Breast cancer is a heterogenous disease, comprised of at least 3 major subtypes: hormone receptor-positive/HER2−(HR+), HER2+, and HR−/HER2−(triple negative) breast cancers. The medical management of each subype is distinct. In this article, we review contemporary data supporting the use of chemotherapy, endocrine therapy and biologic therapies, especially HER2-directed agents, in the adjuvant and neoadjuvant setting in patients with newly diagnosed nonmetastatic (stage I-III) breast cancer.
Inhibiting p21-Activated Kinase Induces Cell Death in Vestibular Schwannoma and Meningioma via Mitotic Catastrophe
Authors: Mercado-Pimentel Melania Ester , Miller Craig , Rolph Daniela N. , Villalobos Edrick F. , Dunn Allison M. , Mohan Prithvi M. , Igarashi Suzu , Liu Xiangdang , Yrun-Duffy Macken , Patel Neal K. , Read Cecilia M. , Francis Ross H. , Lane Adelina Isabella , Murugesh Swaroop , Jacob Abraham
Published: October 2016

Hypothesis:

p21-activated kinase (PAK) regulates signaling pathways that promote cell survival and proliferation; therefore, pharmacological inhibition of PAK will induce cell death in vestibular schwannomas (VS) and meningiomas.

Background:

All VS and many meningiomas result from loss of the neurofibromatosis type 2 (NF2) gene product merlin, with ensuing PAK hyperactivation and increased cell proliferation/survival.

Methods:

The novel small molecule PAK inhibitors PI-8 and PI-15—tested in schwannoma and meningioma cells—perturb molecular signaling and induce cell death. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, flow cytometry, and terminal deoxynucleotidyl transferase dUTP nick end labeling assay analyzed PAK inhibitors’ effect on cell viability, cell cycle, and cell death, respectively. Western blots evaluated activation and expression of cell proliferation, apoptotic, and mitotic catastrophe markers. Light microscopy evaluated cell morphology, and immunocytochemistry analyzed cellular localization of phospho-Merlin and autophagy-related protein.

Results:

Treatment with PI-8 and PI-15 decreased cell viability at 0.65 to 3.7 μM 50% inhibitory concentration (IC50) in schwannoma and meningioma cells. Terminal deoxynucleotidyl transferase dUTP nick end labeling and immunocytochemistry studies show that PI-8 and PI-15 induce mitotic catastrophe but not apoptosis in HEI193 cells while in BenMen1 cells, PI-8 induces autophagy and mitotic catastrophe. PI-15 induces apoptosis in BenMen1 cells. PAK inhibitor treated cells show phospho-Merlin localized to over-duplicated centrosomes of dividing cells, multiple enlarged nuclei, and misaligned/missegregated chromosomes—markers for mitotic catastrophe. Increased autophagy-related protein levels in the nucleus confirmed this cell death type. PI-8 and PI-15 inhibits PAK in both cell lines. However, only PI-15 inhibits v-akt murine thymoma viral oncogene homolog in BenMen1 cells.

Conclusion:

PAK inhibitors induce cell death in schwannoma and meningioma cells, at least in part, by mitotic catastrophe.
Hemifacial Spasm Secondary to Parotid Pleomorphic Adenoma With Stylomastoid Foramen Extension
Authors: Martin Eliot J. , Carlson Matthew L. , Moore Eric J. , Jackson Ryan S.
Published: October 2016

Objective:

To report hemifacial spasm (HFS) as a rare presenting symptom of a benign parotid neoplasm involving the stylomastoid foramen.

Methods:

Case report with literature review.

Results:

An 18-year-old woman presented with a 1-year history of a progressively enlarging right infra-auricular mass with new onset ipsilateral severe HFS. Clinical vetting unveiled a palpable 2 cm, firm, minimally mobile mass medial to the angle of the mandible. Imaging revealed a heterogeneous intraparotid mass with tumor extension into the stylomastoid foramen. Diagnostic consideration was given to neurogenic tumors and neoplasms of parotid origin.

The patient ultimately underwent superficial parotidectomy and the tumor was found superficial and extrinsic to the proximal facial nerve trunk but extended into the stylomastoid foramen. The tumor was removed after performing mastoidectomy with mastoid segment facial nerve decompression. Frozen section pathology was consistent with pleomorphic adenoma. Postoperatively the patient had normal facial nerve function with immediate and complete resolution of HFS. To date there are only three other published reports of benign parotid tumors presenting with HFS and this is the first illustrating intratemporal tumor extension.

Conclusions:

HFS is a rare presenting symptom associated with benign parotid neoplasms with scarce documentation in the literature. In this index case, tumor extirpation with mastoid segment facial nerve decompression provided immediate and durable resolution of symptoms.
The Interaction Between Celiac Disease and Intestinal Microbiota
Authors: Losurdo Giuseppe , Principi Mariabeatrice , Iannone Andrea , Ierardi Enzo , Di Leo Alfredo
Published: October 2016

Celiac disease (CD) is the most common autoimmune enteropathy, triggered by a deregulated immune response to gliadin. It has been hypothesized that human intestinal microbiota may interfere with the pathogenesis of the disease and in the clinical course of CD. In the present review, we analyzed the microbiota alterations observed in the course of CD, how they may influence the pathogenesis of CD, and the possible applications for a microbiota modulation in CD. In detail, most of the current literature underlined that the dysbiosis in CD is hallmarked by an increase in gram-negative and Bacteroidetes species, and by a decrease in Bifidobacteria and Lactobacilli. As the intestinal microbiota is able to modulate the cytokine environment, an unfavorable microbiota could amplify the immune response to gliadin in individuals with CD, whereas the administration of probiotic species could lead to a decrease in proinflammatory cytokine production. Therefore, dysbiosis could represent an important trigger in CD pathogenesis, along with genetic (HLA—haplotypes) and environmental factors (antibiotic administration, mode of delivery, and breastfeeding). Although data on the modulation of microbiota by GFD are conflicting, current evidence has demonstrated that probiotic administration could be useful to improve symptoms and to reduce molecular mucosal inflammation, by downregulating the cytokines involved in CD pathogenesis. However, studies analyzing this aspect are few in number, thus stimulating the exploration of this field, with the aim of achieving a solid pathophysiological basis for probiotic administration in CD.
The Association of Bifidobacterium breve BR03 and B632 is Effective to Prevent Colics in Bottle-fed Infants
Authors: Giglione Enza , Prodam Flavia , Bellone Simonetta , Monticone Sonia , Beux Sheila , Marolda Agostina , Pagani Alessia , Di Gioia Diana , Del Piano Mario , Mogna Giovanni , Bona Gianni
Published: October 2016

Goals:

To assess the effectiveness of Bifidobacterium breve B632 and BR03 association in the reduction of infants crying over time. The second endpoint was to observe the effect of the same strains on daily evacuations and on the number of regurgitations and vomits.

Background:

Infant colics represent a clinical condition in childhood, characterized by an uncontrollable crying that occurs without any apparent organic cause. An altered intestinal microbiota composition in the very first months may induce intestinal colics in infants. Thus far, no treatment is really effective for this problem, but recent literature shows an increasing attention toward probiotics.

Study:

A total of 83 subjects were enrolled, 60 breastfed infants and 23 bottle-fed infants. Sixty of them carried out the study: 29 infants were given probiotics, whereas 31 placebo. During the 90 days of the study, parents were asked to give 5 drops of active product (108 viable cells/strain) or placebo and to daily take note of: minutes of crying, number, color, and consistency of evacuations, and number of regurgitations or vomits.

Results:

No significant differences were detected in the infants treated with probiotics, compared with placebo group (P=0.75). The analysis of the 3 months of treatment demonstrated that during the third month, the probiotic group cried 12.14 minutes on average and the placebo cried 46.65 minutes. This difference is statistically significant (P=0.016).

Conclusions:

The evidence of the usefulness of some probiotic strains in the treatment and prevention of infant colics is growing, and therefore their use in clinical practice is spreading.
Probiotics History
Authors: Gasbarrini Giovanni , Bonvicini Fiorenza , Gramenzi Annagiulia
Published: October 2016

Gut microbiota promotes healthy effects on the host and prevents diseases. Probiotic (probios, for life) are defined as “live microorganisms which when administered in adequate amounts confer a health benefit on the host.” At the beginning of 1900s Louis Pasteur identified the microorganisms responsible for the process of fermentation, whereas E. Metchnikoff associated the enhanced longevity of Bulgarian rural people to the regular consumption of fermented dairy products such as yogurt. He suggested that lactobacilli might counteract the putrefactive effects of gastrointestinal metabolism that contributed to illness and aging. Hippocrates declared, 2000 years earlier, that “death sits in the bowels.” Metchnikoff considered the lactobacilli as probiotics (“probios,” conducive to life of the host as opposed to antibiotics); probiotics could have a positive influence on health and prevent aging. During the neolitic period of the age of the stone, the domestication of animals occurred and man began to get fermented food. Probably serendipitous contaminations in favorable environments played a major role. Fecal microbiota transplantation dates to a fourth-century Chinese handbook for food poisoning or severe diarrhea. To date fecal transplant cures Clostridium difficile infections with more efficacy than vancomycin, and prevents recurrence.
Probiotics and Liver Disease
Authors: Elzouki Abdel-Naser
Published: October 2016

Probiotics are live, nonpathogenic bacteria capable of colonizing the colonic mucosa. The most common probiotics include strains of Lactobacillus or Bifidobacteria, which are part of the normal gastrointestinal microbiota. Initial studies of selected probiotic species have suggested potential efficacy in several gastrointestinal diseases including inflammatory bowel diseases (particularly pouchitis), antibiotic-related diarrhea, Clostridium difficile toxin-induced colitis, infectious diarrhea, irritable bowel syndrome, and allergy. The so-called “gut-liver axis” involves complex interaction between the liver parenchyma and gut microbiota. There is growing evidence to suggest that alteration in gut microbial components may affect the liver and can be a precipitating cofactor in development and modulating of chronic liver damage through ethanol, production of ammonia and endotoxin. This may allow for a better understanding of its role in the pathogenesis of verities of liver diseases and help to identify a microbial target for prevention and treatment of such diseases. This paper discusses the growing evidence that highlights the relationship between gut microbiota and development, prevention and treatment of numbers of liver diseases.
Gut Microbiome and Gastrointestinal Cancer
Authors: Tözün Nurdan , Vardareli Eser
Published: October 2016

Gastrointestinal (GI) cancers are the leading cause of mortality worldwide. These cancers are the end result of a complex interplay between gene and environment. Bacteria, parasites, and viruses have been implicated in some cancers. Recent data have put at focus the gut microbiome as the key player firing tumorigenesis. Experimental and human studies have provided evidence on the role of microbiota in cancer development. Although subject to changes in different settings such as antibiotic treatment, diet or lifestyle, our microbiome is quite stable and is capable of increasing susceptibility to cancer or decrease and halt its progression. The crucial event in carcinogenesis triggered by microbiome seems to be chronic inflammation influencing the genomic stability of host cells and activating immune mechanisms. Infection-related cancers represent 5.5% of the global cancer burden. Chronic inflammation predisposes to cancer in various GI organs, including hepatocellular carcinoma caused by hepatitis B or hepatitis C virus-related chronic hepatitis, gastric cancer (GC) caused by Helicobacter pylori-associated chronic gastritis, colorectal cancer caused by inflammatory bowel disease, bile duct cancer by primary sclerosing cholangitis, and esophageal cancer caused by Barrett esophagus. Apart from its impact in GI cancer development microbiota can also play an important role in the progression of cancer, response to chemotherapy or cancer prevention. In this review we will discuss the role of microbiome in GI cancers in the light of the current literature and the possible therapeutic options targeting microbiota in the near future.
Incarceration of the Gravid Uterus
Authors: Shnaekel Kelsey L. , Wendel Michael P. , Rabie Nader Z. , Magann Everett F.
Published: October 2016

Objective

The aim of this review was to describe the risk factors, clinical and radiographic criteria, and management of this rare complication of pregnancy.

Methods

A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched.

Results

There were 60 articles identified, with 53 articles being the basis of this review. Multiple risk factors have been suggested in the literature including retroverted uterus in the first trimester, deep sacral concavity with an overlying sacral promontory, endometriosis, previous abdominal or pelvic surgery, pelvic or uterine adhesions, ovarian cysts, leiomyomas, multifetal gestation, uterine anomalies, uterine prolapse, and uterine incarceration in a prior pregnancy. The diagnosis is difficult to make owing to the nonspecific presenting symptoms. The diagnosis is clinical and confirmed by imaging. Magnetic resonance imaging is superior to ultrasound to accurately diagnose and elucidate the distorted maternal anatomy. Treatment is dictated by gestational age at diagnosis based on risks and benefits. The recommended route of delivery is cesarean delivery when uterine polarity cannot be corrected.

Conclusions

Incarceration of the gravid uterus is a rare but serious complication of pregnancy. The diagnosis is clinical and confirmed with imaging, with magnetic resonance imaging being superior to delineate the distorted maternal anatomy. Reduction of the incarcerated uterus should be attempted to restore polarity and avoid unnecessary cesarean delivery.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After completing this activity, the learner should be better able to evaluate the published literature regarding incarceration of the gravid uterus and associated outcomes, differentiate normal and pathologic anatomy on various imaging modalities, determine the most beneficial treatment strategy based on gestational age, and review recommendations regarding management of subsequent pregnancies.
Evidence for a Teratogenic Risk in the Offspring of Health Personnel Exposed to Ionizing Radiation?!
Authors: Wiesel Awi , Stolz Gabriela , Queisser-Wahrendorf Annette
Published: October 2016

(Abstracted from Birth Defects Res A 2016;106:475–479)

The adverse effects of ionizing radiation are known through studies on animal models, and further investigations are required to evaluate teratogenic effects and to develop effective protection measures. An exploratory finding from a study undertaken in 2011 revealed teratogenic effects on the infants of mothers working in the medical field, wearing a dosimeter, and potentially exposed to ionizing radiation.