The optimal timing of adipose derived stem cells injection to improve skin flap survival in a rat model

Abstract

Background

Skin flap surgery is a cornerstone in plastic surgery. However, flaps may encounter postoperative partial or complete necrosis. Different modalities have been used to enhance skin flap survival. Adipose-derived stem cells (ASCs) can promote angiogenesis and improve skin flap survival. We aimed to investigate the appropriate timing of ASC administration to get the maximal angiogenic effect and better skin flap survival in rat model.

Methods

Thirty-two male albino Wistar rats were used to study the role of ASCs on caudally based (2 × 8 cm) random pattern skin flap survival; the 32 male albino rats were equally divided into four groups according to timing of ASC injection. We applied the ASCs at three different timing, group A (local injection of ASCs along the flap axis simultaneously with flap elevation), group B (2 days preoperatively), and group C (7 days preoperatively). In the control group (group D), the flap was injected with phosphate buffered saline at the time of flap elevation. Skin flap survival was evaluated on the seventh postoperative day through percentage of flap survival, capillary density, and vascular endothelial growth factor (VEGF) expression.

Results

ASCs led to a statistically significant increase in skin flap viability when administered simultaneously with flap elevation or 2 days prior to flap elevation. This went along with significant increase in capillary density and VEGF expression. However, the ASCs had no effect on flap survival when injected 1 week prior to flap elevation.

Conclusions

We demonstrate that the skin flap viability can be enhanced by local ASC administration simultaneously with flap elevation or 2 days prior to flap elevation. Their beneficial effect is attributed to paracrine secretion VEGF which enhanced the skin flap vascularity. The angiogenic effect of ASCs can be maximized when the ASCs are injected at the time of flap elevation.

Level of Evidence: Not ratable

Correction to: Development and validation of a new assessment tool for suturing skills in medical students

The original version of this article contained a mistake in the section Development of total score for the assessment tool.

Towards standardization of training and practice of reconstructive microsurgery: an evidence-based recommendation for anastomosis thrombosis prophylaxis

Abstract

Background

Despite significant improvements in survival rates, free flap failures still occur even in experienced hands and are most commonly due to arterial or venous thrombosis. In the absence of an evidence-based guideline on the prevention of thrombosis, we reviewed the literature to assess the evidence base for commonly used interventions aimed at its prevention.

Methods

A comprehensive literature search was performed using the following keywords "free flap" and microsurgery with "pre-operative screening," "prevention of thrombosis," "ketorolac," "heparin," "low molecular weight heparin," "aspirin," "dextran," and "statins."

Results

Thirteen clinical studies were included in this review. No high-level evidence is available to support any perioperative or postoperative interventions aimed at reducing the risk of flap thrombosis.

Conclusions

Higher level studies are needed to investigate the clinical use of antithrombotic medications in microsurgery; however, given the small failure rates in modern practice, these will need to be large multicenter trials in order to reach sufficient power.

Level of Evidence: Level III, risk/prognostic study.

An enhanced fresh cadaveric model for reconstructive microsurgery training

Abstract

Background

Performing microsurgery requires a breadth and depth of experience that has arguably been reduced as result of diminishing operating exposure. Fresh frozen cadavers provide similar tissue handling to real-time operating; however, the bloodless condition restricts the realism of the simulation. We describe a model to enhance flap surgery simulation, in conjunction with qualitative assessment.

Methods

The fresh frozen cadaveric limbs used in this study were acquired by the University. A perfused fresh cadaveric model was created using a gelatin and dye mixture in a specific injection protocol in order to increase the visibility and realism of perforating vessels, as well as major vessels. A questionnaire was distributed amongst 50 trainees in order to assess benefit of the model. Specifically, confidence, operative skills, and transferable procedural-based learning were assessed.

Results

Training with this cadaveric model resulted in a statistically significant improvement in self-reported confidence (p < 0.005) and prepared trainees for unsupervised bench work (p < 0.005). Respondents felt that the injected model allowed easier identification of vessels and ultimately increased the similarity to real-time operating. Our analysis showed it cost £10.78 and took 30 min.

Conclusions

Perfusion of cadaveric limbs is both cost- and time-effective, with significant improvement in training potential. The model is easily reproducible and could be a valuable resource in surgical training for several disciplines.

Level of Evidence: Not ratable.

Direct augmented reality computed tomographic angiography technique (ARC): an innovation in preoperative imaging

Abstract

Background

Since the advent of free tissue transfer approximately 40 years ago, constant improvement particularly in the preoperative planning phase has led to flap success rate reaching 99% and improved patient outcomes. The use of imaging, such as computed tomographic angiography (CTA) or magnetic resonance angiography (MRA), for preoperative planning is now routine. However, current image modalities are restricted by being represented in two dimensions (2D) and have led to clinicians seeking novel methods of utilising the scan data, such as augmented (AR) or virtual reality (VR) and holograms. These mixed-reality devices facilitate a natural mode of visual perception and have the capacity to introduce tactile feedback. However, most AR devices are currently expensive, bulky and complicated and require tedious image registration processes. We illustrate our projector-based direct AR technique using CTA, or ARC, for preoperative planning.

Methods

Our bespoke ARC method consists of compact, affordable hardware (MacBook, Philips pocket projector and a 15-cm ruler) and free, open-source software (OsiriX). We have utilised this technique in six cases of perforator flaps of the thigh and abdomen (anterolateral thigh (ALT), transverse upper gracilis (TUG) and deep inferior epigastric artery perforator (DIEP) flaps.

Results

In all cases, 3D-reconstructed images of perforators from CTA were accurately projected onto the donor site. System calibration was rapid and convenient to use.

Conclusions

We illustrate a novel technique of projector-based AR CTA (or ARC) for preoperative planning in perforator flaps. The technique is affordable and readily reproducible.

Level of Evidence: Level IV, diagnostic study.

Is single-stage implant-based breast reconstruction (SSBR) with an acellular matrix safe?

Abstract

Background

Acellular matrices (AM) might enable a direct single-stage breast reconstruction procedure resulting in an improved efficacy of the reconstruction phase for patients. Safety concerns are an important issue due to a recent study which shows that single-stage breast reconstruction with Strattice™ resulted in more complications versus a two-stage reconstruction. Therefore, the goal of this study is to compare the short- and long-term complications of a single-stage breast reconstruction with the use of two types of AM (Strattice™ and Meso Biomatrix®) versus two-stage breast reconstruction without the use of an AM.

Methods

Cohort study with single-stage breast reconstruction with Strattice™ (n = 28) or Meso BioMatrix® (n = 20) or two-stage breast reconstruction without an AM (n = 36) at the Maastricht Academic Hospital, the Netherlands. All complications, in particular major complications with the need for re-admission to the hospital, re-exploration, and implant explantation, were the primary outcome measures. A 1-year follow-up was achieved for all patients.

Results

Baseline characteristics of all 52 patients were similar between groups. There was a significantly higher complication rate in the single-stage AM groups with loss of the implant in 40.0% of the breasts from the Meso BioMatrix® group and in 10.7% of the Strattice™ group compared to no implant loss in the control group.

Conclusions

This cohort study clearly suggests that the use of a single-stage breast reconstruction is not safe with the use of these AMs. Well-designed prospective studies that guarantee the safety of those matrices should be published before these AMs are used in implant-based surgery.

Level of Evidence: Level III, risk / prognostic study.

Can probability theory explain why closure is both intuitive and prone to counterexamples?

Abstract

Epistemic closure under known implication is the principle that knowledge of \(\varphi\) and knowledge of \(\varphi \rightarrow \psi\) , together, imply knowledge of \(\psi\) . This principle is intuitive, yet several putative counterexamples have been formulated against it. This paper addresses the question, why is epistemic closure both intuitive and prone to counterexamples? In particular, the paper examines whether probability theory can offer an answer to this question based on four strategies. The first probability-based strategy rests on the accumulation of risks. The problem with this strategy is that risk accumulation cannot accommodate certain counterexamples to epistemic closure. The second strategy is based on the idea of evidential support, that is, a piece of evidence supports a proposition whenever it increases the probability of the proposition. This strategy makes progress and can accommodate certain putative counterexamples to closure. However, this strategy also gives rise to a number of counterintuitive results. Finally, there are two broadly probabilistic strategies, one based on the idea of resilient probability and the other on the idea of assumptions that are taken for granted. These strategies are promising but are prone to some of the shortcomings of the second strategy. All in all, I conclude that each strategy fails. Probability theory, then, is unlikely to offer the account we need.

Oregon’s Expansion of Prenatal Care Improved Utilization Among Immigrant Women

Abstract

Objectives To determine whether expanding Emergency Medicaid to cover prenatal care in Oregon affected maternal health outcomes for unauthorized immigrants. Methods This study takes place in Oregon from 2003 to 2015 and includes all Emergency Medicaid and Medicaid claims for women aged 12–51 with a pregnancy related claim. To isolate the effect of expanding access to prenatal care, we utilized a difference-in-differences approach that exploits the staggered rollout of the prenatal care program. The primary outcome was a composite measure of severe maternal morbidity and mortality. Additional outcomes include adequacy of prenatal care, detection of pregnancy complications and birth outcomes. Results A total of 213,746 pregnancies were included, with 35,182 covered by Emergency Medicaid, 12,510 covered by Emergency Medicaid Plus (with prenatal care), and 166,054 covered by standard Medicaid. Emergency Medicaid Plus coverage did not affect severe maternal morbidity (all pregnancies 0.05%, CI − 0.29; 0.39; high-risk pregnancies 2.20%, CI − 0.47; 4.88). The program did reduce inadequate care among all pregnancies (− 31.75%, 95% CI − 34.47; − 29.02) and among high risk pregnancies (− 38.60%, CI − 44.17; − 33.02) and increased diagnosis of gestational diabetes (6.24%, CI 4.36; 8.13; high risk pregnancies 10.48%, CI 5.87; 15.08), and poor fetal growth (7.37%, CI 5.69; 9.05; high risk pregnancies 5.34%, CI 1.00; 9.68). The program also increased diagnosis of pre-existing diabetes mellitus (all pregnancies 2.93%, CI 2.16; 3.69), hypertensive diseases of pregnancy (all pregnancies 1.28%, CI 0.52; 2.04) and a history of preterm birth (all pregnancies 0.87%, CI 0.27; 1.47). Conclusions for Practice Oregon's prenatal care expansion program produced positive effects for unauthorized immigrant women and their children.

Beyond Higher Education as We Know it: Gesturing Towards Decolonial Horizons of Possibility

Abstract

This article addresses the conceptual challenges of articulating the ethical–political limits of 'higher education as we know it', and the practical challenges of exploring alternative formations of higher education that are unimaginable from within the dominant imaginary of the higher education field. This article responds to the contemporary conjuncture in which possible futures have been significantly narrowed, and yet these possibilities also appear increasingly unsustainable and unethical. It invites scholars of higher education to rethink the epistemological and ontological frames within which most imaginaries and institutions of higher education are embedded. If we fail to denaturalize these frames, then efforts to pluralize possible higher education futures will risk reproducing existing conceptual limitations and enduring colonial harms.

ASCO – vom amerikanischen Krebskongress 2018

Responsibility and the limits of good and evil

Abstract

P.F. Strawson's compatibilism has had considerable influence. However, as Watson has argued in "Responsibility and the Limits of Evil" (1987/2008), his view appears to have a disturbing consequence: extreme evil exempts an agent from moral responsibility. This is a reductio of the view. Moreover, in some cases our emotional reaction to an evildoer's history clashes with our emotional expressions of blame. Anyone's actions can be explained by his or her history, however, and thereby can conflict with our present blame. Additionally, we too might have been evil if our history had been like the unlucky evildoer's. Thus, our emotional responses to the evildoer compromise our standing to blame them. Since Strawson's view demarcates moral responsibility by moral emotional responses, his view appears to be self-defeating. In this paper, I defend the Strawsonian view from the reductio and self-defeat problems. I argue that two emotions, disgust and elevation, can be moral reactive attitudes in Strawson's sense. First, moral disgust expresses neither blame nor exemption from responsibility. Instead, moral disgust presupposes blameworthiness but is instead a distinct response to the extreme wrongdoer. Secondly, moral disgust involves self-directed attitudes that explain away our apparent lack of standing to blame the evil agent. The structure of disgust as a reactive attitude is mirrored along the positive dimension by the emotion that Haidt (2003a) has called "elevation", a feeling of moral inspiration. I conclude by defending my view from objections about the moral appropriateness of disgust.

Contribution of heterotrophic bacterioplankton to cyanobacterial bloom formation in a tributary backwater area of the Three Gorges Reservoir, China

Abstract

This study investigated phytoplankton and bacterioplankton communities by flow cytometer in a tributary backwater area of the Three Gorges Reservoir, China. Samplings were conducted in two cyanobacterial bloom periods (May and August) and no algal-blooms period (November) of 2014, representing three different operational stages of the reservoir, i.e., reservoir discharge period, fluctuating period in the summer flood season, and high water level in the impoundment period. Phyto- and bacterioplankton exhibit a wide range of variability along the depth profiles of the water column. In the investigated two cyanobacterial bloom periods, prokaryotes accounted for over 50% of the total phytoplankton. As for bacterioplankton, low nucleic acid bacteria were dominant in August and November. A positive correlation was observed between phytoplankton (pico- and nanophytoplankton), Chl a, and bacterioplankton. High nucleic acid groups and prokaryotes were highly coupled in May and August, which indicated that this high nucleic acid group could probably contribute to the explanation of cyanobacterial bloom formation in this area.

Coastline Kriging: A Bayesian Approach

Abstract

Statistical interpolation of chemical concentrations at new locations is an important step in assessing a worker's exposure level. When measurements are available from coastlines, as is the case in coastal clean-up operations in oil spills, one may need a mechanism to carry out spatial interpolation at new locations along the coast. In this article, we present a simple model for analyzing spatial data that is observed over a coastline. We demonstrate four different models using two different representations of the coast using curves. The four models were demonstrated on simulated data and one of them was also demonstrated on a dataset from the GuLF STUDY (Gulf Long-term Follow-up Study). Our contribution here is to offer practicing hygienists and exposure assessors with a simple and easy method to implement Bayesian hierarchical models for analyzing and interpolating coastal chemical concentrations.

A Randomized Controlled Trial of a Truck Seat Intervention: Part 1—Assessment of Whole Body Vibration Exposures

Abstract

Full-time vehicle and heavy equipment operators often have a high prevalence of musculoskeletal disorders, especially low back pain (LBP). In occupations requiring vehicles or heavy equipment operation, exposure to whole body vibration (WBV) has been consistently associated with LBP. LBP is the most common cause of work-related disability and continues to be the leading cause of morbidity and lost productivity in the US workforce. Using a parallel randomized controlled trial design, over a 12-month period, this study evaluated two different seating interventions designed to reduce WBV exposures. Forty professional truck drivers were initially recruited and randomly assigned to one of two groups: (i) a passive suspension/control group—20 drivers who received a new, industry-standard air-suspension seat, and (ii) an intervention group—20 drivers who received an active-suspension seat, which has been shown to reduce vertical WBV exposures by up to 50% compared to passive seats. WBV exposures from the truck seat and floor were collected during driver's full shifts (6–18 h) before (pre-intervention) and after the intervention (0, 3, 6, and 12 months post-intervention) per International Standards Organization (ISO) 2631-1 and 2631–5 WBV standards. After subject dropout and turnover, 16 truck drivers remained in each group. The pre-intervention WBV data showed that there were no differences in the daily equivalent time-weighted average WBV exposures [A(8)], vibration dose values [VDV(8)], and static spinal compression doses [S_ed(8)] between the two groups (P's > 0.36). After the new seats were installed, the A(8) values showed that the active suspension/intervention group experienced much greater reduction in the vertical (z) axis [~50%; P = <0.0001; Cohen's d effect size (95% CI) = 1.80 (1.12, 2.48)] exposures when compared to in the passive suspension/control group [~20%; P = 0.23; 0.33 (−0.36, 1.02)]. The post-intervention z-axis VDV(8) and S_ed(8) WBV exposure measures were not different between the two seat groups [VDV(8), P = 0.33; 0.35 (−0.32, 1.03); S_ed(8), P = 0.61; 0.08 (−0.59, 0.76)]. These study findings indicate that, relative to the current industry-standard, passive air-suspension seats which are ubiquitous in all semi-trucks today, the active suspension seat dramatically reduced average continuous [A(8)] WBV exposures but not periodic, cumulative impulsive exposures [VDV(8) and S_ed(8)].

Retrospective Assessment of Respirable Quartz Exposure for a Silicosis Study of the Industrial Sand Industry

Abstract

Background

In 2016, the OSHA PEL for crystalline silica was reduced, renewing interest in evaluating risk of silicosis from occupational exposures. The industrial sand industry, which deals with high-purity quartz sands, is the setting for a current epidemiologic investigation of silicosis risk and progression. In support of that investigation, respirable quartz (RQ) exposures were retrospectively estimated for 67 workers with silicosis and 167 matched control workers from 21 industrial sand plants, in which some started work as early as 1929.

Methods

A job exposure matrix (JEM) was constructed by integrating a modern (post-1970) RQ exposure database containing more than 40000 measurements with archival particle count exposure data from a 1947 survey. A simulation algorithm was used to develop a conversion factor to convert the archival particle count data into modern measures of RQ by randomly generating 100000 virtual dust particles of varying diameters corresponding to the size distributions of 14 archival particle size distribution samples. The equivalent respirable mass and particle counts of the virtual particles were calculated, totalled, and ratioed to derive the conversion factor. The JEM was integrated with individual job histories to calculate average and cumulative exposure for each case and control. Multiple exposure estimates were derived for unprotected exposures as well as for exposures adjusted for estimated respiratory protective equipment use and efficiency.

Results

The mean of the count to respirable mass conversion factors derived from 14 archival particle size samples was 157 µg m⁻³ per mppcf (SD: 42; range: 96–263) with no statistical difference across process areas (drying, screening, vibrating, binning, bulk loading, bagging), P = 0.29. The JEM demonstrated an industry-wide decrease in prevailing exposures to RQ of up to about 2 orders of magnitude from the distant (1929) to the recent (2012) past. Unadjusted cumulative exposures for cases and controls were statistically different (P < 0.001) with respective medians (range) of 3764 µg m⁻³ year (221–25121) and 1595 µg m⁻³ year (0–16446). Adjustment of exposure for use of respiratory protection showed modest reductions in estimated exposure: median adjusted cumulative exposures assuming a protection factor of 5 were 86% and 77% of the unadjusted values for cases and controls, respectively.

Conclusions

The industrial sand industry offers a unique setting for examination of silicosis risk because of the high silica content of industrial sand and a long history of radiographic silicosis surveillance of industry workers. However, the great majority of silicosis cases in this industry are found among former workers and are associated with exposures occurring in the distant past, which necessitates extensive retrospective exposure assessment and increases the likelihood of exposure misclassification. Nonetheless, the estimated cumulative exposures for silicosis cases and controls in this work were significantly different, with the median cumulative exposure for cases being more than twice that of their matched controls.

Respiratory Health Outcomes, Rhinitis, and Eczema in Workers from Grain Storage Facilities in Costa Rica

Abstract

Objectives

To examine the associations of inhalable grain dust exposure with respiratory health outcomes, rhinitis, and eczema reported by workers from rice, wheat, and maize storage facilities.

Methods

A cross-sectional study of 136 workers (73 operators and 63 administrative staff and other workers) from eight Costa Rican grain storage facilities was conducted in 2014–2015. Full-shift personal inhalable dust samples from all workers were collected. Study participants were administered a short version of the European Community Respiratory Health Survey questionnaire to identify symptoms of asthma, chronic bronchitis, rhinitis, and eczema. Associations between grain dust exposure and health outcomes were assessed using multivariable logistic and negative binomial regression models adjusted for age, smoking history, grain type, and presence of pets or farm animals in the home.

Results

The median inhalable grain dust concentration was 2.0 (25th to 75th percentile: 0.3–7.0) mg m⁻³. Higher concentrations of inhalable dust were associated with increased odds of (i) asthma symptoms or medication use [adjusted Odds ratio (OR_a) per 10-fold increase in dust concentration 2.7; 95% confidence interval (CI): 1.3–6.7]; (ii) a score of at least two out of five symptoms suggestive of asthma (OR_a 1.2; 95% CI: 1.0–1.3); and (iii) eczema (OR_a 3.6; 95% CI: 1.7–9.6). No associations of inhalable grain dust exposure with chronic bronchitis and rhinitis were observed.

Conclusions

High exposure to inhalable dust in Costa Rican grain storage facilities was associated to asthma symptoms and eczema in workers.

A Randomized Controlled Trial of a Truck Seat Intervention: Part 2—Associations Between Whole-Body Vibration Exposures and Health Outcomes

Abstract

This randomized controlled trial study was conducted to determine whether two different seating interventions would reduce exposure to whole-body vibration (WBV) and improve associated health outcomes. Forty professional truck drivers were randomly assigned to two groups: (i) a control group of 20 drivers who received a new, industry-standard air-suspension seat, and (ii) an intervention group of 20 drivers who received an active-suspension seat. This study collected regional body pain (10-point scale), low back disability [Oswestry Disability Index (ODI)], physical and mental health [the Short Form 12-item Health Survey (SF-12)], and work limitations [Work Limitation Questionnaire (WLQ)] before and 3, 6, and 12 months after the seating intervention. WBV exposures were also collected during the same time periods. Due to dropouts at the 12-month time period, only data up to 6 months post-intervention were included in the analyses. The post-intervention A(8) WBV exposures were lower in both groups with a more substantial WBV exposure reduction (~50%) in the intervention group compared to the control group (~26%). There was little to no change in the impulsive exposures [VDV(8) and S_ed(8)] post-intervention and no differences between the two groups. The self-reported musculoskeletal health outcomes showed that intervention group experienced a greater reduction in the low back pain (LBP) and other musculoskeletal outcomes than the control group. The LBP reduction in the intervention group was clinically meaningful (>25%); however, none of the changes in pain reached statistical significance (P's > 0.22). The SF-12 health scores demonstrated that the intervention group's physical health improved after the intervention (P's < 0.06) while the control group experience little to no improvement (P's > 0.11). The WLQ scores showed that the intervention group generally experienced reduced (improved) work limitation over time whereas the control group showed inconsistent changes in work limitation scores. These study findings indicate that reducing truck drivers' exposure to WBV through seating intervention can lead to improvements in LBP and other health outcomes.

The Ethics and Politics of Precarity: Risks and Productive Possibilities of a Critical Pedagogy for Precarity

Abstract

This paper discusses Butler's theory on the possibility of precarity to serve as the nexus of ethical relations, while also exploring some of the pitfalls of her theorization to reconceptualize the pedagogical implications of a critical pedagogy for precarity. In particular, the paper asks: How can precarity—understood as an ambivalent concept, as a paradoxical nexus of both possibilities and constraints—function pedagogically in a way that challenges its moralization? How can educators engage with precarity in ways that 're-frame' it so that both the dangers and prospects of ethics and politics of precarity are properly acknowledged and critically interrogated in pedagogical practice? The risks and possibilities of a critical pedagogy for precarity are addressed, highlighting that there are several complexities involved as much as there are opportunities for ethical transformation and political action in school and beyond.

Reply: Five Step to Internal Mammary Vessel Preparation in Less than Fifteen Minutes

No abstract available

The Impact of Labiaplasty on Sexuality

No abstract available

"Letter to the Editor: response to “Macrotextured Breast Implants with Defined Steps to Minimize Bacterial Contamination around the Device Experience in 42.000 implants.""

No abstract available

Discussion: Staying Safe During Gluteal Fat Transplantation

No abstract available

The Impact of Labiaplasty on Sexuality

No abstract available

Staying Safe during Gluteal Fat Transplantation

No abstract available

Discussion: Staying Safe During Gluteal Fat Transplantation

No abstract available

Thoughts about double capsule physiopathology

No abstract available

“Comparing Efficacy and Costs of Four Facial Fillers in Human Immunodeficiency Virus-Associated Lipodystrophy: A Clinical Trial”

No abstract available

Letter to the Editor PRS regarding “Five Steps to Internal Mammary Vessel Preparation in Less than 15 Minutes”.

No abstract available

Reply to Letter, Re: Determining the Oncologic Safety of Autologous Fat Grafting as a Reconstructive Modality An Institutional Review of Breast Cancer Recurrence Rates and Surgical Outcomes

No abstract available

“Comparing efficacy and costs of four facial fillers in HIV-associated lipodystrophy: a clinical trial.”

No abstract available

Re: Determining the Oncologic safety of Autologous Fat Grafting as a Reconstructive Modality An Institutional Review of Breast Cancer Recurrence Rates and Surgical Outcome.

No abstract available

Patient-reported outcome measures following rhinoplasty

No abstract available

Capsular biofilm formation at the interface of textured implants and acellular dermal matrix: A comparative scanning electron microscopy study

No abstract available

Capsular biofilm formation at the interface of textured expanders and human acellular dermal matrix

No abstract available

Prepectoral Breast Reconstruction.

No abstract available

Staying Safe during Gluteal Fat Transplantation

No abstract available

Geriatrische Onkologie

Zusammenfassung

Aufgrund der demografischen Entwicklung mit einer zunehmenden Zahl alter Menschen und des altersabhängigen Anstiegs der Inzidenzrate der Krebserkrankungen wird die Zahl alter Menschen mit Krebserkrankungen in den kommenden Jahrzehnten erheblich ansteigen. In der Geriatrie wurde ein strukturiertes systematisches Assessment etabliert, um Defizite und Ressourcen des einzelnen Patienten zu erkennen und individuelle Therapieplanungen vornehmen zu können. Die Forschung in der geriatrischen Onkologie hat bisher gezeigt, dass die Übertragung des Assessments von der Geriatrie zur Onkologie hilft, unabhängig vom chronologischen Alter, Patienten mit altersabhängigen Einschränkungen besser zu erkennen. Solche Einschränkungen sind zudem prädiktiv für ein höheres Risiko der Therapieunverträglichkeit und für geringeres Überleben. Geriatrisches Assessment hilft dabei, eine onkologische Therapie besser zu stratifizieren und somit Über- und Untertherapie zu vermeiden. In aktuellen Studien wird untersucht, ob auf den Ergebnissen des Assessments aufbauende Interventionen zu einer Verbesserung von für die Patienten relevanten Endpunkten beitragen. Für alte Patienten relevante Endpunkte, wie der Erhalt der Fähigkeit zur Selbstversorgung, sind bisher unzureichend in onkologische Therapiestudien integriert worden.

Correction to: Adsorption and desorption of potentially toxic metals on modified biosorbents through new green grafting process

The author's email address of Hai Nguyen Tran should be inserted.

Favorable compatibility of nitenpyram with the aphid predator, Coccinella septempunctata L. (Coleoptera: Coccinellidae)

Abstract

The increasing demand for lessening the chemical input in agricultural ecosystems requires an efficient combination of pesticides and biological controls. Thus, fully understanding the compatibility of pesticides and beneficial arthropod predators is helpful and essential. In this study, we evaluated the influence of nitenpyram on both larvae and adults of Coccinella septempunctata using exposure doses of 10, 25, 50, 100, and 150% of the maximum recommended field rate (MRFR) (3, 7.5, 15, 30, and 45 g a.i. ha⁻¹, respectively) and a blank control based on a preliminary acute 72-h toxicity experiment. In the long-term test, the LR₅₀ (application rate causing the mortality of 50% of the individuals) of nitenpyram for C. septempunctata decreased from 73.43 to 63.0 g a.i. ha⁻¹, while the HQ (hazard quotient) values remained below the threshold value of 2. Nitenpyram did not significantly influence the survival rate, fecundity, pupation, or adult emergence at 150% of the label rate (lowest LR₅₀ = 63.0 g a.i. ha⁻¹), and its demonstrated NOER (No Observed Effect application Rates) values are all above 45 g a.i. ha⁻¹. Likewise, the total developmental time and egg hatchability were not significantly affected at 100% of the label rate (NOER = 30 g a.i. ha⁻¹). The assessment of the total effect (E) suggested that nitenpyram could be classified as harmless to C. septempunctata below/at a dose of 30 g a.i. ha⁻¹. The lowest LR₅₀ and NOER values were both above the maximum recommended field application rate for nitenpyram (30 g a.i. ha⁻¹) for controlling aphids in China. All results indicated that the on-label use of nitenpyram is compatible with the natural enemy C. septempunctata in agricultural ecosystems.

Effects of short- and long-term exposures of humic acid on the Anammox activity and microbial community

Abstract

Humic acid has a controversial effect on the biological treatment processes. Here, we have investigated humic acid effects on the Anammox activity by studying the nitrogen removal efficiencies in batch and continuous conditions and analyzing the microbial community using Fluorescence in situ hybridization (FISH) technique. The results showed that the Anammox activity was affected by the presence of humic acid at a concentration higher than 70 mg/L. In fact, in the presence of humic acid concentration of 200 mg/L, the Anammox activity decreased to 57% in batch and under continuous condition, the ammonium removal efficiencies of the reactor decreased from 78 to 41%. This reduction of Anammox activity after humic acid addition was highlighted by FISH analysis which revealed a considerable reduction of the abundance of Anammox bacteria and the bacteria living in symbiosis with them. Furthermore, a total inhibition of Candidatus Brocadia fulgida was observed. However, humic acid has promoted heterotrophic denitrifying bacteria which became dominant in the reactor. In fact, the evolution of the organic matter in the reactor showed that the added humic acid was used as carbon source by heterotrophic bacteria which explained the shift of metabolism to the favor of heterotrophic denitrifying bacteria. Accordingly, humic acid should be controlled in the influent to avoid Anammox activity inhibition.

Effects of rs591323 on serotonin transporter availability in healthy male subjects

Abstract

Objectives

We aimed to investigate the association between genetic factors of SNPs dopamine transporter (DAT) and serotonin transporter (SERT) availabilities in healthy controls.

Methods

The study population consisted of healthy controls with screening ¹²³I-FP-CIT single-photon emission computed tomography. Specific binding of ¹²³I-FP-CIT regarding DAT and SERT was calculated using a region of interest analysis. VOI template was applied to measure specific binding ratios (SBRs) of caudate nucleus, putamen, striatum, midbrain, and pons.

Results

One hundred sixty healthy controls (male 106, female 54, 61.0 ± 11.5 years) were included in this study. Sex difference did not exist in DAT availabilities of caudate nucleus (p = 0.5344), putamen (p = 0.5006), and striatum (p = 0.5056). However, male subjects had higher SERT availabilities of both midbrain (p = 0.0436), and pons (p = 0.0061). Therefore, we analyzed the effect of SNP on DAT availabilities of subjects in all, and that on SERT availabilities of males and females separately. None of 19 SNPs included in this study showed the effect on DAT availabilities. However, rs591323 in Fibroblast Growth Factor 20 on chromosome 8 had a significant impact on SERT availability of both midbrain (p = 0.0056) and pons (p = 0.0007).

Conclusion

SNP rs591323 of risk loci for Parkinson's disease is associated with SERT availability of healthy male subjects.

Optimal monochromatic color combinations for fusion imaging of FDG-PET and diffusion-weighted MR images

Abstract

Objective

To investigate the optimal monochromatic color combination for fusion imaging of FDG-PET and diffusion-weighted MR images (DW) regarding lesion conspicuity of each image.

Methods

Six linear monochromatic color-maps of red, blue, green, cyan, magenta, and yellow were assigned to each of the FDG-PET and DW images. Total perceptual color differences of the lesions were calculated based on the lightness and chromaticity measured with the photometer. Visual lesion conspicuity was also compared among the PET-only, DW-only and PET-DW-double positive portions with mean conspicuity scores. Statistical analysis was performed with a one-way analysis of variance and Spearman's rank correlation coefficient.

Results

Among all the 12 possible monochromatic color-map combinations, the 3 combinations of red/cyan, magenta/green, and red/green produced the highest conspicuity scores. Total color differences between PET-positive and double-positive portions correlated with conspicuity scores (ρ = 0.2933, p < 0.005). Lightness differences showed a significant negative correlation with conspicuity scores between the PET-only and DWI-only positive portions. Chromaticity differences showed a marginally significant correlation with conspicuity scores between DWI-positive and double-positive portions.

Conclusions

Monochromatic color combinations can facilitate the visual evaluation of FDG-uptake and diffusivity as well as registration accuracy on the FDG-PET/DW fusion images, when red- and green-colored elements are assigned to FDG-PET and DW images, respectively.

Radiation exposure after 177 Lu-DOTATATE and 177 Lu-PSMA-617 therapy

Abstract

Purpose

As radionuclide therapy is gaining importance in palliative treatment of patients suffering from neuroendocrine tumour (NET) as well as castration resistant prostate cancer (CRPC), the radiation protection of patients, staff, family members and the general public is of increasing interest. Here, we determine patient discharge dates according to European guidelines.

Methods

In 40 patients with NET and 25 patients with CRPC organ and tumour doses based on the MIRD concept were calculated from data obtained during the first therapy cycle. Planar whole body images were recorded at 0.5, 4, 20, 68 und 92 h postinjection. Residence times were calculated from the respective time-activity-curves based on the conjugated view method. Residence times for critical organs were fitted into the commercially available OLINDA software to calculate the organ doses. The doses of tumours and salivary glands were calculated via their self-irradiation by approximation with spheres of equivalent volume. Kidney volumes were gained by organ segmentation, volumes of all other organs were estimated by means of OLINDA and hence were lean body mass corrected. Out of the whole body curves reference points for patient discharge were estimated.

Results

In patients with NET discharge dates could be properly estimated from dosimetric data, which is not only crucial for radiation protection, but also makes therapy planning easier. For ¹⁷⁷Lu-PSMA-617 ligand therapy it is difficult to seriously estimate a generalized discharge date due to large interpatient variation resulting from different tumor loads and heavy pre-treatment.

Conclusion

Patient release is predictable for ¹⁷⁷Lu-DOTATATE therapy but not for ¹⁷⁷Lu-PSMA ligand therapy.

Reliable radiosynthesis of 4-[ 10 B]borono-2-[ 18 F]fluoro- l -phenylalanine with quality assurance for boron neutron capture therapy-oriented diagnosis

Abstract

Objective

The aim of this study was to establish a reliable and routine method for the preparation of 4-[¹⁰B]borono-2-[¹⁸F]fluoro-l-phenylalanine (l-[¹⁸F]FBPA) for boron neutron capture therapy-oriented diagnosis using positron emission tomography.

Methods

To produce l-[¹⁸F]FBPA by electrophilic fluorination of 4-[¹⁰B]borono-l-phenylalanine (l-BPA) with [¹⁸F]acetylhypofluorite ([¹⁸F]AcOF) via [¹⁸F]F₂ derived from the ²⁰Ne(d,α)¹⁸F nuclear reaction, several preparation parameters and characteristics of l-[¹⁸F]FBPA were investigated, including: pre-irradiation for [¹⁸F]F₂ production, the carrier F₂ content in the Ne target, l-BPA-to-F₂ ratios, separation with high-performance liquid chromatography (HPLC) using 10 different eluents, enantiomeric purity, and residual trifluoroacetic acid used as the reaction solvent by gas chromatography-mass spectrometry.

Results

The activity yields and molar activities of l-[¹⁸F]FBPA (n = 38) were 1200 ± 160 MBq and 46–113 GBq/mmol, respectively, after deuteron-irradiation for 2 h. Two 5 min pre-irradiations prior to [¹⁸F]F₂ production for ¹⁸F-labeling were preferable. For l-[¹⁸F]FBPA synthesis, 0.15–0.2% of carrier F₂ in Ne and l-BPA-to-F₂ ratios > 2 were preferable. HPLC separations with five of the 10 eluents provided injectable l-[¹⁸F]FBPA without any further formulation processing, which resulted in a synthesis time of 32 min. Among the five eluents, 1 mM phosphate-buffered saline was the eluent of choice. The l-[¹⁸F]FBPA injection was sterile and pyrogen-free, and contained very small amounts of D-enantiomer (< 0.1% of l-[¹⁸F]FBPA), l-BPA (< 1% of l-FBPA), and trifluoroacetic acid (< 0.5 ppm).

Conclusions

l-[¹⁸F]FBPA injection was reliably prepared by the electrophilic fluorination of l-BPA with [¹⁸F]AcOF followed by HPLC separation with 1 mM phosphate-buffered saline.

Assessment of tumor response to chemoradiotherapy and predicting prognosis in patients with head and neck squamous cell carcinoma by PERCIST

Abstract

Purpose

To evaluate therapeutic response to chemoradiotherapy and prediction of recurrence and death in patients with head and neck squamous cell carcinoma (HNSCC) using Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST).

Materials and methods

Forty-two patients (mean 63.4, range 20–79 years) with nasopharyngeal (n = 10), oropharyngeal (n = 13), hypopharyngeal (n = 11), or laryngeal (n = 8) cancer underwent fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) before and approximately 3 months (mean 95.0, range 70–119 days) after undergoing concurrent chemoradiotherapy. The effect of PERCIST regarding progression-free survival (PFS) and overall survival (OS) was examined using log-rank and Cox methods.

Results

Complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), and progressive metabolic disease shown by PERCIST were seen in 30 (71.4%), 9 (21.4%), 3 (7.1%), and 0 patients, respectively. Fourteen (33.3%) developed recurrent disease (median follow-up 27.2, range 8.7–123.1 months) and 9 (21.4%) died (median follow-up 43.6, range 9.6–132.6 months). Furthermore, 4 (13.3%) of 30 patients with CMR developed recurrence, while 7 (77.8%) of 9 with PMR and all 3 (100%) with SMD developed recurrence. Two (6.7%) of 30 patients with CMR, 4 (44.4%) of 9 with PMR, and all 3 (100%) with SMD died. Patients who achieved CMR showed significantly longer PFS and OS as compared to those who did not (PMR and SMD) (both, p < 0.0001).

Conclusion

PERCIST is useful for evaluating therapeutic response to chemoradiotherapy and predicting recurrence and death in HNSCC patients.

Enhanced wound healing activity of PEG/PCL copolymer combined with bioactive nanoparticles in wound care after anorectal surgery: Via bio-inspired methodology

Publication date: Available online 22 July 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Fengli Wang, Yan Xu, Chunmei Lv, Chunling Han, Yan Li

Abstract

Over the past decade, the implementation of the novel nanomaterials in the field of nanotechnology for the biomedical applications is essential for the comfort factors such as non-toxicity and biocompatibility in the human biological systems. In this context, a novel synthesis was worked out through bacterial species (citrobacter braakii) in the biofabrication of bioactive gold nanoparticles (Au NPs) for the wound healing management. The biosynthesized Au NPs were further modified and improved its compatibility with polyethylene glycol (PEG) and polycaprolactone (PCL) for formed as Au-PEG/PCL nanocomposites to extent the activity in wound healing application. The combination of bioactive nanoparticles with biocompatible polymeric substances has been upsurges the activity of nanoparticles due to the strong interaction of polymers. The biofabricated Au NPs and its nanocomposites were characterized using UV–Vis, FT-IR, XRD, DLS and TEM studies. Further, the prepared materials were tested in a wound healing model of rat with the wound of 22 mm size. The found results are demonstrated that the improved materials are highly active in growth of keratinocytes proliferation and simultaneously reduce scar formation. After 15 days observations, the wound were almost completely healed by the developed Au- PEG/PCL nanocomposites material which was confirmed by Masson's Trichrome staining histological images and antibacterial efficacy was displayed by the CLSM images. Notably, polymeric Au-PEG/PCL nanocomposites showed no inflammation on the wounded portion and internal implantation on rats thus evidencing it as a safe and biologically very active wound healing agent.

Graphical abstract

Simulation and analysis of XCO 2 in North China based on high accuracy surface modeling

Abstract

As an important cause of global warming, CO₂ concentrations and their changes have aroused worldwide concern. Establishing explicit understanding of the spatial and temporal distributions of CO₂ concentrations at regional scale is a crucial technical problem for climate change research. High accuracy surface modeling (HASM) is employed in this paper using the output of the CO₂ concentrations from weather research and forecasting-chemistry (WRF-CHEM) as the driving fields, and the greenhouse gases observing satellite (GOSAT) retrieval XCO₂ data as the accuracy control conditions to obtain high accuracy XCO₂ fields. WRF-CHEM is an atmospheric chemical transport model designed for regional studies of CO₂ concentrations. Verified by ground- and space-based observations, WRF-CHEM has a limited ability to simulate the conditions of CO₂ concentrations. After conducting HASM, we obtain a higher accuracy distribution of the CO₂ in North China than those calculated using the classical Kriging and inverse distance weighted (IDW) interpolation methods, which were often used in past studies. The cross-validation also shows that the averaging mean absolute error (MAE) of the results from HASM is 1.12 ppmv, and the averaging root mean square error (RMSE) is 1.41 ppmv, both of which are lower than those of the Kriging and IDW methods. This study also analyses the space-time distributions and variations of the XCO₂ from the HASM results. This analysis shows that in February and March, there was the high value zone in the southern region of study area relating to heating in the winter and the dense population. The XCO₂ concentration decreased by the end of the heating period and during the growing period of April and May, and only some relatively high value zones continued to exist.

Pax-5 Inhibits NF-κB Activity in Breast Cancer Cells Through IKKε and miRNA-155 Effectors

Abstract

Pax-5, an essential transcription factor in B cell development, is aberrantly expressed in various B cell cancer lesions and solid tumors such as breast carcinoma. We have recently shown that Pax-5 regulates NF-κB activity which lead to the modulation of breast cancer phenotypic features (EMT-MET). NF-κB is known as a central mediator in inflammation, stress response as well as being a gatekeeper of pro-tumorigenic activity. However, little is known as to how Pax-5 affects this modulation. We thus turned our attention to microRNAs as potential regulatory effectors. In this study, we set out to elucidate the regulatory network between differential Pax-5 expression and NF-κB activity which dictate breast cancer malignancy. Through next-generation sequencing (NGS) of breast cancer cells conditionally expressing Pax-5, we profile significantly upregulated microRNAs; including microRNA-155, a known regulator of pathological processes and suppressor of malignant growth. Through the conditional expression of microRNA-155 in breast cancer models, we identify and validate IKKε (IKBKE) as a downstream target and an essential effector of Pax-5-mediated suppression of NF-κB signaling. Using rescue experiments, we also confirm that Pax-5 modulates NF-κB activity via IKKε downregulation. Interestingly, we also show that microRNA-155, in turn, supresses Pax-5 expression, indicative of an auto-regulatory feedback loop. Altogether, we demonstrate that Pax-5 inhibits NF-κB signalling through the regulation of microRNA-155 and its downstream target IKKε. The elucidation of this signaling network is relevant as Pax-5 and NF-κB are potent transcriptional regulators of breast cancer aggressivity. In addition, IKKε is relevant oncogene aberrantly expressed in 30% of breast carcinomas. Further insight into the regulatory pathways of breast cancer progression will eventually identify strategic therapeutic and prognostic targets to improve cancer patient outcome.

Prediction of long-term heavy metal leaching from dredged marine sediment applied inland as a construction material

Abstract

Column leaching studies have been suggested as a reference for site-specific prediction of the long-term leaching characteristics of trace constituents in granular materials used as construction materials. In this study, the concept of the long-term leaching prediction using column studies is applied for dredged marine sediment impacted by heavy metals. The column studies show tailing of the liquid to solid ratio-dependent heavy metal leaching for sediment after heavy metal treatment by acid washing. A dual-mode first-order decay model, applied for the first time in this study for column leaching studies, is able to reproduce the leaching characteristics observed. A procedure for long-term leaching prediction using the dual-mode model is developed and applied to a virtual field scenario for which the sediment is beneficially used as a construction material. The prediction results show that by more accurately reproducing the column study results, the dual-mode model generally predicts greater long-term heavy metal loading to the underlying soil layer and longer duration of leaching than the single-mode model. The heavy metal leaching observed in the columns does not show any correlation with the sequential extraction procedure and toxicity characteristic leaching procedure (TCLP) results, suggesting that the column leaching test should be considered to be independent of such batch test procedures.

Modeling nitrous oxide emissions from rough fescue grassland soils subjected to long-term grazing of different intensities using the Soil and Water Assessment Tool (SWAT)

Abstract

Given the rising nitrous oxide (N₂O) concentration in the atmosphere, it has become increasingly important to identify hot spots and hot moments of N₂O emissions. With field measurements often failing to capture the spatiotemporal dynamics of N₂O emissions, estimating them with modeling tools has become an attractive alternative. Therefore, we incorporated several semi-empirical equations to estimate N₂O emissions with the Soil and Water Assessment Tool from nitrification and denitrification processes in soil. We then used the model to simulate soil moisture and the N₂O flux from grassland soils subjected to long-term grazing (> 60 years) at different intensities in Alberta, Canada. Sensitivity analysis showed that parameters controlling the N₂O flux from nitrification were most sensitive. On average, the accuracy of N₂O emission simulations were found to be satisfactory, as indicated by the selected goodness-of-fit statistics and predictive uncertainty band, while the model simulated the soil moisture with slightly higher accuracy. As expected, emissions were higher from the plots with greater grazing intensity. Scenario analysis showed that the N₂O emissions with the recommended fertilizer rate would dominate the emissions from the projected wetter and warmer future. The combined effects of fertilization and wetter and warmer climate scenarios would increase the current N₂O emission levels by more than sixfold, which would be comparable to current emission levels from agricultural soils in similar regions.

Theoretical analysis of pollutant mixing zone considering lateral distribution of flow velocity and diffusion coefficient

Abstract

Theoretical formulae have shown significant advantages in describing the characteristic geometric scales of the pollutant mixing zone (PMZ) formed by offshore pollutant discharged by a single general form. They, however, fail to predict the influence of the lateral inhomogeneity of the river flow because constant flow velocity and the lateral diffusion coefficient are assumed during the derivation. The realistic flow velocity in a river is fitted by an exponential law in this study and the lateral diffusion coefficient is proposed to have the same form. Similar idea has been used in previous studies on the vertical dispersion of scalar in the lower atmosphere. Pollutant discharged from a steady onshore point source into a wide straight open channel is examined to characterize the concentration taking into consideration of these lateral variations. Theoretical formulae describing the maximum length, maximum width and its corresponding longitudinal position, as well as the area of the PMZ are derived. A non-dimensional standard curve equation for the isoconcentration boundary of PMZ is also obtained. The results show that the shape of the dimensionless standard curve of PMZ depends only on the exponential constants in the exponential laws. The exponential profiles that fit the near-shore velocity give good prediction, while the ones that match the entire lateral range up to the center of the river underpredict the PMZ significantly. These findings are of great importance for practitioners to characterize the geometry of the PMZ in rivers and for water quality modeling.

Pax-5 Inhibits NF-κB Activity in Breast Cancer Cells Through IKKε and miRNA-155 Effectors

Abstract

Pax-5, an essential transcription factor in B cell development, is aberrantly expressed in various B cell cancer lesions and solid tumors such as breast carcinoma. We have recently shown that Pax-5 regulates NF-κB activity which lead to the modulation of breast cancer phenotypic features (EMT-MET). NF-κB is known as a central mediator in inflammation, stress response as well as being a gatekeeper of pro-tumorigenic activity. However, little is known as to how Pax-5 affects this modulation. We thus turned our attention to microRNAs as potential regulatory effectors. In this study, we set out to elucidate the regulatory network between differential Pax-5 expression and NF-κB activity which dictate breast cancer malignancy. Through next-generation sequencing (NGS) of breast cancer cells conditionally expressing Pax-5, we profile significantly upregulated microRNAs; including microRNA-155, a known regulator of pathological processes and suppressor of malignant growth. Through the conditional expression of microRNA-155 in breast cancer models, we identify and validate IKKε (IKBKE) as a downstream target and an essential effector of Pax-5-mediated suppression of NF-κB signaling. Using rescue experiments, we also confirm that Pax-5 modulates NF-κB activity via IKKε downregulation. Interestingly, we also show that microRNA-155, in turn, supresses Pax-5 expression, indicative of an auto-regulatory feedback loop. Altogether, we demonstrate that Pax-5 inhibits NF-κB signalling through the regulation of microRNA-155 and its downstream target IKKε. The elucidation of this signaling network is relevant as Pax-5 and NF-κB are potent transcriptional regulators of breast cancer aggressivity. In addition, IKKε is relevant oncogene aberrantly expressed in 30% of breast carcinomas. Further insight into the regulatory pathways of breast cancer progression will eventually identify strategic therapeutic and prognostic targets to improve cancer patient outcome.

Association between gentamicin resistance and stress tolerance in water isolates of Ralstonia pickettii and R . mannitolilytica

Abstract

Members of the species Ralstonia pickettii and R. mannitolilytica, although ubiquitous and lacking major virulence factors, have been associated with nosocomial outbreaks. Tolerance to metals, antibiotics, and disinfectants may represent an advantage for their ubiquity and opportunistic pathogenic potential. In this study, we compared five strains that differed on the origin (hospital effluent, tap water, mineral water) and in the susceptibility to aminoglycosides, regarding their tolerance to metals and disinfection. The growth kinetics and biofilm formation capacity were tested in four R. pickettii strains and one R. mannitolilytica at sub-inhibitory concentrations of aminoglycosides or arsenite. The survival to UV radiation, chlorine, or hydrogen peroxide was also compared in aminoglycoside resistant and susceptible strains. Aminoglycoside-resistant strains presented a higher tolerance to arsenite than the susceptible ones and either aminoglycosides or arsenite was observed to stimulate the biofilm formation. Sub-inhibitory concentrations of the aminoglycoside gentamicin or arsenite significantly decreased the growth rate and yield, but only arsenite caused a significant increase of the lag phase. Hydrogen peroxide presented higher disinfection effectiveness against aminoglycoside susceptible than against resistant strains, an effect that was not observed for UV or chlorine. Although this conclusion needs validation based on a larger number of isolates, including clinical, the results suggest that aminoglycoside resistance may be associated with traits that influence Ralstonia spp. fitness in the environment.

The Design and Implementation of the 2016 National Survey of Children’s Health

Abstract

Introduction Since 2001, the Health Resources and Services Administration's Maternal and Child Health Bureau (HRSA MCHB) has funded and directed the National Survey of Children's Health (NSCH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN), unique sources of national and state-level data on child health and health care. Between 2012 and 2015, HRSA MCHB redesigned the surveys, combining content into a single survey, and shifting from a periodic interviewer-assisted telephone survey to an annual self-administered web/paper-based survey utilizing an address-based sampling frame. Methods The U.S. Census Bureau fielded the redesigned NSCH using a random sample of addresses drawn from the Census Master Address File, supplemented with a unique administrative flag to identify households most likely to include children. Data were collected June 2016–February 2017 using a multi-mode design, encouraging web-based responses while allowing for paper mail-in responses. A parent/caregiver knowledgeable about the child's health completed an age-appropriate questionnaire. Experiments on incentives, branding, and contact strategies were conducted. Results Data were released in September 2017. The final sample size was 50,212 children; the overall weighted response rate was 40.7%. Comparison of 2016 estimates to those from previous survey iterations are not appropriate due to sampling and mode changes. Discussion The NSCH remains an invaluable data source for key measures of child health and attendant health care system, family, and community factors. The redesigned survey extended the utility of this resource while seeking a balance between previous strengths and innovations now possible.

Impact of Maternal Infant Weight Perception on Infant Feeding and Dietary Intake

Abstract

Introduction Obesity is a global problem that is challenging to prevent and expensive to treat. Early childhood interventions show promise in establishing lifelong healthy eating patterns, however a better understanding of how parental feeding practices develop is needed. The study aimed to investigate maternal perception of infant weight and its relationship to feeding practices and infant dietary intake. Methods A questionnaire was completed by 263 Queensland mothers of infants aged between 5 and 13 months. Logistic regression was used to describe the association between maternal feeding practices (restriction, pressure-to-eat, monitoring), parenting style (warmth, hostility), infant weight concern and infant dietary intake. Correlation and linear regression were used to identify relationships between maternal feeding practices, parenting style, infant weight concern and infant weight. Results Mothers were found to be more concerned about underweight than overweight, misjudge infants as being underweight and failed to recognise overweight infants. Underweight concern was associated with infant weight (r = −0.27, p < 0.01), early introduction of solids (OR 0.24, CI 0.11–0.51) and pressure-to-eat (r = 0.19, p < 0.01). Pressure-to-eat was associated to maternal perception of infant weight (r = − 0.21, p < 0.01), infant weight (r = − 0.17, p < 0.05) and lower fruit and vegetable intake (OR 0.50, CI 0.27–0.92). Restrictive feeding practices were correlated to overweight concern (r = 0.08, p < 0.05). Discussion Maternal infant weight perception and concerns are related to control feeding practices which can be detrimental to infant dietary intake. Inability to recognise healthy weight may ignite these concerns or fail to address infant feeding risk factors. Discussing healthy growth should be a fundamental component of strategies to support healthy infant feeding and eating.

Association Between Obstetric Provider’s Advice and Gestational Weight Gain

Abstract

Objective This study examined associations between pregnant women's report of obstetric provider GWG advice, self-reported adherence to such advice, and GWG. Methods Healthy pregnant women (N = 91) who started obstetric care prior to 17 weeks of gestation completed assessments between 30 and 34 weeks of gestation. These included survey (questions on receipt of and adherence to provider GWG advice, and demographics) and anthropometric measures. GWG data were abstracted from electronic health records. Analyses included Chi square and Mann–Whitney tests, and binary and multivariate logistic regressions. Results The cohort's median age was 28 years, 68% of women were White, 78% had a college education, 50.5% were overweight or obese before the pregnancy, and 62.6% had GWGs above the Institute of Medicine-recommended ranges. Sixty-seven percent of women reported having received GWG advice from their obstetric providers and, of those, 54.1% reported that they followed their provider's advice. Controlling for race, education and pre-pregnancy BMI, receipt of GWG advice was marginally associated with increased odds of excessive weight gain (OR 2.52, CI 0.89–7.16). However, women that reported following the advice had lower odds of excessive GWG (OR 0.18, CI 0.03–0.91) and, on average, gained 11.3 pounds less than those who reported following the advice somewhat or not at all. Conclusions Frequency of GWG advice from obstetric providers is less than optimal. When given and followed, provider advice may reduce the risk of excessive GWG. Research to understand factors that facilitate providers GWG advice giving and women's adherence to providers' advice, and to develop interventions to optimize both, is needed.

Racial/Ethnic Inequities in Low Birth Weight and Preterm Birth: The Role of Multiple Forms of Stress

Abstract

Introduction Racial/ethnic inequities in low birth weight (LBW) and preterm birth (PTB) persist in the United States. Research has identified numerous risk factors for adverse birth outcomes; however, they do not fully explain the occurrence of, or inequalities in PTB/LBW. Stress has been proposed as one explanation for differences in LBW and PTB by race/ethnicity. Methods Using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2013 for 21 states and one city (n = 15,915) we used Poisson regression to estimate the association between acute, financial and relationship stressors and LBW and PTB, and to examine the contribution of these stressors individually and simultaneously to racial/ethnic differences in LBW and PTB. Results Adjusting for age and race/ethnicity, acute (p < 0.001), financial (p < 0.001) and relationship (p < 0.05) stressors were associated with increased risk of LBW, but only acute (p < 0.05) and financial (p < 0.01) stress increased risk of PTB. Across all models, non-Hispanic blacks had higher risk of LBW and PTB relative to non-Hispanic whites (IRR 1.87, 95% CI 1.55, 2.27 and IRR 1.46, 95% CI 1.18, 1.79). Accounting for the effects of stressors attenuated the risk of LBW and PTB by 17 and 22% respectively, but did not fully explain the increased likelihood of LBW and PTB among non-Hispanic blacks. Discussion Results of this study demonstrate that stress may increase the risk of LBW and PTB. While stressors may contribute to racial/ethnic differences in LBW and PTB, they do not fully explain them. Mitigating stress during pregnancy may help promote healthier birth outcomes and reduce racial/ethnic inequities in LBW and PTB.

Exploring Lactation Consultant Views on Infant Safe Sleep

Abstract

Objectives The purpose of this qualitative study was to explore the infant safe sleep beliefs and occupational practices of lactation consultants and to determine if lactation consultants give advice to clients that is consistent with the American Academy of Pediatrics' recommendations on this topic. Methods Focus groups were conducted with certified lactation consultants in two cities in Ohio. Participants discussed the role of lactation consultants, the infant sleep advice they provide to women, their views on the American Academy of Pediatrics' infant safe sleep recommendations and related policies, and perceived benefits and barriers associated with providing infant safe sleep education as part of their work. A member-checking session was held to ensure the credibility of the findings. Results Four focus groups were conducted with 22 certified lactation consultants between September and November 2015. Major themes that emerged included: lactation consultants' beliefs regarding the importance of bedsharing for supporting breastfeeding success; their disagreement with the infant safe sleep recommendations of the American Academy of Pediatrics; their frustration with policies that restrict consultants' ability to discuss bedsharing; and the impact of infant safe sleep policies on their work and the advice they provide. Conclusions for Practice Lactation consultants interact with mothers of newborns at a critical time for infant safe sleep decision-making and may influence a woman's choices related to this topic. Women may not be receiving messages from lactation consultants that are consistent with the infant safe sleep recommendations of the American Academy of Pediatrics.

Hispanic Immigrant Father Involvement with Young Children in the United States: A Comparison with US-Born Hispanic and White non-Hispanic Fathers

Abstract

Objectives Fathering is known to foster child development and health, yet evidence on Hispanic immigrant fathers' involvement with their young children is sparse. This study assessed disparities in pregnancy intendedness and father involvement with children ages 0–4 among Hispanic immigrant co-resident fathers versus two reference groups: US-born Hispanic and US-born White fathers. We hypothesized that differentials in involvement were associated with socioeconomic and cultural factors. Methods Using 2011–2013 data from the National Survey of Family Growth (N = 598), we performed bivariate, logistic and linear regression analyses to assess disparities in pregnancy intendedness and five father involvement outcomes (physical care, warmth, outings, reading and discipline). The models controlled for socio-economic, structural, health and cultural covariates. Results Pregnancy intendedness did not differ significantly between Hispanic immigrant fathers and the two reference groups. Compared with US-born Hispanics, unadjusted models showed that immigrant fathers were less likely to engage in physical care, warmth and reading, (p ≤ 0.05) though the differences were attenuated when controlling for covariates. Hispanic immigrant fathers were less likely than US-born White fathers to engage in each of the father involvement outcomes (p ≤ 0.05), with the disparity in reading to their child persisting even after controlling for all covariates. Conclusions for Practice We found marked socio-economic and cultural differences between Hispanic immigrant and US-born Hispanic and White fathers which contribute to disparities in father involvement with their young children. Hispanic immigrant status is an important determinant of involved fathering and should be taken into account when planning public health policies and programs.

African-American women’s Upward Economic Mobility and Small for Gestational Age Births: A Population-Based Study

Abstract

Background The relationship between African-American women's upward economic mobility and small for gestational age (weight for gestational < 10th percentile, SGA) rates is incompletely understood. Objective To ascertain the extent to which African-American women's upward economic mobility from early-life impoverishment is coupled with reduced SGA rates. Methods Stratified and multilevel logistic regression analyses were completed on the Illinois transgenerational dataset of African-American infants (1989–1991) and their Chicago-born mothers (1956–1976) with linked U.S. census income information. Results Impoverished-born (defined as lowest quartile of neighborhood income distribution) African-American women (n = 4891) who remained impoverished by the time of delivery had a SGA rate of 19.7%. Individuals who achieved low (n = 5827), modest (n = 2254), or high (n = 732) upward economic mobility by adulthood had lower SGA rates of 17.2, 14.8, and 13.7%, respectively; RR = 0.9 (0.8–0.9), 0.8 (0.7–0.8), and 0.7 (0.6–0.8), respectively. In adjusted (controlling for traditional individual-level risk factors) multilevel regression models, there was a decreasing linear trend in SGA rates with increasing levels of upward economic mobility; the adjusted RR of SGA birth for impoverished-born African-American women who experienced low, modest, of high (compared to no) upward mobility equaled 0.95 (0.91, 0.99), 0.90 (0.83, 0.98), and 0.86 (0.75, 0.98), respectively, p < 0.05. Conclusions African-American women's upward economic mobility from early-life residence in poor urban communities is associated with lower SGA rates independent of adulthood risk status.

Exploring Preconception Care: Insurance Status, Race/Ethnicity, and Health in the Pre-pregnancy Period

Abstract

Objective To measure the association of preconception health insurance status with preconception health among women in New York City, and examine whether this association is modified by race/ethnicity. Methods Using data from the New York City Pregnancy Risk Assessment Monitoring System 2009–2011 (n = 3929), we created a "Preconception Health Score" (PHS) capturing modifiable behaviors, healthcare services utilization, pregnancy intention, and timely entry into prenatal care. We then built multivariable logistic regression models to measure the association of PHS with health insurance status and race/ethnicity. Results We found PHS to be higher among women with private insurance (7.3 ± 0.07) or public insurance (6.3 ± 0.08) before pregnancy than no insurance (5.9 ± 0.09) (p < .001). However, when stratified by race/ethnicity, the positive association of PHS with insurance was absent in the non-white population. Conclusions for Practice Having health insurance during the pre-pregnancy period is associated with greater health among white women, but not among black or Hispanic women in NYC.

Factors Associated with Quality of Life Among Mothers Rearing 4- and 18-Month Old Infants in Japan

Abstract

Objective The purpose of the present study was to investigate factors associated with quality of life (QOL) among mothers raising 4 and 18-month-old infants. Methods A cross-sectional study was conducted using self-report questionnaires. Participants included 400 women who took their infants for health checkups at a city in Aichi Prefecture, Japan (4-month-olds: n = 197, 18-month-olds: n = 203). Study variables included the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale, mother's lifestyle, support from family, and other factors potentially related to QOL. Results For mothers of 4-month-old infants, total QOL was associated with emotional support from families (OR 6.09, 95% CI 2.13–17.43) and having enough sleep (7 h or more; OR 4.18, 95% CI 1.86–9.36). These mothers had shorter sleeping hours than mothers of 18-month-old infants. QOL of mothers of 18-month-old infants was associated with emotional support from families (OR 3.06, 95% CI 1.14–8.22) and using childrearing support facilities (OR 2.02, 95% CI 1.01–4.01). Conclusion Different factors contributed to mothers' QOL as a function of infant age. Emotional support from families was associated with better QOL in both mother groups. Differences were that for mothers of 4-month-old infants, enough sleep was relevant to QOL, while in mothers of 18-month-old infants, childcare services helped improving their QOL.

Continuing Professional Development in Maternal Health Care: Barriers to Applying New Knowledge and Skills in the Hospitals of Rwanda

Abstract

Objectives Training healthcare professionals in emergency maternal healthcare is a critical component of improving overall maternal health in developing countries like Rwanda. This paper explored the challenges that healthcare professionals who participated in a Continuing Professional Development (CPD) program on Advanced Life Support in Obstetrics® (ALSO) face in putting the learned knowledge and skills into practice in hospitals of Rwanda. Methods This study used a mixed methods approach to understand the challenges/barriers to applying new knowledge and skills in the hospitals of Rwanda. We conducted thirteen purposive in-depth interviews with ALSO® trainees (nurses, midwives and physicians) complemented with a cross-sectional survey on staff turnover in eight of the nine hospitals in the Eastern province of Rwanda. Results Our study found that trainees do not get enough opportunity to apply the new knowledge and skills in their hospitals and expand to health centers. In part because they are frequently rotating to different departments of the hospital and are not getting the opportunity to train their colleagues to share the learned knowledge and skills. The lack of refresher trainings/mentorship and the high personnel turnover were also reported as a barrier to applying new knowledge and skills. Reasons for staff turnover included pursuing further studies, a better opportunity (job/remuneration), low morale, and family related motives including joining a spouse or better schools for children. Conclusions for Practice Expanding and formalizing CPD training to all the healthcare professionals involved in providing maternal care services would improve the provision of emergency maternal healthcare in Rwanda.

The Impact of Food Insecurity on the Home Emotional Environment Among Low-Income Mothers of Young Children

Abstract

Objectives Household stressors, such as food insecurity, contribute to the home emotional environment and negatively affect child development. Little research on this topic has been conducted among very young children. This study aimed to examine the relationship between food insecurity and the home emotional environment, as well the extent to which the relationship may be mediated by maternal symptoms of depression. Frequency of praise, affection, and discipline of young children by mothers were examined as markers of the home emotional environment. Methods Data were collected in a cross-sectional study of mothers of children under the age of five (N = 4231). Logistic regression was used to assess the relationship between level of food security and frequency of praise and discipline of children. Mediation analysis using the KHB method was conducted to test whether maternal mental health mediated the relationship between food insecurity and each outcome. Results Low and very low food security were significantly associated with higher odds of disciplining children with high frequency. Controlling for all covariates, frequency of praise was not significantly associated with level of household food insecurity. Differences in praise and discipline frequency were found by language of interview, maternal education, and employment. Conclusions for Practice Parent–child interactions, specifically related to discipline, are related to food insecurity. Further research should consider cultural patterns and mechanisms behind the relationship between food insecurity and the home environment. Household stressors begin affecting children at young ages, and early intervention is essential to prevent further negative sequelae as children grow older.

The Influence of Objectively Measured Physical Activity During Pregnancy on Maternal and Birth Outcomes in Urban Black South African Women

Abstract

Objectives Research indicates the beneficial effects of physical activity during pregnancy on maternal health, although controversy still exists regarding its influence on birth outcomes. Little research has been done to objectively measure physical activity during pregnancy in black African women from low-to-middle income countries. The purpose of this study was to examine the association between physical activity and maternal and birth outcomes in this unique population. Methods This observational, longitudinal study assessed total physical activity using a hip-mounted triaxial accelerometer at 14–18 weeks (second trimester, n = 120) and 29–33 weeks (third trimester, n = 90) gestation. Physical activity is expressed as gravity-based acceleration units (mg). Maternal outcomes included both weight and weight gain at 29–33 weeks gestation. Birth outcomes included gestational age, birth weight, ponderal index and Apgar score, measured within 48 h of delivery. Results There was a significant decline in physical activity from the second to the third trimester (12.8 ± 4.1 mg vs. 9.7 ± 3.6 mg, p ≤ 0.01). Physical activity at 29–33 weeks as well as a change in PA was inversely associated with weight change at 29–33 weeks (β = − 0.24; 95% CI − 0.49; − 0.00; p = 0.05 and β = − 0.36; 95% CI − 0.62; − 0.10; p = 0.01, respectively). No significant associations were found between physical activity and birth outcomes. Conclusions for Practice Physical activity during pregnancy may be an effective method to control gestational weight gain, whilst presenting no adverse risk for fetal development, in women from a low-income urban setting.

Methodological Considerations in Couples’ Fertility Intentions: Missing Men and the Viability of Women’s Proxy Reports

Abstract

Introduction Recent efforts show potential to advance research on unintended childbearing by taking a couple-level approach. However, this work has neither adequately addressed methodological concerns stemming from the challenges associated with male fertility data nor considered the viability of women's proxy reports of fathers intentions. Methods Data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) were used to assess the implications of low response rates among men on couples' unintended childbearing. Then, the accuracy of women's proxy reports of fathers intentions was assessed. Weighted logistic regression analyses were conducted to determine how women's characteristics were associated with men's survey participation whereas weighted multinomial logistic regression analyses were applied to determine how women's characteristics were linked with the accuracy of her proxy report. Results Almost half (46%) of women cannot be matched with data from the child's father, and this discrepancy is most problematic for women who are black, foreign-born, less educated, and unmarried at birth. Women's proxy reports appear viable as 75% of women's reports are consistent with men's responses. Yet, proxy reports underestimate disagreement in couples' intentions as mothers who intended the birth are at an increased risk of "inaccurately" reporting that fathers share their intentions. Discussion Direct approaches to couples' intentions yield privileged samples and systematically omit women at the greatest risk of an unintended birth. However, proxies underestimate disagreement in couples' intentions—a key contribution to the couple approach. Accordingly each approach has its own merits which must be considered in light of specified research questions.

Longitudinal Impact of a Randomized Clinical Trial to Improve Family Function, Reduce Maternal Stress and Improve Child Outcomes in Families of Children with ADHD

Abstract

Objective Evaluate the efficacy of a 12 month nursing case-management intervention over a period of 18 months, 6 months after the end of intervention, for families of children attention deficit hyperactivity disorder (ADHD). Methods Mother and child dyads were enrolled to participate in a randomized controlled clinical trial. Children were 4–18 years old. Data were collected at baseline, 6, 12, and 18 months or 6 months after the termination of direct intervention. Longitudinal analyses, using generalized estimating equations, were conducted to assess change in study outcomes relating to family function, maternal stress, and child behavior over the 18 month period. Results Compared to control families, some family function outcomes were moderately improved in the intervention group. In particular, intervention families demonstrated substantial improvement in implementing family behavior controls (p value = 0.038) and improvement in family satisfaction (not statistically significant p = 0.062). Although there was improvement in the overall family function measure there was not a statistically significant difference between groups. Maternal stress and child behavior outcomes were not significantly different between control and intervention groups by the end of the intervention. Conclusions for Practice Addressing ADHD is complex and requires the assessment of comorbidities that might exacerbate negative behavior. Our findings support the latest American Academy of Pediatrics guidelines to use behavioral therapy as the first line of treatment in young children. Nursing case-management interventions that provide direct family education and improve family function, especially with respect to providing structure and behavior control, may complement and facilitate behavioral therapy for treatment of ADHD and improving child behavior.

Hepatitis C Virus Knowledge Among Pregnant Women with Opioid Use Disorder

Abstract

Objectives To evaluate Hepatitis C virus (HCV) knowledge and awareness among pregnant women with opioid use disorder (OUD). Methods From May through November 2015, a one-time survey was distributed to a convenience sample of pregnant women with OUD to assess their knowledge and awareness of (a) risk factors for HCV infection, (b) HCV transmission prevention strategies, (c) hepatotoxic risk reduction and (d) perinatal transmission and neonatal implications of HCV infection. Chi square and Fisher's exact tests were used to compare demographic characteristics and HCV knowledge between participants who were HCV positive and negative. Results Of 179 pregnant women with OUD approached, 169 (94%) completed the survey. Of these, 153 (90.5%) reported at least one risk factor for HCV infection, 85 (50.3%) were HCV positive and 38 (44.7%) of HCV positive women were diagnosed with HCV for the first time during pregnancy. When HCV knowledge was evaluated, 114 (66.7%) responded that sharing eating utensils could transmit HCV, 69 (55.0%) responded that there is a vaccine to prevent HCV and 56 (32.7%) did not identify intranasal drug use as a risk factor for HCV transmission. Among HCV positive women, 61 (71.8%) associated breastfeeding with an increased risk for HCV transmission, 33 (38.1%) failed to identify the importance of pediatric follow-up for HCV-exposed children and 16 (18.8%) perceived the risk of HCV vertical transmission as "likely" or "very likely." Conclusions for Practice Gaps in HCV knowledge exist among a rapidly growing population of pregnant women with OUD. Healthcare providers have a unique opportunity to provide HCV education and counseling during pregnancy.

Similarities in Maternal Weight and Birth Weight Across Pregnancies and Across Sisters

Abstract

Objectives The current study examined how prepregnancy body mass index (BMI), gestational weight gain, and birth weight cluster between births within women and between women who are sisters. Methods Using data from the National Longitudinal Survey of Youth 1979 cohort, we utilized nested, multivariable hierarchical linear models to examine the correlation of these three outcomes between births (n = 6006) to women (n = 3605) and sisters (n = 3170) so that we can quantify the clustering by sibship and by woman for these three pregnancy-related outcomes. Results After controlling for confounding covariates, prepregnancy BMI (intraclass correlation (ICC) 0.24, 95% CI 0.16, 0.32), gestational weight gain (ICC 0.23, 95% CI 0.16, 0.31), and infant's birthweight (ICC 0.07, 95% CI 0.003, 0.13) were correlated between sisters. Additionally, all three outcomes were significantly correlated between births for each sister, suggesting that prepregnancy BMI (ICC 0.82, 95% CI 0.81, 0.83), gestational weight gain (ICC 0.45, 95% CI 0.42, 0.49), and birth weight (ICC 0.31, 95% CI 0.28, 0.35) track between pregnancies in the same woman. Conclusions for Practice The observed clustering both within women and between sisters suggests that shared genetic and environmental factors among sisters play a role in pregnancy outcomes above and beyond that of women's own genetic and environmental factors. Findings suggest that asking a woman about her sisters' pregnancy outcomes could provide insight into the possible outcomes for her current pregnancy. Future research should test if collecting such a family history and providing tailored clinical recommendations accordingly would be useful.

Impact of Medicaid Policy on the Oral Health of Publicly Insured Children

Abstract

Objective Fluoride varnish (FV) applications among non-dentist primary care providers has increased due to state Medicaid policies. In this study we examine the impact of FV policies on the oral health of publicly insured children aged 2–6 years old. Methods Using three waves of the National Survey of Children's Health (2003, 2007, 2011/12), we used a logistic regression model with state and year fixed effects, adjusting for relevant child characteristics, to examine the association between years since a state implemented a FV policy and the odds of a publicly insured child having very good or excellent teeth. We compared children with public insurance in states with FV policies to children with public insurance in states without FV policies, controlling for the same difference among children with private insurance who were unlikely to be affected by Medicaid FV policies. Results Among 68,890 children aged 2–6 years, 38% had public insurance. Compared to privately insured children, publicly insured children had significantly lower odds of having very good or excellent teeth [odds ratio (OR) 0.70, 95% CI 0.62–0.81]. Publicly insured children in states with FV policies implemented for four or more years had significantly greater odds of having very good or excellent teeth (OR 1.28, 95% CI 1.03–1.60) compared to publicly insured children in states without FV policies. Conclusions for Practice State policies supporting non-dental primary care providers application of FV were associated with improvements in oral health for young children with public insurance.

Functional Information: a Graded Taxonomy of Difference Makers

Abstract

There are many different notions of information in logic, epistemology, psychology, biology and cognitive science, which are employed differently in each discipline, often with little overlap. Since our interest here is in biological processes and organisms, we develop a taxonomy of functional information that extends the standard cue/signal distinction (in animal communication theory). Three general, main claims are advanced here. (1) This new taxonomy can be useful in describing learning and communication. (2) It avoids some problems that the natural/non-natural information distinction faces. (3) Functional information is​ ​produced through exploration and stabilisation processes.

Iatrogenic Dermatoses in Hospitalized Patients

Abstract

Purpose of Review

Hospitalized patients are at risk of skin injury from drugs and procedures. These complications carry a high risk of morbidity, mortality, and internal organ involvement. This review examines updates in the treatment of drug eruptions and diagnosis of newly reported iatrogenic skin injuries that accompany novel procedures.

Recent Findings

Drug eruptions are a common cause of iatrogenic injury and they vary in presentation and severity. Recent research suggests that medications such as cyclosporine and etanercept may improve mortality in patients with epidermal necrosis although a randomized controlled trial is still needed. Innovative non-invasive procedures can have cutaneous complications such as radiation injury and microemboli. In immunocompromised patients, seemingly banal clinical manipulation such as application of medical tape can lead to cutaneous infection.

Summary

Physicians should maintain a high index of suspicion for iatrogenic injury when caring for the hospitalized patient. It is crucial to obtain a thorough medication and procedural history when evaluating these patients.

The effects of three types of environmental regulation on energy consumption—evidence from China

Abstract

Based on panel data from 1997 to 2015 in China, in this paper, the direct and indirect effects of three types of environmental regulation on energy consumption are explored with the 2SLS and system GMM method. The main conclusions of this study are as follows: (1) the effects of three types of environmental regulation on energy consumption are quite varied. The cost effect of the economical environmental regulation is significant in the direct path. However, the phenomenon of "Green Paradox" emerges in legal and supervised types of environmental regulation. The "rebound effect" of energy, which led to a new energy demand, is greater than the energy conservation generated by technological innovation in the indirect path, which is embodied as a suppression effect. (2) The legal and supervised types of environmental regulation in the eastern, central, and western regions have a Green Paradox and rebound effect on energy consumption. By contrast, the economical environmental regulation shows an opposite performance. (3) The counterfactual simulation results indicate that the net effects of three types of environmental regulation on energy consumption are different. Based on the findings, some corresponding policy implications are provided.

Reconstruction mammaire par prothèse d’expansion temporaire

Publication date: Available online 21 July 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): C. Huttin-Marquelet, C. Huttin

Résumé

La reconstruction mammaire par expansion cutanée préalable est une technique simple dans son principe mais sujette à de nombreux pièges. Il faut savoir sélectionner les patientes, préparer la loge de l'expandeur, ne pas précipiter le temps de l'expansion, et ne pas négliger le travail de la loge lors de la pose de l'implant définitif. Cet exposé a pour objectif de détailler point par point les différents temps opératoires, leur mise en pratique, les écueils et les pièges à éviter pour mener à bien la reconstruction par expansion.

Summary

Tissue expansion in breast reconstruction is a technique based on a simple principle but subjected to numerous traps. Its success relies on the patient selection, a good preparation of the skin pocket, no rush during the inflating time, and a specific care during the definitive implant placement inside the skin pocket. This article aims to list and detail point-by-point the different surgical timings, their practical application, the pitfalls and the possible traps to avoid, in order to succeed in breast reconstruction using tissue expander.

Angiokératome circonscrit naeviforme

Publication date: Available online 21 July 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): H. Kasssem Youssef, E. Backobi, C. Michel

Correlation of 18 F-FDG and 11 C-methionine uptake on PET/CT with Ki-67 immunohistochemistry in newly diagnosed intracranial meningiomas

Abstract

Objective

We evaluated the uptake of 2-deoxy-2-¹⁸F-fluoro-d-glucose (FDG) and l-[methyl-¹¹C]-methionine (MET) in patients with newly diagnosed intracranial meningiomas and correlated the results with tumor proliferation.

Methods

Data from 22 patients with newly diagnosed intracranial meningioma (12 grade I and 10 grade II) who underwent both FDG and MET brain PET/CT studies were retrospectively analyzed. The PET images were evaluated by a qualitative method and semiquantitative analysis using standardized uptake value (SUV) (SUV_max and SUV_peak) and tumor-to-reference tissue ratio (T_max/N ratio and T_peak/N ratio). Proliferative activity as indicated by the Ki-67 index was estimated in tissue specimens.

Results

MET PET/CT showed a higher detection rate of meningioma than did FDG PET/CT (100 vs. 46%, respectively). The T_max/N ratio and T_peak/N ratio on MET PET/CT were significantly higher than those on FDG PET/CT (p < 0.001 and p < 0.001, respectively). There was a significant difference between grades I and II with respect to FDG SUVmax (p = 0.003), FDG SUV_peak (p = 0.003), FDG T_max/N ratio (p = 0.02), FDG T_peak/N ratio (p = 0.006), MET SUV_max (p = 0.002), MET SUV_peak (p = 0.002), MET T_max/N ratio (p = 0.002), and MET T_peak/N ratio (p = 0.002). There was a significant correlation between Ki-67 index and FDG PET/CT for SUV_max (p = 0.02), SUV_peak (p = 0.005), and T_peak/N ratio (p = 0.05) and between Ki-67 index and MET PET/CT for SUV_max (p = 0.004), SUV_peak (p = 0.007), T_max/N ratio (p = 0.002), and T_peak/N ratio (p = 0.004).

Conclusion

MET PET/CT showed a high sensitivity compared with FDG PET/CT for detection of newly diagnosed WHO grades I and II intracranial meningiomas. Both FDG and MET uptake were found to be useful for evaluating tumor proliferation in meningiomas.

Investigating vulnerability of ecological industrial symbiosis network based on automatic control theory

Abstract

System fluctuations of eco-industrial symbiosis network (EISN) organization due to disturbance are very similar to the controller adjustment in the automatic control theory. Thus, a methodology is proposed in this study to assess the vulnerability of EISN based on the automatic control theory. The results show that the regulator plays a key role to enhance the resilience of the network system to vulnerability. Therefore, it is imperative to strengthen the real-time regulation and control of EISN so that the system stability is improved. In order to further explore the impact of various regulations on the system vulnerability, the influence of system stability is simulated by means of proportional, differential, and integral control. A case study with Guigang eco-industrial park (EIP) was undertaken to test this model. The results showed that when the system was disturbed at different positions, the key nodes which had great influence on system vulnerability could be selected according to the magnitude of simulation curve. By changing the ratio coefficient of proportional, differential, and integral units to adjust the ecological chain network, the system's resilience to vulnerability can be enhanced. Firstly, if basic conditions of EISN organization remain unchanged, the integral control of the policy support and infrastructure sharing should be strengthened. Secondly, the differential regulation should be improved continuously for the technological innovation capability of key node enterprises. Finally, the key chain filling projects should be introduced for proportional control so that the chain network design can be optimized from the source.

Photocatalytic degradation of imidacloprid by Ag-ZnO composite

Abstract

The present study focused on exploring the potential of Ag-ZnO composites for complete mineralization of imidacloprid with the aim to sustain the pollutant free safe water supply. The composites were prepared by hydrothermal method and characterized by Scanning electron microscope (SEM), Energy dispersive X-ray crystallography (EDX), X-ray diffraction (XRD) and band gap measurements. These composites were used to study the UV irradiated degradation of imidacloprid while optimizing the process parameters such as time of UV irradiation, pH of medium, pesticide concentration and composite loading. The results of the study revealed an increase in photodegradation of imidacloprid by Ag-ZnO composites than pure ZnO. Temperature and catalyst loading had a positive effect on degradation efficiency, while an inverse relation was observed between pesticide concentration and degradation. Moreover, no harmful degradation products of imidacloprid were observed in GC-MS analyses that confirmed its complete mineralization.

Vitiligo and social acceptance