Search

Main Conclusion: The redox homeostasis and photosynthetic pigments changes vary with Tetranychus ludeni infestation, with longer-cycle genotypes showing greater tolerance and efficiency in antioxidant defense. Infestations of Tetranychus ludeni Zacher (Tetranychidae) have been frequently observed in soybean plants. In this context, understanding the oscillation of redox homeostasis is crucial for detecting and assessing the stress levels caused in the plants by these organisms. The impacts of these infestations on redox metabolism and photosynthetic pigments are currently unknown. Therefore, we examined the hypothesis that T. ludeni infestations in soybean plants can influence redox homeostasis and photosynthetic pigments in a spatiotemporal manner, varying between different infestation times, modules and genotypes. For this purpose, soybean plants of the genotypes Monsoy, maturity group 5.7, and Brasmax, maturity group 6.3, grown in a controlled environment, were exposed to infestation and evaluated at two periods: 14 and 24 days. A variation in the distribution of T. ludeni within the infested plants over time increased the activity of ascorbate peroxidase and catalase, especially in Monsoy, reducing the content of hydrogen peroxide and superoxide, which prevented lipid peroxidation in the apical region in both genotypes. In the basal region, low chlorophyll indices corroborated by the yellow coloration of trifoliate leaves, high levels of membrane stability loss, and accumulation of hydrogen peroxide and superoxide characterized senescent trifoliate leaves in Brasmax, 24 days post infestation. Thus, the infestation of T. ludeni has a complex and significant impact on the redox metabolism of soybean plants, especially in shorter-cycle genotypes such as Brasmax. Furthermore, the oscillation of homeostasis can be considered as a good biochemical marker for selecting more suitable genotypes that are less sensitive and prone to infestations., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Given the benefits of neuroendovascular simulation to resident education, this study aimed to assess the efficacy of simulation-based training for neuroendovascular intervention with primary and secondary catheters using a transradial approach (TRA)., Methods: Five neurosurgical residents (PGY 1-3) from our institution enrolled in a standardized pilot training protocol. Trainees used the Mentice (Gothenburg, Vastra Gotaland, Sweden) Visit G5 simulator with a type II arch using a right TRA., Results: All participants improved their total time to complete the task from the first trial to the last trial. Residents improved the overall time required to complete the task by 111.8 ± 57 seconds (52% improvement; P = 0.012). Participants reported improved knowledge of Simmons catheter formation from 1.6 ± 0.8 to 2.8 ± 1 (P = 0.035) and improved knowledge of transradial vessel selection technique from 1.6 ± 0.9 to 2.8 ± 1.1 (P = 0.035). All residents were able to illustrate a bovine arch and types 1-3 arches post-simulation. Residents rated the simulation usefulness as 4.6 ± 0.548 (scale 1 [not useful] to 5 [essential]) with 4 of the 5 residents (80%) identifying this exercise as essential. All residents rated the hands-on component of the training exercise as the most important., Conclusions: Residents demonstrated proficiency at Simmons catheter formation and vessel selection in a type II arch over a short time period (4 attempts and <1 hour total). Residents can use simulator-based training to increase their proficiency of vessel selection using a primary or secondary catheter for a TRA., (Copyright © 2024 Elsevier Inc. All rights reserved.)

In this study, horseradish peroxidase was extracted, purified, and immobilized on a calcium alginate-starch hybrid support by covalent bonding and entrapment. The immobilized HRP was used for the biodegradation of phenol red dye. A 3.74-fold purification was observed after precipitation with ammonium sulfate and dialysis. An immobilization yield of 88.33%, efficiency of 56.89%, and activity recovery of 50.26% were found. The optimum pH and temperature values for immobilized and free HRP were 5.0 and 50 °C and 6.5 and 60 °C, respectively. The immobilized HRP showed better thermal stability than its free form, resulting in a considerable increase in half-life time (t 1/2 ) and deactivation energy (E d ). The immobilized HRP maintained 93.71% of its initial activity after 45 days of storage at 4 °C. Regarding the biodegradation of phenol red, immobilized HRP resulted in 63.57% degradation after 90 min. After 10 cycles of reuse, the immobilized HRP was able to maintain 43.06% of its initial biodegradative capacity and 42.36% of its enzymatic activity. At the end of 15 application cycles, a biodegradation rate of 8.34% was observed. In conclusion, the results demonstrate that the immobilized HRP is a promising option for use as an industrial biocatalyst in various biotechnological applications., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The modern technique of epineural suture repair, along with a detailed reporting of functional restoration, came from Carl Hueter in 1873. While there is extensive information on peripheral nerve surgery throughout recorded history leading up to the 1800s, little early American scientific literature is available. While Schwann, Nissl, and Waller were publishing their work on nerve anatomy and physiology, Francis LeJau Parker was born. The South Carolina native would go on to describe one of the first American cases of peripheral nerve repair with the restoration of function. Francis Parker was born in 1836 in Abbeville, South Carolina. He gained local notoriety as one of the first American surgeons to suture a severed nerve, resulting in restored function. The case dates back to 1880, when a patient presented to his clinic with severing of the posterior interosseous nerve. The details of this case come from the archives of the South Carolina Medical Association. The authors reviewed these records in detail and provide a case description of nerve repair not previously reported in the modern literature. The history, neurological examination, and details of the case provide insight into the adroit surgical skills of Dr. Parker.

The identification of biomarkers for spinal muscular atrophy is crucial for predicting disease progression, severity, and response to new disease-modifying therapies. This study aimed to investigate the role of serum levels of myostatin and follistatin as biomarkers for spinal muscular atrophy, considering muscle atrophy secondary to denervation as the main clinical manifestation of the disease. The study evaluated the differential gene expression of myostatin and follistatin in a lesional model of gastrocnemius denervation in mice, as well as in a meta-analysis of three datasets in transgenic mice models of spinal muscular atrophy, and in two studies involving humans with spinal muscular atrophy. Subsequently, a case-control study involving 27 spinal muscular atrophy patients and 27 controls was conducted, followed by a 12-month cohort study with 25 spinal muscular atrophy cases. Serum levels of myostatin and follistatin were analysed using enzyme-linked immunosorbent assay at a single centre in southern Brazil. Skeletal muscle gene expression of myostatin decreased and of follistatin increased following lesional muscle denervation in mice, consistent with findings in the spinal muscular atrophy transgenic mice meta-analysis and in the iliopsoas muscle of five patients with spinal muscular atrophy type 1. Median serum myostatin levels were significantly lower in spinal muscular atrophy patients (98 pg/mL; 5-157) compared to controls (412 pg/mL; 299-730) ( P < 0.001). Lower myostatin levels were associated with greater disease severity based on clinician-rated outcomes (Rho = 0.493-0.812; P < 0.05). After 12 months, there was a further reduction in myostatin levels among spinal muscular atrophy cases ( P = 0.021). Follistatin levels did not differ between cases and controls, and no significant changes were observed over time. The follistatin:myostatin ratio was significantly increased in spinal muscular atrophy subjects and inversely correlated with motor severity. Serum myostatin levels show promise as a novel biomarker for evaluating the severity and progression of spinal muscular atrophy. The decrease in myostatin levels and the subsequent favourable environment for muscle growth may be attributed to denervation caused by motor neuron dysfunction., Competing Interests: The authors report no competing interests related to the study., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain.)

In this study, horseradish peroxidase (HRP) was immobilized for the first time on Ca alginate-starch hybrid beads and employed for the biodegradation of phenol red dye. The optimal protein loading was 50 mg/g of support. Immobilized HRP demonstrated improved thermal stability and maximum catalytic activity at 50 °C and pH 6.0, with an increase in half-life (t 1/2 ) and enzymatic deactivation energy (E d ) compared to free HRP. After 30 days of storage at 4 °C, immobilized HRP retained 109% of its initial activity. Compared to free HRP, the immobilized enzyme exhibited higher potential for phenol red dye degradation, as evidenced by the removal of 55.87% of initial phenol red after 90 min, which was 11.5 times greater than free HRP. In sequential batch reactions, the immobilized HRP demonstrated good potential efficiency for the biodegradation of phenol red dye. The immobilized HRP was used for a total of 15 cycles, degrading 18.99% after 10 cycles and 11.69% after 15 cycles, with a residual enzymatic activity of 19.40% and 12.34%, respectively. Overall, the results suggest that HRP immobilized on Ca alginate-starch hybrid supports shows promise as a biocatalyst for industrial and biotechnological applications, particularly for the biodegradation of recalcitrant compounds such as phenol red dye., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier B.V.)

The incorporation of non-conventional edible plants into gluten-free food products shows potential and the ability to increase nutritional properties. Therefore, the aim of this study was to develop a gluten-free air yam-based lasagna dough and to evaluate the nutritional, textural, and sensory properties. First, the air yam flour was obtained by drying the tubers at 55 °C for 16 h and then, mixed with the water and egg powder, it constituted the lasagna dough. The nutritional composition and bioaccessible mineral content of air yam flour and lasagna dough were evaluated, as well as the texture, microbiological and sensory properties of the lasagna dough. The results indicated that air yam flour and the lasagna dough had high dietary fiber contents, 17.1% and 9.4%, respectively. Additionally, the low-fat content found means that the lasagna dough can be considered both gluten-free and fat-free. The most bioaccessible mineral present was K in both air yam flour and lasagna dough. In sensory analysis, the lasagna dough containing air yam showed an intermediate acceptability in relation to two already commercialized lasagna doughs. This study shows an application to this group of plants that are still little explored, allowing the development to consumers and industries., Competing Interests: Conflict of interestThe authors declare that they have no competing interests., (© Association of Food Scientists & Technologists (India) 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: The high prevalence of anemia in resource-constrained settings calls for easy-to-use, inexpensive screening tools. The Sanguina Smartphone App, an innovative tool for non-invasive hemoglobin estimation via color-sensitive, algorithm-based analysis of fingernail bed images, was validated in the United States. This study evaluates the performance of the App in a population with different socio-economic, ethnic, demographic and cultural composition in rural Bihar, India., Methods: For 272 mainly adult patients of a private health centre, hemoglobin measurement with the App is compared with the gold standard laboratory blood analysis. For a second sample of 179 children attending pre-schools, hemoglobin measurement with the App is compared to the results of the HemoCue Hb 301, a point-of-care device using a small blood sample, serving as the reference standard for field-based settings., Results: The App reaches ±4.43 g/dl accuracy and 0.38 g/dl bias of comparator values in the clinic-based sample, and ±3.54 g/dl and 1.30 g/dl, respectively in the pre-school sample. After retraining the algorithm with the collected data, the validity of the upgraded version is retested showing an improved performance (accuracy of ±2.25 g/dl, bias of 0.25 g/dl), corresponding to the results of the original validation study from the United States., Conclusions: The initial version of the App does not achieve the accuracy needed for diagnosis or screening. After retraining the algorithm, it achieves an accuracy sufficient for screening. The improved version with the potential for further adaptions is a promising easy-to-use, inexpensive screening tool for anemia in resource-constrained point-of-care settings., (© 2023. The Author(s).)

Objective: Patients identified as black and from disadvantaged backgrounds have a twofold higher hydroxychloroquine (HCQ) non-adherence, which contributes to worse lupus outcomes and disparities. Yet, most adherence interventions lack tailored strategies for racially and socioeconomically diverse patients who face unique challenges with HCQ. We aimed to examine a broadly representative group of patients with SLE and physician perspectives on HCQ adherence and adherence strategies to redesign an adherence intervention., Methods: We conducted four virtual focus groups (90 min each) with 11 racially and socioeconomically diverse patients with SLE recruited from two health systems. Additionally, we hosted two focus group meetings with nine healthcare advisors. In focus groups, patients: (1) shared their perspectives on using HCQ; (2) shared concerns leading to non-adherence; (3) discussed strategies to overcome concerns; (4) prioritised strategies from the most to least valuable to inform an adherence intervention. In two separate focus groups, healthcare advisors gave feedback to optimise an adherence intervention. Using content analysis, we analysed transcripts to redesign our adherence intervention., Results: Worry about side effects was the most common barrier phrase mentioned by patients. Key themes among patients' concerns about HCQ included: information gaps, logistical barriers, misbeliefs and medication burden. Finally, patients suggested adherence strategies and ranked those most valuable including co-pay assistance, personal reminders, etc. Patient and healthcare advisors informed designing a laminate version of an adherence intervention to link each barrier category with four to six patient-recommended adherence strategies., Conclusion: We developed a patient stakeholder-informed and healthcare stakeholder-informed tailored intervention that will target non-adherence at the individual patient level., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

We present results from an analysis of all data taken by the BICEP2, Keck Array, and BICEP3 CMB polarization experiments up to and including the 2018 observing season. We add additional Keck Array observations at 220 GHz and BICEP3 observations at 95 GHz to the previous 95/150/220  GHz dataset. The Q/U maps now reach depths of 2.8, 2.8, and 8.8  μK&#95;{CMB} arcmin at 95, 150, and 220 GHz, respectively, over an effective area of ≈600 square degrees at 95 GHz and ≈400 square degrees at 150 and 220 GHz. The 220 GHz maps now achieve a signal-to-noise ratio on polarized dust emission exceeding that of Planck at 353 GHz. We take auto- and cross-spectra between these maps and publicly available WMAP and Planck maps at frequencies from 23 to 353 GHz and evaluate the joint likelihood of the spectra versus a multicomponent model of lensed ΛCDM+r+dust+synchrotron+noise. The foreground model has seven parameters, and no longer requires a prior on the frequency spectral index of the dust emission taken from measurements on other regions of the sky. This model is an adequate description of the data at the current noise levels. The likelihood analysis yields the constraint r&#95;{0.05}<0.036 at 95% confidence. Running maximum likelihood search on simulations we obtain unbiased results and find that σ(r)=0.009. These are the strongest constraints to date on primordial gravitational waves.

Background: While the prevalence of childhood diseases and related mortality have been decreasing over the past decades, progress has been unequally distributed. The poorest households often carry the highest disease burden. As morbidity and mortality also decline most slowly among children of the poorest households, socioeconomic status may become a more relevant risk factor for childhood diseases., Methods: We analysed the association between socioeconomic status and highly prevalent childhood diseases, specifically diarrhoea, acute respiratory infections (ARI), and malaria, and how this association changed over time. For this observational study, we used repeated cross-sectional data, namely all available Demographic and Health Surveys as well as Multi-Indicator Cluster Surveys from Western and Central Africa between 1995 and 2017. We estimated the predicted prevalence of each disease for the entire region in three time periods. We repeated the analysis separately for each country to highlight heterogeneity between countries., Results: A notable wealth gradient can be seen in the prevalence rates of diarrhoea, ARI, and malaria in Western and Central Africa. Children in the poorest quartile have a much higher morbidity than children in the richest quartile and have experienced a considerably slower decline in prevalence rates. In the period 2010-2017, predicted prevalence of diarrhoea was 17.5% for children in the poorest quartile and 12.5% for children in the richest quartile. Similarly, the predicted prevalence was 11.1% and 8.6% for ARI, and 54.1% and 24.4% for malaria in endemic countries. The pattern does not differ between boys and girls. While exact prevalence rates vary between countries, only few countries have seen a decline in the wealth gradient for childhood diseases., Conclusions: The increasing wealth gradient in health raises concerns of increasing inequality that goes beyond wealth. It suggests a need to further improve targeting of health programmes. Moreover, these programmes should be adapted to address the interlinked challenges which burden the poorest households., Competing Interests: Competing interests: The authors completed the ICMJE Unified Competing Interest form (available from convey.org), and declare no conflicts of interest., (Copyright © 2021 by the Journal of Global Health. All rights reserved.)

Backgound: The global community recognizes the urgent need to end preventable child deaths, making it an essential part of the third Sustainable Development Goal. Pneumonia, diarrhoea, and malaria still remain the leading causes of deaths among children under five years, especially in one of the poorest geographic regions of the world - West and Central Africa. This region carries a disproportionately high share of the global burden, both in terms of morbidity and mortality. The study aims to assess levels and trends of the prevalence of these three childhood diseases in West and Central Africa to better inform ongoing and future programmes to improve child survival., Methods: Demographic and Health Surveys and Multiple Indicator Cluster Surveys available from 1995 to 2017 for 23 countries in West and Central Africa were analysed. We estimated the prevalence of diarrhoea, acute respiratory infections (ARI), malaria, and fever as a proxy for malaria, and split the data into three time periods to assess these trends in disease prevalence over time. Further analyses were done to assess the variations by geographic location (urban and rural) and gender (boys and girls)., Results: In West and Central Africa, the reduction of the prevalence rates of diarrhoea, acute respiratory infections, malaria, and fever has decelerated over time (1995-2009), and little improvements occurred between 2010 and 2017. The reduction within the region has been uneven and the prevalence rates either increased or stagnated for diarrhoea (nine countries), ARI (four countries), and fever (six countries). The proportion of affected children was high in emergency or fragile settings. Disaggregated analyses of population-based data show persistent gaps between the prevalence of diseases by geographic location and gender, albeit not significant for the latter., Conclusions: Without intensified commitment to reducing the prevalence of pneumonia, malaria, and diarrhoea, many countries will not be able to meet the SDG goal to end preventable child deaths. Evidence-driven programmes that focus on improving equitable access to preventive health care information and services must be fostered, especially in complex emergency settings. This will be an opportunity to strengthen primary health care, including community health programmes, to achieve universal health coverage., Competing Interests: Competing interests: The authors completed the ICMJE Unified Competing Interest form (available from convey.org) and declare no conflicts of interest., (Copyright © 2021 by the Journal of Global Health. All rights reserved.)

Background: Globally, health care seeking for childhood diseases seems to be on the rise. However, progress is slow and still, many cases of infectious diseases in children remain untreated, leading to preventable child mortality. A better understanding of care seeking behaviour may help to further increase the probability that a sick child is taken to a health facility for care., Methods: We investigated whether mother's and father's age at birth of the child is associated with health care seeking behaviour for childhood diseases and how this association changed over time. For this observational study, we used repeated cross-sectional data, namely all available Demographic and Health Surveys as well as Multi-Indicator Cluster Surveys from Western and Central Africa, 1995 to 2017. We analysed care seeking behaviour for diarrhoea, acute respiratory infections (ARI), and treatment of diarrhoea with oral rehydration solution (ORS). We estimated ordinary least squares regressions, controlling for socioeconomic characteristics of the household and adding survey year- and country-fixed effects. Estimated associations are presented for the entire region and for each country separately to highlight heterogeneity., Results: Overall, the likelihood that care is sought for a child suffering from diarrhoea or ARI is low in Western and Central Africa. Probability of care seeking for diarrhoea ranges between 49% for mothers above 40 years and 53% for mothers between 25 and 29 years. For ARI, the rates are 60% and 62%, respectively. Treatment of diarrhoea with ORS is even lower, ranging between 23% and 26%. The probability that parents seek health care for their child does not seem to be associated with parents' age at birth. Mother's level of education and household's wealth status seem to be more important factors. There is evidence of the relationship between parents' age and care seeking changing over time, suggesting a stronger association in the past., Conclusions: Parents' age at child birth does not seem to have a relevant association with care seeking for common childhood diseases. Identifying relevant factors may help in improving health care seeking behaviour of parents in low- and middle-income countries leading to reductions in child morbidity and mortality., Competing Interests: Competing interests: The authors completed the ICMJE Unified Competing Interest form (available from convey.org), and declare no conflicts of interest., (Copyright © 2021 by the Journal of Global Health. All rights reserved.)

Cephalexin (CEX) is an antibiotic commonly used to treat bacterial infections in humans and animals. However, it is also a micropollutant. Thus, this study evaluated the degradation of CEX using ultraviolet irradiation (UV-C) and analyzed the by-products as well as their residual antimicrobial activity. A reactor with a mercury vapor lamp was used for the degradation. Irradiated CEX solutions were collected over a period of 4 hours and analyzed using high-performance liquid chromatography coupled with mass spectrometry. For the residual antimicrobial activity the susceptibility test was performed using Staphylococcus aureus and Escherichia coli microorganisms by broth microdilution. It was found that CEX, after treatment, generated a metabolite with a mass of 150 m/z in 15 min. A four- and eightfold increase in the minimum inhibitory concentration of the drug against S. aureus and E. coli could be observed, respectively, after 20 min. Therefore, this treatment proved to be effective in the degradation of CEX, being able to degrade 81% of the initial molecule of the drug in 20 min. Furthermore, the antimicrobial activity of the CEX solution decreased as the irradiation time increased, indicating loss of antimicrobial function of the initial CEX molecule and the resulting by-products.

Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

The essential oil (EO) composition of leaves of Campomanesia aurea was analyzed by GC-MS. The plant was collected in April (EOA) and October (EOO) in São Francisco de Assis/RS. The essential oils were obtained by hydrodistillation in a modified Clevenger apparatus. The yields were 4.44% in April, and 6.15%, in October. Thirty-one compounds were identified in EOA, accounting for 96.87% of the total, and twenty-eight compounds were identified in EOO, accounting for 99.46% of the total. For EOA, the major identified monoterpene was p-cymene (8.33%) and the major identified sesquiterpene was α-cadinol (10.72%), while regarding EOO the major identified monoterpene was repeatedly Terpinolene (3.43%), whereas the major identified sesquiterpene was α-cadinol (12.79%). The antibacterial activity of the essential oil was evaluated against the three Listeria monocytogenes from the American Type Culture Collection (strains ATCC 7644, 19114 and 13932). The essential oil showed a MIC of 10 mg/mL against the strains ATCC 7644 and 19114, with bacteriostatic effect of 20 mg/mL and a MIC of 20 mg/mL for ATCC 13932. Regarding the antibiofilm activity, o EOO showed the best results with an inhibition of 90% in the sessile growth with an applied concentration of 4.0 mg/mL.

Background : Actinic keratosis (AK) is characterized by the occurrence of thick and scaly skin areas caused by damage from ultraviolet radiation. The management of AK aims to reduce lesions and prevent their recurrence by regular monitoring. French guidelines, last updated in 2009, reflect European guidelines for the management of face and scalp AK. However, they do not address all current, available options. Objective : To assess the management of face and scalp AK in French clinical practice. Methods : A two-part online questionnaire comprising a survey among French dermatologists and an analysis of patient medical records was performed to describe AK patients treated with topical therapy, patients' profiles, and characteristics of the affected lesion areas. Results : Decisions for topical treatments for face and scalp AK made by dermatologists were mainly driven by the lesion size. According to the last 10 patients they have seen, dermatologists were prescribing physical therapy in 53% of the cases, a combination of topical and physical therapy in 27% and topical only in 20%. Patient records revealed the average surface area targeted for treatment was 139 ± 113cm 2 . Conclusions : Discrepancies between the guidelines on the treatment of face and scalp AK and clinical practice exist. Further research may help to standardize the treatment.

Orbital compartment syndrome poses a significant risk for vision loss if not promptly treated. The authors report a patient with neuropsychiatric systemic lupus erythematosus presenting with bilateral orbital compartment syndrome and rapid decompensation leading to uncal and tonsillar herniation. While extremely rare, bilateral orbital compartment syndrome should prompt consideration of systemic etiologies including neuropsychiatric systemic lupus erythematosus.

Background: Unstable ankle syndesmosis injuries are common, and the optimal surgical fixation is controversial. The two main options for stabilization of syndesmotic injuries are suture button fixation and screw fixation. Suture button fixation has a higher initial cost, but may have a lower hardware removal rate. The purpose of this study was to compare the costs of syndesmotic fixation., Methods: A cost analysis was performed at a single university-affiliated hospital. Variables included the number of suture buttons, the number and type of syndesmosis screws used, and the frequency of hardware removal and operative time required for hardware removal. There were four clinical scenarios evaluated: (A) one suture button versus one cortical screw; (B) two suture buttons versus two cortical screws; (C) one suture button versus one locking screw; (D) two suture buttons versus two locking screws. Suture button removal rate was assumed to be 0% in the analysis., Results: Cost equivalence was achieved at an 18 to 53% syndesmotic screw removal rate depending on the fixation construct used and the amount of time required for hardware removal. When the syndesmosis screws were removed 100% of the time, suture button fixation was more economical by $85,000-$194,656 per 100 ankles. When hardware was never removed, suture button fixation was more expensive by $169,844-$295,500 per 100 ankles., Conclusion: This study demonstrates that the costs associated with syndesmosis fixation are more dependent on the rate of hardware removal than the type of hardware utilized. Routine removal of syndesmosis screws is clearly less economical than suture button fixation.

We present results from an analysis of all data taken by the bicep2/Keck CMB polarization experiments up to and including the 2015 observing season. This includes the first Keck Array observations at 220 GHz and additional observations at 95 and 150 GHz. The Q and U maps reach depths of 5.2, 2.9, and 26  μK&#95;{CMB} arcmin at 95, 150, and 220 GHz, respectively, over an effective area of ≈400 square degrees. The 220 GHz maps achieve a signal to noise on polarized dust emission approximately equal to that of Planck at 353 GHz. We take auto and cross spectra between these maps and publicly available WMAP and Planck maps at frequencies from 23 to 353 GHz. We evaluate the joint likelihood of the spectra versus a multicomponent model of lensed-ΛCDM+r+dust+synchrotron+noise. The foreground model has seven parameters, and we impose priors on some of these using external information from Planck and WMAP derived from larger regions of sky. The model is shown to be an adequate description of the data at the current noise levels. The likelihood analysis yields the constraint r&#95;{0.05}<0.07 at 95% confidence, which tightens to r&#95;{0.05}<0.06 in conjunction with Planck temperature measurements and other data. The lensing signal is detected at 8.8σ significance. Running a maximum likelihood search on simulations we obtain unbiased results and find that σ(r)=0.020. These are the strongest constraints to date on primordial gravitational waves.

Recently, the Neotropical brown stink bug, Euschistus heros (Pentatomidae: Hemiptera), has been detected in cotton in the Brazilian Cerrado. Several reliable surveys have been conducted on the spatial distribution of stink bugs in soybean; however, few studies have examined the behavior of this insect in cotton in Brazil. Thus, this study examined the spatial distribution of E. heros in cotton using aggregation indices based on the variance-to-mean ratio, Morisita index, exponent k, Poisson and negative binomial distributions. Inverse Distance Weighting interpolation maps were also used to represent insect density. The study was conducted in a 1.1 hectare experimental cotton field in which 64 equally-sized plots were sampled on a weekly basis. Our findings revealed that stink bugs presented an aggregate distribution in 2 sampling weeks based on aggregation indices, and this pattern was best described by a negative binomial distribution. Maps showing the density of pests can be an important tool for sampling pests in crops and control measures in early stages of infestation, when there is an edge effect on the distribution of E. heros, can be an efficient strategy in cotton.

Purpose: To determine the effect of intravenous mannitol on globe and orbital volumes., Methods: Retrospective chart review of a consecutive series of Cleveland Clinic Neurosurgical Intensive Care Unit patients who underwent computed tomographic imaging before and after intravenous mannitol administration. Volume measurements were performed according to a previously described technique by averaging axial image areas. Measurements before and after mannitol administration were compared using paired t-test., Results: Fourteen patients (28 eyes) met inclusion criteria. Average globe volume decreased 186 mm 3 (-2.5%, p = 0.02) after mannitol administration, while average orbital volume increased 353 mm 3 (+3.5%, p = 0.04). Average globe volume change for subjects with follow-up scan less than 4.7 hours (mean 1.9 hours; range 0.2-4.5 hours) after mannitol administration was -125 mm 3 (-1.7%, p = 0.24) and average orbital volume change was +458 mm 3 (+5.1%, p = 0.11). Average globe volume change after mannitol administration for those with follow-up more than 4.7 hours (average 13.9 hours, range 4.9-24.7 hours) was -246 mm 3 (-3.3%, p = 0.05) and orbital volume change was +248 mm 3 (+2.2%, p = 0.24). Dividing the study population into groups based on mannitol dose did not yield any statistically significant change., Conclusions: Human globe volume decreases after intravenous mannitol administration, while orbital volume increases. These volume changes occur during the time period when intraocular pressure normalizes, after the pressure-lowering effects of the drug. This novel volumetric information improves our understanding of mannitol's mechanism of action and its effects on human ocular and periocular tissues.

Although most cases of thyroid eye disease (TED) can be managed medically, some refractory or severe cases are treated surgically with orbital decompression. Due to a lack of randomized controlled trials comparing surgical techniques for orbital decompression, none have been deemed superior. Thus, each case of TED is managed based on patient characteristics and surgeon experience. Surgical considerations include the extent of bony wall removal, the surgical approach, the choice of incision, and the use of fat decompression. Outcomes vary based on surgical indications and techniques; hence, vision can improve or worsen after the surgery.

Objective: To quantify the trends in imaging use for the diagnosis of appendicitis., Methods: A retrospective study covering a 22-year period was conducted at an academic medical center. Patients were identified by International Classification of Diseases-9 diagnosis code for appendicitis. Medical record data extraction of these patients included imaging test used (ultrasound, CT, or MRI), gender, age, and body mass index (BMI). The proportion of patients undergoing each scan was calculated by year. Regression analysis was performed to determine whether age, gender, or BMI affected imaging choice., Results: The study included a total of 2,108 patients, including 967 (43.5%) females and 599 (27%) children (<18 years old). CT use increased over time for the entire cohort (2.9% to 82.4%, P < .0001), and each subgroup (males, females, adults, children; P < .0001 for each). CT use increased more in females and adults than in males and children, but differences in trends were not statistically significant (male versus female, P = .8; adult versus child, P = .1). The percentage of patients who had no imaging used for the diagnosis of appendicitis decreased over time (P < .0001 overall and for each subgroup), and no difference was found in trends between complementary subgroups (male versus female, P = .53; adult versus child, P = .66). No statistically significant changes were found in use of ultrasound or MRI over the study period. With increasing BMI, CT was more frequently used., Conclusions: Of those diagnosed with appendicitis at an academic medical center, CT use increased more than 20-fold. However, no statistically significant trend was found for increased use of ultrasound or MRI., Competing Interests: Financial Conflicts: Perry J. Pickhardt, MD has the following financial disclosures: Co-founder, VirtuoCTC and shareholder, Cellectar Biosciences. The other authors have no financial conflicts. Scott B. Reeder, MD, PhD is a shareholder of Cellectar Biosciences and Neuwave Medical., (Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

The embryology of the eyelid is a complex process that includes interactions between the surface ectoderm and mesenchymal tissues. In the mouse and human, the eyelids form and fuse before birth; they open prenatally in the human and postnatally in the mouse. In the mouse, cell migration is stimulated by different growth factors such as FGF10, TGF-α, Activin B, and HB-EGF. These growth factors modulate downstream BMP4 signaling, the ERK cascade, and JNK/c-JUN. Several mechanisms, such as the Wnt/β-catenin signaling pathway, may inhibit and regulate eyelid fusion. Eyelid opening, on the other hand, is driven by the BMP/Smad signaling system. Several human genetic disorders result from dysregulation of the above molecular pathways.

Purpose: To review the current literature summarizing the state of knowledge on the use of orbital radiation therapy (ORT) in thyroid eye disease., Methods: A systematic review and analysis of the literature were performed. MEDLINE/PubMed, Cochrane Library databases, SCOPUS, and recent relevant journal articles were searched., Results: Thyroid eye disease is an autoimmune disorder that has the propensity to affect multiple orbital tissues and can cause permanent vision loss. In moderate to severe disease, treatment may be warranted and can include multiple therapeutic modalities. Orbital radiation therapy is frequently used in this setting and may act to break the inflammatory cycle of glycosaminoglycan production and deposition. There has been a wealth of data regarding the effectiveness of ORT in thyroid eye disease resulting in the publication of treatment algorithms and management guidelines; however, there continues to be a lack of conformity among experts on the exact role of ORT in thyroid eye disease., Conclusion: The multiple different thyroid eye disease classification schemes and the concurrent use of other therapeutic modalities challenge the interpretation of studies evaluating the effectiveness of thyroid eye disease. Despite these limitations, the current literature indicates that ORT is generally safe and well tolerated. Orbital radiation therapy may have a modest effect on motility and proptosis early in the disease process. It is unclear whether ORT leads to improved quality of life. There are some data to support the use of ORT to prevent compressive optic neuropathy.

We present results from an analysis of all data taken by the BICEP2 and Keck Array cosmic microwave background (CMB) polarization experiments up to and including the 2014 observing season. This includes the first Keck Array observations at 95 GHz. The maps reach a depth of 50 nK deg in Stokes Q and U in the 150 GHz band and 127 nK deg in the 95 GHz band. We take auto- and cross-spectra between these maps and publicly available maps from WMAP and Planck at frequencies from 23 to 353 GHz. An excess over lensed ΛCDM is detected at modest significance in the 95×150 BB spectrum, and is consistent with the dust contribution expected from our previous work. No significant evidence for synchrotron emission is found in spectra such as 23×95, or for correlation between the dust and synchrotron sky patterns in spectra such as 23×353. We take the likelihood of all the spectra for a multicomponent model including lensed ΛCDM, dust, synchrotron, and a possible contribution from inflationary gravitational waves (as parametrized by the tensor-to-scalar ratio r) using priors on the frequency spectral behaviors of dust and synchrotron emission from previous analyses of WMAP and Planck data in other regions of the sky. This analysis yields an upper limit r&#95;{0.05}<0.09 at 95% confidence, which is robust to variations explored in analysis and priors. Combining these B-mode results with the (more model-dependent) constraints from Planck analysis of CMB temperature plus baryon acoustic oscillations and other data yields a combined limit r&#95;{0.05}<0.07 at 95% confidence. These are the strongest constraints to date on inflationary gravitational waves.

Objectives/hypothesis: Determine safety and efficacy of the TranQuill Sling Snoreplasty (TSS) (Surgical Specialties Corp., Vancouver, BC, Canada) for the treatment of snoring in adults with benign snoring or mild obstructive sleep apnea., Study Design: Prospective, unblinded, single-center pilot study., Methods: From February 2014 to July 2014, 20 adult patients with chronic, disruptive snoring assessed by bed partner were recruited to undergo TSS. Subjects with apnea hypopnea index < 15, minimum oxygen saturation > 85%, and body mass index (BMI) < 32 were included. Outcomes were assessed comparing the results of quality-of-life questionnaires, bed partner-assessed snoring, pain visual analog scales, WatchPAT (Itamar Medical Ltd, Caesarea Ind. Park, Israel) home sleep studies, and flexible endoscopy at baseline and 90-day follow-up., Results: Thirteen males and seven females were enrolled. Average age was 49.1 (range 31-67) and BMI of 25.8 ± 2.66. TranQuill Sling Snoreplasty significantly reduced snoring symptom scores from 8.70 ± 4.27 to 6.42 ± 4.14, P = 0.012. Snoring visual analog scores demonstrated reduction of 17.8 mm (59.4 mm ± 22.1 to 41.6 mm ± 29.2), P = 0.0184. Thirty-five percent (7/20) of subjects reported complications related to the trial, with no serious adverse events., Conclusion: TranQuill Sling Snoreplasty is a safe therapy that improves snoring symptoms in most adult subjects with benign snoring or mild sleep apnea. Further study is required to better identify patients likely to respond to the therapy., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Listeria monocytogenes is a rare cause of endogenous endophthalmitis. In the limited number of reported Listeria endophthalmitis cases, visual acuity outcomes have been very poor., Findings: Here, we report a case of Listeria endophthalmitis that was complicated by recurrent inflammation. The patient required treatment with both intravitreal and long-term systemic antibiotics. An anterior chamber washout was necessary for the patient to regain 20/20 visual acuity., Conclusions: This case highlights the importance of considering Listeria early in the disease course, as it has low sensitivity to standard empiric antibiotic therapy. It also stresses the importance of addressing damaging inflammation in infectious conditions.

Objective: Determine the effect of glossectomy as part of multilevel sleep surgery on sleep-related outcomes in patients with obstructive sleep apnea., Data Sources: PubMED, Scopus., Review Methods: Two independent researchers conducted the review using PubMed-NCBI and Scopus literature databases. Studies on glossectomy for obstructive sleep apnea that reported pre- and postoperative apnea-hypopnea index (AHI) score with 10 or more patients were included., Results: A total of 18 articles with 522 patients treated with 3 glossectomy techniques (midline glossectomy, lingualplasty, and submucosal minimally invasive lingual excision) met inclusion criteria. Pooled analyses (baseline vs post surgery) showed a significant improvement in AHI (48.1 ± 22.01 to 19.05 ± 15.46, P < .0001), Epworth Sleepiness Scale (ESS; 11.41 ± 4.38 to 5.66 ± 3.29, P < .0001), snoring visual analog scale (VAS; 9.08 ± 1.21 to 3.14 ± 2.41, P < .0001), and Lowest O2 saturation (76.67 ± 10.58 to 84.09 ± 7.90, P < .0001). Surgical success rate was 59.6% (95% CI, 53.0%-65.9%) and surgical cure was achieved in 22.5% (95% CI, 11.26%-36.26%) of cases. Acute complications occurred in 16.4% (79/481) of reported patients. Glossectomy was used as a standalone therapy in 24 patients. In this limited cohort, significant reductions in AHI (41.84 ± 32.05 to 25.02 ± 20.43, P = .0354) and ESS (12.35 ± 5.05 to 6.99 ± 3.84, P < .0001) were likewise observed., Conclusion: Glossectomy significantly improves sleep outcomes as part of multilevel surgery in adult patients with OSA. Currently, there is insufficient evidence to analyze the role of glossectomy as a standalone procedure for the treatment of sleep apnea, although the evidence suggests positive outcomes in select patients., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)

Purpose: To examine the microanatomical location of hyaluronic acid gel injected within the temporal hollows of cadaver specimens., Methods: The temporal hollows were injected subcutaneously with hyaluronic acid gel in 6 fresh frozen human cadaver hemifaces. Temporal soft tissues were dissected to a preperiosteal plane and fixated in 95% alcohol. A soft tissue section extending from skin to temporal bone was obtained for each specimen. Histologic examination was performed using hematoxylin and eosin stain., Results: In 5 of 6 specimens, at least 95% of the hyaluronic acid was located within the subcutaneous fat. In 1 of 6 specimens, approximately 35% of the material was located within the subcutaneous fat and 60% was located within the superficial temporal fascia. Two specimens had 5% located within the temporalis muscle. In 1 specimen, hyaluronic acid was found to encompass a superficial muscular artery within the superficial temporal fascia., Conclusions: This study elucidates the location of hyaluronic acid gel after subcutaneous injection within the temporal hollow. Histology confirmed consistent placement of the gel within the subcutaneous tissues, but it also showed that injection in this region may produce unintended deeper location of filler, and a significant perivascular collection of the material. The proximity of dense temporal fascial and muscle arterial networks in this region may pose risk for perivascular injection and associated complications.

The NMR spectrum of n-hexane orientationally ordered in the nematic liquid crystal ZLI-1132 is analysed using covariance matrix adaptation evolution strategy (CMA-ES). The spectrum contains over 150 000 transitions, with many sharp features appearing above a broad, underlying background signal that results from the plethora of overlapping transitions from the n-hexane as well as from the liquid crystal. The CMA-ES requires initial search ranges for NMR spectral parameters, notably the direct dipolar couplings. Several sets of such ranges were utilized, including three from MD simulations and others from the modified chord model that is specifically designed to predict hydrocarbon-chain dipolar couplings. In the end, only inaccurate dipolar couplings from an earlier study utilizing proton-proton double quantum 2D-NMR techniques on partially deuterated n-hexane provided the necessary estimates. The precise set of dipolar couplings obtained can now be used to investigate conformational averaging of n-hexane in a nematic environment.

We report the results of a joint analysis of data from BICEP2/Keck Array and Planck. BICEP2 and Keck Array have observed the same approximately 400  deg^{2} patch of sky centered on RA 0 h, Dec. -57.5°. The combined maps reach a depth of 57 nK deg in Stokes Q and U in a band centered at 150 GHz. Planck has observed the full sky in polarization at seven frequencies from 30 to 353 GHz, but much less deeply in any given region (1.2  μK deg in Q and U at 143 GHz). We detect 150×353 cross-correlation in B modes at high significance. We fit the single- and cross-frequency power spectra at frequencies ≥150  GHz to a lensed-ΛCDM model that includes dust and a possible contribution from inflationary gravitational waves (as parametrized by the tensor-to-scalar ratio r), using a prior on the frequency spectral behavior of polarized dust emission from previous Planck analysis of other regions of the sky. We find strong evidence for dust and no statistically significant evidence for tensor modes. We probe various model variations and extensions, including adding a synchrotron component in combination with lower frequency data, and find that these make little difference to the r constraint. Finally, we present an alternative analysis which is similar to a map-based cleaning of the dust contribution, and show that this gives similar constraints. The final result is expressed as a likelihood curve for r, and yields an upper limit r&#95;{0.05}<0.12 at 95% confidence. Marginalizing over dust and r, lensing B modes are detected at 7.0σ significance.

The proton NMR spectra of n-pentane orientationally ordered in two nematic liquid-crystal solvents are studied over a wide temperature range and analysed using covariance matrix adaptation evolutionary strategy. Since alkanes possess small electrostatic moments, their anisotropic intermolecular interactions are dominated by short-range size-and-shape effects. As we assumed for n-butane, the anisotropic energy parameters of each n-pentane conformer are taken to be proportional to those of ethane and propane, independent of temperature. The observed temperature dependence of the n-pentane dipolar couplings allows a model-free separation between conformer degrees of order and conformer probabilities, which cannot be achieved at a single temperature. In this way for n-pentane 13 anisotropic energy parameters (two for trans trans, tt, five for trans gauche, tg, and three for each of gauche+ gauche+, pp, and gauche+ gauche-, pm), the isotropic trans-gauche energy difference Etg and its temperature coefficient Etg(') are obtained. The value obtained for the extra energy associated with the proximity of the two methyl groups in the gauche+ gauche- conformers (the pentane effect) is sensitive to minute details of other assumptions and is thus fixed in the calculations. Conformer populations are affected by the environment. In particular, anisotropic interactions increase the trans probability in the ordered phase.

Background: To determine the safety and effectiveness of full thickness eyelid reconstructions using a semicircular rotational flap without reconstructing the posterior lamella., Methods: The charts of all patients undergoing semicircular flap closure of full thickness eyelid defects by one surgeon (JDP) at the Cole Eye Institute between March 2000 and October 2012 were reviewed. Charts were reviewed for patient demographic information, as well as for the size of the defect, the type of flap used, length of follow-up and complications., Results: Fifty eyelids of 50 patients underwent a semicircular flap repair without posterior lamellar reconstruction during the study period, and 41 charts were available for review. Average patient age was 74 years (range, 40-92 years). Average follow-up was 9.8 months (range, 1-84 months). Average defect size was 19.1 mm (range, 14-30 mm, SD 4.6). Complications included pyogenic granuloma (10 patients, 24.4%), exposure keratopathy (7 patients, 17.1%) lagophthalmos (5 patients, 12.2%), ectropion (6 patients, 14.6%), lateral canthal dystopia (2 cases, 4.9%), eyelid notch (2 cases, 4.9%) and trichiasis (4 cases, 9.8%). Two patients underwent subsequent tarsorrhaphy and one patient underwent ectropion repair. There were no cases of wound dehiscence, diplopia or fornix inadequacy, and the recruited aspect of the eyelid healed well in each case. No case required reconstruction of the eyelid margin or fornix., Conclusions: Semicircular flap repair of full thickness eyelid defects without flap or graft repair of the posterior lamella results in an adequate fornix and a low rate of secondary surgery.