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Background: Obesity is prevalent among patients undergoing total hip arthroplasty and has been associated with the risk of wound complications, particularly when an anterior approach is used. However, most studies have focused on obesity defined by the body mass index (BMI), without considering the metabolic effects of adiposity. Thus, in this study, we investigated the independent effects of the BMI and metabolic syndrome on wound complications after total hip arthroplasty. Methods: Among 804 consecutive patients undergoing total hip arthroplasty between October 2013 and July 2016, we evaluated the associations between obesity (BMI ≥30 mg/kg2), metabolic syndrome (defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines), and wound complication (defined as documented wound dehiscence, drainage, erythema, hematoma, infection, or seroma) over a 1-year follow-up period. We used Cox proportional hazards models adjusting for demographics, smoking status, and hospital length of stay. Results: Patients’ mean age at time of surgery was 62.0 ± 11.9 years. Forty-seven percent were male, 27.9% were obese, and 11.6% met the definition for metabolic syndrome. Metabolic syndrome was associated with a 4-fold higher risk of wound complication (95% confidence interval: 1.4-11.1) after adjusting for all covariates including the BMI. In unadjusted analysis, obesity was associated with a higher risk of wound complication (hazard ratio: 2.8, 95% confidence interval: 1.3-6.2). However, obesity was not associated with the risk of wound complication after adjusting for the metabolic syndrome (P = .16). Conclusions: Metabolic syndrome, but not obesity, defined by a BMI ≥30, was associated with wound complications, suggesting that metabolic effects of adiposity may represent a distinct risk factor in the development of wound complications from a higher BMI alone.

Novel therapies are urgently needed for ovarian cancer, the deadliest gynecologic malignancy. Ovarian cancer has thus far been refractory to immunotherapies that stimulate the host immune system to recognize and kill cancer cells. This may be because of a suppressive tumor immune microenvironment and lack of recruitment and activation of immune cells that kill cancer cells. Our previous work showed that epigenetic drugs including DNA methyltransferase inhibitors and histone deacetylase 6 inhibitors (DNMTis and HDAC6is) individually increase immune signaling in cancer cells. We find that combining DNMTi and HDAC6i results in an amplified type I interferon response, leading to increased cytokine and chemokine expression and higher expression of the MHC I antigen presentation complex in human and mouse ovarian cancer cell lines. Treating mice bearing ID8 Trp53-/- ovarian cancer with HDAC6i/DNMTi led to an increase in tumor-killing cells such as IFNg+ CD8, NK, and NKT cells and a reversal of the immunosuppressive tumor microenvironment with a decrease in MDSCs and PD-1 hi CD4 T cells, corresponding with an increase in survival. Thus combining the epigenetic modulators DNMTi and HDAC6i increases anti-tumor immune signaling from cancer cells and has beneficial effects on the ovarian tumor immune microenvironment.

Background: Practice guidelines (guidelines) have an increasing role in health care delivery and are being published more frequently. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is an approach for guideline development. The GRADE approach has been adopted by multiple national and international organizations producing guidelines related to physical therapist care., Objective: The purpose of this article is to introduce physical therapists to the GRADE approach for guideline development., Results: GRADE provides a consistent approach for guideline development and transparency in the communication of how the guidelines were developed and how the recommendations were reached, leading to informed choices by patients, clinicians, and policy makers in health care. GRADE leads to a clear distinction between the strength of the evidence and the recommendation. Both the direction (for or against) and the strength (weak or strong) of the recommendation are considered. For determining the strength of the recommendation, GRADE takes into account the quality of evidence, the balance of benefit and harm, uncertainty about or variability in patients' values and preferences, and uncertainty about whether the intervention is a wise use of resources., Limitations: The GRADE approach has been used primarily with interventions and clinical questions and less often with questions related to diagnosis and prognosis., Conclusions: The frequency of publication of guidelines is increasing. To make informed choices in the health care system, physical therapists should understand how guidelines are developed. The GRADE approach has been adopted by national and international organizations that produce guidelines relevant to physical therapist practice. Understanding the GRADE approach will enable physical therapists to make informed clinical choices., (© 2014 American Physical Therapy Association.)

Effects of elevated root zone (RZ) CO(2) and air temperature on photosynthesis, productivity, nitrate (NO(3)(-)), and total reduced nitrogen (N) content in aeroponically grown lettuce plants were studied. Three weeks after transplanting, four different RZ [CO(2)] concentrations [ambient (360 ppm) and elevated concentrations of 2000, 10,000, and 50,000 ppm] were imposed on plants grown at two air temperature regimes of 28 degrees C/22 degrees C (day/night) and 36 degrees C/30 degrees C. Photosynthetic CO(2) assimilation (A) and stomatal conductance (g(s)) increased with increasing photosynthetically active radiation (PAR). When grown at 28 degrees C/22 degrees C, all plants accumulated more biomass than at 36 degrees C/30 degrees C. When measured under a PAR >or=600 micromol m(-2) s(-1), elevated RZ [CO(2)] resulted in significantly higher A, lower g(s), and higher midday leaf relative water content in all plants. Under elevated RZ [CO(2)], the increase of biomass was greater in roots than in shoots, causing a lower shoot/root ratio. The percentage increase in growth under elevated RZ [CO(2)] was greater at 36 degrees C/30 degrees C although the total biomass was higher at 28 degrees C/22 degrees C. NO(3)(-) and total reduced N concentrations of shoot and root were significantly higher in all plants under elevated RZ [CO(2)] than under ambient RZ [CO(2)] of 360 ppm at both temperature regimes. At each RZ [CO(2)], NO(3)(-) and total reduced N concentration of shoots were greater at 28 degrees C/22 degrees C than at 36 degrees C/30 degrees C. At all RZ [CO(2)], roots of plants at 36 degrees C/30 degrees C had significantly higher NO(3)(-) and total reduced N concentrations than at 28 degrees C/22 degrees C. Since increased RZ [CO(2)] caused partial stomatal closure, maximal A and maximal g(s) were negatively correlated, with a unique relationship for each air temperature. However, across all RZ [CO(2)] and temperature treatments, there was a close correlation between maximal A and total shoot reduced N concentration of plants under different RZ [CO(2)], indicating that increased A under elevated RZ [CO(2)] could partially be due to the higher shoot total reduced N.

* High-temperature, low-light (HTLL) treatment of 35S:PAP1 Arabidopsis thaliana over-expressing the PAP1 (Production of Anthocyanin Pigment 1) gene results in reversible reduction of red colouration, suggesting the action of additional anthocyanin regulators. High-performance liquid chromatography (HPLC), liquid chromatography mass spectrometry (LCMS) and Affimetrix-based microarrays were used to measure changes in anthocyanin, flavonoids, and gene expression in response to HTLL. * HTLL treatment of control and 35S:PAP1 A. thaliana resulted in a reversible reduction in the concentrations of major anthocyanins despite ongoing over-expression of the PAP1 MYB transcription factor. Twenty-one anthocyanins including eight cis-coumaryl esters were identified by LCMS. The concentrations of nine anthocyanins were reduced and those of three were increased, consistent with a sequential process of anthocyanin degradation. Analysis of gene expression showed down-regulation of flavonol and anthocyanin biosynthesis and of transport-related genes within 24 h of HTLL treatment. No catabolic genes up-regulated by HTLL were found. * Reductions in the concentrations of anthocyanins and down-regulation of the genes of anthocyanin biosynthesis were achieved by environmental manipulation, despite ongoing over-expression of PAP1. Quantitative PCR showed reduced expression of three genes (TT8, TTG1 and EGL3) of the PAP1 transcriptional complex, and increased expression of the potential transcriptional repressors AtMYB3, AtMYB6 and AtMYBL2 coincided with HTLL-induced down-regulation of anthocyanin biosynthesis. * HTLL treatment offers a model system with which to explore anthocyanin catabolism and to discover novel genes involved in the environmental control of anthocyanins.

Patterns of shoot development and the production of different types of shoots were compared with scion leaf area index (LAI) to identify how eight clonal Actinidia rootstocks influence scion development. Rootstocks selected from seven Actinidia species (A. chrysantha Merri., A. deliciosa (A. Chev.) C. F. Liang et A.R. Ferguson, A. eriantha Benth., A. hemsleyana Dunn, A. kolomikta (Maxim. et Rupr.) Maxim., A. kolomikta C.F. Liang and A. polygama (Sieb. et Zucc.) Maxim.) were grafted with the scion Actinidia chinensis Planch. var. chinensis 'Hort16A' (yellow kiwifruit). Based on an earlier architectural analysis of A. chinensis, axillary shoot types produced by the scion were classified as short, medium or long. Short and medium shoots produced a restricted number of preformed leaves before the shoot apex ceased growth and aborted, resulting in a 'terminated' shoot. The apex of long shoots continued growth and produced more nodes throughout the growing seasons. Mid-season LAI of the scion was related to the proportion of shoots that ceased growth early in the season. Scions on low-vigor rootstocks had 50% or less leaf area than scions on the most vigorous rootstocks and had a higher proportion of short and medium shoots. On low-vigor rootstocks, a higher proportion of short shoots was retained during pruning to form the parent structure of the following year. Short parent shoots produced a higher proportion of short daughter shoots than long parent shoots, thus reinforcing the effect of the low-vigor rootstocks. However, overall effects of rootstock on shoot development were consistent regardless of parent shoot type and nodal position within the parent shoot. Slower-growing shoots were more likely to terminate and scions on low-vigor rootstocks produced a higher proportion of slow-growing shoots. Shoot termination also occurred earlier on low-vigor rootstocks. The slower growth of terminating shoots was detectable from about 20 days after bud burst. Removal of a proportion of shoots at the end of bud burst increased the growth rate and decreased the frequency of termination of the remaining shoots on all rootstocks, indicating that the fate of a shoot was linked to competitive interactions among shoots during initial growth immediately after bud burst. Rootstock influenced the process of shoot termination independently of its effect on final leaf size. Scions on low-vigor rootstocks had a higher proportion of short shoots and short shoots on all rootstocks had smaller final leaf sizes at equivalent nodes than medium or long shoots. Only later in the development of long shoots was final leaf size directly related to rootstock, with smaller leaves on low-vigor rootstocks. Thus, the most important effect of these Actinidia rootstocks on scion development occurred during the initial period of shoot growth immediately after bud burst.

This paper presents two models of budbreak on canes of 'Hayward' kiwifruit (Actinidia deliciosa). A conventional 'chill unit' (CU) type model is compared with an alternative 'loss of potential' (LOP) approach, which assumes that the number of buds developing in spring depends on climate and node position-dependent bud-to-bud interactions that vary in duration and intensity. Both models describe how temperature, and application of a dormancy-breaking chemical, determine the overall amount of budbreak for whole canes. However, the LOP model does so by describing patterns of budbreak along canes. To do this, the cumulative influence of distal neighbours is assumed to cause a progressive fall in the capacity for bud development over the autumn-winter period, an influence that gets stronger as temperature rises. The LOP model also assumes that the rate of decline varies along the cane, as a function of some inherent bud property. These two factors mean that buds towards the base of the cane break less often under the suppressive influence of distal neighbours, while low temperature ('chilling') increases budbreak by diminishing the intensity of suppression relative to bud development rate. Under this scenario, dormancy-breaking chemicals (such as hydrogen cyanamide, HC) enhance budbreak by diminishing the duration of suppression. Models were calibrated using daily temperature series and budbreak proportion data from a multi-year regional survey, and were then tested against independent data sets. Both models were run from a fixed start date until the time budbreak was almost complete, or until a standard date. The fitted models described 87 % of variation in amount of budbreak due to site, year, HC and node position effects in the original data set. Results suggest that the correlation between chilling and the amount of budbreak can be interpreted as a population-based phenomenon based on interaction among buds.