bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bilateral Fascia Lata Flap: An Alternative for Massive Abdominal Wall Defect Repair
Authors: De Luna Gallardo Daniel , Cárdenas Salomon Carlos Michel , Barrera García Gabriel , Posada Torres José Antonio , Poucel Sánchez Medal Fernando 
Published: March 2020

Summary:
The abdominal wall represents a unique structure of dermo-myotendinous conformation that is considered a surgical challenge. The musculocutaneous pedicled flap, using tensor fasciae latae muscle (TFL), is a technique of abdominal wall repair, and it is becoming a more frequent reconstructive procedure. It is a well-suited procedure because it provides both a semirigid fascia layer and adequate skin coverage. We present a case of a 61-year-old man with the diagnosis of squamous cell carcinoma of the bladder, clinical stage IV (T4bN1M1), complicated with an ileo-recal-urethrocutaneous fistula. We reconstructed a massive defect of the abdominal wall by rotating bilateral pedicled TFL flaps. The therapeutic plan comprised 2 surgical procedures. The first surgical intervention was intended to obtain and temporarily fix the flap, and to allow the delay phenomenon to occur. Three weeks later, we performed the abdominal wall reconstruction by repositioning the bilateral TFL flaps and placing a dual prolene with regenerated oxidized cellulose mesh. We performed a successful palliative procedure in a terminal oncologic patient. Combined with a massive oncologic procedure (done by the oncologic surgeon), we were able to solve the cutaneous fistula and provided a significant improvement in the quality of life. The patient was discharged with no procedure-related complications. He has remained healthy 18 months after surgery, and there has been no evidence of ventral hernia. Bilateral TFL flaps represent a viable alternative for primary or secondary abdominal wall reconstruction in selected cases. This reconstructive strategy should be considered when plastic and reconstructive surgeon faces large and complex abdominal wall defects, associated with significant lack of skin cover.
Reconstruction of a Monodactylous Hand with Microsurgical Free Foot-to-Hand Transfer in Split-Hand/Split-Foot Malformation with Tibial Aplasia
Authors: Sabapathy S. Raja , Venkatramani Hari , Mohan Monusha , Zhang Dafang 
Published: March 2020

Summary:
Split-hand/split-foot malformation with long bone deficiency (SHLFD syndrome) is a rare congenital disorder, which may be sporadic or autosomal dominant with incomplete penetrance. When complete tibial aplasia is seen, the mainstay of treatment is amputation and lower limb prosthesis. This rare constellation of congenital differences presents an opportunity for microsurgical free tissue transfer using the principle of “spare parts” to improve the functionality of the hand. We present a rare case of split-hand/split-foot malformation with a monodactylous right hand and complete tibial aplasia, treated with microsurgical free foot-to-hand transfer at the time of lower limb amputation, reconstructing key pinch. At the latest 8 months follow-up, the patient had no pain, active key pinch, and ambulated independently with prostheses. He was able to use his right hand independently for a number of daily activities, such as stacking blocks, drinking from a cup, and playing with toys.
Multi-Level Predictors of Discharges Against Medical Advice: Identifying Contributors to Variation Using an All-Payer Database
Authors: Onukwugha Eberechukwu , Nagarajan Madhu , Offurum Ada , Gulati Mangla , Alfandre David 
Published: March 2020

ABSTRACT
There is increasing evidence of the role of non–patient-level factors on discharge against medical advice (DAMA), but limited quantitative information regarding the extent of their impact. This study quantifies the contribution of discharge-level and hospital-level factors to the variation in DAMA. We grouped variables from the 2014 National Inpatient Sample data and ran incremental mixed-effects logit models with grouping at the level of the discharge, the hospital, and the census region. We obtained the intraclass correlation coefficients (ICCs), and evaluated the incremental change in ICC. The final sample included 2,687,430 discharges. 12.8% of the identified variation in the probability of DAMA was associated with the hospital, and 1.2% of the variation was associated with the census division in which the hospital was located. The final, fully-adjusted model had 7.3% of variation in DAMA associated with the hospital-level, with the greatest percentage reductions because of the addition of patient demographics. Even after adjusting for measured patient-level characteristics, there was a contribution of non–patient-level factors to DAMA outcomes. The findings identify a role for a multi-level approach to addressing DAMA.
Relationship Between Preoperative Time of Fasting and Postoperative Nausea and Vomiting
Authors: Şişman Hamide , Aslan Fatma Eti , Alptekin Dudu , Akpolat Refiye 
Published: March 2020

Abstract
The study, conducted in Turkey, explored preoperative fasting in children and post operative complications. The design was prospective, comparative and descriptive. Children (n=82) between 7 and 18 who underwent general anesthesia and who, along with their parents, consented/assented, were included. The researchers note that fasting after midnight, the common practice, often resulted in very long fasting periods in children operated upon as the surgical day progressed. The length of time the child fasted was correlated with presence or absence of post operative nausea and vomiting using the Baxter BARF Scale. The findings report that the longer a child fasted, the more likely he or she was to vomit post operatively. The authors recommend a reconsideration of the potential time each child will be required to fast.
United States liver allocation
Authors: Heimbach Julie K. 
Published: March 2020

Purpose of review
The current review discusses the system of liver allocation in the United States, the adoption of the national liver review board (NLRB), and the pending major change to the system of distribution (acuity circle model).

Recent findings
The system of liver allocation in the United States is based on the model for end-stage liver disease (MELD) score, a formula which uses commonly available tests (international normalized ratio, bilirubin, creatinine, and recently, sodium) prioritizes candidates on the waitlist according to likelihood of death without access to transplant. This review provides an overview of modifications to MELD allocation and well as a summary of the benefits and weaknesses. The review also details the pending major revision to the distribution of liver allografts, which attempts to reduce the geographic disparity in access by sharing across a broader geographic area. Finally, the review describes the implementation of the NLRB, which replaced the previous system in May 2019.

Summary
The system of liver allocation and distribution in the United States has been subject to ongoing optimization, though the recent adoption of the NLRB, and pending change to distribution will significantly impact the system with the goal of reducing geographic disparity.
Predicting Inpatient Glucose Levels and Insulin Dosing by Machine Learning on Electronic Health Records
Authors: Liu Xiran , Jankovic Ivana , Chen Jonathan H 
Published: March 2020

AbstractPoorly controlled glucose levels are associated with serious morbidity and mortality in hospitalized patients. Hospital diabetes management aims to maintain the glucose level within a desired range, primarily via insulin administration. Current inpatient glucose control relies significantly on expert knowledge, but this results in large variability and often suboptimal blood sugars in practice. We applied supervised machine learning methods to electronic health record (EHR) data to build predictive models that can inform inpatient insulin management. We found that individual blood glucose levels and insulin dosing are highly erratic and cannot be predicted precisely (MAE 28mg/dL, R2 0.2). However, prescribing decisions can still be driven by the more reliable predictions of average daily glucose levels (MAE 21mg/dL, R2 0.4) and whether any patient’s glucose levels will be higher than the clinically desired range in the next day (sens 0.73, spec 0.79).
A modular chromosomally integrated toolkit for ectopic gene expression inVibrio cholerae
Authors: Dalia Triana N. , Chlebek Jennifer L. , Dalia Ankur B. 
Published: March 2020

AbstractThe ability to express genes ectopically in bacteria is essential for diverse academic and industrial applications. Two major considerations when utilizing regulated promoter systems for ectopic gene expression are (1) the ability to titrate gene expression by addition of an exogenous inducer and (2) the leakiness of the promoter element in the absence of the inducer. Here, we describe a modular chromosomally integrated platform for ectopic gene expression inVibrio cholerae. We compare the broadly used promoter elements Ptacand PBADto versions that have an additional theophylline-responsive riboswitch (Ptac-riboswitch and PBAD-riboswitch). These constructs all exhibited unimodal titratable induction of gene expression, however, max induction varied with Ptac> PBAD> PBAD-riboswitch > Ptac-riboswitch. We also developed a sensitive reporter system to quantify promoter leakiness and show that leakiness for Ptac> Ptac-riboswitch > PBAD; while the newly developed PBAD-riboswitch exhibited no detectable leakiness. We demonstrate the utility of the tightly inducible PBAD-riboswitch construct using the dynamic activity of type IV competence pili inV. choleraeas a model system. The modular chromosomally integrated toolkit for ectopic gene expression described here should be valuable for the genetic study ofVibrio choleraeand could be adapted for use in other species.
Prophages are associated with extensive CRISPR-Cas auto-immunity
Authors: Nobrega Franklin L. , Walinga Hielke , Dutilh Bas E. , Brouns Stan J.J. 
Published: March 2020

ABSTRACTCRISPR-Cas systems require discriminating self from non-self DNA during adaptation and interference. Yet, multiple cases have been reported of bacteria containing self-targeting spacers (STS), i.e. CRISPR spacers targeting protospacers on the same genome. STS has been suggested to reflect potential auto-immunity as an unwanted side effect of CRISPR-Cas defense, or a regulatory mechanism for gene expression. Here we investigated the incidence, distribution, and evasion of STS in over 100,000 bacterial genomes. We found STS in all CRISPR-Cas types and in one fifth of all CRISPR-carrying bacteria. Notably, up to 40% of I-B and I-F CRISPR-Cas systems contained STS. We observed that STS-containing genomes almost always carry a prophage and that STS map to prophage regions in more than half of the cases. Despite carrying STS, genetic deterioration of CRISPR-Cas systems appears to be rare, suggesting a level of escape from the potentially deleterious effects of STS by other mechanisms such as anti-CRISPR proteins and CRISPR target mutations. We propose a scenario where it is common to acquire an STS against a prophage, and this may trigger more extensive STS buildup by primed spacer acquisition in type I systems, without detrimental autoimmunity effects. The mechanisms of auto-immunity evasion create tolerance to STS-targeted prophages, and contribute both to viral dissemination and bacterial diversification.
Role of the C-terminal tail in regulating Proteinase Activated Receptor 2 (PAR2) signalling
Authors: Thibeault Pierre E. , Ramachandran Rithwik 
Published: March 2020

ABSTRACTThe C-terminal tail of G-protein-coupled receptors contain important regulatory sites that enable interaction with intracellular signalling effectors. Here we examine the relative contribution of the C-tail serine/threonine phosphorylation sites (Ser383-385, Ser387-Thr392) and the helix-8 palmitoylation site (Cys361) in signalling regulation downstream of the proteolytically-activated GPCR, PAR2. We examined Gαq/11-coupled calcium signalling, β-arrestin-1/-2 recruitment, and MAPK activation (p44/42 phosphorylation) by wild-type and mutant receptors expressed in a CRISPR/Cas9 PAR2-knockout HEK-293 cell background. We find that alanine substitution of the membrane proximal serine residues (Ser383-385Ala) had no effect on SLIGRL-NH2- or trypsin-stimulated β-arrestin recruitment. Alanine substitutions in the Ser387-Thr392cluster resulted in a large (∼50%) decrease in β-arrestin-1/2 recruitment triggered by the activating peptide, SLIGRL-NH2,but was without effect on trypsin-activated β-arrestin-1/-2 recruitment. Additionally, we find that alanine substitution of the helix-8 cysteine residue (Cys361Ala) led to a (∼50%) decrease in β-arrestin-1/-2 recruitment in response to both trypsin and SLIGRL-NH2. We further show that Gαq/11inhibition with YM254890, inhibited ERK phosphorylation by PAR2 agonists, while genetic deletion of β-arrestin-1/-2 by CRISPR/Cas9 enhanced MAPK activation. Knockout of β-arrestins also enhanced Gαq/11-mediated calcium signalling. In line with these findings, C-tail serine/threonine and cysteine residue mutants that have decreased β-arrestin recruitment also showed enhanced ERK activation. Thus, our studies point to multiple mechanisms that regulate β-arrestin interaction with PAR2 to regulate receptor-mediated signalling.
Saturation of influenza virus neutralization and antibody consumption can both lead to bistable growth kinetics
Authors: Xu Shilian , Yan Ada W. C. , Peck Heidi , Gillespie Leah , Barr Ian G. , Yang Xiaoyun , Turner Stephen J. , Donato Celeste M , Zhang Tonghua , Olshansky Moshe , Vijaykrishna Dhanasekaran 
Published: March 2020

ABSTRACTInfluenza virus is a major human health threat. Neutralizing antibodies elicited through prior infection or vaccination play an irreplaceable role in protection from subsequent infection. The efficacy of antibody-dependent vaccines relies on both virus replication and neutralization, but their quantitative relationship was unknown. Here we use mathematical models to quantitatively investigate viral survivability determined by antibody concentration and inocula size. We performed focus reduction assays for 49 seasonal influenza A/H3N2 viruses circulating during 2017–2019 against influenza antisera raised in ferrets, and find that the antibody consumption rates of individual reactions were either small or large, and this was strongly positively correlated with virus saturation. Regardless of antibody consumption rate, virus-antibody interactions always lead to antibody-induced bistable viral kinetics. As a result, at a specific interval of antibody concentration, small viral inocula are eliminated but not large virus inocula, which is triggered by saturated virus neutralization or antibody consumption. Our finding highlights virus-antibody interaction with different antigenic properties, thereby explaining commonly observed influenza re-infection and enhancing vaccine efficiency.
Pollinator niche partitioning and asymmetric facilitation contribute to the maintenance of diversity
Authors: Wei Na , Kaczorowski Rainee L. , Arceo-Gómez Gerardo , O’Neill Elizabeth M. , Hayes Rebecca A. , Ashman Tia-Lynn 
Published: March 2020

Abstract:Mechanisms that favor rare species are key to the maintenance of diversity. One of the most critical tasks for biodiversity conservation is understanding how plant–pollinator mutualisms contribute to the persistence of rare species, yet this remains poorly understood. Using a process-based model that integrates plant–pollinator and interspecific pollen transfer networks with floral functional traits, we show that niche partitioning in pollinator use and asymmetric facilitation confer fitness advantage of rare species in a biodiversity hotspot. While co-flowering species filtered pollinators via floral traits, rare species showed greater pollinator specialization leading to higher pollination-mediated male and female fitness than abundant species. When plants shared pollinator resources, asymmetric facilitation via pollen transport dynamics benefited the rare species at the cost of the abundant ones, serving as an alternative diversity-promoting mechanism. Our results emphasize the importance of community-wide plant–pollinator interactions that affect reproduction for biodiversity maintenance.
Sarcoptic mange; an emerging threat to Chilean wild mammals?
Authors: Montecino-Latorre Diego , Napolitano Constanza , Briceño Cristóbal , Uhart Marcela M. 
Published: March 2020

AbstractSarcoptic mange has been anecdotally reported in Chilean wildlife during the last decade. Although this disease can have devastating outcomes for biodiversity, there is no comprehensive assessment of this potential threat in Chile. Because the current capacity to monitor sarcoptic mange and other wildlife diseases is limited in this country, we used abnormal alopecia to search for suspect cases across several sources of information to identify, to the extent available data allow, the location and temporal trends of wild mammals with this characteristic across Chile. We surveyed park rangers, examined rehabilitation center databases, and collated citizen and media reports. The information gathered suggests that observations of alopecic wild mammals, mainly foxes (Lycalopexsp.), their presence in the country, and the number of species fulfilling our case definition have increased over the last 15 years. Moreover, abnormally alopecic mammals are currently located broadly in Chile. We also confirmed the utility of abnormal alopecia to define a suspect sarcoptic mange case in the most commonly affected group,Lycalopexfoxes. Our findings are highly concerning from a conservation perspective. We thus emphasize the need for an urgent surveillance and management plan for sarcoptic mange and other diseases that may be threatening Chilean biodiversity.
Epidemiology and Transmission of COVID-19 in Shenzhen China: Analysis of 391 cases and 1,286 of their close contacts
Authors: Bi Qifang , Wu Yongsheng , Mei Shujiang , Ye Chenfei , Zou Xuan , Zhang Zhen , Liu Xiaojian , Wei Lan , Truelove Shaun A. , Zhang Tong , Gao Wei , Cheng Cong , Tang Xiujuan , Wu Xiaoliang , Wu Yu , Sun Binbin , Huang Suli , Sun Yu , Zhang Juncen , Ma Ting , Lessler Justin , Feng Tiejian 
Published: March 2020

AbstractBackgroundRapid spread of SARS-CoV-2 in Wuhan prompted heightened surveillance in Shenzhen and elsewhere in China. The resulting data provide a rare opportunity to measure key metrics of disease course, transmission, and the impact of control.MethodsThe Shenzhen CDC identified 391 SARS-CoV-2 cases from January 14 to February 12, 2020 and 1286 close contacts. We compare cases identified through symptomatic surveillance and contact tracing, and estimate the time from symptom onset to confirmation, isolation, and hospitalization. We estimate metrics of disease transmission and analyze factors influencing transmission risk.FindingsCases were older than the general population (mean age 45) and balanced between males (187) and females (204). Ninety-one percent had mild or moderate clinical severity at initial assessment. Three have died, 225 have recovered (median time to recovery is 21 days). Cases were isolated on average 4.6 days after developing symptoms; contact tracing reduced this by 1.9 days. Household contacts and those travelling with a case where at higher risk of infection (ORs 6 and 7) than other close contacts. The household secondary attack rate was 15%, and children were as likely to be infected as adults. The observed reproductive number was 0.4, with a mean serial interval of 6.3 days.InterpretationOur data on cases as well as their infected and uninfected close contacts provide key insights into SARS-CoV-2 epidemiology. This work shows that heightened surveillance and isolation, particularly contact tracing, reduces the time cases are infectious in the community, thereby reducing R. Its overall impact, however, is uncertain and highly dependent on the number of asymptomatic cases. We further show that children are at similar risk of infection as the general population, though less likely to have severe symptoms; hence should be considered in analyses of transmission and control.
Multiplexed relative and absolute quantitative immunopeptidomics reveals MHC I repertoire alterations induced by CDK4/6 inhibition
Authors: Stopfer Lauren E , Mesfin Joshua M , Joughin Brian A , Lauffenburger Douglas A , White Forest M 
Published: March 2020

ABSTRACTPeptides bound to class I major histocompatibility complexes (MHC) play a critical role in immune cell recognition and can trigger an antitumor immune response in cancer. Surface MHC levels can be modulated by anticancer agents, altering immunity. However, understanding the peptide repertoire’s response to treatment remains challenging and is limited by quantitative mass spectrometry-based strategies lacking robust normalization controls. We describe a novel approach that leverages recombinant heavy isotope-coded peptide MHCs (hipMHCs) and multiplex isotope tagging to quantify peptide repertoire alterations using low sample input. HipMHCs improve quantitative accuracy of peptide repertoire changes by normalizing for variation across analyses and enable absolute quantification using internal calibrants to determine copies per cell of MHC antigens, which can inform immunotherapy design. Applying this platform in melanoma to profile the immunopeptidome response to CDK4/6 inhibition and interferon gamma, known modulators of antigen presentation, we uncovered treatment-specific alterations, connecting the intracellular response to extracellular immune presentation.
Cell-type specific outcome representation in primary motor cortex
Authors: Lavzin Maria , Levy Shahar , Benisty Hadas , Dubin Uri , Brosh Zohar , Aeed Fadi , Mensh Brett D. , Schiller Yitzhak , Meir Ron , Barak Omri , Talmon Ronen , Hantman Adam W. , Schiller Jackie 
Published: March 2020

AbstractAdaptive movements are critical to animal survival. To guide future actions, the brain monitors different outcomes, including achievement of movement and appetitive goals. The nature of outcome signals and their neuronal and network realization in motor cortex (M1), which commands the performance of skilled movements, is largely unknown. Using a dexterity task, calcium imaging, optogenetic perturbations, and behavioral manipulations, we studied outcome signals in murine M1. We find two populations of layer 2-3 neurons, “success”- and “failure” related neurons that develop with training and report end-result of trials. In these neurons, prolonged responses were recorded after success or failure trials, independent of reward and kinematics. In contrast, the initial state of layer-5 pyramidal tract neurons contains a memory trace of the previous trial’s outcome. Inter-trial cortical activity was needed to learn new task requirements. These M1 reflective layer-specific performance outcome signals, can support reinforcement motor learning of skilled behavior.