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Insect proteins have been proposed as a promising alternative for feed and food formulations. In the present work protease-assisted extraction was studied as a way to separate and extract proteins from two different insect species: Alphitobius diaperinus (AD) and Hermetia illucens (HI). The proteolytic activity of seven enzymes (papain, pancreatin, dispase I, pepsin, protease from Bacillus licheniformis, bromelain and trypsin) was evaluated determining the protein extraction yield, the degree of hydrolysis (DH) and the released free amino acids (FAA). Both insects represent an interesting source of proteins, not only for their amount (more than 40% on dry matter) but also for the nutritional value, with essential amino acid profile exceeding the requirements proposed for human nutrition. Enzyme-assisted protein extraction, performed at laboratory scale, gave for HI an average yield of extraction of 71±8% and for AD 67±6%. Hydrolysates produced from HI gave a DH% ranging between 3 to 18%, whereas hydrolysates produced from AD yielded a DH% between 7 to 23%. The protein hydrolysates were composed by peptides and FAA (which accounted for more than 30% of the extracted protein fraction), which were released according to their abundance in initial protein. A moderate correlation between the DH% and the total amount of FAA was found, except for AD hydrolysed with trypsin and HI with papain. Based on these results, the production of hydrolysates was preliminary scaled up in a proof-of-concept experiment, focusing on the most promising insect-enzyme combination. The final product resulted to be rich in protein (60% on dry matter). This work support enzymatic hydrolysis as an effective method to extract and isolate proteins from insects, with minimal sample preparation, tailoring their composition, preserving the nutritional quality, decreasing the risk of allergic reactions and making them more accessible for their future use as feed/food supplements.

Es ist allgemein anerkannt, dass die Indikation zur Ausschaltung eines DTAA oder eines TAAA ab einem Durchmesser von 6 cm bei degenerativen Aneurysmen und ab 5 cm fur Patienten mit Bindegewebsstorung wie z. B. Marfan-Syndrom besteht. Eine rasche Grosenzunahme kann eine Operation auch dann rechtfertigen, wenn die oben genannten Durchmesser noch nicht erreicht wurden (Jacobs et al. 2007).

ES-4 – Sample Documentation (PDF).

Background Although 20 pancreatic cancer susceptibility loci have been identified through genome-wide association studies in individuals of European ancestry, much of its heritability remains unexplained and the genes responsible largely unknown. Methods To discover novel pancreatic cancer risk loci and possible causal genes, we performed a pancreatic cancer transcriptome-wide association study in Europeans using three approaches: FUSION, MetaXcan, and Summary-MulTiXcan. We integrated genome-wide association studies summary statistics from 9040 pancreatic cancer cases and 12 496 controls, with gene expression prediction models built using transcriptome data from histologically normal pancreatic tissue samples (NCI Laboratory of Translational Genomics [n = 95] and Genotype-Tissue Expression v7 [n = 174] datasets) and data from 48 different tissues (Genotype-Tissue Expression v7, n = 74–421 samples). Results We identified 25 genes whose genetically predicted expression was statistically significantly associated with pancreatic cancer risk (false discovery rate < .05), including 14 candidate genes at 11 novel loci (1p36.12: CELA3B; 9q31.1: SMC2, SMC2-AS1; 10q23.31: RP11-80H5.9; 12q13.13: SMUG1; 14q32.33: BTBD6; 15q23: HEXA; 15q26.1: RCCD1; 17q12: PNMT, CDK12, PGAP3; 17q22: SUPT4H1; 18q11.22: RP11-888D10.3; and 19p13.11: PGPEP1) and 11 at six known risk loci (5p15.33: TERT, CLPTM1L, ZDHHC11B; 7p14.1: INHBA; 9q34.2: ABO; 13q12.2: PDX1; 13q22.1: KLF5; and 16q23.1: WDR59, CFDP1, BCAR1, TMEM170A). The association for 12 of these genes (CELA3B, SMC2, and PNMT at novel risk loci and TERT, CLPTM1L, INHBA, ABO, PDX1, KLF5, WDR59, CFDP1, and BCAR1 at known loci) remained statistically significant after Bonferroni correction. Conclusions By integrating gene expression and genotype data, we identified novel pancreatic cancer risk loci and candidate functional genes that warrant further investigation.

Objective The primary objective was to develop a computerized culturally adapted health literacy intervention for older Hispanics with type 2 diabetes (T2D). Secondary objectives were to assess the usability and acceptability of the intervention by older Hispanics with T2D and clinical pharmacists providing comprehensive medication management (CMM). Materials and methods The study occurred in three phases. During phase I, an integration approach (i.e., quantitative assessments, qualitative interviews) was used to develop the intervention and ensure cultural suitability. In phase II, the intervention was translated to Spanish and modified based on data obtained in phase I. During phase III, the intervention was tested for usability/acceptability. Results Thirty participants (25 older Hispanics with T2D, 5 clinical pharmacists) were included in the study. Five major themes emerged from qualitative interviews and were included in the intervention: 1) financial considerations, 2) polypharmacy, 3) social/family support, 4) access to medication/information, and 5) loneliness/sadness. Participants felt the computerized intervention developed was easy to use, culturally appropriate, and relevant to their needs. Pharmacists agreed the computerized intervention streamlined patient counseling, offered a tailored approach when conducting CMM, and could save them time. Conclusion The ability to offer individualized patient counseling based on information gathered from the computerized intervention allows for precision counseling. Future studies are needed to determine the effectiveness of the developed computerized intervention on adherence and health outcomes.

With the increase of aggregate quarrying to meet the growing need for concrete construction comes a risk associated with new aggregate sources, which may not have uniform compositions and contain potentially harmful substances, such as sulfate and sulfide. To provide insights into the impact of sulfate- and sulfide-bearing sand on susceptibility to delayed ettringite formation (DEF), this study measures the evolution of expansion, acoustic nonlinearity (representing microscale damage), and dynamic elastic modulus of mortars prepared with varying cement compositions and exposed to an early-age high-temperature curing cycle. Samples containing sulfate- and sulfide-bearing sand show substantially higher initial levels of damage, with expansion starting at earlier ages than control samples. Damage in mortars using this sand can be attributed to accelerated decomposition of alkali-feldspar, microcracking due to relative thermal deformation between phases, early release of alkali that increases the amount of sulfate in the pore solution, and release of sulfate ions from aggregates.

Background: Genome-wide association studies (GWAS) identify associations of individual single-nucleotide polymorphisms (SNPs) with cancer risk but usually only explain a fraction of the inherited variability. Pathway analysis of genetic variants is a powerful tool to identify networks of susceptibility genes. Methods: We conducted a large agnostic pathway-based meta-analysis of GWAS data using the summary-based adaptive rank truncated product method to identify gene sets and pathways associated with pancreatic ductal adenocarcinoma (PDAC) in 9040 cases and 12 496 controls. We performed expression quantitative trait loci (eQTL) analysis and functional annotation of the top SNPs in genes contributing to the top associated pathways and gene sets. All statistical tests were two-sided. Results: We identified 14 pathways and gene sets associated with PDAC at a false discovery rate of less than 0.05. After Bonferroni correction (P

To further dissect the genetic architecture of colorectal cancer (CRC), we performed whole-genome sequencing of 1,439 cases and 720 controls, imputed discovered sequence variants and Haplotype Reference Consortium panel variants into genome-wide association study data, and tested for association in 34,869 cases and 29,051 controls. Findings were followed up in an additional 23,262 cases and 38,296 controls. We discovered a strongly protective 0.3% frequency variant signal at CHD1. In a combined meta-analysis of 125,478 individuals, we identified 40 new independent signals at P, Reporting Summary. Further information on experimental design is available in the Life Sciences Reporting Summary linked to this article.

Labor and a vaginal delivery trigger changes in peripheral organs that prepare the mammalian fetus to survive ex utero. Surprisingly little attention has been given to whether birth also influences the brain, and to how alterations in birth mode affect neonatal brain development. These are important questions, given the high rates of cesarean section (C-section) delivery worldwide, many of which are elective. We examined the effect of birth mode on neuronal cell death, a widespread developmental process that occurs primarily during the first postnatal week in mice. Timed-pregnant dams were randomly assigned to C-section deliveries that were yoked to vaginal births to carefully match gestation length and circadian time of parturition. Compared with rates of cell death just before birth, vaginally-born offspring had an abrupt, transient decrease in cell death in many brain regions, suggesting that a vaginal delivery is neuroprotective. In contrast, cell death was either unchanged or increased in C-section–born mice. Effects of delivery mode on cell death were greatest for the paraventricular nucleus of the hypothalamus (PVN), which is central to the stress response and brain–immune interactions. The greater cell death in the PVN of C-section–delivered newborns was associated with a reduction in the number of PVN neurons expressing vasopressin at weaning. C-section–delivered mice also showed altered vocalizations in a maternal separation test and greater body mass at weaning. Our results suggest that vaginal birth acutely impacts brain development, and that alterations in birth mode may have lasting consequences.

This study investigated the sexual practices and perceptions of HIV risk in a national sample women who have sex with women (WSW). A multiethnic sample of 239 WSW aged 18–68 years attending...

In the United States, it is estimated that more than 1.7 million people will be diagnosed with cancer, and more than 600,000 will die of the disease in 2018. The financial costs associated with cancer risk factors and cancer care are enormous. To substantially reduce both the number of individuals diagnosed with and dying from cancer and the costs associated with cancer each year in the United States, government and industry and the public health, medical, and scientific communities must work together to develop, invest in, and implement comprehensive cancer control goals and strategies at the national level and expand ongoing initiatives at the state and local levels. This report is the second in a series of articles in this journal that, together, describe trends in cancer rates and the scientific evidence on cancer prevention, early detection, treatment, and survivorship to inform the identification of priorities for a comprehensive cancer control plan. Herein, we focus on existing evidence about established, modifiable risk factors for cancer, including prevalence estimates and the cancer burden due to each risk factor in the United States, and established primary prevention recommendations and interventions to reduce exposure to each risk factor.

Nonlinear Rayleigh surface waves are used to monitor the damage state due to alkali-silica reaction (ASR) in full-scale reinforced concrete block specimens created as part of a full-scale testing program for concrete nuclear containment structures. The measurement technique uses a wedge/transducer source to generate and a non-contact, air-coupled receiver to detect nonlinear Rayleigh surface waves to obtain the acoustic nonlinearity parameters for three different reinforced block concrete specimens – a confined and an unconfined ASR specimen, plus a control specimen – at three different time intervals. These results further validate the utility of nonlinear Rayleigh waves to quantify the progress of microscale damage due to ASR in full-scale, concrete structures.

OBJECTIVES: To determine the incidence of immediate complications of elective newborn circumcision in 2 community teaching hospitals. METHODS: We performed a retrospective chart review of all term neonates who had circumcision performed between August 2011 and December 2014 at 2 community hospitals in New York. Neonatal hospital records and subsequent inpatient and outpatient records were reviewed. We classified complications as minor, intermediate, and major. RESULTS: Out of a total of 1115 circumcisions, 1064 met inclusion criteria. There were 41 complications (3.9%), all involving hemorrhage. Sutures were used to control hemorrhage in 3 patients (0.3%). Local pressure or application of hemostatic chemical agents controlled bleeding in the remainder of patients. Bleeding was more common with the use of the Gomco clamp than with the Mogen clamp. Circumcisions performed with Gomco clamp represented 73.2% of the total complications compared with 26.8% with the Mogen clamp. There were no injuries to structures outside the prepuce or problems requiring medical treatment after discharge from the neonatal hospitalization. CONCLUSIONS: The most common immediate complication encountered during an elective neonatal circumcision was bleeding that required only pressure or topical thrombin to achieve hemostasis. Bleeding was more common with the use of the Gomco versus the Mogen clamp. To conclude, our data support the theory that elective infant circumcision can be performed safely in a hospital setting.

Background Transient neonatal hypoglycemia occurs most commonly in newborns who are small for gestational age, large for gestational age, infants of diabetic mothers, and late preterm infants. An exact blood glucose value has not been determined for neonatal hypoglycemia, and it is important to note that poor neurologic outcomes can occur if hypoglycemia is left untreated. Interventions that separate mothers and newborns, as well as use of formula to treat hypoglycemia, have the potential to disrupt exclusive breastfeeding. Purpose To determine whether implementation of a toolkit designed to support staff in the adaptation of the practice change for management of newborns at risk for hypoglycemia, that includes 40% glucose gel in an obstetric unit with a level 2 nursery will decrease admissions to the Intermediate Care Nursery, and increase exclusive breastfeeding. Method This descriptive study used a retrospective chart review for pre/postimplementation of the Management of Newborns at Risk for Hypoglycemia Toolkit (Toolkit) using a convenience sample of at-risk newborns in the first 2 days of life to evaluate the proposed outcomes. Results Following implementation of the Toolkit, at-risk newborns had a clinically but not statistically significant 6.5% increase in exclusive breastfeeding and a clinically but not statistically significant 5% decrease in admissions to the Intermediate Care Nursery. Implications for practice The Toolkit was designed for ease of staff use and to improve outcomes for the at-risk newborn. Implications for research Future research includes replication at other level 2 and level 1 obstetric centers and investigation into the number of 40% glucose gel doses that can safely be administered.

Zusammenfassung Einleitung Aortoösophageale Fisteln infolge offener und endovaskulärer Operationen der thorakoabdominellen Aorta sind seltene und lebensbedrohliche Erkrankungen. Im vorliegenden Fall war durch die infektiöse Mitbeteiligung einer einliegenden Ascendens-Bogenprothese sowie einer thorakalen Endoprothese im Bereich der Aorta descendens der vollständige Ersatz der thorakalen Aorta über einen sog. „clamshell“-Zugang notwendig. Kasuistik Bei einer Aortendissektion Typ A nach Stanford erfolgte bei einer 43-jährigen Patientin 2015 ein suprakoronarer Aortenersatz. 2016 wurde bei aortoösophagealer Fistel mit schweren Hämoptysen notfallmäßig eine thorakale Stentprothese (TEVAR) implantiert. Zur definitiven Versorgung mit Entfernung des infizierten Prothesenmaterials erfolgte ein vollständiger Ersatz der thorakalen Aorta im Rahmen einer queren Thorakotomie als Teil eines multimodalen Therapiekonzeptes. Bereits vorab war eine Ösophagektomie erfolgt; abschließend wurde die Passage mittels eines sekundären antesternalen Magenhochzugs rekonstruiert. Schlussfolgerung Aortoösophageale Fisteln stellen eine therapeutische Herausforderung dar, die in Referenzzentren durch ein interdisziplinäres Team behandelt werden sollten. Der „clamshell“-Zugang mittels querer Thorakotomie ermöglichte im vorliegenden Fall den Ersatz der gesamten thorakalen Aorta.

Zusammenfassung Einleitung Sowohl die offene als auch die endovaskuläre Versorgung von thorakoabdominellen Aortenaneurysmen (TAAA) geht mit einem relevanten Risiko für eine Rückenmarksischämie mit einer folgenden Querschnittssymptomatik einher. Verschiedene existente Präventionskonzepte lassen zugleich keine definitive Versorgung des bestehenden TAAA zu. Im vorliegenden Artikel soll ein neuartiges Konzept auf der Basis einer langsam okkludierenden Hydrogel-Textil-Membran vorgestellt werden, das helfen könnte, das Risiko der spinalen Ischämie zu reduzieren. Konzept Als variabel platzierbare Funktionseinheit von endovaskulären Prothesen wird eine Hydrogel-Textil-Membran entwickelt, die unter Einfluss von Blut bzw. dem im Blut enthaltenen Glutathion zur Quellung gebracht wird. Im weiteren Verlauf führt eine Degradation des Hydrogels zur abschließenden Stabilisierung, die nochmals durch zu erwartende, körpereigene Prozesse verstärkt wird. Dieses Hydrogel soll in den In-vitro-Versuchen einen abnehmenden, zeitlich festgelegten Fluss in den Aneurysmasack zulassen und sich letztendlich verschließen. Durch die Einbringung einer solchen Hydrogel-Textil-Membran in einer Stentprothese könnte somit ohne weitere Interventionen oder präoperative Maßnahmen die notwendige Kollateralbildung des spinalen Gefäßsystems ermöglicht werden. Das Risiko einer spinalen Ischämie könnte somit bei jeder endovaskulären Prozedur, unabhängig von allen weiteren Maßnahmen, auf ein Minimum reduziert werden. Es handelt sich beim vorgestellten Konzept um ein in der Entwicklung befindliches Produkt, daher können nur Zwischenergebnisse berichtet werden. Schlussfolgerung Die erfolgreiche Entwicklung einer langsam und gezielt okkludierenden Hydrogel-Textil-Membran als Komponente von endovaskulären Aortenprothesen könnte das klinisch bedeutsame Risiko spinaler Ischämie reduzieren helfen.

Recurrent hemarthrosis is a burdensome complication following TKA, characterized by repeated episodes of intra-articular bleeding that cause effusions and reduced range of motion, and is readily confirmed on aspiration. Coagulopathies should be ruled out first. Excluding patients with coagulopathy, impingement of hypertrophied synovium is typically the most common cause of bleeding. Pseudoaneurysms represent another important cause. Diagnosis relies on angiography to identify offending vessels or arthroscopic/open visualization. Treatment is straightforward and begins with conservative modalities with concurrent evaluation to detect an underlying coagulopathy. If these measures fail, more aggressive treatments may be required.

The objective of this research is to use nonlinear resonance ultrasound spectroscopy (NRUS) to evaluate the sensitivity of the nonclassical hysteretic nonlinearity parameter, α to microscopic material damage in metallic specimens. The proposed NRUS procedure uses both a noncontact source and receiver – an air-coupled piezoelectric transducer source and a laser vibrometer receiver – to excite and detect the axial motion of a slender rod. This fully noncontact configuration avoids mechanical contact which can adversely influence the measurements. This NRUS procedure measures α f and α Q by calculating the amount of the shift of the resonance frequency and the change of quality factor (Q) as a function of increasing excitation amplitudes. The sensitivity of this NRUS measured α parameters to small changes in microstructure is demonstrated on a series of thermally aged 17-4 PH stainless steel samples. These hysteretic nonlinearity ( α f and α Q ) results are then compared to (quadratic) acoustic nonlinearity parameter (β) values previously measured on these same 17-4 PH samples to demonstrate the sensitivity of the hysteretic nonlinearity parameters to changes in microstructure due to precipitate formation.

Fires are a common occurrence in Australian terrestrial ecosystems. A large fire occurred in January 2013 within and adjacent to the Warrumbungle National Park, near Coonabarabran in NSW, burning over 560 km2 of the park and surrounding region (the Wambelong fire). The Wambelong fire affected Dunphy Lake, the only lake in the park. In this study, we assessed the post-fire aquatic animal community of the lake in March and September 2014. At the times of sampling the lake was largely dry and had only small isolated pools. We found 53 invertebrate taxa including the larvae of the dragonfly Austrogynacantha heterogena and one vertebrate species (larvae of the frog Litoria rubella) in the pool-water samples. Artificial inundation of the lake sediment samples under laboratory conditions led to the emergence of 31 taxa, totalling 62 taxa in the lake overall. Most taxa found in the lake are opportunistic and characteristic of those in still-water bodies. Dunphy Lake seems to be highly resilient in sustai...

While all states in the United States require certain vaccinations for school attendance, all but three allow for religious exemptions to receiving such vaccinations, and 18 allow for exemptions on the basis of other deeply held personal beliefs. The rights of parents to raise children as they see fit may conflict with the duty of the government and society to protect the welfare of children. In the U.S., these conflicts have not been settled in a uniform and consistent manner. We apply a test that provides a concrete and formal rubric to evaluate such conflicts. For some vaccinations, based on the individual medical characteristics of the disease and the risks of being unvaccinated, the test would suggest that permitting conscientious exemptions is ethical. However, for vaccinations protecting against other diseases that are more severe or easily transmitted, the test would suggest that the federal government may ethically impose laws that deny such exemptions.

Adverse local tissue reactions to corrosion products can lead to total hip arthroplasty failure. Although this problem has been well known for more than 25 years, it has seemingly increased in frequency over the recent years. The occurrence of corrosion is multifactorial—depending on implant, patient, and surgeon factors. As of now, there is no “one-size-fits-all” solution to prevent corrosion in total hip arthroplasty devices. Thus, it is imperative to fully understand the exact mechanisms of modular junction corrosion to prevent premature implant failure. This review highlights a few key concepts that need to be explored to minimize the impact of corrosion. The key concepts include (1) the prevention of micromotion, (2) the role of implant alloy metallurgy in the corrosion process, (3) the in vivo generation of a corrosive environment, and (4) potential unanticipated problems.

The ability of cool roofs and vegetation to reduce urban temperatures and improve human thermal stress during heat wave conditions is investigated for the city of Melbourne, Australia. The Weather Research and Forecasting Model coupled to the Princeton Urban Canopy Model is employed to simulate 11 scenarios of cool roof uptake across the city, increased vegetation cover across the city, and a combination of these strategies. Cool roofs reduce urban temperatures during the day, and, if they are installed across enough rooftops, their cooling effect extends to the night. In contrast, increasing vegetation coverage reduces nighttime temperatures but results in minimal cooling during the hottest part of the day. The combination of cool roofs and increased vegetation scenarios creates the largest reduction in temperature throughout the heat wave, although the relationship between the combination scenarios is nonsynergistic. This means that the cooling occurring from the combination of both strategies is either larger or smaller than if the cooling from individual strategies were to be added together. The drier, lower-density western suburbs of Melbourne showed a greater cooling response to increased vegetation without enhancing human thermal stress due to the corresponding increase in humidity. The leafy medium-density eastern suburbs of Melbourne showed a greater cooling response to the installation of cool roofs. These results highlight that the optimal urban cooling strategies can be different across a single urban center.

A systematic literature review was conducted to evaluate the role of diet and food intake in age-related macular degeneration (AMD). Eighteen high-quality studies were identified. Adherence to a Mediterranean diet had decreased risk of AMD progression. An Oriental diet pattern had decreased association with AMD prevalence, whereas a Western diet pattern had increased association with AMD prevalence. High consumption of vegetables rich in carotenoids and fatty fish containing omega-3 fatty acids was beneficial for those at risk of AMD. Vegetable oils and animal fats containing omega-6 fatty acids, and red/processed meat should be consumed minimally to reduce the risk of AMD progression. High glycaemic index diets and alcohol consumption of greater than two drinks a day had increased association with AMD. As the quality of diet and food intake had a vital role in AMD, the provision of appropriate nutritional advice to those at risk of AMD is recommended.

In this discussion of Eugene Mahon's excellent paper, I focus on his concept of inwardness, its role in society, and its expression in poetry and psychoanalysis. I also discuss Mahon's view of the psychological appeal of poetry and compare the creative processes in the poet and the analyst.

Objective: The aim was to present current results of open thoracic and thoraco-abdominal aortic repair as secondary procedure after prior endovascular therapy. Methods: This was a retrospective cross border single centre study. From 2006 to July 2017 45 open thoracic aortic (TAA) or thoraco-abdominal aortic aneurysm (TAAA) operations were performed on 44 patients (median age 58 [15-80] years) as secondary surgery after previous endovascular therapy comprising TEVAR (n = 38; 86%), EVAR (n = 3; 7%), fenestrated EVAR (n = 1; 2%) and TEVAR plus EVAR (n = 1; 2%). Eleven patients (25%) had had previous open aortic surgery at the secondary surgery site. Indications for TAA(A) repair were Type I endoleak (n = 10; 23%), post-dissection aneurysm progression due to persisting false lumen perfusion (n = 8; 18%), proximal/distal disease progression (n = 16; 36%), device fracture/dislocation (n = 4; 9%), infection (n = 5; 11%), and initial endograft misplacement (n = 1; 2%). The operations included descending thoracic aortic repair (n = 13, 29%), TAAA Type I (n = 4; 9%), Type II (n = 5; 11%), Type III (n = 13; 29%), Type IV (n = 7; 16%), and Type V repair (n = 3; 7%) with simultaneous arch repair in 18% (n = 8). The median time to secondary surgery was 36 (2-168) months. The median follow up was 39 (3-118) months. Results: In hospital mortality was 20% (n = 9) due to intra-operative aneurysm rupture, pneumonia induced sepsis, hemorrhagic cerebellar infarction, mesenteric ischaemia, broncho-esophageal fistula, and multiorgan failure (1/9) as well as haemorrhage (3/9). Estimated survival was 73% at 1 year and 71% overall. The most frequent complications were pneumonia (n = 19; 43%), bleeding requiring revision (n = 11; 25%) and sepsis (n = 14; 32%). Transient dialysis was required in 32% (n = 14), permanent dialysis in 6% (n = 2). Permanent spinal cord deficit (paraparesis) occurred in 6% (n = 2). Estimated freedom from aortic re-intervention was 86%. Conclusion: Open TAA(A) repair as a secondary procedure after previous endovascular aortic therapy is an important treatment option even in the endovascular era. It represents a durable treatment that can produce respectable outcomes. Yet the peri-operative morbidity and mortality are relevant and a specialised team and infrastructure are mandatory for these complex procedures. Therefore, centralisation is required. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

Peri-implant osteolysis is commonly diagnosed after substantial bone loss has occurred, making revision surgery more challenging. The goal of the current study was to identify urinary biomarkers that differentiate total hip replacement patients who eventually develop osteolysis from patients who do not. We used a repository of 24-h urine samples collected prior to surgery and annually thereafter in 26 patients, 16 who developed osteolysis, and 10 who did not. We examined the markers at radiographic diagnosis, annually for 6 years preceding diagnosis, at the first post-operative sampling point, and pre-operatively. Patients in the osteolysis and non-osteolysis groups were matched according to time post-surgery and did not differ in the male:female ratio or age at surgery. Seven candidate biomarkers were measured, including free deoxypyridinoline (DPD), cross-linked N-telopeptides (NTX), interleukin-6 (IL-6), interleukin-8 (IL-8), osteoprotegerin (OPG), α-crosslaps (α-CTX), and β-crosslaps (β-CTX). As an individual biomarker, DPD demonstrated the highest ability to predict osteolysis, with an area under the curve (AUC) in Receiver Operating Characteristic (ROC) analyses of 0.844 at 6 years prior to diagnosis. A panel of α-CTX and IL-6 was able to identify at-risk patients with an AUC of 0.941 or greater at all post-operative time points and an AUC of 1.000 pre-operatively. The results demonstrate the potential of using non-invasive biomarkers to identify patients at risk for peri-implant osteolysis long before the emergence of radiographic signs. Further, the high accuracy of the pre-operative biomarker levels demonstrates the potential importance of pre-existing, patient-specific factors driving subsequent osteolysis. Study Design © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2754-2761, 2018.

The hippocampus plays a vital role in various aspects of cognition including both memory and spatial navigation. To understand electrophysiologically how the hippocampus supports these processes, we recorded intracranial electroencephalographic activity from 46 neurosurgical patients as they performed a spatial memory task. We measure signals from multiple brain regions, including both left and right hippocampi, and we use spectral analysis to identify oscillatory patterns related to memory encoding and navigation. We show that in the left but not right hippocampus, the amplitude of oscillations in the 1–3-Hz “low theta” band increases when viewing subsequently remembered object–location pairs. In contrast, in the right but not left hippocampus, low-theta activity increases during periods of navigation. The frequencies of these hippocampal signals are slower than task-related signals in the neocortex. These results suggest that the human brain includes multiple lateralized oscillatory networks that support different aspects of cognition.

Genetic changes causing brain size expansion in human evolution have remained elusive. Notch signaling is essential for radial glia stem cell proliferation and is a determinant of neuronal number in the mammalian cortex. We find that three paralogs of human-specific NOTCH2NL are highly expressed in radial glia. Functional analysis reveals that different alleles of NOTCH2NL have varying potencies to enhance Notch signaling by interacting directly with NOTCH receptors. Consistent with a role in Notch signaling, NOTCH2NL ectopic expression delays differentiation of neuronal progenitors, while deletion accelerates differentiation into cortical neurons. Furthermore, NOTCH2NL genes provide the breakpoints in 1q21.1 distal deletion/duplication syndrome, where duplications are associated with macrocephaly and autism and deletions with microcephaly and schizophrenia. Thus, the emergence of human-specific NOTCH2NL genes may have contributed to the rapid evolution of the larger human neocortex, accompanied by loss of genomic stability at the 1q21.1 locus and resulting recurrent neurodevelopmental disorders.

The mission of the Orthopaedic Research Society is to promote and advance musculoskeletal research worldwide. With this in mind, the Annual Meeting Program Committee sought to establish a debate as a key component of the meeting. Our purpose was to provoke discussion on topics that are core to our mission and to engage all constituencies within the society by examining questions of broad relevance. To this end, the topic "Regenerative medicine will make orthopaedic implants obsolete in our time" was selected as the title of the inaugural debate. The arguments for and against the motion are presented in this perspectives article. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2579-2585, 2018.

Purpose Potential cognitive and demographic correlates of medication nonadherence in older Hispanic adults with type 2 diabetes were investigated. Methods Forty community-dwelling participants 65 years of age or older were recruited. Executive control function (ECF) was assessed using the executive clock drawing task (CLOX 1) test and the 25-item Executive Interview. Self-reported medication adherence was measured on a visual analog scale (VAS); measures of glycemic control included glycosylated hemoglobin (HbA 1c ) concentration. The primary objective was to determine if ECF performance correlated with medication adherence or glycemic control. Results Participants’ mean ± S.D. age was 74.95 ± 7.07 years, and 73% ( n = 29) were female. Lower VAS scores correlated with worse CLOX 1 performance ( r = 0.38, p = 0.02) and worse HbA 1c status ( r = −0.42, p = 0.007). Linear regression modeling indicated significant associations between VAS scores and both CLOX 1 results (beta coefficient [β] = 0.41, p = 0.01) and educational level (β = 0.345, p = 0.03). Receiver operating characteristic analysis of CLOX 1 scores (scoring range, 0–15; lower scores indicate greater impairment) showed that a highly sensitive cutoff score for predicting adherence of Conclusion Results of an evaluation of a small sample of Hispanic older adults with type 2 diabetes demonstrated a relationship between ECF, as measured by the CLOX 1 instrument, and self-reported medication adherence.

Background Studies have begun to identify psychosocial factors associated with depressive symptoms in youth with IBD. However, despite considerable speculation in the literature regarding the role of perceived stigma in both social and emotional adjustment outcomes, youth appraisals of stigma have yet to receive empirical attention. The primary purpose of this study was to examine the indirect effect of perceived illness stigma on depressive symptoms through its impact on social belongingness. Methods Eighty youth (Mage = 14.96) with IBD completed measures of illness stigma, thwarted belongingness, and depressive symptoms during a scheduled clinic visit. Pediatric gastroenterologists provided estimates of disease activity. Analyses examined the direct and indirect effects of illness stigma on perceived thwarted belongingness and depressive symptoms. Results Bootstrapped regression results revealed significant illness stigma → depressive symptoms (β = 0.33, 95% CI, 0.108 to 0.526), illness stigma → thwarted belongingness (β =0.41, 95% CI, 0.061 to 0.739), and thwarted belongingness → depressive symptoms (β =0.32, 95% CI, 0.143 to 0.474) direct paths. Mediation analyses revealed a significant illness stigma → thwarted belongingness → depressive symptoms indirect path (β = 0.14, 95% CI, 0.034 to 0.310), suggesting increased appraisals of illness stigma impede youths' perceptions of social belongingness, which in turn, contribute to elevated depressive symptoms. Conclusions Youth perceptions of illness stigma negatively impact social belongingness and depressive symptoms in youth with IBD. Further, decreased perceptions of social belongingness may be one potential route through which stigma influences emotional adjustment outcomes. Results support clinical observations regarding the relevance of illness stigma and social functioning as targets of intervention for improving emotional adjustment in youth with IBD. 10.1093/ibd/izy011_video1izy011.video15775252424001.

This article describes the archives of the Fellowship Foundation, best known as the organizers of the National Prayer Breakfast in Washington DC. The secretive character of the Fellowship probably accounts for its lack of visibility in African historical narratives to date. This article makes a case that this evangelical network was significant as a clandestine “track two” diplomatic organization with ties throughout Africa. Historians of international relations, it is suggested, may find useful sources in the public archives of Fellowship Foundation correspondence at the Billy Graham Center at Wheaton College in Illinois. The article reviews the records for several countries and offers examples of the banal, secretive, and sometimes usefully suggestive evidence to be found in the correspondence.

Summary Secular states may be asked to override parental decisions based on religious beliefs when these decisions lead to concerns for the well-being of the child or welfare of society at large. Particular difficulties arise when goals of limited state importance to secular society conflict with practices that matter a great deal to members of religious groups. We propose a prudentially-based approach to resolving these conflicts by balancing the interests of the affected child, those close to the child, and society, without compromising the child's needs. This approach acknowledges the importance of children's relational interests as members of families and religious cultures. It is compatible both with legal and bioethical practice. Decisions are contextually framed, taking into account the degree to which the state generally tolerates risks to children's health and safety. The constraints built into our approach protect against using child welfare as a pretext for attacks on minorities. Finally, use of this approach partially addresses the imprecision of other standards that have been applied to judge the appropriateness of parental decisions.

This research explores five available signal processing methods: discrete Fourier transform (DFT); least squares method; original Prony method; least squares (LS) Prony method; and known poles (KP) Prony method, to accurately analyze the harmonic content of a tone-burst signal obtained from the second harmonic generation (SHG) measurement. Accurately obtaining the correct frequency content is especially important when the number of cycles is limited by the thickness or high attenuation of a specimen. Results from both numerically generated synthetic signals and experimental data from a specimen demonstrate that the least squares and KP Prony methods provide the most consistent and accurate results for tone-burst signals with low number of cycles. The conventional DFT provides accurate harmonic amplitudes only when the effective number of cycles (neff) is eight or higher. The least squares and KP Prony methods are then applied to a set of thin binary Fe-1.0% Cu alloy specimens where the changes in the nonlinearity parameter, β, as a function of heat treatment time is determined. The β parameters processed with these two methods produce trends that make better physical sense than processing with the original Prony method.

Background: The rate of revision for some designs of total hip replacements due to idiopathic aseptic loosening has been reported as higher for women. However, whether this is environmental or inherently sex-related is not clear. Objective: Can particle induced osteolysis be sex dependent? And if so, is this dependent on the type of implant debris (e.g. metal vs polymer)? The objective of this study was to test for material dependent inflammatory osteolysis that may be linked to sex using CoCrMo and implant grade conventional polyethylene (UHMWPE), using an in vivo murine calvaria model. Methods: Healthy 12 week old female and male C57BL/6J mice were treated with UHMWPE (1.0um ECD) or CoCrMo particles (0.9um ECD) or received sham surgery. Bone resorption was assessed by micro-computed tomography, histology and histomorphometry on day 12 post challenge. Results: Female mice that received CoCrMo particles showed significantly more inflammatory osteolysis and bone destruction compared to the females who received UHMWPE implant debris. Moreover, females challenged with CoCrMo particles exhibited 120% more inflammatory bone loss compared to males (p Conclusion: We demonstrated sex-specific differences in the amount of osteolysis resulting from CoCrMo particle challenge. This suggests osteo-immune responses to metal debris are preferentially higher in female compared to male mice, and supports the contention that there may be inherent sex related susceptibility to some types of implant debris.

Adverse childhood experiences (ACEs) and adult mental health were explored in a sample of urban Aboriginal ( n = 83) and non-Aboriginal ( n = 89) women. Childhood sexual abuse (CSA) was associated with negative home environments, teenage pregnancy, lifetime suicide attempts, and treatment seeking. Aboriginal women with CSA witnessed higher levels of physical/sexual abuse of family members. The severity of current psychological distress was associated with a history of childhood neglect. The results indicate that CSA rarely occurs in isolation, and that multiple ACEs are strongly associated with suicide attempts and treatment seeking in adulthood. Future studies should focus on the role of CSA in suicidality, as well as familial, community, and cultural protective factors.

The structural integrity of components that operate at elevated temperatures can be compromised by the precipitation of second phases during long-term service. In industry, the 475 °C embrittlement phenomenon due to spinodal decomposition of the ferrite phase that results in the formation of Cr-rich α′ precipitates at a relatively low temperature has been a concern because of its adverse effects on ferritic, duplex and super duplex stainless steels; this precipitation causes a rapid decrease in the impact and corrosion resistance of these steels. Some of the precipitates have micro or nanometer dimensions, which makes them difficult to detect with conventional ultrasonic nondestructive evaluation (NDE) methods. In contrast to the conventional linear ultrasonic NDE, nonlinear ultrasound offers a unique advantage of high sensitivity to microstructural changes such as those due to the precipitation of second phases, fatigue damage, plastic deformation, and thermal damage in metallic alloys. In this research, ultrasonic measurements were conducted to determine the nonlinearity parameter (β) of thermally embrittled 2507 SDSS specimens. The β parameters of these specimens were measured by exploiting two different nonlinear effects: the acoustoelastic effect and second harmonic generation in Rayleigh waves. Experimental results indicate that nonlinear parameters obtained from these independent experiments are consistent and sensitive to the 475 °C embrittlement process.

Using original instrumentation four vignettes investigated differences in forgiveness of friends based on gender. A general linear model found significant differences in five items that investigate...

PURPOSE: Use of glucosamine supplements has been associated with reduced risk of colorectal cancer (CRC) in previous studies; however, information on this association remains limited. METHODS: We examined the association between glucosamine use and colorectal cancer risk among 113,067 men and women in the Cancer Prevention Study II Nutrition Cohort. Glucosamine use was first reported in 2001 and updated every two years thereafter. Participants were followed from 2001 through June of 2011, during which time 1440 cases of CRC occurred. RESULTS: As has been observed in prior studies, current use of glucosamine, modeled using a time-varying exposure, was associated with lower risk of colorectal cancer (HR: 0.83; 95% CI: 0.71, 0.97) compared to never use. However, for reasons that are unclear, this reduction in risk was observed for shorter-duration use (HR: 0.68, 95% CI: 0.52–0.87 for current users with ≤2 years use) rather than longer-duration use (HR: 0.90, 95% CI: 0.72–1.13 for current users with 3

Background The fretting-corrosion behavior of mixed metal contacts is affected by various mechanical and electrochemical parameters. Crevice conditions at the junction and patient-specific pathologies can affect the pH of the prosthetic environment. The main objective of this study is to understand the effect of pH variation at the stem/head junction of the hip implant under fretting corrosion exposure. We hypothesized that pH will have a significant influence on the fretting-corrosion behavior hip implant modular junctions. Materials and methods A custom-made setup was used to evaluate the fretting corrosion behavior of hip implant modular junctions. A Newborn calf serum solution (30 g/L protein content) was used to simulate the synovial fluid environment. A sinusoidal fretting motion, with a displacement amplitude of +50 µm, was applied to the Ti alloy rod. The effects of pathology driven, periprosthetic pH variation were simulated at four different pH levels (3.0, 4.5, 6.0 and 7.6). Electrochemical and mechanical properties were evaluated before, during, and after the applied fretting motion. Results The impedance of the system was increased in response to the fretting motion. The hysteresis tangential load/displacement behavior was not affected by pH level. The worn surfaces of CoCrMo pins exhibited the presence of tribolayer or organic deposits, in the pH 4.5 group, which may explain the lower drop in potential and mass loss observed in that group. Mechanically dominated wear mechanisms, namely, adhesive wear was shown in the pH 7.6 group, which may account for a higher potential drop and metal content loss. Conclusions This study suggests that the fretting-corrosion mechanisms in hip implant are affected by the pH levels of the surrounding environment and patient-specific factors.