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Supplementary Figure 1 from Topical Treatment with Black Raspberry Extract Reduces Cutaneous UVB-Induced Carcinogenesis and Inflammation

Topical 17-beta-estradiol (E2) regulates the hair cycle, hair shaft differentiation, and sebum production. Vitamin A also regulates sebum production. Vitamin A metabolism proteins localized to the pilosebaceous unit (PSU; hair follicle and sebaceous gland); and were regulated by E2 in other tissues. This study tests the hypothesis that E2 also regulates vitamin A metabolism in the PSU. First, aromatase and estrogen receptors localized to similar sites as retinoid metabolism proteins during mid-anagen. Next, female and male wax stripped C57BL/6J mice were topically treated with E2, the estrogen receptor antagonist ICI 182,780 (ICI), letrozole, E2 plus letrozole, or vehicle control (acetone) during mid-anagen. E2 or one of its inhibitors regulated most of the vitamin A metabolism genes and proteins examined in a sex-dependent manner. Most components were higher in females and reduced with ICI in females. ICI reductions occurred in the premedulla, sebaceous gland, and epidermis. Reduced E2 also reduced RA receptors in the sebaceous gland and bulge in females. However, reduced E2 increased the number of retinal dehydrogenase 2 positive hair follicle associated dermal dendritic cells in males. These results suggest that estrogen regulates vitamin A metabolism in the skin. Interactions between E2 and vitamin A have implications in acne treatment, hair loss, and skin immunity.

We formulate a notion of modular form on the double half-plane for half-integral weights and explain its relationship to the usual notion of modular form. The construction we provide is compatible with certain physical considerations due to the second author., Comment: 17 pages: Minor corrections in text (due to a helpful referee), updated affiliations. Accepted for publication in the International Journal for Number Theory (IJNT)

DEAP-3600 is a liquid-argon scintillation detector looking for dark matter. Scintillation events in the liquid argon (LAr) are registered by 255 photomultiplier tubes (PMTs), and pulseshape discrimination (PSD) is used to suppress electromagnetic background events. The excellent PSD performance of LAr makes it a viable target for dark matter searches, and the LAr scintillation pulseshape discussed here is the basis of PSD. The observed pulseshape is a combination of LAr scintillation physics with detector effects. We present a model for the pulseshape of electromagnetic background events in the energy region of interest for dark matter searches. The model is composed of (a) LAr scintillation physics, including the so-called intermediate component, (b) the time response of the TPB wavelength shifter, including delayed TPB emission at $${\mathcal {O}}$$O(ms) time-scales, and c) PMT response. TPB is the wavelength shifter of choice in most LAr detectors. We find that approximately 10% of the intensity of the wavelength-shifted light is in a long-lived state of TPB. This causes light from an event to spill into subsequent events to an extent not usually accounted for in the design and data analysis of LAr-based detectors.

The commencement of monstrous moonshine is a connection between the largest sporadic simple group---the monster---and complex elliptic curves. Here we explain how a closer look at this connection leads, via the Thompson group, to recently observed relationships between the non-monstrous sporadic simple group of O'Nan and certain families of elliptic curves defined over the rationals. We also describe umbral moonshine from this perspective.

Since 2007, the Oncofertility Consortium Annual Conference has brought together a diverse network of individuals from a wide range of backgrounds and professional levels to disseminate emerging basic and clinical research findings in fertility preservation. This network also developed enduring educational materials to accelerate the pace and quality of field-wide scientific communication. Between 2007 and 2019, the Oncofertility Consortium Annual Conference was held as an in-person event in Chicago, IL. The conference attracted approximately 250 attendees each year representing 20 countries around the world. In 2020, however, the COVID-19 pandemic disrupted this paradigm and precluded an in-person meeting. Nevertheless, there remained an undeniable demand for the oncofertility community to convene. To maintain the momentum of the field, the Oncofertility Consortium hosted a day-long virtual meeting on March 5, 2021, with the theme of "Oncofertility Around the Globe" to highlight the diversity of clinical care and translational research that is ongoing around the world in this discipline. This virtual meeting was hosted using the vFairs ® conference platform and allowed over 700 people to participate, many of whom were first-time conference attendees. The agenda featured concurrent sessions from presenters in six continents which provided attendees a complete overview of the field and furthered our mission to create a global community of oncofertility practice. This paper provides a synopsis of talks delivered at this event and highlights the new advances and frontiers in the fields of oncofertility and fertility preservation around the globe from clinical practice and patient-centered efforts to translational research.

The DEAP-3600 detector searches for the scintillation signal from dark matter particles scattering on a 3.3 tonne liquid argon target. The largest background comes from $^{39}$Ar beta decays and is suppressed using pulseshape discrimination (PSD). We use two types of PSD algorithm: the prompt-fraction, which considers the fraction of the scintillation signal in a narrow and a wide time window around the event peak, and the log-likelihood-ratio, which compares the observed photon arrival times to a signal and a background model. We furthermore use two algorithms to determine the number of photons detected at a given time: (1) simply dividing the charge of each PMT pulse by the charge of a single photoelectron, and (2) a likelihood analysis that considers the probability to detect a certain number of photons at a given time, based on a model for the scintillation pulseshape and for afterpulsing in the light detectors. The prompt-fraction performs approximately as well as the log-likelihood-ratio PSD algorithm if the photon detection times are not biased by detector effects. We explain this result using a model for the information carried by scintillation photons as a function of the time when they are detected., 14 pages, 9 figures

We propose a correspondence between vertex operator superalgebras and families of sigma models in which the two structures are related by symmetry properties and a certain reflection procedure. The existence of such a correspondence is motivated by previous work on N=(4,4) supersymmetric non-linear sigma models on K3 surfaces and on a vertex operator superalgebra with Conway group symmetry. Here we present an example of the correspondence for N=(4,4) supersymmetric non-linear sigma models on four-tori, and compare it to the K3 case., 31 pages including three appendices

We classify the optimal mock Jacobi forms of weight one with rational coefficients. The space they span is thirty-four-dimensional, and admits a distinguished basis parameterized by genus zero groups of isometries of the hyperbolic plane. We show that their Fourier coefficients can be expressed explicitly in terms of singular moduli, and obtain positivity conditions which distinguish the optimal mock Jacobi forms that appear in umbral moonshine. We find that all of Ramanujan's mock theta functions can be expressed simply in terms of the optimal mock Jacobi forms with rational coefficients., Comment: 68 pages; updated introduction, minor edits, and clarification added to proof of Theorem 1.2.1 in v. 2

Moonshine arose in the 1970s as a collection of coincidences connecting modular functions to the monster simple group, which was newly discovered at that time. The effort to elucidate these connections led to new algebraic structures, and fruitful cross-fertilization between mathematics and physics. In this century the field has been further enriched, with the discovery of new roles for finite groups in geometry, and new relations to number theory. We offer an introduction and invitation to this theory in these notes.

An analytical investigation into compressible gas flow with slight rarefactions through the insect trachea and tracheoles during the closed spiracle phase is undertaken, and a complete set of asymptotic analytical solutions is presented. We first obtain estimates of the Reynolds and Mach numbers at the channel terminal ends where the tracheoles directly deliver respiratory gases to the cells, by comparing the magnitude of the different forces in the compressible gas flow. The 2D Navier-Stokes equations with a slip boundary condition are used to investigate compressibility and rarefied effects in the trachea and tracheoles. Expressions for the velocity components, pressure gradients and net flow inside the trachea are then presented. Numerical simulations of the tracheal compressible flow are performed to validate the analytical results from this study. This work extends previous work of Arkilic et al. (J Microelectromech Syst 6(2):167-178, 1997) on compressible flows through a microchannel. Novel devices for microfluidic compressible flow transport may be invented from results obtained in this study.

In this note, we describe a connection between the enumerative geometry of curves in K3 surfaces and the chiral ring of an auxiliary superconformal field theory. We consider the invariants calculated by Yau--Zaslow (capturing the Euler characters of the moduli spaces of D2-branes on curves of given genus), together with their refinements to carry additional quantum numbers by Katz--Klemm--Vafa (KKV), and Katz--Klemm--Pandharipande (KKP). We show that these invariants can be reproduced by studying the Ramond ground states of an auxiliary chiral superconformal field theory which has recently been observed to give rise to mock modular moonshine for a variety of sporadic simple groups that are subgroups of Conway's group. We also study equivariant versions of these invariants. A K3 sigma model is specified by a choice of 4-plane in the K3 D-brane charge lattice. Symmetries of K3 sigma models are naturally identified with 4-plane preserving subgroups of the Conway group, according to the work of Gaberdiel--Hohenegger--Volpato, and one may consider corresponding equivariant refined K3 Gopakumar--Vafa invariants. The same symmetries naturally arise in the auxiliary CFT state space, affording a suggestive alternative view of the same computation. We comment on a lift of this story to the generating function of elliptic genera of symmetric products of K3 surfaces., 26 pages

Author(s): Ajaj, R; Araujo, GR; Batygov, M; Beltran, B; Bina, CE; Boulay, MG; Broerman, B; Bueno, JF; Burghardt, PM; Butcher, A; Cai, B; Cardenas-Montes, M; Cavuoti, S; Chen, M; Chen, Y; Cleveland, BT; Dering, K; Duncan, FA; Dunford, M; Erlandson, A; Fatemighomi, N; Fiorillo, G; Flower, A; Ford, RJ; Gagnon, R; Gallacher, D; Garcia Abia, P; Garg, S; Giampa, P; Goeldi, D; Golovko, VV; Gorel, P; Graham, K; Grant, DR; Hallin, AL; Hamstra, M; Harvey, PJ; Hearns, C; Joy, A; Jillings, CJ; Kamaev, O; Kaur, G; Kemp, A; Kochanek, I; Kuźniak, M; Langrock, S; La Zia, F; Lehnert, B; Li, X; Litvinov, O; Lock, J; Longo, G; Majewski, P; McDonald, AB; McElroy, T; McGinn, T; McLaughlin, JB; Mehdiyev, R; Mielnichuk, C; Monroe, J; Nadeau, P; Nantais, C; Ng, C; Noble, AJ; Ouellet, C; Pasuthip, P; Peeters, SJM; Pesudo, V; Piro, MC; Pollmann, TR; Rand, ET; Rethmeier, C; Retiere, F; Sanchez Garcia, E; Santorelli, R; Seeburn, N; Skensved, P; Smith, B; Smith, NJT; Sonley, T; Stainforth, R; Stone, C; Strickland, V; Sur, B; Vazquez-Jauregui, E | Abstract: The DEAP-3600 experiment is searching for weakly interacting massive particles dark matter with a 3.3 ×103 kg single phase liquid argon (LAr) target, located 2.1 km underground at SNOLAB. The experimental signature of dark matter interactions is kilo electron volt-scale Ar40 nuclear recoils producing 128 nm LAr scintillation photons observed by photomultiplier tubes. The largest backgrounds in DEAP-3600 are electronic recoils (ERs) induced by β and γ rays originating from internal and external radioactivity in the detector material. A background model of the ER interactions in DEAP-3600 was developed and is described in this work. The model is based on several components which are expected from radioisotopes in the LAr, from ex situ material assay measurements, and from dedicated independent in situ analyses. This prior information is used in a Bayesian fit of the ER components to a 247.2 d dataset to model the radioactivity in the surrounding detector materials. Pulse-shape discrimination separates ER and NR events. However, detailed knowledge of the ER background and activity of detector components sets valuable constraints on NR backgrounds including neutrons and alphas. In addition, the activity of Ar42 in LAr in DEAP-3600 is determined by measuring the daughter decay of K42. This cosmogenically activated trace isotope is a relevant background at higher energies for other rare event searches using atmospheric argon, e.g., DarkSide-20k, GERDA, or LEGEND. The specific activity of Ar42 in the atmosphere is found to be 40.4±5.9 μBq/kg of argon.

In this work we consider an association of meromorphic Jacobi forms of half-integral index to the pure D-type cases of umbral moonshine, and solve the module problem for four of these cases by constructing vertex operator superalgebras that realise the corresponding meromorphic Jacobi forms as graded traces. We also present a general discussion of meromorphic Jacobi forms with half-integral index and their relationship to mock modular forms., 25 pages

The Marine Stewardship Council (MSC) is the frontrunner in fisheries certification, receiving both extensive support and strong criticisms. The increasing uptake by fisheries and markets (almost 10% of world fisheries tonnage engaged by the end of 2014) has been followed by a widening pool of stakeholders interacting with the MSC. However, the applicability of the MSC approach for fisheries in the developing world (DW) remains doubtful, reinforced by a worldwide uptake skewed towards developed world fisheries. Here, a group of MSC stakeholders, with the aid of an ad-hoc questionnaire survey, reviews constraints to MSC certification in DW fisheries, evaluates solutions put forward by the MSC, and recommends actions to improve MSC uptake by DW fisheries. Recommendations to the MSC include researching and benchmarking suitable data-limited assessment methods, systematizing and making readily available the experiences of certified fisheries worldwide and constructing specific fisheries capacity-building for regional leaders. The MSC can further review the certification cost, especially for small-scale fisheries and, in partnership with other institutions, mobilize a fund to support specific DW fishery types. This fund could also support the development of market opportunities and infrastructures likely to satisfy local conditions and needs. For wider market intervention, the MSC should consider embarking on some form of vertical differentiation. Finally, for fisheries that may never move towards certification, the group identifies tools and experiences available at MSC that can improve environmental performance and governance bearing.

Purpose Limited data exist regarding the role of perineural blockade of the distal median, ulnar, and radial nerves as a primary anesthetic in patients undergoing hand surgery. We conducted a prospective and randomized pilot study to compare these techniques to brachial plexus blocks as a primary anesthetic in this patient population. Methods Sixty patients scheduled for hand surgery were randomized to receive either an ultrasound-guided supraclavicular, infraclavicular, or axillary nerve block (brachial plexus blocks) or ultrasound-guided median, ulnar, and radial nerve blocks performed at the level of the mid to proximal forearm (forearm blocks). The ability to undergo surgery without analgesic or local anesthetic supplementation was the primary outcome. Block procedure times, postanesthesia care unit length of stay, instances of nausea/vomiting, and need for narcotic administration were also assessed. Results The 2 groups were similar in terms of the need for conversion to general anesthesia or analgesic or local anesthetic supplementation, with only 1 patient in the forearm block group and 2 in the brachial plexus block group requiring local anesthetic supplementation or conversion to general anesthesia. Similar durations in surgical and tourniquet times were also observed. Both groups reported similarly low numerical rating scale pain scores as well as the need for postoperative analgesic administration (2 patients in the forearm block group and 1 in the brachial plexus block group reported numerical rating scale pain scores > 0 and required opioid administration in the postanesthesia care unit). Block procedure characteristics were similar between the 2 groups. Conclusions Forearm blocks may be used as a primary anesthetic in patients undergoing hand surgery. Further research is warranted to determine the appropriateness of these techniques in patients undergoing surgery in the thumb or proximal to the hand. Type of study/level of evidence Therapeutic II.

No treatment is currently available for mucopolysaccharidosis (MPS) IIIB, a neuropathic lysosomal storage disease due to defect in α-N-acetylglucosaminidase (NAGLU). In preparation for a clinical trial, we performed an IND-enabling GLP-toxicology study to assess systemic rAAV9-CMV-hNAGLU gene delivery in WT C57BL/6 mice at 1 × 10(14) vg/kg and 2 × 10(14) vg/kg (n = 30/group, M:F = 1:1), and non-GLP testing in MPS IIIB mice at 2 × 10(14) vg/kg. Importantly, no adverse clinical signs or chronic toxicity were observed through the 6 month study duration. The rAAV9-mediated rNAGLU expression was rapid and persistent in virtually all tested CNS and somatic tissues. However, acute liver toxicity occurred in 33% (5/15) WT males in the 2 × 10(14) vg/kg cohort, which was dose-dependent, sex-associated, and genotype-specific, likely due to hepatic rNAGLU overexpression. Interestingly, a significant dose response was observed only in the brain and spinal cord, whereas in the liver at 24 weeks postinfection (pi), NAGLU activity was reduced to endogenous levels in the high dose cohort but remained at supranormal levels in the low dose group. The possibility of rAAV9 germline transmission appears to be minimal. The vector delivery resulted in transient T-cell responses and characteristic acute antibody responses to both AAV9 and rNAGLU in all rAAV9-treated animals, with no detectable impacts on tissue transgene expression. This study demonstrates a generally safe and effective profile, and may have identified the upper dosing limit of rAAV9-CMV-hNAGLU via systemic delivery for the treatment of MPS IIIB.

This study compared two popular iPhone-based goniometer applications to the gold standard universal goniometer for the measurement of the hip and knee joints in scenarios mimicking the normal pace of an orthopaedic clinical practice.Three physicians measured hip and knee joint angles 35 times with one of three goniometers: universal 12-inch goniometer, DrGoniometer (iPhone-5 based), and SimpleGoniometer (iPhone-5 based). Data wwere analyzed using Pearson correlation coefficient calculations. Average knee angles measured with the universal goniometer, DrGoniometer, and SimpleGoniometer measured 83.46°, 85.23°, and 80.39°, respectively. The smartphone-based goniometers had moderate agreement with the universal goniometer in the knee (r.322). Average hip angles measured with the universal goniometer, DrGoniometer, and SimpleGoniometer measured 62.34°, 60.87°, and 59.34°, respectively. The smartphone-based goniometers had moderate agreement with the universal goniometer in the hip (r.168). Smartphone-based goniometers gave accurate, with weak to moderate correlation, measurements for the knee and hip. (Journal of Surgical Orthopaedic Advances 26(4):223-226, 2017).

We show that certain BPS counting functions for both fundamental strings and strings arising from fivebranes wrapping divisors in Calabi--Yau threefolds naturally give rise to skew-holomorphic Jacobi forms at rational and attractor points in the moduli space of string compactifications. For M5-branes wrapping divisors these are forms of weight negative one, and in the case of multiple M5-branes skew-holomorphic mock Jacobi forms arise. We further find that in simple examples these forms are related to skew-holomorphic (mock) Jacobi forms of weight two that play starring roles in moonshine. We discuss examples involving M5-branes on the complex projective plane, del Pezzo surfaces of degree one, and half-K3 surfaces. For del Pezzo surfaces of degree one and certain half-K3 surfaces we find a corresponding graded (virtual) module for the degree twelve Mathieu group. This suggests a more extensive relationship between Mathieu groups and complex surfaces, and a broader role for M5-branes in the theory of Jacobi forms and moonshine., Comment: 36 pages, LaTeX; minor typos corrected, footnote added at bottom of page 9 to accommodate JHEP editor's suggestion

Mathieu moonshine attaches a weak Jacobi form of weight zero and index one to each conjugacy class of the largest sporadic simple group of Mathieu. We introduce a modification of this assignment, whereby weak Jacobi forms are replaced by semi-holomorphic Maass–Jacobi forms of weight one and index two. We prove the convergence of some Maass–Jacobi Poincare series of weight one, and then use these to characterize the semi-holomorphic Maass–Jacobi forms arising from the largest Mathieu group.

Background: The radiographic appearance of osteochondritis dissecans (OCD) of the humeral capitellum varies according to the stage of the lesion. It is important to evaluate the stage of OCD lesion carefully to guide treatment. We compared the interobserver reliability of currently used classification systems for OCD of the humeral capitellum to identify the most reliable classification system. Methods: Thirty-two musculoskeletal radiologists and orthopaedic surgeons specialized in elbow surgery from several countries evaluated anteroposterior and lateral radiographs and corresponding computed tomography (CT) scans of 22 patients to classify the stage of OCD of the humeral capitellum according to the classification systems developed by (1) Minami, (2) Berndt and Harty, (3) Ferkel and Sgaglione, and (4) Anderson on a Web-based study platform including a Digital Imaging and Communications in Medicine viewer. Magnetic resonance imaging was not evaluated as part of this study. We measured agreement among observers using the Siegel and Castellan multirater kappa. Results: All OCD classification systems, except for Berndt and Harty, which had poor agreement among observers (kappa = 0.20), had fair interobserver agreement: k was 0.27 for the Minami, 0.23 for Anderson, and 0.22 for Ferkel and Sgaglione classifications. The Minami Classification was significantly more reliable than the other classifications (P

Extraskeletal osteosarcoma is a rare disease that uncommonly affects the upper extremity. A 46-year-old African American man presented for evaluation of a right middle finger mass. Excisional biopsy demonstrated extraskeletal osteosarcoma of the soft tissues. We performed a transmetacarpal ray resection.

In this chapter, we describe the use of peripheral nerve stimulation (PNS) for the treatment of chronic neuropathic pain. Occasionally, median nerve injury is associated with hand trauma or other injury, including iatrogenic. The intractable pain or allodynia can negatively impact the quality of life, even in patients having undergone surgery repair and/or decompression. PNS can provide effective pain relief in patients for whom standard nonoperative therapies have not worked. However, careful selection of the appropriate nerve is important for successful PNS. In this chapter, we aim to help surgeons acquire the necessary knowledge on the indications, contraindications, approach, and clinical outcomes of PNS.

The reverse radial forearm fascial flap can be used to provide coverage for the median nerve in a variety of circumstances. This flap has utility for trauma coverage, recurrent carpal tunnel syndrome, as well as numerous other scenarios. The advantage of this flap is that it preserves the radial artery and has an overall more tolerable aesthetic appearance compared to the traditional reverse radial forearm flap.

Carpal tunnel syndrome is now a well-understood clinical phenomenon in which neuropathic symptoms are secondary to median nerve compression within the carpal tunnel. Prior to this understanding, the symptoms of carpal tunnel syndrome were attributed to several different etiologies: (1) post-traumatic median neuropathy, (2) brachial plexus compression, and (3) thenar neuritis. However it was not until the mid-1900s that the pathophysiology was elucidated to provide a means for clinical care. Herbert Galloway performed the first carpal tunnel release in 1924, and the term “carpal tunnel syndrome” was first used in print by Kremer in 1953.

Answering a question posed by Conway and Norton in their seminal 1979 paper on moonshine, we prove the existence of a graded infinite-dimensional module for the sporadic simple group of O'Nan, for which the McKay--Thompson series are weight $3/2$ modular forms. The coefficients of these series may be expressed in terms of class numbers, traces of singular moduli, and central critical values of quadratic twists of weight 2 modular $L$-functions. As a consequence, for primes $p$ dividing the order of the O'Nan group we obtain congruences between O'Nan group character values and class numbers, $p$-parts of Selmer groups, and Tate--Shafarevich groups of certain elliptic curves. This work represents the first example of moonshine involving arithmetic invariants of this type., Comment: 40 pages, 12 tables. v3: The McKay--Thompson series are all modular in this version. A connection to the cohomology of the O'Nan group is explained. Some clarifications and corrections have been made based on referee advice. v4: Some further clarifications, corrections and edits. This is the final version, accepted for publication in the American Journal of Mathematics

Item does not contain fulltext PURPOSE: Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost containment. In some instances, implants are the largest component of total procedure cost, yet previous studies reveal that surgeons' knowledge of implant prices is poor. Our study aims to (1) understand drivers behind implant selection and (2) assess whether educating surgeons about implant costs affects implant selection. METHODS: We surveyed 226 orthopedic surgeons across 6 continents. The survey presented 8 clinical cases of upper extremity fractures with history, radiographs, and implant options. Surgeons were randomized to receive either a version with each implant's average selling price ("price-aware" group), or a version without prices ("price-naive" group). Surgeons selected a surgical implant and ranked factors affecting implant choice. Descriptive statistics and univariate, multivariable, and subgroup analyses were performed. RESULTS: For cases offering implants within the same class (eg, volar locking plates), price-awareness reduced implant cost by 9% to 11%. When offered different models of distal radius volar locking plates, 25% of price-naive surgeons selected the most expensive plate compared with only 7% of price-aware surgeons. For cases offering different classes of implants (eg, plate vs external fixator), there was no difference in implant choice between price-aware and price-naive surgeons. Familiarity with the implant was the most common reason for choosing an implant in both groups (35% vs 46%). Price-aware surgeons were more likely to rank cost as a factor (29% vs 21%). CONCLUSIONS: Price awareness significantly influences surgeons' choice of a specific model within the same implant class. Merely including prices with a list of implants leads surgeons to select less expensive implants. This implies that an untapped opportunity exists to reduce surgical expenditures simply by enhancing surgeons' cost awareness. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic/Decision Analyses I.

The vector-valued mock modular forms of umbral moonshine may be repackaged into meromorphic Jacobi forms of weight one. In this work we constructively solve two cases of the meromorphic module problem for umbral moonshine. Specifically, for the type A Niemeier root systems with Coxeter numbers seven and thirteen, we construct corresponding bigraded super vertex operator algebras, equip them with actions of the corresponding umbral groups, and verify that the resulting trace functions on canonically twisted modules recover the meromorphic Jacobi forms that are specified by umbral moonshine. We also obtain partial solutions to the meromorphic module problem for the type A Niemeier root systems with Coxeter numbers four and five, by constructing super vertex operator algebras that recover the meromorphic Jacobi forms attached to maximal subgroups of the corresponding umbral groups., Comment: 25 pages

This chapter discusses the pathophysiological mechanisms and contributing factors underlying the etiology of carpal tunnel syndrome. The etiology of carpal tunnel syndrome is complex and still has not been fully elucidated. Many factors have been implicated in the development and progression of carpal tunnel syndrome. Injury due to repetitive mechanical stress and resulting nerve injury has been historically thought to be the cause of carpal tunnel syndrome. Additionally, systemic disease states including diabetes, acromegaly, thyroid dysfunction, and rheumatoid arthritis among others have been linked to carpal tunnel syndrome. Age, gender, and genetic factors have also been associated with the development of carpal tunnel syndrome. The various elements that may predispose to carpal tunnel syndrome have been explored in depth in this chapter.

Background Data are limited regarding the use of peripheral nerve blockade at the level of the forearm, and most studies regard these procedures as rescue techniques for failed or incomplete blocks. The purpose of the study was to investigate patients undergoing hand surgery with distal peripheral nerve (forearm) blocks and compare them with patients having similar procedures under more proximal brachial plexus blockade. No investigations comparing distal nerve blockade to proximal approaches are currently reported in the literature. Methods Medical records were retrospectively reviewed for patients who had undergone hand surgery with a peripheral nerve block between November 2012 and October 2013. The primary outcome was the ability to provide a primary anesthetic without the need for general anesthesia or local anesthetic supplementation by the surgical team. Secondary outcome measures included narcotic administration during the block and intraoperative procedures, block performance times, and the need for rescue analgesics in the post anesthesia care unit (PACU). Results No statistical difference in conversion rates to general anesthesia was observed between the two groups. Total opiate administration for the block and surgical procedure was lower in the forearm block group. There was no difference in block performance times or need for rescue analgesics in the PACU. Conclusions Forearm blocks are viable alternatives to proximal blockade and are effective as a primary anesthetic technique in patients undergoing hand surgery. Compared to the more proximal approaches, these blocks have the benefits of not causing respiratory compromise, the ability to be performed bilaterally, and may be safer in anticoagulated patients.

Loss of contact between radial head fracture fragments is strongly associated with other elbow or forearm injuries. If this finding has adequate interobserver reliability, it could help examiners identify and treat associated ligament injuries and fractures (eg, forearm interosseous ligament injury or elbow dislocation). (1) What is the interobserver agreement on radiographic loss of contact between radial head fracture fragments? (2) Are there factors associated with the observer such as location of practice or subspecialization that increase interobserver reliability? Fully trained practicing orthopaedic and trauma surgeons from around the world evaluated 27 anteroposterior and lateral radiographs of radial head fractures on a web-based platform for the following characteristics: (1) loss of contact between at least one radial head fracture fragment and the remaining radial head and neck; (2) a gap between fragments of 2 mm or greater; (3) anticipated fracture instability (mobility) on operative exposure; (4) anticipated associated ligament injuries; and (5) recommendation for treatment. Agreement among observers was measured using the multirater kappa measure. Kappas for various observer characteristics were compared using 95% confidence intervals. The overall interobserver agreement was moderate (range, 0.49-0.55) for each question except associated ligament injury, which was fair (0.33). Shoulder and elbow surgeons had substantial agreement (range, 0.51-0.61) in many areas, but kappas were generally in the moderate range (0.41-0.59) based on number of years in practice, radial head fractures treated per year, and trainee supervision. Radiographic signs of radial head fracture instability such as loss of contact have moderate reliability. This characteristic seems clinically useful, because loss of contact between at least one radial head fracture fragment and the remaining radial head and neck is strongly associated with associated ligament injury or other fractures. Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence

No treatment is currently available for mucopolysaccharidosis (MPS) IIIB, a neuropathic lysosomal storage disease caused by autosomal recessive defect in α-N-acetylglucosaminidase (NAGLU). In anticipation of a clinical gene therapy treatment for MPS IIIB in humans, we tested the rAAV9-CMV-hNAGLU vector administration to cynomolgus monkeys (n=8) at 1E13 vg/kg or 2E13 vg/kg via intravenous injection. No adverse events or detectable toxicity occurred over a 6-month period. Gene delivery resulted in persistent global central nervous system and broad somatic transduction, with NAGLU activity detected at 2.9-12-fold above endogenous levels in somatic tissues and 1.3-3-fold above endogenous levels in the brain. Secreted rNAGLU was detected in serum. Low levels of preexisting anti-AAV9 antibodies (Abs) did not diminish vector transduction. Importantly, high-level preexisting anti-AAV9 Abs lead to reduced transduction in liver and other somatic tissues, but had no detectable impact on transgene expression in the brain. Enzyme-linked immunoabsorbent assay showed Ab responses to both AAV9 and rNAGLU in treated animals. Serum anti-hNAGLU Abs, but not anti-AAV9 Abs, correlated with the loss of circulating rNAGLU enzyme. However, serum Abs did not affect tissue rNAGLU activity levels. Weekly or monthly peripheral blood interferon-γ enzyme-linked immunospot assays detected a CD4(+) T-cell (Th-1) response to rNAGLU only at 4 weeks postinjection in one treated subject, without observable correlation to tissue transduction levels. The treatment did not result in detectable CTL responses to either AAV9 or rNAGLU. Our data demonstrate an effective and safe profile for systemic rAAV9-hNAGLU vector delivery in nonhuman primates, supporting its clinical potential in humans.

Background Forequarter amputation (FQA) is reserved for large, multifocal, or recurrent tumors affecting the shoulder and upper extremity. Although it is performed less frequently with the advancement of limb salvage surgery, FQA remains an important treatment in select patients. The purpose of this study is to illustrate the surgical technique in a case series of 4 patients. Methods Between 2010 and 2012, 4 patients (mean age, 61 years; range, 36-78 years) presented with malignant disease of the upper extremity that was not amenable to or had failed limb salvage. All patients had FQA by the illustrated anterior clavicular osteotomy technique. Patient data were retrospectively reviewed from preoperative workup until last follow-up or death. Results All patients had tumors that involved major neurovascular structures of the upper extremity and shoulder girdle. One presented with neuroendocrine carcinoma and has achieved local control after FQA. Three presented with high-grade sarcoma. One of these had recurrence after prior limb salvage and neoadjuvant radiation and unfortunately succumbed to metastatic disease 6 months after FQA. An additional sarcoma patient who presented after shoulder arthroscopy for a “labral cyst” with recurrent and fulminant synovial sarcoma succumbed to her disease. The remaining sarcoma patient has had no recurrence and minimal phantom pain at last follow-up. Discussion Obtaining vascular control early in the procedure is crucial to minimize blood loss. When it is indicated, FQA is a relatively safe and reliable procedure for dealing with otherwise challenging tumors of the shoulder girdle and upper extremity.

Objective. This report describes a case in which the off-label use of liposomal bupivacaine (Exparel) in a peripheral nerve block resulted in marked improvement of a patient’s vasoocclusive symptoms. The vasodilating and analgesic properties of liposomal bupivacaine in patients with ischemic symptoms are unknown, but our clinical experience suggests a role in the management of patients suffering from vasoocclusive disease.Case Report. A 45-year-old African American female was admitted to the hospital with severe digital ischemic pain. She was not a candidate for any vascular surgical or procedural interventions. Two continuous supraclavicular nerve blocks were placed with modest clinical improvement. These effects were also short-lived, with the benefits resolving after the discontinuation of the peripheral nerve blocks. She continued to report severe pain and was on multiple anticoagulant medications, so a decision was made to perform an axillary nerve block using liposomal bupivacaine (Exparel) given the compressibility of the site as well as the superficial nature of the target structures.Conclusions. This case report describes the successful off-label usage of liposomal bupivacaine (Exparel) in a patient with digital ischemia. Liposomal bupivacaine (Exparel) is currently FDA approved only for wound infiltration use at this time.

Alopecia areata (AA) is an autoimmune disease that attacks anagen hair follicles. Gene array in graft-induced C3H/HeJ mice revealed that genes involved in retinoic acid (RA) synthesis were increased, whereas RA degradation genes were decreased in AA compared with sham controls. This was confirmed by immunohistochemistry in biopsies from patients with AA and both mouse and rat AA models. RA levels were also increased in C3H/HeJ mice with AA. C3H/HeJ mice were fed a purified diet containing one of the four levels of dietary vitamin A or an unpurified diet 2 weeks before grafting and disease progression followed. High vitamin A accelerated AA, whereas mice that were not fed vitamin A had more severe disease by the end of the study. More hair follicles were in anagen in mice fed high vitamin A. Both the number and localization of granzyme B–positive cells were altered by vitamin A. IFNγ was also the lowest and IL13 highest in mice fed high vitamin A. Other cytokines were reduced and chemokines increased as the disease progressed, but no additional effects of vitamin A were seen. Combined, these results suggest that vitamin A regulates both the hair cycle and immune response to alter the progression of AA.

Purpose It is our impression that there is substantial, unexplained variation in hand surgeon recommendations for treatment of peripheral mononeuropathy. We tested the null hypothesis that specific patient and provider factors do not influence recommendations for surgery. Methods Using a web-based survey, hand surgeons recommended surgical or nonsurgical treatment for patients in 2 different scenarios. Six elements of the first scenario (symptoms, circumstances, mindset, diagnosis, objective testing, and expectations) had 2 possibilities that were each independently and randomly assigned to each rater. For the second scenario, 2 different scenarios were randomly assigned to each rater. Multivariable logistic regression sought factors associated with a recommendation for surgery. Results A total of 186 surgeons of the Science of Variation Group completed a survey regarding recommendation of surgery for 2 different patients based on clinical scenarios. Recommendations for surgery did not vary significantly according to provider characteristics. For the various elements in scenario 1, recommendation for surgery was more likely for patients who were self-employed and continued to work and who had objective electrodiagnostic abnormalities. For the 2 vignettes used in scenario 2, a recommendation for surgery was associated with abnormal electrophysiology. Conclusions The findings of this study suggest that—at least in a survey setting—surgeons prefer to offer peripheral nerve decompression to patients with abnormal electrophysiology, particularly those with effective coping strategies. Clinical relevance The role of objective verification of pathophysiology is debated, but it is an influential factor in recommendations for hand surgery.

Purpose: To report the outcomes of mallet fractures treated with our modified tension band wiring technique.Methods: Eleven men and two women (mean age; 33 years) with mallet fractures in which happened more than five weeks before surgery, or with fracture fragments involving more than 2/3 or less than 1/3 of the distal phalanx articular surface or with previous surgical intervention, were subjected to this study. The fracture fragment was fixed with a modified tension band wiring technique using a stainless steel wire and an injection needle.Results: All patients achieved bone union in nine weeks in average. All patients had no pain except one with mild pain. No patient showed a gap or step-off greater than 1 mm.Conclusions: Our tension band wiring technique can be used regardless of the size of the dorsal fracture fragment or the interval between injury and surgery.

The Sudbury Neutrino Observatory is a 1000 T D 2 O Cerenkov detector that is sensitive to 8 B solar neutrinos. The energy, radius, and direction with respect to the sun is measured for each neutrino event; these distributions are used to separately determine the rates of the charged current, neutral current and electron scattering reactions of neutrinos on deuterium. Assuming an undistorted 8 B spectrum, the ν e component of the 8 B solar flux is φ e = 1.76 +0.05 −0.05 (stat.) +0.09 −0.09 (syst.) × 10 6 cm −2 s −1 based on events with a measured kinetic enegy above 5 MeV. The non- ν e component is φ μτ = 3.41 +0.45 −0.45 (stat.) +0.48 −0.45 (syst.) × 10 6 cm −2 s −1 , 5.3 σ greater than zero, providing strong evidence for solar ν e flavor transformation. The total flux measured with the NC reaction is φ NC = 5.09 +0.044 −0.43 (stat.) +0.46 −0.43 (syst.) × 10 6 cm −2 s −1 , consistent with solar models. The night minus day rate is 14.0% ± 6.3% +1.5 −1.4 % of the average rate. If the total flux of active neutrinos is additionally constrained to have no asymmetry, the ν e asymmetry is found to be 7.0% ± 4.9% +1.3 −1.2 %. A global solar neutrino analysis is terms of matter-enhanced oscillations of two active flavors strongly favors the Large Mixing Angle (LMA) solution.

Data from the Sudbury Neutrino Observatory have been used to constrain the lifetime for nucleon decay to ``invisible'' modes, such as n -> 3 nu. The analysis was based on a search for gamma-rays from the de-excitation of the residual nucleus that would result from the disappearance of either a proton or neutron from O16. A limit of tau_inv > 2 x 10^{29} years is obtained at 90% confidence for either neutron or proton decay modes. This is about an order of magnitude more stringent than previous constraints on invisible proton decay modes and 400 times more stringent than similar neutron modes., Update includes missing efficiency factor (limits change by factor of 2) Submitted to Physical Review Letters

We have performed three searches for high-frequency signals in the solar neutrino flux measured by the Sudbury Neutrino Observatory (SNO), motivated by the possibility that solar $g$-mode oscillations could affect the production or propagation of solar $^8$B neutrinos. The first search looked for any significant peak in the frequency range 1/day to 144/day, with a sensitivity to sinusoidal signals with amplitudes of 12% or greater. The second search focused on regions in which $g$-mode signals have been claimed by experiments aboard the SoHO satellite, and was sensitive to signals with amplitudes of 10% or greater. The third search looked for extra power across the entire frequency band. No statistically significant signal was detected in any of the three searches., 37 pages, 17 figures, submitted to ApJ