bluuebunny/crossref_metadata_2025 huggingface dataset:
Constructing a multivariate distribution function with a vine copula: towards multivariate luminosity and mass functions
Authors: Takeuchi Tsutomu T , Kono Kai T
Published: August 2020

The need for a method to construct multidimensional distribution function is increasing recently, in the era of huge multiwavelength surveys. We have proposed a systematic method to build a bivariate luminosity or mass function of galaxies by using a copula. It allows us to construct a distribution function when only its marginal distributions are known, and we have to estimate the dependence structure from data. A typical example is the situation that we have univariate luminosity functions at some wavelengths for a survey, but the joint distribution is unknown. Main limitation of the copula method is that it is not easy to extend a joint function to higher dimensions (d > 2), except some special cases like multidimensional Gaussian. Even if we find such a multivariate analytic function in some fortunate case, it would often be inflexible and impractical. In this work, we show a systematic method to extend the copula method to unlimitedly higher dimensions by a vine copula. This is based on the pair-copula decomposition of a general multivariate distribution. We show how the vine copula construction is flexible and extendable. We also present an example of the construction of a stellar mass–atomic gas–molecular gas three-dimensional mass function. We demonstrate the maximum likelihood estimation of the best functional form for this function, as well as a proper model selection via vine copula.
How fast do young star clusters expel their natal gas? Estimating the upper limit of the gas expulsion time-scale
Authors: Dinnbier František , Walch Stefanie
Published: August 2020

Formation of massive stars within embedded star clusters starts a complex interplay between their feedback, inflowing gas, and stellar dynamics, which often includes close stellar encounters. Hydrodynamical simulations usually resort to substantial simplifications to model embedded clusters. Here, we address the simplification which approximates the whole star cluster by a single sink particle, which completely neglects the internal stellar dynamics. In order to model the internal stellar dynamics, we implement a Hermite predictor–corrector integration scheme to the hydrodynamic code flash. As we illustrate by a suite of tests, this integrator significantly outperforms the current leap-frog scheme, and it is able to follow the dynamics of small compact stellar systems without the necessity to soften the gravitational potential. We find that resolving individual massive stars instead of representing the whole cluster by a single energetic source has a profound influence on the gas component: for clusters of mass less than $\approx3 \times 10^3 \, \mathrm{M}_{\odot }$ , it slows gas expulsion by a factor of ≈5 to $\approx 1 \, \mathrm{Myr}$, and it results in substantially more complex gas structures. With increasing cluster mass (up to $\approx 3\times 10^3 \, \mathrm{M}_{\odot }$), the gas expulsion time-scale slightly decreases. However, more massive clusters ($\gtrsim 5\times 10^3 \, \mathrm{M}_{\odot }$) are unable to clear their natal gas with photoionizing radiation and stellar winds only if they form with a star formation efficiency (SFE) of 1/3. This implies that the more massive clusters are either cleared with another feedback mechanism or they form with an SFE higher than 1/3.
Constraining the thermally pulsing asymptotic giant branch phase with resolved stellar populations in the Large Magellanic Cloud
Authors: Pastorelli Giada , Marigo Paola , Girardi Léo , Aringer Bernhard , Chen Yang , Rubele Stefano , Trabucchi Michele , Bladh Sara , Boyer Martha L , Bressan Alessandro , Dalcanton Julianne J , Groenewegen Martin A T , Lebzelter Thomas , Mowlavi Nami , Chubb Katy L , Cioni Maria-Rosa L , de Grijs Richard , Ivanov Valentin D , Nanni Ambra , van Loon Jacco Th , Zaggia Simone
Published: August 2020

Reliable models of the thermally pulsing asymptotic giant branch (TP-AGB) phase are of critical importance across astrophysics, including our interpretation of the spectral energy distribution of galaxies, cosmic dust production, and enrichment of the interstellar medium. With the aim of improving sets of stellar isochrones that include a detailed description of the TP-AGB phase, we extend our recent calibration of the AGB population in the Small Magellanic Cloud (SMC) to the more metal-rich Large Magellanic Cloud (LMC). We model the LMC stellar populations with the trilegal code, using the spatially resolved star formation history derived from the VISTA survey. We characterize the efficiency of the third dredge-up by matching the star counts and the Ks-band luminosity functions of the AGB stars identified in the LMC. In line with previous findings, we confirm that, compared to the SMC, the third dredge-up in AGB stars of the LMC is somewhat less efficient, as a consequence of the higher metallicity. The predicted range of initial mass of C-rich stars is between Mi ≈ 1.7 and 3 M⊙ at Zi = 0.008. We show how the inclusion of new opacity data in the carbon star spectra will improve the performance of our models. We discuss the predicted lifetimes, integrated luminosities, and mass-loss rate distributions of the calibrated models. The results of our calibration are included in updated stellar isochrones publicly available.
Search for wormhole candidates in active galactic nuclei: radiation from colliding accreting flows
Authors: Piotrovich M Yu , Krasnikov S V , Buliga S D , Natsvlishvili T M
Published: August 2020

The underlying hypothesis of this work is that the active galactic nuclei (AGNs) are wormhole mouths rather than supermassive black holes. Under some – quite general – assumptions such wormholes may emit gamma radiation as a result of a collision of accreting flows inside the wormholes. This radiation has a distinctive spectrum much different from those of jets or accretion discs of AGNs. An observation of such radiation would serve as evidence of the existence of wormholes.
Effects of self-consistent rest-ultraviolet colours in semi-empirical galaxy formation models
Authors: Mirocha Jordan , Mason Charlotte , Stark Daniel P
Published: August 2020

Connecting the observed rest-ultraviolet (UV) luminosities of high-z galaxies to their intrinsic luminosities (and thus star formation rates, SFRs) requires correcting for the presence of dust. We bypass a common dust-correction approach that uses empirical relationships between infrared (IR) emission and UV colours, and instead augment a semi-empirical model for galaxy formation with a simple – but self-consistent – dust model and use it to jointly fit high-z rest-UV luminosity functions (LFs) and colour–magnitude relations (MUV–β). In doing so, we find that UV colours evolve with redshift (at fixed UV magnitude), as suggested by observations, even in cases without underlying evolution in dust production, destruction, absorption, or geometry. The observed evolution in our model arises due to the reduction in the mean stellar age and rise in specific SFRs with increasing z. The UV extinction, AUV, evolves similarly with redshift, though we find a systematically shallower relation between AUV and MUV than that predicted by IRX–β relationships derived from z ∼ 3 galaxy samples. Finally, assuming that high $1600\hbox{-}{\mathring{\rm A}}$ transmission (≳0.6) is a reliable Ly α emitter (LAE) indicator, modest scatter in the effective dust surface density of galaxies can explain the evolution both in MUV–β and LAE fractions. These predictions are readily testable by deep surveys with the James Webb Space Telescope.
A quasar microlensing event towards J1249+3449?
Authors: De Paolis F , Nucita A A , Strafella F , Licchelli D , Ingrosso G
Published: August 2020

We show that the optical flare event discovered by Graham et al. towards the active galactic nucleus J1249+3449 is fully consistent with being a quasar microlensing event due to a ≃0.1 M⊙ star, although other explanations, such as that, mainly supported by Graham et al., of being the electromagnetic counterpart associated with a binary black hole merger, cannot be completely excluded at present.
Enhanced DNA repair by DNA photolyase bearing an artificial light-harvesting chromophore
Authors: Terai Yuma , Sato Ryuma , Matsumura Risa , Iwai Shigenori , Yamamoto Junpei
Published: August 2020

Photolyases are flavoenzymes responsible for the repair of carcinogenic DNA damage caused by ultraviolet radiation. They harbor the catalytic cofactor flavin adenine dinucleotide (FAD). The light-driven electron transfer from the excited state of the fully-reduced form of FAD to the DNA lesions causes rearrangement of the covalent bonds, leading to the restoration of intact nucleobases. In addition to the catalytic chromophore, some photolyases bear a secondary chromophore with better light absorption capability than FAD, acting as a light-harvesting chromophore that harvests photons in sunlight efficiently and transfers light energy to the catalytic center, as observed in natural photoreceptor proteins. Inspired by nature, we covalently and site-specifically attached a synthetic chromophore to the surface of photolyase using oligonucleotides containing a modified nucleoside and a cyclobutane-type DNA lesion, and successfully enhanced its enzymatic activity in the light-driven DNA repair. Peptide mapping in combination with theoretical calculations identified the amino acid residue that binds to the chromophore, working as an artificial light-harvesting chromophore. Our results broaden the strategies for protein engineering and provide a guideline for tuning of the light perception abilities and enzymatic activity of the photoreceptor proteins.
Stereotactic Radiosurgery With Versus Without Embolization for Brain Arteriovenous Malformations
Authors: Chen Ching-Jen , Ding Dale , Lee Cheng-Chia , Kearns Kathryn N , Pomeraniec I Jonathan , Cifarelli Christopher P , Arsanious David E , Liscak Roman , Hanuska Jaromir , Williams Brian J , Yusuf Mehran B , Woo Shiao Y , Ironside Natasha , Warnick Ronald E , Trifiletti Daniel M , Mathieu David , Mureb Monica , Benjamin Carolina , Kondziolka Douglas , Feliciano Caleb E , Rodriguez-Mercado Rafael , Cockroft Kevin M , Simon Scott , Mackley Heath B , Zammar Samer , Patel Neel T , Padmanaban Varun , Beatson Nathan , Saylany Anissa , Lee John , Sheehan Jason P ,   on behalf of the International Radiosurgery Research Foundation
Published: August 2020

BACKGROUND

Prior comparisons of brain arteriovenous malformations (AVMs) treated using stereotactic radiosurgery (SRS) with or without embolization were inherently flawed, due to differences in the pretreatment nidus volumes.

OBJECTIVE

To compare the outcomes of embolization and SRS, vs SRS alone for AVMs using pre-embolization malformation features.

METHODS

We retrospectively reviewed International Radiosurgery Research Foundation AVM databases from 1987 to 2018. Patients were categorized into the embolization and SRS (E + SRS) or SRS alone (SRS-only) cohorts. The 2 cohorts were matched in a 1:1 ratio using propensity scores. Primary outcome was defined as AVM obliteration. Secondary outcomes were post-SRS hemorrhage, all-cause mortality, radiologic and symptomatic radiation-induced changes (RIC), and cyst formation.

RESULTS

The matched cohorts each comprised 101 patients. Crude AVM obliteration rates were similar between the matched E + SRS vs SRS-only cohorts (48.5% vs 54.5%; odds ratio = 0.788, P = .399). Cumulative probabilities of obliteration at 3, 4, 5, and 6 yr were also similar between the E + SRS (33.0%, 46.4%, 56.2%, and 60.8%, respectively) and SRS-only (32.9%, 46.2%, 56.0%, and 60.6%, respectively) cohorts (subhazard ratio (SHR) = 1.005, P = .981). Cumulative probabilities of radiologic RIC at 3, 4, 5, and 6 yr were lower in the E + SRS (25.0%, 25.7%, 26.7%, and 26.7%, respectively) vs SRS-only (45.3%, 46.2%, 47.8%, and 47.8%, respectively) cohort (SHR = 0.478, P = .004). Symptomatic and asymptomatic embolization-related complication rates were 8.3% and 18.6%, respectively. Rates of post-SRS hemorrhage, all-cause mortality, symptomatic RIC, and cyst formation were similar between the matched cohorts.

CONCLUSION

This study refutes the prevalent notion that AVM embolization negatively affects the likelihood of obliteration after SRS.
Risk of Brain Herniation After Craniotomy With Preoperative Lumbar Spinal Drainage: A Single-Surgeon Experience of 365 Patients Among 3000 Major Cranial Cases
Authors: Lane Brandon C , Scranton Robert , Cohen-Gadol Aaron A
Published: August 2020

BACKGROUND

Lumbar spinal drainage (LSD) can significantly facilitate brain relaxation and improve ease of surgical goals for a variety of neurosurgical indications. Although rapid drainage of large volumes of spinal fluid can theoretically produce shifts in brain compartments and herniation syndromes, the clinical significance of this phenomenon when LSD is used immediately before craniotomy is unclear.

OBJECTIVE

To report a large single-surgeon consecutive experience with symptomatic brain herniation after lumbar drainage before craniotomy.

METHODS

Included were 365 patients who underwent LSD with either lumbar drain or lumbar puncture for a variety of different neurosurgical pathologies between 2008 and 2018 immediately before craniotomy. We reviewed the surgical indications, craniotomy location, approach, type of LSD, presence of postoperative brain herniation on imaging, type of herniation, clinical symptoms, lesion pathology, and 30-d modified Rankin Scale score for each patient.

RESULTS

There was no patient who suffered from the development of new or worsening symptomatic or radiological brain herniation directly related to use of immediate preoperative LSD. This included 204 supratentorial and 161 infratentorial procedures. Surgical indications included 188 tumors, 5 aneurysms, 37 arteriovenous malformations, 2 revascularization procedures, 97 microvascular decompressions, 10 optic nerve decompressions requiring extradural clinoidectomy for tumor removal, and 26 “other” pathologies.

CONCLUSION

Brain herniation did not occur postoperatively with the use of immediate preoperative LSD in our series, regardless of craniotomy location, pathology, extent of mass effect, or approach. Our experience suggests that LSD is a potentially safe preoperative adjunct that can be used to facilitate surgical objectives.
The application of artificial intelligence and radiomics in lung cancer
Authors: Zhou Yaojie , Xu Xiuyuan , Song Lujia , Wang Chengdi , Guo Jixiang , Yi Zhang , Li Weimin
Published: August 2020

Lung cancer is one of the most leading causes of death throughout the world, and there is an urgent requirement for the precision medical management of it. Artificial intelligence (AI) consisting of numerous advanced techniques has been widely applied in the field of medical care. Meanwhile, radiomics based on traditional machine learning also does a great job in mining information through medical images. With the integration of AI and radiomics, great progress has been made in the early diagnosis, specific characterization, and prognosis of lung cancer, which has aroused attention all over the world. In this study, we give a brief review of the current application of AI and radiomics for precision medical management in lung cancer.
Isolation by geographical distance after release from Pleistocene refugia explains genetic and phenotypic variation in Xylotrupes siamensis (Coleoptera: Scarabaeidae)
Authors: Morgan Brett , Huang Jen-Pan
Published: August 2020

Consistent and objective species delimitation is crucial to biodiversity studies, but challenges remain when conflicting taxonomic decisions have been made because different data sets and analytical methods were used to delineate species. In the rhinoceros beetle, Xylotrupes siamensis, the use of different morphological characters has resulted in taxonomic disagreement between studies. We used three molecular loci (mitochondrial CO1 and nuclear ITS2 and H3) to investigate the genetic divergence between populations exhibiting different male horn phenotypes. We also applied an approximate Bayesian computation approach to test alternative historical hypotheses that might explain the present genetic diversity among geographical populations. Furthermore, we used species distribution models to estimate the temporal variation in the geographical distribution of suitable habitats. The results show that the two phenotypic taxa within X. siamensis are not genetically structured and that their genetic structure can be explained using isolation by geographical distance. The emergence of the two phenotypic taxa might have been associated with historical isolation in separate refugia. However, spatial expansion and genetic interchange between populations might have gradually eroded the spatial genetic structure. We demonstrate that understanding the historical processes responsible for phenotypic divergence and genetic diversity among current populations could help with making evolutionarily coherent taxonomic decisions.
The History of Cacao and Its Diseases in the Americas
Authors: Díaz-Valderrama Jorge R. , Leiva-Espinoza Santos T. , Aime M. Catherine
Published: August 2020

Cacao is a commodity crop from the tropics cultivated by about 6 million smallholder farmers. The tree, Theobroma cacao, originated in the Upper Amazon where it was domesticated ca. 5450 to 5300 B.P. From this center of origin, cacao was dispersed and cultivated in Mesoamerica as early as 3800 to 3000 B.P. After the European conquest of the Americas (the 1500s), cacao cultivation intensified in several loci, primarily Mesoamerica, Trinidad, Venezuela, and Ecuador. It was during the colonial period that cacao diseases began emerging as threats to production. One early example is the collapse of the cacao industry in Trinidad in the 1720s, attributed to an unknown disease referred to as the “blast”. Trinidad would resurface as a production center due to the discovery of the Trinitario genetic group, which is still widely used in breeding programs around the world. However, a resurgence of diseases like frosty pod rot during the republican period (the late 1800s and early 1900s) had profound impacts on other centers of Latin American production, especially in Venezuela and Ecuador, shifting the focus of cacao production southward, to Bahia, Brazil. Production in Bahia was, in turn, dramatically curtailed by the introduction of witches’ broom disease in the late 1980s. Today, most of the world’s cacao production occurs in West Africa and parts of Asia, where the primary Latin American diseases have not yet spread. In this review, we discuss the history of cacao cultivation in the Americas and how that history has been shaped by the emergence of diseases.
Association of Umbilical Cord Milking Versus Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants
Authors: Katheria A. , Reister F. , Essers J. , Mendler M. , Hummler H. , Subramaniam A. , Carlo W. , Tita A. , Truong G. , Davis-Nelson S. , Schmölzer G. , Chari R. , Kaempf J. , Tomlinson M. , Yanowitz T. , Beck S. , Simhan H. , Dempsey E. , O'Donoghue K. , Bhat S. , Hoffman M. , Faksh A. , Arnell K. , Rich W. , Finer N. , Vaucher Y. , Khanna P. , Meyers M. , Varner M. , Allman P. , Szychowski J. , Cutter G.
Published: August 2020

(JAMA. 2019;322:1877–1886)

Umbilical cord milking has been cited as an alternative to delayed umbilical cord clamping, which is the current standard of care. Like delayed umbilical cord clamping, umbilical cord milking provides placental transfusion that has been associated with neonatal benefits, including fewer deaths in preterm infants. The aim of this study was to examine whether umbilical cord milking was noninferior to delayed umbilical cord clamping in preterm infants.
Exemplary Segmented Regression Methods Conclude That New Anesthesia Intervention Improves Detection of Postpartum Hemorrhage
Authors: Mascha E.J.
Published: August 2020

(Anesth Analg. 2020;130:854–856)

While a leading cause of maternal morbidity worldwide, postpartum hemorrhage (PPH) is thought to be quite preventable. Thus, new preventative policies and procedures are warranted. The above study by Lumbreras-Marquez examined the association between the detection of PPH after vaginal deliveries (VDs), and the implementation of a new device that combines volumetric and gravimetric measurements of blood loss. The authors hypothesized that a transition from visual estimation of blood loss, to a device that utilizes volumetric and gravimetric measurements of blood loss would increase the odds of detecting PPH following a VD.
Planned Early Delivery or Expectant Management for Late Preterm Preeclampsia (PHOENIX): A Randomized Controlled Trial
Authors: Chappell L.C. , Brocklehurst P. , Green M.E. , Hunter R. , Hardy P. , Juszczak E. , Linsell L. , Chiocchia V. , Greenland M. , Placzek A. , Townend J. , Marlow N. , Sandall J. , Shennan A.
Published: August 2020

(Lancet. 2019;394:1181–1190)

Preeclampsia occurs in 2% to 3% of pregnant women and is associated with substantial maternal and neonatal morbidity and mortality. Prompt delivery is the recommended management for preeclamptic women after 37 weeks’ gestation, as this will decrease the risk of maternal complications while minimally affecting risk to the neonate at this gestational age. However, it is unclear what the best management strategy is for women who develop preeclampsia between 34 and 37 weeks’ gestation. In these cases, complications related to expectant management (EM), such as stillbirth or worsening fetal growth restriction and increased maternal morbidity associated with continuing the pregnancy, must be weighed against the neonatal complications associated with early delivery (infant immaturity). Current guidelines in the UK recommend EM until 37 weeks’ gestation, with earlier delivery if severe preeclampsia or other complications arise. This study from the UK compared earlier initiation of delivery with EM in women diagnosed with preeclampsia between 34 and <37 weeks gestation.
Elective Induction of Labor at 39 Weeks Compared With Expectant Management: A Meta-analysis of Cohort Studies
Authors: Grobman W.A. , Caughey A.B.
Published: August 2020

(Am J Obstet Gynecol. 2019;221:304–310)

Obstetric care providers previously believed that elective induction of labor for low-risk nulliparous women at full term would increase the likelihood of cesarean delivery, but recent research disputes this belief. Recently, the American College of Obstetricians and Gynecologists (ACOG), supported by the Society of Maternal-Fetal Medicine (SMFM), created a Practice Advisory that approved elective induction for low-risk nulliparous women at 39 weeks gestation. The aim of this study was to analyze observational studies on elective induction of labor at 39 weeks’ gestation versus expectant management at 39 weeks to determine the relationship between elective induction and cesarean delivery as well as perinatal and maternal outcomes.
The Association Between Induction of Labor at 38 to 39 Weeks Pregnancy and Indication for Cesarean Delivery: An Observational Study
Authors: de Vries B.S. , McGeechan K. , Barratt A. , Tooher J. , Wong E. , Phipps H. , Gordon A. , Hyett J.A.
Published: August 2020

(Aust N Z J Obstet Gynaecol. 2019;59:791–798)

The cesarean delivery (CD) rate in Australia is ∼34%, and the most common indication for a woman’s first cesarean is slow labor progress. Another 29% of women undergo labor induction. Previous studies have demonstrated that induction of labor (IOL) reduces the risk of CD at 40 weeks gestation or later. Until recently there has been limited research assessing effects of labor induction on CD rate before 40 weeks gestation. Some recent observational studies have found no increased risk of CD in women who underwent IOL before 40 weeks gestation, while perinatal mortality was improved. A large randomized trial reported a reduced CD rate when induction was performed at 39 weeks gestation. The current study aimed to assess the efficacy of IOL in reducing the risk of CD in women at 38 to 39 weeks gestation; it also evaluated the association between IOL and adverse outcomes.
Ursodeoxycholic Acid Versus Placebo in Women With Intrahepatic Cholestasis of Pregnancy (PITCHES): A Randomized Controlled Trial
Authors: Chappell L.C. , Bell J.L. , Smith A. , Linsell L. , Juszczak E. , Dixon P.H. , Chambers J. , Hunter R. , Dorling J. , Williamson C. , Thornton J.G.
Published: August 2020

(Lancet. 2019;394:849–860)

Intrahepatic cholestasis of pregnancy is the most common pregnancy-specific liver disorder and is associated with increased rates of preterm birth, meconium-stained amniotic fluid, neonatal intensive care unit (NICU) admission, and, for women with peak serum bile acid concentrations of ≥100 μmol/L, stillbirth. Ursodeoxycholic acid, a naturally occurring bile acid, is used to treat hepatobiliary disorders in nonpregnant patients and is widely recommended for the treatment of intrahepatic cholestasis of pregnancy. However, there is only a small amount of evidence available supporting its use for this pregnancy disorder. This current trial aimed to investigate whether the use of ursodeoxycholic acid for intrahepatic cholestasis of pregnancy reduced adverse perinatal outcomes, and examined its effects on other short-term maternal and neonatal outcomes.
Programmed Intermittent Epidural Bolus Technique for Maintenance of Labor Analgesia: Does It Work for Everyone?
Authors: Wong C.A. , Mercier F.J.
Published: August 2020

(Br J Anaesth. 2019;123:e190–e193)

Care providers have always worked to provide adequate pain management during childbirth, and neuraxial labor analgesia has been found to be the most effective method of pain relief. Because this delivery method is maintained over long periods of time during labor and delivery, there has been much discussion on the effect of labor analgesia on labor outcomes. While neuraxial labor analgesia has not been found to elevate the risk of cesarean delivery, there is a greater risk for instrumental vaginal delivery due to motor block of the abdominal or pelvic muscles. Wong and colleagues argued that there are many factors involved with epidural analgesia such as anesthetic agents, adjuvant drugs, differing dosages, and various maintenance techniques, and that altering these factors to meet individual needs can reduce the risk of instrumental vaginal delivery and improve labor outcomes.
Comparison of Programmed Intermittent Epidural Boluses With Continuous Epidural Infusion for the Maintenance of Labor Analgesia: A Randomized, Controlled, Double-Blind Study
Authors: Ojo O.A. , Mehdiratta J.E. , Gamez B.H. , Hunting J. , Habib A.S.
Published: August 2020

(Anesth Analg. 2020;130:426–435)

Continuous epidural infusion (CEI) for labor analgesia is highly effective and reduces the workload for providers compared with provider-administered boluses. Local anesthetic consumption is also higher with CEI, however, which may lead to complications in delivery. Programmed intermittent epidural boluses (PIEB) with patient-controlled analgesia may reduce local anesthetic consumption compared with CEI while improving patient satisfaction. Previous studies comparing PIEB using commercially available pumps with continuous infusion yielded unclear results. This was a randomized prospective study comparing CEI with PIEB in terms of labor analgesia and maternal and neonatal outcomes.
Preliminary Findings and Outcomes Associated With the Use of a Continuous Spinal Protocol for Labor Pain Relief Following Accidental Dural Puncture
Authors: Izquierdo M. , Wang X.F. , Wagner K. , Prada C. , Torres A. , Bolden N.
Published: August 2020

(Reg Anesth Pain Med. 2019;44:1098–1103)

Anesthesiologists vary in their management of accidental dural puncture (ADP) and associated postdural puncture headache (PDPH). Possible interventions following ADP include the insertion of a spinal catheter or the administration of intrathecal normal saline. While each of these interventions has been studied alone, combining them into a single continuous spinal protocol for labor pain relief has not been evaluated. This study aimed to compare the outcomes after an ADP of using a standardized continuous spinal protocol versus resiting the epidural catheter.
Neuraxial Labor Analgesia Is Associated With a Reduced Risk of Maternal Depression at 2 Years After Childbirth: A Multicenter, Prospective, Longitudinal Study
Authors: Liu Z.-H. , He S.H. , Deng C.M. , Ding T. , Xu M.J. , Wang L. , Li X.Y. , Wang D.X.
Published: August 2020

(Eur J Anaesthesiol. 2019;36:745–754)

Postpartum depression affects ∼20% of mothers in the first 3 months following childbirth, and can have significant long-term adverse effects. While many factors contribute to postpartum depression, intense labor pain is thought to be a risk factor. The use of epidural labor analgesia has been associated with a decreased risk of postpartum depression, but its impact on long-term depression is unclear. This study aimed to investigate whether neuraxial labor analgesia was associated with a reduced risk of maternal depression at 2 years postpartum.
Disparities in Access to Medications for Opioid Use Disorder in the Veterans Health Administration
Authors: Finlay Andrea K. , Harris Alex H. S. , Timko Christine , Yu Mengfei , Smelson David , Stimmel Matthew , Binswanger Ingrid A.
Published: August 2020

Objectives:

A variety of patients – including women, older, racial/ethnic minority, rural, homeless, and justice-involved patients – are vulnerable to experiencing poor healthcare access and quality, such as lower quality substance use disorder treatment, than other populations. The current study examined receipt of medications for opioid use disorder by vulnerable populations within Veterans Health Administration (VHA) facilities to determine whether there are patient and facility factors that are associated with disparities in care.

Methods:

Using national VHA clinical/administrative data from Fiscal Year 2017, we calculated receipt of medications for opioid use disorder using the American Society for Addiction Medicine quality measure specifications. A mixed-effects logistic regression model tested whether patient vulnerability (ie, women, older age, racial/ethnic minority, rural residence, homeless, and justice-involved) and facility (eg, regional location, availability of a methadone clinic) characteristics were associated with medication receipt.

Results:

Among the 53,568 veterans at VHA facilities diagnosed with opioid use disorder in Fiscal Year 2017, vulnerable populations – including women, older, Black, rural, homeless, and justice-involved veterans – had lower odds of receiving medications for opioid use disorder than their nonvulnerable counterparts. Veterans had higher odds of receiving medications at facilities with a higher proportion of patients with opioid use disorder, but lower odds of receiving medications at facilities in the Southern region compared to the Northeast region of the United States.

Conclusions:

Quality improvement efforts targeted at vulnerable populations are needed at the VHA to ensure these groups receive the same quality of substance use disorder treatment as other veterans.
Revisiting Risk-stratified Whiplash-exposed Patients 12 to 14 Years After Injury
Authors: Rasmussen Martin K. , Kongsted Alice , Carstensen Tina , Jensen Troels S. , Kasch Helge
Published: August 2020

Objective:

The objective of this study was to evaluate the long-term predictive value of the Danish Whiplash Group Risk Assessment Score (DWGRAS) with 7 risk strata.

Design:

E-questionnaire-based follow-up study (n=927) combining 2 cohorts of whiplash-injured patients, 1 observational (n=187) and 1 interventional randomized controlled trial (n=740).

Methods:

Nine hundred twenty-seven previously healthy persons exposed to acute whiplash injury during motor vehicle collision were sent letter by postal service asking the addressee if they would respond to an E-questionnaire. Outcome measures were: whiplash-related disability, pain, use of medication/nonmedical treatment, work capacity.

Results:

The response rate was 37%. Fifty-five percent reported whiplash-related disability. Fourteen percent reported daily symptoms. A strong relationship was found between risk strata and impact of event and between risk strata and disabling symptoms.

Conclusions:

Internal and long-term validation of DWGRAS was performed, but a low response rate indicates that results should be interpreted with caution. Furthermore, external validation needs to be done in long-term studies. An receiver operating characteristics curve of 0.73 (95% confidence interval 0.67; 0.79) predicting daily or weekly whiplash-related disability after 12 to 14 years was found using the DWGRAS risk score.
Calcaneocuboid distraction arthrodesis for children with symptomatic pes planovalgus: does fixation improve outcomes?
Authors: Hyer Lauren C. , Carpenter Ashley M. , Swetenburg John R. , Westberry David E.
Published: August 2020

Lateral column lengthening is a common surgical procedure for addressing symptomatic pes planovalgus foot deformity. For more severe cases, the use of a calcaneocuboid distraction arthrodesis (CCDA) can allow for more powerful correction. Previous reports have cited an increased risk of graft collapse with loss of correction when this procedure is performed without supplemental hardware fixation. The purpose of this study was to assess the outcomes of CCDA in children with and without supplemental locking fixation. A retrospective review from 2008 to 2016 of CCDA procedures with and without supplemental fixation was performed. The primary endpoint was graft collapse. Secondary objectives included evaluation of radiographic loss of correction, hardware failure, pain at 1-year follow-up, reoperations, and changes in the foot loading pattern foot per pedobarography. Twenty-nine feet in 24 patients were eligible for review. Supplemental locked fixation was used in 18 feet [hardware (HW)], with the remaining 11 feet managed without fixation [no hardware (NoHW)]. The overall failure rate on the basis of graft collapse and loss of correction was 55% (56% for the HW group, 55% for the NoHW group). Eleven patients (61%) in the HW group experienced hardware failure, with six (33%) of these requiring hardware removal. Fifty-six percent of the HW group and 45% of the NoHW group reported continued pain at 1-year follow-up. One patient from each group underwent revision arthrodesis. Supplemental locked fixation did not provide additional benefit in preventing graft collapse and loss of correction in this cohort. Alternative strategies should be considered to improve the outcomes for this procedure.
Normal values and ranges of the lateral capitello-humeral angle in healthy children
Authors: Kiyota Yasuhiro , Suzuki Taku , Inaba Naoto , Nishiwaki Masao , Kimura Hiroo , Matsumura Noboru , Sato Kazuki , Nakamura Masaya , Matsumoto Morio , Iwamoto Takuji
Published: August 2020

The lateral capitello-humeral angle (LCHA), which is an index of sagittal alignment of the elbow, has gradually been adopted for the postoperative assessment of radiographic results. However, the normal values and ranges of the LCHA remain unclear. A retrospective cohort study was performed to evaluate the normal values and ranges of the LCHA in a sample of healthy children with even distributions of age, sex and laterality. A total of 168 radiographs of the elbows of healthy children (age range, 0–11 years) with even distributions of age, sex and laterality were reviewed. The primary aim was to analyze the normal values and ranges of the LCHA categorized by age, sex and laterality. The secondary aim was to assess the association of the LCHA with increasing age. The LCHA between sex or laterality in each age category was also compared. The mean LCHA of the 168 patients was 47.1° (range, 27°–63°). There was a weak association between the LCHA and increasing age (r = 0.41). The mean LCHA in females (49.1°) was significantly larger than that in males (45.1°). Significant sex-related differences were observed in age categories between 2 and 7 years. Results of this study will be useful in the postoperative radiographic assessment of sagittal alignment of the elbow in children.
A precision medicine approach to management of acute myeloid leukemia in older adults
Authors: Upadhyay Banskota Shristi , Khanal Nabin , Bhatt Vijaya Raj
Published: August 2020

Purpose of review

Therapy selection in older adults with acute myeloid leukemia (AML) can be challenging because of a higher incidence of high-risk cytogenetic and molecular features conferring chemoresistance and poor functional status leading to increased treatment-related toxicities. The purpose of this review is to highlight the recent advances in precision medicine in AML that have shown promise to improve outcomes of older adults.

Recent findings

The utilization of next generation sequencing to identify and target actionable mutations can influence therapy selection in one-third of patients and can result in higher response rates as well as survival compared with those who do not receive targeted therapy. Oral targeted agents are available for AML with IDH 1, IDH2, or FLT3 mutations. Low-intensity venetoclax-based regimens have shown high rates of responses in AML, particularly among those with NPM1 and IDH2 mutations; responses are often durable and associated with minimal residual disease (MRD) negativity. Multiple studies have demonstrated the prognostic significance of flow cytometric MRD, with potential implications for subsequent therapy.

Novel approaches for AML risk-stratification, MRD assessment, and a precision medicine approach offer significant promise to improve survival and quality of life of older adults.
Characteristics of colorectal carcinoma patients with PMS2 defects detected by immunohistochemistry
Authors: Zeng Zhijun , Yan Qijia , Chen Guodong , Zhang Xiaoli , Huang Jia , Fu Kai , Peng Xiuda , Xiao Shuai
Published: August 2020

Lynch syndrome is the most prevalent form of familial colorectal cancer (CRC) and is caused by pathogenic germline mismatch repair (MMR) gene mutations. MLH1, MSH2 and MSH6 mutations have been well studied, but the rate and characteristics of PMS2 mutations are rare, especially in China. This study enrolled 1706 unselected patients with CRC who underwent colorectal resection from June 2016 to November 2018, the MMR status and clinicopathological features were analysed. A total of 11.8% of patients with CRC had defects in at least one MMR-related protein. Among them, 8.3% were identified with PMS2 defects, and 3.1% of patients had isolated PMS2 defects. Compared with MMR-proficient CRC, PMS2-defect CRC occurred more frequently in the right colon and less frequently in the rectum, had more poorly differentiated and mucinous carcinoma cases, and had fewer perineural invasions and a lower pN stage but a more advanced pT stage and a larger tumour size. In the cases with PMS2 defect, there were fewer tumours in the right colon, fewer poorly differentiated cases and smaller tumour sizes than in the cases with both MLH1 and PMS2 defects. In addition, in cases with isolated PMS2 defects, there were more tumours in the right colon and, more mucinous carcinoma cases than in cases with MMR-proficient CRCs, but had a similar cancer onset age. This study identified the rate, clinicopathological and age characteristics of PMS2 defects in CRCs in China and highlighted the importance of universal screening and germline detection of PMS2 in CRC.
Isolation Requirements and Personal Protective Equipment in the COVID-19 Pandemic
Authors: Rabold Erica , Rovnan Helene , DuMont Tiffany
Published: August 2020

Isolation requirements and subsequent need for personal protective equipment (PPE) are among the many challenges associated with the COVID-19 pandemic. Isolation of COVID-19–positive patients and the use of appropriate PPE by health care professionals are important parts of infection prevention, not only in the hospital setting but also in preventing community spread of the disease. This article addresses isolation requirements, appropriate PPE use, and strategies to overcome challenges such as PPE shortage.
Percutaneous Coronary Intervention Compared with Coronary Artery Bypass Graft Surgery for Patients With 3-vessel Disease: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant Systematic Review and Meta-analysis
Authors: Zhao Hengyi , Zhang Daimin
Published: August 2020

Objectives:

Previous investigations showed inconsistent results for comparison in clinical outcomes between patients with 3-vessel disease (3VD) treated with percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery. A systematic review and meta-analysis is essential to compare the clinical outcomes of PCI with CABG surgery for patients with 3VD.

Methods:

We systematically searched on PubMed and Web of Science for articles which compared PCI with CABG for patients with 3VD and published from January 1989 to January 2020. We computed the hazard ratios (HRs) and 95% confidence intervals (CIs) for individual clinical outcomes.

Results:

This study indicated that the PCI group was associated with a 1.51-fold higher risk of all-cause mortality compared with the CABG group in patients with 3VD (HR 1.51, 95% CI 1.38–1.65). In addition, the PCI group showed a 3.08-fold and 2.94-fold higher risk compared with the CABG group in risks of myocardial infarction (MI) and target-vessel revascularization (TVR), respectively (MI: HR 3.08, 95% CI 2.61–3.63; TVR: HR 2.94, 95% CI 1.94–4.46).

Conclusions:

In conclusion, in patients with 3VD, PCI was consistently associated with higher rates of all-cause mortality, MI, and TVR, compared with CABG.
Long Noncoding RNA OIP5-AS1 Contributes to the Progression of Atherosclerosis by Targeting miR-26a-5p Through the AKT/NF-κB Pathway
Authors: Ren Mingming , Wang Tao , Han Zhen , Fu Pengcheng , Liu Zigang , Ouyang Chun
Published: August 2020

Atherosclerosis (AS) is a cardiovascular disease caused by multiple factors, leading to high mortality and morbidity in aged people. Some long noncoding RNAs have been reported to be associated with AS progression. However, the roles of OIP5-AS1 in AS development are still little known. In this study, the levels of OIP5-AS1 and miR-26a-5p in oxidized low-density lipoprotein (ox-LDL)-treated human umbilical vein endothelial cells (HUVECs) were determined by quantitative real-time polymerase chain reaction. Cell proliferation and apoptosis were evaluated by Cell Counting Kit-8 assay and flow cytometric analysis, respectively. The protein levels of proliferating cell nuclear antigen, B-cell lymphoma-2, cleaved caspase 3, inflammatory cytokines (IL-6 and IL-1β), protein kinase B (AKT), p-AKT, p65, p-p65, IκBα, and p-IκBα were detected by Western blot analysis. The targeting relationship between OIP5-AS1 and miR-26a-5p was verified by dual-luciferase reporter assay, RNA immunoprecipitation assay, and RNA pull-down assay. As a result, the expression of OIP5-AS1 was upregulated and miR-26a-5p was downregulated in ox-LDL–treated HUVECs. MiR-26a-5p was identified as a direct target of OIP5-AS1. OIP5-AS1 knockdown reversed the inhibitory effect on cell proliferation and the promotional effects on apoptosis and inflammation induced by ox-LDL treatment in HUVECs. Interestingly, the effects caused by OIP5-AS1 knockdown were further attenuated by miR-26a-5p inhibition. Furthermore, OIP5-AS1 knockdown blocked the AKT/NF-κB pathway by regulating miR-26a-5p expression. In conclusion, OIP5-AS1 knockdown promoted cell proliferation and suppressed apoptosis and inflammatory response in ox-LDL–treated HUVECs by targeting miR-26a-5p through blocking the AKT/NF-κB pathway, indicating a promising strategy for AS treatment.
Additive association of knowledge and awareness on control of hypertension: a cross-sectional survey in rural India
Authors: Ragavan Rathina Srinivasa , Joshi Rohina , Evans Roger G. , Riddell Michaela A. , Thankappan Kavumpurathu R. , Chow Clara K. , Oldenburg Brian , Mahal Ajay S. , Kalyanram Kartik , Kartik Kamakshi , Suresh Oduru , Thomas Nihal , Mini Gomathyamma K. , Srikanth Velandai K. , Maulik Pallab K. , Alim Mohammed , Guggilla Rama K. , Busingye Doreen , Thrift Amanda G.
Published: August 2020

Objective:

To determine whether there is an interaction between knowledge about hypertension and awareness of hypertension on the treatment and control of hypertension in three regions of South India at different stages of epidemiological transition (see Video, Supplemental Digital Content 1, http://links.lww.com/HJH/B426).

Methods:

Using a cross-sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Chittoor. Sampling was stratified by age group and sex. We measured blood pressure and administered a questionnaire to determine knowledge and awareness of hypertension. Logistic regression was used to assess associations of awareness and knowledge about hypertension with its treatment and control in participants with hypertension, while examining for statistical interaction.

Results:

Among a total of 11 657 participants (50% male; median age 45 years), 3455 had hypertension. In analyses adjusted for age and sex, both knowledge score [adjusted odds ratio (aOR) 1.14 [95% confidence interval (CI) 1.12--1.17)] and awareness [aOR 104 (95% CI 82--134)] were associated with treatment for hypertension. Similarly, both knowledge score [aOR 1.10; 95% CI (1.08--1.12)] and awareness [aOR 13.4; 95% CI (10.7--16.7)], were positively associated with control of blood pressure in those with hypertension, independent of age and sex. There was an interaction between knowledge and awareness on both treatment and control of hypertension (P of attributable proportion <0.001 for each).

Conclusion:

Health education to improve knowledge about hypertension and screening programs to improve awareness of hypertension may act in an additive fashion to improve management of hypertension in rural Indian populations.
Placental lipid metabolism in preeclampsia
Authors: Khaire Amrita A. , Thakar Shivani R. , Wagh Girija N. , Joshi Sadhana R.
Published: August 2020

Objectives:

The current study examines the placental and maternal lipid profile and expression of genes involved in placental lipid metabolism in women with preeclampsia.

Methods:

The current study includes normotensive control women (n = 40) and women with preeclampsia (n = 39). Preeclampsia women were further classified into women delivering at term preeclampsia (T-PE; n = 15) and preterm preeclampsia (PT-PE; n = 24).

Results:

There were no significant differences in maternal lipid profile between the T-PE and normotensive control groups. Maternal plasma VLDL (P < 0.05) and ratios of total cholesterol : HDL (P < 0.05), atherogenic index [log (triglycerides/HDL)] (P < 0.01) and apolipoprotein B : apolipoprotein A (P < 0.05) were higher in the PT-PE group as compared with the normotensive control group. Placental total cholesterol and HDL levels were higher (P < 0.05) in the T-PE as compared with the normotensive control group. Higher placental triglycerides (P < 0.05) were observed in PT-PE group compared with T-PE group. Placental mRNA levels of peroxisome proliferator activated receptor α, carnitine palmitoyl transferase-1, cluster of differentiation 36 and lipoprotein lipases were lower (P < 0.05) in the PT-PE than normotensive control group. A negative association of mRNA levels of peroxisome proliferator activated receptor α (r = −0.246, P = 0.032; r = −0.308, P = 0.007, respectively), carnitine palmitoyl transferase-1 (r = −0.292, P = 0.011; r = −0.366, P = 0.001), lipoprotein lipases (r = −0.296, P = 0.010; r = −0.254, P = 0.028) with SBP and DBP was observed. There was a positive association of placental triglycerides (r = 0.244, P = 0.031) with DBP.

Conclusion:

Women with preeclampsia exhibit higher lipid : lipoprotein ratios suggesting an atherogenic state particularly in women delivering preterm. Lower expression of genes involved in placental fatty acid oxidation and transport was also observed in preeclampsia.