Transformative science from the lunar farside: observations of the dark ages and exoplanetary systems at low radio frequencies.

The farside of the Moon is a pristine, quiet platform to conduct low radio frequency observations of the early Universe's Dark Ages, as well as space weather and magnetospheres associated with habitable exoplanets. In this paper, the astrophysics associated with NASA-funded concept studies will be described including a lunar-orbiting spacecraft, DAPPER, that will measure the 21 cm global spectrum at redshifts ≈40-80, and an array of low frequency dipoles on the lunar farside surface, FARSIDE, that would detect exoplanet magnetic fields. DAPPER observations (17-38 MHz), using a single cross-dipole antenna, will determine the amplitude of the 21 cm spectrum to the level required to distinguish the standard ΛCDM cosmological model from those produced by exotic physics such as nongravitational dark matter interactions. FARSIDE has a notional architecture consisting of 128 dipole antennas deployed across a 10 km area by a rover. FARSIDE would image the entire sky each minute in 1400 channels over 0.1-40 MHz. This would enable monitoring of the nearest stellar systems for the radio signatures of coronal mass ejections and energetic particle events, and would also detect the magnetospheres of the nearest candidate habitable exoplanets. In addition, FARSIDE would provide a pathfinder for power spectrum measurements of the Dark Ages. This article is part of a discussion meeting issue 'Astronomy from the Moon: the next decades'.

Peering into the dark (ages) with low-frequency space interferometers: Using the 21-cm signal of neutral hydrogen from the infant universe to probe fundamental (Astro)physics.

The Dark Ages and Cosmic Dawn are largely unexplored windows on the infant Universe (z ~ 200-10). Observations of the redshifted 21-cm line of neutral hydrogen can provide valuable new insight into fundamental physics and astrophysics during these eras that no other probe can provide, and drives the design of many future ground-based instruments such as the Square Kilometre Array (SKA) and the Hydrogen Epoch of Reionization Array (HERA). We review progress in the field of high-redshift 21-cm Cosmology, in particular focussing on what questions can be addressed by probing the Dark Ages at z > 30. We conclude that only a space- or lunar-based radio telescope, shielded from the Earth's radio-frequency interference (RFI) signals and its ionosphere, enable the 21-cm signal from the Dark Ages to be detected. We suggest a generic mission design concept, CoDEX, that will enable this in the coming decades.

Autologous Fat Grafting Does Not Increase Risk of Oncologic Recurrence in the Reconstructed Breast.

INTRODUCTION: Autologous fat grafting (AFG) is a popular and effective method of breast reconstruction after mastectomy; however, the oncological safety of AFG remains in question. The aim of this study was to determine whether AFG increases the risk of cancer recurrence in the reconstructed breast. METHODS: A matched, case-control study was conducted from 2000 to 2017 at the senior author's institution. Inclusion was limited to female patients who underwent mastectomy and breast reconstruction with or without AFG. Data were further subdivided at the breast level. χ analyses were used to test the association between AFG status and oncologic recurrence. A Cox proportional-hazards model was constructed to assess for possible differences in time to oncologic recurrence. The probability of recurrence was determined by Kaplan-Meier analyses and confirmed with log-rank testing. RESULTS: Overall, 428 breasts met study criteria. Of those, 116 breasts (27.1%) received AFG, whereas 312 (72.9%) did not. No differences in the rates of oncologic recurrence were found between the groups (8.2% vs 9.0%, P < 1.000). Unadjusted (hazard ratio = 1.03, confidence interval = 0.41-2.60, P < 0.957) and adjusted hazard models showed no statistically significant increase in time to oncologic recurrence when comparing AFG to non-AFG. In addition, no statistical differences in disease-free survival were found (P = 0.96 by log rank test). CONCLUSION: Autologous fat grafting for breast reconstruction is oncologically safe and does not increase the likelihood of oncologic recurrence. Larger studies (eg, meta analyses) with longer follow-up are needed to further elucidate the long-term safety of AFG as a reconstructive adjunct.

Appalachian Status Is a Negative Predictor of Breast Reconstruction Following Breast Cancer Resection.

BACKGROUND: Health care disparities in Appalachia are well documented. However, no previous studies have examined possible differences in the utilization of breast reconstruction (BR) in Appalachia. This study aims to determine if a disparity in BR utilization exists in women from Appalachia Kentucky. METHODS: A retrospective, population-based cohort study was conducted from January 1, 2006, to December 31, 2015. The Kentucky Cancer Registry was queried to identify population-level data for female patients diagnosed with breast cancer and treated with mastectomy. A multivariate logistic regression model controlling for patient, disease, and treatment characteristics was constructed to predict the likelihood of BR. RESULTS: Bivariate testing showed differences (P < 0.0001) in BR utilization between Appalachian and non-Appalachian women in Kentucky (15.0% and 26.3%, respectively). Multivariate analysis showed that women from Appalachia (odds ratio, 0.54; confidence interval (95), 0.48-0.61; P < 0.0001) were less likely to undergo BR than non-Appalachian women. Interestingly, the rate of BR increased over time in both Appalachian (r = 0.115; P < 0.0001) and non-Appalachian women (r = 0.148; P < 0.0001). CONCLUSIONS: Despite the benefits of BR, women from Appalachia undergo BR at lower rates and are less likely to receive BR than non-Appalachian Kentuckians. Although the rates of BR increased over time in both populations, access to comprehensive breast cancer care remains a challenge for women from Kentucky's Appalachian region.

Delayed Idiopathic Hardware-Associated Osteomyelitis of the Scaphoid.

Osteomyelitis of the carpal bones is rare and usually occurs in the setting of penetrating wounds or immune compromise. A case of hardware-associated scaphoid osteomyelitis is reported in a 33-year-old man who underwent screw fixation of a scaphoid fracture more than 20 years prior to presentation. The patient was treated with operative debridement including a total scaphoidectomy as well as intravenous antibiotics. Methicillin-sensitive Staphylococcus aureus was isolated from intraoperative cultures. A secondary proximal row carpectomy was performed to provide a stable wrist. Delayed presentation of isolated hardware-associated scaphoid osteomyelitis is exceedingly rare, and little is reported regarding the incidence or management of this entity in the current literature.

DJ-1 ameliorates ischemic cell death in vitro possibly via mitochondrial pathway.

DJ-1 is an important redox-reactive neuroprotective protein implicated in regulation of oxidative stress after ischemia. However the molecular mechanism, especially the mitochondrial function, by which DJ-1 protects neuronal cells in stroke remains to be elucidated. The aim of this study was to reveal whether DJ-1 translocates into the mitochondria in exerting neuroprotection against an in vitro model of stroke. Human neural progenitor cells (hNPCs) were initially exposed to oxygen-glucose deprivation and reperfusion injury, and thereafter, DJ-1 translocation was measured by immunocytochemistry and its secretion by hNPCs was detected by enzyme-linked immunosorbant assay (ELISA). Exposure of hNPCs to experimental stroke injury resulted in DJ-1 translocation into the mitochondria. Moreover, significant levels of DJ-1 protein were secreted by the injured hNPCs. Our findings revealed that DJ-1 principally participates in the early phase of stroke involving the mitochondrial pathway. DJ-1 was detected immediately after stroke and efficiently translocated into the mitochondria offering a new venue for developing treatment strategies against ischemic stroke.

Necrotic Granulomatous Inflammation after Use of Small Intestine Submucosa Matrix for Recurrent Compression Neuropathy.

Various techniques exist for treating recurrent carpal and ulnar tunnel syndrome, but AxoGuard nerve wrap has shown promising results for treatment of compression neuropathies when used in conjunction with neurolysis and tenosynovectomy. Prior results demonstrate no safety concerns, and there have not been any reported cases of infection, persistent inflammation, or recurrent perineural fibrosis. A 41-year-old, right-hand-dominant woman experienced repeated bouts of carpal and ulnar tunnel syndromes, which were treated with a small intestine submucosa matrix wrap around the median and ulnar nerves in the wrist. Here, we report a case of necrotic granulomatous inflammation 2.5 months after AxoGuard xenograft nerve wrap was placed around the median and ulnar nerves. As a salvage, NuShield placental allograft was wrapped around the median nerve, which has shown promising results at several months follow-up. Placental allograft nerve wraps represent a useful tool in compression neuropathy resistant to autografts, xenografts, and revision decompression operations.

Trends in the Surgical Management of Lower Extremity Gustilo Type IIIB/IIIC Injuries.

BACKGROUND: Over the past 20 years, innovations in microsurgical technique have coincided with advances in orthoplastic approaches. However, no single algorithm exists to guide management of limb salvage versus amputation. As such, one would expect these procedures to be performed at equal rates given studies showing similar outcomes. Anecdotally, the observation at the authors' institution is that amputations are being performed more frequently. The purpose of this study was to determine trends in lower extremity trauma management. METHODS: A retrospective cohort study was conducted at a Level I trauma center on patients with Gustilo type IIIB/IIIC lower extremity trauma from 2005 to 2014. Overall, 148 patients were included. Patients were subdivided into amputation (n = 69) and reconstruction (n = 79) cohorts. The Spearman rank correlation coefficient was used to compare trends in amputation and reconstruction groups. Plastic surgery consultation data were analyzed using the Mann-Whitney U and chi-square tests and the Pearson correlation coefficient. RESULTS: Amputation was performed more frequently over the study period (r = 0.292; p < 0.001). Plastic surgeons were consulted in 67.5 percent of cases. A plastic surgery consultation was obtained in only 30 percent of amputation cases (p < 0.001). CONCLUSIONS: Although the data show a trend toward amputation and a shift in management of lower extremity trauma, the observed trend may be attributable in part to deviation from an orthoplastic approach to lower extremity trauma. However, lower extremity reconstruction remains a viable option in select patients, and advances in microsurgery can provide excellent outcomes in the face of severe lower extremity trauma.

Rural-Urban Differences in Breast Reconstruction Utilization Following Oncologic Resection.

BACKGROUND: Breast reconstruction (BR) is the reconstructive surgical technique that focuses on restoring normal form and function to the breast following oncologic resection. The goal of this study was to determine if BR disparities exist among rural female patients in Kentucky. METHODS: A retrospective (2006-2015), population-based cohort study was conducted on breast cancer patients (stages I-III) treated with mastectomy with or without BR. We used 2013 Beale codes to stratify patients according to geographic status. Chi-square tests were used to examine the association of BR along the rural-urban continuum. A multivariate logistic regression model controlling for patient, disease, and treatment factors was used to predict BR. The likelihood of BR was reported in odds ratios (OR) using a 95% confidence interval (CI). RESULTS: Overall, 10,032 patients met study criteria. Of those, 2,159 (21.5%) underwent BR. The rate of BR among urban, near-metro, and rural patients was 31.1%, 20.4%, and 13.4%, respectively (P < .001). Multivariate analysis revealed that women from near metro (OR 0.54, CI: 0.47-0.61; P < .001) and rural areas (OR 0.36, CI: 0.31-0.41; P < .001) were less likely to undergo BR than women from urban areas. CONCLUSION: Although BR benefits are well documented, women from rural Kentucky undergo BR at lower rates and are less likely to receive BR than their urban counterparts. Efforts should seek to promote equitable access to BR for all patients, including those from rural areas.

Financial management and job social skills training components in a summer business institute: a controlled evaluation in high achieving predominantly ethnic minority youth.

Ninety-two adolescents, predominantly ethnic minority high school students, participated in a structured Summer Business Institute (SBI). Participating youth were randomly assigned to receive either job social skills or financial management skills training components. Students who additionally received the job social skills training component were more likely to recommend their employment agency to others than were youth who received the financial management component, rated their overall on-the-job work experience more favorably, and demonstrated higher scores in areas that were relevant to the skills that were taught in the job social skills workshops. The financial management component also appeared to be relatively effective, as youth who received this intervention improved their knowledge of financial management issues more than youth who received job social skills, and rated their workshops as more helpful in financial management, as well as insurance management. Future directions are discussed in light of these results.

Epidemiological survey-based formulae to approximate incidence and prevalence of neurological disorders in the United States: a meta-analysis.

BACKGROUND: This study aims to create a convenient reference for both clinicians and researchers so that vis-à-vis comparisons between brain disorders can be made quickly and accurately. We report here the incidence and prevalence of the major adult-onset brain disorders in the United States using a meta-analysis approach. MATERIAL AND METHODS: Epidemiological figures were collected from the most recent, reliable data available in the research literature. Population statistics were based on the most recent census from the US Census Bureau. Extrapolations were made only when necessary. The most current epidemiological studies for each disorder were chosen. All effort was made to use studies based on national cohorts. Studies reviewed were conducted between 1950 and 2009. The data of the leading studies for several neurological studies was compiled in order to obtain the most accurate extrapolations. Results were compared to commonly accepted values in order to evaluate validity. RESULTS: It was found that 6.75% of the American adult population is afflicted with brain disorders. This number was eclipsed by the 8.02% of Floridians with brain disorders, which is due to the large aged population residing in the state. CONCLUSIONS: There was a noticeable lack of epidemiological data concerning adult-onset brain disorders. Since approximately 1 out of every 7 households is affected by brain disorders, increased research into this arena is warranted.

Effects of short-term training with uncoupled cranks in trained cyclists.

PURPOSE: Manufacturers of uncoupled cycling cranks claim that their use will increase economy of motion and gross efficiency. Purportedly, this occurs by altering the muscle-recruitment patterns contributing to the resistive forces occurring during the recovery phase of the pedal stroke. Uncoupled cranks use an independent-clutch design by which each leg cycles independently of the other (ie, the cranks are not fixed together). However, research examining the efficacy of training with uncoupled cranks is equivocal. The purpose of this study was to determine the effect of short-term training with uncoupled cranks on the performance-related variables economy of motion, gross efficiency, maximal oxygen uptake (VO2max), and muscle-activation patterns. METHODS: Sixteen trained cyclists were matched-paired into either an uncoupled-crank or a normal-crank training group. Both groups performed 5 wk of training on their assigned cranks. Before and after training, participants completed a graded exercise test using normal cranks. Expired gases were collected to determine economy of motion, gross efficiency, and VO2max, while integrated electromyography (iEMG) was used to examine muscle-activation patterns of the vastus lateralis, biceps femoris, and gastrocnemius. RESULTS: No significant changes between groups were observed for economy of motion, gross efficiency, VO2max, or iEMG in the uncoupled- or normal-crank group. CONCLUSIONS: Five weeks of training with uncoupled cycling cranks had no effect on economy of motion, gross efficiency, muscle recruitment, or VO2max compared with training on normal cranks.

A review of laboratory and clinical data supporting the safety and efficacy of cyclosporin A in traumatic brain injury.

For decades, cyclosporin A (CsA) has proved to be safe and effective for use in transplantation. In the past 10 years, this agent has shown neuroprotective effects in animal models of traumatic brain injury (TBI). This review article provides a critical overview of the literature on CsA neuroprotective effects in animal studies and current findings of clinical trials in the treatment of TBI with an emphasis on the possible CsA molecular mechanism of action. Animal data provide compelling evidence of the therapeutic benefits of CsA in TBI, but the outcome indices are heterogeneous with respect to the animal model of TBI as well as the route, dose, and timing of CsA administration. Similarly, clinical studies (phase II trials) adapting almost identical patient inclusion criteria have demonstrated the safety of CsA use in TBI, but the clinical trials are also heterogeneous based on study design, especially with regard to the variable timing of CsA administration after TBI. In view of the translational shortcomings of the preclinical studies and the rather pilot nature of the limited clinical trials that recently reached phase III, we offer guidance on the future directions of laboratory investigations on CsA that could improve the safety and efficacy of this agent in subsequent larger clinical trials.