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Stuart A Robertson,1 Johann A Jeevaratnam,2 Avi Agrawal,2 Ramsey I Cutress,3,4 1Department of Surgery, University Hospital Coventry and Warwickshire NHS Trust, Coventry, 2Department of Breast Surgery, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth, 3Department of Breast Surgery, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, 4Somers Cancer Research UK Centre, Southampton General Hospital Southampton, UK Introduction: Mastectomy skin flap necrosis (MSFN) has a reported incidence of 5%–30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions. Methods: A MEDLINE search was performed using the search term “mastectomy skin flap necrosis”. Titles and abstracts from peer-reviewed publications were screened for relevance. Results: MSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited. Conclusion: MSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem. Keywords: mastectomy, flap, necrosis, complication, breast surgery

The causal association of Zika virus (ZIKV) with microcephaly, congenital malformations in infants, and Guillain-Barré syndrome in adults highlights the need for effective vaccines. Thus far, efforts to develop ZIKV vaccines have focused on the viral envelope. ZIKV NS1 as a vaccine immunogen has not been fully explored, although it can circumvent the risk of antibody-dependent enhancement of ZIKV infection, associated with envelope antibodies. Here, we describe a novel DNA vaccine encoding a secreted ZIKV NS1, that confers rapid protection from systemic ZIKV infection in immunocompetent mice. We identify novel NS1 T cell epitopes in vivo and show that functional NS1-specific T cell responses are critical for protection against ZIKV infection. We demonstrate that vaccine-induced anti-NS1 antibodies fail to confer protection in the absence of a functional T cell response. This highlights the importance of using NS1 as a target for T cell-based ZIKV vaccines.

Background: Adaptation of the maternal immune response to accommodate the semi-allogeneic fetus is necessary for pregnancy success, and disturbances in maternal tolerance are implicated in infertility and reproductive pathologies. T regulatory (Treg) cells are a recently discovered subset of T-lymphocytes with potent suppressive activity and pivotal roles in curtailing destructive immune responses and preventing autoimmune disease.Methods: A systematic review was undertaken of the published literature on Treg cells in the ovary, testes, uterus and gestational tissues in pregnancy, and their link with infertility, miscarriage and pathologies of pregnancy. An overview of current knowledge on the generation, activation and modes of action of Treg cells in controlling immune responses is provided, and strategies for manipulating regulatory T-cells for potential applications in reproductive medicine are discussed.Results: Studies in mouse models show that Treg cells are essential for maternal tolerance of the conceptus, and that expansion of the Treg cell pool through antigen-specific and antigen non-specific pathways allows their suppressive actions to be exerted in the critical peri-implantation phase of pregnancy. In women, Treg cells accumulate in the decidua and are elevated in maternal blood from early in the first trimester. Inadequate numbers of Treg cells or their functional deficiency are linked with infertility, miscarriage and pre-eclampsia.Conclusions: The potency and wide-ranging involvement of Treg cells in immune homeostasis and disease pathology indicates the considerable potential of these cells as therapeutic agents, raising the prospect of their utility in novel treatments for reproductive pathologies. [ABSTRACT FROM AUTHOR]

Cultural intelligence has been described across three parameters of human behavior: cognitive intelligence, emotional intelligence (EQ), and physical intelligence. Each contributes a unique and important perspective to the ability of speech-language pathologists and audiologists to provide benefits to their clients regardless of cultural backgrounds. This article provides an overview of the concept of EQ and its historic and theoretical foundations. Strategies for developing and implementing skills related to EQ to enhance clinical competence and cultural proficiency are explored. [ABSTRACT FROM AUTHOR]

Trap-neuter-return programs have become a popular nonlethal alternative for the control of feral cat populations. The anesthetic used is an integral component of these programs. This study evaluated the use of tiletamine–zolazepam–ketamine–xylazine (TKX) as an IM anesthetic combination for large-scale feral cat sterilization surgery. Between July 1996 and August 2000, a total of 7502 cats entered large-scale feral cat clinics operating at the Colleges of Veterinary Medicine at North Carolina State University and the University of Florida. Up to 12 surgeries were performed simultaneously and up to 200 cats were sterilized in a single day. Cats were not weighed prior to anesthetic injection owing to their feral nature, so the initial anesthetic dose was based on estimated body weight. Tiletamine–zolazepam–ketamine–xylazine was administered IM while cats remained in their traps. Each milliliter of TKX contained 50 mg tiletamine, 50 mg zolazepam, 80 mg ketamine, and 20 mg xylazine. The cats were monitored by observation and palpation for mucous membrane color, heart rate, and respiratory rate, but these values were not recorded. Fluids were not routinely administered but were given subcutaneously in cases of dehydration or excessive blood loss. Yohimbine (0.5 mg) was administered IV at the end of the procedure, and cats were returned to their traps to recover. Cat signalment, drug use, and mortality data were analyzed retrospectively (July 1996–December 1999) and prospectively (December 1999–August 2000). Of those cats with complete drug records, more than 75% received a single dose of TKX with a mean total dose of 0.27 ± 0.09 mL. The overall mortality rate was one in 289 cats (0.347%) and the death rate owing to unknown causes (potential anesthetic deaths) was one in 469 cats (0.213%). These results suggest that the use of TKX for large-scale feral cat sterilization clinics has several benefits,... [ABSTRACT FROM AUTHOR]

The success of Convolutional Neural Networks (CNNs) in image classification has prompted efforts to study their use for classifying image data obtained in Particle Physics experiments. Here, we discuss our efforts to apply CNNs to 2D and 3D image data from particle physics experiments to classify signal from background. In this work we present an extensive convolutional neural architecture search, achieving high accuracy for signal/background discrimination for a HEP classification use-case based on simulated data from the Ice Cube neutrino observatory and an ATLAS-like detector. We demonstrate among other things that we can achieve the same accuracy as complex ResNet architectures with CNNs with less parameters, and present comparisons of computational requirements, training and inference times.

Abstract Background Inhalation of diesel exhaust impairs vascular function in man, by a mechanism that has yet to be fully established. We hypothesised that pulmonary exposure to diesel exhaust particles (DEP) would cause endothelial dysfunction in rats as a consequence of pulmonary and systemic inflammation. Methods Wistar rats were exposed to DEP (0.5 mg) or saline vehicle by intratracheal instillation and hind-limb blood flow, blood pressure and heart rate were monitored in situ 6 or 24 h after exposure. Vascular function was tested by administration of the endothelium-dependent vasodilator acetylcholine (ACh) and the endothelium-independent vasodilator sodium nitroprusside (SNP) in vivo and ex vivo in isolated rings of thoracic aorta, femoral and mesenteric artery from DEP exposed rats. Bronchoalveolar lavage fluid (BALF) and blood plasma were collected to assess pulmonary (cell differentials, protein levels & interleukin-6 (IL-6)) and systemic (IL-6), tumour necrosis factor alpha (TNFα) and C-reactive protein (CRP)) inflammation, respectively. Results DEP instillation increased cell counts, total protein and IL-6 in BALF 6 h after exposure, while levels of IL-6 and TNFα were only raised in blood 24 h after DEP exposure. DEP had no effect on the increased hind-limb blood flow induced by ACh in vivo at 6 or 24 h. However, responses to SNP were impaired at both time points. In contrast, ex vivo responses to ACh and SNP were unaltered in arteries isolated from rats exposed to DEP. Conclusions Exposure of rats to DEP induces both pulmonary and systemic inflammation, but does not modify endothelium-dependent vasodilatation. Other mechanisms in vivo limit dilator responses to SNP and these require further investigation.