cssi/SciSciGPT-SciSciNet huggingface dataset:
Biliary brush cytology and the detection of cholangiocarcinoma in primary sclerosing cholangitis: evaluation of specific cytomorphologic features and CA19-9 levels

Interpreting biliary brush cytology (BBC) findings in primary sclerosing cholangitis (PSC) is problematic. In our study, BBC findings and CA19-9 serum levels were evaluated for their effectiveness in diagnosing cholangiocarcinoma in patients with PSC. We reviewed 107 biliary brushings from 51 patients with PSC and concurrent CA19-9 levels between January 1995 and March 2004 at the University of Washington Medical Center, Seattle. A portion of the brushings were evaluated and scored according to specific cytologic criteria; statistical analysis showed which criteria were most predictive in diagnosing malignancy: nuclear/cytoplasmic ratio, prominent nucleoli, nuclear membrane irregularities, and discohesion were significant predictive features. Sensitivity and specificity of BBC were 62.5% and 100%, respectively. Sensitivity and specificity of CA19-9 at a cutoff of 186 IU/mL were 100% and 94%, respectively. BBC is a specific and relatively sensitive method of detecting cholangiocarcinoma, even in patients with PSC, especially when certain cytomorphologic features are identified. Combining biliary cytology and CA19-9 levels might have an important diagnostic role in PSC.
The Prevention of Residual Abscess by Peritoneal Lavage in Experimental Peritonitis in Dogs

Residual abscess following peritonitis still remains a real problem at present. The worse the appendicular pathology at the time of operation, the more likely is such an abscess. This experiment has shown that postoperative intraperitoneal lavage may be a way of overcoming this problem The objections to lavage have been discussed, and it would seem that the benefits which accrue in the way of lessened morbidity and mortality far outweigh any disadvantages.
The Politics of Environmental Policy in the People's Republic of China

The People's Republic of China (PRC) has made substantial progress in developing environmental legislation and a complementary regulatory structure. These gains are directly related to the economic reforms and opening to the outside world that began in the 1970s, which introduced a greater emphasis on efficiency and more awareness of the costs associated with pollution and environmental degradation. However, the economic growth and devolution of power unleashed by the reforms have also created new environmental stresses and to some extent reduced the regulatory capability of governmental authorities. As a result, some environmental stresses are increasing even as progress is made on other fronts. Political participation is restricted and environmental issues only occasionally acquire political salience. However, international pressure on the PRC to conform its conduct to international environmental norms is likely to increase, which is likely to affect domestic policymaking.
L’évocation de la glace et du froid par le timbre de la flûte dans Icicle de Robert Aitken

Dans cet article, l’auteure, qui est a la fois interprete et chercheuse, presente une investigation heuristique de son propre processus d’interpretation du solo de flute Icicle de Robert Aitken. Dans cette piece, des techniques de jeu contemporaines permettent de produire diverses couleurs sonores evoquant, comme le titre le suggere, le froid, la transparence de la glace, sa cristallinite. Ces techniques sont analysees a partir d’une perspective ancree dans la pratique interpretative et au regard d’un axe imaginaire de temperature du timbre instrumental. L’auteure traite aussi bien des techniques notees dans la partition et prescrites par le compositeur que de celles qui relevent de ses initiatives comme interprete. Ces techniques sont d’abord classifiees selon des categories etablies par le pedagogue de la flute Pierre-Yves Artaud (Artaud 1986), pour etre ensuite evaluees selon les deux grands archetypes instrumentaux – voix et percussion – identifies par Jean-Claude Risset (Risset 2004). L’analyse de ces techniques est doublee d’explications concernant la methode de travail et d’appropriation de l’oeuvre utilisee par l’auteure, methode qui integre la qualification subjective du timbre instrumental et qui mise sur la creativite interpretative.
OPS5 in Architecture: Four Test Cases

The advantage of production systems such as OPS5 over structured programming becomes most evident when they are applied to large, ill-structured problems. These applications are abundant in architectural design. Although efficient algorithms exist for some domains in architecture, empirical knowledge is essential in others. This situation calls for hybrid implementations with traditional efficient procedural packages providing support for production system front ends. OPS5 is a general-purpose production system language. In each one of-the four test cases, one particular aspect of OPS5 was explored in-depth.
In vivo micron scale arthroscopic imaging of human knee osteoarthritis with OCT: Comparison with MRI and arthroscopy

In this study, we perform in vivo OCT human arthroscopic imaging in patients undergoing menisectomy. Results are compared to MRI and arthroscopy.
Salsalate administration : A potential pharmacological model of the sick euthyroid syndrome

This study examined salsalate ingestion as a model of the sequelae of acute inhibition of thyroid hormone binding to serum protein. One dose of salsalate (60–65 mg/kg) was administered to healthy volunteers. Serum salsalate concentrations peaked at 2 h (82 μg/mL), then declined at 8 h to 1.2 μg/mL. Serum total T4 (TT4) and total T3 (TT3) concentrations declined for 4 h, then recovered by 96 h, while T4 binding protein concentrations remained unchanged. TT3 was reduced to a greater extent than TT4 between 2 h and 72 h, and serum total reverse(r)T3 (TrT3) was transiently increased at 8 h. TSH concentrations fell while TT4 and TT3 fell, then recovered while TT4, TT3, and free T3, but not free T4, were still reduced. Subsequently, TSH overshot basal levels and continued to rise after 96 h while TT4, TT3, free T4, free T3, and TrT3 were all at basal levels. We postulate that an acute release of T4 and T3 from circulating transport proteins, induced by an inhibitor of binding, can result in large and rapid redi...
Endovascular management of vascular trauma

There are an estimated 1.6 million traumatic injuries to vascular structures encountered every year at trauma centers across the country. The diagnosis and treatment of these injuries has been cons...
Consequences of the Retained Rectum in Inflammatory Bowel Disease

The creation of an ileostomy or colostomy with diversion of the rectum or creation of a rectal stump is not uncommon in the surgical management of inflammatory bowel disease. There is a distinct set of complications that are directly related to the rectal remnant. Some of these complications such as rectal stump dehiscence with pelvic sepsis can occur in the immediate postoperative period. Other complications such as development or progression of perianal disease may take several months to develop. Finally, development of cancer in the rectal remnant may take years to develop.
The Value of SPECT in the Detection of Stress Injury to the Pars Interarticularis in Patients with Low Back Pain

The medical cost associated with back pain in the United States is considerable and growing. Although the differential diagnosis of back pain is broad, epidemiological studies suggest a correlation between adult and adolescent complaints. Injury of the pars interarticularis is one of the most common identifiable causes of ongoing low back pain in adolescent athletes. It constitutes a spectrum of disease ranging from bone stress to spondylolysis and spondylolisthesis. Bone stress may be the earliest sign of disease. Repetitive bone stress causes bone remodeling and may result in spondylolysis, a non-displaced fracture of the pars interarticularis. A fracture of the pars interarticularis may ultimately become unstable leading to spondylolisthesis. Results in the literature support the use of bone scintigraphy to diagnose bone stress in patients with suspected spondylolysis. Single photon emission computed tomography (SPECT) provides more contrast than planar bone scintigraphy, increases the sensitivity and improves anatomic localization of skeletal lesions without exposing the patient to additional radiation. It also provides an opportunity for better correlation with other imaging modalities, when necessary. As such, the addition of SPECT to standard planar bone scintigraphy can result in a more accurate diagnosis and a better chance for efficient patient care. It is our expectation that by improving our ability to correctly diagnose bone stress in patients with suspected injury of the posterior elements, the long-term cost of managing this condition will be lowered.
The ANG-(1–7)/ACE2/mas axis in the regulation of nephron function

The study of experimental hypertension and the development of drugs with selective inhibitory effects on the enzymes and receptors constituting the components of the circulating and tissue renin-angiotensin systems have led to newer concepts of how this system participates in both physiology and pathology. Over the last decade, a renewed emphasis on understanding the role of angiotensin-(1–7) and angiotensin-converting enzyme 2 in the regulation of blood pressure and renal function has shed new light on the complexity of the mechanisms by which these components of the renin angiotensin system act in the heart and in the kidneys to exert a negative regulatory influence on angiotensin converting enzyme and angiotensin II. The vasodepressor axis composed of angiotensin-(1–7)/angiotensin-converting enzyme 2/mas receptor emerges as a site for therapeutic interventions within the renin-angiotensin system. This review summarizes the evolving knowledge of the counterregulatory arm of the renin-angiotensin system in the control of nephron function and renal disease.
Calibrating abundance indices with population size estimators of red back salamanders (Plethodon cinereus) in a New England forest

Herpetologists and conservation biologists frequently use convenient and cost-eff ective, but less accurate, abundance indices (e.g., number of individuals collected under artificial cover boards or during natural objects surveys) in lieu of more accurate, but costly and destructive, population size estimators to detect and monitor size, state, and trends of amphibian populations. Although there are advantages and disadvantages to each approach, reliable use of abundance indices requires that they be calibrated with accurate population estimators. Such calibrations, however, are rare. The red back salamander, Plethodon cinereus, is an ecologically useful indicator species of forest dynamics, and accurate calibration of indices of salamander abundance could increase the reliability of abundance indices used in monitoring programs. We calibrated abundance indices derived from surveys of P. cinereus under artificial cover boards or natural objects with a more accurate estimator of their population size in a New England forest. Average densities/m 2 and capture probabilities of P. cinereus under natural objects or cover boards in independent, replicate sites at the Harvard Forest (Petersham, Massachusetts, USA) were similar in stands dominated by Tsuga canadensis (eastern hemlock) and deciduous hardwood species (predominantly Quercus rubra [red oak] and Acer rubrum [red maple]). The abundance index based on salamanders surveyed under natural objects was significantly associated with density estimates of P. cinereus derived from depletion (removal) surveys, but underestimated true density by 50%. In contrast, the abundance index based on cover-board surveys overestimated true density by a factor of 8 and the association between the cover-board index and the density estimates was not statistically significant. We conclude that when calibrated and used appropriately, some abundance indices may provide cost-eff ective and reliable measures of P. cinereus abundance that could be used in conservation assessments and long-term monitoring at Harvard Forest and other northeastern USA forests.
Aluminum-Dependent Terminal Differentiation of the Arabidopsis Root Tip Is Mediated through an ATR-, ALT2-, and SOG1-Regulated Transcriptional Response

By screening for suppressors of the aluminum (Al) hypersensitive Arabidopsis thaliana mutant als3-1, it was found that mutational loss of the Arabidopsis DNA damage response transcription factor SUPPRESSOR OF GAMMA RESPONSE1 (SOG1) confers increased Al tolerance similar to the loss-of-function mutants for the cell cycle checkpoint genes ATAXIA TELANGIECTASIA AND RAD3 RELATED (ATR) and ALUMINUM TOLERANT2 (ALT2). This suggests that Al-dependent terminal differentiation of the root tip is an active process resulting from activation of the DNA damage checkpoint by an ATR-regulated pathway, which functions at least in part through SOG1. Consistent with this, ATR can phosphorylate SOG1 in vitro. Analysis of SOG1’s role in Al-dependent root growth inhibition shows that sog1-7 prevents Al-dependent quiescent center differentiation and endoreduplication in the primary root tip. Following Al exposure, SOG1 increases expression of several genes previously associated with DNA damage, including BRCA1 and PARP2, with gel-shift analysis showing that SOG1 can physically associate with the BRCA1 promoter in vitro. Al-responsive expression of these SOG1-regulated genes requires ATR and ALT2, but not ATAXIA TELANGIECTASIA MUTATED, thus demonstrating that in response to chronic Al exposure, ATR, ALT2, and SOG1 function together to halt root growth and promote terminal differentiation at least in part in a transcription-dependent manner.
Review Essay: A structuralist approach to argumentation in education

The authors present a review and critique of Argumentation and Education, a compilation of conceptual and research chapters about the theoretical foundations and practices of using argumentation in education. The book is described as providing a structuralist approach to constructing and evaluating arguments. Contrasting the structuralist paradigm with a dialogic perspective, the authors argue that authentic argumentation is a pedagogical tool, which involves dynamic, ever-changing, and unpredictable interactions. Ultimately, the authors highlight the absence of an essential focus in a book about argumentation and education: an authentic description of natural, spontaneous, student-created, and student-valued argumentation.
Magnetic diagnostics for future tokamaks

Magnetic diagnostics are critical for future tokamaks such as the International Thermonuclear Experimental Reactor (ITER). Existing tokamaks use inductive coils and loops as magnetic sensors. The sensors are located outside the plasma boundary but within the plasma's external magnetic fields. The electrical signals from these sensors are integrated over time to determine the plasma shape and are used for plasma control. Present magnetic diagnostics are designed for plasmas lasting seconds to tens of seconds. In their present form, the inductive magnetic sensors and integrators; are not suitable for future tokamaks with their long duration plasmas lasting for 1000 s or more. Namely, magnetic diagnostics for future tokamaks require: (1) sensors that will not overheat due to plasma radiation heating, (2) sensor materials that can survive the neutron fluence, (3) sensors designed for the remote handling requirements, and (4) integrators that have a 1000 s measurement capability. This paper presents a high frequency inductive magnetic sensor being developed for ITER.
The Sorcerer’s Stone, Mirror of Erised, and Horcruxes: Choice, Individuality, and Authenticity in Harry Potter

Examining the Harry Potter series through the lens of existentialism reveals J.K. Rowling’s unmistakable ties to the philosophy, notably in the recurring theme of self-deception as a manner of avoiding one’s mortality. Rowling explores the role of materialism in self-deception and the fear of death. Her characters choose between material possessions and an authentic life, for it is precisely these belongings that create a false impression of happiness. Rowling’s novels display existential problems concerning material possessions: the Sorcerer’s Stone, Mirror of Erised, and Horcruxes all distract from the anxiety surrounding death by creating an illusion of happiness or success for their owners.
The Managerial Roles of Public Community College Chief Academic Officers.

Utilizing a managerial role survey based on Mintzberg's taxonomy, this study sets out to answer two important questions regarding the duties of the community college Chief Academic Officer: 1) What...
Enterprise Resource Planning Systems: Comparing Firm Performance of Adopters and Nonadopters

Abstract The current study examined the longitudinal impact of ERP adoption on firm performance by matching 63 firms identified by Hayes et al. [J. Inf. Syst. 15 (2001) 3] with peer firms that had not adopted ERP systems. Results indicate that return on assets (ROA), return on investment (ROI), and asset turnover (ATO) were significantly better over a 3-year period for adopters, as compared to nonadopters. Interestingly, our results are consistent with Poston and Grabski [Int. J. Account. Inf. Syst. 2 (2001) 271] who reported no pre- to post-adoption improvement in financial performance for ERP firms. Rather, significant differences arise in the current study because the financial performance of nonadopters decreased over time while it held steady for adopters. We also report a significant interaction between firm size and financial health for ERP adopters with respect to ROA, ROI, and return on sales (ROS). Specifically, we found a positive (negative) relationship between financial health and performance for small (large) firms. Study findings shed new light on the productivity paradox associated with ERP systems and suggest that ERP adoption helps firms gain a competitive advantage over nonadopters.
The role of non-overlap in image registration

Here we model the effect of non-overlapping voxels on image registration, and show that a major defect of overlap-only models—their limited capture range—can be alleviated. Theoretically, we introduce a maximum likelihood model that combines histograms of overlapping and non-overlapping voxels into a common joint distribution. The convex problem for the joint distribution is solved via iterative application of replicator equations that converge monotonically. We then focus on rigidly aligning images with unknown translation, where we present a fast FFT-based method for computing joint histograms for all relative translations of an image pair. We then apply this method to standard overlap-only information theoretic registration criteria such as mutual information as well as to our variants that exploit non-overlap. Our experimental results show that global optima correspond to the correct registration generally only when non-overlapping image regions are included.
DEVELOPMENT OF A PCR ASSAY FOR DETECTION OF SPORE‐FORMING BACTERIA

Degenerate PCR primers were designed based on the published nucleotide sequences of the sporulation sigma factor ***oE (spoIIGB) from Bacillus subtilis, Bacillus thuringiensis, and Clostridium acetobutylicum. The primer set was used in a Hot Start Touch Down-PCR to screen for the presence of the target gene in both spore-forming (eight Bacillus species, eight Clostridium species, Paenibacillus polymyxa, Thermoanaerobacterium thermosaccharolyticum, Moorella thermoacetica) and in nonspore-forming bacteria. Under optimized PCR conditions, all spore-forming bacteria tested yielded a PCR product of the expected size (∼360bp), although the nonspore-forming Listeria monocytogenes and Lactococcus lactis subsp. lactis also yielded PCR products of this approximate size. To improve the specificity and sensitivity of this assay, we Southern blotted gel electrophoresis-separated PCR products with a digoxigenin-labeled B. subtilis spoIIGB probe. This probe hybridized with the ∼ 360 bp PCR product from all spore-forming species but did not hybridize with PCR products of this approximate size from any nonspore-forming bacteria. The PCR-Southern blot assay was 100 to 1,000-fold more sensitive than PCR alone, yielding a lower detection limit of approximately 3 CFU spore-forming bacteria/PCR reaction. We conclude that, based on amplicon size and Southern hybridization, this strategy provides a viable approach for detecting spore-forming bacteria.
Profile of histone lysine methylation across transcribed mammalian chromatin

Complex patterns of histone lysine methylation encode distinct functions within chromatin. We previously reported that trimethylation of lysine 9 of histone H3 (H3K9) occurs at both silent heterochromatin and at the transcribed regions of active mammalian genes, suggesting that the extent of histone lysine methylation involved in mammalian gene activation is not completely defined. To identify additional sites of histone methylation that respond to mammalian gene activity, we describe here a comparative assessment of all six known positions of histone lysine methylation and relate them to gene transcription. Using several model loci, we observed high trimethylation of H3K4, H3K9, H3K36, and H3K79 in the transcribed region, consistent with previous findings. We identify H4K20 monomethylation, a modification previously linked with repression, as a mark of transcription elongation in mammalian cells. In contrast, H3K27 monomethylation, a modification enriched at pericentromeric heterochromatin, was observed broadly distributed throughout all euchromatic sites analyzed, with selective depletion in the vicinity of the transcription start sites at active genes. Together, these results underscore that similar to other described methyl-lysine modifications, H4K20 and H3K27 monomethylation are versatile and dynamic with respect to gene activity, suggesting the existence of novel site-specific methyltransferases and demethylases coupled to the transcription cycle.
Ordering effects, updating effects, and the specter of global skepticism

One widely-endorsed argument in the experimental philosophy literature maintains that intuitive judgments are unreliable because they are influenced by the order in which thought experiments prompting those judgments are presented. Here, we explicitly state this argument from ordering effects and show that any plausible understanding of the argument leads to an untenable conclusion. First, we show that the normative principle is ambiguous. On one reading of the principle, the empirical observation is well-supported, but the normative principle is false. On the other reading, the empirical observation has only weak support, and the normative principle, if correct, would impugn the reliability of deliberative reasoning, testimony, memory, and perception, since judgments in all these areas are sensitive to ordering in the relevant sense. We then reflect on what goes wrong with the argument.
Induction of drug metabolism. I. Differences in the mechanisms by which polycyclic hydrocarbons and phenobarbital produce their inductive effects on microsomal N-demethylating systems.

The administration of 3,4-benzpyrene, 3-methylcholanthrene, or phenobarbital to male rats stimulated the N-demethylation of 3-methyl-4-methylaminoazobenzene (3-MMAB) by hepatic microsomes, but only phenobarbital stimulated the N-demethylation of ethylmorphine. Simultaneous administration of maximum stimulatory doses of 3-methylcholanthrene and phenobarbital resulted in additive stimulation of N-demethylation of 3-MMAB, whereas similar treatment with 3,4-benzpyrene and 3-methylcholanthrene did not stimulate 3-MMAB N-demethylation beyond that observed when either was administered singly. Thioacetamide prevented increases in N-demethylation resulting from phenobarbital administration, but had little effect on increased drug metabolism resulting from 3-methylcholanthrene administration. It was concluded that 3,4-benzpyrene and 3-methylcholanthrene stimulate hepatic microsomal drug-metabolizing activity by the same mechanism and that phenobarbital stimulates drug metabolism through a different mechanism. During phenobarbital administration parallel increases were observed in the N-demethylase activities and in the cytochrome P-450 content of microsomes; when phenobarbital was discontinued, microsomal N-demethylase activities and cytochrome P-450 content decreased in a parallel manner. Thioacetamide, administered alone, caused concomitant decreases in N-demethylase activities and cytochrome P-450 content. When given with phenobarbital, thioacetamide prevented the usual increases in N-demethylase activities and in cytochrome P-450 content seen when phenobarbital is administered. Polycyclic hydrocarbons caused an increase in microsomal P-450 content and in 3-MMAB N-demethylase activity, but the increases were not parallel. No increase in ethylmorphine N-demethylase activity occurred even though the content of microsomal hemoprotein was elevated. These studies suggested either that cytochrome P-450 is not rate-limiting in the over-all ethylmorphine N-demethylation reaction or that the administration of polycyclic hydrocarbons causes the synthesis of a microsomal hemoprotein different from that which was present initially in that it is capable of participating in the N-demethylation of 3-MMAB, but not of ethylmorphine.
A History of the Vietnamese: The provincial era

The empire comes south After conquering the Yangtze River basin and proclaiming the Qin Empire in 221 bce , Qin Shi Huang, “The First Emperor of China,” sent thousands of his soldiers over the mountains into the valleys and coastlands of what is now South China. He also sent convicts and women to establish a population of northerners there. After years of hard fighting against local people, Qin commanders built a city on the site of modern Guangzhou (Canton), the main seaport for trade into the southern seas. When the Qin Empire collapsed after Qin Shi Huang’s death in the year 210 bce , this coastal outpost became the center of a regional kingdom ruled by the senior commanding officer, Zhao To. As armies fought for control of the empire in the north, Zhao To proclaimed himself King of Nan Yue (Southern Yue). Zhao To is among the first historical figures with a role in Vietnamese history. Sometime during the first quarter of the second century bce , he extended his authority over the people living in the Red River plain of northern Vietnam. Yue had been the name of a state on the south-central coast of China (the modern province of Zhejiang) during the sixth to fourth centuries bce . It was appropriated by Zhao To and eventually applied to the Red River plain by ancient Chinese dynasties; in Vietnamese, it is pronounced Viet.
Validation of an inverse association between programmed death ligand 1 (PDL1) and genes in the vascular endothelial growth factor (VEGF) pathway in primary clear cell renal cell (ccRCC).

4567 Background: Trials combining anti-PDL1 and anti-VEGF therapies for clear cell renal cell carcinoma (ccRCC) are underway; however the relationship between the expression of PDL1 and genes in th...
Efficacy of interventions targeting household air pollution from residential wood stoves

Wood is commonly used for residential heating, but there are limited evidence-based interventions for reducing wood smoke exposures in the indoor environment. The Asthma Randomized Trial of Indoor Wood Smoke (ARTIS) study was designed to assess the efficacy of residential interventions to reduce indoor PM exposure from wood stoves. As part of a three-arm randomized placebo-controlled trial, two household-level interventions were evaluated: wood stove changeouts and air filtration units. Exposure outcomes included indoor measures such as continuous PM2.5, particle counts, and carbon monoxide. Median indoor PM2.5 concentration was 17.5 μg/m3 in wood-burning homes prior to interventions. No significant reductions in PM2.5 concentrations were observed in the 40 homes receiving the placebo filter intervention. Sixteen homes received the wood stove changeout and showed no significant changes in PM2.5 or particle counts. PM2.5 concentrations were reduced by 68% in the filter intervention homes. Relative to placebo, air filtration unit homes had an overall PM2.5 reduction of 63% (95% CI: 47-75%). Relative to the wood stove changeout, the filtration unit intervention was more efficacious and less expensive, yet compliance issues indicated a need for the evaluation of additional strategies for improving indoor air quality in homes using wood stoves.
Improved fourth-year medical student clinical decision-making performance as a resuscitation team leader after a simulation-based curriculum.

Objective To determine the impact of simulation-based instruction on student performance in the role of emergency department resuscitation team leader. Methods A randomized, single-blinded, controlled study using an intention to treat analysis. Eighty-three fourth-year medical students enrolled in an emergency medicine clerkship were randomly allocated to two groups differing only by instructional format. Each student individually completed an initial simulation case, followed by a standardized curriculum of eight cases in either group simulation or case-based group discussion format before a second individual simulation case. A remote coinvestigator measured eight objective performance end points using digital recordings of all individual simulation cases. McNemar chi2, Pearson correlation, repeated measures multivariate analysis of variance, and follow-up analysis of variance were used for statistical evaluation. Results Sixty-eight students (82%) completed both initial and follow-up individual simulations. Eight students were lost from the simulation group and seven from the discussion group. The mean postintervention case performance was significantly better for the students allocated to simulation instruction compared with the group discussion students for four outcomes including a decrease in mean time to (1) order an intravenous line; (2) initiate cardiac monitoring; (3) order initial laboratory tests; and (4) initiate blood pressure monitoring. Paired comparisons of each student's initial and follow-up simulations demonstrated significant improvement in the same four areas, in mean time to order an abdominal radiograph and in obtaining an allergy history. Conclusions A single simulation-based teaching session significantly improved student performance as a team leader. Additional simulation sessions provided further improvement compared with instruction provided in case-based group discussion format.
Coherence Effects in Near-Field Optics

Electromagnetic interaction at subwavelength distances is now opening new paths to nanometric optical science and technology and has applications ranging from characterization to fabrication and manipulation. Exploiting concepts of statistical optics in conjuncture with miniaturized devices will lead to the development of a new generation of optical sensors.
Intraoperative goal-directed hemodynamic management in free tissue transfer for head and neck cancer.

Background The purpose of this study was to determine the effect of algorithmic physiologic management on patients undergoing head and neck free tissue transfer and reconstruction. Methods Ninety-four adult patients were randomized to treatment and control groups. The blood pressure of the control group was managed consistent with contemporary standards. The treatment group was managed using an algorithm based on blood pressure and calculated physiologic values derived from arterial waveform analysis. Primary outcome was intensive care unit (ICU) length of stay. Results ICU length of stay was decreased in the treatment group (33.7 vs 58.3 hours; p = .026). The complication rate was not increased in the treatment group. Conclusion The goal-directed hemodynamic management algorithm decreased the ICU length of stay. Judicious use of vasoactive drugs and goal-directed fluid administration has a role in improving perioperative outcomes for patients undergoing head and neck free tissue transfer. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
Evolving Perceptions of the Plastic Surgery Integrated Residency Training Program

Objective In recent years, there has been a transition in plastic surgery residency training. Many programs across the country are now using integrated training modalities vs. independent training programs. This change in residency training has brought into question the effectiveness of integrated residency programs, in which medical students immediately enter the plastic surgery specialty upon graduation. This study assessed plastic surgery residency program directors and faculty members׳ viewpoints on the transition to integrated training programs and the effect this transition has had on the training of plastic surgery residents. Design An anonymous 13-question survey was formulated using a pilot survey sent to members of the plastic surgery department at the University of Florida. The final survey was then electronically sent via SurveyMonkey.com to 92 current plastic surgery residency program directors. Program directors were identified via program lists provided by the American Council of Academic Surgeons. Program directors were then asked to forward the survey to faculty members of their respective institutions. Responses collected were analyzed via SurveyMonkey.com and Microsoft Excel. Setting University of Florida College of Medicine, Department of Plastic Surgery. Participants Plastic surgery residency program directors as identified by the American Council of Academic Surgeons. Results A response rate of 40.2% was achieved via 37 of the 92 plastic surgery program directors responding to the electronic survey. An additional 6 anonymous faculty members also responded to the survey, 13.9% of all responses. Institutions indicated that the majority was using integrated residency programs, with some institutions using both integrated and independent training programs simultaneously. Most respondents indicated that they supported the transition to the integrated residency program at their respective institutions. Respondents indicated several reasons as to why or why not programs have transitioned to the integrated program, with lack of funding being the primary indication of not making the transition. Upon responding with their level of agreement to several statements, respondents indicated that they agreed that the integrated training program is superior to the independent program and is not negatively effecting the specialty. Conclusions The transition to the integrated plastic surgery residency program is continuing to grow. Most respondents in this survey indicated their belief in the superiority of the integrated program. However, a large proportion of respondents stated that they neither agreed nor disagreed with several of the provided statements concerning which residency program is superior. Thus, further research is needed to discern whether or not the integrated program is in fact superior to the independent residency training program.
Analysis on Effect of Network Communication Supervision Management on 120 New Smear Positive Pulmonary Tuberculosis Patients

[Objective]To explore the new ways of supervision management on tuberculosis. [Methods]120 new smear positive pulmonary tuberculosis patients were randomly divided into the intervention group and the control group.The intervention group was given network communication supervision management on the basis of routine supervision management.The control group was only given routine supervision management.The overall medicine-taking rate,regular treatment rate,sputum negative conversion rate at the end of 2 and 3 months,the cure rate after full course treatment of two groups were compared. [Results]The overall medicine-taking rate of the intervention group and the control group was 96.7% and 85% respectively,and the difference was statistically significant(χ2=663.103,P0.01).The regular treatment rate of the intervention group and the control group was 90.0% and 75.0% respectively,and the difference was statistically significant(χ2=4.675,P0.05).The sputum negative conversion rate at the end of 2 and 3 months of the intervention group was 93.3% and 95.0% respectively.The sputum negative conversion rate at the end of 2 and 3 months of the control group was 80.0% and 83.3% respectively.The differences in sputum negative conversion rates at the end of 2 and 3 months between the intervention group and the control group were statistically significant(χ2 = 4.615,χ2 = 4.227,both P0.05).The cure rate of the intervention group and the control group was 96.7% and 71.7% respectively,and the difference was statistically significant(χ2=14.070,P0.01). [Conclusion]The network communication supervision management on the basis of routine supervision management is a new way of tuberculosis supervision management.It has remarkable effect,which is worth popularizing.
Basal joint arthrosis of the thumb.

SUMMARY 1. Involvement of the basal joint of the thumb with rheumatoid arthritis or osteoarthritis is common. 2. Because of the unique function and importance of this joint, arthrosis here will severely compromise hand function. 3. The findings on physical and x-ray examination are reviewed. 4. Care must be taken in differentiating this condition from de Quervain's disease. An associated carpal tunnel syndrome must be carefully ruled out. 5. A spectrum of arthroses exists, and has been divided into four stages; the treatment for each is explained. 6. The role of arthroplasty is discussed in treating basal joint arthrosis of the thumb, in Stages III and IV, and sometimes in Stage II. The surgical technique is described. 7. Attention is called to the frequent need for simultaneous decompression of the first extensor compartment, decompression of the median nerve, release of the adductor muscle from the third metacarpal, or fusion of the metacarpophalangeal joint of the thumb. 8. With proper patient selection and attention to surgical detail, predictable and excellent results can be obtained with implant arthroplasty of the basal joint of the thumb.
Risk of Venous Thromboembolism After Laparoscopic Surgery for Gynecologic Malignancy.

Abstract Study Objective To determine the incidence of venous thromboembolism (VTE) after laparoscopic surgery for gynecologic cancer. Design Retrospective analysis of the ACS-NSQIP database (Canadian Task Force Classification II.1). Setting Academic and community healthcare institutions across the United States. Patients Women who underwent at least 1 major laparoscopic surgery for uterine, ovarian, and cervical cancers. Intervention Data were collected on surgical procedures, patient demographic variables, type of malignancy and VTE, and mortality outcomes within 30 days of surgery. Measurements and Main Results VTE was defined as deep venous thrombosis requiring therapy and pulmonary embolism confirmed by imaging or autopsy within 30 days of surgery. Of the 2219 patients included in the final analysis, 15 patients (.7%) were diagnosed with VTE within 30 days after surgery. Six patients (.3%) were diagnosed before discharge, and 9 patients (.4%) were diagnosed after discharge. The median time from surgery to diagnosis was 6 days (range, 0–28 days). Although most patients included in the study had uterine cancer (86%, n = 1913), no difference was noted based on the site of cancer (.5% for cervical cancer, .7% for endometrial cancer, and .8% for ovarian cancer; p = .95). There was no difference in rate of VTE when stratified by age (p = .10), body mass index (p = .68), diabetes (p = .22), smoking (p = .60), respiratory morbidities (p = .55), cardiac disease (p = .22), hypertension (p = .13), preoperative blood transfusion (p = .90), or American Society of Anesthesiologists class (p = .10). There was a trend toward higher risk of VTE among patients with disseminated cancer compared with those with early cancers (3.6% vs .6%, p = .05). No difference was found in the risk of VTE based on operative time (.7% for 3 hours; p = .96). No difference was noted in the risk of VTE among those who underwent lymphadenectomy compared with those who did not (.9% vs .5%, p = .35). In multivariable logistic regression analysis adjusting age (p = .12), body mass index (p = .90), operative time (p = .71), and lymphadenectomy (p = .30), none of these variables was significantly associated with risk of VTE. In multivariable analysis adjusting for other confounders, VTE within 30 days was a significant predictor of higher 30-day mortality (OR, 26.0; 95% CI, 2.2–306.9; p = .01). Conclusion The rate of VTE is low after major laparoscopic surgery for gynecologic cancers but is associated with increased 30-day mortality. Universal or extended thromboprophylaxis does not appear to be indicated for all patients. Further studies are needed to identify patients at high risk for postoperative VTE who may benefit from pharmacologic prophylaxis.
Glutamine Metabolism Regulates the Pluripotency Transcription Factor OCT4

The molecular mechanisms underlying the regulation of pluripotency by cellular metabolism in human embryonic stem cells (hESCs) are not fully understood. We found that high levels of glutamine metabolism are essential to prevent degradation of OCT4, a key transcription factor regulating hESC pluripotency. Glutamine withdrawal depletes the endogenous antioxidant glutathione (GSH), which results in the oxidation of OCT4 cysteine residues required for its DNA binding and enhanced OCT4 degradation. The emergence of the OCT4(lo) cell population following glutamine withdrawal did not result in greater propensity for cell death. Instead, glutamine withdrawal during vascular differentiation of hESCs generated cells with greater angiogenic capacity, thus indicating that modulating glutamine metabolism enhances the differentiation and functional maturation of cells. These findings demonstrate that the pluripotency transcription factor OCT4 can serve as a metabolic-redox sensor in hESCs and that metabolic cues can act in concert with growth factor signaling to orchestrate stem cell differentiation.
Modeling and implementation of a simplified human tendon structure in a robotic finger

This article presents a prototype robotic finger that has more human-like functionality than other simplified robotic fingers but is more manufacturable than efforts to directly copy human anatomy. A mathematical model that captures the relationship between joint angles and tendon excursions for the finger's simplified flexor and extensor systems is developed. The model is tested experimentally and shown to have good fidelity over the majority of the finger's workspace. The model also provides unique insight into the relationship between the finger's bone structure and tendon arrangements that is absent in other works.
CE-12 Comparison of classification criteria, self-assessments and immunologic profiles in patients with incomplete and systemic lupus erythematosus

Background The syndrome of incomplete lupus erythematosus (ILE) likely includes individuals at risk for development of systemic lupus erythematosus (SLE). Studies of interventions to lower risk or prevent further disease in ILE are of interest. Design of such trials will require methods to classify patients and to assess risk. The goals of the present study were to evaluate performance of updated SLE classification criteria to define ILE and to probe for other features in these patients that might be useful as indicators of disease status. A long term goal is to develop prognostic multifaceted risk profiles that would have clinical applications. Materials and methods Patients with ILE (N = 70) and SLE (N = 32) defined by the 1997 American College of Rheumatology (ACR) criteria were then reclassified using the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria. Disease activity, patient self-assessments and levels of autoantibodies, soluble mediators and expressed Type I interferon (IFN) genes also were measured in the ILE and SLE patients and compared to healthy control (HC) individuals. Results The two sets of classification criteria were highly correlated (Figure 1; R2 = 0.87). ILE patients were older (P = 0.0043), with lower SLEDAI scores (P = 0.023) and greater dissatisfaction with their health status (P = 0.034) than SLE patients. Anti-C1q and sCD27 levels were correlated with ACR criteria and SLE Disease Activity Index (SLEDAI) scores (P ≤ 0.0004). Three cytokines, IL-7, IL12p70 and IL-13, were lower in both ILE and SLE than in HCs. Two IFN-related cytokines IP = 10 and MCP-1, were higher in SLE than in ILE. Of three IFN genes measured, IFI27 showed the greatest difference between ILE and SLE. Conclusions The 2012 SLICC SLE classification criteria likely can be used to define ILE in future research trials. Patients with ILE are somewhat dissatisfied with their condition, possibly related to anxiety about the lack of a clear diagnosis. Further patient-reported outcome studies in this population would be of interest. Reliable assessment of lupus risk will likely include demographic, clinical and immunologic features. Some of the latter may suggest novel approaches to early treatment. Acknowledgements This project was funded, in part, with a grant from the Pennsylvania Department of Health using Tobacco CURE Funds. The Department specifically disclaims responsibility for any analyses, interpretations or conclusions. It was also?supported in part by the National Institutes of Health, NIAMS U34 AR067392. The data entry assistance of Fan He is appreciated.
The Inhibitor of NF-KB Kinase, IKKβ Regulates the Transcriptional Activity of GLI1 By Blocking Its Proteasomal Degradation

Abstract GLI1 is a Hedgehog (Hh) related transcription factor originally discovered as an amplified product in gliomas. Inappropriate activation of the GLI1 has been shown in many cancers including diffuse large B cell lymphoma (DLBCL). We previously showed that GLI1 mediated canonical Hh signaling is constitutive active in DLBCL and contributes to cell survival, proliferation and enhances chemotolerance. Although the importance of GLI1 in tumor development is well recognized, the molecular mechanisms controlling the transcriptional activity of GLI1 are poorly characterized. To identify regulatory components that participate in the transcriptional activity of GLI1, we explored GLI1 putative interacting proteins by liquid chromatography tandem mass spectrometry following immunoprecipitation of endogenous GLI1. We detected that the inhibitor of NF-KB kinase, IKKβ, is one of the proteins associated with GLI1 transcription factor. Here we investigate the regulatory role of IKKβ in the transcriptional activity of GLI1. We show that IKKβ regulates the transcriptional activity of GLI1 by phosphorylating GLI1 in C-terminal region and modulating its protein stability. Short stimulation of SUDHL4 and DOHH2 cells with TNF-α (20ng/mL) resulted in increased GLI1 protein levels. Similar results were observed in 293T cells transiently transfected with GLI1 and IKKβ kinase constructs. Moreover, silencing of IKKβ using siRNA and shRNAs led to decreased GLI1 protein levels and its transcriptional activity in DLBCL cell lines with constitutive activation of the NF-KB. Next, we characterized nine probable IKKβ dependent GLI1 phosphorylation sites (S543-S548, S1070, S1071 and S1074 identified by nanospray ion trap mass spectrometry) using mutational and deletions studies. We show that IKKβ phosphorylates GLI1 at Thr1074 and decreases binding between GLI1 and HECT-type E3 ubiquitin ligase (ITCH) resulting in reduced GLI1 polyubiquitination and degradation. Point mutation of Threonine 1074 to Alanine prevents IKKβ-mediated GLI1 phosphorylation and facilitates GLI1-ITCH interaction, polyubiquitination and degradation of GLI1 in the proteasome. Collectively, our data links IKKβ-mediated NF-kB signaling to the transcriptional activity of GLI1 and illustrates a novel cross talk between these two pathways. This is of clinical interest because activation of the NF-kB pathway is frequent in DLBCL and the connection between Hh and NF-kB pathways may open novel therapeutic avenues for DLBCL. Disclosures No relevant conflicts of interest to declare.