Poor anaerobic threshold and VO2 max recorded during cardiopulmonary exercise testing (CPET) prior to cytoreductive surgery in advanced (stage 3/4) ovarian cancer (AOC) is associated with suboptimal cytoreduction but does not preclude maximum effort cytoreduction.

This study assessed Cardiopulmonary Exercise Testing (CPET) in predicting oncological outcomes, post-operative recovery and complications in advanced ovarian cancer (AOC) cytoreductive surgery. We reviewed all patients who had CPET prior to AOC cytoreductive surgery with evidence of upper abdominal disease on preoperative imaging at the University Hospitals of Derby and Burton (UHDB) between August 2016 and July 2019. Patients were stratified by AT and maximum VO2 levels. 43 patients were identified. AT showed no relationship with major complications. 100% of patients in the AT ≥11 group received R0 (n = 21, 91.30%), or R1 (n = 2, 8.70%) cytoreduction, whereas in the AT <11 group, only 75.00% achieved and R0 or R1 resection (p = .02). Surgical complexity was higher in the AT ≥11 group (p = .001) and the VO2 ≥15 group (p = .0006). No other correlations were seen between AT or VO2 max and complications or readmissions. No difference in overall survival was seen if R0 resection was achieved.IMPACT STATEMENTWhat is already known on this subject? CPET testing allows pre-operative assessment of functional capacity to generate variables that can be used as a risk-stratification tool for major surgery. Whilst CPET testing has been shown to predict morbidity in non-gynaecological surgery, it remains unproven in cytoreductive surgery for ovarian cancer surgery despite being increasingly utilised.What do the results of study add? Our data suggest that CPET testing does not predict complication rates or survival in AOC. Patients with poor CPET performance are more likely to receive suboptimal cytoreductive outcomes from surgery.What are the implications of these findings for clinical practice and/or further research? CPET results should not be used to discount patients from cytoreductive surgery further research should address the interplay with nutrition, haematological markers, neoadjuvant chemotherapy and CPET performance.

The Middle to Later Stone Age transition at Panga ya Saidi, in the tropical coastal forest of eastern Africa.

The Middle to Later Stone Age transition is a critical period of human behavioral change that has been variously argued to pertain to the emergence of modern cognition, substantial population growth, and major dispersals of Homo sapiens within and beyond Africa. However, there is little consensus about when the transition occurred, the geographic patterning of its emergence, or even how it is manifested in the stone tool technology that is used to define it. Here, we examine a long sequence of lithic technological change at the cave site of Panga ya Saidi, Kenya, that spans the Middle and Later Stone Age and includes human occupations in each of the last five Marine Isotope Stages. In addition to the stone artifact technology, Panga ya Saidi preserves osseous and shell artifacts, enabling broader considerations of the covariation between different spheres of material culture. Several environmental proxies contextualize the artifactual record of human behavior at Panga ya Saidi. We compare technological change between the Middle and Later Stone Age with on-site paleoenvironmental manifestations of wider climatic fluctuations in the Late Pleistocene. The principal distinguishing feature of Middle from Later Stone Age technology at Panga ya Saidi is the preference for fine-grained stone, coupled with the creation of small flakes (miniaturization). Our review of the Middle to Later Stone Age transition elsewhere in eastern Africa and across the continent suggests that this broader distinction between the two periods is in fact widespread. We suggest that the Later Stone Age represents new short use-life and multicomponent ways of using stone tools, in which edge sharpness was prioritized over durability.

Publisher Correction: 78,000-year-old record of Middle and Later Stone Age innovation in an East African tropical forest.

The originally published version of this Article contained an error in Fig. 3, whereby an additional unrelated graph was overlaid on top of the magnetic susceptibility plot. Furthermore, the Article title contained an error in the capitalisation of 'Stone Age'. Both of these errors have now been corrected in both the PDF and HTML versions of the Article.

78,000-year-old record of Middle and Later stone age innovation in an East African tropical forest.

The Middle to Later Stone Age transition in Africa has been debated as a significant shift in human technological, cultural, and cognitive evolution. However, the majority of research on this transition is currently focused on southern Africa due to a lack of long-term, stratified sites across much of the African continent. Here, we report a 78,000-year-long archeological record from Panga ya Saidi, a cave in the humid coastal forest of Kenya. Following a shift in toolkits ~67,000 years ago, novel symbolic and technological behaviors assemble in a non-unilinear manner. Against a backdrop of a persistent tropical forest-grassland ecotone, localized innovations better characterize the Late Pleistocene of this part of East Africa than alternative emphases on dramatic revolutions or migrations.

Oral Fluid vs. Urine Analysis to Monitor Synthetic Cannabinoids and Classic Drugs Recent Exposure.

BACKGROUND: Urine is a common biological sample to monitor recent drug exposure, and oral fluid is an alternative matrix of increasing interest in clinical and forensic toxicology. Limited data are available about oral fluid vs. urine drug disposition, especially for synthetic cannabinoids. OBJECTIVE: To compare urine and oral fluid as biological matrices to monitor recent drug exposure among HIV-infected homeless individuals. METHODS: Seventy matched urine and oral fluid samples were collected from 13 participants. Cannabis, amphetamines, benzodiazepines, cocaine and opiates were analyzed in urine by the enzyme-multipliedimmunoassay- technique and in oral fluid by liquid chromatography tandem mass spectrometry (LCMSMS). Eleven synthetic cannabinoids were analyzed in urine and in oral fluid by LC-MSMS. RESULTS: Five oral fluid samples were positive for AB-FUBINACA. In urine, 4 samples tested positive for synthetic cannabinoids PB-22, 5-Fluoro-PB-22, AB-FUBINACA, and metabolites UR-144 5-pentanoic acid and UR-144 4-hydroxypentyl. In only one case, oral fluid and urine results matched, both specimens being AB-FUBINACA positive. For cannabis, 40 samples tested positive in urine and 30 in oral fluid (85.7% match). For cocaine, 37 urine and 52 oral fluid samples were positive (75.7% match). Twenty-four urine samples were positive for opiates, and 25 in oral fluid (81.4% match). For benzodiazepines, 23 samples were positive in urine and 25 in oral fluid (85.7% match). CONCLUSION/DISCUSSION: These results offer new information about drugs disposition between urine and oral fluid. Oral fluid is a good alternative matrix to urine for monitoring cannabis, cocaine, opiates and benzodiazepines recent use; however, synthetic cannabinoids showed mixed results.

Traits of autism spectrum disorders in adults with gender dysphoria.

The literature examining the co-occurrence of gender dysphoria (GD) and autistic traits has so far been limited to a series of small case studies and two systematic studies, one looking at autistic traits in gender dysphoric children and the other set within the context of the extreme male brain hypothesis and looking at adults. The current study examined this co-occurrence of GD and autistic traits in an adult population, to see whether this heightened prevalence persisted from childhood as well as to provide further comparison of MtF versus FtM transsexuals and homosexual versus nonhomosexual individuals. Using the Autistic Spectrum Quotient (AQ), 91 GD adults (63 male-to-female [MtF] and 28 female-to-male [FtM]) undertaking treatment at a gender clinic completed the AQ. The prevalence of autistic traits consistent with a clinical diagnosis for an autism spectrum disorder (ASD) was 5.5 % (n = 3 MtF and n = 2 FtM) compared to reports of clinical diagnoses of 0.5-2.0 % in the general population. In contrast to the single previous report in adults, there was no significant difference between MtF and FtM on AQ scores; however, all of those who scored above the clinical cut-off were classified as nonhomosexual with respect to natal sex. Results were considered in the context of emerging theories for the observed co-occurrence of GD and autistic traits.

Topological and Historical Considerations for Infectious Disease Transmission among Injecting Drug Users in Bushwick, Brooklyn (USA).

Recent interest by physicists in social networks and disease transmission factors has prompted debate over the topology of degree distributions in sexual networks. Social network researchers have been critical of "scale-free" Barabasi-Albert approaches, and largely rejected the preferential attachment, "rich-get-richer" assumptions that underlie that model. Instead, research on sexual networks has pointed to the importance of homophily and local sexual norms in dictating degree distributions, and thus disease transmission thresholds. Injecting Drug User (IDU) network topologies may differ from the emerging models of sexual networks, however. Degree distribution analysis of a Brooklyn, NY, IDU network indicates a different topology than the spanning tree configurations discussed for sexual networks, instead featuring comparatively short cycles and high concurrency. Our findings suggest that IDU networks do in some ways conform to a "scale-free" topology, and thus may represent "reservoirs" of potential infection despite seemingly low transmission thresholds.

Female-to-male transgender chest reconstruction: a large consecutive, single-surgeon experience.

INTRODUCTION: Chest reconstruction in the female-to-male transgender individual is not a common procedure due to the low prevalence of intractable gender dysphoria. It means that few surgeons acquire sufficient expertise and many UK patients find themselves travelling abroad to centres such as Singapore, Amsterdam and the United States. PATIENTS AND METHODS: This study retrospectively evaluated 100 consecutive patients of a single surgeon over a 3-year period with prime outcome measures including surgical technique, complications, surgical revision and patient-reported satisfaction, using a simple, 1-5 linear analogue scoring system. RESULTS: The median age was 28 years with a median excision of 345 g per breast. Complications occurred in 11 patients, five of which required surgical haematoma evacuation. Chi(2) analysis failed to show a correlation between testosterone supplementation and haemorrhagic sequelae (p>0.1). To date, 16 patients have undergone supplementary surgery, predominantly axillary dog-ear revision. Overall patient-reported satisfaction was 4.25. CONCLUSIONS: Whilst only a part of the process in gender transitioning, chest reconstruction is important as it is frequently the initial surgical procedure and enables the large-breasted to live in their chosen role much more easily. Historically associated with high rates of both complication and revision surgery, this study demonstrates that both may be appreciably lower and associated with high levels of patient satisfaction so that there is a realistic, high-quality option for British patients who might otherwise feel the need to travel abroad for their surgery.

Dimensional stability of complete denture permanent acrylic resin denture bases; A comparison of dimensions before and after a second curing cycle.

The purpose of this study was to measure deformation of mandibular complete denture permanent bases after secondary curing. A cast of a flat mandibular edentulous ridge was duplicated ten times. A wax base was laid on the original cast, two wax sprues were attached and an overcast was made. The overcast was used to produce wax bases similar in outline and thickness on the duplicate casts. These were invested and following manufacturer's instructions ten similar acrylic resin bases were produced. The fitting surface of each denture base was scanned on a contacting scanner with an axis resolution of 1 microm and accurate to 25 microm. Denture teeth were waxed up on the base on the original master cast, an overcast was made to produce wax ups and tooth positions that were similar in outline and thickness to the original. These were processed, removed from the flasks and excess acrylic resin was removed. The denture bases were rescanned in an identical fashion to the first scanning procedure. Using commercially developed metrology software calibrated colour maps were generated for each denture base that illustrates measurements of differences between pairs of surfaces. Histograms showing distributions of distances between points were constructed. 50% of the points were separated by a mean 50 microm or less and that 90% of the points were separated by 160 microm or less. The maximum separation was of 380 microm. Complete denture permanent bases were not found to distort significantly as a result of being subjected to a second heat curing cycle as part of final processing of dentures.

Analysis of clinical motor testing for adult patients with diagnosed ulnar neuropathy at the elbow.

OBJECTIVE: To compare the dichotomous results for 7 ulnar nerve clinical motor tests (Froment's sign, Wartenberg's sign, finger flexion sign, Jeanne's sign, crossed finger test, Egawa's sign, presence of clinical fasciculations) with motor nerve conduction velocity findings. DESIGN: A static group comparison design assessed for differences among dichotomous test outcomes with respect to motor nerve conduction velocity. SETTING: Five medical facilities throughout the United States provided data for this study. PARTICIPANTS: Records from participants (N=26) with diagnosed ulnar neuropathy at the elbow were included for data analysis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographic data included age, sex, handedness, duration of symptoms, and the number of days between the clinical and electrodiagnostic exam. Other dependent variables included motor conduction velocity of the ulnar nerve, compound muscle action potential amplitude, and the dichotomous clinical motor test outcomes. RESULTS: Two motor signs, the presence of clinical fasciculations and a positive finger flexion sign, were identified more frequently (each present in 11 patients) than the other motor signs. An analysis of covariance revealed significant differences in motor nerve conduction velocity between positive and negative results for all the clinical motor tests except for the finger flexion sign. Significant chi-square analyses were found for the following comparisons: the presence of clinical fasciculations and Froment's sign, the finger flexion sign and the crossed finger test, Egawa's sign and Froment's sign, Warteberg's sign and Froment's sign, the crossed finger test and Froment's sign, and Egawa's sign and Wartenberg's sign. CONCLUSIONS: Some clinical motor tests are better than others at identifying early motor involvement, providing the rehabilitation professional some insight regarding the relative decrement of motor nerve conduction velocity when a selected test is positive.

Surface roughness of impression materials and dental stones scanned by non-contacting laser profilometry.

OBJECTIVE: To analyze differences in the way dental materials digitize on a non-contacting laser profilometer (NCLP). METHODS: Three Type IV dental stones and 15 impression materials were mixed according to the manufacturer's instructions and expressed against a glass block to record its surface characteristics. From each material an area of 6 x 40 mm was scanned on the NCLP and the Ra, Rq and Rt roughness values measured from 20 randomly selected transverse profiles. The surface of the impression materials was subsequently poured in Moonstone (Bracon Ltd., Etchingham, England) dental stone and the same roughness values obtained from these casts. Differences in roughness values from the dental materials were compared using ANOVA and differences in roughness between impression materials and the Moonstone casts compared using paired t-tests. RESULTS: There were significant differences in roughness values between individual materials within each type (impression material or dental stone) (p<0.05). The roughness of the dental stones varied between Ra=0.87 and 0.99 microm, Rq=1.09 and 1.23 microm, and Rt=5.70 and 6.51 microm. The roughness values of the impression materials varied between Ra=0.75 and 4.56 microm; Rq=0.95 and 6.27 microm and Rt=4.70 and 39.31 microm. Darker materials showed higher roughness values compared to lighter materials (p<0.05). The roughness of the Moonstone casts varied between Ra=0.80 and 0.98 microm; Rq=1.01 and 1.22 microm, and Rt=5.04 and 6.38 microm. Roughness values of some impression materials were statistically significantly lower when the surface was reproduced in Moonstone (p<0.01). SIGNIFICANCE: Digitization of dental materials on optical profilometers was affected by color and transparency.

Effect of GC METALPRIMER II on bond strength of heat-cured acrylic resin to titanium alloy (Ti-6Al-4V) with two different surface treatments.

This study investigated the bond strength of heat-polymerized acrylic resin to titanium alloy using a proprietary bonding agent (GC Metalprimer II). Two surface treatments (sandblasted or roughened with a tungsten carbide bur) were compared for their effect on bond strength with or without thermal cycling. Eighty specimens of heat-polymerized acrylic resin bonded to titanium alloy (Ti-6Al-4V) were prepared: 20 specimens (control) and 60 used a bonding agent. Four-point bend testing was used to record the load at failure. A chemical bond between heat-polymerized resin and alloy was achieved using GC Metalprimer II with both surface treatments. Reduced failure loads were recorded after thermal cycling. The predominant mode of failure was cohesive. GC Metalprimer II was effective in achieving a chemical bond with either the sandblasted or roughened surfaces.

The constitution, physical properties and biocompatibility of modified accelerated cement.

OBJECTIVES: The aim of this study was to determine constitution and physical properties of a prototype material based on Portland cement and assess biocompatibility compared with glass-ionomer cement by evaluating cell morphology. MATERIALS AND METHODS: Analysis of the material was performed using energy dispersive analysis (EDAX) and X-ray diffraction (XRD) analysis. Compressive strength and the effect of changing the mixing and curing conditions on the compressive strength of the materials were evaluated. Dimensional stability was evaluated by measuring water uptake of the materials. Biocompatibility was assessed at 1 and 28 days using a cell-culture technique and semi-quantitative cell morphological evaluation was performed by SEM. RESULTS: Analysis of the material showed that it was primarily composed of tricalcium silicate and dicalcium silicate. The compressive strength of the prototype cement and variants was comparable to Ketac Molar (47.98 N mm(-2) after 1 day, P>0.05). Vacuum mixing did not improve the compressive strength of the prototype cements at any age. Wet curing was detrimental to the neat cement at 1 day (35.98 N mm(-2), P=0.011) and 7 days (44.08 N mm(-2), P=0.025). The filler-replaced cement prototypes were more stable and less susceptible to changes in compressive strength by varying the curing method (P>0.05). The prototype material took up more water (0.9%) than glass-ionomer cement (1.7%) with P=0 after 1 day. Curing at 100% humidity resulted in a net loss of weight for all the materials tested. The test materials were less biocompatible than glass-ionomer cement at 1 day but their biocompatibility improved as the material aged. CONCLUSIONS: The constitution of the prototype material was broadly similar to that of mineral trioxide aggregate. The prototype cement could be a potential dental restorative material as its compressive strength compared well to an established restorative material. However, the material did not support cell growth, with biocompatibility being similar to that of glass-ionomer cement.

Social capital or networks, negotiations, and norms? A neighborhood case study.

"Social capital" has been critiqued as distracting attention from inequalities and policies that produce ill health. We support this critique insofar as social capital refers to the degree of trust and consensus in a locality, but find value in another dimension often included in the concept of social capital--social network ties and their associated communication patterns. We present a case study of Bushwick, a community of 100,000 people in Brooklyn NY, to suggest that the network aspect of "social capital" is useful to understand the active, on-the-ground processes by which residents of some neighborhoods beset by poverty, racial/ethnic subordination, and internal divisions (that themselves arise from inequalities and state policies) work out ways to defend their own and others' safety and health. We use a combination of population-representative survey data for young adults; sexual network survey data; and ethnography to show that Bushwick residents (including drug users and dealers) have used social network ties, communication, and normative pressures to reduce the extent to which they are put at risk by the drug trade and by drug-use-related HIV/AIDS in spite of conflicting interests, disparate values, and widespread distrust both of other community members and of dominant social institutions. This was done by "intravention" health communications, development of protective norms, informal negotiations, and other forms of adjustments within and among various groups--but it occurred in the absence of trust or consensus in this community. We conclude both (1) that social network interpretations of "social capital" might be better conceptualized in dialectic terms as collective action to survive in a harsh social order, and (2) that the social capital theory emphasis on trust and consensus as important causal factors for lowering drug-related risks at the community level may be a romanticized and erroneous perspective.

Deformation of phosphate-bonded investment materials at elevated temperatures.

OBJECTIVES: To determine deformation in phosphate-bonded investment (PBI) materials for "in-service conditions" and to investigate the influence of air bubble pores on deformation at 900 degrees C. METHODS: Surviving high and low strain-rate disc-rupture strength test samples were assessed for deformation. A dental centrifugal casting machine and a dental superplastic-forming machine were used to apply the loads. An indirect technique was used to measure the deformation of investment diaphragms with both a wide pore size distribution and with very low porosity for four investment materials. A total of 128 high strain-rate and 29 low strain-rate samples were investigated. A one-way analysis of variance was carried out. RESULTS: All but one of the high strain-rate test samples showed measurable deformation. All of the low strain-rate test samples containing pores showed measurable deformation. Six out of 14 samples, in which pores had been eliminated, showed no deformation. There was no statistically significant difference in deformation between samples with no pores and those with a large pore size distribution for either the high or low strain-rate tests (P>0.05). SIGNIFICANCE: PBI must survive all forming procedures without deformation if the resultant prosthesis is to fit. One hundred micrometres is generally recognized as the acceptable tolerance of fit for removable metal-based prostheses. The vast majority of deformations measured during this investigation were considerably greater than 100 microm.

Characterization of Portland cement for use as a dental restorative material.

OBJECTIVES: The aim of this study was to evaluate the suitability of fast-setting cement formulations based on Portland cement as dental core build-up materials using two different methods of testing compressive strength and evaluation of setting times. METHODS: Four fast-setting cements based on Portland cement and their four respective densified with small particle (DSP) mortars were tested for setting time, constitution of cement by EDAX, and compressive strength using International and British Standards. Ordinary Portland cement (OPC) was used as a control. RESULTS: All the fast-setting cements had a similar elemental composition to OPC and the setting times were less than 7 min. The compressive strength of OPC was different between the two methods (P<0.001). All the fast-setting cements tested showed no difference in compressive strength regardless of the method of testing at 1 and 7 days (P>0.05), but the cylinders showed a lower compressive strength at 28 days (P<0.05). The OPC DSP mortar showed poorer compressive strength than OPC (P<0.01) at all times for cube testing but not for cylinder testing, where no difference was observed. The fast-setting DSP mortars had a lower compressive strength at 1 day (P<0.005) with both methods. At later times, there was no difference between the cements and DSP mortars for the cubes. SIGNIFICANCE: The pure fast-setting cements set in <7 min and were not susceptible to changes in the compressive strength testing procedure at 1 and 7 days but at 28 days all the fast-setting cements had a significantly higher strength with the test using cubes (P<0.05). A reduction in strength was observed at 28 days in cylinder testing. Most of the cements tested did not show encouraging strengths, however, one of the prototype cements tested could be a prospective dental restorative material.

The constitution of mineral trioxide aggregate.

OBJECTIVES: The aim of this study was to determine the constitution of a commercially available root-end filling material, mineral trioxide aggregate, (MTA) (ProRoot MTA, Tulsa Dental, Tulsa, OK, USA). The surface morphology of the material with various treatment conditions was also evaluated. METHODS: The constitution of two commercial versions of MTA was determined before and after mixing with water. The unset material was analysed using Energy Dispersive Analysis by X-ray (EDAX) in a scanning electron microscope (SEM) and X-ray diffraction (XRD). The first technique identified the constituent elements while XRD analysis identified the compounds or phases present. The set material was evaluated using EDAX. The surface morphology of the material stored under various conditions (100% humidity, immersion in water, or immersion in phosphate solution) was evaluated using SEM. RESULTS: The EDAX showed the white MTA to be composed primarily of calcium, silicon, bismuth and oxygen, with the gray MTA also having small peaks for iron and aluminum. The XRD analysis showed gray MTA to be composed primarily of tricalcium silicate and dicalcium silicate. The surface morphology of the materials differed under the various conditions, particularly following immersion in phosphate solution with crystal formation. SIGNIFICANCE: The commercial versions of MTA were shown to have broadly similar constitution to ordinary Portland cement except for the addition of bismuth compounds. The white MTA did not contain iron.

Optimisation of the superplastic forming of a dental implant for bone augmentation using finite element simulations.

OBJECTIVES: The phenomenon of superplasticity has made it possible to form complex shapes that require extremely high degrees of ductility in titanium alloy with minimal internal stresses. Combined with the use of an investment casting material as the die material, which makes possible the forming of re-entrant angles, it is possible to produce membranes for ridge augmentation. The aim is to characterise the metal alloy sheet and simulate the superplastic forming process in three dimensions to produce process parameters, namely gas pressure as a function of time, to accurately adapt the titanium sheet to the bone surface. METHOD: The surface of the die was digitised using a 3D laser scanning system (UBM-Keyence LC2450). Ti-6Al-4V sheet of 140 mm diameter was modelled using a grid of triangular membrane elements. This mesh was automatically refined during the simulations. Finite element simulation was carried out using the Superflag software program (University of Wales Swansea) Three different options for gas pressure control were adopted, namely, target flow stress, target strain rate and target energy dissipation. The pressure cycles produced from the simulation were used to form titanium alloy sheet at 900 degrees C using argon gas. The deformed regions of the formed sheet were then examined to determine the regions of contact with the die and to characterise surface damage. RESULTS: Comparison of the simulations with experiment showed that there was good agreement between simulated and experimental thickness distributions in most parts of the sheet that were examined. Interrupted tests showed that in the intermediate positions of the forming sheet the simulations were slightly ahead of the experiment. The target stress option was found to produce the best degree of adaptation and the sheet formed using this cycle showed good surface quality, whereas in highly deformed regions using the other target options, the sheet was found to have formed microcracks. The use of a solid lubricant on the surface of the forming sheet was not found to have a significant influence on the adaptation of the titanium alloy sheet except in areas of high deformation where the sheet perforated. SIGNIFICANCE: The finite element membrane formulation is well adapted to the superplastic forming of a ridge augmentation membrane prosthesis. The simulation accurately describes the evolution of the shape of the prosthesis and its thickness distribution with time, which allows the manufacturer to select an appropriate initial thickness of titanium alloy sheet prior to attempting to form the component. The investment dies are found to have sufficient strength to withstand the forming operation if a suitable orientation of the titanium sheet with respect to the die is adopted. A metal surface of good quality can be produced in the formed prosthesis using the appropriate gas control option.