bluuebunny/crossref_metadata_2025 huggingface dataset:
“Health is Wealth”: Valuing Health in the Nineteenth-Century United States
Authors: Kiechle Melanie A
Published: September 2019

This essay traces the evolution of the motto “health is wealth” from its origins as an anticapitalist argument made by antebellum sanitary reformers to its acceptance as a fundamental principle of organized public health in the United States. Sanitarians originally coined the phrase “health is wealth” to counter the capitalist maxim “labor is wealth.” Because city leaders were businessmen who understood economic arguments, public health reformers increasingly gave health a monetary value in order to win over this audience and change urban governance. Although “health is wealth” momentarily co-opted the logic of capitalism in order to successfully make the case for institutionalizing public health within municipal and state governments, the phrase ultimately wrote economic values into the purpose and functions of public health boards and departments. In the course of advancing a proactive public health that prevented both endemic and epidemic diseases, sanitarians reduced the perception of health from a common good to a commodity. The economic logic employed by early reformers is critical, not only for understanding how the long reach of early American capitalism touches us today but also for recognizing that modern public health functions in the way it was created, as a capitalist system.
A 70-Year-Old Female with Unexpected Platelet Function Testing Results
Authors: Kim Moon Joo , Patel Pragna , Vyas Niti , Leveque Christopher , Diaz Orlando , Salazar Eric
Published: September 2019

A 70-year-old female with a history of hypertension and left A2 segment aneurysm was scheduled for pipeline embolization device (PED) placement. Preinterventional antiplatelet prophylaxis included aspirin and ticagrelor. Unexpectedly, after 13 days of treatment, VerifyNow showed a P2Y12 reaction unit (PRU) value of 216, approximately >5 times the mean PRU of other patients on aspirin and ticagrelor. We confirmed platelet reactivity and ticagrelor resistance with light transmission aggregometry. Antiplatelet therapy was switched to prasugrel, and aspirin was continued. Eight days later, the P2Y12 reaction value (PRU) was 164. PED was placed without complications. Unlike clopidogrel, ticagrelor is a direct P2Y12 inhibitor that does not require metabolism to an active metabolite. Ticagrelor resistance is very rarely reported. To the best of our knowledge, there has been no case of ticagrelor resistance reported in the context of pre-PED placement prophylaxis.
Scintillation Arc Brightness and Electron Density for an Analytical Noodle Model
Authors: Gwinn Carl R , Sosenko Evan B
Published: September 2019

We show that narrow filaments or sheets of over- or under-dense plasma, or “noodles,” with fluctuations of scattering phase of less than a radian, can form the scintillation arcs seen for many pulsars. The required local fluctuations of electron density are indefinitely small. We assume a cosine profile for the electron column and find the scattered field by analytic Kirchhoff integration. For a large electron column, corresponding to large amplitude of phase variation, the stationary-phase approximation is accurate; we call this regime “ray optics”. For smaller-amplitude phase variation, the stationary-phase approximation is inaccurate or inapplicable; we call this regime “wave optics”. We show that scattering is most efficient when the width of the strip equals that of one pair of Fresnel zones, and in the wave-optics regime. We show that the resolution of present observations is about 100 Fresnel zones on the scattering screen. Incoherent superposition of strips within a resolution element tends to increase the scattered field. We find that observations match a single noodle per resolution element with phase of up to 12 radians; or many noodles per resolution element with arbitrarily small phase variation each, for net phase of less than a radian. Observations suggest a minimum radius for noodles of about 650 km, comparable to the ion inertial scale or the ion cyclotron radius in the scattering plasma.
A SHARP view of H0LiCOW: H0 from three time-delay gravitational lens systems with adaptive optics imaging
Authors: Chen Geoff C-F , Fassnacht Christopher D , Suyu Sherry H , Rusu Cristian E , Chan James H H , Wong Kenneth C , Auger Matthew W , Hilbert Stefan , Bonvin Vivien , Birrer Simon , Millon Martin , Koopmans Léon V E , Lagattuta David J , McKean John P , Vegetti Simona , Courbin Frederic , Ding Xuheng , Halkola Aleksi , Jee Inh , Shajib Anowar J , Sluse Dominique , Sonnenfeld Alessandro , Treu Tommaso
Published: September 2019

We present the measurement of the Hubble constant, H0, with three strong gravitational lens systems. We describe a blind analysis of both PG 1115+080 and HE 0435−1223 as well as an extension of our previous analysis of RXJ 1131−1231. For each lens, we combine new adaptive optics (AO) imaging from the Keck Telescope, obtained as part of the SHARP (Strong-lensing High Angular Resolution Programme) AO effort, with Hubble Space Telescope (HST) imaging, velocity dispersion measurements, and a description of the line-of-sight mass distribution to build an accurate and precise lens mass model. This mass model is then combined with the COSMOGRAIL-measured time delays in these systems to determine H0. We do both an AO-only and an AO + HST analysis of the systems and find that AO and HST results are consistent. After unblinding, the AO-only analysis gives $H_{0}=82.8^{+9.4}_{-8.3}~\rm km\, s^{-1}\, Mpc^{-1}$ for PG 1115+080, $H_{0}=70.1^{+5.3}_{-4.5}~\rm km\, s^{-1}\, Mpc^{-1}$ for HE 0435−1223, and $H_{0}=77.0^{+4.0}_{-4.6}~\rm km\, s^{-1}\, Mpc^{-1}$ for RXJ 1131−1231. The joint AO-only result for the three lenses is $H_{0}=75.6^{+3.2}_{-3.3}~\rm km\, s^{-1}\, Mpc^{-1}$. The joint result of the AO + HST analysis for the three lenses is $H_{0}=76.8^{+2.6}_{-2.6}~\rm km\, s^{-1}\, Mpc^{-1}$. All of these results assume a flat Λ cold dark matter cosmology with a uniform prior on Ωm in [0.05, 0.5] and H0 in [0, 150] $\rm km\, s^{-1}\, Mpc^{-1}$. This work is a collaboration of the SHARP and H0LiCOW teams, and shows that AO data can be used as the high-resolution imaging component in lens-based measurements of H0. The full time-delay cosmography results from a total of six strongly lensed systems are presented in a companion paper.
Fast and precise light-curve model for transiting exoplanets with rings
Authors: Rein Edan , Ofir Aviv
Published: September 2019

The presence of silicate material in known rings in the Solar system raises the possibility of ring systems existing even within the snow line – where most transiting exoplanets are found. Previous studies have shown that the detection of exoplanetary rings in transit light curves is possible, albeit challenging. To aid such future detection of exoplanetary rings, we present the Polygon + Segments model for modelling the light curve of an exoplanet with rings. This high-precision model includes full ring geometry as well as possible ring transparency and the host star’s limb darkening. It is also computationally efficient, requiring just a 1D integration over a small range, making it faster than existing techniques. The algorithm at its core is further generalized to compute the light curve of any set of convex primitive shapes in transit (e.g. multiple planets, oblate planets, moons, rings, combination thereof, etc.) while accounting for their overlaps. The python source code is made available.
Physical inference from the γ-ray, X-ray, and optical time variability of a large sample of Fermi blazars
Authors: Majumder Anwesh , Mitra Kaustav , Chatterjee Ritaban , Urry C M , Bailyn C D , Nandi Prantik
Published: September 2019

We present cross-correlation studies of γ-ray (0.1–300 GeV), X-ray (0.2–10 keV), and optical (R band) variability of a sample of 26 blazars during 2008–2016. The light curves are from Fermi-LAT, Swift-XRT, and the Yale-SMARTS blazar monitoring program. We stack the discrete cross-correlation functions of the blazars such that the features that are consistently present in a large fraction of the sample become more prominent in the final result. We repeat the same analysis for two subgroups, namely, low synchrotron peaked (LSP) and high synchrotron peaked (HSP) blazars. We find that, on average, the variability at multiple bands is correlated, with a time lag consistent with zero in both subgroups. We describe this correlation with a leptonic model of non-thermal emission from blazar jets. By comparing the model results with those from the actual data, we find that the inter-band cross-correlations are consistent with an emission region of size 0.1 pc within the broad-line region for LSP blazars. We rule out large changes of magnetic field (>0.5 Gauss) across the emission region or small values of magnetic field (e.g., 0.2 Gauss) for this population. We also find that the observed variability of the HSP blazars can be explained if the emission region is much larger than the distance to the broad-line region from the central black hole.
Recombining Your Way Out of Trouble: The Genetic Architecture of Hybrid Fitness under Environmental Stress
Authors: Zhang Zebin , Bendixsen Devin P , Janzen Thijs , Nolte Arne W , Greig Duncan , Stelkens Rike
Published: September 2019

Hybridization between species can either promote or impede adaptation. But we know very little about the genetic basis of hybrid fitness, especially in nondomesticated organisms, and when populations are facing environmental stress. We made genetically variable F2 hybrid populations from two divergent Saccharomyces yeast species. We exposed populations to ten toxins and sequenced the most resilient hybrids on low coverage using ddRADseq to investigate four aspects of their genomes: 1) hybridity, 2) interspecific heterozygosity, 3) epistasis (positive or negative associations between nonhomologous chromosomes), and 4) ploidy. We used linear mixed-effect models and simulations to measure to which extent hybrid genome composition was contingent on the environment. Genomes grown in different environments varied in every aspect of hybridness measured, revealing strong genotype–environment interactions. We also found selection against heterozygosity or directional selection for one of the parental alleles, with larger fitness of genomes carrying more homozygous allelic combinations in an otherwise hybrid genomic background. In addition, individual chromosomes and chromosomal interactions showed significant species biases and pervasive aneuploidies. Against our expectations, we observed multiple beneficial, opposite-species chromosome associations, confirmed by epistasis- and selection-free computer simulations, which is surprising given the large divergence of parental genomes (∼15%). Together, these results suggest that successful, stress-resilient hybrid genomes can be assembled from the best features of both parents without paying high costs of negative epistasis. This illustrates the importance of measuring genetic trait architecture in an environmental context when determining the evolutionary potential of genetically diverse hybrid populations.
Unique and assay specific features of NOMe-, ATAC- and DNase I-seq data
Authors: Nordström Karl J V , Schmidt Florian , Gasparoni Nina , Salhab Abdulrahman , Gasparoni Gilles , Kattler Kathrin , Müller Fabian , Ebert Peter , Costa Ivan G ,   DEEP consortium, Pfeifer Nico , Lengauer Thomas , Schulz Marcel H , Walter Jörn
Published: September 2019

Chromatin accessibility maps are important for the functional interpretation of the genome. Here, we systematically analysed assay specific differences between DNase I-seq, ATAC-seq and NOMe-seq in a side by side experimental and bioinformatic setup. We observe that most prominent nucleosome depleted regions (NDRs, e.g. in promoters) are roboustly called by all three or at least two assays. However, we also find a high proportion of assay specific NDRs that are often ‘called’ by only one of the assays. We show evidence that these assay specific NDRs are indeed genuine open chromatin sites and contribute important information for accurate gene expression prediction. While technically ATAC-seq and DNase I-seq provide a superb high NDR calling rate for relatively low sequencing costs in comparison to NOMe-seq, NOMe-seq singles out for its genome-wide coverage allowing to not only detect NDRs but also endogenous DNA methylation and as we show here genome wide segmentation into heterochromatic B domains and local phasing of nucleosomes outside of NDRs. In summary, our comparisons strongly suggest to consider assay specific differences for the experimental design and for generalized and comparative functional interpretations.
Interbase FRET in RNA: from A to Z
Authors: Füchtbauer Anders F , Wranne Moa S , Bood Mattias , Weis Erik , Pfeiffer Pauline , Nilsson Jesper R , Dahlén Anders , Grøtli Morten , Wilhelmsson L Marcus
Published: September 2019

Interbase FRET can reveal highly detailed information about distance, orientation and dynamics in nucleic acids, complementing the existing structure and dynamics techniques. We here report the first RNA base analogue FRET pair, consisting of the donor tCO and the non-emissive acceptor tCnitro. The acceptor ribonucleoside is here synthesised and incorporated into RNA for the first time. This FRET pair accurately reports the average structure of A-form RNA, and its utility for probing RNA structural changes is demonstrated by monitoring the transition from A- to Z-form RNA. Finally, the measured FRET data were compared with theoretical FRET patterns obtained from two previously reported Z-RNA PDB structures, to shed new light on this elusive RNA conformation.
A Review of Emerging Evidence for Utilization of a Percutaneous Interspinous Process Decompression Device to Treat Symptomatic Lumbar Adjacent-Segment Degeneration
Authors: Deer Timothy R , Sayed Dawood , Malinowski Mark N , Rowe Jeffery J , Jameson Jessica B , Liang Kevin , Sclafani Joseph A
Published: September 2019

Objective

Postlaminectomy syndrome diagnoses secondary to adjacent segment degeneration are a substantial and rising cause of morbidity in the United States. Emerging spinal cord neuromodulation technologies have produced successful outcomes for postlaminectomy neuropathic pain but are less effective in treating neurogenic claudication secondary to recurrent lumbar stenosis. Percutaneous interspinous process decompression systems can be used as a salvage treatment modality for persistent structural neurogenic claudication in postlaminectomy syndrome or after spinal cord stimulator implantation.

Methods

This paper is a review of emerging evidence for efficacious utilization of percutaneous interspinous process decompression.

Results

A recent pragmatic trial of subjects who underwent percutaneous interspinous process decompression for lumbar stenosis with intermittent neurogenic claudication reported that 63% (26/41) maintained minimal clinically important improvement in visual analog scale (VAS) leg pain, 61% (25/41) in VAS back pain, 78% (32/41) in function objective values, and 88% (36/41) reported satisfaction with treatment at 12 months postop. All subjects in a small case series of seven individuals with postlaminectomy adjacent-segment disease reported postoperative satisfaction scores of 3 or 4 on a 0–4 scale and were also able to decrease or wean completely off controlled pain medications. In another study, there was a significant decrease in average leg pain (60% improvement, P < 0.0001, N = 25) and axial low back pain (58% improvement, P < 0.0001, N = 25) in patients who underwent one- or two-level percutaneous interspinous process decompression as a rescue treatment for reemerging neurogenic claudication after spinal cord stimulator implantation.

Conclusions

The spine often is a focus of progressive disease. Furthermore, mechanical changes associated with spinal instrumentation can lead to additional disease at adjacent levels. Many individuals will present with symptomatic neurogenic claudication recalcitrant to multimodal management strategies, including even the most sophisticated neuromodulation technologies. Implementation of salvage percutaneous interspinus process decompression implantation in cases of adjacent segment degeneration or incomplete spinal cord stimulation can decompress structural causes of neurogenic claudication while sparing the patient from more invasive surgical reoperation techniques.
Will trust proceedings of the future be private?
Authors: Alexander Stephen
Published: September 2019

This article considers the development, and future course, of the law of privacy in administrative trust proceedings. The author argues that the principles of open justice should remain as the starting point of judicial thinking; that this should mean that the courts' approach is driven by what is necessary to enable the public to see that justice is being administered fairly and impartially; and that the publication of details of parties and trusts in non-contentious trust proceedings is usually unlikely to help achieve that end. The author concludes that the issues of open justice and privacy are best balanced and accommodated by the policy, in administrative trust proceedings, of the court sitting in private and then issuing an anonymised judgment giving as much information as possible.
Hepatitis C virus genotype 1 and 2 recombinant genomes and the phylogeographic history of the 2k/1b lineage
Authors: Hostager Reilly , Ragonnet-Cronin Manon , Murrell Ben , Hedskog Charlotte , Osinusi Anu , Susser Simone , Sarrazin Christoph , Svarovskaia Evguenia , Wertheim Joel O
Published: September 2019

Recombination is an important driver of genetic diversity, though it is relatively uncommon in hepatitis C virus (HCV). Recent investigation of sequence data acquired from HCV clinical trials produced twenty-one full-genome recombinant viruses belonging to three putative inter-subtype forms 2b/1a, 2b/1b, and 2k/1b. The 2k/1b chimera is the only known HCV circulating recombinant form (CRF), provoking interest in its genetic structure and origin. Discovered in Russia in 1999, 2k/1b cases have since been detected throughout the former Soviet Union, Western Europe, and North America. Although 2k/1b prevalence is highest in the Caucasus mountain region (i.e., Armenia, Azerbaijan, and Georgia), the origin and migration patterns of CRF 2k/1b have remained obscure due to a paucity of available sequences. We assembled an alignment which spans the entire coding region of the HCV genome containing all available 2k/1b sequences (>500 nucleotides; n = 109) sampled in ninteen countries from public databases (102 individuals), additional newly sequenced genomic regions (from 48 of these 102 individuals), unpublished isolates with newly sequenced regions (5 additional individuals), and novel complete genomes (2 additional individuals) generated in this study. Analysis of this expanded dataset reconfirmed the monophyletic origin of 2k/1b with a recombination breakpoint at position 3,187 (95% confidence interval: 3,172–3,202; HCV GT1a reference strain H77). Phylogeography is a valuable tool used to reveal viral migration dynamics. Inference of the timed history of spread in a Bayesian framework identified Russia as the ancestral source of the CRF 2k/1b clade. Further, we found evidence for migration routes leading out of Russia to other former Soviet Republics or countries under the Soviet sphere of influence. These findings suggest an interplay between geopolitics and the historical spread of CRF 2k/1b.
The phylogenetic relationships of neosuchian crocodiles and their implications for the convergent evolution of the longirostrine condition
Authors: Groh Sebastian S , Upchurch Paul , Barrett Paul M , Day Julia J
Published: September 2019

Since their origin in the Late Triassic, crocodylomorphs have had a long history of evolutionary change. Numerous studies examined their phylogeny, but none have attempted to unify their morphological characters into a single, combined dataset. Following a comprehensive review of published character sets, we present a new dataset for the crocodylomorph clade Neosuchia consisting of 569 morphological characters for 112 taxa. For the first time in crocodylian phylogenetic studies, quantitative variation was treated as continuous data (82 characters). To provide the best estimate of neosuchian relationships, and to investigate the origins of longirostry, these data were analysed using a variety of approaches. Our results show that equally weighted parsimony and Bayesian methods cluster unrelated longirostrine forms together, producing a topology that conflicts strongly with their stratigraphic distributions. By contrast, applying extended implied weighting improves stratigraphic congruence and removes longirostrine clustering. The resulting topologies resolve the major neosuchian clades, confirming several recent hypotheses regarding the phylogenetic placements of particular species (e.g. Baryphracta deponiae as a member of Diplocynodontinae) and groups (e.g. Tethysuchia as non-eusuchian neosuchians). The longirostrine condition arose at least three times independently by modification of the maxilla and premaxilla, accompanied by skull roof changes unique to each longirostrine clade.
Identification of Pseudomonas Isolates Associated With Bacterial Canker of Stone Fruit Trees in the Western Cape, South Africa
Authors: Bophela Khumbuzile N. , Petersen Yolanda , Bull Carolee. T. , Coutinho Teresa. A.
Published: September 2019

Bacterial canker is a common bacterial disease of stone fruit trees. The causal agents responsible for the disease include several pathovars in Pseudomonas syringae sensu lato and newly described Pseudomonas species. Pseudomonad strains were isolated from symptomatic stone fruit trees, namely apricot, peach, and plum trees cultivated in spatially separated orchards in the Western Cape. A polyphasic approach was used to identify and characterize these strains. Using a multilocus sequence typing approach of four housekeeping loci, namely cts, gapA, gyrB, and rpoD, the pseudomonad strains were delineated into two phylogenetic groups within P. syringae sensu lato: P. syringae sensu stricto and Pseudomonas viridiflava. These results were further supported by LOPAT diagnostic assays and analysis of clades in the rep-PCR dendrogram. The pseudomonad strains were pathogenic on both apricot and plum seedlings, indicative of a lack of host specificity between Pseudomonas strains infecting Prunus spp. This is a first report of P. viridiflava isolated from plum trees showing symptoms of bacterial canker. P. viridiflava is considered to be an opportunistic pathogen that causes foliar diseases of vegetable crops, fruit trees, and aromatic herbs, and thus the isolation of pathogenic P. viridiflava from twigs of plum trees showing symptoms of bacterial canker suggests that this bacterial species is a potentially emerging stem canker pathogen of stone fruit trees in South Africa.
Overview of breast cancer
Authors: Watkins Elyse J.
Published: September 2019

Each year, more than 250,000 women in the United States are diagnosed with invasive breast cancer. Although overall mortality for breast cancer patients has declined, it is still the second most common cause of cancer death in women. This article provides an overview of nonmetastatic breast cancer in women, including general features, diagnostic considerations, and treatments for the most common breast cancer subtypes.
Using buprenorphine to treat patients with opioid use disorder
Authors: Radi Joshua K. , Fogarty Kieran J. , Lagerwey Mary D.
Published: September 2019

The US opioid epidemic is a complex problem that has resulted in legislative actions to make treatment more accessible to patients. Physician assistants (PAs) have taken an active role in expanding their scope of practice to keep up with treatment needs. This article describes opioid use disorder in the United States, treatment gaps, safe treatment with buprenorphine, and PA prescriptive authority.
Psychosocial Factors and Knee Pain Among Older People in Japan
Authors: Ikeda Takaaki , Aida Jun , Tsuboya Toru , Sugiyama Kemmyo , Kondo Katsunori , Osaka Ken
Published: September 2019

Objectives:

Psychosocial factors are known to affect knee pain. However, the magnitude of depression on the associations between socioeconomic status (SES) and knee pain in older individuals remains unknown. This study aimed to determine (1) the associations between SES and knee pain and (2) how depression mediates the associations between SES and knee pain.

Materials and Methods:

We conducted a survey across 30 Japanese municipalities to collect cross-sectional data. Functionally independent, community-dwelling adults aged 65 years or above (n=26,037) were eligible for the study. Self-reported knee pain in the past year was used as the dependent variable. Past occupation and equivalized household income were separately added to the models as independent variables. Poisson regression analysis was used to examine the associations between SES and knee pain, adjusting for covariates. Mediation analysis was applied to estimate how depression explains these associations.

Results:

The 1-year prevalence of knee pain was 56.0% in our study population. We found that income levels were significantly associated with knee pain: the lowest income level was more prone to experience knee pain compared with the highest income level at a prevalence ratio of 1.22 (95% confidence interval, 1.15-1.28). Depression explained 36.8% of the association of income with knee pain in females and 41.9% in males.

Discussion:

Significant socioeconomic inequalities were observed regarding knee pain among older individuals in Japan. Depression somewhat explained the association between SES and knee pain.
Under Pressure to Perform
Authors: Randall Edin T. , Shapiro Jenna B. , Smith Kelly R. , Jervis Kelsey N. , Logan Deirdre E.
Published: September 2019

Objectives:

Various academic factors are known to influence pain and somatic symptoms in adolescents, but the roles of academic goal orientation, school motivational climate, and school engagement are unknown. This study examined how these understudied academic factors are associated with adolescent pain and somatic symptoms and whether sex moderates the relations.

Materials and Methods:

High school students (n=90) from a high-achieving community completed questionnaires assessing academic variables, various pain characteristics, and somatic symptoms.

Results:

The majority of adolescents (67%) experienced pain and somatic symptoms in the past month, with 56% reporting multisite pain and 58% reporting at least 1 severe somatic symptom. Headache and abdominal pain were the most frequently reported “most bothersome” pains, and pain was rated, on average, as moderately severe, typically occurring several times per month, and was primarily chronic in nature (duration, ≥3 mo). Higher levels of ego goal orientation and perceived performance motivational climate were associated with more somatic symptoms, and ego goal orientation was also associated with more intense and frequent pain. Alternatively, greater school engagement was associated with fewer somatic symptoms. Task goal orientation and mastery motivational climate were unassociated with all pain and somatic symptom outcomes.

Discussion:

This study demonstrates that adolescents from a high-achieving community report more somatic symptoms and pain when they are less engaged in school and when their academic focus is on grades and outperforming peers. Results suggest that de-emphasizing competition and performance outcomes may support physical well-being in adolescents.
A Novel Coding Variant in SLC39A8 Is Associated With Adolescent Idiopathic Scoliosis in Chinese Han Population
Authors: Xu Leilei , Wang Yuwen , Wu Zhichong , Dai Zhicheng , Liu Zhen , Qiu Yong , Cheng Jack Chun-Yiu , Zhu Zezhang
Published: September 2019

Study Design.

A genetic case–control association study.

Objective.

The aim of this study was to investigate the association of SLC39A8 with the susceptibility of adolescent idiopathic scoliosis (AIS) in Chinese Han population.

Summary of Background Data.

A recent exome-wide association study identified a missense variant rs13107325 in SLC39A8 that was associated with AIS. However, there was a lack of study validating the association of this novel mutation with AIS in other populations.

Methods.

The variant rs13107325 was genotyped in 965 AIS patients and 976 healthy controls by allelic specific multiple ligase detection reactions. Variants located in the coding region of SLC39A8 were identified by exon sequencing for 192 AIS patients and 192 controls. Paraspinal muscles from 36 AIS patients and 36 age-matched congenital scoliosis patients were collected for the gene expression analysis. Comparison between the cases and controls was performed with the χ
2 test for genotyping data or with Student t test for gene expression analysis.

Results.

For the missense variant rs13107325, there was no case of mutation detected in the patients or the controls. All the subjects had homozygous genotype CC. Exon sequencing revealed that a coding variant rs11097773 of SLC39A8 had a significantly different distribution of minor allele frequency between patients and controls (7.81% vs. 14.8%, P = 0.002). The mRNA expression of SLC39A8 in the patients was remarkably lower than that in the controls (0.0015 ± 0.00026 vs. 0.0021 ± 0.00033, P < 0.001).

Conclusion.

The association of previously reported novel mutation (rs13107325 in SLC39A8) with AIS was not replicated in the Chinese population. Interestingly, a novel coding variant rs11097773 of SLC39A8 is found significantly associated with AIS. Moreover, the expression of SLC39A8 was obviously decreased in AIS patients. Further study is warranted to clarify the functional role of rs11097773 in the development of AIS.

Level of Evidence: 3
Functional Connectivity Changes of the Visual Cortex in the Cervical Spondylotic Myelopathy Patients
Authors: Chen Zhao , Zhao Rui , Wang Qiu , Yu Chunshui , Li Fengtan , Liang Meng , Zong Yaqi , Zhao Ying , Xiong Wuyi , Su Zhe , Xue Yuan
Published: September 2019

Study Design.

Cross-sectional study.

Objective

To analyze altered functional connectivity (FC) in the visual cortex of cervical spondylotic myelopathy (CSM) patients using resting-state functional magnetic resonance imaging (fMRI).

Summary of Background Data.

We previously showed changes in visual cortex neural activity in CSM patients.

Methods.

Thirty CSM patients and 20 healthy controls were recruited. MR data were collected using a 3.0 T MR. FC of the regions of interest (ROI) (Brodmann areas [BA] 17/18/19/7) were calculated in a voxel-wise manner and compared between groups. Correlation analyses were performed between preoperative Japanese Orthopaedic Association (JOA) scores and altered FC, as well as between preoperative best corrected visual acuity (BCVA) and altered FC. Furthermore, the FC where was compared between the preoperative and the postoperative CSM patients in an ROI-wise manner.

Results.

Increased FC was found between BA19 and the cerebellum inferior lobe; between the left BA7 and bilateral calcarine, right lingual, right fusiform gyrus, and left precuneus (BA17); between the left BA7 and right fusiform gyrus and right inferior occipital gyrus (right BA19); and between the right BA7 and right superior lobe of cerebellum (right BA19) in CSM patients (P < 0.05). A negative correlation was found between JOA score and FC of the left and right BA19, and a positive correlation was found between the BCVA and FC of the left and right BA7 (P < 0.05). ROI analysis demonstrated statistically significant FC differences in between the preoperative and the postoperative CSM patients (P < 0.05).

Conclusion.

FC changes were present in the visual cortex of CSM patients, which negatively correlated with preoperative JOA scores and positively correlated with preoperative BCVA. Significant recovery of FC in the visual cortex was detected in CSM patients postoperatively.

Level of Evidence: 4
Doctor, ask your perimenopausal patient about her physical fitness; association of self-reported physical fitness with cardiometabolic and mental health in perimenopausal women: the FLAMENCO project
Authors: Aparicio Virginia A. , Marín-Jiménez Nuria , Coll-Risco Irene , de la Flor-Alemany Marta , Baena-García Laura , Acosta-Manzano Pedro , Aranda Pilar
Published: September 2019

Objective:

The aim of this study was to explore the association of self-reported physical fitness (PF) and its components with cardiometabolic and mental health in perimenopausal women.

Methods:

These cross-sectional analyses included 191 participants (53 ± 4 y old) from the FLAMENCO project. Self-reported PF was assessed with the International Fitness Scale (IFIS). Body mass index (BMI), fat mass (FM), waist circumference (WC), systolic and diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL-C), triglycerides, C-reactive protein (CRP), and glucose were measured. The Beck's Depression Inventory, State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, Life Orientation Test Revised, and Positive and Negative Affect Schedule were used to assess mental health.

Results:

After adjusting for potential confounders, greater overall PF was associated with lower BMI, FM, WC (P < 0.001), DBP and CRP, and higher HDL-C (P < 0.05). Cardiorespiratory fitness (CRF), speed-agility, and flexibility were associated with lower BMI, WC, and FM (P < 0.001), and muscle strength (MS) with lower WC and FM (P < 0.05). In addition, CRF, MS, and speed-agility were associated with lower CRP (P < 0.01), and flexibility with enhanced triglycerides and HDL-C (P < 0.05). Overall PF and all its components were associated with lower depression, anxiety, and negative affect (P≤0.01), and greater positive affect (P≤0.05). Overall PF and MS were associated with better sleep quality (P < 0.05), and CRF, MS, and speed-agility with greater optimism (P≤0.05). Finally, overall PF showed evidence of significant association with less pharmaceutical expenditure (B = −7.2, β=−0.145, P = 0.08).

Conclusions:

Self-reported PF was associated with better cardiometabolic and mental health in perimenopausal women. The IFIS might be proposed as an inexpensive, quick, and easy tool in clinical settings.
Some Aspects of CD8+ T-Cell Exhaustion Are Associated With Altered T-Cell Mitochondrial Features and ROS Content in HIV Infection
Authors: Deguit Christian Deo T. , Hough Michelle , Hoh Rebecca , Krone Melissa , Pilcher Christopher D. , Martin Jeffrey N. , Deeks Steven G. , McCune Joseph M. , Hunt Peter W. , Rutishauser Rachel L.
Published: September 2019

Background:

Reversing or preventing T-cell exhaustion is an important treatment goal in the context of HIV disease; however, the mechanisms that regulate HIV-specific CD8+ T-cell exhaustion are incompletely understood. Since mitochondrial mass (MM), mitochondrial membrane potential (MMP), and cellular reactive oxygen species (ROS) content are altered in exhausted CD8+ T cells in other settings, we hypothesized that similar lesions may arise in HIV infection.

Methods:

We sampled cryopreserved peripheral blood mononuclear cells from HIV-uninfected (n = 10) and HIV-infected participants with varying levels and mechanisms of viral control: viremic (VL > 2000 copies/mL; n = 8) or aviremic (VL < 40 copies/mL) due to antiretroviral therapy (n = 11) or natural control (n = 9). We characterized the MM, MMP, and ROS content of bulk CD8+ T cells and MHC class I tetramer+ HIV-specific CD8+ T cells by flow cytometry.

Results:

We observed higher MM, MMP, and ROS content across bulk effector-memory CD8+ T-cell subsets in HIV-infected compared with HIV-uninfected participants. Among HIV-specific CD8+ T cells, these features did not vary by the extent or mechanism of viral control but were significantly altered in cells displaying characteristics associated with exhaustion (eg, high PD-1 expression, low CD127 expression, and impaired proliferative capacity).

Conclusions:

While we did not find that control of HIV replication in vivo correlates with the CD8+ T-cell MM, MMP, or ROS content, we did find that some features of CD8+ T-cell exhaustion are associated with alterations in mitochondrial state. Our findings support further studies to probe the relationship between mitochondrial dynamics and CD8+ T-cell functionality in HIV infection.
Temporary Migration for Training
Authors: Abdelrahman Mohamed , Yvon Adrien , Chen Yu-Ray , Grant Janet
Published: September 2019

Background

Against a background of globalization and medical migration, issues have been raised regarding training outside the clinician's own context.

Objective

There is a dearth of published literature on these issues and we aimed to explore these.

Methods

Taking Chang Gung Memorial Hospital fellowships in microfacial and craniofacial surgery as our case study, we developed an online survey to look at the circumstances leading junior doctors to seek specific, high-level training outside their country of intended practice and how effective this was for their future career, the service they provide, and their institutions.

Results

Fellows come to the Chang Gung Memorial Hospital predominantly from Europe, North America, and Asia, rather than specifically from developing countries. The predominant reasons were professional, personal, and to gain training that was not available at home, followed by career development. The fellowship was not commonly used as a career step or a means of migration. Our results showed that most fellows received training that enabled them to provide a service for complex cases on returning to their home country. Implementing newly acquired skills at home did not present any consistent challenges for fellows.

Conclusions

This study addressed a new phenomenon for the literature on medical migration: temporary migration from developed countries for the purposes of training and not permanent migration. The motivation for seeking these fellowships was to make up for training opportunities that were not available in highly planned health economies. To develop their practice in their home institutions, fellows often had to make adjustments to ensure effective transfer of skills and, in doing so, contribute to service development.
A Simple Approach for the Repair of Intermediate-to-Large Cheek Defects
Authors: Qiao Congzhen , Zou Yun , Qiu Yajing , Lin Xiaoxi
Published: September 2019

Background

Surgical management of cheek congenital melanocytic nevus (CMN) remains a huge challenge because of undesirable defects in repair. The use of direct closure is often limited to defect reconstruction with a diameter less than 4 cm.

Objective

This study aimed to evaluate the safety and efficacy of direct vertical closure combined with extensive subcutaneous tissue undermining boundaries for intermediate-to-large cheek defects.

Methods and Materials

A retrospective review was conducted to evaluate patients with cheek CMN who underwent the aforementioned procedure. Projected adult size, defect size, and incision length were measured. The Vancouver scar scale and visual analog scale were applied to assess scar formation and postoperative appearance. Complications within 1 year postoperatively were recorded.

Results

A total of 35 patients with CMN >3.5 cm underwent the procedure. Patients' age ranged from 3 to 36 years. The average projected adult size of the facial CMN was 5.5 ± 1.6 cm. The mean Vancouver scar scale and visual analog scale scores were 2.6 ± 1.0 and 8.0 ± 0.7, respectively. There were 2 cases of dog ear deformity (5.7%) and 1 case of hematoma (2.9%).

Conclusion

This simple algorithm yields satisfying results with low complication rate in the repair of intermediate-to-large cheek defects and may become a useful alternative to cheek reconstruction.
Refining the Latissimus Dorsi Flap
Authors: Maselli Amy M. , Mella Juan Rodolfo , Guo Lifei
Published: September 2019

The latissimus dorsi flap has been used to reconstruct mastectomy defects for more than 100 years. It has remained relevant in breast reconstruction because of its consistent anatomy, robust vascular supply, congruent vector, and ability to cover large surface areas. With the evolution of oncologic and reconstructive techniques as well as improvements in prosthetic devices, however, this myocutaneous flap has largely fallen out of favor in primary breast reconstruction. Our experience demonstrates that the latissimus dorsi flap remains a versatile flap that may be tailored to reconstruct various oncologic breast defects and deformities in an expeditious fashion.
Treatment of Congenital Melanocytic Nevi in the Eyelid and Periorbital Region With Ablative Lasers
Authors: Gu Yifei , Chang Shih-jen , Ma Gang , Wang Yungying , Zhu Jiafang , Chen Hui , Lin Xiaoxi
Published: September 2019

Background

Congenital melanocytic nevi (CMN) that occur on the eyelid and periorbital region cause cosmetic disfiguring. Laser treatment has aroused interest as an alternative treatment method, and resurfacing lasers have shown promising results.

Objective

This study aimed to evaluate the efficacy and safety of carbon dioxide laser and erbium:yttrium aluminum garnet laser to treat CMN of the eyelid and periorbital region.

Methods and Materials

Twenty patients with CMN were included in this study and were treated with either the CO2 or erbium:yttrium aluminum garnet laser. Clinical efficacy outcomes were evaluated by visual assessment and L*a*b* color space evaluation at least 6 months after treatment.

Results

The average (SD) visual evaluation improvement, assessed on a 5-point scale, was 2.8 (1.27). The mean (SD) values of the relative L* improvement rate and blanching rate of the CMN lesion were 32.0% (47.9%) and 34.1% (36.2%), respectively. Spearman rank correlation coefficient between the objective and subjective evaluations was significant (P < 0.001). Three cases developed partial hypopigmentation. No patient developed hypertrophic scars.

Conclusion

The outcomes after laser treatment were variable, although half of the patients achieved greater than 50% clearance. It provides an alternative to surgical excision for the removal of CMN in the difficult regions. Surgery excision is inevitable for some patients.
Evidence for Healing Diabetic Foot Ulcers With Biologic Skin Substitutes
Authors: Gordon Alex J. , Alfonso Allyson R. , Nicholson Joey , Chiu Ernest S.
Published: September 2019

Background

Development of diabetic foot ulcers is a common complication of diabetes. Standard-of-care (SOC) therapy alone is often not sufficient to heal these wounds, resulting in application of adjuvant wound therapies including biologic skin substitutes. Although a variety of products exist, it has been difficult to formulate conclusions on their clinical efficacy. We therefore performed a systematic review and meta-analysis on the efficacy of healing diabetic foot ulcers with biologic skin substitutes.

Methods

A systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Four electronic databases (PubMed/MEDLINE, EMBASE [Ovid], Cochrane CENTRAL [Ovid], and Web of Science) were searched from inception through February 27, 2019. Searches included keywords and subject headings pertaining to 3 main concepts: biologic skin substitutes, wound healing, and diabetic foot ulcers. Cochrane randomized controlled trial filters were used to narrow results. Data were extracted from 54 included articles, and risk-of-bias assessments were conducted by 2 independent reviewers. The primary objective was to calculate a pooled risk ratio for the proportion of wounds completely closed by 12 weeks. Secondary objectives included a pooled risk ratio for the proportion of wounds completely closed by 6 weeks and mean time to healing.

Results

Twenty-five studies were identified that assessed the proportion of complete wound closure by 12 weeks. We found that wounds treated with biologic dressings were 1.67 times more likely to heal by 12 weeks than those treated with SOC dressings (P< 0.00001). Five studies assessed the proportion of complete wound closure by 6 weeks. Wounds treated with biologic dressings were 2.81 times more likely to heal by 6 weeks than those treated with SOC dressings (P= 0.0001). Descriptively, 29 of 31 studies that assessed time to healing favored biologic dressings over SOC dressings.

Conclusions

This systematic review provides supporting evidence that biologic skin substitutes are more effective than SOC dressings at healing diabetic foot ulcers by 12 weeks. Future studies must address the relative benefits of different skin substitutes as well as the long-term implications of these products and their financial considerations.
Frequency of the TREM2 R47H Variant in Various Neurodegenerative Disorders
Authors: Ayer Ariane H. , Wojta Kevin , Ramos Eliana Marisa , Dokuru Deepika , Chen Jason A. , Karydas Anna M. , Papatriantafyllou John D. , Agiomyrgiannakis Dimitrios , Kamtsadeli Vasiliki , Tsinia Niki , Sali Dimitra , Gylys Karen H. , Agosta Federica , Filippi Massimo , Small Gary W. , Bennett David A. , Gearing Marla , Juncos Jorge L. , Kramer Joel , Lee Suzee E. , Yokoyama Jennifer S. , Mendez Mario F. , Chui Helena , Zarow Chris , Ringman John M. , Kilic Ulkan , Babacan-Yildiz Gülsen , Levey Allan , DeCarli Charles S. , Cotman Carl W. , Boxer Adam L. , Miller Bruce L. , Coppola Giovanni
Published: September 2019

Objective:

A rare variant in TREM2 (p.R47H, rs75932628) has been consistently reported to increase the risk for Alzheimer disease (AD), while mixed evidence has been reported for association of the variant with other neurodegenerative diseases. Here, we investigated the frequency of the R47H variant in a diverse and well-characterized multicenter neurodegenerative disease cohort.

Methods:

We examined the frequency of the R47H variant in a diverse neurodegenerative disease cohort, including a total of 3058 patients clinically diagnosed with AD, frontotemporal dementia spectrum syndromes, mild cognitive impairment, progressive supranuclear palsy syndrome, corticobasal syndrome, or amyotrophic lateral sclerosis and 5089 control subjects.

Results:

We observed a significant association between the R47H variant and AD, while no association was observed with any other neurodegenerative disease included in this study.

Conclusions:

Our results support the consensus that the R47H variant is significantly associated with AD. However, we did not find evidence for association of the R47H variant with other neurodegenerative diseases.