A Breast Prosthesis Infection Update: Two-Year Incidence, Risk Factors and Management at Single Institution

Background: Infection following augmentation and prosthetic-based breast reconstruction can cause significant physical and psychological distress for patients. It may delay adjuvant therapies and compromise aesthetic outcomes. The aim of this study is to identify modifiable risk factors for infection and identify common bacterial isolates to achieve optimal outcomes for patients. Methods: A retrospective cohort study was performed for patients undergoing implant-based breast reconstruction over a 2-year period. In each case, we documented demographics, co-morbidities, complications and antibiotic use. We reviewed treatments, infectious species cultured where applicable and all outcomes. Results: A total of 292 patients met the inclusion criteria. Fifty-five patients (19%) developed an infection. Univariate analysis showed a significantly increased infection rate with longer operative times (P = 0.001) and use of tissue expanders (P = 0.001). Multiple logistic regression analysis confirmed drain use and elevated body mass index (BMI) as risk factors (odds ratio [OR] 2.427 and 1.061, respectively). After controlling for BMI, smoking status and radiation, we found an increased odd of infection with allograft use (OR 1.838) and a decreased odd with skin preparation using 2% chlorhexidine gluconate in 70% isopropyl (OR 0.554), though not statistically significant. Forty of 55 patients with infections had cultures, with 62.5% of isolates being Gram-positive species and 30% Gram-negative species. The median time to clinical infection was 25 days. Implant salvage with surgical interventions was achieved in 61.5% of patients. Conclusions: This study identified judicious use of drains and efficiency in the operating room as modifiable risk factors for infections following implant-based breast reconstruction. Prospective trials to analyse techniques for infection prevention are warranted. Implant salvage following infection is a possible end-point in the appropriate patient

Predicting in-Hospital Mortality After an in-Hospital Cardiac Arrest: A Multivariate Analysis

Aim of the study: Most survivors of an in-hospital cardiac arrest do not leave the hospital alive, and there is a need for a more patient-centered, holistic approach to the assessment of prognosis after an arrest. We sought to identify pre-, peri-, and post-arrest variables associated with in-hospital mortality amongst survivors of an in-hospital cardiac arrest. Methods: This was a retrospective cohort study of patients ≥18 years of age who were resuscitated from an in-hospital arrest at our University Medical Center from January 1, 2013 to September 31, 2016. In-hospital mortality was chosen as a primary outcome and unfavorable discharge disposition (discharge disposition other than home or skilled nursing facility) as a secondary outcome. Results: 925 patients comprised the in-hospital arrest cohort with 305 patients failing to survive the arrest and a further 349 patients surviving the initial arrest but dying prior to hospital discharge, resulting in an overall survival of 29%. 620 patients with a ROSC of greater than 20 min following the in-hospital arrest were included in the final analysis. In a stepwise multivariable regression analysis, recurrent cardiac arrest, increasing age, time to ROSC, higher serum creatinine levels, and a history of cancer were predictors of in-hospital mortality. A history of hypertension was found to exert a protective effect on outcomes. In the regression model including serum lactate, increasing lactate levels were associated with lower odds of survival. Conclusion: Amongst survivors of in-hospital cardiac arrest, recurrent cardiac arrest was the strongest predictor of poor outcomes with age, time to ROSC, pre-existing malignancy, and serum creatinine levels linked with increased odds of in-hospital mortality

Analysis of Genes (\u3ci\u3eTMEM106B\u3c/i\u3e, \u3ci\u3eGRN\u3c/i\u3e, \u3ci\u3eABCC9\u3c/i\u3e, \u3ci\u3eKCNMB2\u3c/i\u3e, and \u3ci\u3eAPOE\u3c/i\u3e) Implicated in Risk for LATE-NC and Hippocampal Sclerosis Provides Pathogenetic Insights: A Retrospective Genetic Association Study

Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) is the most prevalent subtype of TDP-43 proteinopathy, affecting up to 1/3rd of aged persons. LATE-NC often co-occurs with hippocampal sclerosis (HS) pathology. It is currently unknown why some individuals with LATE-NC develop HS while others do not, but genetics may play a role. Previous studies found associations between LATE-NC phenotypes and specific genes: TMEM106B, GRN, ABCC9, KCNMB2, and APOE. Data from research participants with genomic and autopsy measures from the National Alzheimer’s Coordinating Center (NACC; n = 631 subjects included) and the Religious Orders Study and Memory and the Rush Aging Project (ROSMAP; n = 780 included) were analyzed in the current study. Our goals were to reevaluate disease-associated genetic variants using newly collected data and to query whether the specific genotype/phenotype associations could provide new insights into disease-driving pathways. Research subjects included in prior LATE/HS genome-wide association studies (GWAS) were excluded. Single nucleotide variants (SNVs) within 10 kb of TMEM106B, GRN, ABCC9, KCNMB2, and APOE were tested for association with HS and LATE-NC, and separately for Alzheimer’s pathologies, i.e. amyloid plaques and neurofibrillary tangles. Significantly associated SNVs were identified. When results were meta-analyzed, TMEM106B, GRN, and APOE had significant gene-based associations with both LATE and HS, whereas ABCC9 had significant associations with HS only. In a sensitivity analysis limited to LATE-NC + cases, ABCC9 variants were again associated with HS. By contrast, the associations of TMEM106B, GRN, and APOE with HS were attenuated when adjusting for TDP-43 proteinopathy, indicating that these genes may be associated primarily with TDP-43 proteinopathy. None of these genes except APOE appeared to be associated with Alzheimer’s-type pathology. In summary, using data not included in prior studies of LATE or HS genomics, we replicated several previously reported gene-based associations and found novel evidence that specific risk alleles can differentially affect LATE-NC and HS

Semileptonic B decays to excited charmed mesons

Exclusive semileptonic B decays into excited charmed mesons are investigated at order $\Lambda_{QCD}/m_Q$ in the heavy quark effective theory. Differential decay rates for each helicity state of the four lightest excited $D$ mesons ($D_1$, $D_2^*$, $D_0^*$, and $D_1^*$) are examined. At zero recoil, $\Lambda_{QCD}/m_Q$ corrections to the matrix elements of the weak currents can be written in terms of the leading Isgur-Wise functions for the corresponding transition and meson mass splittings. A model independent prediction is found for the slope parameter of the decay rate into helicity zero $D_1$ at zero recoil. The differential decay rates are predicted, including $\Lambda_{QCD}/m_Q$ corrections with some model dependence away from zero recoil and including order $\alpha_s$ corrections. Ratios of various exclusive branching ratios are computed. Matrix elements of the weak currents between $B$ mesons and other excited charmed mesons are discussed at zero recoil to order $\Lambda_{QCD}/m_Q$. These amplitudes vanish at leading order, and can be written at order $\Lambda_{QCD}/m_Q$ in terms of local matrix elements. Applications to $B$ decay sum rules and factorization are presented.Comment: 39 pages revtex including 10 figures, uses epsf. Substantial improvements throughout the pape

Discovery of Endangered Mexican Blindcat, Prietella phreatophila, in Texas: Implications for International Groundwater Management and Evolution of the Regional Karst Aquifer Biota

Paper presented July 15, 2017 at the annual Joint Meeting of Ichthyologists and Herpetologists in Austin, Texas, USA (http://conferences.k-state.edu/JMIH-Austin-2017/). The oral presentation of this content mentioned questions about the taxonomy and phylogenetic position of Prietella lundbergi and the only specimens attributed to P. lundbergi apart from the holotype. Since the presentation, we obtained high resolution CT scans of both the holotype and a specimen (TNHC 25767) from Cueva del Nacimiento del Río Frio, not far north of the type locality. The anatomy revealed in those CT scans suggests that these specimens represent a single species, and that P. lundbergi is only remotely related to Prietella phreatophila, which would be consistent with results of Wilcox, T.P., F.J. Garcı́a de León, Dean A. Hendrickson, and D.M. Hillis. 2004. “Convergence among Cave Catfishes: Long-Branch Attraction and a Bayesian Relative Rates Test.” Molecular Phylogenetics and Evolution 31 (3): 1101–13. doi:10.1016/j.ympev.2003.11.006). Thus, further research is in progress by Hendrickson, Lundberg, Luckenbill and Arce that may result in taxonomic revision removing P. lundbergi from Prietella.Mexican blindcat, Prietella phreatophila, described in 1954 from a cave system near the town of Múzquiz in central Coahuila state, and considered a Mexican endemic, was listed by the U.S. Fish and Wildlife Service as a foreign endangered species (protected "wherever found") in 1970. Explorations in the 1990s discovered many new localities extending nearly to the international border, and in 2016 the species was discovered in Amistad National Recreation Area (ANRA) in Texas, just north of the international border near Del Rio. Not only does the discovery support the aquifer of this fish being an internationally shared resource, but the stygobitic invertebrate biota found with the fish indicates a potentially large extent of the aquifer, and thus possibly the fish, in Texas. Invertebrate faunal connections (historic or current) extend from the Amistad Lake area of the new occurrence west into the Trans-Pecos region and east into the Edwards Aquifer of central Texas. We explore implications of this for both water management and evolutionary history of this and other blind ictalurids, and suggest that population genetic studies of both stygobitic fishes and invertebrates could help hydrogeologists better define often difficult to map aquifer extents and interconnections. While NPS is continuing to support the cave explorations of ANRA that produced the Texas discovery, we propose a broader bi-national sampling effort for both the fish and invertebrates extending well beyond the current known distribution of P. phreatophila. We also pointed out questions about phylogenetic relatedness of P. phreatophila and P. lundbergi further south, as well as the possibility of a monophyletic clade of blindcats, including those of the Edwards Aquifer, Satan and Trogloglanis. If substantiated, that evolutionary history would imply broader historic inter-aquifer connections ranging from the San Antonio area as far south as southernmost Tamaulipas. Finally, we report establishment of a small captive population of Prietella phreatophila at San Antonio Zoo for research and possibly eventual conservation applications.U.S. National Park Service; San Antonio Zoo; University of Texas at Austin College of Natural Sciences and Department of Integrative BiologyIntegrative Biolog

Discovery of the Mexican Blindcat, Prietella phreatophila, in the U.S., and an update on its rangewide conservation status

presented at the 2017 meeting of the Texas Academy of Science at Mary Hardin Baylor University, Belton, TexasMexican blindcat, Prietella phreatophila, was described in 1954 from a single locality in Northern Coahuila, México. Long listed as endangered by the Mexican federal government, it was listed by the U.S. Fish and Wildlife Service as a foreign endangered species in 1970, and the most recent (1996) update of its assessment for the IUCN Red List considers it endangered as well. Explorations in the late 1990s discovered many new localities extending nearly to the international border, and a captive population established provided insights into the species’ basic biology and behavior. In 2016 the species was discovered in a cave in the Amistad National Recreation Area (ANRA), just north of the Río Grande in Texas. The 1970 listing instantly gave the TX population full protection under the U.S. Endangered Species Act. The species’ subterranean and mostly inaccessible habitat endows it with extremely low detectability and its actual range is likely broader than physical sampling of specimens has revealed. We review all prior and new knowledge of the species and its habitat to provide an updated international reassessment of its overall conservation status and threats, which most notably include aquifer depletion and contamination in both the Mexican and U.S. portions of its known range. A live captive population of two specimens collected in 1997 in Coahuila and one Texas specimen is now at the San Antonio Zoo, we are working with NPS to further explore ANRA caves and hope eventually to return to Coahuila to more fully update the species’ conservation status.Integrative Biolog

Evolutionary and biomedical insights from the rhesus macaque genome

The rhesus macaque (Macaca mulatta) is an abundant primate species that diverged from the ancestors of Homo sapiens about 25 million years ago. Because they are genetically and physiologically similar to humans, rhesus monkeys are the most widely used nonhuman primate in basic and applied biomedical research. We determined the genome sequence of an Indian-origin Macaca mulatta female and compared the data with chimpanzees and humans to reveal the structure of ancestral primate genomes and to identify evidence for positive selection and lineage-specific expansions and contractions of gene families. A comparison of sequences from individual animals was used to investigate their underlying genetic diversity. The complete description of the macaque genome blueprint enhances the utility of this animal model for biomedical research and improves our understanding of the basic biology of the species

Is bisexuality invisible? A review of sexualities scholarship 1970–2015

This article provides a review of sexualities scholarship within the social sciences between 1970 and 2015. It takes an innovative approach by focusing on the way in which bisexuality is addressed in this body of literature. The article reveals the marginalisation, under-representation and invisibility of bisexuality within and across the social sciences in relation to both bisexual experience and identity. Reasons for this varied across the different eras, including the heterosexist nature of the literature, the impact of gay and lesbian-focused identity politics, and queer deconstructionism. In addition, patterns of bisexual erasure and invisibility were uneven, with some scholarship taking inclusive approaches or criticising prejudice against bisexuality. The initial findings of the review were enriched by critical commentary from key relevant sociologists and political scientists. The article concludes that future sexualities scholarship could be enhanced by greater consideration of bisexuality

Search for a new resonance decaying to a W or Z boson and a Higgs boson in the ll/lv/vv + bb final states with the ATLAS detector

A search for a new resonance decaying to a W or Z boson and a Higgs boson in the ll/lv/vv + bb final states is performed using 20.3 fb −1 of pp collision data recorded at √ s = 8 TeV with the ATLAS detector at the Large Hadron Collider. The search is conducted by examining the W H / Z H invariant mass distribution for a localized excess. No significant deviation from the Standard Model background prediction is observed. The results are interpreted in terms of constraints on the Minimal Walking Technicolor model and on a simplified approach based on a phenomenological Lagrangian of Heavy Vector Triplets